Ganewar asali da magani na clavicle cracture

Shigowa da

Clickricarsratrates suna da kowa gama gari kuma yawanci yana haifar da rauni kai tsaye ko a kaikaice ga yankin kafada. Bincike a farkon shekarun 1960 sun ruwaito cewa rabuwar clavicle na karaya kasa da 1%, da kuma ra'ayin mazan jiya sun haifar da samun gamsuwa mai haƙuri; Tare da ci gaban magunguna na kwanan nan, jiyya ya sami mahimmancin inganci; Saboda haka likitocin asibiti suna aiki a sashen gaggawa ko asibitin gaba ɗaya ya kamata ya zama sanannu tare da bayyanannun gama gari da rikice-rikice na wannan rauni da kuma tsarin sa.

TopideMology

Asusun clavicle don asusun 2.6% -5% na duk fashewar girma [1,2]. Binciken Turai wanda ya haɗa da shari'ar karaya 1,000 a jere [3,4] cewa sama da kashi 66% na clavicle, da 3% daga cikin karagai 1/3. Abin da ya faru na karaya na clavicle ya nuna rarraba bimodal, wanda ke faruwa da farko a cikin maza a cikin shekaru 30 da haihuwa, suka biyo bayan shekaru 70 da suka wuce shekaru 70.

Clinical Anatomy

Farkon farkon mutum jikin mutum ya fara outscification shi ne clonicle din, wanda kawai mai gabatarwa tare da sternum, scter) hadin gwiwa (sc) hadin gwiwa. Ana kiran waɗannan haɗin gwiwa na Atpical Myn icus saboda an yi layi tare da Fibrongrelage maimakon gurinan hyaline. An ancholed a cikin scapula da cinikin da acomioclavicular da rostocovicular da rostoclavicular da rostoclavicular kuma an haɗe shi da sternum ta sternoclavicular fata.

A covicle ne 's ' s 'sned. Ayyukan da suka dace da ayyukan rabin-ArC suna gabato, suna barin ɗakin don ƙwayar ƙwayar ƙwayar cuta ta babba. Distalin rabin na ARC ayyukan baya (concave) sannan kuma ya shiga cikin Scapula (tsari na rostral da maƙarƙashiya). Rarraba na clavicle yawanci suna faruwa a kan jugtion na ArCs guda biyu (tsakiyar Arc), mafi kusantar saboda rashin ƙwayoyin jijiya a wannan yankin kuma saboda shi ne mafi rauni a cikin clavicle. A lokacin da clavicle karbuka da aka yi gudun hijira, kashi naúrar kusan ta tashi sama (Ceepicle) ta hanyar mafi girman dutsen) da kuma coudad) ta hanyar mafi girman mura) da kuma matsakaicin ƙarshen na sama) da kuma matsakaicin sashi ya ƙare da juna), da farko saboda Cangaren Balaguro da Pectoralist Manyan (wanda ke juya zuwa sama da babba). Wannan shi ne akasin haka saboda ƙanƙan da Balaguro da Pectoral manyan tsokoki (waɗanda ke jujjuya su sama da na sama kuma cire shi zuwa kirji).

Fasas

Manufar karaya na clavicle shine rage zafin da kuma mayar da aikin haɗin gwiwa. Yawancin clavicle cracture har yanzu suna kula da ra'ayin farko (yawanci ta gajarta ta fiye da 15 mm); Abubuwan da ke cikin ra'ayin mazan jiya kamar su adon-takwas, abubuwan hannu na gado, sayre Bandages, da imbrization. Ana aiwatar da dakatarwar dakatarwa a cikin matsanancin aiki, kuma farkon kewayon horar da motsi da kuma darussan karfi yawanci ana yin makonni 2-6 makonni bayan fashewar lokacin da yake warwarewa. Ba a bada shawarar adadi na bandeji 8 kamar yadda zai iya haifar da matsakaicin matsakaicin matsakaicin raunuka da kuma ƙarin ƙungiyar karaya ba [5,6].

Tarihi da Binciken Jiki

Clavicle fashe fashewar shine lalacewa ta hanyar tasiri kai tsaye ga faɗuwa kuma ana iya ganin su a cikin wasanni na waje a cikin tsofaffi da kuma a cikin faduwar faduwa a cikin tsofaffi. Yana da mahimmanci a ayyana tsarin rauni. Raunin raunin da ya dace da raunin kai da kuma raunin kirji, alhali karammiski sakamakon karamin rauni na iya zama ilmologanci. Rikicin da ya faru na buƙatar farkon farawa da kuma kulawa da haramtaccen yanki na bango na kirji. Aure, akwai kumburi da ecchymosis a wurin karaya, hade da nakasar da taushi. Ya kamata a biya hankali ga kyallen takarda don jacking, wanda zai iya haifar da necrosis fata da ulceration.

