四肢常见骨折(课堂PPT).ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,常见四肢骨折,The common fracture of limbs,海南医学院附属医院骨科,黄涛,1,Part-one,Fracture of upper limbs,锁骨骨折（,clavicle fracture,）,肱骨外科颈骨折（,surgery neck fracture of humerus,）,肱骨干骨折,(Hemerus shaft fracture),肱骨髁上骨折（,Supracondylar fracture of humerus,）,尺桡骨骨折,(ulna and radius fracture),2,Clavicle fracture-,Anatomy,锁骨干较细，有弯曲呈“,S”,形。内侧半弯凸向前，外侧半弯凸向后。,内端与胸骨相联构成关节，外侧与肩峰相联构成肩锁关节。,横架于胸骨和肩峰之间，是,肩胛带与躯干唯一的联系支架。,3,Cclavicle fracture-,M,echanism,间接暴力造成骨折多见。,跌倒时手或肘着地，外力自前臂或肘部沿上肢向近以端冲击；,肩部着地更多见，撞击锁骨外端造成骨折。,4,Clavicle fracture-,M,echanism,间接暴力造成骨折多为斜形或横行，其部位多见于中段；,直接暴力造成骨折因着力点不同而异，多为粉碎或横型。,5,Clavicle fracture-,M,echanism,骨折好发于中段。,因肌肉牵拉和肢体重力骨折断端重叠移位。,近段,受胸锁乳突肌牵拉,向上,;,远段,因上肢重量及胸大肌牵拉,向下,，向前及和向内移位,.,6,Clavicle fracture-,Diagnosis,局部疼痛，患侧上肢不敢活动。,局部畸形，锁骨上窝消失。,局部压痛,X-ray,确诊,7,Clavicle fracture-,Treatment,Nonoperative management,手法复位“,8”,字石膏固定。,4-6,周,8,Clavicle fracture-,Treatment,Surgical treatment,9,Clavicle fracture-,Treatment,Surgical treatment,10,Clavicle fracture-,Treatment,Surgical treatment,11,Clavicle fracture-,Treatment,Surgical treatment,12,Clavicle fracture-,Recovery,Recovery from clavicle fracture is individualized and somewhat influenced by the age of the person.Children may heal in three weeks,and adults may take four to six weeks to heal.People can generally return to their full activity level in about 12 weeks.,13,surgery neck fracture of humerus,Anatomy and mechanism,肱骨外科颈位于解剖颈下,23cm,，即肱骨大结节之下，胸大肌止点之上。,肱骨干坚质骨与肱骨头松质骨交接处，最易发生骨折故名为外科颈骨折。此种骨折好发于中年和老年人,。,14,Surgery neck fracture of humerus,Anatomy and mechanism,外展型骨折：,间接暴力造成骨折。跌倒时上肢外展，手掌触地在外科颈处发生骨折。,（多见）,内收型骨折：,跌倒时手或肘着地，上肢内收。,（少见）,15,Surgery neck fracture of humerus,Diagnosis,Symptom,X-ray,3D-CT(Three-Dimensional CT reconstruction),16,Surgery neck fracture of humerus,Treatment-,Surgical treatment,17,Hemerus shaft fracture,Anatomy and mechanism and diagnosis,肱骨干骨折诊断容易。,肱骨中、下段骨折应注意桡神经合并伤。,18,Hemerus shaft fracture,key point,移位机理,肱骨干上部骨折，骨折位于,三角肌止点之上,，骨折近端因胸大肌、背阔肌及大园肌牵拉向前内移位，骨折远端受三角肌牵拉向上外移位。,肱骨干中部骨折，骨折位于,三角肌止点以下,，骨折近端因三角肌和喙肱肌收缩向外前移位，骨折远段因肱二头肌，肱三头收缩向上移位,肱骨中、下段骨折应注意桡神经合并伤。,19,Hemerus shaft fracture,Treatment-,Surgical treatment,intramedullary nail,髓内钉,20,Supracondylar fracture of humerus,Anatomy and mechanism and diagnosis,肱骨髁上骨折多发生,10,岁以下儿童，成年人很少见,。本质是,骨骺分离。,根据暴力来源及方向可分为伸直、屈曲和粉碎型三类。伸直型分为尺偏型、桡偏型。,伸直型可损伤血管导致前臂缺血性肌挛缩。,21,Supracondylar fracture of humerus,key point,常见于儿童,伸直型可损伤血管导致,前臂缺血性肌挛缩,（,ischemic contracture of forearm,）,22,Supracondylar fracture of humerus,treatment,内固定加石膏支具固定,4-6,周,23,ulna and radius fracture,Anatomy and mechanism and diagnosis,多发生青少年。,24,ulna and radius fracture,Anatomy and mechanism and diagnosis,1,直接暴力,2,间接暴力,3,扭转暴力,警惕。,What,？,25,ulna and radius fracture,treatment,26,ulna and radius fracture,key points,Monteggia,骨折（,孟氏骨折）：,尺骨上,1,3,骨折合并桡骨头脱位,。