Kodi mukudziwa mbiri ya intramedullary nailing?

Kubwera kwa intramedullary msomali kunasintha kwambiri chithandizo cha kuthyoka kwa mafupa aatali. Ngakhale kuti lusoli linalipo kwa zaka mazana ambiri, silinakwaniritse zomwe zilipo panopa mpaka theka lachiwiri la zaka za m'ma 1900.

Njira yopita kuchipambano sinali yophweka nthawi zonse, popeza njirayo idakumana ndi kukayikira ndi kutsutsidwa ndi akatswiri ambiri m'zaka zoyambirira za zana la 20. Masiku ano, kudzera muzatsopano zazitsulo, njira zopangira opaleshoni ndi luso la fluoroscopic, misomali ya intramedullary yakhala muyezo wosamalira kusweka kwa mafupa aatali.

Kupita patsogolo kwa chidziwitso chaumunthu cha biomechanical kwapangitsa kuti mapangidwe amakono awa atheke. Kukhomerera kwamakono kwa intramedullary kumadziwika ndi kuchepa kwa matenda, mabala ochepa, kukhazikika bwino kwa fracture, komanso kuyenda kwachangu kwa odwala.

Ndemanga ya mbiriyakale yomwe inachitika m'nkhaniyi ikufuna kufotokoza mwachidule za kusintha kwa msomali wa intramedullary, kuwonetsa zochitika zake zofunika kwambiri, kuwonetsa nthawi ya kugwiritsidwa ntchito koyamba ndi kusinthika kotsatira kwa msomali wa intramedullary, ndikuwonetsa malo a msomali wa intramedullary mu orthopedics ndi traumatology yamakono (mwachitsanzo, Chithunzi 1).

Kubadwa kwa msomali wa intramedullary

Anthu a ku Aigupto akale ankagwiritsa ntchito chipangizo cha intramedullary chofanana ndi msomali. Chisamaliro chovutirapo cha fracture sichinali chotheka kukhalapo zaka zambiri zapitazo.

Komabe, chotsimikizirika nchakuti Aigupto akale anali ndi njira zazikulu zoumitsa mitembo zochokera ku chikhulupiriro chawo cha chiukiriro cha thupi pambuyo pa imfa.

Izi zinali choncho ndi amayi otchedwa Usermontu omwe anapezeka m'manda a Tutankhamun, pomwe msomali wa ulusi unayikidwa pakati pa femur ndi tibia kuti akhazikitse mgwirizano wa bondo (monga chithunzi 2).

Akatswiri ofukula zinthu zakale amalingalira kuti mummy mkati mwa sarcophagus sanali Usermontu iyemwini, koma munthu wina yemwe adalowedwa m'malo ndi achifwamba akale mu 600 BCE.

Zaka 2000 pambuyo pake, Bernardino de Sahagun, katswiri wa chikhalidwe cha anthu paulendo wa Hernando Cortes, adanena za kugwiritsidwa ntchito koyamba kwa misomali ya intramedullary mwa wodwala wamoyo ku Mexico.

Mu 1524, adawona dokotala wa opaleshoni wa mafupa a Aztec (wotchedwa 'Tezalo') akuchita osteotomy pogwiritsa ntchito mpeni wa obsidian ndikuyika ndodo ya utomoni mu medullary kuti akhazikike. Chifukwa cha kusowa kwa njira zokwanira zopangira opaleshoni ndi antiseptics, njirazi zinali ndi vuto lalikulu komanso chiwerengero cha imfa.

1800s: Njira Zoyamba

Chapakati pa zaka za m'ma 1800, magazini oyambirira azachipatala adanena za misomali ya intramedullary. Diefenbach, Langenbeck, Bardenheuer ndi madokotala ena olankhula Chijeremani akuti adagwiritsa ntchito misomali ya njovu m'mafupa aatali kuti athetse mafupa.

Panthawiyi, Nicholas Senn wa ku Chicago, wofufuza komanso dokotala wa opaleshoni wamagulu ankhondo, adayesa kuyesa kwa intramedullary fixation. Ankagwiritsa ntchito fupa la bovine lopangidwa ndi fupa la bovine ndikuliyika mu medulla kuti athetse 'pseudarthrosis' pambuyo pothyoka.

