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Some complications are often found after ankle fracture surgery, and early complications are mainly skin margin necrosis and incision infection, lower extremity deep vein thrombosis, etc., and long-term complications are joint dysfunction.
Fixation failure, fracture nonunion, persistent pain, etc., of which ankle dysfunction, persistent pain and swelling are the main complications, clinical findings that ankle fracture often occurs 10% of ankle dysfunction after surgery, and the reasons are:
After ankle fracture surgery, the affected limb is painful, and the postoperative rehabilitation department is not in place, resulting in joint stiffness; Improper surgical methods, no anatomical reduction, healing of the affected limb deformity, affecting ankle motor function, resulting in joint dysfunction. Poor ankle stability, which consists of the medial or deltoid ligament, lateral malleolus, and inferior tibiofibular joint.
Inner malleolus fracture with deltoid ligament rupture, clinically only fix the internal malleolus and ignore the repair of deltoid ligament, Huang Yunpeng and other studies believe that after the anterior inferior tibiofibular ligament is cut, joint stability is reduced.
The orthopedic rehabilitation theory and postoperative rehabilitation exercise methods of orthopedic surgeons are unreasonable, unscientific, and have not attracted attention, resulting in frequent postoperative complications of the affected limb. 2 TCM understanding of fracture surgery, TCM orthopedics believes that after fracture surgery, muscles and veins are damaged, and qi and blood movement is blocked.
Blood does not follow the meridians, meridian overflow, blood stasis, and qi blockade, all of which lead to water, moisture, stagnant body fluids and extravasation, resulting in swelling of the limbs and bruising of the skin of the affected limbs.
The third phase theory of traditional Chinese medicine orthopedics and traumatology is divided into: early to activate blood stasis, reduce swelling and relieve pain as a method, that is, "stasis does not go away, new blood cannot be born", Yang Wei and other flavored pink four-object soup for the treatment of tibial fibular fracture before the clinical observation of limb swelling, which can effectively reduce the swelling of the limb after surgery.
In the medium term, the method of activating blood circulation and removing stasis and pain relief was used as the method, and the representative side used Fuyuan Blood Soup, Fuyuan Blood Soup, to treat ankle swelling after ankle fracture, 32 cases of clinical observation, which can effectively reduce the patient's limb swelling and pain, and its effective rate is 93.8%, in the late stage:
To supplement the liver and kidneys, strengthen tendons and bones, use strong tendons and bone broth to add and subtract, if the three-stage theory is properly applied, it will be conducive to swelling resolution, tissue repair and early healing of fractures. 3. Application of the theory of "dynamic and static combination" in traditional Chinese medicine in postoperative fracture
The emergence of the idea of "combination of dynamic and static" is closely related to the refinement of ancient Chinese philosophical thought and the interpretation of ancient doctors, "Zhou Yi Department of Words Upload" Yun: "Dynamic and static are constant, rigid and flexible, Professor Shang Tianyu of the Department of Orthopedics and Traumatology of Chinese Medicine inherited and developed the experience of orthopedics of traditional Chinese medicine, and put forward the principle of fracture treatment of "combination of movement and static, equal emphasis on muscles and bones, both internal and external treatment, and doctor-patient cooperation", and clarified that "combination of movement and static" is the guiding principle of fracture treatment.
The three-stage differentiation principle of fracture disease in the orthopedic department of traditional Chinese medicine: "static as the main and supplemented by movement" in the early stage of fracture, "dynamic and static balance" in the middle of fracture, "mainly moving, static and moving" in the later stage of fracture, "combination of dynamic and static level" is an important guiding principle of orthopedic rehabilitation of traditional Chinese medicine.
In the rehabilitation treatment of bone injuries in traditional Chinese medicine, attention should be paid not only to the rehabilitation of systemic dysfunction, but also to the rehabilitation of psychological dysfunction. Functional exercise promotes blood flow in the body. TCM bone injury rehabilitation should follow four principles:
The main purpose of TCM orthopedic injury rehabilitation treatment is to restore the physiological functions of the body, to nourish the mind, complement each other with movement and static, rest appropriately during the rehabilitation process, do not insist on each exercise to do a complete exercise, and gradually increase the amount of training.
