Hei taputapu whakatika ā-roto, he mahi nui tonu tā te pereti pēhi i roto i te maimoatanga whati. I ngā tau tata nei, kua māramahia, kua whakamahia hoki te ariā o te osteosynthesis iti rawa te whakaekenga, ā, kua neke haere mai i te aro nui ki ngā mahi mīhini o te taputapu whakatika ā-roto ki te aro nui ki te whakapiri koiora, e kore nei e aro noa ki te tiaki i te toto o te wheua me te kiko ngohengohe, engari e whakatairanga ana hoki i ngā whakapainga o ngā tikanga pokanga me te taputapu whakatika ā-roto.Pereti Kōpeketanga Maukati(LCP) he pūnaha whakapiri pereti hou, i whakawhanakehia i runga i te pereti kōpeketanga hihiri (DCP) me te pereti kōpeketanga hihiri whakapā iti (LC-DCP), ā, i honoa ki ngā painga haumanu o te pereti whakapā pūwāhi o te AO (PC-Fix) me te Pūnaha Whakapūmau iti iho te whakaekenga (LISS). I tīmata te whakamahi haumanu i te pūnaha i te marama o Mei 2000, ā, i tutuki i a ia ngā pānga haumanu pai ake, ā, he maha ngā pūrongo kua tuku aromatawai teitei mōna. Ahakoa he maha ngā painga o tana whakapiri whati, he nui ake ngā tono hangarau me te wheako. Ki te kore e whakamahia tika, tera pea ka hua kino, ā, ka puta he hua kore e taea te whakatika.
1. Ngā Mātāpono Koiora-ā-ringa, te Hoahoa me ngā Painga o te LCP
Ko te pumau o te pereti maitai noa e hangai ana ki te waku i waenga i te pereti me te wheua. Me whakau ake ngā tīwiri. Kia wetekina ngā tīwiri, ka heke te waku i waenga i te pereti me te wheua, ka heke hoki te pumau, ka pakaru te taputapu whakatika ā-roto.LCPhe pereti tautoko hou i roto i te kiko ngohengohe, i whakawhanakehia mā te whakakotahi i te pereti pēhi tuku iho me te tautoko. Kāore tōna kaupapa whakau e whakawhirinaki ki te waku i waenga i te pereti me te kiri wheua, engari e whakawhirinaki ana ki te pumau o te koki i waenga i te pereti me ngā tīwiri raka me te kaha pupuri i waenga i ngā tīwiri me te kiri wheua, kia tutuki ai te whakau whati. Ko te painga tika kei roto i te whakaiti i te pokanoa o te tuku toto periosteal. Nā te pumau o te koki i waenga i te pereti me ngā tīwiri kua tino whakapai ake i te kaha pupuri o ngā tīwiri, nō reira he nui ake te kaha whakau o te pereti, e tika ana mō ngā wheua rerekē. [4-7]
Ko te āhuatanga ahurei o te hoahoa LCP ko te "kōhao whakakotahi", e whakakotahi ana i ngā kōhao pēhi hihiri (DCU) me ngā kōhao miro kōniko. Ka taea e te DCU te whakatutuki i te pēhi tuaka mā te whakamahi i ngā tīwiri paerewa, ka taea rānei te pēhi me te whakau i ngā whati kua nekehia mā te tīwiri whakaroa; he miro kei te kōhao miro kōniko, ka taea te raka i te raka miro o te tīwiri me te nati, te whakawhiti i te taipana i waenga i te tīwiri me te pereti, ā, ka taea te whakawhiti i te ahotea roa ki te taha whati. Hei tāpiri, kua hoahoatia te awaawa tapahi i raro i te pereti, e whakaiti ana i te wāhi pa ki te wheua.
