Children and the cause of rheumatoid pathology

Children like rheumatism is a relatively common systemic connective tissue disease, and its main long-term clinical performance for the more irregular fever, and the large, medium and small joint swelling and pain (especially the small joints Zhizhi), falling into a can Joint deformities, often accompanied with Gan, general swollen lymph nodes and spleen, anemia and self-cells increased, and so on. Children aged less, the clinical manifestations Pianyu more systemic symptoms, older children or adult patients more limited joint symptoms. Therefore, in the category often called Pediatric Rheumatology, compared with the previous “rheumatoid arthritis, the name of a more comprehensive.
Children and adults with chronic rheumatic diseases like rheumatoid arthritis and there are still more differences. If I have more general performance (flip-fever, rash, swollen lymph nodes liver and spleen, WBC number increased significantly, and so on), and joint disease lighter, sometimes with iridocyclitis, pericarditis, cervical involvement Dengzheng; On the other hand relatively rare in children subcutaneous nodules, rheumatoid factor positive rate low.
Cause has not entirely clear, and is generally believed that allergic and autoimmune related. May be due to viruses, mycoplasma or other pathogenic infections continued to make its degeneration into a lgG antigen to stimulate the body produce antibodies called rheumatoid factor, which is IgM antibodies category. One of the elements of serum rheumatoid factor and the five self-antigen IgG with the formation of a complex, this complex antibody response with all the characteristics of precipitation in the body tissue, in particular joint, synovial, after the activation of complement To attract neutrophil and the release of its lysosomal enzyme (protein decomposition enzymes), caused vascular basement membrane and the nearby organizations, including the synovial damage.
Pathological changes in the pathogenesis of the disease mainly occurred in the joints, but can also involve other parts of the connective tissue. Articular synovial first invasion, early congestion, edema and lymphocyte infiltration, then synovial thickening was villous, the final formation of granulation tissue. also swollen joints. Continue to develop inflammation, granulation tissue from the edge of the articular cartilage of the synovial began gradually extended to the cartilage, cartilage covering the end, interdictions of the cartilage from Huanang intake of nutrition, therefore, the surface of cartilage ulcer. At the same time under the cartilage in the bone marrow also lymphocyte infiltration and granulation tissue formation, cartilage stripping. Finally cartilage surface of granulation tissue fibrosis and even ossification, from top to bottom integration and joint stiffness. Joint was near the demineralized bone and osteoporosis, muscle atrophy, joint capsule and ligaments may also be granulation tissue invasion, caused dislocation.
In addition can also see the skin nodules, myocarditis and pericarditis, iridocyclitis Yandeng.

Waist soft tissue injury

Waist mainly involved in the soft tissue and spinal movement control muscles, tendons and connectivity of the vertebral body and the back of the fascia ligament, such as synovium. Under normal circumstances, the common link vertebral played the role of flexible and coordinated participation in the activities of the function of spine. Once, directly or indirectly, by the sudden violence external stimulation, impact and twisting flash or excessive traction, causing waist certain soft tissue injury, waist normal physiological function has been damaged, and a low back pain, incoordination, and other symptoms waist. Commonly known as Zhou Yao, blinking waist Chaqi, was particularly prevalent in young adults.
Acute lumbar sprain occurred in the lumbosacral, sacroiliac, and sacral spine on both sides of the joint and muscle, ligament.
Chinese medicine said: “Congestion low back pain, and powerful flash down in the weightlifting. Covered waist, one of the must, pitching flexion and extension, all from the. If there is damage, blood coagulation Shibuya, Meridian Yongzhi, a rate Zhuaice not pain, the clock Shibuya, the light weight is the night ( “Golden wing Juanlu”). briefly described acute lumbar sprain of the etiology, pathology and symptoms.

[Clinical]
One or both sides of the waist pain, lumbar muscle tension, stiffness, restricted activities. Patients often hands hold down the waist to prevent the activities of even more intense pain, the pain may be due to its activities, cough, exacerbated by deep breathing. Can be involved with lower extremity pain, worse not sitting. Apart from the impact of violence, more than local swelling not obvious.

