Tšebeliso e Nepahetseng ea Locking Plate!

A Locking plate ke sesebelisoa sa ho lokisa fracture se nang le lesoba le khoele. Ha screw e nang le hlooho e khoele e kengoa ka mokoting, poleiti e fetoha sesebelisoa sa ho lokisa (screw) angle angle. Polete e notlelang (e tsitsitseng) e ka ba le likoti tse notlelang le tse sa notleleng bakeng sa likurufu tse fapaneng tse tla kengoa ho tsona (tseo hape li bitsoang poleiti e kopantsoeng). Kaha khopolo ea lipoleiti tsa ho notlela e ne e hlahisoa 'me e sebelisoa ho phekola ho robeha, e' nile ea sebelisoa haholo ho lokisoa ha fractures ea periarticular, comminuted le osteoporotic fractures ka lebaka la melemo ea eona ea ho fana ka ts'ehetso e tsitsitseng le ho lokisoa ha fractures, tekanyo e phahameng ea pholiso ea fracture, tšenyo e fokolang ea lisele tse bonolo le ho senyeha ha mali. 'Malo oa kajeno oa hoseng o tla u fa kenyelletso e qaqileng ea lipoleiti tsa ho notlela, tseo ho leng bohlokoa ho ithuta ho tsona!

(A)Tlhahlobo ea Motheo

1.Letlapa la ho notlela ke eng?

Poleite efe kapa efe ea tšepe e ka kengoang ka li-angle fixing/angle stabilizing screws kapa phini ha e le hantle ke poleiti e notlelang.

2. Melemo le melemo ea ho notlela lipoleiti

Melemo

■ Ho tsitsa ha angular, ho hanyetsa ho kobeha le ho torsion

■ Sebopeho sa conical sa screw head se ntlafatsa kabo ea mochini

■ Fana ka ho kenya radial preload, thibela ho ts'oaroa ha masapo le ho lokoloha

■ Sebopeho sa anatomical ho lumellana le mekhoa ea tlhaho ea tlhaho

■ Li-template tse tsamaellanang ho lumella hore ho be le percutaneous fixation ho diaphysis (cortical e le 'ngoe, ho itšeha, li-self-tapping locking screws)

■ Li-screws tse notlelang li fana ka tšubuhlellano e ntle bakeng sa borokho bo tenyetsehang le ho tsitsa ka ho felletseng.

■ Ha ho hlokahale ho kopana haufi-ufi le bokaholimo ba lesapo, ho boloka phepelo ea mali

■Ho laola micromotion, ho thusa ho fola ha fracture

■Ka kakaretso ha ho hlokahale ho hlomathiseletsoa masapo

E sebetsa haholo bakeng sa fractures ea osteoporotic kapa fractures efe kapa efe e sa tsitsang haholo.

Mefokolo

■ Li-screws tsa ho notlela ha li na phello ea ho fokotsa le ho hatella, haholo-holo ho fractures ea intra-articular kapa fractures e bonolo ea oblique.

■ Poleiti e ke ke ea sebelisoa e le sesebelisoa sa ho fokotsa ho thusa ho fokotsa.

■Likurufu ha li utloahale hantle joaloka likurufu tse tloaelehileng ha li kentsoe.

■Taelo ea li-screw e ke ke ea lokisoa (ntle le li-screws tsa ho notlela tse ngata).

■Likurufu li behiloe ka thata haholo, e leng se ka lebisang ho 'chelleng e batang'.

■ Ho kheloha ha angle > 5°, ho felloa ke matla; > 10 °, phello ea ho koala ha e sebetse

■ Ho ka etsahala hore ho be le protrusion ea subcutaneous haeba poleiti e sa koaheloa

Litaba tsa ho satalla

Ntle le ho kopana ha cortical e ntle kapa ho hatelloa ha lipheletso tsa fracture, tšebeliso ea lisebelisoa tsa ho koala, haholo-holo lisebelisoa tsa tšepe tse sa hloekang, li tla thibela pholiso ea karolo ea II ea ho robeha ka lebaka la ho tsitlella ho feteletseng le ho felisoa ha micromotion e ntle sebakeng sa fracture;

Haeba ts'ebetso ea intraoperative e sebelisoa 'me joale ho lokisoa ha splint ho kenngoa, lekhalo la ho robeha le tla bolokoa, le fella ka ho lieha kapa ho se na pholiso ea ho robeha;

Haeba fracture e bonolo e sa tsosolosoe hape e hatelloa, mojaro o fetisoa ka poleiti, e leng se etsang hore ho be le khatello ea kelello e ka lebisang ho senyeha ha poleiti habonolo.

