Importance of fracture criterion and crack tip material characterization in probabilistic fracture m

Importance of fracture criterion and crack tip material characterization

in probabilistic fracture mechanics analysis of an RPV

under a pressurized thermal shock

Katsuyuki Shibata a,*,Kunio Onizawa a ,Yinsheng Li b ,Daisuke Kato b

a

Japan Atomic Energy Research Institute,Tokai-mura,Ibaraki-ken 319-1195,Japan

b

Fuji Research Institute Corporation,2-3,Kanda-Nishikicho,Chiyoda-ku,Tokyo 101-8443,Japan

Received 18September 2003;revised 11May 2004;accepted 11May 2004

Abstract

Using a probabilistic fracture mechanics code,the importance of the choice of fracture criterion and the material fracture resistance characterization at the crack tip is elucidated in the failure probability analysis of an reactor pressure vessel.The paper describes the procedure to evaluate the crack extension based on R6,where an increase in fracture resistance by ductile crack extension is considered.Two standard J –resistance curves are prepared for applying the elasto-plastic fracture criterion by R6tearing.

Case studies concerning the effect of the tearing fracture criterion were carried out using a severe pressurized thermal Shock transient.Results are discussed with respect to the fracture criterion,the material J –resistance curve,the algorithm for evaluating the crack tip fracture toughness and the initial crack geometry.

The introduction of the elasto-plastic fracture criterion signi?cantly contributes to removal of over-conservatism in applying a linear elastic fracture criterion.It was also con?rmed that the algorithm of the re-evaluation method for crack tip fracture toughness has to be correctly applied.

q 2004Elsevier Ltd.All rights reserved.

Keywords:Probabilistic fracture mechanics (PFM);Reactor pressure vessel (RPV);Pressurized thermal shock (PTS);Failure probability;Fracture criterion;R6method;Ductile crack extension;J –resistance curve;Fracture toughness

1.Introduction

The probabilistic assessment methodology,in compari-son with the current deterministic one,for structural integrity of components in design and in-service inspection of nuclear power plant components is important for establishing a more rational maintenance strategy in order to attain a certain level of reliability of aged components.The methodology also contributes to improved cost performance in inspection.However,it is necessary to prepare a probabilistic fracture mechanics (PFM)code,which has suf?cient accuracy and reliability to conduct the above probabilistic assessment.

In order to prepare for the need for a PFM methodology,Japan Atomic Energy Research Institute (JAERI)has developed a PFM code,PASCAL (PFM Analysis of

Structural Components in Aging LWR),since 1996.This code evaluates the conditional failure probability of an reactor pressure vessel (RPV)subjected to a transient load such as a pressurized thermal shock (PTS).

In PASCAL some improvements in fracture mechanics analysis models and computational techniques have been incorporated [1–6].One of the features in PASCAL is that an elasto-plastic fracture criterion is introduced [4–6].In the algorithm for elasto-plastic fracture analysis,the increase in fracture resistance under crack extension by ductile tearing is taken into account based on the R6method [7].By use of this fracture criterion,the accuracy of the calculated failure probability may be signi?cantly improved compared with that by using a linear elastic fracture criterion for reasons given below.

Under a PTS event,a crack may initiate from an initial surface ?aw by the linear elastic fracture mode (brittle fracture)due to embrittlement by high neutron ?uence and the low coolant temperature at the inner surface of

0308-0161/$-see front matter q 2004Elsevier Ltd.All rights reserved.

doi:10.1016/j.ijpvp.2004.05.003

International Journal of Pressure Vessels and Piping 81(2004)749–756

https://www.wendangku.net/doc/6d16608724.html,/locate/ijpvp

*Corresponding author.Tel.:t81-292-82-5290;fax:t81-292-82-5408.E-mail address:shibata@popsvr.tokai.jaeri.go.jp (K.Shibata).

the vessel.However,due to both the attenuation of neutron ?uence and the temperature increase through the wall thickness,the fracture toughness at the crack tip increases as the crack extends.Thus,a transition of fracture mode from brittle to ductile tearing may occur.Moreover,during ductile crack extension,an increase in fracture resistance according to the J–resistance curve also occurs.

In past PFM analyses of the RPV,the linear elastic fracture criterion has been applied in most cases,which might give an over-conservative failure probability.The application of an elasto-plastic fracture criterion,which enables the analysis of ductile crack extension behaviour, may contribute to removal of the over-conservatism in the fracture analysis based on the linear elastic fracture criterion.

The purpose of the present study is to elucidate the importance of the fracture criterion and the material fracture resistance at the crack tip in a PFM analysis of the RPV. This paper?rst describes the procedure to apply the elasto-plastic fracture criterion,in which the increase in fracture resistance by ductile tearing is considered based on R6[7].

Two standard J–resistance curves as a function of temperature and neutron?uence are prepared considering the usability in applying the elasto-plastic fracture criterion. These standard J–resistance curves were constructed based on existing Japanese and US material fracture toughness data of irradiated low alloy steels[8,9].The procedure for constructing these two standard J–resistance curves, Japanese and US,is also described.

Four options of fracture criteria,linear elasticeK IC=K IaT; R6initiation,tearing and combined initiation/tearing are introduced in https://www.wendangku.net/doc/6d16608724.html,ing these fracture criteria,some case studies were carried out on various parameters under a severe PTS transient prescribed in the NRC/EPRI PTS benchmark problem A5[10].Results obtained from the case studies are discussed with respect to the fracture criterion, the difference in material J–resistance curve,the difference in algorithm for simulating the crack tip fracture toughness and the effect of initial crack geometry.

2.Outline of PFM code PASCAL

The PFM code PASCAL has been developed to evaluate the failure probability of an aged RPV under transient loading such as a PTS.This code has the following features as reported in detail in previous papers[4–6]:

?The elasto-plastic fracture criterion based on the R6 method is introduced.A fracture transition from brittle to ductile tearing can be treated.The increase in fracture resistance under ductile crack extension is taken into account.This code may be applicable to other com-ponents that exhibit ductile fracture.

?The effect of embrittlement recovery by thermal anneal-ing of a vessel can be evaluated probabilistically based

on the method prescribed by USNRC R.G. 1.162-1996[11].

?For semi-elliptical crack extension analysis,three simulation models,Models1,2and3are introduced.

In Model1,an initial semi-elliptical?aw is replaced by an in?nite edge crack following crack initiation at the deepest point.In Model2,an initial semi-elliptical?aw is replaced by an in?nite edge crack following crack initiation at the surface points keeping the crack depth as the initial value.In Model3,incremental crack extension analyses in both surface and depth directions are performed.The crack extension analysis,including the change in crack aspect ratio during extension,can be performed by this model.

?A semi-elliptical initial?aw with a given aspect ratio, given length and given aspect ratio distribution can be analyzed.

?For an in?nite edge crack,an analytical stress intensity factor solution using in?uence function can be applied.

By combining two stress intensity factor solutions,i.e.

applying the in?uence function solution for a shallow crack and another edge crack solution for a deep crack, the effect of a discontinuity in the stress distribution around a cladding-base metal interface can be accurately evaluated because the discontinuity in the stress distribution is exactly re?ected.In addition,an approxi-mate method is introduced to evaluate the in?uence of overlay cladding by dividing the stress distribution into three partial distributions and superposing the stress intensity factors obtained from these distributions[4,5].

3.Ductile crack extension analysis model based on R6 and material J–resistance curves

3.1.Introduction of elasto-plastic fracture criterion based on R6

The following four options of fracture criteria are introduced in PASCAL:

(1)Linear elastic fracture criterion;K IC=K Ia

(2)Initiation analysis of R6

(3)Ductile tearing analysis of R6

(4)Combination of(2)and(3);R6initiation/tearing

In the fourth criterion,the combination of initiation/tear-ing depends on the crack tip condition.Option1or Option2 Failure analysis curves(FAC)de?ned in R6can be chosen in the analyses using the fracture criteria of R6.

Fig.1shows the concept of crack initiation,extension or arrest in the linear elastic fracture criterion in a RPV subject to a transient loading.The crack initiates at K I?K IC from an initial?aw,then,the crack is arrested if the applied load satis?es K I,K Ia:A comparison between the K IC=K Ia criterion and the R6initiation criterion is given in Fig.2.

