中文骨折概論課件

中文骨折概論骨折定義Definition骨折－－骨的連續(xù)性中段Afractureisabreakinthecontinuityofabone.Dept.Orthopedics,1stHospitalSUMS外力引起骨折

ForcesfractureDirectviolence(直接暴力)Indirectviolence（間接暴力）Forcefulpullofmuscles（肌肉拉力引起撕脫骨折）Repeatedstress（重復(fù)應(yīng)力引起疲勞骨折）-----causefatiguefractureBonedisease（骨病變引起病理骨折）-----pathologicalfracDept.Orthopedics,1stHospitalSUMS直接暴力引起橫斷骨折，粉碎性骨折DirectviolenceDept.Orthopedics,1stHospitalSUMS直接暴力Directviolence間接暴力引起螺旋型骨折Indirectviolence(rotational)骨腫瘤容易并發(fā)病理骨折BonetumorDept.Orthopedics,1stHospitalSUMS直接暴力Directforce間接暴力引起骨折和脫位Fracture&dislocationcausedbyIndirectviolence車禍CaraccidentDept.Orthopedics,1stHospitalSUMS骨折分類：閉合/開放骨折

Closed/openfracture根據(jù)骨折斷端是否與皮膚或體腔相通，分為開放性和閉合性骨折Basedonwhetherthereiscommunicationbetweenfractureandskin(bodycavities)閉合骨折Closedfractures開放骨折Openfractures:傷口容易引致感染，因此，需要急診手術(shù)處理傷口和骨折Dept.Orthopedics,1stHospitalSUMSOpenfracDept.Orthopedics,1stHospitalSUMSPatternsoffracture

骨折類型Incompletefracture不全骨折Completefracture完全性骨折Dept.Orthopedics,1stHospitalSUMS不全骨折

Incompletefracture:partialbreakCrackfracture（裂紋骨折）

Greenstickfracturesinchildren青枝骨折不完全性骨折容易引起漏診Dept.Orthopedics,1stHospitalSUMS.兒童的青枝骨折GreenstickfractureofdistaltibiaoccursinchildrenDept.Orthopedics,1stHospitalSUMSCompletefracture

完全性骨折大多數(shù)的骨折屬于完全性骨折CompletebreakoftheinjuredboneMostfracturesDept.Orthopedics,1stHospitalSUMS骨折類型Patternsoffracture根據(jù)骨折線、形狀和程度可分為Basedonfractureline/shape/degrees:Transversefracture（橫形）Oblique（斜形）Spiral（螺旋形）Comminuted(withmorethantwofragments）（splintered)（粉碎性）Compressfra./crushfracture（壓縮性）Impactedfracture（嵌插）Dept.Orthopedics,1stHospitalSUMSStabilityoffracture

骨折的穩(wěn)定性穩(wěn)定型骨折Stablefracture:復(fù)位后不容易發(fā)生移位的骨折，如橫型骨折、嵌插骨折、青枝骨折等noteasilydisplaceafterreductiontransverse,compacted,greenstick不穩(wěn)定骨折Unstable:復(fù)位后容易發(fā)生移位，如斜型骨折、螺旋型骨折，粉碎性骨折等atendencytoredisplaceafterreductionoblique,spiralandcommunitedfractureDept.Orthopedics,1stHospitalSUMSFactorsforfracturedisplacement

骨折移位的因素1.Forcefromtheinjury（外力）2.Gravityorweightofdistalpartofaffectedlimb（重力）3.Pullofmusclesaroundthefracture（肌肉牽拉力）4.Incorrectmovingofthepatientandunsuitablemanipulation（人為因素）Dept.Orthopedics,1stHospitalSUMSTypeoffracturedisplacement

