Ma hope o ka haʻihaʻi ʻana, ua pōʻino ka iwi a me nā ʻiʻo a puni, a aia nā ʻano loina a me nā ʻano hana e like me ke kiʻekiʻe o ka ʻeha. Ma mua o ka mālama ʻana i nā haʻihaʻi āpau, pono e hoʻoholo i ka nui o ka ʻeha.
Nā ʻeha ʻili palupalu
I.Ka hoʻomāmā
Nā haʻihaʻi pani
Hoʻomaʻamaʻa ʻia nā ʻeha o ka ʻiʻo palupalu mai ka maʻalahi a i ke koʻikoʻi, me ka hoʻohana pinepine ʻana i ke ʻano Tscherne (Fig. 1)
ʻEha o ka papa 0: ʻEha liʻiliʻi liʻiliʻi
ʻEha o ka papa 1: ka ʻaʻa ʻana a i ʻole ka ʻāʻī ʻana o ka ʻiʻo palupalu e uhi ana i ka wahi haʻi
ʻEha pae 2: ʻeha nui ka ʻiʻo a i ʻole ka ʻili i haumia a i ʻole nā mea ʻelua
ʻEha Papa 3: ʻEha ʻiʻo palupalu koʻikoʻi me ka hoʻoneʻe koʻikoʻi, ʻūhā, maʻi ʻāpana, a i ʻole ʻeha ʻeha.
Kiʻi 1: Hoʻohālikelike ʻo Tscherne
Haʻi Wehe
Ma muli o ke kamaʻilio ʻana o ka haʻihaʻi i ka honua o waho, pili ke kiʻekiʻe o ka pōʻino o ka ʻiʻo palupalu i ka nui o ka ikehu i ʻike ʻia e ka lālā i ka wā o ka trauma, a hoʻohana mau ʻia ka hoʻohālikelike Gustilo (Figure 2)
Kiʻi 2: GustiloClassification
ʻAno I: ʻO ka lōʻihi o ka ʻeha maʻemaʻe < 1 knm, ka pōʻino liʻiliʻi o ka ʻiʻo, ʻaʻohe ʻano exfoliation periosteal ʻike ʻia ʻAno II: lōʻihi ʻeha> 1 knm, ʻaʻohe pōʻino o ka ʻiʻo palupalu, ka hoʻokumu ʻana a i ʻole ka ʻeha avulsion.
ʻAno III: Aia ka ʻili, ka ʻiʻo, ka periosteum, a me ka iwi, me ka ʻeha nui, me nā ʻano ʻeha pū a me nā ʻeha mahiʻai.
ʻAno IIIa: ʻO ka hoʻohaumia nui ʻana a/a i ʻole ka loaʻa ʻana o nā ʻiʻo ʻiʻo palupalu hohonu, nā ʻiʻo palupalu me ka uhi kūpono o nā iwi a me nā hale neurovascular.
ʻAno IIIb: me ka pōʻino nui o ka ʻiʻo palupalu, Pono nā metastases o ka ʻiʻo rotational a manuahi i ka wā o ka mālama ʻana no ka loaʻa ʻana o ka uhi
ʻAno IIIc: ʻO nā haʻi hāmama me ka pōʻino o ke koko e pono ai ke hoʻoponopono lima ʻia ʻo Gustilo ka hoʻohālikelike ʻana e piʻi nui aʻe ma mua o ka manawa, me nā loli i ka helu ʻeha i ʻike ʻia i ka wā hoʻoponopono.
II. Hooponopono poino
Pono ka ho'ōla ʻana i ka ʻeha i ka oxygenation, ka hoʻōla ʻana i nā mīkini kelepona, ka hoʻomaʻemaʻe ʻana i nā ʻeha me ka ʻole o ka ʻiʻo haumia a me ka necrotic. ʻEhā mau pae nui o ka ho'ōla: coagulation (minuke); ka manawa inflammatory (mau hola); ka pae o ka granulation tissue (nā lā i helu ʻia); Ka wā o ka hoʻokumu ʻana o ka ʻiʻo scar (he pule).
Ke kau ʻana o ka lāʻau lapaʻau
ʻĀpana koʻikoʻi:ʻeha ʻeha, debridement, hana hou ʻana o ka iwi, a me ka hoʻihoʻi ʻana i ke ʻano o ka neʻe
(1) E noʻonoʻo i ka nui o ka ʻeha o ka ʻiʻo palupalu a me ka ʻeha neurovascular pili
(2) E hoʻohana i ka nui o ka wai isotonic no ka hoʻoulu ʻana i ka irrigation i loko o ka lumi hana e wehe i ka ʻiʻo necrotic a me nā kino ʻē.
