Ukutshixa iPlate-Izithintelo zeSicelo kunye neMida

Ukusetyenziswa kwe iipleyiti zokuvala ziye zandisa ubukhulu becala ububanzi bokusetyenziswa kweplate yokulungiswa kwangaphakathi kweefractures. Nangona kunjalo, ukusetyenziswa kwabo kufuneka kuqiniswe kwaye kuphuculwe ngenxa yemigibe kunye nemida. Kweli nqaku, siza kujonga ukuqwalaselwa kwesicelo, imingeni yokususwa, kunye nokulinganiselwa, imiba ye-3 yokutshixa isicelo sepleyiti.

01.Ziziphi iimpawu eziKhethekileyo kunye nobunzima okufuneka buqatshelwe ekufakeni iipleyiti zokutshixa?

Amanyathelo kunye neMingeni ekuNcitshiseni iiFractures kunye neePlate zokutshixa

Amanyathelo okusetha kwakhona i-fracture asemgangathweni. Iipleyiti zokutshixa aziseti ngokutsha iifractures. 

Nje ukuba ibekwe kwicandelo lamathambo, ukongeza izikrufu ezongezelelekileyo akusayi kuyishukumisa. Ukuba ipleyiti yokutshixa eyamkele kuphela izikhonkwane zokutshixa iyasetyenziswa, 

oku kuthetha ukuba ipleyiti inokutshixwa kuphela emva kokuba i-fracture isetyenzisiwe.

Ekubeni iipleyiti zokutshixa zivumela ukuphulukiswa kwethambo ngaphandle kokulahlekelwa kokubeka kwindawo yokuqala, 

oyena nobangela malunion yokutshixa iipleyiti ayichanekanga ekuqaleni repositioning. 

Kwaye, ukubekwa ngokutsha okungalunganga ngenxa yobuchwephesha obungonelanga kunokukhokelela ekuphulukiseni kakubi njengoko ipleyiti yethambo igqabhuka ngenxa yokulibaziseka ukuphiliswa okanye ukunganyangi.

Ukubeka ngokutsha ngaphandle kokusetyenziswa kweepleyiti zokutshixa kunzima ngakumbi xa usenza izinto ezincinci

 iinkqubo ngenxa yokuba ukuvezwa kwamathambo kuncinci kakhulu. Ifuna iinkqubo ezahlukeneyo zokutsala (iitafile zokutsala, iiretractor),

 ezahlukeneyo i-percutaneous repositioning forceps, kunye nezikhonkwane ze-Kirschner zokulawula amaqhekeza amathambo kunye nokulungiswa kwexeshana. 

Ngaphambi kokusetyenziswa kweeplate zokutshixa kunye nezikhonkwane zokutshixa, kubalulekile ukujonga ukusetwa kwakhona nge-fluoroscopy.

Ngokuchaseneyo, xa usebenzisa ipleyiti yokutshixa enemingxuma eqhelekileyo yesikrufu, 

isikrufu esiqhelekileyo sokutsala singafakwa kwimingxuma eqhelekileyo yokubeka kwakhona indawo yokuqala kwipleyiti.

 Iziqwenga zamathambo zibekwe ngokuchasene nepleyiti. Ukuba ipleyiti ihambelana ne-anatomy, ingasetyenziselwa njengesikhokelo sokusetha kwakhona. 

Izikhonkwane zokutshixa ziqinisekisa iziphumo ezizinzileyo ngaphandle kokuguqula ukusetha kwakhona kokuqala. Lo myalelo wokufakwa (izikrufu eziqhelekileyo, emva koko ukutshixa izikhonkwane) zibalulekile (Umfanekiso 4).

Umzobo we-4 Okokuqala faka izikrufu eziqhelekileyo kwaye uziqinise.

Ukunqongophala kweNgxelo yeTactile xa uQinisa izikhonkwane zokutshixa

Akukho mpendulo ye-tactile xa uqinisa izikrufu zentloko yokutshixa. Inyaniso, 

ukuqiniswa kwesikhonkwane sokutshixa kwenzeka ngaxeshanye kwithambo le-cortical okanye i-cancellous kunye nentsimbi yeplate yokutshixa. Ngesi sizathu,

 kulula ukuba ugqirha acinge ngephutha ukuba isikhonkwane sokukhiya sibambe kakuhle kwi-cortical okanye ithambo lokukhansela (Umfanekiso 3).

