Mushure mekuputsika, pfupa uye matishu akapoteredzwa zvakakuvadzwa, uye kune nzira dzakasiyana dzekurapa uye nzira zvinoenderana nehuwandu hwekukuvara. Usati warapa kuputsika kwese, zvakakosha kuziva kuwanda kwekukuvara.
Kukuvara kwenyama yakapfava
I.Kuronga
Yakavharwa kuputsika
Kukuvara kwenyama yakapfava kunoiswa kubva kunyoro kusvika kune yakanyanya, kazhinji kushandisa nzira yeTscherne (Fig. 1)
Grade0 kukuvara: Diki nyoro kukuvara kwetishu
Kukuvara kweGiredhi1: kubvongodzwa kwepamusoro kana kubvongodzwa kwematishu akapfava anovhara nzvimbo yekuputsika
Grade2 kukuvara: kwakakosha tsandanyama contusion kana yakasvibiswa ganda contusion kana zvese zviri zviviri
Kukuvara kweGiredhi3: Kukuvara kwakapfava kwenyama nekutamiswa kwakanyanya, kupwanya, compartment syndrome, kana kukuvara kwevascular
Mufananidzo 1: Tscherne Classification
Vhura Kutsemuka
Nemhaka yokuti kuputsika kunotaurirana kune kunze kwenyika, dhigirii yekukuvara kwenyama yakapfava yakabatana nehuwandu hwesimba rinowanikwa nenhengo panguva yekutambudzika, uye Gustilo classification inowanzoshandiswa (Mufananidzo 2)
Mufananidzo 2: GustiloClassification
Nyora I: Yakachena ronda kureba <1 cm, diki kukuvara kwemhasuru, hapana pachena periosteal exfoliation Rudzi rwechipiri: kureba kweronda> 1 cm, hapana kukuvara kwakapfava kwenyama, kuumbwa kweflap kana kukuvara kweavulsion.
Rudzi rwechitatu: Rudzi rwemaronda runosanganisira ganda, tsandanyama, periosteum, uye pfupa, nekushungurudzika kwakanyanya, kusanganisira mhando dzakasiyana dzemaronda epfuti uye kukuvara kwepurazi.
Rudzi IIIa: Kusvibiswa kwakapararira uye / kana kuvapo kwezvironda zvakadzika zvinyoro zvinyoro, zvinyoro zvinyoro zvine kufukidzwa kwakakwana kwemapfupa uye neurovascular zvimiro.
Type IIIb: ine yakakura yakapfava tishu kukuvara, Rotational kana yemahara tsandanyama metastases inodiwa panguva yekurapa kuti uwane kufukidzwa.
Type IIIc: Vhura mafractures ane vascular kukuvara kunoda kugadziriswa kwemanyorerwo Gustilo classification inoramba ichiwedzera kuipa nekufamba kwenguva, nekuchinja kwegiredhi rekukuvara kunocherechedzwa panguva yekugadzirisa.
II.Injury management
Kuporeswa kwemaronda kunoda oxygenation, activation of cellular mechanisms, kuchenesa maronda asina kusvibiswa uye necrotic tishu. Pane nhanho ina huru dzekuporesa: coagulation (maminitsi); kuputika kwechikamu (maawa); granulation tissue stage (mazuva akaverengwa); Nguva yekugadzirwa kwemavara maronda (mavhiki).
Staging of treatment
Acute phase:kudiridza maronda, kubvongodzwa, kuvakazve pfupa, uye kudzoreredzwa kwemhando yekufamba
(1) Ongorora huwandu hwekukuvadzwa kwetishu dzakapfava uye kukuvara kwakabatana neurovascular
(2)Shandisa yakawandisa isotonic fluid yekupuruzira kudiridza mukamuri yekuvhiya kubvisa necrotic tishu nemitumbi yekunze.
(3) Kusvibiswa kunoitwa maawa ose e24 ~ 48 kubvisa miviri yekunze uye necrotic tissues kubva pachironda kusvikira ronda rinogona kuvharwa kana kuvharwa zvachose (4) Ronda rakazaruka rakawedzerwa zvakakodzera, mutsara wakadzika wakanyatsozarurwa, uye kuongororwa kunobudirira uye kukanganisa kunoitwa.
(5) Iyo yemahara yekutyoka magumo inodzoserwa muronda; Diki yakavharwa cortex inobviswa kuti iongorore uye kuchenesa mhango yemwongo
Kuvaka patsva:kubata nekutevera kwekukuvara (kunonoka kubatana, kusabatana, kuremara, hutachiona)
Convalescence:Psychological, social, uye occupational regression yemurwere
Rudzi rwekuvhara maronda uye kuvhara
Kuvharwa kwekutanga kwevanga kana kuvhara (3 ~ 5 mazuva) kunogona kuwana zvinogutsa kurapwa mhedzisiro: (1) kuvharwa kwekutanga.
