Kev sib txuas ntawm cov pob txha tawg nrog kev pab cuam ntawm kev phais tau nrawm rau ob qho tib si txheej txheem kho thiab kho cov neeg mob nrog cov pob txha nyuaj. Thawj thawj zaug, xws li cov txheej txheem osteosynthesis ntawm cov pob txha tau ua rov qab rau hauv lub xyoo pua puv 19, tab sis vim muaj qhov tshwm sim ntawm cov teeb meem loj heev ntawm cov kab mob purulent, cov kws kho mob raug yuam kom tsis txhob ua. Rov pib sim tom qab kev qhia txog kev siv tshuaj tua kab mob thiab kev kho aseptic rau hauv kev xyaum.
YDab tsi yog osteosynthesis?
Ntau tus neeg mob uas muaj kev puas tsuaj ntau yog muab osteosynthesis los ntawm kws kho mob. Nws yog dab tsi? Qhov no yog kev sib txuas ntawm cov pob txha tawg nrog kev pab ntawm kev ua haujlwm. Nws yog feem ntau yog sau nyob rau hauv kev kho mob ntawm complex pob qij txha, incorrectly fused los yog tshiab tsis-sib koom fractures. Nrog kev pab los ntawm osteosynthesis, cov khoom sib txuam yog tsau. Yog li, cov xwm txheej zoo tshaj plaws yog tsim rau lawv cov fusion, nrog rau kev kho dua tshiab ntawm kev ncaj ncees ntawm limb.
Muaj ob hom kev osteosynthesis:
- submersible (on-osseous, intraosseous, transosseous);
- external (extrafocal).
Muaj kuj yog ultrasonic osteosynthesis. Nws yog dab tsi? Nov yog kev sib txuas ntawm cov pob txha me me.
Kev ua haujlwm tau ua nrog kev pab los ntawm cov clamps sib txawv. Cov ntsia hlau thiab pins yog siv rau submersible intraosseous osteosynthesis, daim hlau nrog screws rau extraosseous osteosynthesis, pins thiab screws rau transosseous osteosynthesis. Cov retainers no yog tsim los ntawm chemically, biologically thiab lub cev nruab nrab cov ntaub ntawv. Yeej, cov qauv hlau ua los ntawm vitalium, stainless hlau, titanium yog siv, feem ntau tsawg - los ntawm inert plastics thiab pob txha. Hlau retainers, tom qab lub pob txha kho, feem ntau raug tshem tawm. Ilizarov apparatus ntawm ceg yog siv rau sab nraud osteosynthesis. Ua tsaug rau nws, cov pob txha tawg tom qab kev sib piv tau ruaj khov. Cov neeg mob tuaj yeem taug kev ib txwm nrog lub nra hnyav.
Kev qhia
Osteosynthesis yog qhia raws li cov txheej txheem tseem ceeb rov qab rau:
- xav pob txha uas tsis loj hlob ua ke tsis muaj kev pab los ntawm kws kho mob;
- kev puas tsuaj nrog qhov ua tau ntawm daim tawv nqaij perforation (thaum kaw pob txha tuaj yeem nkag mus rau hauv qhov qhib);
- pob txha nyuaj los ntawm kev puas tsuaj rau cov hlab ntsha loj.
YContraindications
Kev phais tsis pom zoo rau cov xwm txheej hauv qab no:
- yog tus neeg mob tsis xis nyob;
- muaj ntau qhibpuas;
- thaum thaj chaw cuam tshuam kis;
- yog tias muaj cov kab mob hais tawm ntawm ib qho khoom nruab nrog cev;
- nrog kev loj hlob ntawm kab mob pob txha;
- tus neeg mob muaj venous insufficiency ntawm limb.
Tim phaj
Cov phaj siv thaum lub sijhawm ua haujlwm yog tsim los ntawm ntau yam hlau. Titanium daim hlau raug lees paub tias yog qhov zoo tshaj plaws, vim tias cov khoom siv no muaj qhov nthuav dav: nyob rau hauv huab cua, ib zaj duab xis instantly tsim rau nws, uas nyob rau hauv tsis muaj txoj kev yuav cuam tshuam nrog lub cev nqaij daim tawv. Hauv qhov no, koj tsis tuaj yeem ntshai ntawm kev loj hlob ntawm metallosis. Yog vim li ntawd coob leej thiaj tsis tshem tej daim phiaj ntawd tseg, tiamsis cia lawv mus txojsia.
YImmersion intraosseous osteosynthesis
Lwm lub npe rau kev ua haujlwm yog intramedullary osteosynthesis. Nws qhib thiab kaw. Nyob rau hauv thawj rooj plaub, qhov tawg tsam yog raug, tom qab uas cov fragments raug muab piv, thiab ib tug neeg kho tshuab pas nrig yog muab tso rau hauv lub pob txha kwj dej ntawm cov pob txha puas. Qhib osteosynthesis tsis tas yuav tsum tau siv cov cuab yeej tshwj xeeb rau kev sib koom ua ke; cov txheej txheem no yooj yim dua thiab siv tau ntau dua li kev phais kaw. Txawm li cas los xij, qhov no ua rau muaj kev pheej hmoo ntawm cov nqaij mos mos.
