Kuzindikira ndi Chithandizo cha Clavicle

Chiyambi

Zojambulajambula za clavicle ndizofala ndipo nthawi zambiri zimachitika chifukwa chovutika kapena mosapita m'mbali kudera la phewa. Kafukufuku woyambirira 1960s adanena kuti kuchuluka kwa zopanda pake kwa clavicle kunali kochepera 1%, komanso mankhwala osokoneza bongo omwe adadzetsa chisangalalo chachikulu; ndi chitukuko chaposachedwa cha mankhwala, opaleshoni mankhwalawa akwaniritsa bwino; Chifukwa chake, madokotala akugwira ntchito mu dipatimenti yadzidzidzi kapena chipatala chambiri chomwe chingadziwike ndi zovuta zomwe zimachitika komanso zovuta zake.

Epidemiology

Akaunti ya Clavicle Frecratures for 2.6% -5% ya zolengedwa zonse zankhondo [1). Kafukufuku waku Europe yemwe anali ndi milandu yotsatizana yotsatizana ya Clavicle yopezeka (3,4] kuti zoposa 66% ya maboti a clavicle zinachitika mu clavicle, pafupifupi 25% anali ofatsa 1/3. Kuchuluka kwa mabowo a clavicle kunawonetsa kufalitsa bimodal, kumachitika mwa amuna osakwana zaka 30, kenako ndi azaka zoposa 70.

Chachipatala

Choyambirira cha mafupa aumunthu kuti ayambe kugwedeza ndi chiwongola dzanja, kulumikizana kokha pakati pa mkono wapamwamba ndi thunthu, zomwe zimafotokoza za acamiocular (ac) ophatikizika, ophatikizika. Malumikizidwe awa amatchedwa olumikizira anyenolical synovial chifukwa amapezeka ndi fibroryartage m'malo mopewa hyoline cartilage. Clavicle imazikika ku scapula yotengera zingwe za acomioclavilar komanso ma rostroclalavir ndipo imaphatikizidwa ndi sternum ndi sternucvil ligament.

Clavicle ndi 's '. Provorimal projekiti ya arc yopanda malire, ndikusiya chipinda cha neurovascular kumtunda. Hafu yofananira ya arc projekiti yakumbuyo (concove) kenako imalumikizana ndi scapula (rostral njira ndi acamino). Kuchuluka kwa clavicle nthawi zambiri kumachitika ku gawo la ma arcs awiri (pakatikati), makamaka chifukwa cha kusowa kwa ma roving oyandikana nawo kudera lino ndipo ndi gawo lofooka kwambiri la clavicle. Pamene kuwonongeka kwa clavicle kwatha, gawo loyambirira la pompopompo limangokwera m'mwamba (cephalad) ndi staval) ndi kulemera kwake Zina), makamaka chifukwa cha kuchuluka kwa subscapapurissis ndi pectoratis chachikulu (komwe kumazungulira mkono wapamwamba). Izi zimachitika makamaka chifukwa cha kuchuluka kwa subscapapurissis ndi pectoratis minofu yayikulu (yomwe imazungulira mkono wapamwamba ndikukoka pachifuwa).

Mawonekedwe

Cholinga cha chithandizo cha Clavicle chofiyira ndikuchepetsa ululu ndikubwezeretsa ntchito yolumikizirana. Zojambula zambiri za clavicle zimachitidwabe makamaka (nthawi zambiri zimafupikitsidwa osaposa 15 mm); Mankhwala osokoneza monga chiwonetsero cha ma bandeji asanu ndi atatu ovala, malo otsetsereka, zidziwitso, valpeau sait sutilization suti, komanso kusakhazikika. Kuyimitsidwa kumachitika mu gawo la pachimake, ndipo maphunziro osiyanasiyana oyenda komanso masewera olimbitsa thupi nthawi zambiri amachitidwa masabata 2-6 pambuyo pa kusokonekera pomwe ululu umatha. Kugwiritsa ntchito chithunzi cha manambala 8 sikulimbikitsidwa chifukwa chovuta kwambiri.

