Kushandiswa kwakakodzera kwekuvhara ndiro!

A Locking Plate ndeyekutsvina ficha yekugadzirisa chishandiso chine gomba rakarukwa. Kana banga racho riine musoro wakarukwa rakakwenenzverwa mugomba, iyo ndiro inova (screw) kona yekugadzirisa mudziyo. Kuvhiya Sezvo iyo pfungwa yekuvhara mahwendefa yakakurudzirwa uye yakashandiswa kurapwa, yakavezwa nekukanganiswa kwePertures nekuda kwekutsigira kwakasimba, kurapa kwakanyanya kwekuputika, kushomeka kwemvura nyoro uye kukanganisa kweropa uye kukanganisa kweropa. Kuverenga kwanhasi kwemangwanani kuchakupa iwe rondedzero yeruzivo kumahwendefa ekuvhara, izvo zvakakodzera kudzidza kubva!

(A) Basic Overview

1.Ko ndiro yekuvhara here?

Chero chipi zvacho chesimbi chinogona kukonzeresa kupindira kona

2. Zvakanakira uye zvakashata zvemapurati ekuvhara

Zvakanakira

■ Ingarlar kugadzikana, kuramba kukotama uye tonion

■ Conical chimiro che screw musoro chinovandudza kugoverwa kwemichina

■ Ipa radial preload, dzivirira kudzora pfupa uye screw kusunungura

■ Anatomically yakaumbwa kuti igone kuganhuramo emunatomu

■ Kufananidza matemplate kuti ubvumire kugadziriswa kwehunyanzvi mu diaphyisis (imwe chete cortrial, yekuzvishingisa, yekuzvibata-yekuzvitakura inovhara screws)

■ Kuvhara zviyero zvinopa anchorage yakanaka kune ese anochinjika uye anogadziriswa mhedziso

■ Hapana chikonzero chekusangana padhuze nePfupa pamusoro, kuchengetedza kugovera kweropa

■ Zvinotongwa mikotonion, kufarira kupora kupora

■ Kazhinji hapana mapepa epafuro anodikanwa

Izvo zvinonyanya kushanda kune esteoporotic fractures kana chero hupi husina kugadzikana.

Zvinokuvadza

■ Kuvhiya screws haina kuderedzwa uye kumanikidza maitiro, kunyanya muIntra-artular fractures kana nyore oblique fractures

■ iyo ndiro haigone kushandiswa seyakaderedzwa chishandiso kuti ubatsire mukudzikiswa.

■ Screws hainzwi sezvakanaka seyakajairwa screws kana ichiiswa.

■ kutungamira kwescrews hakugone kuchinjirwa (kunze kwekutarisa multiaxial kukiya screws).

■ Screw inoiswa zvakanyanya, iyo inogona kutungamira ku 'inotonhora tulting '.

■ Angle kutsauka> 5 °, kurasikirwa nesimba; > 10 °, kukiya mari isingabatsiri

■ Zvinogona kuitika subcutaneous protrusion kana iyo ndiro isina kugutsikana

Nyaya dzakaoma

Pasina yakanaka cortical kusangana kana kudzvinyirira kwemahara, kushandiswa kwekuvhara splints splints, kuchengeta chikamu cheI II kurapa kwekunetseka nekuda kwekunyanyisa kuomarara uye kubviswa kweiyo mikotomotion yakanyanya kuwanda.

Kana iyo Intraoperative traction isishandiswe uye wozovhara Splint Fixation inoshandiswa, iyo Bracture Kuregedza GAP ichachengetedzwa, zvichikonzera kunonoka kana kusapora kupora;

Kana kukanganisika kuri nyore kusiri kugadzirwazve uye kwakamanikidzwa, mutoro unopfuudzwa neplate, zvichikonzera kushushikana kwekushushikana uko kunogona kutungamira kuputsa ndiro.

3. Yakakura biomechancal mutsauko pakati pekuvhara mahwendefa uye mahwendefa akajairwa

Mahwendefa akajairwa anovimba nekekupokana pamhirizhonga yepafupa kuti azadzise mundiro yemapepa.