I roto i ngā kupu poto, he maha ngā painga o tēnei pereti i ngā pereti tuku iho: ① ka whakau i te koki: he pumau, he pumau hoki te koki i waenganui i ngā pereti whao, he whai hua mō ngā wheua rerekē; ② ka whakaiti i te mōrearea o te ngaronga whakaiti: kāore he take ki te mahi i te piko-mua tika mō ngā pereti, ka whakaiti i ngā mōrearea o te ngaronga whakaiti-wāhanga tuatahi me te ngaronga whakaiti-wāhanga tuarua; [8] ③ ka tiaki i te rere o te toto: ko te mata pa iti rawa i waenganui i te pereti maitai me te wheua ka whakaiti i ngā ngaronga o te pereti mō te rere o te toto periosteum, he mea hangai ake ki ngā mātāpono o te iti rawa o te whakaekenga; ④ he āhua pupuri pai: he mea tino tika mō te wheua whati osteoporosis, ka whakaiti i te auau o te wetewete me te puta o te tīwiri; ⑤ ka taea te mahi whakakori tinana wawe; ⑥ he whānuitanga o ngā tono: he oti te momo pereti me te roa, he pai te āhua o mua o te tinana, ka taea te whakatutuki i te whakapumautanga o ngā wāhanga rerekē me ngā momo whati rerekē.
2. Ngā tohu o te LCP
Ka taea te whakamahi i te LCP hei pereti pēhi noa, hei tautoko ā-roto rānei. Ka taea hoki e te taote pokanga te whakakotahi i ngā mea e rua, kia whānui ake ai ōna tohu, kia taea ai hoki te whakamahi ki ngā momo tauira whati.
2.1 Ngā Whati Māmā o te Diaphysis, o te Metaphysis rānei: ki te kore e kino te kino o te kiko ngohengohe, ā, he pai te kounga o te wheua, me tapahi me te whakaiti tika ngā whati whakawhiti māmā, ngā whati poto whakarara rānei o ngā wheua roa, ā, me kaha te pēhi i te taha whati, nō reira ka taea te whakamahi i te LCP hei pereti pēhi me te pereti whakakore, hei pereti whakakore rānei.
2.2 Ngā Wāhanga Tapatapahi o te Diaphysis, o te Metaphyseal rānei: Ka taea te whakamahi i te LCP hei pereti piriti, e whakamahi ana i te whakaiti ā-kore me te osteosynthesis piriti. Kāore e hiahiatia he whakaiti anatomical, engari ka whakahokia mai te roa o te peka, te hurihanga me te raina kaha axial. He rerekē te whati o te radius me te ulna, nā te mea ko te mahi hurihanga o ngā ringaringa e whakawhirinaki ana ki te hanganga noa o te radius me te ulna, he rite ki ngā whati intra-articular. Haunga, me whakahaere te whakaiti anatomical, ā, me whakau pūmau ki ngā pereti.
2.3 Ngā Whati o Roto-hononga me ngā Whati i Waenganui-hononga: I roto i te whati o roto-hononga, ehara i te mea me mahi noa te whakaiti hanganga kia maeneene ai te mata o te hononga, engari me pēhi hoki i ngā wheua kia mau tonu ai te mau me te whakatairanga i te whakaora wheua, ā, kia taea ai te whakakorikori wawe i te mahi. Mena ka pāngia ngā wheua e ngā whati hononga, ka taea e te LCP te whakatika i tehonongai waenganui i te hononga kua whakaitihia me te diaphysis. Ā, kāore he take ki te hanga i te pereti i roto i te pokanga, nā tēnei kua whakaitihia te wā pokanga.
2.4 Hononga Whakaroa, Kore-hononga rānei.
2.5 Osteotomy Katia, Tuwhera rānei.
2.6 Kāore e pā ki te honongate whao i roto i te medullarywhati wheua, ā, he huarahi pai rawa atu te LCP. Hei tauira, kāore e taea te whakamahi i te LCP mō ngā whati wheua kua pakaru i te hinu wheua o ngā tamariki, o ngā taiohi rānei, arā, ko te hunga he kuiti rawa, he whānui rawa rānei, he hē rānei te āhua o ō rātou kōhao penupenu.
