Ukuxilongwa kunye noNyango lweClavicle Fractures

Intshayelelo

I-Clavicle fractures ixhaphake kwaye ngokuqhelekileyo ibangelwa ukuxhatshazwa ngokuthe ngqo okanye ngokungathanga ngqo kummandla wegxalaba. Izifundo ekuqaleni kwe-1960s zichaze ukuba izinga elingabonakaliyo le-clavicle fractures lingaphantsi kwe-1%, kwaye unyango olulondolozayo lubangele ukwaneliseka kwesigulane; ngophuhliso lwakutsha nje lweyeza, unyango lotyando lufezekise ukusebenza kakuhle; ngoko ke, oogqirha abasebenza kwisebe elingxamisekileyo okanye iklinikhi yezigulane jikelele kufuneka baqhelane nokubonakaliswa okuqhelekileyo kunye neengxaki zale nzakala kunye nokulawulwa kwayo okusisiseko.

I-Epidemiology

I-Clavicle fractures i-akhawunti ye-2.6% -5% yazo zonke iifractures zabantu abadala [1,2]. Uphononongo lwaseYurophu olubandakanya iimeko ze-1,000 ezilandelelanayo ze-clavicle fracture zifunyenwe [3,4] ukuba ngaphezu kwe-66% ye-clavicle fractures yenzeke phakathi kwe-1 / 3 ye-clavicle, malunga ne-25% yayiyi-lateral 1 / 3 fractures, kunye ne-3% yayiyi-1 / 3 fractures. Iziganeko zokuphuka kwe-clavicle zibonise ukusabalalisa kwe-bimodal, okwenzeka ngokukodwa kumadoda angaphantsi kweminyaka engama-30 ubudala, kulandelwa ngabangaphezu kweminyaka engama-70 ubudala.

I-Anatomy yeklinikhi

Ukuqala kwe-skeleton yomntu ukuqalisa i-ossification yi-clavicle, uxhulumaniso lwe-bony kuphela phakathi kwengalo ephezulu kunye ne-trunk, echaza ngokukhawuleza kunye ne-acromion, i-acromioclavicular (AC) joint, kunye ne-proximally kunye ne-sternum, i-sternoclavicular (SC) joint. La malungu abizwa ngokuba yi-atypical synovial joints kuba ahlanganiswe ne-fibrocartilage kunokuba i-hyaline cartilage. I-clavicle igxininiswe kwi-scapula nge-acromioclavicular kunye ne-rostroclavicular ligaments kwaye ifakwe kwi-sternum yi-sternoclavicular ligament.

I-clavicle yenziwe 'S'. Iiprojekthi ze-half-arc ezikufutshane ngaphambili, zishiya indawo ye-neurovascular bundle yendawo ephezulu. Isiqingatha esikude seeprojekthi ze-arc ngasemva (i-concave) kwaye emva koko idibanisa i-scapula (inkqubo ye-rostral kunye ne-acromion). Ukuqhekeka kwe-clavicle ngokuqhelekileyo kwenzeka ekudibaneni kwee-arcs ezimbini (ephakathi kwe-arc), mhlawumbi ngenxa yokungabikho kwe-ligaments enamathele kumathambo angabamelwane kulo mmandla kwaye ngenxa yokuba iyona nxalenye ebuthakathaka ye-clavicle. Xa i-clavicle fracture igxothwa, i-proximal segment iphantse itsalwe phezulu (cephalad) yi-sternocleidomastoid muscle (iqhotyoshelwe ekupheleni kwe-clavicle) kunye necandelo elikude lihlanjululwa phantsi (caudad) ngobunzima bengalo engaphezulu, kunye ne-clavicle ithande ukuphuka ', i-short fract' enye, enye i-short , enye i-short , i-short fract. ngokuyinhloko ngenxa ye-contraction ye-subscapularis kunye ne-pectoralis enkulu (ejikeleza ngaphakathi kwingalo ephezulu). Oku kubangelwa ikakhulu ngenxa ye-contraction ye-subscapularis kunye ne-pectoralis enkulu yezihlunu (ezijikeleza ngaphakathi ingalo ephezulu kwaye iyitsale esifubeni).

