Ukuqhekeka okuvulekileyo kukulimala okwenzekayo xa ithambo elaphukileyo libonakaliswe ngesikhumba. Oku kusenokuthi ukuba ithambo empeleni likhupha ngaphandle kwesikhumba, okanye lithetha ukuba ulusu kunye nezicubu ezinotshontsho ziphazamiseka kwaye zibonisa indlela eya kwisiza seqhekeza. Ngokuqhelekileyo kuthiwa i-cround break, i-fracture evulekile ifuna unyango olwahlukileyo kwixesha elivame ukuvalwa .
Ukuvulwa kwamaqabunga kuyinkxalabo kuba le nzakala inokuba nzima ukuphilisa, kwaye intsholongwane ingabangela iingxaki ezibalulekileyo ngokuphilisa amathambo kunye nezicubu ezijikelezayo. Uninzi lwonyango lokuqala lwe-fracture evulekileyo lujoliswe ekukhuseleni ukuphuhliswa okanye ukuqhubela phambili kwintsholongwane kwisayithi seqhekeza.
Ngokucoca i-Bone
Ukucoceka ithambo lelinye lamanyathelo okuqala ekuphuleni ukuvuleka okuvulekileyo. Uninzi lwezigulane eziqhubekayo ziqhekeka zivuliwe phantsi kokuhlinzwa okubizwa ngokuba "ukunkcenkceshela kunye nokuxiliswa." Ukunkcenkceshela kuthetha ukuhlamba ithambo kunye nesiza sokulimala. I-Debridment ichazwe kwisinyathelo esilandelayo.
Ukuqaphela ubungakanani bentsholongwane kunokuba nzima ngokujonga i-fracture evulekile. Oku kuyinyani ngokukodwa kwiimpazamo zamandla aphezulu kuquka ukuhlaselwa kwezimoto kunye namanxeba. Ngale ntlobo yokwenzakalisa, kwanokungenwa kwamancinci kwesikhumba kunokufikelela kwimimandla emikhulu yomonakalo we-soft-tissue kwi-fracture evulekile.
Ngako oko, xa ugqirha lokucoca ithambo, kubalulekile ukwenza oku kwigumbi lokusebenza (OR) phantsi kwe-aneshesia - ukuzama ukuvavanya ngokufanelekileyo kwaye uhlambulule ithambo ekamelweni eliphuthumayo, ngaphandle kwe-anesthesia eyaneleyo, inokwaneleyo. Ukongeza, nangona ukulimala kwesikhumba sele kusekhona, ukukhangela okukhulu kunokufuneka kwenziwe.
Ukususwa kweeTishu eziHlangelweyo
Isinyathelo sesibini sokuhlinzwa sokuphulwa kwephulo evulekile sibizwa ngokuba yi- debridement . I-Debridment ithetha ukukhipha izinto ezivela ngaphandle (ukungcola, igravel, izambatho, njl) kunye nezicubu ezincinci. Ukuqulunqwa kokusebenza kwezicubu kunokuba ngumngeni, kwaye kwiindawo ezivulekileyo ezivulekileyo, kufuneka kwenziwe iinkqubo ezininzi zokucwangcisa ukuqinisekisa ukuba zonke izicubu ezingenakudliwa zikhutshwe. Indlela eqhelekileyo yokufumanisa ukuba izicubu ziyakwazi ukubona ukuba unayo igazi. Ukuba akunjalo, izicubu zazingenakwenzeka ukuba ziphile, kwaye ziza kuba negalelo ekuphuhliseni intsholongwane.
Ukuzinzisa iThambo
Ukuzinzisa amathambo aphulekileyo kunceda ukukhusela umonakalo olongezelelweyo lweethambo. Ukuqulunqa indlela yokwenza ngcono ukuzinzisa ithambo kuxhomekeke kwizinto eziliqela. Zininzi iindlela eziqhelekileyo zokuzinzisa ithambo, njengama- plates kunye neentloko okanye iintonga ze-intramedullary , akunakho ukukhetha ukuba kukho ithuba eliphezulu lokungcoliswa kwamagciwane kumanxeba. Kwiintlobo ezininzi ezivulekileyo, isixhobo esibizwa ngokuba ngumlondolozi wangaphandle siya kusetyenziswa ukuzinzisa le nzakala. Izilungiso zangaphandle zineenzuzo ezimbalwa ezihlukeneyo kulo mqathango:
- Zingasetyenziswa ngokukhawuleza, ezidla ngokubaluleka xa zixinzelelekileyo.
