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腕关节骨折

2019-02-05 32页 ppt 1MB 36阅读

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腕关节骨折腕关节骨折(wristfracture)解剖解剖三角纤维软骨复合体(TFCC) 包括 桡-尺韧带 尺-月韧带 尺-三角韧带 腕尺侧副韧带 尺侧腕伸肌腱鞘 三角纤维软骨盘 作用稳定远端桡尺关节及支撑尺侧腕骨Radialinclinationorangle尺偏角尺、桡骨远端测量参数Radialinclinationorangle桡骨远端尺倾角Radialinclinationrepresentstheanglebetweenonelineconnectingtheradialstyloidtipandtheulnaraspecto...
腕关节骨折
腕关节骨折(wristfracture)解剖解剖三角纤维软骨复合体(TFCC) 包括 桡-尺韧带 尺-月韧带 尺-三角韧带 腕尺侧副韧带 尺侧腕伸肌腱鞘 三角纤维软骨盘 作用稳定远端桡尺关节及支撑尺侧腕骨Radialinclinationorangle尺偏角尺、桡骨远端测量参数Radialinclinationorangle桡骨远端尺倾角Radialinclinationrepresentstheanglebetweenonelineconnectingtheradialstyloidtipandtheulnaraspectofthedistalradiusandasecondlineperpendiculartothelongitudinalaxisoftheradius.Theradialinclinationrangesbetween21°and25°尺倾角:桡骨茎突顶端与桡骨远端尺侧面的连线与垂直于桡骨长轴水平线的夹角,正常约:21---25°Lossofradialinclinationwillincreasetheloadacrossthelunate.这一角度消失,会增加月骨的负荷。尺偏角 尺偏角的丢失易导致三角纤维软骨复合体(TFCC)的损伤及尺骨的负荷增加。 临床研究显示尺偏角变小与握力下降有关。Radialtilt掌倾角尺、桡骨远端测量参数Radialtilt掌倾角Radialtiltismeasuredonalateralradiograph.在侧位平片测量掌倾角Theradialtiltrepresentstheanglebetweenalinealongthedistalradialarticularsurfaceandthelineperpendiculartothelongitudinalaxisoftheradiusatthejointmargin.Thenormalvolartiltaverages11°andhasarangeof2°-20°.掌倾角:远端桡骨关节面沿线与垂直于桡骨长轴水平线间的夹角,正常向掌侧倾斜,2°-20°,平均11°。掌倾角 正常掌倾角为10-15° 当掌倾角缩小会同时影响桡腕关节和远端桡尺关节的力学特性。 掌倾角较健侧丢失10°,会增加远端尺桡关节掌、背侧韧带张力,导致前臂旋前畸形。Fernandez分类系统 1993年提出基于力学特点的分类系统,有利于发现潜在的韧带损伤,有助于提出治疗方法。 弯曲型(Colles骨折,Smith骨折) 剪力型(Barton骨折,桡骨茎突骨折) 压缩型(Die-punch骨折) 撕脱型(尺骨茎突骨折) 复合型Bendingfracture弯曲型骨折伸展应力干骺端骨折FernandezClassificationFernandez分类法Thisclassificationispopular,sinceitaddressesthemechanismofinjuryandtheconsequenttreatmentoptions.Instabilityisdefinedasahighriskofsecondarydisplacementafterinitialadequatereduction.Associatedtraumaticlesionsareligamentousrupture,nervecompressionandcompartmentsyndrome.首次复位后,不稳定是发生再次移位的高危因素。伴随的损伤有:韧带断裂、神经受压、骨筋膜室综合症Type1:Bendingfracture屈曲骨折Mechanism:onecortexofthemetaphysisfailsduetotensilestressandtheoppositeundergoesacertaindegreeofcomminution.机制:由于拉伸应力造成干骺端皮质损伤,反方向应力造成不同程度粉碎性骨折。Stability:canbestableorunstable稳定性:可稳定或不稳定Displacementpattern:non-displaced,dorsal(Colles‘)orvolar(Smith’sfracture)移位:不移位,背侧移位或掌侧移位Numberoffragments:twomainfragments骨折处:两处主要骨折Associatedlesions:uncommon联合损伤:少见Recommendedtreatment:usuallyconservative,whenunstable:percutaneouspinningorexternalfixation治疗:保守治疗,不稳定时可行外固定术Colles’骨折(伸直型骨折) 机制:腕关节处于背伸位,手掌着地,前臂旋前时受伤。 临床表现:多见于老年人及骨质疏松的患者。