Impamvu n'ingamba zo kunanirwa gufunga icyapa

Nkumuti wimbere, isahani yo guhunika yamye igira uruhare runini mukuvura kuvunika.Mu myaka yashize, igitekerezo cya osteosynthesis ntoya cyane cyarasobanutse kandi kirashyirwa mubikorwa, buhoro buhoro kiva mubyibanze byibanze kumashini yimashini zikosora imbere hibandwa ku gutunganya ibinyabuzima, bitibanda gusa ku kurinda amagufwa n’amaraso yoroheje, ariko iteza imbere kandi iterambere mubuhanga bwo kubaga no gutunganya imbere.Gufunga Isahani. PC-Gukosora) hamwe na sisitemu yo gutuza cyane (LISS).Sisitemu yatangiye gukoreshwa mubuvuzi muri Gicurasi 2000, yari imaze kugera ku ngaruka nziza z’amavuriro, kandi raporo nyinshi zatanze isuzuma ryinshi kuri yo.Nubwo hari ibyiza byinshi mugukosora kuvunika, ifite byinshi bisabwa mubuhanga n'uburambe.Niba idakoreshejwe nabi, irashobora kutabyara umusaruro, kandi bikavamo ingaruka zidasubirwaho.

1. Amahame ya biomehanike, Igishushanyo ninyungu za LCP
Guhagarara kw'icyuma gisanzwe gishingiye ku guterana hagati y'isahani n'amagufwa.Imigozi isabwa gukomera.Imigozi imaze kurekura, guterana hagati yisahani nigufwa bizagabanuka, ituze naryo rizagabanuka, bikaviramo kunanirwa gukosora imbere.LCPni isahani nshyashya imbere imbere yoroheje, itunganijwe muguhuza isahani ya compression hamwe ninkunga.Ihame ryaryo ryo gukosora ntabwo rishingiye ku guterana hagati yisahani na cortex yamagufwa, ahubwo rishingiye kumurongo uhagaze hagati yisahani no gufunga hamwe nimbaraga zifata hagati yimigozi na cortex yamagufa, kugirango tumenye gukosorwa.Inyungu itaziguye iri mukugabanya kwivanga kwamaraso ya periosteal.Inguni ihamye hagati yisahani hamwe ninsinga byateje imbere cyane imbaraga zo gufata imigozi, bityo imbaraga zo gukosora isahani nini cyane, ikoreshwa kumagufa atandukanye.[4-7]

Umwihariko wihariye wa LCP ni "guhuza umwobo", uhuza imyobo yo kwikuramo imbaraga (DCU) hamwe nu mwobo wuzuye.DCU irashobora gutahura axial ikoresheje imigozi isanzwe, cyangwa kuvunika kwimuwe birashobora guhagarikwa no gukosorwa hakoreshejwe umugozi wa lag;umwobo wa conical ufite urudodo rufite insinga, zishobora gufunga umugozi hamwe nimbuto zometse kumutwe, kwimura itara hagati ya screw na plaque, kandi guhangayika birebire birashobora kwimurwa kuruhande.Mubyongeyeho, gutema ibiti byashushanyije munsi yisahani, bigabanya aho uhurira namagufwa.

Muri make, ifite ibyiza byinshi hejuru yamasahani gakondo: izes ituza inguni: inguni iri hagati yimisumari irahagaze kandi ihamye, ikora neza kumagufa atandukanye;Kugabanya ibyago byo gutakaza igihombo: nta mpamvu yo gukora neza mbere yo kunama ku masahani, kugabanya ingaruka zo gutakaza icyiciro cya mbere cyo kugabanuka nicyiciro cya kabiri cyo gutakaza;.④ ifite kamere nziza ifata: irakoreshwa cyane cyane kumagufa ya osteoporose yamenetse, bigabanya ibyago byo kurekura no gusohoka;⑤ yemerera gukora imyitozo hakiri kare;⑥ ifite intera nini ya porogaramu: ubwoko bwa plaque nuburebure biruzuye, anatomical pre-shusho ni nziza, ishobora kumenya gukosora ibice bitandukanye nubwoko butandukanye bwavunitse.

2. Ibimenyetso bya LCP
LCP irashobora gukoreshwa haba nk'isahani isanzwe yo guhunika cyangwa nk'inkunga y'imbere.Umuganga abaga ashobora kandi guhuza byombi, kugirango yagure cyane ibimenyetso byayo kandi akoreshe muburyo butandukanye bwo kuvunika.
