Ib qho comminuted lossis fragmental fracture yog kev ua txhaum ntawm kev ncaj ncees ntawm cov pob txha nrog kev tsim ntawm peb lossis ntau qhov tawg. Qhov no yog qhov nyuaj tshaj plaws ntawm kev puas tsuaj thiab feem ntau yog nrog los ntawm kev hloov chaw. Qhov ua rau nws tshwm sim feem ntau yog qhov kev txiav txim ntawm cov pob txha axis. Kev raug mob kuj tuaj yeem ua tau nrog daim ntawv thov quab yuam.
Diagnosis
Kev kuaj mob ntawm pob txha comminuted yog tsim los ntawm cov yam ntxwv ntawm cov tsos mob (qhov chaw tsis zoo ntawm lub limb, crepitus, tsis muaj zog, thiab lwm yam). Tsis tas li ntawd, cov ntaub ntawv xoo hluav taws xob yuav tsum raug coj mus rau hauv tus account.
Kev kho mob
Txawm li cas los xij ntawm qhov kev puas tsuaj, kev saib xyuas lossis kev phais yog ua tau. Tom ntej no, peb yuav nyob ntawm ntau yam ntawm cov pob txha zoo li no thiab nrhiav seb txoj kev kho mob li cas hauv txhua kis.
tawg ntawm clavicle nrog kev hloov pauv - piav qhia ntawm kab mob
Comminuted (comminuted) fractures hauv cheeb tsam no feem ntau pom hauv cov neeg laus. ATFeem ntau cov xwm txheej, kev ncaj ncees ntawm cov pob txha yog tawg nyob rau hauv nruab nrab thib peb, tiv thaiv cov tawg tawg vim yog cov leeg rub. Cov neeg mob yws yws ntawm qhov mob, kev txav chaw yog txwv, deformity thiab o yog txiav txim siab nyob rau hauv qhov chaw ntawm kev puas tsuaj. Tawm tsam keeb kwm yav dhau ntawm kev hloov pauv ntawm cov khoom tawg, shortening ntawm lub xub pwg girdle yog qhov ua tau. Nyob rau hauv cov ntaub ntawv ntawm cov hlab ntsha puas, kev puas siab puas ntsws cuam tshuam tau raug kuaj pom. Thaum cov hlab ntsha loj raug mob, los ntshav loj yuav tshwm sim. Palpation nyob rau hauv xws li kev raug mob yuav tsum tau maj mam thiab ceev faj, vim hais tias lub siab ntawm cov pob txha yuav ua rau lub zog ntawm me me fragments thiab ruptures los yog compression ntawm cov hlab ntsha thiab cov hlab ntsha.
Raws li ib feem ntawm kev lees paub qhov kev kuaj mob ntawm qhov tawg comminuted tawg, ib qho x-ray ntawm lub clavicle raug sau tseg. Kev kho mob tactics ncaj qha nyob ntawm qhov chaw ntawm cov pob txha tawg. Thaum tsis muaj teeb meem, kaw qhov rov ua haujlwm nrog rau qhov kev txiav txim ntawm Delbe rings (nyob rau hauv rooj plaub ntawm kev hloov pauv me ntsis), Weinstein lossis Sayre bandages. Nyob rau hauv lub xub ntiag ntawm kev puas tsuaj rau lub brachial plexus, raws li zoo raws li ib feem uas yog qhia nrog ib tug ntse kawg ntawm cov hlab ntsha thiab cov hlab ntsha, kev kho mob phais yog qhia nyob rau hauv daim ntawv ntawm osteosynthesis ntawm lub clavicle nrog ib tug phaj, tus pin los yog tus pin.
Fractured humerus
Dab tsi ntxiv yuav yog pob txha tawg ntawm caj npab?