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1.Kudhonza-kunze kwekuramba kwekuvhara zviyero zvakakwira zvakanyanya kupfuura izvo zvezvakajairwa screws.

2. Iyo epiphyseal screws inokatyamadza kune mumwe nemumwe, inowedzera zvikuru kupokana kwechidimbu kuPulombe kuenzaniswa neyakafanana.

(B) dzidziso yekushandisa

1. Nheyo dzekusaxbilation:

● Pressurization nheyo: Osteoporotic diaphysis bracture

● Nheyo yerarorization: Osteoporotic diaphysis bracture

● Kutamba kwepamutemo: Comminuted diaphysis kana kuwedzera-kujairika metaphyseal kuputswa

Nheyo yeMubatanidzwa: Commined Intra-Articular Metaphyseal Fracture

2. Bridging Nheyo:

● Chaizvoizvo nzira: Percutaneous miviri inosangana neplate fixation (Mipo kana Mippo maitiro)

● Kuderedza kuderedza maitiro

● Nekugadziriswa kwakaringana.

3.Princples of Union:

● Kusanganiswa nekushandiswa kwezvinhu zviviri zvebhumarani zvekumanikidza uye kudzvanywa mune imwe chete ndiro - kuvhara cannservesmed. Lcp)

● Zviripachena zvakareruka mune chimwe chikamu chekupwanya uye kufambidzana kwakarukwa mune imwe (semuenzaniso, makona ekutungamira kweiyo metaphysis, diaphyis)

● Nheyo yemubatanidzwa inofanirwa kungoiswa kune mahwendefa ayo anobvumira kuiswa kwekuiswa kwemaviri kuvhara musoro screcrecs pamwe nezviyero zvakajairika.

Mahwendefa ekuvhara haavimbi nekupokana pakati pefudzi-mundiro yemapapu uye rakatsvuka pane iyo interface pakati peClrew uye ndiro neAngul Kugadzikana kuti urambe wakasimba.

Nekuda kwekubatana kwavo kwakasimba, simba rekutsamwa rezviyero nekuvhara misoro yakakwirira kwazvo kupfuura iyo yematanho akajairwa, kunze kwekunge zviyero zvese zvakatenderedza zvinobviswa kana kutapurwa. Kazhinji, zvakaoma kuti screw imwe ibviswe kana kubhururuka ndeyako. Kuvhara musoro screws haigovanise-fold-fol poldurization. Kuvanikidzwa kunogona kuwanikwa nekushandisa mudziyo wekutonheta kana kutyaira nguva dzose zvidimbu mu \

1.Kana standard screws yakashandiswa kuchengetedza iyo splint (eg 1), screwing mune yekuvhara screws ichave nyore kwazvo (eg 2).

2.Far Locking Screws dzave dzichichengetedza splint uye pfupa (semuenzaniso, 1), hazvikurudzirwe kuti zviyero zvepfupa.

3.Kunyoro metaphyseal block block ine screw nemusoro wekuvhara (LHS), kugadziriswa kwechidimbu

(C) zviratidzo uye zvinokanganisa

1. Zviratidzo

Vazhinji vanobatwa zvakabatwa fractures hazvidi kuvharira plate fixation. Chero bedzi nheyo dzekuvhiya kweOrthopedic inoteverwa, zvidimbu zvakanyanya zvinogona kuporeswa nemabhesi akajairwa kana mumusoro wenguva dzose.

Nekudaro, kune mamwe marudzi ezvakakanganisika kuti anorasikirwa nekudzikiswa, ndiro kana screw kuputsa, 'zvinyararire, Aya marudzi okupwanya anowanzo kutaurwa se 'zvisina kugadziriswa ' kana 'zvinetso Aya maFraints zvese zvinoratidza mahwendefa ekuvhara.

Iyo yekare uye yakakodzera chiratidzo chekuvhara plate yekukatyamara ndeyekupaza mari uye musimboti wezvekuita zvidimbu zvezvakakomberedzwa - zvakakwirira-simba zvevarwere vevarwere kana mapundu evarwere vevarwere.

