Ma hope o ka haki ʻana, ua hōʻino ʻia ka iwi a me nā ʻiʻo a puni, a aia nā loina a me nā ʻano lapaʻau like ʻole e like me ke ʻano o ka ʻeha. Ma mua o ka mālama ʻana i nā haki āpau, he mea nui e hoʻoholo i ka nui o ka ʻeha.
Nā ʻeha palupalu
I. Hoʻokaʻawale ʻana
Nā haki pani ʻia
Hoʻokaʻawale ʻia nā ʻeha palupalu mai ka ʻoluʻolu a i ka ʻino, me ka hoʻohana pinepine ʻana i ke ʻano Tscherne (Kiʻi 1)
ʻEha Papa0: ʻEha palupalu iki
ʻEha Papa 1: ʻoki ʻia ma luna o ka ʻili a i ʻole ka ʻūlū ʻana o nā ʻiʻo palupalu e uhi ana i kahi haki
ʻEha Papa 2: ʻeha nui o nā ʻiʻo a i ʻole ka ʻeha ʻili i haumia ʻia a i ʻole nā mea ʻelua
ʻEha Papa 3: ʻEha koʻikoʻi o nā ʻiʻo palupalu me ka neʻe nui ʻana, ka ʻūlū ʻana, ka maʻi compartment, a i ʻole ka ʻeha vascular
Kiʻi 1: Hoʻohālikelike ʻo Tscherne
Haʻihaʻi Hāmama
Ma muli o ka pili ʻana o ka haki i ke ao waho, pili ka nui o ka hōʻino ʻia o nā ʻiʻo palupalu i ka nui o ka ikehu i loaʻa i ka lālā i ka wā o ka trauma, a hoʻohana pinepine ʻia ka hoʻokaʻawale ʻana o Gustilo (Kiʻi 2)
Kiʻi 2：Ka Hoʻokaʻawale ʻana o Gustilo
ʻAno I: Ka lōʻihi o ka ʻeha maʻemaʻe < 1 cm, hōʻino iki i nā ʻiʻo, ʻaʻohe exfoliation periosteal maopopo ʻAno II: ka lōʻihi o ka ʻeha > 1 cm, ʻaʻohe hōʻino ʻia o nā ʻiʻo palupalu maopopo, ka hoʻokumu ʻana o ka flap a i ʻole ka hōʻeha avulsion
ʻAno III: ʻO ka laulā o nā ʻeha e pili ana i ka ʻili, nā ʻiʻo, ka periosteum, a me ka iwi, me ka trauma nui aʻe, me nā ʻano kūikawā o nā ʻeha pū a me nā ʻeha mahiʻai
ʻAno IIIa: Ka nui o ka haumia a/a i ʻole ke alo o nā ʻeha palupalu hohonu, nā ʻiʻo palupalu me ka uhi kūpono o ka iwi a me nā ʻano neurovascular
ʻAno IIIb: me ka hōʻino nui ʻana o nā ʻiʻo palupalu, pono nā metastases rotational a manuahi paha i ka wā o ka mālama ʻana e hoʻokō ai i ka uhi ʻana
ʻAno IIIc: Nā haki hāmama me ka hōʻino ʻana o nā kīʻaha koko e pono ai ka hoʻoponopono lima ʻana. ʻO ka hoʻokaʻawale ʻana o Gustilo e lilo i mea ʻino aʻe i ka hala ʻana o ka manawa, me nā loli i ke ʻano o ka ʻeha i ʻike ʻia i ka wā o ka hoʻoponopono ʻana.
II. Hoʻokele ʻeha
Pono ka ho'ōla ʻana o ka ʻeha i ka oxygenation, ka hoʻoulu ʻana i nā ʻano hana cellular, ka hoʻomaʻemaʻe ʻana i nā ʻeha me ka ʻole o nā ʻiʻo haumia a me ka necrotic. ʻEhā mau pae nui o ka ho'ōla ʻana: coagulation (mau minuke); pae mumū (mau hola); pae ʻiʻo granulation (nā lā i helu ʻia); Ka wā hoʻokumu ʻana o nā ʻiʻo scar (nā pule).
Ke kahua o ka mālama ʻana
Pae ʻoi:ka hoʻoinu ʻana i nā ʻeha, ka debridement, ke kūkulu hou ʻana i ka iwi, a me ka hoʻōla ʻana i ka laulā o ka neʻe ʻana
(1) E loiloi i ka nui o ka hōʻeha o nā ʻiʻo palupalu a me ka hōʻeha neurovascular pili
(2) E hoʻohana i ka nui o ka wai isotonic no ka hoʻoinu ʻana i ka wai i loko o ka lumi hana e wehe i nā ʻiʻo necrotic a me nā kino ʻē.
