Kuzindikira ndi Kuchiza kwa Clavicle Fractures

Mawu Oyamba

Kuphulika kwa Clavicle kumakhala kofala ndipo kawirikawiri kumabwera chifukwa cha kuvulala kwachindunji kapena kosalunjika kudera la mapewa. Kafukufuku kumayambiriro kwa zaka za m'ma 1960 adanena kuti chiwerengero chosavomerezeka cha fractures cha clavicle chinali chocheperapo kuposa 1%, ndipo chithandizo chodziletsa chinachititsa kuti odwala azikhala okhutira; ndi chitukuko chaposachedwapa cha mankhwala, chithandizo cha opaleshoni chapindula kwambiri; Choncho, madokotala omwe amagwira ntchito mu dipatimenti yodzidzimutsa kapena chipatala chodzidzimutsa ayenera kudziwa bwino mawonetseredwe ndi zovuta za kuvulala kumeneku ndi kasamalidwe kake.

Epidemiology

Kuphulika kwa Clavicle kumapangitsa 2.6% -5% ya fractures onse akuluakulu [1,2]. Kufufuza kwa ku Ulaya komwe kumaphatikizapo milandu ya 1,000 yotsatizana ya fracture ya clavicle inapeza [3,4] kuti kuposa 66% ya fractures ya clavicle inachitika pakati pa 1 / 3 ya clavicle, pafupifupi 25% anali lateral 1 / 3 fractures, ndipo 3% anali apakati 1 / 3 fractures. Kuchuluka kwa clavicle fractures kunawonetsa kugawidwa kwa bimodal, komwe kumachitika makamaka mwa amuna osakwana zaka 30, kutsatiridwa ndi omwe ali ndi zaka zopitilira 70.

Clinical Anatomy

Chigoba choyambirira kwambiri cha munthu kuti chiyambe kugwedezeka ndi clavicle, mgwirizano wokhawo wa mafupa pakati pa mkono wapamwamba ndi thunthu, womwe umamveka kutali ndi acromion, acromioclavicular (AC) joint, ndi proximally ndi sternum, sternoclavicular (SC) joint. Malumikizidwewa amatchedwa atypical synovial joints chifukwa amakhala ndi fibrocartilage osati hyaline cartilage. The clavicle imamangiriridwa ku scapula ndi mitsempha ya acromioclavicular ndi rostroclavicular ndipo imamangiriridwa ku sternum ndi sternoclavicular ligament.

The clavicle ndi 'S' mawonekedwe. Ma proximal theka-arc amapangira kutsogolo, kusiya malo a neurovascular mtolo wa kumtunda. Theka lakutali la arc limapangidwira kumbuyo (concave) ndiyeno limalumikizana ndi scapula (rostral process ndi acromion). Mitsempha ya clavicle nthawi zambiri imapezeka pamagulu awiri a arcs (pakati pa arc), makamaka chifukwa cha kusowa kwa mitsempha yomwe imagwirizanitsa mafupa oyandikana nawo m'derali komanso chifukwa ndi gawo lofooka kwambiri la clavicle. Pamene kupasuka kwa clavicle kumachotsedwa, gawo lozungulira nthawi zonse limakokedwa mmwamba (cephalad) ndi minofu ya sternocleidomastoid (yomwe ili kumapeto kwenikweni kwa clavicle) ndipo gawo la distal limathamangitsidwa pansi (caudad) ndi kulemera kwa mkono wapamwamba, ndipo clavicle imakonda kusweka ',' makamaka chifukwa cha kugwedezeka kwa subscapularis ndi pectoralis yaikulu (yomwe mkati imazungulira kumtunda kwa mkono). Izi makamaka chifukwa cha kugunda kwa subscapularis ndi minofu yaikulu ya pectoralis (yomwe mkati imazungulira mkono wapamwamba ndikuyikokera pachifuwa).

