小儿骨科的临床基础课件

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,*,小儿骨科的临床基础,小儿骨科的临床基础,病史,现病史,出生史（产伤骨折、臂丛神经麻痹、脑瘫等）,发育史（侏儒、甲低、肌营养不良等）,家族史（多指、多发骨软骨瘤病等）,病史现病史,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,体格检查望（整体外观，冠状面、矢状面、水平面）,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（,05,级）,体格检查触,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，不能对抗阻力。,4,级：能对抗一定程度的阻力,5,级：肌力正常,Lovett and Martins,肌力分级法,Texas Scottish Rite Hospital,肌力分级法,肌力0级：无任何收缩,Normal Times of Appearance and Disappearance of Infantile Reflexes and Reactions,Palmar (hand) grasp reflex,Present in neonates and very young infants; normally disappears between ages 2 and 4 mo,Plantar (foot) grasp reflex,Present in neonates and infants; usually disappears between ages 9 and 12 mo,Moros reflex,Present at birth; gradually disappears by ages 3-6 mo,：,CNS,Startle reflex,Appears at birth; present throughout life,Vertical suspension positioning,Reflex normally disappears after age 4 mo,Placing reaction,Normally present at birth in full-term neonates; upper limb placing usually disappears by ages 2-4 mo and lower limb placing by ages 1-2 mo; both responses may persist up to age 12 mo or older,Walking or stepping reflex,Normally present at birth; usually disappears by ages 1-2 mo,Crossed extension reflex,Present at birth; normally disappears by ages 1-2 mo,Withdrawal reflex,Present at birth; disappears between ages 1 and 2 mo,Positive support response/leg-straightening reflex,Present at birth; normally disappears at about 4 mo,Extensor thrust reflex,Present at birth; normally present up to 2 mo,Galants reflex (trunk incurvation),Present at birth; disappears at about 2-2 mo,Rotation reflex,Time of disappearance varies,Tonic neck reflexes,Asymmetric reflex present at birth, normally disappears by 4-6 mo; symmetric reflex usually present by 5-8 mo, often diminished or absent by 12 mo,Landaus reflex,Normally present from 6 mo to 24-30 mo,Parachute reaction,Appears at about 6 mo; remains throughout life,Neck righting reflex,Normally present from birth to about 6 mo,Body righting reflex,Appears around 6 mo; can disappear any time after 5 yr or persist throughout life,Oral reflexes,Usually disappear at 3-4 mo; may be present longer during sleep,Normal Times of Appearance an,深反射,肱二头肌反射,肱三头肌反射,膝反射,踝反射,深反射肱二头肌反射,浅反射,Babibski,反射,提睾反射,Hoffmann,反射,括约肌反射,腹壁反射,浅反射Babibski反射,Muscle,Segmental Innervation,Peripheral Nerve,Trapezius,Cranial XI; C(2)3-4,Spinal accessory nerve,Levator anguli scapulae,C3-4,Nerves to levator anguli scapulae,C4-5,Dorsal scapular nerve,Rhomboideus major,C4-5,Dorsal scapular nerve,Rhomboideus minor,C4-5,Dorsal scapular nerve,Serratus anterior,C5-7,Long thoracic nerve,Deltoid,C5-6,Axillary nerve,Teres minor,C5-6,Axillary nerve,Supraspinatus,C(4)5-6,Suprascapular nerve,Infraspinatus,C(4)5-6,Suprascapular nerve,Latissimus dorsi,C6-8,Thoracodorsal nerve (long subscapular),Pectoralis major,C5-T1,Lateral and medial anterior thoracic,Pectoralis minor,C7-T1,Medial anterior thoracic,Subscapularis,C5-7,Subscapular nerves,Teres major,C5-7,Lower subscapular nerve,Subclavius,C5-6,Nerve to subclavius,Coracobrachialis,C6-7,Musculocutaneous nerve,Biceps brachii,C5-6,Musculocutaneous nerve,Brachialis,C5-6,Musculocutaneous