K.Shibata et al./International Journal of Pressure Vessels and Piping81(2004)749–756 750

The R6initiation criterion may be a linear elastic one in principle.In the R6initiation and tearing criteria,the FAC is applied instead of fracture toughness K IC or K Ia:In both criteria,K IC=K Ia and R6,the cut-off stress is set at the?ow

stress.In the R6initiation criterion,K Ia instead of K IC is used here in the parameter K r;i.e.K I=K Ia;to judge crack arrest.As shown in Fig.2,the FAC of Option1is inside (conservative)the K IC=K Ia criterion.In addition,in the evaluation of the parameter K re?K I=K ICTin R6,a conservative plasticity correction factorerTfor evaluating the stress intensity factor due to secondary stress is introduced.Thus the R6initiation criterion is more conservetive than that of K IC=K Ia:

As mentioned in Section1,a crack may extend in a brittle mode initially.However,the material toughness at the crack tip increases due to the temperature increase and attenuation in neutron?uence.Thus,crack extension or arrest in a ductile mode may occur in the actual crack extension.This crack extension behaviour has to be treated appropriately considering the increase in material resistance according to the J–resistance curve.The elasto-plastic R6ductile tearing fracture criterion was introduced to express this ductile crack extension behaviour to improve the accuracy and reliability of the failure probability in the PFM analysis.

Fig.3shows the principle of crack extension analysis by the R6ductile tearing criterion.In this case,the crack extends along the FAC subsequent to crack initiation.The crack tip fracture toughness increases according to the material J–resistance curve.Thus the increase in fracture resistance can be taken into account appropriately.

3.2.Switch in fracture mode between brittle and ductile during crack extension

In the fourth fracture criterion,a judgment of the applied fracture criterion,initiation or tearing at the crack tip is performed depending on the crack tip condition During crack extension,the fracture mode changes from brittle to ductile tearing by increase in crack tip temperature and ?uence attenuation or even from ductile tearing to brittle due to cooling.In the combined initiation/tearing criterion, initiation or tearing is judged depending on the crack tip condition at every step of crack extension.In this fracture criterion,crack initiation from the initial?aw not only due to the initiation criterion but due to the tearing is also evaluated.Therefore,the fourth criterion,the combined initiation/tearing criterion,may give a higher crack initiation probability than that by the initiation criterion.

Fig.4illustrates the algorithm to judge the fracture mode.By comparing K IC and K0:2;depending on crack tip temperature and?uence at the current crack tip,the

fracture

Fig.4.Algorithm for switch in fracture criterion from initiation or tearing. K.Shibata et al./International Journal of Pressure Vessels and Piping81(2004)749–756751

criterion to be applied is determined.In this analysis,K0:2is de?ned as the value of K V at D a?0:2mm in the K V–D a curve which is the K-equivalent of the J–resistance curve. The applied fracture criterion at the current crack tip is determined by the smaller of K IC or K0:2:

3.3.Construction of standard J–resistance curves

In the R6tearing analysis,which considers ductile crack extension,the material J–resistance curve as a function of temperature and neutron?uence is essential.Two standard J–resistance curves,one for Japanese material and the other for US material,are constructed and K V–D a curves converted from J–resistance curves are incorporated in PASCAL as described below.

Tomimatsu et al.,[8]proposed a procedure to estimate the J–resistance curve for irradiated low alloy steels.In this procedure,the J–resistance curve is estimated from the decrease in the upper shelf energy(USE)of a Charpy impact test.The J–resistance curve is expressed by the following equation:

J?CeD aTme1Twhere C and m are the functions of initial USE,USE after irradiation,temperature and Cu content and are expressed as follows:

for base metal,

C?24:94￡1024USE·T20:375Tt2:624USEt53:0

e2Tand

m?21:59￡1026USE·T29:96￡1025Tt1:83￡1023USEt0:273e3Tand for weld metal,

C?28:74￡1024USE·T20:372Tt2:210USEt73:5

e4Tand

m?21:46￡1026USE·Tt1:04￡1024Tt1:36￡1023USEt0:315e5TIn Eqs.(2)–(5),T is crack tip temperature(8C)and USE is Upper Shelf Energy(J)by v-notch Charpy impact testing considering the degradation by neutron irradiation.The decrease in the USE by irradiation(D USE)is expressed by the following equations:

for base metal,

D USE?UUS

100

2:40t102:6Cu

eTf0:29720:145log fe6T

and for weld metal,

D USE?

UUS

100

e7:20t97:0CuTf0:140e7T

where UUS,f and Cu are the initial USE(J),?uence in

1019n/cm2(E.1MeV)and Cu content in wt%,

respectively.

Alternatively,Eason et al.,[9]derived empirical

equations based on a statistical treatment of J–resistance

curves of irradiated pressure vessel steels in the US.The

expression of the J–resistance curve is the same as Eq.(1).

Values of C and m are expressed as follows:

for base metal,

C?exp?20:0945t0:686lneCVN pT20:00258T

20:0109f t e8T

and

m?0:678t0:120lneCT20:0944lneCVN pTe9T

for weld metal,

C?exp?22:9221:03Cuef tT0:35320:00234Tt1:28

lneCVN pT e10T

and

m?0:363t0:0725lneCT20:115Cuef tT0:353e11T

where T;w t and CVN p are temperature(0F),?uence

(1018n/cm2)and initial USE(ft–lb),respectively.

The J–resistance curve is converted into the fracture

toughness resistance curve K V–D a using the following

relation:

K V?

E

12n2

JeD aT

1=2

e12T

where E and n are elastic modulus and Poisson’s ratio,

respectively.

Two K V2D a curves at2508C irradiated up to

1019n/cm2are compared in Fig.5.Generally,the K V–D

a

Fig.5.K V vs.D a Curves of Japanese and US PV material constructed and

incorporated in PASCAL.

K.Shibata et al./International Journal of Pressure Vessels and Piping81(2004)749–756

752

curve for Japanese material has a50%higher toughness than the US one.

4.Results of case studies and discussions on the effect of fracture criterion

Case studies were carried out on the effect of the fracture criterion on failure probabilities under various parameters. The PTS transient prescribed by the NRC/EPRI PTS benchmark problem A5[10]was applied.Table1shows the main conditions of the benchmark problem.The transient?uid temperature and pressure are illustrated in Fig.6.In this transient,a steep decrease in?uid temperature is assumed under a constant pressure.This transient

represents severe PTS events.An in?nite edge?aw or a semi-elliptical?aw in the longitudinal direction is assumed to exist in a welded joint at the inner surface.In all cases,re-evaluation of crack tip fracture toughness was based on the third method described in Section4.3below,except for the case to examine the effect of the re-evaluation method discussed in Section4.4.

The following items concerning the fracture criterion are studied and discussed in Sections4.1–4.4:

(1)Effect of fracture criterion,

(2)Effect of material J–resistance curve,

(3)Effect of re-evaluation method for material character-

ization at the crack tip,and

(4)Effect of initial?aw geometry.

4.1.Effect of fracture criterion

In Fig.7,crack initiation probabilities by three fracture criteria are compared.In the analysis by the combined initiation/tearing criterion,the K V–D a curve of the US material was used.The option1FAC was applied in the R6 fracture criteria.As shown in Fig.7,the crack initiation probabilities by the R6initiation and initiation/tearing criteria are slightly higher than those of the K IC=K Ia criterion because the FAC in R6is more conservative than the K IC=K Ia criterion as shown in Fig.2.

In the case of the initiation/tearing criterion,most cracks initiate by the initiation criterion and the crack initiation probabilities by initiation/tearing criterion are almost identical to those by initiation the criterion.However,a small difference in the crack initiation probability is seen at the?uence0.5￡1019n/cm2.In the combined initiation/ tearing criterion,crack initiation not only by the initiation criterion but by the tearing criterion is taken into account resulting in a slight difference in the crack initiation probability between initiation and initiation/tearing criteria.

On the other hand,the failure probabilities by initi-ation/tearing are considerably lower than those by initiation and the K IC=K Ia criteria as seen in Fig.8.This is caused by the increase in fracture resistance by ductile crack extension.It is clear from this result that the in?uence of ductile crack extension is very signi?cant.Fig.9shows the percentage of crack arrests,de?ned by Crack arrest %?100￡Arrest probability/Crack initiation probability.

In Fig.9,it is clearly seen that crack arrest occurs more frequently by the elasto-plastic initiation/tearing criterion than by the K IC=K Ia or the initiation criteria.

