ʻO ka ʻike a me ka mālama ʻana i nā ʻāʻī Clavicle

Hoʻolauna

He mea maʻamau ka haʻihaʻi ʻana o Clavicle a ma muli o ka ʻeha pololei a i ʻole ʻole i ka ʻāpana poʻohiwi. Ua hōʻike ʻia nā haʻawina i nā makahiki 1960 i ka liʻiliʻi o ka nonunion rate o nā clavicle fractures ma lalo o 1%, a ʻo ka mālama conservative ka hopena o ka hoʻomanawanui kiʻekiʻe; me ka hoʻomohala hou ʻana o ka lāʻau lapaʻau, ua loaʻa i ka lāʻau lapaʻau ka hopena koʻikoʻi; no laila, pono nā kauka lapaʻau e hana ana i ka keʻena pilikia a i ʻole ke keʻena maʻi maʻi maʻi maʻamau i nā hōʻike maʻamau a me nā pilikia o kēia ʻeha a me kāna hoʻokele kumu.

Epidemiology

ʻO nā haʻihaʻi Clavicle he 2.6%-5% o nā haʻihaʻi āpau āpau [1,2]. Ua ʻike ʻia kahi haʻawina ʻEulopa e komo pū ana me 1,000 mau maʻi haʻihaʻi clavicle [3,4] i ʻoi aku ma mua o 66% o nā haʻihaʻi clavicle i loaʻa i ka waena 1/3 o ka clavicle, ma kahi o 25% he lateral 1/3 fractures, a ʻo 3% he medial 1/3 fractures. Ua hōʻike ʻia ka nui o nā haʻihaʻi clavicle i ka puʻunaue bimodal, i hana mua ʻia i nā kāne ma lalo o 30 mau makahiki, a ukali ʻia e ka poʻe ma mua o 70 mau makahiki.

ʻAnatomy Clinical

ʻO ka iwi mua loa e hoʻomaka i ka ossification ʻo ia ka clavicle, ʻo ia wale nō ka pili iwi ma waena o ka lima luna a me ke kumu, e hoʻopuka ana me ka acromion, ka hui acromioclavicular (AC), a kokoke me ka sternum, ka hui sternoclavicular (SC). Ua kapa ʻia kēia mau hui ʻo atypical synovial joints no ka mea ua hoʻopaʻa ʻia lākou me ka fibrocartilage ma mua o ka cartilage hyaline. Hoʻopaʻa ʻia ka clavicle i ka scapula e nā acromioclavicular a me rostroclavicular ligaments a hoʻopili ʻia i ka sternum e ka sternoclavicular ligament.

ʻO ke ʻano o ka clavicle he 'S'. Hoʻomaka mua ka hapa-arc proximal, e waiho ana i ka lumi no ka pūpū neurovascular o ka ʻaoʻao luna. ʻO ka hapa mamao o ke arc e hana i hope (concave) a laila hui pū me ka scapula (ka hana rostral a me ka acromion). ʻO ka haʻihaʻi ʻana o ka ʻāʻī ma ka hui ʻana o nā arcs ʻelua (mid-arc), ʻo ia paha ma muli o ka nele o nā ligament e pili ana i nā iwi e pili ana i kēia māhele a no ka mea ʻo ia ka ʻāpana nāwaliwali loa o ka clavicle. Ke hoʻoneʻe ʻia ka haʻi ʻana o ka clavicle, ʻaneʻane huki pinepine ʻia ka ʻāpana proximal i luna (cephalad) e ka ʻiʻo sternocleidomastoid (pili ʻia i ka ʻaoʻao proximal o ka clavicle) a hoʻoneʻe ʻia ka ʻaoʻao mamao i lalo (caudad) e ke kaumaha o ka lima luna, a ʻo ka clavicle e hoʻomaka i ka 'shorten fracture' (ʻo ia hoʻi, ʻo ka hopena o ka ʻaoʻao ʻokoʻa) (ʻo ia hoʻi, ma muli o ka 'hoʻopōkole' i kēlā me kēia), ka ʻoki ʻana o ka subscapularis a me ka pectoralis major (e hoʻohuli i loko o ka lima luna). ʻO ka mea nui kēia ma muli o ka hoʻopaʻa ʻana o nā ʻiʻo nui o ka subscapularis a me ka pectoralis (e hoʻohuli i ka lima i luna a huki iā ia i ka umauma).

