Kutyoka kweclavicle, kunowanzonzi kuvhunika collarbone, kunowanzoitika mushure mekudonha, kukuvara kwemitambo, tsaona yebhasikoro, kana kukanganisa kwakananga pabendekete. Mazhinji ari ega clavicle fractures anogona kurapwa pasina kuvhiyiwa. Nekudaro, nzvimbo yekutyoka, kutamiswa, comminution, mamiriro eganda, kukuvara kwakabatana, zera remurwere, uye zvinodiwa zvekuita zvese zvinogona kukanganisa chirongwa chekurapa.
Uhwu humbowo-hwakavakirwa ongororo inotsanangura zviratidzo, kuongororwa, kurongeka, kurapwa kusiri kushanda, sarudzo dzekuvhiya, matambudziko, uye nzira yekudzoreredza yeclavicle fractures. Inoitirwa dzidzo yeruzhinji uye haitsivi kuongororwa nenyanzvi yezvehutano ine hunyanzvi.
Key Takeaways
Yepakati pechitatu, kana shaft, ndiyo inonyanya kuzivikanwa nzvimbo yeclavicle fracture.
Zvimwe zviratidzo zvinosanganisira kurwadziwa, kuzvimba, mavanga, kupfava, uye kunetseka kufambisa ruoko.
Plain X-rays ndiyo yekutanga imaging test; CT inogona kushandiswa kune yakaoma, yepakati, kana preoperative kesi.
Zvizhinji zvidiki zvakaputsika zvinorapwa nechipfuramabwe, yekutevera kufungidzira, uye kufambira mberi kwekuvandudza.
Kuvhurika kuputsika, ganda rinotyisidzirwa, kukuvara kweurovascular, bhanhire repafudzi risina kugadzikana, uye kusarudzwa kwakadzingwa kana kusagadzikana kuputsika kungada kuvhiyiwa.
Plate fixation uye intramedullary fixation zvose zvinogona kupa zvibereko zvakanaka mune zvakasarudzwa shaft fractures yevanhu vakuru, asi chimwe nechimwe chine zvakanakira uye njodzi dzakasiyana.
Kupora kunosiyana nezera, patani yekutyoka, nzira yekurapa, chimiro chekuputa, uye humbowo hwekupora kwemapfupa.
Chii chinonzi Clavicle Fracture?
Iyo clavicle ibhonzo rakafanana neS rinobatanidza sternum iri pakati pechipfuva kune scapula pafudzi. Inoshanda sechiumbwa chekubatanidza pakati pehunde nepamusoro pemakumbo apo ichibatsira kuchengetedza tsinga nemidziyo yeropa inopfuura pasi payo.
Clavicle anatomy uye yakajairika fracture displacement mapatani.
Kutyoka kweclavicle kunoitika kana simba richipfuura simba rebhonzo. Maitiro akajairika anosanganisira kudonha zvakananga papfudzi, kudonha paruoko rwakatambanudzwa, kubonderana panguva yemitambo yekusangana, uye yakakwirira-simba bhasikoro kana mota kukuvadzwa. Muvarwere vaduku, kukuvara uku kunowanzotevera mitambo kana tsaona dzemotokari. Muvanhu vakuru, kuderera kwesimba-simba kunogona kukwana, kunyanya kana hutano hwepfupa hunoderedzwa.
Clavicle fractures inosvika 3% kusvika 5% yevanhu vakuru vakatyoka. Kugovera kunowanzo kutsanangurwa sebimodal, paine imwe yepamusoro pakati pevechiri kuyaruka uye vechidiki vakuru uye imwe pakati pevakuru vakuru.
Zviratidzo zveClavicle Fracture
Zviratidzo zvinoenderana nenzvimbo uye kuoma kwekukuvara, asi kazhinji zvinosanganisira:
Pakarepo kurwadziwa pamusoro pecollarbone mushure mekukuvara
Kuzvimba, mavanga, uye kupfava kwenzvimbo
Marwadzo pakusimudza kana kufambisa ruoko rwakabatwa
Bundu rinooneka, nhanho, kana shanduko mumapendekete
Manzwiro ekugaya kana kufamba panzvimbo yekutyoka
Tsika yekutsigira ruoko rwakakuvara neruwoko rwakapesana
Yambiro Zviratidzo Zvinoda Kukurumidzira Kuongororwa
Kukurumidzira kuongororwa kwechiremba kunokosha kana ganda rakaputsika kana kuti rakanyatso tende pamusoro pechidimbu chakapinza; ruoko kana ruoko runocheneruka, kutonhora, kupera simba, kana kuti chiveve; kufema kwakaoma; kurwadziwa kwechipfuva kuripo; kana kukuvara kwakatevera kukuvadzwa kwepamusoro-simba. Izvi zvakawanikwa zvinogona kuratidza kutyoka kwakavhurika kana kukuvara kwakabatana kunosanganisira mapapu, chipfuva madziro, tsinga, kana tsinga dzeropa.
