Kev kuaj mob thiab kev kho mob ntawm clavicle Fractures

Taw qhia

Clavicle fractures yog ib qho tshwm sim thiab feem ntau tshwm sim los ntawm kev raug mob ncaj qha lossis tsis ncaj rau thaj tsam lub xub pwg. Cov kev tshawb fawb nyob rau hauv thaum ntxov 1960s tau tshaj tawm hais tias lub nonunion tus nqi ntawm clavicle fractures yog tsawg tshaj li 1%, thiab kev saib xyuas kev kho mob ua rau cov neeg mob siab; nrog kev txhim kho cov tshuaj tsis ntev los no, kev kho mob phais tau ua tiav cov txiaj ntsig tseem ceeb; Yog li ntawd, cov kws kho mob ua haujlwm hauv lub chaw kho mob xwm txheej ceev lossis chaw kho mob sab nraud yuav tsum paub txog cov kev tshwm sim thiab cov teeb meem ntawm qhov kev raug mob no thiab nws txoj kev tswj hwm yooj yim.

Kab mob sib kis

Clavicle fractures suav txog 2.6% -5% ntawm tag nrho cov neeg laus pob txha [1,2]. Ib txoj kev tshawb fawb nyob sab Europe uas suav nrog 1,000 qhov sib law liag pob txha tawg tau pom [3,4] tias ntau dua 66% ntawm cov pob txha pob txha tau tshwm sim nyob rau nruab nrab 1/3 ntawm cov pob txha, kwv yees li 25% yog lateral 1/3 pob txha, thiab 3% yog nruab nrab 1/3 pob txha. Qhov tshwm sim ntawm clavicle fractures pom muaj kev faib tawm bimodal, tshwm sim feem ntau hauv cov txiv neej hnub nyoog qis dua 30 xyoo, ua raws li cov hnub nyoog tshaj 70 xyoo.

Clinical Anatomy

Qhov ntxov tshaj plaws ntawm tib neeg lub cev pob txha pib ossification yog clavicle, tib lub pob txha sib txuas ntawm sab caj npab thiab lub cev, uas articulates distally nrog acromion, acromioclavicular (AC) sib koom, thiab ze nrog lub sternum, sternoclavicular (SC) sib koom. Cov pob qij txha no hu ua atypical synovial pob qij txha vim hais tias lawv yog kab nrog fibrocartilage es tsis yog hyaline pob txha mos. Lub clavicle yog anched rau scapula los ntawm acromioclavicular ligaments thiab rostroclavicular ligaments thiab txuas mus rau sternum los ntawm sternoclavicular ligament.

Lub clavicle yog 'S' zoo li tus. Lub zeem muag ib nrab-arc tej yaam num anteriorly, tawm hauv chav rau lub neurovascular pob ntawm lub sab sauv sab. Lub distal ib nrab ntawm cov phiaj xwm arc rov qab (concave) thiab tom qab ntawd koom nrog scapula (rostral txheej txheem thiab acromion). Kev puas tsuaj ntawm clavicle feem ntau tshwm sim ntawm kev sib tshuam ntawm ob lub arcs (mid-arc), feem ntau yuav yog vim tsis muaj ligaments txuas rau cov pob txha nyob sib ze hauv cheeb tsam no thiab vim tias nws yog qhov tsis muaj zog tshaj plaws ntawm lub clavicle. Thaum cov pob txha pob txha raug tshem tawm, cov ntu ze ze yuav luag txhua zaus rub mus rau sab saud (cephalad) los ntawm cov leeg sternocleidomastoid (txuas mus rau qhov kawg ntawm lub clavicle) thiab ntu ntu nruab nrab yog txav mus rau hauv qab (caudad) los ntawm qhov hnyav ntawm sab caj npab, thiab lub clavhortic fractures (txhua qhov kawg), Feem ntau yog vim qhov contraction ntawm lub subscapularis thiab pectoralis loj (uas yog sab hauv rotates sab caj npab). Qhov no feem ntau yog vim qhov contraction ntawm subscapularis thiab pectoralis loj cov leeg (uas yog sab hauv tig sab caj npab thiab rub nws mus rau hauv siab).

