Clavicle tawg

Qhov tshwm sim ntawm clavicle fractures yog 30-60 ib 100,000 tus neeg, nrog ib tug txiv neej thiab poj niam piv ntawm kwv yees li 2: 1, accounting rau 5% mus rau 10% ntawm tag nrho cov pob txha thiab 44% ntawm lub xub pwg leeg raug mob. Lub clavicle yog cov pob txha ntxov tshaj plaws kom tau txais ossification nyob rau hauv tib neeg lub cev, thiab nws ossification pib nyob rau hauv lub thib tsib lub lim tiam ntawm embryonic lub neej, thiab nws yog tib tug ntev tubular pob txha uas ossifies los ntawm txoj kev ntawm intramembranous osteogenesis. Lub hauv paus ossification chaw yog nyob rau hauv nruab nrab ntawm lub clavicle thiab yog lub luag hauj lwm rau kev loj hlob ntawm lub clavicle mus txog rau 5 xyoos. Muaj cov phaj epiphyseal loj hlob ntawm txhua sab hauv thiab sab nraud ntawm lub clavicle, tab sis feem ntau tsuas yog qhov chaw nruab nrab ossification tuaj yeem pom los ntawm x-ray. Qhov nruab nrab epiphyseal phaj yog lub luag haujlwm rau 80% ntawm qhov ntev ntawm kev loj hlob ntawm clavicle, thiab nws qhov chaw ossification feem ntau tsis pib tshwm sim txog 13 txog 19 xyoo, thiab nws tsis fuse nrog clavicle txog 22 txog 25 xyoo. Yog li ntawd, thaum kuaj mob sternoclavicular dislocation nyob rau hauv cov neeg mob hluas, nws yog ib qho tseem ceeb kom paub qhov txawv ntawm qhov nruab nrab clavicular epiphyseal raug mob.

Functional Anatomy

Lub clavicle yog kwv yees li ncaj nraim thaum saib anteriorly, tab sis yog S-puab thaum saib superior, curving dorsally thiab medially mus rau sab ventral. Nws hla ntu hloov pauv raws qhov ntev axis, nrog rau sab nrauv 1/3 flattened kom haum rau cov leeg thiab ligament rub; nruab nrab 1/3 ua tubular, nrog ib tug txo txoj kab uas hla thiab ib tug tuab cortex thiab denser pob txha tshaj li tus so, kom haum axial siab thiab nro thiab tiv thaiv cov hlab ntsha hauv qab nws; sab hauv 1/3 yog rhombic thiab yog txuam nrog sternum thiab thawj tav los ntawm cov ntaub so ntswg muaj zog (Daim duab 1). Cov kev tshawb fawb anatomical tau pom tias cov clavicle tsis muaj zog tshaj ntawm no vim yog qhov hloov pauv ntawm morphological hauv nruab nrab thiab sab nrauv 1/3. Tsis tas li ntawd, nws nyob rau sab nraud ntawm cov leeg subclavian nres thiab tsis muaj kev tiv thaiv ntawm cov leeg nqaij, ua rau nws qhov chaw muaj kev puas tsuaj rau pob txha, raws li pom los ntawm kev soj ntsuam soj ntsuam.

Mechanism ntawm kev raug mob

Rau clavicle fractures nyob rau hauv cov neeg laus, feem ntau cov mechanism ntawm kev raug mob rau clavicle fractures yav tas los xav tias yog los ntawm lub caij nplooj zeeg nrog tes nyob rau hauv lub hyperextended txoj hauj lwm, tab sis Stanley li al. pom tias qhov kev raug mob no suav nrog tsuas yog 6.3% ntawm cov pob txha pob txha hauv nruab nrab thiab 5.9% ntawm cov pob txha pob txha, thiab hauv txhua tus neeg mob, feem ntau cov txheej txheem ntawm kev raug mob yog los ntawm kev ncaj qha quab yuam ua rau lub xub pwg sib koom ua ke, feem ntau cov txheej txheem ntawm kev raug mob ntawm txhua tus neeg mob yog ncaj qha quab yuam ntawm lub xub pwg leeg, feem ntau tsis muaj kev hloov pauv loj lossis nrog kev hloov me me xwb.

Nyob rau hauv cov ntaub ntawv ntawm ntog nrog xibtes nyob rau hauv lub hyperextended txoj hauj lwm, qhov tawg yog feem ntau tshwm sim los ntawm kev cuam tshuam ntawm ib tug sab nraud quab yuam theem nrab mus rau lub caij nplooj zeeg. Lwm hom kev puas tsuaj vim yog kev ua phem tsis ncaj yog thaum lub zog sab nraud ua rau ntawm lub xub pwg nyom, ua rau cov clavicle cuam tshuam nrog thawj tus tav, uas ua rau tsim cov pob txha pob txha nyob hauv nruab nrab 1/3 ntawm lub clavicle. Tsis tas li ntawd, nrog kev tshwm sim ntau zaus ntawm kev sib tsoo hauv xyoo tas los no, vim muaj kev cuam tshuam loj hauv lub tsheb sib tsoo, lub rooj zaum siv lub zog ntawm lub xub pwg nyom, uas feem ntau ua rau muaj kev cuam tshuam los yog oblique puas nyob rau hauv nruab nrab ntawm lub clavicle, uas tib neeg hu ua lub rooj zaum txoj siv tawv puas. Tej zaum vim tias kev ua phem ntawm kev raug mob feem ntau yog ntau dua, hom pob txha no feem ntau ua rau tsis muaj kev sib koom ua ke ntau dua li cov pob txha pob txha li niaj zaus.

