Cov txheej txheem dav dav ntawm kev cob qhia kev kho mob rau Achilles tendon rupture, lub ntsiab lus tseem ceeb ntawm kev kho dua tshiab yog: kev nyab xeeb ua ntej, kev rov ua kom rov zoo li qub raws li lawv tus kheej proprioception.
Thawj theem tom qab phais
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Lub sijhawm tiv thaiv thiab kho (lub lis piam 1-6).
Cov teeb meem xav tau kev saib xyuas: 1. Tsis txhob txav ntawm cov leeg Achilles;2. Lub hauv caug yuav tsum tau flexed ntawm 90 °, thiab pob taws dorsiflexion yuav tsum tau txwv rau ib qho chaw nruab nrab (0 °);3. Tsis txhob kub compresses;4. Tsis txhob sagging ntev.
Kev sib koom ua ke thaum ntxov thiab kev tiv thaiv qhov hnyav yog cov ntsiab lus tseem ceeb tshaj plaws hauv thawj lub sijhawm postoperative.Vim tias qhov hnyav thiab kev sib koom ua ke txhawb nqa kev kho mob thiab lub zog ntawm Achilles leeg, thiab tuaj yeem tiv thaiv qhov tsis zoo ntawm immobilization (piv txwv li, nqaij ntshiv, sib koom ua ke nruj, degenerative mob caj dab, adhesion tsim, thiab sib sib zog nqus cerebral thrombus).
Cov neeg mob tau qhia kom ua ntau yam nquagsib koomtxav ib hnub, nrog rau pob taws dorsiflexion, plantar flexion, varus, thiab valgus.Active pob taws dorsiflexion yuav tsum tau txwv rau 0 ° ntawm 90 ° ntawm lub hauv caug flexion.Kev sib koom tes sib koom ua ke thiab ncab yuav tsum tau zam los tiv thaiv kev kho mob Achilles leeg los ntawm overstretching lossis rupture.
Thaum tus neeg mob pib ib feem ntawm qhov hnyav tag nrho, kev siv tsheb kauj vab nyob ruaj khov tuaj yeem qhia lub sijhawm no.Tus neeg mob yuav tsum tau qhia kom siv lub nraub qaum ntawm ko taw es tsis txhob siv lub hauv ntej ko taw thaum caij tsheb kauj vab.Massaging lub caws pliav thiab lub teeb sib koom ua ke tuaj yeem txhawb kev kho thiab tiv thaiv kev sib koom ua ke thiab nruj.
Kev kho mob khaub thuas thiab nce siab ntawm cov ceg ceg tuaj yeem tswj qhov mob thiab edema.Cov neeg mob yuav tsum tau qhia kom txhawb nqa cov ceg uas cuam tshuam ntau li ntau tau nyob rau ib hnub thiab kom tsis txhob tuav qhov hnyav rau lub sijhawm ntev.Tus neeg mob kuj yuav raug qhia kom siv cov khoom khov nab kuab ob peb zaug rau 20 feeb txhua zaus.
Kev tawm dag zog ntawm lub duav thiab lub hauv caug yuav tsum siv cov txheej txheem kev qhia ua haujlwm hnyav.Qhib-chain ce thiab cov tshuab isotonic tuaj yeem siv los ntawm cov neeg mob uas txwv qhov hnyav.
Kev ntsuas kev kho mob: Thaum siv axillary stick los yog pas nrig nyob rau hauv kev taw qhia ntawm tus kws kho mob, hnav hnyav hnyav hnyav nyob rau hauv cov khau khiab ruaj khov nrog lub log;nquag pob taws dorsiflexion / plantar flexion / varus / valgus;zaws caws pliav;kev sib koom ua ke;proximal leeg lub zog ce;kev kho lub cev;kev kho mob khaub thuas.
Lub lis piam 0-2: luv-ceg brace immobilization, pob taws hauv qhov chaw nruab nrab;ib nrab luj bearing nrog crutches yog zam;dej khov + hauv zos compression / pulse magnetic kho;lub hauv caug flexion thiab pob taws tiv thaiv Active plantar flexion, varus, valgus;tiv thaiv quadriceps, gluteal, hip abduction kev cob qhia.
