随着老龄化加剧,老年骨质疏松性骨折发生率也逐步升高,给社会、家庭带来巨大挑战,西安交大一附院骨科创伤团队从“加速康复管理、骨折微创手术、骨松综合治疗”等三方面入手,为老年患者保驾护航。“重治病”更要“重防病”,下面我们将围绕“骨质疏松的相关问题”为大家进行分析和讲解。一、什么是骨质疏松?1.中老年人,如果出现乏力、腰背部、四肢或全身痛,特别是静息痛、翻身痛,或者出现驼背、变矮,轻微外力导致骨折等,这很可能就是——骨质疏松症。2.骨质疏松症是一种全身性、代谢性骨骼系统疾病,其病理特征为骨量降低、骨微细结构破坏、骨脆性增加,骨强度下降,易发生骨折。
足底筋膜炎康复训练计划远祖的前肢与后肢分离和分工,并开始直立行走,乃是人类进化中最伟大的第一步。同时,也就此奠定了人类终将成为万物之灵的命运。“千里之行始于足下”“知足常乐”这些成语也能侧面看出足在人类历史上的重要性。足部是人体的基部,跟房屋的地基一样,如果地基不稳会造成房屋结构不良。足底筋膜是位于跖骨与跟骨之间的一片扇形筋膜组织。主要功能是维持足弓的高度,保持正确的步姿,平常在行走或跑步时,这片组织会承受体重使跖骨与跟骨分离的拉力,并且因各种不同的情况下给予活动时所需的扭力,弹性以及吸收与地面的反作用力。足底筋膜炎为慢性运动伤害的一种,临床上患有足底筋膜炎的患者往往合伴有足部生物力学异常的问题(扁平足、外翻足、高弓足、姆指外翻等)。由人体生物力学的观点看来,足部距下关节过度外翻会造成足弓低下扁平,连带拉扯足底筋膜,造成筋膜发炎。本病指由于多种原因所致的后足跟疼痛,逐渐发展,早晨起床后或久坐后起立而开始步行时,疼痛较明显,但在行走过程中疼痛可逐渐减轻,而久行则增加疼痛。发病机制大致分为下面几种情况:1.慢性劳损或炎症:跖筋膜在足跟内侧粗隆附着处反复受到牵拉,筋膜出现劳损或慢性炎症。2.神经卡压:支配屈小趾肌的神经受到卡压而引起疼痛。3.滑膜炎:跟骨下滑膜炎引起肿痛。4.退行性病变:如足底脂肪垫萎缩,承重缓冲力减弱;至于跟骨刺,约50%跖筋膜炎患者有跟骨刺但与疼痛无直接关系。解决办法:一、运动疗法:1.足底筋膜按摩运动:用大拇指上下按压脚掌前后端的足底筋膜,按压程度以感觉足底微酸即可。此按摩可舒缓筋膜紧绷。取网球放于足底,脚面与地面平行,缓慢负重用前足挤压网球,顺势向后滚动到足跟部。往复运动,力度循序渐进且缓慢。按摩数分钟后以足底发热,微痛为宜,本动作可放松足底筋膜,增加局部血液循环。2.足底筋膜自我牵拉运动:足部放松,一手固定脚跟,另一手握住脚趾,用力将脚趾向上扳至筋膜感到拉扯感为止,持续数秒。此动作可舒缓筋膜紧绷,增加筋膜弹性。或采坐姿,膝盖伸直,然后拿一条毛巾置于脚掌前端,双手分别握住毛巾两侧,向内用力拉至筋膜有感觉到被拉扯为止,一样每次拉扯后停留数秒。跟腱牵拉运动:双腿分开似弓步状,双手扶于墙上,右脚前脚掌翘起,左腿伸直,右小腿肚有拉扯感为止,维持数秒后放松。(站斜板也可以达到跟腱牵拉的效果)3.加强筋膜组织弹性和整体肌肉力量练习:脚趾抓毛巾:足部固定仅用足趾用力向后抓毛巾,力度适中锻炼后有足部微酸发热为宜。此法加强足底肌肉力量,进而达到缓解疼痛的效果。腿部前群的肌肉;两腿开步与肩同宽,可靠于墙,身体正直目视前方。垂直下蹲,注意膝垂直脚面,不过脚尖,重心放于足中部。静蹲待大腿前侧酸痛为宜。腿部后群的力量也需要加强才能达到整体的锻炼效果:脚踝放沙袋,左腿站直右腿屈曲,数次大腿后面微酸为宜,左右交换练习。提踵锻炼:双腿并拢同时踮起脚尖,维持数秒后落下;也可采取单脚练习增强小腿三头肌的力量。臀部的力量:双手双腿撑于床上腰部与床面平行。右脚踝绑沙袋,屈腿脚面于床面平行,臀部发力垂直将右脚伸向天花板,维持数秒后重复该动作至微酸,左腿如此法练习以达到平衡。二、物理因子治疗:冲击波作用于痛点,局部造成微损伤,缓解疼痛组织的再修复。红外线局部照射,如在照射前局部涂抹扶他林等消炎止痛软膏,效果更佳冰敷急性疼痛发作时效果较好热敷 患者可让疼痛处泡热水或局部热敷,可缓解疼痛。那么如何预防足底筋膜炎的发生呢?1.适合自己的运动装备鞋具不当会引发足部内部结构异常,运动时的肌贴绷带等可以减少足部的压力和限制过度活动。2..控制体重体重是一个很大的因素,全身的重量都要经由足部来承受;如果能控制体重的话,相对的足部负担就会变少。3.增强足部周围韧带的力量练习,增强关节稳定性,避免足部关节过松。4.避免超负荷作业长时间站及坐造成小腿腓肠肌过紧;避免硬地面长时间长跑或蹬踏等动作,学会间歇运动。
1. 唑来膦酸主要用于各种原因引起的严重骨质疏松症,用药前后需要确保钙、维生素D的规范补充,第二次用药间隔时间一年。 2. 有以下情况时应谨慎使用:低钙血症、肾功能不全、甲状腺或甲状旁腺手术史、计划进行牙科手术或者拔牙。 3. 唑来膦酸通过静脉输注,建议输注时间大于40min,输注唑来膦酸注射液之前可以吃饭;首先注射生理盐水250ml,然后注射唑来膦酸,最后再注射生理盐水250ml。 4. 从注射当日算起,连续三天建议每日饮水超过2000ml。 5. 唑来膦酸有强大的抑制破骨细胞作用,注射后可能在短期内(数天)出现:发热、寒战、骨关节痛、肌肉痛等情况,属于正常现象,可以备用退烧药(布洛芬),假如体温超过38.5℃酌情使用。 6. 若有特殊不适随时来医院就诊。
