月光明媚目录
Campbell's Operative Orthopaedics（the 10th edition）(坎贝尔骨科手术学,第十版)
Contents
Volume One
PART I GENERAL PRINCIPLES（普遍原则）
Chapter 1. Surgical Techniques and Approaches(外科技术及入路)
Chapter 2. Magnetic Resonance Imaging in Orthopaedics（磁共振成像在骨科的应用）
PART II ARTHRODESIS（关节融合术）
Chapter 3. Arthrodesis of Ankle, Knee, and Hip单位英语（踝关节、膝关节、髋关节融合术）
Chapter 4. Arthrodesis of Shoulder, Elbow, and Wrist（肩关节、肘关节、腕关节融合术）
PART III ARTHROPLASTY（关节成形术）
Chapter 5. Introduction and Overview（引言与综述）
Chapter 6. Arthroplasty of Ankle and Knee（踝关节与膝关节的成形术）
Chapter 7. Arthroplasty of Hip（髋关节成形术）
Chapter 8. Arthroplasty of Shoulder and Elbow（肩关节、肘关节成形术）
PART IV AMPUTATIONS（截肢术）
Chapter 9. General Principles of Amputations（截肢总论）
Chapter 10. Amputations About Foot（足部截肢）
Chapter 11. Amputations of Lower Extremity（下肢截肢）
Chapter 12. Amputations of Hip and Pelvis（髋关节及骨盆截肢）
Chapter 13. Amputations of Upper Extremity（上肢截肢）
Chapter 14. Amputations of Hand（手部截肢）
PART V INFECTIONS（感染）投标承诺书
Chapter 15. General Principles of Infection（感染总论）
Chapter 16. Osteomyelitis（骨髓炎）
Chapter 17. Infectious Arthritis（感染性关节炎）
Chapter 18. Tuberculosis and Other Unusual Infections（结核及其它少见感染）
PART VI TUMORS（肿瘤）
Chapter 19. General Principles of Tumors（肿瘤总论）
Chapter 20. Benign Tumors of Bone（良性骨肿瘤）
Chapter 21. Benign (Occasionally Aggressive) Tumors of Bone（良性（偶为恶性））的骨肿瘤
Chapter 22. Malignant Tumors of Bone（恶性骨肿瘤）
Chapter 23. Soft Tissue Tumors and Nonneoplastic Conditions Simulating Bone Tumors（软组织肿瘤及与肿瘤相似的非肿瘤性疾病）
PART VII NONTRAUMATIC SOFT TISSUE DISORDERS（非创伤性软组织异常）
Chapter 24. Nontraumatic Soft Tissue Disorders（非创伤性软组织异常）
Chapter 25. Miscellaneous Nontraumatic Disorders（各种非创伤性异常）
Volume Two
PART VIII CONGENITAL ANOMALIES（先天性畸形）
Chapter 26. Congenital Anomalies of Lower Extremity（先天性下肢畸形）
Chapter 27. Congenital and Developmental Anomalies of Hip and Pelvis（先天性和发育
性髋关节及骨盆畸形）
Chapter 28. Congenital Anomalies of Trunk and Upper Extremity（上肢与躯干部先天性畸形）
PART IX OSTEOCHONDROSIS（骨软骨病）
Chapter 29. Osteochondrosis or Epiphysitis and Other Miscellaneous Affections（骨软骨病、骨骺炎和其它病变）
PART X NERVOUS SYSTEM DISORDERS IN CHILDREN（儿童神经系统异常）
Chapter 30. Cerebral Palsy（脑瘫）
Chapter 31. Paralytic Disorders（麻痹性疾病）
Chapter 32. Neuromuscular Disorders（神经肌肉疾病）
PART XI FRACTURES AND DISLOCATIONS IN CHILDREN（儿童骨折脱位）
Chapter 33. Fractures and Dislocations in Children（儿童骨折脱位）
PART XII THE SPINE（脊柱）
Chapter 34. Spinal Anatomy and Surgical Approaches（脊柱解剖及手术入路）
Chapter 35. Fractures, Dislocations, and Fracture-Dislocations of Spine（脊柱的骨折、脱
位与骨折－脱位）
Chapter 36. Arthrodesis of Spine（脊柱融合术）
Chapter 37. Pediatric Cervical Spine（儿童颈椎）
Chapter 38. Scoliosis and Kyphosis（脊柱侧弯与驼背）
