关节镜下治疗前叉止点撕脱性骨折课件.ppt

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1、Avulsion Fracture of Anterior Cruciate Ligament,Zhijie Xi,关节镜下治疗前叉止点撕脱性骨折,1,Avulsion Fracture of Anterior,History,1875 Poncet1970Avulsion fracture of the ACL was classified by Meyers MH1996Veselko M performed arthroscopic placement and removal of cannulated screw for fixation2008Jinzhong Zhao report

2、ed arthroscopic Figure-of-8 suture fixation technique,关节镜下治疗前叉止点撕脱性骨折,2,History1875 Poncet关节镜下治疗前叉止点,Morbidity3/10000014 of ACL injuryDistribution of age children814 years old old womenover 40 years old,Accid E-merg Nurs，2004，12(3)：1 73-1 75International Journal of Pediatrics,2012,Article ID 932702,

3、6 pages,epidemiology,关节镜下治疗前叉止点撕脱性骨折,3,Morbidity3/100000Accid E-mer,Fall injury and traffic accident51Sports injuriesSkiing and football-14%,The Knee，2008，15(3)：164-167,关节镜下治疗前叉止点撕脱性骨折,4,Fall injury and traffic accide,Associated with capsule tear of meniscus or articular capsule,sometimes including

4、medial and lateral collateral ligament injury or injury of articular cartilage,Arthroscopy:The Journal of Arthroscopic and Related Surgery,2005,21(1):86-92.,关节镜下治疗前叉止点撕脱性骨折,5,Associated with capsule tear o,Relevant anatomical structure,关节镜下治疗前叉止点撕脱性骨折,6,Relevant anatomical structure关,Resident ridge,

5、关节镜下治疗前叉止点撕脱性骨折,7,Resident ridge关节镜下治疗前叉止点撕脱性骨折7,Resident ridge,关节镜下治疗前叉止点撕脱性骨折,8,Resident ridge关节镜下治疗前叉止点撕脱性骨折8,Branching ridge,关节镜下治疗前叉止点撕脱性骨折,9,Branching ridge关节镜下治疗前叉止点撕脱性骨折,Footprints,关节镜下治疗前叉止点撕脱性骨折,10,Footprints关节镜下治疗前叉止点撕脱性骨折10,Footprints,关节镜下治疗前叉止点撕脱性骨折,11,Footprints关节镜下治疗前叉止点撕脱性骨折11,关节镜下治疗

6、前叉止点撕脱性骨折,12,关节镜下治疗前叉止点撕脱性骨折12,The anterior medial bundle is tight in flexion the posterior lateral bundle is tight in the straight position,关节镜下治疗前叉止点撕脱性骨折,13,The anterior medial bundle is,1,2,损伤机制,Young people-knee flexion,tibial internal rotation,Adults-hyperextension of the knee,ACL limits anter

7、ior displacement,hyperextension,and internal rotation,关节镜下治疗前叉止点撕脱性骨折,14,12损伤机制Young people-knee flex,Diagnosis,Injury history of hyperextension of kneeBruise and hyphemaThe extension was limitedAnterior drawer test and Lachman sign are positiveX-ray and CT are conducive to understanding of fracture

8、 MRI is helpful to understand injury of ACL,and others combined injury.,关节镜下治疗前叉止点撕脱性骨折,15,DiagnosisInjury history of hyp,Anterior drawer test and Lachman sign,关节镜下治疗前叉止点撕脱性骨折,16,Anterior drawer test and Lachm,X-ray,关节镜下治疗前叉止点撕脱性骨折,17,X-ray关节镜下治疗前叉止点撕脱性骨折17,CT,关节镜下治疗前叉止点撕脱性骨折,18,CT关节镜下治疗前叉止点撕脱性骨折18,

9、MRI,关节镜下治疗前叉止点撕脱性骨折,19,MRI关节镜下治疗前叉止点撕脱性骨折19,Meyers-McKeever classification,Arthroscopy 2005;211:86-92,关节镜下治疗前叉止点撕脱性骨折,20,Meyers-McKeever classificatio,How to identify fresh or old fractures in imaging,关节镜下治疗前叉止点撕脱性骨折,21,How to identify fresh or old f,Treatment,I type-Conservative treatment to keep t

10、he knee in a functional position for 6 weeks and types-Manipulation，if fail，selected surgery type-Surgery,关节镜下治疗前叉止点撕脱性骨折,22,TreatmentI type-Conservati,Reduction,The drawer test after extension,关节镜下治疗前叉止点撕脱性骨折,23,Reduction The drawer test afte,P-R-I-C E program,ProtectionRestIceCompressionElevate,关节

11、镜下治疗前叉止点撕脱性骨折,24,P-R-I-C E program Prot,It used to be the most commonly treatment program to open reduction and fixed with wire,关节镜下治疗前叉止点撕脱性骨折,25,It used to be the most commonl,A failed case,Case 1,关节镜下治疗前叉止点撕脱性骨折,26,A failed caseCase 1关节镜下治疗前叉止点撕,Single tunnel fixation with steel wire and extrusio

