21骨科-骨折各论-shuangyu-new

1、骨与关节损伤各论Bone and joint injury刘建epartment of Orthopedic trauma2nd Hospital of Harbin Medical University主要内容上肢骨、关节损伤锁骨骨折 fracture of clavicle肩锁关节脱位 dislocation of acromioclavicular joint 肩关节脱位 dislocation of shoulder joint肱骨近端骨折 fracture of proximal humerus肱骨干骨折 fracture of humeral shaft肱

2、骨髁上骨折 supracondylar fracture of humerus肘关节脱位 dislocation of elbow joint前臂双骨折 fracture of radius and ulnar桡骨远端骨折 Fractures of distal radius 下肢骨、关节损伤髋关节脱位 dislocation of hip joint股骨颈骨折 fracture of femoral neck股骨转子间骨折 intertrochanteric fracture of femur 股骨干骨折 fracture of femoral shaft髌骨骨折 fracture of p

3、atella 膝关节韧带损伤 ligament injury of knee胫骨平台骨折 fracture of tibial plateau 胫腓骨骨折 fracture of tibia and fibula 踝部骨折 fracture of ankle 专业词汇Orthopaedics 骨科Fracture 骨折Dislocation 脱位Closed and Open 闭合和开放Complication 并发症DVT (deep vein thrombosis) 深静脉血栓Compartment syndrome 骨筋膜室综合症Principle of Treatment治疗原则Red

4、uction 复位Fixation 固定Rehabilitation 康复治疗 Pin, wire, screw, plate 针，钢丝，螺钉，钢板Goal of fracture treatment Obtain union of the fracture in the most anatomical position, with maximal functional return of the extremity. 获得最接近解剖的愈合，和最大的功能恢复。“Whenever you are having your anatomy sessions, pay particular atten

5、tion, because orthopaedics is all anatomy, plus a little bit of common sense.”J. HughstonAnatomy, Anatomy, Anatomy!骨折的治疗原则Principles of fracture treatment复位Reduction固定Fixation康复训练RehabilitationAO principles of fracture treatment anatomical reduction, especially in joint fractures 解剖复位，特别是关节骨折stable

6、fixation 稳定的固定preservation of blood supply 尽力保护血运active pain-free mobilization of muscles and joints 主动、无痛的肌肉和关节的运动第一节 锁骨骨折fracture of the clavicle第二节 肩锁关节脱位 dislocation of acromioclavicular joint classification第三节 肩关节脱位 dislocation of shoulder joint 畸形malformation前脱位后脱位 脱位伴大结节撕脱骨折Dislocation and av

7、ulsion fracture第四节 肱骨近端骨折fracture of proximal humerusClassification: neer第五节 肱骨干骨折fracture of humeral shaft解剖anatomy肱骨干骨折伴桡神经损伤第六节 肱骨髁上骨折supracondylar fracture of the humerus解剖anatomyClassification of Mehne and Matta. A, High T. B, Low T. C, Y-type, D, H-type. E, Medial. F, Lateral. (From Jupiter JB

8、, Mehne DK: Orthopedics 15:825, 1992.) classification伸直型肱骨髁上骨折伸直型肱骨髁上骨折伴肱动脉损伤第七节 肘关节脱位 dislocation of elbow joint临床表现：1.活动障碍、肿胀2.弹性固定、畸形3.肘后三角关系改变4.X-ray 第八节 前臂双骨折 fracture of radius and ulnar孟氏骨折脱位Monteggia Fracture-Dislocation GALEAZZI FRACTURE-DISLOCATION 盖氏骨折脱位 Galeazzi Fracture-Dislocation 第九节

9、桡骨远端骨折 Fractures of distal radius 解剖anatomy尺倾角：20-25掌倾角：10-15伸直型Colles 骨折临床表现：“银叉”畸形：向背侧移位“枪刺刀”畸形：向桡侧移位屈曲型Smith 骨折临床表现：向掌侧移位向桡侧移位Fractures of distal radius classified by mechanism of injury. I, Bending. II, Shear. III, Impaction. IV, Avulsions with fracture-dislocation. V, High velocity. (From Ferna

10、ndez DL: Instr Course Lect 42:73, 1993.) Barton骨折：关节面骨折伴脱位Gavriil Abramovich Ilizarov牵张成骨与外固定架矫形 Ilizarov 于二十世纪50年代通过实验和临床研究，提出了对生物组织施加特定的牵引力引起骨段逐渐分开形成间隙，并由新生骨产生并取代间隙以达到骨延长的生物学理论。James Aronson, Clinical Orthopaedics and related researchIlizarov Bone Transport彻底清除截骨骨搬移软组织牵张成骨截骨术后第7天开始骨延长，第一个1cm的延长速度为

11、1mm/天，分4次完成第二个1cm的延长速度为0.67mm/天，分4次完成，直至延长完毕病例2 近关节面骨搬移病例1 逆向骨搬移 病例3 长段骨搬移病例4 双向骨搬移病例5 双重骨搬移主要内容上肢骨、关节损伤锁骨骨折 fracture of clavicle肩锁关节脱位 dislocation of acromioclavicular joint 肩关节脱位 dislocation of shoulder joint肱骨近端骨折 fracture of proximal humerus肱骨干骨折 fracture of humeral shaft肱骨髁上骨折 supracondylar fra

