![\"Prost\u00fd](\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/05\/Image_300.png\" "\\"Prost\u00fd")
<\/a>Prost\u00fd sn\u00edmek nohy \u2013 PA a \u0161ikm\u00e1 projekce<\/p><\/div><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
INDIKACE K AMPUTACI<\/h6>\n
Pokud je indikac\u00ed k amputaci lok\u00e1ln\u00ed n\u00e1lez (nekr\u00f3zy, gangr\u00e9ny) a je sou\u010dasn\u011b z\u0159ejm\u00e1 hranice vit\u00e1ln\u00ed a avit\u00e1ln\u00ed tk\u00e1n\u011b nebo je nap\u0159. hmatn\u00e1 arteri\u00e1ln\u00ed pulzace ve v\u00fd\u0161i hlezna, je amputace provediteln\u00e1 bez angiografie. Rozsah amputace je d\u00e1n rozsahem lok\u00e1ln\u00edho n\u00e1lezu. Je v\u0161ak nutn\u00e9 v\u017edy myslet tak\u00e9 na mo\u017enosti protetick\u00e9 techniky.P\u0159i poruch\u00e1ch prokrven\u00ed kon\u010detiny (v\u00edceet\u00e1\u017eov\u00e9 sten\u00f3zy a uz\u00e1v\u011bry) je p\u0159ed amputac\u00ed nezbytn\u00e1 kvalitn\u00ed angiografie. Odm\u00edtnut\u00ed chirurgick\u00e9 nebo endovaskul\u00e1rn\u00ed l\u00e9\u010dby je v rukou zku\u0161en\u00e9ho c\u00e9vn\u00edho chirurga a radiologa. Je t\u0159eba p\u0159ipomenout, \u017ee i po nep\u0159\u00edzniv\u00e9m angiografick\u00e9m n\u00e1lezu je mo\u017enost do\u0161et\u0159it perifern\u00ed arteri\u00e1ln\u00ed kmeny barevnou duplexn\u00ed sonografi\u00ed, kter\u00e9 mohou prok\u00e1zat a k revizi indikovat arteri\u00e1ln\u00ed \u00faseky, kter\u00e9 se jev\u00ed na angiografii jako uzav\u0159en\u00e9 (ale jsou za uz\u00e1v\u011brem) a p\u0159i revizi se prok\u00e1\u017eou jako vhodn\u00e9 k dist\u00e1ln\u00ed anastom\u00f3ze a maj\u00edc\u00ed sv\u016fj v\u00fdtokov\u00fd trakt. P\u0159ed amputac\u00ed by m\u011bly b\u00fdt vy\u010derp\u00e1ny v\u0161echny metody\u2013 je t\u0159eba tak\u00e9 zv\u00e1\u017eit mo\u017enost zaveden\u00ed intraarteri\u00e1ln\u00edho mikrokat\u00e9tru do arteri\u00e1ln\u00edho \u0159e\u010di\u0161t\u011b (cestou spole\u010dn\u00e9 femor\u00e1ln\u00ed arterie antegr\u00e1dn\u011b do periferie), prov\u00e9st intraopera\u010dn\u00ed angiografii a skute\u010dn\u011b vylou\u010dit nebo potvrdit mo\u017enost endovaskul\u00e1rn\u00ed nebo chirurgick\u00e9 l\u00e9\u010dby.Je-li indikov\u00e1na minor-amputace (viz v\u00fd\u0161e) jen klinick\u00fdm n\u00e1lezem, je v\u017edy riziko progrese lok\u00e1ln\u00edho procesu. P\u0159\u00ed\u010dinou je v\u00edceet\u00e1\u017eov\u00e9 posti\u017een\u00ed arteri\u00e1ln\u00edho \u0159e\u010di\u0161t\u011b. Amputace bez angiografie by m\u011bla b\u00fdt sp\u00ed\u0161e v\u00fdj\u00edmkou, proto\u017ee nejlep\u0161\u00ed cestou, jak skute\u010dn\u011b rozpoznat pot\u0159ebnou v\u00fd\u0161i amputace, je lok\u00e1ln\u00ed n\u00e1lez po eventu\u00e1ln\u00edm o\u0161et\u0159en\u00ed arteri\u00e1ln\u00edho \u0159e\u010di\u0161t\u011b v cel\u00e9m rozsahu (aorta \u2013 periferie).<\/p>\n
