Ukusetshenziswa Okufanelekile Kweplate Lokukhiya!

A ipuleti lokukhiya iyidivayisi yokulungisa ukuphuka enembobo enentambo. Uma isikulufu esinekhanda elinentambo sijikijelwa embobeni, ipuleti liba idivayisi (isikulufu) yokulungisa i-engeli. Ipuleti lokukhiya (elizinzile) lingaba nazo zombili izimbobo zezikulufu zokukhiya nezingakhiyiyo ukuze kufakwe izikulufu ezihlukene (ephinde ibizwe ngokuthi ipuleti elihlanganisiwe). Njengoba umqondo wokukhiya amapuleti wahlongozwa futhi wasetshenziswa ekwelapheni ukuphuka, uye wasetshenziswa kabanzi ekulungiseni ukuhlukana kwe-periarticular, i-comminuted kanye ne-osteoporotic fractures ngenxa yezinzuzo zayo zokuhlinzeka ngokusekela okuzinzile nokulungiswa kwe-fractures, izinga eliphezulu lokuphulukisa ukuphuka, ukulimala okuncane kwezicubu ezithambile kanye nokuphazamiseka kokunikezwa kwegazi. Ukufunda kwanamuhla ekuseni kuzokunikeza isingeniso esiningiliziwe sokukhiya amapuleti, okufanele ufunde kuwo!

(A)Uhlolojikelele Oluyisisekelo

1.Iyini ipuleti lokukhiya?

Noma yiliphi ipuleti lensimbi elingagqunywa libe yizikulufu zokulungisa ama-engeli/ezinzinzisa i-engeli noma izikhonkwane ziyipuleti lokukhiya.

2. Izinzuzo kanye nokubi amapuleti lokukhiya

Izinzuzo

∎ Ukuzinza kwe-angular, ukumelana nokugoba nokuhlehla

■ Ukuma okukhonkolo kwekhanda lesikulufa kuthuthukisa ukusatshalaliswa komshini

■Nikeza ukulayisha kuqala kwe-radial, vimbela ukubola kwamathambo kanye nokuxegiswa kwezikulufu

■ Okumise okwe-anatom ukuze kuhambisane namaphethini e-anatomical asendaweni

■Izifanekiso ezifanayo ukuvumela ukulungiswa kwe-percutaneous ku-diaphysis (i-cortical eyodwa, i-self-drilling, izikulufu zokukhiya ezizishayayo)

■Izikulufu zokukhiya zinikeza isibambiso esihle kakhulu kukho kokubili ukuguquguquka kwebhuloho kanye nokulungiswa kokuqiniswa okuphelele

∎ Asikho isidingo sokuthintana eduze nendawo yamathambo, ukulondoloza ukutholakala kwegazi

■I-micromotion elawulwayo, evumela ukuphulukiswa kokuphuka

■ Ngokujwayelekile akukho ukuxhunyelelwa kwethambo okudingekayo

Isebenza kahle kakhulu ekwephukeni kwe-osteoporotic noma yikuphi ukuphuka okungazinzile kakhulu.

Ukubi

■ Izikulufu zokukhiya azinawo umphumela wokunciphisa nokucindezela, ikakhulukazi ekuqhekekeni kwe-intra-articular noma ukuphuka okulula kwe-oblique

■ Ipuleti alikwazi ukusetshenziswa njengethuluzi lokunciphisa ukusiza ekwehliseni.

■Izikulufu azizwa kahle njengezikulufu ezivamile uma zifakiwe.

■Indlela yezikulufu ayikwazi ukulungiswa (ngaphandle kwezikulufu zokukhiya eziningi).

■Izikulufu zibekwe ziqine kakhulu, okungaholela 'ekushiseleni okubandayo'.

