张候(Z-H的)骨折.pptxVIP

张候骨折（Z-H骨折）胫骨下1/3螺旋骨折合并后踝骨折;定义;病因——胫骨骨折;病因——后踝骨折;Z-H骨折分型;Z-H骨折分度;漏诊原因分析;According to our retrospective study, in the 1,685 fractures of the tibia, 288 cases showed spiral fractures of the tibia, which were combined with PMFs in 28 cases, the PMF incidence was 9.7%. However, in our prospective study, 30 (88.2%) of 34 fractures of the tibia were combined with the PMFs. ; Plain radiographs are often insuf?cient for detecting posterior malleolus fractures in conjunction with ipsilateral distal third diaphyseal tibia fractures. Using a preoperative CT protocol for tibial shaft fractures can signi?cantly improve the ability to diagnose associated intra-articular fractures that may not be evident on plain radiographs. Knowledge of these associated intra-articular fractures may prompt fracture stabilization and can prevent displacement during intramedullary nailing of tibia shaft fractures. ;Concomitant ipsilateral ankle and distal one- third spiral tibial shaft fractures are more common than previously reported. Utilizing a new imaging protocol, we found that the incidence of this combined injury was 84 %. Recognition of the ankle fracture component in this tibial shaft cohort can be important as it may alter the surgical plan and postoperative management;分度与治疗方式的选择;胫骨远端骨折合并后踝骨折，术中应先固定后踝 美国学者 Harish Kempegowda 进行了一项回顾性研究，分析胫骨远端骨折和后踝骨折的关系，并探讨其骨折固定的先后次序。研究发现，后踝骨折常常伴有胫骨远端螺旋型骨折。为了避免术中骨折块移位，作者建议先固定后踝，再行髓内钉固定胫骨;病例分享;张水金，女，54岁，入院日期：2016.6 跌倒致右小腿肿痛3小时 诊断：开放性胫腓骨骨折（gustiloI型） 后踝——髓内钉;梁敏玲，女，50岁，入院日期：2015.10.6 主诉：扭伤致右小腿肿痛，活动受限2天 后踝——胫骨;林天霞，女，24岁，入院日期：2015.5 主诉：跌倒致右小腿肿痛，活动受限10小时;庄俊瑟，女，52岁，入院日期：2016.4 跌倒致右下肢肿痛，活动受限4小时;陆东兴，男，，入院日期：2015.4 主诉：扭伤致右小腿肿痛，活动受限2天;谢谢聆听