28 April, 2024
    Mob taub hau, mob ko taw

    Mob Ntshav Qab Zib Yam Yuav Tsum Tau Paub Txog

    Mob ko taw mob ko taw yog pathological mob ntawm ko taw nyob rau hauv cov ntshav qab zib mellitus, uas tshwm sim tiv thaiv keeb kwm yav dhau los ntawm kev puas tsuaj rau peripheral qab haus huv, cov tawv nqaij thiab cov nqaij mos, pob txha thiab pob qij txha thiab yog tshwm sim los ntawm mob hnyav thiab mob, mob pob txha-pob txha hniav thiab cov txheej txheem purulent-necrotic.

    Muaj peb hom mob ntshav qab zib ko taw mob:

    sib xyaw (neuroischemic). 60-70% ntawm cov xwm txheej ntawm kev loj hlob ntawm tus mob ko taw mob ko taw yog daim ntawv neuropathic.

    Neuropathic daim ntawv. Thaum pib, nrog kev txhim kho mob ntshav qab zib neuropathy, cov hlab ntsha distal cuam tshuam, thiab cov leeg ntev tshaj yog cuam tshuam. Raws li kev puas tsuaj rau cov leeg ua cov uas ua rau cov leeg, qhov tsis muaj peev xwm ntawm trophic impulse nthuav dav rau cov leeg, cov leeg, ligaments, pob txha thiab tawv nqaij, uas ua rau lawv cov hypotrophy. Qhov tshwm sim ntawm kev noj zaub mov tsis zoo yog lub cev deformation uas cuam tshuam. Hauv qhov no, lub nra nyob rau hauv ko taw yog rov faib, uas yog nrog los ntawm kev nce siab nyob hauv nws hauv qee thaj chaw. Cov chaw no yuav yog lub taub hau ntawm cov pob txha metatarsal, uas yuav pom los ntawm daim tawv nqaij tuab thiab tsim cov hyperkeratoses hauv cov chaw no. Raws li qhov tseeb ntawm qhov tseeb hais tias cov cheeb tsam ntawm ko taw yauv siab tsis tu ncua, cov ntaub so ntswg mos ntawm cov chaw no tau txais kev tiv thaiv kab mob. Tag nrho cov kev ua no thaum kawg ua rau tsim kom muaj qhov mob peptic. Txij li thaum muaj kev ua txhaum ntawm txoj haujlwm ntawm cov qog ua hws, daim tawv nqaij yuav qhuav, thiab cov kab nrib pleev yooj yim tshwm rau nws. Raws li qhov tshwm sim los ntawm kev ua txhaum ntawm tus mob hom mob mloog tsis tau, tus neeg mob yuav tsis ceeb toom qhov no. Nyob rau yav tom ntej, kev kis kab mob ntawm cov cheeb tsam cuam tshuam tshwm sim, uas ua rau pom qhov ntsej muag. Immunodeficiency tshwm sim los ntawm decompensation ntawm cov ntshav qab zib ua rau lawv tsim. Cov kab mob pathogenic, uas feem ntau kis cov qhov txhab me me, yog staphylococci, streptococci thiab cov kab mob ntawm cov hnyuv pab pawg. Txoj kev loj hlob ntawm daim ntawv neuropathic ntawm lub diabetic ko taw yog nrog los ntawm kev ua txhaum ntawm lub suab nrov ntawm cov hlab ntsha ntawm qhov qis qis thiab qhib ntawm cov leeg ntshav ntawm qhov tso. Qhov no tshwm sim los ntawm kev tsis txaus ntseeg ntawm sab hauv ntawm cov hlab ntsha ntawm adrenergic thiab cholinergic xwm. Raws li kev nthuav dav ntawm cov hlab ntsha ntawm ko taw, nws o thiab kub nce tuaj.

    Vim yog qhib ntawm shunts, nqaij hypoperfusion thiab tub sab tshwm sim. Nyob hauv kev cuam tshuam ntawm edema ntawm ko taw, tej zaum yuav muaj kev nce ntxiv ntawm cov hlab ntsha txoj hlab ntshav thiab ischemia ntawm qhov tsis sib xws ntawm ko taw (ib qho tsos mob ntawm tus ntiv tes xiav).

    Cov chaw kho mob yog tus cwj pwmpeb hom mob txhabCov. Cov no suav nrog neuropathic mob rwj,osteoarthropathy thiab neuropathic edema. Mob nqaij mob feem ntau nyob hauv thaj tsam nkaus xwb, kuj yog rau tej thaj chaw me me. Neuropathic osteoarthropathy kev txhim kho los ntawm osteoporosis, osteolysis thiab hyperostosis, i.e., nyob rau hauv kev cuam tshuam ntawm dystrophic cov txheej txheem nyob rau hauv osteoarticular apparatus ntawm ko taw. Nrog neuropathy, mob nthawv pob txha pob txha tuaj yeem tshwm sim. Hauv qee kis, qhov kev txhuam ntawm no tsis muaj mob. Hauv qhov no, nrog palpation ntawm tus taw, nws o thiab hyperemia tau sau tseg. Kev puas tsuaj nyob rau hauv cov pob txha-ligamentous apparatus tuaj yeem siv sijhawm ntev. Qhov no feem ntau nrog kev tsim cov pob txha tsis zoo, uas yog hu ua Charcot sib koom tes. Neuropathic edema nthuav dav los ntawm qhov tsis txaus ntseeg ntawm lub suab hauv lub nkoj me me ntawm ko taw thiab qhib ntawm shunts.

    Kev kho mob hauvNws suav nrog ntau yam kev ntsuas: ua tiav cov nyiaj them rau mob ntshav qab zib mellitus, kho tshuaj tua kab mob, kho qhov txhab, so thiab thim ko taw ntawm ko taw, tshem tawm ntawm thaj chaw hyperkeratosis thiab hnav cov khau tshwj xeeb.

    Kev them nyiaj ntawm cov txheej txheem metabolic hauv ntshav qab zib yog ua tiav los ntawm ntau qhov tshuaj insulin. Cov kev kho mob ntshav qab zib hom II tau ib ntus.

    Kev kho mob nrog cov tshuaj tua kab mob yog nqa tawm raws li kev pom zoo dav dav. Feem ntau, kev kis kab mob ntawm ko taw yog nqa los ntawm gram-zoo thiab gram-tsis zoo cocci, Escherichia coli, clostridia thiab anaerobic microorganisms. Raws li txoj cai, cov tshuaj tua kab mob ntau los sis kev sib xyaw ua ke ntawm ob peb yam tshuaj yog tshuaj. Qhov no yog vim qhov tseeb tias feem ntau cov kab mob pathogenic tau sib xyaw.

    Lub sijhawm ntawm kev kho mob no tuaj yeem siv mus txog ntau lub hlis, uas tau txiav txim siab los ntawm qhov tob thiab dav dav ntawm cov txheej txheem pathological. Yog tias kev siv tshuaj tua kab mob hauv lub sijhawm ntev, tom qab ntawd nws yog qhov yuav tsum tau rov tshawb fawb txog microbiological, lub hom phiaj uas yog txhawm rau txhawm rau txheeb cov kab mob tshwm sim uas tiv taus cov tshuaj no. Nrog tus mob neuropathic lossis mob ntshav qab zib ko taw, nws yog qhov yuav tsum tau tso nws kom txog thaum rov qab los.

    Nrog cov txheej txheem no, cov mob rau sab hauv tuaj yeem kho tau li ntawm ob peb lub lis piam. Yog tias tus neeg mob ua pob txha lov lossis sib koom tes nrog Charcot, ces yuav tsum tshem tus ceg ntawm lub mus kom txog thaum tus pob txha mob tag.

    Ntxiv nrog rau cov hau kev no, nws yog qhov yuav tsum tau ua hauv kev kho lub qhov txhab ntawm lub qhov txhab, uas suav nrog kev kho mob ntawm lub npoo ntawm qhov txhab, tshem tawm cov nqaij mos necrotic nyob rau hauv kev noj qab haus huv, nrog rau kev ua kom tsis nco qab ntawm lub qhov txhab. Kev daws teeb meem ncaj ncees ntawm dioxidine yog 0.25 - 0.5% lossis 1%. Koj tseem tuaj yeem siv cov tshuaj tov ntawm chlorhexidine. Yog tias muaj cov quav hniav ua ke ntawm fibrin ntawm lub qhov txhab, tom qab ntawd cov tshuaj tiv thaiv kab mob yog siv.

    Ischemic daim ntawv ntawm tus mob cov kab mob ntshav qab zib txhawm rau txhim kho qhov kev ua txhaum ntawm cov ntshav ntws loj hauv cov nqua, uas tshwm sim nrog kev txhim kho ntawm atherosclerotic txhab ntawm cov hlab ntsha.

    Daim tawv nqaij ntawm qhov cuam tshuam yuav siv lub ntsej muag daj lossis cyanotic. Feem ntau tsis tshua muaj tshwm sim, yog los ntawm kev nthuav dav ntawm thaj chaw capillaries, daim tawv nqaij tau txais lub ntsej muag pinkish-liab. Kev nthuav dav ntawm cov hlab ntsha no tshwm sim nrog ischemia.

    Nrog rau kev siv ischemic ntawm lub diabetic ko taw, tawv nqaij yuav txias rau qhov sib chwv. Cov nqaij mob ua npaws ntawm cov lus taw ntawm ntiv taw thiab ntawm ntug pob taws. Ntawm palpation ntawm cov leeg ntawm ko taw, zoo li nyob rau hauv cov hlab ntsha popliteal thiab femoral, cov mem tes ua kom tsis muaj zog lossis yuav tsis tuaj yeem ploj, uas tau sau tseg nrog stenosis ntawm lub nkoj, uas ntau tshaj li 90% ntawm nws lumen. Nrog auscultation ntawm cov hlab ntsha loj, qee kis, systolic yws tau txiav txim siab. Feem ntau, daim ntawv qhia txog ntshav qab zib cov tsos mob ntshav qab zib no yog ua rau pom qhov tsos mob tshwm sim.

    Txoj kev hauv kev cov kev tshawb fawb tau siv los txiav txim xyuas lub xeev ntawm txoj hlab ntshav ntws hauv cov hlab ntsha ntawm qhov qis kawg. Siv cov qauv dopplerography, ib qho kev ntsuas ntawm tus ntaiv-brachial index tau ua. Qhov ntsuas no tau ntsuas los ntawm kev sib piv ntawm systolic lub siab ntawm tus taw leeg thiab txoj leeg.

    Nquag, qhov sib piv no yog 1.0 lossis ntau dua. Nyob rau hauv rooj plaub ntawm atherosclerotic txhab ntawm cov hlab ntsha ntawm qhov qis qis, ib qho kev poob qis hauv qhov ntsuas no mus rau 0.8 raug pom. Yog tias qhov ntsuas yog sib npaug rau 0.5 lossis tsawg dua, tom qab ntawd qhov no qhia qhov muaj feem ntau ntawm kev txhim kho necrosis.

    Ntxiv rau dopplerography, yog tias tsim nyog, angiography ntawm cov hlab ntsha ntawm qhov qis qis, suav tomography, cov duab hluav taws xob rov qab muaj zog, nrog rau kev soj ntsuam ultrasound ntawm cov nkoj no tau ua.

