Principles of postoperative rehabilitation training
1, personalized principle: exercise plan should be different from person to person.
2, step by step principle: rehabilitation training needs time, can not be rushed, excessive activities will affect the rehabilitation effect.
3, the principle of whole body exercise: the functional exercise of the diseased joint is important, but the whole body training is also indispensable.
Post-operative rehabilitation training elements
1, confidence: rehabilitation training is hard work, be full of confidence. ?
2.Constancy: rehabilitation training needs long-term persistence, be persistent.
3.Caution: Safety is very important, rehabilitation training should be careful, especially in the early postoperative period.
Postoperative rehabilitation methods
Practice activities should be decided according to the type of fracture, the chosen fixation method and the degree of firmness of fixation.
Femoral intertrochanteric fracture
Common surgical methods: ① Internal fixation with DHS/DCS screw plate ② Internal fixation with intramedullary nail ③ Subtrochanteric wedge-shaped adductor osteotomy.
1. Immediately after waking up from anesthesia, perform active movements of the toes and ankle joint, and pay attention to a wide range of ankle flexion and extension.
(1) Flexion and extension of the ankle joint: slowly hook the toe upward, then extend it farther to make the foot surface tense. 5 to 10 times every hour, each movement lasts 3 seconds; start immediately after surgery until you are fully recovered.
(2) Rotation of the ankle joint: rotate your ankle joint from the inside out; repeat 5 times 3 to 4 times a day.
(3) Exercises on the healthy side: flex your hip and knee to contract the muscles of the healthy side of the lower limb. Practice 1 set every 2 hours, 30 times per set, lasting 10 to 15 seconds each time.
2.Patients can do hip and knee flexion and extension exercises at the bedside 2-3 days after surgery, and start to practice CPM a week later, 70-90º 30 minutes/time, 1~2 times a day. Patients with general fractures (non-comminuted, stable) start to gradually hold the crutches and bear weight two weeks after surgery, and patients with comminuted fractures, weight-bearing exercises are best carried out 4 weeks after surgery.
3.Walking time with crutches out of bed: non-displaced fracture ~ should be earlier than displaced fracture, but the weight-bearing walking time should be decided according to the fracture healing situation shown by X-ray.
Femoral neck fracture
Common types of surgery: cemented hip arthroplasty; biologic total hip arthroplasty; hollow threaded nail internal fixation.
I. Cemented hip arthroplasty rehabilitation training.
1. Early ankle joint active movement
Immediately after waking up from anesthesia, carry out active movements of the toes and ankle joints, paying attention to a wide range of ankle flexion and extension.
a) Flexion and extension of the ankle joint: slowly hook the toe upward, then extend it farther to make the foot surface tense. 5 to 10 times every hour, each movement lasts 3 seconds; start immediately after surgery until you are fully recovered.
b) Ankle rotation: Rotate your ankle joint from the inside out; repeat 5 times 3 to 4 times a day.
c) Exercises on the healthy side: flex the hip and bend the knee to contract the muscles of the healthy side of the lower limb. Practice 1 set of 30 reps every 2 hours, each set lasts 10 to 15 seconds.
2. Early training of quadriceps contraction and hip lift
On the first day after surgery, continue to perform ankle joint exercises, and at the same time, perform quadriceps contraction and hip lift training. During the hip lift training, the patient was instructed to hold the hoop above the traction bed with both hands, raise the upper body, and lift the hip off the bed by stirring the leg on the traumatic surface on the healthy side. When there is no traction bed, use both shoulders or both elbow joints and the head for support, stir on the bed with the leg on the healthy side to lift the upper body and buttocks, and pay attention to keeping the affected limb in abducted neutral position when lifting the buttocks. After the hip lift training, a semi-sitting position was given and deep breathing was performed to effectively cough and expel sputum. Functional exercises were performed 3 to 4 times a day, with the following three exercises repeated 10 times each time.
(1) Flexion and extension of hip and knee exercises: Patients can flex and extend the hip and knee joints on their own so that your heel slides towards the hip and then straightens. Be careful not to swing the knee to the sides.
(2) Hip contraction exercise: Tighten the hip muscles in the flat position and hold for 5 seconds.
(3) Abduction exercise: straighten the leg in the horizontal position and spread it out to the sides as far as possible, then retract it, taking care not to bring it completely together.
