ACL损伤诊断基础与进展概要.ppt

ACL的误诊 外侧半月板桶柄样撕裂卡于髁间窝的影像误认为是正常ACL 双后交叉韧带影的意义 内侧半月板桶柄样撕裂伴卡锁----双后交叉韧带影 ACL区相关病变 前交叉韧带囊肿 后交叉韧带囊肿伴髌下滑膜巨细胞瘤 前交叉韧带血管瘤 前交叉韧带血管瘤 单击此处播放 前交叉韧带后方滑膜透明软骨瘤 术前 术后 前交叉韧带后方滑膜透明软骨瘤关节镜图像 右膝前交叉韧带后外侧束变性增生、滑膜下多发囊肿 右膝前交叉韧带后外侧束变性增生、滑膜下多发囊肿 * -Pain has historically been classified as acute (such as pain following injury), chronic, or as headache. -Chronic pain had been arbitrarily defined as pain lasting greater than 6 months. -Since changes in the nervous system leading to chronic pain have been found to occur within 24 hours after injury, chronic pain is said to occur when symptoms last longer than the typical timeframe expected for resolution. This can be found even after only a few weeks. -Subcategories of pain: -Neuropathic-involves known damage to the nervous system -Mixed- Cancer often will cause both nociceptive pain as well neuropathic pain if there is invasion of neural structures. -Nociceptive- Can be divided into somatic and visceral pain -Somatic- involves ongoing pathology of bone, muscle, fascia, skin. -Visceral- Internal organs can be a source of pain due to distension, inflammation, or compression. Chronic visceral pain includes conditions such as irritable bowel syndrome, pancreatitis, and bladder pain. - It should be noted that most of these chronic conditions may have superimposed neuropathic changes of the nervous system, which provides the rationale of anticonvulsant adjunct therapy for many chronic pain conditions. ACL损伤诊断基础与进展 四川大学华西医院 运动医学/关节镜中心 李箭 教授 诊治流程 病人发病 外伤 疼痛　　 + 功能障碍 病史 + 体征+ 初步诊断 进步步检查及验证 有创伤性检查 进一步诊断 治疗方案确定 原则 最终方案确定及实施 初步方案及预实验 非手术及手术治疗 辅助检查 实验 影像 超声 X线、DAS CT MRI 检查扫描 其它 诊断能力 名称 侧别 骨、软组织 诊断能力 性质 组织 解剖部位 感染 骨病 肿瘤 损伤 畸形 特殊 一般 免疫性、病理性 疾病诊断的思维模式 病史 体征 辅助检查: 关节稳定度（KT1000或KT2000） X光 MRI 关节镜检 ACL损伤的确诊 病史 临床分期 损伤早期首次外伤史： ①扭伤（篮球运动90%、及其他运动伤） 篮球、足球运动图像 ②撞击伤（车祸、摩托车、电瓶车） ③其他 外翻外旋，有关节错动感，自己感到响声。 ACL: 损伤机制 减速运动 扭转 过伸 伤后表现 3-5分钟出现关节肿胀、血性关节液、疼痛不能马上再运动，≥2周。 逐渐恢复，又可开始运动。 第二次外伤史 出现外侧“卡