FRACTURE

骨折

Definition

说明

A fracture is a disruption or break in the continuity of the structure of a bone. Traumatic injuries account for the majority of fractures, although some fractures are secondary to a disease process (pathologic fractures). Fractures are described and classified according to (1) type, (2) communication or noncommunication with the external environment, and (3) location.

骨折就是骨结构连续体的裂开或打断。虽然有些骨折是由疾病引起的（病理性骨折)，但外伤性骨折还是占了大部分。骨折可根据其类型、与外界是否相通及解剖部位加以描述和分类。

Fractures are also described as stable or unstable. A stable fracture occurs when some of the periosteum is intact across the fracture and either external or internal fixation has rendered the fragments stationary. Stable fractures are usually transverse, spiral, or greenstick. An unstable fracture is grossly displaced during injury and is a site of poor fixation. Unstable fractures are usually comminuted or oblique.

骨折也可以分为稳定性或不稳定性骨折。稳定性骨折是指骨折部位某些骨膜完整无损，经内固定或外固定后断片不易移位。稳定性骨折通常表现为横纹骨折、螺旋骨折、青枝骨折。不稳定性骨折在损伤期间移位明显，固定性差。不稳定性骨折通常是粉碎性或斜形骨折。

Clinical Manifestations

临床表现

The patient's history indicates an injury often associated with immediate localized pain, decreased function, and inability to use the affected part. The patient guards and protects the part against movement. The fracture may not be accompanied by obvious bone deformity.

病史表明，损伤常常与直接的局部疼痛、功能下降、患侧无能等相联系。病人警惕并保护骨折部位不会移动。骨折也可能没有明显的骨变形。

Manifestations include edema and swelling, pain and tenderness, muscle spasm, deformity, ecchymosis, loss of function, and crepitation.

临床表现包括浮肿、隆起、疼痛、触痛、肌痉挛、变形、瘀斑、功能丧失和有劈拍声等。

Complications

并发症

The majority of fractures heal without complications. If death occurs after a fracture, it is usually the result of damage to underlying organs and soft tissue or of certain complications of the fracture.

多数骨折愈合后没有并发症。如果骨折后发生死亡，这通常是由潜在器官和软组织毁坏或骨折的某些并发症引起的

The ossification process is arrested by causes such as inadequate immobilization and reduction, excess movement, infection, and poor nutrition.

一些因素导致骨化过程的停止，如固定及复位不够、移动过多、感染和营养不良等。

Direct complications of fractures include problems with bone union, avascular necrosis, and bone infection. Indirect complications are associated with blood vessel and nerve damage resulting in conditions such as compartment syndrome, venous thrombosis, fat embolism, and traumatic or hypovolemic shock.

直接由骨折引起的并发症包括与骨连接、无血管性坏死和骨感染相关的问题。间接并发症则与血管和神经损伤有关，会导致出现间室综合征、静脉血栓、脂肪栓塞、外伤性或低血容量性休克等。

Although most musculoskeletal injuries are not life-threatening, open fractures or fractures accompanied by severe blood loss and fractures that damage vital organs are medical emergencies requiring immediate attention.

虽然多数肌骨损伤并不威胁生命，但是，开放性骨折或伴有大量失血的骨折及破坏重要器官的骨折都应当然以急诊处理。

Diagnostic Studies

诊断检查

An x-ray examination is used to determine the presence of a fracture.

通过X光片确定是否骨折。

Therapeutic Management of Fractures

骨折的治疗

The goals of fracture treatment are (1) anatomic realignment of bone fragments, (2) immobilization to maintain realignment, and (3) restoration of function of the part.医学 全在.线提供www.med126.com

骨折的治疗目的是：（1)断骨的解剖复位；（2)复位固定；和（3)恢复功能。

Nursing Management

骨折的护理

Goals

目的

The patient with a fracture will have no associated complications, obtain satisfactory pain relief, and achieve maximal rehabilitation potential.

骨折患者无相关并发症，疼痛得到有效缓解，达到最大康复潜力。

Nursing Diagnoses/Collaborative Problems

护理诊断/合作性问题

Pain related to edema, movement of bone fragments, and muscle spasms

疼痛　与浮肿、骨折片移动和肌痉挛有关

Risk f'or infection related to disruption of skin integrity and presence of environmental pathogens secondary to open fracture or external fixation pins

有感染危险　与皮肤完全性受损及继发于开放性骨折或外固定引起的外界病菌有关

Activity intolerance related to prolonged immobility

活动耐受不良　与长期不能运动有关

Risk for peripheral neurovascular dysfunction related to nerve compression

有外周神经血管功能障碍危险　与神经压迫有关

Risk for impaired skin integrity related to immobility and presence of cast

有皮肤完整性受损危险　与固定和打石膏有关

Ineffective management of therapeutic regimen related to lack of knowledge regarding muscle atrophy, exercise program, and cast care

治疗处理无效　与肌肉萎缩、运动计划和石膏护理知识缺乏有关

Potential complication: fat embolism related to fracture of a long bone

潜在并发症：脂肪栓塞　与长骨骨折有关 医学 全在.线提供

Nursing Interventions

护理措施

The patient with a fracture may be treated in an emergency department or physician's office and released to home care, or the patient may require hospitalization. Specific nursing measures depend on the type of treatment used and the setting in which the patient is placed.

