Njengesixhobo sokulungisa amathambo ngaphakathi, ipleyiti yoxinzelelo ibisoloko idlala indima ebalulekileyo kunyango lokwaphuka kwamathambo. Kwiminyaka yakutshanje, ingcamango ye-osteosynthesis encinci kakhulu iye yaqondwa kwaye yasetyenziswa ngokunzulu, itshintsha kancinci kancinci ukusuka kugxininiso lwangaphambili kwindlela yokusebenza koomatshini be-internal fixator ukuya kugxininiso kwi-biological fixation, engajolisi nje kuphela ekukhuseleni ukunikezelwa kwegazi ngamathambo kunye nezicubu ezithambileyo, kodwa ikwakhuthaza ukuphuculwa kweendlela zotyando kunye ne-internal fixator.Ipleyiti yokuCinezela yokuKhiya(LCP) yinkqubo entsha yokulungisa iipleyiti, eyenziwe ngokusekelwe kwi-dynamic compression plate (DCP) kunye ne-limited contact dynamic compression plate (LC-DCP), kwaye idityaniswe neenzuzo zeklinikhi ze-AO's point contact plate (PC-Fix) kunye ne-Less Invasive Stabilization System (LISS). Le nkqubo yaqala ukusetyenziswa ngokwezonyango ngoMeyi 2000, ifumene iziphumo ezingcono zeklinikhi, kwaye iingxelo ezininzi zinike uvavanyo olukhulu ngayo. Nangona kukho iingenelo ezininzi kwi-fracture fixation yayo, ineemfuno eziphezulu kubuchwepheshe namava. Ukuba isetyenziswa ngendlela engafanelekanga, inokuba yinto engalunganga, kwaye ibangele iziphumo ezingenakulungiswa.
1. Imigaqo yeBiomechanical, Uyilo kunye neeNzuzo ze-LCP
Uzinzo lwepleyiti yentsimbi eqhelekileyo lusekelwe kukungqubana phakathi kwepleyiti nethambo. Izikrufu kufuneka ziqiniswe. Nje ukuba izikrufu zikhululekile, ukungqubana phakathi kwepleyiti nethambo kuya kuncipha, uzinzo nalo luya kuncipha, nto leyo ekhokelela ekungasebenzini kwe-fixator yangaphakathi.I-LCPyipleyiti entsha yokuxhasa ngaphakathi kwithishu ethambileyo, ephuhliswa ngokudibanisa ipleyiti yoxinzelelo yendabuko kunye nenkxaso. Umgaqo wayo wokuqinisa awuxhomekekanga ekungqubaneni phakathi kwepleyiti kunye ne-bone cortex, kodwa uxhomekeke ekuzinzeni kwe-angle phakathi kwepleyiti kunye nezikrufu zokutshixa kunye namandla okubamba phakathi kwezikrufu kunye ne-bone cortex, ukuze kufezekiswe ukulungiswa kokuqhekeka. Inzuzo ethe ngqo isekunciphiseni ukuphazamiseka kokunikezelwa kwegazi kwe-periosteal. Ukuzinza kwe-angle phakathi kwepleyiti kunye nezikrufu kuphucule kakhulu amandla okubamba ezikrufu, ngoko ke amandla okuqinisa epleyiti makhulu kakhulu, asebenza kumathambo ahlukeneyo. [4-7]
Uphawu olukhethekileyo loyilo lwe-LCP "ngumngxuma odibeneyo", odibanisa imingxuma yokucinezela enamandla (i-DCU) kunye nemingxuma enemisonto ekhoni. I-DCU inokuphumeza ukucinezelwa kwe-axial ngokusebenzisa izikrufu eziqhelekileyo, okanye ukwaphuka okususiweyo kunokucinezelwa kwaye kulungiswe ngesikrufu esilagiweyo; umngxuma onemisonto ekhoni unemisonto, enokutshixa isikrufu kunye ne-latch enemisonto ye-nut, idlulise i-torque phakathi kwesikrufu kunye nepleyiti, kwaye uxinzelelo olude lunokudluliselwa kwicala lokuqhekeka. Ukongeza, umngxuma wokusika uyilo olungaphantsi kwepleyiti, olunciphisa indawo yokudibana nethambo.
