Joalo ka sesebelisoa sa kahare, poleiti ea khatello e 'nile ea phetha karolo ea bohlokoa kalafong ea fracture.Lilemong tsa morao tjena, khopolo ea "osteosynthesis" e fokolang haholo e 'nile ea utloisisoa ka botebo' me ea sebelisoa, butle-butle ea fetoha ho tloha khatisong e fetileng ea mochine oa mochine oa ho lokisa ka hare ho hatisa ho lokisoa ha likokoana-hloko, tse sa shebaneng feela le ts'ireletso ea masapo le mali a bonolo. e boetse e khothalletsa ntlafatso ea mekhoa ea ho buoa le ho lokisa ka hare.Locking Compression Plate(LCP) ke mokhoa o mocha oa ho lokisa lipoleiti, o ntlafalitsoeng motheong oa dynamic compression plate (DCP) le letlapa le lekanyelitsoeng le matla la compression plate (LC-DCP), 'me le kopantsoe le melemo ea kliniki ea poleiti ea puisano ea AO. PC-Fix) le Sistimi ea ho tsitsisa e fokolang (LISS).Sistimi ena e qalile ho sebelisoa ho tsa bongaka ka Mots'eanong 2000, e bile le litlamorao tse betere tsa bongaka, 'me litlaleho tse ngata li fane ka litekanyetso tse ntle bakeng sa eona.Leha ho na le melemo e mengata molemong oa ho lokisa fracture, e na le litlhoko tse phahameng ho theknoloji le boiphihlelo.Haeba e sa sebelisoe ka mokhoa o nepahetseng, e ka 'na ea se ke ea e-ba molemo,' me ea baka liphello tse ke keng tsa lokisoa.
1. Melao-motheo ea Biomechanical, Moralo le Melemo ea LCP
Ho tsitsa ha poleiti e tloaelehileng ea tšepe ho itšetlehile ka khohlano pakeng tsa poleiti le lesapo.Li-screws li tlameha ho tiisoa.Hang ha li-screws li se li hlephile, likhohlano pakeng tsa poleiti le lesapo li tla fokotseha, botsitso bo tla boela bo fokotsehe, e leng se fellang ka ho hlōleha ha fixator ea ka hare.LCPke poleiti e ncha ea tšehetso ka har'a lisele tse bonolo, tse hlahisoang ka ho kopanya poleiti ea khale ea ho hatella le tšehetso.Molao-motheo oa eona oa ho lokisa ha o itšetlehe ka khohlano pakeng tsa poleiti le cortex ea lesapo, empa o itšetlehile ka botsitso ba angle pakeng tsa poleiti le li-screws tsa ho notlela hammoho le matla a ho tšoara pakeng tsa li-screw le cortex ea lesapo, e le ho hlokomela hore ho robeha ha fracture.Molemo o tobileng o teng ho fokotsa ho kena-kenana le phepelo ea mali ea periosteal.Ho tsitsa ha angle pakeng tsa poleiti le li-screw ho ntlafalitse haholo matla a ho tšoara li-screw, kahoo matla a ho lokisa a poleiti a maholo haholo, a sebetsang ho masapo a fapaneng.[4-7]
Ntho e ikhethang ea moralo oa LCP ke "sekoti se kopantsoeng", se kopanyang likoti tse matla tsa compression (DCU) le masoba a khoele a khoele.DCU e ka lemoha khatello ea axial ka ho sebelisa li-screws tse tloaelehileng, kapa maqhetsoana a tlohileng mahaeng a ka hatelloa le ho ts'oaroa ka sekoti sa lag;lesoba la khoele le khole li na le likhoele, tse ka notlelang screw le latch e khoele ea linate, tsa fetisa torque lipakeng tsa screw le poleiti, 'me khatello ea longitudinal e ka fetisetsoa lehlakoreng la ho robeha.Ho phaella moo, groove ea ho itšeha ke moralo o ka tlaase ho poleiti, e fokotsang sebaka sa ho kopana le lesapo.
