The method of rehabilitation treatment of patients with fractures of the pelvis after surgery

 

(57) Abstract:

The invention relates to medicine, namely to traumatology. Restorative treatment of patients divided into four stages: 1 to day 14, from 15 days to 8 weeks from 8 weeks to 12 weeks from 12 weeks to 6 months. In the first stage 2-3 days after the operation, perform active exercises in the supine position and turns in bed. Then spend sitting down in bed with a focus on hands. With 4-5 days of taking the patient support. Spend physiotherapy diadynamic currents. In the second stage, add exercises in the standing position of the support. Include walking in place without additional support and walk with the help of the crutches. Undergo magnetic therapy or ultrasound, acting on the lumbar-sacral region. Conducting a course of massage of the lower extremities. In the third stage of the exercise carried out with great effort and in greater volume. Conduct electrical stimulation of the muscles of the back and lower extremities. After removal of external fixation device massages lumbar, gluteal regions, lower extremities. Include exercises aimed at restoring walking stereotype. In the fourth stage is connected mechanotherapy and/or exercises in PLA the Oia out in a hospital, and the third and fourth steps recommended in the outpatient setting. The method provides full functional recovery of locomotor system, early recovery of physical performance and work capacity, reduced treatment time. 2 C.p. f-crystals, 3 tables.

The invention relates to medicine, namely to traumatology and can be used in the rehabilitation treatment of patients with severe multiple injuries of the pelvis after transosseous osteosynthesis.

As you know, with injuries and diseases of the musculoskeletal system of the body of the patient is in a particularly adverse conditions, not only because of dysfunction of the limbs, but also due to the reduction of General motor activity that leads to the development of hypokinetic diseases. Prolonged restriction of motor activity leads to the development of muscle atrophy, decreased proprioception, i.e., lower trophic level of all organs and systems of the body, which consequently leads to its slow recovery.

Physical exercises improve blood circulation in the periphery, blood oxygenation, extraordinally hemodynamics and respiratory function by increasing the flow of proprioceptive circulation, breathing and movement. A known method of rehabilitation treatment for fractures of the pelvis after immobilization of the pelvic ring using the roller, including physiotherapy and physical therapy exercises to strengthen the pelvic girdle (A. F. Captain. Restorative treatment for injuries and deformations of the musculoskeletal system. M. :Medicine, 1969, S. 151-154).

Along with breathing exercises perform passive and active exercises in the supine position, starting from 4-5 days for 3-4 weeks before lifting the patient. At the first stage within 10-14 days perform exercises involving the muscles of the upper extremities, shoulder girdle, trunk and pelvic girdle supported on the platen. With 15 days to 4 weeks these exercises are carried out more vigorously and without relying on the platen, connecting exercises in the prone position on his stomach. With the rise of the patient in the upright position (after 3-4 weeks) begins the third period of treatment. Exercises performed in the standing, doing squats and begin to teach the patient walking.

However, prolonged restriction of motor activity leads to disruption of the activity of many organs and systems both functional and morphological the program is ineffective for the prevention of trophic disorders of the tissues of the body and muscular atrophy of the lower extremities and pelvic girdle. Rise of the patient in an upright position and training of the walk takes place in the later stages of treatment, leaving the patient does not fully restore the functional relationships of the system motion. Often the patient when walking sways a body, limp. In the conservative treatment of fractures frequent re-displacement of the bones, there are various character complications in early and late stages of the post-traumatic period.

There is a method of rehabilitation treatment of patients with injuries of the pelvis after surgical treatment (Yumashev, S., Epifanov Century A. Operational traumatology and rehabilitation of patients with damage to the musculoskeletal system. M.: Medicine, 1983, S. 357 - 359), including massage, physiotherapy and physiotherapy.

After the operation the patient is placed on his back, under his knees, put a cushion or put the pelvic region of the patient in a sling for 4 weeks. The recovery period is divided into two stages. The first period lasts 4 weeks. In the first 7-10 days of conducting breathing exercises (static and dynamic), gradually connecting special exercises performed under simplified conditions in the supine position, for example the asset is of the roller. With 10 days connect exercise with alternating abduction and adduction of the legs (hips gliding on the platen). On day 14 the platen is removed and include exercises with leg raises and static hold limb exercises for the upper extremities and shoulder girdle. With 21 days perform exercises with the active movements of the lower limbs without relying on a plane bed, turn the patient on his stomach. In the first period massages the lower extremities, ultraviolet irradiation of the chest, electrophoresis. 4 weeks after surgery (since lifting a patient) begins the second period of rehabilitation. Exercises of the first period is carried out with a large number of repetitions of each movement, connect exercise with resistance, weight, standing at the gymnasium wall.

