NjengoFonitator wangaphakathi, ipuleti lokuxutshwa lihlala lidlale izindima ezibalulekile ekwelashweni kwe-Fracture. Eminyakeni yamuva nje, umqondo wokuhlasela okuncane ngokweqile kwe-osteosynthesis ubuqonde kakhulu futhi wasebenza, kancane kancane ukusuka ekugcizeleleni kwangaphambilini kumakhenikhali wemvelo wokugcizelela ukulungiswa kwethambo kanye nokuhlinzekwa kwezicubu ezithambile, kodwa futhi kuthuthukisa ukuthuthukiswa kwamasu okuhlinza kanye nokulungiswa kwangaphakathi.Ukukhiya ipuleti lokucindezela(I-LCP) uhlelo olusha lwePlate Fiftation System, elakhiwa ngesisekelo sepuleti elishukumisayo elishukumisayo (DCP) kanye neplate ye-Chontic Compression yePlate (LC Uhlelo lwaqala ukusetshenziswa emtholampilo ngoMeyi 2000, seluthole imiphumela engcono emtholampilo, futhi imibiko eminingi inikeze ama-appraisals ngakho. Yize kunezindlela eziningi zokulungiswa kwayo kokuqhekeka, zinezidingo eziphakeme kubuchwepheshe kanye nesipiliyoni. Uma kusetshenziswe ngokungafanele, kungahle kube khona okulimazayo, futhi kuholele emiphumeleni engathandeki.
1. Izimiso ze-biomechanical, design kanye nezinzuzo ze-LCP
Ukuqina kweplate evamile yensimbi kususelwa ekuxabaneni phakathi kwepuleti nethambo. Izikulufo ziyadingeka ukuthi ziqiniswe. Lapho izikulufo zikhululekile, ukungqubuzana phakathi kwepuleti nethambo kuzoncishiswa, ukuqina kuzokwehliswa, okuholela ekwehlulekeni kokulungiswa kwangaphakathi.I-LCPiyipuleti yokusekelwa entsha ngaphakathi kwezicubu ezithambile, ezithuthukiswa ngokuhlanganisa ipuleti nokusekelwa kwendabuko. Isimiso saso sokulungiswa asithembeli ekuphambukeni phakathi kwepuleti ne-cortex yamathambo, kepha sincike ekuqineni kwe-angle phakathi kwepuleti kanye nezikulufo ezikhiya kanye namandla ahlanganayo phakathi kwezikulufo kanye ne-bone cortex, ukuze afeze ukulungiswa kwe-cortex. Inzuzo eqondile ilele ekunciphiseni ukuphazanyiswa kwegazi le-periosteal. Ukuqina kwe-angle phakathi kwepuleti nezikulufo zithuthukise kakhulu amandla okubamba izikulufo, ngakho-ke amandla okulungiswa kwepuleti likhulu kakhulu, elisebenza emathanjeni ahlukahlukene. [4-7]
Isici esiyingqayizivele se-LCP Design yiyona "umgodi wokuhlanganisa", okuhlanganisa izimbobo zokucindezela ezinamandla (DCU) ngezimbobo ezihlanganisiwe ze-conical. I-DCU ingabona ukucindezelwa okuxakile ngokusebenzisa izikulufa ezijwayelekile, noma ukuphahlazeka okubalekile kungacindezelwa futhi kulungiswe ngesikulufa se-lag; Umgodi we-conical threaded unemicu, engakhiya isikulufa kanye ne-nati's threaded latch, udlulise i-torque phakathi kwesikulufa nepuleti, kanye nengcindezi ende ingadluliselwa ohlangothini lwe-fracture. Ngaphezu kwalokho, i-groove yokusika iklame ngezansi kwepuleti, elinciphisa indawo yokuxhumana nethambo.
