骨盆骨折课件

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髂会阴线髂坐骨线髋臼前后唇“teardrop”与髂坐线的关系骨盆骨折-Obturatorobliqueview前柱耻骨上支髋臼后壁骨盆骨折-Iliacobliqueview后柱前壁骨盆骨折-Tomographyand3-DReconstructionCT评估常规X线未能显示的骨折关节内的骨折碎片,股骨头骨折骶髂关节的骨折3-D重建能立体的显示骨盆骨盆骨折-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气道呼吸循环伴随损伤：长骨干骨折、脊柱、脑部、腹腔、盆腔、泌尿道骨盆骨折-Surgicalindication

andtiming骨盆骨折-1.病人的全身情况2.经济情况，需求3.外科医师的经验，器械4.骨折类型5.关节面的完整性>2mm骨盆骨折-手术时间：伤后7-10天反指征严重骨质疏松无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