[Signs and inspection]
(1) Discussion
1. Bent down if forced to move heavy objects improperly admitted, could easily lead to the spine and the spine ligament between the ligament injury, pain often injured between spinous process.
2. If forced to carry goods carrying improper, it could easily lead to lumbar muscle injury, pain points in the regular bilateral or unilateral psoas (equivalent Shenshu, sanjiao Yu regional).
3. Bent down, if inadvertently reversed, it could easily lead to iliac after parts of the upper edge of soft tissue injury (or colorectal Yu, Yaowen Point Regional), a tenderness.
4. Walk if inadvertently slipping, with unilateral or bilateral hip, it could easily lead to the sacroiliac joint dislocation and soft tissue damage, pain points in the regular sacroiliac joint region.
(2) function
Make do with flexion, extension, lateral bending, rotation, etc. movements, observe their activities to achieve functional sites, in accordance with the posture with limited activities can be judged from the damaged site.
1. About Cejue are limited and pain, injury and more on both sides psoas.
2. in the spinous process of multiple injuries.
3. If the sacroiliac joint injury, a stretch waist and contralateral Ceque restricted, the affected hip outreach and external rotation limited.
4. If confined to the site of pain and joint tenderness regional Obviously, waist significantly restricted activities of the parties could be considered small joint disorders.
(C) palpation
Patients admitted seat, releasing belts, exposed waist. Doctors used his hands to thumb along the spine, from top to bottom to touch pressure, observe whether spinal scoliosis, whether partial distortion spinous process, there uplift and depression, supraspinous ligament whether peeling, lumbar muscle spasm and whether both sides cord-like reaction and pain points.
In addition, the severe sprain and contusion, to make X-ray, to exclude such as vertebral fractures and spondylolisthesis.

[Syndrome Type]
1. Qichixieyu: blinking down and the strong load, waist severe pain, lumbar muscle cramps, not to straighten her waist, pitching flexion Zhuaice difficulties, or stasis Anjiang Tongue Point, Moss thin veins string tight.
2. Hot and humid Meaning: Labor or improper posture when flash after twisting waist Banchi pain, heartburn flu, with abdominal pain and constipation big knot Niaohuang red, yellow greasy tongue fur, pulse Wenru few.

[Diagnosis]
1. Waist injury history are found mostly in young adults.
2. Waist side or both sides of severe pain, restricted activities, to recover, sitting and walking, and often forced to maintain a certain posture.
3. Gluteal muscle tension and back muscle spasm, can be hit or cord-like reaction, the injury site and obviously anti-Tiaotong point tenderness, spinal curvature physiological changes.

[Diagnosis]
1. Lumbar disc herniation: low back pain associated with radioactive lower extremity pain, functional limitation waist; straight leg raising test, abdominal tests are very positive X-ray, CT can help diagnosis.
2. Vertebral compression fractures: a history of falling from height or waist indirectly History of Violence, accompanied by abdominal distention and constipation, and other symptoms. X-ray showed a wedge-shaped vertebrae change.
3. Renal colic: back side of the Department of colic to the perineum radiation, can be difficult with urine, hematuria, nausea, vomiting, sweating and other symptoms of the hill.

[Prevention and care]
1. Lying hardware Banchuang, waist braking 3 to 5 days.
2. Conservation fixed waist belt.
3. Partial warm.
4. Symptoms after remission, and gradually strengthen the psoas training.

Movement in the finger injury

Movement in the finger contusion regular catcher in basketball, volleyball pass block hand incorrect, could cause finger contusion interphalangeal joint collateral ligament injury or Shenzhi flexor tendon injury.

Interphalangeal joint collateral ligament mild injury, in the finger straight at the distal joints do contusion pull side, in pain, but no loosening or “Mouth” flu. Processing, can be about one centimeter wide tape that their injuries will not injured finger next to be fixed together.

If joint collateral ligament rupture, should be to the hospital surgical suture.

Finger contusion if there can not be extended or joint deformity should be suspected tendon rupture or avulsion fracture and dislocation. For tendon rupture or avulsion fractures, as soon as possible to deal with, according to the circumstances by conservative treatment or surgical suture; dislocation should be looking for those with experience to the entire complex.

Joint dislocation basic common sense

Joint dislocation is sports injuries, a common emergency. The joint body is divided into immovable, movable parts and movable joints. Dislocated bone by means of joint prolapse, a shift phenomenon.

Usually caused dislocation pulled or torn ligament injury, a serious fracture of the merger will occur. Clinical manifestations included: loss of function and prominent joints, joint pain deformation, moderate to severe swelling. If the dislocated bone nerve compression, this will result in the dislocation of the joint limb numbness; if oppression into the bloodstream, the following key dislocated limbs will not touch pulsating and Fazi.
For any fracture and dislocation of patients, we must pulse intensity measurement and inspection of sensory function, if not pulsating feeling, that the limb no longer adequate blood supply, we must immediately hospital treatment. At the same time in the emergency process, regardless of the former is fixed and fixed, to measure pulse and motor and sensory functions.