Ngamafuphi, inezinzuzo eziningi ngaphezulu kwamapuleti endabuko: ② Yehlisa ingozi yokulahleka kokunciphisa: Asikho isidingo sokwenza ukudonsela okunembile kwangaphambili kwangaphambili amapuleti, kunciphisa ubungozi bokulahleka kokuncishiswa kwesigaba sokuqala kanye nesigaba sesibili sokunciphisa ukuncipha; . ④ inemvelo enhle yokubamba: Kusebenza ikakhulukazi kwithambo le-osteoporosis fracture, kunciphisa izehlakalo zokukhululwa kwesikulufa nokuphuma; ⑤ Ivumela umsebenzi wokuzivocavoca wokuqala; ⑥ Inezinhlobonhlobo zezicelo: Uhlobo lwepuleti nobude buqediwe, i-anatomical ebunjiwe yinhle, engabona ukulungiswa kwezingxenye ezahlukahlukene nezinhlobo ezahlukahlukene.
2. Izinkomba ze-LCP
I-LCP ingasetshenziswa njengepuleti elijwayelekile lokucindezela noma njengokusekelwa kwangaphakathi. Udokotela ohlinzayo nawo angahlanganisa konke, ukuze andise kakhulu izinkomba zawo futhi asebenze kumaphethini amakhulu okuqhekeka.
2.1 Ukuqhekeka okulula kwe-diaphysis noma i-metaphysis: Uma umonakalo wezicubu ezithambile awunzima futhi ithambo linekhwalithi enhle, ukuqhekeka okulula okwenziwe ngamathambo amade, futhi uhlangothi olufushane lwe-oblique ludinga ukucindezelwa okuqinile, ngakho-ke i-LCP ingasetshenziswa njengepuleti yokucindezela kanye noma ipuleti noma ipuleti lokungathathi hlangothi.
2.2 UFractures ovuthiwe we-diaphysis noma i-metaphyseal: I-LCP ingasetshenziswa njengepuleti yebhuloho, elisebenzisa ukuncishiswa okungaqondile kanye nebhuloho osteosynthesis. Akudingi ukwehliswa kwe-anatomical, kepha kumane kululaze ubude be-LIMEB, ukujikeleza kanye ne-axial Force Line. Ukuqhekeka kweRadius ne-Ulna kuhlukile, ngoba umsebenzi wokujikeleza kwezingalo uncike kakhulu ku-anatomy ejwayelekile ye-radius ne-ulna, okufana nokuqhekeka kwe-intra-articular. Ngaphandle kwalokho, ukuncishiswa kwe-anatomical kumele kwenziwe, futhi kuzolungiswa kahle ngamapuleti ..
2.3 Ukuqhekeka kwe-Intra-articular fractures kanye nokuqhekeka kwe-inter-articular fractures: Ekuqhekekeni kwe-Intra-articular, asidingi kuphela ukwenza ukuncishiswa kwe-anatomical ukubuyisa ubushelelezi be-articular komhlaba, kodwa futhi kudingeka bacindezele amathambo ukuze bazuze ukulungiswa okuzinzile, futhi kuvumela ukuzivocavoca okusebenzayo. Uma ama-articular fractures anemithelela emathanjeni, i-LCP ingalungisaindawo yokuhlanganaphakathi kwe-arficular ne-diaphysis encishisiwe. Futhi asikho isidingo sobumba ipuleti ekuhlinzweni, okunciphise isikhathi sokuhlinzwa.
2.4 Ibambezele inyunyana noma i-nonunion.
2.5 kuvaliwe noma vula i-osteotomy.
2.6 Akusebenzi ekuxhumekeniI-intramenduvary kilingI-Fracture, ne-LCP yindlela ehlukile ehlukile. Isibonelo, i-LCP ayinakuvalwa ukulimala kokulimala kwezingane noma intsha, abantu abanezimboni zabo ezinamapuleji zincane kakhulu noma zibanzi kakhulu noma zingalungiswa.
2.7 Iziguli ze-Osteoporosis: Njengoba i-cortex yamathambo incane kakhulu, kunzima epuletini lendabuko ukuze lithole ukuqina okuthembekile, okuye kwandisa ubunzima bokuhlinzwa kwe-fracture, futhi kwaholela ekwehlulekeni ngenxa yokulungiswa okulula. I-LCP Lock Screw ne-Anchor yePlate yakha ukuqina kwe-angle, bese kuhlanganiswa izinzipho zeplate. Ngaphezu kwalokho, ububanzi be-mandrel bokukhiya isikulufa bukhulu, bandisa amandla amakhulu wethambo. Ngakho-ke, izehlakalo ze-Screw Soning zincishiswa ngempumelelo. Ukuzivocavoca umzimba kusenesikhathi kuvunyelwe ekusebenzeni ngemuva. I-Osteoporosis iyinkomba eqinile ye-LCP, futhi imibiko eminingi ikunikeze ukuqashelwa okuphezulu.
