Sab nraud Txhab

1.InRoduction

Kev txhim kho sab nraud tuaj yeem siv los ua tiav 'cov kev puas tsuaj hauv zos ' rau kev ua phem nrog kev puas tsuaj nyuaj thiab ua kev kho mob kom muaj ntau yam pob txha lov. Mob pob txha yog qhov qhia tseem ceeb rau kev siv kho sab nraud. Kev kho sab nraud kuj tseem siv tau rau kev kho kom zoo nkauj thiab pob txha tuav.

2 .Yog li cas siv ib Sab nraud Txhab 

2.1 qhov zoo ntawm kev kho sab nraud

- me me cuam tshuam ntawm cov ntshav ntws mus rau pob txha.

- Kev cuam tshuam qis rau ntawm cov nqaij mos ntawm cov nqaij mos.

- tuaj yeem siv tau sai sai hauv xwm txheej kub ntxhov.

- Txhim kho ntawm qhib thiab paug tsis yooj yim.

- Tso cai rau kev faib tawm thiab kho ruaj khov ntawm pob txha tsis muaj kev phais mob.

- Muaj tsawg dua lub cev tsis muaj mob thaum muaj mob.

- Yuav tsum muaj cov kev paub tsawg dua thiab kev phais mob tshaj qhov ntsuas hluav taws xob ntsuas thiab txhim kho sab hauv (Orif).

- Cov pob txha tuav thiab kev kho kom zoo kho tau tuaj yeem ua tau.

2.2 Qhia rau Kev Txhim Kho Sab Nraud

2.2.1 Qhib pob txha lov

Sab nraud txhim kho bracing yog ib qho ntawm cov hau kev immobility ntawm kev qhib pob txha lov thiab yog tshwj xeeb tshaj yog qhia nyob rau hauv lub xub ntiag ntawm kev raug mob muag nqaij tawv. Sab nraud Txhim Kho Kev Txhim Kho Muaj txiaj ntsig zoo rau cov kab mob sib kis nrog txoj kev pheej hmoo kis mob, xws li ncua sijhawm tuaj kawm ntawv thiab / lossis lub qhov txhab tsis huv. Sab nraud txhim kho tau ntev tau muaj txiaj ntsig zoo rau cov kev raug mob thiab tseem suav nrog cov qauv kub.

2.2.2 Kaw pob txi

Qhov ntsuas pom rau daim ntawv thov ntawm kev txhim kho sab nraud kom kaw cov pob txha uas tsis zoo ib ntus, thiab kev raug raug kaw mos mos mos lossis tsis raug raug mob. Nyob rau hauv cov rooj plaub no, ib ntus immobilization siv ib qho kev phais mob sab nraud tuaj yeem ua kom deb ntawm thaj chaw ntawm kev raug mob, kom kho cov nqaij mos muag thaum tswj cov ceg tawv.

2.2.3 Ntau qhov kev raug mob ntau

Cov txheej txheem txhim kho sab nraud yuav tsum raug txiav txim siab thaum ua cov kev tswj kev puas tsuaj rau cov neeg mob ntau yam kev raug mob. Lub ntsiab zoo ntawm kev kho sab nraud yog cov kev sib zog txheeb ze ntawm kev ua kom ntshav, pab txo qhov mob los ntshav, thiab txo cov kab mob ntshav tawm rau kev saib xyuas kom yooj yim.

2.2.4 Kev Txhim Kho Kev Nyab Xeeb

Sab nraud txhim kho bracing feem ntau yog kev ntsuas ib ntus uas tiv thaiv cov nqaij mos uas tsis yooj yim los yog cov pob txha tsis ruaj khov; Nws tseem yog ib qho kev xaiv rau kev sib koom tes lossis txoj kev hloov kho txoj kev ua haujlwm nyob rau qhov twg ib-theem kev hloov kho sab hauv yog qhov ua tau. Txhua lub tsev sib koom ua ke loj tuaj yeem sib koom ua ke hauv txoj kev no, tab sis feem ntau ntawm lub dab teg, lub hauv caug, thiab pob taws.

2.2.5 Pob Txha lossis Cov Ntaub Ntawv Muag Ntaub Ntawv Tsis Txaus

Hauv cov neeg mob uas muaj cov ntaub so ntswg loj thiab pob txha tsis xws luag, sab nraud kho kom luv rau hauv ib theem thiab tom qab ntawd rov qab txia ntev los ntawm kev cuam tshuam epeogenesis nyob rau theem ob.

