Raws li ib qho kev txhim kho sab hauv, lub phaj compression yeej ib txwm ua lub luag haujlwm tseem ceeb hauv kev kho pob txha.Nyob rau hauv xyoo tas los no, lub tswv yim ntawm kev ua kom tsis muaj zog osteosynthesis tau nkag siab tob thiab siv tau, maj mam hloov los ntawm yav dhau los tseem ceeb ntawm kev siv tshuab ntawm cov khoom siv sab hauv kom hais txog kev kho mob lom, uas tsis yog tsom rau kev tiv thaiv cov pob txha thiab cov nqaij mos ntshav, tab sis. kuj txhawb kev txhim kho hauv cov txheej txheem phais thiab sab hauv fixator.Xauv Compression Phaj(LCP) yog hom tshiab phaj fixation system, uas yog tsim nyob rau hauv lub hauv paus ntawm dynamic compression phaj (DCP) thiab txwv kev sib cuag dynamic compression phaj (LC-DCP), thiab ua ke nrog cov kev kho mob zoo ntawm AO's point contact phaj ( PC-Fix) thiab Less Invasive Stabilization System (LISS).Lub kaw lus tau pib siv tshuaj kho mob thaum lub Tsib Hlis 2000, tau ua tiav cov txiaj ntsig kho mob zoo dua, thiab ntau cov ntawv tshaj tawm tau muab kev ntsuam xyuas zoo rau nws.Txawm hais tias muaj ntau qhov zoo hauv nws qhov kev txhim kho pob txha, nws muaj kev xav tau ntau dua ntawm kev siv tshuab thiab kev paub dhau los.Yog tias siv tsis raug, nws yuav ua rau muaj kev cuam tshuam, thiab ua rau muaj kev cuam tshuam tsis zoo.
1. Biomechanical Principles, Tsim thiab Zoo ntawm LCP
Kev ruaj ntseg ntawm cov phaj hlau zoo tib yam yog nyob ntawm kev sib txhuam ntawm cov phaj thiab cov pob txha.Cov screws yuav tsum tau nruj nreem.Thaum cov ntsia hlau xoob, qhov kev sib txhuam ntawm cov phaj thiab cov pob txha yuav raug txo, qhov kev ruaj ntseg kuj yuav raug txo, uas ua rau tsis ua hauj lwm ntawm lub fixator sab hauv.LCPyog lub phaj txhawb nqa tshiab hauv cov ntaub so ntswg, uas yog tsim los ntawm kev sib txuas cov tsoos compression phaj thiab kev txhawb nqa.Nws txoj cai fixation tsis yog nyob ntawm kev sib txhuam ntawm lub phaj thiab cov pob txha cortex, tab sis tso siab rau lub kaum sab xis ntawm lub phaj thiab xauv cov ntsia hlau nrog rau kev tuav lub zog ntawm cov ntsia hlau thiab cov pob txha cortex, txhawm rau txhawm rau txhim kho kev puas tsuaj.Qhov txiaj ntsig ncaj qha yog nyob rau hauv kev txo qis kev cuam tshuam ntawm cov ntshav periosteal.Lub kaum sab xis ntawm lub phaj thiab cov ntsia hlau tau txhim kho lub zog tuav ntawm cov ntsia hlau, yog li lub zog fixation ntawm lub phaj yog ntau dua, uas muaj feem xyuam rau cov pob txha sib txawv.[4-7]
Lub cim tshwj xeeb ntawm LCP tsim yog "lub qhov sib xyaw", uas sib txuas cov qhov sib xyaw ua ke (DCU) nrog cov conical threaded qhov.DCU tuaj yeem paub axial compression los ntawm kev siv tus qauv ntsia hlau, lossis cov pob tawg tawg tuaj yeem raug compressed thiab kho ntawm lub lag luam ntsia hlau;lub conical threaded qhov muaj threads, uas tuaj yeem xauv lub hau ntswj thiab txiv ntseej lub threaded latch, hloov lub torque ntawm cov ntsia hlau thiab phaj, thiab lub longitudinal kev nyuaj siab yuav kis tau mus rau lub puas sab.Tsis tas li ntawd, qhov txiav qhov zawj yog tsim hauv qab phaj, uas txo qhov kev sib cuag nrog cov pob txha.
