Monga chokonzera chamkati, mbale yoponderezedwa yakhala ikugwira ntchito yofunika kwambiri pakuchiza fracture.M'zaka zaposachedwa, lingaliro la osteosynthesis yowononga pang'ono lakhala likumveka bwino ndikugwiritsidwa ntchito, pang'onopang'ono likusintha kuchoka ku kutsindika koyambirira kwa makina opangira mkati kuti agogomeze kukonzanso kwachilengedwe, komwe sikungoyang'ana pa chitetezo cha mafupa ndi minofu yofewa magazi, koma imalimbikitsanso kusintha kwa njira za opaleshoni ndi fixator mkati.Locking Compression Plate(LCP) ndi mtundu watsopano mbale fixation dongosolo, amene amapangidwa pamaziko a mphamvu psinjika mbale (DCP) ndi zochepa kukhudzana zazikulu psinjika mbale (LC-DCP), ndipo pamodzi ndi ubwino matenda a AO a mfundo kukhudzana mbale (LC-DCP) PC-Fix) ndi Less Invasive Stabilization System (LISS).Dongosololi lidayamba kugwiritsidwa ntchito pachipatala mu Meyi 2000, lidapeza zotsatira zabwino zachipatala, ndipo malipoti ambiri apereka kuyamikiridwa kwambiri kwake.Ngakhale pali zabwino zambiri pakukhazikika kwake kwa fracture, ili ndi zofuna zapamwamba paukadaulo komanso chidziwitso.Ngati sichigwiritsidwa ntchito moyenera, chikhoza kukhala chopanda phindu, ndipo zotsatira zake sizingabwezedwe.
1. Mfundo za Biomechanical, Mapangidwe ndi Ubwino wa LCP
Kukhazikika kwa mbale wamba yachitsulo kumatengera kukangana pakati pa mbale ndi fupa.Zomangira zimafunika kumangika.Zomangirazo zikatha, kukangana pakati pa mbale ndi fupa kumachepetsedwa, kukhazikika kudzachepanso, zomwe zimapangitsa kulephera kwa fixator mkati.Zithunzi za LCPndi mbale yatsopano yothandizira mkati mwa minofu yofewa, yomwe imapangidwa pophatikiza mbale yopondereza yachikhalidwe ndi chithandizo.Mfundo yake yokhazikika sikudalira kukangana pakati pa mbale ndi fupa la fupa, koma kumadalira kukhazikika kwa ngodya pakati pa mbale ndi zomangira zotsekera komanso mphamvu yogwira pakati pa zomangira ndi fupa la fupa, kuti muzindikire kukhazikika kwa fracture.Ubwino wachindunji wagona pakuchepetsa kusokoneza kwa magazi a periosteal.Kukhazikika kwa ngodya pakati pa mbale ndi zomangira kwasintha kwambiri mphamvu yogwira zomangira, motero mphamvu yokhazikika ya mbaleyo ndi yayikulu kwambiri, yomwe imagwira ntchito ku mafupa osiyanasiyana.[4-7]
Mbali yapadera ya mapangidwe a LCP ndi "bowo lophatikizira", lomwe limaphatikiza mabowo ophatikizika amphamvu (DCU) ndi mabowo opangidwa ndi conical.DCU imatha kuzindikira kuponderezedwa kwa axial pogwiritsa ntchito zomangira zokhazikika, kapena ma fractures omwe achotsedwa amatha kupanikizidwa ndikukhazikika kudzera pa screw screw;bowo la ulusi wa conical limakhala ndi ulusi, womwe umatha kutseka wononga ndi latch ya nati, kusamutsa torque pakati pa wononga ndi mbale, ndipo kupsinjika kwautali kumatha kusamutsidwa ku mbali yothyoka.Kuonjezera apo, kudula groove ndi mapangidwe pansi pa mbale, zomwe zimachepetsa kukhudzana ndi fupa.
