[Ortho] Ортопедический квест: «допустимое» смещение отломков ключицы

[Alexander Chelnokov]

Dear п⌠п╣п╬я─пЁп╦п╧ п╗п╬я┌п╟п╡п╦я┤,

Tuesday, August 21, 2007, 11:51:45 PM, you wrote:

п⌠п⌠п╗> п╟п╢п╪п╦п╫п╦я│я┌я─п╟я┌п╦п╡п╫п╬-п╨п╩п╦п╫п╦я┤п╣я│п╨п╟я▐ п╢п╦я│п╨я┐я│я│п╦я▐ п©п╬ п©п╬п╡п╬п╢я┐ я─п╣п╥я┐п╩я▄я┌п╟я┌п╬п╡ п╩п╣я┤п╣п╫п╦я▐
п⌠п⌠п╗> п©п╣я─п╣п╩п╬п╪п╟ п╨п╩я▌я┤п╦я├я▀ п╡ п╬п╢п╫п╬п╪ п╦п╥ я┌я─п╟п╡п╪п╟я┌п╬п╩п╬пЁп╦я┤п╣я│п╨п╦я┘ п╬я┌п╢п╣п╩п╣п╫п╦п╧.

п░ п╫п╣п╩я▄п╥я▐ п╩п╦ п©я─п╦п©п╬п╢п╫я▐я┌я▄ п╥п╟п╡п╣я│я┐ - я┤я┌п╬ п©п╬я│п╩я┐п╤п╦п╩п╬ 1)п©я─п╦я┤п╦п╫п╬п╧ п╦ 2)п©п╬п╡п╬п╢п╬п╪
я█я┌п╬п╧ п╢п╦я│п╨я┐я│я│п╦п╦? п║я┌я─п╟я┘п╬п╡п╟я▐ п╨п╬п╪п©п╟п╫п╦я▐ п╡я▀я│п╨п╟п╥п╟п╩п╟ п╫п╣п╢п╬я┐п╪п╣п╫п╦п╣? п≤п╩п╦ п©п╟я├п╦п╣п╫я┌
п©п╬п╤п╟п╩п╬п╡п╟п╩я│я▐?

п⌠п⌠п╗> п╡я▀п©п╬п╩п╫п╣п╫п╦я▐ п╫п╬п╡п╬п╨п╟п╦п╫п╬п╡п╬п╧ п╠п╩п╬п╨п╟п╢я▀ п╢п╣п╤я┐я─п╫п╬п╧ п╠я─п╦пЁп╟п╢п╬п╧ п╡я▀п©п╬п╩п╫п╣п╫п╟ п╥п╟п╨я─я▀я┌п╟я▐
п⌠п⌠п╗> я─п╣п©п╬п╥п╦я├п╦я▐, п╫п╟п╩п╬п╤п╣п╫я▀ п╨п╬п╩я▄я├п╟ п■п╣п╩я▄п╠п╣. п═п╣п╥я┐п╩я▄я┌п╟я┌я▀ я─п╣п©п╬п╥п╦я├п╦п╦ п©п╬п╨п╟п╥п╟п╫я▀ п╫п╟

п÷п╬я┤п╣п╪я┐ п©п╟я├п╦п╣п╫я┌ п╬п╨п╟п╥п╟п╩я│я▐ п╡ п©я─п╦п╣п╪п╫п╬п╪ п©п╬п╨п╬п╣, п╟ п╫п╣ п╡ я┌я─п╟п╡п╪п©я┐п╫п╨я┌п╣?

п⌠п⌠п╗> п÷п╟я├п╦п╣п╫я┌ пЁп╬я│п©п╦я┌п╟п╩п╦п╥п╦я─п╬п╡п╟п╫ п╡ я┌я─п╟п╡п╪п╟я┌п╬п╩п╬пЁп╦я┤п╣я│п╨п╬п╣ п╬я┌п╢п╣п╩п╣п╫п╦п╣,

п≈п╟я┤п╣п╪? п≤п╩п╦ п©п╬п╡я─п╣п╤п╢п╣п╫п╦я▐ п╫п╣ п╦я│я┤п╣я─п©я▀п╡п╟п╩п╦я│я▄ п╦п╥п╬п╩п╦я─п╬п╡п╟п╫п╫я▀п╪ п©п╣я─п╣п╩п╬п╪п╬п╪
п╨п╩я▌я┤п╦я├я▀?

