Ukuxilongwa Nokwelashwa Kwama-Clavicle Fractures

Isingeniso

I-Clavicle fractures ijwayelekile futhi ngokuvamile ibangelwa ukuhlukumezeka okuqondile noma okungaqondile esifundeni sehlombe. Izifundo ekuqaleni kwawo-1960 zibike ukuthi izinga elingelona iqiniso le-clavicle fractures lalingaphansi kwe-1%, futhi ukwelashwa okulondolozayo kubangele ukwaneliseka okukhulu kwesiguli; ngokuthuthukiswa kwamuva kwemithi, ukwelashwa kokuhlinzwa kuye kwazuza ukusebenza kahle okukhulu; ngakho-ke, odokotela abasebenza emnyangweni wezimo eziphuthumayo noma umtholampilo jikelele wesiguli kufanele bajwayele ukubonakaliswa okuvamile kanye nezinkinga zalokhu kulimala kanye nokuphathwa kwayo okuyisisekelo.

I-Epidemiology

I-Clavicle fractures yenza u-2.6% -5% wabo bonke abantu abadala abaphukile [1,2]. Ucwaningo lwaseYurophu oluhlanganisa amacala e-1,000 e-clavicle alandelanayo athola ukuthi [3,4] ukuthi ngaphezu kwe-66% ye-clavicle fractures yenzeke phakathi kwe-1 / 3 ye-clavicle, cishe i-25% yayiyi-lateral 1 / 3 fractures, kanti i-3% yayiyi-1 / 3 fractures ephakathi. Izehlakalo zokuphuka kwe-clavicle zibonise ukusatshalaliswa kwe-bimodal, okwenzeka ikakhulukazi emadodeni angaphansi kweminyaka engu-30 ubudala, kulandelwa yilabo abaneminyaka engaphezu kwengu-70 ubudala.

I-Clinical Anatomy

Owokuqala wohlaka lwamathambo omuntu ukuqalisa i-ossification yi-clavicle, okuwukuphela kokuxhuma kwethambo phakathi kwengalo engenhla nesiqu, okuzwakala kude ne-acromion, i-acromioclavicular (AC) joint, futhi eduze ne-sternum, i-sternoclavicular (SC) joint. Lawa malungu abizwa ngokuthi ama-synovial atypical joints ngoba ahlanganiswe ne-fibrocartilage kune-hyaline cartilage. I-clavicle ifakwe ku-scapula nge-acromioclavicular kanye ne-rostroclavicular ligaments futhi ifakwe ku-sternum nge-sternoclavicular ligament.

I-clavicle inomumo othi 'S'. I-proximal half-arc iphrojekthi ngaphambili, ishiya isikhala senqwaba ye-neurovascular yomkhawulo ongaphezulu. Ingxenye ekude ye-arc iphrojekthi emuva (i-concave) bese ijoyina i-scapula (inqubo ye-rostral ne-acromion). Ukuphuka kwe-clavicle ngokuvamile kwenzeka lapho kuhlangana khona ama-arc amabili (maphakathi ne-arc), cishe ngenxa yokuntuleka kwemigqa enamathela emathanjeni angomakhelwane kulesi sifunda futhi ngenxa yokuthi iyingxenye ebuthakathaka ye-clavicle. Lapho i-clavicle fracture isuswa, ingxenye ye-proximal cishe njalo idonselwa phezulu (i-cephalad) yi-sternocleidomastoid muscle (enamathiselwe ekugcineni kwe-clavicle) futhi ingxenye e-distal isuswa phansi (caudad) ngesisindo sengalo engenhla, futhi i-clavicle ijwayele ukuhlukana, i-shooter ngayinye ngokuyinhloko ngenxa yokufinyela kwe-subscapularis kanye ne-pectoralis enkulu (okuyinto ejikeleza ngaphakathi ingalo engenhla). Lokhu kubangelwa ikakhulukazi ukufinyela kwemisipha emikhulu ye-subscapularis kanye ne-pectoralis (okuyinto ngaphakathi ezungeza ingalo engenhla futhi iyidonsele esifubeni).

