Qovurg‘a sinishi sahifasining manbasini koʻrish

{{Tibbiy holat bilgiqutisi
| nomi                   = Qovurg‘a sinishi
| tasvir                 = Fracturedribsmarked.jpg
| izoh                   = x Shaxsning chap tomonidagi bir nechta eski singan qovurg‘alarni oval bilan belgilangan rentgen nurlari 
| soha                   = [[Tez tibbiy yordam]]
| belgilar               =  
| asoratlari             = [[Pulmonary contusion]], [[pneumothorax]], [[pneumonia]]<ref name=Mos2013/><ref name=May2015/>
| boshlanish vaqti       = 
| davomiyligi            = 
| turlari                = 
| sabablari              = [[Ko‘krak jarohati]]<ref name=May2015/>
| xavf omillar           = 
| tashxis                = Simptomlarga asoslanib, [[ Kompyuter tomografiyasi]]<ref name=Ad2012/>
| differensial tashxis   = 
| oldini olish           = 
| davolash               = 
| dorilar                = [[Paratsetamol]] (atsetaminofen), [[NSAID]], [[opioids]]<ref name=May2015/>
| prognoz                = 6 haftadan keyin og‘riq yaxshilanadi<ref name=Ad2012/>
| takrorlanishi          = Umumiy<ref name=May2015/> 
| oʻlim                  = 
}}
'''Qovurgʻa sinishi''' – bu [[ qovurg‘a]] suyagining [[suyak sinishi|sinishi]]<ref name="Mos2013">{{cite book|title=Mosby's Medical Dictionary |format= E-Book|date=2013|publisher=Elsevier Health Sciences|isbn=978-0323112581|page=1567|url=https://books.google.com/books?id=aW0zkZl0JgQC&pg=PA1567|language=en|url-status=live|archive-url=https://web.archive.org/web/20171013013051/https://books.google.ca/books?id=aW0zkZl0JgQC&pg=PA1567|archive-date=2017-10-13}}</ref>. Ushbu holat odatda nafas olish natijasida koʻkrak qafasida kuchli ogʻriq hosil qiladi<ref name="Mos2013" />. Qovurgʻa [[suyak sinishi|sinish]] joyida koʻkarishlar paydo boʻlishi mumkin<ref name="Ad2012">{{cite book|last1=Adams|first1=James G.|title=Emergency Medicine E-Book: Clinical Essentials (Expert Consult – Online)|date=2012|publisher=Elsevier Health Sciences|isbn=978-1455733941|page=682|url=https://books.google.com/books?id=rpoH-KYE93IC&pg=PA682|language=en|url-status=live|archive-url=https://web.archive.org/web/20171013013053/https://books.google.ca/books?id=rpoH-KYE93IC&pg=PA682|archive-date=2017-10-13}}</ref>. Bir nechta qovurgʻa bir necha joyda singan boʻlsa, koʻkrak qafasi sinib ketadi<ref name="Wanek04">{{cite journal |last1=Wanek |first1=Sandra |last2=Mayberry |first2=John C |title=Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury |url=https://archive.org/details/sim_critical-care-clinics_2004-01_20_1/page/71 |journal=Critical Care Clinics |volume=20 |issue=1 |pages=71–81 |year=2004 |pmid=14979330 |doi=10.1016/S0749-0704(03)00098-8 }}</ref>. Qovurgʻa [[suyak sinishi|sinishi]] natijasida [[pnevmotoraks]], oʻpka kontuziyasi va [[pnevmoniya]] bilan asoratlanishi mumkin<ref name="May2015">{{cite journal|last1=May|first1=L|last2=Hillermann|first2=C|last3=Patil|first3=S|title=Rib fracture management|journal=BJA Education|date=January 2016|volume=16|issue=1|pages=26–32|doi=10.1093/bjaceaccp/mkv011|doi-access=free}}</ref><ref name="Mos2013" />.

