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1、運(yùn)動(dòng)損傷康復(fù) Peking University Third Hospital Sports injuries Peking University Third Hospital Sports injuries Peking University Third Hospital Sports injuries Peking University Third Hospital Sports injuries在體育過(guò)程中發(fā)生的創(chuàng)傷骨折、關(guān)節(jié)脫位(3%)大量的是肌腱、韌帶、肌肉、關(guān)節(jié)囊和軟骨小的慢性損傷 Peking University Third Hospital Sports injuries病理
2、過(guò)程:組織損傷及出血炎癥反應(yīng)及腫脹肉芽組織機(jī)化瘢痕形成 Peking University Third Hospital Sports injuries治療原則: 分期治療原則: 急性期止痛、止血、防止水腫 穩(wěn)定期促進(jìn)滲出液的吸收 恢復(fù)期肌力、穩(wěn)定性、平衡 Peking University Third Hospital RICE原則 Peking University Third Hospital物理因子治療 Peking University Third Hospital物理因子治療 Peking University Third Hospital Sports injuries治療原則:
3、 區(qū)別對(duì)待原則: 非運(yùn)動(dòng)員:恢復(fù)日常生活和工作能力 運(yùn)動(dòng)員:恢復(fù)運(yùn)動(dòng) Peking University Third Hospital Sports injuries前交叉韌帶損傷重建術(shù)后康復(fù)治療半月板損傷術(shù)后康復(fù)治療肩周炎康復(fù)治療 Peking University Third Hospital ACL損傷解剖損傷機(jī)制手術(shù)及保守治療康復(fù)評(píng)定康復(fù)治療 Peking University Third Hospital Peking University Third Hospital ACL損傷重建術(shù)后康復(fù)前交叉韌帶主要限制脛骨的過(guò)度向前滑動(dòng)同時(shí)限制小腿的過(guò)度旋轉(zhuǎn)運(yùn)動(dòng)與后交叉韌帶一同限制過(guò)度屈曲與
4、后交叉韌帶、兩側(cè)副韌帶、關(guān)節(jié)囊及腘斜韌帶共同管制過(guò)度伸直因此在脛骨過(guò)度前后移位、過(guò)度內(nèi)外旋及膝關(guān)節(jié)過(guò)度屈伸運(yùn)動(dòng)時(shí),在韌帶起止點(diǎn)或韌帶本身會(huì)發(fā)生斷裂 Peking University Third Hospital ACL損傷重建術(shù)后康復(fù) Peking University Third Hospital ACL損傷重建術(shù)后康復(fù) ACL:前內(nèi)束和后外束前內(nèi)束損傷:膝關(guān)節(jié)在90位,外展和外旋時(shí)后外束損傷:膝關(guān)節(jié)在近于伸直位內(nèi)收內(nèi)旋時(shí) Peking University Third Hospital ACL損傷重建術(shù)后康復(fù) Peking University Third Hospital ACL損傷重
5、建術(shù)后康復(fù)保守治療:不完全性損傷手術(shù)治療:完全性損傷、陳舊性損傷 Peking University Third Hospital ACL損傷重建術(shù)后康復(fù)目前常用膝關(guān)節(jié)鏡進(jìn)行鏡下微創(chuàng)自體或異體肌腱進(jìn)行韌帶重建,以恢復(fù)其結(jié)構(gòu)保守療法主要通過(guò)患肢肌力及本體感覺(jué)控制能力的強(qiáng)化訓(xùn)練,增強(qiáng)患肢肌肉對(duì)膝關(guān)節(jié)的穩(wěn)定作用,以達(dá)到代償受傷韌帶功能、穩(wěn)固保護(hù)膝關(guān)節(jié)的目的 Peking University Third Hospital ACL損傷重建術(shù)后康復(fù)測(cè)量膝關(guān)節(jié)的圍度疼痛評(píng)定肌力評(píng)定關(guān)節(jié)協(xié)調(diào)性和平衡功能評(píng)定 Peking University Third Hospital ACL損傷重建術(shù)后康復(fù)肌力訓(xùn)練角度
6、訓(xùn)練負(fù)重訓(xùn)練平衡訓(xùn)練運(yùn)動(dòng)恢復(fù) Peking University Third Hospital手術(shù)后1-2周良姿位的擺放踝泵訓(xùn)練股四頭肌的靜力訓(xùn)練 ROM訓(xùn)練髕骨松動(dòng)術(shù) Peking University Third Hospital Peking University Third Hospital Peking University Third Hospital Peking University Third Hospital Peking University Third Hospital Peking University Third Hospital手術(shù)后3-7周繼續(xù)上述練習(xí)肌力訓(xùn)練
