一、根(gen)骨(gu)(gu)骨(gu)(gu)折后如(ru)何鍛煉(lian)
1.主動運動
受(shou)累關節(jie)進(jin)行(xing)各(ge)運動(dong)軸方向的(de)主動(dong)活動(dong)，包(bao)括(kuo)擺(bai)動(dong)訓練、牽張訓練等(deng)。運動(dong)幅度應逐漸增大，在患者耐受(shou)范圍內進(jin)行(xing)，每(mei)(mei)次(ci)3 0 分鐘左右，每(mei)(mei)日數次(ci)。有時(shi)為提高治療效(xiao)果，宜(yi)每(mei)(mei)小(xiao)時(shi)進(jin)行(xing)一次(ci)，每(mei)(mei)次(ci)5 ～1 0 分鐘。
2.被動運動
對有(you)組織攣縮及(ji)粘(zhan)連嚴重，造(zao)(zao)成(cheng)主動運動及(ji)助(zhu)(zhu)力運動無(wu)效者，可(ke)采(cai)用(yong)被(bei)動牽(qian)拉(la)或關(guan)節(jie)松動技術，來松動僵硬(ying)的關(guan)節(jie)，但牽(qian)拉(la)應平穩、輕柔，不(bu)應引起明顯疼痛和腫脹。切忌(ji)暴(bao)力，以免造(zao)(zao)成(cheng)新(xin)的組織損傷。足跟因為出于(yu)血液循環的末端，恢復會相對較慢。剛開(kai)始鍛煉，還是(shi)要(yao)拄拐(guai)(guai)，慢慢從兩拐(guai)(guai)換成(cheng)一拐(guai)(guai)直到不(bu)用(yong)拐(guai)(guai)，不(bu)可(ke)著急，這(zhe)一過(guo)(guo)程可(ke)能(neng)需(xu)要(yao)2個(ge)月左右，因人而異。每(mei)天的鍛煉時(shi)間以你(ni)本人能(neng)承(cheng)受為宜(yi)，不(bu)可(ke)過(guo)(guo)度鍛煉造(zao)(zao)成(cheng)再次損傷，鍛煉過(guo)(guo)程的腫痛是(shi)難(nan)免的，可(ke)用(yong)熱水泡腳，并(bing)把患肢抬高(gao)加以緩解，必要(yao)時(shi)可(ke)輔(fu)助(zhu)(zhu)吃點消(xiao)炎鎮痛藥。長期行走足痛是(shi)正(zheng)常的，至(zhi)于(yu)跑步、打球(qiu)等運動估計要(yao)在1年以后了。運動要(yao)適當，不(bu)可(ke)超之過(guo)(guo)急，根(gen)據自身(shen)(shen)的身(shen)(shen)體情況(kuang)慢慢增加運動量。
二、跟骨骨折(zhe)早期(qi)的治療(liao)方法
(1)患肢抬高
有助于(yu)腫脹(zhang)消退，患肢的遠(yuan)端(duan)必須高于(yu)近(jin)端(duan)，近(jin)端(duan)要高于(yu)心(xin)臟平面。
(2)物理療法
作用(yong)(yong)(yong)為消炎，減(jian)輕腫脹，緩(huan)解(jie)疼痛(tong)，改善(shan)血液循(xun)環(huan)，促(cu)進(jin)骨(gu)痂形成，促(cu)進(jin)骨(gu)折(zhe)愈合，軟化瘢痕(hen)，松解(jie)粘(zhan)連。①超短波：患部(bu)(bu)對置，骨(gu)折(zhe)1 周內，無(wu)熱(re)量， 10分鐘(zhong)(zhong)/ 次(ci)(ci)，1 周以(yi)后，微熱(re)量，10～15 分鐘(zhong)(zhong)/ 次(ci)(ci)， 1次(ci)(ci)/ 天(tian) ，20～30次(ci)(ci)為1療(liao)(liao)程(cheng)。此法可(ke)在石膏(gao)外(wai)進(jin)行(xing)，但有(you)金(jin)屬(shu)內固(gu)定物時禁(jin)用(yong)(yong)(yong)。②紫外(wai)線：骨(gu)折(zhe)體表部(bu)(bu)位(wei)(wei)，弱(ruo)紅斑量或(huo)中(zhong)紅斑量，每日或(huo)隔(ge)日1 次(ci)(ci)，6 ～8 次(ci)(ci)為1 療(liao)(liao)程(cheng)。如局部(bu)(bu)石膏(gao)固(gu)定，可(ke)在健(jian)側相應部(bu)(bu)位(wei)(wei)照(zhao)射。