Mob ko taw mob ntshav tes taw yog qhov nyuaj ntawm txoj kev hloov pauv hauv txoj kev mob ntawm cov leeg. Cov nqua tau raug kev txom nyem vim yog muaj qhov ntau vim cov piam thaj hauv cov ntshav. Kev kho mob ntawm ko taw mob ntshav qab zib yog nyob ntawm kev sib koom tes ntawm kev ua ntawm orthopedist, endocrinologist thiab lwm tus kws kho mob tshwj xeeb.
Mob ntshav qab zib mellitus yog ib qho kev mob nkees mob nrog ntau yam mob. Mob ko taw mob ko taw yog ib tug ntawm lawv. Pathology feem ntau ua rau kev txhim kho cov txheej txheem necrotic, kev ua tub rog thiab txiav tes taw.
Kwv yees li ntawm 85% ntawm cov neeg mob yog txhab qog pob txha, osteomyelitis, phlegmon, mob txhaws ntswg, thiab mob rau leeg mob. Qhov no tseem suav nrog kev mob ntshav qab zib osteoarthropathy.
Ua rau mob ntshav qab zib taw
Hauv cov ntshav qab zib mellitus, kev tsim tawm tsis txaus ntawm cov tshuaj hormone insulin tshwm sim. Lub luag haujlwm tseem ceeb ntawm txoj kev loj hlob yog coj cov piam thaj mus rau hauv lub cev ntawm lub cev. Yog li no cov insulin tsis txaus tsim nyog yog vim li cas cov ntshav qab zib nce ntxiv. Hauv cov mob hnyav, cov kev ncig dav dav tuaj.
Hauv cov neeg muaj ntshav qab zib, cov qhov txhab ntawm ko taw yog kho qeeb dhau. Heels nyob rau hauv cov ntshav qab zib mellitus ua insensitive. Tom qab lub sijhawm tshwj xeeb, qhov no ua rau kev tsim cov mob txhab rau mob, uas, yog tias tsis raug lossis tsis raug kho, hloov mus rau kev ua laib.
Txawm tias qhov mob me tshaj plaws thiab txhim kho me me tuaj yeem ua rau muaj cov kabmob no. Vim tias cov ntshav tsis txaus, qhov tsis hnov mob plab yuav ploj, yog li tus neeg hnov mob tsis hnov mob los ntawm kev raug mob. Cov mob rwj uas tshwm sim nyob rau hauv cov ntaub ntawv no tsis pom muaj los ntawm cov ntshav qab zib tau ntev.
Nws ib txwm tsis tuaj yeem kho kab mob, yog li ntawd, txhais ceg yuav tsum tau txiav tu. Nws yuav tsum raug sau tseg tias qhov txhab mob tshwm sim hauv cov cheeb tsam uas muaj lub nra thaum taug kev. Qhov tawg ntaws dhau los ua - ib puag ncig zoo rau kev nkag thiab kev loj hlob ntawm cov kab mob. Yog li, tus neeg mob ntshav qab zib muaj qhov txhab tsis huv uas tuaj yeem cuam tshuam tsis tsuas yog cov txheej tawv nqaij ntawm sab nqaij daim tawv xwb, tab sis kuj yog leeg thiab pob txha.
Kev kho mob ntawm tus mob ntshav qab zib taw nyob hauv tsev, thiab nrog kev pabcuam ntawm cov tshuaj ib txwm muaj, hauv qhov xwm txheej no coj tau cov nyhuv me. Cov kws kho mob txiav txim siab txiav tu ib sab ceg.
Lub hauv paus tseem ceeb ntawm kev txhim kho mob ntshav qab zib taw tau lees paub:
- txo qhov rhiab ntawm qis dua extremities,
- cov ntshav tsis txaus hauv cov hlab ntsha thiab cov hlab ntaws,
- ko taw deformity,
- cov tawv nqaij qhuav txheej.
