Bayan karaya, kasusuwa da ƙwayoyin da ke kewaye da su sun lalace, kuma akwai ka'idoji da hanyoyin magani daban-daban bisa ga girman rauni. Kafin yin maganin duk karaya, yana da mahimmanci don ƙayyade girman raunin.
Rauni mai laushi
I.Rarrabawa
Rufe karaya
An ƙididdige raunin nama mai laushi daga m zuwa mai tsanani, yawanci ta amfani da hanyar Tscherne (Fig. 1)
Raunin Grade0: Ƙananan rauni mai laushi
Rauni na daraja 1: ɓarna na sama ko ruɗewar nama mai laushi wanda ke rufe wurin karyewar
Rauni na Grade2: Muhimmin raunin tsoka ko gurɓataccen fata ko duka biyun
Rauni na Grade3: Rauni mai laushi mai tsanani tare da matsananciyar ƙaura, murkushewa, ciwo na yanki, ko rauni na jijiyoyin jini
Hoto1: Rarraba Tscherne
Bude Karya
Saboda raunin da ya faru yana sadarwa zuwa waje na waje, girman lalacewar nama mai laushi yana da alaƙa da adadin kuzarin da aka samu a lokacin rauni, kuma ana amfani da rarrabuwar Gustilo (Hoto 2)
Hoto2: GustiloClassification
Nau'in I: Tsaftace tsayin rauni <1 cm, ƙananan lalacewar tsoka, babu bayyananniyar exfoliation na periosteal Nau'in II: tsayin rauni> 1 cm, babu lahani mai laushi mai laushi, haɓakar murɗa ko rauni mai rauni.
Nau'in III: Rauni ya haɗa da fata, tsoka, periosteum, da kashi, tare da ƙarin rauni mai yawa, gami da nau'ikan raunukan harbin bindiga na musamman da raunin gonaki.
Nau'in IIIa: Yaɗuwar gurɓata da / ko kasancewar raunin nama mai laushi mai zurfi, nama mai laushi tare da isasshen ɗaukar hoto na ƙashi da tsarin jijiyoyin jini.
Nau'in IIIb: tare da lalacewar nama mai laushi mai yawa, Ana buƙatar juyawa ko ƙwayoyin tsoka na kyauta yayin jiyya don cimma ɗaukar hoto
Nau'in IIIc: Buɗe karaya tare da lalacewar jijiyoyin bugun jini da ke buƙatar gyaran hannu Rarrabewar Gustilo yana ƙara yin muni a kan lokaci, tare da canje-canje a darajar rauni da aka lura yayin gyarawa.
II.Gudanar da rauni
Warkar da rauni yana buƙatar iskar oxygenation, kunna hanyoyin salon salula, tsabtace raunuka ba tare da gurɓatacce da nama na necrotic ba. Akwai manyan matakai guda hudu na waraka: coagulation (mintuna); lokaci mai kumburi (sa'o'i); matakin nama granulation (kwanakin ƙidaya); Lokacin samuwar tabo (makonni).
Matsayin magani
Matsakaicin lokaci:raunin ban ruwa, lalata, sake gina kashi, da dawo da kewayon motsi
(1) Yi la'akari da girman raunin nama mai laushi da rauni na jijiyoyin jini
(2) Yi amfani da ruwa mai yawa na isotonic don ban ruwa a cikin dakin aiki don cire ƙwayar necrotic da jikin waje.
(3) Ana aiwatar da ɓarna a kowane sa'o'i 24 ~ 48 don cire duk jikin waje da ƙwayoyin necrotic daga rauni har sai an iya rufe rauni ko kuma an rufe shi gaba ɗaya (4) An buɗe raunin da ya dace, nama mai zurfi yana fallasa sosai, kuma ana aiwatar da kimantawa mai inganci da debridement.
(5) Ƙarshen karyewar kyauta yana komawa cikin rauni; Ana cire ƙananan ƙwayoyin da aka kashe don dubawa da tsaftace ramin kasusuwa
Sake ginawa:fama da abubuwan da suka faru na rauni (jinkirta ƙungiya, rashin haɗin kai, nakasa, kamuwa da cuta)
Amincewa:Ilimin tunani, zamantakewa, da koma bayan sana'a na mai haƙuri
Nau'in rufe raunuka da ɗaukar hoto
Rufe raunuka na farko ko ɗaukar hoto (3 ~ 5 kwanaki) na iya cimma sakamako mai gamsarwa: (1) rufewar farko
(2) jinkirta rufewa
(3)rufe na biyu
(4)Matsakaicin kauri mai kauri
(5)fan son rai (matsayi na dijital)
(6).
