Nyuma yo kuvunika, amagufwa nuduce tuyikikije byangiritse, kandi hariho amahame nuburyo butandukanye bwo kuvura ukurikije urugero rwimvune. Mbere yo kuvura ibice byose, ni ngombwa kumenya urugero rw'imvune.
Ibikomere byoroheje
I.Ibisobanuro
Gucika
Ibikomere byoroheje byoroheje biva mu byoroheje bikabije, mubisanzwe hakoreshejwe uburyo bwa Tscherne (Ishusho 1)
Icyiciro cya0: Gukomeretsa byoroheje byoroheje
Icyiciro cya 1 cyo gukomeretsa: gukuramo hejuru cyangwa guhuzagurika kwinyama zoroshye zitwikiriye ikibanza cyacitse
Icyiciro cya 2: gukomeretsa imitsi cyangwa kwanduza uruhu rwanduye cyangwa byombi
Gukomeretsa Icyiciro cya 3: Gukomeretsa bikabije byumubiri hamwe no kwimurwa gukabije, guhonyora, syndrome de santrale, cyangwa gukomeretsa kw'amaraso
Igishushanyo1 ： Ibyiciro bya Tscherne
Gufungura kuvunika
Kubera ko kuvunika kuvugana n’amahanga, urugero rwo kwangirika kwinyama zoroheje zifitanye isano ningufu zatewe ningingo mugihe cyihungabana, kandi mubisanzwe Gustilo ikoreshwa (Ishusho 2)
Igishushanyo2 ： GustiloClassification
Ubwoko bwa I: Sukura uburebure bwikigero
Ubwoko bwa III: Urwego rw ibikomere rurimo uruhu, imitsi, periosteum, namagufwa, hamwe nihungabana ryinshi, harimo ubwoko bwihariye bwibikomere byamasasu no gukomeretsa mu murima
Ubwoko bwa IIIa: Kwandura kwinshi no / cyangwa kuba hari ibibyimba byoroheje byoroheje, ibibyimba byoroshye bifite ubwuzuzanye buhagije bwamagufwa nu mitsi.
Ubwoko bwa IIIb: hamwe no kwangirika kwinyama zoroshye, guhinduranya imitsi cyangwa imitsi yubusa birakenewe mugihe cyo kuvura kugirango bigerweho
Ubwoko bwa IIIc: Gufungura kuvunika hamwe no kwangirika kwamaraso bisaba gusana intoki Gustilo ishyirwa mubikorwa bigenda byiyongera uko ibihe bigenda bisimburana, hamwe nimpinduka mubyiciro byimvune byagaragaye mugihe cyo gusana.
II. Gucunga nabi
Gukiza ibikomere bisaba okisijeni, gukora uburyo bwimikorere ya selile, guhanagura ibikomere bitarimo imyenda yanduye na nerotic. Hariho ibyiciro bine byingenzi byo gukira: coagulation (iminota); icyiciro cyo gutwika (amasaha); icyiciro cya granulation tissue (iminsi ibarwa); Igihe cyo gushiraho inkovu (ibyumweru).
Gutegura imiti
Icyiciro gikaze:Kuvomera ibikomere, kuvanaho, kongera amagufwa, no kugarura urwego rwimikorere
(1) Suzuma urugero rw'imvune zoroheje zoroheje hamwe n’imvune zifitanye isano n’imitsi
.
.
(5) Impera yamenetse yubusa isubizwa mu gikomere; Cortex ntoya yakuweho kugirango isuzumwe kandi isukure umwobo w'amagufwa
Kwiyubaka:guhangana nuruhererekane rwihungabana (gutinda ubumwe, kudahuza, ubumuga, kwandura)
Umwanzuro:Kwisubiraho kwa psychologiya, imibereho, hamwe nakazi k'umurwayi
Ubwoko bwo gufunga ibikomere no gukingirwa
Gufunga ibikomere hakiri kare cyangwa gukwirakwizwa (iminsi 3 ~ 5) birashobora kugera kubisubizo bishimishije byo kuvura: (1) gufunga ibanze
(2) gutinda gufunga
(3) gufunga kabiri
(4) guhinduranya hagati ya flap yo hagati
(5) flap kubushake (flap ya digitale yegeranye)
(6) flap ya pedicle flap (gastrocnemius flap)
(7) flap yubusa (Ishusho 3)
Igishushanyo3 views Ibice bimwe byo guhindurwa kubuntu akenshi bitangwa
Kwangirika kw'amagufwa
I.Icyerekezo cyumurongo
Guhinduranya: Umutwaro wo kuvunika kwa transvers uterwa no guhagarika umutima
bidasubirwaho: Uburyo bwo kwikorera umutwaro kubera kuvunika diagonal
Spiral: Imizigo yuburyo bwavunitse bwa torsional kubera kuvunika
II.Ivunika
Gutondekanya ukurikije kuvunika, ubwoko bwavunitse, nibindi (Ishusho 4)
Kuvunika gukabije ni kuvunika hamwe nibice 3 cyangwa byinshi byamagufwa bizima, mubisanzwe biterwa no gukomeretsa imbaraga nyinshi.
