关节镜下治疗前叉止点撕脱性骨折课件.ppt

1、Avulsion Fracture of Anterior Cruciate Ligament Zhijie Xi 关节镜下治疗前叉止点撕脱性骨折1HistoryHistory18751875 PoncetPoncet1970Avulsion fracture of the ACL was 1970Avulsion fracture of the ACL was classified byclassified by Meyers MHMeyers MH1996Veselko M performed1996Veselko M performed arthroscopic arthroscopic

2、 placement and removal of cannulated screw placement and removal of cannulated screw for fixationfor fixation2008Jinzhong Zhao reported2008Jinzhong Zhao reported arthroscopic arthroscopic Figure-of-8 suture fixation technique Figure-of-8 suture fixation technique 关节镜下治疗前叉止点撕脱性骨折2MorbidityMorbidity3/

3、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,2012,Article ID 932702,6 pages epidemiologyepidemiology关

4、节镜下治疗前叉止点撕脱性骨折3Fall injury and traffic accident51Fall injury and traffic accident51Sports injuriesSkiing and football-14%Sports 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4Associated with Associated with capsule tearcapsule tear ofof meniscusmeniscus oror articular caps

5、ulearticular capsule,sometimes,sometimes includingincluding medial medial and and lateral collateral ligament injury lateral collateral ligament injury or or injury of injury of articular cartilagearticular cartilageArthroscopy:The Journal of Arthroscopic and Related Surgery,2005,21(1):86-92.关节镜下治疗前

6、叉止点撕脱性骨折5RelevantRelevant anatomical structureanatomical structure关节镜下治疗前叉止点撕脱性骨折6Resident ridgeResident ridge关节镜下治疗前叉止点撕脱性骨折7Resident ridgeResident ridge关节镜下治疗前叉止点撕脱性骨折8Branching ridgeBranching ridge关节镜下治疗前叉止点撕脱性骨折9Footprints关节镜下治疗前叉止点撕脱性骨折10FootprintsFootprints关节镜下治疗前叉止点撕脱性骨折11关节镜下治疗前叉止点撕脱性骨折12 Th

7、e 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 is tight in the straight positionstraight position关节镜下治疗前叉止点撕脱性骨折1312损伤机制损伤机制Young people-knee flexion,Young people-knee flexion,tibia

8、l internal rotationtibial internal rotationAdults-hyperextension of the Adults-hyperextension of the kneekneeACL limits anterior displacement,ACL limits anterior displacement,hyperextension,and internal rotationhyperextension,and internal rotation关节镜下治疗前叉止点撕脱性骨折14DiagnosisDiagnosisInjuryInjury histo

9、ryhistory ofof hyperextension of kneehyperextension of kneeBruiseBruise 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 c

10、onducive to understanding of fracture of fracture MRI is helpful to understand injuryMRI is helpful to understand injury ofof ACL,and ACL,and othersothers combined bined injury.关节镜下治疗前叉止点撕脱性骨折15AnteriorAnterior drawer test and drawer test and Lachman sign Lachman sign 关节镜下治疗前叉止点撕脱性骨折16X-rayX-ray关节镜下

11、治疗前叉止点撕脱性骨折17CTCT关节镜下治疗前叉止点撕脱性骨折18MRIMRI关节镜下治疗前叉止点撕脱性骨折19Meyers-McKeever classificationMeyers-McKeever classificationArthroscopy 2005;211:86-92关节镜下治疗前叉止点撕脱性骨折20How to identify fresh or old fractures How to identify fresh or old fractures in imagingin imaging关节镜下治疗前叉止点撕脱性骨折21TreatmentTreatmentI type-

12、Conservative treatmentI type-Conservative treatment toto keepkeep thethe kneeknee inin a a functional positionfunctional position forfor 6 6 weeksweeks andand typestypes -Manipulation-Manipulation，i if failf fail，selected surgery selected surgery typetype -Surgery-Surgery关节镜下治疗前叉止点撕脱性骨折22ReductionRe

13、duction The drawer test after extensionThe drawer test after extension关节镜下治疗前叉止点撕脱性骨折23program ProtectionProtectionRestRestIceIceCompressionCompressionElevateElevate关节镜下治疗前叉止点撕脱性骨折24It It used to be the most commonly used to be the most commonly treatment program to open reduction treatment program

14、to open reduction and fixed with wireand fixed with wire关节镜下治疗前叉止点撕脱性骨折25A failed caseA failed caseCase 1关节镜下治疗前叉止点撕脱性骨折26Single tunnel fixation with steel wire and Single tunnel fixation with steel wire and extrusion screwextrusion screw关节镜下治疗前叉止点撕脱性骨折27nNo extrusion nailwas found beforeoperationim

