Nyuma yo kuvunika, igufwa n'ingingo zikikije birangirika, kandi hari amahame n'uburyo butandukanye bwo kuvura bitewe n'urwego rw'imvune. Mbere yo kuvura imvune zose, ni ngombwa kumenya ingano y'imvune.
Ibikomere byoroshye ku mubiri
I. Gushyira mu byiciro
Amagufwa afunze
Ibikomere byoroshye bipimwa kuva ku byoroheje kugeza ku bikomeye, akenshi hakoreshejwe uburyo bwa Tscherne (Ishusho ya 1)
Imvune yo mu rwego rwa 0: Imvune nto y'umubiri woroshye
Imvune yo mu cyiciro cya mbere: gukomeretsa cyangwa gukomeretsa ingingo zoroshye zitwikiriye aho imvune yavunitse
Imvune yo mu cyiciro cya kabiri: gukomereka cyane kw'imitsi cyangwa gukomereka k'uruhu kwanduye cyangwa byombi
Igikomere cyo mu cyiciro cya 3: Gukomereka gukomeye kw'ingingo zoroshye hamwe no kwimuka gukomeye, gukomereka, indwara y'ibice, cyangwa gukomereka kw'imitsi
Igishushanyo1 ： Ibyiciro bya Tscherne
Gucika kw'ivuniko
Kubera ko kuvunika kw'ingingo bishobora gutuma umuntu amenya ibintu byo hanze, urwego rw'ibyangiritse ku ngingo zoroshye rufitanye isano n'ingufu urwego rw'umubiri rugira mu gihe cy'ihungabana, kandi icyiciro cya Gustilo gikunze gukoreshwa (Ishusho ya 2)
Ishusho ya 2: Gustilo classification
Ubwoko bwa I: Sukura uburebure bw'igikomere < cm 1, kwangirika gato kw'imitsi, nta gusohora kw'inyuma kugaragara Ubwoko bwa II: uburebure bw'igikomere > cm 1, nta kwangirika kugaragara kw'ingingo zoroshye, kurema kw'ikirenge cyangwa gukomereka kw'inyuma
Ubwoko bwa III: Ibikomere birimo uruhu, imitsi, periosteum, n'amagufwa, hamwe n'ihungabana rikomeye, harimo ubwoko bwihariye bw'ibikomere by'amasasu n'ibikomere byo mu murima.
Ubwoko bwa IIIa: Kwandura gukabije no/cyangwa kuba hari ibisebe byimbitse byoroshye, ingingo zoroshye zifite aho zihuriye n’amagufwa n’imitsi bihagije.
Ubwoko bwa IIIb: iyo habayeho kwangirika gukomeye kw'ingingo zoroshye, hakenewe ko habaho kuvurwa indwara zifata imitsi izenguruka cyangwa idafite imitsi.
Ubwoko bwa IIIc: Gutilo ivunika ifunguye, aho imitsi yangiritse isaba gusanwa n'intoki, ishyirwa mu byiciro rya Gustilo rigenda rirushaho kuba ribi uko igihe kigenda gihita, aho impinduka mu gipimo cy'imvune zigaragara mu gihe cyo gusana.
II. Gucunga imvune
Kugira ngo ibikomere bikire bisaba ogisijeni, gukora ku buryo uturemangingo dukora, gusukura ibikomere bidafite ingirabuzimafatizo zanduye cyangwa zirimo kwangirika. Hari ibyiciro bine by'ingenzi byo gukira: gufungana (iminota); igihe cyo kubyimba (amasaha); igihe cy'ingirabuzimafatizo (iminsi ibarwa); igihe cyo kurema inkovu (ibyumweru).
Gutera intambwe z'ubuvuzi
Icyiciro cy’indwara ikabije:kuhira ibikomere, gukuraho ivumbi, kongera gusana amagufwa, no kugarura urwego rw'imikorere
(1) Suzuma ingano y'imvune zoroshye ku mubiri n'imvune zijyanye n'imitsi
(2) Koresha amazi menshi ya isotonic mu kuhira mu cyumba cyo kubaga kugira ngo ukureho ingirangingo zangiritse n'ibindi binyabiziga by'abanyamahanga.
