Ukukhiya Imikhawulo ye-Plate-Application kanye nemikhawulo

Ukusetshenziswa kwe amapuleti okukhiya aye andise kakhulu ububanzi bokusetshenziswa kwepuleti ukulungiswa kwangaphakathi kokuqhekeka. Kodwa-ke, ukusetshenziswa kwabo kufanele kulinganiswe futhi kuthuthukiswe ngenxa yezingibe ezingaba khona kanye nemikhawulo. Kulesi sihloko, sizobheka ukucatshangelwa kwesicelo, izinselelo zokususwa, kanye nemikhawulo, izici ezi-3 zokufaka isicelo sepuleti lokukhiya.

01.Iziphi Izici Ezikhethekile Nobunzima Okufanele Kuphawulwe Ekufakeni Amapuleti Okukhiya?

Izinyathelo Nezinselele Ekwehliseni Ukuphuka Ngezingcwecwe Zokukhiya

Izinyathelo zokusetha kabusha ukuphuka ziyamiswa. Amapuleti okukhiya awabeki kabusha ama-fracture. 

Uma isibekwe engxenyeni yethambo, ukungeza izikulufu ezengeziwe ngeke kuyinyakazise. Uma kusetshenziswa ipuleti lokukhiya elamukela kuphela izinzipho zokukhiya, 

lokhu kusho ukuthi ipuleti lingakhiywa kuphela ngemva kokusetha ukuphuka.

Njengoba amapuleti okukhiya avumela ukuphulukiswa kwamathambo ngaphandle kokulahlekelwa ukumiswa kabusha kokuqala, 

Imbangela eyinhloko ye-malunion yokukhiya amapuleti ukumisa kabusha kokuqala okungalungile. 

Futhi, ukuhlelwa kabusha okungalungile ngenxa yemishini enganele kungaholela ekwelapheni okungekuhle njengoba ipuleti lethambo liphuka ngenxa yokulibaziseka ukuphulukiswa noma ukungaphili.

Ukumisa kabusha ngaphandle kokusetshenziswa kwamapuleti okukhiya kunzima kakhulu uma kwenziwa ukuhlasela kancane

 izinqubo ngoba ukuvezwa kwamathambo kulinganiselwe kakhulu. Kudinga izinqubo ezihlukahlukene zokudonsa (amatafula okudonsa, ama-retractors),

 ama-forceps ahlukahlukene wokubeka kabusha i-percutaneous, kanye nezikhonkwane ze-Kirschner zokukhohlisa izingcezu zamathambo nokulungiswa kwesikhashana. 

Ngaphambi kokufaka amapuleti okukhiya nezipikili zokukhiya, kubalulekile ukuhlola ukusetha kabusha nge-fluoroscopy.

Ngokuphambene, uma usebenzisa ipuleti lokukhiya elinezimbobo zesikulufu ezijwayelekile, 

isikulufu esijwayelekile sokudonsa singafakwa ezimbotsheni ezijwayelekile zokubekwa kabusha kwasekuqaleni epuletini.

 Izingcezu zamathambo zibekwe ngokumelene nepuleti. Uma ipuleti lihambisana ne-anatomy, lingasetshenziswa njengomhlahlandlela wokusetha kabusha. 

Ukukhiya izinzipho kuqinisekisa imiphumela ezinzile ngaphandle kokushintsha ukusetha kabusha kokuqala. Lo myalelo wokufaka (izikulufu ezijwayelekile, bese uvala izikulufo) ubalulekile (Umfanekiso 4).

Umfanekiso 4 Okokuqala faka izikulufo ezijwayelekile bese uziqinisa.

Ukungabi Nempendulo Ethintekayo Lapho Uqinisa Izikhonkwane Zokukhiya

Ayikho impendulo ethintekayo lapho uqinisa izikulufu zekhanda lokukhiya. Empeleni, 

ukuqiniswa kwesipikili sokukhiya kwenzeka ngesikhathi esisodwa ku-cortical noma ithambo elikhansela kanye nasensimbi yepuleti lokukhiya. Ngokwalesi sizathu,

 kulula ukuthi udokotela acabange ngephutha ukuthi isipikili sokukhiya sibambe kahle ethanjeni le-cortical noma lokukhansela (Umfanekiso 3).

