Clavicle Fractures: Kev kuaj mob, kev faib tawm, kev kho mob thiab rov qab los

Ntsiab Cai

• Qhov nruab nrab thib peb, los yog ncej, yog qhov chaw tshaj plaws rau kev puas tsuaj clavicle.

• Cov tsos mob xws li mob, o, bruising, rhiab, thiab nyuaj txav caj npab.

• Plain X-rays yog qhov kev kuaj pom thawj zaug; CT yuav siv tau rau cov teeb meem nyuaj, nruab nrab, lossis ua ntej ua haujlwm.

• Feem ntau cov pob txha tawg me me yog kho nrog txoj hlua khi, ua raws li cov duab, thiab kev kho kom rov zoo.

• Qhib pob txha, hem daim tawv nqaij, raug mob neurovascular, lub xub pwg nyom tsis ruaj khov, thiab xaiv cov pob txha tawg lossis tsis ruaj khov yuav tsum tau phais.

• Phaj fixation thiab intramedullary fixation tuaj yeem muab cov txiaj ntsig zoo hauv cov neeg laus xaiv cov pob txha pob txha, tab sis txhua tus muaj qhov sib txawv thiab muaj kev pheej hmoo.

• Kev rov qab sib txawv raws hnub nyoog, tus qauv tawg, txoj kev kho mob, kev haus luam yeeb, thiab pov thawj ntawm kev kho pob txha.

Dab tsi yog Clavicle Fracture?

Lub clavicle yog cov pob txha zoo li S uas txuas lub sternum ntawm qhov chaw ntawm lub hauv siab mus rau scapula ntawm lub xub pwg nyom. Nws ua raws li cov qauv kev sib txuas ntawm lub cev thiab cov ceg tawv thaum pab tiv thaiv cov hlab ntsha thiab cov hlab ntsha uas hla hauv qab nws.

Kev puas tsuaj clavicle tshwm sim thaum lub zog tshaj lub zog ntawm cov pob txha. Cov txheej txheem feem ntau suav nrog kev poob ncaj qha rau ntawm lub xub pwg nyom, lub caij nplooj zeeg mus rau sab caj npab, kev sib tsoo thaum sib cuag nrog cov kis las, thiab lub zog siab dua lub tsheb kauj vab lossis lub tsheb tsav tsheb. Hauv cov neeg mob hluas, cov kev raug mob no feem ntau ua raws li kev ua kis las lossis kev sib tsoo tsheb. Hauv cov neeg laus, kev poob qis zog tuaj yeem txaus, tshwj xeeb tshaj yog thaum cov pob txha tsis zoo.

Clavicle fractures suav txog kwv yees li 3% mus rau 5% ntawm cov neeg laus pob txha. Kev faib tawm feem ntau tau piav qhia tias yog bimodal, nrog rau ib qho siab tshaj ntawm cov tub ntxhais hluas thiab cov hluas thiab lwm qhov ntawm cov neeg laus.

Cov tsos mob ntawm ib tug clavicle Fracture

Cov tsos mob nyob ntawm qhov chaw thiab qhov mob hnyav, tab sis feem ntau suav nrog:

• Mob tam sim ntawd ntawm pob txha caj dab tom qab raug mob

• o, bruising, thiab localized tenderness

• Mob thaum nqa lossis txav caj npab cuam tshuam

• Pom pom pob, kauj ruam, lossis hloov hauv lub xub pwg nyom

• Kev xav ntawm kev sib tsoo lossis txav ntawm qhov chaw tawg

• Ib qho kev nyiam los txhawb cov neeg raug mob caj npab nrog rau sab tes

Cov cim ceeb toom uas xav tau kev soj ntsuam ceev

Kev ntsuas kho mob ceev yog ib qho tseem ceeb thaum daim tawv nqaij tawg los yog nruj nreem tensed tshaj ib tug ntse tawg; tes lossis caj npab ua daj ntseg, txias, tsis muaj zog, lossis loog; ua pa nyuaj; mob hauv siab tam sim no; los yog kev raug mob ua raws li kev raug mob siab zog. Cov kev tshawb pom no tuaj yeem qhia tau tias muaj pob txha qhib lossis muaj kev raug mob cuam tshuam nrog lub ntsws, lub hauv siab phab ntsa, cov hlab ntsha, lossis cov hlab ntsha.