Nā hiʻohiʻona

ʻO ka pahuhopu o ka hoʻomaʻamaʻa ʻana i ka clavicle fracture e hōʻemi i ka ʻeha a hoʻihoʻi i ka hana hui. ʻO ka hapa nui o nā haʻihaʻi clavicle ke mālama ʻia ma ke ʻano conservative (e hoʻopōkole pinepine ʻia e ka 15 mm); ʻO nā lāʻau lapaʻau e like me nā kāʻei kiʻi-o-ʻewalu, nā maʻa forearm, nā kāʻei Sayre, nā lole immobilization Velpeau, a me ka immobilization. Hana ʻia ka hoʻokuʻu ʻana i ka immobilization ma ke ʻano koʻikoʻi, a ʻo ka hoʻomaʻamaʻa mua ʻana o ka neʻe ʻana a me ka hoʻoikaika ikaika e hana mau ʻia ma 2-6 mau pule ma hope o ka haʻi ʻana i ka wā e pau ai ka ʻeha. ʻAʻole ʻōlelo ʻia ka hoʻohana ʻana i ke kiʻi o 8 bandage no ka mea hiki ke alakaʻi i nā ʻeha axillary a ʻoi aku ka hui ʻole o ka haki [5,6].

Ka Moʻolelo a me ka nānā kino

Hoʻokumu ʻia nā haʻihaʻi Clavicle ma muli o ka hopena pololei i ka poʻohiwi ma hope o ka hāʻule ʻana a ʻike pinepine ʻia i nā haʻuki waho i ka ʻōpio a me ka hāʻule ʻole ʻana o ka poʻe ʻelemakule. He mea nui e wehewehe i ke ʻano o ka ʻeha. Hiki ke hui pū nā ʻeha ikaika kiʻekiʻe me nā ʻeha poʻo a me ka umauma, akā ʻo nā haʻihaʻi i loaʻa mai ka ʻeha liʻiliʻi he pathologic. Pono ka hoʻomaka mua ʻana a me ka wehe ʻana i ka wehe ʻana o ka pā scapular chest, neurologic a me nā ʻeha vascular. ʻO ka maʻi maʻi, aia ka pehu a me ka ecchymosis ma ka wahi haʻihaʻi, i hui pū ʻia me ka deformity a me ka palupalu. Pono e noʻonoʻo i nā ʻiʻo palupalu no ka huki ʻana i luna, hiki ke kumu i ka necrosis o ka ʻili a me ka ulceration.

Kiʻi kiʻi

Hiki ke ʻike ʻia ka hapa nui o nā haʻihaʻi e nā radiographs anteroposterior maʻalahi. Hoʻopau nā radiographs 20° poʻo i ka hopena o ka hoʻopili ʻana i nā lua ʻāʻī. Pono e ho'opa'a 'ia ka po'e ma'i ma ke kūlana kāko'o pono'ī e 'ike maika'i i ka ne'e 'ana o ka ha'i. He mea kōkua ke kaumaha no ka radiographs i ka loiloi ʻana i ka pono o ka rostral clavicular ligament i loko o ka clavicle distal a i ʻole acromioclavicular joint injuries. Kōkua ʻo CT i ka nānā ʻana i nā ʻeha scapular girdle paʻakikī a hāʻawi i ka ʻike maikaʻi ʻana i nā ʻeha clavicle proximal i ka hui sternoclavicular. ʻO ka lawe ʻana i ka radiograph umauma e kōkua i ka hoʻokuʻu ʻana i kahi ʻeha o ka ʻōpū e pili ana, a hiki ke loiloi ʻia ka pōkole ma ka hoʻohālikelike ʻana me ka clavicle contralateral, a me ka hoʻoholo ʻana i ka wehe ʻana o ka pā scapulothoracic.

