關(guān)節(jié)脫位英文教學課件

1、Dislocation of the JointsDefinitionJoint DislocationJoint SubluxationJoint Sprainrefers to damage or tearing of ligaments or a joint capsulepartial dislocationan abnormal separation of the joint關(guān)節(jié)扭傷關(guān)節(jié)半脫位關(guān)節(jié)脫位ClassificationTraumatic dislocationexcessive force is applied to a jointPathological dislocat

2、ionFresh dislocation (within 2 weeks)新鮮脫位Old dislocation (more than 2 weeks)陳舊性脫位Habitual or Recurrent Dislocation習慣性脫位Congenital dislocation 先天性脫位TreatmentReductionImmobilizationRehabilitationTraction-counter-traction techniqueSpecific maneuversWhat happened to the Baseball player?Dislocation of th

3、e ShoulderOutlineAnatomyEtiologyClassificationClinical manifestation and DiagnosisTreatmentComplicationEpidemiologyThe shoulder is the most commonly dislocated joint in the bodyPatients with a previous shoulder dislocation are more prone to redislocation. Younger patients (teenagers and those aged 2

4、0 years) have a much higher frequency of redislocation than patients in their 50s and 60s.AnatomyGlenoid關(guān)節(jié)盂Humeral head肱骨頭Bony Structure Articular surface ratio= 34 ：1Glenoid labrum 關(guān)節(jié)盂Joint capsule 關(guān)節(jié)囊Ligament 韌帶Rotator cuff 肩袖muscles 肌肉PosteriorAnteriorAnatomySoft tissueFeature of AnatomyNo strong

5、 bony stabilityRelies on soft tissues for stabilityGreatest Range of Motion Less StabilityHigh risk of dislocationEtiology96%TraumaticEtiologyligamentous laxity 韌帶松弛癥AtraumaticClassification Anterior dislocation: Over 95%Anterior dislocationPosterior dislocationInferior dislocationAnterior dislocati

6、onSubcoracoid喙突下脫位Subglenoid盂下脫位Subclavicular鎖骨下脫位Intrathoracic胸腔內(nèi)脫位Clinical manifestationGeneral SymptomPainSwellingLoss of functionClinical manifestationSpecific SignDeformity Square shoulder方肩畸形Empty of glenoid fossa關(guān)節(jié)盂空虛Elastic fixation彈性固定 Dugas signDugas sign:L. A. Dugas, Philadelphia, 1857, 1

7、0: 175-179.Clinical manifestation Radiography X-raySubcoracoid dislocation DiagnosisHistoryClinical manifestationX-rayReductionImmobilizationRehabilitationTreatmentReductionDiagnosisMake an agreementStay relaxedPre-reductionIntra-reductionLocal anaesthesiaGeneral anaesthesiaPost-reductionX-ray Re-ch

8、eck假體選擇Kocher ManeuverReduction Maneuver1870 Reduction ManeuverHippocrates Maneuver(460-377 BC)Immobilization3-4 weeksRehabilitationRange of MotionMuscle strengthComplicationBankart lesion Bankart損傷Rotator cuff tear 肩袖損傷Fracture 骨折Nerve injury 神經(jīng)損傷發(fā)病率：肩關(guān)節(jié)前脫位最常見的病理性損傷，53%-100%定義：前下關(guān)節(jié)囊盂唇復合體從關(guān)節(jié)盂的附著點撕脫A

9、rthroscopic Bankart repairBankart lesionLabrum tearComplicationRotator cuff tearNever injuryFractureDislocation of the ElbowThe elbow is the second most commonly dislocated major joint；Elbow dislocations frequently occur due to trauma such as falls from heights or motor vehicle collisionsAnatomyThe

10、elbow is amazingly stable, relying more on bony anatomy configuration for stability rather than ligamentsDislocation of the ElbowThree points forming isosceles triangle on flexed elbowPosterior elbow triangle肘后三角 Olecranon of Ulna(尺骨鷹嘴) Humeral lateral epicondyle (肱骨外上髁) Humeral medial epicondyle (肱

11、骨內(nèi)上髁) ClassificationPosterior (forearm bones go behind the arm bone; most common)AnteriorLateralMedialSimple elbow dislocation: without fractureComplex elbow dislocation: combined with a fractureMechanismDiagnosisHistoryPainDeformitySemiflexion elastic fixation of the elbowPEnerves (median radial ul

12、nar) vascular statusPosterior elbow triangleX rayTreatmentNon-operativeTreatmentNon-operativeTreatmentOperativeneurovascular compromiseassociated fracturesnonreducible dislocationsComplicationsValgus instabilityPosterolateral instabilityHeterotopic ossificationChronic dislocationNerve injurySubluxat

13、ion of the Radial HeadThe most common upper-extremity injury in infants and young childrenNursemaid Elbow or Pulled ElbowOccurs after longitudinal traction which is placed on pronated extended arm.ReductionVedioReductionTechnique1Full extension Full supination（旋后-手掌向上） Downward traction FlextionTech

14、nique 2Extension Hyper-pronation（極度旋前-手掌向下）Dislocation of the HipAnatomicThe hip joint is a ball-and-socket synovial joinDislocation of the HipLarge-force traumas are the most common causes of hip dislocations Types of dislocationanterior dislocation central acetabular fracture dislocationsposterior

15、 dislocationThe anterior dislocation of hipWith wide abduction, impact of knee against dashboard (both) hip.The posterior dislocation of hiplimb is shortened, internally rotated, and adducted DiagnosisHistory traumaSymptom severe hip pain, especially when the leg is moved.Physical Examination The in

16、jured leg is shorter than the uninjured leg（肢體短縮）. The injured leg lies in an abnormal position（異常體位） anterior dislocation: flexion/abduction/external rotation posterior dislocation: flexion/adduction/internal rotation Nerve injury(sciatic nerve坐骨神經(jīng))X rayCT Closed Reduction of Anterior Hip DislocationTreatmentClose Reduction Maneuvers of the Hip Posterior DislocationRochester methodAllis ManeuverStimson ManeuverBigelow ManeuverComplications of hip dislocationAvascular necrosisTraumatic arthritis