Bayan karaya, kashi da kyallen da ke kewaye da shi sun lalace, kuma akwai ka'idoji da hanyoyin magani daban-daban dangane da girman raunin. Kafin a yi maganin dukkan karaya, yana da mahimmanci a tantance girman raunin.
Raunin nama mai laushi
I. Rarrabawa
Karyewar da aka rufe
Ana auna raunin da ya faru daga mai sauƙi zuwa mai tsanani, yawanci ta amfani da hanyar Tscherne (Hoto na 1)
Raunin Daraja 0: Ƙaramin rauni a nama mai laushi
Raunin Grade 1: gogewa ko rauni a saman nama mai laushi wanda ya rufe wurin karyewar
Raunin Grade 2: babban rauni na tsoka ko gurɓataccen rauni na fata ko duka biyun
Raunin Daraja ta 3: Raunin nama mai laushi mai tsanani tare da matsanancin motsi, murƙushewa, ciwon sashe, ko raunin jijiyoyin jini
Hoto1: Rarraba Tscherne
Karyewa Buɗaɗɗe
Saboda karyewar tana da alaƙa da duniyar waje, matakin lalacewar nama mai laushi yana da alaƙa da adadin kuzarin da gaɓɓan suka samu yayin raunin, kuma yawanci ana amfani da rarrabuwar Gustilo (Hoto na 2)
Siffa ta 2: Rarraba Gustilo
Nau'i na I: Tsayin rauni mai tsafta < 1 cm, ƙaramin lalacewar tsoka, babu bayyanannen cirewar periosteal Nau'i na II: tsawon rauni > 1 cm, babu bayyanannen lahani na nama mai laushi, samuwar lanƙwasa ko raunin avulsion
Nau'i na III: Raunuka sun haɗa da fata, tsoka, periosteum, da ƙashi, tare da ƙarin rauni mai yawa, gami da nau'ikan raunuka na musamman na harbin bindiga da raunukan gona
Nau'i na IIIa: Yaɗuwar gurɓatawa da/ko kasancewar raunuka masu zurfi na nama mai laushi, nama mai laushi tare da isasshen rufewar ƙashi da tsarin jijiyoyin jini
Nau'i na IIIb: tare da lalacewar nama mai laushi, ana buƙatar ƙwayoyin tsoka masu juyawa ko marasa lalacewa yayin magani don cimma nasarar rufewa.
Nau'i na IIIc: Karyewar da aka buɗe tare da lalacewar jijiyoyin jini da ke buƙatar gyara da hannu Rarraba Gustilo yana ƙara muni a hankali akan lokaci, tare da canje-canje a matakin rauni da aka lura yayin gyara.
II. Kula da rauni
Warkewar raunuka yana buƙatar iskar oxygen, kunna hanyoyin ƙwayoyin halitta, tsaftace raunukan da ba su da gurɓataccen nama da ƙwayoyin cuta. Akwai manyan matakai guda huɗu na warkarwa: coagulation (minti); matakin kumburi (awanni); matakin ƙwayoyin granulation (kwanaki da aka ƙidaya); Lokacin samuwar tabo nama (makonni).
Tsarin magani
Matakin gaggawa:ban ruwa na rauni, gogewa, sake gina ƙashi, da kuma dawo da yanayin motsi
(1) Kimanta girman raunin nama mai laushi da raunin jijiyoyin jijiyoyi masu alaƙa
(2) Yi amfani da ruwa mai yawa na isotonic don ban ruwa mai motsawa a ɗakin tiyata don cire kyallen necrotic da sauran gabobin jiki
(3) Ana yin aikin cire duk wani abu da ya fito daga jikin rauni bayan sa'o'i 24 zuwa 48 domin cire duk wani abu da ya fito daga jikin rauni har sai an rufe shi ko kuma an rufe shi gaba daya (4) An tsawaita raunin yadda ya kamata, an bude kyallen sosai, kuma ana yin bincike mai inganci da kuma cire shi daga jikin.
(5) An mayar da ƙarshen karyewar da ba ta da matsala zuwa cikin raunin; An cire ƙaramin cortex da aka kashe don duba da tsaftace ramin bargo na ƙashi
Sake ginawa:magance sakamakon rauni (jinkirin haɗuwa, rashin haɗin kai, nakasar tsari, kamuwa da cuta)
Warkewa:Komawar hankali ga majiyyaci a fannin tunani, zamantakewa, da kuma aiki
Nau'in rufewar rauni da kuma rufewa
Rufe rauni da wuri ko rufewa (kwanaki 3-5) na iya cimma sakamako mai gamsarwa na magani: (1) babban rufewa
(2) jinkirin rufewa
(3)rufewa ta biyu
(4) dashen matsakaicin kauri na lanƙwasa
(5) murfin son rai (ƙulli na dijital kusa da shi)
(6) murfin ƙafar jijiyoyin jini (gastrocnemius flap)
(7) faifan kyauta (Hoto na 3)
Hoto na 3: Sau da yawa ana bayar da ra'ayoyi kaɗan game da dashen da aka yi kyauta
Lalacewar ƙashi
I. Alkiblar layin karaya
Juyawa: Tsarin nauyin karyewar da ta faru sakamakon tashin hankali
a hankali: Yanayin ɗaukar nauyi na matsin lamba saboda karyewar diagonal
Karkace-karkace: Tsarin nauyin karyewar karkace saboda karyewar karkace
II. Karyewar Kashi
Rarrabawa bisa ga karaya, nau'in karaya, da sauransu (Hoto na 4)
Karyewar ƙashi mai rauni shine karyewar ƙashi mai rai guda 3 ko fiye, wanda yawanci yakan faru ne sakamakon rauni mai ƙarfi.
