Tom qab pob txha tawg, cov pob txha thiab cov nqaij nyob ib puag ncig raug puas tsuaj, thiab muaj cov ntsiab cai thiab cov txheej txheem kho mob sib txawv raws li qib kev raug mob. Ua ntej kho txhua qhov pob txha tawg, nws yog ib qho tseem ceeb kom txiav txim siab qhov loj ntawm qhov raug mob.
Kev raug mob ntawm cov nqaij mos
I. Kev faib tawm
Cov pob txha tawg kaw
Cov kev raug mob ntawm cov nqaij mos mos raug muab faib ua qib los ntawm qhov me me mus rau qhov hnyav, feem ntau yog siv txoj kev Tscherne (Daim Duab 1)
Kev raug mob qib 0: Kev raug mob me me ntawm cov nqaij mos mos
Kev raug mob theem 1: kev puas tsuaj rau saum npoo lossis kev raug mob ntawm cov ntaub so ntswg mos uas npog qhov chaw tawg
Kev raug mob theem 2: kev raug mob ntawm cov leeg nqaij lossis kev raug mob ntawm daim tawv nqaij lossis ob qho tib si
Kev raug mob theem 3: Kev raug mob hnyav ntawm cov nqaij mos mos nrog rau kev hloov chaw hnyav, kev tsoo, kev mob hauv qhov chaw, lossis kev raug mob ntawm cov hlab ntsha
Daim duab 1: Tscherne Classification
Qhov Pob Txha Qhib
Vim tias qhov pob txha tawg yog kev sib txuas lus rau lub ntiaj teb sab nraud, qib ntawm kev puas tsuaj ntawm cov nqaij mos mos yog cuam tshuam nrog qhov ntau ntawm lub zog uas tus ceg tau ntsib thaum lub sijhawm raug mob, thiab kev faib tawm Gustilo feem ntau yog siv (Daim Duab 2)
Daim Duab 2：Gustilo Kev Faib Pawg
Hom I: Qhov txhab huv si qhov ntev < 1 cm, cov leeg nqaij me me raug mob, tsis pom tseeb periosteal exfoliation Hom II: qhov txhab ntev > 1 cm, tsis pom tseeb cov nqaij mos mos raug mob, tsim daim tawv nqaij lossis raug mob avulsion
Hom III: Qhov txhab suav nrog daim tawv nqaij, cov leeg, periosteum, thiab pob txha, nrog rau kev raug mob ntau dua, suav nrog cov hom mob phom tshwj xeeb thiab kev raug mob ua liaj ua teb
Hom IIIa: Muaj kev kis kab mob dav dav thiab/lossis muaj cov qhov txhab tob tob ntawm cov nqaij mos mos, cov nqaij mos uas npog cov pob txha thiab cov qauv ntawm cov hlab ntsha hauv lub paj hlwb txaus
Hom IIIb: nrog rau kev puas tsuaj loj heev ntawm cov nqaij mos mos, Yuav tsum muaj kev sib hloov lossis cov leeg nqaij dawb metastases thaum lub sijhawm kho mob kom ua tiav kev them nqi
Hom IIIc: Pob txha tawg qhib nrog kev puas tsuaj ntawm cov hlab ntsha uas xav tau kev kho tes Gustilo kev faib tawm feem ntau yuav hnyav zuj zus mus raws sijhawm, nrog rau kev hloov pauv ntawm qib kev raug mob thaum kho.
II. Kev tswj hwm kev raug mob
Kev kho qhov txhab yuav tsum tau muaj oxygen, ua kom cov hlwb ua haujlwm, ntxuav cov qhov txhab kom tsis txhob muaj cov nqaij uas lwj thiab lwj. Muaj plaub theem tseem ceeb ntawm kev kho: coagulation (feeb); o (teev); granulation tissue stage (hnub suav); lub sijhawm tsim cov nqaij caws pliav (lub lis piam).
Kev kho mob theem
Theem mob hnyav:kev ywg dej rau qhov txhab, kev tshem tawm cov pob txha, kev kho pob txha dua tshiab, thiab kev rov qab tau qhov txav mus los
(1) Soj ntsuam qhov dav ntawm kev raug mob ntawm cov nqaij mos thiab kev raug mob ntawm cov hlab ntsha hauv lub paj hlwb
(2) Siv cov kua dej isotonic ntau rau kev ua kom cov kua dej ntws hauv chav ua haujlwm kom tshem tawm cov ntaub so ntswg necrotic thiab cov khoom txawv teb chaws
(3) Kev tshem tawm cov qhov txhab yuav ua txhua 24 ~ 48 teev kom tshem tawm txhua yam khoom txawv teb chaws thiab cov nqaij mos ntawm qhov txhab kom txog thaum qhov txhab kaw lossis npog tag nrho. (4) Qhov txhab qhib tau nthuav dav kom haum, cov nqaij tob tau nthuav tawm tag nrho, thiab kev soj ntsuam zoo thiab kev tshem tawm cov qhov txhab tau ua tiav.
