Trauma Academy独立教学项目Independent teaching project

创伤学院 · 骨科创伤子站TRAUMA ACADEMY · ORTHOPAEDICS

骨科创伤Orthopaedics

成人骨折与脱位 · 12 个教学单元Adult fractures & dislocations · 12 teaching units

真实影像读图 · AO 原则释义 · 中英双语自测Published imaging · AO principles explained · Bilingual case questions

预计学习Estimated learning time · 180 分钟min

学完这门课，你能……After this course, you can…

  1. 辨认脊柱、上肢与下肢的结构和损伤线索。Identify spinal and limb anatomy and injury cues.
  2. 结合稳定性、软组织和神经血管解释分型。Interpret classification with stability, soft tissue and neurovascular findings.
  3. 比较处理前后变化，并识别需要升级的风险。Compare findings around interventions and recognize escalation needs.
实习：识别与报告；规培：决策时机与监督下关键步骤；青年主治：团队指挥与资源调度。Intern: recognize/report; resident: decision timing and supervised key steps; early attending: team leadership and resources.
先做 5 题前测Start five-question pretest学完做 5 题后测Complete five-question posttest本课口袋卡Course pocket card
课前测 · 5 题Pretest · five questions

每题 1 分；用于形成性反馈。One point per item; formative feedback.

合成情境题Synthetic vignette 1. 32岁男性摩托车碰撞伴开放胫骨畸形，HR132次/min、BP86/54 mmHg、SpO₂92%。伤口明显但仍有呼吸急促、骨盆压痛与湿冷；团队已备夹板，尚未共享胸腹骨盆及神经初评。下一步最合适的是？A 32-year-old man has an open tibial deformity after a motorcycle collision; HR 132/min, BP 86/54 mmHg, SpO₂ 92%. The obvious wound coexists with tachypnea, pelvic tenderness and clamminess; a splint is ready but torso/pelvic/neurologic primary assessment is not shared. What is the most appropriate next step?
合成情境题Synthetic vignette 2. 32岁女性坠落后开放前臂骨折，HR96次/min、BP118/72 mmHg、SpO₂97%。伤后30 min，伤口有泥土污染，已用湿敷料覆盖且循环稳定，手术室准备需较长时间。下一步最合适的是？A 32-year-old woman has an open forearm fracture after a fall; HR 96/min, BP 118/72 mmHg, SpO₂ 97%. At 30 min after injury the wound is contaminated with soil; moist coverage is in place, circulation is stable and theatre preparation will take time. What is the most appropriate next step?
3. 严重污染清创时点？Severe-contamination debridement timing?
4. 筋膜室存在脉搏可以？Pulse present in compartment syndrome?
5. 缺血肢体血管路径？Ischemic limb vascular pathway?

学习方法How to learn

每个单元都按三段推进：分阶段展开，文字只给关键层，需要时再深入。Each unit follows three stages: content unfolds step by step — key points first, details on demand.

1先观察Observe

先看解剖与影像：这块骨头长什么样、断在哪里、关节对位丢失多少。Start with anatomy and images: what the bone looks like, where it broke, how much joint alignment is lost.

2再理解Understand

再看机制与分型：分型辅助沟通，结合稳定性、神经血管与软组织状态比较治疗选择。Then mechanism and classification: classifications aid communication; compare treatment options using stability, neurovascular status, and soft-tissue condition.

3再复盘Review

最后自测与复盘：用自测题检验是否真正掌握，错题回看前两段。Finish with a self-quiz and review: check what you really know, then loop back to the earlier stages for anything you missed.

三大模块Three tracks

点击进入各模块。Tap a track to enter.

脊柱Spine

3 个单元3 units
  • 颈椎Cervical
  • 胸椎Thoracic
  • 腰椎Lumbar
进入模块 →Enter →

上肢Upper limb

4 个单元4 units
  • 肩关节脱位Shoulder dislocation
  • 肘关节脱位Elbow dislocation
  • 肱骨骨折Humeral fracture
  • 尺桡骨骨折Radius–ulna fracture
进入模块 →Enter →

下肢Lower limb

5 个单元5 units
  • 髋关节脱位Hip dislocation
  • 股骨骨折Femoral fracture
  • 髌骨骨折Patellar fracture
  • 胫骨平台骨折Tibial plateau fracture
  • 踝关节骨折脱位Ankle fracture-dislocation
进入模块 →Enter →

单元目录Unit catalogue

全部 12 个成人骨折 / 脱位教学单元。点击单元名称进入对应位置。All 12 adult fracture & dislocation units. Tap a unit name to jump to it.

