Locking Plate-Application Mɔxexeɖenu Kple Seɖoƒewo

Alesi wozãa... locking plates keke alesi woate ŋu azã plate ememe fixation of fractures ƒe kekeme ɖe enu ŋutɔ. Gake ele be woatrɔ asi le wo zazã ŋu eye woawɔe wòanyo wu le mɔ̃tetre kple seɖoƒe siwo ate ŋu ado mo ɖa ta. Le nyati sia me la, míalé ŋku ɖe dɔwɔwɔ ŋu bubu, kuxi siwo le eɖeɖeɖa me, kple seɖoƒewo, akpa 3 siwo le locking plate zazã me.

01.Nu Tɔxɛ Kple Sesẽnu Kawoe Wòle Be Woade Dzesi Le Locking Plates Zazã Me?

Afɔɖeɖewo Kple Kuxi Siwo Le Gbagbãƒewo Dzi Ðeɖe Akpɔtɔ Kple Plɛti Siwo Wotsɔna Klɔa Nu

Wowɔ ɖoɖo ɖe afɔɖeɖe siwo woawɔ atsɔ agbugbɔ aɖo gbagbãƒe aɖe anyi la ɖe ɖoɖo nu. Agbalẽvi siwo wotsɔ xea mɔe megbugbɔa gbagbãƒewo ɖoa anyi o. 

Ne wonya tsɔe da ɖe ƒu ƒe akpaa dzi ko la, ne wotsɔ gavi bubuwo kpe ɖe eŋu la, maʋuʋui o. Ne wozã gaƒoɖokui si xɔa ɖa siwo wotsɔ blaa nu ko la, . 

esia fia be ne woɖo gbagbãƒea vɔ ko hafi woate ŋu axe agbaa.

Esi wònye be agbalẽvi siwo wotsɔ xea mɔe ɖea mɔ na ƒuwo ƒe dɔyɔyɔ evɔ womebu alesi wogbugbɔ ɖo wo nɔƒe gbãtɔ o ta la, . 

nusi koŋ gbɔ agbalẽvi siwo wotsɔ xea mɔ na wo ƒe ɖekawɔwɔ nyuie tsoe nye wo gbugbɔgaɖo teƒe bubu le gɔmedzedzea me si mesɔ o. 

Eye, nuwo gbugbɔgaɖoanyi nyuie o le mɔ̃ɖaŋunu siwo mesɔ o ta ate ŋu ahe dɔyɔyɔ gbegblẽ vɛ esime ƒu ƒe gbadzɛa le gbagbãm le dɔyɔyɔ si tsi megbe alo dɔyɔyɔmawɔmawɔ ta.

Gbugbɔgaɖo teƒe bubu evɔ womazã gaƒoɖokui siwo wotsɔ xea mɔ na ame o sesẽna ŋutɔ ne wole dɔ wɔm si me womewɔa nu boo aɖeke le o

 dɔdamɔnuawo elabena ƒu ƒe dɔwɔwɔ mebɔ kura o. Ebia be woawɔ hehe ƒe ɖoɖo vovovowo (hehe ƒe kplɔ̃wo, nusiwo hea nu), .

 lãgbalẽgoe vovovo siwo wotsɔna trɔa asi le ƒumeŋuɖui ŋu, kple Kirschner-kpluwo tsɔ trɔa asi le ƒu kakɛawo ŋu eye wotsɔa wo léa wo ɖe teƒe ɖeka hena ɣeyiɣi aɖe. 

Hafi woatsɔ gaƒoɖokui siwo wotsɔ blaa nu kple ɖa siwo wotsɔ blaa nu la, ele vevie ŋutɔ be woatsɔ fluoroscopy alé ŋku ɖe alesi wogbugbɔe ɖoe ŋu.

Le go bubu me la, ne èle gaƒoɖokui si hã me do siwo me gaviwo le si wozãna ɖaa le zãm la, . 

woate ŋu atsɔ traction screw si wozãna ɖaa ade do siwo wozãna ɖaa me hena gbugbɔgaɖoanyi gbãtɔ le agbalẽa dzi.

 Wotsɔa ƒu kakɛwo dana ɖe agbaa ŋu. Ne agbalẽa wɔ ɖeka kple ŋutilã ƒe wɔwɔme la, woate ŋu azãe abe mɔfianu si woatsɔ agbugbɔ aɖoe ene. 

Nails siwo wotu la kpɔa egbɔ be nusiwo dona tso eme la li ke evɔ wometrɔa asi le nuwo gbugbɔgaɖoanyi gbãtɔ ŋu o. Ðoɖo sia si wotsɔ dea eme (gavi siwo wozãna ɖaa, emegbe gavi siwo wotsɔ blaa nu) le vevie (Nɔnɔmetata 4).

Fig. 4 Gbã la, tsɔ gavi siwo wozãna ɖaa la de eme eye nàbla wo sesĩe.