Nā ʻano

AO/OTA Fracture Dislocation Type: ʻO ka code fracture clavicle 15 he ʻekolu mau wahi: 15.1 proximal (medial), 15.2 diaphysis, a me 15.3 distal (lateral). Hoʻokaʻawale ʻia nā haʻihaʻi proximal (medial) a me ka ʻaoʻao (lateral) e like me ke ʻano A (extra-articular), ʻano B (partially intra-articular), a me ke ʻano C (intra-articular piha). Hoʻokaʻawale ʻia nā haʻihaʻi kumu e like me ke ʻano A (maʻalahi), ʻano B (wedge), a me ke ʻano C (comminuted).

Hoʻokumu ʻia ka paʻi ʻana o Allman ma kahi o ka haki (I: medial, cadent 1/3, II: lateral 1/3, III: medial 1/3) (Fig. 7.2.1).

Ua hoʻomaʻemaʻe hou ʻo Craig i kēia hoʻokaʻawale ʻana ma ke kumu o Allman, ʻo wau ka waena 1/3 o ka clavicle; ʻO ke ʻano II ʻo ia ka 1/3 o waho o ka clavicle, a laila ua māhele ʻia i nā ʻano 5 e pili ana i ka neʻe ʻana o ka haʻihaʻi a me ka pilina me ka rostral clavicular ligament; a ʻo ka ʻano III ka haʻihaʻi o ka 1/3 o loko o ka clavicle, i māhele ʻia i 5 mau ʻano ma muli o ke ʻano o ka neʻe ʻana o ka haʻihaʻi a inā he intra-articular ka haʻi.

ʻO ka paʻi ʻana a Neer i nā haʻihaʻi ʻaoʻao 1/3 e hoʻokūpaʻa i ke koʻikoʻi o ka ligamenti rostral-clavicular: ʻo ke ʻano I hele ma kahi mamao loa i ka ligament rostral-clavicular, me ka hoʻoneʻe ʻana o ka poloka haʻi waena; ʻO keʻano II e pili ana i ka ligament rostral-clavicular a me ka hopena i ka hoʻoneʻeʻiaʻana o ka'āpana haʻi medial; a ʻo ke ʻano III e hoʻonui i ka hui acromioclavicular me ka ligament rostral-clavicular i koe.

ʻO ka paʻi ʻana ʻo Edinburgh he ʻōnaehana o ka hoʻokaʻawale ʻana i nā haʻihaʻi diaphysis e like me ke kiʻekiʻe o ka neʻe ʻana a me ka comminution. Hoʻokaʻawale ʻia nā haʻihaʻi o ka diaphysis e like me ka loaʻa ʻana a i ʻole ka loaʻa ʻole o ka pilina cortical ma waena o nā ʻāpana haʻihaʻi i nā ʻano A a me B. Hoʻopili hou ʻia nā ʻano 2A fractures ma ke ʻano nondisplaced (type 2A1) a me ka angulated (type 2A2), ua hoʻokaʻawale ʻia nā haʻihaʻi 2B ma ke ʻano maʻalahi a i ʻole ke ʻano wedge (type com2B1) a me ke ʻano 2B1 (type com2B1) a me ke ʻano 2B1 (type 2B1) ʻo ka hopena waena o ka diaphysis a me ke ʻano 3 ka hopena hope o ka diaphysis. Hoʻokaʻawale ʻia nā haʻihaʻi hope medial a me lateral i nā pūʻulu 1 a me 2 e like me ka pili ʻana o ka hui pili.

Pēlā nō ke kikokiko ʻana iā Rockwood, Jager type, a me Breitner type.

Nā hōʻailona hōʻailona

Nā haʻihaʻi kikoʻī

1, haʻi hāmama; 

2, hoʻoneʻe > 2 knm; 

3, pōkole >2 knm; 

4, ka hoʻohui ʻana o nā ʻāpana haʻihaʻi (>3); 

5, ʻāpana ʻāpana he nui; 

6, ma lalo o ka haʻihaʻi hāmama me ka ʻeha ʻili palupalu; 

7, deformity nui (ka hoʻoneʻe a me ka pōkole); 

8, eha scaphoid.

