Kugwiritsa ntchito bwino mbale yotseka!

A Kutseka mbale ndi chipangizo chosinthira chokhazikika chokhala ndi dzenje lopsereza. Pamene screw yokhala ndi mutu womangika ndikukhomedwa mdzenje, mbaleyo imakhala chipangizo cha ngodya. Kutseka (ngodya) kumatha kukhala ndi mabowo onse otseka komanso osatseka mabowo onunkhira kuti ajambulidwe mu (omwe amatchedwanso mbale yophatikizika). Popeza lingaliro la mbale zotsekera lidafunsidwa ndikugwiritsidwa ntchito kwambiri pakukonzanso kwa thupi, zokhala ndi zotupa zam'madzi zomwe zimapangitsa kuti zikhale zolimba kwambiri, kuwonongeka kochepa kwa magazi. Kuwerenga kwamawa kumakupatsani chidziwitso mwatsatanetsatane kuti mutsegule mbale, zomwe ndizofunikira kuphunzira!

(A) Mwachidule

1.Kodi mbale yotseka ndi iti?

Mbale iliyonse yachitsulo yomwe imatha kusanja mu konkire / ngodya yokhazikika kapena zikhomo nthawi zonse zimakhala zokhotakhota.

2. Ubwino ndi zovuta za mbale zotsekera

Ubwino

■ kukhazikika kokhazikika, kukana kugwedezeka ndi chimbudzi

■ mawonekedwe owoneka bwino a mutu amayenda bwino

■ Patsani zokolola zokoka, pewani kutulutsa mafupa ndi kumasula

■ kwaatomically yopangidwa kuti igwirizane ndi mawonekedwe a anatomical

Ma tempulo ofanana kuti alolere kukonzanso mu diaphis (imodzi yokha, yobowola, yotseka zopukutira)

■ Kutseka zomata kumapereka mwayi wabwino kwambiri wosinthika komanso kukhazikika kotheratu

Osati kufunika kolumikizana ndi mafupa, kusunga magazi

■

■ Nthawi zambiri palibe mafupa amafunikira

Zimathandiza kwambiri kwa osteoporitic kapena zodetsa nkhawa zilizonse.

Zovuta

■ Kutseka zomangira sizikhala ndi kuchepetsa komanso kuphatikizidwa, makamaka mu maluso a ma entra-art

■ Pulogalamu siyingagwiritsidwe ntchito ngati chida chotsitsa chothandizira kuchepetsa.

■ Zomangira sizimamveka bwino ngati zomata wamba poyikidwa.

■ Malangizo a zomangira sizingasinthidwe (kupatula zomangira zotsekemera mwa mitundu).

■ Zomangira zimayikidwa kwambiri, zomwe zingayambitse 'kuzizira '.

Kupatuka kopatuka> 5 °, kukulimbikitsani; > 10 °, zotseka ndizosagwira

■ Kungakhale kovuta kwambiri ngati mbaleyo sinawonongeke

Nkhani zolimba

Popanda kulumikizana bwino kapena kukakamiza kwa kutha kwa matendawa, kugwiritsa ntchito malo otsetsereka, makamaka zotumphukira za dzimbiri, zimaletsa gawo la masamba a II kuchiritsa chifukwa cha kuuma kwamilandu;

Ngati chisokonezo cholowera chimagwiritsidwa ntchito kenako kutseka chopumira chikugwiritsidwa ntchito, mpweya wosweka udzasungidwa, zomwe zimapangitsa kuchedwa kapena kuchiritsa kapena kuchiritsa;

Ngati kusokonekera kosavuta sikubwezeretsedwa ndikukakamizidwa, katunduyu amafalikira pambale, zomwe zimapangitsa nkhawa zomwe zingayambitse kuwonongeka.

3. Kusiyana kwakukulu kwa biomical

Mbale zachilendo zimadalira kukangana pa mawonekedwe a mbale-mbale kuti akwaniritse bwino kwambiri mbale.

4. Ubwino wofanizira wa kutseka mbale ndi mbale wamba yachitsulo

1. Kukana -ku kukoka kwa zomangira zokhoma ndikokwera kwambiri kuposa zomata wamba.

2. Zomangira zotsekemera za epiphyseal zimalumikizidwa wina ndi mnzake, zomwe zimachulukitsa kukana kwa screw kuti ikokere poyerekeza ndi zomata zofananira.