Mawonekedwe

Cholinga cha chithandizo cha clavicle fracture ndikuchepetsa ululu ndikubwezeretsa ntchito yolumikizana. Ma fractures ambiri a clavicle amathandizidwabe mosamala (nthawi zambiri amafupikitsidwa ndi osapitirira 15 mm); mankhwala osamalidwa bwino monga ma bandeji okwana asanu ndi atatu, ma gulaye am'manja, mabandeji a Sayre, masuti a Velpeau immobilization, ndi kusasunthika. Kuyimitsidwa immobilization ikuchitika pachimake gawo, ndi oyambirira osiyanasiyana zoyenda maphunziro ndi mphamvu zolimbitsa thupi amachitidwa 2-6 masabata pambuyo fracture pamene ululu watsimikiza. Kugwiritsiridwa ntchito kwa chifaniziro cha mabandeji a 8 sikuvomerezeka chifukwa kungayambitse zilonda za axillary ndi zina zosagwirizana ndi fracture [5,6].

Mbiri ndi Mayeso a Thupi

Kuphulika kwa Clavicle kumachitika chifukwa cha kugunda kwachindunji pamapewa pambuyo pa kugwa ndipo nthawi zambiri kumawoneka pamasewera akunja kwa achinyamata komanso kugwa modzidzimutsa kwa okalamba. Ndikofunika kufotokozera njira yovulaza. Kuvulala kwamphamvu kwamphamvu kungaphatikizepo kuvulala kumutu ndi pachifuwa, pomwe kusweka kwapang'onopang'ono kumatha kukhala pathological. Kuvulala kwapang'onopang'ono kumafuna kuyambika koyambirira komanso kusamalidwa mosamalitsa kupatukana kwa khoma lachifuwa la scapular, neurologic ndi kuvulala kwa mitsempha. Kachipatala, pali kutupa ndi ecchymosis pamalo ophwanyidwa, kuphatikizapo kupunduka ndi chifundo. Chisamaliro chiyenera kuperekedwa ku minofu yofewa kuti iwonongeke, zomwe zingayambitse khungu necrosis ndi zilonda.

Kujambula

Ma fractures ambiri amatha kupezeka ndi ma radiographs osavuta a anteroposterior. 20 ° mutu wopendekeka ma radiographs amachotsa zotsatira za kupindika kwa thoracic cavities. Odwala ayenera kujambulidwa ndi radiograph pamalo odzithandizira kuti athe kuwona bwino za kusamuka kwa fracture. Kulemera kwa ma radiographs kumathandiza poyesa kukhulupirika kwa rostral clavicular ligament mu distal clavicle kapena acromioclavicular joint injury.CT imathandiza kuona kuvulala kovutirapo kwa lamba la scapular ndipo kumapereka chithunzithunzi chabwino cha kuvulala komwe kungachitike pakatikati pa sternoclavicular joint. Kutenga chifuwa cha radiograph kumathandiza kuthetsa kuvulala kwa thoracic komwe kumagwirizanitsidwa, ndipo kufupikitsa kungayesedwe poyerekezera ndi contralateral clavicle, komanso kuthetsa kupatukana kwa khoma la scapulothoracic.

Mitundu

AO/OTA Fracture Dislocation Typing: The clavicle fracture code 15 ili ndi malo atatu: 15.1 proximal (medial), 15.2 diaphysis, ndi 15.3 distal (lateral). Proximal (medial) ndi distal (lateral) fractures ali m'gulu A (owonjezera-articular), mtundu B (pang'ono intra-articular), ndi mtundu C (konse intra-articular). Kuphulika kwa thunthu kumagawidwa ngati mtundu wa A (wosavuta), mtundu wa B (wedge), ndi mtundu wa C (wotumizidwa) . Gulu la AO / OTA la fractures ndi dislocations silingaganizire kuchuluka kwa kusamuka kwa fracture, ndipo pakali pano ndi ntchito yochepa pochiza fractures ya clavicle komanso pozindikira zomwe zikuchitika.