Izici

Umgomo wokwelashwa kwe-clavicle fracture ukunciphisa ubuhlungu nokubuyisela ukusebenza okuhlangene. Iningi le-clavicle fracture lisaphathwa ngokuyinhloko ngokulondolozwa (ngokuvamile lifinyezwe ngokungekho ngaphezu kuka-15 mm); Ukwelashwa okuvamile okufana namabhandeshi ayisishiyagalombili, izihlilingi zengalo, amabhandeshi e-Sayre, amasudi e-Velpeau immobilization, kanye nokunganyakazi. Ukumiswa kokumiswa kwe-suspension kwenziwa esigabeni esibucayi, futhi ububanzi bokuqala bokuqeqeshwa kokunyakaza namandla okuzivocavoca ngokuvamile kwenziwa amasonto angu-2-6 ngemva kokuphuka lapho ubuhlungu buxazulula. Ukusetshenziswa kwesibalo samabhandeshi e-8 akunconywa njengoba kungaholela ezilonda ze-axillary kanye nokunye okungeyona inyunyana yokuphuka [5,6].

Umlando Nokuhlolwa Komzimba

Ukuphuka kwe-Clavicle kubangelwa umthelela oqondile ehlombe ngemva kokuwa futhi ngokuvamile kubonakala emidlalweni yangaphandle kwabancane kanye nokuwa okungaqondile kubantu asebekhulile. Kubalulekile ukuchaza indlela yokulimala. Ukulimala okunamandla amakhulu kungase kuhlanganiswe nokulimala kwekhanda nesifuba, kanti ukuphuka okubangelwa ukuhlukumezeka okuncane kungase kube yi-pathologic. Ukulimala kokuphazamiseka kudinga ukuqaliswa kusenesikhathi kanye nokukhishwa ngokucophelela kokuhlukaniswa kodonga lwesifuba se-scapular, ukulimala kwe-neurologic kanye nemithambo yegazi. Ngokomtholampilo, kukhona ukuvuvukala kanye ne-ecchymosis endaweni yokuphuka, kuhlangene nokukhubazeka nokuzwela. Kufanele kuqashelwe izicubu ezithambile ukuze kukhishwe i-jack up, okungase kubangele i-necrosis yesikhumba kanye nezilonda.

Ukufanekisa

Ama-fracture amaningi angatholakala ngama-radiographs alula we-anteroposterior. Ama-radiographs angama-20° ekhanda enyakazisa ikhanda asusa umthelela wemigodi yethoracic eyeqayo. Iziguli kufanele zenziwe nge-radiograph endaweni yokuzisekela ukuze zikubone ngeso lengqondo ukususwa kokuphuka. Ukuthwala isisindo sama-radiographs kuyasiza ekuhloleni ubuqotho be-rostral clavicular ligament ku-distal clavicle noma ukulimala okuhlangene kwe-acromioclavicular.CT isiza ukubona ngeso lengqondo ukulimala okuyinkimbinkimbi kwebhande le-scapular futhi inikeza ukubonwa okungcono kokulimala okungenzeka okuseduze kwe-clavicle ekuhlanganyeleni kwe-sternoclavicular. Ukuthatha i-radiograph yesifuba kusiza ukukhipha ukulimala okuhlobene ne-thoracic, futhi ukunciphisa kungahlolwa ngokuqhathanisa ne-clavicle ye-contralateral, kanye nokukhipha ukuhlukaniswa kodonga lwe-scapulothoracic.