Buri

Mafi yawan karaya na iya lalata ta hanyar radiographs mai sauƙi na cuta. 20 ° Heep kai na radiogrs suna kawar da tasirin wuce gona da iri. Marasa lafiya ya kamata a zubar da kai a matsayin da ke tallafawa don mafi kyawun yanayin fitowar jiki. Weight-ɗaukar hoto yana taimakawa wajen tantance amincin raunin da ya faru a cikin clapomiclavicular chovicle chovemular chovemular chovemular chovemular chovemulal chovimal clavical chovicle chovular chovemular chovemular chovicle chovemular chovemular chovemal chovemular chovicle chovemular chovemal clavemular rauni a stertoclavicular hadin gwiwa. Takeaƙwalwar hoto na kirji yana taimakawa wajen yanke hukunci game da raunin da ya shafi cutar thoracic, kuma ana iya tantance gajeriyar hanya ta hanyar buga shi zuwa ga clovicle clovicle, kazalika da zartar da scapulracic bango rabuwa.

Iri

AO / OTA BAT DARCORGOR: Lambar Clavicle 15 ta ƙunshi shafuka uku: matsakaiciyar wakili (meapimal), disalys 15.3). TOREXIMA (INDIEL) da karkata (ATRAL) an tsara shi azaman (karin magana), nau'in b (wani ɓangare-artara-masoya), da kuma nau'in C (a kusa da C (gaba ɗaya a ciki). Ana rarrabe stractates kamar nau'in (mai sauƙi), nau'in b (weji), kuma a halin yanzu rarrabuwa ta kararwar clavicle.

Allman Typing ya dogara ne akan wurin karaya (i: meaial, mai tamani 1/3, II: a karkata 1/3, III: Mayaƙan 1/3).

Craig ya sake yin wannan rarrabuwa a kan Allman, tare da na kasance tsakiya 1/3 na clavicle; Rubuta II kasancewa da waje na 1/3 na clavicle a ciki, wanda aka kasu kashi 5 dangane da fashewar murƙushe; Kuma buga III kasancewa da rauni na ciki na 1/3 na clavicle, wanda aka kasu kashi 5 bisa ga digiri na rijistar shi ne inna-articular.

Rarraba na kusa da karaya 1/3 ya jaddada mahimmancin layin-zage-zango: Nauda na yakan faru kusa da jijiyoyin-zangon fata, tare da toshe kumburin karaya. Rubuta II ya unshi ligral-clavicle jijjibi kuma yana haifar da karaya karar karaya da kauracewa. Kuma buga iii ya shimfiɗa haɗin gwiwa tare da acromral-clavicular LIGAMIBATAN.

Edinburg zagaye wani tsari ne na rarrabuwa na difysis rauni bisa ga digiri na zirga-zirga.1 Haɗin karaya da nau'in karaya na uku. An rarraba karar gyaran diaphyis gwargwadon kasancewar karaya da kuma rashi karuwa na 2b1) kuma an sake fasalta (nau'in 2b2) kuma an tsara shi (nau'in 2b2) .3 Nau'in karaya 1 Shiga ƙarshen ƙarshen diaphysis da nau'in 3 shine ƙarshen ƙarshen ƙarshen diaphysis. Mearshe da kuma a kaikaitrarshen karaya a cikin subgroups 1 da 2 bisa ga ko hadin gwiwa mai kusa yana da hannu.

Hakanan akwai Rockwood Typing, Jiny Typing, da Breitner Typing.

Alagewa

Takamaiman karaya

1, bude rauni; 

2, gudun hijira> 2 cm; 

3, rage harafi> 2 cm; 

4. 

5, karaya da yawa; 

6, da ke haifar da karaya tare da rauni mai laushi; 

7, babban nakasar (gudun hijira da rage); 

8, Scaphoid rauni.

Hukumar raunin da ya faru

1, hade da raunin matsanancin rauni;

2, raunin kafada;

3, raunin da ya faru;

4, rauni hade da rauni neurovascular rauni;

5, Ipsayals da yawa na rijiyar ribrates sun haɗu da nakasar bango na kirji;

6, a rage gajeren clavicle don samar da kafada wined;

7, karuwar clovical na biyu.

Abubuwan haƙuri

1, marasa lafiya da raunin da ya faru da yawa suna buƙatar ɗaukar nauyi na farko;

2, marasa lafiya suna buƙatar koma baya ga aiki (misali, Elite da wasanni masu gasa).

