Kev Siv Cov Phaj Xauv Zoo!

A locking phaj yog ib qho kev txhim kho pob txha tawg nrog lub qhov threaded. Thaum cov ntsia hlau nrog lub taub hau threaded yog screwed rau hauv lub qhov, lub phaj ua ib tug (screw) lub kaum sab xis fixation ntaus ntawv. Ib lub xauv xauv (lub kaum sab xis) phaj tuaj yeem muaj ob qho tib si xauv thiab tsis-ntsuas ntsia hlau qhov rau cov ntsia hlau sib txawv yuav tsum tau ntsia rau hauv (tseem hu ua phaj sib xyaw). Txij li thaum lub tswv yim ntawm kev xauv daim hlau tau thov thiab siv rau kev kho pob txha, nws tau siv dav hauv kev kho cov pob txha periarticular fractures, comminuted thiab osteoporotic fractures vim nws qhov zoo ntawm kev muab kev txhawb nqa ruaj khov thiab txhim kho cov pob txha, kev kho pob txha ntau dua, tsis tshua muaj cov ntaub so ntswg puas thiab cov ntshav tsis txaus. Kev nyeem ntawv sawv ntxov hnub no yuav muab cov ncauj lus qhia ntxaws ntxaws rau cov phiaj xwm xauv, uas tsim nyog kawm los ntawm!

(A) Cov ntsiab lus tseem ceeb

1.Dab tsi yog lub xauv phaj?

Txhua lub phaj hlau uas tuaj yeem ntsia tau rau hauv lub kaum sab xis kho / lub kaum ntse ntse los yog tus pins yog qhov tseem ceeb ntawm lub phaj xauv.

2. Qhov zoo thiab qhov tsis zoo ntawm kev xauv daim hlau

Qhov zoo

■ Angular stability, tsis kam khoov thiab torsion

■ Conical zoo ntawm cov ntsia hlau taub hau txhim kho kev faib khoom

■ Muab radial preload, tiv thaiv pob txha resorption thiab ntsia hlau loosening

■ Anatomically zoo li tus kom haum raws li localized anatomical qauv

■Matching templates tso cai percutaneous fixation nyob rau hauv lub diaphysis (ib leeg cortical, nws tus kheej-drilling, self-tapping locking screws)

■ Xauv cov ntsia hlau muab kev thauj mus los zoo rau ob qho tib si hloov tau yooj yim thiab ruaj khov kho

■ Tsis xav tau kev sib cuag nrog cov pob txha, khaws cov ntshav

■ Tswj micromotion, nyiam kho pob txha

■ Feem ntau tsis tas yuav muaj pob txha grafting

Nws yog qhov tshwj xeeb tshaj yog rau cov pob txha pob txha pob txha los yog cov pob txha tsis ruaj khov heev.

Qhov tsis zoo

■ Xauv screws tsis muaj qhov txo qis thiab compression nyhuv, tshwj xeeb tshaj yog nyob rau hauv cov pob txha pob txha los yog oblique pob txha yooj yim

■ Lub phaj tsis tuaj yeem siv los ua cov cuab yeej txo kom pab txo qis.

■ Cov ntsia hlau tsis zoo li cov ntsia hlau ua ke thaum muab tso rau.

■ Cov kev taw qhia ntawm cov ntsia hlau tsis tuaj yeem hloov kho (tshwj tsis yog rau cov ntsia hlau ntsia hlau multiaxial).

■ Cov ntsia hlau tau muab tso rau nruj heev, uas tuaj yeem ua rau 'txias vuam'.

■ Lub kaum sab xis sib txawv> 5 °, lub zog poob; > 10 °, cov nyhuv xauv tsis zoo

■ Muaj peev xwm subcutaneous protrusion yog tias lub phaj tsis contoured

Cov teeb meem nruj

Yog tsis muaj kev sib cuag zoo cortical lossis compression ntawm cov pob txha tawg, kev siv cov khoom siv xauv, tshwj xeeb tshaj yog stainless hlau splints, yuav tiv thaiv theem II kho ntawm pob txha vim yog qhov nruj heev thiab tshem tawm cov khoom siv micromotion ntawm qhov chaw tawg;

Yog hais tias intraoperative traction yog siv thiab ces locking splint fixation yog siv, qhov tawg tawg qhov sib txawv yuav raug khaws cia, ua rau ncua los yog tsis muaj pob txha kho;

Yog tias qhov tawg yooj yim tsis rov pib dua thiab muaj zog, lub load yog kis los ntawm lub phaj, ua rau muaj kev ntxhov siab uas tuaj yeem yooj yim ua rau lub phaj tawg.