Umfanekiso 3 Ubude bokusebenza bezikulufu zokukhiya ngokusekelwe ohlotsheni lwethambo kanye nenani lamakhola.

Izikulufu zokukhiya ozithephayo

Ukusetshenziswa kwezikulufu zokuzikhiya ezizishayayo kusho ukuthi ayikho impendulo ethintekayo ngesikhathi sokumba noma ukuqinisa njengoba kwenzeka kanyekanye.

Izakhiwo zabo zemishini ziyefana nalezo zezikulufi zokukhiya i-cortex eyodwa ngesikhathi sokufakwa kwe-cortex eyodwa. Uma zizinde kakhulu, 

bazothinta i-cortex yesibili engabhodliwe, okuholela ekumisweni okungalungile kwesipikili sokukhiya epuleti lokukhiya.

Ngesikhathi sokufakwa kwe-bicortical, zingaba zifushane kakhulu, zizenze zilingane ngokuzenzakalela nezinzipho zokukhiya ezinecortical eyodwa. 

Uma zizinde kakhulu, zizodlulela ngaphesheya kwe-cortex futhi zingalimaza izakhiwo ezibucayi ngakolunye uhlangothi lwepuleti.

Ubude bezinzipho zokukhiya obufanele bungatholakala kuphela ngokukala ubude obufunekayo ngemva kokubhoboza noma ukubuqinisekisa nge-fluoroscopy.

Izici Zezikulufu zokukhiya i-Uniaxial

Ububi obuyinhloko bezinzipho zokukhiya i-uniaxial ukuthi ukuma kwazo kunqunywe kusengaphambili. 

Bangase babe nesinye isiqu sokufakelwa noma sokufakelwa endleleni yabo, okwenza ukufakwa kungenzeki noma kukhawulele ekuqiniseni i-unicortical.

Okwamapuleti okukhiya e-anatomical asetshenziswa ezithweni ezinezinzipho zokukhiya i-uniaxial ezinomumo ongaguquki, 

elungiselelwe izizathu ze-anatomical kanye ne-biomechanical, kunengozi yokubekwa kwe-intra-articular yokuvala izipikili. 

Isibonelo esijwayelekile ukuphuka kweradiyasi ekude. Le ngozi inkulu nakakhulu uma ipuleti lokukhiya liseduze nelunga noma lapho i-anatomy ingekho ezingeni. 

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

I-MIPO Technologies

Indlela ye-percutaneous osteosynthesis (MIPO) ehlasela kancane ibandakanya i-subcutaneous kanye/noma i-submuscular. 

kanye nokufakwa kwe-extraperiosteal kwepuleti lethambo ngembobo encane ethanjeni ngemva kokushelela, ngaphandle kokudalula

 indawo yokuphuka. Lokhu kuvumela ukusikwa okuncane, ukugula okuncane kwendawo yokuhlinzwa, futhi kwenza inqubo ibe 'biologic'

 ngoba asikho isidingo sokudalula isiqeshana sethambo ngalinye futhi akukho ukuphazamiseka kwezicubu ezithambile, i-periosteal vascularization, noma i-hematoma ephukile.

Ingafezwa ngepuleti lokukhiya kanye nensimbi eyakhelwe ngokukhethekile evumela ipuleti 

ukuze isetshenziswe futhi idlule esikhumbeni ukuze kutholwe kalula izimbobo zezinzipho zokukhiya epuletini. 

Izithombe ze-fluoroscopic kufanele zithathwe esinyathelweni ngasinye ukuze kuqinisekiswe inqubekelaphambili. Isinyathelo ngasinye sale nqubo siyinselele. Inselele yokuqala ukusetha kabusha ukuphuka ngaphambi kokulungiswa.

