Njenge-fixator yangaphakathi, i-compression plate isoloko idlala indima ebalulekileyo kunyango lokwaphuka.Kwiminyaka yakutshanje, ingqikelelo ye-osteosynthesis encinci invasive iye yaqondwa ngokunzulu kwaye yasetyenziswa, ngokuthe ngcembe isuka kugxininiso lwangaphambili kumatshini omatshini wokulungisa wangaphakathi ukugxininisa ukulungiswa kwebhayoloji, engagxili kuphela ekukhuselweni kwethambo kunye nezicubu ezithambileyo zegazi, kodwa. ikwakhuthaza ukuphuculwa kweendlela zotyando kunye nokulungiswa kwangaphakathi.Ukutshixa ipleyiti yoxinzelelo(LCP) yinkqubo yokulungiswa kwepleyiti entsha kraca, ephuhliswe ngesiseko sepleyiti yoxinzelelo oluguquguqukayo (DCP) kunye nepleyiti yoxinzelelo eguquguqukayo yonxibelelwano (LC-DCP), kwaye idityaniswe neengenelo zeklinikhi ze-AO's point contact plate ( I-PC-Fix) kunye neNkqubo yokuZinzisa eNgaphantsi (i-LISS).Inkqubo yaqala ukusetyenziswa eklinikhi ngoMeyi ka-2000, iphumelele iziphumo ezingcono zeklinikhi, kwaye iingxelo ezininzi zinike ii-apreyizalis eziphezulu kuyo.Nangona kukho iingenelo ezininzi ekulungiseni kwayo ukwaphuka, ineemfuno eziphezulu kwitekhnoloji kunye namava.Ukuba ayisetyenziswanga ngokufanelekileyo, inokuba nemveliso, kwaye ikhokelela kwiziphumo ezingenakubuyiseka.
1. Imigaqo ye-Biomechanical, i-Design kunye ne-Advantages ye-LCP
Ukuzinza kweplate yentsimbi eqhelekileyo isekelwe kwingxabano phakathi kweplate kunye nethambo.Izikrufu ziyafuneka ukuba ziqiniswe.Emva kokuba i-screws ikhululekile, ukungqubuzana phakathi kweplate kunye nethambo kuya kuncitshiswa, ukuzinza kuya kuncipha, okubangelwa ukungaphumeleli kwe-fixator yangaphakathi.I-LCPipleyiti entsha yenkxaso ngaphakathi kwezicubu ezithambileyo, eziphuhliswa ngokudibanisa ipleyiti yoxinzelelo lwendabuko kunye nenkxaso.Umgaqo wayo wokulungisa awuxhomekekanga kwingxabano phakathi kwepleyiti kunye ne-bone cortex, kodwa uxhomekeke kwi-angle uzinzo phakathi kwepleyiti kunye nezikrufu zokutshixa kunye nokubamba amandla phakathi kwe-screws kunye ne-bone cortex, ukuze kuqondwe ukulungiswa kwe-fracture.Inzuzo ethe ngqo ixhomekeke ekunciphiseni ukuphazanyiswa kwe-periosteal blood supply.Ukuzinza kwe-angle phakathi kwepleyiti kunye nezikrufu kuye kwaphucula kakhulu amandla okubamba izikrufu, ngoko ke amandla okulungisa ipleyiti makhulu kakhulu, asebenza kumathambo ahlukeneyo.[4-7]
Isici esikhethekileyo soyilo lwe-LCP "ngumngxuma odibeneyo", odibanisa imingxuma yoxinzelelo oluguquguqukayo (DCU) kunye nemingxuma ene-conical threaded.I-DCU inokuqonda ukunyanzeliswa kwe-axial ngokusebenzisa izikrufu eziqhelekileyo, okanye iifractures ezisusiweyo zinokucinezelwa kwaye zilungiswe nge-screw lag;umngxuma ophothiweyo we-conical unemisonto, enokuthi itshixe isikrufu kunye ne-latch ye-nut's threaded, ukuhambisa i-torque phakathi kwe-screw kunye nepleyiti, kunye noxinzelelo lwe-longitudinal lunokudluliselwa kwicala lokwaphuka.Ukongezelela, i-groove yokusika iyilwe phantsi kweplate, eyanciphisa indawo yoqhagamshelwano kunye nethambo.