Ka bokhutšoanyane, e na le melemo e mengata ho feta lipoleiti tsa setso: ① e tsitsisa angle: angle pakeng tsa lipekere tsa lipekere e tsitsitse ebile e tsitsitse, e sebetsa hantle bakeng sa masapo a fapaneng;② e fokotsa kotsi ea tahlehelo ea phokotso: ha ho hlokahale ho tsamaisa lipoleiti tse nepahetseng esale pele, ho fokotsa likotsi tsa tahlehelo ea karolo ea pele ea tahlehelo le karolo ea bobeli ea tahlehelo ea ho fokotsa;[8] ③ e sireletsa phepelo ea mali: sebaka se fokolang sa ho kopana pakeng tsa poleiti ea tšepe le lesapo e fokotsa tahlehelo ea poleiti bakeng sa phepelo ea mali ea periosteum, e tsamaellanang haholoanyane le melao-motheo ea ho hlasela hanyenyane;④ e na le tlhaho e ntle ea ho ts'oara: e sebetsa ka ho khetheha ho osteoporosis fracture bone, e fokotsa sekhahla sa ho lokoloha le ho tsoa;⑤ e lumella mosebetsi oa pele oa boikoetliso;⑥ e na le mefuta e mengata ea lits'ebetso: mofuta oa poleiti le bolelele li felile, sebopeho sa anatomical se setle, se ka hlokomelang ho lokisoa ha likarolo tse fapaneng le mefuta e fapaneng ea fractures.
2. Lipontšo tsa LCP
LCP e ka sebelisoa e le poleiti e tloaelehileng ea compressing kapa e le tšehetso ea ka hare.Ngaka e buoang e ka boela ea kopanya ka bobeli, e le ho atolosa haholo matšoao a eona le ho sebetsa ho mefuta e mengata e fapaneng ea ho robeha.
2.1 Fractures e bonolo ea Diaphysis kapa Metaphysis: haeba tšenyo ea lisele tse bonolo e se matla 'me lesapo le na le boleng bo botle, ho robeha habonolo kapa ho robeha ha masapo a malelele ho hlokahala ho khaola le ho fokotseha ka nepo,' me lehlakore la fracture le hloka khatello e matla, ka hona LCP e ka sebelisoa e le poleiti ea compression le poleiti kapa poleiti ea neutralization.
2.2 Fractures e Tloaelehileng ea Diaphysis kapa Metaphyseal: LCP e ka sebelisoa e le poleiti ea borokho, e amohelang phokotso e sa tobang le borokho ba osteosynthesis.Ha e hloke phokotso ea anatomical, empa e khutlisa bolelele ba leoto, ho potoloha le mohala oa matla a axial.Ho robeha ha radius le ulna ke mokhelo, hobane mosebetsi oa ho potoloha oa liphatla o itšetlehile haholo ka sebōpeho se tloaelehileng sa radius le ulna, e tšoanang le fractures ea intra-articular.Ntle le moo, phokotso ea anatomical e tlameha ho etsoa, 'me e tla ts'oaroa ka mokhoa o tsitsitseng ka lipoleiti.
2.3 Intra-articular Fractures le Inter-articular Fractures: Ho fracture ea intra-articular, ha ho hlokahale feela hore re etse phokotso ea anatomical ho khutlisa boreleli ba holim'a articular, empa hape re hloka ho hatella masapo ho fihlela ho tsitsisa ho tsitsitseng le ho khothalletsa lesapo. pholiso, 'me e lumella boikoetliso ba pele bo sebetsang.Haeba fractures ea articular e na le liphello masapong, LCP e ka lokisakopanetsoepakeng tsa articular e fokotsehileng le diaphysis.'Me ha ho hlokahale hore ho bope poleiti nakong ea ho buuoa, e leng ho fokotsa nako ea ho buuoa.
2.4 Liehello tsa Kopano kapa ho ba Nonunion.
2.5 Osteotomy e Koetsoeng kapa e Bulehileng.
2.6 Ha e sebetse tabeng ea ho kopanyaho kokota ka intramedullaryfracture, 'me LCP ke mokhoa o mong o loketseng.Mohlala, LCP ha e sebetse ho senya maro a robehileng a bana kapa bacha, batho bao masoba a bona a masesane haholo kapa a sephara haholo kapa a sa sebetseng hantle.
2.7 Osteoporosis Bakuli: kaha cortex ea masapo e tšesaane haholo, ho thata hore poleiti ea setso e fumane botsitso bo ka tšeptjoang, e leng se ekelitseng bothata ba ho buuoa ka fracture, 'me se fella ka ho hlōleha ka lebaka la ho lokoloha habonolo le ho tsoa ha ho lokisa postoperative.LCP locking screw le plate anchor li theha botsitso ba angle, 'me lipekere tsa poleiti lia kopanngoa.Ho feta moo, bophara ba mandrel ba sekoti sa ho notlela se seholo, se eketsa matla a ho tšoara lesapo.Ka hona, ketsahalo ea ho lokoloha ha screw e fokotsehile ka katleho.Boikoetliso ba 'mele ba pele bo sebetsang bo lumelloa ka mor'a ts'ebetso.Osteoporosis ke pontšo e matla ea LCP, 'me litlaleho tse ngata li fane ka kananelo e phahameng.
