Gusuzuma no kuvura clavicle ivunika

Intangiriro

CLAVICLECTIQUE CCRATION irasanzwe kandi mubisanzwe bivamo ihahamuka ritaziguye cyangwa ritaziguye kugeza ku bitugu. Ubushakashatsi mu ntangiriro ya za 1960 byatangaje ko igipimo kidasanzwe cyo kuvunika clavicle cyari kirenze 1%, kandi ubuvuzi bw'abuhariko bwatumye hashyirwaho umurwayi wo muke; Hamwe niterambere rya vuba ryubuvuzi, ubuvuzi bwo kubaga bwageze ku bikorwa bikomeye; Kubwibyo, abaganga bakorera mu ishami ryihutirwa cyangwa ivuriro risanzwe rigomba kuba rimenyereye kwerekana n'ibikomere n'ibikomere n'imiyoborere yacyo.

Epidemiology

CLAVICLES YATANZE KUBARA MPOVET -6% -5% yo kuvunika abantu bose [1,2]. Inyigisho z'Uburayi zirimo amashusho 1.000 akurikirana yasanze [3,4] ko ibipimo birenga 66% byabaye hagati ya clavicle, hafi 25% byari kumenagura 1/3, naho 3% byari imivurungano 1/3. INTEGO ZITANDUKANYE CLAVECLE yerekanye ikwirakwizwa rya bimodal, bibaho cyane cyane mubagabo bari munsi yimyaka 30, bakurikiwe nabarengeje imyaka 70.

Ivuriro Anatomy

Icyambere cya skeleton yumuntu kugirango itangire koherezwa ni clavicle, gusa hamwe na acmiometero, hamwe na acromioclavicular, hamwe na sternoclavicular (scnoclavicular (sc) hamwe. Izi ngingo zitwa Inzoka ya Atypical Inzobere kuko zijyanye na fibrocartilage aho kuba hyaline cartilage. Clavicle yometse kuri Scapula na Acromioclaviculaglavicular Na Acrociovicular na Rostroclaviclagments kandi ifatanye na sternoclavicular and meternoclavicular.

Clavicle ni 's '. Imishinga ya Proximal-arc imbere, kuva mucyumba cyo guhagarika umugozi wa neurovascular kumurongo wo hejuru. Igice cya kabiri cya ARC imishinga isubira inyuma (concave) hanyuma yinjira muri scapula (inzira ya rostral na acromaion). Kuvunika kwa Clavile mubisanzwe bibaho mugihuye na arc zombi (hagati ya ARC), birashoboka cyane ko kubura amagufwa ajyanye n'amagufwa aturanye muri kano karere kandi kubera ko ari igice gikomeye cya clavicle. Iyo kuvunika clavicle bimuwe, igice cya proximal hafi buri gihe cyakuruwe hejuru (Cephalad) na sternocleidoidtomastoid (caudad) nuburemere bwa '(ni ukuvuga gucika intege birangirana), Ahanini biterwa no kugabanuka kwa subscaular na pectoralis major (izunguruka imbere ukuboko hejuru). Ibi ahanini biterwa no kugabanuka kwa subsca huscaularis na pectoralis bakomeye (zizunguruka imbere ukuboko hejuru hanyuma ukayikuramo igituza).

Ibiranga

Intego ya Clavicle Guvura ni ugugabanya ububabare no kugarura imikorere ihuriweho. Clavicle nyinshi ziracyavurwa cyane cyane kubyutsa cyane cyane (mubisanzwe bigufi bitarenze MM ya 15); Kuvura ibihakanyi nk'ishusho-umunani, igitambaro umunani, imigozi y'imbere, vereau, Velpeuuau Ibiti byihishe bihumeka, kandi bidashira. Guhagarika Impebisinse bikorwa mu cyiciro gikaze, kandi hakiri kare amahugurwa ya interineti n'imyitozo ngororamubiri isanzwe ikorwa ibyumweru 2-6 nyuma yo kuvunika iyo ububabare bukemura. Gukoresha ishusho ya bande 8 ntabwo bisabwa nkuko bishobora kuganisha ku gitutu cya axillary ibisebe kandi bidafite ubumwe bwavunika [5.6].