Mbiri ndi Kuyeserera Kwathupi

Mafuta a Clavicle amayamba chifukwa chokhudza kugwa pambuyo poti kugwa ndipo nthawi zambiri amawoneka m'masewera am'mbuyomu mwa achichepere komanso mosazindikira amagwera mwa okalamba. Ndikofunikira kutanthauzira makina ovulala. Kuvulala kwakukulu kumatha kuphatikiza mutu ndi kuvulala pachifuwa, pomwe fecras yochokera ku zowawa zazing'ono zitha kukhala zambiri. Zovuta zosokoneza zimafunikira kuti ziyambike zoyambirira zoyambira polekanitsa kukhoma, neurologic ndi nkhanza zovulaza. Zachipatala, pamakhala kutupa ndi ecchymosis pamalo osokonekera, kuphatikiza ndi kupanda manyazi ndi kudekha. Chisamaliro chiyenera kulipidwa kwa minofu yofewa yodumphadumpha, yomwe ingayambitse khungu ndi chithokomiro.

Chifanizo

Mafuta ambiri amatha kupezeka ndi ma radiograograph osavuta a anteropnopraor. 20 ° ° Rudigrapht imachotsa zotsatira za mitu yazoracic. Odwala ayenera kukhala odziyimira mu malo odzidalira kuti awonekere bwino. Kulemera kwa ma radiography kumathandiza pakuwona kukhulupirika kwa chiwongola dzanja cham'mimba kapena kuvulala kwabwino kwambiri. Kutenga radiographiography yothandizira kuvulaza pachiwopsezo chachikulu chogwirizanitsa chidwi chophatikizidwa ndi kufupika ndi kufanizira ndi cruvicle clavicle, komanso kulamula khoma la spapulothoracic.

Mitundu

AO / OTA Frecture Sturcation: Code ya Clavicle Frevisity ili ndi masamba atatu: 15.1 Proximal (medial), 15.2 Diafyys, ndi 15.3 Distal (Fialchys (FACYYS). Proxximal (medial) ndi kusokonekera (kufananizidwa) kuphatikizika kwamitundu yofanana ndi (zowonjezera), lembani b (pang'ono b (pang'ono), ndi mtundu wa articular). Matenda a thunthu amatchulidwa kuti ndi mtundu wa (wosavuta), mtundu wa B (wedge), ndikugwiritsa ntchito Cloctocation ya Fractures ndi kugwiritsidwa ntchito pochiza matendawa.

Makina onse amatengera komwe amakhala (I: Medial 1/3, II: Kufatsa 1/3) (Mkuyu 7.2).

Craig adakonzanso kagulu kameneka pamaziko a tentman, ndikadakhala pakati 1/3 za clavicle; Lembani II kukhala wakunja 1/3 ya clavicle, yomwe idagawika m'mitundu isanu yochokera ku Fracturence yosamukira ku nthochi ya chibwano. Ndipo lembani III kukhala wokhumudwa wamkati 1/3 ya clavicle, yomwe idagawika m'mitundu isanu yotengera kuchuluka kwa kuwonongeka kwa kuwonongeka kwa kuwonongeka kwa ulesi komanso kapena ayi.

Kulemba kwa neer kwa masamba ofananira 1/3 kumatsimikizanso kufunikira kwa ma rostral ligamer: mtundu ndimapezeka kuti ndi wopingasa wokhazikika, wokhala ndi malo okhala ndi malo osokoneza bongo omwe adachoka kwambiri; Mtundu wa II umaphatikizapo kusiyanasiyana kwa zingwe zomwe zimapangitsa kuti chiwongolero cham'madzi chikhalepo kwambiri; Ndipo lembani III imafikira mbali ya acromioclar yokhala ndi zingwe zokhala ndi zingwe zotsalira.

Kulemba kwa Edinburgh ndi kachitidwe ka kagawidwe ka diaphysis malinga ndi kuchuluka kwa omwe akusamutsidwa komanso kusinthika kwa ma cecnom.1 Kuchuluka kwa diaphysis kumangidwira malinga ndi kupezeka kwa kupezeka kwa chipata cholumikizira pakatikatikatikatikati (mtundu 2B1). Za diaphissis ndi lemba 3 ndi mathero a Faiphyys. Mankhwala oyenda ndi oyendayenda komanso ofalitsidwa amagawidwa kulowa m'magulu 1 ndi 2 molingana ndi njira zoyandikana nazo.