    Ib yam li nrog daim ntawv neuropathic, nws yog ib qho tsim nyog kom ua tiav kev them nyiaj rau ntshav qab zib. Kev puas tsuaj rau sab nraub qis nrog daim foos ntawm cov mob ntshav qab zib no tuaj yeem ua rau mob hnyav heev.

    Qhov loj ntawm cov txheej txheem feem ntau yog txiav txim siab los ntawm peb yam, nrog rau kev mob hnyav ntawm cov hlab ntsha txhaws, qhov kev loj hlob ntawm cov leeg ntshav ntws nyob hauv cov nqua, thiab lub xeev ntawm cov ntshav coagulation system.

    Cov txheej txheem kev kho mob ib txwm, uas tau nyiam dua hauv ischemic daim ntawv ntawm cov mob ntshav qab zib ko taw, yog kev ua haujlwm rov qab. Cov haujlwm no suav nrog: kev tsim ntawm bypass anastomoses thiab thrombendarterectomy.

    Kev phais mob me me kuj tuaj yeem siv, suav nrog laser angioplasty, percutaneous transluminal angioplasty, thiab kev sib xyaw ntawm cov fibrinolysis hauv lub zos nrog percutaneous transluminal angioplasty thiab kev ntshaw thrombectomy. Thaum muaj qhov mob necrotic thiab kiav txhab tsis tuaj, taug kev yog qhov pom zoo, uas siv sijhawm 1-2 teev nyob rau ib hnub, uas ua rau muaj kev tiv thaiv ntawm cov ntshav tawm mus nyob rau hauv nqua (ergotherapy). Rau kev tiv thaiv ntawm thrombosis, kev siv tshuaj aspirin ntawm koob tshuaj 100 mg ib hnub thiab tshuaj anticoagulants raug pom zoo. Yog tias cov ntshav khov ua haujlwm tam sim no, siv cov fibrinolytics. Nyob rau hauv rooj plaub thaum lub purulent-necrotic txheej txheem nrog rau ib qho txawv ntawm qhov uas mob ko taw yog qhov dav heev, cov lus nug ntawm txiav tes ntawm sab caj pas qis tau daws.

    Cov qauv tseem ceeb rau kev tiv thaiv kev txhim kho mob ntshav qab zib ko taw mob siab ntsws yog kev kho mob ntshav qab zib mellitus kom zoo thiab tswj cov nyiaj metabolic them nyob rau qib zoo. Txhua zaus mus ntsib kws kho mob, kev tshuaj ntsuam ntawm cov ceg qis ntawm tus neeg mob yog qhov tsim nyog.

    Xws li kev kuaj yuav tsum tau ua tsawg kawg 1 zaug hauv 6 lub hlis. Nws tseem yog ib qho tseem ceeb los qhia cov neeg mob ntshav qab zib, uas suav nrog cov cai ntawm kev saib xyuas ko taw. Nws yog qhov tsim nyog kom muaj kev huv thiab kev ua kom tus taw ntawm ko taw, coj da dej kom sov so, siv pleev tshuaj tiv thaiv kom tsis txhob ua kom tawg ntawm daim tawv.

    Sau cov npe luv

    DPN - Mob ntshav qab zib polyneuropathy

    DOAP - Kev Mob Ntshav Qab Zib Osteoarthropathy

    DR - Ntshav Qab Zib Retinopathy

    DN - Mob Ntshav Qab Zib

    ZANK - Tus kab mob nqaj ceg qis leeg

    CINC - Tseem Ceeb Tshaj Lij Tshaj Xeeb Ischemia

    LPI - Pob luj taws-ntiv taw

    MRI - Magnetic Resonance Imaging

    MSCT - Multispiral xam tomography

    PPI - ntiv tes ntiv taw-ntiv taw

    Ntshav Qab Zib Mellitus

    T1DM - Hom 1 Ntshav Qab Zib

    T2DM - Hom 2 mob ntshav qab zib

    SDS - Mob Ntshav Qab Zib Mob

    SCF - Glomerular Pom Tus Nqi

    UZDS - Kev Ntsuam Xyuas Duplex Ultrasonic

    CKD - ​​Mob raum

    TSRO2 - Kev Hloov Ntshav Oximetry / Percutaneous Kev Ntsuas Oxygen

    TOD - Kev Kho Mob Tsis Zoo

    HbA1c - Glycated Hemoglobin A1c

    Cov lus thiab cov lus txhais

    Ntshav qab zib polyneuropathy - kev puas tsuaj rau qhov tsis xws luag lub cev muaj feem cuam tshuam nrog cov metabolism metabolism tsis hnov ​​lus.

    Tsoov-lub cev muaj zog neuropathy - kev puas tsuaj rau lub somatic poob siab, nrog los ntawm qhov txo qis hauv ntau yam muaj rhiab, atrophy ntawm cov nqaij ntshiv interosseous, txha pob qij txha thiab cov xeeb ceem ntawm cov taw.

    Autonomic neuropathy - kev swb ntawm qhov muaj lub zog sib faib thiab sib faib nrog txhawm rau txhawm rau lub zog.

    Neuropathic mob rwj - kev ua txhaum ntawm kev ncaj ncees ntawm daim tawv nqaij, txhim kho feem ntau hauv cov chaw uas ntau dhau ntawm kev thauj khoom ntawm ko taw thiab cuam tshuam nrog kev ua txhaum ntawm kev nkag siab tiv thaiv keeb kwm ntawm cov mob ntshav qab zib polyneuropathy.

    Neuro-ischemic mob rau sab hauv - kev ua txhaum ntawm kev ncaj ncees ntawm daim tawv nqaij cuam tshuam nrog kev ua txhaum ntawm lub ntsiab ntawm cov ntshav ncig ntawm cov hlab ntsha ntawm qis dua ntawm qhov keeb kwm ntawm ntshav qab zib polyneuropathy.

    Ischemia - Cov cim thiab cov tsos mob cuam tshuam nrog kev txo qis ntawm cov hlab ntsha cov ntshav, raug kuaj pom thaum kuaj mob thiab / lossis cov khoom siv ntsuas.

    Mob nyav sab lim ischemia - ib qho xwm txheej uas muaj suab tawm txo qis hauv cov ntshav ntws raws cov hlab ntsha tseem ceeb ntawm qis qis, ua rau cov nqaij mos hypoxia thiab hem lawv txoj kev muaj peev xwm.

    Ntshav Qab Zib Osteoarthropathy (neuroarthropathy, Charcot tus taw) yog qhov tsis mob, qhov zuj zus ntawm ib los yog ntau cov pob qij txha ntawm tus taw tiv thaiv cov keeb kwm yav dhau los ntawm neuropathy.

    1.1 Cov Lus Piav Qhia

    Mob Ntshav Qab Zib Tus Kab Mob Ntshav Qab Zib (CDS) txhais tau hais tias yog tus kab mob, mob rwj thiab / lossis kev rhuav tshem cov ntaub so ntswg tob uas cuam tshuam nrog kev mob hlwb thiab / lossis txo cov ntshav txaus hauv cov hlab ntsha ntawm qhov qis qis ntawm qhov mob sib txawv (kev pom zoo ntawm tus kab mob ko taw thoob ntiaj teb Kev Tshawb Nrhiav Cov Mob Ntshav Qab Zib, 2015).

    1.2 Etiology thiab pathogenesis

    Qhov tseem ceeb ua rau mob rwj hauv cov ntshav qab zib yog mob neuropathy, ischemia, thiab kis kab mob. Kev raug mob tiv thaiv keeb kwm yav dhau los ntawm kev hnov ​​mob-lub cev muaj zog neuropathy thiab / lossis kab mob ntawm cov hlab ntsha txhaws, nrog kev ua txhaum ntawm kev ncaj ncees ntawm daim tawv nqaij, nrog kev tsim cov mob sib kis. Hauv cov neeg mob uas muaj mob puas siab puas ntsoog loj heev, qhov tshwm sim ntawm ko taw mob rau thawj zaug yog 5% ib xyoos twg, xya zaus ntau dua li ntawm cov neeg mob ntshav qab zib tsis mob ntshav qab zib (mob ntshav qab zib) (DPN). Kev puas tsuaj rau lub hlwb autonomic ua rau cov tawv nqaij qhuav, tawg ntawm daim tawv nqaij, thaum tsis muaj qhov tseem ceeb txo qis rau cov ntshav ncig, nce ntshav ncig ntawm ko taw vim yog "autosympatectomy". Ko taw yog sov rau qhov kev sib chwv, nrog ploj mus tsis taus yog qhov tsis tshua muaj kev phom sij rau qhov kev pheej hmoo. Ib qho kev txo qis ntawm lub cev muaj zog ua ke nrog kev ua txhaum ntawm proprioception ua rau tsim ntawm thaj chaw ntawm ib sab ko taw nrog lub siab thauj khoom thaum taug kev thiab nyob hauv qhov chaw sawv. Hauv cov chaw no, muaj qhov ua kom ntau ntawm cov kabmob epidermis, kev tsim cov hyperkeratosis, subcutaneous hemorrhage, autolysis ntawm cov nqaij mos thiab tsim kom muaj lub plab peptic. Lwm qhov kev txaus ntshai tshaj plaws etiological nyob rau hauv kev tsim cov mob rwj hauv cov ntshav qab zib yog ZPA, uas ua rau cov nqaij mos ischemia, thiab nyob rau hauv muaj concomitant sensory neuropathy, nws tseem nyob tsis nco qab thiab tsis paub txog. 1, 2, 6, 7.

    1.3 Kab Mob Sib Tw

    Qhov dav dav ntawm cov mob uas kho tsis zoo ntawm cov nqaij mos ntawm qhov qis qis hauv cov neeg mob ntshav qab zib yog li ntawm 4 txog 15% 1, 2, 5, 6, 9, 10, 53Cov. Cov neeg mob uas muaj mob ntshav qab zib trophic ua rau muaj txog 6-10% ntawm tag nrho cov neeg nyob hauv tsev kho mob ntshav qab zib, thiab lawv qhov ntev nyob hauv tsev kho mob yog 60% ntev dua rau cov neeg tsis muaj kev ncaj ncees ntawm daim tawv. SDS yuav yog qhov pom thawj zaug ntawm tus mob ntshav qab zib hom 2, hauv kev sib txuas nrog qhov muaj qhov tsis zoo ntawm lub qhov ncauj ntawm cov neeg tsis paub dab tsi, nws yog qhov tsim nyog los ua qhov kev tshawb fawb rau qhov pom ntawm cov teeb meem ntawm cov metabolism. Qhov tseem ceeb tshaj plaws ntawm qhov yuav tau txais ntawm SDS yog txiav tawm ntawm qhov nqaj qis 24, 32, 34Cov. Cov neeg mob ntshav qab zib mellitus muaj kev pheej hmoo siab thiab tuag taus, sib npaug rau qee hom mob qog noj ntshav, tshwj xeeb tshaj yog rau cov neeg mob tom qab txiav tawm ntawm qhov qis qis thiab kho cov kua raum hloov.

