I-Percutaneous K-wire fixation ingenye yezindlela ezimbalwa ezisetshenziselwa ukugcina ukuncipha kokuqhekeka kwe-distal radius fracture. Okuphinde kubizwe ngokuthi ukuncishiswa okuvaliwe nokuphina nge-percutaneous, le nqubo isebenzisa izintambo ze-Kirschner ukuzinzisa izingcezu zokuphuka ngemva kokubuyiselwa kokuqondisa.
Akusona isixazululo saso sonke isihlakala esiphukile. Iphethini yokuphuka, ukuzinza kokunciphisa, ukubandakanyeka kwe-articular, ikhwalithi yamathambo, isimo sezicubu ezithambile, izinto eziza kuqala esigulini kanye nezinketho ezitholakalayo zokulungisa konke kuthonya ukukhethwa kokwelashwa. Lo mhlahlandlela uchaza izimiso kanye nemikhawulo ye-distal K-wire fixation ngaphandle kokushintsha ukuqeqeshwa okusemthethweni kokuhlinza noma inkomba yendlela yedivayisi ethile.
Okuthathwayo Okubalulekile
Ukulungiswa kwe-K-wire ngokuvamile kucatshangelwa ngemva kokwehliswa kokuphuka lapho kudingeka ukuzinza okwengeziwe futhi izingcezu zingalawulwa ngezintambo.
I-Radial styloid, i-dorsal, i-fragment-specific kanye ne-intrafocal configuration ichaza izimiso ezihlukene kunephethini yephinikhodi eyodwa eyisibopho.
Inombolo yocingo, i-diameter, i-trajectory kanye necebo lokunganyakazi liyicala- kanye nedivayisi ethize; akufanele zikhethwe esihlokweni sokumaketha jikelele.
Ukukhathazeka okungase kube khona kuhlanganisa ukulahlekelwa ukuncishiswa, ukutheleleka kwe-pin-tract, ukufuduka kwezintambo, ukucasuka kwezicubu ezithambile, ukulimala kwe-tendon noma izinzwa kanye nokuqina kwesihlakala.
Izintambo ze-K, amapuleti e-volar kanye nokulungiswa kwangaphandle ngakunye kunokuhwebelana okuhlukile. Ubufakazi bamanje abuyisekeli indlela eyodwa yokulungisa njengephakeme kakhulu kukho konke ukuphuka kwe-articular okungazinzile noma okuphelele.
Kuyini Ukulungiswa Kwe-K-Wire Kwe-Distal Radius Fracture?
Ukuphuka kwerediyasi ekude kwenzeka eduze nomkhawulo wesahlaka werediyasi. Lapho ukuphuka kususwa, odokotela bahlola ukuthi ukuqondanisa okwamukelekayo kungabuyiselwa futhi kugcinwe. Ukuncishiswa okuvaliwe kubhekisela ekubuyiseleni ukuqondanisa ngaphandle kokuvula indawo yokuphuka. I-Percutaneous pinning bese ibeka intambo eyodwa noma eziningi ezibushelelezi endaweni encane yokungena esikhumbeni ukuze ibambe izingcezu ezikhethiwe ngenkathi ukuphulukiswa kuqhubeka.
Igama lezokwelapha elikhethwayo elokuncishiswa okuvaliwe kanye nokuphina nge-percutaneous , hhayi 'ukufakwa inaliti evaliwe.' Intambo ye-Kirschner iyithuluzi lokulungisa kunenaliti yomjovo. Ngakho-ke i-athikili kufanele isebenzise i-K-wire, intambo, ukuphina kanye namagama okulungisa ngokungaguquki.
I-K-Wires Ikugcina Kanjani Ukuncishiswa
Izintambo zingase zeqe ukuphuka futhi zithenge engxenyeni ezinzile yerediyasi, noma zingase zisekele izingcezu ngazinye ekucushweni okukhethelwe iphethini yokuphuka. Ukuzinza kwemishini kuncike ngaphezu kwenani lezintambo. Ukwehlukana, ukulawulwa kwezingcezu, ukuthengwa kwe-cortical, i-wire diameter, ikhwalithi yamathambo kanye nokuqiniswa okungeziwe kungathinta ukwakhiwa.