Qovurgʻa sinishi odatda koʻkrakka toʻgʻridan-toʻgʻri zarba berishdan, masalan, [[avtomobil to‘qnashuvi]] yoki [[ezilish]] natijasida kelib chiqadi<ref name=May2015/><ref name=Mos2013/>. Yoʻtal yoki [[metastatik saraton]] qovurgʻa sinishiga olib kelishi mumkin<ref name=Mos2013/>. Koʻpincha toʻrtinchi, beshinchi va oltinchi qovurgʻalar sinadi<ref>{{Cite book|title = PET-CT: Rare Findings and Diseases|last = Nanni|first = Christina|publisher = Springer|year = 2012|isbn = 978-3-642-24698-2|page = 257}}</ref><ref name=Mos2013/>. Birinchi yoki ikkinchi qovurgʻalarning sinishi koʻproq asoratlar bilan bogʻliq<ref>{{cite journal|last1=Murphy CE|first1=4th|last2=Raja|first2=AS|last3=Baumann|first3=BM|last4=Medak|first4=AJ|last5=Langdorf|first5=MI|last6=Nishijima|first6=DK|last7=Hendey|first7=GW|last8=Mower|first8=WR|last9=Rodriguez|first9=RM|title=Rib Fracture Diagnosis in the Panscan Era.|journal=Annals of Emergency Medicine|date=27 May 2017|doi=10.1016/j.annemergmed.2017.04.011|pmid=28559032|volume=70|issue=6|pages=904–909|s2cid=23442272|url=https://escholarship.org/content/qt2b3582ws/qt2b3582ws.pdf?t=p0a17a}}</ref>. Qovurgʻa [[suyak sinishi|sinishi]] tashxisi simptomlar asosida va [[tibbiy tekshiruv]] yordamida amalga oshirilishi mumkin<ref name=Ad2012/>.

[[Ogʻriq nazorati|Ogʻriqni nazorat qilish]] davolashning muhim qismidir<ref>{{cite journal|last1=Brown|first1=SD|last2=Walters|first2=MR|title=Patients with rib fractures: use of incentive spirometry volumes to guide care.|journal=Journal of Trauma Nursing |date=2012|volume=19|issue=2|pages=89–91; quiz 92–03|doi=10.1097/JTN.0b013e31825629ee|pmid=22673074|s2cid=45547470}}</ref>. Bunga [[paratsetamol]] (asetaminofen), steroid boʻlmagan yalligʻlanishga qarshi dorilarni (NSAID) yoki [[opioidlar]] dan foydalanish kiradi<ref name=May2015/>. Yana bir variant [[nerv bloki|nerv blokadasi]] boʻlishi mumkin<ref name=Mos2013/>. Singan qovurgʻalarni oʻrash mumkin boʻlsa-da, bu asoratlarni oshirishi mumkin<ref name=Mos2013/>. Koʻkrak qafasi boʻshligʻida jarrohlik amaliyoti natijalarni yaxshilashi mumkin<ref>{{cite journal|last1=Schuurmans|first1=J|last2=Goslings|first2=JC|last3=Schepers|first3=T|title=Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review.|journal=European Journal of Trauma and Emergency Surgery|date=April 2017|volume=43|issue=2|pages=163–68|doi=10.1007/s00068-016-0721-2|pmid=27572897|pmc=5378742}}</ref><ref>{{cite journal|last1=Coughlin|first1=TA|last2=Ng|first2=JW|last3=Rollins|first3=KE|last4=Forward|first4=DP|last5=Ollivere|first5=BJ|title=Management of rib fractures in traumatic flail chest: a meta-analysis of randomised controlled trials.|journal=The Bone & Joint Journal|date=August 2016|volume=98-B|issue=8|pages=1119–25|doi=10.1302/0301-620X.98B8.37282|pmid=27482027}}</ref>. Ular travmadan keyingi keng tarqalgan jarohatlardir<ref>{{cite journal|last1=Senekjian|first1=L|last2=Nirula|first2=R|title=Rib Fracture Fixation: Indications and Outcomes.|journal=Critical Care Clinics|date=January 2017|volume=33|issue=1|pages=153–65|doi=10.1016/j.ccc.2016.08.009|pmid=27894495}}</ref>.