局部疼痛、肿胀、可出现典型的畸形姿态,即侧面观呈“银叉样”畸形,正面观呈“枪刺样”畸形。 X线平片:骨折远端向桡、背侧移位,同时伴有下尺桡关节脱位。CommonFractureEponyms常见的以人名命名的骨折Colles‘fractureColles’骨折AColles‘fractureisafractureofthedistalmetaphysisoftheradiuswithdorsalangulationanddisplacementleadingtoa’silverforkdeformity‘.桡骨远端干骺端背侧成角,其移位形成“银叉样变形”Collesfracturesareseenmorefrequentlywithadvancingageandinwomenwithosteoporosis.此种骨折常见于老年人及有骨质疏松的女性InmanycasesaColles‘fractureisanextraarticular,uncomplicatedandstablefracture,butitcanbeintraarticular.在很多病例中,Colles‘骨折为关节外骨折,不复杂,属于稳定性骨折,但也可为关节内。SolookforsignsofinstabilityinallColles‘fractures,especially:IntraarticularradiocarpalorDRUJextensionofthefractureRadialshorteningLossofradialinclination不稳定的Colles’骨折表现:骨折累及桡腕关节或DRUJ,桡骨短缩,桡骨尺倾角的消失。Colles’骨折(伸直型骨折)CommonFractureEponyms常见的以人名命名的骨折Colles‘fractureColles’骨折AColles‘fractureisafractureofthedistalmetaphysisoftheradiuswithdorsalangulationanddisplacementleadingtoa’silverforkdeformity‘.桡骨远端干骺端背侧成角,其移位形成“银叉样变形”Collesfracturesareseenmorefrequentlywithadvancingageandinwomenwithosteoporosis.此种骨折常见于老年人及有骨质疏松的女性InmanycasesaColles‘fractureisanextraarticular,uncomplicatedandstablefracture,butitcanbeintraarticular.在很多病例中,Colles‘骨折为关节外骨折,不复杂,属于稳定性骨折,但也可为关节内。SolookforsignsofinstabilityinallColles‘fractures,especially:IntraarticularradiocarpalorDRUJextensionofthefractureRadialshorteningLossofradialinclination不稳定的Colles’骨折表现:骨折累及桡腕关节或DRUJ,桡骨短缩,桡骨尺倾角的消失。OntheleftadetailedAPviewofthesamepatientasabove.同一患者后前位细节图。Inadditiontothedorsalangulationseenonthelateralview,noticethefollowing:侧位片可见背侧成角:Extensionintotheradiocarpaljointandthedistalradioulnarjoint累及桡腕关节及远端桡尺关节Displacementofthearticularfragments(bluearrow)蓝箭头所示关节骨折移位Radialshorteningandlossofradialinclinationresultingindistalulnaabuttingthelunate(yellowarrow)黄箭头所示:桡骨短缩及桡骨尺倾角消失,使尺骨远端与月骨靠近。Fractureofulnarstyloid尺骨茎突骨折JustcallingthisfractureaColles‘fracturewouldbeinsufficient.把这一骨折称为Colles骨折,是不恰当的。Allthecharacteristicshavetobementionedintheradiologyreporttoconveythefullextentoftheinjury,possiblecomplicationsandtreatment.放射学中应该描述骨折所有的特点、病变范围及可能出现的并发症及治疗。Smith’s骨折(屈曲型骨折) 机制:跌倒时,腕关节屈曲、手背着地。 临床表现:多见于年轻人,表现为腕部下垂、局部肿胀、皮肤瘀斑等。 X线平片:骨折远端向掌侧、桡侧移位。也称为反Colles’骨折。Smith’s骨折(屈曲型骨折)Smith'sfractureSmith‘sfracturesoccurinyoungerpatientsandaretheresultofhighenergytraumaonthevolarflexedwrist.多发生于年轻人,是腕关节掌屈着力造成的Volarcomminutionandintraarticularextensionaremorecommon.常见粉碎性骨折及累及关节内的骨折。OntheleftanextraarticularSmith‘sfracturewithpalmarandradialangulationanddisplacement.Thereisalsoanavulsionoftheulnarstyloidprocess.