Chapter 39. Lower Back Pain and Disorders of Intervertebral Discs（下腰痛与椎间盘疾病）
Chapter 40. Infections of Spine钟繇读音（脊柱感染）
Chapter 41. Other Disorders of Spine（其它脊柱疾病）
Volume Three
PART XIII SPORTS MEDICINE（运动医学）
Chapter 42. Ankle Injuries（踝关节损伤）
Chapter 43. Knee Injuries（膝关节损伤）
Chapter 44. Shoulder and Elbow Injuries（肩关节与肘关节损伤）
Chapter 45. Recurrent Dislocations（复发性脱位）
Chapter 46. Traumatic Disorders（创伤性疾病）
PART XIV ARTHROSCOPY（关节镜）
Chapter 47. General Principles of Arthroscopy（关节镜总论）
Chapter 48. Arthroscopy of Lower Extremity（下肢关节镜）
Chapter 49. Arthroscopy of Upper Extremity（上肢关节镜）
PART XV FRACTURES AND DISLOCATIONS（骨折与脱位）
Chapter 50. General Principles of Fracture Treatment（骨折治疗总论）
Chapter 51. Fractures of Lower Extremity（下肢骨折）
Chapter 52. Fractures of Hip（髋部骨折）
Chapter 53. Fractures of Acetabulum and Pelvis（髋臼与骨盆骨折）
Chapter 54. Fractures of Shoulder, Arm, and Forearm（肩部、上臂、前臂骨折）
Chapter 55. Malunited Fractures（骨折畸形愈合）
Chapter 56. Delayed Union and Nonunion of Fractures（骨折延迟愈合和骨不连）
Chapter 57. Acute Dislocations（急性脱位）
Chapter 58. Old Unreduced Dislocations（陈旧性未复位的脱位）
Volume Four
PART XVI PERIPHERAL NERVE INJURIES（外周神经损伤）
Chapter 59. Peripheral Nerve Injuries（外周神经损伤）
PART XVII MICROSURGERY（显微外科）
Chapter 60. Microsurgery（显微外科）
PART XVIII THE HAND（手）
Chapter 61. Basic Surgical Technique and Aftercare（基本外科手术技术和术后处理）
Chapter 62. Acute Hand Injuries（急性手外伤）
Chapter 63. Flexor and Extensor Tendon Injuries（屈肌腱、伸肌腱损伤）
Chapter 64. Fractures, Dislocations, and Ligamentous Injuries（骨折、脱位和韧带损伤）
Chapter 65. Nerve Injuries（神经损伤）
Chapter 66. Wrist Disorders（腕关节疾病）
Chapter 67. Special Hand Disorders（特殊手部疾病）
Chapter 68. Paralytic Hand（瘫痪手）
Chapter 69. Cerebral Palsy of the Hand（脑瘫手）
Chapter 70. Arthritic Hand（手部关节炎）
Chapter 71. Compartment Syndromes and Volkmann Contracture（筋膜间室综合征与Volkmann挛缩）
Chapter 72. Dupuytren Contracture（Dupuytren 挛缩）
Chapter 73. Carpal Tunnel, Ulnar Tunnel, and Stenosing Tenosynovitis（腕管综合征、尺管综合征和狭窄性腱鞘炎）
Chapter 74. Tumors and Tumorous Conditions of Hand（手部肿瘤与瘤样疾病）
Chapter 75. Hand Infections（手部感染）
Chapter 76. Congenital Anomalies of Hand（手部先天性畸形）
PART XIX THE FOOT AND ANKLE（足与踝关节）
Chapter 77. Surgical Techniques（外科技术）
Chapter 78. Disorders of Hallux（拇趾疾病）花灯展
Chapter 79. Pes Planus（扁平足）
Chapter 80. Lesr Toe Abnormalities（足趾畸形）
Chapter 81. Rheumatoid Foot（足部类风湿性）
Chapter 82. Diabetic Foot（糖尿病足）
Chapter 83. Neurogenic Disorders（神经源性疾病）
武汉有什么景点Chapter 84. Disorders of Nails and Skin（趾甲、皮肤疾病）
Chapter 85. Disorders of Tendons and Fascia（肌腱筋膜疾病）
Chapter 86. Fractures and Dislocations of Foot（足部骨折脱位）
C H A P T E R 1
Surgical Techniques and Approaches
（外科技术及入路）
Andrew H. Crenshaw, Jr.
