骨肌系统诊断步骤.pptVIP

Approach to Musculoskeletal Injuries Worth Everett, MD Department of Emergency Medicine Hospital of the University of Pennsylvania Guidance For This Lecture Musculoskeletal Medicine (2003) American Academy of Orthopaedic Surgeons, American Academy of Family Physicians, American Academy of Pediatrics Editor: Dr. Joseph Bernstein Musculoskeletal Emergencies (authors: W. Everett and G. Militello) OVERVIEW Significant percentage of all emergency room care rendered. In HUP ED, over 6 month period, survey showed chief complaint of musculoskeletal problem comprised approx. 11% of all patients (1 in 9). Musculoskeletal Injuries ED physician needs a coherent, systematic approach to orthopaedic complaints. Severity ranges from trivial sprains to life- or limb-threatening trauma. Often acute trauma is the cause of the presentation. Pain and decreased ROM are the main symptoms. What We Commonly See Musculoskeletal disorders commonly seen in the ED include: Soft Tissue Injuries (strains and sprains)** Fractures (open, closed, long bone, pelvic, occult) Dislocations Infections (soft-tissue, bite wounds)** Effusions ** Deep venous thrombosis Less Common But… Musculoskeletal disorders less commonly seen in the ED, but unmistakably important: Spinal Injuries Crush Injuries Compartment syndrome FRACTURES Fractures A partial or complete break in a bone. Bone is the only tissue in the human body other than liver that heals by regeneration instead of by scarring. For regeneration to occur the bone must be immobilized to allow uninterrupted formation of new bone. Fractures New Bone Formation: A hematoma forms between realigned Fx fragments. Hematopoietic cells in the hematoma secrete growth factors (GF’s). GF’s stimulate formation of granulation tissue at the Fx ends, slowly resorbing the hematoma. A primary callus forms, progressing from a soft callus to hard callus. Final phase of healing: during remodeling the bone reassumes its original architecture. Fractures Nomenclature