2.1 Ivunika ryoroshye rya Diaphysis cyangwa Metaphysis: niba kwangirika kwinyama zoroheje bidakabije kandi igufwa rifite ireme ryiza, kuvunika kworoheje kworoheje cyangwa kuvunika kugufi kwamagufwa maremare birasabwa gukata no kugabanuka neza, kandi uruhande rwavunitse rusaba kwikuramo imbaraga, bityo LCP irashobora gukoreshwa nkisahani yo guhunika hamwe nisahani cyangwa isahani yo kutabogama.
2.2 Ibice bivunaguye bya Diaphysis cyangwa Metaphyseal: LCP irashobora gukoreshwa nkicyapa cyikiraro, gifata kugabanya mu buryo butaziguye na osteosynthesis.Ntabwo isaba kugabanuka kwa anatomique, ariko igarura gusa uburebure bwigihimba, kuzenguruka hamwe nimbaraga zumurongo.Kuvunika kwa radiyo na ulna ni ibintu bidasanzwe, kubera ko imikorere yo guhinduranya amaboko biterwa ahanini na anatomiya isanzwe ya radiyo na ulna, bisa no kuvunika imbere.Byongeye kandi, kugabanya anatomique bigomba gukorwa, kandi bigomba gushyirwaho neza hamwe namasahani ..
2 gukira, kandi yemerera imyitozo ikora hakiri kare.Niba kuvunika kwa arctular bifite ingaruka kumagufa, LCP irashobora gukosoragufatanyahagati yo kugabanuka kwa articular na diaphysis.Kandi nta mpamvu yo gushiraho isahani mu kubaga, byagabanije igihe cyo kubaga.
2.4 Ubumwe bwatinze cyangwa Ubumwe.
2.5 Gufunga cyangwa gufungura Osteotomy.
2.6 Ntabwo bikurikizwa muguhuzaimisumarikuvunika, na LCP nubundi buryo bwiza bushoboka.Kurugero, LCP ntishobora gukoreshwa kuvunika kwangirika kwabana cyangwa ingimbi, abantu bafite imyanya ndangagitsina iragufi cyane cyangwa yagutse cyane cyangwa idakora neza.
2.7 Abarwayi ba Osteoporose: kubera ko cortex yamagufa yoroheje cyane, biragoye ko isahani gakondo ibona ituze ryizewe, ibyo bikaba byongereye ingorane zo kubagwa kuvunika, bikaviramo no kunanirwa bitewe no kurekura byoroshye no gusohoka nyuma yo gukosorwa.LCP ifunga imigozi hamwe na plaque ya plaque ikora inguni ihamye, kandi imisumari ya plaque irahujwe.Byongeye kandi, diameter ya mandrel ya feri yo gufunga ni nini, byongera imbaraga zo gufata igufwa.Kubwibyo, ikibazo cyo kurekura imigozi kiragabanuka neza.Imyitozo yumubiri hakiri kare iremewe nyuma yo kubagwa.Osteoporose ni ikimenyetso gikomeye cya LCP, kandi raporo nyinshi zayihaye kumenyekana cyane.