Kuongororwa kwekiriniki kunofanirwa kusanganisira ganda, pfudzi contour, kutenderera, uye nerve basa.
Clavicle Fracture Inowanikwa Sei?
Kuongororwa kunotanga nenhoroondo yekukuvara uye kuongorora kwemuviri. Chiremba anoongorora nzvimbo yehunyoro, kuremara kunoonekwa, mamiriro eganda, kufamba kwepfudzi, uye kutenderera uye nerve basa reruoko rwakabatwa. Mukukuvara kwepamusoro-simba, chifuva, mutsipa, scapula, uye zvimwe zvikamu zvebhanhire repafudzi zvinodawo kunyatsoongororwa.
X-Ray
Plain radiographs ndiyo yakajairwa yekutanga-mutsara wekufungidzira bvunzo. Ivo vanosimbisa nzvimbo yekutyoka uye vanobatsira kuratidza kutama, angulation, kupfupisa, uye comminution. Yakarurama radiographs inogona kuratidza kutama kwakawanda kupfuura mifananidzo yakatorwa murwere akarara pasi, kunyanya pakati peshaft clavicle fractures.
CT uye Zvimwe Zvifananidzo
Computed tomography inogona kubatsira kana kuputsika kunosanganisira clavicle yepakati kana sternoclavicular joint, apo mutsara wekuputsika wakaoma, apo kukuvara kwepafudzi-bhanhire kwakabatana kunofungidzirwa, kana kuti kurongeka kwakadzama kwekutanga kwekugadzirira kunodiwa. Kuwedzera imaging inosarudzwa maererano neanofungidzirwa kukuvara kwakabatana pane kushandiswa nguva nenguva kune yega yega clavicle fracture.
Radiographs inobatsira kutsanangura nzvimbo yekutyoka, kutama, kupfupisa, uye kufambisa.
Mhando uye Zvikamu zveClavicle Fractures
Iyo inonyanya kushanda nhanho yekutanga ndeyekurongedza clavicle kuputsika nenzvimbo:
| Nzvimbo | Tsanangudzo | yeKliniki Kufunga |
|---|---|---|
| Midshaft kuputsika | Inosanganisira chikamu chepakati chetatu che clavicle uye ndiyo inonyanya kuzivikanwa pateni. | Displacement, kupfupisa, comminution, ganda mamiriro, uye murwere chiitiko nhanho kubatsira kutungamira kurapwa. |
| Distal clavicle fracture | Inosanganisira lateral end pedyo neacromioclavicular joint. | Kugadzikana kunobva pane chikamu chehukama pakati pekuputsika uye coracoclavicular ligament complex. |
| Medial clavicle fracture | Inosanganisira kuguma pedyo nejojo ye sternoclavicular uye haina kujairika. | Posterior displacement inoda kunyatsotariswa nekuti zvakakosha zvimiro zvakarara kuseri kwepakati clavicle. |
Common Classification Systems
Iyo Allman system inobatanidza clavicle fractures kuita yepakati-yechitatu, distal-yechitatu, uye yepakati-yechitatu kukuvara. Mamwe masisitimu akadzama anosanganisira iyo Neer classification ye distal clavicle fractures, iyo Robinson kana Edinburgh classification, uye AO/OTA classification. Aya masisitimu anotsanangura zvinhu zvakaita senzvimbo, kutama, comminution, articular kubatanidzwa, uye ligament kugadzikana.
Zita rechikwata chete haritauri kurapwa. Murapi anofanirawo kufunga nezveganda uye matishu akapfava, mamiriro eurovascular, kukuvara kwakabatana, zera remurwere, mamiriro ekurapa, basa, nhanho yebasa, uye kurapwa zvaunofarira.
