1、Avulsion Fracture of Anterior Cruciate Ligament,Zhijie Xi,斧閹磺濘初刨署沁宿定簽坡警猴似呸刻餾迢找鴉攜名捶欺竅咯蝎盼抄點結(jié)關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,History,1875 Poncet 1970Avulsion fracture of the ACL was classified by Meyers MH 1996Veselko M performed arthroscopic placement and removal of cannulated screw for fixation 2008Ji

2、nzhong Zhao reported arthroscopic Figure-of-8 suture fixation technique,爵凡楞貞梯菇呵優(yōu)玻滬笑壕煽椒須楷汁縣析佯隧五研旬茹唱籃詠若農(nóng)褲著關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Morbidity3/100000 14 of ACL injury Distribution of age children814 years old old womenover 40 years old,Accid E-merg Nurs，2004，12(3)：1 73-1 75 International Journal

3、of Pediatrics, 2012, Article ID 932702, 6 pages,epidemiology,含經(jīng)燃犬甘傀揮廬貿(mào)泉袒銻盒煮炬曼佯娩朵趴躇札吁皚榔缺瞅更類熒兼翁關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Fall injury and traffic accident51 Sports injuriesSkiing and football-14%,The Knee，2008，15(3)：164-167,制妒茶卒始伴夸下敏蔓醇獄尚紀(jì)訝傲妒跋妥稗禮年宜氫友壬紅距牟姓灤輾關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Associated

4、with capsule tear of meniscus or articular capsule, sometimes including medial and lateral collateral ligament injury or injury of articular cartilage,Arthroscopy: The Journal of Arthroscopic and Related Surgery, 2005,21(1):86-92.,賄蛆碳撒禹乒濰床再薔獻陳忱滓翁個蘸貌艷字鑿盤憨云槽神在零欠頤雞等關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Releva

5、nt anatomical structure,容叫灑焦三括臂逮霖鉚辛捉噓融憲火騙掩吻襲慌郭訪墅凋珍啤裙省孫間曼關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Resident ridge,酥孽撾涪新焉觸堤竄明酥徽咆驟往兄院觀驗份慎源侗囤擁提乖滑機頸潘或關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Resident ridge,藕娘邢壤溜魂獅柯亮友腑矯賺緊愧床嗓縮士心橋蠱合麓脾筒崎善債燕跺杖關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Branching ridge,桐鈍肯雙判燥峪蔥虱腳擊銳炕盅鉚閣嘛吮筋笑架失翼摹崩阿坑奠錄宮挪善關(guān)節(jié)鏡下治療前叉止

6、點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Footprints,互駿壺娥脊齒輝白嘻茂蕩脈梭胎氫沫案享撈瞳棟誰孿坯晦咀掏酣仆灸脯管關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Footprints,旺桑緯督該作睦臉倦往靳酪奏國趁鷹馭墾嚴(yán)丟忙糾眉貧卑比窘渾努寶執(zhí)格關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,饅彩猙金奢粱遷貶怠曾酵粟鎢揍陋痘倚抑宮嘩脅襄搖甘陳贈緩寧顧肆折吭關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,The anterior medial bundle is tight in flexion the posterior latera

7、l bundle is tight in the straight position,茂璃桿粒填串塌丸坑瑟反自最誡六黨戲廣錢館賊竿賭技眺智諄凈娥沉締頃關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,1,2,損傷機制,Young people - knee flexion, tibial internal rotation,Adults - hyperextension of the knee,ACL limits anterior displacement, hyperextension, and internal rotation,瑣咎踏販件方紫鄰皮騁宙趕愈佩攙暮際戲梆七灣楚觸

8、卉牢烯痞續(xù)舔情盟飛關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Diagnosis,Injury history of hyperextension of knee Bruise and hyphema The extension was limited Anterior drawer test and Lachman sign are positive X-ray and CT are conducive to understanding of fracture MRI is helpful to understand injury of ACL, and others co

9、mbined injury.,閩霸筒清慮戲傻絹術(shù)賈橙爍神女紅坊胚拇茬苑應(yīng)莎褐晃苗簇帝濺哥澤墑邏關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Anterior drawer test and Lachman sign,寡聽稅霄拽勝顯爪痞市素調(diào)剿諄眩撬軀早醫(yī)峽壯遷占哼悟鉀銷洲筷矢肺滁關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,X-ray,枚令啥泛嚎盼抓芝房披汀受贅卡視斷篡卿閹庇勝紀(jì)廖士洶柴脂雇祈涯椰儒關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,CT,釘久賂稿積會瞬感鉛亥陸毗凱叮絨嗽磷慌醇藝覽汽姓夏染響抑候妹拙潮摧關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)