    1.4 Coding raws li ICD-10

    E10.4 - Cov kab mob ntshav qab zib insulin feem ntau nrog cov hlab ntsha hlwb,

    E10.5 - Cov kab mob ntshav qab zib Insulin-tiv thaiv kev mob ntshav qab zib nrog cov hlab plawv mob kom ntau,

    E10.6 - Ntshav qab zib mob ntshav Insulin-mellitus nrog rau lwm cov kev mob tshwm sim,

    E 10.7 - Cov kab mob ntshav qab zib nyob hauv Insulin nrog rau cov kev mob ntau yam,

    E11.4 - Tsis mob ntshav qab zib tsis yog-insulin-mob ntshav qab zib nrog cov leeg hlwb,

    E11.5 - Tsis mob ntshav qab zib uas tsis yog insulin-nrog rau kev mob siab rau cov mob ntshav qab zib,

    E11.6 - Tsis mob ntshav qab zib tsis-insulin-mellitus nrog rau lwm cov kev mob tshwm sim,

    E 11.7 - Tsis mob ntshav qab zib-tsis muaj tshuaj insulin uas muaj ntau yam teebmeem,

    E13.4 - Lwm hom kev qhia txog tus mob ntshav qab zib mellitus nrog cov leeg mob hlwb,

    E13.5 - Lwm cov kab mob ntshav qab zib nrog cov teeb meem ntsig mus rau lub plawv,

    E13.6 - Lwm daim ntawv sau tseg ntawm ntshav qab zib mellitus nrog rau lwm cov kev mob tshwm sim,

    E13.7 - Lwm daim ntawv sau tseg ntawm ntshav qab zib mellitus nrog ntau cov teeb meem,

    E14.4 - Tsis paub meej qhov mob ntshav qab zib mellitus nrog cov leeg mob hlwb,

    E14.5 - Tsis pom qhov mob ntshav qab zib mellitus nrog peripheral circulatory ntshawv siab,

    E14.6 - Tsis pom qhov mob ntshav qab zib mellitus nrog rau lwm cov kev mob tshwm sim,

    E14.7 - Cov mob ntshav qab zib tsis tau tso cai uas muaj ntau yam mob.

    1.5 Kev faib tawm

    Nws raug nquahu kom siv cov kev faib tawm ntawm ko taw mob ntshav qab zib mellitus uas ua tau raws li cov hauv qab no: siv tau yooj yim, uas ua rau nws muaj peev xwm sib txawv hom mob, raws li cov ntaub ntawv los ntawm kev ntsuas lub hom phiaj ntawm tus neeg mob, rov yug dua.

    Nyob rau tam sim no, ntau ntawm kev faib tawm ntawm tus kab mob ntshav qab zib mob ko taw tau npaj siab, uas yog ua raws li cov tswv yim hais txog cov kab mob tseem ceeb ntawm kev txhim kho cov kab mob ntshav qab zib no, suav txog qhov mob hnyav ntawm kev puas tsuaj rau peripheral lub paj hlwb, peripheral arterial txaj, kev soj ntsuam ntawm qhov loj me ntawm lub qhov txhab tsis zoo thiab qhov loj ntawm cov txheej txheem kis mob.

    Cov kev faib tawm uas tau thov los ntawm Kev Tshawb Fawb Ntshav Qab Zib Kev Tshawb Fawb thiab tau pom zoo los ntawm Kev Pom Zoo rau Cov Mob Ntshav Qab Zib ntawm 2015 yog ua raws li kev nkag siab ntawm lub pathogenesis ntawm kev mob ko taw tsis zoo nyob rau hauv ntshav qab zib mellitus. Raws li nws, cov ntawv hauv qab no cov kab mob ntshav qab zib hauv ko taw yog qhov txawv:

    • Neuropathic daim ntawv ntawm SDS
    • Ischemic daim ntawv ntawm VDS
    • Daim ntawv neuroischemic

    Raws li qhov tob ntawm qhov mob txhab, qhov txhab tawm tau muab faib ua 5 qib (Wagner kev faib tawm):

    0 degree - khov tawv ntawm daim tawv nqaij
    Kuv kawm ntawv - lub rwj tiag tiag (cov txheej txheem ntes cov epidermis, dermis)
    II degree - cov txheej txheem sib kis tau ua rau cov tawv nqaij, nqaij mos, nqaij mus
    III degree - mob ncauj plab, txhab qog, osteomyelitis, mob caj dab txha nqaj qaum
    IV degree - qhuav / ntub dej txhaws laus: necrosis ntawm txhua cov tawv nqaij txheej ntawm txhua tus neeg ntawm tus ko taw (piv txwv li, ib feem ntawm tus ntiv tes / ntiv tes)
    V degree - qhuav / ntub dej cawv ntawm qhov chaw ntawm ko taw / tag nrho ko taw

    Qee qhov ntawm SDS kev faib tawm uas siv nyob rau hauv kev kho mob niaj hnub coj mus rau hauv tus account ob peb yam ntxwv ua cim xeeb tsis taus.

    Kev faib tawm University of Texas (TU) yog ua raws cov kev ntsuas ntawm qhov tob ntawm lub plab peptic (qib), kev sib kis ntawm tus kab mob, qhov muaj thiab qhov hnyav ntawm txo qis ntshav txaus (theem), (cov lus 1).

    Cov lus tsis. 1. Kev faib tawm cov mob viav vias mob rau hauv SDS ntawm University of Texas

    Qib muaj

    0

    Kuv

    II

    III

    Ua ntej - lossis tom qab mob txhab txhab nyob rau theem ntawm tiav epithelization

    Kev kho lub cev tsis muaj qhov cuam tshuam ntawm pob tw pob zeb, tshuaj ntsiav ntawm pob qij txha lossis pob txha

    Cov qhov txhab, cov leeg zoo siab lossis pob qij txha

    Cov qhov txhab uas muaj cov pob txha lossis pob qij txha

    Ua ntej lossis tom qab mob txhab txhab nyob rau theem ntawm ua tiav epithelization nrog cov cim qhia ntawm kev kis mob

    Kev txhab dag tshwj xeeb uas tsis muaj kev koom tes ntawm pob txha, tsiav tshuaj ntawm pob qij txha lossis pob txha nrog cov cim ntawm kev kis kab mob

    Cov qhov txhab uas muaj cov leeg nqaij lossis tshuaj pob ntawm pob qij txha nrog cov cim mob

    Cov qhov txhab uas muaj feem nrog cov pob txha lossis pob qij txha nrog cov paib qhia

    Ua ntej lossis tom qab mob txhab txhab nyob rau theem ntawm kev ua tiav epithelization tiv thaiv keeb kwm ntawm nqaj ischemia

    Kev kho lub cev uas tsis muaj qhov cuam tshuam nrog cov pob qij txha, tsiav tshuaj ntawm pob qij txha lossis pob txha nyob rau tom qab ntawm nqaj ischemia

    Cov qhov txhab, qhov zoo siab rov qab ua pob txha lossis tshuaj ntsiav ntawm cov pob qij txha tawm tsam keeb kwm ntawm nqaj ischemia

    Cov qhov txhab uas muaj cov pob txha lossis pob qij txha tiv thaiv kom txhob sab ischemia

    Ua ntej lossis tom qab mob txhab txhab nyob rau theem ntawm tiav epithelization tiv thaiv keeb kwm ntawm nqaj ischemia nrog cov cim qhia ntawm tus kab mob

    Kev kho lub cev uas tsis muaj qhov cuam tshuam nrog cov pob qij txha, tsiav tshuaj ntawm pob qij txha lossis pob txha ntawm keeb kwm ntawm nqaj ischemia nrog cov cim ntawm kev kis tus kab mob

    Cov qhov txhab, qhov zoo siab tendons lossis tshuaj ntsiav ntawm pob qij txha tawm tsam keeb kwm ntawm nqaj ischemia nrog cov cim ntawm kev kis mob

    Cov qhov txhab uas muaj cov pob txha lossis pob qij txha tiv thaiv kom tsis txhob mob ischemia nrog cov tsos mob ntawm tus mob

    PEDIS kev faib tawm (Perfusion, Extent, Qhov tob, Kab mob, Hnov qhov muag), npaj siab xyoo 2003. thiab kho nyob rau xyoo 2011, siv mus rau hauv qhov kev txiav txim siab tsis yog qhov tob tshaj plaws ntawm cov nqaij mos ua rau muaj kev puas tsuaj (zoo li tau ua dhau los ntawm kev faib tawm ua ntej), tab sis kuj tseem nyob rau lub xeev ntawm cov ntshav ntws, sab hauv, thiab qhov mob hnyav ntawm cov txheej txheem kis (cov lus 2). Nws siv qhia cov ncauj lus kom ntxaws txog kev swb ntawm cov kws kho mob ntawm ntau qhov tshwj xeeb koom nrog kev kho mob rau tus neeg mob ntshav qab zib mob ko taw ntawm ntau theem (phais mob thiab endocrinological tsev kho mob, chaw kho mob).

    Kem No. 2. Kev faib tawm ntawm PEDIS ulcerative tsis xws luag.

    Perfusion - perfusion

    Tsis muaj cov cim ntawm PPS nyob rau hauv qhov cuam tshuam (1). Hauv qhov no:

    mem ntawm lub plantar thiab posial tibial leeg leeg palpates

    -TsRO 2 (4)> 60 mmHg

    Muaj cov cim qhia ntawm PPP hauv qhov cuam tshuam (1), tab sis tsis muaj ischemia tseem ceeb.

    - txhawj xeeb txog kev sib cav tsis sib haum

    - PLI (2) (3) 30 mmHg

    - TSRO 2 (4) 30-60 mmHg

    - lwm qhov kev hloov pauv ntawm cov kev ntsuam xyuas uas tsis muaj kev coj ua

    Mob tseem ceeb ischemia ntawm Cuam tshuam, uas suav nrog cov tsos mob li nram no:

    - systolic pob luj taws siab siab 2 (4) 2 (ntsuas tom qab pib kho los ntawm ib qho ntug ntawm daim tawv nqaij mus rau lwm qhov)

    Dthib rau lub qhov tob

    Pob txuv ua kom lub cev puas

    Lub voos mob tob ua rau lub dermis thiab subcutaneous cov qauv, suav nrog fascia, leeg thiab leeg

    Kev mob ncauj plab ua rau lub dermis, txheej txheem qis, pob txha thiab / lossis pob qij txha

    Kuvkev mob nkees

    Tsis muaj cov cim ntawm tus kab mob

    Cov txheej txheem kis tau mob rau cov tawv nqaij thiab cov nqaij mos (uas tsis muaj cov qauv sib sib zog nqus thiab tsis muaj cov cim ntawm kev ua tiav ntawm cov txheej txheem). Tsawg kawg 2 qhov ntawm cov tsos mob hauv qab no yuav tsum muaj:

    - hauv zos edema lossis induction

    erythema nyob ib ncig ntawm qhov mob> 0.5-2 cm

    - cov nqaij hauv zos nruj lossis mob

    - qhov ntsuas kub nyob hauv zos

    Erythema> 2 cm ua ke nrog cov paib ntsig txog II art. lossis cov txheej txheem sib kis tau txuas ntxiv tob dua li ntawm daim tawv nqaij thiab cov nqaij mos subcutaneous, piv txwv li, mob qog, txha, mob caj dab, mob txhaws tsis muaj qhov cim ntawm kev ua tiav.

    cov txheej txheem ntawm txhais ko taw nrog muaj qhov tsis sib luag ntawm cov txheej txheem:

    lub cev kub> 38 0 C

    - lub plawv dhia (5)> 90 yeej ib min.

    - NPV (6)> 20 toj.

