Clavicle fracture

Chiitiko che clavicle fractures ndeye 30-60 pa 100,000 vanhu, vane chiyero chevarume nevakadzi chinenge 2: 1, inotora 5% kusvika 10% yezvose zvakaputsika uye 44% yekukuvara kwepafudzi. Iyo clavicle ndiro bhonzo rekutanga kuita ossification mumuviri wemunhu, uye kutsvedza kwaro kunotanga muvhiki yechishanu yehupenyu hwe embryo, uye ndiro chete bhonzo refu refu rinoputika kuburikidza ne intramembranous osteogenesis. Iyo primitive ossification centre iri pakati pe clavicle uye inokonzera kukura kwe clavicle kusvika kumakore mashanu. Kune epiphyseal plate inokura pane imwe neimwe yemukati uye kunze kwemagumo e clavicle, asi kazhinji chete iyo medial ossification centre inogona kuonekwa ne x-ray. Iyo yepakati epiphyseal plate inokonzera 80% yehurefu hwekukura kwe clavicle, uye nzvimbo yayo ye ossification kazhinji haisati yatanga kuonekwa kusvika pamakore gumi nematatu kusvika kumakore gumi nemapfumbamwe, uye haisanganisi ne clavicle kusvika 22 kusvika kumakore makumi maviri nemashanu. Nokudaro, kana uchiongorora sternoclavicular dislocation muvarwere vaduku, zvakakosha kuti uzviparadzanise kubva kune medial clavicular epiphyseal kukuvara.

Functional Anatomy

Iyo clavicle inenge yakatwasuka kana ichitariswa nechekumberi, asi ine S-yakaita kana ichitariswa pamusoro, yakakombamira kumashure uye nepakati kudivi remukati. Muchinjikwa-chikamu chayo chinoshanduka pamwe chete neakisi refu, nekunze 1/3 yakatsetseka kuti igare musuru uye ligament kudhonza; iyo yepakati 1/3 inova tubular, ine dhayamita yakaderedzwa uye gobvu cortex uye denser bone kupfuura mamwe, kugadzirisa axial pressure uye tension uye kudzivirira tsinga dzevascular pasi payo; iyo yemukati 1/3 ine rhombic uye inosanganiswa ne sternum uye mbabvu yekutanga neine simba ligamentous tissue (Mufananidzo 1). Zvidzidzo zveAnatomical zvakaratidza kuti clavicle haina kusimba pano nekuda kwekusiyana kwe morphological pakati nekunze 1/3. Mukuwedzera, iyo inowanikwa nechemberi kune subclavian muscle kumira uye inoshaya kuchengetedzwa kwemascular ligaments, zvichiita kuti ive nzvimbo inonyanya kunetseka yekuputsika, sezvinoratidzwa nekliniki yekucherechedza.

Nzira yekukuvara

Pakuputsika kweclavicle muvanhu vakuru, nzira yakajairika yekukuvadza kwekuputika kweclavicle yaimbofungidzirwa kuva mugumisiro wekudonha neruoko munzvimbo ye hyperextended, asi Stanley et al. akawana kuti iyi nzira yekukuvara yakaverengera chete 6.3% yepakati-clavicle fractures uye 5.9% ye distal clavicle fractures, uye kune varwere vose, nzira yakajairika yekukuvadza yakabva kumasimba akananga anobata pamapfudzi akabatanidzwa Nzira yakajairika yekukuvadza muvarwere vose isimba rakananga pamapfudzi epafudzi, kazhinji pasina kusununguka kwakanyanya kana nekungobva kune unyoro chete.

Muchiitiko chekudonha nechanza mu hyperextended position, kuputsika kunowanzokonzerwa nekukanganiswa kwesimba rekunze kwechipiri kusvika pakudonha. Imwe mhando yekutyoka nekuda kwemhirizhonga isina kunanga ndeye apo simba rekunze rinoshanda pabendekete, zvichiita kuti clavicle ibatane nembabvu yekutanga, zvichikonzera kuumbwa kwekutsemuka kwemhepo pakati pe 1/3 ye clavicle. Mukuwedzera, nekuwanzoitika kwetsaona dzemotokari mumakore achangopfuura, nekuda kwesimba rakasimba mutsaona yemotokari, bhanhire rechigaro rinoumba fulcrum yesimba mufudzi, izvo zvinowanzoita kuti pave nekuputsika kwepakati kana oblique pakati pe clavicle, iyo vanhu vanodana kuti bhanhire rechigaro rakaputsika. Zvichida nokuti chisimba chekutambudzika chinowanzova chikuru, rudzi urwu rwekuputsika kunowanzoita kune vasiri kubatana kupfuura kunowanzoitwa clavicle fracture.

