Among chest injuries, rib fracture is the most common. It can be a single or multiple rib fracture, and the same rib can be fractured at one or more places. The 4th-7th ribs are long and fixed, and they are most easily broken. The child's ribs are elastic and not easy to break. Osteoporosis in adults and the elderly is brittle and prone to fracture.
Clinically, rib fractures are often complicated with serious complications. Attention should be paid to the existence of fatal vascular injury and the diagnosis and treatment of flail chest and lung contusion.
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2) Treatment method
1. Manual reduction
For a single rib fracture without obvious displacement, manual reduction is not needed.
If there are more than two obviously displaced fractures, manual reduction should be performed. During reduction, the patient sits, lifts the affected upper limb and tightens the pectoral muscles. The operator gently presses the raised ribs with his hand and asks the patient to take a deep breath or cough. The depressed ribs swell with the force of the drum.
2. Rib traction
For multiple double rib fractures, the chest must be fixed quickly to reduce the physiological obstacles caused by abnormal breathing. You can put a thick dressing on the injured part and then fix it with adhesive tape. If necessary, internal fixation or rib traction can be used.
Rib traction method: the affected part is disinfected routinely, a small incision is made in the middle of the fracture under local anesthesia, and the middle part of the fracture is peeled off under the periosteum and connected with the traction device through stainless steel wire. If multiple ribs are broken, they need traction one by one.
Traction weight is 0.5- 1 kg. Remove traction after 2-3 weeks, and pull out the steel wire after skin disinfection. You can also use towel tongs to hold the invaginated ribs for traction, and the effect is also good.
3. Fixed measures
① Cloth belt fixing method: use 1 cloth belt with a length of 5m and a width of 8cm for standby. A box of 1 made of cardboard, lined with cotton, is placed at the fracture. Tie the 1 gauze bandage on the patient's shoulders, hang the two ends on the chest and chest respectively, and cross-fasten them to prevent the fixing belt from falling off. Take it out after 3 weeks. The existing rib fracture fixation belt is for clinical use.
(2) Tape fixation method: use wide tape strips and stick them on the upper half of the skin around the affected chest (used with caution for patients with skin allergy). The front and back sides exceed the midline, and each tape overlaps 1-2 cm to make it a whole, and then take it off in 2-3 weeks.
③ Plaster fixation method: after heating and melting, spread it on the corresponding kraft paper and stick it on the fracture.
4. Drug therapy
① Early stage:
Promoting blood circulation and removing blood stasis, regulating qi and relieving pain.
A. those who are mainly injured by qi should regulate qi and relieve pain, supplemented by promoting blood circulation and removing blood stasis. Prescriptions such as liqi Zhitong decoction or Chaihu Shugan powder can be used. For those allergic to asthma and cough, winter melon peel, almond and bitter orange can be added.
B. For patients with blood injury, it is advisable to promote blood circulation to remove blood stasis and assist in regulating qi and relieving pain. Xuefu Zhuyu Decoction or He Ying Zhitong Decoction can be used, and Yunnan Baiyao or Notoginseng Radix can be added for patients with hemoptysis, such as Rhizoma Bletillae, Herba et Gemma Agrimoniae, carbonized blood and lotus root.
C for patients with deficiency of both qi and blood, it is advisable to pay equal attention to promoting blood circulation and removing blood stasis, regulating qi and relieving pain, and use Shunqi Huoxue decoction or chest injury prescription.
D. If cold and heat come and go, the chest and hypochondrium are full, and the treatment should be soothing the liver and relieving depression, and harmonizing the exterior and interior.
② Mid-term: The treatment should benefit qi and nourish blood and continue fracture. Prescription uses Jiegu Zijindan and Jiegu Dan.
③ Late stage:
A. For patients with dull pain in chest and hypochondrium or pain from old injuries, it is advisable to remove blood stasis and wound, promote qi circulation and relieve pain, and use Sanliang Heshang Decoction or Lidong Pill.
B. For people with weak qi and blood, Bazhen Decoction combined with Chaihu Shugan Powder should be used.
3) Home care
1. Prevention of bedsore
Long-term bed rest causes local tissue compression, blood circulation disorder and prone to bedsore. During traction, help to change posture every two hours, and change posture every 3-4 hours at night, for a total of 1 time. At the same time, massage the compressed part with 50% alcohol to improve local blood circulation and prevent bedsore.
2. Prevent falling pneumonia
Long-term bed-ridden lung capacity is reduced, which is easy to cause bronchial secretions to deposit at the bottom of the lung. If complicated with infection, it will cause stagnant pneumonia. Therefore, when helping the elderly to turn over, we should also help to beat their backs, encourage the elderly to take a deep breath and increase their vital capacity, so as to facilitate the discharge of sputum, keep the respiratory tract unobstructed and prevent pneumonia.
In addition, the bedroom of the elderly should keep the air fresh and ventilated regularly, which is also conducive to the cleaning of the respiratory tract.
Prevention of constipation
Patients must pay attention to diet adjustment, eat more fresh vegetables and foods containing more cellulose, and keep defecation every 1-2 days/time. If the stool is not resolved in 3-4 days, laxatives such as Runchang Pills can be given. If constipation is a habit, daily life should be adjusted. Drink 1 small glass of light salt water on an empty stomach every morning, and drink 65430 before going to bed every day.
4. Prevent urinary tract infection
Elderly fracture patients need to be taken care of by others because of bedridden defecation. They are afraid to disturb others and dare not drink more water. In this way, it is easy to cause urinary tract infection, especially for female patients. Therefore, family members should encourage patients to drink more water, drink more than 2000 ml every day, increase urination, clean urethra and prevent infection.
5. Prevent joint contracture
Proper bed exercise should be maintained during bed rest to prevent disuse atrophy of limbs and joint contracture. In addition, attention should be paid to maintaining the functional position of each joint, especially the affected limb should always be in a functional state, so as to avoid being unable to stand after fracture healing.
Prevention of depression
The elderly can't take care of themselves completely after fracture, so they need to be taken care of by others, so they are prone to depression due to long-term bed rest. Therefore, family members should take good care of patients, especially children, and be considerate of the elderly. If the elderly can maintain a good psychological state and be happy and stable mentally, it will greatly promote fracture healing, shorten bed rest time and recover as soon as possible through psychological-physiological reaction.
4) Evaluation of curative effect
The photo examination showed that the fracture was well aligned, the function was restored, there was no squeezing pain in the chest and the breathing was smooth.
Love tip: Please consult the local regular (Chinese medicine) hospital for the above drugs, and choose according to the physiological characteristics and different pathological conditions.
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