A matsayin mai gyara na ciki, farantin matsawa koyaushe yana taka muhimmiyar rawa a cikin maganin karaya.A cikin 'yan shekarun nan, an fahimci ma'anar osteosynthesis kadan mai zurfi kuma an yi amfani da shi, sannu a hankali yana canzawa daga abin da ya gabata a kan injiniyoyi na injiniyoyi na ciki don mayar da hankali kan gyaran ilimin halitta, wanda ba wai kawai yana mayar da hankali ga kariya ga kashi da laushi na jini ba, amma Hakanan yana haɓaka haɓakawa a cikin dabarun tiyata da gyara na ciki.Makullin Matsewa Plate(LCP) sabon tsarin gyaran farantin ne, wanda aka haɓaka bisa ga farantin matsawa mai ƙarfi (DCP) da kuma iyakataccen farantin matsawa mai ƙarfi (LC-DCP), kuma an haɗa shi da fa'idodin asibiti na farantin tuntuɓar AO. PC-Fix) da Ƙarƙashin Ƙarfafa Tsabtatawa (LISS).An fara amfani da tsarin a asibiti a cikin Mayu 2000, ya sami sakamako mai kyau na asibiti, kuma rahotanni da yawa sun ba da ƙima sosai game da shi.Kodayake akwai fa'idodi da yawa a cikin gyare-gyaren karyewar sa, yana da buƙatu mafi girma akan fasaha da ƙwarewa.Idan ba a yi amfani da shi ba da kyau, yana iya zama mara amfani, kuma yana haifar da sakamakon da ba za a iya dawo da shi ba.
1. Ka'idodin Biomechanical, Zane da Amfanin LCP
Zaman lafiyar farantin karfe na yau da kullun yana dogara ne akan gogayya tsakanin farantin da kashi.Ana buƙatar ƙarfafa sukurori.Da zarar screws suna kwance, za a rage juzu'i tsakanin farantin da kashi, kwanciyar hankali kuma za a rage shi, yana haifar da gazawar mai gyara na ciki.LCPsabon farantin tallafi ne a cikin nama mai laushi, wanda aka haɓaka ta hanyar haɗa farantin matsi na gargajiya da tallafi.Ƙa'idar gyaransa ba ta dogara da juzu'i tsakanin farantin karfe da kasusuwa ba, amma yana dogara ne akan kwanciyar hankali tsakanin farantin karfe da makullin kulle da kuma riƙe da karfi tsakanin screws da kashi kashi, don gane gyare-gyaren karaya.Amfanin kai tsaye shine rage tsangwama na samar da jini na periosteal.Kwancen kwanciyar hankali tsakanin farantin karfe da screws ya inganta ƙarfin riƙewa na screws, don haka ƙarfin gyare-gyare na farantin ya fi girma, wanda ya dace da kasusuwa daban-daban.[4-7]
Siffa ta musamman na ƙirar LCP shine "ramin haɗin gwiwa", wanda ya haɗu da ramukan matsawa mai ƙarfi (DCU) tare da ramukan zaren conical.DCU na iya gane matsawa axial ta hanyar amfani da daidaitattun sukurori, ko kuma za a iya matsawa ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun matsuguni.ramin zaren conical yana da zaren, wanda zai iya kulle dunƙule da ƙwanƙwasa zaren goro, canja wurin juzu'i tsakanin dunƙule da farantin karfe, kuma ana iya canza danniya mai tsayi zuwa gefen karaya.Bugu da ƙari, tsagi na yanke shine zane a ƙasa da farantin, wanda ya rage wurin hulɗa tare da kashi.