Ngamafutshane, ineengenelo ezininzi kuneepleyiti zemveli: ① izinzisa i-engile: i-engile ephakathi kweepleyiti zezipikili izinzile kwaye izinzile, isebenza kakuhle kumathambo ahlukeneyo; ② inciphisa umngcipheko wokulahlekelwa kukunciphisa: akukho mfuneko yokwenza ukugoba ngokuchanekileyo kweepleyiti, kunciphisa umngcipheko wokulahlekelwa kukunciphisa kwinqanaba lokuqala kunye nenqanaba lesibini lokulahlekelwa kukunciphisa; [8] ③ ikhusela ukunikezelwa kwegazi: umphezulu omncinci woqhagamshelwano phakathi kwepleyiti yentsimbi kunye nethambo kunciphisa ukulahleka kwepleyiti yokunikezelwa kwegazi kwi-periosteum, ehambelana ngakumbi nemigaqo yokungena kancinci; ④ inendawo yokubamba elungileyo: isebenza ngokukodwa kwithambo le-osteoporosis fracture, kunciphisa amathuba okukhululeka nokuphuma kwezikrufu; ⑤ ivumela umsebenzi wokuzilolonga kwangethuba; ⑥ inoluhlu olubanzi lwezicelo: uhlobo lwepleyiti kunye nobude buphelele, i-anatomical pre-shaped ilungile, enokwenza ukulungiswa kwamacandelo ahlukeneyo kunye neentlobo ezahlukeneyo zokwaphuka.
2. Iimpawu ze-LCP
I-LCP ingasetyenziswa njengepleyiti yokucinezela eqhelekileyo okanye njengenkxaso yangaphakathi. Ugqirha angazidibanisa zombini ezi zinto, ukuze andise kakhulu iimpawu zayo aze azisebenzise kwiintlobo ngeentlobo zeepateni zokuqhekeka.
2.1 Ukwaphuka okulula kweDiaphysis okanye iMetaphysis: ukuba umonakalo kwizicubu ezithambileyo awunzima kwaye ithambo lisemgangathweni olungileyo, ukwaphuka okulula okunqamlezileyo okanye ukwaphuka okufutshane okugobileyo kwamathambo amade kuyafuneka ukuze kusikwe kwaye kuncitshiswe ngokuchanekileyo, kwaye icala lokuqhekeka lifuna ucinezelo oluqinileyo, ngoko ke i-LCP ingasetyenziswa njengepleyiti yokucinezela kunye nepleyiti okanye ipleyiti yokuthomalalisa.
2.2 Ukuqhekeka kweDiaphysis okanye iMetaphyseal: I-LCP ingasetyenziswa njengeplati yebhulorho, eyamkela ukunciphisa okungangqalanga kunye ne-osteosynthesis yebhulorho. Ayifuni ukunciphisa i-anatomical, kodwa ibuyisela ubude belungu, ukujikeleza kunye nomgca wamandla we-axial. Ukuqhekeka kweradius kunye ne-ulna yinto eyahlukileyo, kuba umsebenzi wokujikeleza kweengalo uxhomekeke kakhulu kwi-anatomy eqhelekileyo yeradius kunye ne-ulna, efana nokuqhekeka kwe-intra-articular. Ngaphandle koko, ukunciphisa i-anatomical kufuneka kwenziwe, kwaye kufuneka kulungiswe ngokuzinzileyo ngeeplate.
2.3 Ukuqhekeka Kwamathambo Angaphakathi Kwethambo Nee-Inter-articular Fractures: Kwi-intra-articular fracture, akufuneki nje kuphela senze ukunciphisa umzimba ukuze sibuyisele ubumtyibilizi bomphezulu wethambo, kodwa kufuneka sicinezele amathambo ukuze sifikelele ekuqineni okuzinzileyo nokukhuthaza ukuphiliswa kwamathambo, kwaye sivumele umthambo wokusebenza kwasekuqaleni. Ukuba ukuqhekeka kwamathambo kuchaphazele amathambo, i-LCP inokulungisaijoyintiphakathi kwe-articular ephantsi kunye ne-diaphysis. Kwaye akukho mfuneko yokubumba ipleyiti kutyando, nto leyo eye yanciphisa ixesha lotyando.
2.4 Umanyano okanye ukungaManyano okuLibazisekileyo.
2.5 I-Osteotomy eValiweyo okanye eVulekileyo.
2.6 Ayisebenzi kwi-interlockingukubethela ngaphakathi kwe-medullaryukwaphuka, kwaye i-LCP yindlela efanelekileyo. Umzekelo, i-LCP ayisebenzi kwiimfantu zomongo zabantwana okanye abakwishumi elivisayo, abantu abanemingxuma yepulp emincinci kakhulu okanye ebanzi kakhulu okanye engalunganga.
2.7 Izigulane ze-Osteoporosis: ekubeni i-bone cortex ibhityile kakhulu, kunzima kwi-plate yendabuko ukufumana uzinzo oluthembekileyo, nto leyo eyonyuse ubunzima botyando lokwaphuka, kwaye yabangela ukungaphumeleli ngenxa yokukhululeka nokuphuma lula kokulungiswa emva kotyando. I-LCP locking screw kunye ne-plate anchor zenza uzinzo lwe-angle, kwaye izipikili ze-plate ziyadityaniswa. Ukongeza, ububanzi be-mandrel be-lock screw bukhulu, okwandisa amandla okubamba ethambo. Ke ngoko, ukwenzeka kokukhululeka kwe-screw kuncitshiswa ngempumelelo. Ukuzilolonga komzimba kwangethuba kuyavunyelwa emva kotyando. I-Osteoporosis luphawu oluqinileyo lwe-LCP, kwaye iingxelo ezininzi ziyinike ukuqatshelwa okuphezulu.