Mwachidule, ili ndi zabwino zambiri kuposa mbale zachikhalidwe: ① imakhazikika pamakona: ngodya pakati pa mbale za msomali ndi yokhazikika komanso yokhazikika, yogwira ntchito pa mafupa osiyanasiyana;② amachepetsa chiopsezo chochepetsera kuchepa: palibe chifukwa choyendetsera mbale zolondola, kuchepetsa kuopsa kwa kutayika kwa gawo loyamba ndi gawo lachiwiri la kuchepa;[8] ③ amateteza magazi: kukhudzana kochepa kwambiri pakati pa mbale yachitsulo ndi fupa kumachepetsa kutayika kwa mbale kwa magazi a periosteum, omwe amagwirizana kwambiri ndi mfundo zowonongeka pang'ono;④ ali ndi chikhalidwe chabwino chogwirizira: chimagwiritsidwa ntchito makamaka ku osteoporosis fracture bone, amachepetsa kuchuluka kwa wononga ndikutuluka;⑤ amalola kuchita masewera olimbitsa thupi koyambirira;⑥ ili ndi ntchito zosiyanasiyana: mtundu wa mbale ndi kutalika kwake zatha, mawonekedwe a anatomical pre-mawonekedwe abwino, omwe amatha kuzindikira kukhazikika kwa magawo osiyanasiyana ndi mitundu yosiyanasiyana yosweka.
2. Zizindikiro za LCP
LCP itha kugwiritsidwa ntchito ngati mbale yopondereza wamba kapena ngati chithandizo chamkati.Dokotala wa opaleshoni amathanso kuphatikiza zonse ziwiri, kuti awonjezere kwambiri zizindikiro zake ndikugwiritsanso ntchito pamitundu yambiri yosweka.
2.1 Zowonongeka Zosavuta za Diaphysis kapena Metaphysis: ngati kuwonongeka kwa minofu yofewa sikuli koopsa ndipo fupa liri ndi khalidwe labwino, fractures yosavuta yodutsa kapena yochepa oblique fracture ya mafupa aatali imayenera kudula ndi kuchepetsa molondola, ndipo mbali ya fracture imafuna kuponderezedwa kwakukulu, motero LCP angagwiritsidwe ntchito ngati mbale psinjika ndi mbale kapena neutralization mbale.
2.2 Kuphwanyidwa Kwapadera kwa Diaphysis kapena Metaphyseal: LCP ingagwiritsidwe ntchito ngati mbale ya mlatho, yomwe imatenga kuchepetsa kosalunjika ndi osteosynthesis mlatho.Sikutanthauza kuchepetsa thupi, koma kungobwezeretsa kutalika kwa nthambi, kuzungulira ndi mzere wa axial mphamvu.Kuthyoka kwa radius ndi ulna ndizosiyana, chifukwa kusinthasintha kwa manja kumadalira kwambiri mawonekedwe amtundu wa radius ndi ulna, omwe ali ofanana ndi fractures ya intra-articular.Kupatula apo, kuchepetsedwa kwa anatomical kuyenera kuchitika, ndikukhazikika ndi mbale.
2.3 Intra-articular Fractures ndi Inter-articular Fractures: Pakatikati-articular fracture, sitiyenera kokha kuchita kuchepetsa thupi kuti tibwezeretse kusalala kwa articular pamwamba, komanso tifunika kukanikiza mafupa kuti tikwaniritse kukhazikika kokhazikika ndikulimbikitsa mafupa. kuchiritsa, ndikupangitsa kuti ntchito yoyambira igwire ntchito.Ngati fractures ya articular imakhudza mafupa, LCP ikhoza kukonzapamodzipakati pa kuchepa kwa articular ndi diaphysis.Ndipo palibe chifukwa chopangira mbale mu opaleshoniyo, yomwe yachepetsa nthawi ya opaleshoni.
2.4 Kuchedwa Mgwirizano kapena Nonunion.
2.5 Osteotomy Yotsekedwa kapena Yotseguka.
2.6 Sizikugwira ntchito pakulumikizanamisomali ya intramedullaryfracture, ndipo LCP ndi njira ina yabwino.Mwachitsanzo, LCP siigwiritsidwe ntchito pakuwonongeka kwa m'mafupa a ana kapena achinyamata, anthu omwe zibowo zawo zamkati zimakhala zopapatiza kwambiri kapena zazikulu kwambiri kapena zosapangika bwino.
