中医骨科学外文版 (3).ppt

1 1Classification,Etiology and Pathogenesis of InjuriesOrthopedics and Traumatology of TCMOrthopedics and Traumatology of TCM2023/3/302023/3/302 2Purpose and RequirementsUnderstand the classification and significance of injuriesBe familiar with the etiology of injuries(relationship between internal and external causes)Master the pathogenic characteristics of external factorsUnderstand the relationship between injury and five internal organsUnderstand the relationship between injury and body fluid2023/3/302023/3/303 3Focuses and Difficulties in LearningPathogenic characteristics of external factorsRelationship between the liver and kidney and the bone and muscle during injuryPathological changes of qi and blood during injuryLecture form:Face-to-face teaching combined with self-study2023/3/302023/3/304 4Section I Classification of injuriesInjury refers to the destruction of the skin,bones,soft tissues,internal organs,and other organizational structures caused by various external traumatic factors,and the local and systemic reactions caused by itClassification of diseases(syndromes)is the first step to clinical thinking2023/3/302023/3/305 5Section I Classification of injuries Classification by siteClassification by siteClassification by natureClassification by timeClassification by time of injuryClassification by severityClassification by occupational characteristicsClassification by physicochemical properties of inducing factorClassified as trauma and internal injuryTrauma refers to injuries of the skin,flesh,soft tissues,bones,arteries and veins.It can be divided into fracture,dislocation,and soft tissue injury according to the injured site.Internal injury refers to the dysfunction of qi,blood,viscera,and meridians caused by visceral disorder and injury.2023/3/302023/3/306 6Section I Classification of injuriesClassification by site Classification by natureClassification by natureClassification by timeClassification by time of injuryClassification by severityClassification by occupational characteristicsClassification by physicochemical properties of inducing factorClassified as acute injury and chronic strainAcute injury refers to the injury caused by sudden violenceChronic strain refers to a condition caused by long-term cumulative action of external forces on the human body due to inappropriate work and rest or incorrect posture2023/3/302023/3/307 7Section I Classification of injuriesClassification by siteClassification by nature Classification by timeClassification by timeClassification by time of injuryClassification by severityClassification by occupational characteristicsClassification by physicochemical properties of inducing factorClassified as new injury and old injuryNew injury refers to recent(within 2-3 weeks)injury,or those immediately treated after onsetOld injury,also known as persistent injury,refers to an untreated new injury that is unhealed for a long time or recurs at the original injured site at a certain interval due to some inducement after healing.2023/3/302023/3/308 8Section I Classification of injuriesClassification by siteClassification by natureClassification by time Classification by time of Classification by time of injuryinjuryClassification by severityClassification by occupational characteristicsClassification by physicochemical properties of inducing factorIt is divided into closed injury and open injuryClosed injury refers to the injury without external wounds caused by blunt violenceOpen injury refers to damaged skin or mucosa with wounds caused by sharp instruments,firearms,or blunt violence,and deep tissues exposed to the outside environment.If the skin is damaged,exogenous pathogens can invade from the wound,causing infection2023/3/302023/3/309 9Section I Classification of injuriesClassification by siteClassification by natureClassification by timeClassification by time of injury Classification by severityClassification by severityClassification by occupational characteristicsClassification by physicochemical properties of inducing factorClassified as minor injury and severe injury by the severity of injuryThe severity of injury depends on the nature and intensity of inducing factor,the length of action,the site of injury and the area and depth of injury2023/3/302023/3/301010Section I Classification of injuriesClassification by siteClassification by natureClassification by timeClassification by time of injuryClassification by severity Classification by Classification by occupational occupational characteristicscharacteristicsClassification by physicochemical properties of inducing factorAccording to patients occupational characteristics,injuries can be divided into life injuries,industrial injuries,agricultural injuries,traffic injuries,and sports injuries.Athletes and dancers,acrobats,and martial art actors are prone to various sports injuries.Those who often read books or watch TV in bed with excessive neck flexion and those who work at desks with heads