ʻO ka maʻi maʻi a me ka mālamaʻana i nā fractive clavicle

Hōʻikeʻike

ʻO nā mea maʻamau Clavicle he maʻamau a me ka hopena maʻamau mai ka papa kuhikuhi a iʻole ka hōʻikeʻana i ka trauma i ka wahi poʻohiwi. ʻO nā noiʻi ma nā makahiki 1960 i hōʻikeʻia he nui o ka helu nonunien o nā fravicle i emi iho ma mua o ka loaʻaʻana o ka mea hoʻomanawanui; me ka hoʻomohala houʻana o ka lāʻau lapaʻau hou, ua loaʻa ka hoʻomaʻamaʻaʻana o ka hana. No laila, hanaʻo Conicians e hana ana i ka'Āina Kūʻai Kūʻai Kūʻai a iʻole nā ​​mea e pili ana i ka mea e pili ana i nā hōʻike a me nā hoʻopiʻi maʻamau.

Epideminey

ʻO Clavicle Fuctive Fracturiet no ka 2.6% -5% o nā pākeke āpau [1,2]. ʻO kahi haʻawina european e pili ana i kahi 1,000 mau clavicle flavicle fredit fracture frees i loaʻa [3,4 Ua hōʻikeʻia ka uluʻana o ka clavicle i kahi hōʻailona bimdal, e hana ana i nā kāne ma lalo o nā kāne ma lalo o nā makahiki he 30 mau makahiki ma luna o 70 mau makahiki.

KAHIKOMITI

ʻO ka mua o keʻano o ke kanaka e hoʻomaka i ka ossificationʻo ka clavicle,ʻo ka pilina o ka bony Ua kapaʻia kēia mau'ōhua i kapaʻiaʻo ATYPIcal Synovial no ka mea ua hoʻololiʻia lākou me ka fibrroCartilage ma mua o ka carline cartilage. ʻO ka clavicle i hōʻikeʻia i ka scapula e nā scapula e ka acamulaclavicular a me nā ligamclavicular a me nā listroclavicular

ʻO ka clavicle ka 's ' '. ʻO ka papa inoa o nā papahana a ArcIMal Ka hapalua o nā hana o nā papahana arc ʻO nā pōkole o ka cokackacking pinepine ma ka huakaʻi o nā puaʻelua (waena-ʻo ka hapa nui o nā ligamesst i ko lākou wahi a me ka nāwaliwali o ka Claugict. Ke neʻe nei kahi mea clavicle clavicle, kokoke loa i ka pā o ka cernimal (cuphalad) e ke kaumaha o ka pale. mua ma muli o ka hoʻohālikelikeʻana o ka subscapularis a me nā pectoralnis nui (i loko o ka mea ma loko o ka lima o luna). ʻO ka mea nui kēia ma muli o ka hoʻohālikelikeʻana o nā subscapularis a me nā pectaris nui (ʻo ia ka mea ma loko o ka lima o luna a huki i ka umauma).

Nā hiʻohiʻona

ʻO ka pahuhopu o ka clavicle fractive fracture e hōʻemi i kaʻeha a hoʻihoʻi hou i ka hana hui. ʻO ka hapa nui loa o nā flavicle fractive i mālamaʻia ma mua o ka mālama muaʻana (maʻamau pinepineʻia e ka 15 mm); nā hana lapaʻau conservative e like me ke kiʻi-a me-ʻewalu mau manawa, e'ōlelo ana i nā mea hana a Velpeau, a me ka immobilization. Hoʻohanaʻia ka immobilization ho'ōho i ka hanaʻo ka nui, a me keʻano o ka hoʻomakaʻana o ka hana aʻo a me nā hoʻomaʻamaʻa ikaika. ʻAʻole i hōʻikeʻia ka hoʻohanaʻana o nā helu 8 o 8 mau mea e hiki ai ke alakaʻi i nāʻano ikaika axilliy

