Kev sib koom tsis raug yog ib hom kev tsis sib xws ntawm cov pob txha, uas yog tus cwj pwm los ntawm kev txav mus los, txawv txawv rau lub tuam tsev no. Hauv kev kho mob, ib lo lus tshwj xeeb yog siv rau tus mob no - "pseudoarthrosis". Tam sim no, xws li tus kab mob no tau kho tau zoo, thiab cov kev kho mob tuaj yeem ua haujlwm thiab kev saib xyuas. Tsis tas li ntawd, kev kho mob feem ntau tau txais txiaj ntsig zoo thiab rov qab los rau tib neeg lub neej. Nyob rau hauv tsab xov xwm no, peb yuav soj ntsuam nyob rau hauv kom meej qhov ua rau ntawm tsim ntawm ib tug cuav sib koom. Peb kuj yuav xyuam xim rau kev kuaj mob thiab kev kho mob.
ICD: cuav sib koom, ntau yam
Kev sib koom ua ke tsis raug - ua txhaum ntawm kev ncaj ncees ntawm cov pob txha tubular, nrog rau kev txav mus los ntawm pathological. Raws li kev faib tawm thoob ntiaj teb ntawm cov kab mob, cov cai uas muaj kev sib koom ua ke tsis tseeb yog ICD 10. Nws suav nrog: kev tsis sib haum xeeb ntawm cov pob txha, uas yog, pseudoarthrosis, thiab kev sib koom ua ke tsis tseeb tawm tsam keeb kwm ntawm fusion lossis arthrodesis.
Nrog rau sabdaim duab pathomorphological thiab txoj kev kho cov pob qij txha cuav yog muab faib ua fibrous thiab muaj tseeb. Cov qub yog ib theem nruab nrab ntawm kev sib sau ua ke qeeb thiab qhov tseeb pseudarthrosis. Lawv daim duab kho mob yog qhov sib txawv tsis tseem ceeb ntawm cov khoom tawg, muaj cov ntaub so ntswg, qhov kawg muaj cov pob txha daim hlau uas kaw cov kwj dej medullary.
Muaj tsawg zaus, fibro-synovial pseudoarthrosis yog tsim, nyob rau hauv qhov kawg ntawm cov pob txha raug them nrog cov ntaub so ntswg cartilaginous, thiab cov pob txha tawg yog nyob rau hauv ib hom ntawm cov ntaub so ntswg capsule. Synovial kua accumulates nruab nrab ntawm lawv, sclerosis ntawm qhov kawg ntawm cov fragments yog ua tau.
Kev faib cov pob qij txha cuav
Kev sib koom ua ke tsis raug tuaj yeem yog los yog kis tau. Kev sib koom ua ke tsis tseeb yog qhov tsawg kawg nkaus thiab tsis pub ntau tshaj 0.5% ntawm cov kab mob pathology. Nws tsim yog ua raws li kev ua txhaum ntawm intrauterine ntawm kev tsim cov pob txha cov ntaub so ntswg, ua rau cov pob txha tsis zoo nyob rau hauv ib qho chaw. Thiab tom qab yug me nyuam, los ntawm 2-3 xyoos, kev ncaj ncees ntawm cov pob txha tawg. Raws li txoj cai, kev sib koom ua ke tsis tseeb ntawm sab ceg yog qhov tshwm sim, tsawg dua - clavicle, ulna thiab femur.
Tau txais cov nyiaj sib koom ua ke tsis tseeb txog li 3% ntawm cov kab mob orthopedic. Feem ntau, nws yog qhov tshwm sim ntawm qhov tawg, thaum muaj kev sib koom ua ke tsis raug thiab tsis tiav ntawm cov khoom tawg. Tau pseudarthrosis tau muab faib ua atrophic, normotrophic thiab hypertrophic.
Cov kab mob hauv zos
Local ua rau kev kawmcuav sib koom, nyob rau hauv lem, muab faib ua peb pawg. Thawj pab pawg - cov laj thawj uas cuam tshuam nrog kev ua yuam kev thiab kev ua tsis tiav hauv kev kho mob: kev sib piv tsis tiav ntawm cov pob txha tawg, tsis ua kom tshem tawm cov ntaub so ntswg cuam tshuam, tsis raug immobilization, vim qhov kev txav ntawm cov khoom seem, tsis tu ncua lossis ntxov hloov ntawm plaster casts, Kev siv cov khoom kho tsis raug, kev tawm dag zog ntau dhau thiab kev ua haujlwm ntawm lub cev, sclerotation ntau heev.