■Ukuchezuka kwe-engeli >5°, ukuncipha kwamandla; >10°, umphumela wokukhiya awusebenzi

■ I-protrusion engaphansi kwe-subcutaneous engenzeka uma ipuleti lingajingiwe

Izinkinga zokuqina

Ngaphandle kokuxhumana okuhle kwe-cortical noma ukucindezelwa kokuphela kwe-fracture, ukusetshenziswa kwezintambo zokukhiya, ikakhulukazi izinsimbi zensimbi ezingenasici, kuzovimbela ukuphulukiswa kwesigaba II sokuphuka ngenxa yokuqina ngokweqile nokuqedwa kwe-micromotion evumayo endaweni yokuphuka;

Uma i-intraoperative traction isetshenziswa bese kusetshenziswa ukulungiswa kwe-splint yokukhiya, igebe lekhefu lokuphuka lizogcinwa, okuholela ekubambezelekeni noma kungabikho ukuphulukiswa kokuphuka;

Uma ukuphuka okulula kungasethiwe kabusha futhi kucindezelwe, umthwalo udluliselwa ngepuleti, okuholela ekugxilweni kokucindezeleka okungaholela kalula ekuqhekekeni kwepuleti.

3. Umehluko omkhulu we-biomechanical phakathi kwamapuleti okukhiya namapuleti avamile

Amapuleti avamile ancike ekungqubuzaneni kwe-bone-plate interface ukuze afeze ukuminyanisa kwepuleti lethambo.

4. Izinzuzo zokuqhathanisa zepuleti lokukhiya kanye nepuleti yensimbi evamile

1.Ukumelana nokukhipha izikulufu zokukhiya kuphakeme kakhulu kunokwezikulufu ezijwayelekile.

2. Izikulufu zokukhiya ze-epiphyseal zigoqelwe zodwa, okwandisa kakhulu ukumelana nesikulufu ekukhipheni uma kuqhathaniswa nezikulufu ezihambisanayo.

(B) Izimiso zokusetshenziswa

1. Izimiso zokunganyakazi:

● Isimiso sokucindezela: ukuphuka kwe-osteoporotic diaphysis

● Isimiso se-neutralization: i-osteoporotic diaphysis fracture

● Isimiso sokuhlanganisa: i-diaphysis ehlanganisiwe noma ukuphuka kwe-metaphyseal eyengeziwe

Isimiso senyunyana: ukwephulwa kwe-intra-articular metaphyseal fracture

2. Umgomo wokuhlanganisa:

● Indlela ejwayelekile: ukulungiswa kwepuleti elincane elingena-percutaneous (i-MIPO noma inqubo ye-MIPPO)

●Isu lokunciphisa ngokungaqondile

●Ukulungisa ipuleti lebhuloho okwanele, izimbobo zezikulufu ezingu-3-4 kufanele zishiywe zivuliwe eduze nendawo yokuphuka.

3. Izimiso zenyunyana:

● Ukusetshenziswa okuhlanganisiwe kwezimiso ezimbili ze-biomechanical zokuminyanisa nokuhlanganisa ibhuloho kupuleti elilodwa - ipuleti lokucindezela lokukhiya (LCP)

● Ukuphuka okulula engxenyeni eyodwa yokuphuka kanye nokuhlukana okwedlulele kwenye (isb., ukuphuka okuhlangene kwe-metaphysis, diaphysis)

●Isimiso sokuhlanganisa kufanele sisetshenziswe kuphela kumapuleti avumela ukubekwa kwazo zombili izikulufu zekhanda lokukhiya kanye nezikulufu ezivamile.

Amapuleti okukhiya awanciki ekungqubuzaneni phakathi kwesixhumi esibonakalayo se-bone-plate futhi ancike ngokuyinhloko kusixhumi esibonakalayo phakathi kwesikulufu nepuleti elinokuqina kwe-angular ukuze kugcinwe ukuzinza.

Ngenxa yobunye bazo obuzinzile, amandla okukhipha izikulufu ezinamakhanda okukhiya aphakeme kakhulu kunalawo ezikulufu ezivamile, ngaphandle kwalapho zonke izikulufu ezizungezile zikhishiwe noma zaphuka. Ngokuvamile, kunzima ukuthi isikulufu esisodwa sikhishwe noma siphuke ngokwaso. Izikulufu zekhanda lokukhiya azinikezi i-inter-fold pressurization. Ukucindezela kungatholwa kusetshenziswa idivayisi ecindezelayo noma ngokushayela izikulufu ezivamile 'kuhlanganise izimbobo' (izikulufu ze-tension kuqala, bese zikhiya izinzipho).