Karyewar Jiki Karyewar Jiki Karyewar Jiki Karyewar Jiki na faruwa ne a yankin lalacewar ƙashi na cutar da ta gabata, ciki har da: ciwon ƙashi na farko, metastases na ƙashi, osteoporosis, cutar ƙashi ta metabolism, da sauransu.
Karyewar da ba ta cika ba ba ta karyewa zuwa sassa daban-daban na ƙashi
Karyewar sassa tare da gutsuttsuran karyewar nesa, tsakiya, da kuma kusa. Yankin tsakiya yana shafar jinin da ke kwarara, yawanci sakamakon rauni mai ƙarfi, tare da cire nama mai laushi daga ƙashi, wanda ke haifar da matsaloli wajen warkar da ƙashi.
Karyewar ƙashi mai lahani, karyewar ƙashi mai buɗewa, ko karyewar da ba ta aiki ba wadda ke buƙatar a tsaftace ta, ko kuma karyewar ƙashi mai tsanani wanda ke haifar da lahani a ƙashi.
Karyewar ƙasusuwan malam buɗe ido suna kama da karyewar sassa domin ba sa haɗa dukkan sassan ƙashin kuma yawanci sakamakon tashin hankali ne na lanƙwasawa.
Karyewar damuwa tana faruwa ne sakamakon yawan lodi kuma galibi tana faruwa a cikin ƙashin ƙashi da tibia.
Karyewar ƙashi yana haifar da karyewar wurin da ƙashi ya shiga lokacin da aka miƙa jijiyar ko jijiyar.
Karyewar matsi shine karyewar da ake matse gutsuttsuran ƙashi, yawanci ta hanyar nauyin axial.
Hoto na 4: Rarraba Karyewar Kashi
III. Abubuwan da ke tasiri ga warkar da karaya
Abubuwan Halittu: shekaru, cututtukan ƙashi na rayuwa, cututtuka masu alaƙa da shi, matakin aiki, matsayin abinci mai gina jiki, aikin jijiyoyi, lalacewar jijiyoyin jini, hormones, abubuwan ci gaba, yanayin lafiya na ƙashin nama mai laushi, matakin rashin haihuwa (karyewar buɗewa), shan taba, magani, cututtukan gida, matakin kuzarin rauni, nau'in ƙashi, matakin lahani na ƙashi, abubuwan injiniya, matakin haɗewar nama mai laushi ga ƙashi, kwanciyar hankali, tsarin jiki, matakin kuzarin rauni, matakin lahani na ƙashi.
IV. Hanyoyin magani
Ana nuna maganin da ba na tiyata ba ga marasa lafiya da ke da raunin da ba shi da ƙarfi ko kuma waɗanda ba za a iya yi musu aiki ba saboda dalilai na tsarin jiki ko na gida.
Ragewa: jan hankali tare da dogon layin gaɓɓai, rabuwar karyewa.
Gyaran takalmin gyaran kafa a ƙarshen karaya biyu kuma: gyara ƙashin da ya ragu ta hanyar gyarawa ta waje, gami da dabarar gyarawa mai maki uku.
Hanyar gyaran ƙashi mai ci gaba da matsawa: hanyar ragewa, gami da jan fata, jan kashi.
Maganin tiyata
(1) Gyaran waje ya dace da karyewar da aka buɗe, karyewar da aka rufe tare da mummunan rauni na nama mai laushi, da karyewar da ke tare da kamuwa da cuta (Hoto na 5)
Hoto na 5: Tsarin gyarawa na waje
(2) Gyaran ciki yana aiki ga wasu nau'ikan karaya kuma yana bin ƙa'idar AO (Tebur 1)
Tebur 1: Juyin Halittar AO a cikin maganin karyewa
Gutsuttsuran da ke katsewa suna buƙatar gyara matsi, gami da matsi mai tsauri (sukurin matsi), matsi mai ƙarfi (ƙusoshin intramedullary marasa kullewa), zamewa (zamewa tsakanin abin ciki da ƙashi), da kuma gyara gada (kayan ciki da ke kewaye da yankin da aka yi amfani da shi)
(4)Ragewa kai tsaye:
Ana amfani da fasahar jan ƙarfe a yankin da aka yi wa karyewa don rage guntun ta hanyar tashin hankali na nama mai laushi, kuma ƙarfin jan ƙarfe yana fitowa ne daga na'urar jan ƙarfe ta femur, mai gyarawa na waje, na'urar jan ƙarfe ta haɗin gwiwa ta AO ko kuma mai buɗe lamina.