Nyob rau hauv luv luv, nws muaj ntau yam zoo dua cov tsoos daim hlau: ① stabilizes lub kaum sab xis: lub kaum sab xis ntawm cov ntsia hlau phaj yog ruaj khov thiab ruaj khov, ua tau zoo rau cov pob txha sib txawv;② txo qhov kev pheej hmoo ntawm kev txo qis: tsis tas yuav tsum tau ua qhov tseeb ua ntej khoov rau cov phiaj, txo qhov kev pheej hmoo ntawm kev poob qis thiab theem thib ob ntawm kev txo qis;[8] ③ tiv thaiv cov ntshav: qhov tsawg kawg nkaus sib cuag ntawm cov phaj hlau thiab cov pob txha txo qis ntawm cov phaj rau periosteum cov ntshav muab, uas yog ntau ua raws li cov hauv paus ntsiab lus ntawm minimally invasive;④ muaj qhov tuav zoo: tshwj xeeb tshaj yog siv rau cov pob txha pob txha pob txha, txo qhov tshwm sim ntawm cov ntsia hlau loosening thiab tawm;⑤ tso cai rau kev tawm dag zog thaum ntxov;⑥ muaj ntau yam kev siv: lub phaj hom thiab ntev tiav, lub anatomical pre-shaped zoo, uas muaj peev xwm paub qhov fixation ntawm txawv qhov chaw thiab ntau hom kev puas tsuaj.
2. Cov lus qhia ntawm LCP
LCP tuaj yeem siv los ua cov pa compressing phaj lossis ua kev txhawb nqa sab hauv.Tus kws phais kuj tuaj yeem ua ke ob qho tib si, txhawm rau nthuav dav nws cov lus qhia thiab siv rau ntau yam ntawm cov qauv pob txha.
2.1 Cov pob txha yooj yim ntawm Diaphysis lossis Metaphysis: yog tias qhov kev puas tsuaj rau cov ntaub so ntswg tsis hnyav thiab cov pob txha muaj qhov zoo, qhov yooj yim transverse fractures lossis luv oblique fracture ntawm cov pob txha ntev yuav tsum tau txiav thiab txo kom raug, thiab sab pob txha yuav tsum muaj zog compression, yog li LCP tuaj yeem siv los ua cov phaj compression thiab phaj lossis phaj nruab nrab.
2.2 Comminuted Fractures of Diaphysis lossis Metaphyseal: LCP tuaj yeem siv los ua tus choj phaj, uas tau txais kev txo qis thiab choj osteosynthesis.Nws tsis tas yuav txo qis anatomical, tab sis tsuas yog rov qab cov ceg ntev, kev sib hloov thiab axial quab yuam kab.Kev tawg ntawm lub vojvoog thiab ulna yog qhov tshwj xeeb, vim tias kev sib hloov ua haujlwm ntawm lub hauv pliaj yog nyob ntawm qhov kev xav ntawm lub vojvoog thiab ulna, uas zoo ib yam li cov pob txha pob txha intra-articular.Tsis tas li ntawd, kev txo qis anatomical yuav tsum tau ua, thiab yuav tsum tau kho nrog cov phaj..
2.3 Intra-articular Fractures thiab Inter-articular Fractures: Nyob rau hauv qhov intra-articular puas, peb tsis tsuas yog yuav tsum tau nqa tawm lub anatomical txo kom rov qab tau cov smoothness ntawm articular nto, tab sis kuj yuav tsum tau compress cov pob txha kom ruaj khov kho thiab txhawb cov pob txha. kho, thiab tso cai rau kev ua haujlwm thaum ntxov.Yog tias cov pob txha pob txha muaj kev cuam tshuam rau cov pob txha, LCP tuaj yeem kho tausib koomnruab nrab ntawm qhov txo qis articular thiab diaphysis.Thiab tsis tas yuav tsim cov phaj hauv kev phais, uas tau txo lub sijhawm phais.
2.4 Ncua Union lossis Nonunion.
2.5 Kaw lossis Qhib Osteotomy.
2.6 Nws tsis muaj feem xyuam rau kev sib tshuamintramedullary nailingtawg, thiab LCP yog ib qho kev xaiv zoo tshaj plaws.Piv txwv li, LCP siv tsis tau rau cov pob txha pob txha pob txha ntawm cov menyuam yaus lossis cov hluas, cov neeg uas nws cov kab noj hniav yog nqaim dhau los yog dav dhau los yog tsis zoo.