Ukulungiswa Kwe-K-Wire Kuyindlela Eyodwa Yokwelapha
Okunye ukuphuka kwe-distal radius kungaphathwa ngaphandle kokuhlinzwa, kanti ezinye zingase zelashwe ngezikhonkwane ze-percutaneous, i-volar noma i-dorsal plate, i-fixator yangaphandle noma isu elihlanganisiwe. Ukubuka kabanzi, bheka umhlahlandlela we-XC Medico ku- ukuxilongwa, ukuhlukaniswa nokwelashwa kwe-distal radius fractures .
Lapho I-Percutaneous Pinning Ingena Ekwelapheni
Ukuphatha Okungasebenzi
Ukuphuka okuzinzile okukhethiwe noma ukuphuka okuhlala kuqondaniswe ngokwamukelekayo ngemva kokwehliswa kungase kulawulwe nge-cast noma i-splint kanye nesithombe sokulandelela. Iminyaka yesiguli iyodwa ayinqumi ukwelashwa.
Ukulungiswa Kwe-K-Wire Ye-Percutaneous
Ukuphina kunganikeza ukulawula kweziqephu ezengeziwe ngemva kokwehliswa kwamaphethini akhethiwe. Ngokuvamile kudinga ukunakwa kumasayithi amaphini, ukumiswa kanye nokuphathwa kwezintambo kamuva.
Ukulungiswa Kwepuleti
Ipuleti le-volar noma le-dorsal lihlinzeka ngokulungiswa kwangaphakathi futhi lingase likhethelwe amaphethini adinga ukulawulwa okuqondile kweziqephu. I-XC Medico inikeza eziningana Izinketho zepuleti lokukhiya i-distal radius .
Ukulungiswa Kwangaphandle
Uhlaka olunwetshiwe noma olunganwetshiwe lungasiza ukugcina ubude nokuqondanisa ezindaweni ezikhethiwe ezingaqinile, okuhlanganisa izimo lapho izimo zezicubu ezithambile zithinta ukuhlelwa kokulungisa kwangaphakathi.
Umhlahlandlela wokusebenza komtholampilo we-AAOS/ASSH ubika ukuthi awukho umehluko omkhulu emiphumeleni ye-radiographic noma ebikwe isiguli phakathi kwamasu okulungisa ama-articular aphelele noma angazinzile we-distal radius fracture, nakuba amapuleti akhiyiwe e-volar angase anikeze ukutakula kokusebenza kwangaphambilini esikhathini esifushane. Lokhu kusekela ukukhetha komuntu ngamunye kunesimangalo sokuthi izintambo ze-K noma amapuleti ahlala engcono.
Kungacatshangelwa Nini Ukulungiswa Kwe-K-Wire Ye-Percutaneous?
Ukuthatha izinqumo zomtholampilo kuqala ngokuhlolwa nokuthwebula izithombe. Izinto ezilandelayo zingacatshangelwa ochwepheshe abaqeqeshiwe, kodwa azilona uhlu lokuhlola lwezinkomba ezizimele zodwa.
Iphethini Yokuphuka Nokunciphisa Ukuzinza
Ukuphina cishe kuzoba wusizo uma izingcezu zokhiye zingancishiswa futhi zilawulwe yizintambo ezibekwe ngendlela efanele. I-metaphyseal comminution ephawulwe, izingcezu ezincane ze-articular noma ukuthambekela kokuwa kungase kunciphise ukuthembeka kokwakhiwa kocingo olulula nokucatshangelwa ngokushesha kwenye noma indlela yokwengeza.
Ikhwalithi Yethambo kanye Nosayizi Wesiqephu
Ithambo le-Osteoporotic linganikeza ukuthengwa kwezintambo okuthembekile kancane. Ukwengeza izintambo akwanele ngokuzenzakalelayo ukuxazulula ukungalungisi kahle, futhi awukho umthetho ojwayelekile wokuthi konke ukuphuka kwe-osteoporotic kudinga izikhonkwane ezine noma ezinhlanu. Ukukhethwa kokwakhiwa kufanele kulandele iphethini yokuphuka, ukuthwebula izithombe, inqubo evunyelwe kanye nokwahlulela kukadokotela ohlinzayo.
Iziguli Nezicubu Ezithambile
Isimo sesikhumba, ukuvuvukala, ukulimala okuvulekile, izifo ezihambisana nokwelashwa, izimfuno zomsebenzi, ikhono lokulandela imiyalelo ye-pin-site kanye ne-immobilization kanye nokuvuselelwa okulindelekile konke kunomthelela ekukhethweni kokwelashwa.
