Karyawar Kwatangwalo da Ragewar Hidima: Binciken Jijiya da Rashin Motsawa¶

Bayan fadowa a gefen kwatangwalo a cikin babban babba ko babban hatsarin abin hawa mai ƙarfi, karo na ski, ko faɗuwa daga tsayi, matsananciyar ƙishirwa ko ciwon gindi tare da rashin iya tsayawa ko ɗaga ƙafar ƙafa yana nuna karaya ** kusancin femur (hip)** ko kuma ** ɓarna hips mai rauni . Kawai kallon yanayin hutawa na ƙafar da aka ji rauni idan aka kwatanta da ƙafar da ba a ji rauni ba ya bayyana abin da ya faru a cikin haɗin gwiwa: ** wuyan mace ko kuma karaya ta tsakiya ** ya bar ƙafar ** taqaitaccen kuma ya juya waje (yana juya waje) don haka gefen ƙafar ƙafar ƙafa yana kwance a ƙasa, yayin da wani ** kashi 0 na baya (dislocation) daga baya (dislocation). guiwa yana buga dashboard ɗin mota) ya kulle ƙafar ** a takaice, lanƙwasa, ya ja tsakiyar layi, ya juya INWARD (cikin juyawa). Domin ƙwanƙwasa kan femoral yana shimfiɗa ƙananan jijiyoyi masu gina jiki waɗanda ke ciyar da ƙwallon kwandon kuma yana murƙushe ** jijiyar sciatic ** kai tsaye a bayan soket, ** duk wani rauni na hip ɗin dole ne a mayar da shi a cikin wuri a cikin kwanciyar hankali a cikin sa'o'i 6 ** don hana mutuwa ta dindindin na kashi ( necrosis na jini ***) da ciwon ƙafa na tsawon rai. Kira lambar gaggawa ta gida nan da nan ta lambobin gaggawa, da kuma yin bitar kulawar raunin da ke da alaƙa a ciki karyewar pelvic stabilization da zubar jini na ciki, karaya da kasusuwa, kuma girgiza ganewa da kulawa.

Yi wannan yanzu¶

1. Kira lambar gaggawa ta gida nan take (911 a Amurka da Kanada, 112 a cikin Tarayyar Turai, 999 a cikin Burtaniya). Kada ku taɓa ƙoƙarin ɗaukar wani da ake zargi da karaya ko ɓarna a hannayensu don tafiya da su zuwa kujera ko mota mai zaman kansa; tsaye ko murza wuyan femoral ɗin da ba a gurɓata ba zai iya kama sauran gadar kasusuwa, yaga tasoshin jini da ke ciyar da kan femoral, ko fitar da kaifi mai kaifi tsakanin kasusuwa zuwa wani babban jijiya na pelvic.
2. **Kada ka bar kafa a daidai lankwasa ko jujjuyawar da ka same ta sai ka yi mata matashin kai, ko bargo na nadi, ko Jaket. wuyan mace daidai lokacin da ƙwallon ya makale a waje da soket.
3. ** Yi "30-Second Distal Sciatic Nerve and Arterial Check" akan ƙafar yanzu kuma a maimaita shi kowane minti 15:**
4. ** Gwada Sashin Peroneal na Jijiya Sciatic (Mafi Rauni a Bayan Hip Dilocation):** Tambayi majiyyaci don ** jawo babban yatsan ƙafa da ƙafafu zuwa sama zuwa hancinsu (ƙwaƙwalwar ƙafa da babban yatsan ƙafa)** kuma su taɓa saman ƙafar su da sararin yanar gizo tsakanin yatsun farko da na biyu don tabbatar da jin daɗin al'ada.
5. ** Gwada sashin Tibial na Jijiya Sciatic:** Tambayi majiyyaci su tura ƙafarsu KASA kamar danna fedar iskar gas (plantarflexion) kuma su taɓa tafin ƙafar su.
6. ** Duba Distal Arterial Pulses da Capillary Recill (Mahimmanci a Ciwon Hip na baya & Karya):** Ji bugun bugun jini a saman baka na ƙafa (** dorsalis pedis artery**) da bayan ƙashin idon sawu na ciki (** na baya tibial artery**), sannan danna farcen yatsan ya dawo cikin daƙiƙa biyu. Kwatanta dumin fata da ƙafar da ba ta ji rauni ba.
7. Idan majiyyaci ba zai iya cire kafarsu/ babban yatsan yatsa sama (digin ƙafar ƙafa) KO idan ƙafar tayi fari, sanyi, ko mara ƙarfi: Faɗa wa 911/112/999 mai aikawa da ma'aikatan jinya nan da nan cewa akwai ƙarancin raunin neurovascular (ciwon jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar jijiyar) ko rage jinkirin jijiya na mata kai tsaye)**.
8. Ajiye majiyyaci da dumama da barguna a ƙasa da kuma saman jikinsu don hana kumburin ciki. Manya waɗanda suka faɗo kan fale-falen banɗaki masu sanyi, gareji na siminti, ko shingen waje suna rasa zafin jiki cikin sauri zuwa cikin ƙasa, wanda ke haifar da mummunar cutar hypothermic coagulopathy wanda ke damun zubar jini na ciki daga kwatangwalo ko karaya.
9. ** Kiyaye majiyyaci gaba daya ba komai ta baki (NPO: abinci sifili, ruwan sifili, da sifirin maganin ciwon baka)** Ragewar hanji mai rauni yana buƙatar tsangwama mai zurfi mai zurfi nan da nan (ko maganin sa barci a cikin ɗakin aiki) a cikin sa'o'i, kuma raunin hip yana buƙatar gyaran tiyata a cikin sa'o'i 24 zuwa 48; abinci ko ruwa a ciki yana jinkirta maganin sa barci ko ƙara haɗarin buri.
10. A duba ciwon kai lokaci guda, amfani da jini, da kuma boyayyun abubuwan da ke haifar da faduwa. Tambayi dalilin da yasa mutum ya fadi (jiki, ciwon kirji, baki, ko faduwa) sannan a duba idan sun dauki maganin hana ruwa gudu (apixaban, rivaroxaban, dabigatran, warfarin, ko clopidogrel), a matsayin mai iya shiga tsakani. Lita 2.0 (2 zuwa 4 pints) na jini** na ciki cikin tsokoki na cinya.

