《中医正骨学》模拟试题

《中医正骨学》模拟试题

一、选择题(50分，每题型下每小题各1分)

【A1型题】

1．“令人两手牵其颐已，暂推之，急出大指，或昨伤也。”这是世界上最早记载的颞颌关节脱位的整复方法，此方法记载于

A．《五十二病方》B．《诸病源候论》C．《备急千金要方》

D．《肘后救卒方》E．《世医得效方》

2．一般的单纯性骨折，全身症状不甚明显或不严重，只是由于局部积瘀化热，其体温一般不会超过

A．37.5°B．38°C．38.5°D．39°E．39.5°

3．骨折的临床愈合标准中，下肢功能测定要求，在解除外固定情况下，能连续徒手步行3分钟，并不少于多少步

A．200步B．150步C．100步D．60步E．30步

4．骨折愈合过程分期是

A．炎症期、血肿机化期、塑形期B．炎症反应期、修复期、塑形期

C．炎症期、血肿机化期、骨痂改造期D．炎症反应期、新生骨痂期、骨痂改造期E．炎症期、血肿机化期、修复期

5．锁骨骨折在绷带固定后，常常还可能出现骨折的再次移位，这其中最主要的原因是功能锻炼方法不当而引起的，下列功能锻炼你认为正确的为

A．肘关节的屈伸活动和用力握拳B．早期可作肩后伸及扩胸活动

C．肩外展和外旋练习D．平抬患肢E．耸肩练习

6．下列易并发桡神经损伤的骨折是

A．肱骨干三角肌止点以上骨折B．肱骨干三角肌止点以下骨折

C．肱骨干上段骨折D．肱骨干中下段骨折E．以上都不是

7．肱骨外髁骨折手法复位不佳与夹板固定不牢，都可能导致骨折出现不愈合，在骨骼以后的发育过程中，会出现肘部发育畸形进而发生

A．正中神经麻痹B．桡神经麻痹C．尺神经麻痹

D．前臂外侧皮神经麻痹E．前臂内侧皮神经麻痹

8．尺骨鹰嘴骨折早期不宜采用的功能锻炼方式是

A．肩关节屈伸B．肘关节屈伸C．腕关节屈伸

D．掌指关节屈伸E．腕关节旋转

9．股骨颈骨折持续牵引时，应将患肢置于

A．外展、外旋B．内收、内旋C．内收、中立

D．内收、外旋E．外展、中立

10．Bryant牵引适用于

A．婴儿B．3岁以下的幼儿C．3岁～5岁的幼儿

D．4岁～8岁的儿童E．1岁～4岁的幼儿

11．髌骨骨折适用于抱膝圈固定的为

A．分离移位0.5cm~lcm B．分离移位0cm~0.5cm C．分离移位0.5cm~1.5cm

D．分离移位0cm~lcm E．分离移位0cm~2cm

12．胫腓骨干骨折应采用手术切开复位内固定治疗的是

A．所有开放性胫腓骨干骨折B．陈旧性胫腓骨干骨折不愈合者

C．儿童陈旧性胫腓骨干骨折畸形愈合者D．所有成人胫腓骨干骨折E．以上均不对

13．肋骨牵引固定法适用于何种类型的肋骨骨折

A．对胶布过敏者B．一肋一处骨折C．一肋双处骨折

D．多肋双处骨折E．以上均可

14．关于颈椎骨折脱位的X线照片显示说法错误的是

A．颈椎骨骨折时椎体不会呈楔状

B．半脱位时可出现上位椎体的下关节突移至下位椎体的上关节突尖部或前部

C．颈椎的正常生理弯曲消失

D．受累椎体后缘、椎板前缘与脊髓之间的关系异常

E．受累椎体椎弓根、关节突与椎间孔的关系异常

