Mushure mekupwanyika, iyo pfupa uye kutenderera kwemateki kwakakanganisika, uye pane dzakasiyana dzekurapa maratidziro uye nzira zvinoenderana nehuwandu hwekukuvara. Usati wabata mapundu ese, zvakakosha kuti uone kukura kwekukuvara.
Zvinyoro nyoro kukuvara
I.classudzika
Yakavharwa Fractures
Zvipfeko zvinyoro-nyoro zvinokuvara kubva panyoro kusvika pakakomba, kazhinji uchishandisa nzira yetscherne (Fig. 1)
Kukuvara kweGiredhi: Diki nyoro nyoro kukuvara
Giredhi
Giredhi2 kukuvara: Yakakosha mhasuru yemhasuru kana yakasvibiswa ganda kuunganidzwa kana zvese zviri zviviri
Giredhi3 Kukuvara: Yakanyanya Nyoro Nyoro yekukuvara neyakanyanya kutama, kupwanya, compartment syndrome, kana kukuvara kwekukuvara
Mufananidzo1: Tscherene kuiswa
Vhura Bracture
Nekuti kupunzika ndiko kutaurirana kune vekunze kwekukuvara, degree rezvipfeko zvine chekuita nehuwandu hwesimba rine chekuita nenzvimbo panguva yekutamba, uye kuiswa kweGustilo kunowanzoshandiswa (Mufananidzo 2)
Mufananidzo2: GUSTILLLASTETIZE
Type I: Yakachenuruka rombo rakanaka <1 cm, diki yemasumbu kukuvara, rombo rakanaka> 1 CM
Type III: Ronda Rwonda Runorima rinosanganisira ganda, tsandanyama, periosteum, nepfuma yakawanda, kusanganisira mhando dzakakosha dzemaronda epfuti uye kukuvara kwemapurazi
Type Iia: Yakabikwa Kusvibiswa uye / kana kuvapo kwerevi rakapfava tissue lesions, zvinyoro-nyoro zvine chekuita nekuvhara kwakakwana kwepfupa uye neurovascular zvimiro
Type IIIB: ine yakakura nyoro tishu kukuvara, kutenderera kana yemahara muswe metastases inodikanwa panguva yekurapa kuti uwane kufukidzwa
Type IIC: Vhura Fractures neVascular Kukuvadzwa kunoda bhuku rekugadzirisa Gustilo Classificificiation inowanzoita zvakashata zvishoma nezvishoma nekuchinja giredhi yakacherechedzwa panguva yekugadziriswa.
II.injury Management
Kuporesa kwonda kunoda oksijeni, activation ye cellular mechanisms, kucheneswa kwemaronda asina kusvibiswa uye necrotic tishu. Pane matanho mana makuru ekurapa: Coagulation (maminitsi); chipenga cheshuwa (maawa); granulation tishu nhanho (mazuva akaverengerwa); Scar tissue yekuumba nguva (mavhiki).
Kubata kurapwa
Acute chikamu:kuvhunduka kudiridza, kushomeka, kudzoreredza pfupa, uye kudzoreredzwa kwehuwandu hwekufamba
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(5) Magumo emahara ekupwanya anodzoserwa mune ronda; Diki Deactivated Cortex inobviswa kuti iongorore uye yakachena iyo pfupa marita cavity
Kuvakazve:kubata neiyo sequalae yeTrauma (kunonoka Union, nonunion, kuremara, hutachiona)
Convalescence:Psychological, munharaunda, uye basa rekudzvinyirira remurwere
Rudzi rwe ronda kuvharwa uye kufukidzwa
Kuvhara kwekutanga kwevhu kana kufukidzwa (3 ~ mazuva mashanu) kunogona kuwana inogutsa kurapa mhedzisiro: (1) kuvhara kwekutanga
(2) Yakanonoka kuvharwa
(3) Kuvhara Kwese
(4) yepakati-yakakora flap kutapurirana
(5) Kuzvidira flap (adjacent digital flap)
(6) Vascular pedicle flap (Gastrocnemius flap)
(7) Free flap (Fig. 3)
Mufananidzo3: Chikamu chemaonero ezvemahara transpants zvinowanzopihwa
Pfupa kukuvara
I.Fracture mutsara kutungamirirwa
Transverse: mutoro weti wejira rinokonzerwa nekukanganisika
obliquely: mutoro maitiro ekumanikidzwa nekuda kweiyo diagonal bracture
Spiral: Mutevedzeri mafambiro eiyo tonional bracture nekuda kweiyo spiral bracture
Ii.f.furcray
Kufananidzwa zvichienderana neFraces, Fracture Mhando, nezvimwe (Fig. 4)
Cractured fractures inobhururuka ne3 kana anopfuura zvipfupi zvipfupi zvidimbu, kazhinji zvichikonzera kukuvara kwesimba rakanyanya.