Kev raug mob tuaj yeem tshwm sim nyob qhov twg hauv lub cev. Qhov ua rau feem ntau yog lub caij nplooj zeeg ntawm caj npab, tsawg zaus nws yog ib lub tshuab los yog eversion ntawm sab sauv ceg. Nyob rau hauv cov ntaub ntawv ntawm kev puas tsuaj rau lub sab sauv peb (pob txha ntawm lub taub hau los yog caj dab ntawm lub xub pwg nyom), edema nrog sib koom deformity yog pom. Movements thaumnruj txwv. Kev tawg ntawm cov ntu sib thooj, raws li txoj cai, ua tau zoo dua. Raws li txoj cai, qhov txiaj ntsig zoo tuaj yeem ua tiav siv cov txheej txheem kev saib xyuas (rov ua dua thiab kho tom qab). Yog tias nws tsis tuaj yeem sib piv cov khoom tawg, osteosynthesis ntawm lub taub hau ntawm lub xub pwg nyom yog ua los ntawm kev siv cov ntsia hlau lossis osteosynthesis nrog lub phaj lossis rab koob knitting.
Thaum lub diaphysis ntawm lub xub pwg qhia deformity, o, crepitus thiab pathological mobility. Muaj peev xwm compression lossis ua txhaum ntawm cov hlab ntsha radial lossis hlab ntsha. Nyob rau hauv cov ntaub ntawv ntawm kev puas tsuaj rau sab qis (pob txha ntawm intercondylar eminence), lub luj tshib pob qij txha yog deformed, o, thiab txav yog tsis yooj yim sua. Nyob rau hauv cov ntaub ntawv ntawm ib tug tawg ntawm lub diaphysis thiab lub hauv qab ntawm lub xub pwg nyom, muaj teeb meem feem ntau tshwm sim thaum lub sij hawm sib piv ntawm fragments.
Kev kho mob yog xaiv los ntawm cov teeb meem thiab cov ntaub ntawv X-ray. Yog tias cov hlab ntsha puas lawm, kev phais xwm txheej ceev tau raug sau tseg. Hauv lwm qhov xwm txheej, raws li txoj cai, kev rov ua haujlwm yog ua los yog siv lub pob txha traction. Thaum tsis tuaj yeem sib piv tsis tau, osteosynthesis ntawm cov pob txha diaphysis yog nqa tawm nrog lub phaj lossis rab koob knitting. Kev phais mob los kho cov hlab ntsha feem ntau ua rau lub sijhawm ntev. Thaum tsis muaj qhov nro, cov hlab ntsha tau tshwm sim; txwv tsis pub, kev phais yas ntawm lub cev puas tsuaj yog siv.
pob txha pob txha fractures
Cov kev raug mob zoo li no tuaj yeem yog qhov tshwj xeeb thiab nyob hauv nruab nrab, qis lossis sab sauv thib peb ntawm ntu. Ntawm cov intra-articular muaj xws li ib tug fragmental puas ntawm lub olecranon thiab lub taub hau ntawm lub beam nyob rau hauv ua ke nrog ib tug dislocation ntawm cov pob txha ntawm forearm. Rau tag nrho cov saum toj no hom kev puas tsuajedema thiab deformity ntawm cov pob qij txha tau pom. Nyob rau tib lub sijhawm, kev txav mus los yog qhov txwv nruj lossis ua tsis tau txhua. Cov tactics ntawm kev kho yog txiav txim siab mus rau hauv tus account lub radiography ntawm lub ulnar keeb. Kev phais feem ntau yuav tsum tau ua nyob rau hauv daim ntawv ntawm osteosynthesis ntawm lub olecranon nrog nyob ntawm tej los yog screws, thiab, ntxiv rau, resection ntawm radial taub hau.
Ntxig pob txha ntawm caj npab yog ib qho kev raug mob zoo heev. Nws yog nrog los ntawm pom deformity, mobility, edema, pathology ntawm lub axis ntawm lub limb. Tuav qhov tawg tom qab rov ua haujlwm nrog qhov kev raug mob no feem ntau dhau los ua ib txoj haujlwm nyuaj heev txawm tias qhov yooj yim transverse lossis oblique puas, txij li cov fragments tau rov hloov dua tshiab vim cov leeg traction. Nyob rau hauv cov ntaub ntawv ntawm fragments, txoj hauj lwm yuav nyuaj, yog li ntawd, nws yog feem ntau yuav tsum tau tig mus rau kev kho mob phais. Cov tactics ntawm kev phais kev cuam tshuam yog txiav txim siab mus rau hauv tus account lub radiography ntawm forearm. Osteosynthesis yog ua tau.