Tactile Feedback ƒe Manɔmanɔ Ne Wole Ʋuʋu ƒe Pegs Kpe sesĩe

Nyaŋuɖoɖo aɖeke meli si woate ŋu aka asi ne wole ta ƒe gavi siwo wotsɔ xea mɔe la sesẽm o. Le nyateƒe me, 

ɖa si wotsɔ blaa nu la ƒe sesẽ dzɔna le ɣeyiɣi ɖeka me le ƒu si le lãkusi alo ƒu si le lãkusi me kple ƒu si le ʋuƒoa ƒe ga me. Le susu sia ta la, .

 ele bɔbɔe be ɖɔktaa nasusui vodadatɔe be ɖa si xea mɔ na ame la léa ƒu si le lãkusi alo ƒu si le lãkusi me la nyuie (Nɔnɔmetata 3).

Fig. 3 Dɔwɔwɔ ƒe didime si wotu ɖe ƒu ƒomevi kple ƒu ƒe xexlẽme dzi.

Ðokuisi-Tapping Locking Screws

Wozãa gavi siwo wotsɔ xea mɔ na wo ɖokui la fia be asikaka nyaŋuɖoɖo aɖeke menɔa anyi le tomekuku alo tomekuku me o elabena wodzɔna le ɣeyiɣi ɖeka me.

Woƒe mɔ̃ɖaŋununya sɔ kple esiwo le lãkusi ɖeka ƒe gavi siwo xea mɔ na lãkusi ɖeka ŋu le lãkusi ɖeka zazã me. Ne wodidi akpa la, . 

woaka ɖe lãkusi evelia si womeku o la dzi, si ana be woaɖo ɖa si wotsɔ xea mɔe la ɖe teƒe si mesɔ o le ʋuƒoa ƒe ʋuƒoa me.

Le bicortical zazã me la, woate ŋu anɔ kpuie akpa, si wɔe be le mɔ̃ɖaŋununya gome la, wosɔ kple single-cortical locking nails. 

Ne wodidi akpa la, woakeke ɖe enu ayi ŋgɔ wu lãkusia eye woate ŋu agblẽ nu le xɔ vevi siwo le agbalẽa ƒe akpa kemɛ ŋu.

Ne wodzidze didime si wodi le tomekuku vɔ megbe alo tsɔ fluoroscopy ɖo kpe edzi ko hafi woate ŋu akpɔ ɖa si wotsɔ xea mɔ na nu ƒe didime nyuitɔ.

Features Of Uniaxial Ʋuʋu Screws

Nusi koŋ gblẽ le ɖa siwo wotu ɖe axa ɖeka dzi ŋue nye be woɖo woƒe mɔfiame ɖi do ŋgɔ. 

Woate ŋu atsɔ ati bubu si wotsɔ de wo me alo aŋenu bubu aɖe le woƒe mɔ dzi, si ana be womate ŋu ade wo eme o alo ana woaɖo wo ɖe unicortical fixation ko dzi.

Le ŋutilã ƒe wɔwɔme ƒe nutrenu gbadzɛ siwo wozãna le abɔ kple afɔ siwo ƒe axa ɖeka ƒe ʋuƒo siwo ƒe ŋkume le ɖoɖo nu me gome la, . 

ne wowɔe wònyo wu le ŋutilã ƒe wɔwɔme kple nugbagbeŋusẽ ƒe susuwo ta la, afɔku li be woatsɔ ɖa si wotsɔ xea ʋukawo me la ɖo. 

Kpɔɖeŋu si bɔ enye distal radius fracture. Afɔku sia lolona wu ne ʋuƒoa te ɖe ƒunukpeƒea ŋu alo ne ŋutilã ƒe wɔwɔme mele ɖoɖo nu o. 

Ele be woatsɔ fluoroscopy aɖo kpe ƒunukpeƒe ƒe gbagbã ƒe anyimanɔmanɔ dzi.

MIPO Mɔ̃ɖaŋununyawo

Mɔnu si nye minimally invasive percutaneous osteosynthesis (MIPO) la lɔ ŋutigbalẽ te kple/alo lãmeka te zazã ɖe eme 

kple ƒu ƒe gbadzɛ si wotsɔ de ƒua godo to ʋuƒo sue aɖe me yi ƒua me le eƒe ʋuʋu vɔ megbe, evɔ womaɖee afia o

 afisi wogbãe le. Esia na be woate ŋu atso nu suesuesuewo, amekoko teƒe ƒe dɔléle mebɔ o, eye wònana dɔdamɔnua 'biologic' wu.

 elabena mehiã be woaɖe ƒu kakɛ ɖesiaɖe ɖe go o eye womedoa kplamatse lãkusi falɛfalɛwo, ƒumeŋuɖui ƒe ʋukawo ƒe ʋuʋu, alo ʋuka si me ʋu sina tona le gbagbã me o.