    10% lub hlwb tsis paub qab hau

    Qhakom paub - rhiab

    Poob ntawm kev tiv thaiv rhiab ntawm cov cuam tshuam, txhais raws li

    - qhov tsis muaj qhov xav tias tau chwv 10 g ntawm monofilament hauv 2 ntawm 3 qhov kev kawm tshawb xyuas (raws li tau piav qhia hauv cov lus qhia siv ntawm Daim Ntawv Pom Zoo ntawm Kev Cog Lus Ntawm Cov Mob Ntshav Qab Zib),

    - qhov uas tsis muaj kev co tshee ntawm lub ntiv tes xoo thaum soj ntsuam nrog tuning rab rawg nrog zaus ntawm 128 Hz lossis kev co rhiab ntawm qhov tsis txaus ntawm tus ntiv tes xoo> 25 V thaum kuaj nrog biotheziometer (ib nrab qauv ntawm cov qauv)

    (1) PPS - mob ntawm lub cev viav vias

    (2) PLI - pob qij txha lub hauv pob taw (siab leeg ntshav ntawm txoj kev kawm txoj leeg / leeg ntshav ntawm txoj leeg ntshav)

    (3) PPI - brachio-ntiv tes taw qhia (cov leeg ntshav ntawm txoj hlab ntshav ntawm tus ntiv tes xoo / txoj hlab ntshav ntawm txoj leeg qhwv brachial)

    (4) TSRO2 - transcutaneous pa nro

    (5) Lub plawv dhia - lub plawv dhia

    (6) NPV tus pa ua pa

    WIFI kev faib tawm (Cov qhov txhab, Ischemia, ko taw kis tus kab mob) nthuav tawm hauv cov ntxhuav yuav siv mus rau hauv qhov tob ntawm lub qhov txhab, lub xeev ntawm kev tso ntshav tawm thiab qhov loj ntawm cov txheej txheem kis (rooj 3).

    Rooj No. 3. WIFI Kev Tso Cai

    Cov chaw txhaj tshuaj ntawm qhov kis mob

    Qib (mob heev)

    Tsis muaj cov tsos mob lossis tsos mob ntawm tus kab mob.

    Muaj ib tus mob yog tias 2 ntawm cov tsos mob tau sau tseg:

    • lub zos edema lossis infiltration
    • erythema> 0.5 txog 2 2 cm puag ncig lub qhov txhab
    • hauv zos nro lossis qhov mob
    • hauv zos hyperthermia
    • purulent tawm

    Kev kis mob hauv zos nrog hyperemia> 2 cm lossis koom nrog cov qauv tob dua li daim tawv nqaij thiab cov nqaij mos subcutaneous (mob qog nqaij hlav, osteomyelitis, mob septic mob caj dab, fasciitis).

    Tsis muaj cov kab ke ntawm tag kis

    2 (Nruab nrab)

    Kev kis kab mob hauv zos nrog cov cim qhia tias muaj mob (muaj ob ntawm cov tsos mob lossis ntau dua)

    • lub cev kub> 380? C lossis 90 bpm
    • BH> 20 ib min. lossis RASO2 12,000 lossis 6 ib ntawm cov nqaij mos lossis kuaj pom ntawm? -Hemolytic streptococcus (qib ntawm cov pov thawj 1B). Kev txheeb xyuas qhov tseeb ntawm tus neeg sawv cev ntawm kev tiv thaiv cov mob txhab yog nqa los ntawm kev kuaj cov kab mob ntawm cov khoom siv los ntawm lub qhov txhab. Cov ntaub ntawv rau kev tshawb fawb tuaj yeem muab tau los ntawm kev siv qoj ib ce los yog kho cov hauv qab ntawm lub qhov txhab. Cov ncauj lus tsawg dua yog kev kawm txog cov qhov txhab los yog raug pleev los ntawm kev ntxuav ua ntej thiab ntxuav nrog ntxuav cov kua qab ntsev hauv qab ntawm lub qhov txhab.

    % 11 2.4.2. Kev txheeb xyuas cov kev mob ntshav ntawm cov ntshav txaus (macroangiopathy ntawm qis qis)

    • Nws raug nquahu kom kuaj pom nqaj ischemia siv ultrasound dopplerography (Doppler ultrasound) nrog kev txiav txim siab ntawm pob taws-brachial index (LPI), uas ib txwm dhau 0.9. LPI> 1.3 qhia tias nruj ntawm phab ntsa arterial. 47, 48, 49, 50

    Qhov pom zoo hauv chav kawm I (qib pov thawj A)

    • Nws raug nquahu kom paub meej lub xeev ntawm txoj hlab ntshav txaus nyob rau hauv cov neeg mob nrog ABI> 1.2 los ntawm kev ntsuas ntshav siab hauv cov xaim digital (tus nqi ntawm cov ntiv tes-brachial index, IPI) lossis cov ntaub ntawv transcutaneous oximetry (TcpO2> 40 mmHg). 47, 48, 49, 50

    Qhov pom zoo hauv chav kawm I (qib pov thawj A)

    • Nws raug nquahu kom siv transcutaneous oximetry los tawm tsam qhov tsis zoo ntawm nqaj ischemia hauv cov neeg mob ntshav qab zib.

    Cov lus pom zoo hauv chav kawm I (qib pov thawj B)

    Cov lus:Transcutaneous oximetry ua rau nws muaj peev xwm ntsuas qhov hnyav ntawm nqaj ischemia nyob rau hauv cov neeg mob uas muaj cov tsos mob ntawm tus mob SAD, kev kwv yees ntawm qhov txhab kho kom zoo, kev ua tau zoo ntawm kev saib xyuas kev kho mob thiab kho kom tau txiaj ntsig, thiab kev txiav txim siab txog qib uas txiav pov tseg. Ultrasonic duplex kev soj ntsuam ntawm cov hlab ntsha tuaj yeem qhia txog txoj kev ua pa ntawm txoj kev mob ntawm cov leeg, qhia txog nws qhov chaw ntawm lub cev thiab qhov twg.

    • Nws raug nquahu kom kuaj mob qis dua ischemia raws li tsawg kawg ib ntawm cov tsos mob hauv qab no:

    1) tas li ischemic mob ntawm so, yuav tsum tau tso tshuaj pleev ib ce mus ntev dua ob lub lis piam,

    2) qhov tshwm sim ntawm qhov txhab lossis mob qog ntawm tus ntiv tes lossis taw ntawm tus keeb kwm yav dhau los ntawm systolic siab hauv cov hlab ntsha tibial? 50 mmHg los yog ntiv tes nias? 30 mmHg

    Cov tswv yim hauv chav kawm I (qib pov thawj A) 11%

    2.4.3. Kev kuaj mob ntawm pob txha puas

    • Kev xoo hluav taws xob hauv ko taw thiab pob taws pob qij txha hauv ob qhov kev kwv yees pom zoo rau txhua tus neeg mob uas mob ko taw mob ko taw. 9, 10, 38, 45

    Cov lus pom zoo hauv chav kawm I (qib pov thawj B)

    Cov lus:Qhov kev xoo hluav taws xob tseem yog txoj hauv kev tseem ceeb rau kev ntsuam xyuas qhov mob ntawm cov pob txha thiab pob qij txha, cia kom paub foci ntawm osteolysis (osteomyelitis) nrog kev ntseeg siab.

    • MSCT ntawm tus taw thiab pob taws yog pom zoo rau cov neeg mob uas tsis muaj qhov txhab kom zoo mus ntev thiab ntshav qab zib osteoarthropathy. 9, 10, 38, 45

    Cov lus pom zoo hauv chav kawm I (qib pov thawj B)

    Cov lus:Multispiral xam tomography tso cai rau koj kom paub meej txog hauv cheeb tsam thiab loj me ntawm osteomyelitis ua kom pom tseeb thaum npaj qhov ntim ntawm kev phais mob.

    4. Kev Rov Kho Dua

    • Yuav tsum tau sab laj kev sab laj ntawm orthopedist ntawm txhua tus neeg mob uas mob ko taw mob ko taw tom qab kho qhov txhab tsis zoo. 9, 10, 43, 53

    Cov lus pom zoo hauv chav kawm I (qib pov thawj B)

    Cov lus:Txhawm rau tiv thaiv kom tsis txhob rov ua mob rau cov neeg mob ntshav qab zib tom qab kho qhov txhab, tus neeg mob yuav tsum tau kuaj los ntawm orthopedist kom xaiv ib tus neeg orthopedic pab (kho khau, RPI, tsim khoom ntawm txaws lossis orthosis, kho tus neeg orthopedic khau).

    • Nws raug nquahu kom cov neeg mob thiab lawv tsev neeg tau kawm txog kev ua haujlwm ntawm kev saib xyuas ko taw, thiab nyob rau ntawm qhov muaj qhov txhab tsis zoo, nyob rau hauv txoj cai kev hloov pauv kev hnav khaub ncaws thiab tu tawv nqaij rau cov ceg tawv. 15, 35, 47

    Cov lus pom zoo hauv chav kawm I (qib pov thawj B)

    Cov lus:Ib qho kev mob uas tsim nyog rau kev tiv thaiv ntawm kev rov ua dua ntawm cov mob rau qhov ncauj thiab ua rau muaj kev txiav caj dab hauv cov neeg mob uas muaj ko taw mob ntshav qab zib yog xav kom txuas ntxiv mus thiab muaj ntau txoj hauv kev nyob rau hauv kev saib xyuas mus sij hawm ntev ntawm cov neeg mob no.

    Lub luag haujlwm tiv thaiv yog ua si los ntawm kev cob qhia ib leeg ntawm cov neeg mob uas muaj qhov txhab tsis zoo thiab / lossis kev pheej hmoo siab ntawm lawv txoj kev loj hlob, ntxiv rau (yog tias tsim nyog) lawv cov txheeb ze thiab cov phooj ywg, cov cai ntawm kev saib xyuas ko taw (qib ntawm cov pov thawj 2C). Lub hom phiaj ntawm kev kawm yog los tsim kho tus cwj pwm kom raug ntawm tus neeg mob nyob rau hauv kev saib xyuas ko taw txhua hnub thiab nce siab ntxiv rau cov kev kho mob uas kws kho mob tau hais tseg. Tshwj xeeb yuav tsum tau them rau cov neeg muaj hnub nyoog laus dua, tshwj xeeb cov uas tsis pom kev. Raws li txoj cai, lawv tsis tuaj yeem saib xyuas lawv ko taw ntawm lawv tus kheej thiab xav tau kev pabcuam sab nraud.

    Nws yuav tsum nco ntsoov tias cov neeg mob ntawm txhua lub hnub nyoog nrog trophic mob rau cov qis qis tsis raug rau kev cob qhia hauv pawg. Cov chav kawm nrog lawv yog tuav nkaus ntawm tus kheej.