Yuav Ua Li Cas Kho Mob Clavicle Fracture?

Kev kuaj mob pib nrog keeb kwm raug mob thiab kuaj lub cev. Tus kws kho mob tshuaj xyuas qhov chaw ntawm kev sib tw, pom kev deformity, mob ntawm daim tawv nqaij, lub xub pwg txav, thiab kev ncig thiab paj hlwb ntawm caj npab cuam tshuam. Hauv kev raug mob ntau zog, lub hauv siab, caj dab, scapula, thiab lwm yam ntawm lub xub pwg nyom kuj yuav tsum tau ua tib zoo soj ntsuam.

X-Ray

Plain radiographs yog tus qauv thawj-kab imaging test. Lawv paub meej tias qhov chaw tawg thiab pab qhia kev txav chaw, angulation, shortening, thiab comminution. Upright radiographs tuaj yeem ua rau pom kev hloov pauv ntau dua li cov duab thaij nrog tus neeg mob pw, tshwj xeeb tshaj yog nyob rau hauv nruab nrab ntawm cov pob txha pob txha.

CT thiab lwm yam duab

Computed tomography tej zaum yuav pab tau thaum lub pob txha muaj feem nrog lub nruab nrab clavicle los yog sternoclavicular sib koom, thaum lub fracture qauv yog complex, thaum muaj feem xyuam rau lub xub pwg nyom-girdle raug mob, los yog thaum xav tau ntau yam kev npaj ua ntej. Cov duab ntxiv yog xaiv raws li qhov xav tias raug mob es tsis siv niaj hnub rau txhua qhov kev puas tsuaj clavicle.

Hom thiab Classifications ntawm Clavicle Fractures

Thawj kauj ruam uas ua tau zoo tshaj plaws yog cais cov pob txha clavicle los ntawm qhov chaw:

Common Classification Systems

Allman system pab pawg clavicle fractures rau hauv nruab nrab-thib peb, distal-thib peb, thiab nruab nrab-peb kev raug mob. Cov txheej txheem ntxaws ntxiv suav nrog Neer kev faib tawm rau cov pob txha pob txha pob txha, Robinson lossis Edinburgh kev faib tawm, thiab kev faib tawm AO/OTA. Cov kab ke no piav qhia txog yam xws li qhov chaw, kev hloov pauv, kev sib txuas, kev koom tes ntawm cov leeg, thiab ligament stability.

Ib qho kev faib npe ib leeg tsis txiav txim siab txog kev kho mob. Tus kws kho mob yuav tsum xav txog cov tawv nqaij thiab cov nqaij mos, cov xwm txheej ntawm cov hlab ntsha, cov kev raug mob cuam tshuam, cov neeg mob hnub nyoog, kev kho mob, kev ua haujlwm, theem kev ua haujlwm, thiab kev nyiam kho mob.

Nonoperative Treatment ntawm Clavicle Fractures

Feem ntau cov pob txha clavicle cais tau tswj tsis tau kev phais, tshwj xeeb tshaj yog thaum kev sib raug zoo tau txais thiab cov pob txha yuav tsum nyob ruaj khov. Ib qho yooj yim caj npab sling feem ntau nyiam dua ib daim duab-ntawm-yim brace vim nws yooj yim dua rau kev thov thiab feem ntau nyiam dua.

Kev saib xyuas tsis ua haujlwm yuav suav nrog:

• Sling immobilization rau kev nplij siab thiab kev tiv thaiv

• Kev tswj qhov mob qhia los ntawm tus kws kho mob

• Tsis tu ncua kev kho mob thiab radiographic tshuaj xyuas

• Thaum ntxov txav ntawm lub luj tshib, dab teg, thiab tes

• Progressive lub xub pwg nyom thaum mob thiab pob txha ruaj khov cia

• Ua kom muaj zog tom qab kev kho mob thiab cov kab mob radiographic ntawm kev kho mob

Qhov zoo ntawm kev kho tsis ua haujlwm suav nrog kev zam kev phais, tshuaj loog, kev pheej hmoo kis mob, thiab cov teeb meem cuam tshuam txog kev cog qoob loo. Tej yam tsis zoo muaj xws li kev tsis sib haum xeeb, ncua kev sib koom ua ke, kev tsis sib haum xeeb, malunion, thiab qeeb qeeb rov qab mus rau kev xav tau kev ua haujlwm lossis kev ua kis las hauv kev xaiv cov pob txha tawg.