2.8 I-Periprosthetic Feacracture Fracture: I-Periprosthetic Femoral Fractures imvamisa ihambisana ne-osteoporosis, izifo ezikhulile kanye nezifo ezibucayi zohlelo. Amapuleti endabuko angaphansi kokuvela okubanzi, ebangela umonakalo ongaba khona ekunikezelweni kwegazi kwama-fractures. Ngaphandle kwalokho, izikulufo ezijwayelekile zidinga ukulungiswa kwe-bicortical, okubangela ukulimala ku-bone cement, futhi amandla okugcwala we-osteoporosis nawo ampofu. I-LCP namapuleti e-liss axazulula izinkinga ezinjalo ngendlela enhle. Lokho kusho ukuthi, bamukela ubuchwepheshe be-MIPO ukunciphisa imisebenzi ehlanganayo, banciphise umonakalo ekuhlinzekeni kwegazi, bese kuthi isikulufo esisodwa sokukhiya i-cortical singanikeza ukulimala okwanele, okungeke kubangele ukulimala ku-Bone Cement. Le ndlela ifakwa ngendlela elula, isikhathi esifushane sokusebenza, ukopha okuncane, ibanga elincane lokukhipha kanye nokwenza lula ukuphulukiswa kokuphulukisa. Ngakho-ke, ama-periprosthetic femoral fractures nawo angenye yezinkomba eziqinile ze-LCP. [1, 10, 11]
3. Amasu okuhlinza ahlobene nokusetshenziswa kwe-LCP
3.1 Ubuchwepheshe bokucindezela kwendabuko: yize umqondo wokulungiswa kwangaphakathi kwe-AO ushintshe futhi ukuhlinzekwa kwegazi kwamathambo okuvikela nezicubu ezithambile ngeke kunganakwa ngenxa yokuqina kokulungiswa, okufana nokuphazamiseka kwe-intra-articular, ukulungiswa okulula noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufushane noma okufingqiwe. Izindlela zokuncipha yilezi: ② Njengepuleti lokuvikela, i-LCP isebenzisa izikulufo ze-lag ukulungisa ama-fractures amade; ③ Ngokwamukela umthetho webhendi yengxabano, ipuleti libekwe ohlangothini lwe-tureon lwethambo, luzofakwa ngaphansi kwengxabano, futhi ithambo le-cortical lingathola ukucindezelwa; ④ njengeplanethi ye-butterress, i-LCP isetshenziswa ngokubambisana nezikulufo ze-lag zokulungiswa kokuqhekeka kwezingalo.
3.2 Ibhuloho Lokulungiswa Kwezinhlelo: Okokuqala, yamukela indlela yokuncipha engaqondile yokusetha kabusha ukwaphuka, indawo yonke ezindaweni zokuphuka ngebhuloho bese ilungisa izinhlangothi zombili zokuphuka. Ukuncishiswa kwe-anatomic akudingekile, kepha kudinga kuphela ukululama kobude bedayi, ukujikeleza kanye nokuphoqelela umugqa. Ngaleso sikhathi, ukuxhunyelelwa kwamathambo kungenziwa ukukhuthaza ukwakheka kwe-callus futhi kukhuthaze ukuphulukiswa kokuphulukisa. Kodwa-ke, ukulungiswa kwebhuloho kungafinyelela nje ukuqina okuhlobene, nokho ukuphulukiswa kokuqhekeka kutholakala ngokusebenzisa amabinzana amabili ngenhloso yesibili, ngakho-ke kusebenza kuphela kuma-fractures asusiwe.