1.Uma kusetshenziswe izikulufu ezijwayelekile ukuze kuqiniswe i-splint (isb. 1), ukugoqa izikulufu zokukhiya kuzoba lula kakhulu (isb. 2).

2.Uma izikulufu zokukhiya zisetshenziselwe ukuvikela ukuluka kanye nebhulokhi yethambo (isb., 1), akunconywa ukuthi izikulufu ezijwayelekile ziphoqwe ebhulokhini lethambo elifanayo (isb, 2) ngaphandle uma izikulufo zokukhiya zixegisiwe futhi ziqiniswa kabusha (LHS).

3.Uma i-metaphyseal fracture block isivikelwe ngesikulufu esinekhanda lokukhiya (LHS), ukulungiswa kokucindezelwa phakathi kwamabhulokhi okuphuka kufinyelelwa ngokufaka isikulufu esijwayelekile emgodini wokucindezela amandla wenhlanganisela ye-Locking Compression Plate LCP.

(C) Izinkomba kanye contraindications

1. Izinkomba

Ukuqhekeka okuningi okulashwe ngokuhlinzwa akudingi ukulungiswa kwepuleti lokukhiya. Uma nje kulandelwa izimiso zokuhlinza amathambo, ukuphuka okuningi kungelapheka ngokusebenzisa amapuleti avamile noma ukubethelwa kwe-intramedullary.

Kodwa-ke, kunezinhlobo ezithile zokuphuka okungase kube lula ekulahlekelweni ukuncishiswa, ukuphuka kwepuleti noma isikulufu, kanye nokungahlangani okulandelayo, okuvame ukubizwa ngokuthi 'okungaxazululiwe' noma 'ukuphuka okuyinkinga', okuhlanganisa ukuphuka kwe-intra-articular comminuted, ukuphuka kwe-periarticular kanye nokuphuka kwethambo elincane, i-osteporotic fragments. Lezi zinhlobo zokuphuka ngokuvamile zibizwa ngokuthi 'zingaxazululiwe' noma 'inkinga' ukuphuka futhi zihlanganisa ukuphuka kwe-intra-articular comminuted, i-periarticular short tuberosity fractures kanye ne-osteoporotic fractures. Lokhu kuphuka konke kuyizinkomba zokukhiya amapuleti.

Izinkomba zasendulo nezikahle zokulungisa amapuleti okukhiya ukuqhekeka kuwumgomo wokuvala ibhuloho kanye nomgomo wenyunyana wokuqhekeka okuthe xaxa - ukuphuka okunamandla amakhulu ezigulini ezisencane noma ukuphuka kwe-osteoporotic ezigulini esezikhulile.

2. Contraindications

Nakuba amapuleti okukhiya asetshenziswe kabanzi futhi izinkomba zawo zibanzi, kufanele siqaphele futhi sigweme ukuphikisana okuningana kokukhiya amapuleti. Uma amapuleti okukhiya asetshenziswa ngokungakhethi, ukwehluleka kokulungiswa nokungahambisani nokuphulwa kungase kwenzeke.

Ukuphuka okulula okudinga ukucindezelwa kwe-interbody, njengokuphuka kwesiqu se-forearm elula okulashwa ngokukhiya kwangaphakathi, kujwayele ukungahlangani.

Ngokufanayo, ukubekwa kwe-percutaneous kwamapuleti okukhiya ama-fractures alula kusetshenziswa amasu angavamisile kancane nakho kuyi-contraindication.

Ukunciphisa okungaqondile kanye nokulungiswa kwepuleti lokukhiya nakho akufanelekile ukuhlukana kwe-intra-articular okususiwe, okudinga ukunciphisa okuvulekile kwe-anatomical kanye nokucindezelwa phakathi kwezingcezu zokuphuka kanye nokulungiswa okuqinile.

Ukuphikisana okuhlobene namapuleti okukhiya, ngenxa yezindleko zabo eziphakeme, ama-fractures angalungiswa ngokugculisayo ngamapuleti avamile. Isibonelo, ukuphuka kwe-forearm symphysis kunesilinganiso sokuphulukisa esingaphezu kuka-90% uma kuphathwa ngamapuleti avamile.