Kulemba kwa Allman kumachokera ku malo ophwanyika (I: medial, cadent 1/3, II: lateral 1/3, III: medial 1/3) (Mkuyu 7.2.1).

Craig anakonzanso gululi kachiwiri pamaziko a Allman, ine kukhala pakati 1/3 wa clavicle; mtundu II pokhala 1/3 yakunja ya clavicle, yomwe idagawidwa m'mitundu 5 kutengera kusamuka kwa fracture ndi ubale ndi rostral clavicular ligament; ndi mtundu III kukhala fracture wa mkati 1/3 wa clavicle, amene anagawanika 5 mitundu kutengera mlingo wa fracture kusamutsidwa ndi ngati fracture anali intra-articular.

Neer's typing of lateral 1/3 fractures ikugogomezera kufunika kwa rostral-clavicular ligament: mtundu wa I umapezeka distal kwa rostral-clavicular ligament, ndi fracture block block imasamutsidwa bwino; mtundu wachiwiri umaphatikizapo rostral-clavicular ligament ndipo zimapangitsa kuti phokoso lapakati likhale losamutsidwa bwino; ndipo mtundu wa III umafikira ku mgwirizano wa acromioclavicular ndi rostral-clavicular ligament yotsalira.

Edinburgh typing ndi dongosolo la kagawo ka diaphysis fractures malinga ndi kuchuluka kwa kusamuka ndi comminution.1 Mtundu wa 1 fractures umaphatikizapo mapeto apakati, mtundu wa 2 ndi diaphysis fractures ndipo mtundu wa 3 ndi lateral mapeto fractures. Kuphulika kwa diaphysis kumagawidwa molingana ndi kukhalapo kapena kusapezeka kwa cortical kukhudzana pakati pa zidutswa za fracture mu mitundu A ndi B. Mtundu wa 2A fractures umatchulidwanso kuti ndi wosakhazikika (mtundu wa 2A1) ndi angulated (mtundu wa 2A2), 2B fractures amagawidwa ngati ophweka kapena opangidwa ndi wedge (mtundu wa 2B12) ndi mtundu wa commited 3B11. fractures imaphatikizapo mapeto apakati a diaphysis ndipo mtundu wa 3 ndi mapeto a diaphysis. Kuphulika kwapakati ndi kumapeto kwapakati kumagawidwa m'magulu a 1 ndi 2 malinga ndi momwe mgwirizano woyandikana nawo umakhudzidwa.

Momwemonso pali kulemba kwa Rockwood, Jager typing, ndi Breitner typing.

Zizindikiro za opaleshoni

Zophwanyika zenizeni

1, fracture yotseguka; 

2, kusamutsidwa > 2 cm; 

3, kufupikitsa>2cm; 

4, kupititsa patsogolo zidutswa za fracture (> 3); 

5, kusweka kwamagulu angapo; 

6, kuphulika kwapang'onopang'ono ndi kuvulala kwa minofu yofewa; 

7, kupunduka kwakukulu (kusamuka ndi kufupikitsa); 

8, kuwonongeka kwa scaphoid.

Kuvulala kophatikizana

1, Kuphatikizira kuvulala kwapamtunda kwapamwamba;

2, Kuyandama phewa kuvulala;

3, kuvulala angapo;

4, kupasuka pamodzi ndi kuvulala kwa ubongo;

5, Ipsilateral nthiti zambiri zothyoka kuphatikiza ndi kupunduka kwa khoma pachifuwa;

6, clavicle kufupikitsa kupanga mapewa mapiko;

7, Bilateral clavicle fractures.

Zinthu Zodwala

1, Odwala omwe ali ndi zovulala zingapo amafunikira kulemera koyambirira;

2, Odwala omwe amafunikira kubwerera mwachangu kuntchito (mwachitsanzo, masewera apamwamba komanso ampikisano).