Table1

Conditions of NRC/EPRI PTS benchmark analysis(A5)[10]

Geometry of pressure vessel(mm)Diameter;2286,Wall thickness;228.6Without overlay cladding

Transient pressure

(MPa)

P?6:895(constant)

Transient?uid temperature(C)T?T fteT02T fTexpe2l tTT0?288 T f?65:6l?0:025s21

Cu and Ni content of RPV material(wt%)Cu:Mean value;0.3,Standard dev.;0.025 Ni:Mean value;0.75,Standard dev.;0.0

Initial RT NDT(C)Mean value;26.667,Standard dev.;9.444 Prediction

of D RT NDT(C)

Mean value;Eq.by RG1.99,Standard dev.;0.0%

Estimation of

K IC=K Ia(MPam1/2)Mean value;Eq.by USNRC,Standard dev.;

10%

Fig.7.In?uence of fracture criterion on crack initiation probability(US

J–R curve is applied in the initiation/tearing criterion).

K.Shibata et al./International Journal of Pressure Vessels and Piping81(2004)749–756753

4.2.Effect of material fracture toughness resistance curve The results described in Section 4.1above indicate that the material K V –D a curve is one of the most dominant factors in the analysis in the https://www.wendangku.net/doc/6d16608724.html,ing the two standard K V –D a curves,provided in PASCAL,the in?uence of the K V –D a curve on crack initiation and fracture probabilities is examined.

In Fig.10,the crack initiation probabilities using the Japanese material K V –D a curve and the US one are compared.Nearly the same probabilities were obtained in the two cases.On the other hand,as shown in Fig.11,the failure probabilities with the Japanese material curve are lower than those with the US one when tearing is considered,because the Japanese material curve has higher toughness than that of US one and more crack arrests happen at a higher toughness under the ductile crack extension.The difference in fracture resistance curve causes a difference in failure probabilities of nearly one order of magnitude as seen in Fig.11.However the fracture probabilities using the US material curve are still consider-ably lower than those by the K IC =K Ia and the initiation criteria.

4.3.Effect of re-evaluation method of material characterization at the crack tip

In the crack extension analysis,the re-evaluation of fracture toughness at every crack tip is necessary because the temperature and neutron ?uence differ from the previous crack tip location.In addition,chemical composition and fracture toughness may also ?uctuate along the wall thickness due to the process of fabrication.In a usual PFM analysis,the vessel material is assumed homogeneous and such material ?uctuations are ignored.In order to take the difference in fracture toughness at the new crack tip caused by the difference of ?uence and temperature from the previous crack tip location into account,three methods have been applied.Method I Mean values of D RT NDT (Shift of ductile–brittle

transition temperature)and fracture toughness (K IC =K Ia or K V )are re-evaluated based on the ?uence and temperature at the new crack tip.Deviations from mean values of D RT NDT and fracture toughness are both re-evaluated based on their statistical distribution by random sampling.

Method II Mean values of D RT NDT and fracture toughness

are re-evaluated based on the ?uence and tem-perature at the new crack tip.Deviation from

mean

Fig.8.In?uence of fracture criterion on failure probability (US J –R curve is applied in R6initiation/tearing

criterion).

Fig.9.In?uence of fracture criterion on crack arrest %(US J –R curve is applied in R6initiation/tearing

criterion).

value of only fracture toughness is re-evaluated

based on its statistical distribution by random

sampling.

Method III Mean values of D RT NDT and fracture toughness are re-evaluated based on the?uence and tem-

perature at the new crack tip.Deviations from

mean values of D RT NDT and fracture toughness are

not re-evaluated.

Historically,the?rst method has been adopted in the VISA-II Code[12]and the second one in the OCA-P Code [13].In this section the second and third methods are examined using three fracture criteria to show that the algorithms of the?rst and second method are not appropriate.

In Fig.12,the crack initiation probabilities by Method II and Method III are compared.In principle the crack

initiation probabilities in both cases are identical because the crack initiation probability depends only on the fracture toughness of the initial?aw tip.

The conditional failure probabilities by Method II and Method III are compared in Fig.13using the K IC=K Ia and initiation/tearing criteria.In the case of the K IC=K Ia criterion, the difference in failure probability is small.On the other hand,the difference is1.5–3-orders of magnitude if the initiation/tearing criterion is applied.

The crack arrest%is illustrated in Fig.14to elucidate the above observation more clearly.As seen in this?gure,in the case of the initiation/tearing criterion,Method II gives a higher arrest%than Method III.In a PFM analysis,the incremental crack extension analysis is performed by evaluating whether or not the crack is arrested at every increment.

From the results shown in Fig.14,it is deduced that even if a large deviation,23standard deviations for instance, from the mean fracture toughness is sampled at a previous crack tip and thus crack extension happens,the possibility of sampling a smaller deviation,within^1standard deviation for instance,is high at the current crack tip in the case of Method II.Thus Method II gives a non-conservative failure probability.This non-conservatism may also depend on the amount of crack extension increment by one step.If the increment of crack extension is smaller,crack arrest occurs more frequently in the analysis by Method https://www.wendangku.net/doc/6d16608724.html,ing the linear elastic fracture criterion,similar observations were derived in the NRC/EPRI PTS benchmark study[10]. Hirano et al.[14]performed a comprehensive examination on the re-evaluation models of VISA-II and OCA-P codes and they also pointed out the defect of the algorithm of re-evaluation.The result of this study enhances the above understanding and shows that the effect of the re-evaluation algorithm is more signi?cant if the elasto-plastic fracture criterion is applied.

4.4.In?uence of initial crack geometry

The in?uence of initial?aw geometry,i e.an in?nite edge?aw or a semi-elliptical one,on the crack initiation and failure probabilities is examined as shown in Fig.15.In

this

analysis,the aspect ratio (crack depth/half crack length)of the initial ?aw was ?xed as 1/1or 1/3.The material property of the US K V –D a curve was used in the analysis.The initiation/tearing criterion gives slightly higher crack initiation probabilities than those by the K IC =K Ia criterion.As seen in Fig.15,a large difference in the failure probability between K IC =K Ia and initiation/tearing criteria can also be con?rmed in this case.The general trend of failure probability is the same as that of the case with an initial edge ?aw.

5.Conclusions

It has been shown that consideration of ductile crack extension in PFM analyses is very important.PFM analyses using a tearing fracture criterion give considerably lower conditional failure probabilities than those by the linear elastic fracture criterion K IC =K Ia or the initiation criterion.The difference can reach ?ve orders of magnitude.Similar differences were also found for cases where the initial ?aw shapes were semi-elliptical.Therefore,it is essential to take the effect of ductile crack extension into account.

It was also con?rmed that the algorithm for re-evaluation of crack tip characterization was important.The analysis results on the re-evaluation method revealed that the deviations of D RT NDT and fracture toughness have to be ?xed and it is recon?rmed that only the mean values of D RT NDT and fracture toughness at the crack tip should be re-evaluated in the PFM analysis.

In conclusion,the application of the elasto-plastic ductile tearing fracture criterion with the associated increase in fracture resistance signi?cantly improves the accuracy of failure probability of PFM analysis and contributes to removal of a large conservatism in using a linear elastic fracture criterion.

Acknowledgements

The authors would like to thank Dr M.Suzuki,Head of Reactor Component Reliability Laboratory,JAERI for his support in conducting the present study.PASCAL Ver.1was released in 2001and PASCAL-Ver.1with GUI is registered in the Data Bank of the OECD-Nuclear Energy Agency.Anyone who would like to use PASCAL can acquire the code from the Data Bank.

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Fig.15.In?uence of initial ?aw geometry on failure probability (US J –R curve is applied in R6initiation/tearing criterion).