 Ipuleti lokukhiya kufanele libe phakathi kahle phakathi nobude bethambo, ngaphandle kwalokho ukuqondana kwepuleti lokukhiya kuzoba asymmetric (Umfanekiso 5). Ngaphezu kwalokho, 

ipuleti lokukhiya kumele lihambisane ngokuphelele ne-cortex yethambo eliklanyelwe ukulilandela futhi lisondele ethanjeni 

kungenzeka ngaphandle kokunciphisa kakhulu ukuqina kwesakhiwo. Phakathi nesinyathelo sokugcina sokukhiya, kunzima ukuqinisekisa lokho

 amapayipi ezikulufu aqondaniswe kahle epuleti lokukhiya nokuthi izinzipho zokukhiya zibambene kahle ngesikhathi sokuqiniswa.

Umfanekiso 5 Ukuma kwe-Eccentric kwepuleti lokukhiya kanye nokuntuleka kwempendulo ye-haptic phakathi nokuqiniswa kwesikulufu.

Ukulimala Okungenzeka Kwesikhumba Uma Usebenzisa Amapuleti Okukhiya Iqakala Langaphandle

Ukusetshenziswa kwamapuleti okukhiya ukulungisa ukuphuka kwe-ankle yangaphandle kuye kwahlotshaniswa namazinga aphezulu ngokungavamile we-necrosis yesikhumba. 

Ukuqina kwalawa mapuleti okukhiya angaphansi kwesikhumba kubeka ingcindezi esikhumbeni futhi kuphazamise ukusatshalaliswa nokuphulukiswa kwemithambo yayo. 

Kungase kwenzeke okufanayo lapho amapuleti okukhiya esetshenziselwa ukuphuka kwama-hawksbill.

Ingozi Ye-Osteoporosis Nokukhishwa Kwesikulufu

Ethanjeni le-osteoporotic, izipikili zokukhiya zisiza ukunciphisa ingozi yokudonsa isikulufu noma ukuhoxa. 

Ukwakhiwa akuqinile ngokwanele ngenxa ye-bone cortex encane kanye nokuminyana okuncishisiwe kwe-trabeculae.

Kulokhu, ukulungiswa kwepuleti lokukhiya kuhlala kunamandla futhi kubambelele kangcono uma usebenzisa i-evanescent noma i-convergent monolithic construct (Umfanekiso 3).

Isifinyezo:

1. izikulufu zokukhiya azivumeli ukuphuka kwepuleti lethambo ukuthi kumiswe kabusha.

2. ukuphuka kufanele kusethwe kabusha ngaphambi kokwengeza isikulufu sokukhiya.

3. ukulungiswa kwe-percutaneous ukuze kuncishiswe ukuphuka kudinga izinsimbi zepuleti lokukhiya. indlela ye-MIPO ifuna kakhulu.

02. Izinselelo Zokukhipha Izingcwecwe Zokukhiya

Ukukhipha ipuleti lokukhiya uma ukuphuka sekupholile kuyinselele futhi akulindelekile, 

kodwa isimo singaxazululeka. Inselele enkulu ukukhulula isikulufu sokukhiya.

Kwezinye izimo, izintambo ezisekhanda le-nail yokukhiya zonakaliswa ngesikhathi sokufakwa 

(ukuqinisa kaningi futhi kuxegiswe, iphethini ye-screwdriver yonakalisiwe futhi ayinayo i-hexagonal kahle, ukufakwa kwesikulufa kwenziwa nge-drill yamandla), 

okusho ukuthi ngeke kukhululwe. Ngakho-ke, kungcono kakhulu ukuvimbela le nkinga ngokushintsha ngokushesha noma yisiphi isikulufu nge-a 

iphethini yekhanda elimele ngesikhathi sokufakelwa, kusetshenziswa i-screwdriver ephelele futhi uqinise ngokugcwele isikulufu ngesandla (hhayi nge-drill kagesi).

