骨盆骨折九院課件

1、骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件Radiographic Evaluationof the acetabulumRadiographic EvaluationJudet Views1.Anteroposterior2.iliac oblique3.obturator oblique45Judet Views45Anteroposterior view髂會陰線髂坐骨線髖臼前后唇“teardrop”與髂坐線的關(guān)系A(chǔ)nteroposterior view髂會陰線Obturator oblique view前柱恥骨上支髖臼后壁Obturator oblique view

2、前柱Iliac oblique view后柱前壁Iliac oblique view后柱Tomography and 3-D ReconstructionCT評估常規(guī)X線未能顯示的骨折關(guān)節(jié)內(nèi)的骨折碎片,股骨頭骨折骶髂關(guān)節(jié)的骨折3-D重建能立體的顯示骨盆Tomography and 3-D Reconstruct骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件Classification of AcetabularFractures (Judet and Lelournel)Classification of Acetabular骨盆骨折九院課件骨盆骨折九院課件ChondrolysisClass

3、ification of Acetabular外科醫(yī)師的經(jīng)驗，器械Kocher-Langenbeckand internal fixationThe four most frequently used approaches are:“King Tong” and “Queen Tang” Clamps=Complete articular fracture)Extended iliofemoralcolumn or wallExtended Iliofemoral approachB3Anterior Column and posterior hemitransverseC1High vari

4、ety, extending to the iliacinadequate reduction, articularK-L approach (prone)Injury of sciatic nerve (12-38%)of the acetabulum手術(shù)時間：傷后7-10天A2 (posterior column) K-L approachcolumn or wallType A: Partial articular, involving only one of the two columnsA1 posterior wall fractureA2 posterior columnA3 A

5、nterior column or wallChondrolysisType A: Partial arType B: partial articular, involving a transverse componentB1Pure transverseB2T-shapedB3Anterior Column and posterior hemitransverseType B: partial articular, invType C: Fracture (complete articular : both columns)C1High variety, extending to the i

6、liac C2Low variety, extending to the anterior border of the iliumC3Extension into the Sacroiliac jointType C: Fracture (complete artC1/C2 (both column =Complete articular fracture)Ilioinguinal approachInvolvement of the posteriorcolumn or wallextensile approachC1/C2 (both columnC3( Both column exten

7、ding into SI joint) Extended Iliofemoral approachC3( Both column extending 骨盆骨折九院課件Evaluation and diagnosisThe patient氣道 呼吸 循環(huán)伴隨損傷： 長骨干骨折、脊柱、 腦部、腹腔、盆腔、泌尿道Evaluation and diagnosisThe pSurgical indicationand timingSurgical indicationand timing1. 病人的全身情況2. 經(jīng)濟情況，需求3. 外科醫(yī)師的經(jīng)驗，器械4. 骨折類型5. 關(guān)節(jié)面的完整性 2mm1. 病人

8、的全身情況手術(shù)時間：傷后7-10天反指征嚴(yán)重骨質(zhì)疏松無移位骨折后笠骨折碎片小低位前柱骨折手術(shù)時間：傷后7-10天pulmonary embolism=Complete articular fracture)Extended iliofemoralClassification of AcetabularA2 posterior columnThe four most frequently used approaches are:one of the two columnsIliac oblique view外科醫(yī)師的經(jīng)驗，器械B3Anterior Column and posterior hem

9、itransversefull weight bearing=Complete articular fracture)關(guān)節(jié)面的完整性 2mmInvolvement of the posterior“King Tong” and “Queen Tang” Clampscolumn or wallHip dislocationA2 (posterior column) K-L approachapproach-lateral decubitusIlioinguinalCefazolin for 48-72 hours Thromboembolic prophylaxis Indomethacin

10、75mg once daily sit up with the first 24-48 hourspulmonary embolismCefazolin foActabular and limb fractureInjury of sciatic nerve (12-38%)Hip dislocation(requires prompt reduction)Actabular and limb fractureMalreduction or subluxation of the hip joint will lead to abnormal loading of the articular c

11、artilage and subsequent joint arthrosisMalreduction or subluxation ofPrinciple that performing an accurate reduction of the articular surface, thereby obtaining surface, thereby obtaining a congruent hip joint, will restore normal joint mechanics.Principle that performing an aReduction techniquesand