V. Tsarin magani
Dangane da tsarin biochemical na warkar da karaya, an raba shi zuwa matakai hudu (Tebur na 2). A lokaci guda, tare da tsarin biochemical, maganin karaya an raba shi zuwa matakai uku, wanda ke inganta kammala tsarin biochemical da warkar da karaya (Hoto na 6).
Tebur na 2: Rayuwar warkar da karaya
Hoto na 6: Zane-zanen warkar da karaya a cikin beraye
Matakin kumburi
Zubar jini daga wurin da aka samu karyewar jini da kuma kyallen da ke kewaye da shi suna samar da hematoma, kyallen fibrovascular suna samuwa a ƙarshen karyewar jini, sannan osteoblasts da fibroblasts suna fara yaduwa.
Lokacin rashin aiki
Amsar farko ta calus tana faruwa cikin makonni 2, tare da samuwar kwarangwal na guringuntsi sannan kuma samuwar calus ta hanyar endochondral ossification, kuma duk takamaiman nau'ikan warkar da karyewar suna da alaƙa da hanyar magani.
Sake Ginawa
A lokacin gyaran, ana maye gurbin ƙashin da aka kididdige da ƙashin lamellar, sannan a sake gyara ramin medullary don nuna kammala gyaran karyewar.
Matsaloli
Jinkirin haɗin kai galibi yana bayyana ne ta hanyar karyewar da ba ta warkewa a cikin lokacin da ake tsammani, amma har yanzu tana da wasu ayyukan halitta, kuma dalilan jinkirin haɗin kai sun bambanta, waɗanda ke da alaƙa da abubuwan da ke shafar warkar da karyewar.
Rashin haɗin kai yana bayyana a matsayin karaya ba tare da shaidar warkarwa ta asibiti ko ta rediyo ba, kuma manyan abubuwan da aka gano sune:
(1) Rashin daidaituwar ƙwayoyin halitta saboda rashin samuwar jijiyoyin jini da rashin ikon warkar da su, galibi yana bayyana a matsayin stenosis na ƙarshen ƙashi da rashin jijiyoyin jini, kuma tsarin magani yana buƙatar ƙarfafa ayyukan halittu na gida (dashen ƙashi ko yanke ƙashi da jigilar ƙashi).
(2) Rashin haɗin kai na hypertrophic yana da ikon canzawar jijiyoyin jini da kuma ikon halittu, amma ba shi da kwanciyar hankali na injiniya, wanda yawanci ana bayyana shi a matsayin ƙaruwar ƙarshen karyewar, kuma maganin yana buƙatar ƙara kwanciyar hankali na injiniya (faranti na ƙashi da gyara sukurori).
(3) Rashin haɗin gwiwa na dystrophic yana da isasshen jini, amma kusan babu samuwar ƙuraje, kuma ana buƙatar sake yin rage karyewar saboda rashin isasshen motsi da raguwar ƙarshen karyewar.
(4) Idan aka samu kamuwa da cuta mai tsanani, maganin ya kamata ya fara cire wurin da kamuwa da cuta ke fitowa, sannan ya inganta warkar da karaya. Ciwon ƙashi osteomyelitis cuta ce ta kamuwa da ƙashi da ƙashi, wanda zai iya zama kamuwa kai tsaye da raunukan raunuka ko kamuwa da cuta ta hanyar jini, kuma ya zama dole a gano ƙwayoyin cuta da ƙwayoyin cuta da suka kamu da cutar kafin a yi maganin.
Ciwon ciwo mai rikitarwa na yanki yana da alaƙa da ciwo, yawan zubar jini, rashin lafiyar gaɓoɓi, kwararar jini ta gida ba daidai ba, gumi, da kumburi, gami da rashin daidaituwar tsarin juyayi na autonomic. Yawanci yana faruwa ne bayan rauni da tiyata, kuma ana gano shi kuma ana yi masa magani da wuri, tare da toshewar jijiyoyi idan ya cancanta.
• Ciwon kai mai tsanani (Heterotopic ossification) (HO) ya zama ruwan dare bayan rauni ko tiyata, kuma ya fi yawa a gwiwar hannu, kwatangwalo, da cinya, kuma bisphosphonates na baki na iya hana samuwar ƙashi bayan bayyanar alamun.
• Matsi a cikin sashin periophysal yana ƙaruwa zuwa wani mataki, yana lalata bututun ciki.
• Raunin jijiyoyin jijiyoyi yana da dalilai daban-daban na raunin jijiyoyin jijiyoyi saboda wurare daban-daban na jikin mutum.
• Ciwon jijiyoyin jini (Avascular necrosis) yana faruwa a wuraren da babu isasshen jini, musamman ganin raunin da wurin da ake da shi a jiki, da sauransu, kuma lalacewar da ba za a iya jurewa ba na faruwa.
Lokacin Saƙo: Disamba-31-2024