Mu 1886, Heinrich Bircher wa ku Switzerland adalongosola pamsonkhano wa opaleshoni kuikidwa kwa misomali ya njovu mu medulla kuti athandizidwe kwambiri ndi fractures zovuta (Chithunzi 3).

Zaka zingapo pambuyo pake, Themistocles Gluck ku Germany adapanga msomali woyamba wa njovu wa intramedullary wokhala ndi dzenje kumapeto kwa msomali, motero adayambitsa lingaliro lolumikizana koyamba.

Panthawi yomweyi, Julius Nicolaysen wochokera ku Norway anali woyamba kulemba za mfundo za biomechanical za intramedullary nailing of proximal femoral fractures. Anagogomezera kufunika kowonjezera kutalika kwa msomali wa intramedullary kuti apeze mwayi waukulu wa biomechanical ndi kupereka chitetezo pafupifupi fupa lonse.

Iye analinso woyamba kupereka lingaliro la proximal ndi distal msomali / fupa interlocking kuti apange static locking. Akatswiri ena amamuona ngati tate wa misomali ya intramedullary.

Pofika chapakati pa zaka za m’ma 1800, apainiya monga Ignaz Philipp Semmelweis ku Vienna ndi JosephLister ku Glasgow anali atayala maziko oletsa kubereka kwa opareshoni. Izi zinali zopambana kwambiri chifukwa zidalola kupanga njira zatsopano zopangira opaleshoni pansi pa aseptic.

1900s: Chisinthiko

Mu 1912, dokotala wa opaleshoni waku Britain Ernest Hay Groves anali dokotala woyamba kugwiritsa ntchito ndodo yolimba yachitsulo ngati msomali wa intramedullary ndipo anali mpainiya wa njira ya retrograde intramedullary misomali.

Anapeza chokumana nacho chake m’nthaŵi ya Nkhondo Yadziko I pamene anachiritsa odwala matenda a pseudarthrosis amene sanafune kuwadula manja ndi miyendo. Osati kokha kufotokoza njira yoyamba ya intramedullary nailing njira yomwe inalola osseointegration kupyolera mu zovuta zochepa, komanso anali ndi luso logwiritsa ntchito misomali ya intramedullary ndi misomali yaing'ono kuti akonze zophuka.

Anayesa ma implants opangidwa ndi aluminiyamu, magnesiamu ndi chitsulo ndipo adazindikira kufunika kwa biomechanics pakuchiritsa kwa fracture. Ngakhale zinali choncho, njira ya Ernest Hay Groves inali yodwala kwambiri ndipo chifukwa chake sinali yotchuka kwambiri ndi anthu a m'nthawi yake.

Mu 1931, Smith-Petersen, dokotala wa opaleshoni ya mafupa a ku America, anayambitsa zitsulo zamapiko zitatu zosapanga dzimbiri kuti azitha kuthyola khosi lachikazi la intra-articular capsule. Anapanga njira yotseguka yomwe incised anterior the third of the iliac crest, kulowa m'munda wogwirira ntchito m'mphepete mwa nsonga yotakata, kenaka adayikanso chophwanyikacho ndikugwiritsa ntchito chopondera kuti ayendetse zitsulo zosapanga dzimbiri pamutu wa chikazi (Chithunzi 4).

Chifukwa cha kupambana kwa mayesero a Smith-Petersen, madokotala ambiri ochita opaleshoni anayamba kuyesa zoikamo zitsulo za fractures. Sven Johansson anatulukira misomali yobowoka ya intramedullary mu 1932; luso lake lanzeru anagwiritsa ntchito singano kerfing kuti ankalola kulamulira radiologically motsogozedwa kulowetsa intramedullary msomali. Zida zaukadaulo zomwe adagwiritsa ntchito zikugwirabe ntchito mpaka pano.

Kupitilira gawo limodzi, Rush ndi mchimwene wake adayambitsa lingaliro la msomali wa intramedullary mu 1937.

Anagwiritsa ntchito msomali wopindika, wopindika wosapanga dzimbiri wa intramedullary ndipo anayesa kupanga intramedullary mfundo zitatu zokhazikika kuti athe kuthana ndi chizolowezi cha kusamuka kwa axial mozungulira fractureyo.