Stejn\u00e1 pravidla plat\u00ed pro rozhodnut\u00ed o rozsahu maior-amputace. Na jedn\u00e9 stran\u011b je snaha amputovat co nejdist\u00e1ln\u011bji, ale na druh\u00e9 je t\u0159eba re\u00e1ln\u011b zv\u00e1\u017eit mo\u017enost zhojen\u00ed amputa\u010dn\u00edho pah\u00fdlu. Nejv\u011bt\u0161\u00ed frustraci jak pro nemocn\u00e9ho, tak pro chirurga p\u0159edstavuje nehoj\u00edc\u00ed se pah\u00fdl a nutnost reamputace ve vy\u0161\u0161\u00ed et\u00e1\u017ei. P\u0159ed amputac\u00ed mus\u00ed b\u00fdt vyu\u017eity v\u0161echny mo\u017enosti chirurgick\u00e9 a endovaskul\u00e1rn\u00ed terapie. Z tohoto hlediska p\u0159edstavuje i v dne\u0161n\u00ed dob\u011b nejv\u011bt\u0161\u00ed probl\u00e9m amputace ve stehn\u011b u nemocn\u00fdch s uz\u00e1v\u011brem p\u00e1nevn\u00edho a femor\u00e1ln\u00edho \u0159e\u010di\u0161t\u011b, kdy nehoj\u00edc\u00ed se pah\u00fdl m\u016f\u017ee b\u00fdt zdrojem infekce a sepse. P\u0159ed amputac\u00ed ve stehn\u011b je indikov\u00e1no o\u0161et\u0159en\u00ed p\u00e1nevn\u00edho a femor\u00e1ln\u00edho \u0159e\u010di\u0161t\u011b nap\u0159. hybridn\u00edm v\u00fdkonem.<\/p>\n
TERAPIE<\/h6>\n
Minoramputace je d\u00e1na rozsahem posti\u017een\u00ed ischemi\u00ed a amputa\u010dn\u00ed \u0159ez nebo linie nen\u00ed d\u00e1na anatomick\u00fdmi prvky. P\u0159i amputaci nesm\u00ed b\u00fdt otev\u0159en kloub, resp. p\u0159i jeho otev\u0159en\u00ed mus\u00ed b\u00fdt resekov\u00e1na p\u0159\u00edslu\u0161n\u00e1 kost.Amputace v hleznu se prakticky t\u00e9m\u011b\u0159 neprov\u00e1d\u00ed. P\u0159i amputaci v b\u00e9rci je z\u00e1sadn\u00ed kvalita zachovan\u00fdch tk\u00e1n\u00ed a jejich hojen\u00ed. Dal\u0161\u00ed z\u00e1sadn\u00edm faktorem je d\u00e9lka amputa\u010dn\u00edho pah\u00fdlu k zaji\u0161t\u011bn\u00ed dobr\u00e9 protetick\u00e9 n\u00e1hrady. Pro vytvo\u0159en\u00ed podm\u00ednek pro vhodnou protetickou n\u00e1hradu se n\u011bkdy indikuje m\u00edsto amputace ve stehn\u011b exartikulace v kolenn\u00edm kloubu. Z l\u00e9ka\u0159sk\u00e9ho hlediska se pova\u017euje pro nemocn\u00e9ho za m\u00e9n\u011b traumatizuj\u00edc\u00ed ne\u017e amputace ve stehn\u011b. Nev\u00fdhodou ve srovn\u00e1n\u00ed s amputac\u00ed ve stehn\u011b je jej\u00ed hor\u0161\u00ed hojen\u00ed (p\u0159edev\u0161\u00edm u nemocn\u00fdch s uz\u00e1v\u011brem a. profunda femoris). Tak\u00e9 amputace ve stehn\u011b mus\u00ed splnit popsan\u00e1 krit\u00e9ria hojen\u00ed a d\u00e9lky pah\u00fdlu. Ka\u017ed\u00fd zachovan\u00fd centimetr ponechan\u00e9ho pah\u00fdlu stehna je velmi cenn\u00fd, a to i u le\u017e\u00edc\u00edch nemocn\u00fdch, kdy kvalitn\u00ed pah\u00fdl v\u00fdrazn\u011b zlep\u0161uje mo\u017enosti manipulace s nemocn\u00fdm (viz fotodokumentace).<\/p>\n
