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#1
31.03.2010, 22:51
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Операция на передней крестообразной связке
Добрый день. Уважаемые врачи, около месяца назад моя подруга (48 лет), катаясь на лыжах, порвала переднюю крестообразную связку на левой ноге. Была операция по восстановлению (протезированию) связки. Вроде все прошло успешно. Прошло полторы недели после операции. Ходит на двух костылях или на одном но с опорой. Нога особенно не сгибается. Врачи не могут подсказать, что сейчас делать. Что по поводу ЛФК? Как быстро будет идти восстановление? Есть ли какой-то комплекс упражнений?
Ситуация осложняется тем, что 5 лет назад была проведена операция в связи с раком груди+весь комплекс лечения. То есть нельзя делать физиопроцедуры и массажи. То есть по сути остается только гимнастика. Заранее спасибо за ответ. 
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#3
01.04.2010, 22:21
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Травма была месяц назад. Операция полторы недели назад.
Врач, которые наблюдает, говорит только что все хорошо и ходить надо без костылей,и что он с такой травмой на следующий день танцевал на свадьбе друга. Врачи ЛФК говорят что надо подкладывать валик чтобы нога начала сгибаться, и в принципе все. Кто-то говорит, что надо пытаться приподнять ногу и тд. Кто-то говорит, не надо поднимать. То есть в одной больнице врачи говорят разное. В итоге непонятно что делать. Подскажите пожалуйста.
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#4
02.04.2010, 04:11
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реабилитация - это всегда дело индивидуальное и должна проводиться под врачебным контролем. Можете ориентироваться на эту программу:
REHABILITATION PROGRESSION PHASE I: Immediately post-operatively to week 4 Goals: • Protect graft and graft fixation with use of brace and specific exercises • Minimize effects of immobilization • Control inflammation and swelling • Full active and passive extension/hyperextension range of motion. Caution: avoid hyperextension greater than 10o • Educate patient on rehabilitation progression • Flexion to 90o only in order to protect graft fixation • Restore normal gait on level surfaces Brace: • 0-1 week- post-op brace locked in full extension for ambulation and sleeping • 1-3 weeks- unlock brace (<90o) as quad control allows • 3-4 weeks- wean from brace as patient demonstrates good quad control and normal gait mechanics • 4-8 weeks- patient should only use brace in vulnerable situations (e.g. crowds, uneven terrain, etc) Weightbearing Status: • 0-1 week- partial weightbearing with two crutches to assist with balance • 1-4 weeks- partial weightbearing progressing to full weight bearing with normal gait mechanics • Wean from crutches/brace for ambulation by 4 weeks as patient demonstrates normal gait mechanics and good quad control as defined as lack of quadricpes lag Exercises: • Active-assisted leg curls 0-1 week. Progress to active as tolerated after 1 week. Delay strengthening for 12 weeks. • Heel slides (limit to 90o) • Quad sets (consider NMES for poor quad sets) • Gastroc/Soleus stretching • Very gentle hamstring stretching at 1 week • SLR, all planes, with brace in full extension until quadriceps strength is sufficient to prevent extension lag- add weight as tolerated to hip abduction, adduction and extension. • Quadriceps isometrics at 60o and 90o • If available, aquatic therapy (once sutures removed) for normalizing gait, weightbearing strengthening, deep-water aquajogging for ROM and swelling ACL Hamstring Tendon Autograft Reconstruction Protocol PHASE II: Post-operative weeks 4 to 12 Criteria for advancement to Phase II: • Full extension/hyperextension • Good quad set, SLR without extension lag • Flexion to 90o • Minimal swelling/inflammation • Normal gait on level surfaces Goals: • Restore normal gait with stairclimbing • Maintain full extension, progress toward full flexion range of motion • Protect graft and graft fixation • Increase hip, quadriceps, and calf strength • Increase proprioception Brace/Weightbearing Status: • If necessary, continue to wean from crutches and brace. Exercises: • Continue with range of motion/flexibility exercises as appropriate for the patient • Initiate