12、n screw,关节镜下治疗前叉止点撕脱性骨折,27,Single tunnel fixation with st,No extrusion nailwas found beforeoperation,impinge,关节镜下治疗前叉止点撕脱性骨折,28,No extrusion nailimpinge关节镜下治疗,If the fracture mass is small,using Ethibond suture,关节镜下治疗前叉止点撕脱性骨折,29,If the fracture mass is small,Old fracture of avulsion fracture of ACL

13、,Case 2,关节镜下治疗前叉止点撕脱性骨折,30,Old fracture of avulsion fract,Wound freshness,关节镜下治疗前叉止点撕脱性骨折,31,Wound freshness关节镜下治疗前叉止点撕脱性骨折,To clean and remove all dead,damaged tissue around of the fracture mass,关节镜下治疗前叉止点撕脱性骨折,32,To clean and remove all dead,To introduce the wire by a lumbar puncture needle,关节镜下治疗

14、前叉止点撕脱性骨折,33,To introduce the wire by a lum,To thread through No.5 Ethibond,and fix fracture with 8 tension band,关节镜下治疗前叉止点撕脱性骨折,34,To thread through No.5 Ethibo,To inspect carefully,关节镜下治疗前叉止点撕脱性骨折,35,To inspect carefully关节镜下治疗前叉止点,The patients were followed up for 1 month after surgery,关节镜下治疗前叉止点撕

15、脱性骨折,36,The patients were followed up,Case 3,To use PDSii as the thread,关节镜下治疗前叉止点撕脱性骨折,37,Case 3To use PDSii as the thre,To use PDSii as the thread,关节镜下治疗前叉止点撕脱性骨折,38,To use PDSii as the thread关节镜下,To use PDSii as the thread,关节镜下治疗前叉止点撕脱性骨折,39,To use PDSii as the thread关节镜下,Case 4,Old avulsion frac

16、ture of ACL,关节镜下治疗前叉止点撕脱性骨折,40,Case 4Old avulsion fracture of,With bone sclerosis,and ACL stretch and tear,关节镜下治疗前叉止点撕脱性骨折,41,With bone sclerosis,and ACL s,The bone block cannot be removed with the nucleus pulposus clamp,micro-grinding drillto drill,关节镜下治疗前叉止点撕脱性骨折,42,The bone block micro-grinding,T

17、o remove bone masswith nucleus pulposus forceps,Enlargement of the condylar fossa,关节镜下治疗前叉止点撕脱性骨折,43,To remove bone massEnlargement,The picture was taken after reconstruction of anterior cruciate ligament,关节镜下治疗前叉止点撕脱性骨折,44,The picture was taken after re,Postoperative X-ray,关节镜下治疗前叉止点撕脱性骨折,45,Postop

18、erative X-ray关节镜下治疗前叉止点撕,followed up for 1 month after surgery,关节镜下治疗前叉止点撕脱性骨折,46,followed up for 1 month after,For a bigger fracture block,hollow screw is a good choice,关节镜下治疗前叉止点撕脱性骨折,47,For a bigger fracture block,h,Lateral meniscus(LM)is being pulled and displaced,关节镜下治疗前叉止点撕脱性骨折,48,Lateral meni

19、scus(LM)is being,If the fracture of the tibial plateau is combined,first of all,the fracture should be fixed,关节镜下治疗前叉止点撕脱性骨折,49,If the fracture of the tibial,X-ray showed ACL avulsion fracture combined with tibial plateau fracture,Case 4,关节镜下治疗前叉止点撕脱性骨折,50,X-ray showed ACL avulsion frac,MRI,关节镜下治疗前叉

20、止点撕脱性骨折,51,MRI关节镜下治疗前叉止点撕脱性骨折51,To check the stability of knee joint before operation,关节镜下治疗前叉止点撕脱性骨折,52,To check the stability of knee,To carefully examine the collapse of the lateral tibial plateauTo reduce and fix tibial plateau fractures,关节镜下治疗前叉止点撕脱性骨折,53,To carefully examine the colla,To remov

21、e the synovial tissue of the femoral condyle,Arthroscopic image of the reduce fracture,关节镜下治疗前叉止点撕脱性骨折,54,To remove the synovial tissue,To cut the transverse ligament of meniscus,The reduction of the fracture mass is blockedby the transverse ligament of the meniscus,关节镜下治疗前叉止点撕脱性骨折,55,To cut the tra

22、nsverse ligament,To reduce fracture,To fixed fracture with k-wire temporarily,关节镜下治疗前叉止点撕脱性骨折,56,To reduce fractureTo fixed fr,To drill into secondK-wire,A guide pin is inserted,关节镜下治疗前叉止点撕脱性骨折,57,To drill into secondA guide pi,To screw into the hollow screw,To inspect after fixation,关节镜下治疗前叉止点撕脱性骨折

23、,58,To screw into theTo inspect af,Postoperative X-ray,关节镜下治疗前叉止点撕脱性骨折,59,Postoperative X-ray关节镜下治疗前叉止点撕,Postoperative functional rehabilitation,To take positive exercise of knee flexion and extension in 2 to 4 weeks To load limitedly within 9 weeksphysical exercise can be take 12 weeks later,关节镜下治疗前叉止点撕脱性骨折,60,Postoperative functional rehab,Thanks for your attention,关节镜下治疗前叉止点撕脱性骨折,61,Thanks for your attention关节镜下治,