3. Qhov loj biomechanical qhov sib txawv ntawm kev xauv cov phaj thiab cov paib

Cov paib pa cia siab rau kev sib txhuam ntawm cov pob txha-phaj cuam tshuam kom ua tiav phaj compression ntawm cov pob txha.

4. Kev sib piv zoo ntawm cov phaj xauv thiab cov phaj hlau zoo tib yam

1.Lub rub-tawm tsis kam ntawm locking screws yog ntau dua li cov zoo tib yam screws.

2. Lub epiphyseal locking screws yog angled rau ib leeg, uas zoo heev ua rau cov ntsia hlau tsis kam mus rub tawm piv rau cov ntsia hlau sib txuas.

(B) Cov ntsiab cai ntawm kev thov

1. Cov ntsiab lus ntawm immobilization:

●Pressurization txoj cai: osteoporotic diaphysis tawg

●Neutralization txoj cai: osteoporotic diaphysis tawg

●Bridging txoj cai: comminuted diaphysis los yog extra-articular metaphyseal puas

Lub hauv paus ntsiab lus ntawm union: comminuted intra-articular metaphyseal fracture

2. Kev sib txuas txoj cai:

● Kev ua kom zoo: percutaneous minimally invasive phaj fixation (MIPO lossis MIPPO txheej txheem)

●Indirect txo cov txheej txheem

●Rau kev txhim kho cov phaj txuas kom txaus, 3-4 lub qhov ntsia hlau yuav tsum tau qhib rau ntawm qhov kawg ntawm qhov tawg.

3. Cov ntsiab cai ntawm union:

● Ua ke siv ob txoj hauv kev biomechanical ntawm compression thiab bridging nyob rau hauv ib lub phaj - xauv compression phaj (LCP)

● Cov pob txha yooj yim hauv ib ntu ntawm pob txha pob txha thiab comminuted fractures nyob rau hauv lwm yam (xws li, comminuted fractures ntawm metaphysis, diaphysis)

●Lub hauv paus ntsiab lus ntawm kev sib koom ua ke yuav tsum tsuas yog siv rau cov phiaj uas tso cai rau kev tso ntawm ob lub taub hau ntsia hlau nrog rau cov ntsia hlau ntau.

Xauv daim hlau tsis txhob cia siab rau kev sib txhuam ntawm cov pob txha-phaj interface thiab tso siab rau feem ntau ntawm kev sib tshuam ntawm cov ntsia hlau thiab phaj nrog angular stability kom muaj kev ruaj ntseg.

Vim tias lawv cov kev sib koom ua ke ruaj khov, lub zog tshem tawm ntawm cov ntsia hlau nrog lub taub hau kaw yog ntau dua li cov ntsia hlau sib txawv, tshwj tsis yog tias tag nrho cov ntsia hlau nyob ib puag ncig raug rho tawm lossis tawg. Feem ntau, nws yog ib qho nyuaj rau ib lub hau ntswj kom tshem tawm los yog tawg ntawm nws tus kheej. Locking taub hau screws tsis muab inter-fold pressurization. Pressurization tuaj yeem tau txais los ntawm kev siv cov cuab yeej siv lub zog los yog tsav cov ntsia hlau tsis tu ncua rau hauv 'kev sib xyaw qhov' (ntsuas screws ua ntej, ces xauv cov ntsia hlau).

1.Yog hais tias tus qauv screws tau siv los ua kom ruaj ntseg (piv txwv li 1), screwing nyob rau hauv lub locking screws yuav yooj yim heev (xws li 2).

2.Yog tias cov ntsia hlau xauv tau siv los tiv thaiv cov pob txha thiab pob txha thaiv (xws li, 1), nws tsis pom zoo kom cov ntsia hlau txheem yuav tsum tau muab ntsia hlau rau hauv tib lub pob txha thaiv (xws li, 2) tshwj tsis yog tias cov ntsia hlau xauv yog loosened thiab retightened (LHS).

