Yadda Ya kamata Amfanin Kulle Plate!

A kulle farantin shine na'urar gyara karaya tare da rami mai zare. Lokacin da dunƙule tare da zaren kai aka dunƙule a cikin rami, farantin ya zama (skru) na'urar gyara kusurwa. Farantin kulle (tsawon kwana) na iya samun duka biyun kullewa da ramukan da ba a kulle ba don sukurori daban-daban da za a dunƙule su (wanda ake kira farantin haɗin gwiwa). Tun lokacin da aka gabatar da ra'ayi na kulle faranti da kuma amfani da shi don maganin raunin da ya faru, an yi amfani da shi sosai a cikin gyaran gyare-gyare na periarticular fractures, comminuted da osteoporotic fractures saboda amfanin da ya samu na samar da barga goyon baya da kuma gyaran gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyare , an yi amfani da shi sosai a cikin gyaran gyare-gyare na periarticular fractures, comminuted da osteoporotic fractures saboda amfanin da yake bayarwa na samar da kwanciyar hankali da kuma gyaran gyare-gyare na gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyare, ƙananan lalacewar nama mai laushi da rushewar jini. Karatun safiya na yau zai ba ku cikakken bayani game da kulle faranti, wanda ya cancanci koyo!

(A) Bayani na asali

1.Menene farantin kulle?

Duk wani farantin karfe wanda za'a iya jujjuya shi cikin gyaran kusurwa / kusurwa mai daidaita sukurori ko fil shine ainihin farantin kulle.

2. Amfani da rashin amfani na kulle faranti

Amfani

∎ Kwanciyar hankali na kusurwa, juriya ga lankwasawa da tsagewa

■ Siffar maɗaukaki na screw head yana inganta rarraba inji

∎ Samar da preload na radial, hana juyewar kashi da dunƙule sassautawa

∎ Siffar halittar jiki don ɗaukar nau'ikan nau'ikan halittar jiki

∎ Daidaita samfuri don ba da damar gyare-gyare a cikin diaphysis (ƙwaƙwalwar cortical guda ɗaya, hakowa kai, skru na kulle-ƙulle)

∎ Kulle sukurori suna ba da ingantacciyar ginshiƙi don sassauƙan gada da cikakken daidaitawa.

■Babu buƙatar kusanci kusa da saman kashi, kiyaye wadatar jini

■ Mai sarrafa micromotion, yana son warkar da karaya

■Gaba ɗaya ba a buƙatar dashen kashi

Yana da tasiri musamman ga karayar osteoporotic ko duk wani raunin da ba shi da kwanciyar hankali.

Rashin amfani

∎ Kulle screws ba su da raguwa da tasiri, musamman ma a cikin fashe-fashe na cikin articular ko raunin da ya faru.

■Ba za a iya amfani da farantin azaman kayan aikin ragewa don taimakawa ragewa ba.

■Skrus ba sa jin daɗi kamar na yau da kullun idan an saka su.

■Ba za a iya daidaita alkiblar skru ba (sai dai maɓallan kulle multiaxial).

■An sanya sukullun da kyau sosai, wanda zai iya haifar da 'welding sanyi'.

■ Rage kusurwa> 5 °, asarar ƙarfi; > 10 °, tasirin kulle ba shi da tasiri

■ Yiwuwar fitowar fatar jiki idan farantin ba a kayyade ba

Matsalolin taurin kai

Ba tare da kyakkyawar hulɗar cortical ko matsawa na ƙarewar karaya ba, yin amfani da ƙuƙwalwar kullewa, musamman maɗauran ƙarfe na ƙarfe, zai hana lokaci na II warkar da raunin da ya faru saboda tsananin taurin kai da kuma kawar da micromotion mai kyau a wurin fashe;

Idan an yi amfani da intraoperative traction sa'an nan kuma kulle splint fixing, za a kiyaye ratar karaya, haifar da jinkiri ko babu waraka;

Idan raguwa mai sauƙi ba a sake saitawa da matsawa ba, ana ɗaukar kaya ta hanyar farantin karfe, yana haifar da damuwa mai damuwa wanda zai iya haifar da raguwar farantin.

