Ngemuva kokuphuka, amathambo nezicubu ezizungezile azimele, futhi kunezimiso ezahlukahlukene zokwelashwa nezindlela ngokuya ngezinga lokulimala. Ngaphambi kokukwelapha konke ukuqhekeka, kubalulekile ukuthola ubukhulu bokulimala.
Ukulimala kwezicubu ezithambile
I.Classification
Ama-Fractures avaliwe
Ukulimala kwezicubu ezithambile kufakwe umnene kuya kubunzima, imvamisa kusetshenziswa indlela ye-TScherne (Fig. 1)
Ibanga0 ukulimala kwebanga: ukulimala kwezicubu ezincane ezithambile
Ukulimala kwebanga
Ibanga le-Grade2: Ukukhishwa kwemisipha okubalulekile noma ukungcoliswa kwesikhumba okungcolisiwe noma zombili
Ukulimala kweGrade3: Ukulimala kwezicubu ezithambile ezinzima ngokuxoshwa okukhulu, ukuchoboza, i-agred syndrome, noma ukulimala kwemithambo
Umdwebo1: Ukuhlukaniswa kweTScherne
Vula ukwaphuka
Ngoba ukuqhekeka kungokuxhumana nomhlaba wangaphandle, izinga lomonakalo wezicubu ezithambile lihlobene nenani lamandla atholakele yi-limb ngesikhathi sokuhlukumezeka, futhi ukuhlukaniswa kwe-gustilo kuvame ukusetshenziswa (isithombe 2)
Umdwebo2: I-GustilocLaskussion
Uhlobo I: Ubude obuhlanzekile benxeba <1 cm, ukulimala kwemisipha okuncane, akukho okusobala okusobala kwe-periosteal hlobo II: ubude be-FNLE> 1 cm> Akukho ukulimala kwezicubu ezithambile, ukwakheka kwe-ashulsion
Uhlobo lwe-III: Uhla lwe-FNINY lubandakanya isikhumba, izicubu, i-peroosteum, nethambo, elinobukhazikhazi obukhulu, kufaka phakathi izinhlobo ezikhethekile zamanxeba okuqhuba izibhamu nokulimala kwepulazi
Uhlobo lwe-IIIA: Ukungcoliswa okubanzi kanye / noma ubukhona bezilonda ezithambile ezithambile zezicubu ezithambile, izicubu ezithambile ngokuhlanganiswa okwanele kwezakhiwo zethambo nezezinzwa ze-neurovascular
Uhlobo lwe-IIB: Ngomonakalo obanzi wezicubu ezithambile, ama-metastase eshintshashintshayo noma ama-messus wamahhala adingekayo ngesikhathi sokwelashwa ukuze afezeke
Uhlobo lwe-IIC: Vula ukuqhekeka ngomonakalo we-vascular okudinga ukulungiswa kwezandla kwe-Gustilo kuvame ukuba kubi kakhulu ngokuhamba kwesikhathi, ngezinguquko ku-Imentrategi eboniswe ngesikhathi sokulungiswa.
II.Injury Management
Ukuphulukiswa ngamanxeba kudinga i-okygenation, kusebenze izindlela zokuhlanza amakhaleji, ukuhlanza amanxeba mahhala ezicubu ezingcolile nezingcolisiwe. Kunezigaba ezine eziyinhloko zokuphulukisa: ukubheja (imizuzu); isigaba sokuvuvukala (amahora); isigaba sezicubu zegraneng (izinsuku zibaliwe); Isikhathi sokwakheka kwezicubu (amasonto).
Ukuchithwa Kwelashwa
Isigaba esibuhlungu:Ukunisela icala, ukufuya, ukwakhiwa kabusha kwamathambo, kanye nokubuyiselwa kobubanzi bokunyakaza
(1) ahlole ubukhulu bokulimala kwezicubu ezithambile nokulimala kwe-neurovascular
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(5) Isiphelo sokuphuka samahhala siphindiselwe esilondeni; I-cortex encane eyenziwe yenziwe yenziwe icishiwe ukuze ihlolwe futhi ihlanze umcamelo wamathambo
Ukwakha kabusha:Ukubhekana ne-sequelae ye-trauma (inyunyana ebambezelekile, i-nonnonion, ubuthi, ukutheleleka)
I-Concalescence:I-Psychological, Yenhlalo Yezenhlalo Yesiguli
Uhlobo lokuvalwa kwenxeba nokumboza
Ukuvalwa kwenxeba lasekuqaleni noma ukumbozwa (izinsuku ezingama-3 ~ 5) kungafinyelela imiphumela yokwelashwa ekwanelisayo: (1) Ukuvalwa okuyisisekelo
(2) Ukuvalwa okubambezelekile
(3) Ukuvalwa Kwesekondari
(4) Ukufakelwa okuphakathi nendawo okuphakathi nendawo
(5) Flap ngokuzithandela (i-digital flap esondele)
(6) I-Vascular Pedicle Flap (Gastrocnemius Flap)
(7) Flap Mahhala (Fig. 3)
Umdwebo3: Ukubukwa okuyingxenye kokufakelwa kwamahhala kuvame ukuhlinzekwa
Ukulimala kwamathambo
I.Fracture Line Direction
I-Transverse: Iphethini yokulayisha ye-transverver fracture okubangelwa ukungezwani
ngokungacabangi: Imodi yokulayisha yengcindezi ngenxa yokuqhekeka kwe-diagonal
Kuvunguza: Ukulayishwa kwephethini yokuqhekeka kweTorssional ngenxa yokuqhekeka okulula
II.Fractures
Ukuhlukaniswa ngokuya ngama-fractures, izinhlobo ze-Fracture, njll. (Fig. 4)
Ama-fractures ahlanganisiwe aqhekeka ngezicucu ezi-3 noma ngaphezulu eziphilayo eziphilayo, ezivame ukubangelwa ukulimala kwamandla aphezulu.
