中文骨折概论课件

中文骨折概论骨折定义Definition骨折－－骨的连续性中段Afractureisabreakinthecontinuityofabone.Dept.Orthopedics,1stHospitalSUMS外力引起骨折

ForcesfractureDirectviolence(直接暴力)Indirectviolence（间接暴力）Forcefulpullofmuscles（肌肉拉力引起撕脱骨折）Repeatedstress（重复应力引起疲劳骨折）-----causefatiguefractureBonedisease（骨病变引起病理骨折）-----pathologicalfracDept.Orthopedics,1stHospitalSUMS直接暴力引起横断骨折，粉碎性骨折DirectviolenceDept.Orthopedics,1stHospitalSUMS直接暴力Directviolence间接暴力引起螺旋型骨折Indirectviolence(rotational)骨肿瘤容易并发病理骨折BonetumorDept.Orthopedics,1stHospitalSUMS直接暴力Directforce间接暴力引起骨折和脱位Fracture&dislocationcausedbyIndirectviolence车祸CaraccidentDept.Orthopedics,1stHospitalSUMS骨折分类：闭合/开放骨折

Closed/openfracture根据骨折断端是否与皮肤或体腔相通，分为开放性和闭合性骨折Basedonwhetherthereiscommunicationbetweenfractureandskin(bodycavities)闭合骨折Closedfractures开放骨折Openfractures:伤口容易引致感染，因此，需要急诊手术处理伤口和骨折Dept.Orthopedics,1stHospitalSUMSOpenfracDept.Orthopedics,1stHospitalSUMSPatternsoffracture

骨折类型Incompletefracture不全骨折Completefracture完全性骨折Dept.Orthopedics,1stHospitalSUMS不全骨折

Incompletefracture:partialbreakCrackfracture（裂纹骨折）

Greenstickfracturesinchildren青枝骨折不完全性骨折容易引起漏诊Dept.Orthopedics,1stHospitalSUMS.儿童的青枝骨折GreenstickfractureofdistaltibiaoccursinchildrenDept.Orthopedics,1stHospitalSUMSCompletefracture

完全性骨折大多数的骨折属于完全性骨折CompletebreakoftheinjuredboneMostfracturesDept.Orthopedics,1stHospitalSUMS骨折类型Patternsoffracture根据骨折线、形状和程度可分为Basedonfractureline/shape/degrees:Transversefracture（横形）Oblique（斜形）Spiral（螺旋形）Comminuted(withmorethantwofragments）（splintered)（粉碎性）Compressfra./crushfracture（压缩性）Impactedfracture（嵌插）Dept.Orthopedics,1stHospitalSUMSStabilityoffracture

骨折的稳定性稳定型骨折Stablefracture:复位后不容易发生移位的骨折，如横型骨折、嵌插骨折、青枝骨折等noteasilydisplaceafterreductiontransverse,compacted,greenstick不稳定骨折Unstable:复位后容易发生移位，如斜型骨折、螺旋型骨折，粉碎性骨折等atendencytoredisplaceafterreductionoblique,spiralandcommunitedfractureDept.Orthopedics,1stHospitalSUMSFactorsforfracturedisplacement

骨折移位的因素1.Forcefromtheinjury（外力）2.Gravityorweightofdistalpartofaffectedlimb（重力）3.Pullofmusclesaroundthefracture（肌肉牵拉力）4.Incorrectmovingofthepatientandunsuitablemanipulation（人为因素）Dept.Orthopedics,1stHospitalSUMSTypeoffracturedisplacement

