Nzira yakawanda yekudzidzira kudzidziswa kweAchilles tendon rupture, nheyo huru yekudzorera ndeye: kuchengeteka kutanga, kudzorera kurovedza muviri maererano nekuzvibata kwavo pachavo.
Danho rekutanga mushure mekuvhiyiwa
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Kudzivirirwa uye nguva yekuporesa (vhiki 1-6).
Nyaya dzinoda kutariswa: 1. Dzivisa kutambanudza kweAchilles tendon;2. Ibvi rinoshanda rinofanira kuchinjwa pa90 °, uye dorsiflexion yeankle inofanira kugumira kune imwe nzvimbo isina zvematongerwo enyika (0 °);3. Dzivisa kupisa compresses;4. Dzivisa kupera kwenguva refu .
Kufamba kwekutanga kwekubatana uye kuchengetedzwa kwehuremu ndiyo inonyanya kukosha mukati mekutanga postoperative nguva.Nokuti kutakura uremu uye kufamba kwakabatana kunokurudzira kuporesa uye simba reAchilles tendon, uye inogona kudzivirira kuipa kwekusagadzikana (semuenzaniso, kupera kwemhasuru, kuoma kwemajoini, degenerative arthritis, adhesion formation, uye yakadzika cerebral thrombus).
Varwere vakarayirwa kuti vaite zvakawanda zvekushandajointkufamba pazuva, kusanganisira ankle dorsiflexion, plantar flexion, varus, uye valgus.Active ankle dorsiflexion inofanira kugumira ku 0 ° pa 90 ° yekuchinjika kwemabvi.Passive joint motion uye kutambanudza kunofanira kudziviswa kuchengetedza kuporesa Achilles tendon kubva pakuwedzeredza kana kuputika.
Kana murwere atanga chidimbu kusvika kukutakura huremu hwakazara, maekisesaizi ebhasikoro anogona kuunzwa panguva ino.Murwere anofanira kurairwa kushandisa kumashure kwetsoka panzvimbo yetsoka yepamberi paanenge achichovha bhasikoro.Kukwiza vanga uye chiedza chekubatana kufamba kunogona kukurudzira kupora uye kudzivirira kubatana uye kuoma.
Cold therapy uye kukwidziridzwa kwenhengo yakakanganiswa inogona kudzora marwadzo uye edema.Varwere vanofanira kurairwa kuti vasimudze nhengo yakabatwa zvakanyanya sezvinobvira zuva rose uye kudzivisa kubata uremu kwenguva yakareba.Murwere anogonawo kurairwa kushandisa ice pack kakawanda kwemaminitsi makumi maviri nguva imwe neimwe.
Kudzidzira kweproximal hip nemabvi kunofanira kushandisa inofambira mberi yekudzivirira kudzidzisa regimen.Vhura-cheni maekisesaizi uye isotonic michina inogona kushandiswa nevarwere vane uremu hunorambidzwa.
Matanho ekurapa: Paunenge uchishandisa axillary stick kana nzimbe pasi pekutungamirirwa kwachiremba, pfeka zvinofambira mberi uremu hunotakura pasi pebhutsu dzakagadzika negumbo;kushingaira ankle dorsiflexion/plantar flexion/varus/valgus;masaja vanga;kubatana kusunungura;proximal muscle simba zviitwa;kurapa muviri ;kurapa kunotonhora.
Vhiki 0-2: Pfupi-gumbo brace immobilization, ankle munzvimbo isina kwayakarerekera;chikamu chehuremu chinotakura nemadondoro kana chichibvumirwa;aizi + yemunharaunda compression / pulse magnetic therapy;kuchinjika kwebvi uye kuchengetedzwa kwechidzitiro Kushanda plantar flexion, varus, valgus;kuramba quadriceps, gluteal, hip kubira kudzidziswa.
Vhiki 3: Tsigiro yegumbo pfupi-isingafambiswi, ankle munzvimbo isina kwayakarerekera.Progressive partial weight-kutakura kufamba nemadondoro;anoshanda +- akabatsira ankle plantar flexion/rutsoka varus, tsoka valgus kudzidziswa (+- kuenzanisa bhodhi kudzidziswa);Inomhanyisa madiki majoini ekufamba (intertarsal, subtalar, tibiotalar) munzvimbo isina kwayakarerekera;inoramba quadriceps, gluteal, uye hip abduction kudzidziswa.
