Akɔta ƒe Gbagbãwo Didi Kple Wo Dada

Kpɔkplɔyiɖeme

Abɔta ƒe gbagbã bɔ ŋutɔ eye zi geɖe la, etsoa nuveviwɔame si dzɔ ɖe abɔta ƒe akpa dzi tẽ alo esi metso tẽ o gbɔ. Numekuku siwo wowɔ le ƒe 1960 ƒeawo ƒe gɔmedzedze ka nya ta be akɔta ƒe gbagbã ƒe agbɔsɔsɔ si mewɔ ɖeka o mede 1% o, eye atikewɔwɔ si me womezãa nu geɖe le o na dɔnɔwo ƒe dzi dze eme ŋutɔ; esi woto atikewɔwɔ vɛ nyitsɔ laa ta la, amekoko ƒe atikewɔwɔ wɔ dɔ ɖedzesi aɖe; eyata ele be atikewɔla siwo le dɔ wɔm le dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ alo dɔnɔdzikpɔƒe si wokpɔa dɔnɔwo gbɔ le bliboe la nanya nu tso abi sia ƒe dzesi kple kuxi siwo bɔ kpakple edzikpɔkpɔ veviwo ŋu.

Dɔvɔ̃ŋutinunya

Akɔta ƒe gbagbã nye 2.6%-5% le ame tsitsiwo ƒe gbagbã katã me [1,2]. Europatɔwo ƒe numekuku aɖe si me akɔta ƒe gbagbã 1,000 siwo kplɔ wo nɔewo ɖo le [3,4] be akɔta ƒe gbagbã siwo wu 66% dzɔ le akɔta ƒe titina 1/3, abe 25% nye axadzi 1/3 ƒe gbagbã, eye 3% nye titina 1/3 ƒe gbagbã. Akɔta ƒe gbagbã ƒe dzɔdzɔ ɖe mɔ eve ƒe mama fia, si dzɔna le ŋutsu siwo mexɔ ƒe 30 haɖe o koŋ me, eye amesiwo xɔ wu ƒe 70 kplɔe ɖo.

Dɔnɔdzikpɔƒe ƒe Lãmetsiŋusẽ Ŋuti Nunya

Amegbetɔ ƒe ƒunukpeƒe gbãtɔ si dzea ƒu ƒe wɔwɔ gɔmee nye ƒunukpeƒe, si nye ƒu ƒe kadodo ɖeka kolia si le abɔta kple akɔta dome, si doa ka kple acromion, si nye acromioclavicular (AC) ƒunukpeƒe, kple ƒunukpeƒe si te ɖe akɔta, si nye sternoclavicular (SC) ƒunukpeƒe. Woyɔa ƒunukpeƒe siawo be ƒunukpeƒetetedɔ si mebɔ o elabena ƒunukpeƒetetedɔ (fibrocartilage) le wo ŋu ke menye ƒunukpeƒetetedɔ (hyaline) o. Acromioclavicular kple rostroclavicular ligaments ye léa asike ɖe scapula ŋu eye sternoclavicular ligament lénɛ ɖe sternum ŋu.

Akɔta ƒe nɔnɔme le 'S' me. Akpa afã si te ɖe eŋu la dona ɖe ŋgɔ, si wɔnɛ be teƒe nɔa ahɔhɔ̃mekawo ƒe ƒuƒoƒo si le eƒe akpa si le etame la ŋu. Arc la ƒe afã si le didiƒe la dona ɖe megbe (concave) eye emegbe wòva kpena ɖe scapula (rostral process kple acromion) ŋu. Zi geɖe la, akɔtaƒu ƒe gbagbã dzɔna le afisi aɖaka eveawo do go le (aɖaka titina), anɔ eme be esi lãkusi siwo lé ɖe ƒu siwo te ɖe wo nɔewo ŋu ŋu le nuto sia me ƒe anyimanɔmanɔ gbɔe wòtso eye le esi wònye akɔta ƒe akpa si gbɔdzɔ wu ta. Ne woɖe asike ƒe gbagbãƒe ɖa la, ɣesiaɣi kloe la, sternocleidomastoid lãmeka (si kpe ɖe akɔta ƒe nuwuwu si te ɖe eŋu) hea akpa si te ɖe eŋu la yia dzi (cephalad) eye akpa si le didiƒe la ʋuna yia anyime (caudad) le abɔta ƒe kpekpeme nu, eye akɔtaƒua dina be yea 'kpuie' (si fia be, gbagbãƒea ƒe nuwuƒewo doa go wo nɔewo), vevietɔ le subscapularis kple pectoralis major (siwo trɔa abɔta ƒe akpa si le etame le ememe) ƒe tete ta. Esia tsoa subscapularis kple pectoralis major lãmekawo (siwo trɔa abɔta le ememe hehenɛ yia akɔta) ƒe tete gbɔ koŋ.