nerve,MuscleSegmental InnervationPer,Brachioradialis,C5-6,Radial nerve,Triceps brachii,C6-8(T1),Radial nerve,Anconeus,C7-8,Radial nerve,Supinator brevis,C5-7,Radial nerve,Extensor carpi radialis longus,C(5)6-7(8),Radial nerve,Extensor carpi radialis brevis,C(5)6-7(8),Radial nerve,Extensor carpi ulnaris,C6-8,Radial nerve,Extensor digitorum communis,C6-8,Radial nerve,Extensor indicis proprius,C6-8,Radial nerve,Extensor digiti minimi proprius,C6-8,Radial nerve,Extensor pollicis longus,C6-8,Radial nerve,Extensor pollicis brevis,C6-8,Radial nerve,Abductor pollicis longus,C6-8,Radial nerve,Pronator teres,C6-7,Median nerve,Flexor carpi radialis,C6-7(8),Median nerve,Pronator quadratus,C7-T1,Median nerve,Palmaris longus,C7-T1,Median nerve,Flexor digitorum sublimis,C7-T1,Median nerve,Flexor digitorum profundus (radial half),C7-T1,Median nerve,Lumbricales 1 and 2,C7-T1,Median nerve,Flexor pollicis longus,C8-T1,Median nerve,Flexor pollicis brevis (lateral head),C8-T1,Median nerve,Abductor pollicis brevis,C8-T1,Median nerve,Opponens pollicis,C8-T1,Median nerve,BrachioradialisC5-6Radial nerv,Flexor carpi ulnaris,C7-T1,Ulnar nerve,Flexor digitorum profundus (ulnar half),C7-T1,Ulnar nerve,Interossei,C8-T1,Ulnar nerve,Lumbricales 3 and 4,C8-T1,Ulnar nerve,Flexor pollicis brevis (medial head),C8-T1,Ulnar nerve,Flexor digiti minimi brevis,C8-T1,Ulnar nerve,Abductor digiti minimi,C8-T1,Ulnar nerve,Opponens digiti minimi,C8-T1,Ulnar nerve,Palmaris brevis,C8-T1,Ulnar nerve,Adductor pollicis,C8-T1,Ulnar nerve,Flexor carpi ulnarisC7-T1Ulnar,Muscle,Segmental Innervation,Peripheral Nerve,Psoas major,L(1)2-4,Nerve to psoas major,Psoas minor,L1-2,Nerve to psoas minor,Iliacus,L2-4,Femoral nerve,Quadriceps femoris,L2-4,Femoral nerve,Sartorius,L2-4,Femoral nerve,Pectineus,L2-4,Femoral nerve,Gluteus maximus,L5-S2,Inferior gluteal nerve,Gluteus medius,L4-S1,Superior gluteal nerve,Gluteus minimus,L4-S1,Superior gluteal nerve,Tensor fasciae latae,L4-S1,Superior gluteal nerve,Piriformis,S1-2,Nerve to piriformis,Adductor longus,L2-4,Obturator nerve,Adductor brevis,L2-4,Obturator nerve,Adductor magnus,L2-4,Obturator nerve,L4-5,Sciatic nerve,Gracilis,L2-4,Obturator nerve,Obturator externus,L2-4,Obturator nerve,Obturator internus,L5-S3,Nerve to obturator internus,Gemellus superior,L5-S3,Nerve to obturator internus,Gemellus inferior,L4-S1,Nerve to quadratus femoris,Quadratus femoris,L4-S1,Nerve to quadratus femoris,Biceps femoris (long head),L5-S1,Tibial nerve,Semimembranosus,L4-S1,Tibial nerve,Semitendinosus,L5-S2,Tibial nerve,Popliteus,L5-S1,Tibial nerve,Gastrocnemius,L5-S2,Tibial nerve,Soleus,L5-S2,Tibial nerve,MuscleSegmental InnervationPer,Plantaris,L5-S1,Tibial nerve,Tibialis posterior,L5-S1,Tibial nerve,Flexor digitorum longus,L5-S1,Tibial nerve,Flexor hallucis longus,L5-S1,Tibial nerve,Biceps femoris (short head),L5-S2,Common peroneal nerve,Tibialis anterior,L4-S1,Deep peroneal nerve,Peroneus tertius,L4-S1,Deep peroneal nerve,Extensor digitorum longus,L4-S1,Deep peroneal nerve,Extensor hallucis longus,L4-S1,Deep peroneal nerve,Extensor digitorum brevis,L4-S1,Deep peroneal nerve,Extensor hallucis brevis,L4-S1,Deep peroneal nerve,Peroneus longus,L4-S1,Superficial peroneal