Kuongororwa uye kurapwa kweClavicle Fractures

Nhanganyaya

Clavicle Fractures zvakajairika uye kazhinji zvinokonzeresa kubva kune zvakananga kana zvisina kunanga trauma kudunhu refudzi. Zvidzidzo Mukutanga 1960s zvakanyorwa kuti nonunion chiyero cheClavicle Fracures yaive isingasviki 1%, uye kuchengetedza kurapa kwakaguma nekugutsikana kwakanyanya muromo; Nekuvandudzwa kwekuchangobva kuitika kwekurapa, kurapwa kwekuvhiya kwave kuita kukosha kwakanyanya; Naizvozvo, vanamatira vachishandira mudhipatimendi rekukurumidzira kana kiriniki yakajairika yekuparadza inofanirwa kujaira kuratidzwa kwakawanda uye matambudziko ekukuvara uku uye manejimendi ayo ekutanga.

Epidemiology

Clavicle Fracures Akaunti ye2,6% -5% yevakuru vakura fractures [3,2]. Kudzidza kweEurope kwaisanganisira chiuru chakatevedzana Clavicle Clracle Mhosva dzakawanikwa Chiitiko cheClavicle Fraces yakaratidza kugoverwa kweBimdal, zvichiitika muvanhu vari pasi pemakore makumi matatu, vachiteverwa neaya anopfuura makore makumi manomwe emakore.

Clinical anatomy

Chekutanga cheSkeleto yemunhu kuti vatangezve ndiko clavicle, iyo chete Bony yekubatanidza pakati pe ruoko uye iyo armiodlates kureba, iyo acromicalvicular Majoini aya anonzi atypal synovial majoini nekuti ivo vakarongedzwa neFibrocartilage pane Hyayaline cartilage. Iyo Clavicle inosimbiswa kune iyo scapula neakaromillar uye rostrolavicular ligaments uye inosungirirwa kune iyo sternum neiyo sternocalular ligament.

Clavicle iri 'S ' yakaumbwa. Iyo proximal hafu-arc mapurojekiti anteriorly, uchisiya imba yeiyo neurovascular bundle yemugumo wepamusoro. Iyo distal hafu yezvirongwa zveArC kumashure Fractures of the clavicle inowanzoitika pakaburitswa kweiyo arcs (mid-arc), kazhinji nekuda kwekushaikwa kwemapepa emicheka kwakasungira mapfupa ari mudunhu iri uye nekuti ndirwo rusina kusimba chikamu che clavicle. Kana cravicle braced, iyo proximal chikamu chinowanzo kukweverwa kune contracaper yescapapularlis uye pectoreralis yakakura (iyo inomira mukati mekumusoro ruoko). Izvi zvinonyanya kukonzerwa nekukanganisika kweiyo subscappularlis uye pectoreralis mombe huru (iyo inotenderera mukati mekumusoro ruoko uye inodhonza yakananga pachipfuva).

Zvimiro

Chinangwa cheClavicle Fract marita ndeye kuderedza marwadzo uye kudzoreredza basa rekubatana. Mazhinji Clavicle Fractures achirangarirwa zvakanyanya kuchengetedza (kazhinji anopfupikiswa pasina anopfuura 15 mm); Conservative kurapwa senge nhamba-yemabhandeji-masere mabandeji, mahara slings, sayre mabhendi, velpeau fungidziro masutu, uye kusvibiswa. Kumiswa kweuropi kunoitwa muChikamu chakakomba, uye yekutanga mhando dzekudzidzira uye masimba ekudzidzira kazhinji anowanzoitwa mavhiki maviri mushure mekupwanya kana kurwadziwa kwacho. Iko kushandiswa kwehuwandu hwemabhandeji masere hakukurudzirwe sezvo kunogona kutungamira kuAxillary kudzvanywa maronda uye zvakanyanya kusanzwisisana.