Ŋutinuwo

Taɖodzinu si le akɔta ƒe gbagbã dada ŋue nye be woaɖe vevesese dzi akpɔtɔ eye wòana ƒunukpeƒewo nagawɔ dɔ ake. Wogakpɔtɔ daa akɔta ƒe gbagbã akpa gãtɔ le mɔ si me womezãa nu geɖe le o nu koŋ (zi geɖe la, womewɔa kpuie wu milimeta 15 o); atikewɔwɔ siwo me womezãa nu gbagbewo le o abe aŋetu siwo wotsɔna blaa alɔnu si ƒe nɔnɔmetata le enyi, abɔta ƒe aŋetu, Sayre ƒe aŋekotoku, Velpeau ƒe awu siwo nana ame ƒe ʋuʋu meʋãna o, kple aŋetu siwo wotsɔna blaa alɔnu ene. Wowɔa suspension immobilization le acute phase me, eye zi geɖe la, wowɔa ʋuʋu ƒe hehexɔxɔ le gɔmedzedzea me kple ŋusẽdodo kamedede le kwasiɖa 2-6 le gbagbãa megbe ne vevesesea nu tso. Womekafu figure of 8 blages zazã o elabena ate ŋu ana axillary pressure sores kple non-union of the fracture geɖe wu [5,6].

Ŋutinya Kple Lãmesẽdodokpɔ

Abɔta ƒe gbagbã tsoa abɔta ƒe gbagbã tẽ le anyidzedze megbe eye wokpɔnɛ zi geɖe le gota kamedefefewo me le sɔhɛwo me kple le ame tsitsiwo ƒe anyidzedze le manyamanya me. Ele vevie be woaɖe alesi nuveviwɔame wɔa dɔe me. Nuveviwɔame siwo ŋu ŋusẽ geɖe le ate ŋu akpe ɖe ta kple akɔta ƒe abixɔxɔ ŋu, evɔ abi siwo dona tso nuveviwɔame suewo me ate ŋu anye dɔléle. Nuveviwɔame siwo hea susu ɖa bia be woadze egɔme kaba eye woaɖe akɔta ƒe gli ƒe mama si nye scapular chest wall, ahɔhɔ̃mekawo kple ʋukawo ƒe abixɔxɔ ɖa nyuie. Le atikewɔwɔ me la, vuvu kple ecchymosis nɔa teƒe si wògbã, tsɔ kpe ɖe nɔnɔme madeamedzi kple vevesese ŋu. Ele be woalé ŋku ɖe lãkusi falɛfalɛawo ŋu hena jacking up, si ate ŋu ana ŋutigbalẽa navuvu eye wòaxɔ abi.

Nɔnɔmetatawo ɖeɖe

Woate ŋu akpɔ gbagbã akpa gãtɔ to ŋkume kple megbe ƒe fotoɖeɖe bɔbɔewo dzi. 20° ta ƒe fotoɖeɖe ɖea akɔta ƒe do siwo ƒo xlã wo nɔewo ƒe ŋusẽkpɔɖeamedzi ɖa. Ele be woaɖe foto dɔnɔwo le radio dzi le nɔnɔme si me woate ŋu alé wo ɖokui ɖe te be woakpɔ alesi woƒe gbagbã ƒe ʋuʋu le susu me nyuie wu. Kpekpeme tsɔtsɔ na radiographs kpena ɖe ame ŋu le rostral clavicular ligament ƒe blibonyenye me dzodzro le distal clavicle alo acromioclavicular joint injuries.CT kpena ɖe ame ŋu be woakpɔ scapular girdle injuries sesẽwo le susu me eye wònaa wokpɔa proximal clavicle injuries siwo ate ŋu adzɔ le sternoclavicular joint la nyuie wu. Akɔta ƒe fotoɖeɖe kpena ɖe ame ŋu be woaɖe abi si do ƒome kplii le akɔta ŋu, eye woate ŋu akpɔ eƒe kpuiƒe to etsɔtsɔ sɔ kple akɔta ƒe akpa si tsi tre ɖe eŋu, eye woaɖe asi le akɔta ƒe gli ƒe mama ŋu.