However, the patient after surgical treatment for a long period (up to 4 weeks), and in severe injuries of the pelvic bones and more than 4 weeks, is on bed rest. Massage, physiotherapy and exercises used in the rehabilitation of patients in this period, do not prevent muscle atrophy. The restoration of the functional state of the visceral organs is too slow. Not fully S="ptx2">

Task - complete functional recovery of locomotor system "stereotype bearings and walk", the restoration of physical health and disability, reducing treatment time by maintaining motor stereotypes bearing and distance from the first days of the postoperative period.

The problem is solved as follows. The entire period of rehabilitation treatment for fractures of the pelvis after surgery (after transosseous osteosynthesis with external fixation devices), including physiotherapy, massage and complex therapeutic exercises with step-by holding the breathing, active and passive exercises, according to the invention, divided into four stages 1 through day 14, from 15 days to 8 weeks from 8 weeks to 12 weeks from 12 weeks to 6 months, and 2-3 days after the surgery, begin to pursue an active exercises, first in the supine position by pulling up on the bed frame, perform circular and flexion movements in the joints of the upper and lower limbs, turning in bed, and then 3-4 days spend sitting down in bed with a focus on the hands, and with 4-5 days of taking the patient based, with daily who do not perform standing exercises the bearing, by tilting the body, alternating leads straight leg forward and to the side, alternating flexion of the leg at the knee and hip joints, and the load on the musculoskeletal system of the trunk, hip girdle and lower limbs gradually increase in the complex include walking in place without additional support and walk with the help of the crutches first horizontal plane, and then the stairs, and undergo magnetic therapy or ultrasound, acting on the lumbar-sacral region, conducting a course of massage of the lower extremities, in the third stage of the exercise first and second stages is carried out with great effort and in greater volume, with the transition from smaller loads to large, from small amplitude of motion in the joints for greater and conduct electrical stimulation of the muscles of the back and lower extremities, and after removal of external fixation device connect massage lumbar, gluteal regions, lower extremities and conduct exercises aimed at restoring walking stereotype in standing position without support, kneeling, and standing on all fours, in the fourth stage is connected mechanotherapy and/or exercises in the swimming pool, with 1-2 or 1-2-3 stages of treatment, perform exercises with isomerizations, at least two times per lesson, supervise the General condition of the patient by determining the number of heartbeats for peripheral pulse. When an isolated injury to the pelvic ring, the first and second stages of therapeutic exercises carried out in the hospital, and the third and fourth stages of rehabilitation treatment recommended in the outpatient setting.

Rehabilitation after transosseous osteosynthesis apparatus for external fixation is divided into four stages according to the phases of traumatic disease. Strict stepwise sequence include therapeutic exercise, physical therapy and massage during restorative treatment helps to restore and strengthen the structural basis of the functional system motion sick after a serious injury of the pelvis.

Early activation of patients begin immediately at the first stage of treatment with 2-3 days with the development of movements in the joints of the upper and lower extremities, with prisasyvaniya patient on the bed with 3-4 days of lifting (with stand on the top of the bed, on crutches) with 4-5 days to prevent the development of complications such as fat embolism and thrombosis, the occurrence of bedsores, to avoid muscle atrophy and support function. Physical therapy - diadynamic currents, at this stage analgesic effect, stimulates the trophic processes.

The connection at the second stage of the exercises in the standing position by the bearing, and the inclusion of walking on the spot without the support and supported at the horizontal plane and the stairs can increase mobility in the joints of the lower extremities, increase strength and endurance of the shoulder muscles, gluteal muscles, leg muscles, improve blood and lymph circulation in the pelvic region, which has a beneficial effect on bone regeneration and preservation of stereotype bearing and distance. Physiotherapy - magnetic or ultrasound, at this stage, have analgesic, vasodilatory, anti-inflammatory and trophic action. Massage of the lower extremities reduces tissue swelling, promote resolution of subcutaneous hematoma, enhances the reparative processes in tissues. More intensive implementation of the third stage of the exercise the first two stages - with the transition from smaller loads to large, from small amplitude of motion in the joints for greater, strengthens muscles, increases muscle performance and exercise performed during the removal of the external fixation device in a standing position without proposal.net patient. Electrostimulation of muscles of the back and lower extremities, as well as massage lumbar and gluteal regions and lower limbs helps to strengthen the muscular system, improves metabolic processes. At this stage, completely restored the function of support and movement.