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骨科考试试题

1.下列哪项属于不稳定性骨折 A.嵌插骨折 B.青枝骨折 C.胸椎压缩性骨折（1/5） D.螺旋形骨折 2.导致骨筋膜室综合症的主要原因是 A.主要血管损伤 B.主要神经损伤 C.肌肉挛缩 D.筋膜室内压力过高 3.下列哪项不是骨折功能复位的标准 A.儿童下肢缩短移位<2cm B.侧方成角移位完全矫正 B.长骨干横性骨折，骨折端对位至少达1/2 D.干骺端骨折对位至少3/4 4.肘关节脱位和肱骨髁上骨折的临床鉴别要点 A.局部肿胀 B.肘关节反常活动 C.肘部畸形 D.肘后三角关系改变 5. 关于桡骨下端骨折下列哪项是错误的 A.骨折发生在距桡骨下端关节面3CM以内 B.屈曲型骨折远折端向掌、尺侧移位 C.伸直型骨折远折端向桡、背侧移位骨折易误诊为腕关节脱位 6. 关于手的功能位 A.是手可以随时发挥最大功能的位置 B.腕关节背伸20度~30度 C.轻度尺偏 D.拇指对掌位，远端指间关节半屈位 7. 患者。男，68岁。不慎跌倒，感左髋部疼痛。体检：左下肢短缩2CM、极度外旋畸形。常常提示 A.股骨颈骨折 B.股骨转子间骨折 C.髋关节前脱位 D.髋关节后脱位 8. 骨折的最严重的并发症是： A、正中神经损伤 B、畸形愈合形成肘内翻畸形 C.肌肉 缺血性挛缩 D、骨化性肌炎 9. 处理时，妥善固定的目的，哪一项是错误的 A、为了试行复位 B、避免搬动时骨折端刺伤重要血管神经 C、 防止搬动时疼痛 D、有利于防休克 岁小儿，右肘部被牵拉后即出现哭闹，肘略屈，不敢拿东西，其诊断最大可能是： A.关节脱位 B、右肘关节软组织损伤 C、右桡骨小头半脱位 D、右肱骨髁上骨折 11.胫骨中下1/3交界处最易发生骨折的原因是 A.此处肌肉附着少 B.血液丰富 C.此处骨质疏松 D.骨质形态变化

股骨颈骨折(transcervical fracture)

概述髋关节是躯干与下肢的重要连接装置与承重结构，主要由股骨头、颈与髋臼共同构成。股骨颈的长轴线与股骨干纵轴线之间形成颈干角，为110°-140°，平均为127°儿童颈干角大于成人。成人股骨头的血液供应有多种来源：①股骨头圆韧带内的小凹动脉，提供股骨头凹部的血液循环；②股骨干滋养动脉升支，沿股骨颈进入股骨头；③旋股内、外侧动脉的分支，是股骨头、颈的重要营养动脉。股骨颈骨折（fracture of the fenoral neck）常发生于老年人，随着人的寿命延长，其发病率日渐增高。其临床治疗中存在骨折不愈合和股骨头缺血坏死两个主要问题。病因和发病机制中老年人发生骨折有两个基本因素，一是骨强度下降，二是老年人髋周肌群退变，不能有效地抵消髋部有害应力。而青壮年股骨颈骨折，往往由于严重损伤所致，且多见于不稳定型。一、按骨折部位分类 1、股骨头下骨折骨折线在股骨头下，损伤旋股内、外侧动脉发出的营养血管支，使股骨头的血液供应中断，仅有股骨头圆韧带内的小凹动脉提供是少量供血，导致股骨头缺血严重，发生股骨头缺血性坏死。2、经股骨颈骨折骨折线在股骨颈中部，呈斜形，多有一三角形骨块与股骨头相连。骨折损伤股骨干滋养动脉升支，导致股骨头供血不足，易发生股骨头缺血性坏死和骨折不愈合。3、股骨颈基底骨折骨折线位于股骨颈大、小转子之间连线处。旋股内、外侧动脉的分支提供血液循环，故对骨折部的血液供应影响不大，骨折容易愈合。二、按X线表现分类 1、内收骨折远端骨折线与两侧髂嵴连线的夹角（Pauwells角）大于50°，为内收骨折，属于不稳定型骨折，因为其骨折面接触较少，容易移位。Pauwells角越大，骨折端所遭受的剪切力越大，骨折越不稳定。2、外展骨折远端骨折线与两侧髂嵴连线的夹角小于30°，为外展骨折，属于稳定性骨折。若处理不当，如过度牵引，外旋、内收，或过早负重等，也可发生移位，成为不稳定性骨折。三、按移位程度分类 1、不完全骨折仅有部分骨完整性破坏，股骨颈的一部分出现裂纹，类似于骨折的裂纹骨折。2、完全性骨折骨折线贯穿股骨颈，骨结构完全破坏。可分为：（1）无移位的完全性骨折；（2）部分移位的完全骨折；（3）完全移位的完全骨折。临床表现一、畸形患肢多有轻度屈髋屈膝及外旋畸形，一般在45°-60°之间。二、疼痛移动患肢时髋部疼痛明显。在患肢足跟部或大粗隆部叩击时，髋部感疼痛。三、功能障碍移位骨折病人在伤后不能坐起或站立。有时伤后并不立即出现功能障碍，仍能行走，数天后髋部疼痛逐渐加重，才出现不能行走。实验室及其他检查一、肢体测量通过检查可发现患肢缩短。在平卧位，由髂前上嵴向水平划垂线，再由大转子与髂前上嵴的垂线画水平线，构成Bryant三角，股骨颈骨折时，此三角底边较健侧缩短。在平卧位，由髂前上嵴与坐骨结节之间画线，为Nélaton线。正常情况下，大转子在此线上，若大转子超过此线，表明大转子有向上移位。二、X线检查X线检查可同时发现骨折的部位、类型、移位情况，是选择治疗方法的重要依据。疾病概述病因病理临床表现检查检验诊断鉴别并发症治疗预后预防诊断和鉴别诊断根据中老年患者摔倒后出现髋部疼痛，下肢活动受限，不能站立和行走，应怀疑病人有股骨颈骨折。结合X线检查、肢体测量可明确骨折部位、类型和移位。一般诊断明确，不需要鉴别。并发症一、骨折不愈合。二、股骨头缺血性坏死是股骨颈骨折晚期最常见的并发症，发生率为20%-40%.当患者已恢复正常活动后患髋出现疼痛时应复查，若X线显示股骨变白、囊性变活股骨头塌陷，可认为是股骨头缺血性坏死的表现，但往往难以预测其发病趋势。治疗一、治疗时机早期治疗有利于尽快恢复骨折后血管受压或痉挛。股骨颈骨折手术原则上不超过2周。二、骨折复位准确良好的复位是骨愈合重要的条件。牵引患肢，同时在大腿根部加反牵引，待肢体原长度恢复后，行内旋外展复位。三、内固定目前内固定器材主要四类：①单钉类：三翼钉为代表，三刃钉内固定为众所熟悉的传统疗法。这种单根钉在骨的力学效能上不能持久，另外，此钉也不适于青少年及颈部粉碎性骨折者。②多钉固定类：包括史氏针、三角针和多根螺纹钉。此类固定对骨的损伤较小，利用多钉的布局在生物力学上的优势，疗效较好，缺点是钉退出后骨不愈合。③滑移式钉板固定装置

常见骨科症状体征

1、锁骨骨折症状：局部疼痛，患肩活动受限 体征：肩部或锁骨处可有皮肤擦伤及瘀斑，局部肿胀，有触痛。移位明显者有畸形，可触及骨折断端 注意：锁骨下动脉、臂丛神经、胸膜、肺损伤 2、肱骨外科颈骨折症状：局部疼痛，患肩活动受限 体征：局部肿胀，有触痛，可触及骨折断端 注意：臂丛神经、腋动脉损伤、肩关节脱位。复位后小夹板或超肩U型石膏外固定 3、肱骨髁上骨折肘关节伸直或半屈位时手掌着地病史，导致伸直型或屈曲型骨折 症状：局部疼痛，患肘活动受限 体征：肘部肿胀、畸形、触痛，可有骨擦感及反常活动，可触及骨折断端 注意：肱动脉损伤、尺、桡神经损伤鉴别：肱骨髁骨折、肘关节脱位 复位后石膏外固定，伸直型骨折，肘关节固定于90-120度屈曲位，屈曲型40-60度，1周后改为功能位 4、尺、桡骨骨折症状：局部疼痛，患肘、腕活动及前臂旋转受限 体征：局部肿胀、畸形、触痛，可有骨擦感及反常活动，可触及骨折断端 注意：上、下尺、桡关节脱位、骨筋膜室综合征 5、桡骨远端骨折腕关节于背伸位掌侧着地所致伸直型骨折—Colles骨折 桡骨远端向掌桡侧移位—Smith骨折 症状：局部疼痛，患腕活动受限 体征：局部肿胀、触痛，典型为“枪刺刀”及“餐叉样”畸形，可有骨擦感 注意：桡神经损伤、尺骨茎突骨折、腕关节脱位 6、股骨颈骨折老年骨质疏松者或严重外力 症状：局部疼痛，患髋活动受限，无法站立行走 体征：髋周可有瘀斑、肿胀、患肢短缩外旋畸形，有压痛及纵向叩击痛，大转子上移 鉴别：转子间骨折检查：患髋及骨盆X线。治疗：无明显移位-胫骨结节牵引