Iminyaka Nesidingo Sokusebenza
Ubufakazi kufanele buhunyushwe ngokuhambisana nezici zezinga lesiguli. Umhlahlandlela we-AAOS/ASSH ubika ukuthi ukwelashwa ngokuhlinza kuzibalo ze-geriatric ngokuvamile akuthuthukisi imiphumela yesikhathi eside ebikwe isiguli uma kuqhathaniswa nokunakekelwa okungasebenzi, ngisho noma ukuqondanisa nge-radiographic kuhluka. Ukuthatha izinqumo okwabiwe kusabalulekile.
Umngcele womtholampilo: i-athikili yemfundo evamile ayikwazi ukunquma ukuthi ukuphuka okuthile kudinga izintambo ze-K, ipuleti, ukulungiswa kwangaphandle noma ukwelashwa okungasebenzi. Leso sinqumo sidinga ukuhlolwa kwesiguli, ukuthwebula izithombe kanye nesinqumo sezokwelapha esifanelekayo.
Izimiso Ezivamile Zokulungisa I-K-Wire
Imiqondo eminingana yokuphina ichazwa ekusebenzeni kwamathambo. Amagama angezansi ahlonza amasu abanzi; akufanele zihunyushwe njengezindawo zokungena ezingaguquki, ama-engeli noma isibalo sezintambo eziyisibopho.
I-Radial Styloid Pinning
Intambo ye-radial styloid ingase iqondiswe kuyo yonke indawo ukuze ithole ukuthengwa ku-proximal radius. Igatsha lezinzwa le-radial nerve, imisipha, indawo ehlangene nendawo yocingo kudinga ukucatshangelwa. I-trajectory eqondile incike ku-anatomy, i-fracture morphology kanye nendlela ekhethiwe.
Ukulungiswa kokuphina kwerediyasi ye-distal. Ukufakwa kocingo kokugcina kufanele kusekelwe ku-fracture anatomy, ukuhlolwa kwe-fluoroscopic kanye nezindlela zokuhlinza ezigunyaziwe.
I-Dorsal kanye ne-Fragment-Specific Pinning
Izintambo ezingemuva noma izintambo eziqondiswe engxenyeni yenyanga zingasetshenziswa lapho lezo zingcezu zidinga ukulawula. I-Dorsal anatomy ihlanganisa ama-extensor compartments nama-tendon angacasulwa noma alinyazwe indawo yokungena engafaneleki, intambo evelele noma ukufuduka.
Isibonelo sokulungiswa kwezintambo ezigxile ezingxenyeni. Umfanekiso uchaza isimiso, hhayi isifanekiso esinezintambo ezintathu.
Kapandji Intrafocal Pinning
Ngobuchule be-Kapandji, izintambo zithulwa endaweni yokuphuka futhi zisetshenziselwa ukusiza ukunciphisa nokusekela ucezu olukude ngaphambi kokuba luthuthukiswe ukuze kugcinwe ukwakhiwa. Indlela yehlukile ekumane uwele ukuphuka usuka endaweni yokungena ekude. Ukufaneleka kuncike ekucushweni kokuphuka kanye nekhwalithi yamathambo.
Kapandji intrafocal pinning concept. Usayizi wezintambo othize, inombolo kanye nesiqondiso kufanele kuvele kumasu aqinisekisiwe kanye nokuhlelwa kwecala elithile.
Ukuphina Okungeziwe kanye Nokulungiswa Okuhlanganisiwe
Ukuphuka okuyinkimbinkimbi kungase kudinge isilawuli esingeziwe esiqondene nesiqephu noma ukwakhiwa okuhlanganisiwe. Nokho, izintambo eziningi azikhiqizi ngokuzenzakalelayo ukuzinza okungcono. Ukuhlangana kwentambo, ukusabalala okunganele, ukuthengwa kwekhohlo eliphansi noma ukungakwazi ukulawula isiqeshana esingukhiye kusengaholela ekulahlekelweni kokuncishiswa.
Ukuhlanganiswa kungenza ukuphina okulula kungathembeki kangako. Ukulungiswa okungeziwe noma okunye kungase kuhlolwe ngokuya ngesithombe nezici zesiguli.
