Semuchina wekugadzirisa mapfupa mukati, plate yekumanikidza yagara ichiita basa guru mukurapa kutyoka kwemapfupa. Mumakore achangopfuura, pfungwa yekushandiswa kweosteosynthesis isinganyanyi kukuvadza yave ichinzwisiswa uye ichishandiswa zvakadzama, zvishoma nezvishoma ichichinja kubva pakusimbiswa kwekare kwemakina emuchina wekugadzirisa mapfupa kuenda pakusimbiswa kwehupenyu, uko kusingangotarisi chete pakudzivirira ropa remapfupa nenyama yakapfava, asiwo kunokurudzira kuvandudzwa kwenzira dzekuvhiya nekugadzira mapfupa mukati.Purati Yekudzvanya Inokiya(LCP) isystem itsva yekuisa maplate, yakagadzirwa zvichibva pa dynamic compression plate (DCP) uye limited contact dynamic compression plate (LC-DCP), uye yakabatanidzwa nemabhenefiti ekiriniki eAO's point contact plate (PC-Fix) uye Less Invasive Stabilization System (LISS). Sisitimu iyi yakatanga kushandiswa mukiriniki muna Chivabvu 2000, yakawana mhedzisiro iri nani yekiriniki, uye mishumo yakawanda yakapa kuongororwa kwakakosha kwayo. Kunyangwe paine mabhenefiti akawanda mukuiswa kwayo kwemapundu, inoda tekinoroji yakawanda uye ruzivo rwakawanda. Kana ikashandiswa zvisina kunaka, inogona kunge isina zvayakanakira, uye ikaguma nemigumisiro isingadzoreki.
1. Nheyo dzeBiomechanical, Dhizaini uye Mabhenefiti eLCP
Kugadzikana kweplate yesimbi yakajairika kunobva pakukweshana kuri pakati peplate nepfupa. Zvikuruu zvinofanirwa kusimbiswa. Kana zvikuruu zvasununguka, kukweshana kuri pakati peplate nepfupa kuchaderera, kugadzikana kuchadererawo, zvichikonzera kutadza kweinternal fixator.LCPiplate itsva yekutsigira mukati menyama yakapfava, iyo inogadzirwa nekubatanidza plate yekumanikidza yechinyakare nerutsigiro. Nheyo yayo yekugadzika haitsamiri pakukweshana pakati peplate nebone cortex, asi inovimba nekugadzikana kwekona pakati peplate ne screws dzinokiya pamwe nesimba rekubata pakati pezvikururu nebone cortex, kuitira kuti pave nekugadzikana kwekutyoka. Chinhu chakanaka chiri mukuderedza kupindira kweropa re periosteal. Kugadzikana kwekona pakati peplate ne screws kwakavandudza zvakanyanya simba rekubata re screws, saka simba rekugadzirisa replate rakakura zvikuru, iro rinoshanda kumapfupa akasiyana. [4-7]
Chinhu chakasiyana chekugadzira LCP i "gomba rekubatanidza", iro rinosanganisa maburi e dynamic compression (DCU) nemaburi ane tambo dzakaita seconical. DCU inogona kuita kuti axial compression ishandise screws dzakajairika, kana kuti fractures dzakabviswa dzinogona kumanikidzwa uye kugadziriswa kuburikidza ne lag screw; gomba rine tambo dzakaita seconical rine tambo, dzinogona kukiya screw ne threaded latch ye nati, kutamisa torque pakati pe screw ne plate, uye longitudinal stress inogona kutamisirwa kudivi re fracture. Pamusoro pezvo, cutting groove yakagadzirwa pasi pe plate, izvo zvinoderedza nzvimbo yekubata ne pfupa.
