髌骨骨折(英文版)-课件

髌骨骨折(英文版)PPTItisimportanttofullyevaluatepatellafracturesontheAPx-rayaswellasthelateralx-ray.TheAPx-raydemonstratesthenumberoffragmentsandverticalsplitsinthesagittalplanethatarenotvisibleonthelateralx-ray.ItisimportanttofullyevaluatepatellafracturesontheAPx-rayaswellasthelateralx-ray.TheAPx-raydemonstratesthenumberoffragmentsandverticalsplitsinthesagittalplanethatarenotvisibleonthelateralx-ray.Lateralradiographdemonstratingcompleteseparationofthepatellawithlossofextensormechanism.Averticalmidlineincisionisperformedoverthepatella.Aftercomingthroughsubcutaneoustissue,thepatellafractureisimmediatelyevident.Theclotandcancellousboneedgesarecleaned.大家学习辛苦了，还是要坚持继续保持安静Alaminaspreaderdemonstratesthefracturesite.Thearticularsurfaceofthepatellaandtrochleargrooveareevidentuponflexionoftheknee.PATELLAARTICULARSURFACETROCHLEARGROOVEPROXIMALDISTALRETINACULARTEARWithdisplacedpatellafracturesthereareconcomitantretinaculartearsmediallyandlaterally.TROCHLEAPATELLAARTICULARSURFACEAftercompletedebridementandcleaningofthefractures,acannulatedscrewguidewirecanbeplacedretrogradethroughthefracturesite,closeandparalleltothearticularsurface.Thedrillisthenusedalsoinaretrogradefashion.Thesaggitalplanesplitisseenwhenthedistalfragmentisflexed.Thisfractureisfixedwithatransverselagscrewthatwillnotinterferewiththecannulatedscrews.Usingaclamp,thefractureisreduced.Usingaclamp,thefractureisreduced.FRACTUREREDUCTIONAsecondclampisnecessaryinthiscasetomaintainthereduction.Closeupofthecompletereduction,usingseveralclamps.Afterthereductioniscomplete,theK-wiresarevisualizedinthelateralandAPplanes,whichareusedtoevaluatenotonlytheguidewireplacementbutalsothereduction.LateralandAPviews.Noticethatthelagscrewisplacedbetweentheinferiorlateralandinferiorcentralfragment,butdoesnotextendintothefragmentonthemedialside,asthiswouldinterferewiththeplacementoftheK-wire.Thetwocannulatedscrewsareplacedovertheguidewires.Thesescrewsmustbelargeenoughtoenablethetensionbandtobeplacedthroughthem.Eachmanufacturerisdifferent;thesurgeonmustbeconfidentthatthecannulationofthescrewwillaccommodatethecableorwiresystem.Thescrewshouldbeplacedsuchthatitisshortoftheendofthebone.Thisistoavoidthecableorwiresystemfrombeinginjuredbythesharpthreadedendofthescrew.Thecablesystemisintroducedthroughonescrewloopedaroundanteriorly,thenplacedinthesamedirectionthroughthesecondscrew.Thetwoendsarepulledthroughaconnectorandunderneaththeclamp,whichremainsinplaceduringthetightening.InthiscasetheDahl-Milessystemisusedandthetightenerisconnectedtothetwofreeendsafterafastenerisattached.LateralX-RayAPx-raydemonstratingthetighteningofthecablegripsystem.Afterthewireissufficientlytightenedandcrimpedinplace,itistrimmedveryclosetothesleeve.Theretinaculumisthencarefullyrepairedonboththemedialandlateralsidestoaffordstabilityandadditionalsupporttothereconstruction.Closeupofthefinalreconstruction.Lateralradiographdemonstratingther