Lokacin tiyata

Ya kamata a yi aikin tiyata ba tare da jinkirta ba lokacin da cikakken nuni ga tiyata yake yanzu.

Jinkiri a cikin tiyata fiye da makonni 2-3 a cikin alamomin karaya, musamman idan shirya don rufe gyaran ciki ta hanyar dabaru na Pacutopus.

Samun damar shiga

An sanya mara lafiya a kujerar kujerar rairayin bakin teku ko matsayin zurfin zaune. An cire kafada a ƙarƙashin ƙasa da ta ɗaukaka clavicle don saukin tiyata, kuma hannu ana toweled da haɗuwa da haɗe. Tudun canzawa tare da tsayi na clavicle ko wani sabar inieon na iya zaɓaɓɓu ga mai da yawa tsarin za a zaɓa.

SAURARA: Incin tresverer na samar da girma sosai, yayin da inasirin mai tsayi da ke rage haɗarin kasar Juplavicular rauni kuma ya fi matukar farin ciki.

Gyaran ciki

3.5 Tsara Tsarin Tsawon Tsabtarwa, sake sake gini, ko kuma ana amfani da lcps na filastik don gyara clavicle karye. An sanya faranti a sama ko na gaba da kamshi. Farantin faranti sunada karfi a cikin raunin tari yayin da aka sa su fi gaba, musamman idan akwai karaya da ke ƙasa, kuma suna da sauƙi don gani. Gyirta na Bicigistical na scors ya zama dole, kuma ya kamata a yi ramuka da babbar kulawa, kamar yadda akwai haɗarin rauni ga jijiyoyi da jijiyoyin jini a ƙasa. Abvantbuwan amfãni: Tsaro hakararre na farantin farantin na ciki, kayan kwalliya, mai sauƙin ban sha'awa.

SAURARA: Ba a buƙatar grafting ƙashin don tsarin farko; Bayan gyara na cikin gida, yana da mahimmanci a sanyaya mafi kyawun ƙwayar ƙwayar iri don rufe farantin kuma ya hana kamuwa da cuta.

Gyaran tsallakewa

Na'urori masu gyaran wasan kwaikwayo na yanzu sun haɗa da kirschner na kirschner na katako, rockwood fil, titanium m ranking ingratedullary kusoshi; Misali, titanium mai amfani da kusoshi na motsa jiki ba sa ƙyale kulle na static ba, kar a bada izinin sarrafa tsawon da juyawa, kuma na iya haifar da ragin sakandare lokacin da aka yi amfani da shi. Za'a iya amfani da dabarar dabara ta hanyar zina zuwa sauki, transverse ko oblique clavsicar karaya.

Yan fa'idohu

Karamin ciki, mafi kyau ado, ƙarancin nama mai laushi, ƙananan haɗarin odophyte, da kwanciyar hankali hade da scab.

Rashin daidaito

Fata na fata ko lahani a ƙarshen shigarwa.

SAURARA: Ruwa na rufewar clavicle wani lokaci yana da wahala da wuce gona da iri na hannun jari don an guji gudun hijira a lokacin maneuvers.

M m m m m

Minisally farantin farantin otteosynthasai na clavicle ana tunanin samar da babbar ƙarfi yayin guje wa rashin daidaituwa na bude kayan farantin abinci ko intredullary gyarawa.

Matsakaicin wuri na tsarin LCP na 3.5 LCP ga Clavicle, zai fi dacewa a ƙarƙashin buga koshin lafiya, ya sauƙaƙa siffar farantin a gaba kuma don samun dogon iska mai laushi.

Aikace-aikacen farko na mawuyacin farantin cuta na iya haɗe da rauni na Juver, jeri mara kyau ko gajarta nau'i-nau'i na wayoyi suna shafar aiki, da kuma karar da farantin.

Farantin farfadowa daga ƙarshen ƙarshen ƙarshen na clavicle

Zabi na farantin infolts ya dogara da girman toshe kasusuwa. Ana buƙatar mafi ƙarancin ƙwallon ƙafa 3 na ƙwararrun ƙwallon ƙafa. Ainihi, ya kamata a yi amfani da sukurori masu tashin hankali don fashewar karaya. Idan toshe kasusuwa ya yi kankanta don gyarawa, ana iya amfani da farantin ƙiyayya.

Lura da agogon hadin gwiwa na acomatiwan

Asusun hadin gwiwa na lafazin acromiwular don 12% na raunin da ya faru kuma sau da yawa suna faruwa a cikin 'yan wasan' yan wasan 'yan wasa.