Umzobo 3 Ubude bokusebenza bezikrufu zokutshixa ezisekelwe kuhlobo lwethambo kunye nenani leentambo.

Self-Tapping Locking Izikrufu

Ukusetyenziswa kwe-self-tapping screws yokutshixa kuthetha ukuba akukho mpendulo ye-tactile ngexesha lokugaya okanye ukuqinisa njengoko kwenzeka ngaxeshanye.

Iipropathi zabo zoomatshini ziyafana nezo ze-cortex zokutshixa izikrufu ngexesha lokusetyenziswa kwe-cortex enye. Ukuba zinde kakhulu, 

baya kuqhagamshelana necortex yesibini engagrunjwanga, nto leyo ekhokelela ekumisweni okungalunganga kwesikhonkwane sokutshixa kwipleyiti yokutshixa.

Ngexesha lokusetyenziswa kwe-bicortical, zinokuba mfutshane kakhulu, zizenze zilingane ngomatshini kunye nezikhonkwane zokutshixa zecortical enye. 

Ukuba zide kakhulu, ziya kudlula ngaphaya kwe-cortex kwaye zingonakalisa izakhiwo ezibalulekileyo kwelinye icala leplate.

Ubude bezikhonkwane zokutshixa obuchanekileyo bunokufunyanwa kuphela ngokulinganisa ubude obufunekayo emva kokugrumba okanye ukuqinisekiswa nge-fluoroscopy.

Iimpawu ze-Uniaxial Locking Screw

Eyona nto ingathandekiyo yezikhonkwane zokutshixa i-uniaxial kukuba ukuqhelaniswa kwabo kumiselwe kwangaphambili. 

Basenokuba nesinye isiqu sokufakelwa okanye i-prosthetic endleleni yabo, okwenza ukufakwa kungenakwenzeka okanye ukukhawulela ukulungiswa kwe-unicortical.

Kwiipleyiti zokutshixa ze-anatomical ezisetyenziswa kumalungu anezikhonkwane zokutshixa uniaxial kunye nokuqhelaniswa okusisigxina, 

ilungiselelwe ngenxa yezizathu ze-anatomical kunye ne-biomechanical, kukho umngcipheko wokubekwa kwe-intra-articular yokuvala izikhonkwane. 

Umzekelo oqhelekileyo kukuqhekeka kweradiyasi ekude. Lo mngcipheko mkhulu ngakumbi xa ipleyiti yokutshixa ikufutshane nejoyinti okanye xa i-anatomy ikumgangatho ophantsi. 

Ukungabikho kwe-intra-articular fracture kufuneka kuqinisekiswe nge-fluoroscopy.

MIPO Technologies

Ubuchwephesha obungenabungozi obuncinci be-percutaneous osteosynthesis (MIPO) bubandakanya i-subcutaneous kunye/okanye i-submuscular. 

kunye nokufakwa kwe-extraperiosteal yepleyiti yethambo ngembobo encinci ethanjeni emva kokutyibilika, ngaphandle kokuveza

 indawo yokwaphuka. Oku kuvumela amanxeba amancinci, ukugula okuncinci kwendawo yotyando, kwaye yenze inkqubo ngakumbi 'biologic'

 ngenxa yokuba akukho mfuneko yokubonisa iqhekeza ngalinye lethambo kwaye akukho kuphazamiseka kwezicubu ezithambileyo, i-periosteal vascularization, okanye i-hematoma ye-fracture.

Inokufezekiswa ngesitya sokutshixa kunye nesixhobo esilungiselelwe ngokukodwa esivumela iplate 

ukuba isetyenziswe kwaye igqithwe eluswini ukuze ifumaneke lula imingxuma yezikhonkwane etshixwayo kwipleyiti. 