2.7 Odwala Osteoporosis: popeza fupa la fupa ndi lochepa kwambiri, zimakhala zovuta kuti mbale yachikhalidwe ikhale yokhazikika, yomwe yawonjezera vuto la opaleshoni ya fracture, ndipo inachititsa kulephera chifukwa chosavuta kumasula ndi kutuluka kwa postoperative fixation.LCP locking screw ndi plate nangula zimapanga kukhazikika kwa ngodya, ndipo misomali ya mbale imaphatikizidwa.Kuphatikiza apo, mandrel awiri a zotsekera zotsekera ndi zazikulu, zomwe zimawonjezera mphamvu yogwira ya fupa.Choncho, zochitika za wononga kumasuka bwino zachepetsedwa.Kuchita masewera olimbitsa thupi koyambirira kumaloledwa pambuyo pa opaleshoni.Osteoporosis ndi chisonyezo champhamvu cha LCP, ndipo malipoti ambiri apereka kuzindikira kwakukulu.
2.8 Periprosthetic Femoral Fracture: periprosthetic femoral fractures nthawi zambiri imatsagana ndi osteoporosis, matenda okalamba ndi matenda aakulu a dongosolo.Mambale achikhalidwe amatha kudulidwa kwambiri, zomwe zimapangitsa kuwonongeka kwa magazi a fractures.Kupatula apo, zomangira wamba zimafunikira kukhazikika kwa bicortical, kuwononga simenti ya mafupa, komanso mphamvu yogwira mafupa a mafupa nawonso ndi osauka.Ma mbale a LCP ndi LISS amathetsa mavutowa m'njira yabwino.Izi zikutanthauza kuti, amatengera ukadaulo wa MIPO kuti achepetse ntchito zolumikizana, kuchepetsa kuwonongeka kwa magazi, ndiyeno simenti imodzi ya cortical locking imatha kupereka kukhazikika kokwanira, komwe sikungawononge simenti ya mafupa.Njirayi ikuwonetsedwa ndi kuphweka, nthawi yaifupi ya opaleshoni, kuchepa kwa magazi, kuvula pang'ono ndikuthandizira kuchira kwa fracture.Choncho, periprosthetic femoral fractures ndi chimodzi mwa zizindikiro zamphamvu za LCP.[ 1, 10, 11 ]
3. Njira Zopangira Opaleshoni Zokhudzana ndi Kugwiritsa Ntchito LCP
3.1 Traditional Compression Technology: ngakhale lingaliro la AO fixator lasintha ndipo magazi a chitetezo cha fupa ndi minyewa yofewa sanganyalanyazidwe chifukwa chogogomezera kukhazikika kwa makina okhazikika, mbali yosweka imafunikirabe kupanikizana kuti mupeze kukonza kwa ena. fractures, monga intra-articular fractures, osteotomy fixation, zosavuta zodutsa kapena zochepa zowonongeka.Njira zoponderezera ndi izi: ① LCP imagwiritsidwa ntchito ngati mbale yopondereza, pogwiritsa ntchito zomangira ziwiri zokhazikika zomangira kuti zikhomerere pa mbale yotsetsereka yagawo kapena kugwiritsa ntchito chipangizo chophatikizira kuti muzindikire kukhazikika;② ngati mbale yodzitchinjiriza, LCP imagwiritsa ntchito zomangira zalag kukonza zosweka zazitali;③ potengera mfundo yolumikizirana, mbaleyo imayikidwa pambali ya fupa, imayikidwa pansi, ndipo fupa la cortical likhoza kupeza kuponderezedwa;④ ngati mbale ya buttress, LCP imagwiritsidwa ntchito molumikizana ndi zomangira zomangira zomangira zamkati.
3.2 Ukadaulo Wokonza Mlatho: Choyamba, tsatirani njira yochepetsera yosalunjika kuti mukhazikitsenso fracture, tambani madera ophwanyika kudzera pa mlatho ndikukonza mbali zonse ziwiri za fracture.Kuchepetsa kwa anatomic sikofunikira, koma kumangofunika kuchira kutalika kwa diaphysis, kuzungulira ndi kukakamiza mzere.Pakalipano, kulumikiza mafupa kungathe kuchitidwa pofuna kulimbikitsa mapangidwe a callus ndikulimbikitsa machiritso a fracture.Komabe, kukonza mlatho kungathe kungokwaniritsa kukhazikika kwachibale, komabe machiritso a fracture amapindula kudzera mu calluses ziwiri ndi cholinga chachiwiri, choncho amangogwira ntchito ku fractures comminuted.
