Zãnu si wotsɔ xea nu la zazã nyuie!

A . Locking Plate nye fracture fixation device si me do si wotsɔ ka blae le. Ne wotsɔ gavi si ŋu wotsɔ ka ɖo la ƒo ɖe doa me la, agbaa va zua (screw) angle fixation device. Do siwo wotsɔna ƒoa gaviwoe kple esiwo me womexea ga le o siaa ate ŋu anɔ ʋuƒo si wotsɔ xea mɔe (angle stable) plate kple non-locking siaa na gavi vovovo siwo woatsɔ aƒo ɖe eme (si woyɔna hã be agbalẽ si wotsɔ ƒo ƒui). Tso esime wodo susu si nye be woatsɔ ʋuƒo gbadzɛwo aɖo ɖa eye wozãe ɖe fracture treatment ŋu la, wozãe geɖe le periarticular fractures, comminuted kple osteoporotic fractures ƒe fixation me le eƒe viɖe siwo nye be wòana kpekpeɖeŋu si li ke eye wòali ke na fractures, si nye fracture healing rate si lolo wu kple ʋu ƒe agbɔsɔsɔ. Egbe ƒe ŋdi me nuxexlẽ ana nàkpɔ ŋgɔdonya tsitotsito tso ʋuƒo siwo wotsɔna ƒoa nu ŋu, si sɔ be nàsrɔ̃ tso!

(a)Basic Overview .

1.Nukae nye plating plate?

Ga gbadzɛ ɖesiaɖe si woate ŋu atsɔ ga aƒo ɖe dzogoe dzi fixing/angle stabilizing screws alo pins me la nyea nusi le vevie ŋutɔ.

2. Viɖewo kple nusiwo gblẽ le agba siwo wotsɔ xea mɔe ŋu .

Viɖewo .

■ dzogoe ƒe liƒo, tsitretsitsi ɖe bending kple torsion .

■Konical shape of screw head nyona ɖe edzi le mɔ̃ɖaŋununya me .

■Na radial preload, xe mɔ ɖe ƒu ƒe ʋuʋu nu eye screw naɖe asi le eŋu .

■Anatomically shaped be wòasɔ ɖe teƒe ɖeka ƒe ŋutilã ƒe nɔnɔme ƒe nɔnɔme nu .

■Matching templates be woaɖe mɔ ɖe percutaneous fixation le diaphysis (ɖeka cortical, ɖokui-ku, ɖokui-tapping ʋuƒo screws)

■Locking screws naa anchorage nyuitɔ kekeake na bridging si te ŋu trɔna kple absolute stabilization fixation siaa .

■Mehiã be woawɔ ɖeka kple ƒu ƒe gowo kplikplikpli o, si ana ʋu nayi edzi .

■Wokpɔa micromotion si dzi woɖu dzi, si doa dzidzɔ na fracture dɔyɔyɔ .

■Zi geɖe la, womehiã ƒu ƒe dodo aɖeke o .

Ewɔa dɔ nyuie ŋutɔ le ƒumeŋuɖui ƒe gbagbã alo ƒu ƒe gbagbã ɖesiaɖe si meli ke kura o me.

Nusiwo gblẽ le eŋu .

■Locking screws mekpɔa ŋusẽ ɖe edzi kple nutete ƒe ŋusẽkpɔɖeamedzi o, vevietɔ le intra-articular fractures alo oblique fractures bɔbɔewo me .

■Womate ŋu azã agbalẽvi la abe dɔwɔnu si dzi woaɖe akpɔtɔ ene atsɔ akpe ɖe edziɖeɖe ŋu o.

■Srɔggbeawo mesena le wo ɖokui me abe gavi siwo wozãna ɖaa ene ne wotsɔ wo de eme o.

■Womate ŋu atrɔ asi le gaviawo ƒe mɔfiame ŋu o (negbe multiaxial locking screws koe mele eme o).

■Wotsɔa gaviawo dana ɖe wo nɔewo ŋu sesĩe akpa, si ate ŋu akplɔ ame ayi 'falɛfalɛwo '.

■Anyiehe ƒe tete >5°, ŋusẽ ƒe ɖiɖi; >10°, locking effect mewɔa dɔ o .

