Kev kuaj mob thiab kev kho ntawm clavicle unactures

Lub hauv paus rau phau ntawv

Clavicle pob txha yog sib xws thiab feem ntau ua los ntawm kev raug mob ncaj qha lossis tsis ncaj qha rau ntawm thaj chaw xub pwg. Cov kev tshawb fawb thaum ntxov xyoo 1960 tau tshaj tawm tias qhov tsis muaj nqi ntawm clavicle pob tau tsawg dua 1%, thiab kev saib xyuas tau ua rau muaj cov neeg mob siab; Nrog rau kev nthuav dav tsis ntev los no, kev phais mob tau ua tiav cov txiaj ntsig tseem ceeb; Yog li ntawd, cov kws kuaj mob ua haujlwm hauv chav kho mob kub ceev lossis cov chaw kuaj mob sab nrauv yuav tsum paub txog cov kev raug mob thiab teeb meem no thiab tswj hwm qhov kev raug mob no.

Kev kawm

Clavicle Factures account rau 2.6% -5% ntawm txhua tus neeg laus kev sib tw [1,2]. Kev kawm nyob sab Europe uas suav nrog 1,000 tus neeg sib law liag uas pom [3,4] uas ntau dua li 66% yog li 25% yog ib sab 1/3 yog medial 1/3 pob txha lov. Qhov tshwm sim ntawm clavicle pob tau pom tias muaj kev faib cov tsiaj uas muaj sia nyob hauv hnub nyoog 30 xyoo, ua raws li cov hnub nyoog tshaj 70 xyoo dhau los.

Secorical Anatomy

Qhov ntxov tshaj plaws ntawm tib neeg lub cev ua si pib ossification yog cov sib txuas, tus kheej lub cev, thiab ua raws li lub sternum, stromoclavicular (SC) sib koom tes. Cov pob qij txha no yog hu ua kev sib koom ua ke ntawm cov pob qij txha vim tias lawv yog kab nrog fibrocartilage es tsis yog hyaline pob txha mos. Lub clavle yog anchored rau cov scapula los ntawm cov acromioclavicular thiab rostroclavicular ligaments thiab txuas nrog sternum los ntawm sternoclavic lingament.

Lub clavicle yog 's ' puab. Cov neeg ua haujlwm ib nrab-arc project anteriorly, tawm hauv chav rau neurovascular pob khoom ntawm sab saud. Ib nrab distal ib nrab ntawm cov phiaj xwm arc rov qab (concave) thiab tom qab ntawd koom nrog cov scapula (Rostral cov txheej txheem thiab kev sau npe). Kev sib tsoo ntawm cov hlws ntawm cov hlws ris ntawm ob daim arcs (nruab nrab ntawm cov tsis muaj txiaj ntsig rau cov pob txha sib ze hauv cov neeg nyob sib ze ntawm clavicle. Thaum ib tug clavicle pob txha yog qhov ua rau ib txwm rub tawm (cephald) los ntawm qhov hnyav ntawm lub caj npab (Cahalad) los ntawm qhov hnyav ntawm lub caj npab txhua lwm yam), feem ntau vim yog cov kev cog lus ntawm cov subscapularis thiab pectoralis loj (uas sab hauv tig sab caj npab). Qhov no yog feem ntau yog vim yog cov kev cog lus ntawm cov leeg ntawm cov leeg thiab pectoralis loj cov leeg (uas sab hauv tig lub caj npab sab saud thiab rub nws mus rau hauv siab).

Nta

Lub hom phiaj ntawm Clavicle cov kev kho mob yog kom txo qhov mob thiab rov ua haujlwm. Feem ntau clavicle yog tseem kho feem ntau cov tshuaj tiv thaiv feem ntau (feem ntau shortened los ntawm tsis muaj ntau tshaj 15 mm); Kev kho mob rau kev saib xyuas xws li daim duab pob zeb, forearm slings, Syuam ntaub qhwv, Velpeau Immobilization suits, thiab immobilization. Ncua Kev Rho Tawm imbobilization yog ua nyob rau hauv cov mob hnyav, thiab cov kev tawm dag zog thaum ntxov yog feem ntau ua rau 2-6 lub lis piam tom qab qhov kev sim ua thaum mob. Kev siv ntawm daim duab ntawm 8 cov ntaub qhwv tau pom zoo tias nws tuaj yeem ua rau cov mob axillary sores thiab ntau dua tsis-union ntawm pob txha lov [5,6].

