骨科的基本操作技术

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1、骨科的基本技术骨科魏建军石膏固定技术牵引技术关节穿刺技术骨折手法复位技术石膏固定技术石膏绷带无水硫酸钙粉沫石膏固定的优缺点三点固定原理，固定确实，塑形方便，便于护理沉重，透气性差，影响摄片，关节僵硬用法：骨隆突部皮肤保护衬垫上肢：10-12层下肢：12-15层周径的2/3常用石膏固定类型石膏托（plastersupport)石膏夹板(splint)石膏管型(cast)躯干石膏(trunkplaster)适应症1小夹板难于固定的骨折，脊柱骨折2开放性骨折清创缝合术后3病理性骨折4某些骨关节术后：关节融合5畸形矫正术后：三关节融合6化脓性骨髓炎，

2、关节炎，固定患肢，减轻疼痛，控制炎症7某些软组织损伤：肌腱，肌肉，血管，神经损伤注意事项1平整，切勿将石膏绷带扭转后包扎，防止皱折2塑型成型，符合肢体轮廓。下肢注意足弓塑形3手指及足趾露出，观察血液循环，感觉和活动能力。有剧痛，麻木及血运障碍及时松解，防止发生缺血性肌挛缩和肢体坏死4注意注明时间，及表明伤口位置和开窗5防止骨质疏松和肌萎缩，鼓励功能锻炼PlastersplintsSlightlywarm(notover24°C)waterandbucketStockinette(optional)Softcottonbandage/under

3、splintmaterial(e.g.,Webril®padding),availablein2-,3-,4-,and6-inchwidthsizesPlasterbandages,availablein2-,3-,4-,and6-inchwidthsizesElasticbandages(Ace)AdhesivetapeProcedureImportantconsiderationsbeforesplintingExaminetheextremityforevidenceofanopenfracture,whichwouldrequirec

4、leaning,debridement,andspecialistevaluationbeforesplinting.Performadetailedneurovascularexaminationbeforesplinting.Performreductionifthefracturehassignificantdisplacementormisalignment.ObtainappropriateradiographicstudiesGeneraltechniqueofapplyingplastersplintsApplystockine

5、ttetotheextremity(optional).Becarefultoavoidwrinkles.Measuretherequiredlengthofsplintingmaterial.Thenplaceanadditional3layersofWebril®ontothelayerthatwasusedtomeasurethelength.PlacelayersofdryplasterbandagesontotheWebril®.Ingeneral,upperextremitysplintsrequire8-10layersofpl

6、aster,whereaslowerextremitysplintswillrequire10-15layers.Soakthelayersofplasterbandagesinroomtemperaturewaterinbucket.Raisethelayersverticallyoverthebucket,firmlyholdingeachendoftherollinyourhands.Removeexcesswater.Placethewetplasterontothecastpadding(Webril®),andsmooththes

7、urface.Foldtheoverhangingedgesofcastpaddingovertheplasterandfoldanyexcesspaddingovertheendsofthesplint.Carefullyplacesplintinthedesiredlocation.Gentlymoldtheplasterusingthepalmsofyourhands(notfingertips).Rollanelasticbandageoverthesplint,fromdistaltoproximalwithanoverlapofa

8、pproximately50%.Gentlymoldthesplintagaintotheextremity.骨牵引技术利用牵引力和反牵引力作用于骨折部位，达到复位