Cov txheej txheem dav dav ntawm kev cob qhia kho kom rov zoo rau Achilles tendon tawg, lub hauv paus tseem ceeb ntawm kev kho kom rov zoo yog: kev nyab xeeb ua ntej, kev tawm dag zog kho kom rov zoo raws li lawv tus kheej proprioception.
Theem thawj zaug tom qab phais
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Lub sijhawm tiv thaiv thiab kho (lub lim tiam 1-6).
Tej yam uas yuav tsum tau saib xyuas: 1. Tsis txhob ncab cov leeg Achilles uas tsis ua haujlwm; 2. Lub hauv caug uas nquag ua haujlwm yuav tsum tau khoov ntawm 90 °, thiab qhov dorsiflexion ntawm pob luj taws yuav tsum raug txwv rau qhov chaw nruab nrab (0 °); 3. Tsis txhob siv cov ntaub qhwv kub; 4. Tsis txhob sagging ntev.
Kev txav mus los thaum ntxov ntawm cov pob qij txha thiab kev tiv thaiv kev hnyav yog cov ntsiab lus tseem ceeb tshaj plaws hauv thawj lub sijhawm tom qab phais. Vim tias kev nqa hnyav thiab kev txav mus los ntawm cov pob qij txha txhawb kev kho mob thiab lub zog ntawm Achilles tendon, thiab tuaj yeem tiv thaiv cov teebmeem tsis zoo ntawm kev tsis txav mus los (piv txwv li, cov leeg nqaij poob, cov pob qij txha tawv, mob caj dab, kev sib txuas, thiab cov ntshav txhaws tob hauv lub hlwb).
Cov neeg mob tau raug qhia kom ua ntau yam haujlwm tseem ceebpob qij txhakev txav mus los ib hnub, suav nrog pob luj taws dorsiflexion, plantar flexion, varus, thiab valgus. Kev txav mus los ntawm pob luj taws nquag yuav tsum txwv rau 0 ° ntawm 90 ° ntawm lub hauv caug flexion. Kev txav mus los ntawm cov pob qij txha thiab kev ncab yuav tsum zam kom tiv thaiv cov leeg Achilles uas kho kom zoo los ntawm kev ncab ntau dhau lossis tawg.
Thaum tus neeg mob pib nqa ib feem mus rau tag nrho cov hnyav, kev tawm dag zog caij tsheb kauj vab tuaj yeem pib ua thaum lub sijhawm no. Tus neeg mob yuav tsum tau qhia kom siv sab nraub qaum ntawm ko taw es tsis txhob siv sab pem hauv ntej thaum caij tsheb kauj vab. Kev zaws qhov caws pliav thiab kev txav me ntsis ntawm cov pob qij txha tuaj yeem pab txhawb kev kho thiab tiv thaiv kev sib txuas thiab kev tawv ntawm cov pob qij txha.
Kev kho mob txias thiab tsa ceg uas raug mob kom siab tuaj yeem tswj tau qhov mob thiab o. Cov neeg mob yuav tsum tau qhia kom tsa ceg uas raug mob kom siab ntau li ntau tau thoob plaws hnub thiab kom tsis txhob tuav qhov hnyav ntev. Tus neeg mob kuj tseem yuav tau qhia kom muab cov dej khov rau ob peb zaug rau 20 feeb txhua zaus.
Cov kev tawm dag zog ntawm lub duav thiab lub hauv caug yuav tsum siv kev cob qhia uas siv zog ntau zuj zus. Cov kev tawm dag zog qhib thiab cov tshuab isotonic siv tau rau cov neeg mob uas muaj qhov hnyav tsawg.
Kev ntsuas kev kho mob: Thaum siv tus pas nrig lossis tus pas nrig ntawm tus kws kho mob, hnav cov khoom hnyav uas hnyav zuj zus hauv qab khau ruaj khov uas muaj lub log; ua kom lub pob luj taws dorsiflexion/plantar flexion/varus/valgus; zaws qhov txhab; xoob pob qij txha; kev tawm dag zog rau cov leeg nqaij proximal; kev kho lub cev; kev kho mob txias.
Lub Lim Tiam 0-2: Kev khi ceg luv luv kom tsis txhob txav tau, pob luj taws nyob hauv qhov chaw nruab nrab; kev tuav ib feem ntawm qhov hnyav nrog cov pas nrig yog tias ua tau; dej khov + kev kho mob hauv zos / kev sib nqus magnetic; kev khoov lub hauv caug thiab kev tiv thaiv pob luj taws Kev ua haujlwm nquag ntawm plantar flexion, varus, valgus; kev cob qhia tiv thaiv quadriceps, gluteal, kev rub lub duav.