2.7 Cov Neeg Mob Osteoporosis: txij li cov pob txha cortex nyias dhau lawm, nws yog ib qho nyuaj rau cov tsoos phaj kom tau txais kev ruaj ntseg ruaj khov, uas tau nce qhov nyuaj ntawm kev phais pob txha, thiab ua rau tsis ua hauj lwm vim yooj yim loosening thiab tawm ntawm kev kho tom qab phais.LCP locking ntsia hlau thiab phaj thauj tog rau nkoj tsim lub kaum sab xis ruaj khov, thiab cov ntsia hlau phaj tau sib xyaw ua ke.Tsis tas li ntawd, lub mandrel txoj kab uas hla ntawm xauv ntsia hlau yog loj, ua rau lub zog ntawm cov pob txha.Yog li ntawd, qhov tshwm sim ntawm screw loosening yog zoo txo.Lub cev ua haujlwm thaum ntxov tau tso cai rau tom qab ua haujlwm.Osteoporosis yog qhov qhia tau tias muaj zog ntawm LCP, thiab ntau cov ntawv tshaj tawm tau muab nws qhov kev lees paub siab.
2.8 Periprosthetic Femoral Fracture: periprosthetic femoral fractures feem ntau nrog osteoporosis, cov kab mob laus thiab cov kab mob loj.Cov daim hlau ib txwm muaj nyob rau hauv qhov kev txiav txim siab dav, ua rau muaj kev puas tsuaj rau cov ntshav ntawm cov pob txha.Tsis tas li ntawd, cov ntsia hlau feem ntau yuav tsum tau kho bicortical, ua rau puas tsuaj rau cov pob txha cement, thiab cov pob txha pob txha tuav lub zog kuj tsis zoo.LCP thiab LISS daim hlau daws cov teeb meem zoo li no.Qhov ntawd yog hais tias, lawv txais yuav MIPO thev naus laus zis los txo cov kev sib koom ua haujlwm, txo cov kev puas tsuaj rau cov ntshav, thiab tom qab ntawd cov ntsia hlau cortical nkaus xwb tuaj yeem muab kev ruaj ntseg txaus, uas yuav tsis ua rau cov pob txha puas tsuaj.Txoj kev no yog qhov tshwj xeeb los ntawm kev yooj yim, lub sijhawm ua haujlwm luv dua, los ntshav tsawg dua, me me stripping ntau thiab pab txhawb kev kho pob txha.Yog li ntawd, periprothetic femoral fractures kuj yog ib qho kev qhia muaj zog ntawm LCP.[1, 10, 11]
3. Cov txheej txheem phais mob ntsig txog kev siv LCP
3.1 Traditional Compression Technology: Txawm hais tias lub tswv yim ntawm AO internal fixator tau hloov pauv thiab cov ntshav ntawm kev tiv thaiv cov pob txha thiab cov ntaub so ntswg yuav tsis raug tsis saib xyuas vim overemphasis ntawm cov neeg kho tshuab ruaj khov ntawm fixation, sab pob txha tseem yuav tsum tau compression kom tau fixation rau ib co. pob txha pob txha, xws li pob txha pob txha, pob txha pob txha, pob txha pob txha, yooj yim transverse lossis luv oblique pob txha.Cov txheej txheem compression yog: ① LCP yog siv los ua cov phaj compression, siv ob tus qauv cortical screws los kho eccentrically ntawm lub phaj zawv zawg compression chav tsev lossis siv cov cuab yeej compression kom paub kho;② raws li lub phaj tiv thaiv, LCP siv lub lag luam screws los kho qhov ntev-oblique fractures;③ los ntawm kev siv txoj cai nruj nreem, lub phaj muab tso rau ntawm qhov nro ntawm cov pob txha, yuav tsum tau muab tso rau hauv qhov nro, thiab cov pob txha cortical tuaj yeem tau txais compression;④ raws li lub taub hau phaj, LCP yog siv ua ke nrog lub lag luam screws rau kho cov pob txha pob txha.
3.2 Choj Fixation Technology: Ua ntej, txais yuav txoj kev txo qis qis los rov pib dua qhov tawg, hla mus rau qhov chaw tawg ntawm tus choj thiab kho ob sab ntawm pob txha.Kev txo qis Anatomic tsis tas yuav tsum tau, tab sis tsuas yog yuav tsum tau rov qab los ntawm diaphysis ntev, kev sib hloov thiab txoj kab quab yuam.Lub caij no, pob txha grafting tuaj yeem ua tau los txhawb kev tsim callus thiab txhawb kev puas tsuaj.Txawm li cas los xij, kev txhim kho tus choj tuaj yeem ua tiav qhov kev ruaj ntseg ntawm tus txheeb ze, tab sis qhov kev kho pob txha yog ua tiav los ntawm ob lub calluses los ntawm lub hom phiaj thib ob, yog li nws tsuas yog siv tau rau cov pob txha comminuted.