Izinhlobo

I-AO/OTA Fracture Dislocation Typing: Ikhodi ye-clavicle fracture 15 iqukethe amasayithi amathathu: 15.1 proximal (medial), 15.2 diaphysis, kanye ne-15.3 distal (lateral). Ukuhlukana okuseduze (okumaphakathi) kanye ne-distal (lateral) kuhlukaniswa njengohlobo A (i-extra-articular), uhlobo B (ingxenye ye-intra-articular), kanye nohlobo C (i-intra-articular ngokuphelele). Ukuphuka kwe-trunk kuhlukaniswa njengohlobo A (olulula), uhlobo lwe-B (wedge), kanye nohlobo C (olukhululiwe). Isigaba se-AO/OTA sokuphuka nokuhlakazeka akunaki izinga lokususwa kokuphuka, futhi okwamanje kusetshenziswa okulinganiselwe ekwelapheni ukuphuka kwe-clavicle nasekunqumeni ukubikezelwa.

Ukuthayipha kwe-Allman kusekelwe endaweni yokuphuka (I: medial, cadent 1/3, II: lateral 1/3, III: medial 1/3) (Fig. 7.2.1).

U-Craig ulungise lesi sigaba futhi ngesisekelo sika-Allman, mina ngiphakathi kwe-1/3 ye-clavicle; uhlobo lwe-II oluyi-1/3 yangaphandle ye-clavicle, eyabe ihlukaniswa yaba izinhlobo ezi-5 ngokusekelwe ekuthuthweni kwe-fracture kanye nobudlelwane ne-rostral clavicular ligament; kanye nohlobo lwe-III oluwukuphuka kwe-1/3 yangaphakathi ye-clavicle, eyahlukaniswa yaba izinhlobo ezingu-5 ngokusekelwe kwizinga lokususwa kwe-fracture kanye noma ngabe ukuphuka kwakungaphakathi kwe-intra-articular.

Ukuthayipha kwe-Neer kwe-lateral 1/3 fractures kugcizelela ukubaluleka kwe-rostral-clavicular ligament: uhlobo lwe-I lwenzeka kude ne-rostral-clavicular ligament, ne-medial fracture block isuswa phezulu; uhlobo lwe-II luhilela i-rostral-clavicular ligament futhi kubangele ukuthi i-medial fracture block isuswe endaweni ephakeme; futhi uhlobo lwe-III ludlulela ekuhlanganyeleni kwe-acromioclavicular ne-rostral-clavicular ligament esele iqinile.

Ukuthayipha kwe-Edinburgh kuyisimiso sokuhlukaniswa kwe-diaphysis fractures ngokusho kwezinga lokufuduka kanye nokuhamba.1 Uhlobo lwe-1 fractures luhilela ukuphela kwe-medial, uhlobo lwe-2 luyi-diaphysis fractures futhi uhlobo lwe-3 luyi-lateral end fractures. Ukuphuka kwe-diaphysis kuhlukaniswa ngokuya ngokuba khona noma ukungabikho kokuxhumana kwe-cortical phakathi kwezingcezu zokuphuka zibe izinhlobo A no-B. Uhlobo lwe-2A fractures luphinde lubekwe njenge-nondisplaced (uhlobo lwe-2A1) kanye ne-angulated (uhlobo 2A2), ukuphuka kwe-2B kuhlukaniswa njengokulula noma okumise okwe-wedge (uhlobo lwe-2B1) oluhlanganisiwe (uhlobo 2B1). ukuphuka kuhilela ukuphela okuphakathi kwe-diaphysis kanye nohlobo lwe-3 ukuphela kwe-lateral ye-diaphysis. Ukuhlukana kokuphela kwe-medial ne-lateral kuhlukaniswe ngamaqembu amancane we-1 no-2 ngokuya ngokuthi i-joint eseduze iyabandakanyeka yini.

Ngokufanayo kukhona ukuthayipha kwe-Rockwood, ukuthayipha kwe-Jager, nokuthayipha kwe-Breitner.