(2)kunonoka kuvharwa
(3)kuvharwa kwechipiri
(4) pakati-mukobvu flap transplantation
(5)kuzvidira flap (yakatarisana nedhijitari flap)
(6) vascular pedicle flap (gastrocnemius flap)
(7) free flap (Fig. 3)
Mufananidzo3: Maonero asina kukwana emahara ekutapurirana anowanzo kupihwa
Kukuvadzwa kwebhonzo
I.Fracture line direction
Transverse: Patani yekuremerwa yekutsemuka kwakachinjika kunokonzerwa nekushushikana
obliquely: Rodha maitiro ekumanikidza nekuda kwekutsemuka kwe diagonal
Spiral: Mutoro wemutoro wekutyoka kwe torsional nekuda kwekutyoka kwe spiral
II.Kutsemuka
Kurongeka maererano nekutsemuka, mhando dzekutsemuka, nezvimwewo (Fig. 4)
Kuputsika kwakagadziriswa ndiko kuputsika ne 3 kana kupfuura zvimedu zvemapfupa ehupenyu, kazhinji zvinokonzerwa nekukuvara kwepamusoro-simba.
Pathological fracture fracture line fracture inoitika munzvimbo yekuparara kwemapfupa echirwere chekare, kusanganisira: primary bone bundu, bone metastases, osteoporosis, metabolic bone chirwere, nezvimwe.
Kuputsika kusina kukwana hakuputsi kuita zvidimbu zvakasiyana zvefupa
Segmental fractures ine distal, yepakati, uye proximal fracture zvimedu. Chikamu chepakati chinobatwa neropa, kazhinji semugumisiro wekukuvara kwepamusoro-simba, nekuputika kwenyama yakapfava kubva mupfupa, zvichikonzera matambudziko nemapfupa ekuporesa.
Kuputsika nemapfupa akaremara, akazaruka akavhurika ane zvimedu zvemapfupa, kana kushungurudzika-kusashanda kuputsika kunoda kucheneswa, kana kukanganiswa kwakanyanya kunokonzera kunokonzera kukanganisa kwemapfupa.
Zvimedu zvine butterfly bone zvimedu zvakafanana nesegmental fractures pakuti hazvibatanidzi chikamu chese chepfupa uye kazhinji chigumisiro chekupeta chisimba.
Kushungurudzika kuputsika kunokonzerwa nemitoro inodzokororwa uye inowanzoitika mu calcaneus uye tibia.
Avulsion fractures inokonzera kuputsika kwepfupa rekuisa nzvimbo apo tendon kana ligament yakatambanudzwa.
Compression fractures mafractures umo mapfupa emapfupa anosvinwa, kazhinji neaxial mitoro.
Mufananidzo 4: Kurongwa kwezvimedu
III.Zvikonzero zvinopesvedzera kuporesa kuputsika
Biological factor: zera, metabolic bone chirwere, chirwere chepasi, mashandiro ehutano, chimiro chekudya, basa retsinga, kukuvara kwevascular, mahomoni, kukura zvinhu, hutano hweakapfava tishu capsule, degree of sterility (yakavhurika fracture), kuputa, mushonga, chirwere chenzvimbo, kukuvara kwesimba nhanho, rudzi rwebhonzo, dhigirii remapfupa akaremara, michina zvinhu, dhigirii rekubatana kwepfupa, kugadzikana kwesimba remuviri yekuremara kwemapfupa.
IV. Nzira dzekurapa
Kurapa kusina kuvhiyiwa kunoratidzwa kune varwere vane kukuvara kwepasi-simba kana kuti vasingakwanisi kushanda nekuda kwemaitiro kana nzvimbo.
Kuderedza: kudhonza pamwe chete neakisi refu yegumbo, kupatsanurwa kwekutsemuka.
Kugadziriswa kwebrace kumativi ose maviri ekuputsika zvakare: kugadziriswa kwepfupa rakaderedzwa kuburikidza nekugadzirisa kwekunze, kusanganisira nzira yekugadzirisa katatu.
Tubular bone inopfuurira compression fixation tekinoroji traction: nzira yekudzikisa, kusanganisira ganda traction, bone traction.
Kuvhiya kurapwa
(1) Kugadziriswa kwekunze kwakakodzera kuvhurika kwakavhurika, kuputsika kwakavharwa nekukuvara kwakanyanya kwetishu, uye kuputsika kunoperekedzwa nehutachiona (Fig. 5)
Mufananidzo 5: Maitiro ekugadzirisa kunze
(2) Kugadziriswa kwemukati kunoshanda kune mamwe marudzi ekuputsika uye kunotevera mutemo weAO (Table 1)
Tafura 1: Evolution yeAO mukuputsika kurapwa
Zvimedu zvemukati zvinoda kumisikidzwa, zvinosanganisira static compression (compression screws), dynamic compression (isina-kukiya intramedullary zvipikiri), kuputika (kutsvedza pakati pechinhu chemukati nebhonzo), uye kugadzirisa bhiriji (yemukati zvinhu zvinotenderera nzvimbo yakaderedzwa)
(4) Kuderedza kunanga:
Iyo tekinoroji yekukwevera inoiswa munzvimbo yakatsemuka kuti kuderedze chidimbu kuburikidza nekukakavadzana kwezvinyoro zvinyoro, uye simba rekukwevera rinotorwa kubva kune femoral traction mudziyo, yekunze fixator, AO joint tension mudziyo kana lamina opener.
