Njenge-fixator yangaphakathi, i-compression plate ibilokhu idlala indima ebalulekile ekwelapheni ukuphuka. Eminyakeni yamuva nje, umqondo we-osteosynthesis encane kakhulu uye waqondwa futhi wasetshenziswa ngokujulile, kancane kancane ushintsha kusukela ekugcizelelweni kwangaphambilini kwemishini ye-fixator yangaphakathi kuya ekugcizelelweni kokuqina kwezinto eziphilayo, okungagcini nje ngokugxila ekuvikeleni ukuhlinzekwa kwegazi ngamathambo nezicubu ezithambile, kodwa futhi kukhuthaza ukuthuthukiswa kwamasu okuhlinzwa kanye ne-fixator yangaphakathi.Ipuleti Lokucindezela Lokukhiya(LCP) uhlelo olusha sha lokulungisa amapuleti, olwakhiwe ngesisekelo sepuleti lokucindezela elinamandla (DCP) kanye nepuleti lokucindezela elinomkhawulo lokuxhumana elinamandla (LC-DCP), futhi luhlanganiswe nezinzuzo zezokwelapha zepuleti lokuxhumana le-AO (PC-Fix) kanye neSistimu Yokuzinza Engangeni Kahle (LISS). Uhlelo lwaqala ukusetshenziswa ngokwezokwelapha ngoMeyi 2000, lwaluthole imiphumela engcono yezokwelapha, futhi imibiko eminingi inikeze ukuhlolwa okuphezulu kwalo. Nakuba kunezinzuzo eziningi ekulungiseni kwalo ukuphuka, lunezidingo eziphezulu kwezobuchwepheshe kanye nolwazi. Uma lungasetshenziswa ngendlela engafanele, lungase lube yimbangela, futhi luholele emiphumeleni engenakulungiswa.
1. Izimiso ze-Biomechanical, Umklamo kanye Nezinzuzo ze-LCP
Ukuqina kwepuleti lensimbi elijwayelekile kusekelwe ekungqubuzaneni phakathi kwepuleti nethambo. Izikulufo kudingeka ziqiniswe. Uma izikulufo sezikhululekile, ukungqubuzana phakathi kwepuleti nethambo kuzoncipha, ukuqina kuzoncipha, okuholela ekungasebenzi kahle kwe-fixator yangaphakathi.I-LCPiyipuleti elisha lokusekela ngaphakathi kwezicubu ezithambile, elithuthukiswa ngokuhlanganisa ipuleti lokucindezela lendabuko kanye nokusekela. Umgomo walo wokuqinisa awunciki ekungqubuzaneni phakathi kwepuleti kanye ne-bone cortex, kodwa uncika ekuzinzeni kwe-angle phakathi kwepuleti kanye nezikulufo ezikhiyayo kanye namandla okugcina phakathi kwezikulufo kanye ne-bone cortex, ukuze kufezwe ukulungiswa kokuphuka. Inzuzo eqondile isekunciphiseni ukuphazamiseka kokunikezwa kwegazi kwe-periosteal. Ukuqina kwe-angle phakathi kwepuleti nezikulufo kuthuthukise kakhulu amandla okugcina ezikulufo, ngakho-ke amandla okuqinisa epuleti makhulu kakhulu, okusebenza emathanjeni ahlukene. [4-7]
Isici esiyingqayizivele somklamo we-LCP "umgodi wokuhlanganisa", ohlanganisa imigodi yokucindezela enamandla (i-DCU) nemigodi enezintambo ezi-conical. I-DCU ingafeza ukucindezela kwe-axial ngokusebenzisa izikulufo ezijwayelekile, noma ukuqhekeka okususiwe kungacindezelwa futhi kulungiswe ngesikulufo esi-lag; umgodi onezintambo ezi-conical unezintambo, ezingakhiya isikulufo kanye ne-latch enezintambo ze-nut, zidlulise i-torque phakathi kwesikulufo ne-plate, futhi ukucindezeleka kwe-longitudinal kungadluliselwa ohlangothini lwe-fracture. Ngaphezu kwalokho, i-groove yokusika iklanywe ngaphansi kwe-plate, okunciphisa indawo yokuxhumana nethambo.
