Ku tshoveka ka clavicle .

Ku humelela ka ku tshoveka ka clavicle i 30-60 eka 100,000 wa vanhu, na ratio ya xinuna kuya eka ya xisati ya kwalomu ka 2:1, leyi endlaka 5% kuya eka 10% wa ku tshoveka hinkwako na 44% wa ku vaviseka ka makatla. Clavicle i marhambu yosungula ku hundza eka ossification eka miri wa munhu, naswona ossification ya yona yisungula eka vhiki ra vuntlhanu ra vutomi bya embryo, naswona hi yona ntsena long tubular bone leyi ossifies hiku tirhisa intramembranous osteogenesis. Primitive Ossification Center yi kumeka exikarhi ka clavicle naswona yina vutihlamuleri eka kukula ka clavicle kuya fika eka 5 wa malembe hi vukhale. Kuna epiphyseal plate leyi kulaka eka yin’wana na yin’wana ya makumu ya le ndzeni nale handle ya clavicle, kambe hakanyingi i medial ossification center ntsena leyi nga voniwaka hi X-ray. Medil epiphyseal plate yina vutihlamuleri eka 80% wa kukula ka ku leha ka clavicle, naswona ossification center ya yona hi ntolovelo ayi sunguli ku humelela kufikela eka 13 kuya eka 19 wa malembe hi vukhale, naswona ayi hlangana na clavicle kufikela eka 22 kuya eka 25 wa malembe hi vukhale. Hikokwalaho, loko ku kumiwa sternoclavicular dislocation eka vavabyi lavatsongo, i swa nkoka ku yi hambanisa na ku vaviseka ka le xikarhi ka clavicular epiphyseal.

Anatomy leyi tirhaka .

Clavicle yiva yiri kwalomu ka straight loko yi langutiwa emahlweni, kambe yina xivumbeko xa S loko yi langutiwa hindlela ya le henhla, yi goveka dorsally na le xikarhi kuya eka tlhelo ra ventral. Xiphemu xa yona xo tsemakanya xa cinca kuya hi axis yo leha, laha 1/3 ya le handle yi phaphamaleke leswaku yi amukela ku koka ka misiha na ligament; 1/3 yale xikarhi yiva tubular, na diameter leyi hungutiweke xikan’we na cortex yo tiya na denser bone kutlula leswin’wana, ku amukela axial pressure na tension xikan’we naku sirhelela ti vascular nerves letinga ehansi ka yona; 1/3 yale ndzeni i rhombic naswona yi fambelanisiwa na sternum na rib yosungula hi tissue yo tiya ya ligamentous (Xifaniso 1). Mindzavisiso ya anatomical yi kombisile leswaku clavicle yi tsanile swinene laha hikokwalaho ka ku hambana ka xivumbeko eka 1/3 wa le handle na wa le handle. Ku engetela kwalano, yi kumeka lateral eka subclavian muscle stop naswona yi pfumala nsirhelelo wa ti muscular ligaments, leswi endlaka leswaku yiva ndzhawu leyi nga sirhelelekangiki ngopfu eka ku tshoveka, tani hileswi swikombisiwaka hiku langutiwa ka tliliniki.

Endlelo ro vaviseka .

Eka ku tshoveka ka clavicle eka vanhu lavakulu, endlelo leri tolovelekeke swinene ra ku vaviseka eka ku tshoveka ka clavicle khale a ku ehleketiwa leswaku i vuyelo bya ku wa hi voko eka xiyimo xa hyperextended, kambe Stanley et al. Ku kumiwile leswaku endlelo leri ra ku vaviseka ri endle ntsena 6.3% wa ku tshoveka ka le xikarhi ka clavicle na 5.9% wa ku tshoveka ka clavicle ya le kule, naswona eka vavabyi hinkwavo, endlelo leri tolovelekeke swinene ra ku vaviseka ri huma eka matimba yo kongoma lama tirhaka eka nhlangano wa makatla endlelo leri tolovelekeke swinene ra ku vaviseka eka vavabyi hinkwavo i matimba yo kongoma eka nhlangano wa makatla, hi ntolovelo handle ka ku rhurha lokukulu kumbe ku va na ku rhurha ntsena ka mild.

