级大理学院双语教学查房PPT课件

1、 没有比脚更长的路，没有比人更高的山，我们相信只要我们努力、坚持，我们的梦想一定会实现。相信吧！ “Yes, we can!”第1页/共49页关键词关键词 key Words 胫腓骨干骨折 Fracture of the Tibiofibula 畸形和疼痛 Deformity and pain 牵引 Traction 功能锻炼 Functional exercise 并发症 Complication第2页/共49页内容概要 CONTENT1 1 、病史汇报、病史汇报 Course Course Of Disease Of Disease 2 2、相关临床知识介绍、相关临床知识介绍 The Th

2、e Introduction About The Knowledge Introduction About The Knowledge ( (病因、病理、分类、临床表病因、病理、分类、临床表现、辅助检查、治疗要点现、辅助检查、治疗要点) )3 3、胫腓骨骨折患者的护理、胫腓骨骨折患者的护理 NursingNursing4 4、健康教育、健康教育Health Health EducationEducation第3页/共49页病病 史史Course of Disease Course of Disease 第4页/共49页袁立明，男，袁立明，男，2020岁，学生。岁，学生。 患者因踢足球时不小心，

3、被绊倒地。患者因踢足球时不小心，被绊倒地。当即感到左小腿剧烈疼痛，不能站立和当即感到左小腿剧烈疼痛，不能站立和行走，继而局部肿胀。同学为其做了包行走，继而局部肿胀。同学为其做了包扎、固定等处理，立即送来我院急诊科。扎、固定等处理，立即送来我院急诊科。 YuanliYuanlim ming ,male,ing ,male,20 20 years old years old ,student,student. . The patients left leg was tripped when played football . The patients left leg was tripped wh

4、en played football . Feeling severe pain, he Feeling severe pain, he couldntcouldnt stand and walk. Others helped stand and walk. Others helped him to wrap up and fix, him to wrap up and fix, thenthen sent to Our Emergency Department sent to Our Emergency Department . .第5页/共49页 The consciousness is

5、clear, no nausea, vomiting except the The consciousness is clear, no nausea, vomiting except the pain from left leg.The skin of his left leg pain from left leg.The skin of his left leg is unbroken,butis unbroken,but nono autonomic activities. autonomic activities. After After X-ray X-ray examination

6、examination，the the diagnosisdiagnosis is left tibiofibula fracture. is left tibiofibula fracture. 患者伤后意识清楚，无恶心、呕吐等现象，除左小腿痛外无其他不适。左小腿伤处皮肤无破损，左足不能自主活动。X线片检查后，诊断为“左胫腓骨干骨折”。第6页/共49页This is a picture about the patient 第7页/共49页 T: 37.1 T: 37.1 P P：8080次次/ /分分 R: 16R: 16次次/ /分分 BPBP：110/70mmHg110/70mmHg。

7、患者一般情况可，营养状况良好，饮食、睡眠患者一般情况可，营养状况良好，饮食、睡眠可可，小便，小便3-53-5次次/ /天，大便天，大便1 1次次/ /天。天。 The patients The patients general state general state is is well well .The nutrition is well .The nutrition is well ，the the diet and the sleep are normal.diet and the sleep are normal. He has He has 3 3 to 5 times urine

8、 to 5 times urine 、 one bowel one bowel movement movement everyeveryday .day . 入院时体格检查入院时体格检查第8页/共49页既往史既往史 既往无高压 ，糖尿病史，无“乙肝，结核” 等传染病史，无过敏史、外伤及手术史。 He He has no has no hypertensionhypertension，no no history of infection history of infection and allergic to and allergic to medicine . And the medicine

9、 . And the client has no client has no history of surgeryhistory of surgery and traumaand trauma . .第9页/共49页体格检查幻灯片2.pptPhysical ExaminationPhysical Examination第10页/共49页相关知识相关知识Relevant KnowledgeRelevant Knowledge胫腓骨干骨折（Fractures of the tibiofibula） 指胫骨平台以下至踝以上部分发生的骨折。很常见，约占各类骨折13%17%，青壮年和儿童居多。第11页/

10、共49页 病病 因因 EtiologyEtiology1.直接暴力直接暴力 Direct violenceDirect violence 多为打击、撞击、车轮碾压等多为打击、撞击、车轮碾压等2.2.间接暴力间接暴力Indirect violenceIndirect violence 多由高处坠落、多由高处坠落、 滑倒等所致滑倒等所致第12页/共49页H:H:讲课讲课 骨科：骨折愈合过程动画骨科：骨折愈合过程动画284854E-02.flv284854E-02.flvPathology Pathology And PhysiologyAnd Physiology 骨折的愈合是一个复杂又联系的过程