2.2.6 Kev Txhim Kho Txhab Sab nraud siv los ua cov cuab yeej siv rau kev pib dua tshiab

Tom qab txo qis, thaum cov ntsia sab hauv lossis cov ntsia hlau sab hauv yog tso, txoj hauj lwm ntawm qhov pob txha lov tuaj yeem tiv thaiv kev kho sab nraud. Qee lub sij hawm ib qho kho sab nraud tuaj yeem khaws cia rau ib lub sijhawm los muab kev txhim kho ntxiv thaum txhim kho kev txhim kho sab hauv tsis muaj zog txaus. Sab nraud pab nyiaj lossis cov femoral discorors tau pom tias muaj lub luag haujlwm tseem ceeb thaum them cov ntsia thawv ntsia. Tus lej schnee yog ntsia hlau rau hauv lub dorsal sab ntawm qhov sib cuam tshuam tib lub pob ntseg nkag mus thiab mus rau hauv pob txha pob txha pob txha, txuas nrog tus pas nrig ntev. Qhov no muab cov kev sib tw hauv zos thiab kuj hloov kho qhov ntev, thiab axis ntawm cov pob txha ua ntej nkag mus rau hauv lub hauv caug siab lossis txuas ntxiv.

PUASIAN SCAMTLARDLE NCO THEMASATION NROG Sab Nraud Ruaj Ruaj

3.Qhov kev txhim kho sab nraud txhim kho daim ntawv thov

3.1 Biomeanicals

Qhov chaw tsawg kawg 2 pins ib qho loj blockure thaiv los ntawm anatomic kev nyab xeeb cheeb tsam, nrog pins nthuav dav raws li tau dav. If soft tissue conditions permit, the fixation pins should be placed as close to the fracture end as possible, but should not penetrate into the fracture end hematoma or into the area of ​​skin denudation. Yog tias kev txhim kho sab hauv yog npaj tau, kev txhim kho cov pins yuav tsum zam kev phais mob thiab phais (cheeb tsam phais). Cov pas nrig sib txuas yuav tsum muab tso rau kom ze rau cov pob txha ua tau kom nce ruaj khov. Qhov ruaj khov ntawm sab nraud txhim kho nyob ntawm cov hauv qab no.

- Deb nyob deb ntawm kev txhim kho pins los ntawm pob txha lov: qhov kom ze dua.

- Qhov kev sib tw ntawm kev txhim kho pins rau hauv txhua pob txha lov: qhov loj dua lub zog.

- Deb nyob deb ntawm cov routudinal txuas cov pas nrig los ntawm cov pob txha: qhov kom ze zog.

- Tus naj npawb ntawm kev sib txuas cov pas nrig: ob qho muaj zog dua ib qho.

- Kev teeb tsa ntawm cov txheej txheem txhim kho sab nraud (los ntawm qis tshaj plaws kom muaj zog tshaj plaws): ib leeg dav hlau / a-duab / biplane.

- Sab nraud kho cov ncej sib xyaw ua ke nrog kev txhim kho sab hauv (nro hluav taws xob): Tsis tshua muaj siv vim tias kev sib xyaw ntawm kev txhim kho elastic thiab muaj zog yog ib ntus xwb.

- Txoj kab uas hla ntawm screws lossis schnee pins: 6mm muaj ob zaug flexural zog ntawm 5 hli.

a. Unilateral ib leeg-dav hlau ib-txuas sab nraud txhim kho thav duab. Deb ntawm tus pin los ntawm pob txha lov (x).

Qhov ze dua, ruaj khov. Qhov deb ntawm pins sib txawv ntawm lub ntsiab pob txha pob (Y): qhov txuas ntxiv mus deb dua.

Qhov deb deb, qhov ruaj khov dua. Qhov deb ntawm qhov ntev txuas cov pas nrig ntawm cov pob txha (Z): qhov ze dua qhov ruaj khov dua.

b. Lub unilateral, unclateran, 3-pas nrig ua ke kho txhim kho muaj kev tsim kho rau ntau cov ntawv thov, suav nrog kev rov ua haujlwm ntau yam, suav nrog kev rov ua dua tshiab.

