骨科牵引课件

PreparedBy:shuyeyang

OrthopaedicTraction1骨科牵引Traction

istheapplicationofapullingforcetoapartofthebody

Definition2骨科牵引Purpose:tominimizemusclespasm;toreduce,align,andimmobilizefractures;toreducedeformity;toincreasespacebetweenopposingsurfaces3骨科牵引GeneralConsiderationsSafeanddependablewayoftreatingfracturesformorethan100yearsBonereducedandheldbysofttissueLessriskinfectionatfracturesiteAllowsmorejointmobilitythanplaster4骨科牵引DisadvantagesCostlyintermsofhospitalstayHazardsofprolongedbedrestThromboembolismDecubitiPneumoniaRequiresmeticulousnursingcareCandevelopcontractures(挛缩)5骨科牵引HistorySkintractionusedextensivelyinCivilWarforfracturedfemursKnownasthe“AmericanMethod”SkeletaltractionbyapinthroughboneintroducedbySteinmannandKirschner6骨科牵引BedsAndFramesStandardbedhas4-posttractionframeIdealbedfortractionwithmultipleinjuriesisadjustableheightwithBradfordframeMattressmovesseparatefromframe7骨科牵引BedsandFramesBradfordframeenablesbedpanandlinenchangeswithoutmovingptAlternativelybedcanbeflexibletoallowbendingathiporknee<朗道英汉字典5.0>中的解释:

【医】布莱德福氏架(大腿骨折和脊柱结核患者的床架)8骨科牵引KnotsIdealknotscanbetiedwithonehandwhileholdingweightEasytotieanduntieOverhandloopknotwillnotslip9骨科牵引KnotsAslipknottightensundertensionUpandover,downandover,upandthrough10骨科牵引Tractionmaybeappliedto

theskin(skintraction)

directlytothebonyskeleton(skeletaltraction).

11骨科牵引SkinTraction:indicationChildfractureofshaftoffemurAdultepiphysisFracturepelvicfracturenoevidentdisplaceChildjointcontractureoradultlightjointcontracture12骨科牵引ForearmSkinTractionAdhesivestripwithAcewrapUsefulforelevationinanyinjuryCantreatdifficultclaviclefractureswithexcellentcosmeticresultRiskisskinloss13骨科牵引DoubleSkinTractionUsedforgreatertuberosityorproxhumeralshaftfxArmabducted30degreesElbowflexed90degrees7-10lbsonforearm5-7lbsonarmRiskofischemiaatantecubitalfossa