(7) Tufafin kyauta (Hoto 3)
Hoto3: Ana yawan ba da ra'ayi na ɓangarori na kyauta
Lalacewar kashi
I.Karya hanyar layi
Juyawa: Load nau'in nau'in karaya wanda tashin hankali ya haifar
obliquely: Yanayin lodawa na matsa lamba saboda karyewar diagonal
Karkace: Load nau'in nau'in karyewar juzu'i saboda karaya mai karkace
II.Karya
Rarraba bisa ga karaya, nau'in karaya, da sauransu (Fig. 4)
Ƙunƙarar da aka yanke shine karaya tare da ɓawon kashi 3 ko fiye masu rai, yawanci yana haifar da rauni mai ƙarfi.
Pathological fracture fracture line fracture yana faruwa a cikin yanki na lalacewar kasusuwa na cutar da ta gabata, ciki har da: ciwon kashi na farko, ƙasusuwan kashi, osteoporosis, cututtukan kasusuwa, da dai sauransu.
Karayar da ba ta cika ba ba ta karyewa cikin sassa daban-daban na kashi
Karyewar kashi mai nisa, tsakiya, da guntuwar karaya. Sashin tsakiya yana shafar jinin jini, yawanci saboda sakamakon rauni mai ƙarfi, tare da raguwa mai laushi daga kashi, yana haifar da matsaloli tare da warkar da kashi.
Karya tare da lahani na kashi, buɗaɗɗen ɓarna tare da guntun kashi, ko raunin raunin da ba ya aiki wanda ke buƙatar sharewa, ko raunin da ya faru wanda ke haifar da lahani na kashi.
Karyewar kasusuwan malam buɗe ido suna kama da karyewar ɓangarori domin ba sa haɗawa da dukan ɓangaren kashi kuma yawanci sakamakon lanƙwasa tashin hankali ne.
Ana samun karaya ta damuwa ta hanyar lodi mai yawa kuma yawanci yana faruwa a cikin kashin baya da tibia.
Karyewar shaye-shaye yana haifar da karyewar wurin shigar kashi lokacin da aka miqe agara ko jijiya.
Karyewar matsi shine karaya wanda ake matse guntun kashi, yawanci ta hanyar axial lodi.
Hoto 4: Rarraba karaya
III.Abubuwan da ke shafar karaya
Halittu dalilai: shekaru, na rayuwa kashi cuta, m cuta, aiki matakin, sinadirai masu darajar, neurological aiki, jijiyoyin bugun gini lalacewa, hormones, girma dalilai, kiwon lafiya matsayi na taushi nama capsule, mataki na haihuwa (bude karaya), shan taba, magani, Pathology na gida, rauni makamashi matakin, irin kashi, mataki na kashi lahani, inji, mataki na abin da aka makala taushi nama zuwa kashi, kwanciyar hankali matakin, anatom tsarin, rauni tsarin, makamashi matakin.
IV. Hanyoyin magani
Ana ba da magani ga marasa lafiya da ƙananan raunin kuzari ko waɗanda ba za su iya aiki ba saboda tsarin tsarin ko na gida.
Ragewa: raguwa tare da tsayin tsayin ƙafar ƙafa, raguwa.
Gyaran takalmin gyaran kafa a duka ƙarshen karaya kuma: gyaran gyare-gyaren da aka rage ta hanyar gyaran waje, gami da dabarar gyara maki uku.
Tubular kashi ci gaba da matsawa gyaran gyare-gyaren fasaha: hanyar ragewa, ciki har da ƙwayar fata, ƙwayar kashi.
Maganin tiyata
(1) Gyaran waje ya dace da buɗaɗɗen ɓarna, rufaffiyar ɓarna tare da mummunan rauni mai laushi mai laushi, da raguwa tare da kamuwa da cuta (Fig. 5)
Hoto 5: Hanyar gyarawa na waje
(2) Gyaran ciki yana amfani da wasu nau'ikan karaya kuma ya bi ka'idar AO (Table 1)
Shafin 1: Juyin Halitta na AO a cikin maganin karaya
Gutsutsun gutsuttsura suna buƙatar gyare-gyaren matsawa, gami da matsawa a tsaye (matsin sukurori), matsawa mai ƙarfi (ƙusoshi marasa kullewa na intramedullary), splinting ( zamewa tsakanin abu na ciki da kashi), da daidaitawa (kayan ciki wanda ke faɗin yankin da aka gama)
(4) Rage kai tsaye:
Ana aiwatar da fasahar haɓakawa a cikin ɓangarorin comminuted yanki don rage rarrabuwa ta hanyar tashin hankali na nama mai laushi, kuma ana samun ƙarfin motsa jiki daga na'urar motsa jiki na femoral, mai gyara waje, na'urar haɗin gwiwa ta AO ko mabudin lamina.