N\u00c1SLEDN\u00c1 P\u00c9\u010cE<\/h6>\n
P\u0159i pl\u00e1nov\u00e1n\u00ed protetick\u00e9 n\u00e1hrady je vhodn\u00e9 ji\u017e v p\u0159edamputa\u010dn\u00edm obdob\u00ed posilov\u00e1n\u00ed nemocn\u00e9ho a n\u00e1cvik ch\u016fze o berl\u00edch. Je indikov\u00e1na \u010dasn\u00e1 mobilizace nemocn\u00e9ho a zaji\u0161t\u011bn\u00ed vhodn\u00e9 prot\u00e9zy. N\u00e1sleduje dal\u0161\u00ed n\u00e1cvik ch\u016fze v rehabilita\u010dn\u00edm za\u0159\u00edzen\u00ed. Pokud nen\u00ed nemocn\u00fd schopn\u00fd ch\u016fze s prot\u00e9zou a je z\u0159ejm\u00e1 pot\u0159eba ortopedick\u00e9ho voz\u00edku, je indikov\u00e1no posilov\u00e1n\u00ed a n\u00e1cvik manipulace s voz\u00edkem. Snahou rehabilitace je v\u017edy zajistit co nejv\u011bt\u0161\u00ed sob\u011bsta\u010dnost nemocn\u00e9ho. To plat\u00ed o nutnosti a\u017e agresivn\u00ed rehabilitace hybnosti u le\u017e\u00edc\u00edch nemocn\u00fdch.<\/p>\n","protected":false},"excerpt":{"rendered":"
Akutn\u00ed nebo chronick\u00e1 porucha arteri\u00e1ln\u00edho prokrven\u00ed p\u0159edstavuje vedle traumat a infekc\u00ed nej\u010dast\u011bj\u0161\u00ed p\u0159\u00ed\u010dinu ztr\u00e1ty kon\u010detiny. P\u0159\u00ed\u010dinou chronick\u00e9 poruchy arteri\u00e1ln\u00edho prokrven\u00ed je ve v\u011bt\u0161in\u011b p\u0159\u00edpad\u016f generalizovan\u00e1 obliteruj\u00edc\u00ed ateroskler\u00f3za. U t\u011bchto nemocn\u00fdch je sou\u010dasn\u011b t\u00edmto onemocn\u011bn\u00edm posti\u017eeno tak\u00e9 koron\u00e1rn\u00ed \u0159e\u010di\u0161t\u011b a d\u016fsledkem je extr\u00e9mn\u011b vysok\u00e1 mortalita nemocn\u00fdch s chronick\u00fdmi uz\u00e1v\u011bry perifern\u00edho arteri\u00e1ln\u00edho \u0159e\u010di\u0161t\u011b zvl\u00e1\u0161t\u011b p\u0159i projevech chronick\u00e9 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2447,"menu_order":7,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-2687","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/2687","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2687"}],"version-history":[{"count":13,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/2687\/revisions"}],"predecessor-version":[{"id":3328,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/2687\/revisions\/3328"}],"up":[{"embeddable":true,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/2447"}],"wp:attachment":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2687"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
![\"Amputace](\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/05\/Image_292.png\" "\\"Amputace")
<\/a>![\"Amputace](\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/05\/Image_291.png\" "\\"Amputace")
<\/a>