Ukuqhekeka kwe-Clavicular kubalwa u-2.6% wabo bonke abantu abadala abaqhekekile, kanti u-80% uvela esifundeni se-midshaft. Kusukela ekuqaleni kwawo-1990, inqubo yokuphatha egcinwe kahle ephakanyiswe yi-Neer ibilokhu ibhekwa njengokwelashwa kokuqala kokuqhekeka kwe-clavicular. Noma kunjalo, izifundo eziningi ziqinisekisile ukuthi ukwelashwa okungekona ukuhlinzwa kuvame ukwehluleka ukugcina ukwehla kokuqhekeka kwe-clavicular kwe-midshaft okushintshiwe kakhulu noma okugugile, okuholela ekufudukeni okuqhubekayo kanye nokufinyela okubi kakhulu, okuphakamisa kakhulu izingozi ze-malunion enezimpawu kanye nokungahlangani. Ngaphezu kwalokho, imibiko ikhombisile ukuthi iziguli eziphathwe ngaphandle kokuhlinzwa zihlushwa amandla aphansi ehlombe. Ngakho-ke, ukungenelela kokuhlinzwa kuthole ukuthandwa okwandayo kweziguli eziqhekekile kwe-clavicular eminyakeni yamuva nje, phakathi kwazo okwamukelwa kabanzi ukuncipha okuvulekile kanye nokulungiswa kwangaphakathi (ORIF) nge-plate fixation.

Kulezi ziqhekeko eziyinkimbinkimbi, udokotela ugxile enkambisweni yokuqinisa enwetshwe ngama-mini-plates. Lawa ma-plate asebenza ngendlela efanayo nezikulufo ezilahliwe kodwa anikeza ukusetshenziswa okulula. Ukubonwa ngesikhathi sokuhlinzwa nakho kubonise ukuzinza okuqinile, futhi imiphumela emihle yezokwelapha itholakale ngokusetshenziswa kwawo ekuqhekekeni kwe-patellar okuhlanganisiwe. Ngokusebenzisa ucwaningo oluqinisekisa ukuthi ukufakwa kwama-dual-plate kunikeza ukuzinza okwanele komshini, udokotela usebenziseoi-rthopedicminipsekwephuzileukubopha izingcezu ezincane zokuphuka engxenyeni eyinhloko yethambo, ukuguqula ngempumelelo amaphethini okuphuka ayinkimbinkimbi abe yizimo ezilula. Ukunciphisa okulandelayo kwezindawo zokuphuka kwenziwa lula, kulandelwe ukubekwa kwe-superioripuleti lokucindezelwa elikhiyayo(LCP). Ukuze kuncishiswe ukulimala kwe-periosteal, kwenziwa ukusikwa okuncane kakhulu ukuze kudalulwe izindawo zokufaka izikulufo, okwenze kwaba nokuqina okuhambisana nezimiso ze-minimally invasive plate osteosynthesis (MIPO).

Icala Lomtholampilo

Ukuhlolwa kokwakheka kokuphuka ngaphambi kokuhlinzwa kwenziwa kusetshenziswa amafilimu e-X ray kanye ne-CT scans eyakhiwe kabusha nge-3D. Isiguli sesilisa esineminyaka engu-22 ubudala satholakala sinokwaphuka kwe-clavicular midshaft kwesokudla okwenzeka ngesikhathi semidlalo. I-anteroposterior clavicular radiograph (a) kanye ne-apical oblique radiograph (b) kwaqinisekisa ukuthi ukwaphuka kwakungokwesigaba se-AO/OTA uhlobo lwe-15.2C (comminuted multifragmentary fracture). Izithombe ze-CT ezakhiwe kabusha ezinezinhlangothi ezintathu zesiguli zabonisa ukuboniswa kwe-stereoscopic kokuma kokuphuka kwendawo, okunikeza ubufakazi obunembile bokwakheka kokuhlelwa kwangaphambi kokuhlinzwa.

Isiguli sabekwa esihlalweni sasebhishi ngaphansi kwe-anesthesia ejwayelekile, ikhanda nentamo kuthambekele kude nohlangothi lokuhlinzwa. Ngemva kokuhlanza njalo kanye nokufaka indwangu ehlanzekile, yonke indawo ye-clavicle kanye nendawo yokuqhekeka kwaphawulwa ngophawu lokuhlinzwa ngaphansi kwesiqondiso se-fluoroscopic ngengalo ye-C. Ukusika okuphambeneyo okungaba ngu-5 cm ubude (okufana nobude bendawo yokuqhekeka) kwenziwa eceleni komugqa wokuqhekeka kwe-clavicular.Ipuleti le-Titanium Clavicle(2.0 mm encaneIpuleti le-Clavicle le-Orthopedic) kwasetshenziswa ukusiza ekunciphiseni ukuphuka.

Ipuleti le-Claviclezazisetshenziselwa ukuhlanganisa nokulungisa izingcezu zamathambo ezimise okwesikwele noma eziqhekekile ezingxenyeni eziyinhloko zokuphuka. Ngemva kokuguqula ukuphuka okuyinkimbinkimbi kube ukucushwa okulula ngokwemishini, ukuqinisa nge-superioripuleti lokukhiya lezokwelaphaKwenziwe i-clavicular LCP (uhlelo lwe-clavicular LCP oluyi-3.5 mm oluphezulu) lwabekwa ebusweni be-cortical obuphezulu be-clavicle futhi lwafakwa ngendlela ye-minimally invasive plate osteosynthesis (MIPO).

Isiguli sasigqoka i-sling ezinsukwini zokuqala eziyi-7 ngemva kokuhlinzwa ukuze kuncishiswe ukungakhululeki, kulandelwe ukuqala kokuzivocavoca okuhlukahlukene kokunyakaza. Emasontweni ayi-8 ngemva kokuhlinzwa, ukuqeqeshwa kokuqinisa imisipha kwaqalwa lapho ama-radiograph eqinisekisa ukuhlangana kwamathambo kanye nokuhlolwa kwezokwelapha kwembula ubuhlungu obuncane. Ukuhlolwa kwe-X-ray (umbono we-clavicular we-anteroposterior kanye nombono we-apical oblique clavicular) kwakutholwa ngokushesha ngemva kokuhlinzwa kanye nakuzo zonke izinkambo zokulandelela zesiguli sangaphandle.

Uma ufuna ukufunda kabanzi mayelana ne-Amapuleti Okukhiya E-Clavicle Yamathamboulwazi, sicela uzizwe ukhululekileXhumana nathi; ithimba lethu lizokunikeza ukwesekwa kochwepheshe kanye nezimpendulo.