Kuthyoka kwa Clavicle ndi chimodzi mwazomwe zimachitika kumtunda kwa miyendo kumtunda kwachipatala, ndi 82% ya clavicle fractures kukhala midshaft fractures.Ma fractures ambiri a clavicle popanda kusuntha kwakukulu amatha kuthandizidwa mosamala ndi mabandeji asanu ndi atatu, pomwe omwe ali ndi kusamuka kwakukulu, minofu yofewa, chiopsezo cha mitsempha kapena mitsempha ya mitsempha, kapena zofuna zapamwamba zogwirira ntchito zingafunike kukonza mkati ndi mbale.Mlingo wa Nonunion pambuyo pa kukonza mkati kwa clavicle fractures ndi otsika, pafupifupi 2.6%.Zizindikiro zosagwirizana nazo nthawi zambiri zimafunikira opaleshoni yokonzanso, ndipo njira yodziwika bwino ndiyo kuphatikizira mafupa pamodzi ndi kukonza mkati.Komabe, kuyang'anira ma atrophic nonunion mobwerezabwereza mwa odwala omwe adasinthidwa kale ndizovuta kwambiri ndipo kumakhalabe vuto kwa madokotala ndi odwala.
Pofuna kuthana ndi vutoli, pulofesa wina wa pachipatala cha Xi'an Red Cross anagwiritsa ntchito mwanzeru kumezanitsa fupa la autologous iliac pamodzi ndi kumezanitsa mafupa a autologous cancellous kuti athetserefractory fractures of clavicle fractures pambuyo pa opaleshoni yokonzanso yomwe inalephera, ndipo zotsatira zake zinali zabwino.Zotsatira za kafukufukuyu zidasindikizidwa mu nyuzipepala ya "International Orthopaedics".
Njira ya opaleshoni
Njira zopangira opaleshoni zitha kufotokozedwa mwachidule monga chithunzi pansipa:
a: Chotsani choyambirira cha clavicular fixation, chotsani fupa la sclerotic ndi chilonda cha fiber pamapeto osweka;
b: Zida zomangiranso pulasitiki za pulasitiki zidagwiritsidwa ntchito, zomangira zotsekera zidalowetsedwa mkati ndi kunja kwamkati kuti zisungidwe kukhazikika kwa clavicle, ndipo zomangira sizinakhazikike m'dera lomwe limayenera kuchitiridwa kumapeto kosweka kwa clavicle.
c: Pambuyo mbale fixation, kubowola mabowo ndi Kirschler singano pamodzi wosweka mapeto a fracture mkati ndi kunja mpaka dzenje ozed magazi (red tsabola chizindikiro), kusonyeza zabwino fupa magazi kuyenda pano;
d: Panthawiyi, pitirizani kubowola 5mm mkati ndi kunja, ndikubowola mabowo aatali kumbuyo, omwe amathandiza kuti osteotomy yotsatira;
e: Pambuyo pa osteotomy pabowo loyambirira, sunthani fupa lakumunsi la fupa pansi kuti musiye fupa;
f: Bicortical iliac bone inayikidwa mu fupa la fupa, ndiyeno pamwamba pa cortex, iliac crest ndi m'munsi mwa cortex anaikidwa ndi zomangira;The Iliac cancellous fupa analowetsedwa mu danga fracture
Chitsanzo
milandu:
▲ Wodwalayo anali mwamuna wazaka 42 yemwe ali ndi pakati pa chigawo chapakati cha clavicle yakumanzere chifukwa cha kuvulala (a);Pambuyo pa opaleshoni (b);Kuthyoka kosasunthika ndi mafupa osagwirizanitsa mkati mwa miyezi 8 pambuyo pa opaleshoni (c);Pambuyo pa kukonzanso koyamba (d);Kuphwanyidwa kwa mbale yachitsulo miyezi 7 mutatha kukonzanso ndi kusachiritsa (e);Kuthyokako kunachiritsidwa (h, i) pambuyo pa kulumikiza mafupa (f, g) a ilium cortex.
Mu phunziro la wolemba, chiwerengero cha 12 milandu ya refractory fupa nonunion inaphatikizidwa, zonse zomwe zinapindula machiritso a mafupa pambuyo pa opaleshoni, ndipo odwala a 2 anali ndi zovuta, 1 vuto la ng'ombe ya intermuscular thrombosis ndi 1 vuto la kupweteka kwa fupa la iliac.
Refractory clavicular nonunion ndi vuto lovuta kwambiri pazachipatala, zomwe zimabweretsa kulemedwa kwakukulu kwamalingaliro kwa odwala ndi madokotala.Njira imeneyi, kuphatikizapo structural fupa Ankalumikiza cortical fupa la ilium ndi cancellous fupa Ankalumikiza, akwaniritsa zotsatira zabwino fupa machiritso, ndi efficacy ndi yolondola, amene angagwiritsidwe ntchito monga kufotokoza kwa madokotala.
Nthawi yotumiza: Mar-23-2024