Momwemonso pali zomangira zotchinga, zokulira za karger, ndi kuphwanya breen.

Zojambula

Ma fractures apadera

1, tsekwe; 

2, kuchotsedwa> 2 cm; 

3, kufupikitsa> 2 cm; 

4, Chithandizo cha zidutswa zakuthwa (> 3); 

5, matenda angapo; 

6, mkati mwa kutseguka kotseguka ndi kuvulala kofewa kwa minofu; 

7, kutsimikiza kwakukulu (kusamuka ndi kufupikitsa); 

8, kuvulala kwa scaphoid.

Kuvulala kwawiri

1, kuphatikizira kuperewera kwa ma Iptialateral kumtunda kwa magetsi;

2, mapewa oyandama;

3, kuvulala kambiri;

4, kuwonongeka kophatikizana ndi kuvulala kwa neurovascularcularcularcularcularcular.

5, Ipsiteral angapo nthiti zophatikizika ndi vuto la chifuwa;

6, Clavicle Kufupikitsa kuti apange phewa la phiko;

7, Bilengetala clavicle.

Zovuta

1, odwala omwe ali ndi zovulala zingapo amafunikira kulemera koyambirira kwamphamvu;

2, odwala omwe akufuna kuti abwerere mwachangu kuti agwire ntchito (mwachitsanzo, osankhika ndi masewera opikisana).

Nthawi ya opaleshoni

Opaleshoni iyenera kuchitidwa popanda kuzengereza ngati zisonyezo zopanga opaleshoni zilipo.

Kuchedwa kwa opaleshoni yopitilira 27 m'masabata kumatha kukulitsa kuchepa kwa kuchepa kwa madzi, makamaka pokonzekera kuchepetsedwa kwa njira zochepetsera.

Kupezeka kwa Opaleshoni

Wodwalayo amaikidwa mu mpando wa gombe kapena malo okhala. Mapewa okhudzidwa ali pansi kuti akweze clavocle kuti athe kuchitidwa opaleshoni, ndipo mkono wake umatha kulola kulimbikitsa kulimbikitsa. Chowoneka bwino m'mphepete mwa chikhalire cha clavicle kapena chiwongolero chofanana ndi mawonekedwe a wachisoni chitha kusankhidwa.

Chidziwitso: Kusunthika kumapereka kukulitsa, pomwe chiwopsezo chanthawi yayitali chimachepetsa chiopsezo cha matenda a Supraclavicular ndipo ndiosangalatsa kwambiri.

Kusintha Kwamkati

3.5 Makina ojambula mwadongosolo, omwe amalowa nawonso, kapena ma lcs apulasitiki amatha kugwiritsidwa ntchito kukonza zonunkhira za clavicle. Mbale zimayikidwa bwino pamwambapa kapena kunja kwa clavicle. Mapulogalamu amalimba muzovulala biomechanical ikayika kwambiri, makamaka ngati pali kusokonekera komwe ali pansipa, ndipo ndiosavuta. Kukhazikika kwa zomangirazo ndikofunikira, ndipo mabowo ayenera kuwuma kwambiri, popeza pali chiopsezo chovulaza misempha ndi mitsempha yamagazi pansipa. Ubwino: Kubowola kotetezeka kwa ngalande yamphesa, mbale ya mbale, yosavuta.

Dziwani: Kutsatsa mafupa nthawi zambiri sikufunikira njira yoyamba; Pambuyo pakusintha kwamkati, ndizofunikira kwambiri kuti zitheke kuti ndisanjike ndi ma mbale ndikuletsa matenda.

Intradellallary kukonza

Zipangizo zamakono za intradedory zodzikongoletsera zimaphatikizapo zikhomo, zikhomo, zikhomo za Hagie, zonunkhira za Titanium interdullallary misomali ya intravedullary; Mwachitsanzo, misomali ya titanium ya Titanium siyilola kuti malo otsetsereka, musalole kuyang'anira kutalika ndi kuzungulira, ndipo zitha kufupikitsa kachiwiri, ndipo zitha kufupikitsa kachiwiri, ndipo zimapangitsa kufupikitsa kwachiwiri komwe kumachitika. Njira yolumikizira intradellary imatha kugwiritsidwa ntchito kosavuta, yosinthira kapena yotsatsa maboti a clavicle.