Muchidimbu, ine mabhenefiti akawanda pamusoro pemaplate echinyakare: 1. Inodzikamisa kona: kona iri pakati pemaplate ezvipikiri yakagadzikana uye yakasimbiswa, inoshanda kune mapfupa akasiyana; 1. Inoderedza njodzi yekurasikirwa nekuderedza: hapana chikonzero chekukotamisa nemazvo maplate, zvichideredza njodzi dzekurasikirwa nekuderedza kwechikamu chekutanga uye chikamu chechipiri chekurasikirwa nekuderedza; [8] 1. Inodzivirira ropa: nzvimbo shoma yekubata pakati peplate yesimbi nepfupa inoderedza kurasikirwa kweplate yeropa re periosteum, iro rinoenderana zvakanyanya nemisimboti yekupinda zvishoma; 1. Ine hunhu hwakanaka hwekubata: inonyanya kushanda kune mapfupa emapfupa e osteoporosis, inoderedza kuwanda kwekusunungura nekubuda kwescrew; 1. Inobvumira kushanda kwekutanga kwekurovedza muviri; 1. Ine mashandisirwo akasiyana-siyana: mhando yeplate nehurefu zvakakwana, chimiro che anatomical chakanaka, chinogona kugadzirisa zvikamu zvakasiyana uye mhando dzakasiyana dzemapundu.
2. Zviratidzo zveLCP
LCP inogona kushandiswa sendiro yekudzvanya yakajairika kana sekutsigira mukati. Chiremba anogonawo kusanganisa zvese zviri zviviri, kuitira kuti awedzere zviratidzo zvayo uye azvishandise pamhando dzakasiyana-siyana dzemaronda ekutyoka.
2.1 Kutyoka kuri Nyore kweDiaphysis kana Metaphysis: kana kukuvara kwenyama yakapfava kusina kuipa uye pfupa racho riine mhando yakanaka, kutyoka kuri nyore kwemapfupa akachinjika kana kutyoka kupfupi kwemapfupa marefu kunodiwa kuti ucheke uye uderedze nemazvo, uye divi rekutyoka rinoda kudzvanywa kwakasimba, saka LCP inogona kushandiswa sendiro yekudzvanya nendiro kana plate yekuregedza.
2.2 Kutsemuka Kwemafupa eDiaphysis kana Metaphyseal: LCP inogona kushandiswa se bridge plate, iyo inoshandisa kudzikiswa kwekusanzwisisika uye bridge osteosynthesis. Haidi kudzikiswa kweanatomiki, asi inongodzoreredza kureba kwemakumbo, kutenderera uye mutsetse wesimba re axial. Kutsemuka kweradius neulna chinhu chakasiyana, nekuti basa rekutenderera kwemaoko rinoenderana zvakanyanya neatomu yakajairika yeradius neulna, iyo yakafanana nekutsemuka kwemukati mearticular. Kunze kweizvozvo, kudzikiswa kweanatomiki kunofanirwa kuitwa, uye kunofanira kugadziriswa nemaplates.
2.3 Kutsemuka Kwemapfupa Mukati Memapfupa Uye Kutsemuka Kwemapfupa Mukati Memapfupa: Mutsemuka wemapfupa mukati memapfupa, hatingodi chete kuderedza muviri kuti tidzorere kutsvedzerera kwemapfupa, asiwo tinofanira kudzvanya mapfupa kuti tiwane kugadzikana kwakasimba uye kukurudzira kupora kwemapfupa, uye kunobvumira kurovedza muviri kwekutanga. Kana mapfupa akatsemuka akakanganisa mapfupa, LCP inogona kugadzirisa mapfupa.joinipakati pemabvi akaderedzwa uye diaphysis. Uye hapana chikonzero chekugadzira ndiro mukuvhiyiwa, izvo zvakaderedza nguva yekuvhiyiwa.
2.4 Kunonoka Kubatana kana Kusabatana.
2.5 Osteotomy yakavharwa kana yakavhurika.
2.6 Hazvishande pakukiyanakunamira makumbo mukati memedullarykutyoka, uye LCP inzira yakanaka. Semuenzaniso, LCP haishandi pakutyoka kwevana kana vechidiki, vanhu vane maburi matete kana kuti akafara zvakanyanya kana asina kusimba.
