Emva kokuphuka, ithambo kunye nezicubu ezijikelezileyo zonakaliswe, kwaye kukho imigaqo yonyango eyahlukeneyo kunye neendlela ngokwezinga lokulimala. Ngaphambi kokunyanga zonke iifractures, kubalulekile ukucacisa ubungakanani bokulimala.
Ukulimala kwezicubu ezithambileyo
I.Ukuhlelwa
Ukuqhekeka okuvaliweyo
Ukulimala kwezicubu ezithambileyo zihlelwa ukusuka kumncinci ukuya kubunzima, ngokuqhelekileyo zisebenzisa indlela yeTscherne (Umfanekiso 1)
Ukulimala kweBanga le-0: Ukwenzakala kwezicubu ezithambileyo ezincinci
Ukulimala kweBanga loku-1: Ukulimala okungaphezulu okanye ukuqhawuka kweethishu ezithambileyo ezigqume indawo yokwaphuka
Ukwenzakala kwiBanga lesi-2: ukuqhawuka kwezihlunu okubalulekileyo okanye ukosuleleka kolusu okanye zombini
Ukulimala kweBanga lesi-3: Ukulimala okubuhlungu kwezicubu ezithambileyo kunye nokufuduka kakhulu, ukutyunyuzwa, i-compartment syndrome, okanye ukulimala kwemithambo
Umzobo1: Ulwahlulo lweTscherne
Vula ukwaphuka
Ngenxa yokuba i-fracture inxibelelana nehlabathi langaphandle, iqondo lomonakalo wezicubu ezithambileyo lihambelana nomthamo wamandla afunyenwe yilungu ngexesha lokuxhatshazwa, kwaye ulwahlulo lwe-Gustilo ludla ngokusetyenziswa (Umfanekiso 2)
Umzobo2:GustiloClassification
Uhlobo I: Ukucoca ubude benxeba < 1 cm, umonakalo omncinci we-muscle, akukho nto icacileyo ye-periosteal exfoliation Uhlobo II: ubude benxeba> 1 cm, akukho monakalo ocacileyo wezicubu ezithambileyo, ukubunjwa kwe-flap okanye ukulimala kwe-avulsion
Uhlobo lwe-III: Uluhlu lwesilonda lubandakanya ulusu, i-muscle, i-periosteum, kunye nethambo, kunye nokuxhatshazwa okukhulu, kubandakanywa neentlobo ezikhethekileyo zezilonda kunye nokulimala kwefama.
Uhlobo lwe-III: Ungcoliseko olubanzi kunye / okanye ubukho bezilonda ezithambileyo ezinzulu, izicubu ezithambileyo ezinokugubungela okwaneleyo kwamathambo kunye nezakhiwo ze-neurovascular
Uhlobo lwe-IIIb: kunye nomonakalo omkhulu wezicubu ezithambileyo, i-Rotational okanye i-metastases ye-muscle yamahhala iyafuneka ngexesha lonyango ukufezekisa ukugubungela.
Uhlobo lwe-IIIc: Ukuvula iifractures kunye nomonakalo we-vascular odinga ukulungiswa kwencwadi ye-Gustilo ukuhlelwa kwe-Gustilo kudla ukuba kubi ngakumbi ngokuhamba kwexesha, kunye neenguqu kwibakala lokulimala eliphawulwe ngexesha lokulungiswa.
II.Ulawulo lokwenzakala
Ukuphulukiswa kwesilonda kufuna i-oxygenation, ukusebenza kweendlela zeselula, ukucocwa kwamanxeba angenayo i-necrotic necrotic tissue. Kukho amanqanaba amane aphambili okuphilisa: ukujija (imizuzu); isigaba sokuvuvukala (iiyure); inqanaba lezicubu zegranulation (iintsuku zibaliwe); Ixesha lokuqulunqwa kwezicubu ezibomvu (iiveki).
Inqanaba lonyango
Inqanaba elibukhali:ukunkcenkceshela amanxeba, ukuchithwa, ukwakhiwa kwakhona kwamathambo, kunye nokubuyiselwa koluhlu lwezindululo
(1) Vavanya ubungakanani bokulimala kwezicubu ezithambileyo kunye nokulimala kwe-neurovascular
(2)Sebenzisa isixa esikhulu se-isotonic fluid ukunkcenkceshela ukunkcenkceshela kwigumbi lokusebenza ukususa izicubu ze-necrotic kunye nemizimba yangaphandle.