ʻeha hui

1, Hoʻohui ipsilateral ʻeha hope loa;

2, Eha poohiwi lana;

3, nui na eha;

4, ka haʻihaʻi i hui pū ʻia me ka ʻeha neurovascular;

5, ipsilateral iwi iwi haʻihaʻi i hui pū me ka umauma paia deformity;

6, pōkole clavicle e lilo i poʻohiwi ʻēheu;

7, nā haʻi ʻokoʻa ʻelua.

Nā mea hoʻomanawanui

1, ʻO ka poʻe maʻi me nā ʻeha he nui e koi i ka lawe ʻana i ke koʻikoʻi ma luna o ke kaumaha;

2, Pono nā maʻi e hoʻi wikiwiki i ka hana (e laʻa, elite a me nā haʻuki hoʻokūkū).

Ka manawa o ke oki

Pono e hana ʻia ke ʻoki ʻana me ka kali ʻole ke loaʻa nā hōʻailona maoli no ke ʻoki.

Hiki ke hoʻonui i ka paʻakikī o ka hōʻemi ʻana i ka haʻi, ʻoi aku ka hoʻomākaukau ʻana no ka hoʻohaʻahaʻa paʻa ʻana i ka hoʻopaʻa ʻana i loko e nā ʻenehana percutaneous.

ʻO ke komo ʻana i ke kino

Hoʻonoho ʻia ka mea maʻi ma ke kūlana noho kahakai a i ʻole ke kūlana semi-noho. Hoʻopili ʻia ka poʻohiwi i hoʻopilikia ʻia ma lalo e hoʻokiʻekiʻe i ka clavicle no ka maʻalahi o ke ʻoki ʻana, a ua kāwele ʻia ka lima e ʻae i ka hoʻoneʻe intraoperative. Hiki ke koho ʻia kahi ʻoki ʻoki ma ke koʻi lōʻihi o ka clavicle a i ʻole kahi ʻoki saber e like me ke ʻano langer.

'Ōlelo Aʻo: Hāʻawi ka ʻoki ʻoki ʻana i ka hoʻonui ʻana aku, ʻoiai ka ʻoki longitudinal e hōʻemi i ka hopena o ka ʻeha aʻalolo supraclavicular a ʻoi aku ka maikaʻi o ka nani.

Hoʻoponopono Kuloko

3.5 Hiki ke ho'ohana 'ia nā papa ho'opi'i ma'amau, nā papa hana hou, a i 'ole nā ​​LCP plastic no ka ho'oponopono 'ana i nā ha'i. Hoʻonoho maikaʻi ʻia nā papa ma luna a ma mua paha o ka clavicle. ʻOi aku ka ikaika o nā pā i nā ʻeha biomechanical ke kau ʻia ma luna, ʻoi aku ka maikaʻi inā loaʻa kahi haʻihaʻi ma lalo, a ʻoi aku ka maʻalahi o ka nānā ʻana. Pono ka hoʻoponopono ʻana i ka bicortical o nā wili, a pono e wili ʻia nā puka me ka mālama nui, no ka mea, aia ka pilikia o ka hōʻeha i nā aʻalolo a me nā kīʻaha koko ma lalo. Pōmaikaʻi: ʻo ka hoʻoheheʻe palekana ʻana o ke kaila wili o ka pā mua, ka ʻae ʻana o ka pā, ka maʻalahi o ka contouring.

'Ōlelo Aʻo: ʻAʻole koi ʻia ka grafting iwi no ka hana mua; ma hope o ka hoʻopaʻa ʻana i loko, he mea koʻikoʻi e hoʻopaʻa pono i ka papa myofascial e uhi i ka pā a pale i ka maʻi.

