Ku Tirhisa Hi Ndlela Leyi Faneleke Ka Puleti Yo Khiya!

A locking plate i xitirhisiwa xo khoma ku tshoveka lexi nga ni khumbi leri nga ni tintambhu. Loko screw leyingana nhloko leyingana thread yi screwed eka khumbi, plate yi hundzuka (screw) angle fixation device. Plate yo pfala (angle stable) yingava na ti screw holes leti pfalaka xikan’we na letinga pfalekiki ta swikwirikiri swohambana hambana leswinga screwed eka swona (leswi tlhelaka swivuriwa combined plate). Kusukela loko mhaka ya ku pfala ti plates yi ringanyetiwile no tirhisiwa eka vutshunguri bya fracture, yitirhisiwile ngopfu eka ku khoma ka periarticular fractures, comminuted na osteoporotic fractures hikokwalaho ka swipfuno swa yona swaku nyika nseketelo lowu tiyeke xikan’we naku khoma ku tshoveka, nhlayo yale henhla ya ku hola ka fracture, ku onhaka ka tinyama to olova kutsongo xikan’we naku kavanyeteka ka mphakelo wa ngati. Ku hlaya ka namuntlha ka nimixo ku ta ku nyika xingheniso lexi nga ni vuxokoxoko bya ku pfala tipuleti, lexi faneleke ku dyondza eka xona!

(A)Nkatsakanyo wa Masungulo

1.Xana i yini xiphepherhele xo pfala?

Plate yin’wana na yin’wana ya nsimbi leyinga screwed eka angle fixing/angle stabilizing screws kumbe ti pins kahle kahle i locking plate.

2. Swipfuno ni leswo biha swa tipuleti to pfala

Swipfuno swa kona

■ Ku tiya ka angular, ku lwisana na ku gombonyoka na ku soholoteka

■Xivumbeko xa conical xa nhloko ya screw xi antswisa ku hangalasiwa ka michini

■Nyika radial preload, sivela ku tlhela ku nghenisiwa ka marhambu na ku ntshunxeka ka swikwirikiri

■Yi vumbiwile hi ndlela ya anatomical ku amukela swivumbeko swa anatomical swa ndhawu

■Ku fambisana ka tithempleyiti ku pfumelela ku khomiwa hi percutaneous eka diaphysis (cortical yin’we, ku ti bora, swikwirikiri swo tikhoma swo tikhoma)

■Ti screws to pfala ti nyika anchorage ya kahle swinene eka havumbirhi bya bridging yo olova na ku tiyisisa ku tiyisisa loku heleleke

■A ku na xilaveko xo khumbana swinene na vuandlalo bya marhambu, ku hlayisa mphakelo wa ngati

■Micromotion leyi lawuriwaka, leyi tsakelaka ku hola ka ku tshoveka

■Hi ntolovelo a ku laveki ku hlanganisiwa ka marhambu

Yi tirha ngopfu eka ku tshoveka ka marhambu kumbe ku tshoveka kwihi na kwihi loku nga tshamisekangiki swinene.

Swiphiqo swa kona

■Ti screw to pfala a ti na mbuyelo wo hunguta na ku tshikilela, ngopfu ngopfu eka ku tshoveka ka intra-articular kumbe ku tshoveka ko olova ka oblique

■Puleti a yi nge tirhisiwi tanihi xitirhisiwa xo hunguta ku pfuneta ku hunguta.

■Swikurufu a swi titwi kahle ku fana na swikwirikiri leswi tolovelekeke loko swi nghenisiwa.

■Nkongomiso wa swikwirikiri a wu nge lulamisiwi (handle ka swikwirikiri swo pfala swa multiaxial).

■Swikurufu swi vekiwa swi tiya ngopfu, leswi nga endlaka leswaku ku va na 'cold welding'.