随着我国人口老龄化加剧,老年骨质疏松性骨折发病率逐步升高导致的经济和社会负担成为我国医疗卫生行业的重要挑战。针对这一情况,西安交大一附院骨科创伤团队从“加速康复管理、骨折微创手术、骨松综合治疗”等三方面入手,为老年患者保驾护航。“重治病”更要“重防病”,下面我们将围绕“补钙”常见的误区为大家进行分析和讲解。误区1:“我年轻着呢,没必要补钙和预防骨质疏松” 答案:对于普通成年人来说,适当多吃奶及豆制品,同时多吃绿色蔬菜、坚果、粗粮杂粮以增加钙摄入量。而对于处于青春期、孕期、更年期、老年期的人群,在饮食中钙摄入不足时,应该补充钙剂。误区2:“天天喝骨头汤,不会缺钙,肯定能预防骨质疏松” 答案:骨头汤内含有丰富的脂肪和少量蛋白质,对健康是有一定益处的,但单纯靠喝骨头汤却不能达到补钙目的。因为骨头汤里的钙含量微乎其微。不仅如此,老年人如果大量吸收骨头汤里的脂肪,还会引发其他健康问题。误区3:“天天补钙,肯定能预防骨质疏松” 答案:单纯补钙,而缺乏促进钙吸收的维生素D,并不能够改善骨质疏松。钙+维生素D只是治疗骨质疏松的基础方案,并不能从根本上改善骨量的流失及疼痛等症状。补钙不能替代抗骨质疏松药物,治疗骨质疏松需要有选择的应用抑制骨吸收药物或促骨形成的药物。误区4:“补钙可以促进骨折愈合,补钙越多,骨折愈合越快”答案:发生骨折后补钙可以在骨折2周以后进行,因为 2周以内属于骨折急性期,骨折的部位会释放出大量游离钙盐,同时因活动不便,患者喝水和排尿的次数减少,此时大量进补钙制剂,体内的血钙量增高,可能会增加肾脏的负担。另外,骨早期的再生来源主要是骨膜、骨髓, 此时骨质吸收加速应选用降钙素等强效抗骨质吸收药物进行治疗,从而预防骨量的丢失,减轻疼痛。总体来说,防治骨质疏松,首先中老年需做好筛查,特别是绝经后的女性朋友,由于雌激素的迅速下降极易诱发骨质疏松,最好每年做一次骨密度检测,骨密度是临床上医生诊断骨质疏松症的金标准。其次改变不良的生活习惯,避免吸烟、饮酒和进食过量的咖啡因,吸烟、酒精、浓茶和咖啡会增加患骨质疏松症的风险。每天至少需要散步半小时,长期的运动还可以刺激骨形成,增加骨质量。对于患有老年性骨关节炎和高龄老人,应该在医生指导下选择适当的运动方式以防止跌倒或关节损伤。最后,不能盲目的单纯补钙,需要在骨科医生的指导下进行个体化、专业化的用药,以便达到最佳疗效。背景知识:人体骨骼的发育经过婴儿期、儿童期、青春期及成人早期等生长阶段,在20~40岁时全身骨量到达顶峰,随后骨量随年龄增加而逐渐降低。峰值骨量越高,到老年时发生骨质疏松症和骨质疏松性骨折的危险性就越小,所以治疗骨质疏松对于老年性髋部骨折的预防有着重要意义[1]。补钙是治疗骨质疏松常用的方法,不同年龄钙的推荐摄入量不同。美国骨质疏松基金会(National Osteoporosis Foundation)建议日常钙摄入标准为:50-70 岁男性1000 mg/d;大于50 岁女性及 大于70 岁的男性1200 mg/d。2013年,我国制定的中国居民膳食营养素推荐摄入量建议,每天钙的摄入量应为 :6 个月以下 200 mg,0.5~1 岁 250 mg,1~3 岁 600 mg,4~6 岁 800 mg,7~10 岁 1000 mg,11~13 岁 1200 mg,14~17 岁 1000 mg,18~49 岁 800 mg,50~80 岁 ,1000 mg[2]。参考文献[1] 侯安存. 关于补钙的研究进展 [J]. 临床和实验医学杂志,2016,15(18):1862-1865.[2] 公双双, 吕静, 王双艳. 老年人补钙作用的研究进展 [J]. 当代医学,2017,23(31):178-182.西安交大一附院创伤骨科李萌副主任医师每周四下午开设“骨质疏松性骨折专病门诊”(门诊三楼东侧骨科2诊室)就诊范围包括:脆性骨折的预防和治疗
1、钟摆/画圈练习: 手撑椅面,弯腰90度,上臂随身体以顺时针方向环形旋转10次,之后逆时针旋转10次,每日练习3次。 2、辅助下肩关节前屈练习: 双手交叉,将上肢高举过顶,可以卧位(图A)或坐位(图B)进行练习。注意尽量保持肘关节伸直。每组10-20次,每日3次。 3、肘支撑肩关节外旋练习: 前臂平放在桌子等平面,上臂与身体夹紧,前臂在平面前后旋转移动,每组10次,1天3次。 4、手指爬墙练习: 肘关节伸直,用手指在或门框向上爬行移动,尽力爬到最高,保持10秒,每组3次,每日3组练习。 5、肩关节内旋练习: 手背后,尽力从后方达对侧背部。每组10次,每日3组练习。 6、肩关节前屈练习: 保持肘关节伸直,向天花板反向上举胳膊,坚持10秒,每组3次,每日3组。 7、肩关节外展练习: 手心朝下,肘部伸直,在体侧外展肩关节,不要耸肩或倾斜身体,保持10秒,每组3次,每天3组。 8、肩关节后伸等长收缩练习: 后背靠墙站立,上肢在体侧伸直下垂,手向后推墙,保持5秒,然后放松,每组10次。 