Ukusetyenziswa Ngokukuko kwePleti yokutshixa!

A ipleyiti yokutshixa sisixhobo sokulungisa i-fracture enomngxunya onemisonto. Xa isikrufu esinentloko enemisonto sijijwe emngxunyeni, ipleyiti iba sisixhobo sokulungisa i-engile (isikrufu). Ipleyiti yokutshixa (i-angle stable) ingaba nemingxunya yezikrufu ezitshixwayo nezingatshixwayo kwizikrufu ezohlukeneyo eziza kukrwelwa kuzo (ekwabizwa ngokuba yipleyiti edityanisiweyo). Ekubeni ingcamango yokutshixa iiplati yayicetywayo kwaye isetyenziswe kunyango lwe-fracture, isetyenziswe ngokubanzi ekulungiseni i-periarticular fractures, i-comminuted and osteoporotic fractures ngenxa yeenzuzo zayo zokubonelela ngenkxaso ezinzileyo kunye nokulungiswa kweefractures, izinga eliphezulu lokuphulukisa i-fracture, umonakalo ongaphantsi kwezicubu ezithambileyo kunye nokuphazamiseka kokunikezelwa kwegazi. Ukufundwa kwentsasa yanamhlanje kuya kukunika intshayelelo eneenkcukacha zokutshixa iipleyiti, ekufanele ukuba ufunde kuzo!

(A) Isishwankathelo esiSiseko

1.Yintoni ipleyiti yokutshixa?

Nayiphi na ipleyiti yentsimbi enokuthi ijijwe ibe yi-engile yokulungisa/izikhonkwane zokuzinzisa okanye izikhonkwane yipleyiti yokutshixa.

2. Izinto eziluncedo kunye nezingeloncedo kwiipleyiti zokutshixa

Iingenelo

■ Ukuzinza kwe-angular, ukuxhathisa ukugoba kunye nokushukuma

■ Imilo ekhokoni yentloko yesijivu iphucula ukusasazeka koomatshini

■Bonelela nge-radial preload, thintela ukuphinda kuphinde kuphume amathambo kunye nokukhulula izikrufu

■Imilo ye-anatom ukwamkela iipateni ze-anatomical zasekuhlaleni

■ itemplates zokuthelekisa ukuvumela ukulungiswa kwe-percutaneous kwi-diaphysis (icortical enye, ukuzibamba, izikrufu zokutshixa ezizibambayo)

■ Izikrufu zokutshixa zibonelela ngokugqwesileyo kokubambelela kuzo zombini iibhulorho ezibhetyebhetye kunye nokulungiswa kozinzo olupheleleyo.

∎ Akukho mfuneko yokunxibelelana ngokusondeleyo nomphezulu wethambo, ukugcinwa kwegazi

∎ Ukulawulwa kwe-micromotion, ithanda ukuphiliswa kokwaphuka

■ Ngokubanzi akukho mfuneko yokufakelwa kwamathambo

Isebenza ngakumbi kwi-osteoporotic fractures okanye nakuphi na ukwaphuka okungazinzanga.

Iingxaki

■ Izikrufu zokutshixa azinanciphiso kunye noxinzelelo, ngakumbi kwiifractures ze-intra-articular okanye i-oblique fractures ezilula.

■ Ipleyiti ayinakusetyenziswa njengesixhobo sokunciphisa ukuncedisa ekunciphiseni.

■ Izikrufu azivakali kakuhle njengezikrufu eziqhelekileyo xa zifakiwe.

■Icala lezikrufu alinakuhlengahlengiswa (ngaphandle kwezikrufu zokutshixa ezininzi).

■Izikrufu zibekwe zaqina kakhulu, nto leyo enokukhokelela 'kwi-welding ebandayo'.