③磁(ci)(ci)療(liao)(liao)：選用(yong)(yong)(yong)脈沖電(dian)磁(ci)(ci)療(liao)(liao)法，患肢位(wei)(wei)于環(huan)狀(zhuang)磁(ci)(ci)極中(zhong)，或(huo)采取患部(bu)(bu)對置法，2 0 分鐘(zhong)(zhong)/ 次(ci)(ci)，1 次(ci)(ci)/ 天(tian)， 20次(ci)(ci)為1療(liao)(liao)程(cheng)。④超聲(sheng)波、音頻電(dian)或(huo)超聲(sheng)- 中(zhong)頻電(dian)療(liao)(liao)均可(ke)應用(yong)(yong)(yong)。⑤按摩：在骨(gu)折(zhe)部(bu)(bu)位(wei)(wei)的近心端進(jin)行(xing)按摩，使(shi)用(yong)(yong)(yong)向(xiang)心性(xing)手法，1 5 分鐘(zhong)(zhong)/ 次(ci)(ci)，1 ～2 次(ci)(ci)/ 天(tian)。
(3)運動療法
主(zhu)動(dong)(dong)(dong)(dong)(dong)運動(dong)(dong)(dong)(dong)(dong)是預防(fang)和消除水腫的(de)(de)(de)最有(you)(you)效、最可行和花費(fei)最少的(de)(de)(de)方法。主(zhu)動(dong)(dong)(dong)(dong)(dong)運動(dong)(dong)(dong)(dong)(dong)有(you)(you)助于靜脈和淋巴回流。①傷(shang)肢(zhi)近端和遠端未被固定(ding)關(guan)(guan)(guan)節(jie)(jie)(jie)的(de)(de)(de)各(ge)個軸位(wei)上的(de)(de)(de)主(zhu)動(dong)(dong)(dong)(dong)(dong)運動(dong)(dong)(dong)(dong)(dong)，必(bi)要時給(gei)予(yu)助力(li)。每(mei)次1 0 分(fen)鐘左右，每(mei)日數次。注(zhu)(zhu)意(yi)逐(zhu)漸增加活(huo)動(dong)(dong)(dong)(dong)(dong)強度(du)，以(yi)(yi)免影響骨折端的(de)(de)(de)穩(wen)定(ding)。上肢(zhi)應(ying)注(zhu)(zhu)意(yi)肩(jian)關(guan)(guan)(guan)節(jie)(jie)(jie)外(wai)展(zhan)、外(wai)旋與手掌(zhang)指關(guan)(guan)(guan)節(jie)(jie)(jie)屈(qu)(qu)伸運動(dong)(dong)(dong)(dong)(dong)及(ji)手的(de)(de)(de)功能(neng)位(wei);下(xia)肢(zhi)應(ying)注(zhu)(zhu)意(yi)踝關(guan)(guan)(guan)節(jie)(jie)(jie)背(bei)屈(qu)(qu)運動(dong)(dong)(dong)(dong)(dong)及(ji)背(bei)屈(qu)(qu)位(wei)。老年患者更應(ying)注(zhu)(zhu)意(yi)防(fang)止肩(jian)關(guan)(guan)(guan)節(jie)(jie)(jie)粘(zhan)連(lian)和僵硬發生(sheng)。②行固定(ding)部位(wei)肌(ji)肉有(you)(you)節(jie)(jie)(jie)奏的(de)(de)(de)等長收縮(suo)訓(xun)練(lian)，以(yi)(yi)預防(fang)廢用性肌(ji)萎縮(suo)，并(bing)使骨折端對合有(you)(you)利，促(cu)進(jin)(jin)(jin)骨愈合。每(mei)次訓(xun)練(lian)1 0 分(fen)鐘左右，每(mei)日數次。③關(guan)(guan)(guan)節(jie)(jie)(jie)內(面)骨折，應(ying)盡早(zao)開始功能(neng)訓(xun)練(lian)，既(ji)可促(cu)進(jin)(jin)(jin)關(guan)(guan)(guan)節(jie)(jie)(jie)軟骨面的(de)(de)(de)修復(fu)塑形(xing)，亦可減(jian)輕關(guan)(guan)(guan)節(jie)(jie)(jie)內粘(zhan)連(lian)。