(D) Ukufakwa kwepuleti lokukhiya

1. Khipha i-drill bit embotsheni yesikulufu sepuleti. Ukuchezuka okungu->5° phakathi kwesikulufu kanye nembobo yesikulufu kungaholela ekuhlulekeni kokukhiya ngezikulufu, futhi kutuswa ukuba usebenzise i-drill bit ukuze ubhoboze izimbobo ngokungcono kakhulu.

2. Beka ipuleti lensimbi phezu kwethambo bese ubhoboza izimbobo ngomkhono wokubhoboza.

3. Linganisa ukujula nge-sounder ejulile, uqaphele ukuthi ikhanda le-sounder lifakwe emgodini wesikulufu.

4. Khetha ubude obufanele besikulufu sokukhiya.

5. Ukufakwa kwezikulufu ezicindezelwe kuyafana namapuleti ensimbi ajwayelekile.

6. Ekugcineni qinisa izikulufu zokukhiya ngesikrufu se-torque, lapho siqiniswa, kuzoba nomuzwa osobala wokuslayida nomsindo wokunqamuka, ukugwema ukugoqa kuqine kakhulu, okuholela ebunzimeni bokususa.

(E) Ukususwa kwepuleti lokukhiya

Izikulufu zepuleti lokukhiya lomtholampilo zisetshenziswa kakhulu, kodwa kuhlangatshezwana nazo kalula nezinkinga zokususa, ezibonakala kakhulu kucingo oluyisikulufa olushelelayo kanye nesivalo sezinzipho nemicu yembobo yepuleti phakathi kwebhande elingalungile.

1. Ukulimala kwe-Screw cap groove

Ngaphansi kwezimo ezijwayelekile, igroove ephelele ye-screw cap kanye ne-screwdriver ehambisanayo kuyahambisana. I-screwdriver kufanele iqondaniswe ne-screw cap groove ngaphambi kokufaka noma ukukhishwa kwesikulufu, ngaphandle kwalokho i-screw cap groove ingase yonakale ngesikhathi sokushwibeka noma ukukrufulwa, okuholela ekusheleleni.

Ukwengeza, ngemva kokuphulukiswa kokuphuka, inothi ye-screw cap ivamise ukugoqwa nge-bone crust noma izicubu ze-fibrous, okufanele zihlanzwe ngaphambi kokukhipha isikulufu, kodwa uma kungekho ukunakwa okukhokhelwayo, inothi ye-screw cap kanye nesakhiwo se-angular singalimala ngokuzenzela.

Ngenxa yokuthi i-axis yokuzungezisa yengalo yomqhubi ayihambisani ne-eksisi ende ye-screwdriver, kuvame ukuba ne-engeli ethile, lapho u-opharetha ejikisa isikulufu ngamandla, akunakugwemeka ukuthi isikulufu siyanyakaza, okuholela ekulimaleni kwe-cap groove yesikulufu ngenxa yamandla angalingani. Ngakho-ke, umonakalo we-screw groove ungaholela kalula ekusheleleni ngezikulufu.

2. Isivalo se-nail noma ukuguqulwa kwembobo yezipikili

Enqubweni yokusetshenziswa kwe-intraoperative ye-anatomical locking steel plate, ngezikhathi ezithile ngokuya ngesidingo sokugoba okufanele noma ukubunjwa kwepuleti lensimbi, u-Raja et al. bakholelwa ukuthi uma ingxenye egobayo yenzeka ezimbotsheni zesikulufu sokukhiya, lapho isikulufa kuzikulufu zokukhiya kuzoba isikulufu sekepisi kanye nokungafani kwembobo yezipikili, okungenzeka kakhulu kwenzeke phakathi kwekepisi lezipikili kanye nentambo yensimbi yezimbobo zezipikili ibhande elingalungile, noma liboshwe eduze kwepuleti lensimbi lapho umsila wokuwohloka kwezipikili okubangelwa ukugoqa okuqinile, njll., okungase kuholele ekukhipheni kanzima kamuva.