Qauv rau ntau cov kev siv, suav nrog cov txheej txheem reset.

c. Unilateral unclilanar ob-txuas sab nraud txhim kho thav duab.

d. Unilateral phgerli teeb (▲ kev teeb tsa).

e. Ob tog teeb tsa nrog rau kev kho siab psacation pins. Tam sim no tsis tshua siv siv.

Tsis ruaj khov kho cov khoom nruab sab nraud qeeb qeeb qeeb hauv cov pob txha ua kom zoo kho, tab sis yog li ib qho dhau ntawm cov ncej txhim kho sab nraud.

Nws qee zaum yuav tsum muaj qhov tsim nyog rau kev hloov kho ruaj khov thiab nce cov thauj khoom los ntawm ib nrab lossis ua tiav cov kabmob thiab ua tiav cov kev teeb tsa ntawm kev txhim kho sab nraud.

3.2 cov hau kev sib tw sib xyaw

- Ua kom koj paub txog koj tus kheej nrog lub cev kom tsis txhob raug mob rau cov leeg ua rau mob ntshav, cov hlab ntsha thiab tendons.

- Tsis txhob cia Fixation Pins los yog screws kom nkag mus sib koom ua ke.

- Zam kev txhaws ntswg xaus thiab hematomas.

- Zam thaj tsam ntawm daim tawv nqaij dehiscence lossis kev sib cav.

- Ua ntej-tho cov pob txha cortex kom tsis txhob thermal kev puas tsuaj (ua kom pom kev lom zem necrosis).

- Txhim kho pins yuav tsum yog qhov ntev ntev los tsim cov ncej haum.

3.2.1 nraub qaum

Lub Sharper lub laum lossis kho tus pin, qhov kub tsawg dua yuav tsim tawm. Qhov nrawm dua ntawm cov ntsia hlau, qhov ntsuas kub siab dua yuav nce. Thermal kev puas tsuaj rau cov pob txha yog kev txhawj xeeb loj heev vim qhov no tuaj yeem ua rau muaj kev tsim cov pob txha uas muaj sia muaj peev xwm ua rau cov xoob xoob thiab / lossis mob. Kev muab cov pins kom raug Pins yuav tsum muaj qhov zoo tuav ntawm ob lub tawb, thaum lub taub yuav tsum tsis txhob nkag mus deb.

3.2.2 diaphysis

Nyob rau hauv epiphysis, ntau lawm yog tsis muaj teeb meem. Tej zaum nws yuav muaj kev nyab xeeb dua los siv cov screading tus kheej thaum lub sijhawm no, vim tias nws yooj yim kom nco lub qhov ua ntej tho kev thaum ntsia hlau. Fixation tus pen nkag mus rau hauv kev sib koom ua ke yuav tsum tau zam raws li muaj kev pheej hmoo ntawm rab koob kab mob rab koob tiv thaiv kev sib koom ua ke.

3.2.3 aav) Kev Nyab Xeeb

Txhawm rau kom tsis txhob raug mob rau cov leeg, cov hlab ntsha, cov leeg, tus kws phais neeg yuav tsum paub txog qhov kev nyab xeeb rau kev tso ua koob yees duab.

Daim duab 3.3.3-2 Kev nyab xeeb rau sab nraud Kho Vaj Huam Sib Fog.

ib tug femur.

Daim duab 3.3.3-2 (txuas ntxiv)

b tibia.

Daim duab 3.3.3-2 (txuas ntxiv)

C Humerus, posterior pom.

Thaum siv nyob rau hauv ib lub dav hlau, nws tsis tsim nyog los tsav lub scanz ntsia hlau mus rau hauv lub anterior test. Lub anterior tib lub pob txha tuab muaj cov pob txha tuab cortical thiab drilling yuav tsim kom muaj cua sov ntau dua, uas yuav ua rau theem nrab. Nyob rau hauv distal Tibia, muaj kev pheej hmoo ntawm kev raug mob rau anterior tibialis thiab extensor digitorum cov leeg.

4. Cheebtsam

4.1 Raj-Rod System

4.1.1 Scanz Screws 

Scanz Screws yog ib nrab threaded fixation pins. Lawv muaj nyob rau hauv cov kab sib txawv, ntev (pas nrig ntev, xov ntev) thiab cov lus qhia txawv. Qhov ntxeev ntawm tus qauv scharanz ntsia hlau yog lub trocar-puab taub (Daim duab 3.3.3-33-3 ntev) thiab feem ntau yuav tsum tau ua ntej drilling.

