Lub xub pwg nyom yog ib txoj kev phais thaum tus kws kho mob ntxig ib rab koob rau hauv cov tshuaj ntsiav. Ib txoj kev zoo sib xws yog ua los rau kev kuaj mob lossis raws li cov ntaub ntawv kho mob muaj. Lub hom phiaj ntawm cov txheej txheem no yog txhawm rau txo cov kua dej synovial hauv kev sib koom ua ke.
Ob hom puncture
Surgeons faib punctures ua ob hom:
- Nyob zoo.
- Diagnostic.
Thaum ua qhov sib tsoo ntawm lub xub pwg sib koom ua ke, nws yuav tsum tau coj mus rau hauv tus account cov yam ntxwv ntawm nws lub cev. Lub synovial membrane yog ib daim nyias nyias uas txawv ntawm cov qauv thiab keeb kwm ntawm cov serous daim nyias nyias (xws li daim nyias nyias ntawm lub pleura, peritoneum, pericardium). Qhov sib txawv tseem ceeb yog tias nws sab hauv, tig mus rau sab nraud, tsis muaj lub hau npog epithelial thiab endothelial hauv ob sab phlu. Lub thickness ntawm daim nyias nyias tsis zoo ib yam. Tsis tas li ntawd, nws muaj kev nkag siab zoo rau thermal, raug mob,Kev kis kab mob thiab tshuaj lom neeg.
Vim tias muaj kev nkag siab ntau ntxiv ntawm cov kab mob synovial rau ntau yam kab mob, kev soj ntsuam nruj ntawm asepsis yuav tsum tau ua ua ntej cov txheej txheem puncture, nrog rau ua ntej qhib cov kab noj hniav. Tsis tas li ntawd, nws yuav tsum tau muab kaw. Cov kab noj hniav sib koom ua ke muaj me me ntawm cov kua dej synovial, kwv yees li plaub milliliters. Cov kua synovial yog tsis muaj menyuam, muaj xim daj-straw xim thiab yog pob tshab kiag li. Nws yog tus cwj pwm los ntawm viscosity siab, nws muaj phagocytes thiab leukocytes, tab sis nws cov kab mob bactericidal tsawg heev. Vim hais tias cov kua synovial yog saturated nrog mucopolysaccharides nrog lub ntiajteb txawj nqus siab, nws accumulates nyob rau hauv kev sib koom tes, thiab tsis diffuse tawm ntawm nws kab noj hniav.
Txoj kev ua haujlwm ntawm kev sib tsoo ntawm lub xub pwg ob leeg yuav tham hauv qab no.
About kua dej sib koom
Tau txais cov kua dej sib koom ua ke thiab tsis ua rau cov txheej txheem pathological nyuaj heev vim nws qhov me me, tsis zoo siab thiab siab viscosity. Cov pob qij txha noj qab nyob zoo muaj lub siab tsis zoo:
- Pob Tawb: 270-210 millimeters dej.
- Lub hauv caug sib koom: 75-90 millimeters dej kem.
Qhov muaj qhov tsis zoo siab ua rau osmosis ntawm cov kua dej los ntawm cov phaj subchondral thiab synovial, los ntawm qhov uas cov pob txha mos ntawm cov pob qij txha yog nourished.
Lub xub pwg nyom rau cov neeg noj qab haus huv tsis tshua muaj.
Kev ua haujlwm ntawm cov kua dej synovial
KLub luag haujlwm tseem ceeb uas cov kua dej synovial ua tau suav nrog:
- Locomotor muaj nuj nqi. Synovial kua nyob rau hauv tandem nrog articular pob txha mos pub dawb txav ntawm articulated pob txha nto.
- Metabolic muaj nuj nqi. Cov kua dej synovial koom nrog hauv cov txheej txheem metabolic tshwm sim ntawm lub txaj vascular thiab cov kua dej sib koom ua ke.
- Trophic muaj nuj nqi. Synovial kua nourishes cov avascular txheej ntawm pob txha mos.
Yog tias muaj cov txheej txheem inflammatory tshwm sim hauv kev sib koom ua ke, cov ntsiab lus ntawm cov protein hauv cov kua dej synovial nce. Qhov no yog vim nce vascular permeability. Cov kua dej dhau los ua huab, cov ntsiab lus ntawm neutrophilic leukocytes nce rau hauv nws vim yog mob hnyav synovitis.
