Tom qab kev sim pob txha, cov pob txha thiab ib puag ncig cov ntaub so ntswg puas tsuaj, thiab muaj cov ntsiab cai sib txawv thiab cov hau kev raws li kev raug mob. Ua ntej kho txhua qhov pob zeb tawg, nws yog qhov tseem ceeb kom txiav txim siab qhov kev raug mob.
Kev raug mob so ntswg
I.classification
Kaw Laum
Kev raug mob ntawm cov nqaij mos muaj cov menyuam tau los ntawm qhov mob me mus rau mob hnyav, feem ntau yog siv cov qauv tscherne (Daim duab 1)
Qeb 70 raug mob: me me mos nqaij raug mob
AFFER1 raug mob: kev puas tsuaj loj los yog kev cuam tshuam ntawm cov ntaub so ntswg npog lub qhov chaw sib tw
Qib2 Raug Mob: Qhov tseem ceeb ntawm cov nqaij cov leeg lossis cov tawv nqaij paug tsis huv lossis ob qho tib si
Qeb3 raug mob: kev raug mob muag hnyav nrog kev raug mob hnyav, tsoo cov syndrome, lossis kev mob vascular
Daim Duab1: Tschere Kev Sib Tw
Qhib Txhav
Vim tias qhov tawg yog kev sib txuas lus rau lub ntiaj teb sab nraud, kev ua haujlwm ntawm lub zog uas tau muaj los ntawm lub zog thaum lub sij hawm raug mob feem ntau yog siv (daim duab 2)
Daim Duab2: Gustiloclassification
Hom I: Kev huv si ntev <1 cm, tsis pom tseeb perioster ntev hom II: tsis pom tseeb ntawm cov nqaij mos puas tsuaj, nrov plig plawg kev raug mob lossis kev ua phem avulsion
Hom III: Kev Ntsiav Ntau Yam suav nrog tawv nqaij, periivleum, thiab pob txha, nrog rau cov kev mob phom phom thiab kev raug mob ua liaj ua teb
Hom IIia: Thoob plaws ntawm cov nqaij mos mos muag muag, cov nqaij mos muag nrog cov qauv ntawm cov pob txha txaus
Hom IIib: Nrog cov ntaub so ntswg zoo nkauj, sib hloov lossis cov leeg nqaij me me metastases yuav tsum muaj thaum lub sijhawm kho kom tau txais kev pov hwm
Hom IIIC: Qhib cov pob txha uas tau qhib nrog txoj kev puas tsuaj ntawm txoj kev kawm tau zoo dua li lub sijhawm, nrog kev hloov pauv tau raug mob thaum kho.
II.Koj Tswjhwm
Cov qhov txhab kho kom zoo yuav tsum muaj cov pa oxygenation, ua kom lub cev ntawm cov kab mob cellular, ntxuav cov qhov txhab muaj kua paug thiab necroot. Muaj plaub theem ntawm kev kho kom zoo: kev sib cais (feeb); Inflidmatory phase (teev); granulation cov ntaub so ntswg theem (hnub suav); Txoj kev caws pliav cov ntaub so ntswg (lub lim tiam).
Staging ntawm kev kho mob
Mob PARUSE:Kev tsim cov dej, cov hlab ntsha, pob txha rov tsim kho, thiab rov qab los ntawm ntau yam
(1) ntsuas qhov ntsuas ntawm cov nqaij mos mos mos thiab cuam tshuam kev raug mob neurovascular
(2) Siv cov kua dej yog cov kua dej loj rau kev ua pa hauv chav ua haujlwm kom tshem tawm cov ntaub so ntswg necrotic thiab lub cev txawv teb chaws
(3) Kev tawm dag zog yog nqa tawm txhua 24 ~ 48 teev kom tshem tawm txhua qhov txhab raug kaw, cov kev sib sib zog nqus cov nqaij mos, thiab ua kom muaj zog ua haujlwm thiab cov tawv nqaij tawv.