V. Staging kurapwa
Zvinoenderana neiyo biochemical process yekuputsika kuporeswa, yakakamurwa kuita nhanho ina (Tafura 2). Panguva imwecheteyo, inosanganiswa nehupenyu hwehupenyu, kurapwa kwekuputsika kunokamurwa kuva matanho matatu, izvo zvinokurudzira kupedzwa kwemaitiro ehupenyu uye kuporesa kwekuputsika (Fig. 6).
Tafura 2: Hupenyu nzira yekuporesa kuputsika
Mufananidzo 6: Schematic diagiramu yekuporesa kuputsika mumakonzo
Inflammatory phase
Hemorrhage kubva panzvimbo yekuputsika uye yakakomberedza zvinyoro zvinyoro zvinoumba hematoma, fibrovascular tissue mafomu pamagumo akaputsika, uye osteoblasts uye fibroblasts inotanga kuwedzera.
Nguva yekuzorora
Mhinduro yepakutanga callus inoitika mukati memavhiki e2, nekuumbwa kwekatekete skeleton inoteverwa nekugadzirwa kwe callus kuburikidza ne endochondral ossification, uye marudzi ose chaiwo ekugadzirisa kuputsika ane chokuita nekugadzirisa maitiro.
Restruction
Munguva yekugadzirisa, bhonzo rakarukwa rinoumbwa rinotsiviwa ne lamellar bone, uye medullary cavity inodzokororwa kuti iratidze kupedzwa kwekugadzirisa kuputsika.
Complication
Kunonoka kubatana kunonyanya kuratidzwa nekutyoka kusingapore mukati menguva inotarisirwa, asi kuchine chimwe chiitiko chebhayoloji, uye zvikonzero zvekunonoka mubatanidzwa zvakasiyana, izvo zvine chekuita nezvikonzero zvinokanganisa kuporeswa kwekutsemuka.
Nonunion inoratidzwa sekutyoka pasina humbowo hwekurapwa kwekiriniki kana radiological kuporesa, uye zvinonyanya kuitika ndezvi:
(1) Atrophic nonunion nekuda kwekusava nevascularization uye kushaikwa kweiyo biological kugona kupora, kunowanzo kuratidzwa se stenosis yekuputsika kwepfupa uye pasina tsinga dzeropa, uye nzira yekurapa inoda kukurudzira kwenzvimbo yebiological chiitiko (bone graft kana bone cortical resection uye bone kutakura).
(2)Hypertrophic nonunion ine transitional vascularization uye biological ability, asi inoshaya mechanical kugadzikana, iyo inowanzoratidzwa sekukura kwekuguma kwekuputsika kwekuputsika, uye kurapwa kunoda kuwedzera kugadzikana kwemagetsi (bhoni plate uye screw fixation).
(3) Dystrophic nonunion ine ropa rakakwana, asi panenge pasina kuumbwa kwe callus, uye kuderedzwa kwekuputsika kunoda kudzokororwa nekuda kwekusakwana kwekutamisa uye kuderedzwa kwekuputsika kwekupwanyika.
(4)Kune hutachiona hwehutachiona hune chirwere chisingaperi, kurapwa kunofanira kutanga kubvisa kutarisa kwehutachiona, uyezve kukurudzira kuporeswa kwekuputsika. Bone utachiona osteomyelitis chirwere chemapfupa uye mapfupa utachiona, izvo zvinogona zvakananga kutapukirwa maronda akazaruka maronda kana pathogenic utachiona kuburikidza nzira ropaborne, uye zvakakodzera kuziva utachiona utachiona uye utachiona asati kurapwa.
Complex regional pain syndrome inoratidzwa nemarwadzo, hyperesthesia, kukanganiswa kwemakumbo nemakumbo, kusagadzikana kweropa remunharaunda, kudikitira, uye edema, kusanganisira kusakanganiswa kwe autonomic nervous system. Inowanzoitika mushure mekushungurudzika uye kuvhiyiwa, uye inoonekwa uye kurapwa nekukurumidza, netsitsi dzetsinga block kana zvichidikanwa.
• Heterotopic ossification (H O) inowanzoitika mushure mekutambudzika kana kuvhiyiwa, uye inowanzoitika mugororo, hip, uye chidya, uye oral bisphosphonates inogona kudzivisa mapfupa emapfupa mushure mekutanga kwechiratidzo.
• Kudzvinyirira muchikamu cheperiophysal kunowedzera kune imwe nhanho, kukanganisa kusvibiswa kwemukati.
• Kukuvara kweNeurovascular kune zvikonzero zvakasiyana-siyana zvekukuvara kweurourovascular nekuda kwenzvimbo dzakasiyana dzeanatomical.
• Avascular necrosis inoitika munzvimbo dzisina kukwana ropa, Kunyanya, ona kukuvara uye nzvimbo yeanatomical, nezvimwewo, uye kukanganisa kusingagoneki kunoitika.
Nguva yekutumira: Zvita-31-2024
