骨折專業(yè)知識(shí)講座培訓(xùn)課件

骨折專業(yè)知識(shí)講座Historyandclinicexamination

病史和臨床檢查Carefulhistorytakingwillhelpyouhaveaclearideaaboutwhatkindofinjurymayhaveoccurred.

仔細(xì)詢問病史能幫助你明確發(fā)生了哪種損傷Symptomsandsigns:pain,swelling,deformityanddysfunctionofmovementarethecommonestsymptomsofanorthopaedicpatient.

癥狀與表現(xiàn)：疼痛、腫脹、畸形和運(yùn)動(dòng)功能障礙是對(duì)于一個(gè)骨科病人最常見的癥狀

2骨折專業(yè)知識(shí)講座Routineforclinicexaminationincludesinspection,palpation,movementandstressing.Examingpainfulareaslastandleavingthemostpainfulmanoeuvreuntillast.

常規(guī)臨床檢查包括望、觸、動(dòng)、壓。最后檢查疼痛區(qū)域，將可引起最明顯疼痛的手法操作留在最后施行。

3骨折專業(yè)知識(shí)講座Fracturesdescription

骨折的描述Describewhichbonesaresuspectedtobebroken.

描述懷疑骨折的骨。Describethedeformity:alwaysdescribethedistalfragmentegvarus(medial),valgus(lateral),dorsalorventralangulation,andshortening.

描述畸形：通常描述遠(yuǎn)端，如弓形腿、外翻足、向側(cè)方或中心的異位和短縮。4骨折專業(yè)知識(shí)講座Lookforevidenceofcomplications:compoundiepresenceofpuncturewound,circulationcheckpulsesandcolorofskin,skinviability,anddistalnervetesting.

檢查是否有并發(fā)癥：合并如開放傷口、檢查脈搏、皮膚顏色、皮膚活性及末梢神經(jīng)。5骨折專業(yè)知識(shí)講座Fracture/Dislocationearlycomplications

骨折和脫位的早期并發(fā)癥Compound:requiresearlydebridementandantibiotics.NeedsSpecialistattentionurgently.

開放骨折：需要早期換藥、抗生素。需專家立即參與進(jìn)來vascularcompromise:needsrapidpartialorcompletereduction.

血管損傷：需要立即部分或完全復(fù)位。nervedamage:needsreductionandmonitoring.

神經(jīng)損傷：需要復(fù)位并監(jiān)測(cè)6骨折專業(yè)知識(shí)講座compartmentsyndrome:requiresfasciotomyurgently

骨筋膜室綜合征：需要立即行筋膜室切開術(shù)。tendonrupture:requiressurgicalrepair.

肌腱斷裂：需外科修復(fù)7骨折專業(yè)知識(shí)講座DistalFemurFracture8骨折專業(yè)知識(shí)講座Fractures:Initialcare

骨折：早期治療1.ABC’s氣道，呼吸，循環(huán)2.Removewatches,rings,braceletsandclothesifpotentiallyconstricting

去除手表、戒指、手鐲和衣服等緊縮物品3.Assessfractureandneurovascularstatusbeforeapplyingsplint.Assesspulses,externalhaemorrhage,performmotorandsensoryexamofextremity.

在上夾板之前，評(píng)估骨折和神經(jīng)血管情況。觸脈搏、外部的失血，對(duì)肢體末梢進(jìn)行感覺和運(yùn)動(dòng)的測(cè)試。4.coverwoundswithsteriledressings

傷口用無菌敷料覆蓋。

9骨折專業(yè)知識(shí)講座Fractures:Initialcare5.selectappropriatesizeandtypeofsplintforthefracture.Splintmustimmobilizejointaboveandjointbelow.

選擇一個(gè)大小和型號(hào)合適的夾板。夾板必須延伸到關(guān)節(jié)上下以固定關(guān)節(jié)。6.Applypaddingoverbonyprominencesthatwillbecoveredbysplint.

