Chopart injury
胸部外伤的临床特点分析
胸部外伤的临床特点分析发布时间：2021-03-25T14:08:07.393Z 来源：《世界复合医学》2021年1期作者：秦年健[导读] 如今社会持续发展，在加上自然环境的危害，创伤的发生率很高，特别是胸部创伤。
秦年健荥经县人民医院四川雅安 625200如今社会持续发展，在加上自然环境的危害，创伤的发生率很高，特别是胸部创伤。
随着老年人口的增加，老年人发生胸部创伤的几率较高。
由于老年人有着特殊的病理和生理特征，因此在胸外伤的临床特点上也存在一定的不同。
本次就和大家一起在下文中了解下胸外伤的临床特点以及治疗方法。
一、什么是胸部外伤胸部损伤(Thoracic trauma)多是因外力所致，例如车祸、挤压、高处跌落以及锐器刺伤等，按照伤害性质的不同可将其分为钝性伤及穿透性伤。
并且可按照胸腔膜与外界关系分为闭合伤和开放性伤。
其中胸部钝性伤主要是因减速性、挤压性以及撞击性外力导致发生，其机制行对较为复杂，常伴有多处胸骨及助骨发生骨折，并且会导致其他组织出现损伤。
此种情况在早期阶段不容易检查，较容易产生误诊的情况。
在临床上主要常见的器官损伤为钝挫伤等，在心肺组织发生大范围的钝挫伤后，则会并发水肿，从而可造成患者呼吸困难、心力衰竭等情况。
通常情况下钝性伤患者不需要进行手术治疗。
枪械、刀具或锋利的物体会造成胸部穿透伤。
其伤害的机制很明确。
伤害范围与伤道有着密切的联系。
在早期诊断相对简单。
由组织撕裂引起的进行性血胸是导致病情快速进展，以及至患者死亡的重要因素。
一般情况下的穿透性胸外伤患者需采取手术治疗。
二、胸部外伤的特点胸部外伤的情况变化迅速：胸部有心脏、肺部等重要器官组织，外面有助骨及胸骨予以保护；胸膜腔的负压可对血液回流起到促进作用，以对血液循环予以有效维护。
有助于肺部的扩张，保持正常呼吸功能，若出现严重破胸部损伤，则其负压将会消失，从而严重影响呼吸循环生理，并且病情的进展将会改变。
对肺和心脏的伤害将导致出血以及危及患者的生命。
假肢与矫形器专业词汇英语
假肢与矫形器专业词汇（英语）abdomen anatomical retainer of the intestinesabdominal related to the abdomenabduct to move (a limb) away from the midline of the bodyabducted gait walking with the legs spread away from the midlinemuscleabductor abductingablatio mammae, mastectomy surgical removal of female breastabove elbow (A.E.) prosthesis prosthesis for transhumeral amputationabove the knee (A.K.) prosthesis prosthesis for transfemoral amputation - (AK)abutment counter piece, counter flare, neckacceleration getting continuously fasteracceleration phase sub-phase in the swing phase of gaitinpelvis, receiving the hip jointsocketacetabulum concaveacetone chemical thinner for laquers and paintsAchilles tendon tendon at distal end of calf muscleacrylic resin thermoplastic resin on acrylic basisacute rapid onset or short duration of a conditionadapter device coupling two different endsadduct to move (a limb) toward the midline of the bodyadductor adducting muscleadductor roll medial-proximally located roll oft soft tissue (TF-prosthetics) adhesion contact socket contact socket, type of suction socketadiposity being too large in abdominal and other circumferences, fat ADL's aids for daily livingadolescent juvenile - phase between childhood and adulthoodadultadolescent youngadult “grown up” - beyond adolescenceaetiology reason or factor causing a diseaseAFO ankle-foot-orthosisagonist muscle being active and result-oriented (opposite:antagaonist) aids for daily living (ADL) tools and devices etc.- modified for the disabledair splint orthoses containing an air chamber to customize fitAK (prosthesis) prosthesis after transfemoral amputationAK-socket above knee (transfemoral) socketalignment assembling O&P components referring to a reference system allergy reaction of the immune system against “foreign” matteralloy a mix of metals, changing the specific characteristics aluminum a light metalambulate / ambulation reciprocal walkingambulator a walking frame, supporting a patient's ambulation amputation surgical removal of a body partamputation surgery surgical act of removing a body segment (extremity) analgesia absence of, or insensitivity to pain sensationanalyse, analysis detailed research on components of a wholeanamnesis background of a diseaseanatomical landmarks (bony) prominences, points of importance in O&Panatomy descriptive or functional explanation of the body properties angularity in the shape of an angleangulus sub-pubicus angle of the pubic ramus, important in IC-socketsjointankle tibio-tarsalankle block connector between prosthetic foot and shinankle joint (talus joint) joint connecting foot and shankankle-foot orthosis (AFO) orthosis with functional impact on ankle and footankylosing to unite or stiffen by ankylosisankylosis immobility, posttraumatic fusion of a jointantagonist muscle opposing agonist action, often controllinganterior in front of, the foremostanteversion to bring (a limb) forward, opposite of retroversion anthropometry taking measurements of the human bodyanti… againstanvil block of iron, surface used in forging metalA-P or a-p antero-posterior, from front to backapex top or summit, the highest point, the peakappliance an instrument, O&P: a prosthesis or orthosis, technical aid application making work or connecting to…learning a professionapprentice somebodyapprentice student learning a profession or craft in a structured approach apprentice student learning a profession or craft in a structured approach apprenticeship (course) training course for vocational educationappropriate best (compromise-) solution for a given problem Appropriate Technology technology appropriate (e.g. for the Third World)arch support shell shell-like custom molded medical shoe insertarteries blood vessels transporting oxygenated blood to the periphery arthritis acute or chronic joint inflammationarthrodesis blocking a joint through surgical procedurearthroplasty reconstruction of a joint through surgical procedure arthrosis, osteoarthritis joint disease - degenerating cartilage and joint surfaceGelenkarticulation Articulatio,aseptic not caused by bacterial infectionASIS / A.S.I.S anterior superior iliac spineassessment evaluation, obtaining information (about a condition) athetosis condition of slow withering movementsathletic arch support custom molded medical shoe insert for the athleteatrophy shrinkage, wastage of biological