Nta

Lub hom phiaj ntawm kev kho clavicle tawg yog kom txo qhov mob thiab rov ua haujlwm sib koom ua ke. Feem ntau cov pob txha clavicle tseem raug kho feem ntau conservatively (feem ntau shortened tsis tshaj 15 mm); Cov kev kho mob xws li daim duab-ntawm-yim bandages, forearm slings, Sayre bandages, Velpeau immobilization suits, thiab immobilization. Kev ncua immobilization tau ua nyob rau theem mob hnyav, thiab kev ua haujlwm ntxov ntawm kev tawm dag zog thiab kev tawm dag zog lub zog feem ntau ua 2-6 lub lis piam tom qab pob txha thaum mob. Kev siv daim duab ntawm 8 bandages tsis pom zoo vim nws tuaj yeem ua rau axillary siab mob thiab ntau qhov tsis sib haum xeeb ntawm pob txha [5,6].

Keeb Kwm thiab Kev Xeem Lub Cev

Clavicle fractures yog tshwm sim los ntawm kev cuam tshuam ncaj qha rau lub xub pwg nyom tom qab lub caij nplooj zeeg thiab feem ntau pom nyob rau hauv kev ua si sab nraum zoov hauv cov hluas thiab hauv cov neeg laus poob qis. Nws yog ib qho tseem ceeb uas yuav tsum tau txhais cov txheej txheem ntawm kev raug mob. Kev raug mob lub zog siab tuaj yeem ua ke nrog kev raug mob taub hau thiab hauv siab, qhov kev puas tsuaj uas tshwm sim los ntawm kev raug mob me me tuaj yeem ua rau pathologic. Kev raug mob cuam tshuam yuav tsum tau pib ntxov thiab ceev faj tsis suav nrog scapular hauv siab phab ntsa sib cais, neurologic thiab vascular raug mob. Clinically, muaj o thiab ecchymosis ntawm qhov chaw tawg, ua ke nrog deformity thiab rhiab. Kev saib xyuas yuav tsum tau them rau cov ntaub so ntswg mos rau jacking, uas yuav ua rau daim tawv nqaij necrosis thiab ulceration.

Kev yees duab

Feem ntau cov pob txha tuaj yeem kuaj tau los ntawm cov duab hluav taws xob anteroposterior yooj yim. 20 ° lub taub hau qaij radiographs tshem tawm cov nyhuv ntawm cov kab noj hniav sib tshooj. Cov neeg mob yuav tsum tau radiographed nyob rau hauv txoj hauj lwm txhawb nqa tus kheej kom pom kev zoo dua ntawm pob txha tawg. Qhov hnyav-cov kabmob rau cov duab hluav taws xob muaj txiaj ntsig zoo hauv kev ntsuas kev ncaj ncees ntawm rostral clavicular ligament nyob rau hauv distal clavicle lossis acromioclavicular joint kev raug mob.CT pab pom kev nyuaj scapular girdle raug mob thiab muab kev pom zoo dua ntawm kev raug mob clavicle nyob ze ntawm sternoclavicular leeg. Kev siv lub hauv siab radiograph pab kom txiav txim siab txog kev raug mob ntawm lub thoracic, thiab luv luv tuaj yeem ntsuas los ntawm kev muab piv rau cov clavicle contralateral, nrog rau kev txiav txim siab tawm scapulothoracic phab ntsa sib cais.

Hom

AO/OTA Fracture Dislocation Typing: Lub clavicle fracture code 15 muaj peb qhov chaw: 15.1 proximal (medial), 15.2 diaphysis, thiab 15.3 distal (lateral). Proximal (medial) thiab distal (lateral) fractures yog categorized li hom A (extra-articular), hom B (ib nrab intra-articular), thiab hom C (ua tiav intra-articular). Cov pob txha pob txha yog categorized li hom A (yooj yim), hom B (wedge), thiab hom C (comminuted).Qhov AO/OTA kev faib tawm ntawm pob txha thiab dislocations tsis suav nrog qib ntawm kev tawg ntawm cov pob txha, thiab tam sim no tsuas yog siv los kho cov pob txha pob txha thiab hauv kev txiav txim siab.

