关节脱位Joint Dislocation 中山大学 外科学.ppt

1、Joint Dislocationand Peripheral Nerve Injury,RONG Li-min The 3rd affiliated hospital of Sun Yat-sen university,Joint dislocation,Definition,Joint dislocation, or luxation A dislocation is a separationoftwo bones where they meet at a joint Often caused by a sudden impact to the joint A dislocation ma

2、y also cause ligament or nerve damage Subluxation（半脱位） is a partial dislocation,Classification,Traumatic, Congenital（先天性）, Pathologic Complete, subluxation Anterio- posterio- lateral- central- Acute, old, habitual (shoulders) Close, open,bilateral dislocation of the hip because of traffic accident,C

3、ongenital dislocation of the hip（先天性髋关节脱位） Shentons line,Rheumatoid arthritis（类风湿性关节炎） of the wrist and hands. Subluxation and ulnar deviation at the metacarpophalangeal joint,Occurrence,the most common sites Shoulders Elbows Hips Fingers Ankles ( most likely be accompanied by a fracture) Knees Wris

4、ts,Symptoms of a Joint Dislocation,Intense Pain Swelling Immobility of the affected joint Deformity,NOMENCLATURE FOR DISLOCATIONS,Name the JOINT Name the dislocation by the position of the DISTAL FRAGMENT in relation to the proximal fragment Add FRACTURE to the name if there is a periarticular fract

5、ure. Add OPEN if a wound communicates with the dislocation,Complications,Fracture Nerve, vascular injury Bone necrosis Traumatic arthritis,Galeazzi injury,Monteggia injury,Treatment,Close Reduction Immobilize Rehabilitation program Surgical reduction Ligament reconstruction,Hip joint dislocation,All

6、is maneuver(提拉法),Bigelows maneuver（问号法）,After care Traction(4 weeks) Bed(2 weeks) Walk stick(2 weeks) Ambulate(8 weeks lat),Shoulder injury,Anterior dislocation of the shoulder,Kochers,Hippocrates,Stimsons,Elbow injury,Manipulative reduction,Other joint dislocation,Acromioclavicular separation,Compl

7、ete dislocation of a proximal interphalangeal joint,Lunate dislocation,Perilunate dislocation,Nursemaids elbow(pulled elbow牵拉肘),A partial dislocation of radial head common in toddlers The main symptom is refusal to use the arm Can be easily treated in a doctors office without the following first aid

8、 steps.,Manual reduction,Peripheral nerve injury,Orthopaedic surgery is no longer limited to injuries of the bone, blood vessels, and skin, but has expanded to include nerve injury as well,Axon（轴索） Myelin sheath （髓鞘） Schwann cell（施万细胞） Nodes of Ranvier,Peripheral Nerve,Peripheral Nerve Injury,Acute

9、injury Chronic injury (entrapment neuropathy),CLASSIFICATION OF NERVE INJURIES,neuropraxia(神经传导功能障碍) axonotmesis(神经轴索中断) nerotmesis(神经断裂),neuropraxia(神经传导功能障碍),preservation of the axis-cylinder minor edema or breakdown of myelin sheath recovery is complete in a few days or weeks,axonotmesis(神经轴索中断),

10、breakdown of the axon distal wallerian degeneration preservation of the Schwann cell Spontaneous regeneration with good functional recovery,nerotmesis(神经断裂),complete anatomical severance of the nerve distal wallerian degeneration perineurium and epineurium also are disrupted spontaneous recovery can

11、not be expected,Wallerian degeneration（华勒氏变性）,Symptoms,Pain, with the degree of intensity ranging from a tingling sensation to extreme, burning pain Loss of feeling or abnormal sensations Loss of motor function, such as a hand or leg being difficult to move Loss of active range of motion, such as di

12、fficulty lifting fingers or flexing the wrist,Diagnosis,evaluate motor, sensory and autonomic loss Tinel sign（神经干叩击试验） Electromyogram (EMG or Electromyography) Nerve Conduction Study Magnetic Resonance Imaging (MRI),Peroneal nerve,often damaged during dislocation of the knee, with rupture of the lat

13、eral collateral ligament of the knee or fractures of the upper fibula as the common peroneal nerve wraps around the neck of the fibula,Symptom of peroneal nerve Inj,Complete paralysis of dorsiflexion of the foot and ankle (foot drop and steppage gait 跨阈步态) Sensory loss over the medial two-thirds of

14、the dorsum of the foot and lateral side of the leg,Tibial nerve,Damage due to a dislocation of the knee leads to variable paralysis of plantarflexion of the foot and toes The numbness of the heel and part of the sole and the lateral side of the foot and posterior aspect of the leg,Tingling sensation

15、 or lack of sensation in the back of the arm, forearm and hand Weakness in arm muscles, making it difficult to straighten the elbow, wrist and fingers (wrist drop 垂腕),Radial Nerve Injury,Median nerve,Sensory loss of lateral side of palm Thumb abduction paralysis,Froment sign（夹纸试验）,ULNAR NERVE,Claw-f

16、inger deformity(爪形手),Treatment,Observation Nerve is injured but not cut Rehabilitation and careful monitoring are needed Surgery for Nerve Repair Reconnect（sutures） Nerve graft Nerve transfer Other surgery Tendons transfering,Epineural repair（外膜缝合）,Primary nerve sutures remain the treatment of choic

17、e for the repair of divided peripheral nerves Including:,Group fascicular repair（束膜缝合）,Epineural Repair,Fascicular Repair,Nerve Graft,# leading cause of failure of nerve graft Inadequate resection Distraction of repair site,Nerve graft（神经移植）,Nerve transfer（神经移位术）,Peripheral Nerve Injuries,By the beginning of the 20th century, some measure of success was reported with autografts. Although regeneration axons gain entrance to the distal segment, regeneration is slow.,Key point,Manifestation, diagnosis and management of Hip, Shoulder an