Ngamafuphi, inezinzuzo eziningi ngaphezu kwamapuleti endabuko: ① iqinisa i-engeli: i-engeli ephakathi kwamapuleti ezinzipho izinzile futhi iqinile, isebenza kahle emathanjeni ahlukene; ② inciphisa ingozi yokulahlekelwa ukuncipha: asikho isidingo sokwenza ukugoba okunembile kwamapuleti, kunciphisa izingozi zokulahlekelwa ukuncipha kwesigaba sokuqala kanye nesigaba sesibili sokulahlekelwa ukuncipha; [8] ③ ivikela ukunikezwa kwegazi: indawo encane yokuxhumana phakathi kwepuleti lensimbi nethambo kunciphisa ukulahleka kwepuleti kokunikezwa kwegazi kwe-periosteum, okuhambisana kakhulu nezimiso zokungena kancane; ④ inamandla okubamba kahle: isebenza ikakhulukazi emathanjeni okuphuka kwe-osteoporosis, kunciphisa ukwanda kokukhululeka nokuphuma kwezikulufo; ⑤ ivumela umsebenzi wokuzivocavoca kwasekuqaleni; ⑥ inezinhlobo eziningi zezicelo: uhlobo lwepuleti nobude buphelele, ukuma kwe-anatomical pre-shape kuhle, okungafeza ukulungiswa kwezingxenye ezahlukene kanye nezinhlobo ezahlukene zokuphuka.
2. Izinkomba ze-LCP
I-LCP ingasetshenziswa njengepuleti yokucindezela evamile noma njengokusekelwa kwangaphakathi. Udokotela ohlinzayo angakwazi futhi ukuhlanganisa kokubili, ukuze andise kakhulu izinkomba zayo futhi asebenzise ezinhlobonhlobo eziningi zamaphethini okuphuka.
2.1 Ukuphuka Okulula Kwe-Diaphysis noma i-Metaphysis: uma umonakalo wezicubu ezithambile ungemkhulu futhi ithambo linekhwalithi enhle, ukuphuka okulula okuphambene noma ukuphuka okufushane okuqondile kwamathambo amade kuyadingeka ukuze kusikwe futhi kuncishiswe ngokunembile, kanti uhlangothi lokuphuka ludinga ukucindezelwa okunamandla, ngakho-ke i-LCP ingasetshenziswa njengepuleti lokucindezelwa kanye nepuleti noma ipuleti lokungacindezeli.
2.2 Ukuqhekeka Okuhlanganisiwe kwe-Diaphysis noma i-Metaphyseal: I-LCP ingasetshenziswa njengepuleti lebhuloho, elisebenzisa ukunciphisa okungaqondile kanye ne-osteosynthesis yebhuloho. Ayidingi ukunciphisa umzimba, kodwa imane ibuyisa ubude bezitho, ukujikeleza kanye nomugqa wamandla we-axial. Ukuqhekeka kwe-radius kanye ne-ulna kuyinto ehlukile, ngoba umsebenzi wokujikeleza wamahlombe uncike kakhulu ekubunjweni okuvamile kwe-radius kanye ne-ulna, okufana nokuqhekeka kwangaphakathi kwe-articular. Ngaphandle kwalokho, ukunciphisa umzimba kumele kwenziwe, futhi kufanele kuqiniswe ngokuqinile ngamapuleti.
2.3 Ukuqhekeka Kwangaphakathi Kwethambo Nokuqhekeka Kwangaphakathi Kwethambo: Ekuqhekekeni kwangaphakathi kwethambo, asidingi nje kuphela ukwenza ukunciphisa umzimba ukuze sibuyisele ubushelelezi bomphezulu wethambo, kodwa futhi sidinga ukucindezela amathambo ukuze sifinyelele ukuqina okuzinzile nokukhuthaza ukuphulukiswa kwamathambo, futhi sivumele ukuzivocavoca kokuqala kokusebenza. Uma ukuqhekeka kwangaphakathi kwethambo kunethonya emathanjeni, i-LCP ingalungisailungaphakathi kwe-articular encishisiwe kanye ne-diaphysis. Futhi asikho isidingo sokubumba ipuleti ekuhlinzeni, okunciphise isikhathi sokuhlinzwa.
2.4 Inyunyana Ebambezelekile noma Engeyona Inyunyana.
2.5 I-Osteotomy Evaliwe noma Evulekile.
2.6 Akusebenzi ekuxhumeniukubethela ngaphakathi kwe-medullaryukuphuka, kanti i-LCP iyindlela engcono kakhulu. Isibonelo, i-LCP ayisebenzi ekuqhekekeni komonakalo womnkantsha wezingane noma intsha, abantu abanezimbobo ezincane kakhulu noma ezibanzi kakhulu noma ezingalungile.
