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首页 股骨干骨折骨折ppt课件

股骨干骨折骨折ppt课件.ppt

股骨干骨折骨折ppt课件

爱进修的teache
2019-04-07 0人阅读 告发 0 0 暂无简介

简介:本文档为《股骨干骨折骨折ppt课件ppt》,可适用于医药卫生范畴

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股骨干骨折的治疗骨八科创伤骨科股骨小转子下cm至膝关节上cm的范畴、。发病率占一切骨折的。以青壮年多见。受伤机制干脆暴力间接暴力骨折移位的机理上中下临床表现局部疼痛、肿胀或瘀斑、活动障碍、肢体短缩甚至休克(双侧股骨干骨折死亡率接近)畸形、反常活动、骨擦音X线表现:需拍摄同侧膝髋关节X线片当心观察远端血运循环及感觉骨折分型AO分型治疗原则恢复肢体的对线、旋转和长度保存血液供应以推动骨折愈合并防止感染推动患肢及全身的康复。治疗保守治疗骨牵引手术治疗钉板类髓内钉类外固定悬吊牵引法钢板螺钉固定髓内钉外固定髓内钉固定岁男性驾驶小汽车撞树生命体征平稳无伤口神经血管无损伤右侧闭合股骨骨折病例一*AHowdoyouclassifythisinjuryClickaftereachanswertoshowresults:Bonefemur()Segment:Proximal(),diaphyseal(),ordistal()Diaphyseal()Whattype:Simple(A),wedge(B),complex(C)Simple(A)Whichgroup:Simplespiral(A)Simpleoblique(A)Simpletransverse(A)Simpletransversedeg(A)Classification:A*岁男性右侧闭合股骨骨折DiscusstheindicationsforoperativemanagementoffemurfracturesDiscussthealternativesandindications(damagecontrolwithexternalfixation)TemporaryskeletaltractionHowdootherinjuriesaffectdecisionforsurgicalpositioning*岁男性右侧闭合股骨骨折AnythoughtsontheuseofunreamednailHowarereductionandalignmentDiscussnaillengthDiscusseffectofdistractionatthefracturesiteDiscussthenumberoflockingboltsneededShouldyouusestaticordynamiclockingHowdoesreamingaffectstabilityofconstructHowdoesreamingaffectbiologyofhealingHowtoproceedaftertreatment*术后X光片股骨远端行走时疼痛周Donotdiscussnonunion,thiswillbecoveredlaterinthecourseDiscusscausesofdelayinunionDescribethebiologicandmechanicalconditionatthefractureUnstablebutviableItistryingtoheal,itneedsonlystabilityDescribemethodstoprovidestabilityatthispointExchangenailingDynamization*术后周第一次操作动力加压后周无不适主诉DiscussradiographicandclinicalsignsandsymptomsofbonehealingHowdoesdynamizationhelpAllowstheboneendstocompress,providingstabilitywhichpromoteshealingWhichendtodynamizeandwhyUsuallydynamizethescrewfarthestfromthefracturetohelpmaintainstability*周周周周伤后周,活动如伤前*ResultsatandweekspostoperativeDescribetheradiographicchanges病例二A术后术后个月术后个月病例三A术后个月术后病例四术后B术后个月术后个月A病例五术后个月术后病例六AC术后C病例七术后要点股骨干骨折的金尺度是扩髓的髓内针复合伤会感导手术体位和入路的取舍交锁钉远离骨折应动力加压以供给牢固性*Askparticipantstosummarizethecasediscussion钢板固定岁男性交通事故闭合软组织条件好无神经血管问题病例一Discussionpoints:HowdoyouclassifythisfracturendashA*ADiscussionpoints:IMnailingorplatefixationasoftenbothfixationtechniqueshaveprosandconsReductiontechniquesTypeofstability*间接复位**病例二B病例三术前X线片术后X线片C术后个月复查术后个月复查要点间接复位拉力钉固定微创掩护骨折断端血运患者依从性好Askparticipantstosummarizethecasediscussion*岁老年病人从小凳子上摔下II型糖尿病骨质疏松症闭合损伤无其他损伤病例三AHowwouldyouclassifythisfractureClickaftereachanswertoshowresults:Bonefemur()Segment:Proximal(),diaphyseal(),ordistal()diaphyseal()Whattype:Extraarticular(A),partialarticular(B),completearticular(C)extraarticular(A)Whichgroup:Simplespiral(A)Simpleoblique(A)Simpletransverse(A)simpleoblique(A)Classification:A*术后X光片IsreductionadequateYes,reductionoflength,rotationandalignmentachievedWhatisthisimplantLISSfixatorHowdoesitfunctionAsabridgeplateforrelativestabilityArethesemonocorticalscrewsadequateNotinosteoporoticboneBicorticalscrewsprovidemuchgreaterconstructstiffness*术后周无不适主诉全盘负重*AskparticipantstodescribesomeparametersofhealingRadiographiccallusbridgingfractureNoimplantlooseningorbreakageNopainFullROMWhatshouldbedoneforthepatientrsquososteoporosisComanagementofosteoporosisisessentialtoreducepatientrsquosincreasedriskofsecondaryfracture术后周无不适主诉*ShouldtheimplantberemovedNo,theriskofsecondaryfractureafterplateandscrewremovaloutweighthebenefits要点建议同时治疗骨质疏松在骨质疏松骨折中不推举使用髓内针桥接钢板可以供给相对牢固微创方法有利于愈合*Askparticipantstosummarizethecasediscussion新技术冲洗灌流扩髓器(RIAReamerIrrigatorAspirator)接连扩髓收集髓内物质用于植骨双侧股骨干骨折死亡率接近股骨干骨折合并股骨颈骨折勿漏诊股骨下段骨折合并膝部韧带损伤的比例高达合并半月板损伤比例为股骨干骨折的金尺度是扩髓的髓内针使用接骨板固定时在骨折端上下至少各固定层皮质微创方法有利于愈合(Mippo技术)在骨质疏松骨折中不推举使用髓内针,同时治疗骨质疏松归纳谢谢*HowdoyouclassifythisinjuryClickaftereachanswertoshowresults:Bonefemur()Segment:Proximal(),diaphyseal(),ordistal()Diaphyseal()Whattype:Simple(A),wedge(B),complex(C)Simple(A)Whichgroup:Simplespiral(A)Simpleoblique(A)Simpletransverse(A)Simpletransversedeg(A)Classification:A*DiscusstheindicationsforoperativemanagementoffemurfracturesDiscussthealternativesandindications(damagecontrolwithexternalfixation)TemporaryskeletaltractionHowdootherinjuriesaffectdecisionforsurgicalpositioning*AnythoughtsontheuseofunreamednailHowarereductionandalignmentDiscussnaillengthDiscusseffectofdistractionatthefracturesiteDiscussthenumberoflockingboltsneededShouldyouusestaticordynamiclockingHowdoesreamingaffectstabilityofconstructHowdoesreamingaffectbiologyofhealingHowtoproceedaftertreatment*Donotdiscussnonunion,thiswillbecoveredlaterinthecourseDiscusscausesofdelayinunionDescribethebiologicandmechanicalconditionatthefractureUnstablebutviableItistryingtoheal,itneedsonlystabilityDescribemethodstoprovidestabilityatthispointExchangenailingDynamization*DiscussradiographicandclinicalsignsandsymptomsofbonehealingHowdoesdynamizationhelpAllowstheboneendstocompress,providingstabilitywhichpromoteshealingWhichendtodynamizeandwhyUsuallydynamizethescrewfarthestfromthefracturetohelpmaintainstability**ResultsatandweekspostoperativeDescribetheradiographicchanges*AskparticipantstosummarizethecasediscussionDiscussionpoints:HowdoyouclassifythisfracturendashA*Discussionpoints:IMnailingorplatefixationasoftenbothfixationtechniqueshaveprosandconsReductiontechniquesTypeofstability***Askparticipantstosummarizethecasediscussion*HowwouldyouclassifythisfractureClickaftereachanswertoshowresults:Bonefemur()Segment:Proximal(),diaphyseal(),ordistal()diaphyseal()Whattype:Extraarticular(A),partialarticular(B),completearticular(C)extraarticular(A)Whichgroup:Simplespiral(A)Simpleoblique(A)Simpletransverse(A)simpleoblique(A)Classification:A*IsreductionadequateYes,reductionoflength,rotationandalignmentachievedWhatisthisimplantLISSfixatorHowdoesitfunctionAsabridgeplateforrelativestabilityArethesemonocorticalscrewsadequateNotinosteoporoticboneBicorticalscrewsprovidemuchgreaterconstructstiffness**AskparticipantstodescribesomeparametersofhealingRadiographiccallusbridgingfractureNoimplantlooseningorbreakageNopainFullROMWhatshouldbedoneforthepatientrsquososteoporosisComanagementofosteoporosisisessentialtoreducepatientrsquosincreasedriskofsecondaryfracture*ShouldtheimplantberemovedNo,theriskofsecondaryfractureafterplateandscrewremovaloutweighthebenefits*Askparticipantstosummarizethecasediscussion

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