2.7 Varwere veOsteoporosis: sezvo cortex yemapfupa yakatetepa zvakanyanya, zvinonetsa kuti plate yechinyakare iwane kugadzikana kwakavimbika, izvo zvakawedzera kuoma kwekuvhiyiwa kwekutyoka, uye zvakaita kuti pave nekukundikana nekuda kwekusunungura nekubuda nyore nyore kwekugadzirisa mushure mekuvhiyiwa. Skuruu yekukiya yeLCP uye chibatiso cheplate zvinoumba kugadzikana kwekona, uye nzara dzeplate dzakabatanidzwa. Pamusoro pezvo, dhayamita ye mandrel ye screw yekukiya yakakura, zvichiwedzera simba rekubata mapfupa. Nokudaro, kuwanda kwekusunungura screw kunoderedzwa zvinobudirira. Maekisesaizi emuviri ekutanga anotenderwa mushure mekuvhiyiwa. Osteoporosis chiratidzo chakasimba cheLCP, uye mishumo yakawanda yakaita kuti izivikanwe zvakanyanya.
2.8 Kupwanyika Kwenhengo Dzemudumbu: Kupwanyika kwenhengo dzemudumbu kunowanzo perekedzwa ne osteoporosis, zvirwere zvevakwegura uye zvirwere zvakakomba zvemuviri. Maplate echinyakare anochekwa zvakanyanya, zvichikonzera kukuvara kweropa rinobuda. Kunze kweizvozvo, masikuruu akajairika anoda kugadziriswa kwemakumbo maviri, zvichikonzera kukuvara kwesimende yemapfupa, uye simba rekubata osteoporosis harina kunaka. Maplate eLCP neLISS anogadzirisa matambudziko akadaro nenzira yakanaka. Kureva kuti, anoshandisa tekinoroji yeMIPO kuderedza mashandiro emajoini, kuderedza kukuvara kweropa, uye sikuruu imwe chete yecortical locking inogona kupa kugadzikana kwakakwana, izvo zvisingazokonzere kukuvara kwesimende yemapfupa. Nzira iyi inoratidzwa nekureruka, nguva pfupi yekushanda, kubuda ropa kushoma, kucheka nzvimbo diki uye kufambisa kupora kwemapfupa. Naizvozvo, kupwanyika kwenhengo dzemudumbu kunobva munhengo dzemudumbu ndeimwe yezviratidzo zvakasimba zveLCP. [1, 10, 11]
3. Maitiro Ekuvhiya Ane Chekuita Nekushandisa LCP
3.1 Tekinoroji Yekudzvanya Kwechinyakare: kunyangwe pfungwa yeAO internal fixator yachinja uye ropa rinodzivirira mapfupa nenyama dzakapfava harizoregeredzwi nekuda kwekunyanya kusimbiswa kwekugadzirisa, divi rekupwanyika richiri kuda kudzvanywa kuti riwane kugadzikana kwemamwe mavanga, akadai sekupwanyika kwemukati mearticular, kupwanyika kweosteotomy, kupwanyika kwakapfava kana kupfupi. Nzira dzekudzvanya ndeidzi: ① LCP inoshandiswa seplate yekudzvanya, ichishandisa screw mbiri dze cortical dzakajairwa kugadzirisa paplate inotsvedza compression unit kana kushandisa mudziyo wekudzvanya kuti iite kugadzikana; ② seplate yekudzivirira, LCP inoshandisa screws dzekupwanya kugadzirisa mavanga marefu; ③ nekushandisa musimboti we tension band, plate inoiswa parutivi rwe tension yepfupa, inofanira kuiswa pasi pekumanikidzwa, uye cortical bone inogona kuwana kudzvanywa; ④ seplate yebuttress, LCP inoshandiswa pamwe chete ne screws dzekupwanya kugadzirisa mavanga articular.
3.2 Tekinoroji yeKugadzirisa Bhiriji: Chekutanga, tora nzira yekuderedza isina kunanga kuti udzorere kukuvara, pfuura munzvimbo dzakatyoka uchishandisa bhiriji wogadzirisa mativi ese ekutyoka. Kuderedzwa kwemuviri hakudiwi, asi kunoda kudzoreredzwa kwehurefu hwe diaphysis, kutenderera uye tambo yesimba. Panguva iyi, kubatanidzwa kwemapfupa kunogona kuitwa kukurudzira kuumbwa kwe callus uye kukurudzira kupora kwe breakdown. Zvisinei, kugadzirisa bridge kunogona kungoita kuti breakdown igare zvakanaka, asi breakdown inoporeswa kuburikidza ne callus mbiri nepfungwa yechipiri, saka inongoshanda chete kune breakdown dzakatyoka.