2.8 Ukuqhekeka kweFemoral okujikelezayo: ukuqhekeka kwefemoral okujikelezayo kudla ngokukhatshwa yi-osteoporosis, izifo zabantu abadala kunye nezifo ezinzulu zenkqubo yomzimba. Iipleyiti zemveli zinqunyulwa kakhulu, nto leyo ebangela umonakalo onokubakho ekunikezelweni kwegazi kwezi mfucumfucu. Ngaphandle koko, izikrufu eziqhelekileyo zifuna ukulungiswa kwe-bicortical, nto leyo ebangela umonakalo kwisamente yamathambo, kwaye amandla okubamba i-osteoporosis nawo akasebenzi kakuhle. Iipleyiti ze-LCP kunye ne-LISS zisombulula iingxaki ezinjalo ngendlela elungileyo. Oko kukuthi, zisebenzisa itekhnoloji ye-MIPO ukunciphisa imisebenzi yamalungu, ukunciphisa umonakalo ekunikezelweni kwegazi, kwaye isikrufu esinye sokukhiya i-cortical sinokubonelela ngozinzo olwaneleyo, olungayi kubangela umonakalo kwisamente yamathambo. Le ndlela ibonakaliswa ngokulula, ixesha elifutshane lokusebenza, ukopha kancinci, uluhlu oluncinci lokukrazula kunye nokwenza kube lula ukuphiliswa kweemfucumfucu. Ke ngoko, ukuqhekeka kwefemoral okujikelezayo nako kukwayenye yeempawu ezinamandla ze-LCP. [1, 10, 11]
3. Iindlela Zotyando Ezinxulumene Nokusetyenziswa kwe-LCP
3.1 Iteknoloji yoQinzelelo lweNdalo: nangona ingcamango ye-AO internal fixator itshintshile kwaye ukunikezelwa kwegazi lokukhusela amathambo kunye nezicubu ezithambileyo akuyi kutyeshelwa ngenxa yokugxininisa kakhulu ukuzinza koomatshini bokuqiniswa, icala lokuqhekeka lisafuna ukuxinwa ukuze kufunyanwe ukuqiniswa kwezinye izaphuko, ezinje ngokuqhekeka kwangaphakathi kwe-articular, ukuqiniswa kwe-osteotomy, ukuqhekeka okulula okunqamlezileyo okanye okufutshane kwe-oblique. Iindlela zoxinzelelo zezi: 1. I-LCP isetyenziswa njengepleyiti yokuxinwa, kusetyenziswa izikrufu ezimbini ze-cortical ezisemgangathweni ukuqiniswa ngendlela engaqhelekanga kwiyunithi yokuxinwa etyibilikayo yepleyiti okanye kusetyenziswa isixhobo sokuxinwa ukwenza ukuqiniswa; 1. Njengepleyiti yokukhusela, i-LCP isebenzisa izikrufu zokuqiniswa ukulungisa izaphuko ezinde ezi-oblique; 2. Ngokusebenzisa umgaqo we-tension band, ipleyiti ibekwa kwicala lokuxinwa kwethambo, iya kufakelwa phantsi kokuxinwa, kwaye ithambo le-cortical linokufumana ukuxinwa; 2. Njengepleyiti ye-buttress, i-LCP isetyenziswa kunye nezikrufu zokuqiniswa kokuqhinwa kwamathambo.
3.2 Iteknoloji Yokulungisa Ibhulorho: Okokuqala, sebenzisa indlela yokunciphisa ngokungathanga ngqo ukuze ubuyisele kwakhona ukwaphuka, udlule kwiindawo zokuqhekeka ngebhulorho kwaye ulungise amacala omabini okwaphuka. Ukunciphisa i-anatomic akufuneki, kodwa kufuna kuphela ukubuyiselwa kobude be-diaphysis, ukujikeleza kunye nomgca wamandla. Okwangoku, ukufakelwa kwamathambo kungenziwa ukukhuthaza ukwakheka kwe-callus kunye nokukhuthaza ukuphiliswa kokuqhekeka. Nangona kunjalo, ukulungiswa kwebhulorho kunokufezekisa uzinzo olulinganiselweyo, kodwa ukuphiliswa kokuqhekeka kufezekiswa ngee-callus ezimbini ngenjongo yesibini, ngoko ke kusebenza kuphela kwii-fractures eziqhekekileyo.