Yakajairwa clavicle fracture classification masisitimu anotsanangura nzvimbo, kugadzikana, kutamiswa, uye comminution.
Kusashanda Kurapa kweClavicle Fractures
Mazhinji ari ega clavicle fractures anotariswa pasina kuvhiyiwa, kunyanya kana kurongeka kunogamuchirwa uye kuputsika kunotarisirwa kuramba kwakagadzikana. Chipfuramabwe cheruoko chinowanzofarirwa pane chipfuramabwe-chesere nekuti chiri nyore kuisa uye chinowanzo gadzikana.
Nonoperative care inogona kusanganisira:
Sling immobilization yekunyaradza uye kudzivirira
Pain management inotungamirwa nenyanzvi yezvehutano
Nguva dzose kliniki uye radiographic kutevera
Kutanga kufamba kwegokora, wrist, uye ruoko
Kufambira mberi kwepfudzi kufamba apo kurwadziwa uye kugadzikana kwekutsemuka kunobvumira
Kusimbisa mushure mekiriniki uye radiographic zviratidzo zvekuporesa
Zvakanakira kusashanda kurapwa zvinosanganisira kudzivirira kuchekwa, anesthesia, njodzi yehutachiona, uye matambudziko ane chekuita nekudyara. Zvinogona kukanganisa zvinosanganisira kuenderera mberi kwekuremara, kunonoka kubatana, kusabatana, malunion, uye kunonoka kudzoka kubasa rinoda kana mitambo mune zvakasarudzwa zvakaputsika.
Chipfuramabwe cheruoko chinowanzo shandiswa kunyaradza nekudzivirira panguva yekutanga kusashanda.
Ndeipi Nguva Iyo Clavicle Fracture Inoda Kuvhiyiwa?
Kuvhiyiwa hakudiwi kune yega yega yakabviswa clavicle fracture, uye hapana kuyerwa kumwe chete kunofanirwa kushandiswa kwega. Kurapa kunofanirwa kuve kwakasarudzika kuburikidza nekuita sarudzo pakati pemurwere nachiremba anorapa.
Kuvhiya kurapwa kunogona kukurudzirwa kana kutariswa zvakanyanya kana paine:
Kutyoka kwakavhurika
Kukanganisa kweganda kana kutendeseka kwakanyanya pamusoro pechidimbu chakatyoka
Kukuvara kwakabatana netsinga dzeropa kana tsinga
Bhandi repafudzi risina kugadzikana kana rakasarudzwa multiple-trauma pattern
Kutamiswa kwakaiswa, kupfupisa, kana kudzoreredzwa mumunhu mukuru wepakati pekutyoka
Iyo isina kugadzikana yakadzingwa distal clavicle fracture nekuvhiringidzika kweiyo coracoclavicular ligament complex.
Symptomatic nonunion kana malunion
Chido chekudzorera kurongeka uye kugadzikana mushure mekufunga nezve basa, mutambo, hutano hwese, uye zvinodiwa nemurwere.
Muvanhu vakuru vane midshaft fractures yakadzingwa, kurapwa kwekushanda kunobatanidzwa nehuwandu hwekubatana uye zviri nani zvekutanga zvakashumwa nemurwere pane kusava nehanya. Zvibereko zvenguva refu uye kugutsikana, zvisinei, zvinogona kufanana neimwe nzira. Chiyero chinosiyana muvachiri kuyaruka, avo vane kugona kwekuporesa kwakakura uye kune avo kuvhiyiwa kwega kwega kwega kutsemuka midshaft kutsemuka kunogona kupa pasina basa rakajeka.
Unhu hwekuputsika uye kukuvara kwakabatana kunofungidzirwa pamwe chete pakusarudza kana kuvhiyiwa kungave kwakakodzera.
