Orthopedic trauma guide | External fixation zviratidzo uye furemu mhando
Vanachiremba vemapfupa vanoshandisa kunze zvigadziriso zvekugadzirisa zvimedu zvakasarudzwa zvakavhurika, kukuvara kwakanyanya kwezvinyoro-nyoro, kukurumidza kugadzikana kwechinguva, kumwe kutsemuka pedyo nemajoini, kuvakwa kwemakumbo, kuremara kururamisa, kureba kwemakumbo uye nzira dzakasarudzwa dzekubatanidza. Zvichienderana nekukuvara uye chirongwa chekurapa, chimiro chinogona kunge chiri bhiriji renguva pfupi kusvika mukati mekugadzirisa mukati kana nzira yakananga inoshandiswa apo pfupa rinoporesa.
Chii chinonzi External Fixation Device?
Chigadzirwa chekunze chekugadzirisa is orthopedic frame inoshandiswa kudzikamisa kana kugadzirisa zvishoma nezvishoma nzvimbo yebhonzo. Mapini kana waya anoiswa mubhonzo uye akabatana nemabhawa, mhete, zvisungo kana zvimwe zvinhu zviri kunze kwemuviri. Nemhaka yokuti chimiro chikuru chinoramba chiri kunze, vanachiremba vanovhiya vanogona kuwana zvinyoro zvinyoro uye, nemaitiro akasarudzwa, gadzirisa kurongeka panguva yekurapa.
Kugadziriswa kwekunze kunotsanangura nzira yekurapa pane chimwe chigadzirwa chepasi rose. Mafuremu anotangira kubva kune compact zvishandiso zveruoko kana wrist kuenda kune monolateral mabara uye denderedzwa masisitimu anoshandiswa mukukuvadzwa kwemakumbo uye kuvakazve. Dhizaini yedhizaini, pini kumisikidza uye postoperative mirairo inofanirwa kuenderana neiyo anatomy chaiyo, chinangwa chekushandiswa uye yakatenderwa system.
Musiyano wakakosha: gadziriso yekunze haisi yega mudziyo wenguva pfupi. Inogona kushandiswa kwekanguva mukutarisirwa kwekushungurudzika, kana kuti inogona kushanda seyo nzira yekugadzirisa kusvikira kuporesa kwakakwana kana kugadziriswa kwaitwa.
Ndeapi Orthopedic Surgeries Anoshandisa External Fixators?
Mhinduro yakajeka ndeyokuti kugadzirisa kwekunze kunoshandiswa apo vanachiremba vanoda skeletal kugadzikana pavanenge vachideredza kukanganisa kwakapoteredza nzvimbo yakakuvadzwa kana yakavakwazve. Inonyanya kukosha kana kuwana maronda kana zvinyoro zvinyoro zvinofanira kuchengetedzwa, apo kukurumidza kugadzikana kwepanguva kunodiwa, kana kana kururamisa zvishoma nezvishoma chikamu chechirongwa chekurapa.
Yakakura Yakavhurika Kutsemuka uye Soft-Tissue Kukuvara
Kuvhurika kutsemuka kunotaurirana neronda uye kunogona kusanganisira kusvibiswa, kukuvara kwetishu uye njodzi yehutachiona. Kugadziriswa kwekunze kunogona kupa kugadzikana apo vanachiremba vanovhiya vanoita debridement, kutarisira maronda uye kugadzirisa-nyoro-tishu. Mukutarisira kwakatarwa, iyo yekutanga furemu inogona kuzotsiviwa neimwe nzira yekugadzirisa mushure mekunge matishu uye murwere agadzirira.
Kugadziriswa kwekunze kunogonawo kutariswa kana kuzvimba, kukuvara kweganda kana kukanganisa zvinyoro zvinyoro zvinoita kuti kukurumidza kugadziriswa kwemukati kusade. Izvo hazvidziviriri kudzivirira kutapukirwa kana kuvimbisa kupora; kukanganisa kwakakodzera, mishonga inorwisa mabhakitiriya kana inoratidzwa, kutarisira maronda, kugadzirisa kwakagadzikana uye kutevera zvose zvinobatsira pakurapa.
