關(guān)節(jié)脫位JointDislocation中山大學(xué)外科學(xué).ppt

JointDislocationandPeripheralNerveInjury RONGLi minThe3rdaffiliatedhospitalofSunYat senuniversity Jointdislocation Definition Jointdislocation orluxationAdislocationisaseparationoftwoboneswheretheymeetatajointOftencausedbyasuddenimpacttothejointAdislocationmayalsocauseligamentornervedamageSubluxation 半脫位 isapartialdislocation Classification Traumatic Congenital 先天性 PathologicComplete subluxationAnterio posterio lateral central Acute old habitual shoulders Close open bilateraldislocationofthehipbecauseoftrafficaccident Congenitaldislocationofthehip 先天性髖關(guān)節(jié)脫位 Shenton sline Rheumatoidarthritis 類(lèi)風(fēng)濕性關(guān)節(jié)炎 ofthewristandhands Subluxationandulnardeviationatthemetacarpophalangealjoint Occurrence themostcommonsitesShouldersElbowsHipsFingersAnkles mostlikelybeaccompaniedbyafracture KneesWrists SymptomsofaJointDislocation IntensePainSwellingImmobilityoftheaffectedjointDeformity NOMENCLATUREFORDISLOCATIONS NametheJOINTNamethedislocationbythepositionoftheDISTALFRAGMENTinrelationtotheproximalfragmentAddFRACTUREtothenameifthereisaperiarticularfracture AddOPENifawoundcommunicateswiththedislocation Complications FractureNerve vascularinjuryBonenecrosisTraumaticarthritis Galeazziinjury Monteggiainjury Treatment CloseReductionImmobilizeRehabilitationprogramSurgicalreductionLigamentreconstruction Hipjointdislocation Allismaneuver 提拉法 Bigelow smaneuver 問(wèn)號(hào)法 AftercareTraction 4weeks Bed 2weeks Walkstick 2weeks Ambulate 8weekslat Shoulderinjury Anteriordislocationoftheshoulder Kocher s Hippocrate s Stimson s Elbowinjury Manipulativereduction Otherjointdislocation Acromioclavicularseparation Completedislocationofaproximalinterphalangealjoint Lunatedislocation Perilunatedislocation Nursemaid selbow pulledelbow牽拉肘 ApartialdislocationofradialheadcommonintoddlersThemainsymptomisrefusaltousethearmCanbeeasilytreatedinadoctor sofficewithoutthefollowingfirstaidsteps Manualreduction Peripheralnerveinjury Orthopaedicsurgeryisnolongerlimitedtoinjuriesofthebone bloodvessels andskin buthasexpandedtoincludenerveinjuryaswell Axon 軸索 Myelinsheath 髓鞘 Schwanncell 施萬(wàn)細(xì)胞 NodesofRanvier PeripheralNerve PeripheralNerveInjury AcuteinjuryChronicinjury entrapmentneuropathy CLASSIFICATIONOFNERVEINJURIES neuropraxia 神經(jīng)傳導(dǎo)功能障礙 axonotmesis 神經(jīng)軸索中斷 nerotmesis 神經(jīng)斷裂 neuropraxia 神經(jīng)傳導(dǎo)功能障礙 preservationoftheaxis cylinderminoredemaorbreakdownofmyelinsheathrecoveryiscompleteinafewdaysorweeks axonotmesis 神經(jīng)軸索中斷 breakdownoftheaxondistalwalleriandegenerationpreservationoftheSchwanncellSpontaneousregenerationwithgoodfunctionalrecovery nerotmesis 神經(jīng)斷裂 completeanatomicalseveranceofthenervedistalwalleriandegenerationperineuriumandepineuriumalsoaredisruptedspontaneousrecoverycannotbeexpected Walleriandegeneration 華勒氏變性 Symptoms Pain withthedegreeofintensityrangingfromatinglingsensationtoextreme burningpainLossoffeelingorabnormalsensationsLossofmotorfunction suchasahandorlegbeingdifficulttomoveLossofactiverangeofmotion suchasdifficultyliftingfingersorflexingthewrist Diagnosis evaluatemotor sensoryandautonomiclossTinelsign 神經(jīng)干叩擊試驗(yàn) Electromyogram EMGorElectromyography NerveConductionStudyMagneticResonanceImaging MRI Peronealnerve oftendamagedduringdislocationoftheknee withruptureofthelateralcollateralligamentofthekneeorfracturesoftheupperfibulaasthecommonperonealnervewrapsaroundtheneckofthefibula SymptomofperonealnerveInj Completeparalysisofdorsiflexionofthefootandankle footdropandsteppagegait跨閾步態(tài) Sensorylossoverthemedialtwo thirdsofthedorsumofthefootandlateralsideoftheleg Tibialnerve DamageduetoadislocationofthekneeleadstovariableparalysisofplantarflexionofthefootandtoesThenumbnessoftheheelandpartofthesoleandthelateralsideofthefootandposterioraspectoftheleg Tinglingsensationorlackofsensationinthebackofthearm forearmandhandWeaknessinarmmuscles makingitdifficulttostraightentheelbow wristandfingers wristdrop垂腕 RadialNerveInjury Mediannerve SensorylossoflateralsideofpalmThumbabductionparalysis Fromentsign 夾紙?jiān)囼?yàn) ULNARNERVE Claw fingerdeformity 爪形手 Treatment ObservationNerveisinjuredbutnotcutRehabilitationandcarefulmonitoringareneededSurgeryforNerveRepairReconnect sutures NervegraftNervetransferOthersurgeryTendonstransfering Epineuralrepair 外膜縫合 PrimarynervesuturesremainthetreatmentofchoicefortherepairofdividedperipheralnervesIncluding Groupfascicularrepair 束膜縫合 EpineuralRepair FascicularRepair NerveGraft leadingcauseoffailureofnervegraftInadequateresectionDistractionofrepairsite Nervegraft 神經(jīng)移植 Nervetransfer 神經(jīng)移位術(shù) PeripheralNerveInjuries Bythebeginningofthe20thcentury somemeasureofsuccesswasreportedwithautografts Althoughregenerationaxonsgainentrancetothedistalsegment regenerationisslow Keypoint Manifestation diagnosisandmanagementofHip ShoulderandElbowjointdislocationTreatmentprinciplesofperipheralnerveinjuryBrachialplexusinjury 臂叢損傷 References TEXTBOOKofSURGERY Thebiologicalbasisofmodernsurgicalpractice 17edition ThanksandQuestions Email ronglimin