4.entorsele 1
DESCRIPTION
entorseleTRANSCRIPT
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ENTORSELE
Spitalul Clinic Colentina Clinica de Ortopedie
Conferentiar Rodica Marinescu
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DEFINITIE-ETIOPATOGENIE
• Leziune traumatica :elemente capsuloligamentare +structuri periarticulare.
• Frecventa adulti > sportivi .• Frecventa :glezna,genunchi,mediocarpiana ,ra
diocarpiana .• Grade:I.intindere ligamentara• II.ruptura partiala ligamente • III.ruptura ligamente .
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• “echipa articulara “• Tulburari vasomotorii constante • Fazele repararii leziunilor traumatice
articulare • 1.precolagenica z 5-6 .• 2.colagenica z 6-21 .• 3.maturare >luna aIVa .
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ENTORSELE GENUNCHIULUI
• Frecvente • Mec indirect : picior fixat pe sol cu factor care
actioneaza in var/valg .• Frecvent accidente sportive ,casnice ,rutiere .• Tineri ,activi.
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RAPEL ANATOMIE
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RAPEL ANATOMIE
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VARIETATI ANATOMOPATOLOGICE
• Entorsa compartiment intern • Entorsa compartiment extern • Entorse grave ,complexe ,cu afectare pivot
central.• Entorsa benigna :fara semne de laxitate sau
leziuni meniscale .Dubiu=RMN.• Tratament –conservator .
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VARIETATI ANATOMOPATOLOGICE
• Entorsa medie :ruptura ligament colateral .Trat conservator/chirurgical.
• Entorsa grava :ruptura ligament incrucisat .• Ruptura ligament incrucisat :durere
intensa ,sunet ,hemohidartroza masiva ,rapida,impotenta functionala relativa .
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ENTORSELE INTERNE
• Mecanism :valg+flexie+rot ext /valg pur
• Cele mai frecvente
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ENTORSELE EXTERNE
• Mecanism : varus +flexie +rot .ext.
• frecvent :smulgeri osoase .
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LEZIUNI ASOCIATE
• Osoase :spine tibiale ,cap peroneu RX.• Meniscale ,contuzii osoase :RMN.
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LEZIUNI ASOCIATE-CARTILAGINOASE
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RUPTURI IZOLATE LIA
• Mecanism hiperextensie
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EXAMENUL CLINIC • Testare ligamentara• Palpare interliniu articular ,puncte dureroase .• At.:leziunea LIA –cea mai frecventa leziune lig.
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TESTE STABILITATE LIA Sertar anterior-90 * ,Lachmann-30*. Teste stress
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TESTE STABILITATE LIA
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LAXITATE MEDIOLATERALA
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ATENTIE LEZIUNI ASOCIATE-FRACTURA SEGOND
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TRATAMENT ENTORSE BENIGNE
• Ortopedic:burlan gipsat/orteza.
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ORTEZE PROTECTIE
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TRATAMENT ENTORSE GRAVE
• TOTDEAUNA CHIRURGICAL:urgenta /urgenta amanata
• Urmareste refacerea stabilitatii ligamentare .• LCL,LCM:reinsertie,retensionare ,ligamentopla
stie .
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Tratament entorse grave
• Ligamentoplastie LIA :autogrefa OTO, ST ,alogrefa .
• Fixare :implante bioresorbabile /metalice .
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ATENTIE
• Tratament leziuni asociate :cele mai frecvente =leziuni meniscale .
• Ruptura menisc:durere interliniu ,hidartroza ,blocaj articular ,
• Tratament artroscopic :sutura menisc ,meniscectomie .
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INSTABILITATE CRONICA
• TRATAMENT INCORECT• ESEC LIGAMENTOPLASTIE• RECIDIVA TRAUMATISM• TESTE DE STRES +
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OSIFICARI PERIARTICULARE
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MENISC-ANATOMIE
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TIPURI DE RUPTURI DE MENISC
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BLOCAJ ARTICULAR IN SEMIFLEXIE
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MANEVRE DE EXAMINARE
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ANOMALII CONGENITALE
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CHISTUL MENISCAL
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ASPECTE ARTROSCOPIE
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MENISCECTOMIA ARTROSCOPICA
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MENISCETOMIA –CONSECINTE
• Gonartroza secundara :25%.• Durere reziduala 40-60%.• Pensare spatiu articular 30%.• Solutie:meniscectomie limitata sau sutura .
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SUTURA DE MENISC
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OSTEOCONDRITA DISECANTA
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OCD
ASPECT INTRAOPERATOR TEHNICA MICROFRACTURI
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OCD-MOSAICPLASTIE