骨盆骨折課件

骨盆骨折-骨盆骨折

骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-RadiographicEvaluationoftheacetabulum骨盆骨折-JudetViews1.Anteroposterior2.iliacoblique3.obturatoroblique45°骨盆骨折-Anteroposteriorview髂會陰線髂坐骨線髖臼前后唇“teardrop”與髂坐線的關系骨盆骨折-Obturatorobliqueview前柱恥骨上支髖臼后壁骨盆骨折-Iliacobliqueview后柱前壁骨盆骨折-Tomographyand3-DReconstructionCT評估常規(guī)X線未能顯示的骨折關節(jié)內的骨折碎片,股骨頭骨折骶髂關節(jié)的骨折3-D重建能立體的顯示骨盆骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-ClassificationofAcetabularFractures(JudetandLelournel)骨盆骨折-骨盆骨折-骨盆骨折-TypeA:Partialarticular,involvingonlyoneofthetwocolumnsA1posteriorwallfractureA2posteriorcolumnA3Anteriorcolumnorwall骨盆骨折-TypeB:partialarticular,involvingatransversecomponentB1 PuretransverseB2 T-shapedB3 AnteriorColumnandposterior hemitransverse骨盆骨折-TypeC:Fracture(completearticular:bothcolumns)C1 Highvariety,extendingtotheiliacC2 Lowvariety,extendingtotheanterior borderoftheiliumC3 ExtensionintotheSacroiliacjoint骨盆骨折-C1/C2(bothcolumn=Completearticularfracture)IlioinguinalapproachInvolvementoftheposteriorcolumnorwallextensileapproach骨盆骨折-C3 (BothcolumnextendingintoSIjoint) ExtendedIliofemoralapproach骨盆骨折-骨盆骨折-Evaluationanddiagnosis

Thepatient氣道呼吸循環(huán)伴隨損傷：長骨干骨折、脊柱、腦部、腹腔、盆腔、泌尿道骨盆骨折-Surgicalindication

andtiming骨盆骨折-1.病人的全身情況2.經濟情況，需求3.外科醫(yī)師的經驗，器械4.骨折類型5.關節(jié)面的完整性>2mm骨盆骨折-手術時間：傷后7-10天反指征嚴重骨質疏松無移位骨折后笠骨折碎片小低位前柱骨折骨盆骨折-Cefazolinfor48-72hoursThromboembolicprophylaxisIndomethacin75mgoncedailysitupwiththefirst24-48hours骨盆骨折-ActabularandlimbfractureInjuryofsciaticnerve(12-38%)Hipdislocation(requirespromptreduction)骨盆骨折-Malreductionorsubluxationofthehipjointwillleadtoabnormalloadingofthearticularcartilageandsubsequentjointarthrosis骨盆骨折-Principlethatperforminganaccuratereductionofthearticularsurface,therebyobtainingsurface,therebyobtainingacongruenthipjoint,willrestorenormaljointmechanics.骨盆骨折-Reductiontechniquesandinternalfixation骨盆骨折-Essentialreductiontools

distractorJudetfracturetablemanualreduction“KingTong”and“QueenTang”Clamps骨盆骨折- Themajorityofacetabularfracturescanbemanagedthroughasinglesurgicalapproach,butcombinedapproachesarealsofeasible骨盆骨折-Thefourmostfrequentlyusedapproachesare:1.Kocher-Langenbeck2.Ilioinguinal3.Extendediliofemoral4.Combinationof1)and2)骨盆骨折-InteraoperativetractionIndirectreductionwhichhaveretainedtheircapsularorsoft-tissue骨盆骨折-AdislocatedSacroiliacjointordisplacedsacralfractureisusuallyreducedfirstandfixed.Priortothereductionoftheacetabularfracture骨盆骨折-A1(posteriorwall)Kocher-langenbeck approach-lateraldecubitusA2(posteriorcolumn)K-LapproachA3(anteriorwallorcolumn) Iiloinguinalapproach骨盆骨折-B1(puretransverse) K-Lapproach(prone)B13extensileapproachB2(T-shaped) K-LorilioginguinalB3(anteriorcolumnposteriorhemitransverse) IlioinguinalorK-Lorextendediliofemoral骨盆骨折-Weightbearingisnotadvancedfor6-8weeksDuringthethirdmonth,dependingonradiographicevidenceofhealing,thepatientisallowedtofullweightbearing骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-骨盆骨折-Postoperativemanagement

rehabilitation骨盆骨折-Thethirdday,patientareallowedtoe-touchweightbearingusingcrutches.Strengtheningexercisesandgaittraining骨盆骨折-Complications

骨盆骨折-EarlyNeurovascularinjuryinadequatereduction,articularpenetrationo