Bishiyar yanke shawara: Matsayin ƙafar gani na gani da ƙwayar jijiyoyin jini a cikin mummunan rauni na hip¶

flowchart TD
    Start["Mummunan Ciwon Hip, Ƙwanƙwasa, Ko Ƙashin Ƙashin Ƙashin Ƙashin Ƙarya Bayan Faɗuwa ko Kara"] --> PostureCheck{"Duba Matsayin Ƙafa & Juyawa Idan aka kwatanta da Ƙafar mara rauni"}

    PostureCheck -->|"An GAGARUMIN Ƙafa kuma Yana Jujjuya Waje (Mai Jujjuya Waje, Ƙafar Yana Nuni Zuwa Gefe) KO Daidaita-Kallon Al'ada Tare da Ciwo akan Tafkin Heel / Log-Roll"| FractureOrAnt{"Shin wannan Faɗuwa ne a cikin Tsofaffi na Manya / Axial Load, KO Faɗin Ƙafafun Tilasta Juyin Waje?"}

    FractureOrAnt -->|"Fall / Axial Load (Kafa tana kwance akan gado, gajarta & juyawa waje)"| HipFracture["SUSUPECT PROXIMAL FEMUR (HIP) KARYA (Kwayoyin Femoral, Intertrochanteric, ko Subtrochanteric): 1. Rashin motsi tare da matashin kai tsakanin gwiwoyi; ZERO tafiya. 2. Saka idanu don ɓoyayyun asarar jini (1 zuwa 2 L a cikin karaya na waje). 3. Jirgin zuwa Asibiti don X-ray (ko MRI idan ɓarna na asiri) & Tiyata a cikin 24 zuwa 48 hours."]

    FractureOrAnt -->|"Ƙarƙashin Ƙarfafa Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙwara"| AntDislocation["KASHE HIP NA BAYA (10% na Ragewa): 1. Bincika Jijiyar Femoral / Dorsalis Pedis Pulse & Femoral Nerve (Quad/Cif Femoral Femoral) NAN TAKE. 2. Pad a matsayin da aka samo; ZERO mikewa. 3. Kira 911/112/999 don Rufe Rufe a cikin < 6 Hours."]

    PostureCheck -->|"Ƙafa tana GAjere, Mai sassauƙa, Janye Tsakanin Tsaki (ADDUCTED), da Jujjuyawar Ciki (Cikin Juyawa, Knee/Yatsun Yana Nuna Ciki)"| PostDislocation["BAYANIN HIP NA BAYAN (90% na ɓangarorin ƴan ƙasa & Prosthetic Dislocations, misali, Tasirin Knee): 1. Gwaji JIRGIN SCIATIC nan da nan (Mai haƙuri zai iya cire babban yatsan ƙafa / ƙafa?). 2. Kushin gwiwa / cinya a daidai matsayin lanƙwasa; KADA KA YI amfani da tsattsauran ra'ayi. 3. Kira 911 / 112 / 999 -> Rage Rufe Gaggawa a cikin < 6 Hours don hana Avascular Necrosis (AVN)."]