3. Ukusetshenziswa kwezipikili zokukhiya i-cortical self-tapping

Ngenxa yokuthi ithambo lekhohlo likhulela ngaphakathi eduze kwembobo yezinzipho futhi ngaleyo ndlela lizobamba isikulufu, okuholela ebunzimeni bokukhipha isikulufu, ikakhulukazi ukusetshenziswa kwezikulufu ezizithephayo eziphindwe kabili ze-cortical bone, u-Suzuki et al. ungancomi ukusetshenziswa kwezikulufu zokuzithepha ukuze kulungiswe i-cortical kabili. U-Hou Yunfei et al. uphakamise ukuthi ukulungiswa okungadingekile kwe-bicortical ngezikulufu kufanele kugwenywe ekuqhekekeni komkhawulo ongaphezulu, kanye no-Maehara et al. futhi waphakamisa ukuthi ukusetshenziswa njalo kwezikulufu zokukhiya kufanele kugwenywe lapho kusetshenziswa amapuleti okukhiya, nokuthi kunesidingo sokusungula indinganiso yendawo yonke yokukhetha nokusebenzisa izikulufu zokukhiya.

4. Isakhiwo kanye nendawo yezikulufo

Usayizi, umumo, nendawo yesikulufu sokukhiya kungathinta ukukhishwa kwesikulufu. Ezinye izazi ziye zathola ukuthi uma isikulufu singekho phakathi nendawo yembobo yokukhiya, lapho imbobo yezipikili i-eccentricity engaphezu kuka-5 ° kungase kube khona ukulungiswa kwesikulufa okuxekethile, izintambo ezingalungile zebhande noma ukubola komsila wezinzipho zibambeke futhi kuholele ekuhlulekeni kokulungiswa noma isigaba sesibili sokususwa kobunzima.

5.Ukushisela okubandayo

Indawo evamile yokulungiswa kwangaphakathi ye-titanium inongqimba lwesendlalelo esiyisivikelo esingadluliswanga, ngesikhathi sokuhlinzwa ukubekwa kokulungiswa kwangaphakathi, ngenxa yamathuluzi okubamba nokubunjwa, noma inhloko yesikulufu nokungqubuzana phakathi kwepuleti lensimbi, njll., kungaholela endaweni egugile ungqimba oluvikelayo. 2 indawo yokuxhumana yensimbi phakathi kwendawo yokuxhumana eqinile izolandelwa, okungukuthi, ukwakheka kwe-welding ebandayo.

Ngaphezu kwalokho, ukuhlangana kwe-galvanic phakathi kwe-ion yensimbi, ukusabela kokuvuvukala, njll kungakhuthaza ukwakheka kwama-welds abandayo. Abakhiqizi abaningi bemishini yokulungisa yangaphakathi nabo bayayazi le nkinga, ngakho-ke amapuleti ensimbi okukhiya angasetshenzisiwe ambozwe ubuchwepheshe befilimu ye-oxide phakathi kwezimbobo zezinzipho kanye nezindawo zokuthintana nezikulufa, okubuye kuhloswe ngazo ukuvimbela i-ionization kanye ne-adsorption yamaprotheni emzimbeni futhi kunciphise ukuvela kwama-welds abandayo.

(F) Amasu okususa

Amasu okususa abikwa ezincwadini zikazwelonke nezamazwe ngamazwe angahlukaniswa abe yizigaba ezi-2, okungukuthi, ezilula nezisebenzayo neziyinkimbinkimbi, ezangaphambili ezibonakala ngokufinyeleleka kalula, ukusebenziseka, ukulimala kwezicubu ezithambile eziphansi, ikhono eliphansi futhi asikho isidingo sezinsimbi ezikhethekile, kanti lesi sakamuva sidinga izinsimbi ezikhethekile kanye nemishini.

UMaehara et al. phakamisa ukuthi kusetshenziswe izikrufu ze-torque-limiting ezinamashanki amakhulu noma nini lapho kunokwenzeka. Lapho ebhekene nezikulufu ezishelelayo, uPattison et al. ibike indlela elula yokukhipha izikulufu ezishelelayo ngokusonga ikhanda le-screwdriver nge-platinum metal bese ulifaka emseleni wekepisi lesikulufu. Le ndlela ihlakaniphile ukugcwalisa i-screw cap groove nge-foil yensimbi futhi ikhulise indawo yokuxhumana kanye nokungqubuzana phakathi kwe-screwdriver kanye ne-groove, okusiza ukukhishwa kwezikulufu ngezintambo ezishelelezi. Kule ndlela kusenzima ukususa ikesi, uma ikepisi lesikulufu kanye nemicu yembobo yezipikili zensimbi isaphelele, ungazama ukusebenzisa isikhiphi sokuthepha esihlanekezela esihlanekezekile, okuwukuthi, kusukela ku-screw cap groove efakwe ekuthepheni okuphambene futhi ugcwalise inkatho, kunqubo yokuzungezisa futhi ucindezela isikulufu siphume.

