Nailing - yog dab tsi? Phais repositioning ntawm cov pob txha tawg tsam siv ntau yam kho lug

Tiabsis cov ntawm tawg pob txha siv lub lag luam yuav tau ceev zoo cov txheej txheem, thiab kev ncaj ncees ntawm cov neeg mob nrog tham lov. Rau cov thawj lub sij hawm ib tug txheej txheem xws li fixation ntawm cov pob txha, muaj nyob rau hauv lub xyoo pua puv 19, tab sis vim lub rov tshwm sim ntawm loj heev teeb meem purulent cov kws kho mob tau yuam kom tsis txhob ua nws. Tshiaj los tom qab cov kev taw qhia nyob rau hauv kev xyaum ntawm aseptic thiab antiseptic kev kho mob.

Yuav ua li cas yog fixation?

Muaj ntau cov neeg mob uas complex cov pob txha lov cov kws kho mob muaj los tuav osteosynthesis. Yuav ua li cas yog nws? Qhov no compound pob txha tawg tsam los ntawm txoj kev lag luam. Feem ntau cov tshuaj rau nws nyob rau hauv cov kev kho mob ntawm complex cov pob qij txha, kom fused los yog tshiab uas tsis yog-united pob txha lov. Siv osteosynthesis fixation tshwm sim sib phim tawg tsam. Qhov no ua ib qho kev zoo tagnrho tej yam kev mob rau lawv cov fusion, raws li zoo raws li lub restoration ntawm lub sam xeeb ntawm ib tug limb.

Muaj ob lub ntsiab ntawm ntau yam osteosynthesis:

• immersion (extramedullary, intramedullary, transosseous);
• txheej (extrafocal).

Nws tshwm sim ntau thiab ultrasonic osteosynthesis. Yuav ua li cas yog nws? Nws yog ib tug compound ntawm me me pob txha tawg tsam.

Operations yog nqa tawm siv ntau fixatives. Rau immersion intraosseous osteosynthesis pins thiab rau tes siv rau cov phaj - phaj nrog screws, rau transosseous - spokes thiab screws. Cov tabs no yog ua los ntawm ib tug sib, lub cev thiab biologically nruab nrab khoom. Feem ntau siv hlau lug ntawm vitalliya, stainless hlau, titanium, tsawg npaum li cas - los ntawm inert yas thiab pob txha. Taub txuas ua los ntawm cov hlau tom qab puas srastetsja feem ntau muab tshem tawm. Ilizarov apparatus rau cov ceg siv rau lwm osteosynthesis. Ua tsaug rau nws, cov pob txha tawg tsam tom qab muab piv nrees tsau. Cov neeg mob yuav taug kev ib txwm nrog ib tug tag nrho cov load.

zaj lus tim khawv

Lag luam osteosynthesis qhia raws li thawj rov qab tus txheej txheem thaum:

• Qhov no puas, uas tsis loj hlob ua ke tsis muaj cov kev pab ntawm kev poob plig;
• kev puas tsuaj ntau yam ntawm perforation ntawm daim tawv nqaij (thaum kaw puas yog tau mus rau hauv cov pej xeem);
• puas nyuab los ntawm kev puas tsuaj rau ib tug loj leeg.

Contraindications

Phais pab yog tsis pom zoo rau cov nram qab no tej yam kev mob:

• yog hais tias tus neeg mob yog unwell;
• muaj qhib nws kim heev kev puas tsuaj;
• raws li qhov kab mob ntawm lub cov chaw;
• Yog hais tias muaj yog ib qho kev qhia ntawm pathology ntawm tej internal hloov khoom nruab nrog;
• nyob rau hauv lub mob ntawm muaj quag kab mob ntawm cov pob txha;
• tus neeg mob muaj povtseg venous insufficiency.

hom ntawm daim hlau

Cov phiaj uas yog siv thaum lub sij hawm kev lag luam, yog ua los ntawm txawv hlau. Qhov zoo tshaj plaws pom tau hais tias titanium phiaj, raws li qhov no cov ntaub ntawv uas muaj ib qho kev nthuav feature: cov huab cua zaj duab xis yog tsim rau nws tam sim ntawd, uas nyob rau hauv tsis muaj txoj kev yuav tsis nrog lub cev nqaij. Nyob rau hauv cov ntaub ntawv no, muaj yog tsis muaj kev ntshai ntawm metallosis. Uas yog vim li cas muaj ntau yam ntawm cov phiaj tsis muab tshem tawm thiab tseem tshuav rau lub neej.

Submersible intraosseous osteosynthesis

Lwm lub npe rau lub lag luam - intramedullary osteosynthesis. Nws yog qhib thiab kaw. Nyob rau hauv thawj cov ntaub ntawv, ib tug puas tsam yog raug, whereupon ib tug sib piv ntawm cov tawg tsam thiab nyob rau hauv lub medullary kwj dej ntawm tus puas cov pob txha txhaj txhua yam pas nrig. Sab nraum zoov fixation tsis yuav tsum tau siv tshwj xeeb cov khoom coj mus cuag cov tawg tsam, cov txheej txheem no yog ntau yooj yim thiab ntau mus siv cuag kaw lub lag luam. Txawm li cas los, nyob rau hauv cov ntaub ntawv no nws yuav tsub kev pheej hmoo ntawm nqaij mos.