tissueautonomic nervous system independent nerve tissue, not under voluntary controlaxial rotator joint for socket rotation around the vertical axisback posterior component of the trunkbalance condition of keeping the body stabilized in a desired positionball bearing bearing cage containing rollers, making/keeping axes rotatable ball joint (universal joint) tri-axial jointband, strap, cuff suspension aid (small corset)bandages elastic wrapping, light brace, adhesive wrapping etc.bandaging act of applying bandages, tapingbands m-l connection between orthotic side bars (calf band etc.)bars, side-bars uprights, vertical struts in an orthosisbearing, ball bearing bearing cage containing rollers, making/keeping axes rotatable bed sore pressure/shear related skin trauma of bed-bound individuals below elbow amputation (BE-) forearmamputation (below the elbow joint, transradial, transulnar) below elbow, lower arm arm below the elbow jointbelt suspension component, also light abdominal bandagebench workstation,worktablebench alignment static alignment of prosthetic/orthotic componentsbending providing a shape or contour to sidebars, bands etc.bending iron set of two contouring tools for metal bar bendingbending moment the force or torque bending an objectbending, contouring providing a shape or contour to sidebars, bands etc.BE-prosthesis prosthesis after amputation below the elbow jointbevel to brake an edgebig toe halluxbilateral twosided, double..., relating to “both sides”bio-engineering science of engineering related to living structuresbio-feedback internal autoresponse to a biological eventbiological age the "natural age" - dependent on how a person presentsbiology science related to living structuresbio-mechanics science combining biology and mechanicsbipivotal joint joint with two axesBi-scapular abduction bringing both shoulders forward simultaneously (prosthetic control motion)BK below the kneeBK-prosthesis prosthesis after amputation below the kneeBK-socket below the knee socketblister forming vacuum molding plastic sheet material in a frameblock heels wide basis heelsbody the total appearance of a biological beingbody jacket US-American term for symmetrical spinal orthosesbody powered operated by human power (as opposed to outside energy) bolts machine screw and similarbonding agent connective glue, cement etc.bone single part of the skeletal systembone loss syndrome reduction of bony massbone spur a protrusion of bone or fragment of bonebonification, calcification change into bony tissuebony bridge surgical bony fusion between e.g. tibia and fibulabony landmark anatomically protruding bony surfaces (as the fibula head) bony lock (ischial containment) m-l tight locking design in ischial containment sockets bordering providing a smooth trim line or brimbordering, trimming providing a well-rounded trim line or smooth brimBoston Brace spinal orthosis developed in Boston, USA (scoliosis, kyphosis treatment)bouncy mechanism flexion device for limited flexion in prosthetic kneesbow leg genu varum, o-shaped legs, enlarged distance between knees brace, splint, caliper supportive device, old-fashioned for “orthosis”brain, cerebrum main switch board of the central nervous systembrazing heat supported metal solderingbrazing tool, soldering iron tool for heat supported metal solderingbrim proximal socket area, casting tool / templatebrooch / hook hooks holding a lace, closure of shoes etc.buffing creating a shiny surface finishbuild-up (of a material) location of added plaster in modifications of plaster castsburn heat related injurybursa anatomic padding cavity containing liquidby-law (USA: bill) lawCAD CAM Computer Aided Design, Computer Aided Manufacture cadence rhythm of walkingcalcaneus heelbonecalculation doing mathematical operationscalf band m-l connection between side bars (KAFO)calf corset enclosure of calf and shin (in an orthosis)calf muscle, triceps surae plantar flexor of the foot, muscle in the lower legcaliper measuring tool, precision instrumentcaliper, brace, splint old fashioned term for joint stabilizing lower limb orthoses Canadian Hip Disarticulation Pr. external shell prosthesis for hip disarticulationscane walkingstickcap band finishing element of trim lines, brims of corsetscarbon fiber structural reinforcement in plastic compositescardanic two axes, aligned in 90 degrees toward each othercardio-vascular related to heart and blood circulationcarve shaping by taking material off (chipping off, sanding off)cast positive (plaster or similar) moldcast modification functional changing of the shape of a castcast removal removal of plaster bandage from a poured plaster castcast taking act of taking a plaster- or similar impressioncasters freely moving front wheels at a wheel chaircasting and measurement taking getting 3-dimensional body impressions and measurements casting procedures technique of getting 3-dimensional body impressions caudal direction, toward distal end of the vertebral column (tail)c-clamp clamping tool (woodwork)CDH congenital dislocation of the hipcell (biological and technical) smallest living unit; hollow technical unitcellular made up from cellscelluloid one of the first plastic materials availablecement, glue bonding agentcenter