Ka mōʻaukala a me ka nānā kino kino

Hoʻokomoʻia nā Flavicle i nā hopena pololei i ka poʻohiwi ma hope o ka hāʻuleʻana o ka hāʻule aʻikeʻia ma waho o ka'ōpio i loko o ka'ōpio a me nā mea i loko o ka'ōpio. He mea nui ia e wehewehe i ka hana o ka hōʻeha. Hiki ke hoʻohuiʻia nā hōʻeha ikaika loa me ke poʻo a me nā hōʻehaʻeha, kahi i hopena ai i ka hopena o ka trauma liʻiliʻi. Pono nāʻeha nui e koi i ka hoʻomakaʻana a me ka mālamaʻana i ka weheʻana o ka pā o ka umauma scapular E hoʻopili, aia ke aniani a me ka ecchymis ma ka pūnaewele paʻaʻana, hoʻohuiʻia me ka deformity a me kaʻoluʻolu. Pono e ukuʻia ka nānāʻana i nā'āpana palupalu no ka hoʻopaʻaʻana, e kumu ana i kaʻili necrosis a me ka ulceration.

Hono

Hiki i nā hapa nui o nā mea nui ke hōʻikeʻia e nā leki uila Anteroposter. 20 ° MIRT Tilt Radiographs e hoʻopau i ka hopena o ka hoʻopiliʻana i nā cavitic. Pono nā mea maʻi e lanakila i ke kūlana kākoʻo pilikino e kākoʻo ai i ka maikaʻi o ka haʻaleleʻana i ka hoʻopiʻiʻana. ʻO ke kaupaonaʻana-no ka laweʻana i nā radiographs e kōkua i ka loiloiʻana i keʻano o keʻano clavicular clavicular a iʻole e hōʻike ana i nā hōʻeha claviclar clavicle. ʻO ka laweʻana i kahi pahu pahu pahu pahu e kōkua i ka hōʻehaʻana i kahi hōʻeha o keʻano, a hiki ke loiloiʻia ka pōkole ma ka hoʻohālikelikeʻana i keʻano scapultacic break.

Nāʻano

Ao / OTA Fracture Dislocation TypPecation:ʻO ka CLAVICLE FACCURE CODE 15ʻO nā pūnaeweleʻekolu: 15.2 FIFHYIS, 15.2 FORET). ʻO ka proximal (medial) a me ka weheʻole (hope) i ka heluʻana e like me keʻano he mea hana ʻO nā'āpana kīwaha i heluʻia e like me keʻano he (maʻalahi),ʻano b (maleʻole i ka hoʻohanaʻana i ka nui o ka hoʻopiliʻana o ka clavict

Hoʻokumuʻia ka typingman typing ma kahi o ka wahi o ka fracture (i: medial, cadent 1/3, II) (FIE.

Uaʻae houʻo Craig i kēia Staline ma ke kumu o Allman, me wau i ka waena waena o 1/3 o ka clavile; Type IIʻO ka mea i waho 1/3 o ka clavicle, i hoʻokaʻawaleʻia i nāʻano he 5 mau mea e pili ana i ka neʻeʻana o ka crost clavicular a me ka typei iiii i ka fracture o ka inner 1/3 o ka clavicle, i hoʻokaʻawaleʻia i nāʻano he 5 mau mea a iʻole he meaʻole paha.

ʻO ka leka uila o Neer o Lateral 1/3 Fracties e hoʻomaikaʻi i ka mea nui o ka Lika-Clavicular Lika Pākuʻi i nā mea i pili i ka ligament rostral-clavicular a me nā hopena i loko o ka poloka medial A e hoʻolōʻihi i ka type iii i ka hui acifoinocavicular me ka ligament clavil-clavicular ligament e koe nei.

ʻO Edinburgh Ke kākau nei i kahi'ōnaehana o ka papa o nā diaphysis e like me ke kiʻekiʻe o ka neʻeʻana a me keʻano he nui. ʻO ka helu o nā diaphysis e heluʻia e like me ka heleʻana a iʻole ka hoʻokaʻawaleʻana i nā'āpana a me nā'āpana 2B2). diaphysis a me keʻano he 3 ka hopena hope o ka diaphysis. Hoʻopiliʻia nā mea i waena a me ka hope o ka hopena ma hope i nā subgroups 1 a me 2 e like me keʻano o ka pilina pili kokoke.

Pēlā nō he mea printwood e kākau ana,ʻo ka nānāʻana o ka juger, a me ka hoʻopiliʻana i ke kāʻeiʻana.

