Njira yayikulu yophunzitsira kukonzanso kwa kuphulika kwa tendon ya Achilles, cholinga chachikulu cha kukonzanso ndi: chitetezo choyamba, kukonzanso thupi molingana ndi momwe iwo amafunira.
Gawo loyamba pambuyo opaleshoni
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Chitetezo ndi machiritso nthawi (masabata 1-6).
Mfundo zofunika kuziganizira: 1. Pewani kutambasuka kwa tendon ya Achilles;2. Bondo logwira ntchito liyenera kugwedezeka pa 90 °, ndipo dorsiflexion ya ankle iyenera kukhala yopanda ndale (0 °);3. Pewani compresses otentha;4. Pewani kugwa kwa nthawi yaitali .
Kuyenda kolumikizana koyambirira komanso kutetezedwa kolemera ndizofunika kwambiri munthawi yoyamba ya postoperative.Chifukwa kulemera ndi kuyenda pamodzi kumalimbikitsa machiritso ndi mphamvu za tendon Achilles, ndipo zingalepheretse zotsatira zoipa za immobilization (mwachitsanzo, kuwonongeka kwa minofu, kuuma kwamagulu, nyamakazi yowonongeka, kupanga adhesion, ndi deep cerebral thrombus).
Odwala analangizidwa kuchita angapo yogwirapamodzimayendedwe tsiku lililonse, kuphatikiza dorsiflexion ankle, plantar flexion, varus, ndi valgus.Kupindika kwa akakolo kuyenera kukhala 0 ° pa 90 ° pakupindika kwa bondo.Kusuntha kwapang'onopang'ono ndi kutambasula kuyenera kupewedwa kuti muteteze machiritso Achilles tendon kuti asatambasulidwe kapena kupasuka.
Wodwalayo akayamba kunyamula pang'onopang'ono mpaka kulemera kwathunthu, masewera olimbitsa thupi a njinga amatha kuyambitsidwa panthawiyi.Wodwalayo ayenera kulangizidwa kuti agwiritse ntchito kumbuyo kwa phazi m'malo mwa phazi lakutsogolo pamene akuyendetsa njinga.Kusisita chilonda ndi kuyenda molumikizana pang'onopang'ono kumatha kulimbikitsa machiritso ndikuletsa kulumikizana ndi kuuma.
Thandizo lozizira komanso kukwera kwa nthambi yomwe yakhudzidwayo imatha kuthetsa ululu ndi edema.Odwala ayenera kulangizidwa kuti akweze mwendo womwe wakhudzidwa momwe angathere tsiku lonse ndikupewa kusunga kulemera kwa nthawi yaitali.Wodwala angalangizidwenso kuti azipaka ayezi kangapo kwa mphindi 20 nthawi iliyonse.
Zochita zolimbitsa thupi za proximal hip ndi bondo ziyenera kugwiritsa ntchito njira yophunzitsira yolimbikitsira.Zochita zotsegula ndi makina a isotonic angagwiritsidwe ntchito ndi odwala omwe ali ndi zolemetsa zochepa.
Njira zochizira: Mukamagwiritsa ntchito ndodo kapena ndodo motsogozedwa ndi dokotala, valani zolemetsa zokulirapo pansi pa nsapato zokhazikika ndi gudumu;ankle yogwira dorsiflexion/plantar flexion/varus/valgus;kutikita chilonda;kuphatikiza kumasuka;proximal minofu mphamvu zolimbitsa thupi;chithandizo chamankhwala ;ozizira mankhwala.
Masabata 0-2: Kusasunthika kwa mwendo waufupi, bondo m'malo osalowerera ndale;Kulemera pang'ono ndi ndodo ngati kuloledwa;ayezi + kuponderezana kwanuko / kugunda kwa maginito;kupindika kwa bondo ndi chitetezo cha akakolo Kupindika kogwira ntchito kwa plantar, varus, valgus;kukaniza quadriceps, gluteal, maphunziro olanda m'chiuno.
Masabata a 3: Thandizo la mwendo waufupi wosasunthika, bondo losalowerera ndale.Kuyenda mopitirira malire kolemetsa ndi ndodo;yogwira +- anathandizira ankle plantar flexion/foot varus, foot valgus training (+- balance board training);Imathandizira kaphatikizidwe kakang'ono ka akakolo (intertarsal, subtalar, tibiotalar) osalowerera ndale;amakana maphunziro a quadriceps, gluteal, ndi chiuno.