3.3 Tekinoroji yeMinimally Invasive Plate Osteosynthesis (MIPO) Tekinoroji: Kubva kuma1970, sangano reAO rakaisa pamberi misimboti yekurapa kutyoka: kuderedza anatomic, internal fixator, kudzivirira ropa uye kurovedza muviri pasina kurwadziwa. Misimboti iyi yave ichizivikanwa zvakanyanya pasi rose, uye mhedzisiro yekiriniki iri nani pane nzira dzekurapa dzakapfuura. Zvisinei, kuti uwane anatomic reduction uye internal fixator, inowanzoda kuchekwa kwakawanda, zvichikonzera kudzikira kwemafuta emapfupa, kudzikira kweropa rezvidimbu zvemapundu uye kuwedzera njodzi dzehutachiona. Mumakore achangopfuura, nyanzvi dzemuno nedzekunze kwenyika dzinonyanya kutarisisa uye dzinoisa zvakanyanya patekinoroji isinganyanyi kupinda, ichidzivirira ropa rezvinyama zvakapfava nemapfupa panguva yekusimudzira internal fixator, kwete kubvisa periosteum nezvidimbu zvakapfava pamativi emapundu, kwete kumanikidza anatomic decrease yezvidimbu zvemapundu. Naizvozvo, inodzivirira nharaunda yezvakatyoka, kureva biological osteosynthesis (BO). Muma1990, Krettek akakurudzira tekinoroji yeMIPO, inova kufambira mberi kutsva kwekugadzirisa kutyoka mumakore achangopfuura. Chinangwa chayo ndechekudzivirira ropa rinopa mapfupa nenyama dzakapfava nekukuvara kudiki zvakanyanya. Nzira yacho ndeyekuvaka mugero uri pasi pevhu kuburikidza nekucheka kudiki, kuisa maplate, uye kushandisa nzira dzekuderedza kutyoka dzisina kunanga dzekuderedza kutyoka uye kugadzirisa mukati. Kona iri pakati pemaplate eLCP yakagadzikana. Kunyangwe maplate asinganyatso gadzira chimiro chemuviri, kuderedzwa kwekutyoka kunogona kuramba kuripo, saka mabhenefiti eMIPO tekinoroji anonyanya kuoneka, uye imhando yakanaka kwazvo yeMIPO tekinoroji.
4. Zvikonzero uye Matanho Ekudzivirira Kukundikana kweChikumbiro cheLCP
4.1 Kukundikana kweInternal fixator
Zvese zvinoiswa mumachira zvine mukana wekusunungura, kusuduruka, kutyoka uye dzimwe njodzi dzekukundikana, ma lock plates uye LCP hazvisi zvisizvo. Sekureva kwezvinyorwa, kukundikana kwe internal fixator hakunyanyi kukonzerwa ne plate pachayo, asi nekuti misimboti yekutanga yekurapa kutyoka inotyorwa nekuda kwekusanzwisisa kwakakwana uye ruzivo rwakakwana rwekugadziriswa kweLCP.
