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1、关节脱位关节脱位定义定义：关节脱位（称脱臼），即关节脱位（称脱臼），即组成关节各骨的关节面、失去组成关节各骨的关节面、失去正常的对合关系。正常的对合关系。分类分类1按脱位产生的原因分：按脱位产生的原因分：损伤性脱位损伤性脱位先天性脱位先天性脱位病理性脱位病理性脱位习惯性脱位习惯性脱位2.按脱位程度分按脱位程度分：完全性脱位完全性脱位不完全性脱位不完全性脱位3按脱位后的时间分：按脱位后的时间分：新鲜性脱位新鲜性脱位（伤后未满三周）（伤后未满三周）陈旧性脱位陈旧性脱位（超过三周）（超过三周）临床表现与诊断临床表现与诊断1有外伤史，患处疼痛、肿胀、有外伤史，患处疼痛、肿胀、关节功能丧失。关节功能丧失
2、。有时合并血管、神经损伤。有时合并血管、神经损伤。2关节脱位的特有体征：关节脱位的特有体征：畸形畸形弹性固定弹性固定关节盂空虚关节盂空虚治疗治疗复位复位固定固定功能锻炼功能锻炼肩关节脱位肩关节脱位占全身大关节脱位的占全身大关节脱位的40.1%，多见成年人，多见成年人肩关节脱位有：肩关节脱位有：前脱位（多见）前脱位（多见）后脱位（极少见）后脱位（极少见）肩关节脱位伤因和类型：肩关节脱位伤因和类型：1盂下脱位盂下脱位2喙突下脱位喙突下脱位3锁骨下脱位锁骨下脱位临床表现与诊断临床表现与诊断1外伤史、患处肿胀、疼痛、功能丧失外伤史、患处肿胀、疼痛、功能丧失2弹性固定（专有体征）弹性固定（专有体征）3方
3、肩（三角肌塌陷、肩峰隆突），肩方肩（三角肌塌陷、肩峰隆突），肩峰下部空虚。峰下部空虚。4Dugas（杜加氏征）阳性。（杜加氏征）阳性。治疗治疗1非手术治疗非手术治疗手法复位手法复位手牵足登法（手牵足登法（Hippocrates）旋转复位法（旋转复位法（Kocher）外展复位法（外展复位法（stimson）固定（三角巾悬吊三周）固定（三角巾悬吊三周）功能锻炼功能锻炼2手术治疗手术治疗（切开复位）（切开复位）三周以上陈旧性骨折三周以上陈旧性骨折多次手法未能复位者多次手法未能复位者肘关节脱位肘关节脱位最常见，占全身四大关节脱位的最常见，占全身四大关节脱位的47.3%常见为后脱位，前脱位少见。常见为后
4、脱位，前脱位少见。病因与病理：病因与病理：多为间接暴力所致。多为间接暴力所致。临床表现：临床表现：患处肿痛，功能障碍。患处肿痛，功能障碍。肘部畸形肘部畸形肘关节弹性固定于半伸直位肘关节弹性固定于半伸直位肘后三角失去正常关系肘后三角失去正常关系肘前方可摸到肱骨远端，肘后方可摸到尺肘前方可摸到肱骨远端，肘后方可摸到尺骨鹰嘴骨鹰嘴前臂缩短，肘关节周径增粗前臂缩短，肘关节周径增粗X光线检查可证实光线检查可证实治疗治疗手法复位手法复位固定固定功能锻炼功能锻炼肘关节脱位治疗不当容易发生肘关节脱位治疗不当容易发生骨化性肌炎。骨化性肌炎。髋关节脱位髋关节脱位占四大关节脱位的第三位占四大关节脱位的第三位分类：分
5、类：如下图如下图前脱位：前脱位：股骨头停留在髂坐线的前方股骨头停留在髂坐线的前方后脱位：后脱位：停留在该线的后方（后脱位多见停留在该线的后方（后脱位多见占占85-90%）中心脱位：中心脱位：股骨头被挤向臼底部、或穿过股骨头被挤向臼底部、或穿过髋臼底部裂隙进入盆腔。髋臼底部裂隙进入盆腔。髋关节后脱位髋关节后脱位病因：病因：多为间接暴力所致多为间接暴力所致分类：分类：单纯性髋关节后脱位，无骨折或只有小单纯性髋关节后脱位，无骨折或只有小片骨折片骨折髋臼后缘有粉碎性骨折髋臼后缘有粉碎性骨折髋臼缘或壁亦有骨折髋臼缘或壁亦有骨折合并有股骨头骨折合并有股骨头骨折临床表现与诊断临床表现与诊断有明显外伤史有明显
6、外伤史疼痛、髋部活动受限疼痛、髋部活动受限患肢呈明显的内收、屈曲及旋转畸形患肢呈明显的内收、屈曲及旋转畸形患肢有患肢有1-2寸的短缩寸的短缩在髂坐结节联线后方可摸到股骨头在髂坐结节联线后方可摸到股骨头部分患者有坐骨神经损伤部分患者有坐骨神经损伤X线可见股骨头位于髋臼外上方。线可见股骨头位于髋臼外上方。治疗治疗第第型的治疗型的治疗复位复位（在伤后（在伤后24小时内进行）小时内进行）提拉法（提拉法（Allis）问号法（问号法（Bigelew）固定固定持续皮牵引患肢外展持续皮牵引患肢外展30，3-4周。周。功能锻炼功能锻炼髋关节前脱位髋关节前脱位较少见较少见临床表现与诊断临床表现与诊断明显外伤史明显
7、外伤史患肢呈明显外展、外旋及屈曲畸形患肢呈明显外展、外旋及屈曲畸形在闭孔或腹股沟附近可触到股骨头在闭孔或腹股沟附近可触到股骨头X线股骨头在闭孔内或耻骨上技附近。线股骨头在闭孔内或耻骨上技附近。治疗治疗复位复位固定和功能锻炼固定和功能锻炼髋关节中心脱位髋关节中心脱位较少见较少见多由传达暴力所致多由传达暴力所致分类分类第第型型髋臼内壁骨折（耻骨部）股骨头脱出髋臼内壁骨折（耻骨部）股骨头脱出盆腔内。盆腔内。型：型：后壁有骨折（坐骨部）后壁有骨折（坐骨部）型：型：顶部骨折（髂骨部）顶部骨折（髂骨部）型：型：髋臼全部受损髋臼全部受损临床表现与诊断：临床表现与诊断：外伤史外伤史可出现休克可出现休克伤处肿胀
8、、疼痛、活动受限伤处肿胀、疼痛、活动受限X线检查线检查治疗治疗型：型：皮牵引、骨牵引、卧床皮牵引、骨牵引、卧床10-12周周-型：型：切开复位内固定切开复位内固定-A2D5G8KbNeQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYp!t&w-z1C4G7JaMePhTkWnZr$u*x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+A2E5H9KcNfRiUlXp#
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