Ukufanekisa kanye Nokuhlolwa Kokulungisa
Ukunciphisa kanye Nokuqondanisa Kwe-Articular
Ukuthwebula kusetshenziselwa ukuhlola ukuphakama kweradial, ukuthambekela, ukutsheka, ukuhlangana kwe-articular kanye nobudlelwano obuhlangene be-radial radioulnar. Ithagethi eyamukelekayo incike esigulini kanye nokuphuka. Intambo ebekwe ngokobuchwepheshe ayinxeshezeli ukuncishiswa okungamukeleki.
Indawo Yezintambo kanye Nokuthenga KweCortical
Ukubuka kwe-Fluoroscopic kusiza ukuhlola ukuthi izintambo zilawula izingcezu ezihlosiwe, zigweme izindawo ezihlanganyelwe ze-radiocarpal kanye ne-distal radioulnar lapho kudingekile, futhi zithole ukuthenga okufanele ngaphandle kokuvelela okuyizinkinga. Ukubuka okuningi kungase kudingeke ngenxa yokuthi intambo ebonakala yamukeleka endaweni ethile ingase ingamukeleki kwenye.
Yakha Ukuzinza
Ukuhlola ukuzinza kubheka ukuphuka, ukucushwa kwentambo kanye nokunganyakazi okuhleliwe ndawonye. Izintambo ezihlanganiswe endaweni eyodwa zinganikeza ukulawula okujikelezayo okuncane kunokwakhiwa okusatshalaliswe kahle, kodwa umthetho wokuhlukanisa isikhala ojwayelekile akufanele uthathe indawo yokwahlulela kwe-biomechanical kanye nomtholampilo.
I-wire trajectory kanye nokulawulwa kokuphuka kufanele kuhlolwe ekubukweni kwezithombe ezifanele ngaphambi kokuba kwamukelwe ukwakhiwa.
Izinkinga Ezingenzeka kanye Nokucatshangelwa Kwengozi
Izinkinga azikwazi ukuvinjelwa ngokuphelele ngohlu lokuhlola. Umgomo uwukubona ubungozi obufanele futhi ulandele imiyalelo ethile yokufakelwa, umthetho olandelwayo oyinyumba kanye nohlelo lwangemva kokuhlinzwa.
Okungase kube ukukhathazeka kuhlanganisa:
Ukulahlekelwa kokunciphisa noma ukwehluleka ukulungisa
Ukutheleleka nge-pin-tract noma ukutheleleka okujulile
Ukuxegiswa kwentambo, ukufuduka, ukuphuka noma ukucasuka kwesikhumba
Ukulimala noma ukucasuka okubandakanya imisipha ye-extensor, imizwa yezinzwa noma ezinye izicubu ezithambile
Ukungena ngokuhlanganyela noma ukuvelela okungafanele kwe-cortical
Ukuqina kwesihlakala nomunwe
I-Malunion, i-post-traumatic arthritis noma i-syndrome yobuhlungu besifunda eyinkimbinkimbi
Ukulahlekelwa Ukuncishiswa
Ukuhlanganiswa, ikhwalithi ephansi yamathambo, ukulawulwa kwezingxenye ezinganele, ukumiswa kocingo okungafanelekile noma ukungakwazi ukuhamba kahle kungase kube nomthelela ekuthuthweni kwesibili. Ukuthwebula izithombe zokulandelela kungasetshenziswa ngokuya ngephrothokholi yethimba elelaphayo kanye nokuzinza kokuphuka.
I-Pin-Tract Infection
Isimo se-pin-site kufanele siqashwe ngokwemiyalo yesikhungo kanye nodokotela abahlinzayo. Ukwandisa ububomvu, ukugeleza kwamanzi, ukuvuvukala, ubuhlungu, umkhuhlane noma ezinye izimpawu eziphathelene nezimpawu kudinga ukuhlolwa komtholampilo. Lesi sihloko asinikezi uhlobo lwemithi yokunakekelwa kwephinikhodi.
I-Tendon, Inzwa kanye nokulimala kwe-Soft-Tissue
Indawo yokungena, i-wire trajectory, ukuvelela nokufuduka kungabeka izakhiwo eziseduze engcupheni. I-Lister's tubercle kanye ne-dorsal extensor compartments yizimpawu zendawo ezihambisana nomtholampilo, kuyilapho inzwa yenzwa ye-radial idinga ukucatshangelwa eduze nezindawo zokungena ezisemaceleni eradial.
