骨盆骨折課件

骨盆骨折-骨盆骨折

骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-RadiographicEvaluationoftheacetabulum骨盆骨折-JudetViews1.Anteroposterior2.iliacoblique3.obturatoroblique45°骨盆骨折-Anteroposteriorview髂會(huì)陰線髂坐骨線髖臼前后唇“teardrop”與髂坐線的關(guān)系骨盆骨折-Obturatorobliqueview前柱恥骨上支髖臼后壁骨盆骨折-Iliacobliqueview后柱前壁骨盆骨折-Tomographyand3-DReconstructionCT評(píng)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骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-ClassificationofAcetabularFractures(JudetandLelournel)骨盆骨折-骨盆骨折-骨盆骨折-TypeA:Partialarticular,involvingonlyoneofthetwocolumnsA1posteriorwallfractureA2posteriorcolumnA3Anteriorcolumnorwall骨盆骨折-TypeB:partialarticular,involvingatransversecomponentB1 PuretransverseB2 T-shapedB3 AnteriorColumnandposterior hemitransverse骨盆骨折-TypeC:Fracture(completearticular:bothcolumns)C1 Highvariety,extendingtotheiliacC2 Lowvariety,extendingtotheanterior borderoftheiliumC3 ExtensionintotheSacroiliacjoint骨盆骨折-C1/C2(bothcolumn=Completearticularfracture)IlioinguinalapproachInvolvementoftheposteriorcolumnorwallextensileapproach骨盆骨折-C3 (BothcolumnextendingintoSIjoint) ExtendedIliofemoralapproach骨盆骨折-骨盆骨折-Evaluationanddiagnosis

Thepatient氣道呼吸循環(huán)伴隨損傷：長(zhǎng)骨干骨折、脊柱、腦部、腹腔、盆腔、泌尿道骨盆骨折-Surgicalindication

andtiming骨盆骨折-1.病人的全身情況2.經(jīng)濟(jì)情況，需求3.外科醫(yī)師的經(jīng)驗(yàn)，器械4.骨折類(lèi)型5.關(guān)節(jié)面的完整性>2mm骨盆骨折-手術(shù)時(shí)間：傷后7-10天反指征嚴(yán)重骨質(zhì)疏松無(wú)移位骨折后笠骨折碎片小低位前柱骨折骨盆骨折-Cefazolinfor48-72hoursThromboembolicprophylaxisIndomethacin75mgoncedailysitupwiththefirst24-48hours骨盆骨折-ActabularandlimbfractureInjuryofsciaticnerve(12-38%)Hipdislocation(requirespromptreduction)骨盆骨折-Malreductionorsubluxationofthehipjointwillleadtoabnormalloadingofthearticularcartilageandsubsequentjointarthrosis骨盆骨折-Principlethatperforminganaccuratereductionofthearticularsurface,therebyobtainingsurface,therebyobtainingacongruenthipjoint,willrestorenormaljointmechanics.骨盆骨折-Reductiontechniquesandinternalfixation骨盆骨折-Essentialreductiontools

distractorJudetfracturetablemanualreduction“KingTong”and“QueenTang”Clamps骨盆骨折- Themajorityofacetabularfracturescanbemanagedthroughasinglesurgicalapproach,butcombinedapproachesarealsofeasible骨盆骨折-Thefourmostfrequentlyusedapproachesare:1.Kocher-Langenbeck2.Ilioinguinal3.Extendediliofemoral4.Combinationof1)and2)骨盆骨折-InteraoperativetractionIndirectreductionwhichhaveretainedtheircapsularorsoft-tissue骨盆骨折-AdislocatedSacroiliacjointordisplacedsacralfractureisusuallyreducedfirstandfixed.Priortothereductionoftheacetabularfracture骨盆骨折-A1(posteriorwall)Kocher-langenbeck approach-lateraldecubitusA2(posteriorcolumn)K-LapproachA3(anteriorwallorcolumn) Iiloinguinalapproach骨盆骨折-B1(puretransverse) K-Lapproach(prone)B13extensileapproachB2(T-shaped) K-LorilioginguinalB3(anteriorcolumnposteriorhemitransverse) IlioinguinalorK-Lorextendediliofemoral骨盆骨折-Weightbearingisnotadvancedfor6-8weeksDuringthethirdmonth,dependingonradiographicevidenceofhealing,thepatientisallowedtofullweightbearing骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-Postoperativemanagement

rehabilitation骨盆骨折-Thethirdday,patientareallowedtoe-touchweightbearingusingcrutches.Strengtheningexercisesandgaittraining骨盆骨折-Complications

骨盆骨折-EarlyNeurovascularinjuryinadequatereduction,articularpenetrationo