2.7 Ngā Tūroro Osteoporosis: nā te mea he angiangi rawa te kiri wheua, he uaua ki te pereti tuku iho te whiwhi pumau pono, nā tēnei i whakapiki ake ai te uaua o te pokanga whati, ā, i hua ake ai te rahunga nā te ngāwari o te wetewete me te puta atu i te whakapiringa i muri i te pokanga. Ko te tīwiri raka LCP me te punga pereti te mea e hanga ana i te pumau o te koki, ā, kua whakauruhia ngā whao pereti. Hei tāpiri, he nui te diameter o te mandrel o te tīwiri raka, ka whakanui ake i te kaha hopu o te wheua. Nō reira, ka tino whakaitihia te auau o te wetewete o te tīwiri. Ka whakaaetia ngā mahi whakakori tinana mahi wawe i muri i te pokanga. Ko te Osteoporosis he tohu kaha o te LCP, ā, he maha ngā pūrongo kua whakanuia.
2.8 Te Whati o te Femur Periprosthetic: he maha ngā wā ka haere tahi ngā whati femur periprosthetic me te osteoporosis, ngā mate kaumātua me ngā mate pūnaha kino. Ka tapahia nuitia ngā pereti tuku iho, ka pā kino pea ki te rere o te toto ki ngā whati. Haunga tēnā, me whakapiri ngā tīwiri noa ki te bicortical, ka pā kino ki te sima wheua, ā, he ngoikore hoki te kaha o te pupuri i te osteoporosis. He pai te whakatau a ngā pereti LCP me LISS i ēnei raruraru. Arā, ka whakamahia e rātou te hangarau MIPO hei whakaiti i ngā mahi hononga, hei whakaiti i ngā kino ki te rere o te toto, ā, ka taea e te tīwiri raka cortical kotahi te whakarato i te pumau e tika ana, e kore ai e pā kino ki te sima wheua. Ko te tikanga o tēnei tikanga he māmā noa iho, he poto ake te wā mahi, he iti ake te toto, he iti te whānuitanga tango me te whakahaere i te whakaora whati. Nō reira, ko ngā whati femur periprosthetic tētahi o ngā tohu kaha o te LCP. [1, 10, 11]
3. Ngā Tikanga Pokanga e Pā Ana ki te Whakamahinga o te LCP
3.1 Hangarau Pēhi Tuku Iho: ahakoa kua rerekē te ariā o te whakatikatika ā-roto AO, ā, kāore te rere o te toto ki te tiaki i te wheua me ngā kiko ngohengohe e warewarehia nā te nui rawa o te aro ki te pumau o te whakatikatika, me pēhi tonu te taha whati kia whiwhi ai i te whakatikatika mō ētahi whati, pērā i ngā whati hononga-ā-roto, te whakatikatika osteotomy, ngā whati whakawhiti ngāwari, ngā whati poto rānei. Ko ngā tikanga pēhi: ① Ka whakamahia te LCP hei pereti pēhi, mā te whakamahi i ngā tīwiri cortical paerewa e rua hei whakapiri i te pereti nekehanga, te whakamahi rānei i te taputapu pēhi hei whakatutuki i te whakatikatika; ② Hei pereti tiaki, ka whakamahia e te LCP ngā tīwiri whakaroa hei whakatika i ngā whati roa-whakaroa; ③ Mā te whakamahi i te mātāpono whitiki kume, ka whakatakotoria te pereti ki te taha kume o te wheua, ka whakairihia ki raro i te kume, ā, ka taea e te wheua cortical te whiwhi kume; ④ Hei pereti tautoko, ka whakamahia te LCP me ngā tīwiri whakaroa hei whakatika i ngā whati hononga.
3.2 Hangarau Whakatikatika Piriti: Tuatahi, whakamahia te tikanga whakaiti ā-kore hei tautuhi anō i te whati, horahia puta noa i ngā rohe whati mā te piriti, ā, whakatikahia ngā taha e rua o te whati. Kāore e hiahiatia te whakaiti hanganga tinana, engari me whakaora noa i te roa o te diaphysis, te hurihanga me te raina kaha. I taua wā, ka taea te mahi tāpiri wheua hei whakaoho i te hanganga o te karu me te whakatairanga i te whakaora whati. Heoi, ka taea noa e te whakatikatika piriti te whakatutuki i te pumau ōrite, engari ka tutuki te whakaora whati mā te rua o ngā karu mā te whakaaro tuarua, nō reira ka tika anake mō ngā whati pakaru.
