Tom qab kev puas tsuaj, cov pob txha thiab cov ntaub so ntswg ib puag ncig raug puas tsuaj, thiab muaj ntau txoj hauv kev kho mob thiab cov txheej txheem raws li qhov kev raug mob. Ua ntej kho tag nrho cov pob txha, nws yog ib qho tseem ceeb los txiav txim siab qhov twg ntawm qhov raug mob.
Cov nqaij mos raug mob
I. Kev faib tawm
Kaw pob txha
Kev raug mob ntawm cov nqaij mos raug muab qhab nia los ntawm me me mus rau qhov hnyav, feem ntau yog siv txoj kev Tscherne (Fig. 1)
Qib 0 raug mob: me me cov nqaij mos raug mob
Kev raug mob Qib 1: kev puas tsuaj ntawm daim tawv nqaij lossis kev sib kis ntawm cov ntaub so ntswg uas npog qhov chaw tawg
Kev raug mob Qib 2: mob nqaij hlav loj lossis kis kab mob ntawm daim tawv nqaij los yog ob qho tib si
Kev raug mob Qib 3: Kev raug mob ntawm cov nqaij mos uas muaj mob loj heev, kev sib tsoo, kev sib koom ua ke, lossis kev raug mob vascular
Daim duab 1: Tscherne Classification
Qhib Fracture
Vim tias cov pob txha tawg yog kev sib txuas lus rau lub ntiaj teb sab nraud, qhov kev puas tsuaj ntawm cov ntaub so ntswg muaj feem xyuam nrog lub zog ntawm cov ceg tawv thaum muaj kev raug mob, thiab kev faib tawm Gustilo feem ntau yog siv (Daim duab 2)
Daim duab 2: GustiloClassification
Hom I: huv qhov txhab ntev < 1 cm, me me puas tsuaj, tsis pom tseeb periosteal exfoliation Hom II: qhov txhab ntev> 1 cm, tsis pom tseeb cov ntaub so ntswg puas, flap tsim los yog avulsion raug mob
Hom III: Cov kab mob muaj xws li daim tawv nqaij, nqaij, periosteum, thiab pob txha, nrog rau kev raug mob ntau dua, nrog rau hom tshwj xeeb ntawm cov phom sij thiab kev raug mob ua liaj ua teb.
Hom IIIa: Cov kab mob kis thoob plaws thiab/lossis muaj cov ntaub so ntswg sib sib zog nqus, cov ntaub so ntswg mos uas muaj cov pob txha txaus thiab cov txheej txheem neurovascular
Hom IIIb: nrog kev puas tsuaj ntawm cov nqaij mos uas nws kim heev, Kev sib hloov lossis cov leeg nqaij dawb yuav tsum tau ua thaum kho kom tau txais kev pab
Hom IIIc: Qhib pob txha nrog vascular puas tsuaj uas yuav tsum tau kho phau ntawv qhia Gustilo kev faib tawm zoo li ua zuj zus zuj zus mus rau lub sijhawm, nrog kev hloov pauv ntawm qib raug mob thaum kho.
II. Kev tswj kev raug mob
Kev kho mob yuav tsum tau oxygenation, ua kom cov txheej txheem ntawm tes, ntxuav cov qhov txhab tsis muaj kab mob thiab cov ntaub so ntswg necrotic. Muaj plaub theem tseem ceeb ntawm kev kho: coagulation (feeb); inflammatory theem (teev); granulation cov ntaub so ntswg theem (hnub suav); Daim tawv nqaij tsim lub sijhawm (lub lis piam).