 Ukusebenzisa izikulufu ezenziwe ngezinto eziqinile kungasiza ekunciphiseni le nkinga.

Ezimweni eziningi, kukhona ukukhiya komshini noma ukuminyana phakathi kwemicu yokukhiya yezinzipho kanye nembobo enentambo epuleti lokukhiya. 

Lokhu kubonakala kakhulu ngezikulufu zokukhiya zeshaft eyodwa engu-3.5mm ububanzi be-titanium hex. Awukho umshini owodwa

 ngokuphazamiseka. Izikulufu zivame ukuqina kakhulu ngenxa yokwehluleka ukusebenzisa i-torque wrench enikezwe kukhithi yensimbi, 

okungashintsha imicu kuphegi lokukhiya kanye nepuleti lokukhiya. Kwezinye izimo, 

ukwehluleka ukusebenzisa noma ukusebenzisa i-drill guide engalungile kubangele ukuthi izikulufu zingaqondani uma ziqiniswa, 

okudale ukuthi izikulufu zigxumeke. Ukuze kuncishiswe ubungozi bokuminyana ngesikhathi senqubo yokuqala yokulungisa,

 kubalulekile ukusebenzisa zonke izinsimbi ezitholakalayo: iziqondiso zokubhoboza nezisekelo, ama-torque wrenches kwimodi yobuqotho egcwele lapho uqinisa izipikili zokukhiya.

Indlela ye-MIPO inobungozi obukhulu bokubekwa okungalungile komhlahlandlela wokuqondanisa, 

njengoba kungekho mbono oqondile wepuleti lokukhiya. Ukuqondanisa okungalungile komhlahlandlela wokubhoboza kusho ukuthi imbobo ebhojwe 

isipikili sokukhiya kanye nokufakwa kwesipikili sokukhiya nakho kuzobe kungalungile. Kukhona futhi ingozi yokulimaza iphethini yekhanda le

 ukukhiya isikhonkwane lapho i-screwdriver ingahlangene kahle nesikulufu.

Ngenxa yalezi zizathu, ngaphambi kokukhipha ipuleti lokukhiya, udokotela ohlinzayo kufanele aqaphele ukuthi kungenzeka ukuthi akunjalo 

kungenzeka ukukhulula isipikili sokukhiya, ngaleyo ndlela kudinga ukusetshenziswa kwekhwalithi ephezulu ye-screwdriver ene-hexagonal kanye nezinsimbi ezengeziwe.

Lapho isipikili sokukhiya singakwazi ukukhululeka, noma iphethini yekhanda yonakalisiwe, 

isinyathelo sokuqala ukubeka isikrufu sesikulufu (i-screwdriver ene-tapered enezintambo ezihlanekezelwe) ekhanda lesikulufu;

 lokhu kungase kwanele ukukhulula isikulufu. Enye inketho ukusika ipuleti lokukhiya nhlangothi zombili zezipikili zokukhiya bese usebenzisa

 njenge-screwdriver ukukhulula sonke isakhiwo. Uma isikulufu sisengakwazi ukukhululeka, ipuleti lokukhiya lingaxegiswa 

ukuyibhoboza ngokubhoboza, ukucekela phansi inhloko yesipikili sokukhiya, noma ngokusika nxazonke zepuleti ukuze ukhulule isipikili sokukhiya. Ngemva kwalokho, 

i-vise ingasetshenziswa ukususa izikhonkwane zezikhonkwane zokukhiya. Uma namanje ayikwazi ukuxegiswa (ngoba ihlanganiswe ethanjeni noma ayiphumeli ngokwanele), 

ingasuswa nge-drill ring (Fig. 6).

Umfanekiso 6 Amacebo namathiphu okukhipha izikulufu zokukhiya ezibhajwe ebhodini.

Zonke lezi zinkinga zingandisa isikhathi sokuhlinzwa, zingabangela ukuhuzuka kwezicubu ezithambile ngenxa yezicucu zensimbi ezikhishwe, futhi kube sengozini yokutheleleka. 

