1、關節(jié)鏡下治療前叉止點撕脫性骨折課件History1875 Poncet1970Avulsion fracture of the ACL was classified by Meyers MH1996Veselko M performed arthroscopic placement and removal of cannulated screw for fixation2008Jinzhong Zhao reported arthroscopic Figure-of-8 suture fixation technique Morbidity3/10000014 of ACL injuryDis

2、tribution of age children814 years old old womenover 40 years oldAccid E-merg Nurs，2004，12(3)：1 73-1 75International Journal of Pediatrics, 2012, Article ID 932702, 6 pages epidemiologyFall injury and traffic accident51Sports injuriesSkiing and football-14%The Knee，2008，15(3)：164-167Associated with

3、capsule tear of meniscus or articular capsule, sometimes including medial and lateral collateral ligament injury or injury of articular cartilageArthroscopy: The Journal of Arthroscopic and Related Surgery, 2005,21(1):86-92.Relevant anatomical structureResident ridgeResident ridgeBranching ridgeFoot

4、printsFootprintsThe anterior medial bundle is tight in flexion the posterior lateral bundle is tight in the straight position12損傷機制Young people - knee flexion, tibial internal rotationAdults - hyperextension of the kneeACL limits anterior displacement, hyperextension, and internal rotationDiagnosisI

5、njury history of hyperextension of kneeBruise and hyphemaThe extension was limitedAnterior drawer test and Lachman sign are positiveX-ray and CT are conducive to understanding of fracture MRI is helpful to understand injury of ACL, and others combined injury.Anterior drawer test and Lachman sign X-r

6、ayCTMRIMeyers-McKeever classificationArthroscopy 2005;211:86-92How to identify fresh or old fractures in imagingTreatmentI type Conservative treatment to keep the knee in a functional position for 6 weeks and types Manipulation，if fail，selected surgery type SurgeryReduction The drawer test after ext

7、ensionP - R - I - C E program ProtectionRestIceCompressionElevateIt used to be the most commonly treatment program to open reduction and fixed with wireA failed caseCase 1Single tunnel fixation with steel wire and extrusion screwNo extrusion nailwas found beforeoperationimpingeIf the fracture mass i

8、s small, using Ethibond suture Old fracture of avulsion fracture of ACLCase 2Wound freshnessTo clean and remove all dead, damaged tissue around of the fracture massTo introduce the wire by a lumbar puncture needle To thread through No. 5 Ethibond, and fix fracture with 8 tension band To inspect care

9、fullyThe patients were followed up for 1 month after surgeryCase 3To use PDSii as the threadTo use PDSii as the threadTo use PDSii as the threadCase 4Old avulsion fracture of ACLWith bone sclerosis, and ACL stretch and tearThe bone block cannot be removed with the nucleus pulposus clampmicro-grindin

10、g drillto drill To remove bone masswith nucleus pulposus forcepsEnlargement of the condylar fossaThe picture was taken after reconstruction of anterior cruciate ligamentPostoperative X-rayfollowed up for 1 month after surgeryFor a bigger fracture block, hollow screw is a good choiceLateral meniscus

11、(LM) is being pulled and displacedIf the fracture of the tibial plateau is combined, first of all, the fracture should be fixedX-ray showed ACL avulsion fracture combined with tibial plateau fractureCase 4MRITo check the stability of knee joint before operationTo carefully examine the collapse of th

12、e lateral tibial plateauTo reduce and fix tibial plateau fracturesTo remove the synovial tissue of the femoral condyleArthroscopic image of the reduce fractureTo cut the transverse ligament of meniscus The reduction of the fracture mass is blockedby the transverse ligament of the meniscus To reduce fractureTo fixed fracture with k-wire temporarily To drill into secondK-wire A guide pin is insertedTo screw into the hollow screwTo inspect after fixationPostoper