Inkqubo eqhelekileyo yoqeqesho lokuvuselela ukuqhekeka kwemisipha ye-Achilles, eyona njongo iphambili yokuvuselela kukuba: ukhuseleko kuqala, umthambo wokuvuselela ngokwendlela abaziqonda ngayo.
Inqanaba lokuqala emva kotyando
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Ixesha lokukhusela nokuphiliswa (iiveki 1-6).
Izinto ezifuna ingqwalasela: 1. Kuphephe ukolula okungenziwanga kwe-Achilles tendon; 2. Idolo elisebenzayo kufuneka ligobe kwi-90°, kwaye i-ankle dorsiflexion kufuneka inqunyelwe kwindawo engathathi cala (0°); 3. Kuphephe ukucinezelwa okushushu; 4. Kuphephe ukugoba ixesha elide.
Ukuhamba kwamalungu kwangoko kunye nokuthwala ubunzima obukhuselekileyo zezona zinto zibalulekileyo kwixesha lokuqala emva kotyando. Kuba ukuthwala ubunzima kunye nokuhamba kwamalungu kukhuthaza ukuphiliswa kunye namandla e-Achilles tendon, kwaye kunokuthintela iziphumo ezimbi zokungashukumi (umz., ukuphelelwa ngamandla kwemisipha, ukuqina kwamalungu, isifo samathambo esiwohlokayo, ukwakheka kokunamathela, kunye ne-deep cerebral thrombus).
Izigulane zayalelwa ukuba zenze imisebenzi emininzi esebenzayoijoyintiiintshukumo zemihla ngemihla, kuquka ukujija kweqakala, ukujija kwezityalo, i-varus, kunye ne-valgus. Ukujija kweqakala okusebenzayo kufuneka kunqunyelwe kwi-0° kwi-90° yokujija kwedolo. Ukunyakaza kwamalungu angenamsebenzi kunye nokuzolula kufuneka kuthintelwe ukukhusela i-Achilles tendon ephilisayo ekuzoluleni kakhulu okanye ekuqhekekeni.
Xa isigulana siqala ukuthwala ubunzima obupheleleyo, umthambo webhayisekile ongashukumiyo unokuqaliswa ngeli xesha. Isigulana kufuneka siyalelwe ukuba sisebenzise umva wonyawo endaweni yonyawo lwangaphambili xa sikhwela ibhayisekile. Ukuhlikihla isiva kunye nentshukumo elula yamalungu kunokukhuthaza ukuphiliswa kunye nokuthintela ukunamathelana kunye nokuqina kwamalungu.
Unyango lomkhuhlane kunye nokuphakamisa ilungu elichaphazelekayo kunokulawula iintlungu kunye nokudumba. Izigulane kufuneka ziyalelwe ukuba ziphakamise ilungu elichaphazelekayo kangangoko kunokwenzeka imini yonke kwaye zingagcini ubunzima ixesha elide. Isigulane sinokucetyiswa ukuba sisebenzise iipakethe zomkhenkce izihlandlo ezininzi kangangemizuzu engama-20 ngalo lonke ixesha.
Ukuzilolonga kwesinqe esikufutshane nedolo kufuneka kusebenzise inkqubo yoqeqesho lokuxhathisa oluqhubekekayo. Ukuzilolonga okuvula iintambo kunye noomatshini be-isotonic kunokusetyenziswa zizigulane ezinobunzima obulinganiselweyo.
Amanyathelo onyango: Xa usebenzisa intonga okanye udondolo phantsi kwesikhokelo sikagqirha, nxiba i-progressive weight bearing phantsi kwezihlangu eziqinileyo ezinevili; i-ankle dorsiflexion/plantar flexion/varus/valgus; i-massage scar; ukukhulula amalungu; umthambo wokuqina kwemisipha; unyango lomzimba; unyango lokubanda.
Iiveki 0-2: Ukunganyakazi kwe-brace yemilenze emifutshane, iqatha likwindawo engathathi cala; i-bearing yobunzima obungaphelelanga kunye neentonga ukuba ziyanyamezelwa; umkhenkce + unyango lwe-local compression/pulse magnetic; ukugoba idolo kunye nokukhuselwa kweqatha Ukugoba kwe-plantar esebenzayo, i-varus, i-valgus; i-resistance quadriceps, i-gluteal, uqeqesho lokuhluthwa kwe-hip.
Iiveki ezi-3: Inkxaso yemilenze emifutshane ayishukumi, iqatha likwindawo engathathi hlangothi. Ukuhamba okuqhubekekayo okuthwele ubunzima obuncinci ngeentonga; i-ankle plantar flexion/foot varus esebenzayo, uqeqesho lwe-foot valgus (+- balance board training); Ikhawulezisa iintshukumo ezincinci zeqatha (intertarsal, subtalar, tibiotalar) kwindawo engathathi hlangothi; iyamelana noqeqesho lwe-quadriceps, gluteal, kunye ne-hip abduction.