3.3 Hangarau Whakapūmau i te Osteosynthesis Pereti Whakararu iti (MIPO): Mai i te tekau tau atu i 1970, i whakatakotohia e te whakahaere AO ngā mātāpono o te maimoatanga whati: te whakaiti i te hanganga tinana, te whakatikatika ā-roto, te tiaki i te rere o te toto me te whakakorikori tinana wawe kore mamae. Kua mōhiotia whānuitia ēnei mātāpono puta noa i te ao, ā, he pai ake ngā pānga haumanu i ngā tikanga maimoatanga o mua. Heoi, kia whiwhi ai i te whakaiti hanganga tinana me te whakatikatika ā-roto, he maha ngā wā ka hiahiatia he tapahi whānui, ka hua ake he whakaheke i te rere o te wheua, he whakaheke i te rere o te toto ki ngā kongakonga whati, ā, ka piki ake te tūponotanga o te mate. I ngā tau tata nei, ka aro nui ake ngā tohunga o roto me tāwāhi ki te hangarau whakaiti i te rere o te toto ki ngā kiko ngohengohe me te wheua i te wā e whakatairanga ana i te whakatikatika ā-roto, kāore e tangohia te periosteum me te kiko ngohengohe i ngā taha whati, kāore e akiaki i te whakaiti hanganga tinana o ngā kongakonga whati. Nō reira, ka tiakina te taiao koiora whati, arā, te osteosynthesis koiora (BO). I ngā tau atu i 1990, i whakaarohia e Krettek te hangarau MIPO, he ahunga whakamua hou o te whakatikatika whati i ngā tau tata nei. Ko tōna whāinga he tiaki i te rere o te toto ki te wheua me ngā kiko ngohengohe me te iti rawa o ngā kino ki te whānuitanga nui. Ko te tikanga he hanga i tētahi kauhanga raro i te kiri mā roto i tētahi tapahi iti, ka whakanoho i ngā pereti, ka whakamahi i ngā tikanga whakaiti ā-kore mō te whakaiti i te whati me te whakatikatika ā-roto. He pumau te koki i waenga i ngā pereti LCP. Ahakoa kāore ngā pereti e tino kitea te āhua o te tinana, ka taea tonu te pupuri i te whakaiti whati, nō reira he nui ake ngā painga o te hangarau MIPO, ā, he tino pai te whakaurunga o te hangarau MIPO.
4. Ngā Take me ngā Ārai mō te Korenga o te Tono LCP
4.1 Te rahunga o te taputapu whakatika ā-roto
He tūponotanga mōrearea te wetekina, te neke, te whati me ētahi atu tūponotanga o te rahunga o ngā tākai katoa, kāore he rerekētanga o ngā pereti raka me te LCP. E ai ki ngā pūrongo tuhinga, ehara i te mea ko te pereti tonu te take o te rahunga o te taputapu whakatika ā-roto, engari nā te mea kua takahia ngā mātāpono taketake o te maimoatanga whati nā te kore e mārama me te mōhio ki te whakapiringa LCP.
4.1.1. He poto rawa ngā pereti kua tīpakohia. Ko te roa o te pereti me te tohatoha tīwiri ngā mea matua e pā ana ki te pumau o te whakapiri. I mua i te putanga mai o te hangarau IMIPO, ka taea e ngā pereti poto ake te whakaiti i te roa o te tapahi me te wehenga o te kiko ngohengohe. Ka whakaitihia e ngā pereti poto rawa te kaha o te tuaka me te kaha o te hurihanga mō te hanganga whānui kua whakapirihia, ka hua ake te korenga o te whakatikatika ā-roto. I te whanaketanga o te hangarau whakaiti ā-kore me te hangarau iti rawa te whakaekenga, kāore e whakanuia e ngā pereti roa ake te tapahi o te kiko ngohengohe. Me whiriwhiri e ngā taote pokanga te roa o te pereti i runga anō i ngā tikanga koiora o te whakapiri whati. Mō ngā whati ngāwari, me teitei ake te ōwehenga o te roa o te pereti pai me te roa o te rohe whati katoa i te 8-10 ngā wā, engari mō te whati pakaru, me teitei ake tēnei ōwehenga i te 2-3 ngā wā. [13, 15] Ka whakaitihia e ngā pereti he roa te roa te kawenga o te pereti, ka whakaitihia anō te kawenga o te tīwiri, ā, ka whakaitihia te tūponotanga o te korenga o te whakatikatika ā-roto. E ai ki ngā hua o te tātaritanga huānga mutunga kore LCP, ina 1mm te āputa i waenga i ngā taha whati, ka toe mai he kōhao pereti kōpeke kotahi i te taha whati, ka heke te ahotea i te pereti kōpeke mā te 10%, ā, ka heke te ahotea i ngā tīwiri mā te 63%; ina toe mai he kōhao e rua i te taha whati, ka heke te ahotea i te pereti kōpeke mā te 45%, ā, ka heke te ahotea i ngā tīwiri mā te 78%. Nō reira, hei karo i te kukū ahotea, mō ngā whati ngāwari, me waiho kia 1-2 ngā kōhao e tata ana ki ngā taha whati, engari mō ngā whati pakaru, e toru ngā tīwiri e taunakitia ana kia whakamahia i ia taha whati, ā, kia 2 ngā tīwiri e tata ana ki ngā whati.