3 lub lis piam: Kev txhawb nqa luv-ceg immobilized, pob taws hauv qhov chaw nruab nrab.Progressive ib nrab qhov hnyav-cov kabmob taug kev nrog crutches;nquag +- pab pob qij txha plantar flexion / ko taw varus, kev cob qhia ko taw valgus (+- kev cob qhia sib npaug);Accelerates me pob taws pob qij txha taw (intertarsal, subtalar, tibiotalar) nyob rau hauv nruab nrab txoj hauj lwm;tiv thaiv quadriceps, gluteal, thiab hip abduction kev cob qhia.
4 lub lis piam: Kev cob qhia pob qij txha dorsiflexion;tiv thaiv active plantar flexion, varus, thiab eversion nrog roj hmab elastic qaum;Ib nrab qhov hnyav-cov kabmob gait kev cob qhia-isokinetic tsis tshua muaj kev kawm (> 30 degrees / sec);siab zaum qis Resistance heel rehabilitation treadmill kev cob qhia.
5 lub lis piam: Tshem cov pob taws pob taws, thiab qee cov neeg mob tuaj yeem mus rau kev cob qhia sab nraum zoov;ob txhais ceg calf nce kev cob qhia;ib nrab qhov hnyav-kev coj tus kheej gait kev cob qhia-isokinetic kev cob qhia tsis zoo (20-30 degrees / thib ob);Lub rooj zaum qis pob taws rov ua haujlwm treadmill Kev cob qhia;Kev cob qhia drifting (kev tiv thaiv thaum rov qab los).
6 lub lis piam: Txhua tus neeg mob tshem tawm cov hlua khi thiab ua kev cob qhia taug kev ntawm qhov chaw sab nraum zoov;cov pa Achilles tendon extension kev cob qhia nyob rau hauv zaum;tsis tshua muaj zog (passive) rotational leeg lub zog kev cob qhia (varus resistance, valgus resistance) ob pawg;ib leeg-ceg sib npaug kev cob qhia (Cov kev noj qab haus huv---sab cuam tshuam maj mam hloov);taug kev gait tsom xam.
Cov txheej txheem txhawb nqa: mob thiab edema raug tswj;qhov hnyav tuaj yeem nqa tau raws li kev qhia ntawm tus kws kho mob;pob taws dorsiflexion mus txog qhov chaw nruab nrab;proximal qis extremity nqaij zog mus txog qib 5/5.
Qhov thib ob theem tom qab phais
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Nyob rau theem thib ob, muaj kev hloov pauv pom tseeb hauv qib ntawm qhov hnyav, qhov nce ntawm ROM ntawm cov ceg ntoo cuam tshuam thiab txhim kho cov leeg nqaij.
Lub hom phiaj tseem ceeb: Txhawm rau rov ua kom muaj kev ua haujlwm txaus ntawm cov lus tsa suab rau ib txwm taug kev thiab nce ntaiv.Restore pob taws dorsiflexion, varus, thiab valgus zog rau qib 5/5.Rov qab mus rau qhov qub qub.
Kev ntsuas kev kho mob:
Nyob rau hauv kev tiv thaiv, nws muaj peev xwm tiv taus qhov hnyav-kev coj tus kheej mus rau qhov hnyav-kev coj tus cwj pwm gait, thiab tuaj yeem tshem tawm cov crutches thaum tsis muaj mob;underwater treadmill system xyaum gait;nyob rau hauv khau luj taws ncoo pab kho qhov qub gait;nquag pob taws dorsiflexion / plantar flexion / varus / valgus ce;kev cob qhia proprioceptive;isometric / isotonic zog ce: pob taws inversion / valgus.
Thaum ntxov neuromuscular thiab kev sib koom ua ke ntawm kev tawm dag zog los txhawb kev rov qab los ntawm proprioception, neuromuscular thiab sib npaug.Raws li lub zog thiab qhov sib npaug tau rov qab los, cov qauv kev tawm dag zog kuj hloov los ntawm ob qho tib si sab sab mus rau unilateral qis extremities.Nplaim zaws, kho lub cev, thiab kev sib koom ua ke me me yuav tsum txuas ntxiv raws li xav tau.
7-8 lub lis piam: Tus neeg mob yuav tsum xub hnav ib tug brace nyob rau hauv kev tiv thaiv ntawm crutches kom tiav tag nrho cov hnyav-kev coj tus cwj pwm ntawm cov ceg, thiab ces tshem tawm cov crutches thiab hnav khau kom tag nrho cov luj.Lub pob luj taws tuaj yeem muab tso rau hauv cov khau thaum lub sijhawm hloov ntawm ko taw brace mus rau khau.