3.3 Minimally Invasive Plate Osteosynthesis (MIPO) Technology: Kuyambira m'zaka za m'ma 1970, bungwe la AO linaika patsogolo mfundo za chithandizo cha fracture: kuchepetsa thupi, kukonza mkati, chitetezo cha magazi ndi masewera olimbitsa thupi oyambirira osapweteka.Mfundozi zadziwika kwambiri padziko lonse lapansi, ndipo zotsatira zachipatala zimakhala zabwino kuposa njira zochiritsira zam'mbuyomu.Komabe, kuti mupeze kuchepetsa kwa anatomiki ndi kukonza mkati, nthawi zambiri kumafuna kudulidwa kwakukulu, zomwe zimapangitsa kuti fupa likhale lochepa, kuchepa kwa magazi a zidutswa za fracture ndi kuopsa kwa matenda.M'zaka zaposachedwa, akatswiri apakhomo ndi akunja amayang'anitsitsa kwambiri ndikugogomezera kwambiri teknoloji yochepetsetsa, kuteteza magazi a minofu yofewa ndi fupa pakali pano kulimbikitsa fixator mkati, osati kuchotsa periosteum ndi minofu yofewa pa fracture. mbali, osati kukakamiza kuchepetsa anatomical wa zidutswa fracture.Chifukwa chake, imateteza chilengedwe chachilengedwe chophwanyika, chomwe ndi biological osteosynthesis (BO).M'zaka za m'ma 1990, Krettek adapereka teknoloji ya MIPO, yomwe ndi njira yatsopano yokonza fracture m'zaka zaposachedwa.Cholinga chake ndi kuteteza magazi a chitetezo cha mafupa ndi minofu yofewa ndi kuwonongeka kochepa kwambiri.Njirayi ndi yomanga ngalande yodutsa m'kati mwa kachidutswa kakang'ono, kuika mbale, ndikugwiritsa ntchito njira zochepetsera zochepetsera zowonongeka ndi kukonza mkati.Mbali pakati pa mbale za LCP ndi yokhazikika.Ngakhale kuti mbale sizikuzindikira bwino mawonekedwe a anatomical, kuchepetsa fracture kungathe kusungidwa, kotero ubwino wa teknoloji ya MIPO ndi yodziwika bwino, ndipo ndi njira yabwino yopangira teknoloji ya MIPO.
4. Zifukwa ndi Zotsutsana ndi Kulephera kwa Ntchito ya LCP
4.1 Kulephera kwa Internal fixator
Ma implants onse ali ndi kumasuka, kusamuka, kusweka ndi zoopsa zina zolephera, mbale zotsekera ndi LCP ndizosiyana.Malinga ndi malipoti a mabuku, kulephera kwa fixator mkati sikumayambika makamaka chifukwa cha mbale yokha, koma chifukwa mfundo zazikulu za chithandizo cha fracture zimaphwanyidwa chifukwa chosamvetsetsa komanso chidziwitso cha kukonza kwa LCP.
4.1.1.Mabale osankhidwa ndiafupi kwambiri.Kutalika kwa mbale ndi screw kugawa ndizofunika kwambiri zomwe zimakhudza kukhazikika kwa kukonza.Asanatuluke ukadaulo wa IMIPO, mbale zazifupi zimatha kuchepetsa kutalika kwake komanso kupatukana kwa minofu yofewa.Mabale amfupi kwambiri amachepetsa mphamvu ya axial ndi mphamvu ya torsion pamapangidwe okhazikika, zomwe zimapangitsa kulephera kwa fixator mkati.Ndi chitukuko cha teknoloji yochepetsera mwachindunji komanso teknoloji yochepetsera pang'ono, mbale zazitali sizidzawonjezera kudulidwa kwa minofu yofewa.Madokotala ochita opaleshoni ayenera kusankha kutalika kwa mbale molingana ndi biomechanics ya fracture fixation.Pa zosweka zosavuta, chiŵerengero cha kutalika kwa mbale ndi kutalika kwa malo onse ophwanyika chiyenera kukhala chapamwamba kuposa nthawi 8-10, pamene fracture ya comminuted, chiŵerengerochi chiyenera kukhala choposa nthawi 2-3.[13, 15] Mabale okhala ndi utali wokwanira amatha kuchepetsa kunyamula mbale, kumachepetsanso phula, ndipo potero amachepetsa kulephera kwa fixator mkati.Malingana ndi zotsatira za LCP finite element kusanthula, pamene kusiyana pakati pa mbali yothyoka ndi 1mm, mbali yothyoka imasiya dzenje limodzi la mbale, kupanikizika pa mbale kumachepetsa 10%, ndipo kupanikizika pazitsulo kumachepetsa 63%;pamene mbali yothyoka imasiya mabowo awiri, kupanikizika pa mbale yoponderezedwa kumachepetsa kuchepetsa 45%, ndipo kupanikizika pazitsulo kumachepetsa 78%.Chifukwa chake, kuti mupewe kupsinjika, chifukwa chophwanyika chosavuta, mabowo 1-2 omwe ali pafupi ndi mbali zosweka adzasiyidwa, pomwe zomangira zomwe zimaphwanyidwa, zomangira zitatu zimalimbikitsidwa kuti zizigwiritsidwa ntchito mbali iliyonse yosweka ndi zomangira 2 zizikhala pafupi ndi fractures. zothyoka.
