Sechigadziriso chemukati, iyo yekumanikidza ndiro yagara ichitamba zvakakosha mukurapa kwekutyoka.Mumakore achangopfuura, pfungwa ye minimally invasive osteosynthesis yakanzwisiswa zvakadzika uye inoshandiswa, zvishoma nezvishoma ichichinja kubva pakusimbiswa kwekare pamusoro pemichina mechanics yemukati fixator kuti isimbise kugadzirisa biological fixation, iyo isingatarisi chete kuchengetedzwa kwefupa uye nyoro yeropa, asi. inokurudzirawo kuvandudzwa kwemaitiro ekuvhiya uye kugadzirisa mukati.Kukiya Compression Plate(LCP) imhando nyowani yekumisikidza dhizaini system, iyo inogadzirwa pahwaro hweiyo dynamic compression plate (DCP) uye iyo shoma yekubata ine simba compression plate (LC-DCP), uye yakasanganiswa nemakiriniki mabhenefiti eiyo AO's point contact plate. PC-Fix) uye Zvishoma Invasive Stabilization System (LISS).Iyo sisitimu yakatanga kushandiswa kukiriniki muna Chivabvu 2000, yakange yawana zvirinani mhedzisiro yekiriniki, uye mishumo mizhinji yakapa ongororo yakanyanya pazviri.Kunyangwe paine akawanda mabhenefiti mukugadzirisa kwayo kuputsika, ine zvakakwirira zvinodikanwa pane tekinoroji uye ruzivo.Kana ikasashandiswa zvisina kunaka, inogona kunge inopesana, uye inoguma nemhedzisiro isingadzoreki.
1. Biomechanical Nheyo, Dhizaini uye Zvakanakira zveLCP
Kugadzikana kwesimbi yakajairwa ndiro kunoenderana nekukweshana kuri pakati peplate nebhonzo.Iyo screws inodiwa kuti isimbiswe.Kana imwe nguva screws yakasununguka, kupesana pakati peplate uye pfupa kuchaderedzwa, kugadzikana kuchadererawo, zvichiita kuti kukundikana kwemukati fixator.LCPiplate itsva yekutsigira mukati menyama yakapfava, iyo inogadzirwa nekubatanidza chinyakare yekumanikidza ndiro uye tsigiro.Nheyo yekugadzirisa kwayo haivimbi nekukweshana pakati peplate nebhonzo cortex, asi inovimba nekudzikama kwekona pakati peplate uye yekukiya screws pamwe chete nesimba rekubata pakati pema screws nebone cortex, kuitira kuti uone kutyoka kugadzirisa.Kubatsira kwakananga kuri mukuderedza kupindira kweperiosteal ropa.Iko kugadzikana kwekona pakati peplate uye screws kwakavandudza zvakanyanya simba rekubata remakona, saka simba rekugadzirisa replate rakakura zvikuru, rinoshandiswa kune mapfupa akasiyana.[4-7]
Chinhu chakasarudzika cheLCP dhizaini ndeye "musanganiswa gomba", iyo inosanganisa dynamic compression maburi (DCU) nemakomba ane conical threaded.DCU inogona kuona axial compression nekushandisa yakajairwa screws, kana mafractures akatamiswa anogona kumanikidzwa nekumisikidzwa kuburikidza nelag screw;iyo conical threaded gomba ine shinda, iyo inogona kukiya sikururu uye shinda yenati yakarukwa, kuendesa torque pakati pescuru nendiro, uye iyo longitudinal stress inogona kuendeswa kudivi rekutsemuka.Mukuwedzera, iyo yekucheka groove inogadzira pasi peplate, iyo inoderedza nzvimbo yekubatana nefupa.