Nthawi ya opaleshoni

Opaleshoni iyenera kuchitidwa mosazengereza ngati pali zizindikiro zenizeni za opaleshoniyo.

Kuchedwa kwa opaleshoni kupitirira masabata a 2-3 pazisonyezero zachibale kungapangitse kuvutika kwa kuchepetsa fracture, makamaka pokonzekera kuchepetsa kutsekedwa kwa mkati mwa njira zopangira percutaneous.

Kupeza opaleshoni

Wodwalayo amaikidwa pampando wa gombe kapena malo okhala pansi. Paphewa lomwe lakhudzidwa limakutidwa pansi kuti likweze clavicle kuti achite opaleshoni mosavuta, ndipo mkono umakulungidwa kuti ulole kukakamiza kwa intraoperative. Chocheka chopingasa motsatira mbali yayitali ya clavicle kapena choboola chofanana ndi chalanger chingasankhidwe.

Zindikirani: Kudulira kozungulira kumapereka mwayi wokulirapo, pomwe kudula kwakutali kumachepetsa chiopsezo cha kuvulala kwa mitsempha ya supraclavicular ndipo kumakhala kosangalatsa kwambiri.

Kukonzekera Kwamkati

3.5 Ma mbale ophatikizika mwadongosolo, mbale zomanganso, kapena ma LCP apulasitiki angagwiritsidwe ntchito kukonza ma fractures a clavicle. Mbale amayikidwa bwino pamwamba kapena kutsogolo kwa clavicle. Mbale zimakhala zamphamvu kwambiri pakuvulala kwa biomechanic zikayikidwa pamwamba, makamaka ngati pali kusweka kokhazikika pansipa, ndipo ndizosavuta kuziwona. Bicortical fixation ya zomangira ndizofunikira, ndipo mabowo ayenera kudulidwa mosamala kwambiri, chifukwa pali chiopsezo chovulaza mitsempha ndi mitsempha yomwe ili pansipa. Ubwino: kubowola kotetezeka kwa tchanelo cha anterior plate screw, plate apposition, contouring yosavuta.

Zindikirani: Kumezanitsa mafupa nthawi zambiri sikofunikira pa ndondomeko yoyamba; pambuyo kukonza mkati, ndikofunika kuti mokwanira suture myofascial wosanjikiza kuphimba mbale ndi kupewa matenda.

Kukonzekera kwa intramedullary

Zida zamakono za intramedullary fixation zikuphatikizapo mapini a Kirschner, mapini a Rockwood, mapini a Hagie, titaniyamu zotanuka za intramedullary pins, zomangira zopanda kanthu, ndi misomali yotsekera yotsekeka ya intramedullary; mwachitsanzo, titaniyamu misomali zotanuka salola kutseka malo amodzi, salola kulamulira kutalika ndi kuzungulira, ndipo zingachititse kufupikitsa yachiwiri pamene ntchito comminuted fractures. Njira yopangira misomali ya intramedullary ingagwiritsidwe ntchito pazidutswa zosavuta, zodutsa kapena za oblique clavicle.

Ubwino wake

kung'ambika kwakung'ono, kukongola kwambiri, kuvula minofu yofewa pang'ono, chiopsezo chochepa cha endophyte protrusion, ndi kukhazikika kokhudzana ndi kupanga nkhanambo.

Zoipa

kuyabwa pakhungu kapena zolakwika polowera.

Zindikirani: Kuchepetsa kotseka kwa fractures ya clavicle nthawi zina kumakhala kovuta ndipo kuwonetseredwa mochulukira kwa dzanja la wogwiritsa ntchito ku radiation kumapewa panthawi ya opaleshoni.

Kukonza mbale zocheperako

Osteosynthesis ya clavicle yocheperako pang'ono imaganiziridwa kuti imapereka mphamvu zokulirapo za biomechanical ndikupewa kuipa kotsegulira mbale kapena intramedullary fixation.