Allman typing yog nyob ntawm qhov chaw ntawm qhov tawg (I: medial, cadent 1/3, II: lateral 1/3, III: medial 1/3) (Fig. 7.2.1).

Craig refined no classification dua nyob rau hauv lub hauv paus ntawm Allman, nrog rau kuv yog nruab nrab 1/3 ntawm lub clavicle; hom II yog sab nrauv 1/3 ntawm lub clavicle, uas tau muab faib ua 5 hom raws li pob txha tawg thiab kev sib raug zoo rau rostral clavicular ligament; thiab hom III yog qhov tawg ntawm sab hauv 1/3 ntawm lub clavicle, uas tau muab faib ua 5 hom raws li qib ntawm cov pob txha tawg thiab seb puas muaj pob txha puas yog intra-articular.

Neer txoj kev ntaus ntawv ntawm lateral 1/3 fractures hais txog qhov tseem ceeb ntawm rostral-clavicular ligament: hom kuv tshwm sim distal rau lub ligament rostral-clavicular ligament, nrog rau medial fracture block displaced superiorly; hom II cuam tshuam nrog cov ligament rostral-clavicular thiab ua rau cov pob txha pob txha nruab nrab raug tshem tawm zoo dua; thiab hom III txuas mus rau acromioclavicular kev sib koom ua ke nrog rostral-clavicular ligament tseem tshuav.

Edinburgh typing yog ib qho kev faib tawm ntawm diaphysis fractures raws li qib ntawm kev hloov pauv thiab sib txuas. Cov pob txha ntawm cov diaphysis raug cais raws li qhov muaj lossis tsis muaj kev sib cuag ntawm cortical ntawm cov pob txha tawg rau hauv hom A thiab B. Hom 2A cov pob txha raug cais ntxiv raws li qhov tsis muaj chaw nyob (hom 2A1) thiab angulated (hom 2A2), 2B pob txha tawg yog cais raws li qhov yooj yim los yog kab ntsaum (hom 2B1). Cov pob txha muaj feem rau qhov kawg ntawm lub diaphysis thiab hom 3 yog qhov kawg ntawm lub diaphysis. Qhov nruab nrab thiab sab kawg ntawm cov pob txha tawg tau muab faib ua pawg 1 thiab 2 raws li kev sib koom ua ke uas nyob ib sab.

Ib yam li ntawd muaj Rockwood typing, Jager typing, thiab Breitner typing.

Cov lus qhia phais

Cov pob txha tshwj xeeb

1, qhib pob txha; 

2, tshem tawm> 2 cm; 

3, luv luv> 2 cm; 

4, kev sib txuas ntawm cov pob txha tawg (> 3); 

5, ntau ntu tawg; 

6, lub hauv paus qhib pob txha nrog cov nqaij mos raug mob; 

7, tseem ceeb deformity (tshem tawm thiab shortening); 

8, scaphoid raug mob.

Kev raug mob ua ke

1, Ua ke ipsilateral sab qaum kev raug mob;

2, Floating xub pwg raug mob;

3, ntau yam kev raug mob;

4, tawg ua ke nrog kev raug mob neurovascular;

5, ipsilateral ntau rib fractures ua ke nrog lub hauv siab phab ntsa deformity;

6, clavicle shortening los tsim ib lub xub pwg nyom;

7, Ob sab clavicle tawg.

Tus neeg mob Factors

1, Cov neeg mob uas muaj ntau yam kev raug mob yuav tsum tau thaum ntxov lub cev hnyav hnyav;

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

Lub sijhawm phais

Kev phais yuav tsum tau ua yam tsis muaj ncua sij hawm thaum muaj qhov qhia meej txog kev phais.

Kev ncua ntawm kev phais tshaj li 2-3 lub lis piam hauv cov txheeb ze qhia tau tuaj yeem ua rau muaj kev nyuaj ntawm kev txo cov pob txha, tshwj xeeb tshaj yog thaum npaj rau kev txo qis sab hauv kho los ntawm cov txheej txheem percutaneous.