    • Kev coj tsis tu ncua ntawm cov khau tshwj xeeb orthopedic rau cov neeg mob ntshav qab zib tau pom zoo rau txhua tus neeg mob uas muaj qhov pheej hmoo ntawm kev txhim kho trophic mob rwj (qhov tseem ceeb ntawm txoj hlab ntshav tsis txaus, mob ntawm cov leeg ntshav hnyav, ko taw mob thiab txiav tawm nyob rau hauv anamnesis), thiab rau cov neeg mob uas tau txiav tawm hauv ko taw, cov khau tsis muaj zog. 9, 10, 17, 27, 53

    Cov lus pom zoo hauv chav kawm I (qib pov thawj B)

    Cov lus:Qhov qhia tau rau kev teem caij ntawm cov khau orthopedic ua ke yog cov theem mob ntev ntawm cov ntshav qab zib txhaws, txiav tawm ntawm cov ntim hnyav txaus (forefoot, ob peb tus ntiv tes). Cov kev txaus ntawm cov khau tsim orthopedic yuav tsum tau soj ntsuam tsis tu ncua los ntawm cov kws kho mob koom nrog (kws kho mob endocrinologist, kws phais neeg, kws tshaj lij ntawm cov kws kho mob ko taw) thiab hloov tsawg kawg 1 zaug hauv ib xyoos.

    5. Kev tiv thaiv thiab rov qab soj qab

    Qhov ntau zaus ntawm kev rov ua dua ntawm qhov mob ntawm qhov qis qis yog txo los ntawm kev soj ntsuam txhua hnub ntawm tus taw los ntawm tus neeg mob (lossis nws tus txheeb ze), ua raws li cov cai ntawm kev saib xyuas ko taw. Lub luag haujlwm tseem ceeb yog ua si los ntawm cov txheej txheem ntawm kev saib xyuas kev txawj ntse, uas yuav tsum tau nqa tawm los ntawm tus kws saib xyuas mob tshwj xeeb hauv chav diabetic ko taw.

    • Cov npe hauv qab no ntawm kev tiv thaiv kev tiv thaiv yog pom zoo:
    1. Kev txheeb xyuas ntawm cov neeg mob uas muaj kev pheej hmoo siab mob caj dab,
    2. kev tshuaj xyuas thiab kev tshuaj xyuas tas li ntawm cov neeg mob uas muaj kev pheej hmoo siab ntawm plab,
    3. kev cob qhia cov neeg mob, lawv tsev neeg thiab cov neeg ua haujlwm kho mob rau cov kev cai ntawm kev saib xyuas ko taw,
    4. kev xaiv lossis kev tsim cov khau tsim nyog,

    kev kho mob ntawm kab mob concomitant pathology, uas tsis yog ua kom ncaj ncaj rau qhov tsis txaus ntseeg, tab sis ua rau muaj kev vam meej ntawm SDS (piv txwv li, tswj kev mob ntshav siab, dyslipidemia). 1, 2, 15, 16, 53

    Cov lus pom zoo hauv chav kawm I (qib pov thawj B)

    • Kev tshuaj ntsuam xyuas ntawm txhua tus neeg mob ntshav qab zib raug pom zoo kom ncav sij hawm los kuaj xyuas tus mob cov ntshav sib txuam thiab sab hauv. Qhov kev pheej hmoo siab tshaj plaws ntawm kev txhim kho mob mob txhawm rau qis dua ntawm qhov qis qis yog nyob hauv cov neeg mob uas muaj keeb kwm ntawm qhov mob thiab txiav tawm (tshwj xeeb yog hauv qab taw).

    Cov lus pom zoo hauv chav kawm I (qib pov thawj B)

    Cov lus:Raws li cov txiaj ntsig ntawm kev tshuaj ntsuam, tus neeg mob tuaj yeem raug tso rau ib hom kev pheej hmoo. Nyeg, qhov degree (lossis qeb) ntawm qhov txheeb xyuas pom yuav qhia pom qhov muaj txiaj ntsig zoo ntawm kev mus ntsib (cov lus 5).

    Rooj ntawv 5. Kev ntau ntau ntawm kev mus ntsib rau qhov chaw ua haujlwm ntawm tus mob ko taw, nyob ntawm cov qib phom sij rau kev tsim SDS

    muaj kev ua txhaum ntawm rhiab

    1 lub sijhawm hauv 6 lub hlis

    muaj qhov ua txhaum ntawm kev rhiab siab hauv kev sib xyaw ua ke nrog cov cim ntawm kev ua txhaum ntawm cov ntshav ntws loj thiab / lossis deformities

    1 lub sijhawm hauv 3 lub hlis

    keeb kwm ntawm mob rwj thiab txiav taws ib ce

    1. txhua 1-3 lub hlis

    6. Cov ntaub ntawv ntxiv cuam tshuam rau chav thiab qhov tshwm sim ntawm tus kabmob

    Ntshav osteoarthropathy, xaus

    6.1.1. Kev Piav Txhais

    Ntshav osteoarthropathy (DOAP), neuroarthropathy lossis Charcot txhais ko taw - tsis mob, qhov kev rhuav tshem ntawm ib lossis ntau pob qij txha ntawm ko taw tiv thaiv keeb kwm ntawm neuropathy. Raws li qhov tshwm sim ntawm demyelination ntawm lub cev muaj zog, cov tsis muaj zog ntawm txoj kev ua ligamentous ntawm tus taw tsim, ua rau muaj kev sib koom ua ke tsis khov. Autonomic neuropathy ua rau kev tsis lees paub ntawm cov vascular phab ntsa thiab, vim li ntawd, kev txhim kho ntawm cov hlab ntsha txhaws thiab, vim li ntawd, ntshav nce ntxiv, uas ua rau kev ua kom mob pob txha resorption thiab txha. Lub pob txha poob tsis zoo xwb, tab sis kuj elasticity, uas ua rau lub cev pob txha ntawm ko taw tsis kam tiv thaiv kev raug mob. Raws li txoj cai, qhov tshwm sim ntawm DAP yog kev raug mob me me tsis raug pom los ntawm tus neeg mob. Insignificant sab nraud quab yuam ua rau pob txha lov, subluxations thiab dislocations ntawm pob qij txha. Qhov xwm txheej yog exacerbated los ntawm tsis muaj kev tiv thaiv mob rhiab heev. Tus neeg mob tseem vam khom rau lub cev tsis zoo, uas ua rau kom muaj kev koom tes nrog cov pob txha tshiab thiab pob qij txha hauv cov txheej txheem. Osteochondral fragmentation thiab kev cuam tshuam loj heev ntawm cov pob qij txha. Thaum muaj mob hnyav, txhais ko taw yuav plam tag nrho nws txoj haujlwm kev pabcuam, uas tej zaum yuav tsum txiav tu plaub ntug. Ntxiv rau qhov kev raug mob, txhua qhov txheej txheem nyob rau hauv osteoarticular apparatus ntawm tus taw (piv txwv li, qhov ncauj ntawm qhov txhab ntev ntev uas muaj teeb meem los ntawm osteomyelitis ntawm pob txha hauv qab) uas tshwm sim tiv thaiv keeb kwm yav dhau los ntawm neuropathy tuaj yeem ua rau txhim kho DAP vim muaj ntshav nce ntxiv thaum lub sijhawm o.

    6.1.2 Ethiology thiab pathogenesis

    6.1.3. Phaum Npaum

    6.1.4. ICD Encoding - 10

    6.1.5. Kev faib tawm

    Hauv kev soj ntsuam daim duab ntawm Charcot txhais ko taw, mob hnyav thiab mob txhaws muaj qhov txawv txav. Mob theem tsiag ntawv los ntawm kev cia siab ntawm cov txheej txheem inflammatory hauv teb rau cov kev puas tsuaj uas twb muaj lawm

    Qhov kev tsis txaus siab ib txwm muaj nyob hauv qib mob ceev ntawm qhov mob tshwm sim yog qhov pom ntawm edema ntawm ib qho ntawm ko taw. Qee zaum, thaum nug, nws muaj peev xwm taug qab qhov sib txheeb ntawm qhov pom ntawm ko taw thiab qhov ceeb ntawm sab nraud, tab sis ntau tus neeg mob tsis tuaj yeem hais tias dab tsi ua ntej ntawm tsos mob edema.

    Ntawm kev txheeb xyuas, edema thiab hyperthermia ntawm tus ceg cuam tshuam yog qhia. Hyperthermia yog ib qho cim ntawm kev ua haujlwm txuas ntxiv thiab mob tshwm sim. Raws li txoj cai, lub ntsuas kub hauv zos ntawm cov ceg ntoo cuam tshuam yog 2-5 ° C siab dua qhov ua kom tau. Deformation ntawm lub taw yog txiav txim siab los ntawm qhov chaw thiab sijhawm ntawm txheej txheem. Yog li, thaum ntxov, tsis hais txog qhov chaw ntawm qhov chaw txhab, mob me ntsis ntawm ko taw thiab hyperthermia raug kuaj. Kev ua kom tsis xwm ntawm ko taw thiab cov yam ntxwv radiographic pauv, raws li txoj cai, tsis yog. Qhov tsim nyog ntawm qhov no yuav yog qhov ua txhaum lossis ncua hauv kev kho, uas yuav ua rau deformation ntawm ko taw.

    Cov lus No. 8. Kev faib tawm neuroostearthropathy raws li chaw kho mob, cov duab MRI / MSCT (E.A. Shantelau, G. Crutzner, 2014).

    Cov mob hnyav tsawv (edema, hauv zos hyperthermia, qee zaum mob, nce kev pheej hmoo ntawm kev poob plig thaum taug kev), tsis muaj suab nrov deformities.

    Individual: o ntawm cov leeg pob txha thiab cov nqaij mos, tsis muaj kev ua txhaum ntawm cortical txheej.

    Tau: subchondral trabecular microcracks, kev puas tsuaj rau ligaments.

    Kev mob hnyav (mob edema, mob hyperthermia hauv zos, qee zaum mob, ua rau muaj kev pheej hmoo ntawm kev mob thaum taug kev), deformation nyhav

    Individual: fractures nrog kev ua txhaum ntawm tus cortical txheej, pob txha pob txha o thiab / los yog nqaij mos ua rau lub cev qhuav.

    Tau: osteoarthritis, hlwv, pob txha mos puas, osteochondrosis, mob pob txha, mob pob txha, nyob hauv cov pob qij txha, pob txha yaig / necrosis, pob txha lysis, kev puas tsuaj thiab tawg ntawm pob txha, dislocation / subluxation ntawm pob qij txha, ligament puas tsuaj, mob pob txha, mob pob txha, mob pob txha.

    Tsis muaj cov cim ntawm o, tsis muaj deformation

    Tsis muaj kev hloov lossis hloov pob txha pob txha me me, pob txha txha nqaj qaum, pob txha pob txha, txha osteoarthrosis, pob txha puas.

    Tsis muaj qhov mob, tsis tu ncua ntev deformation, ankylosis

    Lub cev pob txha txha caj qaum, txhaws pob txha, mob pob txha, mob pob txha, mob pob txha, mob pob txha thiab txhaws pob txha, mob pob txha pob txha, txha pob txha pob txha pob txha pob txha pob txha pob txha pob txha pob txha pob txha pob txha pob txha pob txha pob txha pob txha pob txha pob txha pob txha pob txha mos.

    6.2 Kev kuaj mob

    6.2.3 Kev tsis txaus siab thiab keeb kwm kev kho mob

    • Nws raug nquahu tias kev kuaj mob ntawm DAP raug tsim tawm los ntawm cov chaw kuaj mob thiab kho cov khoom siv.

