Njengesilungisi sangaphakathi, ipuleti lokucindezela belilokhu lidlala indima ebalulekile ekwelashweni kokuphuka.Eminyakeni yamuva nje, umqondo we-osteosynthesis engavamile kancane uye waqondwa ngokujulile futhi wasetshenziswa, kancane kancane usuka ekugcizeleleni kwangaphambili kwemishini ye-fixator yangaphakathi ukuze ugcizelele ukulungiswa kwezinto eziphilayo, okungagxili kuphela ekuvikelweni kwegazi lethambo nezicubu ezithambile, kodwa. futhi ikhuthaza ukuthuthukiswa kwamasu okuhlinza kanye ne-fixator yangaphakathi.I-Locking Compression Plate(i-LCP) iwuhlelo olusha sha lokulungisa amapuleti, olwakhiwe ngesisekelo sepuleti lokucindezela elinamandla (DCP) kanye nepuleti lokucindezela elinamandla elithintana naye (LC-DCP), futhi lihlanganiswe nezinzuzo zomtholampilo zepuleti lokuxhumana le-AO ( I-PC-Fix) kanye Nohlelo Lokuqiniswa Olungangeneleli (LISS).Lolu hlelo luqale ukusetshenziswa emtholampilo ngoMeyi 2000, luzuze imiphumela engcono yomtholampilo, futhi imibiko eminingi lunikeze ukubuyekezwa okuphezulu kwalo.Nakuba kunezinzuzo eziningi ekulungiseni kwayo ukuphuka, inezidingo eziphezulu kubuchwepheshe nolwazi.Uma isetshenziswe ngendlela engafanele, ingase ingakhiqizi, futhi ibangele imiphumela engabuyiseleki.
1. Izimiso ze-Biomechanical, Idizayini kanye Nezinzuzo ze-LCP
Ukuzinza kwepuleti lensimbi elivamile kusekelwe ekungqubuzaneni phakathi kwepuleti nethambo.Izikulufu ziyadingeka ukuze ziqiniswe.Uma izikulufi sezikhululekile, ukungqubuzana phakathi kwepuleti nethambo kuzoncishiswa, ukuzinza nakho kuzoncipha, okuholela ekuhlulekeni kwe-fixator yangaphakathi.I-LCPiyipuleti elisha lokusekela ngaphakathi kwezicubu ezithambile, ezithuthukiswa ngokuhlanganisa ipuleti lokucindezela lendabuko kanye nokusekela.Isimiso sayo sokulungisa asinciki ekungqubuzaneni phakathi kwepuleti ne-bone cortex, kodwa sincike ekuzinzeni kwe-engeli phakathi kwepuleti nezikulufu zokukhiya kanye namandla okubamba phakathi kwezikulufu ne-bone cortex, ukuze kubonakale ukuphuka kokuphuka.Inzuzo eqondile isekunciphiseni ukuphazamiseka kokunikezwa kwegazi kwe-periosteal.Ukuzinza kwe-engeli phakathi kwepuleti nezikulufu kuthuthukise kakhulu amandla okubamba izikulufu, ngakho amandla okulungisa epuleti makhulu kakhulu, asebenza emathanjeni ahlukene.[4-7]
Isici esiyingqayizivele somklamo we-LCP "imbobo yokuhlanganisa", ehlanganisa izimbobo zokucindezela ezinamandla (DCU) nezimbobo ezinezintambo eziqinile.I-DCU ingabona ukucindezelwa kwe-axial ngokusebenzisa izikulufo ezijwayelekile, noma ukuphuka okususiwe kungacindezelwa futhi kulungiswe ngesikulufu se-lag;imbobo enemicu eyikhonikhi inemicu, engakhiya isikulufu nentambo yentongomane, idlulise i-torque phakathi kwesikulufu nepuleti, futhi ukucindezelwa kwe-longitudinal kungadluliselwa ohlangothini lokuphuka.Ngaphezu kwalokho, i-groove yokusika iklanywe ngaphansi kwepuleti, okunciphisa indawo yokuxhumana nethambo.
