Ngemuva kokuphuka, ithambo nezicubu ezizungezile zonakalisiwe, futhi kunezimiso nezindlela zokwelashwa ezihlukene ngokusho kwezinga lokulimala. Ngaphambi kokwelapha wonke ama-fractures, kubalulekile ukucacisa izinga lokulimala.
Ukulimala kwezicubu ezithambile
I.Ukuhlukaniswa
Ukuphuka okuvaliwe
Ukulimala kwezicubu ezithambile kulinganiswa kusuka komnene kuya kokuqina, ngokuvamile kusetshenziswa indlela ye-Tscherne (Fig. 1)
Ukulimala kweBanga 0: Ukulimala okuncane kwezicubu ezithambile
Ukulimala kweBanga 1: ukuhuzuka okungaphezulu noma ukuqubuka kwezicubu ezithambile ezimboze indawo yokuphuka
Ukulimala kweBanga lesi-2: ukungqubuzana kwemisipha okuphawulekayo noma ukuqubuka kwesikhumba okungcolile noma kokubili
Ukulimala kweBanga lesi-3: Ukulimala okukhulu kwezicubu ezithambile ngokususwa kakhulu, ukuchotshozwa, i-compartment syndrome, noma ukulimala kwemithambo
Umfanekiso 1: Ukuhlukaniswa kwe-Tscherne
Vula Ukuphuka
Ngenxa yokuthi i-fracture ixhumana nezwe langaphandle, izinga lokulimala kwezicubu ezithambile lihlobene nenani lamandla elitholwa isitho ngesikhathi sokuhlukunyezwa, futhi ukuhlukaniswa kwe-Gustilo kuvame ukusetshenziswa (Umfanekiso 2)
Umfanekiso 2:GustiloClassification
Thayipha I: Ubude benxeba elihlanzekile <1 cm, ukulimala kwemisipha encane, akukho exfoliation esobala ye-periosteal Uhlobo II: ubude besilonda> 1 cm, akukho monakalo osobala wezicubu ezithambile, ukwakheka kwe-flap noma ukulimala kwe-avulsion
Uhlobo III: Uhla lwamanxeba luhlanganisa isikhumba, imisipha, i-periosteum, nethambo, nokuhlukumezeka okukhulu, okuhlanganisa izinhlobo ezikhethekile zamanxeba okudutshulwa nokulimala epulazini.
Uhlobo IIIa: Ukungcoliswa okusabalele kanye/noma ukuba khona kwezilonda ezijulile zezicubu ezithambile, izicubu ezithambile ezinokuvaleka okwanele kwamathambo nezakhiwo ze-neurovascular
Thayipha IIIb: ngomonakalo omkhulu wezicubu ezithambile, ama-metastases emisipha ajikelezayo noma amahhala ayadingeka ngesikhathi sokwelashwa ukuze kufinyelelwe ukumbozwa.
Uhlobo lwe-IIIc: Ukuphuka okuvulekile ngokulimala kwemithambo edinga ukulungiswa ngesandla Ukuhlukaniswa kwe-Gustilo kuvame ukuba kubi kakhulu ngokuhamba kwesikhathi, ngezinguquko ebangeni lokulimala eziphawulwe ngesikhathi sokulungiswa.
II.Ukuphathwa kokulimala
Ukuphulukiswa kwesilonda kudinga umoya-mpilo, ukusebenza kwezinqubo zamaselula, ukuhlanzwa kwamanxeba ngaphandle kwezicubu ezingcolile kanye ne-necrotic. Kunezigaba ezine eziyinhloko zokuphulukisa: ukuhlangana (imizuzu); isigaba sokuvuvukala (amahora); isiteji sezicubu ze-granulation (izinsuku zibaliwe); Isikhathi sokwakheka kwezicubu ezibomvu (amasonto).
Isiteji sokwelashwa
Isigaba esibucayi:ukuchelela kwesilonda, ukuchithwa, ukwakhiwa kabusha kwamathambo, kanye nokubuyiselwa kokunyakaza okuhlukahlukene
(1) Hlola izinga lokulimala kwezicubu ezithambile kanye nokulimala okuhlobene ne-neurovascular
(2)Sebenzisa inani elikhulu loketshezi lwe-isotonic ukuchelela ngenkasa egumbini lokuhlinza ukuze kukhishwe izicubu ze-necrotic kanye nemizimba yangaphandle.