Cov tsos mob ntawm tus mob ko taw
Hauv cov theem pib ntawm pob taws, ntshav qab zib tsis saib pom kev hloov pauv pathologically. Tab sis sijhawm dhau mus, tib neeg pom muaj cov tsos mob tshwm sim.
Nrog ib qho ischemic variant ntawm mob ntshav qab zib ko taw, muaj qhov ua txhaum ntawm cov ntshav mus rau ceg.
Feem ntau cov neeg nco ntsoov:
- hloov xim hauv daim tawv nqaij ntawm ob txhais ceg,
- tas li o
- qaug zog,
- mob thaum taug kev.
Nrog rau cov neuropathic variant, qee qhov teeb meem tshwm sim ob peb zaug ntau zaus. Hauv hom kab mob no, txoj hlab ntsha hauv qhov chaw nruab nrab ntawm txhais ceg cuam tshuam. Tus mob ntshav qab zib to taub tias qhov mob ruas ntawm ob txhais ceg txo qis, qee zaum txawm tias muaj zog kov txhais ceg yuav tsis hnov. Flatfoot tseem muaj kev txhim kho, cov pob txha ua kom yuag, uas yog fraught nrog lub caij nyoog kho hauv kev tawg.
Hauv cov theem thaum ntxov, muaj cov kab nrib pleb hauv pob taws, ntxiv rau qhov txias. Tus neeg mob ib txwm xav tias nws ob txhais ceg khov. Tom qab ntawd trophic mob rau daim ntawv, thiab yam tsis tau kho tus mob gangrene.
Txij thaum pib mob ntshav qab zib mellitus mus rau qhov pom ntawm ko taw mob ntshav qab zib, siv sijhawm ntau heev tuaj yeem dhau mus. Kev kho pob taws me me yuav tsum tau ua tam sim ntawd tom qab kuaj pom. Yog tias tus mob ntshav qab zib tsis ua raws li kev noj haus thiab kev kho mob, qhov yuav tshwm sim tau los ntawm tus kab mob no tuaj yeem hem nws txoj sia.
Kev mob ko taw yog ib qho teeb meem uas cuam tshuam rau ntau tus neeg mob ntshav qab zib, nws ua yog qhov tseem ceeb uas ua rau txhais ceg txiav tawm yam tsis muaj kev raug mob sab nraud. Thaum cov kab nrib pleb tshwm sim rau ntawm luj taws ntawm cov ntshav qab zib mellitus, qhov xwm txheej tuaj yeem yog qhov txaus ntshai heev.
Kev mob ntshav microvascular yog qhov ua rau tsis muaj ntshav qab zib, uas txhais tau hais tias lub cev tsis muaj peev xwm tiv thaiv cov kab mob.
Cov rwj yuav tsim tau, thiab yog tias tsis kho, nws yuav ua rau mob puas hlwb.
Cov hauv paus ntsiab lus ntawm kev kho mob ntshav qab zib taw
Muaj cov chaw kho mob tshwj xeeb rau kev kho mob mob ko taw ko taw. Cov tub yees muaj peev xwm ua haujlwm hauv chaw kho mob loj. Muaj koj tuaj yeem tau txais cov lus qhia sai sai txog yuav ua li cas kho mob ko taw.
Thaum tsis muaj peev xwm hu tau rau lub chaw haujlwm tshwj xeeb, koj yuav tsum mus ntsib tus kws endocrinologist lossis tus kws phais neeg. Nws yog ib qho tseem ceeb kom ua raws li tag nrho cov lus pom zoo ntawm tus kws kho mob. Yog li, ntxiv kev sib cav ntawm qhov xwm txheej tuaj yeem tiv thaiv tau.
Tus kws kho mob yuav tsum tau sab laj sai li sai tau ntawm ko taw pib tawg lossis lwm yam kev hloov. Rau kev kho mob ntawm ko taw mob ntshav qab zib, siv yeeb siv tshuaj nrog cov kev ua haujlwm antimicrobial uas tsis muaj tanning siv. Ua ntej ntawm tag nrho cov, nws yog:
- Chlorhexidine
- Dioxidine thiab lwm tus.