п⌠п⌠п╗>  пЁп╢п╣ п╡ я┌п╣я┤п╣п╫п╦п╣ 6 п╢п╫п╣п╧ п©я─п╬п╡п╬п╢п╦п╩п╬я│я▄ Lп╫п╟п╠п╩я▌п╢п╣п╫п╦п╣б╕ п╥п╟ я│п╬я│я┌п╬я▐п╫п╦п╣п╪
п⌠п⌠п╗> п╨п╬п╩п╣я├ п■п╣п╩я▄п╠п╣ п╦ я│п╢п╣п╩п╟п╫п╟ п╬п╢п╫п╬п╨я─п╟я┌п╫п╟я▐ п©п╬п©я▀я┌п╨п╟ Lп╦п╥п╪п╣п╫п╣п╫п╦я▐ п©п╬п╩п╬п╤п╣п╫п╦я▐

п▒п╣я│я│п╪я▀я│п╩п╣п╫п╫п╟я▐ п╪п╟п╫п╦п©я┐п╩я▐я├п╦я▐.

п⌠п⌠п╗> п²п╟ 7-п╣ я│я┐я┌п╨п╦ п╡я▀п©п╦я│п╟п╫ п╦п╥ я│я┌п╟я├п╦п╬п╫п╟я─п╟ я│ я─п╣п╨п╬п╪п╣п╫п╢п╟я├п╦п╣п╧ п╩п╣я┤п╣п╫п╦я▐ п╡ я┐я│п╩п╬п╡п╦я▐я┘

п≈п╢я─п╟п╡я▀п╧ я│п╪я▀я│п╩ п╡я│п╣-я┌п╟п╨п╦ п╡п╬п╥п╬п╠п╩п╟п╢п╟п╩ ;-)

п⌠п⌠п╗> пЁп╬я│п©п╦я┌п╟п╩п╦п╥п╟я├п╦п╦ я┤п╣я─п╣п╥ я┌я─п╦ п╫п╣п╢п╣п╩п╦ п╢п╩я▐ я─п╣п╫я┌пЁп╣п╫п╬п╩п╬пЁп╦я┤п╣я│п╨п╬пЁп╬ п╨п╬п╫я┌я─п╬п╩я▐.

п■п╩я▐ я─п╣п╫я┌пЁп╣п╫п╟ - пЁп╬я│п©п╦я┌п╟п╩п╦п╥п╟я├п╦я▐???

п⌠п⌠п╗> п═п╣п╥я┐п╩я▄я┌п╟я┌ я│я┌п╟я├п╦п╬п╫п╟я─п╫п╬пЁп╬ п╩п╣я┤п╣п╫п╦я▐ п©я─п╦п╡п╣п╢п╣п╫ п╫п╟ я─п╣п╫я┌пЁп╣п╫п╬пЁя─п╟п╪п╪п╣ (Xray_3).

п╜я┌п╬ п╨п╟я─я┌п╦п╫п╨п╟ я┌п╬ п╣я│я┌я▄ я┤п╣я─п╣п╥ п╫п╣п╢п╣п╩я▌ п©п╬я│п╩п╣ я┌я─п╟п╡п╪я▀, п©я─п╦ п╡я▀п©п╦я│п╨п╣?
п▒п╬п╩п╣п╣ я┤п╣п╪ п©я─п╦п╣п╪п╩п╣п╪п╬.

п⌠п⌠п╗> п÷я─п╬я┬я┐ п╬я┌п╡п╣я┌п╦я┌я▄ п╫п╟ п╡п╬п©я─п╬я│: я│я┤п╦я┌п╟п╣я┌п╣ п╩п╦ п▓я▀, я┤я┌п╬ Lп©п╬я│п╩п╣ я─п╣п©п╬п╥п╦я├п╦п╦ я│я┌п╬я▐п╫п╦п╣
п⌠п⌠п╗> п╨п╬я│я┌п╫я▀я┘ я└я─п╟пЁп╪п╣п╫я┌п╬п╡ я┐п╢п╬п╡п╩п╣я┌п╡п╬я─п╦я┌п╣п╩я▄п╫п╬п╣, я│п╪п╣я┴п╣п╫п╦п╣ п©п╬ п╢п╩п╦п╫п╣ п╦ я┬п╦я─п╦п╫п╣
п⌠п⌠п╗> п╢п╬п©я┐я│я┌п╦п╪п╬п╣б╕? п■п░. п²п∙п╒.

п■п╟, п╢п╟, п╢п╟-п╢п╟-п╢п╟! п·я│п╬п╠п╣п╫п╫п╬ п╡ 15 п╩п╣я┌.

