2/5(月)
◆今日の気持ち
(整形外科 2週目)
・教科書にも間違いはやっぱりあるものなのだな…。標準、の名にだまされずに気をつけねば。
・骨の透視。最初はまったく意味がわからなかった透視が、手術3例目になったらかなり見えるようになっていて、その変化が自分でおもしろかった。
●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
・sever AS
・大腿骨頚部骨折
●今日の病院滞在時間
7時半〜22時
●今日行ったこと・見たこと・知ったこと
・ガンマ3 x2
・DSS
・患者家族の眼を気にしろ
・Ope後の患者の見方。きっちり丁寧にデータを読みぬき、カルテに記載。
・Garden 不完全骨折の1型。骨折腺が横断しているがずれはない2型。ずれているが骨梁がついている3型。骨梁が離れ平行になっている4型。3型で嵌合していたり、足を動かしたときに骨頭も一緒に動くものは血流がよくつきやすいといわれる。動かなければ、人工骨頭に。
・骨接合術か人工骨頭置換か。どちらを選ぶか。前者であれば偽関節ができて再手術の可能性もある。どんな境界を作るか(血流はどんなときに保たれていると判断するか、どんなときに治癒しやすいと判断するか)は施設によって違う。
・大腿骨頚部骨折 外側は大量出血の可能性ある。内側であれば、その可能性は少ない
・大腿骨頚部骨折ope後。坐骨神経に翌日注意。opeで傷つけたり、骨折で挟み込み続けていた、という可能性もある。
・リウマチ。PIP、MPの変化(たいていは同時につぶれる)が有名だが、MCやトウ尺関節の変化も注意する必要あり。尺骨が脱臼していたり、するもの。手根骨がつぶれていたり、するもの。RFはあてにならん。OAと重なっていることも多い。
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