(5) Lub qhov cub dawb tsis hnov qab yog rho tawm mus rau hauv qhov txhab; Kev Txiav Txim Me Me Txiav Tawm Cortex raug tshem tawm thiab ntxuav cov pob txha caj qaum
Kev tsa dua tshiab:Nrog rau cov sequelae ntawm Trauma (qeeb, tsis ua haujlwm, tsis nco qab, kis tau tus mob)
Convalescence:Kev puas siab puas ntsws, kev sib raug zoo, thiab kev ua haujlwm regression ntawm tus neeg mob
Hom Ntsawj Kaw thiab Kev Them Nyiaj
Thaum Ntxov Thaum Ntxov Kaw Los Yog Kev Them Nyiaj (3 ~ 5 hnub) tuaj yeem ua tiav kev pabcuam txaus siab: (1) thawj zaug kaw
(2) Ncua Kaw
(3) theem nrab kaw
(4) nruab nrab-tuab flap transplantation
(5) Nrov kev ywj pheej nrov (nrov plig plawg
(6) vascular pedicle flap (pastrocnius nrov plig plawg)
(7) nrov plig plawg dawb (Daim duab 3)
Daim duab3: Ib nrab pom ntawm cov phiaj hloov dawb yog feem ntau muab
Pob txha puas
I.fracture kab kev taw qhia
Transverse: Thauj cov qauv ntawm transverse lov tshwm sim los ntawm kev nro
Obliquely: Thauj hom ntawm lub siab vim yog kab pheeb ces kaum pob txha
Muab KAUV: LOAD tus qauv ntawm torsional fracture vim tias ib tug kauv blecture
II.FRACTURE
Kev faib tawm raws li kev tawg, pob txha lov, thiab lwm yam (Daim duab 4)
Kev ua raws li cov pob txha lov nrog 3 lossis ntau dua cov pob txha uas muaj sia nyob, feem ntau ua rau muaj kev raug mob hnyav.
Patholog pob txha lov ntawm cov pob txha uas muaj nyob hauv cov pob txha tsis zoo, cov pob txha me me, pob txha me me, cov pob txha metabolic, thiab lwm yam
Tsis ua tiav cov pob txha tsis tiav tsis yog tawg ua cov pob txha sib txawv
Segsal pob txha lov nrog distal, nruab nrab, thiab cov neeg tawg ntxiag. Qhov nruab nrab ntu yog cuam tshuam los ntawm cov ntshav cov ntshav, feem ntau yog los ntawm kev raug mob siab, nrog cov nqaij mos ntawm cov pob txha, ua teeb meem nrog cov pob txha kho.
Cov pob txha uas tawg tau yooj yim, qhib pob txha pob txha, qhib cov pob txha tawg, lossis kev mob khaub thuas, lossis kev sib tw ua kom loj hlob uas ua rau pob txha tsis meej.
Cov pob txha lov nrog cov pob txha npauj npaim zoo ib yam li segmental pob txha lov hauv uas lawv tsis koom nrog tag nrho cov pob txha thiab feem ntau yog cov txiaj ntsig ntawm kev khoov nruj.
Kev ntxhov siab pob txha yog tshwm sim los ntawm kev thauj khoom thiab feem ntau tshwm sim hauv kev calcaneus thiab Tibia.
Kev sib cais avulsion ua rau muaj kev txhads ntawm cov pob txha lub ntxig taw tes thaum ib leeg lossis cov nyom lossis kev nce qib.
COMPRESSURE yog pob txha hauv uas cov pob txha tawg yog nyem, feem ntau yog los ntawm axial loads.
Daim duab 4: Kev faib tawm ntawm pob txha lov
III.FACTOR Coob tus mobile kho kom zoo
Cov Kab Mob Txheeb Xyuas: Hnub Nyoog, Kev Noj Qab Haus Huv, Qib Kev Noj Qab Haus Huv, Qib ntawm Pob Txha, Qib Siab, Kev Ruaj Ntseg, Kev Ruaj Ntseg, Anatomical Qauv, theem ntawm Kev tsis muaj zog, Qib ntawm cov pob txha qhov tsis haum.
IV. Modalities ntawm kev kho
Kev kho tsis yog-phais phais yog qhia rau cov neeg mob uas muaj kev raug mob qis lossis cov uas tsis muaj zog vim yog cov txheej txheem lossis hauv nroog.
Txo: traction raws cov kab ntev ntawm ceg ntoo, txha lov sib cais.
Caj kev txhim kho ntawm ob qho kawg ntawm kev sib tw dua: Txhim kho cov pob txha txo los ntawm kev kho sab nraud, suav nrog kev txhim kho sab nraud, suav nrog kev txhim kho ntawm peb-taw tes.
Tubular pob txha txuas ntxiv cov txheej txheem txhim kho kev txhim kho kev sib txuas: ib txoj kev txo qis, suav nrog cov tawv nqaij traction, pob txha traction.
Kev Kho Mob Kho
(1) Kev txhim kho sab nraud yog qhov tsim nyog rau qhib pob txha lov, kaw cov pob txha uas tsis tshua muaj tus mob mos mos (Daim duab 5)
Daim Duab 5: Tus Txheej Txheem Sab Nraud
(2) Kev txhim kho sab hauv muaj feem xyuam rau lwm hom pob txha lov thiab ua raws li Ao txoj cai (rooj 1)
Cov lus 1: Kev hloov pauv ntawm Ao hauv kev kho mob pob txha
Kev sib txuas lus cuam tshuam yuav tsum tau kho dua tshiab
(4) Kev txo qis:
Cov thev naus laus zis thev naus laus zis ua tiav los txo cov khoom siv tawv nqaij, thiab cov khoom siv sab nraud, Ao sib koom ua ke nro lossis cov lamina qhib.