Thaum nug seb puas muaj iodine lossis dej cawv tuaj yeem siv rau kev kho mob, lo lus teb yuav tsis zoo. Cov khoom lag luam no tuaj yeem ua rau qeeb qeeb vim tias lawv muaj cov neeg ua haujlwm tanning. Kev siv ntawm kev hnav khaub ncaws niaj hnub uas tsis lo rau lub qhov txhab, tsis zoo li cov ntaub qhwv los yog daim ntaub nyias nyias, tau qhia.
Cov qhov txhab yuav tsum tau kho kom tsis tu ncua thiab cov ntaub so ntswg uas tshem tawm. Cov txheej txheem no yuav tsum tau nqa los ntawm kws kho mob lossis kws saib mob nrog ntau zaus ntawm 1 zaug hauv 2-15 hnub. Koj kuj yuav tsum tau tiv thaiv lub qhov txhab thaum qoj ib ce thaum taug kev. Rau cov laj thawj no, ntau yam cuab yeej siv tau:
- ib nrab khau,
- unloading khau raj thiab lwm yam.
Yog tias kev cuam tshuam ntshav ncig los ua ib qho kev xav ntawm qhov tsis xws luag lossis mob, ces cov nyhuv ntawm kev kho mob hauv zos yuav tsawg heev yog tias cov ntshav tsis rov qab los dua. Hauv qhov xwm txheej no, koj tsis tuaj yeem ua yam uas tsis muaj kev phais mob ntawm cov hlab ntsha ntawm ob txhais ceg:
- zais pa angioplasty,
- bypass kev phais.
Kev txiav tawm yog siv nyob rau hauv hais txog 15-20% ntawm tus neeg mob ntshav qab zib ko taw mob. Tab sis, feem ntau, cov kev ua haujlwm no tuaj yeem tiv thaiv yog tias tsim nyog kho pib. Nws yog ib qho tseem ceeb kom ua cov haujlwm tiv thaiv kom tsis txhob mob raphic. Yog tias muaj kev puas tsuaj tshwm sim, tom qab ntawv kho yuav tsum pib sai li sai tau.
Nws yog qhov tsim nyog kom pom ua ntej los ntawm tus kws kho mob endocrinologist txog kev ua haujlwm ntawm lub chaw haujlwm tshwj xeeb ntawm tus mob ntshav qab zib ko taw thiab sab laj hauv lub chaw haujlwm no. Ib qho kev pheej hmoo siab ntawm kev txiav tes txiav:
- Nyob rau hauv rooj plaub thaum osteomyelitis muaj mob ntshav qab zib mellitus - suppuration ntawm cov pob txha nqaij,
- mob rwj ntawm keeb kwm ntawm nqua ischemia - ib qho qhia tau tseeb ntawm cov ntshav ntws mus rau ko taw.
Nrog osteomyelitis, kev kho mob ntawm ko taw mob ntshav qab zib tuaj yeem nqa tawm yam tsis tau txiav tu. Nws yuav tsum noj tshuaj tua kab mob hauv cov tshuaj loj kom ntev txog ob lub hlis, nrog rau kev sib txuas ntawm ntau yam tshuaj. Kev siv ischemia tseem ceeb, cov nyhuv yuav yog los ntawm kev phais mob ib nrab - zais pa angioplasty. Vascular bypass phais kuj tseem yuav raug xaj.
Ntshav qab zib taw tua kab mob yog qhia rau txhua tus neeg mob ntshav qab zib mob ko taw. Tus kws kho mob txiav txim siab:
- Lub sijhawm nkag
- cov tshuaj tiv thaiv zoo
- txoj kev thiab koob tshuaj ntawm kev tswj hwm.
Raws li txoj cai, tshuaj tua kab mob ntawm ob txhais ceg ntshav qab zib muaj feem xyuam nrog kev siv cov tshuaj nrog kev pom dav dav. Ua ntej sau ntawv, koj yuav tsum txiav txim siab qhov rhiab rau tshuaj tua kab mob ntawm cov microbes uas cais tawm ntawm cov ntaub so ntswg cuam tshuam.
