Ukulimala okuvulekile ukulimala okwenzeka lapho ithambo ephukile livezwa ngesikhumba. Lokhu kungase kusho ukuthi amathambo empeleni aphumile esikhumbeni, noma kungase kusho ukuthi isikhumba nezicubu ezithambile ziphazanyiswa futhi ziveza indlela eya kwisayithi ye-fracture. Ngokuvamile okuthiwa ukuphuka kwe-composé, ukuphulwa okuvulekile kudinga ukwelashwa okuhlukile kusukela ekuvimbeni okuvame kuvaliwe .
Ukuvuleka kwama-fractures kungukukhathazeka ngoba lokhu kulimala kungaba nzima ukuphulukisa, futhi ukutheleleka kungabangela izinkinga ezinkulu ngokuphulukiswa kwethambo namathiski azungezile. Iningi lokwelashwa kokuqala kwe-fracture evulekile igxile ekuvimbeleni ukuthuthukiswa noma ukuqhubekela phambili kokutheleleka endaweni yesakhiwo.
Ukuhlanza I-Bone
Ukuhlanza ithambo kungenye yezinyathelo zokuqala zokwelapha okuvulekile. Iningi leziguli ezisekela ukuvuvukala okuvulekile ziyahlinzwa ngokubizwa ngokuthi "ukuchelela kanye ne-driridement." Ukunisela kusho ukuhlanza amathambo nesayithi lokulimala. Ukuphazamiseka kuchazwa kwisinyathelo esilandelayo.
Ukuqaphela izinga lokulimala kungaba nzima ngokubheka ukuvuleka okuvulekile. Lokhu kuyiqiniso ikakhulukazi ekulimaweni okukhulu kwamandla kuhlanganise ukushayisana kwezimoto nokulimala. Ngalolu hlobo lokulimala, ngisho nokungena okuncane esikhumbeni kungakwazi ukumboza izindawo ezinkulu kakhulu zomonakalo we-soft-tissue nxazonke ezivulekile.
Ngakho-ke, lapho uhlinzekwa ngokuhlanza ithambo, kubalulekile ukwenza lokhu ekamelweni lokusebenza (OR) ngaphansi kwe-anesthesia - ukuzama ukuhlola ngokwanele futhi ukuhlanza ithambo ekamelweni eliphuthumayo, ngaphandle kwe-anesthesia eyanele, kungenzeka ukuthi ayanele. Ngaphezu kwalokho, nakuba ukulimala esikhumbeni sekuvele kukhona, ukuqubuka okukhudlwana kungadingeka kwenziwe.
Ukususa izicubu ezingcolile noma ezingenakusebenza
Isinyathelo sesibili sokuhlinzekwa kokwelapha okuvulekile okuvulekile sabizwa ngokuthi yi- debridement . Ukuguqulwa kusho ukukhipha izinto zangaphandle (ukungcola, amatshe, izembatho, njll) kanye nezicubu ezincane ezingasebenzi. Ukunquma izicubu zomzimba kungase kube inselele, futhi lapho kuvuleka amaqabunga avulekile, kungadingeka izinqubo eziningi zokuhlinzeka ukuze kuqinisekiswe ukuthi zonke izicubu ezingenakuvikelwa zisusiwe. Indlela ejwayelekile kunazo zonke yokuthola ukuthi izicubu ziyasebenza yini ukunquma ukuthi inegazi yini. Uma kungenjalo, izicubu ngeke zenzeke, futhi ziyokwenza kuphela amathuba okuthuthukisa ukutheleleka.
Ukuqiniswa kweThambo
Ukuqinisa ithambo eliphukile kusiza ukuvimbela ukulimala okunye kwezicubu. Ukunquma indlela yokwenza ngcono ithambo kuncike eziningana zezici. Izindlela eziningi ezijwayelekile zokusimamisa ithambo, njengezicabha kanye nezilonda noma izindonga ze-intramedullary , zingase zingabi izinketho ezinhle uma kunethuba eliphezulu lokungcoliswa kwamagciwane emanxebeni. Ezingxenyeni eziningi ezivulekile, idivayisi ebizwa ngokuthi i- fixator yangaphandle izosetshenziselwa ukuzinzisa lezi zilimaza. Izilungisi zangaphandle zinezinzuzo ezimbalwa ezihlukile kulokhu kulungiselelwa:
- Zingasetshenziswa ngokushesha, okuvame ukudingeka ngokuhlukunyezwa okukhulu.
