外科-关节脱位和末梢神经损害.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Joint Dislocationand Peripheral Nerve Injury,Joint dislocation,Definition,Joint dislocation,or,luxation,A dislocation is a separationoftwo bones where they meet at a joint,Often caused by a sudden impact to the joint,A dislocation may also cause ligament or nerve damage,Subluxation（半脱位）is a partial dislocation,Classification,Traumatic,Congenital（先天性）,Pathologic,Complete,subluxation,Anterio-posterio-lateral-central-,Acute,old,habitual(shoulders),Close,open,Congenital dislocation of the hip,（先天性髋关节脱位）,Shentons,line,Rheumatoid arthritis,（类风湿性关节炎）,of the wrist and hands.,Subluxation,and,ulnar,deviation at the,metacarpophalangeal,joint,Symptoms of a Joint Dislocation,Intense Pain,Swelling,Immobility of the affected joint,Deformity,NOMENCLATURE FOR DISLOCATIONS,Name the,JOINT,Name the dislocation by the position of the,DISTAL FRAGMENT,in relation to the proximal fragment,Add,FRACTURE,to the name if there is a periarticular fracture.,Add,OPEN,if a wound communicates with the dislocation,Complications,Fracture,Nerve,vascular injury,Bone necrosis,Traumatic arthritis,Monteggia injury,Hip joint dislocation,Allis maneuver(提拉法),Bigelows maneuver（问号法）,After care,Traction(4 weeks),Bed(2 weeks),Walk stick(2 weeks),Ambulate(8 weeks lat),Anterior dislocation of the shoulder,Kochers,Hippocrates,Stimsons,Elbow injury,Other joint dislocation,Acromioclavicular separation,Lunate dislocation,Perilunate dislocation,Nursemaids elbow(pulled elbow牵拉肘),A partial dislocation of radial head common in toddlers,The main symptom is refusal to use the arm,Can be easily treated in a doctors office without the following first aid steps.,Manual reduction,Peripheral nerve injury,Orthopaedic,surgery is no longer limited to injuries of the bone,blood vessels,and skin,but has expanded to include,nerve injury,as well,Axon（轴索）,Myelin sheath（髓鞘）,Schwann cell（施万细胞）,Nodes of Ranvier,Peripheral Nerve,Peripheral Nerve Injury,Acute injury,Chronic injury,(entrapment neuropathy),CLASSIFICATION OF NERVE INJURIES,neuropraxia,(,神经传导功能障碍,),axonotmesis,(,神经轴索中断,),nerotmesis,(,神经断裂,),neuropraxia(神经传导功能障碍),preservation of the axis-cylinder,minor edema or breakdown of myelin sheath,recovery is complete in a few days or weeks,axonotmesis(神经轴索中断),breakdown of the axon,distal wallerian degeneration,preservation of the Schwann cell,Spontaneous regeneration with good functional recovery,nerotmesis(神经断裂),complete anatomical severance of the nerve,distal wallerian degeneration,perineurium and epineurium also are disrupted,spontaneous recovery cannot be expected,Wallerian degeneration（华勒氏变性）,Symptoms,Pain,with the degree of intensity ranging from a tingling sensation to extreme,burning pain,Loss of feeling or abnormal sensations,Loss of motor function,such as a hand or leg being difficult to move,Loss of active range of motion,such as difficulty lifting fingers or flexing the wrist,Diagnosis,evaluate motor,sensory and autonomic loss,Tinel sign（神经干叩击试验）,Electromyogram(EMG or Electromyography),Nerve Conduction Study,Magnetic Resonance Imaging(MRI),Peroneal nerve,often damaged during dislocation of the knee,with rupture of the lateral collateral ligament of the knee or fractures of the upper fibula as the common peroneal nerve wraps around the neck of the fibula,Symptom of peroneal nerve Inj,Complete,paralysis of dorsiflexion of the foot and ankle (foot drop and steppage gait,跨阈步态,),Sensory loss over the medial two-thirds of the dorsum of the foot and lateral side of the leg,Tibial nerve,Damage due to a dislocation of the knee,leads to variable paralysis of plantarflexion of the foot and toes,The numbness of the heel and part of the sole and the lateral side of the foot and posterior aspect of the leg,Tingling sensation or lack of sensation in the back of the arm,forearm and hand,Weakness in arm muscles,making it difficult to straighten the elbow,wrist and fingers(wrist drop,垂腕,),Radial Nerve Injury,Median nerve,Sensory loss of lateral side of palm,Thumb abduction paralysis,Froment sign（夹纸试验）,ULNAR NERVE,Claw-finger deformity(爪形手),Treatment,Observation,Nerve is injured but not cut,Rehabilitation and careful monitoring are needed,Surgery for Nerve Repair,Reconnect（sutures）,Nerve graft,Nerve transfer,Other surgery,Tendons transfering,Epineural repair（外膜缝合）,Primary nerve sutures,remain the treatment of choice for the repair of divided peripheral nerves,Including:,Group fascicular repair（束膜缝合）,Epineural Repair,Fascicular Repair,Nerve Graft,#leading cause of failure of nerve graft,Inadequate resection,Distraction of repair site,Nerve graft（神经移植）,Nerve transfer（神经移位术）,Peripheral Nerve Injuries,By the beginning of the 20th century,some measure of success was reported with autografts.,Although regeneration axons gain entrance to the distal segment,regeneration is slow.,Key point,Manifestation,diagnosis and management of Hip,Shoulder and Elbow joint dislocation,Treatment principles of peripheral nerve injury,Brachial plexus injury（臂丛损伤）,References:,TEXT BOOK of SURGERY-The biological basis of modern surgical practice(17 edition),