Amateka no Gusuzuma umubiri

CLAVICLE FRUCTIQUE N'INGINGO ZIKURIKIRA KUGURI KU IGITUBA RUKURIKIRA KANDI BISANZWE MU MPIR YO MU BIKORWA BYINSHI MU BIKORWA Ni ngombwa gusobanura uburyo bwo gukomeretsa. Imvune nyinshi zingufu zishobora guhuza no gukomeretsa umutwe nigituza, mugihe ibipimo biva mu ihahamuka rito rishobora kuba pathologique. Ibikomere byo kurangaza bisaba gutangiza hakiri kare no guhembwa neza urukuta rw'igituza, ibikomere bya neurologiya na mirongo. Ubuvuzi, harabyimba na ecchymose kurubuga rwavugije, uhujwe nubumuga n'ubwuzu. Kwitondera bigomba kwishyurwa mumyenda yoroshye yo gusiganwa, bishobora gutera uruhu no gusetsa.

Gutekereza

Kuvunika byinshi birashobora gusuzumwa na radiyo yoroshye ya anteropopopio. 20 ° Umuyobozi mukuru kuri radiografiya ikuraho ingaruka zo kurenga kuri thocique. Abarwayi bagomba kuba radiyo mumwanya wo kwishyigikira kugirango bamenyekane neza kwimurwa. Kubyara uburemere kuri radiografiya ifasha mugusuzuma ubusugire bwa ligament ya rostrale muri Clavicle ya kure cyangwa itanga ibikomere byurupfundara. Gufata Isanduku ya Rading ifasha gukomeretsa bifitanye isano, kandi kugabanya birashobora gusuzumwa muguhuza no kugereranya na clavicle ikomoka kuri claviloral, kimwe no gucuruza urukuta rwa scapurac.

Ubwoko

Ao / OTA SLACTION YATANGIYE: CLAVECLE YAKORESHEJWE 15: 15.1 Proximal (Mexial), 15.2 diaphysis, na 15.3 kure (kuruhande). Kugabana (hagati) no kure (kuruhande) byashyizwe mubyiciro byubwoko (bidasanzwe), andika B (intra-artra-Articular). Kuvunika igihangano byashyizwe mubyiciro byubwoko (byoroshye), andika B (Wedge), kandi ni ugukoresha CLUTIONS ntabwo bizirikana muburyo bwo kwimura CLevicle no kugena prognose.

Twese Kwandika ushingiye kumwanya wo kuvunika (i: medial, cadent 1/3, II: Igice cya 1/3, III: Hagati 1/3 7.2.1). 7.2.1). 7.2.1).

Craig yatunganijwe neza ku byitondewe hashingiwe kuri bose, hamwe nanjye ndi hagati 1/3 ya clavicle; Ubwoko bwa II iri inyuma 1/3 ya clavicle, icyo gihe cyagabanijwemo ubwoko 5 bushingiye ku kwimurwa no kwimura no guhuza imitsi ya rostral; Kandi wandike iii kubavunika imbere 1/3 cya clavicle, bigabanyijemo ubwoko 5 bushingiye kurwego rwo kwimurwa no kuba nibatuvumbuwe.

Neer yo kwandika kuruhande 1/3 ashimangira akamaro k'urutonde rw'ubwoga. Ubwoko bwa II ikubiyemo imvugo ya rostral-claviculand hanyuma bivamo kuvunika imitarure bimuwe bimuwe neza; Kandi ubwoko bwa III igera kuri Acromioclaviclaviculaticular hamwe na listrall-inzandiko zisi zisigaye neza.

