关节镜下治疗前叉止点撕脱性骨折.ppt

AvulsionFractureofAnteriorCruciateLigament,ZhijieXi,History,1875Poncet1970AvulsionfractureoftheACLwasclassifiedbyMeyersMH2019VeselkoMperformedarthroscopicplacementandremovalofcannulatedscrewforfixation2019JinzhongZhaoreportedarthroscopicFigure-of-8suturefixationtechnique,Morbidity3/10000014ofACLinjuryDistributionofagechildren814yearsoldoldwomenover40yearsold,AccidE-mergNurs，2019，12(3)：173-175InternationalJournalofPediatrics,2019,ArticleID932702,6pages,epidemiology,Fallinjuryandtrafficaccident51SportsinjuriesSkiingandfootball-14%,TheKnee，2019，15(3)：164-167,Associatedwithcapsuletearofmeniscusorarticularcapsule,sometimesincludingmedialandlateralcollateralligamentinjuryorinjuryofarticularcartilage,Arthroscopy:TheJournalofArthroscopicandRelatedSurgery,2019,21(1):86-92.,Relevantanatomicalstructure,Residentridge,Residentridge,Branchingridge,Footprints,Footprints,Theanteriormedialbundleistightinflexiontheposteriorlateralbundleistightinthestraightposition,1,2,损伤机制,Youngpeople-kneeflexion,tibialinternalrotation,Adults-hyperextensionoftheknee,ACLlimitsanteriordisplacement,hyperextension,andinternalrotation,Diagnosis,InjuryhistoryofhyperextensionofkneeBruiseandhyphemaTheextensionwaslimitedAnteriordrawertestandLachmansignarepositiveX-rayandCTareconducivetounderstandingoffractureMRIishelpfultounderstandinjuryofACL,andotherscombinedinjury.,AnteriordrawertestandLachmansign,X-ray,CT,MRI,Meyers-McKeeverclassification,Arthroscopy2019;211:86-92,Howtoidentifyfreshoroldfracturesinimaging,Treatment,Itype-Conservativetreatmenttokeepthekneeinafunctionalpositionfor6weeksandtypes-Manipulation，iffail，selectedsurgerytype-Surgery,Reduction,Thedrawertestafterextension,P-R-I-CEprogram,ProtectionRestIceCompressionElevate,Itusedtobethemostcommonlytreatmentprogramtoopenreductionandfixedwithwire,Afailedcase,Case1,Singletunnelfixationwithsteelwireandextrusionscrew,Noextrusionnailwasfoundbeforeoperation,impinge,Ifthefracturemassissmall,usingEthibondsuture,OldfractureofavulsionfractureofACL,Case2,Woundfreshness,Tocleanandremovealldead,damagedtissuearoundofthefracturemass,Tointroducethewirebyalumbarpunctureneedle,TothreadthroughNo.5Ethibond,andfixfracturewith8tensionband,Toinspectcarefully,Thepatientswerefollowedupfor1monthaftersurgery,Case3,TousePDSiiasthethread,TousePDSiiasthethread,TousePDSiiasthethread,Case4,OldavulsionfractureofACL,Withbonesclerosis,andACLstretchandtear,Theboneblockcannotberemovedwiththenucleuspulposusclamp,micro-grindingdrilltodrill,Toremovebonemasswithnucleuspulposusforceps,Enlargementofthecondylarfossa,Thepicturewastakenafterreconstructionofanteriorcruciateligament,PostoperativeX-ray,followedupfor1monthaftersurgery,Forabiggerfractureblock,hollowscrewisagoodchoice,Lateralmeniscus(LM)isbeingpulledanddisplaced,Ifthefractureofthetibialplateauiscombined,firstofall,thefractureshouldbefixed,X-rayshowedACLavulsionfracturecombinedwithtibialplateaufracture,Case4,MRI,Tocheckthestabilityofkneejointbeforeoperation,TocarefullyexaminethecollapseofthelateraltibialplateauToreduceandfixtibialplateaufractures,Toremovethesynovialtissueofthefemoralcondyle,Arthroscopicimageofthereducefracture,Tocutthetransverseligamentofmeniscus,Thereductionofthefracturemassisblockedbythetransverseligamentofthemeniscus,Toreducefracture,Tofixedfracturewithk-wiretemporarily,TodrillintosecondK-wire,Aguidepinisinserted,Toscrewintothehollowscrew,Toinspectafterfixation,PostoperativeX-ray,Postop