Ubwino

Zowoneka zazing'ono, zokongoletsa, zokonda minofu yofewa, chiopsezo chochepa cha endophophyte kusinthika, komanso kukhazikika komwe kumalumikizana ndi mapangidwe a stab.

Zovuta

khungu kukwiya kapena zolakwika pakapita.

Chidziwitso: Kuchepetsa kotsekeka kwa clavicle nthawi zina kumakhala kovuta komanso kofananira ndi dzanja la wothandizirayo ku ma radiation kuti apewe nthawi yoyendetsa ndege.

Kusintha kopitilira muyeso

Mitengo yopitilira mu clavicle ya clavicles imaganiziridwa kuti ipereke mphamvu zambiri zopangira ma biongonal`mapewa zowonongeka kapena kukhazikika kwa ma intravedullary.

Kuyika kosautsa kwa 3.5 kachitidwe ka 35.

Kugwiritsa ntchito koyambirira kwa mbale yopanda magazi kwambiri kumatha kuphatikizidwa ndi matenda opatsirana a supracravicular, osavomerezeka kapena kufupikitsa awiriawiri ayanda maaya omwe akukhudza ntchito, komanso mbale yogwedezeka kapena kuwonongeka.

Kukhazikika kwa ma fractures a kumapeto kwa clavicle

Kusankha kwa mbale kumadalira kukula kwa fupa la mafupa. Zomangira zosachepera zitatu za ma bictortical zimafunikira kuti fupa laphiri laphiri. Zabwino, zomata za kusamvana ziyenera kugwiritsidwa ntchito kwa obzala. Ngati fupa la fupa limakhala laling'ono kwambiri pakukonzekera, mbale ya kalankhule ya clavicle ikhoza kugwiritsidwa ntchito.

Chithandizo cha acromioclavicular yolumikizira

Acromioclaricular account ya 12% ya kuvulala kwa gaaprour yovuta ndipo nthawi zambiri zimachitika kawirikawiri.

Dongosolo logwiritsidwa ntchito kwambiri lomwe limagwiritsidwa ntchito kwambiri ndi logwedezeka. Mtundu wa ine ndi kutengeka kwa matenda a acromiocular ndi ma rostrowlavicular. Mtundu II ndi misozi ya matenda a acoromiocular ndi ma rostrowlavicar miyala yolimba; Mtundu wa III ndi misozi ya mbali zonse ziwiri za Acoromioclalari ndi ma rostrowlavicular. Mtundu IV ndi pompopompoortior ya postless Clavicle Expevius; Lembani v ndi misozi yonse ya mawu ophatikizika a acomioclavicular komanso ma rostroclalavicar rogacor, omwe ali ndi zoposa 100 peresenti yochotsa cholumikizira; Ndipo lembani kuvulala kwa VI ndizosowa kwambiri, ndi clavil clavicle idayang'ana pansi pansipa.

Chithandizo cha Conservative ndi kufupika kwakanthawi kochepa kwambiri ndikulimbikitsidwa kuti mtundu wanga ndi mtundu wa II. Kuwongolera kwa kuvulaza kwa III kumatsutsana, ndi mabuku ena akuwonetsa kuti chithandizo chochepa chachangu chikuwonetsedwa kwa achichepere achangu. Kuchira kumachita bwino ngakhale pakhoza kukhala kusiyanasiyana kwa mawonekedwe. Lembani IV - Kuvulala kwa VI ndikwamphamvu kwambiri komanso opaleshoni yochita opaleshoni yomwe ikulimbikitsidwa.

Pakadali pano, njira zopangira opaleshoni ndi: Bosworth Rock Scress Conct Njira yokonzanso gawo limodzi kapena osakonzanso mitu ya clavicle; Kutalika kwa tabu yamphamvu kapena kungulunjika kopindika kudzera pa arthoscope kapena pang'ono. Ndipo Rosstar Kutseka Zigawenga Zoyambirira kapena kuyimitsidwa kokhazikika, ndi zinthu zojambula kapena zitsulo pakati pa miyala yokhazikika ndi clavicle.

