骨折概論(英文版本)陳芒芒課件

THEFIRSTLESSONOFTHESCHOOLYEARIntroductiontoFractures(EnglishVersion)ChenM目CONTENTSIntroductionAnatomyoftheBoneMechanismsofFractureFractureHealingComplicationsofFracturesPreventionofFractures錄01IntroductionFractureisadisruptionintheintegrityofthebonestructure,typicallycausedbyexcessivestressortrauma.Itisacommoninjurythatcanrangefromminortosevere,dependingonthelocationandtypeoffracture.Fracturescanbeclassifiedasopenorclosed,andtheycanalsobecategorizedbasedontheirseverityandcomplexity.DefinitionofFractureSimplefracturesThesearelinearbreaksinthebonewithoutanyfragmentation.ComminutedfracturesTheseareseverefracturesinwhichtheboneshattersintomultiplepieces.GreenstickfracturesTheseoccurinchildren'sbones,whicharemoreflexible,andresultinabendingorbowingofthebonewithoutcompletebreaking.CompoundfracturesWhenthebrokenbonepiercestheskin,itisreferredtoasacompoundfracture.TypesofFracturesCausesofFracturesTraumaFalls,motorvehicleaccidents,sportsinjuries,andotherimpactsarecommoncausesoffractures.RepetitivestressRepetitivestressinjuries,suchasstressfracturesinathletes,canleadtobonefractures.DiseasesBonediseaseslikeosteoporosiscanweakenthebonesandmakethemmorepronetofractures.ViolenceIntentionaltraumainflictedbyanotherpersonisacauseoffracturesinsomecases.01AnatomyoftheBoneCorticalboneistheouterlayeroftheboneandaccountsforabout80%ofthetotalbonemass.Itisdenseandcompact,providingstructuralsupportandprotectiontothebone.Corticalbonehasahoneycomb-likestructurethatallowsittowithstandcompressiveandtensileforces.Italsohasarichsupplyofbloodvesselsandnerves,providingnutrientsandsensationtothebone.CorticalBoneMedullaryboneistheinnerpartoftheboneandconsistsofcancellousboneortrabecularbone.Itoccupiesthecentralportionoftheboneandprovidesaspaceforbonemarrowandbloodcellproduction.Medullaryboneislessdenseandmorelightweightcomparedtocorticalbone.Ithasaspongystructurethatallowsforflexibilityandresilience,helpingthebonewithstandimpactandload-bearingforces.MedullaryBoneBonemarrowisthesofttissueinsidethebone.Itisresponsiblefortheproductionofbloodcells,includingredbloodcells,platelets,andwhitebloodcells.Therearetwotypesofbonemarrow:yellowmarrowandredmarrow.Yellowmarrowisfoundinthefattyareasoftheboneandisprimarilycomposedofadiposetissue.Redmarrowisfoundinthehematopoieticareasoftheboneandisrichinbloodcellprecursorsandstemcells.BoneMarrow01MechanismsofFractureStressShielding應力屏蔽是由于外部應力的減少或消失，導致材料內(nèi)部應力分布不均，從而引發(fā)斷裂。當外部應力減小或消失時，如卸載或卸載后，由于材料內(nèi)部各部分之間的相互作用，使得材料內(nèi)部應力分布不均，從而引發(fā)斷裂。疲勞斷裂是由于材料在循環(huán)應力的作用下，經(jīng)過長時間的應力積累，最終導致斷裂。疲勞斷裂通常發(fā)生在材料承受循環(huán)應力的環(huán)境中，如機械零件、橋梁等。在循環(huán)應力的作用下，材料內(nèi)部的微裂紋逐漸擴展，最終導致斷裂。