Muchidimbu, ine mabhenefiti akawanda pamusoro pemahwendefa echinyakare: ① inodzikamisa kona: kona iri pakati pembambo dzembambo yakagadzikana uye yakagadziriswa, ichishanda kune akasiyana mapfupa;② inoderedza njodzi yekuderedza kurasikirwa: hapana chikonzero chekufambisa kwakarurama kusati kwave kupeta kweplateti, kuderedza njodzi dzekurasikirwa kwekutanga-chikamu chekurasikirwa uye chikamu chechipiri chekuderedza kurasikirwa;[8] ③ inodzivirira kupihwa kweropa: iyo shoma yekubatanidza pamusoro pakati pesimbi ndiro uye bhonzo inoderedza kurasikirwa kweplate kune periosteum ropa rekupa, iro rinonyanya kuenderana nemisimboti yezvishoma invasive;④ ine chimiro chakanaka chekubata: inonyanya kushanda kune osteoporosis fracture bone, inoderedza chiitiko chekusunungura nekubuda;⑤ inobvumira kutanga kwekuita basa;⑥ ine zvakasiyana-siyana zvekushandisa: iyo ndiro yemhando uye kureba zvakakwana, iyo anatomical pre-shaped yakanaka, iyo inogona kuona kugadzirisa kwezvikamu zvakasiyana nemhando dzakasiyana dzakaputsika.
2. Zviratidzo zveLCP
LCP inogona kushandiswa seyakajairika compressing ndiro kana serutsigiro rwemukati.Chiremba anovhiya anogona zvakare kusanganisa ese ari maviri, kuitira kuti iwedzere zvakanyanya zviratidzo zvayo uye ishande kune akasiyana siyana ekutyoka mapatani.
. saka LCP inogona kushandiswa sendiro yekumanikidza uye ndiro kana neutralization ndiro.
2.2 Yakaputsika Yakaputsika yeDiaphysis kana Metaphyseal: LCP inogona kushandiswa sebhiriji ndiro, iyo inotora iyo isina kunanga kuderedzwa uye bhiriji osteosynthesis.Izvo hazvidi kuderedzwa kweanatomical, asi kungodzoreredza kureba kwenhengo, kutenderera uye axial simba mutsara.Kutyoka kweradius uye ulna kwakasiyana, nekuti kutenderera kwemaoko kunoenderana zvakanyanya neyakajairwa anatomy yeradius uye ulna, iyo yakafanana neiyo intra-articular fractures.Kunze kwezvo, kuderedzwa kweanatomical kunofanirwa kuitwa, uye kuchagadzikwa zvakagadzika nemahwendefa.
2.3 Intra-articular Fractures uye Inter-articular Fractures: Mune intra-articular fracture, isu hatifanire chete kuita kuderedzwa kweanatomical kuti tidzore kutsetseka kwearticular surface, asi zvakare tinoda kudzvanya mapfupa kuti agadzirise kugadzikana uye kusimudzira pfupa. kuporesa, uye inobvumira kurovedza muviri kwekutanga.Kana iyo articular fractures inokanganisa mapfupa, LCP inogona kugadzirisa iyojointpakati pekuderedzwa articular uye diaphysis.Uye hapana chikonzero chekugadzira ndiro mukuvhiya, iyo yakaderedza nguva yekuvhiya.
2.4 Kunonoka Mubatanidzwa kana Nonunion.
2.5 Yakavharwa kana Kuvhura Osteotomy.
2.6 Haisi kushanda kune yakabatanaintramedullary nailingkuputsika, uye LCP ndiyo imwe nzira yakanaka.Semuyenzaniso, LCP haishandiswe kukuvadzwa kwemwongo kwakatyoka kwevana kana vechidiki, vanhu vane mhasuru dzakatetepa kana dzakafara zvakanyanya kana dzisina kunaka.
2.7 Osteoporosis Varwere: sezvo pfupa cortex yakanyanya kuonda, zvakaoma kuti ndiro yetsika iwane kugadzikana kwakavimbika, iyo yakawedzera kuoma kwekuvhiyiwa kwekuputsika, uye yakaguma nekukundikana nekuda kwekusunungura nyore uye kubuda kwekugadzirisa mushure mekugadzirisa.LCP yekuvhara screw uye plate anchor inoumba kugadzikana kwekona, uye zvipikiri zveplate zvakabatanidzwa.Mukuwedzera, iyo mandrel dhayamita yekuvhara screw yakakura, ichiwedzera simba rekubata rebhonzo.Naizvozvo, chiitiko che screw loosening chinonyatso kuderedzwa.Maekisesaizi ekutanga emuviri anoshanda anobvumidzwa mushure mekushanda.Osteoporosis chiratidzo chakasimba cheLCP, uye mishumo yakawanda yakapa kuzivikanwa kwepamusoro.