(3) Hana ʻia ka debridement i kēlā me kēia 24 ~ 48 hola e wehe i nā kino ʻē a me nā ʻiʻo necrotic mai ka ʻeha a hiki i ka wā e pani ʻia ai ka ʻeha a uhi piha ʻia paha (4) Hoʻolōʻihi kūpono ʻia ka ʻeha hāmama, hōʻike piha ʻia ka ʻiʻo hohonu, a hana ʻia ka loiloi kūpono a me ka debridement.
(5) Hoʻihoʻi ʻia ka hopena haki manuahi i loko o ka ʻeha; Wehe ʻia ka cortex liʻiliʻi i hoʻopau ʻia e nānā a hoʻomaʻemaʻe i ka lua iwi iwi
Hoʻoponopono hou ʻana:ke hana nei me nā hopena o ka trauma (delayed union, nonunion, deformity, infection)
Hoʻōla hou ʻana:Ka hoʻihoʻi ʻana o ka maʻi ma ke ʻano noʻonoʻo, ka nohona, a me ka hana
ʻAno o ka pani ʻana a me ka uhi ʻana o ka ʻeha
ʻO ka pani mua ʻana o ka ʻeha a i ʻole ka uhi ʻana (3 ~ 5 mau lā) hiki ke hoʻokō i nā hopena lapaʻau kūpono: (1) ka pani mua ʻana
(2) pani lohi
(3) pani lua
(4) ka hoʻoili ʻana o ka ʻili mānoanoa waena
(5) ʻūpā manawaleʻa (ʻūpā kikohoʻe e pili ana)
(6) ʻūpā pedicle vascular (ʻūpā gastrocnemius)
(7) ʻūpā manuahi (Kiʻi 3)
Kiʻi 3: Hāʻawi pinepine ʻia nā hiʻohiʻona hapa o nā hoʻoili manuahi
Ka pōʻino o ka iwi
I. Ke kuhikuhi o ka laina haki
Transverse: ʻAno ukana o kahi haki transverse i hoʻokumu ʻia e ke kaomi
obliquely: ʻAno ukana o ke kaomi ma muli o ka haki diagonal
ʻŌwili: ʻAno ukana o kahi haki torsional ma muli o kahi haki wili
II. Nā haki
Ka hoʻokaʻawale ʻana e like me nā haki, nā ʻano haki, a pēlā aku (Kiʻi 4)
ʻO nā haki i ʻoki ʻia he mau haki me 3 a ʻoi aku paha nā ʻāpana iwi ola, ʻo ia ka maʻamau ma muli o kahi ʻeha ikaika.
ʻO ka haki laina haki pathological e kū mai ana ma kahi o ka hōʻino ʻana o ka iwi o ka maʻi ma mua, me: ka puʻupuʻu iwi mua, nā metastases iwi, osteoporosis, ka maʻi iwi metabolic, a pēlā aku
ʻAʻole haki nā haki piha ʻole i nā ʻāpana iwi kaʻawale
Nā haki ʻāpana me nā ʻāpana haki distal, waena, a me proximal. Hoʻopilikia ʻia ka ʻāpana waena e ka lako koko, ma muli o ka hopena o kahi ʻeha ikehu kiʻekiʻe, me ka hemo ʻana o nā ʻiʻo palupalu mai ka iwi, e hana ana i nā pilikia me ka ho'ōla ʻana o ka iwi.
Nā haki me nā kīnā iwi, nā haki hāmama me nā ʻāpana iwi, a i ʻole nā haki hana ʻole o ka trauma e pono ai ke hoʻomaʻemaʻe, a i ʻole nā haki ʻoki nui e hopena ai i nā kīnā iwi.
Ua like nā haki me nā ʻāpana iwi pulelehua me nā haki segmental no ka mea, ʻaʻole lākou e pili ana i ka ʻāpana holoʻokoʻa o ka iwi a ʻo ka hopena pinepine ia o ka kūlou ʻana.
Hoʻokumu ʻia nā haki koʻikoʻi e nā ukana hana hou a loaʻa pinepine i ka calcaneus a me ka tibia.
ʻO nā haki avulsion ke kumu o ka haki ʻana o kahi hoʻokomo o ka iwi ke kīkoʻo ʻia kahi tendon a i ʻole ligament.
ʻO nā haki compression he mau haki ia e ʻomi ʻia ai nā ʻāpana iwi, maʻamau e nā ukana axial.