15、pinge关节镜下治疗前叉止点撕脱性骨折28If the fracture mass is small,using Ethibond If the fracture mass is small,using Ethibond suture suture 关节镜下治疗前叉止点撕脱性骨折29Old fracture of avulsion fracture of ACLOld fracture of avulsion fracture of ACLCase 2Case 2关节镜下治疗前叉止点撕脱性骨折30Wound freshnessWound freshness关节镜下治疗前叉止点撕脱性骨折31T

16、o 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32To introduce the To introduce the wire by wire by a lumbar a lumbar puncture puncture needle needle 关节镜下治疗前叉止点撕脱性骨折33To thread To thread through No.5 Ethibond,No.5 Ethibond,and fix fracture with 8 tension band and

17、 fix fracture with 8 tension band 关节镜下治疗前叉止点撕脱性骨折34To inspect carefullyTo inspect carefully关节镜下治疗前叉止点撕脱性骨折35The patients were followed up for 1 month after surgery关节镜下治疗前叉止点撕脱性骨折36Case 3Case 3nTo use PDSii as the threadTo use PDSii as the thread关节镜下治疗前叉止点撕脱性骨折37To use PDSii as the threadTo use PDSii

18、 as the thread关节镜下治疗前叉止点撕脱性骨折38To use PDSii as the threadTo use PDSii as the thread关节镜下治疗前叉止点撕脱性骨折39Case 4Case 4Old avulsion fracture of ACLOld avulsion fracture of ACL关节镜下治疗前叉止点撕脱性骨折40With bone sclerosis,and ACL stretch With bone sclerosis,and ACL stretch and tearand tear关节镜下治疗前叉止点撕脱性骨折41The bone b

19、lock The bone block cannot be removed cannot be removed with the nucleus with the nucleus pulposus clamppulposus clampmicro-grinding drillto drill 关节镜下治疗前叉止点撕脱性骨折42To remove bone massTo remove bone masswith nucleus pulposus with nucleus pulposus forcepsforcepsEnlargement of the Enlargement of the co

20、ndylar fossa condylar fossa关节镜下治疗前叉止点撕脱性骨折43The picture was taken after reconstruction of anterior cruciate ligament关节镜下治疗前叉止点撕脱性骨折44Postoperative X-rayPostoperative X-ray关节镜下治疗前叉止点撕脱性骨折45followed up for 1 month after surgery关节镜下治疗前叉止点撕脱性骨折46For a bigger fracture block,hollow For a bigger fracture b

21、lock,hollow screw is a good choicescrew is a good choice关节镜下治疗前叉止点撕脱性骨折47Lateral meniscus(LM)is being pulled and Lateral meniscus(LM)is being pulled and displaceddisplaced关节镜下治疗前叉止点撕脱性骨折48If 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49X-ra

22、y showed ACL avulsion fracture X-ray showed ACL avulsion fracture combined with tibial plateau fracturecombined with tibial plateau fractureCase 4关节镜下治疗前叉止点撕脱性骨折50MRIMRI关节镜下治疗前叉止点撕脱性骨折51To check the stability of knee joint To check the stability of knee joint before operationbefore operation关节镜下治疗前叉

23、止点撕脱性骨折52To 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关节镜下治疗前叉止点撕脱性骨折53To remove the synovial To remove the synovial tissue of the femo

24、ral tissue of the femoral condylecondyleArthroscopic image of Arthroscopic image of the reduce fracture the reduce fracture关节镜下治疗前叉止点撕脱性骨折54To cut the transverse To cut the transverse ligament of meniscus ligament of meniscus The reduction of the The reduction of the fracture mass is blockedfracture

25、 mass is blockedby the transverse ligament by the transverse ligament of the meniscus of the meniscus 关节镜下治疗前叉止点撕脱性骨折55 To reduce fractureTo fixed fracture with k-wire temporarily 关节镜下治疗前叉止点撕脱性骨折56ToTo drilldrill into secondinto secondK-wire K-wire A guide pin is inserted关节镜下治疗前叉止点撕脱性骨折57ToTo screw

26、into thescrew into the hollow screw hollow screwToTo inspectinspect afterafter fixationfixation关节镜下治疗前叉止点撕脱性骨折58Postoperative X-rayPostoperative X-ray关节镜下治疗前叉止点撕脱性骨折59Postoperative 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关节镜下治疗前叉止点撕脱性骨折60Thanks for your attention关节镜下治疗前叉止点撕脱性骨折61