1. After local fixation, keep the posture of holding your chest and lifting your shoulders, practice various activities of your hands, wrists and elbows, and ask you to practice abduction and extension of your shoulder joint. If you hold your chest out and your hands rested on your hips, you can go down to the ground except for patients who have to stay in a prone position and be fixed. However, you should avoid doing some movements, such as shoulder flexion and adduction. 2. The exercise can be carried out according to the following steps. First, practice the movements of the shoulder joint in all directions, focusing on the weak aspects, such as the flexion of the shoulder joint, the range of motion from small to large, and the number of times from small to large, and then practice the circular movements of the shoulder joint and the paddling with both arms. Forearm rotation is forbidden to be externally fixed with small splint or plaster for 7-9 weeks.
Attention should be paid to femoral neck fracture
1, skin traction or tibial traction for 7- 10 days. Patients over the age of 65 can undergo artificial femoral head replacement and walk on the ground with crutches after 3 weeks. Young and middle-aged people can take vascular bone flap transplantation and stay in bed for 3 months, so they can't bear it too early. The affected limb mainly exercises isometric contraction of quadriceps femoris, passive activity of knee joint, flexion and extension of ankle joint and foot activity to avoid muscle atrophy of quadriceps femoris, adhesion of knee extension device and ankylosis of ankle joint and foot joint.
Patella fracture should be paid attention to
1. After the early pain is relieved slightly after the injury, you should start to practice isometric contraction of quadriceps femoris, not less than 100 times per hour, so as to prevent quadriceps femoris from adhesion, atrophy and weakness of knee extension, and lay a good foundation for walking on the ground. If there is no taboo, you should push the patella left and right at any time to prevent the patella from adhering to the articular surface and practice ankle and foot joint activities. 2. For tension band internal fixation, the quadriceps femoris should be actively contracted 3-5 days after operation. After the pain is relieved, they can practice raising the flexion and extension of the affected limb and knee joint. 2-3 weeks after the operation, you should start weight-bearing exercise. Patients in the first place should avoid falling. After standing still, they can practice squatting to further increase knee joint activity.
2 discussion
Femoral neck fracture refers to the fracture from below the femoral head to the base of femur, which belongs to intra-articular fracture except the fracture across the base. Compared with other fractures, the fracture site is special, which leads to large shear force and special blood supply, and is prone to fracture nonunion, avascular necrosis and collapse of femoral head. Since 1960s, AO lag screw, sleeve Rithard screw, compression screw fixation or vascular pedicle bone grafting have been developed at home and abroad, which further improved the fracture healing rate. However, most fractures are still difficult to heal; Even if the fracture heals, the incidence of avascular necrosis of femoral head is as high as 20% ~ 40% due to insufficient blood supply. Based on the fact that femoral head fractures are mostly complete and seriously displaced, most of the elderly people fall because of femoral head fractures, and most of the blood circulation is cut off, which makes it difficult to heal after reduction, so more advanced artificial femoral head replacement and total hip replacement have emerged. In recent years, the domestic research on artificial femoral head has reached a consensus, and the methods to overcome the existing problems are put forward. Bipolar artificial femoral head produced by Bioengineering Company of Beijing Aviation Department was selected in our hospital this time. It has the characteristics of exquisite technology, good biocompatibility and good domestic evaluation. Moreover, bipolar can reduce the shear force and friction between femoral head and acetabulum, and has excellent mobility, long service life and is not easy to produce fatigue fractures. At the same time, the prosthesis can be more fixed by combining with bone cement.
We believe that surgical indications must be selected for artificial femoral head replacement. Because in primary hospitals, the fractures of the elderly are mostly femoral neck fractures, which is of great significance to their classification and selection. There are two classifications: according to the trend of fracture line and according to the trend of fracture line. According to the course of fracture line, there is (1) head-neck type: the fracture line runs obliquely from the posterolateral head, and there is a triangular neck flap on the medial lower side. (2) Subcephalic type: the fracture line passes under the femoral head. More common in the elderly. (3) Transcervical type: the fracture line is low, and it basically runs on the femoral neck, which can be seen in teenagers. According to the fracture line direction, it is classified as Linton's (1949) classification [1] abduction type (1): the angle between the fracture line and the longitudinal axis of the femoral shaft is called Linton's angle, and less than 30 belongs to abduction fracture [1]. (2) adduction type: Linton angle >; 50 is called adduction type [1]. (3) Intermediate type: Linton angle 30 ~ 50 belongs to intermediate type [1]. The greater the Linton angle, the greater the shear stress at the fracture and the more stable the fracture healing. The author thinks that abduction type and intermediate type have the possibility of healing, and the necrosis rate of femoral head is low, so artificial femoral head replacement is generally not suitable, and other methods can be applied. However, once adduction fracture is diagnosed, artificial femoral head replacement should be carried out as soon as possible, so there is almost no possibility of healing. In the past, our hospital used bone traction treatment, but after 3 months or half a year, the femoral head appeared different degrees of necrosis. This has the disadvantages of long-term bed rest, inability to move in the fields and great economic losses.