lowered for a long time are prone to cervical spondylosis2023/3/302023/3/301111Section I Classification of injuriesClassification by siteClassification by natureClassification by timeClassification by time of injuryClassification by severityClassification by occupational characteristics Classification by Classification by physicochemical physicochemical properties of inducing properties of inducing factorfactorPhysical injury,chemical injury and biological injury.Physical injury includes external force,high heat,freezing,electric current,etc.The research object of Orthopedics and Traumatology of TCM is primarily the injuries caused by external factors.2023/3/302023/3/301212Section I Classification of injuriesClassification by siteClassification by natureClassification by timeClassification by time of injuryClassification by severityClassification by occupational characteristicsClassification by physicochemical properties of inducing factor Classification by pre-injury Classification by pre-injury tissue conditiontissue condition Traumatic Pathologic2023/3/302023/3/301313Section II Etiology of injuriesThe etiology of injuries refers to the cause of human injuries or the pathogenic factor of injuriesOnly by mastering the causes of injuries to bones and soft tissues around them,syndrome differentiation according to causes,and diagnosis and treatment by cause examination,correct estimation of the nature and degree of injuries can be carried out,which is of great guiding significance to the treatment and prognosis of injuries2023/3/302023/3/301414Etiology of injuries-external causesThe external causes of injury refer to the external factors causing injury to the human body and are mainly external forces.They are also related to virus infection,exogenous six evils,and so on.2023/3/302023/3/301515(I)External factors Direct violence:Direct violence:At parts of direct external forces(contusion,fracture)Indirect violence:Indirect violence:At parts away from external forces(e.g.,conveying violence and torsional violence can cause fracture and dislocation of corresponding parts)Excessive and intense muscle contraction:Excessive and intense muscle contraction:(e.g.,patella fracture caused by intense contraction of quadriceps femoris when falling)Continuous strain:Continuous strain:Long-term strain or incorrect posture causes the bones and muscles of a certain part of the limb to be subjected to continuous or repeated chronic traction and friction.Etiology of injuries-external causesEtiology of injuries-external causes2023/3/302023/3/301616(II)Exogenous six factorsWind,cold,summer heat,dampness,dryness,and fire are six different climate changes in nature that are referred to as exogenous six evils.Any deficiency or excess of them will cause human diseases.Exogenous six evils can cause diseases of bones,muscles,and joints,leading to joint pain or impaired mobility.According to the Supplement to Traumatology,after catching a cold,the neck stiffens and the head is unable to turn.It indicates that wind-cold-dampness evils can induce stiff neck and other diseases.Etiology of injuries-external causesEtiology of injuries-external causes2023/3/302023/3/301717(III)Viral infectionThe patients are infected after the trauma or virus invades the body from the wound and causes inflammation,ulceration,and abscesses in bone,which will damage soft tissues and bones if not expelled and lead to local and systemic infections with deteriorated syndromes.Improper treatment of open fractures may cause pyogenic osteomyelitis.Etiology of injuries-external causesEtiology of injuries-external causes2023/3/302023/3/301818Etiology of injuries-internal causesIt refers to factors that cause damage in the human body by internal changesInjuries are mainly caused by external factors such as external violence,but they also have various internal factors and certain incidence rules,such as age,physique,local anatomical structure,etc.2023/3/302023/3/301919(I)Age factorThe predilection sites and incidence of injuries are different with age.For example,if the hip lands on the ground when falling,under the same external force,the elderly are vulnerable to femoral neck fracture or intertrochanteric fracture,among which the onset age of intertrochanteric fracture is relatively higher.However,such fractures are less common in adolescents.Young children are prone to fractures due to infirm bones but those fractures are mostly incomplete due to thick and tenacious periosteum.Etiology of injuries-internal causesEtiology of injuries-internal causes2023/3/302023/3/302020(II)Physical factorsPhysical fitness is closely related to the occurrence of injury.Young and strong individuals with vigorous qi and blood,adequate kidney qi,and robust bones and muscles are vulnerable to injury.Old and weak individuals with a deficiency in qi,blood,liver,and kidney,and osteoporosis are prone to injury,such as sudden slip,hip landing on the ground,as well as possible femoral neck fracture