Patharology Fracture Let mutsara unoitika munharaunda yekutsamwa kwepafupa yechirwere chekare, kusanganisira: yekutanga bone tumor, masheti emapfupa, metabolic pfupa, etc
Isina kukwana fractures haina kupaza muzvikamu zvakasiyana zvefupa
Zvikamu zvezvikamu zvezvikamu zvine distal, wepakati, uye proximal bracture zvidimbu. Chikamu chepakati chinokanganiswa neropa, kazhinji semhedzisiro yekukuvara kwakanyanya-simba, ine zvinyoro-nyoro tishushuma kubva kune pfupa, zvichikonzera matambudziko nekuporesa pfupa.
Fractures nePfupa urema, dzakavhurika zvikanganiso nezvimedu zvepfupa, kana kuti dzimba dzekutambudzika dzinoda kujekeswa, kana zvakaringana zvaiguma nekukora pfupa.
Fractures neButterFly Flatgsments dzakafanana nezvakarukwa zvekunyepedzera mukuti ivo havabatanidzane muchinjiko-chikamu chepfupa uye kazhinji kazhinji zvinokonzerwa nekupa mhirizhonga.
Kunetseka kwakakonzerwa kunokonzerwa nekudzokororwa mitoro uye kazhinji kunoitika muCalcaneus uye tibia.
Achilsion fractures inokonzeresa kupwanya kweiyo pfupa rekuisa pfungwa kana tendon kana ligament akatambanudzwa.
Kudzvinyirira Fractures ndiko kupatsanura umo zvidimbu zvemapfupa zvinonyudzwa, kazhinji nezvematoro exial.
Mufananidzo 4: Kuongororwa kweFraces
III.Chictors Kufurira Kuporesa Kunopora
Zvinhu zveBiotilogy: Zera, Pasi peChirwere Chirwere, chinongedzo chesimba, Hurumende, Hurumende, Degnical Smages, Degnical Factors, Degnical Factors Pfupa, kugadzikana, chimiro chechimiro, chikamu chesimba runyararo, degree refupi kuremara.
Iv. Maitiro ekurapwa
Iko kusarapa kusiri kurapwa kunoratidzwa kune varwere vane kukuvara-simba kukuvara kana avo vasingakwanisike nekuda kwehurongwa kana zvinhu zvemunharaunda.
Kuderedza: traction pamwe neiyo axis refu yegumbo, kuparadzaniswa kuparadzaniswa.
Brace Kugadziriswa pamigumo miviri yeiyo bracture zvakare: Kugadziriswa kweiyo yakaderedzwa pfupa kuburikidza nekugadziriswa kwekunze, kusanganisira matatu-point-point fixation maitiro.
Tubular Pfupa Rinoenderera Mukunyepedzera Kugadziriswa Kwematechinjuketi: Nzira yekudzikisira, kusanganisira traction yeganda, traction.
Kurapwa kwekuvhiya
(1.