Daim duab 3.3.3-3 schanz screws.

tus qauv txheem ntswj pin-puab cov lus qhia.

B tus kheej drilling taub.

Kev txiav txim siab rau tus kheej thiab tus kheej-tapping pins muaj qhov tshwj xeeb cov lus qhia ntse tshwj xeeb uas tuaj yeem txiav thiab txiav xov rau hauv.

Scanz Screws muaj nyob rau hauv cov hlau, titanium lossis hydroxyapatite coated. Hydroxyapatite coated pins tuaj yeem ua tiav zoo tuav hauv cov pob txha, tso cai rau cov kabmob ingrowth thaum ntxov thiab zam kev loosening. Hom PIN no yog haum rau cov neeg mob uas muaj cov pab txhim kho sab nraud hauv qhov chaw ntev.

4.1.2 STEEINER PINS

Steiner pins feem ntau yog siv los ua kev txhim kho pins uas nkag mus rau pob txha. Lawv cov lus qhia yog nyob rau hauv cov duab ntawm tho lub tes thiab yuav tsum tau ua ntej drilled nyob rau hauv lub cortical pob txha ua ntej nkag.

4.1.3 hlab / rods

Nyob ntawm cov kev qhia tshwj xeeb ntawm cov hlab / pas nrig, muaj 4 hom qauv sib txawv:

• Loj: 11 hli Tube / Qws, Scanz Screws yog 4 ~ 6 hli.

• Nruab nrab: 8 hli Tube / Qws, Scanz Screws yog 3 ~ 6 hli.

• Me: 4 hli Tube / Qws, Scanz Screws 1.8 rau 4 hli.

• Mini: 2 hli system rau cov ntiv tes, tsim cov khoom siv, nrog ntau tus lej clamp rau kev kho cov pas dej khov kho thiab 2 hli.

Cov qauv ntawm cov kab ke no tau ntxiv nrog cov duab ua ntej, nkhaus carbon fiber ntau. Rau cov chaw daws teeb meem nyuaj xws li lub dab teg, t-sib koom tes modules kuj tseem muaj.

4.1.4 Clamps

Cov clamps yog siv los txuas lub raj / pas nrig thiab cov pins kho kom yooj yim. Lub raj / cov pas nrig kuj tseem tuaj yeem txuas nrog txhua tus nrog qhov haum clamp (raj-raj).

Daim duab 3.3.3-5 Clamps

Ib tus kheej xauv clamp rau kev sib txuas schanz screws thiab cov yas / pas nrig.

b b key ua ke voomreg rau txuas ob lub pas nrig lossis hlab.

c ntiaj teb ntau clamp.

Daj-raj clamp rau txuas ob leeg.

4.2 Nqa Unilateral Sab Nraud Nruab Nrab Ncej Tshuab

Lub pob txha pob uas tuaj yeem tswj nrog ob-pined clamps lossis customized clamps. Ib qho kev ntsuas nruab nrab ntawm kev tuaj yeem txuas nrog rau kev cuam tshuam lossis kev zaws ua kom ntev thiab / lossis pob txha.

Unilateral Sab Nraud System Rau Cov Pob Txha

4.3 sib xyaw ua ke sab nraud

Sib tov ua ke sab nraud yog siv rau cov pob txha lov rau kev sib koom ua ke thiab yuav tsum tau muaj cov ntsia hlau zoo nkauj Kirschner pin rau lub nplhaib txhim kho thiab cov ntsia hlau schologz rau. Ib lub nplhaib 3/4 ragrferorial yog feem ntau siv. Kev sib xyaw ua ke cov fixators yog siv feem ntau rau cov neeg ua txhaum thiab Distal Tibia.

Ua ke sab nraud txhim kho brace rau ciavlaiv pob txha lov. Nws kuj tseem siv tau rau periarticular pob txha lov ntawm distal Tibia. Tus qauv V-puab muab cov Edics Zoo

4.4 Kev sib haum sab nraud txhim kho brair

Qhov kom zoo dua ntawm ib tag nrho lub cev sib dhos sab nraud txhim kho lub kaw lus yog tias axis ntawm cov kab mob sab nraud ntawm lub plawv ntawm cov kab mob sab nraud ntxiv nrog cov kab mob sib txawv ntawm cov pob txha. Lub puab tsaig sab nraud txhim kho sab nraud tuaj yeem siv rau cov pob txha ua kom ntev, pob txha tuav, thiab kev kho mob yooj yim thiab cov pob txha yooj yim.