Iimbonakalo

Injongo yonyango lwe-clavicle fracture kukunciphisa intlungu kunye nokubuyisela umsebenzi odibeneyo. Uninzi lweefractures ze-clavicle lusaphathwa ngokuyinhloko ngononophelo (ngokuqhelekileyo lufutshane ngokungekho ngaphezu kwe-15 mm); unyango olulondolozayo olufana nenani leebhandeji ezisibhozo, izilingi ze-forearm, amabhandeji e-Sayre, iisuti ze-Velpeau immobilization, kunye nokunyanzeliswa. Ukumiswa kwe-Suspension Immobilization kwenziwa kwisigaba esibuhlungu, kwaye uluhlu lwangaphambili lokuqeqeshwa kokunyakaza kunye nokuzivocavoca kwamandla ngokuqhelekileyo kwenziwa kwiiveki ze-2-6 emva kokuphuka xa intlungu ixazulula. Ukusetyenziswa komzobo we-8 bandages akukhuthazwa njengoko kunokukhokelela kwizilonda zoxinzelelo lwe-axillary kunye nokungaphezulu kokungadibanisi kwe-fracture [5,6].

Imbali kunye noVavanyo loMzimba

I-Clavicle fractures ibangelwa yimpembelelo ethe ngqo ehlombe emva kokuwa kwaye ibonakala ngokuqhelekileyo kwimidlalo yangaphandle kulutsha kunye nokuwa ngokungenangqondo kubantu abadala. Kubalulekile ukuchaza indlela yokulimala. Ukulimala okuphezulu kwamandla kunokudibanisa kunye nokulimala kwentloko kunye nesifuba, kanti iifractures ezibangelwa yintlungu encinci ingaba yi-pathologic. Ukulimala kokuphazamiseka kufuna ukuqaliswa kwangethuba kunye nokungabandakanywa ngononophelo lwe-scapular yodonga lwesifuba, ukwenzakala kwe-neurologic kunye ne-vascular. Ngokweklinikhi, kukho ukuvuvukala kunye ne-ecchymosis kwindawo yokuphuka, kudibaniswa nokukhubazeka kunye nokunyamezela. Ingqalelo kufuneka ihlawulwe kwiithishu ezithambileyo zokukhutshwa, ezinokubangela i-necrosis yesikhumba kunye nezilonda.

Ukuqikelela

Uninzi lweefractures lunokuxilongwa nge-radiographs elula ye-anteroposterior. I-radiographs ye-20 ° intloko ye-tilt isusa umphumo we-thoracic cavities. Izigulana kufuneka zenziwe nge-radiographed kwindawo yokuzimela ukuze zibone ngcono ukufuduka kwe-fracture. Ubunzima be-radiographs luncedo ekuhloleni ingqibelelo ye-rostral clavicular ligament kwi-distal clavicle okanye i-acromioclavicular joint injury.CT inceda ekuboneni ngokwenzakala okuntsonkothileyo kwebhanti ye-scapular kwaye ibonelela ngokubona ngcono kokulimala okunokwenzeka kwi-clavicle enokwenzeka kwi-sternoclavicular joint. Ukuthatha i-radiograph yesifuba kunceda ukukhupha ukulimala kwe-thoracic ehambelanayo, kunye nokunciphisa kunokuhlolwa ngokuthelekisa i-clavicle ye-contralateral, kunye nokulawula ukuhlukana kodonga lwe-scapulothoracic.

