Maphunziro ndi chithandizo cha nonunion

Onyenga olowa - ndi mtundu wa kuphwanya kupitiriza kwa fupa, amene amakhala ndi kuyenda nthenda, zachilendo dipatimenti imeneyi. Mu yochizira matenda kwa boma ntchito yapadera akuti - "pseudarthrosis". Pakali pano, matenda ndithu bwinobwino ankachitira ndi mankhwala zimakhala ntchito ndi ndiwofatsa. Komanso, mankhwala nthawi zambiri ndi zotsatira zabwino ndi munthu akubwereranso mwakale. Nkhaniyi yosanthula mwatsatanetsatane chifukwa mapangidwe limodzi onyenga. Ndipo powasamalira matenda ndi mankhwala.

ICD: pseudoarthrosis, zosiyanasiyana

Onyenga olowa - kuphwanya umphumphu wa fupa yokhudza kotekisi, limodzi ndi kuyenda nthenda. Malinga ndi gulu la International wa Matenda malamulo ali wabodza olowa - ICD 10. Pamafunikanso: sanali ogwirizana wovulala, mwachitsanzo psevdoartoroz ndi olowa zonama maziko maphatikizidwe kapena arthrodesis.

Pa mbali ya dongosolo pathological ndi njira chithandizo kwa mfundo zabodza anawagawa fibrous ndi oona. Woyamba ndi gawo wapakatikati pakati pa wodekha ndi kuphatikiza la pseudarthrosis woona. chithunzi matenda kusiyana kakang'ono pakati pa makombo wodzazidwa ndi minofu fibrous, fupa mbale ndi malekezero kuti kuphimba ngalande medullary.

Nthawi zina anapanga fibrous synovial pseudarthrosis amene matsirizidwe a mafupa okutidwa ndi chichereŵechereŵe ndi fupa zidutswa ali kapisozi connective pachiyambi. Pakati pa iwo kudziunjikira madzimadzi synovial, akhoza zidutswa zonse ofoola ziwalo.

Gawo nearthroses

Pseudoarthrosis kungakhale kobadwa nako kapena kugula. Kobadwa nako onyenga olowa ali osowa kwambiri ndipo si oposa 0.5% ya kudwala. Maziko a mapangidwe ake ndi kuphwanya intrauterine fupa minofu mapangidwe, chifukwa mu otsika dongosolo fupa malo enieni. Ndipo pambuyo pa kubadwa, pa zaka 2-3, kukhulupirika kwa fupa wathyoka. Kawirikawiri kobadwa nako onyenga olowa ndi tibia, osachepera - a clavicle ndi, ulna ndi femur.

The pseudarthrosis anapeza ndi za 3% ya matenda mafupa chikhalidwe. Nthawi zambiri ndi zotsatira za wovulala, pamene pali lolakwika ndi chosakwanira maphatikizidwe makombo fupa. Kuthi pseudoarthrosis ogaŵikana atrophic, ndi hypertrophic normotroficheskie.

zimayambitsa Local matenda

zimayambitsa Local la mapangidwe limodzi onyenga nayenso, anawagawa m'magulu atatu. Gulu loyamba - zimayambitsa amene akukhudzana ndi zolakwa ndi zosiyidwa mankhwalawa: ndi chosakwanira poyerekeza ndi makombo fupa, kulephera kuthetsa interposition wa zimakhala zofewa zosayenera immobilization, imene anapitiriza kuyenda makombo, kawirikawiri kapena oyambirira amatulutsa kusintha pulasitala, ntchito loko cholakwika, kayendedwe kwambiri yogwira kuchita masewera olimbitsa thupi , yaikulu sklerotirovanie.

Gulu lachiwiri zikuphatikizapo zifukwa zokhudzana ndi mlingo wa kukula kwa zoipa, ndi mavuto chokumbukira zoopsa: fractures, imfa ya gawo lalikulu la mafupa, minofu tulo kuvulala kwa mtunda ndithu, padzuwa la fupa minofu suppuration, osteomyelitis, kuwonongeka kwa mitsempha ndi mitsempha ya magazi, komanso kusokonezeka nawonso awo.

Ndipo potsiriza, gulu lachitatu la zinthu zimene zimakhudza mapangidwe limodzi onyenga, kugwirizana ndi makhalidwe anatomical ndi thupi la kotunga magazi fupa pa malo wovulala ndi kutanthauzira.

zifukwa trophic

Kuchokera kulemera trophic amachititsa mapangidwe pseudoarthrosis chachikulu ndi: matenda, mwachitsanzo, chindoko, malungo, pachimake matenda; matenda kagayidwe kachakudya makamaka kashiamu-phosphorous kagayidwe mu zimakhala; shuga; beriberi; mtima insufficiency pambuyo choipa innervation Mitsempha; kwambiri X-ray walitsa, okhoza ziletsa ndondomeko mapangidwe fupa; matenda trophic pa fupa lothyoka malo.

chithunzi matenda

Chithunzi matenda a mapangidwe limodzi chonyenga chili makhalidwe yake. M'malo mwa fupa lothyoka anati zoyendayenda, minofu ya manja, kutupa, kuchuluka kwa minofu connective, chilonda mapangidwe. Pa X-ray angazindikire kusiyana kwambiri pakati pa makombo, fupa ofoola ziwalo mathero, maphatikizidwe wa ngalande medullary.

matenda a pseudarthrosis

Pa matenda, kuwonjezera deta ovutika chidwi linaperekedwa kwa tsiku lomalizira, amene n'kofunika kwa maphatikizidwe lathunthu la fupa lothyoka la. Pamene nthawi imeneyi amatha, udindo wa fupa lothyoka la limanenedwa ngati pang'onopang'ono accrete kapena asymphytous, ndipo pambuyo nthawi kawiri choposa ponseponse amaganiziridwa mapangidwe limodzi onyenga.