Ib qho yooj yim caj npab sling feem ntau yog siv rau kev nplij siab thiab kev tiv thaiv thaum ntxov tsis ua haujlwm.

Thaum twg Clavicle Fracture xav tau kev phais?

Kev phais tsis tas yuav tsum tau siv rau txhua qhov tawg ntawm clavicle tawg, thiab tsis muaj ib qho kev ntsuas yuav tsum tau siv nyob rau hauv kev sib cais. Kev kho mob yuav tsum yog tus kheej los ntawm kev sib koom kev txiav txim siab ntawm tus neeg mob thiab tus kws kho mob phais.

Kev kho phais yuav raug pom zoo los yog xav pom zoo thaum muaj:

• Qhib pob txha

• Kev puas tsuaj ntawm daim tawv nqaij los yog hnyav tenting tshaj qhov tawg tawg

• Associated raug mob rau cov hlab ntsha los yog paj hlwb

• Ib lub xub pwg nyom tsis ruaj khov lossis xaiv ntau yam kev raug mob

• Kev hloov pauv, ua kom luv, lossis sib txuas ua ke hauv ib tus neeg laus midshaft puas

• Ib qho tsis ruaj tsis khov distal clavicle tawg nrog kev cuam tshuam ntawm coracoclavicular ligament complex

• Symptomatic nonunion los yog malunion

• Ib qho yuav tsum tau rov qab kho kom haum thiab ruaj khov tom qab xav txog kev ua haujlwm, kev ua kis las, kev noj qab haus huv, thiab cov neeg mob nyiam

Hauv cov neeg laus uas muaj kev puas tsuaj ntawm qhov chaw nruab nrab, kev kho mob yog txuam nrog kev sib koom ua ke siab dua thiab cov txiaj ntsig zoo ntawm tus neeg mob tau tshaj tawm ntxov dua li kev saib xyuas tsis ua haujlwm. Cov txiaj ntsig ntev thiab kev txaus siab, txawm li cas los xij, tuaj yeem zoo ib yam nrog ob qho tib si. Qhov sib npaug sib txawv ntawm cov tub ntxhais hluas, uas nws lub peev xwm kho tau zoo dua thiab rau leej twg niaj hnub kev phais rau ib qho kev sib cais ntawm qhov chaw nruab nrab ntawm cov pob txha tawg tuaj yeem ua rau tsis muaj txiaj ntsig zoo.

Nonoperative Care vs. Surgical Fixation

Kev xaiv kho mob phais

Plate thiab Screw Fixation

Qhib kev txo qis thiab kev kho sab hauv nrog lub phaj yog ib txoj kev phais ntau rau cov pob txha pob txha. Tus kws phais kho kho qhov kev sib raug zoo thiab ruaj ntseg qhov tawg nrog lub phaj thiab screws. Niaj hnub orthopedic locking phaj tshuab muab kev xaiv lub kaum sab xis rau xaiv cov qauv tawg. Phaj fixation yuav pab tau tshwj xeeb tshaj yog thaum lub pob tawg yog comminuted los yog thaum tuav ntev thiab kev sib hloov yog ib qho tseem ceeb.

Pre-contoured implants xws li ib S-shaped clavicle locking phaj yog tsim los ua raws li qhov curvature ntawm clavicle, txawm hais tias zaum kawg implant xaiv thiab contouring nyob ntawm tus neeg mob lub cev thiab pob txha configuration. Tej yam tsis zoo muaj xws li loog nyob ib ncig ntawm qhov kev txiav, implant prominence, soft-tissue irritation, kis kab mob, thiab muaj peev xwm ntawm cov txheej txheem tom qab tshem tawm cov tsos mob. Implant tshem tawm tsis tas yuav tsum tau tom qab txhua qhov kho pob txha.

Phaj fixation restores kev sib raug zoo thiab stabilizes lub clavicle thaum lub pob txha kho.