Hoʻoponopono intramedullary

ʻO nā mea hana hoʻoponopono intramedullary i kēia manawa, ʻo ia nā pine Kirschner, nā pine Rockwood, nā pine Hagie, nā pine intramedullary titanium elastic, nā ʻūwī kīwaha, a me nā kui elastic locking intramedullary; laʻa, ʻaʻole ʻae nā kui elastic titanium i ka laka paʻa, ʻaʻole e ʻae i ka mana o ka lōʻihi a me ka hoʻololi ʻana, a hiki ke hopena i ka pōkole lua ke hoʻohana ʻia no nā haʻihaʻi comminuted. Hiki ke hoʻohana ʻia ke ʻano hana nailing intramedullary i nā haʻi maʻalahi, transverse a i ʻole oblique clavicle fracture.

Nā pono

ʻoki liʻiliʻi, ʻoi aku ka maikaʻi, ʻoi aku ka maikaʻi o ka wehe ʻana o ka ʻiʻo palupalu, haʻahaʻa ka pilikia o ka puka ʻana o ka endophyte, a me ke kūpaʻa e pili ana i ka hoʻokumu ʻana o ka scab.

Nā pōʻino

ka ʻili a i ʻole nā ​​hemahema ma kahi e komo ai.

'Ōlelo Aʻo: Paʻakikī ka hoʻemi paʻa ʻana o nā haʻihaʻi clavicle i kekahi manawa a pale ʻia ka overexposure o ka lima o ka mea hana i ka radiation i ka wā o ke kaʻina hana.

Hoʻopaʻa paʻa liʻiliʻi invasive

Manaʻo ʻia ka osteosynthesis plate invasive liʻiliʻi o ka clavicle e hāʻawi i ka ikaika biomechanical ʻoi aku ka maikaʻi ʻoiai e pale ana i nā hemahema o ka hoʻopaʻa ʻana i ka pā ākea a i ʻole ka hoʻoponopono intramedullary.

ʻO ka hoʻokomo ʻia ʻana o ka ʻōnaehana 3.5 LCP ma mua o ka clavicle, ʻoi aku ka maikaʻi ma mua ma lalo o ka clavicle, hiki ke kuhikuhi i ka clavicle olakino, e maʻalahi ai ke hoʻohālikelike ʻana i ka pā ma mua a loaʻa ka puka wili lōʻihi.

ʻO ka hoʻohana mua ʻana i ka osteosynthesis pā liʻiliʻi liʻiliʻi e pili pū me ka ʻeha aʻalolo supraclavicular, ka alignment maikaʻi ʻole a i ʻole ka pōkole ʻana o nā ʻelua o nā uwea e pili ana i ka hana, a me ka piʻi ʻana a i ʻole ka haki ʻana o ka pā.

ʻO ka hoʻopaʻa ʻana o ka pā i nā haʻihaʻi o ka hope ʻaoʻao o ka clavicle

ʻO ke koho ʻana i nā pā implants ma muli o ka nui o ka poloka iwi ʻaoʻao. Pono ʻia ka liʻiliʻi o 3 wili bicortical no ka poloka iwi ʻaoʻao. ʻO ka maikaʻi, pono e hoʻohana ʻia nā wili hoʻopaʻapaʻa no nā haʻi oblique. Inā liʻiliʻi loa ka ʻāpana iwi no ka hoʻopaʻa ʻana, hiki ke hoʻohana ʻia kahi pā makau clavicle.

Hoʻomaʻamaʻa i ka dislocation hui acromioclavicular

Loaʻa nā ʻeha hui acromioclavicular no 12% o nā ʻeha kāʻei scapular a loaʻa pinepine i nā mea pāʻani pili piha.

ʻO ka ʻōnaehana hoʻokūkū maʻamau i hoʻohana ʻia ʻo ka Rockwood staging. ʻO ke ʻano I he sprain o ka acromioclavicular ligament me ka rostroclavicular ligament i paʻa; ʻO keʻano II he waimaka o ka ligament acromioclavicular me ka ligament rostroclavicular i paʻa; ʻO ke ʻano III he waimaka o ka acromioclavicular ligament a me ka rostroclavicular ligament; ʻO ke ʻano IV he neʻe hope o ka clavicle mamao e hoʻopaʻa ana i ka trapezius; ʻO ke ʻano V he waimaka piha o ka hui acromioclavicular a me ka ligament rostroclavicular, me ka ʻoi aku o 100 pakeneka o ka neʻe ʻana o ka hui; a he kakaikahi loa na eha ma ke ano VI, me ka hoonee ana o ka clavicle i lalo ma lalo o ke ka'ina hana rostral.