■Ukutenxa i-engile >5°, ukwehla kwamandla; > 10 °, umphumo wokutshixa awusebenzi

■Iprotrusion enokwenzeka engaphantsi kwesikhumba ukuba ipleyiti ayijikelwanga

Imiba yokuqina

Ngaphandle koqhagamshelwano olulungileyo lwe-cortical okanye ukunyanzeliswa kweziphelo zokuqhekeka, ukusetyenziswa kweentsimbi zokutshixa, ngokukodwa iintambo zensimbi ezingenasici, ziya kuthintela ukuphulukiswa kwesigaba sesi-II sokuphuka ngenxa yokuqina okugqithisileyo kunye nokupheliswa kwe-micromotion efanelekileyo kwindawo yokuphuka;

Ukuba i-intraoperative traction isetyenzisiwe kwaye emva koko i-locking splint fixation isetyenzisiwe, i-gap ye-fracture breaking iya kugcinwa, okubangelwa ukulibaziseka okanye akukho ukuphulukiswa kwe-fracture;

Ukuba i-fracture elula ayilungiswanga kwaye igxininiswe, umthwalo uhanjiswa ngeplate, okubangelwa ukuxinzezeleka koxinzelelo olunokubangela ukuba kube lula ukuphuka kweplate.

3. Umahluko omkhulu we-biomechanical phakathi kweeplate zokuvala kunye neepleyiti eziqhelekileyo

Iipleyiti eziqhelekileyo zixhomekeke kungquzulwano kwi-bone-plate interface ukuphumeza ukucinezelwa kwepleyiti yethambo.

4. Iinzuzo zokuthelekisa ipleyiti yokutshixa kunye nentsimbi yentsimbi eqhelekileyo

I-1.Ukumelana nokukhupha izikrufu zokutshixa kuphezulu kakhulu kunezikrufu eziqhelekileyo.

2. I-epiphyseal locking screws i-angle enye kwenye, ekwandisa kakhulu ukuchasana kwe-screw ukukhupha xa kuthelekiswa nezikhonkwane ezihambelanayo.

(B) Imigaqo yokusetyenziswa

1. Imigaqo yokuxhoma:

● Umgaqo woxinzelelo: i-osteoporotic diaphysis fracture

● Umgaqo we-neutralization: i-osteoporotic diaphysis fracture

● Umgaqo wokunqanda: i-diaphysis edibeneyo okanye i-extra-articular metaphyseal fracture

Umgaqo-siseko womanyano: i-comminuted intra-articular metaphyseal fracture

2. Umgaqo wokuvala:

● Indlela eqhelekileyo: i-percutaneous minimally invasive plate fixation (i-MIPO okanye ubuchule be-MIPPO)

●Indlela yokunciphisa ngokungangqalanga

●Ukulungisa ngokwaneleyo ipleyiti yokuqhawuka, imingxunya emi-3-4 yezikrufu kufuneka ishiywe ivuliwe kufutshane nesiphelo sokwaphuka.

3. Imigaqo yomanyano:

● Ukusetyenziswa okudityanisiweyo kwemigaqo emibini yebhayomechanical yokucinezela kunye nokubopha ibhulorho kwipleyiti enye - ipleyiti yoxinzelelo lokutshixa (LCP)

● Izahlulo ezilula kwicandelo elinye lokuqhekeka kunye nezahlulo ezidibeneyo kwelinye (umzekelo, iifractures ezidibeneyo ze-metaphysis, i-diaphysis)

●Umgaqo womanyano kufuneka usetyenziswe kuphela kwiipleyiti ezivumela ukubekwa kwezikrufu zombini zokutshixa kunye nezikrufu eziqhelekileyo.

Iipleyiti zokutshixa azithembeli kwi-friction phakathi kwe-bone-plate interface kwaye zithembele ngokuyinhloko kwi-interface phakathi kwe-screw kunye nepleyiti kunye nokuzinza kwe-angular ukugcina uzinzo.

Ngenxa yobunye bawo obuzinzile, amandla okutsalwa kwee-screws aneentloko zokutshixa ziphezulu kakhulu kunezikrufu eziqhelekileyo, ngaphandle kokuba zonke izikrufu ezijikelezileyo zikhutshwe okanye ziphulwe. Ngokuqhelekileyo, kunzima ukuba isikrufu esinye sikhutshwe okanye siphulwe ngokwaso. Izikrufu zentloko zokutshixa aziboneleli ngoxinzelelo oluphakathi. Uxinzelelo lunokufumaneka ngokusebenzisa isixhobo esicinezelayo okanye ngokuqhuba izikrufu rhoqo kwi- 'mixing holes' (izikrufu zoxinzelelo kuqala, emva koko zitshixe).

