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肘关节损伤的康复治疗课件

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肘关节 损伤 康复 治疗 课件
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单击此处编辑母版标题样式 单击此处编辑母版副标题样式 1 n肘关节损伤的康复治疗 积水潭医院北京物理医学康 复科 覃鼎文 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节损伤的康复 n肘关节解剖 n肘关节的生理功能 n肘关节的特点 n肘关节损伤的病理改变 n肘关节僵直的类型 n肘关节损伤类 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节解剖 n肘关节是由肱尺关节 肱桡关节 上尺桡关节组 成的复合关节 n关节囊近端 附于肱骨小头 滑车 鹰嘴窝及冠 状窝的上缘 n关节囊远端 附于鹰嘴 冠状突 滑车切迹的周 缘及桡骨环状韧带 n关节囊前后松弛而薄弱 两侧被侧副韧带加强 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节解剖 n尺侧副韧带 起于肱骨内上髁 由两条纤 维带构成 n桡侧副韧带 起自肱骨外上髁延伸至桡骨 环状韧带 靠近韧带的部分呈放射状达尺 骨 n桡骨环状韧带 附着于尺骨桡切迹的两端 环绕桡骨头 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节解剖 n肱尺关节 肱骨滑车与尺 骨半月切迹相关节 尺骨 半月切迹是自鹰嘴尖至冠 状突 该圆弧度为190 与肱骨滑车相吻合 肱尺 关节是肘关节对抗内翻应 力的主要骨性结构 完成 肘关节的屈伸功能 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节解剖 n肱桡关节 肱骨小头与桡 骨头相关节 肱桡关节是 肘关节对抗外翻应力的骨 性结构 参与肘关节的屈 伸功能 桡骨头平均直径 为23mm 平均高度为 12mm 桡骨头外形椭圆 头的中心与桡骨轴线有 15度的外倾 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节解剖 n上尺桡关节 桡骨头与尺骨近端桡侧切迹 相关节 依赖环状韧带将其稳定 主要完 成前臂的旋转功能 其旋转中心位于自桡 骨头中心至尺骨茎突的直线上 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节解剖 n尺侧副韧带与桡侧副韧带 两侧的副韧 带与两侧的关节囊相融合 限制关节内 外侧活动 在保持关节稳定中起重要作 用 外侧韧带复合体具有重要意义 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节稳定的意义 反映了手在三维空间上的活动要求与 人在抓取重物时的稳定要求之间所需 的平衡 肘关节是上肢关节中的负重关节 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 骨性稳定结构 n 肱尺关节特点 鹰嘴 冠状突 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肱桡关节 n特点 在抗外翻中的作用 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 韧带稳定结构 n尺侧副韧带 结构 作用 在保持肘关节稳定 中的地位 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 韧带稳定结构 n桡侧副韧带 结构 作用 在保持肘关节 稳定中的地位 n环状韧带 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 动力性 肌肉 稳定 n屈肘肌 肱肌 主动肌 作用 意义 肱二头肌 协动肌 肱桡肌 协动肌 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 动力性 肌肉 稳定 n伸肘肌 肱三头肌 肘肌 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节生理功能 n生理功能 屈伸及前臂的旋转 n屈伸活动范围在0 140度 n旋转活动范围160 180度 nMorrey 屈伸活动范围30 130度 旋前 后各50度即可满足人们 日常生活 工作的需要 n特点 n三关节包容在一个滑膜内 关节内空间相对狭小 n关节外周韧带结构复杂 韧带与关节囊融合 n肘关节稳定性要求高 关节运动与稳定的平衡显得格外重要 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节损伤及病理改变 n肘关节损伤 关节内骨折和脱位的一组损伤 n关节内骨折 骨折线通过关节面的骨折 n单纯肘关节脱位 n关节内骨折合并脱位 n病理改变 n破坏了关节的解剖结构 n损伤了关节周围软组织 改变了关节活动与稳定的平衡 n关节内及周围损伤出血 造成关节肿胀 疼痛 关节僵直 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节损伤及病理改变 n肘关节僵直分三型 n外源性 包括关节囊 韧带的粘连 挛缩 异位骨化 n内源性 包括关节内粘连 关节解剖形态改变 关节软 骨丢失等 n混合性 兼有外源性和内源性 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节损伤及病理改变 n影响肘关节僵直的因素 n原始损伤的程度 n骨折愈合情况 n制动时间长短 n是否合并感染 n退行性关节炎 n功能锻炼方法是否恰当 n术后早期开始科学 合理的功能锻炼是预防 肘关节僵直的重要途径之一 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肘关节损伤术后康复治疗程序 n依据肘关节损伤术后骨折愈合 软组织修 复的状况 康复治疗划分为三个阶段 n早期 术后0 3周 n中期 术后3 6周 n后期 术后6周以后 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 早期康复 术后0 3周 n目的 n消除肿胀 n缓解疼痛 n保持损伤关节最大活动范围 n预防相邻关节粘连 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 早期康复 术后0 3周 n消除肿胀 n主动 n通过肌肉收缩 促进 静脉血 淋巴液回流 达到消肿目的 n方法 用力握拳 伸指 保持10秒 10个 组 5 6组 日 2天后 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 早期康复 术后0 3周 n被动 n 抬高患肢 n向心性加压按摩 n超短波治疗等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 早期康复 术后0 3周 n防止关节挛缩 维持关节活动度 n 牵伸关节 n缓解疼痛 放松肌肉 改善 关节内的营养环境 n方法 一手固定近端 另一 手牵伸关节的远端 维持 30 40秒 次 牵伸关节 3 4次 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 