人工关节置换术后康复指南

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2018
人工关节置换术后康复指南
髋关节
讲课人：马晓鹏
概念
• 全髋关节形成术（THA）是治疗晚期髋关节炎最常见的手术操作之一。在美国，每年约 进行25.4万例以上的全髋关节形成术，这表明每10万名美国人中，就有92人曾接受过全髋 关节形成术。外科专科医院（HSS）每年约进行7000例全关节形成术，其中30%为全髋关节 形成术。 THA主要用于缓解退行性关节炎所引起的疼痛，改善功能移动性。为实现这些这些治疗 目标，术后康复已成为必不可少的组成部分 此全髋关节形成术后的康复指导原则，是在循证医学方法及康复治疗师大量临床经验积 累的基础上制定而成的
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手术入路
人工髋关节置换术手术入路很多，主要与患髋局部情况、能否同时作某些附加手术及术 者个人习惯有关。只要显露满意，不必苛求某种入路。常用的入路有： 髋关节后侧入路
手术入路
人工髋关节置换术手术入路很多，主要与患髋局部情况、能否同时作某些附加手术及术 者个人习惯有关。只要显露满意，不必苛求某种入路。常用的入路有：
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77%
82%
12.3W
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PART
02
髋关节解剖特点
髋关节解剖特点
髋关节组成：髋臼和股骨头
1、头大、臼深。有髋臼唇。 2、囊紧壁厚，后下部薄弱。 3、有股骨头韧带。
髋关节运动：屈曲，后伸， 内旋，外旋，内收，外展。
功能解剖
PART
03
康复原则
常见的病损
髋部肌肉力量的缺失
ROM下降
平衡及本体感觉下降
功能性活动耐受不良
$500
$1000
$1500
$2500
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手术入路
人工髋关节置换术手术入路很多，主要与患髋局部情况、能否同时作某些附加手术及术 者个人习惯有关。只要显露满意，不必苛求某种入路。常用的入路有： 髋关节前外侧入路
手术入路
人工髋关节置换术手术入路很多，主要与患髋局部情况、能否同时作某些附加手术及术 者个人习惯有关。只要显露满意，不必苛求某种入路。常用的入路有： 髋关节外侧入路（Watson-Jones入路）
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内植物的选择应当遵循个体化原则，除了根据骨科医生 的临床经验之外，还应考虑患者的具体特征（如日常生 活活动参与量及骨质质量）
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最常见的内植物材料：钴铬合金以及钛合金。所选内植 物部件的类型主要取决于进行的全髋关节形成术是骨水 泥固定、生物固定还是混合固定
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常见的全髋关节形成术为混合固定型，即非骨水泥固定 型髋臼假体与骨水泥固定型股骨假体相结合
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目录
髋关节置换术的临床
ONE 髋关节的解剖特点
源自文库03
康复原则
TWO
04
康复训练
PART
01
髋关节置换术的临床
人工髋关节置换术的 适应症
• • • • • 骨性关节炎 类风湿性关节炎 创伤性关节炎 股骨头无菌性坏死 某些髋关节骨折
髋关节置换术的临床
• 全髋关节形成术获得较满意的结果需基于以下几点因素： 患者的选择、内植物的类型、固定方式及手术技巧。
步态、髋关节稳定性下降 疼痛的再现
上下台阶、如厕、驾驶
站立、功能性转移 空间位置转移
自理能力、社会活动 体育活动等方面
根据术后常见病损，康复原则即为
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