11、，基本历经三个期，即:1.血肿炎症机化期; ( (O Organization of blood and rganization of blood and inflammation)inflammation)2.原始骨痂形成期; (The Primitive bony callus (The Primitive bony callus formation ) formation ) 3.骨板形成塑形期。 （Bone plate mouldingBone plate moulding）病理生理第13页/共49页 临床表现临床表现 Clinical ManifestationClinical Ma

12、nifestation 1.2.局部表现局部表现Local manifestationLocal manifestation 3.并发症并发症 ComplicationComplication.全身表现System manifestation 第14页/共49页（1）休克 Shock （2） 疼痛 Pain（3） 发热 Fever1. 全身表现 System manifestation第15页/共49页2. 局部表现 Local3.nausea and vomiting 2.abdominal distention(1)骨折的专有体征The characteristic signs of fr

13、acture. a. 畸形 Deformity b. 反常活动 Abnormal activity c.骨擦音和骨擦感 Bony crepitus and bony scrape 第16页/共49页2. 局部表现 Local3.nausea and vomiting 2.abdominal distention(2) 一般表现 General manifestation a. 局部肿胀 The swelling of local manifestation c. 活动受限 Activity limitation b. 压痛 Tenderness第17页/共49页 23.并发症 Complica

14、tion(1).骨筋膜室综合征 Compartment syndrome 主要是由于骨折部位骨筋膜室内压力增加致使室内肌和神经缺血、水肿、血循环障碍而产生的一系列严重病理改变。临床表现 ：可记成5个“P”字 1. 由疼痛（pain） 2. 苍白（pallor） 3. 感觉异常（paresthesia）4. 麻痹（paralysis） 5. 无脉（pulselessness） 第18页/共49页3.3.并发症并发症 ComplicationComplication(2)(2). .脂肪栓塞综合征脂肪栓塞综合征 Fat embolism syndrome (FES)Fat embolism syn

15、drome (FES) (3).(3).急性骨萎缩急性骨萎缩 Acute bone atrophyAcute bone atrophy(4).(4).缺血性骨坏死或缺血性肌挛缩缺血性骨坏死或缺血性肌挛缩 Avascular Avascular necrosis or ischemicnecrosis or ischemic muscle contracturemuscle contracture . . 第19页/共49页(5)(5). .关节僵硬关节僵硬 Joint stiffnessJoint stiffness (6).损伤性骨化 Injured ossification (7).创伤性

16、关节炎 Traumatic arthritis3.并发症 Complication第20页/共49页辅助检查辅助检查 Diagnosis TestsDiagnosis Tests 影像学检查 Imageology（1）X-ray（2）The computer tomography (CT)（3） Magnetic resonance imaging (MRI)（4）Bone scan 骨扫描第21页/共49页第22页/共49页辅助检查辅助检查 Diagnosis TestDiagnosis Test实验室检查实验室检查 Laboratory assessment Laboratory asse

17、ssment (1)(1)血常规血常规 Blood RoutineBlood Routine (2) (2)血钙、血磷水平血钙、血磷水平 Serum calcium and Serum calcium and phosphorus levelphosphorus level(3) (3) 尿常规尿常规 Urine RoutineUrine Routine第23页/共49页 1、非手术治疗非手术治疗 Nonsurgical TreatmentNonsurgical Treatment（1 1）牵引）牵引 TractionTraction： 跟骨牵引跟骨牵引（2 2）手法复位外固定）手法复位外固定

18、 Manipulative reductionManipulative reduction（3 3）石膏、绷带外固定）石膏、绷带外固定 Plasterbandage of the external fixationPlasterbandage of the external fixation处理原则 Treatment第24页/共49页 2 2、手术治疗、手术治疗 Surgical Treatment Surgical Treatment（1 1）内固定）内固定 Internal fixation Internal fixation（2 2）外固定术）外固定术 External fixatio

19、n External fixation处理原则 Treatment第25页/共49页手术治疗内固定第26页/共49页外固定骨牵引骨牵引 Skeletal tractionSkeletal traction第27页/共49页Bone plate and screw internal fixation接骨板、螺丝钉内固定第28页/共49页 1.1.疼痛疼痛 与骨折、软组织损伤、肌痉挛和与骨折、软组织损伤、肌痉挛和水肿有关水肿有关 Pain Pain Related to fractureRelated to fracture、 soft tissue trauma soft tissue trau

20、ma ， muscle spasm muscle spasm and edema.and edema. 2.2.躯体活动障碍躯体活动障碍 与骨折、牵引有关与骨折、牵引有关 Impaired physical mobility Impaired physical mobility Related to fracture and traction .Related to fracture and traction .第29页/共49页3.3.有受伤的危险有受伤的危险 与骨折、移动障碍有与骨折、移动障碍有关关 The danger of injury The danger of injury Rel