3 lub lis piam: Kev txhawb nqa ceg luv luv tsis txav tau, pob luj taws nyob hauv qhov chaw nruab nrab. Kev taug kev ib nrab hnyav nrog cov pas nrig; kev cob qhia +- pab txhawb pob luj taws plantar flexion/ko taw varus, ko taw valgus (+- kev cob qhia balance board); Ua kom cov pob qij txha me me ntawm pob luj taws txav tau sai (intertarsal, subtalar, tibiotalar) sai dua hauv qhov chaw nruab nrab; tiv taus kev cob qhia quadriceps, gluteal, thiab lub duav abduction.
4 lub lis piam: Kev cob qhia ua kom lub pob taws nkhaus; kev ua kom lub plantar khoov, varus, thiab eversion nrog cov hlua roj hmab elastic; kev cob qhia taug kev ib nrab uas tuav tau qhov hnyav-kev cob qhia isokinetic qis (>30 degrees/sec); kev cob qhia kho pob taws siab zaum qis Kev cob qhia treadmill.
5 lub lis piam: Tshem tawm cov khoom siv pob luj taws, thiab qee tus neeg mob tuaj yeem mus kawm sab nraum zoov; kev cob qhia tsa ob txhais ceg; kev cob qhia taug kev ib nrab-kev cob qhia isokinetic nruab nrab (20-30 degrees / vib nas this); kev cob qhia kho pob luj taws qis; kev cob qhia drifting (kev tiv thaiv thaum lub sijhawm rov zoo).
6 lub lis piam: Txhua tus neeg mob tau tshem cov hlau nplaum thiab ua kev cob qhia taug kev ntawm qhov chaw tiaj tus sab nraum zoov; kev cob qhia txuas ntxiv Achilles tendon ib txwm muaj nyob rau hauv txoj hauj lwm zaum; kev cob qhia lub zog ntawm cov leeg nqaij uas tsis muaj zog (passive) kev cob qhia lub zog ntawm cov leeg nqaij tig (varus resistance, valgus resistance) ob pawg; kev cob qhia ib ceg sib npaug (Sab noj qab haus huv --- sab cuam tshuam maj mam hloov pauv); kev tshuaj xyuas kev taug kev.
Cov qauv kev nce qib: qhov mob thiab o tuaj yeem tswj tau; kev nqa qhov hnyav tuaj yeem ua tau raws li kev taw qhia ntawm tus kws kho mob; qhov khoov ntawm pob luj taws mus txog qhov chaw nruab nrab; lub zog ntawm cov leeg nqaij ntawm sab qis tshaj plaws ncav cuag qib 5/5.
Theem ob tom qab phais
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Nyob rau theem ob, muaj kev hloov pauv pom tseeb hauv qib kev nqa qhov hnyav, qhov nce ntawm ROM ntawm ceg cuam tshuam thiab kev txhim kho ntawm cov leeg nqaij.
Lub hom phiaj tseem ceeb: Txhawm rau kom rov qab muaj peev xwm txav tau zoo txaus rau kev taug kev thiab nce ntaiv ib txwm muaj. Rov qab kho lub zog ntawm pob luj taws dorsiflexion, varus, thiab valgus mus rau qib ib txwm muaj 5/5. Rov qab mus rau kev taug kev ib txwm muaj.
Kev ntsuas kev kho mob:
Nyob rau hauv kev tiv thaiv, nws tuaj yeem tiv taus qhov hnyav mus rau qhov hnyav tag nrho kev xyaum taug kev, thiab tuaj yeem tshem cov pas nrig thaum tsis muaj mob; kev xyaum taug kev hauv qab dej treadmill; lub ncoo pob taws hauv khau pab rov qab taug kev li qub; kev tawm dag zog ntawm pob luj taws dorsiflexion/plantar flexion / varus / valgus; kev cob qhia proprioceptive; kev tawm dag zog isometric / isotonic: pob luj taws inversion / valgus.
Kev tawm dag zog thaum ntxov rau cov leeg nqaij thiab cov pob qij txha kom txhawb kev rov qab los ntawm proprioception, neuromuscular thiab kev sib npaug. Thaum lub zog thiab kev sib npaug rov qab los, tus qauv kev tawm dag zog kuj hloov pauv ntawm ob sab ceg qis mus rau sab ceg ib sab. Kev zaws qhov caws pliav, kev kho lub cev, thiab kev txav pob qij txha me me yuav tsum txuas ntxiv mus raws li qhov xav tau.
7-8 lub lis piam: Tus neeg mob yuav tsum xub hnav ib lub brace nrog rau kev tiv thaiv ntawm crutches kom ua tiav qhov hnyav ntawm ceg uas raug mob, thiab tom qab ntawd tshem tawm cov crutches thiab hnav khau kom ua tiav qhov hnyav. Ib lub pob taws tuaj yeem muab tso rau hauv khau thaum lub sijhawm hloov ntawm lub brace mus rau khau.