(3) Gukuraho uburibwe bikorwa buri masaha 24 kugeza kuri 48 kugira ngo haveho imibiri yose y’abanyamahanga n’uturemangingo two mu gikomere kugeza igihe igikomere gifungiwe cyangwa gipfutse burundu (4) Igikomere gifunguye kiraguwe neza, ingingo yimbitse igaragara neza, kandi hagakorwa isuzuma n’isukura neza.
(5) Igice cyo hasi cy'ivunika gisubizwa mu gikomere; igice gito cy'igufwa gikurwaho kugira ngo harebwe kandi hasukurwe umwobo w'amagufwa.
Kubaka bundi bushya:guhangana n'ingaruka z'ihungabana (gutinda kw'ishyingiranwa, kudahuza, ubumuga, kwandura)
Gukira:Isubira inyuma ry'umurwayi mu bijyanye n'imitekerereze, imibereho n'akazi
Ubwoko bw'uburyo igikomere gifungwa n'uburyo gitwikirwa
Gufunga igikomere hakiri kare cyangwa kwikingira igikomere (iminsi 3-5) bishobora gutanga umusaruro ushimishije mu kuvura: (1) gufunga igikomere hakiri kare.
(2) gufunga byatinze
(3) ifungwa rya kabiri
(4)guteramo ikiziba cy'ikirenge gifite ubugari buri hagati
(5) icyuma gikingira ku bushake (icyuma gikingira ku buryo bw'ikoranabuhanga kiri hafi)
(6) agahu gafata imitsi (gastrocnemius flap)
(7) ipfundo ry'umugozi (Ishusho ya 3)
Ishusho ya 3: Ibisobanuro by'igice cy'ibipimo by'inyongera ku buntu bikunze gutangwa
Kwangirika kw'amagufwa
I. Icyerekezo cy'umurongo wa fracture
Ihindagurika: Imiterere y'umutwaro w'ivunika ryambukiranya riterwa no guhangayika
mu buryo butaziguye: Uburyo umuvuduko uterwa no kuvunika kw'umurongo ugororotse
Izunguruka: Imiterere y'umuvune wo mu mutwe uterwa no kuvunika kw'uruziga
II. Gucika intege
Ishyirwa mu byiciro hakurikijwe imvune, ubwoko bw'imvune, n'ibindi (Ishusho ya 4)
Kuvunika kw'amagufwa ni ukuvunika kw'amagufwa afite ibice bitatu cyangwa byinshi bizima, akenshi bituruka ku gukomereka gukomeye.
Kuvunika kw'umugozi w'igufwa bikunze kugaragara mu gace k'indwara yabanje, harimo: ikibyimba cy'igufwa cy'ibanze, kugabanuka kw'amagufwa, indwara y'amagufwa akoresha ikoranabuhanga, n'ibindi.
Amagufwa adasesenguye neza ntacikamo ibice bitandukanye by'amagufwa
Gucikamo ibice hamwe n'ibice byacitsemo ibice byo hagati, hagati, n'ibyo hafi. Igice cyo hagati kigirwaho ingaruka n'amaraso atangwa, akenshi bitewe n'ingufu nyinshi, hamwe n'imitsi yoroshye iva mu igufwa, bigatera ibibazo byo gukira kw'amagufwa.
Kuvunika kw'amagufwa, kuvunika kw'amagufwa kufunguye, cyangwa kuvunika kw'amagufwa kutagira ingaruka ku magufwa, cyangwa kuvunika gukomeye kwavuye mu magufwa bigatera ibibazo by'amagufwa.
Uduce tw’amagufwa y’ikinyugunyugu dusa n’uduce tw’amagufwa kuko tudafata igice cyose cy’amagufwa kandi akenshi tuba duterwa no gukomereka.
Kuvunika kw'imitsi biterwa no kuremererwa kenshi kandi akenshi biba muri calcaneus na tibia.
Kuvunika kw'igufwa bitera kuvunika kw'aho igufwa ryinjirira iyo umutsi cyangwa umutsi urambuye.
Gucika intege ni ukuvunika aho ibice by'amagufwa bikandagirwa, akenshi hakoreshejwe imitwaro yo mu ruhande.
