骨科的基本操作技術(shù)課件

骨科的基本技術(shù)

骨科魏建軍1骨科的基本技術(shù)石膏固定技術(shù)牽引技術(shù)關(guān)節(jié)穿刺技術(shù)骨折手法復(fù)位技術(shù)2石膏固定技術(shù)2石膏固定技術(shù)石膏繃帶無(wú)水硫酸鈣粉沫3石膏固定技術(shù)石膏繃帶3石膏固定的優(yōu)缺點(diǎn)三點(diǎn)固定原理，固定確實(shí)，塑形方便，便于護(hù)理沉重，透氣性差，影響攝片，關(guān)節(jié)僵硬4石膏固定的優(yōu)缺點(diǎn)4用法：骨隆突部皮膚保護(hù)襯墊上肢：10-12層下肢：12-15層周徑的2/35用法：骨隆突部皮膚保護(hù)5常用石膏固定類型石膏托（plastersupport)石膏夾板(splint)石膏管型(cast)軀干石膏(trunkplaster)6常用石膏固定類型6適應(yīng)癥1小夾板難于固定的骨折，脊柱骨折2開(kāi)放性骨折清創(chuàng)縫合術(shù)后3病理性骨折4某些骨關(guān)節(jié)術(shù)后：關(guān)節(jié)融合5畸形矯正術(shù)后：三關(guān)節(jié)融合6化膿性骨髓炎，關(guān)節(jié)炎，固定患肢，減輕疼痛，控制炎癥7某些軟組織損傷：肌腱，肌肉，血管，神經(jīng)損傷7適應(yīng)癥7注意事項(xiàng)1平整，切勿將石膏繃帶扭轉(zhuǎn)后包扎，防止皺折2塑型成型，符合肢體輪廓。下肢注意足弓塑形3手指及足趾露出，觀察血液循環(huán)，感覺(jué)和活動(dòng)能力。有劇痛，麻木及血運(yùn)障礙及時(shí)松解，防止發(fā)生缺血性肌攣縮和肢體壞死4注意注明時(shí)間，及表明傷口位置和開(kāi)窗5防止骨質(zhì)疏松和肌萎縮，鼓勵(lì)功能鍛煉8注意事項(xiàng)8PlastersplintsSlightlywarm(notover24°C)waterandbucketStockinette(optional)Softcottonbandage/undersplintmaterial(e.g.,Webril?padding),availablein2-,3-,4-,and6-inchwidthsizesPlasterbandages,availablein2-,3-,4-,and6-inchwidthsizesElasticbandages(Ace)Adhesivetape9PlastersplintsSlightlywarm(ProcedureImportantconsiderationsbeforesplintingExaminetheextremityforevidenceofanopenfracture,whichwouldrequirecleaning,debridement,andspecialistevaluationbeforesplinting.Performadetailedneurovascularexaminationbeforesplinting.Performreductionifthefracturehassignificantdisplacementormisalignment.Obtainappropriateradiographicstudies10ProcedureImportantconsideratiGeneraltechniqueofapplyingplastersplintsApplystockinettetotheextremity(optional).Becarefultoavoidwrinkles.Measuretherequiredlengthofsplintingmaterial.Thenplaceanadditional3layersofWebril?ontothelayerthatwasusedtomeasurethelength.11GeneraltechniqueofapplyingPlacelayersofdryplasterbandagesontotheWebril?.Ingeneral,upperextremitysplintsrequire8-10layersofplaster,whereaslowerextremitysplintswillrequire10-15layers.Soakthelayersofplasterbandagesinroomtemperaturewaterinbucket.Raisethelayersverticallyoverthebucket,firmlyholdingeachendoftherollinyourhands.Removeexcesswater.Placethewetplasterontothecastpadding(Webril?),andsmooththesurface.12PlacelayersofdryplasterbaFoldtheoverhangingedgesofcastpaddingovertheplasterandfoldanyexcesspaddingovertheendsofthesplint.Carefullyplacesplintinthedesiredlocation.Gentlymoldtheplasterusingthepalmsofyourhands(notfingertips).Rollanelasticbandageoverthesplint,fromdistaltoproximalwithanoverlapofapproximately50%.Gentlymoldthesplintagaintotheextremity.