■Ate ŋu adzɔ be tsi si le ete nado ɖe ŋgɔ nenye be womete ŋu ŋlɔ agbalẽa ƒe nɔnɔme o .

Sesẽnyawo .

Ne fracture ƒe nuwuƒewo ƒe akpa si le lãkusi me alo nutete nyui aɖeke mele eŋu o la, aŋenu siwo wotsɔ xea mɔe zazã, vevietɔ gakpo siwo mexɔ dzo o, axe mɔ na akpa II ƒe gbagbã na gbagbãƒea le esi wòsẽ akpa kple micromotion nyui la ɖeɖeɖa le gbagbãƒea ta;

Ne wowɔ dɔ le dɔwɔwɔ me eye emegbe wotsɔ aŋe si wotsɔ xea mɔ na lãkusiwo la, woakpɔ gbagbãƒea ƒe gbagbãƒea ta, si ana woahe ɖe megbe alo womagada gbe le wo ŋu o;

Ne womegbugbɔa gbagbãƒe bɔbɔe aɖe ɖo o eye woƒonɛ ɖe ame nu la, wotsɔa agbaa toa agbaa dzi, si wɔnɛ be nuteɖeamedzi ƒe ƒuƒoƒo si ate ŋu ana woagbã bɔbɔe la nate ŋu agbã.

3. Vovototo gã siwo le biomechanical me le ʋuƒo siwo wotsɔna ƒoa nu kple agba siwo wozãna ɖaa dome .

Plɛti siwo wozãna ɖaa la ɖoa ŋu ɖe ʋuʋudedi ŋu le ƒu-gbadzɛ ƒe ƒomedodoa me be woatsɔ awɔ ƒu ƒe agbalẽviwo ƒe tete ɖe wo nɔewo ŋu.

4. Viɖe siwo wotsɔ sɔ kple wo nɔewo le ʋuƒo si wotsɔ xea mɔ na nu kple gakpo si wotsɔna ƒoa gae dzrowo ŋu .

1.The pull-out resistance of locking screws la kɔ wu gavi dzrowo tɔ sã.

2. Wodoa dzogoe ɖe epiphyseal locking screws la dzi na wo nɔewo, si dzia gavi la ƒe tsitretsitsi ɖe pullout ŋu ɖe edzi ŋutɔ ne wotsɔe sɔ kple parallel screws.

(b) Dɔwɔwɔ ƒe gɔmeɖosewo .

1. Gɔmeɖose siwo ku ɖe ʋuʋu ƒe ʋuʋu ŋu:

●Tameteteɖedzi ƒe gɔmeɖose: ƒumeŋuɖui ƒe ƒuƒoƒo ƒe gbagbã .

●Nuwɔna ne womewɔ naneke le eŋu o: ƒumeŋuɖui ƒe ʋuʋudedi ƒe gbagbã .

●Bridging gɔmeɖose: comnumed diaphysis alo extra-articular metaphyseal fracture .

Gɔmeɖose si le ɖekawɔwɔ me: comminuted intra-articular metaphyseal fracture .

2. Gɔmeɖose si wotsɔ xea mɔ ɖe nuwo nu .

●Typical mɔnu: percutaneous minimally invasive plate fixation (MIPO alo MIPPO mɔnu)

●Atike si dzi woɖea edzi kpɔtɔna le tẽ .

●Na bridging plate fixation si sɔ la, ele be woagblẽ do 3-4 siwo woatsɔ axe gaviwoe la ɖi wòaʋu le afisi te ɖe gbagbãƒea ƒe nuwuwu ŋu.

3.Gɔmeɖosewo le ɖekawɔwɔ me:

● Biomechanical gɔmeɖose eve siwo nye compression kple bridging zazã ɖekae le agbalẽ ɖeka me - locking compression plate (LCP) .

● Ƒutsotsoe bɔbɔe siwo le gbagbãƒea ƒe akpa ɖeka kple gbagbãƒe siwo wotsɔ ƒo ƒu ɖe akpa kemɛa me (le kpɔɖeŋu me, metaphysis ƒe gbagbã siwo wotsɔ ƒo ƒu, diaphysis)

●Ele be woatsɔ ɖekawɔwɔ ƒe gɔmeɖosea ade agbalẽ xatsaxatsa siwo ana woate ŋu atsɔ taƒoƒo ƒe gavi eveawo kpakple gavi siwo bɔ hã ade eme ko.