Izinkomba zokuhlinzwa

Ukuphuka okuqondile

1, ukuphuka okuvulekile; 

2, ukufuduka > 2 cm; 

3, ukufinyeza > 2 cm; 

4, ukukhishwa kwezingcezu zokuphuka (>3); 

5, ukuphuka kwezingxenye eziningi; 

6, ukuphuka okuvulekile okungaphansi nokulimala kwezicubu ezithambile; 

7, ukukhubazeka okuphawulekayo (ukufuduka kanye nokunciphisa); 

8, ukulimala kwe-scaphoid.

Ukulimala okuhlangene

I-1, Ukulimala okuhlangene kwe-ipsilateral upper extremity;

2, Ukulimala kwehlombe elintantayo;

3, ukulimala okuningi;

4, ukuphuka kuhlangene nokulimala kwe-neurovascular;

I-5, i-ipsilateral multiple rib fractures ehlanganiswe nokukhubazeka kodonga lwesifuba;

6, ukufinyeza kwe-clavicle ukwakha ihlombe elinamaphiko;

I-7, i-Bilateral clavicle fractures.

Izici Zesiguli

I-1, Iziguli ezinokulimala okuningi zidinga isisindo sokuqala esiphezulu esiphezulu;

2, Iziguli ezidinga ukubuyela ngokushesha emsebenzini (isb, imidlalo ye-elite neyokuncintisana).

Isikhathi sokuhlinzwa

Ukuhlinzwa kufanele kwenziwe ngaphandle kokulibala lapho izinkomba eziphelele zokuhlinzwa zikhona.

Ukubambezeleka kokuhlinzwa okungaphezu kwamaviki angu-2-3 ezinkomba ezihambisanayo kungase kwandise ubunzima bokunciphisa ukuphuka, ikakhulukazi lapho kulungiselelwa ukunciphisa okuvaliwe ukulungiswa kwangaphakathi ngamasu e-percutaneous.

Ukufinyelela ngokuhlinzwa

Isiguli sibekwe endaweni yesihlalo solwandle noma indawo yokuhlala kancane. Ihlombe elithintekile ligoqwe ngaphansi ukuze liphakamise i-clavicle ukuze kube lula ukuhlinzwa, futhi ingalo idonswe ithawula ukuze ivumele ukuhlanganiswa kwe-intraoperative. Ukusika okuphambene ku-eksisi ende ye-clavicle noma i-saber incision ehambisana nephethini ye-langer kungase kukhethwe.

Qaphela: Ukusika okuphambene kunikeza ukunwetshwa okukhulu, kuyilapho ukusika i-longitudinal kunciphisa ubungozi bokulimala kwenzwa ye-supraclavicular futhi kujabulisa kakhulu ngobuhle.

Ukulungiswa Kwangaphakathi

3.5 Amapuleti okucindezela ahlelekile, amapuleti okwakha kabusha, noma amapulasitiki e-LCP angasetshenziswa ukulungisa ukuphuka kwe-clavicle. Amapuleti abekwe kahle ngenhla noma ngaphambili ku-clavicle. Amapuleti anamandla ekulimaleni kwe-biomechanical uma ebekwe phezulu, ikakhulukazi uma kukhona ukuphuka okungapheli ngezansi, futhi kulula ukukubona ngeso lengqondo. Ukulungiswa kwe-bicortical of screws kuyadingeka, futhi imigodi kufanele ibhojwe ngokucophelela, njengoba kunengozi yokulimala emithanjeni nasemithanjeni yegazi ngezansi. Izinzuzo: ukubhoboza okuphephile kwesiteshi sesikulufu sepuleti yangaphambili, i-apposition yepuleti, ukukhonta okulula.

Qaphela: Ukuxhunyelelwa kwethambo ngokuvamile akudingekile ngenqubo yokuqala; ngemva kokulungiswa kwangaphakathi, kubalulekile ukuthunga ngokwanele ungqimba lwe-myofascial ukumboza ipuleti nokuvimbela ukutheleleka.