Tib lub nplhaib sib txawv sab nraud txhim kho

Cov duab kuaj xyuas ntawm cov ntiv nplhaib tib lub nplhaib sab nraud txhim kho system

Daim ntawv thov ntawm cov txheej txheem no tso cai thaum cov kabmob hnyav thaum ntxov. Rau cov pob txha tshiab, peb nyiam ib qho yooj yim unilateral sab nraud txhim kho lub thav tsev rau kev kho. Cov pob txha tuav thiab ntev yuav kho nrog ib qho kev ua haujlwm sab nraud, tab sis nws yuav tsis yooj yim sua kev kho sab nraud, uas muaj kev sib dhos sab nraud txhim kho sab nraud. Thaum siv raws li kev kho sab nraud sab nraud, lub tshuaj sib tshuam sab nraud txhim kho muab cov kev sib txheeb ruaj khov. Thaum lub koob tau dhau los ntawm cov dav hlau sib txawv rau kev txhim kho ntau, cov qauv no muab qib siab ntawm kev ruaj khov. Lub zog ntawm cov qauv sib txawv nyob ntawm kev teeb tsa ntawm kev kho vaj, tus naj npawb ntawm cov siv siv, xws li Kirschner Pins lossis Scanz Screws. Ua raws li cov kev sib dhos, qhov kev sib tw ua tau rov qab los yog nias, thiab qhov tsis txaus ntshai kuj tseem tuaj yeem kho. Ntiv nplhaib sab nraud yog feem ntau yog siv rau kev cuam tshuam ntawm osteeogenesis kom kho pob txha pob txha, ua kom luv thiab ua tswv teb.

4.5 Hinged Sab Nraud Txhim Kho

Siv los tswj cov pob qij txha tsis sib xws los yog pob txha lov thiab tso cai rau qee tus (tswj) cov lus tsa suab sib zog los tiv thaiv kev sib koom ua ke txhav txhav. Nws yog feem ntau siv rau lub luj tshib sib koom ua ke.

5 Ncej Kev tsim ntawm Kev Txhim Kho Sab Nraum

5.1 nomenclature ntawm cov qauv qauv

Muaj ntau txoj kev ntawm kev faib cov qauv qauv, feem ntau yog raws li:

- Muaj nuj nqi.

- Tsim qauv.

- Plane ntawm daim ntawv thov.

- Cov cim.

5.1.1 unilateral ntas

Lub cim unilateral yog qhov feem ntau siv rau sab nraud txhim kho cov ncej qauv rau kev kho ntawm cov ciakseal tshiab. Tus ncej yog thov hauv ib lub dav hlau, piv txwv li forteromedial lossis medial mus rau tibia thiab anterolateral lossis ib sab rau tus poj niam. Cov Pinsation Pins tau tso los ntawm daim tawv nqaij ntawm ib sab thiab nkag mus rau ob chav Cortex. Tus PIN yuav tsum muab tso rau ntawm cov sib koom ua ke, sab nraud ntawm cov tshuaj tiv thaiv kab mob sib koom ua ke, kom tsis txhob sib koom tes sepsis. Ob pas nrig ob mounted nyob rau hauv tib lub dav hlau lossis hauv ob lub dav hlau sib txawv thiab tom qab ntawd lawv tau koom ua ke.

5.1.2 ob tog

Lub szczecin tus lej dhau los ntawm daim tawv nqaij ntawm ib sab, nkag mus rau lub Bilaminar Cortex, thiab tom qab ntawd dhau los ntawm daim tawv nqaij ntawm sab nraud. Cov thav duab ob tog tsis pom zoo rau kev kho mob los ntawm kev sib cav, tab sis yuav siv rau kev txhim kho ib ntus.

5.1.3 hla kev txhim kho sab nraud sab nraud

Siv nyob rau hauv kev tswj kev puas tsuaj rau cov chaw nyob hauv cov chaw nyob nrog kev raug mob hnyav lossis cov pob txha uas tsis sib xws thiab cov pob txha lov thiab pob txha lov.

