骨盆骨折-九院课件.pptVIP

骨盆骨折 上海第二医科大学附属第九人民医院骨科 孙月华 Radiographic Evaluation of the acetabulum Judet Views 1.Anteroposterior 2.iliac oblique 3.obturator oblique 45° Anteroposterior view 髂会阴线 髂坐骨线 髋臼前后唇 “teardrop”与髂坐线的关系 Obturator oblique view 前柱 耻骨上支 髋臼后壁 Iliac oblique view 后柱 前壁 Tomography and 3-D Reconstruction CT评估常规X线未能显示的骨折 关节内的骨折碎片,股骨头骨折 骶髂关节的骨折 3-D重建能立体的显示骨盆 Classification of Acetabular Fractures (Judet and Lelournel) Type A: Partial articular, involving only one of the two columns A1 posterior wall fracture A2 posterior column A3 Anterior column or wall Type B: partial articular, involving a transverse component B1 Pure transverse B2 T-shaped B3 Anterior Column and posterior hemitransverse Type C: Fracture (complete articular : both columns) C1 High variety, extending to the iliac C2 Low variety, extending to the anterior border of the ilium C3 Extension into the Sacroiliac joint C1/C2 (both column =Complete articular fracture) Ilioinguinal approach Involvement of the posterior column or wall extensile approach C3 ( Both column extending into SI joint) Extended Iliofemoral approach Evaluation and diagnosisThe patient 气道 呼吸 循环 伴随损伤： 长骨干骨折、脊柱、 脑部、腹腔、盆腔、泌尿道 Surgical indicationand timing 1. 病人的全身情况 2. 经济情况，需求 3. 外科医师的经验，器械 4. 骨折类型 5. 关节面的完整性 2mm 手术时间：伤后7-10天 反指征 严重骨质疏松 无移位骨折 后笠骨折碎片小 低位前柱骨折 Cefazolin for 48-72 hours Thromboembolic prophylaxis Indomethacin 75mg once daily sit up with the first 24-48 hours Actabular and limb fracture Injury of sciatic nerve (12-38%) Hip dislocation (requires prompt reduction) Malreduction or subluxation of the hip joint will lead to abnormal loading of the articular cartilage and subsequent joint arthrosis Principle that performing an accurate reduction of the articular surface, thereby obtaining surface, thereby obtaining a congruent hip joint, will restore normal joint mechanics. Reduction techniques and internal fixation Essen