(3)Ukukhishwa kwe-debride kwenziwa njalo emahoreni angama-24~48 ukuze kukhishwe yonke imizimba yangaphandle kanye nezicubu ze-necrotic enxebeni kuze kube yilapho isilonda sivaleka noma simbozwe ngokuphelele (4) Isilonda esivulekile sinwetshwa ngokufanelekile, izicubu ezijulile zivezwe ngokugcwele, futhi ukuhlolwa okuphumelelayo nokuchithwa kwenziwa.
(5)Isiphetho samahhala sokuphuka sihlehliselwa enxebeni; I-cortex encane engasebenzi ikhishwa ukuze kuhlolwe futhi kuhlanzwe imbobo yomnkantsha
Ukwakha kabusha:ukubhekana ne-sequelae ye-trauma (inyunyana ebambezelekile, ukungavumelani, ukukhubazeka, ukutheleleka)
I-Convalescence:Ukwehla ngokwengqondo, kwezenhlalo, kanye nasemsebenzini kwesiguli
Uhlobo lokuvalwa kwesilonda kanye nokumboza
Ukuvalwa kwenxeba kusenesikhathi noma ukumbozwa (izinsuku ezi-3 ~ 5) kungafinyelela imiphumela yokwelashwa eyanelisayo: (1) ukuvalwa okuyinhloko
(2)ukuvalwa ukubambezeleka
(3)ukuvalwa kwesibili
(4)ukufakelwa kwe-flap enogqinsi olumaphakathi
(5)i-flap yokuzithandela (i-digital flap eseduze)
(6)i-vascular pedicle flap (i-gastrocnemius flap)
(7) i-flap yamahhala (Fig. 3)
Umfanekiso 3:Ukubukwa kwengxenye yokufakelwa kwamahhala kuvame ukunikezwa
Ukulimala kwamathambo
I.Indlela yomugqa wokuphuka
I-Transverse: Layisha iphethini yokuphuka okuphambene okubangelwa ukungezwani
i-obliquely: Imodi yokulayisha yokucindezela ngenxa yokuphuka kwe-diagonal
I-Spiral: Layisha iphethini yokuphuka kwe-torsional ngenxa ye-spiral fracture
II.Ukuphuka
Ukuhlukaniswa ngokwehlukana, izinhlobo zokuphuka, njll. (Umfanekiso 4)
Ukuphuka okuhlanganisiwe kuwukuphuka okunezingcezu zamathambo aphilayo ezi-3 noma ngaphezulu, ngokuvamile okubangelwa ukulimala okunamandla amakhulu.
I-Pathological fracture fracture fracture iyenzeka endaweni yokuwohloka kwethambo lesifo sangaphambilini, okuhlanganisa: isimila esiyinhloko samathambo, ama-metastases amathambo, i-osteoporosis, isifo samathambo e-metabolic, njll.
Ukuphuka okungaphelele akunqamuki zibe izingcezu ezihlukene zamathambo
Ukuphuka kwesegmental ngezingcezu zokuphuka ezikude, ezimaphakathi, neziseduze. Ingxenye ephakathi ithinteka ekunikezeni igazi, ngokuvamile ngenxa yokulimala okukhulu kwamandla, nokuhlukaniswa kwezicubu ezithambile ezivela ethanjeni, okubangela izinkinga ngokuphulukiswa kwamathambo.
Ukuphuka okunokukhubazeka kwamathambo, ukuphuka okuvulekile okunezicucu zamathambo, noma ukuphuka okungasebenzi okudabukisayo okudinga ukusulwa, noma ukuphuka okukhulu okuhlangene okubangela ukukhubazeka kwamathambo.
Ukuphuka okunezicucu zamathambo emvemvane kufana nokuhlukana kwezigaba ngoba azibandakanyi yonke ingxenye yethambo futhi ngokuvamile kuwumphumela wobudlova obugobayo.
Ukuphuka kokucindezeleka kubangelwa imithwalo ephindaphindiwe futhi ngokuvamile kwenzeka ku-calcaneus ne-tibia.
Ukuphuka kwe-avulsion kubangela ukuphuka kwendawo yokufaka ithambo lapho i-tendon noma i-ligament yeluliwe.
