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Traymatismoi spondylikhs sthlhs apo atyxhmata

Osoi anthrwpoi emplekontai se atyxhmata aytokinhtwn syxna den aisthanontai ton pono sthn plath toys mexri thn epomenh hmera. Oi diagnwstikes methodoi gia toys traymatismoys aytoys perilambanoyn:

MRI, CT, kai aktines X.Akomh kai se ena atyxhma me xamhlh taxythta mporei na yparksei traymatismos ths plaths kai ths meshs.

Symfwna me thn diethnh bibliografia:

1) h alhtheia einai oti oles oi morfes odhghshs einai epikindynes. Perissotero apo 80% olwn twn sygkroysewn aytokinhtwn ginontai me taxythtes ligotero apo 70 xiliometra/ ana wra. Moiraia gia thn zwh peristatika poy perilambanoyn kai odhgoys poy den foroysan zwnh, exoyn katagrafei kai me taxythtes xamhloteres apo 30 xiliometra, dhladh me thn taxythta odhghshs mesa se ena parkingk aytokinhtwn.

2) Oi ylikes zhmies sto aytokinhto den einai analoges me tis blabes poy yfistatai h ayxenikh moira toy epibainonta. H epitaxynsh ths kefalhs toy epibainonta eksartatai apo thn dynamh poy metadidetai kata thn sygkroysh sto oxhma, apo thn adraneia kai to pososto aporrofhshs ths metadidomenhs energeias apo to oxhma. H adraneia toy xtyphmenoy oxhmatos sysxetizetai

me to baros kai thn epitaxynsh toy oxhmatos.

3)To atyxhma den einai aparaithto na einai sobaro gia na prokalesei trayma sthn ayxenikh moira (AMSS). Akomh kai ena ksafniko frenarisma otan to fanari ginetai ksafnika kokkino kai o epibaths einai para poly xalaros, einai arketo na prokalesei traymatismo. O ayxenas mporei na metakinhthei pros ta pisw akoma kai xwris shmantikh bia.

To kefali to opoio zygizei pente kila kai isorropei panw sthn ayxenikh moira ths spondylikhs sthlhs, yposthrizomeno apo mono dyo mikres arthrwseis me epifaneies oxi megalyteres apo to nyxi toy antixeira, metakineitai pros ta pisw parasyrontas kai thn thn ayxenikh spondylikh sthlh. Epipleon mia ksafnikh anaklastikh syspash twn kampthrwn mywn toy ayxena, emfanizetai me mia sxetikh kathysterhsh.

Einai eykolo na fantastei kaneis oti traymatismoi twn arthrwsewn den einai oi idioi ean kata th diarkeia mias sygkroyshs h opoioydhpote alloy atyxhmatos, to kefali kateythynetai eite kata thn fora ths sygkroyshs (metadidomenhs dynamhs),h ean to kefali peristrefetai h ean h sygkroysh einai plagia.

4) H thesh toy kefalioy kata thn stigmh ths sygkroyshs ephreazei ton typo ths blabhs.Ayto isxyei idiaitera gia to bathmo peristrofhs se sxesh me thn dieythynsh twn dynamewn kata thn sygkroysh.

Ta spondylika trhmata apo opoy bgainoyn ta neyra twn spondylwn einai eksisoy anoixta otan to kefali koitaei pros ta empros alla steneyoyn apo thn pleyra poy to kefali kanei plagia kampsh h pros thn pleyra peristrofhs toy kefalioy. Gia ton logo ayto se tetoies periptwseis h blabh twn syndesmwn einai akomh megalyterh. Epishs h strofh ths kefalhs kata thn diarkeia ths sygkroyshs ayksanei thn pithanothta sobaroteroy traymatismoy.

An kai kamia sygkekrimenh meleth den einai diathesimh gia thn analysh, kapoioi syggrafeis yposthrizoyn oti sygkroyseis me mikres ylikes zhmies bazoyn ton odhgo se megalytero kindyno traymatismoy.

Ayto symbainei giati h paramorfwsh toy amakswmatos kata thn diarkeia ths sygkroyshs aporrofa ena meros ths energeias poy dhmioyrgeitai apo thn proskroysh.'Opoy yparxoyn liges ylikes zhmies ypotithetai oti kamia dynamh den aporrofhthhke apo to amakswma alla perase sthn kampina twn epibatwn ekthetontas toys etsi sto synolo ths metadidomenhs dynamhs.

Apotelesmata twn sxetikwn meletwn edeiksan oti oi epibates meta thn sygkroysh petaxthkan mprosta me megalyterh taxythta poy einai to apotelesma ths athroishs twn taxythtwn sygkroyshs. Epiprostheta parathrhthhke oti h paramorfwsh ths plaths toy kathismatos san epakoloytho ths anaphdhshs poy prokaleitai, symballei sthn emprosthia wthhsh toy epibath enw oi wmoi metatopizontai pros to kefali. H sxetikh ayth metatopish ths kefalhs se sxesh me toys wmoys poy einai gnwsth ws traymatismos «typoy mastigioy», einai o synhthesteros typos traymatismoy kata thn sygkroysh sto pisw meros toy oxhmatos.

1) Makroxronies meletes deixnoyn oti ponoi xwris emfanh swmatikh blabh epimenoyn se megalo pososto twn asthenwn me traymatismo «typoy mastigioy».

Oi aktinologikes meletes deixnoyn oti ekfylistika problhmata anaptyssontai katopin traymatismoy sto 39% twn asthenwn enanti 6% toy genikoy plhthysmoy

panw apo thn hlikia 30. Kata synepeia oi traymatismoi«typoy mastigioy», prodiathetoyn gia ayxenikh ekfylistikh osteoarthritida.