Ishusho ya 4: Ishyirwa mu byiciro ry'amagufwa yavunitse
III. Ibintu bigira ingaruka ku gukira kw'imvune
Ibintu bikomoka ku binyabuzima: imyaka, indwara y’igufwa rikora neza, indwara y’ibanze, urwego rw’imikorere, imirire, imikorere y’imitsi, kwangirika kw’imitsi, imisemburo, ibintu bikura, ubuzima bw’uturemangingo tw’umubiri tworoshye, urwego rwo kutabyara (kwangirika), kunywa itabi, imiti, indwara zo mu gace runaka, urwego rw’ingufu ziterwa n’ihungabana, ubwoko bw’igufwa, urwego rw’igufwa ridafite ubuziranenge, ibintu bifitanye isano n’imikorere, urwego rw’ifata ry’uturemangingo tw’umubiri tworoshye ku magufwa, gukomera, imiterere y’umubiri, urwego rw’ingufu ziterwa n’ihungabana, urwego rw’igufwa ridafite ubuziranenge.
IV. Uburyo bwo kuvura
Ubuvuzi budasaba kubagwa butangwa ku barwayi bafite imvune nkeya cyangwa badashobora kubagwa bitewe n'ibintu bigize umubiri cyangwa aho batuye.
Kugabanya: gukurura ku ruhande rurerure rw'ingingo, gutandukana kw'amagufwa.
Gufata inkingi ku mpera zombi z'aho imvune yavunitse nanone: gufata igufwa ryagabanutse binyuze mu gufata inkingi yo hanze, harimo n'uburyo bwo gufata inkingi eshatu.
Uburyo bwo gufata amagufwa mu buryo bukomeza gukanda: uburyo bwo kugabanya, harimo no gufata uruhu, gufata amagufwa.
Ubuvuzi bwo kubaga
(1) Gufata inyuma birakwiriye ku mvune zifunguye, imvune zifunze hamwe n'ibyago bikomeye by'ingingo zoroshye, hamwe n'imvune ziherekejwe n'ubwandu (Ishusho ya 5)
Igishushanyo cya 5: Uburyo bwo gufunga inyuma
(2) Gufata imbere bikoreshwa ku bundi bwoko bw'imvune kandi bikurikiza ihame rya AO (Imbonerahamwe ya 1)
Imbonerahamwe ya 1: Iterambere rya AO mu kuvura imvune
Ibice by'amagufwa bikenera guhagarara, harimo guhagarara neza (compression screws), guhagarara neza (dynamic compression) (imisumari yo mu nda idafunga), guhagarara hagati y'ikintu cy'imbere n'igufwa), no guhagarara neza (ibintu by'imbere bizenguruka agace kari hagati y'aho byashyizwe)
(4) Kugabanya ibintu mu buryo butaziguye:
Ikoranabuhanga ryo gukurura rishyirwa mu bikorwa mu gace kavunitse kugira ngo bigabanye igice binyuze mu gukurura kw'ingingo zoroshye, kandi imbaraga zo gukurura zikomoka ku gikoresho gikurura igitsina cy'umugore, icyuma gikurura inyuma, igikoresho gikurura ingingo cya AO cyangwa icyuma gifungura lamina.
V. Gutegura ibyiciro by'ubuvuzi
Dukurikije uburyo bwo gukiza imvune mu buryo bwa biochemical, bugabanyijemo ibice bine (Imbonerahamwe ya 2). Muri icyo gihe, hamwe n'uburyo bwo kuvura imvune mu buryo bwa biochemical, uburyo bwo kuvura imvune bugabanyijemo ibice bitatu, bifasha kurangiza imikorere ya biochemical no gukira kw'imvune (Ishusho ya 6).
Imbonerahamwe ya 2: Ubuzima bwo gukira kw'imvune
Ishusho ya 6: Ishusho y'icyitegererezo yerekana gukira kw'imvune mu mbeba
Icyiciro cyo kubyimba
Kuva amaraso ava aho yavunitse n'uturemangingo tworoshye tuyikikije birema hematoma, uturemangingo twa fibrovascular tugakora ku mpera yavunitse, maze osteoblast na fibroblast zigatangira kwiyongera.
Igihe cyo kuruhuka
Igisubizo cya mbere cya callus kibaho mu byumweru 2, hagakorwa igikanka cy'umugongo gikurikirwa n'irema rya callus binyuze mu gucika kw'imitsi mu ruhu, kandi uburyo bwose bwihariye bwo gukira kw'imvune bufitanye isano n'uburyo bwo kuvura.