1.Ukuba izikrufu eziqhelekileyo zisetyenziselwe ukukhusela i-splint (umz. 1), ukujiya kwizikrufu zokutshixa kuya kuba lula kakhulu (umz. 2).

2.Ukuba izikrufu zokutshixa zisetyenziselwe ukukhusela i-splint kunye nebloko yamathambo (umz., 1), akukhuthazwa ukuba izikrufu eziqhelekileyo zikrwelwe kwibhloko yethambo efanayo (umz., 2) ngaphandle kokuba izikhonkwane zokutshixa zikhululekile kwaye ziqiniswe kwakhona (LHS).

3.Emva kokuba ibhloko ye-metaphyseal fracture ikhuselekile nge-screw enentloko yokuvala (LHS), ukulungiswa koxinzelelo phakathi kweebhloko zokuphuka kufezekiswa ngokukrazula i-screw esemgangathweni kwi-screen compression hole ye-Locking Compression Plate LCP inhlanganisela.

(C) Iimpawu kunye nokuchasana

1. Iimpawu

Uninzi lweefractures ezinyangwa ngotyando alufuni ukulungiswa kwepleyiti yokutshixa. Logama nje imigaqo yotyando lwamathambo ilandelwa, uninzi lwezaphulelo zinokunyangwa ngokusebenzisa iipleyiti eziqhelekileyo okanye ukubethelwa nge-intramedullary.

Nangona kunjalo, kukho iintlobo ezithile zeefractures ezinokuthi zilahlekelwe yilahleko yokunciphisa, i-plate okanye i-screw breakage, kunye ne-nonunion elandelayo, edla ngokubizwa ngokuba 'i-'unresolved' okanye 'ingxaki' ye-fractures, kubandakanywa i-intra-articular comminuted fractures, i-periarticular fractures kunye ne-fractures yamathambo amancinci, kunye ne-fractures yamathambo amancinci. Ezi ntlobo zokwaphuka zisoloko zibizwa ngokuba 'zii-'unresolved' okanye 'ingxaki' fractures kwaye ziquka i-intra-articular comminuted fractures, i-periarticular short tuberosity fractures kunye ne-osteoporotic fractures. Ezi zaphuka zonke zizalathiso zokutshixa iipleyiti.

Iimpawu eziqhelekileyo nezifanelekileyo zokulungiswa kwepleyiti yokutshixa iifractures ngumgaqo wokudibanisa kunye nomgaqo-siseko womanyano wokophuka okuthe kratya - ukophuka kwamandla aphezulu kwizigulane eziselula okanye ukwaphuka kwe-osteoporotic kwizigulana ezindala.

2. Contraindications

Nangona iipleyiti zokutshixa zisetyenziswe ngokubanzi kwaye izibonakaliso zabo zibanzi, kufuneka siqaphele kwaye siphephe izinto ezininzi ezichaseneyo kwiipleyiti zokutshixa. Ukuba iipleyiti zokukhiya zisetyenziswe ngokungakhethiyo, ukungaphumeleli kokulungiswa kunye nokungahambelani kweqhekeza kungenzeka.

Izaphulelo ezilula ezifuna ukunyanzeliswa kwe-interbody, ezifana ne-forearm stem fractures eziphathwayo ngokutshixa ukulungiswa kwangaphakathi, ziqhelekile ukuba zingabikho umanyano.

Ngokufanayo, ukubekwa kwe-percutaneous iipleyiti zokutshixa kwiifractures ezilula kusetyenziswa ubuchule obuncinci obungenabuqhetseba bukwayinto echaseneyo.

Ukunciphisa ngokungathanga ngqo kunye nokulungiswa kwepleyiti yokutshixa kwakhona akufanelekanga ukuchithwa kwe-intra-articular fractures, efuna ukunciphisa okuvulekileyo kwe-anatomical kunye nokunyanzeliswa phakathi kweeqhekeza kunye nokulungiswa okuqinileyo.

I-contraindication ehambelanayo kwiiplati zokukhiya, ngenxa yeendleko zabo eziphezulu, i-fractures inokulungiswa ngokwanelisayo kunye namacwecwe aqhelekileyo. Ngokomzekelo, iifractures ze-forearm symphysis zinezinga lokuphulukisa elingaphezu kwe-90% xa liphathwa ngamacwecwe aqhelekileyo.