2. Kukanganisa

Kunyangwe mahwendefa ekuvhiya akashandiswa zvakanyanya uye zviratidzo zvavo zviri preated, isu tinofanirwa kuziva uye kudzivirira kupesana kwakawanda kune mahwendefa ekuvhara. Kana mahwendefa ekuvhara anoshandiswa anoshandiswa zvisina tsananguro, kutadza kwekugadziriswa uye kusaziva kwekupwanya kunogona kuitika.

Zvikanganiso zviri nyore izvo zvinoda kukanganisika kumanikidzwa, sekuti sekureruka kwemberi stem fractures kurapwa nekuvhara nzvimbo yemukati, vanowanzobatana.

Saizvozvovo, kuiswa kwezvinangwa zvekuvhara mahwendefa ekureruka achishandisa nzira dzinopindwa mikana zvakare inosanganisa.

Kusarongeka kwekudzikisira uye kukiya plate yekugadziriswa zvakare haina kukodzera kutariswa intra-articular fractures, izvo zvinoda kuvhura omatomical kudzikisira uye kumanikidza pakati pezvimedu zvinokatyamadza uye kugadziriswa kwakasimba.

Kudyidzana kwehukama kune mahwendefa ekuvhara, nekuda kwemutengo wavo wepamusoro, zvidimbu zvinogona kuiswa zvinogutsa nemahwendefa akajairika. Semuenzaniso, fractures yerufu rweSymphysis ine huwandu hwekupora hwakawanda kupfuura 90% paakarapwa nemahwendefa akajairwa.

(D) kuisirwa kwekukiya ndiro

1. Screw the drill bit mumapundu emakona emapuranga. Kutsauka kwe> 5 ° pakati peScrew uye gomba gomba kunogona kutungamira mukukundikana kweScrew kuvhara, uye zvinokurudzirwa kushandisa dhizaini yekukwevera kudhiraivha.

2. Isa iyo simbi ndiro pamusoro pepfupa uye kugera maburi kuburikidza neyekutsiura sleeve.

3. Kuyera kudzika nehuremu hwakadzika, uchichengetedza kuti musoro wejira unoiswa mugomba rakatsetseka.

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5. Kuisirwa kweiyo yakamanikidzwa screws yakafanana neyakajairika simbi mahwendefa.

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(E) kuvhara ndiro yekubvisa

Clinical Locking Plate inoshandiswa zvakanyanya, asi ichisangana nekubvisa matambudziko ekubvisa, zvinonyanya kuratidzwa muCSPL Slipping waya uye zvipikiri zviviri uye plate gomba tambo pakati pebhisiki isiriyo.

1. Screw cap groove kukuvara

Mumamiriro ezvinhu akajairika, iyo yakazara screw cap groove uye iyo inoenderana screwdriver inoenderana. Iyo screwdriver inofanira kuenderana neiyo screw cap groove isati yasvika screw kusimuka kana kuti kana zvikasadaro screw cap groove iri mukana wekuputika mukati kana kusvetuka kunze, zvichikonzera kuderera.

Mukuwedzera, mushure mekupora kupora, iyo screw cap notch inowanzo kuputirwa nemhombwe kana kuti inofanirwa kucheneswa isati yafa, iyo screw cap notch uye maAngar chimiro chinogona kunge chakakuvara.

Nekuti iyo yekutenderera axis yemufudzi yeiyo isingashandurwe neiyo Screwdriver's refu axis, pane iyo imwe kona yakakwenenzverwa, inokonzerwa nekukuvadzwa kweiyo cap grow yekukonzeresa screw nekuda kwesimba risina kuenzana. Naizvozvo, kukuvadzwa kweiyo screw groove kunogona kutungamira nyore nyore kuti screw kutsvedza.

2.

Mukuita kwekushandiswa kwekunzwa kweAnatomical kuvhara simbi simbi, apo neapo maererano nekudikanwa kwekukotama kwakakodzera kana kuumbwa kweiyo simbi ndiro, raja et al. Tenda kuti kana chikamu chekukotama chikaitika mumaputi ekuvhiya, kana zvichikwanisika padhuze nepamhepo.