骨折移位类型Angulation成角Lateraldisplacement侧方移位Overlapdisplacement重叠Separatedisplacement分离Rotational旋转Comminutedfrac.粉碎mixtogether混合多数骨折为混合型骨折Dept.Orthopedics,1stHospitalSUMS骨折的类型与移位与治疗选择有关与预后有关Dept.Orthopedics,1stHospitalSUMS.完全Completefrac横型Transversefrac.成角Angulation稳定Stablefrac.Dept.Orthopedics,1stHospitalSUMS.完全Completefrac.斜型Obliquefrac.不稳定Unstablefrac.成角Angulationdisp.Dept.Orthopedics,1stHospitalSUMS.完全Completefrac.螺旋Spiralfrac.短缩重叠Shortening(overlap)侧方移位Lateraldisp.分离Separatefrac.不稳定Unstablefrac.Dept.Orthopedics,1stHospitalSUMS.粉碎Comminutedfrac.Dept.Orthopedics,1stHospitalSUMS多发骨折MultiplefractureDept.Orthopedics,1stHospitalSUMS.多发Multiplesegmentalfrac.粉碎Comminutedfrac.Dept.Orthopedics,1stHospitalSUMS.CoxaVara髋内翻分离Separate粉碎comminutedDept.Orthopedics,1stHospitalSUMS.

请分析骨折类型Whatisthetypeoffra.?Dept.Orthopedics,1stHospitalSUMSHealingoffracture

骨折愈合骨折愈合时间与众多因素有关，包括年龄，全身情况，局部血供，骨折部位和类型骨折愈合通常需要6～8周以上Howlongdoesafracturetaketounite?Dependonmanyfactors:-----age,patientcondition,localbloodsupply,typeandsiteoffracture…Dept.Orthopedics,1stHospitalSUMS.骨痂CallusinfracturehealingDept.Orthopedics,1stHospitalSUMSFactorsthatinfluenceunion

影响骨折愈合因素Generalcondition全身情况Age年龄Healthycondition健康状况疾病情况Dept.Orthopedics,1stHospitalSUMS影响骨折愈合的局部因素

LocalfactorforfractureunionTypesofbone骨的类型Sites,types,severityoffracture骨折因素多发骨折、分离骨折、粉碎骨折、股骨颈骨折、胫骨远端骨折等影响骨折愈合union↓multiplefrac.Separatefrac.Comminutedfrac.femoralneckfrac.distalpartoftibiaDept.Orthopedics,1stHospitalSUMS影响骨折愈合的局部因素

LocalfactorforfractureunionBloodsupply血供，局部血供与骨折的解剖部位、骨折类型、严重程度、软组织损伤程度和感染有关Relatedwithanatomicalsite,types,severityoffractureandsofttissueinjureSevereinjuryofsofttissueInfection

Dept.Orthopedics,1stHospitalSUMS影响骨折愈合的因素

Factorsthatinfluenceunion不恰当的处理Unsuitablemanagement:反复多次复位repeatedreduction过度牵引excessivetraction:separation不恰当的运动unsuitableimmobility:movement固定不可靠unstablefixationDept.Orthopedics,1stHospitalSUMSClinicalmanifestationoffracture(骨折临床表现）History:injury外伤史Generalcondition全身情况:Shock?Hemorrhage?是否有休克、出血Damagetobrain?Tolungsandheart?Toabdomen?Tospinalcord?Toothers?是否有重要器官损伤？Itisimportanttolookforotherinjuries.重视重要器官损伤是重要的

Dept.Orthopedics,1stHospitalSUMS骨折的局部表现

LocalmanifestationSpecificsignsoffracture

骨折特有体征Deformity畸形Abnormalmobility(movementbetweenthefragments)反常活动Crepitus骨擦感或骨擦音三者中有一可作出诊断，但三者都没有不可以否定骨折OneofthemcanmakediagnosisCaution:noneofthemisfoundinsomefractures.Dept.Orthopedics,1stHospitalSUMS骨折的其他表现，但没有特异性

Othersignsoffracture

notspecificSwelling肿胀Bruising(ecchymosis)淤斑Tenderness压痛Impairmentoffunction功能障碍以上表现没有特征性，但可提供参考Allsingsabovearenotspecifictofracture.Dept.Orthopedics,1stHospitalSUMS当你处理骨折患者时，需要了解AskyourselfwhenyoudealwithafractureAwound?Openfracture?是否开放骨折Anyimpairmentofcirculation?局部血液循环情况Anyevidenceofnerveinjury?是否有神经损伤？Anyevidenceofvisceralinjury?是否有重要器官损伤？Compartmentsyndromes?是否有骨筋膜室综合骨筋膜室综合征Dept.Orthopedics,1stHospitalSUMSTestforcheckingcirculation