(3) Ukutshatyalaliswa kwenziwa rhoqo kwiiyure ezingama-24 ~ 48 ukususa yonke imizimba yangaphandle kunye nezicubu ze-necrotic kwinxeba de inxeba livalwe okanye ligqunywe ngokupheleleyo (4) Inxeba elivulekileyo landiswa ngokufanelekileyo, izicubu ezinzulu zibonakaliswe ngokupheleleyo, kwaye uvavanyo olusebenzayo kunye nokutshatyalaliswa kwenziwa.
(5)Isiphelo sasimahla sokuqhekeka sirholwa kwinxeba; Icortex encinci engasebenziyo iyasuswa ukuze kuhlolwe kwaye kucocwe umongo wethambo
Ukwakhiwa ngokutsha:ukujongana ne-sequelae yokwenzakala (ukulibaziseka komanyano, ukunganyaniseki, ukukhubazeka, usulelo)
Ukuchacha:Psychological, social, and occupational regression of the patient
Uhlobo lokuvalwa kwenxeba kunye nokugubungela
Ukuvalwa kwangaphambili kwenxeba okanye ukugubungela (iintsuku ezi-3 ~ 5) kunokufikelela kwiziphumo zonyango ezanelisayo: (1) ukuvalwa okuphambili
(2)ukuvalwa okulibazisekileyo
(3)ukuvalwa okwesibini
(4)ufakelo lweflap etyebileyo ephakathi
(5)iflap yokuzithandela (iflap yedijithali ekufuphi)
(6) i-vascular pedicle flap (i-gastrocnemius flap)
(7) i-flap yasimahla (umzobo 3)
Umzobo3:Iimbono ezingaphelelanga zofakelo lwasimahla zihlala zibonelelwa
Umonakalo wamathambo
I.Indlela yomgca wokuqhekeka
Uguqulo: Ipatheni yomthwalo wokwaphuka okunqamlezayo okubangelwa kukuxinezeleka
obliquely: Imo yomthwalo woxinzelelo ngenxa ye-diagonal fracture
I-Spiral: Ipateni yomthwalo wokwaphuka komqolo ngenxa yokwaphuka okujikelezayo
II.Ukwaphuka
Ukwahlula ngokwezahlulo, iintlobo zokuqhekeka, njl. (Umfanekiso 4)
Ukuqhekeka okuxutywayo kukuqhekeka kunye ne-3 okanye ngaphezulu kwamathambo aphilileyo aphilayo, ngokuqhelekileyo ngenxa yokulimala okuphezulu kwamandla.
I-Pratlical Fracture Fracture Fracture ye-Fracture yenzeka kwindawo yethambo lesi sifo sangaphambili, kubandakanya: i-tumoor yethambo, i-bone metastases, i-osteoporolic, njl
Izaphulelo ezingaphelelanga aziqhekeki zibe ngamacandelo ahlukeneyo amathambo
Ukuqhekeka kweSegmental kunye ne-distal, middle, kunye ne-proximal fracture fragments. Icandelo eliphakathi lichaphazeleka ngokunikezelwa kwegazi, ngokuqhelekileyo ngenxa yokulimala okuphezulu kwamandla, kunye ne-soft tissue detachment esuka kwithambo, ebangela iingxaki zokuphulukiswa kwamathambo.
Ukuqhekeka okuneziphene zamathambo, ukuvuleka okuvulekileyo kunye namathambo amathambo, okanye i-trauma-inactive fractures ekufuneka ihlanjululwe, okanye iifractures ezinzima ezibangelwa amathambo.
Ukuqhekeka ngamaqhekeza amathambo e-butterfly kufana nokuqhekeka kwamacandelo kuba akubandakanyi yonke i-cross-section yethambo kwaye ngokuqhelekileyo isiphumo sobundlobongela obugoba.
Ukuqhekeka kwengcinezelo kubangelwa yimithwalo ephindaphindiweyo kwaye kaninzi kwenzeka kwi-calcaneus kunye ne-tibia.
I-Avulsion fractures ibangela ukuphulwa kwendawo yokufakwa kwethambo xa i-tendon okanye i-ligament iluliwe.
Iifractures zoxinzelelo ziqhekeza apho amathambo amathambo agxininiswe, ngokuqhelekileyo yimithwalo ye-axial.
