21骨科-骨折各论-shuangyu-new

骨与关节损伤各论Boneandjointinjury刘建宇13804609775DepartmentofOrthopedictrauma2ndHospitalofHarbinMedicalUniversity主要内容上肢骨、关节损伤锁骨骨折fractureofclavicle肩锁关节脱位dislocationofacromioclavicularjoint肩关节脱位dislocationofshoulderjoint肱骨近端骨折fractureofproximalhumerus肱骨干骨折fractureofhumeralshaft肱骨髁上骨折supracondylarfractureofhumerus肘关节脱位dislocationofelbowjoint前臂双骨折fractureofradiusandulnar桡骨远端骨折Fracturesofdistalradius下肢骨、关节损伤髋关节脱位dislocationofhipjoint股骨颈骨折fractureoffemoralneck股骨转子间骨折intertrochantericfractureoffemur股骨干骨折fractureoffemoralshaft髌骨骨折fractureofpatella膝关节韧带损伤ligamentinjuryofknee胫骨平台骨折fractureoftibialplateau胫腓骨骨折fractureoftibiaandfibula踝部骨折fractureofankle专业词汇Orthopaedics骨科Fracture骨折Dislocation脱位ClosedandOpen闭合和开放Complication并发症DVT(deepveinthrombosis)深静脉血栓Compartmentsyndrome骨筋膜室综合症PrincipleofTreatment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GoaloffracturetreatmentObtainunionofthefractureinthemostanatomicalposition,withmaximalfunctionalreturnoftheextremity.获得最接近解剖的愈合，和最大的功能恢复。“Wheneveryouarehavingyouranatomysessions,payparticularattention,becauseorthopaedicsisallanatomy,plusalittlebitofcommonsense.”J.Hughston骨折的治疗原则Principlesoffracturetreatment复位Reduction固定Fixation康复训练RehabilitationAOprinciplesoffracturetreatmentanatomicalreduction,especiallyinjointfractures解剖复位，特别是关节骨折stablefixation稳定的固定preservationofbloodsupply尽力保护血运activepain-freemobilizationofmusclesandjoints主动、无痛的肌肉和关节的运动第一节锁骨骨折fractureoftheclavicle第二节肩锁关节脱位dislocationofacromioclavicularjointclassification第三节肩关节脱位dislocationofshoulderjoint畸形malformation前脱位后脱位脱位伴大结节撕脱骨折Dislocationandavulsionfracture第四节肱骨近端骨折fractureofproximalhumerusClassification:neer第五节肱骨干骨折fractureofhumeralshaft解剖anatomy肱骨干骨折伴桡神经损伤第六节肱骨髁上骨折supracondylarfractureofthehumerus解剖anatomyClassificationofMehneandMatta.A,HighT.B,LowT.C,Y-type,D,H-type.E,Medial.F,Lateral.(FromJupiterJB,MehneDK:Orthopedics15:825,1992.)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dislocationofelbowjoint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fractureofradiusandulnar孟氏骨折脱位MonteggiaFracture-DislocationGALEAZZIFRACTURE-DISLOCATION盖氏骨折脱位GaleazziFracture-Dislocation第九节桡骨远端骨折Fracturesofdistalradius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Fracturesofdistalradiusclassifiedbymechanismofinjury.I,Bending.II,Shear.III,Impaction.IV,Avulsionswithfracture-dislocation.V,Highvelocity.(FromFernandezDL:InstrCourseLect42:73,1993.)Barton骨折：关节面骨折伴脱位GavriilAbramovichIlizarov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。JamesAronson,ClinicalOrthopaedicsandrelatedresearchIlizarovBoneTransport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fractureofclavicle肩锁关节脱位dislocationofacromioclavicularjoint肩关节脱位dislocationofshoulderjoint肱骨近端骨折fractureofproximalhumerus肱骨干骨折fractureofhumeralshaft肱骨髁上骨折supracondylarfractureofhumerus肘关节脱位dislocationofelbowjoint前臂双骨折fractureofradiusandulnar桡骨远端骨折Fracturesofdistalradius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dislocationofhipjoint股骨颈骨折fractureoffemoralneck股骨转子间骨折intertrochantericfractureoffemur股骨干骨折fractureoffemoralshaft髌骨骨折fractureofpatella膝关节韧带损伤ligamentinjuryofknee胫骨平台骨折fractureoftibialplateau胫腓骨骨折fractureoftibiaandfibula踝部骨折fractureofankle骨与关节损伤各论Boneandjointinjury刘建宇13804609775DepartmentofOrthopedictrauma2ndHospitalofHarbinMedicalUniversity下肢骨、关节损伤髋关节脱位dislocationofhipjoint股骨颈骨折fractureoffemoralneck股骨转子间骨折intertrochantericfractureoffemur股骨干骨折fractureoffemoralshaft髌骨骨折fractureofpatella膝关节韧带损伤ligamentinjuryofknee胫骨平台骨折fractureoftibialplateau胫腓骨骨折fractureoftibiaandfibula踝部骨折fractureofankle专业词汇Orthopaedics骨科Fracture骨折Dislocation脱位ClosedandOpen闭合和开放Complication并发症DVT(deepveinthrombosis)深静脉血栓Compartmentsyndrome骨筋膜室综合症PrincipleofTreatment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GoaloffracturetreatmentObtainunionofthefractureinthemostanatomicalposition,withmaximalfunctionalreturnoftheextremity.获得最接近解剖的愈合，和最大的功能恢复。“Wheneveryouarehavingyouranatomysessions,payparticularattention,becauseorthopaedicsisallanatomy,plusalittlebitofcommonsense.”J.Hughston骨折的治疗原则Principlesoffracturetreatment复位Reduction固定Fixation康复训练RehabilitationAOprinciplesoffracturetreatmentanatomicalreduction,especiallyinjointfractures解剖复位，特别是关节骨折stablefixation稳定的固定preservationofbloodsupply尽力保护血运activepain-freemobilizationofmusclesandjoints主动、无痛的肌肉和关节的运动第一节髋关节脱位dislocationofthehipjoint第二节股骨颈骨折fractureoffemoralneck解剖anatomy颈干角：127°前倾角：12°-15°BloodsupplyBloodsupply分类Classification1.按骨折线部位：头下型经股骨颈型基底型分类Classification2.按移位程度：GardonType1:incompleteType2:completebutundisplacedType3:completeandpartiallydisplacedType4:completeandtotallydisplacedclassificationGARDENAO临床表现1.摔倒史2.疼痛，活动障碍3.外旋畸形45°-60°4.肢体短缩治疗Treatment1.非手术治疗Nonoperativetreatment:closedreductionandfixation2.手术治疗Operativetreatment:加压钉compressionscrew动力髋钉板compressionscrewandplate关节置换totalhipreplacementcompressionscrew加压