Ngamafuphi, inezinzuzo eziningi ngaphezu kwamapuleti endabuko: ① iqinisa i-engeli: i-engeli phakathi kwamapuleti ezinzipho izinzile futhi ayiguquki, isebenza ngempumelelo emathanjeni ahlukene;② inciphisa ingozi yokulahlekelwa kokunciphisa: asikho isidingo sokuqhuba ukugoba kwangaphambili okunembile kwamapuleti, ukunciphisa izingozi zokulahlekelwa kokunciphisa isigaba sokuqala kanye nesigaba sesibili sokulahlekelwa kokunciphisa;[8] ③ ivikela ukunikezwa kwegazi: ubuncane bokuxhumana obuphakathi kwepuleti lensimbi nethambo lehlisa ukulahleka kwepuleti legazi le-periosteum, eliqondaniswe kakhulu nezimiso zokuhlasela kancane;④ inobuntu obuhle bokubamba: isebenza ikakhulukazi ethanjeni lokuphuka kwe-osteoporosis, inciphisa izehlakalo zokuxegisa isikulufu nokuphuma;⑤ ivumela umsebenzi ekuqaleni umsebenzi;⑥ inezinhlobonhlobo zezinhlelo zokusebenza: uhlobo lwepuleti nobude buphelele, i-anatomical pre-shaped muhle, engakwazi ukubona ukulungiswa kwezingxenye ezahlukene kanye nezinhlobo ezahlukene zokuphuka.
2. Izinkomba ze-LCP
I-LCP ingasetshenziswa njengepuleti lokucindezela elivamile noma njengosekelo lwangaphakathi.Udokotela ohlinzayo angakwazi futhi ukuhlanganisa kokubili, ukuze andise kakhulu izinkomba zayo futhi asebenze ezinhlobonhlobo ezinkulu zamaphethini okuphuka.
I-2.1 I-Fractures elula ye-Diaphysis noma i-Metaphysis: uma umonakalo wezicubu ezithambile ungenzima futhi ithambo linekhwalithi enhle, ama-fractures alula aguquguqukayo noma i-oblique fracture emfushane yamathambo amade ayadingeka ukusika nokunciphisa ngokunembile, futhi uhlangothi lwe-fracture ludinga ukucindezela okuqinile, ngaleyo ndlela i-LCP ingasetshenziswa njengepuleti lokucindezela kanye nepuleti noma ipuleti lokungathathi hlangothi.
2.2 Ukuqhekeka Okuhlanganisiwe Kwe-Diaphysis noma I-Metaphyseal: I-LCP ingasetshenziswa njengepuleti lebhuloho, elamukela ukuncishiswa okungaqondile kanye ne-osteosynthesis yebhuloho.Ayidingi ukuncishiswa kwe-anatomical, kodwa iphinda ibuyisele ubude besitho, ukuzungezisa kanye nomugqa wamandla we-axial.Ukuphuka kwe-radius kanye ne-ulna kuyinto ehlukile, ngoba umsebenzi wokujikeleza kwezingalo uncike kakhulu ku-anatomy evamile ye-radius ne-ulna, efana nokuphuka kwe-intra-articular.Ngaphandle kwalokho, ukuncishiswa kwe-anatomical kufanele kwenziwe, futhi kufanele kulungiswe ngokuqinile ngamapuleti.
2.3 I-Intra-articular Fractures kanye ne-Inter-articular Fractures: Ekuqhekekeni kwe-intra-articular, asidingi nje kuphela ukwenza ukunciphisa kwe-anatomical ukuze sibuyisele ubushelelezi bendawo ye-articular, kodwa futhi sidinga ukucindezela amathambo ukuze sifinyelele ukulungiswa okuzinzile nokukhuthaza ithambo. ukuphulukisa, futhi kuvumela umsebenzi wokuqala wokusebenza.Uma ukuphuka kwe-articular kunomthelela emathanjeni, i-LCP ingakwazi ukulungisaokuhlangenephakathi kwe-articular encishisiwe ne-diaphysis.Futhi asikho isidingo sokubumba ipuleti lapho kuhlinzwa, okuye kwanciphisa isikhathi sokuhlinzwa.
2.4 Inyunyana Ebambezelekile noma Inyunyana.
2.5 I-Osteotomy evaliwe noma evuliwe.
2.6 Ayisebenzi ekuxhumaneniukufakwa kwe-intramedullaryukuphuka, futhi i-LCP iyindlela ehlukile uma kuqhathaniswa.Isibonelo, i-LCP ayisebenzi ekulimaleni komnkantsha ukuphuka kwezingane noma intsha, abantu abanezimbobo ze-pulp emincane kakhulu noma ebanzi kakhulu noma engalungile.
I-2.7 Iziguli Zamathambo: njengoba i-bone cortex incane kakhulu, kunzima ukuthi ipuleti yendabuko ithole ukuzinza okuthembekile, okuye kwandisa ubunzima bokuhlinzwa kwe-fracture, futhi kubangele ukwehluleka ngenxa yokukhululeka kalula nokuphuma kokulungiswa kwangemva kokuhlinzwa.Isikulufu sokukhiya se-LCP kanye nehange lepuleti kwenza i-engeli yokuqina, futhi izipikili zepuleti ziyahlanganiswa.Ngaphezu kwalokho, ububanzi be-mandrel be-screw yokukhiya bukhulu, okwandisa amandla okubamba ithambo.Ngakho-ke, izehlakalo zokuthukululwa kwesikulufa zincishiswa ngokuphumelelayo.Ukuzivocavoca umzimba okusebenza kusenesikhathi kuvunyelwe ngemuva kokuhlinzwa.I-Osteoporosis iyinkomba enamandla ye-LCP, futhi imibiko eminingi iyenze yaqashelwa kakhulu.
