手外伤

null 手外伤 手外伤中国康复研究中心 北京博爱医院骨科 刘四海null应用解剖应用解剖休息位：自然静止和相对平衡状态，腕关节背伸10 – 20度，轻度尺偏 功能位：发挥最大功能的位置，腕关节背伸20 – 25度，轻度尺偏 休息位和功能位休息位和功能位损伤的原因损伤的原因检查与诊断检查与诊断皮肤损伤的检查 肌腱损伤的检查 神经损伤的检查 血管损伤的检查 骨关节损伤检查皮肤损伤的检查皮肤损伤的检查伤口部位和性质 皮肤缺损的估计 皮肤活力的判断皮肤活力的判断皮肤活力的判断皮肤的颜色与温度 毛细血管回流试验 皮瓣的形状与大小 皮瓣的长宽与比例 皮肤边缘出血情况 皮瓣的方向肌腱损伤的检查肌腱损伤的检查nullnullnullnullnullnullnullnull神经损伤的检查神经损伤的检查正中神经损伤正中神经损伤拇短展肌麻痹 拇指对掌功能障碍 拇食指捏物功能障碍 皮肤感觉功能障碍 猿手畸形尺神经损伤尺神经损伤骨间肌和蚓状肌麻痹 Froment征 爪状手畸形 皮肤感觉功能障碍FROMENT征FROMENT征食指用力与拇指对指时，出现食指近侧指间明显屈曲、远侧指间关节过伸及拇指掌指关节过伸、指间关节屈曲桡神经损伤桡神经损伤腕部以下无运动支 皮肤感觉功能障碍 垂腕畸形血管损伤的检查血管损伤的检查手指颜色 手指温度 血管搏动 毛细血管回流 指腹充盈程度 Allen试验骨关节损伤的检查骨关节损伤的检查疼痛、肿胀、畸形 X—线检查 双侧对照检查null现场急救现场急救止血 伤口包扎 局部固定治疗原则治疗原则早期彻底清创：6 ~ 8 小时 正确处理深部组织损伤 一期闭合伤口：Z字成形术、皮瓣 正确的术后处理：功能位固定固定时间固定时间血管吻合：2 周 关节脱位：3 周 肌腱吻合：3 ～ 4 周 神经吻合：4 ～ 6 周 骨折固定：4 ～ 6 周nullnull清创和手术过程清创和手术过程清创和手术过程清创和手术过程清创和手术过程清创和手术过程nullnullnullnullnull掌骨骨折掌骨骨折掌骨骨折掌骨骨折掌骨骨折掌骨骨折指骨骨折指骨骨折指骨骨折指骨骨折第一掌指关节脱位第一掌指关节脱位Proximal InterPhalangeal Joint Fracture-dislocationsProximal InterPhalangeal Joint Fracture-dislocationsAnatomy Anatomy Each finger has three phalanges, separated by two interphalangeal joints (IP joints) The one closest to the MCP joint (knuckle) is called the proximal IP joint (PIP joint) The joint near the end of the finger is called the distal IP joint (DIP joint). nullLigamentsLigamentsThe volar plate:This ligament connects the proximal phalanx to the middle phalanx on the palm side of the joint. The ligament tightens as the joint is straightened and keeps the joint from hyperextending The collateral ligaments:on each side of the PIP joint which tighten when the joint is bent sideways and keep the joint stable from side to side. The volar plate The volar plate The collateral ligaments The collateral ligamentsMechanismMechanismThe typical mechanism of injury is a direct force applied to the fingertip with hyperextension axial loading which result in impaction of the volar articular surface of the middle phalanx against the condyles of the proximal phalanx Causes Causes Injury to the volar plate can occur when the joint is hyperextended Injury to the collateral ligaments can occur when the joint is forced to bend too far sideways until one of the collateral ligaments ruptures Symptoms Symptoms Pain Swelling DeformityDiagnosis Diagnosis Symptoms and signs Radiography X-ray nullClassification of fractures of the base of the middle phalanx Classification of fractures of the base of the middle phalanx Treatment Treatment Nonsurgical Treatment SurgeryNonsurgical TreatmentNonsurgical TreatmentClose reduction Dorsal fracture dislocation involving 30% or less of the volar articular surfaceSurgerySurgeryMore than 40% to 50% of the volar articular surface More than 60% of the volar articular surface-bone grafting and dynamic external fixation nullnullDynamic external fixationDynamic external fixationStability Distraction Early active movement Pins and Rubbers Traction System (PRTS) Pins and Rubbers Traction System (PRTS)nullnullnullnullComplicationsComplicationsPersistent pain Stiffness instability Degenerative arthritisnullThank U