Qhov siab ntawm lub pob luj taws yuav tsum txo qis thaum qhov kev txav ntawm cov pob qij txha nce ntxiv. Thaum tus neeg mob txoj kev taug kev rov qab mus rau qhov qub, ces siv lub pob luj taws tau.
Kev taug kev ib txwm yog qhov yuav tsum tau ua ua ntej rau kev taug kev yam tsis muaj kev rub tawm. Cov twj tso kua mis ntawm pob luj taws suav nrog kev khoov ntawm plantar thiab kev ncab ntawm dorsi. Dorsiflexion txhais tau tias cov ntiv taw raug txuas rov qab kom nruj li nruj tau, uas yog, ko taw raug yuam rov qab mus rau qhov chaw txwv;
Nyob rau theem no, kev tawm dag zog me me ntawm kev tig rov qab thiab kev tig rov qab isometric ntawm cov leeg nqaij tuaj yeem pib ua tau, thiab cov hlua roj hmab tuaj yeem siv los xyaum rau theem tom qab. Tsim kom muaj zog ntawm cov leeg nqaij los ntawm kev kos duab ntawm cov ntawv nrog koj pob luj taws ntawm lub cuab yeej ntau-axis. Thaum muaj kev txav mus los txaus.
Koj tuaj yeem pib xyaum ob lub leeg tseem ceeb ntawm kev khoov ntawm lub plab hlaub. Kev tawm dag zog tiv thaiv kev khoov ntawm lub plab hlaub nrog kev khoov lub hauv caug mus rau 90 ° tuaj yeem pib 6 lub lis piam tom qab phais. Kev tawm dag zog tiv thaiv kev khoov ntawm lub plab hlaub nrog kev ncab lub hauv caug tuaj yeem pib los ntawm lub lim tiam thib 8.
Kev khoov ko taw kuj tseem tuaj yeem xyaum tau rau theem no siv lub cuab yeej pedal uas ntev rau hauv caug thiab lub tshuab khoov ceg. Lub sijhawm no, kev tawm dag zog caij tsheb kauj vab yuav tsum tau ua nrog ko taw pem hauv ntej, thiab qhov ntau yuav tsum maj mam nce ntxiv. Kev taug kev rov qab ntawm lub treadmill ua rau kev tswj hwm kev khoov ko taw eccentric txhim kho. Cov neeg mob no feem ntau pom tias kev taug kev rov qab xis dua vim nws txo qhov xav tau kev npaj. Nws kuj tseem ua tau los qhia cov kauj ruam pem hauv ntej. Qhov siab ntawm cov kauj ruam tuaj yeem maj mam nce ntxiv.
Ua ib qho kev tawm dag zog me me (micro-squat) nrog kev tiv thaiv pob luj taws (cov leeg Achilles raug nthuav tawm raws li qhov mob uas kam tau); peb pawg ntawm kev tawm dag zog nruab nrab (passive) kev cob qhia cov leeg nqaij tig (varus tsis kam, valgus tsis kam); Ntiv taw tsa (kev cob qhia soleus tsis kam siab); ntiv taw tsa nrog lub hauv caug ncaj nraim hauv qhov chaw zaum (kev cob qhia gastrocnemius tsis kam siab).
Txhawb qhov hnyav ntawm lub cev rau ntawm lub bar sib npaug kom txhawb nqa kev cob qhia kev taug kev ywj pheej; ua kev cob qhia tsa nyuj +- EMG thaum sawv ntsug; ua kev qhia rov qab kev taug kev hauv qab lub treadmill; ua kev cob qhia kho dua tshiab nrog lub forefoot (kwv yees li 15 feeb); kev cob qhia kev sib npaug (balance board).
9-12 lub lis piam: sawv ntsug calf triceps extension kev cob qhia; sawv ntsug calf tsa resistance kev cob qhia (ntiv taw kov hauv av, yog tias tsim nyog, hluav taws xob stimulation yuav ntxiv); forefoot rehabilitation treadmill endurance kev cob qhia (kwv yees li 30 feeb); nqa ko taw, tsaws gait kev cob qhia, txhua kauj ruam yog 12 ntiv tes sib nrug, nrog concentric thiab eccentric tswj; mus tom ntej nce toj, rov qab downhill kev cob qhia; trampoline kev cob qhia sib npaug.
Kev kho dua tshiab tom qab
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Lim Tiam 16: Kev cob qhia kom yoog tau yooj yim (Tai Chi); kev khiav pib; kev cob qhia isometric ntau lub ntsiab lus.
6 lub hlis: Kev sib piv ntawm cov ceg qis; kev sim kev tawm dag zog isokinetic; kev tshawb fawb txog kev taug kev; tsa ib ceg nyuj rau 30 vib nas this.
Sichuan CAH
WhatsApp / Wechat: +8615682071283
Email: liuyaoyao@medtechcah.com
Lub sijhawm tshaj tawm: Kaum Ib Hlis-25-2022