Kiʻi 4: Ka hoʻokaʻawale ʻana o nā haki
III. Nā mea e hoʻopilikia ai i ka ho'ōla ʻana o ka haki
Nā kumu olaola: ka makahiki, ka maʻi iwi metabolic, ka maʻi kumu, ka pae hana, ke kūlana meaʻai, ka hana neurological, ka hōʻino ʻana o nā kīʻaha koko, nā hormones, nā kumu ulu, ke kūlana olakino o ka capsule palupalu, ke kekelē o ka sterility (haʻi hāmama), ka puhi paka, ka lāʻau lapaʻau, ka pathology kūloko, ka pae ikehu traumatic, ke ʻano iwi, ke kekelē o ke kīnā iwi, nā kumu mechanical, ke kekelē o ka hoʻopili ʻana o ka ʻiʻo palupalu i ka iwi, ke kūpaʻa, ke ʻano anatomical, ka pae o ka ikehu traumatic, ke kekelē o ke kīnā iwi.
IV. Nā ʻano lapaʻau
Hōʻike ʻia ka lāʻau lapaʻau ʻoki ʻole no nā poʻe maʻi me nā ʻeha ikehu haʻahaʻa a i ʻole hiki ʻole ke hana ʻia ma muli o nā kumu kūloko a i ʻole nā kumu.
Hoʻemi ʻana: ka huki ʻana ma ke koʻokoʻo lōʻihi o ka lālā, ka hoʻokaʻawale ʻana o ka haki.
Hoʻopaʻa hou ʻia ke kākoʻo ma nā wēlau ʻelua o ka haki: hoʻopaʻa ʻana i ka iwi i hoʻemi ʻia ma o ka hoʻopaʻa ʻana o waho, me ke ʻano hoʻopaʻa ʻekolu-kiko.
ʻO ke ʻano hana hoʻopaʻa mau ʻana o ka iwi tubular traction: kahi ala o ka hōʻemi ʻana, me ka traction ʻili, ka traction iwi.
Lapaʻau ʻoki kino
(1) He kūpono ka hoʻopaʻa ʻana o waho no nā haki hāmama, nā haki pani me ka ʻeha palupalu koʻikoʻi, a me nā haki i hele pū ʻia me ka maʻi (Kiʻi 5)
Kiʻi 5: Kaʻina hana hoʻopaʻa waho
(2) Pili ka hoʻopaʻa ʻana i loko i nā ʻano haki ʻē aʻe a hahai i ke kumumanaʻo AO (Papa 1)
Papa 1: Ka ulu ʻana o AO i ka mālama ʻana i ka haki
Pono nā ʻāpana interfracture i ka hoʻopaʻa ʻana i ka compression, me ka compression static (nā wili compression), ka compression dynamic (nā kui intramedullary ʻaʻole laka), splinting (ka paheʻe ʻana ma waena o ka mea kūloko a me ka iwi), a me ka hoʻopaʻa ʻana i ke alahaka (mea kūloko e uhi ana i ka ʻāpana i hoʻopili ʻia).
(4) Hoʻemi pololei ʻole:
Hoʻokō ʻia ka ʻenehana traction ma ka ʻāpana i ʻoki ʻia i ka haki e hōʻemi i ka ʻāpana ma o ke koʻikoʻi o ka ʻiʻo palupalu, a ua loaʻa ka ikaika traction mai ka mea traction femoral, ka mea hoʻopaʻa waho, ka mea hoʻopaʻa hui AO a i ʻole ka mea wehe lamina.
V. Ka Papa Hana o ka Lāʻau Lapaʻau
Wahi a ke kaʻina hana biochemical o ka ho'ōla ʻana o ka haki, ua māhele ʻia i ʻehā mau pae (Papa 2). I ka manawa like, i hui pū ʻia me ke kaʻina hana biochemical, ua māhele ʻia ka mālama ʻana i ka haki i ʻekolu mau pae, kahi e paipai ai i ka hoʻopau ʻana o ke kaʻina hana biochemical a me ka ho'ōla ʻana o ka haki (Kiʻi 6).
Papa 2: Ke ola o ka ho'ōla ʻana o ka haki
Kiʻi 6: Kiʻikuhi hoʻolālā o ka ho'ōla ʻana o ka haki i nā ʻiole
Ka pae mumū
Hoʻokumu ke koko mai kahi o ka haki a me nā ʻiʻo palupalu a puni i kahi hematoma, hana ʻia nā ʻiʻo fibrovascular ma ka hopena i haki, a hoʻomaka nā osteoblasts a me nā fibroblasts e hoʻonui.