Tsarin sarrafa mai yawanci ana amfani da shi shine madaidaicin dutsen. Nau'in da nake kwance na raunin fata tare da raunin zuciyarku ta rostoclavicular; Rubuta ii wani hawaye ne na fata mai cinyewa tare da raunin zuciyarku ta Rostocavicular. Type III wani hawaye ne na cin gashin gwiwa da jijiyoyin jiki; Rubuta IIL shine waje na waje na Motovicle Chovicle wanda keɓance trapezius. Rubuta va'idodin hatsar da kayan haɗin gwiwa da haɗin gwiwa da rostroclavicular jijiyoyin gwiwa, tare da fifita 100 cikin dari na haɗin gwiwa; Kuma buga raunin VI yana da wuya, tare da distal chovicle gudun hijira zuwa ƙasa a ƙasa tsari.

Binciken ra'ayin mazan jiya tare da ɗan kwalliya na ɗan lokaci tare da mai narkewa mai narkewa don nau'in raunin da na samu da nau'in raunin II. Gudanar da raunin III yana da rigima, tare da wasu littattafai na nuna cewa ana nuna cewa ana nuna cewa ana nuna maganin kula da ra'ayin mazan jiya. Maidowa mai aiki yana da kyau kodayake akwai wasu bambakun matakan digiri na bayyanar. Nau'in IV - raunin VI ya fi ƙarfin shiga ciki kuma ana bada shawarar shiga tsakani.

A yanzu haka, hanyoyin da aka saba amfani da su na yau da kullun sune: Bosworth Rostroring dabarar dunƙule tare da gyaran mataki guda ɗaya ko kuma babu gyaran jijiyoyin jiki; Tab ɗin Tagwali na Taby ficewa ko anchor pinning m ta hanyar arthroscope ko karamin incision; Kuma kulle na rustral ko sake dakatar da dakatarwa, tare da kayan wucin gadi ko jita-jita tsakanin alamu da kuma clavicle.

Ba a bayyana waccan dabara ba ta fi mawuyacin hali, kuma kodayake akwai wani matakin asarar resurficing, babban inganci na duk waɗannan dabarun yana da gamsarwa.

Jiyya na medial ƙarshen clavicle karaya da karkara na fternoclavicular hadin gwiwa

Wadannan lamuran suna da wuya, kuma sake akwai rashin kulawa dangane da maganin hujja.

Karatun Clavicle clavicle sukan zama karaya-articular karuwa tare da mroventifant gudun hijira kuma za'a iya kula da shi ta muhalli. Asifissis na ƙarshen ƙirar clavical yawanci rufe shekaru 23-25 kuma shine farkon epiphysis don rufewa a jiki. Sabili da haka, raunin da ya faru da yawa sune ainihin epiphyseal faranti na Salter-Harris nau'in i ko iI. Alamar al'ada X-haskoki suna da wuya a gane, tare da fa'ida wacce 40 ° kanshi za ta iya fito da gudun hijira na ƙarshen ofa, da kuma CT yana ba da kyakkyawan ɗaukar hoto.

Karji ko dislocations wanda aka rasa su na yawanci ana iya rufe shi da kuma sake juyawa, amma galibi ba shi da tabbas kuma a matse shi don sake fitarwa. Ana ba da shawarar kulawa ta PALLAD don abubuwan ban sha'awa ko ƙaura saboda yawanci ba sa haifar da rashin ƙarfi. Rage ƙarshen ƙarshen clavicle yana haifar da raunin da ya ji na sama, gami da rauni na jijiyoyin jini ko ma tracheal basewa ko korar tracheal da matsawa na jirgin ruwa. Don dislocations da karaya inda yanki na tsakiya yake ƙanana, ana iya burge faranti a fadin haɗin gwiwa don gyarawa zuwa sternum.

Sauran hanyoyin ficewa

Misali ficewa na waje tare da stent, gyaran waje tare da farantin clavicle, da sauransu.

Gudanar da Educerative

Dole ne a fara aiki da hannu a cikin jirgin ruwan pendulum ya kamata a fara horo nan da nan. Makonni 2 daga baya, ya kamata a bi mai haƙuri don bincika rauni da kuma nazarin X-haskoki za a iya farawa, amma ya kamata a gaya wa mara nauyi horo mai nauyi tare da reshe da abin ya shafa. Za'a iya farawa da horo na ƙarfi a cikin makonni 6 da ba a sani ba lokacin da alamun Bony waraka bayyana. Ya kamata a guji tuntuɓar wasanni ko matsanancin wasanni na tsawon watanni 3 bayan bugun jini har sai karar ya warke.