Staging ntawm kev kho mob
Mob theem:kev kho mob ntawm lub qhov txhab, debridement, pob txha reconstruction, thiab rov qab los ntawm ntau yam kev txav
(1) Ntsuas qhov ntawm cov nqaij mos raug mob thiab cuam tshuam txog kev raug mob neurovascular
(2) Siv ntau cov kua isotonic rau pulsating irrigation hauv chav ua haujlwm kom tshem tawm cov ntaub so ntswg necrotic thiab lub cev txawv teb chaws
(3) Kev tshem tawm yog nqa tawm txhua 24 ~ 48 teev kom tshem tawm tag nrho lub cev txawv teb chaws thiab cov ntaub so ntswg necrotic los ntawm lub qhov txhab kom txog thaum lub qhov txhab tuaj yeem raug kaw lossis npog tag nrho (4) Lub qhov txhab qhib kom tsim nyog, cov ntaub so ntswg sib sib zog nqus tau nthuav dav, thiab kev soj ntsuam zoo thiab kev txiav txim siab tau ua tiav.
(5) Qhov kawg tawg yog rov qab rau hauv qhov txhab; Me me deactivated cortex raug tshem tawm los tshuaj xyuas thiab ntxuav cov pob txha kab noj hniav
Kev tsim kho dua tshiab:kev cuam tshuam nrog cov sequelae ntawm kev raug mob (kev ncua sijhawm, kev tsis sib haum xeeb, deformity, kis kab mob)
Convalescence:Psychological, kev sib raug zoo, thiab kev ua hauj lwm regression ntawm tus neeg mob
Hom qhov txhab kaw thiab kev pab them nqi
Kev kaw qhov txhab thaum ntxov los yog kev pab them nqi (3 ~ 5 hnub) tuaj yeem ua tiav cov txiaj ntsig kev kho mob zoo: (1) kev kaw thawj zaug
(2) ncua kev kaw
(3) kev kaw theem nrab
(4) nruab nrab-tuab nrov plig plawg transplantation
(5) yeem nrov plig plawg (nyob ib sab digital flap)
(6) vascular pedicle nrov plig plawg (gastrocnemius flap)
(7) dawb flap (Fig. 3)
Daim duab 3: Kev pom ib nrab ntawm kev hloov pauv dawb yog feem ntau muab
Pob txha puas
I.Fracture kab kev taw qhia
Transverse: Load qauv ntawm ib tug transverse puas los ntawm nro
obliquely: Load hom ntawm lub siab vim muaj kab pheeb ces kaum
Kauv: Load pattern of a torsional fracture because of a spiral fracture
II.Fractures
Kev faib tawm raws li pob txha, hom pob txha, thiab lwm yam. (Fig. 4)
Comminuted fractures yog pob txha pob txha nrog 3 los yog ntau dua cov pob txha nyob, feem ntau tshwm sim los ntawm kev raug mob siab zog.
Pathological fracture fracture kab fracture tshwm sim nyob rau hauv cheeb tsam ntawm pob txha deterioration ntawm tus kab mob yav dhau los, xws li: thawj pob txha qog, pob txha metastases, osteoporosis, kab mob metabolic pob txha, thiab lwm yam.
Cov pob txha tsis tiav tsis tawg rau hauv cov pob txha sib cais
Segmental fractures nrog distal, nruab nrab, thiab proximal fracture fragments. Cov ntu nruab nrab yog cuam tshuam los ntawm cov ntshav, feem ntau yog tshwm sim los ntawm kev raug mob ntawm lub zog siab, nrog cov ntaub so ntswg detachment los ntawm cov pob txha, ua rau muaj teeb meem nrog cov pob txha kho.
Kev puas tsuaj ntawm cov pob txha tsis xws luag, qhib pob txha tawg nrog cov pob txha tawg, lossis cov pob txha tsis muaj zog uas yuav tsum tau muab tshem tawm, lossis cov pob txha loj heev uas ua rau cov pob txha puas lawm.
Kev puas tsuaj nrog cov pob txha npauj npaim zoo ib yam li segmental fractures nyob rau hauv uas lawv tsis koom nrog tag nrho cov ntoo khaub lig-section ntawm cov pob txha thiab feem ntau yog tshwm sim los ntawm kev nruj kev tsiv.
Kev ntxhov siab tawg yog tshwm sim los ntawm kev rov ua dua thiab feem ntau tshwm sim hauv calcaneus thiab tibia.
Avulsion fractures ua rau pob txha pob txha qhov taw qhia thaum lub leeg lossis ligament stretched.