H osteoarthritida einai mia diadikasia synexhs kai epomenws den mporoyme na anamenoyme mia monimh therapeia symperilambanomenhs kai ths xeiroyrgikhs epembashs.

2) Epipleon yparxoyn makroprothesma apotelesmata meta apo traymatismoys troxaiwn atyxhmatwn, ta opoia ekdhlwnontai xronia meta to atyxhma opws gia paradeigma einai h osteoarthritida kai oi epilhptikes kriseis.

3) ΄Allh morfh blabhs poy einai h dhmioyrgia khlhs mesospondylioy diskoy- mh anastrepsimh blabh- syxna apaitei xeiroyrgikh apokatastash kai mporei na prokalesei symptwmata gia xronia.

O ponos entopizetai ston ayxena, ston wmo, se meros ths wmoplaths kai sto xeri.Aytos o ponos anakoyfizetai me thn ksekoyrash, thn akinhtopoihsh kai thn elksh, epanerxetai omws otan o asthenhs epanadrasthriopoieitai.

4) Ta symptwmata poy prokalei o traymatismos malakwn istwn mporei na epanemfanistoyn sto mellon.

Atyxhmata aytokinhtwn: pws na prostateysete ta dikaiwmata sas protoy na einai «Para poly arga!»

Pws syndeetai h aifnidia emfanish osteoarthritidas me palioys traymatismoys apo atyxhmata aytokinhtwn.

Giati akomh kai oi pio ashmantoi traymatismoi se atyxhmata aytokinhtwn prepei na aksiologoyntai.

Giati ta xorhgoymena gia thn antimetwpish toy ponoy farmaka (antiflegmonwdh) mporei na xeiroterepsoyn epipleon thn katastash sas.

Poia einai h shmasia ths ameshs iatrikhs aksiologhshs twn traymatismwn sas etsi wste na diekdikeite thn pragmatikh apozhmiwsh poy analogei sthn periptwsh sas.

PROEIDOPOIHSH: Oi krymmenoi traymatismoi syndeontai me ypoylh kai aifnidia emfanish symptwmatwn, endexomena kai xronia meta apo to atyxhma.

H agnoia h/kai h elleipsh enhmerwshs prokalei se polla thymata synepeies gia to ypoloipo ths zwhs toys opws: prowrh osteoarthritida (katastrofh twn arthrwsewn poy apaitei xeiroyrgikh antikatastash toys), monimes blabes se mys h syndesmoys, pollapla xeiroyrgeia, klp.

Twra omws yparxei bohtheia diathesimh se sas poy sas efodiazei me to swsto eidos plhroforiwn kai parallhla diasfalizei ta dikaiwmata sas. H anagnwsh ayths ths istoselidas mporei na einai to shmantikotero pragma poy exete kanei. Giati;

Epeidh kapoios apokalyptei thn alhtheia.

Oi plhrofories aytes einai zwtikhs shmasias ean thelete na apofygete ton xronio pono apo thn osteoarthritida h alla problhmata. Einai epishs zwtikhs shmasias ean thelete na apofygete xronies nomikes parenoxlhseis apo alla symballomena merh kai asfalistikes etaireies, poy aforoyn to atyxhma sas.

Thymhtheite oti h ygeia sas genika alla kai h kalh fysikh sas katastash einai apo ta shmantikotera sth zwh sas!

Aimothwrakas

O aimothwrakas einai mia syllogh toy aimatos mesa sth thwrakikh koilothta synhthestera, ayto emfanizetai meta apo trayma. H eswterikh aimorragia apo enan pneymona, mporei na odhghsei se enan aimothwraka. Kathe pneymonas mporei na krathsei 1 ews 2 litra aimatos se ena atomo mesoy baroys . Ayto to problhma apaitei amesh bohtheia.

Ta koina symptwmata perilambanoyn: thwrakiko pono, dyskolia sthn anapnoh, kai shock, ean h sysswreysh toy aimatos sto sththos einai poly megalh.

H aksiologhsh perilambanei mia aktinografia X poy epitrepei th diagnwsh kai thn ektimhsh toy megethoys toy aimothwraka , kai eksetaseis poy tha bohthhsoyn thn ektimhsh ths apwleias aimatos.

H antimetwpish perilambanei th xeiroyrgikh topothethsh enos plastikoy swlhna sto sththos poy tha parameinei sto sththos ews otoy o pneymonas (poy ypodeiknyetai apo thn aktina X) exei apokatastathei eparkws.

Otan h aimorragia den mporei na elegxthei me th bohtheia toy thwrakikoy swlhna, h xeiroyrgikh epembash einai synhthws aparaithth.

Akrwthriasmoi akrwn daktyloy

Oi traymatismoi twn istwn twn akrwn daktylwn einai enas koinos sxetika me thn ergasia traymatismos xeriwn. Opoiadhpote apwleia istoy mporei na exei epiptwseis sto mhkos, th morfh, h/kai th leitoyrgia daktylwn. H diathrhsh ths leitoyrgikothtas einai o yp' arithmon ena stoxos sth diaxeirish aytwn twn traymatismwn

Prosoxh dinetai sth biwsimothta (neyroaggeiakh akeraiothta) opoioydhpote ypoloipoy istoy.

H apofash gia thn peraiterw antimetwpish toy akrwthriasmenoy istoy einai basismenh

•sto bathmo kai th thesh toy traymatismoy,

•ston typo toy traymatismoy,

•sta oria toy akrwthriasmenoy istoy (brwmikoy kai poy syntribetai)

• sthn hlikia,

•Kai th genikh katastash ygeias toy asthenh

Merikoi apo aytoys toys traymatismoys mporoyn na einai

epanorthwsimoi ean h aggeiwsh den exei blafthei sobara.

Enas allos shmantikos paragontas einai h paroysia ektetheimenoy ostoy.

