踝关节骨折-教学课件.pptx

Ankle Fracture踝部骨折 Fuxin Wei, MD, PhD魏富鑫Spinal Department of 1st Affiliated Hospital of SYSUDefinition（定义）Fracture that involves the medial and lateral malleolus fracture , and distal fracture of tibia or fibular articular surface, which accounts for about 3.8% of whole body fracture. 包括内、外踝骨折以及同时累及胫骨、腓骨远端关节面的骨折。约占全身骨折的3.8％ Contents(内容)1、Anatomy (解剖概要)2、Pathogenesis and classification (病因与分类)3、Diagnosis (诊断)4、Treatment (治疗)5、Rehabilitation (康复) Anatomy (解剖概要)The ankle, or the talocrural regionIncludes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the Inferior tibiofibular joint(包含3个关节：踝关节、距下关节、下胫腓关节)The main bony structure includes talus, tibia and fibula (主要骨性结构包括距骨、胫骨和腓骨)The ligaments of Ankle joint内侧副韧带（三角韧带） 起自内踝，扇形向下止于舟骨、距骨和跟骨。踝关节最坚强的韧带防止踝关节外翻。三角韧带The ligaments of Ankle joint外侧副韧带 起自外踝，止于距骨前、后部及外侧部。距腓前韧带距腓后韧带跟腓韧带距跟后韧带跟腓韧带距腓前韧带跟腓韧带The movement of Ankle jointThe movements produced at this joint are dorsiflexion and plantarflexion of the foot. （运动主要包括背屈和跖屈）Dorsiflexion(背屈) 20°－30°，Plantarflexion (跖屈) 45 °－50 °Inversion (内翻) 30 °，Eversion(外翻)30 °－35 ° Abduction(外展) 10 °，Adduction(内收) 10 °Composite Motion旋前旋后The Reason of Ankle fractureIndirect injury(间接): Common， Plantarflexion+ SprainDirect Injury：Complicated fractureFatigue fractureClassification Lange-HansonDavis-WeberAO ClassificationClassification Ⅰ型：Inversion-Adduction 内翻（内收）型Ⅱ型：Eversion-Abduction 外翻（外展）型Ⅲ型：External Rotation 外旋型Ⅳ型：Vertical compression 垂直压缩型 Type I Inversion-adduction内翻（内收）型Grade I: Lateral malleolus fracture 单纯外踝撕脱骨折，骨折缘由胫骨下关节面斜上内上 Grade II：Medical and Lateral malleolus fracture 暴力较大，外踝发生骨折的同时，内踝发生撞击骨折， 称双踝骨折Grade III： Three malleolus fracture 暴力较大，在内外踝骨折同时距骨向后撞击胫骨后缘，发生 后踝骨折(三踝骨折)Type I Inversion-adduction内翻（内收）型Type Ⅱ Eversion-abduction 外翻（外展）型Grade I: Medial malleolus fracture 单纯内踝撕脱骨折，骨折线呈横行或短斜行，骨 折面呈冠状，多不移位 Grade II：Medical and Lateral malleolus fracture 暴力继续作用，距骨体向外踝撞击，发生外踝斜 行骨折，即双踝骨折 Grade III： Three malleolus fracture