2.8 Periprosthetic Femoral Fracture: periprosthetic femoral fractures hangata e tsamaea le osteoporosis, maloetse a tsofetseng le maloetse a tebileng a tsamaiso.Lipoleiti tsa setso li ka sehoa haholo, ho baka tšenyo e ka bang teng phepelong ea mali ea maqeba.Ntle le moo, li-screw tse tloaelehileng li hloka ho lokisoa ha bicortical, ho baka tšenyo masapong a samente, 'me matla a ho tšoara lefu la masapo le ona a fokola.Lipoleiti tsa LCP le LISS li rarolla mathata a joalo ka tsela e ntle.Ka mantsoe a mang, ba sebelisa theknoloji ea MIPO ho fokotsa ts'ebetso e kopanetsoeng, ho fokotsa ts'enyehelo ea phepelo ea mali, ebe sekoti se le seng sa cortical locking se ka fana ka botsitso bo lekaneng, bo ke keng ba baka tšenyo ea samente ea masapo.Mokhoa ona o hlahisoa ka mokhoa o bonolo, nako e khuts'oane ea ts'ebetso, ho tsoa mali ho fokolang, mefuta e nyane ea ho hlobola le ho thusa ho fola ha fracture.Ka hona, periprosthetic femoral fractures le eona ke e 'ngoe ea matšoao a matla a LCP.[1, 10, 11]
3. Mekhoa ea ho Buoa e Amanang le Tšebeliso ea LCP
3.1 Traditional Compression Technology: le hoja khopolo ea AO fixator ea ka hare e fetohile 'me phepelo ea mali ea lesapo la tšireletso le lisele tse bonolo li ke ke tsa hlokomolohuoa ka lebaka la ho hatisoa ho feteletseng ha mochine o tsitsitseng oa ho lokisa, lehlakore la fracture le ntse le hloka khatello ho fumana ho lokisa ba bang. fractures, tse kang intra-articular fractures, osteotomy fixation, bonolo transverse kapa khutšoanyane oblique fractures.Mekhoa ea ho hatella ke: ① LCP e sebelisoa joalo ka poleiti ea khatello, e sebelisa li-screw tse peli tse tloaelehileng tsa cortical ho lokisa ka mokhoa o ikhethileng holim'a poleiti e thellang kapa sesebelisoa sa compression ho hlokomela ho lokisa;② joalo ka poleiti ea ts'ireletso, LCP e sebelisa li-screws tsa lag ho lokisa maqheka a malelele a oblique;③ ka ho amohela molao-motheo oa sehlopha sa tsitsipano, poleiti e behiloe ka lehlakoreng la tsitsipano ea lesapo, e tla beoa tlas'a tsitsipano, 'me lesapo la cortical le ka fumana khatello;④ joalo ka poleiti ea buttress, LCP e sebelisoa mmoho le li-screws tsa lag bakeng sa ho lokisa fractures ea articular.
3.2 Theknoloji ea ho Lokisoa ha Borokho: Ntlha ea pele, sebelisa mokhoa o sa tobang oa ho fokotsa ho robeha, ho pholletsa le libaka tse robehileng ka borokho le ho lokisa mahlakore ka bobeli a ho robeha.Phokotso ea anatomic ha e hlokehe, empa e hloka feela ho hlaphoheloa ha bolelele ba diaphysis, ho potoloha le mohala oa matla.Ho sa le joalo, ho hlomathisoa ha masapo ho ka etsoa ho susumetsa sebopeho sa callus le ho khothalletsa pholiso ea fracture.Leha ho le joalo, ho lokisa borokho ho ka finyella botsitso bo lekanyelitsoeng, leha ho le joalo pholiso ea fracture e finyelloa ka li-calluses tse peli ka sepheo sa bobeli, kahoo e sebetsa feela ho fractures e kopanetsoeng.