Locking platewo meɖoa ŋu ɖe friction si le bone-plate interface dome ŋu o eye woɖoa ŋu ɖe ƒomedodo si le screw kple plate dome koŋ ŋu kple dzogoe ƒe liƒo be wòali ke.

Le woƒe ɖekawɔwɔ si li ke ta la, gavi siwo ƒe tawo wotu la ƒe ŋusẽ si woɖena tsoa eme la lolo wu gavi siwo bɔ la tɔ sã, negbe ɖe woɖe gavi siwo katã ƒo xlãe la alo wogbã ko hafi. Zi geɖe la, esesẽna be woaɖe gavi ɖeka alo agbã le eɖokui si. Ta ƒe ʋuƒo siwo wotsɔna ƒoa nu la menaa nyaƒoɖeamenu ƒe ʋuʋu le wo nɔewo dome o. Woate ŋu akpɔ nyaƒoɖeamenu to mɔ̃ si wotsɔna ƒoa nya ɖe ame nu alo to gavi siwo wozãna edziedzi la tsɔtsɔ yi 'do siwo wotsaka me' (Tension screws gbã, emegbe wotsɔa ɖawo ƒoa woe).

1.Ne wozã standard screws tsɔ lé aŋea ɖe te (le kpɔɖeŋu me 1) la, ke screwing in the locking screws anɔ bɔbɔe ŋutɔ (le kpɔɖeŋu me 2).

2.Ne wozã gavi siwo wotsɔna xea mɔe tsɔ lé aŋe kple ƒu ƒe ʋuƒoa ɖe te (le kpɔɖeŋu me, 1) la, womeɖo aɖaŋu be woatsɔ gavi siwo wozãna ɖaa la aƒo ƒu ƒe ʋuƒo ɖeka (le kpɔɖeŋu me, 2) o negbe ɖe woɖe gavi siwo wotsɔ xea mɔ̃a ƒe gaviawo la ɖa eye wogabla wo (LHS).

3.Ne wotsɔ gavi si ƒe ta le ʋuʋu (LHS) bla metaphyseal fracture block la ko la, wokpɔa nutete ƒe fixation le fracture blocks dome to screwing a standard screw into the power compression hole of the locking compression plate LCP combination me.

(c) Nufiamewo kple nusiwo woawɔ atsɔ awɔ dɔe .

1. Nufiafiawo .

Akpa gãtɔ siwo ŋu wowɔ dɔ le siwo ŋu wowɔ dɔ le la mehiã be woatsɔ ga aɖo agba me o. Zi alesi wowɔ ɖe ƒumeŋuɖui ƒe dɔwɔwɔ ƒe gɔmeɖosewo dzi ko la, woate ŋu ada gbe le ƒunukpeƒetetedɔ akpa gãtɔ ŋu to agba siwo wozãna ɖaa alo lãkusi me ƒoƒoe dzi.

Ke hã, ƒuƒu ƒomevi aɖewo koŋ li siwo ŋu woate ŋu abu bɔbɔe le, plate alo screw ƒe gbagbã, kple nonunion si kplɔe ɖo, si woyɔna zi geɖe be 'unresolved' alo 'problematic' gbagbã, siwo dometɔ aɖewoe nye intra-articular commimad fractures, periarticular fractures. Woyɔa gbagbãƒe ƒomevi siawo zi geɖe be 'unresolved' alo 'kuxiwo ƒe gbagbã eye wo dometɔ aɖewoe nye intra-articular comminud fractures, periarticular short tuberosity fractures kple osteoporotic fractures. gbagbã siawo katã nye nusiwo ɖea nu siwo woatsɔ axe mɔ ɖe agbawo nu la fiana.

Nusiwo wonya nyuie eye wosɔ nyuie wu na ʋuƒo siwo wotsɔ xea mɔ na gbadzɛwo ƒe ƒoƒoe nye bridging principle kple union principle na commimed fractures geɖe wu - ŋusẽ gã ƒe gbagbã le dɔnɔ siwo metsi o me alo ƒumeŋuɖui ƒe gbagbã le dɔnɔ tsitsiwo me.