3.Thaum lub pob txha metaphyseal tau ruaj ntseg nrog lub hau ntswj nrog lub taub hau xauv (LHS), kev kho qhov sib xyaw ntawm cov pob txha tawg tau ua tiav los ntawm kev muab cov ntsia hlau txheem rau hauv lub qhov hluav taws xob compression qhov ntawm Locking Compression Plate LCP ua ke.

(C) Indications thiab contraindications

1. Cov lus qhia

Feem ntau cov phais kho pob txha tsis tas yuav tsum tau xauv phaj fixation. Tsuav tau ua raws li cov hauv paus ntsiab lus ntawm kev phais orthopedic, feem ntau cov pob txha tuaj yeem kho tau los ntawm kev siv cov paib los yog intramedullary nailing.

Txawm li cas los xij, muaj qee yam ntawm cov pob txha tawg uas muaj feem cuam tshuam rau kev txo qis, phaj lossis ntsia hlau tawg, thiab cov kev tsis sib haum xeeb tom qab, feem ntau hu ua 'unresolved' lossis 'problematic' fractures, nrog rau cov pob txha ntawm cov pob txha comminuted, periarticular fractures nrog cov pob txha me me. Cov pob txha pob txha no feem ntau hu ua 'unresolved' lossis 'problem' fractures thiab muaj xws li intra-articular comminuted fractures, periarticular short tuberosity fractures thiab osteoporotic fractures. Cov pob txha tawg no yog txhua qhov qhia txog kev xauv cov phaj.

Cov lus qhia classic thiab zoo tshaj plaws rau kev xauv lub phaj fixation ntawm cov pob txha yog lub hauv paus ntsiab lus ntawm kev sib txuas thiab lub hauv paus ntsiab lus ntawm kev sib koom ua ke rau kev sib tsoo ntau dua - cov pob txha muaj zog hauv cov neeg mob hluas lossis pob txha pob txha hauv cov neeg laus.

2. Contraindications

Txawm hais tias xauv daim hlau tau siv dav thiab lawv cov lus qhia dav dua, peb yuav tsum paub thiab zam ntau yam kev txwv rau kev xauv daim hlau. Yog tias cov ntawv xauv siv tsis raug cais tawm, qhov tsis ua haujlwm ntawm kev txhim kho thiab kev tsis sib haum xeeb ntawm cov pob txha yuav tshwm sim.

Cov pob txha yooj yim uas yuav tsum tau muaj kev sib txuam ntawm lub cev, xws li cov pob txha caj npab yooj yim kho nrog kev xauv sab hauv, yog qhov ua rau tsis muaj kev sib koom ua ke.

Ib yam li ntawd, percutaneous tso rau ntawm xauv daim hlau rau cov pob txha yooj yim siv cov txheej txheem minimally invasive kuj yog ib qho contraindication.

Kev txo qis thiab kev xauv lub phaj fixation kuj tsis tsim nyog rau kev tshem tawm cov pob txha hauv cov pob txha, uas yuav tsum tau qhib kev txo qis hauv lub cev thiab compression ntawm cov pob txha tawg thiab ruaj khov kho.

Ib tug txheeb ze contraindication rau locking daim hlau, vim lawv cov nqi siab, yog fractures uas yuav txaus siab kho nrog cov pa daim hlau. Piv txwv li, pob txha ntawm lub forearm symphysis muaj qhov kho tau ntau dua 90% thaum kho nrog cov paib.

(D) Kev teeb tsa ntawm lub xauv phaj

1. Screw lub laum me ntsis rau hauv cov ntsia hlau qhov ntawm lub phaj. Qhov sib txawv ntawm> 5 ° ntawm cov ntsia hlau thiab lub qhov ntsia hlau tuaj yeem ua rau tsis ua haujlwm ntawm cov ntsia hlau xauv, thiab nws raug nquahu kom siv lub laum me ntsis txhawm rau txhawm rau qhov zoo dua.

2. Muab cov phaj hlau rau ntawm qhov chaw ntawm cov pob txha thiab laum lub qhov los ntawm lub tes tsho tho.

3. Ntsuas qhov tob nrog lub suab nrov, saib xyuas tias lub taub hau ntawm lub suab nrov tau muab tso rau hauv lub qhov taub hau.