Nhoroondo uye Kuongororwa Kwemuviri

Clavicle Fracures inokonzerwa nekukonzeresa kufudzi kutevera kudonha uye kunowanzoonekwa mumitambo yekunze muVadiki uye mune kusaziva kunowira muvakuru. Izvo zvakakosha kuti utsanangure maitiro ekukuvara. Kukuvara-simba kwepamusoro kunogona kuwirirana nemusoro uye ne chest kukuvara, nepo mapundu anokonzerwa nediki kutambudzika kunogona kunge kuri kweparamende. Kuvhiringidzwa kwakakanganisika kunoda kutanga kwekutanga uye kunyatsosarudzika kwechikepe chechipfuva chekuparadzaniswa kwemadziro, neurolologc nekukuvara kwevascular. Clinically, pane kuzvimba uye ecchymosis panzvimbo yakatsemuka, yakasanganiswa nekuremara uye nyoro. Kutarisirwa kunofanirwa kubhadharwa kune yakapfava tishu kuti icise kumusoro, iyo inogona kukonzera ganda necrosis uye ulceration.

Kufungidzira

Zvakawanda zvinopwanya zvinogona kuwanikwa neakareruka anteroposter radiographs. 20 ° musoro unonamira radiographs kubvisa mhedzisiro yekunyora marara emitambo. Varwere vanofanirwa kuve radioirpured munzvimbo yekuzvisarudzira kuti ive nani kuona zvinokwezva kudzikama. Kuremerwa kweRadio Kutora chest radiograph inobatsira kukuvadzwa kwekuvharirwa

Mhando

AO / OTA Bracture dislocation typing: Iyo Clavicle Fracture Code 15 ine nzvimbo nhatu: 15.1 Proximal (Medial), 15,2 diaphysis, uye 15.3 Distal (Littal (Littal (Littal (Littal (Littal (Littal (Littal (Littal (Littal (Littal (Littal (Littal (Littal (Littal (Littal (Littal (Littal). Proximal (MEDIAL) uye Disal (Literal) Fractures yakarongedzwa semhando ye (Evertarilar), Type B (Type by Intra-Artra-Artra-Intra-Artacular). Travel Fracures yakarongedzwa semhando A (Nyore), mhando b (wedges comment of fraw

Allman Typing yakavakirwa pane iyo nzvimbo yekupwanya (i: Medial, Cadent 1/3, II: LALERAL: Medial: Medial: (Fig. 7.2)

Craig akanatswa ichi chikamu zvakare pahwaro hwemamiriro ezvinhu, neangu ari wepakati 1/3 ye clavicle; Type II Kuve Wekunze 1/3 yeClavicle, iyo yakakamurwa kuita marudzi mashanu zvichienderana nekukasira uye hukama hwenzvimbo yerudzi rwelamende. uye nyora iii ichava yakavhiringidzika yemukati 1/3 yeClavicle, iyo yakakamurwa kuita marudzi mashanu zvichienderana nedanho rekutungamira uye kana kuti kana kupwanya kwacho kwaive kunyengera.

Neery Typing yeAlteral 1/3 Fractures inosimbisa kukosha kweRastvic-clavicular Ligtral-Ligvicular Ligntral-ligament Ligntral-ligament Ligntral-Ligntral Lident Type II inosanganisira rostral-clavicular ligament uye inoguma mune medial bracture block ichimanikidzwa zvakanyanya; uye nyora iii wiii inoenda kuacromoodvicular yakabatanidzwa neRastral-Clavicular Ligament yasara yakasara.

Edinburgh Typing is system yeDiaphysis Fractures Zvinoenderana neDhigineti yekudzikisira Zvidimbu zve diaphysis zvinoverengerwa zvichienderana nekuvapo kana kusavapo kwekusangana nezvimedu zvakareruka (Type 2b1) uye Type 2b2). Iyo diaphysis uye mhando 3 ndiyo yekupedzisira yekupedzisira yeiyo diaphysis. Mediel uye gare gare magumo ekupedzisira anozadzwa mu subgroups 1 ne2 zvichienderana nekukwana kuita kwakabatana kwakabatanidzwa.