(B) mfundo zofunika

1. Mfundo za Undebolization:

● Sonyezani Mfundo: Osteoporotic Diaphysis fractar

● MERUTU YA KUSANGALATSA: OSTEONOTOTICICYYIS FRUBY

● Mfundo yokulungizira: Kuchulukitsa diaphyys kapena zowonjezera zowonjezera fanizo

Mfundo ya Union: Kuyitanitsa intra-articular metaphyseal fraclure

2. Mfundo yokulungizira:

● Njira zomwe mungachite:

● Njira yochepetsetsa yosasinthika

● Kuti mabowo azikhala okwanira, mabowo 3-4 akuyenera kusiyidwa pafupi ndi kutha kwa kuwonongeka.

3.Pruiples of Union:

● Kuphatikiza kugwiritsa ntchito mfundo ziwiri za biomenchanical ya kukakamizidwa ndi kukhazikika mu mbale imodzi - yotseka mbale (LCP)

● Kusungunuka kosavuta mu gawo limodzi la kuthyolako komanso kuphatikizidwa ndi ma fraclumis ena (mwachitsanzo, otsogola a metaphysis, Diaphys)

● Mfundo ya umodzi iyenera kugwiritsidwa ntchito kuyika mbale zomwe zimalola kuyikapo malovu opindika mutu komanso zomangira zofananira.

Mbale zotsekera sizidalira mikangano pakati pa mawonekedwe a mafupa ndikudalira mawonekedwe pakati pa screw ndi mbale yokhala ndi kukhazikika kwamphamvu.

Chifukwa cha mgwirizano wawo wokhazikika, mphamvu ya zomangira zokhotakhota ndi mitu yotseka ndiyokwera kwambiri kuposa zomangira wamba, pokhapokha zomangira zonse zozungulira zimachotsedwa kapena kuwonongeka. Nthawi zambiri, zimakhala zovuta kuti chovala chimodzi chizichotsedwe kapena kutopa nokha. Kutseka zomangira zamutu sikupereka chibwibwi. Kulimbikira kumatha kupezeka pogwiritsa ntchito chida cholumikizira kapena poyendetsa zomangira zokhazikika mu 'kusakaniza mabowo ' (ma scrops to screpse koyamba, ndiye kuti misomali).

1. Ngati zomangira zotsutsana zakhala zikugwiritsidwa ntchito kuti zitetezetse gawo (mwachitsanzo 1), zopukutira mu zomangira zokhoma zikhala zosavuta (mwachitsanzo 2).

2.Mungwe wotsekedwa wagwiritsidwa ntchito kuti ateteze mpweya ndi fupa (mwachitsanzo, 1), osavomerezeka kuti zomata zofananirazo zikakhazikika mu fupa lomwelo (mwachitsanzo, 2) pokhapokha zopindika zotsekedwa.

3.once kakhomakol fracture block yakhala yotetezedwa ndi mutu wokhotakhota (mabs), kuphatikiza pakati pa zotchinga pakati pa zotsekemera za popikisano

(C) Zisonyezo ndi contraindication

1. Zizindikiro

Zochita zambiri zoyesedwa kwambiri sizimafuna kutseka kolowera. Malingana ngati mfundo za opaleshoni ya orthopedic zimatsatiridwa, zonunkhira zambiri zimatha kuchiritsidwa pogwiritsa ntchito mbale kapena intramillary mitaing.

Komabe, pali mitundu inayake ya zonunkhira zomwe zimatha kuchepetsedwa, mbale kapena scretege startives, osagwirizana ndi zotupa zazitali, kuphatikizapo zotupa zazitali, ndi zonunkhira za mafupa. Mitundu iyi ya fracration nthawi zambiri imatumizidwa ku 'kapena ' Zojambula zonsezi ndi zisonyezo zonse zotsekera mbale.

Zizindikiro zapamwamba komanso zabwino zokometsera zowoneka bwino za zotchinga ndi mfundo yosungirako komanso mfundo zolumikizirana ndi magetsi ofunikira kwambiri kwa odwala kapena ogulitsa odwala okalamba.

2. Contraindication

Ngakhale kuti mbale zozikika zinkagwiritsidwa ntchito kwambiri komanso zosonyeza zawo ndizowonjezera, tiyenera kuzindikira ndikupewa zigawo zingapo kuti tikwere mbale. Ngati mbale zotsekera zimagwiritsidwa ntchito mopanda tsankho, kulephera kukhazikika ndi kusamvana kwa kuwonongeka kumatha kuchitika.