V.staging ntawm kev kho mob
Raws li cov txheej txheem biochemical ntawm kev kho kom zoo, nws tau muab faib ua plaub ntu (rooj 2). Nyob rau tib lub sijhawm, ua ke nrog cov txheej txheem biochemical, kev kho mob ntawm kev sib cais tau muab faib ua peb theem, uas txhawb kev ua tiav ntawm kev ua tiav (Daim duab 6).
Rooj 2: Chav kawm lub neej ntawm benacture kho
Daim Duab 6: Schematic daim duab ntawm bacture kho hauv nas
Inflidation theem
Hemorrhage los ntawm qhov chaw mos thiab ib puag ncig cov ntaub so ntswg mos ntim cov ntaub ntawv hematoma, Fibrovascular cov ntaub so ntswg ntawm qhov kawg thiab cov fibraiglasts pib ua kom muaj zog.
Downtime
Cov lus teb thawj zaug tau tshwm sim tsis pub dhau 2 lub lis piam, nrog kev tsim cov pob txha pob txha taub hau los ntawm kev tsim ntawm kev kho kom zoo rau kev kho kom zoo yog cuam tshuam nrog kev kho mob qauv.
Kev muas
Thaum lub sij hawm kho cov pob txha kho yog hloov los ntawm lamellar pob txha, thiab cov medullary kab noj hniav, thiab cov medullary kab noj hniav yog rov ua dua rau kev ua tiav ntawm kev ua kom tiav.
Yam tab kaum
Kev ncua sij hawm feem ntau yog ua kom muaj kev kho kom zoo nyob rau hauv lub sij hawm tsim nyog lub sijhawm, thiab cov laj thawj rau cov neeg nyob sib txuam yog sib txawv, uas cuam tshuam rau kev kho kom zoo.
Nonunic yog manifested li bacture tsis muaj pov thawj ntawm kev kho mob lossis hluav taws xob kho kom zoo, thiab cov kev paub tseeb yog:
(1) atrophic tsis yog vim tsis muaj peev xwm kho mob biological thiab cov pob txha ntaus ntawv, thiab pob txha thauj khoom thiab pob txha thauj).
(2) Hypertrophic Nonunion tau muaj peev xwm hloov pauv hloov pauv, thiab tsis muaj kev cuam tshuam zoo li kev sib cais ntawm cov khoom tawg, thiab cov kev kho mob yuav tsum nce ntxiv rau cov tshuab ruaj khov (pob txha nrig thiab ntsia hlau kho).
(3) Lub dystrophic tsis muaj ntshav txaus, tab sis yuav luag tsis muaj kev txiav txim siab tsis txaus thiab txo qis kev tsis txaus thiab txo qis qhov tawg kawg ntawm kev tawg.
(4) rau kev sib kis tau nrog kev kis tus mob ntev, kev kho mob yuav tsum xub tawm txoj kev kho mob, thiab tom qab ntawd txhawb kev kho mob. Mob pob txha txw yog kab mob ntawm cov pob txha thiab mob pob txha los ntawm kev coj noj coj ua, thiab nws yuav tsum qhia cov kabmob microorganism thiab cov pathogens ua ntej kev kho mob.
Txoj kev mob hauv cheeb tsam muaj kev mob nkeeg, kev ua xua, tawm hws, tawm hws, suav nrog kev txawv txav ntawm cov nyiaj hauv lub nroog autonomic. Feem ntau nws tshwm sim tom qab kev raug mob thiab phais mob, thiab raug kuaj pom thiab kho thaum ntxov, nrog kev cuam tshuam ntawm cov hlab ntsha yog tsim nyog.
• Heterotopic OSSIICATION (Ho) yog ib txwm tom qab raug phais lossis phais, thiab yog ntau dua hauv lub luj tshib, thiab lub ntsej muag bisphos tuaj yeem tiv thaiv cov pob txha tom qab qhov ncauj tom qab cov khoom pib.
• Hlwb hauv Periophysal Compined nce mus rau qee theem, cuam tshuam rau sab hauv qab zib.
• Neurovascular raug mob muaj cov ua rau muaj kev cuam tshuam sib txawv vim yog cov chaw sib txawv.
• Avascular necrosis tshwm sim rau thaj chaw ntawm cov ntshav tsis txaus, tshwj xeeb, saib qhov chaw raug mob thiab lwm yam, thiab kev puas tsuaj tsis txaus ntseeg.
Lub Sijhawm Post: Dec-31-2024
