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Fractured ribs diagnosis and treatment technology

 

 

 

China's traditional Chinese medicine reported

 

 

 

        There are 12 ribs on, show the bow, points left and right sides is symmetrical arrangement, and thoracic and sternal connected constitute a thoracic, chest organs of the protection. On 7 ribs borrow directly attached on the sternum cartilage, 8 ~ 10 ribs borrow ribs and sternal connected indirectly 7, 11 to 12 ribs front-end free, called float rib. 1 ~ 3 short ribs, and subject, Withers and upper arm clavicle protection, and elastic floating rib bigger, so are not easily broken. 4 to 9 ribs are longer and fixed, under external force is vulnerable to fracture.

 

        Conventional treatment

 

        Pure fractured ribs, because have fixed and the rest intercostals muscle rib support, no significant shift, generally do not need to individual conditions. The focus of therapy is to prevent pain and pulmonary infection. Many root or with more paragraphs of fracture, shift obvious, even a floating chest wall abnormally breathing, need to reset and fixed.

 

        1. Reduction method

 

        Patients are sitting, assistant behind in patients, patients with a knee against the back, the hands hold his shoulders, slowly force to the rear pulled open, so that patients with high, one hand on the medical health side, according to a set of the same, according to the gimmick with crowded high protruding part according to ping. If the clinical weak, desirable supine, back cushion is high, the same technique will fracture reduction in crowded.

 

        Much more than the root cause for fractured ribs floating chest wall, appear abnormal breathing, the ribs traction method, can choose in the central choose a floating chest wall ribs, and innings after Massachusetts with sterile towels forceps clamp ribs, fasten drawing rope for sliding traction, traction weight 2 ~ 3 kg.

 

        2. Fixed method

 

        (1) tape fixed law: the victim is sitting in the skin of the tape with compound benzoic acid ding, expiratory make bust narrowed to the minimum, and then breathless, with wide seven to 10 cm long tape, since health side line around the shoulder the fracture to the center line close to the health of clavicle, article 2 of article 1 of the cover on the margin, overlap each other 1/2 by after forward, bottom-up on fixed, always will fracture zone and the upper and lower adjacent ribs all fixed so far, fixed time of three to four weeks.

 

        If the skin allergy or to tape with the bronchus asthma, chronic bronchitis, emphysema, or old man cardiopulmonary reserves the ability is limited, because half ring type tape fixed may increase boundaries and breathing unfavorable use.

 

        (2) nylon strap or elastic bandage fixed law: apply to old people with lung disease, or skin allergy to tape. The fracture can be attached with injury plaster or away stasis cream, instructing patients to be deep breath, then with nylon strap or wide elastic bandage around the chest area and fracture fixation upper and lower adjacent ribs, fixed time about 3 ~ 4 weeks.

 

        3. The surgical treatment of indication

 

        Many in the root cause fractured ribs floating chest wall, appear abnormal breathing, and can't fully take a breath, those who cannot effectively cough row phlegm, can choose wire cut inside fixed, or silicone plate fixation.

 

        4. The drugs

 

        (1) inside cure: initial should remove blood stasis, regulating the pain. The injury is angry give priority to, can choose ShuGan radix scattered (radix, peony, ZhiKe, river xiong, sweet, Ian attached by), JinLingZi scattered (sichuan melia japonica son, yuan hu); Hurt the blood give priority to, can choose recovery huoxue soup (radix, TianHuaFen, angelica, pangolin, peachseed, liquorice), therapeutic soup (angelica 10 grams, born dihuang 10 grams, which is 12 grams, the red flower 10 grams, ZhiKe 6 grams of herbaceous peony, 6 grams, radix 3 g, balloonflower 4.5 g and 4.5 g, ligustici chuanxiong rhizoma ~ 10 grams, liquorice 3 g), add a KuanDong flowers, balloonflower, almond, radix scutellariae, etc. In order to promote lung reduce phlegm.

 

        Later breast ache steadily or the injured Chen rib, appropriate removing stasis and injury, gas line pain, can choose three edges and injured soup (three edges and shows, green husk, dried tangerine or orange peel, largehead atractylodes rhizome, ZhiKe, angelica, root of herbaceous peony, dangshen, frankincense, myrrh, liquorice); On hand to qi, with eight Jane soup (dangshen 10 grams, white atractylodes 10 grams, poria cocos 10 grams, liquorice 6 g, river xiong 6 g, angelica 10 grams, ripe dihuang 10 grams, the root of herbaceous peony 10 grams, ginger 3 pieces, big jujube 2 pieces) and ShuGan radix scattered (radix, peony, ZhiKe, river xiong, sweet attached, liquorice).

 

        (2) the external treatment: initial can choose detumescence scattered, detumescence as; With thin steel middle to oil or thin anointed; By the late 'anointed or all souls anointed apply stick, or with HaiTong skin soup fumigation.

 

        Appropriate technology

 

        Small plywood suspension traction treatment in root more fractured ribs (xiangxi autonomous region, hunan province people's hospital)

 

        1. The operation method

 

        Regular disinfection, 0.5% lidocaine local anesthesia, small plywood area along the walk along the Central Line direction in the ribs on the chest wall; Both ends must go beyond subsided, have MianDian side of the close to the chest wall, and then in large triangle needle wearing number 10 silk thread or double 7 from central area he cut ends the central, stick the ribs ribs in the ribs in pushing back ribs with wear a skin, then in small plywood thread on knot, this area was hanging up the chest wall, relieving from abnormal breathing and its complications. According to the scope of other area of effect increased traction treatment the number of small plywood traction to chest wall basic calmed down shall prevail.

 

        2. Features

 

        Take common limbs small plywood suspension traction for local external fixation, simple operation, easy to care.

 

        3. The matters needing attention

 

        (1) with XieQiXiong, illness critical take emergency measures, eliminate respiratory secretions, maintain airway open.

 

        (2) exclusion may merge cerebral and intraabdominal visceral injury.

 

        (3) merger XieQiXiong must first place closed drainage.

 

        (4) open XieQiXiong must first suture closed to buy closed drainage was again after the surgery.

 

        (5) to cough cannot effectively ruled out to the secretion, should emergency trachea cut or endotracheal tube to oxygen and sputum suction and help to breathe.

 

        (6) the stitches into needle position should be attached inferior ribs line, and avoid will sides seam in line and nerve inside.

 

        (7) chest wall skin and soft tissue contusion in small plywood ends in normal skin small MianDian mat high impending disposal.

 

        (8) progressive XieQiXiong for contraindication, need to open thoracic surgery. (excerpt from "formulary disease treatment technology, traditional Chinese and western medicine")