2. Nusiwo ŋu woatsi tre ɖo .

Togbɔ be wozã ʋuƒo siwo wotsɔ xea mɔ na nuawo le afisiafi eye woƒe dzesiwo keke ta hã la, ele be míade dzesi nu geɖe siwo ŋu womeƒo nu tsoe o eye míaƒo asa na nutrenu siwo woatsɔ axe mɔ ɖe wo nu. Ne wozã ʋuƒo siwo wotsɔ xea mɔ na nuawo la, wometsɔa nu ɖe wo nɔewo ŋu o, eye ne wometsɔ nuawo ƒo ƒui o la, woƒe lãme gblẽna eye womegaƒoa ƒu ɖe wo ŋu o.

Gblẽƒe bɔbɔe siwo hiã be woawɔ interbody compression, abe abɔta ƒe stem fractures bɔbɔe siwo ŋu wotsɔ locking internal fixation da dɔe ene la, te ŋu xɔa non-union bɔbɔe.

Nenema ke ne wotsɔ ʋuƒo siwo wotsɔ xea mɔ na gbagbã bɔbɔewo la ɖo to lãkusi me to mɔnu siwo me womezãa nu boo aɖeke le o zazã me hã nye nusi tsi tre ɖe wo nɔewo ŋu.

Womeɖea asi le nu dzi kpɔtɔna le mɔ si mele tẽ o nu eye wotsɔa ʋuƒo siwo wotsɔna ƒoa nu ɖe nu dzi hã mesɔ na ƒunukpeƒea ƒe gbagbã siwo woɖe ɖa o, si bia be woaɖe ŋutilã ƒe wɔwɔme dzi akpɔtɔ eye woawɔ nu ɖe wo nɔewo ŋu le kakɛawo ƒe kakɛawo kple firm fixation dome.

Nusi tsi tre ɖe nutrenu ƒe agbawo ŋu le mɔ aɖe nu, le woƒe asi gã ta, enye gbagbã siwo woate ŋu atsɔ agba siwo wozãna ɖaa aɖo wo ŋu wòadze ame ŋu. Le kpɔɖeŋu me, abɔta ƒe symphysis ƒe gbagbãƒewo ƒe dɔyɔyɔ ƒe agbɔsɔsɔme wu 90% ne wotsɔ agba siwo wozãna ɖaa da dɔ na wo.

(d) Nuƒomɔ̃ ƒe agbatsɔɖoɖo .

1. Klo drill bit la ɖe plate siwo le plate la me la me. Deviations of >5° le screw la kple screw hole dome ate ŋu ana gavi la nado kpo nu, eye wokafui be woazã drill bit la atsɔ aku doawo nyuie wu.

2. Da gakpoa ɖe ƒu ƒe go dzi eye nàku doawo to drill sleeve la me.

3. Dzidze goglomea kple goglome ƒe gbeɖiɖimɔ̃, eye nàkpɔ egbɔ be wotsɔ gbeɖiɖimɔ̃a ƒe ta de do si me woɖea gavi le la me.

4. Tia ʋuƒo si wotsɔ xea mɔ̃a ƒe gavi la ƒe didime si sɔ.

5. Gavi siwo wotsɔ ƒoa nui la dede sɔ kple gakpo gbadzɛ dzrowo tɔ.

6. Mlɔeba la, tsɔ torque wrench bla gaviawo ƒe gaviawo, ne wobla wo sesĩe la, seselelãme si dze ƒã be sliding feeling kple snapping sound anɔ anyi, be woaƒo asa na screwing in sesẽ akpa, si ana be woaɖe wo ɖa.

(e) Locking Plate Removal .

Wozãa Clinical Locking Plate Screws geɖe, gake wodoa go wo bɔbɔe be woaɖe wo ɖa, vevietɔ dzena le gavi si le ʋuʋum le ka kple ɖa ƒe nutrenu kple plate nail hole threads dome le buckle si mesɔ o dome.

