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Лечебная гимнастика и трудотерапия.

Лечебная гимнастика и трудотерапия.

Лечебную гимнастику после операции сухожильного шва и тендопластики назначали через 3 недели, тенолиза – через 1 неделю.

Общие методические правила: 1) систематичность занятий; 2) постепенность нагрузки (нарастание нагрузки); 3) длительность занятий; 4) индивидуализация; 5) эмоциональность занятий; 6) регулярный учет эффективности.

Принципы дозировки: 1) продолжительность занятий; 2) число повторений упражнений (движения) в сеансе и количество процедур на лечебный курс; 3) темп упражнений, их амплитуда и степень силовых напряжений; 4) сложность упражнений (количество занятых мышечных групп, количество элементов движений, характер координации); 5) взаимоотношения между упражнениями «местного» и общего характера (упражнения общего и специального характера); 6) насыщенность сеанса, количество и продолжительность перерывов между отдельными упражнениями.

Разработка движений выполняется пассивно на расслабленных мышцах медленно. Комплекс упражнений должен включать полный объем движений в лучезапястном суставе, сгибание и разгибание вначале в суставах здоровых пальцев, затем травмированного пальца поочередно и всех вместе, разведение и сведение пальцев на скользящей поверхности, восстановление супинационно-пронационных движений, восстановление силы захвата предметов. Первые 3 дня каждое движение из назначенного комплекса упражнений выполняется 3-4 раза, последующие дни количество движений следует увеличивать на 1-2 раза. Постепенно в течении 2-3 дней переходят на активные движения. При наличие контрактуры возможно приложение дополнительного (умеренного) пассивного усилия, направленного в сторону, противоположную контрактуре. Интенсивность и продолжительность занятий со временем следует увеличивать. Вырабатывают изолированное, дифференцированное движение в суставах поврежденных пальцев за счет фиксации фаланги пальца, расположенной проксимальнее сустава.

Механотерапию следует проводить в комплексе с лечебной гимнастикой. Вначале упражнения проводят с поролоном различной плотности, затем переходят к более твердым предметам, таким как резиновые и теннисные мячи, деревянные цилиндры,бруски, шары, различные предметы быта, захватывание мелких предметов, расстегивание и застегивание пуговиц различного размера, откравание и закрывание ключом замка, лепка фигур из теплого парафина или просто из пластилина и.т.д.

Все упражнения направлены на выработку стереотипа: активного захвата предметов различной величины, противопоставления пальцев, разведения и сведения, сгибания и разгибания пальцев.

Результаты и их обсуждения.

Оценка отдаленных результатов восстановительных операций на сухожилиях сгибателей пальцев кисти осуществлялась не раньше 5-12 месяцев после оперативного вмешательства. Была использована методика оценки восстановления функции пальцев и кисти после восстановительных операций на сухожилиях Американской ассоциации хирургов кисти (AAHS), в модификации И.Н. Куринного, (1991).

Система построена на количественном определении основных функций кисти: чувствительности, движений, силы основных захватов и анализ координации движений. Результатом расчета является процент потерии функции кисти по сравнению с соответствующими показателями здоровой конечности.

При лечении пациентов основной группы были получены следующие результаты:

- отличные – 78,2%; - хорошие – 20,7%; - удовлетворительные – 1,1%

В контрольной группе мы имели следующие показатели:

- отличные – 13,1%; - хорошие – 56,7%; - удовлетворительные – 20,8%; - неудовлетворительные – 9,4%.

Интегральные показатели функции кисти у больных основной группы намного выше, чем в контрольной группе, что и доказывает целесообразность использования нами нового подхода к реабилитации больных после восстановительных операций на сухожилиях сгибателей пальцев кисти.

Выводы.

Полученные данные свидетельствуют об эффективности используемой нами системы реабилитации больных после оперативного лечения по поводу повреждений сухожилий сгибателей пальцев кисти, достоверном улучшении функции кисти и пальцев, снижения послеоперационных осложнений, в том числе и несостоятельностей сухожильного шва, а также эффективности использования протокольной формы реабилитации, современных схем «домашних» упражнений, эффективности применения информационно-волновой терапии и светолечения.

Комплексное восстановительное лечение в различные периоды после оперативного вмешательства, последовательное направленное восстановление амплитуды движений пальцев и кисти в целом, координация основных функциональных захватов и силы являются обязательными условиями при восстановлении функциональной и профессиональной пригодности кисти.

Список используемой литературы.

1. Белоусов А.Е. Пластическая реконструктивная и эстетическая хирургия. – Санкт-Петербург, изд-во "Гиппократ", 1991. – 743с.

2. Волкова А.М. Хирургия кисти Т.1. – Екатеринбург: Сред.-Урал. кн. изд-во, 1991. – 304с.

3. Дрюк М.М. Хірургічне лікування та післяопераційна реаабілітація хворих з застарілими пошкодженнями сухожиль згиначів пальців кисті в критичній зоні: Автореф. дис. … канд. мед. наук.-К. 1998.-18с.

4. Колонтай Ю.Ю. НауменкоЛ.Ю. Милославский Ф.А. Головаха Н.Д. Хірургія пошкоджень кисті. – Дніпропетровськ: Пороги, 1997.-460с.

5. Крыжановский Я.Й. Пинчук В.Д. Черенок Е.П. Куценок В.А. Опыт применения информационно-волновой терапии (ИВТ) при травматических повреждениях предплечья, кисти и пальцев // Інформаційна та негентропійна терапія. – 1999.-№1.-С.60-61.

6. Львов С.Е. Реабилитация больных с повреждениями кисти: Дис. … д-ра мед. наук. - Нижний Новгород, 1993.-218с.

7. Науменко Л.Ю. Современные возможности применения энзимной терапии при травмах и их последствиях // Системная энзимотерапия. II междунар. науч. конф: Тез. докл. – Санкт-Петербург, 1996.-С.79-84.

8. Рання активна мобілізація при лікуванні застарілих пошкоджень сухожиль згиначів пальців кисті в критичній зоні // Клінічна хірургія. – 1997.-№7-8.-С.52-53.

9. Хірургічне лікування та післяопераційна реабілітація хворих з пошкодженнями сухожиль згиначів пальців кисті / Страфун С.С. НауменкоЛ.Ю. Дрюк М.М. Курінний І.М. // Методичні рекомендації. К.,-1998,-17с.

10. Штутин А.А. Хирургическое лечение открытых повреждений кисти. – Донецк: ООО "Лебедь", 1998.-250с.

11. Kleinert H.E. Schepel S. Gill T. Flexor tendon injuries // Surg. Clin. N. Amer. – 1981.-Vol.61, №2.-P.267-286.

Источник: handsurg-kiev.narod.ru