Hoʻomaʻamaʻa ʻia ka mālama ʻana me ka wā pōkole me ka maʻa cantilever no nā ʻeha ʻano I a me ke ʻano II. Hoʻopaʻapaʻa ka mālama ʻana i nā ʻeha ʻano III, me kekahi mau palapala e hōʻike ana e hōʻike ʻia ka mālama conservative no nā ʻōpio ʻōpio ikaika. Maikaʻi ka hoʻihoʻi ʻana i ka hana ʻoiai aia nā ʻano deformity like ʻole i ka helehelena. ʻOi aku ka koʻikoʻi o nā ʻeha ʻano IV - VI a ua ʻōlelo ʻia ke ʻano o ke kaʻi.

I kēia manawa, ʻo nā kaʻina hana kaʻina hana maʻamau: ʻo Bosworth rostral locking screw technique me ka hoʻoponopono ʻana i hoʻokahi pae a i ʻole ka hoʻoponopono ʻana i ka ligament; ʻO ka hoʻopaʻa ʻana i ka pā pā o Tightrope a i ʻole ke kuʻi ʻana i ka heleuma ma o ka arthroscope a i ʻole kahi ʻoki liʻiliʻi; a me ka locking ligament suture a i ʻole ka hoʻokuʻu ʻia ʻana, me ka mea hana a i ʻole ka tendon ma waena o ka rostral eminence a me ka clavicle.

ʻAʻole maopopo i ke ʻano o ke kaʻina hana i ʻoi aku ka maikaʻi, a ʻoiai aia paha kekahi degere o ka nalowale ʻana o ka hoʻōla hou ʻana, ʻoi aku ka maikaʻi o kēia mau ʻenehana āpau.

Hoʻomaʻamaʻa ʻana i nā haʻihaʻi waena waena a me nā dislocations o ka hui sternoclavicular

He kakaikahi kēia mau ʻeha, a ʻaʻole hoʻi he hemahema o nā alakaʻi lapaʻau e pili ana i ka lāʻau lapaʻau.

ʻO nā haʻihaʻi waena waena he mau haʻihaʻi extra-articular me ka hoʻoneʻe liʻiliʻi a hiki ke mālama ʻia me ka conservative. ʻO ka epiphysis o ka hopena waena o ka clavicle e pani maʻamau i ka 23-25 ​​mau makahiki a ʻo ia ka epiphysis hope loa e pani i loko o ke kino. No laila, ʻo ka nui o nā hōʻeha medial he mau haʻihaʻi pā epiphyseal o Salter-Harris ʻano I a i ʻole II. He paʻakikī ke ʻike ʻana i nā kukui X maʻamau, me ka maikaʻi o ka radiograph 40 ° head tilt a me ka hoʻohālikelike ʻana i ka ʻaoʻao olakino e hōʻike i ka neʻe ʻana o ka hopena medial o ka clavicle, a hāʻawi ʻo CT i ke kiʻi diagnostic maikaʻi loa.

ʻO nā haʻihaʻi a i ʻole nā ​​haʻihaʻi i hoʻoneʻe ʻia ma mua e hiki ke pani ʻia a hoʻonohonoho hou ʻia, akā pinepine ka paʻa ʻole a lobotomized no ka hoʻoneʻe hou ʻana. Manaʻo ʻia ka mālama palliative no nā dislocation mau a i ʻole ka neʻe ʻana no ka mea pinepine ʻole lākou i ka hopena o ka hana. ʻO ka wehe ʻana o ka ʻaoʻao waena o ka clavicle ma hope ʻaʻole hiki ke loaʻa i ka ʻeha mediastinal luna, e komo pū ana i ka ʻeha vascular a i ʻole ke keakea ʻana o ka tracheal a me ke kaomi ʻana i ke ea. No nā dislocations a me nā haʻihaʻi kahi i liʻiliʻi loa ka ʻāpana medial, hiki ke hoʻopili ʻia nā papa ma waena o ka hui no ka hoʻopaʻa ʻana i ka sternum.