Inclusion on the stages of treatment exercises isometric exercise weakened muscles improves circulation in tense muscles, eliminates the occurrence of atrophy, helps in the restoration of their tone and trophism.

Monitoring the condition of the cardiovascular system of the patient, at least two times during the sessions of physiotherapy (measurement of blood pressure and pulse rate) allows you to take an individual approach to dosing loads.

In the fourth stage of treatment is considered complete Union of the fracture and fracture of the pelvic ring. During this period, mechanotherapy and exercises in the swimming pool reinforce restored stereotype of support and help to adapt to the natural conditions of the walk.

According to the proposed method, in the Ural research Institute of traumatology and orthopedics treated 105 patients with unstable injuries of the pelvic ring th is I. For an objective evaluation of the anatomical and functional recovery of locomotor system patients after restorative treatment were applied clinical-radiological methods of examination of all patients and complex biomechanical study of 54 patients, including the definition of static load on the limbs, photografia, the support reactions stop, geneography, oscillography fluctuations segments of the trunk and electromyography. All patients in the earlier period, in comparison with the prototype, fully restored function of the musculoskeletal system, the returned physical performance.

The method of rehabilitation treatment is as follows.

After conducting external fixation external fixation device (patent RF N 1811386 and 2062612), the patient is placed in bed and spend analgesic drug therapy, psychotherapy, may topically apply hypothermia. Immediately appoint diadynamic currents (DDT). DDT appoint transversely on the hearth with the change of polarity. Modulation: 2-stroke wave 3 to 5 minutes, a short period of 3 to 5 minutes, a long period of 2 - 4 min, daily, no more than 3 fields in the procedure. The number of procedures 10.

Sm practitioner. Exercises performed with the patient individually, without large load, perform them slowly to the threshold of pain to avoid reflex muscle tension and possible blocking of the joints.

In 1-2 days perform breathing exercises and restorative (passive) for the upper and lower extremities and trunk. With 2-3 days of the patient activates. He performs pulling up on the bed frame in the supine position, is rotated in bed on his side, performs active movement in the joints of the upper and lower extremities, for example, perform a set of exercises 1-6 of table 1. With 3-4 days, depending on the condition, the patient begins to sit up in bed, get in bed with emphasis on the hands, and then help him to move from lying to sitting position with legs hang and stand based on the headboard and with the help of the crutches. The time spent standing with crutches gradually increased. The patient performs isometric training of the quadriceps femoris and gluteus muscle groups and includes the complex of exercises 7-13, (see table 1). Exercises should be performed with the transition from lighter to exercise with the maximum load, reducing it to the end of the session. Load the course of the economic pulse. The maximum load should not cause increased heart rate more than 50% of the original value, and return time of the pulse to its original value after the lesson should not exceed 2 - 3 minutes. Physical activity is considered optimal when the number of heart contractions in the middle of the class within 20-25% of the original. The increase or decrease of the load is achieved by changing the number of exercises, repetition of each exercise, change the original terms and pace of the exercises. With 4-5 days after surgery the patient began to get up and walk with crutches.

In the second stage of rehabilitation treatment therapeutic gymnastics start with the exercises of the first phase, connecting exercises in standing position with support and walk with support. The patient begins to sit with emphasis on the lower limbs to the appearance of pain or discomfort in the pelvic area.

Exercises of the first period perform with greater amplitude, load and greater repeatability. The load increases gradually due to the inclusion in the set of new exercises with capture other muscle groups, perform exercises with isometric muscle tension of the femur and tibia (table 2).

To prevent inflammation, reduce pain, improve blood and lymph circulation in the pelvis of patients to designate magnet or ultrasound.

Magnetotherapy is assigned transversely on the hearth in 1-3 fields (using machines: "pole-1", "pole-2", "Alimp"), induction 10 - 12 - 25 MT, the exposure time is 15 - 20 min on the field daily, 15 to 20 procedures under the supervision of AD.

