Manipulation is an important link in external treatment of traumatology, which is mostly used for injuries of bones and muscles. "Jin Jian of Medical Sect, Essentials of Bone-Setting and Heart-Therapy" says: "A husband who practices means that the injured bones and muscles are resettled with the second hand, so that they can be restored to the old." Due to the limitation of conditions, most of the previous traumatology manipulations were performed without anesthesia. Therefore, it is required that the manipulations be accurate, fast, powerful and stable. The so-called "method makes people suddenly feel unconscious, and the patients are already disturbed if they know". "Therefore, we must know its body shape and know its parts. Once we are in the clinic, we will touch the outside, be born in the inside, turn our hands at will, and the method will come out from our hands." Shi's common methods include pulling and stretching, lifting and rubbing, and the so-called "twelve-character method". It can be used according to the affected part and the injury. Generally speaking, pulling, stretching and pressing are used for fracture reduction, pulling, pinching and lifting are used for epiphysis, and kneading and turning are mostly used for those who need manual treatment for tendon injuries.
first, the treatment of tendon injury-tendon hernia
tendon should have its place. If there are ribs exposed and bulges in the flat subsidence without bulges, it is called "tendon sticking out". Knee is the most common, every time it is caused by falling servant injury. Knee pain can't be flexed and stretched, and there are two lying silkworm-like protrusions in the shape of eight above the patella. If only the drugs for promoting blood circulation and relaxing muscles and tendons are taken orally and externally, the symptoms will be prolonged, the protrusion will be difficult to calm down, and the recovery of flexion and extension will not be easy. If the manipulation is applied, the protrusion will be flat, and most of the flexion and extension will be restored, and the tendon of "out of the nest" will be returned to its original position. The method is to press the protrusion with thumb and thumb, and hold the ankle with the other hand. When the patient doesn't mind, the semi-extended knee will be quickly flexed, and then it will be straightened immediately. After this flexion and extension, you can see that the process is calm, the pain is reduced, and the flexion and extension are also beneficial. However, the manipulation is very painful, so the operation should be performed quickly so that the patient will not feel it, otherwise the manipulation will be difficult to implement because of the spasm caused by the pain. There are many knee injuries caused by falling servants. If you want to do it well, you must make a clear diagnosis, otherwise you will be injured by wrong manipulation. The main point is that there is a figure-eight lying silkworm-like protrusion on the patella, which has no obvious swelling. The point of the technique is fast. A similar situation can be seen in the elbow. Every time this syndrome is ignored in clinic. It is more common in young people, especially in women. Its symptoms are behind the elbow, and this protrusion is seen on both sides of the elbow tip, and the elbow is mostly in a semi-extended and semi-flexed position. Quickly bend and stretch and press and rub the part, and it will also heal quickly.
Second, bending tendons-the reduction method of subluxation of radial head in children
This is a common injury in children. Shi's usual technique is: place the elbow of the child with one hand, so that the thumb just presses the head of the radius, and hold the palm of the affected limb with the other hand. After straightening it, rotate it firmly and forcefully, and most of them can feel the snap of reset. If not, you must bend your elbow again or rotate it inward. The key point of manipulation is to pinch the child's palm and rotate it fully. The reason why Shi adopted this technique was that the injury was caused by rotation, and some children's symptoms were not in elbow but in wrist. It is generally believed that the disease is caused by traction, and traction fixation is its factor, but traction alone can't cause it, just because there is rotation during traction, which leads to adult syndrome. Children play with each other, crying and pulling, falling down and pulling up, etc., although they are pulling, it is not difficult to detect that there must be rotation in the meantime. Bend the tendons, and the tendons are twisted. Stretching is stretching, but not bending. Only rotation can distort its tendons, so reduction can only be done by rotation. Whether it is traction or not is irrelevant. Pinch the child's hand because the disease may be in the wrist. Or why children are unique? Because children's tendons and veins are soft and relaxed, they are called "pulling elbows"; Also known as the shoulder also has its own diseases, also known as "pulling the shoulder." Children's elbow and shoulder tendons are loose, but why is their wrist not loose? It is very difficult to distinguish between elbow and wrist, so rotation is the most important thing in treatment. Squeeze his hand and turn it, then both elbows and wrists can be taken care of. In the process of reset, we can know where we are suffering from it. There are also older children who can clearly point out that the disease is in the wrist or elbow during the diagnosis.