Kuvunika kwa pathologiya kuvunika kumurongo biboneka mugice cyo kwangirika kwamagufwa yindwara zabanjirije iyi, harimo: ikibyimba cyambere cyamagufwa, metastase yamagufa, osteoporose, indwara yamagufwa ya metabolike, nibindi
Ivunika rituzuye ntirigabanyamo ibice bitandukanye byamagufwa
Ibice byavunitse hamwe nibice byavunitse, hagati, na hafi. Igice cyo hagati cyibasiwe no gutanga amaraso, mubisanzwe biturutse ku gukomeretsa ingufu nyinshi, hamwe no gutandukanya ingirabuzimafatizo zoroheje ziva mu magufa, bigatera ibibazo byo gukira amagufwa.
Ivunika rifite inenge yamagufa, kuvunika gufungura ibice byamagufwa, cyangwa kuvunika-kudakora gukenera gukenera, cyangwa kuvunika gukabije kuvamo amagufwa.
Kumeneka hamwe n'ibice by'amagufwa y'ibinyugunyugu bisa no kuvunika igice kuko bitarimo ibice byose byamagufwa kandi mubisanzwe biterwa no kugoreka urugomo.
Ivunika rya Stress riterwa numuzigo usubirwamo kandi bikunze kugaragara muri calcane na tibia.
Ivunika rya Avulsion ritera kuvunika kw'amagufwa yinjizamo iyo tendon cyangwa ligament irambuye.
Ivunika ryo kwikuramo ni ibice byavunaguye ibice byamagufwa, mubisanzwe imitwaro ya axial.
Igishushanyo 4: Gutondekanya ibice
III.Ibintu bigira uruhare mu gukiza kuvunika
Impamvu zishingiye ku binyabuzima: imyaka, indwara yamagufwa ya metabolike, indwara zifatika, urwego rwimikorere, imiterere yimirire, imikorere yimitsi, kwangirika kwimitsi, imisemburo, ibintu bikura, imiterere yubuzima bwa capsule yoroheje, urwego rwo kutabyara (kuvunika gufungura), kunywa itabi, imiti, indwara ya pathologiya yaho, urwego rwingufu zihahamuka, ubwoko bwamagufwa, urugero rwubumuga bwamagufwa, urwego rwimiterere yamagufa yoroheje, urwego rwimiterere yamagufwa, urwego rwimiterere yamagufa, urwego rwimiterere yamagufa, urwego rwimiterere yamagufwa, urwego rwimiterere yamagufwa, urwego rwumubiri.
IV. Uburyo bwo kuvura
Ubuvuzi budasanzwe bwo kubaga bwerekanwa ku barwayi bafite ibikomere bidafite ingufu nke cyangwa badashobora gukora bitewe na sisitemu cyangwa ibintu byaho.
Kugabanya: gukwega kumurongo muremure wigice, gutandukana kuvunika.
Gufata neza ku mpande zombi zavunitse nanone: gukosora amagufwa yagabanutse binyuze mugukosora hanze, harimo tekinike yo gukosora ingingo eshatu.
Tubular amagufwa akomeje kwikuramo tekinike yo gukurura tekinike: uburyo bwo kugabanuka, harimo gukurura uruhu, gukurura amagufwa.
Kuvura
.