左图关节外Smith‘骨折,桡骨成角及移位。有尺骨茎突的撕脱性骨折关节面骨折Shearingfracture剪力型骨折Type2:Shearingfracture剪力骨折Mechanism:fractureofthejointsurface(i.e.volaranddorsalBarton‘s,radialstyloidprocessfractures,simplearticularfracture)机制:关节面骨折(背侧或掌侧Barton‘s骨折,桡骨茎突骨折,单纯关节骨折)Stability:unstable稳定性:不稳定Displacementpattern:dorsal,volarorradial移位:背侧、掌侧或桡侧移位Numberoffragments:two-part,three-partorcomminuted骨折数量:两部分、三部分或粉碎性骨折Associatedlesions:lesscommon联合损伤:更少见Recommendedtreatment:openreductionwithscrew-orplatefixation治疗:切开复位,螺钉或钢板外固定术Borton’s骨折 桡骨远端关节面骨折伴腕关节脱位 机制:腕背伸、前臂旋前、手掌着地、暴力通过腕骨传导,撞击桡骨背侧关节面发生骨折,腕关节随之而向背侧移位。 临床表现:与Colles’骨折相似的“银叉样”畸形及体征。 当跌倒时,腕关节屈曲、手背着地,可以出现相反的桡骨下端掌侧关节面骨折及腕骨向掌侧移位。Barton'sfractureVolar-typeBarton‘sisafracture-dislocationofthevolarrimoftheradius.掌侧型Barton’s骨折,桡骨掌侧骨折,脱位Thistypeisthemostcommon.这型较常见Dorsal-typeBarton‘sisafracture-dislocationofthedorsalrimoftheradius.背侧型:桡骨背侧骨折及脱位DislocationoftheradiocarpaljointisthehallmarkofBarton‘sfractures.桡腕关节的脱位是Barton’s骨折的特征表现Thesearesheartypefracturesofthedistalarticularsurfaceoftheradiuswithtranslationofthedistalradialfragmentandthecarpus.伴有远端桡骨及腕骨移位的桡骨远端关节表面骨折。Thesefractureshaveagreattendencyforredislocationandmalunion.这种骨折再脱位及畸形愈合的可能性大Theyusuallyrequireoperativetreatment.需要手术治疗Borton’s骨折Barton'sfractureVolar-typeBarton‘sisafracture-dislocationofthevolarrimoftheradius.掌侧型Barton’s骨折,桡骨掌侧骨折,脱位Thistypeisthemostcommon.这型较常见Dorsal-typeBarton‘sisafracture-dislocationofthedorsalrimoftheradius.背侧型:桡骨背侧骨折及脱位DislocationoftheradiocarpaljointisthehallmarkofBarton‘sfractures.桡腕关节的脱位是Barton’s骨折的特征表现Thesearesheartypefracturesofthedistalarticularsurfaceoftheradiuswithtranslationofthedistalradialfragmentandthecarpus.伴有远端桡骨及腕骨移位的桡骨远端关节表面骨折。Thesefractureshaveagreattendencyforredislocationandmalunion.这种骨折再脱位及畸形愈合的可能性大Theyusuallyrequireoperativetreatment.需要手术治疗volar-typeBarton’s骨折Ontheleftavolar-typeBarton‘sfracture.左图是掌侧Barton’s骨折Theradiographicfindingsarethefollowing:平片表现:Comminutedintraarticularfractureofthedistalradius桡骨远端关节内粉碎性骨折Volarrimmaintainsrelationshipwiththecarpusandbotharedisplacedproximally(bluearrow)蓝色箭头所示手掌保持与腕骨的关系,两者距离靠近。Fractureofradialstyloidprocesswithlossofradialinclination(yellowarrow)黄箭头所示:桡骨茎突骨折,桡骨尺侧倾斜消失dorsal-typeBarton’s骨折Ontheleftadorsal-typeBarton‘sfracture.