Woate ŋu awɔe to agbalẽvi si wotsɔ xea nu kple dɔwɔnu si ŋu wotrɔ asi le etɔxɛe si na woate ŋu atsɔ agbalẽvi la awɔe 

be woatrɔ asi le eŋu eye woatsɔe ato ŋutigbalẽa me be wòate ŋu akpɔ ɖa ƒe do siwo wotu ɖe agbaa me bɔbɔe. 

Ele be woaɖe foto siwo wotsɔ fluoroscopic wɔe le afɔɖeɖe ɖesiaɖe me be woatsɔ aɖo kpe ŋgɔyiyi si wowɔ dzi. Mɔnu sia ƒe afɔɖeɖe ɖesiaɖe sesẽ. Kuxi gbãtɔe nye be nàgbugbɔ aɖo gbagbãƒea hafi aɖɔe ɖo.

 Emegbe ele be woatsɔ gaƒoɖokui la aɖo titina nyuie le ƒua ƒe didime nu, ne menye nenema o la, ʋuƒoa ƒe ɖoɖo si sɔ la masɔ o (Nɔnɔmetata 5). Kpeɖe eŋu la, 

ele be nusi wotsɔ xea mɔ na ƒua nasɔ pɛpɛpɛ kple ƒu si ŋu wotrɔ asi le be wòakplɔe ɖo ƒe lãkusi eye wòate ɖe ƒua ŋu abe alesi 

ate ŋu adzɔ evɔ womaɖe xɔa ƒe sesẽ dzi akpɔtɔ boo o. Le afɔɖeɖe mamlɛtɔ si wowɔna tsɔ xea ʋua me la, esesẽna be woakpɔ egbɔ be ema

 gaviawo ƒe mɔ̃wo le ɖoɖo nu nyuie le gavi si wotsɔ xea mɔe dzi eye be gavi siwo wotsɔ xea mɔ na wo la naƒo wo ɖokui nyuie ne wole wo tem sesĩe.

Figure 5 Eccentric positioning of the locking plate kple haptic feedback ƒe anyimanɔmanɔ le screw ƒe sesẽɣi.

Nuveviwɔame Siwo Ate Ŋu Ate Ŋu Axɔ le Ŋutilã Ŋu Ne Wozã Afɔkpodzi ƒe Gotagome Kplamatsedonu

Wogblɔ be agbalẽvi siwo wotsɔna xea afɔkpodzi ƒe gbagbã siwo le gota la zazã do ƒome kple ŋutigbalẽ ƒe kuku ƒe agbɔsɔsɔ si mesɔ o. 

Alesi lãkusi siawo siwo xea mɔ na ŋutigbalẽa ƒe titrime naa ŋutigbalẽa tea ŋu eye wòdoa kplamatse eƒe ʋukawo ƒe mama kple dɔyɔyɔ. 

Nu ma tɔgbe ate ŋu adzɔ ne wozã gaƒoɖokui siwo wotsɔ xea mɔ na hawksbill ƒe gbagbã.

Afɔku Si Le Ƒumeŋuɖui Kple Screw Extraction Me

Le ƒu si me ƒu le me la, ɖa siwo wotu ɖe wo nɔewo ŋu kpena ɖe ame ŋu be afɔku si le gavi ƒe hehe alo eƒe ɖeɖeɖa me dzi ɖena kpɔtɔna. 

Nusi wowɔ la mesẽ nyuie o le ƒu ƒe lãkusi si le tsɛ wu kple ƒu ƒe lãkusi ƒe kpekpeme dzi ɖeɖe kpɔtɔ ta.

Le go sia me la, locking plate fixation sesẽna ɣesiaɣi eye wòsea seke nyuie wu ne wozã evanescent alo convergent monolithic construct (Nɔnɔmetata 3).

Totoɖeme:

1. gavi siwo wotsɔ xea mɔ na ƒu ƒe gbagbãƒea meɖea mɔ be woagbugbɔ aɖo ƒu ƒe gbagbãƒea o.

2. ele be woagbugbɔ aɖo gbagbãƒea hafi atsɔ gavi si wotsɔ xea mɔe akpe ɖe eŋu.

3. percutaneous fixation na gbagbã dzi ɖeɖe kpɔtɔ bia locking plate instrumentation. MIPO ƒe mɔnu la bia nu geɖe wu.

02. Kuxi Siwo Le Ʋuʋudediwo Ðeɖe Me

Ne wonya haya ko la, ʋuƒo si wotsɔ xea nu la ɖeɖe ɖa nyea kuxi eye womate ŋu agblɔe ɖi o, . 

gake woate ŋu akpɔ nɔnɔmea gbɔ. Kuxi gãtɔ kekeakee nye be nàɖe gavi si wotsɔ xea mɔe la ɖa.