Nā hōʻike hōʻike

Nā mea kiko'ī

1, e wehe i ka uila; 

2, e hoʻokaʻawale iā> 2 cm; 

3, pōkole> 2 cm; 

4, ka hoʻopiʻiʻana i nā'āpana fragture (> 3); 

5, ka palena o ka lehulehu; 

6, e wehe ana i ka weheʻana i ka hōʻehaʻana me ka hōʻeha kino; 

7, he deformity koʻikoʻi (neʻe a me ka pōkole); 

8, ua eha ino ia hai.

Nā hōʻeha hōʻeha

1, hui pū me nā hōʻeha opsillate

2, e hōʻeha ana ka poʻohiwi poʻohiwi;

3, nā hōʻeha he nui;

4, hui pūʻia me ka hōʻeha neurovascular;

5, ipsilateral i nā'ōpala nui o nā rib fractud i hui pūʻia me ka deformation pā umauma;

6, e pohō puʻeʻana o Clacticle i kapa i kahi poʻohiwi wili;

7, nā bladral clavicle clavicle.

Nā mea maʻi maʻi

1, nā mea maʻi me nā hōʻeha he nui e koi ai i ke kaupaonaʻana ma mua

2, nā poʻe maʻi e koi ana i ka hoʻihoʻi wikiwikiʻana i ka hana (e like me, elite a me nā hoʻokūkū hoʻokūkū).

Ka manawa o ka hanaʻana

Pono e hanaʻia ka mea kūʻai aku me kaʻole o ke kaliʻole i ka wā e hōʻikeʻia ana no nā hōʻike no ka hanaʻana i kēia manawa.

Ke lohi nei i ka hoʻokele ma mua o 2-3 mau wiki i nā hōʻike pili e hoʻonui ai i ka hōʻemiʻana i ka hoʻohanaʻana i ka hoʻoponopono kūloko

Loaʻaʻia kaʻike

Hoʻokomoʻia ka mea maʻi i ke kūlana noho noho ma kahakai a iʻole ke kūlana noho. ʻO ka poʻohiwi pili i paʻiʻia ma lalo o ke ea i lalo o ka clavicle no ka maʻalahi o ka hoʻomaʻamaʻa, a ua hoʻopiliʻia ka lima eʻae i ka hoʻopiliʻana. ʻO kahi hanana transversed ma ka lōʻihi o ke axis lōʻihi o ka claviclel a iʻole kahi paila o ka saber incisionl i kohoʻia i ke kumu hoʻohālike.

Kahakaha: Hāʻawi kahi hanana transversed i ka hoʻonuiʻana i ka hoʻonuiʻana,ʻoiai he hopena lōʻihi e hōʻemi i ka hopena o ka hōʻehaʻana o ka nui

Hoʻoponopono kūloko

3.5 Nā papa hoʻonohonoho hoʻonohonoho'ōnaehana, hana hou i nā papa, hiki ke hoʻohanaʻia nā lcps Ua kau maikaʻiʻia nā papa i luna a iʻole a iʻole ma kahi o ka clavicle. He ikaika nā papa i nā hōʻeha biomechanins i ka wā i kauʻia,ʻoiai inā he mea kūʻai aku ma lalo nei, a he mea maʻalahi keʻike. Pono ka hoʻoponoponoʻana o ka bicortical o nā screws, a pono e hoʻoheheʻeʻia nā lua me ka mālama nui, me he mea lā e hōʻeha ana i nāʻili a me nā kino koko ma lalo. Advent: palekana i ka mālamaʻana i ka pā o ke kahua mokulele antiory, plate apopo

Kahakaha:ʻAʻole pono ke koiʻia ka BRAN BRANGING BARFING no ke kaʻina hana mua; Ma hope o ka hoʻoponoponoʻana i loko

Hoʻoponoponoʻo Intramedullary

ʻO nā mea hoʻoponopono loiloi intramedullary i loko o nā kiʻinaʻo KirsChuld, Rockwood ♥, Hagie Jatics Eg,ʻaʻoleʻaeʻia nā nula elastic elima no ka paleʻana o Static, maiʻae no ka mālamaʻana i ka lōʻihi a me ka huliʻana i ka pōkole o ka lōʻihi. Hiki ke hoʻopiliʻia kaʻenehana Nratingurellary naramedullery i maʻalahi i ka maʻalahi, transclece clavicle.