2.8 I-Periprosthetic Femoral Fracture: I-periprosthetic femoral fractures ngokuvamile ihambisana ne-osteoporosis, izifo ezikhulile kanye nezifo ezinzima zesistimu.Amapuleti endabuko angaphansi kokusikwa okukhulu, okubangela umonakalo ongase ube khona ekunikezeni igazi kokuphuka.Ngaphandle kwalokho, izikulufu ezivamile zidinga ukulungiswa kwe-bicortical, okubangela ukulimala kusimende wamathambo, futhi amandla okubamba i-osteoporosis nawo ampofu.Amapuleti e-LCP ne-LISS axazulula izinkinga ezinjalo ngendlela enhle.Okusho ukuthi, bamukela ubuchwepheshe be-MIPO ukunciphisa ukusebenza okuhlangene, ukunciphisa umonakalo ekunikezeni igazi, bese isikulufa sokukhiya i-cortical esisodwa singanikeza ukuzinza okwanele, okungeke kubangele umonakalo kusimende wamathambo.Le ndlela ibonakala ngokuba lula, isikhathi sokuhlinzwa esifushane, ukopha okuncane, uhla lokukhumula okuncane kanye nokwenza lula ukuphulukiswa kokuphuka.Ngakho-ke, ukuphuka kwe-periprosthetic femoral nakho kungenye yezinkomba eziqinile ze-LCP.[1, 10, 11]
3. Amasu okuhlinza ahlobene nokusetshenziswa kwe-LCP
3.1 I-Traditional Compression Technology: nakuba umqondo we-AO fixator yangaphakathi ushintshile futhi ukunikezwa kwegazi kwethambo lokuvikela kanye nezicubu ezithambile ngeke kunganakwa ngenxa yokugcizelela ngokweqile ukuzinza komshini wokulungisa, uhlangothi lokuphuka lusadinga ukucindezelwa ukuze kutholakale ukulungiswa kokunye. ukuphuka, njengokuphuka kwe-intra-articular, ukulungiswa kwe-osteotomy, ukuphuka okulula okuphambene noma okufushane kwe-oblique.Izindlela zokuminyanisa yilezi: ① I-LCP isetshenziswa njengepuleti lokuminyanisa, kusetshenziswa izikulufu ezimbili ezijwayelekile zecortical ukulungisa ngokugqamile kuyunithi yokuminyanisa yepuleti noma kusetshenziswa idivayisi yokuminyanisa ukubona ukucindezelwa;② njengepuleti lokuvikela, i-LCP isebenzisa izikulufu ze-lag ukulungisa ukuphuka kwe-oblique ende;③ ngokwamukela isimiso se-tension band, ipuleti libekwe ohlangothini lokungezwani kwethambo, lizofakwa ngaphansi kokucindezeleka, futhi ithambo le-cortical lingathola ukucindezelwa;④ njengepuleti le-buttress, i-LCP isetshenziswa ngokuhambisana nezikulufu ze-lag ukulungisa ukuphuka kwe-articular.
3.2 Ubuchwepheshe Bokulungisa Ibhuloho: Okokuqala, sebenzisa indlela yokunciphisa engaqondile ukuze usethe kabusha ukuphuka, udlulele kuzo zonke izindawo zokuphuka ngebhuloho futhi ulungise izinhlangothi zombili zokuphuka.Ukunciphisa i-anatomic akudingekile, kodwa kudinga kuphela ukubuyiswa kobude be-diaphysis, ukujikeleza kanye nomugqa wamandla.Phakathi naleso sikhathi, ukuxhunyelelwa kwamathambo kungenziwa ukuze kugqugquzelwe ukwakheka kwe-callus futhi kukhuthaze ukuphulukiswa kokuphuka.Kodwa-ke, ukulungiswa kwebhuloho kungafinyelela ukuzinza okuhlobene, kodwa ukuphulukiswa kokuphuka kufinyelelwa ngama-calluses amabili ngenhloso yesibili, ngakho-ke kusebenza kuphela ekuqhekekeni okuhlangene.