4.1.2 Kusiyana pakati pa mbale ndi pamwamba pa fupa ndikwambiri.LCP ikatengera ukadaulo wowongolera mlatho, mbale siziyenera kulumikizana ndi periosteum kuti ateteze kutulutsa kwa magazi kwa fracture zone.Ndi gulu la zotanuka fixation, kulimbikitsa mphamvu yachiwiri ya callus kukula.Pophunzira kukhazikika kwa biomechanical, Ahmad M, Nanda R [16] et al anapeza kuti pamene kusiyana pakati pa LCP ndi fupa pamwamba ndi kwakukulu kuposa 5mm, mphamvu ya axial ndi torsion ya mbale imachepa kwambiri;pamene kusiyana kuli kochepa kuposa 2mm, palibe kuchepa kwakukulu.Choncho, kusiyana tikulimbikitsidwa kukhala osachepera 2mm.
4.1.3 Chimbalecho chimachoka ku diaphysis axis, ndipo zomangira zimakhala eccentric mpaka fixation.Pamene LCP ikuphatikizidwa teknoloji ya MIPO, mbale zimafunika kuyika kwa percutaneous, ndipo nthawi zina zimakhala zovuta kulamulira malo a mbale.Ngati fupa la fupa silingafanane ndi nsonga ya mbale, mbale ya distal ikhoza kupatuka kuchokera kumtunda wa fupa, zomwe zidzatsogolera kukhazikika kwa zomangira ndi kufooketsa kukhazikika.[9, 15]Ndibwino kuti mutenge kachipangizo koyenera, ndipo kufufuza kwa X-ray kudzapangidwa pambuyo pa malo otsogolera a kukhudza kwa chala ndi Kuntscher pin fixation.
4.1.4 Kulephera kutsatira mfundo zoyambirira za chithandizo cha fracture ndikusankha teknoloji yolakwika ya fixator ndi fixation.Kwa fractures ya intra-articular, yosavuta yodutsa diaphysis fractures, LCP ingagwiritsidwe ntchito ngati mbale yoponderezedwa kuti ikonze kukhazikika kwa fracture kudzera pa teknoloji yoponderezedwa, ndikulimbikitsa machiritso oyambirira a fractures;kwa Metaphyseal kapena fractures comminuted, luso lokonzekera mlatho liyenera kugwiritsidwa ntchito, tcherani khutu ku magazi a chitetezo cha fupa ndi minofu yofewa, kulola kukhazikika kokhazikika kwa fractures, kulimbikitsa kukula kwa callus kuti akwaniritse machiritso ndi mphamvu yachiwiri.M'malo mwake, kugwiritsa ntchito teknoloji yokonza mlatho pochiza fractures yosavuta kungayambitse fractures yosakhazikika, zomwe zimabweretsa kuchedwa kuchira kwa fracture;[17] comminuted fractures 'kufunafuna kwambiri kuchepetsa thupi ndi kupanikizana kumbali yosweka kungayambitse kuwonongeka kwa mafupa a mafupa, zomwe zimapangitsa kuti kuchedwetsa mgwirizano kapena kusamvana.