Iintlobo

I-AO / OTA Ukuchwetheza Ukuchithwa kweFracture: Ikhowudi ye-clavicle fracture ye-15 iqukethe iziza ezintathu: 15.1 proximal (medial), 15.2 diaphysis, kunye ne-15.3 distal (lateral). Iifractures ezikufutshane (eziphakathi) kunye ne-distal (lateral) zihlelwa njengohlobo lwe-A (i-extra-articular), uhlobo lwe-B (ingxenye ye-intra-articular), kunye nohlobo C (ngokupheleleyo intra-articular). I-Trunk fractures ihlelwe njengohlobo lwe-A (elula), uhlobo lwe-B (i-wedge), kunye nohlobo lwe-C (olugqityiweyo) .I-AO / OTA yokuhlelwa kweefractures kunye nokuchithwa akuthatheli ingqalelo iqondo lokufuduka kwe-fracture, kwaye okwangoku kusetyenziswa ngokulinganiselweyo kunyango lwe-clavicle fractures kunye nokumisela i-prognosis.

Ukuchwetheza kwe-Allman kusekelwe kwindawo yokwaphuka (I: medial, cadent 1/3, II: lateral 1/3, III: medial 1/3) (Fig. 7.2.1).

UCraig walucoca kwakhona olu luhlu ngokwesiseko sika-Allman, mna ndiphakathi kwe-1/3 ye-clavicle; uhlobo lwe-II lube yi-1/3 yangaphandle ye-clavicle, eyathi ke yahlulahlulwe kwiintlobo ze-5 ngokusekelwe kwi-fracture displacement kunye nobudlelwane kwi-rostral clavicular ligament; kunye nohlobo lwe-III lube ukuphuka kwe-1/3 yangaphakathi ye-clavicle, eyahlulahlulwe kwiintlobo ze-5 ngokusekelwe kwinqanaba lokuchithwa kwe-fracture kunye nokuba i-fracture yayiyi-intra-articular.

I-Neer's typing of lateral 1/3 fractures igxininisa ukubaluleka kwe-rostral-clavicular ligament: uhlobo lwe-I lwenzeka kwi-distal kwi-rostral-clavicular ligament, kunye ne-medial fracture block displaced ephezulu; uhlobo lwe-II lubandakanya i-rostral-clavicular ligament kwaye ibangele ibhloko ye-fracture ye-medial ihanjiswe ngokuphezulu; kunye nohlobo lwe-III ludlulela kwi-acromioclavicular joint kunye ne-rostral-clavicular ligament eseleyo.

Ukuchwetheza kwe-Edinburgh yinkqubo yokuhlela i-diaphysis fractures ngokwenqanaba lokufuduka kunye nokuhamba.1 Uhlobo lwe-1 lweentlobo lubandakanya isiphelo se-medial, uhlobo lwe-2 luyi-diaphysis fractures kunye nohlobo lwe-3 luyi-lateral end fractures. Iifractures ze-diaphysis zihlelwa ngokuhambelana nobukho okanye ukungabikho koqhagamshelwano lwe-cortical phakathi kweengcezu eziqhekezayo kwiintlobo ze-A kunye ne-B. Uhlobo lwe-2A fractures luphinde luhlelwe njenge-nondisplaced (uhlobo lwe-2A1) kunye ne-angulated (uhlobo lwe-2A2), i-2B i-fractures ihlelwa njengento elula okanye i-wedge-shaped (uhlobo lwe-2B12) iifractures zibandakanya ukuphela kwe-medial ye-diaphysis kunye nohlobo lwe-3 luyi-lateral end of diaphysis. Iifractures zokuphela kwe-Medil kunye ne-lateral zihlulwe kwii-subgroups ze-1 kunye ne-2 malunga nokuba i-joint edibeneyo ibandakanyekayo.

Ngokukwanjalo kukho ukuchwetheza kweRockwood, ukuchwetheza kweJager, kunye nokuchwetheza kukaBreitner.