    Qhov pom zoo hauv chav kawm I (qib pov thawj A)1,48,49

    Cov lus:Kev kuaj mob ntawm DAPA yog tsim los ntawm cov keeb kwm ntawm tus xeeb ceem, cov lus tsis txaus siab thiab cov duab hauv chaw kuaj mob (hyperthermia, deformation, o ntawm cov ceg cuam tshuam), qhov tshwm sim ntawm cov twj paj nruag thiab kev tshawb nrhiav. Feem ntau, kev kuaj pom yog ncaj ncaj.

    6.2.4 Kuaj kev

    Tam sim no tsis tau muaj cov cim tshwj xeeb txog pob txha metabolism thiab kuaj ntshav kuaj mob txha tshwj xeeb rau mob txha txha caj qaum.

    6.2.5 Instrumental txoj kev

    • Kev xoo hluav taws xob ntawm ko taw thiab pob taws yog pom zoo rau txhua tus neeg mob uas xav tias ADA.

    Qhov pom zoo hauv chav kawm I (qib pov thawj A)9, 10, 38, 45

    • MRI ntawm ko taw thiab pob taws sib koom tes yog pom zoo rau kev kuaj mob ntawm tus mob ntu ntawm cov mob ntshav qab zib osteoarthropathy.

    Cov lus pom zoo hauv chav kawm I (qib pov thawj B)9, 10, 38, 45

    Cov lus:Cov qauv tseem ceeb ntawm cov khoom siv kuaj mob ntawm Charcot tus taw yog duab hluav taws xob. Hauv qhov xwm txheej no, hypertrophic lossis atrophic hloov uas tshwm sim hauv kev teb rau kev puas tsuaj tau cuam tshuam ntawm duab hluav taws xob. Feem ntau, rau kev kuaj pom tus mob nyob ntev ntawm DOAP, lwm txoj kev kuaj twj paj nruag tsis tas yuav tsum ua. Cov teeb meem tseem ceeb tshwm sim hauv kev kuaj mob ntawm theem mob nyav, thaum, nyob rau ntawm qhov muaj cov duab hauv chaw kuaj mob tshwj xeeb, tsis muaj kev hloov pauv hauv radiographic, zoo li hauv kev kuaj mob txawv ntawm Charcot txhais ko taw thiab osteomyelitis. Hauv qhov no, tshwj xeeb yuav tsum tau them rau qhov tseeb tias qhov tsis muaj hloov ntawm lub xov tooj hluav taws xob thaum muaj kev soj ntsuam daim duab (edema, hyperthermia, ko taw deformity) tsis txhais tau tias tsis muaj neuroosteoarthropathy.

    Qhov tsis sib xws ntawm cov duab hauv chaw soj ntsuam thiab duab hluav taws xob tau pom nyob rau thaum ntxov ntawm kev txhim kho ntawm cov kev mob tsis tshua meej heev ("theem pib", "theem 0"). Thaum muaj qhov xwm txheej zoo li no, ua tib zoo khaws keeb kwm kev kho mob, kev soj ntsuam kab mob nrog cov kev soj ntsuam cov neurological thiab kev ntsuas cov ntshav ntws tseem ceeb yuav pab tau siab ntau ntawm qhov tshwm sim rau kev kuaj mob Charcot tus taw.

    • Cov nqaj hlau resonance imaging (MRI) ntawm lub taw tau pom zoo rau cov kabke ntawm neuroosteoarthropathy.

    Cov lus pom zoo ntawm qib II (qib pov thawj B)9, 10, 38, 45

    6.2.3 Lwm yam kev kuaj mob

    • Nws raug nquahu kom ua fistulography thiab / lossis multispiral xam tomography thaum lub sijhawm kuaj mob txawv ntawm DAPA thiab osteomyelitis.

    Cov lus pom zoo ntawm qib II (qib pov thawj B)9, 10, 38, 45

    Cov lus:Hauv qhov pom ntawm osteoarthropathy nrog mob pob txha, nws yog qhov yuav tsum tau ua qhov kev mob txawv txav ntawm qhov mob siab ntawm ntu ntawm Charcot txhais ko taw thiab osteomyelitis. Nov yog qhov tseem ceeb ntawm kev muab tshuaj kho kom haum rau kev noj tshuaj thiab xaiv cov kev kho kom zoo. Rau kev kuaj mob tshawb nrhiav, cov hau kev soj ntsuam ntxiv (fistulography, multispiral xam qhov tomography) tau qhia. Kev sib xyaw ntawm positron emission tomography thiab compose tomography (PET / CT) ua rau nws muaj peev xwm txheeb xyuas nrog qhov tseeb ntawm cov kev ua hauv cheeb tsam ntawm cov txheej txheem thaum ntxov, los saib xyuas cov theem ntawm kev txhim kho thiab kom muaj nuj nqis ntawm cov kev ua haujlwm ntawm cov txheej txheem los tswj cov kev vam meej ntawm cov kev cuam tshuam.

    6.3 Kev Kho Mob

    6.3.1. Kev txuag tshwj tseg

    • Nws raug nquahu tias cov ceg tawv cuam tshuam yuav tsum tau siv ib tus neeg hnav khaub ncaws tsis sib haum (IRP, TSS) lossis orthosis rau txhua tus neeg mob uas muaj theem ntawm DOAP.

    Cov lus pom zoo hauv chav kawm I (qib pov thawj B)3, 27, 46

    Cov lus:Qhov nyuaj ntawm cov txheej txheem tshuaj rau DOAP yog txiav txim siab los ntawm theem ntawm kev tsis txaus siab. Lub hom phiaj tseem ceeb ntawm kev kho mob hauv ntse theem ntawm tus txheej txheem yog kom nres qhov kev vam meej ntawm cov txheej txheem kev ua haujlwm hauv osteoarticular apparatus ntawm ko taw, tiv thaiv kev txhim kho ntawm ntxiv kev deformation thiab kev mob ntawm ko taw. Yuav kom ua tiav lub hom phiaj no, cov hau kev ntawm kev thauj khoom ntau tshaj plaws ntawm qhov teeb meem cuam tshuam tau thov - siv ntawm ib tus neeg hnav khaub ncaws (IRP) lossis siv cov cuab yeej orthopedic apparatus (orthosis). Limb immobilization yuav tsum tau pib thaum ntxov li sai tau. Nyob rau ntawm lub xub ntiag ntawm cov duab saib mob sib haum rau cov mob huam ntawm Charcot tus taw (edema, hyperthermia ntawm ko taw) thiab qhov tsis muaj cov lus qhia (cov duab xoo hluav taws xob tsis zoo, qhov tsis muaj peev xwm ntawm MRI), cov kev kho mob yuav tsum yog tib yam li tau tsim los kuaj mob osteoarthropathy.

    Tus txheeb ze sib kis rau qhov kev txiav txim tsis xaiv IRP txoj kev xaiv rau Charcot tus taw yog qhov muaj qhov mob rwj uas yuav tsum tau saib xyuas txhua hnub thiab hloov cov hnav khaub ncaws. Qhov tseeb tsis pom zoo rau kev thov IRP (ob qho tib si tshem tawm thiab tshem tawm kev xaiv) yog qhov muaj cov txheej txheem purulent-ua kev puas tsuaj uas xav tau txoj kev kho mob uas yuav tsum tau ua.

    • Nws raug nquahu kom siv IRP ua ntej qhov kev hloov pauv ntawm tus mob ntu ntawm neuroosteoarthropathy rau tus mob mus ntev. Qhov nruab nrab, lub sijhawm ntawm immobilization yog 4-8 lub hlis. Lub sijhawm no nyob ntawm qhov chaw thiab qhov dav ntawm txheej txheem.

    Cov lus pom zoo ntawm qib II (qib pov thawj B)3, 27,28 46

    Tam sim no, tsis muaj pov thawj txaus ntseeg txog kev ua haujlwm ntawm kev siv tshuaj rau kev kho mob neuroostearthropathy (bisphosphonates, calcitonin). Tsis tas li ntawd, bisphosphonates yog contraindicated nyob rau hauv rooj plaub ntawm tsis muaj zog nitrogen excretory muaj nuj nqi ntawm lub raum, uas feem ntau pom nyob rau hauv cov neeg mob uas muaj lub sij hawm ntev thiab tsis zoo tswj ntshav qab zib.

    • Kev coj tsis tu tas li ntawm cov khau orthopedic tsis zoo yog pom zoo rau txhua tus neeg mob uas mob ua ntu zus ntawm DAP.

    Cov lus pom zoo ntawm qib II (qib pov thawj B)

    Cov lus:Lub hom phiaj ntawm kev kho mob thiab kho cov kev ntsuas nyob rau theem cov nyom (qib mob ntev) yog los tiv thaiv kev ua kom raug mob ntawm ko taw, pob txha tawg tshiab thiab qhov tsim ntawm plantar ulcerative tsis xws luag. Nyob rau theem no, tsis tas yuav tsum muaj qhov siab mus ib txhis ntawm kev vias. Tom qab tshem tawm ntawm IRP, kev nthuav dav zuj zus ntawm lub cev muaj zog yog kev pom zoo. Raws li kev nruab nrab ntawm kev txhim kho thiab tshem tawm ntawm ko taw, koj tuaj yeem siv IRP tshem tawm tsis yog rau tag nrho ib hnub, nrog rau kev siv orthopedic. Ntawm qhov tseem ceeb hauv theem ua ntu ntev yog xaiv khau. Qhov xav tau ntawm nkawm khau yog nyob ntawm seb hom mob thiab qhov txawv txav ntawm lub ko taw. Yog hais tias deformation ntawm ko taw tsawg heev, nws txaus txaus los hnav tas li tiv thaiv khau rau cov neeg mob ntshav qab zib. Yog hais tias kev tshaj tawm ntawm ko taw lossis lub cev tsis zoo ntawm cov hom "ko taw-pob zeb" tau tsim, ces kev sib tham orthopedic thiab kev tsim cov khau orthopedic uas tsim nyog.

    6.3.2 Kev phais mob

    • Kev sab laj ntawm tus kws phais neeg mob pob qij txha tau raug pom zoo rau txhua tus neeg mob uas muaj ceg tsis zoo ntawm lub cev vim DAP los daws qhov teebmeem ntawm kev kho mob kom zoo.

    Chav kawm ntawm cov lus pom zoo II (qib pov thawj C)29.

    Cov lus:Tsis ntev los no, kev tsim kho dua tshiab ntawm tus ntoo Charcot tau ua ntau dav. Lub ntsiab tseem ceeb rau kev phais mob ntawm ko taw yog qhov tsis muaj txiaj ntsig ntawm kev txuag txoj kev kho mob, uas tau pom los ntawm kev rov ua dua tshiab ntawm tsob ntoo ulcerative tsis xws luag thiab / lossis qhov tsis muaj peev xwm ua kom muaj kev ruaj ntseg ntawm ko taw thaum taug kev. Kev phais mob yuav tsum tau hais meej rau txoj haujlwm. Yog tias tsis muaj kev nyab xeeb nyob rau hauv pob taws lossis lwm yam pob qij txha, arthrodesis yog siv nrog kev txhav sab hauv. Thaum rov mob rov zoo li qub, qhov ua mob exostectomy, ua raws li kev phais mob ntawm lub qhov txhab. Yog tias qhov mob peptic ua rau mob nyuaj siab los ntawm osteomyelitis, kev siv tshuaj tua kab mob, kev tso ntshav tawm, thiab kev phais mob ntawm lub qhov txhab raug mob. Heev ntau zaus, ua kom luv luv ntawm Achilles leeg yog qhia, uas ua rau kev deformation ntxiv ntawm ko taw thiab nce ntxiv ntawm lub nra hnyav rau ntawm lub caj npab. Cov neeg mob zoo li no tau pom muaj kev phais kom ua kom ntev li cov leeg Achilles leeg.