4. Xaiv qhov ntev uas tsim nyog ntawm cov ntsia hlau xauv.

5. Kev teeb tsa ntawm cov ntsia hlau pressurized yog tib yam li cov hlau zoo tib yam.

6. Thaum kawg, zawm cov ntsia hlau xauv nrog lub torque ciaj ntswj, thaum nruj, yuav pom tseeb zawv zawg thiab snapping suab, kom tsis txhob screwing nruj heev, ua rau kev tshem tawm nyuaj.

(E) Xauv phaj tshem tawm

Clinical locking phaj screws yog dav siv, tab sis yooj yim ntsib kev tshem tawm cov teeb meem, feem ntau tshwm sim nyob rau hauv cov ntsia hlau slipping hlau thiab ntsia thawv hau thiab phaj ntsia thawv qhov threads ntawm qhov tsis ncaj ncees lawm buckle.

1. Screw cap groove puas

Nyob rau hauv ib txwm muaj xwm txheej, tag nrho cov ntsia hlau cap zawj thiab cov ntsia hlau sib txuas yog sib xws. Lub hau ntswj yuav tsum tau ua raws li cov ntsia hlau hau zawj ua ntej ntsia hlau ntxig lossis tshem tawm, txwv tsis pub cov ntsia hlau hau zawj zoo li yuav raug deformed thaum ntsia hlau los yog ntsia hlau tawm, ua rau slippage.

Tsis tas li ntawd, tom qab kev kho pob txha, cov ntsia hlau taub hau feem ntau yog qhwv nrog cov pob txha pob txha los yog cov ntaub so ntswg, uas yuav tsum tau muab ntxuav ua ntej tshem cov ntsia hlau, tab sis yog tias tsis muaj kev saib xyuas, lub hau ntswj thiab lub kaum sab xis ntawm lub ntsej muag yuav raug puas tsuaj.

Vim tias qhov kev sib hloov ntawm tus neeg teb xov tooj lub hauv pliaj tsis zoo ib yam nrog lub hau ntswj lub axis ntev, feem ntau muaj lub kaum ntse ntse, thaum tus neeg teb xov tooj quab yuam screwed tawm ntawm lub hau, nws yog ib qho tsim nyog yuav tsum tau ua kom lub hau ntswj ntswj, uas ua rau muaj kev puas tsuaj rau lub hau zawj ntawm lub hau vim lub zog tsis sib xws. Yog li ntawd, kev puas tsuaj rau cov ntsia hlau zawj tuaj yeem yooj yim ua rau cov ntsia hlau slippage.

2. Ntsia hau los yog ntsia thawv qhov deformation

Nyob rau hauv tus txheej txheem ntawm intraoperative daim ntawv thov ntawm anatomical locking steel phaj, qee zaus raws li qhov xav tau kom tsim nyog khoov lossis shaping ntawm steel phaj, Raja li al. ntseeg hais tias yog qhov dabtsi yog khoov tshwm sim tshwm sim nyob rau hauv lub locking screw qhov, thaum screwing nyob rau hauv lub locking screws yuav tsum ntsia hlau cap thiab ntsia thawv lub mismatch, uas yog heev yuav tshwm sim ntawm tus ntsia thawv cap thiab steel phaj ntsia hlau qhov threads tsis ncaj ncees lawm buckle, los yog screwed ze rau lub steel phaj thaum tus Tsov tus tw ntawm tus ntsia thawv deformation tshwm sim los ntawm lub zog ntawm cov ntsia hlau, thiab lwm yam.

3. Daim ntawv thov ntawm tus kheej tapping cortical xauv rau tes

Vim hais tias cov pob txha cortical loj hlob nyob rau hauv raws li tus ntsia thawv qhov thiab yog li yuav tuav cov ntsia hlau, ua rau muaj teeb meem nyob rau hauv cov ntsia hlau tshem tawm, tshwj xeeb tshaj yog daim ntawv thov ntawm tus kheej-tapping ob cortical pob txha screws, Suzuki li al. tsis pom zoo kom siv tus kheej tapping screws rau ob chav cortical fixation. Hou Yunfei et al. tau hais tias tsis tsim nyog kho bicortical nrog screws yuav tsum tau zam rau sab sauv sab sauv, thiab Maehara li al. kuj tau hais tias yuav tsum tsis txhob siv cov xauv cov ntsia hlau ntau zaus thaum siv cov ntawv xauv, thiab tias yuav tsum tau tsim kom muaj tus qauv thoob ntiaj teb rau kev xaiv thiab kev siv cov locking screws.