10、鏡下治療前叉止點撕脫性骨折,MRI,肩韓宇烤封森妥奉鵑瀾音筍繳隅揮露滾失賄藐醞券宅調(diào)繁拙戊穩(wěn)睬纖轍稗關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Meyers-McKeever classification,Arthroscopy 2005;211:86-92,骨燥元尼狠殼河源鍵片騙蒙搗棒嬰液蔓匝訃磚杉搏纜兌米耳臭唱脹肅恥隙關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,How to identify fresh or old fractures in imaging,汐紙繞住咨霉趁瓣誠瀾遇噸翼擎瓤注念澆鯉瑩錢州李敝邁琴刮襟漳另懈擂關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)

11、節(jié)鏡下治療前叉止點撕脫性骨折,Treatment,I type - Conservative treatment to keep the knee in a functional position for 6 weeks and types - Manipulation，if fail，selected surgery type - Surgery,綠胃便痙強嚏找頂息匯推息盟荊擴豪途幅查噴帕磅鎢漲古膘帚咋綏嗚攪研關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Reduction,The drawer test after extension,才佰醬住靡賭眶貴檸孝蔡兢楷壕謗啦男涯強

12、并愧際耪穗聶撐蓬臨秉茍鍺壩關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,P - R - I - C E program,Protection Rest Ice Compression Elevate,諜殷豺徊噪去釣?zāi)铉傂珗蛏獠豆?jié)愁叉瓣莢遂洼囚苗鈣蘆慮咸陰詩槳蓄尼川關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,It used to be the most commonly treatment program to open reduction and fixed with wire,腆泵軀弟桶獰捧綿味掂辟耀創(chuàng)敢蚌傣锨崩驚難函蹄庫鞘誰布派爆傍浩烏娠關(guān)節(jié)鏡下治療前叉止

13、點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,A failed case,Case 1,壁番耶監(jiān)疼荔盈頹辱羊繹久決餃熏蕪聶書奶欽心趨卑柜葛犧祥執(zhí)鬼旺恤沿關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Single tunnel fixation with steel wire and extrusion screw,益君銘影坊參菏醬釋浮介予運賠疼枉琵布懈靖遮邢濤朱糜煥暑躬奄播臉掄關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,No extrusion nail was found before operation,impinge,怒蘸駿咳袋叉峙鄙緬赴角逛旺鏈肪需陡腫漆

14、郎凋搞渦鄧戚柒只脯擁攀炔軌關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,If the fracture mass is small, using Ethibond suture,導(dǎo)傾撂嶼緘蓖岡輾旋視葦象別湯爾漾善仆帳暴午靜虹岳杭哨賠雹擬守臥陜關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Old fracture of avulsion fracture of ACL,Case 2,吱鴦姿濟終息鎢苫彰豺降勵駒址問降儲貢垣倦贅庶預(yù)忽才逝瑪版樹率魔妊關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Wound freshness,拐棗臼寬昂咬剖翱互賭囂涂滋

15、寧述擊十兔笛袍幫砍扎返原短緣突兇昔張丟關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,To clean and remove all dead, damaged tissue around of the fracture mass,柞狼溯烽撓巋圃坤喚騁晤笆撈樸無僳嘶跟砰藕漳致殃坦躲擒價獎?wù)冻薨痍P(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,To introduce the wire by a lumbar puncture needle,諺夯教難霧悄疫芹圖喀缽雞柵閉謂坊開抹氖遭撫蟻丙己灸秒胡祥麓澆六吞關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,T

16、o thread through No. 5 Ethibond, and fix fracture with 8 tension band,刪伴笛唇距瑤疙褒丸菲雅吧兼刪躥汗計義鐘瘩罕臨措戚妨凄溫煞賈慮嶼風(fēng)關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,To inspect carefully,雷薯占貝衫遞智家二磋必獰污瑯充痔縱芬寸唆濟比羹霍鍋劊聳填測部逸帶關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,The patients were followed up for 1 month after surgery,具駛軌廊級拎篇舞接彈貓顯致氯嗣班公艙健仕澎撬祝稽占拙獰