15．胸腰椎骨折与脱位早期局部肿痛，胃纳欠佳，大便秘结，舌苔白薄，脉弦紧等，血瘀气滞的，治以活血行气、消肿止痛，可内服

A．复员活血汤加减B．腰伤二方C．八珍汤D．壮腰健肾汤E．六味地黄丸16．下列哪项骨折不是因骨盆侧面受挤压时容易发生的骨折

A．坐骨结节骨折B骶骨纵形骨折C．耻骨联合分离

D．髂骨翼骨折E．耻骨单侧上下支骨折

17．关节脱位的特有症状是

A．疼痛B肿胀C．局部压痛D．关节盂空虚E．功能障碍

18．陈旧性关节脱位手法复位较难的原因是

A．关节囊内、外血肿机化B．关节周围肌肉萎缩C．近关节伴有骨折

D．近关节骨质疏松E．关节韧带萎缩

19．肘关节新鲜性后脱位整复手法哪项不可用

A．拔伸屈肘法B．膝顶复位法C．推肘尖复位法

D．牵引回旋法E．A、B、C皆可用

20．关于月骨脱位，错误的是

A．掌腕横纹处有压痛B．腕关节呈背伸位，手指伸直困难C．腕关节功能障碍D．握拳时第3掌骨头明显塌陷E．X线正位片显示月骨由正常的四方形变成三角形【A2型题】

1．某学生在上体育课时，因投掷手榴弹用力过猛，而造成肱骨干骨折，此病因为A．间接暴力B．累积性力C．骨疾病D．肌肉牵拉暴力E．直接暴力

2．某患者，男，37岁。伤后臂部疼痛．肿胀，臂部有明显的环形压痛，并出现腕下垂，临床应考虑的诊断为

A．肱骨干骨折B．肱骨外科颈骨折C．肱骨髁上骨折

D．肱骨干骨折合并桡神经损伤E．肱骨内髁骨折

3．某患者，女，62岁，伤后腕关节上方明显肿胀．疼痛，腕关节活动受限，桡骨下端处压痛明显，从侧面观察桡骨远端呈“餐叉样”畸形，应考虑的诊断是

A．科勒(colle)骨折B．史密斯骨折C．巴尔通骨折

D．桡骨远端掌侧缘劈裂骨折E．以上都不是

4．男性，69岁，外伤致左股骨颈骨折，体检最可能发现的体征为

A．左下肢感觉障碍B．左下肢短缩、外旋畸形C．左下肢活动受限

D．左下肢运动时，腹股沟部出现骨擦音E．左腹股沟部肿胀及皮下瘀斑

5．女性，43岁，右踝坠跌伤一天，x线片示：右胫骨下端严重粉碎性骨折。治宜A．手法复位、石膏固定B．撬拨复位、石膏固定C．手法复位、夹板固定

D．跟骨牵引复位固定E．袜套悬吊牵引复位

6．女性，68岁，上卫生间时摔倒，当即右髋疼痛，无法站立，查患侧下肢短缩、内收、外

旋畸形，大转子局部压痛并上移。最可能的诊断为

A．股骨颈骨折B．股骨转子间骨折C．髋关节后脱位

D．髋关节前脱位E．股骨颈骨折并脱位

7．刘某外伤引起胸部损伤，除查出有肋骨骨折外，病人还表现有呼吸困难、紫绀，在头、颈、胸部出现皮下气肿，气管偏向健侧。此病人出现了何种并发症

A．闭全性气胸B．开放性气胸C．张力性气胸D．血胸E．肺脏损伤

8．某男士，43岁，昨日因车祸致左髂骨骨折伴耻骨联合分离，入院后经用多头带固定配合骨牵引处理，现患者述：小腹胀满不适，小便不利，刺痛。此治疗宜

A．复元活血汤B．活血止痛汤C．导赤散合八正散D．云南白药E．顺气活血汤9．马某，女，38岁。昨日不慎跌伤，左肩肿痛。患处出现青紫瘀斑，左肩关节功能活动障碍，呈“方肩畸形”，被动活动呈现弹性阻力，无骨擦音。此病人首先应考虑何病