3.3 Theknoloji ea Minimally Invasive Plate Osteosynthesis (MIPO): Ho tloha lilemong tsa bo-1970, mokhatlo oa AO o ile oa fana ka melao-motheo ea phekolo ea ho robeha: ho fokotsa anatomical, fixator ea ka hare, tšireletso ea mali le boikoetliso ba pele bo se nang bohloko bo sebetsang.Melao-motheo e 'nile ea tsejoa ka ho pharaletseng lefatšeng,' me liphello tsa kliniki li molemo ho feta mekhoa ea pele ea phekolo.Leha ho le joalo, ho fumana phokotso ea anatomic le fixator ea ka hare, hangata e hloka ho phunyeha ho hoholo, ho fella ka ho fokotseha ha lesapo, ho fokotsa phepelo ea mali ea likaroloana tsa fracture le likotsi tse eketsehileng tsa tšoaetso.Lilemong tsa morao tjena, litsebi tsa malapeng le tsa mose ho maoatle li ela hloko haholo le ho tsepamisa mohopolo haholoanyane ho thekenoloji e fokolang haholo, ho sireletsa phepelo ea mali ea lisele tse bonolo le lesapo nakong ea ho khothalletsa fixator ea ka hare, eseng ho tlosa periosteum le lisele tse bonolo ho robeha. mahlakoreng, eseng ho qobella phokotso ea anatomical ea likhechana tsa fracture.Ka hona, e sireletsa tikoloho ea tlhaho ea ho robeha, e leng biological osteosynthesis (BO).Lilemong tsa bo-1990, Krettek o ile a etsa tlhahiso ea theknoloji ea MIPO, e leng tsoelo-pele e ncha ea ho lokisa fracture lilemong tsa morao tjena.E ikemiselitse ho sireletsa phepelo ea mali ea lesapo la tšireletso le lisele tse bonolo ka tšenyo e nyane ho isa tekanyong e kholo.Mokhoa ke ho haha kotopo e ka tlas'a letlalo ka sekhahla se senyenyane, ho beha lipoleiti, le ho sebelisa mekhoa e sa tobang ea ho fokotsa ho fokotsa ho robeha le ho lokisa ka hare.Sebaka pakeng tsa lipoleiti tsa LCP se tsitsitse.Leha lipoleiti li sa elelloe ka botlalo sebopeho sa anatomical, phokotso ea fracture e ntse e ka bolokoa, ka hona melemo ea theknoloji ea MIPO e hlahella haholoanyane, 'me ke ho kenngoa ho loketseng ha theknoloji ea MIPO.
4. Mabaka le Mehato ea ho Thibela ho Hlōleha ha Kopo ea LCP
4.1 Ho hloleha ho lokisa ka hare
Li-implants tsohle li na le ho lokoloha, ho falla, ho robeha le likotsi tse ling tsa ho hloleha, lipoleiti tsa ho notlela le LCP ha ho mekhelo.Ho ea ka litlaleho tsa lingoliloeng, ho hlōleha ha fixator ka hare ha e bakoe haholo-holo ke poleiti ka boeona, empa hobane melao-motheo ea phekolo ea fracture e tlōloa ka lebaka la kutloisiso e sa lekaneng le tsebo ea ho lokisa LCP.
4.1.1.Lipoleiti tse khethiloeng li khutšoanyane haholo.Bolelele ba poleiti le kabo ea screw ke lintlha tsa bohlokoa tse amang botsitso ba ho lokisa.Pele ho hlaha theknoloji ea IMIPO, lipoleiti tse khuts'oane li ka fokotsa bolelele ba bolelele le ho arohana ha lisele tse bonolo.Lipoleiti tse khutšoanyane haholo li tla fokotsa matla a axial le matla a torsion bakeng sa sebopeho se tsitsitseng ka kakaretso, se fella ka ho hlōleha ha fixator ea ka hare.Ka nts'etsopele ea theknoloji e sa tobang ea phokotso le thekenoloji e fokolang haholo, lipoleiti tse telele li ke ke tsa eketsa ho phunyeha ha lisele tse bonolo.Lingaka tse buoang li lokela ho khetha bolelele ba poleiti ho latela biomechanics ea ho lokisa fracture.Bakeng sa fractures e bonolo, karo-karolelano ea bolelele bo loketseng ba poleiti le bolelele ba sebaka sa ho robeha kaofela e lokela ho ba holimo ho makhetlo a 8-10, athe bakeng sa ho robeha ho fokolang, karolelano ena e lokela ho ba holimo ho feta makhetlo a 2-3.[13]Ho ea ka liphello tsa LCP finite element analysis, ha lekhalo pakeng tsa mahlakoreng a robehileng ke 1mm, lehlakore la fracture le siea lesoba le le leng la compression plate, khatello ea maikutlo holim'a poleiti ea compression e fokotsa 10%, 'me khatello ea kelello ho li-screw e fokotsa 63%;ha lehlakore la ho robeha le siea likoti tse peli, khatello ea maikutlo holim'a poleiti ea compression e fokotsa ho fokotseha ka 45%, 'me khatello ea maikutlo ho li-screw e fokotsa 78%.Ka hona, ho qoba khatello ea maikutlo, bakeng sa fractures tse bonolo, likoti tse 1-2 tse haufi le mahlakore a robehileng li tla siuoa, athe bakeng sa fractures e fokotsehileng, li-screws tse tharo li khothalletsoa hore li sebelisoe lehlakoreng le leng le le leng la fracture le li-screw tse 2 li tla atamela haufi. fractures.
