2018年踝关节骨折课件.ppt

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1、EPIDEMIOLOGYOFANKLEFRACTURES1.芬兰大于60岁的人群，踝关节骨折的发生人数从每10万57人（1970年），增加到130人（1994年）。2.危险因素：体重指数的增加；吸烟的影响3.绝经和一般身体状况的好坏与踝关节骨折的发生无关.RadiographicMeasurementsofAlignmentandStabilityRadiographicappearanceofthenormalankleonmortiseview.Thecondensedsubchondral

2、boneshouldformacontinuouslinearoundthetalus.Talocruralangleshouldbeapproximately83degrees.Whentheoppositesidecanbeusedasacontrol,thetalocruralangleoftheinjuredsideshouldbewithinafewdegreesofthenoninjuredside.Themedialclearspaceshouldbeequaltothesuper

3、iorclearspacebetweenthetalusandthedistaltibiaandlessthanorequalto4mmonstandardradiographs.Thedistancebetweenthemedialwallofthefibulaandtheincisuralsurfaceofthetibia,thetibiofibularclearspace,shouldbelessthan6mm.Thecondensedsubchondralboneshouldformac

4、ontinuouslinearoundthetalus.Talocruralangleshouldbeapproximately83degrees.MedialClearSpaceEvaluationofSyndesmosisEvaluatingsyndesmoticwideningisperhapsthemostdifficulttaskwheninterpretingankleradiographsforalignmentandstability.Thesimplestapproachist

5、omeasurethedistancebetweenthemedialwallofthefibulaandtheincisuralsurfaceofthetibia.Thistibiofibularclearspaceshouldbelessthan6mmonbothAPandmortiseviewsWefindthisapproachsimplerthanmeasuringoverlapoftheanteriortubercleofthetibiaonthefibula,becausethel

6、attermeasureisrotationallydependent.ClassificationsinCurrentUseLauge-HansenClassificationAO/OrthopaedicTraumaAssociationFractureClassificationLauge-HansenClassification1.依据踝关节骨折损伤时,足的位置和外力作用的方向.2.足的位置:旋前和旋后3.外力致使距骨外旋,内翻,外翻.4.分为旋后-外旋(SER),旋后-内收,旋前-外旋(

7、PER),旋前-外展.Anteroposteriorandlateralradiographsshowanunstablesupination-externalrotationstageIVanklefracturewiththecharacteristicobliquedistalfibulafractureandamedialsideinjury.Ananteroposteriorradiographofasupination-adductionanklefracturewithatra

8、nsversefibulafractureandanimpactedmedialmalleolarfracture.Ananteroposteriorradiographofatypicalpronation-abductionanklefracture.Thefibulaislaterallycomminuted.特殊骨折Dupuytren骨折－－一种少见的旋前－外展型损伤，即腓骨高位骨折，胫骨下端腓骨切迹撕脱骨折，三角韧带断裂同时有下胫腓分离。Tillaux骨折－－旋前－外旋型2度，胫骨远端