Measurement methods are as follows: First, check the pulse: injury from the side of the distant feel the pulse of the heart, such as the radial artery inspection dislocated elbow, shoulder dislocation inspection brachial artery, ankle dislocation inspection dorsalis pedis artery, and in patients with injury Limb fingernails, after easing pressure, measured return to normal color, the normal value should be less than two seconds, if not feel the pulse or nail color restoration is slow, that seriously injured or fixed bandaging intensity is too strict and must be relax. Second, check the distal motor and sensory function: require patients to their own swing, under the limbs, fingers or toes touching patients, depending on whether they can identify a clear, if patients consciousness, then gently Qia observed in patients with pain response situations.

On the shoulder joint as a ball in the glove in the same feeling more insecure. If that were hit falls, cramps, forced concede, would most likely cause shoulder dislocation. 96% of patients, the humeral head will be forced to move forward, the merger will shoulder dislocation fracture of the upper limb, and ligament tear or blood vessels and nerve injury. In addition to patients unable to move, sometimes due to severe pain and collapsed, and only if there is no shoulder pain and traumatic circumstances, we must first patients to assess the causes, such as the location of the pain, feeling side injury with contralateral motor function of the comparison, debilitating and powerlessness, and other circumstances.

※ emergency treatment

First of all patients in order to avoid further falls injuries, should help to sit down or lie down to check whether there are other it and checked the pulse distal to patients quiet, warm and to prevent shock, usually sitting in the most comfortable.

Dislocation is a fixed location best way to alleviate pain, and self-help methods can be used magazines, newspapers or cardboard up against and supported by thick elbow, and the use of Sangujin, will be fixed elbow in the chest, shoulder to avoid the activities and reduce pain. Prohibit the consumption, which may need systemic paralysis treatment, patients can chat mode dispersion attention, in order to reduce their pain, another patient using ice compress to reduce pain and swelling, to mobile patients, try to let her move, if it can not Auto, while child care elbow and wrist to help him, at the same time can use a small pillow or cushion, making the patients injured the medial and lateral chest and upper limbs.

If patients can be in pain, the immediate reduction is very good. On the shoulder dislocation, patients can be considered hands firmly elbow injury limbs, was Jiushidu, another one foot to rescue the trouble department armpit mining force, forward, to the drop-down, and sometimes it can resume the status quo ante.

Fractures can not be ignored functional exercise

Fracture treatment on the following principles: “reset, fixed and functional training.” Why is the functional exercise seen so important? This is often many orthopedic patients and their families do not understand, and are often not pay attention to. We know that the orthopaedic trauma treatment ultimate purpose is to enable the greatest possible injury site, as soon as possible the restoration of normal function. The health care measures are also on this purpose, whether the entire complex fixed, or surgery, are only the initial treatment, even if the fracture healing, but also from far cry from the injured limb function, in order to as soon as possible to achieve this objective, the medical staff must be conducted in a scientific and various forms of exercise. So that patients can reduce complications, healed smoothly, and return to work as soon as possible and life skills. Some people use “one-third treatment, 11.07 tempered” to describe functional training, functional training that orthopedic patients how important it is, then the functional training in the end what the significance of this?

1. Promote swelling and prevent joint stiffness and adhesion: fractures, fractures, soft tissue in varying degrees of edema and hemorrhage, venous and lymphatic are making return disruption, which will appear injured legs mass, the mass not timely Elimination can lead to a corresponding soft tissue adhesion, and even stiffen. Such adhesions can occur in the muscles and tendons, tendon, as well as inter-and intra-articular synovial membrane, thus affecting the function of muscle contraction exercises can promote lymphatic and venous reflux, and promote absorption hematoma, swelling subsided, reduce synovial fluid leakage. Thus preventing a result of joint and soft tissue adhesion itself caused by the joint stiffness.

2. Promote fracture healing: the injured legs of repeated muscle contractile activity, the pressure will strengthen crowded vertical fractures, fractures crevice smaller, more stable fracture Department, the Department of fracture can improve nutrition, bone fracture site to promote the empowerment of the fracture healing. Correction function can also practice tiny fracture dislocation, but also conducive to the healing of fractures.

3. Promote blood circulation: Functional training can promote blood circulation, preventing thrombosis. Bed-ridden patients, the absence of systolic and diastolic muscle movement, blood circulation might be slowing, lowering the metabolic organizations, the healing process extended injury, as bleeding trauma damage to the wall itself, the damaged blood vessels in a slow blood flow easier clots, known as the “thrombosis.” Thrombosis of the small self-dissolution, if large thrombus from the vessel wall piece, with the blood into the systemic circulation, can cause heart, brain and vital organs pulmonary infarction, and in serious cases the patient may cause sudden death.

4. Reduce complications: Regular exercise activities can prevent bone, joint, muscle and other complications, such as osteoporosis, fracture healing slow, adhesive joints, joint capsule contracture, joint stiffness and muscle atrophy, and other complications.