2.8 Periprosthetic Femoral Fracture: periprosthetic femoral fractures inowanzoperekedzwa neosteoporosis, zvirwere zvakwegura uye zvirwere zvakakomba zvehurongwa.Mahwendefa echinyakare anoiswa pasi pekuchekwa kwakawanda, zvichikonzera kukanganisa kunowanikwa kweropa rematsemuka.Kunze kwezvo, iwo akajairwa screws anoda bicortical fixation, zvichikonzera kukuvadza kune bhonzo simende, uye osteoporosis gripping simba zvakare irombo.LCP neLISS mahwendefa anogadzirisa matambudziko akadaro nenzira yakanaka.Kureva kuti, vanotora tekinoroji yeMIPO kudzikisa mashandiro ejoint, kuderedza kukuvadzwa kweropa, uye ipapo iyo imwechete cortical locking screw inogona kupa kugadzikana kwakakwana, izvo zvisingazokonzere kukuvadza kune simende yebhonzo.Iyi nzira inoratidzwa nekureruka, kupfupika kwenguva yekuvhiya, kubuda ropa kushoma, madiki ekubvisa uye kufambisa kupora kwekutyoka.Nokudaro, periprosthetic femoral fractures zvakare chimwe chezviratidzo zvakasimba zveLCP.[1, 10, 11]
3. Maitiro ekuvhiya ane chekuita nekushandiswa kweLCP
3.1 Traditional Compression Technology: kunyangwe iyo pfungwa yeAO yemukati inogadzirisa yakachinja uye kupihwa kweropa kwebhonzo rekudzivirira uye zvinyoro zvinyoro hazvizoregeredzwa nekuda kwekunyanya kusimba kweiyo mechanical kugadzikana kwekugadzirisa, iyo fracture side ichiri kuda kudzvanywa kuti iwane kugadzirisa kune vamwe. kuputsika, zvakadai se-intra-articular fractures, osteotomy fixation, nyore kutenderera kana kupfupika kwe oblique fractures.Nzira dzekumanikidza ndeidzi: ① LCP inoshandiswa sendiro yekutsikirira, uchishandisa maviri akajairwa cortical screws kugadzirisa eccentrically pandiro inotsvedza compression unit kana kushandisa compression mudziyo kuona kugadzirisa;② sendiro yekudzivirira, LCP inoshandisa lag screws kugadzirisa marefu-oblique fractures;③ nekutora tension band musimboti, ndiro inoiswa padivi rekunetsana kwebhonzo, ichaiswa pasi pekunetsekana, uye cortical bone inogona kuwana compression;④ sendiro yebuttress, LCP inoshandiswa pamwe chete neiyo lag screws kugadzirisa kwe articular fractures.
3.2 Bridge Fixation Tekinoroji: Chekutanga, tora nzira yekudzikisa isina kunanga yekumisikidza zvakare kutyoka, kutenderera munzvimbo dzakatyoka kuburikidza nebhiriji uye gadzirisa mativi ese ekutyoka.Anatomic kuderedzwa hakudiwi, asi kunongoda kudzoreredzwa kweiyo diaphysis kureba, kutenderera uye simba mutsara.Zvichakadaro, kubatanidza pfupa kunogona kuitwa kukurudzira callus kuumbwa uye kukurudzira kuporeswa kwekuputsika.Nekudaro, kugadzirisa bhiriji kunogona kungowana kugadzikana kwehukama, zvakadaro kuporeswa kwekutyoka kunowanikwa kuburikidza nemacalluses maviri nechinangwa chechipiri, saka inongoshanda kune comminuted fractures.