4.1.5 Sankhani mitundu yosayenera ya screws.Bowo lophatikizira la LCP litha kukhomedwa m'mitundu inayi ya zomangira: zomangira zokhazikika, zomangira zomata za mafupa, zomangira zodzibowolera zokha/zodzibowolera komanso zomangira.Zomangira zodzibowolera zokha/zodzibowolera zokha nthawi zambiri zimagwiritsidwa ntchito ngati zomangira zopangira unicortical kukonza zosweka bwino za mafupa a diaphyseal.Nsonga yake ya msomali ili ndi mapangidwe a kubowola, omwe ndi osavuta kudutsa mu kotekisi nthawi zambiri popanda kuyeza kuya kwake.Ngati zibowo za diaphyseal zamkati ndi zopapatiza kwambiri, zomangira za mtedza sizingafanane ndi wononga, ndipo nsonga ya wonongayo ikhudza cortex yopingasa, ndiye kuti kuwonongeka kwa kotekisi yokhazikika kumakhudza mphamvu yogwira pakati pa zomangira ndi mafupa, ndipo zomangira zodzigudubuza za bicortical ziyenera. kugwiritsidwa ntchito pa nthawi ino.Zomangira zoyera za unicortical zimakhala ndi mphamvu yogwira bwino pamafupa abwinobwino, koma fupa la osteoporosis nthawi zambiri limakhala ndi kotekisi yofooka.Popeza kuti nthawi yogwiritsira ntchito zomangira imachepa, nthawi yomwe zitsulo zomangira zomangira zimapindika zimachepa, zomwe zimapangitsa kuti fupa la cortex lidulidwe mosavuta, kumasula phula ndi kusamuka kwachiwiri.[18] Popeza zomangira za bicortical zawonjezera kutalika kwa zomangira, mphamvu yogwira ya mafupa imawonjezekanso.Koposa zonse, fupa labwinobwino litha kugwiritsa ntchito zomangira za unicortical kukonza, komabe fupa la osteoporosis ndiloyenera kugwiritsa ntchito zomangira za bicortical.Kuonjezera apo, humerus bone cortex ndi yopyapyala, imayambitsa mosavuta, choncho zitsulo za bicortical zimafunika kukonza pochiza fractures za humeral.
4.1.6 Kugawa kwa screw ndi wandiweyani kwambiri kapena pang'ono.Kukonza screw kumafunika kuti zigwirizane ndi fracture biomechanics.Kugawa kwambiri wononga wononga kumabweretsa kupsinjika kwa m'deralo ndi kusweka kwa fixator mkati;zomangira zong'ambika pang'ono komanso mphamvu zosakwanira zokhazikika zidzapangitsanso kulephera kwa fixator yamkati.Ukadaulo wa mlatho ukagwiritsidwa ntchito pokonza fracture, kachulukidwe ka wononga koyenera kuyenera kukhala kochepera 40% -50% kapena kuchepera.[7,13,15] Choncho, mbale ndizotalikirapo, kuti awonjezere kusinthasintha kwa makina;Mabowo a 2-3 ayenera kusiyidwa kumbali zosweka, kuti alole kusungunuka kwa mbale, kupeŵa kupsinjika maganizo ndi kuchepetsa zochitika za kusweka kwa mkati [19].Gautier ndi Sommer [15] ankaganiza kuti zomangira ziwiri za unicortical zidzakhazikika kumbali zonse ziwiri za fractures, kuchuluka kwa cortex yokhazikika sikungachepetse kulephera kwa mbale, motero zitsulo zosachepera zitatu zimalangizidwa kuti zitsutsidwe mbali zonse ziwiri. kusweka.Zomangira zosachepera 3-4 zimafunikira mbali zonse za humerus ndi kusweka kwa mkono, kunyamula katundu wambiri.