2.8 Ivunika rya Periprosthetic Femoral: kuvunika kwa periprosthetic femorale akenshi biherekejwe na osteoporose, indwara zishaje n'indwara zikomeye za sisitemu.Isahani gakondo irashobora gukomeretsa cyane, bigatera kwangirika kwamaraso kumeneka.Byongeye kandi, imiyoboro isanzwe isaba gukosorwa kabiri, bigatera kwangirika kwa sima, kandi imbaraga zo gufata osteoporose nazo ni mbi.Isahani ya LCP na LISS ikemura ibibazo nkibi muburyo bwiza.Nukuvuga ko, bakoresheje tekinoroji ya MIPO kugirango bagabanye ibikorwa bihuriweho, bagabanye ibyangiritse kumaraso, hanyuma umugozi umwe wo gufunga cortical urashobora gutanga umutekano uhagije, utazangiza ibyangiritse kuri sima.Ubu buryo bugaragazwa n'ubworoherane, igihe gito cyo gukora, kuva amaraso make, intera ntoya no koroshya kuvunika.Kubwibyo, kuvunika periprosthetic femorale nayo ni kimwe mubimenyetso bikomeye bya LCP.[1, 10, 11]

3. Ubuhanga bwo kubaga bujyanye no gukoresha LCP
3.1 Ikoranabuhanga rya Gakondo gakondo: nubwo igitekerezo cya AO gikosora imbere cyahindutse kandi amaraso yo kurinda amagufwa hamwe nuduce tworoshye ntabwo azirengagizwa bitewe no gushimangira gukabije kwimikorere yimikorere, uruhande rwacitse ruracyasaba kwikuramo kugirango ubone gukosorwa kuri bamwe kuvunika, nk'imvune zo mu nda-articular, gukosora osteotomy, byoroshye guhinduranya cyangwa kuvunika kugufi.Uburyo bwo kwikuramo ni: ① LCP ikoreshwa nk'isahani yo guhunika, ikoresheje imigozi ibiri isanzwe ya cortical kugirango ikosore ku buryo butandukanye ku gice cyo kunyerera ku isahani cyangwa gukoresha igikoresho cyo guhunika kugirango umenye gukosorwa;② nk'isahani yo gukingira, LCP ikoresha imigozi ya lag kugirango ikosore imvune ndende-ndende;③ mugukurikiza ihame ryumutwe, isahani ishyirwa kuruhande rwigufwa ryamagufwa, igomba gushyirwaho munsi yuburemere, kandi amagufwa ya cortique ashobora kubona compression;④ nk'isahani ya buttress, LCP ikoreshwa ifatanije nu mugozi wa lag kugirango ukosore ibice byavunitse.
3.2 Ikoranabuhanga ryo Kuringaniza Ikiraro: Icya mbere, fata uburyo bwo kugabanya mu buryo butaziguye kugirango usubire kuvunika, uzenguruke uturere twavunitse unyuze mu kiraro hanyuma ukosore impande zombi zavunitse.Kugabanya Anatomic ntabwo bisabwa, ariko bisaba gusa gukira uburebure bwa diaphysis, kuzunguruka n'umurongo w'imbaraga.Hagati aho, guhuza amagufwa birashobora gukorwa kugirango habeho Callus no guteza imbere gukira kuvunika.Nyamara, gukosora ikiraro birashobora gusa kugera kumurongo ugereranije, nyamara gukira kuvunika kugerwaho hifashishijwe guhamagarwa kabiri kubushake bwa kabiri, kubwibyo birakoreshwa gusa kuvunika.
3.3 Ikoranabuhanga ryibanze rya Osteosynthesis (MIPO) Ikoranabuhanga: Kuva mu myaka ya za 70, umuryango AO washyizeho amahame yo kuvura kuvunika: kugabanya anatomique, gukosora imbere, kurinda amaraso no gukora imyitozo itababaza hakiri kare.Amahame yamenyekanye cyane kwisi, kandi ingaruka zamavuriro ni nziza kuruta uburyo bwambere bwo kuvura.Ariko, kugirango ugabanye anatomic no gukosora imbere, akenshi bisaba gukomeretsa cyane, bigatuma kugabanuka kwamagufwa kugabanuka, kugabanuka kwamaraso kumeneka yamenetse kandi byongera ibyago byo kwandura.Mu myaka yashize, intiti zo mu gihugu ndetse no mu mahanga zita cyane kandi zigashimangira cyane ku ikoranabuhanga ryibasirwa cyane, ririnda amaraso y’inyama zoroheje n’amagufwa hagati aho guteza imbere igikosora imbere, ntikwambure periosteum nuduce tworoshye kuvunika. mpande, ntagahato kugabanya anatomique kugabanya ibice byavunitse.Kubwibyo, irinda ibidukikije byavunitse, aribyo biologiya osteosynthesis (BO).Mu myaka ya za 90, Krettek yatanze tekinoroji ya MIPO, ni intambwe nshya yo gukosora imvune mu myaka yashize.Igamije kurinda amaraso yo kurinda amagufwa nuduce tworoheje hamwe n’ibyangiritse byibuze ku rugero runini.Uburyo ni ukubaka umuyoboro wubutaka unyuze mugice gito, ugashyira amasahani, kandi ugakoresha uburyo bwo kugabanya butaziguye bwo kugabanya kuvunika no gukosora imbere.Inguni iri hagati ya plaque ya LCP irahagaze.Nubwo amasahani atamenya neza imiterere ya anatomique, kugabanya kuvunika birashobora gukomeza, bityo ibyiza byikoranabuhanga rya MIPO biragaragara cyane, kandi ni byiza gushira muburyo bwa tekinoroji ya MIPO.