Masabata a 4: Kuphunzitsidwa kwa ankle dorsiflexion;kukana yogwira plantar flexion, varus, ndi eversion ndi mphira zotanuka zingwe;maphunziro olemetsa pang'ono-isokinetic low resistance training (>30 degrees/sec);high atakhala otsika Kukana chidendene kukonzanso treadmill maphunziro.
Masabata a 5: Chotsani chingwe cha m'chiuno, ndipo odwala ena akhoza kupita ku maphunziro akunja;ng'ombe iwiri yokweza maphunziro;maphunziro olemetsa pang'ono-isokinetic zolimbitsa kukana maphunziro (20-30 madigiri / sekondi);pansi-mpando chidendene kukonzanso treadmill Maphunziro;Maphunziro oyendetsa galimoto (chitetezo panthawi yochira).
Masabata a 6: Odwala onse adachotsa zingwe ndikuchita maphunziro oyenda pamtunda wakunja;maphunziro ochiritsira a Achilles tendon pakukhala;kukana kutsika (kungokhala) kulimbitsa mphamvu kwa minofu yozungulira (varus resistance, valgus resistance) magulu awiri;Kuphunzitsidwa kwa mwendo umodzi (mbali yathanzi --- mbali yomwe yakhudzidwa imasintha pang'onopang'ono);kusanthula kuyenda kwakuyenda.
Njira zotsatsira: ululu ndi edema zimayendetsedwa;kulemera kungathe kuchitidwa motsogoleredwa ndi dokotala;ankle dorsiflexion imafika pamalo osalowerera ndale;Kulimba kwa minofu yapakatikati kumafika giredi 5/5.
Gawo lachiwiri pambuyo pa opaleshoni
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Mu gawo lachiwiri, panali kusintha koonekeratu pakukula kwa kulemera, kuwonjezeka kwa ROM ya mwendo wokhudzidwa ndi kuwonjezereka kwa mphamvu ya minofu.
Cholinga chachikulu: Kubwezeretsa magwiridwe antchito okwanira kuti muyende bwino komanso kukwera masitepe.Bwezeretsani dorsiflexion ya akakolo, varus, ndi mphamvu ya valgus ku giredi 5/5.Bwererani kumayendedwe abwinobwino.
Njira zochizira:
Pansi pa chitetezo, imatha kupirira kulemera mpaka kufika pakuchita masewera olimbitsa thupi, ndipo imatha kuvula ndodo pamene palibe ululu;pansi pa madzi treadmill dongosolo mchitidwe kuyenda;mu-nsapato chidendene chidendene chimathandizira kubwezeretsa kuyenda bwino;yogwira akakolo dorsiflexion/plantar flexion / varus / valgus masewera;maphunziro oyenerera;masewera olimbitsa thupi a isometric / isotonic: ankle inversion / valgus.
Zochita zoyambira za neuromuscular komanso zolumikizana zolumikizana kuti zilimbikitse kubwezeretsedwa kwa proprioception, neuromuscular ndi balance.Pamene mphamvu ndi kulinganiza zimabwezeretsedwa, machitidwe ochita masewera olimbitsa thupi amasinthanso kuchokera kumagulu onse apansi kupita ku unilateral m'munsi.Kutikita minofu ya zipsera, chithandizo cholimbitsa thupi, komanso kulimbikitsana pang'ono kophatikizana kuyenera kupitilirabe ngati pakufunika.
Masabata a 7-8: Wodwalayo ayenera kuvala kaye kansalu pansi pa chitetezo cha ndodo kuti amalize kulemera kwathunthu kwa mwendo wokhudzidwa, ndiyeno kuchotsa ndodo ndi kuvala nsapato kuti athe kunyamula kulemera kwake.Chophimba chidendene chikhoza kuikidwa mu nsapato panthawi ya kusintha kuchokera ku phazi kupita ku nsapato.