Imifanekiso yeFluoroscopic kufuneka ithathwe kwinqanaba ngalinye ukuqinisekisa inkqubela. Inyathelo ngalinye lobu buchule linomngeni. Umngeni wokuqala kukusetha kwakhona i-fracture ngaphambi kokulungiswa.

 Isitya sokutshixa kufuneka sibekwe ngokufanelekileyo kubude bethambo, ngaphandle koko ukulungelelaniswa kweplate yokutshixa kuya kuba yi-asymmetric (Umfanekiso 5). Ukwengeza, 

ipleyiti yokutshixa kufuneka ihambelane ngokugqibeleleyo nomqolo wethambo eyenzelwe ukuba ilandele kwaye isondele kwithambo njengoko 

kunokwenzeka ngaphandle kokunciphisa kakhulu ukuqina kwesakhiwo. Ngexesha lokuvala inyathelo lokugqibela, kunzima ukuqinisekisa ukuba

 i-conduits ye-screws ihambelana ngokufanelekileyo kwi-plate yokutshixa kunye nokuba izikhonkwane zokutshixa zidibene ngokufanelekileyo ngexesha lokuqinisa.

Umfanekiso we-5 Ukubekwa kwe-Eccentric yepleyiti yokutshixa kunye nokungabikho kwempendulo ye-haptic ngexesha lokuqiniswa kwe-screw.

Ukwenzakala okunokwenzeka kolusu xa usebenzisa iipleyiti zokutshixa ze-Ankle zangaphandle

Ukusetyenziswa kwamacwecwe okutshixa ukulungisa i-ankle fractures yangaphandle iye yadibaniswa namazinga aphezulu angaqhelekanga e-necrosis yesikhumba. 

Ubukhulu bezi cwecwe zokutshixa ezingaphantsi kwe-subcutaneous zibeka uxinzelelo esikhumbeni kwaye ziphazamise ukusabalalisa kunye nokuphulukiswa kwe-vascular. 

Kwenzeka into efanayo xa iipleyiti zokutshixa zisetyenziselwa ukwaphuka kwe-hawksbill.

Umngcipheko weOsteoporosis kunye neScrew Extraction

Kwithambo le-osteoporotic, ukutshixa izikhonkwane kunceda ukunciphisa umngcipheko wokukhupha okanye ukurhoxiswa. 

Ulwakhiwo alunzima ngokwaneleyo ngenxa ye-cortex yamathambo amancinci kunye nokunciphisa ubuninzi be-trabeculae.

Kule meko, ukulungiswa kweplate yokutshixa kuhlala kunamandla kwaye kugxininise ngakumbi xa usebenzisa i-evanescent okanye i-convergent monolithic construct (Umfanekiso 3).

Isishwankathelo:

1. izikrufu zokutshixa azivumeli ukuqhekeka kwipleyiti yethambo ukuba kubuyiselwe.

2. Ukwaphuka kufuneka kumiselwe kwakhona phambi kokongeza isikrufu sokutshixa.

3. ukulungiswa kwe-percutaneous yokunciphisa i-fracture kufuna ukutshixa izixhobo zeplate. ubuchule beMIPO bufuna kakhulu.

02. Imingeni yokuSusa iipleyiti zokutshixa

Ukususa ipleyiti yokutshixa emva kokuba i-fracture ipholile ngumngeni kwaye ayiqikeleleki, 

kodwa imeko ingasonjululwa. Owona mceli mngeni mkhulu kukukhulula isikrufu sokutshixa.

Kwezinye iimeko, imicu entloko yesikhonkwane sokukhiya yonakaliswe ngexesha lokufakwa 

(ukuqiniswa okuphindaphindiweyo kunye nokukhulula, ipateni ye-screwdriver yonakele kwaye ayinayo i-hexagonal ngokugqibeleleyo, ukufakwa kwe-screw kwenziwa nge-drill yamandla), 

into ethetha ukuba ayinako ukuqhawuka. Ngoko ke, kungcono ukukhusela le ngxaki ngokususa ngokukhawuleza nasiphi na isikrufu nge 

ipateni yentloko eyonakalisiweyo ngexesha lokufakelwa, usebenzisa i-screwdriver epheleleyo kunye nokuqinisa ngokupheleleyo i-screw ngesandla (kungekhona nge-drill yombane).

