腕部舟状骨骨折医学课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,D,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Department of Traumatic Orthopedic,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Department of Traumatic Orthopedic,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Department of Traumatic Orthopedic,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Department of Traumatic Orthopedic,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Department of Traumatic Orthopedic,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Department of Traumatic Orthopedic,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Department of Traumatic Orthopedic,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Department of Traumatic Orthopedic,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Department of Traumatic Orthopedic,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Department of Traumatic Orthopedic,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Department of Traumatic Orthopedic,*,2024/10/2,D,1,腕部舟状骨骨折,Scaphoid fracture,2022/10/3D1腕部舟状骨骨折 Scaphoid f,2024/10/2,D,2,近极部,腰部,结节部,最大的一块近排腕骨,4,个关节面,近侧面桡舟关节,远内侧面头舟关节,尺侧面舟月关节,远侧面舟骨大小多角骨关节,STT joint,（,scaphotrapezotrapezoidal joint,）,2022/10/3D2近极部腰部结节部 最大的一块近排腕,2024/10/2,D,3,关节软骨覆盖,80,舟骨结节重要韧带的附着点,舟骨腰部无关节软骨覆盖，腰部最细又正对桡骨茎突,2022/10/3D3 关节软骨覆盖80,2024/10/2,D,4,Blood supply to the scaphoid,Radial artery,7080% -,radial artery through the dorsal ridge,2030%- volar radial artery branches,2022/10/3D4 Blood supply to th,2024/10/2,D,5,愈合时间,68,周,1012,周,1220,周,愈合时间为,45,个月,2022/10/3D5愈合时间愈合时间为45个月,2024/10/2,D,6,占全身骨折的,2%,占腕部骨折的,60,70,发病率仅次于桡骨远端骨折,几乎全部发生于青壮年,连接近排与远排腕骨的杠杆,治疗过程长,效果相对较差,2022/10/3D6占全身骨折的 2%,2024/10/2,D,7,损伤机制,最常见过伸-跌倒手掌触地，手腕强度背屈，轻微桡偏，,桡骨,背侧缘切断,舟骨,较少见冲压工舟骨-腕关节处于中立或轻度屈曲,暴力沿第二掌骨经大小多角骨经舟骨远端形成屈曲剪力.