I-Pathological Fracture Fracture Line Fracture Ivela endaweni yokuwohloka kwamathambo wesifo sangaphambilini, kufaka phakathi: isimila samathambo, ama-amatastases amathambo, isifo se-metabolic, i-metabolic bone, njll.
Ama-fractures angaphelele awaqhubeki izingcezu zethambo ezihlukile
Izingxenye zezingxenye ezihlukaniswe ngezingcezu eziphakathi nendawo, eziphakathi nendawo. Ingxenye ephakathi iyathinteka ekunikezelweni kwegazi, imvamisa ngenxa yokulimala kwamandla aphezulu, ngeziqu ezithambile zezicubu ezivela ethanjeni, kubangele izinkinga ngokuphulukiswa kwamathambo.
Ama-Fractures anezinkinga zamathambo, ukuvulwa okuvulelekile ngezicucu zamathambo, noma ukuqhekeka okungekho emthethweni okudinga ukusulwa, noma ukuphazamiseka okukhulu okutholwe kuholela ekulimaleni kwamathambo.
Ama-Fractures nge-Butterfly amathambo afanayo afana nokwehla kwezingalo kutsi awabandakanyi sonke lesiphambano sethambo futhi kuvame ukubangelwa udlame lokugoba.
Ukuphazamiseka kwengcindezi kubangelwa imithwalo ephindaphindwayo futhi kuvame ukwenzeka e-calcaneus naseTibia.
Ama-ashulsion ama-fractures abangela ukuqhekeka kwephuzu lokufakwa kwethambo lapho i-tendon noma i-ligament yeluliwe.
Ukuqhekeka kwe-Compry Fractures kuyizingcezu lapho izingcezwana zamathambo zincipha khona, imvamisa imithwalo ye-axial.
Umdwebo 4: Ukuhlukaniswa kwama-fractures
Iii.Factor Ithonya ukuphulukiswa kokuphulukisa
Izici zemvelo: iminyaka, isifo se-metabolic ithambo, izinga elisebenzayo, isimo sokudla okunempilo, isimo se-vascular, iziqu ze-turculure, izilinganiso ze-turculity, izilinganiso zezicubu zethango, iziqu ze-mechan, izilinganiso zokunamathiselwe kwezicubu ezithambile kuthambo, ukuqina, Isakhiwo se-anatomical, izinga lamandla abuhlungu, izinga lesici samathambo.
IV. Izinhlobo zokwelashwa
Ukwelashwa okungaphuzi kuboniswa iziguli ezinokulimala kwamandla aphansi noma ezingasebenzi ngenxa yezici ezihlelekile noma zasendaweni.
Ukunciphisa: Ukuphonsa kanye ne-axis ende ye-limb, ukwahlukana kwe-Fracture.
Ukulungiswa kwe-brace emaphethelweni womabili okuphuka futhi: Ukulungiswa kwethambo elincishisiwe ngokulungiswa kwangaphandle, kufaka phakathi inqubo yamaphoyinti amathathu.
I-tubular bone eqhubekayo yokuguqula inqubo yenqubo yokuphumula: indlela yokunciphisa, kufaka phakathi ukulandelwa kwesikhumba, ukuthathwa kwamathambo.
