骨科實習(xí)課件：骨折與脫位X-ray

FractureandDislocation

(X-ray)FractureDefinitionCauseClassificationDisplacementClinicalfeaturesBoneunionComplicationTreatmentDefinition骨折：骨的完整性和連續(xù)性中斷Cause外傷性骨折直接暴力間接暴力病理性骨折疲勞性骨折Classification(1)不完全骨折裂縫骨折青枝骨折完全骨折橫行骨折斜行骨折螺旋形骨折粉碎性骨折嵌插骨折壓縮性骨折凹陷性骨折骨骺分離Classification(2)穩(wěn)定性骨折裂縫骨折青枝骨折橫行骨折嵌插骨折壓縮性骨折凹陷性骨折不穩(wěn)定性骨折斜行骨折螺旋形骨折粉碎性骨折Classification(3)開放性骨折骨折刺破膀胱、尿道、直腸閉合性骨折Displacement骨折移位成角移位側(cè)方移位短縮移位分離移位旋轉(zhuǎn)移位Clinicalfeatures全身表現(xiàn)休克發(fā)熱一般不超過38度局部表現(xiàn)一般表現(xiàn)疼痛腫脹功能障礙特有體征畸形異常活動骨擦音或骨擦感Boneunion一期愈合二期愈合血腫炎癥機(jī)化期原始骨痂形成期骨板形成塑形期臨床上骨折愈合多為二期愈合*延遲愈合、不愈合、畸形愈合*臨床愈合標(biāo)準(zhǔn)Complications早期并發(fā)癥休克脂肪栓塞綜合征內(nèi)臟器官損傷周圍組織損傷血管損傷神經(jīng)損傷骨筋膜室綜合征晚期并發(fā)癥墜積性肺炎褥瘡DVT形成感染損傷性骨化創(chuàng)傷性關(guān)節(jié)炎關(guān)節(jié)僵硬急性骨萎縮缺血性骨壞死缺血性肌攣縮（5P征）TreatmentReduction（apposition，aligment）anatomic～，functional～Fixationinternal～，external～ExerciseDislocationDefinitionClinicalfeaturesDefinitivetreatmentDefinition關(guān)節(jié)脫位是指組成關(guān)節(jié)的各骨的關(guān)節(jié)面失去正常的對應(yīng)關(guān)系。Clinicalfeatures一般癥狀疼痛腫脹功能障礙特殊表現(xiàn)畸形彈性固定關(guān)節(jié)盂空虛DefinitivetreatmentReductionFixationExerciseX線片應(yīng)用價值骨關(guān)節(jié)創(chuàng)傷最基本常規(guī)檢查方便、快捷空間定位好于CT和MRI技術(shù)進(jìn)步（CR、DR）不可替代X線片應(yīng)用缺陷復(fù)合投影，復(fù)雜部位和重疊部位容易漏診分辨率低不能顯示隱匿性骨折、軟骨損傷、肌腱、韌帶和脊髓等軟組織損傷X線片注意事項四肢長骨需要包括附近關(guān)節(jié)一般需要正側(cè)位，必要時有軸位、斜位和切線位如果癥狀重，而X線陰性，需要數(shù)天后復(fù)查X線，或行CT、MRI檢查骨折和關(guān)節(jié)脫位X線分析原則正常解剖和正常變異是基礎(chǔ)要有一定的閱片順序閱片內(nèi)容:骨關(guān)節(jié)外形骨質(zhì)的密度和紋理骨折的畸形和移位關(guān)節(jié)脫位健側(cè)對照結(jié)合臨床UpperLimbFracturesanddislocationsNormalclavicleClaviclefractureClaviclefractureAcromioclaviculardislocationNormalShoulderShoulderdislocationShoulderdislocationGreatertuberosityfractureFractureofthesurgicalneckofthehumerusHumeralshaftfractureHumeralshaftfractureNormalelbowNormalelbowSupracondylarfractureofthehumerusSupracondylarfractureofthehumerusIntercondylarfractureofthehumerusOlecranonfractureElbowdislocationNormalradiusandulnaDoublefractures

ofradiusandulnaFracturesofradiusandulnaMonteggiafractureGaleazzifractureNormalwristCollesfractureSmithfractureSmithfractureBartonfractureScaphoidfractureⅠⅡMetacarpalfractureBennett’sfractureFractureanddislocationoffingerBreakandTest（1）Whatisthis?(2)Whatisthis?(3)Whatisthis?(4)Whatisthis?LowerlimbFracturesandDislocationsNormalHipDislocationofthehipFemoralneckfractureFemoralneckfractureIntertrochantericfractureNormalfemurFemoralshaftfractureFemoralshaftfractureFemoralshaftfractureNormalKneeSupracondylarfractureofthefemurIntercondylarfractureofthefemurPatellafractureTibialplateaufractureNormaltibiaandfibulaTibiaandfibulafractureTibiaandfibulafractureNormalankleStabilityBimalleolarfractureNormalcalcaneusCalcaneusfractureFractureofthebaseofthe5thmetatarsal(Jonesfracture)FractureofmetatarsalSpineandPelvicFracturesandDislocationsFractureanddislocationofcervicalspineFractureanddislocationofthoracicspineFractureanddislocationo