手外伤（学习资料）ppt课件.pptVIP

乙方有义务提供相应的执业资格证、执业印章等配合甲方工程招投标、承担的工程项目报建及建设施工过程中各类手续办理。 Department of Orthopedic Surgery Zhou Xiang, M.D. Learning outcomes 熟悉手外伤的诊断方法、周围神经损伤的病因和诊断。 掌握手开放性损伤的治疗原则。 Contents 一、手外伤 　　1.创口情况检查、诊断 2.手部开放性损伤、骨折的处理原则 3.肌腱与神经损伤的诊断与处理原则 二、断肢（指）再植 　　1．断肢（指）的分类及预后 　　2．断肢（指）的急救内容及注意事项 3．常温下一般再植时限 Anatomy Hand Injury Mostly open injury May affect personality Skin Injury Tendon Injury Flexor tendon Extensor tendon Vessel Injury Neurovascular bundles Contain digital artery, vein, and nerve Two bundles: one radial and the other ulnar Radial and Ulnar arteries join in 2 arches Superficial Palmar Arch: superficial to flexor tendon Located at base of first web space Deep Palmar Arch (deep to flexor tendons) Proximal to superficial arch by 1 cm Nerve Injury Ulnar Nerve Motor Allows for power grip Innervates all hand intrinsic muscles except: Does not innervate two radial lumbricals Does not innervate thenar muscles Sensation Ulnar 1.5 fingers (palmar) Course Passes with ulnar artery via Guyons Canal in wrist Test function Finger abduction against resistance Palpate belly of first dorsal interosseus muscle Nerve Injury Median Nerve Motor Allows for fine control of pincer grasp Innervates thenar muscles and two radial lumbricals Sensation Radial 3.5 fingers, and their dorsal tips Cutaneous innervation Image Course Passes via carpal tunnel through volar wrist Test function Opposition of thumb to each finger Observe thenar muscles for contractions Nerve Injury Radial Nerve Motor Innervates extrinsic wrist and finger extensors Does not innervate any intrinsic muscles Sensation Dorsally for 3.5 fingers Cutaneous innervation image Test function Wrist and hand extension against resistance Examination and diagnosis Examination of the wound Size and location Depth of the wound Blood circulation Blood vessel injury Nerve injury Tendon injury Bone and joint injury X-ray First aid Stop bleeding Reduce contamination Temporary fix