1、关节镜下治疗前叉止点撕脱性骨关节镜下治疗前叉止点撕脱性骨折折第1页，共61页。关节镜下治疗前叉止点撕脱性骨折第1 页，共6 1 页。HistoryHistory1875 Poncet1875 Poncet1970Avulsion fracture of the ACL was 1970Avulsion fracture of the ACL was classified by Meyers MHclassified by Meyers MH1996Veselko M performed arthroscopic 1996Veselko M performed arthroscopic plac
2、ement and removal of cannulated screw for placement and removal of cannulated screw for fixationfixation2021Jinzhong Zhao reported arthroscopic 2021Jinzhong Zhao reported arthroscopic Figure-of-8 suture fixation technique Figure-of-8 suture fixation technique 第2页，共61页。H i s t o r y 1 8 7 5 P o n c e
3、 t 第2 页，共6 1 页。MorbidityMorbidity3/1000003/1000001414 ofof ACLACL injuryinjuryDistributionDistribution ofof ageage childrenchildren8 81414 yearsyears oldold oldold womenoverwomenover 4040 yearsyears oldoldAccid E-merg Nurs，2004，12(3)：1 73-1 75International Journal of Pediatrics,2021,Article ID 93270
4、2,6 pages epidemiologyepidemiology第3页，共61页。Mo r b i d i t y 3/1 0 0 0 0 0 A c c i d E-m e rFall injury and traffic accident51Fall injury and traffic accident51Sports injuriesSkiing and football-14%Sports injuriesSkiing and football-14%The Knee，2021，15(3)：164-167第4页，共61页。F a l l i n j u r y a n d t r
5、 a f f i c a c c i d eAssociated with Associated with capsule tearcapsule tear ofof meniscusmeniscus oror articular articular capsulecapsule,sometimes,sometimes includingincluding medial medial and and lateral lateral collateral ligament injury collateral ligament injury or or injury of articular ca
6、rtilageinjury of articular cartilageArthroscopy:The Journal of Arthroscopic and Related Surgery,2005,21(1):86-92.第5页，共61页。A s s o c i a t e d w i t h c a p s u l e t e a r oRelevantRelevant anatomical structureanatomical structure第6页，共61页。R e l e v a n t a n a t o m i c a l s t r u c t u r e 第Reside
7、nt ridgeResident ridge第7页，共61页。R e s i d e n t r i d g e 第7 页，共6 1 页。Resident ridgeResident ridge第8页，共61页。R e s i d e n t r i d g e 第8 页，共6 1 页。Branching ridgeBranching ridge第9页，共61页。B r a n c h i n g r i d g e 第9 页，共6 1 页。Footprints第10页，共61页。F o o t p r i n t s 第1 0 页，共6 1 页。FootprintsFootprints第11
8、页，共61页。F o o t p r i n t s 第1 1 页，共6 1 页。第12页，共61页。第1 2 页，共6 1 页。The The anterior medial bundle anterior medial bundle is tight in flexion is tight in flexion the the posterior lateral bundle posterior lateral bundle is tight in the straight is tight in the straight positionposition第13页，共61页。T h e a
9、 n t e r i o r m e d i a l b u n d l e i s 2021Jinzhong 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 93270
10、2,6 pageschildren814 years oldfracture mass is 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
11、 tissue around of the fracture massIf the fracture mass is small,using Ethibond suturethe reduce fractureTo drill into second12损伤机制损伤机制Young people-knee flexion,Young people-knee flexion,tibial internal rotationtibial internal rotationAdults-hyperextension of the Adults-hyperextension of the kneekne
12、eACL limits anterior displacement,ACL limits anterior displacement,hyperextension,and internal rotationhyperextension,and internal rotation第14页，共61页。2 0 2 1 J i n z h o n g Z h a o r e p o r t e d aDiagnosisDiagnosisInjuryInjury historyhistory ofof hyperextension of kneehyperextension of kneeBruiseB
13、ruise andand hyphemahyphemaThe extension was limitedThe extension was limitedAnteriorAnterior drawer test and Lachman sign aredrawer test and Lachman sign are positivepositiveX-ray X-ray andand CTCT areare conducive to understanding of conducive to understanding of fracture fracture MRI is helpful t
