[医药卫生]骨科牵引.ppt

1 PreparedBy shuyeyang OrthopaedicTraction CompanyLogo 2 Tractionistheapplicationofapullingforcetoapartofthebody Definition CompanyLogo 3 Purpose tominimizemusclespasm toreduce align andimmobilizefractures toreducedeformity toincreasespacebetweenopposingsurfaces CompanyLogo 4 GeneralConsiderations Safeanddependablewayoftreatingfracturesformorethan100yearsBonereducedandheldbysofttissueLessriskinfectionatfracturesiteAllowsmorejointmobilitythanplaster CompanyLogo 5 Disadvantages CostlyintermsofhospitalstayHazardsofprolongedbedrestThromboembolismDecubitiPneumoniaRequiresmeticulousnursingcareCandevelopcontractures 挛缩 CompanyLogo 6 History SkintractionusedextensivelyinCivilWarforfracturedfemursKnownasthe AmericanMethod SkeletaltractionbyapinthroughboneintroducedbySteinmannandKirschner CompanyLogo 7 BedsAndFrames Standardbedhas4 posttractionframeIdealbedfortractionwithmultipleinjuriesisadjustableheightwithBradfordframeMattressmovesseparatefromframe CompanyLogo 8 BedsandFrames BradfordframeenablesbedpanandlinenchangeswithoutmovingptAlternativelybedcanbeflexibletoallowbendingathiporknee 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 CompanyLogo 9 Knots IdealknotscanbetiedwithonehandwhileholdingweightEasytotieanduntieOverhandloopknotwillnotslip CompanyLogo 10 Knots AslipknottightensundertensionUpandover downandover upandthrough CompanyLogo 11 Tractionmaybeappliedto theskin skintraction directlytothebonyskeleton skeletaltraction CompanyLogo 12 SkinTraction indication ChildfractureofshaftoffemurAdultepiphysisFracturepelvicfracturenoevidentdisplaceChildjointcontractureoradultlightjointcontracture CompanyLogo 13 ForearmSkinTraction AdhesivestripwithAcewrapUsefulforelevationinanyinjuryCantreatdifficultclaviclefractureswithexcellentcosmeticresultRiskisskinloss CompanyLogo 14 DoubleSkinTraction UsedforgreatertuberosityorproxhumeralshaftfxArmabducted30degreesElbowflexed90degrees7 10lbsonforearm5 7lbsonarmRiskofischemiaatantecubitalfossa CompanyLogo 15 Dunlop sTraction UsedforsupracondylarandtranscondylarfracturesinchildrenUsedwhenclosedreductiondifficultortraumaticForearmskintractionwithweightonupperarmElbowflexed45degrees CompanyLogo 16 Buck sTraction OftenusedpreoperativelyforfemoralfracturesCanusetapeorpre madebootNomorethan10lbsNotusedtoobtainorholdreduction CompanyLogo 17 SplitRussell sTraction Buck swithslingMaybeusedinmoredistalfemurfxinchildrenCanbemodifiedtohipandkneeexerciser CompanyLogo 18 Bryant sTraction UsefulfortreatmentfemoralshaftfxininfantorsmallchildCombinesgallowstractionandBuck stractionRaisemattressforcountertractionRarely ifeverusedcurrently CompanyLogo 19 announcements Nodamage ulcer inflammation phlebeurysma embolismonskin 2 3weeks Nomorethan2to3kg 4 5to8lb oftra ctioncanbeusedonanextremity otherwisebubblewillcanbeseen Monitoringangleoftraction weigh lineoftractioneveryday Getoutofthewayoffibularheadtoprotectthecommonperonealnerve Guidethepatienttodofunctionalexercise CompanyLogo 20 SkeletalTraction totreatfracturesofthefemur thetibia andthecervicalspine Thetractionisapplieddirectlytothebonebyuseofametalpinorwire