Compression fractures yog cov pob txha tawg uas cov pob txha tawg, feem ntau yog los ntawm axial loads.
Daim duab 4: Kev faib cov pob txha
III.Cov yam ntxwv cuam tshuam rau kev kho pob txha
Cov yam ntxwv lom: muaj hnub nyoog, kab mob metabolic, kab mob hauv qab, theem kev ua haujlwm, kev noj zaub mov zoo, kev ua haujlwm ntawm lub paj hlwb, vascular puas, cov tshuaj hormones, kev loj hlob, kev noj qab haus huv ntawm cov nqaij mos capsule, qib ntawm kev tsis muaj menyuam (qhib pob txha), haus luam yeeb, tshuaj, hauv zos pathology, qib kev puas tsuaj, hom pob txha, qib ntawm cov pob txha tsis xws luag, cov txheej txheem ntawm cov pob txha mos, qib ntawm cov ntaub so ntswg. traumatic zog, degree ntawm pob txha tsis xws luag.
IV. Cov kev kho mob
Kev kho tsis yog phais yog qhia rau cov neeg mob uas raug mob tsis muaj zog lossis ua haujlwm tsis tau vim yog lub cev lossis lub hauv paus.
Kev txo qis: traction raws lub axis ntev ntawm lub limb, tawg tawg.
Brace fixation ntawm ob qhov kawg ntawm qhov tawg dua: kho cov pob txha txo los ntawm kev kho sab nraud, suav nrog cov txheej txheem peb-taw tes fixation.
Tubular pob txha nruam compression fixation txheej txheem traction: ib txoj kev txo, nrog rau cov tawv nqaij traction, pob txha traction.
Kev kho mob phais
(1) Kev kho sab nrauv yog tsim rau cov pob txha qhib, kaw cov pob txha nrog cov ntaub so ntswg hnyav, thiab cov pob txha nrog cov kab mob (Fig. 5)
Daim duab 5: Sab nrauv fixation txheej txheem
(2) Kev kho sab hauv yog siv tau rau lwm hom kev puas tsuaj thiab ua raws li AO txoj cai (Table 1)
Table 1: Evolution of AO hauv kev kho pob txha
Interfracture fragments yuav tsum tau compression fixation, xws li zoo li qub compression (compression screws), dynamic compression (tsis-locking intramedullary rau tes), splinting (sliding ntawm cov khoom sab hauv thiab cov pob txha), thiab bridging fixation (cov khoom siv sab hauv spanning cheeb tsam comminuted)
(4) Indirect txo:
Lub tshuab traction yog siv nyob rau hauv qhov tawg comminuted cheeb tsam kom txo tau qhov tawg los ntawm qhov nro ntawm cov ntaub so ntswg, thiab lub zog traction yog muab los ntawm lub femoral traction ntaus ntawv, sab nraud fixator, AO sib koom tes nro ntaus ntawv los yog lamina opener.
V. Kev kho mob
Raws li cov txheej txheem biochemical ntawm kev kho pob txha, nws muab faib ua plaub theem (Table 2). Nyob rau tib lub sijhawm, ua ke nrog cov txheej txheem biochemical, kev kho mob ntawm cov pob txha tawg tau muab faib ua peb theem, uas txhawb kev ua tiav ntawm cov txheej txheem biochemical thiab kho cov pob txha puas (daim duab 6).
Table 2: Lub neej txoj kev kho pob txha
Daim duab 6: Schematic daim duab ntawm pob txha kho nyob rau hauv nas
Mob theem
Hemorrhage los ntawm qhov chaw tawg thiab ib puag ncig cov ntaub so ntswg ua rau hematoma, cov ntaub so ntswg fibrovascular ntawm qhov tawg, thiab osteoblasts thiab fibroblasts pib proliferate.
Lub sijhawm poob
Cov lus teb thawj callus tshwm sim hauv 2 lub lis piam, nrog rau kev tsim cov pob txha pob txha pob txha ua raws li kev tsim ntawm callus los ntawm endochondral ossification, thiab txhua hom kev kho pob txha muaj feem xyuam nrog kev kho mob.