3.3 Minimally Invasive Plate Osteosynthesis (MIPO) Technology: Txij li xyoo 1970s, AO lub koom haum tau muab cov hauv paus ntsiab lus ntawm kev kho pob txha: kev txo qis hauv lub cev, kho qhov muag sab hauv, kev tiv thaiv cov ntshav thiab kev tawm dag zog thaum ntxov.Cov hauv paus ntsiab lus tau lees paub thoob plaws ntiaj teb, thiab cov txiaj ntsig kho mob tau zoo dua li cov kev kho mob yav dhau los.Txawm li cas los xij, kom tau txais qhov txo qis hauv anatomic thiab cov fixator sab hauv, nws feem ntau yuav tsum tau txiav ntau yam, ua rau txo cov pob txha perfusion, txo cov ntshav ntawm cov pob txha tawg thiab muaj kev pheej hmoo ntawm kev kis kab mob.Nyob rau hauv xyoo tas los no, cov kws tshawb fawb hauv tsev thiab txawv teb chaws tau them nyiaj ntau dua rau kev siv thev naus laus zis tsawg, tiv thaiv cov ntshav ntawm cov nqaij mos thiab cov pob txha nyob rau lub sijhawm txhawb kev txhim kho sab hauv, tsis txhob tshem tawm cov periosteum thiab cov ntaub so ntswg ntawm pob txha. sab, tsis yuam anatomical txo ntawm cov pob txha tawg.Yog li ntawd, nws tiv thaiv kev puas tsuaj ntawm ib puag ncig lom neeg, uas yog cov tshuaj lom neeg osteosynthesis (BO).Hauv xyoo 1990, Krettek tau tshaj tawm MIPO thev naus laus zis, uas yog qhov kev vam meej tshiab ntawm kev txhim kho pob txha hauv xyoo tas los.Nws lub hom phiaj ntawm kev tiv thaiv cov ntshav ntawm kev tiv thaiv cov pob txha thiab cov ntaub so ntswg nrog qhov tsawg kawg nkaus kev puas tsuaj mus rau qhov loj tshaj plaws.Cov txheej txheem yog los tsim ib lub qhov subcutaneous los ntawm ib qho me me incision, tso cov phiaj, thiab txais yuav cov txheej txheem txo qis rau kev txo cov pob txha thiab sab hauv fixator.Lub kaum sab xis ntawm LCP daim hlau yog ruaj khov.Txawm hais tias cov phiaj xwm tsis tau paub txog qhov anatomical shaping, qhov kev txo qis tseem tuaj yeem khaws cia, yog li qhov zoo ntawm MIPO thev naus laus zis yog qhov tseem ceeb dua, thiab nws yog qhov zoo tshaj plaws cog ntawm MIPO thev naus laus zis.
4. Yog vim li cas thiab kev ntsuas rau qhov ua tsis tiav ntawm daim ntawv thov LCP
4.1 Failure ntawm Internal fixator
Txhua qhov kev cog hniav muaj qhov xoob, hloov chaw, pob txha thiab lwm yam kev pheej hmoo ntawm kev ua tsis tiav, xauv daim hlau thiab LCP tsis muaj kev zam.Raws li cov ntaub ntawv qhia, tsis ua hauj lwm ntawm lub fixator sab hauv tsis yog tsuas yog tshwm sim los ntawm lub phaj nws tus kheej, tab sis vim hais tias lub hauv paus ntsiab lus ntawm kev kho mob pob txha raug ua txhaum vim tsis txaus kev nkag siab thiab kev paub txog LCP fixation.
4.1.1.Cov phaj xaiv luv dhau lawm.Qhov ntev ntawm phaj thiab ntsia hlau faib yog qhov tseem ceeb cuam tshuam rau kev ruaj ntseg fixation.Ua ntej qhov tshwm sim ntawm IMIPO thev naus laus zis, cov ntawv luv luv tuaj yeem txo qhov ntev ntawm qhov txiav thiab sib cais ntawm cov ntaub so ntswg.Cov phaj luv luv yuav txo tau lub zog axial thiab torsion lub zog rau qhov ruaj khov tag nrho cov qauv, uas ua rau tsis ua hauj lwm ntawm lub fixator sab hauv.Nrog rau txoj kev loj hlob ntawm indirect reduction technology thiab lub minimally invasive technology, lub ntev daim hlau yuav tsis nce qhov incision ntawm cov ntaub so ntswg.Cov kws phais yuav tsum xaiv lub phaj ntev raws li biomechanics ntawm pob txha fixation.Rau cov pob txha yooj yim, qhov sib piv ntawm qhov zoo tshaj plaws phaj ntev thiab qhov ntev ntawm tag nrho cov pob txha pob txha yuav tsum siab tshaj 8-10 zaug, whereas rau comminuted puas, qhov piv no yuav tsum siab tshaj 2-3 zaug.[13, 15] Cov phaj nrog ntev txaus yuav txo cov phaj load, ntxiv txo cov ntsia hlau load, thiab yog li txo qhov tsis ua hauj lwm tshwm sim ntawm lub fixator sab hauv.Raws li cov txiaj ntsig ntawm LCP finite element tsom xam, thaum qhov sib txawv ntawm cov pob txha tawg yog 1 hli, lub pob txha tawg tawm ib lub phaj compression qhov, kev ntxhov siab ntawm lub phaj compression txo 10%, thiab kev ntxhov siab ntawm cov ntsia hlau txo 63%;Thaum cov pob txha tawg tawm ob lub qhov, kev ntxhov siab ntawm lub phaj compression txo 45%, thiab kev ntxhov siab ntawm cov ntsia hlau txo 78%.Yog li ntawd, kom tsis txhob muaj kev ntxhov siab, rau qhov yooj yim fractures, 1-2 qhov ze ntawm lub pob txha tawg yuav tsum tau sab laug, whereas rau cov comminuted fractures, peb cov ntsia hlau raug pom zoo kom siv rau ntawm txhua qhov tawg thiab 2 screws yuav tsum tau ze rau ntawm qhov chaw. pob txha.