Loaʻa

ʻO ka liʻiliʻi liʻiliʻi,ʻoi aku ka nui o kahi aesthetic,ʻoi aku ka palupalu palupalu, hoʻohaʻahaʻa i ka paleʻana o ka hopena o ka hopena o ka scab.

Loaʻa nā hemahema

ʻiliʻili a iʻole nā ​​hemahema i ke kumu o ke komoʻana.

Hoʻomaopopo: Hoʻonui ka hōʻemi o ka clavicle i kekahi manawa a paʻakikī loa o ka lima o ka mea hana i ka wā o ka radiation.

Ke hoʻonohonohoʻana i nā papa inoa Plate

Manaʻoʻiaʻo ka papa o ka plate geveally gotesosynthesis o ka claviclesis o ka claviclesi e hāʻawi i nā ikaika biomechanical nui i ka wā e pale aku ai i ka hoʻoponoponoʻana i nā mea i hoʻopauʻia a iʻole ka hoʻoponoponoʻana i nā hopena

ʻO ka hoʻonohonohoʻana o ka wahi o ka pono o ka clavicley 3.5 i ka clayicle,ʻoi aku ka maʻalahi o ka claviclely ma lalo o keʻano o ka pakali.

ʻO ka noi muaʻana o ka papa inoa o ke kīleʻa e hoʻopiliʻia aiʻo Osteosynthesis i pili me Supraclavicular

Hoʻopili i ka hoʻonohonohoʻana o nā pā o ka hope o ka hope o ka clavicle

Ke koho nei ke koho o nā popo plate e pili ana i ka nui o ka pā o ka iwi ma hope. ʻO ka liʻiliʻi loa o 3 bicortical screws e koiʻia no ka block Bront Bront. Pono e hoʻohana ponoʻia, e hoʻohanaʻia nā screws trinsin no ka nui oblique. Inā liʻiliʻi loa ka iwi o ka iwi no ka hoʻoponoponoʻana, e hoʻohanaʻia kahi papa pā puke clavix.

ʻO ka mālamaʻana i ka hoʻokūkū hoʻokūkū Acromoclacular

ʻO nā acrities acrominiclavicular e hōʻehaʻia no 12% o nā hōʻeha huhū a me ka pinepine e hele i ka nui o nā mea pāʻani.

ʻO ka'ōnaehana maʻamau maʻamau maʻamauʻo ia ka papa pōhaku. Pākuʻi wau he scrain o ka ligameculacular acromoclacular a me ka ligament rostroclavicular; Type II he waimaka o ka ligamecularular a me ka ligament rostroclavicular; ʻO Type IIA he waimaka o ka ligamecular a me ka ligament a me ka ligament rostroplacular; ʻO Type IVʻO kahi kiʻi paʻi kiʻi kiʻi o ka clavict clavicleng claviclening e hoʻopiʻi ana i ke trapezius; Pākuʻiʻiaʻo Vy Type V ka waimaka piha o ka hui AcromoClacular a me keʻano o ka rostclavicular a me nā mea i hōʻeha nuiʻiaʻo Vy Vy VI VI, me ka weheʻana o ka clavicle clavicle i lalo ma lalo o ke kaʻina hana rotsal.

ʻO ka mālama mālamaʻana me ka braking pōkole me kahi slinglever sling i'ōleloʻia no keʻano heʻano me a me nā hōʻeha II. ʻO ka hoʻokeleʻana o nā hōʻeha o Type III, me kekahi mau leka uila e hōʻike ana e hōʻikeʻia ana no ka mālamaʻana i nā mea'ōpio. ʻO ka hoʻolaʻaʻana i ka hana maikaʻiʻoiai he meaʻole paha keʻano o ka deformity i keʻano. Pākuʻi iv

I kēia manawa,ʻo nā hana hana maʻamau maʻamau: Bosworld Rostral locker Screcle me ka hoʻoponoponoʻana i ka ligament; ʻO ka papa hoʻonohonoho pākaka o ka papaʻaina a iʻole e hoʻoponopono i ka lepo lepo a iʻole nā ​​mea i hoʻopiliʻia ma o kahi'ōpū a iʻole kahi'āpana liʻiliʻi; a me nā rostrater locking suture suture a hoʻoikaika paha i ka hoʻokuʻuʻana, me nā mea kūlohelohe a iʻole tendon ma waena o ka hana rotstal a me ka clavicle.