Combination of movement and static, muscles and bones, including muscles and bones under the control of the central nervous system, static system and dynamic system to maintain a coordinated balance to maintain the normal functional activities of the human body.
The basic principle that early rehabilitation after ankle fracture surgery should be followed is "gradual" recovery from less to more, time from short to long, the number of gradually increased, can not be blindly forced, according to the individual situation of the patient specific implementation, orthopedic master Robert Jones and Watson, Jones believes that fracture healing absolutely requires uninterrupted continuous rest and fixation.
However, in Europe, MD Lucas's philosophy is that "life is sports", through surgery, exercise muscles and joints, injuries must recover early.
Many studies have found that early exercise provides better results than fixation and better functional recovery for acute limb function recovery. Forced rest and limited movement inevitably lead to postoperative complications.
The impact of early postoperative rehabilitation on ankle fracture is summarized as follows: Promote blood circulation of the affected limb: early activity can reduce the edema of the affected limb, after the fracture of the patient, tissue edema, intraoperative traction after surgery, blood circulation disorders, limb exudation caused by edema of the affected limb, local and systemic exercise to promote the flow of qi and blood, to achieve blood circulation and stasis, swelling and pain relief.
Early activity can prevent joint adhesions, postoperative fracture patients due to pain and fear, patients often prefer to take the complex rehabilitation process to choose pain reduction drugs, rather than choose to carry out rehabilitation therapist intervention under limited conditions, resulting in the lack of daily interactive feedback and self-movement failure of patients missed the best time for rehabilitation resulting in joint adhesions.
Early activity promotes muscle contraction, prevents joint muscle adhesion, smooth blood circulation after ankle joint activity promotes fracture healing, early ankle movement makes the fracture end longitudinally squeezed to make the broken end contact, so that local tissue blood circulation and promote fracture healing.
Ankle fractures are often intra-articular fractures, and early exercise can promote the plasticity of ankle fractures, make the broken end run-in, and promote the formation of callus.
Avoid joint adhesions and disuse osteoporosis: patients are fixed for a long time after fracture and lack of exercise due to fear of pain, which is the main cause of joint adhesion and osteoporosis, and early postoperative rehabilitation can be smooth and bloody, joint slippery, muscles and bones are strong, and joint stiffness and disuse osteoporosis can be avoided.
After fracture surgery, patients due to blood loss and fracture trauma caused by qi and blood deficiency, long-term bed rest, poor flow of qi and blood, resulting in lower limb edema, poor feeding, dry stool, early postoperative rehabilitation can promote qi and blood circulation, strengthen body recovery.
Standardized and reasonable, moderate rehabilitation training its effect is no less than surgery, orthopedic surgeons should not only be familiar with the surgical steps and programs, but also understand various rehabilitation methods, organically combine rehabilitation methods, form a scientific, reasonable and safe rehabilitation plan, in order to maximize the surgical effect and restore the function of the affected limb.
At present, rehabilitation training continuous passive motion (CPM) is a commonly used postoperative passive joint range of motion, fracture surgery patients muscle weakness, unable to move independently, under the guidance of physicians or rehabilitation physicians to carry out auxiliary rehabilitation exercises.
CPM can not only increase joint mobility, but also promote cartilage repair and hematoma resorption, and patients with joint stiffness after ankle surgery can use tibial joint loosening training plus foot subtalar joint and scaphoid joint loosening to improve joint mobility. The manual operation during passive movement is gentle, does not increase the patient's pain, does not displace the fracture, and does not aggravate the trauma of the fracture site.
Active range of motion (AROM) active training refers to the patient's autonomous movement under the guidance of a doctor. These activities can be simple activities that are conducive to restoring the level of activity.
Voluntary activities after ankle fracture surgery, including ankle pump exercise, surround movement, weight-bearing standing, rolling wine bottles, etc., the main purpose is for patients to walk as soon as possible, autonomous activities should be gradual, the range of activities from large to small, from less to more, can not make patients fatigue, encourage patients to adhere to exercise, doctor-patient cooperation, give play to the patient's subjective initiative, fight with the disease, and strive for the early recovery of patients.
Physical factor therapy, physical factor therapy mainly includes electrical stimulation, low-intensity ultrasound, phototherapy, etc. Electrical stimulation includes invasive direct electrical stimulation and capacitively coupled and induced coupled electrical stimulation placed on the skin surface.
