I muri i te whati, ka pakaru te wheua me ngā kiko e karapoti ana, ā, he rerekē ngā mātāpono me ngā tikanga maimoatanga e ai ki te nui o te whara. I mua i te rongoā i ngā whati katoa, he mea nui kia whakatauhia te nui o te whara.
Ngā whara o te kiko ngohengohe
I. Whakarōpūtanga
Ngā whati kua kati
Ka whakarōpūtia ngā whara kiko ngohengohe mai i te ngawari ki te kino, mā te whakamahi i te tikanga Tscherne (Pikitia 1)
Whara Tau 0: Whara iti o te kiko ngohengohe
Whara Taumata 1: te karawarawa o te papa o te kiko ngohengohe e kapi ana i te wāhi whati
Whara Tau 2: he whara uaua nui, he whara kiri kua pangia, he whara e rua rānei
Whara Tau 3: Whara kiko ngohengohe kino me te nekehanga kino, te kuru, te mate wāhanga, te whara toto rānei
Figure1:Tscherne whakarōpūtanga
Whati Tuwhera
Nā te mea he hononga te whati ki te ao o waho, ko te nui o te kino o ngā kiko ngohengohe e pā ana ki te nui o te pūngao e pā ana ki te peka i te wā o te whara, ā, ko te whakarōpūtanga Gustilo te tikanga e whakamahia ana (Pikitia 2)
Pikitia 2：Whakarōpūtanga Gustilo
Momo I: Te roa o te patunga ma < 1 cm, he iti te kino o te uaua, kāore he kitea o te tangohanga o te periosteal Momo II: te roa o te patunga > 1 cm, kāore he kitea o te kino o te kiko ngohengohe, te hanganga o te papa, te whara rānei o te avulsion
Momo III: Ko te whānuitanga o te patunga kei roto ko te kiri, te uaua, te periosteum, me te wheua, me te whara nui ake, tae atu ki ngā momo patunga pū motuhake me ngā whara pāmu.
Momo IIIa: Te horapa whānui me/te kitea rānei o ngā whara kiko ngohengohe hohonu, ngā kiko ngohengohe e kapi ana i te wheua me ngā hanganga io
Momo IIIb: me te nui o te kino o ngā kiko ngohengohe, me puta ngā metastases i roto i ngā uaua hurihuri, i ngā uaua kore rānei i te wā o te maimoatanga kia tutuki ai te kapinga
Momo IIIc: Ngā whati tuwhera me ngā pakaru toto e hiahia ana kia whakatikahia ā-ringa. Ko te whakarōpūtanga Gustilo ka kino haere i roto i te wā, me ngā huringa o te taumata whara ka kitea i te wā e whakatikahia ana.
II. Te whakahaere i te whara
Ko te whakaora i te patunga me whai hāora, me whakahohe i ngā tikanga pūtau, me horoi i ngā patunga kia kore he kiko poke me te kiko necrotic. E whā ngā wāhanga matua o te whakaora: te toto totoka (meneti); te wāhanga mumura (hāora); te wāhanga kiko granulation (ngā rā i tatauhia); te wā hanganga kiko ira (wiki).
Te whakarite i te maimoatanga
Wāhanga whakapeka:te whakamakuku i te patunga, te tango i ngā kongakonga, te hanga anō i te wheua, me te whakaora i te whānuitanga o te nekehanga
(1) Aromatawai i te whānuitanga o te whara o ngā kiko ngohengohe me ngā whara o ngā pūnaha io e pā ana
(2) Whakamahia he nui o te wai isotonic hei whakamakuku i roto i te rūma pokanga hei tango i ngā kiko necrotic me ngā mea ke
(3) Ka mahia te tango i ngā mea pirau i ia 24~48 hāora hei tango i ngā mea ke me ngā kiko pirau katoa mai i te patunga kia taea rā anō te kati, te kapi katoa rānei i te patunga (4) Ka toro tika te patunga tuwhera, ka kitea katoatia te kiko hohonu, ā, ka mahia he aromatawai me te tango i ngā mea pirau whai hua.
(5) Ka whakahokia te pito whati kore utu ki roto i te patunga; Ka tangohia te kiriuhi iti kua whakakorea hei tirotiro me te horoi i te kōhao hinu wheua
Te Whakahoutanga:te whakatau i ngā pānga kino o te whara (te roa o te hononga, te kore hononga, te āhua rerekē, te mate)
Te whakaoranga:Te hokinga whakamuri o te tūroro ki te hinengaro, ki te pāpori, me te mahi
Te momo katinga me te hipoki o te patunga
Ka taea e te katinga wawe o te patunga, te hipoki rānei (3~5 rā) te whakatutuki i ngā hua maimoatanga pai: (1) te katinga tuatahi
(2) te whakaroa o te katinga
(3) te katinga tuarua
(4) te whakawhitinga o te papa matotoru-waenga
(5) te taupoki ā-tūao (te taupoki matihiko e tata ana)
(6) te papa o te waewae toto (te papa o te gastrocnemius)
(7) te taupoki kore utu (Pikitia 3)
Pikitia 3: He maha ngā tirohanga wāhanga o ngā whakawhitinga kore utu e whakaratohia ana
Te pakaru o te wheua
I. Te ahunga o te rārangi whati
Whakawhiti: Tauira kawenga o te whati whakawhiti i puta mai i te kume
whakarara: Aratau kawenga o te pēhanga nā te whati whakarara
Porowhita: Tauira kawenga o te whati porowhita nā te whati porowhita
II. Ngā whatiwhatinga
Te whakarōpūtanga i runga i ngā whati, ngā momo whati, me ētahi atu (Pikitia 4)
Ko ngā whati pakaru kopikopiko he whati e 3, neke atu rānei ngā kongakonga wheua ora, ko te nuinga o te wā ka puta mai i tētahi whara kaha-nui.