Ukusetshenziswa kwe-drill drill kwandisa ingozi yokuphuka kwe-perioperative.

Isifinyezo:

1. Inselele yokukhipha izinzipho zokukhiya yenzeka ikakhulukazi ngezikulufu ze-titanium ze-hex zokukhiya ikhanda le-titanium.

2.Indlela engcono kakhulu yokugwema le nkinga ukusebenzisa zonke izinsimbi ezinikeziwe lapho ufaka isikulufu. Lobu bunzima bungaxazululeka ngokusebenzisa amathuluzi afanele.

03. Iyini Imikhawulo Yesicelo Sepuleti Lokukhiya?

I-Clavicle plate fracture kanye ne-osseous nonunion

Ngokuqinisekisa ukuthi isakhiwo asiqini kakhulu ngenxa yobude obunganele bokusebenza bepuleti lokukhiya noma inani eleqile lezipikili zokukhiya (Umfanekiso 7), ingozi yokuphuka kwepuleti lokukhiya ngaphansi kwezimbobo zesikulufu noma lapho kuhlangana khona isikulufa/ithambo lepuleti lingancishiswa.

Umfanekiso 7 Ukuphulukiswa kwamathambo kwafinyelelwa ngemva kwezinsuku ezingu-60 ngokushintsha inombolo nendawo yezikulufu zokukhiya kanye nokwandisa ukunwebeka kwezakhiwo eziqine kakhulu.

Ukuxilongwa kwe-bone nonnunion ngokuvamile kuqinisekiswa ukuphuka kwamapuleti. 

Ukuphuka sekwephuzile kwepuleti lokukhiya noma isikhonkwane sokukhiya sekuyisikhathi esifanele njengoba i-micromotion ingenzeka okuholela ekwelapheni kwamathambo.

Ezingxenyeni ezilula ezidinga ukucindezelwa, okuncike ohlotsheni lokuphuka esikhundleni sethambo elihilelekile, 

isakhiwo esiqinile lapho izingcezu ezimbili zingathinti zingaholela ekuhlulekeni kokuphulukisa nokukhathala kwepuleti. 

Inhlanganisela ye-splint eqinile + isikhonkwane sokukhiya + ukudonsa endaweni yokuphuka kuphumela ekungahlangani kwethambo.

Ukwehluka kwalokhu ukugqabuka kanyekanye kwesipikili sokukhiya ngaphansi kokunamathiselwe kwalo epuletini, 

okuphinde kube ngenxa yesakhiwo esiqine kakhulu. Lokhu kubangela ukuthi ingxenye eyodwa yepuleti ikhiphe 'isiqephu esisodwa' futhi ukuphulukiswa akutholakali (Umfanekiso 8).

Umfanekiso 8 Ukwehluleka kwesibili kwesakhiwo esiqine kakhulu nesingalingani: izikulufu zokukhiya eziningi zisetshenziswe kude futhi i-proximal splice plate ibingende ngokwanele.

Ngakho-ke, ukulungiswa kwe-intracapsular fractures ye-hip ngamapuleti okukhiya kungaholela ekungabini kwethambo ngoba isakhiwo siqinile kakhulu ukuthi singangena endaweni yokuphuka. 

Ngaphandle kwe-micromotion edingekayo ekuphulukiseni, wonke umthwalo uthwalwa yi-implant futhi ekugcineni wehluleke.

izicubu zokuphulukisa ze-asymmetric

I-Periosteal bone scabs ingaba i-asymmetric, 

ikakhulukazi ekuqhekekeni kwe-distal 1/3 ye-femur. I-Micromotion ngenxa ye-elasticity ivumela 

ukuthuthukiswa okufanayo kwezicubu zokuphulukisa ukuphuka okwenzeka kuphela ezindaweni ezihambisanayo zepuleti lokukhiya/ukwakhiwa kwezinzipho.