CKC quad strengthening and progress as tolerated (wall sits, step-ups, mini-squats, Leg Press 90o-30o, lunges) • Progressive hip, hamstring, calf strengthening (gradually add resistance to open chain hamstring exercises at week 12) • Continue hamstring, Gastroc/Soleus stretches • Stairmaster (begin with short steps, avoid hyperextension) • Nordic Trac, Elliptical machine for conditioning • Stationary Biking (progressive time and resistance) • Single leg balance/proprioception work (ball toss, balance beam, mini-tramp balance work) • If available, begin running in the pool (waist deep) or on an unweighted treadmill at 10-12 weeks ACL Hamstring Tendon Autograft Reconstruction Protocol Phase III: Post-operative weeks 12 to 18-20 (4 ½-5 months) Criteria to advance to Phase III include: • No patellofemoral pain • Minimum of 120 degrees of flexion • Sufficient strength and proprioception to initiate running (unweighted or in pool) • Minimal swelling/inflammation Goals: • Full range of motion • Improve strength, endurance, and proprioception of the lower extremity to prepare for sport activities • Avoid overstressing the graft. Progressively increase resistance for hamstring strengthening • Protect the patellofemoral joint • Normalize running mechanics • Strength approximately 70% of the uninvolved lower extremity per isokinetic evaluation Exercises: • Continue flexibility and ROM exercises as appropriate for patient • Initiate open kinetic chain leg extension (90o-30o), progress to eccentrics as tolerated • Isokinetics (with anti-shear device)- begin with mid range speeds (120o/sec-240o/sec) • Progress toward full weightbearing running at about 16 weeks • Begin swimming if desired • Recommend isokinetic test with anti-shear device at 14-16 weeks to guide continued strengthening • Progressive hip, quad, hamstring, calf strengthening • Cardiovascular/endurance training via stairmaster, elliptical, bike • Advance proprioceptive activities ACL Hamstring Tendon Autograft Reconstruction Protocol Phase IV: Post-operative months 4 ½ or 5 through 6-7 Criteria for advancement to Phase IV: • No significant swelling/inflammation • Full, pain-free ROM • No evidence of patellofemoral joint irritation • Strength approximately 70% of uninvolved lower extremity per isokinetic evaluation • Sufficient strength and proprioception to initiate agility activities • Normal running gait Goals: • Symmetric performance of basic and sport specific agility drills • Single hop and three hop tests 85% of uninvolved leg • Quadriceps and hamstring strength at least 85% of uninvolved lower extremity per isokinetic strength test Exercises: • Continue and progress flexibility and strengthening program based on individual needs and deficits • Initiate plyometric program as appropriate for patient’s athletic goals • Agility progression including, but not limited to: Side steps Crossovers Figure 8 running Shuttle running One leg and two leg jumping Cutting Acceleration/deceleration/springs Agility ladder drills • Continue progression of running distance based on patient needs • Initiate sport-specific drills as appropriate for patient ACL Hamstring Tendon Autograft Reconstruction Protocol Phase V: Begins at post-operative months 6 or 7 Criteria for advancement to Phase V: • No patellofemoral or soft tissue complaints • Necessary joint ROM, strength, endurance, and proprioception to safely return to work or athletics • Physician clearance to resume partial or full activity Goals: • Safe return to athletics/work • Maintenance of strength, endurance, proprioception • Patient education with regards to any possible limitations Exercises: • Gradual return to sports participation • Maintenance program for strength, endurance Bracing: • Functional brace generally not used, but may be recommended by the physician on an individual basis Formatted: Mike Cowell Reviewers: Reg Wilcox III Copyright © 2007 The Brigham and Women's Hospital, Inc
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#5
04.04.2010, 10:36
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я владею английским, но, к сожалению, разобраться во всех терминах не представляется возможным. Можно хотя бы в общих чертах то же самое, но по-русски?
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Линейный вид
