Ngemva kokuphuka, ithambo nezicubu ezizungezile ziyalimala, futhi kunezimiso nezindlela ezahlukene zokwelapha ngokuya ngezinga lokulimala. Ngaphambi kokwelapha wonke ama-fracture, kubalulekile ukunquma ubukhulu bokulimala.
Ukulimala kwezicubu ezithambile
I. Ukuhlukaniswa
Ukuqhekeka okuvaliwe
Ukulimala kwezicubu ezithambile kulinganiswa kusukela kokuncane kuya kokukhulu, ngokuvamile kusetshenziswa indlela ye-Tscherne (Isithombe 1)
Ukulimala kwebanga lesi-0: Ukulimala okuncane kwezicubu ezithambile
Ukulimala kwebanga 1: ukuklwebheka noma ukubhidlika kwezicubu ezithambile ezimboze indawo yokuqhekeka
Ukulimala kwebanga lesi-2: ukuphuka okukhulu kwemisipha noma ukuphuka kwesikhumba okungcolile noma kokubili
Ukulimala kwebanga lesi-3: Ukulimala okukhulu kwezicubu ezithambile okunokususwa okukhulu, ukuchotshozwa, i-compartment syndrome, noma ukulimala kwemithambo yegazi
Umfanekiso 1: Ukuhlukaniswa kwe-Tscherne
Ukuphuka Okuvulekile
Ngenxa yokuthi ukwaphuka kuthintana nomhlaba wangaphandle, izinga lomonakalo wezicubu ezithambile lihlobene nenani lamandla atholwa yilungu ngesikhathi sokulimala, futhi ukuhlukaniswa kweGustilo kuvame ukusetshenziswa (Isithombe 2)
Umfanekiso 2: Ukuhlukaniswa kweGustilo
Uhlobo I: Ubude benxeba elihlanzekile < 1 cm, umonakalo omncane wemisipha, akukho ukukhucululwa kwesikhumba okusobala Uhlobo II: ubude benxeba > 1 cm, akukho monakalo obonakalayo wezicubu ezithambile, ukwakheka kwe-flap noma ukulimala kwe-avulsion
Uhlobo III: Uhla lwamanxeba luhlanganisa isikhumba, imisipha, i-periosteum, kanye nethambo, kanye nokulimala okukhulu, okuhlanganisa izinhlobo ezikhethekile zamanxeba okudutshulwa kanye nokulimala kwasepulazini
Uhlobo IIIa: Ukungcola okusabalele kanye/noma ukuba khona kwezilonda zezicubu ezithambile ezijulile, izicubu ezithambile ezimbozwe ngokwanele izakhiwo zamathambo nemithambo yegazi
Uhlobo lwe-IIIb: ngomonakalo omkhulu wezicubu ezithambile, i-Rotational noma i-free muscle metastases iyadingeka ngesikhathi sokwelashwa ukuze kutholakale ukumbozwa
Uhlobo lwesithathu: Ukuqhekeka okuvulekile okunomonakalo wemithambo yegazi odinga ukulungiswa ngesandla Ukuhlukaniswa kwe-Gustilo kuvame ukuba kubi kancane kancane ngokuhamba kwesikhathi, kanye noshintsho ezingeni lokulimala oluphawulwe ngesikhathi sokulungiswa.
II. Ukuphathwa kokulimala
Ukuphulukiswa kwesilonda kudinga ukunikezwa umoya-mpilo, ukuvuselelwa kwezinqubo zamaseli, ukuhlanzwa kwamanxeba angenazo izicubu ezingcolisiwe nezifile. Kunezigaba ezine eziyinhloko zokuphulukiswa: ukujiya (imizuzu); isigaba sokuvuvukala (amahora); isigaba sezicubu ze-granulation (izinsuku ezibalwayo); Isikhathi sokwakheka kwezicubu zezibazi (amasonto).
Ukuhlelwa kwesigaba sokwelashwa
Isigaba esibuhlungu:ukunisela amanxeba, ukususwa kwezicubu, ukwakhiwa kabusha kwamathambo, kanye nokubuyiselwa kobubanzi bokunyakaza
(1) Hlola izinga lokulimala kwezicubu ezithambile kanye nokulimala kwemithambo yegazi okuhlobene nakho
(2) Sebenzisa inani elikhulu loketshezi lwe-isotonic ukuze unisele ngokunisela egumbini lokuhlinza ukuze ususe izicubu ezifile kanye nemizimba yangaphandle
(3) Ukususwa kwezicubu kwenziwa njalo emahoreni angama-24 kuya kwangama-48 ukuze kususwe zonke izidumbu zangaphandle kanye nezicubu ezifile enxebeni kuze kube yilapho inxeba lingavalwa noma limbozwe ngokuphelele (4) Inxeba elivulekile leluliwe ngendlela efanele, izicubu ezijulile zivezwe ngokuphelele, futhi kwenziwa ukuhlolwa okuphumelelayo kanye nokususwa kwezicubu.