Kutalika kwa chidendene cha chidendene kuyenera kuchepa pamene kusuntha kwa mgwirizano kumawonjezeka.Pamene kuyenda kwa wodwala kumabwerera mwakale, chidendene cha chidendene chikhoza kuperekedwa.
Kuyenda bwino ndikofunikira kuti muyende popanda kubedwa.Mapampu a ankle amaphatikiza kupindika kwa plantar ndi kukulitsa kwa dorsi.Dorsiflexion imatanthawuza kuti zala zala zimakokedwa mmbuyo molimbika momwe zingathere, ndiko kuti, phazi limakakamizika kubwerera kumalo omalirira;
Panthawiyi, kusinthika pang'ono ndi kusinthika kwa mphamvu za minofu ya isometric kumatha kuyambika, ndipo magulu a mphira angagwiritsidwe ntchito poyeserera pambuyo pake.Pangani mphamvu ya minofu pojambula mawonekedwe a zilembo ndi bondo pa chipangizo chokhala ndi ma axis ambiri.Pamene kusuntha kokwanira kwakwaniritsidwa.
Mutha kuyamba kuyeserera minofu ikuluikulu iwiri yakukula kwa mbewu ya ng'ombe.Zochita zolimbitsa thupi za Plantar flexion ndi mawondo mpaka 90 ° zitha kuyambika masabata 6 pambuyo pa opaleshoni.Zochita zolimbitsa thupi za Plantar ndi bondo lotambasulidwa zitha kuyambika ndi sabata la 8.
Kupindika kwa Plantar kungathenso kuchitidwa panthawiyi pogwiritsa ntchito chipangizo chowongolera mawondo ndi makina opinda mwendo.Panthawiyi, masewera olimbitsa thupi a njinga ayenera kuchitidwa ndi phazi lakutsogolo, ndipo kuchuluka kwake kuyenera kuwonjezeka pang'onopang'ono.Kuyenda chammbuyo pa treadmill kumawonjezera eccentric plantar flexion control.Odwalawa nthawi zambiri amapeza kuyenda chammbuyo momasuka chifukwa kumachepetsa kufunika koyambira.Ndizothekanso kuyambitsa zolimbitsa thupi zamtsogolo.Kutalika kwa masitepe kumatha kuwonjezeka pang'onopang'ono.
Micro-squat yokhala ndi chitetezo cha akakolo (tendon ya Achilles imakulitsidwa chifukwa cha ululu wolekerera);magulu atatu a kukana kwapang'onopang'ono (passive) kuphunzitsidwa kwa minofu yozungulira (varus resistance, valgus resistance);Kukweza kwa zala zala (kuthamanga kwambiri kwa soleus);chala chikukweza ndi mawondo molunjika pamalo okhala (high resistance gastrocnemius training).
Thandizani kulemera kwa thupi pa bala yoyenera kulimbitsa maphunziro odziyimira pawokha;phunzitsani kukweza ng'ombe + - kukondoweza kwa EMG poyimirira;kuchita gait re-maphunziro pansi pa treadmill;phunzitsani zowongolera zowongolera ndi phazi lakutsogolo (pafupifupi mphindi 15);maphunziro a balance board (balance board).
Masabata a 9-12: maphunziro owonjezera a ng'ombe ya triceps;kuyimirira ng'ombe kukweza kukana maphunziro (zala kukhudza pansi, ngati n'koyenera, magetsi kukondoweza minofu kukondoweza);maphunziro olimbikira kupirira kwa forefoot (pafupifupi mphindi 30);kukweza phazi , Maphunziro okwera pamakwerero, sitepe iliyonse imakhala yotalikirana ndi mainchesi 12, ndikuwongolera kokhazikika komanso kozungulira;kupita patsogolo kukwera, kuyenda mobwerera kumtunda;maphunziro a trampoline balance.
Pambuyo pokonzanso
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Sabata 16: Maphunziro osinthasintha (Tai Chi);pulogalamu imayamba;maphunziro a isometric ambiri.
Miyezi ya 6: Kuyerekeza kwa malekezero apansi;mayeso a isokinetic;kuphunzira gait kusanthula;ng'ombe wa mwendo umodzi amakwezera kwa masekondi 30.
Sichuan CAH
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Email: liuyaoyao@medtechcah.com
Nthawi yotumiza: Nov-25-2022