Ka puta te whati wheua i te wāhi kua pirau te wheua o te mate o mua, tae atu ki: te pukupuku wheua tuatahi, te horapa o te wheua, te osteoporosis, te mate wheua metabolic, me ētahi atu
Kāore ngā whati kāore i oti te pakaru ki ngā wahi wheua motuhake
Ngā whati wāhanga me ngā kongakonga whati tawhiti, waenganui, me te taha tata. Ka pāngia te wāhanga waenga e te rere o te toto, ko te nuinga o te wā he hua o te whara pūngao nui, me te wehenga o ngā kiko ngohengohe mai i te wheua, ka puta he raruraru ki te whakaora wheua.
Ko ngā whatiwhati he koha wheua, ko ngā whatiwhati tuwhera he kongakonga wheua, ko ngā whatiwhati kāore i te mahi nā te whara me whakakore, ko ngā whatiwhati pakaru kino rānei e hua ake ai he koha wheua.
He rite ngā whati wheua pūrerehua ki ngā whati wāhanga, nā te mea kāore e pā te wāhanga katoa o te wheua, ā, ko te nuinga o te wā he hua nō te piko nui.
Ka puta ngā whati ahotea i ngā kawenga maha, ā, he maha ngā wā ka puta ki te calcaneus me te tibia.
Ka whati te pūwāhi whakauru o te wheua i ngā whati avulsion ina totorohia te uaua, te hononga rānei.
Ko ngā whati kōpeketanga he whati e kōpeketia ana ngā kongakonga wheua, i te nuinga o te wā nā ngā kawenga axial.
Pikitia 4: Te whakarōpūtanga o ngā whati
III. Ngā āhuatanga e pā ana ki te whakaora whati
Ngā āhuatanga koiora: te pakeketanga, te mate pāwera o te wheua, te mate pūtake, te taumata mahi, te āhua kai, te mahi io, te kino o ngā oko toto, ngā homoni, ngā āhuatanga tipu, te āhua hauora o te kāpū kiko ngohengohe, te nui o te koretake (te whati tuwhera), te momi hikareti, te rongoā, te mate pāwera ā-rohe, te taumata pūngao whara, te momo wheua, te nui o te koha o te wheua, ngā āhuatanga miihini, te nui o te piri o te kiko ngohengohe ki te wheua, te pumau, te hanganga tinana, te taumata o te pūngao whara, te nui o te koha o te wheua.
IV. Ngā tikanga maimoatanga
Ko te maimoatanga kore-pokanga e tohua ana mō ngā tūroro he iti te kaha o te tinana, kāore rānei e taea te pokanga nā ngā āhuatanga ā-tinana, ā-rohe rānei.
Te whakaiti: te kukume i te tuaka roa o te peka, te wehenga whati.
Te whakapiri anō i ngā whītiki ki ngā pito e rua o te whati: te whakapiri i te wheua kua whakaitihia mā te whakapiringa o waho, tae atu ki te tikanga whakapiringa toru-ira.
Te tikanga whakapiri tonu o te wheua ngongo ki te kukume: he huarahi whakaiti, tae atu ki te kukume kiri, te kukume wheua.
Te maimoatanga pokanga
(1) He pai te whakapiri ā-waho mō ngā whati tuwhera, ngā whati kua kati me te whara nui o ngā kiko ngohengohe, me ngā whati e haere tahi ana me te mate (Pikitia 5)
Pikitia 5: Tukanga whakapiri ā-waho
(2) Ka taea te whakamahi i te whakapiri ā-roto mō ētahi atu momo whati, ā, e whai ana i te mātāpono AO (Ripanga 1)
Ripanga 1: Te whanaketanga o te AO i roto i te rongoā whati
Me whakapiripiri te pēhitanga o ngā kongakonga whatiwhati, tae atu ki te pēhitanga tūmau (ngā tīwiri pēhitanga), te pēhitanga hihiri (ngā whao intramedullary kore-raka), te whakatā (te paheke i waenga i te mea o roto me te wheua), me te whakapiripiri piriti (te rauemi o roto e horapa ana i te wāhi pakaru).