of gravity (COG) mathematic-physical mass concentration in one point center of mass calculated concentration of mass (in bio-mechanics) center of mass (COM) mathematic-physical mass concentration in one point centrode graph for the path of the instantaneous centers of rotation cerebral related to the cerebrum, braincerebral palsy loss of neural muscle control by congenital brain damage cerebral paresis dysfunction of muscle tissue related to cerebral trauma cerebro vascular accident vascular bloodclotting in a part of the brainbraincerebrum thecerebrum / cerebral brain / related to the braincervical related to the neckcervical collar (cervical brace) orthosis for the neck (after whiplash syndrome)cervical spine most proximal segment of the spinal columnchairback brace posterior semi-shell trunk orthosischamfer to thin out the edges of a materialCharcot joint rapid progressive degeneration of a joint (foot)check-, or diagnostic socket transparent or translucent socket for diagnosis of fit chiropedist (Canada) medical doctor specialized in foot careChopart amputation tarsal (partial) foot amputation at the Chopart joint line Chopart joint tarsal joint line of several bones in the footchronic long term (disease; opposite of acute)circumduction semi-circular (mowing) forward swing of a leg circumference the measurment around a physical bodyclam shell design longitudinally split socket or shellclosure mechanism used to closeclub foot, talipes varus pes equino varus, a congenital (or acquired) foot deformity CNC Computer Numeric Controlled design and manufacturing CO cervical orthosis, orthosis for neck immobilizationCO - CP - CPO Certified ... Orthotist..Prosthetist..Prosthetist/Orthotist coating surface cover (as plasticising metal surfaces)coccyx Anatomy: the “tailbone”coefficient of friction number determining forces between sliding surfacescollar cervical orthosis, orthosis for neck immobilization collateral ligaments ligaments bridging the side of jointscompatible fitting to each othercompliance measure of willingness to follow a therapeutic ordercomponents single parts of a whole, construction parts, pre-fab partscomposite reinforced plastic component, matrix and fillercompound result of a chemical binding processcompression panty hose orthotic garment to treat varicosisconcave inwardly shaped, hollow (opposite of convex)condyle massive rounded end of bone, basis for forming a joint surfacewithborncongenital beingconstant friction continuous application of a braking forcecontact cushion distal contact padding in prosthetic socketcontact measuring measuring while touching the object measuredcontact pad contact cushion (prosthetics)continuous passive motion (CPM) keeping a joint mobile through passive motion in motorized device contour (the) the outer perimeter of a bodycontour (to) creating a shape by forming, bendingcontour drawing draft of the outer perimeter of a bodycontracture condition of motion limitation in jointsconvex outwardly shaped, bulged (opposite of concave)cork bark of a tree, natural cellular leight weight materialcoronal plane frontal planecorrection, rectification modification (of shapes, designs etc.) in order to improvecorrosion deterioration of materials by chemical influence (as oxdation)corset therapeutic circular enclosement of body segmentscorset, fabric corset lumbar brace made from textile materialcountersinking taking the edge off a drilled hole, creating circular concavitycoupler a connective devicecoxitis/coxarthritis inflammation of the hip jointCPM, continuous passive motion keeping a joint mobile through passive motion in motorized device CPO Certified Prosthetist / Orthotistcraft & trade European (German) vocational structuring systemcranial relating to the headcrossline filing using a handheld file in a 90 degrees offset directioncruciates, cruciate ligaments crossed ligaments at the knee centerCRW Community based Rehabilitation Worker (WHO Geneva)CT, computer tomography a method to take X-rays in "slices"Orthosis CTLSO Cervico-Thoraco-Lumbo-SacralOrthosisCTO Cervico-Thoracocuff, band, strap suspension aid (small corset)cup, connection cup socket connector in prostheticscure (med.) medical therapeutic measurecure (techn.) to set, hardencushion, pad upholstering device, providing soft surfacecustom made made to measurements as a single unitdeceleration to become continuously slowerdeceleration phase sub-phase in the swing phase of human gaitdecree, directive, regulation text in the lawbooks or regulation with law-like characterdeficiency lack of necessary function or ability by physical impairmentdeflector plate a leaf spring design in prosthetic feet, energy return devicedeformity malformation of form, may be influencing functiondegeneration biological wear and tearDelrin a plastic material, used as a flexible, energy returning keeldensity foaming hard foam block on a socket as a connector to componentsdeposit (biological or pathological) storage mechanism, sedimentdermatitis skin disease, infection of the skinderotating orthosis (scoliosis) orthosis for derotation - one of the priciples of scoliosis treatment design construction, functional lay-out and planningdexterity, manual skill skill of creating by hand, craftsman skilldiabetes