M'malingaliro awo, gawo la minofu yofewa yosasunthika limakhala ngati gulu lolimba lomwe limakana kupsinjika komwe kumapangidwa ndi msomali wopindika kale. Kumanga kwawo kunali kocheperako chifukwa cha zotanuka za zitsulo zosapanga dzimbiri, zomwe zinasintha msanga kuchoka ku zotanuka kupita ku pulasitiki. Zotsirizirazi zingayambitse kusamuka kwachiwiri komanso kuchira kwachilema.

Kuphatikiza apo, misomali ya intramedullary imakonda kutuluka pakhomo kapena kulowa m'mafupa owonongeka, kapena ngakhale kuphulika mkati mwa olowa. Komabe, katswiri wamaphunziro a ku Viennese Ender adapitiliza kugwiritsa ntchito njirayi ngati maziko a Ender school of fracture fixation ndipo ikugwiritsidwabe ntchito masiku ano pokonza zosweka za ana.

Msomali wa mafupa

Mu 1939, dokotala wa opaleshoni wa ku Germany Gerhard Küntscher, amene anasankhidwa ndi Nobel Prize, anapanga msomali wosapanga dzimbiri wa intramedullary misomali yochizira kuthyoka kwa tsinde lachikazi.

Küntscher ndi ena anauziridwa ndi zomangira zitsulo zosapanga dzimbiri za Smith-Petersen zomwe zimagwiritsidwa ntchito pochiza khosi lothyoka khosi lachikazi ndipo amakhulupirira kuti mfundo zomwezi zingagwiritsidwe ntchito pothyoka tsinde. Msomali wa intramedullary womwe adapanga poyamba udali wooneka ngati V m'mbali mwake ndi 7-10 mm m'mimba mwake.

Pambuyo pa maphunziro a cadaveric ndi zinyama, adapereka msomali wa intramedullary ndi njira ya opaleshoni pamsonkhano wa opaleshoni ku Berlin mu 1940. Poyamba, luso lake linanyozedwa ndi anzake a ku Germany, ngakhale kuti njira yake inadziwika pambuyo pa nkhondo yachiwiri ya padziko lonse.

Hippocrates (460-370 BC), dotolo wakale wachi Greek yemwe nthawi zambiri amatchedwa tate wamankhwala, nthawi ina adati, 'Iye amene akufuna kuchita opaleshoni ayenera kupita kunkhondo'; ndi mmenenso zinalili ndi Küntscher.

M’nthawi ya chipani cha Nazi, Küntscher ankagonekedwa m’chipatala cha ku Finland. Kumeneko, anatha kuchita opaleshoni odwala ndi akaidi ankhondo m’deralo. Anayambitsa lingaliro la misomali ya mafupa pogwiritsa ntchito njira yotsekedwa ndi yotseguka, motero.

M'njira yotsekedwa, adadutsa msomali wa intramedullary mu njira yowonjezera kupyolera mu trochanter yaikulu ndikuyiyika pa tebulo lobwezeretsa lomwe likugwiritsidwa ntchito ndi gulaye. Kuthyokako kumayikidwanso ndipo msomali umalowetsedwa mu ndege ziwiri pogwiritsa ntchito mutu wa fluoroscopy. Potseguka, msomali wa intramedullary umalowetsedwa kupyolera mu fracture mu medulla kupyolera muzitsulo pafupi ndi mzere wophulika.

Njira ya Küntscher inadziwika padziko lonse pambuyo pobweza akaidi ankhondo a mayiko Ogwirizana nawo.

Mwanjira imeneyi madokotala ochita opaleshoni a ku America ndi a ku Britain anadziŵa bwino msomali wa intramedullary wopangidwa ndi Küntscher ndipo anazindikira ubwino wake woonekeratu panthawiyi ya njira zochizira fracture.

M’kanthaŵi kochepa, madokotala ochita opaleshoni owonjezereka padziko lonse anayamba kutengera njira yake, ndipo msomali wa Küntscher unasintha kwambiri chithandizo cha thyoka mwa kuchepetsa nthaŵi ya kuchira kwa wodwalayo pafupifupi chaka chimodzi. Odwala omwe amayenera kukhala osasunthika kwa miyezi ingapo tsopano atha kusuntha m'masiku ochepa.

Mpaka pano, dokotala wa opaleshoni waku Germany amaonedwa kuti ndiye woyambitsa misomali ya intramedullary, ndipo ali ndi malo ofunikira kwambiri m'mbiri ya opaleshoni yowopsa.