Keeb Kwm thiab Kev Ntsuam Xyuas Lub Cev

Clavense yog tshwm sim los ntawm kev cuam tshuam ncaj qha rau lub xub pwg ua raws lub caij nplooj zeeg thiab feem ntau pom hauv cov tub ntxhais hluas thiab hauv kev ua haujlwm poob qis hauv cov laus. Nws yog ib qho tseem ceeb kom txhais tau cov txheej txheem ntawm kev raug mob. Kev raug mob siab yuav ua ke nrog lub taub hau thiab hauv siab raug mob, hos pob txha lov uas ua rau muaj kev phom sij me me yuav yog pathologic. Kev cog lus raug mob yuav tsum tau pib ua kom ntxov ntawm scapular lub hauv siab phab ntsa sib cais, neurologic raug mob. Clinically, muaj kev o thiab ecchymosis ntawm pob txha hniav tawg, ua ke nrog deformity thiab rhiab. Saib xyuas yuav tsum tau them rau cov ntaub so ntswg muag rau Jacking li Jacking, uas yuav ua rau cov tawv nqaij necrosis thiab ulceritive.

Kev ua duab

Feem ntau cov pob txha me tuaj yeem kuaj tau los ntawm cov xov xwm anteroposteric yooj yim. 20 ° Lub taub hau tailbraphs tshem tawm cov nyhuv ntawm overlapping thoracic kab noj hniav. Cov neeg mob yuav tsum yog cov xov xwm kev txhawb nqa rau kev txhawb nqa tus kheej kom pom tau yooj yim dua. Qhov hnyav-cov kabmob rau cov radebraphs yog qhov muaj txiaj ntsig zoo ntawm cov kab mob sib koom tes ntawm cov kev raug mob uas ua tau zoo ntawm cov kev raug mob uas ua tau ntawm qhov sib koom ua ke ntawm kev sib koom ua ke. Noj lub hauv siab xoo hluav taws xob pab tswj cov kev raug mob thoracic, thiab luv tuaj yeem raug ntsuas tau los ntawm contralatateral raug mob, raws li kev txiav txim siab scapulothoracic phab ntsa sib cais.

Hom

Ao / ota tsoo dislocation typing: lub clavicle pobkeeb - muaj peb qhov chaw: 15.1 ua txhaum (medial), thiab 15.3 distal (tom qab). Qhov sib thooj (medial) thiab distal (tom qab) pob zeb tau faib ua hom (extrai-articular), thiab hom c (hom c (ua kom tiav ntawm-articular). Lub cev pob txha pob tawg yog categorized li hom a (yooj yim), ntaus b (wednute tsis coj mus rau hauv kev kho mob clavicle thiab hauv kev txiav txim siab prabious.

Allman ntaus ntawv yog nyob ntawm qhov chaw ntawm lub pob txha lov (Kuv: medial, cunent 1/3, II: nruab nrab 1/3) (Daim duab 7.2.1).

Craig ua kom zoo rau qhov kev faib tawm no dua ntawm Allman, nrog kuv yog qhov nruab nrab 1/3 ntawm clavicle; Ntaus II ua sab nraud 1/3 ntawm clavicle, uas tau muab faib ua 5 hom raws li kev tawg thiab kev sib raug zoo rau cov rostral clavicular licentam; Thiab hom III yog qhov tawg ntawm sab hauv 1/3 ntawm cov clavicle, uas tau muab faib ua 5 hom raws li kev tawg thiab seb puas lossis tsis yog qhov tawg yog kev ua haujlwm tau.

Nerer tus ntaus ntawv ntawm tom qab 1/3 pob txha qhia txog qhov tseem ceeb ntawm cov rostral-clavicular ligricamular lidament, nrog nruab nrab pob txha lov Hom II cuam tshuam nrog cov rostral-clavicular ligment lilam thiab cov txiaj ntsig nyob rau hauv lub medial blocke thaiv kev tsis hloov pauv zoo dua; Thiab hom III txuas ntxiv rau lub acromiooclavicular sib koom tes nrog lub rostral-clillicular laisicular litact.