(3) Hoʻopau ʻia ka debridement i kēlā me kēia 24-48 hola e wehe i nā kino ʻē aʻe a me nā ʻiʻo necrotic mai ka ʻeha a hiki ke pani ʻia a uhi ʻia paha ka ʻeha.
(5) Hoʻihoʻi ʻia ka hope haʻi manuahi i loko o ka ʻeha; Wehe ʻia ka cortex liʻiliʻi i hoʻopau ʻia e nānā a hoʻomaʻemaʻe i ka lua o ka iwi
Hana hou:e pili ana i ka hopena o ka trauma (ka hui hoʻopaneʻe, nonunion, deformity, maʻi)
Hoʻōla hou:Hoʻihoʻi noʻonoʻo, pilikanaka, a me ka hana o ka mea maʻi
Ke ʻano o ka pani ʻana a me ka uhi ʻana
ʻO ka pani ʻana i ka ʻeha mua a i ʻole ka uhi ʻana (3 ~ 5 mau lā) hiki ke loaʻa nā hopena lapaʻau maikaʻi: (1) pani mua
(2) lohi pani
(3) pani lua
(4) ka hoʻololi ʻana o ka pā ma waena o ka mānoanoa
(5) peʻa manuahi (pepa kikohoʻe pili)
(6) ka pedicle flap (gastrocnemius flap)
(7) ka lau manuahi (Fig. 3)
Kiʻi 3: Hāʻawi pinepine ʻia nā manaʻo hapa o nā transplant manuahi
Poino iwi
I.Fracture laina kuhikuhi
Kū'ē: Hoʻouka i ke ʻano o kahi haʻihaʻi kūwaho i kumu ʻia e ka haʻalulu
obliquely: Hoʻouka i ke ʻano o ke kaomi ma muli o ka haʻi diagonal
Spiral: Hoʻouka i ke ʻano o ka haʻi torsional ma muli o ka haki ʻana
II.Hai
Hoʻokaʻawale ʻia e like me nā haʻihaʻi, nā ʻano haʻihaʻi, etc. (Fig. 4)
ʻO nā haʻihaʻi comminuted he mau haʻihaʻi me 3 a ʻoi aʻe paha nā ʻāpana iwi ola, ʻo ka hopena maʻamau mai kahi hōʻeha ikaika.
Pathological fracture fracture line fracture aia ma kahi o ka iwi deterioration o ka maʻi mua, e like me: kumu iwi koko, iwi metastases, osteoporosis, metabolic iwi maʻi, etc.
ʻAʻole nahā nā haʻihaʻi piha ʻole i ʻāpana iwi ʻokoʻa
ʻO nā haʻihaʻi māhele me nā'āpana'āpana'ākau, waena, a kokoke. Hoʻopili ʻia ka ʻāpana waena e ka hāʻawi ʻana i ke koko, ma muli o ka ʻeha nui o ka ikehu, me ka wehe ʻana o ka ʻiʻo palupalu mai ka iwi, e hoʻopilikia ai i ka ho'ōla iwi.
ʻO nā haʻihaʻi me nā iwi kīnā, nā haʻihaʻi hāmama me nā ʻāpana iwi, a i ʻole nā ʻeha trauma-nonactive e pono e hoʻomaʻemaʻe ʻia, a i ʻole nā haʻihaʻi koʻikoʻi e hopena i nā pōʻino iwi.
ʻO nā haʻihaʻi me nā ʻāpana iwi pepeke ua like ia me nā ʻāpana ʻāpana ʻaʻole lākou e komo i ka ʻāpana āpau o ka iwi a ʻo ka hopena maʻamau ka hopena o ka kulou ʻana.
ʻO nā haʻihaʻi koʻikoʻi ma muli o nā haʻahaʻa pinepine a loaʻa pinepine i ka calcaneus a me ka tibia.
ʻO nā haʻihaʻi avulsion ke kumu o ka haʻihaʻi ʻana o ka wahi hoʻokomo o ka iwi i ka wā e ʻōloʻi ʻia ai kahi tendon a ligament.
ʻO nā haʻihaʻi hoʻopaʻa ʻia ʻo ia nā haʻihaʻi kahi e ʻoki ʻia ai nā ʻāpana iwi, maʻamau e nā ukana axial.