A．肩周炎B．肩关节脱位C．左肱骨外科颈骨折

D．急性肩部扭挫伤E．左肩胛骨骨折

10．孙某，男，22岁，由于工地建筑塌方其右膝关节受伤。来就诊时，右膝关节剧痛、肿胀明显，其横径增大，外侧向活动明显，可在膝关节外侧扪到股骨髁下缘，内侧扪及胫骨平台上缘。此病人可初诊为

A．髌骨脱位B．膝关节前脱位C．膝关节后脱位

D．膝关节外侧脱位E．膝关节内侧脱位

【B型题】

A．复杂性骨折B．开放骨折C．不完全性骨折

D．病理性骨折E．不稳定性骨折

1．螺旋形骨折属

2．骨盆骨折属

A．向前、向内移位B．向后、内旋移位C．向外、向前移位

D．向上、向外移位E．向上、向前移位

3．肱骨中段骨折时，骨折近端移位多

4．肱骨上段骨折时，骨折近端移位多

A．髌骨横形骨折，分离移位较大，手法复位外固定有困难者

B．分离移位明显的髌骨骨折C．陈旧性髌骨骨折断端分离不大者

D．分离移位小于0.5cm的髌骨骨折E．复位困难的严重粉碎性髌骨骨折

5．抱膝圈固定适用于

6．闭合穿针复位固定适用于

A．第2肋间锁骨中线B．第2肋间腋中线C．第6～7肋间腋前线

D．第6～7肋间腋后线E．第6～7肋问腋中线

7．张力性气胸的穿刺抽气点位置在

8．血胸的穿刺抽血点位置在

A．肘关节B．指间关节C．下尺桡关节D．颞颌关节E．肩锁关节

9．关节脱位手法整复容易，但维持其对位困难的关节是

10．脱位后易并发骨化性肌炎的关节是

【X型题】

l．下列哪些骨折X线片照片当时可能显示不出骨折线。应于两周后再摄片复查A．跖骨疲劳骨折B．腕舟骨骨折C．股骨颈无移位骨折

D．尺骨鹰嘴骨折E．踝部骨折

2．属于骨折晚期并发症的是

A．缺血性骨坏死B．泌尿系感染和结石C．坠积性肺炎

D．脂肪栓塞E．缺血性肌挛缩

3．肱骨外科颈骨折内收型的典型的临床表现有

A．肩部剧烈疼痛，肿胀明显，上臂内侧可见瘀斑B．肩关节活动障碍，患肢不能平举C．肱骨上端有较明显的环形压痛D．肩部下方呈凹陷，似“方肩畸形”

E．肩部下方明显向外突起

4．整复肱骨内上髁三度骨折中，能使前臂屈肌紧张将骨块拉出的做法是A．内旋前臂B．内翻肘关节C．极度背伸手指及腕关节

D．极度屈曲腕关节E．将前臂旋后外展

5．股骨干下l／3骨折后，以下哪些情况出现即应考虑神经、血管损伤

A．末梢血循障碍B．小腿感觉障碍C．足运动障碍

D．胫后动脉搏动消失E．足背动脉搏动减弱或消失

6．男性，37岁，左大腿下端被重物砸压后，见患肢缩短畸形，大腿下端环形压痛，纵向叩击痛，胫后动脉搏动减弱，足伸屈功能障碍。应考虑存在

A．腘动脉损伤B．胫神经损伤C．腓总神经损伤

D．股骨髁上骨折E半月板损伤

7．肋骨骨折并发开放性气胸时可出现

A．呼吸困难B．紫绀C．血压下降D．伤侧呼吸音增强E．肺部叩诊为鼓音8．新鲜关节脱位手术复位的适应症是

A．多次手法复位失败者B．复杂性脱位，须行血管神经探查者

C．脱位并发骨折片潜入关节腔内者

D．脱位并发较大骨折，肌腱、韧带断裂复位关节不稳定者E．骨化性肌炎

9．髋关节后脱位的体征是患肢呈

A．内收内旋畸形B外展外旋畸形C．屈曲畸形D．轻度屈曲畸形E．患肢增长10．髋关节后脱位复位手法有

A．屈髋拔伸法B．回旋法C．拔伸足蹬法D．俯卧下垂法E．反回

二、名词解释(10分，每小题各2分)