Iimpawu zotyando

Ukuqhekeka okuthe ngqo

1, ukwaphuka okuvulekileyo; 

2, ukufuduswa >2 cm; 

3, mfutshane >2 cm; 

I-4, ukuhanjiswa kweengcezu zokuphuka (> 3); 

5, ukwaphuka kwamacandelo amaninzi; 

I-6, i-fracture ephantsi evulekileyo kunye nokulimala kwezicubu ezithambileyo; 

I-7, ukukhubazeka okubonakalayo (ukufuduka kunye nokunciphisa); 

8, ukwenzakala kwe-scaphoid.

Ukwenzakala okudibeneyo

I-1, idibaniswe nokulimala kwe-ipsilateral ephezulu;

2, Ukwenzakala egxalabeni elidadayo;

3, ukwenzakala izihlandlo ezininzi;

I-4, i-fracture idibene nokulimala kwe-neurovascular;

I-5, i-ipsilateral i-ipsilateral rib fractures edibeneyo kunye nokukhubazeka kodonga lwesifuba;

6, ukucutha kwe-clavicle ukwenza igxalaba elinamaphiko;

I-7, i-Bilateral clavicle fractures.

Imiba Yesigulane

I-1, Izigulane ezinokulimala okuphindaphindiweyo zifuna ubunzima bokuqala obuphezulu;

I-2, Izigulane ezifuna ukubuya ngokukhawuleza emsebenzini (umzekelo, i-elite kunye nemidlalo ekhuphisanayo).

Ixesha lotyando

Utyando kufuneka lwenziwe ngaphandle kokulibazisa xa kukho iimpawu ezicacileyo zotyando.

Ukulibaziseka kotyando ngaphaya kweeveki ezi-2-3 kwizibonakaliso ezihambelanayo kunokunyusa ubunzima bokunciphisa ukuphuka, ngakumbi xa ulungiselela ukunciphisa okuvaliweyo ukulungiswa kwangaphakathi ngobuchule be-percutaneous.

Ufikelelo ngotyando

Isigulana sibekwe kwindawo yesitulo elunxwemeni okanye kwindawo ehleli kancinci. Igxalaba elichaphazelekayo lifakwe phantsi ukuze liphakamise i-clavicle ukuze kube lula utyando, kwaye ingalo ihlanjululwe ukuze ivumele ukuhlanganiswa kwe-intraoperative. Ukusika okunqamlezayo ecaleni kwe-axis ende ye-clavicle okanye i-saber yokusika ehambelana nepateni yelanger inokukhethwa.

Qaphela: I-transverse incision inika ukwandiswa okukhulu, ngelixa i-longitudinal incision inciphisa umngcipheko wokulimala kwe-nerve ye-supraclavicular kwaye iyathandeka ngakumbi.

Ukulungiswa kwangaphakathi

3.5 Iiplati zokunyathela ezicwangcisiweyo, iiplate zokuvuselela, okanye iiplastiki ze-LCP zingasetyenziselwa ukulungisa i-clavicle fractures. Amacwecwe abekwe kakuhle phezulu okanye ngaphambili kwi-clavicle. Amacwecwe anamandla kukulimala kwe-biomechanical xa ebekwe phezulu, ngakumbi ukuba kukho i-fracture edibeneyo engezantsi, kwaye kulula ukuyibona. Ukulungiswa kwe-bicortical ye-screws kuyimfuneko, kwaye imingxuma kufuneka iqhutywe ngononophelo olukhulu, njengoko kukho umngcipheko wokulimala kwiimbilini kunye nemithambo yegazi engezantsi. Izinto eziluncedo: ukugrumba ngokukhuselekileyo kwetshaneli ye-screw plate yangaphambili, i-plate apposition, i-contouring elula.

Qaphela: Ukufakelwa kwethambo ngokuqhelekileyo akufuneki kwinkqubo yokuqala; emva kokulungiswa kwangaphakathi, kubalulekile ukuthunga ngokwaneleyo i-myofascial layer ukugubungela ipleyiti kunye nokuthintela usulelo.