Kiʻi 4: Ka hoʻokaʻawale ʻana o nā haʻihaʻi
III. Nā mea e ho'ōla ai i ka haʻi
Nā kumu olaola: ka makahiki, ka maʻi o ka iwi metabolic, ka maʻi ma lalo, ka pae hana, ke kūlana meaʻai, ka hana neurological, ka pōʻino vascular, nā hormones, nā kumu ulu, ke kūlana olakino o ka capsule tissue palupalu, degere o sterility (open fracture), puhi paka, lāʻau lapaʻau, local pathology, traumatic ikehu pae, ʻano iwi, degere o ka iwi defect, mechanical factors, degere o ka hoʻopili ʻana o ka ʻiʻo palupalu i ka iwi, kūpaʻa o ka ʻili o ka ʻiʻo maʻemaʻe i ka iwi, kūpaʻa o ke ʻano o ke kino traumatic defect.
IV. Nā ʻano hana lapaʻau
Hōʻike ʻia ka lāʻau lapaʻau ʻole no ka poʻe maʻi me nā hōʻeha haʻahaʻa haʻahaʻa a i ʻole hiki ke hana ʻia ma muli o nā kumu ʻōnaehana a kūloko paha.
Hoʻemi: traction ma ke axis lōʻihi o ka lālā, kaʻawale ʻana.
Hoʻopaʻa paʻa ma nā ʻaoʻao ʻelua o ka haʻi: hoʻopaʻa ʻana i ka iwi i hōʻemi ʻia ma o ka hoʻopaʻa ʻana i waho, me ka ʻenehana hoʻopaʻa ʻekolu.
ʻO ka ʻenehana hoʻopaʻa hoʻopaʻa ʻana i ka iwi tubular: kahi ala e hōʻemi ai, me ka ʻili ʻili, ka huki ʻana o ka iwi.
Lapaʻau ʻokiʻoki
(1) He kūpono ka hoʻopaʻa ʻana i waho no nā haʻihaʻi hāmama, nā haʻi paʻa me ka ʻeha o ka ʻiʻo palupalu koʻikoʻi, a me nā haki i hui pū ʻia me ka maʻi (Fig. 5)
Kiʻi 5: Kaʻina hana hoʻoponopono waho
2
Papa 1: Hoʻololi o AO i ka lāʻau fracture
Pono nā ʻāpana interfracture i ka hoʻopaʻa paʻa ʻana, me ka hoʻopili paʻa ʻana (nā ʻūlū hoʻopiʻi), ka hoʻoikaika ikaika (nā kui intramedullary ʻole paʻa ʻole), ka splinting (ka hoʻoheheʻe ʻana ma waena o ka mea o loko a me ka iwi), a me ka hoʻopaʻa ʻana i ke kaulahao (nā mea i loko o ka wahi i hoʻopili ʻia)
(4) Hoemi pololei:
Hoʻokō ʻia ka ʻenehana traction i ka wahi i hoʻopili ʻia e hōʻemi i ka ʻāpana ma o ka ʻāʻī ʻana o ka ʻiʻo palupalu, a loaʻa ka ikaika traction mai ka hāmeʻa traction femoral, fixator waho, AO joint tension device a lamina opener.
V.Staging o ka lapaau
Wahi a ke kaʻina hana biochemical o ka ho'ōla ʻana i ka haʻihaʻi, ua māhele ʻia i ʻehā mau ʻāpana (Papa 2). I ka manawa like, i hui pū ʻia me ke kaʻina biochemical, ua māhele ʻia ka mālama ʻana i ka haʻihaʻi i ʻekolu mau pae, e hāpai ana i ka hoʻopau ʻana o ke kaʻina biochemical a me ka ho'ōla ʻana o ka haki (Fig. 6).
Papa 2: Ke ola o ka ho'ōla ha'i
Kiʻi 6: Hōʻike kiʻi kiʻi o ka ho'ōla haʻi ʻana i nā ʻiole
ʻĀpana inflammatory
ʻO ka hemorrhage mai ka wahi haʻihaʻi a me nā ʻiʻo palupalu e hoʻopuni ana i kahi hematoma, hana ʻia nā ʻiʻo fibrovascular ma ka hope haʻihaʻi, a hoʻomaka nā osteoblasts a me nā fibroblasts e hoʻonui.
Hoʻohaʻahaʻa manawa
Loaʻa ka pane callus mua i loko o 2 mau pule, me ka hoʻokumu ʻana i kahi iwi cartilage a ukali ʻia e ka hoʻokumu ʻana o kahi callus ma o ka endochondral ossification, a ʻo nā ʻano kikoʻī āpau o ka hoʻōla ʻana e pili ana i ke ʻano o ka mālama ʻana.