Ƒomeviwo

AO/OTA Fracture Dislocation Typing: Akɔta ƒe gbagbã ƒe dzesi 15 nye teƒe etɔ̃: 15.1 proximal (medial), 15.2 diaphysis, kple 15.3 distal (lateral). Woma ƒunukpeƒetetedɔ siwo te ɖe wo nɔewo ŋu (titina) kple esiwo le didiƒe (axadzi) ɖe hatsotso A (extra-articular), ƒomevi B (si ƒe akpa aɖe nye intra-articular), kple ƒomevi C (intra-articular keŋkeŋ). Woda akɔta ƒe gbagbã ɖe hatsotsowo me be ƒomevi A (si le bɔbɔe), ƒomevi B (wedge), kple ƒomevi C (comminuted).AO/OTA ƒe hatsotso si me woɖea gbagbã kple ʋuʋudedi le la mebua alesi gbegbe ʋuʋudedia ʋunae ŋu o, eye fifia la, wozãnɛ boo le akɔta ƒe gbagbãwo dada me kple le ŋgɔdonya nyanya me.

Allman ƒe nuŋɔŋlɔ nɔ te ɖe afisi gbagbãƒea le dzi (I: titina, cadent 1/3, II: axadzi 1/3, III: titina 1/3) (Fig. 7.2.1).

Craig gagbugbɔ trɔ asi le hatsotso sia ŋu le Allman dzi, eye nyee nye akɔta ƒe titina 1/3; ƒomevi II nye akɔta ƒe akpa 1/3 si le gota, si emegbe woma ɖe ƒomevi 5 me le esi wotu ɖe gbagbã ƒe ʋuʋu kple ƒomedodo si le rostral clavicular ligament dome dzi; eye ƒomevi III nye akɔta ƒe akpa 1/3 ememetɔ ƒe gbagbã, si woma ɖe ƒomevi 5 me le alesi gbegbe gbagbãa ƒe ʋuʋu le kple nenye be ƒunukpeƒetetedɔa le ƒunukpeƒe alo menyee o nu.

Neer ƒe axadzi 1/3 ƒe gbagbã ƒe ƒomeviwo te gbe ɖe rostral-clavicular ligament ƒe vevienyenye dzi: ƒomevi I dzɔna le adzɔge tso rostral-clavicular ligament gbɔ, eye medial fracture block la ʋuna yia ŋgɔ; ƒomevi II lɔ rostral-clavicular ligament ɖe eme eye wònana be medial fracture block la ʋuna yia ŋgɔ; eye ƒomevi III kekena ɖe enu va ɖoa acromioclavicular ƒunukpeƒea eye rostral-clavicular ligament gakpɔtɔ le nenema.

Edinburgh typing nye ɖoɖo si me woama diaphysis ƒe gbagbãwo ɖe hatsotsowo me le alesi gbegbe woʋuʋui kple alesi wogbãe nu.1 Gbagbã ƒomevi 1 lɔ titina ƒe nuwuwu ɖe eme, ƒomevi 2 nye diaphysis ƒe gbagbã eye ƒomevi 3 nye axadzi nuwuwu ƒe gbagbã. Woma diaphysis ƒe gbagbãwo ɖe hatsotsowo me le cortical contact ƒe anyinɔnɔ alo manɔmanɔ nu le gbagbãƒea ƒe kakɛawo dome nu ɖe ƒomevi A kple B. Wogade gbagbã ƒomevi 2A me be nondisplaced (ƒomevi 2A1) kple angulated (ƒomevi 2A2),2B gbagbãwo woda ɖe hatsotso siwo le bɔbɔe alo wedge-nɔnɔme (ƒomevi 2B1) kple comminuted (ƒomevi 2B2).3 Ƒomevi 1 gbagbãwo lɔ akɔta ƒe titina ƒe nuwuwu ɖe eme eye ƒomevi 3 nye lãkusi ƒe axadzi nuwuwu. Woma titina kple axadzi ƒe nuwuwu ƒe gbagbãƒewo ɖe hatsotso sue 1 kple 2 me le ne ƒunukpeƒe si te ɖe eŋu la le eme nu.

Nenema ke Rockwood ƒe nuŋɔŋlɔ, Jager ƒe nuŋɔŋlɔ, kple Breitner ƒe nuŋɔŋlɔ hã li.

Amekoko ƒe dzesiwo

Gbagbãƒe tɔxɛwo

1, gbagbã si le ʋuʋu ɖi; 

2, ʋuʋu >2 cm; 

3, eƒe kpuiƒe >2 cm; 

4, gbagbã ƒe kakɛwo ƒe gbagbã (>3); 

5, akpa geɖe ƒe gbagbã; 

6, si le ete ƒe gbagbã si le ʋuʋu ɖi si me lãkusi falɛfalɛwo xɔ abi; 

7, nɔnɔme madeamedzi ɖedzesi (ʋuʋu kple kpuiƒe); 

8, scaphoid ƒe abixɔxɔ.