Umzobo 4: Ukuhlelwa kweefractures
III.Izinto eziphembelela ukuphiliswa kokwaphuka
Izinto zebhayoloji: ubudala, isifo se-metabolic, isifo esisisiseko, inqanaba lokusebenza, imeko yesondlo, umsebenzi we-neurological, umonakalo wemithambo, iihomoni, ukukhula, imeko yezempilo ye-capsule yezicubu ezithambileyo, inqanaba lobuncinci (ukuqhekeka okuvulekileyo), ukutshaya, amayeza, i-pathology yendawo, inqanaba lamandla abuhlungu, uhlobo lwethambo, inqanaba lesiphene samathambo, imiba yomatshini, inqanaba lokuncamathela kwithambo, ukuqina, ukuqina kwezicubu ezithambileyo. yesiphene samathambo.
IV. Iindlela zonyango
Unyango olungenalo utyando luboniswa kwizigulane ezinokulimala okuphantsi kwamandla okanye ezingasebenziyo ngenxa yezinto zenkqubo okanye zendawo.
Ukunciphisa: ukutsala ecaleni kwe-axis ende yelungu, ukuhlukana kwe-fracture.
Ukulungiswa kwebrace kuzo zombini iziphelo zokuphuka kwakhona: ukulungiswa kwethambo elincitshisiweyo ngokulungiswa kwangaphandle, kubandakanywa ubuchule bokulungiswa kwamanqaku amathathu.
I-tubular bone i-continuous compression fixation technique traction: indlela yokunciphisa, kubandakanywa ukutsalwa kwesikhumba, ukutsalwa kwethambo.
Unyango lotyando
(1) Ukulungiswa kwangaphandle kukulungele ukuphuka okuvulekileyo, ukuqhekeka okuvaliweyo kunye nokulimala okukhulu kwezicubu ezithambileyo, kunye nokuphuka okuhamba kunye nokusuleleka (umzobo 5)
Umzobo 5: Inkqubo yokulungiswa kwangaphandle
(2) Ukulungiswa kwangaphakathi kuyasebenza kwezinye iintlobo zeefractures kwaye zilandela umgaqo we-AO (iThebhile 1)
Itheyibhile 1: Ukuziphendukela kwe-AO kunyango lokwaphuka
Iingceba ze-Interfracture zifuna ukulungiswa koxinzelelo, kubandakanywa ukunyanzeliswa kwe-static (i-compression screws), ucinezelo oluguquguqukayo (izikhonkwane ze-intramedullary ezingatshixwanga), ukuqhekeka (ukutyibilika phakathi kwento yangaphakathi kunye nethambo), kunye nokulungiswa kwebhulorho (izinto zangaphakathi ezithatha indawo edibeneyo)
(4)Unciphiso olungathanga ngqo:
Itekhnoloji ye-traction iphunyezwe kwindawo edibeneyo yokunciphisa i-fragment ngokusebenzisa ukunyanzeliswa kwezicubu ezithambileyo, kwaye i-traction force iphuma kwisixhobo se-femoral traction, i-fixator yangaphandle, isixhobo se-AO esidibeneyo okanye i-lamina opener.
V.Inqanaba lonyango
Ngokwenkqubo ye-biochemical yokuphulukiswa kwe-fracture, ihlulwe ibe yizigaba ezine (iThebhile 2). Ngexesha elifanayo, kudibaniswa nenkqubo ye-biochemical, unyango lwe-fracture luhlukaniswe ngamanyathelo amathathu, okukhuthaza ukugqitywa kwenkqubo yezinto eziphilayo kunye nokuphulukiswa kokuphuka (umzobo 6).
Itheyibhile 2: Ikhondo lobomi lokuphiliswa kokwaphuka
Umzobo 6: Umzobo weSchematic of fracture impiliso kwiigundane
Inqanaba lokukrala
I-Hemorrhage evela kwindawo yokuphuka kunye nezicubu ezithambileyo ezijikelezayo zenza i-hematoma, iifom ze-fibrovascular tissue ekupheleni kokuqhekeka, kunye ne-osteoblasts kunye ne-fibroblasts ziqala ukwanda.
Ixesha lokuphumla
Impendulo ye-callus yasekuqaleni iyenzeka kwiiveki ze-2, kunye nokuqulunqwa kwe-cartilage skeleton elandelwa ukubunjwa kwefowuni ngokusebenzisa i-endochondral ossification, kwaye zonke iindlela ezithile zokuphulukiswa kwe-fracture zihambelana nendlela yonyango.