Iiveki ezi-4: Uqeqesho lwe-ankle dorsiflexion olusebenzayo; ukujija kwe-plantar esebenzayo, i-varus, kunye ne-eversion ngeentambo zerabha ze-elastic; uqeqesho lokuhamba oluthwala ubunzima obuncinci-uqeqesho lwe-isokinetic oluphantsi lokumelana (>30 degrees/sec); uqeqesho lwe-treadmill lokuvuselela isithende esiphantsi lokumelana.
Iiveki ezi-5: Susa i-ankle brace, kwaye abanye abaguli banokuya kuqeqesho lwangaphandle; uqeqesho lokuphakamisa ithole lemilenze emibini; uqeqesho lokuhamba olungenabunzima obuthile-uqeqesho lokumelana nobunzima obuphakathi (20-30 degrees/sekondi); uqeqesho lwe-treadmill yokuvuselela isithende esisezantsi; Uqeqesho lokushukuma (ukuzikhusela ngexesha lokuchacha).
Iiveki ezi-6: Zonke izigulana zikhuphe iibraces kwaye zenze uqeqesho lokuhamba phezu komphezulu othe tyaba ongaphandle; uqeqesho oluqhelekileyo lokwandiswa kwemisipha ye-Achilles kwindawo yokuhlala; uqeqesho lokuqina kwemisipha oluphantsi (olungashukumiyo) (ukumelana ne-varus, ukumelana ne-valgus) amaqela amabini; uqeqesho lokulinganisela umlenze omnye (Icala eliphilileyo --- icala elichaphazelekayo liyatshintsha kancinci kancinci); uhlalutyo lokuhamba ngokuhamba.
Iikhrayitheriya zokunyuswa: iintlungu kunye nokudumba ziyalawulwa; ukuthwala ubunzima kungenziwa phantsi kwesikhokelo sikagqirha; ukugoba kweqakala kufikelela kwindawo engathathi cala; amandla emisipha esezantsi afikelela kwibanga lesi-5/5.
Inqanaba lesibini emva kotyando
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Kwinqanaba lesibini, bekukho utshintsho olucacileyo kwinqanaba lokuthwala ubunzima, ukwanda kwe-ROM yelungu elichaphazelekayo kunye nokwandiswa kwamandla emisipha.
Injongo ephambili: Ukubuyisela umgama owaneleyo wokusebenza wokuhamba okuqhelekileyo kunye nokunyuka izitebhisi. Buyisela i-ankle dorsiflexion, i-varus, kunye namandla e-valgus kwibanga eliqhelekileyo le-5/5. Buyela kwi-normal gait.
Amanyathelo onyango:
Ikhuselwe, inokumelana nokuhamba nzima xa ithwele ubunzima, kwaye inokukhumula iinduku xa kungekho ntlungu; inkqubo yokuziqhelanisa ne-treadmill phantsi kwamanzi; i-heel pad efakwe kwizihlangu inceda ukubuyisela ukuhamba okuqhelekileyo; i-ankle dorsiflexion/plantar flexion/varus/valgus exercises; uqeqesho lokuzimela; i-isometric/isotonic strength exercises: i-ankle inversion/valgus.
Uqeqesho lokuqala lwemisipha ye-neuromuscular kunye ne-joint lokukhuthaza ukubuyiselwa kwe-proprioception, i-neuromuscular kunye ne-balance. Njengoko amandla kunye ne-balance zibuyiselwa, indlela yokuzilolonga nayo itshintsha ukusuka kwi-end esezantsi ukuya kwi-end esezantsi ecaleni kwelinye icala. Ukuphululwa kwamanxeba, unyango lomzimba, kunye nokuhlanganiswa kwamalungu amancinci kufuneka kuqhubeke njengoko kufuneka.
Iiveki ezisi-7-8: Isigulana kufuneka siqale sinxibe i-brace phantsi kokhuselo lwee-crutches ukuze sigqibezele ukuthwala ubunzima belungu elichaphazelekayo, size emva koko sikhulule ii-crutches size sinxibe izihlangu ukuze sithwale ubunzima ngokupheleleyo. I-heel pad ingafakwa kwisihlangu ngexesha lokutshintsha ukusuka kwi-brace yeenyawo ukuya kwisihlangu.
Ukuphakama kwe-heel pad kufuneka kwehle njengoko uluhlu lokunyakaza kwelungu lusanda. Xa i-hait yesigulana ibuyela kwisiqhelo, i-heel pad inokupheliswa.