Ngamafutshane, ineenzuzo ezininzi ngaphezu kwamacwecwe emveli: ① uzinzisa i-angle: i-angle phakathi kwamacwecwe e-nail izinzile kwaye igxininisekile, isebenza kakuhle kumathambo ahlukeneyo;② inciphisa umngcipheko wokunciphisa ukulahleka: akukho mfuneko yokuqhuba ngokuchanekileyo ukugoba kwangaphambili kwiiplate, ukunciphisa ingozi yokulahlekelwa kwenqanaba lokuqala kunye nesigaba sesibini sokunciphisa ukunciphisa;[8] ③ ikhusela unikezelo lwegazi: ubuncinci bomphezulu woqhagamshelwano phakathi kwepleyiti yentsimbi kunye nethambo inciphisa ilahleko yepleyiti yonikezelo lwegazi lweperiosteum, olulungelelaniswa ngakumbi nemigaqo yokuhlasela kancinane;④ inesimo esihle sokubamba: sisebenza ngakumbi kwithambo le-osteoporosis fracture, linciphisa izehlo zokukhulula i-screw kunye nokuphuma;⑤ ivumela umsebenzi wokuqala wokuzilolonga;I-⑥ inoluhlu olubanzi lwezicelo: uhlobo lwepleyiti kunye nobude bugqityiweyo, i-anatomical pre-shaped ilungile, enokuqonda ukulungiswa kwamacandelo ahlukeneyo kunye neentlobo ezahlukeneyo zokuphuka.
2. Iimpawu zeLCP
I-LCP inokusetyenziswa mhlawumbi njengeplate yokucinezela eqhelekileyo okanye njengenkxaso yangaphakathi.Ugqirha wotyando unokudibanisa zombini, ukuze kwandiswe kakhulu izalathiso zayo kwaye isebenze kwiipatheni ezahlukeneyo zokwaphuka.
I-2.1 I-Fractures elula ye-Diaphysis okanye i-Metaphysis: ukuba umonakalo kwizicubu ezithambileyo awunzima kwaye ithambo linomgangatho omhle, iifractures ezinqamlekileyo ezinqamlekileyo okanye i-short oblique fracture yamathambo amade afunekayo ukusika kunye nokunciphisa ngokuchanekileyo, kunye necala lokuphuka lifuna ukunyanzeliswa okunamandla, ngaloo ndlela i-LCP ingasetyenziswa njengepleyiti yoxinzelelo kunye nepleyiti okanye ipleyiti yokungathathi hlangothi.
I-2.2 I-Fractures edibeneyo ye-Diaphysis okanye i-Metaphyseal: I-LCP ingasetyenziselwa njengeplate yebhuloho, eyamkela ukucutha okungathanga ngqo kunye ne-bridge osteosynthesis.Ayifuni kuncitshiswa kwe-anatomical, kodwa ibuyisela nje ubude belungu, ukujikeleza kunye nomgca we-axial force.Ukuqhekeka kwe-radius kunye ne-ulna yinto ekhethekileyo, kuba umsebenzi wokujikeleza we-forearm uxhomekeke kakhulu kwi-anatomy eqhelekileyo ye-radius kunye ne-ulna, efana ne-intra-articular fractures.Ngaphandle koko, ukuncitshiswa kwe-anatomical kufuneka kuqhutywe, kwaye kuya kulungiswa ngokuzinzileyo kunye neepleyiti.
2.3 I-Intra-articular Fractures kunye ne-Inter-articular Fractures: Kwi-intra-articular fracture, akufuneki nje ukuba siqhube ukunciphisa i-anatomical ukuze siphinde siphinde siphinde sihlaziye i-articular surface, kodwa kufuneka sicinezele amathambo ukufezekisa ukulungiswa okuzinzile kunye nokukhuthaza ithambo. ukuphilisa, kwaye ivumela umthambo wokusebenza kwangaphambili.Ukuba i-articular fractures ineempembelelo kumathambo, i-LCP inokulungisangokubambisanaphakathi kwe-articular encitshisiweyo kunye ne-diaphysis.Kwaye akukho mfuneko yokubumba ipleyiti kwi-operation, eye yanciphisa ixesha lotyando.
2.4 Ilibazisekile iManyano okanye iNonunion.
2.5 I-Osteotomy evaliweyo okanye evulekileyo.
2.6 Ayisebenzi kwi-interlockingukubethelwa kwe-intramedullaryUkwaphuka, kwaye i-LCP yeyona ndlela ifanelekileyo.Umzekelo, i-LCP ayisebenzi kumonakalo womongo wokuqhekeka kwabantwana okanye abafikisayo, abantu abanemingxuma yepulp emxinwa kakhulu okanye ebanzi kakhulu okanye engalunganga.