The mechanism is to induce the synthesis of osteoblast paracrine and autocrine growth factors, thereby promoting fracture healing, low-intensity pulsed ultrasound (LIPUS) has a long history of postoperative rehabilitation of fractures, the principle may be musculoskeletal mechanostimulus receptors to convert ultrasound mechanical signals into biological signals, and promote the release of COX-2 by cells, promoting fracture healing.
The current project of our hospital is Radial Shockwave Pain Treatment, which is an innovative non-contact, non-invasive, natural treatment of pain that can directly reach the source of pain.
After the low-temperature impact analgesic device treatment handle sprays high-pressure carbon monoxide gas (dry ice), the skin of the treatment part can be directly reduced from the body surface temperature to below 4 °C within 30 seconds, so as to achieve the effect of deep temperature shock, this deep temperature shock will then cause a series of physiological effects, so as to quickly play the role of "reducing swelling, relieving pain, relieving spasms, accurate repair, inhibiting deterioration", its efficacy is remarkable, and the patient satisfaction in our hospital is high.
Traditional Chinese medicine rehabilitation therapies include acupuncture and traditional Chinese medicine. Acupuncture can stimulate acupuncture points and produce analgesic effects, thereby reducing the amount of postoperative analgesics, oral Chinese medicine or Chinese medicine fumigation can help reduce swelling and relieve pain in the affected limb.
After oral application of rosé four-substance decoction to femoral shaft fracture, it was found that the WBC count, ESR equation K value, IL-1, IL-6 and TNF-α levels in the study group decreased significantly, while the blood rheological indexes including high η, medium η, low η, η plasma and HCT decreased.
Application of ankle fracture braces: Fractures are treated surgically, and their healing process is influenced by many factors, including fracture type, age, underlying medical conditions, and rehabilitation training methods, fixation is an important part of rehabilitation, and ankle fractures need to limit the load of the affected person.
Fixation with a cast or splint was the traditional method of previous medical predecessors, and with the advancement of modern medicine, the development of foot and ankle medicine, the application of foot and ankle surgery rehabilitation braces, short-legged walking boots were reported to be an effective alternative to plaster.
The use of WBS (ankle walking boots) is a rehabilitation fixation brace studied according to the shape characteristics of the patient's foot and ankle, and its effect makes the patient's recovery speed significantly faster.
The WBS has an adjustable heel lift that allows patients to change ankles. The soles of the feet are slightly curved to help you walk when your ankle is swollen after surgery. The WBS is easy to put on and the ankle is easy to adjust, in line with the swelling, so that the position is maintained with minimal pain during walking. WBS has good fixation and immediate postoperative weight bearing.
6 Advantages of Chinese medicine fumigation in the postoperative ankle joint Chinese medicine fumigation has long been recorded in the "Immortal Healing Injury Continuation Secret Recipe", put the drug into a pot and boil, first use hot air to smoke the affected area, and then wash the affected area with medicinal water after the water temperature is suitable, 2-3 times a day, about 20 minutes each time.
Before fumigation, while moving joints while smoking, its representative formulas are: sea tong peel soup, upper limb injury lotion, lower limb injury washing formula, etc., inpatients in our department currently use hot ironing method, and the use of traditional Chinese medicine hot pack steaming after steaming placed in the affected limb, wrapping limb, its main role is to dredge qi and blood, unblock joints.
Dilate blood vessels, promote blood circulation, reduce limb edema, swelling of the affected limb after fracture surgery, tissue edema, Chinese medicine fumigation can promote local blood circulation, accelerate tissue metabolism, Chinese medicine fumigation can promote postoperative functional rehabilitation of ankle fracture, reduce the patient's limb edema.
Thermal effect, the thermal effect of traditional Chinese medicine fumigation in the main application of traditional Chinese medicine, makes traditional Chinese medicine contact with the skin, expands the pores, and traditional Chinese medicine enters the inside of the tissue through the pores, promotes blood circulation, promotes drug absorption, accelerates tissue metabolism, and reduces edema.
Analgesic effect, orthopedic lotion added to sea tung bark, sea wind vine, green wind vine, red soda wood, vinegar milk has anti-inflammatory and analgesic effect, Chinese medicine fumigation can inhibit the production of inflammatory substances, accelerate the removal of inflammatory substances, relax skeletal muscle, thereby producing analgesic effect.