(5) Ingxenye yokuqhekeka yamahhala ibuyiselwa enxebeni; I-cortex encane engasebenzi iyasuswa ukuze kuhlolwe futhi kuhlanzwe umgodi womongo wethambo.
Ukwakhiwa kabusha:ukubhekana nemiphumela yokulimala (ukuhlangana okubambezelekile, ukungahlangani, ukukhubazeka, ukutheleleka)
Ukululama:Ukuhlehla kwengqondo, kwezenhlalo, kanye nomsebenzi wesiguli
Uhlobo lokuvalwa kwenxeba kanye nokumbozwa kwalo
Ukuvalwa noma ukumbozwa kwenxeba kusenesikhathi (izinsuku ezingu-3-5) kungaletha imiphumela yokwelashwa eyanelisayo: (1) ukuvalwa kokuqala
(2) ukuvalwa okulibazisekile
(3) ukuvalwa kwesibili
(4) ukufakelwa kwe-flap enobukhulu obuphakathi
(5) i-flap yokuzithandela (i-flap yedijithali eseduze)
(6) i-vascular pedicle flap (i-gastrocnemius flap)
(7) i-free flap (Isithombe 3)
Isithombe 3: Imibono engaphelele yokufakelwa kwamahhala ivame ukunikezwa
Ukulimala kwamathambo
I. Isiqondiso somugqa wokuphuka
I-Transverse: Iphethini yomthwalo wokuphuka okuphambene okubangelwa ukucindezeleka
ngokungaqondile: Imodi yokulayisha yokucindezela ngenxa yokuphuka okuphambene
Iphethini yomthwalo yokuphuka kwe-torsional ngenxa yokuphuka kwe-spiral
II. Ukuqhekeka
Ukuhlukaniswa ngokwezaphuka, izinhlobo zaphuka, njll. (Isithombe 4)
Ukuphuka kwamathambo okubangelwa ukuqhuma kwamathambo kuwukuphuka kwamathambo aphilayo amathathu noma ngaphezulu, ngokuvamile okubangelwa ukulimala okunamandla amakhulu.
Ukuphuka kwethambo okubangelwa yizifo kwenzeka endaweni lapho amathambo ewohloka khona ngenxa yesifo sangaphambilini, okuhlanganisa: isimila samathambo esiyinhloko, ukusabalala kwamathambo, i-osteoporosis, isifo samathambo esibangelwa yizinto eziphilayo, njll.
Ukuphuka okungaphelele akuqhekeki kube yizicucu zamathambo ezihlukene
Ukuqhekeka kwezingxenye ezinezingcezu zokuqhekeka ezikude, eziphakathi, kanye neziseduze. Ingxenye ephakathi ithintwa ukuhlinzekwa kwegazi, ngokuvamile ngenxa yokulimala okunamandla aphezulu, kanye nokuhlukana kwezicubu ezithambile ethanjeni, okubangela izinkinga zokuphulukiswa kwethambo.
Ukuphuka okunezinkinga zamathambo, ukuphuka okuvulekile okunezingcezu zamathambo, noma ukuphuka okungasebenzi ngenxa yokulimala okudingeka kususwe, noma ukuphuka okukhulu okubangelwa ukukhubazeka kwamathambo.
Ukuqhekeka okunezingcezu zamathambo e-butterfly kufana nokuqhekeka kwezingxenye ngoba akubandakanyi yonke ingxenye yethambo futhi ngokuvamile kuba umphumela wobudlova obugobile.
Ukuqhekeka kokucindezeleka kubangelwa imithwalo ephindaphindwayo futhi kuvame ukwenzeka ku-calcaneus kanye ne-tibia.
Ukuphuka kwethambo ngenxa yokuvuvukala kubangela ukuphuka kwendawo yokufaka ithambo lapho i-tendon noma i-ligament yelulwa.
Ukuqhekeka kokucindezela kuwukuqhekeka lapho izingcezu zamathambo zicindezelwa khona, ngokuvamile ngemithwalo ye-axial.