■Ku hambuka ka angle >5°, ku lahlekeriwa hi matimba; >10°, locking effect a yi tirhi

■Ku humelela ka subcutaneous protrusion loko plate yinga contoured

Timhaka ta ku tsana

Handle ka cortical contact ya kahle kumbe compression ya makumu ya fracture, kutirhisiwa ka ti locking splints, ngopfu ngopfu stainless steel splints, swita sivela ku hola ka phase II ka fracture hikokwalaho ka ku tsana ngopfu xikan’we naku herisiwa ka micromotion leyinene eka ndzhawu ya fracture;

Loko ku tirhisiwa intraoperative traction kutani ku tirhisiwa locking splint fixation, fracture break gap yita hlayisiwa, leswinga endla leswaku ku hlwela kumbe ku pfumaleka ka ku hola ka fracture;

Loko ku tshoveka ko olova kunga tlheriseriwi endzhaku naku tshikileriwa, ndzhwalo wu hundziseriwa hiku tirhisa plate, leswi endlaka leswaku kuva na stress concentration leyinga endla leswaku plate yi tshoveka hiku olova.

3. Ku hambana lokukulu ka biomechanical exikarhi ka ti locking plates na ti plates leti tolovelekeke

Ti plates leti tolovelekeke ti titshege hi friction eka bone-plate interface kuva ti hetisisa plate compression ya marhambu.

4. Swipfuno swo pimanisa swa ku pfala pulati na pulati ya nsimbi leyi tolovelekeke

1.Ku tiya ka ku koka ehandle ka swikwirikiri swo pfala swi le henhla swinene ku tlula swa swikwirikiri leswi tolovelekeke.

2. Ti screws to pfala epiphyseal ti angled eka yin’wana na yin’wana, leswi engetelaka swinene ku tiya ka screw eka pullout loko ku pimanyisiwa na ti parallel screws.

(B) Misinya ya milawu ya ku tirhisiwa

1. Misinya ya milawu ya ku nga fambi:

●Nsinya wa nawu wa ntshikelelo: ku tshoveka ka diaphysis ya osteoporotic

●Nsinya wa nawu wa ku herisa marhambu: ku tshoveka ka diaphysis ya marhambu

●Nsinya wa nawu wa ku hlanganisa: diaphysis leyi tshovekeke kumbe ku tshoveka ka metaphyseal ehandle ka xirho

Nsinya wa nawu wa ku hlangana: ku tshoveka ka metaphyseal ka le ndzeni ka xirho loku tsemiweke

2. Nsinya wa nawu wa ku hlanganisa:

●Ndlela leyi tolovelekeke: ku vekiwa ka pulati hi ku tirhisa nhlonge leyi nga ngheneriki ngopfu (thekiniki ya MIPO kumbe MIPPO)

●Thekiniki yo hunguta hi ndlela leyi nga kongomangiki

●Ku kuma ku khomiwa ka bridging plate loku ringaneleke, 3-4 wa ti screw holes tifanele ku tshikiwa ti pfulekile ekusuhi na makumu ya fracture.

3.Misinya ya milawu ya vun’we:

● Ku tirhisiwa loku hlanganisiweke ka misinya ya milawu yimbirhi ya biomechanical ya ku tshikileriwa na ku hlanganisa eka pulati yin’we - ku pfala ntshikelelo (LCP) .

● Ku tshoveka ko olova eka xiphemu xin’wana xa ku tshoveka ni ku tshoveka loku tshovekeke eka xin’wana (xikombiso, ku tshoveka loku tshovekeke ka metaphysis, diaphysis) .

●Nsinya wa nawu wa union wu fanele ku tirhisiwa ntsena eka tipuleti leti pfumelelaka ku vekiwa ka swikwirikiri swa nhloko yo pfala xikan’we na swikwirikiri leswi tolovelekeke.

Ti locking plates ati titsheganga hi friction exikarhi ka bone-plate interface naswona titshege ngopfu hi interface exikarhi ka screw na plate leyingana angular stability kuva yi hlayisa kutshamiseka.

Hikwalaho ka vun’we bya tona lebyi tiyeke, matimba yo humesa swikwirikiri leswi nga ni tinhloko to pfala ma le henhla swinene ku tlula ya swikwirikiri leswi tolovelekeke, handle ka loko swikwirikiri hinkwaswo leswi rhendzeleke swi humesiwile kumbe swi tshovekile. Hi ntolovelo, swa tika leswaku xikurufu xin’we xi humesiwa kumbe xi tshoveka hi xoxe. Swikwirikiri swa nhloko yo pfala a swi nyiki ntshikelelo wa inter-fold. Ntshikelelo wunga kumiwa hiku tirhisa xitirhisiwa xo tshikelela kumbe hiku chayela ti screws ta ntolovelo eka 'mixing holes' (tension screws kusungula, kutani ku pfala swipikiri).