4.1.1. Maplate akasarudzwa mapfupi kwazvo. Kureba kweplate ne screw distribution ndizvo zvinhu zvikuru zvinokanganisa kugadzikana kwe fixation. Teknolojia yeMIPO isati yatanga, maplate mapfupi anogona kuderedza kureba kwe incision uye kupatsanurwa kwe soft tissue. Maplate mapfupi kwazvo anoderedza simba re axial uye torsion strength ye fixed overall structure, zvichikonzera kutadza kwe internal fixator. Nekuvandudzwa kwetekinoroji yekudzikisa zvisina kunanga uye tekinoroji isinganyanyi kupinda, maplate marefu haazowedzeri incision ye soft tissue. Vanachiremba vanofanira kusarudza urefu hweplate zvichienderana ne biomechanics ye fracture fixation. Kune fractures dziri nyore, chiyero che ideal plate length uye urefu hwe whole fracture zone chinofanira kunge chakakwirira kupfuura ka8-10, nepo kune fracture yakatyoka, chiyero ichi chinofanira kunge chakakwirira kupfuura ka2-3. [13, 15] Maplate ane kureba kwakakwana anoderedza mutoro weplate, anowedzera kuderedza mutoro we screw, uye nokudaro anoderedza kutadza kwe internal fixator. Zvichienderana nemhedzisiro yekuongorora kweLCP finite element, kana mukaha uri pakati pemativi ekutyoka uri 1mm, divi rekutyoka rinosiya buri rimwe chete rekudzvanya, kumanikidzwa papureti yekudzvanya kunodzikira ne10%, uye kumanikidzwa pazvikururu kunodzikira ne63%; kana divi rekutyoka richisiya maburi maviri, kumanikidzwa papureti yekudzvanya kunodzikira ne45%, uye kumanikidzwa pazvikururu kunodzikira ne78%. Saka, kudzivirira kushushikana, kune maburi akapfava, maburi 1-2 ari pedyo nemativi ekutyoka anofanira kusiiwa, nepo kune maburi akapwanyika, zvikururu zvitatu zvinokurudzirwa kushandiswa padivi rega rega rekutyoka uye zvikururu zviviri zvinofanirwa kusvika padyo nemapfupa akapwanyika.
4.1.2 Mukana uri pakati pemaplate nepamusoro pemapfupa wakanyanya. Kana LCP ikatora tekinoroji yekuisa bridge, maplate haafanirwe kubata periosteum kuchengetedza ropa rinobuda munzvimbo yakatyoka. Ndeyechikamu che elastic fixation, zvichikurudzira kukura kwechipiri kwe callus. Nekudzidza kugadzikana kwe biomechanical, Ahmad M, Nanda R [16] nevamwe vakaona kuti kana mukana uri pakati peLCP nepamusoro pemapfupa wakakura kupfuura 5mm, simba re axial ne torsion remaplates rinodzikira zvakanyanya; kana mukaha uri pasi pe2mm, hapana kudzikira kwakakosha. Nokudaro, mukaha unokurudzirwa kuti uve pasi pe2mm.
4.1.3 Ndiro inotsauka kubva padivi rediaphysis, uye masikuruu haachinjiki pakugadzika. Kana LCP ikasanganiswa tekinoroji yeMIPO, maplates anodiwa kuiswa percutaneous, uye dzimwe nguva zvinonetsa kudzora nzvimbo yeplate. Kana divi remapfupa risingaenzaniswi nedivi replate, distal plate inogona kutsauka kubva padivi remapfupa, izvo zvinozotungamira pakugadzika kwemasikuruu uye kusimba kusina simba. [9,15]. Zvinokurudzirwa kutora incision yakakodzera, uye X-ray inofanira kuongororwa mushure mekunge nzvimbo yekutungamira yekubata kwemunwe yakwana uye Kuntscher pin fixation.
4.1.4 Kukundikana kutevedzera misimboti yekutanga yekurapa kutyoka uye kusarudza tekinoroji isina kunaka yekuisa mukati uye yekugadzirisa. Kune fractures intra-articular, simple transverse diaphysis fractures, LCP inogona kushandiswa se compression plate kugadzirisa kugadzikana kwe fracture kuburikidza ne compression technology, uye kukurudzira primary healing of fractures; kune Metaphyseal kana comminuted fractures, tekinoroji yekuisa bridge inofanira kushandiswa, kutarisisa ropa rekudzivirira mapfupa nenyama yakapfava, kubvumira kugadzikana kwakasimba kwema fractures, kukurudzira callus growth kuti iwane kuporesa ne intension yechipiri. Kusiyana neizvi, kushandiswa kwe bridge fixation technology kurapa fractures dziri nyore kunogona kukonzera fractures dzisina kugadzikana, zvichikonzera kunonoka kupora kwema fractures; [17] fractures dzakatyoka dzinoda kuderedza uye kudzvanywa zvakanyanya pamativi ema fractures zvinogona kukonzera kukuvara kweropa remapfupa, zvichikonzera kunonoka kubatana kana kusabatana.