4.1.2 Lekhalo pakeng tsa lipoleiti le bokaholimo ba lesapo le fetelletse.Ha LCP e amohela theknoloji ea ho lokisa borokho, lipoleiti ha li hlokehe ho ikopanya le periosteum ho sireletsa phepelo ea mali ea sebaka sa fracture.Ke ea sehlopha sa elastic fixation, se susumetsang matla a bobeli a kholo ea callus.Ka ho ithuta botsitso ba biomechanical, Ahmad M, Nanda R [16] et al ba fumane hore ha lekhalo pakeng tsa LCP le lesapo le le leholo ho feta 5mm, matla a axial le torsion a lipoleiti a fokotsehile haholo;ha lekhalo le ka tlase ho 2mm, ha ho na ho fokotseha ho hoholo.Ka hona, lekhalo le khothalletsoa hore le be ka tlase ho 2mm.
4.1.3 Letlapa le kheloha ho tloha ho diaphysis axis, 'me li-screws li na le eccentric ho fixation.Ha LCP e kopantsoe theknoloji ea MIPO, lipoleiti li hlokeha ho kenngoa ka percutaneous, 'me ka linako tse ling ho thata ho laola boemo ba poleiti.Haeba mokokotlo oa lesapo o sa bapisoe le axis ea poleiti, poleiti ea distal e ka 'na ea kheloha ho tloha mokokotlong oa lesapo, e leng ho tla lebisa ho eccentric fixation ea li-screw le ho fokola ho fokolang.[9,15].Ho kgothaletswa ho nka sekala se loketseng, mme tlhahlobo ea X-ray e tla etsoa ka mor'a hore sebaka sa tataiso sa ho ama monoana se nepahetse le ho lokisa pin ea Kuntscher.
4.1.4 Ho hloleha ho latela melao-motheo ea phekolo ea fracture le ho khetha mokhoa o fosahetseng oa ho lokisa ka hare le theknoloji ea ho lokisa.Bakeng sa fractures ea intra-articular, fractures e bonolo ea transverse diaphysis, LCP e ka sebelisoa e le letlapa la khatello ho lokisa botsitso bo feletseng ba fracture ka theknoloji ea compression, le ho khothalletsa pholiso ea mantlha ea fractures;bakeng sa Metaphyseal kapa fractures e tsamaisoang, theknoloji ea ho lokisa borokho e lokela ho sebelisoa, ho ela hloko phepelo ea mali ea lesapo la tšireletso le lisele tse bonolo, ho lumella ho lokisoa ho tsitsitseng ha fractures, ho susumetsa khōlo ea callus ho finyella pholiso ka matla a bobeli.Ho e-na le hoo, tšebeliso ea theknoloji ea ho lokisa borokho ho phekola ho robeha habonolo ho ka baka ho robeha ho sa tsitsang, ho fella ka ho lieha ho fola ha fracture;[17] comminuted fractures' ho lelekisa ho feteletseng ha phokotso ea anatomical le ho hatella mahlakoreng a robehileng ho ka baka tšenyo phepelong ea mali ea masapo, e leng se bakang ho lieha ho kopana kapa ho se kopane.
