骨盆骨折九院第1頁/共69頁骨盆骨折

第2頁/共69頁第3頁/共69頁第4頁/共69頁第5頁/共69頁第6頁/共69頁RadiographicEvaluationoftheacetabulum第7頁/共69頁JudetViews1.Anteroposterior2.iliacoblique3.obturatoroblique45°第8頁/共69頁Anteroposteriorview髂會陰線髂坐骨線髖臼前后唇“teardrop”與髂坐線的關(guān)系第9頁/共69頁Obturatorobliqueview前柱恥骨上支髖臼后壁第10頁/共69頁Iliacobliqueview后柱前壁第11頁/共69頁Tomographyand3-DReconstructionCT評估常規(guī)X線未能顯示的骨折關(guān)節(jié)內(nèi)的骨折碎片,股骨頭骨折骶髂關(guān)節(jié)的骨折3-D重建能立體的顯示骨盆第12頁/共69頁第13頁/共69頁第14頁/共69頁第15頁/共69頁ClassificationofAcetabularFractures(JudetandLelournel)第16頁/共69頁第17頁/共69頁第18頁/共69頁TypeA:Partialarticular,involvingonlyoneofthetwocolumnsA1posteriorwallfractureA2posteriorcolumnA3Anteriorcolumnorwall第19頁/共69頁TypeB:partialarticular,involvingatransversecomponentB1 PuretransverseB2 T-shapedB3 AnteriorColumnandposterior hemitransverse第20頁/共69頁TypeC:Fracture(completearticular:bothcolumns)C1 Highvariety,extendingtotheiliacC2 Lowvariety,extendingtotheanterior borderoftheiliumC3 ExtensionintotheSacroiliacjoint第21頁/共69頁C1/C2(bothcolumn=Completearticularfracture)IlioinguinalapproachInvolvementoftheposteriorcolumnorwallextensileapproach第22頁/共69頁C3 (BothcolumnextendingintoSIjoint) ExtendedIliofemoralapproach第23頁/共69頁第24頁/共69頁Evaluationanddiagnosis

Thepatient氣道呼吸循環(huán)伴隨損傷：長骨干骨折、脊柱、腦部、腹腔、盆腔、泌尿道第25頁/共69頁Surgicalindication

andtiming第26頁/共69頁1.病人的全身情況2.經(jīng)濟情況，需求3.外科醫(yī)師的經(jīng)驗，器械4.骨折類型5.關(guān)節(jié)面的完整性>2mm第27頁/共69頁手術(shù)時間：傷后7-10天反指征嚴重骨質(zhì)疏松無移位骨折后笠骨折碎片小低位前柱骨折第28頁/共69頁Cefazolinfor48-72hoursThromboembolicprophylaxisIndomethacin75mgoncedailysitupwiththefirst24-48hours第29頁/共69頁ActabularandlimbfractureInjuryofsciaticnerve(12-38%)Hipdislocation(requirespromptreduction)第30頁/共69頁Malreductionorsubluxationofthehipjointwillleadtoabnormalloadingofthearticularcartilageandsubsequentjointarthrosis第31頁/共69頁Principlethatperforminganaccuratereductionofthearticularsurface,therebyobtainingsurface,therebyobtainingacongruenthipjoint,willrestorenormaljointmechanics.第32頁/共69頁Reductiontechniquesandinternalfixation第33頁/共69頁Essentialreductiontools

distractorJudetfracturetablemanualreduction“KingTong”and“QueenTang”Clamps第34頁/共69頁 Themajorityofacetabularfracturescanbemanagedthroughasinglesurgicalapproach,butcombinedapproachesarealsofeasible第35頁/共69頁Thefourmostfrequentlyusedapproachesare:1.Kocher-Langenbeck2.Ilioinguinal3.Extendediliofemoral4.Combinationof1)and2)第36頁/共69頁InteraoperativetractionIndirectreductionwhichhaveretainedtheircapsularorsoft-tissue第37頁/共69頁AdislocatedSacroiliacjointordisplacedsacralfractureisusuallyreducedfirstandfixed.Priortothereductionoftheacetabularfracture第38頁/共69頁A1(posteriorwall)Kocher-langenbeck approach-lateraldecubitusA2(posteriorcolumn)K-LapproachA3(anteriorwallorcolumn) Iiloinguinalapproach第39頁/共69頁B1(puretransverse) K-Lapproach(prone)B13extensileapproachB2(T-shaped) K-LorilioginguinalB3(anteriorcolumnposteriorhemitransverse) IlioinguinalorK-Lorextendediliofemoral第40頁/共69頁Weightbearingisnotadvancedfor6-8weeksDuringthethirdmonth,dependingonradiographicevidenceofhealing,thepatientisallowedtofullweightbearing第41頁/共69頁第42頁/共69頁第43頁/共69頁第44頁/共69頁第45頁/共69頁第46頁/共69頁第47頁/共69頁第48頁/共69頁第49頁/共69頁第50頁/共69頁第51頁/共69頁第52頁/共69頁第53頁/共69頁Postoperativemanagement

rehabilitation第54頁/共69頁Thethirdday,patientareallowedtoe-touchweightbearingusingcrutches.Strengtheningexercisesandgaittraining第55頁/共69頁Complications

第56頁/共69頁EarlyNeurovascularinjuryinadequatereduction,articularpenetrationofhardware,pulmonaryembolism第57頁/共69頁LateHeterotopicossificationChondrolysisavascularne