Eka ku wa ka nhamu eka xiyimo xa hyperextended, ku tshoveka ku tala ku vangiwa hi ku khumbeka ka matimba ya le handle ya vumbirhi eka ku wa. Muxaka wun’wana wa ku tshoveka loku vangiwaka hi madzolonga lawa yanga kongomangiki i loko matimba yale handle ya tirha eka makatla, leswi endlaka leswaku clavicle yi khumba hi rib yosungula, leswi endlaka leswaku kuva na ku pfimba ka spiral eka 1/3 wale xikarhi wa clavicle. Ku engetela kwalaho, hi ku tshamela ku humelela ka timhangu ta le magondzweni emalembeni ya sweswinyana, hikwalaho ka ku khumbeka lokukulu eka mhangu ya movha, bandi ra vuhlayiseki ri vumba fulcrum ya matimba emakatleni, leswi talaka ku yisa eka ku tshoveka loku tsemakanyaka kumbe loku oblique exikarhi ka clavicle, leswi vanhu va swi vitanaka ku tshoveka ka bandi ra vuhlayiseki. Kumbexana hikuva madzolonga ya khombo hi ntolovelo ya va makulu, muxaka lowu wa ku tshoveka wu tala ku va wu nga ri wa nhlangano ku tlula ku tshoveka loku tolovelekeke ka clavicle.

Vutshunguri

Ku tshoveka ka xirho xa le xikarhi xa clavicle: .

Splint fixation:Ku hlanganisiwa ka swiphemu swa clavicle fractures swa ha ri 'gold standard'. Ti plates ti katsa 3.5mm LC-DCP, 3.5mm reconstruction plates, LCP locking plates, na swivumbeko swin’wana swo hlawuleka swa ti plates. Swipfuno swa swiphemuphemu swi katsa: ku tshikileriwa ka ku tshoveka loku tsemakanyaka; ku lulamisiwa ka ku tshoveka ka oblique kumbe butterfly hi swikwirikiri swa tension leswi hlanganisiweke na swiphemu leswi nga neutralizing splints; vulawuri lebyi humelelaka bya ku rhendzeleka; ku vekiwa loku sirhelelekeke ka ku tshoveka ka mintirho ya siku na siku ya muvabyi; na mhaka ya leswaku ti splints hi ntolovelo ati lavi ku susiwa (loko tifanele ku susiwa kufikela eka 12 kuya eka 18 wa tinhweti endzhaku ka vuhandzuri).

Ku tshoveka ka clavicle ya le kule: .

Clavicle hook splint i ndlela yo khoma leyi nga kongomangiki, leyi yi pfunaka ku katsa ku vekiwa ko olova ka ku khomiwa ka le ndzeni, ku hlayisiwa lokunene ka ku vekiwa nakambe, ku hava ku kavanyeteka ka nhlangano wa acromioclavicular, na ku tshamiseka loku ringanaka ka ku khomiwa ka le ndzeni handle ko rhetela eka tinyama leti rhendzeleke tanihi hi pini ya ndhavuko ya kyphotic.

Ku tshoveka ka clavicle ya le kusuhi: .

Matsalwa ya vika leswaku vutshunguri lebyi nga endliwiki vuhandzuri bya tsakeriwa eka muxaka lowu wa ku tshoveka, hi ku buluka ka cervical-wrist sling braking. Incisional internal fixation yinga tekeriwa enhlokweni loko kuri na ku vaviseka ka misiha ya misiha, kumbe loko ku tshoveka ku rhurhisiwa endzhaku leswi endlaka leswaku muvabyi a va na swiphiqo swo hefemula kumbe ku mita, kumbe loko ku nga ri na swikombiso swo tano kambe ku endla swifaniso swi paluxa leswaku ku tshoveka loku rhurheriweke ku khumba xivumbeko xa nkoka xa le ndzhaku na leswaku ku vekiwa nakambe ka xiyimo xa le ndzhaku ku tirha. Loko fixation yinga koteki, proximal clavicle yinga susiwa loko swilaveka.

