10手外伤 PPT课件

– X-ray
03/04/2014
First aid
• Stop bleeding • Reduce contamination • Temporary fixation • Transportation to a
hospital03/04/2014来自Debridement
• In 6-8hours • Washing • Removal of dead
• Sensation
– Radial 3.5 fingers, and their dorsal tips – Cutaneous innervation Image
• Course
– Passes via carpal tunnel through volar wrist
• Test function
• Test function
– Finger abduction against resistance – Palpate belly of first dorsal interosseus muscle
03/04/2014
Nerve Injury
• Median Nerve • Motor
– Allows for fine control of pincer grasp – Innervates thenar muscles and two radial lumbricals
• Does not innervate two radial lumbricals • Does not innervate thenar muscles
• Sensation
– Ulnar 1.5 fingers (palmar)
• Course
– Passes with ulnar artery via Guyon's Canal in wrist
Tendon Injury
• Flexor tendon • Extensor tendon
03/04/2014
03/04/2014
Vessel Injury
• Neurovascular bundles
– Contain digital artery, vein, and nerve – Two bundles: one radial and the other ulnar
• Proximal to superficial arch by 1 cm
03/04/2014
Nerve Injury
• Ulnar Nerve • Motor
– Allows for power grip – Innervates all hand intrinsic muscles except:
• Radial and Ulnar arteries join in 2 arches
– Superficial Palmar Arch: superficial to flexor tendon
• Located at base of first web space
– Deep Palmar Arch (deep to flexor tendons)
• Sensation
– Dorsally for 3.5 fingers – Cutaneous innervation image
• Test function
– Wrist and hand extension against resistance
03/04/2014
03/04/2014
Examination and diagnosis
• Examination of the wound
– Size and location – Depth of the wound – Blood circulation
• Blood vessel injury • Nerve injury • Tendon injury • Bone and joint injury
03/04/2014
Department of Orthopedic Surgery Zhou Xiang, M.D.
Learning outcomes
• 熟悉手外伤的诊断方法、周围神经损伤 的病因和诊断。
• 掌握手开放性损伤的治疗原则。
03/04/2014
Contents
一、手外伤 1.创口情况检查、诊断 2.手部开放性损伤、骨折的处理原则 3.肌腱与神经损伤的诊断与处理原则
– Avoid over-immobilization – Correct angular malalignment and rotation
• Splint in position of moderate flexion • Avoid splinting fingers in extension (esp MCP) • Axes of all flexed fingers should point at Scaphoid
二、断肢（指）再植 1．断肢（指）的分类及预后 2．断肢（指）的急救内容及注意事项 3．常温下一般再植时限
Anatomy
Hand Injury
• Mostly open injury • May affect personality
03/04/2014
Skin Injury
03/04/2014
– Opposition of thumb to each finger – Observe thenar muscles for contractions
03/04/2014
03/04/2014
Nerve Injury
• Radial Nerve • Motor
– Innervates extrinsic wrist and finger extensors – Does not innervate any intrinsic muscles
tissue
03/04/2014
Repair
• Bone and joint • Vessel • Tendon and ligament • Nerve • Skin
03/04/2014
手部骨与关节损伤处理
• General Principles of Hand Fracture Management