Manawa hoʻomaha
ʻIke ʻia ka pane callus mua i loko o 2 mau pule, me ke kūkulu ʻia ʻana o kahi iwi cartilage i ukali ʻia e ke kūkulu ʻia ʻana o kahi callus ma o ka endochondral ossification, a ʻo nā ʻano kikoʻī āpau o ka ho'ōla ʻana o ka haki e pili ana i ke ʻano lapaʻau.
Hoʻoponopono hou ʻana
I ka wā o ke kaʻina hana hoʻoponopono, ua pani ʻia ka iwi ulana i hana ʻia e ka iwi lamellar, a ua hana hou ʻia ke kahawai medullary e hōʻailona i ka pau ʻana o ka hoʻoponopono ʻana i ka haki.
Ka pilikia
ʻO ka lohi o ka hui ʻana ua hōʻike nui ʻia e ka hoʻōla ʻole ʻana o ka haki i loko o ka manawa i manaʻo ʻia, akā aia nō kekahi hana olaola, a ʻokoʻa nā kumu no ka lohi o ka hui ʻana, e pili ana i nā mea e pili ana i ka ho'ōla ʻana o ka haki.
Hōʻike ʻia ka nonunion ma ke ʻano he haki me ka ʻole o ka hōʻike o ka ho'ōla lapaʻau a radiological paha, a ʻo nā ʻike nui:
(1) ʻO ka nonunion atrophic ma muli o ka nonvascularization a me ka nele o ka hiki ke olaola e ho'ōla, i hōʻike pinepine ʻia e like me ka stenosis o ka wēlau haʻihaʻi o ka iwi a ʻaʻohe kīʻaha koko, a pono ke kaʻina hana lapaʻau i ka hoʻoulu ʻana i ka hana olaola kūloko (bone graft a i ʻole bone cortical resection a me ka lawe ʻana o ka iwi).
(2) Loaʻa i ka nonunion hypertrophic ka vascularization transitional a me ka hiki ke olaola, akā nele i ke kūpaʻa mechanical, ka mea i hōʻike pinepine ʻia e like me ka ulu nui ʻana o ka ʻaoʻao haki o ka haki, a pono ka lāʻau e hoʻonui i ke kūpaʻa mechanical (paʻa iwi a me ka wili).
(3) Loaʻa i ka dystrophic nonunion ka lako koko kūpono, akā ʻaneʻane ʻaʻohe hoʻokumu ʻana o ka callus, a pono e hana hou ʻia ka hōʻemi ʻana o ka haki ma muli o ka lawa ʻole o ka neʻe ʻana a me ka hōʻemi ʻana o ka ʻaoʻao haki o ka haki.
(4) No ka hui ʻole ʻana o ka maʻi me ka maʻi maʻi mau, pono e wehe mua ka lāʻau i ke kiko o ka maʻi, a laila e hoʻoulu i ka ho'ōla ʻana o ka haki. ʻO ka maʻi iwi osteomyelitis kahi maʻi o ka maʻi iwi a me ka iwi, hiki ke lilo i maʻi pololei o nā ʻeha hāmama a i ʻole ka maʻi pathogenic ma o nā ala koko, a pono e ʻike i nā microorganisms a me nā pathogens i loaʻa i ka maʻi ma mua o ka lāʻau.
ʻO ka maʻi ʻeha kūloko paʻakikī e hōʻike ʻia e ka ʻeha, ka hyperesthesia, nā maʻi ʻaleka o nā lālā, ke kahe koko kūloko ʻole, ka hou ʻana, a me ka edema, me nā ʻano ʻē o ka ʻōnaehana nerve autonomic. Loaʻa pinepine ia ma hope o ka trauma a me ke ʻoki ʻana, a ʻike ʻia a mālama ʻia i ka wā mua, me ka poloka nerve sympathetic inā pono.
• He mea maʻamau ka ossification Heterotopic (HO) ma hope o ka trauma a i ʻole ke ʻoki ʻana, a ʻoi aku ka maʻamau ma ke kuʻekuʻe lima, 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 nā hōʻailona.
• Piʻi ke kaomi i loko o ka ʻāpana periophysal i kahi pae, e hoʻopilikia ana i ka perfusion kūloko.
• He ʻokoʻa nā kumu o ka ʻeha neurovascular no ka ʻeha neurovascular ma muli o nā wahi anatomical like ʻole.
• Loaʻa ka necrosis avascular ma nā wahi i lawa ʻole ke koko, ʻOi aku ka kikoʻī, e ʻike i ka ʻeha a me ka wahi anatomical, a pēlā aku, a loaʻa ka hōʻino hiki ʻole ke hoʻihoʻi ʻia.
Ka manawa hoʻouna: Dec-31-2024