左图是背侧型Barton’骨折Theradiographicfindingsarethefollowing:平片表现:Comminutedintraarticularfractureofthedistalradius桡骨远端关节内粉碎性骨折Dorsalrimandcarpusaredisplaceddorsallyandproximally背侧边缘与腕骨向背侧移位,二者距离靠近关节面骨折合并软骨下和干骺端骨嵌插Compressionfracture压缩型骨折Type3:Compressionfracture压缩骨折Mechanism:compressionfractureofthejointsurfacewithimpactionofsubchondralandmetaphysealbone(i.e.die-punchfractureorintraarticularcomminutedfracture嵌入软骨下及干骺端骨质的关节面的压缩骨折Stability:stableorunstable稳定性:稳定或不稳定Displacementpattern:non-displaced,dorsal,volarorradial移位:不移位,背侧、掌侧及桡侧移位Numberoffragments:3-or4-partorcomminuted骨折数量:3-4处或粉碎性骨折Associatedlesions:common联合损伤:常见Recommendedtreatment:治疗:closed闭合的limitedarthroscopicassisted关节镜辅助extensileopenreduction切开复位percutaneouspinscombinedwithexternalandinternalfixation内固定与外固定相结合bonegraft骨移植Die-punch骨折桡骨远端月骨关节面的垂直压缩骨折Die-punchfractureAdie-punchfractureisadepressionfractureofthelunatefossaofthedistalradius.桡骨远端月骨窝凹陷性骨折Itistheresultofatransverseloadthroughthelunate.是通过月骨横向应力的作用造成的Theradiographicfindingscanbeverysubtle.平片只有微小的变化Inmanycasesthereisalsoasubtleproximaldisplacementoflunate,seenasabreakincarpalarcI.(seethearticleWrist-Carpalinstability).在许多病例中月骨微小的近端移位,(详见腕关节不稳定)Ontheleftatypicaldie-punchfracture.Thebluearrowindicatesthedepressedfragmentofthelunatefossa.蓝箭头所示:月骨窝的压缩性骨折Noticethearticularstep-off.关节脱位Theyellowarrowindicatesasubtlefractureoftheradialstyloidprocess.黄箭头示:桡骨茎突微小的骨折ThereisnodisruptionofcarpalarcI.无腕骨骨折Noticethatyoucaneasilyoverlooksuchafracture.很容易漏诊3D重建图像Onthelefttwo3D-reconstructionsofthesamefractureasabove.同一患者3D重建图像Avulsionfracture撕脱性骨折由于韧带牵拉造成韧带附着处骨质剥离,形成的碎骨片Type4:Avulsionfracture撕脱性骨折Mechanism:avulsionfractureusuallyassociatedwithligamentousinjury机制:与韧带损伤相关Stability:unstable稳定性:不稳定Displacementpattern:dorsal,volar,radialorproximal移位:掌侧、背侧或近端移位Numberoffragments:骨折处:2-part:radialstyloid,ulnarstyloid两部分,桡骨茎突、尺骨茎突3-part:volar,dorsalmargin三部分,掌侧、背侧边缘Comminuted粉碎性Associatedlesions:frequentligamentousinjury联合损伤Recommendedtreatment:closedoropenreductionwithpinorscrewfixationortensionwiring治疗:闭合性或开放性复位,使用针或螺钉固定或拉伸缝合。Combinedfractures复合性骨折Type5:Combinedfractures复合性骨折Mechanism:combinationofforcesoftypeI-IVasaresultofhighvelocityinjuries机制:高速损伤造成的,I-IV型混合型Stability:unstable稳定性:不稳定Displacementpattern:dorsal,volar,radialorproximal移位:背侧、掌侧、桡侧或近端移位Numberoffragments:comminuted骨折数量:粉碎性Associatedlesions:alwayspresent联合损伤:常见Recommendedtreatment:combinedmethod治疗:联合治疗 强调骨损伤的逐级严重程度 A型:关节外骨折 B型:关节局部骨折根据骨折片位置分亚型 C型:关节完全骨折根据关节面粉碎程度和干骺端情况分亚型MüllerAO-分类系统A1:尺骨骨折A2:桡骨嵌插骨折、尺骨茎突撕脱A3:桡骨粉碎性骨折、尺骨茎突撕脱Classificationsystems分类系统MüllerAO-classificationTheMüllerAO-classificationisadaptedbytheOrthopaedicTraumaAssociation.