14、o understand injuryMRI is helpful to understand injury ofof ACL,and ACL,and othersothers combined bined injury.第15页，共61页。D i a g n o s i s I n j u r y h i s t o r y o f h y pAnteriorAnterior drawer test and drawer test and Lachman sign Lachman sign 第16页，共61页。A n t e r i o r d r a w e r t e s t a n d
15、 L a c h mX-rayX-ray第17页，共61页。X-r a y 第1 7 页，共6 1 页。CTCT第18页，共61页。C T 第1 8 页，共6 1 页。MRIMRI第19页，共61页。MR I 第1 9 页，共6 1 页。Meyers-McKeever classificationMeyers-McKeever classificationArthroscopy 2005;211:86-92第20页，共61页。Me y e r s-Mc K e e v e r c l a s s i f i c a t i oHow to identify fresh or old fract
16、ures How to identify fresh or old fractures in imagingin imaging第21页，共61页。H o w t o i d e n t i f y f r e s h o r o l d fTreatmentTreatmentI type-Conservative treatmentI type-Conservative treatment toto keepkeep thethe kneeknee inin a a functional positionfunctional position forfor 6 weeks6 weeks an
17、dand typestypes -Manipulation-Manipulation，i if failf fail，selected selected surgery surgery typetype -Surgery-Surgery第22页，共61页。T r e a t m e n t I t y p e -C o n s e r v a t iReductionReduction The drawer test after extensionThe drawer test after extension第23页，共61页。R e d u c t i o n T h e d r a w e
18、 r t e s t a f t eprogram ProtectionProtectionRestRestIceIceCompressionCompressionElevateElevate第24页，共61页。P -R -I -C E p r o g r a m P r o tIt It used to be the most commonly used to be the most commonly treatment program to open reduction and treatment program to open reduction and fixed with wiref
19、ixed with wire第25页，共61页。I t u s e d t o b e t h e m o s t c o m m o n lA failed caseA failed caseCase 1第26页，共61页。A f a i l e d c a s e C a s e 1 第2 6 页，共6 1 页。Single tunnel fixation with steel wire and Single tunnel fixation with steel wire and extrusion screwextrusion screw第27页，共61页。S i n g l e t u
20、 n n e l f i x a t i o n w i t h s tNo extrusion nailwas found beforeoperationimpinge第28页，共61页。N o e x t r u s i o n n a i l i m p i n g e 第2 8 页，共If the fracture mass is small,using Ethibond If the fracture mass is small,using Ethibond suture suture 第29页，共61页。I f t h e f r a c t u r e m a s s i s s
21、 m a l l,Old fracture of avulsion fracture of ACLOld fracture of avulsion fracture of ACLCase 2Case 2第30页，共61页。O l d f r a c t u r e o f a v u l s i o n f r a c tWound freshnessWound freshness第31页，共61页。Wo u n d f r e s h n e s s 第3 1 页，共6 1 页。To clean and remove all dead,damaged tissue around of the
22、 fracture mass第32页，共61页。T o c l e a n a n d r e m o v e a l l d e a d,To introduce the To introduce the wire by wire by a lumbar a lumbar puncture puncture needle needle 第33页，共61页。T o i n t r o d u c e t h e w i r e b y a l u mTo thread To thread through No.5 Ethibond,and fix No.5 Ethibond,and fix f
23、racture with 8 tension band fracture with 8 tension band 第34页，共61页。T o t h r e a d t h r o u g h N o.5 E t h i b oTo inspect carefullyTo inspect carefully第35页，共61页。T o i n s p e c t c a r e f u l l y 第3 5 页，共6 1 页。The patients were followed up for 1 month after surgery第36页，共61页。T h e p a t i e n t s
24、 w e r e f o l l o w e d u p Case 3Case 3To use PDSii as the threadTo use PDSii as the thread第37页，共61页。C a s e 3 T o u s e P D S i i a s t h e t h r eTo use PDSii as the threadTo use PDSii as the thread第38页，共61页。T o u s e P D S i i a s t h e t h r e a d 第3 8 页To use PDSii as the threadTo use PDSii a
25、s the thread第39页，共61页。T o u s e P D S i i a s t h e t h r e a d 第3 9 页Case 4Case 4Old avulsion fracture of ACLOld avulsion fracture of ACL第40页，共61页。C a s e 4 O l d a v u l s i o n f r a c t u r e o fWith bone sclerosis,and ACL stretch and With bone sclerosis,and ACL stretch and teartear第41页，共61页。Wi
26、t h b o n e s c l e r o s i s,a n d A C L sThe 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 after surgerySingle tunnel fixation with steel wire and
