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积水潭骨科护理系列教程：积水潭小儿骨科护理

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Jingdong book

积水潭骨科护理系列教程：积水潭小儿骨科护理

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《积水潭骨科护理系列教程：积水潭小儿骨科护理》主要内容包括：小儿骨科发展史、小儿骨科常见疾病及新技术应用、小儿骨科护理特点、小儿骨科护士应具备的素质、儿童生长发育各阶段的特点、儿童骨骼损伤、儿童骨折的分型、特点及类型、儿童骨折的治疗原则、儿童骨折的功能锻炼、儿童骨骺的生长发育及骨骺损伤等。
Author Description

高小雁，北京积水潭医院护理部主任，主任护师。现任中华护理学会骨科护理专业委员会主任委员，中华护理学会理事，中华护理学会管理专业委员会委员；中华医学会创伤专业委员会护理学组委员，中华医学会骨科专业委员会护理学组组长，中华医学会血栓预防专业委员会特邀护理专家，亚太血栓预防委员会委员，北京护理学会管理委员会委员，北京医学会骨科分会护理学组组长，北京医学会创面修复分会护理学组副组长；中国医院协会“单病种质量控制”护理专家组组员，北京护理工作者协会专家库成员。担任《中华护理杂志》《中华现代护理杂志》《中国护理管理杂志》《中国实用护理杂志》《中华损伤与修复杂志（电子版）》编委。
主编《实用骨科护理及技术》《骨科护理必备》《骨科临床护理思维与实践》《骨科用具护理指南》《积水潭创伤骨科护理》《震后骨伤处理》等多部护理专业书籍。参与制订了《医院内静脉血栓栓塞症预防与管理建议》和《亚洲静脉血栓栓塞症预防指南》。在核心期刊上发表护理论文100余篇。
Catalogue

第一篇 小儿骨科总论
第一章 小儿骨科概述
第一节 小儿骨科发展史
第二节 小儿骨科常见疾病及新技术应用
第三节 小儿骨科护理特点
第四节 小儿骨科护士应具备的素质
第二章 儿童骨骼概述
第一节 儿童生长发育各阶段的特点
第二节 儿童骨骼损伤
第三节 儿童骨折的分型、特点及类型
第四节 儿童骨折的治疗原则
第五节 儿童骨折的功能锻炼
第六节 儿童骨骺的生长发育及骨骺损伤

第二篇 小儿骨科常用检查方法及护理技术
第三章 小儿骨科检查方法
第一节 小儿骨科一般体格检查
第二节 小儿骨科常用专科检查
第四章 小儿骨科常用护理技术
第一节 护理评估技术
第二节 石膏的护理
第三节 外固定架的护理
第四节 牵引的护理
第五节 支具的应用与护理
第六节 儿童颈托的护理
附录2013版中国儿童心肺复苏指南
第五章 PICC在小儿骨科的应用
第一节 PICC穿刺术
第二节 B超引导下PICC穿刺术配合
第三节 PICC穿刺处换药法

第三篇 儿童头颈胸疾病
第六章 肌性斜颈
第一节 概述
第二节 护理
第七章 寰枢椎旋转移位
第一节 概述
第二节 护理

第四篇 儿童上肢疾病的护理
第八章 肱骨髁上骨折
第一节 概述
第二节 护理
第九章 肱骨外髁骨折
第一节 概述
第二节 护理
第十章 肘内翻
第一节 概述
……
第五篇 儿童髋部疾病
第六篇 儿童下肢疾病
第七篇 儿童骨肿瘤
第八篇 关爱篇
Book Abstract