多伴发于掌 骨头开放性骨折,2022/10/3D7损伤机制最常见过伸-跌倒手掌触地，手腕,2024/10/2,D,8,查体,鼻烟壶局部肿胀、压痛 ,腕部活动受限,2022/10/3D8查体鼻烟壶局部肿胀、压痛 ,腕部活动受,2024/10/2,D,9,腕舟骨移动试验（,Wastons test),检查方法,:,将患者患侧腕关节被动尺偏,检查者一只手握住患者腕部,用拇指压迫舟骨结节,另一只手握住患者手掌使腕关节逐渐转向桡侧,感觉腕部疼痛剧烈则为阳性,2022/10/3D9腕舟骨移动试验（Wastons te,2024/10/2,D,10,舟骨冲击试验：拇指向背侧按压舟骨结节,舟骨剪力试验：拇指、示指捏住舟骨远、近极，向掌侧、背侧或尺、桡侧推移舟骨,2022/10/3D10舟骨冲击试验：拇指向背侧按压舟骨结节,2024/10/2,D,11,X线检查,常规腕关节正侧位片,-,舟骨长轴向前下方倾斜，舟骨骨折线不易显示,(,阴性率,22%43%),2022/10/3D11X线检查常规腕关节正侧位片-舟骨长轴,2024/10/2,D,12,常规腕关节正侧位片,舟骨尺偏位片,(Stecher,位,):,腕掌面朝下,平放于胶片上,然后抬高腕部,23,并使腕尽量尺偏,.,旋前,/,旋后,45,2022/10/3D12常规腕关节正侧位片,2024/10/2,D,13,要告知拍片者行舟骨矢状面照片,CT,2022/10/3D13要告知拍片者行舟骨矢状面照片CT,2024/10/2,D,14,MR,能很好的评价舟骨结构的完整性,能准确的反映舟骨血液灌注情况,发现舟骨损伤后缺血情况以选择治疗方案并判断预后提供了条件,可以鉴别腕舟骨骨折后出现的延迟愈合、 不愈合或缺血性坏死,评价其手术适应症并选择合适的手术方法,2022/10/3D14MR能很好的评价舟骨结构的完整性,2024/10/2,D,15,其它诊断方法包括,:,核素骨扫描、腕舟脂肪垫征、 音频震动及超声检查,其它诊断方法,核素骨扫描,-,诊断舟骨骨治疗与骨生物力学研究析的黄金指标,腕舟脂肪垫征,音频震动,超声检查,2022/10/3D15其它诊断方法包括:核素骨扫描、腕舟脂,2024/10/2,D,16,分型,2022/10/3D16分型,2024/10/2,D,17,2022/10/3D17,2024/10/2,D,18,治疗方法,急性,(3,周,),无移位稳定型腕舟骨骨折多采用保守治疗,固定体位,:,国内多采用肘下管形石膏固定,国外大多主张采用超肘关节石膏固定,1973,年,Thomaidis,的解剖研究证明,腕关节用肘以下石膏固定,前臂在旋前、 旋后活动时骨折部位仍有直接的活动,不能忍受长时间石膏外固定的可考虑手术治疗,2022/10/3D18治疗方法急性(3周)无移位稳定型腕舟,2024/10/2,D,19,移位或不稳定骨折,(,以下任何一种表现,),任意,X,线片上骨折移位超过一毫米,舟月角,(,舟骨轴线与月骨纵轴线轴线的夹角,),超过,60,月头角,(,月骨纵轴线与头骨轴线的夹角,),大于,15,或侧位舟骨内角大于,20,舟月角,2022/10/3D19移位或不稳定骨折(以下任何一种表现),2024/10/2,D,20,手术方法,经皮穿针或螺钉内固定,关节镜下穿针或螺钉内固定,切开复位穿针或螺钉内固定,近端骨折多选用背侧入路,远端骨折多选用掌侧入路,经皮穿针或螺钉内固定,2022/10/3D20手术方法经皮穿针或螺钉内固定,2024/10/2,D,21,2022/10/3D21,2024/10/2,D,22,骨不连,骨不连,植骨,+,内固定术,1,松质骨填塞,2,纵形骨栓,3Matti-Russe,嵌入植骨,4,楔形或梯形插入植骨,5,带血管蒂骨瓣植骨,6,游离骨移植,7,异体骨移植,8,植骨,+,血管束植入,2022/10/3D22骨不连骨不连植骨+内固定术1松质骨,2024/10/2,D,23,带血运骨移植术,掌侧的旋前方肌带蒂植骨,1,2,背侧骨间动脉带蒂植骨,Fernandez,血管束移植,带游离血管髂骨嵴骨块植骨,2022/10/3D23带血运骨移植术掌侧的旋前方肌带蒂植骨,2024/10/2,D,24,骨折不愈合伴关节炎,手术方法,:,桡骨茎突切除术,近排腕骨切除术,关节融合术,肋骨,骨软骨移植,2022/10/3D24骨折不愈合伴关节炎手术方法:,2024/10/2,D,25,怀疑舟状骨骨折,X,光片检查,发现骨折，进行分类,稳定骨折,不稳定骨折,前臂管型石膏制动,8,周,腰部及结节部骨折,近极骨折,长臂管型,4,周再前臂管型,8,周,CT,检查愈合情况,愈合,不愈合,阴性，仍高度怀疑,前臂管型,2,周,复查平片,阴性,支具固定一周,手术治疗,不能忍受长时间石膏固定,植骨术,SNAC,腕,桡骨茎突切除、四角融合、近排腕骨切除和全腕关节融合术,2022/10/3D25怀疑舟状骨骨折X光片检查发现骨折，进,2024/10/2,D,26,Thank you,！,2022/10/3D26Thank you！,