4.1.2 He nui rawa te āputa i waenganui i ngā pereti me te mata o te wheua. Ina whakamahia e te LCP te hangarau whakapiri piriti, kāore e hiahiatia kia pa atu ngā pereti ki te periosteum hei tiaki i te rere o te toto ki te rohe whati. Kei roto i te kāwai whakapiri rapa, e whakaoho ana i te kaha tuarua o te tipu o te karu. Mā te ako i te pumau koiora, i kitea e Ahmad M, Nanda R [16] me ētahi atu, ina nui ake te āputa i waenganui i te LCP me te mata o te wheua i te 5mm, ka tino heke te kaha o te axial me te torsion o ngā pereti; ina iti iho te āputa i te 2mm, kāore he hekenga nui. Nō reira, e taunakihia ana kia iti iho te āputa i te 2mm.
4.1.3 Ka peka ke te pereti mai i te tuaka diaphysis, ā, he rerekē ngā tīwiri ki te whakapiringa. Ina whakakotahihia te LCP ki te hangarau MIPO, me whakauru ngā pereti ki te kiri, ā, he uaua ki te whakahaere i te tūranga o te pereti i ētahi wā. Mena he rerekē te tuaka wheua ki te tuaka pereti, ka peka ke pea te pereti tawhiti mai i te tuaka wheua, ka arahi pea tēnei ki te whakapiringa rerekē o ngā tīwiri me te ngoikore o te whakapiringa. [9,15]. E taunakihia ana kia tapahia tika, ā, me tirotiro te hihi-X i muri i te tika o te tūranga ārahi o te pā o te maihao me te whakapiringa o te pine Kuntscher.
4.1.4 Te kore e whai i ngā mātāpono taketake o te maimoatanga whati, me te whiriwhiri i te taputapu whakatika ā-roto me te hangarau whakatika he. Mō ngā whati hononga-ā-roto, ngā whati diaphysis whakawhiti māmā, ka taea te whakamahi i te LCP hei pereti pēhi hei whakatika i te pumau o te whati mā te hangarau pēhi, me te whakatairanga i te whakaora tuatahi o ngā whati; mō ngā whati Metaphyseal, ngā whati pakaru rānei, me whakamahi te hangarau whakatika piriti, me aro ki te rere toto o te wheua me te kiko ngohengohe, me tuku kia pumau te whakatika o ngā whati, me whakaoho i te tipu o te callus kia ora ai i te kaha tuarua. Engari, ko te whakamahinga o te hangarau whakatika piriti hei rongoā i ngā whati māmā ka puta he whati kāore i te pumau, ka roa te whakaora whati; [17] ko te whai nui o ngā whati pakaru ki te whakaiti me te pēhi anatomical i ngā taha whati ka puta he kino ki te rere toto o ngā wheua, ka roa te hononga, te kore hononga rānei.