Pathophysiology: Samar da jini na haɗin gwiwa na hip da kuma dalilin da yasa agogon 6-hour ke da mahimmanci¶

1. Rashin isar da jinin macen mace¶

Ba kamar yawancin kasusuwa a cikin jiki waɗanda ke karɓar jini mai karimci daga abubuwan haɗin tsoka da ke kewaye da su ba, ƙwallon ƙafar hip (** shugaban mata ) yana zaune gaba ɗaya a rufe a cikin kwandon fibrous na kwandon kwandon ruwa ( intracapsular ), an rufe shi da slick articular cartilage ba tare da haɗe-haɗe na tsoka ba: - A cikin manya, ligamentum teres artery (jijiyoyin foveolar) a bakin ƙwallon yana ɗaukar kusan jini mai ma'ana (kasa da kashi 5 zuwa 10). - Maimakon haka, ** sama da kashi 90 cikin 100 na jinin da ke kiyaye kan mace gaba ɗaya ya fito ne daga zobe mai laushi a gindin wuyan femoral wanda Medial and Lateral Femoral Circumflex Arteries (reshe na profunda femoris / zurfin jijiya na mata). - Daga Medial Femoral Circumflex Artery, ƙananan rassan da suke hawa da ake kira ** retinacular arteries (Arteries epiphyseal arteries na Trueta)* hawa ** sama (retrograde)** tare da kunkuntar saman wuyan mace ***, suna huda capsule don ciyar da kubba mai ɗaukar nauyi na kan femoral.

2. Me yasa Karyewar Intracapsular da Ragewar Hip ke haifar da Necrosis na Avascular (AVN)¶

Fahimtar waɗancan ƙananan ƙwayoyin jijiya na retinacular da ke manne da wuyan femoral suna bayyana duk dabarun gaggawa a cikin rauni na hip: - A cikin Rashin Mutuwar Hidima (Baya ko Gaba): Lokacin da ƙwallon femur ya tsage da ƙarfi daga cikin soket ɗin acetabular, ligamentum teres ɗin ya karye gabaɗaya sannan kuma jijiyoyin jijiyoyi da ke gefen wuyan femoral suna miƙe, kiɗe, da matsawa a gefen soket ɗin. - ** Tagar Rayuwa ta Sa'o'i 6:** Nazari na asibiti na likitanci ya tabbatar da cewa idan an rage raguwar ƙwanƙwasa a cikin kwandonsa ** a cikin sa'o'i 6 na hadarin , ƙimar ** Avascular Necrosis (AVN / Osteonecrosis na shugaban mata) shine kawai ** 5 zuwa 10 bisa dari ***. Idan an jinkirta raguwa ** bayan sa'o'i 6 ***, adadin mutuwar kashi na dindindin da rushewar haɗin gwiwa ya tashi zuwa ** 40 zuwa sama da kashi 50 , yana buƙatar maye gurbin kwatangwalo ko da a cikin majiyyaci mai shekaru 20. - In a Displaced Intracapsular Femoral Neck Fracture (Subcapital or Transcervical): A fracture line that cracks right across the femoral neck inside the joint capsule shears the retinacular arteries in half. Mafi muni, idan karyewar ya kasance ba a matsewa ba * (tasoin retinacular har yanzu ba su cika ba), zubar jini a cikin matsi, madaidaicin capsule na haɗin gwiwa yana haifar da intracapsular tamponade** wanda ke shake venous da jijiyoyin jini har saan datse ko gyarawa. - In an Extracapsul Hip Fracture (Intertrochanteric or Subtrochanteric): Because the fracture line sits outside and below the hip joint capsule through rich, vascular cancellous bone between the greater and lesser trochanters, the blood supply to the femoral head remains intact (AVN is rare). **Duk daaka, saboda karaya a waje da capsule ba tare da wani abu da zai iya tayar da zubar da jini ba, fashewar intertrochanteric ko subtrochanteric yana zubar da jini cikin laushin cinya (rasa 1,000 zuwa 2,000 na jini) gigice.

3. Me yasa Ragewar Hip na Baya Yana Rushe Jijiya Sciatic (Kashi 10 zuwa 20%)¶

The ** sciatic jijiya *** (mafi kauri jijiya a cikin jikin mutum, dauke da L4, L5, S1, S2, da kuma S3 zaruruwa masu sarrafa hamstrings da kowane guda tsoka a kasa gwiwa) fita daga ƙashin ƙugu ta mafi girma sciatic notch da gudu ** kai tsaye a fadin baya (bangon baya) na kwandon hip **. - Lokacin da gwiwa direba ko fasinja ya shiga cikin dashboard yayin hadarin mota na gaba yayin da hip ɗin yana lanƙwasa kuma an haɗa shi, femur yana aiki kamar ragon bugun jini, yana tuƙi kan femoral kai tsaye ta cikin capsule na baya (kuma sau da yawa yana cire guntun bangon bangon acetabular **) daidai akan jijiyar sciatic. - Anatomical Quirk (Me ya sa Peroneal Division ke shan wahala na farko): A cikin babban kututturen jijiya na sciatic a hip, an riga an raba jijiyar jijiyoyi zuwa cikin na kowa peroneal (fibular) division ** (wand ke zaune mafi ** a aikaice da sama) , an haɗa shi sosai a duka sciatic wuyansa da tsciatic wuyansa da tsciatic wuyansa. mafi tsaka-tsaki kuma yana da rauni). Saboda haka, raunin hip na baya kusan koyaushe yana lalata ** kashi na farko **, yana haifar da faɗuwar ƙafar ƙafa (rashin iya ɗaga ƙafar ƙafa ko babban yatsa sama) da ƙumburi a saman ƙafar **, koda lokacin da sashin tibial ( nuna ƙafar ƙafa) har yanzu yana aiki.