1.Loko ku tirhisiwile swikwirikiri swa ntolovelo ku tiyisisa xisirhelelo (xikombiso 1), ku swikwirikiri eka swikwirikiri swo pfala swi ta olova swinene (xikombiso 2).

2.Loko ku tirhisiwile swikwirikiri swo pfala ku tiyisisa splint na bone block (xikombiso, 1), a swi bumabumeriwi leswaku swikwirikiri swa ntolovelo swi pfaleriwa eka xisirhelelo xa marhambu lexi fanaka (xikombiso, 2) handle ka loko swikwirikiri swo pfala swi ntshunxiwile no tlhela swi tiyisiwa (LHS).

3.Loko metaphyseal fracture block yi tiyisisiwile hi screw leyi nga na nhloko yo pfala (LHS), compression fixation exikarhi ka fracture blocks yi fikeleriwa hi ku screw standard screw eka power compression hole ya Locking Compression Plate LCP combination.

(C) Swikombiso na swikombiso leswi lwisanaka na swona

1. Swikombiso

Vunyingi bya ku tshoveka loku tshunguriweke hi vuhandzuri a ku lavi ku khomiwa ka ti- locking plate. Loko ntsena misinya ya milawu ya vuhandzuri bya marhambu yi landzeriwa, ku tshoveka ko tala ku nga horisiwa hi ku tirhisa tipuleti leti tolovelekeke kumbe ku belela endzeni ka medullary.

Hambiswiritano, ku na tinxaka to karhi ta ku tshoveka loku nga na ku lahlekeriwa hi ku hunguteka, ku tshoveka ka plate kumbe screw, na ku nga hlanganisiwa loku landzelaka, loku talaka ku vuriwa 'unresolved' kumbe 'problematic' fractures, ku katsa na intra-articular comminuted fractures, periarticular fractures na swiphemu leswintsongo swa marhambu, na osteoporotic fractures. Tinxaka leti ta ku tshoveka ti tala ku vuriwa 'unresolved' kumbe 'problem' fractures naswona ti katsa ku tshoveka ka intra-articular comminuted, ku tshoveka ka periarticular short tuberosity na ku tshoveka ka osteoporotic. Ku tshoveka loku hinkwako i swikombiso swa ku pfala ti plate.

Swikombiso swa classic na leswinene swa locking plate fixation ya fractures i bridging principle na union principle eka more comminuted fractures - high-energy fractures eka vavabyi lavatsongo kumbe osteoporotic fractures eka vavabyi lavakulu.

2. Swikombiso leswi lwisanaka na swona

Hambileswi tipuleti to pfala ti tirhisiweke ngopfu naswona swikombiso swa tona swi anameke, hi fanele ku lemuka ni ku papalata swikombiso swo hlayanyana leswi lwisanaka ni tipuleti to pfala. Loko ti locking plates ti tirhisiwa handle ko hlawula, ku tsandzeka ka fixation na nonunion ya fracture swinga humelela.

Ku tshoveka ko olova loku lavaka ku tshikileriwa exikarhi ka miri, kufana na ku tshoveka ko olova ka nsinya wa voko ra le mahlweni loku tshunguriweke hi ku pfaleriwa ka le ndzeni, switala kuva na non-union.

Hilaha ku fanaka, ku vekiwa ka tipuleti to pfala hi nhlonge eka ku tshoveka ko olova hi ku tirhisa tindlela leti nga ngheneriki ngopfu na swona i xikombiso lexi lwisanaka.

Kuhungutiwa lokunga kongomangiki xikan’we naku khomiwa ka locking plate na swona aswi ringanelanga eka displaced intra-articular fractures, leswi lavaka ku hungutiwa loku pfulekeke ka anatomical xikan’we naku tshikileriwa exikarhi ka swiphemu swa fracture xikan’we na firm fixation.