Ukwelashwa okuhlinza
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Umdwebo 5: Inqubo yokulungiswa kwangaphandle
(2) Ukulungiswa kwangaphakathi kusebenza kwezinye izinhlobo zokuqhekeka futhi kulandela umgomo we-AO (Ithebula 1)
Ithebula 1: Ukuziphendukela kwemvelo ka-Ao ekwelashweni kwe-Fracture
Izingcezu ze-Interfracture zidinga ukulungiswa kwe-compression, kufaka phakathi i-static compression (compression screpress), ukucindezelwa okunamandla (ukuxhumeka kwezipikili zomhlaba)
(4) Ukwehliswa okungaqondile:
Ubuchwepheshe be-traction buqaliswa endaweni esetshenzisiwe ye-Fracture ukunciphisa isiqeshana ngokungezwani kwezicubu ezithambile, futhi amabutho okuphonsa atholakala edivaysi le-feofty traction, iforda yangaphandle, idivaysi ehlanganyelwe ye-lamina noma i-lamina evulekile.
V.Station of Treatment
Ngokusho kwenqubo ye-biochemical yokwelashwa kwe-fracture, ihlukaniswe izigaba ezine (ithebula 2). Ngasikhathi sinye, kuhlangene nenqubo ye-biochemical, ukuphathwa kwe-fracture kuhlukaniswe izigaba ezintathu, ezikhuthaza ukugcwaliswa kwenqubo ye-biochemical kanye nokuphulukiswa kokuqhekeka (Fig. 6).
Ithebula 2: Inkambo yempilo yokuphulukiswa kokuphulukisa
Umdwebo 6: Umdwebo we-Schematic wokuphulukiswa kokuphulukisa egunjini
Isigaba sokuvuvukala
I-Hemorrhage esuka esizeni sokuphuka futhi izicubu ezithambile ezizungezile zakha i-hematoma, amafomu wezicubu ze-fibrovascular endaweni ephukile, kanye nama-osteoblasts kanye nama-fibroblasts aqala ukwanda.
Isikhathi sokuphumula
Ukuphendula kwe-callus yasekuqaleni kwenzeka kungakapheli amasonto ama-2, ngokwakheka kwe-cartilage skeleton elandelwa ukwakheka kwe-callus ngokusebenzisa ama-endochondral ossation, futhi zonke izinhlobo zokuphulukiswa kwe-fracture zihlobene nokwelashwa.
Bulala
Ngesikhathi senqubo yokulungisa, kwakhiwa ithambo elivuthiwe esikhundleni yi-lamellar ithambo, kanti umthambo we-medullary uhlelwa kabusha ukumaka ukugcwaliswa kokulungiswa kwe-fracture.
Ubunzima
I-Delized Union iboniswa ikakhulukazi ngokuphulukisa okungaphuluki ngaphakathi kwesikhathi esilindelekile, kepha nokho sinomsebenzi othile wezinto eziphilayo, futhi izizathu zenyunyana ezibambezelekile zihlukahlukene, ezihlobene nezici ezithinta ukuphulukiswa kokuphulukisa.
I-nonunion ibonakaliswa njengokuphuka ngaphandle kobufakazi bokuphulukiswa komtholampilo noma kwe-radiological, kanye nokuqaphela okuyinhloko yile:
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. Ukutheleleka kwamathambo i-osteomyelitis isifo sethambo nethambo, okungaba ukutheleleka okuqondile kwamanxeba enxeba okuvulekile noma ukutheleleka kwe-pathogenic ngokusebenzisa ama-microorganics anegazi, futhi kuyadingeka ukukhomba ama-microorganisms angenwe yigazi namagciwane ngaphambi kokwelashwa.
I-Complex Regional Pain Syndrome ibonakala ngobuhlungu, i-hyperesthesia, i-limb allergies, ukugeleza kwegazi okungekho emthethweni, ukujuluka kanye ne-edema, kufaka phakathi ukungahambi kahle kohlelo lwezinzwa oluzimele. Imvamisa kwenzeka ngemuva kokuhlukumezeka nokuhlinzwa, futhi kutholakele futhi kuphathwe kusenesikhathi, ngebhulokhi yezinzwa enozwela uma kunesidingo.
• I-HeterotoPic Ossification (Ho) ivamile ngemuva kokuhlukumezeka noma ukuhlinzwa, futhi ivame kakhulu ku-elbow, okhalweni nasethangeni, futhi ama-bisphosphonate omlomo angavimba ama-bone mineralization ngemuva kokuqala kokunaka ngemuva kokuqala.
• Ingcindezi egumbini lePriviofysal lenyuka ezingeni elithile, elikhubazekile amakha angaphakathi.
• Ukulimala kwe-neurovascular kunezimbangela ezahlukahlukene zokulimala kwe-neurovascular ngenxa yezindawo ezahlukahlukene ze-anatomical.
• I-Necrosis ye-Avascular yenzeka ezindaweni zokuhlinzekwa ngegazi ezinganele, ikakhulukazi, bona ukulimala nendawo ye-anatomical, njll., Nomonakalo ongaphenduki kwenzeka.
Isikhathi sePosi: Dec-31-2024