 Ukuze ulawule le ngozi, ubude bokusebenza bepuleti lokukhiya kufanele bunyuswe, ngokusebenzisa amapuleti e-titanium avumelana nezimo noma ngokusebenzisa imiklamo emisha yokukhiya yezinzipho. 

Ngakolunye uhlangothi, ukwakheka okuguquguquka ngokweqile kungaholela ekwakhiweni kwethambo le-hypertrophic.

I-deformation yepulasitiki yamapuleti ensimbi

Ukubeka ipuleti eduze ne-cortex ngangokunokwenzeka kunciphisa ingozi yokuguqulwa kwepulasitiki phakathi kwepuleti;

 lapho ibanga phakathi kwepuleti ne-cortex lidlula ama-5 mm,

 amandla esakhiwo ancishiswa kakhulu futhi ingozi yokuguqulwa kwepulasitiki yepuleti kanye nokwehluleka kwepuleti le-titanium kuphezulu.

Ukuphuka kwakamuva kwe-diaphysis noma i-metaphysis ekugcineni kwepuleti lokukhiya

Ingozi yokuphuka sekwephuzile ekupheleni kwepuleti lokukhiya i-diaphysis noma i-metaphysis, 

ikakhulukazi kuthambo le-osteoporotic, lingancishiswa ngokufaka isikhonkwane esisodwa sokukhiya i-cortical noma isikulufu esijwayelekile se-bicortical ekupheleni kwepuleti ukuze kuncishiswe izingcindezi kulesi sifunda.

Ukuhluleka Kwemishini

Lezi zimo ezilandelayo zandisa ingozi yokwehluleka kwemishini kwepuleti lokukhiya:

1. Ukulungiswa kokuphuka kwe-humeral diaphysis kudinga ukusetshenziswa kwezinzipho ezine zokukhiya nhlangothi zombili zesiza sokuphuka ukuze kumelane nokuvunguza nokwandisa ukwehluleka kwemishini ;futhi

2. Ukulungiswa kwe-epiphyseal fractures kunzima ngoba ngokuvamile azinzile, 

ikakhulukazi ngoba indawo yokuphuka ayikwazi ukucindezelwa izipikili zokukhiya futhi ithambo liyi-osteoporotic;

3. Ukuqhekeka kwe-intra-articular kanye ne-extra-articular comminuted kwe-epiphysis akuzinzile

 (isb, ukuhlukana kwe-distal femur, ukuphuka kwe-bicondylar tibial plateau, ukuhlukana kwe-distal radius);

4. Ukuthuthukiswa okuphakathi kokuqhekeka kwe-metaphyseal okuvame ukugudluka ekuguqukeni (isb, i-proximal humerus, i-proximal femur, kanye nokuphuka kwe-tibia eseduze).

 Amapuleti okukhiya afakwe engxenyeni engemuva yethambo ahlinzeka ngesakhiwo esiqinile esivame ukwanele 

ukuzinzisa lokhu kuphuka ngaphandle kwesidingo sokwengeza amapuleti ohlobo lwe-console phakathi nendawo noma ukwengeza ithambo ngenkathi kugcinwa imvelo yokuphuka kwe-biologic. 

Ukuzinza kuncike kuphela epuleti lokukhiya/esixhumi esibonakalayo sezipikili, 

okugcizelelwa kakhulu ngemva kokusetha kabusha lapho i-epiphysis ihlala ihlanekezelwe noma lapho ikhonsoli ephakathi ingakhiwa kabusha. Ipuleti lokukhiya lingase lehluleke ngemva kokukhathala.

Ngakho-ke, ukulungiswa kwe-bicondylar tibial plateau fractures usebenzisa amapuleti okukhiya kuphela ohlangothini lwe-lateral kufanele kucatshangelwe kuye ngokuthi hlobo luni.