A takaice dai, yana da fa'idodi da yawa akan faranti na gargajiya: ① yana daidaita kusurwa: kusurwar da ke tsakanin faranti na ƙusa yana da kwanciyar hankali kuma yana daidaitawa, yana da tasiri ga kasusuwa daban-daban;② yana rage haɗarin raguwar hasara: babu buƙatar gudanar da daidaitattun lankwasawa don faranti, rage haɗarin raguwar raguwar kashi na farko da kashi na biyu na raguwa;[8] ③ yana kare samar da jini: mafi ƙarancin lamba tsakanin farantin karfe da kasusuwa yana rage asarar farantin don samar da jini na periosteum, wanda ya fi dacewa da ka'idoji na ƙananan ɓarna;④ yana da dabi'ar riƙewa mai kyau: yana da amfani musamman ga kashin raunin osteoporosis, yana rage abin da ya faru na raguwa da kuma fita;⑤ yana ba da damar aikin motsa jiki na farko;⑥ yana da nau'i mai yawa na aikace-aikace: nau'in farantin karfe da tsayin daka sun cika, pre-siffar anatomical yana da kyau, wanda zai iya gane gyaran sassa daban-daban da nau'i-nau'i daban-daban.
2. Alamun LCP
Ana iya amfani da LCP ko dai azaman farantin matsewa na al'ada ko azaman tallafi na ciki.Likitan fiɗa kuma zai iya haɗa duka biyun, don faɗaɗa alamunsa sosai kuma ya shafi nau'ikan nau'ikan karaya iri-iri.
2.1 Ragewararrun karaya na diaphysis ko mephysis: Idan lalacewar nama mai laushi ba mai tsanani ba, raguwar murƙushe mai kyau, da gefen karaya yana buƙatar matsawa mai ƙarfi, Don haka ana iya amfani da LCP azaman farantin matsawa da farantin karfe ko tsaka tsaki.
2.2 Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙira na Diaphysis ko Metaphyseal: Ana iya amfani da LCP azaman farantin gada, wanda ke ɗaukar raguwa kai tsaye da gada osteosynthesis.Ba ya buƙatar raguwar jiki, amma kawai yana dawo da tsayin gaɓa, juyawa da layin ƙarfin axial.Karaya na radius da ulna banbanta ne, saboda aikin jujjuyawar hannaye ya ta'allaka ne da tsarin jikin radius da ulna na al'ada, wanda yayi kama da karaya na cikin-goshi.Bayan haka, dole ne a aiwatar da raguwar jiki, kuma a daidaita shi da faranti.
2.3-artra-articular Karatu da Karatu na Inter-articular: A cikin hadari-art-articular don dawo da ƙasusuwa don samun ƙasusuwa don cimma daidaito da haɓaka ƙasusuwa da inganta ƙasusuwa waraka, kuma yana ba da damar aikin motsa jiki na farko.Idan ɓarkewar articular yana da tasiri akan ƙasusuwa, LCP na iya gyarawahadin gwiwatsakanin raguwar articular da diaphysis.Kuma babu buƙatar siffanta farantin a cikin tiyata, wanda ya rage lokacin tiyata.
2.4 Jinkirin Ƙungiya ko Ƙarfafawa.
2.5 Rufe ko Buɗe Osteotomy.
2.6 Ba a zartar da haɗin kai baintramedullary nailingkaraya, kuma LCP shine ingantaccen madadin.Misali, LCP ba shi da amfani ga ɓarna ɓarnar ɓarna na yara ko matasa, mutanen da raƙuman ɓangaren litattafan almara ya yi kunkuntar ko fadi ko rashin tsari.
2.7 Osteoporosis Marasa lafiya: tun da kasusuwa na kasusuwa yana da bakin ciki sosai, yana da wuya ga farantin gargajiya don samun kwanciyar hankali mai dogara, wanda ya kara wahalar aikin tiyata, kuma ya haifar da gazawar saboda sauƙin sassautawa da fita daga gyaran bayan tiyata.LCP kulle dunƙule da farantin anga samar da kwana kwanciyar hankali, da farantin an hadedde kusoshi.Bugu da kari, diamita na mandrel na kulle dunƙule yana da girma, yana ƙaruwa da ƙarfi na kashin.Sabili da haka, an rage abin da ya faru na sassautawar dunƙulewa da kyau.An ba da izinin aikin motsa jiki na farko a bayan aiki.Osteoporosis alama ce mai ƙarfi ta LCP, kuma rahotanni da yawa sun ba shi babban fifiko.