3.3 Minimally Invasive Plate Osteosynthesis (MIPO) Technology: Kubva ku1970s, sangano reAO rakaisa mberi mitemo yekurapa kwekuputsika: kuderedzwa kweanatomical, kugadzirisa mukati, kudzivirira kweropa uye kutanga kusingarwadzi kushanda.Nheyo dzakave dzichizivikanwa zvakanyanya munyika, uye mhedzisiro yekiriniki iri nani kupfuura nzira dzekare dzekurapa.Zvisinei, kuti uwane kuderedzwa kweanatomic uye kugadzirisa mukati, inowanzoda kuvharwa kwakawanda, zvichiita kuti kuderedzwa kwepfupa kuderedzwa, kuderera kweropa rezvimedu zvekuputsika uye kuwedzera kwengozi dzehutachiona.Mumakore achangopfuura, nyanzvi dzemumba nedzemhiri kwemakungwa dzinonyanya kutarisisa uye kuisa zvakanyanya kusimba kune ishoma invasive tekinoroji, kuchengetedza kupihwa kweropa kwezvinyoro zvinyoro uye pfupa panguva yekusimudzira yemukati fixator, kwete kubvisa periosteum uye zvinyoro zvinyoro pane pakatyoka. mativi, kwete kumanikidza kuderedzwa kweanatomical yezvimedu zvekuputsika.Naizvozvo, inodzivirira kuputsika kwebiological nharaunda, iyo biological osteosynthesis (BO).Mumakore ekuma1990, Krettek akakurudzira tekinoroji yeMIPO, inova kufambira mberi kutsva kwekugadzirisa kuputsika mumakore achangopfuura.Inonangana nekudzivirira kupihwa kweropa kwebhonzo rekudzivirira uye matishu akapfava ane hushoma kukuvadza kusvika pamwero mukuru.Iyo nzira ndeyekuvaka subcutaneous tunnel kuburikidza nediki incision, kuisa mahwendefa, uye kutora nzira dzisina kunanga dzekudzikisa yekudzikisa kuputsika uye kugadzirisa mukati.Iyo angle pakati peLCP mahwendefa yakagadzikana.Kunyangwe iwo mahwendefa asinganyatso nyatsoona kuumbwa kweanatomical, kudzikiswa kwekutyoka kuchiri kuchengetedzwa, saka zvakanakira tekinoroji yeMIPO zvinonyanya kuoneka, uye ndiyo yakanyatso kuisirwa yeMIPO tekinoroji.
4. Zvikonzero uye Countermeasures yekukundikana kweLCP Kushandisa
4.1 Kutadza kwemugadziriso wemukati
Ese maimplants ane kusunungura, kutamiswa, kuputsika uye dzimwe njodzi dzekutadza, kukiya mahwendefa uye LCP hazvisi izvo.Maererano nemishumo yezvinyorwa, kukundikana kwekugadzirisa kwemukati hakusi kunyanya kukonzerwa neplate pachayo, asi nokuti nheyo dzepamusoro dzekurapa kwekuputsika dzinoputsika nekuda kwekunzwisisa kusina kukwana uye ruzivo rwekugadzirisa LCP.
4.1.1.Mahwendefa akasarudzwa akapfupika.Kureba kweplate uye screw kugovera zvinhu zvakakosha zvinokanganisa kugadzirisa kugadzikana.Pamberi pekubuda kweiyo IMIPO tekinoroji, mapfupi mahwendefa anogona kudzikisa kureba kweiyo incision uye kupatsanurwa kwezvinyoro zvinyoro.Kunyanya mapfupi mahwendefa anozoderedza iyo axial simba uye torsion simba kune yakagadziriswa yakazara chimiro, zvichikonzera kutadza kwemukati fixator.Nekuvandudzwa kwe tekinoroji yekudzikisira isina kunanga uye tekinoroji inopinza zvishoma, mahwendefa akareba haawedzere kupinza kwenyama yakapfava.Vanachiremba vanovhiya vanofanira kusarudza kureba kweplate maererano ne biomechanics yekuputsika kugadzirisa.Pakutyoka kuri nyore, chiyero cheurefu hweplate rakakodzera uye kureba kwenzvimbo yese yekutyoka kunofanirwa kunge kwakakwira kupfuura ka8-10, nepo kune iyo yakaputsika, chiyero ichi chinofanira kunge chakakwira kupfuura ka2-3.[13, 15] Mahwendefa ane hurefu hwakakwana huchaderedza mutoro weplate, kuwedzera kuderedza screw load, uye nokudaro kuderedza kukundikana kwechiitiko chekugadzirisa mukati.Zvinoenderana nemhedzisiro yeLCP finite element analysis, kana gwanza riri pakati pemativi ekutyoka kuri 1mm, divi rekutyoka rinosiya gomba rimwe rekumanikidza, kushushikana paplate yekumanikidza kunoderedza 10%, uye kushushikana pa screws kunoderedza 63%;kana divi rekutyoka richisiya maburi maviri, kushushikana paplate yekutsikirira kunoderedza 45%, uye kushushikana pamascrews kunoderedza 78%.Naizvozvo, kuti udzivise kusungirirwa kwekushushikana, kune akaputsika akareruka, 1-2 maburi padyo nemativi ekutyoka achasiiwa, nepo kune zvakaputsika zvakaputsika, matatu screws anokurudzirwa kuti ashandiswe padivi rega rekutyoka uye 2 screws ichaswedera pedyo. kutyoka.
