胫腓骨骨折急诊处理课件

胫腓骨骨折的急诊处理Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL是最常见的严重骨骼损伤之多见于青壮年,高能量损伤发病率上升;多见开放性骨折,同时合并严重的软组织损伤愈合缓慢,常常可引起永久性的后遗症;低能量损伤多见于扭伤及钝器打击儿童多为单纯胫骨干骨折Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL75%闭合、25%开放,53%中度软组织损伤Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL解剖应用解剖(-)胫骨干中上段横截面呈三角形,下1/3处横截面呈四方形。中下1/3交界处比较细,又是形态发生改变的部位,为骨折好发部位。胫骨前嵴向前、外侧弯曲,形成一个生理弧度。Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL1/31/3胫骨前面及后面WANGBINEvaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL)胫骨前缘及前内侧仅有皮肤覆盖,骨折时骨断端易戳破皮肤形成开放性骨折。皮肤胫骨腓骨小腿中段横断面解剖WANGBINEvaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL白腓总神经绕行于腓骨头下外侧,故腓骨上端骨折时易损伤腓总神经。腓总神经腓总神经行走示意图WANGBINEvaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL认识“膝—踝关节轴”的意义当胫骨骨折时生物力学上出现成角胫骨是维旋转移位,则持膝与踝关破坏关节轴的节面平行的平行,而发生生理轴创伤性关节炎Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL四正常人踝、膝关节是在两个平行的轴线上运动。若骨折后在有成角或旋转畸形的情况下愈合,两轴关系不平行,必然导致步行和负重障碍,出现创伤性关节炎。WANGBINEvaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL病因病理、病因病理胫腓骨骨折多见于10岁以下儿童及青壮年。儿童以胫骨干骨折最多,成人以胫腓骨干双骨折多见(-)病因1直接暴力:常见于车祸伤、重物打击、挤压伤或枪击伤等,暴力多由外侧或前外侧而来,多为粉碎或横斷骨折,双骨骨折时骨折线通常在同平面,常为开放性损伤,软组织损伤严重。WANGBINEvaluauononr.chAsposeslidesforNET4od