Kev sib tsoo ntawm cov nqaj hauv thaj chaw raug kuj tsis tshua muaj. Feem ntau pom kev xaav ntawm cov khoom tawg. Lub dab teg pob qij txha yog deformed, edematous, thiab txav tau sharply hampered. Crepitus yog uncharacteristic. X-ray qhia qhov tawg nrog ntau qhov sib txawv ntawm cov tawg. Feem ntau, qhov kev hloov pauv tau raug tshem tawm thaum lub sijhawm kaw rov qab; hauv qee qhov xwm txheej, osteosynthesis ntawm txoj kab hluav taws xob metaepiphysis nrog pins lossis phaj yog tsim nyog.
Pelvic Fracture
Comminuted fractures ntawm lub plab mog yog tsim thaum lub sij hawm mob hnyav (kev raug mob, ntoglos ntawm qhov siab loj), feem ntau mus ua ke nrog kev tsis sib haum ntawm lub nplhaib thiab ua raws li kev puas tsuaj loj, uas yog nrog los ntawm kev txhim kho ntawm kev puas tsuaj. Kev puas tsuaj rau lub ntsej muag thiab tom qab ib nrab-ntiv nplhaib, qhov loj ntawm lub sacrum thiab acetabulum tsis suav nrog. Cov kws kho mob qhia tib lub sij hawm ib tug pronounced mob syndrome. Cov kev txav yog txwv tsis pub, ntawm lwm yam, kev cia siab ntawm ob txhais ceg yog tsis yooj yim sua, ib txoj hauj lwm quab yuam ntawm cov ceg ceg raug pom, uas nyob ntawm hom pob txha. Kev kuaj mob yog tsim los ntawm lub hauv paus ntawm pelvic radiograph. Thaum hloov chaw, skeletal traction yog ua.
Comminuted hip fracture
Qhov kev raug mob no tshwm sim nyob rau hauv qis thib peb, tsawg zaus hauv thaj tsam ntawm trochanter. Ib qho comminuted cervical fracture yog tsawg heev. Kev puas tsuaj feem ntau yog nrog rau qhov mob, o, deformity, thiab mob txav mus los. Kev them nyiaj yug tsis tau. Nrog kev puas tsuaj rau hauv cov hlab ntsha, hemarthrosis tau txiav txim siab. Kev kuaj mob tau lees paub los ntawm X-ray ntawm tus ncej puab.
Kev kho mob
Kev kho mob pob txha hauv qhov no feem ntau yog kev saib xyuas, siv cov pob txha traction. Nyob rau hauv cov ntaub ntawv ntawm kev puas tsuaj tsis ruaj tsis khov, osteosynthesis yog ua nrog daim hlau nkhaus los yog spongy screws. Kev kho cov pob txha diaphyseal tuaj yeem yog kev saib xyuas (skeletal traction) lossis phais. Kev cuam tshuam kev phais yog muab rau cov neeg mob thaum nws tsis tuaj yeem ua kom zoo sib xws ntawm cov khoom tawg vim cov ntaub so ntswg cuam tshuam.
Kev mob pob txha ntawm sab ceg
Shrapnel fracture of the leg in the shin area is a common raug mob,uas yog tsim raws li ib tug tshwm sim ntawm ib tug dhia los ntawm ib tug tej yam qhov siab los yog ib tug tshuab mus rau lub shin. Nws feem ntau yog tshwm sim los ntawm kev sib tsoo ntawm txoj kev (bumper fractures). Kev raug mob nyob rau hauv qis qis feem ntau tshwm sim thaum tus ceg ceg twisted. Tawm tsam keeb kwm ntawm intra-articular fractures ntawm sab sauv thib peb, qhov mob tau sau tseg nrog rau hemarthrosis, qhov o loj thiab deformity ntawm lub hauv caug pob qij txha. Crepitus tej zaum yuav tsis tag. Cov pob txha zoo li no nrog rau qhov mob hnyav, deformity, tsis ua haujlwm ntawm axis ntawm ceg, thiab pathological mobility. Kev deformity tuaj yeem tshwm sim ua ke nrog qhov mob hnyav ntawm pob taws pob taws.