Nā ʻano hana hoʻoponopono ʻē aʻe

e laʻa me ka hoʻopaʻa ʻana o waho me ka stent, ka hoʻopaʻa ʻana o waho me ka pā clavicle, etc.

ʻO ka hoʻoponopono postoperative

Pono e hoʻopaʻa ʻia ka lima o luna i ka maʻa a hoʻomaka koke ke aʻo ʻana i ka pendulum poʻohiwi. Ma hope o 2 mau pule, pono e hahai ʻia ka mea maʻi e nānā i ka ʻeha a nānā i nā hihi X, ʻoiai hiki ke wehe ʻia ka maʻa forearm a hiki ke hoʻomaka i ka hoʻomaʻamaʻa ʻana i ka hui ʻana, akā pono e ʻōlelo ʻia ka mea maʻi ʻaʻole e hāpai i ke kaumaha me ka lālā i hoʻopilikia ʻia. Hiki ke hoʻomaka i ka hoʻomaʻamaʻa ikaika ma 6 mau pule ma hope o ka hana ʻana ke ʻike ʻia nā hōʻailona o ka ho'ōla ʻana i ka iwi. Pono e hoʻokaʻawale i nā haʻuki a i ʻole nā ​​haʻuki koʻikoʻi no 3 mau mahina ma hope o ke ʻoki ʻana a hiki i ka hoʻōla ʻana o ka haʻi.

Nā pilikia.

ʻO nā pilikia mua

Hiki ke loaʻa nā maʻi ʻeha postoperative a hiki i ka 4.8% o nā hihia;

ʻO ka helu ʻana ma ka ʻāina subclavian ka pilikia maʻamau, me kahi noiʻi moʻolelo kūlohelohe a hiki i ka 83% o nā mea maʻi me kēia hōʻailona, ​​e hoʻemi ana i ka manawa a ʻaʻole e alakaʻi i ka dysfunction nui, ʻoiai hiki ke hoʻomau a hiki i 2 mau makahiki ma hope o ka hana;

ʻO ka endophyte protrusion a me ka hoʻoulu ʻana o ka ʻili, maʻamau me ka hoʻohana ʻana i nā pā voluminous a i ʻole nā ​​huelo kui me ka uhi ʻole ʻana o ke kino palupalu maikaʻi;

ka haʻihaʻi hou, hiki ke hana ʻia ma hope o ka hoʻomaʻamaʻa ʻana a me ka mālama conservative; ʻO ka hōʻeha hou ʻana ma hope o ke kaʻa ʻana hiki ke hopena i ke kūlou a haki ʻana paha o ka endoprosthesis, a i ʻole ka haki ʻana a puni ka endoprosthesis;

nonunion, me ka 15% nonunion rate me ka conservative treatment and a 2% nonunion rate with surgical treatment for completely displaced diaphyseal fractures; ka hoʻoneʻe piha ʻana o ka haʻihaʻi, ka pōkole ʻoi aku ma mua o 2 knm, ka puhi ʻana, ka piʻi ʻana o ka makahiki, nā ʻeha kiʻekiʻe o ka ikehu, ka haʻihaʻi hou (mechanical instability), recalcitrant diaphyseal dislocations, maikaʻi ʻole o ka iwi, a me ka nui o ka poho iwi.

Nā pilikia lohi

ʻO ka Osteoarthritis o ka hui acromioclavicular e ulu pinepine ana me nā haʻihaʻi intra-articular (Edinburgh type 3B2); inā ʻaʻole pono ka mālama ʻana i ka hōʻailona a me ka conservative, hiki ke ʻoki ʻia ka clavicle distal i ka arthroscopically a i ʻole ma ke ʻoki wehe ʻana;