创伤整形外科协会的分类系统Inreference(6)alinkisprovidedtodownloadtheillustrationsoftheMüllerAOClassificationofFractures.A=extra-articularfracture关节外骨折A1=ulna,radiusintact尺骨骨折、桡骨正常A2=radius,simpleandimpacted桡骨、单纯骨折或压缩A3=radius,multifragmentary桡骨多发骨折B1:劈裂骨折B2:塌陷骨折B3:劈裂塌陷骨折B=partialarticularfracture关节部分骨折B1=radius,sagittal桡骨矢状位B2=radius,frontal,dorsalrim桡骨、冠位、背侧B3=radius,frontal,volarrim桡骨、冠位、掌侧C1:关节和干骺端单纯骨折C2:关节单纯骨折、干骺端粉碎性骨折C3:关节及干骺端粉碎性骨折C=completearticularfractureofradius桡骨完全性关节骨折C1=articularsimple,metaphysealsimple关节、干骺端单纯骨折C2=articularsimple,metaphysealmultifragmentary关节单纯、干骺端复杂性骨折C3=articularmultifragmentary关节复杂性骨折FernandezClassificationFernandez分类法Thisclassificationispopular,sinceitaddressesthemechanismofinjuryandtheconsequenttreatmentoptions.Instabilityisdefinedasahighriskofsecondarydisplacementafterinitialadequatereduction.Associatedtraumaticlesionsareligamentousrupture,nervecompressionandcompartmentsyndrome.首次复位后,不稳定是发生再次移位的高危因素。伴随的损伤有:韧带断裂、神经受压、骨筋膜室综合症Radialinclinationorangle桡骨远端尺倾角Radialinclinationrepresentstheanglebetweenonelineconnectingtheradialstyloidtipandtheulnaraspectofthedistalradiusandasecondlineperpendiculartothelongitudinalaxisoftheradius.Theradialinclinationrangesbetween21°and25°尺倾角:桡骨茎突顶端与桡骨远端尺侧表面的连线与垂直于桡骨长轴水平线的夹角,正常约:21---25°Lossofradialinclinationwillincreasetheloadacrossthelunate.这一角度消失,会增加月骨的负荷。Radialtilt掌倾角Radialtiltismeasuredonalateralradiograph.在侧位平片测量掌倾角Theradialtiltrepresentstheanglebetweenalinealongthedistalradialarticularsurfaceandthelineperpendiculartothelongitudinalaxisoftheradiusatthejointmargin.Thenormalvolartiltaverages11°andhasarangeof2°-20°.掌倾角:远端桡骨关节面沿线与垂直于桡骨长轴水平线间的夹角,正常向掌侧倾斜,2°-20°,平均11°。FernandezClassificationFernandez分类法Thisclassificationispopular,sinceitaddressesthemechanismofinjuryandtheconsequenttreatmentoptions.Instabilityisdefinedasahighriskofsecondarydisplacementafterinitialadequatereduction.Associatedtraumaticlesionsareligamentousrupture,nervecompressionandcompartmentsyndrome.首次复位后,不稳定是发生再次移位的高危因素。伴随的损伤有:韧带断裂、神经受压、骨筋膜室综合症Type1:Bendingfracture屈曲骨折Mechanism:onecortexofthemetaphysisfailsduetotensilestressandtheoppositeundergoesacertaindegreeofcomminution.机制:由于拉伸应力造成干骺端皮质损伤,反方向应力造成不同程度粉碎性骨折。Stability:canbestableorunstable稳定性:可稳定或不稳定Displacementpattern:non-displaced,dorsal(Colles‘)orvolar(Smith’sfracture)移位:不移位,背侧移位或掌侧移位Numberoffragments:twomainfragments骨折处:两处主要骨折Associatedlesions:uncommon联合损伤:少见Recommendedtreatment:usuallyconservative,whenunstable:percutaneouspinningorexternalfixation治疗:保守治疗,不稳定时可行外固定术CommonFractureEponyms常见的以人名命名的骨折Colles‘fractureColles’骨折AColles‘fractureisafractureofthedistalmetaphysisoftheradiuswithdorsalangulationanddisplacementleadingtoa’silverforkdeformity‘.