ʻAʻole maopopo kaʻike i keʻano hanaʻoi aku ka maikaʻi o ka hanaʻana, aʻoiai heʻano hope o ka pauʻana, he maikaʻi loa o kēia mauʻano he nui.

ʻO ka mālamaʻana i nā hana clavicled Medial Flavicle a me Sternoclavicular hui

ʻO kēia mau hōʻeha e nui loa, a he hapa hou, aia kahi hemahema o nā alakaʻi lapaʻau e pili ana i nā lāʻau lapaʻau e hōʻikeʻia ana.

ʻO nā Flivicle Clavicle Fractive pinepine pinepine pinepine i nā mea hana hou me ka haʻaleleʻoleʻana a hiki ke mālamaʻia. ʻO ka epiphysis o ka hopena o keʻano o ka clavicle e pani pinepineʻia ma 23-25 ​​mau makahiki o ka makahiki aʻo ia ka epiphysis hope e pani ai i ke kino. No laila, he nui nā mea hōʻeha a me nā maʻi maʻi maʻi epiphyseal epiphyseal epiphyseal plate fractures of salter-harris type I or II. He paʻakikī keʻano o ka hana X-ray i ka diagnose, me ka pono o ka radio a me ka hoʻohālikelikeʻana o ka clavicle.

ʻO nā hoʻopiʻi a iʻole nāʻaeʻana i ka haʻaleleʻana a hiki ke paniʻia a hiki ke paniʻia, akā naʻe,ʻaʻole pinepine a weheʻia no ka haʻaleleʻana. Ua hōʻikeʻia ka mālamaʻana o ka paloiatative no ka hoʻoweliweli mauʻana a iʻole ka neʻeʻana no ka mea pinepineʻole lākou e hopena i ka hoʻopiʻiʻana. ʻO ka weheʻana o ka hopena medial o ka flavicle posteriorly e hōʻeha i ka hōʻeha ma luna No nā unahi a me nā'āpana kahi e liʻiliʻi ai keʻano medial, hiki i nā mea liʻiliʻi, hiki ke hoʻohālikelikeʻia nā papa ma luna o ka hoʻoponoponoʻana i ka sternum.

Nā hana hoʻoponopono'ē aʻe

eg i waho o ka hoʻoponoponoʻana i waho me ka hoʻonohonohoʻana, ka hoʻoponoponoʻana o waho me ka papa claylic plate, etc.

Hōʻikeʻike posterofative

Pono ka lima o luna e like me ka immobilized i loko o kahi sling a me ka hoʻomaʻamaʻa penikala pedulum e hoʻomaka koke e hoʻomaka koke. 2 mau pule ma hope mai, e laweʻia ka mea maʻi e nānā i ka hōʻeha a loiloi i ka hoʻomaʻamaʻaʻana o ka moder Hiki ke hoʻomaka i ka hoʻomaʻamaʻa ikaika ma 6 mau pule postoperally i ka wā e kūʻia ai nā hōʻailona o bony ho'ōla. E nānā i nā haʻuki haʻuki a he haʻuki paha e paleʻia no 3 mau mahina ma hope o ka hanaʻana a hiki i ka mea i ho'ōla pihaʻia ai ka fracture.

Nā hoʻopiʻi.