9、肩关节外旋等长收缩练习: 站在墙角,屈肘90度,上臂夹于体侧,前臂贴在墙壁后外旋用力推墙壁。保持5秒,然后放松,每组10次。 10、肩关节内旋等长收缩练习: 站在墙拐角或门框,屈肘90度,前臂贴在墙壁后内旋用力推墙壁,保持5秒,然后放松,每组10次。 11、肩关节内收等长收缩练习: 在体侧夹一小枕头用力内收,坚持5秒,每组10次,每天3组。 12、肩关节外展等长收缩练习: 向外侧抗阻推椅背练习,坚持5秒,每组10次,每天3组。 13、肩关节内旋练习: 患侧卧位屈肘90度,手持轻物,向体侧内旋抬手举物,慢慢放下,每组10次,每天3组。 14、肩关节外旋练习: 对侧卧位屈肘90度,手持轻物,向外侧外旋抬手,慢慢放下,每组10次,每天3组。
Getting Around After Hip Replacement Surgery 髋关节置换术后功能锻炼The following are some ways to incorporate movement after you have had hip replacement surgery. Discuss these techniques with your physicians and orthopedist before attempting them. Your physical therapist may modify some of these techniques depending upon your situation (i.e., age, weight, and procedure). Only do the techniques that are recommended by your physician and/or therapist.下床步骤1由床的患腿侧下床,理疗师会教你怎样挪动手术肢体并帮助你怎样使用助行器。Get out of the bed on the same side as your operated leg. You physician and/or physical therapist will show you how to move your operated leg properly and will assist you the first few times while you're in the hospital.步骤2Pivot on your hips using your elbows to help. Keep your body straight with your operated leg kept to the side. Do not twist your leg.以肘关节帮助支撑髋部,保持手术肢体与躯干在一条线上,禁止扭转患肢。步骤3Move your unoperated leg around and sit on the edge of the bed keeping your operated leg straight. Hold onto your walker for support and stand. Do not bend forward as you try to stand. 将非手术侧腿移动至床边并保持患腿伸直。扶住助行器支撑站立,努力站起来时不能向前倾斜。Sitting 坐下步骤1Sit in firm, straight-backed chairs with high seats and armrests. You should avoid low, overstuffed chairs. Back your walker up until you feel the chair touching the back of your legs. 坐高位直靠背带扶手的座椅,座椅避免过低,坐垫避免过厚过软。后退助行器直至感觉到腿的后方接触到座椅。步骤2Release your hands from the walker and reach down and hold onto the arm rests. Slowly lower yourself keeping your operated leg straight out in front. 将手从助行器上解放出来后抓住座椅扶手,支持慢慢降低身体,保持手术侧肢体伸直在前方。步骤3Sit then slide back in the chair bending your unoperated leg first. You use this technique when using a toilet with arm rails as well.先弯曲健侧腿向后滑动身体坐下,同样将此方法用于上卫生间。