骨折愈合Fracture healing.docx
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骨折愈合Fracture healing.docx
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骨折愈合Fracturehealing
骨折愈合(Fracturehealing)
Generalfracturehealingschedule:
Fracturesitehealingtime(week),fracturesitehealingtime(unit:
week)
Phalanx(metacarpalbone)4-8
Pelvic6-10
Phalanx(metatarsus)6-8
Femoralneck12-24
Commonfracturehealingtimeunit:
Week
Fracturetype-spiralorlongoblique:
upperlimbclinicalhealing3,firmheal6
Lowerlimbclinicalhealing6,firmhealing12
Fracturetypetransversesection:
upperlimbclinicalhealing6,firmunion12
Lowerlimbclinicalhealing12,firmhealing24
Note:
suitablefortubularbone;childrenhealhalftime
Howlongisthefracturehealingtime?
Inordertopromotefracturehealingfasterandbetter,fracturehealingtimeisfaster.
Fracturepatientsshouldalsobebasedonfracturehealingintheearly,middleandlatethreestages,accordingtothedevelopmentofthedisease,withdifferentfood,inordertopromotetheabsorptionofhematomaorcallusformation.
Thefracturehealingtimeisearly:
thewoundedpartbloodstasisswelling,themeridianobstruction,thebloodandQiblock,thisstagetreatmenttoinvigoratethecirculationofbloodstasis,themaingasdissipation.Atthisstage,thedietavailable3710grams,angelica10grams,1pigeonstew,cookedmeat,soupand,1timesadayfor7-10days.
Thehealingtimeoffractureisinthemiddlestage:
mostofthebloodstasisisabsorbed,andthetreatmentofthisgroupismainlytorelievepain,removebloodstasis,producenewboneandreinforcebone.Thedietconsistsoflightintohighnutritionalsupplements,tomeettheneedsofthegrowthofcallus,canbebonesoup,chicken,animalliver,Tianqipotintheearlydaysofthediet,inordertosupplymorevitaminA,d,
Calciumandprotein.
Thefracturehealingtimeislate:
after5weeksofinjury,thehematomainthefracturesiteisabsorbedbasically,andthecallushasalreadybeguntogrow.Thisisthelaterstageoffracture.ThetreatmentshouldbeupbyTonifyingtheliverandkidney,Qiandblood,topromotecallusformation,moresolidandShujin,adjacentjointfracturecanmakeflexiblemovement,restorefunction.
Criteriaforfracturehealing
(1)standardofclinicalhealing;
1.fracturedepartmentdoesnothavetenderness,andalonglimblongitudinalaxisdoesnothavepercussionpain.
2.raisingyouraffectedlimbswithoutdiscomfort.
3.twisttheaffectedlimbwithproperstrength,andthereisnoabnormalmotionatthefracture.
4.X-rayshowedthefracturelinewasvagueandtherewasacontinuouscallusthroughthefractureline.
5.externalfixationaftertheliftingoftheinjuredlimbcanmeetthefollowingrequirementsofupperlimbcanforwardflat1kgweightupto1minutes;thelowerlimbscannotcrutchesinthegroundfor3minuteswalk,notlessthan30.
6.continuousobservationfortwoweeks,fracturewithoutdeformation.
Thedeterminationof3,5andtwoitemsmustbecareful.Theycanbepracticedforafewdaysandthenmeasured,inordernottodamagethecallus.
(two)fracturehealingcriteria;
1.haveclinicalhealingcriteria.
2.X-rayshowedthefracturelinedisappearedornearlydisappeared.
*generalinternalfixation(needle)wasremovedin1to2years.
*patientswithfracturesofthefemoralshaftshouldbeprotectedwithabracefor3monthsandavoidmovementduringthefirsthalfoftheyear,dependingonthemajorityofthefracturesoccurringwithin3monthsaftertheoperation.Intheleghasthesteelneedlethefracture,hasnottaken,ismoreafraidtofall!
Thetimeoffracturehealingisverycomplicated,
Althoughinrecentyears,withthedevelopmentofscienceandtechnology,manynewtechnologiessuchastheapplicationofradioactiveisotope,electronmicroscopy,histochemistry,immunologyandgeneengineeringhasdonealotofresearchonthemechanismoffracturehealing,ofwhichthenumberoflinkshasamorein-depthunderstanding,butsomemechanismisnotyetfullyunderstood.Generallyspeaking,thewholeprocessoffracturehealingisdividedinto6stages:
impact,induction,inflammation,cartilage,callusandreconstruction.Thehistologicalprocessischaracterizedbyhematoma,inflammation,periostealreaction,chondrogenesis,endochondralossificationandboneformation.However,thefracturehealingprocessisnotexactlythesameatdifferentfracturesitesorunderdifferenttreatmentconditions,andcanbebroadlydividedintothefollowingconditions.
1.thehealingoflongtubularbonewithanexternalperiosteum
Generallyspeaking,fracturehealingistheprocessofcallusformationandreconstruction,whichcanbedividedinto4periods.