Jagoran kwatancen asibiti: Yadda yanayin kafa ya bambanta 4 m rauni na hip¶

A wurin da wani hatsarin ya faru ko a wurin gaggawa na gaggawa, duba ƙafafun majiyyacin da ke kwance a ƙasa ko shimfiɗa kafin a taɓa su:

Tarko na musamman na asibiti: "Occult" ko Tasirin Hip Fracture (Tafiya akan Karyewar Hip)¶

Shin mutum zai iya samun karyewar kugu idan har yanzu yana iya tashi tsaye, ya ɗauki wasu matakai masu raɗaɗi, kuma a gajarta ƙafar da ba ta *** ba ko ta juya waje? - YES (kashi 5 zuwa 10 na duk raunin hip) A Garden Stage I Complete or Valgus-Impacted Femoral Neck Fracture (inda kashi biyun da suka karye a cikin junansu kamar nau'in ice cream guda biyu) ko kuma wanda ba a gurɓace ba, ƙafar ƙafar tana kallon tsawon 100 ko ɗari zuwa asibiti. gidan wanka na kwanaki 2 zuwa 3 yana gunaguni kawai na " tsokar da aka ja" ko "ciwoyin gwiwa wanda ba'a bayyana shi ba" (saboda ** jijiyar obturator ** tana ba da capsule na hip da gwiwa na ciki, cututtukan hanji akai-akai yana haifar da ** ciwon da ake magana da shi kawai a gwiwa**). - Hatsarin Tafiya Akan Karyawar Hip mai Tasiri: Idan an rasa raunin wuyan mace mai tasiri ko ɓoyayyiya kuma majiyyaci ya ci gaba da ɗaukar nauyi a gida, filayen ƙashin da abin ya shafa ba zato ba tsammani (** ƙaura na biyu**). Wannan zamewar tana jujjuya karaya mai sauƙi wanda za'a iya gyarawa a cikin mintuna 20 tare da ƙananan ƙwanƙwasa guda uku (kiyaye majinyacin ƙwallon hip ɗin majiyyaci) zuwa ɓarna gaba ɗaya tare da tsagewar tasoshin jini wanda ke buƙatar babban hemiarthroplasty ko jimlar maye gurbin hip. - Yadda Ake Gwaji Fannin Karyawar Hidima A Amincewa + Dokokin MRI: 1. Mai Girman Heel-Strike (Axial Loading) da Gwaje-gwajen Log-Roll: Idan majiyyaci dattijo ya fadi ya yi korafin ciwon mara, cinya, ko gwiwa duk da yanayin kafa na al'ada, kada ku nemi su tashi. Tare da majiyyaci kwance, a hankali a mirgine ƙafar mai annashuwa a ciki da waje kamar gungu (Gwajin-Roll, ƙayyadaddun gwajin gwaji na jiki don ilimin cututtukan hanji na ciki) ko taɓa ƙasan diddige a hankali zuwa hips. Ciwo mai kaifi yana nuna karayar hanji har sai an tabbatar da haka. 2. Me yasa Filayen X-rays ke rasa kashi 2 zuwa 10 cikin 100 na ɓangarorin hip: Ƙashin ƙashin ƙugu (AP) da ɓangarorin ɓangarorin ƙetaren giciye da ke gefen teburi suna rasa har zuwa kashi 2 zuwa 10 na waɗanda ba a gurɓata ba ko osteoporotic wuyan mata da kuma karaya tsakanin juna. 3. ** Umurnin Jagoran Kula da Lafiya (AAOS & NICE): *** Idan majiyyaci yana da ciwon hip, makwancin gwai, ko cinya mai tsayi ko kuma ba zai iya ɗaukar nauyi ba bayan faɗuwar kuma X-ray na farko na hip ya yi kama da "al'ada," BA dole ne a aika su gida don tafiya a kai ba**. The gold standard test is an immediate non-contrast MRI of the hip (100 percent sensitive for occult bone marrow edema and trabecular fracture lines) or a high-resolution CT scan of the hip if MRI is unavailable or contraindicated.

Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙaƙwalwa¶

.¶

Saboda ƙwanƙarar ƙwallon ƙafa na halitta yana da zurfi, an ƙarfafa shi da lokacin farin ciki ** iliofemoral ligament na Bigelow ** (mafi karfi ligament a cikin jikin mutum), kuma kewaye da karfi gluteal da iliopsoas tsokoki, dislocating na halitta hip yana bukatar gagarumin tashin hankali (wani babban hadarin mota mota, fitar da babur, mai tafiya da yawa yajin, ko faduwa): - ** kashi 95 cikin 100 na marasa lafiya tare da raunin rauni na asali na asali suna da manyan raunin rauni na lokaci guda:** Koyaushe bincika ** raunin gwiwa na ipsilateral ** ( hawaye na cruciate na ligament, fashewar patellar, ko bugun femoral shaft** daga tasirin dashboard; lura cewa wani lokaci na ipsilateral shaft na ciki na bayan gida na juzu'in juzu'i na juzu'in juzu'i na juzu'in juzu'i na ciki. dislocation, yana haifar da kashi 50 cikin 100 na ɓarna hips da za a rasa a farkon lokacin da raunin femur ya kasance), karaya, zubar jini na ciki, ko ciwon kirji/kaya. - ** Me yasa Pre-Rage X-Ray / CT Mahimmanci kafin Ja da Ƙaƙwalwar Ƙwallon Ƙasa: ** Kafin yin rufaffiyar ragewa a ƙarƙashin kwanciyar hankali mai zurfi (ta yin amfani da ** Allis maneuver **, ** Captain Morgan maneuver , ko ** Gabashin Baltimore Lift ), likitoci suna samun saurin AP pelvis X-ray don tabbatar da cewa babu wani abu mai rikitarwa. Idan likita ya ja da karfi a kan kwatangwalo wanda kuma yana da tsagewar gashi a wuyan femoral, wuyan femoral ya kama gaba daya, ya bar matataccen kan mace a makale a cikin gindi yana bukatar ceton tiyata a bude. - Bayan Rage CT Scan Mandate: Bayan kowane ɓacin rai na asali ya dawo cikin wuri, ** CT scan na pelvic pelvic slice ya zama tilas don bincika ** gutsuttsuran kasusuwa na intra-articular kashi a cikin sararin haɗin gwiwa (wanda zai niƙa wurin guringuntsi idan ba a cire shi ba) da kuma kimanta girman bangon bangon bango.

2. Jimillar Hip Arthroplasty (THA) Rushewa (Matsayin Gaggawa na Ƙarƙashin Ƙarfafawa)¶

Ya bambanta da ɗan kwatangwalo, majiyyaci wanda a baya yana da Jimillar Sauyawa Hip (Total Hip Arthroplasty, THA) an ƙera capsule ɗin haɗin gwiwa na halitta kuma an maye gurbinsu da ƙaramin ƙarfe / yumbu ball da murfin polyethylene. Kusan ** 1 zuwa 3 bisa dari na maye gurbin hip na farko *** (kuma har zuwa kashi 10 zuwa 15 na gyaran hips maye gurbin) sun rabu, yawanci tare da ** ƙarancin kuzarin ƙarfi *: - Mafi kusancin THA dislocation (Mafi Yawanci): Yana faruwa ne lokacin da majiyyaci ** ya lanƙwasa gaba a kugu ya wuce digiri 90 (zurfin ƙwanƙwasa mai zurfi) yayin da suke tsallaka ƙafafu (ƙara) ko murɗa gwiwa zuwa ciki (juyawa ta ciki), kamar kai ƙasa don ɗaure takalmi, ɗaukar wani abu daga ƙasa yayin da yake zaune a ƙasan kujera, ko zaune a ƙaramin kujera. Makullin ƙafar ** an jarta, lanƙwasa, ɗaureda jujjuyawar ciki . - **Tsarin Gabatarw THA: Yana faruwa lokacin daajiyyaci ya miƙe hips ɗin su baya yayin da suke juya ƙafar su waje (kamar komawa baya ko jujjuya kan gado). Kulle kafa waje ya juya aka sace. - Bambanci cikin Gaggawa: Saboda ƙarfen ƙarfe ko yumbun ball ba shi da sifili mai rai na ƙwayoyin kasusuwa ko wadatar jini, ** avascular necrosis (AVN) ba zai iya faruwa a cikin ɓarnawar hip ɗin prosthetic **. Duk da haka, ƙayyadadden ƙwayar cuta har yanzu yana haifar da ciwo mai tsanani, yana iya shimfiɗa ** sciatic ko jijiyar femoral **, kuma ya zama da wuya a rage rufaffiyar yayin da tsokoki na gluteal da cinya suna spasm fiye da sa'o'i, don haka gaggawar jigilar motar asibiti don kwantar da hankali na ciki da kuma raguwa a cikin Sashen Gaggawa har yanzu ana buƙata.