Lub xub pwg nyom: qhia
- Kev txiav txim siab ntawm cov ntsiab lus ntawm cov ntsiab lus (rau qhov muaj kua paug, exudate lossis ntshav hauv nws). Yog hais tias cov pob qij txha puas muaj cov ntshav, ces synovitis, pob txha mos ntawm ib tug degenerative-dystrophic xwm, thiab intra-articular adhesions yuav tshwm sim. Nyob rau hauv cov ntaub ntawv ntawm traumatic hemarthrosis, txhav thiab o ntawm ib tug nplaum xwm yog tshwm sim los ntawm kev puas tsuaj rau lub thickness ntawm pob txha mos, thiab tsis yog los ntawm kev ua ntawm cov ntshav tawm. Cov pob txha mos regeneration tshwm sim nrog proliferative hloov nyob rau hauv cov ntaub so ntswg connective. Nyob rau hauv cov ntaub ntawv ntawm kev puas tsuaj rau daim nyias nyias, cov ntshav coagulation tshwm sim sai heev, thiab tom qab ntawd txhaws daim ntawv, uas yuav ua rau kom loj hlob.sheath ntaub so ntswg. Yog li ntawd, obliteration ntawm kab noj hniav pib.
- Tsim kom muaj kev raug mob meniscal hauv lub hauv caug sib koom siv pneumoarthrography lossis radiography.
- Tsim kom muaj "lub cev mov" lossis "cov nas sib txuas" hauv cov kab noj hniav.
Rau qhov no, tshuaj ntsuam xyuas ntawm lub xub pwg sib koom ua ke tau sau tseg.
Cov lus qhia rau kev kho mob hom puncture
- Kev tshem tawm cov ntshav hauv kev txhim kho hemarthrosis.
- Kev tshem tawm cov exudate, kua paug los ntawm cov kab noj hniav sib koom ua ke, kev siv tshuaj tua kab mob.
- Taw qhia ntawm cov tshuaj novocaine thaum txo qis ntawm kev txav chaw.
- Taw qhia cov tshuaj corticosteroid ua ke nrog lidase nyob rau hauv lub xub ntiag ntawm deforming arthrosis.
- Kev taw qhia ntawm oxygen lossis cua rau cov txheej txheem maj mam rau kev puas tsuaj ntawm articular adhesions tsim nyob rau hauv rooj plaub ntawm fibrous fusion. Kev taw qhia txog cov pa oxygen kuj tseem ua tau txhawm rau txhawm rau txhim kho lub cev muaj zog lossis rau kev kho kom rov zoo.
Rau lub hom phiaj no, ua rau lub xub pwg nyom thiab lub hauv caug pob qij txha tuaj yeem ua tau.
Ua cov txheej txheem
Vim qhov kev nkag siab zoo ntawm cov kua synovial rau kev kis kab mob, thaum ua kev sib tsoo ntawm qhov sib koom ua ke, txhua txoj cai ntawm kev tiv thaiv kab mob thiab asepsis yuav tsum tau ua nruj me ntsis.
Ua ntej ua qhov puncture, qhov chaw puncture yuav tsum tau muab tshuaj tua kab mob kom huv si. Nws raug nquahu kom siv xya caum feem pua ntawm cawv. Tom qab daim tawv nqaij ntawm qhov chaw puncturetau smeared nrog tsib feem pua ntawm cov tshuaj iodine, nws cov residues yuav tsum tau muab tshem tawm los ntawm so ob zaug nrog cawv. Kev tshem tawm cov iodine residues, tshwj xeeb tshaj yog nrog ntau lubrication, yuav tsum tau vim lub fact tias iodine, ua ke nrog cov koob, yuav nkag mus rau hauv lub articular kab noj hniav, thiab qhov no ua rau irritation ntawm lub synovial daim nyias nyias thiab ib tug hnyav burning tshwm sim. Ntawm lwm yam, iodine muaj peev xwm nqus tau X-rays, thiab qhov no tuaj yeem cuam tshuam qhov kev ntseeg ntawm cov duab - ntxiv duab ntxoov ntxoo distorting cov duab yuav tshwm sim rau nws.
Siv lub zos infiltration anesthesia.
Yuav ua li cas thiaj ua tau?