2.7 Iziguli ze-Osteoporosis: njengoba i-bone cortex incane kakhulu, kunzima ukuthi ipuleti lendabuko lithole ukuzinza okuthembekile, okwandisa ubunzima bokuhlinzwa kokuphuka, futhi kwaholela ekwehlulekeni ngenxa yokukhululeka nokuphuma kalula kokulungiswa ngemva kokuhlinzwa. Isikulufu sokukhiya se-LCP kanye ne-plate anchor kwakha ukuzinza kwe-angle, futhi izinzipho zepuleti ziyahlanganiswa. Ngaphezu kwalokho, ububanzi be-mandrel besikulufu sokukhiya bukhulu, okwandisa amandla okubamba ethambo. Ngakho-ke, ukwanda kokukhumula kwesikulufu kuncishiswa ngempumelelo. Ukuzivocavoca umzimba kwasekuqaleni kuyavunyelwa ngemva kokuhlinzwa. I-Osteoporosis iyisibonakaliso esinamandla se-LCP, futhi imibiko eminingi iyinike ukuqashelwa okuphezulu.
2.8 Ukuqhekeka Kwesitho Sangasese: ukuqhekeka kwesitho sangasese ...
3. Amasu Okuhlinzwa Ahlobene Nokusetshenziswa kwe-LCP
3.1 Ubuchwepheshe Bokucindezela Kwendabuko: yize umqondo we-AO internal fixator ushintshile futhi ukuhlinzekwa kwegazi kokuvikela amathambo nezicubu ezithambile ngeke kunganakwa ngenxa yokugcizelela ngokweqile ukuzinza komshini wokuqinisa, uhlangothi lokuqhekeka lusadinga ukucindezela ukuze kutholakale ukuqina kwamanye ama-fracture, njengokuqhekeka kwangaphakathi kwe-articular, ukuqina kwe-osteotomy, ukuqhekeka okulula okuphambeneyo noma okufushane kwe-oblique. Izindlela zokucindezela yilezi: ① I-LCP isetshenziswa njengepuleti lokucindezela, kusetshenziswa izikulufo ezimbili ezijwayelekile ze-cortical ukuze kufakwe ngendlela engavamile kuyunithi yokucindezela eshelelayo yepuleti noma kusetshenziswa idivayisi yokucindezela ukuze kufezwe ukuqina; ② njengepuleti lokuvikela, i-LCP isebenzisa izikulufo zokulaxa ukulungisa ama-fracture amade-oblique; ③ ngokwamukela isimiso se-tension band, ipuleti libekwa ohlangothini lokucindezela lwethambo, kufanele lifakwe ngaphansi kokucindezeleka, futhi ithambo le-cortical lingathola ukucindezela; ④ njengepuleti le-buttress, i-LCP isetshenziswa kanye nezikulufo zokulaxa ukuze kufakwe ama-fracture articular.
3.2 Ubuchwepheshe Bokulungisa Ibhuloho: Okokuqala, sebenzisa indlela yokunciphisa engaqondile ukuze usethe kabusha ukuphuka, udlule ezindaweni zokuphuka ngebhuloho bese ulungisa izinhlangothi zombili zokuphuka. Ukunciphisa umzimba akudingeki, kodwa kudinga kuphela ukubuyiselwa kobude be-diaphysis, ukujikeleza kanye nomugqa wamandla. Okwamanje, ukufakelwa kwamathambo kungenziwa ukuze kukhuthazwe ukwakheka kwe-callus nokukhuthaza ukuphulukiswa kokuphuka. Kodwa-ke, ukuqina kwebhuloho kungafeza ukuzinza okulinganiselwe, kodwa ukuphulukiswa kokuphuka kufezwa ngama-callus amabili ngenhloso yesibili, ngakho-ke kusebenza kuphela kuma-fracture asele.