Ean to kokalo(osto) einai spasmeno kai se epafh me ton aera, o kindynos molynshs (osteomyelitida)tha einai megalyteros

Symperasmatika, aytoi oi traymatismoi apaitoyn eidikh xeiroyrgikh antimetwpish kai amesh iatrikh perithalpsh.

Diabrwsh keratoeidoys

Einai metatraymatikh katastash arketa epwdynh me pono erethismo toy matioy, polla dakrya kai alla symptwmata.

To elkos toy keratoeidoys mporei na proerxetai apo erph stafylokokko, erph zwsthra.

Gia na diagnwstei pio eykola yparxei tropos na xrwmatistei h blabh meta apo topikh efarmogh sygkekrimenhs xhmikhs oysias

Diatomes ekteinontwn tenontwn

H kampsh kai h ektash twn daktylwn epitygxanetai me toys kampthres kai toy ekteinontes tenontes (einai ta «kordonia» poy enwnoyn ta osta me toys mys).

Traymatismos twn ekteinontwn odhgei se adynamia ektashs twn daktylwn.

An h blabh ginei sthn perioxh poy ta daxtyla enwnontai me thn palamh h apokatastash einai mono xeiroyrgikh kai sxetika eykolh ,enw an h blabh ginei sta daxtyla h apokatastash einai sobaroterh .

Se merikes periptwseis logw ths sobarothtas toy traymatismoy mporei na parameinei sxetikh dyskampsia, me pithanh epanegxeirhsh.

O pio synhthismenos traymatismos sto xeri legetai sfyrodaktylia kai einai otan dhmioyrgeitai adynamia ektashs toy telikoy tmhmatos toy daktyloy poy einai to nyxi (na kraththei tentwmeno)

Emfanizetai syxnotera se andres meshs kai nearhs hlikias kai mporei na yparxei taytoxrona kai katagma eksarthrhma ths onyxoforoy falaggas ( to tmhma poy exei to nyxi).

Egkaymata

Sthn periptwsh ayth prokaleitai katastrofh toy dermatos kai ofeiletai se fwtia kai se tribh.

Thermikh blabh symbainei panw apo toys 48 bathmoys Kelsioy. To megethos ths blabhs eksartatai apo thn thermokrasia kai thn diarkeia ayths.

H ikanothta toy dermatos gia aytoiash eksartatai apo to bathos toy egkaymatos.

Ta egkaymata aksiologoyntai me th diethnh klimaka BSA opoy to kefali kai ta anw akra antiproswpeyoyn to kathena to 9% toy swmatos, enw ta katw akra kathws kai h empros kai h pisw pleyra toy kormoy to 18%.Telos 1% antiproswpeyoyn to perineo kai oi palames.

To athroisma twn posostwn krinei th therapeia kai kathorizei thn prognwsh.

Ta egkaymata xwrizontai se epifaneiaka kai se merikoy kai olikoy paxoys.

Ta epifaneiaka egkaymata thewroyntai epwdyna, xreiazontai peripoy 10 meres gia apokatastash, to derma asprizei me thn piesh kai symmetexei mono h epidermida.

Ta merikoy paxoys egkaymata - symmetexei h epidermida kai meros toy dermatos - exoyn xrwma roz kai aspro, den asprizoyn otan piezontai, prokaloyn meiwsh ths aisthhtikothtas, xreiazontai 14 peripoy meres gia apokatastash, symbainei merikos apoxrwmatismos toy dermatos,mporei na xreiastei mosxeyma.

Ta olikoy paxoys egkaymata xarakthrizontai apo katastrofh epidermidas kai dermatos, apo apwleia aisthhtikothtas, h perioxh fainetai asprh kai h apokatastash ksekinaei perimetrika toy egkaymatos.

Eksarthrhma krotafognathikhs arthrwshs

Ta eksarthrhmata ayta mporoyn na symboyn meta apo trayma alla akoma kai kata thn mashsh, xasmoyrhto, kai prokaloyn pono, adynamia na kleisei to stoma, adynamia na mashsei kai dyskolia na milhsei.

Apaiteitai anaisthhsia kai kleisth anataksh me liges epiplokes.

Eksarthrhma wmoy

H arthrwsh toy wmoy einai kataskeyastika astathhs kai mono to 1/3 ths kefalhs toy braxionioy einai kalymmeno ,gi ayto kai yparxei peraiterw statherothta apo syndesmoys, mys, thylako poy periballoyn thn arthrwsh kai epitrepoyn parallhla megalo eyros kinhshs.

Mporei na dhmioyrghthei prosthio eksarthrhma (97%) kai opisthio eksarthrhma (3%).Legetai prosthio, giati h kefalh erxetai mprosta apo thn wmoplath kai antistoixa opisthio giati erxetai h kefalh pisw apo thn wmoplath.

To prosthio erxetai sthn thesh toy me eidikoys xeirismoys kai menei se eidikh thesh gia ena mhna .

Prosoxh sto masxaliaio neyro, kai kyriws sto strofiko petalo poy para polles fores diafeygei ths prosoxhs kai odhgei se xeiroyrgikh apokatastash ton traymatia ( to xeri den shkwnetai meta to xroniko orio twn 4 ebdomadwn poy apaitoyntai an htan ena aplo eksarthrhma)

Se ena pososto 15% synyparxei katagma toy meizonos braxionioy ogkwmatos to opoio an exei apomakrynthei apo thn thesh toy perissotero apo 1,5 ekatosto, tote prepei na sygkrateitai xeiroyrgika sth thesh toy

Eswterikh aimorragia

ESWTERIKH AIMORRAGIA (YPOBOLAIMIKO SOK)

Yparxoyn 4 bathmoi poy eksartwntai apo thn apwleia aimatos kai ta symptwmata:

1os bathmos me 15% apwleia aimatos (750ml) me elafra taxykardia.2os bathmos me 15-30 % apwleia aimatos (750-1500ml) me metria taxykardia.3os bathmos me 30-40% apwleia aimatos (1500- 2000 ml me ypotonia kai taxykardia.4os bathmos me 40-50 % apwleia aimatos (2000- 2500 ml)Mporei na symbei meta apo traymatismo diaforwn endokoiliakwn organwn, katagmata megalwn ostwn, aimothwraka, k.a.