SURGICAL TECHNIQUES（外科技术）
Tourniquets（止血带）
Roentgenograms in the Operating Room（X线在手术室中的应用）
Positioning of Patient（病人体位）
Local Preparation of Patient（局部准备）
Draping(冲洗)
Special Operative Techniques(特殊手术技术)
SURGICAL APPROACHES(手术入路)
Toes(足趾)
Calcaneus(跟骨)
自律演讲稿Tarsus and Ankle(跗跖骨与踝)
Tibia(胫骨)
Fibula(腓骨)
Knee(膝)
Femur(股骨)
Hip(髋)
Acetabulum and Pelvis(髋臼与骨盆)
Sacroiliac Joint(骶髂关节)
Spine(脊柱)
Shoulder(肩)
Humerus(肱骨)
Elbow(肘)
Radius(桡骨)
Ulna(尺骨)
Wrist(腕)
Hand (手)
SURGICAL TECHNIQUES（外科技术）
This ction describes veral surgical techniques especially important in orthopaedics: u of tourniquets, u of roentgenograms and image intensifiers in the operating room, positioning of the patient, local preparation of the patient, and draping of the appropriate part or parts. To avoid repetition in other chapters, two operative techniques common to many procedures, fixation of tendons or fascia to bone and bone grafting, are also descri
bed.
这一部分描述了几种在矫形外科非常重要的外科技术，包括止血带的应用、X线与图像增强剂在手术室的应用以及患者的体位、术区准备和手术部位或多部位的铺单。为了避免在其他章节重述，肌腱或筋膜固定至骨的方法及骨移植这两种在许多手术中常用的技术也在本章加以描述。
Tourniquets （止血带）
Operations on the extremities are made easier by the u of a tourniquet. The tourniquet is a potentially dangerous instrument that must be ud with proper knowledge and care. In some procedures, a tourniquet is a luxury, whereas in others, such as delicate operations on the hand, it is a necessity. A pneumatic tourniquet is safer than an Esmarch tourniquet or the Martin sheet rubber bandage.
应用止血带使四肢的手术更加简单清晰，止血带是一种具有潜在危险性的设备。因此，使用时必须具备相关的知识并且非常小心。在一些手术当中，止血带是多余的，但在一些精细的手术如手外科手术，止血带则是必需具备的。与埃斯马赫止血带(Esmarch tourniquet)以及马丁橡胶膜带(Martin sheet rubber bandage)相比，充气止血带则更安全。
A pneumatic tourniquet with a hand pump and an accurate pressure gauge is probably the safest, but a constantly regulated pressure tourniquet is quite satisfactory if it is properly maintained and checked. A tourniquet should be applied by an experienced person and not delegated to someone who does not understand its u.
具有手动加压泵及精确气压表的充气止血带可能是最为安全的，但是只要正确保养和检查，持续调压式止血带也相当满意。止血带的应用必须由有经验的人来进行，而不能交给那些不懂它的用法的人来代替操作。
Several sizes of pneumatic tourniquets are available for the upper and lower extremities. The upper arm or the thigh is wrapped with veral thickness of smoothly applied cotton cast padding. Krackow described a maneuver that improves positioning of the tourniquet in obe patients. An assistant manually grasps the flesh of the extremity just distal to the level of tourniquet application and firmly pulls this loo tissue distally before the cast padding is placed. Traction on the soft tissue is maintained while the padding and tourniquet are applied and the latter is cured. The assistant's grasp is then relead, resulting in a greater proportion of the subcutaneous tissue remaining distal to t
he tourniquet. This bulky tissue tends to support the tourniquet and push it into an even more proximal position. All air is expresd from the sphygmomanometer or pneumatic tourniquet before application. When a sphygmomanometer cuff is ud, it should be wrapped with a gauze bandage to prevent its slipping during inflation. Every effort is made to decrea tourniquet time; the extremity often is prepared and ready before the tourniquet is inflated. The extremity is then elevated for 2 minutes, or the blood is expresd by a sterile sheet rubber bandage or a cotton elastic bandage. Beginning at the fingertips or toes, the extremity is wrapped proximally to within 2.5 to 5 cm of the tourniquet. If a Martin sheet rubber bandage or an elastic bandage is applied up to the level of the tourniquet, the latter will tend to slip distally at the time of inflation. The tourniquet should be inflated quickly to prevent filling of the superficial veins before the arterial blood flow has been occluded.