Umfanekiso 4: Ukuhlukaniswa kwama-fracture
III. Izinto ezithinta ukuphulukiswa kokuphuka
Izici zebhayoloji: ubudala, isifo samathambo esishintshashintshayo, isifo esiyisisekelo, izinga lokusebenza, isimo sokudla okunempilo, umsebenzi wezinzwa, umonakalo wemithambo yegazi, ama-hormone, izici zokukhula, isimo sempilo ye-capsule yezicubu ezithambile, izinga lokungabi nanzalo (ukuphuka okuvulekile), ukubhema, imithi, isifo sendawo, izinga lamandla okulimaza, uhlobo lwethambo, izinga lokukhubazeka kwethambo, izici zomshini, izinga lokunamathela kwezicubu ezithambile emathanjeni, ukuzinza, isakhiwo somzimba, izinga lamandla okulimaza, izinga lokukhubazeka kwethambo.
IV. Izindlela zokwelapha
Ukwelashwa okungenakuhlinzwa kuboniswa iziguli ezinokulimala okunamandla amancane noma ezingakwazi ukuhlinza ngenxa yezici zomzimba noma zendawo.
Ukunciphisa: ukubambelela eceleni kwe-axis ende yesitho, ukuhlukaniswa kokuphuka.
Ukuqinisa i-brace kuzo zombili izinhlangothi zokuphuka futhi: ukuqinisa ithambo elincishisiwe ngokuqinisa kwangaphandle, okuhlanganisa nobuchwepheshe bokuqinisa obunamaphuzu amathathu.
Indlela yokuqinisa ukuqina okuqhubekayo kwethambo le-tubular: indlela yokunciphisa, okuhlanganisa ukudonsa kwesikhumba, ukudonsa kwamathambo.
Ukwelashwa ngokuhlinzwa
(1) Ukuqina kwangaphandle kufanelekela ukwaphuka okuvulekile, ukwaphuka okuvaliwe okunokulimala okukhulu kwezicubu ezithambile, kanye nokuqhekeka okuhambisana nokutheleleka (Isithombe 5)
Umfanekiso 5: Inqubo yokulungisa yangaphandle
(2) Ukulungiswa kwangaphakathi kusebenza kwezinye izinhlobo zokuqhekeka futhi kulandela isimiso se-AO (Ithebula 1)
Ithebula 1: Ukuvela kwe-AO ekwelashweni kokuqhekeka
Izingcezu ze-interfracture zidinga ukulungiswa kokucindezelwa, okuhlanganisa ukucindezela okungaguquki (izikulufo zokucindezela), ukucindezela okunamandla (izinzipho zangaphakathi ezingakhiyi), ukugoba (ukushelela phakathi kwento yangaphakathi nethambo), kanye nokulungiswa kokubopha (izinto zangaphakathi ezihlanganisa indawo ehlanganisiwe)
(4) Ukunciphisa okungaqondile:
Ubuchwepheshe bokudonsa busetshenziswa endaweni ehlukanisiwe ukuze kuncishiswe ucezu ngokucindezeleka kwezicubu ezithambile, futhi amandla okudonsa atholakala kudivayisi yokudonsa ye-femoral, i-fixator yangaphandle, idivayisi yokucindezela amalunga e-AO noma i-lamina opener.
V. Ukuhlelwa kwesigaba sokwelashwa
Ngokwenqubo yamakhemikhali yokuphulukiswa kokuphuka, ihlukaniswe ngezigaba ezine (Ithebula 2). Ngesikhathi esifanayo, kuhlanganiswe nenqubo yamakhemikhali, ukwelashwa kokuphuka kuhlukaniswe ngezigaba ezintathu, okukhuthaza ukuqedwa kwenqubo yamakhemikhali kanye nokuphulukiswa kokuphuka (Isithombe 6).
Ithebula 2: Inkambo yokuphila yokuphulukiswa kokuphuka
Umfanekiso 6: Umdwebo wesimiso wokwelashwa kokuphuka kwamagundane
Isigaba sokuvuvukala
Ukopha okuvela endaweni yokuqhekeka kanye nezicubu ezithambile ezizungezile kwakha i-hematoma, kwakheka izicubu ze-fibrovascular ekugcineni okuqhekekile, bese ama-osteoblast nama-fibroblast aqala ukwanda.
