ʻO ka haʻi ʻana o ka clavicle

ʻO ka nui o nā haʻihaʻi clavicle he 30-60 no 100,000 poʻe, me ka lakio kāne a me ka wahine ma kahi o 2: 1, helu no 5% a 10% o nā haki āpau a me 44% o nā ʻeha hui poʻohiwi. ʻO ka clavicle ka iwi mua loa e hana i ka ossification i loko o ke kino o ke kanaka, a hoʻomaka kona ossification i ka lima o ka pule o ke ola ʻōpiopio, a ʻo ia wale nō ka iwi tubular lōʻihi e ossifies ma o ka intramembranous osteogenesis. Aia ke kikowaena ossification primitive ma waenakonu o ka clavicle a nona ke kuleana no ka ulu ʻana o ka clavicle a hiki i 5 mau makahiki. Ke ulu nei ka pā epiphyseal ma kēlā me kēia ʻaoʻao o loko a me waho o ka clavicle, akā pinepine ʻo ke kikowaena ossification medial wale nō ke ʻike ʻia e ka x-ray. ʻO ka medial epiphyseal plate ke kuleana no ka 80% o ka lōʻihi o ka ulu ʻana o ka clavicle, a ʻaʻole hoʻomaka kona kikowaena ossification a hiki i ka 13 a hiki i ka 19 makahiki, a ʻaʻole ia e hui pū me ka clavicle a hiki i ka 22 a 25 mau makahiki. No laila, i kaʻikeʻana i ka dislocation sternoclavicular i nā maʻi'ōpiopio, he mea nui e hoʻokaʻawale iā ia mai kaʻeha medial clavicular epiphyseal.

Hana Anatomy

Aneane pololei ka clavicle ke nanaia ma ke alo, aka, he ano S ke nana aku maluna, e huli ana ma ke kua a ma ka aoao waena i ka aoao ventral. Hoʻololi kona ʻāpana keʻa ma ke koʻi lōʻihi, me ka 1/3 o waho i palahalaha e hoʻokipa i ka ʻiʻo a me ka huki ligament; lilo ka waena 1/3 i tubular, me ke anawaena hoemi a me ka cortex manoanoa a me ka iwi oi aku mamua o ke koena, no ka hookipa ana i ke kaomi axial a me ka haalulu a no ka pale ana i na aalolo ma lalo iho; ʻO ka 1/3 i loko he rhombic a pili pū me ka sternum a me ka iwi ʻaoʻao mua e ka ʻiʻo ligamentous ikaika (Figure 1). Ua hōʻike ʻia nā haʻawina anatomical ʻoi aku ka nāwaliwali o ka clavicle ma muli o nā ʻano ʻano morphological ma waena a me waho 1/3. Eia kekahi, aia ma ka ʻaoʻao o ka puʻupuʻu subclavian a nele i ka pale o nā ligaments muscular, e lilo ia i wahi pilikia loa no ka haʻihaʻi ʻana, e like me ka mea i ʻike ʻia e nā ʻike lapaʻau.

Mechanism o ka eha

No ka haʻihaʻi clavicle i ka poʻe mākua, ua manaʻo mua ʻia ka hana maʻamau o ka hōʻeha ʻana no ka hāʻule ʻana me ka lima i ke kūlana hyperextended, akā ʻo Stanley et al. Uaʻikeʻia he 6.3% wale nō o nā haʻihaʻi waena waena a me 5.9% o nā haʻihaʻi clavicle distal, a ma nā maʻi a pau,ʻo ka hana maʻamau o kaʻeha mai nā mana pololei e hana ana ma ka hui poʻohiwi.

I ka hāʻule ʻana me ka pāma i ke kūlana hyperextended, ʻo ka haʻihaʻi pinepine ʻia ma muli o ka hopena o ka ikaika o waho i ka lua o ka hāʻule. ʻO kekahi ʻano haʻihaʻi ʻē aʻe ma muli o ka hoʻomāinoino ʻole ʻia ʻo ia ke hana ʻana o ka ikaika o waho ma ka poʻohiwi, e hoʻopā ai ka clavicle me ka iwi ʻaoʻao mua, a laila e hoʻokumu ʻia ai kahi haʻi spiral ma ka waena 1/3 o ka clavicle. Eia kekahi, me ka hana pinepine ʻana o nā ulia pōpilikia i nā makahiki i hala iho nei, ma muli o ka hopena ikaika o ka ulia kaʻa, ua hoʻokumu ke kāʻei noho i ka fulcrum o ka ikaika ma ka poʻohiwi, kahi e alakaʻi pinepine ai i kahi haʻi transverse a oblique paha i waena o ka clavicle, i kapa ʻia e nā kānaka he haʻihaʻi noho. Ma muli paha o ka ʻoi aku ka nui o ka ʻeha o ka ʻeha, ʻoi aku ka maʻalahi o kēia ʻano o ka haʻihaʻi i ka hui ʻole ʻana ma mua o ka haʻihaʻi maʻamau.

Lapaʻau

ʻO ka haʻihaʻi o ka waena waena:

Hoʻopaʻa maʻa: ʻO ka hoʻopaʻa ʻana i ka maʻi maʻi o nā ʻāpana clavicle ʻo ia ka ' kūlana gula '. Loaʻa i nā papa nā 3.5mm LC-DCP, 3.5mm mau papa hana hou, nā papa laka LCP, a me kekahi mau ʻano papa kūikawā. ʻO nā mea maikaʻi o nā splints, ʻo ia hoʻi: ka hoʻopaʻa ʻana i nā haʻihaʻi transverse; ka hoʻopaʻa ʻana i nā haʻihaʻi oblique a i ʻole nā ​​​​pepepepa me nā ʻili hoʻopaʻapaʻa i hui pū ʻia me nā splints neutralizing; ka mana pono o ka hoololi ana; hoʻopaʻa paʻa i ka haʻihaʻi no nā hana a ka mea maʻi i kēlā me kēia lā; a ʻo ka ʻoiaʻiʻo ʻaʻole pono e wehe ʻia nā splints (inā pono e wehe ʻia a hiki i ka 12 a 18 mau mahina ma hope o ka hana).