Edinburgh ni gahunda yo gushyira mu byiciro dicracys ukurikije urwego rwo kwimura no kwinginga 1 imiterere kandi ubwoko bwa diaphysis hamwe nubwoko bwa giships Kuvunika kwa diaphysis byashyizwe mubikorwa ukurikije ukubaho cyangwa kubura guhuza imiterere hagati ya froctured muburyo bworoshye cyangwa bwuzuye (ubwoko bwa 2b2) birimo impera yo hagati ya Diaphysis na Ubwoko 3 ni iherezo rya difryos. Guhuza imitako kandi kuruhande bigabanijwe muri subroups 1 na 2 ukurikije niba igitekerezo cyegeranye kirimo.

Mu buryo nk'ubwo hari kwandika Rockwood, Jager Tsheping, na Breiter wandika.

Ibimenyetso byerekana

Kuvunika

1, kuvunika; 

2, kwimurwa> cm 2; 

3, kugabanya> cm 2; 

4, kwiyubakira ibice (> 3); 

5, kuvunika igice kinini; 

6, shyira imbere gufungurwa hamwe no gukomeretsa amatara yoroshye; 

7, ubumuga bukomeye (kwimurwa no kugabanya); 

8, imvune ya scaphoid.

Gukomeretsa

1, ihuriweho na ipilateral gukomeretsa hejuru;

2, gukomeretsa ibihuru;

3, ibikomere byinshi;

4, kuvunika hamwe n'imvune za neurovascular;

5, ipilateral imivurungano nyinshi ihujwe ninzitizi yigituza;

6, Clavicle igabanuka kugirango ikore urutugu;

7, kuvunika ibihugu byombi.

Ibintu by'indwara

1, abarwayi bafite ibikomere byinshi bisaba ko ibirori byo hejuru bikabije;

2, abarwayi basaba gusubira inyuma kumurimo (urugero, intore na siporo irushanwa).

Igihe cyo kubaga

Kubaga bigomba gukorwa bidatinze mugihe ibimenyetso byuzuye byo kubaga birahari.

Gutinda kubagwa kurenza ibyumweru 2-3 mubimenyetso ugereranije birashobora kongera ingorane zo kugabanya gukabije, cyane cyane mugihe witegura kugabanya gufunga imbere muburyo bwa percaneous.

Kubaga

Umurwayi ashyirwa mumwanya wa intebe cyangwa igice cyo kwicara. Urutugu rwibasiwe rwabakishijwe munsi kugirango uzamure clavicle yo kubaga, kandi ukuboko gutontoma kwemerera ubukangurambaga. Gucika intege kumurongo muremure wa clavicle cyangwa ibisanzwe bitera ishusho ya langer birashobora guhitamo.

Icyitonderwa: Guhagarika kwanduza gutanga kwaguka, mugihe hagamijwe guhagarika igihe kirekire cyo gukomeretsa supraclavicular kandi ni byiza cyane.

Gukosora imbere

3.5 Ibyapa byateganijwe kuri gahunda, amasahani yo kubaka, cyangwa LCPS ya plastike irashobora gukoreshwa mugukosora clavicle. Amasahani ashyirwa neza hejuru cyangwa imbere kuri clavicle. Isahani irakomeye mubikomere biomenicanshuro mugihe bishyizwe hejuru, cyane cyane niba hari kuvunika byemewe hepfo, kandi biroroshye kwiyumvisha. Gukosora amatori birakenewe, kandi ibyobo bigomba gucukurwa cyane, kuko hari ibyago byo gukomeretsa imitsi n'amaraso hepfo. Ibyiza: Gucukura umutekano wisahani yisahani yumuyoboro wa screw, plate, yoroshye.

Icyitonderwa: Gutegura amagufwa mubisanzwe ntibisabwa muburyo bwambere; Nyuma yo gukosorwa imbere, ni ingenzi cyane ku buryo buhagije igice cyanomentasi kugirango gitwikire isahani kandi wirinde kwandura.

Intramedillary Gukosora

Ibikoresho byo ku isonga byo gutunganya ibidukikije birimo Kirschner Amapine, Amapine ya Hagie, Titanium Elastium IntramediLlary pin, imigozi iboneye, hamwe no gufunga imisumari y'intangiriro; Urugero, imisumari ya titaniyu ntabwo yemerera gufunga guhagarara, ntukemere kugenzura uburebure no kuzunguruka, kandi bishobora kuvamo kugabanuka kwa kabiri mugihe ukoreshwa kubicuruzwa byabigenewe. Ubutumire bwimisumari bwimisumari bushobora gukoreshwa gusa kubintu byoroshye, byahinduye clavile cyangwa oblique clavile.