Kev kho dua tshiab
Thaum lub sij hawm kho, cov pob txha braided tsim yog hloov los ntawm cov pob txha lamellar, thiab cov kab noj hniav medullary yog recanalized los cim qhov ua tiav ntawm kev kho pob txha.
Teeb meem
Kev ncua kev koom ua ke feem ntau yog tshwm sim los ntawm pob txha tsis kho nyob rau hauv lub sijhawm xav tau, tab sis tseem muaj qee qhov kev ua haujlwm lom neeg, thiab cov laj thawj ntawm kev ncua kev sib koom ua ke muaj ntau yam, uas muaj feem xyuam rau qhov cuam tshuam rau kev kho pob txha.
Nonunion yog manifested li tawg tsis muaj pov thawj ntawm kev kho mob los yog radiological kho, thiab lub ntsiab realizations yog:
(1) Atrophic nonunion vim nonvascularization thiab tsis muaj peev xwm kho mob lom, feem ntau tshwm sim raws li stenosis ntawm qhov kawg ntawm cov pob txha thiab tsis muaj cov hlab ntsha, thiab cov txheej txheem kho yuav tsum tau stimulation ntawm cov kab mob hauv zos (pob txha graft lossis pob txha cortical resection thiab pob txha thauj).
(2) Hypertrophic nonunion muaj kev hloov pauv vascularization thiab kev muaj peev xwm lom neeg, tab sis tsis muaj kev ruaj ntseg, uas feem ntau tshwm sim raws li kev loj hlob ntawm qhov kawg ntawm cov pob txha, thiab kev kho mob yuav tsum tau ua kom muaj kev ruaj ntseg (pob txha phaj thiab ntsia hlau fixation).
(3) Lub dystrophic nonunion muaj cov ntshav txaus, tab sis yuav luag tsis muaj callus tsim, thiab kev txo cov pob txha yuav tsum tau rov ua dua vim tias tsis muaj kev hloov pauv thiab txo qhov kawg ntawm qhov tawg.
(4) Rau cov kab mob sib kis nrog cov kab mob ntev, kev kho mob yuav tsum ua ntej tshem tawm cov kab mob kom pom tseeb, thiab tom qab ntawd txhawb kev kho pob txha. Cov pob txha kab mob osteomyelitis yog ib yam kab mob ntawm cov pob txha thiab cov pob txha, uas tuaj yeem kis ncaj qha rau ntawm qhov txhab qhib qhov txhab lossis cov kab mob pathogenic los ntawm cov hlab ntshav, thiab yuav tsum txheeb xyuas cov kab mob thiab cov kab mob ua ntej kev kho mob.
Complex regional mob syndrome yog tus cwj pwm los ntawm qhov mob, hyperesthesia, lib allergens, tsis xwm yeem hauv zos cov ntshav khiav, tawm hws, thiab edema, nrog rau kev txawv txav ntawm lub paj hlwb autonomic. Nws feem ntau tshwm sim tom qab kev raug mob thiab kev phais, thiab kuaj pom thiab kho thaum ntxov, nrog kev pab cuam paj hlwb yog tias tsim nyog.
• Heterotopic ossification (HO) muaj tshwm sim tom qab raug mob los yog phais, thiab muaj ntau dua nyob rau hauv lub luj tshib, lub duav, thiab ncej puab, thiab qhov ncauj bisphosphonates yuav inhibit pob txha mineralization tom qab cov tsos mob tshwm sim.
• Siab nyob rau hauv periophysal compartment nce mus rau ib theem, impairing sab hauv perfusion.
• Kev raug mob Neurovascular muaj ntau yam ua rau muaj kev raug mob neurovascular vim qhov chaw sib txawv ntawm lub cev.
• Avascular necrosis tshwm sim nyob rau hauv cov cheeb tsam ntawm cov ntshav tsis txaus, tshwj xeeb tshaj yog, pom qhov raug mob thiab qhov chaw anatomical, thiab lwm yam, thiab qhov kev puas tsuaj tsis tuaj yeem tshwm sim.
Post lub sij hawm: Dec-31-2024
