外科学课件 9、Deng-Fx-2013.ppt

一、古代骨科简述一、古代骨科简述周朝（周朝（BC1100770） 伤骨科（疡医科：折、疡之分）伤骨科（疡医科：折、疡之分）春秋战国时期（皇帝内经）春秋战国时期（皇帝内经） 截肢术（脱痈）截肢术（脱痈）汉代华佗（汉代华佗（AC147207） 骨折复位、夹板固定，清创术，骨折复位、夹板固定，清创术， “麻沸散麻沸散” ：手术无痛原则：手术无痛原则晋代葛洪（晋代葛洪（AC261347） 竹夹板外固定骨折竹夹板外固定骨折隋代巢元方（隋代巢元方（AC581618） 骨折内固定：线连接碎骨骨折内固定：线连接碎骨唐代蔺道人唐代蔺道人“仙授理伤续断秘方仙授理伤续断秘方”： 骨折治疗四大原则：骨折治疗四大原则： 复位、固定、内外用药、功能锻炼复位、固定、内外用药、功能锻炼明代杨清叟明代杨清叟 止血带：绢袋止血带：绢袋清代江考鲫清代江考鲫 骨移植：以别骨填接骨移植：以别骨填接古希腊古希腊Hippocrates（Bc460377） 骨折脱位等的治疗骨折脱位等的治疗古罗马古罗马Galen（Ac130200） 人体解剖人体解剖16世纪世纪Azeecs 人人 骨不连内固定治疗：木片骨不连内固定治疗：木片Orthopaedics named in 1741Nicholas Andry coined the word. Orthos: correct, straight. Paedion: childJean-Andre Venel(1740-1791): Venevese, be called the Father of OrthopaedicsPlaster cast of Paris 1751Movement system(Orthopaedics) is composed with spine, extremities, bone, joint, muscles, vessels, nerves, lymph, fascia, synovium, etc.现代骨科及相关组织AASOS骨科骨科 需要创造性需要创造性 相关学科的发展相关学科的发展Creative , Innovation Multiidiciplines developmentOrthopaedicsOrthopaedicsINTRODUCTION OF FRACTUREZhong-Liang Deng Prof., MD, Ph.D 邓忠良邓忠良 Department of Orthopaedics Second Affiliated Hospital Chongqing Medical UniversityDefinition ClassificationTreatmentPrognosisHealing process and the affecting factorsClinical findings and imageology examinationCausesEmergency care Bone Fracture1. DEFINITION OF FRACTUREA fracture is a break in the continuity of a bone2. Causes of fracturesTraumaDirect forceDirect force causes the fracture2. Causes of fracturesTraumaDirect forceIndirect force Indirect force causes the fractureMuscular contraction force2. Causes of fracturesTraumaDirect forceIndirect force fracture caused by muscular contractionCyclic forceMuscular contraction force2. Causes of fracturesTraumaDirect forceIndirect force Bone diseasesLocalized diseasesGeneralized diseasesCyclic forceMuscular contraction force2. Causes of fracturesTraumaDirect forceIndirect force tubercular osteomyelitis, osteosarcoma, localized metastatic carcinoma, etc.osteoporosis, multiple myeloma, diffuse metaststic carcinoma, etc.3. Classification of fracturesOn the basis of etiology Traumatic fracturePathological fractureTraumatic fracturePathological fractureOn the basis of relationship with external environment Closed fractureOpen fracture3. Classification of fracturesOn the basis of etiology Open fractureOn the basis of patternOn the basis of relationship with external environment 3. Classification of fracturesOn the basis of aetiology Comminuted“T” fractureTransverseObliqueSpiralOn the basis of displacementsUndisplaced fractureOn the basis of patternOn the basis of relationship with external environment 3. Classification of fracturesOn the basis of aetiology No significant displacement fracturesDisplaced fracture angulation shift overlap gap rotation Different sorts of displaced fracturesFactors responsible for displacements The fracturing forceThe muscle pull on the fracture fragmentsThe gravityIncorrect medical careOn the basis of displacementsOn the basis of patternOn the basis of relationship with external environment 3. Classification of fracturesOn the basis of aetiology On the basis of timefresh fractureold fractureWithin 3 wksover 3 wksOn the basis of displacementsOn the basis of patternOn the basis of relationship with external environment 3. Classification of fracturesOn the basis of aetiology On the basis of timestable fractureunstable fractureOn the basis of stabilityAO/ASIF CLASSIFICATIONAO (Arbeitsgemeinschaft fur Osteosynthesefragen)ASIF (Association for the Study of Internal Fixation)Location + type + subtype + group骨折的AO分型12-A14. Emergency care of fracturesRescue the lifeABCDEF stepsABCDEFAir way and breathingBleeding and circulationCentral nerve systemDigestive systemExcretionFracture(Mc Murtry 1980)Manage the wound 4. Emergency care of fracturesPreserve the lifeImmobilize the fractureManage the wound 4. Emergency care of fracturesPreserve the lifeTransfer the patientImmobilize the fractureManage the wound 4. Emergency care of fracturesPreserve the lifeTwo methods to transport the spine fracturerollingliftingFalse method to transport the spine fractureDefinition ClassificationTreatmentPrognosisHealing Process and the affecting factorsClinical findings and imaging studiesCausesEmergency careFractureCLINICAL & RADIOLOGICAL FEATURESCLINICAL & RADIOLOGICAL FEATURESSystemic Manifestations Primary Shock ( Neurogenic Shock ) Secondary Shock Haemorrhage Notice : exclude to cerebral injury and respiratory embarrassment CLINICAL & RADIOLOGICAL FEATURESCLINICAL & RADIOLOGICAL FEATURES Local Manifestation Swelling Traumatic Inflammation Pain Impairment of function Deformity Specific Signs Abnormal Motion Bony Crepitus or GratingCLINICAL & RADIOLOGICAL FEATURESCLINICAL & RADIOLOGICAL FEATURESCLINICAL & RADIOLOGICAL FEATURES Imageology Examination Fracture yes or no ? Pattern of fracture Decide the Treatment MethodsCOMPLICATION OF FRACTURE Early Complications Shock Fat embolism Injury to Important Organ and Tissue Osteofascial Compartment Syndrome COMPLICATION OF FRACTURE 。