 Ukusebenzisa izikrufu ezenziwe ngezinto ezomeleleyo kunokunceda ukunciphisa le ngxaki.

Kwiimeko ezininzi, kukho ukutshixa ngoomatshini okanye ukuxinana phakathi kwemisonto yezikhonkwane zokutshixa kunye nomngxuma ophothiweyo kwipleyiti yokutshixa. 

Oku kudla ngokubonwa nge-3.5mm ubukhulu be-titanium hex iphethini yezikrufu zokutshixa ishaft enye. Akukho ndlela enye

 ukuphazamisa. Izikrufu zihlala ziqiniswa kakhulu ngenxa yokusilela ukusebenzisa isitshixo setorque esibonelelwe kwikhithi yesixhobo, 

enokuguqula imisonto kwiphegi yokutshixa kunye nepleyiti yokutshixa. Kwezinye iimeko, 

ukusilela ukusebenzisa okanye ukusebenzisa isikhokelo esingalunganga sokuqhuba kubangele ukuba izikrufu zingahambelani xa ziqinisiwe; 

nto leyo ebangele ukuba izikrufu zijamke. Ukuze unciphise umngcipheko wokuxinana ngexesha lenkqubo yokuqala yokulungisa,

 kubalulekile ukusebenzisa zonke izixhobo ezikhoyo: izikhokelo ze-drill kunye neziseko, i-torque wrenches kwimodi epheleleyo yokunyaniseka xa uqinisa izikhonkwane zokutshixa.

Ubuchule be-MIPO bunomngcipheko omkhulu wokubekwa ngendlela engafanelekanga kwesikhokelo solungelelwaniso, 

njengoko kungekho mbono othe ngqo wepleyiti yokutshixa. Ulungelelwaniso olungachanekanga lwesikhokelo se-drill kuthetha ukuba umngxuma ogrunjiweyo 

isikhonkwane sokutshixa kunye nokufakwa kwesikhonkwane sokutshixa kuya kuba nokungalunganga. Kukho umngcipheko wokonakalisa ipateni yentloko ye

 ukutshixa isikhonkwane xa i-screwdriver ingabandakanywanga ngokufanelekileyo kunye ne-screw.

Ngenxa yezi zizathu, ngaphambi kokususa ipleyiti yokutshixa, ugqirha kufuneka aqaphele ukuba kungabi njalo 

kunokwenzeka ukukhulula isikhonkwane sokutshixa, ngaloo ndlela ifuna ukusetyenziswa kwe-screwdriver ye-hexagonal ephezulu kunye nesixhobo esongezelelweyo.

Xa isikhonkwane sokutshixa singenakukhululwa, okanye ipateni yentloko yonakaliswe, 

inyathelo lokuqala kukubeka i-screw extractor (i-screwdriver ene-tapered enemisonto eguqulweyo) kwintloko yesikrufu;

 oku kunokwanela ukukhulula isikrufu. Enye inketho kukusika ipleyiti yokutshixa ngapha nangapha kwesikhonkwane sokutshixa kwaye usebenzise

 njenge-screwdriver ukukhulula isakhiwo sonke. Ukuba isikrufu asikakhululi, ipleyiti yokutshixa inokukhululwa 

ukugrumba nge-drill, ukutshabalalisa intloko yesikhonkwane sokutshixa, okanye ngokusika malunga nepleyiti ukukhulula isikhonkwane sokutshixa. Emveni kwalonto, 

i-vise ingasetyenziselwa ukususa izibonda zezikhonkwane zokutshixa. Ukuba ayisakwazi ukukhululwa (kuba idityaniswe kwithambo okanye ayiphumeli ngokwaneleyo), 

inokususwa nge-drill ring (umzobo 6).

Umzobo 6 Iingcebiso kunye neengcebiso zokususa izikrufu zokutshixa ezincanyatheliswe ebhodini.