13Foldtheoverhangingedgesof骨牽引技術(shù)利用牽引力和反牽引力作用于骨折部位，達(dá)到復(fù)位和固定的目的，也是肢體炎癥的制動(dòng)和攣縮畸形肢體的治療14骨牽引技術(shù)利用牽引力和反牽引力作用于骨折部位，達(dá)到復(fù)位和固定類型持續(xù)性皮膚牽引持續(xù)性骨胳牽引特殊類型15類型15皮膚牽引重量不超過(guò)5kg，注意腓骨頭部的保護(hù)適應(yīng)癥：小兒股骨骨折老年體弱者術(shù)前及術(shù)后的輔助治療16皮膚牽引16骨牽引適應(yīng)癥成人長(zhǎng)骨不穩(wěn)定性骨折肌強(qiáng)大或容易移位的骨折骨折部位的皮膚損傷或軟組織缺損時(shí)開(kāi)放性骨折感染或戰(zhàn)傷骨折復(fù)合性損傷，密切觀察肢體不宜固定時(shí)17骨牽引適應(yīng)癥17常見(jiàn)的骨牽引股骨髁上牽引移位的股骨骨折，骨盆環(huán)骨折，髖關(guān)節(jié)脫位陳舊性髖關(guān)節(jié)脫位或先天性髖關(guān)節(jié)脫位的術(shù)前準(zhǔn)備進(jìn)針點(diǎn)：髕骨上緣作和股骨垂直的橫線股骨內(nèi)髁隆起的最高點(diǎn)的垂直線內(nèi)----外，重量1/7---1/8注意：收肌腱裂孔股血管和神經(jīng)18常見(jiàn)的骨牽引股骨髁上牽引18脛骨結(jié)節(jié)牽引進(jìn)針點(diǎn)：脛骨結(jié)節(jié)和腓骨小頭連線中點(diǎn)外---內(nèi)，腓總神經(jīng)19脛骨結(jié)節(jié)牽引19跟骨結(jié)節(jié)骨牽引進(jìn)針點(diǎn)：內(nèi)踝尖和足跟后下緣連線的中點(diǎn)

4-6kg20跟骨結(jié)節(jié)骨牽引20顱骨牽引進(jìn)針點(diǎn)：兩側(cè)乳突作冠狀線，沿鼻尖到枕外隆突的矢狀線，一般為兩側(cè)眉弓外緣矢狀線和乳突冠狀線的交點(diǎn)

6-8kg，一般不超過(guò)15kg

頸部伸屈調(diào)整，利于復(fù)位21顱骨牽引212222特殊牽引枕頜帶骨盆懸吊牽引23特殊牽引枕頜帶23關(guān)節(jié)穿刺技術(shù)穿刺抽液檢查/引流藥物注射治療關(guān)節(jié)造影24關(guān)節(jié)穿刺技術(shù)穿刺抽液檢查/引流242525注意事項(xiàng)無(wú)菌操作邊抽邊進(jìn)針，吸出血液，退針改變方向不宜過(guò)深，避免軟骨損傷關(guān)節(jié)腔內(nèi)類固醇注射，一年不超過(guò)3次明顯關(guān)節(jié)積液時(shí)，加壓包扎，適當(dāng)固定，一周不超過(guò)兩次26注意事項(xiàng)無(wú)菌操作26Shoulder27Shoulder27knee28knee28ankle29ankle29骨折手法復(fù)位三點(diǎn)固定原理和杠桿原理復(fù)位時(shí)機(jī)傷后1-4小時(shí)，腫脹不明顯，軟組織彈性好，休克昏迷時(shí)，待全身情況平穩(wěn)后手法復(fù)位傷肢出現(xiàn)嚴(yán)重的腫脹，水皰，待消腫后復(fù)位30骨折手法復(fù)位三點(diǎn)固定原理和杠桿原理30解除疼痛肌肉松弛對(duì)準(zhǔn)方向拔伸牽引手模心會(huì)反折回旋端提捺正板正分骨31解除疼痛31骨科的基本技術(shù)

