I-Case Study: Ukulungiswa Kwe-Rib & Clavicle Fracture nge-Chest Wall Stabilization e-Mexico

Isiginali Yomtholampilo

Leli cala libandakanya ukungazinzi kodonga lwesifuba okudabukisayo okubangelwa ukuphuka kwezimbambo ezisusiwe ngemva kwengozi yemoto enamandla amakhulu. Ukuqiniswa kodonga lwesifuba sokuhlinzwa kwakudingeka ukuze kubuyiselwe ubuqotho be-thoracic futhi kuthuthukiswe imishini yokuphefumula.

Isifinyezo secala

Isiguli esineminyaka engu-60 ubudala saseMexico sabandakanyeka engozini embi yemoto, okuholele ekuqhekekeni kaningi kwe-scapula, izimbambo, ne-clavicle. Isiguli sethulwe ngobuhlungu besifuba, ukunyakaza kokuphefumula okukhubazekile, nokungaqini kokusebenza kwekheji lesifuba.

I-imaging yangaphambi kokuhlinzwa iqinisekise ukuphuka kwezimbambo ezisusiwe ezihambisana nokungaqini kodonga lwesifuba, kanye nokubandakanyeka kwe-clavicular. Njengoba kunikezwe izinga lokuphazamiseka kwamathambo kanye nengozi yokungena komoya engozini, ukuqiniswa kokuhlinzwa kwakhethwa. Inqubo yenziwa ngempumelelo nguDkt Israel Eduardo, ehlose ukubuyisela ukuqondanisa kwe-thoracic, ukuthuthukisa imishini yokuphefumula, nokuhlinzeka ngokulungiswa okuzinzile kokululama kokuqala kokusebenza.

Leli cala libonisa inselele evamile ekuhlinzeni kwe-thoracic trauma, lapho ukuphathwa okulondolozayo kukodwa kungase kungenele lapho kukhona ukuphulwa kwezimbambo ezisusiwe kanye nokungazinzi kwesakhiwo.

Imiphumela ye-Imaging Preoperative

Ukuhlolwa kwe-radiographic yangaphambi kokuhlinzwa kubonise ukuphuka kwezimbambo eziningi ezisusiwe ezinezimpawu ezihambisana nokungaqini kwezindonga zesifuba. Ukuphazamiseka kokuqhubeka kwezimbambo kubonisa ukunyakaza kwe-thoracic okungavamile, okwandisa ingozi yokuphefumula kokuphefumula.

Ukutholwa kwezithombe kudlale indima ebalulekile ekuqinisekiseni ubukhulu bokulimala futhi kusekela isinqumo sokungenelela ngokuhlinza kunokuphathwa okungahlinzeki.

Isizathu Sesinqumo Sokuhlinzwa

Ngokusekelwe ekususweni kwembambo okuqinisekisiwe ngesithombe kanye nokungaqini kahle kodonga lwesifuba, ukwelashwa okulondolozayo kukodwa kwakubhekwa njengokunganele. Ukuqiniswa kodonga lwesifuba sokuhlinzwa kwakhethwa ukuze kuvinjwe ukuwohloka okwengeziwe kokuphefumula, ukunciphisa ukunyakaza kwe-thoracic okungavamile, nokwenza lula ukuhlanganisa kusenesikhathi kanye nokuvuselelwa kwamaphaphu.

Ezimweni ezibuhlungu ezibandakanya ukuphuka kwezimbambo eziningi, ukungenelela kokuhlinzwa okufika ngesikhathi kungathuthukisa kakhulu imishini ye-thoracic kanye nokululama kwesiguli sonke lapho kukhona izinkomba ezifanele.

  

Uhlolojikelele Lwesu Lokuhlinza

Inqubo yokuhlinzwa igxile ekubuyiseleni ukuzinza kwezindonga zesifuba ngokulungiswa kwangaphakathi kwe-sternum kanye nezingxenye zezimbambo, kuhlanganiswe nokuzinza kwe-clavicular fractures ehambisanayo lapho kuboniswa.

Izinjongo ezibalulekile zenqubo zazihlanganisa:

• Ukusungula kabusha ukulungiswa kwekheji ye-thoracic nokuqhubeka

• Ukunciphisa ukunyakaza kodonga lwesifuba okuyindida

• Ukuthuthukisa imishini yokuphefumula

• Ukunikeza ukulungiswa okuzinzile ukuze kusekelwe ukuhlanganisa kwangaphambi kokuhlinzwa

Izimila ze-thoracic fixation ezisezingeni eliphansi zazisetshenziselwa ukufeza ukuvumelana kwe-anatomical ngenkathi kugcinwa amandla okwanele okusebenza kwezicelo zokuhlukumezeka.

Ukufanekisa kanye Nomphumela Wangemva Kokuhlinzwa

I-Postoperative imaging iqinisekise ukulungiswa okuzinzile kwezingxenye zezimbambo nokubuyiselwa kokuqondanisa kwe-thoracic. Ikheji ye-thoracic ibonise ubuqotho besakhiwo obuthuthukisiwe ngaphandle kobufakazi bokuthi i-implant displacement.

Ukwakhiwa kokulungisa kunikeze ukuzinza okwanele ukusekela umsebenzi wokuphefumula wangemva kokuhlinzwa kanye nezinqubo zokuvuselela.

Ukuqinisekiswa Komphumela

Umphumela wokuhlinzwa ubonise ukulungiswa kwe-anatomical okubuyiselwe kanye nokuzinza okusebenzayo kodonga lwesifuba, okuqinisekisa ukuphumelela kokuqiniswa kodonga lwesifuba sokuhlinzwa kuleli cala lokuhlukumezeka. Ukuqinisekiswa kwezithombe kanye nokuthuthukiswa komtholampilo kubonise ukungenelela okuyimpumelelo.