4.1.7 Zida zopangira zida zimagwiritsidwa ntchito molakwika, zomwe zimapangitsa kulephera kwa fixator mkati.Sommer C [9] adayendera odwala 127 okhala ndi milandu 151 yothyoka omwe agwiritsa ntchito LCP kwa chaka chimodzi, zotsatira zowunikira zikuwonetsa kuti pakati pa zomangira 700, zomangira zochepa zokhala ndi mainchesi a 3.5mm zimamasulidwa.Chifukwa chake ndikusiya kugwiritsa ntchito zomangira zotsekera zowonera.M'malo mwake, zotsekera zotsekera ndi mbale sizoyimirira kwathunthu, koma zimawonetsa madigiri 50 a ngodya.Kapangidwe kameneka kamafuna kuchepetsa kupsinjika kwa screw screw.Kusiya kugwiritsa ntchito chipangizo chowonera kungasinthe ndime ya misomali ndikupangitsa kuwonongeka kwa mphamvu yokhazikika.Kääb [20] adachita kafukufuku woyesera, adapeza kuti ngodya pakati pa zomangira ndi mbale za LCP ndi yayikulu kwambiri, motero mphamvu yogwira ya zomangira imachepa kwambiri.
4.1.8 Kukweza kulemera kwa miyendo ndikoyambika kwambiri.Malipoti abwino kwambiri amatsogolera madokotala ambiri kukhulupirira monyanyira kulimba kwa mbale zokhoma ndi zomangira komanso kukhazikika kokhazikika, amakhulupirira molakwika kuti kulimba kwa mbale zokhoma kumatha kunyamula zolemetsa zoyamba, zomwe zimapangitsa kuti mbale kapena zomangira ziphwanyike.Pogwiritsa ntchito ma fractures a mlatho, LCP imakhala yokhazikika, ndipo imayenera kupanga callus kuti izindikire machiritso ndi mphamvu yachiwiri.Ngati odwala adzuka mofulumira kwambiri ndikulemera kwambiri, mbale ndi wononga zimathyoka kapena kumasulidwa.Kukonzekera kwa mbale kumalimbikitsa kuchitapo kanthu koyambirira, koma kudzaza pang'onopang'ono kudzakhala masabata asanu ndi limodzi pambuyo pake, ndipo mafilimu a x-ray amasonyeza kuti mbali yosweka ikuwonetsa callus yaikulu.[9]
4.2 Kuvulala kwa Tendon ndi Neurovascular:
Tekinoloje ya MIPO imafuna kuyika kwapang'onopang'ono ndikuyikidwa pansi pa minofu, kotero kuti zomangira za mbale zikayikidwa, madokotala ochita opaleshoni samatha kuwona mawonekedwe a subcutaneous, motero kuwonongeka kwa tendon ndi neurovascular kumawonjezeka.Van Hensbroek PB [21] adanena nkhani yogwiritsa ntchito luso la LISS kuti agwiritse ntchito LCP, zomwe zinachititsa kuti anterior tibial artery pseudoaneurysms.AI-Rashid M. [22] et al adanena kuti amachiza kuchedwa kwa tendon yachiwiri ya distal radial fractures ndi LCP.Zifukwa zazikulu zowonongeka ndi iatrogenic.Choyamba ndi kuwonongeka kwachindunji komwe kumabwera ndi zomangira kapena pini ya Kirschner.Chachiwiri ndi kuwonongeka kwa manja.Ndipo chachitatu ndi kuwonongeka kwa kutentha komwe kumachitika pobowola zomangira zodzibowolera zokha.[9] Choncho, madokotala ochita opaleshoni amafunikira kuti adziwe bwino za thupi lozungulira, tcherani khutu kuteteza mitsempha ya mitsempha ndi zinthu zina zofunika, kuyendetsa bwino dissection poyika manja, kupewa kuponderezedwa kapena kugwedezeka kwa mitsempha.Kuonjezera apo, pobowola zomangira zodziboolera, gwiritsani ntchito madzi kuti muchepetse kutentha komanso kuchepetsa kutentha.
4.3 Matenda Opangira Opaleshoni ndi Kuwonekera kwa Plate:
LCP ndi dongosolo lokonzekera mkati lomwe lidachitika kumbuyo kwa kulimbikitsa lingaliro locheperako, lomwe likufuna kuchepetsa zowonongeka, kuchepetsa matenda, kusagwirizana ndi zovuta zina.Pochita opaleshoni, tiyenera kuyang'anitsitsa chitetezo cha minofu yofewa, makamaka mbali zofooka za minofu yofewa.Poyerekeza ndi DCP, LCP ili ndi m'lifupi mwake ndi makulidwe okulirapo.Mukamagwiritsa ntchito ukadaulo wa MIPO pakuyika kwa percutaneous kapena intramuscular, zitha kuyambitsa kusokonezeka kwa minofu yofewa kapena kuwonongeka kwamphamvu ndikuyambitsa matenda.Phinit P [23] inanena kuti dongosolo la LISS lachiza milandu ya 37 ya kupasuka kwa tibia, ndipo chiwerengero cha matenda a postoperative chinali mpaka 22%.Namazi H [24] inanena kuti LCP inachitira 34 milandu ya tibial shaft fracture ya 34 ya metaphyseal fracture ya tibia, ndipo zochitika za postoperative bala matenda ndi kuwonekera mbale anali mpaka 23.5%.Choncho, isanayambe ntchito, mwayi ndi fixator wamkati adzaganiziridwa mowopsya molingana ndi kuwonongeka kwa minofu yofewa ndi zovuta zovuta za fractures.