3. Manyan bambance-bambancen biomechanical tsakanin faranti na kullewa da faranti na al'ada

Faranti na al'ada sun dogara da gogayya a cikin farantin karfe don cimma matsayar farantin kashi.

4. Comparative abũbuwan amfãni na kulle farantin da talakawa karfe farantin

1.The ja-fita juriya na kulle sukurori ne da yawa mafi girma fiye da na talakawa sukurori.

2. Kulle-ƙulle na epiphyseal suna angled da juna, wanda ke ƙara ƙarfin jurewar sukurori idan aka kwatanta da daidaitattun sukurori.

(B) Ka'idodin aikace-aikace

1. Ka'idodin hana motsi:

●Ka'idar matsa lamba: osteoporotic diaphysis fracture

●Ka'idar tsaka-tsaki: osteoporotic diaphysis fracture

● Ƙa'idar haɗin gwiwa: comminuted diaphysis ko karin-articular metaphyseal karaya.

Ƙa'idar haɗin gwiwa: ƙaddamar da karaya na intra-articular metaphyseal

2. Ƙa'idar daidaitawa:

●Tsarin hanya: percutaneous kadan invasive farantin gyarawa (MIPO ko MIPPO dabara)

●Dabarun rage kai tsaye

●Don isassun gyare-gyaren farantin gado, ya kamata a bar ramukan dunƙule 3-4 a buɗe kusa da ƙarshen karaya.

3. Ka'idojin kungiya:

● Haɗin amfani da ƙa'idodin biomechanical guda biyu na matsawa da haɗawa a cikin faranti ɗaya - kulle matsi (LCP)

● Sauƙaƙan karaya a cikin kashi ɗaya na karaya da raunin karaya a ɗayan (misali, raunin raunin metaphysis, diaphysis)

●Ka'idar ƙungiyar yakamata a yi amfani da faranti ne kawai waɗanda ke ba da damar sanya sukurori na kulle-kulle da skru na gama gari.

Makulle faranti ba sa dogara da juzu'i tsakanin mu'amalar farantin kashi kuma sun dogara da farko akan mu'amala tsakanin dunƙule da farantin tare da kwanciyar hankali na kusurwa don kiyaye kwanciyar hankali.

Saboda tabbataccen haɗin kai, ƙarfin hakar sukurori tare da kawuna masu kullewa ya fi na sukurori na gama-gari, sai dai idan an fitar da duk skru da ke kewaye da su. Yawanci, yana da wahala a cire dunƙule guda ɗaya ko karye da kanta. Makulle kai sukurori baya samar da matsa lamba tsakanin-ninka. Ana iya samun matsi ta hanyar amfani da na'ura mai matsa lamba ko ta hanyar tuƙi na yau da kullun zuwa cikin 'ramukan hadawa' ( sukukuwan tashin hankali da farko, sannan kulle kusoshi).

1.Idan an yi amfani da sukurori na yau da kullun don tabbatar da tsattsauran ra'ayi (misali 1), yin dunƙulewa a cikin sukurori na kulle zai zama da sauƙi (misali 2).

2.Idan an yi amfani da kusoshi na kulle don tabbatar da tsattsauran ra'ayi da toshe kashi (misali, 1), ba a ba da shawarar cewa a dunƙule daidaitattun sukurori a cikin toshe kashi ɗaya (misali, 2) sai dai idan an sassauta sukulan kulle kuma an sake dawo da su (LHS).

3.Da zarar an kiyaye toshewar fashewar metaphyseal tare da dunƙule tare da kulle kai (LHS), ƙaddamarwar matsawa tsakanin ɓangarorin karaya ana samun su ta hanyar dunƙule madaidaicin dunƙule cikin ramin matsawa wutar lantarki na Haɗin Maɓalli Plate LCP.

(C) Alamomi da contraindications

1. Alamu

Yawancin karayar da aka yi wa tiyata ba sa buƙatar gyara farantin kulle. Muddin ana bin ƙa'idodin aikin tiyata na kasusuwa, yawancin karaya za a iya warkar da su ta hanyar faranti na al'ada ko ƙusa na ciki.

