關(guān)節(jié)鏡下治療前叉止點(diǎn)撕脫性骨折課件

1、Avulsion Fracture of Anterior Cruciate Ligament Zhijie Xi Avulsion Fracture of AnteriorHistory1875 Poncet1970Avulsion fracture of the ACL was classified by Meyers MH1996Veselko M performed arthroscopic placement and removal of cannulated screw for fixation2008Jinzhong Zhao reported arthroscopic Figu

2、re-of-8 suture fixation technique History1875 PoncetMorbidity3/10000014 of ACL injuryDistribution of age children814 years old old womenover 40 years oldAccid E-merg Nurs，2004，12(3)：1 73-1 75International Journal of Pediatrics, 2012, Article ID 932702, 6 pages epidemiologyMorbidity3/100000Accid E-me

3、rFall injury and traffic accident51Sports injuriesSkiing and football-14%The Knee，2008，15(3)：164-167Fall injury and traffic accideAssociated with capsule tear of meniscus or articular capsule, sometimes including medial and lateral collateral ligament injury or injury of articular cartilageArthrosco

4、py: The Journal of Arthroscopic and Related Surgery, 2005,21(1):86-92.Associated with capsule tear oRelevant anatomical structureRelevant anatomical structureResident ridgeResident ridgeResident ridgeResident ridgeBranching ridgeBranching ridgeFootprintsFootprintsFootprintsFootprints關(guān)節(jié)鏡下治療前叉止點(diǎn)撕脫性骨折課

5、件The anterior medial bundle is tight in flexion the posterior lateral bundle is tight in the straight positionThe anterior medial bundle is 12損傷機(jī)制Young people - knee flexion, tibial internal rotationAdults - hyperextension of the kneeACL limits anterior displacement, hyperextension, and internal rot

6、ation12損傷機(jī)制Young people - knee flexDiagnosisInjury history of hyperextension of kneeBruise and hyphemaThe extension was limitedAnterior drawer test and Lachman sign are positiveX-ray and CT are conducive to understanding of fracture MRI is helpful to understand injury of ACL, and others combined inj

7、ury.DiagnosisInjury history of hypAnterior drawer test and Lachman sign Anterior drawer test and LachmX-rayX-rayCTCTMRIMRIMeyers-McKeever classificationArthroscopy 2005;211:86-92Meyers-McKeever classificatioHow to identify fresh or old fractures in imagingHow to identify fresh or old fTreatmentI typ

8、e Conservative treatment to keep the knee in a functional position for 6 weeks and types Manipulation，if fail，selected surgery type SurgeryTreatmentI type ConservatiReduction The drawer test after extensionReduction The drawer test afteP - R - I - C E program ProtectionRestIceCompressionElevateP - R

9、 - I - C E program ProtIt used to be the most commonly treatment program to open reduction and fixed with wireIt used to be the most commonlA failed caseCase 1A failed caseCase 1Single tunnel fixation with steel wire and extrusion screwSingle tunnel fixation with stNo extrusion nailwas found beforeo

10、perationimpingeNo extrusion nailimpingeIf the fracture mass is small, using Ethibond suture If the fracture mass is small,Old fracture of avulsion fracture of ACLCase 2Old fracture of avulsion fractWound freshnessWound freshnessTo clean and remove all dead, damaged tissue around of the fracture mass

11、To clean and remove all dead, To introduce the wire by a lumbar puncture needle To introduce the wire by a lumTo thread through No. 5 Ethibond, and fix fracture with 8 tension band To thread through No. 5 EthiboTo inspect carefullyTo inspect carefullyThe patients were followed up for 1 month after s

12、urgeryThe patients were followed up Case 3To use PDSii as the threadCase 3To use PDSii as the threTo use PDSii as the threadTo use PDSii as the threadTo use PDSii as the threadTo use PDSii as the threadCase 4Old avulsion fracture of ACLCase 4Old avulsion fracture ofWith bone sclerosis, and ACL stret

13、ch and tearWith bone sclerosis, and ACL sThe bone block cannot be removed with the nucleus pulposus clampmicro-grinding drillto drill The bone block micro-grinding To remove bone masswith nucleus pulposus forcepsEnlargement of the condylar fossaTo remove bone massEnlargementThe picture was taken aft

14、er reconstruction of anterior cruciate ligamentThe picture was taken after rePostoperative X-rayPostoperative X-rayfollowed up for 1 month after surgeryfollowed up for 1 month after For a bigger fracture block, hollow screw is a good choiceFor a bigger fracture block, hLateral meniscus (LM) is being

15、 pulled and displacedLateral meniscus (LM) is beingIf the fracture of the tibial plateau is combined, first of all, the fracture should be fixedIf the fracture of the tibial X-ray showed ACL avulsion fracture combined with tibial plateau fractureCase 4X-ray showed ACL avulsion fracMRIMRITo check the

16、 stability of knee joint before operationTo check the stability of kneeTo carefully examine the collapse of the lateral tibial plateauTo reduce and fix tibial plateau fracturesTo carefully examine the collaTo remove the synovial tissue of the femoral condyleArthroscopic image of the reduce fractureT

17、o remove the synovial tissue To cut the transverse ligament of meniscus The reduction of the fracture mass is blockedby the transverse ligament of the meniscus To cut the transverse ligament To reduce fractureTo fixed fracture with k-wire temporarily To reduce fractureTo fixed frTo drill into secondK-wire A guide pin is insertedTo drill into secondA guide piTo screw into the hollow screwTo inspect after fixationTo screw into theTo inspect afPostoperative X-rayPostopera