I-2.7 Izigulane ze-Osteoporosis: ekubeni i-bone cortex incinci kakhulu, kunzima ukuba iplate yendabuko ifumane ukuzinza okuthembekileyo, okuye kwandisa ubunzima bokuhlinzwa kwe-fracture, kwaye kubangele ukungaphumeleli ngenxa yokukhulula lula kunye nokuphuma kwe-postoperative fixation.I-LCP yokuvala i-screw kunye ne-anchor yepleyiti yenza i-angle ukuzinza, kunye nezikhonkwane zeplate zidibeneyo.Ukongeza, mandrel ububanzi lokutshixa screw inkulu, ukwandisa amandla okubamba ithambo.Ngoko ke, iziganeko zokukhulula i-screw ziyancipha ngokufanelekileyo.Ukuzivocavoca umzimba kwangaphambili kuvunyelwe emva kokuhlinzwa.I-Osteoporosis luphawu olunamandla lwe-LCP, kwaye iingxelo ezininzi zinike ingqalelo ephezulu.
2.8 I-Periprosthetic Femoral Fracture: I-periprosthetic femoral fractures ihlala ihamba kunye ne-osteoporosis, izifo eziguga kunye nezifo ezinzulu zenkqubo.Iipleyiti zesiNtu zixhomekeke ekusikweni okubanzi, okubangela umonakalo onokwenzeka kunikezelo lwegazi lokuqhekeka.Ngaphandle koko, izikrufu eziqhelekileyo zifuna ukulungiswa kwe-bicortical, okubangela umonakalo kwisamente yamathambo, kwaye amandla okubambisa i-osteoporosis nawo akubikho.Iipleyiti ze-LCP kunye ne-LISS zixazulula iingxaki ezinjalo ngendlela efanelekileyo.Oko kukuthi, bamkela itekhnoloji ye-MIPO yokunciphisa imisebenzi edibeneyo, ukunciphisa umonakalo ekunikezeni igazi, kwaye ke i-cortical locking screw enye inokubonelela ngozinzo olwaneleyo, olungayi kubangela umonakalo kwi-samente yamathambo.Le ndlela ibonakaliswe ngokulula, ixesha elifutshane lokusebenza, ukopha okuncinci, uluhlu oluncinci lokuhluthwa kunye nokuququzelela ukuphiliswa kophuka.Ke ngoko, i-periprosthetic femoral fractures yenye yeempawu ezinamandla ze-LCP.[1, 10, 11]
3. IiNdlela zoTyando eziNxulumene nokuSetyenziswa kwe-LCP
I-3.1 ITekhnoloji yoNyango lweNdalo: nangona ingcamango ye-AO yokulungisa yangaphakathi itshintshile kwaye ukunikezelwa kwegazi kwethambo lokukhusela kunye nezicubu ezithambileyo aziyi kuhoywa ngenxa yogxininiso lokuqina komatshini wokulungiswa, icala lokuphuka lisafuna ukunyanzeliswa ukufumana ukulungiswa kwabanye. iifractures, ezifana ne-intra-articular fractures, ukulungiswa kwe-osteotomy, i-transverse elula okanye i-oblique fractures emfutshane.Iindlela zokucinezela zezi: ① LCP isetyenziswa njengepleyiti yocinezelo, kusetyenziswa izikrufu ezibini zecortical ezisemgangathweni ukulungisa ngokweeccentrically kwipleyiti etyibilikayo iyunithi yokucinezela okanye ukusebenzisa isixhobo sokucinezela ukuqonda ukulungiswa;② njengeplate yokukhusela, i-LCP isebenzisa i-screws ye-lag ukulungisa i-oblique fractures ende;③ ngokwamkela umgaqo webhendi yoxinzelelo, ipleyiti ibekwe kwicala loxinzelelo lwethambo, iya kunyuswa phantsi koxinzelelo, kwaye ithambo lecortical linokufumana uxinzelelo;④ njengepleyiti ye-buttress, i-LCP isetyenziswa ngokudibeneyo kunye nezikrufu ze-lag ukulungiswa kwe-articular fractures.
3.2 I-Bridge Fixation Technology: Okokuqala, sebenzisa indlela yokunciphisa ngokungathanga ngqo ukuseta ngokutsha i-fracture, idlule kwiindawo eziqhekezayo ngebhulorho kwaye ulungise amacala omabini okuphuka.Ukunciphisa i-anatomic akufunwa, kodwa kufuna kuphela ukubuyiswa kobude be-diaphysis, ukujikeleza kunye nomgca wokunyanzela.Okwangoku, ukufakwa kwamathambo kunokwenziwa ukuvuselela ukubunjwa kwe-callus kunye nokukhuthaza ukuphulukiswa kwe-fracture.Nangona kunjalo, ukulungiswa kwebhulorho kunokufezekisa nje ukuzinza okuhambelanayo, kodwa ukuphulukiswa kwe-fracture kufezekiswa ngeefowuni ezimbini ngenjongo yesibini, ngoko ke kusebenza kuphela kwiifractures ezidibeneyo.