Ngaphansi, ezinye izikulufu zokukhiya kusenzima ukusebenza kahle kusetshenziswa i-conical reverse tapping screw extractor, esifana no-Ehlinger et al. kanye no-Bae et al. owathola ukuthi le ndlela yayivame ukusebenza ngokushelela kwesikulufa esingu-3.5 mm, kodwa ngokuvamile ingasebenzi ekusheleleni kwesikulufu esingu-4.5 mm. Kulokhu, akuwona wonke umkhakha wezokwelapha wamathambo esibhedlela afakwe okokusebenza okukhethekile kwensimbi okufana ne-carbide drill, ama-diamond drill, noma amasondo okugaya anesivinini esikhulu.

UGopinathan et al. yethula indlela engayidingi lezi zisetshenziswa ezikhethekile ngokubika icala lokukhishwa kwesikulufu esinzima epuleti lokwakha kabusha i-clavicular, okungukuthi, kusetshenziswa i-cutout ephansi yepuleti lokwakha kabusha, i-wire cutter enkulu isetshenziselwa ukugunda ingxenye encane yepuleti phakathi kwezimbobo zezipikili zepuleti, ukuze izikulufu nengxenye yembobo yezipikili zepuleti zibe iyunithi encane, futhi i-screw ikhishwe kalula. Le nqubo isebenza kuphela kumapuleti okukhiya okwakha kabusha i-titanium, amapuleti okukhiya umphambili anamanotshi amancane aphansi, namapuleti ohlobo lweshubhu angu-1/3, futhi awakwazi ukusetshenziselwa amapuleti abanzi noma aminyene endaweni ephansi.

Kuphinde kwachazwa indlela elula lapho kusetshenziswa khona imbobo enkulu kancane ukuze kubhobozwe imbobo evamile eduze kwesikulufu sokukhiya esishelelayo, bese kuthi ipuleti nesikulufu sicoshwe ngendlela yembobo evamile esanda kumbiwa, bese kukhishwa ipuleti nesikulufu kusetshenziswa into yokusika ithambo ebekwe ngaphansi kwepuleti futhi isihlinze ngomgomo wokulikhulula.

Yiqiniso, akhona amandla okulimala kwamathambo ngale ndlela, ngakho-ke ukuvikelwa kwesisindo ngemuva kokuhlinzwa kunconywa. Ngaphezu kwalokho, kuyadingeka futhi ukulungisa amathuluzi athile asetshenziswayo asetshenziswa kakhulu ngaphambi kokuhlinzwa kwangaphakathi kokususwa kokulungiswa, okufana ne-bolt extractor, i-hole reamer, i-screw extraction pliers, i-T-type pressurized socket nokunye.

Lapho kubhekene nobunzima bokukhiya intambo eshelelayo yokukhiya, ezinye izazi zasekhaya zahlongoza ukushintsha indlela ye-groove, okungukuthi, ukusetshenziswa komshini wamazinyo omncane wokugaya ucezu lwesihlabathi sensimbi ukushintsha i-screw cap groove ene-hexagonal noma i-quadrangular groove 'yoyodwa' noma 'ishumi' igroove, noma ukujulisa inkaba yokuqala.

Ehlinger et al. ibike ukuthi ezimeni lapho i-screw extractor ye-conical tapping reverse isenobunzima ekususeni isikulufu, kwaphakanyiswa ukuthi i-steel plate ingasuswa ngokucekela phansi ikhanda lesikulufu ngokugaya i-tungsten drill nokukhulisa izimbobo zezinzipho ku-steel plate, bese umzimba wesikulufu ungasuswa kusetshenziswa isaha lokukhala.

