脊柱和骨盆骨折2中山大學(xué)外科學(xué)-資料下載頁(yè)
2025-01-20 11:16本頁(yè)面
【正文】 articular extension ? TypeA3: Obturator fracturesthe pubic or ischial ramiminimally displaced Treatment of Type A ? Conservative treatment usually sufficient ? Symptomatic, with bed rest and analgesia, early ambulation, and weight bearing as tolerated. Type B Fracture ? Involve the pelvic ring in two or more sites create a segment that is rotationally unstable but vertically stable ? Type B1: openbook fractures occur from anteroposterior pression ? Type B2 and B3: lateral pression fractures. A lateral forceinward displacement of hemipelvis through the sacroiliac plex and ipsilateral (B2) or, contralateral pubic rami (B3) Treatment of Type B ? Symptomatic treatment ? Reductionlateral pression ? Manipulation under general anesthesia ? Reduction can be maintainted ? A hip spica ? But more often external or internal fixation is currently favored Type C ? Both rotationally and vertically unstable ? Result from a vertical shear mechanism, like a fall from a height Treatment of Type C ? Reduction longitudinal skeletal traction through the distal femur or the proximal tibia, 812 weeks ? External fixation alone is insufficient to maintain reduction in highly unstable fractures, but it may help control bleeding and eases nursing care ? Open reduction and internal fixation is often required ? The surgical technique is demanding, and there is a significant risk of plications. Complications ? Chronic low back pain and posterior sacroiliac painlongterm plain, 50% ? Nearly 5% of type C injuriesa leg length discrepancy of more than 25cm ? Residual gait abnormalities1232% ? Nonunion rate around 3% ? Neurologic deficit610% ? Urologic 520% Fractures of the acetabulum ? Direct trauma on the trochanteric region ? Indirect axial loading through the lower limb ? The position of the limb at the time of impact (rotation, flexion, abduction, or adduction)determine the pattern of injury ? Comminution is mon Classification ? Letournel based on which column is involved ? The anterior column the anterior iliac crest, the anterior half of the acetabulum, and the pubic ramus ? The posterior columnthe sciatic buttress and the sciatic notch, the posterior half of the acetabulum, and the ischial tuberosity ? Two oblique views , Ct scanning ? Ten different types ? Five simple patterns (one fracture line) ? Five plex patterns (the association of two or more simple patterns) Treatment ? The goal a spherical congruency between the femoral head and weightbearing acetabular dome, and to maintain it until bones are healed ? longitudinal skeletal traction through a distal femoral or proximal tibial pin pulling axially, 68 weeks before full weight bearing ? Any residual displacement after traction is an indication for open reduction and internal fixation ? A clear correlation between anatomic reduction and prognosis Complications ? Posttraumatic degenerative joint disease ? Heterotopic ossification ? Femoral head osteonecrosis ? Deep vein thrombosis ? When the reduction is stable and fixation is solid, the patient can be mobilized after a few days with nonweightbearing ambulation, and weight bearing may begin as early as 6 weeks ? Routinely use postoperative prophylactic anticoagulation and heterotopic bone formation prophylaxis with irradiation or indomethacin, or both 重點(diǎn)和難點(diǎn) ? 重點(diǎn) ? 脊柱骨折診斷 ? 骨盆骨折的治療原則 ? 難點(diǎn) ? 脊髓損傷
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