1. Screw Cap Groove Gbegblẽ .

Le nɔnɔme siwo sɔ me la, screw cap groove bliboa kple screwdriver si sɔ kplii la sɔ. Ele be woatsɔ gavi si wotsɔna ƒoa gavi la asɔ kple gavi si wotsɔna ƒoa gavi la hafi woatsɔ gavi la ade eme alo aɖee ɖa, ne menye nenema o la, anɔ eme be woagblẽ gavi si wotsɔna ƒoa gavi la me le gavi la me alo le gavi ƒom, si ana wòadze.

Tsɔ kpe ɖe eŋu la, le ƒu gbagbã ƒe dɔyɔyɔ megbe la, zi geɖe la, wotsɔa ƒu ƒe ƒuƒu alo ka si me ka le la xatsaa gavi si wotsɔna ƒoa gavi lae, si wòle be woakɔ hafi ɖea gavi la ɖa, gake ne womelé ŋku ɖe eŋu o la, woate ŋu agblẽ nu le gavi la ƒe nugbɔ kple dzogoe ƒe wɔwɔme ŋu le mɔ̃ɖaŋununya nu.

Esi wònye be dɔwɔla ƒe abɔta ƒe tɔtrɔ ƒe axis mewɔ ɖeka kple screwdriver la ƒe axis didi la o ta la, zi geɖe la, dzogoe aɖe nɔa anyi, ne dɔwɔla la tsɔ ŋusẽ ƒo gavi la sesĩe, enye nusi womate ŋu aƒo asa na o be screwdriver la ʋuʋuna, si wɔnɛ be wògblẽa nu le gavi la ƒe cap groove ŋu le ŋusẽ si mesɔ o ta. Eyata nusiwo gblẽ le gavi si wotsɔna ƒoa gavi la ŋu ate ŋu ana screw slippage nanɔ bɔbɔe.

2. Nail Cap alo Nail Hole Deformation .

Le dɔwɔwɔ le dɔwɔwɔ me le ŋutilã ƒe wɔwɔme ƒe ʋuƒo gakpo gbadzɛ, ɣeaɖewoɣi le alesi wòhiã be woabɔbɔ alo nɔnɔme si sɔ le gakpo gbadzɛ me, Raja et al. Xɔe se be ne edzɔ be akpa si le ƒoƒom la dzɔ le do siwo me wotsɔa gaviwo ƒoa nui me la, ne gavi siwo wotsɔ ƒo gaviawo me la anye gavi ƒe nutrenu kple ɖa ƒe do ƒe masɔmasɔ, si ate ŋu adzɔ ŋutɔ le ɖa ƒe nutrenu kple gakpo ƒe ʋuƒo ƒe ʋuƒo ƒe ka siwo gblẽ dome, alo woatsɔ ga aƒo ɖe gakpoa ŋu ne wotsɔ gavi la ƒe asike si le sesẽm la ƒe asike.

3. Ðokuisi-tapping cortical locking nails zazã .

Esi wònye be cortical bone la tsina ɖe eme le ɖa ƒe doa me eye to esia me la, alé screw la, si ahe kuxiwo vɛ le screw ɖeɖe me, vevietɔ ɖokui-tapping double cortical bone screws zazã ta la, Suzuki et al. Mègaɖo aɖaŋu be nàzã gavi siwo wotsɔ ƒoa wo ɖokui ɖe wo ɖokui ŋu hena cortical fixation eve zazã o. Hou Yunfei kple exɔlɔ̃wo. do susua ɖa be ele be woaƒo asa na bicortical fixation si mehiã o kple screws na upper extremity fractures, eye Maehara et al. do susua ɖa hã be ele be woaƒo asa na gavi siwo wotsɔna xea mɔe zazã enuenu ne wole gavi siwo wotsɔna xea mɔ̃a ƒe gaviwo zãm, eye be ehiã be woaɖo xexeame katã ƒe dzidzenu aɖe anyi na gavi siwo wotsɔna xea mɔ̃a ƒe gaviwo tiatia kple wo zazã.

