HƯỚNG DẪN PHỤC HỒI CHỨC NẲNG GÃY HAI XƯƠNG CẲNG CHÂN

PHỤC HỒI CHỨC NẲNG GÃY HAI XƯƠNG CẲNG CHÂN

I. ĐẠICƯƠNG

- Gãy 2 xương cẳng chân siêu hay gặp, chiếm 18% các ví như gãy xươngchân.Gãyxươngchàylàxươngchịulựcchínhcủacơthểdovậyyêucầu điều trị và phục hồi chức năng đòi hỏi khácao.

- các biện pháp vật lý trị liệu, di chuyển trị liệu và thuốc được tận dụng để thúc đẩy quá trình liền xương, phục hồi hiệu năng đi lại khớp gối, cổ chân vàchịulựccủaxươngchày.Phòngtránhcácbiếnchứngteocơ,cứngkhớp…

II. CHẨNĐOÁN

1. những công việc của chẩnđoán

1.1. Hỏibệnh

- Tìnhhuốngxảyrachấnthương?

- Thời gian bị chấn thương đến thời điểm hiện tại?

- những biện pháp đã can thiệp, xửtrí?

- Hỏi bệnh nhân có đau chói tại nơi gãykhông?

- Có đau, tránh di chuyển các khớp gối, cổ chân lúc vận độngkhông?

1.2. Khám lâmsàng

- Cơ năng: Cẳng chân bị gập góc nơi gãy, ngắn hơn bên lành và bàn chân xoay rangoài.

- Thựcthể:Sờcóđiểmđauchóihoặccótiếnglạosạocủaxươngvỡ.

- Toàn thân: Bệnh nhân đau nhiều, có thể sốc chấn thương giả dụ gãy hở cả hai xương cẳngchân.

1.3. Chỉ định xét nghiệm cận lâm sàng: Chụp X-quang xương cẳng chân tưthếthẳngvànghiêngđểxácđịnhvàkiểmtravịtrígãyvàđộdilệchcủaxương.

2. Chẩn đoán xác định: Dựa vào phim X-quang chẩn đoán xácđịnh.

3. Chẩn đoán nguyênnhân

Gãy do: chấn thương, loãng xương, lao xương, ung thư xương…

III. PHỤC HỒI CHỨC NẲNG VÀ ĐIỀUTRỊ

1. quy định phục hồi chức năng và điềutrị

- Tiến hànhsớm

- Cố định tốt điểm gãy trong công đoạn bấtđộng

- Giảm đau, giảm phùnề

- Chống huyết khối tĩnhmạch

- Khôi phục lại tầm vận động khớp gối và cổchân

- gia tăng sức mạnh và dẻo dai các nhóm cơ vùng đùi và cẳngchân

- Khôi phục lại dáng đi.

- Lấylạihoạtđộngbìnhthƣờngchobệnhnhân

2. Cácphươngphápvàkỹthuậtphụchồichứcnăng

* Mụcđích:

- gia tăng tuầnhoàn.

- Giảm đau và giảm co thắt cáccơ.

- lớn mạnh tầm di chuyển khớp gối và khớp cổchân.

- lớn mạnh sức mạnh các cơ vùng gối, cổ chân và bànchân.

- Tập dáng điđúng.

* Phươngpháp:

- Cử động những ngón chân để lớn mạnh tuần hoàn và nằm tăng chân để giảm sưng nềchân.

- Gồng cơ tứ đầu đùi, cơ ụngồi

- Tập chủ động có trợ giúp hay tự do những cử động gập duỗi, dạng áp khớp

hông.

- Tậpđinạngvớidángđiđúng,khôngchịusứcnặnghaychịusứcnặng

một phần tuỳ thuộc đường gãy ngang hay chéo và theo chỉ định của bác sỹ.

- Khitháobộtcóthểápdụngbồnxoáy,túichườmnóng.

- Xoabóptrongtưthếnângcaochânđểgiảmsưng.

- Tập chủ động tự do tại khớpgối.

- Tập có lực kháng bằng tay của kỹ thuật viên hay bằng tạ cho những cơ ở cẳng chân, đùi và bànchân.

- Tập điều hợp nhặt vật bằng ngónchân.

- Tậpđitrênđườngthẳng,đitrênđầungónchân,đivớidángđiđúng.

- sinh hoạt trị liệu: chơi những trò chơi dùng bằng haichân.

- Sau khi bỏ bột cần băng chun từ ngón chân đến đầu gối cho đến khi chân hếtsưng.

3. các điều trịkhác

- các thuốc giảm đauParacetamol...

- Cácthuốctáitạokíchthíchliềnxươngnhanh:Calcitonin,Biphosphonat, Calcium…

IV. THEO DÕI VÀ TÁI KHÁM

- Tìnhtrạngổgãy:đau,sưngnề,dilệch,biếndạng…

- Phản ứng của người bệnh trong công đoạn tập luyện: thái độ hợp tác, sự tiếnbộ…

- Tình trạng chung toànthân

- Theo dõi và tái khám sau 3 tháng, 6 tháng và 1năm.

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