Kev muab ntshav: Cov ntshav muab thiab periosteum xwm txheej ntawm qhov chaw tawg yog ncaj qha cuam tshuam rau kev nce qib ntawm kev kho pob txha. Yog li ntawd, ib qho kev cuam tshuam ntxiv ntawm cov ntshav hauv zos yuav tsum tau zam thaum kho pob txha. Kev siv cov - cov phaj sib chwv tsawg pab txhawb kev rov tsim cov ntshav mus rau cov pob txha hauv qab tom qab kev phais. Ntshav muab ob lub luag haujlwm tseem ceeb hauv kev tsim cov pob txha: muab cov as-ham thiab muab cov qia hlwb uas tuaj yeem sib txawv rau hauv osteoblasts. Reconstruction ntawm cov hlab ntsha puas lawm tom qab ib tug tawg yuav siv sij hawm ob peb lub lis piam, thiab callus tsim precedes tshiab hlab ntsha ingress. Yog li ntawd, thaum ntxov callus nourishment nyob ntawm qhov nthuav ntawm cov hlab ntsha uas tseem tshuav. Cells koom nrog hauv kev kho pob txha caj qaum los ntawm periosteum thiab lwm qhov chaw. Kev tshem tawm ntau ntawm periosteum thaum kho pob txha tuaj yeem ncua kev kho pob txha.
Hauv qhov tsis yog- cov pob txha tawg, cov hlab ntsha tshiab tuaj yeem tshwm sim los ntawm cov kab noj hniav medullary, thaum nyob hauv cov pob txha tawg, cov hlab ntsha tshiab uas txhawb cov callus feem ntau yog los ntawm vasculature hauv cov ntaub so ntswg ib puag ncig. Yog li ntawd, kev puas tsuaj ntawm cov leeg ib puag ncig thaum kho pob txha yog qhov tseem ceeb hauv kev kho pob txha qeeb.
Qhov cuam tshuam tseem ceeb: Kev tso rau ntawm tus ntsia thawv intramedullary cuam tshuam rau cov ntshav mus rau qhov chaw tawg mus rau qee qhov, tab sis cov ntshav yuav rov ua dua -tsim los ntawm ingrowth ntawm cov hlab ntsha los ntawm periosteum thiab ib puag ncig cov ntaub so ntswg. Rau kev qhib pob txha nrog kev raug mob hnyav, kev siv cov ntsia hlau intramedullary yuav tsum tau siv yam tsis muaj medullary reaming kom txo qis ntxiv cuam tshuam nrog cov ntshav cortical.
Kev cuam tshuam: Kev cuam tshuam ntau dhau ntawm cov pob txha tawg tuaj yeem cuam tshuam rau kev kho pob txha. Urist kwv yees tias thaum qhov sib txawv ntawm qhov tawg yog ntau dua 0.5 cm, lub sijhawm kho pob txha yuav raug ncua mus rau 12-18 lub hlis vim tias callus yuav tsum txuas qhov sib txawv loj dua. Clinically, fixation nrog cov pob txha daim hlau thiab cov ntsia hlau tuaj yeem cuam tshuam kev sib cuag tom qab cov pob txha resorption, thiab ntau dhau traction thiab cov ntaub so ntswg embedding tuaj yeem ua rau muaj qhov sib txawv loj heev. A wide fracture gap will be filled with dense fibrous tissue, hindering bone formation and ultimately leading to nonunion. Txawm li cas los xij, nyob rau hauv qhov tsim nyog txhua yam thiab kev lom neeg, kev sib koom ua ke tuaj yeem tshwm sim nyob rau hauv qhov sib txawv loj dua, hu ua kev cuam tshuam kev kho mob lossis kev kho mob ntev. Cov xwm txheej no muaj xws li: cov periosteum tsis zoo, cov ntshav zoo rau cov pob txha xaus, nruam thiab ruaj khov traction quab yuam, thiab tswj cov rog hauv lwm cov lus qhia. Nyob rau theem no, pob txha kho tau tshwm sim los ntawm intramembranous ossification, nrog cov hlwb koom nrog kev kho mob los ntawm periosteum thiab endosteum. Clinically, kev kho mob ntev yog feem ntau siv rau kev ua kom ntev ntev, kho deformity, kho qhov tsis xws luag, thiab kho qee qhov xwm txheej tsis sib xws nrog luv luv. Tsuas yog qee qhov tsis tshua muaj, xws li pob txha pob txha uas muaj qhov tsis xws luag, kev kho kom ntev ntev tsis haum rau cov pob txha tshiab.
Compression: Tsim nyog siab txhawb cov pob txha loj hlob, thaum lub siab ntau dhau tuaj yeem ua rau microfractures ntawm cov pob txha trabecular, lub zos ischemia, pob txha resorption, thiab txawm osteonecrosis. Kev ua haujlwm zoo muab kev ruaj ntseg txaus rau qhov tawg, yuav tsum muaj lub siab ntawm yam tsawg 70-120 kg / cm³. Kev ruaj ntseg ntawm cov pob txha tawg kawg tiv thaiv kev txav ntawm lawv, thiab compression kuj pab txo qhov sib txawv ntawm pob txha, tag nrho cov no muaj txiaj ntsig zoo rau kev kho pob txha.
Nyob rau hauv kev kho kom zoo compression thiab nrog cov ntshav zoo rau cov pob txha tawg, kev kho thawj zaug tuaj yeem ua tiav. Txawm li cas los xij, nws yuav tsum tau muab sau tseg tias nyob rau hauv xws li compression fixation, necrosis ntawm cov pob txha tawg tuaj yeem ncav cuag 7-12 hli, ua rau compression fixation yam tsis muaj zawv zawg qhov tseem ceeb. Qhov no tuaj yeem cuam tshuam kev sib cuag ntawm cov pob txha tawg thiab ntev lub sijhawm kho pob txha. Lwm qhov teeb meem nrog kev kho compression kiag li yog nws cov nyhuv tiv thaiv kev ntxhov siab. Hauv cov theem tom qab ntawm kev kho pob txha, cov pob txha subplate poob qhov tsim nyog kev ntxhov siab, ua rau cov pob txha hauv zos thiab cov khoom siv tsis zoo, ua rau muaj kev pheej hmoo ntawm cov phaj qaug zog thiab rov ua dua tom qab tshem cov phaj. Yog li ntawd, cov cuab yeej kho kom zoo yuav tsum tau muab tshem tawm kwv yees li ib xyoos tom qab- kev phais, lossis lub phaj-ntsia hlau nrog maj mam txo qis yuav tsum tau siv.
Kev kis kab mob: Kev kis kab mob - ua rau cov ntaub so ntswg puas tsuaj thiab lub sijhawm ntev tuaj yeem ua rau necrosis ntawm cov pob txha tawg thiab cov nqaij mos, nrog rau cov pob txha resorption. Qhov no cuam tshuam thiab ua rau cov txheej txheem kho pob txha zoo li qub, thiab hauv qhov xwm txheej hnyav, tuaj yeem nres kev puas tsuaj ntawm pob txha. Nws tuaj yeem ua rau osteomyelitis thiab tuaj yeem ua rau sequestrum thiab sinus tract tsim.
Iatrogenic Factors: Iatrogenic yam tseem ceeb suav nrog kev txo qis thiab rov ua dua, kev sib tw ntau dhau, kev rub tawm ntau dhau thaum qhib kev txo qis, kev kho tsis ruaj khov, thiab kev tawm dag zog tsis zoo.