4. Screws ƒe wɔwɔme kple afisi wòle .

Gavi si wotsɔ xea mɔ̃a ƒe lolome, eƒe ɖoɖo, kple afisi wòle ate ŋu akpɔ ŋusẽ ɖe gavi la ɖeɖe ɖa dzi. Agbalẽnyala aɖewo kpɔe be ne gavi la mele do si wotu la titina o la, ne ɖado ƒe do si wu 5 ° ko la, screw ƒe tsɔtsɔme si le gbadzaa ate ŋu anɔ anyi, ka siwo mesɔ o alo nail tail deformation si tsi eye wòahe fixation alo akpa evelia ƒe akpa evelia si nye kuxiwo ɖeɖeɖa vɛ.

5.Cold Welding .

normal titanium ememe fixation surface nye ƒuƒoƒo si me passivated protective layer le, le dɔwɔwɔ na amekoko ɖoɖo ememe fixation, le dɔwɔnuwo ƒe asiléle kple nɔnɔme, alo ta ƒe screw kple friction le gakpo plate la dome, kple bubuawo, ate ŋu ana passivated protective layer wear area. 2 Woalé ga ƒe kadodo ƒe anyigba si le substantive contact point la dome ɖe, si fia be woawɔ welding fafɛ ƒe wɔwɔme.

Tsɔ kpe ɖe eŋu la, galvanic coupling le ga ions, dɔdzẽ ƒe dɔwɔwɔ, kple bubuawo dome hã ate ŋu ado vuvɔ ƒe weldwo ƒe wɔwɔ ɖe ŋgɔ. Mɔ̃ siwo wotsɔna léa nu ɖe nu me ƒe akpa gãtɔ hã nya kuxi sia, eye le esia ta wotsɔa oxide film mɔ̃ɖaŋununya tsyɔa gayibɔ gbadzɛ siwo womezãna o la dzi le ɖa ƒe dowo kple screw contact surfaces dome, si hã ƒe taɖodzinue nye be wòaxe mɔ na ionization kple adsorption of proteins in the body eye woaɖe cold welds ƒe dzɔdzɔ dzi akpɔtɔ.

(f) Mɔnuwo ɖeɖeɖa ƒe mɔnuwo .

Woate ŋu ama aɖaŋu siwo ŋu woka nya ta le le dukɔa kple dukɔwo dome agbalẽwo me la ɖe hatsotso 2 me, si nye, bɔbɔe eye wòwɔa dɔ eye wòsesẽ, gbãtɔ si woɖe dzesi le be woate ŋu akpɔ wo bɔbɔe, woate ŋu awɔ dɔ le wo ŋu, woƒe ŋutilã fa miamiamia, aɖaŋu si mebɔ o kple dɔwɔnu tɔxɛwo mehiã o, eye evelia bia dɔwɔnu tɔxɛ kple dɔwɔnu tɔxɛ aɖewo.

Maehara kple exɔlɔ̃wo. Do susua ɖa be nàzã torque-seɖoƒe ƒe ʋuƒo siwo ŋu afɔti gãwo le ɣesiaɣi si wòanya wɔ. Esi wotsɔ gavi siwo wotsɔ ƒo ƒui dze ŋgɔe la, Pattison kple exɔlɔ̃wo dze ŋgɔe. ka nya ta be mɔnu bɔbɔe aɖe si dzi woato aɖe gavi siwo wotsɔ ƒo ƒui ɖa to gavi si wotsɔna ƒoa gavi la ƒe ta xatsa ɖe platinum ga ŋu me eye woatsɔe ade gavi la ƒe nutrenu ƒe gavi me. Mɔnu sia dze aɖaŋu be woatsɔ ga gbadzɛ ayɔ gavi ƒe nutrenu ƒe ʋuƒoa me eye wòadzi teƒe si woatsɔ aƒo gavi la kple ʋuƒoa dome ɖe edzi, si wɔnɛ be woate ŋu aɖe gavi siwo wotsɔ ka siwo wotsɔ ƒo ƒu la ɖa bɔbɔe. Le mɔnu sia me la, egasesẽna be woaɖe nutunua ɖa, ne gavi ƒe nutrenu kple gakpo si wotsɔ ƒoa ɖae ƒe do ƒe kaawo gakpɔtɔ le nenema la, àte ŋu adze agbagba azã conical reverse tapping screw remover, si nye be, tso screw cap groove si wotsɔ de megbeƒuƒoƒoa me eye wòayɔ ʋuƒoa me, le alesi wòtrɔa gavi lae heƒonɛ ɖe enu la me.