Iridodialysh

Einai sobaros traymatismos opoy apospatai h irida apo to aktinwto swma, me apotelesma paramorfwsh toy sxhmatos ths korhs h opoia pairnei sxhma axladioy

Kakwseis agkwna

•EKsWARThRIKA KATAGMATA otan to katagma ekteinetai eksw apo thn arthrwsh

•ENDARThRIKA KATAGMATA otan to katagma ekteinetai mesa sthn arthrwsh

•EKsARThRHMA AGKWNA opisthio (einai to syxnotero) & se prosthio

•KATAGMA WLEKRANOY synhthws «afhnoyn» kapoia dyskampsia

•KATAGMA KEFALHS KERKIDAS

•KATAGMATA DIAFYSHS KERKIDAS &WLENHS synhthws spane kai ta dyo osta mazi ,peripoy sto idio ypsos, otan h bia poy ta prokalese einai amesh h askhthhke ypo gwnia .Otan h ptwsh ginetai epanw sthn palamh me ton agkwna se ektash & sygxronws strofh tote ta dyo osta spazoyn se diaforetiko epipedo

•KATAGMA EKsARThRHMA MONTEGGIA otan synyparxei katagma wlenhs (meso & katw 1/3) me taytoxrono eksarthrhma kefalhs kerkidas

•KATAGMA EKsARThRHMA GALEAZZI otan synyparxei katagma toy katw 1/3 ths kerkidas me taytoxronh rhksh ths katw kerkidwlenikhs syndesmwshs

An h blabh den entopisthei katholoy h egkaira o traymatias odhgeitai se elliph therapeia. kai ayth me thn seira ths se enan faylo kyklo poikilias symptwmatwn arketa epwdynwn poy tha periorisoyn proswrina h monima tis kathhmerines drasthriothtes toy anthrwpoy kai mporei na ton anagkasoyn na tropopoihsei h na allaksei thn ergasia toy monima h proswrina .

An malista den thewreitai o ypeythynos toy atyxhmatos kindyneyei kai na mhn apozhmiwthei gia thn apwleia toy eisodhmatos toy gia twra kai gia to xroniko diasthma poy apaiteitai gia thn plhrh apokatastashs toy ,poy mporei kai na mhn symbei kai pote.

Kakwseis akroy podos

KATAGMA ASTRAGALOY spania men, alla otan syndyazetai me eksarthrhma einai sobaro giati yparxei kindynos ashpths nekrwshs astragaloy.

KATAGMA EKsARTRHMA TARSOY

KATAGMA EKsARThRHMA TARSO-METATARSIWN ARThRWSEWN

KATAGMA METATARSIWN

1.Apospastiko katagma 5oy metatarsioy

2.Katagma ayxena metatarsioy

3.Katagma falaggwn daktylwn

An h blabh den entopisthei katholoy h egkaira o traymatias odhgeitai se elliph therapeia. kai ayth me thn seira ths se enan faylo kyklo poikilias symptwmatwn arketa epwdynwn poy tha periorisoyn proswrina h monima tis kathhmerines drasthriothtes toy anthrwpoy kai mporei na ton anagkasoyn na tropopoihsei h na allaksei thn ergasia toy monima h proswrina .

An malista den thewreitai o ypeythynos toy atyxhmatos kindyneyei kai na mhn apozhmiwthei gia thn apwleia toy eisodhmatos toy gia twra kai gia to xroniko diasthma poy apaiteitai gia thn plhrh apokatastashs toy ,poy mporei kai na mhn symbei kai pote.

Kakwseis akrwmiokleidikhs arthrwshs

Ptwsh epi toy wmoy mporei na prokalesei rhksh twn syndesmwn sthn akrwmiokleidikh arthrwsh, poy fainetai san skalopati katw apo to derma, me pono kai meiwmenh dynatothta kinhshs toy wmoy.

Eykola mpainei sthn thesh ths h kleida alla eksisoy eykola bgainei, me apotelesma tis perissoteres fores na odhgeitai poly argotera gia xeiroyrgikh apokatastash.

Kakwseis ayxena

H ayxenikh spondylikh sthlh arxizei sth bash toy kranioy kai periexei epta spondyloys kai oktw zeygaria ayxenikwn neyrwn armodiwn gia ton elegxo toy laimoy, twn anw akrwn kai toy anwteroy meroys toy swmatos. H kyria enwsh metaksy dyo spondylwn apoteleitai apo mia megalh spoggwdh maza gnwsth san mesospondylio disko (M. D) h apla disko. Oi diskoi mporoyn na aporrofhsoyn tis pros ta katw dynameis poy prokaloyntai apo to baros kai th metakinhsh toy kefalioy.

Oi diskoi apoteloyntai apo mia ekswterikh merida gnwsth ws daktylio kai ena malako kentro gnwsto ws pyrhna. Otan yparxoyn aities traymatismoy h ekfylismoy o pyrhnas ektinassetai mesw toy daktylioy kai prokalei thn khlh toy M. D.

Ean h khlh M. D piezei kapoio neyro mporei na prokalesei neyrologiko problhma sthn ayxenikh spondylikh sthlh poy mporei na einai sobaro kai se merikes periptwseis, na prokalesei thn paralysh. Stis perissoteres periptwseis oi astheneis paraponioyntai gia ton pono ston ayxena poy aktinobolei sto anw akro. To epipedo A5-A6 antiproswpeyei to 90% twn traymatwn se M. D toy ayxena.

