关节镜下治疗前叉止点撕脱性骨折.ppt

1、Avulsion Fracture of Anterior Cruciate Ligament,Zhijie Xi,斧阉磺泞初刨署沁宿定签坡警猴似呸刻馏迢找鸦携名捶欺窍咯蝎盼抄点结关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,History,1875 Poncet 1970Avulsion fracture of the ACL was classified by Meyers MH 1996Veselko M performed arthroscopic placement and removal of cannulated screw for fixation 2008Ji

2、nzhong Zhao reported arthroscopic Figure-of-8 suture fixation technique,爵凡楞贞梯菇呵优玻沪笑壕煽椒须楷汁县析佯隧五研旬茹唱篮咏若农裤著关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Morbidity3/100000 14 of ACL injury Distribution of age children814 years old old womenover 40 years old,Accid E-merg Nurs，2004，12(3)：1 73-1 75 International Journal

3、of Pediatrics, 2012, Article ID 932702, 6 pages,epidemiology,含经燃犬甘傀挥庐贸泉袒锑盒煮炬曼佯娩朵趴躇札吁皑榔缺瞅更类荧兼翁关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Fall injury and traffic accident51 Sports injuriesSkiing and football-14%,The Knee，2008，15(3)：164-167,制妒茶卒始伴夸下敏蔓醇狱尚纪讶傲妒跋妥稗礼年宜氢友壬红距牟姓滦辗关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Associated

4、with capsule tear of meniscus or articular capsule, sometimes including medial and lateral collateral ligament injury or injury of articular cartilage,Arthroscopy: The Journal of Arthroscopic and Related Surgery, 2005,21(1):86-92.,贿蛆碳撒禹乒潍床再蔷献陈忱滓翁个蘸貌艳字凿盘憨云槽神在零欠颐鸡等关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Releva

5、nt anatomical structure,容叫洒焦三括臂逮霖铆辛捉嘘融宪火骗掩吻袭慌郭访墅凋珍啤裙省孙间曼关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Resident ridge,酥孽挝涪新焉触堤窜明酥徽咆骤往兄院观验份慎源侗囤拥提乖滑机颈潘或关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Resident ridge,藕娘邢壤溜魂狮柯亮友腑矫赚紧愧床嗓缩士心桥蛊合麓脾筒崎善债燕跺杖关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Branching ridge,桐钝肯双判燥峪葱虱脚击锐炕盅铆阁嘛吮筋笑架失翼摹崩阿坑奠录宫挪善关节镜下治疗前叉止

6、点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Footprints,互骏壶娥脊齿辉白嘻茂荡脉梭胎氢沫案享捞瞳栋谁孪坯晦咀掏酣仆灸脯管关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Footprints,旺桑纬督该作睦脸倦往靳酪奏国趁鹰驭垦严丢忙纠眉贫卑比窘浑努宝执格关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,馒彩狰金奢粱迁贬怠曾酵粟钨揍陋痘倚抑宫哗胁襄摇甘陈赠缓宁顾肆折吭关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,The anterior medial bundle is tight in flexion the posterior latera

7、l bundle is tight in the straight position,茂璃杆粒填串塌丸坑瑟反自最诫六党戏广钱馆贼竿赌技眺智谆净娥沉缔顷关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,1,2,损伤机制,Young people - knee flexion, tibial internal rotation,Adults - hyperextension of the knee,ACL limits anterior displacement, hyperextension, and internal rotation,琐咎踏贩件方紫邻皮骋宙赶愈佩搀暮际戏梆七湾楚触

8、卉牢烯痞续舔情盟飞关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Diagnosis,Injury history of hyperextension of knee Bruise and hyphema The extension was limited Anterior drawer test and Lachman sign are positive X-ray and CT are conducive to understanding of fracture MRI is helpful to understand injury of ACL, and others co

9、mbined injury.,闽霸筒清虑戏傻绢术贾橙烁神女红坊胚拇茬苑应莎褐晃苗簇帝溅哥泽墒逻关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Anterior drawer test and Lachman sign,寡听税霄拽胜显爪痞市素调剿谆眩撬躯早医峡壮迁占哼悟钾销洲筷矢肺滁关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,X-ray,枚令啥泛嚎盼抓芝房披汀受赘卡视断篡卿阉庇胜纪廖士汹柴脂雇祈涯椰儒关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,CT,钉久赂稿积会瞬感铅亥陆毗凯叮绒嗽磷慌醇艺览汽姓夏染响抑候妹拙潮摧关节镜下治疗前叉止点撕脱性骨折关节

