traction

Traction technology is to apply the force and reaction force away from the soft tissue to resist tension and retraction, so that fracture or dislocation can be repaired, prevent and correct deformity. Classification traction is mostly used for limbs or spine in the form of skin traction, bone traction, belt traction and mechanical traction. Treatment of diseases: lumbar disc herniation, cervical spine fracture and dislocation Indication 1. If the fracture of the backbone or the dislocation of the joint is unstable, it is necessary to maintain the contraposition. 2. Fracture dislocation requires continuous traction to reduce, such as cervical fracture and dislocation. 3. It is necessary to correct and prevent joint deformities caused by muscle contracture. 4. Cervical spondylosis and lumbar disc herniation, need to be treated by traction. 5. Children's epiphysis is easily damaged. Avoid needles or skin traction when wearing needles. For children with 6.3 years of age, femoral shaft fractures should be pulled with double lower limbs. Contraindications 1. Skin damage, inflammation and allergic to tape should not be used for skin traction. 2. There is inflammation in the needle site and it is impossible to avoid it. No bone traction is applied. 3. Older people who are unconscious are not allowed to use headband traction. Surgical procedure 1, bone traction (1) Needle-piercing site: 1 ulnar olecranon: the elbow joint is flexed 90°, and the forearm is in the middle position. A vertical line intersecting the dorsal lateral edge of the ulna is drawn at the extension of the medial edge of the humerus (equivalent to 2.5-3 cm distal to the apex of the olecranon). Then take the dorsal lateral edge of the ulna as the midpoint and draw a line parallel to the ulna at 1.5-2.5 cm on both sides. The two points of intersection are the in and out points of the needle (positive to the lower end of the humerus), and the needle is inserted from the inside to the outside to prevent accidental injury to the ulnar nerve. 2 tibial tuberosity: first draw a horizontal line perpendicular to the longitudinal axis of the tibia from the tibial tuberosity 1cm; then draw two vertical lines parallel to the longitudinal axis at 2.5-3cm on both sides of the vertical axis, the two lines intersect The needle is inserted into and out of the spot. From the outside to the inside, do not hurt the common nerve. In elderly patients, the needle is placed at the distal end 1 cm away, and children should be careful not to damage the epiphysis. 3 calcaneus: the neutral position of the ankle joint, the needle is inserted from the midpoint of the line connecting the tip of the iliac crest and the lower part of the heel. Needle from the inside out, do not hurt the medial nerve vessels of the foot. 4 upper part of the epiphysis: the affected limb is placed on the banquet, or the corresponding position. Within 1cm from the upper edge of the humerus, draw a horizontal line perpendicular to the femoral shaft (the older person is slightly higher from the upper edge of the humerus, younger and younger), and then along the anterior border of the humeral head and the highest point of the femoral condyle. A vertical line intersecting the horizontal line of the upper edge of the iliac crest; two points intersecting as the mark (ie, the point of entry and exit of the traction needle), and the needle is inserted vertically from the inside. Old hip dislocation or acute traumatic hip dislocation, often used here. Do not advance the front or back, so as not to damage the supraorbital sac and axillary nerves and blood vessels. 5 Skull traction: First, connect the lines through the mastoids on both sides, and then draw a line from the tip of the nose to the trochanter. The entrance of the traction bow is 5 cm from the intersection of the two lines. (2) Traction method: 1 After determining the entry point of the traction needle (or nail), it is routinely disinfected, laid, and partially infiltrated and anesthetized to the subperiosteum. The entrance range is slightly smaller and the exit is umbrella-like. 2 The assistant will pull the skin slightly upwards and then move (in the opposite direction of the traction), and pay close attention to the direction of the needle during the needle insertion process, and constantly correct it. The general operator pays attention to the horizontal direction, and the assistant pays attention to the height. 3 Install the two ends of the traction pin or nail on the towing bow (the tip should not be exposed to avoid stab or hooking the bedding), and pull through the traction rope, pulley, traction bracket and weight. 4 According to the different traction weight, the foot of the bed can be raised by 10, 30, 50cm. And pay attention to the traction line to eliminate the resistance. 5 Skull traction: shaved hair before surgery, a small incision after anesthesia to the outer bone plate, use a safety drill to drill through the outer skull plate (do not enter the inner plate, the direction of the hole should be consistent with the direction of the nail tip on the traction bow) Insert the nail tips on both sides of the traction bow into the hole, tighten the fixing screws, and tighten them to prevent slipping. 2, leather traction 1 Clean the skin, the hairy should be shaved, apply the compound benzoin on the proposed adhesive tape, and put the tape before the dry. 2 Adhesive strips attached to the limbs should be prepared in advance, and should be flat without wrinkles, and split at both ends. 3 Bone ridges are protected with gauze, avoid using tape strips around the limbs. 4 The expansion plate used for the end of the tape traction should be narrow and suitable. 5 The Blanc frame and the Thomas frame should be wrapped flat, and the armpits and crotch should be covered with cotton. 6 plus appropriate traction weight (generally not more than 3kg), raise the bed tail when pulling the lower limbs to increase the anti-traction effect. A swing handle is placed on the bed so that the patient can practice upper limb muscles and get up and move. 3, belt traction (1) Headband traction: suitable for patients with cervical spondylosis. It can be taken in a sitting position or a lying position, with regular and intermittent traction, and the lower jaw and the back head are properly padded with cotton pads. (2) pelvic pocket traction: suitable for lumbar disc herniation. Use special chest and pelvis pockets, use cotton pad cushions on the bone protrusions, bolt the chest straps on the bed frame for reverse traction, add appropriate weight on the pelvis pockets, and intermittently pull them at regular intervals. If available, it can also be towed on a special electric traction bed.

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