骨科牽引課件

PreparedBy:shuyeyang

OrthopaedicTraction1骨科牽引Traction

istheapplicationofapullingforcetoapartofthebody

Definition2骨科牽引Purpose:tominimizemusclespasm;toreduce,align,andimmobilizefractures;toreducedeformity;toincreasespacebetweenopposingsurfaces3骨科牽引GeneralConsiderationsSafeanddependablewayoftreatingfracturesformorethan100yearsBonereducedandheldbysofttissueLessriskinfectionatfracturesiteAllowsmorejointmobilitythanplaster4骨科牽引DisadvantagesCostlyintermsofhospitalstayHazardsofprolongedbedrestThromboembolismDecubitiPneumoniaRequiresmeticulousnursingcareCandevelopcontractures(攣縮)5骨科牽引HistorySkintractionusedextensivelyinCivilWarforfracturedfemursKnownasthe“AmericanMethod”SkeletaltractionbyapinthroughboneintroducedbySteinmannandKirschner6骨科牽引BedsAndFramesStandardbedhas4-posttractionframeIdealbedfortractionwithmultipleinjuriesisadjustableheightwithBradfordframeMattressmovesseparatefromframe7骨科牽引BedsandFramesBradfordframeenablesbedpanandlinenchangeswithoutmovingptAlternativelybedcanbeflexibletoallowbendingathiporknee<朗道英漢字典5.0>中的解釋:

【醫(yī)】布萊德福氏架(大腿骨折和脊柱結(jié)核患者的床架)8骨科牽引KnotsIdealknotscanbetiedwithonehandwhileholdingweightEasytotieanduntieOverhandloopknotwillnotslip9骨科牽引KnotsAslipknottightensundertensionUpandover,downandover,upandthrough10骨科牽引Tractionmaybeappliedto

theskin(skintraction)

directlytothebonyskeleton(skeletaltraction).

11骨科牽引SkinTraction:indicationChildfractureofshaftoffemurAdultepiphysisFracturepelvicfracturenoevidentdisplaceChildjointcontractureoradultlightjointcontracture12骨科牽引ForearmSkinTractionAdhesivestripwithAcewrapUsefulforelevationinanyinjuryCantreatdifficultclaviclefractureswithexcellentcosmeticresultRiskisskinloss13骨科牽引DoubleSkinTractionUsedforgreatertuberosityorproxhumeralshaftfxArmabducted30degreesElbowflexed90degrees7-10lbsonforearm5-7lbsonarmRiskofischemiaatantecubitalfossa