Ukulungiswa kwe-Intramedullary

Imishini yamanje yokulungisa i-intramedullary ihlanganisa izikhonkwane ze-Kirschner, izikhonkwane ze-Rockwood, izikhonkwane ze-Hagie, izikhonkwane ze-titanium elastic intramedullary, izikulufu ezingenalutho, nezikhonkwane zokuvala ezinwebekayo ze-intramedullary; isb, izinzipho ezinwebekayo ze-titanium azikuvumeli ukukhiya okumile, azikuvumeli ukulawula ubude nokuzungezisa, futhi kungase kubangele ukufushaniswa kwesibili lapho kusetshenziselwa ukuphuka okuncishisiwe. I-intramedullary nailing technique ingasetshenziswa kuphela ekuqhekekeni kwe-clavicle elula, eguquguqukayo noma e-oblique.

Izinzuzo

ukusika okuncane, ubuhle obuningi, ukukhumula izicubu ezithambile kancane, ingozi ephansi yokuphuma kwe-endophyte, nokuzinza okuhambisana nokwakheka kotwayi.

Ukubi

ukucasuka kwesikhumba noma amaphutha endaweni yokungena.

Qaphela: Ukwehliswa okuvaliwe kokuphuka kwe-clavicle ngezinye izikhathi kunzima futhi ukuchayeka ngokweqile kwesandla somsebenzisi emisebeni kuyagwenywa ngesikhathi sokuhlinzwa.

Ukulungiswa kwamapuleti okuhlaselayo okuncane

I-plate osteosynthesis ye-clavicle ehlasela kancane kucatshangwa ukuthi inikeza amandla amakhulu e-biomechanical kuyilapho igwema ububi bokulungiswa kwepuleti elivulekile noma ukulungiswa kwe-intramedullary.

Ukubekwa kwangaphakathi kokuhlinzwa kwesistimu ye-LCP engu-3.5 ngaphambili kuya ku-clavicle, okungcono kakhulu ngaphambili ngaphansi kwe-clavicle, kuvumela ireferensi ye-clavicle enempilo, okwenza kube lula ukulolonga ipuleti kusengaphambili kanye nokuthola indawo yokuvula isikulufu eside.

Ukufakwa kusenesikhathi kwe-osteosynthesis yepuleti elingangeneleli kancane kungase kuhlotshaniswe nokulimala kwenzwa ye-supraclavicular, ukuqondanisa kabi noma ukufinyezwa kwamapheya ezintambo ezithinta ukusebenza, nokugoba kwepuleti noma ukuphuka.

Ukulungiswa kwepuleti lokuqhekeka kokuphela kwe-lateral ye-clavicle

Ukukhethwa kokufakwa kwepuleti kuncike kusayizi we-lateral bone block. Kudingeka ubuncane bezikulufi ezi-bicortical ezi-3 kubhulokhi yamathambo engemuva. Ngokufanelekile, izikulufa zokungezwani kufanele zisetshenziselwe ukuphuka kwe-oblique. Uma i-bone block incane kakhulu ukuthi ingalungiswa, i-clavicle hook plate ingasetshenziswa.

Ukwelashwa kwe-acromioclavicular joint dislocation

Ukulimala okuhlangene kwe-Acromioclavicular kubala i-12% yokulimala kwebhande le-scapular futhi kuvame ukwenzeka kubasubathi abagcwele ukuxhumana.

Uhlelo lwesiteji olusetshenziswa kakhulu yisiteji se-Rockwood. Uhlobo I luyi-sprain ye-acromioclavicular ligament ene-rostroclavicular ligament iqinile; uhlobo II ukudabuka komsipha we-acromioclavicular ne-rostroclavicular ligament iqinile; uhlobo lwe-III ukudabuka kwakho kokubili i-acromioclavicular ligament kanye ne-rostroclavicular ligament; uhlobo lwe-IV luyi-posterior displacement ye-distal clavicle efaka i-trapezius; uhlobo lwe-V ukudabuka okuphelele kokubili kwe-acromioclavicular joint kanye ne-rostroclavicular ligament, okungaphezu kwamaphesenti angu-100 okuhamba kwelunga; kanye nokulimala kohlobo lwe-VI akuvamile kakhulu, kanti i-distal clavicle ihanjiswe phansi ngaphansi kwenqubo ye-rostral.