3. Kushandiswa kwekuzvisarudzira kukosora zvipikiri zvipfupi

Nekuti pfupa rechechi rinokura mukati nepamaira gomba uye nekudaro richabata chikwangwani, zvichitungamira mukunetseka nekuregedza Usakurudzira kushandiswa kwekuzvibata-kurongedza zviyero kune maviri kortiki yekugadzirisa. Hou yunfei et al. yakakurudzira kuti zvisina basa biticical bixation ine zviyero zvinofanirwa kudzivirirwa kumucheto kwepamusoro mhedziso, uye maehara et al. Zvakare zano rekuti nguva zhinji kushandiswa kwezvibodzwa zvinokonzerwa nekuvandudzwa kana uchishandisa mahwendefa ekuvhara, uye kuti pane kudiwa kwekutanga mamiriro ezvinhu epasirese yekusarudza uye kushandiswa kwekuvhara screws.

4. Chimiro uye nzvimbo ye screws

Saizi, kutaridzika, uye nzvimbo yekuvhara screw inogona kukanganisa kubviswa kweiyo screw. Vamwe vadzidzi vakaona kuti kana iyo screw isiri pakati pegomba rekuvhara, kana tambo yechipikisi checrew

5.6cld Welding

Zvakajairika Titanium Yemukati Fixation ine dhizaini yekudzivirirwa 2 Metal International Scource pakati peiyo substantity yekuwonana pfungwa ichanamatira, kureva kuti kuumbwa kwekutonhora.

Mukuwedzera, maGalanic coupling pakati pevasimbi ion, kusanganisa, etc. inogona zvakare kukurudzira kuumbwa kwechitonhora. Vazhinji vagadziri vemukati mechigadzirwa vanozivawo dambudziko iri, uye saka zvisina kushandiswa kubhadhara mahwendefa emabhiza ehupfumi uye anovavarira kuti mitezo uye adsorption yemuviri uye kuderedza chiitiko chekutonhora.

(F) Kubvisa maitiro

Maitiro ekubvisa anotaurwa mumabhuku eNational uye epasi rose anogona kukamurwa kuita zvikamu zviviri, zvinonyatsoshandiswa uye zvinoshanda, hunyanzvi hwekushaikwa, uye chekupedzisira chinoda zviridzwa zvine hunyanzvi uye zvishandiso zvakakosha.

Maehara et al. Kupa zano uchishandisa torque-kudzikisira screwdrivers ine shanks yakakura pese pazvinogoneka. Paunenge wasangana neakatsvedza screws, pattison et al. Inoshuma nzira yakapfava yekubvisa slweed screws nekuputira musoro we screwdriver ine platin simbi uye nekuisa iyo mu groove ye screw cap. Iyi nzira yakangwara kuzadza iyo screw cap groove ine simbi foil uye kuwedzera nzvimbo yekunyepedzera uye kupfava pakati pe screwdriver uye iyo Groove, iyo inofambisa kubviswa kwemasvomhu nemitsetse yakatsvedza. Nenzira iyi ichiri yakaoma kubvisa nyaya yacho, kana iyo screw cap uye simbi plate gomba renji remoever

Padunhu, vamwe vanovhara mitezo vachiri kuoma kuti vabudirire kushandisa conical reverse screw inowedzera, senge ehlinder et al. uye bae et al. uyo akawana kuti nzira iyi yaiwanzobudirira ye3,5 mm screw slipage, asi kazhinji isingabatsiri ne4,5 mm mm screw slippage. Mune ino kesi, kwete yega yega yechipatara erthopeics ine nyanzvi yesimbi yekukuya yakakwenenzverwa senge madhiri emakondo, madhaimondi madhiraivha, kana yakakwira-kumhanya mhepo yekukwevera.