In order to enable patients to overcome injuries, the biggest of the restoration of the body function only under the guidance of medical personnel adhere to the scientific exercise to obtain the best therapeutic effect.

Replantation of severed fingers, how successful rescue

Modern society, from machinery, accidents and other causes injury from the broken finger was increasing trend. Hand function is extremely complicated and difficult to replace prosthetics. Finger disability, the patient will lose the ability to work to varying degrees, seriously affecting life and affected the family, the community, thus breaking the finger injury should try to replantation surgery. 

China’s rapid development of microsurgery, digital replantation forefront of the world level. Many severed finger injury patients in the doctor’s timely rescue and meticulous treatment, the survival finger replantation, the basic restoration of function. This regard by the excellent hospital equipment, medical ethics and lofty superior technique, correctly handle the scene at the same time also very important. 

Preservation of the right finger, replantation is the foundation and prerequisite for success. But trauma often difficult to spot the correct guidance of medical personnel, rescue personnel panic often wrong. Here to remind everyone from the broken finger in the face of the wounded to pay attention to the following points: 

Once the accident occurred, the first life to the rescue of the wounded, to check for spinal cord and nerve injury, the need to protect and prevent injury caused or exacerbated. If bleeding, according to the bleeding site, the selection of compression bandaging, massage, bar methods such as emergency tourniquet to stop bleeding, prevent shock. Suspected fractures, dislocation, first to give up the entire complex can be used plywood, gypsum or substitutes for simple fixed.

Done or, in the meantime, these should be dealt with finger. Sometimes not completely broken finger from, there are still some skin or organizations linked, which may take a small blood vessels to provide nutrition to avoid finger necrosis, care must be carefully and properly dress protection against vascular distortion or stretching. 

If bleeding stump finger, we should first stop bleeding. Limb, finger breaking, although the loss of blood nourishment, but there are short-term vitality, and over time, the degeneration decomposed. Cold Storage finger can lower its metabolic rate, and maintain vitality. Winter temperatures low, easy to do; spring and autumn, especially in midsummer, and the hot weather, then quickly frozen cryopreservation finger is particularly important. Finger can be used to clean sterile dressing or relative substitutes, such as the Bujin parcels outside sealed with plastic film. Since then placed in a suitable container and Rubing bottle, placed around the ice, and patients with conditions replantation transferred to nearby hospitals. Ice can be obtained from refrigerator. 1:00 difficult to achieve, can be popsicles, ice cream substitute. Finger not direct contact with ice or ice water to prevent frostbite degeneration. Alcohol will protein denaturation, it will be absolutely taboo breaking limbs (fingers) soaked in alcohol directly within. For washing, can only be saline. Hypertonic or hypotonic solution, the cells were harmful, it will affect the survival rate of replantation can not be used to soak, wash finger. Under certain circumstances, the finger can be pigs, dogs, chickens and other animals Tianchi. Encountered such a situation, the animals were killed immediately, remove finger from the stomach, there may be replanted survived. If a slight delay, finger animals were gastric digestion degeneration, it is difficult to survive.

Rib fracture How is it treated?

The focus is the treatment of pain, complications and control of fixed thorax.

1. Closed the single rib fracture treatment is the focus of pain, complications and control of fixed thorax.

(1) Fixed-root or 2 to 3-rib fractures, general thoracic with fixed, can also be used in some large plaster paste spreads chest wall or tape of the fixed thorax. (2) adequate analgesia analgesic, to take oral pain tablets, tramadol, casual benefit pain analgesic, sedative drugs, if necessary, to morphine, such as intramuscular meperidine. Can also be used one percent solution of procaine to intercostal nerve block or closed fracture. (3) 37 Chinese medicine treatment, such as Yunnan Baiyao also good effect. (4) the need to encourage patients cough Reiner Reiner, to the antitussive, phlegm oral drugs to reduce respiratory complications. Elderly or have chronic lung disease patients, when respiratory secretions accumulation, should be the early use of antibiotics.

2. Closed Multi-multiple rib fractures

(1) If the softening of the smaller chest wall to local compression bandaging, strengthening pain control, respiratory complications and improve hypoxia and carbon dioxide accumulation.