▲ Pelvic pob txha pob txha pob zeb, thiab ua rau tus poj niam ua pob txha lov

Lub ruaj khov muab los ntawm sab nraud txhim kho lub cim tso cai rau cov ntaub so ntswg muag ib yam li CT scanning thiab npaj phiaj xwm. Cov thav duab unilateral yog feem ntau siv, thiab kev txhim kho pins yuav tsum tau muab tso rau sab nraum thaj chaw ntawm kev raug mob thiab kev phais yav tom ntej ntawm kev phais mob kom raug.

5.1.4 txuas ntxiv thav ntawv

Ilizarov tau qhia cov txheej txheem no nrog txoj kev limhiam ntxiv sab nraud. Tubular kev kho vaj tse sab nraud thiab unilateral sab nraud txhim kho cov ntsiab lus ntawm tib lub sij hawm tshwj tsis ntev yog ua los ntawm intramed cliping.

5.2 Qauv Regositioning Techniques

Qhov kom zoo dua ntawm kev sib xyaw ua ke sab nraud thav duab yog tias nws tso cai rau kev txo qis, thaj chaw uas nyob ib sab ntawm kev sib koom ua ke, thiab cov sib koom tes nws tus kheej (hloov pauv).

Kev tso chaw ntawm Scanz Screws tuaj yeem yog kev xaiv ntawm qhov kev xaiv ntawm qhov zoo tshaj plaws lossis qhov chaw zoo ntawm kev txhim kho nyob ntawm seb cov pob txha caj dab zoo thiab hnov ​​mos. Txo cov thooj me me tuaj yeem ua los ntawm kev siv cov kev txo qis thiab kev tiv thaiv kev txo qis, thaum khaws cov ntshav ntws mus rau pob txha thiab cov nqaij mos. Daim ntawv thov ntawm cov txheej txheem no tso cai rau kev txo qis ntawm kev txo qis thaum twg los tau.

Sib xyaw ua ke cov txheej txheem.

Ib hom b tibial tem bacture.

B rau txhua qhov loj me me thaiv, 2 kev txhim kho pins tau raug ntsia hlau rau sab nraum thaj chaw ntawm kev raug mob.

C Txhim kho Pins tau ruaj rau cov pas nrig sib txuas nrog cov clamms clamps, ua rau lawv 2 leeg rau kev tsis ncaj.

D Tom qab lub pob txha no tau raug xa rov qab, qhov thib 3 txuas tus pas nrig yog txuas nrog thawj 2 txuas Rods nrog lub raj-raj clamp.

Ua qhia txog kev sib xyaw ua ke sab nraud txhim kho sab nraud. tibia. b pojniam qws. C Trans-mnoee.

6 Daim Ntawv Qhia Tshwj Xeeb

6.1 Koom Tes Sib Koom Tes

Kev siv tshwj xeeb ntawm cov hixators sab nraud yog qhov fusion ntawm pob qij txha los ntawm kev sib koom tes los ntawm kev compression nrog cov pab pawg sab nraud. Lub ntsiab cai no qee zaus siv rau kev sib koom ua ke ntawm pob luj taws, lub hauv caug, thiab lub luj tshib, tshwj xeeb tshaj yog nyob ntawm muaj tus kab mob.

6.2 Muaj Kab Mob

Kev txhim kho sab nraud yog qhov kawg kho rau kev kis mob lossis tus kab mob uas muaj mob los ntawm kev txhads, raws li kev txhim kho pins feem ntau tuaj yeem tso tawm ntawm lub xaib ntawm kab mob.

6.3 Kho kom raug osteotomy

Osteotomies rau kev kho ntawm deformities thaum mos cov nqaij tsis zoo lossis tsis muaj kev siv sab hauv yog qhov siab sab nraud txhim kho nkhaus Lwm qhov kev taw qhia yog osteotomy nrog ib txhij pob txha tuav. Qhov no feem ntau yuav tsum tau kho nrog txoj kev sib tsoo sab nraud nruab nrab thav duab.

