1、Fracture and Dislocation (X-ray),孙浩林,Fracture,Definition Cause Classification Displacement Clinical features Bone union Complication Treatment,Definition,骨折:骨的完整性和连续性中断,Cause,外伤性骨折 直接暴力 间接暴力 病理性骨折 疲劳性骨折,Classification(1),不完全骨折 裂缝骨折 青枝骨折,完全骨折 横行骨折 斜行骨折 螺旋形骨折 粉碎性骨折 嵌插骨折 压缩性骨折 凹陷性骨折 骨骺分离,Classification
2、(2),稳定性骨折 裂缝骨折 青枝骨折 横行骨折 嵌插骨折 压缩性骨折 凹陷性骨折,不稳定性骨折 斜行骨折 螺旋形骨折 粉碎性骨折,Classification(3),开放性骨折 骨折刺破膀胱、尿道、直肠 闭合性骨折,Displacement,骨折移位 成角移位 侧方移位 短缩移位 分离移位 旋转移位,Clinical features,全身表现 休克 发热 一般不超过38度,局部表现 一般表现 疼痛 肿胀 功能障碍 特有体征 畸形 异常活动 骨擦音或骨擦感,Bone union,一期愈合,二期愈合 血肿炎症机化期 原始骨痂形成期 骨板形成塑形期 临床上骨折愈合多为二期愈合,*延迟愈合、不愈合
3、、畸形愈合,*临床愈合标准,Complications,早期并发症 休克 脂肪栓塞综合征 内脏器官损伤 周围组织损伤 血管损伤 神经损伤 骨筋膜室综合征,晚期并发症 坠积性肺炎 褥疮 DVT形成 感染 损伤性骨化 创伤性关节炎 关节僵硬 急性骨萎缩 缺血性骨坏死 缺血性肌挛缩(5P征),Treatment,Reduction (apposition ,aligment) anatomic, functional Fixation internal, external Exercise,Dislocation,Definition Clinical features Definitive tre
4、atment,Definition,关节脱位是指组成关节的各骨的关节面失去正常的对应关系。,Clinical features,一般症状 疼痛 肿胀 功能障碍,特殊表现 畸形 弹性固定 关节盂空虚,Definitive treatment,Reduction Fixation Exercise,X线片应用价值,骨关节创伤最基本常规检查 方便、快捷 空间定位好于CT和MRI 技术进步(CR、DR) 不可替代,X线片应用缺陷,复合投影,复杂部位和重叠部位容易漏诊 分辨率低 不能显示隐匿性骨折、软骨损伤、肌腱、韧带和脊髓等软组织损伤,X线片注意事项,四肢长骨需要包括附近关节 一般需要正侧位,必要时有
5、轴位、斜位和切线位 如果症状重,而X线阴性,需要数天后复查X线,或行CT、MRI检查,骨折和关节脱位X线分析原则,正常解剖和正常变异是基础 要有一定的阅片顺序 阅片内容: 骨关节外形 骨质的密度和纹理 骨折的畸形和移位 关节脱位 健侧对照 结合临床,Upper Limb Fractures and dislocations,Normal clavicle,Clavicle fracture,Clavicle fracture,Acromioclavicular dislocation,Normal Shoulder,Shoulder dislocation,Shoulder dislocati
6、on,Greater tuberosity fracture,Fracture of the surgical neck of the humerus,Humeral shaft fracture,Humeral shaft fracture,Normal elbow,Normal elbow,Supracondylar fracture of the humerus,Supracondylar fracture of the humerus,Intercondylar fracture of the humerus,Olecranon fracture,Elbow dislocation,N
7、ormal radius and ulna,Double fractures of radius and ulna,Fractures of radius and ulna,Monteggia fracture,Galeazzi fracture,Normal wrist,Colles fracture,Smith fracture,Smith fracture,Barton fracture,Scaphoid fracture,Metacarpal fracture,Bennetts fracture,Fracture and dislocation of finger,Break and
8、Test,(1)What is this?,(2) What is this?,(3) What is this?,(4) What is this?,Lower limb Fractures and Dislocations,Normal Hip,Dislocation of the hip,Femoral neck fracture,Femoral neck fracture,Intertrochanteric fracture,Normal femur,Femoral shaft fracture,Femoral shaft fracture,Femoral shaft fracture
9、,Normal Knee,Supracondylar fracture of the femur,Intercondylar fracture of the femur,Patella fracture,Tibial plateau fracture,Normal tibia and fibula,Tibia and fibula fracture,Tibia and fibula fracture,Normal ankle,Stability,Bimalleolar fracture,Normal calcaneus,Calcaneus fracture,Fracture of the ba
10、se of the 5th metatarsal (Jones fracture),Fracture of metatarsal,Spine and Pelvic Fractures and Dislocations,Fracture and dislocation of cervical spine,Fracture and dislocation of thoracic spine,Fracture and dislocation of lumbar spine,Pelvic fracture,Acetabular fracture,Break and Test,(1)What is this?,(2)What is this?,(3)What is this?,(4)What is this?,Thank You!,