12、cture of humerus肘关节脱位 dislocation of elbow joint前臂双骨折 fracture of radius and ulnar桡骨远端骨折 Fractures of distal radius 思考题1.肱骨中下段骨折容易出现哪个神经损伤？临床表现？2.什么是孟氏骨折？盖氏骨折？下肢骨、关节损伤髋关节脱位 dislocation of hip joint股骨颈骨折 fracture of femoral neck股骨转子间骨折 intertrochanteric fracture of femur 股骨干骨折 fracture of femoral sha

13、ft髌骨骨折 fracture of patella 膝关节韧带损伤 ligament injury of knee胫骨平台骨折 fracture of tibial plateau 胫腓骨骨折 fracture of tibia and fibula 踝部骨折 fracture of ankle 骨与关节损伤各论Bone and joint injury刘建epartment of Orthopedic trauma2nd Hospital of Harbin Medical University下肢骨、关节损伤髋关节脱位 dislocation of hip jo

14、int股骨颈骨折 fracture of femoral neck股骨转子间骨折 intertrochanteric fracture of femur 股骨干骨折 fracture of femoral shaft髌骨骨折 fracture of patella 膝关节韧带损伤 ligament injury of knee胫骨平台骨折 fracture of tibial plateau 胫腓骨骨折 fracture of tibia and fibula 踝部骨折 fracture of ankle 专业词汇Orthopaedics 骨科Fracture 骨折Dislocation 脱位

15、Closed and Open 闭合和开放Complication 并发症DVT (deep vein thrombosis) 深静脉血栓Compartment syndrome 骨筋膜室综合症Principle of Treatment治疗原则Reduction 复位Fixation 固定Rehabilitation 康复治疗 Pin, wire, screw, plate 针，钢丝，螺钉，钢板Goal of fracture treatment Obtain union of the fracture in the most anatomical position, with maxima

16、l functional return of the extremity. 获得最接近解剖的愈合，和最大的功能恢复。“Whenever you are having your anatomy sessions, pay particular attention, because orthopaedics is all anatomy, plus a little bit of common sense.”J. HughstonAnatomy, Anatomy, Anatomy!骨折的治疗原则Principles of fracture treatment复位Reduction固定Fixatio

17、n康复训练RehabilitationAO principles of fracture treatment anatomical reduction, especially in joint fractures 解剖复位，特别是关节骨折stable fixation 稳定的固定preservation of blood supply 尽力保护血运active pain-free mobilization of muscles and joints 主动、无痛的肌肉和关节的运动第一节 髋关节脱位dislocation of the hip joint第二节 股骨颈骨折fracture of f

18、emoral neck解剖anatomy颈干角：127前倾角：12-15Blood supplyBlood supply分类Classification1.按骨折线部位： 头下型 经股骨颈型 基底型分类Classification2.按移位程度：GardonType 1 : incompleteType 2 : complete but undisplacedType 3 : complete and partially displacedType 4 : complete and totally displacedclassificationGARDEN AO临床表现摔倒史疼痛，活动障碍外旋

19、畸形45-60肢体短缩治疗Treatment1. 非手术治疗 Nonoperative treatment : closed reduction and fixation 2. 手术治疗 Operative treatment : 加压钉 compression screw 动力髋钉板 compression screw and plate 关节置换 total hip replacement compression screw加压钉动力髋关节置换Total hip replacement 第三节 股骨转子间骨折intertrochanteric fracture of the femur 分

20、类classification：EvansII型III型治疗Treatment1. 非手术治疗 Nonoperative treatment :2. 手术治疗 Operative treatment : 动力髋钉板 compression screw and plate 股骨近端髓内钉 proximal femur nail, PFN PFNPFN第四节 股骨干骨折fracture of femoral shaft解剖anatomy治疗方法Treatment Methods非手术治疗石膏固定 cast immobilization 骨牵引 Skeletal traction 外固定架 Exte

21、rnal fixation 手术治疗 髓内钉 Intramedullary nailing 钢板 Plate fixation 小切口微创技术钢板固定第五节髌骨骨折patella fracture 生物力学BiomechanicsForces is 3 to 7 times the body weightFrom extension to flexion patella track on femur surface 分类classificationUndisplaced and displaced TransverseComminutedVerticalLower or upper pole治

22、疗 Tension band wiringtension band wiring第六节 膝关节韧带损伤ligament injury of knee Anatomy诊断 DiagnosisInjuryPhysical exam: lachman test povit shift testMRITibial and Femoral TunnelsSurgical TechniqueTran-tibial approachPortal approachAMPLAMPL90Surgical TechniqueGraft FixationPL fixed in full extensionAMPLSu

23、rgical TechniqueAM fixed in 60o of knee flexion第七节 胫骨平台骨折tibial plateau fracture Schatzker classificationIIIIIIIVVVI第八节 胫腓骨骨折fracture of tibia and fibula Anatomy胫腓骨骨折的特点开放骨折多见骨筋膜室综合征骨不愈合开放骨折返回骨筋膜室综合征开放性骨折的处理开放性骨折的分度开放性骨折的处理原则 开放性骨折的分度第一度：皮肤被自内向外骨折端刺破第二度：皮肤被割裂或压碎，皮下组织、 肌肉有中度损伤第三度：广泛的皮肤、皮下组织与肌肉的 严重损伤，常合并血管神经