Feem ntau, cov neeg mob ntshav qab zib nyiam siv cov tshuaj pleev. Qhov no tsis ncaj ncees lawm, vim tias tshuaj pleev, zoo li cov tshuaj pleev, tuaj yeem tsim qhov chaw zoo rau nce ntau ntawm cov kab mob thiab ua rau tsis tuaj yeem tawm ntawm cov kua dej los ntawm lub qhov txhab. Tshuaj pleev los ntawm mob ko taw tsis yog qhov zoo tshaj plaws kho rau mob ko taw.
Qhov txiaj ntsig zoo tshaj plaws yog muab los ntawm cov kev tawm tshiab tshaj tawm, cov no yog cov ntaub so nrog lub siab nqus thiab cov dej ua haujlwm tiv thaiv kab mob. Collagen sponges kuj tseem siv los sau cov qhov txhab.
Ib qho kev kho tshwj xeeb, nrog rau cov hau kev dav dav ntawm kev kho, ib txwm xaiv los ntawm tus kws kho mob niaj hnub tuaj kawm tom qab kawm txog qee tus yam ntxwv ntawm tus kab mob pathology.
Kev kho hauv zos
Yog tias tsis muaj mob ntawm ko taw mob ko taw, koj yuav tsum sab laj nrog kws kho mob sai. Qhov ua tiav ntawm txoj kev kho yog nyob ntawm kev saib xyuas lub luag haujlwm ntawm cov lus pom zoo ntawm podologist.
Tus neeg mob raug pom zoo:
- ntxuav qhov txhab kom huv
- tiv thaiv cov dej kom tsis txhob nkag mus rau thaj chaw muaj kev puas tsuaj,
- hloov pauv txhua hnub
- siv cov tshuaj pleev thiab lwm yam tshuaj uas koj tus kws kho mob sau,
- Tsis txhob taug kev yam khau
- siv thom khwm rau cov ntshav qab zib;
- qis qoj ib ce.
Kev kho mob rwj hauv zos nrog:
- ntxuav qhov txhab
- ntxuav nrog antiseptics
- daim ntaub qhwv daim ntaub ntawv.
Nws yog qhov zoo tshaj los ntxuav tu lub qhov txhab nrog ib qho taub hau. Ib txoj kev ntxuav kev phais mob tau qhia rau qhov sib cais los ntawm cov kua paug thiab cov kab mob ntawm lub qhov txhab. Rau kev siv zoo dua ntawm kev siv tshuab tu, lub qhov txhab yuav tsum muaj cov nqaij zoo.
Koj tuaj yeem ntxuav lub voos nrog saline. Cov cuab yeej tseem ua tiav tiav nrog 0.9% ntsev tov. Cov kws kho mob qhia kom ntxuav nrog 3% hydrogen peroxide kom tshem tawm cov kua paug thiab cov kab mob anaerobic. Miramistin tsis ua rau poob rau kev tsim dua tshiab, tsis zoo li hydrogen peroxide thiab iodine. Cov nyiaj teev yuav tsum tau siv sib hloov.
Yog tias tus kabmob muaj mob hnyav, yuav tsum muaj kev kho mob phais mob. Hauv qhov no, lub qhov txhab ib txwm npog nrog cov ntaub qhwv uas tsis ua rau raug mob thaum hloov, thiab uas tso cua nkag.
Txog rau hnub tim, cov ntaub ntawv zoo tshaj plaws rau kev hnav khaub ncaws yog cov yeeb yaj kiab semi-permeable uas qhia tau rau qhov tsis muaj mob ntshav siab. Lawv tuaj yeem siv tsis tau ntev. Cov tshuaj pleev xim rau sponges tseem tuaj yeem siv thaum lub sij hawm kho kom zoo yog tias muaj qhov tso tawm me me ntawm exudate.