3.3 Ubuchwepheshe obuncane bokuhlasela iplasithosi Izimiso ziye zaziwa kabanzi emhlabeni, futhi imiphumela yemitholampilo ingcono kunezindlela zokwelashwa zangaphambilini. Kodwa-ke, ukuthola ukuncishiswa kwe-anatomic nokulungiswa kwangaphakathi, kuvame ukudinga ukuvela okubanzi, okuholela ekunciphiseni ithambo elincishisiwe, kunciphise ukunikezwa kwegazi kwezingcezwana zokutheleleka kanye nobungozi obukhulayo bokutheleleka. Eminyakeni yamuva nje, izifundiswa ezifuywayo nezakwama-phesheya zikunaka kakhulu ubuchwepheshe obuhlaselayo, ukuvikela ukuhlinzekwa kwegazi kwezicubu ezithambile kanye nethambo lezihlakala ezikhuthaza izingcezwana zangaphakathi, hhayi ukuphoqa ukuncishiswa kwezingcezu ze-fracture. Ngakho-ke, ivikela imvelo yemvelo yokuqhekeka, okungukuthi i-osteosynthesis yemvelo (bo). Ngeminyaka yama-1990s, iKrettek iphakamise ubuchwepheshe be-MIPO, okuyinqubekela phambili entsha yokulungiswa kokuqhekeka eminyakeni yamuva. Ihlose ukuvikela ukuhlinzekwa kwegazi kwamathambo okuvikela izicubu nezicubu ezithambile ngokulimala okuncane kuze kube sezingeni eliphakeme kakhulu. Indlela ukwakha umhubhe ongenambhalo ngokuvela okuncane, beka amapuleti, bese wamukela amasu wokunciphisa okungaqondile wokuncishiswa kokuqhekeka nokulungiswa kwangaphakathi. I-angle ephakathi kwamapuleti e-LCP izinzile. Noma amapuleti awaboni ngokugcwele ukwakheka kwe-anatomical, ukuncishiswa kwe-fracture kusengagcinwa, ngakho-ke izinzuzo ze-MiPo Technology zivelele kakhulu, futhi kungukufaka okuhle kobuchwepheshe be-MIPO.
4. Izizathu kanye ne-countermeasure yokwehluleka kwe-LCP application
4.1 Ukwehluleka kokulungiswa kwangaphakathi
Zonke izimila zinokukhulula, ukuthutha, ukuqhekeka kanye nezinye izingozi zokwehluleka, ukukhiya amapuleti kanye ne-LCP akuzona okuhlukile. Ngokwemibiko yezincwadi, ukwehluleka kokulungiswa kwangaphakathi akubangelwa ikakhulukazi yipuleti uqobo, kodwa ngoba izimiso eziyisisekelo zokwelashwa kwe-Fracture zephulwa ngenxa yokuqonda okunganele nolwazi lwe-LCP Fiftation.
4.1.1. Amapuleti akhethiwe amafushane kakhulu. Ubude bepuleti kanye nokusatshalaliswa kwesikulufa yizici ezibalulekile ezithinta ukuqina kokulungiswa. Ngaphambi kokuvela kobuchwepheshe be -IMiPo, amapuleti amafushane anganciphisa ubude be-incision kanye nokuhlukaniswa kwezicubu ezithambile. Amapuleti amafushane kakhulu azonciphisa amandla ama-axial kanye namandla okuhlola ekwakhekeni okuphelele okuphelele, okuholela ekwehlulekeni kokulungiswa kwangaphakathi. Ngokuthuthukiswa kobuchwepheshe bokunciphisa okungaqondile nobuchwepheshe obuhlaselayo obuncane, amapuleti amade ngeke akhuphule ukuvela kwezicubu ezithambile. Odokotela abahlinzayo kufanele bakhethe ubude bepuleti ngokuya nge-biomechanics of Fracture Fiftation. Okokuphazamiseka okulula, isilinganiso sobude obuhle sepuleti kanye nobude bendawo yonke yokuqhekeka kufanele kube ngaphezulu kwezikhathi ezingama-8-10, kanti ngokuqhekeka okususiwe, lesi silinganiso kufanele sibe ngaphezulu kwezikhathi ezingama-2-3. . Ngokusho kwemiphumela yokuhlaziywa kwe-LCP Fite Element, lapho igebe phakathi kwezinhlangothi ze-fracture lingu-1mm, uhlangothi lwe-fracture lushiya umgodi owodwa wepuleti, ukucindezela epuletini lokucindezela kunciphisa ama-10%, futhi ukucindezela ngezikulufo kunciphisa ama-63%; Lapho uhlangothi lwe-Fracture lushiya izimbobo ezimbili, ukucindezela epuletini lokucindezela kunciphisa ukuncishiswa kwama-45%, futhi ukucindezela ngezikulufo kunciphisa ama-78%. Ngakho-ke, ukugwema ukugxila kwengcindezi, ukuqhekeka okulula, izimbobo ezi-1-2 eziseduze nezinhlangothi ze-fracture kuzoshiywa, kanti izikulufu ezintathu ezihlanganisiwe, kunconyelwa izikulufa ezintathu, izikulufo ezintathu zizosondela ekuqhekekeni.