Edinburgh ntaus ntawv yog ib qho system ntawm kev faib tawm ntawm diaphysis kev sib tw raws li kev sib tsoo thiab hom 2 yog cov kab xev diahysis thiab hom 3 yog lateral enderures. The fractures of the diaphysis are classified according to the presence or absence of cortical contact between the fracture fragments into types A and B. Type 2A fractures are further classified as nondisplaced (type 2A1) and angulated (type 2A2),2B fractures are classified as simple or wedge-shaped (type 2B1) and comminuted (type 2B2).3 Type 1 fractures involve the medial end of the diaphysis thiab hom 3 yog ib sab laug kawg ntawm lub doghysis. Medial thiab lateral ob kawg yog subdivided mus rau hauv pawg neeg 1 thiab 2 raws li seb puas muaj kev sib koom ua ke ib sab.

Ib yam li ntawd muaj rockwood typing, jager ntaus ntawv, thiab breitner ntaus.

Kev phais mob

Tej xwm txheej tshwj xeeb

1, qhib pob txha lov; 

2, kev pov tseg> 2 cm; 

3, luv> 2 cm; 

4, kev ua txhaum ntawm pob zeb tawg (> 3); 

5, Ntau ntu bacture; 

6, underlying qhib pob txha lov nrog kev raug mos mos; 

7, qhov tsis txaus ntseeg tseem ceeb (kev hloov chaw thiab ua kom luv); 

8, SCAPHOID raug kev raug mob.

Sib xyaw kev raug mob

1, ua ke ipsilateral sab saud raug mob;

2, lub xub pwg me me;

3, Ntau qhov kev raug mob ntau;

4, bavure ua ke nrog neurovascular raug mob;

5, ipsilateral ntau tus tav pob txha lov ua ke nrog hauv siab wrormity;

6, clavass frequening rau tsim lub xub pwg winged;

7, Ob tog clavicle unactures.

Tus Neeg Mob Tej Yam

1, cov neeg mob uas muaj ntau qhov kev raug mob yuav tsum muaj qhov hnyav hnyav;

2, Cov neeg mob uas xav tau sai sai rau kev ua haujlwm (piv txwv li, cov kis las tseem ceeb thiab kev sib tw).

Sij hawm phais

Kev phais mob yuav tsum ua kom tsis muaj ncua thaum kev qhia txog kev phais mob.

Kev phais mob nyob rau hauv kev phais mob tshaj li ntawm 2-3 lub lis piam hauv cov kev qhia txog kev nyuaj, tshwj xeeb yog thaum npaj rau kev sib cais sab hauv los ntawm kev txawj sib xyaw.

Kev Nkag Mus

Tus neeg mob tau muab tso rau hauv lub rooj zaum lub rooj zaum lossis chaw zaum ib nrab. Cuam tshuam lub xub pwg yog padded hauv qab los tsa cov clavicle kom yooj yim ntawm kev phais, thiab caj npab tau phuam kom tso cai rau intraopization. Ib qho kev phais ncua kev ncua raws cov kab mob ntev ntawm cov clavicle los yog tus saber phais kom zoo nkauj rau tus qauv tsis muaj qauv yuav raug xaiv.

Nco tseg: Qhov kev ntsuas hloov pauv tau muab cov kev pheej hmoo siab ntev dua, thaum muaj kev pheej hmoo ntawm cov kev pheej hmoo ntawm cov kev raug mob ntawm cov paj hlwb thiab muaj kev mob siab rau cov tshuaj loog.

Sab hauv Kev Txhim Kho

3.5 systemsicatic Compression cov hlau, daim phiajcim rov hais dua, lossis yas LCPS tuaj yeem siv los kho cov clavicle clavicle. Cov paib yog txoj kev muab tso rau saum toj saud lossis anterior rau clavicle. Cov paib muaj zog nyob hauv Biomeananical raug mob thaum muab tso rau superiorly, tshwj xeeb tshaj yog tias muaj kev sib tsoo hauv qab no, thiab yooj yim dua kom pom. Bicortical Fixation ntawm cov screws yog qhov tsim nyog, thiab lub qhov yuav tsum tau ua kom zoo nkauj nrog kev tu siab rau cov leeg thiab cov hlab ntshav hauv qab no. Cov txiaj ntsig: Kev nyab xeeb drilling ntawm Anterior phaj ntsia hlau channel, lub phaj ayositioning, yooj yim kev sib nraus.