Kwenguva Kukuvadza-Kudzora Orthopedics
Mune varwere vane kukuvadzwa kwakawanda kana kusagadzikana kwe physiologic, kukurumidza kushandiswa kwekunze kwekunze kunogona kugadzirisa kwekanguva pfupa refu kana kukuvadzwa kwepelvic apo boka rekushungurudza rinotarisana nematambudziko ehupenyu. Iyi nzira inowanzonzi damage-control orthopedics.
Sarudzo yekushandura kukugadzirisa kwemukati, kugadzirisa chimiro kana kuchengetedza kunze kwekugadziriswa kunoenderana nekupora kwemurwere, kusvibiswa, nyoro-tishu mamiriro, kurongeka uye yakazara yekuvhiya zano. Hapana zuva rekushandura rinoshanda kune kukuvara kwese.
Tibial Plateau, Pilon uye Zvimwe Periarticular Fractures
High-energy fractures padyo nebvi kana ankle inogona kuperekedzwa nekuzvimba kukuru uye kukuvara kwenyama yakapfava. A joint-spanning frame inogona kuchengetedza kureba uye kurongeka ukuwo kuzvimba kuchivandudza uye kuronga kwechokwadi kunoenderera mberi. Muzviitiko zvakasarudzwa, denderedzwa, yakasanganiswa kana imwe yekunze system inogona kuumba chikamu chechokwadi chekuvakazve.
Nekuti chinotenderera chimiro chinogona kudzora kufamba kwakabatana, nzvimbo yepini, furemu geometry, nyoro-matishu kuwana uye nhanho inotevera yekurapa inofanirwa kutariswa isati yaiswa.
Kureba kweLimb uye Deformity Correction
Mafuremu edenderedzwa uye akasarudzika ekunze anogona kushandiswa mushure mekurongwa kwebhonzo kucheka zvishoma nezvishoma kuchinja kureba, angulation, kutenderera kana kududzira. Marongedzero ekugadzirisa anotarwa neboka rekurapa-ekuvakazve nhengo uye anogadziriswa zvinoenderana neradiographs, kuumbwa kwemapfupa, kushivirira kwetishu-nyoro, kushanda kwetsinga uye kufamba kwakabatana.
Chiyero chekuvhiringidza chinowanzo kurukurwa hachifanirwe kubatwa semurayiridzo wemurwere wepasi rose. Chiyero chakakodzera uye rhythm inosiyana neanatomy, zera, chinangwa chekugadzirisa uye biological mhinduro.
Joint Fusion, Nonunion uye Limb Reconstruction
Kugadziriswa kwekunze kunogona kushandiswa mune zvakasarudzwa arthrodesis maitiro, ane utachiona kana yakaoma nonnunion kurapwa, kutakura pfupa uye kuvakazve mushure mekurasikirwa kwepfupa. Izvi zviratidzo zvehunyanzvi zvinoda kunyatsoronga kugadzikana, kudzvanya kana kukanganisa, bone biology, kutapurirana hutachiona uye kugadzirisa.
Mini ekunze ekugadzirisa masisitimu anogona zvakare kushandiswa kune akasarudzwa kutyoka, dislocation kana maitiro ekugadzirisa anosanganisira ruoko, wrist, tsoka kana ankle apo chigadzirwa chinotarisirwa kushandiswa uye chirongwa chekuvhiya chinotsigira icho chishandiso.