    Kev kho mob hauv lub sijhawm tom qab kawg yog ua tiav nrog kev tswj hwm ntawm tus neeg mob nrog kev mob hnyav ntawm Charcot tus taw: kev tsis ua haujlwm, suav nrog kev tsim ua ntawm IRP, dosed nthuav dav ntawm lub cev muaj zog tom qab kev kho kom zoo.

    Mob ntshav taw ua dab tsi

    Yog tias koj, tus koj hlub hnov ​​tus mob "diabete", tsis txhob poob siab. Nrog rau tus kab mob no, tib neeg nyob rau ntau xyoo thiab ntau caum xyoo. Tab sis koj yuav tsum ua raws txhua tus kws kho mob pom zoo, tswj cov piam thaj hauv ntshav, saib xyuas koj kev noj qab haus huv zoo. Thiab, qhov tseeb, koj yuav tsum tsis txhob "faus koj lub taub hau hauv cov xuab zeb": yog tias koj saib ntawm kev muaj tiag nrog lub hom phiaj, saib qhov tseem ceeb, koj yuav muaj peev xwm nkag siab txog dab tsi tos koj. Nco ntsoov cov lus hais tias: “Tus uas raug cim cia yog riam phom”?

    Kev mob ntshav qab zib - txoj kev mob ntawm ko taw hauv cov neeg mob ntshav qab zib, uas tau npau taws los ntawm kev hloov pauv ntawm cov hlab ntsha hauv cov hlab ntsha, cov hlab ntsha, nrog rau ntau qhov chaw mob (los ntawm kev mob raum, purulent necrotic cov txheej txheem thiab xaus nrog pob txha-articular deformities) ntawm cov tawv nqaij ua ke, pob qij txha, thiab pob txha. Cov lus txhais ntawm tus kabmob tau muab rau xyoo 1987 ntawm WHO Geneva Symposium.


    Nws yog ib qho tseem ceeb kom nco ntsoov tias qhov kev pheej hmoo ntawm cov teeb meem tsis yog txiav txim siab los ntawm hom mob ntshav qab zib, tab sis los ntawm nws lub sijhawm. Raws li WHO hais, kwv yees li kaum tsib feem pua ​​ntawm cov neeg mob ntshav qab zib nrog “kev paub” ntawm tsib xyoos kev SDS. Yog tias "kev paub" yog li ntawm 15-20 xyoo, tom qab ntawd nws yuav luag tsis yooj yim uas yuav zam rau qhov kev tsis txaus ntseeg no - 90% ntawm cov neeg mob nrhiav pom phlegmon, mob rau sab hauv thiab mob qog ntawm lawv ko taw.

    Cov ua kom muaj tus mob

    Yog tias koj tau ntsib qhov teeb meem loj heev xws li mob ntshav qab zib ko taw, qhov ua rau cov kev tsis txaus ntseeg yuav tsum txheeb xyuas kom sai li sai tau. Tsuas yog los ntawm kev tshem tawm lawv, koj tuaj yeem cia siab tias tus kabmob tuaj yeem tawm tsam (lossis tsawg kawg ua rau nws txoj haujlwm), thiab kev puas tsuaj rau daim tawv nqaij ntawm ob txhais ceg tuaj yeem raug tshem tawm.

    Raws li twb tau hais los lawm, kev puas tsuaj ntawm ko taw nyob hauv ntshav qab zib yog qhov tshwm sim ntau. Ntau yam laj thawj tuaj yeem tsim txoj hauv kev tsim teeb meem:

    • autonomic thiab peripheral sensory neuropathy (mob ntshav qab zib feem ntau raug kev txom nyem los ntawm qhov mob no),
    • mob caj dab ntev tsis txaus ntawm cov ceg, uas feem ntau nrog atherosclerosis,
    • deformation ntawm taw,
    • ntau yam kev raug mob ceg
    • keeb kwm ntawm kev txiav tes txiav thiab / lossis mob txhab,
    • vim li cas kev xav-kev mob hlwb (kev pheej hmoo - cov neeg mob laus)
    • teej tug mus rau ib co haiv neeg,
    • tsis xis, khaus khau,
    • ntev "kev paub" mob ntshav qab zib.

    Tus yam ntxwv hnyav rau ntawm cov txheej txheem ntawm kev txhim kho kabmob muaj:

    • peripheral neuropathy,
    • qhov txhab ntawm cov hlab ntshav ntawm ob txhais ceg ntawm tus neeg mob,
    • sib kis mob thib ob
    • osteoarthropathy (mob txhab ntxiv) nyob rau tom qab ntawm kev puas tsuaj rau cov leeg me.

    Nyob ntawm seb yam kev mob twg ua rau muaj VDS, ntau yam kev hloov ntawm cov leeg ko taw tshwm sim. Nws yog qhov xwm txheej no ua ke nrog lwm tus (kev hloov thiab qhov sib txawv ntawm cov ntaub so ntswg) uas txiav txim siab xaiv cov txheej txheem kev kho mob, tib neeg tus cwj pwm ntxiv.

    Hom Mob Ntshav Qab Zib

    Nco ntsoov tias kev faib tawm ntawm kev puas tsuaj ntawm ko taw hauv cov tshuaj niaj hnub yog sawv cev los ntawm ntau hom (raws li cov tswv yim ntawm lub ntiaj teb kev kho mob hauv zej zog):

    • ischemic daim ntawv, cim tau los ntawm kev ua txhaum ntawm cov ntshav hauv cov hlab ntsha ntawm ob txhais ceg,
    • neuropathic (ob leeg nrog osteoarthropathy thiab tsis muaj nws) daim ntawv. Yuav cuam tshuam cov leeg nqaij hauv cov pob txha los sis cais,
    • neuro-ischemic (ua ke ntawm cov paib ntawm ob daim ntawv no).

    Ua ntej yuav muab tshuaj kho, tus kws kho mob yuav tsum txiav txim siab hauv daim ntawv - rau qhov no, kev tshuaj xyuas tau ua thiab kev kuaj mob raug kuaj.

    Muaj ntxiv kev faib tawm uas tsim nyog rau kws kho mob los txiav txim siab kho qhov kev kho mob:

    • kev hloov tawm hauv pawg, ntsuas cov kev pheej hmoo ntawm mob txhab, xav tau txiav npluav,
    • cov txheej txheem mob ntshav qab zib mob rau hauv lub cev, noj mus rau qib siab thiab qib mob plab peptic.

    Ua ntej tshaj, cov paib sab nraud ntawm tus kab mob ntshav qab zib tau raug kuaj pom, tom qab ntawd tus kab mob ntshav qab zib tau xa mus rau MRS lossis X-ray ntawm ko taw txhawm rau txhawm rau txhawm rau hloov kev hloov hauv cov nqaij hauv, pob txha Yog tias tus neeg mob muaj mob rau ntawm nws ob txhais taw, tus kws kho mob tshwj xeeb yuav hno thiab xa nws mus rau qhov chaw kuaj ntshav kom txiav txim siab hom kab mob thiab sau tshuaj tua kab mob kom zoo.

    Tom ntej, cov theem raug txiav txim siab raws li Wagner kev faib tawm (txij ntawm xoom txog tsib), thiab kev kho yog raug txiav txim.

    Mob taw ruam ntshav qab zib

    Kev puas tsuaj rau tus taw hauv ntshav qab zib yog qhov nyom uas tuaj yeem hloov sai heev. Qhov teeb meem tseem nyob hauv qhov tseeb uas qee zaum taw yuav poob lawv qhov kev hnov ​​mob (hnov mob neuropathy) - koj yuav tsum kuaj xyuas ko taw txhua hnub: yog tias koj pom thawj qhov kev hloov pauv, tam sim ntawd hu rau kws kho mob lossis kws kho mob menyuam yaus.

    Nyob ntawm qhov ntsuas qib, theem, cov kws tshaj lij muaj ntau yam txheej txheem kho thiab phais mob. Nws yog qhov tseeb tias sai npaum li cas koj pom kev txhim kho ntawm tus kab mob, qhov yooj yim dua nws yuav nres nws txoj kev ua tiav.

    1. Nyob rau theem no, tus neeg mob yuav pom daim tawv nqaij, saib tus ntug loj, taw kev deformation. Koj puas muaj cov tsos mob no? Tham nrog kws kho mob - qhov yuav muaj peev xwm tshem tawm tus mob tam sim no siab dua puas tau.
    2. Yog tias koj twb pom qhov mob txhab ntawm ko taw - qhov no yog thawj theem (cov duab raug nthuav tawm ntawm peb lub vev xaib). Nws tseem tsis tau lig rau khiav ntawm tus kws kho mob.
    3. Los ntawm lub sijhawm mob rwj twb kis rau sab hauv ko taw, cuam tshuam rau cov leeg nqaij thiab cov leeg pob txha, peb tuaj yeem ruaj ntseg hais tias kev kho mob yog qhov hnyav.
    4. Hauv theem peb, lub rwj yuav ua rau cov pob txha tsis meej.
    5. Hauv qib plaub, tus menyuam laib tau pib tsim. Ib thaj chaw me me tseem tau them, tab sis tsis txhob dag - tus mob no kis tau sai heev.
    6. Thaum kawg, theem thib tsib yog tus cwj pwm ntawm kev nthuav dav hauv zej zog ntawm cov neeg qog caj dab - tag nrho txhais ko taw pib lwj, thiab yog tias tsis muaj kev nqis tes ua, tag nrho cheeb tsam ntawm ceg yog qhov txaus ntshai.

    Koj yuav pom hauv cov duab thaij li cas taw tau saib ntawm txhua theem - cov duab piav qhia ntau hom VDS. Peb lub xaib qhia ntau yam duab ntawm tus mob ko taw ko taw - los ntawm theem pib mus rau zaum kawg. Txhawm rau kom tsis txhob ua rau lub cev tsis zoo, nws yog qhov yuav tsum tau soj ntsuam tas li los ntawm tus kws kho mob endocrinologist, kws kho pob txha, thiab kws phais neeg.

    Cov tsos mob thiab Kev Kho Mob

    Lwm qhov teeb meem tuaj yeem tsim tau raws li hauv qab no: feem ntau nrog mob ko taw rau tus kab mob ntshav qab zib cov tsos mob tau plooj - vim qhov tsis hnov ​​ntawm lub siab nyob hauv qis qis, tus mob ntshav qab zib tsuas yog tsis yooj yim hnov ​​cov tawv nqaij, khawb, txiav ntawm ko taw.

    Xav txo koj txoj kev pheej hmoo ntawm kev tsim tus mob? Nws yog ib qho tsim nyog yuav tau soj ntsuam lub xeev ntawm lawv ko taw. Yog tias muaj kev txawv txav ntawm daim tawv nqaij, nws yog qhov yuav tsum tau hu rau tus kws tshaj lij (cov kws kho mob tshwj xeeb, orthopedist, kws kho pob kws tshwj xeeb). Niaj hnub no, muaj cov qauv pom tseeb ua ntej rau kev kho mob ntshav qab zib mellitus, SDS, yog li kev kho mob raws sij hawm ua rau peb cia siab nrog qhov muaj peev xwm siab rau kev kho kom zoo rau kev puas tsuaj rau ko taw.