I-3.3 I-Technology ye-Minimally Invasive Plate Osteosynthesis (MIPO): Ukususela kwi-1970s, i-AO intlangano ibeka phambili imigaqo yokunyangwa kwe-fracture: ukunciphisa i-anatomical, i-fixator yangaphakathi, ukukhuselwa kwegazi kunye nokuzivocavoca kwangaphambili okungenabuhlungu.Imigaqo iye yaqatshelwa ngokubanzi kwihlabathi, kwaye iziphumo zeklinikhi zingcono kuneendlela zonyango zangaphambili.Nangona kunjalo, ukufumana ukucutha kwe-anatomic kunye ne-fixator yangaphakathi, ihlala ifuna ukucolwa okukhulu, okukhokelela ekuncitshisweni kwethambo, ukunciphisa unikezelo lwegazi lwamaqhekeza okuqhekeka kunye nokwanda kweengozi zosulelo.Kwiminyaka yakutshanje, abaphengululi basekhaya nabaphesheya banika ingqwalasela ngakumbi kwaye bagxininise ngakumbi kwitekhnoloji ye-invasive encinci, ukukhusela ukunikezelwa kwegazi kwezicubu ezithambileyo kunye nethambo ngeli xesha lokukhuthaza ukulungiswa kwangaphakathi, kungekhona ukukhulula i-periosteum kunye nezicubu ezithambileyo kwi-fracture. macala, ukunganyanzeli ukuncitshiswa kwe-anatomical yamaqhekeza okuqhekeka.Ke ngoko, ikhusela i-fracture biological environment, oko kukuthi i-biological osteosynthesis (BO).Kwiminyaka ye-1990, i-Krettek iphakamise iteknoloji ye-MIPO, eyinkqubela entsha yokulungiswa kwe-fracture kwiminyaka yamuva.Ijolise ekukhuseleni ukunikezelwa kwegazi kwethambo lokukhusela kunye nezicubu ezithambileyo kunye nomonakalo omncinci ukuya kwinqanaba elikhulu.Indlela kukwakha i-tunnel engaphantsi kwe-subcutaneous ngokusebenzisa i-incision encinci, ukubeka iiplate, kunye nokwamkela iindlela zokunciphisa ngokungathanga ngqo zokunciphisa i-fracture kunye ne-fixator yangaphakathi.I-angle phakathi kweepleyiti ze-LCP izinzile.Nangona iipleyiti zingaqapheli ngokupheleleyo ukubunjwa kwe-anatomical, ukuncitshiswa kwe-fracture kusenakho ukugcinwa, ngoko ke iinzuzo zeteknoloji ye-MIPO zivelele ngakumbi, kwaye kukufakelwa ngokufanelekileyo kweteknoloji ye-MIPO.
4. Izizathu kunye neMiqathango yokuNgaphumeleli kweSicelo seLCP
4.1 Ukusilela koLungiso lwangaphakathi
Zonke izifakelo zinokukhulula, ukufuduswa, ukwaphuka kunye neminye imingcipheko yokungaphumeleli, iipleyiti zokutshixa kunye ne-LCP azikho ngaphandle.Ngokweengxelo zoncwadi, ukungaphumeleli kwe-fixator yangaphakathi akubangelwa ikakhulu yi-plate ngokwayo, kodwa ngenxa yokuba imigaqo esisiseko yonyango lokuphuka iphulwa ngenxa yokungaqondi kakuhle kunye nolwazi lokulungiswa kwe-LCP.
4.1.1.Amacwecwe akhethiweyo mafutshane kakhulu.Ubude beplate kunye ne-screw distribution yizinto eziphambili ezichaphazela ukuzinza kokulungiswa.Ngaphambi kokuvela kweteknoloji ye-IMIPO, iiplati ezimfutshane zinokunciphisa ubude be-incision kunye nokwahlulwa kwezicubu ezithambileyo.Iipleyiti ezimfutshane kakhulu ziya kunciphisa amandla e-axial kunye namandla e-torsion kwisakhiwo esisisigxina esipheleleyo, okubangelwa ukungaphumeleli kwe-fixator yangaphakathi.Ngophuhliso lwetekhnoloji yokunciphisa ngokungathanga ngqo kunye nethekhnoloji encinci ye-invasive, iipleyiti ezide aziyi kwandisa ukusika kwezicubu ezithambileyo.Oogqirha kufuneka bakhethe ubude beplate ngokuhambelana ne-biomechanics ye-fracture fixation.Ukwaphuka okulula, umlinganiselo wobude beplati efanelekileyo kunye nobude bendawo yonke yokuphuka kufuneka ibe phezulu kunamaxesha angama-8-10, ngelixa ukuphuka okudibeneyo, lo mlinganiselo kufuneka ube phezulu kunamaxesha angama-2-3.[13, 15] Iipleyiti ezinobude obude obaneleyo ziya kunciphisa umthwalo weplate, zinciphise ngakumbi umthwalo we-screw, kwaye ngaloo ndlela zinciphise iziganeko zokungaphumeleli kwe-fixator yangaphakathi.Ngokutsho kweziphumo ze-LCP yohlalutyo olulinganiselweyo, xa i-gap phakathi kwamacala aqhekezayo yi-1mm, icala le-fracture lishiya umngxuma wepleyiti yoxinzelelo, uxinzelelo kwi-plate yoxinzelelo lunciphisa i-10%, kwaye uxinzelelo kwi-screws lunciphisa i-63%;xa i-fracture side ishiya imingxuma emibini, uxinzelelo kwi-compression plate kunciphisa i-45% yokunciphisa, kwaye uxinzelelo kwi-screws lunciphisa i-78%.Ke ngoko, ukuthintela uxinzelelo loxinzelelo, ngenxa yezaphulelo ezilula, imingxuma eyi-1-2 kufutshane namacala oqhekeko iya kushiywa, ngelixa iifractures ezidibeneyo, izikrufu ezintathu ziyacetyiswa ukuba zisetyenziswe kwicala ngalinye lokuphuka kunye nezikrufu ezi-2 ziya kusondela ukwaphuka.