Ibyiza

Gitoya, ibintu byinshi byiza, bike byoroheje byicapura, ibyago byo hasi bya endophyte protrusion, kandi ituze rijyanye no kwisiga.

Ibibi

Kurakara uruhu cyangwa inenge mugihe cyo kwinjira.

Icyitonderwa: Kugabanuka kwa Clavicle biragoye kandi gukabya ukuboko kubakoresha kumirasire birinda mugihe cyo kubaga.

Ikintu gito cyo gusohora plaque

Ibibanza byiza byibasiye osteosynthesis ya clavicle atekereza gutanga imbaraga zikomeye mugihe yirinda ibibi byo gukosora isahani yo gukosora ibimenyetso cyangwa intramedillary.

Gushyira ibintu byinshi bya sisitemu ya 3.5 LCP Imbere kuri Clavicle, nibyiza cyane munsi ya clavicle, yemerera clavicle nziza, yemerera clavicle nziza, yemerera clavile nziza, yorohereza gushiraho isahani mbere no kubona aperture ndende.

Gukoresha hakiri kare plate iteye ubwoba osteosynthesis irashobora kuba ifitanye isano na supraclavicular of mecraclaviclarnic, guhuza cyangwa kugabanya ibice bibiri byibitsi bireba imikorere, kandi isahani.

Amasahani yo gukosora ibiranga kuruhande rwa clavicle

Guhitamo ibisome biterwa nubunini bwamagufwa yinyuma. Byibuze imigozi 3 ya bicortique irakenewe kugirango igufwa ryamagufwa. Nibyiza, imigozi ya terefone igomba gukoreshwa kubiranga. Niba igufwa ryamagufa ari nto cyane kugirango ikosorwe, clavicle hook plate irashobora gukoreshwa.

Kuvura AcromioclavicLevices Gutandukanya

Gukomeretsa Acromioclaviclaticular konte yo gukomeretsa 12% by'imisatsi y'insake kandi akenshi bibaho mu kuzuza abakinnyi buzuye.

Sisitemu ikoreshwa cyane na sisitemu ya rockwood. Andika i ni sprain ya ligamen ya acromioclaticular hamwe na ligamen ya rostroclaticular; Ubwoko bwa II ni amarira ya ligamenLavicular acomiovicular hamwe na ligamen ya rostroclaticular; Ubwoko bwa III ni amarira ya ligamen ya acromioclaticular hamwe nindimi ya rostrocicular; Andika IV ni imyambarire yinyuma ya Clavicle ya kure ya Trapzi bitanga Trapezius; Andika v ni amarira yuzuye ya acromioclaviclavicular hamwe na listroclavicular hamwe na rostroclaticlaviclag na rostroclatillavicular, hamwe nukurenga 100 ku ijana; Kandi andika ibikomere VI nibisanzwe cyane, hamwe na clavicke ya kure yimuwe hepfo hepfo yumurongo.

Kuvura ibihakanyi hamwe nigihe gito hamwe numugozi wa cantilew urasabwa ubwoko bwa I nandika II Ibikomere II. Ubuyobozi bwubwoko bwa III ntabwo butavugwaho rumwe, hamwe nubuvanganzo bwerekana ko ubuvuzi bubanga bwerekanwe kubakuze bakuze. Gukira imikorere nibyiza nubwo hashobora kuba impamyabumenyi itandukanye mumiterere igaragara. Andika iv - ibikomere bya VI nibyo gutabara gukabije kandi kubaga.

