After amputation, in order to promote the removal of swelling of the stump, early stereotyping, treatment of various stump diseases, increase the range of motion of the stump joint and increase the muscle

Strengthen the prosthetic limbs factory to meet the requirements of good residual limb conditions. It is very necessary to nurse and train the disabled limbs in time. It's also amputee rehabilitation

It's an essential part of. The following introduces several main methods of disabled limb nursing and training. '

1. Elastic bandage

This is a traditional treatment. After the wound is removed, elastic bandage should be applied immediately to prevent or reduce the swelling and excessive fat tissue of the stump

The key step to the maturity and finalization of the stump. The following aspects should be paid attention to when bandaging:

(1) The leg stump is 10cm wide and the thigh stump is 12.5-15cm wide elastic bandage with a length of 2-4m.

(2) The winding steps are shown in the following two pictures. Firstly, wrap it 2-3 times along the long axis of the stump, and then wrap it as spirally as possible above the syncline. Yes

The stump of the leg amputation shall be wound to the pelvis; the middle and short length stump of the leg amputation shall be wound to the thigh.

(3) It should be bandaged all day, even at night, but it should be changed 4 times a day and 5 times a day.

(4) As shown in the figure below, the elasticity of elastic bandage should be more and more tight towards the end of the residual limb, which should not be neglected.

In addition, in addition to the above-mentioned method of bandaging, there are also methods of bandaging with hard bandages and semi-rigid bandages.

2. Physical therapy

Physical therapy is physical therapy. In a broad sense, it refers to the use of physical means, that is, the use of sports, electricity, heat and other treatment. With the development of rehabilitation medicine, physical therapy, as one of the important means of rehabilitation treatment, has become a system centered on sports therapy. Therefore, from the perspective of rehabilitation medicine, physical therapy should include exercise therapy (physical therapy) and other physical therapy. This is the work of the so-called "physical therapist Qi" (PT).

But in a narrow sense, according to the hospital's custom, physical therapy refers to the physical therapy with other physical means besides sports therapy. Here, we first introduce this "other" physical therapy. The function of physical therapy is to reduce swelling, increase or decrease blood supply. In the rehabilitation treatment of amputees, it is mainly used for the pre-treatment and treatment of various stump complications, such as swelling, pain, contracture, adhesion, ulcer, inflammation, etc. When doctors use all kinds of physical therapy methods, they must understand the indications, advantages and disadvantages. Taking pain as an example, there are many kinds of states from acute pain to chronic pain, so we must choose physical means according to the specific state.

At present, the commonly used physical therapy methods are: temperature therapy (cold, hot), mechanical therapy (massage, whirlpool bath, electrotherapy, SPA) can also be considered as part of temperature therapy. The following focuses on the two most commonly used temperature therapies: cold therapy and heat therapy

(1) Cryotherapy

Cryotherapy can be divided into cryotherapy and cryotherapy. There is a significant difference in the use temperature between them. Low temperature is generally higher than 0 ℃. Slow cooling for a long time (to avoid irreversible damage to tissue and cells); while freezing is to use a very low temperature (close to or lower than 0 ℃), in a short time (seconds or minutes). The effect of cold therapy is to relieve pain, relieve acute muscle spasm, increase collagen elasticity, reduce local circulation, increase local circulation, reduce local tissue metabolism, reduce edema and so on. Among them, a short cooling time of less than 10 minutes can reduce the local circulation, while a long cooling time of 15-30 minutes can increase the local circulation.

① Usage: at present, the products used in the cold treatment include ice, colloidal cooling products, cooling bags of chemicals, cooling steam, etc. Recently, in order to obtain low temperature (- 30 ℃), larger local cooling devices are also used.

② Indications: acute inflammation of muscles and bones and diseases with similar symptoms (such as sprain, soft tissue contusion, etc.). In addition, it can also be used to obtain a temporary pain free state in the early stage of joint range of motion training.

③ Note: when using under 3 and 4 degrees, do not touch the skin directly, and then cool it with towel. In addition, because of the decrease of pain threshold after cold treatment, patients should avoid intensive exercise immediately after treatment.

(2) Thermotherapy

According to the tissue depth, it can be divided into superficial heat and deep heat, dry heat and damp heat according to its properties, and further divided into direct contact conduction (heat compress, etc.), conduction through media (infrared, etc.), and heat conversion (ultrasonic wave, etc.) in other energy forms according to the heat conduction mode. The commonly used methods of hyperthermia and the depth of tissue they reach

① Physiological effect: the physiological response caused by hyperthermia is affected by the degree of tissue temperature rise, the duration of temperature rise, the range of temperature rise and other factors. The first is the effect on cardiovascular system, which can cause vasodilation and increase capillary permeability. Among them, vasodilation is due to the direct effect on smooth muscle and the indirect effect on inflammatory symptoms caused by warm heat. Secondly, as an important role of physical therapy, collagen elasticity is enhanced. Therefore, if warm method is applied before stretching the contracted muscle, the stretching effect will be better. Moreover, warm heat can reduce fiber activity, which results in inhibition of muscle spindle excitability. This property can be used in the treatment of muscle spasm or spasmodic muscle. It also has a good effect on the treatment of pain. This effect is considered to be the effect of warm and hot stimulation entering the so-called entrance of pain. It can avoid the introduction of pain stimulation.

