Ngokuqinisekile umuntu angaholela kwenye, kodwa ahlukile
Ukulimala kwekhanda nokulimala kobuchopho obuhlungu kuyimigomo ekhombisa izinkinga ezibucayi ngobuchopho besiguli kanye namandla akhe okuphulukisa nokuhola impilo evamile esikhathini eside. Ukulimala okubuhlungu kwengqondo kubhekisela kunenkinga ebuchosheni obuholela ekutheni kube khona ukulahleka okuhlala njalo (ukulahlekelwa isikhathi eside komsebenzi).
Eminyakeni edlule, ukulimala kwentloko evaliwe kwakuyigama elivamile kakhulu elisetshenziselwa ukuchaza imoto (ukuhamba kwemisipha) nokuzwa (ukukwazi ukuzwa, ukubona, ukuthinta, ukunambitha, noma ukuhogela) izinhlobo zokulimala.
Ukuze uqonde ukuthi ukulimala kwekhanda kuhluke kanjani ngokulimala koguquko okudakayo kudinga ukuqonda okuyisisekelo kwe-skull nobuchopho. I-skull yiyona icala elibamba futhi livikela ubuchopho.
Skull noBongo: Akunjalo
I-skull iyisetshenziswa esisebenzayo kakhulu ukuvikela ubuchopho bethu emonakalweni. Yenziwe ngamathambo amaningana ahlangane ndawonye (okusho ukuthi asekhulile ndawonye, hhayi ukuthi othile uwakhulume ndawonye). I-skull (eyaziwa nangokuthi i- cranium ) ine-cap phezu kobuchopho obunamafu amane amakhulu, aphambene namapulanka abizwa ngokuthi i-parietal yangaphambili, kwesokudla nangesobunxele, namathambo e-occipital. Isisekelo se-skull senziwe ngamathambo amaningana, kuhlanganise ne-ethmoid, i-temporal, ingxenye ye-frontal, nengxenye ye-occipital. Ubuchopho buhlezi phezulu kwesisekelo se-skull kanye nekhanda le-skull lidlula phezu kobuchopho ukulivikela ekulimaleni. Konke, ubuchopho buqotshwe ngokuphelele emathanjeni uma zonke izinto eziphilayo zikhona futhi zingenalutho.
Izindlalelo Zokuvikelwa
Ukwakhiwa okuvela ngaphandle, ngaphakathi kwe-skull kuhlanganiswe ne-membrane enzima okuthiwa i- dura mater (ukuhumusha kwe-literal latin: umama onzima). Ngaphansi kwe-mater ehlala isikhathi eside yi- too mater (umama omncane) naphakathi kwe-mater ehlala isikhathi eside futhi i- layer ehambisana ne- arachnoid ungqimba, ungqimba lwe -spongy okuthiwa yi-spiderweb uma ubhekwa ngaphansi kwe-microscope.
Amagundane amathathu ayaziwa ngokuthi i-meninges futhi ahlinzeka kokubili ukuvikelwa kanye nezondlo ebuchosheni. I-Cerebrospinal fluid igeleza ngokusebenzisa ungqimba lwe-arachnoid, igeza ubuchopho ushukela nezakhi. Umswakama uvumela ubuchopho ukuthi buhambe futhi buklayile ngaphandle kokulimazwa kusuka kumabhomu amancane nokunyakaza. Igazi ligeleza ngokusebenzisa ama-mening kanye nobuchopho. Ezimweni eziningi, ukuphuma kwegazi kubangela ukulimala kwekhanda evaliwe.
Ukulimala Kwekhanda Okuvaliwe
Yonke leyo bone ayikhotheleli kakhulu uma kuziwa ekuvupheni noma egazini ngaphakathi kwe-skull. Ithemba limelela ukuma kwalo futhi alivumeli noma yikuphi ukucindezela ukukhululeka uma kwenzeka ukuphuma. Njengoba igazi liqoqa ngaphakathi kwekhanda, ukucindezela okwandayo kuphazamisa ubuchopho, okungenzeka kubonakalise izicubu zobuchopho.
