Ukuphuka kwe-Clavicle

Isigameko sokuphuka kwe-clavicle singama-30-60 kubantu abangu-100,000, ngesilinganiso sowesilisa nowesifazane cishe u-2: 1, okubalelwa ku-5% kuya ku-10% yazo zonke izinhlobo ze-fracture kanye ne-44% yokulimala okuhlangene kwamahlombe. I-clavicle iyithambo lokuqala elingena emzimbeni womuntu, futhi i-ossification yayo iqala ngesonto lesihlanu lokuphila kombungu, futhi iwukuphela kwethambo elide elishubhu eligobhoza ngokusebenzisa i-intramembranous osteogenesis. Isikhungo sakudala se-ossification siphakathi nendawo futhi sinesibopho sokukhula kwe-clavicle kuze kufike eminyakeni engu-5 ubudala. Kukhona ipuleti le-epiphyseal elikhulayo engxenyeni ngayinye yangaphakathi nangaphandle ye-clavicle, kodwa ngokuvamile isikhungo se-ossification esiphakathi singabonwa nge-x-ray. Ipuleti le-epiphyseal eliphakathi linesibopho se-80% yokukhula kobude be-clavicle, futhi isikhungo sayo se-ossification ngokuvamile asiqali ukuvela kuze kube yi-13 kuya ku-19 ubudala, futhi ayihlanganisi ne-clavicle kuze kube ngu-22 kuya ku-25 ubudala. Ngakho-ke, lapho uhlola i-sternoclavicular dislocation ezigulini ezincane, kubalulekile ukuyihlukanisa nokulimala kwe-clavicular epiphyseal ephakathi.

I-Anatomy esebenzayo

I-clavicle icishe iqonde uma ibukwa ngaphambili, kodwa inomumo ongu-S uma ibukwa phezulu, igobe ngemuva namaphakathi ukuya ohlangothini lwe-ventral. I-cross-section yayo ishintsha eduze kwe-axis ende, ne-1/3 yangaphandle ifakwe isicaba ukuze ifake ukudonsa kwemisipha kanye ne-ligament; i-middle 1/3 iba yi-tubular, enobubanzi obuncishisiwe kanye ne-cortex eningi kanye nethambo eliminyene kunamanye, ukuhambisana nokucindezela kwe-axial nokucindezeleka nokuvikela imizwa ye-vascular ngaphansi kwayo; i-1/3 yangaphakathi i-rhombic futhi ihlotshaniswa ne-sternum kanye nombambo wokuqala ngezicubu eziqinile ze-ligamentous (Umfanekiso 1). Ucwaningo lwe-anatomical lubonise ukuthi i-clavicle ibuthakathaka kakhulu lapha ngenxa yokuhlukahluka kwe-morphological phakathi nangaphandle kwe-1/3. Ngaphezu kwalokho, itholakala eceleni kwe-subclavia muscle stop futhi ayinakho ukuvikelwa kwemigqa yemisipha, okwenza kube yindawo esengozini kakhulu yokuphuka, njengoba kuboniswa ukubhekwa komtholampilo.

Indlela yokulimala

Ukuze uthole i-clavicle fractures kubantu abadala, indlela evamile yokulimala kwe-clavicle fracture ngaphambili kwakucatshangwa ukuthi iwumphumela wokuwa ngesandla endaweni ye-hyperextended, kodwa uStanley et al. ithole ukuthi le nqubo yokulimala ibalwa kuphela i-6.3% ye-middle-clavicle fractures kanye ne-5.9% ye-distal clavicle fractures, futhi kuzo zonke iziguli, indlela evamile yokulimala ivela emandleni aqondile asebenza ekuhlanganyeleni kwehlombe Indlela evamile yokulimala kuzo zonke iziguli inamandla aqondile ekuhlanganyeleni kwehlombe, ngokuvamile ngaphandle kokuhamba okuphawulekayo noma ngokufuduka okuncane kuphela.

Endabeni yokuwa nesundu endaweni ye-hyperextended, ukuphuka kuvame ukubangelwa umthelela wamandla angaphandle okwesibili kuya ekwindla. Olunye uhlobo lokuphuka ngenxa yodlame olungaqondile yilapho amandla angaphandle esebenza ehlombe, okubangela ukuthi i-clavicle ithinte ubambo lokuqala, okuholela ekwakhekeni kokuphuka okuvunguzayo phakathi kwe-1/3 ye-clavicle. Ngaphezu kwalokho, ngokuvela njalo kwezingozi zomgwaqo eminyakeni yamuva, ngenxa yethonya elinamandla engozini yemoto, ibhande lesihlalo lakha i-fulcrum yamandla ehlombe, okuvame ukuholela ekuqhekekeni okuphambene noma oku-oblique phakathi kwe-clavicle, abantu ababiza ngokuthi ukuphuka kwebhande lesihlalo. Mhlawumbe ngenxa yokuthi udlame lwe-trauma luvame ukuba lukhulu, lolu hlobo lokuphuka luthambekele kakhulu ekungewona inyunyana kune-clavicle fracture evamile.

