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肘关节损伤课件_2

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肘关节 损伤 课件 _2
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Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肱骨远端骨折 Distal Humeral Fracture 传统分型 肱骨髁上骨折 肱骨髁间骨折 解剖 肱骨干轴线与肱骨髁轴线之间 有15 前倾角 这是易发生骨 折的解剖因素 单击此处编辑母版标题样式 单击此处编辑母版副标题样式 5 5 AO肱骨远端骨折的分类 A型 关节外骨折 B型 关节内骨折 单髁骨折 C型 关节内骨折 双髁骨折 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肱骨远端骨折 Distal Humeral Fracture A1 A2 A3 C1 C2 C3 B1 B2 B3 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肱骨远端骨折解剖学分类 肱骨内上髁骨折 肱骨外上髁骨折 肱骨髁上骨折 肱骨髁间骨折 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肱骨外上髁骨折的治疗 无移位的稳定的外上髁骨折 肘关节屈曲前臂旋后位石膏外固定 移位的不稳定的外上髁骨折 切开复位松质骨螺钉固定 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肱骨内上髁骨折的治疗 无移位的稳定的内上髁骨折 肘关节屈曲前臂旋前位石膏外固定 移位的不稳定的内上髁骨折 可复位者切开复位松质骨螺内固定 不可复位者内上髁切除 尺神经前移术 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肱骨髁上骨折 Humeral Supracondylar Fracture 定义 肱骨髁上骨折是指肱骨干与肱骨髁交接处发生的 骨折 鹰嘴窝平面以上2 3cm骨折 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肱骨髁上骨折 Humeral Supracondylar Fracture 分型 伸直型肱骨髁上骨折 屈曲型肱骨髁上骨折 伸直型屈曲型 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肱骨髁上骨折 Humeral Supracondylar Fracture 伸直型肱骨髁上骨折 儿童有手着地外伤史 肘部肿胀 疼痛 肘后三角结构正常 可至肱动脉损伤 前臂骨筋膜室综合症 肱动脉损伤 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肱骨髁上骨折的治疗 无移位的稳定的髁上骨折 肘关节悬垂石膏外固定 移位的不稳定的髁上骨折 儿童 外固定架或交叉克氏针固定 成人 钢板螺钉固定 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肱骨髁间骨折 Humeral Intercondylar Fracture 肱骨远端解剖结构复杂 关节内骨折 特别是复杂得 肱骨髁间骨折复位固定难度 大 60年代以前非手术治疗 为主 近年来关节面解剖复 位 坚强内固定 早期功 能锻炼已成为获得良好疗效 的重要原则 保守治疗很难 取得良好效果 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 骨折分型 较常用的为 Riseborough分型 AO分型 Mehen分型 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Mehen提出的肱骨髁间骨折的分型 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 手术治疗的指征 有移位的关节内骨折 伴随同侧肢体的骨折 漂浮肘 骨折伴有神经或血管损伤 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 手术入路的选择 体位选择侧卧或俯卧位 切口为肘后正中切口或肘内外侧联合切口 肘后正中为经典的Campbell入路以及尺骨鹰嘴截骨入路 近来有人尝试经后路肱三头肌内外侧间隙入路 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 髁上采用相应的半管形板或重建板加以固定 半管形板固定于内侧骨嵴上 重建板与之垂直 固定于外侧后方 以加压螺钉或克氏针张力带 固定尺骨鹰嘴 手术复位固定的原则 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 尺骨鹰嘴骨折 Olecranon Fracture 尺骨鹰嘴骨折可以由直接暴力引起 如肘部跌伤 也 可由间接暴力所致 如部分屈肘位跌倒 肱三头肌收 缩的间接力量使鹰嘴撕脱 非手术治疗需要肘关节伸直位固定 易造成屈肘功能 受限 因此 目前对成人的尺骨鹰嘴骨折更多提倡切开复位 和内固定 复位必须准确 因为任何残留的关节面不 整齐会引起活动受限 恢复延迟和创伤性关节炎 固 定应足够牢固 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 分类 型骨折影响关节面的近侧1 3 型骨折影响中1 3 型骨折影响远侧1 3 此外 型骨折可以伴有桡骨近端向前移位 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 手术适应症 成人的尺骨鹰嘴骨折中骨块分离 者 需做切开复位和内固定 手术种类 切开复位和张力带固定 髓腔内固定 3 LCP接骨板 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 标准的克氏针张 力带固定技术 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 尺骨冠状突骨折 大块冠状突骨折时 为了恢复滑车的 屈戍关节的稳定性 应行内固定 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 尺骨冠状突手术前方入路切口 尺骨冠状突手术前方入路 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后治疗 上臂屈肘90 位用后侧石膏托固定 1周后去除 石膏托 改用吊带悬吊上臂 此时即可开始做主 动性或辅助主动功能锻炼 3周时去除吊带 在能耐受的情况下可逐渐增加 锻炼 但绝不可对肘关节做强力的手法治疗 