Ektos apo khlh M. D se traymatismo toy ayxena mporei na symbainei eksarthrhma spondylwn, katagma spondylwn, plhrhs diatomh toy nwtiaioy myeloy h sympiesh toy N. M apo ena aimatwma.

Kathe etos sthn Eyrwph symbainoyn peripoy 11.500 shmantikoi traymatismoi nwtiaioy myeloy (N.M). Peripoy 6.500 anthrwpoi pethainoyn apo toys traymatismwn toys kai 500 neoi tetraplhgikoi kai paraplhgikoi astheneis dhmioyrgoyntai. Peraiterw exei ypologistei oti 37% olwn twn traymatismwn toy ayxena proerxetai apo troxaia atyxhmata, pososto 26% apo koinwnikh bia, 24% apo ptwseis kai 7% apo athlhtikes drasthriothtes. Shmeiwnetai oti to 50% twn katagmatwn twn spondylwn symbainei sthn ayxenikh moira.

H MRI diadramatizei enan shmantiko rolo stoys astheneis poy einai endexetai na exoyn blabh toy M. D, giati kathorizei to megethos, thn thesh kai thn sobarothta ths khlhs toy M.D.

Merikes meletes edeiksan kathysterhsh sthn diagnwsh ths blabhs toy N. M se pososto 33% kyriws logw aneparkoys ergasthriakhs apeikonistikhs methodoy h kathysterhmenhs proseleyshs toy traymatia sto nosokomeio.

Epomenws estw ki an enas traymatismos dhmioyrgei hpia symptwmata ston ayxena einai aparaithth h egkairh parakoloythhsh kai therapeia.

Kakwseis braxionioy plegmatos

S΄ena troxaio dhmioyrgoyntai synhthws apo emmeso traymatismo opws biaio elkysmo toy braxionioy plegmatos. O bathmos ths blabhs kymainetai metaksy neyrapraksias kai aksonotmhshs.

O mhxanismos ths blabhs mporei na ginei eite me biaih klish ths kefalhs pros to plai me taytoxronh kataspash toy wmoy, opws symbainei me toys motosikletistes poy meta apo mia sygkroysh me megalh taxythta tinazontai kai xtypoyne ston dromo me to plai toy laimoy toys.

Mporei na einai blabh:

1.anwteroy typoy (afora sta neyra A5- A6),

2.katwteroy typoy (afora sta neyra A8 kai Th1),

3.olikh blabh dhladh prosbolh olwn twn stoixeiwn toy plegmatos me apotelesma paralysh olwn twn mywn periferika toy wmoy kai thn anaisthhsia sxedon oloklhroy toy wmoy.

Analoga me to ypsos ths blabhs diakrinoyme kakwseis toy B. P se:

1.Ypokleidies me sxetika kalh prognwsh,

2.Yperkleidies me ligotero kalh prognwsh apo tis ypokleidies, poy xeirotereyoyn oso h blabh einai kontytera ston nwtiaio myelo.

Analoga me to anatomiko meros toy neyroy poy exei ypostei blabh exoyme tis ekshs kathgories:

Neyrapraksia: to neyro diathrei thn synexeia toy kai thn arxitektonikh toy alla sto shmeio ths blabhs diakoptetai h agwgh twn erethismatwn. To apotelesma fainetai klinika giati prokalei kinhtikh paralysh periferika ths blabhs, enw h aisthhsh mporei na yparxei xwris problhma. To neyro meta apo meres h ebdomades apokathistatai aytomata oson afora thn leitoyrgikothta toy.

Aksonotmhsh: oi neyraksones ekfylizontai periferika ths blabhs me apotelesma thn kinhtikh kai aisthhtikh paralysh periferika ths blabhs. ¨Exei kalh prognwsh me apokatastash ena xiliosto thn hmera.

Neyrotmhsh: plhrhs diakoph ths synexeias toy neyroy poy xreiazetai xeiroyrgikh apokatastash.

S΄ena neyro mporei na synyparxoyn diaforetikoi bathmoi blabhs.

Merikes ines na exoyn neyrapraksia, alles aksonotmhsh kai alles na exoyn ypostei alloiwseis poy isodynamoyn me neyrotmhsh.

Kakwseis thwrakikhs kai osfyikhs moiras ths spondylikhs sthlhs

Se sobara atyxhmata panta prepei na elegxetai h spondylikh sthlh akomh ki an den ponaei o traymatias epeidh dhmioyrgoyntai kakwseis. Oi kakwseis aytes prokaloyntai apo kampsh kata thn proskroysh kyriws me thn morfh sympiestikwn katagmatwn.Ta katagmata ayta legontai sympiestika giati sympiezetai h mia pleyra twn spondylwn (mikrainei dhladh to ypsos toys).Se merikes periptwseis sympiestikwn katagmatwn, eidikotera otan h sympiesh (apwleia ypsoys) kseperna to 50% toy ypsoys toys, h paramorfwsh einai megalh kai pithano na aykshthei me thn parodo twn etwn.΄Alloi typoi traymatismwn einai to katagma- eksarthrhma, poy syndeetai tis perissoteres fores apo neyrologikes diataraxes, oi opoies mporei na ftasoyn mexri thn plhrh paraplhgia..Oi pio syxnes kakwseis aytoy toy eidoys, entopizontai sthn thwrakikh osfyikh moira ths spondylikhs sthlhs kai mporei na exoyn kapoies apo tis ekshs morfes: 1.Eksarthrhma xwris neyrologikes diataraxes.

2.Eksarthrhma me atelh paraplhgia,

3.Eksarthrhma me plhrh paraplhgia.