骨折移位類型Angulation成角Lateraldisplacement側(cè)方移位Overlapdisplacement重疊Separatedisplacement分離Rotational旋轉(zhuǎn)Comminutedfrac.粉碎mixtogether混合多數(shù)骨折為混合型骨折Dept.Orthopedics,1stHospitalSUMS骨折的類型與移位與治療選擇有關(guān)與預(yù)后有關(guān)Dept.Orthopedics,1stHospitalSUMS.完全Completefrac橫型Transversefrac.成角Angulation穩(wěn)定Stablefrac.Dept.Orthopedics,1stHospitalSUMS.完全Completefrac.斜型Obliquefrac.不穩(wěn)定Unstablefrac.成角Angulationdisp.Dept.Orthopedics,1stHospitalSUMS.完全Completefrac.螺旋Spiralfrac.短縮重疊Shortening(overlap)側(cè)方移位Lateraldisp.分離Separatefrac.不穩(wěn)定Unstablefrac.Dept.Orthopedics,1stHospitalSUMS.粉碎Comminutedfrac.Dept.Orthopedics,1stHospitalSUMS多發(fā)骨折MultiplefractureDept.Orthopedics,1stHospitalSUMS.多發(fā)Multiplesegmentalfrac.粉碎Comminutedfrac.Dept.Orthopedics,1stHospitalSUMS.CoxaVara髖內(nèi)翻分離Separate粉碎comminutedDept.Orthopedics,1stHospitalSUMS.

請(qǐng)分析骨折類型Whatisthetypeoffra.?Dept.Orthopedics,1stHospitalSUMSHealingoffracture

骨折愈合骨折愈合時(shí)間與眾多因素有關(guān)，包括年齡，全身情況，局部血供，骨折部位和類型骨折愈合通常需要6～8周以上Howlongdoesafracturetaketounite?Dependonmanyfactors:-----age,patientcondition,localbloodsupply,typeandsiteoffracture…Dept.Orthopedics,1stHospitalSUMS.骨痂CallusinfracturehealingDept.Orthopedics,1stHospitalSUMSFactorsthatinfluenceunion

影響骨折愈合因素Generalcondition全身情況Age年齡Healthycondition健康狀況疾病情況Dept.Orthopedics,1stHospitalSUMS影響骨折愈合的局部因素

LocalfactorforfractureunionTypesofbone骨的類型Sites,types,severityoffracture骨折因素多發(fā)骨折、分離骨折、粉碎骨折、股骨頸骨折、脛骨遠(yuǎn)端骨折等影響骨折愈合union↓multiplefrac.Separatefrac.Comminutedfrac.femoralneckfrac.distalpartoftibiaDept.Orthopedics,1stHospitalSUMS影響骨折愈合的局部因素

LocalfactorforfractureunionBloodsupply血供，局部血供與骨折的解剖部位、骨折類型、嚴(yán)重程度、軟組織損傷程度和感染有關(guān)Relatedwithanatomicalsite,types,severityoffractureandsofttissueinjureSevereinjuryofsofttissueInfection

Dept.Orthopedics,1stHospitalSUMS影響骨折愈合的因素

Factorsthatinfluenceunion不恰當(dāng)?shù)奶幚鞺nsuitablemanagement:反復(fù)多次復(fù)位repeatedreduction過度牽引excessivetraction:separation不恰當(dāng)?shù)倪\(yùn)動(dòng)unsuitableimmobility:movement固定不可靠unstablefixationDept.Orthopedics,1stHospitalSUMSClinicalmanifestationoffracture(骨折臨床表現(xiàn)）History:injury外傷史Generalcondition全身情況:Shock?Hemorrhage?是否有休克、出血Damagetobrain?Tolungsandheart?Toabdomen?Tospinalcord?Toothers?是否有重要器官損傷？Itisimportanttolookforotherinjuries.重視重要器官損傷是重要的

Dept.Orthopedics,1stHospitalSUMS骨折的局部表現(xiàn)

LocalmanifestationSpecificsignsoffracture

骨折特有體征Deformity畸形Abnormalmobility(movementbetweenthefragments)反?；顒?dòng)Crepitus骨擦感或骨擦音三者中有一可作出診斷，但三者都沒有不可以否定骨折OneofthemcanmakediagnosisCaution:noneofthemisfoundinsomefractures.Dept.Orthopedics,1stHospitalSUMS骨折的其他表現(xiàn)，但沒有特異性

Othersignsoffracture

notspecificSwelling腫脹Bruising(ecchymosis)淤斑Tenderness壓痛Impairmentoffunction功能障礙以上表現(xiàn)沒有特征性，但可提供參考Allsingsabovearenotspecifictofracture.Dept.Orthopedics,1stHospitalSUMS當(dāng)你處理骨折患者時(shí)，需要了解AskyourselfwhenyoudealwithafractureAwound?Openfracture?是否開放骨折Anyimpairmentofcirculation?局部血液循環(huán)情況Anyevidenceofnerveinjury?是否有神經(jīng)損傷？Anyevidenceofvisceralinjury?是否有重要器官損傷？Compartmentsyndromes?是否有骨筋膜室綜合骨筋膜室綜合征Dept.Orthopedics,1stHospitalSUMSTestforcheckingcirculation