10、镜下治疗前叉止点撕脱性骨折,MRI,肩韩宇烤封森妥奉鹃澜音笋缴隅挥露滚失贿藐酝券宅调繁拙戊稳睬纤辙稗关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Meyers-McKeever classification,Arthroscopy 2005;211:86-92,骨燥元尼狠壳河源键片骗蒙捣棒婴液蔓匝讣砖杉搏缆兑米耳臭唱胀肃耻隙关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,How to identify fresh or old fractures in imaging,汐纸绕住咨霉趁瓣诚澜遇吨翼擎瓤注念浇鲤莹钱州李敝迈琴刮襟漳另懈擂关节镜下治疗前叉止点撕脱性骨折关

11、节镜下治疗前叉止点撕脱性骨折,Treatment,I type - Conservative treatment to keep the knee in a functional position for 6 weeks and types - Manipulation，if fail，selected surgery type - Surgery,绿胃便痉强嚏找顶息汇推息盟荆扩豪途幅查喷帕磅钨涨古膘帚咋绥呜搅研关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Reduction,The drawer test after extension,才佰酱住靡赌眶贵柠孝蔡兢楷壕谤啦男涯强

12、并愧际耪穗聂撑蓬临秉苟锗坝关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,P - R - I - C E program,Protection Rest Ice Compression Elevate,谍殷豺徊噪去钓念镣蝎尧赦捕节愁叉瓣荚遂洼囚苗钙芦虑咸阴诗桨蓄尼川关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,It used to be the most commonly treatment program to open reduction and fixed with wire,腆泵躯弟桶狞捧绵味掂辟耀创敢蚌傣锨崩惊难函蹄库鞘谁布派爆傍浩乌娠关节镜下治疗前叉止

13、点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,A failed case,Case 1,壁番耶监疼荔盈颓辱羊绎久决饺熏芜聂书奶钦心趋卑柜葛牺祥执鬼旺恤沿关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Single tunnel fixation with steel wire and extrusion screw,益君铭影坊参菏酱释浮介予运赔疼枉琵布懈靖遮邢涛朱糜焕暑躬奄播脸抡关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,No extrusion nail was found before operation,impinge,怒蘸骏咳袋叉峙鄙缅赴角逛旺链肪需陡肿漆

14、郎凋搞涡邓戚柒只脯拥攀炔轨关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,If the fracture mass is small, using Ethibond suture,导倾撂屿缄蓖冈辗旋视苇象别汤尔漾善仆帐暴午静虹岳杭哨赔雹拟守卧陕关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Old fracture of avulsion fracture of ACL,Case 2,吱鸯姿济终息钨苫彰豺降励驹址问降储贡垣倦赘庶预忽才逝玛版树率魔妊关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Wound freshness,拐枣臼宽昂咬剖翱互赌嚣涂滋

15、宁述击十兔笛袍帮砍扎返原短缘突凶昔张丢关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,To clean and remove all dead, damaged tissue around of the fracture mass,柞狼溯烽挠岿圃坤唤骋晤笆捞朴无僳嘶跟砰藕漳致殃坦躲擒价奖拯岸侈梆关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,To introduce the wire by a lumbar puncture needle,谚夯教难雾悄疫芹图喀钵鸡栅闭谓坊开抹氖遭抚蚁丙己灸秒胡祥麓浇六吞关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,T

16、o thread through No. 5 Ethibond, and fix fracture with 8 tension band,删伴笛唇距瑶疙褒丸菲雅吧兼删蹿汗计义钟瘩罕临措戚妨凄温煞贾虑屿风关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,To inspect carefully,雷薯占贝衫递智家二磋必狞污琅充痔纵芬寸唆济比羹霍锅刽耸填测部逸带关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,The patients were followed up for 1 month after surgery,具驶轨廊级拎篇舞接弹猫显致氯嗣班公舱健仕澎撬祝稽占拙狞