| Mamiriro ekiriniki | Inogoneka basa rekugadzirisa kwekunze | Kufunga kwekuronga kwakajairwa |
|---|---|---|
| Vhura kutyoka nekukuvara kwenyama yakapfava | Kugadzikana kwekanguva kana kusarudzwa kwekugadzirisa kugadzirisa | Kupinda kwemaronda, kusvibiswa, kurongeka uye kufukidzwa kweganda rakapfava |
| Polytrauma kana murwere asina kugadzikana | Kukurumidza kukanganisa-kudzora kugadzikana | Physiologic mamiriro, gare gare shanduko yekushandura uye furemu yekuwana |
| High-energy periarticular fracture | Joint-spanning yenguva pfupi furemu kana yakasarudzwa yakasarudzika kuvaka | Kuzvimba, kukuvara kwemajoini pamusoro, kuiswa kwepini uye kuchekwa kweramangwana |
| Kugadziriswa kwekuremara kana kureba kwemakumbo | Zvishoma nezvishoma postoperative kugadziriswa | Kugadzirisa chirongwa, gadzirazve bhonzo, tsinga, tsandanyama uye majoini kufamba |
| Nonunion, utachiona kana kurasikirwa kwemapfupa | Kugadzikana, kudzvanya, kutakura kwebhonzo kana kuvakwa patsva | Bone biology, kutapurira hutachiona, saizi yekuremara uye kushivirira kwemurwere |
| Kusanganiswa kwakasarudzwa | Kumanikidza uye kuchengetedza kurongeka | Kubata pfupa, kugadzikana kwefuremu, zvinyoro zvinyoro uye chirongwa chekuremerwa |
Temporary vs Definitive External Fixation
Inoshandiswa kuwana kugadzikana kwekutanga apo murwere, ronda kana matishu akapfava anopora. Urongwa hwekurapa hunogona kuchinja gare gare kukugadzirisa kwemukati kana imwe nzira yekuvandudza.
Iyo furemu inoramba iri iyo huru yekugadzirisa inovaka panguva yekupwanyika kuporeswa, fusion kana zvishoma nezvishoma kugadzirisa uye inobviswa kana timu yekurapa yaona kuti chinangwa chekurapa chaitwa.
Yenguva pfupi hairevi kusakosha, uye chirevo hachirevi chigarire. Mazano ese ari maviri anoda kuiswa kwepini kwakaringana, kugadzikana kwakakwana kwefuremu, kurongeka kwakakodzera uye hurongwa hwekutevera hwakanyorwa.
AAOS inotaura kuti chigadziriso chekunze chinogona kushandiswa kana ganda uye zvinyoro zvinyoro zvakakuvadzwa zvakanyanya kusvikira murwere achikwanisa kushivirira kuvhiyiwa, asi mune dzimwe nguva inogona kunge iri kurapa kwechokwadi. Iyo nzira chaiyo saka yakanangana nemakesi pane kutsanangurwa nezita remudziyo chete.
Mhando dzeKunze Fixation Frames
Rudzi rweframe inosarudzwa zvinoenderana nedunhu reanatomical, kutsemuka kana patani yekuvakazve, inodiwa kugadzikana, kudiwa kwekugadzirisa uye chigadzirwa-chakanangana nekushandiswa kwakanangana. XC Medico mapoka ayo anowanikwa zvigadzirwa mukati mayo orthopedic ekunze kugadzirisa masisitimu.
Monolateral External Fixators
A monolateral frame inogadzikwa zvakanyanya parutivi rumwe rwenhengo. Zvichienderana nehurongwa, inogona kupa yakaenzana yakatwasuka bar-uye-clamp kumisikidzwa uye kuwana yakatenderedza yakawanda yenhengo. Inogona kushandiswa mukushungurudzika kwakasarudzwa uye zvikumbiro zvekugadzirisa apo kugadzikana kwakakwana kunogona kuwanikwa.
Nyanzvi vatengi vanogona kuongorora zviripo monolateral yekunze fixation masisitimu , asi iyo chaiyo chiratidzo uye gadziriso inofanirwa kusimbiswa kubva kune yazvino label uye zvinyorwa zvekuvhiya maitiro.
Circular uye Ilizarov Frames
Mafuremu edenderedzwa anoshandisa zvindori zvakabatanidzwa netambo dzakasungwa, hafu yepini uye tsvimbo kana tambo. Geometry yavo inogona kutsigira multiplanar kugadzikana uye zvishoma nezvishoma kugadzirisa, zvichiita kuti ive yakakosha kune dzakasarudzwa dzakaoma mafractures, kuremara kururamisa, kutakura kwemapfupa uye kuvakazve mitezo.