I-Compression fractures yizicucu lapho izingcezu zamathambo zicindezelwa khona, ngokuvamile ngemithwalo ye-axial.
Umfanekiso 4: Ukuhlukaniswa kwama-fractures
III.Izici ezithonya ukuphulukiswa kokuphuka
Izici zebhayoloji: iminyaka, isifo samathambo, isifo esiwumsuka, izinga lokusebenza, isimo sokudla okunempilo, ukusebenza kwemizwa, ukulimala kwemithambo, amahomoni, izici zokukhula, isimo sezempilo se-capsule yezicubu ezithambile, izinga lokuqina (ukuphuka okuvulekile), ukubhema, imithi, isifo sendawo, izinga lamandla ahlukumezayo, uhlobo lwethambo, izinga lokukhubazeka kwethambo, izici zemishini, izinga lokunamathela kwethambo, ukuqina kwesakhiwo, i-anantic energy level yokukhubazeka kwamathambo.
IV. Izindlela zokwelapha
Ukwelashwa okungahlinzeki kuboniswa ezigulini ezinokulimala okuphansi kwamandla noma ezingasebenzi ngenxa yezici zesistimu noma zendawo.
Ukunciphisa: ukudonsa eduze kwe-eksisi ende yelunga, ukuhlukana kokuphuka.
Ukulungiswa kwezikaki kuzo zombili iziphetho zokuphuka futhi: ukulungiswa kwethambo elincishisiwe ngokulungiswa kwangaphandle, kuhlanganisa nendlela yokulungisa amaphuzu amathathu.
I-tubular bone eqhubekayo yokucindezelwa kwesu lokuqiniswa: indlela yokunciphisa, okuhlanganisa ukudonsa kwesikhumba, ukudonsa kwamathambo.
Ukwelashwa ngokuhlinzwa
(1) Ukulungiswa kwangaphandle kulungele ukuphuka okuvulekile, ukuphuka okuvaliwe okunobuhlungu obukhulu bezicubu ezithambile, nokuphuka okuhambisana nokutheleleka (Umdwebo 5)
Umfanekiso wesi-5: Inqubo yokulungisa yangaphandle
(2) Ukulungiswa kwangaphakathi kuyasebenza kwezinye izinhlobo zokuphuka futhi kulandela isimiso se-AO (Ithebula 1)
Ithebula 1: Ukuvela kwe-AO ekwelashweni kokuphuka
Izingcezu zokuxhuma zidinga ukulungiswa kokucindezela, okuhlanganisa ukucindezela okumile (izikulufu zokuminyanisa), ukucindezela okunamandla (izinzipho ze-intramedullary ezingakhiyi), ukuhlukaniswa (ukuslayida phakathi kwento yangaphakathi nethambo), nokulungiswa kwebhuloho (into yangaphakathi ehlanganisa indawo encishisiwe)
(4)Ukwehliswa okungaqondile:
Ubuchwepheshe bokudonsa busetshenziswa endaweni enqanyuliwe ukuze kuncishiswe ucezu ngokusebenzisa ukungezwani kwezicubu ezithambile, futhi amandla okudonsa atholakala kudivayisi yokudonsa isifazane, i-fixator yangaphandle, idivayisi ye-AO ehlangene ye-tension noma i-lamina opener.
V.Isiteji sokwelashwa
Ngokwenqubo ye-biochemical yokuphulukiswa kokuphuka, ihlukaniswe ngezigaba ezine (Ithebula 2). Ngesikhathi esifanayo, kuhlanganiswe nenqubo ye-biochemical, ukwelashwa kwe-fracture kuhlukaniswe ngezigaba ezintathu, okukhuthaza ukuqedwa kwenqubo ye-biochemical kanye nokuphulukiswa kokuphuka (Fig. 6).
Ithebula 2: Inkambo yempilo yokuphulukiswa kokuphuka
Umfanekiso 6: Umdwebo wohlelo lokuphulukiswa kokuphuka kumagundane
Isigaba sokuvuvukala
Ukopha okuvela endaweni yokuphuka kanye nezicubu ezithambile ezizungezile zakha i-hematoma, amafomu ezicubu ze-fibrovascular ekugcineni okuphukile, futhi ama-osteoblasts nama-fibroblasts aqala ukwanda.
