Ukwaphuka kweClavicle

Iziganeko ze-clavicle fractures yi-30-60 kubantu abayi-100,000, kunye nomlinganiso wendoda kunye nowesifazana malunga ne-2: i-1, ibalwa kwi-5% ukuya kwi-10% yazo zonke iifractures kunye ne-44% yokulimala ngokubambisana kwamagxa. I-clavicle lelona thambo lokuqala ukutyhutyha umzimba womntu, kwaye ukufakwa kwayo kwi-ossification kuqala kwiveki yesihlanu yobomi be-embryonic, kwaye kuphela kwethambo elide le-tubular elihamba nge-osteogenesis ye-intramembranous. Iziko le-ossification lamandulo liphakathi kwe-clavicle kwaye lijongene nokukhula kwe-clavicle ukuya kwi-5 yeminyaka ubudala. Kukho ipleyiti ye-epiphyseal ekhulayo kwinqanaba ngalinye langaphakathi nangaphandle le-clavicle, kodwa ngokuqhelekileyo kuphela i-medial ossification center inokubonwa nge-x-ray. I-medial epiphyseal plate ijongene ne-80% yokukhula kobude be-clavicle, kwaye isikhungo sayo se-ossification ngokuqhelekileyo asiqali ukubonakala kude kube yi-13 ukuya kwi-19 iminyaka ubudala, kwaye ayifaki kunye ne-clavicle kude kube yi-22 ukuya kwi-25 yeminyaka ubudala. Ngoko ke, xa ufumanisa i-sternoclavicular dislocation kwizigulane ezincinci, kubalulekile ukuhlula kwi-medial clavicular epiphyseal ukulimala.

I-Anatomy esebenzayo

I-clavicle iphantse yathe tye xa ijongwe ngaphambili, kodwa imile okwe-S xa ijongwe phezulu, igophe ngasemva naphakathi kwicala le-ventral. I-cross-section yayo iyatshintsha kunye ne-axis ende, kunye ne-1 / 3 yangaphandle inqunyulwe ukuze ifake i-muscle kunye ne-ligament pulling; umbindi we-1/3 uba yi-tubular, enobubanzi obuncitshisiweyo kunye ne-cortex etyebileyo kunye nethambo elixineneyo kunalo lonke, ukulungiselela uxinzelelo lwe-axial kunye noxinzelelo kunye nokukhusela imithambo yemithambo engaphantsi kwayo; i-1/3 yangaphakathi i-rhombic kwaye idibene ne-sternum kunye ne-rib yokuqala ngezicubu eziqinileyo ze-ligamentous (Umfanekiso 1). Izifundo ze-anatomical zibonise ukuba i-clavicle ibuthathaka kakhulu apha ngenxa yeenguqu ze-morphological phakathi nangaphandle kwe-1/3. Ukongezelela, ibekwe ecaleni kwe-subclavia ye-muscle stop kwaye ayinakho ukukhuselwa kwemisipha ye-muscular, eyenza ibe yindawo esengozini kakhulu yokuphuka, njengoko kubonakaliswe kuqwalaselo lweklinikhi.

Indlela yokwenzakala

Kwi-clavicle fractures kubantu abadala, eyona ndlela ixhaphakileyo yokulimala kwi-clavicle fractures ngaphambili kwakucingelwa ukuba yisiphumo sokuwa ngesandla kwi-hyperextended position, kodwa uStanley et al. ifumene ukuba le ndlela yokulimala ibalwa kuphela i-6.3% ye-middle-clavicle fractures kunye ne-5.9% ye-distal clavicle fractures, kwaye kuzo zonke izigulane, eyona ndlela ixhaphakileyo yokulimala ivela kwimikhosi ethe ngqo esebenza ngokudibeneyo egxalabeni Indlela eqhelekileyo yokulimala kuzo zonke izigulane zinyanzeliswa ngokuthe ngqo kwi-joint joint, ngokuqhelekileyo ngaphandle kokufuduka okubalulekileyo okanye ngokufuduka kancinci.

Kwimeko yokuwa kunye nesundu kwindawo ye-hyperextended, i-fracture idla ngokubangelwa yimpembelelo yamandla angaphandle okwesibini ukuya. Olunye uhlobo lokuqhekeka ngenxa yobundlobongela obungathanga ngqo kuxa amandla angaphandle asebenza egxalabeni, abangela ukuba i-clavicle ibe nefuthe kwimbambo yokuqala, okubangelwa ukubunjwa kwe-spiral fracture phakathi kwe-1/3 ye-clavicle. Ukongeza, kunye nokuvela rhoqo kweengozi zendlela kwiminyaka yakutshanje, ngenxa yempembelelo enamandla kwingozi yemoto, ibhanti lesihlalo lenza i-fulcrum yamandla egxalabeni, elihlala likhokelela ekuqhekekeni okunqamlezayo okanye oblique phakathi kwe-clavicle, abantu abayibiza ngokuba yi-belt belt fracture. Mhlawumbi ngenxa yokuba ubundlobongela be-trauma ngokuqhelekileyo bukhulu, olu hlobo lokuqhekeka luxhomekeke ngakumbi kwi-non-union kune-clavicle fracture eqhelekileyo.

