21骨科-骨折各论-shuangyu-new(1).ppt

骨与关节损伤各论Bone and joint injury,刘建宇13804609775Department 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 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 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 attention,because orthopaedics is all anatomy,plus a little bit of common sense.”,J.Hughston,Anatomy,Anatomy,Anatomy!,骨折的治疗原则Principles of fracture treatment,复位Reduction固定Fixation康复训练Rehabilitation,AO 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 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 avulsion fracture,第四节 肱骨近端骨折fracture of proximal humerus,Classification: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anatomy,Classification of Mehne and Matta.A,High T.B,Low T.C,Y-type,D,H-type.E,Medial.F,Lateral.(From Jupiter JB,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 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 Fernandez 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 research,Ilizarov 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 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,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 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,骨与关节损伤各论Bone and joint injury,刘建宇13804609775Department of Orthopedic trauma2nd Hospital of Harbin Medical University,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 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 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 attention,because orthopaedics is all anatomy,plus a little bit of common sense.”,J.Hughston,Anatomy,Anatomy,Anatomy!,骨折的治疗原则Principles of fracture treatment,复位Reduction固定Fixation康复训练Rehabilitation,AO 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 m