 Ngokuphuka kwe-humerus eseduze, inani lamabhulokhi wokuphuka, ukulahlekelwa ukusekelwa okuphakathi,

 kanye nokuguqulwa kwe-epiphysis ukuze kulungiswe yizici eziyingozi ezaziwayo. Ukunciphisa ingozi yokwehluleka ukwakha, 

izinzipho ezithile zokukhiya zizosekelwa ngomshini ukuze kunxeshezelwe ukungabikho kokusekelwa okuphakathi ekunciphiseni ukuphuka okuhunyushwe ngaphandle.

Ukuhluleka Kwebhayoloji Kwamapuleti Okukhiya

Izindlela zokuhluleka kwebhayoloji zamapuleti okukhiya ziyisikulufu esisikwe futhi siphuke noma sifakwe isipikili sokukhiya. 

Lezi zingozi zikhulu uma i-bone osteoporosis ikhona ku-skeleton, 

okusho ukuthi ukuvuselelwa kusenesikhathi kanye nokubuyela ekuthwaleni isisindo kufanele kwenziwe ngokucophelela ngaphambi kokuba kutholakale ukuphulukiswa kwamathambo.

(1) Ukususwa Kwezikulufu Zokukhiya

Ukukhipha isikulufu kuhambelana 'inani' kanye nokususwa kanyekanye kwesipikili sokukhiya ethanjeni emaphethelweni awodwa noma womabili epuleti. Kwezinye izimo, 

isipikili sokukhiya sikhishwa ngocezu lwethambo nxazonke.

Esifundeni se-epiphyseal, isakhiwo sepuleti lokukhiya ingxenye eyodwa ngokuvamile sinikeza ukuzinza okwanele ngenxa ye-anchorage yokukhiya yezipikili ehlakazekile noma eguquguqukayo, 

futhi isakhiwo esinezinhlangothi ezintathu kwandisa ukumelana nokukhipha isikulufu ethanjeni elikhansela.

Esifundeni se-diaphyseal, izipikili zokukhiya eziguqukayo nezihlakazekile kanye nezakhiwo ezinamapuleti akhiya amade zinamandla angcono wokudonsa . 

Lolu hlobo lokwakhiwa lufaneleka kakhulu ukuphuka kwe-periprosthetic. Ngethambo le-osteoporotic, 

ukulungiswa kwesikulufu se-bicortical stem kuphakeme kunokulungiswa kwesikulufu se-monocortical. Ngokuphuka kwe-periprosthetic, izikulufu ze-unicortical ezinekhanda eliyisicaba zisiza ukugwema ukuthintana nezifakelo ze-intramedullary.

Lokhu kwehluleka kokulungisa kuhlotshaniswa nekhwalithi ephansi yamathambo, ngisho noma isakhiwo sinomshini oqinile.

(2) Ukusika noma ukufakwa kwezikulufu zokukhiya

Ukusikwa noma ukufakwa kwezipikili zokukhiya ezinokungena kwe-intra-articular kungenzeka endaweni ye-epiphyseal ekhansela.

Lokhu kususwa ukugudluzwa kwezingcezu ze-epiphyseal zamathambo anesisindo esiphansi agudluzwe eduze kwesipikili sokukhiya.

 Lokhu kubangela ukulahlekelwa kwe-epiphyseal fracture yokunciphisa. Esimweni esihle kakhulu, i-epiphyseal locking nail impinges futhi

 lingena ethanjeni elikhansela. Esimweni esibi kakhulu, isikhonkwane sokukhiya i-epiphyseal siphuma ku-epiphysis futhi sihambe singene ekuhlanganyeleni.

Lezi zinkinga ezimbili zenzeka kakhulu kuma-proximal humerus kanye ne-distal radius fractures. 

Ukulungiswa kwepuleti lokukhiya lokuphuka kwe-humerus eseduze, kunconywa ukuthi ubude be- 

I-epiphyseal locking nail ikhawulelwe ukunciphisa ubungozi bokungena kwe-ingrowth kanye nokungena okuhlangene kwesibili.

Lokhu kwehluleka kokulungiswa kungenxa yekhwalithi enganele yamathambo kanye nokufuduka okukhulu kokuqala kwezingcezu zokuphuka ngaphambi kokunciphisa, 

noma ngabe isakhiwo sinomshini.