Sthn teleytaia kathgoria poy thewreitai prognwstika baryterh an h katastash den beltiwthei tis dyo prwtes meres, h tetraplhgia thewreitai monimh.An h blabh den entopisthei katholoy h egkaira o traymatias odhgeitai se elliph therapeia. kai ayth me thn seira ths se enan faylo kyklo poikilias symptwmatwn arketa epwdynwn poy tha periorisoyn proswrina h monima tis kathhmerines drasthriothtes toy anthrwpoy kai mporei na ton anagkasoyn na tropopoihsei h na allaksei thn ergasia toy monima h proswrina .

An malista den thewreitai o ypeythynos toy atyxhmatos kindyneyei kai na mhn apozhmiwthei gia thn apwleia toy eisodhmatos toy gia twra kai gia to xroniko diasthma poy apaiteitai gia thn plhrh apokatastashs toy ,poy mporei kai na mhn symbei kai pote

Kakwseis isxioy

Apo embiomhxanikh apopsh oi dynameis poy droyn sto isxio proerxontai apo dyo omades mywn.

H mia omada apoteleitai apo ton lagonopsoith, toys strofeis & toys apagwgoys poy dra epi ta ektos & anaptyssoyn dynameis elkysmoy sthn kefalh toy isxioy .

H deyterh omada apoteleitai apo prosagwgoys kai toys opisthioys mhriaioys poy droyn epi ta entos & anaptyssoyn sympiestikes dynameis sthn kefalh toy isxyoy.

Kata thn sygkroysh to gonato poy synhthws einai se kampsh xtypa sto prosthio tmhma systhma aytokinhtoy kai h dynamh metaferetai dia mesoy toy mhriaioy ostoy sthn arthrwsh twn isxywn.

An to mhriaio osto ekeinh thn stigmh brisketai se prosagwgh tote prokyptei opisthio eksarthrhma, an brisketai se oydeterh thesh tote ginetai katagma kotylhs me eksarthrhma, an brisketai se elafra apagwgh tote kanei eksarthrhma endokotyliko kai telos an brisketai se megalh apagwgh tote kanei prosthio eksarthrhma.

Apo ta parapanw symperainetai oti analoga me ton typo toy traymatismoy, mporei kaneis na symperanei thn thesh poy eixe o epibaths toy oxhmatos kata thn stigmh ths sygkroyshs, an aifnidiasthke h an antedrase grhgora.

Oi traymatismoi sto isxio einai shmantikotatoi kai dystyxws afhnoyn ta ixnh toys me to perasma twn xronwn epeidh ayksanoyn thn emfanish osteoarthritidas, katastashs epwdynhs kai dyskola therapeysimhs.

Synopsizontas o traymatismos toy isxioy mporei na prokalesei:

◦Katagma kefalhs toy mhriaioy, ◦Katagma ayxena toy mhriaioy, ◦Diatroxanthrio katagma, ◦Ypotroxanthrio katagma, ◦Eksarthrhma prosthio, eksarthrhma opisthio to opoio synodeyetai apo endexomeno katagma.

Kakwseis meshs

O ponos ths meshs (osfyalgia) einai ena apo ta synhthestera problhmata (to 25% twn enhlikwn exei antimetwpisei toylaxiston mia krish osfyalgias sthn zwh toy). H spondylikh sthlh apoteleitai apo 3 moires kai 24 spondyloys kathws kai apo ton kokyga kai to iero ostoyn.

H ayxenikh moira (AMSS) apoteleitai apo 7 spondyloys, h thwrakikh (ThMSS) exei 12 spondyloys kai h osfyikh (OMSS) exei 5 spondyloys.

H spondylikh sthlh (S. S) eythygrammizetai apo mys, syndesmoys kai xondroys poy prostateyoyn ton nwtiaio myelo.Anamesa stoys spondyloys einai oi mesospondylioi diskoi (MD) poy epitrepoyn thn kinhsh ths SS kai aporrofoyn tis pieseis.

H osfyalgia mporei na proklhthei apo polloys paragontes opws:

Stresarisma (strain h sprain) symbainei otan oi myes ths meshs diateinontai h kataponoyntai yperbolika. Kathe aifnidiastikh kinhsh mporei na prokalesei blabh stoys syndesmoys, oi opoioi ginontai dyskamptoi h adynamoi.Katagmata spondylwn ta opoia mporoyn na sympiesoyn h kai na synthlipsoyn ton spondylo kai poy mporoyn na proklhthoyn apo troxaia atyxhmata. Khlh mesospondylioy diskoy (KMD) dhladh blabh poy prokalei piesh toy nwtiaioy myeloy kai antanaklastiko pono sta podia.

H orthopedikh ektimhsh sthrizetai se 4 stoixeia:

◦To iatriko istoriko kai ton tropo traymatismoy, ◦Thn klinikh eksetash, ◦Tis ergasthriakes eksetaseis (MRI kai CT), ◦Thn epilogh ths eksatomikeymenhs therapeias.

Kakwseis nwtiaioy myeloy

Kakwseis nwtiaioy myeloy orizontai san mia okseia traymatikh blabh twn neyrikwn stoixeiwn toy nwtiaioy myaloy poy prokalei proswrinh h monimh apwleia aisthhshs, kinhshs h leitoyrgias oyrodoxoy kysths kai enteroy.

Epeidh aytoi oi traymatismoi einai synhthws monimoi, mporoyn na einai katastreptikoi mesa sta oria twn ypshlwn dapanwn ths okseias kai makroprothesmhs apokatastashs. Aytoi mporei epishs na einai synaisthhmatika katastreptikoi kyriws sta neotera atoma, poy einai statistika ta syxnotera thymata sta troxaia atyxhmata.

Traymatismoi toy nwtiaioy myeloy (N. M) apo troxaia atyxhmata antiproswpeyoyn to 53% olwn twn traymatismwn N. M kai to 63% twn traymatismwn toy N. M symbainei se hlikies 15- 44.