Kaw intramedullary osteosynthesis yog tus cwj pwm los ntawm qhov tseeb tias cov khoom tawg tau muab piv, tom qab ntawd qhov kev txiav me me tau ua nyob deb ntawm qhov chaw tawg. Raws li kev tswj hwm X-ray, los ntawm qhov kev txiav no, siv lub cuab yeej tshwj xeeb, lawv tau nkag mus rau hauv cov pob txha pob txha kwj dej ntawm qhov puas.cov pob txha raws tus neeg xyuas pib yog ib tug ntev hlau hollow pas nrig ntawm tus coj txoj kab uas hla. Tom qab ntawd, tus neeg xyuas pib raug tshem tawm, thiab lub qhov txhab yog sutured.
Internal pob txha osteosynthesis
Qhov no yog dab tsi? Txoj kev sib txuas ntawm cov pob txha tawg yog siv rau ntau yam pob txha tawg (comminuted, helical, periarticular, oblique, transverse, intraarticular), tsis hais qhov khoov thiab cov duab ntawm medullary kwj dej. Cov fixators uas siv rau cov kev ua haujlwm zoo li no tau nthuav tawm nyob rau hauv daim ntawv ntawm cov phaj sib txawv thiab cov duab, txuas nrog cov pob txha nrog screws. Ntau daim hlau niaj hnub muaj cov cuab yeej tshwj xeeb, suav nrog cov uas tshem tau thiab tsis tshem tau. Tom qab cov txheej txheem, plaster cam khwb cia feem ntau kuj siv.
Nyob rau hauv helical thiab oblique fractures, sab nraud osteosynthesis feem ntau yog ua los ntawm cov hlau bands thiab nyob ntawm tej, nrog rau tshwj xeeb stainless hlau rings thiab semi-rings. Hom kev sib txuas ntawm cov pob txha, tshwj xeeb tshaj yog cov hlau, tsis tshua muaj siv los ua ib qho kev ywj pheej vim tsis muaj zog fixation thiab feem ntau yog ib qho ntxiv rau lwm hom osteosynthesis.
Cov khoom siv mos mos (silk, catgut, lavsan) yog qhov tsis tshua muaj siv rau kev ua haujlwm no, vim tias cov xov zoo li no tsis tuaj yeem tiv taus cov leeg traction thiab txav ntawm cov khoom tawg.
Internal transosseous osteosynthesis
Qhov kev phais no yog ua los ntawm kev pab ntawm bolts, screws, spokes, thiab cov fixators no tau ua nyob rau hauv oblique los yog transverse kev taw qhialos ntawm cov pob txha phab ntsa ntawm qhov chaw ntawm kev raug mob. Ib hom tshwj xeeb ntawm transosseous osteosynthesis yog pob txha suture - qhov no yog thaum cov channel tau drilled nyob rau hauv cov fragments thiab ligatures (catgut, txhob lo lo ntxhuav, xaim) hla lawv, uas yog ces nruj thiab khi. Cov pob txha suture yog siv rau pob txha ntawm olecranon lossis patella. Transosseous osteosynthesis koom nrog daim ntawv thov ntawm plaster cam khwb cia.
YExternal osteosynthesis
Qhov kev hloov pauv no yog ua los ntawm kev pabcuam tshwj xeeb (apparatuses ntawm Ilizarov, Volkov - Oganesyan). Qhov no tso cai rau koj los sib piv cov khoom tawg yooj yim yam tsis tau nthuav tawm qhov chaw tawg thiab khov kho lawv. Cov txheej txheem no tau ua yam tsis muaj kev cuam tshuam ntawm lub cam khwb cia, thiab Ilizarov apparatus ntawm ceg tso cai rau tus neeg mob taug kev nrog lub load tag nrho.
Kev nyuaj siab
Cov teeb meem hnyav tuaj yeem tshwm sim tom qab ua haujlwm. Ua rau lawv:
- Kev xaiv yuam kev ntawm kev kho cov pob txha tawg;
- kev tsis sib haum xeeb ntawm cov pob txha sib luag;
- cov ntaub so ntswg roughness;
- xaiv tus tuav tsis raug;
- tsis ua raws li asepsis thiab antisepsis.
Cov teeb meem zoo li no ua rau muaj kev sib koom ua ke tsis raug ntawm kev tawg, nws cov suppuration lossis ua tiav tsis yog koom haum.
Txij li cov phaj loj ntev tau siv rau hauv cov pob txha osteosynthesis, thiab rau qhov no cov pob txha raug nthuav tawm ntau thaj chaw, nws cov ntshav tau cuam tshuam ntau zaus, uas ua rau qeeb fusion. Tshem cov ntsia hlau tawm ntau qhov uas ua rau cov pob txha tsis muaj zog.
Zoo kawg
Yog li, peb tau txheeb xyuas cov txheej txheem xws li osteosynthesis. Nws yog dab tsi? Qhov no yog txoj kev niaj hnub tshaj plaws los txuas cov pob txha tawg tom qab tawg. Ua tsaug rau nws, cov txheej txheem ntawm kev kho mob thiab kev kho mob ntawm cov neeg mob tau nrawm nrawm heev. Osteosynthesis yog ua los ntawm ntau yam fixators. Qhov ruaj khov tshaj plaws yog titanium daim hlau, uas tsis tuaj yeem tshem tawm.