3.3 I-Minimally Invasive Plate Osteosynthesis (MIPO) Technology: Kusukela ngeminyaka yawo-1970, inhlangano ye-AO yabeka phambili imigomo yokwelashwa kokuphuka: ukunciphisa umzimba, isilungisi sangaphakathi, ukuvikelwa kokunikezwa kwegazi kanye nokuzivocavoca okungenabuhlungu kwasekuqaleni.Izimiso ziye zaqashelwa kabanzi emhlabeni, futhi imiphumela yomtholampilo ingcono kunezindlela zokwelashwa zangaphambilini.Kodwa-ke, ukuze uthole ukuncishiswa kwe-anatomic kanye ne-fixator yangaphakathi, ngokuvamile kudinga ukusika okukhulu, okuholela ekunciphiseni ukuchithwa kwamathambo, ukwehla kwegazi lezicucu zokuphuka kanye nezingozi ezikhulayo zokutheleleka.Eminyakeni yamuva nje, osolwazi basekhaya nabaphesheya kwezilwandle banaka kakhulu futhi bagcizelele kakhulu ubuchwepheshe obungangeneleli kancane, ukuvikela ukutholakala kwegazi kwezicubu ezithambile kanye nethambo phakathi naleso sikhathi sokuthuthukisa i-fixator yangaphakathi, hhayi ukukhumula i-periosteum nezicubu ezithambile lapho kuphuka. izinhlangothi, hhayi ukuphoqelela ukuncishiswa kwe-anatomical kwezingcezu zokuphuka.Ngakho-ke, ivikela imvelo yebhayoloji yokuphuka, okuyi-biological osteosynthesis (BO).Ngawo-1990, u-Krettek uhlongoze ubuchwepheshe be-MIPO, okuyinqubekelaphambili entsha yokulungisa ukuphuka eminyakeni yamuva.Ihlose ukuvikela ukunikezwa kwegazi kwethambo lokuvikela kanye nezicubu ezithambile ezinomonakalo omncane ngokwezinga elikhulu kakhulu.Indlela iwukwakha umhubhe ongaphansi kwesikhumba ngokusebenzisa i-incision encane, ubeke amapuleti, futhi usebenzise amasu okunciphisa angaqondile okunciphisa ukuphuka kanye ne-fixator yangaphakathi.I-engeli ephakathi kwamapuleti e-LCP izinzile.Ngisho noma amapuleti engakuqapheli ngokugcwele ukubunjwa kwe-anatomical, ukuncishiswa kokuphuka kusengagcinwa, ngakho izinzuzo zobuchwepheshe be-MIPO zivelele kakhulu, futhi kuwukufakelwa okulungile kobuchwepheshe be-MIPO.
4. Izizathu Nezinyathelo Zokulwa Nokwehluleka Kwesicelo se-LCP
4.1 Ukwehluleka kwesilungisi sangaphakathi
Zonke izimila zinokuxega, ukugudluzwa, ukuphuka nezinye izingozi zokwehluleka, amapuleti okukhiya kanye ne-LCP kukhona okufanayo.Ngokusho kwemibiko yezincwadi, ukwehluleka kwe-fixator yangaphakathi akubangelwa ikakhulukazi ipuleti ngokwayo, kodwa ngenxa yokuthi izimiso eziyisisekelo zokwelashwa kwe-fracture ziphulwa ngenxa yokuqonda okwanele nolwazi lokulungiswa kwe-LCP.
4.1.1.Amapuleti akhethiwe mafushane kakhulu.Ubude bokusabalalisa kwepuleti nesikulufu yizici ezibalulekile ezithinta ukuqina kokulungisa.Ngaphambi kokuvela kobuchwepheshe be-IMIPO, amapuleti amafushane anganciphisa ubude be-incision kanye nokuhlukaniswa kwezicubu ezithambile.Amapuleti amafushane kakhulu azonciphisa amandla e-axial namandla e-torsion wesakhiwo sonke esingaguquki, okuholela ekuhlulekeni kwesilungisi sangaphakathi.Ngokuthuthukiswa kobuchwepheshe bokunciphisa obungaqondile kanye nobuchwepheshe obungena kancane kancane, amapuleti amade ngeke akhulise ukusika kwezicubu ezithambile.Odokotela abahlinzayo kufanele bakhethe ubude bepuleti ngokuhambisana ne-biomechanics yokulungisa ukuphuka.Ngokuphuka okulula, isilinganiso sobude bepuleti efanelekile kanye nobude bendawo yonke yokuphuka kufanele kube ngaphezu kwezikhathi ezingu-8-10, kuyilapho ukuphuka okuhlangene, lesi silinganiso kufanele sibe ngaphezu kwezikhathi ezingu-2-3.[13, 15] Amapuleti anobude obanele obanele azonciphisa ukulayishwa kwepuleti, aphinde anciphise ukulayishwa kwesikulufu, futhi ngaleyo ndlela anciphise izehlakalo zokuhluleka kwesilungisi sangaphakathi.Ngokusho kwemiphumela yokuhlaziywa kwesici esilinganiselwe se-LCP, lapho igebe phakathi kwezinhlangothi zokuphuka liyi-1mm, uhlangothi lokuphuka lushiya imbobo eyodwa yepuleti yokucindezela, ukucindezeleka epuleti lokucindezela kunciphisa u-10%, futhi ukucindezeleka ezikrinini kunciphisa 63%;lapho uhlangothi lokuphuka lushiya izimbobo ezimbili, ukucindezeleka ku-compress plate kunciphisa u-45%, futhi ukucindezeleka ezikrinini kunciphisa ngo-78%.Ngakho-ke, ukuze ugweme ukugxila ekucindezelekeni, ngenxa yokuqhekeka okulula, izimbobo ezingu-1-2 eduze nezinhlangothi zokuphuka zizoshiywa, kuyilapho ukuhlukana okuphelile, izikulufu ezintathu zinconywa ukuthi zisetshenziswe ohlangothini ngalunye lokuphuka kanye nezikulufu ezi-2 zizosondela eduze kwe-fracture. ukuphuka.