Le go aɖewo me la, ka siwo le ɖa si wotsɔ blaa nu ƒe ta ŋu la gblẽna ne wole edem 

(zi geɖe tightening kple loosening, screwdriver ƒe nɔnɔme gblẽ eye menye bliboe hexagonal o, screw dede wowɔe kple ŋusẽ drill), 

si fia be womate ŋu aɖee le gavi me o. Eyata anyo wu be nàxe mɔ ɖe kuxi sia nu to gavi ɖesiaɖe ɖɔliɖɔli enumake kple a 

ta ƒe nɔnɔme si gblẽ le edede me, wozãa gavi blibo eye woatsɔ asi abla gavi la keŋkeŋ (menye kple elektrik-mɔ̃ o).

 Gavi siwo wotsɔ nu sesẽwo wɔ zazã ate ŋu akpe ɖe ŋuwò nàɖe kuxi sia dzi akpɔtɔ.

Zi geɖe la, mɔ̃ aɖe nɔa ʋuƒoa ƒe ka siwo wotsɔ xea mɔe kple do si me ka le si le ʋuƒoa ƒe ʋuƒoa me dome. 

Esia dzena zi geɖe kple 3.5mm ƒe didime titanium hex kpɔɖeŋu ɖeka shaft locking screws. Mɔ̃ ɖeka aɖeke meli si dzi woato awɔ dɔa o

 hena nudede nyawo me. Zi geɖe la, woblaa gaviwo wògbɔa eme le gɔmedzedzea me le esi womezã torque wrench si wona le dɔwɔnuawo ƒe dɔwɔnu me o ta, . 

si ate ŋu atrɔ ka siwo le gaƒoɖokui si wotsɔ blaa nu kple gavi si wotsɔ blaa nu la dzi. Le go bubuwo me la, . 

ne womezã drill guide si mesɔ o alo zãe o la, ena be gaviawo mewɔ ɖeka ne wobla wo sesĩe o, . 

si na be gaviawo xaxa. Be woaɖe afɔku si le ʋuʋu me le eɖɔɖɔɖodɔ gbãtɔ me dzi akpɔtɔ la, .

 ele vevie be woazã dɔwɔnu siwo katã li: drill guides kple sockets, torque wrenches le full integrity mode me ne wole ʋuƒo siwo wotsɔ blaa nu la sesẽm.

MIPO mɔnu la hea afɔku gã aɖe vɛ be woatsɔ mɔfiame si woatsɔ aɖo nuwo ɖe ɖoɖo nu la ɖe teƒe si mesɔ o, . 

elabena womekpɔa nusi wotsɔ xea mɔ na nu la tẽ o. Ne womeɖo drill guide la ɖe ɖoɖo nu nyuie o la, efia be do si wodo na 

ɖa si wotsɔ blaa nu kple ɖa si wotsɔ blaa nu la dede eme hã masɔ o. Afɔku hã li be wòagblẽ nu le ta ƒe nɔnɔme si le...

 ʋuƒo si wotsɔ blaa nu ne gavi la mewɔ ɖeka kple gavi la nyuie o.

Le susu siawo ta la, hafi amekolaa naɖe nutrenu si wotsɔ xea mɔe la, ele be wòanya be ɖewohĩ menye nenemae o 

ate ŋu adzɔ be woaɖe ɖa si wotsɔ blaa nu la ɖa, si abia be woazã dzogoe ade ƒe ʋuƒo nyuitɔ kple dɔwɔnu bubuwo.

Ne womate ŋu aɖe ɖa si wotsɔ xea mɔe o, alo ta ƒe nɔnɔme gblẽ la, . 

afɔɖeɖe gbãtɔe nye be woatsɔ gavi si ɖea gavi (si nye gavi si le gbadzaa si me ka siwo wogbugbɔ trɔ) ade gavi la ƒe ta me;

 esia ate ŋu asu be wòaɖe gavi la ɖa. Mɔnu bubue nye be nàtso ʋuƒo si le ʋuƒoa ƒe akpa eveawo eye nàzãe

 eyama abe gavi ene be wòaɖe xɔ bliboa katã ɖa. Ne womate ŋu aɖe gavi la ɖa kokoko o la, woate ŋu aɖe gaƒoɖokui si wotsɔ xea mɔe la to 

toku ɖe eŋu kple drill, tsɔtsrɔ̃ ɖa si wotsɔ blae ƒe ta, alo to lãɖeɖe ƒo xlã agbaa be wòaɖe ɖa si wotsɔ blae la me. Le ema megbe la, . 

woate ŋu azã vise atsɔ aɖe gavi siwo wotsɔ xea mɔe ƒe atiwo ɖa. Ne womate ŋu aɖee kokoko o (elabena ewɔ ɖeka kple ƒua alo medona ɖe gota nyuie o ta), . 

woate ŋu atsɔ asigɛ drill aɖee ɖa (Fig. 6).