I-Thermal and Mechanical Tissue Injury
Ukubhoboza okuphindaphindiwe, ukushisa okwedlulele, okokusebenza okungafanele noma amasu angalungile kungalimaza amathambo noma izicubu ezithambile. Abasebenzisi abaqeqeshiwe kufanele balandele indlela egunyaziwe, imiyalelo yemishini kanye nezimiso zesikhungo kunezinyathelo ezijwayelekile zokusebenza ku-inthanethi.
Ukucatshangelwa kokulandela ngemuva kokulungiswa
Ukulandelela kuyahlukahluka ngokuzinza kokuphuka, indlela yokulungisa kanye nezici zesiguli. Izindawo ezijwayelekile ezihlolwayo zihlanganisa isimo senxeba noma iphinikhodi, isimo se-neurovascular, ukunyakaza kweminwe, ukuvuvukala, ubuhlungu, ukuqondanisa kwe-radiographic kanye nezimpawu zokuxegiswa kwezintambo noma ukufuduka.
Ubude besikhathi sokunganyakazi, ukuvuselelwa, ukususwa kwezintambo nokubuyela emsebenzini kwenziwa ngabanye. Iziguli akufanele ziguqule i-splint, zenze izivivinyo noma zilawule intambo eveziwe ngokusekelwe olwazini oluku-inthanethi kuphela.
Ukunyakaza kweminwe nesimo sezicubu ezithambile kungase kubuyekezwe ngesikhathi sokulandelela, kuyilapho ukuvuselelwa kwesihlakala kuncike ekuzinzeni kokwakhiwa kanye nohlelo lukadokotela owelaphayo.
I-K-Wires vs Volar Plates vs Ukulungiswa Kwangaphandle
Indlela
Ejwayelekile Izimpawu Okucatshangelwayo
Okubalulekile
I-Percutaneous K-wire fixation
Isebenzisa izimila ezincane ze-percutaneous ukugcina izingcezu ezikhethiwe ezincishisiwe.
Ukulawulwa kweziqephu, izingosi zamaphini, ukufuduka, ukunganyakazi kanye nokuphathwa kwezintambo kamuva.
I-Volar noma i-dorsal plate fixation
Ihlinzeka ngokulungiswa kwangaphakathi futhi ingavumela ukulawula okuqondile kwezingcezu ezikhethiwe.
Ukuchayeka ngokuhlinzwa, ukuma kwesikulufu, ukucasuka kwe-tendon, iphrofayili yokufakelwa kanye nokucatshangelwa kokususwa.
Ukulungiswa kwangaphandle
Isebenzisa ifreyimu yangaphandle ukugcina ubude nokuqondanisa; ingase ibe yinde noma ingafinyeleli.
Izingosi zamaphini, ukuphathwa kohlaka, izicubu ezithambile, ukuqina kwamalunga kanye nokubekezelela isiguli.
Ukulungiswa okuhlanganisiwe
Isebenzisa indlela engaphezu kweyodwa uma isakhiwo esisodwa singakubheki kahle ukuphuka.
Ubunkimbinkimbi obengeziwe kanye nezingozi eziqondene nendlela ethile; kufanele kuhlelwe ukuphuka komuntu ngamunye.
Ukulungiswa kwangaphandle kungenye indlela noma isu elingeziwe lokuqhekeka kwerediyasi engazinzile ekhethiwe. Ayishintsheki nokuphina nge-percutaneous kuzo zonke izimo.
Imikhiqizo yokulungisa i-Distal Radius kanye nezinsimbi
Kubasabalalisi namaqembu amathambo ahlola iphothifoliyo yerediyasi ekude, imikhiqizo edingekayo ingase ihluke ngamasu okwelapha. I-XC Medico inikeza i-distal radius instrument sets , izinketho zepuleti lokukhiya kanye nobubanzi izixazululo ze-orthopedic trauma implant .
Ngezidingo zokulungiswa kwangaphandle, i isilungisi sangaphandle sesihlakala serediyasi eyi-distal kanye nokuphuka kwe-ulna kuhlanganisa ukucushwa kozimele okuningana. Ukutholakala komkhiqizo, ubukhulu, ukusetshenziswa okuhlosiwe, isimo esiyinyumba kanye nokuvunyelwa ngokomthetho kufanele kuqinisekiswe emakethe yendawo ngaphambi koku-oda.
