骨盆骨折(九院).ppt

《骨盆骨折(九院).ppt》由会员上传分享，免费在线阅读，更多相关内容在行业资料-天天文库。

1、骨盆骨折上海第二医科大学附属第九人民医院骨科孙月华RadiographicEvaluationoftheacetabulumJudetViews1.Anteroposterior2.iliacoblique3.obturatoroblique45°Anteroposteriorview髂会阴线髂坐骨线髋臼前后唇“teardrop”与髂坐线的关系Obturatorobliqueview前柱耻骨上支髋臼后壁Iliacobliqueview后柱前壁Tomographyand3-DReconstructionCT评估常规X线未能显示的骨折关节内的骨折碎片,股骨头骨

2、折骶髂关节的骨折3-D重建能立体的显示骨盆ClassificationofAcetabularFractures(JudetandLelournel)TypeA:Partialarticular,involvingonlyoneofthetwocolumnsA1posteriorwallfractureA2posteriorcolumnA3AnteriorcolumnorwallTypeB:partialarticular,involvingatransversecomponentB1PuretransverseB2T-shapedB3AnteriorCol

3、umnandposteriorhemitransverseTypeC:Fracture(completearticular:bothcolumns)C1Highvariety,extendingtotheiliacC2Lowvariety,extendingtotheanteriorborderoftheiliumC3ExtensionintotheSacroiliacjointC1/C2(bothcolumn=Completearticularfracture)IlioinguinalapproachInvolvementoftheposteriorcol

4、umnorwallextensileapproachC3(BothcolumnextendingintoSIjoint)ExtendedIliofemoralapproachEvaluationanddiagnosisThepatient气道呼吸循环伴随损伤：长骨干骨折、脊柱、脑部、腹腔、盆腔、泌尿道Surgicalindicationandtiming1.病人的全身情况2.经济情况，需求3.外科医师的经验，器械4.骨折类型5.关节面的完整性>2mm手术时间：伤后7-10天反指征严重骨质疏松无移位骨折后笠骨折碎片小低位前柱骨折Cefazolinfor48

5、-72hoursThromboembolicprophylaxisIndomethacin75mgoncedailysitupwiththefirst24-48hoursActabularandlimbfractureInjuryofsciaticnerve(12-38%)Hipdislocation(requirespromptreduction)Malreductionorsubluxationofthehipjointwillleadtoabnormalloadingofthearticularcartilageandsubsequentjointar

6、throsisPrinciplethatperforminganaccuratereductionofthearticularsurface,therebyobtainingsurface,therebyobtainingacongruenthipjoint,willrestorenormaljointmechanics.ReductiontechniquesandinternalfixationEssentialreductiontoolsdistractorJudetfracturetablemanualreduction“KingTong”and“Qu

7、eenTang”ClampsThemajorityofacetabularfracturescanbemanagedthroughasinglesurgicalapproach,butcombinedapproachesarealsofeasibleThefourmostfrequentlyusedapproachesare:1.Kocher-Langenbeck2.Ilioinguinal3.Extendediliofemoral4.Combinationof1)and2)InteraoperativetractionIndirectreductionwh

8、ichhaveretainedtheircapsul