Zonke ezi ngxaki zinokwandisa ixesha lotyando, zinokubangela ukukrala kwezicubu ezithambileyo ngenxa yokukhutshwa kwamaqhekeza esinyithi, kwaye zithwele umngcipheko wosulelo. 

Ukusetyenziswa kwe-drill drill kwandisa umngcipheko we-perioperative fractures.

Isishwankathelo:

1. Umceli mngeni wokukhupha izikhonkwane zokutshixa kwenzeka ngokuyintloko nge-3.5mm hex head locking screws titanium.

2.Eyona ndlela yokuphepha le ngxaki kukusebenzisa zonke izixhobo ezibonelelweyo xa ufaka isikrufu. Obu bunzima bunokusonjululwa ngokusebenzisa izixhobo ezifanelekileyo.

03. Ithini iMida yesicelo sePleyiti yokutshixa?

I-Clavicle plate fracture kunye ne-osseous nonunion

Ngokuqinisekisa ukuba ulwakhiwo alunzima kakhulu ngenxa yobude obunganeleyo bokusebenza kweplati yokutshixa okanye inani eligqithisileyo lezikhonkwane zokutshixa (umzobo 7), umngcipheko wokuqhekeka kweplate yokutshixa ngaphantsi kwemingxuma yesikrufu okanye kwi-screw/bone plate junction ingancitshiswa.

Umzobo 7 Ukuphiliswa kwethambo kwaphunyezwa emva kweentsuku ze-60 ngokutshintsha inani kunye nendawo yokutshixa izikrufu kunye nokwandisa ukuqina kwezakhiwo eziqine kakhulu.

Ukuxilongwa kwe-bone nonunion ngokuqhelekileyo kuqinisekiswa ngokuphuka kwepleyiti. 

Ukuqhekeka kade kwepleyiti yokutshixa okanye isikhonkwane sokutshixa kufike ngexesha njengoko i-micromotion inokuthi yenzeke ekhokelela ekuphiliseni amathambo.

Kwiifractures ezilula ezifuna ukunyanzeliswa, okuxhomekeke kuhlobo lokwaphuka kunokuba ithambo elibandakanyekayo, 

isakhiwo esiqinileyo apho amaqhekeza amabini angathinti kunokukhokelela ekungaphumeleli kokuphilisa kunye nokukhathala kweplate. 

Ukudityaniswa kweqhina eliqinileyo + ukutshixa isikhonkwane + ukutsaleka kwindawo yokwaphuka kuphumela ekubeni kungabikho kwamathambo.

Ukwahluka koku kukugqabhuka kwangaxeshanye kwesikhonkwane sokutshixa phantsi kokuncamathisela kwayo kwipleyiti, 

nto leyo ekwangenxa yesakhiwo esingqongqo ngokugqithisileyo. Oku kubangela ukuba isiphelo esinye sepleyiti sikhuphe 'kwiqhekeza elinye' kwaye ukuphilisa akuphunyezwanga (Umfanekiso 8).

Umzobo 8 Ukungaphumeleli okwesibini kwesakhiwo esomeleleyo nesingalungelelanisiyo: izikrufu ezininzi zokutshixa zisetyenzisiwe kude kwaye ipleyiti ye-proximal splice ibingende ngokwaneleyo.

Ngoko ke, ukulungiswa kwe-intracapsular fractures ye-hip kunye neeplate zokutshixa kunokukhokelela kwi-bone nonnunion ngenxa yokuba isakhiwo sinzima kakhulu ukuba singangena kwindawo yokuphuka. 

Ngaphandle kwe-micromotion efunekayo ukuze uphilise, wonke umthwalo uthwalwa yi-implant kwaye ekugqibeleni uyasilela.

izicubu zokuphilisa ezi-asymmetric

Ukhoko lwamathambo ePeriosteal lunokuba lune-asymmetric, 

ngakumbi kwiifractures ze-distal 1/3 ye-femur. I-Micromotion ngenxa ye-elasticity ivumela ukuba 

ukuphuhliswa okufanayo kwezicubu zokuphulukisa ukuphuka okwenzeka kuphela kwiindawo ezihambelanayo zeplati yokutshixa / ukwakhiwa kwezikhonkwane.