(5) Qhov kawg ntawm qhov tawg dawb raug rub rov qab rau hauv qhov txhab; Lub cortex me me uas tsis ua haujlwm raug tshem tawm los kuaj xyuas thiab ntxuav cov pob txha pob txha.
Kev Tsim Kho Dua Tshiab:kev daws teeb meem ntawm kev raug mob (kev sib koom ua ke qeeb, tsis sib koom ua ke, kev puas tsuaj, kev kis kab mob)
Kev Kho Mob:Kev puas siab puas ntsws, kev sib raug zoo, thiab kev ua haujlwm ntawm tus neeg mob
Hom kev kaw qhov txhab thiab kev npog
Kev kaw qhov txhab thaum ntxov lossis kev npog (3 ~ 5 hnub) tuaj yeem ua tiav cov txiaj ntsig kho mob zoo: (1) kev kaw thawj zaug
(2) kev kaw qeeb
(3) kev kaw thib ob
(4) kev hloov pauv ntawm daim tawv nqaij nruab nrab tuab
(5) daim ntaub nplaum (daim ntaub nplaum digital uas nyob ib sab)
(6) daim tawv nqaij ntawm lub plab (gastrocnemius flap)
(7) daim ntaub dawb (Daim Duab 3)
Daim Duab 3: Feem ntau pom ib feem ntawm kev hloov pauv dawb
Kev puas tsuaj rau pob txha
I. Kev taw qhia ntawm kab tawg
Transverse: Tus qauv thauj khoom ntawm qhov tawg transverse uas tshwm sim los ntawm kev nruj
obliquely: Hom kev thauj khoom ntawm lub siab vim yog qhov tawg ntawm kab pheeb ces kaum
Spiral: Tus qauv thauj khoom ntawm qhov tawg torsional vim yog qhov tawg spiral
II. Cov pob txha tawg
Kev faib tawm raws li qhov tawg, hom tawg, thiab lwm yam (Daim Duab 4)
Cov pob txha tawg uas raug sib tsoo yog cov pob txha tawg uas muaj 3 lossis ntau dua cov pob txha uas muaj sia nyob, feem ntau yog los ntawm kev raug mob hnyav.
Kev tawg pob txha pathological tshwm sim hauv thaj chaw ntawm kev puas tsuaj ntawm cov pob txha yav dhau los, suav nrog: thawj pob txha qog, pob txha metastases, osteoporosis, metabolic pob txha kab mob, thiab lwm yam
Cov pob txha tawg tsis tiav tsis tawg ua tej daim sib cais
Cov pob txha tawg uas muaj cov pob txha tawg ntawm qhov deb, nruab nrab, thiab qhov proximal. Cov pob txha tawg nruab nrab raug cuam tshuam los ntawm cov ntshav ntws, feem ntau yog vim muaj kev raug mob hnyav, nrog rau cov nqaij mos mos tawm ntawm pob txha, ua rau muaj teeb meem nrog kev kho pob txha.
Cov pob txha tawg uas muaj cov pob txha tsis zoo, cov pob txha tawg qhib uas muaj cov pob txha tawg, lossis cov pob txha tawg uas tsis muaj zog uas yuav tsum tau kho, lossis cov pob txha tawg loj heev uas ua rau cov pob txha tsis zoo.
Cov pob txha tawg nrog cov pob txha npauj npaim zoo ib yam li cov pob txha tawg segmental uas lawv tsis koom nrog tag nrho cov pob txha thiab feem ntau yog qhov tshwm sim ntawm kev khoov.
Kev tawg pob txha vim kev ntxhov siab yog tshwm sim los ntawm kev rov ua dua thiab feem ntau tshwm sim hauv calcaneus thiab tibia.
Cov pob txha tawg ua rau pob txha tawg thaum cov leeg lossis ligament raug ncab.
Cov pob txha tawg uas raug nias yog cov pob txha tawg uas cov pob txha raug nias, feem ntau yog los ntawm cov khoom hnyav axial.