Isikhathi sokuphumula
Impendulo yokuqala ye-callus yenzeka zingakapheli amasonto amabili, ngokwakhiwa kohlaka lwe-cartilage kulandelwa ukwakheka kwe-callus ngokusebenzisa i-endochondral ossification, futhi zonke izinhlobo ezithile zokuphulukiswa kwama-fracture zihlobene nendlela yokwelapha.
Ukwakhiwa kabusha
Ngesikhathi senqubo yokulungisa, ithambo elilukiwe elakhiwe lithathelwa indawo yithambo le-lamellar, bese kuthi umgodi we-medullary uphinde ulungiswe ukuze kuphawulwe ukuqedwa kokulungiswa kokuphuka.
Inkinga
Ukuhlangana okubambezelekile kubonakala kakhulu ngokuthi ukuphuka kungapholi ngaphakathi kwesikhathi esilindelekile, kodwa kusenomsebenzi othile webhayoloji, futhi izizathu zokuhlangana okubambezelekile ziyahlukahluka, ezihlobene nezici ezithinta ukuphulukiswa kokuphuka.
Ukungahlangani komzimba kubonakala njengokuphuka ngaphandle kobufakazi bokwelashwa kwemitholampilo noma ngemisebe, futhi okuqashelwa kakhulu yile:
(1) Ukungahlangani kahle ngenxa yokungahlangani kahle kwemithambo yegazi kanye nokuntuleka kwamandla ezinto eziphilayo okuphulukisa, okuvame ukubonakala njengokuqina kwengxenye ephukile yethambo kanye nokungabikho kwemithambo yegazi, kanye nenqubo yokwelapha idinga ukukhuthazwa komsebenzi wezinto eziphilayo wendawo (ukufakelwa kwamathambo noma ukususwa kwe-cortical yethambo kanye nokuthuthwa kwamathambo).
(2) I-Hypertrophic nonunion inekhono lokushintsha imithambo yegazi kanye nekhono lebhayoloji, kodwa ayinakho ukuzinza komshini, okuvame ukubonakala njengokukhula ngokweqile kwengxenye ephukile yokuqhekeka, futhi ukwelashwa kudinga ukwandisa ukuzinza komshini (i-bone plate kanye ne-screw fixation).
(3) I-dystrophic nonunion inegazi elanele, kodwa cishe akukho ukwakheka kwe-callus, futhi ukunciphisa ukuqhekeka kudinga ukwenziwa kabusha ngenxa yokungashintshwa okwanele kanye nokunciphisa ingxenye ephukile yokuqhekeka.
(4) Uma ukutheleleka kungangeni ezifweni ezithathelwanayo nokutheleleka okungapheli, ukwelashwa kufanele kuqale kususe ukugxila kokutheleleka, bese kukhuthaza ukuphulukiswa kokuphuka. I-osteomyelitis yokutheleleka kwamathambo yisifo sokutheleleka kwamathambo namathambo, okungaba ukutheleleka okuqondile kwamanxeba avulekile noma ukutheleleka okubangelwa izifo ngemizila yegazi, futhi kuyadingeka ukuhlonza amagciwane athelelekile namagciwane ngaphambi kokwelashwa.
I-complex regional pain syndrome ibonakala ngobuhlungu, i-hyperesthesia, ukungezwani komzimba nezitho, ukugeleza kwegazi okungavamile endaweni, ukujuluka, kanye nokuvuvukala, okuhlanganisa nokukhubazeka kwesistimu yezinzwa ezizimele. Ngokuvamile kwenzeka ngemva kokulimala nokuhlinzwa, futhi kutholakala futhi kwelashwe kusenesikhathi, ngokuvinjelwa kwemizwa okuzwela uma kudingeka.
• I-Heterotopic ossification (HO) ivame kakhulu ngemva kokulimala noma ukuhlinzwa, futhi ivame kakhulu endololwaneni, esinqeni, nasethangeni, kanti ama-bisphosphonates omlomo angavimbela ukuwohloka kwamathambo ngemva kokuqala kwezimpawu.
• Ingcindezi engxenyeni ye-periophysal iyanda iye ezingeni elithile, okuphazamisa ukuhanjiswa kwegazi ngaphakathi.
• Ukulimala kwemithambo yegazi kunezimbangela ezahlukene zokulimala kwemithambo yegazi ngenxa yezindawo ezahlukene zomzimba.
• I-Avascular necrosis yenzeka ezindaweni lapho igazi linganele khona, Ngokukhethekile, bheka ukulimala nendawo yokwakheka komzimba, njll., bese kwenzeka umonakalo ongenakulungiseka.
Isikhathi sokuthunyelwe: Disemba 31-2024
