I-fractures evulekile yalimala amathambo okwenzeka lapho amathambo aphukile evezwa emzimbeni kuya endaweni ezungezile. I-fractures evulekile , ngezinye izikhathi ebizwa ngokuthi i-fracture ye-compound, ingenzeka uma kunesikhumba esincane esikhunjeni esivumelana nokuphuka, noma singase senzeke ngokulimala okunamandla okwesibindi okusongela ukusinda kwesitho.
Ngomzamo wokwenza lo mkhuba ukulimala, ngokuvamile bahlukaniswa ngokweqile.
Uhlelo oluvame kakhulu ukuhlukanisa ukuvuleka okuvulekile kulandela uhlelo lokuhlukanisa i-Gustilo-Anderson.
Amabanga we-Open Fractures
- I-Grade I Vula ukuhlukana
Iphutha lokuvuleka kwesigaba I kwenzeka uma kunesilonda lesikhumba esikhuluma ngokulinganisa ukuhlukana okungaphansi kwesentimitha esisodwa. Ngezinye izikhathi kunzima ukuhlola uma kuvulwe ukuphuka (okusho ukuthi isilonda sixhuma esitheni esiphukile), kodwa lokhu kungathathwa ngokujova uketshezi kusayithi lokuqhekeka, futhi ubone uma umkhuhlane uphuma esivinini. - I-Grade II I-Open Fracture
Ama-fractures weBanga II anezikhukhula ezincane ezithambile, ezilinganisa ngaphezu kwamamentimitha amabili. - I-Grade III I-Fracture evulekile
Ukuhlukunyezwa kweBanga III kuvame ukulimala kanzima futhi kufaka phakathi izinhlobo ezintathu ezimele zokulimala:- I-Grade IIIA: I-3A fractures yilokho okulimala okubandakanya ukuqhuma okukhulu kwamandla njengoba kuboniswa ukulimala okukhulu kwamathambo (ama-segmental noma ama-fractures amakhulu) kanye / noma enkulu, evame ukungcola, amanxeba amancane. Odokotela abaningi abahlinzayo bahlukanisa ama-fracture aphezulu njengama-3A ngisho noma isilonda sesikhumba asikhulu.
- I-Grade IIIB: I-3B i-fractures ine-umonakalo / ukulahlekelwa okuyisisindo esibonakalayo esithambile esifana nesifuba, futhi ukwakha kabusha kungadinga ukudluliselwa kwamathambo okuthutha (i-flap) okwenziwe ukuze kuhlanganiswe isilonda.
- I-Grade IIIC: I-3C ye-fracture ifuna ukungenelela kwe-vascular njengoba i-fracture ihlotshaniswa nokulimala kwamathambo emkhawulweni.
Indlela Ukuqoqa Kuyasiza Ngayo
Uhlelo lwe-Gustilo-Anderson lokuhlukanisa luwusizo kakhulu ekunikezeni izingcezu ezimbili zolwazi: yikuphi amathuba okuthuthukisa ukutheleleka, nokuthi kuzothatha isikhathi esingakanani ukuphulukiswa ukuphulukiswa ukuze kwenzeke. Njengoba ibanga likhuphuka, izinga lokutheleleka likhuphuka ngokuphawulekayo, futhi isikhathi sokuphulukiswa kokuphuka siphuthuma.
Ukulimala kweGrade I evulekile kwe-Tibia kunezinga elingaphansi kuka-2% lokutheleleka (ngokuphathwa ngendlela efanele), futhi kuthatha izinyanga ezine-4-5 zokuphulukiswa. I-Grade IIIB ne-IIIC fractures inezinga elingama-50% lokutheleleka futhi kuthatha izinyanga ezingu-8-9 zokuphulukisa amathambo.
Isigaba se-Gustilo-Anderson sanyatheliswa okokuqala ngawo-1970 futhi senze izinguquko eziningana. Okuyinhloko yesistimu yokuhlukanisa ukuhlinzeka ngezigaba zokulimala ngokusekelwe ebucayi babo. Kusukela kulolu lwazi, ukuhlukana kungahlukaniswa ngezinhloso zocwaningo, futhi ulwazi lungasetshenziswa ekulimaweni okusha okusekelwe ocwaningweni olwenziwe.
Ukulinganiselwa kohlelo
Kunemikhawulo eminingana yohlelo lokuhlukanisa i-Gustilo-Anderson okufanele luqashelwa:
- Odokotela Ngokuvamile Abavumelani: Izifundo zibonise ukuthi odokotela bama-orthopedic, abawazi kahle lesi simiso sokuhlukanisa, bavumelana kuphela ebangeni lokuphuka cishe ngo-60% wesikhathi. Ngakho-ke, yimuphi omunye odokotela ohlinzayo obheka ukuhlukana kwebanga I, angase abizwe ngokuthi iBanga IIIA ngenye. Lokhu kwenza uqhathanisa idatha inselele.
- Akuklanyelwe wonke ama-Fractures avuliwe: Nakuba odokotela abaningi bebhekisela kulesi simiso sokuhlukanisa ukuchaza noma yikuphi ukuphuka okuvulekile, okokuqala kwaklanyelwe ukuchaza ama-tibia fractures avulekile, futhi kamuva, ukuvuleka kwe-bone evulekile. Lokhu akusho ukuthi angeke isetshenziselwe ukuchaza ezinye ukulimala, kodwa akusiyo indlela lolu hlelo lokuhlukanisa oluthathwa ngayo.
Kuziguli ezisekela ukuvuvukala okuvulekile, isihluthulelo somphumela ophumelelayo ukuphathwa okuphuthumayo. Ukwelapha ukuvuvukala okuvulekile kudinga ukuhlola okuphuthumayo nokuhlanzwa kwesilonda, ukwelashwa okufanele kwama-antibiotic, kanye nokuqiniswa kwephutha.
Umthombo:
I-Zalavras CG nePatzakis MJ. "Vula ama-Fractures: Ukuhlolwa Nokuphathwa" J Am Acad Orthop Surg May / Juni 2003; 11: 212-219.