 Ukulawula lo mngcipheko, ubude bokusebenza kwepleyiti yokutshixa kufuneka bunyuswe, mhlawumbi ngokusebenzisa iipleyiti zetitanium eziguquguqukayo okanye ngokusebenzisa izikhonkwane zokutshixa ezintsha. 

Ngokwahlukileyo, ulwakhiwo oluguquguqukayo olugqithisileyo lunokukhokelela kwi-hypertrophic bone nonunion.

I-deformation yeplastiki yamacwecwe ensimbi

Ukubeka ipleyiti ngokusondeleyo kwi-cortex kunokwenzeka ukunciphisa umngcipheko wokuguqulwa kweplastiki phakathi kweplate;

 xa umgama phakathi kwepleyiti kunye ne-cortex idlula i-5 mm;

 amandla okwakhiwa ayancipha kakhulu kwaye umngcipheko wokuguqulwa kweplastiki yeplate kunye nokungaphumeleli kweplate ye-titanium kuphezulu.

Ukuqhekeka kade kwe-diaphysis okanye i-metaphysis ekupheleni kweplate yokuvala

Umngcipheko wokuphuka kade ekupheleni kweplate yokutshixa i-diaphysis okanye i-metaphysis, 

ngakumbi kwithambo le-osteoporotic, inokuncitshiswa ngokufaka isikhonkwane esisodwa sokutshixa i-cortical okanye isikrufu esiqhelekileyo se-bicortical ekupheleni kwepleyiti ukunciphisa uxinzelelo kulo mmandla.

Ukusilela koomatshini

Ezi meko zilandelayo zonyusa umngcipheko wokungaphumeleli koomatshini kwipleyiti yokutshixa:

1. Ukulungiswa kwe-humeral diaphysis fractures kufuna ukusetyenziswa kwezikhonkwane ezine zokutshixa ngapha nangapha kwendawo yokuphuka ukuxhathisa i-torsion kunye nokwandisa ukusilela komatshini; kwaye

2. Ukulungiswa kwe-epiphyseal fractures kunzima kuba bahlala bengazinzanga, 

ngakumbi ngenxa yokuba indawo yokuphuka ayinakunyanzeliswa ngezikhonkwane zokuvala kwaye ithambo li-osteoporotic;

3. Ukuqhekeka kwe-intra-articular kunye ne-extra-articular comminuted fractures ye-epiphysis azinzile.

 (umzekelo, i-distal femur fractures, i-bicondylar tibial plateau fractures, i-distal radius fractures);

4. ukuhanjiswa kwe-medial ye-metaphyseal fractures ejwayele ukufuduka kwi-inversion (umzekelo, i-humerus ehamba phambili, i-femur ehamba phambili, kunye ne-proximal tibia fractures).

 Iipleyiti zokutshixa ezigxininiswe kwicala elisecaleni lethambo zibonelela ngesakhiwo esomeleleyo esihlala sanele 

ukuzinzisa ezi fractures ngaphandle kwesidingo sokongeza iipleyiti ze-console-type medially okanye ukongeza ithambo ngelixa ugcina indawo ye-biologic fracture. 

Uzinzo luxhomekeke kuphela kwipleyiti yokutshixa/isikhonkwane sokutshixa, 

eyona igxininiswe kakhulu emva kokusetha kwakhona xa i-epiphysis ihlala iguqulwe okanye xa i-console ye-medial ingakhiwanga kwakhona. Ipleyiti yokutshixa inokusilela emva kokudinwa.

Ngoko ke, ukulungiswa kwe-bicondylar tibial plateau fractures usebenzisa iipleyiti zokukhiya kuphela kwicala elisecaleni kufuneka kuthathelwe ingqalelo kuxhomekeke kuhlobo.