Pab pawg thib ob suav nrog ua rau muaj feem cuam tshuam rau qhov mob hnyav thiab mob tom qab mob: pob txha, poob ntawm cov pob txha loj, tsoo cov leeg ntau ntau, pob txha raug mob, suppuration ntawm cov ntaub so ntswg, osteomyelitis, kev puas tsuaj rau cov hlab ntsha thiab cov hlab ntsha, nrog rau kev ua txhaum cov zaub mov hauv lawv.
Thiab, thaum kawg, pawg thib peb ntawm qhov ua rau cuam tshuam rau kev tsim ntawm kev sib koom ua ke tsis tseeb yog cuam tshuam nrog cov yam ntxwv ntawm lub cev thiab lub cev ntawm cov ntshav muab rau cov pob txha thiab qhov chaw ntawm pob txha.
Trophic ua rau
Ntawm qhov loj ntawm qhov ua rau trophic, cov tseem ceeb hauv kev tsim cov pob qij txha cuav yog: kab mob, piv txwv li, syphilis, malaria, mob hnyav; metabolic ntshawv siab thiab tshwj xeeb tshaj yog calcium-phosphorus metabolism hauv cov ntaub so ntswg; ntshav qab zib; avitaminosis; vascular insufficiency tom qab kev puas tsuaj rau innervation ntawm cov hlab ntsha; tseem ceeb X-ray raug, uas tuaj yeem cuam tshuam cov txheej txheem ntawm osteogenesis; Cov kab mob trophic ntawm qhov chaw tawg.
daim duab kho mob
Daim duab kho mob hauv kev tsim cov pob qij txha cuav muaj nws tus yam ntxwv. Ntawm qhov chaw ntawm qhov tawgmuaj kev txav mus los, atrophy ntawm cov leeg nqaij, o, proliferation ntawm connective cov ntaub so ntswg, caws pliav tsim. X-ray tuaj yeem kuaj pom qhov sib txawv ntawm qhov tawg, sclerosis ntawm qhov kawg ntawm cov pob txha, fusion ntawm cov pob txha pob txha kwj dej.
Kev kuaj mob pseudoarthrosis
Thaum kuaj mob, ntxiv rau cov ntaub ntawv kho mob, kev saib xyuas kuj tau them rau lub sijhawm uas tsim nyog rau kev ua tiav kev sib koom ua ke ntawm qhov tawg no. Thaum lub sijhawm no tas sijhawm, qhov xwm txheej ntawm pob txha raug txiav txim siab tias kho tau qeeb lossis tsis kho, thiab tom qab lub sijhawm ob zaug ntawm lub sijhawm ib txwm muaj, kev tsim ntawm kev sib koom ua ke tsis tseeb yog xav tias.
Txhawm rau kom paub meej qhov kev xav, ib qho x-ray raug coj mus rau hauv ob qhov kev sib koom ua ke, thiab qee zaum hauv oblique qhov projections. Cov cim qhia tias muaj qhov sib koom ua ke tsis tseeb yog cov duab x-ray hauv qab no: qhov tsis muaj callus, uas yog qhov sib txuas ntawm cov pob txha tawg; qhov kawg ntawm cov fragments muaj ib tug smoothed puag ncig los yog conical zoo; cov kab noj hniav ntawm qhov kawg ntawm cov fragments overgrows thiab kaw phaj yog tsim. Nrog ib tug cuav sib koom nyob rau hauv ib los yog ob qho tib si cov pob txha tawg, qhov kawg muaj ib tug hemispherical puab, thiab nyob rau hauv tsos zoo li ib tug articular taub hau. Lwm qhov tawg tuaj yeem muaj kab noj hniav. Hauv qhov no, qhov chaw sib koom tau pom meej meej.
Txhawm rau txiav txim siab qhov kev siv ntawm cov txheej txheem, kev tshawb fawb radionuclide tau sau tseg.
