上肢骨折重点.ppt

Upper extremity fractures Orthorpeadic department of the second affiliated hospital of Chongqing Medical University Dr. Liang main content Clavicular fracture（锁骨骨折） fracture of the proximal humerus（肱骨近端骨折） Humeral shaft fracture（肱骨干骨折） ?supracondylar fracture of humerus （肱骨髁上骨折） fracture of radius and ulna （尺桡骨骨折） distal?radius fracture（桡骨远端骨折） Section 1 fracture of clavicle 解剖概要（anatomy review） function：connect the arm to the trunk(躯干) shape：“S” shape and irregular(不规则) Lateral 1/3 part:flat；middle 1/3 part: cylindrical ，weak；medial 1/3 part:prismatic(陵柱状)?shape joint：lateral-acromioclavicular?joint肩锁关节；medial-sternoclavicular?joint胸锁关节 ligament韧带：acromioclavicular ligament肩锁韧带，Coracoclavicular ligament喙锁韧带:trapezoid ligament (斜方韧带) conoid ligament锥状韧带 ?adjacent?structure毗邻结构：Subclavian vessels锁骨下血管，brachial?plexus臂丛神经 adjacent?structure毗邻结构 毗邻结构 ?mechanism?of?injury and fracture displacement受伤机制及骨折移位 Indirect Violence间接暴力 Fall with the shoulder hitting the ground侧方摔倒，肩部着地 Result in transverse or oblique fracture多导致横行骨折或斜行骨折 Indirect Violence直接暴力 Hit directly直接击打 ?Comminuted fracture可导致粉碎骨折 （中1/3）骨折移位（fracture displacement in the middle third）：proximal fragment displaced proximally and posteriorly 近端向上、后移位（draw by the sternocleidomastoid 胸锁乳突肌牵拉），the distal fragment displaced inferiorly and anteriorly (caused by gravity and the traction of the deltoid)远端向前下移位（三角肌锁骨部牵拉及重力）。 fracture classification（骨折分类） According to the fracture site解剖部位：lateral外侧，middle中段，medial内侧 Fracture morphology骨折形状：横行(transverse)，斜行(oblique)，粉碎(comminuted) 外1/3骨折分型： typeⅠ型：fracture locates between the acromioclavicular lig. and the Coracoclavicular lig. With minimum displacement位于肩锁韧带与喙锁韧带之间，移位不明显。 typeⅡ型：with damage of the Coracoclavicular lig. The proximal fragment displaced superiorly.合并喙锁韧带损伤，骨折近端向上移位。 Type Type Ⅲ型：the acromioclavicular?joint involved骨折累及肩锁关节 Ⅱ型 A .B Clinical manifestations and diagnosis临床表现及诊断 Clinical manifestations clinical sign (症状)：pain疼痛，limitation of motion活