Duk da haka, akwai takamaiman nau'ikan karaya waɗanda ke da sauƙi ga asarar raguwa, faranti ko ƙullewar dunƙulewa, da kuma rashin haɗin kai na gaba, galibi ana kiranta 'rashin warwarewa' ko 'matsala', ciki har da ɓarnawar ɓoyayyen ɓoyayyiyar ɓarna, ɓarnawar ido tare da ƙananan guntuwar kasusuwa. Ana kiran waɗannan nau'ikan karaya sau da yawa a matsayin 'ba a warware ba' ko 'matsala' kuma sun haɗa da karaya mai rauni na ciki, guntun tuberosity na periarticular da fractures na osteoporotic. Wadannan karaya duk alamomi ne na kulle faranti.

Alamu na yau da kullun da manufa don kulle farantin karfe na karaya sune ka'idar haɗin gwiwa da ka'idar ƙungiyar don ƙarin ɓarnawar ɓarna - raunin ƙarfi mai ƙarfi a cikin ƙananan marasa lafiya ko raunin osteoporotic a cikin tsofaffin marasa lafiya.

2. Contraindications

Ko da yake an yi amfani da faranti na kulle ko'ina kuma alamun su sun fi girma, dole ne mu gane kuma mu guje wa sabani da yawa na kulle faranti. Idan ana amfani da faranti na kulle ba tare da nuna bambanci ba, gazawar gyarawa da rashin haɗuwa da karaya na iya faruwa.

Karaya masu sauƙi waɗanda ke buƙatar matsawa tsakanin juna, kamar sassauƙan karaya mai sassauƙa na goshin hannu da aka bi da su tare da kulle gyare-gyare na ciki, suna da wuyar rashin haɗin kai.

Hakazalika, sanya faranti na kulle-kulle don sassauƙan karaya ta hanyar amfani da dabarun cin zarafi kaɗan shima yana da alaƙa.

Rage kai tsaye da gyare-gyaren faranti ba su dace da ɓarkewar ɓarna ba, waɗanda ke buƙatar buɗaɗɗen raguwar jiki da matsawa tsakanin ɓangarorin ɓarke ​​​​da tsayayyen gyarawa.

Matsakaicin dangi na kulle faranti, saboda tsadar su, karaya ne wanda za'a iya daidaita shi da kyau tare da faranti na al'ada. Misali, karaya na symphysis na gaban hannu yana da adadin waraka fiye da 90% idan aka bi da su da faranti na al'ada.

(D) Shigar da farantin kulle

1. Maƙala ɗan rawar jiki a cikin ramukan dunƙule na farantin. Bambance-bambancen>5° tsakanin dunƙule da rami mai dunƙulewa na iya haifar da gazawar kulle dunƙule, kuma ana ba da shawarar yin amfani da ɗigon ramuka don haƙa ramukan da kyau.

2. Sanya farantin karfe a saman kashin kuma sanya ramukan ta hannun rigar rawar soja.

3. Auna zurfin tare da sauti mai zurfi, kula da cewa an shigar da kan mai sauti a cikin ramin dunƙule.

4. Zaɓi tsayin da ya dace na kulle kulle.

5. Shigar da sukurori mai matsa lamba daidai yake da faranti na ƙarfe na yau da kullun.

6. A ƙarshe ƙara maƙule sukurori tare da maƙarƙashiya mai ƙarfi, lokacin da aka matsa, za a sami ji na zamewa da ƙara sauti, don guje wa murƙushewa sosai, yana haifar da matsalolin cirewa.

(E) Cire farantin kulle

Clinical kulle farantin sukurori ana amfani da ko'ina, amma sauƙi gamu da kau matsaloli, yafi bayyana a dunƙule slipping waya da ƙusa hula da farantin ƙusa rami zaren tsakanin kuskure zare.

1. Dunƙule hula tsagi lalacewa

A ƙarƙashin yanayi na al'ada, cikakken tsagi na screw cap da madaidaicin sukudireba sun dace. Ya kamata a daidaita screwdriver tare da dunƙule hula kafin sakawa ko cirewa, in ba haka ba mai yuwuwa screw cap ɗin ya zama naƙasa a lokacin da ake murɗawa ko zamewa, wanda zai haifar da zamewa.

