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第二节 老年骨折(第2页)

章节目录保存书签

与骨折、骨复位不良有关。

4。潜在并发症

骨筋膜室综合征。

知识拓展

骨筋膜室综合征

骨筋膜室内压力增高,使软组织血循环障碍,肌肉、神经急性缺血而出现一系列早期症候群,常见于前臂和小腿骨折,主要表现为:肢体剧痛、肿胀、指(趾)呈屈曲状活动受限、局部肤色苍白或发绀,常由于骨折血肿、组织水肿或石膏管过紧引起。

三、康复护理计划与实施

老年骨折处理原则:复位、固定、功能锻炼。

康复护理的总体目标:减轻患者的疼痛、肿胀,增加舒适感。通过有效康复锻炼,恢复日常生活能力,防止并发症的发生。具体康复护理措施如下:

1。休息与活动:患者骨折后应进行复位、固定。术后应先卧床休息。根据骨折的愈合程度制定适当的康复锻炼。

骨折早期康复锻炼(骨折后1~2周):

(1)被动运动:可进行局部按摩和关节的被动活动。①肌力训练:固定部位的肌肉进行等长收缩练习;②关节活动度训练:如关节的外展、外旋、屈伸训练,可有效地防止关节粘连。

(2)主动运动:病人可进行自主的活动,做增强肌力的练习。

骨折后期的康复锻炼:(1)主动运动:恢复关节活动度。(2)肌力训练:增强肌力练习可采用沙袋、哑铃等。

2。老年人常见的骨折的功能锻炼:肱骨外科颈骨折和股骨颈骨折是老年人常见的骨折。在此重点介绍这两种骨折的康复锻炼。

(1)肱骨外科颈骨折:肱骨外科颈骨折常因间接暴力所致,分为外展型和内收型。外展型多是稳定型,可用三角巾悬吊固定4周,早期可进行握拳,腕、肘关节屈伸训练,限制肩关节的外展活动。解除固定后进行肩关节及肩胛带的各个方向活动度训练及肌力训练。内收型复位后三角巾制动4~6周,限制肩关节内收肌力训练。

(2)股骨颈骨折:老年人股骨颈骨折后不容易愈合,常引起股骨头坏死及塌陷。

①内固定术后患者,原则上术后第1天做患肢各肌群的等长收缩练习,第2~3天即可进行**锻炼。1周以后进行髋部肌群的等张练习、髋及膝关节的屈伸运动,幅度应逐步增大,以免引起疼痛。8~12周患侧股骨头的不负重休息,可扶双拐早期下地不负重行走。

②牵引治疗的患者,早期可进行**锻炼,4周后去除牵引,可进行床边坐—站立—患肢不负重行走练习,3个月后逐渐增加肌力和关节活动度训练,然后进行负重行走训练。

3。饮食护理:摄入含钙质丰富的食物。如牛奶、豆制品,同时补充维生素D,以促进钙的吸收。多吃新鲜水果与蔬菜,以促进骨痂生长和伤口愈合。

4。疼痛护理:必要时遵医嘱使用镇静剂。常用物理治疗:如红外线、超短波等可以减轻疼痛,促进骨愈合。

5。心理护理:向患者介绍骨折康复的案例,鼓励其积极锻炼,增强自信心。

6。康复健康指导:(1)预防骨折发生:为老人提供安全舒适的生活环境。饮食多摄入钙质;(2)康复锻炼指导:因人而异制订康复计划,并长期坚持,防止并发症。

知识拓展

成人常见骨折临床愈合时间

四、康复护理评价

疼痛感减轻或消除,肿胀、淤斑消失,舒适感增加,骨愈合良好,未发生并发症。

章节目录

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