Ukwelashwa okulondolozayo nge-braking yesikhashana nge-cantilever sling kunconywa ngokulimala kohlobo I kanye nohlobo lwe-II. Ukuphathwa kokulimala kohlobo lwe-III kuyimpikiswano, kanti ezinye izincwadi ziphakamisa ukuthi ukwelashwa okulondolozayo kuboniswa kubantu abadala abakhuthele. Ukululama kokusebenza kuhle nakuba kungase kube namazinga ahlukahlukene okukhubazeka ekubukekeni. Uhlobo lwe-IV - VI ukulimala kunzima kakhulu futhi ukungenelela kokuhlinzwa kunconywa.

Njengamanje, izinqubo zokuhlinza ezivame ukusetshenziswa yilezi: Inqubo ye-screw yokukhiya i-Bosworth rostral ngokulungiswa kwesiteji esisodwa noma ukungalungiswa kwe-ligament;, ukulungiswa kwepuleti le-clavicle hook, okufana nokuphela kwe-lateral kwe-clavicle fracture; Ukulungiswa kwepuleti lethebhu ye-Tightrope noma i-anchor pinning suture nge-arthroscope noma i-incision encane; kanye ne-rostral locking ligament suture noma ukumiswa okuqinisiwe, okunezinto zokwenziwa noma i-tendon phakathi kwe-rostral eminence kanye ne-clavicle.

Akucaci ukuthi iyiphi indlela yokuhlinza enenzuzo enkulu, futhi nakuba kungase kube nezinga elithile lokulahlekelwa ukuvela kabusha, ukuphumelela kokugcina kwazo zonke lezi zindlela kuyanelisa.

Ukwelashwa kwe-medial end clavicle fractures kanye ne-sternoclavicular joint dislocations

Lokhu kulimala akuvamile, futhi futhi kukhona ukuntuleka kwemikhombandlela yokwelapha esekelwe emuthini osekelwe ebufakazini.

Ukuphuka kwe-clavicle emaphakathi kuvame ukuphuka okungaphezulu kwe-articular ngokususwa okungabalulekile futhi kungelashwa ngendlela elondolozayo. I-epiphysis yokuphela kwe-medial ye-clavicle ngokuvamile ivala eminyakeni engu-23-25 ​​futhi iyi-epiphysis yokugcina ukuvala emzimbeni. Ngakho-ke, ukulimala okuningi okuphakathi empeleni kuyi-epiphyseal plate fractures yohlobo lwe-Salter-Harris I noma II. I-X-ray evamile inzima ukuyixilonga, ngenzuzo yokuthi i-radiograph yekhanda elinyakazayo elingu-40 ° kanye nokuqhathaniswa nohlangothi olunempilo kungase kuveze ukugudluka kokuphela kwe-clavicle emaphakathi, futhi i-CT inikeza isithombe esihle kakhulu sokuxilonga.

Ukuphuka noma ukugudluzwa okugudluzwa ngaphambili kuvame ukuvalwa futhi kubekwe kabusha, kodwa ngokuvamile akuzinzile futhi kufakwe ama-lobotomized ukuze kuthuthwe kabusha. Ukunakekelwa kwe-Palliative kuyanconywa ngokususwa okuqhubekayo noma ukususwa ngoba ngokuvamile akubangeli ukonakala kokusebenza. Ukususwa komkhawulo omaphakathi we-clavicle ngemuva akuvamile ukuphumela ekulimaleni okuphezulu kwe-mediastinal, okuhlanganisa ukulimala kwemithambo noma ngisho nokuvinjwa koqhoqho kanye nokucindezelwa kwendlela yomoya. Ngokususwa kanye nokuphuka lapho ucezu oluphakathi luncane kakhulu, amapuleti angakwazi ukuboshwa ngaphesheya kwejoyinti ukuze alungiswe ku-sternum.

