肱骨近端骨折合并肩关节后脱位一例课件

,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,Case Presentation,Case Presentation,1,History,Female,56,-year-old;,摔伤右上肢致右肩疼痛伴活动受限,6,小时,查体：右上肢位于内旋内收位,(internal and adduction);,固定于内旋位,10-60,HistoryFemale,56-year-old;摔伤右,2,X-ray,X-ray,3,Primary Diagnosis,Proximal humeral fracture,（,Neer type I,）,Primary DiagnosisProximal hum,4,Confusion,Is X-ray Normal?,Final Diagnosis?,Further Examination?,ConfusionIs X-ray Normal?,5,X-ray manifestation,The trough line,electric light-bulb,head-glenoid(vacant glenoid sign)6mm,-the normal overlap between humeral head and glenoid vanished,X-ray manifestation The trough,6,CT scan,CT scan,7,3D Recon,3D Recon,8,Final Diagnosis,肱骨近端骨折伴肩关节后脱位,反,Hill-Sachs,损伤,Final Diagnosis肱骨近端骨折伴肩关节后脱位,9,Surgical,PLAN,Deltopectoral,(,三角肌胸大肌入路,),The lesser tuberosity osteotomy,（小结节截骨）,Reduction of dislocation,（肱骨头复位）,Neer Modification of McLaughlin,（改良法）,Proximal fracture fixed with PHILOS,（钢板固定）,Brace fixed in a slightly external position,（支具固定于轻度外旋位）,Surgical PLAN Deltopectoral(,10,Procedures,Beach chair position,Deltopectoral approach,ProceduresBeach chair position,11,通过二头肌长头腱确定小结节位置,找到肩袖的间隙并判断肩胛下肌的下缘,结扎旋肱前动脉（,Anterior Circumflex Humeral A,）,Procedures,通过二头肌长头腱确定小结节位置找到肩袖的间隙并判断肩胛下肌的,12,Procedures,直视下从结节间沟（,bicipital sulcus,）向内侧进行小结节截骨（,Osteotomy,）直到肱骨头缺损处（,H-S,）,截骨完成后将小结节及附着的肩胛下肌一同掀起,因,Hill-Sachs,损伤部位崁插于肩胛盂前柱，肱骨头无法自行复位,Procedures直视下从结节间沟（bicipital,13,Procedures,将骨翘插入骨缺损部位撬拨复位肱骨头,将肱骨外旋以充分显露,H-S,损伤骨缺损部位,将附着肩胛下肌的小结节以,4.0mm,空心钉固定于缺损，,PHILOS,钢板固定肱骨近端骨折,Procedures将骨翘插入骨缺损部位撬拨复位肱骨头将肱骨,14,External rotation,6 weeks,Procedures,External rotation Procedures,15,X-ray post-operation,X-ray post-operation,16,Six weeks later,remove the external fixator,Initial functional practice,Six weeks later,remove the ex,17,Follow up in Six months,Follow up in Six months,18,Follow up in Six months,Follow up in Six months,19,Follow up in Six months,Follow up in Six months,20,Follow up in Six months,Follow up in Six months,21,What can we learn from this,Dr.McLaughlin accounted 581 shoulder dislocations,in which posterior dislocation only account for 4%;,Missed diagnosis rate is up to 50-80%,；,Main reasons,：,no adequate history and physical examination,，,no sufficient experience of reading X-ray;,Mechanism,：,axially loaded with arm in forward elevation,adduction,and internal rotation.,What can we learn from thisDr,22,X-ray manifestation,The Trough line,Electric light-bulb like head,Vacant glenoid sign 6mm,X-ray manifestation The Trough,23,CT&3D-Recon,Practical in clinic,CT&3D-ReconPractical in clin,24,Summary,Posterior shoulder dislocation can be rarely seen in our daily work,（罕见）,;,Missed diagnosis occur with careless examination and misreading of the X-ray and no further examinations,（漏诊因查体及阅片经验不足）,;,Trough line,Electric Bulb sign and Glenoid vacant sign are important ones in X-ray,（,X,线信息重要）,;,CT and Reconstruction is practical in Emergency Room,（肩关节,CT,和重建有实用价值）；,Reconditioning Exercises should be followed up,（需要进行术后康复）,.,SummaryPosterior shoulder disl,25,Thank you for your,attention,謝謝！,Thank you for your 謝謝！,26,