Ngaphandle kwegazi, ezinye izikhukhula zingakwazi ukuqoqa ngaphakathi kwegazi futhi ziholele ekulimaleni kwezicubu zobuchopho. Ubuchopho obonakalisiwe bungakhuphukela kwezinye izikhukhula futhi ukucindezeleka okubangelwayo kungabangela ukucindezeleka okungeziwe emathisini obuchopho. Kuyisiprofetho esizigcwalisayo; ukuvuvukala kubangela ukulimala, okubangela ukuvuvukala.
Uma nje i-skull igxile, noma yikuphi uhlobo lokuphapha noma ukuvuvukala ngaphakathi kwe-skull ehlanganisiwe kuholela kulokhu kucindezela okwandisiwe. Njengoba i-skull ihambile, sibiza ngokuthi ukulimala ikhanda elivaliwe.
Ngamanye amazwi, i-skull ayivumeli ukucindezelwa ukukhishwa njengegazi noma uketshezi kuqoqa ngoba "kuvaliwe" kunokuba "kuvulwe" (ikhefu ku-skull evumela igazi noma uketshezi ukubalekele i-skull futhi kuncishiswe ukucindezelwa).
Esikhathini sokuvuleka kwe-skull evulekile, ukuphahlaza noma izingxenye ezigcwele ze-skull elahlekile kuholela uketshezi olulahlekile noma igazi ebuchosheni. Lokhu kuyingozi kakhulu emsebenzini wobuchopho, kodwa ukulimala kwentloko evaliwe kuchazwe ngempela ngokucindezela okwandisiwe.
Izinhlobo Zokulimala Kwekhanda Okuvaliwe
Ukucindezela ngaphakathi kwe-skull kuvela ezimbangela eziningi, kodwa izinhlobo ezivame kakhulu ziphuma ekugezeni ngaphakathi kwe-skull (okuthiwa i-hemorrhage engasebenzi).
I- hematoma ye- subdural kanye ne- epidural yizibonelo zokugaya ngaphakathi kwe-skull (hematoma), okungenhla noma ngaphansi kwesibindi sokuhlala.
Ukukhipha igazi ngaphezu kwesikhumba sokugcina (epidural) kuvela ekuhlinzekeni kwegazi, okuyinto ephuma ngamandla futhi enobudlova ngaphezu kwe-venous. Ukuhlwitha okuvela ngaphansi kwesibindi sokugcina (i-subdural) i-venous, ehamba kancane futhi ithatha isikhathi eside ukuqoqa ngaphakathi kwe-skull.
Ngaphandle kwe-hematomas ye-subdural kanye ne-epidural, kungase futhi kube nokuphuma kwegazi okujule kunokwesimo se-arachnoid kanye ( ukubola kwesisu ). Ihambisana nokulimala noma ngezimo ezithile zezokwelapha ezifana ne-aneurysm ye-cerebral noma i-arteriovenous malformation (AVM), kokubili okungabangela ukushaya kanzima .
I-Skull Fractures
I-skull ilukhuni, kodwa ayinakuqedwa. Kungenziwa ukulimaza noma ukuphulwa, njenganoma yimuphi omunye amathambo. Ama-fractures noma ama-break of skull amathambo angabangela ukuphuma noma ukuvuza kwe- cerebrospinal fluid (i-CSF) egeza ubuchopho futhi igeleza ngokusebenzisa ungqimba lwe-arachnoid wamadoda.
I-Skull fractures yiyona ndlela eyingozi kakhulu yokulimala kwekhanda. Okubi kunazo zonke kungenza ikhanda libukeke likhubazekile uma i-skull iphukile kakhulu kangangokuthi idlulisela ithambo. Iningi lama-skull fractures ahlakaniphile kakhulu, azibonakalisa ngezibonakaliso ezinjengegazi noma i-CSF ephuma ezindlebeni noma ekhaleni.