Bugu da kari, bayan warakawar karaya, screw cap notch yawanci ana nannade shi da ɓawon kashi ko nama mai fibrous, wanda yakamata a tsaftace shi kafin cire dunƙule, amma idan ba a kula ba, ƙirar hular dunƙule da tsarin angular na iya lalacewa ta hanyar wucin gadi.

Domin jujjuyawar gaɓoɓin ma’aikacin bai yi daidai da doguwar igiyar screwdriver ba, sau da yawa akan sami wani kusurwa, lokacin da ma’aikacin ya zazzage shi da ƙarfi, to babu makawa screwdriver ya yi rawar jiki, wanda ke haifar da lahani ga ɗigon hular dunƙulewar saboda rashin daidaituwar ƙarfin. Saboda haka, lalacewa ga tsagi na dunƙule na iya haifar da zamewa cikin sauƙi.

2. Nail hula ko ƙusa rami

A cikin aiwatar da aikace-aikacen intraoperative farantin karfe na kulle anatomical, lokaci-lokaci bisa ga buƙatar lanƙwasa da ta dace ko tsara farantin karfe, Raja et al. yi imani da cewa idan da lankwasawa part faruwa faruwa a cikin kulle dunƙule ramukan, a lokacin da dunƙule a cikin kulle sukurori za a dunƙule hula da ƙusa rami mismatch, wanda shi ne sosai m ya faru tsakanin ƙusa hula da karfe farantin ƙusa ramukan zaren kuskure zare, ko dunƙule kusa da karfe farantin lokacin da wutsiya na ƙusa nakasawa lalacewa ta hanyar da gubar da sauransu. Wahala.

3. Aikace-aikacen kusoshi na kulle kusoshi masu ɗaukar kai

Saboda cortical kashi girma ciki tare da ƙusa rami da haka zai rike dunƙule, haifar da matsaloli a dunƙule cire, musamman aikace-aikace na kai tapping biyu cortical kashi sukurori, Suzuki et al. kar a ba da shawarar yin amfani da skru masu ɗaukar kai don gyaran gyare-gyare sau biyu. Hou Yunfei et al. ya ba da shawarar cewa dole ne a guje wa gyare-gyaren bicortical da ba dole ba tare da sukurori don ɓarke ​​​​na sama, kuma Maehara et al. Har ila yau, ya ba da shawarar cewa, ya kamata a guji yin amfani da screws akai-akai yayin amfani da faranti na kullewa, kuma akwai buƙatar kafa ƙa'ida ta duniya don zaɓi da kuma amfani da screws.

4. Tsarin da wuri na sukurori

Girman, daidaitawa, da wurin kulle kulle na iya shafar kawar da dunƙulewa. Wasu malaman sun gano cewa idan dunƙule ba located a tsakiyar kulle rami, da zarar ƙusa ramin eccentricity na fiye da 5 ° za a iya samun sako-sako da dunƙule gyarawa, zaren kuskure zare ko ƙusa nakasawa makale da kai ga gazawar gyara ko kashi na biyu na kau da matsaloli.

5.Cold walda

Al'ada titanium ciki kayyade surface yana da wani Layer na passivated m Layer, a kan aiwatar da tiyata jeri na ciki kayyade, saboda kayan aikin grasping da siffata, ko shugaban dunƙule da gogayya tsakanin karfe farantin, da dai sauransu, na iya haifar da passivated m Layer lalacewa yankin. 2 karfe lamba surface tsakanin tabbatacce lamba batu za a manne da, wato, samuwar sanyi waldi.

Bugu da ƙari, haɗin gwiwar galvanic tsakanin ions karfe, halayen kumburi, da dai sauransu na iya inganta samuwar welds mai sanyi. Yawancin masana'antun na na'urorin gyara na ciki suma suna sane da wannan matsala, sabili da haka faranti na kulle da ba a yi amfani da su ba an rufe su da fasahar fim ɗin oxide tsakanin ramukan ƙusa da wuraren hulɗar ƙusa, wanda kuma ke da nufin hana ionization da adsorption na sunadaran a cikin jiki da rage faruwar welds mai sanyi.