Nonoperative Care vs. Kuvhiya Fixation
| Kurapa | Kunowanzo fungwa kune | Zvinogona Kubatsira Zvingangoitika | Zvisingakwanisi |
|---|---|---|---|
| Chipfuramabwe uye kugadzirisa | Vazhinji vasina kugariswa, vakadzingwa zvishoma, uye vakatyoka vakatsiga | Inodzivirira kuvhiyiwa uye matambudziko ane chekuita nekudyara | Kuputsika kwakasarudzwa kune njodzi huru yekusabatana, malunion, kana kunonoka kupora kwekutanga. |
| Plate uye screw fixation | Akasarudzwa akatamiswa, akapfupikiswa, akadzorwa, akavhurika, kana asina kugadzikana mafractures | Kuderedzwa kwakananga, kugadzirisa kwakasimba, uye huwandu hwemubatanidzwa | Vanga, utachiona, chiveve, kusimba kwehardware, uye nekugona kubviswa kwekudyara |
| Intramedullary fixation | Yakasarudzwa clavicle shaft fractures ine yakakodzera pateni | Diki incisions uye zvishoma zvinyoro-zvinyama kuratidzwa mune dzimwe nguva | Kudyara kushatirwa, kutama, kubviswa, uye kushomeka kwekukodzera kune mamwe mapatani akagadziriswa |
Kuvhiya Kurapa Sarudzo
Plate uye Screw Fixation
Kuzarura kuderedza uye kugadziriswa kwemukati nendiro ndiyo nzira yakajairika yekuvhiya ye clavicle fractures. Chiremba anovhiya anodzosera kurongeka uye anochengetedza pakatyoka nendiro uye screws. Mazuvano orthopedic locking plate systems inopa yakagadziriswa-angle sarudzo kune dzakasarudzwa dzakaputsika mapatani. Plate fixation inogona kunyanya kubatsira kana kuputsika kuchiitwa kana kuchengetedza urefu uye kutenderera kunokosha.
Pre-contoured implants senge S-shaped clavicle locking plate yakagadzirirwa kutevedzera curvature ye clavicle, kunyangwe yekupedzisira kuisirwa kusarudzwa uye contouring zvinoenderana nemunhu anatomy uye fracture kumisikidzwa. Zvinogona kukanganisa zvinosanganisira chiveve chakatenderedza kuchekwa, kuisirwa mukurumbira, nyoro-tishu kutsamwa, kutapukirwa, uye mukana wepashure maitiro ekubvisa chiratidzo hardware. Kubviswa kweimplant hakungodiwe wega mushure mekutsemuka kwega kwega.
Plate fixation inodzorera kurongeka uye inodzikamisa clavicle apo kuputsika kunoporesa.
Intramedullary Fixation
Intramedullary midziyo inoiswa mukati me canal ye clavicle kuti igadzikane yakasarudzwa shaft fractures. Kuenzaniswa neplating, nzira iyi inogona kushandisa zvidiki incisions uye kuderedza kumwe kunyorova-kwenyama kuratidzwa. Nekudaro, hakusi kwese kutsemuka kwakakodzera kune intramedullary fixation, kunyanya kana comminution ichiita kureba kana kutenderera kudzora kunetsa. Zvose mahwendefa nezvipikiri zvinoumba chikamu chekufara orthopedic trauma fixation system.
Kune munhu mukuru clavicle shaft fractures, intramedullary nailing uye single-plate fixation inogona kuburitsa zvakafanana zvenguva refu mhedzisiro yekiriniki uye complication rates. Plate fixation inogona kupa mukana muhupo hweku comminution.
Intramedullary fixation inogona kutariswa kune yakasarudzwa clavicle shaft fracture mapatani.
Minimally Invasive Plate Osteosynthesis
Minimally invasive plate osteosynthesis inoshandisa diki incisions uye kushomeka kuratidzwa uku ichidzikamisa pakatyoka nendiro. Iyo tekinoroji inovavarira kuchengetedza zvinyoro zvinyoro uye fracture biology, asi kudzikisira chaiko uye kudzivirira kweiyo supraclavicular nerves inoramba yakakosha.
Mienzaniso yeashoma invasive plate fixation ye clavicle fractures.
Distal Clavicle Fixation
Distal clavicle fractures inoda kuongororwa nzvimbo yekuputsika, chidimbu chekukura, kubatanidzwa kwearticular, uye kuvimbika kwekoracoclavicular ligament complex. Sarudzo dzinogona kusanganisira a distal clavicle locking plate , coracoclavicular stabilization, kana mamwe maitiro ekugadzirisa akasarudzwa nokuda kwemaitiro chaiwo. Uchapupu hahutsigire nzira imwe yekuputsika kwega kwega.