14骨科牵引Dunlop’sTractionUsedforsupracondylarandtranscondylarfracturesinchildrenUsedwhenclosedreductiondifficultortraumaticForearmskintractionwithweightonupperarmElbowflexed45degrees15骨科牵引Buck’sTractionOftenusedpreoperativelyforfemoralfracturesCanusetapeorpre-madebootNomorethan10lbsNotusedtoobtainorholdreduction16骨科牵引SplitRussell’sTractionBuck’swithslingMaybeusedinmoredistalfemurfxinchildrenCanbemodifiedtohipandkneeexerciser17骨科牵引Bryant’sTractionUsefulfortreatmentfemoralshaftfxininfantorsmallchildCombinesgallowstractionandBuck’stractionRaisemattressforcountertractionRarely,ifeverusedcurrently18骨科牵引announcementsNodamage,ulcer,inflammation,phlebeurysma,embolismonskin;2-3weeks;Nomorethan2to3kg(4.5to8lb)oftra­ctioncanbeusedonanextremity,otherwisebubblewillcanbeseen.Monitoringangleoftraction,weigh,lineoftractioneveryday.Getoutofthewayoffibularheadtoprotectthecommonperonealnerve;Guidethepatienttodofunctionalexercise.19骨科牵引SkeletalTraction:totreatfracturesofthefemur,thetibia,andthecervicalspine.Thetractionisapplieddirectlytothebonebyuseofametalpinorwire20骨科牵引CervicalskeletaltractionUsedtotreattheunstablespine(fx,dislocation,especialySCIwithdislocation)PullalongaxisofspinePreservesalignmentandvolumeofcanalGardner-WellsandCrutchfieldtongscommonlyusedSCI;spinalcordinjury颈脊髓损伤21骨科牵引GardnerTongsEasytoapplyPlacedirectlycephaladtoexternalauditorymeatusInlinewithmastoidprocessJustcleartopofearsScrewsappliedwith30lbspressure22骨科牵引GardnerTongsPinsitecareimportantWeightrangesfrom5lbsforc-spinetoabout20lbsforlumbarspineExcessivemanipulationwithplacementmustbeavoidedPoorplacementcancauseflex/extforcesCangetoccipitaldecubitus（褥疮）23骨科牵引CrutchfieldTongsMustinciseskinanddrillcortextoplaceRotatemetaltractionloopsotouchesskullinmidsagittalplanePlacedirectlyaboveextauditorymeatusRiskssimilartoGardnertongs24骨科牵引OlecranonPinTractionDifficultsupracondylar/distalhumerusfxGreatertractionforcesallowedCanmakeangularandrotationalcorrectionsPlacepin1.25inchesdistaltotipAvoidulnarnerve3cm2cm25骨科牵引LateralOlecranonTractionUsedforhumeralfracturesArmheldinmoderateabductionForearminskintractionExcessiveweightwilldistractfracture26骨科牵引MetacarpalPinTractionUsedforobtainingdifficultreductionforearm/distalradiusfxOncereductionobtained,pinscanbeincorporatedincastPinplacedradialtoulnarthroughbase2nd/3rdMCStiffnessintrinsicscommon27骨科牵引90-90TractionUsefulforsubtrochandproximal3rdfemurfxEspeciallyinyoungchildrenMatchesflexionofproximalfragmentCancauseflexioncontractureinadult28骨科牵引FemoralTractionPinMustavoidsuprapatellarpouch,NVstructures,andgrowthplateinchildrenPlacejustproximaltoadductortuberclealongmidcoronalplaneAtlevelproximalpolepatellainextendedposition29骨科牵引DistalFemoralTractionAlignmentoftractionalongaxisoffemurUsedforsuperiorforceacetabularfxandfemoralshaftfxUsedwhenstrongforceneededorkneepathologypresent30骨科牵引ProximalTibialTractionUsedfordistal2/3rd

femoralshaftfxFemoralpinallowsrotationalmomentsEasytoavoidjointandgrowthplate1inchdistalandposteriortotibialtubercle1cm3cm31骨科牵引DistalTibialTractionUsefulincertaintibialplateaufxPininserted1.25inchesproximaltotipmedialmalleolusAvoidsaphenousveinPlacethroughfibulatoavoidperonealnerveMaintainpartialhipandkneeflexion32骨科牵引CalcanealTractionTemporarytractionfortibialshaftfxorcalcanealfxInsertabout1.5inchesinferiorandposteriortomedialmalleolusDonotskewersubtalarjointorNVbundleMaintainslightelevationleg33骨科牵引Specialtraction34骨科牵引HeadHaltertractionSimpletypecervicaltractionManagementofneckpainWeightshouldnotexceed5lbsinitiallyCanonlybeusedafewhoursatatime头颈部系带牵引1lbs=0.45kg35骨科牵引OutpatientheadhaltertractionUsedtotrainneckpainandradicularsymptomsfromcervicaldiscdiseaseDevicehooksoverdoorFacedoortoaddflexionUseabout30minperdayWeight10-20lbs神经根症状1lbs=0.45kg36骨科牵引HaloRingTractionDirectionoftractionforcecanbecontrolledNomovementbetweenskullandfixationpinsAllowstheptoutofbedwhiletractionmaintainedUsedforc-spineort-spinefx37骨科牵引HaloRingTractionRingwiththreadedholesAllow1-1.5cmclearancear