骨盆骨折九院课件

骨盆骨折九院课件1骨盆骨折九院课件2骨盆骨折九院课件3骨盆骨折九院课件4Radiographic Evaluationof the acetabulumRadiographic Evaluation5Judet Views1.Anteroposterior2.iliac oblique3.obturator oblique45Judet Views456Anteroposterior view髂会阴线髂会阴线髂坐骨线髂坐骨线髋臼前后唇髋臼前后唇“teardrop”与髂坐线的关系与髂坐线的关系Anteroposterior view髂会阴线7Obturator oblique view前柱前柱耻骨上支耻骨上支髋臼后壁髋臼后壁Obturator oblique view前柱8Iliac oblique view后柱后柱前壁前壁Iliac oblique view后柱9Tomography and 3-D ReconstructionCT评估常规评估常规X线未能显示的骨折线未能显示的骨折关节内的骨折碎片关节内的骨折碎片,股骨头骨折股骨头骨折骶髂关节的骨折骶髂关节的骨折3-D重建能立体的显示骨盆重建能立体的显示骨盆Tomography and 3-D Reconstruct10骨盆骨折九院课件11骨盆骨折九院课件12骨盆骨折九院课件13Classification of AcetabularFractures(Judet and Lelournel)Classification of Acetabular14骨盆骨折九院课件15骨盆骨折九院课件16ChondrolysisClassification of Acetabular外科医师的经验，器械Kocher-Langenbeckand internal fixationThe four most frequently used approaches are:“King Tong”and“Queen Tang”Clamps=Complete articular fracture)Extended iliofemoralcolumn or wallExtended Iliofemoral approachB3Anterior Column and posterior hemitransverseC1High variety,extending to the iliacinadequate reduction,articularK-L approach(prone)Injury of sciatic nerve(12-38%)of the acetabulum手术时间：伤后7-10天A2(posterior column)K-L approachcolumn or wallType A:Partial articular,involving only one of the two columnsA1 posterior wall fractureA2 posterior columnA3 Anterior column or wallChondrolysisType A:Partial ar17Type B:partial articular,involving a transverse componentB1Pure transverseB2T-shapedB3Anterior Column and posterior hemitransverseType B:partial articular,inv18Type C:Fracture(complete articular:both columns)C1High variety,extending to the iliac C2Low variety,extending to the anterior border of the iliumC3Extension into the Sacroiliac jointType C:Fracture(complete art19C1/C2(both column =Complete articular fracture)Ilioinguinal approachInvolvement of the posteriorcolumn or wallextensile approachC1/C2(both column20C3(Both column extending into SI joint)Extended Iliofemoral approachC3(Both column extending 21骨盆骨折九院课件22Evaluation and diagnosisThe patient气道气道 呼吸呼吸 循环循环伴随损伤：伴随损伤：长骨干骨折、脊柱、长骨干骨折、脊柱、脑部、腹腔、脑部、腹腔、盆腔、泌尿道盆腔、泌尿道Evaluation and diagnosisThe p23Surgical indicationand timingSurgical indicationand timing241.病人的全身情况病人的全身情况2.经济情况，需求经济情况，需求3.外科医师的经验，器械外科医师的经验，器械4.骨折类型骨折类型5.关节面的完整性关节面的完整性 2mm1.病人的全身情况25手术时间：伤后手术时间：伤后7-10天天反指征反指征严重骨质疏松严重骨质疏松无移位骨折无移位骨折后笠骨折碎片小后笠骨折碎片小低位前柱骨折低位前柱骨折手术时间：伤后7-10天26pulmonary embolism=Complete articular fracture)Extended iliofemoralClassification of AcetabularA2 posterior columnThe four most frequently used approaches are:one of the two columnsIliac oblique view外科医师的经验，器械B3Anterior Column and posterior hemitransversefull weight bearing=Complete articular fracture)关节面的完整性 2mmInvolvement of the posterior“King Tong”and“Queen Tang”Clampscolumn or wallHip dislocationA2(posterior column)K-L approachapproach-lateral decubitusIlioinguinalCefazolin for 48-72 hours Thromboembolic prophylaxis Indomethacin 75mg once daily sit up with the first 24-48 hourspulmonary embolismCefazolin fo27Actabular and limb fractureInjury of sciatic nerve(12-38%)Hip dislocation(requires prompt reduction)Actabular and limb fracture28Malreduction or subluxation of the hip joint will lead to abnormal loading of the articular cartilage and subsequent joint arthrosisMalreduction or subluxation of29Principle that performing an accurate reduction of the articular surface,thereby obtaining surface,thereby obtaining a congruent hip joint,will restore normal joint mechanics.Principle that performing an a30Reduction techniquesand internal fixationReduction