Kaw intramedullary fixation yog tsiag ntawv los ntawm qhov tseeb hais tias lawv ua ib tug sib piv ntawm cov tawg tsam, thiab ces ua ib tug me me incision deb ntawm lub pob txha lov ua qhov chaw. Nyob rau hauv X-ray tswj los ntawm no incision siv ib tug tshwj xeeb apparatus yog tswvcuab rau hauv lub medullary kwj dej ntawm ib tug puas pob txha neeg xyuas pib es ntev nws yog xim hlau hollow pas nrig uas tsim nyog hauv lub cheeb. Tom qab ntawd, tus neeg xyuas pib yog raug tshem tawm thiab lub qhov txhab yog sutured.

Submersible osteosynthesis

Yuav ua li cas yog nws? Qhov no txoj kev cov pob txha tawg tsam compound yog thov nyob rau hauv ntau cov pob txha lov (comminuted, helical, periarticular, oblique, sab, intraarticular), tsis hais txog ntawm dabtsi yog khoov thiab zoo ntawm lub medullary kwj dej. Clamps, uas yog siv rau xws li ua hauj lwm muaj qhia nyob rau hauv daim ntawv ntawm cov phiaj sib txawv thickness thiab cov duab, txuas mus rau tus pob txha siv screws. Muaj ntau niaj hnub paib yog nqa ua ke ib tug tshwj xeeb ntaus ntawv, xws li tshem tau thiab uas tsis yog-tshem. Tom qab sai, feem ntau kom txawm tias ib tug plaster cam khwb cia.

Thaum helical oblique lov thiab osteosynthesis yog feem ntau yog ua los ntawm txoj kev hlau ib daim hlab thiab hlau, raws li zoo raws li tshwj xeeb rings thiab stainless steel ib nrab-ib ncig. Qhov no txoj kev pob txha compound, tshwj xeeb tshaj yog ib tug hlau, yog tsis tshua muaj siv raws li ib qho kev ywj vim fixation yog tsis muaj zog heev thiab feem ntau ua hauj lwm pab raws li ib tug ntxiv rau lwm yam kev osteosynthesis.

Qhov no lub lag luam yog heev tsis tshua muaj siv mos suture (txhob lo lo ntxhuav, catgut, dacron), vim hais tias xws filaments yog tsis muaj peev xwm mus tiv thaiv cov npag traction thiab xaav thooj.

Submersible transosseus osteosynthesis

Tej phais repositioning los ntawm txoj kev bolts, screws, spokes, thiab cov clamps yog nqa tawm nyob rau hauv kosopoperechnom los yog transversely los ntawm cov pob txha phab ntsa rau hauv lub qhov chaw ntawm kev raug mob. Ib tug tshwj xeeb ntawm osteosynthesis chreskostnogo ib tug pob txha rau ob leeg - qhov no yog thaum cov tawg tsam muaj drilled raws thiab los ntawm lawv siv ligatures (catgut, txhob lo lo ntxhuav, hlau), uas ces ceev thiab khi. Nws yog siv thaum tus pob txha ob leeg puas ntawm cov olecranon los yog patella. Transosseous osteosynthesis muab rau tus imposition ntawm cov cam khwb cia.

Sab nraum zoov fixation

Qhov no repositioning yog ua los ntawm txhais tau tias ntawm tshwj xeeb pab kiag li lawm (Ilizarov apparatus, Volkova - Oganessian). Qhov no pub rau ib tug sib piv ntawm cov tawg tsam tsis muaj raug tus kab mob ntawm cov pob txha lov ua qhov chaw thiab txhim kho lawv nrees. Cov txheej txheem no yog nqa tawm tsis muaj tus imposition ntawm gypsum, thiab cov Ilizarov apparatus mus ko taw tso cai rau koj taug kev mus rau tus neeg mob nrog ib tug tag nrho cov load.

teeb meem

Tom qab lub lag luam yuav ua mob loj teeb meem. Cov kev tshwm sim:

• tsis yog xaiv cov txheej txheem fixation ntawm cov pob txha tawg tsam;
• instability matched pob txha khib nyiab;
• tsis paub kev kho mob ntawm cov nqaij mos;
• incorrectly khaws lub xauv;
• uas tsis yog raws kev cai nrog aseptic thiab antiseptic.

Cov teeb meem ua rau kom tsis puas zoo, nws fester los sis tag nonunion.

Txij li thaum lub submersible osteosynthesis siv ntev loj heev daim hlau thiab las tus pob txha rau qhov no rau ib tug deb, nws yog feem ntau cuam tshuam cov ntshav txaus, uas ua rau yus qeeb tom qab zoo. Tom qab tshem tawm cov screws yog heev heev qhov, uas tsis muaj zog hauv lub pob txha.

xaus

Yog li ntawd, peb tau sib tham txog ib tug txheej txheem xws li osteosynthesis. Yuav ua li cas yog nws? Nws yog lub feem ntau niaj hnub txoj kev mus cuag cov pob txha tawg tsam tom qab ib tug puas. Ua tsaug rau nws, tus txheej txheem ntawm kev kho mob thiab kev ncaj ncees ntawm cov neeg mob nrog ceev ho. DVR osteosynthesis siv ntau fixatives. Nws yog suav hais tias yog feem ntau check titanium phiaj, uas yuav tsis txawm tua.