前臂双骨折的手术入路.ppt

《前臂双骨折的手术入路.ppt》由会员上传分享，免费在线阅读，更多相关内容在应用文档-天天文库。

1、尺桡骨双骨折骨二科学习APandlateralviewsofthebothbonesfractureoftheforearm,demonstratingsignificantshorteningandrelativelysimpleobliquefracturepatterns.Thepatientispositionedsupinewiththearmpreppedanddrapedtojustabovetheelbowandatourniquetinplace.Thisfiguredemonstratesthearmheldinsupination.Notethepositi

2、onofthebicepsinsertionaswellasthepalpabletendonoftheFCRandradialartery.BICEPSTENDONRADIALARTERYFLEXORCARPIRADIALIS(FCR)AusefultechniquetomaketheskinincisionistotakeabovicordandpullittaughtfromtheradialsideofthebicepstendontotheFCRatthelevelofthewrist.Thiscanthenbeusedasatemplatefortheincision

3、line.Theincisionistakendownthroughtheskin,identifyingthefasciallayerwithcaretakennottodamageanysuperficialveinsthatmaybeintact.TheFCRtendonisclearlyvisiblethroughoutthewound,asistheradialarteryinthedistalextentofthewound.FCRRADIALARTERYAcloseupofthedistalaspectofthewounddemonstratingTheradial

4、arteryanditsvenouscommtantes.RADIALARTERYANDVENOUSCOMMTANTESFCRRADIALARTERYThefasciaontheradialsideoftheflexorcarpiradialisisreleased,exposingthedeeptissue.Theradialarterycanbefollowednowthroughouttheentireincision.Theradialarterymaybetakenineitherdirection,however,typicallyitiseasiertotaketh

5、earterytotheradialside.FCRRADIALARTERYThedeepdissectionisnowperformedbetweentheflexor-pronatormassontheulnarsideandthearteryandthemobilewadontheradialside.PRONATORFortheproximaldissection,theforearmisbroughtintosupinationandthepronator,FDSandFDParereleasedfromthevolaraspectoftheradiusFDSThepr

6、onatorisbeingreleasedfromtheradialaspectoftheradiusinasubperiostealmanner.Thissubperiostealdissectioncontinuesdistallytoreleasetheoriginofthecommonflexor.Afterexposureofthevolaraspectoftheradiusproximallyanddistally,twoclampscanbeplacedontheendsoftheboneinordertodeliverthemforcleaning.FCRRADI

7、ALARTERYEachsideofthefractureisbedeliveredinordertoexposeandcleanthecorticaledges.Thesefiguresdemonstratedeliveryofthedistalfragmentandacurvedcurettebeingusedtocleanthecorticaledge.Nocleaningshouldbeperformedwithintheintramedullarycanal,asthi