Ukuvuselelwa Okuhlangene kanye Nesisindo Esisheshayo

Ukuvuselela kanye nokuthwala isisindo kuvunyelwe kuphela ngemva kokuba ukulungiswa okuphelele sekufinyelelwe futhi kwaqinisekiswa kuma-X ray wangemva kokuhlinzwa.

Ucwaningo lwe-biomechanical lubonise ukuthi emathanjeni avamile, uma igebe phakathi kwezingcezu lingaphansi kwe-1 mm, 

ukuthwala isisindo kungenzeka ngaphandle kwengozi. ngemva kwemijikelezo eyizigidi ezingu-1, ukuqina kufana nethambo elivamile, elanele ukuphulukiswa ukuba kwenzeke.

Uma kuzwakala ngokwesakhiwo, amapuleti okukhiya nezinzipho zokukhiya ezine-engeli engaguquki zivumela ukubuya kusenesikhathi 

isisindo ngenxa yokuthi umthwalo udluliswa ngokuqondile usuka esipikili sokukhiya uye epuleti lokukhiya, ngaphandle kwengozi yokwehluleka ukulungisa lapho kuhlangana khona i-nail plate.

Kodwa-ke, lapho i-axis yesikhonkwane sokukhiya i-multiaxial ingekho eduze nepuleti lokukhiya, ukuthwala isisindo sokuqala akuvunyelwe.

Ku-MIPO, ukuthwala isisindo kwangaphambi kwesikhathi kuvunyelwe ama-extra-articular, ama-fracture alula kanye/noma ahlanganiswe kalula. 

Izakhiwo eziqondile ezinde kakhulu zivumelana nezimo ngokwanele ngezipikili zokukhiya ezishintshayo ze-bicortical kanye nezimbobo zokumuncwa nokusabalalisa umthwalo.

Isiphetho:

1.Izifundo ze-Biomechanical ziye zahlola izinhlobo ezihlukahlukene zokwakha kanye nezakhiwo zazo zemishini.

Izincwadi zisiza ukuqinisekisa amathemba etiyetha ahlobene nalolu hlobo lokulungiswa. 

Kodwa-ke, izincwadi zakamuva ziphinde ziqokomise ubunzima bezobuchwepheshe kanye nokwehluleka okuhambisana namapuleti okukhiya.

2.Isizathu esiyinhloko sokwehluleka ukuhlela kahle indlela yokuhlinza, 

okuyinto edinga kakhulu, ikakhulukazi uma kwenziwa izinqubo ezihlasela kancane.

3.Ukuphuka kufanele kusethwe kabusha kuqala, ngaphandle kokukhiya izikulufu epuletini,

njengoba ukusetha kabusha okungaqondile kwepuleti ngokukhiya izikulufi akunakwenzeka.

4.Isakhiwo kumele sibe nobude namandla afanele, 

okusho ukuthi udokotela ohlinzayo kufanele ajwayelene nezimiso nemithetho eqondisa ukusetshenziswa kwalezi zingcwecwe. 

Ngakho-ke isakhiwo kumele sibe nokunwebeka, sibe nenani elilinganiselwe lezikulufu zokukhiya ezinezikhala ezishintshana nezimbobo ezingenalutho.

5.Naphezu kokuzinza okungcono kwasekuqaleni kwamapuleti okukhiya, 

ukulungiswa kwesakhiwo kunqunyelwe ukuba yinkimbinkimbi kokuphuka, ikhwalithi yokunciphisa, kanye nekhwalithi yebhayoloji yethambo.

6. Uma isakhiwo siqinile, izinga lethambo lihle futhi ukuphuka ku-extra-articular, 

isiguli esinokuzimela okwanele singavunyelwa ukuba sithwale isisindo esithweni esiphukile. Ezimweni eziningi, ukulungiswa kwepuleti lokukhiya kuvumela ukuvuselelwa kusenesikhathi.