(2) large chest wall softening or have roots on both sides of the chest wall when multiple rib fractures due to abnormal respiration, respiratory secretions or Xietan increased airway obstruction can be caused by breathing difficulties, and even respiratory and circulatory failure to take urgent measures: 1) removal of respiratory secretions, to ensure that airway. Inability to cough, Reiner can not be effectively or respiratory failure, endotracheal intubation or do tracheotomy to facilitate sputum suction, oxygen and implementation of assisted breathing. 2) abnormal chest wall respiratory movement partial treatment ① dressing fixation: apply to the scene or smaller scope of the chest wall softening. Cover with thick dressings softening in the chest wall, chest belt packed with fixed thorax, or paste tape fixed. ② traction fixation: applicable to large chest wall softening or bandaging fixed to fail. Clamp with sterile towels cradling the center of the chest wall free of the rib, and then Mindai a cause, so gravity traction, weighing about 2 to 3 kg, the floating chest wall reset. For a fixed period of time to two weeks. Another way in the lateral chest wall injury traction stent placed the towel in the fixed wire clamp bracket. ③ fixation method: applied to larger dislocation, the severity of patients. Open stainless steel wire fixed to the chest wall. 3) respiratory failure, we must immediately tracheal intubation and positive pressure ventilation to ventilator-assisted breathing.

3. Openness of rib fracture

Single fractured ribs on the patient’s chest wall to be wound debridement, after stratification suture fixation bandaging. If pleural has been pierced, to be done by closed drainage of pleural cavity. Multi-multiple rib fractures, after debridement using stainless steel wire to internal fixation.

Acetabular fracture treatment

Acetabular fracture is a very serious hip injury, pelvic fractures can be suprapubic, ischium, and the affected hip acetabular fracture, and can also be hip dislocation caused by the Centre. With the traditional treatment of poor traction, traumatic arthritis, ankylosis of the high incidence of the majority of scholars of displaced acetabular fractures should adopt a basic consensus was reached on surgical treatment. From 1992 to 2003 were treated 48 patients with acetabular fractures are used Judet conventional X-ray and 3D reconstruction of spiral CT examination and open reduction and internal fixation for the treatment, surgical treatment satisfaction.

1 Materials and Methods

1.1 general information in the 48 cases male group of 34 cases, 14 cases of women aged 17 to 68 years old, with an average age of 36. Fracture reasons: injury accident 33 cases, 10 cases of injury crashes, smashing injured five cases. Letoumet fracture by typing criteria [1], 12 cases of anterior column fracture, the anterior column fracture of the former two cases, 13 cases of posterior column fracture, posterior column fracture after the five cases, posterior wall fractures eight cases, the transverse fracture two cases, double Fracture-four cases. Merger injury: four cases of traumatic brain injury, hip dislocation of one case of the former, hip dislocation after five cases. The patients were injured in the 5 to 7 d after surgery.

1.2 The patients surgical methods of conventional preoperative skin traction 33 cases, 15 cases of femoral condyle in skeletal traction. According to preoperative 3D reconstruction of spiral CT results choice Kocher-Langenbeck approach or groin or iliofemoral approach to the road trip and in accordance with specific circumstances acetabular fracture fixation plate 18 cases, lag screw in the 22 cases (which can be absorbed screw fixation two cases), Kirschner wire fixation five cases, 3 cases of autologous iliac bone graft reconstruction of the acetabulum block plate and screw fixation. Conventional skin traction after four weeks, a week after hip and knee moderate passive static muscle contraction of the exercise, 8 to 10 weeks after fracture healing under X-ray, Shimoji load gradually walk.

2 Results

This group all 48 cases a surgical incision healing, no incisions or deep infection. Follow-up for 6 to 36 months, with an average of 20 months. All fractures healed and heterotopic ossification five cases, with one case of sciatic nerve injury, and two cases in hip osteoarthritis, the loss of joint function, the two firms Dance arthroplasty. [2] by Matta score: excellent 32 cases, good in eight cases, five cases, three cases of poor, good rate of 83.3%.

3 discussion

3.1 surgical indications for the ball-socket hip joint, acetabular fracture of the articular surface does not lead to the formation will lead to load conduction disorders, stress distribution anomaly, thereby causing the degeneration of articular cartilage resulting in the occurrence of traumatic arthritis, the hip acetabular fracture treatment, it should be with other intra-articular fracture of the same principles, to the extent possible, anatomical reduction. In recent years, as the level of diagnosis and conservative treatment of the many complications of awareness, more and more scholars have advocated early surgical fixation. At present the pulp acetabular fractures in general surgery indications: (1) fracture displacement> 3 mm (2) the merger dislocation or subluxation of the femoral head (3) a free intra-articular bone (4) CT shows the posterior wall fracture defect> 40% (5) translocation involving fractures of the acetabulum (Matta top angle standards); (6) No osteoporosis [3].

