踝关节的稳定性-科赖娘交流3.pptVIP

踝关节的稳定性;踝关节稳定性—距骨在踝穴内有无侧方倾斜、侧方移位、前后移位及其可能性。;内侧结构及相关损伤;内侧结构损伤;内踝骨折小，前结节骨折可合并三角韧带后部（深层）损伤，虽将前结节固定，但距骨仍可外移→不稳定 前结节骨折，内侧间隙＞2mm,深层三角韧带损伤，如合并腓骨骨折则踝穴不稳定 ;内踝骨折侧位片＜1.7cm，可能合并三角韧带深层断裂，固定骨折后不稳定 内踝骨折侧位片＞2.4cm，所有三角韧带附丽于骨折部，固定骨折后稳定 前结节骨折合并三角韧带深层（后部）断裂，固定骨折后距骨仍可外移，术中应探查深层！ ;前结节骨折：旋后外旋或旋前外旋损伤 后结节骨折也是旋后外旋损伤，由于胫后肌腱、屈趾长肌腱的作用而稳定 内侧结构是稳定踝关节的关键 只有内侧结构损伤，距骨始有可能外移 内踝固定（三角韧带完整）则距骨稳定;外侧结构及相关损伤;勿漏诊腓骨高位骨折 腓骨挤压试验（Fibular Compression test) 沿腓骨干检查压痛 Maisonneuve骨折 ;外踝骨折内固定;外踝韧带断裂 足内翻→腓距前韧带断裂，前抽屉试验阳性→腓跟韧带断裂，前抽屉试验强阳性;外侧韧带损伤的治疗 新鲜损伤：外翻位短腿石膏固定4-6周 撕脱骨折内固定 康复期—足底外侧垫高1cm 陈旧损伤：外踝韧带重建术--腓骨短肌腱移位;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;后侧结构及相关损伤;下胫腓联合 下胫腓韧带：前韧带、骨间韧带（与骨间膜连续）、后韧带、横韧带 下胫腓分离的条件：内侧结构损伤（内踝或三角韧带断裂）、下胫腓韧带损伤、骨间膜损伤（或由腓骨中下1/3骨折）;Maisonneuve骨折 腓骨高位骨折、三角韧带断裂或内踝骨折、下胫腓分离 无骨折之下胫腓分离 三角韧带断裂，下胫腓韧带断裂，骨间膜损伤 ;下胫腓分离的诊断;下胫腓固定 B型、C型骨折内侧为三角韧带损伤 或内踝固定后，钩拉腓骨下胫腓不稳定 腓骨高位骨折或无骨折之下胫腓分离 陈旧骨折脱位切开复位后;下胫腓固定方法;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;踝关节骨折脱位分类;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.