4.1.2 Igebe phakathi kwamapuleti kanye nethambo lethambo liyeqisayo. Lapho i-LCP yamukela ubuchwepheshe bebhuloho le-Bridge, amapuleti awadingeki ukuthi axhumane ne-periosteum ukuvikela ukulethwa kwegazi kwe-fracture zone. Kungokwesigaba sokulungiswa okunwebekile, okuvuselela amandla wesibili okukhula kwe-callus. Ngokutadisha ukuqina kwe-biomechanical, ahmad m, uNanda R [16] et al uthole ukuthi lapho igebe phakathi kwe-LCP nethambo likhulu kune-5mm, ama-axial kanye namapheya amapuleti ancipha kakhulu; Lapho igebe lingaphansi kwe-2mm, akukho ukwehla okubalulekile. Ngakho-ke, igebe linconyelwa ukuba ngaphansi kwe-2mm.
4.1.3 Ipuleti liphambuka kusuka ku-axis yedayidi, futhi izikulufo zilandelana kokulungisa. Lapho i-LCP ihlanganiswe nobuchwepheshe be-MIPO, amapuleti ayadingeka ukufakwa kwe-Percutaneounaneounaneounaneourg, futhi kwesinye isikhathi kunzima ukulawula isikhundla sepuleti. Uma i-axis yamathambo ingaqhathaniswa ne-axis yepuleti, ipuleti elide lingaphambukela e-axis yamathambo, okuzoholela ekulungiseni okulungile kwezikulufo kanye nokulungiswa okubuthakathaka. [9,15]. Kunconywa ukuthatha ukuvela okufanele, kanti ukuhlolwa kwe-X-ray kuzokwenziwa ngemuva kwesikhundla sokuthinta umunwe kufanelekile futhi kulungile
4.1.4 Yehlulekile ukulandela imigomo eyisisekelo yokwelashwa kokuphuka futhi ukhethe i-Fishator engaphakathi nezobuchwepheshe bokulungisa. Okwe-intra-articular fractures, i-LCP elula yokuqhekeka, i-LCP ingasetshenziswa njengepuleti lokucindezela ukulungisa ukuqina okuphelele kokuqina nge-compression technow Okwe-metaphyeeal noma ovuthiwe, ubuchwepheshe bokulungiswa kwebhuloho kufanele busetshenziswe, banake ukuhlinzekwa kwegazi kwethambo lokuvikelwa nezicubu ezithambile, vumela ukulungiswa okuzinzile kokuqhekeka, kuvuse ukukhula kwe-callus ukufeza ukuphulukiswa kokuqina kwesibili. Ngokuphambene nalokho, ukusetshenziswa kobuchwepheshe be-Bridge Fix Technology ukwelapha ama-fractures alula kungadala ukuphazamiseka okungazinzile, okuholele ekuphulukeni okubambezelekile; [17] Ukuphishekela ukukhubazeka okwedlulele kokuncishiswa kwe-anatomical kanye nokucindezelwa ezinhlangothini ze-fracture kungadala ukulimala kwamathambo egazi, okuholela ekubambezeleni inyunyana noma ungenza.