检查患肢血循环Color皮肤颜色Warmth皮温Arterialpulse搏动Capillaryreturn毛细血管回流Nerveconductivity神经功能Specifictests:Dopplerultrasonographyorarteriography特殊检查：超声，血管造影Dept.Orthopedics,1stHospitalSUMS影像学检查

RadiographicexaminationX线检查是最基本、最必须的检查X线照片可明确骨折的部位、类型X-ray(plainfilm)isimportant,basicandinevitablefordiagnosisandtreatment.X-raycanshow:fractureSiteoffractureTypeoffractureDept.Orthopedics,1stHospitalSUMSX线检查

X-rayexamination需要对有怀疑骨折的病人进行X线检查MusttakeX-rayfilmforeachsuspectfractureDept.Orthopedics,1stHospitalSUMS股骨粗隆间骨折IntertrochantericfactureoffemurDept.Orthopedics,1stHospitalSUMS多发骨折MultiplefracDept.Orthopedics,1stHospitalSUMSA-PviewshownormalLateralviewshowdisplacement正侧位检查的必要性Dept.Orthopedics,1stHospitalSUMSA-PviewLateralviewX线检查的正侧位TwodirectionviewsDept.Orthopedics,1stHospitalSUMSCTorMRI骨盆、脊柱等一些特殊部位需要CT或MRI检查意义：骨折移位情况，与周围结构的关系，指导治疗Necessaryinfracturesofspineandpelvis,orinsomespecificfrac.Significance:displacementoffragmentsRelationbetweenfragmentsandnearbystructureGuidefortreatmentDept.Orthopedics,1stHospitalSUMS髋臼骨折

Acetabularfrac.

Dept.Orthopedics,1stHospitalSUMSComplicationoffracture

骨折并发症Earlycomplication早期并发症1.Shock休克2.Infection感染3.Viscerainjury内脏损伤肋骨骨折Ribfractureinjuretolungs,liver,spleen(rupture)骨盆骨折Pelvicfractureinjuretobladder,rectalDept.Orthopedics,1stHospitalSUMSComplicationoffracture4.Mainarteryorveininjury血管损伤5.Spinalcordinjury脊髓损伤6.Peripheralnerveinjury周围神经损伤7.Lipoembolization脂肪栓塞8.compartmentsyndrome骨筋膜室综合征Dept.Orthopedics,1stHospitalSUMSMiddleandlatestagecomplication

后期并发症1.Pneumonia肺炎2.Bedsore褥疮3.DVT深静脉血栓形成4.Ossification(ossifyingmyositis)骨化性肌炎Dept.Orthopedics,1stHospitalSUMSComplicationoffracture5.Traumaticarthritis创伤性关节炎6.Stiffofjoint关节僵硬7.ischemicnecrosisoftheaffectedbone骨坏死8.Ischemiccontratureoftheaffectedmuscle缺血性肌挛缩9.Boneatrophy,Sudeck’satrophy骨萎缩10.感染、骨髓炎Dept.Orthopedics,1stHospitalSUMSTreatmentoffracture

骨折治疗Firstaid急救:1.Savelives抢救生命2.dressingofwoundandcontrolbleeding(hemostasia)包扎伤口，止血3.temporaryimmobilizationofthefracturedlimbs骨折临时固定4.rapidtransportation迅速送医院Dept.Orthopedics,1stHospitalSUMSPrincepleofTreatment

forfracture

骨折治疗原则Reduction复位Immobilization固定Preservationoffunctionorfunctionalexercise功能锻练Dept.Orthopedics,1stHospitalSUMSReduction复位Restoretonormalposition----Correctdeformity注意骨折的对线和对位AlignmentismoreimportantthanappositionDept.Orthopedics,1stHospitalSUMSMethodsofreduction复位Closereduction(manual)闭合复位Openreduction(operation)开放复位Dept.Orthopedics,1stHospitalSUMSClosereduction(manual)手法复位Dept.Orthopedics,1stHospitalSUMSImmobilization固定

