骨盆骨折与下肢骨折.ppt

Surgical treatment FRACTURE OF TIBIA AND FIBULA 钢板治疗胫腓骨骨折 Surgical treatment FRACTURE OF TIBIA AND FIBULA 髓内钉固定 Surgical treatment FRACTURE OF TIBIA AND FIBULA 外固定支架固定 THANK YOUANY QUESTIONS ??? 　Clinical sign 髋部肿胀、皮下瘀斑 患肢短缩、外旋畸形，一般在45°~60°之间 压痛，患肢纵向叩击痛 　FRACTURE OF FEMORAL NECK Radiological Evaluation 　FRACTURE OF FEMORAL NECK X-rays AP pelvis AP and lateral view of hip CT scan Complications: Nonunion AVN of femoral head 　FRACTURE OF FEMORAL NECK Conservative treatment Indications: 无明显移位的骨折 外展型或嵌插型骨折 手术禁忌 Methods: 下肢皮牵引 丁字鞋 长期卧床并发症的防治 　FRACTURE OF FEMORAL NECK 　FRACTURE OF FEMORAL NECK Surgical treatment Indications: 移位或不稳定 老年患者，无手术禁忌 陈旧性骨折不愈合 Methods: 空心螺钉内固定 DHS或解剖钢板 半髋关节或全髋关节置换 　FRACTURE OF FEMORAL NECK Surgical treatment 空心螺钉 DHS DHS+空心螺钉 　FRACTURE OF FEMORAL NECK Surgical treatment 半髋关节置换 THA(骨水泥型） THA(生物型） INTERTROCHANTERIC FRACTURE INTERTROCHANTERIC FRACTURE Anatomy Calcar Femorale Posteromedial dense plate of bone INTERTROCHANTERIC FRACTUREClassification Tronzo evans classification AO分型 A1 A1.1:转子间线骨折 A1.2：经小转子骨折 A1.3：小转子下骨折 A2 A2.1：转子周一处骨折 A2.2：转子周多处骨折 A2.3：转子周骨折延伸小转子超1CM A3 A3.1：单纯反向斜行 A3.2：单纯横断骨折 A3.3：多处粉碎性骨折 A2 INTERTROCHANTERIC FRACTURE 　Clinical manifestation 外伤史 疼痛，肿胀，瘀斑 患肢功能障碍 　Clinical sign 压痛 纵向叩击痛 下肢短缩，外旋畸形明显，可达90° 　Radiological Evaluation X-rays CT scan Conservative treatment 骨牵引 长期卧床并发症的防治 INTERTROCHANTERIC FRACTURE Surgical treatment DHS, DCS 解剖钢板 PFN 关节置换 INTERTROCHANTERIC FRACTURE Surgical treatment INTERTROCHANTERIC FRACTURE DHS DCS 解剖钢板 Surgical treatment INTERTROCHANTERIC FRACTURE PFN 关节置换 FRACTURE OF THE SHAFT OF THE FEMUR Femoral shaft Anatomy FRACTURE OF THE SHAFT OF THE FEMUR Mechanism 直接暴力 重物打击、车轮碾压、火器性损伤 易致横行或粉碎性骨折，广泛软组织损伤 间接暴力 高处坠落伤、机器扭转易致斜形或螺旋形骨折，软组织损伤较轻 FRACTURE OF THE SHAFT OF THE FEMUR Classification FRACTURE OF THE SHAFT OF THE FEMUR Complications Popliteal artery and vein, tibial