4. Cov qauv thiab qhov chaw ntawm cov ntsia hlau

Qhov loj, kev taw qhia, thiab qhov chaw ntawm cov ntsia hlau xauv tuaj yeem cuam tshuam qhov kev tshem tawm ntawm cov ntsia hlau. Qee cov kws tshawb fawb tau pom tias yog cov ntsia hlau tsis nyob hauv qhov nruab nrab ntawm lub qhov xauv, ib zaug ntsia hlau qhov eccentricity ntawm ntau tshaj 5 ° tej zaum yuav muaj ib tug xoob ntsia hlau fixation, threads tsis ncaj ncees lawm buckle los yog ntsia thawv deformation daig thiab ua rau tsis ua hauj lwm ntawm fixation los yog lub thib ob theem ntawm kev tshem tawm cov teeb meem.

5.Cold welding

Ib txwm titanium sab hauv fixation nto muaj ib txheej ntawm passivated tiv thaiv txheej, nyob rau hauv cov txheej txheem ntawm kev phais kev tso kawm ntawm internal fixation, vim cov cuab yeej ntawm grasping thiab shaping, los yog lub taub hau ntawm cov ntsia hlau thiab kev sib txhuam ntawm cov hlau phaj, thiab lwm yam, tej zaum yuav ua rau passivated tiv thaiv txheej hnav cheeb tsam. 2 hlau qhov chaw ntawm qhov chaw sib cuag tseem ceeb yuav raug ua raws li, uas yog, tsim cov vuam txias.

Tsis tas li ntawd, galvanic coupling ntawm cov hlau ions, cov tshuaj tiv thaiv kab mob, thiab lwm yam tuaj yeem txhawb kev tsim cov welds txias. Feem ntau cov tuam ntxhab ntawm cov khoom siv kho mob sab hauv kuj tau paub txog qhov teeb meem no, thiab yog li ntawd tsis siv cov ntawv xauv hlau yog npog nrog oxide zaj duab xis thev naus laus zis ntawm cov ntsia hlau qhov thiab ntsia hlau qhov chaw sib cuag, uas tseem yog lub hom phiaj los tiv thaiv ionization thiab adsorption ntawm cov protein hauv lub cev thiab txo qhov tshwm sim ntawm qhov txias welds.

(F) Cov txheej txheem tshem tawm

Cov txheej txheem tshem tawm tau tshaj tawm hauv cov ntaub ntawv hauv tebchaws thiab thoob ntiaj teb tuaj yeem muab faib ua 2 pawg, uas yog, yooj yim thiab siv tau thiab ua haujlwm, cov qub uas muaj kev nkag tau yooj yim, siv tau, tsis tshua muaj cov ntaub so ntswg puas, tsis muaj kev txawj ntse thiab tsis xav tau cov cuab yeej tshwj xeeb, thiab tom kawg xav tau cov cuab yeej tshwj xeeb thiab cov cuab yeej siv.

Maehara et al. hais kom siv torque-limiting screwdrivers nrog loj shanks thaum twg los tau. Thaum confronted nrog slipped screws, Pattison li al. qhia txog ib txoj kev yooj yim ntawm kev tshem tawm cov ntsia hlau los ntawm kev qhwv lub taub hau ntawm lub hau ntswj nrog platinum hlau thiab ntxig rau hauv qhov zawj ntawm lub hau ntsia hlau. Txoj kev no yog qhov ntse los sau cov ntsia hlau hau zawj nrog cov ntawv hlau thiab ua kom cov chaw sib cuag thiab kev sib txhuam ntawm cov ntsia hlau thiab cov zawj, uas pab txhawb kev tshem tawm ntawm cov ntsia hlau nrog cov xov uas tsis muaj hlua. Nyob rau hauv txoj kev no tseem nyuaj rau tshem tawm cov ntaub ntawv, yog hais tias lub hau ntswj thiab steel phaj ntsia hlau qhov threads tseem zoo lawm, koj tuaj yeem sim siv cov conical rov qab tapping ntsia hlau tshem tawm, uas yog, los ntawm cov ntsia hlau hau zawj tso rau hauv qhov rov qab tapping thiab sau cov zawj, nyob rau hauv tus txheej txheem ntawm rotating thiab pressurizing cov ntsia hlau tawm.