Kuti atsimikizire kungoganizira, kuchita ndi X-ray awiri zolosera matanthauzo perpendicular, ndi zina - ndi zolosera oblique. Zizindikiro za kukhalapo kwa nonunion kuganizira chithunzi otsatirawa pa X-ray: pakalibe callus, ndilo gawo kulumikiza zidutswa fupa; malekezero a makombo ndi yosalala anamaliza kapena conical mawonekedwe; atachuluka M'mimbamo malekezero a zotsala ndi kutseka mbale aumbike. Pamene olowa chonyenga limodzi kapena onse a zotsala fupa mapeto ali ndi mawonekedwe hemispherical ndi maonekedwe akufanana mutu olowa. The mpukutu wina angakhale glenoid patsekeke. Pankhaniyi, malo olowa ndi kuoneka bwino.

Pofuna kudziwa kukula kwa ndondomeko mwamphamvu Kwalamulidwa kuphunzira radionuclide.

opaleshoni mfundo chithandizo

Ngakhale nkhokwe njira ndiwofatsa mankhwala (ka mankhwala, magetsi, ndi maginito, ndi zina zotero. D.), njira yaikulu amachitira pseudarthrosis ndi ntchito. Malo kutsogolera ali wotanganidwa ndi psinjika osteosynthesis. Kodi azisamalila pseudoarthrosis? opaleshoni ziyenera kuperekedwa pa miyezi 8-12 pambuyo pa kuchiritsidwa wathunthu pa chilonda fractures zovuta. Ngati pali zipsera zomwe soldered kuti fupa, iwo ayenera excised ndi opaleshoni pulasitiki kukonza chilema.

Zikusonyezanso ntchito ndi kufanizitsa molondola zidutswa fupa, komanso mpumulo wa zofuna zawo, excision a minofu yovulazidwa ndi kubwezeretsa patency wa ngalande medullary.

pvsedoartroza chithandizo pa zida za Ilizarov

Izi njira zimathandiza kuti asonkhanitse zotsala ndipo facilitates mofulumira maphatikizidwe wa popanda yomweyo opaleshoni. N'chifukwa chake ili njira amatchedwa extrafocal osteosynthesis.

Kuyamba, wodwalayo ntchito masipoko wa chipangizo mafupa imene zidutswa fupa ndi lokhazikika. Ndiye, pafupi sabata kumatenga ndondomeko kuchira pambuyo ntchito chipangizo imene malo, kumene masipoko, kuchiritsa ndi imayamba fupa maphatikizidwe. Bone zidutswa pang'onopang'ono kufikako mzake, kuwononga aya osafunika ndi kufinya olowa onyenga.

Komanso pali fixation, ndiye mapangidwe calluses ndi ndondomeko ya ossification. Nthawiyi ndi yaitali, koma ali otetezeka ndi sikutanthauza miyeso wapadera. Wodwala ayenera kutenga mavitamini, kudya bwino komanso kusiya zizolowezi zoipa.

Pomaliza, pali nthawi yomalizira ya konzanso, imene malangizo onse oyenera kutsatira dokotala ndi kupanga akonzedwa zokambirana zapadera. Yabwino pa nthawi imeneyo ankaona kuti akuyenda, kusambira.

Intra- ndi extramedullary osteosynthesis

An njira ya mankhwala opaleshoni intramedullary kaphatikizidwe. Pamaso wozengereza dokotala wake amachotsa zowonongeka, zimakhala zofewa, amene alibe periosteum ndi magazi kuundana. Pambuyo makombo yolusa fupa ndi pini wapadera. chilonda pambuyo opaleshoni sutured mu zigawo, mu malo ake zikhale chipsera yaing'ono.

Pa extramedullary osteosynthesis makombo fupa ananamizira Supraspinous loko. Iwo unkagunda fupa owonongeka ndipo pambuyo splice makombo mbale achotsedwa ndi kudula.

Choncho, nkhani ankakambirana mwatsatanetsatane pseudarthrosis. Pomaliza, tisaiwale kuti mfundo zoopsa mapangidwe limodzi onyenga kutumikira zosiyanasiyana matenda endocrine, zizolowezi zoipa (kusuta fodya, kumwa mowa), kunenepa, zakudya osauka ndi kupanda zolimbitsa thupi. Choncho, kukhala moyo wathanzi kuchepetsa chiopsezo cha matenda.