檢查患肢血循環(huán)Color皮膚顏色Warmth皮溫Arterialpulse搏動(dòng)Capillaryreturn毛細(xì)血管回流Nerveconductivity神經(jīng)功能Specifictests:Dopplerultrasonographyorarteriography特殊檢查：超聲，血管造影Dept.Orthopedics,1stHospitalSUMS影像學(xué)檢查

RadiographicexaminationX線檢查是最基本、最必須的檢查X線照片可明確骨折的部位、類型X-ray(plainfilm)isimportant,basicandinevitablefordiagnosisandtreatment.X-raycanshow:fractureSiteoffractureTypeoffractureDept.Orthopedics,1stHospitalSUMSX線檢查

X-rayexamination需要對(duì)有懷疑骨折的病人進(jìn)行X線檢查MusttakeX-rayfilmforeachsuspectfractureDept.Orthopedics,1stHospitalSUMS股骨粗隆間骨折IntertrochantericfactureoffemurDept.Orthopedics,1stHospitalSUMS多發(fā)骨折MultiplefracDept.Orthopedics,1stHospitalSUMSA-PviewshownormalLateralviewshowdisplacement正側(cè)位檢查的必要性Dept.Orthopedics,1stHospitalSUMSA-PviewLateralviewX線檢查的正側(cè)位TwodirectionviewsDept.Orthopedics,1stHospitalSUMSCTorMRI骨盆、脊柱等一些特殊部位需要CT或MRI檢查意義：骨折移位情況，與周圍結(jié)構(gòu)的關(guān)系，指導(dǎo)治療Necessaryinfracturesofspineandpelvis,orinsomespecificfrac.Significance:displacementoffragmentsRelationbetweenfragmentsandnearbystructureGuidefortreatmentDept.Orthopedics,1stHospitalSUMS髖臼骨折

Acetabularfrac.

Dept.Orthopedics,1stHospitalSUMSComplicationoffracture

骨折并發(fā)癥Earlycomplication早期并發(fā)癥1.Shock休克2.Infection感染3.Viscerainjury內(nèi)臟損傷肋骨骨折Ribfractureinjuretolungs,liver,spleen(rupture)骨盆骨折Pelvicfractureinjuretobladder,rectalDept.Orthopedics,1stHospitalSUMSComplicationoffracture4.Mainarteryorveininjury血管損傷5.Spinalcordinjury脊髓損傷6.Peripheralnerveinjury周圍神經(jīng)損傷7.Lipoembolization脂肪栓塞8.compartmentsyndrome骨筋膜室綜合征Dept.Orthopedics,1stHospitalSUMSMiddleandlatestagecomplication

后期并發(fā)癥1.Pneumonia肺炎2.Bedsore褥瘡3.DVT深靜脈血栓形成4.Ossification(ossifyingmyositis)骨化性肌炎Dept.Orthopedics,1stHospitalSUMSComplicationoffracture5.Traumaticarthritis創(chuàng)傷性關(guān)節(jié)炎6.Stiffofjoint關(guān)節(jié)僵硬7.ischemicnecrosisoftheaffectedbone骨壞死8.Ischemiccontratureoftheaffectedmuscle缺血性肌攣縮9.Boneatrophy,Sudeck’satrophy骨萎縮10.感染、骨髓炎Dept.Orthopedics,1stHospitalSUMSTreatmentoffracture

骨折治療Firstaid急救:1.Savelives搶救生命2.dressingofwoundandcontrolbleeding(hemostasia)包扎傷口，止血3.temporaryimmobilizationofthefracturedlimbs骨折臨時(shí)固定4.rapidtransportation迅速送醫(yī)院Dept.Orthopedics,1stHospitalSUMSPrincepleofTreatment

forfracture

骨折治療原則Reduction復(fù)位Immobilization固定Preservationoffunctionorfunctionalexercise功能鍛練Dept.Orthopedics,1stHospitalSUMSReduction復(fù)位Restoretonormalposition----Correctdeformity注意骨折的對(duì)線和對(duì)位AlignmentismoreimportantthanappositionDept.Orthopedics,1stHospitalSUMSMethodsofreduction復(fù)位Closereduction(manual)閉合復(fù)位Openreduction(operation)開放復(fù)位Dept.Orthopedics,1stHospitalSUMSClosereduction(manual)手法復(fù)位Dept.Orthopedics,1stHospitalSUMSImmobilization固定