Ultrasound is assigned to the hearth 1 - 3 field (frequency of 880 kHz). Methodology labile, method of contact, mode pulse is 2 MS. The power flux-density - 0,2 - 0,4 - 0,7 W/cm, daily, 10 - 15 procedures, under the supervision of AD and reflexogenic zone (lumbosacral region), frequency - 2640 kHz, contact the labile mode pulse 10 MS, the power flux-Density - 0.2 W/cm2time - 3-5 sec.

To improve circulation and prevent muscle atrophy appoint a massage of the lower extremities. The massage is carried out after the relief of pain.

To strengthen the muscular corset perform massage and conduct electrical stimulation of the muscles of the back and lower extremities. Electrical stimulation spend DDT or sinusoidal modulated currents (SMC). Parameters DDT: DV (2-stroke wave) 3-5 min, 0V (single-cycle wave) 5-10 minutes to change the polarity, current - to medium cuts, daily, 15 to 20 procedures. The CMT parameters: mode 1 or 2, work 2, the modulation frequency of 50 - 80 Hz, the modulation depth of 75 - 100% > 100%, S1- S2(time parcels pauses) 4 - 6 min, 10-20 procedures, daily.

Patients, after the removal of the device from the pelvis refresher course massage lumbar, gluteal areas and lower extremities. is - 3 fields. Mode - AC, the kind of work III and IV, the modulation frequency of 70 - 80 Hz, the modulation depth of 75-100%, S1-S22 to 3 minutes, 5-7 min each kind of work, 10-15 procedures daily. Current - to srednevyrazhennoy vibration.

Patients in this period can walk without crutches with a full load on the lower limbs and perform exercises that contribute to the acquisition of the right foot (see table 3).

At the third stage there is complete recovery of function, movement and support.

The fourth stage is a late recovery period (from 12 weeks to 6 months). During this period complete the Union of fractures and breaks connections pelvic ring. For fixing the restored function of the musculoskeletal system of the patient is undergoing a course of practice mechanotherapy, i.e., classes at the gym (on the wall of the "Health" of the bike). To adapt to the natural conditions of the walk use a special training track. If possible, the patient performs exercises in the treatment and swimming pool. In the aquatic environment creates the opportunity to dose load, painless to restore joint mobility, prevent the development of deforming arthrosis. Bo is haunted baths or baths with sea salt.

Example. Patient E. , age 15, I. B. N 91044 was admitted to the hospital, UNITO with the diagnosis: comminuted fracture of the right wing of the Ilium, bilateral fracture of the pubic and ischial bones. Rupture of the right sacroiliac joint, injury to the bladder.

On the second day after receipt produced an indoor transosseous osteosynthesis multiple injuries of the pelvic ring external fixation device, developed in UNICO (U.S. Pat. N 1811386). During the operation produced reposition damage and rigidly fixed front and rear sections of the pelvic ring, the area of the fractures of the right wing of the Ilium. After the operation, according to the proposed method, the patient underwent a course of rehabilitation treatment. On the first day, the course of breathing exercises. With 2 days sick activated - exercises 1-6, and with 3 days of exercise 7-13 table 1 (see description), was performed by pulling on the Balkan bedside frame, independently turned. Isometric training gluteal muscles and the muscles of the anterior surface of ribs carried out 6-8 times with the maximum stress and the subsequent relaxation. With 3 days for pain injuries of the pelvis and stimulate crop receivetime in bed, lifting with an emphasis on the hands, on the 5th day to stand on his feet, based on the headboard and on crutches. The time spent standing with crutches gradually increased (to fatigue). After 14 days the patient independently moved in the house with the help of crutches. The second stage of rehabilitation treatment included exercises 1-17 (table 2 in the description). Exercises conducted with greater amplitude, load and greater frequency than in the first stage. On day 16, the patient was assigned to a massage of the lower extremities to improve circulation and prevent muscle atrophy (10 treatments) and assigned elastic bandaging of the lower extremities to prevent thromboembolic complications. On the 20th day was appointed, magnet therapy course - 15 procedures.

After 8 weeks, the patient began to walk with a cane. On roentgenograms showed signs of Union fractures of the pelvis, there was no secondary displacement in fractures and joints of the pelvis.

At 70 days after surgery (the third stage of treatment prescribed for the patient massage to strengthen the back muscles and the stimulation of muscles - 15 procedures. Consistently exercises 1-2 phase of treatment the patient did some additional exercises 1-9 (table 3 the after the clinical and radiological examination and conducting functional tests at a relaxed apparatus.