注意：其股骨头坏死、骨折不愈合比转子间骨折概率高 7、转子间骨折症状：局部疼痛，患髋活动受限，无法站立行走 体征：髋周可有瘀斑、肿胀、患肢短缩外旋畸形，有压痛及纵向叩击痛，大转子上移 8、股骨干骨折症状：局部疼痛，患髋、膝活动受限，无法站立行走，甚至休克 体征：局部肿胀、畸形，成角短缩畸形，可有骨擦感及反常活动 注意：腘动脉、腓总神经、胫神经损伤 9、髌骨骨折症状：局部疼痛，患膝活动受限，无法站立行走 体征：局部肿胀、畸形，压痛，可触及骨擦感，有关节积液征 10、胫腓骨骨折症状：局部疼痛，患膝、踝活动受限，无法站立行走 体征：局部肿胀、畸形，压痛，可触及骨擦感，可有反常活动，开放性者有骨外露 注意：腓总神经损伤、骨筋膜室综合征 11、踝部骨折症状：局部疼痛，患踝活动受限，无法站立行走 体征：局部瘀斑、肿胀、畸形，压痛，可触及骨擦感，重者有内外翻畸形 注意：三角韧带、下胫腓韧带损伤、踝关节脱位治疗：U型石膏外固定 12、脊柱骨折症状：局部疼痛，脊柱活动受限，并脊髓损伤者出现相应平面的运动、感觉障碍 体征：局部肿胀、压痛叩击痛 注意：脊髓损伤、脊柱滑脱、内脏损伤 13、骨盆骨折症状：局部疼痛，无法站立行走 体征：可有会阴、腹股沟、腰骶部瘀斑，肿胀、压痛，骨盆挤压分离试验（+） 注意：失血性休克、尿道、直肠损伤 14、肩关节脱位症状：局部疼痛，患肩活动受限 体征：方肩畸形，肩胛盂处右空虚感，杜加氏征（+） 注意：骨折，尤其是肱骨大结节

中医骨科常见骨折病历书写模板

骨科常见骨折病历书写模板 入院记录 主诉：**致***部肿痛、畸形、活动受限**天。 现病史：自述**天前在****因****不慎跌倒，***最先着地，致伤***部，伤后觉***部**（疼痛类型）痛难忍，***部逐渐肿胀，并出现畸形，活动时疼 痛加重，***关节活动受限，伤后***（处理情况）。为求进一步治疗， 于今（入院方式）我院门诊就诊，门诊拟“*****”收住我科进一步诊 疗。伤后无头晕头痛、恶心呕吐、胸闷气促、腹胀腹痛、二便失禁或血 尿血便。入院证见：**部肿痛、畸形、活动受限。 既往史：平素体健，否认有肝炎、肺结核、心脏病、糖尿病及肾炎等病史；预防接种史不详；否认外伤、手术及输血史，未发现药物过敏史。其他系统 回顾未见异常。 个人史：出生及生长于原籍，否认曾到过其他地方病或传染病流行地区及其接触情况，无烟酒、食鱼生及其他特殊嗜好，生活及居住条件一般。否认有 冶游史。 婚育史：**岁结婚，有*儿*女，子女及配偶均健康。 月经史：**岁*-*/**-**，既往月经量中等，颜色暗红，无血块，否认痛经、白带异常及闭经史等。 家族史：否认家族成员中有特殊的传染病及遗传病史。 体格检查 T**℃，P**次/分，R**次/分，BP***/**mmHg，体重：**Kg，身高：***cm。 一般情况：神志清楚，**面容；面色红润、含蓄；音语清晰，语声如常。发育正常，营养中等，自主体位,查体合作。舌质淡红，苔薄白，脉***。皮肤粘膜：全身皮肤、粘膜无黄染，无水肿、皮疹、瘀斑、紫癜、皮下结节、肿块、焦痂、溃疡、瘢痕、肝掌及蜘蛛痣，全身毛发生长、分布正常。淋巴结：全身或局部浅表淋巴结未触及肿大及压痛。 头部及其器官：头颅五官大小正常，无肿块、压痛、瘢痕，双瞳孔等圆等大，直径2.5mm，对光反射灵敏，巩膜无黄染，双眼睑无浮肿，乳突区 无压痛，外耳道及鼻道未见异常分泌物，各鼻窦区无压痛，口唇 无紫绀，口腔粘膜无出血点及溃疡，咽无红肿充血，双侧扁桃体 无肿大。 颈部：颈部软，两侧对称，颈静脉无曲张，无抵抗及压痛，双侧甲状腺不大，未触及肿块及结节。 胸部： 胸廓：两侧胸廓对称无畸形，胸壁未见有静脉曲张、皮下气肿，肋间隙无增宽或变窄，胸骨无压痛。 肺脏：两肺呼吸运动对称，呼吸平稳，节律整齐；两侧语颤无明显增强或减弱，无胸膜摩擦感、皮下捻发感等；双肺叩诊清音，无实音或浊音；听诊两 肺呼吸音清，未闻及明显干湿性罗音及胸膜摩擦音。 心脏：心前区无隆起，心尖搏动无弥漫，心前区未触及震颤和摩擦感，心界叩诊无增大，心率**次/分，律齐，心音有力，各瓣膜区未闻及明显病理性杂 音。

常见骨科疾病诊疗知识

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(1)顺粗隆间线型（骨折），即骨折线由大粗隆向内下至小粗隆，其走行与粗隆间线平行，称为稳定型。 (2)逆粗隆间线型（骨折）：即骨折线由大粗隆下方向内上达小粗隆的上方，称为不稳定型。有时骨折线难以分辨走向，呈粉碎骨折，其稳定性亦差。 临床实践表现，以骨折的原始状态来判断其稳定性似乎更为重要。凡伤后髋内翻越严重，骨折越不稳定，反之，原始髋内翻越轻或无内翻者，骨折越趋稳定。因此，骨折的稳定性似与骨折走向方向无关。 A图为顺粗隆间线型（骨折） B图为逆粗隆间线型（骨折） 2. 改良Evans或Evans-Jensen分型系统： Jensen对于Evans分型进行了改进，基于大小粗隆是否受累及复位后骨折是否稳定而分为五型。Ⅰa型：两骨折片段，骨折无移位。Ⅰb型：两骨折片段，骨折有移位。Ⅱa型：三骨折片段，累及大粗隆，因为移位的大粗隆片段而缺乏后外侧支持。Ⅱb型：3骨折片段，累及小粗隆，由于小粗隆或股骨矩骨折缺乏后内侧支持。Ⅲ型：四骨折片段，骨折累及两个粗隆，缺乏内侧和外侧的支持，为Ⅱa型和Ⅱb型的结合。Jensen研究发现Ⅰa、Ⅰb型骨折94％复位后稳定；Ⅱa型骨折33％复位后稳定；Ⅱb 型骨折21％复位后稳定；Ⅲ型骨折8％复位后稳定。Jensen指出大小粗隆的粉碎程度与复位后骨折的稳定性成反比，改良的Evans分型为判断复位后的稳定性和骨折再次移位的风险提供了最为可靠的预测。

骨科常见专科诊断

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2018骨科考试题

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2 桡、尺骨双折的治疗原则是恢复前臂的 _______ 。 3?髌骨骨折的治疗原则主要是恢复膝关节 ____________ 的功能。 4 中医认为骨折的愈合过程为 _______________ 、 ______________ 和骨合。 5 骨折的基本移位方式有缩短移位、移位、 _______ 移位、 __________ 移位和 __________ 移位。 三、名词解释：（每题6分，共18分） 1?颈干角 2?功能复位 3?弹性固定 四、问答题：（每15题分，共30分） 1?小夹板固定后的注意事项有哪些？ 2?股骨颈骨折为什么常常难愈合

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【创伤骨科常用汉英词汇】 A 凹陷骨折depressed fracture B 半脱位subluxation 半月板meniscus 闭合性骨折closed fracture 髌骨patella 髌骨骨折fracture of patella 髌骨脱位dislocation of patella 髌上囊suprapatellar bursa 髌下脂肪垫subpatellar fat pad 髌韧带patellar ligament 病理性骨折pathological fracture 爆裂骨折bursting fracture 鼻骨骨折fracture of nasal bone 不完全骨折no-complete fracture C 尺骨ulnar 尺骨茎突styloid process of ulna

尺骨鹰嘴骨折olecranon fracture of ulna 创伤性脱位traumatic dislocation 创伤性关节炎traumatic arthritis 创伤性滑膜炎traumatic synovitis 耻骨pubis 耻骨联合pubic symphysis 耻骨上支superior ramus of pubis 耻骨下支inferior ramus of pubis 陈旧性骨折old fracture 垂直压迫损伤vertical compression injuries 齿状突odontoid process 错位displacement D 骶骨sacrum 骶椎sacral vertebrae 骶髂关节cacroiliac joint 骶髂关节分离separation of cacroiliac joint 大多角骨trapezium bone 大结节greater tubercle 大转子greater trochanter 对位paratope 对线alignment

