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膝關節屈曲性攣縮之牽引治療

Traction Therapy for Knee Flexion Contractures

摘要


關節固定(immobilization)長久時間後,引起的攣縮(contracture)是一般骨科病人常見後遺症。低重量及長時間伸長(low-load prolonged stretch)已多次被證實比短時間及高重量伸展(high-load brief stretch)效果好。長時間伸展可改變組識黏性,使組識產生最大殘餘伸長(residual elongation)和最小傷害。熱與伸展合併產生的永久性伸長比熱或伸展單獨使用好得多。本文報告利用Light,K.E等人所改良之Buck's skin traction,並合併水療、肌力訓練、行走訓練和關節調整術(Joint Mobilization),治療因韌帶傷害或骨折後手術治療後仍合併有膝關節屈曲性攣縮(Flexion contracure)之7位病患,所得之結果。膝伸長角度對步態影響頗巨,即使在些微的伸直角度限制,仍會影響行走姿勢,所以儘可能達到正常值,本文所報告為沿著脛骨方向之牽引方式,不但使結締組織拉長外,尚包括膝關節之關展(distraction),因而增加了股一經關節面活動(femorotibial joint play),是一種操作簡單,病患不感覺疼痛,且效果相當良好之方法。

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並列摘要


Contraction after a long time immobilization is a common sequale of the orthopedic patients. Low-load prolonged stretch has been proved a better method than high-load brief stretch. Prolonged stretch could change viscosity of the tissue and produce greater residual elongation. The study uses Light K.E. et al modified Buck's skin traction, combining hydrotherapy, muscle strengthing, ambulation training and joint mobilization to treat 7 patients who have knee flexion contractures after operations for ligament injuries or bony fractures. All of them have reached nearly normal range of extension. Angle of extension of the knee joint is very critical for gait pattern. Even limitation of few terminal degrees will influence posture of walking. So we prefer the knee extension as normal as possible. The direction of the traction used in the study is along with that of the tibia. So the effect is distraction of the knee joint to increase the femorotibial joint play in addition to elongation of the connective tissue. The traction is simple, non-stressful, and the result is excellent.

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