Ilizarov denderedzwa rekunze fixator imhuri imwe mukati mechikamu ichi. Gungano uye kururamisa mapuroteni zvinoda kudzidziswa kwehunyanzvi uye hazvifanirwe kutorwa kubva kune yakajairika chigadzirwa mufananidzo.
Modular uye Hybrid Fixators
Modular masisitimu inobvumira zvikamu kurongerwa nzvimbo dzakasiyana dzekutsemuka uye zvinodiwa zvekuwana. Hybrid inovaka inogona kusanganisa mhete, waya, hafu pini kana unilateral zvikamu kuti zvisangane nekugadzikana kwakasarudzwa uye anatomy zvinodiwa.
Mini uye Joint-Spanning Fixators
Mini mafuremu anogona kugadzirwa kune akasarudzwa akakuvara-mabhonzo madiki, nepo majoini-anotenderera anovaka anogona kuvharika kwechinguva ibvi rakakuvara zvakaipisisa, ankle, wrist kana mamwe majoini. Chimiro chinotenderera chinogona kubatsira kuchengetedza kurongeka asi chinogona kudzora kufamba kwakabatana, saka nguva uye chirongwa chekuvandudza chinoda kutariswa kwepedyo.
Bone quality nyaya: ekunze mapini ekugadzirisa uye waya dzinofanirwa kuwana zvakakwana kutenga mumapfupa. Osteoporosis haingoiti kuti kugadzirisa kwekunze kuve kwakanaka; hurombo husina kunaka hwemapfupa hunogona kuomesera kugadzirisa uye hunofanirwa kutariswa mukusarudzwa kwechishandiso, zano repini uye chirongwa chese chekurapa.
Iyo External Fixator Inoshandiswa Sei?
Kugadziriswa kwekunze kunoitwa munzvimbo yekushanda-yekamuri uchishandisa anesthesia yakakodzera uye chirongwa chekufungidzira. Iwo chaiwo matanho anosiyana nedunhu remuviri, dhizaini dhizaini uye kana chinangwa chiri kudzikamisa kwenguva pfupi, tsigiro yekugadziriswa kana kururamisa zvishoma nezvishoma.
Kuiswa kwepini kunofanirwa kudzivirira tsinga dzakakosha, midziyo, majoini uye akakuvadzwa zvinyoro zvinyoro. Kana kumwe kuvhiya kuchitarisirwa, nzvimbo dzepini dzinofanirawo kurongwa kuitira kuti dzisazokanganisa kudzokororwa kana kuisirwa. Aya madeti anotemerwa nechikwata chekuvhiya uye haagone kutsiviwa nemirayiridzo yakawanda yepamhepo.
Vanovhiya Vanosarudza Sei Yekunze Fixation System?
Iko hakuna 'yakanakisa' yekunze inogadzirisa yekuvhiya kwese kwemapfupa. Sarudzo inofanirwa kutevedzera chiratidziro, anatomy uye inodiwa yemuchina maitiro eiyo yakazara kuvaka.
Mapeji echigadzirwa akadai se ankle joint yekunze fixator inogona kubatsira vashandisi vehunyanzvi kuona mhuri yechigadzirwa. Ivo havatsivire manyorerwo anoshanda, nzira yekuvhiya, kunyoreswa kwenzvimbo kana murwere-chaiwo kutongwa kwekiriniki.
Kudzoreredza, Weight Bearing uye Frame Duration
Kupora kunosiyana zvakanyanya. Nguva yenguva inogona kupesvedzerwa nekutyoka pateni, kuporeswa kwepfupa, kuvakwazve kwenyama yakapfava, hutachiona, chinangwa chekugadzirisa, zera, hutano uye nharaunda yemagetsi. Nhamba yakatarwa yemavhiki kana mwedzi haifaniri kuvimbiswa kune varwere vose.
Mirayiridzo yekutakura uremu zvakare yakasarudzika. Zvimwe zvivakwa zvakagadzirirwa kubvumidza kurodha kwakasarudzwa, nepo zvimwe zvinoda kutakura kana kusarema. Varwere vanofanira kutevera mirairo yakanyorwa yezvikwata zvavo zvemapfupa uye zvekudzorera pane kufungidzira kuti kuvapo kwefuremu kunoita kuti kufamba kwakachengeteka.