② Usage: the easiest way is to warm the towel at hand with hot water and then apply hot compress, but this method has the disadvantage that the temperature will decrease quickly. In order to effectively carry out hyperthermia, many methods have been developed, including methods to slow down the temperature drop (hot pad), methods to give high temperature which can not normally be given (wax therapy), methods to reduce the attenuation of body heat and transfer the heat to the deep tissue (microwave), etc.

1. Hot compress

One is the hot pack bag with silica gel in the cloth bag sold on the market. Put the bag into the heating tank and heat it to about 65 ℃ before use. This kind of bag can keep warm for 20-30 minutes as long as it is not dry. When using, put a towel or cloth between the bag and the skin to prevent scalding.

The other is a heat pack bag made of chemical heating agent that can heat itself when encountering air, which is more convenient to use. For example, a Japanese hot pack called "haokalong" has a maximum temperature of 63 degrees, an average temperature of 53 degrees, and a duration of more than 40 degrees for up to 14 hours. When using, also pay attention to add cloth pad to prevent scalding.

b. Wax therapy

The paraffin and mineral oil are mixed in a proportion of 7-8:1 and put into a metal tank with a heat preservation device, and dissolved at a temperature of 51.7-54.4 ℃. Then immerse the treatment part in the tank for 5-10 seconds and take it out immediately. After the wax solidifies, it will not enter again. Repeat for 10 times. Wrap the wax with a pattern cloth and keep for 30 minutes. Then remove the wax and put it back into the tank. In the process of wax therapy, pay attention to prevent the rupture of wax film, and the immersion depth gradually becomes shallow from the second time.

Wax brushing may also be used. Brush the melted wax layer by layer with a brush to a thickness of 1-2cm, and then wrap it with cotton cloth for 30 minutes to an hour.

c. Electrothermal therapy

The method of heating by conduction. Commonly used are ultrashort wave, microwave, Zhao sonic, etc. Various methods transmit heat to the deep tissue by different ways of heat conduction.

——Ultrashort wave. In this method, the gap between the electrodes is used as the electric boundary, where the electric energy is converted into heat energy. The ultrashort wave device used is 800w-1.5kw input power and 300 ~ 500W output power. Usually, the method of capacitance electrode is adopted, and the electrode is covered with soft rubber or plastic. When using, just put the electrode on the treatment site. In addition, the thermal conductivity of ultrashort wave is related to the water content of tissue. The tissue with abundant water has good thermal conductivity and can improve the thermal efficiency. Therefore, for the muscle tissue with more water content, the temperature can be increased appropriately; and for the joints or muscles that need heat treatment, the effect is the best in the parts not covered by the thicker soft tissue.

——Microwave. 2450MHz is used for medical treatment. But according to American research, microwave with short wavelength has a great effect on improving muscle temperature, and also causes bone damage

The so-called "hot sports" generated by reflection are also less dangerous, so 916mhz is currently used as physical therapy. Microwave is generated by the magnetic control tube in the device, and the radiator and control board are installed outside the device. When using, just irradiate the radiator to the affected part. According to the depth of the tissue to be heated, the radiator is separated from the skin by 5-10cm, and the radiation intensity is adjusted by adjusting the spacing. In addition, the output power and irradiation time can be controlled by adjusting the control board.

——Ultrasound. It is a method of transforming electrical energy into mechanical vibration of sound wave and treating it by acoustic hair shooting. Because the sound wave can not be effectively transmitted in the air, it is necessary to place a medium (water or mineral oil) between the sound wave and the skin that is easy to conduct the sound wave. The actual function of ultrasound is to change the high frequency sound energy (vibration) into heat energy in the tissue, so that the temperature of muscle will rise 7-8 degrees. The transmission of ultrasound to tissues is related to the absorption characteristics of tissues and the reflection of interferents. Bone absorbs 10 times more ultrasound than muscle, so it heats up strongly at the interface between muscle and bone. Ultrasound therapy, in addition to other electrothermal therapy

In addition to the same thermal effect, the mechanical vibration generated by sound wave can also be used to expand the permeability of biofilm, so as to achieve the effect that other electrothermal therapies cannot.

d. Indications and contraindications of electrothermal therapy

All electrothermal treatments are suitable for subacute and chronic diseases.

Contraindications: the heart is equipped with a pacemaker and there are metal substances in the body. Because electrothermal therapy can selectively cause the temperature of such metals to rise, thus causing peripheral burns. In this regard, ultrasound is relatively safer than microwave and ultrashort wave.

Other taboos include vascular diseases, phlebitis and malignant tumors. In addition, it should be avoided to use in the affected area of sensory disturbance, so as to prevent the patient from being scalded due to not feeling the heat.