Ezemfundo kanye nokwelashwa nonunion

ngokuhlanganyela Amanga - uhlobo kokunikezwa kwe-phambili ithambo, esibonakala by ukuhamba normal, okungavamile lokhu umnyango. Zokwelapha ngalesi simo usebenzise eside ekhethekile - "pseudarthrosis". Okwamanje, lesi sifo iphathwa ngempela ngempumelelo, futhi ukwelashwa kungase kube kokubili tekusebenta kanye olandelanayo. Ngaphezu kwalokho, ukuphathwa ezimweni eziningi kuba nomphumela omuhle futhi umuntu ubuyela evamile. Lesi sihloko sihlaziya ngokuningiliziwe izizathu ekwakhekeni ngokuhlanganyela zamanga. Futhi benaka ukuxilongwa kanye lokwelatshwa.

I-ICD: pseudoarthrosis, ezihlukahlukene

ngokuhlanganyela Amanga - kokunikezwa kwe-ubuqotho ithambo cortical, ephelezelwa ukuhamba ongaphilile. Ngokwe-International Ukwahlukanisa Diseases ikhodi ukuthi unesikhathi ngokuhlanganyela zamanga - ICD 10. Kuhlanganisa: ukwa-non-union, okusho psevdoartoroz futhi ngokuhlanganyela kwamanga Fusion isizinda noma arthrodesis.

On the ingxenye amaphethini sokugembula kanye nokwelashwa indlela amalunga zamanga zihlukaniswe fibrous futhi kuyiqiniso. Esokuqala isigaba esimaphakathi phakathi kancane futhi sokuhlanganiswa a pseudarthrosis kweqiniso. isithombe sabo sokucindezeleka igebe encane phakathi kwezingcezu egcwele izicubu lunemicu ithambo amapuleti ube semikhawulweni ezimboze umsele medullary.

Ezimweni ezingavamile lo kwakhiwa fibrous pseudarthrosis lwamalunga lapho amaphethelo ala mathambo imbozwe uqwanga futhi izinsalela basesimweni capsule yasekuqaleni zezinzwa. Phakathi kwabo buthelela uketshezi lwamalunga, ningakwazi nonke izingcezwana sclerosis.

Ukwahlukanisa nearthroses

Pseudoarthrosis kungenzeka azalwa naso noma bathenga. Azalwa naso ngokuhlanganyela zamanga kukalutshwana kakhulu futhi akuyona ezingaphezu kuka-0.5% zokugula. Ngesisekelo lasungulwa ukuhlukumeza ithambo intrauterine izicubu ekwakhekeni, okuholela oluphansi amathambo aqatha endaweni ethize. Futhi ngemva kokuzalwa, eneminyaka engu-2-3, ubuqotho ithambo eliphukile. Ngokuvamile azalwa naso ngokuhlanganyela samanga tibia, okungenani - we clavicle, ulna futhi kunawo wonke.

I pseudarthrosis atholwe imayelana 3% izifo imvelo wamathambo. Ezimweni eziningi kuba wobujamo ukwa, lapho kukhona Fusion elingalungile ongaphelele izingcezwana ithambo. pseudoarthrosis Kutholiwe ihlukaniswe atrophic, futhi normotroficheskie hypertrophic.

izimbangela endawo isifo

izimbangela endawo ekwakhekeni ngokuhlanganyela zamanga, esikhundleni salokho, zihlukaniswe amaqembu amathathu. iqembu Okokuqala - izizathu okuhlotshaniswa amaphutha kanye kwamaphutha ekwelapheni: juxtaposition ngokwengxenye imvuthuluka kwethambo, ukwehluleka ukuqeda interposition kwezicubu ezithambile, immobilization normal, ngenxa okuyinto ukuhamba egcinwe izingcezwana eziyizinsalela, ushintsho njalo noma ekuqaleni kuka ephonsa, ukusetshenziswa fastener okungafanele, ukunyakaza kakhulu asebenzayo futhi umsebenzi ngokomzimba , sklerotirovanie ebanzi.

Isigaba sesibili sihlanganisa izizathu ezihlobene degree of kobukhulu ukulimala, kanye nezinkinga ukucindezeleka kwangemva kwenhlekelele: waphuka, ukulahlekelwa ingxenye enkulu amathambo, imisipha wayichoboza ukulinyazwa amabanga amade uma liya, ukuchayeka we suppuration ithambo izicubu, osteomyelitis, ukulimala imizwa nemithambo yegazi, kanye ukuphazamiseka e zinamanzi.

Futhi ekugcineni, iqembu lesithathu izici ezithinta ekwakhekeni ngokuhlanganyela amanga, ehambisana ne-izici yokwakheka bokuphila kokuphakelwa kwegazi ithambo kusayithi ukwa futhi kwasendaweni.

izizathu trophic

Kusukela trophic isisindo kubangela ukwakheka pseudoarthrosis eziyinhloko: ukutheleleka, isib, ugcunsula, umalaleveva, isifo oyingozi; isifo umzimba kanye ikakhulukazi calcium-phosphorus umzimba ezicutshini; sikashukela; beriberi; esingamahlalakhona semithambo ngemva ukulimala innervation yegazi; abalulekile-X-ray ngemisebe, elikwaziyo zivimbela inqubo ithambo kumiswa; iziyaluyalu trophic kusayithi ukwa.

emitholampilo isithombe

Isithombe basemtholampilo ekwakhekeni ngokuhlanganyela zamanga has izici zayo siqu. Esikhundleni ukwa waphawula ukuhamba, imisipha yoma, ukuvuvukala, ekwandeni ezicutshini, isibanda kumiswa. Ku-X-ray ungakwazi ukuthola neligebe emkhatsini izingcezwana eziyizinsalela, ithambo sclerosis eziyimpumelelo, Fusion umsele medullary.

ukuxilongwa pseudarthrosis

Ngezinye uphethwe, ngaphezu idatha emitholampilo, ukunakwa ikhokhelwa umnqamulajuqu, okuyinto ebalulekile Fusion ephelele ukwa. Lapho le nkathi iphela, isimo ukwa uchazwa ngokuthi kancane accrete noma asymphytous, futhi ngemva esikhathini esingangezinyanga kabili kuyinsakavukela kumiswa esolwa ilunga zamanga.