有多种尺寸的气囊止血带可供上胶及下肢使用。上肢或大腿需要包裹数层柔软的管型棉垫。Krackow描述了一种如何给过度肥胖的病人安放止血带的改良方法，助手将肢体要放止血带的部位的软组织尽可能地推向远端，并维持对软组织的推压直到棉垫及止血带安放
好，助手放松软组织，此时止血带远端维持有较多的皮下组织，这些软组织可支持止血带并将其推向肢体近端。应在止血带或血压计使用前压出所有剩余气体。当使用血压计袖套时外面要用薄纱布绷带包裹，以防加压时出现滑动。应尽一切可能减少使用止血带的时间，肢体要在止血带加压前灭菌完善，拾高2分钟或使用无菌薄橡胶绷带或棉弹力绷带驱血，从指尖或足趾开始直至距止血带2.5—5cm电子邮件英语处，如果在使用马丁薄膜带或弹力绷带驱血时近端与止血带距离过近，上：血带加压时往往会向远端滑动。止血带加压要足够快，以防动脉阻断前的血流使浅表静脉再次充盈。
The exact pressure to which the tourniquet should be inflated has not been determined. Evidence indicates that pressures greater than necessary have been ud for many years. The correct pressure depends somewhat on the age of the patient, the blood pressure, and the size of the extremity. Reid, Camp, and Jacob[1] ud pneumatic tourniquet pressures determined by the pressure required to obliterate the peripheral pul using a Doppler stethoscope; they then added 50 to 75 mm Hg to allow for collateral circulation and blood pressure changes. Tourniquet pressures from 135 to 255 mm Hg for the upper extremity and 175 to 305 mm Hg for the lower extremity were satisf
actory for maintaining hemostasis. Estersohn and Sourifman[2] recommended pressures of 90 to 100 mm Hg above the preoperative systolic arm blood pressure for the lower extremity. This resulted in an average tourniquet pressure of 210 mm Hg. Others have recommended 50 to 75 mm Hg above the systolic blood pressure for surgery in the upper extremity and 100 to 150 mm Hg for surgery in the lower extremity.
1. Reid HS, Camp RA, Jacob WH: Tourniquet hemostasis: a clinical study, Clin Orthop 177:230, 1983.
2. Estersohn HS, Sourifman HA: The minimum effective midthigh tourniquet pressure, J Foot Surg 21:281, 1982.
止血带加压所需的精确压力尚未确定，有证据表明许多年来我们所使用的压力偏大，真正需要的正确压力在某种程度上要根据患者年龄、血压以及肢体的周径来确定，Reid、Camp 和 Jacob[1]借助于多普勒听诊器(Doppler stethoscope)测量使外周脉搏消失所需的压力，并以此确定使用止血带所需压力。考虑到侧支循环及血压的变化，他们将此压力提高50~75 mmHg，即止血带压力在上肢为135~255 mmHg，下肢为175~305 mmHg，维持此压力即可达到满意的止血效果。Estersohn 和Sourifman[2]推荐下肢止血带的压力应比术
前在上肢测量的收缩压高90~100 mmHg。如此测算平均的止血带压力为210 mmHg，其他一些人则推荐上肢止血带压力比收缩压高50~75 mmHg，下肢则高100~150mmHg。
According to Crenshaw et al.[1], wide tourniquet cuffs are more effective at lower inflation pressures than are narrow ones. Pedowitz et al.[2] demonstrated that curved tourniquets on conical extremities require significantly lower arterial occlusion pressures than straight (rectangular) tourniquets (Fig. 1-1). The u of straight tourniquets on conical thighs should be avoided, especially in extremely muscular or obe individuals.
1． Crenshaw AG, Hargens AR, Gershuni DH, et al: Wide tourniquet cuffs more effective at lower inflation pressures, Acta Orthop Scand 59:447, 1988.
2． Pedowitz RA, Gershuni DH, Botte MJ, et al: The u of lower tourniquet inflation pressures in extremity surgery facilitated by curved and wide tourniquets and integrated cuff inflation system, Clin Orthop 287:237, 1993.
根据Crenshaw[1]等人的研究，充气压力较低时宽的止血带比窄的止血带更为有效：Pedowitz[2]等人证实采用弧形止血带(curved tourniquet)对圆锥形的肢体部分加压时，使动脉闭塞所需的压力比使用直止血带(长方形，straight tourniquet)显著降低(图1—1)。因此在圆锥形的大腿上应避免使用直止血带，尤其是在那些肌肉非常发达或过度肥胖的患者。