mellitus carbohydrate metabolism disorder (frequent amputation reason) diabetic gangrene death of tissue caused by diabetesdiagnosis searching and finding a cause and details of diseasediaphysis shaft of a long bonedimension seize as measureddimensional stability keeping the dimensionsdiplegia paralysis, affecting both sides of the bodydirect socket technique manufacture of a prosthetic socket directly on the amputee's limb directive information or order on how to …..directive, regulation, decree text in the lawbooks or regulation with law-like characterdisability handicap, functional loss of abilitydisabled person a person with a disability, handicapdisabled, handicapped handicapped, having a functional loss of ability"amputation"directly through a joint linedisarticulation thedisc, intervertebral disc intervertebral cartilaginous cushioning elementdislocation joint injury resulting in complete discontiuity of joint surfaces dislocation overstretching or rupture of ligaments, also in combination with fracture doff US-colloquial: do - off = take offdoffing a prosthesis taking off a prosthesiscontrollingdominant leading,don US-colloquial: do - on = put ondonning a prosthesis putting on a prosthesisdonning aid aid to don a prosthesis as pull sock, stockinette, silk tie etc.dorsal related to the dorsum = back, posteriorly locateddorsiflexion lifting the forefoot, correct would be “dorsal extension”, lift of footdraft first drawing of a new ideadrawer effect a-p instability of the knee caused by slack cruciatesdrill (to) to machine a holeDS(L)T Direct Socket (Lamination) TechniqueDUCHENNE's disease severe progressive form of muscular dystrophyDUCHENNE's sign trunk bends lateral toward stance leg during stance phaseDUPUYTREN’sche Kontraktur fibrosis, flexion contracture of fingers into palmstiffnessdurometer hardness,duroplastic resin synthetic resin, not thermoplastic after initial curingdystrophy pathologic loss of muscle massCommunityEC Europeanedema, oedema swelling, high concentration of fluids in the soft tissueelastic capable of recovering form and shape after deformation elastic anklet ankle foot orthosiselastic bandage, ACE-bandage stretchable, expandable bandageelastic knee sleeve knee supporting soft orthosis, tt-prosthetic suspensionelbow splint old-fashioned term for: elbow orthosiselectrical stimulation neuromuscular stimulation by electric impulses electromyography recording of electrical activity of a muscleembedding enclosing, encapsulating, (German: socket retainer function) embossing manual shaping of sheet metal by special hammerEMG recording of electrical activity of a muscleendo-skeletal pylon type prosthetic components covered by external cover energy consumption use of energy in physical activitiesenergy expenditure spending of energy in physical activitiesenergy return energy output, achieved by spring-like design in O&PorthosisEO elbowepicondylitis stress related inflammation of the elbow, (tennis)epiphysis dist./prox. End of a bone, zone of longitudinal growth equilibrium keeping of balanceequinovalgus combined drop foot and valgus deformityequinovarus combined drop foot and varus deformityeversion rotation of hand or foot around long axis of the limbeversion turning foot outward and up (opposite of inversion)EWHO elbow wrist hand orthosisexamination, assessment evaluation, obtaining information (about a condition)exo-skeletal prosthetics: external structural components (opposite: modular) extension straightening motion of a jointextension assist strap or other means assisting joint extensionextension moment force (torque) causing extension (straightening) of joints extension stop bumper or other means of extension limitationextensor muscle causing extensionexternal related to the outside (opposite: internal)external fixation outside orthotic fixation (of a fracture or a surgical result) extremity upper or lower extremities: arms or legsfabric corset textile orthosis for the abdomen or trunkfabrication the procedure of mechanically creating a devicefatality mortality, death ratefatigue (material) time-dependent alteration of typical material propertiesfatigue (muscles) time-dependent slow down of muscle actionFederal Trade Association German professional trade associationfeedback return of informationfelt material made up from compressed, interwoven hair or fiber female the woman species in a creature (opposite: male)femoral channel dorso-lateral convex channel in a prosthetic socketfemoral condyles the distal ends (close to the knee joint) of the femurfemur the thigh boneFES functional electrical stimulationfibre glass (fiber glass) glass reinforcement component in compositesfibula calfbone, the lesser of two bones in the calffibular head the proximal thicker portion of the fibulafit compatibility between patient and device in function/comfortflab abundance of soft tissueflaccid paralysis, paresis non-spastic paralysis, loss of voluntary muscle innervationflare even anatomical surface (as the tibial flare)flat evenflat foot foot deformity, loss of medial-longitudinal arch heightflatfoot, talipes planus foot deformity, loss of any medial-longitudinal arch heightflexion joint motion, buckling or bending a jointflexion assist device assisting (joint) flexionflexion moment force (torque) causing flexionflexor muscle creating a flexion motionfloor reaction orthosis orthosis utilizing floor reaction forces for patient stabilizationFO (either) finger orthosis (or) foot orthosisfoam a cellular resin (polyurethane foam hard or soft)foaming act of manual creation of a prosthetic foam connectorchildfoetus unbornfollow-up continuous control and maintenance, aftertreatmentfoot cradel anatomically adapted plantar foot supportfoot deformity misalignment (functional misshape) of the footfoot flat stance phase: sole of the foot getting in complete ground contact foot slap stance phase: uncontrolled quick foot flat motionforce cause or reason for acceleration, deceleration, movementforging non-chipping iron shaping process under the influence of heat fracture traumatic breaking of a boneframe the outer supportive, stiffening elementframe socket the outer supportive, stiff element as a retainer for a flexible socket freehand drawing, draft manual first draft or drawingcounter-acting sliding movement, "rubbing"friction forcefrontal plane, coronal plane reference plane as seen from the frontfulcrum center of a single axis joint, center of rotationfully synthetical man-made (material)functional component i.e. joints etc. (as opposed to structural components)functional level degree of function a disabled patient still achievesfunctional needs component need to satisfy specific needsfundamental of basic importanceambulationgait walking,gait analysis research of gait patterns and time-related specificsgait deviation pathological changes in normal walking patternsgait pattern physiological or pathological walking characteristicsgait trainer somebody teaching how to walkgait training lessons in learning how to walkgalvanization surface protection of metalsgangrene local death of soft tissue due to lack of blood supply gastrocnemii, “gastrocs” double-headed calf musclegauge measuring instrument (measures width / thickness)gear train joint joint components, forcing each other trough toggled connection gel man-made or natural material, consistency similar to gelantine genu kneegenu recurvatum hyper-extended knee joint (frequently seen in poliomyelitis) genu valgum/knock knee knock knees, knees frequently touching each other medially genu varum/bowleg bow legs, knee distance too large (opposite of genu valgum) geometric locking locking systematic of polycentric knee jointsgeometrical stance control locking systematic for the provision of stance stabilitygeriatric elderly, old, aged,glue, cement bonding agentgoniometer instrument (tool) for measuring anglesgrease fat, as lubricant or tissuegrid particle size indication in abrassive materialsgrind surface modification by abrasion, sanding etc.ground reaction force force directed from the ground toward the body Haemo.., haema... related to the bloodhallux, halluces big toeHalo brace cranial/cervical orthoses, ring fixed at proximal cranium hamstrings popliteal tendons, insertion of flexor muscleshand splint old fashioned for hand orthosishard and soft foaming technique of using hard and soft PU-foams in combinationhd extra sturdy version of…..disarticulationHD hipHDPE HighPolyethyleneDensityHD-socket pelvic socket of the hip disarticulation prosthesisheavy metals a specific group of metals (heavy in weight)heel clamp prosthesis a partial foot prosthesis, suspension by a posterior "clamp" heel cup foot orthosis, Berkely cupheel off / heel rise moment in stance phase when the heel risesheel spur bony protrusion at the distal-medial aspect of the calcaneus heel strike moment in stance phase when the heel touches the ground heel wedge heel bumper in foot or length compensation, absorbs shockHelfet’s heel cup foot orthosis, similar Berkely cupremoving the distal half of the bodysurgery,hemicorporectomy amputationhemipelvectomy amputation surgery removing one half of the pelvis hemipelvectomy-prosthesis artificial leg after hemipelvectomyhemiplegia paralysis of one half side of the bodyheredetary congenital by transmission from parent to offspringhernia subcutaneous protrusion of intestinshindfoot posterior 1/3 of the foot (heel and tarsus)hinge simple joint, single axiship dysplasia pathological development of hip socket leading to dislocation hip hiking exaggerated movement (lifting) of the hip joint in gaithip joint, articulatio coxae proximal joint of the leg, leg-pelvis jointhip positioning orthoses a brace controlling functional alignment of the hip jointhip socket concave component of the hip jointhip spica cast applied to pelvis and legHKAFO Hip-Knee-Ankle-Foot-OrthosisHO (either) Hand Orthosis (or) Hip Orthosis (!!)hobby-handicraft hobbyists work also meaning: non-professional resulthook and eyelet closure closure of textile fabric corsetshook and pile closure Closure material with interlocking surfaces (e.g. Velcro)hook and pile, Velcro self-adhesive strap materialhorizontal plane reference plane as seen from the tophosiery, medical hosiery medical compression hosiery (phlebology)humerus bone in the upper armhybrid something having properties of at least two different resources hydraulic joint control cylinder/piston device controlling prosthetic joint motion hyper… more of somethinghyperextension over-stretching (of a joint)hyperextension orthosis a spinal brace serving for reclination of the thoracic spinegrowthhyperplasia increasedhyper-reflexia pathologically exaggerated reflexeshypertonia elevated blood pressurehypertonicity increased muscle tone or muscle tensionhypertrophy growth of tissue by enlargement of cellshypo… less of somethinghypoplasia biological structure significantly diminished in sizehypotonia low blood pressurehypotonicity loss of muscle tone (or tension)ContainmentIC IschialICRC International Committee of the Red CrossICRC Ischial and ramus containmentIC-socket ischial containment socketidiopathic scoliosis adolescent scoliosis without a known causeilium, os ilium the medial or lateral "wing-shaped" bone in the pelvis。