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 桡骨头骨折 概述 桡骨头骨折在肘关节骨折中较为常见 若骨折仅有轻度移位 通常旋转功能恢复满意 如果为孤立性大块非粉碎性桡骨头骨折 可采用切开 复位和小型AO螺丝钉或Herbert螺丝钉内固定治疗 但如果是骨破坏较为严重 则宜行桡骨小头切除 术 前行重建CT检查可以较好的判断骨折的真实情况 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 分型 Mason将桡骨头骨折分为四种类型 型 骨块无移位的 边缘 骨折 型 骨块有移位的骨折 型 粉碎性骨折 型 型骨折 粉碎性骨折 伴有肘关节后脱位 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 手术指征 桡骨头和桡骨颈严重粉碎性骨折 超过1 3关节面的边缘骨折 尤其是骨折累及尺 桡关节者 肘关节内有游离骨块的骨折 桡骨颈骨折有成角而影响旋转 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 桡骨头入路 桡骨小头内固定模式图 单击此处编辑母版标题样式 单击此处编辑母版副标题样式 3131 肘关节置换治疗肘关节严重骨折 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 英国20世纪六十年代 McKee the Shiers and Dee 首先进行了肘关节置换 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节严重损伤的处理方法 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 单纯切除肘关节成形术 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 切除后软组 织嵌入术 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 关节置换 半关节置换 全关节置换 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Coonrad Morry 全肘系统 Discovery全肘系统 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 半限制型假体允许 远端5 10度的活动 范围 2000 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 半肘关节置换 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肱骨远端骨折 应用半关节置换术 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 全肘关节置换 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Coonrad Morry全肘系统为例 适应症 一 风湿 类风湿关节炎 二 骨折 创伤性关节炎 骨折不愈合 三 肘关节不稳定 关节僵直 关节脱位 四 关节置换的翻修 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 典型病例 一 严重的骨性关节炎 应用非连接假体置换 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节置换治疗肘关节骨性关节炎 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 风湿性关节炎的患者伴有肱骨远端骨折 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 二 肘关节置换治疗肘关节粉碎骨折 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 三 慢性肘关节 后脱位伴冠状突 骨折 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 骨溶解 关节松动 四 肘关节的翻修 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 同种骨移植重 建肱骨缺损 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节置换的合并症 皮肤软组织问题 感染 松动 假体周围骨折 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Soft tissue complication of total elbow arthroplasty Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 骨溶解 关节松动 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 感染 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 关节置换术后尺骨近端骨折 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 关节置换术后肱骨干骨折 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 关节置换术后尺骨近端骨折 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 康 复 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节置换术后的CPM的应用存在争议 Williams and Yamaguchi倡导 主动 辅助的肘关节活动 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节置换术后 主动 辅助锻炼 Active asisited range of motion exercise Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 第一阶段 0 4周 个体化 A 非限制型假体 1 5 10天肘关节屈曲90的制动 2 开始主动 辅助肘关节功能锻炼 3 如果修复了侧副韧带 避免肘关节的旋转 4 肩 腕关节正常活动 B 半限制型假体 1 5 10天肘关节伸直位的制动 2 开始主动 辅助肘关节功能锻炼 完全的旋转 伸屈运动 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 第二阶段 4 6周 个体化 A 非限制型假体 1 逐步主动 辅助肘关节功能锻炼 强调完全伸直肘关节 2 如果修复了侧副韧带 