== Belgilari va alomatlari ==
Ushbu holat odatda nafas olish natijasida koʻkrak qafasida kuchli ogʻriq hosil qiladi<ref name=Mos2013/>. Qovurgʻa [[suyak sinishi|sinish]] joyida koʻkarishlar paydo boʻlishi mumkin<ref name=Ad2012/>.

== Asoratlari ==
Bir nechta qovurgʻalar bir necha joyda singanda, koʻkrak qafasi sinib ketadi<ref name=Wanek04/>. Qovurgʻa [[suyak sinishi|sinishi]] natijasida pnevmotoraks, oʻpka kontuziyasi va pnevmoniya bilan asoratlanishi mumkin<ref name=May2015/><ref name=Mos2013/>.

== Sabablari ==
Qovurgʻa sinishlari dam olish paytida bevosita jarohatlar bilan yoki jarohatlarsiz sodir boʻlishi mumkin. [[Kardiopulmonar reanimatsiya]] koʻkrak qafasining shikastlanishiga, jumladan, qovurgʻa va [[ko‘krak qafasi sinishi]]ga olib kelishi maʼlum. Ular saraton yoki revmatoid artrit kabi kasalliklar natijasida ham paydo boʻlishi mumkin. Keksa odamlarda yiqilish qovurgʻa sinishiga olib kelishi mumkin boʻlsa-da, voyaga yetganlarda avtohalokatlar bunday jarohatlar uchun keng tarqalgan hodisa hisoblanadi.
== Diagnostikasi ==
Qovurgʻa sinishi belgilari quyidagilarni oʻz ichiga olishi mumkin<ref>{{Cite web|url = http://www.nhs.uk/conditions/rib-injuries/Pages/Introduction.aspx|title = Broken or bruised ribs|date = 2015|access-date = 15 August 2015|website = NHS.UK|url-status = live|archive-url = https://web.archive.org/web/20150820045022/http://www.nhs.uk/conditions/rib-injuries/Pages/Introduction.aspx|archive-date = 20 August 2015}}</ref>:
* Nafas olishdagi ogʻriq

* Koʻkrak sohasida shish

* Koʻkrak sohasidagi jarohat

* Nafas qisishning kuchayishi

* Qonli yoʻtalishi (qovurgʻa oʻpkaga zarar yetkazgan boʻlishi mumkin)

Oddiy rentgen nurlari koʻpincha siljigan sinishlarni aniqlaydi, lekin koʻpincha siljimagan sinishlarni oʻtkazib yuboradi<ref name=Den2017>{{cite journal |last1=Dennis |first1=BM |last2=Bellister |first2=SA |last3=Guillamondegui |first3=OD |title=Thoracic Trauma. |journal=The Surgical Clinics of North America |date=October 2017 |volume=97 |issue=5 |pages=1047–1064 |doi=10.1016/j.suc.2017.06.009 |pmid=28958357}}</ref>. [[Kompyuter tomografiyasi]] odatda ikkala turdagi sinishlarni ham aniqlay oladi<ref name=Den2017/>.

Bolalarda koʻkrak qafasi devorlari kattalarga qaraganda egiluvchanroq boʻlgani sababli, ularning qovurgʻalari sinishdan koʻra egilishi ehtimoli koʻproq. Shuning uchun bolalarda qovurgʻa sinishlari mavjudligi katta miqdordagi kuchga ishora qiladi va oʻpka kontuziyasi kabi ogʻir koʻkrak shikastlanishlarini koʻrsatishi mumkin<ref name=Wanek04/>. Qovurgʻa sinishlari ham keksa odamlarda jiddiy jarohatlanishning belgisidir<ref>{{Cite journal|title = Fatality Risk and the Presence of Rib Fractures|journal = Annals of Advances in Automotive Medicine / Annual Scientific Conference|date = 2008-01-01|issn = 1943-2461|pmc = 3256783|pmid = 19026224|pages = 73–84|volume = 52|first1 = Richard|last1 = Kent|first2 = William|last2 = Woods|first3 = Ola|last3 = Bostrom}}</ref>.
<gallery widths="300px" heights="200px">
File:Rib fractures 2 -- Smart-Servier.png|3-, 4- va 5-qovurgʻadagi qovurgʻa sinishi tasvirlangan rasm
File:X-ray of rib fractures and pneumothorax.jpg|Oʻng tomondagi pnevmotoraks va qovurgʻa sinishlari
File:BrokenRidCTParaSag.png|Parasagittal [[Kompyuter tomografiyasi]]<nowiki/>da ikkita qovurgʻa singan
</gallery>