Clinical observation of joint stiffness after ankle fracture combined with Tuina combined with Tuina in the treatment of ankle fracture, its sea tong peel has anti-inflammatory and analgesic effect, and its effect is not much different from the effect of anti-inflammatory painkiller relying on coxie.
7 orthopedic medicine prescription medicine and modern pharmacological research orthopedic medicine is founded by the chief physician Wang Jixian, a famous old Chinese medicine doctor in our hospital, born in 1938, from Shangshui County, Henan, once served as the director of the teaching and research office of orthopedic massage of Xinjiang College of Traditional Chinese Medicine, engaged in orthopedic injury for more than 20 years, diligent in ancient training, learning from everyone, familiar with bone and joint injuries.
Bone paralysis, dialectical treatment of soft injuries, proficient in the theory and prescription of bone injuries, orthopedic washing is obtained by Director Wang Jixian through his own clinical experience, with the effect of activating blood circulation and removing stasis, reducing swelling and relieving pain.
The party is composed of extensor grass, bone-piercing grass, black medicine, ox knee, rhubarb, Qin Jiao, Haitong bark, sea wind vine, Qingfeng vine, safflower, peach kernel, baiju, hematum, vinegar frankincense, cinnamon branch, etc., stretching tendon grass, through-bone grass, black medicine, Qin Jiao, sea tung bark, sea wind vine, Qingfeng vine has wind and dehumidification.
Blood circulation effect, safflower, peach kernel, ox knee, rhubarb has the function of activating blood circulation and removing stasis, reducing swelling and relieving pain, hematoxylum, vinegar frankincense and bone jointing. Modern pharmacology on orthopedic lotion:
Stretching grass: "Materia Medica" is recorded as a perennial herb of the Pinus family, which has the effect of dispelling wind and dehumidification, relaxing tendons and activating the body, and treating patients with various bruises and postoperative limb swelling and pain. Ox knee: "Compendium of Materia Medica" records that it activates blood and removes stasis, improves water and joints, tonifies liver and kidneys, strengthens muscles and bones, Wang Jixian believes:
After fracture surgery, patients have insufficient qi and blood, insufficient qi and blood, blood stasis obstruction, kidney main bone pulp, use ox knee to supplement liver and kidney, strengthen muscles and bones, congestion does not go, new blood does not grow, congestion does not go away, limb swelling, modern pharmacological research ox knee extract can inhibit the progression of arthritis, the swelling subsides obviously.
Stretching grass: dispel wind and circulation, relax tendons and activate the network, patients after fracture surgery, congestion obstruction, pain if it is not passed, the use of drugs to promote the dissipation of congestion, modern pharmacological research has the combination of tonglu drugs to treat various bruises.
Safflower: for the Asteraceae plant, xinwen, guixin liver meridian, often with Chuanxiong, ox knee, Wang Lao believes that "blood travel is meridian, stasis is painful to" safflower extract inhibits platelet agglutination, increase fibrolysis, safflower oil, safflower tincture external rubbing treatment of various sprains.
Qingfeng vine: for the family deciduous vine, bitter temperature, return to the liver meridian, xinwen dispersal, into the liver tendon, modern pharmacological research its anti-inflammatory analgesia, inhibition of hypothalamus affects the pituitary, analgesic effect is one-tenth of morphine, and not addictive.
Haitong bark: Qiao Ben plant bark, return to the liver meridian, channel pain relief, with ox knee, Wujia peel for patients with low back and leg pain has a significant effect, its alkaloids have paralysis and relaxation of striated muscle, fracture surgery patients muscle spasm, functional exercise before with traditional Chinese medicine external washing can make the muscles in a relaxed state, conducive to functional exercise.
Qin Jiao: for the gentian family herbs, slightly cold, clear humidity and heat, congestion blocking the network for a long time and heat formation, the formation of heat paralysis, Wang Lao chose the purpose of the second party again, experiments have shown that the treatment of arthritis its swelling speed is fast.
Orthopedic lotion combined with functional exercise can effectively improve the patient's postoperative joint mobility, reduce postoperative pain and reduce swelling, and its efficacy is reliable, practical and convenient for postoperative patients, which is worthy of clinical promotion and application.