4.1.2 Umsantsa phakathi kweepleyiti nomphezulu wethambo ugqithise kakhulu.Xa i-LCP ithatha iteknoloji yokulungiswa kwebhulorho, iiplate azifunwa ukuba ziqhagamshelane ne-periosteum ukukhusela ukunikezelwa kwegazi kwendawo yokuphuka.Kudidi lwe-elastic fixation, ivuselela ukuqina kwesibini kokukhula kwecallus.Ngokufunda ukuzinza kwe-biomechanical, u-Ahmad M, uNanda R [16] et al wafumanisa ukuba xa i-gap phakathi kwe-LCP kunye ne-bone surface ingaphezu kwe-5mm, amandla e-axial kunye ne-torsion yamacwecwe ayancipha kakhulu;xa i-gap ingaphantsi kwe-2mm, akukho kuncipha okukhulu.Ngoko ke, i-gap inconywa ukuba ibe ngaphantsi kwe-2mm.
4.1.3 Ipleyiti iyaphambuka kwi-diaphysis axis, kwaye izikrufu zi-eccentric ukuya ku-fixation.Xa i-LCP idityanisiwe iteknoloji ye-MIPO, iipleyiti zifunekayo ukufakwa kwe-percutaneous, kwaye ngamanye amaxesha kunzima ukulawula indawo yeplate.Ukuba i-axis yethambo ayihambelani ne-axis yepleyiti, i-distal plate inokuphambuka kwi-axis yethambo, okuya kuthi ngokuqinisekileyo kubangele ukulungiswa kwe-eccentric yezikrufu kunye nokulungiswa okubuthathaka.[9,15].Kucetyiswa ukuba kuthathwe i-incision efanelekileyo, kwaye uvavanyo lwe-X-ray luya kwenziwa emva kokuba indawo yesikhokelo sokuchukumisa umnwe ifanelekile kunye ne-Kuntscher pin fixation.
4.1.4 Ukungaphumeleli ukulandela imigaqo esisiseko yonyango lokwaphuka kunye nokukhetha isilungisi sangaphakathi esingalunganga kunye nobuchwepheshe bokulungisa.Kwi-intra-articular fractures, i-transverse diaphysis fractures elula, i-LCP ingasetyenziselwa njengeplate yokunyanzeliswa ukulungisa ukuzinza okupheleleyo kwe-fracture ngokusebenzisa iteknoloji yoxinzelelo, kunye nokukhuthaza ukuphulukiswa okuphambili kweefractures;ngenxa ye-Metaphyseal okanye i-fractures edibeneyo, iteknoloji yokulungiswa kwebhuloho kufuneka isetyenziswe, qwa lasela ukunikezelwa kwegazi kwithambo lokukhusela kunye nezicubu ezithambileyo, vumela ukulungiswa okuzinzile kweefractures, ukukhuthaza ukukhula kwe-callus ukufezekisa ukuphilisa ngokunyuka kwesibini.Ngokuchasene noko, ukusetyenziswa kweteknoloji yokulungiswa kwebhulorho ukunyanga iifractures ezilula kunokubangela ukuphuka okungazinzanga, okubangelwa ukulibaziseka ukuphulukiswa kokuphuka;[17] ukuqhubela phambili kokuqhekeka 'ukusukelana ngokugqithisileyo kokunciphisa i-anatomical kunye nokunyanzeliswa kumacala aqhekekileyo kunokubangela umonakalo kunikezelo lwegazi lwamathambo, okukhokelela ekulibazisekeni komanyano okanye ukungabikho.
