踝關(guān)節(jié)骨折課件文檔資料

1、1.芬蘭大于60歲的人群，踝關(guān)節(jié)骨折的發(fā)生人數(shù)從每10萬57人（1970年），增加到130人（1994年）。2.危險(xiǎn)因素：體重指數(shù)的增加；吸煙的影響3.絕經(jīng)和一般身體狀況的好壞與踝關(guān)節(jié)骨折的發(fā)生無關(guān). radiographic appearance of the normal ankle on mortise view. the condensed subchondral bone should form a continuous line around the talus. talocrural angle should be approximately 83 degrees. when t

2、he opposite side can be used as a control, the talocrural angle of the injured side should be within a few degrees of the noninjured side. the medial clear space should be equal to the superior clear space between the talus and the distal tibia and less than or equal to 4 mm on standard radiographs.

3、 the distance between the medial wall of the fibula and the incisural surface of the tibia, the tibiofibular clear space, should be less than 6 mm. evaluating syndesmotic widening is perhaps the most difficult task when interpreting ankle radiographs for alignment and stability. the simplest approac

4、h is to measure the distance between the medial wall of the fibula and the incisural surface of the tibia. this tibiofibular clear space should be less than 6 mm on both ap and mortise views we find this approach simpler than measuring overlap of the anterior tubercle of the tibia on the fibula, bec

5、ause the latter measure is rotationally dependent. lauge-hansen classification ao/orthopaedic trauma association fracture classification1.依據(jù)踝關(guān)節(jié)骨折損傷時(shí),足的位置和外力作用的方向.2.足的位置:旋前和旋后3.外力致使距骨外旋,內(nèi)翻,外翻.4.分為旋后-外旋(ser),旋后-內(nèi)收,旋前-外旋(per),旋前-外展. dupuytren骨折一種少見的旋前外展型損傷，即腓骨高位骨折，脛骨下端腓骨切跡撕脫骨折，三角韌帶斷裂同時(shí)有下脛腓分離。 tillaux骨折

6、旋前外旋型2度，脛骨遠(yuǎn)端前結(jié)節(jié)撕脫骨折。 maisonneuve骨折旋前外旋型骨折中，如果腓骨骨折達(dá)到中上1/3或腓骨頸骨折或上脛腓分離。 it is an extension of the classification introduced by danis and modified by weber, and it was popularized by the ao during a time when malleolar fractures were increasingly treated by operative reduction and fixation rather than

7、by closed reduction. this simple classification provided initial guidelines for surgical treatment because a fractures frequently do not require surgical treatment, b fractures are treated by stabilization of the lateral malleolus, and c fractures require syndesmosis fixation in addition to stabiliz

8、ation of the lateral malleolus. this classification was attractive for its simplicity and because it guided treatment.目標(biāo)：骨折解剖復(fù)位，恢復(fù)關(guān)節(jié)功能。手術(shù)適應(yīng)癥： 1保守治療失敗 2有移位或不穩(wěn)定的雙踝骨折，且有距骨脫位或踝穴增寬超過12mm。 3后踝骨折涉及關(guān)節(jié)面超過25，且關(guān)節(jié)面的移位超過2mm。 4垂直壓縮型骨折 5開放骨折1多為旋后外旋2度或ao的b1型2多數(shù)保守治療3是否手術(shù)有爭議 bauer（1985）認(rèn)為保守治療的功能優(yōu)良為9498。 yue（1980）認(rèn)為旋后

9、外旋2度的手術(shù)治療的結(jié)果并不優(yōu)于保守治療。1多為旋前外旋或旋前外展的1度損傷。2多保守治療（無移位的）3有移位的使用松質(zhì)骨螺釘固定 固定的指征 內(nèi)固定的選擇 固定時(shí)踝關(guān)節(jié)的位置 內(nèi)固定物是否取出 內(nèi)踝三角韌帶損傷，腓骨骨折高于踝關(guān)節(jié)水平間隙上方3cm。 下脛腓聯(lián)合損傷合并腓骨近端骨折，如maisonneuve骨折 陳舊的下脛腓分離公認(rèn)的是使用螺釘固定。一般均使用3.5-4.5mm的皮質(zhì)骨螺釘。有學(xué)者認(rèn)為必要時(shí)可使用2枚。1螺釘?shù)奈恢胢cbryde（1997）認(rèn)為脛距關(guān)節(jié)間隙上方2cm是最佳位置。2螺釘方向平行脛距關(guān)節(jié)面且向前傾斜2530度。3是否使用拉力螺釘不使用。下脛腓螺釘?shù)闹饕康氖蔷S持下脛腓聯(lián)合的正常位置，加壓易導(dǎo)致下脛腓聯(lián)合變窄，導(dǎo)致踝關(guān)節(jié)背伸受限。 因?yàn)榫喙求w前寬后窄，多數(shù)學(xué)者認(rèn)為應(yīng)在