开始肘关节的旋转运动 3 肩 腕关节正常活动 B 半限制型假体 1 主动 辅助肘关节功能锻炼 完全的旋转 伸屈运动 2 完全的肩 腕关节活动 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 第三阶段 6 12周 个体化 A 非限制型假体 1 逐步主动 辅助肘关节功能锻炼 强调完全伸直肘关节 2 肩 腕关节正常活动 3 开始有限制的负重功能锻炼 B 半限制型假体 1 主动 辅助肘关节功能锻炼 完全的旋转 伸屈运动 2 完全的肩 腕关节活动 3 强调肘关节的功能锻炼 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 第四阶段 12 16周 个体化 A 非限制型假体 1 主动 辅助肘关节功能锻炼 2 肩 腕关节正常活动 3 肘关节的负重功能锻炼 B 半限制型假体 1 主动 辅助肘关节功能锻炼 完全的旋转 伸屈运动 2 完全的肩 腕关节活动 3 肘关节的负重功能锻炼 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 北京大学人民医院创伤骨科 应用肘关节置换的经验总结 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 近3年发表肘关节置换173篇文章 其中综述24篇 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 人工肘关节置换是一种较人工髋 膝关节置换更新的技术 分 类 1 非连接型 非限制型 容易 脱位 应用不多 2 限制型 绞链式 容易松动 3 半限制型 聚乙烯内衬 允许 8度的内外翻 不易松动 目前应用主流 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节置换的适应症 1 风湿 类风湿关节炎 创伤关节炎患者晚期功能障碍 严重疼痛是肘关节置换术的主要指征 42 2 肿瘤 感染引起的肘关节骨缺损 感染患者至少完全稳 定后一年以上方能考虑手术 18 3 创伤引起的肘关节粉碎骨折 无法行内固定 或内固定 失败的患者 40 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 禁忌症 1 肘关节近期感染 2 charcot关节 3 软组织损伤伴有大量的骨和软组织缺损 4 支配肱二头肌 肱三头肌和肱肌的神经损伤 5 术中病人不能配合以及对手术结果期望过高 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节假体的选择 不同类型假体的选择取决于关节囊和韧带的稳定性 关节周围肌肉的肌力以及肘关节骨组织的条件 一般认为 关节越稳定 残余骨组织越多 越有条件 使用表面置换或非限制性假体 制约性高的假体 如铰链型假体 术后因应力集中而 容易出现假体松动 假体柄断裂等现象 目前仅用于 严重肘关节破坏 韧带松弛 关节稳定性差 骨组织 广泛缺损或肌肉明显萎缩的病例 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术 前 评 估 1 术前X线检查 必要时行肘 关节的CT或重建CT检查 2 注意血管 神经 软组织 损伤情况 3 注意询问既往病史 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节置换的体位和手术入路 平卧或侧卧位 患肘放于胸前 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 临床常用的肘关节假体 Stryker solar Link endo model Zimmer Coonrad Morrey 共同特点 都是半限制绞链式假体 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 操作技术 以半限制型Coonrad Morrey假体为例 体位及入路 后正中偏内侧切口 游离尺神经并前置 清理碎骨块 估计需要的假体插入的深度和翼的长度 非定制型全肘关节置换术治疗肱骨远端骨折手术技术 姜保国译 JBJS中文版 2006 9 2 3 174 182 The Journal of Bone Joint Surgery Chinese Version 2006 9 2 3 174 182 Distal Humeral Fractures Treated with Noncustom Total Elbow Replacement Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 尺骨端假体插入点的定位和钻孔 游离三头肌腱的鹰嘴内侧 尺骨近端扩髓 采用标准的骨水泥浇注技术提供充分的假体 骨水泥界面 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 自体骨块置于肱骨端前面假体翼下方 打入肱骨端假体假体两端置于合适深度 后用连接装置连到一起 尤其注意肱骨柄不要向近端插入太深 因为这在屈肘时 容易导致软组织的卡压 同时会在屈肘时造成假体 骨 水泥界面的张应力和剪应力 伸肌总腱和屈肌总腱腱膜缝合于肱三头肌腱 远端接近止点处的内 外侧 以防止腕关节 屈伸力量和握力的明显减弱 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 假体标定的截骨 平面为肱骨远端 3cm 选用长翼 假体时可允许有 6cm的骨量丢失 如有8cm的骨 量丢失时 可将 长翼假体向近端 缩短2cm插入 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节置换手术并发症及本组结果 1 假体松动 近期未发现 2 神经损伤和异位骨化 2例神经炎症状 3 关节置换后的DVT和PTE 本组无 4 手术失败后的关节融合和截肢的可能 本组无 5 假体的疲劳断裂 本组无 6 手术切口II期愈合率 本组10 本组肘关节平均活动度数25 100度左右 关节炎病人活动度和疼痛缓解明显 骨折病人缺乏术前对比 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后处理 术后半屈曲45度石膏固定 48小时内拔除引流管 术后8 10天伤口干燥后开始主动屈和被动伸练习 肘关节夜间交替固定在伸直和屈曲位 使用颈腕吊带保护3周 不作大活动度的强力训练 最初3月内不提重量超过0 5kg的东西 以后患肢也 不要提重量超过2 5kg的东西 单击此处编辑母版标题样式 单击此处编辑母版副标题样式 8181 使用时 直接删除本页 精品课件 你值得拥有 精品课件 你值得拥有 单击此处编辑母版标题样式 单击此处编辑母版副标题样式 8282 使用时 直接删除本页 精品课件 你值得拥有 精品课件
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