techniques31Essential reduction tools distractorJudet fracture tablemanual reduction“King Tong”and“Queen Tang”ClampsEssential reduction tools dis32The majority of acetabular fractures can be managed through a single surgical approach,but combined approaches are also feasibleThe majority of acetabular fr33The four most frequently used approaches are:1.Kocher-Langenbeck2.Ilioinguinal3.Extended iliofemoral4.Combination of 1)and 2)The four most frequently used 34Interaoperative traction Indirect reduction which have retained their capsular or soft-tissueInteraoperative traction Indir35A dislocated Sacroiliac joint or displaced sacral fracture is usually reduced first and fixed.Prior to the reduction of the acetabular fractureA dislocated Sacroiliac joint 36Involvement of the posteriorAnteroposteriorDuring the third month,depending on radiographic evidence of healing,column or wallExtended Iliofemoral approach手术时间：伤后7-10天IlioinguinalJudet fracture tablepulmonary embolismIliac oblique viewExtended Iliofemoral approachfull weight bearingKocher-LangenbeckFractures(Judet and Lelournel)pulmonary embolism“King Tong”and“Queen Tang”ClampsIiloinguinal approach手术时间：伤后7-10天K-L or ilioginguinal3-D重建能立体的显示骨盆A1(posterior wall)Kocher-langenbeckapproach-lateral decubitusA2(posterior column)K-L approachA3(anterior wall or column)Iiloinguinal approachInvolvement of the posteriorA137B1(pure transverse)K-L approach(prone)B13 extensile approachB2(T-shaped)K-L or ilioginguinalB3(anterior column posterior hemitransverse)Ilioinguinal or K-L or extended iliofemoralB1(pure transverse)38Weight bearing is not advanced for 6-8 weeksDuring the third month,depending on radiographic evidence of healing,the patient is allowed to full weight bearingWeight bearing is not advanced39骨盆骨折九院课件40骨盆骨折九院课件41骨盆骨折九院课件42骨盆骨折九院课件43骨盆骨折九院课件44骨盆骨折九院课件45骨盆骨折九院课件46B1Pure transverseKocher-LangenbeckIlioinguinal approachJudet fracture tablefull weight bearingA1(posterior wall)Kocher-langenbeckfull weight bearingEssential reduction toolsfull weight bearingA1 posterior wall fractureExtended iliofemoralKocher-LangenbeckIlioinguinalfull weight bearingB2(T-shaped)Injury of sciatic nerve(12-38%)extensile approachJudet ViewsChondrolysisA1(posterior wall)Kocher-langenbeckB1 Pure transverse47骨盆骨折九院课件48骨盆骨折九院课件49骨盆骨折九院课件50骨盆骨折九院课件51Postoperative managementrehabilitationPostoperative managementrehab52The third day,patient are allowed toe-touch weight bearing using crutches.Strengthening exercises and gait trainingThe third day,patient are all53ComplicationsComplications54EarlyNeurovascular injuryinadequate reduction,articularpenetration of hardware,pulmonary embolismEarlyNeurovascular injury55LateHeterotopic ossificationChondrolysisavascular necrosisposttraumatic arthrosisLateHeterotopic ossification56Injury of sciatic nerve(12-38%)A dislocated Sacroiliac joint or displaced sacral fracture is usually reduced first and fixed.column or wallone of the two columnsThe majority of acetabular fractures can be managed through a single surgical approach,but combined approaches are also feasibleNeurovascular injuryHip dislocation“teardrop”与髂坐线的关系手术时间：伤后7-10天both columns)Essential reduction toolsIliac oblique viewTomography and 3-D ReconstructionA2(posterior column)K-L approachAnteroposteriorB13 extensile approach=Complete articular fracture)A3(anterior wall or column)and internal fixationExtended iliofemoralInjury of sciatic nerve(12-3857骨盆骨折九院课件58骨盆骨折九院课件59骨盆骨折九院课件60骨盆骨折九院课件61骨盆骨折九院课件62骨盆骨折九院课件63骨盆骨折九院课件64骨盆骨折九院课件65骨盆骨折九院课件66Thank YouThank You67