1．早期骨痂反应

2．对位、对线

3．筋膜间隔区综合征

4．胸廓挤压试验

5．分歧性脱位

三、填空题(10分，每小题1分)

1．整复骨折前必须要拟定一个比较完善的整复方案，包括具体的______、步骤及______。2．传递暴力导致的桡、尺骨干双骨折，桡骨远端常出现旋前移位，主要是由于_______及______的影响。

3．尺骨干中段骨折，近端受肱肌的作用向______移位，远端因骨间膜及旋前方肌的前拉而向______。

4．开放性趾骨骨折，伤口较大者，一般给予______处理，必要时______，预防感染。5．股骨髁间骨折后若骨折块复位不良，晚期可继发______甚至造成膝关节______畸形。6．骨盆骨折，骨折伴______损伤而造成______是休克的主要原因。此外，______、______是加重休克的重要因素。

7．脊髓损伤根据其功能障碍程度，一般可分为______、______和______三种。

8．关节脱位的内因包括生理和病理因素两方面，病理因素有______，体质虚弱，______易

发生脱位。

9．月骨脱位复位后用外固定将腕关节固定于______，l周后改为______。

10．下桡尺关节脱位复位或手术后会留有长期______，一般经过______时间的治疗，疼痛症状可逐渐减轻或消失。

四、简答题(10分，每小题5分)

1．骨折迟缓愈合的预防方法有哪些?

2．说出脱位整复手法大致可概括为几种?

五、论述题(20分，每小题10分)

1．论述伸直型桡骨下端骨折诊断要点，牵抖复位手法和固定方法? (诊断要点3分，牵抖复位手法4分，固定方法3分)

2．病案：患者章某，男性，44岁，劳作时不慎自约1.5米高处跌落地上，右足跟部先着地，当即感右足跟及腰部疼痛，无法站立活动。查见右足跟部瘀斑及肿胀、明显压痛，腰肌紧张，脊柱活动明显受限，L椎体棘突有明显压痛。

试分析(1)该患者应进一步完善哪些检查? (4分)

(2)该患者的初步诊断是什么? (分)

(3)对该患者宜怎样治疗? (4分)

参考答案

一、选择题(50分，每题型下每小题各1分)

【A1型题】

1．D 2．C 3．E 4．B 5．A 6．D 7．C 8．B 9．E 10．B 11．B 12．B 13．D 14．A 15．A 16．A 17．D 18．A 19．D 20．B 【A2型题】

1．D 2．D 3．A 4．B 5．D 6．B 7．E 8．E 9．B 10．E 【B型题】

1．E 2．A 3．C 4．A 5．D 6．A 7．A 8．D 9．E l0．A 【X型题】

1．ABC 2．ABC 3．BCE 4．CE 5．ABCDE 6．ABD 7．ABCE 8．ABCD 9．AC 10．ABCD 二、名词解释(10分，每小题各2分)

1．这些细胞通过周围血管侵入的肉芽组织而进入血肿内。早期为纤维骨痂，由纤维组织、软骨及不成熟的纤维软骨构成。纤维骨痂很快包绕骨折端，使骨折端逐渐变得稳定。这一过程又称为“早期骨痂反应”。

2．对位：指两骨折端的接触面。对线：指两骨折段在纵轴上的关系。

3．肢体损伤严重，在各筋膜间隔区单独或同时出现：严重肿胀、扪之硬实，肌肉紧张无力、有压痛和被动牵拉痛，神经分布区皮肤感觉消失等症状体征，即为筋膜间隔区综合征。4．肋骨骨折移位重者，医者两手分别置于胸骨和胸椎，前后或左右挤压胸廓，均可引起骨折处疼痛加剧，即胸廓挤压征阳性。