Ukuqinisekisa umbono, ingabe-X ray ezenziwa ezimbili Okusizayo perpendicular, futhi kwezinye izimo - futhi projection etshekile. Izimpawu khona nonunion cabanga isithombe esilandelayo ku-X-ray: ukungabi khona callus, okuyinto ingxenye yokuxhuma ye izingcezwana bone; imikhawulo izingcezwana abe ukuma bushelelezi oyindilinga noma oyindilinga; Kumiswa ingaphakathi yene enisemikhawulweni izingcezwana nesitsha lokuvala. Lapho ilunga kwamanga esisodwa noma zombili izingcezwana ithambo ngizibulale has simise hemispherical futhi ukubukeka ungathi ikhanda ngokuhlanganyela. Enye isinqamu kungenzeka umgodi glenoid. Kulokhu, isikhala Ilunga kulapho kuyabonakala.

Ukuze kutholakale umsuka wendaba yesihluku isifundo radionuclide inqubo umfutho ebekiwe.

izimiso ukwelashwa kuhlinzwa

Nakuba i izindlela arsenal olandelanayo yokwelashwa (administration izidakamizwa, ugesi, kazibuthe, nokunye. D.), Indlela eyinhloko ekwelapheni pseudarthrosis sisebenza. Indawo ehamba phambili kuhlala kokucindezelwa osteosynthesis. Indlela aphathe pseudoarthrosis? Ukusebenza kumelwe kwenziwe izinyanga 8-12 emva ukuphulukiswa okuphelele ngesikhathi nilimaza waphuka eziyinkimbinkimbi. Uma kukhona izibazi ukuthi soldered ukuba ithambo, kumele excised futhi ube nokuhlinzwa plastic ukulungisa inkinga.

Iphuzu elibalulekile kule msebenzi ukuqhathanisa olunembile izinsalela, kanye aqabulayo izinjongo zabo, excision ka isibanda izicubu kanye nokubuyiselwa patency we-canal medullary.

ukwelashwa pvsedoartroza ngesikhathi Ilizarov apharathasi

Le ndlela yenza kube lula makuqoqwe izingcezwana futhi kusiza Fusion yabo okusheshayo ngaphandle ahlinzwe ngokushesha. Yingakho le ndlela ibizwa ngokuthi osteosynthesis extrafocal.

Ukuze uqale, isiguli wasisebenzisa spokes zedivayisi wamathambo ngawo izinsalela awashintsheki. Khona-ke, cishe ngemva kwesonto elilodwa ihlala inqubo emumva isicelo zedivayisi lapho indawo, lapho spokes, ukuphulukisa kanye iqala inqubo ithambo Fusion. Izinsalela kancane kancane asondele nomunye, abhubhise ukuxhumana engadingeki futhi ecindezela ngokuhlanganyela zamanga.

Ngaphezu kwalokho kukhona nenkanuko edlulele, okungukuthi, ukwakheka calluses futhi inqubo Ukuqina sekuyenzeka. Lesikhatsi lesi eside, kodwa kuphephile futhi akudingi izinyathelo ezikhethekile. Isiguli kufanele uthathe amavithamini, ukudla ngendlela efanele, bayeke imikhuba emibi.

Ekugcineni, kukhona enkathini yokugcina nokuvuselelwa, ngesikhathi lapho zonke iziqondiso ezidingekayo ukuze ihambisane udokotela bese wenza iqoqo izivivinyo ezikhethekile. Ideal ngaleso sikhathi babonwa ukuhamba, ebhukuda.

Intra- futhi osteosynthesis extramedullary

Indlela ephumelelayo kwelashwa kuhlinzwa intramedullary zamagama. Ngaphambi enifeza udokotela wakhe kususa ezilimele izicubu ezithambile, okuyinto awunawo periosteum kanye amahlule. Ngemva kwalokho izingcezwana le yasibamba bone pin ekhethekile. Isilonda emva kokuhlinzwa sutured ngongqimba, endaweni yayo angahlala isibazi encane.

Phakathi osteosynthesis extramedullary of izinsalela abethela Ilokhi Supraspinous. It is yayicindezele ithambo ezilimele, futhi ngemva Splice ipuleti izingcezwana ziyasuswa ngokusika.

Ngakho, waxoxa sihloko ngokuningiliziwe pseudarthrosis. Ekuphetheni, kufanele kuphawulwe ukuthi engcupheni ekwakhekeni ngokuhlanganyela zamanga ukukhonza ezihlukahlukene nezifo endocrine, imikhuba emibi (ukubhema, ukusebenzisa kabi utshwala), ukukhuluphala, ukudla okungenamsoco futhi zingenzi lutho olunyakazisa umzimba. Ngakho-ke, ukugcina indlela yokuphila enempilo kuyonciphisa ingozi yalesi sifo.