4. Impamvu n'ingamba zo kunanirwa gusaba LCP
4.1 Kunanirwa gukosora imbere
Ibyatewe byose bifite irekura, kwimurwa, kuvunika nizindi ngaruka zo kunanirwa, ibyapa bifunga na LCP nabyo ntibisanzwe.Nk’uko raporo y’ubuvanganzo ibigaragaza, kunanirwa gukosora imbere ntibiterwa ahanini n’isahani ubwayo, ahubwo ni ukubera ko amahame shingiro yo kuvura imvune yarenze kubera gusobanukirwa no kumenya bidahagije byo gukosora LCP.
4.1.1.Ibyapa byatoranijwe ni bigufi cyane.Uburebure bw'isahani hamwe no kugabura ni ibintu by'ingenzi bigira ingaruka ku gukosorwa.Mbere yo kugaragara kwa tekinoroji ya IMIPO, amasahani magufi arashobora kugabanya uburebure bwo gutemagura no gutandukanya imyenda yoroshye.Isahani ngufi cyane izagabanya imbaraga za axial nimbaraga za torsion kumiterere ihamye muri rusange, bikaviramo kunanirwa gukosora imbere.Hamwe niterambere rya tekinoroji yo kugabanya mu buryo butaziguye hamwe n’ikoranabuhanga ritera cyane, amasahani maremare ntazongera kwangirika kwinyama zoroshye.Abaganga babaga bagomba guhitamo uburebure bwa plaque bakurikije ibinyabuzima byo kuvunika.Kubuvunika bworoshye, igipimo cyuburebure bwa plaque nziza nuburebure bwa zone yose yamenetse bigomba kuba hejuru yinshuro 8-10, mugihe kubuvunitse bwatangiye, iki kigereranyo kigomba kuba hejuru yinshuro 2-3.Isahani ifite uburebure burebure buhagije bizagabanya umutwaro wibisahani, birusheho kugabanya imitwaro ya screw, bityo bigabanye kunanirwa kwimbere yimbere.Ukurikije ibisubizo byisesengura ryibintu bya LCP, iyo ikinyuranyo hagati yimpande zavunitse ari 1mm, uruhande rwavunitse rusiga umwobo umwe wo guhagarika, guhangayikishwa nisahani yo kugabanuka bigabanya 10%, naho guhangayika kuri screw bigabanya 63%;iyo uruhande rwacitse rusize ibyobo bibiri, guhangayikishwa no gufata plaque bigabanya kugabanuka kwa 45%, naho guhangayikishwa na screw bigabanya 78%.Kubwibyo, kugirango wirinde guhangayikishwa cyane, kubuvunika bworoshye, hasigaye hasigaye imyobo 1-2 yegereye impande zavunitse, mugihe kubice byavunitse, hasabwa imiyoboro itatu kugirango ikoreshwe kuruhande rumwe kandi imigozi 2 igomba kwegera u kuvunika.
4.1.2 Ikinyuranyo kiri hagati yamasahani nubuso bwamagufwa birakabije.Iyo LCP yakoresheje tekinoroji yo gutunganya ikiraro, amasahani ntasabwa kuvugana na periosteum kugirango arinde amaraso ya zone yamenetse.Ni mubyiciro byo gukosora byoroshye, bitera imbaraga ya kabiri yo gukura kwa callus.Mu kwiga ituze ryibinyabuzima, Ahmad M, Nanda R [16] nabandi basanze iyo itandukaniro riri hagati ya LCP nubuso bwamagufwa rirenze 5mm, imbaraga za axial na torsion zisahani zigabanuka cyane;iyo icyuho kiri munsi ya 2mm, nta kugabanuka gukomeye.Kubwibyo, icyuho kirasabwa kuba munsi ya 2mm.