Hana hou
I ka wā o ka hoʻoponopono ʻana, hoʻololi ʻia ka iwi wili i hana ʻia e ka iwi lamellar, a hoʻihoʻi ʻia ka lua medullary e hōʻailona ai i ka pau ʻana o ka hoʻoponopono ʻana.
Hoʻopiʻi
Hōʻike nui ʻia ka hui hoʻopaneʻe ʻana e ka haʻi ʻaʻole hoʻōla i loko o ka manawa i manaʻo ʻia, akā aia nō kekahi mau hana olaola, a ʻokoʻa nā kumu o ka lohi ʻana i ka hui ʻana, pili i nā mea e pili ana i ka hoʻōla ʻana o ka haʻi.
Hōʻike ʻia ʻo Nonunion ma ke ʻano he haʻihaʻi me ka ʻole o ka hōʻike o ka ho'ōla lāʻau lapaʻau a radiological paha, a ʻo nā ʻike nui:
(1) Atrophic nonunion ma muli o ka nonvascularization a me ka nele o ke ola kino hiki ke ho'ōla, maʻamau i hōʻike ʻia ma ke ʻano he stenosis o ka haʻihaʻi o ka iwi a ʻaʻohe kīʻaha koko, a ʻo ke kaʻina hana e pono ai ka hoʻoulu ʻana i ka hana biological kūloko (bone graft or bone cortical resection and bone transport).
(2) ʻO ka hypertrophic nonunion he transitional vascularization a me ka hiki ke ola, akā nele i ka mechanical stability, ka mea maʻamau i hōʻike ʻia e like me ka ulu nui ʻana o ka hopena haʻihaʻi, a pono ka mālama ʻana e hoʻonui i ke kūpaʻa mechanical (ka iwi iwi a me ka hoʻoponopono ʻana).
(3) He lawa ke koko ka dystrophic nonunion, akā, ʻaneʻane ʻaʻohe hoʻokumu callus, a pono e hana hou ʻia ka hoʻohaʻahaʻa haʻihaʻi ma muli o ka lawa ʻole o ka neʻe ʻana a me ka hōʻemi ʻana i ka hopena haʻihaʻi o ka haʻihaʻi.
(4) No ka infectious nonunion me ka maʻi maʻi mau, pono e wehe mua ka lāʻau i ka nānā ʻana i ka maʻi, a laila hoʻoikaika i ka ho'ōla ʻana i ka haʻihaʻi. ʻO ka osteomyelitis ka maʻi iwi he maʻi ia o ka iwi a me ka iwi maʻi, hiki ke hoʻopili pololei i nā ʻeha ʻeha ākea a i ʻole ka maʻi pathogenic ma o nā ala koko, a pono e ʻike i nā microorganisms a me nā pathogens ma mua o ka mālama ʻana.
Hōʻike ʻia ka maʻi ʻeha o ka ʻāina paʻakikī e ka ʻeha, hyperesthesia, nā allergies o nā lālā, ke kahe ʻana o ke koko kūloko, ka wela, a me ka edema, me nā mea ʻino o ka ʻōnaehana neʻe autonomic. He mea maʻamau ia ma hope o ka ʻeha a me ka ʻoki ʻana, a ʻike ʻia a mālama ʻia i ka wā mua, me ka poloka nerve sympathetic inā pono.
• He mea maʻamau ka Heterotopic ossification (HO) ma hope o ka ʻeha a i ʻole ka ʻoki ʻana, a ʻoi aku ka maʻamau i ka kuʻekuʻe, ka ʻūhā, a me ka ʻūhā, a hiki i nā bisphosphonates waha ke kāohi i ka mineralization iwi ma hope o ka hoʻomaka ʻana o ka hōʻailona.
• Piʻi ka paʻi i loko o ke keʻena periophysal i kekahi pae, e hoʻopilikia ana i ka perfusion o loko.
• Loaʻa nā kumu like ʻole o ka ʻeha neurovascular ma muli o nā wahi anatomical like ʻole.
• Loaʻa ka necrosis Avascular ma nā wahi i lawa ʻole ke koko, ʻike pono i ka ʻeha a me kahi anatomical, etc., a hiki mai ka pōʻino hiki ʻole ke hoʻololi.
Ka manawa hoʻouna: Dec-31-2024
