骨伤- 下肢骨折2

completed to detect any ligamentous or bony injury.
X线。
治疗 treatment
重视对骨折的急救处理。多采用手术治疗。
Currently, surgery is indicated for most femur fractures because of the high rate of union, low rate of complications, and the advantage of early fracture stabilization, which decreases the morbidity and mortality rates in patients
Buttress [‘bΛtris]支持，支持物
Promising [‘pr%misiŋ]有希望的
Antegrade [‘æ ntigreid] 顺行的，前进的 Retrograde [‘retrəugreid] 逆行的，倒退的 Obesity [əu’bi:siti]肥胖
股骨干骨折 FEMORAL SHAFT FRACTURES
return to full weight bearing. Normal activities and
stair climbing can be achieved at 4 to 6 months, but full return to running and sports can take up to a year.
Subtrochanteric fractures of the femur are difficult to manage because of the high bending forces on the proximal
femur. Complication rates increase when a medial buttress
股骨干由前侧伸肌群、后侧屈肌群、内收肌群三群
肌肉包围。
Affiliated hospital of Shandong University of TCM
坐骨神经和股动脉、股静脉，在股骨下1/3处紧贴着
股骨下行至腘窝部。
The metaphyseal area begins proximally with the
also exists due to the attachment of the iliopsoas on the
less trochanter.
诊查要点 clinical features and investigation
Clinically, the injury is most often apparent. Pain, swelling, shortening, and deformity are usually
surgery. Those who should not be treated surgically include patients too unstable to tolerate the procedure and children under 80 lb.
上、中1/3骨折，多采用髓内针，下1/3骨折多采用
占全身骨折的6.2%. 成人一处的出血量500-1000ml。
Affiliated hospital of Shandong University of TCM
Summary
Most femoral shaft fractures occur in young
patients and are the result of high-energy trauma, including motorcycle and other motor vehicle accidents and gunshot wounds. Elderly and osteopenic patients can sustain a femur fracture after low-energy injuries or falls.
①垂直悬吊皮肤牵引：适用于3岁以内的儿童。
Affiliated hospital of Shandong University of TCM
②皮肤牵引skin traction：适用于小儿或年老体弱的人。
③骨骼牵引skeletal traction：较大儿童及成人采用。
股骨髁上牵引
病因病机 etiology and classification
以股骨干中部骨折最多，可为横行、斜形、螺旋、 粉碎及青枝型。
Fractures are most often due to a bending load
applied to the femur with comminution occurring via higher magnitude forces. Torsional loads, in contrast, form a spiral fracture pattern.
cannot be reconstituted.
Open fractures of the femur, perhaps with the
exception of grade 3B fractures, are amenable to
treatment with a reamed intramedullary nail.
subtrochanteric region and distally with the
supracondylar region with the diaphysis in between.
Lying posterior on the femur is the linea aspera,
which provides a major attachment for fascia. The
femur is not perfectly straight; it has a noted
anterior bow.
Affiliated hospital of Shandong University of TCM
Affiliated hospital of Shandong University of TCM
injuries, and ipsilateral femoral neck and shaft
fractures.
Relevant anatomy
股骨干是指股骨转子下至股骨髁上的部分。
股骨干有一个轻度向前外的弧度，表面光滑，后面
有一条隆起的粗线。
股骨干的皮质厚而致密，骨髓腔略呈圆形。
Treatment with intramedullary nails has led to a
functional approach with early ambulation and
range of motion of the knee and hip. Generally 3
months is needed to obtain fracture union and
接骨板。
During the last half century, antegrade
intramedullary rodding has become the standard of
care for most femoral shaft fractures.
(especially polytrauma patients) with these fractures.
手法整复：manipulative reduction
⑴股骨上1/3骨折：将伤肢外展，一手握近端向后挤按，另 一手握住远端由后向前端提。 ⑵股骨中1/3骨折：自断端的外侧向内挤按。
⑶股骨下1/3骨折：
中医骨伤科 下肢骨折
Fracture of the lower extremity 2
林江豪 LIM CHIANG HOU 22/8/2013
New words：
Contamination [kən,tæmi’neiſən] 污染
Condylar [‘kndilə] 髁的
Meticulously [mi‘tikjuləsli]谨慎地
shaft fractures.
Examination of the pelvis and hip is of great importance to
investigate possible fracture or dislocation.
A thorough examination of the knee also should be
present in the region.
损伤严重者，早期可合并外伤性休克。 严重挤压伤、粉碎性或多发性骨折，还可并发脂 肪栓塞。
As always, a neurovascular assessment should be
completed, though this type of injury is rare with femoral-
Susceptible [sə’seplainmənt]排列
ipsilateral [,ipsi’lætərə]同侧的
osteopenic [,%stiəu’pi:nik]骨量减少的
intramedullary [,intrəme’dΛləri] nails 髓内钉
股骨髁牵引
胫骨结节牵引
手术治疗 surgical intervention
除不能耐受或体重低于35公斤的儿童，一般手术。
Most patients are surgical candidates because of the lower