4.1.5 Khetha iintlobo zezikrufu ezingafanelekanga.Umngxuma wokudibanisa we-LCP unokugqunywa kwiintlobo ezine zezikhonkwane: izikrufu eziqhelekileyo zecortical, i-standard cancellous bone screws, i-self-drilling/self-tapping screws kunye nezikrufu zokuzicofa.I-self-drilling / self-tapping screws idla ngokusetyenziswa njenge-screws ye-unicortical ukulungisa i-diaphyseal fractures eqhelekileyo yamathambo.Incam yayo yesikhonkwane inoyilo lwepateni yokubhola, ekulula ukudlula kwi-cortex ngokuqhelekileyo ngaphandle kwemfuneko yokulinganisa ubunzulu.Ukuba ipulp cavity yediaphyseal imxinwa kakhulu, i-screw nut inokungalungeli ngokupheleleyo isikrufu, kwaye incam yesijivu ichukumisa icortex ye-contralateral, ngoko ke umonakalo okwi-lateral cortex esisigxina uchaphazela amandla okubamba phakathi kwezikrufu namathambo, kunye nezikrufu zokuzicofa nge-bicortical. zisetyenziswe ngeli xesha.Izikrufu ezinyulu ze-unicortical zinamandla abambekayo afanelekileyo ukuya kumathambo aqhelekileyo, kodwa ithambo le-osteoporosis lidla ngokuba ne-cortex ebuthathaka.Ukusukela ukuba ixesha lokusebenza kwezikrufu liyancipha, umzuzu wengalo yokuxhathisa isikrufu ekugobeni uyehla, nto leyo ekhokelela ngokulula ekusikeni isikrufu icortex yethambo, ukukhulula isikrufu kunye nokufuduswa kokwaphuka kwesibini.[18] Ekubeni izikrufu ze-bicortical zonyuse ubude bokusebenza kwezikrufu, amandla okubamba amathambo nawo ayanda.Ngaphezu kwako konke, ithambo eliqhelekileyo linokusebenzisa izikrufu ze-unicortical ukulungisa, kodwa ithambo le-osteoporosis liyacetyiswa ukuba lisebenzise izikrufu ze-bicortical.Ukongeza, i-humerus bone cortex incinci, ibangela ngokulula ukusika, ngoko ke izikrufu ze-bicortical ziyadingeka ukulungisa ukunyangwa kwe-humeral fractures.
4.1.6 Ukuhanjiswa kwezikrufu kuxinene kakhulu okanye kuncinci kakhulu.Ukulungiswa kweScrew kuyafuneka ukuze kuthotyelwe i-fracture biomechanics.Ukusabalalisa izikrufu ezixineneyo kakhulu kuya kubangela ukugxininiswa koxinzelelo lwendawo kunye nokwaphuka kwesilungisi sangaphakathi;izikrufu ezisezantsi kakhulu kunye nokungonelanga kokuqina kuya kubangela ukusilela kwesilungisi sangaphakathi.Xa iteknoloji yebhulorho isetyenziselwa ukulungiswa kwe-fracture, i-screw density ekhuthazwayo kufuneka ibe ngaphantsi kwe-40% -50% okanye ngaphantsi.[7,13,15] Ngoko ke, iipleyiti zide kakhulu, ukwenzela ukunyusa ibhalansi ye-mechanics;I-2-3 imingxuma kufuneka ishiywe kumacala aqhekezayo, ukwenzela ukuvumela i-plate elasticity enkulu, ugweme ugxininiso loxinzelelo kunye nokunciphisa iziganeko zokuphulwa kwe-fixator yangaphakathi [19].UGautier noSommer [15] babecinga ukuba ubuncinane izikrufu ezibini zeyunikorithi ziya kumiswa kumacala omabini oqhekeko, inani elongeziweyo lecortex esisigxina aliyi kunciphisa izinga lokungaphumeleli kweepleyiti, ngoko ke ubuncinane izikrufu ezithathu ziyacetyiswa ukuba zimangalelwe kumacala omabini. ukwaphuka.Ubuncinci i-screws ezi-3-4 ziyafuneka kumacala omabini e-humerus kunye ne-forearm fracture, imithwalo engaphezulu ye-torsion kufuneka iqhutywe.