Kuyika kwa intraoperative kwa 3.5 system LCP kutsogolo kwa clavicle, makamaka kutsogolo pansi pa clavicle, kumalola kutchulidwa kwa clavicle yathanzi, zomwe zimapangitsa kuti zikhale zosavuta kuumba mbale pasadakhale komanso kupeza kabowo kakang'ono katali.

Kugwiritsa ntchito msanga kwa osteosynthesis ya mbale yocheperako kumatha kulumikizidwa ndi kuvulala kwa mitsempha ya supraclavicular, kusayenda bwino kapena kufupikitsa mawaya omwe amakhudza kugwira ntchito, komanso kupindika kapena kusweka kwa mbale.

Kukonzekera kwa mbale zophulika za kumapeto kwa clavicle

Kusankhidwa kwa ma implants a mbale kumadalira kukula kwa fupa la lateral. Pakufunika zomangira 3 za bicortical zomangira fupa lakumbuyo. Moyenera, zomangira zomangika ziyenera kugwiritsidwa ntchito pakupanga ma oblique fractures. Ngati fupa la fupa ndi laling'ono kwambiri kuti lipangidwe, mbale ya clavicle ingagwiritsidwe ntchito.

Chithandizo cha acromioclavicular joint dislocation

Kuvulala kophatikizana kwa Acromioclavicular kumapangitsa 12% ya kuvulala kwa lamba wa scapular ndipo nthawi zambiri kumachitika mwa othamanga odzaza.

Njira yomwe imagwiritsidwa ntchito kwambiri ndi Rockwood staging. Mtundu Woyamba ndi sprain wa acromioclavicular ligament ndi rostroclavicular ligament intact; mtundu wachiwiri ndi kung'ambika kwa ligament ya acromioclavicular ndi rostroclavicular ligament; mtundu wa III ndi kung'ambika kwa acromioclavicular ligament ndi rostroclavicular ligament; mtundu wa IV ndikusunthira kumbuyo kwa distal clavicle kuyika trapezius; mtundu wa V ndikung'ambika kwathunthu kwa acromioclavicular joint ndi rostroclavicular ligament, ndi kupitirira 100 peresenti kusamuka kwa mgwirizano; ndi kuvulala kwa mtundu wa VI ndizosowa kwambiri, ndipo distal clavicle imasunthira pansi pansi pa ndondomeko ya rostral.

Chithandizo chokhazikika chokhala ndi braking kwakanthawi kochepa ndi cantilever sling tikulimbikitsidwa kuvulala kwa mtundu wa I ndi mtundu wa II. Ulamuliro wa kuvulala kwa mtundu wa III ndi wotsutsana, ndi zolemba zina zomwe zimasonyeza kuti chithandizo chodziletsa chimasonyezedwa kwa achinyamata omwe akukula. Kuchira kogwira ntchito ndikwabwino ngakhale pangakhale mawonekedwe osiyanasiyana opunduka. Kuvulala kwamtundu wa IV - VI kumakhala koopsa kwambiri ndipo kuchitidwa opaleshoni kumalimbikitsidwa.

Pakalipano, njira zomwe zimagwiritsidwa ntchito popanga opaleshoni ndi: Bosworth rostral locking screw njira yokhala ndi gawo limodzi lokonzekera kapena kukonzanso ligament;, clavicle hook plate fixation, yofanana ndi mapeto a fracture ya clavicle; Kukhazikika kwa mbale ya Tightrope kapena kulumikiza kwa nangula kudzera pa arthroscope kapena pang'ono; ndi rostral locking ligament suture kapena kulimbikitsa kuyimitsidwa, ndi zinthu zopangira kapena tendon pakati pa rostral eminence ndi clavicle.