4.1.2 Mukaha uripo pakati pemaplate nepamusoro pebhonzo wakawandisa.Kana LCP ikatora tekinoroji yekugadzirisa bhiriji, mahwendefa haafanirwe kubata periosteum kuchengetedza kupihwa kweropa kwenzvimbo yekutyoka.Iyo ndeye elastic fixation chikamu, inosimudzira yechipiri intension ye callus kukura.Nokudzidza kugadzikana kwebiomechanical, Ahmad M, Nanda R [16] et al vakawana kuti kana mukaha pakati peLCP uye pfupa pamusoro pepamusoro pe5mm, axial uye torsion simba remahwendefa zvakanyanya kuderera;apo gaka riri pasi pe2mm, hapana kuderera kukuru.Naizvozvo, gaka rinokurudzirwa kuti rive risingasviki 2mm.
4.1.3 Indiro inotsauka kubva pa diaphysis axis, uye screws eccentric kune kugadzirisa.Kana LCP yasanganiswa MIPO tekinoroji, mahwendefa anodiwa percutaneous kuiswa, uye dzimwe nguva zvakaoma kudzora nzvimbo yeplate.Kana iyo pfupa axis isingaenzaniswi neakisi yeplate, iyo distal plate inogona kutsauka kubva kune pfupa axis, izvo zvinozotungamira kune eccentric fixation ye screws uye kupera simba kugadzirisa.[9,15].Inokurudzirwa kutora incision yakakodzera, uye X-ray kuongororwa ichaitwa mushure mekutungamira chinzvimbo chegunwe kubata chakakodzera uye Kuntscher pin fixation.
4.1.4 Kutadza kutevedzera misimboti yekurapa kutyoka uye kusarudza zvisiri izvo mukati mekugadzirisa uye kugadzirisa tekinoroji.Kune intra-articular fractures, nyore transverse diaphysis fractures, LCP inogona kushandiswa sendiro yekumanikidza kugadzirisa zvachose kugadzikana kwekutyoka kuburikidza nekomisheni yekumanikidza, uye kukurudzira kupora kwekutanga kwekuputsika;nokuda kweMetaphyseal kana fractures yakagadziriswa, teknolojia yekugadzirisa bhiriji inofanira kushandiswa, teerera kuropa rekudzivirira pfupa uye zvinyoro zvinyoro, kubvumira kugadziriswa kwakadzikama kwekuputsika, kukurudzira callus kukura kuti uwane kuporesa nekuwedzera kwechipiri.Kusiyana neizvi, kushandiswa kwebhiriji kugadzirisa teknolojia yekurapa zvimedu zviri nyore zvinogona kukonzera kuputsika kusina kugadzikana, zvichiita kuti kunonoka kupora kupora;[17] kukanganisa kutyora 'kunyanya kutsvaga kuderedza anatomical uye kudzvanya pamativi ekutyoka kunogona kukonzera kukuvadzwa kweropa remapfupa, zvichikonzera kunonoka kubatana kana kusabatanidzwa.