Ukulungiswa kwe-Intramedullary

Izixhobo zangoku zokulungiswa kwe-intramedullary ziquka izikhonkwane ze-Kirschner, izikhonkwane ze-Rockwood, izikhonkwane ze-Hagie, i-titanium elastic intramedullary pins, izikhonkwane ezingenanto, kunye ne-elastic locking intramedullary pins; umz., izikhonkwane ze-titanium elastic azivumeli ukutshixa okumileyo, akuvumeli ukulawula ubude kunye nokujikeleza, kwaye kunokubangela ukunciphisa okwesibini xa kusetyenziselwa ukuphuka kwe-comminuted. I-intramedullary nailing technique ingasetyenziswa kuphela kwi-clavicle fractures elula, enqamlezayo okanye e-oblique.

Iingenelo

Ukusika okuncinci, ubuhle obuninzi, ukuhluthwa kwezicubu ezithambileyo kancinci, umngcipheko ophantsi we-endophyte protrusion, kunye nokuzinza okuhambelana nokwakheka kwebhula.

Iingxaki

ukucaphuka kwesikhumba okanye iziphene kwindawo yokungena.

Qaphela: Ukucuthwa okuvaliweyo kokwaphuka kwe-clavicle ngamanye amaxesha kunzima kwaye ukubonakaliswa okugqithisileyo kwesandla somqhubi kwimitha kuyathintelwa ngexesha lokwenziwa kotyando.

Ubuncinci bokulungiswa kwepleyiti

I-osteosynthesis yepleyiti encinci ye-clavicle icingelwa ukuba ibonelele amandla amakhulu e-biomechanical ngelixa unqanda izinto ezingalunganga zokulungiswa kwepleyiti evulekileyo okanye ukulungiswa kwe-intramedullary.

Ukubekwa kwe-Intraoperative ye-3.5 inkqubo ye-LCP yangaphambili kwi-clavicle, ngokukhethekileyo ngaphambili ngaphantsi kwe-clavicle, ivumela ukubhekisela kwi-clavicle enempilo, okwenza kube lula ukubumba ipleyiti kwangaphambili kunye nokufumana i-screw aperture ende.

Ukusetyenziswa kwangethuba kwe-osteosynthesis yepleyiti encinci ye-invasive plate inokunxulunyaniswa nokulimala kwe-nerve ye-supraclavicular, ukulungelelaniswa okungahambi kakuhle okanye ukunciphisa izibini zeengcingo ezichaphazela umsebenzi, kunye nokugoba kwepleyiti okanye ukwaphuka.

Ukulungiswa kweplate yeefractures ekupheleni kwecala le-clavicle

Ukukhethwa kokufakelwa kweplate kuxhomekeke kubukhulu bebhloko yethambo elisecaleni. Ubuncinci bezikrufu ezi-3 ze-bicortical ziyafuneka kwibhloko yethambo elisecaleni. Ngokufanelekileyo, izikrufu zoxinzelelo kufuneka zisetyenziswe kwi-oblique fractures. Ukuba ibhloko yethambo incinci kakhulu ukulungiswa, i-clavicle hook plate ingasetyenziswa.

Unyango lwe-acromioclavicular joint dislocation

Ukulimala ngokudibeneyo kwe-Acromioclavicular kwi-12% yokulimala kwebhanti ye-scapular kwaye kaninzi kwenzeka kwiimbaleki ezidibeneyo zoqhagamshelwano.