1.1repairperiodofgranulationtissue
Afterfracture,besidesthedestructionofthenormalstructureofbone,thesurroundingsofttissueisalsodamaged.Periosteumwasraisedortearandbonesurfaceseparation,themembraneofboneintobonebloodvessels,bonenutritionarteryandHaversiancanalfracture,alargeamountofbloodgatheredatthefractureend(femoralfracturebleedingabout1000ml,pelvicfractureismorethan1000ml)toformthehematoma,6~8hisformedinthecoagulationblockcontainingfibrinnetworkthe.Themacrophages,capillaries,andimmatureconnectivetissuearoundthehematomarapidlygrowintothehematoma,whichmainlydividesintofibroblaststhatproducecollagenfibrils.
Thelocalosteonecrosisoccurredatthefracturesitebecauseoftheinterruptionofbloodinthebone,
Rapidasepticinflammationoccursaroundthebleedingandnecroticareas.Multinucleatedcellsandmacrophagesinvadethenecroticareaandremovetheredbloodcells,hemoglobin,collagen,andbonefragmentsfromthefractureend.Thedeadboneisremovedbyosteoclasts.Asthehematomaisremovedandintensified,theingrowthofnewbloodvesselsandtheproliferationoflargenumbersofinterstitialcellsaroundthevesselleadtotheformationofgranulationtissueinitiallyassociatedwiththefractureends.Thisprocessiscompletedapproximately2-3weeksafterfracture.
1.2primarycallusformationstage
Theexternalperiosteumplaysanimportantroleinthehealingofthiskindoffracture.Byformingthebridge,thecallushastheabilitytostabilizethefractureends.Inthe24hafterfracture,theouterperiosteumnearthefractureendbegantohyperplasiaandhypertrophy,andthentheperiostealvascularnetworkwasbentandexpanded,andthenewbloodvesselsenteredtheperiosteumandbegantointernalizethebone.DeepPeriostealOsteoblastProliferationrapidly,inafewdays,formaringobviousperiosteumdeepcellsnearthefractureline,andfirmlyattachedtothebonecortexonthefractureliveordead,thisistheperiostealcallus(ratfracturethirddaymembraneboneformationofbonescab).Theperiostealcalluscontinuestogrowandstopsuntilabout8-9days,waitingforthecartilagetomature.Onthethirdday,granulationtissuemesenchymalcellshavebeenstrippedofcalminperiostealfracture,betweentheproliferationofmesenchymalcellsdifferentiateintocartilagecellsfifthdaysbegantoformcollagen,withthegerminationandgrowthofcapillaries,penetratetheperiostealfibermembraneintocartilageandendochondralboneformationbegan,finallyformabridgeinthefractureend,periostealcallusisthebridgeabutment(abutment).Meanwhile,
Bonemarrowandinternalperiosteumformedendochondralbonethroughendochondralossificationandendochondralossification.Withtheoperationofthehematoma,thefibroustissueisconnectedwiththeinternalandexternalcallusthroughossificationofthecartilage,andtheinitialhealingisachieved.
Theproliferationofosteoblastsoutsidetheperiosteumisevidentinthesofttissuerichareas,especiallyatthemuscleattachments,becausethisisthesourceofthebloodsupplyofthecallus.Thisisthereasonfortheabsenceofanexternalcallusatthefrontofthetibiaandthepresenceofbonycallusattheposteriorandothersites.Theangiographyofthecallusalsoillustratesthisproblem.Mostofthebloodsupplyoftheexternalcallusoriginatesfromtheextraperiostealtissue,especiallythemusclesaroundthefractureend.Theamountofcallusformationdependsontheextentandintegrityofperiosteuminjury.Thefibroustissueformedbythehematomaattheendofthefractureandtheperiosteumthathasbeenstrippedismostlyconvertedtoatemporarycartilageandeventuallyreplacedbybone.Theprocessofchondrocyteproliferation,degeneration,ossificationandosteogenesisiscalledendochondralossification.Thisprocessissimilartoendochondralossificationprocessofepiphysealgrowthplate.Chondrocytesarealsothrough4developmentalphase,RobertofNewZealandrabbitsfracturecallusindifferentperiodsweredividedintomorphologicalseparationmodel,undifferentiatedgranulationtissue,hyperplasiaoffibroustissue,cartilagecallusandcalluscalcification.Biochemicalanalysisofthe4morphologicaltissuesshowedthat,intermsofbiochemicalactivity,the4tissuesweresimilartothe4bandsinthegrowthplate.
1.3matureboneformationstage
Inthisstage,thenewbonetrabeculaincreasesgradually,andthearrangementbecomesregular.Thenecroticpartofthefractureendinvadesthroughthebloodvessel,theosteoblastandtheosteoclast,andcompletestheremovalofthedeadboneandthecreepingsubstitutionprocess.
Thecallusossificationandendochondralossificationformationinthefilm,itisnaivetoreticulatedbone,hardnessandstrengthisnotenough,alsoneedtobeconvertedintoamorematurestructure,graduallybyosteoclastswasremoved,lamellarbonesubstitute,thisprocessneeds8-12weeks.Theinitiallamellarboneandbonewiththeimmaturereticulartrabecularbonebecamethicker,
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