4.1.5 Sarudza mhando dzemascrew asina kukodzera. Gomba reLCP rinogona kukweshwa mumhando ina dzemascrew: mascrew e cortical akajairwa, mascrew e cancellous bone akajairwa, mascrew ekuzviboorera/kuzvitapa uye mascrew ekuzvitapa. Mascrew ekuzviboorera/kuzvitapa anowanzo shandiswa semascrew e unicortical kugadzirisa kutyoka kwemapfupa kwakajairika kwe diaphyseal. Chinongedzo chayo chenzara chine dhizaini yedhiri, iyo iri nyore kupfuura nepakati pe cortex kazhinji pasina kudikanwa kwekuyera kudzika. Kana diaphyseal pulp cavity yakamanikana kwazvo, screw nut ingasakwane zvakakwana nescrew, uye screw tip ichibata contralateral cortex, ipapo kukuvara kwe fixed lateral cortex kunokanganisa simba rekubata pakati pemascrew nemapfupa, uye bicortical self-tapping screws inofanira kushandiswa panguva ino. Mascrew e unicortical akachena ane simba rakanaka rekubata kumapfupa akajairwa, asi pfupa re osteoporosis rinowanzova ne cortex isina simba. Sezvo nguva yekushanda kwe screws ichiderera, nguva iyo ruoko rwe screw runodzivirira kukotama inoderera, izvo zviri nyore kukonzera screw cutting bone cortex, screw kusunungura uye secondary fracture displacement. [18] Sezvo masikuruu emakumbo maviri akawedzera urefu hwekushanda kwesikuruu, simba rekubata mapfupa rinowedzerawo. Pamusoro pezvose, pfupa rakajairika rinogona kushandisa masikuruu emakumbo maviri kugadzirisa, asi pfupa remapfupa e ...
4.1.6 Kugoverwa kwescrews kwakanyanyisa kana kuti kushoma. Kugadziriswa kwescrews kunodiwa kuti zvienderane ne biomechanics yekuputsika. Kugoverwa kwescrews kwakanyanyisa kuchaita kuti kuwedzere kushushikana uye kutyoka kwe internal fixator; screws dzisina kuputsika zvakanyanya uye simba rekugadzirisa risina kukwana zvichakonzerawo kukundikana kwe internal fixator. Kana tekinoroji yebridge ikashandiswa pakugadzirisa kuputsika, huwandu hwescrews hunokurudzirwa hunofanira kunge huri pasi pe40% -50% kana pasi. [7,13,15] Saka, maplates akareba, kuitira kuwedzera kuenzana kwemakanika; maburi 2-3 anofanira kusiiwa kumativi ekuputsika, kuitira kuti plate irambe yakasimba, kudzivirira kushushikana uye kuderedza kuwanda kwekuputsika kweinternal fixator [19]. Gautier naSommer [15] vaifunga kuti screws mbiri dze unicortical dzinofanira kugadziriswa kumativi ese ekuputsika, huwandu hwakawanda hwe fixed cortex hahuzoderedzi mwero wekukundikana kwemaplates, saka screws nhatu dzinokurudzirwa kusungwa kumativi ese ekuputsika. Zvikuruu zvitatu kusvika zvina zvinodiwa kumativi ese ehumerus neruoko rwakatyoka, mitoro yakawanda yekutenderera inofanira kutakurwa.
4.1.7 Midziyo yekugadzirisa haishandiswi zvisizvo, zvichikonzera kutadza kwemuchina wekugadzirisa mukati. Sommer C [9] akashanyira varwere 127 vane 151 vakatyoka avo vakashandisa LCP kwegore rimwe, mhedzisiro yekuongorora inoratidza kuti pakati pezvikuro zvinokiya mazana manomwe, zvikuro zvishoma chete zvine dhayamita ye3.5mm ndizvo zvakasunungurwa. Chikonzero ndechekurega kushandisa mudziyo wekuona zvikuro zvinokiya. Kutaura zvazviri, chikuro chinokiya neplate hazvina kumira zvakanaka, asi zvinoratidza 50 degrees yekona. Dhizaini iyi ine chinangwa chekuderedza kushushikana kwezvikuro zvinokiya. Kurega kushandisa mudziyo wekuona kunogona kuchinja nzira yechipikiri uye nokudaro kukonzera kukuvara kwesimba rekugadzirisa. Kääb [20] akaita ongororo yekuedza, akawana kuti kona iri pakati pezvikuro nemaplate eLCP yakakura zvakanyanya, uye nokudaro simba rekubata zvikuro rinoderera zvakanyanya.