3.3 Iteknoloji ye-Minimally Invasive Plate Osteosynthesis (MIPO) Technology: Ukususela ngeminyaka yoo-1970, umbutho we-AO ubeke phambili imigaqo yonyango lokuqhekeka: ukunciphisa i-anatomical, i-internal fixator, ukukhuselwa kwegazi kunye nokuzilolonga kwangethuba ngaphandle kwentlungu. Le migaqo iye yaqatshelwa ngokubanzi kwihlabathi liphela, kwaye iziphumo zonyango zingcono kuneendlela zonyango zangaphambili. Nangona kunjalo, ukuze kufunyanwe i-anatomical reduction kunye ne-internal fixator, kudla ngokufuna ukunqunyulwa okukhulu, okubangela ukuncipha kokuphuma kwamathambo, ukuncipha kokunikezelwa kwegazi kweziqwenga zamathambo kunye nokwanda kwemingcipheko yosulelo. Kwiminyaka yakutshanje, iingcali zasekhaya nakwamanye amazwe zinika ingqalelo engakumbi kwaye zigxininisa ngakumbi kwiteknoloji engaphantsi kokungenelela, zikhusela ukunikezelwa kwegazi kwezicwili ezithambileyo kunye namathambo ngelixa zikhuthaza i-internal fixator, zingasusi i-periosteum kunye nezicwili ezithambileyo kumacala okwaphuka, zinganyanzelisi ukuncipha kwe-anatomical kweziqwenga zamathambo. Ke ngoko, ikhusela imeko-bume yebhayoloji yokwaphuka, oko kukuthi i-biological osteosynthesis (BO). Ngeminyaka yoo-1990, uKrettek wacebisa iteknoloji ye-MIPO, eyinkqubela phambili entsha yokulungiswa kwe-fracture kwiminyaka yakutshanje. Ijolise ekukhuseleni ukuhanjiswa kwegazi lokukhusela amathambo kunye nezicubu ezithambileyo ngomonakalo omncinci kakhulu. Le ndlela kukwakha umngxuma ongaphantsi komhlaba nge-incision encinci, ukubeka iiplate, kunye nokusebenzisa iindlela zokunciphisa ngokungathanga ngqo zokunciphisa ukwaphuka kunye ne-fixator yangaphakathi. I-engile phakathi kweeplate ze-LCP izinzile. Nangona iiplate zingayiqondi ngokupheleleyo i-anatomical shaping, ukunciphisa ukwaphuka kusenokugcinwa, ngoko ke iingenelo zobuchwepheshe be-MIPO zibonakala ngakumbi, kwaye yindlela efanelekileyo yokufakelwa ubuchwepheshe be-MIPO.
4. Izizathu kunye neMiqathango yokuchasana nokusilela kwesicelo se-LCP
4.1 Ukusilela kwe-Internal fixator
Zonke izinto ezifakelweyo zinokukhululeka, ukufuduka, ukwaphuka kunye neminye imingcipheko yokusilela, iipleyiti ezitshixwayo kunye ne-LCP azikho ngaphandle. Ngokweengxelo zoncwadi, ukungaphumeleli kwe-fixator yangaphakathi akubangelwa ikakhulu yipleyiti ngokwayo, kodwa kungenxa yokuba imigaqo esisiseko yonyango lokuqhekeka iyaphulwa ngenxa yokuqonda okunganelanga kunye nolwazi olupheleleyo malunga nokulungiswa kwe-LCP.
4.1.1. Iipleyiti ezikhethiweyo zimfutshane kakhulu. Ubude bepleyiti kunye nokusasazwa kwezikrufu zezona zinto ziphambili ezichaphazela uzinzo lokufakelwa. Ngaphambi kokuba kuvele ubuchwepheshe be-IMIPO, iipleyiti ezimfutshane zinokunciphisa ubude bokunqunyulwa kunye nokwahlukana kwezicubu ezithambileyo. Iipleyiti ezimfutshane kakhulu ziya kunciphisa amandla e-axial kunye namandla okujika kwisakhiwo esisisigxina, nto leyo ebangela ukungaphumeleli kwe-fixator yangaphakathi. Ngophuhliso lweteknoloji yokunciphisa ngokungathanga ngqo kunye neteknoloji engaphantsi kakhulu, iipleyiti ezinde aziyi kwandisa ukunqunyulwa kwezicubu ezithambileyo. Oogqirha kufuneka bakhethe ubude bepleyiti ngokuhambelana ne-biomechanics yokulungiswa kokuqhekeka. Kwii-fractures ezilula, umlinganiselo wobude bepleyiti obufanelekileyo kunye nobude bendawo yonke yokuqhekeka kufuneka ube ngaphezulu kwe-8-10 amaxesha, ngelixa kwi-fracture edibeneyo, lo mlinganiselo kufuneka ube ngaphezulu kwe-2-3 amaxesha. [13, 15] Iipleyiti ezinobude obaneleyo ziya kunciphisa umthwalo wepleyiti, zinciphise ngakumbi umthwalo we-screw, kwaye ngaloo ndlela zinciphise ukungaphumeleli kwe-fixator yangaphakathi. Ngokweziphumo zohlalutyo lwe-LCP finite element, xa umsantsa phakathi kwamacala okwaphuka uyi-1mm, icala lokuqhekeka lishiya umngxuma omnye weplate yokucinezela, uxinzelelo kwiplate yokucinezela lunciphisa i-10%, kwaye uxinzelelo kwizikrufu lunciphisa i-63%; xa icala lokuqhekeka lishiya imingxunya emibini, uxinzelelo kwiplate yokucinezela lunciphisa i-45% yokunciphisa, kwaye uxinzelelo kwizikrufu lunciphisa i-78%. Ke ngoko, ukuze kuthintelwe uxinzelelo loxinzelelo, kwiikrufu ezilula, kuya kushiyeka imingxunya eyi-1-2 ekufutshane namacala okwaphuka, ngelixa kwiikrufu eziqhekekileyo, kucetyiswa ukuba kusetyenziswe izikrufu ezintathu kwicala ngalinye lokuqhekeka kwaye izikrufu ezi-2 ziya kusondela kwiikrufu.