14骨科牽引Dunlop’sTractionUsedforsupracondylarandtranscondylarfracturesinchildrenUsedwhenclosedreductiondifficultortraumaticForearmskintractionwithweightonupperarmElbowflexed45degrees15骨科牽引Buck’sTractionOftenusedpreoperativelyforfemoralfracturesCanusetapeorpre-madebootNomorethan10lbsNotusedtoobtainorholdreduction16骨科牽引SplitRussell’sTractionBuck’swithslingMaybeusedinmoredistalfemurfxinchildrenCanbemodifiedtohipandkneeexerciser17骨科牽引Bryant’sTractionUsefulfortreatmentfemoralshaftfxininfantorsmallchildCombinesgallowstractionandBuck’stractionRaisemattressforcountertractionRarely,ifeverusedcurrently18骨科牽引announcementsNodamage,ulcer,inflammation,phlebeurysma,embolismonskin;2-3weeks;Nomorethan2to3kg(4.5to8lb)oftra-ctioncanbeusedonanextremity,otherwisebubblewillcanbeseen.Monitoringangleoftraction,weigh,lineoftractioneveryday.Getoutofthewayoffibularheadtoprotectthecommonperonealnerve;Guidethepatienttodofunctionalexercise.19骨科牽引SkeletalTraction:totreatfracturesofthefemur,thetibia,andthecervicalspine.Thetractionisapplieddirectlytothebonebyuseofametalpinorwire20骨科牽引CervicalskeletaltractionUsedtotreattheunstablespine(fx,dislocation,especialySCIwithdislocation)PullalongaxisofspinePreservesalignmentandvolumeofcanalGardner-WellsandCrutchfieldtongscommonlyusedSCI;spinalcordinjury頸脊髓損傷21骨科牽引GardnerTongsEasytoapplyPlacedirectlycephaladtoexternalauditorymeatusInlinewithmastoidprocessJustcleartopofearsScrewsappliedwith30lbspressure22骨科牽引GardnerTongsPinsitecareimportantWeightrangesfrom5lbsforc-spinetoabout20lbsforlumbarspineExcessivemanipulationwithplacementmustbeavoidedPoorplacementcancauseflex/extforcesCangetoccipitaldecubitus（褥瘡）23骨科牽引CrutchfieldTongsMustinciseskinanddrillcortextoplaceRotatemetaltractionloopsotouchesskullinmidsagittalplanePlacedirectlyaboveextauditorymeatusRiskssimilartoGardnertongs24骨科牽引OlecranonPinTractionDifficultsupracondylar/distalhumerusfxGreatertractionforcesallowedCanmakeangularandrotationalcorrectionsPlacepin1.25inchesdistaltotipAvoidulnarnerve3cm2cm25骨科牽引LateralOlecranonTractionUsedforhumeralfracturesArmheldinmoderateabductionForearminskintractionExcessiveweightwilldistractfracture26骨科牽引MetacarpalPinTractionUsedforobtainingdifficultreductionforearm/distalradiusfxOncereductionobtained,pinscanbeincorporatedincastPinplacedradialtoulnarthroughbase2nd/3rdMCStiffnessintrinsicscommon27骨科牽引90-90TractionUsefulforsubtrochandproximal3rdfemurfxEspeciallyinyoungchildrenMatchesflexionofproximalfragmentCancauseflexioncontractureinadult28骨科牽引FemoralTractionPinMustavoidsuprapatellarpouch,NVstructures,andgrowthplateinchildrenPlacejustproximaltoadductortuberclealongmidcoronalplaneAtlevelproximalpolepatellainextendedposition29骨科牽引DistalFemoralTractionAlignmentoftractionalongaxisoffemurUsedforsuperiorforceacetabularfxandfemoralshaftfxUsedwhenstrongforceneededorkneepathologypresent30骨科牽引ProximalTibialTractionUsedfordistal2/3rd

femoralshaftfxFemoralpinallowsrotationalmomentsEasytoavoidjointandgrowthplate1inchdistalandposteriortotibialtubercle1cm3cm31骨科牽引DistalTibialTractionUsefulincertaintibialplateaufxPininserted1.25inchesproximaltotipmedialmalleolusAvoidsaphenousveinPlacethroughfibulatoavoidperonealnerveMaintainpartialhipandkneeflexion32骨科牽引CalcanealTractionTemporarytractionfortibialshaftfxorcalcanealfxInsertabout1.5inchesinferiorandposteriortomedialmalleolusDonotskewersubtalarjointorNVbundleMaintainslightelevationleg33骨科牽引Specialtraction34骨科牽引HeadHaltertractionSimpletypecervicaltractionManagementofneckpainWeightshouldnotexceed5lbsinitiallyCanonlybeusedafewhoursatatime頭頸部系帶牽引1lbs=0.45kg35骨科牽引OutpatientheadhaltertractionUsedtotrainneckpainandradicularsymptomsfromcervicaldiscdiseaseDevicehooksoverdoorFacedoortoaddflexionUseabout30minperdayWeight10-20lbs神經(jīng)根癥狀1lbs=0.45kg36骨科牽引HaloRingTractionDirectionoftractionforcecanbecontrolledNomovementbetweenskullandfixationpinsAllowstheptoutofbedwhiletractionmaintainedUsedforc-spineort-spinefx37骨科牽引HaloRingTractionRingwiththreadedholesAllow1-1.5cmclearancear