Lexi lwisanaka swinene na ti plates to pfala, hikokwalaho ka ntsengo wa tona wale henhla, i ku tshoveka lokunga lulamisiwaka hindlela leyi enerisaka hi ti plates leti tolovelekeke. Xikombiso, ku tshoveka ka forearm symphysis swina mpimo wo hola kutlula 90% loko ku tshunguriwa hi ti plates leti tolovelekeke.

(D) Ku vekiwa ka pulati yo pfala

1. Skruve drill bit eka ti screw holes ta plate. Ku hambuka ka >5° exikarhi ka screw na screw hole swinga endla leswaku kuva na ku tsandzeka ka screw locking, naswona swa hlohleteriwa kutirhisa drill bit ku bora ti holes swikahle.

2. Veka pulati ya nsimbi ehenhla ka marhambu kutani u bora timbobo hi sleeve yo bora.

3. Pima vuenti hi depth sounder, u tivonela leswaku nhloko ya sounder yi nghenisiwa eka khumbi ra screw.

4. Hlawula ku leha loku faneleke ka xikurufu xo pfala.

5. Ku vekiwa ka swikwirikiri leswi tshikileleriweke swi fana ni le ka tipuleti ta nsimbi leti tolovelekeke.

6. Eku heteleleni tiyisisa swikwirikiri swo pfala hi xilotlelo xa torque, loko swi tiyisiwile, ku ta va na ku titwa loku nga erivaleni ka ku rhetela na mpfumawulo wo tshoveka, ku papalata ku skruer hi ku tiya ngopfu, leswi nga ta endla leswaku ku va na swiphiqo swo susa.

(E) Ku susiwa ka pulati yo pfala

Ti clinical locking plate screws titirhisiwa ngopfu, kambe swihlangana hiku olova eka swiphiqo swo susa, ngopfu ngopfu leswi vonakaka eka screw slipping wire na nail cap na plate nail hole threads exikarhi ka buckle leyi hoxeke.

1. Ku onhaka ka groove ya xifunengeto xa xikurufu

Ehansi ka swiyimo leswi tolovelekeke, groove ya screw cap leyi heleleke na screwdriver leyi fambelanaka na yona swa fambisana. Screwdriver yifanele kuva yiringanisiwa na screw cap groove loko kungase nghenisiwa kumbe ku susiwa ka screw, handle ka sweswo screw cap groove yingava yi onhaka hinkarhi wa screw in kumbe screw out, leswi endlaka leswaku kuva na ku rhetela.

Ku engetela kwalano, endzhaku ka ku hola ka fracture, screw cap notch hi ntolovelo yi phutseriwe hi bone crust kumbe fibrous tissue, leswi faneleke ku basisiwa loko kungase susiwa screw, kambe loko kungari na nyingiso, screw cap notch na angular structure swinga onhaka hindlela yo endliwa.

Hikuva axis yo rhendzeleka ya voko ra le mahlweni ra mutirhisi yinga fambisani na axis yo leha ya screwdriver, hakanyingi kuva na angle yokarhi, loko mutirhisi a screwed out screw hi matimba, aswi papalateki leswaku screwdriver yi tsekatseka, leswi endlaka leswaku ku onhaka cap groove ya screw hikokwalaho ka matimba lawa yanga ringaniki. Hikwalaho, ku onhaka ka groove ya screw swi nga endla leswaku screw yi rhetela hi ku olova.

2. Xifunengeto xa swipikiri kumbe ku onhaka ka khumbi ra swipikiri

Eka endlelo ra ku tirhisiwa ka intraoperative ka anatomical locking steel plate, nkarhi wun’wana kuya hi xilaveko xa ku gombonyoka loku faneleke kumbe ku vumbiwa ka steel plate, Raja et al. tshemba leswaku loko xiphemu xo gombonyoka xi humelela eka ti holes ta swikwirikiri swo pfala, loko ku screw eka swikwirikiri swo pfala switava swiri screw cap na nail hole mismatch, leswi swinga endlekaka swinene exikarhi ka nail cap na steel plate nail holes threads wrong buckle, kumbe screwed ekusuhi na steel plate loko ncila wa nail deformation leswi vangiwaka hi screw yo tiya, etc., leswinga rhangelaka ku ya eka ku susiwa ka le ndzhaku ka Xiphiqo.