4.1.5 Khetha mefuta e sa lokelang.Lesoba la motsoako oa LCP le ka kengoa ka mefuta e mene ea likurufu: likurufu tse tloaelehileng tsa cortical, likurufu tse tloaelehileng tsa ho hlakola masapo, likurufu tsa ho itšebetsa/tsa ho iphotla le likurufu tsa ho itapa.Hangata li-screws tsa ho iphunya / tsa ho itšebetsa li sebelisoa e le li-screw tsa unicortical ho lokisa ho robeha ho tloaelehileng ha masapo a diaphyseal.Ntlha ea eona ea manala e na le moralo oa mokhoa oa ho cheka, oo ho leng bonolo ho feta ka har'a cortex hangata ntle le tlhokahalo ea ho lekanya botebo.Haeba "diaphyseal pulp cavity" e le moqotetsane haholo, screw nut e ka 'na ea se ke ea lekana ka ho feletseng screw,' me ntlha ea screw e ama cortex ea contralateral, joale ts'enyehelo ea lateral cortex e tsitsitseng e ama matla a ho tšoara pakeng tsa li-screw le masapo, 'me li-screw tsa bicortical self-tapping. sebetsa ka nako ena.Li-screw tse hloekileng tsa unicortical li na le matla a ho ts'oara ho ea masapong a tloaelehileng, empa lesapo la osteoporosis hangata le na le cortex e fokolang.Ho tloha ha nako ea ts'ebetso ea li-screw e fokotseha, nako eo letsoho la "screw resistance" le fokotseha, e leng se bakang habonolo ho seha cortex ea lesapo, ho lokoloha ha screw le ho falla ha fracture ea bobeli.[18] Kaha li-screw tsa bicortical li ekelitse bolelele ba ts'ebetso ea li-screw, matla a ho tšoara masapo le ona a eketseha.Ka holim'a tsohle, lesapo le tloaelehileng le ka 'na la sebelisa li-screw tsa unicortical ho lokisa, leha ho le joalo lesapo la osteoporosis le khothalletsoa ho sebelisa li-screw tsa bicortical.Ho phaella moo, humerus bone cortex e batla e le tšesaane, e baka habonolo ho phunyeha, kahoo li-screws tsa bicortical lia hlokahala ho lokisa ho phekola fractures ea humeral.
4.1.6 Kabo ea screw e teteaneng haholo kapa e nyane haholo.Screw fixation ea hlokahala ho tsamaisana le fracture biomechanics.Ho ajoa ha screw e teteaneng haholo ho tla fella ka khatello ea maikutlo ea lehae le ho robeha ha fixator ea kahare;li-screws tse fokolang haholo le matla a sa lekaneng a ho lokisa li tla fella ka ho hlōleha ha fixator ea ka hare.Ha thekenoloji ea borokho e sebelisoa ho lokisa fracture, "screw density" e khothaletsoang e lokela ho ba ka tlase ho 40% -50% kapa ka tlase.[7,13,15] Ka hona, lipoleiti li batla li le telele, e le ho eketsa tekanyo ea mechine;Likoti tsa 2-3 li lokela ho siuoa bakeng sa mahlakoreng a fracture, e le ho lumella plate elasticity e kholoanyane, ho qoba khatello ea kelello le ho fokotsa liketsahalo tsa ho senyeha ha ka hare ho fixator [19].Gautier le Sommer [15] ba ne ba nahana hore bonyane li-screws tse peli tsa unicortical li tla ts'oaroa mahlakoreng ka bobeli a fractures, palo e ntseng e eketseha ea cortex e tsitsitseng e ke ke ea fokotsa sekhahla sa ho hlōleha ha lipoleiti, kahoo bonyane li-screw tse tharo li khothalletsoa hore li qosoe mahlakoreng ka bobeli. robeha.Ho hlokahala bonyane li-screw tse 3-4 mahlakoreng ka bobeli a ho robeha ha humerus le forearm, ho tlameha ho jara meroalo e mengata ea torsion.
4.1.7 Lisebelisoa tsa ho lokisa ha li sebelisoe ka tsela e fosahetseng, e leng se bakang ho hlōleha ha mochine oa ka hare.Sommer C [9] o etetse bakuli ba 127 ba nang le linyeoe tse 151 tsa ho robeha ba sebelisitseng LCP bakeng sa selemo se le seng, liphetho tsa tlhahlobo li bontša hore har'a li-screws tse 700, ke li-screws tse fokolang feela tse bophara ba 3.5mm tse lokolotsoeng.Lebaka ke tšebeliso e lahliloeng ea lisebelisoa tsa ho bona li-screws tse notlellang.Ha e le hantle, sekoti sa ho notlela le poleiti ha li eme ka ho feletseng, empa li bontša likhato tse 50 tsa angle.Moralo ona o ikemiselitse ho fokotsa khatello ea screw screw.Tšebeliso e lahliloeng ea sesebelisoa sa ho bona e ka fetola tselana ea manala 'me kahoo ea baka tšenyo ea matla a ho lokisa.Kääb [20] o ne a entse boithuto ba liteko, a fumana hore angle e lipakeng tsa likurufu le lipoleiti tsa LCP e kholo haholo, ka hona matla a ho ts'oara a li-screw a fokotsehile haholo.