4.1.2 Igebe phakathi kwamapuleti nendawo yethambo likhulu kakhulu.Lapho i-LCP ithatha ubuchwepheshe bokulungisa ibhuloho, amapuleti akudingekile ukuthi axhumane ne-periosteum ukuze avikele ukunikezwa kwegazi kwendawo yokuphuka.Kungokwesigaba sokuqina kwe-elastic, okukhuthaza ukushuba kwesibili kokukhula kwe-callus.Ngokutadisha ukuzinza kwe-biomechanical, u-Ahmad M, uNanda R [16] et al bathola ukuthi lapho igebe phakathi kwe-LCP ne-bone surface likhulu kune-5mm, amandla e-axial kanye ne-torsion yamapuleti ancipha kakhulu;lapho igebe lingaphansi kuka-2mm, akukho ukwehla okuphawulekayo.Ngakho-ke, igebe linconywa ukuba libe ngaphansi kuka-2mm.
4.1.3 Ipuleti liyachezuka ku-axis ye-diaphysis, futhi izikulufu zigxile kakhulu ekuqiniseni.Uma i-LCP ihlangene nobuchwepheshe be-MIPO, amapuleti ayadingeka ukufaka i-percutaneous, futhi ngezinye izikhathi kunzima ukulawula isikhundla sepuleti.Uma i-axis yethambo ingafani ne-axis yepuleti, i-distal plate ingase iphambuke ku-axis yethambo, okuzoholela nakanjani ekugxilweni kwe-eccentric yezikulufu kanye nokulungiswa okubuthakathaka.[9,15].Kunconywa ukuba kuthathwe i-incision efanele, futhi ukuhlolwa kwe-X-ray kuzokwenziwa ngemuva kokuthi indawo yomhlahlandlela yokuthinta umunwe isilungile kanye nokulungiswa kwephinikhodi ye-Kuntscher.
4.1.4 Ukwehluleka ukulandela izimiso eziyisisekelo zokwelashwa kokuphuka nokukhetha isilungisi sangaphakathi esingalungile kanye nobuchwepheshe bokulungisa.Ngokuphuka kwe-intra-articular, i-diaphysis fractures elula eguquguqukayo, i-LCP ingasetshenziswa njengepuleti yokucindezela ukuze kulungiswe ukuzinza okuphelele kokuphuka ngobuchwepheshe bokucindezela, futhi kukhuthaze ukuphulukiswa okuyinhloko kwama-fractures;ngenxa ye-Metaphyseal noma i-fractures comminuted, ubuchwepheshe bokulungisa ibhuloho kufanele busetshenziswe, qaphela ukunikezwa kwegazi kwethambo lokuvikela kanye nezicubu ezithambile, vumela ukulungiswa okuzinzile kokuphuka, kukhuthaze ukukhula kwe-callus ukuze kuzuze ukuphulukiswa ngokucindezela kwesibili.Ngokuphambene nalokho, ukusetshenziswa kobuchwepheshe bokulungisa ibhuloho ukwelapha ukuphuka okulula kungase kubangele ukuphuka okungazinzile, okuholela ekubambezelekeni kokuphulukiswa kokuphuka;[17] Ukuphishekela okweqile kokuqhekeka kokunciphisa umzimba kanye nokucindezelwa ezinhlangothini zokuphuka kungabangela umonakalo ekunikezeni igazi kwamathambo, okuholela ekubambezelekeni kokuhlangana noma ukungavumelani.