使用夾板時(shí)，在骨性凸起的地方加用襯墊。10骨折專業(yè)知識(shí)講座Splinttheextremityinpositionedfoundifdistalpulsesarepresent.Ifdistalpulsesabsentthenanattemptatrealignmentshouldbetriedafteradministrationofanalgesiaeg5mgIVmorphine.

如果肢體遠(yuǎn)端的脈搏存在時(shí)，可用夾板固定。如果遠(yuǎn)端脈搏消失，應(yīng)該考慮在給予鎮(zhèn)痛劑后重新安排夾板，如5mg嗎啡靜注。Donotforcerealignmentofdeformedextremity.Ifnoteasilyrealignssplintinpositionfound.

如果在現(xiàn)有的姿勢(shì)上有困難的話，不要對(duì)畸形的肢體用力復(fù)位。11骨折專業(yè)知識(shí)講座OPENfracture開放骨折

NPO禁食水Cleanwoundgrossly,removedebris

初步清創(chuàng)，去除壞死組織。Dressingwoundwithasepticcovers在傷口上覆蓋以無菌敷料Splinting夾板固定1stgen.Cefalosporinsandtetanus

一克Cefalosporins和破傷風(fēng)transportingpatienttotheatrebetterwithin4hrsfromtimeofinjuryasthisallowsinternalfixationasapossibility.

最好在4小時(shí)之內(nèi)將病人運(yùn)送到醫(yī)院，這使一期內(nèi)固定手術(shù)成為可能。12骨折專業(yè)知識(shí)講座SEVEREDEFORMITY

嚴(yán)重畸形anysevereDEFORMITY?

任何嚴(yán)重的畸形嗎？Ifcirculationand/or(sometimes)nervewasjeopardizedduetothedeformity,thenminorreductioncanbedonebeforeX-ray,toreleasepressuretothem

如果畸形使神經(jīng)/血管受損，在X線檢查之后，對(duì)他們的減壓可以減少傷害。

VESSELorNERVEINJURY?

是否有神經(jīng)血管損傷？SPLINTING

夾板固定13骨折專業(yè)知識(shí)講座

Checkpulse(distal)forvesselinj.

檢查末端血管搏動(dòng)

Checkfunction(distal)fornerveinj.

檢查末端神經(jīng)的功能14骨折專業(yè)知識(shí)講座15骨折專業(yè)知識(shí)講座16骨折專業(yè)知識(shí)講座17骨折專業(yè)知識(shí)講座Fractureofthescaphoid

舟狀骨骨折Thefractureofthewristofthescaphoidiscommon.Violenthyperextensionofthewristduetoafallontheoutstretchedhandwillcrackthewaistofthescaphoidacrossitsnarrowestpoint.

腕部的舟狀骨骨折是常見的。對(duì)腕部的過度牽拉，比如在手外展位置時(shí)跌倒，會(huì)使舟狀骨在其最薄弱的地方骨折。

Fractureofthewaistofthescaphoidisanotoriousfracturebecauseitisnoteasilyseenoninitialradiographs.手舟狀骨骨折在早期的X線上往往無法見及。18骨折專業(yè)知識(shí)講座Fractureofthescaphoid

DiagnosisandTreatment:

舟狀骨骨折的診斷和治療Historyofinjury:FOOSH

病史Physicalsigns:Tendernessintheanatomicalsnuff-boxwithswelling,weaknessofpinchingandpainonhyperextension.

表現(xiàn)：在鼻煙窩處的壓痛、腫脹，拿捏物體的無力和過伸時(shí)的疼痛。X-rayexamshouldincludesfourviewsatdifferentangles,includingobliqueviews.

從四個(gè)不同角度進(jìn)行X線檢查，包括斜位。19骨折專業(yè)知識(shí)講座

Treatment:suspectedScaphoidfracturesshouldbeimmobilizedinascaphoidplasterandifnecessaryrepeatX-rayoutofplasterat10days.治療：懷疑舟狀骨骨折的病人應(yīng)使用舟狀骨石膏固定，如果必要的話，10天后去除石膏再復(fù)查X線。20骨折專業(yè)知識(shí)講座21骨折專業(yè)知識(shí)講座22骨折專業(yè)知識(shí)講座Colles’fracture

Colles’骨折Duetofallontheoutstretchedhand.