We think that there are four problems to be paid attention to in artificial femoral head replacement: (1) The operator should have a high sense of responsibility for the patient, and the operation must be meticulous, skilled and skilled. (2) Choose advanced methods and use excellent materials. We use bipolar artificial femoral head of Beijing Jinghang Bioengineering Company and bone cement produced by Tianjin Orthopedic Instrument Factory. The diameter of femoral head must be measured according to X-ray before operation, and the measurement should be based on the healthy side, and then it should be reduced by 15%. According to this data, the artificial femoral head should be selected, and large, medium and small artificial femoral heads should be prepared for use during the operation. (3) Improve the treatment technology. Special attention should be paid to maintaining the length of femur and calcaneus during operation, because too long will lead to limited hip movement or postoperative hip pain; If it is too short, it will lead to the shortening of the affected limb and the failure of the operation due to limping. Therefore, the femoral distance should be kept at 0.7 ~ 1.0 cm. When using the medullary cavity dilator, the quasi-trochanter should be enlarged and leaned forward 15. The use of bone cement should be standardized quickly, and the pulp cavity should be filled by finger pressing. Bone cement can't move after fixation, and it will be reset after curing 15min. Drainage tube should be placed after operation, and the drainage volume should be recorded for 24 hours, so as to estimate the blood loss of patients. Antibiotics should be used to prevent infection 10 ~ 14 days. (4) Cause analysis of side effects of artificial femoral head replacement. According to Fan Fengchuan, beijing jishuitan hospital, 90 cases of monopolar and bipolar artificial femoral head were followed up for 8 years, and the satisfactory rate of curative effect was 96.8% [2], with symptoms such as central dislocation, mainly caused by improper proportion of head and socket [2]. Although many reports have caused postoperative hip pain or aggravated the original pain, there are very few cases that lead to severe loss of limb function. X-ray image analysis shows that acetabular degeneration is an important cause of pain after long-term use of artificial femoral head. Bipolar femoral head can reduce acetabular injury, thus prolonging or reducing the degenerative changes of acetabulum, reducing shear force and avoiding the functional changes of affected limbs caused by loosening and sinking of artificial femoral head after operation [2]. In the author's opinion, many previous reports believed that the failure to use bone cement in the operation was the main reason for the loosening and sinking of the prosthesis. Don't mistakenly think that artificial femoral head replacement is simple and easy, but ignore the complications.
The improvements in treatment and technology of artificial femoral head replacement in our hospital are as follows: (1) Strict selection of suitable artificial femoral head; (2) Strengthening fixation with bone cement; (3) The medullary cavity must be enlarged until the prosthesis is properly placed; (4) After enlarging the medullary cavity, try to repair the prosthesis first; (5) When the prosthesis is placed, it does not need a hammer to directly knock; (6) Strictly control the length of femoral distance. At the same time, with the increase of technical parameters and the accumulation of clinical experience, long-term research should be carried out in the treatment to prevent loosening, sinking and pain of artificial femoral head. If it is emphasized that the diameter of the artificial femoral head must match the acetabulum, the difference should be
refer to
Zhu Tongbo. Plastic surgery. Beijing: People's Health Publishing House,1988,657-659.
2 Fan Fengchuan, Rong Guowei, Zhai Guihua. Long-term follow-up results of artificial femoral head replacement for femoral neck fracture. Chinese Journal of Orthopedics, 1997, 17:96-98.
(Editor Hsinchu)
Author: 5 16400 Department of Orthopaedics, Haifeng County Hospital of Traditional Chinese Medicine, Shanwei City, Guangdong Province
Release date: September 2, 20051