Qhov siab ntawm lub luj tshib yuav tsum txo qis raws li qhov ntau ntawm kev txav ntawm qhov sib koom ua ke nce.Thaum tus neeg mob lub gait rov qab mus rau qhov qub, lub pob taws tuaj yeem muab tso rau.
Kev taug kev ib txwm yog qhov yuav tsum tau ua ua ntej rau kev taug kev yam tsis muaj kev abduction.Cov pob qij txha muaj xws li plantar flexion thiab dorsi extension.Dorsiflexion txhais tau hais tias cov ntiv taw yog hooked rov qab nyuaj li qhov ua tau, uas yog, ko taw raug yuam rov qab mus rau txoj haujlwm txwv;
Nyob rau theem no, kev hloov pauv me me thiab kev hloov pauv ntawm isometric leeg lub zog qoj ib ce tuaj yeem pib, thiab cov hlua roj hmab tuaj yeem siv los xyaum hauv theem tom ntej.Ua kom cov leeg muaj zog los ntawm kev kos cov duab ntawm cov ntawv nrog koj pob taws ntawm ntau lub axis.Thaum txaus ntau yam ntawm cov lus tsa suab tau ua tiav.
Koj tuaj yeem pib xyaum ob lub ntsiab nqaij leeg ntawm plantar flexion ntawm calf.Plantar flexion resistance ce nrog lub hauv caug flexion mus rau 90 ° tuaj yeem pib 6 lub lis piam tom qab kev phais.Plantar flexion resistance ce nrog lub hauv caug txuas ntxiv tuaj yeem pib los ntawm lub lim tiam thib 8.
Plantar flexion tseem tuaj yeem xyaum nyob rau theem no siv lub hauv caug-ntev pedaling ntaus ntawv thiab ceg-bending tshuab.Lub sijhawm no, lub tsheb kauj vab ruaj khov yuav tsum tau ua nrog lub forefoot, thiab tus nqi yuav tsum tau maj mam nce.Rov qab taug kev ntawm lub treadmill txhim kho eccentric plantar flexion tswj.Cov neeg mob no feem ntau pom kev taug kev rov qab zoo dua vim nws txo qhov xav tau ntawm priming.Nws tseem ua tau los qhia cov kauj ruam tom ntej.Qhov siab ntawm cov kauj ruam yuav maj mam nce.
Micro-squat nrog pob taws tiv thaiv (lub Achilles leeg yog txuas ntxiv nyob rau hauv qhov chaw ntawm kev mob siab);peb pawg ntawm nruab nrab kuj (passive) rotational leeg nqaij (varus kuj, valgus kuj);ntiv taw nce (siab tiv thaiv soleus kev cob qhia);ntiv taw tsa nrog lub hauv caug ncaj nraim hauv txoj hauj lwm zaum (high resistance gastrocnemius training).
Txhawb nqa lub cev qhov hnyav ntawm qhov sib npaug bar kom ntxiv dag zog rau kev kawm autonomous gait;ua calf nce kev cob qhia +- EMG stimulation hauv txoj hauj lwm sawv;ua gait rov kawm ntawv nyob rau hauv lub treadmill;ua kev kho mob treadmill kev cob qhia nrog lub forefoot (li 15 feeb);kev sib npaug (balance board).
9-12 lub lis piam: sawv calf triceps extension kev cob qhia;sawv calf nce kev kawm tiv thaiv (ko taw kov hauv av, yog tias tsim nyog, hluav taws xob cov leeg stimulation tuaj yeem ntxiv);forefoot rehabilitation treadmill endurance kev cob qhia (kwv yees li 30 feeb);ko taw nqa, Kev cob qhia kev tsaws tsaws, txhua kauj ruam yog 12 ntiv sib nrug, nrog kev tswj hwm thiab eccentric;pem hauv ntej nce toj taug kev, thim rov qab taug kev;trampoline sib npaug kev cob qhia.
Tom qab kev kho mob
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Lub Limtiam 16: Kev cob qhia Flexibility (Tai Chi);kev khiav haujlwm pib;multi-point isometric kev cob qhia.
6 lub hlis: Kev sib piv ntawm qis extremities;kev xeem isokinetic ce;kev tshawb nrhiav gait;ib ceg calf nce rau 30 vib nas this.
Sichuan CAJ
WhatsApp / Wechat: +8615682071283
Email: liuyaoyao@medtechcah.com
Post lub sij hawm: Nov-25-2022