跌傷時(shí)手為外展位Dinnerforkdeformity

手部銀叉樣畸形X-rayshowsfractureofthedistalradiusandulnawithdorsalangulation,impactionandradialdeviation.

X線示骨折向背側(cè)成角、嵌插、撓偏。Firstaidistoplaceinairsplintorbackslab,analgesiaandsendtolocalhospitalforXray.急救措施是用充氣夾板或石膏托固定，鎮(zhèn)痛并送到地方醫(yī)院進(jìn)行X線。TreatmentisreductionandaboveelbowPOP復(fù)位及肘部以上石膏固定

23骨折專業(yè)知識(shí)講座ComplicationsofColles’fracture

Colles’骨折的并發(fā)癥Aswithallfracturesimmediatelycheckcirculationwithskincolorandpulses.Checkdistalnervefunctionanddistalmovements.Occasionallypartialreductionmaybeattemptedunderanalgesiaifdistalcirculationisatimmediaterisk.

如同所有骨折一樣，立即通過皮膚顏色脈搏來檢查循環(huán)。檢查末端神經(jīng)功能和運(yùn)動(dòng)。遠(yuǎn)端循環(huán)受到威脅時(shí)，偶可在使用止痛劑的情況下施行部分復(fù)位。24骨折專業(yè)知識(shí)講座SpecificcomplicationsofCollesfractureinclude:Colles骨折的特殊并發(fā)癥Mediannerveinjury正中神經(jīng)損傷Ruptureofextensorpollicislongus拇長(zhǎng)伸肌斷裂Latecomplicationssuchas:Mal-unionandSudeck’satrophy遠(yuǎn)期并發(fā)癥，如Mal-unionandSudeck’s萎縮。ComplicationsofColles’fracture

Colles’骨折的并發(fā)癥25骨折專業(yè)知識(shí)講座26骨折專業(yè)知識(shí)講座27骨折專業(yè)知識(shí)講座Smith’fracture

Smith’骨折Afractureofthedistalradiusandulnaduetoafallonthebackofthehandwithforcedflexion.

在有彎曲暴力從背側(cè)作用于手部尺橈骨遠(yuǎn)端骨折X-raywillrevealventralangulationofdistalfragment. X線檢查可見骨折向腹側(cè)成角28骨折專業(yè)知識(shí)講座Smith’fracture-Smith’骨折

Firstaidisairsplintorslab,analgesiaandtransporttolocalfacilityforX-ray.急救的方式是使用充氣夾板、止痛、轉(zhuǎn)運(yùn)到當(dāng)?shù)蒯t(yī)院行X線檢查Treatedinaforearmcastwiththehandsupinatedandthewristinfullextension.Ifagoodpositioncannotbeachievedandmaintained,openreductionandinternalfixationareneeded.以前臂石膏固定使腕部旋外背展。但如果不能保持一個(gè)良好的位置，則需要結(jié)和內(nèi)固定。29骨折專業(yè)知識(shí)講座30骨折專業(yè)知識(shí)講座Fractureoftheclavicle:treatment

鎖骨骨折的治療

Abroadarmslingisneededingreenstickorundisplacedfractures.Noothertreatmentisneeded. 寬的頸腕吊帶對(duì)青枝骨折或無明顯移位的骨折，且不需要其它任何處理。Afirmsupportsuchasafigure-of-eightbandagetopulltheshouldersbackwardsalsohelpstorelievepainbutitmustbeadjustedeveryfewdays.Additionalsupportisnotaimedtoreducethefracture。一個(gè)比較緊的8字繃帶可以將肩部向后方牽拉以環(huán)節(jié)疼痛，但必須每幾天調(diào)整。其它的支持不是為了骨折的復(fù)位。32骨折專業(yè)知識(shí)講座33骨折專業(yè)知識(shí)講座Supracondylarfractureofthehumerus(肱骨髁上骨折)Thismajorlyoccurinchildrenwhofallontheoutstretchedarm.Itisafracturewhichoccursinthedistalthirdofthehumerus.Thefracturelineisgenerallytransverse.