特殊名称骨折及骨科评分汇总速记
特殊名称骨折上肢：【bankart骨折】指肩关节盂前下边缘骨折，伴或者不伴有肩前脱位。
英国骨科医生Arthur Sydney Blundell Bankart（1879-1951）首先命名这类损伤。
【Hill-Sachs损伤】指肱骨头压缩性骨折，当肩关节前脱位时，关节盂前缘撞击导致肱骨头后外侧压缩骨折。
两位美国圣地亚哥放射科医生HaroldArthurHill（1901–1973）和MauriceDavidSachs（1909–1987) 首先报道该病故此得名。
【Holstein—Lewis骨折】肱骨远端1/3骨折伴桡神经嵌压。
【Posadas骨折】经髁的肱骨骨折，伴有骨折碎块向前移位，以及因双髁骨折造成尺桡骨的脱位。
【Kocher骨折】肱骨小头骨折（分四型，Ⅰ型为Hahn-steinthal骨折；Ⅱ型为Kocher-lorenz 骨折；Ⅲ型粉碎性骨折；Ⅳ型软骨挫伤。
）【Hahn-steinthal骨折】全肱骨小头骨折，为一种少见的关节内骨折，多见于成年人。
【Hume骨折】译休姆【Monteggia骨折】孟氏骨折定义孟氏骨折Monteggiafractures指桡骨头脱位合并尺骨骨折。
孟氏骨折孟氏骨折Bado分类（1967）I型:尺骨干骨折向前成角，桡骨头向前脱位，约占60%，石膏固定于屈肘110°，前臂旋后II型:尺骨干骨折向后成角，桡骨头向后脱位，约占15%，石膏固定于屈肘70°，前臂旋后III型:儿童尺骨近端干骺端骨折合并桡骨头前/外侧脱位，约占20% IV:型尺骨近端1/3骨折，桡骨头脱位。
约占5%。
【肘关节恐怖三联征】特指伴有桡骨头和尺骨冠突骨折的肘关节后脱位，属于肘关节内复杂骨折脱位的一种类型。
这类损伤均同时伴有肘内外侧副韧带的撕裂，但不伴有尺骨鹰嘴骨折。
【Essex—Lopresti骨折】指桡骨颈骨折伴有远端尺桡关节分离。
英国Birmingham外科医生PeterGordon Essex-Lopresti（1918–1951）首先描述这类骨折，故此得名。
Chopart关节损伤治疗研究进展
Chopart关节损伤治疗研究进展桂勤【摘要】Chopart关节是连接中足及后足的枢纽,对足部稳定及平衡起决定性的作用,其损伤发生率低,漏诊及误诊率高,临床医师对其认识不足,患者往往因得不到及时有效的治疗,产生不同程度的足部慢性疼痛及功能受限,甚至关节融合.该文通过对Chopart关节的解剖及生理功能、诊断、损伤分型和损伤机制、治疗以及预后的介绍,旨在提高临床医师对Chopart关节损伤的诊断及治疗的认识,为临床治疗提供适当建议,以改善患者预后.【期刊名称】《医学综述》【年(卷),期】2014(020)013【总页数】3页(P2402-2404)【关键词】Chopart关节;损伤机制;治疗【作者】桂勤【作者单位】新疆医科大学第一附属医院显微修复外科,乌鲁木齐830054【正文语种】中文【中图分类】R687.3Chopart关节又称为跗中关节或跗横关节，由距舟关节及跟骰关节组成。
法国医师François Chopart(1743～1795)对出现坏死的前足经此关节行截肢术，Chopart关节因此命名。
Chopart关节损伤发病率低，约占所有骨折的0.15%[1]。
但其漏诊及误诊率达41%[2]。
经此关节损伤可引起内外侧柱的短缩、足弓的塌陷、持久的不稳定、畸形愈合及关节炎，尤其是在诊断和治疗被延误的患者[3]。
因此,正确及时的诊疗对Chopart关节损伤患者尤为重要。
1 Chopart关节的解剖及生理功能Chopart关节的关节面垂直于足的纵弓，与距下关节共同参与足部的内翻及外翻，距舟关节与跟骰关节在解剖上由跟距韧带分为2个互不相通的关节腔，但在功能上作为一个整体发挥作用，距舟关节是个髁状关节，其稳定性某种程度要依靠距跟舟关节、跟舟跖侧韧带(弹簧韧带)、分歧韧带。
韧带及距跟舟关节损伤都可能会造成距舟关节不稳。
跟骰关节由骰骨垂直的凹面及跟骨前部横向的凸面组成，骰骨下方有腓骨长肌肌腱穿过，如损伤可能造成腓骨长肌肌腱炎。
肱骨外科颈骨折并发症
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肱骨外科颈骨折并发症
肱骨外科颈骨折并发症：
1.血管损伤肱骨近端骨折合并血管损伤者较为少见。
一般以腋动脉损伤发生率最高。
老年病人由于血管硬化、血管壁弹性较差，较易发生血管损伤。
动脉损伤后局部形成膨胀性血肿，疼痛明显。
肢体苍白或发绀、皮肤感觉异常。
一些病例由于侧支循环，肢端仍有血液供应。
动脉造影可确定血管损伤的部位及性质。
应尽早手术探查，固定骨折，同时修复损伤的血管，可行大隐静脉移植或人工血管移植医学教育|网。
2.臂丛神经损伤肱骨近端骨折合并臂丛神经损伤，以腋神经最多受累，肩胛上神经、肌皮神经和桡神经损伤也偶有发生。
腋神经损伤时，肩外侧皮肤感觉丧失，但测定三角肌纤维的收缩更为准确、可靠。
腋神经损伤时，可采用肌电图观察神经损伤恢复的进程。
绝大多数病例在4个月内可恢复功能，如伤后2～3个月仍无恢复迹象时，则可早期进行神经探查。
3.胸部损伤高能量所致肱骨近端骨折时，常合并多发损伤，应注意除外肋骨骨折、血胸、气胸等。
骨科特殊类型骨折汇总 考博真题
＞特殊类型骨折＞上腔[bankart骨析】指肩关节i前下边缘骨折，伴我才不伴有肩前脱仪。
[Hill-Sachs损伤】指肱骨头压缩性骨折，当眉关节前脱位时，关节i前缘扌上击导致肱腎头后外侧压编骨折。
[Holstein—Lewis骨折】肱脅远端1/3骨折伴挠神经嵌压。
[Posadas骨折】经照得肱脅骨折，伴有骨折碎块向前移位，以及19双殊骨折造戒尺挠骨得脱位。
[Kocher 折】龜骨4、头骨折（分四型，I型为Hahn-steinthal骨折；II型为Kocher-lorenz 腎折；III燮粉砕性骨折：IV型软骨挫伤。
）[Hahn-steinthal骨折】全肱腎小头骨折，为一种少见得关节内骨折■多见千成年人。
【Hume廿折】译休姆[Monteggia脅折】i氏骨折，指槎骨头脱位合并尺骨骨折。
i氏骨折孟氏脅折Bado分类（1967）1型；尺脅干腎折向前成角，挠骨头向前脱位，约占60九石膏ra定于屈肘门0° •前臂验后II 型：尺脅千腎折向后成角，挠骨头向后枕位，约占15汕石膏®定于屈肘70° •前臂试治III型：儿女尺勞近鵡干《6端骨折合并骨头前/外侧枕位，约占20% IV:型尺骨近端1/3腎折, 挠骨头脱位。
约占5乐。
[Galeazzi腎折】指挠骨干骨折伴下尺挠关节枕位枕位。
【双极骨折】即Monteggia腎折合并Galeazzi骨折、【肘关节恐将三联霍】特指伴有税席头与尺骨冠突骨折得肘关节后脱仪，属于肘关节内复杂脅折脱位得一种类型。
这类损伤均同时伴有肘內外侧副韧带碍撕裂，但不伴有尺骨层嘴骨折。
[Essex—Lopresti骨折】指决骨预骨折伴有远端尺挠关节分离・【夜盗（杖）骨折】即尺片干骨折【录棍骨折】（Night-stick fracture）前臂单纯得尺制•骨折[Colifts#折】Col les骨折指税骨远端骨折，伴有税骨远端向背侧得移位，就足关节外骨折. 常常伴有尺骨茎吏腎折。
挤压综合征
定义
挤压综合征是在四肢或躯干肌肉丰富部位， 遭受重物长时间挤压，在挤压解除后出现 的，临床以肢体肿胀、肌红蛋白尿、高血 钾为特点的急性肾功能衰竭。
容易混淆的概念
筋膜间隔区压力升高造成肌肉缺血坏 死形成肌红蛋白血症，而无肾功能衰竭， 只能称为挤压伤或筋膜间隔区综合征。 严重创伤亦可发生急性肾功能衰竭， 如无肌肉缺血坏死、肌红蛋白尿和高血钾， 则不能称为挤压综合征
3．实验室检查
（1）尿液检查：早期尿量少，比重在 1.020以上,尿钠少于60mmol/L,尿素多于 1.020以上,尿钠少于60mmol/L,尿素多于 0.333mmol/L.在少尿或无尿期, 0.333mmol/L.在少尿或无尿期,尿量少或 尿闭,尿比重低,固定于1.010左右, 尿闭,尿比重低,固定于1.010左右,尿肌红 蛋白阳性, 蛋白阳性,尿中含有蛋白、红细胞或见管型。 尿钠多于60mmol/L，尿素少于 尿钠多于60mmol/L，尿素少于 0.1665mmol/L，尿中尿素氮与血中尿素 0.1665mmol/L，尿中尿素氮与血中尿素 氮之比小于10： 氮之比小于10：1，尿肌酐与血肌酐之比小 于20：1。至多尿期及恢复期一般尿比重仍 20： 低，尿常规可渐渐恢复正常。
综上所述，挤压综合征的发生主要是通过 创伤后肌肉缺血性坏死和肾缺血二个中心 环节。只要伤势足以使这个二个病理过程 继续发展，最终将导致以肌红蛋白尿为特 征的急性肾功能衰竭。
诊断要点
1．病史 详细了解致伤原因和方式，肢体受压和肿胀 时间，以及相应的全身及局部症状等。注意伤后 有无“红棕色” 有无“红棕色”、“深褐色”或“茶色”尿及尿 深褐色” 茶色” 量情况，若每日少于400ml为少尿，少于50ml为 量情况，若每日少于400ml为少尿，少于50ml为 尿闭。 肢体肌肉丰富的部位遭受砸压损伤时，即应警 惕本症发生的可能。在伤后24小时内发生无尿或 惕本症发生的可能。在伤后24小时内发生无尿或 尿量少于每小时17ml，尿液褐红色，出现肌红蛋 尿量少于每小时17ml，尿液褐红色，出现肌红蛋 白尿，则可诊断本症。
临床特殊类型骨折定义、类型和疾病特点
临床特殊类型骨折定义、类型和特点Bosworth 骨折Bosworth 骨折是指踝关节骨折脱位，腓骨近端骨折段向胫骨后面移位并交锁于胫骨后面，此类骨折是由于踝关节遭受外旋暴力时，腓骨脱位至胫骨后面，然后再骨折，近端骨折段受阻于胫骨后嵴处。
由于骨间膜和韧带紧张，腓骨肌腱被拉紧，腓骨近侧骨折段绞锁于胫骨后面。
这类骨折通常闭合复位失败，需要切开复位内固定。
Logsplitter 骨折Logsplitter 骨折又称为劈木机损伤、经下胫腓联合踝关节骨折脱位，是一种特殊类型的踝关节骨折，主要是指以高能量垂直暴力为主、多种暴力复合所致的踝关节骨折，合并距骨向上楔入下胫腓联合而导致下胫腓联合分离，可合并腓骨骨折、内踝骨折或三角韧带断裂，踝关节完全脱位，可伴有胫骨「天花板」骨折和（或）距骨骨折。
Dupuytren 骨折1800 年，法国医生 Dafon Guillaume Dupuytren 首先注意到踝部骨折伴下胫腓联合分离。
Dupuytren 骨折可分为高位型和低位型 2 个类型∶ 1、高位 Dupuytren 骨折（腓骨骨折位于下胫腓联合上方 6.5~7.5 cm）是踝部遭受外展暴力的结果，腓骨在下胫腓联合近侧骨折，伴有下胫腓联合的撕裂、骨间膜撕裂、内踝骨折或三角韧带损伤，同时距骨在踝穴内向外脱位。