(4) quadriceps contraction exercises: your front thigh muscles (quadriceps), try to straighten the knee joint, hold for 5-10 seconds, practice 10 times every 10 minutes until you feel a little fatigue of the thigh muscles.
(5) Straight leg raise exercise: your front thigh muscles, straighten the knee joint as much as possible, raise the lower limb (10cm from the bed) and hold it for 5-10 seconds, then lower it slowly. Repeat the exercise, you will feel a little tired thigh muscles.
(6) Hip straightening exercises: active straightening action of the hip joint on the operated side or a pillow under the hip, which can stretch the hip flexors and the anterior part of the joint capsule.
3. The second day after surgery, the patient sits at the bedside to carry out hip and knee joint activities
The doctor and nurse (or family members) will move the patient’s body outward to the bedside, lift the lower limbs on the affected side away from the bed and move with the body at the same time, hang both lower legs naturally on the bedside, bend the knee joint by 90. Sit up and stabilize with pillows or quilts on the back. Pay attention to avoid hip rotation during movement. After you adapt to the sitting position, start to do kicking exercises to increase the mobility of the knee joint.
4. Bedside standing and walking exercises
Starting from the third day after surgery, continue the previous exercise according to the recovery situation, and further increase the exercises in sitting and standing position to restore the normal hip mobility and strengthen the muscle strength at the same time. Most patients can already perform the following rehabilitation training elements with partial weight-bearing.
(1) How to get down to the ground.
★ Place the walker next to the operated leg and move the body toward the bedside.
★ Move the operated side leg under the bed to prevent external rotation of the operated side hip.
★ Move the leg on the healthy side under the bed, turn the body and stand with the walker.
(2) How to sit down.
Before sitting down, prepare well, need a chair with backrest and armrest, add cushion, back up, watch the position, hold steady with both hands and sit down slowly. Hip flexion should not exceed 90b, and sit in a higher chair.
(3) How to stand.
When standing up from the chair, first move your body to the edge of the chair, put the affected limb in front, and let the healthy side leg bear most of the body weight.
(4) Standing exercises.
You will feel dizzy at first, so make sure someone is there to assist you until you have enough strength to stand on your own. You must hold the handrail next to the bed or the wall when doing standing exercises, and practice 3 to 4 times a day.
★ Standing leg lift exercise.
Hold the handrail with both hands and lift your affected leg, pay attention to the knee joint not to exceed the waist when lifting the leg, practice 2 to 3 times each time.
Standing back extension and abduction exercises.
Slowly extend the affected limb backward, lift your head and chest, stretch the hip capsule and hip flexors, pay attention to keep your upper body upright, 2 to 3 times each time; then lift the lower limb straight up and outward, slowly retract it, stretch the hip abductor and adductor muscles, 2 to 3 times each time.
(5) How to walk with a walking aid
First use the walker to assist walking, and when the center of gravity is stable, use the bilateral axillary canes instead. First place the walker at 20 cm in front of the body, first step on the art side leg, then the healthy side leg to follow, and so on.
At the beginning, walk 3-4 times a day for 5-10 minutes each time; then gradually get used to it and increase to 2-3 times a day for 20-30 minutes each time. After full recovery, you should keep walking 3 to 4 times for 20 to 30 minutes each time. Walking helps you maintain the strength of the muscles around the hip joint.
Second, rehabilitation training for biologic total hip arthroplasty for femoral neck fracture: keep the affected limb in abducted neutral position after surgery, and focus on muscle exercise and ankle exercise during bed rest, such as quadriceps stretching, ankle flexion and extension, and rotation activities. From the 3rd day after surgery, the knee joint flexion and extension exercises can be performed by sitting at the bedside according to the whole body condition, while the bedside standing of the affected limb without weight bearing can be practiced; from the 6th week onwards, walking exercises without weight bearing or partial weight bearing can be performed with the help of crutches, and after 3 months, weight bearing walking with the help of crutches can be considered according to the x-ray picture.
Third, femoral neck fracture hollow nail threaded internal fixation rehabilitation training: 1 week after surgery to active muscle exercise and passive joint exercise, such as quadriceps flexion and contraction exercise, CPM lower limb joints passive exercise; the second week onwards can sit up ankle and knee joint exercise, such as ankle, knee flexion and extension activities; the sixth week onwards can support the affected limb walking without weight bearing. The time of weight-bearing exercises for the affected limb was determined according to the fracture healing condition after six months.