4.1.5 Khetha izinhlobo ezingafanele zesikulufa. I-LCP Combination Hole ingahle ibekwe ngezinhlobo ezine zezikulufo ezinama-cortical Izikulufo zokuzibamba / zokuzishaya zivame ukusetshenziswa njengezikulufo ze-unicortical ukulungisa ama-diaphyseal ajwayelekile amathambo amathambo. Ithiphu yayo yesipikili inomklamo wephethini we-drill, okulula ukudlula kwi-cortex ngokuvamile ngaphandle kwesidingo sokulinganisa ukujula. Uma i-diaphyseal pulp cavity incane kakhulu, isikulufa nut kungenzeka ingalingani ngokuphelele isikulufa, bese isikulufa ithiphu ithinta i-cortex yama-cortex, bese kuthi umonakalo wokuhlehlisa ama-cortex athinta amandla aphakathi kwezikulufo namathambo, kanye nezikulufo zokuzishaya nge-bicortical zizosetshenziswa ngalesi sikhathi. Izikulufo ezihlanzekile ze-Unicortical zinamandla amahle agxile emathanjeni ajwayelekile, kepha amathambo e-osteoporosis ajwayele ukuba ne-cortex ebuthakathaka. Njengoba isikhathi sokusebenza kwezikulufo sinciphisa, ingalo yesikhathi sokumelana nesikulufu sokuya ngokugoba siyancipha, okuholela kalula ku-screw cutting bone cortex, isikulufa ukukhulula nokuthungwa kwesibili. . Ngaphezu kwakho konke, ithambo elijwayelekile lingasebenzisa izikulufo ze-Unicortorical ukulungisa, kepha amathambo e-osteoporosis anconyelwa ukusebenzisa izikulufa ze-bicortical. Ngaphezu kwalokho, i-Humerus Bone Cortex incane, ibangela kalula incision, ngakho-ke izikulufo ze-bicortical ziyadingeka ukulungisa ukwelapha ama-fractures ahunyuthelayo.
I-4.1.6 Ukusatshalaliswa kwesikulufa kuyaminyene kakhulu noma kuncane kakhulu. Ukulungiswa kwesikulufa kuyadingeka ukuze kuhambisane ne-fracture biomechanics. Ukusatshalaliswa kwesikulufu okuminyene kuzoholela ekuhluthelweni kwengcindezi yendawo kanye nokuqhekeka kokulungiswa kwangaphakathi; Izikulufo ezingezinhle kakhulu ze-Fracture futhi amandla anele okusebenza nawo azoholela ekwehlulekeni kokulungiswa kwangaphakathi. Lapho ubuchwepheshe bebhuloho busetshenziswa ekuhlelweni kokuqhekeka, isikulufa esinconyiwe kufanele kube ngaphansi kwama-40% -50% noma ngaphansi. [7,13,15] Ngakho-ke, amapulathi ahle isikhathi eside, ukuze andise ukulingana kwama-mechanics; Izimbobo ezi-2-3 kufanele zishiyelwe izinhlangothi ze-fracture, ukuze zivumele ukugcwala kwepuleti enkulu, gwema ukugxila kwengcindezelo futhi unciphise izehlakalo zokuqhekeka kokulungiswa kwangaphakathi. UGautier noSommer [15] bacabanga ukuthi okungenani izikulufo ezimbili ze-Unicortical zizolungiswa ezinhlangothini zombili ze-fractures, inani elikhulayo le-cortex elungisiwe ngeke linciphise ukubhekelwa ezinhlangothini zombili zokuqhekeka. Okungenani izikulufa ezi-3-4 ziyadingeka ezinhlangothini zombili ze-humerus kanye ne-forearm fracture, kuzokwenziwa imithwalo eminingi ye-torsion.
4.1.7 Izinsizakusebenza zokulungiswa zisetshenziswe ngokungafanele, okuholela ekwehlulekeni kokulungiswa kwangaphakathi. USommer C [9] uvakashele iziguli eziyi-127 ezinamacala angu-151 we-Fracture asebenzise i-LCP ngonyaka owodwa, imiphumela yokuhlaziywa ikhombisa ukuthi phakathi kwezikulufo ezikhiyiwe ezingama-700, kukhululwa izikulufa ezimbalwa ze-3.5mm. Isizathu sokusetshenziswa okushiywe kokukhiya isikulufu sokuvala ukubona. Eqinisweni, isikulufa sokukhiya kanye neplate asikho mpo ngokuphelele, kepha khombisa ama-degree angama-50 we-angle. Lo mklamo uhlose ukunciphisa ukucindezelwa kwesikulufa sokukhiya. Ukusetshenziswa okushiywe kwedivaysi yokubona kungashintsha isigaba sezipikili futhi ngenxa yalokho kubangela ukulimala kwamandla okulungiswa. I-Kääb [20] iqhube isifundo sokuhlola, yathola i-angle phakathi kwezikulufu namapuleti e-LCP inkulu kakhulu, futhi amandla acwebile ancipha kakhulu.