桡骨远端干骺端背侧成角,其移位形成“银叉样变形”Collesfracturesareseenmorefrequentlywithadvancingageandinwomenwithosteoporosis.此种骨折常见于老年人及有骨质疏松的女性InmanycasesaColles‘fractureisanextraarticular,uncomplicatedandstablefracture,butitcanbeintraarticular.在很多病例中,Colles‘骨折为关节外骨折,不复杂,属于稳定性骨折,但也可为关节内。SolookforsignsofinstabilityinallColles‘fractures,especially:IntraarticularradiocarpalorDRUJextensionofthefractureRadialshorteningLossofradialinclination不稳定的Colles’骨折表现:骨折累及桡腕关节或DRUJ,桡骨短缩,桡骨尺倾角的消失。CommonFractureEponyms常见的以人名命名的骨折Colles‘fractureColles’骨折AColles‘fractureisafractureofthedistalmetaphysisoftheradiuswithdorsalangulationanddisplacementleadingtoa’silverforkdeformity‘.桡骨远端干骺端背侧成角,其移位形成“银叉样变形”Collesfracturesareseenmorefrequentlywithadvancingageandinwomenwithosteoporosis.此种骨折常见于老年人及有骨质疏松的女性InmanycasesaColles‘fractureisanextraarticular,uncomplicatedandstablefracture,butitcanbeintraarticular.在很多病例中,Colles‘骨折为关节外骨折,不复杂,属于稳定性骨折,但也可为关节内。SolookforsignsofinstabilityinallColles‘fractures,especially:IntraarticularradiocarpalorDRUJextensionofthefractureRadialshorteningLossofradialinclination不稳定的Colles’骨折表现:骨折累及桡腕关节或DRUJ,桡骨短缩,桡骨尺倾角的消失。OntheleftadetailedAPviewofthesamepatientasabove.同一患者后前位细节图。Inadditiontothedorsalangulationseenonthelateralview,noticethefollowing:侧位片可见背侧成角:Extensionintotheradiocarpaljointandthedistalradioulnarjoint累及桡腕关节及远端桡尺关节Displacementofthearticularfragments(bluearrow)蓝箭头所示关节骨折移位Radialshorteningandlossofradialinclinationresultingindistalulnaabuttingthelunate(yellowarrow)黄箭头所示:桡骨短缩及桡骨尺倾角消失,使尺骨远端与月骨靠近。Fractureofulnarstyloid尺骨茎突骨折JustcallingthisfractureaColles‘fracturewouldbeinsufficient.把这一骨折称为Colles骨折,是不恰当的。Allthecharacteristicshavetobementionedintheradiologyreporttoconveythefullextentoftheinjury,possiblecomplicationsandtreatment.放射学报告中应该描述骨折所有的特点、病变范围及可能出现的并发症及治疗。Smith'sfractureSmith‘sfracturesoccurinyoungerpatientsandaretheresultofhighenergytraumaonthevolarflexedwrist.多发生于年轻人,是腕关节掌屈着力造成的Volarcomminutionandintraarticularextensionaremorecommon.常见粉碎性骨折及累及关节内的骨折。OntheleftanextraarticularSmith‘sfracturewithpalmarandradialangulationanddisplacement.Thereisalsoanavulsionoftheulnarstyloidprocess.左图关节外Smith‘骨折,桡骨成角及移位。