NCO TSEG: Cov pob txha grafting feem ntau tsis tas yuav tsum muaj rau thawj cov txheej txheem; Tom qab txhim kho sab hauv, nws yog qhov tseem ceeb rau cov txheej suequatately soob cov phaj myOfascial los npog cov phaj thiab tiv thaiv kab mob.

Intramedullary kho

Tam sim no cov khoom siv hluav taws xob muaj xws li Kirschner pins, Hagie Pins, Hagie elastingtrullary, hollow screwstullly, thiab elastic ntsuas intramed climly; Xws li, Titanium Elastic ntsia hlau Tsis txhob pub rau kev tswj qhov ntev thiab kev sib hloov, thiab tuaj yeem ua rau muaj kev sib tsoo pob txha lov. Cov txheej txheem ntsia dav hlau intramined climique tsuas yog siv tau yooj yim, hloov pauv lossis oblique clavicle.

Qhov Zoo

Kev phais me me, muaj kev ua kom zoo dua, cov nqaij mos tsawg dua, txo qis kev phom sij, thiab kev ruaj ntseg cuam tshuam nrog scab tsim.

Tsis zoo

Daim tawv nqaij voos lossis tsis xws luag nyob rau ntawm qhov chaw nkag.

NCO TSEG: Kev kaw kom txo qis ntawm clavensures yog qee zaum nyuaj thiab kev ua kom muaj kev cuam tshuam hluav taws xob yog zam thaum phais cov maneuvers.

Tsawg heev kev nqus phaj

Tsawg tsawg lub phaj osteosynthesis ntawm cov clavicle yog xav kom muab cov tsis zoo ntawm cov phaj qhib lossis txhim kho kev sib kho.

Intra Sovoptative tso cai ntawm 3.5 system LCP anterior rau cov clavicle, ua rau muaj kev siv rau cov phaj zoo hauv qab thiab kom tau txais ntev ntsia hlau aperture.

Kev thov ntxov ntawm cov phaj tsis tshua muaj mob osteosynthesis yuav cuam tshuam nrog supraclavicular raug mob, tsis zoo ntawm cov xov hlau uas cuam tshuam rau kev ua haujlwm, thiab phaj sib cuam tshuam lossis sib tsoo.

Phaj txhim kho ntawm pob txha ntawm cov kab tom qab ntawm clavicle

Kev xaiv ntawm cov phaj cog yog nyob ntawm qhov loj me ntawm cov pob txha tom qab thaiv. Qhov tsawg kawg ntawm 3 bicortical screws yog qhov yuav tsum tau rau cov pob txha tom qab thaiv. Qhov tsim nyog, nruj cov screws yuav tsum tau siv rau oblique pob txha lov. Yog tias cov pob txha pob txha yog qhov me me rau kev txhim kho, cov clavicle nuv yuav siv tau.

Kev kho cov acromioclavicular sib koom ua ke dislocration

Acromioclavular sib koom ua ke tus account rau 12% ntawm scapular raug mob thiab feem ntau tshwm sim hauv cov neeg ua kis las.

Feem ntau siv staging stine yog lub pob zeb pob zeb staging. Hom Kuv yog ib qho av ntawm lub npog acromioclavic trigament nrog lub rostroclavicular ligament li; Hom II yog lub kua muag ntawm lub npog acromioclavicular Ligament nrog Rostroclavicular Ligament; Ntaus i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i ii Hom IV yog ib qho kev hloov pauv ntawm cov ntoo khaub ncaws ntawm cov clavicle distal imtraling lub trapezius; Hom V yog cov kua muag tag nrho ntawm cov acrioclavicular sib koom tes thiab rostroclavicular lidament lizam, muaj ntau tshaj 100 feem pua ​​kev hloov pauv; Thiab ntaus Vi Kev Raug Mob yog tsawg heev, nrog distal clavicle displaced downward hauv qab ntawm cov txheej txheem rostral.