    Kev kuaj mob

    Ntawm thawj lub cim ntawm CDS, koj yuav tsum sab laj tus kws kho mob tshwj xeeb. Qhov zoo tshaj plaws tawm yog mus ntsib tus kws kho mob hauv tsev. Puas muaj ib qho? Teem lub sijhawm mus ntsib ib tus kws kho mob, tus kws kho mob endocrinologist lossis tus kws phais mob.

    Nws yog qhov zoo thaum muaj Dhia Diav Hauv Tsev Kho Mob hauv tsev kho mob uas koj tau tshuaj xyuas, yog tias koj tsis muaj, tsis txhob tag kev cia siab thiab ceeb siab: kws kho mob muaj peev xwm ntawm cov lus qhia saum toj no yuav taw koj rau kev kuaj kom paub qhov teeb meem thiab xaiv txoj kev kho uas tsim nyog.

    Txawm li cas los xij, tus kws tshaj lij yuav ua cov kev tshawb fawb dav dav, kuaj xyuas cov hlab hlwb, ntsuas cov ntshav khiav hauv ob txhais ceg, tshuaj xyuas cov qhov txhab, thiab X-ray cov cheeb tsam cuam tshuam. Txhua yam kev tshuaj ntsuam thiab kev tshawb fawb no yuav tso cai rau tus kws kho mob kom ua tiav daim ntawv ntawm koj tus mob thiab sau ntawv kho kom zoo.

    Ob peb xyoos dhau los, kev kuaj pom ntawm "ko taw mob ntshav qab zib" tau hnov ​​zoo li kab lus - yuav luag txhua qhov tshwm sim ntawm qhov mob rau ntawm txhais ko taw ntawm tus mob ntshav qab zib tau ua tiav los ntawm kev txiav tes taw. Niaj hnub no qhov xwm txheej tau hloov pauv ntau: yog tias tus neeg mob saib xyuas tus mob ntawm ko taw, ua txhua yam kev tiv thaiv, tus kws kho mob sau ntawv, soj ntsuam cov ntshav qab zib, tom qab kev ntsuas pom zoo. Ua tib zoo saib xyuas qhov xwm txheej ntawm daim tawv nqaij ntawm tus taw, tsis txhob cia lub ntsej muag thiab pob txha, qhov txhab. Ntawm thawj cov cim ntawm VDS, saib hauv chav lis haujlwm ntawm tus kws kho mob profile, thiab koj yuav muaj peev xwm zam kom dhau teeb meem loj.

    Txawm tias tsis tau them zoo mloog rau qhov mob ntawm koj txhais taw, koj tuaj yeem plam lub sijhawm thaum tus kabmob tseem tuaj yeem kho kom zoo. Yuav ua li cas tus neeg mob phem tshwm sim? Hauv kev taug kev ntawm kev taug kev, tus neeg mob yuav ua rau mob me ntsis (piv txwv li, muab tawv los ntawm khau). Cov ntshav ncig tsis txaus nyob hauv ko taw yuav ua rau lub ntsej muag, uas thawj cuam tshuam cov nqaij mos, thiab tom qab ntawd cov pob txha, yuav loj tuaj ntxiv. Tus kab mob kis tau sai heev, yog li muaj qhov pheej hmoo tias yuav tsum tau txiav tes taw.

    Ntub dej ua laib

    Mob plab hnyuv twm taw yuav ua tau qhuav lossis ntub dej. Yog tias qhov mob caj dab qhuav tsis tsim teeb meem rau tus neeg mob lub neej (feem ntau nws nthuav tawm rau cov ntiv taw thiab txiav tau ua tiav, es, rau kev kho kom zoo nkauj), tom qab ntawd ntub ua rau muaj kev phom sij: necrosis nrog gangrene ntawm ko taw yog nrog los ntawm qhov pom ntawm decomposition khoom uas lom lub cev, uas ua rau muaj ntshav lom. uas yuav ua tau neeg tuag taus. Kev kho rau tus neeg mob vwm txhawm rau koom nrog txiav tu lub cev thiab kev siv tshuaj tua kab mob. Hauv kev tshwj xeeb tshaj plaws, cov kws kho mob tau yuam kom txiav tsis tsuas yog ko taw xwb, tab sis txhais ceg ntawm qib lub hauv caug thiab txawm lub ncej puab.

    Ntshav qab zib ko taw prophylaxis

    Txoj kev zoo tshaj los kho ib yam kabmob yog los tiv thaiv nws. SDS tsis muaj kev zam. Yog tias koj tsis xav ua tus qhua nquag ntawm tus kws phais mob lub chaw haujlwm, ua tib zoo saib xyuas thiab koj yuav tsis paub dab tsi nws yog qhov zoo los kho qhov mob ko taw hauv ntshav qab zib.

    Cov kev cai tseem ceeb tshaj plaws yog txiav txim siab seb koj puas muaj feem yuav raug tus mob VDS. Yog tias koj raug mob neuropathy, mob atherosclerotic ntawm cov hlab ntsha ntawm ob txhais ceg tau pom, yog tias tus kws kho mob tshwj xeeb tau qhia kev hloov pauv hauv ob txhais taw, raum muaj teeb meem vim mob ntshav qab zib, yog tias koj tau txo qhov muag pom los yog muaj keeb kwm txo qis ntawm cov kab mob, qhov kev pheej hmoo tau txais SDS, hmoov tsis, muaj.

    Tsuas yog coj cov ntaub ntawv no mus rau hauv kev saib xyuas thiab koom nrog kev tiv thaiv kabmob. Hu rau tus kws tshaj lij, nws yuav qhia koj kom taug qab thiab tswj koj cov ntshav qab zib (nrog kev pab zaub mov noj, insulin, kev siv tshuaj txo cov ntshav qab zib), xaiv cov kev pab cuam nrog kev ua kom lub cev zoo tshaj plaws, txiav txim siab seb ib hnub twg. Kev saib xyuas yuav tsum tau them nyiaj rau kev xaiv ntawm cov khau txhua hnub - nws yog qhov zoo dua los xaj khau hauv chav ua haujlwm orthopedic tshwj xeeb.

    Mob ntshav qab zib Pedicure

    Pedicure rau cov mob ntshav qab zib taw yog qhia tsuas yog tsis muaj kev txwv - ib qho, txawm tias kev txiav me me tuaj yeem ua rau muaj qhov tsis zoo. Qhov siab tshaj plaws uas tus tswv salon tuaj yeem ua rau koj yog kho cov ntiv taw (ntaub ntawv ntsia hlau), npog cov ntsia hlau nrog cov kua roj vanish, tshem tawm cov tawv nqaij tuag, kho nrog pumice lossis cov ntaub ntawv tshuaj pleev ib ce.

    Cov yam ntxwv ntawm ntxuav ko taw rau mob ntshav qab zib

    Cov tawv nqaij ntawm tus taw yuav tsum tau khaws cia hauv qhov chaw huv thiab qhuav. Ntxuav koj txhais taw txhua hnub, ua tib zoo saib xyuas qhov khoob ntawm koj cov ntiv tes, thiab so lawv maj mam so nrog lub phuam da dej. Hloov thom khwm thiab thom khwm niaj hnub, tswj qhov kub ntawm qhov qis qis (tsis txhob overheating thiab hypothermia). Tsis txhob ua tub nkeeg los kuaj xyuas tus taw txhua txhua hnub kom thiaj li pom qhov tawg, khawb, txiav lossis lwm yam kev puas tsuaj hauv lub sijhawm.

    Cov hau kev kho

    Kev xa mus kom ncav sijhawm rau cov kws kho mob tshwj xeeb yuav tsis tsuas yog txwv kev txhim kho CDS, tab sis kuj kho tus neeg mob. Cov kev kho mob hauv pej xeem hauv kev kho mob ntshav qab zib ko taw yuav tsis pab (lawv tuaj yeem ua rau mob hnyav) - tsuas yog kho cov tshuaj kho mob kom ua tiav qhov xav tau.

    1. Ntxuav, tshuaj pleev. Thaum nyuam qhuav pib, ntaub qhwv thiab pleev pleev yuav pab: tus kws kho mob yuav tshem cov ntaub so ntswg uas tuag, uas yuav tiv thaiv kom tus mob kis mus, yuav ntxuav lub qhov txhab nrog kua qaub lossis tshuaj tiv thaiv kab mob me. Tsis tas li, tus kws kho mob tshwj xeeb yuav sau cov tshuaj tua kab mob uas tiv thaiv kev kis tus kabmob - lawv yuav tsum tau coj mus ntev.
    2. Kev phais mob Tus kws phais yuav qhia tawm ntau yam kev phais mob: piv txwv, tso dej raws li kev ntxuav lub qhov txhab. Yog tias tus neeg mob tsis muaj pob txha tsis muaj zog, lawv yuav tsum tau muab tshem tawm. Kev phais mob yas thiab shunting qee zaum qhia. Thiab ntau qhov xwm txheej loj tshaj plaws, thaum tus neeg mob hloov mus lig heev thiab txhais ceg yuav cawm tsis tau, txiav tes taw ntawm taw yog qhia.
    3. Kev Pab Kho Mob, qhia tawm hauv kev kho cov kab mob sib kis, tseem ua rau muaj kev cuam tshuam loj rau kev tshem tawm SDS. Cov kws tshwj xeeb tau mob tshwj xeeb rau kev kho mob siab, mob qog, thiab nws kuj yog qhov yuav tsum tau txhim kho cov khoom noj tsis raug cai thiab kev tsis txaus siab hauv cov neeg mob - tag nrho cov no yog cov tseem ceeb uas ua rau cov nqaij mob kho sai, ua rau muaj kev phom sij. Cov kws kho mob nco ntsoov: kev kho mob yuav tsum tsis tsuas yog ua tau zoo, tab sis yuav tsum xis nws.
    4. Nqaij tsis siv khoom thauj khoom. Kev mob siab rau lub qhov txhab yuav ua rau muaj qhov nyuaj ua rau tsis muaj qhov txhab zoo. Hmoov tsis zoo, hauv ntau cov neeg mob ntshav qab zib, cov ceg yuav muaj lub cev tsis raug, yog li lub nra ntawm ob txhais ceg feem ntau tshaj qhov txwv xav tau. Cov kws kho mob pom zoo kom txo lub sijhawm uas tus neeg mob siv nyiaj sawv ntsug; koj yuav tsum sim ua kom tsis txhob muaj qhov khau sab nraum zoov.
    5. Kev tswj ntshav qab zib. Tshaj dhau qhov tshwj xeeb hauv qhov ntsuas no tsis tsuas yog ua rau qeeb qis kho kom zoo dua qub ntawm cov mob rwj, tab sis kuj cuam tshuam cov tsos ntawm cov tshiab. Tus kws kho mob yuav xaiv cov tshuaj insulin kom raug thiab sau tshuaj kom zoo hypoglycemic.

    Nco ntsoov, SDS tsis yog qhov ua rau nws tag kev cia siab. Ua raws li cov lus pom zoo, ntsib koj tus kws kho mob, thiab cov muaj feem uas tsab xov xwm no tsuas yog kev ceeb toom ntawm DS yuav nce siab xwb.

    Cia Koj Saib

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