骨科学运动系统慢性损伤骨肿瘤精选课件.ppt

关于骨科学运动系统慢性损伤骨肿瘤第一页，本课件共有136页Chronic injury of Locomotor system 第二页，本课件共有136页ClassificationSoft tissue injuryBone injuryCartilagine injuryNervous peripheralis crush injury第三页，本课件共有136页ClassificationSoft tissue injury:muscle/tendon/epitenon/ligament/bursa mucosa第四页，本课件共有136页ClassificationSoft tissue injurySoft tissue injuryBone injury:fatigue fracture第五页，本课件共有136页ClassificationSoft tissue injurySoft tissue injuryBone injuryBone injuryCartilage injury:including arthrodial cartilage and epiphyseal cartilage第六页，本课件共有136页ClassificationSoft tissue injurySoft tissue injuryBone injuryBone injuryCartilagine injuryCartilagine injuryNervous peripheralis crush injury:for the special function of the nerves,the clinical manifestation and consequence after injury are different from other soft tissues第七页，本课件共有136页Clinical manifestationLong-term pain;without history of injuryLocal tenderness No inflammation signsusually correlated to over-activity第八页，本课件共有136页Therapeutic principle1 Key point:eliminating inducing factors 2 Physical therapy:massage etc.3 Regional injection 4 NSAID 5 Operation 第九页，本课件共有136页PreventionMost of injuries can be preventedMost of injuries can be preventedPhysical exercises Timely change posture When the injury appear first-time,may remind When the injury appear first-time,may remind patient that must breakdown short periodpatient that must breakdown short period第十页，本课件共有136页Chronic soft tissue injury第十一页，本课件共有136页Lumbar muscle strain Lumbar muscle strain is injury of lumbar muscle Lumbar muscle strain is injury of lumbar muscle and attachment fascia or even periosteum,and attachment fascia or even periosteum,it is also a common cause of back pain 腰肌劳损第十二页，本课件共有136页Lumbar muscle strainlumbar part accepts the most body lumbar part accepts the most body weightweightthe spine is unstablethe spine is unstablebend ones back for long-timebend ones back for long-timeacute trauma changes to chronic acute trauma changes to chronic phasephaseEtiology and PathologyEtiology and Pathology第十三页，本课件共有136页Chronic pain without obvious motivationChronic pain without obvious motivationFixed pressure pain points which usually Fixed pressure pain points which usually locate at starting point or insertion of musclelocate at starting point or insertion of muscleMusculus sacrospinous spasmMusculus sacrospinous spasmClinical ManifestationClinical ManifestationLumbar muscle strain第十四页，本课件共有136页Tenosynovitis stenosans狭窄性腱鞘炎TRIGGER FINGER/THUMB弹响指和弹响拇弹响指和弹响拇弹响指和弹响拇弹响指和弹响拇DE QUERVAINS TENOSYNOVITIS桡骨茎突狭窄性腱鞘炎桡骨茎突狭窄性腱鞘炎桡骨茎突狭窄性腱鞘炎桡骨茎突狭窄性腱鞘炎第十五页，本课件共有136页Trigger finger/thumb弹响指/弹响拇第十六页，本课件共有136页Etiology and PathologyEtiology and PathologyThe The flexor profundus longus tendonflexor profundus longus tendon （指深屈肌）（指深屈肌）（指深屈肌）（指深屈肌）is subjected is subjected to friction where it enters its tendon sheath and swelling can to friction where it enters its tendon sheath and swelling can occur on the tendon at this point.occur on the tendon at this point.As the swelling enters the tendon sheath it irritates the As the swelling enters the tendon sheath it irritates the opening of the sheath and this can narrow it still further.opening of the sheath and this can narrow it still further.Trigger finger/thumb第十七页，本课件共有136页Trigger finger/thumb第十八页，本课件共有136页The swelling on the tendon,prevents the tendon moving The swelling on the tendon,prevents the tendon moving easily and causes a pop as it enters the tendon sheath.easily and causes a pop as it enters the tendon sheath.This phenomenon is known as triggering.This phenomenon is known as triggering.It is usually worse in the morning after sleeping with It is usually worse in the morning after sleeping with the fingers flexed,but improves during the day as the