21、ated Related to fracture and impaired physical to fracture and impaired physical mobility .mobility .4.4.恐惧与焦虑恐惧与焦虑 与创伤，手术和担心预与创伤，手术和担心预后有关后有关 Fear Fear and and anxietyanxiety Related to Related to trauma, operation and worry about trauma, operation and worry about consequence.consequence.5.5.潜在并发症潜

22、在并发症 感染感染 Potential complication Potential complication：infectioinfection n 第30页/共49页护理措施护理措施 Nursing InterventionNursing Intervention 1 1、疼痛护理、疼痛护理 PainPain manegement manegement 2 2、观察病情、观察病情 Observation of the Observation of the diseasedisease 3 3、生活护理、生活护理 Living careLiving care 4 4、预防感染、预防感染 Pr

23、event infectionPrevent infection 5 5、防止受伤、防止受伤 Injury Injury preventpreventionion 6 6、心理护理、心理护理 Psychological carePsychological care 7 7、功能锻炼、功能锻炼 Functional exerciseFunctional exercise第31页/共49页(1) 疼痛评分 Scoring pain (2) 镇痛药 Using drugs(3) 松弛疗法 Relaxation therapy1、疼痛护理 Pain manegement第32页/共49页第33页/共4

24、9页2.abdominal distention2.观察病情Observation of the disease监测生命体征Monitoring the vital signs.末梢血液循环情末梢血液循环情况况P Peripheral eripheral blood blood circulationcirculation伤口渗血情况伤口渗血情况W Wound bleeding ound bleeding 第34页/共49页3 3、生活护理、生活护理 liliving careving care .口腔护理 Oral care皮肤护理，预防压疮 Skin care, prevent press

25、ure sores进食营养、易消化食物，保持大便通畅Nutritious, easy to digest food, maintain smooth stool第35页/共49页口腔护理口腔护理预防压疮预防压疮生活护理第36页/共49页 4 4、预防感染、预防感染 Prevent infection 75%75%酒精酒精 清洁针眼周围皮肤清洁针眼周围皮肤bid bid ，遵医，遵医嘱使用抗生素嘱使用抗生素Clean the eye of a needle skin Clean the eye of a needle skin with with 75% alcohol , prescribed

26、75% alcohol , prescribed. .第37页/共49页 5、防止受伤 Injury prevention （1）正确搬运病人 Properly handling patient. （2）指导病人坐起、移动到轮椅上和行走的方法 Instruct client to sit up and move to the wheelchair ,and walk . 第38页/共49页6 6、心理护理、心理护理 Psychological care Psychological care（1 1）介绍疾病相关知识）介绍疾病相关知识, ,消除患者的消除患者的紧张和焦虑，使患者能够理解并配合紧张

27、和焦虑，使患者能够理解并配合治疗，早日康复。治疗，早日康复。（2 2）采用放松疗法，转移患者注意力。）采用放松疗法，转移患者注意力。 Introduce related knowledge of Introduce related knowledge of the disease.the disease.第39页/共49页7.7.功能锻炼功能锻炼 Functional exercise术后24小时伤后36周伤后68周第40页/共49页术后术后2424小时小时 24 hours later24 hours later 开始指导患肢股四头肌的等长收缩锻炼，开始指导患肢股四头肌的等长收缩锻炼，收缩收

28、缩10s10s，放松，放松10s,10s,患肢患肢15152020次次/ /组，健侧组，健侧20203030次次/ /组，组，2 23 3次次/ /天。天。 Began to guide patients quadriceps Began to guide patients quadriceps femoris of isometric contraction femoris of isometric contraction exerciseexercise第41页/共49页伤后伤后3 36 6周周 3 to 6 weeks after injury3 to 6 weeks after inj

29、ury 指导患者进行膝关节挺直、抬腿练习及指导患者进行膝关节挺直、抬腿练习及下床负重练习下床负重练习. . Guidance in patients with knee Guidance in patients with knee straight weight-bearing exercises, straight weight-bearing exercises, leg exercises and get out of bedleg exercises and get out of bed. .第42页/共49页伤后伤后6 68 8周周 6 to 8 weeks after injury 进行全面的肌肉和关节锻炼，逐步进行全面的肌肉和关节锻炼，逐步恢复肢体功能恢复肢体功能. . E Exercise the muscles and joints xercise the muscles and joints fullyfully, recovery of limb function, recovery of limb function. .第43页/共49页健康教育健康教育 Health educationHealth educationFunctional exercise Functional