下胫腓联合损伤的诊治.ppt

Cliquez pour modifier le style du titre du masque,Cliquez pour modifier les styles du texte du masque,踝关节损伤中下胫腓联合分离,的诊断及治疗,读书报告,解剖,下胫腓韧带复合体,下胫腓前韧带,anterior inferior,tibiofibular,ligament,AITFL,下胫腓后韧带,posterior inferior,tibiofibular,ligament,PITFL,骨间韧带,interosseous,ligament,IOL,胫腓横韧带,inferior transverse ligament,ITL,损伤机制,Supination,-adduction,Supinaton,-external rotation,Pronation,-abduction,Pronation,-external rotation,Supinaton,-external rotation 4075,损伤机制,I,III,II,IV,AITFL,PITFL,LM spiral,fracture,Deltoid ligament,MM fracture,X,线表现：,外踝螺旋形骨折内踝骨折（或三角韧带断裂）,隐藏的损伤：下胫腓前（后）韧带撕裂,临床特点,Supinaton,-external rotation,诊断：,1 术中固定外踝，固定内踝或修复三角韧带，,2,Cotton,试验,，外旋试验。,Cotton,试验,Skeletal Trauma P:2372,CASE 1,Supinaton,-external rotation,IV,X-ray：,LM spiral Fracture,+,MM fracture,韧带损伤：,AITFL,+,PITFL,CASE 2,Supinaton,-external rotation,IV,X-ray：,LM spiral Fracture,韧带损伤：,AITFL,+,PITFL+Deltoid ligament rupture,损伤机制,Pronation,-abduction 521,II,III,I,Deltoid ligament,MM fracture,AITFL+PITFL,LM,fracture,临床特点,Pronation,-abduction,X,线表现：,内踝骨折或三角韧带断裂,临近关节面水平外踝粉碎性骨折,隐藏的损伤：下胫腓前（后）韧带撕裂,诊断：,韧带损伤水平极少超过外踝骨折水平，,外踝粉碎骨折水平较高时往往有下胫腓分离,(,Dupuytren,fracture and dislocation,),，,如无明显分离与旋后外旋型处理相同。,CASE3,Pronation,-abduction III,CASE3,Pronation,-abduction III,I,II,III,IV,Pronation,-external rotation,AO 43 C,型,Pronation,-external rotation,AITFL,IOL,PITFL,临床特点,X,线表现：,内踝骨折或三角韧带断裂,明显高于关节面水平的外踝骨折,（,Maisonneuve,骨折）,隐藏的损伤：下胫腓前（后）韧带撕裂骨间韧带撕裂,诊断：,III、IV,度,损伤往往有明显下胫腓分离,如无明显分离，固定内外踝后做,Cotton,试验,往往为,阳性,CASE4,Pronation,-external rotation III,CASE4,Pronation,-external rotation III,Cotton test,挤压试验,无应力片,CASE4,Pronation,-external rotation III,Case 5,Pronation,-external rotation,IV,Pronation,-external rotation,IV,三角韧带断裂（深层）,or,内踝骨折,下胫腓联合损伤与踝关节稳定性的关系,下胫腓韧带断裂,下胫腓联合损伤与踝关节稳定性的关系,韧带断裂,下胫腓分离,AITFL,2.3,mm,AITFL+IOL,4.5,mm,AITFL+IOL+PITFL,7.3,mm,Grass R,Rammelt,S,Biewener,A,et al.Foot Ankle,Int,2003;24:392-397,下胫腓联合损伤与踝关节稳定性的关系,腓骨负重比例减小，腓骨外翻；,距骨外旋，外翻；,胫距接触面积减小。,手术固定下胫腓联合的指针,Ebraheim,等认为,固定下胫腓联合的绝对指征是对腓骨和内踝进行固定后仍存在下胫腓联合的不稳定。,谢谢！,