Mufananidzo 5: Kunze Kugadziriswa maitiro
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Tafura 1: Mhedzisiro yeAo Muvhenekere Kurapa
Zvikamu zvekupokana zvinoda kugadziriswa kwekumanikidza, kusanganisira compress
(4) Kuderedza zvisina kunanga:
Tekinoroji yekutsamwa inoitwa munzvimbo yakatsemuka yekukanganisika kuti ideredze chidimbu kuburikidza nekukanganisika kwetsika nyoro, uye simba rekutengesa ratidziro yechikadzi, yekunze ficha, aojoinha tension chishandiso kana lamina kuvhurika.
V.Sangano rekurapwa
Maererano neBiochemical maitiro ekupora kupora, zvakakamurwa kuita zvikamu zvina (Tafura 2). Panguva imwecheteyo, zvakasanganiswa ne biochemical maitiro, kurapwa kwekupwanya kwakakamurwa kuita matanho matatu, ayo anokurudzira kupedzwa kweiyo biochemical maitiro uye kurapa kwekupwanya (Fig. 6).
Tafura 2: Hupenyu Hupenyu hwekupora Kuporesa
Mufananidzo 6: Schematic Diagram yekupora kupora mumakonzo
Chipenga chinopisa
Hemorrhage kubva kune inokatyamadza saiti uye yakatenderedza mitezo inoumba hematoma, mafaira emuti akaputsika kumagumo, uye osteoblasts uye fibroblasts anotanga kuwanda.
Nguva yekudya
Mhinduro yekutanga yekufona inoitika mukati memavhiki maviri, nekuumbwa kweiyo cartilage skeleton inoteverwa nekuumbwa kwefadimu kuburikidza neye endochondral Onssized, uye marudzi ese ekurapa anopora zvine chekuita nehurongwa hwekurapa.
Kutangwazve
Munguva yekugadzirisa, iyo pfupa rakakomberedzwa rinotsiviwa naLamellar Bone, uye nzvimbo dzepedyo dzinodzokororwa kuti dziratidze kugadziriswa kwekuparadza.
Complication
Kunonoka Union kunonyanya kuratidzwa nekupwanya kusapora mukati menguva yakatarwa nguva, asi ichine basa rekubereka, uye zvikonzero zvekunonoka kubatana kwakasiyana-siyana, zvinoenderana nezvinhu zvinokanganisa kupora.
Nonunion inoratidzwa seyakakombama pasina humbowo hwekupora kana radiological kupora, uye izvo zvikuru zvauri kuziva ndezvekuti:
(1.
(2.
(3.
. Bone utachiona osteomyelitis chirwere chepfupa uye hutachiona hwehupfumi, chinogona kuve chakananga maronda maronda kana kuti pathogenic hutachiona, uye zvakakodzera kuziva hutachiona hutachiona uye hutachiona usati warapwa.
Dunhu rakaoma redunhu rinorwadza kurwadza nekurwadziwa, hyperesrestesia, rambidza ropa, kuyerera kweropa remunharaunda, kutsvaira, kusanganisira zvisingaite zvechisimba. Izvo zvinowanzoitika mushure mekuvhiringidzika uye kuvhiya, uye kunoonekwa uye kurapwa pakutanga, nekunzwira tsitsi nerve block kana zvichidikanwa.
• Heteroptopic Osssized (ho) inozivikanwa mushure mekutambudzika kana kuvhiyiwa, uye inowanzoitika muhudyu, uye chidya, uye mbichana, uye mbichana, uye mbichana mhuka dzinogona kudzivirira mineralization mushure mezviratidzo.
• Dzvinyiriro mune iyo praiphy compartment inowedzera kune imwe nhanho, inokanganisa kutaridzika kwemukati.
• Neurovascular kukuvara kune zvakasiyana zvinokonzeresa neurovascular kukuvara nekuda kwenzvimbo dzakasiyana dzenyunomical.
• Avascular necrosis inoitika munzvimbo dzisina kukwana kweropa, zvakananga, ona kukuvara neAnatomical nzvimbo, etc., uye kukuvadza kusinga tsanangurike kunoitika.
Kutumira Nguva: Dec-31-2024