-----MaintainpositionafterreductionMethods固定方法:非手術(shù)：石膏、小夾板手術(shù)：各種內(nèi)固定Dept.Orthopedics,1stHospitalSUMS牽引ContinuousTraction具有復(fù)位和固定的作用，需要較長時(shí)間的臥床Effect:ReductionandImmobilizationDept.Orthopedics,1stHospitalSUMS牽引類型

Typesoftraction

皮膚牽引Skintraction骨牽引SkeletaltractionDept.Orthopedics,1stHospitalSUMS外固定支架，用于開放性骨折

Externalfixationinstrument

specialuseforopenfractureDept.Orthopedics,1stHospitalSUMSDept.Orthopedics,1stHospitalSUMS骨折治療的選擇

Choiceoftreatmentmethod保守治療Conservativetreatment手術(shù)治療operationDept.Orthopedics,1stHospitalSUMS保守治療的適應(yīng)癥

IndicationofConservativetreatment多數(shù)的閉合穩(wěn)定型骨折不適合手術(shù)者Dept.Orthopedics,1stHospitalSUMS手術(shù)適應(yīng)癥

Indicationforoperation

閉合復(fù)位失敗Closereductionisdifficultorfail不穩(wěn)定骨折Unstablefracture開放骨折Openfracture關(guān)節(jié)內(nèi)骨折Fractureinvolvejoint并發(fā)神經(jīng)血管損傷Complicatebloodvesselandnerveinjury多發(fā)骨折multiplefractures需要早期活動(dòng)者NeedearlymobilityforsomepatientsDept.Orthopedics,1stHospitalSUMS手術(shù)治療的優(yōu)點(diǎn)

Advantagesofoperationforfracture解剖復(fù)位Anatomicalreduction早期活動(dòng)AllowEarlyexercise避免長期臥床Avoidtolieinbedforalongtime避免關(guān)節(jié)僵硬AvoidjointstiffDept.Orthopedics,1stHospitalSUMS內(nèi)固定的形式

SomeExamplesofinternalfixation

Dept.Orthopedics,1stHospitalSUMS.IntramedullarynailSpecialforintertrochantericFrac.&proximalpartfractureoffemur.

Dept.Orthopedics,1stHospitalSUMS手術(shù)的缺點(diǎn)

DisadvantagesandComplicationsofoperation感染機(jī)會(huì)Infection內(nèi)植物失敗Implantfailure手術(shù)風(fēng)險(xiǎn)DangeroustosomepatientsDept.Orthopedics,1stHospitalSUMSExamplesofoperation.Dept.Orthopedics,1stHospitalSUMSInterlockingmedullarynail交鎖髓內(nèi)釘Dept.Orthopedics,1stHospitalSUMSPlateandscrewDept.Orthopedics,1stHospitalSUMSFrac.HealingAfterremovingplateandscrewDept.Orthopedics,1stHospitalSUMSInterlockingmedullarynailDept.Orthopedics,1stHospitalSUMSA-ppositionLateralpositionSupracondylarfrac.Dept.Orthopedics,1stHospitalSUMS.A-ppositionLateralpositionFixedbyplateandscrewDept.Orthopedics,1stHospitalSUMSFixedbyKwireFixedbyk-wireDept.Orthopedics,1stHospitalSUMSPlatebrokenReplacedbyinterlockingnailDept.Orthopedics,1stHospitalSUMSBothconservativeandoperativemethodareavailable

Dept.Orthopedics,1stHospitalSUMSA-PviewDept.Orthopedics,1stHospitalSUMS.DCSDynamicCondylarScrewComminutedfrac.OffemoralintercondyleDept.Orthopedics,1stHospitalSUMS.Multiplefrac.IndicationforopDept.Orthopedics,1stHospitalSUMSDept.Orthopedics,1stHospitalSUMS.FixedbySpecialmedullarnailandwireDept.Orthopedics,1stHospitalSUMSFrac.InbothlegsDept.Orthopedics,1stHospitalSUMSInterlockingIntromedullarynailDept.Orthopedics,1stHospitalSUMSMultiplefrac.Dept.Orthopedics,1stHospitalSUMSFixationbyscrewsDept.Orthopedics,1stHospitalSUMSDept.Orthoped