6.4 Pob Txha Handling - cuam tshuam Osteogenesis

Pob txha cuam tshuam yog nyob ntawm Ilizarov lub hauv paus ntsiab lus ntawm cov pob txha ua kom zoo rau cov pob txha ua kom yooj yim (0.5-1 mm / d), thiab pob txha tshiab yog tsim hauv qhov sib txawv no. Kev cuam tshuam rau cov pob txha kho kom zoo, hereas sai dua kev cuam tshuam ntawm cov nqaij tsis ua rau cov pob txha ua kom raug. Nqa lossis cuam tshuam cov pob txha scabs, zoo li cov pob txha lov no, kuj mus dhau txhua theem ntawm scab mature kom txog thaum kev kho mob. Muaj 3 yam taw qhia rau kev siv cov txheej txheem no, thiab qee zaum cov lus qhia no yuav ua rau cov neeg tuaj yeem:

- Muab txoj phuam cia ntev.

- Segenal cov pob txha tuav kom kho pob txha tsis xws luag.

- Kho kom raug osteotomy.

Qhov tsim nyog txhim kho fixation feem ntau rau lub hom phiaj no yog qhov sib dhos sab nraud nruab nrab (nrog lossis tsis muaj qhov sib dhos sab nraud ntawm cov ncej txheem sab nraud) thiab cov khoom sib kho sab nraud sab nraud.

6.5 Joeroration Restorumor thiab txhawb nqa

Ib qho hinged sab nraud kho sab nraud yog qhov tseem ceeb ntxiv rau tus lej ntawm lub luj tshib tsis muaj kev pheej mob, suav nrog Elbe lossis Unvesolved Elbotitioning thiab Ligament Kho. Ib qho hinged sab nraud kho sab nraud tuav lauj tshib rov pib dua nrog kev siv tau. Tswj cov repositioning yog thawj qhov tseem ceeb. Qhov tsis txaus ntseeg tau nyuaj rau kev tswj hwm dua li kev ploj ntawm cov lus tsa suab. Lub axis xav tau kom muaj kev tso cai nyob rau hauv fluoroscopy. Kev sib txawv me ntsis hauv txoj haujlwm ntawm lub pob khawm tuaj yeem cuam tshuam ntau yam cuam tshuam nws txoj haujlwm.

▲ Kev tso chaw ntawm ib lub pob zeb sab nraud txhim kho rau lub luj tshib.

7 Kev Kho Mob Ncua

7.1 Pin Pov Tseg

Pin cov tshuaj tiv thaiv nyob ntawm txoj haujlwm thiab kev ruaj ntseg ntawm kev kho tus pin, kev kho mob postive ntawm pab neeg mob thiab tus neeg mob. Cov txheej txheem txo kev sib sau ua ke yog qhov zoo dua ntxiv vim tias nws tso cai rau kev xaiv qhov zoo tshaj plaws anatomical txoj hauj lwm rau cov lej rov qab raws li hom pob txha lov. Lub tsev khomob yuav tsum muaj cov txheej txheem saib xyuas tseeb PIN, thiab cov kws tu mob paub yuav tsum qhia cov neeg mob ua kom ua cov PIN los ntawm lawv tus kheej. Los ntawm kev zam kev raug mob hnyav thiab kev ua haujlwm hauv zos ua kom ntxuav, thiab siv cov kev hnav cawv kaw, thiab txo qis ntawm tus lej PIN tuaj yeem txo qis.

7.2 PIN kab mob pin 

Pin npaj saib xyuas yuav tsum yog ua ntej muaj cov ntxig pin kom yog. Rau cov pa screws, kev siv ua ntej ua ntej yog yuav tsum tau thiab tus pin yog tus ntiv tes xoo hauv los txo thermal necrosis. Cov ntaub so ntswg tsis tsim nyog ib puag ncig tus lej PIN yuav tsum raug tso tawm thaum phais mob. Kev saib xyuas kom zoo ntawm tus lej PIN yog qhov tseem ceeb los txo qhov tshwm sim ntawm tus lej PIN rau cov kab mob. Pin kab mob kis tau thiab cov ntsia hlau xoob yuav daws tau los ntawm kev tshem cov xoob tus pin thiab rov ntsia tus pin rau lwm qhov chaw.