Rikicewa.

Rikice-rikice

Cututtukan rauni na ciki na iya faruwa har zuwa 4.8% na shari'ar;

Numbness a yankin Subclavian shine mafi yawan rikitarwa na yau da kullun, tare da binciken tarihin na halitta har zuwa wannan alamar, kodayake yana iya dagewa zuwa ga shekaru 2, kodayake yana iya dagewa zuwa shekaru 2.

Rashin daidaituwa da raunin fata, gama gari tare da amfani da faranti ko wutsiyoyi na ƙusa ba tare da kyakkyawan ɗaukar nama mai laushi ba;

sake-karaya, wanda zai iya faruwa bayan magani biyu da ra'ayin mazan jiya; Rauni na tiyata na iya haifar da lanƙwasa ko kuma karya na ƙarshen enoprosrostesis, ko karaya a kusa da endoprrostesis;

Nassunion, tare da ragi na 15% tare da yarjejeniyar ra'ayin mazan jiya da kuma ragin kudi 2% tare da jiyya na mai gudun hijira don jiyya na companyalseseals; Cikakken ƙaura na kararwar, gajarta mafi girma fiye da 2 cm, karuwa, raunin da ya faru, rashin ƙarfi na dimail, da rashin ingancin kashi.

M rikitarwa

Osteoarthritis na acomioclavicular hadin gwiwa yana faruwa sosai tare da hadin kai-arli-articular 3B2); A lokacin da jiyya ta jiyya da ra'ayin mazan jiya ba shi da inganci, ana iya ɗaukar hoto mai nisa, ta hanyar buɗewa da aka bude;

Rashin halakarwa, wanda ya faru ga bambancin digiri a cikin duk abubuwan da aka ruwaito su gudun hijira; Darajar slipular mai narkewa tare da jujjuyawar karaya na iya haifar da rage ƙarfi da ƙarfi da jurewa, musamman ma satar kafada; Tarraro game da babban abin da aka yi na iya haifar da alamun bayyanar da matsawa na Bugawa; da Malalegnment na Wallokin Wallon bango na iya haifar da matsanancin rauni da samar da ciwon kai, idan a bayyane yake cewa bayyanar cututtuka da farantin suna yiwuwa dangane da bukatun mai haƙuri.

Hangen nesa da sakamako

Nazari mai dangantaka a cikin Turai ya ruwaito cewa lura da tiyata ta nuna inganci a cikin kungiyar mai rikitarwa yayin da aka kwatanta tiyata tare da maganin ra'ayin mazan jiya; Bugu da kari, kungiyar tiyata ta rage ciwo da wuri, kuma ci gaba a cikin ci gaba da dash ayyukan da aka fada.

Taƙaita

Yawancin clavicle fashe fashewar shine lalacewa ta hanyar tashin hankali kai tsaye ko kai tsaye, kuma ana iya rarrabe jiyya a matsayin maganin ra'ayin mazan jiya ko magani. Dangane da batun magani, kodayake yawancin clavicle chracrates ba tare da ingantaccen motsawa ba a hankali, zaɓi na magani don rauni tare da haɓaka mai haɓaka yana da rigima. Don fashewar clavicle clavicle, tiyata yana da mafi girman adadin warkar da kashi na kashi da farkon aiki mai amfani idan aka kwatanta da maganin ra'ayin mazan jiya.

Nassoshi

[1] bompchchini f, guyatacchini f, guyatacchini f, guyatacch J Kener Enlbow Surg 2002; 11: 452.

[2] EIFIF, MAP, Hyan Hyan, et al. Clavicle da Scapula Karshe. A cikin: Rashin kulawa don kulawa ta farko, 2DD Ed, Wib Saunders, Philadelphia 2002. P.198.

[3] Robinson CM. Karancin murfi a cikin babba. Annobar magana da rarrabuwa. J kashi jingin Surg Br 1998; 80: 476.

[4] neer cs 2nd. Karancin karaya na na uku na clavicle. Clinhop Remat Res 1968; 58:43.

[5] Andersen K, Jensen Po, Lauritzen J. lura da clavicular karar karaya. Adadi-na-bandeji game da mai sauki sming. Actta Orthop Scand 1987; 58:71.

[6] Koren A, Atalalar Ac, Birisik F, et al. Kwatanta swing mai sauki da adadi na bandeji takwas na bandeji guda takwas na bandeji na miji: binciken da aka tsara. Hadin gwiwa na kashi na kashi na 2015; 97-B: 1562.