(D) Ukufakwa kwepleyiti yokutshixa

1. Krwela isuntswana le-drill kwimingxuma yesikrufu sepleyiti. Ukutenxa nge>5° phakathi kwesikrufu kunye nomngxuma wesikrufu kunokukhokelela ekohlulekeni kokutshixa isikrufu, kwaye kuyacetyiswa ukuba usebenzise i-drill bit ukubhoboza imingxuma ngokukhethekayo.

2. Beka ipleyiti yensimbi phezu kwethambo kwaye uqhube imingxuma ngokusebenzisa umkhono we-drill.

3. Ukulinganisa ubunzulu ngesandi esinzulu, unakekele ukuba intloko yesandi ifakwe kwi-screw hole.

4. Khetha ubude obufanelekileyo besikrufu sokutshixa.

5. Ukufakwa kwee-screws ezicinezelekileyo kufana neeplate zetsimbi eziqhelekileyo.

6. Ekugqibeleni qinisa izikhonkwane zokutshixa nge-torque wrench, xa ziqinisiwe, kuya kubakho ukuvakalelwa okucacileyo kwe-sliding kunye ne-snapping sound, ukuphepha ukukrazula ngokungqongqo kakhulu, okubangela ubunzima bokususa.

(E) Ukususwa kwepleyiti yokutshixa

Izikrufu zepleyiti yokutshixa yonyango zisetyenziswa kakhulu, kodwa kuhlangatyezwana nazo ngokulula iingxaki zokususa, ikakhulu zibonakaliswa kwisixhobo sokutyibilika socingo kunye nesivalo sesikhonkwane kunye nepleyiti yomngxuma wesikhonkwane phakathi kweqhina elingalunganga.

1. Screw cap umonakalo groove

Ngaphantsi kweemeko eziqhelekileyo, i-groove ye-screw cap epheleleyo kunye ne-screwdriver ehambelanayo iyahambelana. I-screwdriver kufuneka ilungelelaniswe ne-screw cap groove phambi kokufakwa okanye ukususwa kwesikrufu, kungenjalo i-screw cap groove kungenzeka yonakale ngexesha lokuskroba okanye ukujijwa, kubangele ukutyibilika.

Ukongeza, emva kokuphiliswa kokuqhekeka, inotshi ye-screw cap idla ngokugqunywa ngethambo le-crust okanye i-fibrous tissue, ekufuneka icocwe ngaphambi kokuba isuse isikrufu, kodwa ukuba akukho ngqalelo ihlawulwayo, i-screw cap notch kunye nesakhiwo se-angular sinokonakaliswa ngokufanelekileyo.

Ngenxa yokuba i-axis ejikelezayo ye-forearm yomsebenzi ayihambelani ne-screwdriver's axis ende, kuhlala kukho i-engile ethile, xa umqhubi we-screw ngokunyanzeliswa kwe-screw, ayinakuphepheka ukuba i-screwdriver i-wbbles, ibangele umonakalo kwi-cap groove ye-screw ngenxa yamandla angalinganiyo. Ke ngoko, umonakalo kwi-screw groove unokukhokelela ngokulula kwi-screw slippage.

2. Umnqwazi we-nail okanye ukuguqulwa komngxuma we-nail

Kwinkqubo yokusetyenziswa kwe-intraoperative ye-anatomical locking steel plate, ngamanye amaxesha ngokwesidingo sokugoba okufanelekileyo okanye ukubunjwa kwepleyiti yensimbi, uRaja et al. kholelwa ukuba ukuba indawo egobayo iyenzeka kwimingxuma yokutshixa isikhonkwane, xa isikrufu kwisikrufu sokutshixa siya kuba sisijiva sobuso kunye nesikhonkwane somngxuma wokungahambelani, nto leyo enokwenzeka kakhulu phakathi kwesivalo sesikhonkwane kunye nepleyiti yentsimbi imingxuma imisonto iqhina engalunganga, okanye ijijelwe kufutshane nepleyiti yentsimbi xa umsila wesikhonkwane deformation obangelwa sisikrufuli esinamandla, njl.

