桡骨远端骨折.ppt

Company Logo 治疗未达成共识 * 美国骨科医师协会 * 背侧成角大于20，背侧粉碎，桡腕关节受累，合并尺骨骨折 * 桡侧腕伸肌和拇长伸肌 * 外周神经麻痹 * 指浅屈和尺侧腕屈肌 * 旋后、屈、伸 * 桡骨远端骨折的诊治 Introduction Indications Approaches Techniques Conclusion Main Contents Introduction 桡骨远端骨折：距桡骨远端关节面3cm以内的骨折 松质骨与皮质骨交接区，解剖薄弱区 上肢骨折中最常见的骨折 First noted by J.L. Petit in the 18th century Represents 16% of all fractures managed by orthopaedic surgeons   Bucholz RW, et al. Fractures In Adults. Lippincott Williams Wilkins,2010 Our understanding of distal radius fractures developed over centuries, but the treatments remained without consensus. Indications 骨折端有肌肉或肌腱等软组织嵌入 关节内骨折 手法复位未能达到功能复位的标准 骨折合并血管、神经损伤 不稳定性骨折 多发骨折，便于护理和治疗，防止并发症 陈孝平, 汪建平. 外科学[M]. 第8版. 北京: 人民卫生出版社, 2013:638. . Indications Indications for operative fixation in 2000 fractures cannot be closed or reduced unstable fractures open fractures polytrauma patients concomitant carpal fracture severe articular displacement Chung KC, et al. Predictors of functional outcomes after surgical treatment of distal radius fractures. J Hand Surg Am. 2001. Indications The American Academy of Orthopedic Surgeons(AAOS) in 2009 Intra-articular displacement or step off greater than 2 mm Radial shortening greater than 3 mm Dorsal tilt greater than 10° from neutral Lichtman DM, et al. Treatment of distal radius fractures. J Am Acad Orthop Surg. 2010. Indications 新标准（ AAOS ，2014） Initial dorsal angulation 20° Dorsal comminution Radiocarpal intra-articular involvement Associated ulna fracture Fractures with 3 factors are associated with surgery Watters WC, et al. The American Academy of Orthopaedic Surgeons Appropriate Use Criteria on the treatment of distal radius fractures. J Bone Joint Surg Am. 2014. Approaches 背侧入路 桡侧腕伸肌和拇长伸肌之间  Approaches 掌侧入路/“Henry approach” 桡侧腕屈肌和桡动脉之间 Satake H,et al. Complications?of?Distal?Radius Fractures?Treated?by?Volar?Locking?Plate?Fixation. Orthopedics,?2016.? Approaches 掌尺侧入路 指浅屈肌和尺侧腕屈肌之间 固定骨折端的孤立性骨折 桡骨茎