Kutevera kunowanzo kutariswa:
- radiographic alignment uye uchapupu hwekuporesa kana kuvandudza mapfupa ekugadzirwa;
- furemu uye pini kugadzikana;
- kurwadziwa, kuzvimba, mamiriro eganda uye kutaridzika kwepini-nzvimbo;
- tsinga uye basa retsinga yeropa;
- kufamba kwemajoini ari pedyo uye kushanda kwemhasuru;
- kufambira mberi kusvika kune zvakatarwa kurodha uye kugadzirisa zvinangwa.
Mushure mekubviswa kwefuremu, vamwe varwere vanoda kuchengetedzwa, bracing kana kufambira mberi kwekuvandudza. Nguva uye kufambira mberi kwechiito kunoenderana nekuongororwa kweboka rekurapa kwekugadzikana kwemapfupa uye basa.
Njodzi, Matambudziko uye Pin-Site Care
Kugadziriswa kwekunze kunogona kupa zvakakosha kurapwa mumatambudziko akasarudzwa, asi inewo njodzi. Pini-saiti kushatirwa kana kutapukirwa ndeimwe yezvinonyanya kunetsekana. Zvimwe zvipingamupinyi zvinogona kusanganisira kusunungurwa kwepini, kurasikirwa kwekugadzirisa, kunonoka kubatana, kusabatana, malunion, kuoma kwemajoini, musuru kana tendon tethering, kukuvara kwetsinga kana tsinga yeropa, kukanganisa hardware uye utachiona hwakadzama.
Pin-care protocol anosiyana pakati pezvipatara nezvikwata zvemafuremu, uye humbowo hautsigire nzira imwe yekuchenesa yepasirese yemamiriro ese. Varwere vanofanirwa kushandisa zvinopihwa, kuwanda uye hunyanzvi hunodzidziswa nechikwata chavo chekiriniki.
Bata boka rinorapa nekukasira kuti uwedzere kurwadziwa papini, kupararira kutsvuka, kuwedzera kuzvimba, pus kana kubuda zvisina kujairika, fivha, kunzwa kusanzwa zvakanaka, kutadza kubereka huremu, chinhu chakasununguka, shanduko yechimiro chenhengo, chiveve chitsva kana kucheneruka kana kutonhora nhengo. Zviratidzo zvakakomba kana kufungidzirwa kukanganiswa neurovascular kunoda kuongororwa kwechiremba nekukurumidza.
Mafuremu haafaniri kugadziriswa, kusimbiswa kana kubviswa nemurwere kunze kwekunge boka rekurapa rakapa chirongwa chakananga chekugadzirisa uye kudzidziswa. Chero chipi nechipi chisingatarisirwi chekufambisa kwefuremu kana chikamu chakakuvadzwa chinofanira kuziviswa.
External Fixation Systems yeZvipatara uye Vanogovera
Kune zvipatara, vagoveri uye veOEM/ODM vanodyidzana, ongororo inofanirwa kuvhara iyo yakazara sisitimu kwete bhawa imwe chete, mhete kana simbi. Sarudzo dzekutenga dzinofanirwa kuonesa kunyoreswa kwakanangana nemusika, kushandiswa kwakanangana, zvinyorwa zvezvinhu, kuteedzera, kuyedzwa kwemakanika, kunyora, kuchenesa kana sterilization mirairo, mapini anoenderana nezviridzwa, kurongedza kurongedza uye mushure mekutengesa kutsigirwa.
