Emva kokuqhekeka, ithambo kunye nezicubu ezingqongileyo zonakele, kwaye kukho imigaqo eyahlukeneyo yonyango kunye neendlela ngokwenqanaba lokwenzakala. Ngaphambi kokunyanga zonke iiqhekeka, kubalulekile ukufumanisa ubungakanani bengozi.
Ukulimala kwezicubu ezithambileyo
I. Ukwahlulahlula
Iimfucumfucu ezivaliweyo
Ukulimala kwezicubu ezithambileyo kulinganiswa ukusuka kokuncinci ukuya kokukhulu, kusetyenziswa indlela yeTscherne (Umzobo 1)
Ukulimala kwebanga lesi-0: Ukulimala okuncinci kwezicubu ezithambileyo
Ukulimala kweGrade 1: ukukrazulwa okungaphezulu okanye ukudumba kwezicubu ezithambileyo ezigquma indawo yokuqhekeka
Ukulimala kweGrade 2: ukudumba okukhulu kwemisipha okanye ukudumba kwesikhumba okungcolisiweyo okanye zombini
Ukulimala kwebanga lesi-3: Ukulimala okukhulu kwezicubu ezithambileyo kunye nokushukuma okukhulu, ukutyumza, isifo sendawo, okanye ukwenzakala kwemithambo yegazi
Umzobo1: Ulwahlulo lweTscherne
Ukwaphuka Okuvulekileyo
Ngenxa yokuba ukwaphuka kunxulumene nehlabathi langaphandle, ubungakanani bomonakalo wezicubu ezithambileyo buhambelana nobungakanani bamandla afunyanwa lilungu ngexesha lokwenzakala, kwaye udidi lweGustilo ludla ngokusetyenziswa (Umfanekiso 2)
Umfanekiso 2: Ukwahlulwahlulwa kweGustilo
Uhlobo I: Ubude benxeba elicocekileyo < 1 cm, umonakalo omncinci wemisipha, akukho kususwa kwesikhumba okucacileyo Uhlobo II: ubude benxeba > 1 cm, akukho monakalo ucacileyo wezicubu ezithambileyo, ukwakheka kweflephu okanye ukwenzakala kwe-avulsion
Uhlobo lwesithathu: Uluhlu lwamanxeba luquka ulusu, izihlunu, i-periosteum, kunye nethambo, kunye nokulimala okukhulu, kuquka iintlobo ezikhethekileyo zamanxeba okudutyulwa kunye nokwenzakala efama
Uhlobo lwe-IIIa: Ungcoliseko olusasazekayo kunye/okanye ukubakho kwezilonda ezinzulu zezicubu ezithambileyo, izicubu ezithambileyo ezigqunywe ngokwaneleyo zizakhiwo zamathambo kunye nemithambo-luvo
Uhlobo lwe-IIIb: xa kukho umonakalo omkhulu kwizicubu ezithambileyo, kufuneka i-Rotational okanye i-free muscle metastases ngexesha lonyango ukuze kufumaneke ukugutyungelwa
Uhlobo lwe-IIIc: Ukuqhekeka okuvulekileyo okunomonakalo wemithambo yegazi ofuna ukulungiswa ngesandla Ukwahlulwahlulwa kweGustilo kudla ngokuba mandundu ngokuhamba kwexesha, kunye notshintsho kwinqanaba lokulimala oluphawulwayo ngexesha lokulungiswa.
II. Ulawulo lokulimala
Ukuphiliswa kwenxeba kufuna ioksijini, ukusebenza kweendlela zeeseli, ukucocwa kwamanxeba angenazo izicwili ezingcolisiweyo nezifileyo. Kukho amanqanaba amane aphambili okuphiliswa: ukujiya (imizuzu); isigaba sokudumba (iiyure); isigaba sezicubu zegranulation (iintsuku ezibaliweyo); ixesha lokwakheka kwezicwili (iiveki).
Ukubekwa kwinqanaba lonyango
Isigaba esikhawulezileyo:ukunkcenkceshela amanxeba, ukususwa kweentsholongwane, ukwakhiwa kwakhona kwamathambo, kunye nokubuyiselwa komgama wokuhamba
(1) Vavanya ubungakanani bokwenzakala kwezicubu ezithambileyo kunye nokulimala okunxulumene nemithambo-luvo
(2) Sebenzisa isixa esikhulu solwelo lwe-isotonic ukunkcenkceshela okuphefumlayo kwigumbi lokutyanda ukususa izicubu ezifileyo kunye nemizimba yangaphandle
(3) Ukucoca inxeba kwenziwa rhoqo emva kweeyure ezingama-24 ukuya kuma-48 ukususa zonke izidumbu zangaphandle kunye nezicubu ezifileyo enxebeni de inxeba livalwe okanye ligqunywe ngokupheleleyo (4) Inxeba elivulekileyo lolulwe ngokufanelekileyo, izicwili ezinzulu zivele ngokupheleleyo, kwaye uvavanyo olusebenzayo kunye nokucoca inxeba kwenziwa.