Nuveviwɔame siwo nu sẽ wu

1, ipsilateral ƒe akpa si le etame ƒe abi si wotsɔ ƒo ƒui;

2, Abɔta ƒe abi si le tsia dzi;

3, abi geɖe xɔxɔ;

4, gbagbã si wotsɔ kpe ɖe ahɔhɔ̃mekawo ƒe abixɔxɔ ŋu;

5, ipsilateral multiple rib fractures ƒo ƒu kple akɔta ƒe gli ƒe gbagbã;

6, akɔta ƒe kpuiƒe be wòazu abɔta si ŋu aʋala le;

7, Akpa eve ƒe akɔta ƒe gbagbã.

Nusiwo Gbɔ Dɔnɔwo Gbɔna

1, Dɔnɔ siwo xɔ abi geɖe hiã be woatsɔ kpekpeme si le woƒe akpa si le etame kaba;

2, Dɔnɔ siwo hiã be woatrɔ ayi woƒe dɔwɔwɔ me kabakaba (le kpɔɖeŋu me, kamedefefe siwo me ame ŋkutawo kple esiwo me woʋlia ho le).

Ɣeyiɣi si woatsɔ awɔ amekoko

Ele be woawɔ dɔ na amea heheɖemegbe manɔmee ne amekoko ƒe dzesi blibowo li.

Amekoko ƒe megbetsitsi wu kwasiɖa 2-3 le dzesi siwo sɔ gbɔ ate ŋu ana wòasesẽ be woaɖe gbagbã dzi akpɔtɔ, vevietɔ ne wole dzadzram ɖo ɖe ememe tsɔtsɔ ɖe anyi si wotu nu to mɔnu siwo wozãna to ŋutigbalẽ me dzi.

Amekoko ƒe mɔnukpɔkpɔ

Wotsɔa dɔnɔa dana ɖe ƒutazikpui ƒe nɔnɔme alo anyinɔƒe afã ƒe nɔnɔme me. Wotsɔa nu ƒoa abɔta si ŋu dɔlélea le la te be wòakɔ akɔta be amekokoa nanɔ bɔbɔe, eye wotsɔa afɔkpa ƒoa abɔa be wòate ŋu aʋuʋu le dɔwɔwɔ me. Woate ŋu atia lãɖeɖe si le ŋgɔgbe le akɔta ƒe axa didi la dzi alo saber ƒe lãɖeɖe si sɔ kple langer ƒe nɔnɔme.

De dzesii: Ne wotsoe wòkeke ɖe enu wu, gake ne wotsoe wòdidi la ɖea afɔku si le supraclavicular nerve nerve ŋu dzi kpɔtɔna eye wòdzea ame ŋu wu le atsyɔ̃ɖoɖo gome.

Ememe Fixation

3.5 Woateŋu azã ɖoɖo nu compression plates, reconstruction plates, alo plastic LCPs atsɔ aɖɔ akɔta ƒe gbagbãwo ɖo. Wotsɔa agbalẽviwo dana ɖe akɔtaƒua tame alo doa ŋgɔ bɔbɔe. Plɛtiwo sesẽna wu le biomechanical injuries me ne woda wo ɖe etame, vevietɔ ne comminuted gbadzɛ aɖe le ete, eye wo kpɔkpɔ le susu me le bɔbɔe wu. Ehiã be woatsɔ gaviawo abla ɖe lãkusi eve me, eye ele be woatsɔ beléle gã aɖe aku doawo, elabena afɔku le lãmekawo kple ʋuka siwo le ete la ŋu be woaxɔ abi. Viɖewo: dedie drilling le ŋgɔgbe gbadzɛ screw mɔ̃, agbalẽvi apposition, bɔbɔe contouring.

De dzesii: Zi geɖe la, mehiã be woatsɔ ƒu ado ƒui le dɔdamɔnu gbãtɔa me o; le ememe léle vɔ megbe la, ele vevie ŋutɔ be woabla myofascial layer la nyuie be wòatsyɔ nu agbaa dzi eye wòaxe mɔ ɖe dɔlékuiwo xɔxɔ nu.