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骨科专业英语

骨科相关词汇 abduction 外展 abrasion 擦伤 abscess 脓肿 acromegaly 肢端肥大症 adenoma 腺瘤 adolescent 青少年的 adduction 内收 afferent neuron 传入神经 ankylosing spondylitis 强直性脊柱炎 achilles tendon 跟腱 arthritis 关节炎 arthrogryposis 关节屈曲 Aseptic Necrosis 无菌坏死 Avascular necrosis of femoral head 股骨头坏死 axillary nerve 腋神经 bone 骨 brachial plexus 臂丛 Bunion拇囊炎 bursitis 粘液囊炎 calcaneus 跟骨 callus 胼胝 Cellulitis 蜂窝组织炎 cervical 颈椎的 bone cement 骨水泥 chiropody 足科 clubfoot 马蹄内翻足 corn 鸡眼 crescent 新月形 cubital 尺侧的 cyst 囊 cystic 囊性变 débridement 清创术 dislocation 脱位 dysplasia 发育不良 effusion 渗出 erosion 侵蚀 extension 伸展 flexion 屈曲 fracture 骨折 fungal 真菌的 fusion 融合 humeral 肱骨的 humerus 肱骨 hyperostosis 骨肥厚 hypertrophy 肥大 lumbar 腰椎的 idiopathic 特发的 Ingrown toenail 嵌甲

骨科常见疾病

骨科常见疾病疾病种类: 1．手外伤 2．断肢再植 3．肱骨髁上骨折 4．肱骨干骨折 5．尺桡骨骨折 6．股骨颈骨折 7．股骨干骨折 8．髌骨骨折 9．胫腓骨骨干骨折 10．胫骨平台骨折 11．踝部骨折 12．跟骨骨折 13．锁骨骨折 14．肩锁关节脱位 15．肩关节脱位 16．肘关节脱位 17．髋关节脱位 18．足拇外翻 19．腰椎间盘突出症 20．腰椎管狭窄症 21．皮瓣修复术 22．VSD负压吸引术 23.骨科病人的功能锻炼

手外伤 观察要点 1.创口的部位及性质，皮肤缺损范围、程度，肌腱、神经、血管及骨关节损 伤的程度。 2.患手血运情况：是否存在皮肤苍白、批温降低、指腹瘪陷、毛细血管回流 缓慢或消失、皮肤青紫或肿胀等情况。 3.伤口疼痛情况，正确评估疼痛程度。 4.全身情况是否有烦躁不安或表情淡漠、皮肤粘膜苍白、湿冷、尿量减少、 脉搏细速、血压下降等失血性休克的早期表现，即使补充血容量。 术前护理 1.心理护理意外致伤，顾虑手术效果，易产生焦虑心理。应给予耐心地开 导，介绍治疗方法及预后情况，并给予悉心的护理，同时争取家属的理解和支持，减轻和消除心理问题，积极配合治疗。 2.体位平卧位患手高于心脏，有利于血液回流，减轻水肿和疼痛。 3.症状护理手部创伤常伴有明显疼痛，剧烈的疼痛会引起血管痉挛，还可 引起情绪、凝血机制等一系列的变化，因此，应及时遵医嘱使用止痛药物。 4.病情观察包括生命体征及患手局部情况，尤其应警惕失血性休克，正确 使用止血带。 术后护理 1.体位平卧位患手高于心脏，有利于血液回流，减轻肿胀。患手尽快消肿， 可减少新生纤维组织生成，防止关节活动受限。 2.饮食高热量、高蛋白、高维生素、高铁、粗纤维饮食。 3.局部保暖应用烤灯距离30-40cm照射局部，保持室温22-25°C，使局 部血管扩张，改善末梢循环。术后3-4日内持续照射。以后可于清晨、夜间气温较低时照射，术后1周即可停用。 4.用药护理及时、准确执行医嘱，正确使用解痉、抗凝药物，以降低红细 胞之间的凝集作用和对血管壁的附着作用，并可增加血容量，减低血液粘 稠度，利于血液流通及伤口愈合；用药过程中，需注意观察药物不良反应。 5.功能锻炼一般可于术后3-4周开始主动练习法，主动屈曲伸直各关节， 减少肌腱粘连。被动活动开始的时间要以手术缝合方式、愈合是否牢骨而 定。术后5周内不做与肌腱活动方向相反的被动或牵拉肌腱活动。

骨科常见疾病的诊疗指南2017

骨科常见疾病的诊疗指南 第一节儿童肱骨髁上骨 【概述】 肱骨髁上骨折是最常见的儿童肘部骨折，约占全部肘关节损伤的50% ~ 70%，常见于3一10岁的儿童，以5 ~7岁的男孩最多见，肱骨髁上骨折多发生在手的非优势侧。早期处理不当可致前臂骨筋膜室综合征，导致Volkmann挛缩，造成终身残疾。骨折畸形愈合形成肘内翻，影响患儿的肘关节外观，需行截骨术矫正畸形。因此，肱骨髁上骨折是儿童肘部的严重损伤。 【影像检查】 肱骨髁上骨折的诊断以普通X线片检查为主。因肘关节肿胀和疼痛，不能完全伸直肘关节，拍标准的肘关节正侧位片困难。怀疑肱骨髁上骨折时应拍肱骨远端正侧位片。若怀疑无移位或轻度移位骨折而正侧位片未发现骨折线，应拍斜位片。建议术前加照对侧肘关节，对于粉碎性骨折和陈旧性骨折常规行CT 检查。 【分类】 根据远端骨折块移位方向，可分为伸直型与屈曲型骨折。远端骨折块向后上移位者为伸直型骨折，向前上移位则为屈曲型骨折;伸直型骨折又可细分为伸直尺偏型(远端向尺侧移位);伸直桡偏型(远端向桡侧移位)。伸直尺偏型多见(75 % )，可能与肌肉轴线偏内侧和受伤时多处于伸肘、前臂旋前位有关，易合并肘内翻。伸直桡偏型虽仅占伸直型骨折的25 %，但易伴发血管、神经损伤。Gartland依据骨折块移位程度，将伸直型骨折细分为三型: 1、I型骨折无移位; 2、Ⅱ型仅一侧皮质断裂，通常后侧皮质保持完整，骨折断端有成角畸形。 3、Ⅲ型前后侧皮质均断裂，骨折断端完全移位。 【诊断】 严重移位骨折容易诊断，但要注意有无其他伴发骨折和神经血管损伤。约5%的患儿同时伴发同侧其他骨折(通常为桡骨远端骨折)。因而对诊断肱骨髁上骨折的患儿，应作详细检查，以免漏诊。查体可见肘关节肿胀，髁上处有环形

骨科常见疾病名称

1．锁骨骨折 2．肩锁关节脱位 3．肩关节脱位 4．肱骨外科颈骨折 5．肱骨干骨折 6．肱骨髁上骨折 7．肘关节脱位 8．前臂双骨折 9．桡骨下端骨折 10．手外伤 11．断指再植 12．髋关节脱位 13．股骨颈骨折 14．股骨转子间骨折 15．股骨干骨折 16．髌骨骨折 17．髌骨脱位 18．膝关节韧带损伤 19．膝关节半月板损伤 20．胫骨平台骨折 21．胫腓骨骨折 22．踝部骨折 23．踝部扭伤 24．跟腱断裂 25．跟骨骨折 26．跖骨骨折 27．趾骨骨折 28．颞下颌关节脱位 29．脊柱骨折

30．脊髓损伤 31．骨盆骨折 32．周围神经损伤 33．上肢神经损伤 34．下肢神经损伤 35．腰肌劳损 36．棘上棘间韧带损伤 37．滑囊炎 38．狭窄性腱鞘炎 39．腱鞘囊肿 40．肱骨外上髁炎 41．肩关节周围炎 42．疲劳骨折 43．月骨无菌性坏死 44．髌骨软化症 45．胫骨结节骨软骨病 46．股骨头骨软骨病 47．椎体骨软骨病 48．腕管综合征 49．肘管综合征 50．旋后肌综合征 51．梨状肌综合征 52．脊柱骨折和脱位 53．脊柱椎弓崩裂 54．脊椎滑脱 55．椎间盘突出 56．腰扭伤 57．腰背筋膜脂肪疝 58．腰肌劳损