Saizvozvovo kune rockwood typing, sjiger typing, uye breitner typing.

Kuvhiya Zviratidzo

Chaiyo fractures

1, kuvhurika kuvhurika; 

2, kutamiswa> 2 cm; 

3, kupfupikisa> 2 cm; 

4, Commintion yeFracture Fragment (> 3); 

5, yakawanda-chikamu chakapwanyika; 

6, Pasi pakavhurika yakavhurika nekukuvara kwakapfava. 

7, kuremara kwakakosha (kutamiswa uye kupfupiswa); 

8, Scaphoid kukuvara.

Kukuvara Kwakaoma

1, yakasanganiswa ipsilateral kumusoro kwekukuvara kwemugumo;

2, Kukuvadzwa kwemberi;

3, kukuvara kwakawanda;

4, kupwanyika kwakabatanidzwa neiyo neurovascular kukuvara;

5, Ipstilateral yakawanda rib fracures inosanganiswa neye chest wall kuremara;

6, clavicle kupfupikiswa kuti iite pfudzi rine mapapiro;

7, Bilateral Clavicle Fractures.

Zvepamoyo Zvinhu

1, varwere vane kukuvara kwakawanda kunoda kutanga kumusoro kwehuremu hwehuremu;

2, varwere vanoda kukurumidza kudzoka kubasa (semuenzaniso, elite uye yemakwikwi emitambo).

Nguva yekuvhiya

Kuvhiya kunofanirwa kuitwa pasina kunonoka kana zvachose zviratidzo zvekuvhiya zviripo.

Kunonoka kuvhiyiwa kupfuura 2-3 mavhiki ezvinyorwa kunogona kuwedzera kuoma kwekudzora kuderedzwa, kunyanya kana uchigadzirira kuderedzwa kwemukati kwekugadziriswa kwemukati neyezvinetso.

Kuvhiya Kuwanikwa

Murwere anoiswa muhombodo wechigaro pachigaro kana hafu-akagara chinzvimbo. Iyo pfudzi rakakanganisika rakabatanidzwa pasi pekusimudza clavicle for Elevicle yekuvhiyiwa, uye ruoko rwacho rwunoshandiswa kubvumira kuwanda kwemukati. A transversel insionline padhuze neiyo axis yeClavicle kana saber incision yakafanana neyekupedzisira maitiro anogona kusarudzwa.

Ongorora: Chinyorwa chinotapukira chinopa kuwedzera kwakanyanya, nepo nzvimbo refu yekutarisa inoderedza njodzi ye supraclar nerve kukuvara uye inonyanya kufadza.

Kugadziriswa kwemukati

3.5 Systematic compression complates, mahwendefa ekuvakisa, kana mapurasitiki ePurasitiki anogona kushandiswa kugadzirisa Clavicle Fraces. Mahwendefa akaiswa kumusoro kumusoro kana anterior kune clavicle. Mahwendefa ane simba muBiomechancal akakuvara kana akaiswa zvakanyanya, kunyanya kana paine kukanganiswa kwepazasi, uye zviri nyore kuona. Bicortical gadziriso yezviyero zvinodiwa, uye maburi anofanirwa kurohwa nekutarisirwa kukuru, sezvo paine njodzi yekukuvara kune mitsipa nemidziyo yeropa pazasi. Zvakanakira: Kudhirowa kwakachengeteka kweiyo anterior plate screw screw, ndiro appposition, nyore kufungidzira.

ONA: Bone Graining kazhinji haifanirwe kudikanwa kuti maitiro ekutanga; Mushure mekugadziriswa kwemukati, zvinokoshesesa kuuraya zvakakwana myofascial layer kuvhara ndiro uye kudzivirira hutachiona.

Intramedullary Fixation

Zviripo zvemukati zveTestueal semuenzaniso, titanium elastic zvipikiri hazvitenderi kuvhara, usatendera kudzora kwekureba uye kutenderera, uye zvinogona kukonzera kupfupika kwepasirese kana ichishandiswa kuunganidzwa. Iyo Intramedullary Nailing Technique inogona kungoiswa kune yakapusa, inoburitsa kana oblique clavicle fractures.