4.1.3 Isahani itandukana na diaphysis axis, kandi imigozi ntisanzwe kugirango ikosorwe.Iyo LCP ihujwe na tekinoroji ya MIPO, amasahani arasabwa kwinjiza percutaneous, kandi rimwe na rimwe biragoye kugenzura umwanya wa plaque.Niba igufwa ryamagufwa ntagereranywa na plaque axis, isahani ya kure irashobora gutandukana nigufwa ryamagufwa, byanze bikunze biganisha kumurongo wikurikiranya ryimigozi no gukosorwa gukomeye.[9,15].Birasabwa gufata incike ikwiye, kandi X-ray ikorwa nyuma yumwanya wo kuyobora urutoki rukwiye kandi gukosora pin ya Kuntscher.
4.1.4 Kunanirwa gukurikiza amahame shingiro yo kuvura kuvunika no guhitamo ikosora ryimbere imbere hamwe nikoranabuhanga ryo gukosora.Kuvunika kwimbere-articular, kuvunika kworoheje kwa diaphysis, LCP irashobora gukoreshwa nkisahani yo kwikuramo kugirango ikosore itajegajega ryuzuye hakoreshejwe ikoranabuhanga ryo guhonyora, kandi igateza imbere gukira kwambere kuvunika;kubice bya Metaphyseal cyangwa byavunitse, hagomba gukoreshwa tekinoroji yo gutunganya ikiraro, kwitondera itangwa ryamaraso yo kurinda amagufwa hamwe nuduce tworoheje, kwemerera gukosorwa gukomeye kuvunika, gutera imikurire ya callus kugirango igere ku gukira nubushake bwa kabiri.Ibinyuranye na byo, gukoresha tekinoroji yo gutunganya ikiraro mu kuvura imvune zoroheje zishobora gutera kuvunika kudahindagurika, bigatuma gukira kuvunika gutinda;17

4.1.5 Hitamo ubwoko bwimigozi idakwiye.LCP ihuza umwobo irashobora gukururwa muburyo bune bwimigozi: imiyoboro isanzwe ya cortical, imiyoboro isanzwe yamagufwa, amagufwa yo kwikuramo / kwikubita wenyine.Kwishiriraho / kwikuramo-imashini isanzwe ikoreshwa nk'imigozi imwe idasanzwe kugirango ikosore ibice bisanzwe bya diaphyseal amagufwa.Imisumari yacyo ifite igishushanyo mbonera, byoroshye kunyura muri cortex mubisanzwe bitabaye ngombwa gupima ubujyakuzimu.Niba diaphyseal pulp cavity ari ntoya cyane, ibinyomoro ntibishobora kuba bihuye neza na screw, kandi insinga ya screw ikora kuri cortex itandukanijwe, noneho ibyangiritse kuri cortex ihagaze neza bigira ingaruka kumbaraga zifata hagati yimigozi namagufwa, kandi imigozi yo kwikuramo kabiri. gukoreshwa muri iki gihe.Imiyoboro isukuye idasanzwe ifite imbaraga zo gufata amagufwa asanzwe, ariko igufwa rya osteoporose ubusanzwe rifite cortex idakomeye.Kubera ko igihe cyo gukora cya screw kigabanuka, umwanya wamaboko yo kurwanya imigozi yo kunama ugabanuka, ibyo bikaba byoroshye kuvamo imigozi yo guca amagufwa cortex, kurekura imigozi no kwimuka kwa kabiri.[18] Kuva imigozi ya bicortical yongereye uburebure bwimikorere ya screw, imbaraga zo gufata amagufwa nazo ziriyongera.Ikirenze byose, igufwa risanzwe rishobora gukoresha imiyoboro imwe kugirango ikosore, nyamara igufwa rya osteoporose rirasabwa gukoresha imigozi ya bicortical.Byongeye kandi, cortex yamagufa ya cortex iroroshye cyane, byoroshye gutera incike, bityo imigozi ya bicortical irakenewe kugirango ikosorwe mukuvura ibice byavutse.