Gopinathan et al. Suma nzira isingabvumire izvi zvishandiso zvekutaurisa nekumwe kudzikisira mari yekuvakirwa, zvekuti svutugadzike uye chipangamabwe chivharo chemucheka chidiki chidiki, uye zviyero zvinogona kubviswa zviri nyore. Iyi nzira inongoshanda chete kune titanium yekuvakazve mahwendefa ane mahwendefa akaderera, uye 1/3 tube-mhando mahwendefa akafara kana mahwendefa emugumo mumugumo wezasi.

Nzira iri nyore yave ichirondedzerwa zvakare iyo yakakura drill kudhiraini inoshandiswa kugeza gomba riri padhuze nekupfekedzwa kwemapepa akaiswa pasi peplate uye pry

Ehezve, pane mukana wekukuvara kwepfupa nenzira iyi, saka dziviriro yekuremerwa inorema inokurudzirwa. Uye zvakare, zvinodikanwa kuti ugadzire zvimwe zvinowanzoshandiswa zvishandiso zvekushomeka kwemukati kusati kwaitika, senge bolt Extractor

Pamberi pekuvhara screw inotsvedza yekubvisa matambudziko ekutsvedza, vamwe vadzidzi vanokurudzirwa kuti vachinje nzira yegomba, '' '' '' '' '' '

Ehlinder et al. Yakashuma kuti mune iyo contical reverse screw inowedzera kuendesa kuClrew by screw by simbi iri mumapani wechiSimbi.

Georgiadis et al. Riah et al. Kukurudzirwa muCSREG uye STEEL PLATING YAKAITWA KWAKAITWA, DZINOGARA DZINOGARA DZESVONDO DZESVONDO RAKATAURWA SELAred.

Kumar uye Dunlopl yakataura muakanaka femur inovhara simbi yemukati Screw Screwd. Iyo incision, usavhura iyo simbi plate gomba rekuzadza cap, kuitira kuti kubviswa kwakabudirira kwekuvhara screws.

Izvo zvakakosha kuti uzive kuti nzira dziri pamusoro dzinofanirwa kufambira mberi zvishoma nezvishoma sezvinobvira panguva yekucheka kana kugeda kwedanda rekumhanyisa kudzivisa mumusoro wechikepe uye kukuvadza pfupa uye zvakapfava. Uye zvakare, maitiro aya anogona kugadzira tembiricha yakakwira uye marara esimbi, izvo zvinogona kuguma nengozi yakawedzera yekudzora yakadzora-kupwanyika, tishu thermal necrosis, uye hutachiona.

(G) pfupiso

■ Bvumira isina kukwana plate kusangana neiyo periostum

■ Ndima yacho inofanira kuiswa kusasimudzirwa isati yavhara, sezvo iyo bracture isingakwanise kuiswa mushure mekuvhara.

■Locking plate can not be pressurized, need to use a pressurizer or centrifugal screwing in the union hole into the ordinary screw, first pressurized, then locking

.. .. uye

■ Kugadziriswa kwemocortical kwe diaphysis kana gobvu pfupa cortex, uye gadziriro yepafupa rakanaka; uye

■ Akangovharwa, haigone kutsigirwa kunze, nepo yakajairika screws inogona kutsigirwa kunze

■ Kugadziriswa kwakasimba uye zviyero zvakawandisa zvinogona kutungamira kune nonunion; Iyo nheyo ndeyekuti mahwendefa anofanirwa kuve akareba uye mashoma mashoma anofanirwa kushandiswa; Mukurapa kwePeriarticular Fractures, mashoma screws anofanirwa kuiswa kune tsinde uye zvimwe zviyero zvinofanirwa kushandiswa kugadziriswa kupokana neyekurovera pasi

■ Kureba kwendiro yekubheka kunofanirwa kuve kaviri kureba kwenzvimbo inokatyamadza, zviyero zvinofanirwa kugoverwa zvakanyanyisa, uye kugadziriswa kwakanaka kunofanirwa kunge kuri kuburikidza-iyo-iyo-yekugadzirisa

■ Kumanikidza kunoparadzirwa zvakanyanya pamusoro pechimwe ndiro refu, uye kugadziriswa ne screws vashoma kunogona kukurudzira scab scab uye kusimudzira kupora kwepfupa.