本科大课骨折概论()精简课件
General Concept of Fracture 骨折概论,Houqing LONG (龙厚清) Dr.Med. Ph.D, Prof. & Director Dept. of Orthopedic Surgery，the First Affiliated Hospital, Sun Yatsen University 中山大学附属第一医院骨科,骨折概论,第一节,骨折的定义、成因、分类及移位,什么是骨折？,Dept. Orthopedics, 1st Hospital SUMS,骨折定义 Definition of fracture,骨折骨的连续性的中断 A fracture is a break in the continuity of a bone.,骨折的发生与外力有关,Direct violence (直接暴力) Indirect violence （间接暴力） Forceful pull of muscles（肌肉拉力引起撕脱骨折） Repeated stress（重复应力引起疲劳骨折） -cause fatigue fracture (long distance marching, dancing, running),Dept. Orthopedics, 1st Hospital SUMS,直接暴力Direct violence,间接暴力引起螺旋型骨折 Indirect violence (rotational ) Spiral frac.,Dept. Orthopedics, 1st Hospital SUMS,直接暴力 Direct force,间接暴力引起骨折或者脱位Fracture & dislocation caused by Indirect violence,车祸 Car accident,撕脱骨折，肌肉韧带强力收缩,轻微外力引起的骨折警惕骨质疏松骨折，或者病理骨折,骨质疏松性骨折：行走摔倒 病理性骨折：原有骨骼疾病，比如骨肿瘤等,Dept. Orthopedics, 1st Hospital SUMS,骨折分类：闭合 / 开放骨折 Closed / open fracture,根据骨折断端是否与皮肤或体腔粘膜相通，分为开放性和闭合性骨折 Based on whether there is communication between fracture and skin (body cavities) Closed fractures Open fractures: 骨盆骨折引起膀胱尿道或直肠损伤等 开放性骨折的伤口容易引致感染，因此，需要急诊手术处理伤口和骨折,Dept. Orthopedics, 1st Hospital SUMS,Open frac.,Close frac Skin intact,Dept. Orthopedics, 1st Hospital SUMS,Open fracture,The fragments breakthrough the soft tissue and skin 骨折端穿破软组织与皮肤,Dept. Orthopedics, 1st Hospital SUMS,Patterns of fracture 骨折类型,Incomplete fracture 不全骨折 partial break Complete fracture 完全性骨折,Dept. Orthopedics, 1st Hospital SUMS,不全骨折 Incomplete fracture: partial break,Crack fracture（裂纹骨折） Greenstick fractures in children （青枝骨折） 不完全性骨折容易引起漏诊,Dept. Orthopedics, 1st Hospital SUMS,.,Greenstick fracture of distal tibia occurs in children Notch in cortex in X-ray,Dept. Orthopedics, 1st Hospital SUMS,Complete fracture 完全性骨折,大多数骨折属于完全性骨折,Dept. Orthopedics, 1st Hospital SUMS,骨折类型 Patterns of fracture,根据骨折线、形状和程度可分为 Based on fracture line / shape / degrees : Transverse fracture（横形） Oblique（斜形） Spiral （螺旋形） Comminuted (with more than two fragments)（粉碎性） Compress fra. / crush fracture（压缩性） Impacted fracture （嵌插）,各种骨折类型,Stability of fracture 骨折的稳定性,稳定型骨折 Stable fracture: 复位后不容易发生移位的骨折，如横型骨折、嵌插骨折、青枝骨折等 not easily displace after reduction transverse, compacted, greenstick 不稳定骨折 Unstable fracture: 复位后容易发生移位，如斜型骨折、螺旋型骨折，粉碎性骨折等 a tendency to redisplace after reduction oblique, spiral and communited fracture,Type of fracture displacement 骨折移位类型,Angulation 成角 Lateral displacement 侧方移位 Overlap displacement 重叠（短缩） Separate displacement 分离 Rotational 