关节内骨折.ppt

1、Management of Intra-articular Fractures关节内骨折的诊治,Wing Tip Wong DVM,MVS,MACVSc WTW Veterinary Surgical Service Veterinary Clinic and Hospital The University of Melbourne Werribee 3030 王文狄 墨尔本大学 动物医院外科 Caring, listening and sharing 关怀, 聆听 与分享,Management of Intra-articular Fractures,Intra-articular frac

2、ture management 关节内骨折处理 Early repair 尽早采取治疗措施,关节内骨折诊治,Management of Intra-articular Fractures,Intra-articular fracture management 关节内骨折治疗 Perfect anatomical reduction 恢复正常解剖结构的治疗方法,关节内骨折诊治,Management of Intra-articular Fractures,Intra-articular fracture management 关节内骨折治疗 Rigid fixation 固定方法,关节内骨折诊治

3、,Management of Intra-articular Fractures,Intra-articular fracture management 关节内骨折治疗 Passive range of motion, early active exercise 被动性辅助活动, 尽早进行主动运动,关节内骨折治疗,Management of Intra-articular Fractures,Intra-articular fracture management 关节内骨折的治疗 Chondro-protective agents, NSAIDs, and nutraceuticals 保护软

4、骨的药物, 非类固醇抗炎剂, 营养性药物,关节内骨折治疗,Management of Intra-articular Fractures,Radiography X-光检查 At least two views 至少拍2个不同角度 Good definition 清晰度良好,关节内骨折处理,Management of Intra-articular Fractures,关节内骨折处理,Radiography X-光检查 At least two views 至少拍2个不同角度 Good definition清晰度良好,Management of Intra-articular Fracture

5、s,关节内骨折处理,RadiographyX-光检查 At least two views 至少拍2个不同角度 Good definition清晰度良好,Management of Intra-articular Fractures,Perfect anatomical reduction and rigid fixation are imperative for a favourable outcome. 恢复正常解剖结构与牢靠的固定是治愈本病所必须的,关节内骨折处理,Management of Intra-articular Fractures,Repair ASAP 尽早手术 Anato

6、mical reduction 解剖结构的复位 Rigid fixation 坚直固定 Compression for additional stability 辅助固定 Early use of joint 尽早恢复关节的使用,关节内骨折处理,Management of Intra-articular Fractures,Degree of comminution 粉碎程度 Potential for reconstruction 粉碎的程度决定修复的结果,关节内骨折处理,Management of Intra-articular Fractures,关节内骨折处理,Degree of co

7、mminution 粉碎程度 Potential for reconstruction 粉碎的程度决定修复的结果,Management of Intra-articular Fractures,关节内骨折处理,Degree of comminution 粉碎程度 Potential for reconstruction 粉碎的程度决定修复的结果,Management of Intra-articular Fractures,关节内骨折处理,Degree of comminution 粉碎程度 Potential for reconstruction 粉碎的程度决定修复的结果,Managemen

8、t of Intra-articular Fractures,Selection of technique/implants 固定方法/固定用器械的选择 Small bone fragments 骨碎片 Softer epiphyseal/metaphyseal bone 较软的骺/干骺端骨,关节内骨折处理,Management of Intra-articular Fractures,关节内骨折处理,Selection of technique/implants 固定方法/固定用器械的选择 Small bone fragments 骨碎片 Softer epiphyseal/metaphys

9、eal bone 较软的骺/干骺端骨,Management of Intra-articular Fractures,关节内骨折处理,Selection of technique/implants 固定方法/固定用器械的选择 Small bone fragments 骨碎片 Softer epiphyseal/metaphyseal bone 较软的骺/干骺端骨,Management of Intra-articular Fractures,关节内骨折处理,Selection of technique/implants 固定方法/固定用器械的选择 Small bone fragments 骨碎

10、片 Softer epiphyseal/metaphyseal bone 较软的骺/干骺端骨,Management of Intra-articular Fractures,Should comminuted intra-articular fractures be repaired? 关节内粉碎性骨折是否需要手术? Location of the joint 骨折于关节内的位置,关节内骨折处理,Management of Intra-articular Fractures,Should comminuted intra-articular fractures be repaired? 关节内

11、粉碎性骨折是否需要手术? Availability of other options 其他可行方法,关节内骨折处理,Management of Intra-articular Fractures,How much articular cartilage and subchondral bone loss can a joint tolerate?关节可承受多大程度的关节软骨损伤? Size of defect 损伤的大小,关节内骨折处理,Management of Intra-articular Fractures,How much articular cartilage and subcho

12、ndral bone loss can a joint tolerate? 关节可承受多大程度的关节软骨损伤? Location within the joint 骨折于关节内的位置,关节内骨折处理,Management of Intra-articular Fractures,Is incongruity more detrimental than a gap? 错位是否比骨碎片间隙更重要? Yes 对,关节内骨折处理,Management of Intra-articular Fractures,Salvage procedures 挽救步骤 Arthroplasty 关节成形术 Arthrodesis 关节固定术 Amputation 截肢术,关节内骨折处理,Management of Intra-articular Fractures,Salvage p