4 mavhiki: Active ankle dorsiflexion kudzidziswa;kuramba kunoshanda plantar flexion, varus, uye eversion ine rabha elastic tambo;chikamu chinorema-kubereka gait kudzidziswa-isokinetic yakaderera kuramba kudzidziswa (> 30 madhigirii/sec);high sitting low Resistance heel rehabilitation treadmill training.
Vhiki 5: Bvisa chitsitsinho chemakumbo, uye vamwe varwere vanogona kuenda kunodzidzira kunze;makumbo maviri emhuru kusimudzira kudzidziswa;chikamu chinorema-chinotakura gait kudzidziswa-isokinetic mwero kuramba kudzidziswa (20-30 madhigirii/sekondi);pasi-chigaro chitsitsinho kugadzirisa treadmill Kudzidzira;Kudzidzira kudonha (kudzivirirwa panguva yekupora).
Vhiki dze6: Varwere vese vakabvisa mabhureki uye vakaita kudzidzira kufamba padenga rekunze;yakajairika Achilles tendon yekuwedzera kudzidziswa munzvimbo yekugara;kuderera kwekudzivirira (passive) kutenderera kwemasimba masimba ekudzidzira (varus resistance, valgus resistance) mapoka maviri;kudzidziswa kwegumbo rimwe-gumbo (Iyo ine hutano divi --- iro rakakanganisika rinoshanduka zvishoma nezvishoma);kufamba gait kuongorora.
Maitiro ekukurudzira: kurwadziwa uye edema zvinodzorwa;kutakura uremu kunogona kuitwa pasi pekutungamirirwa kwachiremba;ankle dorsiflexion inosvika panzvimbo isina kwayakarerekera;proximal low low extremity tsandanyama simba rinosvika giredhi 5/5.
Danho rechipiri mushure mekuvhiyiwa
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Muchikamu chechipiri, pakanga pane kuchinja kwakajeka muchiyero chekutakura uremu, kuwedzera kweROM yenhengo yakakanganiswa uye kuwedzera kwesimba remhasuru.
Chinangwa chikuru: Kudzoreredza basa rakakwana rekufamba kweyakajairika gait uye kukwira masitepisi.Dzosera ankle dorsiflexion, varus, uye valgus simba kune yakajairika giredhi 5/5.Dzokera kune zvakajairika kufamba.
Matanho ekurapa:
Pasi pedziviriro, inogona kumira kurema-kuremerwa kuzere-kuremerwa tsika yekudzidzira, uye inogona kubvisa madondoro kana pasina kurwadziwa;underwater treadmill system kudzidzira kufamba;mu-shangu chitsitsinho pad inobatsira kudzorera yakajairika gait;kushingaira ankle dorsiflexion/plantar flexion / varus / valgus maekisesaizi;proprioceptive training;isometric / isotonic simba rekudzidzira: ankle inversion / valgus.
Early neuromuscular and joint range of motion exercises kukurudzira kudzorerwa kweproprioception, neuromuscular uye balance.Sezvo simba uye kuenzanisa zvakadzorerwa, maitiro ekudzidzira zvakare anoshanduka kubva kumativi ose ezasi kusvika kune unilateral yakaderera.Scar massage, kurapa kwemuviri, uye diki yekuunganidza majoini inofanira kuenderera sezvinodiwa.
Vhiki 7-8: Murwere anofanira kutanga apfekedza bhanhire pasi pekuchengetedzwa kwezvitsigiro kuti apedze huremu hwakazara hwemuviri wakakanganiswa, uye obva abvisa madondoro uye kupfeka shangu kuti atakure zvakakwana uremu.Chitsitsinho chitsitsinho chinogona kuiswa mushangu panguva yekushandura kubva pamakumbo etsoka kusvika kune shangu.