- Bavumela isilonda ukuba sithandeke.
- Bavikela ithambo ngaphandle kokubeka izinto zangaphandle ngqo endaweni yokulimala.
Ukunquma uhlobo olufanele lokulungiswa ukuvuleka okuvulekile kuxhomeke endaweni kanye nobukhulu bokulimala, phakathi kwezinye izici.
Ukulawulwa kwama-antibiotic
Ama-antibiotics angenye yezingxenye ezibaluleke kakhulu zokwelashwa kwe-fracture evulekile. Ukunquma i-antibiotic efanelekile kuncike ekutheni luhlobo nobunzima bokulimala. Uma ukulimala kwenzeka endaweni engcolile, njengengozi yokulima, kucatshangelwa okukhethekile uma ukhetha imithi elwa namagciwane.
Ama-antibiotics kufanele alawulwe ngokushesha ngangokunokwenzeka, ngisho nangaphambi kokwenza ukuchelela nokukhathala okuchazwe ngenhla. I-antibiotics ivame ukuqhubeka ngamahora angu-48. Uma kukhona ukutheleleka okunye okusolakala ukuthi, ama-antibiotic angase aqhutshwe ngisho nangaphezulu.
Isikhathi sezehlakalo
Kungakanani okuphuthumayo ukuphuka okuvulekile okumele kube khona kuyindaba yokuphikisana phakathi kwama-orthopedists. Ngokwesiko, kwakuyizinga elijwayelekile ukuqinisekisa ukuthi zonke iziphuzo ezivulekile zahlinzwa ngokuhlinzwa ngaphakathi kwamahora angu-6 okulimala.
Muva nje, abanye odokotela abahlinzayo banomuzwa wokuthi ukuqhuma okuvulekile, ikakhulukazi, ukuhlukana kwesandla, kungase kungavumelekile ukuthi ukwelashwa okuphuthumayo, futhi ukwelashwa kungabambezeleka. Ngaphezu kwalokho, ingxabano ingenziwa ukuthi ukugijimela ku-OR ngethimba lokushaya ucingo phakathi nobusuku kungenzeka ukuthi akuphephile njengokulinda kuze kube usuku olulandelayo ukwenza ukuhlinzwa okuvulekile okuvulekile.
Amagciwane amaningi avumelana ukuthi ukuphuka okuvulekile ngamunye kudinga ukuphathwa ngokushesha futhi ngokuphepha. Uma ukwelashwa okuphephile kuhilela ukubambezeleka isikhathi esingaphezu kwamahora angu-6, lokho kungase kube kufanele, kodwa kwezinye izimo, ukwelashwa okuphephile ukuletha isiguli ku-OR ngokushesha ngangokunokwenzeka. Kungakhathaliseki ukuthi yikuphi, ukuvuvukala okuvulekile kukhona izimo eziphuthumayo ze-orthopedic, futhi ukuhlolwa akufanele kubambezeleke.
Ukubikezelwa kwe-Open Fractures
Ukubikezelwa kokuvuvukala okuvulekile kuncike ebukhulu bokulimala. I-Fractures evuliwe ihlelwa iBanga I, iBanga lesi-II, neBanga III, ngokulimala kwamandla kanye nesisindo somzimba esifanayo njengoba ukwanda kukhula. Ukulimala kweBakala I kuvame ukuphulukisa njengokuphuka okuvame ukuvalwa. Ukulimala kweBanga III kunengozi enkulu yokutheleleka kanye nokungabambisani futhi kungathatha isikhathi eside ukuphulukiswa.
Abantu abahlala behluleka ukuvuvukala bangalindela ukuphulukiswa kwabo ukuphuka kuthatha isikhathi eside, futhi ukutakula kwabo kube yisikhathi eside kunokuba kube njalo ngokuhlukana okuvaliwe.
Imithombo:
I-Zalavras CG nePatzakis MJ "I-Open Fractures: Ukuhlolwa Nokuphathwa" J Am Acad Orthop Surg May / June 2003; 11: 212-219.
Werner CM, et al. "Ukuphuthuma kokuPhuthukiswa kokuThuthukiswa kokuThuthukiswa kweMisebenzi yokuPhulwa kwamaFree Open" IJ Am Acad Orthop Surg ngoJulayi 2008; 16: 369-375.