4.1.5 Khetha izinhlobo zezikulufu ezingafanele.Imbobo yenhlanganisela ye-LCP ingajikijelwa ngezinhlobo ezine zezikulufu: izikulufu ezijwayelekile zecortical, izikulufu ezijwayelekile zokukhansela ezikhanselwayo, izikulufu zokuzibhoboza/ezizithinta wena kanye nezikulufu ezizithintayo.Izikulufu zokuzibhoboza/ukuzithinta ngokwakho zivame ukusetshenziswa njengezikulufu ze-unicortical ukulungisa ukuphuka okuvamile kwamathambo e-diaphyseal.Iphoyinti layo lezinzipho linomklamo wephethini yokubhoboza, okulula ukudlula ku-cortex ngokuvamile ngaphandle kwesidingo sokulinganisa ukujula.Uma imbobo ye-diaphyseal pulp incane kakhulu, i-screw nut ingase ingalingani ngokugcwele isikulufu, futhi ithiphu yesikulufu ithinta i-contralateral cortex, khona-ke umonakalo we-lateral cortex egxilile uthinta amandla okubamba phakathi kwezikulufu namathambo, futhi izikulufu ezizithephayo ze-bicortical kufanele ukusetshenziswa ngalesi sikhathi.Izikulufu ezihlanzekile ze-unicortical zinamandla amahle okubambelela emathanjeni avamile, kodwa ithambo le-osteoporosis livamise ukuba ne-cortex ebuthaka.Njengoba isikhathi sokusebenza kwezikulufi sincipha, izingalo lesikhashana lokumelana nezikulufu ekugobeni liyancipha, okuholela kalula ekusikeni isikulufu i-bone cortex, ukuxegiswa kwesikulufu kanye nokugudluka kokuphuka kwesibili.[18] Njengoba izikulufu ze-bicortical zikhuphule ubude bokusebenza kwezikulufu, amandla okubamba amathambo nawo ayanda.Ngaphezu kwakho konke, ithambo elivamile lingase lisebenzise izikulufu ze-unicortical ukulungisa, kodwa ithambo le-osteoporosis liyanconywa ukuthi lisebenzise izikulufu ze-bicortical.Ngaphezu kwalokho, i-humerus bone cortex incane kakhulu, ibangela kalula ukusika, ngakho-ke izikulufu ze-bicortical ziyadingeka ukulungisa ekwelapheni ukuphuka kwe-humeral.
4.1.6 Ukusabalalisa izikulufu kuminyene kakhulu noma kuncane kakhulu.Ukulungiswa kwesikulufu kuyadingeka ukuze kuhambisane ne-fracture biomechanics.Ukusatshalaliswa kwesikulufu esiminyene kakhulu kuzoholela ekugxilweni kwengcindezi yendawo kanye nokuphuka kwesilungisi sangaphakathi;izikulufu zokuphuka okuncane kakhulu namandla anganele okulungisa kuzoholela ekwehlulekeni kwesilungisi sangaphakathi.Uma ubuchwepheshe bebhuloho busetshenziswa ekulungiseni ukuphuka, ukuminyana kwesikulufa okunconyiwe kufanele kube ngaphansi kuka-40% -50% noma ngaphansi.[7,13,15] Ngakho-ke, amapuleti made kakhulu, ukuze kwandiswe ibhalansi yemishini;Izimbobo ze-2-3 kufanele zishiywe ezinhlangothini zokuphuka, ukuze kuvunyelwe ukuqina kwepuleti enkulu, ugweme ukugxila kokucindezeleka futhi unciphise isigameko sokuphuka kwangaphakathi kwe-fixator [19].U-Gautier no-Sommer [15] bacabanga ukuthi okungenani izikulufi ezimbili ze-unicortical zizomiswa ezinhlangothini zombili zokuphuka, inani elengeziwe le-cortex engashintshi ngeke linciphise izinga lokuhluleka kwamapuleti, ngakho-ke okungenani izikulufu ezintathu zinconywa ukuba ziboshwe ezinhlangothini zombili ukuphuka.Okungenani izikulufi ezi-3-4 ziyadingeka ezinhlangothini zombili zokuphuka kwe-humerus kanye ne-forearm, imithwalo ye-torsion eyengeziwe kufanele ithwalwe.
4.1.7 Impahla yokulungisa isetshenziswa ngendlela engalungile, okuholela ekuhlulekeni kwesilungisi sangaphakathi.USommer C [9] uvakashele iziguli eziyi-127 ezinamakesi okuphuka angu-151 asebenzise i-LCP unyaka owodwa, imiphumela yokuhlaziya ibonisa ukuthi phakathi kwezikulufu zokukhiya ezingama-700, kuxegiswe izikulufu ezimbalwa kuphela ezinobubanzi obungu-3.5mm.Isizathu siwukuyeka ukusetshenziswa kwedivayisi yokubona izikulufi zokukhiya.Eqinisweni, isikulufu sokukhiya nepuleti akume mpo ngokuphelele, kodwa kubonisa ama-engeli angu-50.Lo mklamo uhlose ukunciphisa ukucindezelwa kwesikulufa sokukhiya.Ukusetshenziswa okuyekiwe kwedivayisi yokubona kungase kushintshe indlela yezipikili futhi ngaleyo ndlela kubangele umonakalo emandleni okulungisa.U-Kääb [20] wenze ucwaningo lokuhlola, wathola i-engeli ephakathi kwezikulufi namapuleti e-LCP inkulu kakhulu, futhi ngaleyo ndlela amandla okubamba ezikulufu ehle kakhulu.