3. Phapang e kholo ea biomechanical pakeng tsa lipoleiti tsa ho notlela le lipoleiti tse tloaelehileng

Lipoleiti tse tloaelehileng li itšetlehile ka ho khohlana ha lesapo la lesapo ho finyella ho hatella lesapo.

4. Melemo e bapisoang ea poleiti ea ho notlela le poleiti e tloaelehileng ea tšepe

1.Ho hanyetsa ho hula ha li-screws tsa ho notlela ho phahame haholo ho feta li-screws tse tloaelehileng.

2. Li-screws tsa ho notlela tsa epiphyseal li na le angled ho tse ling, e leng se eketsang haholo khanyetso ea screw ho hula ha e bapisoa le li-parallel screws.

(B) Melao-motheo ea tšebeliso

1. Melao-motheo ea ho sitisa:

● Molao-motheo oa khatello ea kelello: ho robeha ha lefu la osteoporotic diaphysis

● Molao-motheo oa ho se nke lehlakore: osteoporotic diaphysis fracture

●Molao-motheo oa ho koala: ho senyeha ha diaphysis kapa ho robeha ha metaphyseal e eketsehileng.

Molao-motheo oa bonngoe: ho robeha ha metaphyseal ka intra-articular

2. Molao-motheo oa ho koala:

● Mokhoa o tloaelehileng: percutaneous minimally invasive plate fixation (MIPO kapa mokhoa oa MIPPO)

● Mokhoa oa ho fokotsa ka tsela e sa tobang

● Bakeng sa ho lokisa poleiti e lekaneng, likoti tse 3-4 tsa screw li lokela ho siuoa li butsoe haufi le ntlha ea ho robeha.

3. Melao-motheo ea kopano:

● Tšebeliso e kopanetsoeng ea melao-motheo e 'meli ea biomechanical ea ho hatella le ho koala borokho ka poleiti e le 'ngoe - locking compression plate (LCP)

● Ho robeha habonolo karolong e 'ngoe ea ho robeha le ho fokotseha ho hoholo ho e 'ngoe (mohlala, ho robeha ho sa feleng ha metaphysis, diaphysis)

● Molao-motheo oa bonngoe o lokela ho sebelisoa feela ho lipoleiti tse lumellang ho behoa ha li-screws tsa hlooho tse notlelang hammoho le li-screw tse tloaelehileng.

Lipoleiti tse notlelang ha li itšetlehe ka khohlano lipakeng tsa sehokelo sa lesapo la lesapo 'me li itšetlehile haholo-holo holim'a sehokelo se pakeng tsa screw le poleiti e nang le botsitso ba angular ho boloka botsitso.

Ka lebaka la bonngoe ba bona bo tsitsitseng, matla a ho ntša li-screws tse nang le lihlooho tse koalang li phahame haholo ho feta li-screw tse tloaelehileng, ntle le haeba li-screw tsohle tse potolohileng li ntšoa kapa li robehile. Ka tloaelo, ho thata hore screw e le 'ngoe e ntšoe kapa e robehe ka boeona. Li-screws tsa hlooho tse notlelang ha li fane ka khatello e lipakeng. Ho hatella ho ka fumanoa ka ho sebelisa sesebediswa se hatellang kapa ka ho kganna dikurufu tse tlwaelehileng ho 'mixing holes' (dikurufu tsa tsitsipano pele, ebe ho notlela manala).

