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1、前臂骨折前臂骨折五附院骨二科 第一页，共一百四十页。五附院骨二科五附院骨二科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。五附院骨二科五附院骨二科体表标志第三页，共一百四十页。五附院骨二科五附院骨二科体表标志第四页，共一百四十页。五附院骨二科五附院骨二科前臂前区第五页，共一百四十页。五附院骨二科五附院骨二科第六页，共一百四十页。五附院骨二科五附院骨二科前臂前区第七页，共一百四十页。五附院骨二科五附院骨二科前臂前区第八页，共一百四十页。五附院骨二科五附院骨二科前臂前区第九页，共一百四十页。五附院骨二科五附院骨二科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
2、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 深层第十页，共一百四十页。五附院骨二科五附院骨二科前臂后区第十一页，共一百四十页。五附院骨二科五附院骨二科前臂后区第十二页，共一百四十页。五附院骨二科五附院骨二科前臂后区第十三页，共一百四十页。五附院骨二科五附院骨二科前臂后区第十四页，共一百四十页。五附院骨二科五附院骨二科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。五
3、附院骨二科五附院骨二科A1.1 斜型骨折第十六页，共一百四十页。五附院骨二科五附院骨二科A1.2 横型骨折第十七页，共一百四十页。五附院骨二科五附院骨二科A 1.3 伴有桡骨头脱位孟氏骨折第十八页，共一百四十页。五附院骨二科五附院骨二科A2.1 斜型骨折第十九页，共一百四十页。五附院骨二科五附院骨二科A2.2 横型骨折第二十页，共一百四十页。五附院骨二科五附院骨二科A2.3 伴头下尺桡关节脱位盖氏骨折第二十一页，共一百四十页。五附院骨二科五附院骨二科A 3 简单的双骨折第二十二页，共一百四十页。五附院骨二科五附院骨二科B1.1 完整锲型第二十三页，共一百四十页。五附院骨二科五附院骨二科B1.2
4、 带有碎片的锲型骨折第二十四页，共一百四十页。五附院骨二科五附院骨二科B1.3 伴有桡骨头脱位孟氏骨折第二十五页，共一百四十页。五附院骨二科五附院骨二科B2.1 完整锲型第二十六页，共一百四十页。五附院骨二科五附院骨二科B2.2 碎片锲型第二十七页，共一百四十页。五附院骨二科五附院骨二科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。五附院骨二科五附院骨二科B3.1 尺骨锲型 ，桡骨简单骨折第二十九页，共一百四十页。五附院骨二科五附院骨二科B3.2 桡骨锲型，尺骨简单骨折第三十页，共一百四十页。五附院骨二科五附院骨二科B3.3 尺桡骨锲型骨折第三十一页，共一百四十页。五附院骨二科
5、五附院骨二科C1.1 两端，桡骨完整第三十二页，共一百四十页。五附院骨二科五附院骨二科C1.2 两段 桡骨骨折第三十三页，共一百四十页。五附院骨二科五附院骨二科C1.3 不规那么第三十四页，共一百四十页。五附院骨二科五附院骨二科C2.1 两段 ，尺骨完整第三十五页，共一百四十页。五附院骨二科五附院骨二科C2.2 两段 ，尺骨骨折 第三十六页，共一百四十页。五附院骨二科五附院骨二科C2.3 不规那么第三十七页，共一百四十页。五附院骨二科五附院骨二科C 3 尺桡骨复杂骨折第三十八页，共一百四十页。五附院骨二科五附院骨二科桡骨干前外侧入路：桡骨干全长 Henry切口桡骨干后侧入路：桡骨干上中部Tho
6、mpson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 of 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 tourniqu
7、et in place. This figure demonstrates the arm held in supination. Note theposition of the biceps insertion as well as the palpable tendonof the FCR and radial artery.BICEPSTENDONRADIALARTERYFLEXOR 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
8、pull it taught from the radial side of the biceps tendonto the FCR at the level of the 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 v
9、eins that may be intact. The FCR tendon is clearly visible throughout the wound, as is the radial artery in the distal extent of the wound.FCRRADIALARTERY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 COMMTANT
10、ES第四十五页，共一百四十页。FCRRADIALARTERYThe fascia on the radial side of the flexor carpi 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 ta
11、ke the artery to the radial side.FCRRADIALARTERY第四十七页，共一百四十页。The deep dissection 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。PRONATORFor the proximal dissection, the forearm is brought intosupination and the pr
12、onator, FDS and FDP are releasedfrom the volar aspect of the radius第四十九页，共一百四十页。FDSThe 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 th
13、e volar aspect of the radius proximallyand distally, two clamps can be placed on the ends of thebone in order to deliver them for cleaning.第五十一页，共一百四十页。FCRRADIAL ARTERYEach 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 del
14、ivery of the distal fragment and acurved curette being used to clean 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
15、 such that the fracture reduction can be visualized, the two clamps 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 simp
16、le pattern and is reduced by delivering the bones jointly, accentuating 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 appropriate dynamic compression plate is placed and held in place with a clamp. It is important that this plate must have the appropri