3. Ku tirhisiwa ka swipikiri leswi tikhomaka swa cortical leswi tikhomaka

Hikuva marhambu ya cortical ya kula endzeni kuya hi nail hole naswona xisweswo yata khoma screw, leswi tisaka swiphiqo eka ku susiwa ka screw, ngopfu ngopfu ku tirhisiwa ka self-tapping double cortical bone screws, Suzuki et al. a swi bumabumeli ku tirhisiwa ka swikwirikiri leswi tikhomaka eka ku khomiwa ka cortical kambirhi. Hou Yunfei na van’wana. va ringanyete leswaku ku khomiwa ka bicortical loku nga lavekiki hi swikwirikiri swi fanele ku papalatiwa eka ku tshoveka ka makumu ya le henhla, naswona Maehara et al. va tlhele va ringanyeta leswaku ku tirhisiwa ka swikwirikiri swo pfala nkarhi na nkarhi swi fanele ku papalatiwa loko ku tirhisiwa tipuleti to pfala, na leswaku ku na xilaveko xo simeka mpimanyeto wa misava hinkwayo wa ku hlawuriwa na ku tirhisiwa ka swikwirikiri swo pfala.

4. Xivumbeko na ndhawu ya swikwirikiri

Vukulu, ku kongoma ni ndhawu ya xikurufu xo pfala swi nga khumba ku susiwa ka xikurufu. Swidyondzeki swin’wana swi kumile leswaku loko screw yinga kumi exikarhi ka hole yo pfala, loko nail hole eccentricity ya kutlula 5 ° kungava na loose screw fixation, threads wrong buckle kumbe nail tail deformation yi namarhela naswona swiyisa eka ku tsandzeka ka fixation kumbe xiphemu xa vumbirhi xa ku susiwa ka swiphiqo.

5.Ku welda hi xirhami

Normal titanium internal fixation surface yina leyara ya pasivated protective layer, eka maendlelo ya vuhandzuri bya ku vekiwa ka internal fixation, hikokwalaho ka switirhisiwa swo khoma naku vumba, kumbe nhloko ya screw na friction exikarhi ka steel plate, na swin’wana, swinga endla leswaku kuva na passivated protective layer wear area. 2 nsimbi contact surface exikarhi ka substantive contact point yi ta namarhela, hi leswaku, ku vumbiwa ka cold welding.

Ku engetela kwalano, galvanic coupling exikarhi ka ti ions ta nsimbi, inflammatory reactions, na swin’wana swinga tlhela swi hlohletela ku endliwa ka ti cold welds. Vunyingi bya vaendli va switirhisiwa swo khoma endzeni na vona va tiva xiphiqo lexi, naswona hikokwalaho ka sweswo ti plates ta nsimbi to pfala letinga tirhisiwangiki ti funengetiwile hi thekinoloji ya oxide film exikarhi ka ti nail holes na screw contact surfaces, leswi tlhelaka swi kongomisa eka ku sivela ionization na adsorption ya ti proteins emirini naku hunguta ku humelela ka ti cold welds.

(F) Maendlelo yo susa

Maendlelo yo susa lama vikiweke eka matsalwa ya tiko na ya matiko ya misava ya nga avanyisiwa hi swiyenge swa 2, ku nga, yo olova na ku tirha na ku rharhangana, yo sungula yi tiveka hi ku fikelela ko olova, ku tirha, ku onhaka ka tinyama to olova ka le hansi, vutshila bya le hansi na ku nga laveki switirhisiwa swo hlawuleka, naswona ya vumbirhi yi lava switirhisiwa swo hlawuleka swo hlawuleka na switirhisiwa.

Maehara na van’wana. ringanyeta ku tirhisa swikwirikiri leswi hungutaka torque leswi nga ni swirhendzevutana leswikulu loko swi koteka. Loko va langutane na swikwirikiri leswi rhetaka, Pattison et al. yi vike ndlela yo olova yo susa swikwirikiri leswi rhetaka hi ku phutsela nhloko ya xikurufu hi nsimbi ya platinum ivi yi yi nghenisa eka xirhendzevutana xa xifunengeto xa swikwirikiri. Ndlela leyi yi tlharihile ku tata screw cap groove hi metal foil xikan’we naku engetela ndzhawu yo khumbana xikan’we na friction exikarhi ka screwdriver na groove, leswi olovisaka ku susiwa ka swikwirikiri leswingana ti thread leti rhetaka. Eka ndlela leyi swaha tika ku susa case, loko screw cap na steel plate nail hole threads swahari kona, unga ringeta ku tirhisa conical reverse tapping screw remover, hi leswaku, kusuka eka screw cap groove leyi nghenisiweke eka reverse tapping naku tata groove, eka maendlelo yo rhendzeleka naku tshikelela screw ehandle.