Kurapa

Kuputsika kwepakati clavicle:

Kugadziriswa kweSplint: Kugadziriswa kwe clavicle fractures ichiri 'yegoridhe standard'. Plates anosanganisira iyo 3.5mm LC-DCP, 3.5mm mahwendefa ekuvakazve, LCP yekukiya mahwendefa, uye mamwe akakosha mahwendefa. Zvakanakira splints zvinosanganisira: compression of transverse fractures; kugadzirisa kwe oblique kana butterfly fractures ine tension screws yakasanganiswa ne neutralizing splints; kudzora kunoshanda kwekutenderera; kugadziriswa kwakachengeteka kwekuputsika kwezviitiko zvezuva nezuva zvemurwere; uye chokwadi chekuti splints kazhinji hazvidi kubviswa (kana zvichifanira kubviswa kusvika 12 kusvika 18 mwedzi mushure mekushanda).

Distal clavicle fracture:

Iyo clavicle hook splint inzira isina kunanga yekugadzirisa, zvakanakira izvo zvinosanganisira kuiswa nyore kweiyo mukati mekugadzirisa, kunyatsogadzirisa kugadzirisa, kusakanganiswa kweiyo acromioclavicular joint, uye kugadzikana kwakagadzikana kwemukati kugadzirisa pasina kutsvedza mukati mematishu akapoteredzwa sekunge neyakajairwa kyphotic pin.

Proximal clavicle fracture:

Mabhuku anoshuma kuti kurapwa kusiri kushanda kunosarudzwa kune rudzi urwu rwekutyoka, necervical-wrist sling braking. Incisional internal fixation inogona kuonekwa kana pane kukuvara kwetsinga yevascular, kana kana kuputsika kwacho kuchibviswa shure kwekuita kuti murwere ave nechinetso chekufema kana kumedza, kana kana pasina zviratidzo zvakadaro asi kufungidzira kunoratidza kuti kuputsika kwakadzingwa kuri kukanganisa pane zvakakosha shure kwekugadzirisa uye kuti kugadzirisa hakubatsiri. Kana kugadzirisa kusingagoneki, iyo proximal clavicle inogona kubviswa kana zvichidikanwa.

Matambudziko

• Hapana kuporeswa:Mabhuku apfuura akashuma kusapora kwe 0.9% kusvika 4% yekutyoka kweclavicle, uye ongororo ichangobva kuitika yakawanda yakawana kuti mwero chaiwo usiri wekupora wakakwira zvakanyanya kupfuura zvaungatarisira.

• Kuporeswa kwekuremara: Maonero echinyakare ndeokuti kuremara kupora kweclavicle idambudziko rekunaka uye kuti kana pasina kuporeswa mushure mekuvhiyiwa, mhedzisiro iri nani pane kubvumira kuremara kuvepo. Zvisinei, kuongorora kwemazuva ano kwakaratidza kuti kupfupisa kwe clavicle inopfuura 15 cm kunowanzotungamirira kumarwadzo uye kuderedzwa kwekufamba munguva yekupedzisira. Pamusoro pezvo, dzimwe nyanzvi dzakaronga 'clavicle shaping' iri nyore mukurapa kuremara, asi nzira iyi haifanirwe. Kubvisa chete ganga rakabudikira kunogona kuita kuti chikwambo chitete uye chiwedzere zvakanyanya njodzi yekutyoka, uye sezvo kuremara kwegomba kuchiratidzwa mumativi matatu, 'inotsvedza' iyo clavicle mundege yakachinjika chete haizogadzirise zvachose kuremara. Nokudaro, imwe nzira inovimbika yakafanana nekurapa kwezvisina-nonunion: kubviswa kwekuwedzerwa kwepfupa scab zvakanyanya sezvinobvira mushure mekucheka, kugadzikana kwekugadzirisa kwemukati uye imwe-nhanho pfupa grafting. Zvechokwadi, murwere anofanira kuziviswa nezvenjodzi yekusabatanidzwa asati avhiyiwa.

• Vascular nerve injury: Mukana wekukuvara kwetsinga yevascular mushure mekuputsika kweclavicle yakaderera mumatanho ekutanga, uye kukuvara kwechipiri hakuwanzo kuitika nekuda kwekusimuka kwekutyoka nekuda kwekuwedzera kwevascular nerve space mushure mekutyoka, nepo mumatanho ekupedzisira, kukura kwebhonzo scabs kunogona kukonzera zviratidzo zvekupinzwa. Kana izvi zvangoitika, decompression yekuvhiya inowanzodiwa.

• Traumatic arthritis: Traumatic arthritis mushure mekuputsika kweclavicle kunowanzo kuitika mujojo ye acromioclavicular mushure mekuputsika kwekunze kwe 1/3 ye clavicle, kunyanya nekuda kwekuparadzwa kwejoini iri nechisimba panguva yekushungurudzika, uye pamwe nekuda kwekuputsika kunosanganisira articular surface. Kana kuvhara kusingabatsiri, iyo distal 1 cm ye clavicle inofanira kugadziriswa, uye intraoperative kutarisirwa kunofanira kutorwa kuchengetedza rostral-clavicular ligament.

  
  

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