骨科的基本操作技术.PPT

骨科的基本技术 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 24°C) 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 plast