Eka tlhelo rale hansi, swikwirikiri swin’wana swo pfala swaha tika kuva switirha hiku tirhisa conical reverse tapping screw extractor, kufana na Ehlinger et al. na Bae na van’wana. lava va kumeke leswaku ndlela leyi yitala ku tirha eka 3.5 mm screw slippage, kambe hakanyingi ayi tirhi eka 4.5 mm screw slippage. Eka xiyimo lexi, a hi xiyenge xin’wana ni xin’wana xa vutshunguri bya marhambu ya le xibedlhele lexi nga ni switirhisiwa swo hlawuleka swo sila nsimbi swo tanihi swilo swo bora tikhabayidi, swilo swo bora dayimani kumbe mavhilwa yo sila hi rivilo lerikulu.

Gopinathan na van’wana. ku nghenisa ndlela leyi nga laviki switirhisiwa leswi swo hlawuleka hi ku vika mhaka ya ku susiwa ka swikwirikiri swo tika eka pulati yo aka hi vuntshwa ya clavicular, i.e., hi ku tirhisa ku tsemiwa ka le hansi ka pulati yo aka hi vuntshwa, ku tsemiwa lokukulu ka waya ku tsemeta xiphemu lexitsongo xa pulati exikarhi ka timbobo ta swipikiri swa pulati, leswaku swikwirikiri na xiphemu xa khumbi ra swipikiri xa pulati swi endla yuniti leyitsongo, naswona swikwirikiri swi nga susiwa hi ku olova. Thekiniki leyi yitirha ntsena eka ti titanium reconstruction locking plates, ti forearm locking plates letingana ti notches tale hansi letintsongo, na 1/3 wa ti tube-type plates, naswona ayi tirhisiwi eka ti plates to anama kumbe to tiya eka makumu yale hansi.

Ndlela yo olova yitlhele yi hlamuseriwa laha ku tirhisiwaka drill bit leyikulu nyana ku bora khumbi eka common hole ekusuhi na slipped locking screw, kutani plate na screw swi ba hi tlhelo ra common hole leyintshwa leyi boriweke, kutani plate na screw swi susiwa hiku tirhisa bone cutter leyi vekiweke ehansi ka plate ivi yi hlometela hi principle of leverage loko yiri ku ntshunxiwile.

I ntiyiso leswaku ku ni ku onhaka ka marhambu hi ndlela leyi, hikwalaho ku bumabumeriwa ku sirhelela ku rhwala ntiko endzhaku ka vuhandzuri. Ku engetela kwalano, switlhela swilaveka ku lulamisela switirhisiwa swin’wana swa xiphurofexinali leswi tirhisiwaka ngopfu loko kungase endliwa vuhandzuri byo susa fixation yale ndzeni, kufana na bolt extractor, hole reamer, screw extraction pliers, T-type pressurized socket na swin’wana.

Emahlweni ka swiphiqo swa ku susa waya wo rhetela wa ku pfala screw, swidyondzeki swin’wana swa laha kaya swi ringanyete ku cinca ndlela ya groove, hi leswaku, ku tirhisiwa ka muchini wo sila wa meno wa micro-grinding steel sand piece ku cinca screw cap groove hexagonal kumbe quadrangular groove eka 'one' kumbe 'ten' groove, kumbe ku dzikisa groove yo sungula.

Ehlinger na van’wana. yi vike leswaku eka swiyimo laha conical reverse tapping screw extractor ya ha ri na xiphiqo xo susa xikurufu, ku ringanyetiwe leswaku pulati ya nsimbi yi nga susiwa hi ku onha nhloko ya xikurufu hi ku sila hi tungsten drill ni ku kurisa timbobo ta swipikiri eka pulati ya nsimbi, ivi miri wa xikurufu wu nga susiwa hi ku tirhisa ring saw.