一般在(zai)固定(ding)2 ～3 周(zhou)后(hou)，每(mei)日短時取下(xia)外(wai)固定(ding)裝置，進(jin)(jin)(jin)行損(sun)傷(shang)關(guan)(guan)(guan)節(jie)(jie)(jie)不負(fu)重(zhong)的(de)(de)(de)主(zhu)動(dong)(dong)(dong)(dong)(dong)運動(dong)(dong)(dong)(dong)(dong)或被動(dong)(dong)(dong)(dong)(dong)運動(dong)(dong)(dong)(dong)(dong)，運動(dong)(dong)(dong)(dong)(dong)結束后(hou)，繼續(xu)原(yuan)位(wei)固定(ding)。若固定(ding)時無特殊需要，關(guan)(guan)(guan)節(jie)(jie)(jie)應(ying)置于功能(neng)位(wei)。這樣，既(ji)可促(cu)進(jin)(jin)(jin)關(guan)(guan)(guan)節(jie)(jie)(jie)軟骨的(de)(de)(de)修復(fu)，利用相應(ying)關(guan)(guan)(guan)節(jie)(jie)(jie)面的(de)(de)(de)研磨塑形(xing)，并(bing)減(jian)少關(guan)(guan)(guan)節(jie)(jie)(jie)內的(de)(de)(de)粘(zhan)連(lian)。④健肢(zhi)和軀干部應(ying)盡可能(neng)維(wei)持(chi)其正常活(huo)動(dong)(dong)(dong)(dong)(dong)，以(yi)(yi)改(gai)善(shan)全身(shen)狀(zhuang)況，防(fang)止合并(bing)癥(壓瘡、呼吸系統(tong)疾患等)的(de)(de)(de)發生(sheng)。
三、跟骨骨折(zhe)后期的治療(liao)方法(fa)
(1)運動療法
1)關(guan)(guan)(guan)節活(huo)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)度訓練(lian)a、助力(li)主(zhu)(zhu)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)運(yun)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)限(xian)制解(jie)除后肢體難以(yi)自主(zhu)(zhu)活(huo)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)，可(ke)采(cai)用助力(li)運(yun)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)，以(yi)后隨(sui)著關(guan)(guan)(guan)節活(huo)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)度的改善，可(ke)減(jian)少助力(li)。b、主(zhu)(zhu)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)運(yun)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)：受(shou)累關(guan)(guan)(guan)節進(jin)行(xing)(xing)各(ge)運(yun)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)軸方向(xiang)的主(zhu)(zhu)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)活(huo)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)，包(bao)括擺動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)訓練(lian)、牽張訓練(lian)等。