Zvakanakira

Zvishoma zvisinganzwisisike, zvinonyanya kugadzirwa, zvishoma zvinyoro-nyoro tishu zvinokwenenzverwa, zvakadzika njodzi yekutsungirira kwekupedzisira, uye kugadzikana kwakabatana ne scab kuumbwa.

Zvinokuvadza

kushatirisa kweganda kana kuremara panguva yekupinda.

Ongorora: Kudzivirirwa kuderedzwa kweClavicle Fractures dzimwe nguva kwakaoma uye overexposure ruoko rwevairengi kuti radiation inodzivirirwa panguva yekuvhiya maneja.

Zvishoma zvisingagoneki plate fixation

Zvishoma nezvishoma kupinda mundiro yeClavicle inofungidzirwa kuti inofungidzirwa kuti inopa simba rakakura paunenge uchidzivirira zvakashata zvekuvhurika plate yekugadziriswa kana intrameduutllary gadziriso.

Intraperating kuiswa kweiyo 3.5 system LCP anterior kune clavicle

Kushandisa kwekutanga kweshoma kusanzwisisika mundiro yeStEosynthesis inogona kuve yakabatana ne Supraclar nerve kukuvara, kusarongeka kwekunyepedzera kana kupfupika kwemaroyi kunokanganisa basa, uye plate kukotama kana kupwanyika.

Plate Fixation of Fractures yeiyo inotevera kuguma kweClavicle

Iko kusarudzwa kweplate implants kunoenderana nehukuru hweiyo yakazotevera pfupa. Chikamu chegumi che3 bicortical chinodiwa kune yakazotevera pfupa. Zvine musoro, kushushikana kwekutadza kunofanirwa kushandiswa kune oblique fractures. Kana iyo pfupa racho idiki kwazvo kuti gadziriswe, iyo clavicle hook plate inogona kushandiswa.

Kurapwa kweacromoodclavicular yakabatana dislocation

Acromioclavicular Joint Kukuvara account ye12% ye scapular bhandi kukuvara uye kazhinji kunoitika mumatanda akazadzwa anowoneka.

Iyo inonyanya kushandiswa kushandiswa system system ndeye dombo redombo rinomirira. Nyora ini ndiri sprain yeiyo acromiclavicular ligament neRostroclarular ligament lact. Type II kubvarura kweiyo acromiclavicular ligament neRostroclarular Ligmenty yakasimba; Type III Iro kubvarura kweiyo acromiclavicular ligament uye iyo rostrolarular ligament; Type IV ndeyekupindirana kwekufamba kweiyo distal Clavictic inopa iyo trapezius; Type v ndeye kubvaruka kwakazara kweiyo acromiclavicular yakabatanidzwa uye rostrolarular ligrament, ine zvinopfuura zana muzana kubva kujoina kujoina; Uye nyora vi kukuvara kazhinji kazhinji, neiyo distal Clavicle yakadzingwa pasi pazasi peRostral maitiro.

Conservative kurapwa nehurefu-terking braking neclimberever shlet inokurudzirwa mhando ini uye Type II Kukuvara. Iko kutarisana kwemhando yeII kukuvara kune gakava, paine mamwe mabhuku achiratidza kuti kurapa kwakaratidzirwa kunoratidzwa kune vakuru vadiki vanoshanda. Kudzoreredza kupora kwakanaka kunyangwe panogona kunge paine madhigirii akasiyana ekuremara mukutaridzika. Type IV - VI kukuvara kwakanyanya uye kupindira kwekuvhiya kunokurudzirwa.

Parizvino, iyo inowanzoshandiswa kurira maitiro ndeye: Bosworth Rostral inovhara Screw Technque neChikamu cheLignthile kana Hapana Kugadziriswa kweLigament ;, Clavicle Hook Plate Fixation, yakafanana neyekupedzisira kuguma kweClavelly; Blatrope's tab ndiro plate gadziriso kana anchor pinning kujaira kuburikidza nearthroscope kana chidimbu chidiki; uye restral yekuvhara ligament suture kana kusimbisa kumiswa, nezvinhu zvekunyepedzera kana tendon pakati pe rostral mukurumbira uye clavicle.

