骨折内固定基本原则与技术(2007年5月重庆）.pptVIP

骨折内固定基本原则和技术 重庆AO Basic Course 学习班内容汇报 AO Principle Course for Chinese Residents 2007,5,18～20 重庆 王满宜（北京积水谭医院） Steven Morgan（Denver,） 唐佩福（北京解放军总医院） 武勇（北京积水谭医院） 付中国（北京大学人民医院） 汤欣（大连医学院） Aims of fracture care Full function No pain Normal mechanical axes Joint stability Normal range of motion 1875年，Franz Konig首次报道使用螺丝钉治疗骨折 1886年，Carl Hansmann首次报道使用金属接骨板和螺丝钉治疗骨折 1907年，Albin Lambotte首次介绍了“骨折接合术”（Osteosynthesis）这一名词 1958年，瑞士AO小组成立 1960年，AO首次提出骨折治疗的四个基本原则 M Allg?wer M E Müller R Schneider H Willenegger R Mathys AO Principles(1958) Anatomy reduction Absolute stable internal fixation Preservation of blood supply Early active mobilization 即通过骨折块间加压而达到绝对的稳定性，从而实现坚强的固定，使骨折一期愈合 Bone healing direct No callus formation indirect Callus formation Rigid Fixation =1 Bone Healing Relative Stability =2 Bone Healing Relative Stability Absolute Stability Practically speaking…. Most fixation probably involves components of both types of healing. Even in situations of excellent rigid internal fixation one often sees a small degree of callus formation... Indications and Benefits of Internal Fixation Displaced intraarticular fracture Axial or angulatory instability which cannot be controlled by closed methods Open fracture Malreduction/interposed soft tissue Multiple trauma Early functional recovery Principles of Internal Fixation Open reduction Surgical exposure of the fracture site for fixation Fixation is usually internal Closed reduction Fracture site is not opened External fixation (casts, splints, etc.) Becoming more popular with advanced imaging Principles of Internal Fixation The Goals of fracture repair are Atraumatic technique Good reduction/alignment Stable fixation Early return to full function****** Principles of Internal Fixation Advantages of internal fixation Rigid fixation usually Allows weight bearing during healing Health of the limb and joints Increases the circulation Promotes healing Hidden implan