運(yun)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)幅度應逐漸(jian)增(zeng)大，在患者耐受(shou)范圍(wei)內進(jin)行(xing)(xing)，每次(ci)3 0 分鐘(zhong)左右，每日數次(ci)。有(you)(you)時為提高治療(liao)效果，宜(yi)每小時進(jin)行(xing)(xing)一次(ci)，每次(ci)5 ～1 0 分鐘(zhong)。c、被動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)運(yun)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)：對(dui)有(you)(you)組(zu)(zu)織攣縮及(ji)粘連嚴重(zhong)，造(zao)成(cheng)主(zhu)(zhu)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)運(yun)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)及(ji)助力(li)運(yun)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)無效者，可(ke)采(cai)用被動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)牽拉或關(guan)(guan)(guan)節松動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)技術(shu)，來(lai)松動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)僵硬的關(guan)(guan)(guan)節，但牽拉應平穩、輕柔，不(bu)應引(yin)(yin)起明顯疼痛和腫脹。切忌暴力(li)，以(yi)免造(zao)成(cheng)新(xin)的組(zu)(zu)織損傷(shang)。方法(fa)有(you)(you)：關(guan)(guan)(guan)節連續性被動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)運(yun)動(dong)(dong)(dong)(dong)(dong)(dong)(dong)(dong)。手法(fa)治療(liao)。牽引(yin)(yin)療(liao)法(fa)。
(2)肌力增強訓練
a、肌力(li)(li)增(zeng)強(qiang)運(yun)(yun)動(dong)被動(dong)運(yun)(yun)動(dong)：當肌力(li)(li)檢查評(ping)(ping)定(ding)為0-1級時采用助力(li)(li)主(zhu)(zhu)(zhu)動(dong)運(yun)(yun)動(dong)：當肌力(li)(li)檢查評(ping)(ping)定(ding)為1級或2級時采用主(zhu)(zhu)(zhu)動(dong)運(yun)(yun)動(dong)：恢復到3級肌力(li)(li)時開始主(zhu)(zhu)(zhu)動(dong)運(yun)(yun)動(dong)訓(xun)(xun)練。抗(kang)阻運(yun)(yun)動(dong)：當肌力(li)(li)檢查評(ping)(ping)定(ding)為4-5級時采用b、等(deng)(deng)長(chang)運(yun)(yun)動(dong)：在要求(qiu)保持(chi)術后體位的(de)(de)(de)期間內需要進(jin)行等(deng)(deng)長(chang)性(xing)運(yun)(yun)動(dong)。如圖8所示等(deng)(deng)長(chang)肌力(li)(li)訓(xun)(xun)練。c、等(deng)(deng)張運(yun)(yun)動(dong)：隨著關節活動(dong)度(du)的(de)(de)(de)擴大及主(zhu)(zhu)(zhu)動(dong)運(yun)(yun)動(dong)的(de)(de)(de)增(zeng)大，開始進(jin)行等(deng)(deng)張性(xing)運(yun)(yun)動(dong)。如圖9所示髖關節外(wai)展抗(kang)阻運(yun)(yun)動(dong)對抗(kang)彈性(xing)帶(dai)拉(la)力(li)(li)下髖外(wai)展以增(zeng)強(qiang)肌力(li)(li)。d、等(deng)(deng)速(su)運(yun)(yun)動(dong)：動(dong)態性(xing)訓(xun)(xun)練使(shi)肌力(li)(li)以迅(xun)速(su)增(zeng)加(jia)，等(deng)(deng)速(su)性(xing)運(yun)(yun)動(dong)可進(jin)一(yi)步強(qiang)化肌力(li)(li)。常見的(de)(de)(de)訓(xun)(xun)練速(su)度(du)為60°/s，120°/s和180°/s的(de)(de)(de)收縮(suo)速(su)率。