4.1.2 Qhov sib txawv ntawm daim hlau thiab pob txha saum npoo yog ntau dhau.Thaum LCP tau txais kev siv thev naus laus zis thev naus laus zis, cov phiaj xwm tsis tas yuav tsum tau hu rau periosteum los tiv thaiv cov ntshav ntawm cov pob txha.Nws belongs rau qeb elastic fixation, stimulating lub thib ob intension ntawm callus kev loj hlob.Los ntawm kev kawm txog biomechanical stability, Ahmad M, Nanda R [16] thiab al pom tias thaum qhov sib txawv ntawm LCP thiab pob txha saum npoo yog ntau dua 5 hli, axial thiab torsion lub zog ntawm daim hlau yog txo qis;thaum qhov sib txawv tsawg dua 2 hli, tsis muaj qhov txo qis.Yog li, qhov sib txawv yog pom zoo kom tsawg dua 2 hli.
4.1.3 Lub phaj deviates los ntawm diaphysis axis, thiab cov ntsia hlau yog eccentric rau fixation.Thaum LCP tau ua ke nrog MIPO thev naus laus zis, daim hlau yuav tsum tau muab tso rau hauv percutaneous, thiab qee zaum nws nyuaj rau tswj lub phaj txoj hauj lwm.Yog hais tias cov pob txha axis tsis sib xws nrog lub phaj axis, lub phaj distal yuav sib txawv ntawm cov pob txha axis, uas yuav ua rau eccentric fixation ntawm screws thiab tsis muaj zog fixation.[9, 15].Nws raug nquahu kom ua qhov kev txiav kom tsim nyog, thiab kev kuaj X-ray yuav tsum tau ua tom qab kev taw qhia txoj hauj lwm ntawm tus ntiv tes kov yog qhov tsim nyog thiab Kuntscher pin fixation.
4.1.4 Tsis ua raws li cov hauv paus ntsiab lus ntawm kev kho pob txha thiab xaiv tsis raug sab hauv fixator thiab fixation technology.Rau cov pob txha intra-articular, yooj yim transverse diaphysis fractures, LCP tuaj yeem siv los ua cov phaj compression los txhim kho cov pob txha ruaj khov ntawm cov tshuab compression, thiab txhawb kev kho cov pob txha;Rau cov Metaphyseal los yog comminuted fractures, tus choj fixation technology yuav tsum tau siv, xyuam xim rau cov ntshav ntawm cov pob txha tiv thaiv thiab cov ntaub so ntswg mos, tso cai rau tus kuj ruaj khov fixation ntawm pob txha, txhawb kev loj hlob callus kom ua tau zoo los ntawm qhov thib ob intension.Ntawm qhov tsis sib xws, kev siv thev naus laus zis thev naus laus zis los kho cov pob txha yooj yim tuaj yeem ua rau cov pob txha tsis ruaj khov, ua rau ncua kev kho pob txha;[17] comminuted fractures 'ntau dhau los ntawm kev txo qis hauv anatomical thiab compression ntawm cov pob txha pob txha tuaj yeem ua rau muaj kev puas tsuaj rau cov ntshav ntawm cov pob txha, uas ua rau ncua kev sib koom siab lossis kev tsis sib haum xeeb.