Eyona nkqubo isetyenziswa ngokuqhelekileyo yi-Rockwood staging. Uhlobo lwe-I luyi-sprain ye-acromioclavicular ligament kunye ne-rostroclavicular ligament intact; uhlobo lwe-II ukukrazula kwe-acromioclavicular ligament kunye ne-rostroclavicular ligament intact; uhlobo lwe-III lukrazula zombini i-acromioclavicular ligament kunye ne-rostroclavicular ligament; uhlobo lwe-IV luyi-posterior displacement ye-distal clavicle efaka i-trapezius; uhlobo lwe-V luyinyembezi epheleleyo zombini i-acromioclavicular joint kunye ne-rostroclavicular ligament, kunye neepesenti ezingaphezu kwe-100 yokufuduka komgudu; kunye nohlobo lokulimala kwe-VI lunqabile kakhulu, kunye ne-distal clavicle ehlanjululwayo phantsi kwenkqubo ye-rostral.

Ukunyangwa kwe-Conservative kunye ne-braking yexesha elifutshane kunye ne-cantilever sling kunconywa kuhlobo lwe-I kunye nokulimala kohlobo lwe-II. Ulawulo lokulimala kohlobo lwe-III luyimpikiswano, kunye nolunye uncwadi olubonisa ukuba unyango olulondolozayo luboniswa kubantu abadala abasebenzayo. Ukuchacha kokusebenza kulungile nangona kunokubakho amanqanaba ahlukeneyo okukhubazeka kwinkangeleko. Uhlobo lwe-IV - Ukulimala kwe-VI kunzima kakhulu kwaye ukungenelela ngokuhlinzwa kuyacetyiswa.

Okwangoku, iinkqubo zotyando ezisetyenziswa ngokuqhelekileyo zezi: I-Bosworth rostral yokutshixa i-screw technique kunye nokulungiswa kwenqanaba elinye okanye akukho ukulungiswa kwe-ligament;, ukulungiswa kweplate ye-clavicle hook, efana ne-lateral end of clavicle fracture; Ukulungiswa kwepleyiti yethebhu ye-Tightrope okanye i-anchor pinning suture ngokusebenzisa i-arthroscope okanye i-incision encinci; kunye ne-rostral locking ligament suture okanye ukumiswa okuqinisiweyo, kunye nezinto ezenziweyo okanye i-tendon phakathi kwe-rostral eminence kunye ne-clavicle.

Akucaci ukuba yeyiphi indlela yotyando enenzuzo ngakumbi, kwaye nangona kusenokubakho inqanaba elithile lelahleko yokuphinda kuvele umphezulu, ukuphumelela kokugqibela kwazo zonke ezi ndlela zobuchule kuyanelisa.

Unyango lwe-medial end clavicle fractures kunye ne-sternoclavicular joint dislocations

Olu konzakala lunqabile, kwaye kwakhona kukho ukungabikho kwezikhokelo zonyango ezisekelwe kubungqina beyeza.

Ukuqhekeka kwe-clavicle ye-Medical fractures kaninzi kukwaphulwa kwe-articular extra-articular kunye nokufuduka okungabalulekanga kwaye kunokunyangwa ngononophelo. I-epiphysis yesiphelo se-medial se-clavicle ngokuqhelekileyo ivala kwi-23-25 ​​yeminyaka ubudala kwaye i-epiphysis yokugqibela yokuvala emzimbeni. Ngoko ke, amaninzi amanxeba angaphakathi ngokwenene yi-epiphyseal plate fractures ye-Salter-Harris uhlobo lwe-I okanye lwe-II. I-X-rays eqhelekileyo inzima ukuyixilonga, ngenzuzo yokuba i-radiograph ye-40 ° yentloko ye-tilt kunye nokuthelekisa kwicala elinempilo inokubonakalisa ukufuduka kwesiphelo se-medial se-clavicle, kwaye i-CT inikezela ngeyona ndlela ingcono yokuxilonga.