Intramedullary Fixation

Cov khoom siv intramedullary tau muab tso rau hauv lub kwj dej ntawm lub clavicle kom ruaj khov xaiv cov pob txha pob txha. Piv nrog rau plating, cov txheej txheem no yuav siv cov incisions me me thiab txo qee cov ntaub so ntswg. Txawm li cas los xij, tsis yog txhua qhov tawg yog tsim rau kev kho intramedullary, tshwj xeeb tshaj yog thaum comminution ua rau ntev lossis kev sib hloov tswj nyuaj. Ob daim hlau thiab cov rau tes ua ib feem ntawm qhov dav orthopedic trauma fixation system.

Rau cov neeg laus clavicle ncej fractures, intramedullary nailing thiab ib-phaj fixation tuaj yeem tsim cov txiaj ntsig zoo sib xws mus ntev thiab muaj teeb meem. Phaj fixation yuav muab qhov zoo dua thaum muaj kev sib txuas.

Minimally Invasive Phaj Osteosynthesis

Minimally invasive phaj osteosynthesis siv me me incisions thiab raug txwv thaum stabilizing lub pob txha tawg nrog lub phaj. Cov txheej txheem tsom mus khaws cov ntaub so ntswg thiab pob txha caj dab, tab sis qhov tseeb txo thiab tiv thaiv cov hlab ntsha supraclavicular tseem ceeb.

Distal Clavicle Fixation

Distal clavicle fractures xav tau kev ntsuam xyuas ntawm qhov chaw pob txha, qhov loj me, kev koom tes ntawm articular, thiab kev ncaj ncees ntawm coracoclavicular ligament complex. Cov kev xaiv yuav suav nrog a distal clavicle locking phaj , coracoclavicular stabilization, los yog lwm yam fixation txheej txheem xaiv rau cov qauv tshwj xeeb. Cov ntaub ntawv pov thawj tsis txhawb nqa ib qho txheej txheem rau txhua qhov kev puas tsuaj.

Medial Clavicle Fractures

Feem ntau qhov me me ntawm qhov nruab nrab clavicle tawg tuaj yeem tswj tau yam tsis muaj kev phais. CT feem ntau muaj txiaj ntsig thaum kev hloov pauv nyuaj los txhais tau lossis thaum xav tias qhov kev hloov pauv tom qab raug xav. Vim tias txoj hlab pas, txoj hlab pas, cov hlab ntsha loj, thiab lwm cov kab mob mediastinal nyob ze, cov kev raug mob tom qab tshem tawm qhov nruab nrab yuav tsum tau soj ntsuam cov kws kho mob sai.

Clavicle Fracture Recovery thiab Rehabilitation

Tsis muaj ib lub sijhawm rov qab los rau txhua qhov clavicle tawg. Hnub nyoog, qhov chaw tawg, kev hloov pauv, txoj kev kho mob, kev haus luam yeeb, kev raug mob, thiab kev kho mob radiographic txhua yam cuam tshuam rau kev loj hlob. Ntau tus neeg mob rov qab ua haujlwm tau zoo hauv 6 mus rau 12 lub lis piam, tab sis ua tiav cov pob txha kho, rov ua kom muaj zog, thiab rov qab mus rau qhov kev xav tau siab yuav siv sijhawm ntev dua.

1. Kev tiv thaiv theem: Ib txoj hlua khi yog siv rau kev nplij siab thiab kev tiv thaiv. Tes, dab teg, thiab lub luj tshib feem ntau txhawb nqa tshwj tsis yog lwm qhov kev raug mob tiv thaiv nws.

2. Kev ua haujlwm thaum ntxov: Kev tawm dag zog lub xub pwg maj mam pib thaum qhov mob txo qis thiab tus kws kho mob pom zoo tias kev txav mus los yog qhov tsim nyog.

3. Ua kom muaj zog theem: Cov kev tawm dag zog kuj tau qhia tom qab kev kho mob txaus thiab radiographic kho.

4. Rov qab mus rau qhov kev ua si: Kev nqa hnyav, kev sib cuag nrog cov kis las, thiab kev ua si uas muaj kev pheej hmoo ntawm kev poob siab yuav tsum tau tos kom txog thaum lub pob txha zoo lawm thiab lub zog thiab kev txav tau zoo.

