英语查房剧本

☆☆☆( Orthopeadic Department of XX Hospital ) The scripts of Ward Round in English——Distal Radius Fracture XX医院 骨科 英语查房剧本——桡骨远端骨折 A．Morning report 情景 A：交班 Professor: Good afternoon everyone, today we will check the patient of bed No. 48. Doctor He , would you please say something about this patient？ 主任医师：各位下午好，今天我们检查一下 48 床的患者。何医生请你谈谈这个患者的情况 好吗？ Intern: Ok, This patient is a 25 years man ,feel pain， swelling, deformity of left wrist.2 hours after a fall ,then he came to the emergency department of our hospital. After taking a x-ray film, fracture of distal radius was found .In the emergency ,the doctor try to close reduce the fracture .The fracture is too comminuted to reduce successful ,then this patient was hospitalised in our department in order to do an opration. In our department we can see tenderness, swelling, deformity of left wrist and loss of range of motion of this patient. We can find this deformity is like a diner fork with dorsal angulation and radial displacement. and we did not find any neurovesular symptom on the left hand.. From the x-ray of left wrist .we can find this fracture is called Colles'fracture ,but this fracture is so communited and intra-articular. 实习医师：好的，这是一个男性病人，25 岁，摔倒致左腕疼痛、肿胀、变形 2 小时。然后 来我院急诊室，经 X 线检查发现桡骨远端骨折。在急诊室医生试图给予闭合复位，但由于 骨折太粉碎复位没有成功。所以这位患者收入院准备手术。 入院后可见该患者左腕压痛、肿胀、变形以及活动受限。左腕畸形向背侧成角、桡侧移位就 象一把餐叉。我们没有发现患者左手有神经血管症状。我们从 X 线片上可以看到这是 Colles’骨折，而且骨折很粉碎，而且涉及关节面。 Attending:We ‘d better check the patient first ,ok? 主治医师：我们最好先检查一下患者好吗？ Professor: Ok. 主任医师：好的。 B．Professor’s Ground 情景 B：主任查房 Attending:May I check your hand please? 主治医师：我可以检查一下你的手吗？ Patient:Yes . 患者：可以。 Attending:Pain here? 主治医师：这儿疼吗？ Patient:Yes . 患者：是的。 Attending:Do you have feeling here? 主治医师：这儿有感觉吗？ Patient:Yes . 患者：是的。 Attending:Could you move your finger? 主治医师：你能活动你的手指吗？ Patient:Yes . 患者：可以。 Attending:Thank you. 主治医师：谢谢。 Professor: Let’s go to the office to discuss this patient. 主任医师：让我们到办公室讨论一下这个患者。 C.Discussion 情景 C: 病例讨论 Professor:Dr Ding, can you summarize the history of the patient? 主任医师：丁医生你能总结一下这个患者的病史吗？ Resident:Ok, history summary of the patient as follow: 1. Patient,male,78 years old. 2. Feel pain,swelling,deformity of left wrist.for 2 hours after a fall. 3. No special past history. 4. PE:swelling,deformity of left wrist and loss of range of motion, X-ray of left wrist.we can find this fracture is called Colles’fracture,but this fracture is so comminuted,and intra-articular.. 住院医师：好的，让我先总结一下这个病人的病史，这是一个男性病人，25 岁，摔倒致左 腕疼痛肿胀，变形 2 小时。无其他特殊的过去史。查体：左腕肿胀，变形，活动受限，我 们从 X线片上可以看到这是 Colles’骨折，而且骨折很粉碎，而且涉及关节面。 Attending:Dr He, what is the basic principles for the treatment of distal radial fracture? 主治医师：何医生桡骨远端骨折治疗的基本原则是什么？ Intern: Generally speaking,it should be reduction of displacment fractures and functional rehabilitation of the limb. 实习医师：总的来说是骨折复位和上肢的功能康复。 Attending:Good, do you aware of two angles of radials in X-ray to determine the extent of deformity? 主治医师：很好，你知道在 X线片上判断桡骨畸形程度的 2 个角度吗？ Intern: They are Palmar tilt angel and radial inclination angel,the former one is around 10-15 degree and the last one is around 20-25 degree. 实习医师：它们是掌倾角和尺偏角，前者大约 10～15 度，后者 20～25 度。 Attending:Dr Ding ,could you talk about the classification of distal radial fracture? 主治医师：丁医生你能谈谈桡骨远端骨折的分类吗？ Resident: Yes. The most popular classification systems for distal radius fractures is Eponymic Classification .In this system, there are three types for distal radius fractures including Colles’fracture. Smith’s fracture and Barton’s fracture. Colles’fracture occurs when a person falls forward on an extended arm and on the palm of the hand. It is generally extra-articular with dorsal angulation,radial displacement,and shortening with a dinner fork deformity.Colles’ fracture is the most common distal radius fracture. Smith’s fracture,which is also called a reverse colles fracture,occurs from falling buckward on an extended arm and on the palm of the hand.It has a palmardrsplacement with a garden spade deformy. 住院医师：好，最常用的桡骨远端骨折分类是 Eponymic 分类。在这个分类系统中，有三 种骨折类型，分别是 Colles’骨折，Smith’ 骨折，Barton 骨折。 Colles 骨折发生在前 臂伸展时手掌撑地。通常在关节外有背侧成角移位，短缩呈刀叉样畸形。Colles 骨折是最 常见的骨折类型。 Smith 骨折也叫做反 Colles 骨折，是在前臂伸展时手背撑地出现。一般 向掌侧移位，呈刀铲样畸形。 Attending:Good ,generally speaking ,most patients suffered from distal radial fracture could be treated by close manipulation. The reason for why we refer this patient to operation is ,first, he is young and active, with highly functional needed; secondly, we failed to get anatomical reduction of distal radial after close manipulation in emergency room.. The operation name should be open reduction and internal fixation. 主治医师：好的，总的来说大多数桡骨远端骨折的患者可以通过闭合复位进行治疗。但我们 选择这个患者进行手术治疗的原因是：首先这个患者年轻有活力，具有较高的功能要求，其 次我们在急诊室给予闭合复位没有成功。手术名称是切开复位内固定术。 Professor:As we all know, distal radius fractures are some of the most common fractures in the upper extremity. It has been estimated that they account for more than one sixth of all fractures. The fracture is almost within 2.5cm of wrist joint. There were so many kinds of classification of distal radius fractures. The most serious type of fracture is the comminuted, intra-articular and displaced fracture. 主任医师：我们都知道桡骨远端骨折是常见的上肢骨折，据估计其占所有骨折的六分之一。 桡骨远端骨折的骨折线位于关节线以下 2.5cm以内，有许多分类方法，最严重的是粉碎的、 涉及关节面和移位的骨折。 Except for two angles, other 3 anatomic structure should be noted. They are Radial Height, TFCC (Triangle Fibrocartilage Complex) and DRUJ (Distal Radiounlar Joint). When we want to reduce this fracture, we should pay more attention to these structures. 除了 2 个角度，还有另外 3 个解剖结构需要注意。它们是桡骨高度、三角纤维软骨复合体 和下尺桡关节，当我们复位骨折时我们应该注意这些结构。 The treatment options are quite varied, depending on the type of the fracture, age, activing level and so on. Anatomic reduction and stable interal fixation may be good choice for young patient who is active and has an unstable, displaced and intra-articular fracture. But in older individuals, there may not be as great a need for anatomic reduction. The functional outcome may relate more to the patient’s ability to maintain finger motion than to the degree of distal radius. 桡骨远端骨折的治疗方法有很多，需根据患者骨折的类型、年龄、活动水平等。对于年轻的、 活动度大、不稳定移位涉及关节面的骨折患者选择切开解剖复位内固定，但对老年人解剖复 位可能不是主要的要求，老年人的治疗结果可能与手指的活动度关系比桡骨的复位程度更密 切。 Over the past 20 years, rigid internal fixation with plate and screws has become the standard for the treatment of fracture. Recently, the new locking plate system has been widely used in orthopeadic department. The advantage of locking plate system were not allowing the stripping of screws and prevented movement and loosening of screws. Since the plate did not have to be as precisely adapted to the underlying bone and did not have to be compressed against the bone. There was less interference with underlying vascular supply and the plate provided primary stability.I recommend that this patient should use locking plated. Dr Cao, what’s your opinion. 过去的 20 年，坚强的钢板螺钉内固定成为治疗骨折的 标准 excel标准偏差excel标准偏差函数exl标准差函数国标检验抽样标准表免费下载红头文件格式标准下载 。近年来新的锁定钢板系统广泛 地应用于骨科。锁定钢板系统的优点是不允许螺钉滑动、可避免螺钉松动和移位。由于钢板 不需要精确地与其下方的骨相适应，所以钢板不会对骨组织造成挤压。这对骨组织的血供破 坏较少，并提供初始的稳定性。我建议这个患者使用锁定钢板。曹医生，你的意见呢？ Attending:I agree with you. 主治医师：我同意。