Figure 6 Kpekpeɖeŋu kple aɖaŋuɖoɖo siwo woatsɔ aɖe gavi siwo wotsɔ xea ʋuƒoa me la ɖa.

Kuxi siawo katã ate ŋu ana amekokoa nadidi, ate ŋu ana lãmeka falɛfalɛwo navuvu le ga kakɛ siwo dona ta, eye woate ŋu axɔ dɔlékuiwo. 

Ring drill zazã nana be afɔku si le amekokoa me ƒe gbagbã me dzina ɖe edzi.

Totoɖeme:

1. Kuxi si le ɖa siwo wotsɔ xea mɔe ɖeɖeɖa me la dzɔna koŋ kple 3.5mm hex ta si xea mɔ na titanium screws.

2.Mɔ nyuitɔ si dzi nàto aƒo asa na kuxi siae nye be nàzã dɔwɔnu siwo katã wona ne èle gavi la dem eme. Woate ŋu akpɔ kuxi siawo gbɔ to dɔwɔnu siwo sɔ zazã me.

03. Nukae Nye Seɖoƒe Siwo Le Dɔwɔwɔ Ŋu Le Locking Plate La Ŋu?

Clavicle plate ƒe gbagbã kple ƒu ƒe nonunion

Ne wokpɔ egbɔ be xɔtunua mesẽ akpa o le esi ʋuƒoa ƒe dɔwɔwɔ ƒe didime mesɔ gbɔ o alo gaƒoɖokui ƒe ʋuƒo ƒe xexlẽme si gbɔ eme ta (Nɔnɔm. 7) la, woate ŋu aɖe afɔku si le ʋuƒoa ƒe gbagbãƒe le gavi ƒe doawo te alo le gavi/ƒu gbadzɛ ƒe ƒoƒoƒe dzi akpɔtɔ.

Nɔnɔmetata 7 Wokpɔ ƒu ƒe dɔyɔyɔ le ŋkeke 60 megbe to asitɔtrɔ le gavi siwo wotsɔ xea mɔe ƒe xexlẽme kple teƒe si wole ŋu eye wodzi xɔtunu siwo sesẽ akpa ƒe tete ɖe edzi.

Zi geɖe la, woɖoa kpe ƒu ƒe nonunion ƒe dzesi dzi to agbalẽvi ƒe gbagbã me. 

Kplu si wotsɔ blaa nu alo ɖa si wotsɔ blaa nu ƒe gbagbã megbe le ɣeyiɣi nyuitɔ dzi elabena micromotion ate ŋu adzɔ si ana ƒu nahaya.

Le ƒu gbagbã bɔbɔe siwo hiã be woazi wo dzi, si nɔa te ɖe ƒu si ƒomevi gbagbã dzi tsɔ wu be wòanɔ te ɖe ƒu si ŋu wòku ɖo dzi la, . 

xɔ sesẽ si me kakɛ eveawo meka asi o ate ŋu ana agbaa nagada gbe le eŋu o eye ɖeɖi nate eŋu. 

Aŋe sesẽ + ɖa si wotu + hehe le afisi ƒu gbagbã le ƒe ƒuƒoƒo wɔnɛ be ƒu megawɔa ɖeka o.

Esia ƒe tɔtrɔ aɖee nye alesi lãgbalẽgolo si wotsɔ xea mɔe la ƒe gbagbã le ɣeyiɣi ɖeka me le eƒe kadodo ɖe agbalẽa ŋu te, . 

si hã tso xɔtunu si sesẽ akpa gbɔ. Esia nana be agbaa ƒe nuwuwu ɖeka hea 'le akpa ɖeka' eye womekpɔa dɔyɔyɔ o (Nɔnɔmetata 8).

Nɔnɔmetata 8 Xɔtunu si sesẽ akpa eye meda sɔ o ƒe kpododonu evelia: wozã gavi geɖe akpa siwo wotsɔ xea mɔ na nu le didiƒe eye proximal splice plate la medidi o.

Eyata ne wotsɔ agbalẽvi siwo xea mɔ na akɔta ƒe gbagbãƒe siwo le lãkusi me la ɖɔ li wo nɔewo ate ŋu ana ƒu nagawɔ ɖeka o elabena eƒe wɔwɔme sesẽ akpa be wòate ŋu adze afisi wògbã le. 

Ne micromotion si hiã be woada gbe le ame ŋu meli o la, agba siwo katã wotsɔ de eme la tsɔa eye wòdoa kpo nu mlɔeba.

asymmetric dɔyɔyɔ ƒe lãkusi

Ƒumeŋuɖui ƒe ƒumeŋuɖui ate ŋu anye esi mesɔ o, . 

vevietɔ le afɔkpodzi ƒe akpa 1/3 si le didiƒe ƒe gbagbãwo me. Micromotion le elasticity ta ɖe mɔ ɖe... 

lãmenugbagbevi siwo daa gbe le gbagbã ŋu ƒe ŋgɔyiyi ɖekae si dzɔna le ʋuƒo si wotsɔ xea mɔ na nu/aɖabɛ ƒe xɔtunu ƒe akpa siwo sɔ dzi ko.

