资源描述：
《手外伤的诊断和处理课件》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。
1、手外伤的诊断和处理手外伤的诊断和处理中山医科大学附属第一医院显微外科概述Introduction复杂的结构重要的功能改造和征服自然的工具仅次于眼睛的感觉器官广泛的大脑皮层代表区Thecomplicationandimportanceofhandfunctionandstructure.HandisthetoolwithwhichhumanmanipulateshisenvironmentAsasensoryorganitrivalstheeyeBroadcorticalrepresentation发病率Incidence整体发病率不清楚所有工伤中占25%所有骨折中，掌骨和指骨
2、骨折占10%占所有骨科急诊1/3Theover-allincidenceofhandinjuriesisunknownWork-relatedaccidentsofhand--25%allsuchinjuriesMetacarpalsandphalanges--10allfracturesHandinjuries--1/3allorthopedicemergency解剖（一）Anatomy固定单位和运动单位手的骨骼可分为维持稳定的固定部份和产生灵活运动的部份ThefixedunitandmobileunitsTheskeletonissubdividedintoafixedu
3、nitforstabilityandmobileunitsfordexterityandpower解剖（二）Anatomy三个重要的关节1腕关节2第一腕掌关节3掌指关节Threegroupsimportantjoints1Carpaljoint2Firstcarpometacarpaljoint3Metacarpophalangealjoints解剖（三）Anatomy体位和功能体位：休息位，功能位，保护位功能：握，持，抓，捏，对掌GestureandfunctionGesture:restposition,functionposition,protectivepositio
4、nFunction:grasping,holding,pushing,lifting,opponening病因学Etiology暴力：直接，间接类型：切割，撕裂，毁损，断裂。Violence:direct,indirectInjuries:incision,laceration,contision,twisting,cutting,amputation.诊断要点Dianosticology病史一般信息：年龄，性别，优势手，嗜好，职业，有无合并其他器官系统损伤现在史：主诉，损伤时间、地点、方式及损伤后已作什么处理？Historygeneralinformationtobeobt
5、ainedmustincludethefolloqing:age,sex,handdominande,occupation,avocationandgeneralmedicalconditionPresentillnessdiscussionshouldincludechiefconplaintwithdateandtimeofonset.whathappened?Howdidhappaned?When?Where?Treeatmentsafterinjuries诊断要点Dianosticology体查：1一般体查：位置，畸形，皮肤缺损2血循环3感觉功能Examination
6、:1Generalcondition:Posture,deformities,skiinchanges,skinvitality2Bloodcirculation:Allen’stest3Sensory诊断要点Dianosticology4运动功能检查：肌腱，关节脱位，骨折5手内在肌功能6骨、关节Ｘ线检查4Motorexamination:tendonfunction,jointdislocation,bonefracture5Instrinsicmusclefunctionexamination6Skelstaljointinjuries:X-rayexamination处
7、理基本原则Basicprinciplesoftreatment1止血:止血带的应用上臂上1/3处,每隔1小时放松5-10分钟2麻醉:区域神经阻滞1Bleedingcontrol:touniquetapplication2Anesthesia:localnerveblockanesthesia处理基本原则Basicprinciplesoftreatment3清创清洗伤肢,无菌盐水冲洗伤口,消毒由浅入深,清除血肿、异物及失活组织，检查深部结构骨，关节，肌腱，神经和血管的处理伤口的闭合固定：置于保护体位，不影