Iyubakwa
Mu gihe cyo gusana, igufwa ryakozwe risimbuzwa igufwa rya lamellar, maze umwobo wa medullary ugahindurwa kugira ngo hagaragazwe ko gusana imvune byarangiye.
Ingorane
Gutinda guterana kw'amagufwa bigaragazwa ahanini n'uko gucika kw'amagufwa kudakira mu gihe giteganijwe, ariko bigakomeza kugira ibikorwa bimwe na bimwe by'umubiri, kandi impamvu zo gutinda guterana ziratandukanye, zijyanye n'ibintu bigira ingaruka ku gukira kw'amagufwa.
Kutagira aho bihurira bigaragazwa no kuvunika nta kimenyetso cy’uko byavuwe cyangwa byakiriwe n’imirasire, kandi ibintu by’ingenzi bigerwaho ni ibi bikurikira:
(1) Kudahuza kw'imitsi bitewe no kudahuza kw'imitsi no kubura ubushobozi bwo gukira, bikunze kugaragara nko kugabanya impera y'igufwa ryavunitse no kutagira imiyoboro y'amaraso, kandi inzira yo kuvura isaba gukangura ibikorwa bya biology byo mu gace runaka (gufata amagufwa cyangwa gukata amagufwa no kuyatwara).
(2) Hypertrophic nonunion ifite ubushobozi bwo guhindura imitsi y'amaraso n'ibinyabuzima, ariko nta buryo bwo guhagarara neza mu mikorere, bukunze kugaragara nko gukura cyane kw'igice cyavunitse, kandi ubuvuzi bugomba kongera uburyo bwo guhagarara neza mu mikorere (gufata amagufwa n'imitsi).
(3) Uruhu rwo mu gice cy'inyuma cy'inyuma rufite amaraso ahagije, ariko nta miterere y'inyuma ibaho, kandi kugabanuka kw'ivunika bigomba kongera gukorwa bitewe no kudakora neza no kugabanuka kw'intambwe yavunitse.
(4) Ku ndwara zidakwirakwira hamwe n’indwara zidakira, ubuvuzi bugomba kubanza gukuraho ubwandu, hanyuma bugatuma imvune zikira. Indwara ya osteomyelitis y’amagufwa ni indwara yandurira mu magufwa n’amagufwa, ishobora kuba kwandurira mu buryo butaziguye ibikomere bifunguye cyangwa indwara ziterwa n’amaraso binyuze mu nzira z’amaraso, kandi ni ngombwa kumenya mikorobe n’udukoko twanduriye mbere yo kuvurwa.
Indwara y’ububabare bw’akarere irangwa no kubabara, guhangayika cyane, ubwivumbure bw’amaguru, gutembera nabi kw’amaraso mu gace runaka, ibyuya, no kubyimba, harimo n’ibibazo by’imitsi ikora ku buryo budasanzwe. Akenshi ibaho nyuma yo gukomereka no kubagwa, kandi iraboneka ikavurwa hakiri kare, ikanaziba imitsi ikora ku mutima iyo bibaye ngombwa.
• Heterotopic ossification (HO) ikunze kugaragara nyuma yo gukomereka cyangwa kubagwa, kandi ikunze kugaragara cyane mu nkokora, mu kibuno no mu itako, kandi bisphosphonates zo mu kanwa zishobora kubuza amagufwa kwiyubaka nyuma yo kugaragaza ibimenyetso.
• Umuvuduko mu gice cy’imbere mu mubiri wiyongera ku rugero runaka, bigatuma amazi yinjira imbere mu mubiri adakora neza.
• Gukomereka kw'imitsi y'ubwonko bifite impamvu zitandukanye zitera gukomereka kw'imitsi y'ubwonko bitewe n'aho ingingo z'umubiri ziherereye.
• Kurwara kw'imitsi itera amaraso mu bice bidafite amaraso ahagije, By'umwihariko, reba imvune n'aho umubiri uherereye, n'ibindi, maze hakabaho kwangirika ku buryo budasubirwaho.
Igihe cyo kohereza: Ukuboza 31-2024