1. Haeba li-screws tse tloaelehileng li sebelisitsoe ho tiisa lekhalo (mohlala, 1), ho tlaba bonolo haholo (mohlala, 2).

2.Haeba li-screws tsa ho notlela li sebelisitsoe ho tiisa splint le lesapo la masapo (mohlala, 1), ha ho khothalletsoe hore li-screw tse tloaelehileng li kenngoe ka har'a boloko bo tšoanang ba masapo (mohlala, 2) ntle le haeba li-screws tsa ho notlela li lokoloha 'me li tiisoa hape (LHS).

3. Hang ha sekhahla sa metaphyseal fracture se sirelelitsoe ka sekoti se nang le hlooho e koalang (LHS), ho lokisa khatello pakeng tsa li-blocks tsa fracture ho finyelloa ka ho phunyeletsa sekoti se tloaelehileng ka har'a lesoba la khatello ea matla ea motsoako oa Locking Compression Plate LCP.

(C) Lipontšo le li-contraindications

1. Lipontšo

Boholo ba fractures tse phekoloang ka ho buuoa ha li hloke ho lokisoa ha poleiti ea ho notlela. Hafeela melao-motheo ea ho buoa masapo e ntse e lateloa, likarolo tse ngata tsa ho robeha li ka phekoloa ka lipoleiti tse tloaelehileng kapa ho kokotela ka har'a intramedullary.

Leha ho le joalo, ho na le mefuta e itseng ea fractures e kotsing ea ho lahleheloa ke phokotso, plate kapa screw breakage, le nonunion e latelang, e atisang ho bitsoa 'ho sa rarolloe' kapa 'mathata' fractures, ho kenyelletsa le fractures e entsoeng ka intra-articular, fractures ea periarticular le fractures e nyenyane ea masapo, le masapo a manyenyane. Mefuta ena ea fractures hangata e bitsoa 'e sa rarolloang' kapa 'bothata' fractures 'me e kenyelletsa fractures ea intra-articular comminuted, periarticular short tuberosity fractures le osteoporotic fractures. Lithako tsena kaofela ke matšoao a ho notlela lipoleiti.

Lipontšo tsa khale le tse loketseng bakeng sa ho lokisa poleiti ea ho robeha ha fractures ke molao-motheo oa bridging le molao-motheo oa bonngoe bakeng sa fractures e eketsehileng - ho robeha ho matla ho bakuli ba banyenyane kapa ho robeha ha masapo ho bakuli ba hōlileng.

2. Contraindications

Le hoja lipoleiti tsa ho notlela li 'nile tsa sebelisoa haholo' me matšoao a tsona a pharaletseng, re tlameha ho lemoha le ho qoba li-contraindications tse 'maloa tsa ho notlela lipoleiti. Haeba lipoleiti tsa ho notlela li sebelisoa ka mokhoa o sa khetheng, ho hlōleha ha ho lokisa le ho se kopane ha fracture ho ka etsahala.

Lithako tse bonolo tse hlokang ho hatelloa ha li-interbody, tse kang ho robeha ha forearm stem fractures tse tšoaroang ka ho notlela ka hare, li atisa ho se kopane.

Ka mokhoa o ts'oanang, ho beoa ka percutaneous ea lipoleiti tsa ho notlela bakeng sa fractures tse bonolo ho sebelisa mekhoa e fokolang e hlaselang hape ke contraindication.

Phokotso e sa tobang le ho lokisa poleiti ea ho notlela le eona ha e tšoanelehe bakeng sa fractures e pharalletseng ea intra-articular, e hlokang phokotso e bulehileng ea anatomical le khatello lipakeng tsa likhechana tsa fracture le ho tiisa ka thata.

Khanyetsano e lekanyelitsoeng ho lipoleiti tsa ho notlela, ka lebaka la litšenyehelo tsa tsona tse phahameng, ke fractures e ka lokisoang ka mokhoa o khotsofatsang ka lipoleiti tse tloaelehileng. Ka mohlala, ho robeha ha forearm symphysis ho na le tekanyo ea pholiso ea ho feta 90% ha e phekoloa ka lipoleiti tse tloaelehileng.