4.1.5 Xaiv hom ntsia hlau tsis tsim nyog.LCP qhov sib xyaw ua ke tuaj yeem ntsia tau rau hauv plaub hom ntsia hlau: tus qauv cortical screws, tus qauv tshem tawm pob txha screws, tus kheej-drilling / self-tapping screws thiab self-tapping screws.Self-drilling / self-tapping screws feem ntau yog siv los ua unicortical screws los kho cov pob txha diaphyseal li qub.Nws cov ntsia hlau taub hau muaj cov qauv tsim, uas yooj yim dua los ntawm cortex feem ntau tsis tas yuav ntsuas qhov tob.Yog hais tias lub diaphyseal kab noj hniav yog nqaim heev, ntsia hlau txiv ntseej yuav tsis haum rau lub hau, thiab lub hau ntswj kov lub contralateral cortex, ces qhov kev puas tsuaj rau lub lateral cortex cuam tshuam rau lub zog tuav ntawm screws thiab pob txha, thiab bicortical self-tapping screws yuav tsum. siv rau lub sijhawm no.Cov ntshiab unicortical screws muaj lub zog zoo ntawm cov pob txha ib txwm muaj, tab sis cov pob txha pob txha feem ntau muaj cov cortex tsis muaj zog.Txij li thaum lub sij hawm ua hauj lwm ntawm screws txo, lub sij hawm lub caj npab ntawm cov ntsia hlau tsis kam rau dabtsi yog khoov txo, uas yog yooj yim ua rau cov ntsia hlau txiav pob txha cortex, ntsia hlau loosening thiab lwm yam tawg tawg.[18] Txij li thaum lub bicortical screws tau nce lub screws 'kev ua hauj lwm ntev, lub gripping quab yuam ntawm cov pob txha kuj nce.Qhov tseem ceeb tshaj, cov pob txha ib txwm yuav siv cov unicortical screws los kho, tab sis cov pob txha pob txha raug pom zoo kom siv cov ntsia hlau bicortical.Tsis tas li ntawd, cov pob txha humerus cortex yog qhov nyias nyias, yooj yim ua rau incision, yog li cov bicortical screws yuav tsum tau kho hauv kev kho cov pob txha humeral.
4.1.6 Screw faib yog tuab heev lossis tsawg dhau.Screw fixation yuav tsum tau ua raws li kev puas tsuaj biomechanics.Kev faib tawm tuab heev yuav ua rau muaj kev ntxhov siab hauv cheeb tsam thiab pob txha lov ntawm cov txhim kho sab hauv;tsawg dua tawg screws thiab tsis txaus fixation zog yuav ua rau tsis ua hauj lwm ntawm lub fixator.Thaum tus choj thev naus laus zis siv rau kev txhim kho pob txha, qhov pom zoo ntawm cov ntsia hlau ntom ntom yuav tsum qis dua 40% -50% lossis tsawg dua.[7,13,15] Yog li ntawd, cov phiaj yog ntev dua, thiaj li ua kom qhov sib npaug ntawm mechanics;2-3 qhov yuav tsum tau sab laug rau cov pob txha pob txha, thiaj li tso cai rau cov phaj elasticity ntau dua, tsis txhob muaj kev ntxhov siab thiab txo qhov tshwm sim ntawm kev txhim kho sab hauv [19].Gautier thiab Sommer [15] xav tias tsawg kawg yog ob lub unicortical screws yuav tsum tau kho ntawm ob sab ntawm cov pob txha, qhov nce ntawm cov cortex ruaj khov yuav tsis txo cov phaj tsis ua hauj lwm, yog li tsawg kawg peb screws raug pom zoo kom raug foob ntawm ob sab ntawm tawg.Yam tsawg kawg 3-4 screws yuav tsum tau nyob rau ntawm ob sab ntawm humerus thiab forearm puas, ntau torsion loads yuav tsum tau nqa.
4.1.7 Fixation equipments yog siv tsis raug, ua rau tsis ua hauj lwm ntawm fixator sab hauv.Sommer C [9] tau mus xyuas 127 tus neeg mob nrog 151 tus neeg mob pob txha uas tau siv LCP rau ib xyoos, cov txiaj ntsig kev soj ntsuam qhia tau hais tias ntawm 700 cov ntsia hlau xauv, tsuas yog ob peb lub taub hau nrog txoj kab uas hla ntawm 3.5 hli yog xoob.Yog vim li cas yog qhov tso tseg kev siv cov locking screws pom cov cuab yeej.Qhov tseeb, cov ntsia hlau xauv thiab lub phaj tsis yog tag nrho ntsug, tab sis qhia 50 degrees ntawm lub kaum sab xis.Qhov kev tsim no aims ntawm kev txo cov locking ntsia hlau kev nyuaj siab.Kev siv cov cuab yeej pom kev tso tseg tuaj yeem hloov cov ntsia hlau hla thiab yog li ua rau kev puas tsuaj rau lub zog kho.Kääb [20] tau ua txoj kev tshawb fawb, nws pom lub kaum sab xis ntawm cov ntsia hlau thiab LCP daim hlau loj dhau, thiab yog li lub zog tuav ntawm cov ntsia hlau tau txo qis.