7、ROM訓(xùn)練負(fù)重訓(xùn)練平衡訓(xùn)練 Peking University Third Hospital手術(shù)后7-12周肌力訓(xùn)練:股四頭肌力、腘繩肌、小腿三頭肌力訓(xùn)練漸進(jìn)性抗阻訓(xùn)練神經(jīng)肌肉控制訓(xùn)練、敏捷性訓(xùn)練功能訓(xùn)練水中慢跑、跑步訓(xùn)練 Peking University Third Hospital半月板損傷解剖:半月板位于膝關(guān)節(jié)間的半月形軟骨板,切面呈三角形,邊緣有血供,其他部分的營(yíng)養(yǎng)來(lái)自關(guān)節(jié)的滑液損傷后表現(xiàn):膝關(guān)節(jié)腫脹,關(guān)節(jié)間隙處有壓痛。關(guān)節(jié)經(jīng)常有“絞鎖”使。MC征陽(yáng)性。晚期可以出現(xiàn)股四頭肌萎縮。 Peking University Third Hospital Peking University T
8、hird Hospital Peking University Third Hospital半月板損傷的康復(fù)評(píng)定關(guān)節(jié)圍度股四頭肌力的評(píng)定關(guān)節(jié)活動(dòng)度的評(píng)定關(guān)節(jié)協(xié)調(diào)性和平衡功能的評(píng)定 Peking University Third Hospital半月板損傷修正/切除術(shù)后康復(fù)治療:手術(shù)后當(dāng)日作股四頭和腘繩肌等長(zhǎng)收縮訓(xùn)練和踝泵訓(xùn)練手術(shù)后第一天轉(zhuǎn)移訓(xùn)練和直抬腿訓(xùn)練手術(shù)后第二天開(kāi)始ROM訓(xùn)練、行走訓(xùn)練手術(shù)后第三天開(kāi)始平衡訓(xùn)練手術(shù)后第七天開(kāi)始靜蹲訓(xùn)練物理治療幫助消腫 Peking University Third Hospital肩周炎定義評(píng)定治療康復(fù) Peking University Third Ho
9、spital肩周炎發(fā)生于肩關(guān)節(jié)周圍軟組織的一種無(wú)菌性炎癥以肩關(guān)節(jié)疼痛和活動(dòng)功能障礙為特征的疾病 Peking University Third Hospital病因肩關(guān)節(jié)退行性病變外傷慢性勞損肩部制動(dòng) Peking University Third Hospital病理肩袖和肱二頭肌腱長(zhǎng)頭肌腱結(jié)締組織退行病變肩周軟組織急、慢性無(wú)菌性炎癥局部疼痛、反射性肌肉痙攣局部組織纖維化、關(guān)節(jié)囊攣縮肩關(guān)節(jié)活動(dòng)功能障礙 Peking University Third Hospital診斷癥狀、體征肩關(guān)節(jié)疼痛、肩關(guān)節(jié)活動(dòng)受限、肩關(guān)節(jié)壓痛、肌肉萎縮 Peking University Third Hospital
10、治療藥物治療:消炎鎮(zhèn)痛藥物物理因子治療:紅外線止痛治療、激光治療、低頻和中頻治療 Peking University Third Hospital康復(fù)康復(fù)評(píng)定:全面評(píng)定肩關(guān)節(jié)疼痛、穩(wěn)定性、功能、活動(dòng)度、肌力內(nèi)旋可以用拇指抵達(dá)腰背的水平(hand behind back,HBB)評(píng)定 Peking University Third Hospital康復(fù)治療急性期:制動(dòng)為主,在不引起明顯疼痛的同時(shí)可以適當(dāng)活動(dòng)。(消炎止痛、緩解肌肉痙攣、改善血液循環(huán)、防止關(guān)節(jié)功能障礙) Peking University Third Hospital康復(fù)治療粘連期:運(yùn)動(dòng)療法下垂擺動(dòng)練習(xí)、體操棒練習(xí)、肩梯或爬墻練習(xí)、吊環(huán)練習(xí)、肌力訓(xùn)練 Peking University Third Hospital Peking University Third Hospital Peking University Third Hospital康復(fù)治療緩解期:針對(duì)還存在的功能障礙繼續(xù)治療,使得肩關(guān)節(jié)恢復(fù)正常的功能和力量 Peking University Third Hospital預(yù)防工作要?jiǎng)谝萁Y(jié)合、運(yùn)動(dòng)要適量,避免肩部過(guò)度勞損注意保暖肩關(guān)節(jié)外傷后徹底治療,避免遺留后遺癥避免肩關(guān)節(jié)不活動(dòng) Peking University Third Hospital THANK YOUFOR YOUR ATTENTION