fingers flexed,but improves during the day as soft tissue swelling subsides.soft tissue swelling subsides.Clinical ManifestationClinical ManifestationTrigger finger/thumb第十九页，本课件共有136页Trigger finger/thumb第二十页，本课件共有136页Elimination of the causeSteroid injection into the tendon sheathFibrous opening of the flexor tendon sheathTreatmentTreatmentTrigger finger/thumb第二十一页，本课件共有136页Trigger finger/thumb第二十二页，本课件共有136页DE QUERVAINS TENOSYNOVITIS桡骨茎突狭窄性腱鞘炎 The tendon swells,movements become painful,the fibrous The tendon swells,movements become painful,the fibrous bridge becomes thickened and forms a firm swelling on the bridge becomes thickened and forms a firm swelling on the lateral side of the radius just proximal to the wrist.lateral side of the radius just proximal to the wrist.第二十三页，本课件共有136页DE QUERVAINS TENOSYNOVITISEtiology and PathologyEtiology and Pathology the extensor pollicis brevis and the abductor pollicis longus pass beneath a tight fibrous bridge第二十四页，本课件共有136页Clinical Clinical ManifestationManifestationDE QUERVAINS TENOSYNOVITIS第二十五页，本课件共有136页Elimination of the activityElimination of the activitySteroid injection into the tendon sheathsSteroid injection into the tendon sheathsSurgical release of the fibrous bridgeSurgical release of the fibrous bridgeTreatmentTreatmentDE QUERVAINS TENOSYNOVITIS第二十六页，本课件共有136页 A ganglion is a collection of thick fluid,similar to synovial fluid,surrounded by a thin layer of synovium in the soft tissues around joints and tendons.Ganglia 腱鞘囊腱鞘囊肿肿第二十七页，本课件共有136页Sometimes rupture or Sometimes rupture or disappear disappear spontaneouslyspontaneouslyIf the ganglion is If the ganglion is causing neurological causing neurological problems,early problems,early excision is indicatedexcision is indicatedGanglia 第二十八页，本课件共有136页TENNIS ELBOW(lateral epicondylitis of humer)网球肘 The common lesion of the insertion of muscle or The common lesion of the insertion of muscle or tendon onto bone is tennis elbow in which a tear tendon onto bone is tennis elbow in which a tear occurs in or near the insertion of the common occurs in or near the insertion of the common extensor tendon on the lateral condyle of extensor tendon on the lateral condyle of humerus.humerus.第二十九页，本课件共有136页Etiology and PathologyEtiology and PathologyThe injury is caused by sharp flexion of the wrist The injury is caused by sharp flexion of the wrist while the extensors are contracted.while the extensors are contracted.The injury also occurs in everyday activities such as gardening and lifting.TENNIS ELBOW第三十页，本课件共有136页n nlateral epicondyle is tendernesslateral epicondyle is tendernessn nstressing the extensor origin,by forcing the wrist stressing the extensor origin,by forcing the wrist into flexion with the extensors contracted,into flexion with the extensors contracted,reproduces the patients symptoms.reproduces the patients symptoms.Clinical ManifestationClinical ManifestationTENNIS ELBOW第三十一页，本课件共有136页TENNIS ELBOW第三十二页，本课件共有136页Rest and avoiding contraction of the Rest and avoiding contraction of the extensor musclesextensor musclesInjection of hydrocortisone acetate into the Injection of hydrocortisone acetate into the tender areatender areaA release of the extensor origin from the distal A release of the extensor origin from the distal humerushumerusTreatmentTreatmentTENNIS ELBOW第三十三页，本课件共有136页ADHENSIVE CAPSULITIS OF SHOULDER粘连性肩关节囊炎第三十四页，本课件共有136页Etiology and PathologyEtiology and PathologyUnknown.Unknown.May be a precipitating cause,such as a May be a precipitating cause,such as a minor injury,but there is often none.minor injury,but there is often none.One possible explanation is a localized autoimmune response to the tissues of the rotator cuff.Adhensive capsulitis of shoulder第三十五页，本课件共有136页Rotator cuffRotator cuffSupraspinatus m.Infraspinatus m.Teres minor m.subscapularis m.