關(guān)節(jié)鏡下治療前叉止點撕脫性骨折課件

Avulsion

Fracture

ofAnteriorCruciateLigamentZhijieXiHistory1875——Poncet1970——AvulsionfractureoftheACLwasclassifiedbyMeyersMH1996——VeselkoMperformedarthroscopicplacementandremovalofcannulatedscrewforfixation2021——JinzhongZhaoreportedarthroscopicFigure-of-8suturefixationtechniqueMorbidity——3/10000014％of

ACL

injuryDistribution

of

age

children——8～14

years

old

old

women——over

40

years

oldAccidE-mergNurs，2004，12(3)：173-175．InternationalJournalofPediatrics,2021,ArticleID932702,6pages

epidemiologyFallinjuryandtrafficaccident——51％Sportsinjuries——Skiingandfootball--14%TheKnee，2021，15(3)：164-167．Associatedwithcapsuletear

of

meniscus

or

articularcapsule,sometimes

including

medialandlateralcollateralligamentinjuryorinjuryofarticularcartilageArthroscopy:TheJournalofArthroscopicandRelatedSurgery,2005,21(1):86-92.Relevant

anatomicalstructureResidentridgeResidentridgeBranchingridgeFootprintsFootprintsTheanteriormedialbundleistightinflexion

theposteriorlateralbundleistightinthestraightposition12損傷機制Youngpeople-kneeflexion,tibialinternalrotationAdults-hyperextensionofthekneeACLlimitsanteriordisplacement,hyperextension,andinternalrotationDiagnosisInjury

history

of

hyperextensionofkneeBruise

and

hyphemaTheextensionwaslimitedAnterior

drawertestandLachmansignare

positiveX-ray

and

CT

are

conducivetounderstandingoffractureMRIishelpfultounderstandinjury

of

ACL,andothers

combinedinjury.Anterior

drawertestandLachmansignX-rayCTMRIMeyers-McKeeverclassificationArthroscopy2005;21[1]:86-92HowtoidentifyfreshoroldfracturesinimagingTreatmentItypeConservativetreatment

to

keep

the

knee

in

a

functionalposition

for

6weeksⅡ

and

Ⅲ

types

Manipulation，iffail，selectedsurgeryⅣ

type

SurgeryReduction

ThedrawertestafterextensionP-R-I-C–E

programProtectionRestIceCompressionElevate

It

usedtobethemostcommonlytreatmentprogramtoopenreductionandfixedwithwireAfailedcaseCase1SingletunnelfixationwithsteelwireandextrusionscrewNoextrusionnailwasfoundbeforeoperationimpingeIfthefracturemassissmall,usingEthibondsutureOldfractureofavulsionfractureofACLCase2WoundfreshnessTocleanandremovealldead,damagedtissuearoundofthefracturemassTointroducethewirebyalumbarpunctureneedleTothreadthroughNo.5Ethibond,andfixfracturewith"8"tensionbandToinspectcarefullyThepatientswerefollowedupfor1monthaftersurgeryCase3TousePDSiiasthethreadTousePDSiiasthethreadTousePDSiiasthethreadCase4OldavulsionfractureofACLWithbonesclerosis,andACLstretchandtearTheboneblockcannotberemovedwiththenucleuspulposusclampmicro-grindingdrilltodrillToremovebonemasswithnucleuspulposusforcepsEnlargementofthecondylarfossaThepicturewastakenafterreconstructionofanteriorcruciateligamentPostoperativeX-rayfollowedupfor1monthaftersurgeryForabiggerfractureblock,hollowscrewisagoodchoiceLateralmeniscus(LM)isbeingpulledanddisplacedIfthefractureofthetibialplateauiscombined,firstofall,thefractureshouldbefixedX-rayshowedACLavulsionfracturecombinedwithtibialplateaufractureCase4MRITocheckthestabilityofkneejointbeforeoperationTocarefullyexaminethecollapseofthelateraltibialplateauToreduceandfixtibialplateaufracturesToremovethesynovialtissueofthefemoralcondyleArthroscopicimageofthereducefractureTocutthetransverseligamentofmeniscusThereductionofthefracturemassisblockedbythetransverseligamentofthemeniscusToreducefractureTofixedfracturewithk-wiretemporarilyTo

drill

intosecondK-wireAguidepinisinsertedTo

screwintothe

hollowscrewTo

inspect

after

fixationPostoperativeX-rayPo