Kugeza ubu, uburyo bwo kubaga bukunze gukoreshwa ni: Boswortra yo gufunga tekinike yashizwemo hamwe no gusana imvugo imwe cyangwa ngo basubize imvugo ;, Clavicle Inkongi Akabuto ka Tabroprope Plaque cyangwa Ankeri yometseho muri Arthroscope cyangwa ntoya; Kandi gufunga imigozi yimyandikire cyangwa uhagaritswe, hamwe nibikoresho cyangwa tendon hagati ya rostrace ya rostrace na clavicle.

Ntabwo byumvikana ubuhanga bwo kubaga burusha inyungu, kandi nubwo hashobora kubaho urwego runaka rwo gutakaza, imikorere yanyuma yubuhanga bwose irashimishije.

Kuvura Clavicle Clavicle Clavicle na SternocLaviction hamwe

Ibyo bikomere ntibike cyane, kandi harasubirwaho kubura amabwiriza yavuriye ashingiye ku buvuzi bushingiye ku bimenyetso.

Clavicle Mecketicle Tarekana akenshi ivunika bidasanzwe hamwe nimurwa udasanzwe kandi urashobora gufatwa nabi. Epiphysis irangira metalicle ya clavicle isanzwe ifunga imyaka 23-25 ​​y'amavuko kandi niyo epipysis yanyuma yo gufunga umubiri. Kubwibyo, ibikomere byinshi bijyanwa mubyukuri biravunika icyapa bwa salter-harris ubwoko I cyangwa II. Imirasire isanzwe X-Imirasire iragoye kuyisuzuma, hamwe ninyungu zingana na radiyo nziza kandi ugereranije nuruhande rwiza rushobora guhishura kwimura imitarure ya clavile, na ct itanga amashusho meza yo gusuzuma.

Kuvunika cyangwa gutandukana byimuwe imbere birashobora gufungwa no gusubirwamo, ariko akenshi bidahungabana kandi bidafite ubushake bwo kwimurwa. Ubuvuzi bwa palliative burasabwa gutandukanya cyangwa kwimurwa kuko akenshi bidatanga umusaruro mubumuga bukora. Kwirinda iherezo rya Clavicle YorSeriorly Reroseticly Indwara yo hejuru yo hejuru, irimo imvune nyinshi cyangwa ndetse no guhagarika imizigo no kwikuramo inzira. Kugabanuka no kuvunika aho igice cyo hagati ari gito cyane, amasahani arashobora gukemurwa hakurya yingingo ikosorwa kugeza kuri sternum.

Ubundi buryo bwo gukosora

urugero ikosora hanze hamwe ninteko, ikosora hanze hamwe na clavicle plate, nibindi

Ubuyobozi bw'iposita

Ukuboko kwo hejuru bigomba guhitana mumahugurwa ya pendulum kandi yigitugu bigomba gutangira ako kanya. Nyuma y'ibyumweru 2, umurwayi agomba gukurikiranwa kugirango agenzure igikomere no gusuzuma x-imirasire, mugihe umuhoro wikiranuka ushobora gutamburwa no kugabanuka kwimibanire bishobora gutangira, ariko umurwayi akwiye kubwirwa kutazamura ibiro hamwe ningingo zibasiwe. Amahugurwa yimbaraga arashobora gutangira icyumweru 6 nyuma yigihe gito mugihe ibimenyetso byamaduka bigaragara. Menyesha Imikino cyangwa siporo ikabije igomba kwirindwa amezi 3 nyuma yo kubagwa kugeza igihe kuvunika byakira rwose.

Ingorane.

Ingorane zambere

Indwara zanduye za posita zirashobora kubaho kugeza ku manza 4.8%;

Kunanirwa mukarere ka Subclavian nicyo kibazo gikunze kugaragara, hamwe namateka karemano yiga kugeza kuri 83% byiki kimenyetso, bigabanuka mugihe kandi ntibiganisha ku mitekerereze ikomeye, nubwo bishobora guhitana imyaka 2;

Endophyte Protrusion nuruhu rwuruhu, rusanzwe hamwe no gukoresha amasahani yibihuha cyangwa umurizo wimisumari udafite tissue nziza yoroshye;