(F) Dabarun cirewa

Hanyoyin cirewa da aka ruwaito a cikin wallafe-wallafen na kasa da na duniya za a iya raba su zuwa nau'i na 2, wato, mai sauƙi da aiki da kuma hadaddun, wanda ya kasance mai sauƙi mai sauƙi, mai amfani, ƙananan lalacewa mai laushi, ƙananan fasaha da rashin buƙatar kayan aiki na musamman, kuma na ƙarshe yana buƙatar kayan aiki na musamman da kayan aiki.

Maehara et al. bayar da shawarar yin amfani da sukurori masu iyakance karfin juyi tare da manyan shanks a duk lokacin da zai yiwu. Lokacin da aka fuskanci screws, Pattison et al. ya ba da rahoton wata hanya mai sauƙi ta cire screws ta hanyar nannade kan screwdriver da karfe platinum da saka shi a cikin tsagi na dunƙule hula. Wannan hanya tana da wayo don cika ƙugiya mai dunƙule dunƙule tare da bangon ƙarfe kuma ƙara wurin lamba da gogayya tsakanin sukudireba da tsagi, wanda ke sauƙaƙe kawar da sukurori tare da zaren zamewa. A cikin wannan hanya har yanzu da wuya a cire harka, idan dunƙule hula da karfe farantin ƙusa ramin zaren har yanzu m, za ka iya kokarin yin amfani da conical reverse tapping dunƙule remover, wato, daga dunƙule hula tsagi saka a cikin baya tapping da cika tsagi, a cikin aiwatar da juyawa da kuma matsa lamba dunƙule fita.

A gefen ƙasa, wasu makullin kullewa har yanzu suna da wahalar yin tasiri ta amfani da na'urar cirewa ta juzu'i, kamar Ehlinger et al. da Bae et al. wanda ya gano cewa wannan hanya sau da yawa yana tasiri ga 3.5 mm screw slipping, amma sau da yawa ba shi da tasiri ga 4.5 mm screw slipping. A wannan yanayin, ba kowane matakin likitocin kashin asibiti ba ne ke da kayan aikin niƙa na musamman kamar su carbide drills, lu'u-lu'u, ko kuma ƙafafun niƙa masu sauri.

Gopinathan et al. gabatar da hanyar da ba ya buƙatar waɗannan kayan aiki na musamman ta hanyar ba da rahoton wani lamari na cirewar dunƙule mai wahala daga farantin gyare-gyare na clavicular, watau, ta yin amfani da ƙananan yankewa na farantin sake ginawa, ana amfani da babban abin yanka na waya don raguwa mafi ƙarancin rabo na farantin tsakanin ramukan ƙusa na farantin, don haka sukurori da ƙusa ramin ƙusa na farantin zai iya zama sauƙi cire ƙananan raka'a. Wannan dabarar tana aiki ne kawai ga faranti na gyare-gyare na titanium, faranti na kulle hannun gaba tare da kunkuntar ƙananan notches, da faranti nau'in nau'in 1/3, kuma ba za a iya amfani da su don faranti mai faɗi ko kauri a cikin ƙananan ƙarshen ba.

An kuma bayyana wata hanya mai sauƙi wacce za a yi amfani da ɗan ƙaramin ɗan ƙaramin girma don tono rami a cikin ramin gama gari kusa da dunƙulewar da aka zame, sannan a danna faranti da dunƙule a cikin hanyar sabon ramin da aka haƙa, sannan a cire farantin da dunƙule ta hanyar amfani da na'urar yankan ƙashi da aka sanya a ƙarƙashin farantin sannan a fitar da shi tare da ka'idar yin amfani idan aka kwance shi.

Tabbas, akwai yuwuwar lalacewar kashi tare da wannan hanyar, don haka ana ba da shawarar kariyar ɗaukar nauyi bayan tiyata. Bugu da ƙari, ya zama dole a shirya wasu kayan aikin ƙwararrun da aka saba amfani da su kafin tiyatar cirewa na ciki, kamar su mai cire kusoshi, rami reamer, dunƙule filan cirewa, soket ɗin nau'in T-type da sauransu.

A cikin fuskantar matsaloli na kau da waya mai zamewa, wasu malaman cikin gida sun ba da shawarar canza hanyar tsagi, wato, yin amfani da na'urar micro-nika karfe yanki yashi don canza dunƙule hular tsagi hexagonal ko quadrangular tsagi don tsagi 'ɗaya' ko 'goma', ko zurfafa tushen tsagi.