- Zivumela ukuba isilonda sixhaswe.
- Zikhusele ithambo ngaphandle kokubeka izinto zangaphandle ngqo kwindawo yokulimala.
Ukuchonga uhlobo olulungelelweyo lokulungiswa kwento evulekileyo kuxhomekeke kwindawo kunye nobukhulu bokulimala, phakathi kwezinye izinto.
Ulawulo lweeAntiyotic
I-antibiotics ingenye yezona ndawo zibaluleke kakhulu zonyango lwenkunkuma evulekileyo. Ukuqulunqa i-antibiotiki efanelekileyo kuxhomekeke kulolu hlobo kunye nobunzima bokulimala. Ukuba ukulimala kwenzeka kwindawo engcolileyo, njengengozi yokulima, kufuneka kwenziwe ingqalelo ekhethekileyo xa ukhetha i-antibiotic efanelekileyo.
Ama-antibiotics kufuneka alawulwe ngokukhawuleza, nangaphambi kokuba enze ukunkcenkceshela kunye ne-debridement echazwe ngasentla. Iimithi zonyango zihlala ziqhubeka iiyure ezingama-48. Ukuba kukho isifo esithe satshatyalaliswayo, i-antibiotics inokuthi iqhutywe kude.
Ixesha leZenzo
Ingakanani inxunguphalo yokuvuleka okuvulekileyo kufuneka ibe yimpikiswano phakathi kwama-orthopedists. Ngokwesiko, kwakunomgangatho wokuqinisekisa ukuba zonke iintambo ezivulekileyo zaqhutyelwa ngonyango ngaphakathi kweeyure ezingama-6 zenxeba.
Ngoku kutshanje, abanye oogqirha banomuvo wokuba iingubo ezivulekileyo, ngokukodwa, ukuphulwa kwesandla, akuvumelekanga ukuba unyango oluphuthumayo, kwaye unyango lunokulibaziseka. Ukongezelela, ingxabano ingenziwa ukuba iqhutywe kwi-OR kunye neqela lokubizela kwi-intanethi phakathi kobusuku ingenakukhuseleka njengoko ilinde kuze kube lusuku olulandelayo ukwenza utyando oluvuliwe.
Amathambo amaninzi avuma ukuba i-fracture nganye evulekile ifuna ukuphathwa ngokukhawuleza nangokukhuselekileyo. Ukuba unyango olukhuselekileyo lubandakanya ukulibaziseka kwexesha elingaphezu kweeyure ezingama-6, oko kuyafaneleka, kodwa kwezinye iimeko, unyango olukhuselekileyo kukufumana isigulane kwi-OR ngokukhawuleza. Ngandlela-thile, i-fracture evulekileyo yimiba ephuthumayo yomzimba, kwaye ukuvavanya akufanele kulibaziseke.
Ukuxhamlaliswa kweeFractures ezivulekileyo
Ukugxekwa kwephulo evulekileyo kuxhomekeke kubunzima bokulimala. Izahlulelo ezivulekileyo zihlelwa njengeBakala I, iBanga lesi-II, kunye neBakala III, ngokunyuka kwamandla kunye nokulimala kwesikhumba njengoko ukuhluma kwandisa. Ukulimala kweBakala I kuvame ukuphulukisa njengento eqhelekileyo evaliweyo. Ukulimala kweBakala III kunomngcipheko omkhulu wokusuleleka kunye nokungabandakanyekanga kwaye kunokuthatha ixesha elide ukuphilisa.
Abantu abahlala bevulekileyo bafuna ukuphulukana nokuphulukana nokuthatha isithuba eside, kwaye ukuphulukana kwabo kuqhubekeka ixesha elide kunokuba kunjalo nangendlela yokuvalwa kwevaliweyo.
Imithombo:
I-Zalavras CG kunye nePatzakis MJ "Izahlulo ezivulekileyo: Uvavanyo kunye noLawulo" J Am Acad Orthop Surg Meyi / Juni 2003; 11: 212-219.
Werner CM, et al. "Ukuphuthuma kokuPhepha ukuThuthukiswa kweMpahla yokuLawula kweZakhiwo ezivulekileyo" J Am Acad Orthop Surg ngoJulayi 2008; 16: 369-375.