骨折患者可以在急诊室或医生诊室治疗后回家中护理，也可要求住院。具体护理措施取决于治疗手段及病人所处的环境。

Preoperative management. If surgical intervention is required to treat the fracture, the patient will need preoperative preparation. In addition to the usual preoperative nursing measures, the nurse should inform the patient of the type of immobilization device to be used and expected activity limitations.

术前处理。如需手术治疗，病人就应进行术前准备。除了平时的术前护理准备外，护士应告诉病人所用的固定装置类型及活动限止。

Proper skin preparation is an important part of preoperative preparation. The aim of skin preparation is to clean the skin and remove debris and hair to reduce the possibility of infection.

皮肤准备是术前准备的重要内容之一，皮肤准备的目的是清洁皮肤除去杂质和毛发，减少感染机会。

The patient must be assured that all needs will be met by the nursing staff until the patient can again meet his/her own needs Assurance that pain medication will be available if needed is often beneficial.

使病人相信，在其能自行满足需要前，他的所有需要都将由护理人员来满足，使他相信必要的止痛药是有益的。

Postoperative management. Frequent neurovascular assessments of the affected extremity are necessary to detect subtle changes. Any limitations of movement or activity related to turning, positioning, and extremity support should be monitored closely

术后护理。必须经常对患肢进行神经血管评估，发现细微变化。与翻身、体位及肢体支撑相关的移动或活动限制都应加以密切监护。

Pain and discomfort can be minimized through proper alignment and positioning.

体恣端正或适当体位可以减轻疼痛与不适

Dressings or casts should be carefully observed for any covert signs of bleeding or drainage. Increased bleeding can be monitored by drawing a circle on the cast around an area of drainage and by noting the date and time. A significant increase in the size of the drainage area should be reported.

应仔细观察敷裹或石膏，及时发现不明显的出血或渗液迹象。可在渗液周围的石膏上画一圆圈，记录日期和时间，以此监视出血的增多。如渗液范围明显扩大，就应马上报告。

If a wound-drainage system is in place, patency of the system and volume of drainage should be assessed at least once each shift. Whenever the contents of a drainage system are measured or emptied, the nurse should use sterile technique to avoid contamination.

如使用引流系统，至少要每轮班评估一次引流的通畅度与引流量。在测定或处置引流系统时，护士都应采取无菌技术，避免污染。

If the patient is immobilized as a result of the fracture, the nurse must plan care to prevent constipation and renal calculi.

如病人因骨折而卧床，护士必须制定护理计划，防止便秘与肾结石。

Constipation can be prevented by maintenance of a high fluid intake and a diet high in bulk and roughage. If these measures are not effective in maintaining the patient's normal bowel pattern, stool softeners, laxatives, or suppositories may be necessary. Maintaining a regular time for elimination despite bed rest is effective in promoting regularity.

便秘可以通过饮食纤维含量高的食物或粗粮得以预防。如果这些措施无法维持病人的正常排便习惯，可使用软便剂、缓泻药、开塞露等。尽管病人卧床休息，但保持定期排泄对养成规律很有效。

Renal calculi can develop as a result of bone demineralization caused by immobilization. Unless contraindicated, a fluid intake of 2100 to 2800 ml/day is recommended. Cranberry juice is often recommended to acidify the urine and discourage development of stones.

卧床造成骨头矿物质脱落，最终出现肾结石。因此，除禁忌者外，应建议每天摄取2100－2800 ml的液体。桔子汁可以酸化尿液，阻碍结石的形成。

Rapid deconditioning of the circulatory system can occur as a result of bed rest. These effects can be diminished by permitting the patient to sit on the side of the bed, allowing the lower limbs to dangle over the bedside, and performing standing transfers (unless these measures are contraindicated).

由于卧床，循环系统适应功能迅速下降。可通过下列方法减少这些影响：允许病人坐在床沿、使下肢垂在床边，做站立过渡练习（禁忌者除外)。

When the patient is allowed to increase activity, careful evaluation should be made to assess for orthostatic hypotension.

许可病人增加运动时，应对病人进行仔细的评估，确认没无体位性低血压。

Patient Teaching

病人宣教

Because a fracture often is cast in an outpatient setting, the patient may require only a short hospitalization or none at all. Therefore patient education is an important nursing responsibility to prevent complications. In addition to giving specific instructions for cast care and recognition of complications, the nurse should encourage the patient to contact the clinic or care provider if questions arise. The nurse should validate patient understanding of these instructions before discharge from the clinic or hospital.

在门诊中，骨折常常就是打石膏，病人住院时间很短，甚至不用住院。因此，进行病人宣教，防止并发症发生，这是一项重要的护理职责。除了给予具体的石膏护理指导和并发症确认教育外，护士应鼓励病人有疑问时联系诊所或施护人员。在出院前，护士应确认病人已经理解这些指导。