手舟骨骨折ppt課件

1、手舟骨骨折手舟骨骨折手舟骨解剖特點(diǎn)手舟骨解剖特點(diǎn)英文名英文名“Scaphoid來(lái)源于希臘詞匯來(lái)源于希臘詞匯“skaphos，意思為，意思為“小船，將其翻譯小船，將其翻譯為為“舟狀骨舟狀骨 或又稱(chēng)之為或又稱(chēng)之為“手舟骨。手舟骨。與橈骨、月骨、頭骨、大與橈骨、月骨、頭骨、大多角骨相關(guān)聯(lián)；多角骨相關(guān)聯(lián)；外表為透明軟骨覆蓋；外表為透明軟骨覆蓋；血供較少，缺乏骨膜：血供較少，缺乏骨膜： 1.骨折一期愈合，難以骨折一期愈合，難以構(gòu)成骨痂。構(gòu)成骨痂。 2.背側(cè)支橈動(dòng)脈分支提背側(cè)支橈動(dòng)脈分支提供供70%-80%血供，主要包血供，主要包含近極；掌側(cè)支提供含近極；掌側(cè)支提供20%-30%血供，主要包含遠(yuǎn)極。血供，

2、主要包含遠(yuǎn)極。發(fā)病機(jī)制發(fā)病機(jī)制 跌倒時(shí)腕部撐地 腰部70%-80%，近極10%-20%，遠(yuǎn)極及舟狀骨結(jié)節(jié)占5%兒童骨折多以遠(yuǎn)極為多Type A (acute stable fractures)A 1 : fractures of the tubercleA2 : undisplaced “crack fracture of waistType B (acute unstable fractures)Bl : oblique fractures of distal thirdB2 : displaced or mobile fractures of waistB3 : proximal pole

3、 fractures B4: fracture dislocations of carpusB5 : comminuted fracturesType C (delayed union)Type D (established non-union)Dl : fibrous non-unionD2 : pseudarthrosisD3: Sclerotic pseudarthrosisD4: Avascular Necrosis骨折分型骨折分型病史及體格檢查病史及體格檢查外傷史，跌倒時(shí)手撐地外傷史，跌倒時(shí)手撐地 腕關(guān)節(jié)橈側(cè)腫脹、疼痛，活動(dòng)受限，腕關(guān)節(jié)橈側(cè)腫脹、疼痛，活動(dòng)受限，尤其為背伸活動(dòng)受限尤其

4、為背伸活動(dòng)受限 鼻煙窩壓痛鼻煙窩壓痛舟狀骨遠(yuǎn)端結(jié)節(jié)壓痛舟狀骨遠(yuǎn)端結(jié)節(jié)壓痛舟骨擠壓實(shí)驗(yàn)舟骨擠壓實(shí)驗(yàn)+輔助檢查輔助檢查 蝶側(cè)位蝶側(cè)位X片片 不穩(wěn)定骨折的診斷規(guī)范：不穩(wěn)定骨折的診斷規(guī)范： 1.移位超越移位超越1mm 2.成角大于成角大于10 3.粉碎性粉碎性 4.橈月角大于橈月角大于15 5.舟月角大于舟月角大于60 6.舟骨內(nèi)角大于舟骨內(nèi)角大于35輔助檢查輔助檢查 腕關(guān)節(jié)腕關(guān)節(jié)CT：評(píng)價(jià)骨折程度及不易發(fā)現(xiàn)的骨折。：評(píng)價(jià)骨折程度及不易發(fā)現(xiàn)的骨折。腕關(guān)節(jié)腕關(guān)節(jié)MRI：用于診斷隱匿性骨折，結(jié)合造影劑用：用于診斷隱匿性骨折，結(jié)合造影劑用于判別血供及有無(wú)缺血壞死的發(fā)生。于判別血供及有無(wú)缺血壞死的發(fā)生。鑒別診

5、斷鑒別診斷 舟月?lián)p傷舟月?lián)p傷腕關(guān)節(jié)扭傷腕關(guān)節(jié)扭傷腕關(guān)節(jié)軟組織挫傷腕關(guān)節(jié)軟組織挫傷其他腕骨骨折其他腕骨骨折橈骨遠(yuǎn)端骨折橈骨遠(yuǎn)端骨折治治 療療 非手術(shù)治療非手術(shù)治療-石膏固定石膏固定手術(shù)治療手術(shù)治療-切開(kāi)復(fù)位內(nèi)固定切開(kāi)復(fù)位內(nèi)固定 閉合復(fù)位內(nèi)固定閉合復(fù)位內(nèi)固定 關(guān)節(jié)鏡輔助下內(nèi)固定關(guān)節(jié)鏡輔助下內(nèi)固定 Steven J Rhemrev, Daan Ootes, Frank JP Beeres, Sven AG Meylaerts, Inger B Schipper. Rhemrev et al. International Journal of Emergency Medicine 2019, 4:4治