12、 internal fixationReduction techniquesEssential reduction tools distractorJudet fracture tablemanual reduction“King Tong” and “Queen Tang” ClampsEssential reduction tools disThe majority of acetabular fractures can be managed through a single surgical approach, but combined approaches are also feasi

13、bleThe majority of acetabular frThe four most frequently used approaches are:1. Kocher-Langenbeck2. Ilioinguinal3. Extended iliofemoral4. Combination of 1) and 2)The four most frequently used Interaoperative traction Indirect reduction which have retained their capsular or soft-tissueInteraoperative

14、 traction IndirA dislocated Sacroiliac joint or displaced sacral fracture is usually reduced first and fixed. Prior to the reduction of the acetabular fractureA dislocated Sacroiliac joint Involvement of the posteriorAnteroposteriorDuring the third month, depending on radiographic evidence of healin

15、g,column or wallExtended Iliofemoral approach手術(shù)時間：傷后7-10天IlioinguinalJudet fracture tablepulmonary embolismIliac oblique viewExtended Iliofemoral approachfull weight bearingKocher-LangenbeckFractures (Judet and Lelournel)pulmonary embolism“King Tong” and “Queen Tang” ClampsIiloinguinal approach手術(shù)時間：

16、傷后7-10天K-L or ilioginguinal3-D重建能立體的顯示骨盆A1 (posterior wall) Kocher-langenbeckapproach-lateral decubitusA2 (posterior column) K-L approachA3 (anterior wall or column) Iiloinguinal approachInvolvement of the posteriorA1B1 (pure transverse)K-L approach (prone)B13 extensile approachB2 (T-shaped)K-L or i

17、lioginguinalB3 (anterior column posterior hemitransverse)Ilioinguinal or K-L or extended iliofemoralB1 (pure transverse)Weight bearing is not advanced for 6-8 weeksDuring the third month, depending on radiographic evidence of healing, the patient is allowed to full weight bearingWeight bearing is no

18、t advanced骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件B1Pure transverseKocher-LangenbeckIlioinguinal approachJudet fracture tablefull weight bearingA1 (posterior wall) Kocher-langenbeckfull weight bearingEssential reduction toolsfull weight bearingA1 posterior wall fractureExtended iliof

19、emoralKocher-LangenbeckIlioinguinalfull weight bearingB2 (T-shaped)Injury of sciatic nerve (12-38%)extensile approachJudet ViewsChondrolysisA1 (posterior wall) Kocher-langenbeckB1Pure transverse骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件Postoperative managementrehabilitationPostoperative managementrehabThe thi

20、rd day, patient are allowed toe-touch weight bearing using crutches.Strengthening exercises and gait trainingThe third day, patient are allComplicationsComplicationsEarlyNeurovascular injuryinadequate reduction, articularpenetration of hardware,pulmonary embolismEarlyNeurovascular injuryLateHeteroto

21、pic ossificationChondrolysisavascular necrosisposttraumatic arthrosisLateHeterotopic ossificationInjury of sciatic nerve (12-38%)A dislocated Sacroiliac joint or displaced sacral fracture is usually reduced first and fixed.column or wallone of the two columnsThe majority of acetabular fractures can

22、be managed through a single surgical approach, but combined approaches are also feasibleNeurovascular injuryHip dislocation“teardrop”與髂坐線的關(guān)系手術(shù)時間：傷后7-10天both columns)Essential reduction toolsIliac oblique viewTomography and 3-D ReconstructionA2 (posterior column) K-L approachAnteroposteriorB13 extens

23、ile approach=Complete articular fracture)A3 (anterior wall or column)and internal fixationExtended iliofemoralInjury of sciatic nerve (12-38骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件Thank YouThank You骨盆骨折九院課件骨盆骨折九院課件骨盆骨折九院課件C1/C2 (both column =Complete articular fracture)Ilioinguinal approachInvolvement of the posteriorcolumn or wallextensile approachC1/C2 (both column骨盆骨折九院課件The four most frequently used approaches are:1. Kocher-Langenbeck2. Ilioinguinal3. Ex