關節(jié)脫位JointDislocation中山大學外科學.ppt
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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 先天性髖關節(jié)脫位 Shenton sline Rheumatoidarthritis 類風濕性關節(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 問號法 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 施萬細胞 NodesofRanvier PeripheralNerve PeripheralNerveInjury AcuteinjuryChronicinjury entrapmentneuropathy CLASSIFICATIONOFNERVEINJURIES neuropraxia 神經傳導功能障礙 axonotmesis 神經軸索中斷 nerotmesis 神經斷裂 neuropraxia 神經傳導功能障礙 preservationoftheaxis cylinderminoredemaorbreakdownofmyelinsheathrecoveryiscompleteinafewdaysorweeks axonotmesis 神經軸索中斷 breakdownoftheaxondistalwalleriandegenerationpreservationoftheSchwanncellSpontaneousregenerationwithgoodfunctionalrecovery nerotmesis 神經斷裂 completeanatomicalseveranceofthenervedistalwalleriandegenerationperineuriumandepineuriumalsoaredisruptedspontaneousrecoverycannotbeexpected Walleriandegeneration 華勒氏變性 Symptoms Pain withthedegreeofintensityrangingfromatinglingsensationtoextreme burningpainLossoffeelingorabnormalsensationsLossofmotorfunction suchasahandorlegbeingdifficulttomoveLossofactiverangeofmotion suchasdifficultyliftingfingersorflexingthewrist Diagnosis evaluatemotor sensoryandautonomiclossTinelsign 神經干叩擊試驗 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 夾紙試驗 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 神經移植 Nervetransfer 神經移位術 PeripheralNerveInjuries Bythebeginningofthe20thcentury somemeasureofsuccesswasreportedwithautografts Althoughregenerationaxonsgainentrancetothedistalsegment regenerationisslow Keypoint Manifestation diagnosisandmanagementofHip ShoulderandElbowjointdislocationTreatmentprinciplesofperipheralnerveinjuryBrachialplexusinjury 臂叢損傷 References TEXTBOOKofSURGERY Thebiologicalbasisofmodernsurgicalpractice 17edition ThanksandQuestions Email ronglimin
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