Ezinye izindlela zokulungisa

isib. ukulungiswa kwangaphandle nge-stent, ukulungiswa kwangaphandle nge-clavicle plate, njll.

Ukuphathwa kwangemva kokuhlinzwa

Ingalo engenhla kufanele inganyakazi ku-sling kanye nokuqeqeshwa kwe-pendulum yehlombe kufanele kuqalwe ngokushesha. Emasontweni angu-2 kamuva, isiguli kufanele silandelwe ukuze kuhlolwe isilonda futhi sibuyekeze ama-X-ray, kuyilapho isihlilingi se-forearm singasuswa futhi kuqaliswe ukuqeqeshwa kokuhamba okuhlangene okungavinjelwe, kodwa isiguli kufanele sitshelwe ukuthi singaphakamisi izinsimbi ngesitho esithintekile. Ukuqeqeshwa kwamandla kungaqalwa emavikini angu-6 ngemva kokuhlinzwa lapho kuvela izimpawu zokuphola kwamathambo. Imidlalo yokuxhumana noma imidlalo eyingozi kufanele igwenywe izinyanga ezingu-3 ngemuva kokuhlinzwa kuze kube yilapho ukuphuka sekuphuluke ngokuphelele.

Izinkinga.

Izinkinga zakuqala

Ukutheleleka kwesilonda kwangemva kokuhlinzwa kungenzeka ku-4.8% wamacala;

I-numbness esifundeni se-subclavia iyinkimbinkimbi evamile kakhulu, ngocwaningo lomlando wemvelo olufinyelela ku-83% weziguli ezinalesi sibonakaliso, esinciphisa ngokuhamba kwesikhathi futhi singabangeli ukungasebenzi okuphawulekayo, nakuba kungase kuqhubeke kuze kube yiminyaka engu-2 emva kokuhlinzwa;

I-Endophyte protrusion kanye nokuyaluza kwesikhumba, okuvamile nokusetshenziswa kwamapuleti agqamile noma imisila yezinzipho ngaphandle kokumbozwa kahle kwezicubu ezithambile;

ukuphuka kabusha, okungenzeka ngemva kokubili kokuhlinzwa nokwelashwa okulondolozayo; ukulimala kabusha ngemva kokuhlinzwa kungase kubangele ukugoba noma ukuphuka kwe-endoprosthesis, noma ukuphuka eduze kwe-endoprosthesis;

i-nonnunion, enezinga le-15% elingelona i-nonunion elinokwelashwa okulondolozayo kanye nesilinganiso esingu-2% esingahlangene nokwelashwa okuhlinzayo kokuphulwa ngokuphelele kwe-diaphyseal fractures; ukususwa okuphelele kokuphuka, ukufinyeza okukhulu kune-2 cm, ukubhema, iminyaka ekhulayo, ukulimala kwamandla aphezulu, ukuphuka kabusha (ukungazinzi komshini), ukuhlukaniswa kwe-diaphyseal recalcitrant, ikhwalithi ephansi yamathambo, nokulahlekelwa kwamathambo ngokweqile.