Walking 行走Once you can stand, you will use a walker to help you keep your balance. Initially you will be told to place only a small amount of weight on your operated leg as you walk. As you become stronger, your doctor will tell you when you can increase the amount of weight placed on your operated leg. 当你能够站立时,可以借助于助行器保持平衡。刚开始患肢只能部分负重行走。当肢体力量强壮时,医生会告诉你什么时候增加患肢负重量。步骤1 Place the walker a few inches in front on you and hold on to the walker firmly with both hands. Keep you hip straight and step your unoperated leg into the center of the walker. To protect your hip, avoid rotating your hip or foot. 将助行器放置在面前几英寸处,用双手握紧助行器,保持髋关节伸直,将健腿置于助行器中间。步骤2 Lean on the walker and let it support your weight. Step forward and through the walker with your operated leg. Be careful not to wrap your leg around the legs of the walker. 借助行器支持体重,术侧腿与助行器一起踏向前,注意不要碰到助行器腿。步骤3 Lift your walker straight up (if it doesn't have wheels). Be sure to place all four of its legs down before stepping forward again. 提起助行器(如果助行器没有轮子),确定放稳所有助行器四条腿后方可再次迈向前方。Crutches 拐杖Once your muscles are strong enough, your physical therapist and/or physician may recommend crutches instead of using a walker. Your therapist will give you guidelines on how far and how long you may walk. When using crutches, put your weight on your palms, not your armpits. Don't twist to turn, take small steps instead. Your physician and/or therapist will tell you how much weight you can put on your operated leg. 当肌肉力量足够强的时候,理疗师会建议使用拐杖代替助行器。理疗师会制定行走实时间和距离方案。当使用拐杖时,身体的重量负在手掌上,而不是负重于腋窝下方。不能扭转身体,而以一小步代替旋转。理疗师会告诉你患肢能够负多少重量。步骤1 With the crutches firmly in place, place pressure on your hands, not on your armpits. 正确握紧拐杖,将符合置于手上,而不是腋下。步骤2 Move the operated leg and both crutches forward at the same time. 同时向前移动患肢和双拐。步骤3 Looking up and straight ahead, first step through the crutches with the operated leg followed by your unoperated leg。 注视前方,首先拐杖和患肢迈出,紧跟着迈非手术腿。Walking Up Stairs with Crutches 扶拐杖上楼With your crutches upright on the floor and firmly planted for support, lift your unoperated leg and place it on the step. Leaning forward on the crutches, lift yourself up. Use the crutches and your unoperated leg to support your weight. Now lift your operated leg up onto the step. You may want to have someone help you the first few times until you become comfortable with stairs. 