(4) Te whakaiti ā-kore:
Ka whakatinanahia te hangarau kukume ki te wāhi pakaru hei whakaiti i te kongakonga mā te kume o te kiko ngohengohe, ā, ka ahu mai te kaha kukume i te taputapu kukume o te femur, te whakatikatika o waho, te taputapu kume hononga AO, te whakatuwhera lamina rānei.
V. Te whakarārangi o te maimoatanga
E ai ki te tukanga matū koiora o te whakaora whati, ka wehea kia whā ngā wāhanga (Ripanga 2). I taua wā anō, me te tukanga matū koiora, ka wehea te maimoatanga o te whati kia toru ngā wāhanga, e whakatairanga ana i te otinga o te tukanga matū koiora me te whakaora o te whati (Pikitia 6).
Ripanga 2: Te roanga o te oranga o te whakaora whati
Pikitia 6: Kauwhata hoahoa o te whakaora whati i roto i ngā kiore
Wāhanga mumura
Ka puta he hematoma mai i te wāhi whati me ngā kiko ngohengohe e karapoti ana, ka puta he kiko fibrovascular ki te pito whati, ā, ka tīmata te horapa o ngā osteoblast me ngā fibroblast.
Wā kore mahi
Ka puta te urupare taketake o te karu i roto i ngā wiki e rua, me te hanganga o te angaanga kiriuhi, ā, ka whai ake ko te hanganga o te karu mā te whakapūmautanga endochondral, ā, ko ngā momo whakaora whati katoa e pā ana ki te momo maimoatanga.
Te Whakakorenga
I te wā e whakatikatika ana, ka whakakapia te wheua whiri i hangaia e te wheua lamellar, ā, ka whakahoutia te kōhao medullary hei tohu i te otinga o te whakatikatika whati.
Ngā raruraru
Ko te roa o te hononga ka kitea nuitia e te korenga o te whati e ora i roto i te wā e tika ana, engari kei te mau tonu ētahi mahi koiora, ā, he rerekē ngā take mō te roa o te hononga, e pā ana ki ngā mea e pā ana ki te whakaora o te whati.
Ko te kore-union ka puta hei whati, kāore he tohu o te whakaora haumanu, te whakaora hihi-X rānei, ā, ko ngā kitenga matua ko:
(1) Ko te kore-hononga ngoikore nā te kore-toto o te wheua me te kore o te kaha koiora ki te whakaora, e kitea ana ko te stenosis o te pito whati o te wheua me te kore o ngā oko toto, ā, ko te tukanga maimoatanga me whakaoho i te mahi koiora ā-rohe (te tārai wheua, te tango rānei i te cortical wheua me te kawe wheua).
(2) He kaha whakawhiti toto me te kaha koiora tō te hypertrophic nonunion, engari kāore i te pumau ā-pūnaha, e kitea ana i te nuinga o te wā ko te tipu nui rawa o te pito whati o te whati, ā, me whakanui ake te pumau ā-pūnaha i te maimoatanga (te whakapiri i te pereti wheua me te tīwiri).
(3) He nui te toto e tukuna ana ki te dystrophic nonunion, engari kāore rawa he hanganga karu, ā, me mahi anō te whakaiti whati nā te kore e ranea te nekehanga me te whakaiti i te pito whati o te whati.
(4)Mō te mate urutā kāore e hono tahi me te mate mau tonu, me tango tuatahi te arotahi o te mate i te maimoatanga, kātahi ka whakatairanga i te whakaora whati. Ko te osteomyelitis mate wheua he mate o te mate wheua me te wheua, ka taea te pangia tika mai i ngā patunga tuwhera, te pangia rānei e te mate kino mā roto i te toto, ā, he mea tika kia tautuhia ngā moroiti me ngā mate kino kua pangia i mua i te maimoatanga.
Ko te mamae ā-rohe matatini e tohuhia ana e te mamae, te nui haere o te ātete, te mate pāwera ki ngā peka, te rere toto ā-rohe koretake, te werawera, me te pupuhi, tae atu ki ngā āhuatanga rerekē o te pūnaha io ā-motu. I te nuinga o te wā ka puta i muri i te whara me te pokanga, ā, ka kitea wawetia, ka rongoātia hoki, mā te aukati io sympathetic mēnā e tika ana.
• He mea noa te whakapūtanga wheua heterotopic (HO) i muri i te whara, i te pokanga rānei, ā, he mea noa ake i roto i te tuke, te hope, me te huha, ā, ka taea e ngā bisphosphonates ā-waha te aukati i te whakapūtanga o te wheua i muri i te tīmatanga o ngā tohu.
• Ka piki te pēhanga i roto i te wāhanga periophysal ki tētahi taumata, ka whakararu i te rere o te toto ki roto.
• He rerekē ngā take o te whara o te pūnaha io, te pūnaha toto rānei, nā te rerekētanga o ngā wāhi o te tinana.
• Ka puta te mate pukupuku toto kore i ngā wāhi kāore i te rawaka te rere o te toto, tirohia te whara me te wāhi o te tinana, me ētahi atu, ā, ka puta he kino kāore e taea te whakatika.
Wā tuku: Hakihea-31-2024