(5) Isiphelo sokuqhekeka kwamahhala sibuyiselwa enxebeni; I-cortex encinci engasebenziyo iyasuswa ukuze kuhlolwe kwaye kucocwe umngxuma womongo wethambo.
Ukwakhiwa kwakhona:ukujongana neziphumo zengozi (ukulibaziseka komanyano, ukungadibani, ukukhubazeka, usulelo)
Ukuchacha:Ukubuyela umva kwengqondo, intlalo, kunye nomsebenzi wesigulana
Uhlobo lokuvalwa kunye nokugqunywa kwenxeba
Ukuvalwa okanye ukugqunywa kwenxeba kwangethuba (iintsuku ezi-3 ukuya kwezi-5) kunokufezekisa iziphumo zonyango ezanelisayo: (1) ukuvalwa kwenxeba kokuqala
(2) ukuvalwa okulibazisekileyo
(3) ukuvalwa kwesibini
(4) ukufakelwa kwe-flap enobukhulu obuphakathi
(5) i-voluntary flap (i-digital flap esecaleni)
(6)i-vascular pedicle flap (i-gastrocnemius flap)
(7) i-free flap (Umzobo 3)
Umfanekiso 3: Imbono engaphelelanga yokufakelwa kwamahhala idla ngokunikezelwa
Umonakalo wethambo
I. Isikhokelo somgca wokwaphuka
I-Transverse: Ipatheni yomthwalo we-transverse fracture ebangelwa kukuxinana
ngokungangqalanga: Imo yomthwalo woxinzelelo ngenxa yokuqhekeka okuthe tyaba
I-Spiral: Ipatheni yomthwalo wokwaphuka kwe-torsional ngenxa yokuqhekeka kwe-spiral
II. Ukuqhekeka
Uhlu ngokwezaphuko, iintlobo zaphuko, njl.njl. (Umzobo 4)
Ukuqhekeka kwamathambo aqhekekileyo kukwaphuka kwamathambo aphilayo amathathu okanye ngaphezulu, okuhlala kubangelwa kukwenzakala okunamandla aphezulu.
Ukuqhekeka komgca wokuqhekeka kwenzeka kwindawo apho amathambo ewohloka khona kwisifo sangaphambili, kuquka: ithumba lamathambo eliphambili, ukusasazeka kwe-bone metastases, i-osteoporosis, isifo samathambo esitshintshatshintshayo, njl.
Ukuqhekeka okungaphelelanga akuqhekeki kube ziingceba zamathambo ezahlukeneyo
Ukuqhekeka kwecandelo kunye neziqwenga zokuqhekeka ezikude, eziphakathi, kunye nezikufutshane. Icandelo eliphakathi lichaphazeleka kukunikezelwa kwegazi, ngokuqhelekileyo ngenxa yokwenzakala kwamandla aphezulu, kunye nokuqhekeka kwezicubu ezithambileyo kwithambo, okubangela iingxaki zokuphiliswa kwethambo.
Ukuqhekeka okuneziphene zamathambo, ukwaphuka okuvulekileyo okuneziqwenga zamathambo, okanye ukwaphuka okungasebenziyo ngenxa yokwenzakala okanye ukwaphuka okunzima okubangela iziphene zamathambo.
Ukuqhekeka okuneenxalenye zamathambo ebhabhathane kufana nokuqhekeka kwecandelo kuba akubandakanyi lonke icandelo lethambo kwaye kudla ngokuba yimiphumo yogonyamelo olugobileyo.
Ukwaphuka koxinzelelo kubangelwa yimithwalo ephindaphindayo kwaye kudla ngokuvela kwi-calcaneus kunye ne-tibia.
Ukuqhekeka kwethambo ngenxa yokuvuvukala kubangela ukwaphuka kwendawo yokufaka ithambo xa i-tendon okanye i-ligament yoluliwe.
Ukuqhekeka koxinzelelo kukwaphuka apho iziqwenga zamathambo zicinezelwa khona, ngokuqhelekileyo ngemithwalo ye-axial.