Georgiadis na van’wana. na Raia na van’wana. leswi ringanyetiweke eka ku hlanganisiwa ka screw na steel plate swi tiyile ngopfu naswona swa tika ku swi susa, switirhisiwa swo hlawuleka (ku fana na ti pneumatic high-speed cutting drills, carbide drills, mavhilwa ya dayimani, na swin’wana) eka nail hole ku rhendzela steel plate cutting method, eka steel plate yi tsemiwa ku olovisa screw, screw na yona hi ntumbuluko ya olova ku yi susa.

Kumar na Dunlopl va vikile eka distal femur locking steel plate screw system internal fixation removal system, hiku tirhisiwa ka standard self-limiting torque screwdriver, conical screw extractor va tsandzekile, kambe vatlhele va nghenisa ndlela leyintshwa, hi leswaku, kutirhisiwa ka mavhilwa ya rivilo lerikulu ya thin-flake abrasive kuya etlhelo ka ncila wa steel plate kuya emakumu ka screw hole radial incision, ivi u wedge banga ra marhambu leri nghenisiweke eka incision, u nga pfuli steel plate nail hole leswaku u ta olovisa xifunengeto, leswaku ku susiwa loku humelelaka ka Locking screws.

I swa nkoka ku xiya leswaku maendlelo lawa yanga laha henhla yafanele ku yisiwa emahlweni hiku nonoka hilaha swinga kotekaka hakona loko ku tsemiwa kumbe ku sila plate hiku tirhisa high-speed cutting disk kuva ku papalata ku tsema enhlokweni ya screw naku onha marhambu na ti soft tissues. Ku engetela kwalaho, tindlela leti ti nga ha endla leswaku ku va ni mahiselo lama tlakukeke ni thyaka ra nsimbi, leswi nga endlaka leswaku ku va ni khombo leri engetelekeke ra ku tlhela ku tshoveka loku vangiwaka hi vutshunguri, tissue thermal necrosis ni ku tluleriwa.

(G) Nkatsakanyo

■ Pfumelela ku khumbana ka pulati loku nga helelangiki na periosteum

■Puleti yifanele ku vekiwa nakambe loko yinga se pfala, tani hileswi ku tshoveka kunga tlheriseriwaka endzhaku ko pfala.

■Locking plate a yi nge tshikileriwa, swi lava ku tirhisa pressurizer kumbe centrifugal screwing eka union hole eka screw leyi tolovelekeke, rhanga hi ku tshikileriwa, kutani u khiya

■ Ndhawu yo tshoveka 3~4 wa swikwirikiri leswi nga riki na swikwirikiri ku hangalasa ntshikilelo; ■ Ndhawu yo tshoveka 3~4 wa swikwirikiri leswi nga riki na swikwirikiri ku hangalasa ntshikilelo; na

■ ku khomiwa hi monocortical ka diaphysis kumbe thick bone cortex, na laha khwalithi ya marhambu yi nga kahle; na

■Loko yi lotleriwile, a yi nge tlheriseriwi endzhaku, kasi swikwirikiri leswi tolovelekeke swi nga tlheriseriwa endzhaku

■Ku khomiwa hi matimba na swikwirikiri swo tala swi nga endla leswaku ku nga hlanganisiwanga; nsinya wa nawu hileswaku tipuleti tifanele kuva to leha naswona kufanele kutirhisiwa swikwirikiri swintsongo; eka vutshunguri bya ku tshoveka ka periarticular, swikwirikiri swintsongo swifanele ku cheriwa eka nsinya naswona swikwirikiri swotala swifanele kutirhisiwa ku khoma eka vuandlalo bya articular

■ ku leha ka pulati ya buloho ku fanele ku leha kambirhi ku tlula ndhawu leyi tshovekeke, swikwirikiri swi fanele ku hangalasiwa hi ku ringana, naswona ku khoma lokunene ku fanele ku va ku khoma hi ku tirhisa aperture

■ Matimba ya hangalasiwa hi ku ringana eka pulati yo leha, naswona ku khomiwa hi swikwirikiri swi nga ri swingani swi nga endla leswaku ku va ni swirhumbana ni ku endla leswaku marhambu ma hola.