4.1.8 Kurema kwemakumbo kwanyanya kunonoka. Mishumo yakawanda yakanaka inotungamira vanachiremba vazhinji kuti vatende zvakanyanya kusimba kwemaplates anokiya nemasikuru pamwe nekugadzikana kwekugadzirisa, vanotenda zvisirizvo kuti kusimba kwemaplates anokiya kunogona kutakura mutoro wakakura, zvichikonzera kuputsika kweplate kana sikuruu. Mukushandisa kuputsika kwekugadzirisa bridge, LCP yakagadzikana, uye inodiwa kuti igadzire callus kuitira kuti iporeswe nekukasira kwechipiri. Kana varwere vakamuka pamubhedha nekukurumidza uye vakatakura uremu hwakanyanya, plate nesikuruu zvichatyoka kana kusunungurwa. Kugadziriswa kweplate inokiya kunokurudzira kushanda kwekutanga, asi mutoro wakakwana zvishoma nezvishoma uchaitwa mushure memavhiki matanhatu, uye mafirimu e x-ray anoratidza kuti divi rekuputsika rine callus yakakosha. [9]
4.2 Kukuvara kweTendon neNeurovascular:
Tekinoroji yeMIPO inoda kuiswa kwepercutaneous uye kuiswa pasi petsandanyama, saka kana plate screws dzakaiswa, vanachiremba vekurapa vaisakwanisa kuona chimiro che subcutaneous, uye nekudaro kukuvara kwetendon ne neurovascular kunowedzera. Van Hensbroek PB [21] vakataura nezvenyaya yekushandisa tekinoroji yeLISS kushandisa LCP, izvo zvakakonzera anterior tibial artery pseudoaneurysms. AI-Rashid M. [22] nevamwe vakataura kuti vakarapa kunonoka kuputika kwe extensor tendon secondary stensor fractures neLCP. Zvikonzero zvikuru zvekukuvara ndezve iatrogenic. Chekutanga kukuvara zvakananga kunounzwa ne screws kana Kirschner pin. Chechipiri kukuvara kunokonzerwa ne sleeve. Uye chechitatu kukuvara kwekupisa kunokonzerwa nekuboorera self-tapping screws. [9] Saka, vanachiremba vekurapa vanofanirwa kujairana ne anatomy yakapoteredza, kungwarira kuchengetedza nervus vascularis nedzimwe structures dzakakosha, kuita blunt dissection zvizere mukuisa sleeve, kudzivirira kumanikidzwa kana kudhonzwa kwetsinga. Pamusoro pezvo, kana uchiboora screws dzekuzvitapira, shandisa mvura kuderedza kugadzirwa kwekupisa uye kuderedza kufambiswa kwekupisa.
4.3 Kubatwa nehutachiona panzvimbo yekuvhiyiwa uye kusangana neplate:
LCP inzira yekuisa mapfupa mukati yakaitwa pasi pekusimudzira pfungwa isinganyanyi kupinda muropa, ichivavarira kuderedza kukuvara, kuderedza hutachiona, kusabatana nezvimwe zvinetso. Mukuvhiyiwa, tinofanira kunyanya kutarisisa dziviriro yemapfupa akapfava, kunyanya zvikamu zvisina simba zvemapfupa akapfava. Kana tichienzanisa neDCP, LCP ine upamhi hwakakura uye ukobvu hwakakura. Pakushandisa tekinoroji yeMIPO yekuisa percutaneous kana intramuscular, inogona kukonzera kukuvara kwemapfupa akapfava kana avulsion uye kutungamira kuhutachiona hwemaronda. Phinit P [23] yakashuma kuti LISS system yakarapa zviitiko makumi matatu nenomwe zvekutyoka kwetibia, uye kuwanda kwehutachiona hwakadzika mushure mekuvhiyiwa kwakasvika pa22%. Namazi H [24] yakashuma kuti LCP yakarapa zviitiko makumi matatu nemana zvekutyoka kwetibia muzvikamu makumi matatu nemana zvekutyoka kwetibia muzvikamu makumi matatu nemana, uye kuwanda kwehutachiona hwemaronda mushure mekuvhiyiwa uye kuonekwa kweplate kwakasvika pa23.5%. Saka, tisati tavhiyiwa, mikana uye internal fixator inofanira kutariswa zvakanyanya zvichienderana nekukuvara kwemapfupa akapfava uye kuoma kwekutyoka.