 Be woaɖu afɔku sia dzi la, ele be woadzi ʋuƒoa ƒe dɔwɔwɔ ƒe didime ɖe edzi, to titanium-gbadzɛ siwo te ŋu trɔna bɔbɔe wu zazã me alo to ʋuƒo yeye siwo wotsɔ xea mɔe zazã me. 

Le go bubu me la, xɔtunu siwo te ŋu trɔna bɔbɔe akpa ate ŋu ana ƒu ƒe nonunion si lolo akpa nava.

Plastik ƒe nɔnɔmetɔtrɔ le gakpo gbadzɛwo ŋu

Ne wotsɔ agbaa da ɖe lãkusia gbɔ alesi woate ŋui la, eɖea afɔku si le plastic ƒe tɔtrɔ le agbaa titina dzi kpɔtɔna;

 ne didime si le agbalẽa kple lãkusia dome wu milimeta 5 la, .

 xɔtuɖaŋu ƒe ŋusẽ dzi ɖena kpɔtɔna ŋutɔ eye afɔku si le plastic ƒe tɔtrɔ le agbalẽa ŋu kple titanium-gbadzɛa ƒe kpododonu me lolo ŋutɔ.

Diaphysis alo metaphysis ƒe gbagbã megbe le agbalẽvi si wotsɔ xea mɔ na nu ƒe nuwuwu

Afɔku si le gbagbã megbe le locking plate diaphysis alo metaphysis ƒe nuwuwu, . 

vevietɔ le ƒu si me ƒu le me la, woate ŋu aɖe edzi akpɔtɔ ne wotsɔ ɖa ɖeka si xea ƒumeŋuɖui alo bicortical screw si wozãna ɖaa dede agbaa ƒe nuwuwu be wòaɖe nuteɖeamedzi siwo le nuto sia me dzi akpɔtɔ.

Mɔ̃wo ƒe Dodokpɔ

Nɔnɔme siwo gbɔna dzia afɔku si le mɔ̃a ƒe gbagbãƒe si le ʋuƒoa ŋu ɖe edzi:

1. Fixation of humeral diaphysis fractures bia be woazã nail ene siwo xea mɔ na fracture teƒea ƒe akpa eveawo be woatsi tre ɖe torsion ŋu eye woadzi mɔ̃wo ƒe kpododonu ɖe ​​edzi ;eye

2. Epiphyseal fractures ƒe ɖɔɖɔɖo sesẽ elabena zi geɖe la, womeli ke o, . 

vevietɔ le esi ɖa siwo wotu la mate ŋu aƒo teƒe si ƒua gbã la nu ƒu o eye ƒua nye ƒumeŋuɖui ta;

3. comminuted intra-articular kple extra-articular comminuted fractures of the epiphysis meli ke o

 (le kpɔɖeŋu me, afɔkpodzi ƒe gbagbã le didiƒe, bicondylar tibial plateau ƒe gbagbã, didiƒe ƒe didime ƒe gbagbã);

4. medial comminution of metaphyseal fractures si dina be yeaʋu ayi inversion (le kpɔɖeŋu me, proximal humerus, proximal femur, kple proximal tibia fractures).

 Kplu siwo wotsɔ blaa ƒua ƒe axadzi la naa xɔtunu sesẽ aɖe si sɔ gbɔ zi geɖe 

be woana ƒu gbagbã siawo nali ke evɔ mahiã be woatsɔ console-ƒomevi ƒe agbalẽviwo akpe ɖe eŋu le titina alo atsɔ ƒu akpe ɖe eŋu esime wole nugbagbewo ƒe gbagbãƒe ƒe nɔnɔme me ɖe asi o. 

Liƒo nɔ te ɖe ʋuƒo si wotsɔ xea mɔe/aŋenu si wotsɔ xea mɔe dzi ko, . 

si tea ɖeɖi ame ŋu wu le gbugbɔgaɖoanyi megbe ne epiphysis la gakpɔtɔ le megbe alo ne womegbugbɔ medial console la tu o. Emegbe nusi wotsɔ xea mɔe ate ŋu ado kpo nu le ɖeɖiteameŋu ta.

Eyata ele be woabu bicondylar tibial plateau fractures ƒe fixation to locking plates zazã le axadzi gome ɖeɖeko zazã ŋu le ƒomevi si le wo ŋu nu.

