关节镜下治疗前叉止点撕脱性骨折.ppt

Avulsion Fracture of Anterior Cruciate Ligament 1HistoryHistory1875 Poncet1875 Poncet1970Avulsion fracture of the ACL was 1970Avulsion fracture of the ACL was classified byclassified by Meyers MHMeyers MH1996Veselko M performed1996Veselko M performed arthroscopic arthroscopic placement and removal of cannulated screw placement and removal of cannulated screw for fixationfor fixation2008Jinzhong Zhao reported2008Jinzhong Zhao reported arthroscopic arthroscopic Figure-of-8 suture fixation technique Figure-of-8 suture fixation technique 2MorbidityMorbidity3/1000003/1000001414 ofof ACLACL injuryinjuryDistributionDistribution ofof ageage childrenchildren8 81414 yearsyears oldold oldold womenwomenoverover 4040 yearsyears oldoldAccid E-merg Nurs，2004，12(3)：1 73-1 75International Journal of Pediatrics,2012,Article ID 932702,6 pages epidemiologyepidemiology3Fall injury and traffic accident51Fall injury and traffic accident51Sports injuriesSkiing and football-14%Sports injuriesSkiing and football-14%The Knee，2008，15(3)：164-1674Associated with Associated with capsule tearcapsule tear ofof meniscusmeniscus oror articular capsulearticular capsule,sometimes,sometimes includingincluding medial medial and and lateral collateral ligament injury lateral collateral ligament injury or or injury of injury of articular cartilagearticular cartilageArthroscopy:The Journal of Arthroscopic and Related Surgery,2005,21(1):86-92.5RelevantRelevant anatomical structureanatomical structure6Resident ridgeResident ridge7Resident ridgeResident ridge8Branching ridgeBranching ridge9Footprints10FootprintsFootprints1112The The anterior medial bundle anterior medial bundle is tight in flexion is tight in flexion the the posterior lateral bundle posterior lateral bundle is tight in the is tight in the straight positionstraight position1312损伤机制损伤机制Young people-knee flexion,Young people-knee flexion,tibial internal rotationtibial internal rotationAdults-hyperextension of the Adults-hyperextension of the kneekneeACL limits anterior displacement,ACL limits anterior displacement,hyperextension,and internal rotationhyperextension,and internal rotation14DiagnosisDiagnosisInjuryInjury historyhistory ofof hyperextension of kneehyperextension of kneeBruiseBruise andand hyphemahyphemaThe extension was limitedThe extension was limitedAnteriorAnterior drawer test and Lachman sign aredrawer test and Lachman sign are positivepositiveX-ray X-ray andand CTCT areare conducive to understanding conducive to understanding of fracture of fracture MRI is helpful to understand injuryMRI is helpful to understand injury ofof ACL,and ACL,and othersothers combined bined injury.15AnteriorAnterior drawer test and drawer test and Lachman sign Lachman sign 16X-rayX-ray17CTCT18MRIMRI19Meyers-McKeever classificationMeyers-McKeever classificationArthroscopy 2005;211:86-9220How to identify fresh or old fractures How to identify fresh or old fractures in imagingin imaging21TreatmentTreatmentI type-Conservative treatmentI type-Conservative treatment toto keepkeep thethe kneeknee inin a a functional positionfunctional position forfor 6 weeks6 weeks andand typestypes -Manipulation-Manipulation，i if failf fail，selected surgery selected surgery typetype -Surgery-Surgery22ReductionReduction The drawer test after extensionThe drawer test after extension23P-R-I-C EP-R-I-C E program ProtectionProtectionRestRestIceIceCompressionCompressionElevateElevate24It It used to be the most commonly used to be the most commonly treatment program to open reduction treatment program to open reduction and fixed with wireand fixed with wire25A failed caseA failed caseCase 126Single tunnel fixation with steel wire and Single tunnel fixation with steel wire and extrusion screwextrusion screw27nNo extrusion nailwas found beforeoperationimpinge28If the fracture mass is small,using Ethibond If the fracture mass is small,using Ethibond suture suture 29Old fracture of avulsion fracture of ACLOld fracture of avulsion fracture of ACLCase 2Case 230Wound freshnessWound freshness31To clean and remove all dead,damaged tissue around of the fracture mass32To introduce the To introduce the wire by wire by a lumbar a lumbar puncture puncture needle needle 33To thread To thread through No.5 Ethibond,No.5 Ethibond,and fix fracture with 8 tension band and fix fracture with 8 tension band 34To inspect carefullyTo inspect carefully35The patients were followed up for 1 month after surgery36Case 3Case 3nTo use PDSii as the threadTo use PDSii as the thread37To use PDSii as the threadTo use PDSii as the thread38To use PDSii as the threadTo use PDSii as the thread39Case 4Case 4Old avulsion fracture of ACLOld avulsion fracture of ACL40With bone sclerosis,and ACL stretch With bone sclerosis,and ACL stretch and tearand tear41The bone block The bone block cannot be removed cannot be removed with the nucleus with the nucleus pulposus clamppulposus clampmicro-grinding drillto drill 42To remove bone massTo remove bone masswith nucleus pulposus with nucleus pulposus forcepsforcepsEnlargement of the Enlargement of the condylar fossa condylar fossa43The picture was taken after reconstruction of anterior cruciate ligament44Postoperative X-rayPostoperative X-ray45followed up for 1 month after surgery46For a bigger fracture block,hollow For a bigger fracture block,hollow screw is a good choicescrew is a good choice47Lateral meniscus(LM)is being pulled and Lateral meniscus(LM)is being pulled and displaceddisplaced48If the fracture of the tibial plateau is combined,first of all,the fracture should be fixed49X-ray showed ACL avulsion fracture X-ray showed ACL avulsion fracture combined with tibial plateau fracturecombined with tibial plateau fractureCase 450MRIMRI51To check the stability of knee joint To check the stability of knee joint before operationbefore operation52To carefully examine the collapse of the To carefully examine the collapse of the lateral tibial plateaulateral tibial plateauTo reduce and fix tibial plateau fracturesTo reduce and fix tibial plateau fractures53To remove the synovial To remove the synovial tissue of the femoral tissue of the femoral condylecondyleArthroscopic image of Arthroscopic image of the reduce fracture the reduce fracture54To cut the transverse To cut the transverse ligament of meniscus ligament of meniscus The reduction of the The reduction of the fracture mass is blockedfracture mass is blockedby the transverse ligament by the transverse ligament of the meniscus of the meniscus 55 To reduce fractureTo fixed fracture with k-wire temporarily 56ToTo drilldrill into secondinto secondK-wire K-wire A guide pin is inserted57ToTo screw into thescrew into the hollow screw hollow screwToTo inspectinspect afterafter fixationfixation58Postoperative X-rayPostoperative X-ray59Postoperative functional Postoperative functional rehabilitationrehabilitationTo take positive exercise of knee flexion and extension in 2 to 4 weeks To load limitedly within 9 weeksphysical exercise can be take 12 weeks later60Thanks for your attention61