四、如何預(yu)防跟骨(gu)骨(gu)折
(一)練功強身
應積極長期地堅持鍛煉，增多在戶外活(huo)動(dong)時間，多呼吸新鮮(xian)空(kong)氣(qi)，促進全身血(xue)液循環(huan)和新陳代謝。可(ke)選(xuan)擇散步、慢跑、太(tai)極拳、保健操(cao)等項(xiang)目。多活(huo)動(dong)能使血(xue)液中的鈣質更多地在骨骼(ge)內(nei)存留，因而提高(gao)骨的硬度(du)，能有效地減少(shao)骨折的發生。
(二)多曬太陽
陽光可以促(cu)進(jin)維(wei)生素D的(de)(de)(de)合成(cheng)，而鈣的(de)(de)(de)代謝(xie)依(yi)賴(lai)維(wei)生素D的(de)(de)(de)作用;陽光中(zhong)的(de)(de)(de)紫外線能促(cu)進(jin)體(ti)內鈣的(de)(de)(de)形(xing)成(cheng)和吸(xi)收(shou)，維(wei)持正(zheng)常的(de)(de)(de)鈣磷代謝(xie)，使骨骼中(zhong)鈣質增(zeng)加(jia)而提高(gao)骨的(de)(de)(de)硬度。
(三)未病先防
老年人(ren)不(bu)宜(yi)(yi)到(dao)人(ren)多和(he)車多的(de)地(di)方活動(dong)，下(xia)雨、下(xia)雪或地(di)上(shang)積(ji)水、結冰時(shi)不(bu)要外出，以(yi)免跌(die)倒而(er)(er)發生骨折。不(bu)要攀(pan)登梯(ti)子或爬(pa)高活動(dong)，不(bu)宜(yi)(yi)在陡坡上(shang)行走，因老年人(ren)下(xia)肢(zhi)無(wu)力(li)，反應(ying)遲鈍而(er)(er)易(yi)跌(die)倒。平時(shi)出門時(shi)，須(xu)緩步慢行，若有(you)眼花(hua)、耳聾、頭暈等癥狀時(shi)盡量減少外出，必須(xu)外出時(shi)要有(you)幫(bang)助攙扶走路或手(shou)拄拐杖。夜間上(shang)廁所(suo)之前(qian)，應(ying)先在床(chuang)沿坐(zuo)上(shang)片刻，以(yi)使腿(tui)部肌肉力(li)量處于興奮狀態，并可防止(zhi)(zhi)體位(wei)改(gai)變時(shi)的(de)一時(shi)性低血(xue)壓的(de)發生。洗(xi)澡時(shi)，要準備好小凳子，坐(zuo)著穿褲(ku)和(he)鞋，防止(zhi)(zhi)跌(die)倒。
(四)飲食調攝
多吃(chi)蔬菜、蛋白質和(he)(he)富(fu)有維生素的(de)飲(yin)食(shi)(shi)，可(ke)防止(zhi)骨質疏松(song)的(de)發生和(he)(he)發展。骨折早期(qi)飲(yin)食(shi)(shi)宜(yi)清淡，以利于祛(qu)瘀(yu)消腫，后(hou)期(qi)應偏味(wei)重，選擇合(he)適(shi)的(de)飲(yin)食(shi)(shi)調(diao)補(bu)肝腎(shen)，有利于骨折的(de)愈合(he)和(he)(he)功能的(de)恢復。
(五)密切觀察