4.1.2 Umsantsa phakathi kweepleyiti nomphezulu wamathambo ugqithisile. Xa i-LCP isebenzisa itekhnoloji yokulungisa ibhuloho, iipleyiti azinyanzelekanga ukuba ziqhagamshelane ne-periosteum ukukhusela ukuhanjiswa kwegazi kwindawo yokuqhekeka. Ikwicandelo lokulungisa i-elastic, ivuselela amandla esibini okukhula kwe-callus. Ngokufunda uzinzo lwe-biomechanical, u-Ahmad M, uNanda R [16] nabanye bafumanise ukuba xa umsantsa phakathi kwe-LCP nomphezulu wamathambo ungaphezulu kwe-5mm, amandla e-axial kunye ne-torsion yeepleyiti ancipha kakhulu; xa umsantsa ungaphantsi kwe-2mm, akukho kuncipha kubalulekileyo. Ke ngoko, umsantsa ucetyiswa ukuba ungaphantsi kwe-2mm.
4.1.3 Ipleyiti iyaphambuka kwi-axis ye-diaphysis, kwaye izikrufu azifani ne-fixation. Xa i-LCP idityaniswe netekhnoloji ye-MIPO, iipleyiti ziyafuneka zifakwe nge-percutaneous, kwaye ngamanye amaxesha kunzima ukulawula indawo yepleyiti. Ukuba i-axis yethambo ayifani ne-axis yepleyiti, ipleyiti ekude inokuphambuka kwi-axis yethambo, nto leyo eya kukhokelela ekufakweni kwe-screws ngendlela engaqhelekanga kunye nokufakwa okubuthathaka. [9,15]. Kucetyiswa ukuba kwenziwe i-incision efanelekileyo, kwaye uvavanyo lwe-X-ray luya kwenziwa emva kokuba indawo yesikhokelo yokuchukumisa iminwe ifanelekile kwaye i-pin ye-Kuntscher ifanelekile.
4.1.4 Ukusilela ukulandela imigaqo esisiseko yonyango lokuqhekeka kwamathambo kunye nokukhetha iteknoloji engalunganga yokuqiniswa kwamathambo kunye nobuchwepheshe bokuqiniswa kwamathambo. Kwii-fractures zangaphakathi, ii-fractures ezilula ze-diaphysis ezinqamlezileyo, i-LCP ingasetyenziswa njengepleyiti yokuxinzelela ukulungisa uzinzo olupheleleyo lwee-fracture ngeteknoloji yokuxinzelela, kunye nokukhuthaza ukuphiliswa okuphambili kwee-fractures; kwii-fractures ze-Metaphyseal okanye ezi-comminuted, kufuneka kusetyenziswe iteknoloji yokuqiniswa kwe-bridge, kunikelwe ingqalelo ekunikezelweni kwegazi kokukhusela amathambo kunye nezicubu ezithambileyo, kuvunyelwe ukulungiswa okuzinzileyo kwee-fractures, kukhuthazwe ukukhula kwe-callus ukuze kufezekiswe ukuphiliswa nge-intension yesibini. Ngokwahlukileyo koko, ukusetyenziswa kweteknoloji yokuqiniswa kwe-bridge ukunyanga ii-fractures ezilula kunokubangela ii-fractures ezingazinzanga, okukhokelela ekupholisweni kwee-fractures ezilibazisekileyo; [17] ukuphishekela kakhulu ii-fractures ezi-comminuted ukunciphisa kunye nokuxinzelela kumacala e-fracture kunokubangela umonakalo ekunikezelweni kwegazi kwamathambo, okukhokelela ekudibaneni okanye ekungadibanini.