2.8 Periprosthetic Femoral Fracture: Periprosthetic femoral fractures sau da yawa tare da osteoporosis, tsofaffi cututtuka da kuma tsanani tsarin cututtuka.Faranti na gargajiya suna fuskantar babban katsewa, suna haifar da lahani ga samar da jini na karaya.Bayan haka, dunƙule na yau da kullun suna buƙatar gyara bicortical, haifar da lahani ga simintin ƙashi, kuma ƙarfin kamawar osteoporosis shima mara kyau.LCP da LISS faranti suna magance irin waɗannan matsalolin ta hanya mai kyau.Wato suna amfani da fasahar MIPO don rage ayyukan haɗin gwiwa, rage lalacewar samar da jini, sa'an nan kuma makullin kulle cortical guda ɗaya na iya samar da isasshen kwanciyar hankali, wanda ba zai haifar da lahani ga simintin kashi ba.Ana nuna wannan hanyar ta sauƙi, ɗan gajeren lokacin aiki, ƙarancin zubar jini, ƙananan kewayon tsigewa da sauƙaƙe waraka.Sabili da haka, ɓarna na mata na periprosthetic shima ɗaya ne daga cikin manyan alamun LCP.[1, 10, 11]
3. Dabarun tiyata masu alaƙa da Amfani da LCP
3.1 Fasahar Kayayyaki na Gargajiya: Kodayake manufar mai gyara na ciki ya canza kuma kariyar kayan kariya, har yanzu gefe mai taushi har yanzu ana buƙatar matsawa don wasu karaya, irin su ɓangarorin intra-articular, gyaran gyare-gyaren osteotomy, mai sauƙi mai sauƙi ko gajeriyar karaya.Hanyoyin matsawa sune: ① Ana amfani da LCP azaman farantin matsawa, ta yin amfani da daidaitattun sukurori biyu na cortical don gyara eccentrically akan rukunin matsawa na zamiya ko amfani da na'urar matsawa don gane gyarawa;② a matsayin farantin kariya, LCP yana amfani da screws na lag don gyara karaya mai tsayi;③ ta hanyar ɗaukar ka'idar bandungiyar tashin hankali, ana sanya farantin a gefen tashin hankali na kashin, za a ɗaura shi ƙarƙashin tashin hankali, kuma kashin cortical zai iya samun matsawa;④ a matsayin farantin buttress, ana amfani da LCP tare da lag screws don gyaran gyare-gyare na articular fractures.
3.2 Fasaha Gyaran Gadar: Da fari dai, ɗauki hanyar rage kai tsaye don sake saita karyewar, tazara a cikin ɓangarorin karaya ta hanyar gada da gyara bangarorin biyu na karaya.Ba a buƙatar raguwar kwayoyin halitta, amma kawai yana buƙatar dawo da tsayin diaphysis, juyawa da layin karfi.A halin yanzu, ana iya yin gyaran kashi don tada samuwar kira da inganta waraka.Koyaya, gyare-gyaren gada na iya samun kwanciyar hankali kawai, duk da haka ana samun waraka ta hanyar kira biyu ta hanyar niyya ta biyu, don haka yana da amfani ne kawai ga karaya.