Ukuphuka kwamathambo okwenza isisekelo se-skull (amathambo lapho ubuchopho buhlala khona lapho ikhanda lisezingeni eliqondile) kunzima kakhulu ukubona. Kulokhu, ukuphuma kwephunga kungase kubangele ukuvuthwa kuvele lapho igazi liqoqa ngemuva kwezindlebe (isibonakaliso sempi) noma eduze kwamehlo (periorbital ecchymosis).
Ukucindezela Kwenyuka Kwezingcingo
Zonke lezi zingaholela ekucindezelweni okweqile ngaphakathi kwegazi ( ingcindezi ye-intracranial ). I-CSF, negazi eligeleza ngezicubu ezizungezile, kufanele lithinte kancane kakhulu, uma likhona, ebuchosheni ngokwayo. Ukukhula kwe-ICP ekugcineni kubangela ukulimala ebuchosheni. Yileyo monakalo ebaluleke ngempela.
Ubuchopho abukho indawo yokuhamba ngaphakathi kwe-skull bese uvumelanisa nokwandisa i-ICP. Ezimweni ezimbi kakhulu, ukucindezelwa ngaphakathi kwe-skull kungashintsha ubuchopho ekuvukeni okukhulu ekugcineni kwe-skull, okuthiwa i-foramen magnum (ehunyushwa ngokuqondile: enkulu imbobo ). Kungena kulo mgobo ukuthi intambo yomgogodla ifakwe ebuchosheni. Kungenzeka kube ukuvula okukhulu, kodwa sisakhuluma ngamamentimitha amabili noma amathathu kuphela, ngokucacile akukho isikhala esanele sokuba lonke ubuchopho buphume.
Njengoba ubuchopho buhlambalaza i-foramen magnum, kuvinjelwe futhi umonakalo ubangelwa ukucindezela okuqondile kwendaba yobuchopho. Konke kuzo zonke, akulungile.
Ukulimala Okubuhlungu Kobunzima
Kuze kufike leli phuzu, ingxoxo yonke ibilokhu ikulimala ku-skull noma izingqimba zezicubu ezizungezile ubuchopho, ukucindezela ukwakha ngaphakathi kwendlela evaliwe ye-skull, noma ngokuphuma kwegazi noma okunye ukushintshashintsha kwamanzi. Noma yikuphi uhlobo lokucindezelwa-ngokuqondile noma ngokungaqondile-endabeni yobuchopho kungabangela ukulimala kuso.
Lokhu ukulimala kwengqondo ebuhlungu: umonakalo emathanjeni wangempela ebuchosheni. Lishintsha umsebenzi wobuchopho, ngezinye izikhathi unomphela. Singabona umsebenzi oshintshiwe ngezibonakaliso ezifana nabafundi abangalingani, ubuthakathaka obunzima, ukudideka , ukukhuluma kanzima, ukulahlekelwa ukwazi , njll. Uma sikhuluma ngokulimala kobuchopho, sibiza lezi zimpawu zokulahlekelwa .
Ngaphandle kokulahlekelwa okwenza izibonakaliso zokulimala kwengqondo, ukulimala kwengqondo ebuhlungu (TBI) isiguli kungase kukhononde izimpawu. Isiguli se-TBI singathola ubuhlungu bekhanda, inselele, ukubona izinkinga, noma ukukhala ezindlebeni (izinhlamvu).
Njengalapho kukhona izinhlobo ezahlukene zokulimala kwekhanda nokulimala kwekhanda, kukhona izinhlobo ezahlukene noma amazinga we-TBI. Ukulimala ngokuqondile ebuchosheni (isibhamu isigundane, isibonelo) kungase kubangele ukulahlekelwa okungaphezu kwalokho okungaqondakali kancane. Ngempela, ezinye ukulimala kwekhanda ziholela ekulimaweni kwengqondo kancane kangangokuthi kungase kube lula ukuphutha ukuqala kokulahlekelwa noma isiguli singakwazi ukungaqondi kahle ukubaluleka kwezimpawu.