V.Tsarin magani
Bisa ga tsarin biochemical na warkar da karaya, an raba shi zuwa matakai hudu (Table 2). A lokaci guda, haɗe tare da tsarin kwayoyin halitta, maganin raunin da ya faru ya kasu kashi uku, wanda ke inganta ƙaddamar da tsarin kwayoyin halitta da kuma warkar da raguwa (Fig. 6).
Shafin 2: Hanyar rayuwa ta warkar da karaya
Hoto 6: Tsarin tsari na warkar da karaya a cikin mice
Lokaci mai kumburi
Zubar da jini daga wurin da aka rushe da kuma kewaye da kyallen takarda mai laushi ya haifar da hematoma, nau'in nama na fibrovascular a ƙarshen karya, kuma osteoblasts da fibroblasts sun fara karuwa.
Downtime
Amsar kiran asali na asali yana faruwa a cikin makonni 2, tare da samuwar kwarangwal na guringuntsi wanda ya biyo bayan samuwar kira ta hanyar endochondral ossification, kuma duk takamaiman nau'i na warkarwa na karya yana da alaƙa da tsarin kulawa.
Gyarawa
A lokacin aikin gyaran, an maye gurbin kashin da aka yi masa waƙa da kashin lamellar, kuma an sake dawo da rami na medullary don alamar kammala gyaran karaya.
rikitarwa
Haɗin haɗin da aka jinkirta yana bayyana ne ta hanyar karyewar ba ta warkewa cikin lokacin da ake tsammani ba, amma har yanzu yana da wasu ayyukan ilimin halitta, kuma dalilan jinkirin ƙungiyar sun bambanta, waɗanda ke da alaƙa da abubuwan da ke shafar waraka.
Ana bayyana rashin jin daɗi a matsayin karaya ba tare da shaidar warkewar asibiti ko rediyo ba, kuma manyan abubuwan da aka gano sune:
(1) Atrophic nonunion saboda nonvascularization da kuma rashin nazarin halittu ikon warkewa, yawanci bayyana a matsayin stenosis na karye karshen kashi kuma babu jini, da kuma magani tsari na bukatar ruri na gida nazarin halittu aiki (kashi graft ko kashi cortical resection da kashi kai).
(2) Hypertrophic nonunion yana da tsaka-tsakin vascularization da ikon ilimin halitta, amma ba shi da kwanciyar hankali na injiniya, wanda yawanci yana nunawa a matsayin haɓakar karyewar ƙarshen fashe, kuma magani yana buƙatar haɓaka kwanciyar hankali na inji (farantin kasusuwa da screw fixation).
(3) Dystrophic nonunion yana da isasshen jini, amma kusan babu samuwar callus, kuma raguwar raguwa yana buƙatar sake yin aiki saboda rashin matsuwa da raguwar karyewar ƙarshen fashe.
(4)Don rashin haɗin kai tare da kamuwa da cuta na yau da kullun, magani ya kamata ya fara cire mayar da hankali kan kamuwa da cuta, sannan ya inganta warkar da karaya. Ciwon kashi osteomyelitis cuta ce ta kamuwa da kashi da kashi, wanda zai iya zama kamuwa da raunuka kai tsaye na raunukan rauni ko kamuwa da cuta ta hanyoyin jini, kuma kafin a yi maganin ya zama dole a gano masu kamuwa da cutar.
Ciwon ciwo mai rikitarwa na yanki yana da zafi, hyperesthesia, rashin lafiyar jiki, jini na gida mara kyau, gumi, da edema, ciki har da rashin daidaituwa na tsarin juyayi mai cin gashin kansa. Yawanci yana faruwa bayan rauni da tiyata, kuma ana gano shi kuma ana bi da shi da wuri, tare da toshewar jijiya idan ya cancanta.
• Heterotopic ossification (HO) ya zama ruwan dare bayan rauni ko tiyata, kuma ya fi dacewa a gwiwar hannu, hip, da cinya, da bisphosphonates na baka na iya hana ma'adinan kashi bayan bayyanar alamun.
• Matsawa a cikin sashin periophysal yana ƙaruwa zuwa wani matakin, yana lalata ruɗar ciki.
• Raunin jijiyoyin jini yana da dalilai daban-daban na raunin jijiyoyin jini saboda wurare daban-daban na jiki.
• Avascular necrosis yana faruwa a wuraren da ba su da isasshen jini, Musamman, duba rauni da wurin jiki, da dai sauransu, kuma lalacewar da ba za a iya jurewa ba ta faru.
Lokacin aikawa: Dec-31-2024