3.3 Minimally Invasive Plate Osteosynthesis (MIPO) Fasaha: Tun daga shekarun 1970s, kungiyar AO ta gabatar da ka'idodin maganin karaya: ragewar jiki, mai gyarawa na ciki, kariya ta jini da kuma aikin motsa jiki na farko.An san ka'idodin a ko'ina cikin duniya, kuma tasirin asibiti ya fi hanyoyin da aka yi amfani da su a baya.Duk da haka, don samun raguwar ƙwayar jiki da mai gyara na ciki, sau da yawa yana buƙatar ƙaddamarwa mai yawa, wanda ke haifar da raguwar ƙwayar kashi, rage yawan jini na raguwa da kuma ƙara haɗarin kamuwa da cuta.A cikin 'yan shekarun nan, masana na gida da na kasashen waje suna ba da hankali sosai da kuma mayar da hankali kan fasahar da ba ta da yawa, da kare jinin jini na nama mai laushi da kasusuwa a halin yanzu na inganta mai gyara na ciki, ba cire periosteum da laushi mai laushi a kan karaya. ɓangarorin, ba tilasta raguwar ɓarkewar ɓarkewar jiki ba.Sabili da haka, yana kare yanayin yanayin halitta na karya, wato osteosynthesis na halitta (BO).A cikin 1990s, Krettek ya ba da shawarar fasahar MIPO, wanda shine sabon ci gaba na gyaran karaya a cikin 'yan shekarun nan.Yana nufin kare samar da jini na kashin kariya da kyallen takarda tare da mafi ƙarancin lalacewa zuwa mafi girma.Hanyar ita ce a gina rami mai ɓoye ta hanyar ɗan ƙaramin yanki, sanya faranti, da ɗaukar dabarun rage kai tsaye don rage karaya da mai gyara ciki.Matsakaicin tsakanin faranti na LCP ya tabbata.Duk da cewa faranti ba su da cikakkiyar fahimtar siffar jiki, ana iya kiyaye raguwar karaya, don haka fa'idar fasahar MIPO ta fi fice, kuma ita ce ingantacciyar ingantacciyar fasahar MIPO.
4. Dalilai da Ma'auni na gazawar Aikace-aikacen LCP
4.1 Rashin Ciki Mai Gyara
Duk abubuwan da aka shuka suna da sassautawa, ƙaura, karaya da sauran haɗarin gazawa, faranti na kulle da LCP ba keɓantacce ba.Dangane da rahotannin wallafe-wallafen, gazawar mai gyara na ciki ba ta haifar da farantin kanta ba, amma saboda an keta ka'idodin ka'idodin jiyya na fashe saboda rashin isasshen fahimta da sanin ƙayyadaddun LCP.
4.1.1.Faranti da aka zaɓa sun yi gajeru.Tsawon farantin karfe da rarraba dunƙule shine mahimman abubuwan da ke shafar kwanciyar hankali.Kafin fitowar fasahar IMIPO, guntun faranti na iya rage tsayin daka da kuma rabuwar nama mai laushi.Gajerun faranti da yawa za su rage ƙarfin axial da ƙarfin tarkace don ƙayyadaddun tsarin gaba ɗaya, yana haifar da gazawar mai gyara na ciki.Tare da haɓaka fasahar rage kaikaice da fasaha mara ƙarancin ƙarfi, faranti mai tsayi ba zai ƙara ƙaddamar da nama mai laushi ba.Likitocin tiyata su zaɓi tsayin farantin daidai da biomechanics na gyaran karaya.Don raguwa mai sauƙi, rabon tsayin faranti mai kyau da tsawon dukan yanki ya kamata ya zama mafi girma fiye da sau 8-10, yayin da raunin da ya faru, wannan rabo ya kamata ya zama mafi girma fiye da sau 2-3.[13, 15] Faranti mai tsayi mai tsayi zai rage nauyin farantin, ya kara rage nauyin kullun, kuma ta haka ne ya rage gazawar mai gyara na ciki.Dangane da sakamakon binciken bincike na ƙarshe na LCP, lokacin da rata tsakanin sassan fashe ya kasance 1mm, gefen karaya ya bar ramin faranti guda ɗaya, damuwa a farantin matsawa yana rage 10%, damuwa a cikin sukurori yana rage 63%;lokacin da gefen karaya ya bar ramuka biyu, damuwa a farantin matsawa yana rage raguwa 45%, kuma damuwa a skru yana rage 78%.Sabili da haka, don kauce wa ƙaddamar da damuwa, don raguwa mai sauƙi, 1-2 ramukan da ke kusa da ɓangarorin ɓangarorin za a bar su, yayin da ɓangarorin da aka yi amfani da su, ana ba da shawarar yin amfani da kullun guda uku a kowane gefe kuma 2 screws za su kusanci kusa. karaya.