4.1.5 Khetha iintlobo zezikrufu ezingafanelekanga. Umngxuma wokudibanisa we-LCP unokukrufulwa ngeentlobo ezine zezikrufu: izikrufu ze-cortical eziqhelekileyo, izikrufu zethambo ezirhoxisiweyo eziqhelekileyo, izikrufu zokuzibhoboza/ukuzicofa kunye nezikrufu zokuzicofa. Izikrufu zokuzibhoboza/ukuzicofa zihlala zisetyenziswa njengezikrufu ze-unicortical ukulungisa ukwaphuka okuqhelekileyo kwamathambo e-diaphyseal. Incam yayo yeenzipho inoyilo lwepateni yokubhola, okulula ukuyidlula kwi-cortex ngaphandle kwemfuneko yokulinganisa ubunzulu. Ukuba umngxuma we-pulp ye-diaphyseal umxinwa kakhulu, i-screw nut isenokungangeni ngokupheleleyo kwi-screw, kwaye incam yesikrufu ichukumisa i-cortex echaseneyo, ngoko umonakalo kwi-cortex esisigxina esecaleni ichaphazela amandla okubamba phakathi kwezikrufu kunye namathambo, kwaye izikrufu zokuzicofa nge-bicortical ziya kusetyenziswa ngeli xesha. Izikrufu ze-unicortical ezicocekileyo zinamandla okubamba kakuhle amathambo aqhelekileyo, kodwa ithambo le-osteoporosis lidla ngokuba ne-cortex ebuthathaka. Ekubeni ixesha lokusebenza kwezikrufu liyancipha, ukumelana kwengalo yesikrufu ekugobeni kuyehla, nto leyo ekhokelela ngokulula kwi-cortex yethambo yokusikwa kwezikrufu, ukukhululeka kwezikrufu kunye nokufuduka kwesibini kokuqhekeka. [18] Ekubeni izikrufu ze-bicortical zonyuse ubude bokusebenza kwezikrufu, amandla okubamba amathambo nawo ayakhula. Ngaphezu kwako konke, ithambo eliqhelekileyo lingasebenzisa izikrufu ze-unicortical ukulungisa, kodwa ithambo le-osteoporosis liyacetyiswa ukusebenzisa izikrufu ze-bicortical. Ukongeza, i-humerus bone cortex incinci kakhulu, ibangela ukunqunyulwa ngokulula, ngoko ke izikrufu ze-bicortical ziyafuneka ukulungisa ekunyangeni ukwaphuka kwe-humeral.
4.1.6 Ukusasazwa kwezikrufu kuxinene kakhulu okanye kuncinci kakhulu. Ukufakelwa kwezikrufu kuyafuneka ukuze kuhambelane ne-biomechanics yokuqhekeka. Ukusasazwa kwezikrufu kuxinene kakhulu kuya kubangela uxinzelelo lwendawo kunye nokuqhekeka kwe-fixator yangaphakathi; izikrufu zokuqhekeka ezincinci kakhulu kunye namandla okunqongophala aneleyo kuya kubangela ukungaphumeleli kwe-fixator yangaphakathi. Xa iteknoloji yebridge isetyenziswa ekufakweni kwezikrufu, uxinano lwezikrufu olucetyiswayo kufuneka lube ngaphantsi kwe-40% -50% okanye ngaphantsi. [7,13,15] Ke ngoko, iipleyiti zinde kakhulu, ukuze kwandiswe ibhalansi ye-mechanics; kufuneka kushiywe imingxunya emi-2-3 kumacala okuqhekeka, ukuze kuvunyelwe ukuthamba okukhulu kwepleyiti, kuthintelwe uxinano loxinzelelo kwaye kuncitshiswe ukwanda kokuqhekeka kwe-fixator yangaphakathi [19]. UGautier noSommer [15] bacinga ukuba ubuncinane izikrufu ezimbini ze-unicortical ziya kulungiswa kumacala omabini okuqhekeka, inani elongezelelweyo le-cortex esisigxina aliyi kunciphisa izinga lokungaphumeleli kweepleyiti, ngoko ke ubuncinane izikrufu ezintathu ziyacetyiswa ukuba zifakwe kumacala omabini okuqhekeka. Kufuneka ubuncinane izikrufu ezi-3-4 kumacala omabini e-humerus kunye nokuqhekeka kwengalo, kufuneka kuthwalwe imithwalo emininzi yokugoba.
4.1.7 Izixhobo zokulungisa zisetyenziswa gwenxa, nto leyo ebangela ukungasebenzi kakuhle kwe-fixator yangaphakathi. USommer C [9] utyelele izigulane ezili-127 ezine-151 fracture cases ezisebenzise i-LCP unyaka omnye, iziphumo zohlalutyo zibonisa ukuba phakathi kwezikrufu zokutshixa ezingama-700, zimbalwa izikrufu ezinobubanzi obuyi-3.5mm ezikhululekileyo. Isizathu kukusetyenziswa kwesixhobo sokubona izikrufu zokutshixa. Enyanisweni, isikrufu sokutshixa kunye nepleyiti azikho nkqo ngokupheleleyo, kodwa zibonisa i-50 degrees ye-engile. Olu yilo lujolise ekunciphiseni uxinzelelo lwe-screw yokutshixa. Ukusetyenziswa kwesixhobo sokubona okulahliweyo kunokutshintsha indlela yezipikili kwaye ngaloo ndlela kubangele umonakalo kumandla okuxixa. UKääb [20] wayeqhube uphando lovavanyo, wafumanisa ukuba i-engile phakathi kwezikrufu kunye neepleyiti ze-LCP inkulu kakhulu, kwaye ngaloo ndlela amandla okubamba ezikrufu anciphile kakhulu.