4.1.7 Izixhobo zokulungisa zisetyenziswa ngokungachanekanga, nto leyo ebangele ukusilela kwesilungisi sangaphakathi.USommer C [9] undwendwele izigulane eziyi-127 ezineemeko zokwaphuka ezili-151 ezisebenzise i-LCP unyaka omnye, iziphumo zohlalutyo zibonisa ukuba phakathi kwezikrufu ezingama-700 zokutshixa, kuphela izikrufu ezimbalwa ezinobubanzi obuyi-3.5mm eziye zakhululwa.Isizathu silahliwe ukusetyenziswa kwesixhobo sokubona izikrufu zokutshixa.Enyanisweni, i-screw yokutshixa kunye nepleyiti azikho nkqo ngokupheleleyo, kodwa zibonisa i-50 degrees of angle.Olu yilo lujolise ekunciphiseni uxinzelelo lwesijiva sokutshixa.Ukulahlwa kokusetyenziswa kwesixhobo sokubona kunokutshintsha indawo yesikhonkwane kwaye ngaloo ndlela kubangele umonakalo kumandla okulungisa.U-Kääb [20] wenze uphononongo lovavanyo, wafumanisa ukuba i-engile phakathi kwezikrufu kunye neepleyiti ze-LCP inkulu kakhulu, kwaye ngoko amandla okubamba izikrufu ehle kakhulu.
4.1.8 Ukulayishwa kobunzima bomzimba kusengethuba kakhulu.Iingxelo ezintle kakhulu zikhokelela oogqirha abaninzi ukuba bakholelwe ngokugqithiseleyo amandla okutshixa iipleyiti kunye nezikrufu kunye nokuzinza kokulungiswa, bakholelwa ngempazamo ukuba amandla okutshixa iipleyiti anokuthwala ubunzima obupheleleyo bokuqala, okukhokelela ekuqhekekeni kwepleyiti okanye isikrufu.Ekusebenziseni iifractures zokulungisa ibhulorho, i-LCP izinzile, kwaye kufuneka yenze i-callus ukuze iqonde ukuphiliswa ngokunyuka okwesibini.Ukuba izigulana ziphuma ebhedini kwangoko kakhulu kwaye zilayisha ubunzima obugqithisileyo, ipleyiti kunye nesikrufu ziyakophuka okanye zikhutshwe.Ukulungiswa kwepleyiti yokutshixa kukhuthaza umsebenzi wangethuba, kodwa ukulayisha ngokuthe ngcembe kuya kuba kwiiveki ezintandathu kamva, kwaye iifilimu ze-x-reyi zibonisa ukuba icala lokwaphuka libonisa i-callus ebalulekileyo.[9]
4.2 I-Tendon kunye ne-Neurovascular Injuries:
I-teknoloji ye-MIPO idinga ukufakwa kwe-percutaneous kwaye ifakwe phantsi kwemisipha, ngoko xa i-screws yeplate ibekwe, oogqirha abakwazanga ukubona isakhiwo esingaphantsi kwe-subcutaneous, kwaye ngaloo ndlela i-tendon kunye nomonakalo we-neurovascular yanda.U-Van Hensbroek PB [21] wabika ityala lokusebenzisa iteknoloji ye-LISS ukusebenzisa i-LCP, eyabangela ukuba i-pseudoaneurysms ye-anterior tibial artery pseudoaneurysms.I-AI-Rashid M. [22] et al ibike ukuba iphathe ukulibaziseka kwe-tendon ye-extensor yesibini kwi-distal radial fractures kunye ne-LCP.Izizathu eziphambili zomonakalo yi-iatrogenic.Eyokuqala ngumonakalo othe ngqo oziswa ngezikrufu okanye i-Kirschner pin.Owesibini ngumonakalo owenziwe ngumkhono.Kwaye owesithathu ngumonakalo wobushushu oveliswa kukugrumba izikrufu ezizibambayo.[9] Ngoko ke, oogqirha botyando kufuneka baqhelane ne-anatomy ejikelezileyo, banikele ingqalelo ekukhuseleni i-nervus vascularis kunye nezinye izakhiwo ezibalulekileyo, baqhube ngokupheleleyo i-dissection blunt ekubekeni imikhono, bagweme ukunyanzeliswa okanye i-nerve traction.Ukongeza, xa ugrumba izikrufu ezizibambayo, sebenzisa amanzi ukunciphisa imveliso yobushushu kunye nokunciphisa ukuhanjiswa kobushushu.