旋转 mix together 混合 意义：与治疗选择有关,Factors for fracture displacement 骨折移位的因素,1. Force from the injury（外力作用点和方向） 2. Gravity or weight of distal part of affected limb（重力, 肢体重量） 3. Pull of muscles around the fracture （肌肉牵拉） 4. Incorrect moving of the patient and unsuitable manipulation（人为因素：如不合适的搬运）,骨折分类的意义,选择合理的治疗方式 制定合理治疗方案 评估并发症的风险 合理制定功能康复计划 预后的评估,第二节,骨折的临床表现和及影像学检查,Clinical manifestation of fracture (骨折临床表现）,History: injury 外伤史：外力作用 General condition 全身情况: Shock? Hemorrhage? 是否有休克、出血 Damage to brain? To lungs and heart? To abdomen? To spinal cord? To others? 是否有重要器官损伤？ 任何时候都要关注骨折以外重要器官损伤的可能性 关键的体检和实验室检查是必要的,临床表现（Clinical manifestation of fracture ）,全身表现（ General condition ） 1休克（Shock）:骨折所致的休克主要原因是出血，特别是骨盆骨折、股骨骨折和多发性骨折 ,严重的开放性骨折或并发重要内脏器官损伤时亦可导致休克。 2发热 （ Fever）:骨折后一般体温正常，出血量较大的骨折，如股骨骨折、骨盆骨折，血肿吸收时可出现低热，不超过38。,Dept. Orthopedics, 1st Hospital SUMS,骨折的局部表现 Local manifestation,Specific signs of fracture 骨折特有体征 Deformity 畸形 Abnormal mobility (movement between the fragments) 反常活动 Crepitus 骨擦感或骨擦音 三者中有一项可作出诊断，但三者都没有不可以否定骨折 One of them can make diagnosis Caution: none of them is found in some fractures.,Dept. Orthopedics, 1st Hospital SUMS,骨折的其他表现，虽然没有特异性，但常常可以提示可能骨折的线索,Swelling 肿胀 Bruising (ecchymosis) 淤斑 Tenderness 压痛 Impairment of function 功能障碍 以上表现虽然没有特征性，但可为诊断或进一步检查提供参考或线索,Dept. Orthopedics, 1st Hospital SUMS,当你处理骨折时，需要进一步了解 Ask yourself when you deal with a fracture,A wound? Open fracture?是否开放骨折？ Multiple? 是否多发骨折？ Any impairment of circulation? 局部血液循环情况？ Any evidence of nerve injury? 是否有神经损伤？ Any evidence of visceral injury? 是否有重要器官损伤？ Compartment syndromes? 是否有骨筋膜室综合症？,处理骨折不能只看到骨折,生命体征（vital signs）：心率、血压、呼吸、神志 关注脑、心、肺、腹部、脊柱、神经功能、休克等 原有疾病（preexisting disease） 全身状况（general conditions ）,Dept. Orthopedics, 1st Hospital SUMS,Test for checking circulation 检查患肢血循环,Color 皮肤颜色 Warmth 皮温 Arterial pulse 肢体远端动脉搏动 Capillary return 毛细血管回流 Nerve function 神经功能 Specific tests: Doppler ultrasonography or arteriography 必要时的特殊检查：血管超声，血管造影，肌电图等,骨折的影像学检查 Radiographic examination,X线检查是诊断骨折最基本、必须的检查 X线照片可明确骨折的部位、类型 X-ray (plain film) is important, basic and necessary for diagnosis and treatment. X-ray can show: fracture Site of fracture Type of fracture,临床已经明确骨折的诊断，还需要进行X线检查吗？,Dept. Orthopedics, 1st Hospital SUMS,Dept. Orthopedics, 1st Hospital SUMS,X线检查 X-ray examination,需要对有怀疑骨折的病人进行X线检查 Must take X-ray film for each suspect fracture A-P view and lateral view is necessary for fracture by radiography,X线检查的注意方面,骨的正侧位 长骨应包括两端邻近关节 必要时动态观察 可能多个部位 特殊位的投照（例如：轴位、切线位、张口位、断层等）,骨折的CT检查