 Ukophuka kwe-humerus ekufutshane, inani leebhloko zokuqhekeka, ukulahleka kwenkxaso ye-medial,

 kunye nokuguqulwa kwe-epiphysis yokulungiswa zizinto ezaziwayo ezinobungozi. Ukunciphisa umngcipheko wokusilela kokwakha, 

izikhonkwane ezithile zokutshixa ziya kuxhaswa ngoomatshini ukuhlawulela ukungabikho kwenkxaso ye-medial ekunciphiseni iifractures eziguqulelwe ngaphandle.

Ukungaphumeleli kwebhayoloji kwiiPleti zokutshixa

Iimowudi zebhayoloji zokungaphumeleli kweepleyiti zokutshixa zisikwe ngezikrufu kunye nokwaphuka okanye ukufakwa kwesikhonkwane sokutshixa. 

Le mingcipheko inkulu xa i-bone osteoporosis ikhona kwi-skeleton, 

oku kuthetha ukuba ukuvuselelwa kwangaphambili kunye nokubuyela ekuthwaleni ubunzima kufuneka kwenziwe ngokucophelela ngaphambi kokuba ukuphulukiswa kwamathambo kufezekiswe.

(1) Ukususwa kwezikrweqe zokutshixa

Ukutsalwa kwe-Screw kuhambelana 'itotali' kunye nokususwa ngaxeshanye kwesikhonkwane sokutshixa kwithambo kwelinye okanye zombini iziphelo zepleyiti. Kwezinye iimeko, 

isikhonkwane sokutshixa sitsalwa ngeqhekeza lethambo elijikelezileyo.

Kwingingqi ye-epiphyseal, isakhiwo sepleyiti yokutshixa isiqwenga esinye sihlala sibonelela ngozinzo olwaneleyo ngenxa ye-anchorage yokutshixa yezikhonkwane echithakeleyo okanye eguqukayo, 

kunye nesakhiwo se-dimensional-dimensional kwandisa ukuchasana kwe-screw extraction ukusuka kwithambo lokukhansela.

Kwingingqi ye-diaphyseal, izikhonkwane zokutshixa eziguqukayo kunye nezisasazekileyo kunye nolwakhiwo kunye neepleyiti zokutshixa ezinde zinamandla angcono wokutsala. 

Olu hlobo lolwakhiwo lufanelekile ngakumbi kwiifractures ze-periprosthetic. Kwithambo le-osteoporotic, 

ulungiso lwe-bicortical stem screw luphezulu kune-monocortical screw fixation. Ngokwaphuka kwe-periprosthetic, izikrufu ze-unicortical ze-flat-head zinceda ukuphepha ukudibanisa nokufakelwa kwe-intramedullary.

Ezi ntsilelo zokulungiswa zihambelana nomgangatho ophantsi wamathambo, nokuba isakhiwo sisebenza ngoomatshini.

(2) Ukusika okanye ukufakwa kwezikrufu zokutshixa

Ukunqunyulwa okanye ukunyanzeliswa kwezikhonkwane zokutshixa kunye nokungena kwe-intra-articular kungenzeka kwingingqi ye-epiphyseal yokukhansela.

Oku kufuduswa kukufuduswa kwamaqhekeza e-epiphyseal amathambo anobunzima obuphantsi asuswe kwindawo ejikeleze isikhonkwane sokutshixa.

 Oku kubangela ukulahlekelwa kwe-epiphyseal fracture yokunciphisa. Kwimeko engcono kakhulu, i-epiphyseal yokuvala i-nail impinges kunye

 ingena kwithambo elirhoxisayo. Kwimeko embi kakhulu, isikhonkwane sokuvala i-epiphyseal siphuma kwi-epiphysis kwaye sihamba singene kwi-joint.

Ezi ngxaki zimbini zenzeka rhoqo kwi-proximal humerus kunye ne-distal radius fractures. 

Ukulungiswa kweplate yokutshixa i-proximal humerus fractures, kucetyiswa ukuba ubude be 

I-epiphyseal yokuvala isikhonkwane inqunyelwe ukunciphisa umngcipheko we-ingrowth kunye nokungena okuhlangeneyo okwesibini.

Ezi ntsilelo zokulungiswa zibangelwa kumgangatho onganelanga wamathambo kunye nokufuduka okukhulu kokuqala kwamaqhekeza ngaphambi kokunciphisa, 

nokuba ulwakhiwo lusebenza ngoomatshini.

