2/13(火)
◆今日の気持ち
(整形外科 2週目)
・やっぱり循環器が苦手…。とりあえず、今日明日で一冊読み終えてみよう
●目指す医師像
まずは、医者
●今の目標
・整形外科を味わいきる
●今日の新患・診断
・脛骨・ヒ骨骨折
・megaloblastic anemia(胃切後B12 deficiency)
・paroxysmal supravenricular tachycardia
・Patella骨折
・脛骨骨折
・距踵骨関節拘縮
●今日の病院滞在時間
7時半〜20時
●今日行ったこと・見たこと・知ったこと
・B12欠乏。汎血球減少起こる。葉酸投与で神経症状悪化することがある。葉酸欠乏では神経症状は見られない
・肩X-ray
軸: 上腕挙上の側面。側面を見るのにいい。烏口突起、鎖骨をみるのによい
スカプラーY: 腕を下げた側面。肩甲骨側面を見る。肩を吊り下げているときとかの上腕骨の側面を見るのにいい。
中間位、内、外
・骨盤骨折で、尿潜血・Hbチェック
・ラミノプラスティー(脊柱管拡大術)後の筋力低下
→血腫・doorの閉鎖に注意
・脊椎損傷の反射。もとからミエロパチーあると増強される。少し意識しただけで反応したり
・オッペンハイム反射
・ヘルニアは2週くらい安静しているとよくなる
・脊柱管狭窄症。PGE1で狭窄部位の血流よくなり運動よくなる。報告多数。経験からも良好。
・リウマチの手
手根骨がつぶれる。尺骨が脱臼する。
伸筋腱。切れやすい(滑膜炎で)→腱移植。束ねてしまうのも手段。尺骨の頭はトウ骨にネジでつなげる。尺骨全体を固定してしまうと回内・外ができなくなるため体は切り離す。MPの尺側変移とともに腱がずれても指は伸びなくなる
・整形では、指を番号で呼ばない。先天性の奇形があるから。
・加重と加動は同時にやらない。負担が掛け合わされるから
・ヒ骨骨折。関節面・靭帯に関与しないところは手術はしない。加重されないから。
・腱板断裂のX-ray。腱峰・大結節に骨局ができたり不整になったりする
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