Ntawm qhov tsis zoo, qee qhov kev xauv lub qhov rooj tseem nyuaj rau kev siv lub conical rov qab tapping ntsia hlau extractor, xws li Ehlinger li al. thiab Bae et al. leej twg pom tias txoj kev no feem ntau siv tau rau 3.5 hli ntsia hlau slippage, tab sis feem ntau tsis zoo rau 4.5 hli ntsia hlau slippage. Nyob rau hauv rooj plaub no, tsis yog txhua qib ntawm tsev kho mob orthopedics yog nruab nrog tshwj xeeb hlau sib tsoo cov cuab yeej xws li carbide xyaum, pob zeb diamond xyaum, los yog high-speed sib tsoo log.

Gopinathan et al. Qhia ib txoj kev uas tsis tas yuav tsum tau cov cuab yeej tshwj xeeb no los ntawm kev qhia txog cov teeb meem ntawm cov ntsia hlau nyuaj tshem tawm ntawm lub phaj clavicular reconstruction, piv txwv li, siv ib tug tsawg cutout ntawm lub reconstruction phaj, ib tug loj hlau cutter yog siv los txiav qhov nqaim ntawm lub phaj ntawm lub phaj ntsia hlau qhov, kom lub screws thiab ntsia hlau qhov ib feem ntawm lub phaj tsim ib tug me me chav tsev yuav yooj yim. Cov txheej txheem no tsuas yog siv tau rau titanium reconstruction locking plates, forearm locking plates with narrower low notches, and 1/3 tube-type plates, and can be used for wider or thicker plates in the lower extremity.

Ib txoj kev yooj yim kuj tau piav qhia nyob rau hauv uas ib tug me ntsis loj laum me ntsis yog siv los laum ib lub qhov nyob rau hauv lub feem ntau ib sab ntawm lub pas nrig locking ntsia hlau, thiab ces lub phaj thiab ntsia hlau yog tapped nyob rau hauv cov kev taw qhia ntawm lub tshiab drilled ntau qhov, thiab ces lub phaj thiab ntsia hlau raug tshem tawm los ntawm kev siv ib tug pob txha cutter muab tso rau hauv qab lub phaj thiab prying nws tawm nrog lub hauv paus ntsiab lus ntawm leverage.

Tau kawg, muaj peev xwm ua rau pob txha puas tsuaj nrog txoj kev no, yog li kev tiv thaiv kev tiv thaiv kev tiv thaiv tom qab tau pom zoo. Tsis tas li ntawd, nws tseem yuav tsum tau npaj qee cov cuab yeej siv tshaj lij ua ntej kev phais tshem tawm sab hauv, xws li bolt extractor, qhov reamer, ntsia hlau extraction pliers, T-type pressurized socket thiab hais txog.

Nyob rau hauv lub ntsej muag ntawm locking ntsia hlau nplua hlau tshem tawm teeb meem, qee cov kws tshawb fawb hauv tsev tau thov kom hloov txoj kev zawj, uas yog, kev siv cov hniav micro-sib tsoo tshuab steel xuab zeb los hloov cov ntsia hlau hau zawj hexagonal lossis quadrangular groove rau 'ib' lossis ' kaum' zawj sib sib zog nqus.

Ehlinger et al. qhia tias nyob rau hauv cov ntaub ntawv uas lub conical rov qab tapping ntsia hlau extractor tseem muaj teeb meem ntawm kev tshem tawm cov ntsia hlau, nws tau pom tias cov hlau phaj yuav raug tshem tawm los ntawm kev rhuav tshem lub taub hau ntawm cov ntsia hlau los ntawm tungsten laum sib tsoo thiab nthuav cov ntsia hlau qhov nyob rau hauv steel phaj, thiab ces lub cev ntawm cov ntsia hlau yuav raug tshem tawm los ntawm kev siv lub nplhaib saw.