,Galeazzi,骨折（,盖氏骨折）：,桡骨中下,1,3,骨折合并下桡尺并节脱位。,27,ulna and radius fracture,key points,Monteggia,or,Galeazzi,fracture,？,28,ulna and radius fracture,key points,Colles and smith fracture,桡骨型骨折,（,Colles,骨折）,最常见，多为间接暴力致伤。跌倒时腕背屈掌心触地。,骨折远段向背侧，桡侧移位，近段向掌侧移位,。,屈曲型骨折,（,Smith,骨折）,较少见。骨折发生原因与伸直型相反，故又称“,Colles”,骨折。跌倒时腕掌屈，手背触地发生桡骨远端骨折。,骨折远端向掌侧移位，骨折近端向背侧移位。,29,ulna and radius fracture,key points,Colles or smith fracture,？,30,ulna and radius fracture,key points,31,Fracture of Upper limbs,summary 4-6,周,锁骨骨折：,骨折端移位,肱骨外科颈骨折：,老人、骨折端移位,肱骨干骨折：,桡神经损伤骨折端移位,肱骨髁上骨折：,儿童、伸直型、缺血性肌挛缩,尺桡骨骨折：,盖氏与孟氏骨折、,colles,与,smith,骨折,警惕前臂骨筋膜室综合征,32,Fracture of Upper limbs,think about it,肱骨髁上骨折与肘关节脱位鉴别要点？,肱骨髁上骨折易发生何种并发症，如何预防及处理？,前臂骨筋膜室综合征的病理变化？如何进行早期诊断与早期治疗？,33,Part-two,Fracture of lower limbs,股骨颈骨折（,Fracture of the femoral neck,）,股骨粗隆间骨折（,intertrochanteric fracture,）股骨干骨折,(Hemerus shaft fracture),髌骨骨折（,femoral shaft frature,）,胫腓骨骨折,(tibiofibular fracture),踝部骨折,(ankle fractures),足部骨折,(fracture of foot),34,femoral neck Fracture,intertrochanteric fracture,多见于骨质疏松老年人。,年轻人见于强大暴力，或骨结构发育不良。,35,femoral neck Fracture,intertrochanteric fracture,股骨颈骨折,股骨头缺血性坏死,旋股内侧动脉,损伤是导致股骨头缺血性坏死的主要因素,36,femoral neck Fracture,分型,头下型、头颈型、经颈型,系囊内骨折；,基底型,系囊外骨折，因其血运好，愈合佳，与囊内骨折性质不同，故应列入股骨粗隆部骨折。,Pauwels,角,分类法：依骨折线与股骨干垂直线所成的角度分为：,型,30,；,型,3050,，,型,50,。骨折线之倾斜度愈大，愈不稳定。,Garden,分类法,37,femoral neck Fracture,intertrochanteric fracture,38,femoral neck Fracture,intertrochanteric fracture,39,femoral shaft Fracture,股骨干骨折多由强大暴力所造成。,骨折端因受暴力作用，肌群的收缩，下肢本身重力的牵拉和不适当的搬运与手法整复，发生各种不同的移位。,40,femoral shaft Fracture,treatment,41,femoral shaft Fracture,treatment,42,femoral shaft Fracture,treatment,43,femoral shaft Fracture,treatment,44,femoral shaft Fracture,treatment,45,Petellar fracture,直接暴力,间接暴力,46,Petellar fracture,克氏针张力带,47,Petellar fracture,髌骨爪,48,Petellar fracture,髌骨环,49,tibiofibular fracture,胫骨中下,1/3,常发生骨折延迟连接或不连接。,胫骨内侧紧贴皮下，直接暴力常引起开放性骨折，,骨髓炎多见,。,胫骨可以发生,疲劳性骨折,。,腓骨为非主要承重骨，移位不严重，无需特别处理。,如腓骨头及腓骨颈骨折，应注意检查腓总神经损伤,。,50,tibiofibular fracture,胫腓骨闭合性骨折易发生骨筋膜室综合征。,小腿骨筋膜室综合征,的治疗：无论小腿的闭合骨折还是开放骨折，骨折复位后密切观察，抬高伤肢，一旦考虑骨筋膜室综合征迹象，彻底行纵向切开（包括深层筋膜）缓解内压改善血循。如发现已有肌肉广泛坏死、感染、血循环不见恢复好转，必要时应施行截肢，密切注意肾功能状态，防止急性肾功能衰竭。,51,tibial plateau fracture,胫骨平台骨折,52,ankle fracture,踝部循环较差，处于极度承重位，损伤后肿胀，愈合及抗感染能力差，恢复时间长；易发生畸形和关节僵硬，严重地影响患者的承重走路功能。,53,ankle fracture,内踝骨折、外踝骨折、双踝骨折、三踝骨折,54,ankle fracture,Pilon,骨折,三踝骨折,55,ankle fracture,Pilon,骨折,三踝骨折,56,Fracture of foot,跟骨骨折,calcaneal fractures,57,Fracture of lower limbs,summary 8-12,周,股骨颈骨折：,老龄，股骨头解剖、血供特点及分型、分类,股骨粗隆间骨折：,老龄,股骨干骨折：,髌骨骨折：,胫腓骨骨折：,胫骨中下段骨折不易愈合、注意腓总 神经损伤，闭合性骨折可发生骨筋膜室综合征，关节面有骨折最重要为恢复关节面平整。,踝部骨折：,足部骨折：,58,Fracture of lower limbs,Think about it,简述股骨颈骨折的常用临床分型？,股骨颈骨折的手术治疗适应症？,胫腓骨骨折的常见并发症有哪些？,59,learning method and key point,Anatomy,M,echanism,Diagnosis,Treatment,population,displacement,Complication,师傅引进门，修行靠自身！,60,