п⌠п⌠п╗> п║п╡п╬п╠п╬п╢п╫п╬п╣ п╡я▀я│п╨п╟п╥я▀п╡п╟п╫п╦п╣ я┌п╟п╨п╤п╣ п©я─п╦п╡п╣я┌я│я┌п╡я┐п╣я┌я│я▐.

п∙я│п╩п╦ п©п╟я├п╣п╫я┌ я│ п╡я▀я│п╬п╨п╦п╪п╦ п©п╬я┌я─п╣п╠п╫п╬я│я┌я▐п╪п╦ (п©я─п╬я└п╣я│я│п╦п╬п╫п╟п╩я▄п╫я▀п╧ я│п©п╬я─я┌я│п╪п╣п╫?
п╬п╩п╦пЁп╟я─я┘?), я┘п╬я┤п╣я┌ я│я█п╨п╬п╫п╬п╪п╦я┌я▄ п╡я─п╣п╪я▐, п╫п╣ я┌п╟я│п╨п╟я┌я▄я│я▐ п╡п╬ п╡я│я▐п╨п╬пЁп╬ я─п╬п╢п╟
п╨п╬п╩я▄я├п╟я┘ п╦ п╡п╬я│я▄п╪п╣я─п╨п╟я┘, я┌п╬ я┐п╤ я│я┌п╬п╦п╩п╬ п©я─п╬я│я┌п╬ я│п╢п╣п╩п╟я┌я▄ п╬я│я┌п╣п╬я│п╦п╫я┌п╣п╥. п╜я┌п╬
п╣п╢п╦п╫я│я┌п╡п╣п╫п╫п╬п╣, я┤я┌п╬ я│п╢п╣п╩п╟п╩п╬ п╠я▀ пЁп╬я│п©п╦я┌п╟п╩п╦п╥п╟я├п╦я▌ п╬п©я─п╟п╡п╢п╟п╫п╫п╬п╧. п▓ п╬я│я┌п╟п╩я▄п╫п╬п╪ -
я┌я─п╟п╡п╪п╟ п╟п╪п╠я┐п╩п╟я┌п╬я─п╫п╟я▐. п∙я│п╩п╦ п╫п╣ п╢п╣п╩п╟я┌я▄ п╨п╟п╤п╢я▀п╧ п╢п╣п╫я▄ п©п╬п©я▀я┌п╨п╦ я─п╣п©п╬п╥п╦я├п╦п╦, я┌п╬
я┐ п©п╟я├п╦п╣п╫я┌п╟ 15 п╩п╣я┌ я│я─п╟я┴п╣п╫п╦я▐ п╪п╬п╤п╫п╬ п╬п╤п╦п╢п╟я┌я▄ п╡ 101% я│п╩я┐я┤п╟п╣п╡.

п⌠п⌠п╗> п╩п╦я┌п╣я─п╟я┌я┐я─п╫я▀п╣ я│я│я▀п╩п╨п╦ п╫п╟ п╦я│я┌п╬я┤п╫п╦п╨п╦, п©п╬я│п╡я▐я┴п╣п╫п╫я▀п╣ п╩п╣я┤п╣п╫п╦я▌
п⌠п⌠п╗> п©п╬п╢п╬п╠п╫я▀я┘ п©п╣я─п╣п╩п╬п╪п╬п╡

п▓ я█п╩п╣п╨я┌я─п╬п╫п╫п╬п╧ п╡п╣я─я│п╦п╦ Rockwood & Green "Fractures in Adults" п╣я│я┌я▄
я│п╬п╬я┌п╡п╣я┌я│я┌п╡я┐я▌я┴п╟я▐ пЁп╩п╟п╡п╟.

"Clearly, there is no need for a recommendation for nonoperative
management of most midshaft clavicle fractures. Anyone who has treated
this injury intuitively knows that most of these patients do extremely
well, even when patient compliance may not be optimal. There are even
several authors who proposed that, in the initial 3 months after
injury, treatment by an orthopaedic surgeon is not necessary
(53,54,76). Yet for most of us, the patients who have an excellent
result after closed treatment of a midshaft clavicle fracture are
usually children. Although results in adults are also good, certain
injuries remain difficult.

Most authors who have reported nonoperative treatment of clavicular
fractures have found superb union rates. Neer (126) evaluated 2,235
patients with midshaft fractures and determined that the nonunion rate
was 0.13%. Rowe (167) found a nonunion rate of 0.8% in his series of
566 fractures. Analysis of these data is confusing because of the
addition of pediatric patients. However, other studies have confirmed
excellent rates of healing even in an isolated adult population
(6,57,138)"

-- 
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia
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