Le nusi gblẽ me la, gavi aɖewo gakpɔtɔ le sesẽm be woawɔ dɔ nyuie to conical reverse tapping screw extractor zazã me, abe Ehlinger et al. kple Bae kple exɔlɔ̃wo. ame siwo kpɔe be zi geɖe la, mɔnu sia wɔa dɔ nyuie na 3.5 mm screw slippage, gake zi geɖe la, mewɔa dɔ na 4.5 mm screw slippage o. Le go sia me la, menye kɔdzi ƒe ƒumeŋutinunya ƒe akpa ɖesiaɖee wotsɔ ga ƒokpli ƒe dɔwɔnu tɔxɛwo abe carbide drill, diamond drills, alo tasiaɖamfɔ siwo zɔna kabakaba ene ɖo o.

Gopinathan kple exɔlɔ̃wo. To mɔnu aɖe si mehiã dɔwɔnu tɔxɛ siawo o la vɛ to nyatakaka si ku ɖe gavi si woɖe ɖa sesẽ ƒe nya aɖe ŋu tso klavicular gbugbɔgatu gbadzɛ aɖe me, si nye, zã gbugbɔgatu gbadzɛa ƒe akpa si le sue la, wozãa gaku gã aɖe tsɔ ɖea agbaa ƒe akpa si le gbadzaa wu la ɖa, eye woate ŋu aɖe gaviawo ƒe akpa sue aɖe ɖa bɔbɔe. Mɔnu sia sɔ na titanium gbugbɔgatu ƒe ʋuƒo, abɔta ƒe ʋuƒo gbadzɛ siwo ƒe notch siwo le gbadzaa wu, kple 1/3 tube-ƒomevi ƒe agbalẽviwo ko, eye womate ŋu azã wo na agba siwo keke wu alo esiwo le kpekpem wu le eƒe akpa si le ete la me o.

Woƒo nu tso mɔnu bɔbɔe aɖe hã ŋu si me wozãa drill bit si lolo vie tsɔ kua do ɖe do si bɔ me le ʋuƒo si wotsɔ ƒoa nui la xa, eye emegbe woɖea agbaa kple gavi la ɖe do si me woɖe do yeye si me woku nu le yeyee la ƒe mɔ nu, eye emegbe woɖea agbaa kple gavi la ɖa to ƒumetsomɔ̃ si woda ɖe agbaa te zazã me eye woɖea asi le eŋu.

Nyateƒee, ŋutete li be ƒu nagblẽ le ƒu ŋu to mɔnu sia dzi, eyata wokafu ametakpɔnu si woatsɔ akpɔ ame ta le dɔwɔwɔ vɔ megbe. Tsɔ kpe ɖe eŋu la, ehiã hã be woadzra dɔwɔnu siwo wozãna zi geɖe la dometɔ aɖewo ɖo hafi woawɔ dɔ na ame le ememe si woatsɔ aɖe wo ɖa le eme, abe bolt extractor, hole reamer, screw extraction pliers, T-type pressurized socket kple bubuawo ene.

Le mo na ʋuʋu screw slippery ka ɖeɖeɖa kuxiwo, aɖewo aƒeme agbalẽnyala aɖewo do susu ɖa be woatrɔ groove mɔnu, si nye aɖu micro-grinding mɔ̃ gakpo ke piece be woatrɔ screw cap groove hexagonal alo quadrangular groove na 'one' alo 'ten'.

Ehlinger kple exɔlɔ̃wo. ka nya ta be le nɔnɔme siwo me conical reverse tapping screw extractor la gakpɔtɔ sesẽ be woaɖe gavi la ɖa la, wodo susua ɖa be woate ŋu aɖe gakpoa ɖa to gavi la ƒe ta tsɔtsrɔ̃ to tungsten drill grinding me eye wòalolo ɖe edzi le gayibɔa ƒe agbaa me, eye emegbe woate ŋu aɖe gavi la ƒe ŋutilã ɖa to ring saw zazã me.