4.1.8 Limb hnyav loading yog ntxov dhau.Cov ntawv ceeb toom zoo ntau dhau los qhia ntau tus kws kho mob kom ntseeg tau ntau dhau ntawm lub zog ntawm lub xauv phaj thiab cov ntsia hlau nrog rau kev ruaj ntseg ruaj khov, lawv tsis ntseeg tias lub zog ntawm cov phaj xauv tuaj yeem dais qhov hnyav thaum ntxov, ua rau lub phaj lossis ntsia hlau tawg.Nyob rau hauv kev siv tus choj fixation fractures, LCP yog qhov ruaj khov, thiab yuav tsum tau tsim callus thiaj li paub txog kev kho mob los ntawm qhov mob thib ob.Yog tias cov neeg mob tau tawm ntawm txaj ntxov dhau lawm thiab thauj khoom hnyav heev, lub phaj thiab cov ntsia hlau yuav tawg lossis tshem tawm.Locking phaj fixation txhawb kev ua haujlwm thaum ntxov, tab sis ua kom tiav cov khoom ua kom tiav yuav tsum yog rau lub lis piam tom qab, thiab cov yeeb yaj kiab x-ray qhia tau hais tias sab pob txha muaj qhov tseem ceeb callus.[9]
4.2 Tendon thiab Neurovascular Injuries:
MIPO thev naus laus zis yuav tsum tau muab tso rau hauv percutaneous thiab muab tso rau hauv cov leeg, yog li thaum lub phaj screws muab tso rau, cov kws phais tsis tuaj yeem pom cov qauv subcutaneous, thiab yog li cov leeg thiab cov hlab ntsha puas tsuaj ntxiv.Van Hensbroek PB [21] tau tshaj tawm ib rooj plaub ntawm kev siv LISS thev naus laus zis los siv LCP, uas ua rau cov hlab ntsha tibial pseudoaneurysms.AI-Rashid M. [22] thiab al qhia los kho qeeb ruptures ntawm extensor tendon thib ob rau distal radial fractures nrog LCP.Cov laj thawj tseem ceeb rau kev puas tsuaj yog iatrogenic.Thawj qhov yog kev puas tsuaj ncaj qha los ntawm cov ntsia hlau lossis Kirschner tus pin.Qhov thib ob yog qhov kev puas tsuaj los ntawm lub tes tsho.Thiab qhov thib peb yog thermal puas tsim los ntawm drilling self-tapping screws.[9] Yog li ntawd, cov kws phais yuav tsum tau paub txog lub cev nqaij daim tawv nyob ib puag ncig, ua tib zoo saib xyuas kev tiv thaiv cov hlab ntsha vascularis thiab lwm cov qauv tseem ceeb, ua kom tag nrho cov blunt dissection nyob rau hauv tso lub tes tsho, tsis txhob compression los yog paj hlwb traction.Tsis tas li ntawd, thaum drilling tus kheej tapping screws, siv dej los txo cov cua sov thiab txo cov cua sov.
4.3 Kev kis kab mob ntawm qhov chaw phais thiab phaj phaj:
LCP yog ib qho kev txhim kho sab hauv tau tshwm sim nyob rau hauv keeb kwm yav dhau los ntawm kev txhawb nqa lub tswv yim me me, txhawm rau txo kev puas tsuaj, txo kev kis kab mob, tsis muaj kev sib koom tes thiab lwm yam teeb meem.Hauv kev phais, peb yuav tsum tau them nyiaj tshwj xeeb rau kev tiv thaiv cov ntaub so ntswg, tshwj xeeb tshaj yog qhov tsis muaj zog ntawm cov ntaub so ntswg.Piv nrog DCP, LCP muaj qhov dav dav thiab ntau dua.Thaum siv MIPO thev naus laus zis rau percutaneous lossis intramuscular insertion, nws tuaj yeem ua rau cov nqaij mos contusion lossis avulsion puas thiab ua rau muaj kab mob.Phinit P [23] tau tshaj tawm tias LISS system tau kho 37 tus neeg mob ntawm tibia pob txha pob txha, thiab qhov tshwm sim ntawm kev kis kab mob sib sib zog nqus tau mus txog 22%.Namazi H [24] tau tshaj tawm tias LCP tau kho 34 tus neeg mob ntawm tibial ncej pob txha ntawm 34 tus neeg mob metaphyseal fracture ntawm tibia, thiab qhov tshwm sim ntawm kev mob tom qab phais mob thiab cov phaj kis tau mus txog 23.5%.Yog li ntawd, ua ntej kev khiav hauj lwm, lub cib fim thiab sab hauv fixator yuav tsum tau xav phem heev raws li kev puas tsuaj ntawm cov ntaub so ntswg thiab complexity degree ntawm pob txha.
