中医骨科学外文版 (38).ppt

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1、Section VLigament Injury of KneeI.Overview1.The knee joint is a large movable joint of the human body with complex anatomical relationships;it only has flexion and extension function,but no lateral and rotation function,which is one of the causes for its easy injury.2.The most vulnerable ligaments i

2、n the knee are the collateral ligament and cruciate ligament.3.Cruciate ligament injury is often complicated by collateral ligament and meniscus injury.4.Treatment:Comprehensive treatment is preferred.5.Prognosis:Simple collateral ligament injury has a better prognosis,but the prognosis is poor for

3、patients with triple injuries of the knee.II.Anatomy Medial Collateral Ligament(Tibial Collateral Ligament)Superior origin:medial condyle tubercle of femur,superior wide and inferior narrow,fan-shaped posterior connected to the medial meniscus Prevention of genu valgumInferior stop:lateral tibial me

4、dial condyleFunctionLateral Collateral Ligament(Fibular Collateral Ligament)Superior origin:lateral condyle tubercle of femur,strip shape,(through popliteus muscle)Inferior stop:fibular headPrevention of genu varumFunctionThe tibial and fibular collateral ligaments and anterior and posterior cruciat

5、e ligaments of the knee joint play an important role in maintaining joint stability.Triple injuries of the knee ODonoghue Terrible Triad,Unfortunate Triad):rupture of the medial collateral ligament,rupture of the anterior cruciate ligament of the knee,and medial meniscus injury.Cruciate LigamentAnte

6、rior cruciate:Prevention of antedisplacement of the tibia(anterior portion of the medial intercondylar eminence of the lateral condyle of femur,anterior horn of the medial and lateral meniscus)Posterior cruciate:Prevention of posterior displacement of the tibia(posterior portion of the lateral inter

7、condylar eminence of the medial condyle of femur,posterior horn of the lateral meniscus)III.Etiology and PathologyCollateral ligament injuryViolent StrikeWeight ExtrusionStrong TorsionExternal forces act on the lower femur or upper tibia.Most fractures occur at the stop point.Strong violence may be

8、accompanied by dislocation or fracture.(I)CausesSemi-flexion Position of KneeCruciate Ligament(II)Pathology1.ClassificationMedial(1)Collateral Ligament(2)Cruciate Ligament(3)Triple Injuries of the KneeLateralRupture of Anterior Cruciate LigamentRupture of Posterior Cruciate LigamentMedial Meniscus I

9、njuryRupture of Medial Collateral LigamentRupture of Bicruciate ligamentRupture of Anterior Cruciate Ligament2.Characteristics(1)Strong violence may be accompanied by articular capsule tear or injury of common peroneal nerve;(2)Collateral ligament injuries are frequent on the medial side and may be

10、combined with injuries of meniscus and cruciate ligament in severe cases.(3)Poor repair of cruciate ligament tears may cause knee instability;(4)Triple injuries of the knee are prone to leave dysfunction of the knee joint.IV.Diagnosis(I)Medical history:(I)Medical history:history history of traumaof

11、trauma(II)Symptoms:(II)Symptoms:swelling swelling and painand painDysfunctionDysfunction1.Ecchymosis2.Tender point3.Positive varus and valgus tests4.Feeling of joint clicking5.Joint laxity6.Positive drawer test7.Positive patellar floating test(III)Signs(IV)X-ray1.Increased joint space can be observe

12、d.(V)Arthroscopy3.Hematoma can be found.2.Complications(fracture and dislocation)can be found.Arthroscopy can be adopted when a cruciate ligament or meniscus injury is suspected (I)Treatment principles:V.TreatmentEffective fixation;Comprehensive treatment;Pay attention to the prevention and treatmen

13、t of complications.(II)Treatment methods 1.Non-surgical therapyIndications:Elderly and frail patients with partial rupture or simple cruciate ligament injury.Treatment principles:promoting blood circulation to remove blood stasis,and relieving swelling and pain.(1)Manipulation of restoring and treat

14、ing injured soft tissuesManipulation:Discern tendons and apply method,with pain as the acupoint.(2)Drug treatment Medicine for oral administrationEarly stage:Modified Taohong Siwu DecoctionMiddle and later stage:Zhuangjin Yangxue Decoction or Yougui Pills Drug for external useEarly stage:External Ap

15、plication of Huoxue Powder or Jinhuang PowderMiddle and later stage:Fumigation and Washing with Haitongpi Decoction or Qizhang Powder Fixation mode:Fixation mode:In the early stage,wire support or wood support In the early stage,wire support or wood support can be used,and plaster support can also b

16、e used.can be used,and plaster support can also be used.In the later stage,it is fixed with the kneelet until In the later stage,it is fixed with the kneelet until the function is recovered.the function is recovered.Fixed position:Fixed position:(3)Fixed treatment(4)PhysiotherapyAfter relieving the

17、external fixation,physiotherapy can be used.(5)Functional exercisePerform the active functional exercise under the guidance of medical staff.collateral ligament-knee flexion at 20 to 30,collateral ligament-knee flexion at 20 to 30,and cruciate ligament at 10 to 15.and cruciate ligament at 10 to 15.F

18、ixation time:4 5 weeksFixation time:4 5 weeks 2.Surgical therapyIndications:(1)Complete rupture of medial and lateral collateral ligaments;(2)Complete rupture of cruciate ligament,joint laxity and instability;(3)Triple injuries of the knee.Surgical methods:(1)Repair(2)Reconstruction:old injuryCollateral ligament repairCruciate ligament repair