== Davolash ==
Qovurgʻa sinishlari uchun maxsus davolash usuli mavjud emas, lekin turli yordam choralari koʻrilishi mumkin. Oddiy qovurgʻa sinishlarida ogʻriq harakatning pasayishiga, yoʻtalning susayishiga olib kelishi va buning oqibatida esa koʻkrak qafasining ikkilamchi infektsiyasi rivojlanishiga hissa qoʻshishi mumkin<ref>{{cite journal |last1=Morice |first1=A H |last2=McGarvey |first2=L |last3=Pavord |first3=I |title=Recommendations for the management of cough in adults |journal=Thorax |volume=61  |issue=Suppl 1 |pages=i1–24 |year=2006 |pmid=16936230 |pmc=2080754 |doi=10.1136/thx.2006.065144 }}</ref>. Koʻkrak qafasi saratoni hayot uchun xavfli jarohat boʻlib, koʻpincha bir muncha vaqt davomida yordamchi ventilyatsiyani talab qiladi<ref>{{Cite book|title = Brunner & Suddarth's Textbook of Canadian Medical-surgical Nursing|url = https://books.google.com/books?id=SB_-CRXvZPYC&q=flail+chest+sometimes+needs+assisted+ventilation&pg=PA637|publisher = Lippincott Williams & Wil|page = 637|date = 2009-01-01|isbn = 9780781799898|language = en|first1 = Pauline|last1 = Paul|first2 = Beverly|last2 = Williams|url-status = live|archive-url = https://web.archive.org/web/20160629114720/https://books.google.com/books?id=SB_-CRXvZPYC&pg=PA637&lpg=PA637&dq=flail+chest+sometimes+needs+assisted+ventilation&source=bl&ots=LRmcVdhbz3&sig=KtI8XKo2R3QEdGiRIVK1ElqdaVw&hl=en&sa=X&ved=0CEQQ6AEwBmoVChMI84fwyaqrxwIVStKACh0AKwyV#v=onepage&q=flail%2520chest%2520sometimes%2520needs%2520assisted%2520ventilation&f=false|archive-date = 2016-06-29}}</ref>. Koʻkrak qafasi va qovurgʻaning birinchi sinishi yuqori darajali jarohatlar boʻlib, ular pastki ichki aʼzolarning shikastlanishini (masalan, oʻpka kontuziyasi) yoki masofadan turib (masalan, boʻyin umurtqa pogʻonasi shikastlanishi) tekshirishni talab qiladi. Sportchilardagi spontan sinishlar odatda ogʻriqni toʻxtatishni talab qiladi, masalan, yurak-qon tomir holatini saqlab qolish maqsadida qayiqda eshkak eshish lozim.