Kev kho mob nrog lub sijhawm luv luv braking nrog cantilever sling yog pom zoo rau hom I thiab hom II raug mob. Kev tswj hwm ntawm hom III kev raug mob muaj kev sib cav, nrog qee cov ntaub ntawv hais qhia tias kev saib xyuas kev kho mob yog qhia rau cov neeg hluas ua haujlwm. Kev ua haujlwm rov qab zoo yog qhov zoo txawm hais tias yuav muaj sib txawv ntawm qib ntawm deformity hauv tsos. Hom IV - VI raug mob ntau dua thiab kev phais mob raug pom zoo.

Tam sim no, feem ntau siv cov txheej txheem phais Tightrope's tab phaj kho lossis thauj tog rau nkoj pinning suture los ntawm arthriscope lossis kev phais me me; Thiab Rostral qhib lub xov tooj ntawm kev ncua lossis cov khoom siv dag ntxias, nrog cov khoom siv dag lossis cov quav tshuaj ntawm rostral eminence thiab cletral.

Nws tsis yog qhov kev phais mob tau zoo dua, thiab txawm hais tias muaj qee qhov kev poob qis, qhov ua tau zoo kawg ntawm txhua yam ntawm cov kev qhia no zoo siab.

Kev Kho Mob ntawm Medial Kawg Clavensures thiab Sternoclavicular Sib Koom Tes

Cov kev raug mob no tsis tshua muaj, thiab ntxiv muaj cov lus qhia kev kho mob raws li cov ua pov thawj tshuaj.

Medical clavicle feem ntau ntxiv-articular pob txha uas muaj qhov tsis txaus ntseeg thiab tuaj yeem kho tau cov tshuaj tiv thaiv. Epiphysis ntawm nruab nrab ntawm clavicle feem ntau kaw thaum muaj 23-25 ​​xyoos thiab yog tus kawg epiphysis kom kaw hauv lub cev. Yog li ntawd, ntau qhov kev raug mob me yog qhov tseeb epiphyseal phaj tawg ntawm Salter-Harris hom I lossis II. Cov tshuaj X-rays yog qhov nyuaj rau kev kuaj mob, nrog rau lub taub hau nyeem ntawv zoo kawg nkaus uas yuav qhia tau qhov chaw noj qab haus huv ntawm lub clavicle, thiab CT muab cov kev kuaj mob tshaj plaws.

Kev tawg lossis tsis txaus ntseeg uas tau hloov pauv ntawm lub cev tsis tuaj yeem kaw thiab xa rov qab, tab sis feem ntau tsis ruaj khov thiab lobotomized rau kev rov pov tseg. Palliative Tu yog pom zoo rau kev tsis txaus ntseeg lossis kev tsis txaus siab vim tias lawv feem ntau tsis ua rau muaj kev cuam tshuam tsis taus. Kev rho tawm ntawm cov nruab nrab ntawm cov huab cua ntawm cov postericine tsis tshua muaj qhov tshwm sim hauv lub shocing socumentinal raug mob, suav nrog cov vascular thaiv thiab txawm tracheal thaiv thiab airway compression. Rau kev rho tawm thiab pob txha uas nruab nrab uas nruab nrab me me, cov phiaj tuaj yeem sib txuas tau txuas thoob plaws kev sib koom ua ke rau kev sib koom tes rau lub sternum.

Lwm txoj kev txhim kho

EG txhim kho sab nraud nrog stent, txhim kho sab nraud nrog clavicle phaj, thiab lwm yam.

Kev Tswj Xyuas Dua

Sab caj npab yuav tsum immobilized nyob rau hauv lub sling thiab lub xub pwg pendulum kev cob qhia yuav tsum tau pib tam sim ntawd. 2 lub lis piam tom qab, tus neeg mob yuav tsum tau saib xyuas lub qhov txhab thiab rov qab qhia txog cov x-rays, tab sis tus neeg mob yuav tsum tau muab nws thaiv kom tsis txhob muab luj. Kev cob qhia lub zog tuaj yeem pib ntawm 6 lub lis piam posteropitalively thaum cov cim ntawm bony kho tshwm sim. Hu rau kis las lossis kis las heev yuav tsum zam rau 3 lub hlis tom qab phais mob kom txog thaum lub pob txha tau kho kiag li.