6、治 療療 非手術(shù)治療非手術(shù)治療-石膏固定石膏固定 順應(yīng)癥：急性、遠(yuǎn)極無(wú)位移無(wú)位順應(yīng)癥：急性、遠(yuǎn)極無(wú)位移無(wú)位移腰部骨折仍存爭(zhēng)議移腰部骨折仍存爭(zhēng)議 通常固定時(shí)間為通常固定時(shí)間為6-12周，根據(jù)周，根據(jù) 復(fù)復(fù)查情況而定查情況而定 Colles-type cast with the wrist in slight extensionJ. E. Hambidge, V. V. Desai, P. J. Schranz, J. P. Compson, T. R. C. Davis, N. J. Barton. TREATMENT BY CAST IMMOBILISATION WITH THE WRIST

7、IN FLEXION OR EXTENSION? J Bone Joint Surg Br 2019;81-B:91-2.治治 療療手術(shù)治療手術(shù)治療-斷端加壓螺釘固定斷端加壓螺釘固定 閉合閉合 OR 切開(kāi)切開(kāi) OR 其他其他 ？ 切開(kāi)復(fù)位內(nèi)固定切開(kāi)復(fù)位內(nèi)固定 切開(kāi)復(fù)位內(nèi)固定切開(kāi)復(fù)位內(nèi)固定 431 patients, Scaphoid fracture, ORIF, over a 13-year period by T. J. HERBERT S. L. FILAN, T. J. HERBERT HERBERT SCREW FIXATION OF SCAPHOID FRACTURES J Bon

8、e Joint Surg Br 2019;78-B:519-29.Table III. Rate of union related to type of fracture forpatients with at least 6 months follow-upFracture type Union Nonunion % UnionDistal oblique B1 9 1 90Waist B2 29 4 88Proximal pole B3 11 2 85Fibrous union D1 65 9 88Pseudarthrosis D2 73 37 66Sclerotic D3 25 25 5

9、0pseudarthrosisS. L. FILAN, T. J. HERBERT HERBERT SCREW FIXATION OF SCAPHOID FRACTURES J Bone Joint Surg Br 2019;78-B:519-29.閉合復(fù)位內(nèi)固定閉合復(fù)位內(nèi)固定40 patients, Scaphoid fracture, A1，B1，B2， semi-closed method of Herbert screw fixation G. INOUE, K. SHIONOYA . HERBERT SCREW FIXATION BY LIMITED ACCESS FOR ACUTE

10、 FRACTURES OF THE SCAPHOID J Bone Joint Surg Br 2019;79-B:418-21.閉合復(fù)位內(nèi)固定閉合復(fù)位內(nèi)固定 Conservative SurgicalScaphoid union 38 of 39 40 of 40Mean time for union(weeks) 9.7 4.0* 6 2.1Mean time for union intype-B fracture (weeks) 12.2 4.6 6.5 2.4Mean time to return tomanual work (weeks) 10.2 3.9* 5.8 2.2* p 0

11、.001 p 0.0001G. INOUE, K. SHIONOYA . HERBERT SCREW FIXATION BY LIMITED ACCESS FOR ACUTE FRACTURES OF THE SCAPHOID J Bone Joint Surg Br 2019;79-B:418-21.閉合復(fù)位內(nèi)固定閉合復(fù)位內(nèi)固定32 patients, Scaphoid fracture, B1, B2 and C types， percutaneous fixation of scaphoid fractures via a dorsal approach閉合復(fù)位內(nèi)固定閉合復(fù)位內(nèi)固定All

12、 fractures united over an average of nine weeks. There was no avascular necrosisSameer Naranje & P. P. Kotwal & P. Shamshery &Vikas Gupta & H. L. Nag. Percutaneous fixation of selected scaphoid fractures by dorsal approach.International Orthopaedics (SICOT) (2019) 34:9971003關(guān)節(jié)鏡輔助下內(nèi)固定

13、關(guān)節(jié)鏡輔助下內(nèi)固定234 scaphoid fractures and nonunions 126 acute injuries;65 proximal pole fractures; 67 grossly displaced fractures; 12 trans-scaphoid perilunate dislocations including four trans-scaphoid trans-capitate fractures;10 combined scaphoid and distal radius fractures. 99% union rate by CT scan in 12 weeksArthroscopy with the dorsal percutaneous implantation of a headless compression screwSlade JF 3rd, Gillon T. Retr