4.1.5 Sarudza masiuruu asina kufanira.LCP buri remusanganiswa rinogona kukwizwa mumhando ina dzemasiruuru: akajairwa cortical screws, akajairwa cancellous bhonzo screws, yekuzviboora/self-tapping screws uye self-tapping screws.Self-drilling/self-tapping screws anowanzo shandiswa seunicortical screws kugadzirisa zvakajairika diaphyseal fractures yemapfupa.Chipikiri chayo chine dhizaini yedhizaini, iri nyore kupfuura nepakati pecortex kazhinji pasina kukosha kwekuyera kudzika.Kana iyo diaphyseal pulp cavity iri yakatetepa, screw nut inogona kusakwana zvakakwana screw, uye screw tip inobata contralateral cortex, ipapo kukuvadza kune yakagadziriswa lateral cortex kunokanganisa simba rinobata pakati pema screws nemapfupa, uye bicortical self-tapping screws inofanira. kushandiswa panguva ino.Iwo akachena unicortical screws ane simba rekubata rakanaka rakananga kumapfupa akajairwa, asi osteoporosis bone kazhinji rine isina kusimba cortex.Sezvo nguva yekushanda yescrews ichidzikira, nguva iyo ruoko rwescrew kuramba kukotama inodzikira, izvo zviri nyore kukonzera screw yekucheka bone cortex, screw kusunungura uye yechipiri kuputsika kusimuka.[18] Sezvo mabicortical screws awedzera kureba kwekushanda kwescrews, simba rekubata remapfupa rinowedzerawo.Pamusoro pazvose, bhonzo rakajairika rinogona kushandisa unicortical screws kugadzirisa, asi osteoporosis bone rinokurudzirwa kushandisa bicortical screws.Mukuwedzera, iyo humerus bone cortex inenge yakatetepa, inokonzera nyore nyore, saka bicortical screws inodiwa kugadzirisa mukurapa humeral fractures.
4.1.6 Screws distribution yakanyanyisa kana kuti ishoma.Screw fixation inodiwa kuti ienderane neiyo fracture biomechanics.Kunyanya kuomeswa screw kugovera kunokonzeresa kushushikana kwenzvimbo uye kutsemuka kwemukati fixator;zvakanyanyisa zvishoma kuputsika screws uye kusakwana kugadzirisa simba kuchaitawo kuti kukundikana kwemukati fixator.Kana tekinoroji yebhiriji ikaiswa pakugadzirisa kuputsika, iyo yakakurudzirwa screw density inofanira kunge iri pasi pe40% -50% kana pasi.[7,13,15] Naizvozvo, mahwendefa akareba, kuitira kuti awedzere kuenzana kwemakanika;2-3 maburi anofanira kusiiwa kune mativi ekuputsika, kuitira kuti abvumire hukuru hweplate elasticity, kudzivisa kushungurudzika mupfungwa uye kuderedza chiitiko chemukati mekugadzirisa kupera [19].Gautier naSommer [15] vakafunga kuti angangoita maviri unicortical screws achagadzikwa pamativi ese ezvakatyoka, iyo yakawedzera nhamba yefixed cortex haizodzikisi kutadza kwema plates, nekudaro angangoita matatu screws anokurudzirwa kumhan'arwa mativi ese e. kutyoka.Anenge 3-4 screws anodiwa pamativi ese ehumerus uye forearm kuputsika, mitoro yakawanda inotakurwa.
4.1.7 Midziyo yekugadzirisa inoshandiswa zvisiri izvo, zvichiita kuti kukundikana kwekugadzirisa mukati.Sommer C [9] akashanyira varwere zana nemakumi maviri nevanomwe vane makesi ekutyoka 151 avo vakashandisa LCP kwegore rimwe, ongororo yakabuda inoratidza kuti pakati pe700 zvekukiya masiruu, masruuru mashoma ane dhayamita ye3.5mm ndiwo akasunungurwa.Chikonzero ndiko kusiiwa kushandiswa kwekuvhara screws yekuona mudziyo.Muchokwadi, siruu yekukiya nendiro haina kumira mushe, asi inoratidza 50 madhigirii emakona.Iyi dhizaini ine chinangwa chekudzikisa kukiya screw stress.Kurega kushandiswa kwekuona mudziyo kunogona kushandura nzira yembambo uye nekudaro kukonzeresa kukuvadzwa kwesimba rekugadzirisa.Kääb [20] akanga aita ongororo, akawana kona iri pakati pemasiruu uye mahwendefa eLCP yakakurisa, uye nokudaro simba rekubata remasiruu rinodzikira zvakanyanya.
