腕部舟状骨骨折VIP免费

24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic11腕部舟状骨骨折Scaphoidfracture24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic22近极部腰部结节部最大的一块近排腕骨4个关节面•近侧面桡舟关节•远内侧面头舟关节•尺侧面舟月关节•远侧面舟骨大小多角骨关节STTjoint（scaphotrapezotrapezoidaljoint）24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic33关节软骨覆盖80％舟骨结节－重要韧带的附着点舟骨腰部－无关节软骨覆盖，腰部最细又正对桡骨茎突24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic44BloodsupplytothescaphoidRadialartery70~80%-radialarterythroughthedorsalridge20~30%-volarradialarterybranches24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic55愈合时间6~8周10~12周12~20周｝愈合时间为4~5个月24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic66占全身骨折的2%占腕部骨折的60～70％发病率仅次于桡骨远端骨折几乎全部发生于青壮年连接近排与远排腕骨的杠杆治疗过程长,效果相对较差24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic77损伤机制最常见过伸-跌倒手掌触地，手腕强度背屈，轻微桡偏，桡骨背侧缘切断舟骨较少见冲压工舟骨-腕关节处于中立或轻度屈曲,暴力沿第二掌骨经大小多角骨经舟骨远端形成屈曲剪力.多伴发于掌骨头开放性骨折24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic88查体鼻烟壶局部肿胀、压痛,腕部活动受限24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic99腕舟骨移动试验（Waston’stest)检查方法:将患者患侧腕关节被动尺偏,检查者一只手握住患者腕部,用拇指压迫舟骨结节,另一只手握住患者手掌使腕关节逐渐转向桡侧,感觉腕部疼痛剧烈则为阳性24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic1010舟骨冲击试验：拇指向背侧按压舟骨结节舟骨剪力试验：拇指、示指捏住舟骨远、近极，向掌侧、背侧或尺、桡侧推移舟骨24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic1111X线检查常规腕关节正侧位片-舟骨长轴向前下方倾斜，舟骨骨折线不易显示(阴性率22%~43%)24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic1212常规腕关节正侧位片舟骨尺偏位片(Stecher位):腕掌面朝下,平放于胶片上,然后抬高腕部23°,并使腕尽量尺偏.旋前/旋后45°24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic1313要告知拍片者行舟骨矢状面照片CT24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic1414MR能很好的评价舟骨结构的完整性能准确的反映舟骨血液灌注情况发现舟骨损伤后缺血情况以选择治疗方案并判断预后提供了条件可以鉴别腕舟骨骨折后出现的延迟愈合、不愈合或缺血性坏死评价其手术适应症并选择合适的手术方法24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic1515其它诊断方法包括:核素骨扫描、腕舟脂肪垫征、音频震动及超声检查其它诊断方法核素骨扫描----诊断舟骨骨治疗与骨生物力学研究析的黄金指标腕舟脂肪垫征音频震动超声检查24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic1616分型24/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic171724/12/2424/12/24DepartmentofTraumaticOrthopedicDepartmentofTraumaticOrthopedic1818治疗方法急性(3周)无移位稳定型腕舟骨骨折多采用保守治疗固定体位:国内多采用肘下管形石膏固定国外大多主张采用超肘关节石膏固定1973年Thomaidis的解剖研究证明,腕关节用肘以下石膏...