Enas traymatismos

Mporeite na me bohthhsete na apozhmiwthw gia to aytokinhto moy;

Giati einai kalytero na kalesete ena iatro- pragmatognwmona troxaiwn atyxhmatwn otan traymatizeste;

Oi prwtes-prwtes hmeres meta apo ena atyxhma einai poly shmantikes ston kathorismo h sthn endexomenh ekbash ths periptwshs sas kai ths apozhmiwshs sas kata thn apopsh mas. Mporoyme na sas poyme ti prepei na ginei gia na megistopoihste th apozhmiwsh sas.

Mporeite na me bohthhsete na kalypsw toys iatrikoys logariasmoys twn traymatismwn moy se aytokinhtistiko atyxhma;

Nai, ta asfalisthria symbolaia atyxhmatos aytokinhtwn epitrepoyn thn plhrwmh twn iatrikwn logariasmwn & twn xamenwn amoibwn apo apwleia eisodhmatos otan apexete apo thn ergasia sas enw anarrwnete apo toys traymatismoys sas.Mporeite na exete to dikaiwma apozhmiwshs sas akoma ki an hsaste epibaths se ena atyxhma aytokinhtwn. Oi asfalistikes diekdikhseis poy mporoyme na kerdisoyme sto dikasthrio einai basismenes sta problhmata ygeias poy dhmioyrghthhkan apo to atyxhma kai sto bathmo poy dyskoleyoyn tis kathhmerines sas drasthriothtes (suffering), kathws epishs kai gia toys logariasmoys poy proekypsan kata th diarkeia ths apokatastashs.

Pws mporei enas iatros- pragmatognwmonas troxaiwn atyxhmatwn na me bohthhsei;

Diathetoyme thn empeiria diapragmateyshs me tis asfalistikes etaireies , kseroyme pws aytes ergazontai kai poioi paragontes einai shmantikoi gia thn apodeiksh kai megistopoihsh ths diekdikhshs sas.

H periptwsh moy einai pragmatika asynhthisth h syntheth. Mporeite na me bohthhsete;

Kanoyme thn aparaithth iatrikh ereyna akomh kai gia tis pio asynhthistes h synthetes periptwseis anadeiknyontas se bathos to megethos toy traymatismoy kathws kai tis ameses kai makroprothesmes synepeies sthn ygeia, poy teloyn se amesh synarthsh me tis diekdikoymenes apozhmiwseis.

Apozhmiwsh apo traymatismoys ayxena se troxaia atyxhmata.

Sygkroysh aytokinhtwn me 10-15 Km mporei na mhn prokalei ylikes zhmies den shmainei omws oti den prokalei traymatismo ston ayxena .

O traymatismos toy ayxena afora :

se osta MONON kata 14%

se malaka moria (oxi osta)86% twn opoiwn h blabh den diagnwsketai me tis aples aktinografies.

Ta apotelesmata traymatismoy toy ayxena (AMSS) prokaloyn apwleia eisodhmatos giati prokaloyn:

200% pithanothta na xeiroyrghthoyn ston ayxena

86% pithanothta na exoyn symptwmata akoma kai 10 xronia meta (poios mporei na fantastei oti yparxei sxesh twn problhmatwn poy aisthanetai me ton traymatismo poy eixe kapote kai malista otan exoyn perasei kai kapoia xronia. )

600% pithanothta anaptykshs ayxenikhs spondylwshs.

1000% h pithanothta na anaptyxthei pathhsh toy mesospondylioy diskoy.

Ola osa anaferame ekdhlwnontai me megalh poikilia symptwmatwn poy xreiazontai eite therapeia synthrhtikh eite therapeia xeiroyrgikh me tis antistoixes epiptwseis

1.Apoxh apo ergasia

2.tropopoihsh ths ergasias h akoma allagh h paysh ayths an xreiastei- poy synhthws prokalei meiwsh toy proteroy eisodhmatos·

3.dapanes gia xeiroyrgikh apokatastash (id.nosokomeio)·

4.dapanes gia fys/peies (kathhmerina, periodika)·

5.dapanes gia orthopedika eidh·

6.dapanes gia farmaka kai apo pithanes parenergeies ths xrhshs toys

7.dapanes gia ergasthriakes eksetaseis·

8.dapanes gia amoibes therapontwn iatrwn

9.dapanes gia synodeia apo deytero atomo an einai aparaithth·

10.dapanes gia metakinhsh ep' amoibh·

11.tropopoihsh ,periorismos h akoma kai katarghsh synhtheiwn (sport,kathhmerines drasthriothtes) me poly pithano apotelesma metabolh toy swmatikoy baroys poy synhthws prokyptei aykshmeno me oles tis pithanes mesomakroprothesmes epiptwseis·

12.pithanes monimes h proswrines metaboles ths psyxikhs sfairas kai h mallon arnhtikh epidrash aytwn sthn epaggelmatikh poreia toy asthenoys.

Ektos apo ta eyrhmata twn klinikwn kai ergasthriakwn eksetasewn thn ekseliksh ths poreias toy asthenoys kathorizoyn kai orismenoi paragontes (prognwstikoi paragontes) poy h paroysia toys «problepei» asxhmh poreia ths apokatastashs toy traymatia kai antistoixa h apoysia toys problepei kalh apokatastash toy .

Stoys paragontes aytoys anhkoyn orismena symptwmata, klinika kai ergasthriaka eyrhmata twn opoiwn h shmasia ws pros thn problepsh ths poreias toy traymatia kathista anagkaia ton endelexh kliniko kai ergasthriako elegxo kathws kai thn leptomerh katagrafh toys ,paragontes poy tha perigrapsoyme se epomeno arthro.