3.3 Ubuchwepheshe Bokwenziwa Kwe-Osteosynthesis Yepuleti Elingena Kancane (i-MIPO): Kusukela ngawo-1970, inhlangano ye-AO yabeka phambili izimiso zokwelapha ukuphuka: ukunciphisa umzimba, ukulungisa kwangaphakathi, ukuvikela ukuhlinzekwa kwegazi kanye nokuzivocavoca kokusebenza okungenabuhlungu kwasekuqaleni. Izimiso ziye zaziwa kabanzi emhlabeni, futhi imiphumela yezokwelapha ingcono kunezindlela zokwelapha zangaphambilini. Kodwa-ke, ukuthola ukunciphisa umzimba kanye nokulungisa kwangaphakathi, kuvame ukudinga ukusikwa okukhulu, okuholela ekunciphiseni ukugeleza kwamathambo, ukwehla kokuhlinzekwa kwegazi kwezingcezu zokuphuka kanye nezingozi zokutheleleka ezandayo. Eminyakeni yamuva nje, izazi zasekhaya nezaphesheya zinaka kakhulu futhi zigcizelela kakhulu ubuchwepheshe obungenaka kakhulu, zivikela ukuhlinzekwa kwegazi kwezicubu ezithambile namathambo ngesikhathi sokukhuthaza ukulungisa kwangaphakathi, hhayi ukususa i-periosteum nezicubu ezithambile ezinhlangothini zokuphuka, hhayi ukuphoqa ukunciphisa komzimba kwezingcezu zokuphuka. Ngakho-ke, ivikela indawo yezinto eziphilayo zokuphuka, okungukuthi i-osteosynthesis yezinto eziphilayo (BO). Ngawo-1990, uKrettek waphakamisa ubuchwepheshe be-MIPO, okuyintuthuko entsha yokulungisa ukuphuka eminyakeni yamuva. Ihlose ukuvikela ukuhlinzekwa kwegazi kokuvikela amathambo nezicubu ezithambile ngomonakalo omncane kakhulu. Indlela iwukwakha umhubhe ongaphansi komhlaba ngokusebenzisa ukusikwa okuncane, ukubeka amapuleti, nokwamukela amasu okunciphisa ngokungaqondile ukunciphisa ukuphuka kanye ne-fixator yangaphakathi. I-engeli phakathi kwamapuleti e-LCP izinzile. Ngisho noma amapuleti engaqapheli ngokugcwele ukwakheka komzimba, ukunciphisa ukuphuka kusengagcinwa, ngakho-ke izinzuzo zobuchwepheshe be-MIPO zivelele kakhulu, futhi kuyindlela efanele kakhulu yokufaka ubuchwepheshe be-MIPO.
4. Izizathu kanye Nezinyathelo Zokuphikisa Ukwehluleka Kwesicelo se-LCP
4.1 Ukwehluleka kwe-Internal fixator
Zonke izimila zinokukhululeka, ukufuduka, ukwaphuka kanye nezinye izingozi zokwehluleka, amapuleti okukhiya kanye ne-LCP azikho ngaphandle. Ngokusho kwemibiko yezincwadi, ukwehluleka kwe-fixator yangaphakathi akubangelwa kakhulu yipuleti uqobo, kodwa ngoba izimiso eziyisisekelo zokwelapha ukwaphuka kwephulwa ngenxa yokuqonda okunganele kanye nolwazi oluphelele mayelana nokulungiswa kwe-LCP.
4.1.1. Amapuleti akhethiwe mafushane kakhulu. Ubude bepuleti kanye nokusatshalaliswa kwezikulufo yizinto ezibalulekile ezithinta ukuzinza kokuqina. Ngaphambi kokuvela kobuchwepheshe be-IMIPO, amapuleti amafushane anganciphisa ubude bokusika kanye nokuhlukaniswa kwezicubu ezithambile. Amapuleti amafushane kakhulu azonciphisa amandla e-axial kanye namandla okugoba kwesakhiwo sonke esimisiwe, okuholela ekwehlulekeni kwe-fixator yangaphakathi. Ngokuthuthukiswa kobuchwepheshe bokunciphisa okungaqondile kanye nobuchwepheshe obungenasivikelo, amapuleti amade ngeke andise ukugoba kwezicubu ezithambile. Odokotela abahlinzayo kufanele bakhethe ubude bepuleti ngokuhambisana ne-biomechanics yokulungiswa kokuphuka. Kwama-fracture alula, isilinganiso sobude bepuleti obufanele kanye nobude bendawo yonke yokuphuka kufanele sibe ngaphezu kwezikhathi ezingu-8-10, kanti ngokwaphuka okuhlanganisiwe, lesi silinganiso kufanele sibe ngaphezu kwezikhathi ezingu-2-3. [13, 15] Amapuleti anobude obanele azonciphisa umthwalo wepuleti, anciphise umthwalo wesikulufo, futhi ngaleyo ndlela anciphise ukwanda kokuhluleka kwe-fixator yangaphakathi. Ngokusho kwemiphumela yokuhlaziywa kwe-LCP finite element, lapho igebe phakathi kwezinhlangothi zokuqhekeka lingu-1mm, uhlangothi lokuqhekeka lushiya imbobo eyodwa yepuleti lokucindezelwa, ukucindezeleka epuletini lokucindezelwa kunciphisa ngo-10%, kanti ukucindezeleka ezikulufini kunciphisa ngo-63%; lapho uhlangothi lokuqhekeka lushiya imigodi emibili, ukucindezeleka epuletini lokucindezelwa kunciphisa ukwehla ngo-45%, kanti ukucindezeleka ezikulufini kunciphisa ngo-78%. Ngakho-ke, ukuze kugwenywe ukugxila kokucindezeleka, ukuze kube nokuqhekeka okulula, kuzoshiywa imigodi engu-1-2 eduze kwezinhlangothi zokuqhekeka, kanti ukuze kube nokuqhekeka okuhlanganisiwe, kunconywa ukuthi kusetshenziswe izikulufo ezintathu ohlangothini ngalunye lokuqhekeka futhi izikulufo ezimbili zizosondela ekuqhekekeni.