Intramedullary ƒe ʋuʋu

Mɔ̃ siwo wozãna fifia tsɔ léa lãkusiwo ɖe te dometɔ aɖewoe nye Kirschner pins, Rockwood pins, Hagie pins, titanium elastic intramedullary pins, hollow screws, kple elastic locking intramedullary nails; le kpɔɖeŋu me, titanium elastic nails meɖea mɔ na static locking o, meɖea mɔ be woakpɔ didime kple tɔtrɔ dzi o, eye ate ŋu ana evelia nanɔ kpuie ne wozãe na comminuted fractures. Woate ŋu azã intramedullary nailing mɔnu la ɖe asike ƒe gbagbã bɔbɔe, si le tsia dzi alo esi le tsia dzi ko ŋu.

Viɖe siwo le eŋu

lãɖeɖe suetɔ, ​​atsyɔ̃ɖoɖo wu, lãmeka falɛfalɛwo ƒe ɖeɖe mesɔ gbɔ o, endophyte ƒe dodo ƒe afɔku si le ʋɛ wu, kple liƒo si do ƒome kple ʋuʋudedi ƒe wɔwɔme.

Nusiwo gblẽ le eŋu

ŋutigbalẽ ƒe dzikudodo alo nusiwo gblẽ le afisi wòge ɖo.

De dzesii:Esesẽna ɣeaɖewoɣi be woaɖe akɔta ƒe gbagbã dzi akpɔtɔ eye woƒoa asa na dɔwɔla ƒe asi ƒe keklẽ si gbɔ eme le amekoko ƒe afɔɖeɖewo me.

Plate fixation si mewɔa nu boo aɖeke o

Wosusu be ƒumeŋuɖui ƒe ƒunukpeƒetetedɔ si mexɔa ame boo aɖeke o naa ŋusẽ geɖe wu le nugbagbewo ƒe dɔwɔwɔ me esime wòƒoa asa na nusiwo gblẽ le aŋekotoku si le ʋuʋu ɖi alo ƒunukpeƒetete ƒe ʋuʋu ŋu.

3.5 system LCP ƒe dada ɖe dɔwɔwɔ me le ŋgɔgbe na akɔta, eye anyo wu be woatsɔe aɖo ŋgɔgbe le akɔta te, na be woate ŋu aƒo nu tso akɔta si le lãmesẽ me ŋu, si wɔnɛ be wònɔa bɔbɔe be woatrɔ asi le agbalẽvi la ŋu do ŋgɔ eye woakpɔ gavi ƒe ʋuƒo didi wu.

Plato osteosynthesis si mewɔa nu boo aɖeke o zazã kaba ate ŋu ado ƒome kple supraclavicular nerve injury, ka eve siwo mewɔ ɖeka nyuie o alo woƒe kpuiƒe si gblẽa nu le dɔwɔwɔ ŋu, kple plate ƒe bɔbɔ alo gbagbã.

Plate fixation of fractures of the axadzinuwuwu le akɔta

Tiatia si woatsɔ ade aŋekotokuwo me nɔ te ɖe ƒu si le axadzi ƒe lolome dzi. Wohiã na bicortical screws 3 ya teti na axadziƒu ƒe mɔxexe. Le mɔ nyuitɔ nu la, ele be woazã tension screws na oblique fractures. Ne ƒu ƒe ʋuƒoa le sue akpa be woate ŋu alée ɖe te la, woate ŋu azã akɔta ƒe kɔsɔkɔsɔ ƒe agbalẽvi.

Acromioclavicular ƒunukpeƒetetedɔ ƒe ʋuʋu

Acromioclavicular ƒunukpeƒe ƒe abixɔxɔ nye 12% le scapular girdle ƒe abixɔxɔ me eye zi geɖe la, edzɔna le kamedefefewɔla siwo yɔ fũ kple kadodo me.

Nuƒolanɔƒe ƒe ɖoɖo si wozãna wue nye Rockwood fefewɔƒe. Ƒomevi I nye acromioclavicular ligament ƒe ŋeŋe eye rostroclavicular ligament la me gblẽ o; ƒomevi II nye acromioclavicular ligament ƒe aɖatsi si me rostroclavicular ligament la me gblẽ o; ƒomevi III nye acromioclavicular ligament kple rostroclavicular ligament siaa ƒe aɖatsi; ƒomevi IV nye akɔtaƒu si le didiƒe ƒe megbeʋuʋu si ƒoa trapezius la; ƒomevi V nye acromioclavicular ƒunukpeƒe kple rostroclavicular ligament siaa ƒe vuvu keŋkeŋ, eye ƒunukpeƒea ƒe ʋuʋu wu 100 le alafa me; eye abi ƒomevi VI mebɔ kura o, eye akɔta si le didiƒe la ʋuna yia anyime le rostral ƒe dɔwɔwɔ te.

