关节镜下治疗前叉止点撕脱性骨折 ppt课件.ppt

AvulsionFractureofAnteriorCruciateLigament,1,History,1875Poncet1970AvulsionfractureoftheACLwasclassifiedbyMeyersMH1996VeselkoMperformedarthroscopicplacementandremovalofcannulatedscrewforfixation2008JinzhongZhaoreportedarthroscopicFigure-of-8suturefixationtechnique,2,Morbidity3/10000014ofACLinjuryDistributionofagechildren814yearsoldoldwomenover40yearsold,AccidE-mergNurs，2004，12(3)：173-175InternationalJournalofPediatrics,2012,ArticleID932702,6pages,epidemiology,3,Fallinjuryandtrafficaccident51SportsinjuriesSkiingandfootball-14%,TheKnee，2008，15(3)：164-167,4,Associatedwithcapsuletearofmeniscusorarticularcapsule,sometimesincludingmedialandlateralcollateralligamentinjuryorinjuryofarticularcartilage,Arthroscopy:TheJournalofArthroscopicandRelatedSurgery,2005,21(1):86-92.,5,Relevantanatomicalstructure,6,Residentridge,7,Residentridge,8,Branchingridge,9,Footprints,10,Footprints,11,12,Theanteriormedialbundleistightinflexiontheposteriorlateralbundleistightinthestraightposition,13,1,2,损伤机制,Youngpeople-kneeflexion,tibialinternalrotation,Adults-hyperextensionoftheknee,ACLlimitsanteriordisplacement,hyperextension,andinternalrotation,14,Diagnosis,InjuryhistoryofhyperextensionofkneeBruiseandhyphemaTheextensionwaslimitedAnteriordrawertestandLachmansignarepositiveX-rayandCTareconducivetounderstandingoffractureMRIishelpfultounderstandinjuryofACL,andotherscombinedinjury.,15,AnteriordrawertestandLachmansign,16,X-ray,17,CT,18,MRI,19,Meyers-McKeeverclassification,Arthroscopy2005;211:86-92,20,Howtoidentifyfreshoroldfracturesinimaging,21,Treatment,Itype-Conservativetreatmenttokeepthekneeinafunctionalpositionfor6weeksandtypes-Manipulation，iffail，selectedsurgerytype-Surgery,22,Reduction,Thedrawertestafterextension,23,P-R-I-CEprogram,ProtectionRestIceCompressionElevate,24,Itusedtobethemostcommonlytreatmentprogramtoopenreductionandfixedwithwire,25,Afailedcase,Case1,26,Singletunnelfixationwithsteelwireandextrusionscrew,27,Noextrusionnailwasfoundbeforeoperation,impinge,28,Ifthefracturemassissmall,usingEthibondsuture,29,OldfractureofavulsionfractureofACL,Case2,30,Woundfreshness,31,Tocleanandremovealldead,damagedtissuearoundofthefracturemass,32,Tointroducethewirebyalumbarpunctureneedle,33,TothreadthroughNo.5Ethibond,andfixfracturewith8tensionband,34,Toinspectcarefully,35,Thepatientswerefollowedupfor1monthaftersurgery,36,Case3,TousePDSiiasthethread,37,TousePDSiiasthethread,38,TousePDSiiasthethread,39,Case4,OldavulsionfractureofACL,40,Withbonesclerosis,andACLstretchandtear,41,Theboneblockcannotberemovedwiththenucleuspulposusclamp,micro-grindingdrilltodrill,42,Toremovebonemasswithnucleuspulposusforceps,Enlargementofthecondylarfossa,43,Thepicturewastakenafterreconstructionofanteriorcruciateligament,44,PostoperativeX-ray,45,followedupfor1monthaftersurgery,46,Forabiggerfractureblock,hollowscrewisagoodchoice,47,Lateralmeniscus(LM)isbeingpulledanddisplaced,48,Ifthefractureofthetibialplateauiscombined,firstofall,thefractureshouldbefixed,49,X-rayshowedACLavulsionfracturecombinedwithtibialplateaufracture,Case4,50,MRI,51,Tocheckthestabilityofkneejointbeforeoperation,52,TocarefullyexaminethecollapseofthelateraltibialplateauToreduceandfixtibialplateaufractures,53,Toremovethesynovialtissueofthefemoralcondyle,Arthroscopicimageofthereducefracture,54,Tocutthetransverseligamentofmeniscus,Thereductionofthefracturemassisblockedbythetransverseligamentofthemeniscus,55,Toreducefracture,Tofixedfracturewithk-wiretemporarily,56,TodrillintosecondK-wire,Aguidepinisinserted,57,Toscrewintothehollowscrew,Toinspectafterfixation,58,PostoperativeX-ray,59,Pos