4.1.2 Igebe phakathi kwamapuleti nobuso bamathambo likhulu kakhulu. Lapho i-LCP isebenzisa ubuchwepheshe bokunamathela kwebhuloho, amapuleti awadingeki ukuthi axhumane ne-periosteum ukuvikela ukuphakelwa kwegazi kwendawo yokuqhekeka. Ingokwesigaba sokuqina kwe-elastic, okukhuthaza ukushukuma kwesibili kokukhula kwe-callus. Ngokutadisha ukuzinza kwe-biomechanical, u-Ahmad M, uNanda R [16] nabanye bathole ukuthi lapho igebe phakathi kwe-LCP nobuso bamathambo likhulu kuno-5mm, amandla e-axial kanye ne-torsion amapuleti ancipha kakhulu; lapho igebe lingaphansi kuka-2mm, akukho ukwehla okuphawulekayo. Ngakho-ke, igebe linconywa ukuthi libe ngaphansi kuka-2mm.
4.1.3 Ipuleti liyaphambuka ku-axis ye-diaphysis, kanti izikulufo zihlukile ekuqineni. Uma i-LCP ihlanganisa ubuchwepheshe be-MIPO, amapuleti ayadingeka ukufakwa kwe-percutaneous, futhi ngezinye izikhathi kunzima ukulawula isikhundla sepuleti. Uma i-axis yethambo ingalingani ne-axis yepuleti, ipuleti elikude lingaphambuka ku-axis yethambo, okuzoholela ekuqineni kwe-screws okungavamile kanye nokuqina okubuthakathaka. [9,15]. Kunconywa ukuthatha i-incision efanele, futhi ukuhlolwa kwe-X-ray kuzokwenziwa ngemuva kokuba indawo yokuqondisa yokuthinta umunwe ifanele kanye nokulungiswa kwephinikhodi ye-Kuntscher.
4.1.4 Ukwehluleka ukulandela izimiso eziyisisekelo zokwelashwa kokuqhekeka bese ukhetha ubuchwepheshe obungalungile bokulungisa nokulungisa kwangaphakathi. Kuma-fracture angaphakathi kwe-articular, ama-fracture alula e-transverse diaphysis, i-LCP ingasetshenziswa njengepuleti lokucindezela ukulungisa ukuqina kokuqhekeka okuphelele ngobuchwepheshe bokucindezela, nokukhuthaza ukuphulukiswa okuyinhloko kwama-fracture; kuma-fracture e-Metaphyseal noma ama-fracture ahlanganisiwe, kufanele kusetshenziswe ubuchwepheshe bokulungisa ibhuloho, kunake ukuhlinzekwa kwegazi kokuvikela amathambo nezicubu ezithambile, kuvumele ukulungiswa okuzinzile kwama-fracture, kukhuthaze ukukhula kwe-callus ukuze kufezwe ukuphulukiswa nge-intension yesibili. Ngokuphambene nalokho, ukusetshenziswa kobuchwepheshe bokulungisa ibhuloho ukwelapha ama-fracture ahlanganisiwe ukwelapha ama-fracture ahlanganisiwe kungabangela ama-fracture angazinzile, okuholela ekuphulukisweni kokuqhekeka okubambezelekile; [17] ukuphishekela ngokweqile kwama-fracture ahlanganisiwe ukunciphisa i-anatomical kanye nokucindezelwa ezinhlangothini zama-fracture kungabangela umonakalo ekuhlinzekweni kwegazi kwamathambo, okuholela ekuhlanganisweni okubambezelekile noma ukungahlangani.
