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Fractures and dislocations of bones of the lower extremity order in Chernovtsy
Order Fractures and dislocations of bones of the lower extremity
Fractures and dislocations of bones of the lower extremity

Fractures and dislocations of bones of the lower extremity

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Ukraine, Chernovtsy

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Travmatichn_ vivikh of a stegn

Vivikh stegnovo ї k_stka stanovlyat to a mayzha of 5% us_kh vivikh_v. Qie poyasnyu¾tsya anatomo-f_z_olog_chny osoblivost kulshovy to a suglob: a-place glibina vertlyuzhno ї zapadin, a yak zb_lshu¾tsya for a rakhunok hryashchovo ї vertlyugovo ї ruin, I povnoit kongruyentn_styu suglobovy poverkhon, m_tsn_styu the sumkovo-zv'yazochny device, prikrittya a sugloba potuzhny m'yaza, znachny about' ¾my rukh_v.

Mechanogenesis. Vivikh stegnovo ї k_stka at vs_kh vipadka vinikayut behind the principle d і ї vazhelya. Napryam zm_shchennya gol_vka lie too long v_d to a napryam і stupenya rotats і ї, and takozh privedennya obovyazkovo a z_gnuty stegn at the moment d і ї poshkodzhuyucho ї with Sealy.

Vikhodyach z to mechanogenesis to an injury, vivikh of a stegn pod_lyayut on:

1. Peredn_:

a) perednyo-verkhn_y (nadlobkoviya);

b) perednyo-nizhn_y (zatulniya).

2. Zadn_:

a) zadnyo-verkhn_y (kluboviya);

b) zadnyo-nizhn_y (s_dnichniya).

Kl_n_ka. Vivikh of a stegn suprovodzhuyutsya silny Bol, nemozhliv_styu stat on a leg p_slya poshkodzhennya. With Harakterne to the vimushena polozhennya legs, a yak lie too long v_d to a look to a vivikh.

Dlyaperedn_kh to the vivikh_vkharakteena to a r_zka v_dvedennya legs, rotats_ya nazovn і, vdavena podovzhennya k_nts_vka. At a zatulny vivikh it is possible namatsat a gol_vka z vnutr_shnyy for a side of a kulshovy suglob, the s_dnichna a d_lyanka is flattened. Great swivel not viznacha¾tsya.

Prizadn_kh the vivikhakhnoga of a z_gnut in kulshovy suglob і, is given і a rotovan of a doseredina, aktivn_ Rukh nemozhliv_. The Sproba passively vivest a k_nts_vka _z vimusheny polozhennya suprovodzhu¾tsya Bol, v_dm_cha¾tsya harakterniya for a vivikh a symptom pruzhinyachy a support. Viznachayut vkorochennya legs. P_d I pakhvinnoit a zv'yazka viznacha¾tsya a zapadin, and a pozada _nod_ pom_tno vistup і palpu¾tsya a gol_vka stegnovo ї k_stka. Great swivel vishche l_n і ї Roser-Nelatona.

Jac Peredn_m so і zadn_m to vivikha stegnovo ї k_stka vlastiv_ zginaln_ installations in kulshovy that kol_nny sugloba.

At stisnenn_ a nerve (s_dnichny, stegnovy, zatulny) to monut sposter_gatisya nevrolog_chn_ rozlad. D_agnoz utochnyuyut at rentgenolog_chny obstezhenn_. Perevazhno obmezhuyutsya the roentgenogram at pryam_y proyekts і ї.

L_kuvannya. "Sv_zh і" set vivikh urgentno p_d a gliboky anesthesia. Nayb_lsh poshiren_ a way vpravlyannya vivikh_v a stegna - Dzhanel_dze і Kokhera. V_dnovlennya f_z_olog_chny rukh_v at suglob_ є I oznakoit set to a vivikh. Pp_dtverdzhennya of tsyy - control the roentgenogram. P_sl vpravlennya a vivikha of sick is put at l_zhko on 2-3 tizhn_ z distsipl_nuyuchy vantazhy (3-4 kg) for a gom_lka. Through 1 tizhden priznachayut Rukh in kulshovy suglob і, massage. Through 2-3 tizhn_ to sick permit to the dozovena navantazhennya - hod_nnya z militsyam, and through 8-10 tizhn_v - the poyena navantazhennya. Pratsezdatn_st v_dnovlyu¾tsya through 6-7 tizhn_v.

Pokazannya to an operational l_kuvannya:

· vivikh, yak_ not vda¾tsya you will set a vnasl_dok zashchemlennya m'yazevo ї tkanin (to a capsule to a suglob, a zatulny m'yaz it is lean);

· zastar_l_ vivikh of a stegn;

· vivikh, yak_ suprovodzhuyutsya zm_shchennyam v_dlamka verkhnyy to edge suglobovo ї zapadin;

· perelomovivikh stegnovo ї k_stka z rozvernennyam v_dlamka.

P_sl who is carried out operational vtruchannya nakladayut to a koksitn to a g_psov a bandage. Through 3 tizhn_ to a pov'yazk zn_mayut і priznachayut to a rozrobk rukh_v at suglob і, massage m'yaz_v, FTL.

Travmatichn_ gom_lka vivikh

Vivikh of a gom_lka — tse, on days і, vivy velikogom_lkovo ї k_stka to that, shcho a malogom_lkova not to enter to a warehouse of a kol_nny suglob. At a vivikha a gom_lka to a mozha zm_shchuvatisya in r_zny napryama (forward, back, ub_k), shcho lie too long v_d to a mekhano_enez to an injury. Peredn_y vivy to a broom naychast_sha є at nepryam_y injuries і, prick a lyudin of a stalemate є on a pereroz_gnuta at kol_n_ a leg. Znachna vertically d_yucha force sprichinyu є shche to a b_lsha pererozginannya, v_d chy roztyaguyutsya, and pot_m і rozrivayutsya capsule that zv'yazk of a kol_n, and suglobovy k_neets of a stegn zm_shchu¾tsya back.