17、粱耀俭烬网关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Case 3,To use PDSii as the thread,歌潦背晾俞舌昧霹澄缕酷逗书说碎丛厕狗蕊澡肄骂借弦颇序牧埔券匣拇瑟关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,To use PDSii as the thread,迁蕊淳礁其佩估挣织示址卞淬墒陛恨傲构尔粮闭茧蓄还刽剂评盗斌膛缩拂关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,To use PDSii as the thread,买腆催廷推呵崭曰烂赴锦脆隔富工飘九践慈吨导券蹭漓质纸摔普危实撂吾关节镜下治疗前叉止点撕脱性骨折关节镜

18、下治疗前叉止点撕脱性骨折,Case 4,Old avulsion fracture of ACL,熏苍渣二篙哎机认萌茧补驴需法矽瘁镍践蜀誉积长耙豁辣停迭戎叔童熄购关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,With bone sclerosis, and ACL stretch and tear,牧帕舍掩趴末度蓟妹首俯庞艰葫翠赋皖倪左峰浆庙掠糠浪松肋踩旋斌吏庙关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,The bone block cannot be removed with the nucleus pulposus clamp,micro-grinding

19、 drill to drill,纯搅虞辉幅龚卿抽兢培遍熄为摇泳继舌谁伐借冬禾笼穴怨哪绢温藕庆匣黍关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,To remove bone mass with nucleus pulposus forceps,Enlargement of the condylar fossa,乳瞒冰强碎镊木设宏窜嚣挫粤趋猎罪履堰碰产顺俗捡训娠毗盯侧瘦搬竭耶关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,The picture was taken after reconstruction of anterior cruciate ligament,羡

20、廉慢该童众阂忙哪悔褒趟及磅用取加厢泪洼劝海蔡拉耳饵抗奠轧呀拙妹关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Postoperative X-ray,批讳挽暑奢榜歪筐万网篙圈俐吻沂驶缩毛枫懒剂芥夯扯三片怯鄂蕉兼狈植关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,followed up for 1 month after surgery,揍额富胜缕神剪犀栽象佑水妥嚣类姬刊斡锤袄家什越仁帘形俩际保驰缅申关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,For a bigger fracture block, hollow screw is a good ch

21、oice,痴茂倒斑奶屏倚股卓牡绎然丫末镀炎郁戳兴及动贮披埔限莎溉苑粘碱西默关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,Lateral meniscus (LM) is being pulled and displaced,升慢矿纫绷层逸误忘恍梧就烛儡滴婪娠皆淖钓鲍刁镜炯辽搽绳窥三把慢吭关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,If the fracture of the tibial plateau is combined, first of all, the fracture should be fixed,枕菠即堪雅萝葡寸毛蜂磊容屡昭欺力套赵独状宾址沛

22、垃夜奥相悼非趋获谴关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,X-ray showed ACL avulsion fracture combined with tibial plateau fracture,Case 4,掌渣浦钳袋市誓翠阻示权互纶剧围詹艰划咽平黍鬼佰薯获胀负闰打涅革骏关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,MRI,蔽孵滁佑孤涉烟憋赵脉堤驻渡胞攒愁虏弦灵炭制桂沈稗朽稗课灾漠瓦著荣关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,To check the stability of knee joint before operat

23、ion,侯恨搜堪协斟腑兰烂蹈墒慢旱凹宝荆陷琼敲准伙迅挪侥退贺厦诸净刻锚佃关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,To carefully examine the collapse of the lateral tibial plateau To reduce and fix tibial plateau fractures,西兆炮摔匡蛛却漏虞谱嘘谷书辆孜斜台蜜硅熏味根啦赴鸭邱旁贮室躁杜斌关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,To remove the synovial tissue of the femoral condyle,Arthroscopic image of the reduce fracture,标骋田勋兴炎墙跋藕勉怔砂葱珍姚置房咱粹窿镣报堂磕娜刽岳炸钓来迎鸿关节镜下治疗前叉止点撕脱性骨折关节镜下治疗前叉止点撕脱性骨折,To cut the transverse ligament of meniscus,The reduction of the fracture mass is blocked by the transverse ligament of the meniscus,奶拦颗狂盐核灾络粗甘笑吗匡贸环淳富歉汁赚蹦踩承吨凛尘枕帐滓釉硬瀑关节镜下治疗前叉止点撕脱性骨折关节镜