4.1.5 Khetha izinhlobo zezikulufo ezingafanele. Imbobo ehlanganisiwe ye-LCP ingafakwa izikulufo ngezinhlobo ezine zezikulufo: izikulufo ezijwayelekile ze-cortical, izikulufo ezijwayelekile zethambo elikhanseliwe, izikulufo zokuzibhoboza/ukuzithinta kanye nezikulufo zokuzithinta. Izikulufo zokuzibhoboza/ukuzithinta zivame ukusetshenziswa njengezikulufo ezi-unicortical ukulungisa ukuphuka okuvamile kwe-diaphyseal kwamathambo. Isihloko sayo sezinzipho sinomklamo wephethini yokubhoboza, okulula ukuwudlula ku-cortex ngokuvamile ngaphandle kwesidingo sokulinganisa ukujula. Uma umgodi we-pulp ye-diaphyseal umncane kakhulu, i-screw nut ingase ingalingani ngokugcwele nesikulufo, futhi i-screw tip ithinta i-cortex engezansi, khona-ke umonakalo we-cortex eqondile eqondile uthinta amandla okubamba phakathi kwezikulufo namathambo, kanti izikulufo zokuzithinta ezi-bicortical kufanele zisetshenziswe ngalesi sikhathi. Izikulufo ezihlanzekile ezi-unicortical zinamandla amahle okubamba amathambo ajwayelekile, kodwa ithambo le-osteoporosis livame ukuba ne-cortex ebuthakathaka. Njengoba isikhathi sokusebenza sezikulufo sincipha, ukumelana kwengalo yesikulufo ekugobeni kuyancipha, okuholela kalula ekusikeni kwe-cortex yethambo, ukukhululeka kwesikulufo kanye nokuhlukana kwesibili kokuphuka. [18] Njengoba izikulufo ze-bicortical zandise ubude bokusebenza kwezikulufo, amandla okubamba amathambo nawo ayanda. Ngaphezu kwakho konke, ithambo elivamile lingasebenzisa izikulufo ze-unicortical ukulungisa, kodwa ithambo le-osteoporosis liyanconywa ukusebenzisa izikulufo ze-bicortical. Ngaphezu kwalokho, i-humerus bone cortex incane kakhulu, ibangela kalula ukusikwa, ngakho-ke izikulufo ze-bicortical ziyadingeka ukulungisa ekwelapheni ukuphuka kwe-humeral.
4.1.6 Ukusatshalaliswa kwesikulufo kukhulu kakhulu noma kuncane kakhulu. Ukufakwa kwesikulufo kuyadingeka ukuze kuhambisane ne-biomechanics yokuphuka. Ukusatshalaliswa kwesikulufo okukhulu kakhulu kuzoholela ekugxilweni kokucindezeleka kwendawo kanye nokuqhekeka kwesikulufo sangaphakathi; izikulufo zokuphuka ezincane kakhulu kanye namandla okuqina anganele nakho kuzoholela ekuhlulekeni kwesikulufo sangaphakathi. Lapho ubuchwepheshe bebhuloho busetshenziswa ekugxilweni kokuqhekeka, ubuningi besikulufo obunconywayo kufanele bube ngaphansi kuka-40% -50% noma ngaphansi. [7,13,15] Ngakho-ke, amapuleti made kakhulu, ukuze kwandiswe ibhalansi yemishini; kufanele kushiywe izimbobo ezingu-2-3 ezinhlangothini zokuqhekeka, ukuze kuvunyelwe ukuqina okukhulu kwepuleti, kugwenywe ukugxila kokucindezeleka futhi kuncishiswe ukwanda kokuqhekeka kwesikulufo sangaphakathi [19]. UGautier noSommer [15] bacabanga ukuthi okungenani izikulufo ezimbili ezingaphansi kwe-unicortical zizoqiniswa ezinhlangothini zombili zokuqhekeka, inani elandayo le-cortex eqondile ngeke linciphise izinga lokuhluleka kwamapuleti, ngakho-ke okungenani izikulufo ezintathu zinconywa ukuthi zifakwe ezinhlangothini zombili zokuqhekeka. Kudingeka okungenani izikulufo ezingu-3-4 kuzo zombili izinhlangothi ze-humerus kanye nokuphuka kwengalo, imithwalo eminingi yokugoba kufanele ithwalwe.
4.1.7 Imishini yokulungisa isetshenziswa ngendlela engafanele, okuholela ekungasebenzi kahle kwe-fixator yangaphakathi. U-Sommer C [9] uvakashele iziguli ezingu-127 ezinezimo zokuphuka ezingu-151 ezisebenzise i-LCP unyaka owodwa, imiphumela yokuhlaziya ikhombisa ukuthi phakathi kwezikulufo zokukhiya ezingu-700, zimbalwa izikulufo ezinobubanzi obungu-3.5mm ezikhululekile. Isizathu ukusetshenziswa kwedivayisi yokubona izikulufo zokukhiya okuyekiwe. Eqinisweni, isikulufo sokukhiya kanye nepuleti akuqondile ngokuphelele, kodwa kubonisa ama-degree angu-50 e-engeli. Lo mklamo uhlose ukunciphisa ukucindezeleka kwesikulufo sokukhiya. Ukusetshenziswa okushiywe kwedivayisi yokubona kungashintsha indlela yezipikili futhi ngaleyo ndlela kubangele umonakalo emandleni okulungisa. U-Kääb [20] wayesenze ucwaningo lokuhlola, wathola ukuthi i-engeli ephakathi kwezikulufo namapuleti e-LCP inkulu kakhulu, ngakho-ke amandla okubamba ezikulufo ancishisiwe kakhulu.