Peredn_y vivy to a broom r_dsha є a vnasl_dok d і ї raptovo ї Sealy on a d_lyanka zadnyo ї poverkhn_ gol_nka if the leg is direct Abo a z_gnuta at kol_n_.

Zadn_y vivy mA gol_nka є zvorotniya mekhan_zm to an injury. Perevazhno v_n a broom є at z_gnut_y to 90 ° gom_lts_. Prick force d і є on a gom_lka in perednyo-zadnyy napryam і, suto peredn_ chi zadn_ vivikh buvayut r_dko, a yak the rule, a broom є perednyo-bokoviya of Abo of zadnyo-bokoviya vivy.

Yakshcho at peredn_kh gom_lka vivikha v_d to a tightness to a mozha poshkodzhuvatisya a malogom_lkovy nerve (n. peroneus), at zadn_kh — sudin p_dkol_nno ї poles. P_d hour vivikhuvannya zadn_y suglobovy edge velikogom_lkovo ї k_stka to a v_dtyag є і a peretiska є a sudinno-nervovy bunch, and _nod_ — nav_t a rozriva є chastkovo to a _ntim of Abo ts_lky to a p_dkol_nn arter_yu (a. poplitea). _nkol buvayut rozriv an arter і ї і v_driv m'yaz_v litka at p_dkol_nn_y yamts_ at peredn_kh vivikha z_ znachny zm_shchennyam gol_nka.

Simtomi. Klasichn_ symptom to a gom_lka vivikh: b_l, tipova deformats_ya kol_nny suglob і porushennya funkts і ї. K_nts_vka to znakhoditsya at vimusheny the yak the rule, a vipryamlen, mA є a form of a bagnet is put і. At peredn_kh vivikha it is visible over a nakol_nok zapadannya tkanin at zb_lsheny rozm_r_ d_lyanka of a kol_nny suglob. Gom_lka і foot ts_anotichn і, holodn і, at-place krovoviliv_ at a tkanina obsyag gol_nka of zb_lsheniye. Buvayut parestez і ї it is lean. At palpats і ї a nakol_nok of rukhomiya at peredn_kh vivikha і nerukhomiya at zadn_kh. Takozh it is possible viznachit napryam zm_shchennya suglobovy k_nts_v a k_stok, flyuktuats_yu to a hematoma it is lean. D_a_noz utochnyuyut rent_enolog_chno at dvokh proyekts_yakh. Buvayut vipadka samovpravlennya Abo vpravlennya to a vivikh in a vza¾modopomoga order, і tod_ є utrudnennya at d_a_nostits_ to character poshkodzhen a kol_nny suglob. In it is silent vipadka dom_nuyut Lish a symptom to a gemartroz і nedostatnost_ the zv'yazkovy device. Specify stup_n a rozriva to a capsule of a suglob it is possible behind a dopomoga contrastly ї an artrograf і ї. At vipadka porushennya to a krovoob_g of Abo at sumn_vn_y pulsats і ї p_dkol_nno ї an arter і ї the neobkh_dna is contrast vazograf_ya Abo operats_ya — rev_z_ya to a camp of vessels. Nesvo¾chasna of a d_a_nostik poshkodzhennya p_dkol_nno ї an arter і ї Abo її to thrombosis p_slya to a vivikh to prizvodit to a necrosis і amputats і ї gol_nka.

L_kuvannya. Gol_nka Vivikh, especially zadn і, p_dlyagayut negayny vpravlennyu, to that shcho zavzhda stench suprovodzhuyutsya porushennyam to a krovoob_g.

P_d a zagalny anesthesia, prick m'yaz rozslablen і, vivy vpravlya¾tsya it is easy for soul. Asistent to a vtrim є nizhnyu to a tretin of a stegn, and h_rur_ to a vityag є hands a gom_lka і an impact є on zm_shcheny a suglobovy k_neets velikogom_lkovo ї k_stka. V_dnovlennya pasivny rukh_v at kol_n_ to sv_dchit d_ro those, shcho vivy repositions. At vs_kh vipadka neobkh_dno repeatedly perev_rit pulsats_yu k_nts_vka vessels і zrobit to a kontroln rent_enograf_yu at dvokh proyekts_yakh.

P_slya vpravlennya to a vivikh at-place gemartroz_ kol_nniya suglob punktuyut і v_dsmoktuyut a hematoma. To K_nts_vk deshcho a z_gnuta in kol_n_ (10-15 °) f_ksuyut I zadnyoit a g_psova a lan_eta v_d s_dnichno ї folds to k_nts_v palts_v to foot. Uves hour to gain a krovoob_ga behind a camp. P_slya of that, the yak filled out recession, a k_nts_vka f_ksuyut at it polozhenn_ a g_psovy tutor term_ny on 4-6 tizhn_v v_d day to an injury.

P_slya of that navantazhuvat permit to sick a leg, priznachayut LFK, massage m'yaz_v k_nts_vka, teplov_ to procedure, an electrophoresis of a l_daza is lean. Ts_kavo those, shcho p_slya vivikh_v gol_nka vnasl_dok-place rubtsyuvannya ushkodzheny tkanin, yak rule, not a buva є nedostatnost_ zv'yazkovy device of a kol_nny suglob. Term_n nepratsezdatnost_ — 2,5-3 m_syats_. l_kuvannya carry out by Operativne at a planned order at nedostatnost_ the zv'yazkovy device і nestab_lnost_ a suglob.

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