骨科魏建軍32骨科的基本技術(shù)石膏固定技術(shù)牽引技術(shù)關(guān)節(jié)穿刺技術(shù)骨折手法復(fù)位技術(shù)33石膏固定技術(shù)2石膏固定技術(shù)石膏繃帶無(wú)水硫酸鈣粉沫34石膏固定技術(shù)石膏繃帶3石膏固定的優(yōu)缺點(diǎn)三點(diǎn)固定原理，固定確實(shí)，塑形方便，便于護(hù)理沉重，透氣性差，影響攝片，關(guān)節(jié)僵硬35石膏固定的優(yōu)缺點(diǎn)4用法：骨隆突部皮膚保護(hù)襯墊上肢：10-12層下肢：12-15層周徑的2/336用法：骨隆突部皮膚保護(hù)5常用石膏固定類型石膏托（plastersupport)石膏夾板(splint)石膏管型(cast)軀干石膏(trunkplaster)37常用石膏固定類型6適應(yīng)癥1小夾板難于固定的骨折，脊柱骨折2開(kāi)放性骨折清創(chuàng)縫合術(shù)后3病理性骨折4某些骨關(guān)節(jié)術(shù)后：關(guān)節(jié)融合5畸形矯正術(shù)后：三關(guān)節(jié)融合6化膿性骨髓炎，關(guān)節(jié)炎，固定患肢，減輕疼痛，控制炎癥7某些軟組織損傷：肌腱，肌肉，血管，神經(jīng)損傷38適應(yīng)癥7注意事項(xiàng)1平整，切勿將石膏繃帶扭轉(zhuǎn)后包扎，防止皺折2塑型成型，符合肢體輪廓。下肢注意足弓塑形3手指及足趾露出，觀察血液循環(huán)，感覺(jué)和活動(dòng)能力。有劇痛，麻木及血運(yùn)障礙及時(shí)松解，防止發(fā)生缺血性肌攣縮和肢體壞死4注意注明時(shí)間，及表明傷口位置和開(kāi)窗5防止骨質(zhì)疏松和肌萎縮，鼓勵(lì)功能鍛煉39注意事項(xiàng)8PlastersplintsSlightlywarm(notover24°C)waterandbucketStockinette(optional)Softcottonbandage/undersplintmaterial(e.g.,Webril?padding),availablein2-,3-,4-,and6-inchwidthsizesPlasterbandages,availablein2-,3-,4-,and6-inchwidthsizesElasticbandages(Ace)Adhesivetape40PlastersplintsSlightlywarm(ProcedureImportantconsiderationsbeforesplintingExaminetheextremityforevidenceofanopenfracture,whichwouldrequirecleaning,debridement,andspecialistevaluationbeforesplinting.Performadetailedneurovascularexaminationbeforesplinting.Performreductionifthefracturehassignificantdisplacementormisalignment.Obtainappropriateradiographicstudies41ProcedureImportantconsideratiGeneraltechniqueofapplyingplastersplintsApplystockinettetotheextremity(optional).Becarefultoavoidwrinkles.Measuretherequiredlengthofsplintingmaterial.Thenplaceanadditional3layersofWebril?ontothelayerthatwasusedtomeasurethelength.42GeneraltechniqueofapplyingPlacelayersofdryplasterbandagesontotheWebril?.Ingeneral,upperextremitysplintsrequire8-10layersofplaster,whereaslowerextremitysplintswillrequire10-15layers.Soakthelayersofplasterbandagesinroomtemperaturewaterinbucket.Raisethelayersverticallyoverthebucket,firmlyholdingeachendoftherollinyourhands.Removeexcesswater.Placethewetplasterontothecastpadding(Webril?),andsmooththesurface.43PlacelayersofdryplasterbaFoldtheoverhangingedgesofcastpaddingovertheplasterandfoldanyexcesspaddingovertheendsofthesplint.Carefullyplacesplintinthedesiredlocation.Gentlymoldtheplasterusingthepalmsofyourhands(notfingertips).Rollanelasticbandageoverthesplint,fromdistaltoproximalwithanoverlapofapproximately50%.Gentlymoldthesplintagaintotheextremity.

44Foldtheoverhangingedgesof骨牽引技術(shù)利用牽引力和反牽引力作用于骨折部位，達(dá)到復(fù)位和固定的目的，也是肢體炎癥的制動(dòng)和攣縮畸形肢體的治療45骨牽引技術(shù)利用牽引力和反牽引力作用于骨折部位，達(dá)到復(fù)位和固定類型持續(xù)性皮膚牽引持續(xù)性骨胳牽引特殊類型46類型15皮膚牽引重量不超過(guò)5kg，注意腓骨頭部的保護(hù)適應(yīng)癥：小兒股骨骨折老年體弱者術(shù)前及術(shù)后的輔助治療47皮膚牽引16骨牽引適應(yīng)癥成人長(zhǎng)骨不穩(wěn)定性骨折肌強(qiáng)大或容易移位的骨折骨折部位的皮膚損傷或軟組織缺損時(shí)開(kāi)放性骨折感染或戰(zhàn)傷骨折復(fù)合性損傷，密切觀察肢體不宜固定時(shí)48骨牽引適應(yīng)癥17常見(jiàn)的骨牽引股骨髁上牽引移位的股骨骨折，骨盆環(huán)骨折，髖關(guān)節(jié)脫位陳舊性髖關(guān)節(jié)脫位或