2、低位 Dupuytren 骨折（腓骨骨折位于下胫腓联合处骨折）是踝部遭受外旋暴力的结果，腓骨在下胫腓联合处骨折，伴下胫腓联合前韧带撕裂、内踝骨折或三角韧带断裂。
Pott 骨折腓骨远端（5~7.5 cm）的骨折，远端腓骨骨折端向内侧移位且紧贴胫骨，外踝向外上移位，同时伴有内踝骨折或三角韧带断裂，踝关节发生半脱位（距骨向外脱位），内踝处有时可能出现皮肤破损。
Wagstaffe（Lefort）骨折又称为 Le Fort-Wagstaffe 骨折，是指外踝前缘的垂直（纵行）骨折，认为是下胫腓前韧带在腓骨的附着点处发生的撕脱骨折，骨折块称为Wagstaffe 骨块。
各种骨折英文名称
Aviator骨折：是距骨的骨折，在第一次世界大战期间被描述，是一种水平压力造成的骨折。
Barton骨折：累及桡骨远端关节面移位骨折，可能发生腕关节半脱位，骨折线可以发生在背侧或掌侧。
Bennett骨折：第1掌骨基底的斜形骨折，掌骨近端形成轴向移位，掌侧边缘形成三角形的骨碎片。
Bosworth骨折：腓骨远端骨折伴有胫骨脊近端后外的骨碎片。
Boxer骨折：第5掌骨颈骨折伴有掌骨头向掌侧移位。
Burst骨折椎体轴向压力造成的骨折，通常发生骨折碎片向外侧的移位。
可以发生在颈椎、胸椎或腰椎。
Chance骨折：胸腰段椎体的分离性骨折，伴随脊髓、神经根、椎体的水平方向的崩裂骨折。
Chauffeur骨折：桡骨干的斜形骨折，早期有机械性弯曲，进而通过逆性外力造成的斜形骨折。
Chopart骨折：骨折或移位累及足的Chopart关节。
Clay—shoveler骨折：下颈椎或上胸椎脊柱序列的骨折，损伤是由于工人企图向上扔一满铁铲的泥土，但是泥土粘住铁铲，引起一个突然的屈曲力量反作用于颈部引起的损伤。
Colles骨折：桡骨远端骨折的一般术语，伴有桡骨远端向背侧的移位，可以有或没有尺骨干的骨折。
Cotton骨折：是指伴有双踝及后踝的三踝骨折。
Die—punch骨折：远端桡骨的关节内骨折，伴有月骨陷窝背侧表面的压迫。
Dupuytren骨折：腓骨远端骨折伴有远端胫腓韧带断裂，以及距骨侧方移位。
Duverney骨折：髂骨翼的骨折，但么有骨盆环的分离移位。
Essex—Lopresti骨折：桡骨颈骨折伴有远端尺桡关节分离。
Galeazzi骨折：桡骨远端1/3骨折伴有尺骨远端半脱位。
Greenstick骨折：儿童的不完全性骨折，伴有骨折的压力侧部分皮质和骨膜的连接。
Hangman骨折：骨折通过第2颈椎椎体（轴位）神经弓。
Hill—Sachs骨折：后外侧肱骨头压缩性骨折，是由于前方关节盂移位或肱骨碰撞前方关节盂边缘引起。
Holstein—Lewis骨折：肱骨远端1/3骨折伴桡神经嵌压。
中足骨折与脱位Chopart和Lisfranc损伤
中足骨折与脱位-Chopart 和Lisfranc 损伤I |定义与流行病学Chopart关节也称跗间关节或跗横关节， 由跟骰关节和距舟关节组成， 以距下关节为参照， 分别处于内翻和外翻位。
二者作为一个功能单位连接后足。
Lisfranc 关节由跖跗关节复合体构成，包括内、中、外楔骨、骰骨及与 5块跖骨形成的关节面。
足舟骨与楔骨及足舟骨与骰骨间也形成关节，但并未专门命名。
Lisfranc 关节构成了足纵弓和足横弓的基础（图 .1 ）。
涉及Chopart 关节和Lisfranc 关节的中足骨折在临床上极易漏诊， 33%的此类损伤均没有明显的 X 线表现，不少临床医师对此类骨折也 较为陌生。
据统计，Chopart 关节损伤在临床上极为罕见，而Lisfranc 关节复合体的损伤也不常见， 上述2关节损伤的年发生率仅为0.2%或1/55000。
其中近1/3的此类损伤病例均由类似于运动损伤的低能量损伤造成， 多与其他中足损伤同时出现， 从而进一步增大了诊断难度。
L^Franc's CuneiformsNavicularLi banc's jointChoparts jcmt图.1中足骨结构解剖图。
图 .1-A ，上面观；图 .1-B ，下面观；图 .1-C ，内侧观；图 .1-D ，外侧观；图.1-E ，冠状面观。
注意图 .1-A 禾口 1-C 中的红线，表示中足的正常对线 包括距骨、足舟骨、内侧楔骨和第 1跖骨骨与软组织结构的解剖Chopart关节由距舟关节和马鞍形的跟骰关节构成。
距舟关节为类球窝关节，足舟骨近侧面为深袋状，内容距骨头，可提供部分的关节稳定性。
相关结构还包括跟骨前、中面，跟舟足底韧带和Y形的分歧韧带（图.2 ）。
跟骰关节在垂直面上呈凹陷状，而在横断面上呈突起状，由跟骨的前关节面和骰骨的后关节面对合形成，此关节为高形合度关节，在足部着地时呈锁定”状态。
Navicular articular facetTalonavicular jotnf capsuleInterosseous lalocaicaneal ligamentBifurcate y ligamentAntenor facetCuboidPosierior facetNavicularCalcaneusSpring Itgament Middle facet图.2足窝的解剖Lisfranc关节由前侧和近侧跗间关节组成，是足纵弓和横弓的关键结构。
手术治疗Chopart关节骨折脱位53例
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韩 慧）
手术 治疗 Ｃ ｈ ｏ ｐ ａ ｒ ｔ 关 节骨折脱位 ５ ３ 例
沈 鸿飞 ， 李俊 华 ， 汤样 华 摘 要 目的 ： 探讨手术治疗Ｃ ｈ ｏ ｐ ａ ｒ ｔ 骨折脱位的临床效果。方 法 ： 对５ ３ 例Ｃ ｈ ｏ ｐ ａ ￣ 关节骨折脱位患者均行手术治疗， 术
后随访２ ４ — ９ ８ 个月， 平均５ ２ 个月， 运用Ａ Ｏ Ｆ Ａ Ｓ 评分评价治疗效果。结 果 ： 依照Ａ Ｏ Ｆ Ａ Ｓ 评分标准， ５ ３ 例中优３ ８例， 良１ ２ 例， 可２ 例， 差１ 例， 优良率９ ４ ％。结论 ： 积极恰当的手术治疗Ｃ ｈ ｏ ｐ ａ ￣ 骨折脱位， 效果良好。 关键词 ： Ｃ ｈ ｏ ｐ ａ ｒ ｔ 关节； 骨折； 脱位； 手术治疗
例 经 过 良好 的 内 固 定 和 术 后 早 期 功 能 锻 炼 ， 疗 效 满意。
参考文献 ：
［ １ ］胡 永 成． 骨科 疾 出 版 社，
２ ０ １ ２ ： ２ ５ －２ ６．
ａ ｄ ｕ ｌ ｔ ｓ［ Ｊ ］ ． Ｊ Ｂ ｏ ｎ ｅ Ｊ ｏ ｉ ｎ ｔ Ｓ ｕ ｒ ｇ Ａ ｍ， ２ ０ １ １ ， ９ ３ （ ７ ） ： ６ ８ ６ － ７ ０ ０ ．
端骨折 ［ Ｊ ］ ． 河南外科学杂志， ２ ０ １ ３ ， １ ９ （ １ ） ： ３ ０ — ３ １ ．
（ 收稿 ： ２ ０ １ ３ — １ ２ － ２ ０ 修回 ： ２ ０ １ ４ — ０ ３ — ２ ６ ）
『 ２ １ Ｎａ ｕ ｔ ｈ Ａ ，Ｍｃ Ｋ ｅ ｅ ＭＤ ， Ｒｉ ｓ ｔ ｅ ｖ ｓ ｋ ｉ Ｂ ， ｅ ｔ １． ａ Ｄ ｉ ｓ ｔ ａ ｌ ｈ ｕ ｍｅ ｒ ａ ｌ ｆ ｒ ａ ｃ ｔ ｕ ｒ ｅ ｓ ｉ ｎ
外固定结合有限切开复位内固定术治疗Chopart关节损伤效果观察
外固定结合有限切开复位内固定术治疗Chopart关节损伤效果观察李绍良;鲁谊;滕星;王满宜【摘要】目的探讨外固定结合有限切开复位内固定术治疗Chopart关节损伤的效果. 方法选择新鲜Chopart关节损伤患者20例,均采用外固定及有限切开复位内固定术治疗. 术后随访12个月,按照美国骨科足踝外科协会( AOFAS)评分标准评估治疗效果. 结果 20例患者术后2~3周拆线,8~12周骨折均愈合. 术后均完成12个月随访,期间均未发生切口感染、外固定针道反应、内固定失效或断裂. AOFAS评分优13例、良5例、可2例,优良率为90%. 结论外固定结合有限切开复位内固定术治疗Chopart关节损伤疗效良好.【期刊名称】《山东医药》【年(卷),期】2016(056)008【总页数】2页(P59-60)【关键词】Chopart关节损伤;外固定术;切开复位;内固定术【作者】李绍良;鲁谊;滕星;王满宜【作者单位】北京积水潭医院,北京100035;北京积水潭医院,北京100035;北京积水潭医院,北京100035;北京积水潭医院,北京100035【正文语种】中文【中图分类】R683Chopart关节包括距舟关节和跟骰关节，这两个关节与距下关节一起，完成足的内外翻动作。
Chopart关节损伤导致关节面破坏，足的内侧柱和外侧柱缩短以及足弓塌陷；如治疗不当，可造成关节不完整，解剖结构紊乱，导致足的不稳定和骨性关节炎，严重影响患者站立、行走等日常生活[1,2]。
切开复位钢板内固定术是目前治疗Chopart关节损伤的常用术式[3~5]，但术后常伴有疼痛、创伤性关节炎等并发症[6]。
本研究探讨外固定结合有限切开复位内固定术治疗Chopart关节损伤的临床效果。
1.1 临床资料选择2010年1月～2013年10月我院收治的新鲜Chopart关节损伤患者20例，男13例、女7例，年龄27～57岁、平均38岁，左侧11例、右侧9例，致伤原因：交通事故伤11例、高处坠落伤8例、重物砸伤1例。
足踝知识小广播--Chopart关节损伤Main和Jowett分型
足踝知识小广播--Chopart关节损伤Main和Jowett分型
1、足踝知识
2、足踝经典病例
3、足踝诊治经验分享
4、足踝经典文献解读
投稿邮箱：
*******************（标注足踝知识）
I型：内向暴力--易形成足部内翻、前足内收、足部内侧旋转，X 线表现为舟骨、距骨背侧及跟骨和骰骨外侧撕脱性骨折，距舟关节内侧及跖侧脱位。
II型：轴向暴力--足舟骨受到楔骨及距骨头挤压，X线表现舟骨体部骨折脱位、距骨的压缩性骨折。
III型：外向暴力--易形成足部外翻、前足外展、足部外旋，舟骨结节、距舟关节背侧撕脱性骨折，骰骨及跟骨前部压缩性骨折。
IV型：跖向暴力--易形成前足跖屈，距舟关节背侧及跟骰关节外侧撕脱性骨折，舟骨及骰骨跖侧脱位，距舟关节和跟骰关节上方压缩性骨折。
V型：挤压损伤--形成复杂畸形，X线表现为中足粉碎性骨折。
自行车运动手部伤害认识与预防
自行车运动手部伤害认识与预防在骑行过后，手部是否曾有过麻痹、刺痛、无力的感觉呢？假如你的答案是YES，那你可能就犯了手部过度使用的问题，运动伤害分为急性伤害(acute injury)与累积性伤害(overuse injury )两种，手部的问题便占了累积型伤害的大宗，最常见的状况为手握把麻痹(handlebar palsy)与腕隧道症候群(carpal tunnelsyndrome)两种。
认识骑车时常见的运动伤害，其实，只要透过动作的调整和装备的使用，就能帮助你远离伤痛发生。
一、手握把麻痹(handlebar palsy)手握把麻痹在自行车运动当中很常见，俗称“手握把麻痹”的症状，名为尺骨神经病变(Ulnar neuropathy)，顾名思义，是因为压迫尺骨神经所造成。
尺骨神经控制你的无名指和小指，主掌手部的肌肉功能，抓握车手把时，压迫尺骨神经的状况，无论在休闲或竞赛型的车友身上都经常发生，主因为抓握下把时，尺骨神经的过度延伸，导致手部出现麻痹、无力，无名指或小指发生疼痛的状况。
这些症状不仅会个别来敲门，还可能同时来报到，演变为数日到长期的情形，虽然烦人，不过倒不一定需要手术治疗。
只要透过适当的休息、配合伸展运动和消炎药物的使用，就能达到缓解的功效；骑行时，调整抓握车手把的姿势与力道，则可以帮助避免复发的状况再次发生。
二、腕隧道症候群(carpal tunnel syndrome)俗称鼠标手的腕隧道症候群，虽然不如手握把麻痹那么普遍，但在生活中的各行各业却是屡见不鲜，举凡钢琴家、木工等需重复使用到手腕的职业类别，都应特别注意腕隧道症候群。
对自行车爱好者来说，主要原因是因为抓握平把时，压力直接传达到主控拇指、食指、中指及一部分无名指的正中神经(Median nerve)所致，造成手麻、手指疼痛、无力的情况，车友们应该也不陌生。
手握把麻痹症，是由拇指、食指、中指及一部分无名指的正中神经(Median nerve)所致。
寰椎骨折脱位
寰椎骨折脱位【病因】本病发生于由高处落下的物体撞击于头顶部，或由高处坠落，头顶垂直触地所致。