Zosavuta zophweka zomwe zimafuna kuti munthu akwatire, monga mawonekedwe osavuta a stem omwe amathandizidwa ndikutseka mawonekedwe amkati, amakonda osakhala mgwirizano.

Mofananamo, panjira yopenyerera mbale yokhotakhota kwa zosavuta pogwiritsa ntchito njira zowonongera zomwe zimabweretsanso.

Kuchepetsa kwachilendo ndi kutseka kwa Plate sikuyeneranso kusamutsidwa ndi ma a intra-articular fractures, omwe amafunikira kutseguka kwa anatomical kutsika ndikuphatikizidwa pakati pa zidutswa za ku Fractor ndikukhazikika.

Chosiyana ndi kutseka mbale, chifukwa cha mtengo wawo wokwera, ndiwosanja zomwe zingakhazikitsidwe mokwanira ndi mbale wamba. Mwachitsanzo, mabungwe amtundu wa sympu amakhala ndi magetsi oposa 90% atathandizidwa ndi mbale wamba.

(D) kukhazikitsa mbale yotseka

1. Sankhani kubowola pang'ono mu mabowo a mbale. Kupatuka kwa> 5 ° pakati pa screw ndi chibowo cha chikhomo chingayambitse kulephera kotseka, ndipo tikulimbikitsidwa kugwiritsa ntchito mabowo kuti apititse mabowo makamaka.

2. Ikani mbale yachitsulo pamwamba pa fupa ndi kubowola mabowo kudzera pabowo.

3. Yethetsani kuya kuya kwa bwino, kusamalira kuti mutu wa mawuwo umayikidwa mu dzenje.

4. Sankhani kutalika koyenera kwa mbewa yotseka.

5. Kukhazikitsa kwa zomata zosindikizidwa ndizofanana ndi mbale wamba zachitsulo.

6. Pomaliza limbitsani zomata zotsekera ndi chipongwe cha torque, mukamalimbikitsidwa, padzakhala kumvekedwa kowoneka bwino komanso kumveketsa phokoso, kuti mupewe kupukutira kwambiri, ndikuchotsa zovuta.

(E) Kutseka kuchotsera

Zomangira zokhotakhota zipatala zimagwiritsidwa ntchito kwambiri, koma zimakumana mosavuta kuchotsa, makamaka kuwonetsedwa mu screw stuw stal ndi msomali wa msomali ndi misomali ya msomali pakati pa zingwe zolakwika.

1.

Pakakhala zovuta zina, zoyambitsa zoyambitsa Cap pove ndipo screwdriver yofanana imagwirizana. The screwdriver iyenera kuphatikizidwa ndi screw cap poves screw screkeon kapena kuchotsedwa, apo ayi kakho kakhoma kakhomayo akuyenera kusokonekera mu scrove kapena show, zomwe zimayambitsa.

Kuphatikiza apo, machiritso okusaka, oyambitsa screc sotu nthawi zambiri amakulungidwa ndi mafupa a mafupa kapena minofu ya fibrous, yomwe iyenera kutsukidwa musanachotse, koma ngati mawonekedwe a stud suc sungunuka.

Chifukwa cha njira yosinthira ya omwe amagwira ntchito sakhala ndi ma screwrriver a bongo, nthawi zambiri amakhala ngodya inayake, pomwe wogwiritsa ntchito adatulutsa screws, zomwe zimapangitsa kuwonongeka kwa kapika chifukwa champhamvu. Chifukwa chake, kuwonongeka kwa scre scrove pove kungayambitse kusanja mosavuta.

2.

Mukugwiritsa ntchito ma carratiatic Kugwiritsa kwa manatomical Kutseka mbale, nthawi zina malinga ndi kufunikira kwa kugwada koyenera kapena kukwera kwa mbale yachitsulo, raja et al. Khulupirirani kuti ngati gawo la kugwada likachitika m'mabowo otchinga, pomwe mabowo okhomerera azikhala ndi nthunzi yachitsulo yomwe imapangika ndi misomali ya misomali pomwe imachitika kuti ichotsedwenso movutikira.