Feem ntau sau npe rau hydrogels, uas muaj cov txiaj ntsig zoo ntawm cov tawv ncauj tsis qhuav thiab qhia cov nyhuv ntawm ntxuav lub qhov txhab. Lub cuab yeej txhawb kev kho kom zoo uas tsis muaj kev tsim cov ntxiab.
Tsis ntev los no, hydrocolloid coatings tau txais cov muaj koob meej. Cov peev nyiaj no tsis xav tau hloov ntau zaus thiab muaj qhov txawv ntawm cov nqi tus nqi-zoo. Alginates tau zoo kho ntau qhov mob nrog ntau qhov ntawm exudate. Tom qab txheej, nws yog qhov zoo dua los ntxuav lub qhov txhab nrog saline.
Cov kev kho mob hauv zos nrog cov tshuaj hauv zej zog muaj kev siv cov ris tsho hnav nrog roj:
- hiav txwv buckthorn
- sawv duav,
- millet.
Ua ntej thov cov ntaub qhwv, koj yuav tsum ntxuav qhov txhab nrog ointments:
- Iruxol
- Dioxicain-P.
Lawv muaj enzymes protease thiab collagenase. Thaum cov qhov txhab raug mob vim yog cov tshuaj lom, cov tshuaj yuav tsum tau tsim nrog kev ceev faj, vim lawv kuj cuam tshuam cov nqaij zoo.
Nrog purulent mob txhab, uas yog nrog los ntawm kev mob hnyav, qhia cov tshuaj uas muaj iodine thiab polyethylene oxide. Ib qho ntxiv, tus kws kho mob tuaj yeem sau tshuaj tua kab mob xws li:
- Lavasept
- Iodopiron
- Xim av
- Cov roj ntsha.
Kev siv cov nyiaj zoo li no rau ntawm txhais ceg yuav tsum muaj kev soj ntsuam txhua hnub ntawm lub qhov txhab vim muaj kev pheej hmoo ntawm qhov tob tob ntawm lub qhov txhab thaum txhab zoo. Bepanten yog qhov kev kho mob niaj hnub siv los txiav kev txhim kho ntawm cov teeb meem.
Kev siv tshuaj kho kab mob ntshav qab zib siv tau los siv. Kev siv tau zoo ntawm xiav nplooj. Rau nplooj yuav tsum tau nchuav nrog ib khob ntawm dej kub thiab infused rau 2 teev. Nqa 100 ml thaum sawv ntxov thiab yav tsaus ntuj.
Ko taw yuav tau plentifully smeared nrog zib ntab thiab tshiab burdock yog thov nyob rau sab saum toj. Ua ntej siv, tsob nroj yog ncuav nrog dej npau npau. Lub cheeb tsam cuam tshuam yog kho nrog qhov ua kom tsis muaj zog ntawm furatsilina.
Kev kho mob ntawm mob ntshav taw nyob rau hauv tsev tuaj yeem nqa tawm siv tinctures ntawm eucalyptus. On ib tug loj diav ntawm undiluted tincture, koj yuav tsum tau coj tib tus nqi ntawm zib ntab. Ib daim ntaub qhwv hnav khaub ncaws yog tsau rau hauv qhov sib tov thiab thov rau thaj chaw cuam tshuam. Tsis tas li, qhov muaj pes tsawg leeg tuaj yeem siv rau chav dej da dej. Lawv cia koj muag muag pob taws spurs, yog tias koj ua tus da dej tsis tu ncua.
Koj tuaj yeem ua kom yaig ib daim ntaub ntawm cov nqaij mos hauv yogurt lossis kefir thiab txuas mus rau thaj chaw cuam tshuam. Lub siab hloov pauv tam sim ntawd tom qab nws dries. Shredded juniper los yog spruce koob tau ntxiv rau cov khoom siv mis ua kua. Daim vis dis aus hauv tsab xov xwm no yuav qhia koj kom ua dab tsi nrog ib tus mob ntshav qab zib.