Gudanar da gaggawa na asibiti: Fascia Iliaca tubalan jijiya da taga aikin tiyata na awanni 24 zuwa 48¶

1. Pre-Aiki Pain Control Ba tare da Opioid Delirium: Ƙaƙwalwar Fascia Iliaca¶

A cikin tsofaffi masu karyewar kwatangwalo, ba da maimaita yawan allurai na morphine na ciki, hydromorphone, ko fentanyl a cikin Sashen Gaggawa akai-akai yana haifar da rikicewar rashin lafiya na asibiti, damuwa na numfashi, tashin zuciya, da riƙewar fitsari , yayin da barin hip ɗin yana da zafi a duk lokacin da aka motsa mara lafiya akan tebur X-ray ko kwanon rufi. - ** Ka'idodin Zinare na Zamani (AAOS, NICE, & ACEP Jagororin): Nan da nan bayan tabbatar da raunin hip a cikin Sashen Gaggawa, likitocin gaggawa ko masu ilimin likitancin jiki suna yin ** Fascia Iliaca Compartment Block (FICB) mai jagorar Ultrasound (FICB) ko Femoral Nerve / PENG (Pericapsular Nerve Group) ta amfani da rukunin jijiya mai tsayi (ta amfani da rukunin jiyya na gida). ko bupivacaine). - A cikin mintuna 15, toshewar jijiya na yanki yana rage ƙwayar mace, na gefe na mace, da kuma rassan jijiyar obturator da ke ba da karyewar hip, yana kawar da kashi 80 zuwa 90 na radadin karaya na tsawon sa'o'i 12 zuwa 24 ba tare da girgiza kwakwalwar majiyyaci ba ko sauke numfashin su.

2. Me yasa Tiyatar Karyawar Hip A Cikin Sa'o'i 24 zuwa 48 Yana Ceton Rayuwa¶

A tarihi, an ajiye tsofaffin marasa lafiya da suka karye a kwankwaso a gadon su na tsawon kwanaki yayin da suke fuskantar dogon izinin likita. Gwajin gwaji na ƙasa da ƙasa sun tabbatar da cewa ** kowane jinkiri na sa'o'i 24 sama da sa'o'i 48 a cikin yin gyaran gyare-gyare na hip ko arthroplasty yana ƙaruwa sosai na tsawon kwanaki 30 da shekara 1** saboda rikice-rikice huɗu masu mutuwa na rashin motsin gado: 1. Ƙunƙarar Huɗa da Zurfin Jijiyoyin Thrombosis (DVT) daga venous stasis da rauni-induced hypercoagulability. 2. Buri na asibiti da ciwon huhu daga rashin iya zama a tsaye da tari sosai. 3. Cutar sacral da gyambon diddige (maganin gado) Yana kaiwa ga sepsis. 4. Mmunan hazaka da ɓatawar tsoka da ba za a iya jurewa ba.

Saboda haka, ka'idojin orthopedic na kasa da kasa (** NICE CG124** a cikin Burtaniya da AAOS a cikin Amurka) suna kula da karaya ta hanji a matsayin ** fifikon tiyata na gaggawa wanda aka yi amfani da shi a cikin sa'o'i 24 zuwa 36 na shiga** don haka mai haƙuri zai iya tsayawa da ɗaukar nauyi tare da jiyya ta jiki da safe.

3. Mayar da Maganganun Jini (Anticoagulants) Kafin Fitar Karya¶

Idan majiyyaci ya sha maganin siriri na jini, gaya wa tawagar gaggawar tantancewa da ** ainihin sunan magani da ainihin sa'ar da aka hadiye kwaya ta ƙarshe : - Warfarin (Coumadin): Ana juyawa da sauri tare da Bitamin K na Jiki (\(5\rubutu{zuwa}10\rubutu{mg}\) IV) da 4-Factor Prothrombin Complex Concentrate (4F-PCC) idan ana buƙatar tiyatar gaggawa cikin sa'o'i, ana nufin \(\ rubutu{INR} <1.5\). - ** Masu hana masu hana kai tsaye Xa (Apixaban [Eliquis], Rivaroxaban [Xarelto], Edoxaban): Matakan ƙwayoyi suna share sama da sa'o'i 24 zuwa 36 tare da aikin koda na yau da kullun, ko kuma za'a iya jujjuya shi cikin zubar da jini mai barazanar rai tare da ** Andexanet alfa ** ko ** 4F-PCC. - ** Mai hana Thrombin kai tsaye (Dabigatran [Pradaxa]):* Yana juyawa cikin sauri cikin mintuna ta amfani da takamaiman guntun antibody monoclonal Idarucizumab (Praxbind). - Tranexamic Acid (TXA, \(1\rubutu{g}\) IV): Ana gudanar da shi akai-akai yayin tiyatar karyewar hangi don rage asarar jini da buƙatun ƙarin ƙarin jini.

