骨科实习课件：骨折与脱位X-ray

FractureandDislocation

(X-ray)FractureDefinitionCauseClassificationDisplacementClinicalfeaturesBoneunionComplicationTreatmentDefinition骨折：骨的完整性和连续性中断Cause外伤性骨折直接暴力间接暴力病理性骨折疲劳性骨折Classification(1)不完全骨折裂缝骨折青枝骨折完全骨折横行骨折斜行骨折螺旋形骨折粉碎性骨折嵌插骨折压缩性骨折凹陷性骨折骨骺分离Classification(2)稳定性骨折裂缝骨折青枝骨折横行骨折嵌插骨折压缩性骨折凹陷性骨折不稳定性骨折斜行骨折螺旋形骨折粉碎性骨折Classification(3)开放性骨折骨折刺破膀胱、尿道、直肠闭合性骨折Displacement骨折移位成角移位侧方移位短缩移位分离移位旋转移位Clinicalfeatures全身表现休克发热一般不超过38度局部表现一般表现疼痛肿胀功能障碍特有体征畸形异常活动骨擦音或骨擦感Boneunion一期愈合二期愈合血肿炎症机化期原始骨痂形成期骨板形成塑形期临床上骨折愈合多为二期愈合*延迟愈合、不愈合、畸形愈合*临床愈合标准Complications早期并发症休克脂肪栓塞综合征内脏器官损伤周围组织损伤血管损伤神经损伤骨筋膜室综合征晚期并发症坠积性肺炎褥疮DVT形成感染损伤性骨化创伤性关节炎关节僵硬急性骨萎缩缺血性骨坏死缺血性肌挛缩（5P征）TreatmentReduction（apposition，aligment）anatomic～，functional～Fixationinternal～，external～ExerciseDislocationDefinitionClinicalfeaturesDefinitivetreatmentDefinition关节脱位是指组成关节的各骨的关节面失去正常的对应关系。Clinicalfeatures一般症状疼痛肿胀功能障碍特殊表现畸形弹性固定关节盂空虚DefinitivetreatmentReductionFixationExerciseX线片应用价值骨关节创伤最基本常规检查方便、快捷空间定位好于CT和MRI技术进步（CR、DR）不可替代X线片应用缺陷复合投影，复杂部位和重叠部位容易漏诊分辨率低不能显示隐匿性骨折、软骨损伤、肌腱、韧带和脊髓等软组织损伤X线片注意事项四肢长骨需要包括附近关节一般需要正侧位，必要时有轴位、斜位和切线位如果症状重，而X线阴性，需要数天后复查X线，或行CT、MRI检查骨折和关节脱位X线分析原则正常解剖和正常变异是基础要有一定的阅片顺序阅片内容:骨关节外形骨质的密度和纹理骨折的畸形和移位关节脱位健侧对照结合临床UpperLimbFracturesanddislocationsNormalclavicleClaviclefractureClaviclefractureAcromioclaviculardislocationNormalShoulderShoulderdislocationShoulderdislocationGreatertuberosityfractureFractureofthesurgicalneckofthehumerusHumeralshaftfractureHumeralshaftfractureNormalelbowNormalelbowSupracondylarfractureofthehumerusSupracondylarfractureofthehumerusIntercondylarfractureofthehumerusOlecranonfractureElbowdislocationNormalradiusandulnaDoublefractures

ofradiusandulnaFracturesofradiusandulnaMonteggiafractureGaleazzifractureNormalwristCollesfractureSmithfractureSmithfractureBartonfractureScaphoidfractureⅠⅡMetacarpalfractureBennett’sfractureFractureanddislocationoffingerBreakandTest（1）Whatisthis?(2)Whatisthis?(3)Whatisthis?(4)Whatisthis?LowerlimbFracturesandDislocationsNormalHipDislocationofthehipFemoralneckfractureFemoralneckfractureIntertrochantericfractureNormalfemurFemoralshaftfractureFemoralshaftfractureFemoralshaftfractureNormalKneeSupracondylarfractureofthefemurIntercondylarfractureofthefemurPatellafractureTibialplateaufractureNormaltibiaandfibulaTibiaandfibulafractureTibiaandfibulafractureNormalankleStabilityBimalleolarfractureNormalcalcaneusCalcaneusfractureFractureofthebaseofthe5thmetatarsal(Jonesfracture)FractureofmetatarsalSpineandPelvicFracturesandDislocationsFractureanddislocationofcervicalspineFractureanddislocationofthoracicspineFractureanddislocationo