Distal clavicle fixation inosarudzwa maererano nekukura kwechidimbu uye ligament kugadzikana.
Medial Clavicle Fractures
Mazhinji mashoma akadzimirwa medial clavicle fractures anogona kutarisirwa pasina kuvhiyiwa. CT inowanzokosha kana kutama kwakaoma kutsanangura kana kana kusimuka kwemashure kuchifungidzirwa. Nekuda kwekuti trachea, esophagus, midziyo mikuru, uye zvimwe zvimiro zvemukati zvakarara padyo, kukuvara kwepashure kwakadzingwa kunoda kukurumidza kuongororwa.
Kukuvara kwakaomarara kweclavicle kungada zano rekugadzirisa rinoenderana neyakaputsika pateni.
Clavicle Fracture Recovery uye Rehabilitation
Iko hakuna imwe nguva yekudzoreredza nguva yega yega clavicle fracture. Zera, nzvimbo yekutyoka, kutamiswa, nzira yekurapa, chimiro chekuputa, kukuvara kwakabatana, uye kuporesa kweradiographic zvese zvinokanganisa kufambira mberi. Varwere vazhinji vanowanazve basa rinobatsira mukati me6 kusvika kumavhiki e12, asi kupora kwemapfupa akazara, kupora simba, uye kudzokera kune-yakanyanya kudiwa basa kunogona kutora nguva yakareba.
Chikamu chekudzivirira: Chipfuramabwe chinoshandiswa kunyaradza nekudzivirira. Kufambisa ruoko, ruoko, uye nemagokora zvinowanzokurudzirwa kutoti kumwe kukuvara kwazvidzivirira.
Chikamu chekutanga chekufamba: Zvinyoro zvemapfudzi zvinogona kutanga apo kurwadziwa kunoderera uye chiremba anorapa anosimbisa kuti kufamba kwakakodzera.
Kusimbisa chikamu: Resistance maekisesaizi anounzwa mushure mekukwana kwekiriniki uye radiographic kuporesa.
Kudzokera-kune-chiito chikamu: Kusimudza kunorema, kusangana nemitambo, uye zviitiko zvine njodzi yakakura yekudonha zvinofanirwa kumirira kusvika kutyoka kwapora uye simba uye kufamba zvapora.
Kutevera kwakakosha nekuti kuwedzera kuremara, kurwadziwa kunoramba kuripo, kana kushaikwa kweradiographic kufambira mberi kunogona kuratidza kutama, kunonoka kubatana, kana kusabatana. Kusvuta kunogona kukanganisa kuporeswa kwekutyoka uye kunofanirwa kutariswa sechikamu chechirongwa chekurapa.
Zvinetso Zvinoitika
Matambudziko Mushure meKurapwa Kusina Kushanda
Nonunion: kuputsika kunokundikana kupora, izvo zvinogona kukonzera kurwadziwa kunoramba kuripo kana kushaya simba.
Malunion: kuputsika kunoporesa munzvimbo yakapfupikiswa, yakagumburwa, kana yakabviswa.
Zvinooneka mukurumbira: bundu rinogona kuramba riri pamusoro pekutyoka kwaporeswa.
Kuoma kwepafudzi kana kushaya simba: kugadzirisa kunogona kudiwa kuti udzorere basa.
Neurovascular zviratidzo: izvi hazvina kujairika asi zvinoda kukurumidza kuongororwa.
Matambudziko Mushure mekuvhiyiwa
Utachiona hwemaronda
Chiveve kana kuchinjwa kwekunzwa kwakatenderedza kuchekwa
Hardware irritation kana mukurumbira
Isa kusunungura, kukotama, kana kuputsika
Kunonoka kubatana, kusabatana, kana malunion
Refracture, kusanganisira mushure mekubvisa implant
Kuda kumwe kuvhiya, kazhinji nekuda kwezviratidzo zvehardware
Dambudziko rekukanganisa rinoenderana nekutyoka uye murwere. A high radiographic union rate hazvirevi kuti kuvhiyiwa isarudzo yakanakisa kumunhu wese, sekuti kudzivirira kuvhiyiwa hakubvisi mukana wekuzopindira.
Kutevera kufungidzira kunogona kubatsira kuona matambudziko ekuporesa uye matambudziko ane chekuita nekudyara.