Wokafu atikewɔwɔ si me womezãa brek le ɣeyiɣi kpui aɖe me kple cantilever sling na abi ƒomevi I kple ƒomevi II. Woʋlia nya le abi ƒomevi III dzi kpɔkpɔ ŋu, eye agbalẽ aɖewo gblɔ be wofia be woawɔ atike na sɔhɛ tsitsi siwo le dɔ dzi vevie. Dɔwɔwɔ ƒe hayahaya nyo togbɔ be ate ŋu anye be nɔnɔme madeamedzi vovovowo ate ŋu anɔ anyi le dzedzeme me hã. Abi ƒomevi IV - VI nu sẽna wu eye wokafui be woawɔ dɔ na ame.

Fifia la, amekokomɔnu siwo wozãna zi geɖee nye: Bosworth rostral locking screw mɔnu si me wodzraa ligament ɖo le afɔɖeɖe ɖeka me alo womedzraae ɖo o;, clavicle hook plate fixation, si sɔ kple clavicle fracture ƒe axadzi nuwuwu; Tightrope ƒe tab plate fixation alo anchor pinning suture to ƒunukpeƒekpɔmɔ̃ alo lãɖeɖe sue aɖe me; kple rostral locking ligament suture alo reinforced suspension, kple nusi wowɔ alo lãkusi si le rostral eminence kple clavicle dome.

Womenya amekokomɔnu si ɖea vi wu o, eye togbɔ be ate ŋu anye be woate ŋu abu alesi wogawɔa dɔe ake hã la, alesi mɔnu siawo katã wɔa dɔe mlɔeba la dzea ame ŋu.

Atikewɔwɔ na medial end clavicle fractures kple sternoclavicular ƒunukpeƒe ƒe ʋuʋu

Abi siawo mebɔ kura o, eye le afisia hã la, atikewɔwɔ ŋuti mɔfiame siwo wotu ɖe atikewɔwɔ si wotu ɖe kpeɖodzi dzi dzi meli o.

Zi geɖe la, medial clavicle fractures nyea extra-articular fractures siwo me ʋuʋu mele vevie o eye woate ŋu adae le mɔ si me womezãa nu geɖe le o nu. Zi geɖe la, akɔta ƒe titina ƒe nuwuwu ƒe epiphysis tuna ne woxɔ ƒe 23-25 ​​eye wònye epiphysis mamlɛtɔ si tu le ŋutilãa me. Eyata le nyateƒe me la, titina ƒe abi geɖe nye Salter-Harris ƒomevi I alo II ƒe epiphyseal plate gbagbã. X-ray siwo wozãna ɖaa ƒe dzesidede sesẽ, eye viɖe si le eŋu be fotoɖeɖe si woɖena le ta 40° kple esi wotsɔe sɔ kple akpa si le lãmesẽ me ate ŋu aɖee afia be akɔta ƒe titina ƒe nuwuwu aʋuʋu, eye CT naa wokpɔa nɔnɔmetata nyuitɔ kekeake.

Zi geɖe la, woate ŋu atu gbagbãƒe alo ʋuʋudedi siwo woɖe le ŋgɔgbe eye woagbugbɔ aɖo wo ɖe teƒe bubu, gake zi geɖe la, womeli ke o eye wowɔa lobotomized hena wo gbugbɔ ʋuʋu. Wokafu beléle na ame ƒe dziɖeɖi le ʋuʋu alo ʋuʋu atraɖii ŋu elabena zi geɖe la, womehea dɔwɔwɔ ƒe gbɔdzɔgbɔdzɔ vɛ o. Ƒã hafi akɔta ƒe titina ƒe nuwuwu ƒe ʋuʋu le megbe hea abi si le titina ƒe akpa si le etame vɛ, si me ʋukawo ƒe abi alo yaƒoƒo ƒe xexe kple yaƒoƒomɔ̃ ƒe tete gɔ̃ hã le. Le ʋuʋudedi kple gbagbãƒe siwo domedome kakɛa le sue akpa gome la, woate ŋu atsɔ agbalẽviawo atso ƒunukpeƒea dzi be woatsɔ alé wo ɖe akɔtaƒua ŋu.

Mɔnu bubu siwo wozãna tsɔ léa nu ɖe ​​te

eg gotagome fixation kple stent, gota fixation kple clavicle plate, kple bubuawo.