59．腰3横突综合征 60．臀上皮神经炎 61．椎管陈旧性骨折脱位 62．椎管畸形 63．硬脊膜囊肿 64．脊柱结核 65．脊柱骨髓炎 66．强直性脊柱炎 67．类风湿性关节炎 68．软组织纤维质炎 69．软组织筋膜炎 70．血管炎 71．神经炎 72．蛛网膜炎 73．硬膜外感染 74．脊髓炎 75．神经根炎 76．腰椎骨关节炎 77．小关节紊乱 78．骨质疏松症 79．椎体后缘骨赘 80．椎管狭窄 81．黄韧带增厚 82．脊柱裂 83．先天性脊柱侧弯 84．退变性脊柱侧弯 85．移行椎 86．水平骶椎 87．脊肌瘫痪性侧弯

骨伤科常用医疗技术操作规范

骨伤科常用医疗技术操作规范 骨牵引 一、穿针原则 １、术前征得患者同意，签手术知情同意书； ２、熟悉穿针部位的血管神经走行。原则是在重要结构的一侧穿针，以避免损伤这些重要的结果。 ３、遵循无菌操作的技术进行皮肤准备。 ４、麻醉以１％利多卡因局部浸润麻醉皮肤，但要告知病人完全将骨膜阻滞是困难的，在操作中可能会有疼痛。 ５、皮肤切口穿针前，应用小尖刀片预先做一小切口，再行穿针，针眼处每日以酒精消毒，可减少针道的感染。 ６、尽量用手摇钻而不用动力钻，以避免高温高热造成骨坏死。 ７、穿刺针最好位于干骺端避免损伤骺板，理想的穿刺针是只穿过皮肤、皮下和骨骼，避开肌肉和肌腱。 ８、不要破坏骨折血肿以免人为将闭合骨折变为开放状态。 ９、不要穿入关节否则会造成化脓性关节炎的发生。 １０、其它如在穿刺过程中针不要弯曲；要选择合适的牵引弓；牵引的力线要与骨折的纵轴一致；要注意牵引重量，不要过牵；随时给予Ｘ线检查。 二、常用部位骨牵引 １、胫骨结节胫骨结节向后一横指，在其平面下部，由外向内穿针。 ２、跟骨外踝顶点下２㎝，再向后２㎝或内踝顶点下３㎝，由内向外穿针。 ３、股骨下端髌骨上缘２㎝或内收肌结节上２横指处，由内向外穿针。

４、尺骨鹰嘴由鹰嘴尖端向远端⒈５横指处，由内向外穿针。 ５、指骨指骨远节基底远侧。 ６、颅骨双侧外耳道经顶部的连线与两眉弓外缘向枕部划线的交点。 皮牵引 一、牵引机制 将胶布和皮肤之间的摩擦力通过浅筋膜、深筋膜及肌间隔等传导到骨骼上。 二、牵引方法 胶布宽度为肢体最细周径的一半，上端在骨折部位，下端超过肢体远端１０㎝。也有特制的泡沫塑料带牵引。 三、注意事项 １、适用于儿童、老人或作为一种最初的、暂时的治疗手段； ２、仔细检查牵引处皮肤，祛除污物； ３、保护骨突起部位，避免胶布粘贴骨突起； ４、最大牵引重量一般为５㎏，具体因人而异； ５、抬高患肢，防止水肿； ６、每天检查肢体长度，调整牵引力度。 五、常用皮牵引 １、上肢皮牵引； ２、下肢皮牵引。 石膏固定 一、适应证 １、用于骨折，脱位，韧带损伤和关节感染性疾病，用来缓解疼痛，促进愈合；

骨科常见疾病名称

. 1．锁骨骨折 2．肩锁关节脱位 3．肩关节脱位 4．肱骨外科颈骨折 5．肱骨干骨折 6．肱骨髁上骨折 7．肘关节脱位 8．前臂双骨折 9．桡骨下端骨折 10．手外伤 11．断指再植 12．髋关节脱位 13．股骨颈骨折 14．股骨转子间骨折 15．股骨干骨折 16．髌骨骨折 17．髌骨脱位 18．膝关节韧带损伤 19．膝关节半月板损伤 20．胫骨平台骨折 21．胫腓骨骨折 22．踝部骨折 23．踝部扭伤 24．跟腱断裂 25．跟骨骨折 26．跖骨骨折 27．趾骨骨折 28．颞下颌关节脱位 29．脊柱骨折

. 30．脊髓损伤 31．骨盆骨折 32．周围神经损伤 33．上肢神经损伤 34．下肢神经损伤 35．腰肌劳损 36．棘上棘间韧带损伤 37．滑囊炎 38．狭窄性腱鞘炎 39．腱鞘囊肿 40．肱骨外上髁炎 41．肩关节周围炎 42．疲劳骨折 43．月骨无菌性坏死 44．髌骨软化症 45．胫骨结节骨软骨病 46．股骨头骨软骨病 47．椎体骨软骨病 48．腕管综合征 49．肘管综合征 50．旋后肌综合征 51．梨状肌综合征 52．脊柱骨折和脱位 53．脊柱椎弓崩裂 54．脊椎滑脱 55．椎间盘突出 56．腰扭伤 57．腰背筋膜脂肪疝 58．腰肌劳损

. 59．腰3横突综合征 60．臀上皮神经炎 61．椎管陈旧性骨折脱位 62．椎管畸形 63．硬脊膜囊肿 64．脊柱结核 65．脊柱骨髓炎 66．强直性脊柱炎 67．类风湿性关节炎 68．软组织纤维质炎 69．软组织筋膜炎 70．血管炎 71．神经炎 72．蛛网膜炎 73．硬膜外感染 74．脊髓炎 75．神经根炎 76．腰椎骨关节炎 77．小关节紊乱 78．骨质疏松症 79．椎体后缘骨赘 80．椎管狭窄 81．黄韧带增厚 82．脊柱裂 83．先天性脊柱侧弯 84．退变性脊柱侧弯 85．移行椎 86．水平骶椎 87．脊肌瘫痪性侧弯

骨科常见专科诊断

上肢及上肢带骨骨折 锁骨骨折［类病鉴别] 1、肩锁关节脱位：锁骨外端高于肩峰，甚至形成梯状崎形，向下牵拉上肢时，骨外端隆起更明显；向下按压骨外端可回复，松手后又隆起；X线片显示肩锁关节脱位。 2、胸锁关节脱位：两侧胸锁关节不对称，可有异常活动，锁骨内端可突出或空虚。 3、臂丛神经瘫疾：易与婴幼儿锁骨骨折相混淆。前者锁骨仍完整，同时可见典型的肩部内收内旋、肘部伸直畸形；一般在2个月—3个月后可有显著恢复。 肩胛骨骨折〔类病鉴别〕 1、肋骨骨折：伤后胸部疼痛，咳嗽及深呼吸时疼痛加重；挤压胸廊时，骨折部分疼痛加剧；有时可合并气、血胸；X线片示肋骨骨折。 2、肱骨外科颈骨折：多为传达暴力所致，上臂内侧可见瘀斑，有疼痛、压痛、功能障碍，可触及骨擦感及异常活动。 肱骨大结节骨折〔类病鉴别〕 l、肩关节前脱位：受伤机制与本病相近，也表现为肩部肿痛，活动受限．但有方肩畸形，可扪及异位肱骨头，肩关节弹性固定．有时两者常合并存在。 2、肩峰骨折：均为肩部肿痛，但压痛点位于肩峰部，被动外展时可有一定的活动度；x 线片可见肩峰骨折。 3、肱骨外科颈骨折：症状、体征相似，但本病肿胀及瘀斑较明显，肱骨上端环形压痛，可有异常活动；X线片见骨折线位于肱骨外颈．亦可两者合并存在。 肱骨外科颈骨折〔类病鉴别〕 1、肩关节前脱位：亦表现肩部疼痛、压痛、活动受限，典型方肩畸形；但伤肢外展25°一30°位弹性固定，搭肩试验阳性；X线可鉴别．有时两者合并存在。 2、肱骨大结节骨折：肩外侧大结节处压痛，外展活动受限，上臂内侧无瘀斑，无环形压痛。 3、肩部挫伤：系直接暴力所致．局部皮肤有擦伤、瘀斑，肿胀、压痛局限于着力部位，无环形压痛及纵向叩击痛；X线片无骨折征象。 肱骨干骨折〔类病鉴别〕 1、肱骨外科颈骨折：肿痛在肩部，肱骨上端压痛；X线正位片及穿胸位可显示骨折线在肱骨解剖颈下2厘米一3厘米；治疗后骨折多能愈合。 2、肱骨肱骨上骨折：多发生于儿童，肘部肿胀较明显，呈靴状畸形；X线片示骨折线在肱骨下端扁薄处；治疗后常遗有肘内翻畸形。 3、上臂扭伤：压痛局限于损伤部位，有牵拉痛，上臂功能障碍较轻；无环形压痛及纵向叩击痛，无异常活动。 肱骨髁上骨折〔类病鉴别〕