3.2 fracture surgical approach and internal fixation of the 3D-CT reconstruction make up for X-ray can not do acetabular fractures accurate anatomical diagnosis of insufficient acetabular fractures can display integrity outlook accurately acetabular fracture classification, the operative Road and within a fixed choice of guiding significance. The choice of surgical approach: previous column, a fracture of the anterior wall of groin approach, the advantages of this approach are: small surgical scar and handsome, gluteus not peeling, postoperative functional recovery faster, a little heterotopic ossification, Joint activities with satisfaction, but this approach complex anatomy, it is necessary to prevent damage blood vessels and nerves. The posterior column fracture of the posterior wall with Kocher-Langenbeck approach can be very good show, this approach is relatively simple anatomy, and to protect the sciatic nerve. For more complex cross-or double-column fracture available before and after the incision, the rear by Kocher-Langen ˉ beck incision, shorter front of the iliofemoral incision to reveal a square area and suprapubic sticks, surgical time and blood loss with the expansion of the iliofemoral incision similar, but less damage, the lower the incidence of heterotopic ossification [4]. Acetabular fracture surgery reduction and internal fixation for many ways, open reduction and Kirschner wire, screws, reconstruction plates, percutaneous screw fixation of acetabular fractures. Reconstruction plate effect has been recognized in the treatment of acetabular fractures can have the advantage of the shear resistance, and high stability, reconstruction plate plasticity strong, and can be fully pre-bent to suit the particular location of acetabular form after plate loosening, fracture incidence of low reset satisfied with the solid fixed. Early CPM exercise can be carried out. Kirschner wire fixation is easy to operate, easy adjustment, the advantages of early firmly fixed, but because it Lever Arm smooth, sliding displacement may occur, resulting in failure or fixed in pinning down the issue, pinning only fitness in the fracture of the Provisional fixed block.

3.2 .1 operation time of acetabular fractures in general not emergency surgery, injuries to 3 to 7 d after surgery is the best, because at this time the patient’s condition has stabilized, pelvic injury in the wound had stopped bleeding, less bleeding during surgery. Also during this time can use to the full the preoperative preparation, understanding of fracture displacement and improve the general condition of patients. Adequate preoperative preparation is the key to success of surgery one of the factors. By the time it is not appropriate surgery> 3 w, because the bleeding in surgery at this time, reduction is directly affecting surgery.

3.3 the prevention of complications

3.3.1 after trauma-induced arthritis in bad fracture reduction is a traumatic arthritis of important factors. As the crush fracture block poor blood supply, resulting in cartilage ischemic necrosis, traumatic arthritis is an important factor. The group has two cases of traumatic arthritis, poor quality are reset. Reduce the trauma of open drainage, after deep infection prevention, early exercise can reduce the incidence of traumatic arthritis.

3.3.2 heterotopic ossification of the group five cases occurred after heterotopic ossification, but to a lesser extent, the hip flexion function mildly limited. Heterotopic ossification of the reasons is not yet clear, but the reduction of the periosteal stripping conducive to reducing the incidence of heterotopic ossification, the local radiotherapy after surgery and post-operative oral NSAIDS heterotopic ossification also significantly inhibited.

2.3.3 femoral head necrosis Moed [5] reported that within 24 h after injury to the femoral head reduction, its first rate necrosis of the larger reduction in the 24 h decreased significantly. Closed reduction emphasis on the failure of the femoral head dislocation emergency trip to open reduction, in order to reduce necrosis of the femoral head.

3.3.4 sciatic nerve injury in the Group 1 patients with a sciatic nerve injury to the posterior acetabular fracture and dislocation after the result of such patients to emergency treatment, early reset operation should actively symptomatic treatment, strengthening exercise.

3.4 acetabular fracture rehabilitation therapy after the rehabilitation treatment is also very important to begin the week after lower limb muscle contraction training, can be passive CPM machine for the local physiotherapy and joint activities, such as lifting skeletal traction after loading Shimoji not walk, to be effective improve the function of the hip joint.

Penetrating eye injury treatment

Because of a sharp sword or sophisticated objects incised wound or stab wounds, foreign body into the eyeball debris, as well as a result of blunt force injuries to the eyeball to eyeball that the rupture of penetrating eye injury (perforating wounds of the eyeball). By the former Department penetrate throughout the eyeball from the rear of the two-piercing penetrating eye injury called penetrating injuries (penetration wounds of the eyeball), the eyeball is a penetrating injury.

[Diagnosis]

Penetrating eye injury in accordance with the diagnosis, summarized as the following: ⑴ trauma history; ⑵ eye wound; ⑶ IOP decreased ⑷ anterior chamber shallowing; ⑸ iris perforation; ⑹ pupil deformation; ⑺ Crystal turbidity; ⑻ vitreous traumatic channel; ⑼ retinal injury; ⑽ retained foreign body; ⑾ decreased visual acuity.

Some of the above can not obvious or did not happen, especially that of small penetrating injury, or even all the symptoms are not obvious. Therefore, for each suspected ocular trauma patients must be asked in detail about history, and meticulous examination, and therefore delaying treatment and avoid misdiagnosis.