Dɔwɔwɔ vɔ megbe ƒe dɔdzikpɔkpɔ

Ele be woana abɔ si le etame la nagaʋuʋu le aŋetu me o eye woadze abɔta ƒe pendulum hehexɔxɔ gɔme enumake. Kwasiɖa 2 megbe la, ele be woakplɔ dɔnɔa ɖo be woalé ŋku ɖe abi la ŋu eye woato X-ray-awo me, evɔ woate ŋu aɖe abɔta ƒe ʋuƒoa ɖa eye woadze ƒunukpeƒetetedɔ ƒe hehexɔxɔ gɔme seɖoƒemanɔmee, gake ele be woagblɔ na dɔnɔa be megakɔ kpekpemewo kple abɔ si ŋu dɔlélea le o. Woate ŋu adze ŋusẽdodo hehexɔxɔ gɔme le kwasiɖa 6 le dɔwɔwɔ vɔ megbe ne ƒu ƒe dɔyɔyɔ ƒe dzesiwo dze. Ele be woaƒo asa na kadodo kple kamedefefe alo kamedefefe siwo gbɔ eme ɣleti 3 le amekokoa megbe vaseɖe esime ƒu gbagbãa haya keŋkeŋ.

Kuxi siwo dona tso eme.

Kuxi siwo doa mo ɖa le gɔmedzedzea me

Abi ƒe dɔlékuiwo xɔxɔ le dɔwɔwɔ vɔ megbe ate ŋu adzɔ le ame siwo ade 4.8% me;

Kuxi le subclavian nuto me nye kuxi si bɔ wu, kple dzɔdzɔmeŋutinya me numekuku le dɔnɔ siwo ŋu dzesi sia le ƒe 83% ŋu, si dzi ɖena kpɔtɔna le ɣeyiɣi aɖe megbe eye mehea dɔmawɔmawɔ nyuie gã aɖeke vɛ o, togbɔ be ate ŋu anɔ anyi vaseɖe ƒe 2 le dɔwɔwɔ vɔ megbe hã;

Endophyte ƒe dodo kple ŋutigbalẽ ƒe ʋuʋu, si bɔ le agbalẽ siwo lolo alo ɖa ƒe asike zazã me evɔ wometsyɔa lãkusi falɛfalɛ nyuiwo dzi o;

gbugbɔgagbã, si ate ŋu adzɔ le amekoko kple atikewɔwɔ si me womezãa atike aɖeke le o siaa megbe; abixɔxɔ le amekoko megbe ate ŋu ana be lãkusia nabɔbɔ alo agbã, alo wòagbã ƒo xlã lãkusia;

nonunion, kple nonunion ƒe xexlẽme 15% kple atikewɔwɔ si me womezãa nu geɖe le o eye 2% nonunion ƒe agbɔsɔsɔme le amekoko ƒe atikewɔwɔ na diaphyseal fractures siwo woɖe ɖa keŋkeŋ; ƒu gbagbãƒea ƒe ʋuʋu keŋkeŋ, ƒu ƒe kpuiƒe si wu sentimeta 2, atamanono, ƒe si le dzidzim ɖe edzi, abi siwo ŋusẽ geɖe xɔxɔ, ƒu ƒe gbagbã ake (mɔ̃wo ƒe malikenyenye), ƒu ƒe ʋuʋu si mewɔa naneke o, ƒu ƒe nyonyome manyomanyo, kple ƒu ƒe bu fũ akpa.

Kuxi siwo doa mo ɖa le megbe

Ƒunukpeƒetetedɔ si le acromioclavicular ƒunukpeƒea dzɔna zi geɖe wu ne ƒunukpeƒetetedɔ ƒe gbagbã (Edinburgh ƒomevi 3B2); ne atikewɔwɔ si me dzesiwo le kple esi me womezãa dɔlélea le o mewɔa dɔ o la, woate ŋu aɖe akɔta si le didiƒe la ɖa to ƒunukpeƒetetedɔ alo amekoko le gaglãgbe me;

Nuwɔametɔnyenye ƒe dɔyɔyɔ, si dzɔna le agbɔsɔsɔ vovovowo me le lãmeka siwo katã woɖe le teƒe bubu siwo ŋu wowɔ atike na le mɔ si mesɔ o nu; abɔta ƒe alidziblanu ƒe kpuiƒe si kpe ɖe abɔta ƒe gbagbãƒe si le didiƒe ƒe tɔtrɔ ŋu ate ŋu ana abɔta ƒe ŋusẽ kple dzidodo mlɔeba dzi naɖe akpɔtɔ, vevietɔ le abɔta ƒe ameléle sesẽe me; akɔta ƒe dodoƒe ƒe ɖeɖe ate ŋu ana abɔta ƒe ʋuka ƒe tete ƒe dzesiwo nadze; kple ƒunukpeƒe ƒe gli ƒe ƒunukpeƒewo ƒe masɔmasɔ ate ŋu ana abɔta nate ɖe ŋgɔgbe eye wòana abɔta nase veve eye wòana lãme nasẽ, ne edze ƒã be dzesiawo tso nɔnɔme madeamedzi gbɔ Ne dɔyɔyɔ dzɔ la, woate ŋu aɖɔ ƒumeŋuɖui ɖɔɖɔɖo kple agbalẽvi ƒe ƒoƒo ɖo le dɔnɔa ƒe nuhiahiãwo nu.

