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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,踝关节骨折的分型,最常见:旋后,-,外旋型,Lauge-Hansen,分类的意义,Lauge-Hansen,分类,反映骨折移位的病理,便于了解损伤机制,制订治疗计划,Lauge-Hansen,分类,旋后,内翻,型(,supination-adduction,),旋后外旋型(,supination external rotation,),旋前,外展,型,(pronation-abduction),旋前,外旋,型,(pronation external rotation,),大概就涵盖所有骨折的,85%,左右,没有内旋型:受伤时小腿绝大多向外侧转。,旋后,-,内收,第一阶段:外踝或外侧副韧带损伤,外踝骨折往往是低于或等于关节面的撕脱骨折,第二阶段:内踝骨折或内上角压缩,内踝多为斜行骨折,旋后,-,内收,1,度(第一阶段),第一阶段:,外踝或外侧副韧带损伤,外踝骨折往往是低于或等于关节面的撕脱骨折,旋后,-,内收,2,度(第二阶段),第二阶段:,内踝骨折或内上角压缩,内踝多为斜行骨折,旋,后,-,内收型手术方法,旋后,-,外,旋型(最常见),旋后,-,外旋,1,度,下胫腓前韧带断裂,或胫骨前结节撕脱性骨折,旋后,-,外旋,2,度,下胫腓前韧带断裂,I,或胫骨前结节撕脱,性骨折,加上:,外踝骨折,(在下胫腓联合水平位于冠状面自前下向后上),旋后,-,外旋,3,度,下胫腓前韧带断裂,或胫骨前结节撕脱,II,度,性骨折,外踝骨折,(在下胫腓联合水,平位于冠状面自前,下向后上),加上后踝或下胫腓后韧带骨折,旋后,-,外旋,4,度,下胫腓前韧带断裂,或胫骨前结节撕脱,性骨折,外踝骨折,III,(在下胫腓联合水,平位于冠状面自前,下向后上),后踝或下胫腓后韧,带骨折,加上: 内踝或三角韧带断裂,旋后,-,外旋 损伤顺序,旋后,-,外旋 损伤顺序,旋后,-,外旋 损伤分度图,旋后,-,外旋,旋后,-,外旋,2,度与,4,度的鉴别,2,度外踝骨折,内侧完整,4,度外踝骨折,内侧三角韧带深层断裂,如何区分:,内侧压痛(不靠谱),瘀斑(不靠谱),内侧肿胀(不靠谱),应力位片(踝外旋、外翻摄,X,线片。较靠谱),旋前,-,外展,旋前,-,外展,旋前,-,外展,1,度,旋前,-,外展,23,度,旋前,-,外旋型,旋前,-,外旋型,旋前,-,外旋型,旋前,-,外旋型,旋前,-,外旋型,特点:,外踝骨折相对较高,外踝骨折斜形或螺旋形,骨折线前上到后下,前下到后上都有可能,不要纠结,旋前,-,外旋,1,度,旋前,-,外旋,2,度,旋前,-,外旋,3,度,旋前,-,外旋,4,度,下胫腓看片技巧,无论任何角度,腓骨与下胫腓前结节都有至少,1mm,重叠。若没有重叠,则有问题,Lauge-Hansen,分型,自我总结,外,旋型断裂的四个节点:,内踝,下胫腓前韧带,外踝,下胫腓后韧带,旋后,-,外旋型:起于,下,胫腓前韧带,止于内踝,旋前,-,外旋型:起于内踝,止于下胫腓后韧带。,Lauge-Hansen,分型,自我总结,:通过外踝骨折形态进行快速识别,不同,分,型,外踝,断裂形态,旋,后,内收,:,往往是低于或等于,关节面,旋,后,外旋型:,在下胫腓联合水,平,位于冠状面自,前下,向后上,Lauge-Hansen,分,型,自我总结,:通过外踝骨折形态进行快速识别,旋前,外展:,下胫腓联合近端水平横断或有小片蝶形骨片,旋,前,外旋:,下胫腓联合近端水平螺旋形骨折,Lauge-Hansen,分,型,自我总结,:通过外踝骨折形态进行快速识别,以下胫腓联合上缘为界限:,其上骨折为旋前,横行或横行带有楔形骨片:外展,螺旋,形:外旋,其,下骨折为旋后,关节面以下撕脱骨折:内收,下胫腓联合水平前下向后上骨折:外旋,AO-Dannis-Weber,分型与下胫腓,A,型 下胫腓无损伤,B,型 下胫腓,50%,可能损伤,C,型 下胫腓,100%,损伤,Tibia,Fibula,MM,LM,Talus,Please Do Not Remove this Hidden Slide,I am casting this PowerPoint presentation in cyberspace in the hope that others may find it useful or instructional.,Please feel free to share this material with others.,Please feel free to use this material, as is, in your own presentations; or modify it as you see fit.,I make no guarantees as to the validity of any of this material, nor do I guarantee this file is virus-free.,I am retaining the copyright to this presentation and derivative works.,If you decide to use or modify this material, I have just two requests:,1) The e-mail address below is a permanent forwarding address. Please do not remove it or my name.,2) Please send me an e-mail at some time, telling me if you found this material useful. Better yet, send me YOUR improvements and/or suggestions.,Ken L Schreibman, PhD/MD 2002schreibmanalum.MIT.edu,IOM,Delt,Lig,Tibia,Fibula,MM,LM,Talus,Talo-Fib,Lig,Tib-Fib,Lig,IOM,Delt,Lig,Tibia,Fibula,MM,LM,Talus,Talo-Fib,Lig,Tib-Fib,Lig,INVERSION,Delt,Lig,IOM,Tibia,Fibula,MM,LM,Tib-Fib,Lig,Talus,INVERSION,Talo-Fib,Lig,Weber A,IOM,Delt,Lig,Tibia,Fibula,MM,LM,Talus,Talo-Fib,Lig,Tib-Fib,Lig,EVERSION,IOM,Delt,Lig,Tibia,Fibula,MM,LM,Talo-Fib,Lig,Tib-Fib,Lig,Talus,EVERSION,Weber B,IOM,Delt,Lig,Tibia,Fibula,MM,LM,Talo-Fib,Lig,Tib-Fib,Lig,Talus,EVERSION,Weber C,IOM,Delt,Lig,Tibia,Fibula,MM,LM,Talo-Fib,Lig,Tib-Fib,Lig,Talus,EVERSION,Maisonneuve Fx,AO,与,L-H,分型的对应,旋前型:外踝骨折较高,积水潭李庭不同意把,旋前外展型,放在这个地方进行对应:认为旋前型外踝骨折线一般高于下胫腓联合,Maisonneuve,骨折,指,由外旋暴力导致的腓骨近端骨折, 常常合并内踝骨折、三角韧带撕裂、前距腓韧带断裂、骨间韧带损伤、下胫腓韧带撕裂、后踝骨折等损伤。该骨折,1840,年由法国医师,Maisonneuve,首先报道,故此,得名。,属于旋前,-,外旋三度损伤,踝关节不稳定,
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