4.1.5 Kōwhiria ngā momo tīwiri kāore e tika ana. E whā ngā momo tīwiri ka taea te whakawiri i te kōhao whakakotahi LCP: ngā tīwiri cortical paerewa, ngā tīwiri wheua cancellous paerewa, ngā tīwiri keri-ake/tāpiri-ake me ngā tīwiri tāpiri-ake. Ko ngā tīwiri keri-ake/tāpiri-ake e whakamahia ana hei tīwiri unicortical hei whakatika i ngā whati diaphyseal noa o ngā wheua. He hoahoa tauira keri tōna pito whao, he māmā ake te haere mā roto i te cortex me te kore e hiahiatia te ine i te hohonu. Mena he tino whaiti te kōhao penupenu diaphyseal, kāore pea te nati tīwiri e uru pai ki te tīwiri, ā, ka pā te pito tīwiri ki te cortex contralateral, ka pā te kino ki te cortex lateral pumau ki te kaha hopu i waenga i ngā tīwiri me ngā wheua, ā, me whakamahi ngā tīwiri tāpiri-ake bicortical i tēnei wā. He pai te kaha hopu o ngā tīwiri unicortical parakore ki ngā wheua noa, engari he ngoikore te cortex o te wheua osteoporosis. Nā te mea ka whakaitihia te wā mahi o ngā tīwiri, ka heke te ātete o te ringa nekehanga o te tīwiri ki te piko, ka hua ake he tapahi tīwiri i te cortex wheua, te wetekina o te tīwiri me te nekehanga tuarua o te whati. [18] Nā te mea kua roa ake te mahi a ngā tīwiri bicortical, ka piki ake hoki te kaha pupuri o ngā wheua. Engari, tera pea ka whakamahia e te wheua noa ngā tīwiri unicortical hei whakatika, engari ko te wheua osteoporosis e taunakitia ana kia whakamahia ngā tīwiri bicortical. Hei tāpiri, he angiangi te cortex o te wheua humerus, ā, ka ngāwari te tapahi, nō reira me whakamahi ngā tīwiri bicortical hei whakatika i te rongoā i ngā whati humerus.
4.1.6 He tino matotoru, he iti rawa rānei te tohatoha o ngā tīwiri. Me whakapūmau te tīwiri kia rite ki ngā tikanga koiora o te whati. Ka hua ake te kukū o te ahotea ā-rohe me te whati o te kaiwhakapūmau ā-roto i te tohatoha o ngā tīwiri tino matotoru; ka hua ake hoki te ngoikore o te kaiwhakapūmau ā-roto i te iti rawa o ngā tīwiri whati me te kore e ranea te kaha o te whakapūmau. Ina whakamahia te hangarau piriti ki te whakapūmau whati, me iti iho i te 40% -50% te kiato tīwiri e taunakitia ana. [7,13,15] Nō reira, he roa ake ngā pereti, kia pai ake ai te taurite o ngā tikanga; me waiho kia 2-3 ngā kōhao mō ngā taha whati, kia nui ake ai te ngāwari o te pereti, kia kore ai e kukū te ahotea, kia iti ake ai hoki te pakaru o te kaiwhakapūmau ā-roto [19]. I whakaaro a Gautier rāua ko Sommer [15] kia rua, kia toru ngā tīwiri kotahi-koritika me whakapūmau ki ngā taha e rua o ngā whati, ko te nui haere o te maha o ngā kiriuhi kua whakapūmautia kāore e whakaiti i te tere o te pakaru o ngā pereti, nō reira e taunakitia ana kia toru, kia toru ngā tīwiri me whakapūmau ki ngā taha e rua o te whati. E hiahiatia ana kia 3-4 ngā tīwiri i ngā taha e rua o te humerus me te whati o te ringaringa; me nui ake ngā kawenga torsion me pikau.