ʻO ka haʻi ʻana o ka clavicle mamao:

ʻO ka clavicle hook splint he ala hoʻoponopono pololei ʻole, ʻo nā mea maikaʻi e komo i ka maʻalahi o ka hoʻonohonoho ʻana i loko, ka mālama pono ʻana o ka repositioning, ʻaʻohe pilikia o ka hui acromioclavicular, a me ka paʻa o ka hoʻopaʻa ʻana i loko me ka ʻole o ka paheʻe ʻana i nā ʻiʻo a puni e like me ka pine kyphotic kahiko.

ʻO ka haʻi ʻana o ka clavicle proximal:

Hōʻike ka moʻolelo e ʻoi aku ka maikaʻi o ka mālama ʻole ʻana no kēia ʻano haʻi, me ka maʻa maʻa cervical-wrist. Hiki ke noʻonoʻo ʻia ka hoʻoponopono ʻana i loko inā loaʻa ka ʻeha o ke aʻalolo, a i ʻole ka haʻi ʻia ʻana ma hope o ka mea e pilikia ai ka mea maʻi i ka hanu ʻana a i ʻole ka ʻona ʻana, a inā ʻaʻohe mau hōʻailona like ʻole akā ke hōʻike nei ke kiʻi ʻana e pili ana ka haʻihaʻi i hoʻoneʻe ʻia i kahi hale koʻikoʻi hope a ʻaʻole pono ka hoʻonohonoho ʻana. Inā ʻaʻole hiki ke hoʻoponopono, hiki ke wehe ʻia ka clavicle proximal inā pono.

Nā pilikia

• ʻAʻole hoʻōla: Ua hōʻike ʻia nā palapala mua he 0.9% a hiki i ka 4% no ka haʻi ʻia ʻana o ka clavicle, a ua ʻike ʻia kahi noiʻi nui o ka hihia i ʻoi aku ka kiʻekiʻe ma mua o ka mea i manaʻo ʻia.

• Ho'ōla deformity: ʻO ka manaʻo kuʻuna ʻo ka ho'ōla deformity o ka clavicle he pilikia aesthetic wale nō a inā he hoʻōla ʻole ma hope o ke ʻoki ʻana, ʻoi aku ka maikaʻi o ka hopena ma mua o ka ʻae ʻana i ka deformity. Eia naʻe, ua hōʻike ʻia nā ʻike hou ʻana i ka pōkole o ka clavicle ma mua o 15 cm e alakaʻi pinepine ai i ka ʻeha a me ka palena o ka neʻe ʻana i ka wā hope. Eia kekahi, ua ʻōlelo kekahi poʻe loea i ka 'clavicle shaping' maʻalahi i ka mālama ʻana i ka ho'ōla deformity, akā ʻaʻole kūpono kēia ʻano. ʻO ka wehe wale ʻana i ka ʻōpala e puka mai ana e ʻoi aku ka lahilahi a hoʻonui i ka pilikia o ka haʻihaʻi ʻana, a no ka mea, ʻike ʻia ka deformity o ka clavicle i ʻekolu mau ana, ʻo ka 'smoothing' ʻo ka clavicle i ka mokulele ākea ʻaʻole ia e hoʻoponopono loa i ka deformity. No laila, ʻoi aku ka hilinaʻi e like me ka mālama ʻana i ka nonunion: ka wehe ʻana i ka ʻōpala iwi keu ma hope o ka ʻoki ʻana, ka hoʻokūpaʻa ʻana o ka hoʻoponopono kūloko a me ka grafting iwi hoʻokahi. ʻOiaʻiʻo, pono e hoʻomaopopo ʻia ka mea maʻi i ka pilikia o ka non-union ma mua o ke kaʻina.

• ʻO ka ʻeha aʻalolo: He haʻahaʻa ka ʻeha o ke aʻalolo ma hope o ka haʻi ʻana o ka clavicle i ka wā mua, a ʻaʻole maʻamau ka ʻeha lua ma muli o ka neʻe ʻana o ka haʻihaʻi ma muli o ka piʻi ʻana o ke aʻalolo vascular ma hope o ka haʻihaʻi ʻana, ʻoiai ma nā pae hope loa, hiki i ka ulu ʻana o nā ʻōpala iwi ke hōʻailona o ka hoʻopaʻa ʻana. Ke hana ʻia kēia, koi pinepine ʻia ka decompression ʻokiʻoki.

• ʻO ka maʻi ʻehaʻeha: ʻO ka maʻi ʻeha ma hope o ka haʻi ʻana o ka clavicle e ulu ana i ka hui acromioclavicular ma hope o ka haʻi ʻana o ka 1/3 o waho o ka clavicle, ma muli o ka luku ʻia ʻana o kēia hui e ka hana ʻino i ka manawa o ka trauma, a ʻo kekahi hapa ma muli o ka haʻi e pili ana i ka ʻili articular. Inā maikaʻi ʻole ka pani ʻana, pono e hoʻokaʻawale ʻia ka distal 1 cm o ka clavicle, a pono e mālama i ka mālama intraoperative e pale i ka ligament rostral-clavicular.

  
  

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