Apozhmiwsh gia toys epibates poy yfistantai traymatismoys:

Prepei:

oi traymaties na kinhthoyn oso to dynaton syntomotera gia na bohthhthoyn me kathe dynato tropo.

O skopos aytoy toy arthroy einai na perigrapsei th diadikasia poy mporeite na akoloythhsete kai na sas dwsoyme ikanopoihtikes odhgies gia na mporesoyme na sas bohthhsoyme.

Oi traymaties prepei na parexoyn sto grafeio mas otidhpote apo ta akoloytha:

1.Oles tis gnwmateyseis nosokomeiwn h giatrwn poy exete sthn katoxh sas poy einai sxetikes me to atyxhma.

2.Fwtografies twn traymatismwn sas( an yparxoyn).

3.Fwtografies ths perioxhs atyxhmatos kai ths theshs twn emplekomenwn oxhmatwn, (an yparxoyn).

4.Opoioysdhpote logariasmoys xrhmatwn apo dapanes poy exoyn prokypsei.

5.Mhn dwsete pote mia ypogegrammenh dhlwsh sthn asfalistikh etaireia twn allwn emplekomenwn sto atyxhma odhgwn.

6.Apofygete opoiadhpote dhlwsh apo to thlefwno giati mporei na xrhsimopoihthei enantion sas sto dikasthrio.

7.Mhn syzhthsete thn periptwsh sas me kanenan ektos apo toys giatroys kai ton dikhgoro sas.

8.Mhn kanete opoiesdhpote dhlwseis h mhn dwsete opoiesdhpote plhrofories.

9.Mhn ypograpste opoiedhpote dhlwseis, ektheseis, morfes h eggrafa opoioydhpote eidoys.

10.Mhn emfanisteite sthn astynomia h se alles akroaseis xwris prwta na synanthsate ton pragmatognwmona giatro kai ton dikhgoro sas.

11.Mhn distazete na milate me ton giatro kai ton dikhgoro sas gia opoiadhpote ypografh h dhlwsh sas zhththei h gia opoiondhpote anazhta plhrofories sxetikes me thn periptwsh sas.

12.Eidopoihste ton pragmatognwmona giatro amesws gia opoiesdhpote nees ekselikseis. Ta mikra pragmata mporoyn na einai shmantika.

13.Diathrhste ta akribh arxeia olwn twn plhroforiwn kai twn stoixeiwn sxetika me esas.

14.Na eiste enhmeroi gia opoiadhpote allagh toy topoy diamonhs twn martyrwn toy atyxhmatos.

15.Krathste hmerologio apo thn mera toy atyxhmatos kai meta. Krathste stoixeia opws ti kanete otan ksypnate to prwi, to prwto pragma poy kanete molis pate sthn doyleia, me poies drasthriothtes asxoleiste meta thn doyleia sas klp. Me liga logia prepei na perigrapsete tis allages poy proekypsan apo to atyxhma sthn kathhmerinothta sas (ergasiako periballon, oikogeneia, drasthriothtes ston eleythero xrono sas klp) kathws kai sthn proswpikothta alla kai sthn emfanish sas. Na thymaste oti shmasia den exei mono o ponos alla kai h dyskolia poy sas dhmioyrgei stis kathhmerines drasthriothtes tis opoies prin to atyxhma kanate me eykolia. Ayto exei ws apotelesma thn dhmioyrgia synaisthhmatikhs diataraxhs poy metadidetai kai sto oikogeneiako, ergasiako kai koinwniko sas periballon.

Krathste hmerologio gia ola ta peristatika poy aforoyn to atyxhma aneksarthta apo ton bathmo dikastikhs aksiopoihshs toys. Kalo tha htan na perilabete shmeiwseis gia thn farmakeytikh sas agwgh, thn therapeia poy kanete, toys narthhkes poy tyxon xrhsimopoihsate, bohthhtikes syskeyes, thn noshleia sas, tis allages twn giatrwn, tis allages sthn therapeia sas, ta symptwmata, thn apokatastash sas, toys epanelegxoys stis iatrikes sas eksetaseis, th proswrinh sas anikanothta tyxon adynamia ekteleshs kathhmerinwn drasthriothtwn.

16.Arxeio dapanwn:Krathste stoixeia poy aforoyn dapanes stis opoies ypoblhthhkate eksaitias toy atyxhmatos sas.

17.Arxeio apodeiktikwn stoixeiwn:

Krathste otidhpote poy perierxetai sthn katoxh sas kai mporei na xrhsimopoihthei ws apodeiktiko stoixeio opws: papoytsia, royxa, gyalia, fwtografies, katestrammeno eksoplismo (kinhto, kamera, fwtografikh mhxanh klp), ksenes oysies poy endexomena epaiksan rolo sto atyxhma sas klp.

18. Fwtografiste ola ta oxhmata poy emplekontai sto atyxhma, thn thesh toy atyxhmatos kathws kai alla stoixeia poy syndeontai amesa h emmesa me to atyxhma.

19.Xamena hmeromisthia

Krathste plhres arxeio gia ola ta hmeromisthia poy xanete. Parte bebaiwsh apo ton ergodoth sas sxetika me ton xrono apoysia sas apo thn ergasia sas, to pososto misthoy poy tyxon pairnete meta to atyxhma, tis kanonikes wres ergasias sas, ton meso oro ths ebdomadiaias h mhniaias amoibhs sas kathws kai opoiesdhpote meiwseis twn apodoxwn sas poy ofeilontai sto atyxhma.

SYMPERASMATA

Kathe diekdikhsh gia apozhmiwsh eksartatai apo tis swmatikes kai psyxikes blabes-akomh kai apo elaxistes, apo thn therapeia poy akoloythhthhke kai kyriws apo tis iatrikes ektheseis poy tha prepei na proerxontai apo pragmatognwmones giatroys wste na einai analytikes kai emperistatwmenes.

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