(D) Ho kenngoa ha poleiti ea ho notlela

1. Kenyelletsa karoloana ea boro ka har'a masoba a screw a poleiti. Ho kheloha ho> 5° lipakeng tsa screw le screw hole ho ka lebisa ho hloleheng ha ho notlella ha screw, 'me ho khothaletsoa ho sebelisa sebono ho phunya masoba ka ho khetheha.

2. Beha poleiti ea tšepe holim'a lesapo 'me u phunye likoti ka letsoho la ho phunya.

3. Lekanya botebo ka molumo o tebileng oa molumo, u hlokomele hore hlooho ea molumo e kenngoa ka har'a lesoba la screw.

4. Khetha bolelele bo loketseng ba sekoti sa ho notlela.

5. Ho kenngoa ha li-screws tse hatelitsoeng ho tšoana le lipoleiti tse tloaelehileng tsa tšepe.

6. Qetellong tiisa li-screws tsa ho notlela ka mochine oa torque, ha o tiisitsoe, ho tla ba le boikutlo bo hlakileng ba ho thella le molumo oa ho phunya, ho qoba ho phunyeletsa ka thata haholo, ho fella ka mathata a ho tlosa.

(E) Ho tlosa lipoleiti tsa ho notlela

Li-screw plate tsa kliniki li sebelisoa haholo, empa ho na le mathata a ho tlosa habonolo, haholo-holo ho terata e thellang le sekoaelo sa manala le likhoele tsa lesoba la lipekere lipakeng tsa sekoti se fosahetseng.

1. Tšenyo ea Screw cap groove

Tlas'a maemo a tloaelehileng, 'screw cap groove' e felletseng le screwdriver e tsamaellanang. The screwdriver e lokela ho tsamaisana le screw cap groove pele e kenya kapa e tlosoa, ho seng joalo 'screw cap groove' e ka 'na ea holofala nakong ea ho screwing kapa ho screwing, e leng ho etsang hore ho thellehe.

Ho phaella moo, ka mor'a ho fola ha fracture, 'screw cap notch' hangata e phuthetsoe ka lesapo kapa lesela la fibrous, le lokelang ho hloekisoa pele le tlosa screw, empa haeba ho sa hlokomeloe, 'screw cap notch' le sebopeho sa angular se ka senyeha ka maiketsetso.

Hobane ntlha e potolohang ea forearm ea opareitara ha e tsamaellane le axis e telele ea screwdriver, hangata ho na le angle e itseng, ha opareitara a ne a senya sekoti ka matla, ho ke ke ha qojoa hore screwdriver e sisinyehe, e bakang tšenyo ea cap groove ea screw ka lebaka la matla a sa lekaneng. Ka hona, ts'enyehelo ea 'screw groove' e ka lebisa ho thellang habonolo.

2. Sekoahelo sa Nail kapa deformation ea lesoba la sepekere

Ts'ebetsong ea ts'ebetso ea ts'ebetso ea poleiti ea tšepe ea anatomical, ka linako tse ling ho latela tlhoko ea ho kobeha ho loketseng kapa ho bopa poleiti ea tšepe, Raja et al. lumela hore haeba karolo e kobehang e etsahala ka masoba a ho notlela sekorufu, ha screwing ka sekurufu notlela e tla ba screw cap le nail lesoba mismatch, e leng ntho e ka etsahala haholo ho etsahala pakeng tsa Nail cap, le tšepe poleiti Nail masoba likhoele fosahetse, kapa screwed haufi le poleiti tšepe ha mohatla oa lenala deformation bakoang ke screwing e matla, joalo-joalo, e leng ho ka 'na ha tlosoa ka mor'a nako e thata, e leng ho ka 'na ha tlosoa.