The patient walked without additional support. Movement in the joints of the lower extremities has been restored in full.

Through 89 days after the operation the patient was discharged to outpatient treatment for the passage of the fourth stage of rehabilitation, which included a set of exercises of the previous three stages in more intense pace, the course on the bike. Patients underwent a General massage course took therapeutic baths.

Viewed through the year. No complaints. The patient started to school. Conducted comprehensive biomechanical study, which confirmed the complete rehabilitation of the locomotor system (all indicators of musculoskeletal system in the walk are normal). Radiograph showed complete recovery of bone structures of the pelvic ring.

Thus, the restorative treatment of patients with severe injuries of the pelvis after transosseous osteosynthesis with external fixation devices, in a stepwise connection special therapeutic physical exercises in conjunction with massage and physiotherapy from the first days after surgery enables you to fully recover stereotype of support and joanie.

1. The method of rehabilitation treatment of patients with fractures of the pelvis after surgery, including physiotherapy, massage and complex therapeutic exercises with step-by holding the breathing, active and passive exercises, characterized in that the entire period of rehabilitation treatment of patients with imposed external fixation device is divided into four stages: 1 to day 14, from 15 days to 8 weeks from 8 weeks to 12 weeks from 12 weeks to 6 months, and at the first stage with 2 - 3 days to respiratory and passive exercises connect the active exercise conducted first in the supine position by pulling up on the bed frame, perform circular and flexion movements in the joints of the upper and lower limbs, turning in bed, and then 3 - 4 hours to spend sitting down in bed with a focus on the hands, and with 4 - 5 days of taking the patient based, with daily physiotherapy diadynamic currents, in the second phase after exercise in the supine position perform exercises while standing by the bearing, by tilting the body, alternating leads straight leg forward and to the side alternately bending the legs at the knee and hip joints the military, in the complex include walking in place without additional support and walk with the help of the crutches first horizontal plane, and then the stairs, and undergo magnetic therapy or ultrasound, acting on the lumbar-sacral region, conducting a course of massage of the lower extremities, in the third stage of the exercise first and second stages is carried out with great effort and in greater volume, with the transition from smaller loads to large, from small amplitude of motion in the joints for greater and conduct electrical stimulation of the muscles of the back and lower extremities, and after removal of external fixation device connect massage lumbar, gluteal areas, lower limbs and conduct exercises aimed at restoring walking stereotype in standing position without support, kneeling, and standing on all fours, in the fourth stage is connected mechanotherapy and/or exercises in the swimming pool.

2. The method according to p. 1, characterized in that 1 to 2-Ohm or 1 - 2 - 3 stages of treatment, perform exercises with isometric exercise weakened muscles with the highest possible voltage and subsequent relaxation and periodically, at least twice during the lesson, supervise the General condition of the patient by changing"ptx2">

3. The method according to p. 1, characterized in that when an isolated injury to the pelvic ring, the first and second phases of restorative treatment in the hospital, and the third and fourth stages is possible to spend on an outpatient basis.

 

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FIELD: medicine, narcology.

SUBSTANCE: one should detect satisfaction insufficiency syndrome due to performing genetic analysis by the presence of, at least, one of the genes coding the exchange of neuromediators being the constituents of human satisfaction system. One should compensate satisfaction insufficiency due to performing, at least, one complex of physical exercises. Moreover, in case of availability of pathological gene allele of dopamine D2 receptor and/or protein gene of reverse dopamine capture in patient one should apply the complex of physical exercises including those to provide sedative effect, and in case of availability of pathological gene allele of dopamine-beta-hydroxylase protein one should apply the complex of physical exercises including those that induce an activating effect. In case of availability of pathological gene allele of dopamine D2 receptor and/or protein gene of reverse dopamine capture one should apply additional food biologically active additives based upon amino acids being the precursors of neuromediators, such as taurine, D-, L-phenylalanine in combination with 5-hydroxytryptophan, hypericin and vitamin B6, and in case of pathological gene allele of dopamine-beta-hydroxylase protein one should additionally apply food biologically active additives based upon amino acids being the precursors of neuromediators, such as: taurine, tyrosine and/or dimethylaminoethanol, lecithin and group B-vitamins. The present innovation enables to take into account pathological disease mechanism.

EFFECT: higher efficiency of prophylaxis.

14 cl, 5 ex

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