Ehlinger et al. An ba da rahoton cewa, a cikin lokuta inda mai cire dunƙule mai jujjuyawar juzu'i har yanzu yana da matsala wajen cire dunƙule, an ba da shawarar cewa za a iya cire farantin karfe ta hanyar lalata kan dunƙule ta hanyar niƙa tungsten da faɗaɗa ramukan ƙusa a cikin farantin karfe, sannan za a iya cire jikin dunƙule ta hanyar amfani da zobe.

Georgiadis et al. da Raia et al. samarwa a cikin dunƙule da karfe farantin hade ne ma m da wuya a cire, musamman kayan aiki (kamar pneumatic high-gudun yankan drills, carbide drills, lu'u-lu'u ƙafafun, da dai sauransu) a kan ƙusa rami a kusa da karfe farantin yankan hanyar, a cikin karfe farantin da aka yanke don sassauta da dunƙule, da dunƙule ne kuma ta halitta sauki cire.

Kumar da Dunlopl sun ruwaito a cikin distal femur kulle karfe farantin dunƙule tsarin ciki gyarawa kau tsari, a cikin yin amfani da daidaitattun kai-iyakance karfin juyi sukudireba, conical dunƙule extractor sun kasa, amma kuma gabatar da wani sabon hanya, wato, da yin amfani da high-gudun bakin ciki-flake abrasive ƙafafun tare da gefen da karfe farantin zuwa ga ramin da kasusuwa saka wuka, sa'an nan kuma muka gabatar da wani sabon hanya. ƙusa, kar a buɗe ramin ƙusa na farantin karfe don shakatawa da hular, ta yadda ingantaccen kawar da sukurori.

Yana da mahimmanci a lura cewa hanyoyin da ke sama ya kamata a ci gaba da sannu a hankali yayin yankan ko niƙa na farantin ta yin amfani da faifan yankan mai sauri don guje wa yankewa a cikin kan dunƙule da lalata kashi da laushi mai laushi. Bugu da ƙari, waɗannan fasahohin na iya haifar da yanayin zafi mai zafi da tarkace na ƙarfe, wanda zai iya haifar da ƙarin haɗari na sake dawowa da ƙwayar cuta ta hanyar likitanci, nama thermal necrosis, da kamuwa da cuta.

(G) Takaitawa

∎ Bada damar haɗin faranti mara cika tare da periosteum

■Dole ne a mayar da farantin kafin a kulle, saboda ba za a iya mayar da karaya bayan kullewa ba.

■ Ba za a iya matsawa farantin kulle ba, buƙatar amfani da matsi ko screwing a cikin ramin ƙungiyar zuwa cikin dunƙule na yau da kullun, fara dannawa, sannan a kulle.

∎ Wurin karye 3 ~ 4 na dunƙule ramuka ba tare da sukurori don yada damuwa ba; ∎ Wurin karye 3 ~ 4 na dunƙule ramuka ba tare da sukurori don yada damuwa ba; kuma

∎ Gyaran monocortical na diaphysis ko kauri mai kauri, kuma inda ingancin kashi yake da kyau; kuma

∎ Da zarar an kulle, ba za a iya mayar da shi ba, yayin da skru na yau da kullun za a iya baya

■ Ƙarfafawa mai ƙarfi da ƙulle-ƙulle da yawa na iya haifar da rashin daidaituwa; ka'idar ita ce faranti ya zama tsayi kuma a yi amfani da ƙananan sukurori; a cikin maganin raunin da ya faru na periarticular, ya kamata a yi amfani da ƙananan sukurori a kan tushe kuma a yi amfani da ƙarin screws don gyarawa a kan farfajiyar articular.

■ Tsawon farantin gado ya kamata ya zama ninki biyu na tsawon yanki na karaya, ya kamata a rarraba screws daidai, kuma daidaitaccen gyare-gyare ya kamata ya kasance ta hanyar budewa.

∎ Ana rarraba ƙarfi daidai gwargwado akan dogon faranti, kuma gyarawa tare da ƴan ƙulle-ƙulle na iya haifar da ƙumburi da haɓaka waraka.