Nyagblɔɖi kple emetsonu

Numekuku aɖe si do ƒome kplii le Europa ka nya ta be amekoko ƒe atikewɔwɔ na titinaƒu ƒe gbagbã siwo woɖe ɖa la wɔ dɔ nyuie, eye eƒe meta-kuxiwo me dzodzro ɖee fia be dɔmawɔmawɔ nyuie si hea gbagbã ƒe nonunion vɛ kple dɔmawɔmawɔ nyuie si hea dzesiwo vɛ la bɔbɔ ŋutɔ le amekoko ƒe ƒuƒoƒoa me wu ƒuƒoƒo si wowɔ atike na le mɔ si me womezãa atike vɔ̃ɖiwo le o nu ne wotsɔ amekoko sɔ kple atikewɔwɔ si me womezãa nu geɖe le o; tsɔ kpe ɖe eŋu la, amekoko ƒe ƒuƒoƒoa ɖe vevesese dzi kpɔtɔ le gɔmedzedzea me, eye Constant kple DASH ƒe dɔwɔwɔ ƒe dzesiwo ƒe ŋgɔyiyi dze ƒã wu.

Gblɔe kpuie

Ŋutasẽnuwɔwɔ tẽ alo esi metso tẽ o gbɔe akɔta ƒe gbagbã akpa gãtɔ tsona, eye woate ŋu ade atikewɔwɔa ɖe hatsotsowo me be enye atikewɔwɔ si me womezãa atike o alo amekoko. Le atikewɔwɔ gome la, togbɔ be woate ŋu ada akɔta ƒe gbagbã akpa gãtɔ siwo me ʋuʋu ɖedzesi aɖeke le o le mɔ si me womezãa nu geɖe le o nu hã la, woʋlia nya le amekoko ƒe atikewɔwɔ ƒe tiatia si woate ŋu azã na ƒu gbagbã siwo me ʋuʋu gã aɖeke le ŋu. Le akɔta ƒe gbagbã siwo woɖe ɖa gome la, amekoko ƒe atikewɔwɔ na ƒu ƒe dɔyɔyɔ kple dɔwɔwɔ me tsonu kaba wu ne wotsɔe sɔ kple atikewɔwɔ si me womezãa nu geɖe le o.

Nusiwo ŋu woke ɖo

[1] Postacchini F, Gumina S, De Santis P, Albo F. Dɔvɔ̃ŋutinunya le akɔta ƒe gbagbã ŋu. J Abɔta ƒe Abɔta Surg 2002; 11:452 me nyawo.

[2] Eiff, M. P., Hatch, kple ame bubuwo. Clavicle kple scapula ƒe gbagbã. Le: Fracture Management na Gbãtɔ ƒe Dɔnɔdzikpɔkpɔ, 2nd ed, W. B. Saunders, Philadelphia 2002. p.198.

[3] Robinson C. M. Akɔta ƒe gbagbã le ame tsitsia me. Dɔvɔ̃ŋutinunya kple hatsotsowo me toto. J Ƒumeŋuɖui ƒe Dɔléle Br 1998; 80:476 me.

[4] Neer C. S. 2 lia. Akɔta ƒe akpa etɔ̃lia si le didiƒe ʋĩ ƒe gbagbã. Clin Orthop Relat Res ƒe 1968; 58:43 me.

[5] Andersen K, Jensen PO, Lauritzen J. Atikewɔwɔ na akɔta ƒe gbagbã. Figure-of-eight ƒe aŋekotoku tsɔtsɔ sɔ kple aŋetu bɔbɔe. Acta Orthop Scand ƒe 1987; 58:71 me nyawo.

[6] Ersen A, Atalar A. C., Birisik F, kple ame bubuwo. Abɔta ƒe ʋuƒo bɔbɔe kple akɔta ƒe aŋe enyi ƒe nɔnɔmetata tsɔtsɔ sɔ kple wo nɔewo hena midshaft clavicular fractures: numekuku si wowɔ le vome. Ƒu ƒe Ƒunukpeƒe J 2015; 97-B:1562 ƒe agbalẽa.