Teeb meem.

Kev teeb meem thaum ntxov

Postoperative cov kab mob kis tau tuaj yeem muaj nyob txog li ntawm 4.8% ntawm rooj plaub;

Loog nyob rau hauv thaj av subclavian yog qhov tshwm sim ntawm cov neeg mob keeb kwm txog li 83 uas ploj zuj zus nyob rau lub sijhawm, txawm tias nws tuaj yeem ua ntev txog 2 xyoos posterperatively;

EnricophteThe kev tawm tsam thiab cov tawv nqaij ntxhov, ib txwm muaj nrog kev siv cov phiaj hlau voluminous lossis tus tw ntsia hlau tsis muaj cov nqaij mos zoo duav;

Rov ua dua tshiab, uas yuav tshwm sim tom qab ob qho tib si phais thiab kev saib xyuas kev kho mob; Kev phais mob tom qab phais yuav ua rau khoov lossis rhuav tshem ntawm cov endoprosises, lossis kev sim mob ib ncig ntawm cov kab ke;

nonunion, nrog rau ib qho 15% tsis them nrog kev saib xyuas thiab 2% tsis muaj cai nrog kev phais diaphyseal untactures; Ua tiav kev hloov pauv ntawm qhov tawg, ua kom luv tshaj 2 cm, haus luam yeeb, ua kom tsis muaj zog, cov pob txha ua kom zoo, thiab pob txha tsis zoo.

Cov teeb meem lig

Osteoarthritis ntawm cov acromioclavicular tshwm sim ntau ntau nrog kev ua haujlwm zoo li kev ua haujlwm (EDINBURGH hom 3B2); Thaum cov tsos mob thiab kev saib xyuas tau yog qhov tsis muaj txiaj ntsig, cov neeg sib zog tsis muaj arthcopically lossis los ntawm kev phais mob qhib;

Deformity kho, uas tshwm sim rau kev sib txawv hauv txhua qhov kev kho mob txhad tsis zoo; Shortening ntawm cov scapular girdle nrog kev sib hloov ntawm distal blocker block yuav ua rau muaj zog kawg thiab thev taus, tshwj xeeb hauv lub xub pwg; nqaim ntawm cov thoracic lub qhov hluav taws xob yuav ua rau cov tsos mob ntawm brachial plexus compression; Thiab cov txiv neej ua ke ntawm cov pob zeb scapulothoracic tuaj yeem ua rau mob sab nrauv thaum kho tau, yog tias nws yog qhov ua kom zoo, yog tias nws tau txhim kho raws li tus neeg mob cov kev xav tau.

Kev ntsuas qhov tshwm sim thiab tshwm sim

Kev tshawb fawb ntsig txog hauv Tebchaws Europe uas phais mob Midclalicular tau muab piv rau kev phais mob uas muaj kev phais mob piv nrog kev kho mob tau muab piv nrog kev kho mob; Ib qho ntxiv, cov pab pawg phais tau raug txo mob thaum ntxov, thiab kev txhim kho hauv qhov qhab nia sib luag thiab kev ua haujlwm tau tshaj tawm.

Lub ntsiab

Feem ntau ntawm cov pob zeb feem ntau yog tshwm sim los ntawm kev ua phem lossis tsis ncaj ncees, thiab kev kho mob tuaj yeem faib ua kev kho mob lossis phais mob. Nyob rau hauv cov nqe lus ntawm kev kho mob, txawm tias feem ntau clavicle tsis muaj kev tiv thaiv tseem ceeb tuaj yeem kho tau, kev kho mob kev kho mob rau cov pob txha uas muaj kev sib cav. Rau cov txheej txheem clavicle, kev phais mob muaj tus nqi ntau dua ntawm cov pob txha kho thiab ua haujlwm tau zoo piv nrog kev kho mob.

Ntawv Sawv cev

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[2] PEIFF, MP, daug, li al. Clavicle thiab scapula tawg. Hauv: Kev tswj mob me me rau thawj kev saib xyuas, thib ob ed, WB sauners, Philadelphia 2002.

[3] Robinson cm. Pob txha ntawm clavicle hauv tus neeg laus. Epidemiology thiab kev faib tawm. J pob txha sib koom tes phais br 1998; 80: 476.

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