有尺骨茎突的撕脱性骨折Type2:Shearingfracture剪力骨折Mechanism:fractureofthejointsurface(i.e.volaranddorsalBarton‘s,radialstyloidprocessfractures,simplearticularfracture)机制:关节面骨折(背侧或掌侧Barton‘s骨折,桡骨茎突骨折,单纯关节骨折)Stability:unstable稳定性:不稳定Displacementpattern:dorsal,volarorradial移位:背侧、掌侧或桡侧移位Numberoffragments:two-part,three-partorcomminuted骨折数量:两部分、三部分或粉碎性骨折Associatedlesions:lesscommon联合损伤:更少见Recommendedtreatment:openreductionwithscrew-orplatefixation治疗:切开复位,螺钉或钢板外固定术Barton'sfractureVolar-typeBarton‘sisafracture-dislocationofthevolarrimoftheradius.掌侧型Barton’s骨折,桡骨掌侧骨折,脱位Thistypeisthemostcommon.这型较常见Dorsal-typeBarton‘sisafracture-dislocationofthedorsalrimoftheradius.背侧型:桡骨背侧骨折及脱位DislocationoftheradiocarpaljointisthehallmarkofBarton‘sfractures.桡腕关节的脱位是Barton’s骨折的特征表现Thesearesheartypefracturesofthedistalarticularsurfaceoftheradiuswithtranslationofthedistalradialfragmentandthecarpus.伴有远端桡骨及腕骨移位的桡骨远端关节表面骨折。Thesefractureshaveagreattendencyforredislocationandmalunion.这种骨折再脱位及畸形愈合的可能性大Theyusuallyrequireoperativetreatment.需要手术治疗Barton'sfractureVolar-typeBarton‘sisafracture-dislocationofthevolarrimoftheradius.掌侧型Barton’s骨折,桡骨掌侧骨折,脱位Thistypeisthemostcommon.这型较常见Dorsal-typeBarton‘sisafracture-dislocationofthedorsalrimoftheradius.背侧型:桡骨背侧骨折及脱位DislocationoftheradiocarpaljointisthehallmarkofBarton‘sfractures.桡腕关节的脱位是Barton’s骨折的特征表现Thesearesheartypefracturesofthedistalarticularsurfaceoftheradiuswithtranslationofthedistalradialfragmentandthecarpus.伴有远端桡骨及腕骨移位的桡骨远端关节表面骨折。Thesefractureshaveagreattendencyforredislocationandmalunion.这种骨折再脱位及畸形愈合的可能性大Theyusuallyrequireoperativetreatment.需要手术治疗Ontheleftavolar-typeBarton‘sfracture.左图是掌侧Barton’s骨折Theradiographicfindingsarethefollowing:平片表现:Comminutedintraarticularfractureofthedistalradius桡骨远端关节内粉碎性骨折Volarrimmaintainsrelationshipwiththecarpusandbotharedisplacedproximally(bluearrow)蓝色箭头所示手掌保持与腕骨的关系,两者距离靠近。Fractureofradialstyloidprocesswithlossofradialinclination(yellowarrow)黄箭头所示:桡骨茎突骨折,桡骨尺侧倾斜消失Ontheleftadorsal-typeBarton‘sfracture.左图是背侧型Barton’骨折Theradiographicfindingsarethefollowing:平片表现:Comminutedintraarticularfractureofthedistalradius桡骨远端关节内粉碎性骨折Dorsalrimandcarpusaredisplaceddorsallyandproximally背侧边缘与腕骨向背侧移位,二者距离靠近Type3:Compressionfracture压缩骨折Mechanism:compressionfractureofthejointsurfacewithimpactionofsubchondralandmetaphysealbone(i.e.die-punchfractureorintraarticularcomminutedfracture嵌入软骨下及干骺端骨质的关节面的压缩骨折Stability:stableorunstable稳定性:稳定或不稳定Displacementpattern:non-displaced,dorsal,volarorradial移位:不移位,背侧、掌侧及桡侧移位Numberoffragments:3-or4-partorcomminuted骨折数量:3-4处或粉碎性骨折Associatedlesions:common联合损伤:常见Recommendedtreatment:治疗:closed闭合的limitedarthroscopicassisted关节镜辅助extensileopenreduction切开复位percutaneouspinscombinedwithexternalandinternalfixation内固定与外固定相结合bonegraft骨移植Die-punchfractureAdie-punchfractureisadepressionfractureofthelunatefossaofthedistalradius.