Hazvina kujeka kuti ndeipi nzira yekuvhiya inonyanya kubatsira, uye kunyangwe paine imwe nhanho yekurasikirwa kwekurasikirwa, iko kugona kwekupedzisira kwezvinhu izvi zvese zvinogutsa.

Kurapa kweMedial End Clavicle Fractures uye Sternoclavicular Joint dislocations

Kukuvara uku hakuna kujairika, uye zvakare kune kushaikwa kwekurapa nhungamiro dzakavakirwa pamishonga-yakavakirwa mushonga.

MEDIAL CLavicle Fractures inowanzo kuve yakawedzera-manyepedzeri pakukasira nekukasira kudzikama uye kunogona kubatwa zvakaringana. Iyo epiphysis yemugumo madimikira eClavicle kazhinji inovhara pamakore 23-25 ​​ezera uye ndiyo yekupedzisira Epiphysis kusvika padyo nemuviri. Naizvozvo, kukuvara kwakawanda kwepamhepo kuri kuita Epiphyseal Plate Fractures yeSalter-Harris Type i kana Ii. Commal X-rays yakaoma kuongorora, neyakanaka kuti idare redhiyo uye kuenzanisa nedivi rine hutano rinogona kuratidza kuguma kweClavicle, uye CT inopa iyo yakanyanya kuongororwa kufungidzira.

Fractures kana dislocations dzakatakurwa naAneriorly dzinogona kuvharwa uye kuisirwa, asi kazhinji dzisingagadzikwi uye dzisingawanzo kudzoreredzwa. Palliative Care inokurudzirwa kuti uenderere mberi nekureji kana kutamiswa nekuti kazhinji havafanirwe kuiswa mukukanganisika. Dislocation yemugumo wekupedzisira weClavicle Posteriorly inowanzoitika mukukuvara kukuru kwemweya Zvekuzivisa uye Fracts kuti chikamu cheMidial chakanyanya kuderera, mahwendefa anogona kubhururuka mhirizhonga yekugadzirisa kugadziriswa kune sternum.

Dzimwe nzira dzekugadzirisa

eg kunze kwekunze kwehunhu, kwekunze kugadziriswa neClavicl ndiro, etc.

Postoperative Management

Ruoko rwekumusoro runofanira kusvibiswa mune chipfuramabwe uye pfudzi pendulum kudzidziswa zvinofanirwa kutangwa nekukurumidza. Mavhiki maviri gare gare, murwere anofanira kuteverwa kuti aongorore ronda uye adzorere majenji, nepo mwaranzi, asi murwere anofanirwa kuunganidzwa anogona kutangwa, asi murwere anofanira kuudzwa kuti asakwidziridze zviyero negumbo rakakanganisika. Kudzidziswa kwesimba kunogona kutangwa pamavhiki matanhatu postopuleratively kana zviratidzo zvekupora kwebhoni kuoneka. Bata mitambo kana mitambo yakanyanyisa inofanira kudzivirirwa kwemwedzi mitatu mushure mekuvhiyiwa kusvikira kupwanya kwakapora zvachose.

Matambudziko.

Zvekutanga Zvinetso

Postoperative ronda hutachiona hunogona kuitika kusvika 4.8% yezviitiko;

Kuverengera munzvimbo yeSubclavian ndiyo inonyanya kujairika, neyakajairika nhoroondo yekudzidza inosvika 83% yevarwere neiyi chiratidzo, izvo hazvitungamire kune yakakosha dysfanction, kunyangwe ichiramba ichisvika pamakore maviri.