3. Kopo ea ho iketsetsa lipekere tsa ho notlela cortical

Hobane lesapo la cortical le hola ka har'a lesoba la lenala 'me kahoo le tla tšoara screw, e leng se lebisang mathateng a ho tlosoa ha screw, haholo-holo ts'ebeliso ea li-screw tse peli tsa cortical bone, Suzuki et al. u se ke ua khothaletsa tšebeliso ea li-screws tsa ho itšebetsa bakeng sa ho lokisa cortical habeli. Hou Yunfei et al. o ile a fana ka tlhahiso ea hore ho lokisa li-bicortical tse sa hlokahaleng ka li-screw ho lokela ho qojoa bakeng sa ho robeha ha karolo e ka holimo, le Maehara et al. e boetse e fana ka tlhahiso ea hore tšebeliso ea khafetsa ea li-screws tsa ho notlela e lokela ho qojoa ha ho sebelisoa lipoleiti tsa ho notlela, le hore ho hlokahala hore ho thehoe maemo a akaretsang bakeng sa khetho le tšebeliso ea likurufu tsa ho notlela.

4. Sebopeho le sebaka sa li-screws

Boholo, mokhoa, le sebaka sa screw ea ho notlela li ka ama ho tlosoa ha screw. Litsebi tse ling li fumane hore haeba screw e sa fumaneha bohareng ba lesoba notlela, hang ha Nail lesoba eccentricity tse fetang 5 ° ho ka 'na ba hlephileng screw fixation, likhoele fosahetse buckle kapa Nail mohatla deformation khomaretse le lebisa ho hloleha ho fixation kapa karolo ea bobeli ea ho tlosoa ha mathata.

5.Ho tjheseletsa ho batang

Tloaelehileng titanium ka hare fixation holim o na le mposo ya passivated lera sireletsang, ka tshebetso ya ho buoa placement ea fixation ka hare, ka lebaka la ho lithulusi tsa ho tšoara le ho bōptjoa, kapa hlooho ea sekoti le khohlano pakeng tsa poleiti tšepe, joalo-joalo, ka 'na lebisa ho passivated lera lera apara sebakeng seo. 2 tšepe kopana holim 'a pakeng tsa substantive ho kopana ntlha tla khomareloa, ke hore, sebopeho sa batang tjheseletsa.

Ho phaella moo, ho kopanya galvanic pakeng tsa li-ion tsa tšepe, liketso tsa ho ruruha, joalo-joalo li ka boela tsa khothalletsa ho thehoa ha li-welds tse batang. Bahlahisi ba bangata ba lisebelisoa tsa ho lokisa ka hare ba boetse ba tseba bothata bona, 'me ka hona, lipoleiti tsa tšepe tse sa sebelisoeng li koahetsoe ke theknoloji ea filimi ea oxide pakeng tsa likoti tsa lipekere le li-screw contact surfaces, tseo hape li ikemiselitseng ho thibela ionization le adsorption ea liprotheine' meleng le ho fokotsa ketsahalo ea li-welds tse batang.

(F) Mekhoa ea ho tlosa

Mekhoa ea ho tlosa e tlalehiloeng libukeng tsa naha le tsa machaba e ka aroloa ka mekhahlelo ea 2, e leng, e bonolo le e sebetsang le e rarahaneng, ea pele e khetholloang ke ho fumaneha habonolo, ho sebetsa, tšenyo e tlaase ea lisele tse bonolo, tsebo e tlaase le ho se hloke lisebelisoa tse khethehileng, 'me e qetellang e hloka lisebelisoa tse khethehileng le lisebelisoa.

Maehara et al. etsa tlhahiso ea ho sebelisa li-screwdrivers tse fokotsang torque tse nang le shank tse kholo neng kapa neng ha ho khoneha. Ha a tobane le li-screw tse thellang, Pattison et al. e tlalehile mokhoa o bonolo oa ho tlosa li-screw tse thellang ka ho phuthela hlooho ea screwdriver ka tšepe ea platinum le ho e kenya ka har'a groove ea 'screw cap'. Mokhoa ona o bohlale ho tlatsa sekoti cap groove ka tšepe foil le ho eketsa sebaka sa ho kopana le khohlano pakeng tsa screwdriver le groove, e leng ho nolofalletsang ho tlosoa ha li-screw ka likhoele tse thellang. Ka mokhoa ona ho ntse ho le thata ho tlosa sekoahelo, haeba sekoahelo sa sekoti le likhoele tsa tšepe tsa tšepe li ntse li le teng, u ka leka ho sebelisa 'conical reverse tapping screw remover', ke hore, ho tloha ho 'screw cap' groove e kentsoeng ka ho penya ka morao le ho tlatsa groove, nakong ea ho potoloha le ho hatella screw ho tsoa.