-----MaintainpositionafterreductionMethods固定方法:非手术：石膏、小夹板手术：各种内固定Dept.Orthopedics,1stHospitalSUMS牵引ContinuousTraction具有复位和固定的作用，需要较长时间的卧床Effect:ReductionandImmobilizationDept.Orthopedics,1stHospitalSUMS牵引类型

Typesoftraction

皮肤牵引Skintraction骨牵引SkeletaltractionDept.Orthopedics,1stHospitalSUMS外固定支架，用于开放性骨折

Externalfixationinstrument

specialuseforopenfractureDept.Orthopedics,1stHospitalSUMSDept.Orthopedics,1stHospitalSUMS骨折治疗的选择

Choiceoftreatmentmethod保守治疗Conservativetreatment手术治疗operationDept.Orthopedics,1stHospitalSUMS保守治疗的适应症

IndicationofConservativetreatment多数的闭合稳定型骨折不适合手术者Dept.Orthopedics,1stHospitalSUMS手术适应症

Indicationforoperation

闭合复位失败Closereductionisdifficultorfail不稳定骨折Unstablefracture开放骨折Openfracture关节内骨折Fractureinvolvejoint并发神经血管损伤Complicatebloodvesselandnerveinjury多发骨折multiplefractures需要早期活动者NeedearlymobilityforsomepatientsDept.Orthopedics,1stHospitalSUMS手术治疗的优点

Advantagesofoperationforfracture解剖复位Anatomicalreduction早期活动AllowEarlyexercise避免长期卧床Avoidtolieinbedforalongtime避免关节僵硬AvoidjointstiffDept.Orthopedics,1stHospitalSUMS内固定的形式

SomeExamplesofinternalfixation

Dept.Orthopedics,1stHospitalSUMS.IntramedullarynailSpecialforintertrochantericFrac.&proximalpartfractureoffemur.

Dept.Orthopedics,1stHospitalSUMS手术的缺点

DisadvantagesandComplicationsofoperation感染机会Infection内植物失败Implantfailure手术风险DangeroustosomepatientsDept.Orthopedics,1stHospitalSUMSExamplesofoperation.Dept.Orthopedics,1stHospitalSUMSInterlockingmedullarynail交锁髓内钉Dept.Orthopedics,1stHospitalSUMSPlateandscrewDept.Orthopedics,1stHospitalSUMSFrac.HealingAfterremovingplateandscrewDept.Orthopedics,1stHospitalSUMSInterlockingmedullarynailDept.Orthopedics,1stHospitalSUMSA-ppositionLateralpositionSupracondylarfrac.Dept.Orthopedics,1stHospitalSUMS.A-ppositionLateralpositionFixedbyplateandscrewDept.Orthopedics,1stHospitalSUMSFixedbyKwireFixedbyk-wireDept.Orthopedics,1stHospitalSUMSPlatebrokenReplacedbyinterlockingnailDept.Orthopedics,1stHospitalSUMSBothconservativeandoperativemethodareavailable

Dept.Orthopedics,1stHospitalSUMSA-PviewDept.Orthopedics,1stHospitalSUMS.DCSDynamicCondylarScrewComminutedfrac.OffemoralintercondyleDept.Orthopedics,1stHospitalSUMS.Multiplefrac.IndicationforopDept.Orthopedics,1stHospitalSUMSDept.Orthopedics,1stHospitalSUMS.FixedbySpecialmedullarnailandwireDept.Orthopedics,1stHospitalSUMSFrac.InbothlegsDept.Orthopedics,1stHospitalSUMSInterlockingIntromedullarynailDept.Orthopedics,1stHospitalSUMSMultiplefrac.Dept.Orthopedics,1stHospitalSUMSFixationbyscrewsDept.Orthopedics,1stHospitalSUMSDept.Orthoped