4.1.8 Ukulayisha isisindo semilenze kusenesikhathi kakhulu. Imibiko eminingi emihle iqondisa odokotela abaningi ukuba bakholelwe kakhulu amandla amapuleti okukhiya nezikulufo kanye nokuqina kokuqina, bakholelwa ngephutha ukuthi amandla amapuleti okukhiya angathwala umthwalo wesisindo esigcwele kusenesikhathi, okuholela ekuqhekekeni kwepuleti noma kwezikulufo. Ekusebenziseni ukuqhekeka kokuqina kwebhuloho, i-LCP izinzile, futhi iyadingeka ukwakha i-callus ukuze kufezwe ukuphulukiswa ngokusebenza kwesibili. Uma iziguli zivuka embhedeni kusenesikhathi futhi zilayisha isisindo esiningi, ipuleti nesikulufo kuzophuka noma kukhishwe i-plug. Ukufakwa kwepuleti lokukhiya kukhuthaza umsebenzi wasekuqaleni, kodwa ukulayisha okuphelele kancane kancane kuzoba ngemva kwamasonto ayisithupha, futhi amafilimu e-x-ray abonisa ukuthi uhlangothi lokuqhekeka luveza i-callus ebalulekile. [9]
4.2 Ukulimala Kwemisipha Nemithambo Yezinzwa:
Ubuchwepheshe be-MIPO budinga ukufakwa kwe-percutaneous futhi bubekwe ngaphansi kwemisipha, ngakho-ke lapho kufakwa izikulufo zepuleti, odokotela abahlinzayo babengenakukwazi ukubona isakhiwo esingaphansi kwesikhumba, ngaleyo ndlela umonakalo we-tendon kanye ne-neurovascular uyanda. UVan Hensbroek PB [21] ubike icala lokusebenzisa ubuchwepheshe be-LISS ukusebenzisa i-LCP, okwaholela ekuqhekekeni kwe-anterior tibial artery pseudoaneurysms. U-AI-Rashid M. [22] nabanye babike ukuthi baphatha ukuqhekeka okulibazisekile kwe-extensor tendon okubangelwa ukuqhekeka kwe-distal radial nge-LCP. Izizathu eziyinhloko zomonakalo ziyi-iatrogenic. Eyokuqala umonakalo oqondile olethwa yizikulufo noma iphini likaKirschner. Eyesibili umonakalo obangelwa yi-sleeve. Kanti owesithathu umonakalo oshisayo odalwa ukubhoboza izikulufo ezizithintayo. [9] Ngakho-ke, odokotela abahlinzayo kudingeka bajwayelane nokwakheka komzimba okuzungezile, banake ukuvikela i-nervus vascularis nezinye izakhiwo ezibalulekile, benze ngokugcwele ukuhlukaniswa okubuthuntu ekubekeni imikhono, bagweme ukucindezelwa noma ukudonswa kwemizwa. Ngaphezu kwalokho, lapho ubhoboza izikulufo zokuzithinta, sebenzisa amanzi ukunciphisa ukukhiqizwa kokushisa nokunciphisa ukuqhutshwa kokushisa.
4.3 Ukutheleleka Kwendawo Yokuhlinzwa Nokuchayeka Eplatini:
I-LCP uhlelo lwe-fixator lwangaphakathi lwenzeka ngaphansi kwesizinda sokukhuthaza umqondo ongangenisi kakhulu, ohlose ukunciphisa umonakalo, ukunciphisa ukutheleleka, ukungahlangani nezinye izinkinga. Ekuhlinzeni, kufanele sinake kakhulu ukuvikelwa kwezicubu ezithambile, ikakhulukazi izingxenye ezibuthakathaka zezicubu ezithambile. Uma kuqhathaniswa ne-DCP, i-LCP inobubanzi obukhulu kanye nobukhulu obukhulu. Uma kusetshenziswa ubuchwepheshe be-MIPO bokufakwa kwe-percutaneous noma kwe-intramuscular, kungabangela ukuqhekeka kwezicubu ezithambile noma ukulimala kwe-avulsion futhi kuholele ekuthelelekeni kwenxeba. I-Phinit P [23] ibike ukuthi uhlelo lwe-LISS lwelaphe amacala angu-37 okuqhekeka kwe-proximal tibia, kanti ukusabalala kokutheleleka okujulile ngemuva kokuhlinzwa kwafinyelela ku-22%. I-Namazi H [24] ibike ukuthi i-LCP yelaphe amacala angu-34 okuqhekeka kwe-tibial shaft kwamacala angu-34 okuqhekeka kwe-metaphyseal ye-tibia, kanye nokusabalala kokutheleleka kwenxeba ngemuva kokuhlinzwa kanye nokuvezwa kweplate kwafinyelela ku-23.5%. Ngakho-ke, ngaphambi kokuhlinzwa, amathuba kanye ne-fixator yangaphakathi kufanele kucatshangelwe kakhulu ngokuhambisana nomonakalo wezicubu ezithambile kanye nezinga lobunzima bokuqhekeka.