#模块Track单元Unit
01脊柱Spine颈椎骨折脱位Cervical spine fracture-dislocation
02脊柱Spine胸椎骨折Thoracic spine fracture
03脊柱Spine腰椎骨折Lumbar spine fracture
04上肢Upper limb肩关节脱位Shoulder dislocation
05上肢Upper limb肘关节脱位Elbow dislocation
06上肢Upper limb肱骨骨折Humeral fracture
07上肢Upper limb尺桡骨骨折Radius–ulna fracture
08下肢Lower limb髋关节脱位Hip dislocation
09下肢Lower limb股骨骨折Femoral fracture
10下肢Lower limb髌骨骨折Patellar fracture
11下肢Lower limb胫骨平台骨折Tibial plateau fracture
12下肢Lower limb踝关节骨折脱位Ankle fracture-dislocation

影像 · 图例 · 许可Images, figures & licensing

本子站的影像政策，一条一条说清楚。This subsite's imaging policy, stated plainly.

  • 本页零配图：不编造医学影像，不用卡通解剖图教学。Zero images on this page: no fabricated medical imagery, no cartoon anatomy for teaching.
  • 各单元真实影像读图见内容页，逐图注来源、许可与原 caption。Real imaging for each unit lives on the content pages, with per-image source, license, and original caption.
  • AO 官方图例不转载、不热链（据 AO 网站使用条款，转载需事先申请许可）；分型图例请经内容页"官方资源入口"进入官方原页查看。AO figures are never reposted or hotlinked (republication requires prior permission under AO's site terms); view classification figures on the official pages via each unit's official-resource entries.
  • 官方视频资源仅以官方原链形式引用，不转存、不二传。Official videos are referenced by their original official links only; never re-uploaded or redistributed.

来源与限制Sources & limitations

  • 本子站为教学演示内容，依据公开医学教材与临床共识整理，不构成个体诊疗建议。Teaching material based on public textbooks and clinical consensus; not individual medical advice.
  • 分型引用（如 AO/OTA）仅作教学表述，不代表任何机构的认证或授权。Classifications (e.g. AO/OTA) are cited for teaching only and imply no certification or authorization by any institution.

临床判断与关键步骤Clinical decisions and key steps

具体方案；以本院为准；每项数字同时核对人群、阶段和来源。Follow institutional protocols; check population, stage and source with every number.

开放骨折：抗生素、清创与覆盖Open fracture: antibiotics, debridement and coverage

抗生素依据并列Antibiotic sources side by side

尽早静脉抗生素，尽量伤后1 h内。国内2019 Gustilo I–II以一代头孢（原文头孢唑啉）为基础；III加氨基糖苷，粪便/厌氧污染加青霉素或甲硝唑；过敏/肾功能及本地耐药谱决定替代。以本院规范为准。Early IV antibiotics, ideally within one hour. Chinese 2019 GustiloI–II first-generation cephalosporin(cefazolin), III adds aminoglycoside, fecal/anaerobic contamination adds penicillin/metronidazole; allergy/renal function/local resistance guide alternatives. Follow institutional policy.

国内2019持续至闭合后48 h；不能当所有现代方案统一疗程，按本院抗菌管理选择。盐水湿敷+封闭层与授权照片；BOAST/NICE不做急诊小冲洗，国内旧文急诊清洗说法另需本院定标。以本院规范为准。Chinese 2019 continues until48 hours after closure, not a universal modern duration; use local stewardship. Saline-moist/occlusive dressing and authorized photo; BOAST/NICE no ED mini-washout differs from older Chinese cleaning text. Follow institutional policy.