Georgiadis et al. kanye noRaia et al. okuhlongozwayo kunhlanganisela yesikulufu nepuleti lensimbi kuqine kakhulu futhi kunzima ukukususa, okokusebenza okukhethekile (okufana nemishini yokusika yesivinini esiphezulu somoya, ukubhola kwe-carbide, amasondo edayimane, njll.) embotsheni yezipikili ezungeze indlela yokusika ipuleti lensimbi, kupuleti lensimbi liyasikwa ukuze kuxegiswe isikulufu, isikulufu naso kulula ngokwemvelo ukusisusa.

U-Kumar no-Dunlopl babike ohlelweni lwesikulufu sepuleti lensimbi lokukhiya i-distal femur inqubo yokulungisa yangaphakathi, ekusetshenzisweni kwe-screwdriver ye-torque esizikhawulelayo, i-conical screw extractor yehlulekile, kodwa futhi yethula indlela entsha, okungukuthi, ukusetshenziswa kwamasondo abrasive anesivinini esiphezulu aneflake elincane emaphethelweni epuleti lensimbi onqenqemeni lwesikulufu sembobo kanye ne-radial. ungavuli imbobo ye-nail plate ukuze ukhulule ikepisi, ukuze ukukhishwa okusebenzayo kwezikulufu zokukhiya.

Kubalulekile ukuqaphela ukuthi lezi zindlela ezingenhla kufanele zithuthukiswe kancane ngangokunokwenzeka ngesikhathi sokusika noma ukugaya ipuleti usebenzisa i-disk yokusika ngesivinini esiphezulu ukuze ugweme ukusika ekhanda lesikulufu nokulimaza ithambo nezicubu ezithambile. Ngaphezu kwalokho, lezi zindlela zingase zikhiqize amazinga okushisa aphezulu kanye nemfucumfucu yensimbi, okungase kubangele ingozi eyengeziwe yokuphuka kabusha okubangelwa ukwelashwa, i-tissue thermal necrosis, kanye nokutheleleka.

(G) Isifinyezo

■ Vumela ukuthintana kwepuleti okungaphelele ne-periosteum

■ Ipuleti kufanele libekwe kabusha ngaphambi kokukhiya, njengoba ukuphuka akukwazi ukubekwa kabusha ngemva kokukhiya.

■ Ipuleti lokukhiya alikwazi ukucindezelwa, lidinga ukusebenzisa i-pressurizer noma i-centrifugal screwing embotsheni yenyunyana ibe isikulufu esijwayelekile, iqale icindezeleke, bese ikhiya.

■ Isayithi lokuphuka 3 ~ 4 izimbobo ngezikulufu ngaphandle kwezikulufu ukusabalalisa ingcindezi; ■ Isayithi lokuphuka 3 ~ 4 izimbobo ngezikulufu ngaphandle kwezikulufu ukusabalalisa ingcindezi; futhi

■ ukulungiswa kwe-monocortical ye-diaphysis noma i-bone cortex ewugqinsi, nalapho izinga lethambo lilihle; futhi

■Uma isikhiyiwe, ayikwazi ukuhlehliswa, kuyilapho izikulufu ezijwayelekile zingahlehliswa

■ Ukulungiswa okuqinile nezikulufu eziningi kungaholela ekungahlangani; isimiso siwukuthi amapuleti kufanele abe made futhi kusetshenziswe izikulufu ezimbalwa; ekwelapheni ukuphuka kwe-periarticular, izikulufu ezimbalwa kufanele zifakwe esiqwini futhi izikulufu eziningi kufanele zisetshenziselwe ukulungisa indawo ezungezile.

■ ubude bepuleti lebhuloho kufanele buphindwe kabili ubude bendawo yokuphuka, izikulufu kufanele zisatshalaliswe ngokulinganayo, futhi ukulungisa okufanelekile kufanele kube ukulungiswa kwendawo evulekile.

■ Amandla asabalaliswa ngokulinganayo phezu kwepuleti elide, futhi ukulungisa ngezikulufu ezimbalwa kungashukumisa ukwakheka kotwayi futhi kukhuthaze ukuphulukiswa kwamathambo.