4.1.8 Ukulayisha isisindo sezitho kusesekuseni kakhulu.Imibiko eminingi emihle kakhulu iqondisa odokotela abaningi ukuba bakholwe ngokweqile amandla okukhiya amapuleti nezikulufu kanye nokuzinza kokulungisa, bakholelwa ngephutha ukuthi amandla okukhiya amapuleti angathwala isisindo esigcwele ngaphambi kwesikhathi, okuholela ekuqhekekeni kwepuleti noma ngezikulufu.Lapho kusetshenziswa ukuqhekeka kokulungiswa kwebhuloho, i-LCP izinzile uma kuqhathaniswa, futhi iyadingeka ukuthi yakhe i-callus ukuze ibone ukuphulukiswa ngokuqinisa okwesibili.Uma iziguli zivuka ekuseni kakhulu futhi zilayisha isisindo eseqile, ipuleti nesikulufu kuzophuka noma kukhishwe.Ukulungiswa kwepuleti lokukhiya kukhuthaza umsebenzi wangaphambi kwesikhathi, kodwa ukulayisha kancane kancane kuzoba ngemva kwamasonto ayisithupha, futhi amafilimu e-x-ray abonisa ukuthi uhlangothi lokuphuka luveza i-callus ebalulekile.[9]
4.2 Ukulimala Kwethambo kanye Neurovascular:
Ubuchwepheshe be-MIPO budinga ukufakwa kwe-percutaneous futhi kufakwe ngaphansi kwemisipha, ngakho-ke lapho izikulufa zepuleti zifakwa, odokotela abahlinzayo abakwazanga ukubona isakhiwo esingaphansi kwesikhumba, futhi ngaleyo ndlela i-tendon kanye nokulimala kwe-neurovascular kwanda.U-Van Hensbroek PB [21] ubike icala lokusebenzisa ubuchwepheshe be-LISS ukusebenzisa i-LCP, okubangele i-pseudoaneurysms ye-anterior tibial artery pseudoaneurysms.I-AI-Rashid M. [22] et al ibike ukuthi yelapha ukuphuka ukubambezeleka kwe-tendon yesibili ye-extensor ye-distal radial fractures nge-LCP.Izizathu eziyinhloko zomonakalo yi-iatrogenic.Owokuqala uwumonakalo oqondile olethwa ngezikulufo noma iphinikhodi ye-Kirschner.Owesibili umonakalo owenziwe umkhono.Futhi eyesithathu iwumonakalo wokushisa okhiqizwa ukubhoboza izikulufu ezizithephayo.[9] Ngakho-ke, odokotela abahlinzayo bayadingeka ukuze bajwayelane ne-anatomy ezungezile, banake ukuvikela i-nervus vascularis nezinye izakhiwo ezibalulekile, baqhube ngokugcwele i-dissection blunt ekubekeni imikhono, bagweme ukucindezelwa noma ukudonsa kwezinzwa.Ngaphezu kwalokho, lapho ubhoboza izikulufu ezizithephayo, sebenzisa amanzi ukuze unciphise ukukhiqizwa kokushisa futhi wehlise ukuqhutshwa kokushisa.
4.3 Ukutheleleka Kwendawo Yokuhlinza kanye Nokuchayeka Kwengcwecwe:
I-LCP iwuhlelo lwangaphakathi lokulungisa olwenzeka ngaphansi kwesizinda sokuphromotha umqondo wokuhlasela kancane, okuhloswe ngawo ukunciphisa umonakalo, ukunciphisa ukutheleleka, ukungavumelani nezinye izinkinga.Ekuhlinzweni, kufanele sinake ngokukhethekile ukuvikelwa kwezicubu ezithambile, ikakhulukazi izingxenye ezibuthakathaka zezicubu ezithambile.Uma kuqhathaniswa ne-DCP, i-LCP inobubanzi obukhudlwana nokushuba okukhulu.Uma usebenzisa ubuchwepheshe be-MIPO bokufaka i-percutaneous noma i-intramuscular, kungase kubangele ukungqubuzana kwezicubu ezithambile noma ukulimala kokuhushulwa futhi kuholele ekuthelelekeni kwesilonda.U-Phinit P [23] ubike ukuthi uhlelo lwe-LISS lwelaphe amacala angu-37 okuphuka kwe-tibia eseduze, futhi izehlakalo zokutheleleka okujulile kwangemva kokuhlinzwa zazifika ku-22%.U-Namazi H [24] ubike ukuthi i-LCP yayiphathe amacala angu-34 okuphuka kwe-tibial shaft yamacala angu-34 we-metaphyseal fracture ye-tibia, futhi izehlakalo zokutheleleka kwesilonda se-postoperative kanye nokuvezwa kwepuleti kwakufike ku-23.5%.Ngakho-ke, ngaphambi kokusebenza, amathuba kanye ne-fixator yangaphakathi kuzocatshangelwa ngokumangalisayo ngokuhambisana nokulimala kwezicubu ezithambile kanye nezinga eliyinkimbinkimbi lokuphuka.