當遭受損傷(shang)后(hou)(hou)，如(ru)(ru)(ru)懷(huai)疑有(you)骨(gu)(gu)折(zhe)應(ying)(ying)及時去醫院(yuan)診(zhen)治。在轉(zhuan)送途中(zhong)，應(ying)(ying)采(cai)取必要的(de)(de)臨(lin)時固(gu)(gu)(gu)定(ding)(ding)措施。如(ru)(ru)(ru)上(shang)(shang)肢(zhi)(zhi)(zhi)骨(gu)(gu)折(zhe)應(ying)(ying)用(yong)木(mu)(mu)板(ban)將(jiang)(jiang)手(shou)臂固(gu)(gu)(gu)定(ding)(ding)，木(mu)(mu)板(ban)長(chang)度應(ying)(ying)超過骨(gu)(gu)折(zhe)部(bu)位的(de)(de)上(shang)(shang)、下(xia)兩個關節面(mian)。也可(ke)將(jiang)(jiang)骨(gu)(gu)折(zhe)的(de)(de)手(shou)臂與胸部(bu)縛(fu)在一起(qi)(qi)固(gu)(gu)(gu)定(ding)(ding)。下(xia)肢(zhi)(zhi)(zhi)骨(gu)(gu)折(zhe)可(ke)用(yong)長(chang)木(mu)(mu)板(ban)將(jiang)(jiang)傷(shang)肢(zhi)(zhi)(zhi)縛(fu)扎(zha)(zha)在一起(qi)(qi)，木(mu)(mu)板(ban)長(chang)度上(shang)(shang)至腋下(xia)，下(xia)應(ying)(ying)超過腳跟(gen)，或可(ke)將(jiang)(jiang)患肢(zhi)(zhi)(zhi)與另(ling)一健肢(zhi)(zhi)(zhi)縛(fu)扎(zha)(zha)在一起(qi)(qi)固(gu)(gu)(gu)定(ding)(ding)。脊柱骨(gu)(gu)折(zhe)應(ying)(ying)由(you)雙人平行(xing)搬至木(mu)(mu)板(ban)上(shang)(shang)縛(fu)扎(zha)(zha)固(gu)(gu)(gu)定(ding)(ding)，頸椎骨(gu)(gu)折(zhe)應(ying)(ying)將(jiang)(jiang)頭(tou)部(bu)兩側用(yong)沙(sha)袋墊好，限制頭(tou)部(bu)活動，然(ran)后(hou)(hou)才(cai)能送醫院(yuan)。如(ru)(ru)(ru)有(you)出血(xue)，應(ying)(ying)用(yong)清潔布臨(lin)時包扎(zha)(zha)傷(shang)口，然(ran)后(hou)(hou)用(yong)止血(xue)帶(dai)結扎(zha)(zha)。一般止血(xue)帶(dai)結扎(zha)(zha)時間每(mei)次不(bu)超過1小(xiao)時，每(mei)隔(ge)1小(xiao)時可(ke)放(fang)松止血(xue)帶(dai)1～2分鐘，以看到鮮血(xue)流出為止，可(ke)防(fang)止因結扎(zha)(zha)時間過長(chang)而引(yin)(yin)起(qi)(qi)肢(zhi)(zhi)(zhi)體缺血(xue)壞死。用(yong)石(shi)膏(gao)(gao)等(deng)方法(fa)作骨(gu)(gu)折(zhe)固(gu)(gu)(gu)定(ding)(ding)后(hou)(hou)，24小(xiao)時內(nei)須密切觀察傷(shang)肢(zhi)(zhi)(zhi)末端(duan)皮膚(fu)色澤的(de)(de)變化和腫(zhong)脹情況(kuang)。如(ru)(ru)(ru)發現腫(zhong)脹加劇，皮膚(fu)有(you)瘀(yu)紫應(ying)(ying)立即就診(zhen)，放(fang)松或拆除(chu)石(shi)膏(gao)(gao)，以防(fang)因石(shi)膏(gao)(gao)固(gu)(gu)(gu)定(ding)(ding)太緊而引(yin)(yin)起(qi)(qi)肢(zhi)(zhi)(zhi)體缺血(xue)、回(hui)流不(bu)暢而壞死。骨(gu)(gu)折(zhe)固(gu)(gu)(gu)定(ding)(ding)期應(ying)(ying)遵醫囑定(ding)(ding)期復查。
(六)功能鍛煉
在醫(yi)生指導(dao)下積極鍛煉未(wei)受傷的(de)(de)(de)關節，每(mei)(mei)天每(mei)(mei)小時一(yi)百次(ci)，能避免關節僵(jiang)硬、攣縮和(he)肌(ji)肉萎縮。采用輕按摩(mo)的(de)(de)(de)方(fang)法(fa)自(zi)我(wo)按摩(mo)，可促(cu)進局(ju)部(bu)血液循(xun)環，有利于(yu)骨折(zhe)的(de)(de)(de)恢(hui)復。
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