医药-骨盆髋臼入路选择.pptx

骨盆髋臼骨折;目 的;关于髋臼骨折至今有三个重要观点;髋臼骨折常用手术入路;髂腹股沟入路;髂腹股沟入路：显露;髂腹股沟入路：适应症;髂腹股沟入路：体位和切口;手术步骤Ⅰ;手术步骤Ⅱ;手术步骤Ⅲ;窗口操作;窗口操作;优 点:;缺 点;关于死亡之冠;如何避免损伤?;并发症;Kocher-Langenbeck入路;Kocher Langenbeck入路:显露;适应症;体位与切口;手术步骤Ⅰ;手术步骤Ⅱ;手术步骤Ⅲ;Kocher-Langenbeck入路:并发症;改良Stoppa入路;历史回顾;历史回顾;历史回顾;Stoppa Approach;2007年芬兰Hirvensalo采用下腹正中切口固 定骨盆骨折;;体位 大腿垫枕，患侧屈曲;术者位于患髋对侧;1、皮肤-腹直肌前鞘、腹白线;2、切开腹白线、腹直肌;2、切开腹白线、腹直肌;钝性分离;电刀切口韧带、骨膜、复位、固定;电刀切口韧带、骨膜;复位、固定;缝合;手术显露---简便、快捷;www.themegall;;;;;;;Comparison of Acetabular Fracture Reduction Quality by the Ilioinguinal or the Anterior Intrapelvic (Modified Rives–Stoppa) Surgical Approaches Conclusions: The AIP approach is a safe alternative that offers better exposure and possibly improved reduction quality of acetabular fractures compared with the ilioinguinal approach. We believe that the major advantage of the AIP approach is that it enables reduction of the posterior column and the uadrilateral plate from the contralateral side and enables application of a buttress plate below the pelvic brim. J Orthop Trauma 2014;28:313–319;Randomized, Controlled Trial of the Modified Stoppa Versus the Ilioinguinal Approach for Acetabular Fractures;;;其他：扩展的髂股入路;;扩展髂股入路 extensile Iliofemoral approach;前后联合入路;前后联合入路;;显露：整个真骨盆缘全程，能得到骨盆前环及四边体的完整信息 优点：操作简单，显露充分，复位方便，固定满意，软组织修复容易 缺点：不能显露髋臼关节面、有时需联合其他入路，髂外血管损伤风 险 注意：既往有下腹部手术史，腹膜外粘连可能非常严重;手术入路选择;关节面压缩的处理;后壁撞击压缩骨折;;;A3前柱＋前;.;经stoppa入路;;.;;;后方移位大伴后壁;B1;;经stoppa入路;5mons Fu;;;;;;;;;;;T-型骨折;;;;;;;;;;;;;;spur sign;Type C;;