4.1.6 Gukwirakwiza ibice ni byinshi cyangwa bike.Gukosora ibice birasabwa kubahiriza ibinyabuzima byavunitse.Ikwirakwizwa ryinshi rya screw bizavamo guhangayikishwa cyane no kuvunika imbere;imiyoboro mike cyane yamenetse nimbaraga zidahagije zo gukosora nabyo bizavamo kunanirwa gukosora imbere.Iyo tekinoroji yikiraro ikoreshwa mugukosora kuvunika, ibyifuzo bya screw bigomba kuba munsi ya 40% -50% cyangwa munsi yayo.[7,13,15] Kubwibyo, amasahani ni maremare ugereranije, kugirango yongere uburinganire bwabakanishi;Ibyobo 2-3 bigomba gusigara ku mpande zavunitse, kugira ngo isahani irusheho gukomera, irinde guhangayikishwa no kugabanya ibibazo byo kumeneka imbere [19].Gautier na Sommer [15] batekereje ko byibura imigozi ibiri idahwitse igomba gushyirwaho kumpande zombi zavunitse, umubare wiyongereye wa cortex ntuzagabanya igipimo cyatsinzwe, bityo byibuze imigozi itatu irasabwa kuregwa kumpande zombi. kuvunika.Nibura hasabwa imigozi 3-4 kumpande zombi za humerus no kuvunika amaboko, hagomba gutwarwa imitwaro myinshi ya torsion.
4.1.7 Ibikoresho byo gukosora bikoreshwa nabi, bikaviramo kunanirwa gukosora imbere.Sommer C]Impamvu nugutereranwa gukoresha ibikoresho byo gufunga ibikoresho byo kureba.Mubyukuri, umugozi wo gufunga hamwe nisahani ntabwo bihagaritse rwose, ariko byerekana dogere 50 zinguni.Igishushanyo kigamije kugabanya imihangayiko yo gufunga.Kureka gukoresha ibikoresho byo kureba birashobora guhindura imisumari bityo bigatera kwangirika kwimbaraga zo gukosora.Kääb [20] yari yakoze ubushakashatsi bwubushakashatsi, yasanze inguni iri hagati yimigozi na plaque ya LCP ari nini cyane, bityo imbaraga zo gufata imigozi zigabanuka cyane.
4.1.8 Ibipimisho bipima gupakira ni kare cyane.Raporo nziza cyane ziyobora abaganga benshi kwizera birenze urugero imbaraga zo gufunga amasahani hamwe n’imigozi kimwe no gukosora neza, baribeshya ko imbaraga zo gufunga amasahani zishobora kwihanganira uburemere bwuzuye bwuzuye, bikaviramo kuvunika amasahani cyangwa imigozi.Mugukoresha kuvunika ikiraro, LCP irahagaze neza, kandi irasabwa gukora callus kugirango tumenye gukira kubushake bwa kabiri.Niba abarwayi bava muburiri hakiri kare kandi bakaremerera uburemere bukabije, isahani hamwe na screw bizavunika cyangwa bidacomeka.Gufunga isahani ishimangira ibikorwa hakiri kare, ariko gupakira buhoro buhoro bizaba nyuma yibyumweru bitandatu, kandi firime ya x-ray yerekana ko uruhande rwacitse rugaragaza umuhamagaro ukomeye.[9]
4.2 Ibikomere bya Tendon na Neurovasculaire:
Ikoranabuhanga rya MIPO risaba kwinjizwamo percutaneous no gushyirwa munsi yimitsi, mugihe rero iyo hashyizweho imigozi ya plaque, abaganga ntibashobora kubona imiterere yubutaka, bityo ibyangiritse bikangirika bikabije.Van Hensbroek PB [21] yatangaje ikibazo cyo gukoresha ikoranabuhanga rya LISS kugirango akoreshe LCP, byaviriyemo tibial arteriire pseudoaneurysms.AI-Rashid M.Impamvu nyamukuru zibyangiritse ni iatrogenic.Iya mbere ni ibyangiritse bitaziguye bizanwa na screw cyangwa Kirschner pin.Iya kabiri ni ibyangiritse biterwa nintoki.Kandi icya gatatu ni ibyangiritse byubushyuhe biterwa no gucukura imashini yo kwikuramo.[9] Kubwibyo, kubaga basabwa kumenyera anatomiya ikikije, kwitondera kurinda nervus vascularis nizindi nzego zingenzi, bagakora byimazeyo gutandukana mugushira amaboko, bakirinda kwikuramo cyangwa gukurura imitsi.Byongeye kandi, mugihe ucukura imigozi yo kwikuramo, koresha amazi kugirango ugabanye umusaruro wubushyuhe kandi ugabanye ubushyuhe.
