医学精品课件：04.2017-关节脱位-03.ppt

1、Dislocation of the JointsMao Nie,MD,PhD Attending and LecturerDepartment of OrthopaedicsThe 2nd Affiliated Hospital of CQMUSChongqing,ChinaTel&wechat:13678428205DefinitionJoint DislocationJoint SubluxationJoint Sprainrefers to damage or tearing of ligaments or a joint capsulepartial dislocationan ab

2、normal separation of the joint关节扭伤关节扭伤关节半脱位关节半脱位关节脱位关节脱位ClassificationTraumatic dislocationexcessive force is applied to a jointPathological dislocationFresh dislocation (within 2 weeks)新鲜脱位新鲜脱位Old dislocation (more than 2 weeks)陈旧性脱位陈旧性脱位Habitual or Recurrent Dislocation习惯性脱位习惯性脱位Congenital disloca

3、tion 先天性脱位先天性脱位TreatmentReductionImmobilizationRehabilitationTraction-counter-traction techniqueSpecific maneuversWhat happened to the Baseball player?Dislocation of the ShoulderOutlineAnatomyEtiologyClassificationClinical manifestation and DiagnosisTreatmentComplicationEpidemiologyThe shoulder is t

4、he most commonly dislocated joint in the bodyPatients with a previous shoulder dislocation are more prone to redislocation.Younger patients(teenagers and those aged 20 years)have a much higher frequency of redislocation than patients in their 50s and 60s.AnatomyGlenoid关节盂关节盂Humeral head肱骨头肱骨头Bony St

5、ructure Articular surface ratio=34：1 Glenoid labrum 关节盂关节盂 Joint capsule 关节囊关节囊 Ligament 韧带韧带 Rotator cuff 肩袖肩袖 muscles 肌肉肌肉PosteriorAnteriorAnatomySoft tissueFeature of AnatomyNo strong bony stabilityRelies on soft tissues for stabilityGreatest Range of Motion Less StabilityHigh risk of dislocation

6、Etiology96%TraumaticEtiologyligamentous laxity 韧带松弛症AtraumaticClassification Anterior dislocation:Over 95%Anterior dislocationPosterior dislocationInferior dislocationAnterior dislocationSubcoracoid喙突下脱位喙突下脱位Subglenoid盂下脱位盂下脱位Subclavicular锁骨下脱位锁骨下脱位Intrathoracic胸腔内脱位胸腔内脱位Clinical manifestationGenera

7、l SymptomPainSwellingLoss of functionClinical manifestationSpecific SignDeformity Square shoulder方肩畸形方肩畸形Empty of glenoid fossa关节盂空虚关节盂空虚Elastic fixation弹性固定弹性固定 Dugas signDugas sign:L.A.Dugas,Philadelphia,1857,10:175-179.Clinical manifestation Radiography X-raySubcoracoid dislocation Diagnosisl His

8、toryl Clinical manifestationl X-rayReductionImmobilizationRehabilitationTreatmentReductionDiagnosisMake an agreementStay relaxedPre-reductionIntra-reductionLocal anaesthesiaGeneral anaesthesiaPost-reductionX-ray Re-check假体选择Kocher ManeuverReduction Maneuver1870 Reduction ManeuverHippocrates Maneuver

9、(460-377 BC)Immobilization3-4 weeksRehabilitation Range of Motion Muscle strengthComplicationBankart lesion Bankart损伤损伤Rotator cuff tear 肩袖损伤肩袖损伤Fracture 骨折骨折Nerve injury 神经损伤神经损伤发病率：肩关节前脱位最常见的病理性损伤，53%-100%定义：前下关节囊盂唇复合体定义：前下关节囊盂唇复合体从关节盂的附着点撕脱从关节盂的附着点撕脱Arthroscopic Bankart repairBankart lesionLabrum

10、 tearComplicationRotator cuff tearNever injuryFractureDislocation of the Elbowu The elbow is the second most commonly dislocated major joint；u Elbow dislocations frequently occur due to trauma such as falls from heights or motor vehicle collisionsAnatomyThe elbow is amazingly stable,relying more on

11、bony anatomy configuration for stability rather than ligamentsDislocation of the ElbowThree points forming isosceles triangle on flexed elbowPosterior elbow triangle肘后三角肘后三角 Olecranon of Ulna(尺骨鹰嘴)Humeral lateral epicondyle(肱骨外上髁)Humeral medial epicondyle(肱骨内上髁)Classification Posterior (forearm bone

12、s go behind the arm bone;most common)Anterior Lateral MedialSimple elbow dislocation:without fractureComplex elbow dislocation:combined with a fractureMechanismDiagnosisHistoryPainDeformitySemiflexion elastic fixation of the elbowPEnerves(median radial ulnar)vascular statusPosterior elbow triangleX

13、rayTreatmentNon-operativeTreatmentNon-operativeTreatmentOperativeneurovascular compromiseassociated fracturesnonreducible dislocationsComplicationsValgus instabilityPosterolateral instabilityHeterotopic ossificationChronic dislocationNerve injurySubluxation of the Radial HeadThe most common upper-ex

14、tremity injury in infants and young childrenNursemaid Elbow or Pulled ElbowOccurs after longitudinal traction which is placed on pronated extended arm.ReductionVedioReductionTechnique1Full extension Full supination（旋后-手掌向上）Downward traction FlextionTechnique 2Extension Hyper-pronation（极度旋前-手掌向下）Disl

15、ocation of the HipAnatomicThe hip joint is a ball-and-socket synovial joinDislocation of the HipLarge-force traumas are the most common causes of hip dislocations Types of dislocation anterior dislocation central acetabular fracture dislocations posterior dislocationThe anterior dislocation of hipWi

16、th wide abduction,impact of knee against dashboard(both)hip.The posterior dislocation of hiplimb is shortened,internally rotated,and adducted Diagnosis History trauma Symptom severe hip pain,especially when the leg is moved.Physical Examination The injured leg is shorter than the uninjured leg（肢体短缩）

17、（肢体短缩）.The injured leg lies in an abnormal position（异常体位）（异常体位）anterior dislocation:flexion/abduction/external rotation posterior dislocation:flexion/adduction/internal rotation Nerve injury(sciatic nerve坐骨神经)X rayCT Closed Reduction of Anterior Hip DislocationTreatmentClose Reduction Maneuvers of t

18、he Hip Posterior DislocationRochester methodAllis ManeuverStimson ManeuverBigelow ManeuverComplications of hip dislocation Avascular necrosis Traumatic arthritis myositis ossificans.-Heterotopic ossificans Sciatic nerve injury-Late sciatic nerve palsy Recurrent dislocation Thromboembolism Joint stiffness