握紧拐杖直立于地面上,先健侧脚放置在楼梯台阶上,将身体倾向前,利用拐杖支撑身体向上,利用拐杖和健腿支撑支撑自己的体重,然后抬患侧脚置于台阶上。Walking Down Stairs with Crutches 扶拐杖下楼梯Place your crutches and your operated leg on the lower step. Use the crutches for balance and lower yourself carefully down onto the step moving the crutches as you move the operated leg. Again, you may wish to have someone assist you the first few times you try this. 将双拐和患侧脚放到下一级台阶上,利用拐杖保持平衡和移动身体,再次移动拐杖同时移动患脚,最初几次可以由其他人来帮助。应该的避免危险动作At first some movements will put too much strain on your new hip joint, which could cause the ball to slip from its socket. A therapist will teach you which movements to avoid. A few of the most risky ones are: 最开始活动时避免过度活动,否则会导致关节脱位,理疗师会讲述什么动作需要避免,最危险的动作是什么:坐Don't let your knee cross the midline of your body.不能使你的膝关节交叉过身体中线错误Rather, sit with both feet on the floor, with your knees six inches apart.双足置于地上,双膝关节之间保持6英寸距离。正确转身Don't plant your foot and rotate your new hip inward.避免将足固定而旋转患侧髋关节。错误Rather, turn both your feet and your body.应该同时转动躯干和患足。正确弯腰Don't bend all the way over from the waist.不能完全弯腰错误Rather, use a device, such as a long-handled grabber to reach down.正确的做法是以一种装长柄抓钩延长正确Once You Are At Home 当你在家时It is very important that you follow your surgeon's instructions. The following suggestions should be discussed with your surgeon before your hospital discharge遵循外科医师的指导是非常重要的,指导意见是主治医师在出院之前决定的。If you will be using a walker or crutches to assist with walking, ask your doctor how much weight you may put on your operated leg. 如果需要使用助行器或者拐杖,向医生问明患者可以负多少重量。Remember that you will probably tire more easily than usual. You may want to plan a rest period of 30 to 60 minutes mid-morning and mid-afternoon. 记得你会较平时更容易疲劳,可以计划每天上午十点左右和下午3点左右休息30-60分钟。It is safer and easier to get in and out of chairs using both arms and you should avoid low or overstuffed furniture. To increase your comfort, use a cushion or pillow to raise your body while seated. 充分利用双臂起落座椅是比较安全和简单的做法,避免坐过低和厚软垫座椅。坐起的时候可以用电子或者枕头垫高垫着。An elevated toilet seat may reduce stress to your hips and knees as you sit and stand. 利用高位马桶在起来和坐下来时可以减少髋关节和膝关节的应力。