Igishushanyo 5: Uburyo bwo gutunganya hanze
(2) Gukosora imbere birakoreshwa mubundi bwoko bwimvune kandi bukurikiza ihame rya AO (Imbonerahamwe 1)
Imbonerahamwe 1: Ubwihindurize bwa AO mu kuvura kuvunika
Ibice bitavunitse bisaba gukosorwa gukosorwa, harimo kwikuramo static (screw compression), compression dinamike (imisumari idafunze imisumari), gucamo ibice (kunyerera hagati yikintu cyimbere namagufwa), no gukosora ibiraro (ibikoresho byimbere bikikije agace kegeranye)
(4) Kugabanya mu buryo butaziguye:
Ikoranabuhanga ryo gukwega rishyirwa mubikorwa byavunitse kugirango bigabanye ibice binyuze muburemere bwinyama zoroshye, kandi imbaraga zo gukurura zikomoka kubikoresho bikurura femorale, bikosora hanze, AO ihuriweho hamwe cyangwa gufungura lamina.
V.Gutegura imiti
Ukurikije inzira ya biohimiki yo gukiza kuvunika, igabanijwemo ibyiciro bine (Imbonerahamwe 2). Muri icyo gihe, hamwe n’ibikorwa bya biohimiki, kuvura kuvunika bigabanyijemo ibyiciro bitatu, biteza imbere kurangiza inzira y’ibinyabuzima no gukiza kuvunika (Ishusho 6).
Imbonerahamwe 2: Inzira yubuzima bwo gukiza kuvunika
Igishushanyo 6: Igishushanyo mbonera cyo gukiza kuvunika mu mbeba
Icyiciro cyo gutwika
Amaraso ava ahantu havunitse hamwe nuduce tworoshye dukikije hematoma, tissue fibrovasculaire yibice byacitse, kandi osteoblasts na fibroblast bitangira kwiyongera.
Isaha
Igisubizo cyambere cyo guhamagarwa kibaho mugihe cyibyumweru 2, hamwe no gukora skeleton ya karitsiye ikurikirwa no guhamagarwa binyuze muri ossifike ya endochondral, kandi uburyo bwose bwihariye bwo gukiza kuvunika bujyanye nuburyo bwo kuvura.
Kwiyubaka
Mugihe cyo gusana, igufwa ryakubiswe ryakozwe risimburwa namagufwa ya lamellar, hanyuma umwobo wa medullary wongeye guhindurwa kugirango urangize gusana kuvunika.
Ingorabahizi
Ubumwe bwatinze bugaragazwa cyane cyane no kuvunika kutakira mugihe giteganijwe, ariko biracyafite ibikorwa byibinyabuzima, kandi impamvu zitinda ubumwe ziratandukanye, zifitanye isano nibintu bigira ingaruka kumyuka.
Nonunion igaragarira nko kuvunika nta bimenyetso byerekana gukira kwa clinique cyangwa radiologiya, kandi ibyingenzi ni:
.
.
.
. Indwara yo mu magufa osteomyelitis ni indwara yanduye amagufwa n'amagufwa, ashobora kuba kwandura mu buryo butaziguye ibikomere bikinguye cyangwa kwandura indwara binyuze mu nzira ziva mu maraso, kandi ni ngombwa kumenya mikorobe zanduye na virusi mbere yo kuvurwa.
Indwara ya syndrome igoye yo mu karere irangwa n'ububabare, hyperesthesia, allergie yo mu gihimba, umuvuduko w'amaraso udasanzwe, kubira ibyuya, no kuribwa, harimo n'ubudasanzwe bwa sisitemu ya autonomic nervous. Ubusanzwe bibaho nyuma yo guhahamuka no kubagwa, bikamenyekana kandi bikavurwa hakiri kare, hamwe nimpuhwe zimpuhwe nibiba ngombwa.
• Heterotopic ossification (HO) ikunze kugaragara nyuma yo guhahamuka cyangwa kubagwa, kandi ikunze kugaragara cyane mu nkokora, mu kibuno, no mu kibero, kandi bisphosifone yo mu kanwa irashobora kubuza kwangiza amagufwa nyuma yo gutangira ibimenyetso.
• Umuvuduko mubice bya periophysal wiyongera kurwego runaka, bikangiza ububobere bwimbere.
• Imvune zo mu mitsi zifite impamvu zitandukanye zitera imvune zifata imitsi kubera ahantu hatandukanye.
• Necrosis yo mu mitsi iba mu bice bidahagije by'amaraso, By'umwihariko, reba igikomere n'ahantu hatandukanye, n'ibindi, kandi ibyangiritse bidasubirwaho bibaho.
Igihe cyo kohereza: Ukuboza-31-2024