4.1.8 I-LIMB SOUCHING i-LEAD isencane kakhulu. Imibiko eminingi emihle kakhulu iqondisa odokotela abaningi ngokweqisa bakholelwa amandla amapuleti okukhiya nezikulufo kanye nokuqina kwephutha, bakholelwa ngephutha ukuthi amandla okufakwa kwamapuleti agcwele akwazi ukuthwala isisindo esigcwele, okuholele ekutheni ipuleti noma ku-screw fractures. Ngokusebenzisa i-Bridge Fixent Fractures, i-LCP iqinile, futhi iyadingeka ukwakha i-callus ukuze ibone ukwelashwa ngobuqili besibili. Uma iziguli ziphuma embhedeni kusenesikhathi futhi zilayishe isisindo ngokweqile, ipuleti nesikulufa zizophulwa noma zikhishwe. Ukufakwa kokulungiswa kwepuleti kukhuthaza umsebenzi wokuqala, kepha ukulayisha okuphelele kancane kancane kuzoba amaviki ayisithupha kamuva, futhi amafilimu we-X-ray akhombisa ukuthi uhlangothi lwe-Fracture luveza izingcingo ezibalulekile. [9]
4.2 I-tendon nokulimala kwe-neurovascular:
Ubuchwepheshe be-MIPO budinga ukufakwa kwe-percutaneounaneounaneous futhi kufakwe ngaphansi kwemisipha, ngakho-ke lapho kufakwa izikulufu zeplate, odokotela abahlinzayo abakwazanga ukubona isakhiwo esibi, futhi ngenxa yalokho umonakalo we-tendon no-neurovascular akhuphukile. IVan Hensbroek PB [21] ibike icala lokusebenzisa ubuchwepheshe be-Liss ukusebenzisa i-LCP, okuholele ekutheni i-artterior tibial artery pseudoaneysms. I-AI-Rashid M. [22] et al ibikiwe ukuthi yaphathwe ukuncipha okubambezelekile kwe-Extensor Tendon Secondary Fractures nge-LCP. Izizathu eziphambili zomonakalo yi-Iatrogenic. Owokuqala umonakalo oqondile olethwe ngezikulufo noma i-kirschner pin. Okwesibili kuwumonakalo odalwe ngumkhono. Futhi owesithathu umonakalo owenziwe ngokumba izikulufo zokuzishaya. [9] Ngakho-ke, odokotela abahlinzayo bayadingeka ukuthi bajwayele i-anatomy ezungezile, banake ukuvikela i-narculis nezakhiwo ezibalulekile, benza ngokugcwele ukuhlukaniswa okufushane ekubekeni imikhono, gwema ukucindezela noma ukucindezelwa kwe-nerve. Ngaphezu kwalokho, lapho ushayela izikulufo zokuzishaya, sebenzisa amanzi ukunciphisa ukukhiqizwa kokushisa nokwehlisa ukuncipha kokushisa.
4.3 Ukutheleleka KwamaSayithi Ukuhlinzwa Nokuvezwa Kwepuleti:
I-LCP uhlelo lwangaphakathi lwe-Fishator lwenzeka ngaphansi kwesizinda sokuqhakambisa umqondo omncane wokuhlasela, okuhlose ukunciphisa umonakalo, ukunciphisa ukutheleleka, ukungazinzi nezinye izinkinga. Lapho ehlinzwa, kufanele sinake ngokukhethekile izicubu ezithambile zezicubu, ikakhulukazi izingxenye ezibuthakathaka zezicubu ezithambile. Uma kuqhathaniswa ne-DCP, i-LCP inobubanzi obukhulu nobukhulu obukhulu. Lapho usebenzisa ubuchwepheshe be-MIPO ngokufakwa kwe-percutaneour noma i-intramuscular, kungadala ukungqubuzana kwezicubu noma ukulimala kwe-aurion futhi kuholele ekuthelelekeni ngamanxeba. UPhinit P [23] wabika ukuthi uhlelo lwe-Liss luphathe amacala angama-37 e-Proximal Tibia Fractures, kanye nezehlakalo zokutheleleka okujulile kwe-postoperative kwafika ku-22%. I-Namazi H [24] ibike ukuthi i-LCP ibiphatha amacala angama-34 e-tibial shaft fracture yamacala angama-34 we-metaphyeeal fracture ye-tibia, kanye nezimo zokutheleleka kwenxeba lokulimala kanye nokuvezwa kwepuleti kwakufika ku-23.5%. Ngakho-ke, ngaphambi kokusebenza, amathuba kanye noFidator wangaphakathi kufanele acatshangwe ngokuhambisana nomonakalo wezicubu ezithambile kanye nezinga lobunkimbinkimbi bokuqhekeka.