Izinkinga ezingemuva kwesikhathi

I-osteoarthritis ye-joint acromioclavicular ivela kaningi ngokuphuka kwe-intra-articular (uhlobo lwe-Edinburgh 3B2); lapho ukwelashwa okuphawulekayo nokulondoloza kungasebenzi, i-distal clavicle ingase ikhishwe nge-arthroscopically noma ngokuhlinzwa okuvulekile;

Ukuphulukiswa kokukhubazeka, okwenzeka ngamazinga ahlukahlukene kuzo zonke izithonjana ezilashwa ngendlela ephephile; ukufinyezwa kwebhande le-scapular elihambisana nokujikeleza kwe-distal fracture block kungase kubangele ukwehla kwamandla okugcina amahlombe nokukhuthazela, ikakhulukazi ekuthunjweni kwehlombe; ukuncipha kwe-thoracic outlet kungase kubangele izimpawu zokucindezelwa kwe-brachial plexus; kanye nokungahambi kahle kwamalunga odonga lwe-scapulothoracic kungabangela ukutsheka kwangaphambili kwe-scapula futhi kukhiqize ubuhlungu behlombe kanye ne-myalgias, uma kucacile ukuthi izimpawu zivela ekukhubazekeni Lapho ukuphulukiswa kwenzeka, ukulungiswa kwe-osteotomy kanye nokulungiswa kwepuleti kungenzeka kuye ngezidingo zesiguli.

Isibikezelo kanye nomphumela

Ucwaningo oluhlobene eYurophu lubike ukuthi ukwelashwa kokuhlinzwa kwe-midclavicular fractures esusiwe kwasebenza kahle, futhi ukuhlaziywa kwayo kwe-meta kubonise ukuthi isigameko se-malunion esiholela ekuqhekekeni kwe-malunion kanye ne-malunion ekhiqiza izimpawu yayiphansi kakhulu eqenjini elihlinzayo kuneqembu eliphathwa ngendlela elondolozayo lapho ukuhlinzwa kuqhathaniswa nokwelashwa okulondolozayo; ngaphezu kwalokho, iqembu elihlinzayo liye lanciphisa ubuhlungu kusenesikhathi, futhi ukuthuthukiswa kwezikolo ezisebenzayo ze-Constant kanye ne-DASH kwakuzwakala kakhulu.

Fingqa

Iningi le-clavicle fracture libangelwa udlame oluqondile noma olungaqondile, futhi ukwelashwa kungahlukaniswa njengokwelashwa okulondolozayo noma okuhlinzayo. Mayelana nokwelashwa, nakuba iningi le-clavicle fractures ngaphandle kokususwa okuphawulekayo lingelashwa ngendlela efanele, inketho yokwelashwa yokuhlinzwa yokuphuka ngokususwa okuphawulekayo kuyimpikiswano. Ngokuhlukana kwe-clavicle esusiwe, ukwelashwa kokuhlinzwa kunezinga eliphezulu lokuphulukiswa kwamathambo kanye nemiphumela yokuqala yokusebenza uma kuqhathaniswa nokwelashwa okulondolozayo.

Izithenjwa

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[2] Eiff, MP, Hatch, et al. I-Clavicle ne-scapula fractures. Ku: Ukuphathwa Kwe-Fracture for Primary Care, 2nd ed, WB Saunders, Philadelphia 2002. p.198.

[3] Robinson CM. Ukuphuka kwe-clavicle kumuntu omdala. I-Epidemiology kanye nezigaba. J Bone Joint Surg Br 1998; 80:476.

[4] Neer CS 2nd. Ukuphuka kwe-distal third ye-clavicle. I-Clin Orthop Relat Res 1968; 58:43.

[5] Andersen K, Jensen PO, Lauritzen J. Ukwelashwa kwe-clavicular fractures. Ibhandeshi elingumfanekiso-kwesishiyagalombili liqhathaniswa nendwayimane elula. Acta Orthop Scand 1987; 58:71.

[6] Ersen A, Atalar AC, Birisik F, et al. Ukuqhathaniswa kwe-sling yengalo elula kanye nenani le-bandage eyisishiyagalombili ye-clavicular ye-midshaft clavicular fractures: isifundo esilawulwa ngokungahleliwe. I-Bone Joint J 2015; 97-B:1562.