Daim Duab 4: Kev faib tawm ntawm cov pob txha tawg
III. Cov yam ntxwv uas cuam tshuam rau kev kho pob txha tawg
Tej yam tseem ceeb ntawm lub cev: hnub nyoog, kab mob pob txha metabolic, kab mob hauv qab, qib kev ua haujlwm, kev noj zaub mov zoo, kev ua haujlwm ntawm lub paj hlwb, kev puas tsuaj ntawm cov hlab ntsha, cov tshuaj hormones, cov yam tseem ceeb ntawm kev loj hlob, kev noj qab haus huv ntawm cov ntaub so ntswg mos, qib kev tsis muaj menyuam (qhib pob txha tawg), kev haus luam yeeb, tshuaj, kab mob hauv zos, qib zog raug mob, hom pob txha, qib ntawm qhov tsis zoo ntawm pob txha, cov yam ntxwv ntawm lub cev, qib kev txuas ntawm cov ntaub so ntswg mos rau pob txha, kev ruaj khov, cov qauv ntawm lub cev, qib ntawm lub zog raug mob, qib ntawm qhov tsis zoo ntawm pob txha.
IV. Cov Hom Kev Kho Mob
Kev kho mob uas tsis yog phais yog qhia rau cov neeg mob uas raug mob tsawg zog lossis cov neeg uas tsis tuaj yeem phais tau vim yog cov yam ntxwv ntawm lub cev lossis hauv zos.
Txo: traction raws txoj kab ntev ntawm ceg, tawg sib cais.
Rov kho qhov txhav ntawm ob sab kawg ntawm qhov tawg dua: kho cov pob txha uas txo qis los ntawm kev kho sab nraud, suav nrog cov txheej txheem kho peb-taw tes.
Cov txheej txheem kho kom ruaj khov ntawm cov pob txha tubular traction: ib txoj hauv kev txo qis, suav nrog kev rub tawv nqaij, kev rub pob txha.
Kev phais mob
(1) Kev kho sab nraud yog qhov tsim nyog rau cov pob txha tawg qhib, cov pob txha tawg kaw nrog kev raug mob hnyav ntawm cov nqaij mos, thiab cov pob txha tawg nrog kev kis kab mob (Daim Duab 5)
Daim Duab 5: Cov txheej txheem kho sab nraud
(2) Kev kho sab hauv yog siv rau lwm hom pob txha tawg thiab ua raws li txoj cai AO (Rooj 1)
Rooj 1: Kev Hloov Pauv ntawm AO hauv kev kho pob txha tawg
Cov pob txha tawg uas nyob ib sab ntawm pob txha yuav tsum tau kho kom ruaj khov, suav nrog kev nias kom ruaj khov (cov ntsia hlau nias), kev nias kom ruaj khov (cov rau tes uas tsis xauv), kev sib txuas (kev txav ntawm cov khoom sab hauv thiab pob txha), thiab kev kho kom ruaj khov (cov khoom sab hauv uas hla thaj chaw uas raug sib tsoo).
(4) Kev txo qis tsis ncaj qha:
Cov thev naus laus zis traction tau siv rau hauv thaj chaw tawg kom txo qhov tawg los ntawm kev nruj ntawm cov ntaub so ntswg mos, thiab lub zog traction yog los ntawm lub cuab yeej traction femoral, lub cuab yeej kho sab nraud, lub cuab yeej nruj AO sib koom ua ke lossis lub tshuab qhib lamina.
V. Kev teeb tsa theem ntawm kev kho mob
Raws li cov txheej txheem biochemical ntawm kev kho pob txha tawg, nws muab faib ua plaub theem (Rooj 2). Tib lub sijhawm, ua ke nrog cov txheej txheem biochemical, kev kho pob txha tawg raug muab faib ua peb theem, uas txhawb nqa kev ua tiav ntawm cov txheej txheem biochemical thiab kev kho pob txha tawg (Daim Duab 6).
Rooj 2: Lub neej ntawm kev kho pob txha tawg
Daim Duab 6: Daim duab qhia txog kev kho pob txha tawg hauv nas
Theem mob
Los ntshav ntawm qhov chaw tawg pob txha thiab cov nqaij mos ib puag ncig tsim cov ntshav tawm, cov nqaij fibrovascular tsim ntawm qhov kawg tawg, thiab osteoblasts thiab fibroblasts pib loj hlob.
Lub sijhawm tsis ua haujlwm
Qhov kev teb rov qab ntawm cov pob txha mos pib tshwm sim hauv 2 lub lis piam, nrog rau kev tsim cov pob txha mos mos ua raws li kev tsim cov pob txha mos mos los ntawm kev sib sau ua ke ntawm cov pob txha mos mos, thiab txhua hom kev kho pob txha tawg yog cuam tshuam nrog hom kev kho mob.