[Treatment]

Eye wear their causes injury, the injured part, the severity of injuries and different circumstances in different, and therefore the treatment is not the same, penetrating eye injury to major surgery, the treatment is only in its principles and attention to the point.

1. Prevent infection: penetrating eye injury in the injury time of the injury of pathogenic microorganisms often directly into the eyes, or because of the wound will remain open and after infection. Therefore, in dealing with the penetrating eye injury, the first attention should be paid to prevent infection and stop the infection has occurred. Is injured in a preliminary understanding of the location and injuries, the first-swab eyelid and the surrounding skin, eye saline Mianqian clean but not washed. If suspected pollution to 1:5000 mercuric chloride solution or oxygen-cyanide solution mercury swab. In the inspection and proper closure of the wound, conjunctival injection of antibiotics, and the conjunctival sac of antibiotic eye drops drops to gauze bandage covered. If larger deeper wound, wound exposed longer, it would eyeball injection of antibiotics, systemic antibiotics or adequate medicine plus Qingrejiedu agent, and anti-tetanus toxin injection or category, such as Adriamycin.

2. Closed wounds, the wound must be properly handled so that the tight closure, in order to prevent secondary infections, the prevention of eye prolapse, stop bleeding, the IOP restoring, maintaining the organizational structure of the normal position. Approach is as follows:

⑴ small wound treatment: the wounds of the cornea and sclera, in principle, should be tight stitching, but not pyridoxine and smaller wounds opened eyes contents prolapse or incarcerated, also may not be sutured, according to the above approach, the eyes monocular or bandaging, or increase protection goggles, supine.

⑵ corneal wound must immediately direct suture. In the operation under the microscope, with the spade-shaped needle suture closure 10-0 or 9-0, deep corneal thickness of 2 / 3 or more oblique at the time and wound or a corneal edema, should be as deep as 3 / 4 above, but not penetrating keratoplasty, the center of the cornea to minimize sutures, suture to close in order to maintain the same degree of normal. Sutured into the anterior chamber after saline or sterile air balance, iris to prevent adhesion. Cornea and broken no suture, viable keratoplasty repair the early absence of such conditions conjunctival flap can be used to cover up.

⑶ scleral wound, regardless of whether the ball conjunctival rupture, and should be sutured. Sometimes scleral wound backward extension is a long one, or to ophthalmoplegia, the wounds of the back-end must be found, properly sutured. If the sclera surface wounds are still bleeding, burning bleeding, including vascular organizations should curettage clean, not gripping wounds of the sclera, the simple little scleral wound, a wound or conjunctival wound has healed, and can not suture.

⑷ larger wound has eyes contents prolapse, extricate himself from the organization if the uveal pollution or necrosis, should be resected. But prolapse or necrosis of the uveal clean, though slightly long time, the use of antibiotics can be fully laundered and returned to the eyes, and then sutured wound. Emerge in the uveal bulbar conjunctiva, as a conjunctival cover, as long as no obvious necrosis, rather than be sent back to resection. Incarcerated in the vitreous should be wound excision and repeatedly to plastic or sponge swab from剪去Mianqian James, to be fully wound up without vitrectomy. Best to vitrectomy wound excision of the vitreous. Incarcerated the broken should be fully removed the crystal.

⑸ wound see foreign body, should first foreign body extraction, to deal with the wound.

⑹ very big wound, very serious eye injury, whether to retain the eyeball, with sympathetic ophthalmia prevention be taken into account.

3. Prevent bleeding: uveal and retinal damage involved, care should be taken to prevent bleeding. Has been found bleeding, and even more aggressive treatment should be. A common clinical some cases, the wounds of the eyeball ministries have been handled properly, and was satisfied with the healing, but bleeding and hemorrhage due to the vitreous opacities and machine, has become the main reason for visual effects, and even cause blindness. Prevent bleeding can be all kinds of western medicine and Chinese medicine hemostatic agents, the patient supine, eye injury or eye bandage, and deepen goggles, to avoid shock and oppression eyeball. Absorbed more slowly and bleeding, viable vitrectomy.

4. Prevent the inflammatory response: a heavier penetrating injury, in particular the injured uveal, should pay attention to preventing inflammation, a mydriasis, local and systemic corticosteroid use, or oral administration of sodium salicylate, or aspirin and indomethacin pain, and other non-steroidal anti-inflammatory agents and hormone medicine Qingre Qufeng agent.