Third, the missing cheek joint-the method of extraoral reduction for dislocation of temporomandibular joint
It has been recorded in Qian Jin Fang of Tang Dynasty that "to treat missing cheek joint ....................................................................................................................... Pushing the finger out of the disease, I am afraid that I will bite the finger by mistake. " This method has been used up to now, and it has its effects, but it also has shortcomings. Doctors put their fingers into the patient's mouth, and every time they wrap their fingers with gauze, patients often feel sick and hinder the manipulation. Moreover, the technique is "the law makes people suddenly feel it." How can you not notice that your mouth is open and your fingers are included? The patient is nervous and prone to nausea, which makes the oral muscles exert force, making it difficult to implement the manipulation. Extraoral reduction has no such disadvantages. The method is that the thumb is pressed at the position of the last molar, the rest finger holds the mandibular angle, and the thumb is rubbed to make it sour. "If you push it gradually, you will re-enter." Fat people have rich cheeks, so it is a little difficult to operate. However, most of them are elderly, weak and habitually dislocated, and there is nothing difficult to do. As long as the thumb is pressed accurately and pushed hard, it can be successful.
Fourth, the prone pressing method-the reduction method of posterior dislocation of hip joint
There are abundant muscles around hip joint, and most of the dislocations are young and strong adults, so, as "Supplement to Traumatology" said, "If it comes out, it will be difficult to get on". Insufficient force makes it difficult to reset. If the force is large or improper, it will easily increase local injury and lead to complications such as fracture and blood supply disorder of femoral head. The diagnosis and reduction methods of dislocation of hip joint are described in detail in the literature since the Secret Recipe of Immortal Healing for Wounds and Dipsacs. For example, in the Criterion of Syndrome Treatment, sticking the knee but not sticking the knee is used to distinguish the dislocation before or after dislocation. The reduction technique, as stated in Supplementary Essentials for Traumatology, is very appropriate, that is, "make the patient lie on his side, one person holds him, one person pulls his knee off, one hand presses his epiphysis head in, and the other hand bends his big arm to make his knee close to his abdomen, and then straighten him, and the person whose epiphysis is noisy has gone up". Shi changed slightly according to its purpose. In this method, the patient is instructed to lie prone, and the two assistants hold the axils of the two shoulders and the guo of the knee of the affected side respectively, and pull them relatively. The doctor presses the lumbosacral region with one hand, and pushes the femoral head downward with the other hand until the two heels are even, and the sound of epiphysis can be heard in the arms and hips. Under the traction, the patient was changed from prone to supine, and the doctor shook the affected hip with a little traction to relax the tendons and veins, which could make the femoral head deeper. Shi changed to prone position, which is more convenient to pull and push. Moreover, the doctor presses the lumbosacral region with one hand as the fulcrum and pushes the femoral head with the other hand, which is more effective and can make greater force applied to the affected area. After the supine position is changed and the hip is rotated, the epiphyseal position will be restored and the tendons and veins will be smooth, just as the so-called "returning the turned tendons forward" in the Supplement to Traumatology. In a word, it is powerful and gentle, and both bones and muscles are taken into account, which makes the reduction easy to succeed without any future trouble. Shi used this method to treat the old cases of dislocation for two weeks to one month without restoration, and every time it was effective.
V. Manipulation of restoring anterior dislocation of hip joint
Anterior dislocation of hip joint is rare in clinic, and it is rare in anterior dislocation of hip joint. Most of the anterior dislocation of hip joint is caused by the injury of hip joint in the outer booth. The external force makes the hip joint suddenly abduct excessively, so that the top of the trochanter contacts with the upper edge of the acetabulum to become a fulcrum, so that the femoral head leaves the acetabulum under the leverage, penetrates the anterior lower part of the joint wrap and moves to the pubic bone or obturator, resulting in anterior dislocation of the hip joint.
Shi's method of restoring dislocation of hip joint is to lift the foot on the back. The specific operation method is as follows: the patient lies on his back on the ground, and a mattress sheet is pre-laid on the ground, and an assistant presses it on the anterior superior iliac spine with his second hand to fix the pelvis; The second assistant lifts the affected limb, so that the affected limb bends hip and knees slightly. The ankle of the calf is clamped under the assistant's armpit, and the second hand is placed above and below the knee joint to fix the affected limb and pull it out. The operator put his second hand on that knee of the leg for traction, and stepped one foot on the groin of the affect side, while pulling the affected limb, pedaled the detach femoral head outwards and downwards, and when the femoral head moves to the acetabulum, it flexes the hip joint under traction, and then the femoral head can slide into the acetabulum, so that the reduction is successful. The characteristic of this method is that the patient takes a lower position, and both the surgeon and an assistant take an upright position, which is easy to exert force. Foot stepping on the slipped femoral head can not only prevent the femoral head from slipping out again during hip flexion, but also become the fulcrum of leverage during hip flexion, so that the femoral head can smoothly slide into the acetabulum. In the whole reduction process, the range of motion of hip joint is not large, so it can also avoid new damage to surrounding tissues caused by manual reduction.