Kev kho cov pob txha pob txha ntawm sab ceg yog feem ntau ua phais. Cov kws kho mob ua osteosynthesis ntawm tibia nrog screws. Nrog rau pob txha diaphyseal, nws muaj peev xwm siv cov pob txha traction rau plaub lub lis piam, nyob rau hauv cov txheej txheem tom qab kev kho mob tshwm sim nyob rau hauv ib tug plaster cam khwb cia. Txawm li cas los xij, vim qhov nyuaj ntawm kev sib piv cov khoom tawg thiab qhov xav tau los tiv thaiv kev cog lus niaj hnub no, nrog rau cov kev raug mob zoo li no, cov txheej txheem phais tau siv ntau ntxiv hauv daim ntawv osteosynthesis ntawm tibia cov pob txha nrog screws lossis pins.
pob txha pob txha
Thaum pob qij txha tawg, cov kws kho mob nyiam ua raws li kev coj noj coj ua. Nyob rau hauv cov ntaub ntawv uas cov fragments tsis tau muab piv thaum kaw reposition, osteosynthesis nrog ib tug phaj los yog nro voj yog resorted rau. Qee zaum transarticular fixation nrog cov xov hlau yog ua.
pob txha nraub qaum
Puas muaj qhov tawg ntawm tus txha nraub qaum?Cia peb kawm saib.
Qhov kev raug mob no tsawg heev (tsuas yog kaum ob feem pua ntawm cov neeg mob) thiab yog ib qho ntawm cov pob txha loj tshaj plaws. Lub pathology tau txais nws lub npe vim qhov tseeb tias cov pob txha tawg tawm ntawm lub vertebrae, uas tuaj yeem ua rau tus txha caj qaum, paj hlwb lossis cov hlab ntsha. Ib qho kev hloov ntawm qhov tawg no yog hom tawg. Nws yog tus cwj pwm los ntawm qhov muaj ob lossis ntau qhov tawg (feem ntau nws yog tsib lossis ntau dua).
Raws li ib feem ntawm kev kho mob, kev kho kom zoo yog ua tiav. Tus neeg mob tau muab tshuaj tua kab mob hauv daim ntawv ntawm "Ketanov" lossis "Ketalong". Ib qho tshwj xeeb corset los yog ntaub qhwv ntaub yog muab tso rau ntawm qhov chaw puas ntawm tus txha nraub qaum mus txog rau lub hlis.
Ntoe thiab pob taws tawg - piav qhia ntxaws
Nrog rau qhov tawg ntawm pob taws, ib yam li yav dhau los, cov khoom tawg tau tsim. Kev kho mob yuav tsum tau conservative. Tab sis nyob rau hauv tas li ntawd, nrog xws li raug mob, raws li txoj cai, skeletal traction yog thov rau cov raug mob ntiv tes. Txhawm rau tshem tawm pob taws raug mob, kev phais kev phais yog ua nyob rau hauv daim ntawv ntawm qhib reposition thiab osteosynthesis nrog tus pin. Comminuted ntiv tes pob txha kho sai dua.
Kev nyuaj siab
Hauv cov neeg mob uas muaj cov pob txha zoo li no, tshwj xeeb tshaj yog muaj ntau yam thiab sib xyaw ua ke, nrog kev raug mob ntawm cov pob txha hauv plab lossis ncej puab, rog embolism tuaj yeem tshwm sim nrog rau kev mob toxicosis, anemia. Cov pob txha hauv cov neeg laus feem ntau nyuaj los ntawm kev mob ntsws, thiab hauv cov neeg uas raug kev quav dej quav cawv, mob hnyavpsychosis.
Nrog qhib pob txha (tshwj xeeb tshaj yog nrog kev puas tsuaj ntawm cov ntaub so ntswg), suppuration ntawm qhov txhab tuaj yeem ua ke nrog osteomyelitis. Cov teeb meem lig muaj xws li ncua pob txha fusion thiab tsim kom muaj kev sib koom ua ke tsis tseeb. Tsis tas li ntawd, kev sib xyaw ua ke tsis tsim nyog tuaj yeem ua tau nrog kev cog lus, kev mob caj dab tom qab, edema, thiab ntau dua.
Yog li, thaum tau txais kev raug mob zoo li no, tsis hais thaj chaw ntawm nws qhov chaw, nws yuav tsum tau kho kom raug thiab ua raws li tag nrho cov kws kho mob cov lus pom zoo, vim tias lwm yam kev mob tshwm sim tuaj yeem tshwm sim.