Sizidziwikiratu kuti ndi njira iti ya opaleshoni yomwe ili yopindulitsa kwambiri, ndipo ngakhale kuti pangakhale kutayika kwina kwa kubwezeretsanso, mphamvu yomaliza ya njira zonsezi ndi yokhutiritsa.

Chithandizo cha medial end clavicle fractures ndi sternoclavicular joint dislocations

Kuvulala kumeneku sikochitika kawirikawiri, ndipo palinso kusowa kwa malangizo ochiritsira malinga ndi umboni wa mankhwala.

Mitsempha yapakati ya clavicle nthawi zambiri imakhala yophulika kwambiri ndi kusamuka kosafunikira ndipo imatha kuthandizidwa mosamala. Epiphysis ya kumapeto kwapakati pa clavicle nthawi zambiri imatseka pazaka 23-25 ​​ndipo ndi epiphysis yomaliza kutseka m'thupi. Chifukwa chake, kuvulala kwapakatikati kumakhaladi ma epiphyseal plate fractures a Salter-Harris mtundu I kapena II. X-ray wamba ndizovuta kuzindikira, ndi mwayi kuti 40 ° mutu wopendekeka radiograph ndi kuyerekeza ndi mbali yathanzi kukhoza kuwulula kusamuka kwapakati pakatikati pa clavicle, ndipo CT imapereka chithunzithunzi chabwino kwambiri cha matenda.

Ziphuphu kapena ma dislocation omwe amasamutsidwa kunja nthawi zambiri amatha kutsekedwa ndi kuikidwanso, koma nthawi zambiri amakhala osakhazikika komanso opangidwa ndi lobotomized kuti asamutsidwenso. Kusamalidwa bwino kumalimbikitsidwa pakusamuka kosalekeza kapena kusamuka chifukwa nthawi zambiri sizimayambitsa kuwonongeka kwa magwiridwe antchito. Kusunthika kwa kumapeto kwapakati kwa clavicle pambuyo pake sikumabweretsa kuvulala kwapamwamba kwapakati, kuphatikizapo kuvulala kwa mitsempha kapena kutsekeka kwa tracheal ndi kuponderezana kwa mpweya. Pakusweka ndi kusweka komwe chidutswa chapakati ndi chaching'ono kwambiri, mbale zitha kulumikizidwa pagulu kuti zikhazikike ku sternum.

Njira zina zokonzera

mwachitsanzo kukonza kwakunja ndi stent, kukonza kwakunja ndi mbale ya clavicle, ndi zina.

Kasamalidwe ka postoperative

Dzanja lapamwamba liyenera kukhala losasunthika mu gulaye ndipo maphunziro a pendulum a pamapewa ayenera kuyambika nthawi yomweyo. Pakatha masabata a 2, wodwalayo ayenera kutsatiridwa kuti ayang'ane bala ndikuwunikanso ma X-ray, pomwe gulaye imatha kuchotsedwa ndipo maphunziro osagwirizana ndi olumikizana amatha kuyambika, koma wodwalayo ayenera kuuzidwa kuti asanyamule zolemera ndi mwendo womwe wakhudzidwa. Maphunziro a mphamvu amatha kuyambika pa masabata a 6 pambuyo pa opaleshoni pamene zizindikiro za kuchira kwa mafupa zikuwonekera. Masewera okhudzana kapena masewera olimbitsa thupi ayenera kupewedwa kwa miyezi 3 mutatha opaleshoni mpaka fracture yachira kwathunthu.

Zovuta.