4.3 Indwara yo kubaga no kwanduza ibyapa:
LCP ni sisitemu yo gukosora imbere yabayeho nyuma yo guteza imbere igitekerezo cyibasirwa cyane, kigamije kugabanya ibyangiritse, kugabanya ubwandu, kudahuza nibindi bibazo.Kubaga, dukwiye kwita cyane cyane kurinda ingirabuzimafatizo zoroshye, cyane cyane ibice byintege nke byumubiri.Ugereranije na DCP, LCP ifite ubugari bunini n'ubugari bunini.Iyo ukoresheje tekinoroji ya MIPO kugirango ushiremo percutaneous cyangwa intramuscular, irashobora gutera ingirabuzimafatizo zoroshye cyangwa kwangirika kwa avulion kandi bigatera kwandura ibikomere.Phinit P [23] yatangaje ko sisitemu ya LISS imaze kuvura indwara 37 zavunitse za tibia zegeranye, kandi ko indwara zanduye nyuma yo kubagwa zigeze kuri 22%.Namazi H]Kubwibyo, mbere yimikorere, amahirwe nuwakosoye imbere agomba gutekerezwa nabi akurikije ibyangiritse byumubiri hamwe nurwego rugoye rwo kuvunika.
4.4 Indwara yo Kurakara Indwara ya Tissue yoroshye:
Phinit P [23] yatangaje ko sisitemu ya LISS yakemuye ibibazo 37 byavunitse bya tibia yegeranye, inshuro 4 zatewe no guterwa no kubyara nyuma yo kubagwa (ububabare bw’ibisahani byoroshye kandi bikikije amasahani), aho usanga amasahani 3 ari 5mm uvuye kuri igufwa ryamagufwa na dosiye 1 ni 10mm uvuye hejuru yamagufwa.Hasenboehler.E.Impamvu nuko ingano yisahani ari nini cyane cyangwa amasahani ashyizwe muburyo budakwiye kandi tissue yoroshye iba yoroheje kuri malleolus yo hagati, bityo abarwayi bakumva batamerewe neza mugihe abarwayi bambaye inkweto ndende kandi bagahindura uruhu.Amakuru meza nuko isahani ya metafhyseal ya kure yakozwe na Synthes yoroheje kandi ifatanye hejuru yamagufwa hamwe nimpande zoroshye, byakemuye neza iki kibazo.

4.5 Ingorane zo gukuraho imiyoboro ifunga:
Ibikoresho bya LCP bifite imbaraga nyinshi titanium, bifite aho bihurira cyane numubiri wumuntu, byoroshye gupakirwa na callus.Mugukuraho, kubanza gukuraho umuhamagaro biganisha kukibazo cyiyongera.Indi mpamvu yo gukuraho ingorane iri muburyo bukabije bwo gufunga imigozi yo gufunga cyangwa kwangirika kwimbuto, ubusanzwe biterwa no gusimbuza ibikoresho byo gufunga ibyuma byatereranywe nibikoresho byo kwireba.Kubwibyo, igikoresho cyo kureba kizakoreshwa mugukurikiza imigozi ifunga, kugirango imigozi ya screw ishobora guhuzwa neza nududodo twa plaque.[9] Umuyoboro wihariye urasabwa gukoreshwa mugukomeza imigozi, kugirango ugenzure ubunini bwimbaraga.
Ikirenze byose, nk'isahani yo kwikuramo iterambere rya AO igezweho, LCP yatanze uburyo bushya bwo kuvura kijyambere kubaga kuvunika.Hamwe na tekinoroji ya MIPO, LCP ikomatanya kubika amaraso kumpande zavunitse ku rugero runini, igatera gukira kuvunika, kugabanya ibyago byo kwandura no kongera kuvunika, ikomeza guhagarara neza, bityo ikaba ifite ibyifuzo byinshi byo kuvura kuvunika.Kuva wasabye, LCP yabonye ibisubizo byiza byigihe gito byubuvuzi, nyamara ibibazo bimwe na bimwe biragaragara.Kubaga bisaba igenamigambi rirambuye mbere yuburambe hamwe nuburambe bunini bwubuvuzi, hitamo ibikwiye byimbere hamwe nikoranabuhanga hashingiwe kumiterere yibice byavunitse, byubahiriza amahame shingiro yo kuvura kuvunika, ukoresha ibikosora muburyo bukwiye kandi busanzwe, kugirango wirinde ingorane no kubona ingaruka nziza zo kuvura.