Endophyte proturusion uye kushungurudzika kweganda, zvakajairika nekushandiswa kwemapuranga ezvipfeko kana zviputi zvipikiri pasina yakanaka nyoro tishu

kudzorerwazve, izvo zvinogona kuitika mushure mekuvhiringidzika uye kuchengetedza kurapwa; Post-Kuvhiya Kukuvara-kukuvara kunogona kukonzera kukotama kana kutyora kwe endtoprastisis, kana kupwanya kutenderedza endtoposthesis;

nonunion, ine 15% nonunion huwandu hwekurapa uye ne2% nonunion chiyero nehurongwa hwekuvhiya kwekurapa kwerudzi rwakanyatsoratidzwa dightsive; Kureba kwekubviswa kwekupwanya, kupfupisa kwakakura kupfuura 2 cm, kuputa, kuwedzera-simba kwekukuvara (kudzoreredza dicracations, kudzoreredza dihivations, kurasika kwemapfupa emapfupa, uye kurasikirwa kwakanyanya kwepa pfupa.

Nguva dzekunonoka

Osteoarthritis yeAcromoolvicular Joint inoitika kazhinji neIntra-Articular Fractures (Edinburgh Type 3B2); Kana kuratidzwa uye kuchengetedza kurapwa kusingabatsiri, iyo distal clavicle inogona kuve yakagadzirirwa arthroscopicicciccicciccicctically kana nekuvhiyiwa kwakashama;

Kuremara kurapa, uko kunoitika kune madhigirii akasiyana mukurapwa kwakarapwa kwakadzingwa; Kupfupikisa bhandi rezvematanho kudzikisira kweiyo thoracic kubuda kunogona kukonzera zviratidzo zvebrachial plexus kumanikidzwa; Uye chilamigment ye scapuloth wall majoini anogona kukonzeresa scapula uye gadzira maronda emba kubva pakupora kana kururamisa kukaitika, itstomy kururamisa uye plate kugadziriswa kunoitika pazvinhu zvemurwere.

Prognosis uye mhedzisiro

Kudzidza kwakabatana muEurope kwakashuma kuti kurapwa kwekushora kwekusatarwa midclavicular kwakashanda, uye kuongororwa kwaro kunowedzera kuwanda kweboka rekuvhiya pane muboka rakarapwa pakafanana nekuvhiyiwa kwakaenzaniswa nekurapa kwekuchengetedza. Uye zvakare, boka rekuvhiya rakange rakaderedza kurwadziwa mangwanani, uye kuvandudzwa mumazuva ese uye dash mashandiro ezviitiko zvakadaidzwa.

Pfupisa

Vazhinji vanokanganiswa vanokonzerwa nekukonzerwa nekureba kana zvisina kunanga mhirizhonga, uye kurapwa kunogona kuve kwakakamurwa seanochengetedza kana kurapwa. Panyaya yekurapa, kunyangwe kazhinji crcracle frcraces pasina kudzikiswa kwakakosha kunogona kurapwa kunogona kurapwa, sarudzo yekurapa yekuvhiringidza nekukasira nekukosheswa kwakakosha. Nekuraswa kwakadzingwa

Mareferensi

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[2] Eiff, MP, Hatch, et al. Clavicle uye scapula fractures. In: Fracture Management yeKutarisira Kwekutanga, 2nd Ed, WB sungers, Philadelphia 2002. PHILELPHIA 2002. P.198.

[3] Robinson cm. Fractures yeClavicle mumukuru. Epidepiology uye kuiswa. J BONGE Joint Surg BR 1998; 80: 476.

[4] Neer cs 2nd. Fractures yeiyo distal chetatu ye clavicle. Cliness porthop inodaro 1968; 58:43.

[5] Andersen K, Jensen Po, Lauritzen J. Kurapa kweClavicular Fractures. Mufananidzo-we-masere-bandage inopesana neslamu iri nyore. Acta Ortop Scand 1987; 58:71.

[6] Ersen a, Atars ac, birais f, et al. Kuenzanisa kweiyo nyore ruoko kusuruvara uye nhamba yevasere clavicular bhandi reMidhaft Clavicular Fractures: Chidzidzo chakadziviswa chakadzorwa. Bone Joint J 2015; 97-b: 1562.