Qhov ntev ntawm rab koob rau puncture yog 5-6 centimeters. Yog tias siv cov pa oxygen, ces cov koob yuav tsum tau siv nyias, mus txog ib millimeter inch. Txwv tsis pub, cov roj yuav tuaj yeem nkag mus rau hauv cov ntaub so ntswg uas nyob ib puag ncig ntawm kev sib koom tes. Uas, nyob rau hauv lem, yuav provoke subcutaneous, periarticular los yog muscular emphysema.
Daim tawv nqaij ntawm qhov taw tes ntawm lub xub pwg sib koom yuav tsum tau txav mus rau sab. Qhov no tso cai rau koj khoov lub qhov txhab channel sab laug los ntawm rab koob, thiab tom qab cov txheej txheem, daim tawv nqaij rov qab mus rau nws qhov chaw. Cov txheej txheem no zam kev nkag mus ntawm cov kab mob ntawm lub cev mus rau hauv cov kab noj hniav sib koom ua ke.
Cov koob yuav tsum maj mam maj mam, sim txiav txim siab thaum twg qhov kawg ntawm nws yuav dhau mus rau hauv lub hnab articular. Yog hais tias muaj cov ntshav nyob rau hauv cov kab noj hniav, ces cov tshuaj novocaine nyob rau hauv lub koob txhaj yuav stains, thiab yog hais tias muaj kua paug, cov tshuaj yuav ua pos huab.
Hais txog qhov tob uas nws yuav tsum tau puncture,muaj kev xav sib txawv. Qee cov ntaub ntawv hais tias rab koob yuav tsum nkag mus rau qhov siab tshaj plaws ntawm ib centimeter, thiab lwm qhov - 2-3 centimeters.
Cov kua dej thaum lub sij hawm puncture yuav tsum tau aspirated nrog ib tug syringe nrog ib tug ntim ntawm 10 mus rau 20 grams. Yog tias xav tau, cov tshuaj raug muab tshuaj. Tom qab tshem cov koob, cov tawv nqaij tshem tawm raug tso tawm, yog li khoov lub qhov txhab channel, tom qab ntawd qhov chaw txhaj tshuaj raug kho nrog cawv thiab siv cov ntaub qhwv tsis muaj menyuam.
Kev siv lub xub pwg nyom
Txoj kev sib koom tes no yuav tsum ua los ntawm sab, pem hauv ntej lossis nraub qaum. Yog hais tias tus txheej txheem yog ua los ntawm pem hauv ntej, ces tus neeg mob yuav tsum tau muab tso rau ntawm nws nraub qaum. Tom qab ntawd, tus kws phais yuav tsum xav txog cov txheej txheem coracoid ntawm scapula, uas yog peb centimeters qis dua qhov kawg ntawm lub clavicle. Lub koob yuav tsum tau muab tso rau hauv qab nws thiab coj ntawm lub taub hau ntawm lub xub pwg pob txha thiab nws cov txheej txheem nyob rau hauv kev coj ntawm pem hauv ntej mus rau sab nraum qab. Lub koob tau muab tso rau hauv qhov tob ntawm 4 centimeters.
Yog tias qhov kev sib tsoo ntawm lub xub pwg yog ua los ntawm tus kws phais mob los ntawm sab, ces tus neeg mob yuav tsum tau muab tso rau sab nraud, thiab nws txhais caj npab yuav tsum tau muab tso rau hauv lub cev nruj me ntsis. Ib tug ntiv tes dav me ntsis hauv qab lub tubercle loj yog lub taub hau ntawm humerus, nws lub taub hau. Lub koob yuav tsum tau muab tso rau hauv qab ib feem ntawm lub acromion uas yog lub protruding tshaj plaws, thiab ces nce mus txog ntawm lub deltoid nqaij nyob rau hauv lub frontal dav hlau.
Thaum ua cov txheej txheem puncture los ntawm qab, tus neeg mob yuav tsum tau muab tso rau ntawm lub plab. Tom qab ntawd, tus kws phais mob gropes rau cov leeg deltoid thiab nws sab ntug. Muaj ib lub qhov ntawm qhov chaw nome ntsis qis dua qhov posterior margin ntawm cov txheej txheem acromial. Nyob rau hauv qhov chaw no, nws yog tsim nyog los prick lub koob thiab ntxig rau ib tug tob ntawm 5 centimeters nyob rau hauv kev coj ntawm cov txheej txheem coracoid ntawm scapula.