I-Coup-Contrecoup
I-Coup-contrecoup (i- coo-contra-coo ebizwa ngokuthi i- coo-contra-coo ) uhlobo lokulimala ebuchosheni obuvela ekhanda ekhanda. Isiguli singayeka ngokuzumayo-ukuwa noma ingozi yemoto-noma ingase ifakwe ngento. Kuzo zonke izibonelo, ubuchopho abukashintshi isivinini ngesilinganiso esifanayo njenge-skull, okubangela ukuba ihlasele ngaphakathi ngaphakathi kwe-cranium (ukukhwabanisa) bese ubuyisa emuva bese ushaya ohlangothini oluhlukile lwe-cranium (contrecoup).
Uhlobo oluvame kakhulu lwe-coup-contrecoup luyinkinga. Ngezinye izikhathi ukuxilongwa kuthiwa yi- TBI encane futhi ngeke kuholele kunoma yikuphi ukulahlekelwa okuphakade okubonakalayo.
Ukujikijela nxazonke kobuchopho ngaphakathi kwe-cranium kungaholela ekuphumeni kwe-intracranial engakhulumi ngakho ngenhla, kepha kungabangela ukulimala okuqondile ebuchosheni, esibubona njengokwehluleka okusheshayo. Ukulimala kwe-Coup-contrecoup kuvame kakhulu emabhokisini, amasosha, nabadlali bebhola: Noma yini eholela kanzima igoqa.
Ukubuyiswa kwe-TBI
Ubuchopho buyisici esimangalisayo. Kwacatshangwa ngeminyaka ukuthi noma yimuphi umonakalo ebuchosheni obunomphela, kodwa siyazi kangcono manje. Ukucubungula, isibonelo, kwakungacatshangwa ukuthi kungumonakalo wangempela wobuchopho. Odokotela manje bayaqonda ukuthi izimpikiswano zilimaza izicubu zobuchopho kanye nezimpikiswano eziphindaphindiwe zingaba nemiphumela engunaphakade.
Ngakolunye uhlangothi, ukulimala okukhulu kobuchopho obangelwa ukulimala okukhulu kwekhanda-njenge-epidural hematoma-kungaphulukisa futhi ngokuvamile, ngokuhamba kwesikhathi, kungcono. Isiguli kungenzeka singabuyeli emsebenzini we-TB wangaphambi, kodwa ubuchopho buyakwazi ukuziphilisa ngezindlela ezimangalisayo. Njengemisipha kufanele inselele ngokusebenzisa ukwelashwa ngokomzimba ukuze uqinise, ubuchopho kufanele bubekelwe inselele ngokusebenzisa ukwelashwa kwengqondo ukulungisa lezo zixhumanisi ze-neural.
> Imithombo:
> Kucera, K., Yau, R., Bhalisa-Mihalik, J., Marshall, S., Thomas, L., & Wolf, S. et al. (2017). Ubuchopho Obunzima Nezigqoko Zezintambo Ukufa Phakathi Kokuphakeme Kwezikole Naseball College Abadlali - United States, 2005-2014. I-MMWR. Ukulimaza nokufa kweMasonto onke , Umbiko ( 65 ), 1465-1469. i-doi: 10.15585 / mmwr.mm6552a2
> Soberg, H., Roe, C., Brunborg, C., von Steinbüchel, N., & Andelic, N. (2017). I-Norwegian version ye-QOLIBRI - isifundo sempahla yamatriki esekelwe ukulandelwa kwezinyanga ezingu-12 zabantu abanezimo ezilimazayo zobuchopho. Ezempilo Nezinga Lemiphumela Yokuphila , 15 (1). i-doi: 10.1186 / s12955-017-0589-9