骨折治疗的AO原则-肱骨远端

27
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
28
www.art-com.co.kr
（三）内植物的选择
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
Copyright © by ARTCOM PT All rights reserved.
9
www.art-com.co.kr
B型

Company
Logo


B型：部分关节内骨折，其中B1型为外侧矢状面的 部分关节内骨折，B2型为内侧矢状面的部分关节 内骨折，B3型为累及前面的冠状位的部分关节内 骨折。 B1 .1 分2个亚型：骨折线通过肱骨小头、骨折线 通过肱骨小头与滑车之间。 B1. 2 骨折线通过肱骨滑车外侧简单骨折分5个亚 型：内侧韧带完整、合并内侧韧带断裂、 B1. 3 骨折线通过肱骨滑车外侧复杂骨折分2个亚 型：
47
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
48
www.art-com.co.kr
病历2

Company
Logo
林某，女，右肱骨外髁骨折
X片 （13-b1.1 ）
Copyright © by ARTCOM PT All rights reserved.
21
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
22
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
35
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
36
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
33
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
34
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
15
www.art-com.co.kr
（三）影像学
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
16
www.art-com.co.kr
三、外科解剖
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
www.art-com.co.kr
肘关节骨折分类
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
14
www.art-com.co.kr
（二）神经血管问题
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
wenku.baidu.com19
www.art-com.co.kr
(一)体位与手术入路
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
20
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
31
www.art-com.co.kr
五、手术处理技巧与建议
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
32
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
Copyright © by ARTCOM PT All rights reserved.
8
www.art-com.co.kr
Company
Logo

A3.1 干骺端简单粉碎骨折，分2个亚型：内侧型、 外侧型。 A3.2 干骺端一侧粉碎骨折，分2个亚型：内侧型、 外侧型。 A3.3 干骺端复杂粉碎骨折
双柱理论

Company
Logo
根据肱骨远端类似三 角形结构而提出的， 两边类似两根柱子， 撑起了肱骨远端及肱 骨，相当于肱骨远端 的内外侧棱
Copyright © by ARTCOM PT All rights reserved.
4
www.art-com.co.kr
解剖生理特点

Company
23
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
24
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
25
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
26
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
Copyright © by ARTCOM PT All rights reserved.
11
www.art-com.co.kr
Company
Logo

B3 .1 肱骨小头骨折 B3. 2 滑车骨折 B3. 3 肱骨小头与滑车骨折
Copyright © by ARTCOM PT All rights reserved.
Copyright © by ARTCOM PT All rights reserved.
6
www.art-com.co.kr
A型

Company
Logo
A型：关节外骨折，其中A1型为骨突撕脱骨折，A2型为简 单干骺端骨折，A3型为干骺端粉碎骨折。 A1 .1 肱骨外髁撕脱骨折 A1. 2 肱骨内髁撕脱骨折，骨折块未嵌入关节； 分3个亚型：无移位、移位、粉碎型 A1. 3 肱骨内髁撕脱骨折，骨折块嵌入关节；
43
www.art-com.co.kr
（八）结论
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
44
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
17
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
18
www.art-com.co.kr
四、术前计划
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
Company
Logo
骨折治疗的AO原则-肱骨远端
山东省中医院显微骨科 2011级研究生 李兰山
Copyright © by ARTCOM PT All rights reserved.
1
www.art-com.co.kr
肱骨远端
一、引言 二、骨折与软组织损伤评估 三、外科解剖 四、术前计划 五、手术处理技巧与建议 六、术后处理 七、隐患与并发症 八、结论 九、总结

Copyright © by ARTCOM PT All rights reserved.
Company
Logo
2
www.art-com.co.kr
一、引言
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
3
www.art-com.co.kr
37
www.art-com.co.kr
（六）术后处理
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
38
www.art-com.co.kr
（七）隐患与并发症
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
39
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
40
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
Logo
肱骨远端向下变薄，向两侧变宽、变厚 外髁与肱骨长轴形成向前30～50°的前倾角 内外髁与滑车关节之间形成一薄的骨片；滑车关节略低于肱骨小头 肘关节伸直时呈现10～15°外翻角（男性），20～25°外翻角（女性）， 称生理性携带角（或提携角） 肱骨内外髁各形成一个骨性隆起，即肱骨内上髁(前臂屈肌总肌腱附着点)和 外上髁(前臂伸肌总肌腱附着点)。 内上髁后面是尺神经沟的组成部分
29
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
30
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
Copyright © by ARTCOM PT All rights reserved.
10
www.art-com.co.kr
Company
Logo

B2 .1 骨折线通过肱骨滑车内侧简单骨折。 B2. 2 骨折线通过肱骨滑车内侧简单骨折、骨折 线通过肱骨滑车 B2. 3 骨折线通过肱骨滑车内侧复杂骨折
12
www.art-com.co.kr
C型

Company
Logo
C型：完全关节内骨折，其中C1型为简单关节内、简单干 骺端骨折，C2型为关节内简单、干骺端粉碎骨折，C3型为 关节内粉碎、干骺端粉碎骨折。
Copyright © by ARTCOM PT All rights reserved.
13
41
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.
42
www.art-com.co.kr
Company
Logo
Copyright © by ARTCOM PT All rights reserved.



Copyright © by ARTCOM PT All rights reserved.
7
www.art-com.co.kr
Company
Logo

A2. 1 骨折线斜向下内关节外骨折 A2. 2 骨折线斜向下外关节外骨折 A2. 3 横行关节外骨折，分3个亚型：干骺端无明 显移位、干骺端向后移位、干骺端向前移位。
45
www.art-com.co.kr
病历1
Company
Logo

沙某----术前片子（13A2.3--干垢端向前移）
Copyright © by ARTCOM PT All rights reserved.
46
www.art-com.co.kr
Company
Logo

术后X片
Copyright © by ARTCOM PT All rights reserved.





Copyright © by ARTCOM PT All rights reserved.
5
www.art-com.co.kr
二、骨折与软组织损伤评估

Company
Logo
（一）肱骨远端骨折的AO分型

肱骨远端骨折目前被广泛接受的是AO分型，其按照关 节外、部分关节内、完全关节内分为A、B、C3大类型， 其更细的分类为27个亚分类，共61小类。