Zovuta zoyamba

Matenda a postoperative amatha kuchitika mpaka 4.8% ya milandu;

Dzanzi m'dera la subclavia ndilofala kwambiri, ndi kafukufuku wa mbiri yakale mpaka 83% ya odwala omwe ali ndi chizindikiro ichi, chomwe chimachepa pakapita nthawi ndipo sichimayambitsa vuto lalikulu, ngakhale kuti likhoza kupitirira zaka 2 pambuyo pake;

Endophyte protrusion ndi khungu mukubwadamuka, wamba ndi ntchito voluminous mbale kapena misomali michira popanda kuphimba zabwino zofewa minofu;

kuthyokanso, komwe kungachitike pambuyo pa chithandizo cha opaleshoni komanso chokhazikika; kuvulazidwanso pambuyo pa opaleshoni kungayambitse kupindika kapena kuthyoka kwa endoprosthesis, kapena kupasuka kuzungulira endoprosthesis;

Nonunion, ndi 15% Nonunion mlingo ndi mankhwala wodziletsa ndi 2% nonunion mlingo ndi chithandizo cha opaleshoni fractures diaphyseal osatha; kusamuka kwathunthu kwa fracture, kufupikitsa wamkulu kuposa 2 cm, kusuta, kukula kwa zaka, kuvulala kwamphamvu kwambiri, kupasukanso (kusakhazikika kwa makina), recalcitrant diaphyseal dislocations, kuperewera kwa mafupa, ndi mafupa ochuluka kwambiri.

Zovuta mochedwa

Osteoarthritis ya acromioclavicular joint imapezeka kawirikawiri ndi intra-articular fractures (mtundu wa Edinburgh 3B2); pamene chithandizo cha zizindikiro ndi chodziletsa sichigwira ntchito, clavicle ya distal ikhoza kupangidwanso ndi arthroscopically kapena opaleshoni yotsegula;

Machiritso opunduka, omwe amapezeka mosiyanasiyana m'mitsempha yonse yosamalidwa mosadukiza; kufupikitsa lamba wa scapular limodzi ndi kuzungulira kwa distal fracture block kungayambitse kuchepa kwamphamvu kwa mapewa ndi kupirira, makamaka pakubedwa kwa mapewa; kuchepetsa kutuluka kwa thoracic kungayambitse zizindikiro za kupsinjika kwa brachial plexus; ndi kusagwirizana kwa khoma la scapulothoracic kungayambitse kupendekeka kwapambuyo kwa scapula ndikupanga kupweteka kwa mapewa ndi myalgias, ngati zikuwonekeratu kuti zizindikirozo zimachokera ku chilema Pamene machiritso amachitika, kukonzanso kwa osteotomy ndi kukonza mbale ndi kotheka malinga ndi zosowa za wodwalayo.

Kuneneratu ndi zotsatira zake

Kafukufuku wokhudzana ndi ku Ulaya adanena kuti chithandizo cha opaleshoni cha fractures chapakati pa othawa kwawo chinali chothandiza, ndipo kusanthula kwake kwa meta kunasonyeza kuti zochitika za malunion zomwe zimatsogolera ku fracture nonunion ndi malunion yotulutsa zizindikiro inali yotsika kwambiri mu gulu la opaleshoni kusiyana ndi gulu lachidziwitso chokhazikika pamene opaleshoni inafanizidwa ndi chithandizo chamankhwala; kuonjezera apo, gulu la opaleshoni linachepetsa ululu kumayambiriro, ndipo kusintha kwa ntchito za Constant ndi DASH kunadziwika bwino.

Fotokozerani mwachidule

Ma fractures ambiri a clavicle amayamba chifukwa cha nkhanza zachindunji kapena zosalunjika, ndipo chithandizocho chikhoza kugawidwa ngati chithandizo chodziletsa kapena opaleshoni. Pankhani ya chithandizo, ngakhale kuti fractures zambiri za clavicle popanda kusamuka kwakukulu zimatha kuthandizidwa mosamala, njira yopangira opaleshoni ya fractures ndi kusamuka kwakukulu ndiyotsutsana. Kwa fractures ya clavicle yosamutsidwa, chithandizo cha opaleshoni chimakhala ndi chiwopsezo chachikulu cha machiritso a mafupa ndi zotsatira zoyamba zogwirira ntchito poyerekeza ndi chithandizo chodziletsa.

Maumboni

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