3. Ukusetyenziswa kwe-self-tapping cortical locking izikhonkwane

Kuba ithambo lecortical likhulela ngaphakathi ecaleni komngxunya wesikhonkwane kwaye ke liya kubamba isikrufu, okukhokelela kubunzima bokususwa kwesijivu, ngakumbi ukusetyenziswa kwezikrufu zamathambo e-cortical kabini, uSuzuki et al. ungacebisi ukusetyenziswa kwe-self-tapping screws ukulungiswa kwe-cortical kabini. Hou Yunfei et al. icebise ukuba ukulungiswa okungadingekile kwe-bicortical kunye nezikhonkwane kufuneka kugwenywe kwiifractures eziphezulu, kunye no-Maehara et al. kwakhona ucebise ukuba ukusetyenziswa rhoqo kwezikrufu zokutshixa kufuneka kuphetshwe xa usebenzisa iipleyiti zokutshixa, kwaye kukho imfuneko yokuseka umgangatho wendalo yonke wokukhethwa kunye nokusetyenziswa kwezikrufu zokutshixa.

4. Ubume kunye nendawo yezikrufu

Ubungakanani, ukuqhelaniswa, kunye nendawo yesikrufu sokutshixa kunokuchaphazela ukususwa kwesikrufu. Abanye abaphengululi baye bafumanisa ukuba ukuba isikrufu singekho embindini womngxuma wokutshixa, kanye umngxuma isikhonkwane eccentricity ngaphezu 5 ° kusenokubakho ekhululekileyo ukulungiswa Screw, imicu engalunganga buckle okanye isikhonkwane umsila deformation waxinga kwaye kukhokelela ukusilela ukulungiswa okanye isigaba sesibini ukususwa kobunzima.

5.I-welding ebandayo

Umphezulu we-titanium oqhelekileyo wokulungiswa kwangaphakathi unomaleko we-passivated layer yokukhusela, kwinkqubo yokubeka utyando lokulungiswa kwangaphakathi, ngenxa yezixhobo zokubamba kunye nokubunjwa, okanye intloko ye-screw kunye ne-friction phakathi kwepleyiti yensimbi, njl. I-2 yentsimbi yoqhagamshelwano phakathi kwendawo yoqhagamshelwano engundoqo iya kuthotyelwa, oko kukuthi, ukubunjwa kwe-welding ebandayo.

Ukongezelela, ukudibanisa i-galvanic phakathi kwee-ion zetsimbi, ukuphendulwa kokuvuvukala, njl. Uninzi lwabavelisi bezixhobo zokulungiswa kwangaphakathi bayayazi le ngxaki, kwaye ngenxa yoko iipleyiti zentsimbi zokutshixa ezingasetyenziswanga zigqunywe ngetekhnoloji yefilimu ye-oxide phakathi kwemingxuma yezikhonkwane kunye nemiphezulu yokunxibelelana ngesijija, ekwajolise ekuthinteleni i-ionization kunye ne-adsorption yeeproteni emzimbeni kunye nokunciphisa ukwenzeka kweentsimbi ezibandayo.

(F) Iindlela zokususa

Iindlela zokususa ezichazwe kwiincwadi zelizwe kunye nezamazwe ngamazwe zinokwahlulwa zibe ziindidi ze-2, ezizezi, ezilula kwaye ezisebenzayo kunye neziyinkimbinkimbi, zangaphambili zibonakaliswe ngokufikeleleka okulula, okusebenzayo, umonakalo ophantsi wezicubu ezithambileyo, ubuchule obuphantsi kwaye akukho mfuneko yezixhobo ezikhethekileyo, kunye nokugqibela kufuna izixhobo ezikhethekileyo kunye nezixhobo.

UMaehara et al. cebisa ukusebenzisa i-screwdrivers ezinciphisa i-torque ngamanqina amakhulu xa kunokwenzeka. Xa ujongene nezikrufu ezityibilikayo, uPattison et al. ingxelo ngendlela elula yokususa izikrufu ezityibilikayo ngokusonga intloko yescrewdriver ngentsimbi yeplatinam kwaye uyifake kumjelo we-screw cap. Le ndlela ihlakaniphile ukuzalisa i-screw cap groove nge-foil yentsimbi kunye nokwandisa indawo yoqhagamshelwano kunye nokukhuhlana phakathi kwe-screwdriver kunye ne-groove, eququzelela ukukhutshwa kwezikrufu kunye nemicu edibeneyo. Kule ndlela kusenzima ukususa ityala, ukuba i-screw cap kunye nepleyiti yentsimbi yesikhonkwane imisonto yomngxuma zisasebenza, ungazama ukusebenzisa i-conical reverse tapping screw remover, oko kukuthi, ukusuka kwi-screw cap groove efakwe kwi-reverse tapping kwaye ugcwalise i-groove, kwinkqubo yokujikeleza kunye noxinzelelo lwe-screw out.