Ukwelashwa

Ukuphuka kwe-clavicle ephakathi:

Ukulungiswa kwe-Splint:Ukulungiswa kwe-Splint kokuqhekeka kwe-clavicle kuse'izinga legolide'. Amapuleti ahlanganisa i-3.5mm LC-DCP, amapuleti okwakha kabusha angu-3.5mm, amapuleti okukhiya e-LCP, nezinye izinhlobo ezikhethekile zamapuleti. Izinzuzo zama-splints zihlanganisa: ukucindezelwa kwama-transverse fractures; ukulungiswa kwe-oblique noma i-butterfly fractures nge-tension screws kuhlanganiswe ne-neutralizing splints; ukulawula okusebenzayo kokujikeleza; ukulungiswa okuvikelekile kokuphuka kwemisebenzi yansuku zonke yesiguli; kanye neqiniso lokuthi ama-splints ngokuvamile awadingi ukususwa (uma kufanele asuswe kuze kube yizinyanga eziyi-12 kuya kweziyi-18 ngemuva kokuhlinzwa).

Ukuphuka kwe-Distal clavicle:

I-clavicle hook splint iyindlela yokulungisa engaqondile, izinzuzo zayo ezihlanganisa ukubekwa kalula kokulungiswa kwangaphakathi, ukugcinwa okunembe kakhudlwana kokubeka kabusha, akukho ukuphazamiseka kokuhlangana kwe-acromioclavicular, nokuzinza okuhlobene kokulungiswa kwangaphakathi ngaphandle kokushelela ezicutshini ezizungezile njengephinikhodi yendabuko ye-kyphotic.

I-Proximal clavicle fracture:

Izincwadi zibika ukuthi ukwelashwa okungasebenzi kuyakhethwa kulolu hlobo lokuphuka, ngokubhuleka kwesihlilingi sesandla somlomo wesibeletho. Ukulungiswa kwangaphakathi kwe-incisional kungase kucatshangelwe uma kukhona ukulimala kwenzwa ye-vascular, noma uma ukuphuka kususwa ngemuva kokudala ukuthi isiguli sibe nobunzima bokuphefumula noma ukugwinya, noma uma zingekho izimpawu ezinjalo kodwa ukuthwebula izithombe kuveza ukuthi ukuphuka okususiwe kugxilile esakhiweni esibalulekile sangemuva nokuthi ukubeka kabusha akusebenzi. Uma ukulungiswa kungenakwenzeka, i-proximal clavicle ingase isuswe uma kunesidingo.

Izinkinga

• Akukho ukuphulukiswa:Izincwadi zangaphambilini zibike izinga lokungapholi lika-0.9% kuya ku-4% lokuphuka kwe-clavicle, futhi inhlolovo yecala lenqwaba yakamuva ithole ukuthi izinga langempela lokungapholi liphezulu kakhulu kunalokho umuntu angakulindela.

• Ukuphulukiswa kokukhubazeka: Umbono wendabuko ukuthi ukuphulukiswa kokukhubazeka kwe-clavicle kuyinkinga yobuhle kuphela nokuthi uma kungekho ukuphulukiswa ngemva kokuhlinzwa, umphumela ungcono kunokuvumela ukukhubazeka ukuba kube khona. Kodwa-ke, ukubhekwa kwamuva kubonise ukuthi ukufinyezwa kwe-clavicle engaphezu kuka-15 cm ngokuvamile kuholela ebuhlungu nokunciphisa ukunyakaza ekupheleni kwesigaba. Ukwengeza, ezinye izazi ziye zaphakamisa 'i-clavicle shaping' elula ekwelapheni ukuphulukiswa kokukhubazeka, kodwa le ndlela ayifaneleki. Ukukhipha kuphela utwayi oluphumile kuphela kungenza i-clavicle ibe mncane futhi kwandise kakhulu ingozi yokuphuka, futhi njengoba ukukhubazeka kwe-clavicle kubonakala ngezilinganiso ezintathu, 'ukushelela' i-clavicle endizeni evundlile iyodwa ngeke ilungise ngokuphelele ukukhubazeka. Ngakho-ke, indlela enokwethenjelwa kakhudlwana ifana nokwelapha okungezona ezivamile: ukususwa koqweqwe lwamathambo okweqile ngangokunokwenzeka ngemva kokusikwa, ukuqiniswa kokulungiswa kwangaphakathi kanye nesiteji esisodwa sokuxhunyelelwa kwamathambo. Yiqiniso, isiguli kufanele saziswe ngengozi yokungahlanganisi ngaphambi kokuhlinzwa.

• Ukulimala kwe-Vascular nerve: Amathuba okulimala kwe-vascular nerve ngemva kokuphuka kwe-clavicle aphansi ezinyathelweni zokuqala, futhi ukulimala kwesibili akuvamile ukwenzeka ngenxa yokufuduka kwe-fracture ngenxa yokwanda kwesikhala se-vascular nerve ngemva kokuphuka, kuyilapho ezinyathelweni zokugcina, ukukhula kwama-scabs amathambo kungase kubangele izimpawu zokuvaleleka. Uma lokhu kwenzeka, ukuwohloka kokuhlinzwa kuvame ukudingeka.

• I-Traumatic arthritis:I-traumatic arthritis ngemva kokuphuka kwe-clavicle ijwayele ukwenzeka ejoyintini le-acromioclavicular ngemva kokuphuka kwe-1/3 yangaphandle ye-clavicle, ikakhulukazi ngenxa yokubhujiswa kwaleli lungu ngodlame ngesikhathi sokuhlukumezeka, futhi ngokwengxenye ngenxa yokuphuka okubandakanya i-articular surface. Uma ukuvala kungasebenzi, i-distal 1 cm ye-clavicle kufanele ikhishwe, futhi ukunakekelwa kwe-intraoperative kufanele kuthathwe ukuze kuvikelwe i-rostral-clavicular ligament.

  
  

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