 Le proximal humerus fractures gome la, fracture blocks ƒe xexlẽme, medial support ƒe bu, .

 kple epiphysis ƒe tɔtrɔ ɖe megbe hena fixation nye afɔku siwo wonya. Be woaɖe afɔku si le xɔtudɔa ƒe kpododonu me dzi akpɔtɔ la, . 

woatsɔ mɔ̃ alé ɖa aɖewo siwo wotsɔ blaa nu ɖe ​​te be woatsɔ axe fe ɖe titina ƒe kpeɖeŋutɔ ƒe anyimanɔmanɔ le gbagbã siwo gɔme woɖe tso gota dzi ɖeɖe kpɔtɔ me ta

Nu Gbagbewo ƒe Dodokpɔ le Plɛti Siwo Wotsɔna Ƒoa Nu Me

Nu gbagbewo ƒe kpododonu ƒe mɔnu siwo le ʋuƒo siwo wotsɔ xea mɔe ŋue nye gavi si wotso kple gavi si wotsɔ blaa nu la ƒe gbagbã alo eƒe ƒoƒo. 

Afɔku siawo lolona wu ne ƒumeŋuɖui le ƒumeŋuɖui me, . 

si fia be ele be woawɔ ɖɔɖɔɖo kaba eye woatrɔ ɖe kpekpeme tsɔtsɔ ŋu nyuie hafi woakpɔ ƒuwo ƒe dɔyɔyɔ gbɔ.

(1) Kplu Siwo Wotsɔna Klɔa Nuwo Ƒe Ʋuʋudediwo Ƒe Ðeɖe

Screw ɖeɖe sɔ kple 'total' kple ɣeyiɣi ɖeka me ɖeɖe ɖa le ʋuƒo si xea mɔ na ƒu si le agbaa ƒe nuwuwu ɖeka alo evea siaa ŋu. Le go aɖewo me la, . 

wotsɔa ƒu kakɛ aɖe ƒoa xlãe ɖea ɖa si wotu la.

Le epiphyseal nutoa me la, zi geɖe la, akpa ɖeka ƒe ʋuƒo ƒe wɔwɔme naa liƒo si sɔ le ʋuƒo ƒe seke si kaka alo si le ƒoƒom ta, . 

eye akpa etɔ̃ ƒe wɔwɔme dzia tsitretsitsi ɖe screw ɖeɖe tso cancellous ƒu me ŋu ɖe edzi.

Le diaphyseal nuto me la, ŋusẽ si wotsɔna hea nu kple xɔtunu siwo ƒe ʋuƒo didi wu siwo ƒoa ƒu kple esiwo kaka ɖe teƒeteƒewo ƒe hehe ƒe ŋusẽ nyona wu . 

Xɔtutu sia ƒomevi sɔ wu na periprothetic fractures. Le ƒu si me ƒu le me la, . 

bicortical stem screw fixation nyo wu monocortical screw fixation. Le periprothetic fractures gome la, unicortical screws siwo ƒe ta le gbadzaa kpena ɖe ame ŋu be woaƒo asa na kadodo kple intramedullary implants.

Ƒu ƒe kpododonu siawo do ƒome kple ƒu ƒe nyonyome madeamedzi, ne mɔ̃a ƒe wɔwɔme me gblẽ o gɔ̃ hã.

(2) Gavi siwo wotsɔ xea mɔ na nu ƒe lãɖeɖe alo woƒe ƒoƒo

Lãɖeɖe alo woƒe ƒoƒo ɖe ɖa siwo wotu kple esiwo gena ɖe ƒunukpeƒewo me ate ŋu adzɔ le cancellous epiphyseal nuto me.

Ʋuʋu siawo nye ƒu si ƒe lolome mede o ƒe epiphyseal kakɛ siwo woɖe ɖa ƒo xlã fixation locking nail la ƒe ʋuʋu.

 Esia wɔnɛ be epiphyseal fracture dzi ɖeɖe kpɔtɔ meganɔa anyi o. Le nɔnɔme nyuitɔ me la, epiphyseal locking nail impinges kple...

 gena ɖe ƒu si woyɔna be cancellous bone la me. Le nɔnɔme si vɔ̃ɖi wu me la, ɖa si xea mɔ na ƒunukpeƒea la dona le lãkusia me eye wòzɔa mɔ yia ƒunukpeƒea.

Kuxi eve siawo dzɔna zi geɖe le proximal humerus kple distal radius fractures me. 

Le locking plate fixation of proximal humerus fractures, wokafui be didime si le... 

woaɖo seɖoƒe na epiphyseal locking nail be woaɖe afɔku si le ƒunukpeƒetetedɔ kple evelia ƒe gege ɖe ƒunukpeƒewo me dzi akpɔtɔ.

Ƒu ƒe nyonyome ƒe kpododonu siawo tso ƒu ƒe nyonyome si mesɔ o kple ƒu gbagbã ƒe kakɛawo ƒe ʋuʋu gã le gɔmedzedzea me hafi woɖe wo dzi kpɔtɔ gbɔ, . 

ne mɔ̃a ƒe xɔtunua me gblẽ o gɔ̃ hã.