早期康复 术后0 3周 n关节被动活动 n被动将关节活动至最大范围 n在极限处停留5 8秒 n3 5次 组 2组 日 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 早期康复 术后0 3周 n主 辅助运动 n患者主动做屈伸活动 治疗师可握住患肢腕部 在患者主动伸肘时稍 微给一点助力 使关节 活动至最大活动范围 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 早期康复 术后0 3周 n冰敷 n康复治疗结束后局部冰敷 n方法 化学冰袋将关节包 扎 进行冷敷 n目的 缓解疼痛 减少渗 出 消除肿胀 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 早期康复 术后0 3周 n预防相邻关节畸形 n肩 腕和手指各关节主动全 方位 全范围活动 n方法 10个 组 2组 日 n运动的顺序是从远端到近端 即手 腕 肩 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 早期康复 术后0 3周 n静态肌肉收缩 n减轻废用性肌萎缩 n方法同前 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 中期康复 术后3 6周 n目的 n增加关节的活动范围 n增强肌力 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 中期康复 术后3 6周 n增加关节活动度 n关节松动技术 n西方现代康复治疗技术中的基本技能 n治疗关节疼痛 关节活动受限和关节僵硬 n方法 患者姿势放松 舒适 治疗师用力缓慢持续 一手 固定关节近端 一手松动关节远端 n手法的类型 n长轴牵伸 摆动 滑动手法等 n45秒 次 4 5次 组 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 中期康复 术后3 6周 n关节被动活动 n在行关节松动术后操作 n方法 治疗师一手固定关节近端 一手轻柔 缓慢地被动活动关节远端 n在屈伸的极限保持10秒 5次 组 n目的 n牵拉关节囊 韧带 减轻挛缩 n遵循患者能耐受的原则 防止粗暴 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 中期康复 术后3 6周 关节被动活动 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 中期康复 术后3 6周 主动活动 n 患者坐于桌前 肩前屈90度 将上肢置于桌上 肘后垫枕 双手等肩宽持一木棍 上身直立 n主动屈肘达到极限 保持10秒 主动伸肘达到极限 保持10秒 n一个伸屈为一个动作 10 15个 组 3组 日 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 中期康复 术后3 6周 主辅助 主动 被动关节活动 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 中期康复 术后3 6周 n日常生活活动训练 n 是通过日常生活动作改善或恢复关节功能 提高关节 的灵活性 协调性 n患肢开始免负重所有日常生活活动 n洗漱 用餐 拧毛巾 接听电话等 n维持中枢对效应器官的反射 协调伸屈肌群的转换 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 中期康复 术后3 6周 n增强肌力的训练 徒手抗阻肌力训练 n 治疗师施加给患者的阻力 阻力的方向与运动肢体成 直角 阻力的大小 时间可根据具体情况而变化 n徒手抗阻肌力训练因其阻力是治疗师施加的 阻力的大 小可随时调整 变化 所以在骨折愈合尚不坚固阶段是 训练肌力方便 安全 有效的一种方法 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 中期康复 术后3 6周 抗阻屈伸肘关节 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 中期康复 术后3 6周 n抗阻训练 n 应用器械进行抗阻训练 n等长肌力训练 n等张肌力训练 n应用等长肌力训练更安全 n应用等张肌力训练提倡低负荷 多重复的训练原则 n方法有拉橡皮筋 墙壁拉力器等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 后期康复 术后6周后 n目标 n增加活动度接近正常 n增强肌力 n恢复关节功能 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 后期康复 术后6周后 n增加关节活动范围 n蜡疗 n关节周围软组织软化 肌肉放松 为 锻炼创造条件 n治疗前用蜡块 50 敷于患部 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 后期康复 术后6周后 nX光片示骨折已基本愈合 n关节牵拉 n方法 治疗师一手固定肱骨近端 另一手握住前臂 被动伸肘至最大范围 维持30 40秒 n放松肘关节周围肌肉 n关节松动术 n关节主动活动 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 后期康复 术后6周后 n关节僵直 n支具治疗 应用小负荷 持续牵 伸的方法 改善关节的功能 n动力性支具 n静态支具 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 后期康复 术后6周后 伸肘支具 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 后期康复 术后6周后 n增强肌力 n抗阻肌力训练 n借助各种设备及器械 n等张肌力训练 n等速肌力训练 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 后期康复 术后6周后 等张肌力训练 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 总 结 n肘关节的屈伸改变了手与躯干间的距离 有利于发挥手部的功能 肘关节功能障碍 严重影响人们的日常生活 n在功能锻炼中应把屈肘功能的恢复放在首 要位置 在确保屈肘的前提下兼顾伸肘 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 总 结 n在不影响骨折愈合的前提下 越早进行功能锻炼 对肘关节功能恢复的效果越好 n视肘关节损伤情况 减少肘关节固定时间是避免 关节僵直的关键之一 n提倡患者积极主动练习 避免对肘关节进行强力 的按摩 被动活动及牵伸 这是防止肘关节僵直 的有效方法 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 总 结 n面对缓慢改善的肘关节功能 有些家属甚至有些 治疗师不能抗拒使用大力被动牵伸的诱惑力 这 些引起明显疼痛的粗暴的动作会造成附加损伤 必须注意避免 n总之 减少关节制动时间 早期开始功能锻炼 科学的锻炼方法是功能获得恢复的基础 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial
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