Kukulitsa Msomali wa Intramedullary

Mu 1942, Fisher et al. poyamba anafotokoza kugwiritsa ntchito kubowola m'mafupa-wokulitsa kuonjezera malo olumikizana pakati pa msomali wa intramedullary ndi fupa komanso kupititsa patsogolo kukhazikika kwa fracture fixation.

Komabe, Küntscher adayambitsa kubowola kosinthika komwe kumagwiritsidwabe ntchito masiku ano ndipo kumathandizira kukonzanso kutalika kwa medulary ya tsinde la fupa kuti athandizire kuyika misomali yokulirapo ya intramedullary.

Poyambirira, kukonzanso kwa intramedullary kunapangidwa kuti kuwonjezere kwambiri malo okhudzana ndi fupa ndi msomali wa intramedullary kuti ukhale wokhazikika wa fracture ndi kuyenda mofulumira kwa odwala.

Monga tafotokozera Smith et al, 1 mm iliyonse ya kukula kwa medullary imawonjezera malo okhudzana ndi 38%. Izi zimathandiza kugwiritsa ntchito misomali yayikulu komanso yolimba ya intramedullary, kupititsa patsogolo kukhazikika kwa dongosolo la fracture fixation.

Komabe, ngakhale kuti msomali wa Küntscher intramedullary ndi kubowola kwake kosinthika kwa intramedullary reaming kunakhala chisankho choyenera cha chipangizo chamkati cha osteotomy, akatswiri adasiya kukondwera nacho kumapeto kwa zaka za m'ma 1960 mokomera mbale zomwe zidangopangidwa kumene za Arbeitsgemeinschaft für Osteosynthesefragen (AO).

1960s: Nyengo Zamdima

M'zaka za m'ma 1960, kukhomerera misomali mwapang'onopang'ono kunathetsedwa m'malo mwa kukonza mbale ndi zomata.

Ngakhale kuti njira ya Küntscher inayenda bwino, madokotala padziko lonse anaikana chifukwa cha zotsatira zoipa za pambuyo pa opaleshoni.

Kuphatikiza apo, madokotala ena ochita maopaleshoni anayamba kusiya njira zopangira ma radiation, monga fluoroscopy ya mutu, chifukwa madokotala adanyansidwa ndi zotsatira zoyipa zomwe zimayenderana ndi radiation. Kukula kwa misomali ya intramedullary sikunayime pamenepo, ngakhale kuti mgwirizano wapadziko lonse lapansi wagwiritsa ntchito mbale zowongolera mkati.

Küntscher, dokotala wa ku Germany, anazindikira ubwino wolumikizirana ndipo anapanga msomali wopingasa wooneka ngati cloverleaf, umene anautcha kuti 'msomali wotsekereza'. The Achilles chidendene cha intramedullary msomali mapangidwe a nthawi imeneyo anali kulephera kukhazikika fractures kwambiri comminuted kapena fractures amene anasamutsidwa mu ngodya zazikulu Njira yothetsera vutoli inali kugwiritsa ntchito zomangira zokhoma.

Njira yothetsera vutoli inali kukhazikika kwa msomali wa intramedullary ndi screw screw.

Mwanjira imeneyi, implant imatha kukana kupindika ndi mphamvu zopindika ndikupewa kufupikitsa miyendo. Pogwiritsa ntchito malingaliro osakanikirana ochokera kwa Küntscher, Klaus Klemm, ndi Wolf-Dieter Schellmann, msomali wa intramedullary unapangidwa kuti ukhale wolimba kwambiri pobowola zibowo zomangira mozungulira ndi distal mpaka msomali wa intramedullary, womwe unatsekeredwa ku screw yomwe idayikidwa.

M'zaka zingapo zotsatira, kupita patsogolo kwa chithunzithunzi cha fluoroscopic kunalola kusankhidwanso kwa kutsekedwa kwa fracture ndi njira zochepetsera.

1970s ndi 1980s: Chitsitsimutso

M'zaka za m'ma 1970, chidwi cha misomali ya intramedullary ya dokotala wa opaleshoni wa ku Germany Küntscher chinali chachikulu.

