膝关节的评估及处理汇总.pptVIP

膝关节MRI Overview History Examination X-rays Fractures and Dislocations. Soft Tissue Injuries Other Knee/Lower limb Problems Anatomy of the Knee Meniscus Quads insertion Ligamentum patellae Patella Femur Tibia Medial Collateral Ligt Fibula ACL PCL HISTORY Mechanism of injury is vitally important. Flexed/Twisting Forced flexion/Hyperextension Falls/Direct Blow Swelling Rapid/Gradual Previous Knee Problems No Injury or Previous Problems? KNEE EXAMINATION Look Wasting,swelling,deformity ,redness,scars Feel Temp,Effusion,crepitus Move Passive,Active Resting position,SLR,Extension,flexion,collateral ligaments, cruciates menisci X-RAYS Ottawa Knee Rules Xrays are only required if the following are present. Isolated bony tenderness of the patella. Bony tenderness of the fibula head. Patient cannot flex knee to 90° Patient cannot weight bear (4 steps) after injury or in AE Exceptions Knee Tibia Plateau fracture Fall extended leg,compression # proximal tibia. Valgus stress, # lateral tibia plateau Varus stress, # medial tibia plateau Proximal tibia examination reveals tenderness. Swelling, haemarthrosis, ligament damage. X-ray Fracture of lateral tibial plateau Patella Facture Patella Patella Fracture Direct blow, Fall, Violent flexion, Quadriceps contraction. Pain/Swelling, Crepitus, Pain on extension Straight leg raise. Haemarthrosis X-ray Treatment Vertical Transverse High Patella Patella Dislocation Medial stress Lateral dislocation Knee in flexion. Dislocation usually obvious. Entonox Medial reduction with knee extension. Obtain X-rays, cylinder POP, Analgesia, and orthopaedic follow up. Dislocation of the Knee Dislocation Serious ligamentous and soft tissue damage. Assess above and below knee. Vascular and Nerve damage. Reduction Adequate analgesia Traction/Reduction of deformity Check Pulses and Sensation POP backslab Admission Knee Tibia Plateau Fracture Treatment Long POP backslab Orthopaedic referral Elevation ORIF/Bone grafting Haemarthrosis