Kev phais mob

Tus neeg mob muab tso rau hauv lub rooj zaum puam lossis ib nrab zaum. Lub xub pwg nyom cuam tshuam yog padded hauv qab kom elevate lub clavicle kom yooj yim ntawm kev phais, thiab caj npab yog phuam kom tso cai rau kev sib koom tes. Ib qho kev hlais hlais raws qhov ntev ntawm lub clavicle lossis saber incision thaum uas tig mus rau tus qauv langer tuaj yeem xaiv.

Nco tseg: Ib qho kev hlais hlais muab kev txuas ntxiv ntau dua, thaum qhov kev txiav ntev ntev txo qhov kev pheej hmoo ntawm kev raug mob supraclavicular paj hlwb thiab ua kom zoo nkauj dua.

Sab hauv Fixation

3.5 Cov phiaj xwm compression, daim phiaj rov tsim kho, lossis cov yas LCP tuaj yeem siv los kho cov pob txha pob txha. Cov phaj yog smoothly muab tso rau saum toj los yog anterior rau clavicle. Cov phaj muaj zog nyob rau hauv biomechanical raug mob thaum muab tso rau superior, tshwj xeeb tshaj yog yog hais tias muaj ib tug comminuted puas hauv qab no, thiab yog yooj yim rau pom. Bicortical fixation ntawm cov ntsia hlau yog tsim nyog, thiab lub qhov yuav tsum tau drilled nrog kev saib xyuas zoo, vim hais tias muaj kev pheej hmoo ntawm kev raug mob rau cov hlab ntsha thiab cov hlab ntsha hauv qab no. Qhov zoo: kev nyab xeeb drilling ntawm anterior phaj ntsia hlau channel, phaj apposition, yooj yim contouring.

Faj seeb: Pob txha grafting feem ntau tsis tas yuav tsum tau ua thawj zaug; Tom qab kev txhim kho sab hauv, nws yog ib qho tseem ceeb kom ua tiav cov txheej txheem myofascial kom npog lub phaj thiab tiv thaiv kev kis kab mob.

Intramedullary fixation

Tam sim no intramedullary fixation li muaj xws li Kirschner pins, Rockwood pins, Hagie pins, titanium elastic intramedullary pins, hollow screws, thiab elastic locking intramedullary rau tes; Piv txwv li, titanium elastic rau tes tsis tso cai rau qhov ntsuas qhov zoo li qub, tsis txhob tso cai rau kev tswj qhov ntev thiab kev sib hloov, thiab tej zaum yuav ua rau lub sijhawm luv luv thaum siv rau cov pob txha tawg. Cov txheej txheem intramedullary nailing tsuas yog siv tau rau qhov yooj yim, transverse lossis oblique clavicle fractures.

Qhov zoo

me me incision, ntau aesthetic, tsis tshua muaj cov ntaub so ntswg stripping, txo kev pheej hmoo ntawm endophyte protrusion, thiab stability txuam nrog scab tsim.

Qhov tsis zoo

tawv nqaij khaus los yog tsis xws luag ntawm qhov chaw nkag.

Nco tseg: Kaw txo cov pob txha pob txha yog qee zaum nyuaj thiab overexposure ntawm tus neeg teb xov tooj tes rau hluav taws xob yog zam thaum lub sij hawm phais maneuvers.

Minimally invasive phaj fixation

Minimally invasive phaj osteosynthesis ntawm clavicle yog xav tias yuav muab ntau dua biomechanical zog thaum zam qhov tsis zoo ntawm qhib phaj fixation los yog intramedullary fixation.

Intraoperative kev tso kawm ntawm 3.5 system LCP anterior mus rau lub clavicle, nyiam dua anteriorly hauv qab lub clavicle, tso cai rau siv rau lub noj qab haus huv clavicle, ua kom nws yooj yim dua rau lub phaj ua ntej thiab kom tau ib tug ntev ntsia hlau aperture.