4.1.2 Rata tsakanin faranti da saman kashi ya wuce kima.Lokacin da LCP ta karɓi fasahar gyara gada, ba a buƙatar faranti don tuntuɓar periosteum don kare samar da jini na yankin karaya.Yana cikin nau'in gyaran gyare-gyare na roba, yana ƙarfafa niyya ta biyu na ci gaban callus.Ta hanyar nazarin kwanciyar hankali na biomechanical, Ahmad M, Nanda R [16] et al sun gano cewa lokacin da rata tsakanin LCP da kashi kashi ya fi 5mm, ƙarfin axial da torsion na faranti yana raguwa sosai;lokacin da tazarar ta kasa da 2mm, babu wani raguwa mai mahimmanci.Sabili da haka, ana bada shawarar rata ya zama ƙasa da 2mm.
4.1.3 Farantin yana karkata daga axis diaphysis, kuma sukurori sun yi daidai da daidaitawa.Lokacin da aka haɗa fasahar MIPO ta LCP, ana buƙatar shigar da faranti a kai a kai, kuma wani lokaci yana da wahala a sarrafa matsayin farantin.Idan kusurwar kashi ba ta da misaltuwa tare da axis na farantin, farantin mai nisa na iya karkata daga axis na kashi, wanda ba makawa zai haifar da daidaitawar sukurori da raunana gyarawa.[9,15].Ana ba da shawarar yin yankewar da ta dace, kuma za a yi gwajin X-ray bayan matsayin jagorar taɓa yatsa daidai kuma kuntscher fil ɗin gyarawa.
4.1.4 Rashin bin ƙa'idodin ƙa'idodin jiyya na karaya da zaɓin ba daidai ba na ciki da fasahar gyarawa.Don ɓangarorin intra-articular, raunin diaphysis mai sauƙi mai sauƙi, LCP za a iya amfani dashi azaman farantin matsawa don gyara cikakkiyar kwanciyar hankali ta hanyar fasaha na matsawa, da kuma inganta warkarwa na farko;don Metaphyseal ko comminuted fractures, ya kamata a yi amfani da fasaha na gyaran gada, kula da samar da jini na kashin kariya da nama mai laushi, ba da izinin daidaitawar gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gada, da kuma ba da izinin daidaitawar gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gyare-gyaren gada, mai da hankali ga samar da jini na kasusuwa da nama mai laushi, ba da izini ga daidaitawar ƙwanƙwasa, ƙarfafa haɓakar callus don samun warkaswa ta hanyar hankali na biyu.Akasin haka, yin amfani da fasaha na gyaran gada don magance raguwa mai sauƙi na iya haifar da raguwa maras kyau, wanda zai haifar da jinkirin waraka;[17] comminuted fractures' wuce kima bin ragi na jiki da matsawa a ɓangarorin karaya na iya haifar da lahani ga samar da jini na ƙasusuwa, yana haifar da jinkirin haɗin gwiwa ko rashin haɗin kai.