4.4 Chirwere cheMatumbu Ane Hasha cheNyama Yakapfava:
Phinit P [23] akataura kuti LISS system yakarapa nyaya makumi matatu nemanomwe dzekutyoka kwetibia, nyaya ina dzekutsamwiswa kwenyama yakapfava mushure mekuvhiyiwa (kurwadziwa kweplate inonzwika pasi peganda uye yakakomberedza maplate), umo nyaya nhatu dzeplate dziri 5mm kure nepamusoro pemapfupa uye nyaya imwe iri 10mm kure nepamusoro pemapfupa. Hasenboehler.E [17] nevamwe vakataura kuti LCP yakarapa nyaya makumi matatu nemaviri dzekutyoka kwetibial distal, kusanganisira nyaya makumi maviri nemapfumbamwe dzekusagadzikana kwemedial malleolus. Chikonzero ndechekuti vhoriyamu yeplate yakakura zvakanyanya kana kuti maplate akaiswa zvisina kunaka uye soft tissue yakatetepa pamedial malleolus, saka varwere vachanzwa kusagadzikana kana varwere vakapfeka bhutsu refu uye vachidzvanya ganda. Mashoko akanaka ndeekuti plate itsva ye distal metaphyseal yakagadzirwa neSynthes yakatetepa uye inonamatira pamusoro pemapfupa ine mipendero yakatsetseka, izvo zvakagadzirisa dambudziko iri zvinobudirira.
4.5 Kuoma Pakubvisa Zvikuruu Zvinokiya:
Zvinhu zveLCP zvine simba guru re titanium, zvinoenderana zvakanyanya nemuviri wemunhu, zviri nyore kurongedza ne callus. Pakubvisa, kubvisa callus kekutanga kunotungamira pakuoma kwakanyanya. Chimwe chikonzero chekubvisa kuoma chiri mukusimba zvakanyanya kwe lock screws kana kukuvara kwe nati, izvo zvinowanzo kukonzerwa nekutsiva lock screw seeking device yakasiyiwa ne self-seeking device. Saka, sighting device inofanira kushandiswa pakushandisa lock screws, kuitira kuti screw threads dzikwanise kusungirirwa nema plate threads. [9] Wrench chaiyo inodiwa kuti ishandiswe mu strucks, kuitira kudzora simba resimba.
Pamusoro pezvose, senzira yekumanikidza yekuvandudzwa kweAO, LCP yakapa sarudzo itsva yekurapa kwekukuvara kwemapfupa kwemazuva ano. Pamwe chete netekinoroji yeMIPO, LCP inosanganisa ropa rinochengetedza ropa kumativi ekutyoka zvakanyanya, inokurudzira kupora kwekukuvara, inoderedza njodzi dzehutachiona uye kutyoka zvakare, inochengetedza kugadzikana kwekukuvara, saka ine mikana yakawanda yekushandiswa mukurapa kutyoka. Kubva pakushandiswa, LCP yakawana mhedzisiro yakanaka yekiriniki yenguva pfupi, asi mamwe matambudziko anoonekwawo. Kuvhiya kunoda kuronga kwakadzama usati wavhiyiwa uye ruzivo rwakakura rwekiriniki, inosarudza magadzirirwo emukati akakodzera uye matekinoroji zvichibva pane hunhu hwekukuvara kwacho, inotevedzera misimboti yekutanga yekurapa kutyoka, inoshandisa magadzirirwo nenzira chaiyo uye yakajairika, kuitira kudzivirira matambudziko uye kuwana mhedzisiro yakanaka yekurapa.
Nguva yekutumira: Chikumi-02-2022