Kev siv thaum ntxov ntawm cov phaj osteosynthesis tsawg tsawg tuaj yeem cuam tshuam nrog kev raug mob supraclavicular paj hlwb, kev sib raug zoo tsis zoo los yog luv luv ntawm cov khub ntawm cov xov hlau uas cuam tshuam rau kev ua haujlwm, thiab phaj dabtsi yog khoov lossis tawg.

Phaj fixation ntawm fractures ntawm sab kawg ntawm lub clavicle

Kev xaiv ntawm cov phaj cog yog nyob ntawm qhov loj ntawm cov pob txha lateral block. Yam tsawg kawg ntawm 3 bicortical screws yog xav tau rau cov pob txha lateral block. Qhov zoo tshaj plaws, nro screws yuav tsum tau siv rau oblique puas. Yog tias cov pob txha pob txha me dhau rau kev kho, yuav siv lub phaj clavicle.

Kev kho mob ntawm acromioclavicular joint dislocation

Acromioclavicular kev sib koom tes raug mob rau 12% ntawm kev raug mob scapular girdle thiab feem ntau tshwm sim hauv cov neeg ncaws pob uas muaj kev sib cuag.

Qhov feem ntau siv staging system yog Rockwood staging. Hom I yog pob txha ntawm acromioclavicular ligament nrog rostroclavicular ligament tsis zoo; hom II yog lub kua muag ntawm lub acromioclavicular ligament nrog lub rostroclavicular ligament lawm; hom III yog lub kua muag ntawm ob qho tib si acromioclavicular ligament thiab rostroclavicular ligament; hom IV yog kev hloov pauv tom qab ntawm qhov distal clavicle impaling lub trapezius; hom V yog ua tiav tsim kua muag ntawm ob qho tib si acromioclavicular kev sib koom tes thiab rostroclavicular ligament, nrog ntau tshaj 100 feem pua ​​​​ntawm kev sib koom ua ke; thiab hom VI kev raug mob yog tsawg heev, nrog rau qhov distal clavicle txav mus rau hauv qab ntawm cov txheej txheem rostral.

Conservative kev kho mob nrog luv luv braking nrog ib tug cantilever sling yog pom zoo rau hom I thiab hom II raug mob. Kev tswj hwm ntawm hom III kev raug mob yog qhov tsis sib haum xeeb, nrog qee cov ntaub ntawv qhia tias kev saib xyuas kev kho mob yog qhia rau cov tub ntxhais hluas nquag. Kev ua haujlwm rov qab zoo yog qhov zoo txawm hais tias yuav muaj qhov sib txawv ntawm deformity hauv qhov tsos. Hom IV - VI raug mob hnyav dua thiab kev phais raug pom zoo.

Tam sim no, feem ntau siv cov txheej txheem phais yog: Bosworth rostral locking ntsia hlau txheej txheem nrog ib-theem kho los yog tsis kho ligament;, clavicle nuv phaj fixation, zoo ib yam li lateral kawg ntawm clavicle tawg; Tightrope's tab phaj fixation los yog thauj tog rau nkoj pinning suture los ntawm ib tug arthroscope los yog ib tug me me incision; thiab rostral locking ligament suture los yog kev ncua ntxiv, nrog cov khoom siv dag zog lossis cov leeg ntawm rostral eminence thiab clavicle.

Nws tsis paub meej tias cov txheej txheem phais twg yog qhov zoo dua, thiab txawm hais tias tej zaum yuav muaj qee qhov kev poob ntawm resurfacing, qhov ua tau zoo ntawm tag nrho cov txheej txheem no yog qhov txaus siab.

Kev kho mob ntawm nruab nrab kawg clavicle fractures thiab sternoclavicular joint dislocations

Cov kev raug mob no kuj tsis tshua muaj, thiab tsis muaj cov txheej txheem kho mob raws li pov thawj cov tshuaj.