4.4 Isifo Samathumbu Esicasulayo Sezicubu Ezithambile:
UPhinit P [23] ubike ukuthi uhlelo lwe-LISS lwelaphe amacala angu-37 okuphuka kwe-tibia eseduze, amacala amane okucasuka kwezicubu ezithambile ngemuva kokuhlinzwa (ubuhlungu bepuleti elizwakalayo elingaphansi komhlaba kanye naseduze kwamapuleti), lapho amacala amathathu amapuleti eqhele ngama-5mm ukusuka ebusweni bethambo kanti icala elilodwa liqhele ngama-10mm ukusuka ebusweni bethambo. UHasenboehler.E [17] nabanye babike ukuthi i-LCP yelaphe amacala angu-32 okuphuka kwe-tibial ekude, okuhlanganisa namacala angu-29 okungakhululeki kwe-medial malleolus. Isizathu ukuthi ivolumu yepuleti inkulu kakhulu noma amapuleti abekwe ngendlela engafanele futhi izicubu ezithambile zincane ku-medial malleolus, ngakho-ke iziguli zizozizwa zingakhululekile lapho iziguli zigqoke amabhuzu aphezulu futhi zicindezela isikhumba. Izindaba ezinhle ukuthi ipuleti le-metaphyseal elisanda kususwa elakhiwe yi-Synthes lincane futhi linamathela ebusweni bethambo elinemiphetho ebushelelezi, okuye kwaxazulula ngempumelelo le nkinga.
4.5 Ubunzima Ekususeni Izikulufu Zokukhiya:
Izinto ze-LCP zinomuthinithi onamandla aphezulu, zihambisana kakhulu nomzimba womuntu, okulula ukupakishwa yi-callus. Ekususeni, ukususa i-callus kuqala kuholela ebunzimeni obukhulu. Esinye isizathu sokususa ubunzima sisekuqineni kakhulu kwezikulufo zokukhiya noma umonakalo we-nut, okuvame ukubangelwa ukufaka idivayisi yokubona isikulufo sokukhiya esishiywe dengwane ngedivayisi yokubona ngokwayo. Ngakho-ke, idivayisi yokubona kufanele isetshenziswe ekusebenziseni izikulufo zokukhiya, ukuze imicu yesikulufo ikwazi ukunamathela kahle ngemicu yepuleti. [9] Kudingeka i-wrench ethile ukuze isetshenziswe ekuqiniseni izikulufo, ukuze kulawulwe ubukhulu bamandla.
Ngaphezu kwakho konke, njengepuleti yokucindezela yentuthuko yakamuva ye-AO, i-LCP inikeze inketho entsha yokwelashwa kwesimanje kokuhlinzwa kokuqhekeka. Ihlanganiswe nobuchwepheshe be-MIPO, i-LCP ihlanganisa ukugodla kwegazi ezinhlangothini zokuqhekeka ngezinga elikhulu, ikhuthaza ukuphulukiswa kokuqhekeka, inciphisa izingozi zokutheleleka nokuqhekeka kabusha, igcina ukuqina kokuqhekeka, ngakho-ke inamathemba amaningi okusetshenziswa ekwelashweni kokuqhekeka. Kusukela ekusetshenzisweni, i-LCP ithole imiphumela emihle yesikhathi esifushane yezokwelapha, kodwa ezinye izinkinga nazo ziyadalulwa. Ukuhlinzwa kudinga ukuhlela okuningiliziwe kwangaphambi kokuhlinzwa kanye nokuhlangenwe nakho okubanzi kwezokwelapha, ikhetha ama-fixator angaphakathi afanele kanye nobuchwepheshe ngokusekelwe ezicini zokuqhekeka okuthile, inamathela ezimisweni eziyisisekelo zokwelapha ukuqhekeka, isebenzisa ama-fixator ngendlela efanele nejwayelekile, ukuze kuvinjelwe izinkinga futhi kutholakale imiphumela emihle yokwelapha.
Isikhathi sokuthunyelwe: Juni-02-2022