桡骨远端月骨窝凹陷性骨折Itistheresultofatransverseloadthroughthelunate.是通过月骨横向应力的作用造成的Theradiographicfindingscanbeverysubtle.平片只有微小的变化Inmanycasesthereisalsoasubtleproximaldisplacementoflunate,seenasabreakincarpalarcI.(seethearticleWrist-Carpalinstability).在许多病例中月骨微小的近端移位,(详见腕关节不稳定)Ontheleftatypicaldie-punchfracture.Thebluearrowindicatesthedepressedfragmentofthelunatefossa.蓝箭头所示:月骨窝的压缩性骨折Noticethearticularstep-off.关节脱位Theyellowarrowindicatesasubtlefractureoftheradialstyloidprocess.黄箭头示:桡骨茎突微小的骨折ThereisnodisruptionofcarpalarcI.无腕骨骨折Noticethatyoucaneasilyoverlooksuchafracture.很容易漏诊Onthelefttwo3D-reconstructionsofthesamefractureasabove.同一患者3D重建图像Type4:Avulsionfracture撕脱性骨折Mechanism:avulsionfractureusuallyassociatedwithligamentousinjury机制:与韧带损伤相关Stability:unstable稳定性:不稳定Displacementpattern:dorsal,volar,radialorproximal移位:掌侧、背侧或近端移位Numberoffragments:骨折处:2-part:radialstyloid,ulnarstyloid两部分,桡骨茎突、尺骨茎突3-part:volar,dorsalmargin三部分,掌侧、背侧边缘Comminuted粉碎性Associatedlesions:frequentligamentousinjury联合损伤Recommendedtreatment:closedoropenreductionwithpinorscrewfixationortensionwiring治疗:闭合性或开放性复位,使用针或螺钉固定或拉伸缝合。Type5:Combinedfractures复合性骨折Mechanism:combinationofforcesoftypeI-IVasaresultofhighvelocityinjuries机制:高速损伤造成的,I-IV型混合型Stability:unstable稳定性:不稳定Displacementpattern:dorsal,volar,radialorproximal移位:背侧、掌侧、桡侧或近端移位Numberoffragments:comminuted骨折数量:粉碎性Associatedlesions:alwayspresent联合损伤:常见Recommendedtreatment:combinedmethod治疗:联合治疗Classificationsystems分类系统MüllerAO-classificationTheMüllerAO-classificationisadaptedbytheOrthopaedicTraumaAssociation.创伤整形外科协会的分类系统Inreference(6)alinkisprovidedtodownloadtheillustrationsoftheMüllerAOClassificationofFractures.A=extra-articularfracture关节外骨折A1=ulna,radiusintact尺骨骨折、桡骨正常A2=radius,simpleandimpacted桡骨、单纯骨折或压缩A3=radius,multifragmentary桡骨多发骨折B=partialarticularfracture关节部分骨折B1=radius,sagittal桡骨矢状位B2=radius,frontal,dorsalrim桡骨、冠位、背侧B3=radius,frontal,volarrim桡骨、冠位、掌侧C=completearticularfractureofradius桡骨完全性关节骨折C1=articularsimple,metaphysealsimple关节、干骺端单纯骨折C2=articularsimple,metaphysealmultifragmentary关节单纯、干骺端复杂性骨折C3=articularmultifragmentary关节复杂性骨折FernandezClassificationFernandez分类法Thisclassificationispopular,sinceitaddressesthemechanismofinjuryandtheconsequenttreatmentoptions.Instabilityisdefinedasahighriskofsecondarydispl
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