Kuchepetsa kutsekedwa kwa misomali ya intramedullary kwa fractures, ndi mphambano yake ya kusinthika kwa reming ndi malingaliro osakanikirana komanso kumveka bwino kwa njira za fluoroscopic, zinayendetsa patsogolo ndi kufalitsa njira yabwino kwambiri ya opaleshoniyi, yodziwika ndi kuwonongeka kochepa kwa minofu yofewa, kukhazikika kwabwino, komanso kuyenda kwachangu kwa odwala.

Panthawiyo, dziko la maphunziro linasesedwa muzinthu zatsopano zomwe zinayendetsa chitukuko cha m'badwo wachiwiri wa misomali ya intramedullary.

Mu 1976, Grosse ndi Kempf adapanga msomali wotsekeka pang'ono kuti athetse vuto la zotanuka za msomali wa intramedullary. Msomali wa intramedullary sunalowedwe m'dera loyandikira ndipo unali ndi dzenje la misomali, lomwe linayikidwa pakona ya 45-degree kuonjezera mphamvu yokhazikika ya mkati mwa intramedullary misomali yokhazikika.

Zaka zingapo pambuyo pake, AO adalowa m'gulu la misomali ya intramedullary ndikupanga misomali yofanana ndi intramedullary (Chithunzi 5)

Mu 1984, Weinquist et al. anakonza njira yosinthira, yomwe inali yopititsa patsogolo machiritso a misomali yothyoka poika mabowo akuluakulu okhoma, kuchotsa zomangira zotsekera zokhazikika, ndikusintha mabowo otsekera kukhala mabowo ozungulira amisomali mwamapangidwe amakono.

Cholinga cha njira yosinthira ndikulimbikitsa machiritso a fracture komanso kupewa kusagwirizana kwa mafupa chifukwa cha ntchito mochedwa.

Pakalipano, intramedullary nailing dynamics yataya otsutsa ake ngati njira yodziyimira yokha ndipo pakali pano imagwiritsidwa ntchito ngati njira yotsika mtengo kusiyana ndi kukonzanso kwathunthu kwa dongosolo lokonzekera mkati pochiza fractures zopanda machiritso.

Mu kafukufuku wa biomechanical, Gimeno et al. linanena kuti kusintha zone pakati pa sanali slotted ndi slotted mbali ya intramedullary msomali kumabweretsa kupsinjika maganizo ndi kulephera opaleshoni ya implantation fixation mkati.

Pofuna kuthana ndi mavutowa, a Russell ndi Taylor et al. adapanga msomali woyamba wopanda slot, wosatambasuka mu 1986, ndi zotsatira zokhutiritsa.

Panthawi imeneyi, vuto la interlocking intramedullary misomali komanso anapitiriza patsogolo, ndipo monga tikudziwira lero, interlocking ndi wononga kudzera intramedullary msomali chisanadze mobowola dzenje anali mapangidwe Klemm ndi Schleman ku Germany. Kuyika kwa screw kungawongoleredwe ndi fluoroscopy yaulere, yomwe ingawonetse dokotalayo ku radiation yambiri.

Masiku ano, vutoli lathetsedwa ndi njira yolondolera ya distal yomwe imaphatikizapo ukadaulo wotsata ma elekitirodi, ukadaulo wotsogozedwa ndi fluoroscopically freehand, komanso kalozera wolondola woyika misomali.

1990s: Titanium intramedullary msomali

M'zaka khumi zotsatira, msomali wa Russel-Taylor wa intramedullary unakhala wotchuka kwambiri m'magulu a mafupa a padziko lonse. Muyezo wa chisamaliro pang'onopang'ono unakhala misomali ya intramedullary ndi kutseka kwa static kwa zomangira, monga momwe zasonyezedwera ndi zotsatira za kafukufuku wa Brumback et al.

Mu phunziro lomwe likuyembekezeka, zotsatira zake zikuwonetsa kuti kutseka kumatulutsa zotsatira zabwino nthawi zambiri ndipo sikunagwirizane ndi kusagwirizana kwa fracture.

Kupita patsogolo kwazitsulo kunapangitsa kuti misomali ya titaniyamu intramedullary ituluke, yomwe imagwiritsidwa ntchito kwambiri m'makampani azachipatala chifukwa cha mphamvu zawo, kukana kwa dzimbiri komanso kuyanjana kwachilengedwe.

Alta intramedullary nailing system inali yoyamba kupezeka titanium intramedullary msomali, ndipo yalandiridwa kwambiri ndi azachipatala chifukwa cha makina a titaniyamu, omwe ndi chitsulo champhamvu koma chochepa kwambiri kuposa chitsulo chosapanga dzimbiri.