Ukuqhekeka okanye ukuchithwa okufuduswa ngaphandle ngokuqhelekileyo kunokuvalwa kwaye kubekwe kwakhona, kodwa kaninzi azinzile kwaye i-lobotomized ukufuduswa kwakhona. Ukhathalelo lwePalliative luyacetyiswa kwi-slocation eqhubekayo okanye ukufuduswa kuba kaninzi akubangeli ukonakala kokusebenza. Ukuchithwa kwesiphelo esiphakathi kwe-clavicle ngasemva kunqabile ukuba kubangele ukulimala kwe-mediastinal ephezulu, kubandakanywa nokulimala kwe-vascular or even tracheal obstruction and compression airway. Ukutshatyalaliswa kunye nokuqhekeka apho i-fragment medial incinci kakhulu, iiplate zinokuthi ziboshwe kwi-joint for fixation to the sternum.

Ezinye iindlela zokulungisa

umzekelo, ukulungiswa kwangaphandle nge-stent, ukulungiswa kwangaphandle kunye ne-clavicle plate, njl.

Ulawulo lwasemva kotyando

Ingalo ephezulu kufuneka ingashukumi kwi-sling kunye nokuqeqeshwa kwe-pendulum yamagxa kufuneka kuqalwe ngokukhawuleza. Kwiiveki ezi-2 kamva, isigulane kufuneka silandelwe ukujonga isilonda kunye nokuphonononga i-X-rays, ngelixa i-forearm sling ingasuswa kwaye ukuqeqeshwa kokuhamba okuhlangeneyo okungathintelekiyo kunokuqaliswa, kodwa isigulane kufuneka sixelelwe ukuba singaphakamisi izisindo kunye nelungu elichaphazelekayo. Uqeqesho lwamandla lunokuqaliswa kwiiveki ze-6 emva kokusebenza xa iimpawu zokuphulukisa amathambo zibonakala. Ukuqhagamshelana nemidlalo okanye imidlalo enzima kufuneka igwenywe kwiinyanga ze-3 emva kokuhlinzwa de kube ukuphuka kuphuluke ngokupheleleyo.

Iingxaki.

Iingxaki zakwangoko

Usulelo lwenxeba emva kokuhlinzwa lunokwenzeka ukuya kuthi ga kwi-4.8% yamatyala;

I-numbness kwingingqi ye-subclavia iyona nto ixhaphake kakhulu, kunye nesifundo sembali yendalo ukuya kwi-83% yezigulane ezinolu phawu, olunciphisa ixesha elide kwaye alubangeli ukungasebenzi okubonakalayo, nangona kunokuqhubeka ukuya kwi-2 iminyaka emva kokusebenza;

I-Endophyte protrusion kunye nokuphazamiseka kwesikhumba, okuqhelekileyo kunye nokusetyenziswa kwamacwecwe e-voluminous okanye imisila yezikhonkwane ngaphandle kokugubungela kakuhle izicubu ezithambileyo;

ukuqhekeka kwakhona, okunokuthi kwenzeke emva kokubini unyango kunye nonyango olulondolozayo; Ukulimala kwakhona emva kokuhlinzwa kunokubangela ukugoba okanye ukuphulwa kwe-endoprosthesis, okanye i-fracture ejikeleze i-endoprosthesis;

i-nonunion, kunye ne-15% yezinga le-nonnunion kunye ne-conservative treatment kunye ne-2% ye-nonunion rate kunye nonyango lotyando lwe-diaphyseal fractures ngokupheleleyo; ukufuduswa okupheleleyo kokuqhekeka, ukunciphisa okukhulu kune-2 cm, ukutshaya, ukunyuka kweminyaka, ukulimala kwamandla aphezulu, ukuphuka kwakhona (ukungazinzi komatshini), ukuchithwa kwe-diaphyseal ye-recalcitrant, umgangatho ophantsi wamathambo, kunye nokulahleka kwethambo ngokugqithiseleyo.