5．跖趾关节在外力作用下发生的第l跖骨向内侧脱位、第2～第5跖骨向外侧或背侧脱位，称为分歧性脱位。

三、填空题(10分，每小题1分)

1．手法注意事项

2．旋前圆肌旋前方肌

3．掌侧桡侧

4．清创缝合拔除趾甲

5．创伤性关节炎内翻或外翻

6．血管大量出血尿液外渗肠内容物外溢

7．暂时性不完全性完全性

8．先天性关节发育不良关节囊和关节周围韧带松弛

9．掌屈30°～40°中立位

10．疼痛l／2～1年

四、简答题(10分，每小题5分)

1．答：预防方法有：(1)预防骨折迟缓愈合的方法首先是了解骨折发生的机制，熟悉骨折移位的倾向，尽量避免不必要的手术干预，早期进行有效的手法整复固定。(2)断端间嵌有软组织者，应在复位时用手法解除，必要时用手术解除。(3)固定稳妥后，鼓励病人及早进行有效的功能锻炼，祛除骨折愈合的不利因素，增加骨折愈合的有利条件，避免迟缓愈合的发生。

2．答：大致可概括为以下几种：牵引复位法，原路返回法、杠杆复位法、松弛肌肉复位法。

五、论述题(20分，每小题10分)

1．答：(1)诊断要点：外伤史：患者常常有明显的跌倒或打击等外伤史。临床表现：损伤后，腕部出现疼痛．肿胀和畸形，严重受伤者，可出现局部水疱和瘀斑。患侧腕部活动障碍，握拳时疼痛加剧，手指无力。专科检查：桡骨下端压痛明显，有纵向叩击痛，腕关节活动功能部分或完全丧失，部分患者可扪及到骨折块，骨擦音。有移位骨折常有典型畸形。

伸直型骨折远端向背侧移位时，形成典型的“餐叉样”畸形。X线检查：腕关节正侧位X线照片，可明确骨折类型和移位方向。

(2)牵抖复位手法：整复时，患者取坐位或平卧位，患肢外展，屈肘90°，前臂中立位。

助手握住患肢前臂近端，术者用两手握持患肢手掌，两拇指置于骨折远端背侧，其余四指置于腕掌部，先顺势拔伸牵引2～3分钟，以矫正重叠移位，然后将前臂远端旋前，利用牵引力，顺纵轴方向骤然猛抖，同时迅速尺偏掌屈，使之复位。

(3)固定方法：伸直型骨折在骨折远端背侧和近端掌侧分别放一平垫，在骨折远端的背桡

侧处放一横档纸垫。压垫放置妥后，再放上夹板。夹板上端达前臂中．上段，桡侧夹板和背侧夹板的下端应超过腕关节，限制手腕的桡偏和背伸活动。尺侧夹板与掌侧夹板则不超过腕关节。固定垫．夹板放妥后，扎上三条布带，最后将前臂置于中立位，屈肘90°悬挂于胸前，固定4～5周，儿童患者固定3周左右。

2．答：①对该患者应拍右跟骨侧位、轴位及腰椎正、侧位X线片检查。②初步诊断为右跟骨骨折和腰椎椎体压缩性骨折。③治疗措施：跟骨骨折，若移位不明显，早期可局部制动，活血祛瘀药物外敷，扶拐不负重步行锻炼4周左右；若明显移位，则宜手法撬拨复位，尽可能恢复结节关节角，复位后固定患肢屈膝、足跖屈30°位4周～6周。对于腰椎压缩性骨折应平卧硬板床，骨折处垫枕复位，l周～2周后逐渐行五点支撑等功能锻炼。

内服药物均按骨折三期辨证用药。

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