A shelf placed in the shower at chest height may reduce having to bend to retrieve items while in the shower. A bathtub seat (bench) allows you to sit while bathing for increased safety and comfort.为了增加安全性和舒适度,洗浴时可以坐在浴缸座上。A long-handled bath sponge may be used to reach lower legs. Women can also purchase razor extenders to shave their legs. 使用长的搓澡巾可以到达下肢,女患者可以购买剃刀给自己的腿剃面。Avoid sweeping, mopping, and running the vacuum cleaner. Use long-handled feather dusters for dusting high and low items. Your doctor will tell you when it is okay to sweep, mop, and vacuum.避免扫地、拖地和使用吸尘器,用长把手羽毛单子打扫高位和地位置的灰尘。你的主治医师会告诉你什么时候可以扫地、拖地和使用吸尘器。You may ride in a car, but you must follow your doctor's instructions for how to get in and out of the vehicle. You can raise the height of the car seat with pillows to protect your hips and knees as well. 你可以乘坐轿车,但是必须按照医生的知道上下车,用枕头垫高车上的坐垫保护髋膝关节。Your doctor will talk with you about when you can drive, typically within four to six weeks after surgery. If you have a car with manual transmission, talk with your doctor about driving limitations. Make sure you can brake the car without discomfort before you attempt to drive in traffic. 医生会告诉你什么时候可以驾车,一般情况下在手术后4-6个星期,如果你的汽车是手动变速器,医生会告诉你驾驶注意事项,确信你在驾驶时刹车没有不舒服。Constipation is a common problem for patients following surgery. This is usually due to your limited activity and any pain medications you may be taking. Discuss your diet with your doctor. It should include fresh fruits and vegetables as well as eight full glasses of liquid each day, unless your doctor tells you otherwise.便秘是患者术后最常见的问题,便秘可限制活动和止痛药物的应用。Your doctor will probably give you a prescription for pain pills. Please follow your doctor's instructions concerning these medications.主治医生会给你止痛方案,请按遗嘱服药物。Some swelling around the incision is normal. You will find it more comfortable to wear loose clothing to avoid pressure on the incision. Ask your doctor or other qualified health professional about appropriate wound care. 伤口周围稍微隆起是正常的,穿宽松的衣物可以减少对伤口的压力,找主治医生或者有许可证的专科医生做适当的伤口护理。
石膏固定是骨科常用的一种治疗方法,固定后有哪些注意事项?需要观察什么?希望这个视频对您有帮助。
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希望您通过这个科普短视频得到答案。