Uhlaziyo
Ngethuba lenkqubo yokulungisa, ithambo eliphothiweyo elibunjiweyo lithatyathelwa indawo yithambo le-lamellar, kwaye i-medullary cavity ihlaziywa ukuphawula ukugqitywa kokulungiswa kwe-fracture.
Ukuntsonkotha
Umanyano olulibazisekileyo lubonakaliswa ikakhulu kukuqhekeka okungapholiyo ngexesha elilindelekileyo, kodwa kusenomsebenzi othile webhayoloji, kwaye izizathu zokulibaziseka komanyano ziyahlukahlukana, ezinxulumene nezinto ezichaphazela ukuphiliswa kokwaphuka.
I-Nonunion ibonakaliswa njengokwaphuka ngaphandle kobungqina bokuphilisa kweklinikhi okanye ngeradiyoloji, kwaye eyona nto iyinyani yile:
(1) I-atrophic nonunion ngenxa yokungabikho kwe-vascularization kunye nokungabikho kobuchule bebhayoloji bokuphilisa, ngokuqhelekileyo kubonakaliswe njenge-stenosis yokuphela kwethambo kwaye akukho mithambo yegazi, kwaye inkqubo yonyango idinga ukuvuselela umsebenzi we-biological wendawo (i-bone graft okanye i-bone cortical resection kunye nokuthuthwa kwethambo).
(2) I-Hypertrophic nonunion ine-transitional vascularization kunye nobuchule be-biological, kodwa ayinakho ukuzinza komatshini, okubonakaliswa ngokuqhelekileyo njengokugqithiswa kwesiphelo esiphukileyo sokuphuka, kwaye unyango lufuna ukunyusa ukuzinza komatshini (i-bone plate kunye ne-screw fixation).
(3) I-dystrophic nonunion inonikezelo lwegazi olwaneleyo, kodwa akukho phantse ukubunjwa kwe-callus, kwaye ukuncitshiswa kwe-fracture kufuneka kuqhutywe kwakhona ngenxa yokungonelanga kokufuduka kunye nokunciphisa isiphelo esiphukileyo sokuphuka.
(4) Kwi-nonunion eyosulelayo kunye nosulelo olungapheliyo, unyango kufuneka luqale lususe ugxininiso losulelo, kwaye lukhuthaze ukuphiliswa kwe-fracture. Usulelo lwethambo i-osteomyelitis sisifo sethambo kunye nosulelo lwethambo, olunokuthi lube lusulelo oluthe ngqo lwamanxeba avulekileyo okanye usulelo lwe-pathogenic ngokusebenzisa imizila yegazi, kwaye kuyimfuneko ukuchonga i-microorganisms ezosulelekileyo kunye ne-pathogens phambi kokuba unyango.
I-syndrome ye-complex yengingqi yeentlungu ibonakaliswe yintlungu, i-hyperesthesia, i-allergies ye-allergies, ukuhamba kwegazi okungaqhelekanga kwendawo, ukujuluka, kunye ne-edema, kuquka ukungaqhelekanga kwenkqubo ye-nervous autonomic. Ngokuqhelekileyo kwenzeka emva komonzakalo kunye notyando, kwaye ifunyenwe kwaye inyangwe kwangoko, kunye ne-nerve block block ukuba kuyimfuneko.
• I-Heterotopic ossification (HO) ixhaphake emva kokulimala okanye utyando, kwaye ixhaphake kakhulu kwi-elbow, i-hip, kunye nethanga, kunye ne-bisphosphonates yomlomo inokuthintela i-mineralization yamathambo emva kokuqala kweempawu.
• Uxinzelelo kwi-periophysal compartment inyuka ukuya kwinqanaba elithile, ukuphazamisa ukugqithiswa kwangaphakathi.
• Ukulimala kwe-Neurovascular kunezizathu ezahlukeneyo zokulimala kwe-neurovascular ngenxa yeendawo ezahlukeneyo ze-anatomical.
• I-Avascular necrosis yenzeke kwiindawo zokungabikho kwegazi okwaneleyo, Ngokukodwa, jonga ukulimala kunye nendawo ye-anatomical, njl., kunye nomonakalo ongenakuguqulwa.
Ixesha lokuposa: Dec-31-2024
