后交叉韧带损伤的诊疗

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,LOGO,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,后交叉韧带,(rndi),损伤的诊疗,第一页，共三十页。,PCL,损伤,(snshng),概况,局部(jb)解剖,损伤,(snshng),原因,损伤机制,治疗,诊断,第二页，共三十页。,局部,(jb),解剖（一）,股骨,(gg),外侧,(wi c),半月板,后交叉韧带,内侧半月板,腓骨,胫骨,第三页，共三十页。,局部,(jb),解剖（二）,起点,股骨内侧髁的外侧面,走形,斜向后,下方,止点,胫骨髁间隆起的后部,和,外侧半月板的后角,第四页，共三十页。,部位,(bwi),分类,股骨,(gg),止点,体部,胫骨,(jngg),止点,第五页，共三十页。,分度,（,根据韧带断裂,(dun li),的程度和合并损伤的程度分类,）,度：韧带部分断裂,(dun li),能摸到胫骨台阶，但已减少,度：韧带完全断裂,不能摸到胫骨台阶,度：联合韧带损伤,后交叉韧带完全断裂+其他主要韧带断裂,不能摸到胫骨台阶,刘志雄,.,骨科常用诊断分类方法和功能结果评定标准(biozhn),.,北京：科学技术出版社，,2005.,第六页，共三十页。,焦晨,敖英芳.后交叉韧带损伤的临床,(ln chun),流行病学研究J.中国运动医学杂志,2008,27(4):420-423.,人群,(rnqn),分布,第七页，共三十页。,焦晨,敖英芳.后交叉韧带损伤的临床流行病学研究J.中国,(zhn u),运动医学杂志,2008,27(4):420-423.,原因,其它,0.54%,运动伤,32.62%,意外伤,66.84%,损伤,(snshng),原因,第八页，共三十页。,损伤,(snshng),机制（一）,屈膝位胫骨,(jngg),上,端暴力作用,PCL损伤,(snshng),小腿上段突然后移,继续后移,后关节囊撕裂,可合并,股骨、胫骨及,髌骨骨折脱位,胥少汀，葛宝丰，徐印坎.实用骨科学M.4北京人民军医出版社，20121041,第九页，共三十页。,损伤,(snshng),机制（二）,膝过伸暴力,(bol),PCL损伤,(snshng),ACL损伤,导致,暴力继续,股骨髁附着部,胥少汀，葛宝丰，徐印坎.实用骨科学M.4北京人民军医出版社，20121041,第十页，共三十页。,损,伤,伤,(s,nsh,ng),机,制,制,（,（,三,三,）,）,后,旋,旋,暴,暴,力,力,(b,ol,),（,足,足,部,部,固,固,定,定,）,）,胫,骨,骨,(j,ngg,),后,移,移,并,并,旋,旋,转,转,PCL,损,损,伤,伤,合,合,并,并,侧,侧,方,方,结,结,构,构,损,损,伤,伤,导,致,致,导,致,致,胥,少,少,汀,汀,，,，,葛,葛,宝,宝,丰,丰,，,，,徐,徐,印,印,坎,坎.,实,实,用,用,骨,骨,科,科,学,学M.4,北,北,京,京,人,人,民,民,军,军,医,医,出,出,版,版,社,社,，,，2012,1041,第,十,十,一,一,页,页,，,，,共,共,三,三,十,十,页,页,。,。,诊,断,断,(zh,ndu,n),1,外伤史,2,体格检查,3,影像学,第,十,十,二,二,页,页,，,，,共,共,三,三,十,十,页,页,。,。,体,格,格,检,检,查,查,（,（,一,一,）,）,屈,膝,膝90,，,，,拇,拇,指,指,从,从,股,股,骨,骨,内,内,髁,髁,向,向,下,下,滑,滑,动,动,，,，,如,如,触,触,及,及,的,的,胫,胫,骨,骨,(j,ngg,),内,侧,侧,平,平,台,台,台,台,阶,阶,较,较,健,侧,变,变,小,小,或,或,消,消,失,失,为,为,阳,阳,性,性,，,，,提,提,示,示PCL,损,损,伤,伤,。,。,台,阶,阶,(t,iji,),征,第,十,十,三,三,页,页,，,，,共,共,三,三,十,十,页,页,。,。