4.1.8 Kutakura huremu hwemakumbo kwakakurumidza.Yakawanda mishumo yakanaka inotungamira vanachiremba vazhinji kuti vatende zvakanyanya kusimba kwekukiya mahwendefa uye screws pamwe nekugadzirisa kugadzikana, vanotenda zvisirizvo kuti simba rekuvhara ndiro rinogona kutakura huremu hwekutanga huremu, zvichiita kuti ndiro kana screw fractures.Mukushandisa bhiriji kugadzirisa kuputsika, LCP haina kugadzikana, uye inodikanwa kuti igadzire callus kuti ione kuporeswa nekusimbisa kechipiri.Kana varwere vakakurumidza kubva pamubhedha uye vakaremedza huremu hwakawandisa, ndiro uye screw inotyoka kana kuburitswa.Kuvhara ndiro kugadzirisa kunokurudzira chiitiko chekutanga, asi kuzara zvishoma nezvishoma kurodha kuchaita mavhiki matanhatu gare gare, uye x-ray mafirimu anoratidza kuti divi rekutyoka rinopa yakakosha callus.[9]
4.2 Tendon uye Neurovascular Injuries:
MIPO tekinoroji inoda kuiswa kwepercutaneous uye kuiswa pasi pemamhasuru, saka kana maplate screws akaiswa, vanachiremba vakatadza kuona subcutaneous chimiro, uye nekudaro tendon uye neurovascular kukuvara kunowedzera.Van Hensbroek PB [21] yakashuma nyaya yekushandisa LISS tekinoroji kushandisa LCP, iyo yakaguma neanterior tibial artery pseudoaneurysms.AI-Rashid M. [22] et al vakashuma kuti vabate kunonoka kuputika kweextensor tendon yechipiri ye distal radial fractures neLCP.Zvikonzero zvikuru zvekukuvadza iatrogenic.Yekutanga kukuvara kwakananga kwakaunzwa nema screws kana Kirschner pin.Yechipiri ndiyo kukanganisa kunokonzerwa nesleeve.Uye chechitatu kukuvara kwekupisa kunogadzirwa nekuzviboora self-tapping screws.[9] Nokudaro, vanachiremba vanovhiyiwa vanodiwa kuti vazive maitiro akapoteredza, kunyatsoteerera kuchengetedza nervus vascularis nezvimwe zvivako zvakakosha, kufambisa zvizere dissection yakasvibiswa mukuisa maoko, kudzivisa kudzvinyirira kana nerve traction.Pamusoro pezvo, pakudhirowa ma-self-tapping screws, shandisa mvura kuderedza kugadzirwa kwekupisa uye kuderedza kupisa.
4.3 Kuvhiya Saiti Kutapukira uye Plate Kuratidzwa:
LCP ndeyemukati inogadzirisa sisitimu yakaitika pasi pemashure ekusimudzira iyo idiki invasive pfungwa, ichivavarira kudzikisa kukuvadzwa, kuderedza hutachiona, kusabatana uye mamwe matambudziko.Mukuvhiya, isu tinofanirwa kutarisisa zvakanyanya kune yakapfava kuchengetedzwa kwenyama, kunyanya iyo isina kusimba zvikamu zvezvinyoro zvinyoro.Kuenzaniswa neDCP, LCP ine hupamhi hukuru uye hukuru hukuru.Paunenge uchiisa tekinoroji yeMIPO yekuisa percutaneous kana intramuscular, inogona kukonzera kunyorova kwetishu kana kukuvadzwa kwekukuvara uye kutungamirira kuhutachiona hwemaronda.Phinit P [23] yakashuma kuti LISS system yakanga yabata 37 zviitiko zveproximal tibia fractures, uye chiitiko chemashure ekuvhiyiwa kwakadzika hutachiona hwaive kusvika ku22%.Namazi H [24] yakashuma kuti LCP yakanga yabata 34 zviitiko zvetibial shaft fracture ye 34 kesi dzemetaphyseal fracture ye tibia, uye zviitiko zvehutachiona hwemaronda epashure uye kuputika kweplate kwakasvika ku23.5%.Naizvozvo, pamberi pekushanda, mikana uye yemukati fixator ichatariswa zvakanyanya maererano nekukuvadzwa kwetishu dzakapfava uye kuomarara dhigirii rekutsemuka.