Xhumana ne-XC Medico ukuze uthole ukucaciswa komkhiqizo, ukulungiselelwa kwamathuluzi, ulwazi lwekhathalogi kanye nemibhalo eqondene nemakethe yemikhiqizo yokulungisa i-distal radius.
Xhumana ne-XC Medico
imibuzo ejwayelekile ukubuzwa
Kuyini ukulungiswa kwe-K-wire ye-percutaneous?
Kuyindlela yokuzinzisa izingcezu ezikhethiwe zokuphuka ngezintambo ze-Kirschner ezifakwe ezindaweni ezincane zokungena kwesikhumba, ngokuvamile ngemva kokuba ukuphuka kuncishisiwe.
Ingabe ukulungiswa kwe-K-wire kulungele wonke ama-distal radius fracture?
Cha. Ukufaneleka kuncike ku-morphology yokuphuka, ukuzinza kokunciphisa, usayizi wesiqephu, ikhwalithi yamathambo, izicubu ezithambile, izici zesiguli kanye nekhono lokwakha ucingo ukuze ulondoloze ukuqondana.
Zingaki izintambo ze-K ezisetshenziselwa ukuphuka kwerediyasi ekude?
Ayikho inombolo yendawo yonke. Isibalo sezintambo nokucushwa kukhethwa iphethini yokuphuka kanye nezindlela eziqinisekisiwe. Ubufakazi abusekeli ukwethulwa kwesibopho sokucushwa kwezintambo ezintathu kuzo zonke izimo.
Iyini inqubo kaKapandji?
I-Kapandji pinning iyindlela ye-intrafocal lapho izintambo zethulwa khona endaweni yokuphuka ukuze zisize ukunciphisa futhi zisekele i-distal fragment. Kuyindlela eyodwa yesu, hhayi indinganiso yendawo yonke.
Yiziphi izingozi ezivamile zokulungiswa kwe-K-wire?
Izingozi ezingaba khona zihlanganisa ukulahlekelwa ukuncishiswa, ukutheleleka kwe-pin-tract, ukuxegiswa kwentambo noma ukufuduka, ukucasuka kwezicubu ezithambile, ukulimala kwe-tendon noma izinzwa, ukungena kwamalunga nokuqina.
Ingabe izintambo ze-K zingcono kunepuleti lokukhiya le-volar?
Ayikho enye indlela engcono kunazo zonke. Imihlahlandlela yamanje isekela ukukhetha ukulungiswa ngokusho kokuphuka kanye nesiguli. Amapuleti e-Volar angase anikeze ukululama kokusebenza kwesikhathi esifushane kwangaphambi kwesikhathi kwezinye iziqhekeko ezingazinzile noma ze-articular, kuyilapho imiphumela yesikhathi eside ingase ifane kuzo zonke izindlela zokulungisa.
Izithenjwa
I-American Academy of Orthopedic Surgeons kanye ne-American Society for Surgery of the Hand. Ukuphathwa kwe-Distal Radius Fractures Umhlahlandlela Wokuzilolonga Womtholampilo. Buka umhlahlandlela .
Kamal RN, Shapiro LM. I-AAOS/ASSH Clinical Practice Guideline Summary: Ukuphathwa kwe-Distal Radius Fractures. Buka isifinyezo sombhalo ogcwele .
Shapiro LM, Kamal RN, et al. I-Distal Radius Fracture Clinical Practice Guidelines—Izibuyekezo kanye Nemiphumela Yomtholampilo. Buka irekhodi le-PubMed .
I-American Academy of Orthopedic Surgeons. Imibandela Yokusebenzisa Efanelekile: Ukwelashwa Kwe-Distal Radius Fractures. Buka i-athikili yombhalo ogcwele .
Isaziso sokusetshenziswa kochwepheshe: Lesi sihloko sihlinzeka ngemfundo evamile kochwepheshe bezokunakekelwa kwempilo, izibhedlela nabasabalalisi bedivayisi yezokwelapha. Akusona iseluleko sezokwelashwa, iphrothokholi yokuhlinzwa noma esikhundleni sokuqeqeshwa okusemthethweni, ukuhlolwa okuqondene nesiguli, imibhalo yendlela yokuhlinza egunyaziwe noma imiyalelo yokusetshenziswa kwedivayisi. Izinkomba zomkhiqizo kanye nesimo sokulawula siyahlukahluka ngokwemakethe.