== Nerv blokadalari ==
Nerv blokadalari ogʻriqqa qarshi va qovurgʻa sinishi bilan bogʻliq nafas olish asoratlarini kamaytirish uchun ishlatilishi mumkin<ref>{{Cite journal |last1=Mladenovic |first1=Jordanna |last2=Erskine |first2=Ryan N. |last3=Riley |first3=Brooke |last4=Mitchell |first4=Andrew |last5=Abi-fares |first5=Catherine |last6=Basson |first6=Willem |last7=Anstey |first7=Chris |last8=White |first8=Leigh |date=2022-11-01 |title=The association between erector spinae plane block timing and reduced rib fracture related respiratory complications: A cohort study |url=https://www.sciencedirect.com/science/article/pii/S0952818022002987 |journal=Journal of Clinical Anesthesia |language=en |volume=82 |pages=110940 |doi=10.1016/j.jclinane.2022.110940 |pmid=35917775 |s2cid=251206240 |issn=0952-8180}}</ref>. Bularga [[rombsimon qovurg‘alararo blokada]]<ref name="Ökmen">{{cite journal |last1=Ökmen |first1=K |title=Efficacy of rhomboid intercostal block for analgesia after thoracotomy. |journal=The Korean Journal of Pain |date=1 April 2019 |volume=32 |issue=2 |pages=129–132 |doi=10.3344/kjp.2019.32.2.129 |pmid=31091512|pmc=6549589 }}</ref>, [[epidural anesteziya]], [[paravertebral blok|paravertebral blokada]], tiklovchi umurtqalar tekisligi blokadasi va [[serratus old yassi bloki|serratus oldingi tekislik blokadasi]] kiradi<ref>{{cite journal |last1=Wardhan |first1=R |title=Assessment and management of rib fracture pain in geriatric population: an ode to old age. |journal=Current Opinion in Anesthesiology |date=October 2013 |volume=26 |issue=5 |pages=626–31 |doi=10.1097/01.aco.0000432516.93715.a7 |pmid=23995061|s2cid=35082310 }}</ref><ref>{{cite book |last1=Grant |first1=Stuart A. |last2=Auyong |first2=David B. |title=Ultrasound Guided Regional Anesthesia |date=2016 |publisher=Oxford University Press |isbn=9780190630478 |page=PT388 |url=https://books.google.com/books?id=Rd8oDQAAQBAJ&pg=PT388 |language=en}}</ref><ref>{{Cite journal|last1=Riley|first1=B.|last2=Malla|first2=U.|last3=Snels|first3=N.|last4=Mitchell|first4=A.|last5=Abi-Fares|first5=C.|last6=Basson|first6=W.|last7=Anstey|first7=C.|last8=White|first8=L.|date=2020|title=Erector spinae and serratus anterior blocks for the management of rib fractures: A retrospective exploratory matched study|journal=The American Journal of Emergency Medicine|volume=38|issue=8|language=en|pages=1689–1691|doi=10.1016/j.ajem.2020.01.007|pmid=31932127|s2cid=210194417}}</ref>. Ogʻriqsizlantirish yoki xavfsizlik asosida bir asab blokadasidan boshqa blokadaga nisbatan foydalanishni qoʻllab-quvvatlaydigan dalillar juda kam<ref>{{Cite journal|last1=White|first1=L.|last2=Riley|first2=B.|last3=Malla|first3=U.|last4=Snels|first4=N.|last5=Mitchell|first5=A.|last6=Abi-Fares|first6=C.|last7=Basson|first7=W.|last8=Anstey|first8=C.|date=2020-08-15|title=ESB vs SAB in chest wall trauma, which is better?: A response and decision making guide|url=https://www.ajemjournal.com/article/S0735-6757(20)30687-2/abstract|journal=The American Journal of Emergency Medicine|volume=38|language=en|issue=10|pages=2221–2223|doi=10.1016/j.ajem.2020.08.004|pmid=32843243|s2cid=221328812|issn=0735-6757}}{{Dead link|date=November 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref>{{cite journal |last1=White |first1=L. D. |last2=Riley |first2=B. |last3=Davis |first3=K. |last4=Thang |first4=C. |last5=Mitchell |first5=A. |last6=Abi-fares |first6=C. |last7=Basson |first7=W. |last8=Anstey |first8=C. |title=Safety of Continuous Erector Spinae Catheters in Chest Trauma: A Retrospective Cohort Study |journal=Anesthesia & Analgesia |year=2021 |volume=133 |issue=5 |pages=1296–1302 |doi=10.1213/ANE.0000000000005730 |pmid=34473654 |url=https://journals.lww.com/anesthesia-analgesia/Abstract/9900/Safety_of_Continuous_Erector_Spinae_Catheters_in.220.aspx |issn=0003-2999|hdl=10072/407871 |s2cid=237400070 |hdl-access=free }}</ref>.