Ka lehlakoreng le ka tlase, li-screws tse ling tsa ho notlela li ntse li le thata ho sebetsa ka ho sebelisa 'conical reverse tapping screw extractor', joalo ka Ehlinger et al. le Bae et al. ba fumaneng hore mokhoa ona hangata o sebetsa bakeng sa ho thella ha 3.5 mm, empa hangata o ne o sa sebetse bakeng sa 4.5 mm screw slippage. Tabeng ena, ha se sehlopha se seng le se seng sa lingaka tsa masapo tsa sepetlele se nang le lisebelisoa tse khethehileng tsa ho sila tsa tšepe tse kang liboro tsa carbide, li-drill tsa taemane, kapa mabili a silang a lebelo le phahameng.

Gopinathan et al. hlahisa mokhoa o sa hlokeng lisebelisoa tsena tse khethehileng ka ho tlaleha nyeoe ea ho tlosoa ha sekoti ka thata ho tloha poleiting ea ho haha ​​bocha, ke hore, ka ho sebelisa sekheo se tlaase sa poleiti ea kaho, seha se seholo sa terata se sebelisetsoa ho kuta karolo e nyenyane ea poleiti pakeng tsa likoti tsa lipekere, e le hore li-screw le karolo ea lesoba la sepekere li thehe yuniti e nyane, 'me lesela le ka tlosoa habonolo. Mokhoa ona o sebetsa feela ho lipoleiti tsa ho notlela tsa titanium, lipoleiti tsa ho notlela forearm tse nang le li-notch tse fokolang, le lipoleiti tsa mofuta oa 1/3, 'me li ke ke tsa sebelisoa bakeng sa lipoleiti tse pharaletseng kapa tse teteaneng karolong e ka tlaase.

Ho boetse ho hlalositsoe mokhoa o bonolo oo ho oona ho sebelisoang sekoti se seholoanyane ho phunya lesoba lesobeng le tloaelehileng le haufi le sekoti sa ho notlela se thellehileng, ebe poleiti le kururufu li kengoa ka nqa ea lesoba le tloaelehileng le sa tsoa chekoa, ebe poleiti le screw li ntšoa ka ho sebelisa sekhechana sa masapo se behiloeng ka tlas'a poleiti le ho e phunya ka molao-motheo oa ho e phunya.

Ha e le hantle, ho na le monyetla oa ho senya masapo ka mokhoa ona, kahoo ho khothalletsoa tšireletso ea boima ba 'mele ka mor'a ho buuoa. Ntle le moo, ho boetse hoa hlokahala ho lokisa lisebelisoa tse ling tse sebelisoang hangata pele ho ts'ebetso ea ts'ebetso ea ts'ebetso ea ka hare, joalo ka bolt extractor, hole reamer, screw extraction pliers, T-type pressurized socket joalo-joalo.

Ha a tobane le mathata a ho tlosa terata e thellang, litsebi tse ling tsa malapeng li ile tsa etsa tlhahiso ea ho fetola mokhoa oa groove, ke hore, tšebeliso ea mochine oa lehlabathe oa lehlabathe la menoana ho fetola 'screw cap groove' hexagonal kapa quadrangular groove bakeng sa 'groove' e le 'ngoe kapa 'leshome', kapa ho tebisa groove ea pele.

Ehlinger et al. e tlalehile hore maemong ao sekoti sa conical reverse tapping screw se ntse se na le bothata ba ho tlosa screw, ho ile ha khothaletsoa hore poleiti ea tšepe e ka ntšoa ka ho senya hlooho ea screw ka ho sila le ho holisa masoba a lipekere ka har'a poleiti ea tšepe, ebe 'mele oa screw o ka ntšoa ka ho sebelisa sakha ea lesale.