4.1.5 Zaɓi nau'in dunƙule mara kyau.LCP hade rami za a iya zamewa cikin nau'ikan skurori hudu: daidaitattun abubuwan kwalliya na corticous, scarfin ƙwararrun ƙwararrun ƙwararru / scarfin kai da kuma sukurorin hakowa.Ana amfani da sukulan haƙowa da kai/tatsin kai azaman screws na unicortical don gyara karaya na diaphyseal na ƙasusuwa.Tushen ƙusa yana da ƙirar ƙira, wanda ya fi sauƙi don wucewa ta cikin cortex yawanci ba tare da larura na auna zurfin ba.Idan ɗigon ɓangaren litattafan almara yana da kunkuntar sosai, dunƙule goro ba zai cika daidai da dunƙule ba, kuma tip ɗin ya taɓa cortex ɗin da ba ta dace ba, to, lahanin da aka yi wa kafaffen cortex na gefe yana shafar ƙarfi tsakanin sukurori da ƙasusuwa, kuma skru na bicortical za su taɓa kai. amfani a wannan lokacin.Tsantsar sukurori na unicortical suna da kyakykyawan ƙarfi na kamawa zuwa ƙasusuwa na yau da kullun, amma kashi na osteoporosis yawanci yana da rauni mai rauni.Tun da lokacin aiki na sukurori ya ragu, lokacin hannun juriya na juriya ga lankwasawa yana raguwa, wanda ke haifar da sauƙi yankan bawo, dunƙule sassautawa da ƙaurawar karaya ta biyu.[18] Tun da screws bicortical sun ƙara tsayin aiki na sukurori, ƙarfin kamawa na ƙasusuwa kuma yana ƙaruwa.Fiye da duka, kashi na al'ada zai iya amfani da sukurori na unicortical don gyarawa, duk da haka ana ba da shawarar kashin osteoporosis don amfani da sukurori na bicortical.Bugu da ƙari, ƙwayar ƙashi na humerus yana da ɗan ƙaramin bakin ciki, yana haifar da raguwa a cikin sauƙi, don haka ana buƙatar screws bicortical don gyarawa wajen magance raunin humeral.
4.1.6 Rarraba Screw yayi yawa ko kadan.Ana buƙatar gyaran dunƙule don yin biyayya ga karaya biomechanics.Rarraba dunƙule mai yawa zai haifar da ƙaddamar da damuwa na gida da karaya na mai gyara na ciki;ƙananan karaya sukurori da rashin isasshen ƙarfi zai haifar da gazawar mai gyara na ciki.Lokacin da aka yi amfani da fasahar gada don gyaran karaya, ƙimar da aka ba da shawarar ya kamata ya kasance ƙasa da 40% -50% ko ƙasa da haka.[7,13,15] Saboda haka, faranti sun fi tsayi, don ƙara ma'auni na injiniyoyi;Ya kamata a bar ramuka 2-3 don bangarorin da suka karye, don ba da damar elasticity mai girma, guje wa damuwa da damuwa da rage abin da ya faru na fashewar mai gyara na ciki [19].Gautier da Sommer [15] sun yi tunanin cewa aƙalla screws guda biyu za a gyara su a ɓangarorin biyu na karyewar, ƙara yawan adadin kafaffen cortex ba zai rage ƙimar gazawar faranti ba, don haka ana ba da shawarar a kai aƙalla screws uku a ɓangarorin biyu. karaya.Aƙalla 3-4 screws ana buƙatar a ɓangarorin biyu na humerus da karaya, dole ne a ɗauki ƙarin nauyi.
4.1.7 Ana amfani da kayan aikin gyara ba daidai ba, yana haifar da gazawar mai gyara na ciki.Sommer C [9] ya ziyarci marasa lafiya 127 tare da kararraki 151 da suka yi amfani da LCP har tsawon shekara guda, sakamakon bincike ya nuna cewa a cikin screws 700 na kulle, ƙananan screws da diamita na 3.5mm an saki.Dalili kuwa shine watsi da amfani da na'urar ganin makullin kulle.A zahiri, dunƙule kulle da farantin ba gaba ɗaya a tsaye ba ne, amma suna nuna digiri 50 na kusurwa.Wannan ƙirar tana nufin rage damuwa na kulle kulle.Yin watsi da amfani da na'urar gani na iya canza hanyar ƙusa kuma don haka ya haifar da lalacewa ga ƙarfin gyarawa.Kääb [20] ya gudanar da bincike na gwaji, ya gano kusurwar da ke tsakanin sukurori da faranti na LCP ya yi girma sosai, don haka ƙarfin skru yana raguwa sosai.