Medial clavicle fractures feem ntau yog cov pob txha pob txha ntxiv nrog qhov tsis tseem ceeb thiab tuaj yeem kho tau zoo. Lub epiphysis ntawm qhov kawg ntawm lub clavicle feem ntau kaw thaum muaj hnub nyoog 23-25 ​​xyoo thiab yog qhov kawg epiphysis kaw hauv lub cev. Yog li ntawd, ntau qhov kev raug mob ntawm qhov nruab nrab yog qhov ua tau zoo ntawm cov pob txha epiphyseal ntawm Salter-Harris hom I lossis II. Cov X-rays yog ib qho nyuaj rau kev kuaj mob, nrog rau qhov zoo ntawm 40 ° lub taub hau qaij xov tooj cua thiab kev sib piv rau sab noj qab haus huv tuaj yeem nthuav tawm qhov kev hloov pauv ntawm qhov nruab nrab ntawm lub clavicle, thiab CT muab qhov kev kuaj pom zoo tshaj plaws.

Kev puas tsuaj los yog kev puas tsuaj uas tau hloov mus rau yav tom ntej feem ntau tuaj yeem raug kaw thiab rov ua dua, tab sis feem ntau tsis ruaj khov thiab lobotomized rau rov hloov dua tshiab. Kev kho mob Palliative raug pom zoo rau kev txav mus los tsis tu ncua lossis hloov chaw vim tias lawv feem ntau tsis ua rau muaj kev ua haujlwm tsis zoo. Dislocation ntawm qhov kawg ntawm lub clavicle posteriorly tsis tshua muaj tshwm sim nyob rau hauv lub Upper mediastinal raug mob, nrog rau kev raug mob vascular los yog tracheal obstruction thiab airway compression. Rau dislocations thiab fractures qhov twg qhov nruab nrab feem me me dhau lawm, daim hlau tuaj yeem txuas mus rau qhov sib koom ua ke rau kev kho rau lub sternum.

Lwm txoj kev fixation

xws li sab nrauv fixation nrog stent, sab nrauv fixation nrog clavicle phaj, thiab lwm yam.

Kev tswj xyuas tom qab phais

Sab caj npab yuav tsum tau immobilized nyob rau hauv ib tug sling thiab lub xub pwg nyom pendulum kev cob qhia yuav tsum tau pib tam sim ntawd. 2 lub lis piam tom qab, tus neeg mob yuav tsum tau ua raws li mus xyuas lub qhov txhab thiab tshuaj xyuas X-rays, thaum lub forearm sling yuav raug tshem tawm thiab unrestricted kev sib koom tes kev cob qhia yuav tsum tau pib, tab sis tus neeg mob yuav tsum tau hais kom tus neeg mob tsis txhob nqa hnyav nrog rau cov ceg. Kev cob qhia muaj zog tuaj yeem pib ntawm 6 lub lis piam tom qab kev phais thaum cov tsos mob ntawm pob txha kho. Kev sib cuag nrog cov kis las lossis kev ua kis las hnyav yuav tsum zam rau 3 lub hlis tom qab kev phais kom txog thaum lub pob txha zoo lawm.

Teeb meem.

Cov teeb meem thaum ntxov

Cov kab mob tom qab phais tuaj yeem tshwm sim txog li 4.8% ntawm cov neeg mob;

loog hauv thaj tsam subclavian yog qhov teeb meem tshwm sim ntau tshaj plaws, nrog rau kev tshawb fawb keeb kwm yav dhau los txog li 83% ntawm cov neeg mob uas muaj cov tsos mob no, uas ploj zuj zus mus rau lub sijhawm thiab tsis ua rau muaj kev cuam tshuam loj heev, txawm hais tias nws yuav mob ntev txog 2 xyoos tom qab phais;

Endophyte protrusion thiab agitation ntawm daim tawv nqaij, feem ntau yog siv cov voluminous daim hlau los yog ntsia thawv tails uas tsis muaj cov ntaub so ntswg zoo;

rov tawg, uas yuav tshwm sim tom qab phais thiab kev kho mob; Tom qab kev phais mob rov qab tuaj yeem ua rau khoov lossis tawg ntawm endoprosthesis, lossis pob txha ib ncig ntawm endoprosthesis;

nonunion, nrog 15% nonunion tus nqi nrog kev saib xyuas kev kho mob thiab 2% nonunion tus nqi nrog kev kho mob phais kom tshem tawm tag nrho cov pob txha diaphyseal; ua kom tiav cov pob txha tawg, luv luv ntau dua 2 cm, haus luam yeeb, muaj hnub nyoog zuj zus, kev raug mob ntawm lub zog siab, rov ua kom tawg (kev tsis sib haum xeeb), recalcitrant diaphyseal dislocations, cov pob txha tsis zoo, thiab cov pob txha ntau dhau.

