矯形器在肘關(guān)節(jié)僵直中的應(yīng)用

1、肘關(guān)節(jié)易于在創(chuàng)傷或手術(shù)后發(fā)生僵直粘連 高能量的創(chuàng)傷容易造成肘關(guān)節(jié)活動的喪失，輕微的創(chuàng)傷也能導(dǎo)致肘關(guān)節(jié)的僵直。 25%的肱骨遠(yuǎn)端骨折和15%的單純肘關(guān)節(jié)脫位導(dǎo)致關(guān)節(jié)僵直， 而21%的肘關(guān)節(jié)脫位合并橈骨小頭骨折的患者遺留有肘關(guān)節(jié)僵直。 多方面證據(jù)表明肘關(guān)節(jié)是一個對創(chuàng)傷非常敏感的關(guān)節(jié) 概 述 肘關(guān)節(jié)易于在創(chuàng)傷或手術(shù)后發(fā)生僵直粘連 高能量 輕微創(chuàng)傷 25%的肱骨遠(yuǎn)端骨折 15%的單純肘關(guān)節(jié)脫位 21%的肘關(guān)節(jié)脫位合并橈骨小頭骨折Part 1 多方面證據(jù)表明肘關(guān)節(jié)是一個對創(chuàng)傷非常敏感的關(guān)節(jié)。肘關(guān)節(jié)僵直后的康復(fù)治療，無論對臨床醫(yī)生、康復(fù)治療師還是患者來說都是一個非常棘手的問題。治療方法人工訓(xùn)練麻醉下手法松

2、解手術(shù)治療肘關(guān)節(jié)僵直切開松解關(guān)節(jié)鏡松解 連續(xù)被動活動（continuous postive motion, CPM） stiffness after total knee replacement occurs in about 1% of cases after ACL reconstruction has shown our rate to be less than 1%-35% in major studies It is not easy to determine the incidence of arthrofibrosis triggered by fractureTibial Pl

3、ateau Femoral Condyle Fracture Patella 矯形器治療的特點 n非手術(shù)康復(fù)治療往往需要相應(yīng)的矯形器，而且時間可能長達(dá)6個月去維持或增加關(guān)節(jié)的PROM。n對于手術(shù)的患者來說，手術(shù)前矯形器的應(yīng)用可減少關(guān)節(jié)外攣縮因素，同時也能評價患者的依從性。n而對于肘關(guān)節(jié)僵直手術(shù)后患者來說，矯形器的應(yīng)用往往是必須的。 n ROM required for activities of daily living Part 2 normal ROM is usually minus 5 to 143 degrees in women normal ROM is usually minu

4、s 6 to 140 degrees in men. You use your knee in normal walking from two degrees of flexion to seventy degrees of flexionthe 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 is require

5、d for shoelace tying n 135 degrees of flexion is required to properly take a bath (/ntbcweb/tidtreat.htm)(/ntbcweb/history.htm)Knee Anatomy 年齡例數(shù)年齡bleedingedemaGranulation TissueFibrosisprevetionearly rehalbilitationsurgery and early rehalbilitationa considerable amount of r

6、ough endoplasmic reticulum was noted.n symtoms and signs The 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 chronically painful and completely restricts all motion of the knee.

7、established by Donald Shelbourne. He categorised arthrofibrosis into four types nrisks of complication The goal of treatment The goal of treatment in a stiff knee is restoration of normal motion without inflicting additional damage on the joint or adjacent structuresStretching devices Stretching dev

8、ices are intended to stretch joints that have reduced range of motion secondary to immobilization, surgery, contracture, fracture, dislocation, or a number of additional non-traumatic disorders.Arthroscopy Arthroscopy is a less invasive surgical technique performed through small incisions that give

9、full access to a joint.FIGURE 1 -filled up with tough, fibrous scar tissue (the white, fluffy/fibrous material)FIGURE 2-arthroscopic resector has uncovered a portion of the smooth, white femoral condylar surface, marked with an F. FIGURE 3-The normal, internal joint space has been restored and the m

10、edial femoral condyle has been completely released from its enveloping scar tissue cocoon. 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 room table, the biggest challenge is maintaining that ran

11、ge of motion after surgery. Rehabilitation After Operative Procedures for Arthrofibrosis 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

12、 supported Then, the flexion exercise is done.The patient is placed in a “figure-four” position in bed. A strap or towel is placed, with approximately 15 to 20 pounds of pull allowed on the ankle Case Reportcase1. a 45-year-old male worker,2 years after exteral fixation of femur shaft fracturePE:PRO

13、M 20-40 bleedingedemaGranulation TissueFibrosisprevetionearly rehalbilitationsurgery and early rehalbilitationStretching devices Stretching devices are intended to stretch joints that have reduced range of motion secondary to immobilization, surgery, contracture, fracture, dislocation, or a number of additional non-traumatic disorders.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 w