Umfanekiso 4: Uhlu lwezaphuko
III. Izinto ezichaphazela ukuphiliswa kwamathambo
Izinto zebhayoloji: ubudala, isifo samathambo esisebenza ngokwe-metabolic, isifo esisisiseko, inqanaba lokusebenza, imeko yesondlo, umsebenzi wemithambo-luvo, umonakalo wemithambo-luvo, iihomoni, izinto zokukhula, imeko yempilo ye-capsule yezicubu ezithambileyo, inqanaba lokungazali (ukuqhekeka okuvulekileyo), ukutshaya, amayeza, isifo sendawo, inqanaba lamandla okwenzakala, uhlobo lwethambo, inqanaba lesiphene sethambo, izinto ezisebenza ngomatshini, inqanaba lokuncamathela kwezicubu ezithambileyo emathanjeni, ukuzinza, ulwakhiwo lwe-anatomical, inqanaba lamandla okwenzakala, inqanaba lesiphene sethambo.
IV. Iindlela zonyango
Unyango olungelulo utyando luboniswa kwizigulane ezineengozi ezingasebenzi kakuhle okanye ezingakwaziyo ukuhlinzwa ngenxa yeemeko zenkqubo yomzimba okanye zasekuhlaleni.
Ukunciphisa: ukubambelela kumgca omde welungu, ukwahlukana kwamathambo.
Ukulungiswa kwe-brace kuzo zombini iziphelo zokwaphuka kwakhona: ukulungiswa kwethambo elinciphileyo ngokusebenzisa ukulungiswa kwangaphandle, kuquka nendlela yokulungiswa kwe-three-point.
Indlela yokuqinisa ucinezelo oluqhubekayo lwethambo le-tubular: indlela yokunciphisa, kuquka ukutsala ulusu, ukutsala amathambo.
Unyango lotyando
(1) Ukufakelwa kwangaphandle kufanelekile kwiingozi ezivulekileyo, iingozi ezivaliweyo ezineentlungu ezinkulu zezicubu ezithambileyo, kunye neengozi ezihamba nosulelo (Umzobo 5)
Umfanekiso 5: Inkqubo yokulungisa ngaphandle
(2) Ukulungiswa kwangaphakathi kusebenza kwezinye iintlobo zokwaphuka kwaye kulandela umgaqo we-AO (Itheyibhile 1)
Itheyibhile 1: Uphuhliso lwe-AO kunyango lokuqhekeka kwamathambo
Iziqwenga ze-interfracture zifuna ukulungiswa koxinzelelo, kuquka ukunyanzeliswa okungashukumiyo (izikrufu zoxinzelelo), uxinzelelo olunamandla (izipikili ze-intramedullary ezingatshixwanga), ukubopha (ukutyibilika phakathi kwento yangaphakathi kunye nethambo), kunye nokulungiswa kokubopha (izinto zangaphakathi ezigubungela indawo edibeneyo)
(4) Ukunciphisa okungathanga ngqo:
Itekhnoloji yokutsala isetyenziswa kwindawo eqhekeziweyo ukuze kuncitshiswe isiqwenga ngokusebenzisa uxinzelelo lwezicubu ezithambileyo, kwaye amandla okutsala afunyanwa kwisixhobo sokutsala se-femoral, i-external fixator, isixhobo sokutsala amalungu esidibeneyo se-AO okanye i-lamina opener.
V. Ukucwangcisa unyango
Ngokwenkqubo ye-biochemical yokuphiliswa kwamathambo, yahlulwe yangamanqanaba amane (Itheyibhile 2). Kwangaxeshanye, xa idibene nenkqubo ye-biochemical, unyango lwamathambo lwahlulwe ngamanqanaba amathathu, nto leyo ekhuthaza ukugqitywa kwenkqubo ye-biochemical kunye nokuphiliswa kwamathambo (Umzobo 6).
Itheyibhile 2: Ubomi bokuphilisa ukwaphuka kwamathambo
Umfanekiso 6: Umzobo wesicwangciso sokuphiliswa kwamathambo kwiimpuku
Isigaba sokudumba
Ukopha kwegazi okuvela kwindawo yokuqhekeka kunye nezicubu ezithambileyo ezingqongileyo kwenza i-hematoma, izicubu ze-fibrovascular zakha kwisiphelo esiqhekekileyo, kwaye ii-osteoblasts kunye ne-fibroblasts ziqala ukwanda.