Isikhathi sokuphumula
Ukusabela kwe-callus yasekuqaleni kwenzeka phakathi kwamasonto e-2, ngokwakhiwa kwe-cartilage skeleton elandelwa ukwakheka kwe-callus ngokusebenzisa i-endochondral ossification, futhi zonke izinhlobo ezithile zokuphulukiswa kwe-fracture zihlobene nendlela yokwelapha.
Ukulungiswa kabusha
Phakathi nenqubo yokulungisa, ithambo eliboshiwe elakhiwe lithathelwa indawo ithambo le-lamellar, futhi i-medullary cavity iyashintshwa ukuze kuphawulwe ukuqedwa kokulungiswa kokuphuka.
Inkinga
Inyunyana ebambezelekile ibonakala ngokuyinhloko ukuphuka okungapholi phakathi nesikhathi esilindelekile, kodwa kusenomsebenzi othile webhayoloji, futhi izizathu zokubambezeleka kwenyunyana ziyahlukahluka, ezihlobene nezici ezithinta ukuphulukiswa kokuphuka.
I-Nonunion ibonakala njengokuphuka ngaphandle kobufakazi bokuphulukiswa komtholampilo noma nge-radiological, futhi ukugcwaliseka okuyinhloko yizi:
(1) I-Atrophic nonunion ngenxa yokungaguquki kwemithambo kanye nokuntuleka kwekhono lebhayoloji lokuphulukisa, ngokuvamile elibonakala njenge-stenosis yokuphela kwethambo eliphukile futhi elingenayo imithambo yegazi, futhi inqubo yokwelapha idinga ukukhuthazwa komsebenzi wendawo yezinto eziphilayo (ukuxhunyelelwa kwethambo noma ukukhishwa kwe-bone cortical kanye nokuthuthwa kwethambo).
(2)I-Hypertrophic nonunion inekhono lesikhashana le-vascularization kanye nekhono lebhayoloji, kodwa alinakho ukuzinza komshini, okubonakala njengokukhula okungaphezu kwesiphetho esiphukile sokuphuka, futhi ukwelashwa kudinga ukukhulisa ukuzinza komshini (i-bone plate kanye nokulungiswa kwezikulufu).
(3)I-dystrophic nonunion inokunikezwa kwegazi elanele, kodwa cishe akukho ukwakheka kwekholi, futhi ukuncishiswa kokuphuka kudinga ukwenziwa kabusha ngenxa yokungagudluki okwanele kanye nokwehliswa kwesiphetho esiphukile sokuphuka.
4 I-Bone infection i-osteomyelitis yisifo sokutheleleka kwamathambo namathambo, okungaba ukutheleleka okuqondile kwamanxeba amanxeba avulekile noma ukutheleleka kwe-pathogenic ngokusebenzisa imizila yegazi, futhi kuyadingeka ukukhomba ama-microorganisms anegciwane kanye namagciwane ngaphambi kokwelashwa.
I-complex region pain syndrome ibonakala ngobuhlungu, i-hyperesthesia, ukungezwani komzimba nezitho zomzimba, ukugeleza kwegazi okungavamile kwendawo, ukujuluka, kanye ne-edema, kuhlanganise nokungajwayelekile kwesimiso sezinzwa ezizimele. Ngokuvamile kwenzeka ngemva kokuhlukumezeka nokuhlinzwa, futhi kutholwa futhi kwelashwe kusenesikhathi, ngokuvimba kwezinzwa ezinozwela uma kunesidingo.
• I-Heterotopic ossification (HO) ivamile ngemva kokulimala noma ukuhlinzwa, futhi kuvame kakhulu endololwaneni, enqulwini, nasethangeni, futhi ama-bisphosphonates omlomo angavimbela ukuchithwa kwamathambo ngemva kokuqala kwezimpawu.
• Ukucindezela ku-periophysal compartment kukhuphukela ezingeni elithile, kukhinyabeze ukugcwala kwangaphakathi.
• Ukulimala kwe-Neurovascular kunezimbangela ezihlukene zokulimala kwe-neurovascular ngenxa yezindawo ezihlukahlukene ze-anatomical.
• I-Avascular necrosis yenzeka ezindaweni lapho igazi lingatholakali khona ngokwanele, Ngokuqondile, bheka ukulimala kanye nendawo ye-anatomical, njll., futhi kwenzeka umonakalo ongenakulungiseka.
Isikhathi sokuthumela: Dec-31-2024