3. Kugwiritsa ntchito misomali yotseka

Chifukwa fupa la cortical limamera mkati motsatira dzenje la msomali ndipo lizigwira mawuwo, zomwe zimayambitsa kuchotsedwa, makamaka kugwiritsa ntchito zomangira ziwiri zamoto, Suzuki et al. Musalimbikitse kugwiritsa ntchito zomangira zodzikongoletsera zodzikongoletsera pawiri. Hou yunfei et al. Ananenetsa kuti makonda osafunikira ndi zomangira ziyenera kupewedwa chifukwa cha zonunkhira zapamwamba kwambiri, ndipo mahahara et al. Ananenanso kuti kugwiritsa ntchito zomata zotsekemera kuyenera kupewedwa mukamagwiritsa ntchito mbale zotsetsereka, ndipo kuti pali kufunika kukhazikitsa njira ya chilengedwe chonse pakusankhidwa ndikugwiritsa ntchito zomangira zotsekemera.

4. Kapangidwe ndi malo a zomangira

Kukula kwake, mawonekedwe, ndi malo omwe nyumba yokhoma imatha kukhudza kuchotsa. Akatswiri ena awona kuti ngati lingaliro silinapezeka pakatikati pa dzenje lotseka, kamodzi kakhomera kolakwika kwa opitilira 5 °

5.Chold

Malo abwinobwino a Titanium omwe ali ndi osanjikiza otetezedwa, chifukwa cha opaleshoni yopangira mkati, chifukwa cha zida zothandizirana ndi kunyamula, kapena mutu wa mbale yachitsulo, etc. Kulumikizana kwachitsulo pakati pa mfundo yolowera kutsatiridwa, ndiye kuti, mapangidwe owuzira kuzizira.

Kuphatikiza apo, galvanic kuphatikiza pakati pa zitsulo, zotupa zotupa, etc. zimalimbikitsanso mapangidwe a welds ozizira. Opanga ambiri omwe amapanga zida za mkati amadziwikanso za vutoli, chifukwa chake osagwiritsidwa ntchito poimbira mabokosi apakatikati amadzaza ndi mabowo a msomali ndi malo olumikizirana, omwe amakhalanso ndi ma ionization ndi maenje ozizira.

(F) Njira zochotsa

Njira zochotsera zomwe zanenedwa mu dziko ndi mayiko zimagawika m'magulu awiri, omwe ndi ambiri, osavuta komanso owoneka bwino, osafunikira, osafunikira zida zapadera, ndi zida zapadera.

Mahara et al. Fotokozerani kugwiritsa ntchito zingwe zochepetsetsa zotsika ndi zingwe zazikulu ngati zotheka. Mukakumana ndi zomangira zotsalira, Pattison et al. Adanenanso njira yosavuta yochotsera zomata ndikukulunga mutu wa screwdriver ndi chitsulo cha platinam ndikuyika mu poyambira chipewa. Njira iyi ndi yopanga yodzaza ndi screw poove ndi zojambula zachitsulo ndikuwonjezera malo olumikizirana ndi poyambira, yomwe imathandizira kuchotsa kwa zingwe ndi ulusi wokhazikika. Munjira imeneyi ndi yovutayi kuchotsa mlanduwo, ngati chingwe cha zipilala ndi zingwe zopaka zingwe zolimba, mutha kuyesa kugwiritsa ntchito poyambira, kuti, kuchokera ku poove, polimbana ndi kukanikiza sturket.

Pa zolimba, zomangira zina zotsekemera sizingakhalebe zothandiza kugwiritsa ntchito zomwe zimapangitsa kuti musinthe, monga ehtalir et al. ndi bae et al. Yemwe adawona kuti njirayi nthawi zambiri inali yothandiza pa screet 3.5 mm screppage, koma nthawi zambiri sizimagwira ntchito kwa 4.5 mm screep. Pankhaniyi, sikuti ndi zida zonse za chipatala zam'manja zokhudzana ndi zokutira monga ma carbide, mabowo oyendetsa miyala, kapena mawilo othamanga kwambiri.

Gopinathan et al. Yambitsitsani njira yomwe siyifuna zida zamakono izi popereka nkhani yovuta yomanganso, mwachitsanzo, kugwiritsa ntchito malo otsetsereka a mbale pakati pa mbaleyo, ndipo zomangira zimatha kuchotsedwa mosavuta. Njirayi imangogwira ntchito zomangira zotseguka za Titanium, zomwe zimapangika ndi mitengo yocheperako, ndi 1/3 mbale zophulika, ndipo sizingagwiritsidwe ntchito pamtunda wokulirapo kapena wam'matumbo m'munsi.