4.1.7 Kāore i te tika te whakamahinga o ngā taputapu whakapiri, ā, ka pakaru te taputapu whakapiri ā-roto. I toro atu a Sommer C [9] ki te 127 tūroro me te 151 ngā whati kua whakamahia te LCP mō te tau kotahi, ā, e whakaatu ana ngā hua tātaritanga i roto i ngā tīwiri raka 700, he iti noa iho ngā tīwiri me te diameter o te 3.5mm kua wetekina. Ko te take ko te korenga o te whakamahinga o te taputapu tirotiro tīwiri raka. Inaa, kāore te tīwiri raka me te pereti i tino poutū, engari e whakaatu ana i te 50 nekehanga o te koki. Ko te whāinga o tēnei hoahoa he whakaiti i te ahotea o te tīwiri raka. Mā te korenga o te whakamahinga o te taputapu tirotiro ka huri pea te ara whao, ā, ka kino te kaha o te whakapiri. I whakahaerehia e Kääb [20] tētahi rangahau whakamātautau, i kitea e ia he nui rawa te koki i waenga i ngā tīwiri me ngā pereti LCP, ā, ka tino heke te kaha hopu o ngā tīwiri.
4.1.8 He wawe rawa te taumaha o ngā peka. He nui rawa ngā pūrongo pai e ārahi ana i te tini o ngā tākuta ki te whakapono nui ki te kaha o ngā pereti me ngā tīwiri raka me te pumau o te whakapiri, e whakapono hē ana rātou ka taea e te kaha o ngā pereti raka te tu atu i te taumaha katoa i te tīmatanga, ka puta he whati pereti, he tīwiri rānei. I te whakamahi i ngā whati whakapiri piriti, he pumau te LCP, ā, me hanga he karu kia taea ai te whakaora mā te kaha tuarua. Mena ka ara wawe rawa ngā tūroro i te moenga, ā, ka utaina he taumaha nui rawa, ka whati, ka momotu rānei te pereti me te tīwiri. Mā te whakapiri pereti raka ka akiaki i te mahi wawe, engari me ono wiki i muri mai te uta mārire katoa, ā, e whakaatu ana ngā kiriata hihi-X he nui te karu o te taha whati. [9]
4.2 Ngā Whara o te Uaua me te Neurovascular:
Me whakauru te hangarau MIPO ki roto i te kiri, ā, me whakanoho ki raro i ngā uaua, kia kore ai e kitea e ngā taote te hanganga o raro i te kiri, ā, ka nui ake te kino o te uaua me te pūnaha io. I kōrero a Van Hensbroek PB [21] mō tētahi take o te whakamahi i te hangarau LISS hei whakamahi i te LCP, i hua ake ai he pseudoaneurysms o te uaua tibial o mua. I kōrero a AI-Rashid M. [22] me ētahi atu hei rongoā i ngā pakaru whakaroa o te uaua extensor tuarua mō ngā whati radial distal me te LCP. Ko ngā take matua mō ngā kino he iatrogenic. Ko te tuatahi ko te kino tika i puta mai i ngā tīwiri, i te pine Kirschner rānei. Ko te tuarua ko te kino i puta mai i te ringaringa. Ā, ko te tuatoru ko ngā kino wera i puta mai i te keri i ngā tīwiri whaiaro-tapping. [9] Nō reira, me mōhio ngā taote ki te hanganga o te tinana e karapoti ana, me aro ki te tiaki i te nervus vascularis me ētahi atu hanganga nui, me mahi katoa i te tapahi punga i te whakatakotoranga o ngā ringaringa, me karo i te pēhitanga, te kukume io rānei. Hei tāpiri, i te keri i ngā tīwiri whaiaro-tapping, whakamahia te wai hei whakaiti i te whakaputanga wera me te whakaiti i te kawe wera.
4.3 Te Mate Pāwera me te Whakatūpato i te Wāhi Pokanga:
He pūnaha whakatikatika ā-roto te LCP i hangaia i raro i te kaupapa whakatairanga i te ariā iti rawa te whakaekenga, e whai ana ki te whakaiti i ngā kino, te whakaiti i te mate, te kore hononga me ētahi atu raruraru. I roto i te pokanga, me aro nui tātou ki te tiaki i ngā kiko ngohengohe, inā koa ko ngā wāhanga ngoikore o te kiko ngohengohe. Ki te whakatauritea ki te DCP, he whānui ake te LCP me te matotoru ake. Ina whakamahia te hangarau MIPO mō te whakaurunga ā-kiri, ā-roto rānei, ka pāngia pea te kiko ngohengohe e te whara, te avulsion rānei, ā, ka arahi ki te mate patunga. I kōrero a Phinit P [23] kua rongoatia e te pūnaha LISS te 37 ngā take o ngā whati tibia proximal, ā, ko te maha o ngā mate hohonu i muri i te pokanga i tae ki te 22%. I kōrero a Namazi H [24] kua rongoatia e te LCP te 34 ngā take o te whati tibial shaft o te 34 ngā take o te whati metaphyseal o te tibia, ā, ko te maha o ngā mate patunga me te whakaaturanga pereti i muri i te pokanga i tae ki te 23.5%. Nō reira, i mua i te pokanga, me whai whakaaro nui ki ngā whai wāhitanga me te whakatikatika ā-roto i runga i ngā kino o te kiko ngohengohe me te uaua o ngā whati.