Ƒunukpeƒewo Gbugbɔgaɖɔɖo Kple Kpekpeme Dzitsɔtsɔ Enumake

Ne wonya ɖo kpe edzi bliboe eye woɖo kpe edzi le dɔwɔwɔ vɔ megbe ƒe X-raywo me ko hafi woɖea mɔ ɖe nuwo ɖɔɖɔɖo kple kpekpeme tsɔtsɔ ŋu.

Biomechanical numekukuwo ɖee fia be le ƒu si sɔ me la, ne dometsotso si le kakɛawo dome mede milimeta 1 o la, . 

kpekpeme tsɔtsɔ ate ŋu adzɔ afɔku manɔmee. le tsatsam miliɔn 1 megbe la, ƒu ƒe sesẽme sɔ kple ƒu si sɔ, si sɔ gbɔ be wòada gbe le eŋu.

Ne xɔtuɖoɖo le nyuie la, ʋuƒo siwo wotsɔ xea mɔe kple ʋuƒo siwo wotsɔ xea mɔe le dzogoe ɖeka dzi ɖea mɔ be woate ŋu atrɔ ayi kaba 

kpekpeme tsɔtsɔ elabena wotsɔa agbaa tsoa ɖa si wotsɔ xea nu la dzi yia nusi wotsɔ xea nu ƒe agbaa dzi tẽ, eye afɔku aɖeke mele eme be nusi wotsɔ blaa nu la nado kpo nu le ʋuƒoa ƒe ƒoƒoƒe o.

Gake ne multiaxial locking peg ƒe axis mele tsitre ɖe locking plate la ŋu o la, womeɖea mɔ ɖe kpekpeme tsɔtsɔ kaba ŋu o.

Le MIPO gome la, woɖe mɔ ɖe kpekpeme tsɔtsɔ kaba ŋu na ƒunukpeƒetetedɔ siwo le vovo, siwo le bɔbɔe kple/alo esiwo wogbã bɔbɔe. 

Xɔtunu tɔxɛ siwo didi ŋutɔ la te ŋu trɔna bɔbɔe kple bicortical locking nails siwo trɔna kple ʋuʋu hena agba xɔxɔ kple emama.

Nyanuwuwuw:

1.Biomechanical numekukuwo da xɔtu ƒomevi vovovowo kple woƒe mɔ̃ɖaŋununya ƒe nɔnɔmewo kpɔ.

Agbalẽawo kpena ɖe ame ŋu be woaɖo kpe nukpɔsusu ƒe mɔkpɔkpɔ siwo do ƒome kple fixation sia ƒomevi dzi. 

Gake agbalẽ siwo wota nyitsɔ laa hã te gbe ɖe mɔ̃ɖaŋununya ƒe kuxiwo kple kpododonu siwo dona tso agbalẽvi siwo wotsɔ xea mɔe me dzi.

2.Nusi koŋ gbɔ wòtso be wòdo kpo nu enye be womewɔ ɖoɖo ɖe amekokomɔnua ŋu nyuie o, . 

si bia nu geɖe ŋutɔ, vevietɔ ne wole dɔ siwo me womewɔa nu boo aɖeke le o wɔm.

3.Ele be woagbugbɔ aɖo gbagbãƒea gbã, evɔ womaxe gaviawo ɖe agbaa ŋu o, .

esi wònye be manya wɔ be woagbugbɔ agbalẽvia atrɔ tẽ to gaviawo tutu me o.

4.Ele be xɔa ƒe didime kple ŋusẽ nasɔ, . 

si fia be ele be amekolaa nanya gɔmeɖose kple se siwo fiaa mɔ agbalẽvi siawo zazã nyuie. 

Eyata ele be xɔa nanye esi te ŋu trɔna, eye gavi siwo wotsɔ xea mɔe siwo dome didi edziedzi siwo nɔa tɔtrɔm kple do ƒuƒlu ʋɛ aɖewo koe anɔ eme.

5.Togbɔ be nukpɔsusu ƒe gɔmedzedze li ke nyuie wu le ʋuƒo siwo wotsɔ xea mɔ na wo ŋu hã la, . 

ƒu ƒe gbagbã ƒe sesẽ, alesi wòɖee dzi kpɔtɔ, kple ƒua ƒe nugbagbeŋusẽ ƒe nyonyome seɖoƒe li na xɔtuɖoɖoa.

6.Ne mɔ̃a ƒe wɔwɔme me gblẽ o la, ƒua ƒe nyonyome nyo eye ƒua ƒe gbagbã nye extra-articular, . 

woate ŋu aɖe mɔ na dɔnɔ si si ɖokuisinɔnɔ si sɔ le be wòatsɔ kpekpeme ɖe abɔ kple afɔ si gbã la dzi. Le go geɖe me la, gaƒoɖokui si wotsɔ blaa nu la ɖea mɔ be woagbugbɔ aɖɔe ɖo kaba.