27、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 displacedThe bone block The bone block cannot be removed cannot be removed with the nucleus with the nucleus
28、pulposus clamppulposus clampmicro-grinding drillto drill 第42页，共61页。T h e d r a w e r t e s t a f t e r e x t e n s i o To remove bone massTo remove bone masswith nucleus pulposus with nucleus pulposus forcepsforcepsEnlargement of the Enlargement of the condylar fossa condylar fossa第43页，共61页。T o r e
29、m o v e b o n e m a s s E n l a r g e m e n tThe picture was taken after reconstruction of anterior cruciate ligament第44页，共61页。T h e p i c t u r e w a s t a k e n a f t e r r ePostoperative X-rayPostoperative X-ray第45页，共61页。P o s t o p e r a t i v e X-r a y 第4 5 页，共6 1 页。followed up for 1 month afte
30、r surgery第46页，共61页。f o l l o w e d u p f o r 1 m o n t h a f t e r For a bigger fracture block,hollow screw For a bigger fracture block,hollow screw is a good choiceis a good choice第47页，共61页。F o r a b i g g e r f r a c t u r e b l o c k,hLateral meniscus(LM)is being pulled and Lateral meniscus(LM)is
31、 being pulled and displaceddisplaced第48页，共61页。L a t e r a l m e n i s c u s (L M)i s b e i n g2021Jinzhong 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 ar
32、ound of the fracture massTo inspect 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
33、Meyers MHThe bone blockInternational Journal of Pediatrics,2021,Article ID 932702,6 pagesIf the fracture of the tibial plateau is combined,first of all,the fracture should be fixed第49页，共61页。2 0 2 1 J i n z h o n g Z h a o r e p o r t e d aX-ray showed ACL avulsion fracture X-ray showed ACL avulsion
34、fracture combined with tibial plateau fracturecombined with tibial plateau fractureCase 4第50页，共61页。X-r a y s h o w e d A C L a v u l s i o n f r a cMRIMRI第51页，共61页。MR I 第5 1 页，共6 1 页。To check the stability of knee joint before To check the stability of knee joint before operationoperation第52页，共61页。T
35、 o c h e c k t h e s t a b i l i t y o f k n e eTo carefully examine the collapse of the To carefully examine the collapse of the lateral tibial plateaulateral tibial plateauTo reduce and fix tibial plateau fracturesTo reduce and fix tibial plateau fractures第53页，共61页。T o c a r e f u l l y e x a m i
36、n e t h e c o l l aTo remove the synovial To remove the synovial tissue of the femoral tissue of the femoral condylecondyleArthroscopic image of Arthroscopic image of the reduce fracture the reduce fracture第54页，共61页。T o r e m o v e t h e s y n o v i a l t i s s u e To cut the transverse To cut the t
37、ransverse ligament of meniscus ligament of meniscus The reduction of the The reduction of the fracture mass is blockedfracture mass is blockedby the transverse ligament by the transverse ligament of the meniscus of the meniscus 第55页，共61页。T o c u t t h e t r a n s v e r s e l i g a m e n t To reduce
38、fractureTo fixed fracture with k-wire temporarily 第56页，共61页。T o r e d u c e f r a c t u r e T o f i x e d f rToTo drilldrill into secondinto secondK-wire K-wire A guide pin is inserted第57页，共61页。T o d r i l l i n t o s e c o n d A g u i d e p i ToTo screw into thescrew into the hollow screw hollow sc
39、rew ToTo inspectinspect afterafter fixationfixation第58页，共61页。T o s c r e w i n t o t h e T o i n s p e c t a fPostoperative X-rayPostoperative X-ray第59页，共61页。P o s t o p e r a t i v e X-r a y 第5 9 页，共6 1 页。Postoperative functional Postoperative functional rehabilitationrehabilitationTo 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。P o s t o p e r a t i v e f u n c t i o n a l r e h a bThanks for your attention第61页，共61页。T h a n k s f o r y o u r a t t e n t i o n 第6 1 页，