Izicaciso zokufakelwa ezisetshenziswa kuleli cala

Kule nqubo, a I-Chest Wall Stabilization System yasetshenziswa ukuze kulawuleke ukuphuka kwezimbambo ezisusiwe nokubuyisela ukuzinza kwe-thoracic. Uhlelo luklanyelwe ngokukhethekile izimo zokuhlukumezeka kwesifuba ezihlanganisa ukuphuka kwezimbambo, ukuntengantenga kodonga lwesifuba, nokulimala okuyinkimbinkimbi kwamathambo esifuba.

Isistimu yokulungisa izimbambo iqukethe amapuleti ezimbambo ajikijelwe ngokwendalo kanye nezikulufu zokukhiya ezihambisanayo, ezivumela ukulungiswa okuzinzile kuyilapho kugcinwa idizayini yephrofayela ephansi. Amapuleti angenziwa ajikijelwe ngokuhlanganyela ukuze ahambisane nokwakheka kwezimbambo ngazinye, awenze afanelekele ukulungiswa kodonga lwesifuba lwangaphambili, olungemuva, nangemuva. Kulesi simo, uhlelo lwasetshenziswa ukuze kuqiniswe izingxenye zezimbambo ezisusiwe futhi kumiswe kabusha ukuqhubeka kwekheji ye-thoracic.

Ngaphezu kwalokho, i-a I-Clavicle Fixation Plate System yasetshenziswa ukubhekana nokuphuka kwe-clavicular ehambisanayo. Ukubuyisela ukuqondanisa nobude be-clavicular kube nomthelela ekuzinzeni kodonga lwesifuba kanye nebhande lehlombe, okubaluleke kakhulu ezimweni ezihlangene zokuhlukumezeka kwe-thoracic.

Izinzuzo zomtholampilo zamasistimu okufakelwa zihlanganisa:

• Idizayini yepuleti lephrofayili ephansi ukuze unciphise ukucasuka kwezicubu ezithambile

• Amapuleti amaningi osayizi kanye nomumo ukuze kuhlangatshezwane nezimbambo kanye ne-clavicle anatomy

• Ubuchwepheshe bezikulufu zokukhiya ukuze kuthuthukiswe ukuzinza kokulungisa

• Ukufaneleka kokuphuka kwezimbambo okubuhlungu nokwakhiwa kabusha kodonga lwesifuba

I-Instrument Setha Uhlolojikelele

Ukusekela ukuhamba komsebenzi okuphephile nokusebenzayo, i-a Isethi Yensimbi Yokulungisa Izimbambo Ezinikezelwe yasetshenziswa phakathi nenqubo. Le sethi yensimbi yakhelwe ngokukhethekile ukulungisa ukuphuka kwezimbambo nokuhlinzwa kokuqinisa udonga lwesifuba, okumboza inqubo egcwele yokusebenza kusukela ekujikeni kwepuleti kuya ekulungiseni isikulufu sokugcina.

Ikhithi yezinsimbi ihlanganisa ama-plate bender, ama-forceps okunciphisa ukuphuka, iziqondiso zokubhoboza, amathuluzi okubhola, nama-screwdrivers okukhiya, okunika amandla ukuphathwa okunembayo kwamapuleti ezimbambo emkhakheni wokusebenza okulinganiselwe wokuhlinzwa kwesifuba. Ukwakheka okuhleliwe kwethreyi yensimbi kusiza ukuguqulwa okushelelayo kwangaphakathi kokuhlinzwa futhi kusiza ukunciphisa isikhathi sokusebenza.

Ezimeni zokuphuka kwezimbambo eziningi kanye nokungaqini kwezindonga zesifuba, ukusetshenziswa kwesethi yensimbi ezinikele kuthuthukisa ukusebenza kahle kokuhlinzwa futhi kusekela ukufakwa okunembile kokufakwayo, okubalulekile ekuzuzeni ukulungiswa okuzinzile kanye nemiphumela ekwazi ukukhiqiza kabusha.

Izici ezibalulekile zesethi yensimbi zihlanganisa:

• Qedela i-instrumentation ye-rib plate contouring, ukunciphisa, nokulungiswa

• Umklamo we-ergonomic wokuphatha okulawulwayo ezinkambisweni ze-thoracic

• Ukucushwa kwe-modular kuvumelana namaphethini ahlukene okuphuka kwezimbambo

• Ifanele ukuhlukumezeka kwe-thoracic okuyinkimbinkimbi kanye nokuhlinzwa kokuqiniswa kodonga lwesifuba

Isifinyezo Sokuhlinza & Nokuthathwa Kwezokwelapha

Leli cala lokuhlukumezeka elisekelwe eMexico libonisa ukuthi, ezigulini ezikhethiwe ezinezimbambo ezixoshiwe kanye nokungazinzi kwezindonga zesifuba, ukuqiniswa kokuhlinzwa kungabuyisela ngokuphumelelayo ubuqotho be-thoracic futhi kuthuthukise imishini yokuphefumula.

Ukukhethwa okufanele kwesiguli, ukulungiswa okuzinzile, nokuhlolwa kwe-imaging yangemva kokuhlinzwa kuyizici ezibalulekile ekufinyeleleni imiphumela emihle ekuhlinzeni kwe-thoracic trauma. Ukuqiniswa kodonga lwesifuba kuhlala kuyinketho ebalulekile yokulawula amaphethini ayinkimbinkimbi ezimbambo lapho ukwelashwa okuvamile kunganele.

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