Sizikudziwikiratu kuti njira yochita opaleshoni ndi yopindulitsa kwambiri, ndipo ngakhale kuti pakhoza kutayika kofananirako, kufunikira kwenikweni kwa maluso onsewa ndikokhutiritsa.

Chithandizo cha Madical Omaliza Clavicle Fractures ndi Stermoclavicular Jount

Zovuta izi ndizosowa, ndiponso kulibe upangiri wochitira mankhwala malinga ndi mankhwala osonyeza umboni.

Mankhwala a Clavicle Clavicle nthawi zambiri amakhala owonjezera owonjezera omwe ali ndi vuto losatha ndipo amatha kuthandizidwa mosasamala. Epiphysis ya kumapeto kwa clavicle ya clavicle imatseka zaka 23-25 ​​ndipo ndi epiphoys yomaliza kuti itseke m'thupi. Chifukwa chake, kuvulala kwamankhwala kumakhala kwenikweni kwa epiphyseal mbale ya plant-harris i kapena ii. Misewu yachilendo ya x-ray ndizovuta kuzindikira, ndi mwayi kuti ma radiographight and 40 ° stard radiogragragragraph ndikuyerekeza mbali yathanzi ingawonetsetse kutha kwa clavicle.

Kuwonongeka kapena kusokonekera komwe kumachotsedwa mosapita m'mbali kumatha kutsekedwa ndikubwezeretsedwa, koma nthawi zambiri kumakhala kosakhazikika komanso lobotomized kuti abwezeretse. Kusamalira Palalliert ndikulimbikitsidwa kuti musunthire kapena kusamutsidwa chifukwa nthawi zambiri sizimabweretsa zovuta. Kusungunuka kwa mathanthwe a clavicle omwe ali otsika nthawi zambiri amabweretsa kuvulala kwapakatikati, kuphatikizapo kuvulala kwamkati kapena ngakhale kubzala kwa mpweya. Kuti muchepetse ndi kufooka komwe kachidutswa kazigawo ndi kochepa kwambiri, ma mbale amatha kuwuluka pazenera kuti akonzekere ku Sternum.

Njira Zina Zosinthira

EG yakunja yokhala ndi stent, kukhazikika kwakunja ndi mbale ya clavicle, etc.

Kuwongolera Kuyang'anira

Mkono wapamwamba uyenera kusungunuka mu gawo lokhala ndi mapewa ndi mapewa a penutum ayenera kuyamba nthawi yomweyo. Masabata awiri pambuyo pake, wodwalayo ayenera kutsatila kuti ayang'anire chilondacho ndikuwunika ma X-ray, pomwe ophunzitsira akhama amatha kuchotsedwa ndikuphunzitsidwa molumikizana akhoza kukhazikitsidwa, koma wodwalayo ayenera kuwuzidwa kuti asakweze miyeso ndi miyendo yomwe yakhudzidwayo. Kuphunzitsa mphamvu kungayambike pa masabata 6 posta akakhala zizindikiro za ma brity. Kulumikizana ndi masewera kapena masewera owopsa kuyenera kupewedwa kwa miyezi itatu atachitidwa opaleshoni mpaka kuwonongeka kwachira kwathunthu.

Zovuta.

Zovuta Zoyambirira

Matenda opatsirana a postoperative agwera mpaka 4.8% milandu;

Chipongwe cha subclavian ndi chovuta chofala kwambiri, ndi maphunziro achilengedwe okwanira 83% ya odwala omwe ali ndi matendawa, omwe amathetsa kusaka kwa nthawi ndipo satha kupitirira zaka ziwiri.