== Jarrohlik ==
Qovurgʻa sinishlarini ichki fiksatsiya/taʼmirlash uchun davolash usullari quyidagilarni oʻz ichiga oladi:

* Judet va/yoki sanches plitalari/strutlar qovurgʻa atrofida egiluvchi chiziqlar boʻlgan metall plastinka boʻlib, keyin yana tikuvlar bilan mahkamlanadi<ref>{{cite journal |last1=Fitzpatrick |first1=D. C. |last2=Denard |first2=P. J. |last3=Phelan |first3=D. |last4=Long |first4=W. B. |last5=Madey |first5=S. M. |last6=Bottlang |first6=M. |title=Operative stabilization of flail chest injuries: review of literature and fixation options |journal=European Journal of Trauma and Emergency Surgery |volume=36 |issue=5 |pages=427–33 |year=2010 |pmid=21841954 |pmc=3150812 |doi=10.1007/s00068-010-0027-8 }}</ref>.
* Bu borada turli xil qovurgʻa fiksatsiyasi tizimlar bor. Ularda ikkita variant mavjud: plastinkani qovurgʻaga mahkamlash uchun vintlardan foydalanadigan old konturli metall plita yoki qovurgʻaga tunnel qilingan va oʻrnatilgan vint bilan mahkamlangan ichki medullyar splint<ref>{{cite book|last1=Mathison|first1=Douglas|title=Master Techniques in Surgery: Thoracic Surgery: Transplantation, Tracheal Resections, Mediastinal Tumors, Extended Thoracic Resections|date=2014|publisher=Walters-Kluwer Health|isbn=978-1-46988-903-0|url=https://books.google.com/books?id=2u8NBQAAQBAJ&q=Synthes+MatrixRIB+Fixation+System&pg=PT338|access-date=15 August 2015|url-status=live|archive-url=https://web.archive.org/web/20160512081713/https://books.google.com/books?id=2u8NBQAAQBAJ&pg=PT338&dq=Synthes+MatrixRIB+Fixation+System&hl=en&sa=X&ved=0CB4Q6AEwAGoVChMIgZ_dpZ2rxwIVypWACh3JUwpm#v=onepage&q=Synthes%20MatrixRIB%20Fixation%20System&f=false|archive-date=12 May 2016}}{{Google books}}</ref>.
* Old qulflash plitalari metall plitalar boʻlib, ular plita boʻylab vintlar uchun teshiklarga ega. Plastinka qovurgʻa ustida joylashgan va kerakli holatda suyakka burab kiritiladi. Plitalar kesimning konturiga mos kelishi uchun egilishi mumkin<ref>{{Cite book|title = Skeletal Trauma: Basic Science, Management, and Reconstruction|url = https://books.google.com/books?id=IDXgoS0vLFQC&q=anterior+locking+plate&pg=PA1418|publisher = Elsevier Health Scien|page = 1418|date = 2009-01-01|isbn = 978-1416022206|language = en|first = Bruce D.|last = Browner|url-status = live|archive-url = https://web.archive.org/web/20160508172225/https://books.google.com/books?id=IDXgoS0vLFQC&pg=PA1418&dq=anterior+locking+plate&hl=en&sa=X&ved=0CD4Q6AEwBmoVChMIzNqshZyrxwIVy9SACh1ozgL0#v=onepage&q=anterior%2520locking%2520plate&f=false|archive-date = 2016-05-08}}</ref>.
* U-plastinkalarni qulflovchi vintlar yordamida qovurgʻalarning yuqori qismiga mahkamlash uchun ham ishlatish mumkin<ref>{{cite journal |last1=de Jong |first1=M. B. |last2=Kokke |first2=M. C. |last3=Hietbrink |first3=F. |last4=Leenen |first4=L. P. H. |title=Surgical Management of Rib Fractures: Strategies and Literature Review |journal=Scandinavian Journal of Surgery |volume=103 |issue=2 |pages=120–25 |year=2014 |pmid=24782038 |doi=10.1177/1457496914531928 |s2cid=11113635 |doi-access=free }}</ref>.

== Yana qarang ==
* [[Pulmonary hygiene]]

== Manbalar ==
{{Reflist}}

== Havolalar ==
* {{ICD10|S|22|3|s|20}}-{{ICD10|S|22|4|s|20}}
* {{ICD9|807.0}}, {{ICD9|807.1}}
* {{eMedicine2|radio|609}}

[[Turkum:Suyak sinishi]]
[[Turkum:Ko'krak jarrohligi]]
[[Turkum:Tez tibbiy yordam]]