关节镜下治疗前叉止点撕脱性骨折(介绍：治疗)共61张课件.pptx

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1、关节镜下治疗前叉止点撕脱性骨折,第1页，共61页。,关节镜下治疗前叉止点撕脱性骨折第1页，共61页。,History,1875 Poncet1970Avulsion fracture of the ACL was classified by Meyers MH1996Veselko M performed arthroscopic placement and removal of cannulated screw for fixation2021Jinzhong Zhao reported arthroscopic Figure-of-8 suture fixation technique,第

2、2页，共61页。,History1875 Poncet第2页，共61页。,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,2021,Article ID 932702,6 pages,epidemiology,第3页，共61页。,Morbidity3/100000Accid E-mer,Fall

3、 injury and traffic accident51Sports injuriesSkiing and football-14%,The Knee，2021，15(3)：164-167,第4页，共61页。,Fall injury and traffic accide,Associated with capsule tear of meniscus or articular capsule,sometimes including medial and lateral collateral ligament injury or injury of articular cartilage,A

4、rthroscopy:The Journal of Arthroscopic and Related Surgery,2005,21(1):86-92.,第5页，共61页。,Associated with capsule tear o,Relevant anatomical structure,第6页，共61页。,Relevant anatomical structure第,Resident ridge,第7页，共61页。,Resident ridge第7页，共61页。,Resident ridge,第8页，共61页。,Resident ridge第8页，共61页。,Branching rid

5、ge,第9页，共61页。,Branching ridge第9页，共61页。,Footprints,第10页，共61页。,Footprints第10页，共61页。,Footprints,第11页，共61页。,Footprints第11页，共61页。,第12页，共61页。,第12页，共61页。,The anterior medial bundle is tight in flexion the posterior lateral bundle is tight in the straight position,第13页，共61页。,The anterior medial bundle is,202

6、1Jinzhong Zhao reported arthroscopic Figure-of-8 suture fixation techniqueWound freshnessNo extrusion nailIf the fracture of the tibial plateau is combined,first of all,the fracture should be fixedInternational Journal of Pediatrics,2021,Article ID 932702,6 pageschildren814 years oldfracture mass is

7、 blockedInternational Journal of Pediatrics,2021,Article ID 932702,6 pages1970Avulsion fracture of the ACL was classified by Meyers MHWith bone sclerosis,and ACL stretch and tearInjury history of hyperextension of kneeTo clean and remove all dead,damaged tissue around of the fracture massIf the frac

8、ture mass is small,using Ethibond suturethe reduce fractureTo drill into second,1,2,损伤机制,Young people-knee flexion,tibial internal rotation,Adults-hyperextension of the knee,ACL limits anterior displacement,hyperextension,and internal rotation,第14页，共61页。,2021Jinzhong Zhao reported a,Diagnosis,Injury

9、 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 MRI is helpful to understand injury of ACL,and others combined injury.,第15页，共61页。,DiagnosisInjury history of hyp,Ante

10、rior drawer test and Lachman sign,第16页，共61页。,Anterior drawer test and Lachm,X-ray,第17页，共61页。,X-ray第17页，共61页。,CT,第18页，共61页。,CT第18页，共61页。,MRI,第19页，共61页。,MRI第19页，共61页。,Meyers-McKeever classification,Arthroscopy 2005;211:86-92,第20页，共61页。,Meyers-McKeever classificatio,How to identify fresh or old fractur

11、es in imaging,第21页，共61页。,How to identify fresh or old f,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,第22页，共61页。,TreatmentI type-Conservati,Reduction,The drawer test after extension,第23页，共61页

12、。,Reduction The drawer test afte,P-R-I-C E program,ProtectionRestIceCompressionElevate,第24页，共61页。,P-R-I-C E program Prot,It used to be the most commonly treatment program to open reduction and fixed with wire,第25页，共61页。,It used to be the most commonl,A failed case,Case 1,第26页，共61页。,A failed caseCase

13、 1第26页，共61页。,Single tunnel fixation with steel wire and extrusion screw,第27页，共61页。,Single tunnel fixation with st,No extrusion nailwas found beforeoperation,impinge,第28页，共61页。,No extrusion nailimpinge第28页，共,If the fracture mass is small,using Ethibond suture,第29页，共61页。,If the fracture mass is small,