寰椎连接枕骨和其他颈椎，是一节非典型的脊椎，外观呈椭圆环状，无椎体，在环形两侧增厚变粗，称之侧块，其上下表面为斜向内前方的关节面。
从侧块伸出的前后椎弓在伸出部位为寰椎最薄弱部，也是最常见的骨折部位。
当暴力和反作用力聚积作用于寰椎时，因寰椎上下关节面的内向性，暴力和反作用力的合力使寰椎侧块受到离心性暴力，从而在寰椎前后弓与其侧块连接处的最薄弱部位发生骨折，这种骨折也称为Jefferson骨折。
其特点是寰椎骨折呈四处对应的骨折，形成四块骨折段，即两个侧块和前后两弓。
当暴力作用方向不正，仅作用于头部一侧或当头部倾向一侧受到暴力时，可致一侧椎弓骨折，偶尔也可引起侧块骨折。
【症状】临床上见到的寰椎骨折脱位，神经症状轻重不一，有的当场死亡，有的病情严重，伴有不同程度的脑干与脊髓高位损伤，表现为脑神经瘫痪、四肢瘫或不全瘫和呼吸障碍，常需立即辅助呼吸，有的仅为枕颈部疼痛和活动障碍，神经症状轻微，但这类患者仍有潜在危险，应予以高度重视和相应治疗。
寰椎两侧块与齿状突间的距离相等而对称，寰椎前弓后缘与齿状突前缘即寰齿间距正常为3mm，在3mm内是较恒定的标志，如果寰齿间隙大于正常，可能为寰椎骨折合并横韧带断裂。
【饮食保健】【护理】【治疗】目前尚无有效预防措施，应尽早明确诊断，早治疗。
【检查】1.需投照开口位X线片、侧位X线片，并在开口位片上测量了解寰椎压迫骨折与寰枢椎不稳的情况，正常的寰椎侧块外缘与枢椎关节突外缘在同一直线上，寰椎骨折者双侧侧块向外移位，侧块外缘超过枢椎关节突外缘。
测量侧块向外移位的距离，两侧之和超过6.9mm，表明寰椎横韧带断裂，导致寰枢不稳定。
侧位X线片上可见到寰椎后弓双重骨折，骨折线经过椎动脉沟。
2.为了解寰枢区损伤细微结构的变化，宜采用断层拍片及CT扫描，常能显示寰椎暴裂的骨折分离状况，对确定其稳定程度是有益的。
臂丛神经损伤的症状
臂丛神经损伤的症状文章目录*一、臂丛神经损伤的症状*二、臂丛神经损伤的并发症*三、臂丛神经损伤的饮食注意事项1. 臂丛神经损伤吃什么好2. 臂丛神经损伤不能吃什么臂丛神经损伤的症状1、臂丛神经损伤的根性损伤C5根性撕脱伤:肩胛背神经及其所支配的提肩胛肌及大、小菱形肌麻痹。
C5、C6、C7根性损伤:一般认为胸长神经支配的前锯肌应麻痹,但近年来研究发现前锯肌受胸长神经和肋间神经的双重支配,因此,C5、C6、C7根性损伤可不出现前锯肌麻痹的症状。
C8、T1根性损伤:出现霍纳综合征。
2、臂丛神经损伤的根以下损伤C5、C6神经损伤:表现为肩胛上神经所支配的因上、下肌,肌皮神经支配的肱二头肌、喙肱肌、肱肌,腋神经支配的三角肌、小圆肌,部分桡神经支配的肱桡肌、旋后肌及肱三头肌外侧头麻痹。
C5、C6、C7神经损伤:除上述肌肉麻痹外,另外肱三头肌、伸腕肌、伸指肌、背阔肌及正中神经所支配的旋前圆肌、桡侧腕屈肌麻痹。
C6、T1神经损伤:霍纳征(一),尺神经及除去旋前圆肌、桡侧腕屈肌肌支以外的正中神经支配肌肉麻痹,部分胸大、小肌麻痹。
C7、C8、T1损伤:正中神经及尺神经完全麻痹,伸肘、伸腕、伸指力减弱。
3、臂丛神经损伤的神经干部损伤上干损伤:与不含胸长神经和肩胛背神经麻痹的C5、C6神经损伤相同。
下干损伤:除霍纳征(一)外,与C8、T1神经损伤相同。
4、臂丛神经损伤的神经束部损伤外侧束损伤:肌皮神经支配的肱二头肌、喙肱肌、肱肌麻痹,正中神经外侧头所支配的旋前圆肌、桡侧腕屈肌麻痹。
内侧束损伤:除去旋前圆肌、桡侧腕屈肌以外的正中神经及尺神经所支配的肌肉麻痹。
后侧束损伤:腋神经支配的三角肌、小圆肌麻痹;桡神经支配的伸肘、伸腕、伸指麻痹;胸背神经支配的背阔肌麻痹;上、下肩胛下神经支配的大圆肌及肩胛下肌麻痹。
臂丛神经损伤的并发症无特殊并发症。
臂丛神经损伤的饮食注意事项1、臂丛神经损伤吃什么好多喝水,多吃水果、蔬莱:患者应多摄取水分,并避免咖啡、汽水、香烟等刺激物。
2021年主动脉钝性伤诊断和治疗(全文)
2021年主动脉钝性伤诊断和治疗（全文）摘要主动脉钝性伤（BTAI）是钝性胸部外伤的致命性损伤之一。
根据损伤程度分为4型。
BTAI常用诊断技术有4种，CT血管成像（CTA）成为最为常用的确诊方法，成为美国东部创伤外科协会（EAST）的强烈推荐诊断方法。
BTAI的治疗方式包括胸主动脉腔内修复（TEVAR）和开放手术治疗，在降低脑卒中、脊髓缺血及肾功能衰竭等发生率方面TEVAR均具有显著的优势，而开放手术还具有较高的移植物和肺部感染率。
EAST强烈推荐在确诊的BTAI病人治疗中首选TEVAR治疗。
BTAI后24 h内病死率最高，急诊手术治疗被视为手术时机的最佳选择。
但对于Ⅰ、Ⅱ型病人延期手术（损伤16 h后）病人获益更大。
另外，TEVAR手术的抗凝及脑脊液引流将视病人情况而定。
主动脉钝性伤（blunt thoracic aortic injury，BTAI）是钝性胸部外伤的严重致命性损伤之一，是创伤病人的第二大主要死因。
车祸或高空坠落时血液突然减速、反射性的高压波的产生、胸骨和脊柱的挤压被认为是导致钝性主动脉损伤最可能的原因，当然主动脉本身的病变也是导致主动脉损伤的重要原因［1］。
由于主动脉峡部位于相对活动的胸主动脉和固定的主动脉弓部，以及动脉导管韧带的牵拉，因此，80％~95％的主动脉损伤发生在主动脉峡部［2］。
统计数据显示：主动脉钝性伤病人院前病死率约80％，入院后24 h病死率为50％，交通事故仍是BTAI最主要的原因。
美国血管外科学会（Society for Vascular Surgery，SVS）指南根据主动脉损伤的程度将主动脉钝性伤进分为4型：Ⅰ型，主动脉内膜撕裂；Ⅱ型，主动脉壁内血肿；Ⅲ型，主动脉血管壁假性动脉瘤形成；Ⅳ型，主动脉血管壁破裂出血。
1 BTAI的诊断约50％BTAI 病人体格检查时缺少特异性胸部创伤的外部体征，少数病人早期可见胸部血肿，其他可能体征有：上腔静脉综合征、咽下困难、膨胀和搏动性胸骨下肿块。
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Surgical approaches
• The antero-medial approach runs from the first (medial) cuneiform to the sustentaculum tali
Chopart Injury
陈龙
L/O/G/O
Background
• Chopart articular space was used by Francois Chopart (1743–1795) as a practical space for amputation in cases of distal foot tumor.
Principles of treatment
• The basic principle of treatment is to reestablish the anatomical orientation of the foot by immediate reduction of any dislocation.
How about Fusion?
• CC fusion • Lead to pain due to a relatively stiff lateral foot column • TN Fusion • Involve locking the talocalcaneo-navicular joint
• • • • • • • Frequently overlooked Misinterpreted Inadequate reduction Inadequate stabilization Painful malunions or nonunions Residual instability Deformity
• The talo-navicular (TN) and the calcaneocuboid (CC) joints are commonly known as the‘‘midtarsal joint’’or‘‘Chopart’s joint’’.
• TN joint priority anatomical reconstruction • CC joint is approached secondarily • Bone graft in restoring the anatomical orientation of the lateral column.
•
Kaj Klaue. Treatment of Chopart Fracture-Dislocations. Eur J Trauma Emerg Surg 2010;36:191–5
Thank You !
谢谢！
L/O/G/O
Evidence
• Stefan Rammelt et al • Report 8 case with 2 years F/U with secondary anatomical and jointsparing reconstruction AOFAS improved significantly from 38.8 preoperatively to 80.8
What is the aim of treatment?
• Axial realignment • midfoot to the hindfoot • Restoration of the length • lateral and medial column
Classification(Main and Jowett)
• (1) A medial sprain (medial force to the forefoot)with dorsal edge fractures of the navicular and/or the talar head, including ‘‘swivel’’ dislocations, or medial dislocation with fracture of the body of the navicular (lateral fracture). • (2) Axial (longitudinal force along the first ray), Navicular central fracture(s) along the borders of the cuneiforms • (3) Lateral dislocation (cuboid or anterior calcaneal fracture) • (4) Plantar dislocation (flexion force on forefoot) either both TN and CC dislocations or TN and TC dislocation. • (5) Crush injury due to random forces (high velocity • and energy)
• Lateral approach
Malunited Chopart Injury
Long Chen Allan Liew
L/O/G/O
What happened with Chopart Injury?
• Nonunion
•
Debrided and bone-grafted
• Avascular necrosis • Posttraumatic arthritis
•
Fusionwww.the源自•Stefan Rammelt et al Anatomic Reconstruction of Malunited Chopart Joint Injuries.European Journal of Trauma and Emergency Surgery.2010;3:196-205.
What result of malunion?
• Impairment of foot function • Rapid development of posttraumatic arthritis
What should we do?
• No symptomatic arthritis • No avascular necrosis
•
• • •
Anatomical reconstruction Secondary correction Joint realignment Internal fixation