Unyango

Ukuqhekeka kwe-clavicle ephakathi:

Ukulungiswa koqhekeko: Ukulungiswa kwentsimbi yokuqhekeka kwe-clavicle kusenguwo 'umgangatho wegolide'. Amacwecwe aquka i-3.5mm LC-DCP, iipleyiti zokuvuselela i-3.5mm, iipleyiti zokutshixa i-LCP, kunye nezinye iifom ezikhethekileyo zamacwecwe. Iingenelo ze-splints ziquka: ukunyanzeliswa kweefractures ezinqamlezileyo; ukulungiswa kwe-oblique okanye i-butterfly fractures kunye ne-screws ye-tension edibeneyo kunye ne-neutralizing splints; ulawulo olusebenzayo lokujikeleza; ukulungiswa okukhuselekileyo kokuphulwa kwemisebenzi yemihla ngemihla yesigulane; kunye nenyaniso yokuba i-splints ngokuqhelekileyo ayifuni ukususwa (ukuba kufuneka isuswe kude kube yi-12 kwiinyanga ze-18 emva kokusebenza).

Ukuqhekeka kwe-Distal clavicle:

I-clavicle hook splint yindlela yokulungisa engathanga ngqo, iingenelo ezibandakanya ukubeka lula ukulungiswa kwangaphakathi, ukugcinwa ngokuchanekileyo kokulungiswa ngokutsha, akukho ukuphazamiseka kwe-acromioclavicular joint, kunye nokuzinza okuhambelanayo kokulungiswa kwangaphakathi ngaphandle kokungena kwizicubu ezijikelezayo njengepini yendabuko ye-kyphotic.

Ukwaphuka kwe-clavicle ekufutshane:

Uncwadi lubika ukuba unyango olungasebenziyo lukhethwa ngolu hlobo lokuphuka, kunye ne-cervical-wrist sling braking. Ukulungiswa kwangaphakathi kwe-incisional kungaqwalaselwa ukuba kukho ukulimala kwe-nerve ye-vascular, okanye ukuba i-fracture ifuduka ngasemva ibangela ukuba isigulane sibe nobunzima bokuphefumla okanye ukugwinya, okanye ukuba akukho zimpawu ezinjalo kodwa umfanekiso ubonisa ukuba i-fracture efudukayo igxininisekile kwisakhiwo esibalulekileyo sangasemva kwaye ukubekwa kwakhona kungasebenzi. Ukuba ukulungiswa akunakwenzeka, i-clavicle esondeleyo inokususwa xa kuyimfuneko.

Iingxaki

• Akukho kuphiliswa:Uncwadi lwangaphambili luchaze izinga lokunganyangi kwe-0.9% ukuya kwi-4% yokwaphuka kwe-clavicle, kunye novavanyo lwamva nje lwetyala elikhulu lafumanisa ukuba elona zinga lokunganyangi liphezulu kakhulu kunokuba umntu unokulindela.

• Ukuphulukiswa kokukhubazeka: Umbono wendabuko kukuba ukuphulukiswa kokukhubazeka kwe-clavicle yingxaki yobuhle kuphela kwaye ukuba kukho ukunganyangeki emva kokuhlinzwa, umphumo ungcono kunokuvumela ukuba kubekho ukukhubazeka. Nangona kunjalo, ukuqwalaselwa kwamva nje kubonise ukuba ukunciphisa i-clavicle engaphezu kwe-15 cm kaninzi kukhokelela kwiintlungu kunye nokunciphisa ukunyakaza kwinqanaba lokugqibela. Ukongeza, abanye abaphengululi baye bacebisa 'i-clavicle shaping' elula kunyango lokunyanga ukukhubazeka, kodwa le ndlela ayikhuthazwa. Ukususa kuphela i-scab ephumayo kunokwenza i-clavicle ibe yincinci kwaye inyuse kakhulu ingozi yokuphuka, kwaye ekubeni ukukhubazeka kwe-clavicle kubonakaliswe kwimilinganiselo emithathu, 'i-smoothing' i-clavicle kwi-plane ethe tye kuphela ayiyi kulungisa ngokupheleleyo ukukhubazeka. Ngoko ke, indlela enokwethenjelwa ngakumbi ifana nokunyangwa kwe-nonnunion: ukususwa kwe-scab yamathambo engaphezulu kangangoko kunokwenzeka emva kokusikwa, ukuzinzisa ukulungiswa kwangaphakathi kunye nesigaba esisodwa sokufakelwa kwamathambo. Ngokuqinisekileyo, isigulane kufuneka sixelelwe ngomngcipheko wokungahambelani ngaphambi kokuhlinzwa.

• Ukulimala kwe-Vascular nerve: Amathuba okulimala kwe-vascular nerve emva kokuphuka kwe-clavicle iphantsi kumanqanaba okuqala, kwaye ukulimala okwesibini akuqhelekanga ngenxa yokufuduka kwe-fracture ngenxa yokwanda kwendawo ye-vascular nerve emva kokuphuka, ngelixa kwinqanaba lokugqibela, ukukhula kwee-scabs zethambo kunokubangela iimpawu zokubanjwa. Xa oku kusenzeka, ukuthotywa kotyando kuye kufuneke.

• I-arthritis ye-Traumatic: I-arthritis ebuhlungu emva kokuphuka kwe-clavicle ivame ukwenzeka kwi-joint acromioclavicular emva kokuphuka kwe-1/3 yangaphandle ye-clavicle, ngokukodwa ngenxa yokutshatyalaliswa kweli lungu ngobundlobongela ngexesha lokwenzakala, kwaye ngokuyinxenye ngenxa yokuphuka okubandakanya umphezulu we-articular. Ukuba ukuvalwa kungasebenzi, i-distal 1 cm ye-clavicle kufuneka ikhutshwe, kwaye ukunakekelwa kwe-intraoperative kufuneka kuthathwe ukukhusela i-rostral-clavicular ligament.

  
  

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