常用骨科鉴别诊断模板

常用骨科鉴别诊断 上肢及上肢带骨骨折 锁骨骨折 1、肩锁关节脱位：锁骨外端高于肩峰，甚至形成梯状畸形，向下牵拉上肢时，骨外端隆起更明显；向下按压骨外端可恢复，松手后又隆起；X线片显示肩锁关节脱位。 2、胸锁关节脱位：两侧胸锁关节不对称，可有异常活动，锁骨内端可突出或空虚。 3、臂丛神经瘫疾：易与婴幼儿锁骨骨折相混淆。前者锁骨仍完整，同时可见典型的肩部内收内旋、肘部伸直畸形；一般在2-3个月后可有显著恢复。 肩胛骨骨折 1、肋骨骨折：伤后胸部疼痛，咳嗽及深呼吸时疼痛加重；挤压胸廓时，骨折部分疼痛加剧；有时可合并气、血胸；X线片示肋骨骨折。 2、肱骨外科颈骨折：多为传达暴力所致，上臂内侧可见瘀斑，有疼痛、压痛、功能障碍，可触及骨擦感及异常活动。 肱骨大结节骨折 1、肩关节前脱位：受伤机制与本病相近，也表现为肩部肿痛，活动受限，但有方肩畸形，可扪及异位肱骨头，肩关节弹性固定，有时两者常合并存在。 2、肩峰骨折：均为肩部肿痛，但压痛点位于肩峰部，被动外展时可有一定的活动度；X线片可见肩峰骨折。 3、肱骨外科颈骨折：症状、体征相似，但本病肿胀及瘀斑较明显，肱骨上端环形压痛，可有异常活动；Ⅹ线片见骨折线位于肱骨外颈，亦可两者合并存在。 肱骨外科颈骨折 1、肩关节前脱位：亦表现肩部疼痛、压痛、活动受限，典型方肩畸形；但伤肢外展250一300位弹性固定，搭肩试验阳性；X线可鉴别，有时两者合并存在。 2、肱骨大结节骨折：肩外侧大结节处压痛，外展活动受限，上臂内侧无瘀斑，无环形压痛。

3、肩部挫伤：系直接暴力所致，局部皮肤有擦伤、瘀斑，肿胀、压痛局限于着力部位，无环形压痛及纵向叩击痛；X线片无骨折征象。 肱骨干骨折 1、肱骨外科颈骨折：肿痛在肩部，肱骨上端压痛；X线正位片及穿胸位可显示骨折线在肱骨解剖颈下2一3cm；治疗后骨折多能愈合。 2、肱骨髁上骨折：多发生于儿童，肘部肿胀较明显，呈靴状畸形；X线片示骨折线在肱骨下端扁薄处；治疗后常遗有肘内翻畸形。 3、上臂扭伤：压痛局限于损伤部位，有牵拉痛，上臂功能障碍较轻；无环形压痛及纵向叩击痛，无异常活动。 肱骨髁上骨折 1、肘关节后脱位：儿童肘关节后脱位极少见，脱位后肘后三角关系改变，患肢缩短，屈肘弹性固定；X线片可确诊。 2、肱骨外髁骨折：肿胀及压痛局限于肘外侧，有时可触及骨折块；X片摄片桡骨纵轴线不通过肱骨小头骨化中心。 肱骨髁间骨折 1、肱骨髁上骨折：多发生于儿童，肘部肿胀疼痛相对较轻；X线片示骨折线未波及关节面；治疗后肘关节功能恢复较好。 2、肘关节后脱位：弹性固定于135°左右，肘窝前方饱满，可扪及肱骨滑车；肘后鹰嘴异常后突，上方凹陷、空虚；X线摄片有脱位征象，无骨折。 肱骨外髁骨折 1、肱骨髁上骨折：肿痛较明显，呈环周压痛；X线片示骨折线不波及关节面，桡骨纵轴线通过肱骨小头骨化中心。

(完整版)骨科常见护理诊断与措施

骨科常见护理诊断与措施 1.疼痛：与创伤、骨折、手术切口有关； 措施：根据疼痛的刺激源，给予不同的方法，如遵医嘱给予止痛剂，护患沟通，转移患者对疼痛的注意力，或采用中医疗法，针刺止痛、按摩等以活血化瘀，疏通经络等，也有很好的止痛效果，也可物理止痛，如冷疗、热疗等。 2.知识缺乏：与角色突变，未接受相关知识有关； 措施：根据患者的健康状况，疾病的性质、原因、向患者及家属宣教医学知识，介绍有关治疗护理的方法和意义， 3.焦虑、恐惧：与意外受伤，无思想准备，担心不良预后有关； 措施：鼓励患者讲出自身感受（心理、生理等）给予针对性处理，介绍疾病相关知识，讲解成功病例，鼓励患者有战胜疾病的信心。 4.生活自理缺陷：与疾病和治疗限制，骨折后患肢功能受限有关； 措施：指导病人使用呼叫器，将常用物品放置病人易取到的地方，及时给予生活上的护理，协助病人使用拐杖、助行器、轮椅等，使其进行力所能及的自理活动，鼓励病人完成病情允许的自理活动或部分自理活动，使病人的生活需要得到满足。 5.躯体移动障碍：与受伤后肢体功能障碍和治疗限制有关； 6.有皮肤完整性受损的可能；与长期卧床有关； 7.有废用综合症的危险：与长期卧床及患肢制动，活动受限和减少有关； 措施：医护合作，鼓励并指导患者进行功能锻炼，做示范动作，教会病人并检查患者是否掌握。 8.睡眠形态紊乱：与疾病、心理因素、治疗限制和环境改变有关； 措施：给予心理护理，减轻患者对疾病及相关因素的紧张情绪，针对患者主诉及症状，配合医生给予相应的处理，保持病室环境安静整洁舒适，并给予患者讲解促进睡眠的方法。 9.体温升高：与手术创伤、感染有关； 措施：给予必要的解释工作，根据病因，遵医嘱给予降温措施，指导患者多饮水，按时进行病室内空气净化消毒。 10.潜在并发症：肺部感染、泌尿系感染、压疮、深静脉血栓、便秘、心脑血管意外等 措施： （1）预防心脑血管疾病：如老年人骨折后，循环系统发生明显衰退性变化，心血管系统不能适应应激状态，加之受伤后疼痛刺激，易导致心脑血管疾病发生，要多巡视病房，严密观察血压、脉搏、患者神志、表情变化等，多与病人交流，倾听患者主诉，及时了解病情，发现问题及时处理。 （2）预防消化系统疾病：患者患病后由于长时间卧床，个别病人因生活不能自理，怕给他人增添麻烦，为减少大小便次数，而控制饮食。这样的病人应向其说明营养的重要性。因为胃肠蠕动慢，排空慢，易引起腹胀，便秘，应鼓励患者多进行顺时针按摩腹部，增强肠蠕动，从而预防并减轻腹胀、便秘。另外督促患者多饮水，饮食平衡，多吃新鲜蔬菜及粗粮等，饮食有规律、定时定量，并养成定时排便的习惯，必要时给予缓泻剂。 （3）预防呼吸系统疾病：老年人骨折后，呼吸功能相对减弱，长期卧床及术后病人易发生肺部并发症。因此病人入院，要求不吸烟，讲清吸烟对术后身体的危害性。鼓励病人咳嗽、作深呼吸，上肢能活动的作扩胸运动，增加肺活量。在协助病人翻身时，给予叩背，使积痰易于排出，怕疼痛、不能咳嗽的病人鼓励病人尽量把痰咳出，若痰液粘稠可给予雾化吸入。病房应经常开窗通气，保持空气新鲜，注意保暖，预防感冒。 （4）预防泌尿系统疾病：患者因卧床时间长，加之骨折处疼痛，怕多饮水排尿不方便，易发生泌尿系感染。要鼓励患者多饮水，定时改变体位，有利于尿沉渣的排出，保持会阴部清