Mibvunzo Inowanzo bvunzwa
Ko clavicle fracture inogona kuporesa pasina kuvhiyiwa?
Ehe. Mazhinji ari ega clavicle fractures anorapwa pasina kuvhiyiwa uye anoporesa nerutsigiro rwechipfuramabwe, kutevera, uye kufambira mberi kwekuvandudza. Mukana wekubudirira kusingashandi kutarisirwa kunoenderana nekutsiga kwekutyoka, kutama, kutenderera, nzvimbo, zera remurwere, uye zvimwe zvinhu zvekiriniki.
Kutyoka kweclavicle kunotora nguva yakareba sei kupora?
Varwere vazhinji vanowanazve zvakajairika kana pedyo-zvakajairika mukati memasvondo matanhatu kusvika gumi nemaviri, asi nguva yekuporesa inosiyana. Vakuru, vanosvuta, vanhu vane hutsinye hwakasiyana-siyana kana kuti vakatyoka, uye varwere vane mamwe mamiriro ekurapa vangada nguva yakareba. Kudzokera kumitambo yekuonana kunoda kuporeswa kwakasimbiswa uye mvumo yekurapa.
Ndeupi rudzi rwakajairika rweclavicle fracture?
Midshaft clavicle fractures ndiyo yakajairika. Distal fractures haiwanzo kuitika, uye medial clavicle fractures haina kujairika.
Ko bundu rinoonekwa mushure mekutsemuka kweclavicle zvakajairika?
Kubwinya kunooneka kunowanzoitika panguva yekuporesa uye kunogona kusara mushure mokunge pfupa rabatana. Muvana nevechiri kuyaruka inogona kugadzirisa zvakanyanya nekufamba kwenguva. Kuremara kuri kukura, ganda rinotyisidzirwa, marwadzo ari kuwedzera, chiveve, kana kushaya simba kunofanira kuongororwa nekukurumidza.
Kugadziriswa kweplate kuri nani pane kugadzirisa intramedullary?
Hapana nzira yakanakira murwere wese. Zvose zviri zviviri zvinogona kupa zvibereko zvakanaka zvenguva refu mune zvakasarudzwa shaft fractures yevanhu vakuru. Kugadziriswa kweplate kunogona kunge kuri kudiwa kune comminuted mapatani, nepo intramedullary kugadzirisa kunogona kuderedza saizi yekucheka mune yakakodzera mafractures. Sarudzo inoenderana nekutyoka morphology, ruzivo rwekuvhiya, zvinodiwa nemurwere, uye njodzi dzine chekuita nekudyara.
Clavicle hardware inogara ichida kubviswa here?
Kwete. Plates, screws, and intramedullary devices hazviwanzo bviswa kana zviine asymptomatic uye kutyoka kwapora. Kubvisa kunogona kutariswa nekuda kwekutsamwa kunoramba kuripo, mukurumbira, kurwadziwa, matambudziko ekuisa, kana zvimwe zvikonzero zvekiriniki mushure mekukurukura nezve njodzi dzekumwe kuvhiya.
Ndezvipi zviratidzo zvekuti clavicle fracture inogona kunge isiri kuporesa?
Kuramba kunorwadza panzvimbo yekutyoka, kufamba kunoramba kuripo kana kunyorova, kuvandudzwa kwemaitiro mashoma, uye kushaikwa kwekufambira mberi pakufungidzira kwekutevera kunogona kuratidza kunonoka kubatana kana kusabatana. Izvi zvakawanikwa zvinoda kuongororwa nachiremba anorapa.
Mhedziso
Kurapa kweClavicle fracture kunobva pane zvinopfuura kuonekwa kwe X-ray imwe chete. Zvizhinji zvakatsiga kana zvishoma zvakaputsika zvinogona kugadziriswa zvinobudirira pasina kuvhiyiwa. Kusarudzwa kwakadzingwa, kupfupikiswa, kuderedzwa, kuvhurika, kana kusagadzikana kukuvadzwa kunogona kubatsirwa nekugadzirisa kushanda, kunyanya muvakuru. Kunyatsoongorora kwepattern yekutyoka, ganda uye neurovascular mamiriro, kukuvara kwakabatana, zera remurwere, zvinodiwa zvekuita, uye zvinangwa zvekurapa zvakakosha pakuita sarudzo.