although the external force is slight.Etiology of injuries-internal causesEtiology of injuries-internal causes2023/3/302023/3/302121(III)Anatomical structureInjury is also related to local anatomical structure.When conveying violence acts on certain bones and tissues,fractures often occur at the junction of compact bone and cancellous bone.For example,fracture of the distal radius often occurs 2-3 m below the distal radius at the junction of cancellous bone and compact bone.Etiology of injuries-internal causesEtiology of injuries-internal causes2023/3/302023/3/302222(IV)Congenital factorsThe occurrence of injury is also closely related to congenital endowment deficiencyFor the recessive spina bifida of S1 sacral vertebra,due to the absence of spinous process,the supraspinous ligament and interspinous ligament lose attachment,which reduces the stability of lumbosacral joint and is prone to strainCongenital fragililis ossium:It can cause bone tissue fragility and fracture easilyEtiology of injuries-internal causesEtiology of injuries-internal causes2023/3/302023/3/302323(V)Pathological factorsThe occurrence of injuries is also closely related to the pathological changes of tissuesEndocrine and metabolic disorders can affect bone compositionBone tissue diseases such as bone tumor,bone tuberculosis and osteomyelitis can destroy bone tissue and lead to the destruction of local structuresEtiology of injuries-internal causesEtiology of injuries-internal causes2023/3/302023/3/302424(VI)OccupationThere is a certain relationship between the occurrence of injury and occupationHand injuries:Most of them happen to mechanical workers who work without necessary protective equipmentChronic lumbar strain:It occurs mostly in workers who often bend over to carry weight Athletes and dancers,acrobats,and martial art actors are prone to various sports injuries.Workers who often bow their heads are prone to cervical spondylosisEtiology of injuries-internal causesEtiology of injuries-internal causes2023/3/302023/3/302525(VII)Seven emotions and internal injuriesInternal injuries are closely related to the changes of seven emotions(joy,anger,worry,thought,sadness,fear and shock)Chronic arthralgia:If the emotion is depressed,the internal consumption of Qi and blood may aggravate the local conditionAmong the patients with planed fracture,those with cheerful personality and strong will are beneficial to wound repair and disease improvement.If the will is weak and the anxiety is excessive,the internal consumption of Qi and blood will be aggravated,which is not conducive to the recovery of the disease,and even aggravates the illnessTraditional Chinese Medicine traumatology department has always attached importance to mental rehabilitationEtiology of injuries-internal causesEtiology of injuries-internal causes2023/3/302023/3/302626Summary of the etiology of injuryHuman is a unified whole inside and outside,and the occurrence and development of injury is the result of the comprehensive action of internal and external factorsDifferent external factors can cause different injury diseasesThe same external cause acts on individuals with different internal causes,and the types,nature and degree of injuries are differentAlthough external factors are very important for the occurrence of diseases,we should not ignore the internal factors of the body2023/3/302023/3/302727Section 3 Pathogenesis of InjuryThe human body is an organic whole:Viscera-qi-blood-body fluid,which are connected with the skin,bones and muscles of the whole body through channels and collaterals.They are balanced,interrelated,interdependent and restricted,and are inextricably linked in both physiological activities and pathological changesAnalysis of overall concept:while differentiating and treating local skin and bone injuries,we should pay attention to the pathological changes of qi,blood,body fluid,viscera and meridian functions caused by injuries,and understand the nature of injuries and the causal relationship between pathological phenomenaThe unity of local and whole is the principle of traumatology in treating injury diseases2023/3/302023/3/302828(I)The relationship between injury and skin and bones and muscles(1)Injury of skin and superficial musclesMechanism:Invasion of exogenous pathogens,infection of local skin tissues by pathogens,obstruction of the function of the Ying and Wei,stagnation of qi and bloodSymptoms:Local redness,swelling,heat and painPathogenesis of injuryPathogenesis of injury2023/3/302023/3/302929(I)The relationship between injury and flesh and bones(2)Tendons injuryFor any traumatic injuries,the tendons bear the brunt of long-term fatigue,which can cause the injuries of the tendonsThere are many clinical opportunities for soft tissue injury,and its symptoms and pathological changes are complicated,such as muscular contracture,muscular flaccidity,contracted sinew,muscular spasm,muscle fullness,cold-like eminence of soft tissue and spasmodic jerk of musclePatho