骨科的基本操作技术

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,*,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（,plaster support),石膏夹板,(splint),石膏管型,(cast),躯干石膏,(trunk plaster),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，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,Plaster splints,Slightly warm(not over 24C)water and bucket,Stockinette,(optional),Soft cotton bandage/,undersplint,material(e.g.,Webril,padding),available in 2-,3-,4-,and 6-inch width sizes,Plaster bandages,available in 2-,3-,4-,and 6-inch width sizes,Elastic bandages(Ace),Adhesive tape,Procedure,Important considerations before splinting,Examine the extremity for evidence of an open fracture,which would require cleaning,debridement,and specialist evaluation before splinting.,Perform a detailed neurovascular examination before splinting.,Perform reduction if the fracture has significant displacement or misalignment.,Obtain appropriate radiographic studies,General technique of applying plaster splints,Apply,stockinette,to the extremity(optional).Be careful to avoid wrinkles.,Measure the required length of splinting material.Then place an additional 3 layers of,Webril,onto the layer that was used to measure the length.,Place layers of dry plaster bandages onto the,Webril,.In general,upper extremity splints require 8-10 layers of plaster,whereas lower extremity splints will require 10-15 layers.,Soak the layers of plaster bandages in room temperature water in bucket.,Raise the layers vertically over the bucket,firmly holding each end of the roll in your hands.Remove excess water.,Place the wet plaster onto the cast padding(,Webril,),and smooth the surface.,Fold the overhanging edges of cast padding over the plaster and fold any excess padding over the ends of the splint.,Carefully place splint in the desired location.,Gently mold the plaster using the palms of your hands(not finger tips).,Roll an elastic bandage over the splint,from distal to proximal with an overlap of approximately 50%.,Gently mold the splint again to the extremity.,骨牵引技术,利用牵引力和反牵引力作用于骨折部位，达到复位和固定的目的，也是肢体炎症的制动和挛缩畸形肢体的治疗,类型,持续性皮肤牵引,持续性骨胳牵引,特殊类型,皮肤牵引,重量不超过,5kg,，注意腓骨头部的保护,适应症：小儿股骨骨折,老年体弱者,术前及术后的辅助治疗,骨牵引,适应症,成人长骨不稳定性骨折,肌强大或容易移位的骨折,骨折部位的皮肤损伤或软组织缺损时,开放性骨折感染或战伤骨折,复合性损伤，密切观察肢体不宜固定时,常见的骨牵引,股骨髁上牵引,移位的股骨骨折，骨盆环骨折，髋关节脱位,陈旧性髋关节脱位或先天性髋关节脱位的术前准备,进针点：髌骨上缘作和股骨垂直的横线,股骨内髁隆起的最高点的垂直线,内,-,外，重量,1/7-1/8,注意：收肌腱裂孔股血管和神经,胫骨结节牵引,进针点：胫骨结节和腓骨小头连线中点,外,-,内，腓总神经,跟骨结节骨牵引,进针点：内踝尖和足跟后下缘连线的中点,4-6kg,颅骨牵引,进针点：两侧乳突作冠状线，沿鼻尖到枕外隆突的矢状线，一般为两侧眉弓外缘矢状线和乳突冠状线的交点,6-8kg,，一般不超过,15kg,颈部伸屈调整，利于复位,特殊牵引,枕颌带,骨盆悬吊牵引,关节穿刺技术,穿刺抽液检查,/,引流,药物注射治疗,关节造影,注意事项,无菌操作,边抽边进针，吸出血液，退针改变方向,不宜过深，避免软骨损伤,关节腔内类固醇注射，一年不超过,3,次,明显关节积液时，加压包扎，适当固定，一周不超过两次,Shoulder,knee,ankle,骨折手法复位,三点固定原理和杠杆原理,复位时机,伤后,1-4,小时，肿胀不明显，软组织弹性好，,休克昏迷时，待全身情况平稳后手法复位,伤肢出现严重的肿胀，水疱，待消肿后复位,解除疼痛,肌肉松弛,对准方向,拔伸牵引,手模心会,反折回旋,端提捺正,板正分骨,