陈旧性跟骨骨折的手术治疗课件

Mastertitelformat bearbeiten,Mastertextformat bearbeiten,Zweite Ebene,Dritte Ebene,2009 Synthes Foot&Ankle Seminar,*,陈旧性跟骨骨折的手术治疗,同济大学附属同济医院骨科,俞光荣,2009 Synthes Foot&Ankle Seminar,跟骨骨折畸形愈合的病理学基础,2009 Synthes Foot&Ankle Seminar,跟骨丘部平坦或消失,距下关节不平整,后跟增宽穿鞋困难,跟腓撞击及前胫距撞击,跟腱短缩、小腿三头肌肌力下降,距下关节或跟骰关节创伤性关节炎,后足力线异常,距骨倾斜角缩小或消失致胫距撞击,关节面硬化或后关节面缺血性坏死,腓骨肌腱脱位,创伤性扁平足（后足、中足、动力性）,后足的内外翻（主要为跟骨）,踝痛,膝痛,髋痛,下腰背痛,颈和头痛,2009 Synthes Foot&Ankle Seminar,陈旧性跟骨骨折,至今没有理想、公认的分类,2009 Synthes Foot&Ankle Seminar,Stephens,和,Sanders,的,CT,分型,型畸形愈合：跟骨外侧外膨，有或没有极外侧的局限性距下关节炎,型畸形愈合：跟骨外侧外膨，伴有广泛的距下关节炎,型畸形愈合：跟骨外侧外膨，伴有广泛、严重的距下关节炎，跟骨体畸形愈合伴有后足内翻或外翻成角畸形,2009 Synthes Foot&Ankle Seminar,Stephens,、,Sanders,分型,2009 Synthes Foot&Ankle Seminar,Zwipp,陈旧性跟骨骨折分类,2009 Synthes Foot&Ankle Seminar,型骨折,:,关节活动不协调，有关节炎表现,2009 Synthes Foot&Ankle Seminar,采用原位单纯距下关节融合术,2009 Synthes Foot&Ankle Seminar,型骨折：伴有后足的内外翻畸形,2009 Synthes Foot&Ankle Seminar,距下关节融合植骨纠正畸形,2009 Synthes Foot&Ankle Seminar,2009 Synthes Foot&Ankle Seminar,2009 Synthes Foot&Ankle Seminar,2009 Synthes Foot&Ankle Seminar,型骨折：伴有足高度丢失，负,B,hler,角,2009 Synthes Foot&Ankle Seminar,距下关节融合截骨纠正畸形,2009 Synthes Foot&Ankle Seminar,骨折：伴有跟骨平行移位,2009 Synthes Foot&Ankle Seminar,距下关节融合截骨纠正畸形,2009 Synthes Foot&Ankle Seminar,2009 Synthes Foot&Ankle Seminar,型骨折：伴有距骨倾斜,2009 Synthes Foot&Ankle Seminar,距下关节融合截骨纠正畸形,2009 Synthes Foot&Ankle Seminar,单、三关节融合术,主要指征,严重畸形愈合涉及距下和跟骰关节关节,2009 Synthes Foot&Ankle Seminar,切开复位内固定,2009 Synthes Foot&Ankle Seminar,适应证,骨折时间在伤后,6,周之内,软组织条件较好,距下关节和跟骰关节破坏不严重,2009 Synthes Foot&Ankle Seminar,男性，,42,岁，跟骨骨折后,5,周,2009 Synthes Foot&Ankle Seminar,2009 Synthes Foot&Ankle Seminar,2009 Synthes Foot&Ankle Seminar,跟骨丘部重建、距下关节融合,2009 Synthes Foot&Ankle Seminar,主要适应征与禁忌征,适应证,各种类型后关节面塌陷畸形愈合的严重陈旧性跟骨骨折,有严重跟骨轴成角畸形,禁忌证,局部有感染或血管性疾病,有严重重要脏器病变或代谢性疾病,2009 Synthes Foot&Ankle Seminar,2009 Synthes Foot&Ankle Seminar,2009 Synthes Foot&Ankle Seminar,2009 Synthes Foot&Ankle Seminar,2009 Synthes Foot&Ankle Seminar,保留距下关节的跟骨截骨矫形,2009 Synthes Foot&Ankle Seminar,距下关节对维护足踝功能的重要性,对踝关节冠状面运动具有重要的缓冲作用,维护后足各关节的正常活动范围,距下关节具有承重及三维活动功能,主要完成后足的内外翻功能，以能够完成跑、跳、爬及适应高低不平路面行走等活动,活动范围改变将导致步态异常、活动受限、足部畸形，及整个下肢或下腰椎的病理改变,2009 Synthes Foot&Ankle Seminar,单纯距下关节融合后,距舟关节的活动度背、跖屈减少,56,距下关节对距舟关节功能的正常发挥具有重要意义,足内、外翻减少,70,2009 Synthes Foot&Ankle Seminar,手术指征和禁忌征,手术指征,年龄较轻，骨折畸形不很严重，受伤后时间在,9,个月内,舌型骨折块和后关节面压缩骨折块外形可见,手术禁忌征,同其它跟骨骨折手术,严重粉碎性、畸形愈合的跟骨骨折,舌型骨折块和后关节面压缩骨折块外形模糊,2009 Synthes Foot&Ankle Seminar,2009 Synthes Foot&Ankle Seminar,2009 Synthes Foot&Ankle Seminar,2009 Synthes Foot&Ankle Seminar,谢谢！,2009 Synthes Foot&Ankle Seminar,