4.1.8 Ho beha boima ba setho ho sa le pele haholo.Litlaleho tse ngata tse ntle li tataisa lingaka tse ngata hore li lumele ka mokhoa o feteletseng matla a ho notlela lipoleiti le likurufu hammoho le botsitso ba ho lokisa, ka phoso ba lumela hore matla a ho notlela lipoleiti a ka jara boima ba 'mele kapele, e leng se bakang ho robeha ha poleiti kapa screw.Ha ho sebelisoa maqhetsoana a ho lokisa borokho, LCP e batla e tsitsitse, 'me e hlokeha ho theha callus e le ho hlokomela pholiso ka matla a bobeli.Haeba bakuli ba tsoha esale pele haholo 'me ba jara boima bo feteletseng, poleiti le screw li tla robeha kapa li lokolloe.Ho lokisa poleiti ea ho notlela ho khothaletsa ts'ebetso ea pele, empa ho kenya butle butle ho tla nka libeke tse ts'eletseng hamorao, 'me lifilimi tsa x-ray li bonts'a hore lehlakore le robehileng le hlahisa mohala oa bohlokoa.[9]
4.2 Likotsi tsa Tendon le Neurovascular:
Theknoloji ea MIPO e hloka ho kenngoa ha percutaneous le ho behoa tlas'a mesifa, kahoo ha li-screws tsa poleiti li behoa, lingaka tse buoang li ne li sa khone ho bona sebopeho sa subcutaneous, 'me ka hona tšenyo ea tendon le neurovascular e eketseha.Van Hensbroek PB [21] o tlalehile nyeoe ea ho sebelisa theknoloji ea LISS ho sebelisa LCP, e leng se ileng sa fella ka hore ho be le li-pseudoaneurysms tsa anterior tibial artery pseudoaneurysms.AI-Rashid M. [22] et al e tlalehile ho tšoara ho phatloha ho liehang ha tendon ea extensor ea bobeli bakeng sa fractures ea distal radial le LCP.Mabaka a ka sehloohong a ts'enyehelo ke iatrogenic.Ea pele ke tšenyo e tobileng e tlisoang ke li-screws kapa pin ea Kirschner.Ea bobeli ke tšenyo e bakiloeng ke letsoho.'Me ea boraro ke tšenyo ea mocheso e hlahisoang ke ho cheka li-self-tapping screws.[9] Ka hona, lingaka tse buoang li hlokoa ho tloaelana le sebōpeho se potolohileng, ho ela hloko ho sireletsa methapo ea methapo ea kutlo le likarolo tse ling tsa bohlokoa, ho tsamaisa ka ho feletseng dissection e hlabang ka ho beha matsoho, ho qoba khatello kapa methapo ea methapo.Ho feta moo, ha u cheka li-screws tse itšebetsang, sebelisa metsi ho fokotsa tlhahiso ea mocheso le ho fokotsa mocheso oa mocheso.
4.3 Tšoaetso ea Sebaka sa Opereishene le Ho Iponahatsa ka Plate:
LCP ke sistimi ea ka hare ea ho lokisa e etsahetseng tlasa semelo sa ho khothaletsa mohopolo o fokolang, o ikemiselitseng ho fokotsa ts'enyehelo, ho fokotsa ts'oaetso, ho se kopane le mathata a mang.Nakong ea ho buuoa, re lokela ho ela hloko ka ho khetheha tšireletso ea lisele tse bonolo, haholo-holo likarolo tse fokolang tsa lisele tse bonolo.Ha e bapisoa le DCP, LCP e na le bophara bo boholo le botenya bo boholo.Ha o sebelisa theknoloji ea MIPO bakeng sa ho kenngoa ka percutaneous kapa intramuscular, e ka baka ho ferekana ha lisele tse bonolo kapa ho senya le ho lebisa tšoaetsong ea maqeba.Phinit P [23] o tlalehile hore tsamaiso ea LISS e ne e alafa linyeoe tse 37 tsa ho robeha ha tibia, 'me ts'oaetso ea ts'oaetso e tebileng ea postoperative e fihlile ho 22%.Namazi H [24] o tlalehile hore LCP e ne e tšoere linyeoe tsa 34 tsa fracture ea tibial shaft ea linyeoe tsa 34 tsa metaphyseal fracture ea tibia, 'me liketsahalo tsa ts'oaetso ea maqeba ka mor'a ts'ebetso le ho pepeseha ha poleiti ho fihlela ho 23.5%.Ka hona, pele ho ts'ebetso, menyetla le fixator ea ka hare e tla nkoa ka mokhoa o makatsang ho latela tšenyo ea lisele tse bonolo le tekanyo e rarahaneng ea fractures.