Ukuvuselelwa ngokuManyeneyo kunye nokuBuyiselwa kobunzima kwangoko

Ukuvuselela kunye nokuthwala ubunzima kuvunyelwe kuphela emva kokuba ukulungiswa okugqibeleleyo kuphunyeziwe kwaye kuqinisekiswe kwi-X-rays emva kokuhlinzwa.

Izifundo ze-Biomechanical zibonise ukuba kwithambo eliqhelekileyo, ukuba umsantsa phakathi kwamaqhekeza ungaphantsi kwe-1 mm, 

ukuthwala ubunzima kunokwenzeka ngaphandle komngcipheko. emva kwemijikelo ye-1 yezigidi, ukuqina kufana nethambo eliqhelekileyo, elanele ukuphiliswa ukuba kwenzeke.

Xa isandi sesakhiwo, iipleyiti zokutshixa kunye nezikhonkwane zokuvala i-angle-angle zivumela ukubuyela kwangethuba 

ubunzima ngenxa yokuba umthwalo udluliselwa ngokuthe ngqo kwisikhonkwane sokutshixa ukuya kwipleyiti yokutshixa, kungekho mngcipheko wokungaphumeleli kokulungiswa kwi-junction ye-nail-plate.

Nangona kunjalo, xa i-axis yesikhonkwane sokuvala i-multiaxial ingekho i-perpendicular kwi-plate yokutshixa, ukuthwala ubunzima bokuqala akuvumelekanga.

Kwi-MIPO, ubunzima bokuqala buvunyelwe ukongeza, kulula kunye / okanye ukuqhekeka okulula. 

Izakhiwo ezide kakhulu ezikhethekileyo ziguquguquka ngokwaneleyo kunye nezikhonkwane zokutshixa ze-bicortical kunye nokuvuleka kokufakwa komthwalo kunye nokusabalalisa.

Isiphelo:

I-1.Izifundo ze-Biomechanical ziye zavavanya iintlobo ezahlukeneyo zokwakha kunye neempawu zabo zomatshini.

Uncwadi lunceda ekuqinisekiseni ithemba lethiyori elinxulumene nolu hlobo lokulungiswa. 

Nangona kunjalo, uncwadi lwamva nje lukwaqaqambisa ubunzima bobugcisa kunye nokusilela okuhambelana neepleyiti zokutshixa.

2. Esona sizathu siphambili sokungaphumeleli kukungacwangciswa ngokwaneleyo kwendlela yotyando, 

okufuneka kakhulu, ngakumbi xa kusenziwa iinkqubo ezingephi.

3. Ukwaphuka kufuneka kubuyiselwe kuqala, ngaphandle kokutshixa izikrufu kwipleyiti.

njengoko ukusetwa ngokutsha kwepleyiti ngokutshixa izikrufu akunakwenzeka.

4.Ulwakhiwo kufuneka lube nobude namandla achanekileyo, 

nto leyo ethetha ukuba ugqirha wotyando kufuneka aqhelene nemigaqo nemithetho ekhokela ukusetyenziswa kwala macwecwe. 

Ulwakhiwo ke ngoko kufuneka lube nelastiki, lube nenani eliqingqiweyo lezikrufu zokutshixa ezihlala zishiyana ngemingxuma engenanto.

5. Ngaphandle kozinzo olungcono lwethiyori yokuqala yokutshixa iipleyiti, 

ukulungiswa kwesakhiwo kukhawulelwe ngobunzima bokuphuka, umgangatho wokunciphisa, kunye nomgangatho webhayoloji wethambo.

6.Ukuba ulwakhiwo lusebenza ngoomatshini, umgangatho wethambo ulungile kwaye i-fracture i-extra-articular, 

isigulane esinokuzimela okwaneleyo sinokuvunyelwa ukuba sithwale ubunzima kwilungu eliphukileyo. Kwiimeko ezininzi, ukulungiswa kwepleyiti yokutshixa kuvumela ukubuyisela kwangethuba.