Lambobin gaggawa na yanki da ka'idojin hukumar¶

• Amurka da Kanada: Dial 911. Karkashin ** Kwalejin Likitocin Amurka (ACS) ATLS** da ** Cibiyar Nazarin Magungunan Orthopedic ta Amurka (AAOS)*** jagororin, ana jigilar ɓarkewar ɓarna kai tsaye zuwa Cibiyar Taimako don rufewa a cikin $ <6\rubutu{hours}$, yayin da ɓarnawar hip ɗin geriatric ke shiga cikin sauri-tafiya ** Orthogeriatric Co-undation a cikin hanyoyin tiyata. 24 zuwa 48 hours).
• ** United Kingdom:** Kiran kira 999 (ko 112). A karkashin ** NICE Clinical Guideline CG124 (Hip Fracture: Management)** da ** National Hip Fracture Database (NHFD) Mafi Kyawun Tariff (NHFD) , kowane mai raunin raunin hip dole ne ya sami analgesia nan da nan (ciki har da ƙididdigar ƙwayar jijiya na fascia iliaca), ƙima na haɗin gwiwar orthogeriatrician, da tiyata a ranar *, 3 hours bayan, ko ranar shiga.
• ** Tarayyar Turai:** Kiran Kira 112. Follow EFORT (European Federation of National Associations of Orthopaedics and Traumatology) guidelines for fast-track hip fracture care and immediate native hip dislocation reduction.
• ** Ostiraliya da New Zealand:** Kiran kira 000 a Ostiraliya ko 111 a New Zealand. Bi ** Australian da New Zealand Hip Fracture Registry (ANZHFR) Matsayin Kula da Lafiya na Clinical ** (ƙimar ciwo da toshewar jijiya a cikin mintuna 30 na isowar ED, tiyata a cikin awanni 48).
• Indiya da Asiya-Pacific:* Dial 112 a Indiya,119* a Japan da Koriya ta Kudu, ko 995 a Singapore. Nemi motar asibiti tare da ** shimfiɗar ɗaki ko katifa mai ƙyalli ** don haka za a iya ɗaga majiyyaci daga ƙasa a kwance ba tare da lanƙwasa ko juya haɗin hip ɗin da ya ji rauni ba.

Duba lambobin gaggawa don duk lambobin aika gaggawa na duniya.

Tambayoyin da ake yawan yi¶

Ta yaya zan iya gane kawai ta hanyar kallon ƙafar wani bayan faɗuwar ko sun karya hips ko kuma sun rabu da kugu?¶

Dubi hanyar da gwiwa da ƙafar ƙafar da suka ji rauni ke nunawa idan aka kwatanta da kyakkyawar kafa. Kusan duk **karyewar kwatangwalo (wuyan femoral ko intertrochanteric fractures)** kafar ta miqe ta miqe, gajarta ce 2 zuwa 4 centimeters, sannan ta mirgine ** WAJE (wajen juyawa)** haka gefen kafar ya tsaya a kasa. A cikin kashi 90 cikin 100 na ** watsewar hips (magudanar hips na baya)** ana lankwashe hips da gwiwa, a ja da baya a tsallaka dayar kafa, sannan a juya ** INWARD (cikin juyayi)** don haka gwiwa da yatsu suna nuna kishiyar kafa.

Shin wani zai iya samun karyewar kwatangwalo idan za su iya tashi tsaye su tafi bandaki bayan sun fadi?¶

Na'am; Kimanin kashi 5 zuwa 10 cikin 100 na karaya na hip sune ** raunin da ya shafi valgus ko rashin matsuguni na damuwa** inda ƙarshen kashin da ya karye ke dunƙule su tare a cikin capsule na haɗin gwiwa. Mutum na iya har yanzu yana iya ratsawa na kwanaki da yawa kuma yana iya jin zafi kawai a makwancinsa ko gwiwa na ciki. Duk da haka, yin tafiya a kan raunin da ya faru na hip yana da matukar haɗari saboda kuskure guda ɗaya zai iya sa kasusuwan ƙasusuwan su zamewa gaba daya, yage jinin da ke cikin kwandon kwandon kuma yana juya hanyar daidaitawa mai sauƙi a cikin cikakken maye gurbin hip.

Me yasa raunin hip zai iya haifar da ciwo a gwiwa yayin da babu wani abu da ke damun gwiwa?¶

** Jijiya obturator *** da ** jijiya na mata *** suna aika rassan hankali zuwa duka capsule na ciki na haɗin gwiwa na hip da fata da capsule na haɗin gwiwa a gaban gwiwa na ciki. Domin kwakwalwa tana raba waɗancan hanyoyin wayoyi masu azanci, haushi ko karaya a cikin haɗin gwiwa na hip yana yawan ji ta majiyyaci kawai azaman ciwo mai zurfi a gwiwarsu (** ciwon gwiwa da ake magana akai**). Kowane yaro, matashi (tare da zamewar babban femoral femoral epiphysis), ko babba mai ciwon gwiwa wanda ba a bayyana shi ba bayan zamewa dole ne a gwada ** hip ɗin su da X-ray **.