4.3 Usulelo lweNdawo yoTyando kunye nokuBoneleka kwePlayiti:
I-LCP yinkqubo yokulungiswa kwangaphakathi yenzeke phantsi kwemvelaphi yokukhuthaza ingcamango encinci, ejolise ekunciphiseni umonakalo, ukunciphisa usulelo, ukungabikho kunye nezinye iingxaki.Kutyando, kufuneka sinikele ingqalelo ekhethekileyo ekukhuselweni kwezicubu ezithambileyo, ngakumbi iindawo ezibuthathaka zezicubu ezithambileyo.Xa kuthelekiswa ne-DCP, i-LCP inobubanzi obukhulu kunye nobukhulu obukhulu.Xa usebenzisa iteknoloji ye-MIPO yokufaka i-percutaneous okanye kwi-intramuscular, inokubangela ukungqubuzana kwezicubu ezithambileyo okanye umonakalo we-avulsion kwaye kukhokelela kusulelo lwenxeba.I-Phinit P [23] ibike ukuba inkqubo ye-LISS iye yaphatha amatyala e-37 e-proximal tibia fractures, kunye nesiganeko sokusuleleka kwi-postoperative enzulu ukuya kwi-22%.I-Namazi H [24] ibike ukuba i-LCP iye yaphatha iimeko ze-34 ze-tibial shaft fracture ye-34 iimeko ze-metaphyseal fracture ye-tibia, kunye neziganeko zokusuleleka kwesilonda emva kokusebenza kunye nokuvezwa kweplate ukuya kwi-23.5%.Ngoko ke, ngaphambi kokusebenza, amathuba kunye ne-fixator yangaphakathi iya kuqwalaselwa ngokukrakra ngokuhambelana nomonakalo wezicubu ezithambileyo kunye neqondo elinzima lokuphuka.
4.4 Irritable Bowel Syndrome ye Soft Tissue:
I-Phinit P [23] ibike ukuba inkqubo ye-LISS iye yaphatha amatyala e-37 e-proximal tibia fractures, iimeko ze-4 ze-postoperative soft tissue irritation (iintlungu ze-subcutaneous palpable plate kunye neeplate), apho iimeko ze-3 zamacwecwe zi-5mm kude. indawo yethambo kunye necala eli-1 li-10mm kude nomphezulu wethambo.I-Hasenboehler.E [17] et al ibike i-LCP iye yaphatha iimeko ze-32 ze-distal tibial fractures, kubandakanywa iimeko ze-29 ze-medial malleolus discomfort.Isizathu kukuba umthamo weplate mkhulu kakhulu okanye iiplate zibekwe ngokungafanelekanga kwaye izicubu ezithambileyo zincinci kwi-malleolus ephakathi, ngoko izigulane ziya kuziva zikhululekile xa izigulane zigqoke iibhuthi eziphezulu kwaye zicinezele ulusu.Iindaba ezimnandi zezokuba ipleyiti entsha ye-distal metaphyseal ephuhliswe yi-Synthes ibhityile kwaye incamathele kumphezulu wethambo elinemiphetho egudileyo, eyisombulule ngempumelelo le ngxaki.
4.5 Ubunzima bokukhupha izikrufu zokutshixa:
Izinto ze-LCP zinamandla aphezulu e-titanium, inokuhambelana okuphezulu kunye nomzimba womntu, okulula ukupakishwa yi-callus.Ekususeni, ukususwa kokuqala kwe-callus kukhokelela kubunzima obuninzi.Esinye isizathu sokususa ubunzima kukuqiniswa kakhulu kwezikrufu zokutshixa okanye umonakalo we nut, odla ngokubangelwa kukutshintsha isixhobo sokubona isikrufu esishiyiweyo ngesixhobo sokuzibona.Ngoko ke, isixhobo sokubona siya kusetyenziswa ekwamkeleni izikrufu zokutshixa, ukuze imisonto ye-screw ibotshelelwe ngokuchanekileyo ngemisonto yepleyiti.[9] I-wrench ecacileyo iyadingeka ukuba isetyenziswe ekuqiniseni izikhonkwane, ukwenzela ukulawula ubukhulu bamandla.
Ngaphezulu kwayo yonke into, njengepleyiti yoxinzelelo lophuhliso lwamva nje lwe-AO, i-LCP ibonelele ngokhetho olutsha lonyango lwangoku lotyando lokwaphuka.Idityaniswe neteknoloji ye-MIPO, i-LCP idibanisa ukugcinwa kwegazi kumacala okuqhekeka ukuya kwinqanaba elikhulu, ikhuthaza ukuphulukiswa kwe-fracture, inciphisa imingcipheko yokusuleleka kunye nokuqhekeka kwakhona, igcina ukuzinza kwe-fracture, ngoko inethuba elibanzi lesicelo kunyango lokwaphuka.Ukusukela kwisicelo, i-LCP ifumene iziphumo ezilungileyo zexesha elifutshane zeklinikhi, kodwa ezinye iingxaki ziyavezwa.Utyando ludinga ukucwangciswa okucacileyo kwangaphambi kokuhlinzwa kunye namava amaninzi ekliniki, ukhetha ukulungiswa kwangaphakathi kwangaphakathi kunye nobuchwepheshe ngesiseko seempawu zokuphuka okuthe ngqo, uhambelana nemigaqo esisiseko yonyango lokuphuka, usebenzisa i-fixators ngendlela echanekileyo kunye neyomgangatho, ukwenzela ukukhusela. iingxaki kwaye ufumane iziphumo ezichanekileyo zonyango.
Ixesha lokuposa: Jun-02-2022