4.4 Te Mate Puku Whakararuraru o te Kiko Ngāwari:
I kōrero a Phinit P [23] kua rongoatia e te pūnaha LISS ngā take 37 o ngā whati tibia proximal, 4 ngā take o te riri o ngā kiko ngohengohe i muri i te pokanga (ngā mamae o te pereti palpable i raro i te kiri me te taha o ngā pereti), e 3 ngā take o ngā pereti e 5mm te tawhiti atu i te mata o te wheua, ā, 1 te take e 10mm te tawhiti atu i te mata o te wheua. I kōrero a Hasenboehler.E [17] me ētahi atu kua rongoatia e LCP ngā take 32 o ngā whati tibial distal, tae atu ki te 29 ngā take o te mamae o te medial malleolus. Ko te take he nui rawa te rahi o te pereti, he kore tika rānei te whakanoho o ngā pereti, ā, he angiangi ake te kiko ngohengohe i te medial malleolus, nō reira ka kore e pai te noho o ngā tūroro ina mau ana ngā tūroro i ngā pūtu teitei me te pēhi i te kiri. Ko te rongo pai ko te pereti metaphyseal distal hou i hangaia e Synthes he angiangi, he piri ki te mata o te wheua me ngā taha maeneene, ā, kua tino whakatau i tēnei raruraru.
4.5 Te Uauatanga ki te Tango i ngā Wiri Maukati:
He tino kaha te rauemi LCP, he hototahi ki te tinana tangata, he ngāwari ki te tākai mā te karu. I te tango, ka nui ake te uaua o te tango tuatahi i te karu. Ko tētahi atu take mō te uaua o te tango ko te whakakī rawa o ngā tīwiri raka, te pakaru rānei o te nati, e puta pinepine ana i te whakakapinga o te taputapu tirotiro tīwiri raka kua whakarērea ki te taputapu tirotiro-ake. Nō reira, me whakamahi te taputapu tirotiro hei tango i ngā tīwiri raka, kia taea ai te here tika i ngā miro tīwiri ki ngā miro pereti. [9] Me whakamahi he kī motuhake hei whakakī i ngā tīwiri, kia taea ai te whakahaere i te kaha o te kaha.
I runga ake i ngā mea katoa, hei pereti pēhi o te whanaketanga hou a AO, kua whakaratohia e te LCP tētahi kōwhiringa hou mō te maimoatanga pokanga hou o ngā whati. I te whakakotahitanga me te hangarau MIPO, ka tiakina e ngā whakakotahitanga LCP te rere o te toto ki ngā taha whati ki te whānuitanga nui, ka whakatairanga i te whakaora whati, ka whakaiti i te mōrearea o te mate me te whati anō, ka pupuri i te pumau o te whati, nō reira he whānui ngā tūmanakohanga tono mō te maimoatanga whati. Mai i te whakamahinga, kua whiwhi a LCP i ngā hua haumanu poto pai, engari kei te kitea anō hoki ētahi raruraru. Me whakamahere taipitopito i mua i te pokanga me te wheako haumanu whānui, ka whiriwhiri i ngā whakatikatika ā-roto me ngā hangarau tika i runga i ngā āhuatanga o ngā whati motuhake, ka piri ki ngā mātāpono taketake o te maimoatanga whati, ka whakamahi i ngā whakatikatika i roto i te huarahi tika me te paerewa, kia ārai i ngā raruraru me te whiwhi i ngā pānga rongoā tino pai.
Wā tuku: Pipiri-02-2022