Me yasa sa'o'i 6 shine lokacin ƙarshe na sihiri don mayar da ƙwanƙolin da ba a kwance ba a cikin kwandon sa?¶

Lokacin da ƙwallon haɗin gwiwar hip ɗin ku na dabi'a (kan femoral) ya buge daga soket ɗinsa, ƙananan jijiyoyi na retinacular da ke gudana sama da wuyan femoral wanda ke kiyaye kashi a raye suna miƙewa kuma a rufe su. Bincike na Orthopedic ya nuna cewa idan hip ɗin ya koma baya a hankali a ƙarƙashin kwanciyar hankali ** a cikin sa'o'i 6 **, kawai kusan 5 zuwa 10 bisa dari na marasa lafiya suna haifar da mutuwar kashi (** avascular necrosis, ko AVN ***); idan kwankwason ya tsaya a wargaje na **fiye da sa'o'i 6**, hadarin kan macen ya mutu da rugujewa a cikin shekaru 2 masu zuwa ya tashi sama da kashi 40 zuwa 50.

Me yasa ma'aikatan lafiya suka duba ko zan iya ja babban yatsana zuwa hancina bayan hadarin motata?¶

Ja da babban yatsan ƙafarka da ƙafarka zuwa sama zuwa ga shinshininka (** dorsiflexion ***) ana sarrafa shi ta ** sashin peroneal na jijiyar sciatic**. Saboda jijiyar sciatic tana gudana kai tsaye a bayan bangon baya na kwasfa na hip, raunin hip na baya (daga gwiwar gwiwa da ke bugun dashboard) ya rushe kan femoral kai tsaye a cikin jijiyar sciatic a cikin kashi 10 zuwa 20 na wadanda abin ya shafa. Dubawa ko za ku iya ɗaga babban yatsan ƙafar ku kuma ku ji saman ƙafar ku yana gaya wa ƙungiyar rauni nan da nan ko jijiyar sciatic tana murƙushe kwatangwalo.

Jinin nawa ne mutum zai iya yin hasarar ciki daga karyewar kugu ba tare da digon jini daya ya bayyana a fata ba?¶

Yayin da karaya ya tashi sama a cikin capsule na haɗin gwiwa mai ƙarfi (karyewar wuyan mata na intracapsular) kawai yana da damar zubar da jini kusan 50 zuwa 150 milliliters kafin matsa lamba na capsule ya dakatar da shi, ** karaya mai ƙarfi ** rage ƙasa a cikin trochanters ko babba femur (** intertrochanteric ko subtrochanteric) cikin tsoka mai rauni. sassan cinya. Majiyyaci na iya rasa **1.0 zuwa lita 2.0 na jini** a cikin cinyarsu, kusan kashi 30 zuwa 40 na jimlar adadin jinin tsoho, yana buƙatar kulawa ta kusa don kodaddun fata, saurin bugun zuciya, da girgizar hypovolemic.

Jagora masu alaƙa¶

• Karyawar ƙashin ƙashin ƙugu da kula da zubar jini na ciki
• Karyewar kasusuwa, karaya, da sprains
• Rage kafada, ƙwanƙwasa gwiwa, da hana haɗin gwiwa
• Ganewar girgiza da kulawar gaggawa

Tushen da jagorar hukuma¶

• American Academy of Orthopaedic Surgeons (AAOS, United States): Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline (occult fracture MRI mandate, pre-operative regional nerve blocks,surgical timing within 24 to 48 hours, and tranexamic acid/VTE protocols).
• National Institute for Health and Care Excellence (NICE, United Kingdom): Hip Fracture: Management (Clinical Guideline CG124) and British Orthopaedic Association Standards for Trauma (BOAST): The Care of the Older or Frail Patient with a Fracture.
• ** Kwamitin Kwalejin Likitoci na Amurka (ACS, Amurka) Kwamitin Ci Gaban Taimakon Rayuwa (ATLS) Jagoran Koyarwar Dalibai * (Traumatic Hip Dislocation 6-hour AVN rage taga, sciatic da femoral neurovascular kima, da kuma contraindications na traction splints a hip / pelvic rauni).
• ** Rijista Rijistar Hip Fracture na Ostiraliya da New Zealand (ANZHFR) da Hukumar Ostiraliya kan Tsaro da Inganci a cikin Kiwon Lafiya:** * Matsayin Kulawa na Ciwon Hip*.
• Orthopaedic Trauma Association (OTA): Clinical Practice Guidelines for High-Energy Femoral Neck Fractures and Native Hip Dislocations.