4.4 Irritable Bowel Syndrome of Soft Tissue:
Phinit P [23] inanena kuti dongosolo la LISS lidachitira 37 milandu ya proximal tibia fractures, 4 milandu ya postoperative yofewa minofu irritation (zowawa za subcutaneous palpable plate ndi kuzungulira mbale), momwe 3 mbale za mbale zili 5mm kutali ndi fupa pamwamba ndi 1 mlandu ndi 10mm kutali fupa pamwamba.Hasenboehler.E [17] et al adanenanso kuti LCP idachitira milandu ya 32 ya distal tibial fractures, kuphatikiza milandu ya 29 ya medial malleolus discomfort.Chifukwa chake ndikuti voliyumu ya mbaleyo ndi yaikulu kwambiri kapena mbale zimayikidwa molakwika ndipo minofu yofewa imakhala yochepa kwambiri pa medial malleolus, kotero odwalawo amamva bwino pamene odwala avala nsapato zapamwamba ndikupondaponda khungu.Nkhani yabwino ndiyakuti mbale yatsopano ya distal metaphyseal yopangidwa ndi Synthes ndi yopyapyala komanso yomatira pamafupa okhala ndi m'mphepete mwake, zomwe zathetsa vutoli.
4.5 Kuvuta Kuchotsa Zokhoma Zokhoma:
Zinthu za LCP ndi za titaniyamu yamphamvu kwambiri, zimagwirizana kwambiri ndi thupi la munthu, zomwe ndizosavuta kunyamula ndi callus.Pochotsa, kuchotsa koyamba kwa callus kumabweretsa zovuta.Chifukwa chinanso chochotsera zovuta chagona pakumangitsa kwambiri zomangira zotsekera kapena kuwonongeka kwa mtedza, zomwe nthawi zambiri zimayamba chifukwa chosintha chipangizo chodziwonera chokha chosiyidwa ndi makina owonera.Chifukwa chake, chida chowonera chidzagwiritsidwa ntchito potengera zomangira zotsekera, kuti ulusi wa screw uzitha kumangika bwino ndi ulusi wa mbale.[9] Wrench yeniyeni imayenera kugwiritsidwa ntchito polimbitsa zomangira, kuti athe kulamulira kukula kwa mphamvu.
Koposa zonse, monga mbale yopondereza ya chitukuko chaposachedwa cha AO, LCP yapereka njira yatsopano yothandizira maopaleshoni amakono a fractures.Kuphatikizidwa ndi ukadaulo wa MIPO, LCP imaphatikiza nkhokwe zamagazi m'mbali zosweka kwambiri, zimathandizira kuchiritsa kwa fracture, zimachepetsa chiopsezo cha matenda ndi kuswekanso, zimasunga kukhazikika kwa fracture, kotero zimakhala ndi chiyembekezo chogwiritsa ntchito pochiza fracture.Chiyambireni kugwiritsa ntchito, LCP yapeza zotsatira zabwino zachipatala kwakanthawi kochepa, komabe mavuto ena amawonekeranso.Opaleshoni imafuna kukonzekera kwatsatanetsatane komanso zochitika zambiri zachipatala, amasankha okonza mkati ndi matekinoloje oyenera malinga ndi mawonekedwe a fractures enieni, amatsatira mfundo zazikulu za chithandizo cha fracture, amagwiritsa ntchito fixators m'njira yolondola komanso yovomerezeka, pofuna kupewa. mavuto ndi kupeza zotsatira mulingo woyenera kwambiri achire.
Nthawi yotumiza: Jun-02-2022