Ukuhamba okuqhelekileyo kuyimfuneko ukuze uhambe ngaphandle kokuxhwilwa. Iipompo zeqatha ziquka ukujijeka kwe-plantar kunye nokwandiswa kwe-dorsi. I-Dorsiflexion ithetha ukuba iinzwane zibotshelelwe ngasemva ngamandla kangangoko kunokwenzeka, oko kukuthi, unyawo luphoqeleka ukubuyela kwindawo enomda;
Kule nqanaba, umthambo wokuqinisa izihlunu we-inversion kunye ne-inversion isometric ungaqaliswa, kwaye iibhendi zerabha zingasetyenziselwa ukuziqhelanisa kwinqanaba elilandelayo. Yakha amandla ezihlunu ngokuzoba imilo yoonobumba ngeqatha lakho kwisixhobo esine-axis ezininzi. Xa kufinyelelwe uluhlu olwaneleyo lokushukuma.
Ungaqala ukuziqhelanisa nezihlunu ezibini eziphambili ze-plantar flexion yethole. Uqheliso lokumelana ne-Plantar flexion kunye ne-knee flexion ukuya kwi-90° lunokuqaliswa kwiiveki ezi-6 emva kotyando. Uqheliso lokumelana ne-Plantar flexion kunye nedolo eloluliweyo lunokuqaliswa ngeveki yesi-8.
Ukujija kwePlantar nako kungenziwa kweli nqanaba kusetyenziswa isixhobo sokujija esinwetshiweyo ngamadolo kunye nomatshini wokugoba imilenze. Ngeli xesha, umthambo webhayisekile omiselweyo kufuneka wenziwe ngenyawo yangaphambili, kwaye ubungakanani kufuneka bunyuswe kancinci kancinci. Ukuhamba ngasemva kwi-treadmill kuphucula ulawulo lokujija kwe-plantar olungaqhelekanga. Aba baguli badla ngokufumana ukuhamba ngasemva kukhululekile kuba kunciphisa isidingo sokuyilungisa. Kukwanokwenzeka ukwazisa umthambo wenyathelo lokuya phambili. Ukuphakama kwamanyathelo kunokwandiswa kancinci kancinci.
Ukuqubha nge-micro-squat kunye nokukhuselwa kweqatha (i-Achilles tendon yoluliwe phantsi kwengcamango yentlungu enyamezelekayo); amaqela amathathu oqeqesho lwemisipha olujikelezayo oluphakathi (olungashukumiyo) (ukumelana ne-varus, ukumelana ne-valgus); Ukuphakamisa iinzwane (uqeqesho lwe-soleus olunamandla); ukuphakamisa iinzwane ngamadolo athe nkqo kwindawo yokuhlala (uqeqesho lwe-gastrocnemius olunamandla).
Xhasa ubunzima bomzimba kwi-balance bar ukuze uqinise uqeqesho lokuhamba ngokuzimela; yenza uqeqesho lokuphakamisa ithole +- EMG xa umile; yenza uhlengahlengiso lokuhamba phantsi kwe-treadmill; yenza uqeqesho lokubuyisela i-treadmill kwi-rehabilitation nge-forefoot (malunga nemizuzu eli-15); uqeqesho lokulinganisela (ibhodi yokulinganisela).
Iiveki ezili-9-12: uqeqesho lokwandisa ithole elime nge-triceps; uqeqesho lokuphakamisa ukumelana nethole elime nge-early (iinzwane zichukumisa umhlaba, ukuba kuyimfuneko, kunokongezwa ukuvuselelwa kwemisipha ngombane); uqeqesho lokunyamezela i-treadmill yokuvuselela iinyawo zangaphambili (malunga nemizuzu engama-30); ukuphakanyiswa kweenyawo, uqeqesho lokuhamba ngeenyawo, inyathelo ngalinye likude ngee-intshi ezili-12, kunye nolawulo olujikelezayo nolungaqhelekanga; ukuhamba phambili ukunyuka intaba, ukuhamba umva uhla; uqeqesho lokulinganisela i-trampoline.
Emva kokuvuselelwa
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Iveki ye-16: Uqeqesho lokuguquguquka (iTai Chi); ukuqala kwenkqubo yokusebenza; uqeqesho lwe-isometric olunamanqaku amaninzi.
Iinyanga ezi-6: Ukuthelekiswa kwamalungu asezantsi; uvavanyo lokuzilolonga lwe-isokinetic; uphando lohlalutyo lokuhamba; ukuphakamisa ithole lomlenze omnye imizuzwana engama-30.
I-Sichuan CAH
WhatsApp/Wechat: +8615682071283
Email: liuyaoyao@medtechcah.com
Ixesha lokuthumela: Novemba-25-2022
