前臂双骨折的手术入路PPT.ppt

尺桡骨双骨折;AP and lateral views of the both bones fracture of the forearm, demonstrating significant shortening and relatively simple oblique fracture patterns.;The patient is positioned supine with the arm prepped and draped to just above the elbow and a tourniquet in place. This figure demonstrates the arm held in supination. Note the position of the biceps insertion as well as the palpable tendon of the FCR and radial artery.;A useful technique to make the skin incision is to take a bovi cord and pull it taught from the radial side of the biceps tendon to the FCR at the level of the wrist. This can then be used as a template for the incision line.;The incision is taken down through the skin, identifying the fascial layer with care taken not to damage any superficial veins that may be intact. The FCR tendon is clearly visible throughout the wound, as is the radial artery in the distal extent of the wound.;FCR;The radial artery may be taken in either direction, however, typically it is easier to take the artery to the radial side.;The deep dissection is now performed between the flexor-pronator mass on the ulnar side and the artery and the mobile wad on the radial side.;PRONATOR;FDS;After exposure of the volar aspect of the radius proximally and distally, two clamps can be placed on the ends of the bone in order to deliver them for cleaning.;FCR;These figures demonstrate delivery of the distal fragment and a curved curette being used to clean the cortical edge. No cleaning should be performed within the intramedullary canal,as this is healthy tissue and can be useful for the healing process.;Once the fractures are completely cleaned along their cortical edges such that the fracture reduction can be visualized, the two clamps are used to reduce the fracture. If a butterfly fragment exists, it is necessary to fix this with a lag screw back to one of the fracture ends in order to realign the fracture.;;Once the bones are held reduced, as seen in the follo