4.1.8 Umthwalo wemilenze uselula kakhulu. Iingxelo ezininzi ezintle zikhokelela oogqirha abaninzi ukuba bakholelwe kakhulu kumandla eepleyiti zokutshixa kunye nezikrufu kunye nokuzinza kokuqina, bakholelwa ngempazamo ukuba amandla eepleyiti zokutshixa anokuthwala umthwalo opheleleyo kwangoko, nto leyo ebangela ukuba ipleyiti okanye izikrufu ziqhekeke. Xa kusetyenziswa ukwaphuka kwebridge fixation, i-LCP izinzile, kwaye iyadingeka ukwenza i-callus ukuze ikwazi ukuphiliswa ngokuxinwa kwesibini. Ukuba izigulane zivuka ebhedini kwangethuba kwaye zilayishe ubunzima obugqithisileyo, ipleyiti kunye nesikrufu ziya kwaphuka okanye zikhutshwe. Ukufakwa kwepleyiti yokutshixa kukhuthaza umsebenzi wangethuba, kodwa umthwalo opheleleyo ohamba kancinci uya kuba emva kweeveki ezintandathu, kwaye iifilimu ze-x-ray zibonisa ukuba icala lokuqhekeka libonisa i-callus ebalulekileyo. [9]
4.2 Ukulimala kweMisipha kunye neMithambo yeNtyolo:
Itekhnoloji ye-MIPO ifuna ukufakwa kwe-percutaneous kwaye ibekwe phantsi kwemisipha, ukuze xa kufakwa izikrufu zeplate, oogqirha botyando babengenakubona isakhiwo esingaphantsi kwesikhumba, kwaye ngaloo ndlela umonakalo we-tendon kunye ne-neurovascular uyanda. UVan Hensbroek PB [21] uxele ngetyala lokusebenzisa itekhnoloji ye-LISS ukusebenzisa i-LCP, nto leyo eyabangela i-pseudoaneurysms ye-anterior tibial artery. U-AI-Rashid M. [22] nabanye baxele ukuba banyanga ukuqhekeka okulibazisekileyo kwe-extensor tendon okwesibini ngenxa yokuqhekeka kwe-distal radial nge-LCP. Izizathu eziphambili zomonakalo yi-iatrogenic. Eyokuqala ngumonakalo othe ngqo oziswa zizikrufu okanye i-Kirschner pin. Eyesibini ngumonakalo obangelwe yi-sleeve. Kwaye eyesithathu ngumonakalo wobushushu oveliswa kukubhoboza izikrufu zokuzicofa. [9] Ke ngoko, oogqirha botyando kufuneka baqhelane ne-anatomy ejikelezileyo, banikele ingqalelo ekukhuseleni i-nervus vascularis kunye nezinye izakhiwo ezibalulekileyo, benze ngokupheleleyo ukuqhekeka okucacileyo ekubekeni imikhono, baphephe ukucinezelwa okanye ukutsalwa kwemithambo-luvo. Ukongeza, xa ugqobhoza izikrufu zokuzicofa, sebenzisa amanzi ukunciphisa ukuveliswa kobushushu kunye nokunciphisa ukuhanjiswa kobushushu.
4.3 Usulelo kwindawo yotyando kunye nokuchaphazeleka kwepleyiti:
I-LCP yinkqubo ye-fixator yangaphakathi eyenzeka phantsi kwemvelaphi yokukhuthaza ingcamango yokungena kancinci, ejolise ekunciphiseni umonakalo, ukunciphisa usulelo, ukungadibani kunye nezinye iingxaki. Kutyando, kufuneka sinikele ingqalelo ekhethekileyo kukhuseleko lwezicubu ezithambileyo, ingakumbi iindawo ezibuthathaka zezicubu ezithambileyo. Xa kuthelekiswa ne-DCP, i-LCP inobubanzi obukhulu kunye nobukhulu obukhulu. Xa kusetyenziswa iteknoloji ye-MIPO yokufaka i-percutaneous okanye i-intramuscular, inokubangela ukuqhekeka kwezicubu ezithambileyo okanye umonakalo we-avulsion kwaye ikhokelele kusulelo lwenxeba. I-Phinit P [23] ibike ukuba inkqubo ye-LISS inyange amatyala angama-37 okuqhekeka kwe-tibia ekufutshane, kwaye ukuvela kosulelo olujulile emva kotyando bekuya kuthi ga kwi-22%. UNamazi H [24] ibike ukuba i-LCP inyange amatyala angama-34 okuqhekeka kwe-tibial shaft kwamatyala angama-34 okuqhekeka kwe-tibia e-metaphyseal, kwaye ukuvela kosulelo lwenxeba emva kotyando kunye nokuvezwa kweplate bekuya kuthi ga kwi-23.5%. Ke ngoko, ngaphambi kotyando, amathuba kunye ne-fixator yangaphakathi kufuneka iqwalaselwe ngokugqithisileyo ngokuhambelana nomonakalo wezicubu ezithambileyo kunye nobunzima bokuqhekeka.