Endophophyte Tsewation ndi kusokonezeka kwa khungu, pofala ndi kugwiritsa ntchito ma mbale ofala kapena michira ya misomali popanda minofu yabwino yofewa;

Kubwezeretsanso, komwe kumatha kuchitika pambuyo pa mankhwala onse ochita opaleshoni; Kuvulala kwa post-opaleshoni kumatha kugwada kapena kuthyola kwa endoprosthesis, kapena kuwonongeka kuzungulira endoprosthesis;

Nunsion, yemwe ali ndi 15% ya nonunion ndi mankhwala osokoneza bongo komanso kuchuluka kwa 2% osachita opaleshoni ya diaphyseal kwathunthu; Kusamutsidwa kwathunthu kwa kusokonekera, kufupikitsa kwakukulu kwa 2 cm, kusuta, kuwononga magetsi, kukonzanso kwamagetsi (kukhazikika kwa mafupa), komanso kutaya mafupa kwambiri.

Mavuto Ochezera

Osteoarthritis a acromioclavicular ophatikizika pafupipafupi ndi ma a intra-articular fractures (Edinburgh mtundu 3b2); Ngati chizindikiro chachizindikiro komanso choseketsa sichitha, convil clavorictopically kapena opaleshoni yotseguka;

Kuchiritsa kumachiritso, komwe kumachitika ku madigiri osiyanasiyana mu onse omwe achitiridwa zinthu zoponderezedwa; Kufupikitsa kwa gaple ya grird yophatikizidwa ndi kuzungulira kwa chipika cha kuwonongeka kungayambitse kuchepa mphamvu ndi kupirira, makamaka pakuchotsa kwamphamvu; Kuchepetsa chitsamba cha thoracic kumatha kubweretsa zizindikiro za mpweya wopumira; Ndipo malangizi a mafupa a scapulotoracc amatha kuyambitsa kuchepa kwa scapula ndikupanga kupweteka kwa phewa ndi mnetais, ngati zikuwonekeratu kuti zizindikiro zachitika kuti machiritso amapezeka kuti machiritso adwala.

Prenanosis ndi Zotsatira

Kafukufuku wokhudzana ndi ku Europe adanenanso kuti kuchita opaleshoniyo kunawonetsa kuti kuchuluka kwa ukhondo kumayambitsa matenda opatsirana kwambiri pochita opaleshoniyo pochita opaleshoniyo adafanizidwa ndi chithandizo chamankhwala; Kuphatikiza apo, ochita opaleshoni anali atachepetsa ululu msanga, ndipo kusintha kwambiri mokhazikika ndi magwiritsidwe antchito kunatchulidwa kwambiri.

Duliza

Mafuta ambiri a clavicle amayamba chifukwa cha zachiwawa kapena zosagwirizana, ndipo mankhwalawa atha kugawanika ngati mankhwala osokoneza bongo kapena opaleshoni. Pazinthu zamankhwala, ngakhale kuti ma clavicle ambiri osazoloweredwa amatha kuthandizidwa mosasamala, njira yopangira opaleshoni ya zojambula zoyendetsedwa ndi zinthu zofunika kwambiri ndizotsutsana. Kwa osemphana ndi Clavicle Clavicle, opaleshoni ya opaleshoni imakhala ndi machiritso ochulukirapo komanso zotsatira zogwirizira zoyambirira zogwira ntchito poyerekeza ndi mankhwala osokoneza bongo.

Maumboni

[1] poschini f, guuma s, de Santis p, Albo F. Epidemiology ya clavicle fractures. Jhruster erbon Surg 2002; 11: 452.

[2] Eiff, mp, hatch, et al. Clavicle ndi scapula flactures. Mkati: Kusamalira kuwonongeka kwa chisamaliro choyambirira, 2 EMS Saunders, Philadelphia 2002. P.198.

[3] robinson cm. Mafuta a clavicle wachikulire. Epidemiology ndi gulu. Jyard Jount Org Br 1998; 80: 476.

[4] neer cs 2nd. Ma fractures a gawo lachitatu la clavicle. Chipatala Orthop Extret Rep 1968; 583.

[5] Anderson K, Jnsen P, Lauriten J. Chithandizo cha zojambulajambula. Chithunzi-cha-zisanu ndi zitatu bandes motsutsana ndi slung yosavuta. SCA ORTHOP SCANAM 1987; 58:71.

[6] Acnin ACS, ACIRONC, Birsik F, et al. Kuyerekeza kwa ma mkono osavuta ndi chithunzi cha bandeji eyiti kuti Midshaft Clavical fravices: Phunziro losinthidwa. Fupa Lord J 2015; 97-B: 1562.