Kev soj ntsuam xyuas yog ib qho tseem ceeb vim tias kev ua kom tsis zoo, qhov mob tsis tu ncua, lossis tsis muaj kev cuam tshuam ntawm hluav taws xob tuaj yeem qhia tau tias muaj kev hloov pauv, ncua kev sib koom ua ke, lossis kev tsis sib haum xeeb. Kev haus luam yeeb tuaj yeem cuam tshuam kev kho pob txha thiab yuav tsum tau hais los ua ib feem ntawm txoj kev kho mob.

Muaj Teeb Meem

Cov teeb meem tom qab kev kho tsis ua haujlwm

• Nonunion: pob txha tsis kho, uas yuav ua rau mob tsis tu ncua lossis tsis muaj zog.

• Malunion: lub pob tawg zoo nyob rau hauv ib qho luv luv, angulated, los yog hloov chaw.

• Pom pom kev zoo: ib pob tuaj yeem nyob ntawm qhov kho pob txha.

• Lub xub pwg nyom lossis tsis muaj zog: kev kho kom rov zoo tuaj yeem yuav tsum tau rov qab ua haujlwm.

• Cov tsos mob ntawm Neurovascular: cov no tsis tshua muaj tab sis yuav tsum tau soj ntsuam sai.

Teeb meem tom qab phais

• Qhov txhab mob

• Ntshai los yog hloov kev hnov ​​​​qab nyob ib ncig ntawm qhov incision

• Hardware irritation los yog prominence

• Implant loosening, khoov, los yog tawg

• Kev ncua sij hawm, kev tsis sib haum xeeb, lossis kev tsis sib haum xeeb

• Refracture, suav nrog tom qab kev tshem tawm

• Xav tau lwm txoj haujlwm, feem ntau vim muaj cov tsos mob kho vajtse

Kev pheej hmoo cuam tshuam yog nyob ntawm pob txha thiab tus neeg mob. Ib tus nqi hluav taws xob ntau dua tsis tau txhais hais tias kev phais yog qhov kev xaiv zoo tshaj plaws rau txhua tus, ib yam li kev zam kev phais tsis tshem tawm qhov muaj peev xwm ntawm kev cuam tshuam tom qab.

Cov lus nug nquag

Puas muaj pob txha clavicle kho tsis tau phais?

Yog lawm. Feem ntau cov pob txha clavicle cais tau kho yam tsis muaj kev phais thiab kho nrog kev txhawb nqa sling, rov qab ua dua, thiab kho dua tshiab. Qhov ua tau zoo ntawm kev saib xyuas tsis zoo yog nyob ntawm pob txha ruaj khov, hloov chaw, sib txuas, qhov chaw, hnub nyoog tus neeg mob, thiab lwm yam kev kho mob.

Ntev npaum li cas clavicle puas yuav kho tau?

Ntau tus neeg mob rov ua haujlwm zoo li qub lossis ze li qub li ntawm 6 txog 12 lub lis piam, tab sis lub sijhawm kho nws txawv. Cov neeg laus, cov neeg haus luam yeeb, cov neeg uas muaj kev cuam tshuam loj heev los yog kev puas tsuaj, thiab cov neeg mob uas muaj lwm yam mob yuav xav tau ntev dua. Rov qab mus rau kev sib cuag nrog cov kis las yuav tsum tau lees paub kev kho mob thiab tshem tawm kev kho mob.

Dab tsi yog hom clavicle tawg ntau tshaj plaws?

Midshaft clavicle fractures yog feem ntau tshwm sim. Distal fractures tsawg dua, thiab cov pob txha clavicle nruab nrab yog qhov tsis tshua muaj.

Puas yog qhov pom pob tom qab clavicle puas ib txwm?

Ib qho kev pom pom muaj tshwm sim thaum kho thiab yuav nyob twj ywm tom qab cov pob txha sib sau ua ke. Hauv cov menyuam yaus thiab cov tub ntxhais hluas nws tuaj yeem hloov kho ntau yam dhau sijhawm. Kev loj hlob deformity, hem ntawm daim tawv nqaij, mob hnyav, loog, lossis qaug zog yuav tsum tau soj ntsuam tam sim ntawd.