nerve,Peroneus brevis,L4-S1,Superficial peroneal nerve,Flexor digitorum brevis,L4-S1,Medial plantar nerve,Flexor hallucis brevis,L5-S1,Medial plantar nerve,Abductor hallucis,L4-S1,Medial plantar nerve,Lumbricales (medial 1 or 2),L4-S1,Medial plantar nerve,Quadratus plantae,S1-2,Lateral plantar nerve,Adductor hallucis,L5-S2,Lateral plantar nerve,Abductor digiti quinti,S1-2,Lateral plantar nerve,Flexor digiti quinti brevis,S1-2,Lateral plantar nerve,Lumbricales (lateral 2 or 3),S1-2,Lateral plantar nerve,Interossei,S1-2,Lateral plantar nerve,PlantarisL5-S1Tibial nerveTibi,临床检查,腹壁反射,敲击试验,Barlow,试验,Coleman,试验（足外翻）,Ely,试验（股直肌）,足前进角,前弯试验,Galeazzi,征,Gower,试验,髋关节旋转实验,Nelaton,线,Ober,试验,Ortolani,试验,Patrick,试验,Phelps,股薄肌试验,Thomas,试验,腘窝角,Trenderlenburg,试验,临床检查腹壁反射Nelaton线,体格检查,动（肢体活动范围）,屈：关节弯曲活动，关节向远离中立位的方向活动。,伸：关节伸直活动，关节向靠近中立位的方向活动。,过伸：关节伸展超过中立位的范围（膝关节和肘关节）,内收：肢体向靠近身体的中线的方向移动,外展：肢体向远离身体的中线的方向移动,旋后：前臂或手部的掌面向前或指向身体的前面,旋前：前臂或手部的掌面向后或指向身体的后面,内翻：向内翻转（中立位）,外翻：向外翻转（中立位）,内旋：向着身体轴线的方向旋转,外旋：远离身体轴线的方向旋转,体格检查动（肢体活动范围）,Flexion:,Act of bending a joint; a motion away from the zero starting position.,Extension:,Act of straightening a joint; a return motion to the zero starting position.,Hyperextension:,When the motion opposite to flexion is an extreme or abnormal extension (as may be seen with the knee or elbow joint), and the joint extends beyond the zero starting position.,Abduction:,Lateral movement of the limbs away from the median plane of the body, or lateral bending of the head or trunk.,Adduction:,Movement of a limb toward the median plane of the body.,Supination:,Act of turning the forearm or hand so that the palm of the hand faces upward or toward the anterior surface of the body.,Pronation:,Turning of the palm of the hand so that it faces downward or toward the posterior surface of the body.,Inversion:,An inward turning motion (seen primarily in the subtalar joint of the foot).,Eversion:,An outward turning motion.,Internal (inward) rotation:,Process of turning on an axis toward the body.,External (outward) rotation:,Process of turning on an axis away from the body (opposite motion of internal rotation).,Flexion: Act of bending a join,体格检查,颈椎（屈、伸、左侧屈、右侧屈、左环转、右环转）,体格检查颈椎（屈、伸、左侧屈、右侧屈、左环转、右环转）,体格检查,腰椎（屈、伸、左侧屈、右侧屈、左旋转、右旋转）,体格检查腰椎（屈、伸、左侧屈、右侧屈、左旋转、右旋转）,体格检查,肩关节（屈、伸、外展、上举、前伸、后伸、左环转、右环转）,体格检查肩关节（屈、伸、外展、上举、前伸、后伸、左环转、右环,小儿骨科的临床基础课件,小儿骨科的临床基础课件,小儿骨科的临床基础课件,体格检查,肘关节（屈、伸）,体格检查肘关节（屈、伸）,前臂（旋前、旋后）,体格检查,前臂（旋前、旋后）体格检查,体格检查,腕关节（掌屈、背屈、尺偏、桡偏）,60,60 ,30 ,20 ,体格检查腕关节（掌屈、背屈、尺偏、桡偏）,体格检查,掌指关节和指间关节（屈、伸）,-2090,（掌指）,-30100,（近侧指间）,-2070,（远侧指间）,-4060,（拇指掌指关节）,-3080,（拇指指间关节）,体格检查掌指关节和指间关节（屈、伸）,体格检查,髋关节（屈、伸、内收、外展、内旋、外旋）,体格检查髋关节（屈、伸、内收、外展、内旋、外旋）,体格检查,膝关节（屈、伸）,体格检查膝关节（屈、伸）,体格检查,踝关节（背屈、跖屈）,体格检查踝关节（背屈、跖屈）,体格检查,量,（各种身体轴线长度和关节活动角度）,体格检查量（各种身体轴线长度和关节活动角度）,骨科换药操作,带帽子和口罩,洗手,剪开石膏，显露患肢（尽量保持肢体位置不变）,去除敷料,切口或创面消毒（污染和非污染创口）,敷料包扎（厚度和形状尽可能与去除敷料一致）,石膏固定，包扎绷带，固定患肢,洗手,去除帽子和口罩,骨科换药操作带帽子和口罩,骨科石膏固定要求,普通石膏：跨越骨折处上下关节固定；上肢,810,层石膏绷带，,23,层棉花衬垫；下肢,1214,层石膏绷带，,34,层棉花衬垫；要注意骨突部位；尽可能不翻转石膏；管形石膏固定时过关节时要走,8,字；管形石膏固定后要注意患肢血运（,5P,）；刚刚发生外伤时，骨折移位明显，石膏固定以患儿最舒适的体位（痛苦程度最轻）固定，可随弯就弯，不要求功能位；骨折移位不明显，则尽可能行,功能位,固定。,骨科石膏固定要求普通石膏：跨越骨折处上下关节固定；上肢81,如何判断血管神经损伤,血管损伤：以动脉搏动为准（桡动脉和足背动脉）；手部和足部的色泽（暗红色或紫色），肢体常伴有难以忍受的疼痛。,神经损伤：以神经支配的肌肉活动进行判断。,如何判断血管神经损伤血管损伤：以动脉搏动为准（桡动脉和足背动,