第三十六页，本课件共有136页Acromioclavicual jointCoracoclavicular lig.Acromiocracoid lig.第三十七页，本课件共有136页Adhensive capsulitis of shoulder第三十八页，本课件共有136页painful restriction of external rotation.painful restriction of external rotation.first painful,then stiff.first painful,then stiff.difficult to bring the hand to the mouth,difficult to bring the hand to the mouth,behind the head to comb hair or behind behind the head to comb hair or behind the back to fasten buttons or hooks.the back to fasten buttons or hooks.Clinical ManifestationClinical ManifestationAdhensive capsulitis of shoulder第三十九页，本课件共有136页Apron-string gripgluteallumbosacraL3T12T6第四十页，本课件共有136页Nape of neck grip第四十一页，本课件共有136页Adhensive capsulitis of shoulder第四十二页，本课件共有136页n nAnti-inflammatory drugsn nPhysiotherapyn nActive exerciseTreatmentTreatmentAdhensive capsulitis of shoulder第四十三页，本课件共有136页第四十四页，本课件共有136页Chronic injury of bone第四十五页，本课件共有136页Fatigued fracture疲劳骨折n nlong-term accumulation of minor injuriesn nsecond metatarsal bone,tibia,ribs第四十六页，本课件共有136页第四十七页，本课件共有136页Chronic injury of cartilage第四十八页，本课件共有136页 Chondromalacia patellae means softening of Chondromalacia patellae means softening of the articular cartilage of the patella and is the articular cartilage of the patella and is commonly used as a synonym for anterior commonly used as a synonym for anterior knee pain in an adolescent.knee pain in an adolescent.髌骨软骨软化症髌骨软骨软化症Chondromalacia of the patella第四十九页，本课件共有136页第五十页，本课件共有136页Chondromalacia of the patella第五十一页，本课件共有136页第五十二页，本课件共有136页 Osgood-Schlatters disease is the commonest traction apophysitis in which the apophysis of the tibial tubercle is lifted off the tibia.胫骨结节骨软骨病胫骨结节骨软骨病Osgood-Schlatters disease 第五十三页，本课件共有136页第五十四页，本课件共有136页股骨头骨软骨病股骨头骨软骨病股骨头骨软骨病股骨头骨软骨病 Legg-Calve-Perthes第五十五页，本课件共有136页Peripheral nerve entrapment syndrome第五十六页，本课件共有136页CARPAL TUNNEL SYNDROME腕管综合征第五十七页，本课件共有136页Carpal tunnel syndrome第五十八页，本课件共有136页Carpal tunnel syndrome第五十九页，本课件共有136页Carpal tunnel syndrome第六十页，本课件共有136页Rest and diureticsRest and diureticsHydrocortisone injectionHydrocortisone injectionOperation:a longitudinal incision Operation:a longitudinal incision the tunnel is decompressed by dividing the flexor retinaculum throughout its lengthTreatmentTreatmentCarpal tunnel syndrome第六十一页，本课件共有136页第六十二页，本课件共有136页肘管综合征肘管综合征Elbow tunnel syndrome第六十三页，本课件共有136页Elbow tunnel syndrome第六十四页，本课件共有136页Elbow tunnel syndrome第六十五页，本课件共有136页olercranonolercranonDistal Distal humerushumerusUlnar Ulnar nervenerve第六十六页，本课件共有136页梨状肌综合征梨状肌综合征Piriformis第六十七页，本课件共有136页Short break第六十八页，本课件共有136页Bone Tumor第六十九页，本课件共有136页Benign bone tumor osteochondromaosteochondroma骨软骨瘤骨软骨瘤.giant-cell tumorgiant-cell tumor骨巨细胞瘤骨巨细胞瘤.chondromachondroma软骨瘤软骨瘤.第七十页，本课件共有136页Primarily malignant bone tumorOsteosarcomaOsteosarcoma骨肉瘤骨肉瘤44.6%44.6%ChondrosarcomaChondrosarcoma软骨肉瘤软骨肉瘤14.2%14.2%FebrosarcomaFebrosarcoma纤维肉瘤纤维肉瘤6.66.6MyelomaMyeloma骨髓瘤骨髓瘤6 6Ewings sarcomaEwings sarcoma尤文肉瘤尤文肉瘤4.64.6Malignant Giant-Malignant Giant-Cell TumorCell Tumor恶性骨巨细胞瘤恶性骨巨细胞瘤4 4第七十一页，本课件共有136页 Age of onset infant infantbone cystbone cyst骨囊肿骨囊肿chondroblastomachondroblastoma软骨母细胞瘤软骨母细胞瘤childchildosteosarcomaosteosarcoma骨肉瘤骨肉瘤osteochondromaosteochondroma骨软骨瘤骨软骨瘤 adult adultGiant-Cell TumorGiant-Cell Tumor骨巨细胞瘤骨巨细胞瘤 elderlyelderlytumors metastatic to the skeletontumors metastatic to the skeleton转移性骨肿瘤转移性骨肿瘤第七十二页，本课件共有136页locationn nmalignant distal of femur、the proximal of tibian nmetastatic spine、pelvisn nbenign bone far from knee joint or elbow joint第七十三页，本课件共有136页Main compliantsn nMassn nPain n nSwellingn nWarm and redness第七十四页，本课件共有136页DiagnosisClinical finds ImagingBiochemicalBiopsy/Pathology第七十五页，本课件共有136页Laboratory