Puas yog phaj fixation zoo dua intramedullary fixation?

Tsis yog ob txoj kev yog qhov zoo tshaj rau txhua tus neeg mob. Ob leeg tuaj yeem muab cov txiaj ntsig zoo mus ntev hauv cov neeg laus xaiv cov pob txha pob txha. Phaj fixation tej zaum yuav zoo dua rau cov qauv comminuted, thaum intramedullary fixation yuav txo qhov luaj li cas nyob rau hauv haum fractures. Qhov kev txiav txim siab nyob ntawm pob txha morphology, kev paub ntawm kws phais neeg, qhov tseem ceeb ntawm tus neeg mob, thiab kev pheej hmoo ntawm kev cog hniav.

Puas yog clavicle kho vajtse ib txwm yuav tsum tau muab tshem tawm?

Tsis yog. Cov phaj, cov ntsia hlau, thiab cov khoom siv intramedullary tsis raug tshem tawm txhua zaus thaum lawv tsis muaj tsos mob thiab qhov tawg tau zoo lawm. Kev tshem tawm tej zaum yuav raug txiav txim siab rau qhov mob tsis tu ncua, ua kom pom tseeb, mob, teeb meem cog, lossis lwm yam kev kho mob tom qab sib tham txog qhov pheej hmoo ntawm lwm txoj haujlwm.

Dab tsi yog cov cim qhia tias clavicle puas yuav tsis kho?

Kev mob tsis tu ncua ntawm qhov chaw tawg, kev txav mus los lossis kev sib tw, kev txhim kho kev ua haujlwm tsis zoo, thiab tsis muaj kev vam meej ntawm kev soj ntsuam cov duab yuav qhia tau tias muaj kev sib koom ua haujlwm qeeb lossis tsis koom nrog. Cov kev tshawb pom no xav tau kev ntsuam xyuas los ntawm tus kws kho mob.

Xaus

Clavicle fracture kho nyob ntawm ntau tshaj qhov pom ntawm ib qho X-ray. Feem ntau ruaj khov los yog tsawg tsawg qhov tawg pob txha tuaj yeem tswj tau yam tsis muaj kev phais. Kev xaiv tshem tawm, luv luv, comminuted, qhib, lossis tsis ruaj khov raug mob yuav tau txais txiaj ntsig los ntawm kev kho, tshwj xeeb tshaj yog rau cov neeg laus. Kev soj ntsuam ceev faj txog cov qauv ntawm pob txha, daim tawv nqaij thiab cov hlab ntsha, cov kev raug mob cuam tshuam, cov neeg mob hnub nyoog, kev xav tau kev ua haujlwm, thiab cov hom phiaj kho mob yog qhov tseem ceeb rau kev txiav txim siab sib koom.

Related XC Medico Cov Khoom Siv Khoom

Cov ntaub ntawv kho mob

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2. American Academy ntawm Orthopedic Surgeons. Kev Kho Mob Clavicle Fractures: Plain Language Summary.

3. Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology ntawm clavicle fractures. Phau ntawv Journal ntawm Lub xub pwg nyom thiab lub luj tshib phais. 2002; 11(5):452-456.

4. Robinson CM. Cractures ntawm clavicle nyob rau hauv cov neeg laus: epidemiology thiab kev faib tawm. Phau ntawv Journal of Bone and Joint Surgery British Volume. 1998; 80(3): 476-484.

5. Ersen A, Atalar AC, Birisik F, et al. Kev sib piv ntawm caj npab yooj yooj yim thiab daim duab-ntawm-yim clavicular bandage rau midshaft clavicular fractures: ib qho kev tshawb fawb randomized. Pob txha & Joint Journal. 2015; 97-B(11): 1562-1565.

6. Thurston D, Jordan RW, Thangarajah T, et al. Puas yog distal clavicle fractures cuam tshuam nrog cov txiaj ntsig kev kho mob tsis zoo tom qab kev tswj xyuas tsis ua haujlwm? Kev tshuaj xyuas qhov systematic. Phau ntawv Journal ntawm Lub xub pwg nyom thiab lub luj tshib phais. 2024; 33(8): 1847-1857.