Georgiadis et al. le Raia et al. sisintsweng ka sekoti le tšepe poleiti motsoako o thata haholo 'me ho le thata ho tlosa, thepa e khethehileng (tse kang pneumatic high-speed seha drill, carbide drills, mabili taemane, joalo-joalo) holim'a lesoba lenala ho pota-pota poleiti ea tšepe ho itšeha mokhoa, ka poleiti tšepe e sehiloeng ho lokolla screw, screw e boetse ke ka tlhaho bonolo ho tlosa.

Kumar le Dunlopl ba tlalehile ka distal femur notlela poleiti sekoti tsamaiso ea ka hare fixation ho tloswa tshebetso, ka tshebediso ya maemo a ho itšebelletsa torque screwdriver, conical screw extractor ba hloleha, empa hape o ile a hlahisa mokhoa o mocha, ke hore, tšebeliso ea lebelo le phahameng tšesaane-flake mabili abrasive haufi bohale ba poleiti tšepe ho ea moeling oa sekoahelo lesapo, k sekoti le radial, ka nako eo re kenya lesapo ka har'a sekoti. u se ke ua bula lesoba la lipekere tsa tšepe molemong oa ho khatholla kepisi, e le hore ho tlosoe ka katleho li-Locking screws.

Ke habohlokoa ho hlokomela hore mekhoa e ka holimo e lokela ho hatela pele butle-butle ka hohle kamoo ho ka khonehang nakong ea ho seha kapa ho sila poleiti ho sebelisa disk ea ho itšeha ka lebelo le phahameng ho qoba ho khaola hloohong ea screw le ho senya lesapo le lisele tse bonolo. Ho feta moo, mekhoa ena e ka hlahisa mocheso o phahameng le litšila tsa tšepe, tse ka bakang kotsi e eketsehileng ea ho robeha hape ka lebaka la bongaka, tishu thermal necrosis, le tšoaetso.

(G) Kakaretso

■ Lumella poleiti e sa fellang ho kopana le periosteum

■ poleiti e tlameha ho behoa sebakeng se seng pele ho notleloa, kaha ho robeha ho ke ke ha behoa sebakeng se seng ka mor'a ho notlela.

■ Locking plate e ke ke ea hatelloa, e hloka ho sebelisa pressurizer kapa centrifugal screwing ka har'a sekoti se tloaelehileng, pele e hatelloa, ebe e notlela.

■ Sebaka sa ho robeha 3 ~ 4 likoti tse se nang li-screws ho jala khatello ea kelello; ■ Sebaka sa ho robeha 3 ~ 4 likoti tse se nang li-screws ho jala khatello ea kelello; le

■ monocortical fixation ea diaphysis kapa cortex e teteaneng ea lesapo, le moo boleng ba lesapo bo leng molemo; le

■ Hang ha e notletsoe, e ke ke ea ntšetsoa ka ntle, ha li-screw tse tloaelehileng li ka tšelisoa

■ Ho lokisa ka matla le likurufu tse ngata haholo ho ka etsa hore motho a se ke a kopana; molao-motheo ke hore lipoleiti li lokela ho ba nako e telele le li-screw tse fokolang li lokela ho sebelisoa; ha ho phekoloa fractures ea periarticular, li-screws tse fokolang li lokela ho sebelisoa ho stem 'me li-screw tse ngata li lokela ho sebelisoa bakeng sa ho lokisa khahlanong le bokaholimo ba articular.

■ bolelele ba poleiti ea borokho e lokela ho ba bolelele ba habeli ba sebaka se robehileng, likurufu li lokela ho ajoa ka ho lekana, 'me ho lokisoa ho loketseng e lokela ho ba ho lokisa ka har'a lesoba.

■ Matla a ajoa ka ho lekana holim'a poleiti e telele, 'me ho lokisa ka li-screw tse fokolang ho ka tsosolosa lekhoa le ho folisa masapo.