4.4 Isifo se-Mitretable Bowel Syndrome yezicubu ezithambile:
Phinit P [23] reported that the LISS system had treated 37 cases of proximal tibia fractures, 4 cases of postoperative soft tissue irritation (the pains of subcutaneous palpable plate and around the plates), in which 3 cases of plates are 5mm away from the bone surface and 1 case is 10mm away from the bone surface. I-Hasenbooehler.e [17] et al-et I-LCP yaphathe amacala angama-32 e-distal tibial fractures, kufaka phakathi amacala angama-29 wokungakhululeki kwe-malleolus. Isizathu ukuthi ivolumu yepuleti likhulu kakhulu noma amapuleti afakwa ngokungafanele futhi izicubu ezithambile zincipha eMedial Malleolus, ngakho-ke iziguli zizozizwa zingakhululekile lapho iziguli zigqoke amabhuzu aphezulu futhi zicindezela isikhumba. Izindaba ezimnandi ukuthi ipuleti le-metaphyeeal elisha elisanda kusulwa yi-synthes lincane futhi linamathela endaweni yamathambo ngemiphetho ebushelelezi, eye yaxazulula ngempumelelo le nkinga ngempumelelo.
4.5 Ubunzima ekususeni izikulufo ezikhiyiwe:
Izinto ze-LCP zenzelwe amandla aphezulu titanium, zinokuhambisana okuphezulu nomzimba womuntu, okulula ukugcwala yi-callus. Ekususeni, ukususa okokuqala kwe-callus kuholela ebunzimeni obukhulayo. Esinye isizathu sokususa ubunzima silele ngokweqile kwezikulufo ezikhiyayo noma ukulimala kwe-nati, okuvame ukubangelwa ukufaka esikhundleni sedivayisi yokuvala isikulungi eshiywe. Ngakho-ke, idivaysi ebonakalayo izosetshenziswa ekwamukeleni izikulufa ezikhiyiwe, ukuze imicu yesikulufo ingafakwa kahle ngentambo yepuleti. [9] Instranct ethize iyadingeka ukuthi isetshenziswe ezikulumweni eziqinisa amandla, ukuze ilawula ubukhulu bamandla.
Ngaphezu kwakho konke, njengepuleti yokucindezela kwentuthuko yakamuva ka-Ao, i-LCP inikeze inketho entsha ekwelashweni kwanamuhla kokuhlinzwa kwama-fractures. Kuhlanganiswe nobuchwepheshe be-MIPO, i-LCP ihlanganisa igcina ukuhlinzekwa kwegazi ezinhlangeni ezihlaselwe kakhulu, kuthuthukisa ubungozi bokutheleleka kanye nokuqhekeka, ngakho-ke inethemba lokuhlaselwa, ngakho-ke linamathemba wohlelo lokusebenza olubanzi ekwelashweni kwe-Fracture. Njengoba uhlelo lokusebenza, i-LCP ithole imiphumela emisha yomtholampilo yesikhashana, kepha ezinye izinkinga ziyavezwa. Ukuhlinzwa kudinga ukuhlelwa okuningiliziwe okubunguwe kanye nokuhlangenwe nakho okubanzi komtholampilo, ukhetha ama-Fishar Featy Okwenziwa kanye nobuchwepheshe ngokwesisekelo sezici zokuqhekeka okuthize, kunamathela kwizimiso eziyisisekelo zendlela efanelekile futhi ezimile, ukuze uvikele izinkinga futhi uthole imiphumela efanele yokwelapha.
Isikhathi sePosi: Jun-02-2022