CompanyLogo 21 Cervicalskeletaltraction Usedtotreattheunstablespine fx dislocation especialySCIwithdislocation PullalongaxisofspinePreservesalignmentandvolumeofcanalGardner WellsandCrutchfieldtongscommonlyused SCI spinalcordinjury颈脊髓损伤 CompanyLogo 22 GardnerTongs EasytoapplyPlacedirectlycephaladtoexternalauditorymeatusInlinewithmastoidprocessJustcleartopofearsScrewsappliedwith30lbspressure CompanyLogo 23 GardnerTongs PinsitecareimportantWeightrangesfrom5lbsforc spinetoabout20lbsforlumbarspineExcessivemanipulationwithplacementmustbeavoidedPoorplacementcancauseflex extforcesCangetoccipitaldecubitus 褥疮 CompanyLogo 24 CrutchfieldTongs MustinciseskinanddrillcortextoplaceRotatemetaltractionloopsotouchesskullinmidsagittalplanePlacedirectlyaboveextauditorymeatusRiskssimilartoGardnertongs CompanyLogo 25 OlecranonPinTraction Difficultsupracondylar distalhumerusfxGreatertractionforcesallowedCanmakeangularandrotationalcorrectionsPlacepin1 25inchesdistaltotipAvoidulnarnerve 3cm 2cm CompanyLogo 26 LateralOlecranonTraction UsedforhumeralfracturesArmheldinmoderateabductionForearminskintractionExcessiveweightwilldistractfracture CompanyLogo 27 MetacarpalPinTraction Usedforobtainingdifficultreductionforearm distalradiusfxOncereductionobtained pinscanbeincorporatedincastPinplacedradialtoulnarthroughbase2nd 3rdMCStiffnessintrinsicscommon CompanyLogo 28 90 90Traction Usefulforsubtrochandproximal3rdfemurfxEspeciallyinyoungchildrenMatchesflexionofproximalfragmentCancauseflexioncontractureinadult CompanyLogo 29 FemoralTractionPin Mustavoidsuprapatellarpouch NVstructures andgrowthplateinchildrenPlacejustproximaltoadductortuberclealongmidcoronalplaneAtlevelproximalpolepatellainextendedposition CompanyLogo 30 DistalFemoralTraction AlignmentoftractionalongaxisoffemurUsedforsuperiorforceacetabularfxandfemoralshaftfxUsedwhenstrongforceneededorkneepathologypresent CompanyLogo 31 ProximalTibialTraction Usedfordistal2 3rdfemoralshaftfxFemoralpinallowsrotationalmomentsEasytoavoidjointandgrowthplate1inchdistalandposteriortotibialtubercle 1cm 3cm CompanyLogo 32 DistalTibialTraction UsefulincertaintibialplateaufxPininserted1 25inchesproximaltotipmedialmalleolusAvoidsaphenousveinPlacethroughfibulatoavoidperonealnerveMaintainpartialhipandkneeflexion CompanyLogo 33 CalcanealTraction TemporarytractionfortibialshaftfxorcalcanealfxInsertabout1 5inchesinferiorandposteriortomedialmalleolusDonotskewersubtalarjointorNVbundleMaintainslightelevationleg 34 Specialtraction CompanyLogo 35 HeadHaltertraction SimpletypecervicaltractionManagementofneckpainWeightshouldnotexceed5lbsinitiallyCanonlybeusedafewhoursatatime 头颈部系带牵引 1lbs 0 45kg CompanyLogo 36 Outpatientheadhaltertraction UsedtotrainneckpainandradicularsymptomsfromcervicaldiscdiseaseDevicehooksoverdoorFacedoortoaddflexionUseabout30minperdayWeight10 20lbs 神经根症状 1lbs 0 45kg CompanyLogo 37 HaloRingTraction DirectionoftractionforcecanbecontrolledNomovementbetweenskullandfixationpinsAllowstheptoutofbedwhiletractionmaintainedUsedforc spineort spinefx CompanyLogo 38 HaloRingTraction RingwiththreadedholesAllow1 1 5cmclea