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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,一、运动系统理学检查法,L,ocomotor system,examination,理学检查原则,先健侧后患侧,检查顺序,先健处后患处,先主动后被动,充分暴露、两侧对比,全面、反复、轻柔、到位,理学检查的基本内容,视诊（,inspection,）,触诊（,palpation,）,叩诊（,percussion,）,动诊（,assessment of mobility,）,量诊（,measurement,）,神经系统检查（,examination of joint motion,）,神经系统检查,neurologic check,肌张力检查,肌力检查,感觉检查,深反射,Hoffmann,征,反射检查,浅反射,Babinski,征,病理反射,髌阵挛,踝阵挛,自主神经检查,neurologic check,examination of the muscular tension,examination of the myodynamia,examination of paresthesia area,deep reflex,examination of reflex,superficial reflex,pathologic reflex,Hoffman,Babinski,patelar clonus,ankle clonua,qutonomic nerve examination,特殊检查,special,examination,Dugas,征,(,Dugas sign,),直腿抬高试验（,Lasegue sign,）,直腿抬高加强试验（,Bragard sign,）,4,字试验（,Patrick sign,）,托马斯征（,Thomas sign,）,抽屉试验（,drawer test,）,麦氏试验（,McMurray test,）,上肢神经检查 桡神经,radial nerve,正中神经,median nerve,尺神经,ulnar nerve,下肢神经检查 坐骨神经,sciatic nerve,胫神经,tibial nerve,腓总神经,commom peroneal nerve,二、骨科的基本操作技术,Basic skills of,orthopaedics,石膏绷带与夹板固定技术,（,Plaster bandage and splint,）,牵引技术,（,Traction,）,骨折手法复位技术,（,Manipulative reduction,）,石膏固定技术,石膏绷带是将无水硫酸钙（熟石灰）的细粉末撒在特制的细孔绷带上，吸水结晶后硬结成型,Plaster,bandage,is formed,fr,om,dried gypsum,which is sprinkled in special-made pore bandage,absorbing water and crystallized to be adament,石膏固定,适应证,Indication,小夹板难于固定的骨折,Bone fracture difficult for splint,开放性骨折清创缝合术后,After debridement and suturing of open fracture,病理性骨折,Pathologic fracture,骨关节术后需长时间固定于特定位置者,Need a long fixtion time in a definite location,石膏固定,注意事项,要平整,be even,塑捏成型,knead and shaping,手指足趾露出,Outerop fingers and toes,注明包石膏的日期和类型,Note bandages time and style,密切观察肢体远端的血液循环、感觉及运动,Observe distal limbs blood circulation,sense and motion,鼓励病人积极进行功能锻炼,Encourage patients to do functional exercise positively,石膏固定,注意事项,小夹板固定技术,小夹板固定的,适应证,（,Indication,）,（1）不全骨折,I,ncomplete fracture,（2）稳定性骨折,Stable fracture,（3）四肢闭合性管状骨折,Closed,tubiformal,fracture of limbs,（4）四肢开放性骨折,Open fracture of,limbs,小夹板固定的,适应证,（,Indication,）,（5）陈旧性四肢骨折仍适合于手法复位者,Old fracture of limbs,（6）石膏固定后骨折虽愈合，但尚不坚固,为缩小固定范围可用以代替石膏固定,After plaster bandage,小夹板固定技术,牵引技术,Tr,action,持续皮牵引的适应证,Indication,of,Skin traction,1.小儿股骨头骨折,Femoral head fracture of kids,2.年老体弱者的股骨骨折，夹板固定的同时辅以,The older and weaklings facture of femur,to assist,the splint,3.手术前的辅助治疗,Preoperative adjunctive therapy,4.手术后的辅助治疗,Postoperative adjunctive therapy,持续皮肤牵引,注意事项,Skin traction,牵引的重量一般不超过5Kg,Weight 5Kg,行下肢牵引时，牵引带不能压迫,腓骨头部以免压迫非总神经,Traction belt do not press the fibular head when low,er,limb traction,持续骨牵引的,适应证,Indication:,（1）成人长骨不稳定性骨折,Unstable fracture of adults long bones,（2）,肌力强大或容易移位的骨折,S,trong-muscle or easy-dislocated,fracture,骨牵引,Skeletal traction,持续骨牵引的,适应证,Indication:,（3）骨折部皮肤损伤或部分软组织缺损时,Where there is skin destruction or,some soft tissue defect,（4）开放性骨折感染或战伤骨折,Infection of open fracture or war-injury,fracture,（5）病人有严重的复合损伤，需密切观察而肢,体不宜作其它固定者,Severe complex trauma,骨牵引,Skeletal traction,常用的骨牵引,frequently used skeletal traction,股骨髁上骨折牵引,skeletal traction through supracondyle of femur,胫骨结节骨牵引,skeletal traction through tibial tuberclethroug,跟骨骨牵引,transcalcaneal traction,尺骨鹰嘴骨牵引,skeletal traction through olecranon of ulna,颅骨牵引,skull traction,特殊牵引,颌枕带牵引,骨盆悬吊牵引,骨折手法复位技术,M,anipulative,reduction,手法复位的时机,一般伤后,1,4,小时局部肿胀不严重，软组织弹性较好,1,4h after trauma,当病人有休克、昏迷等情况时，须待全身情况稳定后，才能作手法复位,After condition is stable When shock or coma happens,当伤肢出现严重的肿胀或水疱时，可待肿胀减轻后,After injury extremitys swelling or blister makes ease,手法复位方法,Me,thod,of,manipulative reduction,减除疼痛,Abate pain,肌松弛位,Muscle-relax position,对准方向,Aim at the right direction,拔伸牵引,Pull up,stretch and traction,手法复位方法,手摸心会,Feel with your hands and understand with your brain,反折、回旋,Reflexion and convolution,端提、捺正,扳正、分骨,Thank You,
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