4.4 Irritable Bowel Syndrome of Soft Tissue:
Phinit P [23] o tlalehile hore tsamaiso ea LISS e ne e tšoere linyeoe tsa 37 tsa ho robeha ha tibia, linyeoe tsa 4 tsa ho halefisoa ke lisele tse bonolo tsa postoperative (bohloko ba poleiti e nang le subcutaneous palpable le ho pota-pota lipoleiti), moo linyeoe tsa 3 tsa lipoleiti li leng 5mm hole le bokaholimo ba lesapo le nyeoe e le 'ngoe e bolelele ba 10mm ho tloha holim'a lesapo.Hasenboehler.E [17] et al tlaleha hore LCP e ile ea tšoara linyeoe tsa 32 tsa distal tibial fractures, ho akarelletsa le linyeoe tsa 29 tsa malleolus a sa thabiseng.Lebaka ke hore palo ea poleiti e kholo haholo kapa lipoleiti li behiloe ka mokhoa o sa lokelang 'me lisele tse bonolo li fokotseha ho malleolus e bohareng, kahoo bakuli ba tla ikutloa ba sa phutholoha ha bakuli ba apere lieta tse phahameng le ho hatella letlalo.Litaba tse monate ke hore poleiti e ncha ea distal metaphyseal e entsoeng ke Synthes e tšesaane ebile e khomarela holim'a lesapo le nang le likarolo tse boreleli, tse rarollotseng bothata bona ka katleho.
4.5 Bothata ba ho Tlosa Li-Screws tse Locking:
Lintho tse bonahalang tsa LCP li na le titanium e matla haholo, li lumellana haholo le 'mele oa motho, oo ho leng bonolo ho o phuthela ke callus.Ha o tlosa, ho tlosoa ha callus pele ho lebisa ho boima bo eketsehileng.Lebaka le leng la ho tlosa bothata ke ho tiea ho feta tekano ha li-screws tsa ho notlela kapa tšenyo ea linate, eo hangata e bakoang ke ho nkela sesebelisoa sa ho bona se iponelang sebaka se lahliloeng.Ka hona, sesebelisoa sa ho bona se tla sebelisoa ho nka likurufu tsa ho notlela, e le hore likhoele tsa screw li ka tšehelloa hantle ka likhoele tsa poleiti.[9] Wrench e khethehileng e hlokeha ho sebelisoa ho tiisa li-screw, e le ho laola boholo ba matla.
Ka holim'a tsohle, joalo ka sethala sa khatello ea nts'etsopele ea morao-rao ea AO, LCP e fane ka khetho e ncha bakeng sa kalafo ea sejoale-joale ea fractures.E kopantsoe le theknoloji ea MIPO, LCP e kopanya mehloli ea mali ka mahlakoreng a robehileng ho isa tekanyong e kholo ka ho fetisisa, e khothalletsa pholiso ea fracture, e fokotsa likotsi tsa tšoaetso le ho robeha hape, e boloka botsitso ba fracture, kahoo e na le menyetla e pharaletseng ea tšebeliso ea phekolo ea fracture.Ho tloha ts'ebetsong, LCP e fumane liphetho tse ntle tsa nako e khuts'oane tsa kliniki, empa mathata a mang le 'ona a pepesitsoe.Ho buuoa ho hloka tlhophiso e qaqileng ea pele ho ts'ebetso le phihlelo e pharaletseng ea kliniki, e khetha li-fixator tse nepahetseng tsa ka hare le theknoloji ho latela likarolo tsa fractures tse itseng, e khomarela melao-motheo ea phekolo ea fracture, e sebelisa li-fixator ka mokhoa o nepahetseng le o tloaelehileng, e le ho thibela. mathata le ho fumana litlamorao tse nepahetseng tsa kalafo.
Nako ea poso: Jun-02-2022