ʻO ka ho'ōla deformity, ka mea i loaʻa i nā pae like ʻole i nā haʻihaʻi i mālama ʻia me ka mālama ʻole ʻia; ʻO ka hoʻopōkole ʻana i ke kāʻei scapular i hui pū ʻia me ka hoʻololi ʻana o ka poloka haʻihaʻi mamao e hiki ke hopena i ka emi ʻana o ka ikaika o ka poʻohiwi hope loa a me ka hoʻomanawanui, ʻoi aku hoʻi i ka lawe ʻana i ka poʻohiwi; ʻO ka hōʻemi ʻana o ka puka o ka ʻāʻī ke hopena i nā hōʻailona o ka hoʻopili ʻana o ka plexus brachial; a me ka malalignment o na ami paia scapulothoracic hiki ke hana i ka tilting anterior o ka scapula a hana i ka eha o ka poohiwi a me ka myalgias, ina ua maopopo ia mai ka deformity nā hōʻailona I ka wā e ho'ōla ai, hiki ke hoʻoponopono i ka osteotomy a me ka hoʻoponopono papa ma muli o ka pono o ka mea maʻi.

Ka wānana a me ka hopena

Ua hōʻike ʻia kahi noiʻi pili ma ʻEulopa e ʻoi aku ka maikaʻi o ka hoʻomaʻamaʻa ʻana i nā haʻihaʻi midclavicular i hoʻoneʻe ʻia, a ua hōʻike ʻia kāna meta-analysis i ka ulu ʻana o ka malunion e alakaʻi i ka haʻi nonunion a me ka malunion e hana ana i nā hōʻailona he haʻahaʻa haʻahaʻa loa i loko o ka hui ʻokiʻoki ma mua o ka hui conservatively mālama ʻia ke hoʻohālikelike ʻia ke ʻano me ka mālama conservative; Eia kekahi, ua hoʻemi mua ka hui ʻokiʻoki i ka ʻeha, a ʻoi aku ka maikaʻi o nā helu hana Constant a me DASH.

Hōʻuluʻulu

ʻO ka hapa nui o nā haʻihaʻi clavicle ma muli o ka hoʻomāinoino pololei a i ʻole, a hiki ke hoʻokaʻawale ʻia ka lāʻau lapaʻau ma ke ʻano he lapaʻau conservative a ʻokiʻoki paha. Ma ke ʻano o ka lāʻau lapaʻau, ʻoiai ʻo ka hapa nui o nā haʻihaʻi clavicle me ka ʻole o ka hoʻoneʻe nui ʻana hiki ke mālama ʻia me ka conservative, ʻo ke koho lapaʻau ʻokiʻoki no nā haʻihaʻi me ka neʻe nui ʻana he mea hoʻopaʻapaʻa. No nā haʻihaʻi o ka clavicle i hoʻoneʻe ʻia, ʻoi aku ka kiʻekiʻe o ka mālama ʻana i ka iwi a me nā hopena hana mua i hoʻohālikelike ʻia me ka mālama conservative.

Nā kuhikuhi

[1] Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Poʻohiwi Kuʻekuʻe wāwae 2002; 11:452.

[2] Eiff, MP, Hatch, et al. ʻO ka haʻi ʻana o Clavicle a me scapula. In: Fracture Management for Primary Care, 2nd ed, WB Saunders, Philadelphia 2002. p.198.

[3] Robinson CM. ʻO ka haʻi ʻana o ka ʻāʻī o ke kanaka makua. Epidemiology and classification. J Bone Joint Surg Br 1998; 80:476.

[4] Neer CS 2nd. Nā haʻihaʻi o ka hapakolu o ka ʻāʻī. Clin Orthop Relat Res 1968; 58:43.

[5] Andersen K, Jensen PO, Lauritzen J. Hoʻomaʻamaʻa i nā haʻihaʻi clavicular. He kiʻi-o-ʻewalu kāʻei kūʻē i kahi maʻa maʻalahi. Acta Orthop Scand 1987; 58:71.

[6] Ersen A, Atalar AC, Birisik F, et al. Hoʻohālikelike o ka maʻa lima maʻalahi a me ke kiʻi o ʻewalu kāʻei clavicular no nā haʻihaʻi clavicular midshaft: kahi haʻawina i hoʻopaʻa ʻia. Hui Iwi J 2015; 97-B:1562.