,体,格,格,检,检,查,查,（,（,二,二,）,）,后,抽,抽,屉,屉,(ch,uti),试,验,验,患,者,者,仰,仰,卧,卧,，,，,屈,屈,膝,膝90,，,，,足,足,平,平,放,放,床,床,上,上,，,，,检,检,查,查,者,者,两,两,手,手,环,环,握,握,小,小,腿,腿,上,上,端,端,做,后,推,推,动,动,作,作,。,。,（,注,注,：,：1.,首,首,先,先,将,将,小,小,腿,腿,恢,恢,复,复,至,至,正,正,常,常,位,位,置,置,；,；2.,急,急,性,性,期,期,由,由,于,于,(y,uy,),患,者,者,疼,疼,痛,痛,和,和,肌,肌,肉,肉,痉,痉,挛,挛,等,等,会,会,产,产,生,生,假,假,阴,阴,性,性,）,）,第,十,十,四,四,页,页,，,，,共,共,三,三,十,十,页,页,。,。,体格,检,检查,（,（三,）,）,屈膝,(q,x,),小腿,后,后掉,征,征,患者,平,平卧,伸,伸膝,，,，完,全,全放,松,松，,对,对PCL,断,断裂,，,，检,查,查者,双,双手,缓,缓缓,地,地抬,起,起患,侧,侧大,腿,腿下,段,段膝,上,上10cm处,，,，可,见,见,(k,jin),胫骨,上,上段,向,向后,滑,滑移,。,。髌,下,下段,明,明显,塌,塌陷,。,。,第十,五,五页,，,，共,三,三十,页,页。,体格,检,检查,（,（四,）,）,胫骨,(j,ngg,),外旋,试,试验,在屈,膝,膝30,时,时外,旋,旋角,增,增加,，,，屈,膝,膝90,时,时外,旋,旋角,减,减少,，,，提,示,示单,纯,纯后,外,外侧,(w,ic,),角损,伤,伤；,在,在屈,膝,膝30,和,和90,时,时外,旋,旋角,均,均增,加,加，,提,提示,后,后交,叉,叉韧,带,带和,后,后外,侧,侧,(w,ic,),角均,受,受损,伤,伤,第十,六,六页,，,，共,三,三十,页,页。,影像,学,学（,一,一）,第十,七,七页,，,，共,三,三十,页,页。,影像,学,学（,二,二）,正常,(zhngch,ng),PCL,第十,八,八页,，,，共,三,三十,页,页。,影像,学,学（,三,三）,损伤,(s,nsh,ng),的PCL,第十,九,九页,，,，共,三,三十,页,页。,治疗,(zhli,o),非手,术,术治,疗,疗：,度,和,和,度的,损,损伤,(s,nsh,ng),手术,治,治疗,：,：,度,损,损伤,和,和复,合,合型,韧,韧带,损,损伤,TrockeyEL.Ruptureoftheposteriorcruciateligamentofknee.JBoneJointSurg(Br),1968,50;331-341,第二,十,十页,，,，共,三,三十,页,页。,非手,术,术治,疗,疗,胫骨,旋,旋转,中,中立,位,位（,胫,胫骨,相,相对,于,于股,骨,骨内,旋,旋后,抽,抽屉,移,移位,将,将减,小,小）,后,后抽,屉,屉小,于,于10mm（II,度,度）,小于5,的,的异,常,常旋,转,转松,弛,弛,(s,n,ch,),无明,显,显的,内,内外,异,异常,松,松弛,PCL不,全,全断,裂,裂,第二,十,十一,页,页，,共,共三,十,十页,。,。,非手,术,术治,疗,疗,用长,腿,腿石,膏,膏,(shgo),或支,具,具固,定,定患,膝,膝于,屈,屈曲,30,位，,应,应注,意,意将,患,患侧,胫,胫骨,上,上端,向,向前,推,推至,与,与正,常,常膝,部,部形,态,态一,致,致，,固,固定,6,周。,注：,固定,中,中锻,炼,炼,(dunlin),股四,头,头肌,，,，以,免,免肌,萎,萎缩,。,。,第二,十,十二,页,页，,共,共三,十,十页,。,。,手术,治,治疗,(zhli,o),（早,期,期）,胫止,点,点撕,脱,脱骨,折,折移,位,位者,；,；,合并,有,有半,月,月板,损,损伤,有,有关,节,节交,锁,锁，,不,不能,自,自解,者,者，,应,应早,期,期手,术,术修,复,复；,严重,(y,nzh,ng),膝关,节,节脱,位,位，,前,前、,后,后交,叉,叉韧,带,带断,裂,裂、,后,后外,角,角损,伤,伤,第二,十,十三,页,页，,共,共三,十,十页,。,。,手术,治,治疗,(zhli,o),（晚,期,期）,患者,年,年轻,，,，一,般,般,(y,b,n),45,岁以,下,下,膝关,节,节反,复,复疼,痛,痛、,肿,肿胀,，,，有,