前臂双骨折的手术入路培训课件.pptVIP

BICEPSTENDONRADIALARTERYFLEXORCARPIRADIALIS(FCR)

AusefultechniquetomaketheskinincisionistotakeabovicordandpullittaughtfromtheradialsideofthebicepstendontotheFCRatthelevelofthewrist.Thiscanthenbeusedasatemplatefortheincisionline.

Theincisionistakendownthroughtheskin,identifyingthefasciallayerwithcaretakennottodamageanysuperficialveinsthatmaybeintact.TheFCRtendonisclearlyvisiblethroughoutthewound,asistheradialarteryinthedistalextentofthewound.FCRRADIALARTERY

RADIALARTERYANDVENOUSCOMMTANTES

FCRRADIALARTERYThefasciaontheradialsideoftheflexorcarpiradialisisreleased,exposingthedeeptissue.Theradialarterycanbefollowednowthroughouttheentireincision.

Theradialarterymaybetakenineitherdirection,however,typicallyitiseasiertotakethearterytotheradialside.FCRRADIALARTERY

Thedeepdissectionisnowperformedbetweentheflexor-pronatormassontheulnarsideandthearteryandthemobilewadontheradialside.

PRONATORFortheproximaldissection,theforearmisbroughtintosupinationandthepronator,FDSandFDParereleasedfromthevolaraspectoftheradius

FDSThepronatorisbeingreleasedfromtheradialaspectoftheradiusinasubperiostealmanner.Thissubperiostealdissectioncontinuesdistallytoreleasetheoriginofthecommonflexor.

Afterexposureofthevolaraspectoftheradiusproximallyanddistally,twoclampscanbeplacedontheendsoftheboneinordertodeliverthemforcleaning.

FCRRADIALARTERYEachsideofthefractureisbedeliveredinordertoexposeandcleanthecorticaledges.

Oncethefracturesarecompletelycleanedalongtheircorticaledgessuchthatthefracturereductioncanbevisualized,thetwoclampsareusedtoreducethefracture.Ifabutterflyfragmentexists,itisnecessarytofixthiswithalagscrewbacktooneofthefractureendsinordertorealignthefracture.

Inthecurrentcase,