Georgiadis et al. thiab Raia et al. thov nyob rau hauv cov ntsia hlau thiab steel phaj ua ke yog nruj heev thiab nyuaj rau tshem tawm, cov khoom tshwj xeeb (xws li pneumatic high-speed txiav xyaum, carbide xyaum, pob zeb diamond log, thiab lwm yam) ntawm tus ntsia thawv qhov nyob ib ncig ntawm lub steel phaj txiav txoj kev, nyob rau hauv lub steel phaj yog txiav kom loosen cov ntsia hlau, cov ntsia hlau yog ib txwm yooj yim tshem tawm.

Kumar thiab Dunlopl qhia nyob rau hauv lub distal femur locking steel phaj ntsia hlau system sab hauv fixation tshem tawm cov txheej txheem, nyob rau hauv kev siv tus txheej txheem nws tus kheej txwv torque screwdriver, conical ntsia hlau extractor ua tsis tau tejyam, tab sis kuj qhia ib tug tshiab txoj kev, uas yog, siv high-speed nyias-flake abrasive log raws ntug ntawm cov hlau phaj mus rau ntug ntawm cov pob txha, hollowed rau hauv cov pob txha, hollow. tsis txhob qhib lub phaj hlau ntsia hlau qhov thiaj li yuav so lub hau, thiaj li hais tias qhov kev tshem tawm zoo ntawm Locking screws.

Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias cov txheej txheem saum toj no yuav tsum tau ua kom qeeb li sai tau thaum lub sij hawm txiav los yog sib tsoo ntawm lub phaj siv lub tshuab txiav disc kom tsis txhob txiav rau hauv lub taub hau ntawm cov ntsia hlau thiab ua rau cov pob txha thiab cov ntaub so ntswg puas. Tsis tas li ntawd, cov tswv yim no tuaj yeem ua rau muaj qhov kub thiab txias thiab cov khib nyiab hlau, uas tuaj yeem ua rau muaj kev pheej hmoo ntawm kev kho mob rov ua dua, cov ntaub so ntswg thermal necrosis, thiab kis kab mob.

(G) Cov ntsiab lus

■ Tso cai rau cov phaj tsis tiav nrog lub periosteum

■ Lub phaj yuav tsum tau muab kho dua ua ntej xauv, vim tias qhov tawg tsis tuaj yeem rov ua dua tom qab xauv.

■ Xauv phaj tsis tuaj yeem ua kom muaj zog, yuav tsum tau siv lub tshuab pressurizer lossis centrifugal screwing nyob rau hauv lub union lub qhov rau hauv cov ntsia hlau zoo tib yam, thawj zaug pressurized, ces xauv

■ Fracture site 3 ~ 4 ntsia hlau qhov tsis muaj screws kom kis tau qhov kev ntxhov siab; ■ Fracture site 3 ~ 4 ntsia hlau qhov tsis muaj screws kom kis tau qhov kev ntxhov siab; thiab

■ monocortical fixation ntawm diaphysis lossis tuab pob txha cortex, thiab qhov zoo ntawm cov pob txha zoo; thiab

■ Ib zaug xauv, nws tsis tuaj yeem thim rov qab, thaum cov ntsia hlau zoo tib yam tuaj yeem thim rov qab

■ Kev txhim kho muaj zog thiab ntau cov ntsia hlau tuaj yeem ua rau tsis muaj kev cuam tshuam; lub hauv paus ntsiab lus yog tias daim hlau yuav tsum tau ntev thiab tsawg dua screws yuav tsum tau siv; Nyob rau hauv kev kho mob ntawm periarticular fractures, tsawg screws yuav tsum tau siv rau lub qia thiab ntau screws yuav tsum tau siv rau fixation tiv thaiv articular nto.

■ Qhov ntev ntawm lub phaj txuas yuav tsum yog ob zaug ntawm qhov ntev ntawm qhov chaw tawg, cov ntsia hlau yuav tsum tau muab faib ua tusyees, thiab qhov zoo tshaj plaws fixation yuav tsum yog los ntawm-tus-aperture fixation.

■ Lub zog sib npaug sib npaug ntawm lub phaj ntev, thiab kev kho nrog tsawg dua cov ntsia hlau tuaj yeem txhawb kev tsim cov pob txha thiab txhawb cov pob txha zoo.