疲勞斷裂通常具有明顯的疲勞輝紋和斷口特征。FatigueFracture病理性斷裂是由于材料內(nèi)部存在缺陷或損傷，如裂紋、孔洞等，在外力作用下引發(fā)斷裂。病理性斷裂通常與材料的制造、加工、使用環(huán)境等因素有關。例如，焊接過程中產(chǎn)生的裂紋、機械加工過程中產(chǎn)生的微裂紋等都可能導致病理性斷裂。此外，腐蝕、高溫等環(huán)境因素也可能導致材料內(nèi)部損傷，引發(fā)斷裂。PathologicalFracture01FractureHealingDefinitionPrimarybonehealingreferstotheinitialprocessoffracturehealingwherethebonetissuerepairsitselfdirectlyaftertheinjury.MechanismItinvolvesthedirectappositionofboneendsandtheformationofabloodclotatthefracturesite.Thebloodclotservesasascaffoldfortherecruitmentofstemcellsandosteoblasts,whichaidinboneformation.FactorsAffectingPrimaryBoneHealingAge,bonedensity,andthestabilityofthefracturesitecaninfluenceprimarybonehealing.Forinstance,fracturesinchildrenhealfasterthanthoseinadultsduetohigherbone-formingactivity.PrimaryBoneHealingSecondaryBoneHealingDefinition:Secondarybonehealingisamoreprolongedprocessthanprimarybonehealing,involvingtherecruitmentofosteoblastsandmesenchymalstemcellstothefracturesite.Mechanism:Itinvolvestheformationofacallusaroundthefracturesite,whichisasofttissuethatgraduallyossifiesandstrengthensashealingprogresses.Thecallusservesasatemporarysupportstructureforthefracturedboneends.FactorsAffectingSecondaryBoneHealing:Factorssuchasage,bonedensity,andthestabilityofthefracturesitecaninfluencesecondarybonehealing.Additionally,thetypeoffractureanditslocationwithinthebonecanalsoaffectthehealingprocess.IntramembranousHealingThistypeofhealingoccursinflatbonessuchastheskullandinvolvesthedirectformationofnewbonetissueatthefracturesite.EndochondralHealingThistypeofhealingoccursinlongbonesandinvolvestheformationofacartilageintermediatebeforethefinalboneformation.HybridHealingThistypeofhealingcombinesfeaturesofintramembranousandendochondralhealingandoccursinbothflatandlongbones.Itinvolvesdirectboneformationatthefracturesiteandtheformationofacartilageintermediate.TypesofFractureHealing01ComplicationsofFractures定義原因后果預防與治療Nonunion01020304骨折端未能愈合，形成永久性的裂隙或間隙。骨折端血液供應不足、感染、軟組織損傷嚴重、骨折類型及治療不當?shù)?。長期疼痛、骨不連、功能障礙等。選擇合適的固定方式、促進骨折端血液供應、控制感染、早期功能鍛煉等。Malunion骨折端畸形愈合，形成成角、旋轉(zhuǎn)或縮短等畸形。骨折端不穩(wěn)定、固定不牢固、過早活動或外力作用等。關節(jié)活動受限、疼痛、肢體功能障礙等。選擇合適的固定方式、定期復查X線片、及時調(diào)整固定方式或手術(shù)治療等。定義原因后果預防與治療由于骨折端血液供應中斷，導致骨折端缺血壞死。定義骨折端血液供應不足、軟組織損傷嚴重、長時間固定等。原因骨折端硬化、疼痛、關節(jié)活動受限等。后果選擇合適的固定方式、促進骨折端血液供應、控制感染、定期復查X線片等。預防與治療AvascularNecrosis01PreventionofFracturesEatabalanceddiet:Incorporateenoughcalcium,vitaminD,andproteinintoyourdiettosupportbonehealth.Avoidsmokingandexcessivealcoholconsumption:Thesehabitscanweakenbones.Exerciseregularly:Weight-bearingandimpactexercisescanhelpstrengthenbones.Getregularbonedensitytests:Thiscanhelpdetectosteoporosisearlyandallowforearlyinterven