骨折66教学ppt课件

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1、Fractures骨折Commonfractures/dislocations一般的骨折和脫位Historyandclinicexamination病史和臨床檢查Carefulhistorytakingwillhelpyouhaveaclearideaaboutwhatkindofinjurymayhaveoccurred.仔細詢問病史能幫助你明确發生了哪种損傷Symptomsandsigns:pain,swelling,deformityanddysfunctionofmovementarethecommonestsymptomsofanort

2、hopaedicpatient.症狀与表現：疼痛、腫脹、畸形和運動功能障礙是對于一個骨科病人最常見的症狀Routineforclinicexaminationincludesinspection,palpation,movementandstressing.Examingpainfulareaslastandleavingthemostpainfulmanoeuvreuntillast.常規臨床檢查包括望、触、動、壓。最后檢查疼痛區域，將可引起最明顯疼痛的手法操作留在最后施行。Fracturesdescription骨折的描述Describewh

3、ichbonesaresuspectedtobebroken.描述怀疑骨折的骨。Describethedeformity:alwaysdescribethedistalfragmentegvarus(medial),valgus(lateral),dorsalorventralangulation,andshortening.描述畸形：通常描述远端，如弓形腿、外翻足、向側方或中心的异位和短縮。Lookforevidenceofcomplications:compoundiepresenceofpuncturewound,circulationch

4、eckpulsesandcolorofskin,skinviability,anddistalnervetesting.檢查是否有并發症：合并如開放傷口、檢查脈搏、皮膚顏色、皮膚活性及末梢神經。Fracture/Dislocationearlycomplications骨折和脫位的早期并發症Compound:requiresearlydebridementandantibiotics.NeedsSpecialistattentionurgently.開放骨折：需要早期換藥、抗生素。需專家立即參与進來vascularcompromise:needs

5、rapidpartialorcompletereduction.血管損傷：需要立即部分或完全复位。nervedamage:needsreductionandmonitoring.神經損傷：需要复位并監測compartmentsyndrome:requiresfasciotomyurgently骨筋膜室綜合征：需要立即行筋膜室切開術。tendonrupture:requiressurgicalrepair.肌腱斷裂：需外科修复DistalFemurFractureFractures:Initialcare骨折：早期治療1.ABC’s气道，呼吸，循环

6、2.Removewatches,rings,braceletsandclothesifpotentiallyconstricting去除手表、戒指、手鐲和衣服等紧缩物品3.Assessfractureandneurovascularstatusbeforeapplyingsplint.Assesspulses,externalhaemorrhage,performmotorandsensoryexamofextremity.在上夾板之前，評估骨折和神經血管情況。触脈搏、外部的失血，對肢体末梢進行感覺和運動的測試。4.coverwoundswith

7、steriledressings傷口用無菌敷料覆蓋。Fractures:Initialcare5.selectappropriatesizeandtypeofsplintforthefracture.Splintmustimmobilizejointaboveandjointbelow.选择一个大小和型号合适的夹板。夹板必须延伸到关节上下以固定关节。6.Applypaddingoverbonyprominencesthatwillbecoveredbysplint.使用夹板时，在骨性凸起的地方加用衬垫。Splinttheextremityinpo

8、sitionedfoundifdistalpulsesarepresent.Ifdistalpulsesabsentthenanatte