Njira yosavuta yafotokozedwanso yomwe imangojambulidwa pang'ono kubowola pang'ono pobowola bowo lodziwika bwino, kenako mbale ndi chidutswacho chimachotsedwa poyambira pansi pa mbaleyo ndikuwumangirira.

Zachidziwikire, zimatha kuwonongeka kwa mafupa ndi njirayi, motero potengera kulemera kolemetsa kumalimbikitsidwa. Kuphatikiza apo, ndikofunikiranso kukonzekera zida za akatswiri omwe amagwiritsa ntchito asanachotsere opaleshoni yamkati, monga boll Referactor, Reamer Recorcy, Th-T-T-Typertured Socket,

Pamaso pa zotsekemera mavidi oterera, akatswiri ena am'nyumba adaganiza kuti asintha njira ya danga, ndiye kuti, kapena 'KAPENA, kapena amalima pophimba.

EHisider et al. Adanenedwa kuti nthawi yomweyo kumene kusinthidwe kalankhulidwe kamene kakusoweka, adanenedwa kuti mbale yamiyala itha kuchotsedwa ndikukulitsa mphotho yachitsulo, kenako thupi limatha kuchotsedwa pogwiritsa ntchito mphete.

Georgiadis et al. ndi Raia et al. Kufunsidwa mu screw ndi kuphatikiza kwamasamba ndi kovuta kwambiri komanso kovuta kuchotsa, zida zapadera (monga mawindo ang'onoang'ono, zotupa za diamondi, ndizosavuta kuchotsa.

Kumar ndi Dunlopl adanenanso za kutseka kwa femur yotsekemera patali, pogwiritsa ntchito screker screw-flake owoneka bwino, kenako Kukhazikika

Ndikofunikira kudziwa kuti njira zomwe zili pamwambapa ziyenera kuwonekera pang'onopang'ono podula kapena kupera mbale pogwiritsa ntchito disk yodula kuti muchepetse kudula mutu ndikuwononga mafupa ndi minofu yofewa. Kuphatikiza apo, njirazi zimatha kupanga kutentha kwambiri ndi zinyalala zachitsulo, zomwe zimatha kubweretsa chiopsezo chowonjezereka cha kukomoka kwamankhwala, minofu ya ma necrosis, ndi matenda.

(G) Chidule

Lolani kulumikizana kosakwanira ndi periosteum

■ Mbaleyo iyenera kuyikidwanso isananyamuke, popeza kuwonongeka sikungabwezeretsedwe pambuyo kutseka.

■ Kutseka mbale sikungasunthidwe, muyenera kugwiritsa ntchito spirturizer kapena startge screm mu dzenje wamba mu stock wamba, kenako ndikutseka

Masamba a Fracraure 3 ~ 4 scre scre scles popanda zomata kufalitsa nkhawa; Masamba a Fracraure 3 ~ 4 scre scre scles popanda zomata kufalitsa nkhawa; ndi

Kukonzekera kwa colocortical kwa diaphys kapena cortex cortex, ndipo komwe mtundu wa fupa ndi wabwino; ndi

■ Kalasi yotseka, siyingayiridwe, pomwe zomangira wamba zitha kuthandizidwa

■ Kukonzekera kwamphamvu komanso zomangira zambiri zitha kuyambitsa kusamvera; Mfundo yake ndikuti mbale ziyenera kukhala zazitali komanso zochepa zomwe zimayenera kugwiritsidwa ntchito; Mankhwalawa onunkhira, zomangira zochepa ziyenera kugwiritsidwa ntchito pa tsinde ndi zomangira zina ziyenera kugwiritsidwa ntchito pokonza motsutsana ndi mawonekedwe a artular

■ Kutalika kwa mbale yotchinga kuyenera kutalika kwa malo owombera, zomangira ziyenera kugawidwa moyenera, ndipo kukonza koyenera kuyenera kukhala njira yokhazikika

Off amagawananso pambale yayitali, ndikukhazikika ndi zomangira zochepa zimatha kulimbikitsa mapangidwe a nkhanambo ndikulimbikitsa mafupa.