7.3 ME MOILIZ KHIB

Tsuas yog ob peb kis tshwj xeeb (kev siv tus bridging, kev siv thaum muaj xwm ceev kho, kev sib haum xeeb yog tso cai thaum pib kho sab nraud. Raws li kev kho kom zoo zuj zus, cov kabmob hnyav tuaj yeem nce zuj zus. Tsis tas yuav tsum tau ntxiv cov khoom siv ntxiv rau lwm cov khoom siv sab nraud. Ib feem los yog tag nrho cov kabmob hnyav yog qhov zoo tshaj plaws thiab zoo tshaj plaws ntawm kev siv dynamization.

8 Ntev ntawm Kev Kho Vaj Tse

8.1 Hloov ntawm Kev Kho Mob

Muaj 3 txoj kev kho kho tshiab:

• Siv cov tshuab kho sab nraud raws li kev kho kom paub kom txog thaum lub pob txha lov.

• Thaum hloov dua siab tshiab rau kev kho sab hauv.

• Hloov mus rau kev kho mob tsis-phais, xws li plaster, ortthosis, thiab lwm yam.

Yog tias hloov dua siab tshiab rau kev kho sab hauv yuav tsum tau, nws yuav tsum tau ua kom ntxov li ntxov (tsis pub dhau ntawm 2 lub lis piam) qis dua li ntawm kev hloov dua siab tshiab.

Cov kev cai lij choj hauv qab no yuav tsum ua raws thaum npaj kev phais ua ntej, thaum, lossis tom qab txhim kho ib nyuag ntu:

• Yog tias qhov kev cog hniav tshiab tau muab tso rau ntawm tus thawj sab nraud txhim kho sab nraud, tag nrho cov kab xev pin yuav tsum huv. Qee lub sij hawm cov txheej txheem tau ua tiav hauv ob theem, nrog ib ntu los ntxuav tus pin qub kab ntawv thiab theem thib ob los ua kev txhim kho muaj zog.

• Tus lej PIN laus dua li 10 txog 14 hnub tau txiav txim siab ua kom khov thiab ua haujlwm tau zoo ua ntej kev kho ua ntej.

• Yog muaj kev ua xyem xyav txog kev muaj menyuam tsis muaj menyuam los yog tus lej PIN

• Cov tshuaj tua kab mob yuav tsum tau siv prophylactically nrog cov tshuaj tiv thaiv kab mob antimrical uas npog cov kab mob pin dhau los.

• Sib ze saib xyuas thawj zaug rau thawj 6 lub lis piam tom qab hloov pauv ntawm tus txhim kho sab hauv.

Yog tias muaj cov pov thawj ntawm qhov teeb meem nrog tus lej PIN, nws yog qhov zoo tshaj plaws los txheeb xyuas cov kab mob kab mob, hloov nws tus lej PIN thiab rov kho dua nrog kev kho sab nraud. Cov ntawv pov npav rau peb yuav tsum koom tes nrog tus neeg mob kom ntseeg tau tias kom ntseeg tau. Yog tias txhim kho sab nraud yuav tsum tau hloov nrog kev kho sab hauv nyob rau hauv cov teeb meem lig, nws raug nquahu kom muaj qhov teeb meem sab nraud, thiab tom qab ntawd, tom qab kev phais cov nyiaj sab hauv. Cov tshuaj tua kab mob tuaj yeem siv rau lub sijhawm no.

8.2 Kev Txhim Kho Zaum Kawg

Kev txhim kho thaum muaj xwm ceev sab nraud tuaj yeem ua tiav kev ruaj khov ib ntus ntawm cov ceg ntoo thiab cia cov nqaij mos nqaij rov qab. Tsuav cov ntaub so ntswg muag yog ruaj khov, sab nraud txhim kho tuaj yeem hloov nrog kev txhim kho sab hauv. Qhov tseeb, nws yuav tsum tau hloov nrog kev txhim kho sab hauv tsis pub dhau 10 hnub.

Yog tias kev txhim kho sab nraud tseem ruaj khov thiab tsis muaj cov cim ntawm qhov teeb meem, hloov kho tsis tsim nyog. Yog daim tawv nqaij kev pab tawv nqaij yog cov neeg txom nyem, lossis muaj kev pheej hmoo ntawm kev txo qis yog qhov siab, tus kho sab nraud tuaj yeem khaws cia ua qhov kev kho mob zaum kawg.

Txoj kev nce qib ntawm kev kho kom zoo yuav tsum tau pom zoo, thiab yog tias tsis muaj kev vam meej, lwm yam kev yuav tsum tau txiav txim siab.