examinationn nHemoglobin(HB)Hemoglobin(HB)n nerythrocyte sedimentation rate(ESR)erythrocyte sedimentation rate(ESR)n nAKPn n酸性磷酸酶酸性磷酸酶 ACP ACP n n血清总蛋白增加血清总蛋白增加血清总蛋白增加血清总蛋白增加 total serum protein(TSP)total serum protein(TSP)ESR and AKP can act as dynamic index when observing therapeutic effect of bone tumorstherapeutic effect of bone tumors第七十六页，本课件共有136页Routine histology slice Histological chemistry examination 组织化学检查组织化学检查 Immunohistochemistry 免疫组织化学免疫组织化学 Pathologic examination第七十七页，本课件共有136页Some tumors have generate osteoid tissueor neoplastic bone,called reactive bone appears as high density area in X-rays有些肿瘤产生类骨或肿瘤骨称为反应骨，有些肿瘤产生类骨或肿瘤骨称为反应骨，在在X X线片上表现为高密度区线片上表现为高密度区第七十八页，本课件共有136页Some bone tumor destroy bone or makebone resorbed,appears as low density area in X-rays.有些骨肿瘤破骨或使骨吸收，有些骨肿瘤破骨或使骨吸收，在在X线片上表现为低密度区线片上表现为低密度区第七十九页，本课件共有136页Bone expansible changes 骨膨胀性改变骨膨胀性改变第八十页，本课件共有136页G G express bone tumor cytology character,differentiation degree,development mode,appearance in X-ray.表示骨肿瘤的细胞学特征、分化表示骨肿瘤的细胞学特征、分化程度发生方式及程度发生方式及X X片表现。片表现。T T express bone tumor invasion range,demarcate between balloon and mesooecium.表示骨肿瘤侵袭范围，表示骨肿瘤侵袭范围，以肿瘤囊室和间室为分界。以肿瘤囊室和间室为分界。M M express bone tumor whether etastasize or not 表表示骨肿瘤有无转移。示骨肿瘤有无转移。G T M G T M Surgical stagingSurgical staging第八十一页，本课件共有136页Establish a tumor staging system to help judge Establish a tumor staging system to help judge prognosisprognosis建立一个肿瘤分期体系以利于判断预后建立一个肿瘤分期体系以利于判断预后建立一个肿瘤分期体系以利于判断预后建立一个肿瘤分期体系以利于判断预后 According to different staging,choose surgery According to different staging,choose surgery project reasonablyproject reasonably根据不同分期合理选择外科手术方案根据不同分期合理选择外科手术方案根据不同分期合理选择外科手术方案根据不同分期合理选择外科手术方案 propose subsidiary treatment recommendationpropose subsidiary treatment recommendation提出辅助性治疗建议提出辅助性治疗建议 significance of G T M Surgical staging第八十二页，本课件共有136页The differences in X-ray between benign and malignant bone tumorbenignbenignmalignantmalignantshapeshaperegularregularclear borderclear borderunregular,unregular,ununclear borderclear bordergrowth patterngrowth patternexpansiveexpansivedestruction of destruction of compact bonecompact boneperiosteal periosteal proliferationproliferationnonenoneCodman triangleCodman trianglesoft tissue soft tissue shadow shadow nonenonesunshine radial sunshine radial shadowsshadowsdistant metastasisdistant metastasisnonenonelung,brainlung,brain第八十三页，本课件共有136页Codman triangleCodman triangleandsunshine radial shadowssunshine radial shadows第八十四页，本课件共有136页Bone tumor treatmentcombined chemotherapy 联合化疗联合化疗 radiotherapy 放射治疗放射治疗 immunotherapy 免疫治疗免疫治疗 exairesis and assisted chemical-deactivation,freezing treatment,onych-olefinic acid methylester treatment,thermotherapy手术切除辅助化学灭活、冷冻处理、甲烯酸甲酯处理、热疗手术切除辅助化学灭活、冷冻处理、甲烯酸甲酯处理、热疗第八十五页，本课件共有136页Osteochondroma骨软骨瘤骨软骨瘤第八十六页，本课件共有136页osteochondroma骨软骨瘤（骨软骨瘤（epostoma外生骨疣）外生骨疣）第八十七页，本课件共有136页overviewOccupy in 21.41%of whole bone tumor and 38.46%of whole benign tumor.Predilection site:femur,humerus,tibia第八十八页，本课件共有136页clinical manifestationLocal lump:absence of tenderness,growing up graduallyPain and limitation of joint function,when tumor irritating surrounding tissue第八十九页，本课件共有136页Complicationn nfracture n nbone deformation n nblood vessel and nerve injuryn nmucous bursa cystogenesis 滑囊肿形成滑囊肿形成 n ncanceration（）（）第九十页，本课件共有136页X-ray findingbone prominence in surface of metaphysis，pedunculated or not 第九十一页，本课件共有136页Therapy Need not operation if no symptom第九十二页，本课件共有136页Chondroma软骨瘤软骨瘤第九十三页，本课件共有136页Overview predilection site:40%-65%occur in hand,especially in proximal phalanxpredilection age:teenagers，youth第九十四页，本课件共有136页第九十五页，本课件共有136页第九十六页，本课件共有136页Giant cell tumor of bone骨巨细胞瘤骨巨细胞瘤第九十七页，本课件共有136页overviewn none of the most frequent primary bone tumorsn nits origin is in nubibusn