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外傷「脱臼」編
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外傷「脱臼」編

外傷編もパート2になりました。
一回で終わるかと思ったのですが余計なことを喋りすぎた
意外と要点・症例が多かったですね。

ので、パートⅡはじまるよ~。

 

まず、多く見ることになるであろう
肘内障です。

自分も、過去に3~4人+自分の子供2人みました。
このケガの厄介なとこは、時と場所を選ばないこと、
相手が小さな子供というところですかね。

まあ、ケガはみな時と場所を選びませんが、
小さな子供は基本、我慢とかできませんよね。

なので、休憩時間とか休みの日とか構わず飛び込んできて
泣きわめきます笑

白衣を見てさらにヒートアップします笑

 

うるさいのでさっさと治して帰ってもらいましょう笑

まず、患者さん。
自分の子供だったのでよく観察できたのですが

わかりやすく患側を押さえ、不安そうな顔でじっとしています。
少しでも手を取ろうとしたりするとギャーと泣きます。

長男の場合、嫁さんがわかりやすくぐいっと手を引っ張ったとき、
長女の場合、自分がわかりやすく両手を持ってブランコしたとき、
外れました(ゴメン)

まず、術者が患側側(かんそくがわって言うかな?)の手で
患者さんの肘関節を把持し、母指を橈骨頭に当てます。

患者さん、回内位でいると思いますので逆の手で回外してあげます。
とゆうか腕ずもうするような恰好で握手して、自然に回外します。
自分は、そこで牽引をかけるのですが、教科書的には牽引しないんですってね!

へー。

でもでも!自分はほぼこのタイミングで入りましたよ!?
あとは回内しつつ肘関節を屈曲していき、最大屈曲・最大回内したあたりで
上から前腕長軸方向にキュッと力をかけてやります。

教科書的には最後のキュッで入るんでしょうけど
一連の整復動作のどこかで軽い、ホントに軽いクリック音
のようなものが触知できます。それが整復音ですね。

整復後も大概泣き止みませんが、飴をあげるなりご機嫌を取って
去り際に患側でバイバイできれば治ってるとみて間違いないでしょう。

ここで自分の失敗談を一つ。
飴をあげようと思ったらその子はⅠ型糖尿病の子で、
母親から止められたという。

相手が子供で泣いていても問診はちゃんとしないといけませんね。
ケガをして痛い思いはするわ、飴がもらえると思ったらもらえないわで
辛い思いをさせてしまいました。

 

いかがでしたか?
自分が扱った脱臼はたったの3種類です。
20年仕事してきてたったの3種類です。

もちろん、院の特色として骨折、脱臼がバンバンくる、なんて
ところもあるでしょうが自分が勤めてた治療院は残念ながらそうではないです。

骨折・脱臼を治してこその柔整師!とは思いますが、
コレが現状なんですよね。。。
治すといっても所詮応急処置ですしね。