這多發(fā)生于兒童跌倒時(shí)其處于上臂外展位。這種骨折發(fā)生在肱骨的下1/3。骨折線往往是橫行的。Withposteriorangulationanddisplacementofthedistalfragment.

骨折端向后成角移位。

34骨折專業(yè)知識(shí)講座SupracondylarfractureComplications(髁上骨折的并發(fā)癥)

Supracondylarfractureofthehumerusisnotoriousforitscomplications:

肱骨髁上骨折的并發(fā)癥的并發(fā)癥很多：1.Vascularproblems.(血管損傷)

2.Compartmentsyndrome.(骨筋膜室綜合征)

3.Mediannervedamage.(正中神經(jīng)損損傷)4.Mal-union.(？)5.Volkmann’sischaemiccontracture(Volkmann’s缺血攣縮)35骨折專業(yè)知識(shí)講座SupracondylarfractureDiagnosis

(髁上骨折的診斷)Theolecranonandmedialandlateralepicondylespreservetheirnormalequilateraltriangularrelationship(鷹嘴和內(nèi)外上髁呈等邊三角形關(guān)系)

Thereistendernessoverthedistalhumerus,theremaybemarkedswellinganddeformity,andthechildgenerallyresistsexamination(肱骨遠(yuǎn)端的壓痛，并可能還有腫脹和畸形，兒童通常有拒按)Radiographyismandatory(必須要進(jìn)行X線檢查)36骨折專業(yè)知識(shí)講座SupracondylarfractureTreatment(髁上骨折的治療)Undisplacedfracturescanbetreatedinabackslabwiththeelbowflexedforthreeweeks.

無明顯移位的骨折應(yīng)使用石膏托保持屈肘位三周。Reductionshouldbedonefirstfordisplacedfracture.Oncereduced,theelbowisflexedbeyondarightangle,aplasterbackslabappliedandthearmsupportedinacollarandcuff.

對(duì)有移位的骨折應(yīng)先進(jìn)行復(fù)位。當(dāng)進(jìn)行復(fù)位時(shí)，肘關(guān)節(jié)需要固定在一個(gè)大于90度的位置，使用石膏背托并輔以領(lǐng)和袖筒。37骨折專業(yè)知識(shí)講座38骨折專業(yè)知識(shí)講座Pelvicfractures

骨盆骨折Fracturesofthepelvisareofvaryingseverity.(骨盆骨折變化多樣，可非常嚴(yán)重)Pelvicfractureshaveareputationforbeingmissed.(骨盆骨折常被漏診)Thepelvisiseasilyfracturedincrushinginjuriesorfromfallsfromaheight(骨盆骨折常發(fā)生于車禍或墜落)39骨折專業(yè)知識(shí)講座signsinclude:ecchymosisaroundthepelvis,perinealhaematoma,bloodaturethralmeatus,bloodPRandmobileprostate.(表現(xiàn)有：骨盆周圍的淤斑、后腹膜血腫、尿道口流血、血壓的變化及活動(dòng)的前列腺)Screeningfilmsofthepelvisshouldbetakenineverycaseofmultipletrauma(especiallyinunconsciouspatients),unexplainedshockfollowingtrauma,bluntabdominalinjury,andfemoralshaftfractures每個(gè)多發(fā)傷的病人和創(chuàng)傷、腹部鈍性傷和股骨干骨折后存在不可解釋的休克的病人都應(yīng)常規(guī)篩查骨盆片(尤其在昏迷病人)PelvicfracturesDiagnosis

骨盆骨折的診斷40骨折專業(yè)知識(shí)講座Typesofpelvicfract