關(guān)節(jié)鏡下治療前叉止點撕脫性骨折課件

Avulsion Fracture

of

AnteriorCruciate

Ligament1Zhijie

XiHistory21875——

Poncet1970——Avulsion

fracture

of

the

ACL

wasclassified

by

Meyers

MH1996——Veselko

M

performed

arthroscopicplacement

and

removal

of

cannulated

screwfor

fixation2008——Jinzhong

Zhao

reported

arthroscopicFigure-of-8

suture

fixation

techniqueMorbidity——3/10000014％

of

ACL

injuryDistribution

of

agechildren——8～14

years

oldold

women——over

40

years

oldAccid

E-merg

Nurs，2004，12(3)：173-1

75．International

Journal

of

Pediatrics,

2012,

Article

ID

932702,

6

pagesepidemiology3Fall

injury

and

traffic

accident——51％Sports

injuries——Skiing

and

football--14%The

Knee，2008，15(3)：164-167．4Associated

with

capsule

tear

of

meniscus

orarticular

capsule,

sometimes

including

medialand

lateral

collateral

ligament

injury

or

injury

ofarticular

cartilageArthroscopy:

The

Journal

of

Arthroscopic

and

Related

Surgery,

2005,21(1):86-92.5Relevant

anatomical

structure6Resident

ridge7Resident

ridge8Branching

ridge9Footprints10Footprints1112The

anterior

medial

bundle

is

tight

in

flexionthe

posterior

lateral

bundle

is

tight

in

thestraight

position1312損傷機制Young

people

-

knee

flexion,tibial

internal

rotationAdults

-

hyperextension

of

thekneeACL

limits

anterior

displacement,hyperextension,

and

internal

rotation14DiagnosisInjury

history

of

hyperextension

of

kneeBruise

and

hyphemaThe

extension

was

limitedAnterior

drawer

test

and

Lachman

sign

arepositiveX-ray and

CT

are

conducive

to

understandingof

fractureMRI

is

helpful

to

understand

injury

of

ACL,

andothers

combined

injury.15Anterior

drawer

test

andLachman

sign16X-ray17CT18MRI19Meyers-McKeeverclassificationArthroscopy

2005;21[1]:86-9220

How

to

identify

fresh

or

old

fracturesin

imaging21TreatmentI

type

---

Conservative

treatment

to

keep

theknee

in

a

functional

position

for

6

weeksⅡ

and

Ⅲ

types

---

Manipulation，if

fail，selected

surgeryⅣ

type

---

Surgery22Reduction23

The

drawer

test

after

extensionP

-

R

-

I

-

C

–

Eprogram24ProtectionRestIceCompressionElevateIt

used

to

be

the

most

commonlytreatment

program

to

open

reductionand

fixed

with

wire25

A

failed

case26Case

1Single

tunnel

fixation

with

steel

wire

andextrusion

screw27No

extrusion

nailwas

found

beforeoperation

impinge28If

the

fracture

mass

is

small,

using

Ethibondsuture29Old

fracture

of

avulsion

fracture

of

ACLCase

230Wound

freshness31To

clean

and

remove

all

dead,

damagedtissue

around

of

the

fracture

mass32To

introduce

the

wire

by

a

lumbarpuncture

needle33To

thread

through

No.

5

Ethibond,

andfix

fracture

with

"8"

tension

band34To

inspect

carefully35

The

patients

were

followed

up

for

1month

after

surgery36Case

3To

use

PDSii

as

the

thread37To

use

PDSii

as

the

thread38To

use

PDSii

as

the

thread39Case

4Old

avulsion

fracture

of

ACL40

With

bone

sclerosis,

and

ACL

stretchand

tear41

The

bone

blockcannot

be

removedwith

the

nucleuspulposus

clamp

micro-grinding

drilltodrill42To

remove

bone

mass

Enlargement

of

thewith

nucleus

pulposus

condylar

fossaforceps43The

picture

was

taken

after

reconstructionof

anterior

cruciate

ligament44Postoperative

X-ray45followed

up

for

1

month

after

surgery46For

a

bigger

fracture

block,

hollowscrew

is

a

good

choice47

Lateral

meniscus

(LM)

is

being

pulled

anddisplaced48If

the

fracture

of

the

tibial

plateau

iscombined,

first

of

all,

the

fractureshould

be

fixed49

X-ray

showed

ACL

avulsion

fracturecombined

with

tibial

plateau

fracture50Case

4MRI51To

check

the

stability

of

knee

jointbefore

operation52To

carefully

examine

the

collapse

of

thelateral

tibial

plateauTo

reduce

and

fix

tibial

plateau

fractures53

To

remove

the

synovialtissue

of

the

femoralcondyle54

Arthroscopic

image

ofthe

reduce

fracture

To

cut

the

transverseligament

of

meniscus

The

reduction

of

thefracture

mass

is

blockedby

the

transverse

ligamentof

the

meniscus55To

reduce

fracture

To

fixedfracturewith

k-wiretemporarily56

To

drill

into

secondK-wire

A

guide

pin

isinserted57To

screw

into

thehollow

screwTo

inspect

afterfixation58Postoperative

X-ray59Postope