Teeb meem lig

Osteoarthritis ntawm cov pob qij txha acromioclavicular tshwm sim ntau zaus nrog cov pob txha pob txha (Edinburgh hom 3B2); Thaum cov tsos mob thiab kev saib xyuas kev kho mob tsis zoo, qhov distal clavicle yuav raug kho dua tshiab los yog los ntawm kev phais qhib;

Kev kho deformity, uas tshwm sim rau qhov sib txawv ntawm txhua qhov kev kho kom zoo nkauj tawg; shortening ntawm scapular girdle nrog los ntawm kev sib hloov ntawm lub distal fracture block yuav ua rau txo qis lub xub pwg nyom lub zog thiab endurance, tshwj xeeb tshaj yog nyob rau hauv lub xub pwg abduction; nqaim ntawm lub qhov hluav taws xob thoracic tuaj yeem ua rau cov tsos mob ntawm brachial plexus compression; thiab malalignment ntawm scapulothoracic phab ntsa pob qij txha tuaj yeem ua rau anterior tilting ntawm scapula thiab ua rau mob lub xub pwg nyom thiab myalgias, yog tias nws pom tseeb tias cov tsos mob tshwm sim los ntawm deformity thaum kho, kho osteotomy thiab kho phaj yog ua tau nyob ntawm tus neeg mob qhov kev xav tau.

Prognosis thiab tshwm sim

Ib txoj kev tshawb fawb muaj feem xyuam hauv Tebchaws Europe tau tshaj tawm tias kev kho mob phais ntawm cov pob txha midclavicular puas tau ua haujlwm tau zoo, thiab nws cov kev tshuaj ntsuam xyuas meta tau pom tias qhov tshwm sim ntawm malunion ua rau cov pob txha tsis zoo thiab cov tsos mob ua rau malunion tau qis dua hauv pab pawg phais dua li hauv pawg kws kho mob thaum phais tau muab piv nrog kev kho mob; Tsis tas li ntawd, pawg kws phais tau txo qhov mob thaum ntxov, thiab kev txhim kho hauv Cov qhabnias ua haujlwm tas li thiab DASH tau tshaj tawm.

Cov ntsiab lus

Feem ntau cov pob txha pob txha yog tshwm sim los ntawm kev ua phem ncaj qha lossis tsis ncaj, thiab kev kho mob tuaj yeem raug cais raws li kev saib xyuas lossis kev phais. Nyob rau hauv cov nqe lus ntawm kev kho mob, txawm hais tias feem ntau clavicle fractures tsis muaj kev hloov pauv tseem ceeb tuaj yeem kho tau zoo, kev xaiv kev kho mob phais rau cov pob txha tawg nrog kev hloov pauv tseem ceeb yog qhov teeb meem. Rau kev tshem tawm cov pob txha pob txha, kev kho mob phais muaj tus nqi siab dua ntawm cov pob txha zoo thiab cov txiaj ntsig ua haujlwm thaum ntxov piv nrog kev kho mob.

Cov ntaub ntawv

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[4] Neer CS 2nd. Fractures ntawm lub distal thib peb ntawm lub clavicle. Clin Orthop Relat Res 1968; 58:43 ib.

[5] Andersen K, Jensen PO, Lauritzen J. Kev kho cov pob txha clavicular. Daim duab-ntawm- yim daim ntaub qhwv tiv thaiv ib qho yooj yim sling. Acta Orthop Scand 1987; 58:7 1.

[6] 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 tug randomized tswj kev kawm. Pob txha Joint J 2015; 97-B: 1562 Ib.