4.4 Irritable Bowel Syndrome yeSoft Tissue:
Phinit P [23] yakashuma kuti iyo LISS system yakanga yabata 37 zviitiko zveproximal tibia fractures, 4 zviitiko zve postoperative soft tissue irritation (marwadzo e-subcutaneous palpable plate uye kumativi mahwendefa), umo 3 nyaya dzeplateti dziri 5mm kure ne pfupa pamusoro uye 1 kesi iri 10mm kubva pabhonzo.Hasenboehler.E [17] et al vakashuma LCP yakanga yabata 32 zviitiko zve distal tibial fractures, kusanganisira 29 zviitiko zvemukati malleolus kusagadzikana.Chikonzero ndechokuti vhoriyamu yeplate yakakura zvikuru kana kuti mahwendefa akaiswa zvisina kunaka uye mutsara wakapfava wakaonda kune medial malleolus, saka varwere vanozonzwa vasinganzwisisiki kana varwere vakapfeka mabhoti akakwirira uye vanodzvinyirira ganda.Nhau dzakanaka ndedzekuti iyo ichangobva distal metaphyseal plate yakagadzirwa neSynthes yakatetepa uye inonamira kune bhonzo kumusoro ine yakatsetseka mipendero, iyo yakanyatsogadzirisa dambudziko iri.
4.5 Kuomerwa nekubvisa maScrews ekukiya:
LCP zvinhu ndeye simba repamusoro titanium, ine kuenderana kwakanyanya nemuviri wemunhu, zviri nyore kutakurwa necallus.Mukubvisa, kutanga kubvisa callus kunotungamirira kukuwedzera kuoma.Chimwe chikonzero chekubvisa kuomerwa kuri mukuomesesa kwezvibodzwa zvekukiya kana kukuvara kwenati, izvo zvinowanzo konzerwa nekutsiva yakasiiwa yekukiya screw yekuona mudziyo neinozviona wega mudziyo.Naizvozvo, mudziyo wekuona uchashandiswa kutora masiruuru ekukiya, kuitira kuti shinda dzescuruu dzigone kusungirirwa neshinda dzendiro.[9] Chipanera chakananga chinodiwa kuti chishandiswe mukusimbisa screws, kuitira kudzora ukuru hwesimba.
Pamusoro pazvose, sendiro yekumanikidza yekuvandudzwa kweAO, LCP yakapa sarudzo nyowani yekuvhiya kwemazuva ano kwekutyoka.Yakasanganiswa neiyo MIPO tekinoroji, LCP inosanganisa chengetedzo yeropa pamativi ekutyoka kusvika pamwero mukuru, inosimudzira kuporeswa kwekutyoka, inoderedza njodzi dzekutapukirwa uye kutsemukazve, inochengetedza kugadzikana kwekutyoka, saka ine tarisiro yakakura yekushandisa mukurapwa kwekutyoka.Kubva chikumbiro, LCP yakawana yakanaka yenguva pfupi yekiriniki mhedzisiro, asi mamwe matambudziko anoburitswa.Kuvhiya kunoda yakadzama preoperative kuronga uye yakakura ruzivo rwekiriniki, inosarudza iyo yakakodzera yemukati inogadzirisa uye matekinoroji pahwaro hwezvinhu zveakaputsika chaiwo, inoteedzera kune yakakosha misimboti yekutyoka kurapwa, inoshandisa zvigadziriso nenzira kwayo uye yakaenzana, kuitira kudzivirira. matambudziko uye kuwana optimal therapeutic effects.
Nguva yekutumira: Jun-02-2022