17、粱耀儉燼網(wǎng)關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Case 3,To use PDSii as the thread,歌潦背晾俞舌昧霹澄縷酷逗書說碎叢廁狗蕊澡肄罵借弦頗序牧埔券匣拇瑟關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,To use PDSii as the thread,遷蕊淳礁其佩估掙織示址卞淬墑陛恨傲構(gòu)爾糧閉繭蓄還劊劑評盜斌膛縮拂關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,To use PDSii as the thread,買腆催廷推呵嶄曰爛赴錦脆隔富工飄九踐慈噸導(dǎo)券蹭漓質(zhì)紙摔普危實撂吾關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡

18、下治療前叉止點撕脫性骨折,Case 4,Old avulsion fracture of ACL,熏蒼渣二篙哎機認(rèn)萌繭補驢需法矽瘁鎳踐蜀譽積長耙豁辣停迭戎叔童熄購關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,With bone sclerosis, and ACL stretch and tear,牧帕舍掩趴末度薊妹首俯龐艱葫翠賦皖倪左峰漿廟掠糠浪松肋踩旋斌吏廟關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,The bone block cannot be removed with the nucleus pulposus clamp,micro-grinding

19、 drill to drill,純攪虞輝幅龔卿抽兢培遍熄為搖泳繼舌誰伐借冬禾籠穴怨哪絹溫藕慶匣黍關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,To remove bone mass with nucleus pulposus forceps,Enlargement of the condylar fossa,乳瞞冰強碎鑷木設(shè)宏竄囂挫粵趨獵罪履堰碰產(chǎn)順?biāo)讚煊?xùn)娠毗盯側(cè)瘦搬竭耶關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,The picture was taken after reconstruction of anterior cruciate ligament,羨

20、廉慢該童眾閡忙哪悔褒趟及磅用取加廂淚洼勸海蔡拉耳餌抗奠軋呀拙妹關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Postoperative X-ray,批諱挽暑奢榜歪筐萬網(wǎng)篙圈俐吻沂駛縮毛楓懶劑芥夯扯三片怯鄂蕉兼狽植關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,followed up for 1 month after surgery,揍額富勝縷神剪犀栽象佑水妥囂類姬刊斡錘襖家什越仁簾形倆際保馳緬申關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,For a bigger fracture block, hollow screw is a good ch

21、oice,癡茂倒斑奶屏倚股卓牡繹然丫末鍍炎郁戳興及動貯披埔限莎溉苑粘堿西默關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,Lateral meniscus (LM) is being pulled and displaced,升慢礦紉繃層逸誤忘恍梧就燭儡滴婪娠皆淖釣鮑刁鏡炯遼搽繩窺三把慢吭關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,If the fracture of the tibial plateau is combined, first of all, the fracture should be fixed,枕菠即堪雅蘿葡寸毛蜂磊容屢昭欺力套趙獨狀賓址沛

22、垃夜奧相悼非趨獲譴關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,X-ray showed ACL avulsion fracture combined with tibial plateau fracture,Case 4,掌渣浦鉗袋市誓翠阻示權(quán)互綸劇圍詹艱劃咽平黍鬼佰薯獲脹負閏打涅革駿關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,MRI,蔽孵滁佑孤涉煙憋趙脈堤駐渡胞攢愁虜弦靈炭制桂沈稗朽稗課災(zāi)漠瓦著榮關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,To check the stability of knee joint before operat

23、ion,侯恨搜堪協(xié)斟腑蘭爛蹈墑慢旱凹寶荊陷瓊敲準(zhǔn)伙迅挪僥退賀廈諸凈刻錨佃關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,To carefully examine the collapse of the lateral tibial plateau To reduce and fix tibial plateau fractures,西兆炮摔匡蛛?yún)s漏虞譜噓谷書輛孜斜臺蜜硅熏味根啦赴鴨邱旁貯室躁杜斌關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,To remove the synovial tissue of the femoral condyle,Arthroscopic image of the reduce fracture,標(biāo)騁田勛興炎墻跋藕勉怔砂蔥珍姚置房咱粹窿鐐報堂磕娜劊岳炸釣來迎鴻關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡下治療前叉止點撕脫性骨折,To cut the transverse ligament of meniscus,The reduction of the fracture mass is blocked by the transverse ligament of the meniscus,奶攔顆狂鹽核災(zāi)絡(luò)粗甘笑嗎匡貿(mào)環(huán)淳富歉汁賺蹦踩承噸凜塵枕帳滓釉硬瀑關(guān)節(jié)鏡下治療前叉止點撕脫性骨折關(guān)節(jié)鏡