Kev tsim kho dua tshiab
Thaum lub sijhawm kho, cov pob txha braided uas tsim tau hloov los ntawm cov pob txha lamellar, thiab lub qhov medullary raug rov qab kho dua los cim qhov ua tiav ntawm kev kho pob txha tawg.
Kev nyuaj siab
Qhov kev sib koom ua ke qeeb feem ntau yog pom los ntawm qhov pob txha tawg tsis kho hauv lub sijhawm xav tau, tab sis tseem muaj qee yam kev ua haujlwm ntawm lub cev, thiab cov laj thawj rau kev sib koom ua ke qeeb yog ntau yam, uas cuam tshuam nrog cov yam ntxwv cuam tshuam rau kev kho pob txha tawg.
Nonunion yog qhia tau tias yog pob txha tawg yam tsis muaj pov thawj ntawm kev kho mob lossis kev kho mob radiological, thiab qhov kev paub tseem ceeb yog:
(1) Atrophic nonunion vim tsis muaj vascularization thiab tsis muaj peev xwm kho tau, feem ntau pom tias yog stenosis ntawm qhov kawg ntawm pob txha tawg thiab tsis muaj cov hlab ntsha, thiab cov txheej txheem kho mob xav tau kev txhawb nqa ntawm cov haujlwm hauv zos (pob txha graft lossis pob txha cortical resection thiab kev thauj pob txha).
(2) Hypertrophic nonunion muaj kev hloov pauv ntawm cov hlab ntsha thiab lub peev xwm ntawm lub cev, tab sis tsis muaj kev ruaj khov ntawm lub cev, uas feem ntau pom tau tias yog kev loj hlob ntau dhau ntawm qhov kawg ntawm qhov tawg, thiab kev kho mob yuav tsum tau ua kom muaj kev ruaj khov ntawm lub cev (phaj pob txha thiab kev kho ntsia hlau).
(3) Cov dystrophic nonunion muaj cov ntshav txaus, tab sis yuav luag tsis muaj callus tsim, thiab qhov kev txo qhov tawg yuav tsum tau rov ua dua vim tsis txaus qhov kev hloov chaw thiab kev txo qis ntawm qhov kawg ntawm qhov tawg.
(4) Rau cov kab mob sib kis uas tsis sib koom ua ke nrog kev kis kab mob ntev, kev kho mob yuav tsum tshem tawm qhov kev kis kab mob ua ntej, thiab tom qab ntawd txhawb kev kho pob txha tawg. Kev kis kab mob pob txha osteomyelitis yog ib qho kab mob ntawm pob txha thiab pob txha kis kab mob, uas tuaj yeem yog kev kis kab mob ncaj qha ntawm cov qhov txhab qhib lossis kev kis kab mob los ntawm cov ntshav, thiab nws yog qhov tsim nyog los txheeb xyuas cov kab mob me me thiab cov kab mob ua ntej kho.
Kab mob mob hauv cheeb tsam uas nyuaj heev yog tus yam ntxwv los ntawm kev mob, kev ntxhov siab ntau dhau, kev ua xua rau ceg, cov ntshav ntws tsis xwm yeem, tawm hws, thiab o, suav nrog kev ua tsis zoo ntawm lub paj hlwb autonomic. Feem ntau nws tshwm sim tom qab raug mob thiab phais, thiab pom thiab kho thaum ntxov, nrog rau kev thaiv cov hlab ntsha sympathetic yog tias tsim nyog.
• Kev tawg pob txha heterotopic (HO) yog ib qho uas tshwm sim tom qab raug mob lossis phais, thiab feem ntau tshwm sim rau ntawm lub luj tshib, lub duav, thiab lub duav, thiab cov tshuaj bisphosphonates hauv qhov ncauj tuaj yeem tiv thaiv kev tawg pob txha tom qab muaj cov tsos mob.
• Qhov siab nyob rau hauv lub periophysal compartment nce mus txog ib qib, ua rau cov ntshav ntws hauv lub cev tsis zoo.
• Kev raug mob ntawm cov hlab ntsha hauv lub paj hlwb muaj ntau yam ua rau raug mob ntawm cov hlab ntsha hauv lub paj hlwb vim yog qhov chaw sib txawv ntawm lub cev.
• Avascular necrosis tshwm sim nyob rau hauv cov cheeb tsam uas tsis muaj ntshav txaus, Tshwj xeeb, saib qhov raug mob thiab qhov chaw ntawm lub cev, thiab lwm yam, thiab kev puas tsuaj uas tsis rov qab los tshwm sim.
Lub sijhawm tshaj tawm: Lub Kaum Ob Hlis-31-2024