Principle of surgical kho mob
Txawm hais tias tag nrho cov arsenal ntawm kev saib xyuas kev kho mob (txhaj tshuaj, hluav taws xob stimulation, sib nqus kho, thiab lwm yam), lub ntsiabTxoj kev kho ntawm pseudarthrosis yog ua haujlwm. Qhov chaw ua haujlwm yog nyob ntawm compression osteosynthesis. Yuav ua li cas kho qhov sib koom ua ke tsis raug? Kev ua haujlwm yuav tsum tau ua 8-12 lub hlis tom qab ua tiav kev kho mob ntawm qhov txhab hauv cov pob txha tawg. Yog tias muaj qhov caws pliav rau cov pob txha, lawv yuav tsum tau txiav tawm thiab phais yas kom tshem tawm qhov tsis xws luag.
Ib qho tseem ceeb hauv kev ua haujlwm yog qhov sib piv tseeb ntawm cov pob txha tawg, nrog rau kev ua kom rov zoo ntawm lawv qhov kawg, tshem tawm cov caws pliav thiab kho kom zoo ntawm cov pob txha pob txha kwj dej.
Kev kho mob ntawm pvseudarthrosis siv Ilizarov apparatus
Txoj kev no tso cai rau koj nqa cov khoom tawg ua ke thiab ua rau lawv cov fusion sai yam tsis muaj kev cuam tshuam ncaj qha. Yog vim li cas qhov no hu ua extrafocal osteosynthesis.
Pib nrog, tus neeg mob tau muab tso rau ntawm qhov ncauj ntawm lub cuab yeej orthopedic, nrog kev pab ntawm cov pob txha tawg. Tom qab ntawd, txog ib lub lim tiam, cov txheej txheem rov qab los tom qab siv lub cuab yeej siv sijhawm ntev, thaum lub sij hawm qhov chaw uas cov spokes kis tau zoo thiab cov txheej txheem ntawm pob txha fusion nws tus kheej pib. Maj mam, cov pob txha tawg txav los ze zog rau ib leeg, rhuav tshem cov kev sib txuas uas tsis tsim nyog thiab tuav cov pob txha cuav.
Ntxiv mus, fixation tshwm sim, uas yog, tsim ntawm callus thiab cov txheej txheem ntawm nws ossification. Lub sijhawm no ntev, tab sis tib lub sijhawm muaj kev nyab xeeb thiab tsis xav tau kev ntsuas tshwj xeeb. Tus neeg mob yuav tsum noj cov vitamins, noj kom raug thiab tso tus cwj pwm phem.
Thiab kawg,Qhov kawg yog lub sijhawm kho kom rov zoo, thaum lub sijhawm nws yuav tsum ua raws li tag nrho cov lus qhia ntawm tus kws kho mob thiab ua ib qho kev tawm dag zog tshwj xeeb. Taug kev thiab ua luam dej yog qhov zoo tshaj plaws rau lub sijhawm no.
Intra- thiab extramedullary osteosynthesis
Ib txoj hauv kev zoo ntawm kev kho mob phais yog intramedullary synthesis. Ua ntej nws yuav ua tiav, tus kws kho mob tshem tawm cov ntaub so ntswg puas lawm uas tsis muaj periosteum thiab ntshav txhaws. Tom qab ntawd, cov pob txha tawg yog fastened nrog ib tug tshwj xeeb tus pin. Lub qhov txhab tom qab kev ua haujlwm yog sutured hauv cov khaubncaws sab nraud povtseg, ib qho caws pliav me me yuav nyob hauv nws qhov chaw.
Lub sijhawm osteosynthesis extramedullary, cov pob txha tawg tau txuas nrog lub periosteal fixator. Nws yog nias tawm tsam cov pob txha puas, thiab tom qab cov khoom tawg tau tawg, lub phaj raug tshem tawm siv qhov kev txiav.
Yog li, hauv tsab xov xwm pseudarthrosis tau tham ntxaws ntxaws. Hauv kev xaus, nws yuav tsum tau muab sau tseg tias muaj feem cuam tshuam rau kev tsim ntawm kev sib koom ua ke tsis tseeb yog ntau yam kab mob endocrine, tus cwj pwm tsis zoo (kev haus luam yeeb, haus dej cawv), rog rog, tsis muaj zaub mov noj thiab tsis muaj zog ntawm lub cev. Yog li ntawd, kev tswj hwm txoj kev noj qab haus huv yuav txo qhov kev pheej hmoo ntawm tus kab mob no.