4.4 Isifo samathumbu esirhawuzelelayo sezicubu ezithambileyo:
UPhinit P [23] uxele ukuba inkqubo yeLISS inyange iimeko ezingama-37 zokuqhekeka kwe-tibia ekufutshane, iimeko ezi-4 zokurhawuzelelwa kwezicubu ezithambileyo emva kotyando (iintlungu zepleyiti ephathwayo engaphantsi komhlaba kwaye ijikeleze iipleyiti), apho iimeko ezi-3 zeepleyiti zikude nge-5mm ukusuka kumphezulu wethambo kwaye ityala eli-1 likude nge-10mm ukusuka kumphezulu wethambo. UHasenboehler.E [17] nabanye baxele ukuba i-LCP inyange iimeko ezingama-32 zokuqhekeka kwe-tibial ekude, kuquka iimeko ezingama-29 zokungakhululeki kwe-medial malleolus. Isizathu kukuba umthamo wepleyiti mkhulu kakhulu okanye iipleyiti zibekwe ngendlela engafanelekanga kwaye izicubu ezithambileyo zincinci kwi-medial malleolus, ngoko ke izigulane ziya kuziva zingakhululekanga xa izigulane zinxibe izihlangu eziphakamileyo kwaye zicinezela ulusu. Iindaba ezimnandi zezokuba ipleyiti entsha ye-distal metaphyseal eyenziwe yiSynthes incinci kwaye inamathela kumphezulu wethambo enemiphetho egudileyo, nto leyo eyisombulule ngempumelelo le ngxaki.
4.5 Ubunzima bokususa izikrufu zokutshixa:
Izinto ze-LCP zenziwe nge-titanium enamandla kakhulu, zihambelana kakhulu nomzimba womntu, okulula ukupakishwa yi-callus. Ekususeni, ukususa okokuqala i-callus kukhokelela kubunzima obuninzi. Esinye isizathu sokususa ubunzima sikwi-tightening over-tighting ye-lock screws okanye umonakalo we-nut, odla ngokubangelwa kukutshintsha isixhobo sokubona isikrufu esitshixwayo esilahliweyo ngesixhobo sokubona esizisebenzelayo. Ke ngoko, isixhobo sokubona kufuneka sisetyenziswe ekuthatheni izikrufu ezitshixwayo, ukuze imisonto yesikrufu inamathele ngokuchanekileyo ngemisonto yeplate. [9] Kufuneka kusetyenziswe i-wrench ethile kwi-strum eziqinisayo, ukuze kulawulwe ubukhulu bamandla.
Ngaphezu kwako konke, njengepleyiti yokucinezela yophuhliso lwamva nje lwe-AO, i-LCP ibonelele ngokhetho olutsha kunyango lwanamhlanje lotyando lwamathambo aqhekekileyo. Idityaniswe netekhnoloji ye-MIPO, i-LCP idibanisa igcina unikezelo lwegazi kumacala aqhekekileyo kakhulu, ikhuthaza ukuphiliswa kwamathambo aqhekekileyo, inciphisa iingozi zosulelo kunye nokuqhekeka kwakhona, igcina uzinzo lwamathambo aqhekekileyo, ngoko ke inamathuba amaninzi okusetyenziswa kunyango lwamathambo aqhekekileyo. Ukusukela oko yasetyenziswa, i-LCP ifumene iziphumo ezilungileyo zeklinikhi zexesha elifutshane, kodwa ezinye iingxaki nazo ziyavezwa. Utyando lufuna ucwangciso oluneenkcukacha lwangaphambi kotyando kunye namava amaninzi eklinikhi, ikhetha izixhobo zokulungisa zangaphakathi ezifanelekileyo kunye nobuchwepheshe ngokusekelwe kwiimpawu zamathambo athile, inamathela kwimigaqo esisiseko yonyango lwamathambo aqhekekileyo, isebenzisa izixhobo zokulungisa ngendlela echanekileyo nesemgangathweni, ukuze kuthintelwe iingxaki kwaye kufumane iziphumo zonyango ezifanelekileyo.
Ixesha lokuthumela: Juni-02-2022