Swiphiqo .

• Ku hava ku horisa:Matsalwa ya khale lawa ya vikeke mpimo lowu nga horisiki wa 0.9% ku ya eka 4% eka ku tshoveka ka clavicle, naswona ndzavisiso wa xiyimo xa le henhla wa xiyimo xa le henhla wu kumile leswaku mpimo wa xiviri wa ku nga horisi wu le henhla swinene ku tlula leswi munhu a nga swi langutelaka.

• Ku horisa ka deformity: Langutelo ra ndhavuko hileswaku ku horisa ka deformity ka clavicle i xiphiqo xa aesthetic ntsena naswona loko kuri na ku nga horisi endzhaku ka vuhandzuri, mbuyelo wa antswa ku tlula ku pfumelela deformity kuva yiva kona. Hambiswiritano, ku langutiwa ka sweswinyana ku kombisile leswaku ku pfuxetiwa ka clavicle yo tlula 15 cm switala ku yisa eka kuvava naku hunguteka ka ku famba eka xiyimo xale ndzhaku. Ku engetela kwalaho, swidyondzeki swin'wana swi ringanyete 'clavicle shaping' yo olova eka vutshunguri bya ku horisa ka deformity, kambe endlelo leri a ri tsundzuxiwi. Ku susa ntsena scab leyi humelaka ehandle swi nga endla leswaku clavicle yi olova naswona yi engetela swinene khombo ra ku tshoveka, naswona tanihi leswi ku onhaka ka clavicle ku vonakaka eka swiyenge swinharhu, 'smoothing' clavicle eka horizontal plane ntsena a yi nge lulamisi ku onhaka hi ku helela. Hikokwalaho, endlelo ro tshembheka swinene rifana na vutshunguri bya nonunion: ku susiwa ka excess bone scab hilaha swinga kotekaka hakona endzhaku ka ku tsemiwa, ku tiyisisiwa ka fixation yale ndzeni xikan’we naku hlanganisiwa ka marhambu ya xiteji xin’we. I ntiyiso leswaku muvabyi u fanele a tivisiwa hi khombo ra ku nga hlanganyeli emahlweni ka vuhandzuri.

• Ku vaviseka ka misiha ya misiha:Ku koteka ka ku vaviseka ka misiha ya misiha endzhaku ka ku tshoveka ka clavicle swi le hansi eka swiyimo swo sungula, naswona ku vaviseka ka vumbirhi a ku tali ku humelela hikwalaho ka ku rhurha ka ku tshoveka hikwalaho ka ku tlakuka ka ndhawu ya misiha ya misiha endzhaku ka ku tshoveka, kasi eka switeji swa le ndzhaku, ku kula ka swirhumbana swa marhambu ku nga vanga swikombiso swa ku khomiwa. Loko leswi swihumelela, kuhunguteka ka vuhandzuri kutala ku laveka.

• Traumatic arthritis:traumatic arthritis endzhaku ka clavicle fracture yitala kuva kona eka acromioclavicular joint endzhaku ka ku tshoveka ka outer 1/3 ya clavicle, ngopfu ngopfu hikokwalaho ka ku herisiwa ka nhlonge leyi hi madzolonga eka nkarhi wa ku vaviseka, naswona xiphemu xin’wana hikokwalaho ka ku tshoveka loku katsaka vuandlalo bya articular. Loko ku pfala swinga tirhi, distal 1 cm ya clavicle yifanele ku tsemiwa, naswona nhlayiso wale ndzeni ka vuhandzuri wufanele ku tekiwa ku sirhelela rostral-clavicular ligament.

  
  

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