清创与重建Debridement and reconstruction

重污染/血管受损立即；其他高能12 h内、低能24 h内清创；确定覆盖尽量72 h内，内固定需与覆盖配合。破伤风与多区域复评同步。以本院规范为准。Immediate debridement for severe contamination/vascular compromise; other high-energy within 12 hours/low-energy within 24; definitive coverage ideally within 72, coordinated with fixation. Include tetanus and whole-patient review. Follow institutional policy.

中国开放骨折2019Chinese open fracture2019 · BOAST开放骨折2017BOAST open fracture2017 · NICE NG37NICE NG37

筋膜室：早诊与立即减压Compartment syndrome: early diagnosis and immediate decompression

有脉搏也可缺血A pulse can coexist with ischemia

高风险每小时查体，记录疼痛/被动牵拉痛及镇痛剂量；有症状松解环形层至皮肤，心脏水平，30 min内复评并即时骨科会诊。以本院规范为准。High risk: hourly exam, pain/passive stretch/analgesic dose. Symptoms: release circumferential layers to skin, heart-level limb, reassess within 30 minutes and consult orthopedics immediately. Follow institutional policy.

DBP−间室压<30 mmHg风险增加；绝对压>40 mmHg考虑紧急减压，不能脱离临床。确诊后立即切开；国内2019“6–8 h内”是旧表述，不能作为等待理由。以本院规范为准。DBP minus compartment pressure below 30 increases risk; absolute over 40 prompts urgent decompression assessment in context. Once diagnosed, immediate fasciotomy; older Chinese 2019 wording within 6–8 hours is not permission to delay. Follow institutional policy.

BOAST筋膜室2025BOAST compartment2025 · 中国开放骨折2019Chinese open fracture2019

肢体血管伤：没有安全等待时间Limb vascular injury: no safe waiting time

硬征与紧急复流Hard signs and urgent reperfusion

无脉、持续出血、扩张性血肿为硬征；毛细血管再充盈或Doppler不能单独排除。立即骨科/血管/整形协同，必要时临时分流。以本院规范为准。Absent pulse/ongoing bleeding/expanding hematoma are hard signs; CRT/Doppler alone cannot exclude injury. Immediate orthopedic/vascular/plastic coordination, temporary shunt when needed. Follow institutional policy.

BOAST2026：到院1 h内开始血运重建（commenced），不是承诺1 h内已恢复；不因复杂影像延误复流。以本院规范为准。BOAST 2026: commence revascularization within one hour of arrival, not a guarantee of completed flow restoration by then; complex imaging must not delay reperfusion. Follow institutional policy.

BOAST血管2026BOAST arterial2026 · NICE NG37NICE NG37

课后测 · 5 题Posttest · five questions

每题 1 分；用于形成性反馈。One point per item; formative feedback.

合成情境题Synthetic vignette 1. 43岁男性摩托车碰撞伴开放胫骨畸形，HR144次/min、BP78/48 mmHg、SpO₂90%。伤口明显但仍有呼吸急促、骨盆压痛与湿冷；团队已备夹板，尚未共享胸腹骨盆及神经初评。下一步最合适的是？A 43-year-old man has an open tibial deformity after a motorcycle collision; HR 144/min, BP 78/48 mmHg, SpO₂ 90%. The obvious wound coexists with tachypnea, pelvic tenderness and clamminess; a splint is ready but torso/pelvic/neurologic primary assessment is not shared. What is the most appropriate next step?
合成情境题Synthetic vignette 2. 47岁女性坠落后开放前臂骨折，HR102次/min、BP112/70 mmHg、SpO₂96%。伤后30 min，伤口有泥土污染，已用湿敷料覆盖且循环稳定，手术室准备需较长时间。下一步最合适的是？A 47-year-old woman has an open forearm fracture after a fall; HR 102/min, BP 112/70 mmHg, SpO₂ 96%. At 30 min after injury the wound is contaminated with soil; moist coverage is in place, circulation is stable and theatre preparation will take time. What is the most appropriate next step?
3. 严重污染或血管缺血的开放骨折清创时机怎样选？How is debridement timed for heavily contaminated or ischemic open fracture?
4. 疑筋膜室但脉搏存在，是否可以排除？Can a palpable pulse exclude suspected compartment syndrome?
5. 创伤缺血肢体为什么不能等待所谓安全缺血时间？Why should a traumatically ischemic limb not wait for a supposed safe interval?