Kev kho mob

Fracture ntawm nruab nrab clavicle:

Splint fixation: Splint fixation ntawm clavicle fractures tseem yog 'tus qauv kub'. Cov phaj muaj xws li 3.5 hli LC-DCP, 3.5 hli reconstruction daim hlau, LCP xauv daim hlau, thiab ib co tshwj xeeb daim hlau. Qhov zoo ntawm splints muaj xws li: compression ntawm transverse puas; fixation ntawm oblique los yog npauj npaim tawg nrog nro screws ua ke nrog neutralizing splints; zoo tswj kev sib hloov; ruaj khov kho ntawm pob txha pob txha rau tus neeg mob cov dej num txhua hnub; thiab qhov tseeb tias cov pob txha feem ntau tsis tas yuav raug tshem tawm (yog tias lawv yuav tsum tau muab tshem tawm kom txog thaum 12 txog 18 lub hlis tom qab phais).

Distal clavicle tawg:

Lub clavicle nuv splint yog ib txoj kev kho tsis ncaj, qhov zoo ntawm qhov muaj xws li kev yooj yim ntawm kev kho sab hauv, kev kho kom raug ntau dua, tsis muaj kev cuam tshuam ntawm cov pob qij txha acromioclavicular, thiab cov txheeb ze ruaj khov ntawm kev txhim kho sab hauv yam tsis tau swb rau hauv cov ntaub so ntswg ib puag ncig xws li cov tsoos kyphotic tus pin.

Proximal clavicle tawg:

Cov ntaub ntawv tshaj tawm hais tias kev kho mob tsis zoo yog nyiam rau hom pob txha no, nrog rau lub ncauj tsev menyuam-ntxuav sling braking. Incisional internal fixation yuav raug txiav txim siab yog tias muaj cov hlab ntsha raug mob, lossis yog tias cov pob txha raug tshem tawm tom qab ua rau tus neeg mob ua pa nyuaj lossis nqos, lossis yog tias tsis muaj cov tsos mob zoo li no, tab sis cov duab qhia tau tias qhov tawg tawg yog cuam tshuam rau ntawm cov qauv tseem ceeb tom qab thiab qhov kev rov ua haujlwm tsis zoo. Yog tias kho tsis tau, qhov proximal clavicle tuaj yeem raug tshem tawm yog tias tsim nyog.

Teeb meem

• Tsis muaj kev kho mob: Cov ntaub ntawv yav dhau los tau qhia txog qhov tsis zoo ntawm 0.9% mus rau 4% rau cov pob txha pob txha, thiab cov ntaub ntawv tshawb fawb tsis ntev los no tau pom tias qhov tsis zoo ntawm qhov tseeb yog ntau dua li qhov xav tau.

• Kev kho deformity: Cov kev pom ib txwm muaj yog tias kev kho deformity ntawm clavicle tsuas yog qhov teeb meem zoo nkauj thiab yog tias tsis muaj kev kho mob tom qab phais, qhov tshwm sim zoo dua li tso cai rau qhov deformity nyob. Txawm li cas los xij, cov kev soj ntsuam tsis ntev los no tau pom tias qhov luv ntawm cov clavicle ntau dua 15 cm feem ntau ua rau mob thiab txwv kev txav mus rau theem kawg. Tsis tas li ntawd, qee cov kws tshawb fawb tau hais kom yooj yim 'clavicle shaping' hauv kev kho deformity kho, tab sis txoj kev no tsis pom zoo. Tshem tawm tsuas yog cov pob txha pob txha tuaj yeem ua rau cov clavicle thinner thiab ua rau muaj kev pheej hmoo ntawm pob txha, thiab vim tias qhov deformity ntawm clavicle tau tshwm sim nyob rau hauv peb qhov ntev, 'smoothing' clavicle nyob rau hauv kab rov tav dav hlau ib leeg yuav tsis kho qhov deformity. Yog li ntawd, ib qho kev txhim khu kev qha ntau dua yog zoo ib yam li kev kho mob ntawm nonunion: tshem tawm cov pob txha pob txha ntau npaum li sai tau tom qab txiav, stabilization ntawm sab hauv fixation thiab ib-theem pob txha grafting. Tau kawg, tus neeg mob yuav tsum tau ceeb toom txog kev pheej hmoo ntawm kev tsis sib haum xeeb ua ntej kev phais.

• Kev raug mob ntawm lub paj hlwb: Qhov tshwm sim ntawm cov hlab ntsha raug mob tom qab lub pob txha pob txha yog tsawg nyob rau theem pib, thiab qhov kev raug mob thib ob feem ntau tsis tshwm sim vim kev tawg ntawm cov pob txha vim tias qhov chaw vascular ntau ntxiv tom qab pob txha, thaum nyob rau theem lig, kev loj hlob ntawm cov pob txha pob txha yuav ua rau cov tsos mob ntawm kev nkag mus. Thaum qhov no tshwm sim, kev phais decompression feem ntau xav tau.

• Kev mob caj dab: Kev mob caj dab tom qab clavicle tawg zoo li tshwm sim hauv cov pob txha acromioclavicular tom qab tawg ntawm sab nrauv 1/3 ntawm lub clavicle, feem ntau yog vim kev puas tsuaj ntawm qhov kev sib koom tes los ntawm kev ua phem rau lub sijhawm ntawm kev raug mob, thiab ib feem yog vim qhov tawg ntawm cov pob qij txha. Yog tias kaw tsis tau zoo, qhov distal 1 cm ntawm lub clavicle yuav tsum tau muab tshem tawm, thiab kev kho mob yuav tsum tau coj los tiv thaiv cov ligament rostral-clavicular.

  
  

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