小儿骨科的临床基础汇编.ppt

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8~10层石膏绷带，2~3层棉花衬垫；下肢12~14层石膏绷带，3~4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。 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。 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） 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，不能对抗阻力。 4级：能对抗一定程度的阻力 5级：肌力正常 Lovett and Martin’s肌力分级法 Texas Scottish Rite Hospital肌力分级法 ?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