4.4 I-Irritable Bowel Syndrome ye-Soft Tissue:
U-Phinit P [23] ubike ukuthi uhlelo lwe-LISS lwaluphathe amacala angu-37 okuphuka kwe-tibia eseduze, amacala angu-4 wokucasuka kwezicubu ezithambile ze-postoperative (izinhlungu zepuleti elithambile elingaphansi futhi elizungeze amapuleti), lapho amacala angu-3 amapuleti angu-5mm kude indawo yethambo kanye nekesi elingu-1 liqhele ngo-10mm ukusuka endaweni yethambo.U-Hasenboehler.E [17] et al ubike ukuthi i-LCP iphathe amacala angu-32 okuphuka kwe-distal tibial, okuhlanganisa namacala angu-29 wokungakhululeki kwe-malleolus ephakathi.Isizathu siwukuthi umthamo wepuleti mkhulu kakhulu noma amapuleti abekwe ngendlela engafanele futhi izicubu ezithambile zincane ku-malleolus ephakathi, ngakho iziguli zizozizwa zingakhululekile lapho iziguli zigqoke amabhuzu aphezulu futhi zicindezela isikhumba.Izindaba ezinhle ukuthi ipuleti elisha le-metaphyseal elisanda kuhlukaniswa elakhiwe yi-Synthes lincane futhi linamathela endaweni yamathambo enemiphetho ebushelelezi, okuyixazulule ngempumelelo le nkinga.
4.5 Ubunzima bokukhipha izikulufu zokukhiya:
Impahla ye-LCP inamandla aphezulu e-titanium, inokuhambisana okuphezulu nomzimba womuntu, okulula ukupakishwa nge-callus.Ekususeni, ukukhishwa kokuqala kwe-callus kuholela enkingeni eyandayo.Esinye isizathu sokususa ubunzima sisekuqinisweni kwezikulufu zokukhiya noma ukulimala kwamantongomane, okuvamise ukubangelwa ukubuyisela idivayisi yokubona ngezikulufo ezivaliwe ngomshini wokuzibona.Ngakho-ke, idivayisi yokubona izosetshenziswa ekwamukeleni izikulufo zokukhiya, ukuze imicu yesikulufu ikwazi ukuqiniswa ngokunembile nemicu yepuleti.[9] Isikrufu esiqondile siyadingeka ukuze sisetshenziswe ekuqiniseni izikulufu, ukuze kulawulwe ubukhulu bamandla.
Ngaphezu kwakho konke, njengepuleti lokucindezela lentuthuko yakamuva ye-AO, i-LCP inikeze inketho entsha yokwelashwa kwesimanje kokuhlinzwa kokuphuka.Ihlanganiswe nobuchwepheshe be-MIPO, i-LCP ihlanganisa ukugcinwa kwegazi ezinhlangothini zokuphuka ngezinga elikhulu kakhulu, ikhuthaza ukuphulukiswa kokuphuka, inciphisa izingozi zokutheleleka kanye nokuphuka kabusha, igcina ukuqina kokuphuka, ngakho-ke inamathemba abanzi okusebenza ekwelapheni ukuphuka.Selokhu kwafakwa isicelo, i-LCP ithole imiphumela emihle yomtholampilo yesikhashana esifushane, nokho ezinye izinkinga nazo ziyadalulwa.Ukuhlinzwa kudinga ukuhlela okuningiliziwe kwangaphambi kokuhlinzwa kanye nokuhlangenwe nakho okubanzi komtholampilo, ukukhetha izilungisi zangaphakathi ezifanele kanye nobuchwepheshe ngesisekelo sezici zokuqhekeka okuthile, kubambelela ezimisweni eziyisisekelo zokwelashwa kokuphuka, kusebenzisa izilungisi ngendlela efanele nemisiwe, ukuze kuvinjelwe izinkinga futhi uthole imiphumela elilungile yokwelapha.
Isikhathi sokuthumela: Jun-02-2022