5. Early vitrectomy, wearing a serious eye injury in the first dealing with the closure of the wound at the same time, if necessary, can hold vitrectomy. Vitreous or injured with vitreous hemorrhage, such as with broken crystal. Ciliary body into the flat by the Department of resection, resection plot to blood or injury Crystal and vitreous is relatively safe and reliable. And after resection can be in the fundus examination, and to facilitate the further processing. Early vitrectomy significance also lies in the prevention of vitreous contraction after the formation of retinal detachment, and other serious results. In addition, purulent inflammation of the eyes or inflammation of the eyeball early vitrectomy injection of antibiotics eyeball a good therapeutic effect.

6. Eye penetrating injury treatment: eyeball penetrating injury, double penetrating eye injury or secondary penetrating injury. In dealing with the front of the wound at the same time, the wounds should be dealt with the rear. Rear wounds less, if required stitching, can be carried out by the vitreous of Diathermy, condensation wound around chorioretinopathy, such as rear larger wound, or retinal detachment have been obvious, the sclera should be sutured wound, sclera to the permeability of heat or condensation or sclera of folding pad pressure, eye injury should be run through early trip vitrectomy.

7. Blast injury treatment: blast injury except eye injury, is often associated with other parts of the body the trauma, when attention should be paid to the treatment head, viscera, limb trauma treatment, first of all, should be to save lives. Blast injury for more than eyes, a majority of the wound, or the majority of foreign body retention. Most of the debris at the explosion carried mud, dirt. Treatment to pay particular attention to the prevention of infection. By location and extent of injuries, the reference to the aforementioned method for processing.

8. Traumatic cataract and lens dislocation treatment: see Crystal disease.

9. Suppurative endophthalmitis and the treatment of ocular inflammation: Exogenous vitreous of eyes endophthalmitis, and the entire uveitis, endogenous endophthalmitis eyes.

10. Sympathetic ophthalmia control: See uveitis.

Sports Injury Emergency Treatment Tips

Damage was particularly prevalent in the youth sports group, they love sports, and actively participate in various sports activities, but often because of a lack of certain knowledge and training health after a sports injury of the contingency measures, to the injured and causing unnecessary suffering or more seriously, lead to lifelong regret.

First, skin abrasions - that is, skin abrasions. Junior positions such as abrasions, red syrup can only Tu; a dirty wound such as abrasions or bleeding, after the cleaning of saline or Zilueshui painted red syrup.

Second, muscle strain - that muscle fiber tear caused the injury. Mainly due to overuse or inadequate warm-up, under pain of the severity of injuries that, once pain should immediately stop campaign, and in the pain points Fushang ice or cold towels, and maintain 30 minutes, to enable small vasoconstriction, reducing the local hyperemia and edema. Knead and refrain fomentation.

Third, contusion - as a blunt object against the body partially caused by the tissue damage. Mild injury no special treatment, the cooling can be used for 24 hours after the Blood Circulation Pharmacy, local Shangshizhengtonggao paste available in the first days after injury to be cooling, heat the next day. About a week after absorption disappeared.

Fourth, because of a sprained joint position - excessive suddenly reversed, twisting the screw attached to the outside of the ligaments and joints due to tendon. Festival occurred in the ankle, knee, wrist and waist, the different parts of sprains, treatment methods are also different.

1, allows patients with acute lumbar sprain in the supine thick wooden mat in the bed, a pillow lumbar Xiadian first cooling, after the heat.

2, joint sprains ankle, knee, a sprained wrist, a sprained site will be boosted, the first cold compress 2 3 days later fomentation.

5. Dislocation - namely dislocation. Dislocation event, patients should be told to keep quiet and not to activities, not rub dislocation site. Sites such as dislocation in the shoulder, elbow Wancheng patients can be rectangular, and then Sangujin forearm and elbow to hold up, hanging from his neck, and then a broadband tied the brain, in the contralateral brain for guitar. If dislocated hip in the site, they should immediately allow patients lying on the softly to the hospital.

6, fractures common fracture - divided into two kinds of skin is not broken, no wounds, Duangu not linked with the outside world, known as closed fractures; the other is advanced through the skin and bone, and the wound outside the same, as open fractures. On the open fracture, to be satisfied with their hands, to avoid osteomyelitis, application disinfected gauze bandage on the wound preliminary bleeding after, and then taken to the hospital-plank fixed address. After limb fracture instability, easily moved and will add to injury and severe pain, can find wood, plastic sheeting and other limb fractures to the upper and lower parts of two joints fixed up. If no external fixation 1:00 materials, in the upper extremity fractures, the elbow can be fixed on the trunk; fractures in the lower extremities, may extend Tuiju fixed in the contralateral limb. A suspected spinal fracture, to a spot on the door or a stretcher, the trunk surrounded by clothes, linens, etc. pad, and not mobile, can not carry the injured head, it will cause the injured spinal cord injury or paraplegia occurred.