Iingxaki zamva

I-osteoarthritis ye-joint acromioclavicular iyenzeka ngokuphindaphindiweyo kunye ne-intra-articular fractures (uhlobo lwe-Edinburgh 3B2); xa unyango lwe-symptomatic kunye ne-conservative lungasebenzi, i-distal clavicle inokuthi ifakwe kwi-arthroscopically okanye ngotyando oluvulekileyo;

Ukuphiliswa kokukhubazeka, okwenzeka kumaqondo ahlukeneyo kuzo zonke iifractures eziphathwa ngokukhuselekileyo; ukucuthwa kwebhanti ye-scapular ehamba kunye nokujikeleza kwebhloko ye-distal fracture kunokubangela ukunciphisa amandla amagxa kunye nokunyamezela, ngakumbi ekubanjweni kwegxalaba; ukucuthwa kwe-thoracic outlet kunokubangela iimpawu ze-brachial plexus compression; kunye nokungahambi kakuhle kwamalungu odonga lwe-scapulothoracic kunokubangela ukunyanzeliswa kwangaphambili kwe-scapula kwaye kuvelise intlungu yegxalaba kunye ne-myalgias, ukuba kuyacaca ukuba iimpawu zivela kwi-deformity Xa ukuphiliswa kwenzeka, ukulungiswa kwe-osteotomy kunye nokulungiswa kweplate kunokwenzeka ngokuxhomekeka kwiimfuno zesigulane.

Uqikelelo kunye nesiphumo

Uphononongo olunxulumeneyo eYurophu luchaze ukuba unyango lotyando lwezahlulo ze-midclavicular ezisusiweyo lwalusebenza, kwaye uhlalutyo lwe-meta lubonise ukuba iziganeko ze-malunion ezikhokelela ekuqhekekeni kwe-malunion kunye nokuvelisa impawu ze-malunion zaziphantsi kakhulu kwiqela lotyando kuneqela elinyangwa ngokukhuselekileyo xa utyando luthelekiswa nonyango olulondolozayo; ukongeza, iqela lotyando liye lanciphisa intlungu kwangethuba, kwaye ukuphuculwa kwe-Constant kunye ne-DASH amanqaku asebenzayo avakaliswa ngakumbi.

Shwankathela

Uninzi lwe-clavicle fractures lubangelwa ubundlobongela obuthe ngqo okanye obungathanga ngqo, kwaye unyango lunokwahlulwa njengonyango olulondolozayo okanye lotyando. Ngokonyango, nangona uninzi lwe-clavicle fractures ngaphandle kokufuduswa okubalulekileyo kunokunyangwa ngokucokisekileyo, ukhetho lonyango lotyando lokuqhekeka ngokufuduswa okubalulekileyo luyimpikiswano. Ukukhutshwa kwe-clavicle fractures, unyango lotyando lunezinga eliphezulu lokuphulukisa amathambo kunye neziphumo zokusebenza kwangaphambili xa kuthelekiswa nonyango olulondolozayo.

Iimbekiselo

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[2] Eiff, MP, Hatch, et al. I-Clavicle kunye ne-scapula fractures. Ku: Ulawulo lweFracture yoNyango oluPhambili, i-2nd ed, i-WB Saunders, i-Philadelphia 2002. p.198.

[3] Robinson CM. Ukuqhekeka kwe-clavicle kumntu omdala. I-Epidemiology kunye nokuhlelwa. J Bone Joint Surg Br 1998; 80:476.

[4] Neer CS 2nd. Ukuqhekeka kwe-distal yesithathu ye-clavicle. UClin Orthop Relat Res 1968; 58:43.

[5] Andersen K, Jensen PO, Lauritzen J. Unyango lwe-clavicular fractures. Umzobo-wesibhozo i-bandage ngokuchasene ne-sling elula. Acta Orthop Scand 1987; 58:71.

[6] Ersen A, Atalar AC, Birisik F, et al. Ukuthelekiswa kwe-sling yengalo elula kunye nomfanekiso we-bandage ye-clavicular esibhozo kwi-midshaft clavicular fractures: isifundo esilawulwa ngokungahleliwe. I-Bone Joint J 2015; 97-B:1562.