Kwicala elisezantsi, ezinye izikrufu zokutshixa kusenzima ukusebenza kusetyenziswa i-conical reverse tapping screw extractor, efana no-Ehlinger et al. kunye noBae et al. owafumanisa ukuba le ndlela yayisoloko isebenzayo kwi-3.5 mm screw slippage, kodwa ihlala ingasebenzi kwi-4.5 mm screw slippage. Kule meko, ayizizo zonke izigaba zamathambo esibhedlele ezinezixhobo ezikhethekileyo zokusila zesinyithi ezifana ne-carbide drills, i-diamond drills, okanye amavili okusila anesantya esiphezulu.

UGopinathan et al. yazisa indlela engadingi ezi zixhobo zikhethekileyo ngokunika ingxelo kwimeko yokususwa kwesijivu esinzima kwipleyiti yokwakhiwa kwakhona kwe-clavicular, oko kukuthi, usebenzisa i-cutout ephantsi yepleyiti yokwakha, i-wire cutter enkulu isetyenziselwa ukucheba isahlulo esincinci sepleyiti phakathi kwepleyiti imingxuma yezikhonkwane, ukuze izikrufu kunye nenxalenye yomngxuma wezikhonkwane zeplate yenze iyunithi encinci, kwaye isuswe ngokulula. Obu buchule busebenza kuphela kwiipleyiti zokuvala ukwakhiwa kwakhona kwe-titanium, iipleyiti zokutshixa i-forearm ezinenotshi eziphantsi, kunye ne-1/3 ye-tube-type plates, kwaye ayinakusetyenziselwa iipleyiti ezibanzi okanye ezityebileyo kwindawo esezantsi.

Indlela elula ikwachazwe apho intwana yokubhola enkulwana kancinane isetyenziselwa ukugrumba umngxuma kumngxuma oqhelekileyo ecaleni kwesikrufu sokutshixa esityibilikayo, emva koko ipleyiti kunye nesikrufu zicofe kwicala lomngxuma oqhelekileyo osandula ukugrunjwa, emva koko ipleyiti kunye nesikrufu zisuswe ngokusebenzisa isixhobo sokusika ithambo esibekwe ngaphantsi kwepleyiti kwaye siyikrole ngaphandle ngomgaqo wokuyikhulula.

Ngokuqinisekileyo, kukho ukonakala kwamathambo ngale ndlela, ngoko ke kucetyiswa ukuba kukhuselwe ukukhuselwa kwesisindo emva kokusebenza. Ukongeza, kuyafuneka ukuba ulungiselele izixhobo ezisetyenziswa ngokuqhelekileyo phambi kotyando lokususa ukulungiswa kwangaphakathi, njenge-bolt extractor, i-hole reamer, i-screw extraction pliers, i-T-type pressurized socket njalo njalo.

Ebusweni ukutshixa Screw ezimtyibilizi ukususwa ubunzima, abanye abaphengululi basekhaya ecetywayo ukutshintsha indlela groove, oko kukuthi, ukusetyenziswa kwamazinyo micro-wokusila iqhekeza isanti yentsimbi umatshini ukutshintsha isijija cap groove hexagonal okanye quadrangular groove for 'enye' ​​okanye 'yeshumi' groove, okanye nzulu imvelaphi.

Ehlinger et al. yanika ingxelo yokuba kwiimeko apho i-conical reverse tapping screw extractor isenobunzima ekususeni isikrufu, kwacetyiswa ukuba ipleyiti yentsimbi inokususwa ngokutshabalalisa intloko yesikrufu nge-tungsten drill yokucola kunye nokwandisa imingxuma yezikhonkwane kwipleyiti yentsimbi, kwaye ke umzimba wesikrufu unokususwa ngokusebenzisa isarha yeringi.