Ixesha lokungasebenzi
Impendulo yokuqala ye-callus yenzeka kwiiveki ezimbini, ngokwenziwa kwe-cartilage skeleton kulandele ukwakheka kwe-callus nge-endochondral ossification, kwaye zonke iindlela ezithile zokuphiliswa kwamathambo zinxulumene nendlela yonyango.
Ukwakhiwa kwakhona
Ngexesha lenkqubo yokulungisa, ithambo elilukiweyo elenziweyo lithatyathelw’ indawo yithambo le-lamellar, kwaye umgodi we-medullary uyahlengahlengiswa ukuze kuphawulwe ukugqitywa kokulungiswa kokuqhekeka.
Ingxaki
Ukulibaziseka kokudibana kwelungu kubonakala kakhulu ngokuba ukwaphuka kungapholi ngexesha elilindelekileyo, kodwa kusenomsebenzi othile webhayoloji, kwaye izizathu zokulibaziseka kokudibana kwelungu zahlukile, ezinxulumene nezinto ezichaphazela ukuphiliswa kokwaphuka kwelungu.
Ukungabandakanywa komzimba kubonakaliswa njengokuqhekeka ngaphandle kobungqina bonyango lwezonyango okanye lwe-radiological, kwaye izinto eziphambili eziqatshelwayo zezi:
(1) Ukungadibani okubangelwa kukungasebenzi kakuhle kwemithambo yegazi kunye nokungabikho kwamandla ebhayoloji okuphilisa, okubonakala ngokuqaqamba kwesiphelo sethambo esiphukileyo kunye nokungabikho kwemithambo yegazi, kwaye inkqubo yonyango ifuna ukukhuthazwa komsebenzi webhayoloji wasekuhlaleni (ukufakelwa kwamathambo okanye ukususwa kwethambo kunye nokuthuthwa kwamathambo).
(2) I-Hypertrophic nonunion ine-transitional vascularization kunye nobuchule bebhayoloji, kodwa ayinazo uzinzo loomatshini, oluhlala lubonakala njengokukhula kakhulu kwesiphelo esiqhekekileyo sokwaphuka, kwaye unyango lufuna ukwandisa uzinzo loomatshini (i-bone plate kunye ne-screw fixation).
(3)I-dystrophic nonunion inegazi elaneleyo, kodwa phantse akukho ukwakheka kwe-callus, kwaye ukunciphisa ukwaphuka kufuneka kwenziwe kwakhona ngenxa yokungafuduki ngokwaneleyo kunye nokunciphisa isiphelo esiqhekekileyo sokwaphuka.
(4) Xa usulelo lungadibani nosulelo olungapheliyo, unyango kufuneka luqale lususe ugxininiso losulelo, luze emva koko lukhuthaze ukuphiliswa kwamathambo. I-osteomyelitis yosulelo lwamathambo sisifo sosulelo lwamathambo namathambo, esinokuba lusulelo oluthe ngqo lwamanxeba avulekileyo okanye usulelo olubangela izifo ngokusebenzisa iindlela zegazi, kwaye kuyimfuneko ukuchonga iintsholongwane kunye neentsholongwane ezisulelekileyo ngaphambi konyango.
I-Complex regional pain syndrome ibonakaliswa ziintlungu, i-hyperesthesia, i-allergies yemilenze, ukuhamba kwegazi okungaqhelekanga, ukubila, kunye nokudumba, kubandakanya nokungahambi kakuhle kwenkqubo ye-autonomic nervous. Ihlala isenzeka emva kokwenzakala notyando, kwaye ifunyanwa kwaye inyangwe kwangethuba, nge-sympathetic nerve block ukuba kuyimfuneko.
• I-Heterotopic ossification (HO) ixhaphakile emva kokwenzakala okanye utyando, kwaye ixhaphake kakhulu kwingqiniba, esinqeni, nasethangeni, kwaye i-oral bisphosphonates inokuthintela ukwakheka kwamathambo emva kokuba iimpawu ziqalile.
• Uxinzelelo olukwi-periophysal compartment luyanda ukuya kwinqanaba elithile, nto leyo ephazamisa ukuvuza kwamanzi ngaphakathi.
• Ukulimala kwemithambo-luvo kunezizathu ezahlukeneyo zokulimala kwemithambo-luvo ngenxa yeendawo ezahlukeneyo zomzimba.
• I-Avascular necrosis yenzeka kwiindawo apho igazi lingaphelelanga khona, Ngokukodwa, bona ukwenzakala kunye nendawo yomzimba, njl.njl., kwaye kwenzeka umonakalo ongenakuguqulwa.
Ixesha leposi: Disemba-31-2024
