矫形器在肘关节僵直中的应用课件

1、矫形器在肘关节僵直中的应用矫形器在创伤后肘关矫形器在创伤后肘关节功能障碍康复中的节功能障碍康复中的应用应用Capital Medical University China Rehalbilitation Center崔志刚2011矫形器在肘关节僵直中的应用肘关节易于在创伤或手术后发生僵直粘连 高能量的创伤容易造成肘关节活动的丧失，轻微的创伤也能导致肘关节的僵直。 25%的肱骨远端骨折和15%的单纯肘关节脱位导致关节僵直， 而21%的肘关节脱位合并桡骨小头骨折的患者遗留有肘关节僵直。 多方面证据表明肘关节是一个对创伤非常敏感的关节 矫形器在肘关节僵直中的应用 矫形器在肘关节僵直中的应用概 述 肘

2、关节易于在创伤或手术后发生僵直粘连 高能量 轻微创伤 25%的肱骨远端骨折15%的单纯肘关节脱位21%的肘关节脱位合并桡骨小头骨折Part 1矫形器在肘关节僵直中的应用 多方面证据表明肘关节是一个对创伤非常敏感的关节。肘关节僵直后的康复治疗，无论对临床医生、康复治疗师还是患者来说都是一个非常棘手的问题。矫形器在肘关节僵直中的应用治疗方法人工训练麻醉下手法松解手术治疗肘关节僵直切开松解关节镜松解 连续被动活动（continuous postive motion, CPM）矫形器在肘关节僵直中的应用 矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用 stiffness after total

3、knee replacement occurs in about 1% of cases 矫形器在肘关节僵直中的应用 after ACL reconstruction has shown our rate to be less than 1%-35% in major studies 矫形器在肘关节僵直中的应用 It is not easy to determine the incidence of arthrofibrosis triggered by fractureTibial Plateau Femoral Condyle FractureFracture Patella 矫形器在肘关

4、节僵直中的应用矫形器治疗的特点 n 非手术康复治疗往往需要相应的矫形器，而且时间可能长达6个月去维持或增加关节的PROM。n 对于手术的患者来说，手术前矫形器的应用可减少关节外挛缩因素，同时也能评价患者的依从性。n 而对于肘关节僵直手术后患者来说，矫形器的应用往往是必须的。 n ROM required for activities of daily living Part 2 矫形器在肘关节僵直中的应用 normal ROM is usually minus 5 to 143 degrees in women normal ROM is usually minus 6 to 140 degr

5、ees in men. 矫形器在肘关节僵直中的应用You use your knee in normal walking from two degrees of flexion to seventy degrees of flexion矫形器在肘关节僵直中的应用the range of knee motion required for activities of daily living n 93 degrees of knee flexion is required for rising from a seated position n 106 degrees of knee flexion

6、 is required for shoelace tying n 135 degrees of flexion is required to properly take a bath 矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用Knee Anatomy矫形器在肘关节僵直中的应用 矫形器在肘关节僵直中的应用年龄例数年龄矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用bleedingedemaGranulation TissueFibrosisprevetionearly rehalbilitationsu

7、rgery and early rehalbilitation矫形器在肘关节僵直中的应用noted.矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用n 矫形器在肘关节僵直中的应用symtoms and signsThe severity can range from small amounts of scar tissue in certain locations within the knee that may only cause symptoms with certain activities to diffuse scarring that is chro

8、nically painful and completely restricts all motion of the knee.矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用established by Donald Shelbourne. He categorised arthrofibrosis into four types 矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用 nrisks of complication 矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用The goal of treatment The go

9、al of treatment in a stiff knee is restoration of normal motion without inflicting additional damage on the joint or adjacent structures矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用Stretching devices Stretching devices are intended to stretch joints that have reduced range of motion secondary to immobiliz

10、ation, surgery, contracture, fracture, dislocation, or a number of additional non-traumatic disorders.矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用Arthroscopy Arthroscopy is a less invasive surgical technique performed through small incisions that give full access to a joint.矫形器在肘关节僵直中的应用FIGURE 1 -filled

11、up with FIGURE 1 -filled up with tough, fibrous scar tough, fibrous scar tissue (the white, tissue (the white, fluffy/fibrous fluffy/fibrous material)material)FIGURE 2-FIGURE 2-arthroscopic arthroscopic resector has uncovered a resector has uncovered a portion of the smooth, portion of the smooth, w

12、hite femoral condylar white femoral condylar surface, marked with an surface, marked with an F.F. FIGURE 3-FIGURE 3-The normal, internal The normal, internal joint space has been restored joint space has been restored and the medial femoral condyle and the medial femoral condyle has been completely

13、released has been completely released from its enveloping scar tissue from its enveloping scar tissue cocoon. cocoon. 矫形器在肘关节僵直中的应用矫形器在肘关节僵直中的应用 No matter how meticulous and thorough a scar tissue resection may be, and even if a full range of knee motion is successfully restored on the operating roo

14、m table, the biggest challenge is maintainingmaintaining that range of motion after surgery. Rehabilitation After Operative Procedures for Arthrofibrosis 矫形器在肘关节僵直中的应用Patient Physical Therapy Program The extension exercise is done first.The amount of weight to be used is determined before the operation. 15-20-25 pounds of weight is placed over the knee with the foot and ankle supported 矫形器在肘关节僵直中的应用Then, the flexion exercise is done.The patient is placed in a “figure-four” position in bed. A strap or towel is plac