14、Old fracture of avulsion fracture of ACL,Case 2,第30页，共61页。,Old fracture of avulsion fract,Wound freshness,第31页，共61页。,Wound freshness第31页，共61页。,To clean and remove all dead,damaged tissue around of the fracture mass,第32页，共61页。,To clean and remove all dead,To introduce the wire by a lumbar puncture ne

15、edle,第33页，共61页。,To introduce the wire by a lum,To thread through No.5 Ethibond,and fix fracture with 8 tension band,第34页，共61页。,To thread through No.5 Ethibo,To inspect carefully,第35页，共61页。,To inspect carefully第35页，共61页。,The patients were followed up for 1 month after surgery,第36页，共61页。,The patients

16、were followed up,Case 3,To use PDSii as the thread,第37页，共61页。,Case 3To use PDSii as the thre,To use PDSii as the thread,第38页，共61页。,To use PDSii as the thread第38页,To use PDSii as the thread,第39页，共61页。,To use PDSii as the thread第39页,Case 4,Old avulsion fracture of ACL,第40页，共61页。,Case 4Old avulsion fra

17、cture of,With bone sclerosis,and ACL stretch and tear,第41页，共61页。,With bone sclerosis,and ACL s,The drawer test after extension14 of ACL injury关节镜下治疗前叉止点撕脱性骨折1875 PoncetSingle tunnel fixation with steel wire and extrusion screwResident ridgeThe bone blockThe patients were followed up for 1 month afte

18、r surgerySingle tunnel fixation with steel wire and extrusion screw2021Jinzhong Zhao reported arthroscopic Figure-of-8 suture fixation techniqueAccid E-merg Nurs，2004，12(3)：1 73-1 75To thread through No.Lateral meniscus(LM)is being pulled and displaced,The bone block cannot be removed with the nucle

19、us pulposus clamp,micro-grinding drillto drill,第42页，共61页。,The drawer test after extensio,To remove bone masswith nucleus pulposus forceps,Enlargement of the condylar fossa,第43页，共61页。,To remove bone massEnlargement,The picture was taken after reconstruction of anterior cruciate ligament,第44页，共61页。,Th

20、e picture was taken after re,Postoperative X-ray,第45页，共61页。,Postoperative X-ray第45页，共61页。,followed up for 1 month after surgery,第46页，共61页。,followed up for 1 month after,For a bigger fracture block,hollow screw is a good choice,第47页，共61页。,For a bigger fracture block,h,Lateral meniscus(LM)is being pul

21、led and displaced,第48页，共61页。,Lateral meniscus(LM)is being,2021Jinzhong Zhao reported arthroscopic Figure-of-8 suture fixation technique14 of ACL injuryby the transverse ligamentTo inspect carefullyTo thread through No.To clean and remove all dead,damaged tissue around of the fracture massTo inspect

22、carefullyResident ridgeI type-Conservative treatment to keep the knee in a functional position for 6 weeks关节镜下治疗前叉止点撕脱性骨折No extrusion nailwith nucleus pulposushollow screwTo reduce and fix tibial plateau fractures1970Avulsion fracture of the ACL was classified by Meyers MHThe bone blockInternational

23、 Journal of Pediatrics,2021,Article ID 932702,6 pages,If the fracture of the tibial plateau is combined,first of all,the fracture should be fixed,第49页，共61页。,2021Jinzhong Zhao reported a,X-ray showed ACL avulsion fracture combined with tibial plateau fracture,Case 4,第50页，共61页。,X-ray showed ACL avulsi

24、on frac,MRI,第51页，共61页。,MRI第51页，共61页。,To check the stability of knee joint before operation,第52页，共61页。,To check the stability of knee,To carefully examine the collapse of the lateral tibial plateauTo reduce and fix tibial plateau fractures,第53页，共61页。,To carefully examine the colla,To remove the synov

25、ial tissue of the femoral condyle,Arthroscopic image of the reduce fracture,第54页，共61页。,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,第55页，共61页。,To cut the transverse ligament,To reduce

26、fracture,To fixed fracture with k-wire temporarily,第56页，共61页。,To reduce fractureTo fixed fr,To drill into secondK-wire,A guide pin is inserted,第57页，共61页。,To drill into secondA guide pi,To screw into the hollow screw,To inspect after fixation,第58页，共61页。,To screw into theTo inspect af,Postoperative X-

27、ray,第59页，共61页。,Postoperative X-ray第59页，共61页。,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,第60页，共61页。,Postoperative functional rehab,Thanks for your attention,第61页，共61页。,Thanks for your attention第61页，,