小儿骨科的临床基础复习课程.ppt

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1、小儿骨科的临床基础体格检查望（整体外观，冠状面、矢状面、水平面）患儿的面容（痛苦面容，21三体面容等）表皮的色泽和皮肤生长情况患儿身材比例肢体对称情况肢体长短情况肢体活动情况肢体畸形情况躯干部活动情况躯干部畸形情况患儿的步态体格检查触皮肤弹性皮肤变色情况局部肿胀情况，温度变化包块（位置、大小、质地、界限、温度、皮色、与周边关系、活动度、压缩性）压痛（位置，最大压痛点）反常活动、骨擦音、骨擦感紧张挛缩感痉挛感肌力（0~5级）肌力0级：无任何收缩1级：只可触及收缩，没有任何活动。2级：可于水平方向移动，不能对抗重力。3级：仅能对抗重力，不能对抗阻

2、力。4级：能对抗一定程度的阻力5级：肌力正常LovettandMartin’s肌力分级法TexasScottishRiteHospital肌力分级法NormalTimesofAppearanceandDisappearanceofInfantileReflexesandReactionsPalmar(hand)graspreflexPresentinneonatesandveryyounginfants;normallydisappearsbetweenages2and4moPlantar(foot)graspreflexPresentinn

3、eonatesandinfants;usuallydisappearsbetweenages9and12moMoro'sreflexPresentatbirth;graduallydisappearsbyages3-6mo：CNSStartlereflexAppearsatbirth;presentthroughoutlifeVerticalsuspensionpositioningReflexnormallydisappearsafterage4moPlacingreactionNormallypresentatbirthinfull-te

4、rmneonates;upperlimbplacingusuallydisappearsbyages2-4moandlowerlimbplacingbyages1-2mo;bothresponsesmaypersistuptoage12moorolderWalkingorsteppingreflexNormallypresentatbirth;usuallydisappearsbyages1-2moCrossedextensionreflexPresentatbirth;normallydisappearsbyages1-2moWithdra

5、walreflexPresentatbirth;disappearsbetweenages1and2moPositivesupportresponse/leg-straighteningreflexPresentatbirth;normallydisappearsatabout4moExtensorthrustreflexPresentatbirth;normallypresentupto2moGalant'sreflex(trunkincurvation)Presentatbirth;disappearsatabout2-2½moRotat

6、ionreflexTimeofdisappearancevariesTonicneckreflexesAsymmetricreflexpresentatbirth,normallydisappearsby4-6mo;symmetricreflexusuallypresentby5-8mo,oftendiminishedorabsentby12moLandau'sreflexNormallypresentfrom6moto24-30moParachutereactionAppearsatabout6mo;remainsthroughoutlif

7、eNeckrightingreflexNormallypresentfrombirthtoabout6moBodyrightingreflexAppearsaround6mo;candisappearanytimeafter5yrorpersistthroughoutlifeOralreflexesUsuallydisappearat3-4mo;maybepresentlongerduringsleep深反射肱二头肌反射肱三头肌反射膝反射踝反射浅反射Babibski反射提睾反射Hoffmann反射括约肌反射腹壁反射MuscleSegmenta

8、lInnervationPeripheralNerveTrapeziusCranialXI;C(2)3-4SpinalaccessorynerveLevatoran