Kongera kuvunika, bishobora kugaragara nyuma yo kubaga no kuba impanda; Nyuma-kubaga byongeye gukomeretsa bishobora kuvamo kunama cyangwa kumena endoprosthesi, cyangwa kuvunika hafi ya endofrosthesis;

Noninenion, ifite umubare utari 15% ufite ubuvuzi bugamije kandi igipimo cya 2% gifite ubuvuzi bwo kubaga cyo kwimurwa rwose kuvuza diapyseal; Kwimura neza kuvunika, kugabanya itabi rirenga 2, kunywa itabi, kongera imyaka myinshi, kongera kuvunika imbaraga) gutandukanya diyapécal, igihombo cy'amagufwa gikennye, hamwe no gutakaza amagufwa.

Ibibazo byatinze

Osteoarthritis yingingo ya acromioclaviclavicular iboneka cyane hamwe no kuvunika-artra-arcticular (Ubwoko bwa Edinburgh 3b2); Iyo ibimenyetso byerekana ibimenyetso kandi bidahwitse bidakora, Clavicle ya kure irashobora kugarurwa ahitwa arthroskopi cyangwa kubaga gufungura;

Gukira, bikabaho kuri dogere zitandukanye mu bicuruzwa byose bivuwe; Kugabanya umukandara wigituba uherekejwe no kuzenguruka guhagarika guhagarika kure bishobora kuvamo kugabanuka imbaraga zurusengero rwanyuma, cyane cyane mubitugu; Kugabanuka kw'ibiti bya thoracic bishobora kuvamo ibimenyetso by'ibinyabuzima bya plexus; Kandi gukwirakwiza urukuta rwa Scapuloracheractic rushobora gutera urusaku rwimbere rwa Scapula kandi rukabyara ububabare bwa my

Prognose n'ibisubizo

Ubushakashatsi bujyanye mu Burayi bwatangaje ko kuvura ubwinshi bw'ivangura ryakozwe mu kwimurwa, kandi isesengura ryayo ryerekanaga ko mu majwi yo kubaga no mu rwego rwo kubaga ugereranije no kubaga abantu bagereranijwe no guhabwa ubuvuzi bw'abuhaka; Byongeye kandi, itsinda ryo kubaga ryagabanije ububabare kare, kandi iterambere rihoraho kandi rya Dash rikora ryavuzwe cyane.

Incamake

Ibishishwa byinshi bya clavicle biterwa nihohoterwa ritaziguye cyangwa butaziguye, kandi kuvura birashobora gushyirwa mu byiciro nkibintu bya conservateur cyangwa kubaga. Kubijyanye no kuvura, nubwo clavicle nyinshi zidafite kwimurwa zikomeye zishobora gufatwa neza, uburyo bwo kwivuza bwo kuvura buvuranganya hamwe no kwimurwa cyane. Ku miterere ya Clavicle yimburwa, ubuvuzi bwo kubaga bufite umubare munini w'amagufwa gukira no kubyara hakiri kare ugereranije no kuvura ibihakanyi.

INGINGO

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[2] EFF, MP, Hatch, et al. CLAVICLE NA SCAPULe. Muri: Gutunganya imiyoborere yo kwitabwaho mbere, ibyatsi bya 2 ed, Philadelphia 2002. P.198.

Cm. Kuvunika kwa clavicle kumurwa mukuru. Epidemiology no Kwitondera. J amagufwa atandukanye BR 1998; 80: 476.

[4] Neer CS ya 2. Kuvunika kwa kure ya gatatu ya clavicle. Clin Orthop une Mata 1968; 588.

[5] Andersen K, Jensen Po, Lauritzen J. Kuvura ibikururwa mu mvugo. Igishushanyo-cya-umunani na bande na sling yoroshye. Acta Orthop SCANDAnd 1987; 58:71.

[6] Ersen A, Astalar ac, Birisik F, et al. Kugereranya ukuboko kworoheje no kugereranya igitambaro umunani cya Clavicular kuri Clavicular Clavicurt Clavicurt Clavicular Clavicurt Clavicular: Kwiga byagenzuwe. Amagufwa Joint J 2015; 97-B: 1562.