Georgiadis et al. kunye noRaia et al. okucetywayo kwi-screw kunye nendibaniselwano yepleyiti yentsimbi iqinile kakhulu kwaye kunzima ukuyisusa, izixhobo ezikhethekileyo (ezifana ne-pneumatic high-speed cutting drills, i-carbide drills, ivili ledayimani, njl.

I-Kumar kunye ne-Dunlopl baxeliwe kwi-distal femur yokutshixa ipleyiti yentsimbi yokutshixa inkqubo yangaphakathi yokulungiswa kwenkqubo yokususwa, ekusebenziseni i-screwdriver ye-torque eqhelekileyo, i-conical screw extractor ayiphumelelanga, kodwa yazisa indlela entsha, oko kukuthi, ukusetyenziswa kwamavili abrasive ngesantya esiphezulu se-flake emphethweni weplate yentsimbi ukuya emphethweni wesikrubhu kwi-scracy kunye ne-radial. musa ukuvula ipleyiti yentsimbi umngxuma isikhonkwane ukuze uphumle ikepusi, ukuze ukususwa ngempumelelo izikrufu lokutshixa.

Kubalulekile ukuba uqaphele ukuba ezi ndlela zingasentla kufuneka ziqhubele phambili ngokukhawuleza kunokwenzeka ngexesha lokusika okanye ukugaya ipleyiti usebenzisa i-disk ye-high-speed cutting ukuphepha ukusika entloko ye-screw kunye nokonakalisa ithambo kunye nezicubu ezithambileyo. Ukongeza, obu buchule bunokuvelisa amaqondo obushushu aphezulu kunye nobutyobo besinyithi, obunokubangela ukonyuka komngcipheko wokwaphuka kwakhona ngokwezonyango, i-tissue thermal necrosis, kunye nosulelo.

(G) Isishwankathelo

■ Ukuvumela ukudityaniswa kwepleyiti engaphelelanga neperiosteum

■ Ipleyiti kufuneka ibekwe kwindawo enye phambi kokuba itshixe, njengoko ukwaphuka kungenakuphinda kubekwe kwindawo emva kokutshixa.

■ Ipleyiti yokutshixa ayinakunyanzeliswa, kufuneka isebenzise isicinezeli okanye i-centrifugal screwing kumngxunya womanyano kwisikrufu esiqhelekileyo, kuqala icinezelwe, emva koko itshixeke.

■ Isiza sokuqhekeza i-3 ~ 4 imingxuma yezikrufu ngaphandle kwezikrufu ukusabalalisa uxinzelelo; ■ Isiza sokuqhekeza i-3 ~ 4 imingxuma yezikrufu ngaphandle kwezikrufu ukusabalalisa uxinzelelo; kwaye

■ ukulungiswa kwe-monocortical ye-diaphysis okanye icortex yamathambo angqindilili, nalapho umgangatho wethambo ulungile; kwaye

■ Nje ukuba itshixiwe, ayinakukhutshelwa ngaphandle, ngelixa izikrufu eziqhelekileyo zinokukhutshelwa ngaphandle

■ Ukulungiswa okuqinileyo kunye nezikrufu ezininzi kunokukhokelela ekungajoni; umgaqo kukuba iipleyiti kufuneka zibe nde kwaye izikrufu ezimbalwa kufuneka zisetyenziswe; kunyango lweefractures zeperiarticular, izikrufu ezimbalwa kufuneka zifakwe kwisiqu kwaye izikrufu ezininzi kufuneka zisetyenziselwe ukulungiswa ngokuchasene nomphezulu we-articular.

■ ubude bepleyiti yokuvala ibhulorho kufuneka buphindwe kabini ubude bendawo yokwaphuka, izikrufu kufuneka zisasazwe ngokulinganayo, kwaye ukulungiswa okufanelekileyo kufuneka kube kukulungiswa komngxunya.

∎ Amandla asasazwa ngokulinganayo phezu kwepleyiti ende, kwaye ukulungisa ngezikrufu ezimbalwa kunokuvuselela ukumila kokhwekhwe kwaye kukhuthaze ukuphiliswa kwamathambo.