三、儿童骨折的复位位置及手术指征
至于哪些骨折复位后，什么位置是可以接受的，什么位置是不能接受的；哪些必须立即切开复位，哪些则可以等到骨折愈合后再二期矫形更为可取，需要根据发生骨折时不同的年龄、不同的部位、不同的类型而有所不同。比如锁骨骨折，除了个别大龄儿童锁骨肩峰端类似骺分离，骨折后近心端高撬起插入肌肉中，手法难以使骨折端接触之外，根本不需要任何手术治疗，8字绷带制动3周，骨折很快愈合，通过生长再塑形不会残留任何问题。相反，锁骨骨折不愈合几乎无一例外地发生在切开复位内固定的病例，特别是发生在应用克氏针不可靠固定的病例中。再如儿童肱骨近端干骺端骨折，虽然其解剖部位类似于成人的肱骨外科颈骨折，但其结果却不相同。只要患儿还有生长发育再塑形时间，40°～50°成角畸形3年后可以完全再塑形至正常。儿童股骨干骨折2岁以下20°内外翻成角、30°前后成角；5岁以下15。内外翻成角、20°前后成角、2cm以内短缩；10岁以内10°内外翻成角、15°前后成角、1.5cm以内短缩，均可接受。10岁以下儿童前臂骨折整复后成角不超过10°、旋转畸形小于10°，也是可以接受的位置。但是如果同时合并同侧肱骨髁上骨折即“漂浮肘”，或已出现间隔综合征，为稳定骨折便于处理伤口，或者是对位对线不可接受的再骨折，则应手术切开复位。儿童桡骨颈骨折也只有闭合整复失败、成角大于30°、移位大于30%时才考虑切开复位。
肘内翻是肱骨髁上骨折很常见的并发症，特别是伸直尺偏型骨折，原因是肱骨髁上内侧皮质的嵌压与肢体重力所造成的远骨折端内旋应力。闭合复位经皮穿针可以大大减少肘内翻的发生，但并不能完全避免，整复后或复查中发现Baumann角（肱骨外髁骺生长板两端连线与肱骨纵轴线在正位X线片的交角称为Baumann角，正常为锐角，约75。）已成钝角，骨折复位的位置又基本上可以接受，骨折还没有纤维愈合前，就不宜为了防止肘内翻的并发症而再次整复，更不宜不恰当地切开复位内固定。因为，等骨折愈合肘关节功能恢复后再二期截骨矫形并不会影响最终的结果。相反，再整复失去原来可以接受的位置或手术切开复位，往往会造成关节僵直活动受限等永久性的残疾。同样的情况也见于桡骨远端干骺端骨折，但处理则不尽相同，此型骨折多发生在年龄偏大的儿童，生长再塑形能力已很有限，积极一点切开复位内固定对腕关节的功能恢复影响不是很大。如果发生在年龄小的儿童，则可以保守一些，先让骨折愈合，观察生长再塑形的变化，如有必要再二期截骨矫形，也可避免因手术暴露损伤桡骨远端骨骺。
四、儿童骨折合并神经损伤
儿童骨折后合并神经损伤并不一定是切开复位探查神经的适应证，如孟氏骨折合并桡神经损伤（骨间背侧神经损伤）。桡神经深支经桡骨头前侧向前外侧走行，穿过旋后肌深浅层及Frohse肌弓经桡骨颈的前外侧绕过至骨间膜的背侧，当桡骨头向前或向前外侧脱位时，桡神经深支可受到牵拉损伤。有10%～20%的病例发生桡神经损伤，特别是桡骨头向前外侧脱位的所谓Ⅲ型（儿童型）孟氏骨折。神经受损伤部位往往位于Frohse弓处，多数为SunderlandI度损伤（神经轴束传导中断，轴束并未断裂），少数为SunderlandⅡ度损伤（轴束损伤，Schwann细胞鞘尚保持完整）。多数病例只要桡骨头复位，数周至3个月后神经麻痹可以自行恢复，根本不需要任何手术处理。只有对伤后已经3个月仍无任何恢复迹象的病例，才考虑手术探查。当然这并不排除对闭合复位失败或首诊漏诊及合并桡骨骨折的Ⅳ型孟氏骨折，为了处理骨折脱位、争取早期环状韧带修补，行切开复位的治疗方法。肱骨髁上骨折也是容易并发神经损伤的一种骨折，发生率大约为7010，以桡神经损伤最多见，多见于远骨折端向后内侧移位的病例。远骨折端向后外侧移位时易出现正中神经损伤，而屈曲型骨折则易出现尺神经损伤。多数神经损伤是牵拉伤，多可自行恢复，真正的神经嵌压断裂并不多见。对于这种病例，最适当的治疗是严密观察
……

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