Kureba kwechitsitsinho chitsitsinho kunofanira kuderera sezvo huwandu hwekufamba kwekubatana hunowedzera.Apo kufamba kwemurwere kunodzokera kune zvakajairika, chitsitsinho chitsitsinho chinogona kugoverwa.
A normal gait chinhu chinodiwa pakufamba pasina kubirwa.Mapombi eAnkle anosanganisira plantar flexion uye dorsi kuwedzera.Dorsiflexion inoreva kuti zvigunwe zvakasungirirwa kumashure zvakasimba sezvinobvira, kureva kuti, tsoka inomanikidzwa kudzokera kunzvimbo yemuganhu;
Panguva ino, nyoro inversion uye inversion isometric mhasuru simba maekisesaizi anogona kutangwa, uye mabhendi erubha anogona kushandiswa kudzidzira mune inotevera nhanho.Vaka simba remhasuru nekudhirowa chimiro chemabhii nechiziso chegumbo pamudziyo we-multi-axis.Kana huwandu hwekufamba hwakakwana hwawanikwa.
Unogona kutanga kudzidzira mhasuru mbiri huru dzeplantar kuchinjika kwemhuru.Plantar flexion resistance exercises nemabvi kuchinjika kusvika ku90 ° anogona kutangwa mavhiki matanhatu mushure mekuvhiyiwa.Plantar flexion resistance exercises nemabvi akawedzerwa anogona kutangwa nevhiki ye8.
Plantar flexion inogonawo kuitwa panguva ino uchishandisa ibvi-yakawedzerwa pedaling mudziyo uye gumbo-kupeta muchina.Panguva ino, iyo yakagadziriswa bhasikoro kurovedza muviri kunofanirwa kuitwa nechemberi, uye chiyero chinofanira kuwedzera zvishoma nezvishoma.Kudzokera kumashure kufamba pane treadmill kunowedzera eccentric plantar flexion control.Varwere ava vanowanzoona kufamba vachidzokera kumashure kwakasununguka nekuti kunoderedza kudiwa kwepriming.Zvinokwanisikawo kusuma mberi nhanho zviitwa.Kureba kwematanho kunogona kuwedzera zvishoma nezvishoma.
Micro-squat ine kuchengetedzwa kwechidzitiro (the Achilles tendon inowedzerwa pasi pechikonzero chekurwadziwa kunoshivirira);mapoka matatu ekudzivirira kwepakati (passive) rotational muscle training (varus resistance, valgus resistance);Zvigunwe zvinosimudza (high resistance soleus training);chigunwe chinosimudza nemabvi chakatwasuka panzvimbo yakagara (high resistance gastrocnemius training).
Tsigira uremu hwemuviri pabharari yekusimbisa yekuzvimiririra gait kudzidziswa;ita kudzidzira kusimudza mhuru + - EMG kukurudzira pakumira;ita gait re-dzidzo pasi pekutsika;ita rehabilitation treadmill training ne forefoot (anenge maminitsi gumi nemashanu);kuenzanisa kudzidziswa ( balance board).
9-12 mavhiki: kumira mhuru triceps kuwedzera kudzidziswa;kumira mhuru kusimudza kudzidzira kupikisa (zvigunwe zvinobata pasi, kana zvichidiwa, kukurudzirwa kwemagetsi emagetsi kunogona kuwedzerwa);forefoot rehabilitation treadmill endurance training (anenge maminitsi makumi matatu);kusimudza tsoka , Kudzika gait kudzidziswa, nhanho imwe neimwe iri 12 inches kure, ine concentric uye eccentric control;kumberi uchikwidza, dzokera shure uchidzika kufamba;trampoline kuenzanisa kudzidziswa.
Post-rehabilitation
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Vhiki 16: Kudzidzira kushanduka (Tai Chi);chirongwa chinomhanya chinotanga;multi-point isometric kudzidziswa.
Mwedzi ye6: Kuenzanisa kwezvikamu zvakaderera;isokinetic exercise test;gait analysis kudzidza;gumbo rimwe mhuru inosimudza kwemasekonzi makumi matatu.
Sichuan CAH
WhatsApp/Wechat: +8615682071283
Email: liuyaoyao@medtechcah.com
Nguva yekutumira: Nov-25-2022