4.4 Irritable bowel Syndrome ntawm Soft Tissue:
Phinit P [23] tau tshaj tawm tias LISS system tau kho 37 tus neeg mob ntawm tibia pob txha pob txha, 4 qhov mob ntawm cov nqaij mos tom qab phais (qhov mob ntawm subcutaneous palpable phaj thiab nyob ib ncig ntawm daim hlau), nyob rau hauv uas 3 rooj plaub ntawm daim hlau yog 5 hli ntawm qhov. pob txha nto thiab 1 rooj plaub yog 10 hli ntawm cov pob txha nto.Hasenboehler.E [17] et al qhia LCP tau kho 32 tus neeg mob ntawm cov pob txha pob txha, suav nrog 29 tus neeg mob ntawm cov kab mob hauv nruab nrab malleolus tsis xis nyob.Yog vim li cas yog tias cov phaj ntim loj dhau los yog cov phaj tso rau hauv qhov tsis raug thiab cov ntaub so ntswg yog thinner ntawm medial malleolus, yog li cov neeg mob yuav tsis xis nyob thaum cov neeg mob hnav khau siab thiab compress ntawm daim tawv nqaij.Qhov xov xwm zoo yog tias qhov tshiab distal metaphyseal phaj tsim los ntawm Synthes yog nyias thiab nplaum rau cov pob txha nto nrog cov npoo du, uas tau daws qhov teeb meem no zoo.
4.5 Qhov nyuaj ntawm Kev Tshem Tawm Cov Ntsia Hlau Xauv:
Cov khoom siv LCP yog lub zog siab titanium, muaj kev sib raug zoo nrog tib neeg lub cev, uas yooj yim rau ntim los ntawm callus.Hauv kev tshem tawm, thawj qhov kev tshem tawm ntawm callus ua rau muaj kev nyuaj siab ntxiv.Lwm qhov laj thawj rau kev tshem tawm qhov nyuaj yog nyob rau hauv kev nruj dua ntawm cov ntsia hlau xauv los yog cov txiv ntoo puas, uas feem ntau yog tshwm sim los ntawm kev hloov cov khoom pov tseg xauv ntsia hlau pom nrog cov cuab yeej pom tus kheej.Yog li ntawd, cov cuab yeej pom yuav tsum tau siv los siv rau hauv kev siv cov ntsia hlau xauv, kom cov ntsia hlau threads tuaj yeem raug khi nrog cov phaj threads.[9] Cov ciaj ntswj tshwj xeeb yuav tsum tau siv rau hauv cov ntsia hlau nruj, thiaj li tswj tau qhov loj ntawm lub zog.
Qhov tseem ceeb tshaj, raws li lub phaj compression ntawm AO qhov kev txhim kho tshiab kawg, LCP tau muab cov kev xaiv tshiab rau kev kho mob niaj hnub ntawm cov pob txha.Ua ke nrog MIPO thev naus laus zis, LCP ua ke khaws cov ntshav ntawm cov pob txha pob txha mus rau qhov loj tshaj plaws, txhawb kev kho pob txha, txo cov kev pheej hmoo ntawm kev kis kab mob thiab rov ua dua, ua kom cov pob txha ruaj khov, yog li nws muaj cov ntawv thov dav dav hauv kev kho pob txha.Txij li thaum daim ntawv thov, LCP tau txais txiaj ntsig zoo nyob rau lub sijhawm luv luv, tseem muaj qee qhov teeb meem tshwm sim.Kev phais yuav tsum muaj kev npaj ua ntej ua ntej thiab kev kho mob dav dav, xaiv cov khoom siv sab hauv thiab cov thev naus laus zis los ntawm cov yam ntxwv ntawm cov pob txha tshwj xeeb, ua raws li cov hauv paus ntsiab lus ntawm kev kho pob txha, siv cov fixators kom raug thiab tsim qauv, txhawm rau tiv thaiv. cov teeb meem thiab tau txais qhov zoo tshaj plaws kho cov teebmeem.
Post lub sij hawm: Jun-02-2022
