席智杰桡骨远端骨折课件_1.pptVIP

手术治疗的常用固定器械 常见的钢板 掌侧切口 一枚钢板固定 外固定支架合并内固定 背侧双钢板 三钢板固定 髓内钉固定 关节镜辅助下手术. 功能锻炼 开始时间：固定后即刻开始 要求：早期进行指间关节、掌指关节、肩关节、肘关节活动 外固定拆除后进行腕关节的屈伸、旋转及前臂的旋转活动 但对于粉碎性骨折要进行早期的腕关节活动，使关节面得到模造 功能评定——4个90° 并发症分析 (1) Tendon Irritation or Rupture Due to Past-pointing of Distal Screws? All screws are past the dorsal cortex and into the tendons,? but none will be seen as too long on a lateral x-ray. 螺钉进入关节 尺月撞击症 神经损伤 Pain was persistent and disabling The patient is a 79 years old who had a?distal radius fracture which was treated with an volar plate Intraoperative view with the screw tip impinging on the posterior interosseous nerve Another intraoperative view with a better view of the screw tip. 神经损伤 骨不愈合 AAOS 指南（2011） 指南推荐的内容共有29条 14条是目前没有结论（争论的焦点） 7条有结论，但证据强较低 5条证据强度中等 3条有专家的一致意见  切开复位内固定术的适应证：复位后短缩移 位 3mm, 背侧倾斜10 °, 关节内移位2mm 非手术疗法治疗有移位骨折时坚强制动优于夹板固定 不必要进行早期的腕关节活动 Vitamin C 可以预防不相称性疼痛 复位后侧位X线片评价下尺桡关节的稳定性 5条证据强度中等 问题和争论 如此众多的治疗方法却缺乏大样本前瞻性研究结果来说明哪种治疗最有效？ 解剖复位对后期的功能恢复是必须的吗？ 锁定钢板固定后早期腕关节活动能改善临床结局吗？ 影像学上的退变改变和较差的临床结局之间有明确的关系吗？ 总结 定义（掌握） 流行病学（了解） 解剖学和生物力学（掌握） 发病机制（掌握） 骨折分类（掌握） 诊断（掌握） 治疗（掌握） 进展和争论（了解） 敬请批评指正！ * * * * * Smith’s 骨折 1847 Robert William Smith?considered this an injury of exceedingly rare occurrence, but its description heralded the age of vehicular trauma in 1847: The patient, in endeavouring to save himself from being run over by a car, fell with great violence upon the back of his hand . . . Robert William Smith?(1807-1873) The classic Bartons fracture describes the dorsal rim fracture subluxation, a shear-type injury. John Rhea Bartons addresses the difference between a true dislocation and this fracture: a dislocation typically has no crepitus, and once reduced tends to remain that way John Rhea Barton(1794-1871) Barton’s 骨折(1838) Die punch 骨折 die punch fracture, or lunate load impact fracture of the posteromedial corner of the radius, was more recently described by?Scheck The absence of ligamentous attachments to the depre