Nā hoʻopiʻi mua

Hiki i nā maʻi postoperative e hiki mai i ka 4.8% o nā hihia;

ʻO kaʻeha ma ka'āina subclavianʻo ia ka hoʻopiʻi maʻamau, me kahi haʻawina kūlohelohe o 83% o nā mea maʻi i ka manawa nui

ʻO ka hopena o keʻano a me keʻano o ke kino a me kaʻili o kaʻili,ʻo ka hoʻohanaʻana i nā papa hana maʻamau a iʻole nā ​​huelo o nā meaʻala maikaʻiʻole

re-fracture Hiki i ka hōʻeha hou-hōʻeha hou i ka hōʻeha a wāwahi paha i ka pauʻole o ka hope, a iʻole e hoʻopili a puni i ka hope loa;

noninion, me kahi helu helu 15% no ka mālamaʻana a me ka mālamaʻana a me ka 2% noniniona ka neʻeʻana o ka neʻeʻana o ka fracture,ʻoi aku ka pōkole ma mua o 2 cm, ka ulaula

Nā hoʻopiʻi hope

ʻO ka osteoarthritis o ka hui Acromoclavicular e hele pinepine ana me nā mea hana intra-articular (edinburgh type 3b2); I ka wā eʻikeʻia ai ka mālamaʻana a me ka mālamaʻana i ka mālamaʻana,ʻaʻole i hoʻohālikelikeʻia ka clavicle clavicle

ʻO ka ho'ōlaʻana o ka hana, e hele mai ana i nā pae kiʻekiʻe i nā hana i mālamaʻia i nā neʻe i mālamaʻia E hoʻolōʻihi i ka pōkole o ka scapular, e like me ka wili o ka pale o ka pale o ka pale o ka pale a me ka hoʻomauʻana,ʻoi aku ka nui o ka hoʻomanawanui; ʻO ka hapa nui o ka pukaʻana o ka thoracic e hopena i nā hōʻailona o ka brachus plexus plexus plexus plexus plexus; a me ka hoʻonuiʻana o ka nui o nā pūnāwai scapulholothac e hiki ke hana i keʻano o ka scapula a me nā mea e ho'ōla ai i ka maʻi o ka maʻi.

Prognosis a me ka hopena

Ua hōʻikeʻia kahi noiʻi e pili ana i ka Europa i ka mālamaʻana i kaʻoihana i nā mea i hanaʻia ma keʻano he nui o keʻano Eia kekahi hoʻohuiʻana i ka nui o nā hui he wahine i emi i kaʻeha, a me ka hoʻomaikaʻiʻana i nā helu mau a me Dash Hana.

Hōʻuluʻuluʻia

ʻO ka hapa nui o nā flavicle i hoʻokumuʻia e ka pololei a iʻole ka hanaʻole, a hiki i ka mālamaʻana ke hoʻohālikelikeʻia e like me ka mālama ponoʻana. I nā hua'ōlelo o ka mālamaʻana,ʻoiaiʻo ka hapa nui o nā fravicle iʻole ka neʻe nuiʻana e mālama ponoʻia, keʻano o ka neʻeʻana o ka neʻeʻana i nā neʻe nui. No nā pale clavicled clavicled,ʻoi aku ka maikaʻi o ka mālamaʻana o ka morgical i kahi kiʻekiʻe o ka iwi kaumaha a me keʻano o ka hanaʻana i ka hana conservative.

Nā manaʻo aʻoaʻo

[1] Postischini F, Gumina S, de Santis P, Albo f. Epidemirology. J HOOSER ELDGE ENBG 2002; 11: 452.

[2] Eiia, mp, Hatpa, et al. Clavicle a me nā scapula fcapula. I:ʻO ka hoʻokele kālā no ka mālama mua, 2nd Ed, WB Saunders, PhiladelPhia 2002. P.198.

[Listen] 3 Roonawai REN. Ka nui o ka clavicle ma ka pākeke. Epidemiollogy a me ka helu. J iwin stug br 1998; 80: 476.

[4] neer cs 2nd. Ka nui o ke kolu o ka mamao o ka clavicle. Ho'ākālaʻo Clin OtPor Bult i ka makahiki 1968; 58:43.

[5] A nāuuā kauaʻo Gensed e, Nā lālau ma St. Kiʻi-o-ʻewalu pahu ma luna o kahi sling maʻalahi. Ua halaʻo ACTH OTPHCH Scate 1987; 58:71.

[6] E na mea, he, ATalar AT, Birisik F, Et al. Hoʻohālikelikeʻia o ka Sling Simple Sling Sling a me ke kiʻi oʻewalu clavicular no nā papa clavicular clavicular: kahi aʻo i hoʻopaʻaʻia. E nā leo JODN Z 2015; 97-B: 1562.