4.1.8 Ma'aunin nauyi ya yi da wuri.Rahotanni masu kyau da yawa suna jagorantar likitoci da yawa don yin imani da ƙarfin kulle faranti da screws da kuma daidaitawar kwanciyar hankali, sun yi kuskuren yarda cewa ƙarfin kulle faranti na iya ɗaukar nauyin nauyin nauyi da wuri, wanda ya haifar da faranti ko dunƙule karaya.A cikin amfani da karyewar gada, LCP yana da ɗan kwanciyar hankali, kuma ana buƙatar samar da kira don gane waraka ta niyya ta biyu.Idan majiyyatan sun tashi daga gado da wuri kuma suka ɗora nauyin da ya wuce kima, farantin da dunƙule za a karye ko a cire su.Gyaran farantin kulle yana ƙarfafa aiki da wuri, amma cikakken ɗaukar nauyi a hankali zai kasance makonni shida bayan haka, kuma fina-finai na x-ray sun nuna cewa gefen karaya yana nuna mahimmancin kira.[9]
4.2 Raunin Jijiya da Jijiya:
Fasaha ta MIPO tana buƙatar shigar da tawul kuma a sanya shi a ƙarƙashin tsokoki, don haka lokacin da aka sanya screws na farantin, likitocin ba su iya ganin tsarin da ke ƙarƙashin jikinsu ba, kuma ta haka ne aka ƙara lalacewa da jijiyoyi da jijiyoyin jini.Van Hensbroek PB [21] ya ba da rahoton wani lamari na amfani da fasahar LISS don amfani da LCP, wanda ya haifar da jijiya ta tibial pseudoaneurysms.AI-Rashid M. [22] et al ya ruwaito don magance jinkirin ruptures na extensor tendon secondary don raguwa na radial tare da LCP.Babban dalilai na lalacewa shine iatrogenic.Na farko shine lalacewa kai tsaye ta hanyar sukurori ko Kirschner fil.Na biyu shine lalacewar da hannun riga ya yi.Kuma na uku shine lahani na thermal da ake samu ta hanyar haƙon kusoshi masu ɗaukar kai.[9] Saboda haka, ana buƙatar likitocin tiyata don sanin abubuwan da ke kewaye da su, kula da kariya ga nervus vascularis da sauran muhimman sifofi, da cikakken gudanar da ɓarna a cikin sanya hannun riga, guje wa matsawa ko jijiyoyi.Bugu da kari, lokacin da ake hako skru masu kai da kai, yi amfani da ruwa don rage samar da zafi da rage zafin zafi.
4.3 Kamuwa da cuta ta wurin tiyata da bayyanar faranti:
LCP wani tsarin gyara ne na ciki wanda ya faru a ƙarƙashin tushen haɓaka ra'ayi kaɗan na mamayewa, da nufin rage lalacewa, rage kamuwa da cuta, rashin haɗin kai da sauran rikice-rikice.A cikin aikin tiyata, ya kamata mu ba da kulawa ta musamman ga kariya mai laushi, musamman ma sassa masu rauni na nama mai laushi.Idan aka kwatanta da DCP, LCP yana da faɗin girma da girma girma.Lokacin da ake amfani da fasahar MIPO don shigar da jiki ko cikin tsoka, yana iya haifar da taurin nama mai laushi ko lalata da kuma haifar da kamuwa da cuta.Phinit P [23] ya ruwaito cewa tsarin LISS ya yi maganin 37 lokuta na raunin tibia na kusa, kuma abin da ya faru na kamuwa da cuta mai zurfi ya kai 22%.Namazi H [24] ya ruwaito cewa LCP ta yi maganin 34 lokuta na raunin tibial shaft na 34 lokuta na metaphyseal fracture na tibia, da kuma abubuwan da suka faru na kamuwa da rauni bayan tiyata da bayyanar faranti sun kasance har zuwa 23.5%.Sabili da haka, kafin a yi aiki, za a yi la'akari da dama da mai gyara na ciki da kyau daidai da lalacewar nama mai laushi da rikitaccen digiri na karaya.