XC Medico's ekunze fixation mudziyo zvikamu zvinosanganisira modular, monolateral, denderedzwa uye anatomy-chaiwo sarudzo. Kuvepo uye mamiriro ekutonga anogona kusiyana nemusika, saka vatengi vanofanirwa kukumbira zvinyorwa zvazvino zveiyo chaiyo catalog nhamba uye nyika yekuenda.
| Procurement checkpoint | Mibvunzo yekuona |
|---|---|
| Chinangwa chekushandisa | Ndeapi mapfupa, maitiro uye furemu zvigadziriso zvinosanganisirwa mune yazvino chigadzirwa label? |
| System kukwana | Mapini, waya, zvisungiso, tsvimbo, mhete, zviridzwa nezvimwe zvinotsiva zviripo here? |
| Zvinyorwa | Mutengesi anogona here kupa zvitupa, marekodhi ekuyedza, mirairo yekushandisa uye yakawanda-level traceability? |
| Sterile status | Ndezvipi zvikamu zvinopihwa steril kana isina-sterile, uye ndeipi yakagadziriswa mirairo yekugadzira inoshanda? |
| Kudzidziswa uye kutsigirwa | Ko kutungamira kwegungano, zvinyorwa zvezviridzwa, kudzidziswa kwechigadzirwa uye maitiro ekubata zvichemo aripo here? |
| Kuwana musika | Iyo chaiyo yekumisikidzwa kwemudziyo inotenderwa kumusika kwekuenda uye chiratidzo chakapihwa? |
Zvekutenga zvehunyanzvi: ongororai mhuri dziripo dzekugadziridza dzekunze uye kumbira iyo yazvino catalogue, chikamu rondedzero uye misika-yakananga magwaro ekutonga usati wasarudza sisitimu.
Mibvunzo Inowanzo bvunzwa Nezve Kunze Kugadziriswa
Ndekupi kuvhiyiwa kwemapfupa kunowanzo shandisa kugadzirisa kwekunze?
Kugadziriswa kwekunze kunogona kushandiswa kune zvakasarudzwa zvakavhurika fractures, zvakakomba zvakapfava-tisu kukuvara, kukuvadza-kudzora kugadzikana, high-energy periarticular fractures, kureba kwemakumbo, kuremara kwekugadzirisa, kusabatanidzwa kana pfupa-kurasikirwa kwekuvakazve, uye yakasarudzwa majoini-fusion maitiro.
Chigadziriso chekunze chinogara chiri chenguva pfupi here?
Kwete. Mamwe mafuremu mazambuko echinguvana kune kumwe kushanda, asi mamwe anoitirwa kuti arambe ari iwo magadzirirwo ekugadzirisa panguva yekupora kana kugadzirisa.
Ko murwere anogona kufamba nechigadziriso chekunze?
Chete kana chiremba anovhiya uye timu yekudzorera inobvumira. Huremu-huremu hunoenderana nekukuvara, chimiro chechimiro, hutano hwemapfupa, kuporesa uye chirongwa chekurapa chese.
Mugadziri wekunze anogara kwenguva yakareba sei?
Iko hakuna nguva yepasi rose. Iyo furemu inoramba inoenderana nechinangwa chekurapa, radiographic kufambira mberi, nyoro-tishu mamiriro, kugadzikana uye kuongororwa kweboka rinorapa.
Chii chinonyanya kunetseka panguva yekugadziriswa kwekunze?
Pin-saiti kushatirwa kana hutachiona chinhu chinowanzoitika. Varwere vanoda mirairo yepini-yekutarisirwa uye vanofanirwa kuzivisa kurwadziwa kuri kuwedzera, kuparadzira hutsvuku, kuzvimba, pus, fivha kana furemu kusunungurwa nekukurumidza.
Kugadziriswa kwekunze kwakachengeteka kupfuura kugadzirisa kwemukati here?
Hapana nzira yakachengeteka pasi rose. Chimwe nechimwe chine zviratidzo zvakasiyana, zvinobatsira uye njodzi. Chisarudzo chakakodzera chinoenderana nekuputsika, zvinyoro zvinyoro, kusvibiswa, mamiriro evarwere uye chirongwa chekuvakazve.
Medical uye Regulatory References
- American Academy of Orthopedic Surgeons: Kutyoka (Akatyoka Mabhonzo).
- US Food and Drug Administration: Muongorori's Guidance for Orthopedic External Fixation Devices.
- Royal National Orthopedic Hospital: Kugadziriswa Kwekunze Kwekugadzirisa Bone uye Kureba.
- Royal National Orthopedic Hospital: Pin-Site Care Guide.