Komabe, mabuku omwe alipo tsopano akukayikira ngati titaniyamu ndi chinthu choyenera kwambiri chokonzekera mkati kuposa chitsulo chosapanga dzimbiri, makamaka chifukwa cha kuchuluka kwa ndalama zomwe zimagwiritsidwa ntchito pogwiritsa ntchito titaniyamu.

Komabe, zabwino zina za titaniyamu, monga zotanuka modulus pafupi ndi fupa la cortical ndi kufananiza kwa maginito a resonance imaging, zimapangitsa kuti ikhale yokongola.

Kuphatikiza apo, titaniyamu ndi njira yokongola kwambiri ikafunika misomali yaying'ono ya intramedullary.

Zochitika Zamakono

Pambuyo pakuchita bwino komanso kulephera kwazaka makumi angapo zapitazi, madokotala ochita opaleshoni ya mafupa amakhala ndi chidziwitso chochulukirapo pakukhomerera kwa intramedullary.

Kukonzekera kwa msomali wa intramedullary wa femoral, tibial ndi humeral fractures wakhala muyezo wa chisamaliro cha fractures zambiri zotsekedwa ndi zina zotseguka. Njira zatsopano zowunikira komanso zoyikapo zapangitsa kuti njirayi ikhale yosavuta komanso yopangikanso ngakhale kwa maopaleshoni osadziwa zambiri.

Zomwe zachitika posachedwa zikuwonetsa kuti titaniyamu ndi zitsulo zosapanga dzimbiri zimakhala ndi elasticity yayikulu kwambiri ndipo kupsinjika kumalepheretsa kupsinjika komwe kumafunikira kuti mafupa achiritsidwe. Zatsopano za biomatadium monga ma aloyi a magnesium, ma aloyi okumbukira mawonekedwe ndi zida zotha kubwezanso zikuyesedwa kumaphunziro.

Misomali ya intramedullary yopangidwa ndi ma polima osalekeza a carbon fiber-reinforced modulus yotanuka komanso kutopa kwakukulu kulipo. Magnesium alloys ali ndi modulus of elasticity yofanana ndi ya cortical bone ndipo amatha kuwonongeka.

Maphunziro aposachedwa a Li et al. asonyeza ubwino waukulu pochiza matenda a osteoporotic fractures m'zitsanzo za nyama zomwe zimagwirizanitsidwa ndi kuphatikiza kwa magnesium ndi zoledronate zokutira pofuna kukonza fracture, njira yomwe ingakhale yochiza matenda a osteoporotic fractures m'tsogolomu.

Mapeto

Kwa zaka zambiri, ndi kusintha kwakukulu kwa mapangidwe a misomali ya intramedullary, njira zachitsulo, ndi njira zopangira opaleshoni, misomali ya intramedullary yakhala njira yamakono yosamalira mafupa aatali aatali ndipo ndi njira yabwino, yochepetsera pang'ono, komanso yobereka.

Komabe, chifukwa cha misomali yambiri ya intramedullary, pali zambiri zomwe zikusowa zokhudzana ndi zotsatira za postoperative. Kafukufuku wochulukirapo akufunika kuti adziwe kukula kwamtundu wa msomali wa intramedullary, mawonekedwe ndi utali wopindika.

Tikuneneratu kuti zatsopano pazachilengedwe zidzayambitsa kuwonekera kwa misomali yatsopano ya intramedullary.

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Za CZMEDITECH , tili ndi mzere wathunthu wazopanga za opareshoni ya mafupa ndi zida zofananira, zinthu kuphatikiza implants za msana, misomali ya intramedullary, trauma plate, mbale yotsekera, cranial-maxillofacial, prosthesis, zida zamagetsi, okonza kunja, arthroscopy, chisamaliro cha ziweto ndi zida zawo zothandizira.

Kuphatikiza apo, tadzipereka kupitiliza kupanga zinthu zatsopano ndikukulitsa mizere yazogulitsa, kuti tikwaniritse zosowa za maopaleshoni a madokotala ndi odwala ambiri, ndikupangitsanso kampani yathu kukhala yopikisana pamakampani onse apadziko lonse oyika mafupa ndi zida zamagetsi.

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