4.4 Ciwon Hanji mai Haushi na Nama mai laushi:
Phinit P [23] ya ba da rahoton cewa tsarin LISS ya yi maganin 37 lokuta na raunin tibia na kusa, lokuta 4 na haushi mai laushi bayan aiki (zafin farantin da ke cikin subcutaneous da kewaye da faranti), wanda 3 lokuta na faranti sun kasance 5mm daga fuskar kashi kuma harka 1 yana da nisa da 10mm daga saman kashi.Hasenboehler.E [17] et al sun ruwaito LCP sun yi maganin 32 lokuta na raunin tibial mai nisa, ciki har da lokuta 29 na rashin jin daɗi na medial malleolus.Dalilin shi ne cewa girman farantin yana da girma sosai ko kuma an sanya faranti ba daidai ba kuma nama mai laushi ya fi ƙanƙara a cikin malleolus na tsakiya, don haka marasa lafiya za su ji dadi lokacin da marasa lafiya suna sanye da manyan takalma da kuma damfara fata.Labari mai dadi shine sabon farantin metaphyseal mai nisa wanda Synthes ya kirkira yana da bakin ciki kuma yana manne da saman kashi tare da santsin gefuna, wanda ya magance wannan matsalar yadda yakamata.
4.5 Wahala wajen Cire Makulli:
Kayan LCP yana da ƙarfin titanium mai ƙarfi, yana da babban jituwa tare da jikin ɗan adam, wanda ke da sauƙin tattarawa ta callus.A cirewa, fara cire kiran yana haifar da ƙarin wahala.Wani dalili na kawar da wahala ya ta'allaka ne a kan wuce gona da iri na makullin kullewa ko lalacewa na goro, wanda yawanci ke faruwa ta hanyar maye gurbin na'urar hangen nesa ta kulle da aka watsar da na'urar gani kai.Don haka, za a yi amfani da na'urar gani wajen ɗaukar ƙulle-ƙulle, ta yadda zaren zaren za a iya daidaita daidai da zaren farantin.[9] Ana buƙatar takamaiman maƙarƙashiya don yin amfani da su wajen kunkuntar skru, don sarrafa girman ƙarfi.
Sama da duka, a matsayin farantin matsawa na sabon ci gaba na AO, LCP ya ba da sabon zaɓi don aikin tiyata na zamani na karaya.Haɗe tare da fasahar MIPO, LCP yana haɗawa da tanadin samar da jini a ɓangarorin ɓarkewa zuwa mafi girma, yana haɓaka warakawar ɓarna, rage haɗarin kamuwa da cuta da sake karaya, yana kula da kwanciyar hankali, don haka yana da fa'idodin aikace-aikace a cikin jiyya.Tun da aikace-aikacen, LCP ya sami sakamako mai kyau na ɗan gajeren lokaci na asibiti, duk da haka wasu matsalolin kuma ana fallasa su.Tiyata yana buƙatar cikakken shiri kafin aiki da ƙwarewar asibiti mai yawa, zaɓin daidaitattun masu gyara na ciki da fasaha bisa sifofin ƙayyadaddun ƙayyadaddun ɓarkewa, bin ƙa'idodin ka'idodin jiyya, yana amfani da masu gyara daidai kuma daidaitaccen tsari, don hanawa. da rikitarwa da kuma samun mafi kyau duka warkewa effects.
Lokacin aikawa: Juni-02-2022
