1、前臂骨折五附院骨二科,第一页，共一百四十页。,尺桡骨双骨折尺骨单骨折桡骨单骨折前臂远端骨折,授课内容,第二页，共一百四十页。,体表标志,第三页，共一百四十页。,体表标志,第四页，共一百四十页。,前臂前区,第五页，共一百四十页。,第六页，共一百四十页。,前臂前区,第七页，共一百四十页。,前臂前区,第八页，共一百四十页。,前臂前区,第九页，共一百四十页。,桡神经深支和后侧骨间神经：桡神经在肘窝外侧，肱骨外上髁前方，分浅、深两支桡神经深支发出肌支至桡侧腕长、短伸肌和旋后肌，然后穿入旋后肌，在桡骨头下方57CM出穿出该肌，称为后侧骨间神经，走行与前臂肌后群浅、深两层之间分短支与长支,前臂后区 深层,第
2、十页，共一百四十页。,前臂后区,第十一页，共一百四十页。,前臂后区,第十二页，共一百四十页。,前臂后区,第十三页，共一百四十页。,前臂后区,第十四页，共一百四十页。,A型 简单骨折A1,A2,A3B型 锲型骨折(B1,B2,B3)C型 复杂骨折(C1,C2,C3),前臂骨折AO分型,第十五页，共一百四十页。,A1.1 斜型骨折,第十六页，共一百四十页。,A1.2 横型骨折,第十七页，共一百四十页。,A 1.3 伴有桡骨头脱位孟氏骨折,第十八页，共一百四十页。,A2.1 斜型骨折,第十九页，共一百四十页。,A2.2 横型骨折,第二十页，共一百四十页。,A2.3 伴头下尺桡关节脱位盖氏骨折,第二十
3、一页，共一百四十页。,A 3 简单的双骨折,第二十二页，共一百四十页。,B1.1 完整锲型,第二十三页，共一百四十页。,B1.2 带有碎片的锲型骨折,第二十四页，共一百四十页。,B1.3 伴有桡骨头脱位孟氏骨折,第二十五页，共一百四十页。,B2.1 完整锲型,第二十六页，共一百四十页。,B2.2 碎片锲型,第二十七页，共一百四十页。,B2.3 伴有下尺桡关节脱位盖氏骨折,第二十八页，共一百四十页。,B3.1 尺骨锲型，桡骨简单骨折,第二十九页，共一百四十页。,B3.2 桡骨锲型，尺骨简单骨折,第三十页，共一百四十页。,B3.3 尺桡骨锲型骨折,第三十一页，共一百四十页。,C1.1 两端，桡骨完
4、整,第三十二页，共一百四十页。,C1.2 两段 桡骨骨折,第三十三页，共一百四十页。,C1.3 不规那么,第三十四页，共一百四十页。,C2.1 两段，尺骨完整,第三十五页，共一百四十页。,C2.2 两段，尺骨骨折,第三十六页，共一百四十页。,C2.3 不规那么,第三十七页，共一百四十页。,C 3 尺桡骨复杂骨折,第三十八页，共一百四十页。,桡骨干前外侧入路：桡骨干全长 Henry切口桡骨干后侧入路：桡骨干上中部Thompson切口尺骨干后侧入路：尺骨全长,常用手术入路,第三十九页，共一百四十页。,AP and lateral views of the both bones fracture o
5、f the forearm,demonstrating significant shortening and relatively simpleoblique fracture patterns.,第四十页，共一百四十页。,The patient is positioned supine with the arm prepped anddraped to just above the elbow and a tourniquet in place.This figure demonstrates the arm held in supination.Note theposition of th
6、e biceps insertion as well as the palpable tendonof the FCR and radial artery.,BICEPSTENDON,RADIALARTERY,FLEXOR CARPIRADIALIS(FCR),第四十一页，共一百四十页。,A useful technique to make the skin incision is to take a bovicord and pull it taught from the radial side of the biceps tendonto the FCR at the level of t
7、he wrist.This can then be used as a template for the incision line.,第四十二页，共一百四十页。,第四十三页，共一百四十页。,The incision is taken down through the skin,identifying the fascial layer with care taken not to damage any superficial veins that may be intact.The FCR tendon is clearly visible throughout the wound,as i
8、s the radial artery in the distal extent of the wound.,FCR,RADIALARTERY,第四十四页，共一百四十页。,A closeup of the distal aspect of the wound demonstratingThe radial artery and its venous commtantes.,RADIAL ARTERY ANDVENOUS COMMTANTES,第四十五页，共一百四十页。,FCR,RADIALARTERY,The fascia on the radial side of the flexor ca
9、rpi radialis is released,exposing the deep tissue.The radial artery can be followed now throughout the entire incision.,第四十六页，共一百四十页。,The radial artery may be taken in either direction,however,typically it is easier to take the artery to the radial side.,FCR,RADIALARTERY,第四十七页，共一百四十页。,The deep disse
10、ction is now performed between the flexor-pronator mass on the ulnar side and the artery and the mobile wad on the radial side.,第四十八页，共一百四十页。,PRONATOR,For the proximal dissection,the forearm is brought intosupination and the pronator,FDS and FDP are releasedfrom the volar aspect of the radius,第四十九页，
11、共一百四十页。,FDS,The pronator is being released from the radial aspect of the radius in a subperiosteal manner.This subperiostealdissection continues distally to release the origin of thecommon flexor.,第五十页，共一百四十页。,After exposure of the volar aspect of the radius proximallyand distally,two clamps can be
12、placed on the ends of thebone in order to deliver them for cleaning.,第五十一页，共一百四十页。,FCR,RADIAL ARTERY,Each side of the fracture is be delivered in order to expose and clean the cortical edges.,第五十二页，共一百四十页。,These figures demonstrate delivery of the distal fragment and acurved curette being used to cl
13、ean the cortical edge.Nocleaning should be performed within the intramedullary canal,as this is healthy tissue and can be useful for the healing process.,第五十三页，共一百四十页。,Once the fractures are completely cleaned along their cortical edges such that the fracture reduction can be visualized,the two clam
14、ps are used to reduce the fracture.If a butterfly fragment exists,it is necessary to fix this with a lag screw back to one of the fracture ends in order to realign the fracture.,第五十四页，共一百四十页。,In the current case,the fracture is a simple pattern and is reduced by delivering the bones jointly,accentua
15、ting the deformity and then rotating and fitting the bones together with progressive compression while pushing the bones back into the wound,obtaining alignment by steric interference of one side against the other.,第五十五页，共一百四十页。,Once the bones are held reduced,as seen in the following sequence,an ap
16、propriate dynamic compression plate is placed and held in place with a clamp.It is important that this plate must have the appropriate bend for the volar aspect of the forearm so as not to gap open the dorsal side as the plate is fixed to the bone.Thus,it should be slightly underbent with respect to the standard volar concavity.,第五十六页，共一百四十页。,第五十七页，共一百四十页。,第五十八页，共一百四十页。,第五十九页，共一百四十页。,These figures demonstrate reduction of the fracture with a plateheld in place on the flat,volar aspect of the bon
