上期试题：下列骨折类型中属于不完全性骨折的是（B、E）
A．粉碎骨折
B．青枝骨折
C．压缩性骨折
D．骨骺分离
E．裂缝骨折
一、（关节脱位）(dislocation of joints)：
关节脱位以肩、肘关节多见，这期先说说这两个脱位的问题；
The joint is unshaggable with shoulder and elbow, and this is the first time to talk about these two dislocations
（1）、肩关节脱位：
肩关节脱位分为肱骨头前脱位和后脱位两种，以前脱位常见。肱骨头前脱位时，常同时向下移位，位于肩胛盂的下方，称为盂下脱位。也可向上脱位，位于喙突下方或锁骨下分，分别称之为喙突下或锁骨下脱位。肩关节脱位常并发肱骨大结节或肱骨颈骨折。肱骨头后脱位少见，只有侧位才能发现肱骨头在肩胛盂的后方，正位易漏诊。
The dislocation of the shoulder is divided into the anterior dislocation of the humerus and the posterior dislocation. When the humerus is dislocated, it often shifts downward at the same time, located below the glenoid cavity, called the underside of the pelvis. It can also be uplifted, located below the beaks or under the clavicular, which is called the proboscus or subclavian dislocation. The joint of the shoulder is frequently associated with a large tubercular tubercle or a humeral neck fracture. After the humeral head, it is rare that the humerus can be found behind the glenoid cavity.
（2）、肘关节脱位：
肘关节脱位常为后脱位。尺骨与桡骨端同时肱骨后方脱位，尺骨鹰嘴半月切迹脱离肱骨滑车。少数可为侧方脱位，尺、桡骨向外侧移位。肘关节脱位常并发骨折。关节囊及韧带损伤严重，还可并发血管及神经损伤。
The elbow is often out of position. The ulnar and the radial end of the humerus are also removed, and the ulnar hummus is removed from the humerus. A few can be removed from the side, the ruler, the radius of the radius shift outward. The elbow dislocations frequently and fractures. The joints and ligaments are severely damaged and can also be associated with vascular and nerve damage.
二、（关节软骨损伤）（articular injury）：
关节骨端的骨折常引起关节软骨的损伤或断裂；
Fractures of the arthrosis often cause damage or rupture of joint cartilage;
（1）、X线平片和CT不能直接显示关节软骨的损伤，如果发现骨折线波及骨性关节面、甚至骨性关节面因此而错位时，应考虑合并有关节软骨骨折。
(1)、X ray plain film and CT can't directly display of articular cartilage injury, if it is found that the fracture line spread osseous articular surface, bony even joint surface and dislocation, joint cartilage fractures should be considered.
（2）、MR扫描可直接显示断裂的关节软骨，表现为低信号的关节软骨中断，该处呈较高信号，甚至关节软骨和骨性关节面呈阶梯状，受损的软骨下的骨髓腔内可见局部的水肿和出血。
(2)、MR scanning can directly show that fracture of articular cartilage, characterized by low signal interruption of articular cartilage, it has higher signal, articular cartilage and osseous joints are angled trapezium, even damaged the subchondral bone marrow cavity of the visible local edema and hemorrhage.
如有软骨撕脱，须通过CT关节软骨造影或MR方可发现。
If cartilage is torn, it must be found by a CT joint chondrogram or MR.
三、（韧带和肌腱损伤）（Ligament and tendon damage）：
撕裂表现为局部肿胀，疼痛和压痛，关节活动受限，牵拉可加重疼痛。关节韧带完全撕裂则关节不稳定，出现异常活动。肌腱损伤主要表现为其功能异常。
The tear is a partial swelling, pain and tenderness, and joint activity is limited, and the traction can aggravate the pain. The joint ligament is completely torn and the joints are unstable and abnormal activity occurs. Tendon injuries are characterized by functional abnormalities.
不完全撕裂无异常X线表现；如果怀疑韧带完全撕裂时，除了常规X线摄影外，还应行应力X线摄影，及在施与关节一定方向的外力下摄影，应与健侧对比。如发现伤侧关节过度活动则说明限制这种活动的韧带完全断裂。
Incomplete tearing without abnormal X-ray representation; If the suspected ligament tear in full, in addition to conventional X-ray photography, should also stress X-ray photography, and in the joint must give direction under the force of photography, should be compared with the healthy side. If the injury is found to be overactive, the ligaments that restrict the activity are completely broken.
MR可直接显示韧带、肌腱。正常韧带、肌腱在所有的MR序列上都表现为低信号影。不完全撕裂表现为T2WI上韧带低信号中出现散在的高信号，其外形可以增粗，边缘不规则。完全断裂者则可表现断裂分离和退缩。两者的周围都可见水肿和（或）出血。
MR can show the ligaments and tendons directly. The normal ligaments and tendons present in all the MR sequences as low signal. The incomplete tear is a high signal in the low signal of the ligaments in T2WI, which can be thickened and irregular. A complete fracture may show fracture separation and withdrawal. Both are surrounded by edema and (or) bleeding.
左图：跟腱损伤
右图：正常跟腱
本期试题：临床上常见且易合并撕脱骨折的是？
A．肩关节后脱位
B．肩关节前脱位
C．桡骨小头半脱位
D．髋关节后脱位
E．髋关节前脱位
联系客服