Georgiadis kple eƒe dɔwɔhatiwo ƒe nyawo. eye Raia kple exɔlɔ̃wo gblɔ be: Wodo susua ɖa le screw kple steel plate combination la me sesĩe akpa eye wo ɖeɖe ɖa sesẽ akpa, dɔwɔnu tɔxɛwo (abe pneumatic high-speed cutting drills, carbide drills, diamond wheels, kple bubuawo) le nail hole si ƒo xlã steel plate cutting method la dzi, le gakpo gbadzɛa me be woaɖe screw la ɖa, screw la hã le bɔbɔe le dzɔdzɔme nu be woaɖee ɖa.

Kumar kple Dunlopl ka nya ta le distal femur locking steel plate screw system me ememe fixation ɖeɖeɖa ƒe ɖoɖoa, le standard self-limiting torque screwdriver zazã me la, conical screw extractor la do kpo nu, gake woto mɔnu yeye aɖe hã vɛ, si nye be, n-flake abrasision si ƒe duƒuƒu le abe ʋuʋudedi ene la zazã, eye emegbe Mègaʋu gakpo si wotsɔ ƒoa ɖae la ƒe do la be wòana nutrenua naɖe dzi ɖi o, ale be woaɖe gavi siwo wotsɔ xea mɔ̃a ƒe gaviwo la ɖa nyuie.

Ele vevie be míade dzesii be ele be woado mɔnu siwo le etame la ɖe ŋgɔ vivivi alesi woate ŋui le agbaa ƒe lãɖeɖe alo etutu me to disk si wotsɔna lãa nu kabakabae zazã me be wòagatso ɖe gavi la ƒe ta me ahagblẽ nu le ƒu kple lãkusi falɛfalɛwo ŋu o. Tsɔ kpe ɖe eŋu la, mɔnu siawo ate ŋu ana dzoxɔxɔ gã kple ga ƒe gbegblẽ nado, si ate ŋu ana afɔku si nye be woagagblẽ nu le atikewɔwɔ me, lãmenugbagbeviwo ƒe dzoxɔxɔ ƒe kuku, kple dɔlékuiwo nado tso eme.

(g) Kpuie ko .

■ Ðe mɔ na plate ƒe kadodo si mede blibo o kple periosteum .

■Ele be woatrɔ asi le agbalẽa ŋu hafi woaxee, elabena womate ŋu atrɔ asi le gbagbãƒea ŋu le etutu vɔ megbe o.

■Womate ŋu atsɔ ʋuƒo si wotsɔna ƒoa ʋuƒoe la aƒoe o, ehiã be woazã nyaƒoɖeamenu alo centrifugal screwing le union hole la me ɖe ordinary screw me, woazi edzi gbã, emegbe woaxe mɔ ɖe enu .

■ Akpa 3 ~ 4 screw holes si me screws mele o be woatsɔ akaka nuteɖeamedzia; ■ Akpa 3 ~ 4 screw holes si me screws mele o be woatsɔ akaka nuteɖeamedzia; kple

■ Diaphysis alo ƒumeŋuɖui si le ʋeʋẽm la ƒe monocortical fixation, kple afisi ƒu ƒe nyonyome nyo le; kple

■Ne wonya ƒoe ko la, womate ŋu atsɔe aɖo megbe o, gake woate ŋu agbugbɔ gavi dzrowo awɔ ɖe megbe .

■Nuléle sesẽ kple gavi siwo sɔ gbɔ akpa ate ŋu ahe nonunion vɛ; Gɔmeɖoseae nye be ele be agbalẽviwo nadidi eye woazã gavi ʋɛ aɖewo; Le periarticular fractures dada me la, ele be woatsɔ screws ʋɛ aɖewo asisi ɖe kea ŋu eye ele be woazã screws geɖe wu hena fixation ɖe articular surface .

■ Ele be bridging plate ƒe didime nanye afisi woaƒu le ƒe didime ƒe teƒe eve, ele be woama gaviawo sɔsɔe, eye ele be fixation nyuitɔ nanye through-the-aperture fixation .

■ Womaa ŋusẽ ɖe agba didi aɖe dzi sɔsɔe, eye fixation si me screws ʋɛ aɖewo koe le ate ŋu aʋã ƒunukpeƒetetedɔ eye wòana ƒu nahaya.