踝關(guān)節(jié)扭傷的患者的指南

1、踝關(guān)節(jié)扭傷的患者的指南踝關(guān)節(jié)扭傷的患者的指南第1頁踝關(guān)節(jié)扭傷患者指南Ankle Sprain踝關(guān)節(jié)扭傷A Patients Guide to Ankle Sprain踝關(guān)節(jié)扭傷患者指南Introduction介紹踝關(guān)節(jié)扭傷的患者的指南第2頁踝關(guān)節(jié)扭傷的患者的指南第3頁Anankle sprainis a common injury and usually results when the ankle is twisted, or turned in (inverted). The termsprainsignifies injury to the soft tissues, usually t

2、he ligaments, of the ankle. 踝關(guān)節(jié)扭傷是生活中很常見損傷，通常是因?yàn)轷钻P(guān)節(jié)內(nèi)翻損傷所造成。術(shù)語“扭傷”普通指是軟組織損傷，在踝關(guān)節(jié)，通常指是韌帶損傷。踝關(guān)節(jié)扭傷的患者的指南第4頁This guide will help you understandhow an ankle sprain occurshow doctors diagnose the conditionwhat can be done to treat a sprain本指南意在幫助你了解踝關(guān)節(jié)扭傷是怎樣發(fā)生怎樣診療踝關(guān)節(jié)扭傷怎樣治療踝關(guān)節(jié)扭傷踝關(guān)節(jié)扭傷的患者的指南第5頁Anatomy解剖What pa

3、rt of the ankle is involved?踝關(guān)節(jié)包含哪些結(jié)構(gòu)？踝關(guān)節(jié)扭傷的患者的指南第6頁Anatomy解剖What part of the ankle is involved?踝關(guān)節(jié)包含哪些結(jié)構(gòu)？踝關(guān)節(jié)扭傷的患者的指南第7頁踝關(guān)節(jié)扭傷的患者的指南第8頁Ligamentsare tough bands of tissue that help connect bones together. Three ligaments make up thelateral ligament complexon the side of the ankle farthest from the oth

4、er ankle. They are theanterior talofibular ligament(ATFL),thecalcaneofibular ligament(CFL), and theposterior talofibular ligament(PTFL).The common inversion injury to the ankle usually involves two ligaments, the ATFL and CFL. Normally, the ATFL keeps the ankle from sliding forward, and the CFL keep

5、s the ankle from rolling inward on its side. 踝關(guān)節(jié)扭傷的患者的指南第9頁 韌帶是一個(gè)致密帶狀組織，它把相鄰骨關(guān)節(jié)連接在一起。踝關(guān)節(jié)外側(cè)韌帶復(fù)合體由三條韌帶組成：距腓前韌帶、跟腓韌帶、距腓后韌帶。踝關(guān)節(jié)內(nèi)翻扭傷通常累及其中兩條韌帶：距腓前韌帶和跟腓韌帶。距腓前韌帶預(yù)防踝關(guān)節(jié)前移，跟腓韌帶預(yù)防踝關(guān)節(jié)過分內(nèi)收。踝關(guān)節(jié)扭傷的患者的指南第10頁踝關(guān)節(jié)扭傷的患者的指南第11頁A ligament is made up of multiple strands of connective tissue, similar to a nylon rope. A spr

6、ain results in stretching or tearing of the ligaments. Minor sprains only stretch the ligament. A tear may be either a complete tear of all the strands of the ligament or a partial tear of only some of the strands. The ligament is weakened by the injury; how much it is weakened depends on the degree

7、 of the sprain. 踝關(guān)節(jié)扭傷的患者的指南第12頁 韌帶是由多股束帶狀結(jié)締組織組成，很像是一股尼龍繩。扭傷會(huì)造成韌帶拉傷或撕裂。輕微扭傷僅僅造成韌帶拉傷。嚴(yán)重扭傷會(huì)造成韌帶撕裂，而韌帶撕裂既可能是韌帶內(nèi)全部束帶斷裂，也可能是個(gè)別束帶斷裂。韌帶損傷后，其力量會(huì)減弱，詳細(xì)減弱程度取決于扭傷程度。踝關(guān)節(jié)扭傷的患者的指南第13頁The lateral ligaments are by far the most commonly injured ligaments in a typicalinversion injuryof the ankle. In an inversion injury

8、 the ankle tilts inward, meaning the bottom of thefootangles toward the other foot. This forces all the pressure of your body weight onto the outside edge of the ankle. As a result, the ligaments on the outside of the ankle are stretched and possibly torn.踝關(guān)節(jié)扭傷的患者的指南第14頁 踝關(guān)節(jié)外側(cè)韌帶損傷最常見于踝關(guān)節(jié)內(nèi)翻損傷。何謂踝關(guān)節(jié)內(nèi)翻

9、損傷？就是發(fā)生扭傷時(shí)，扭傷這只腳足底朝向另外一只腳，這么全身重量都集中于踝關(guān)節(jié)外側(cè)，結(jié)果造成了踝關(guān)節(jié)外側(cè)韌帶拉傷或撕裂。踝關(guān)節(jié)扭傷的患者的指南第15頁踝關(guān)節(jié)扭傷的患者的指南第16頁A severe form of ankle sprain, called anankle syndesmosis injury, involves damage to other supportive ligaments in the ankle. This type of injury is sometimes called ahigh ankle sprainbecause it involves the li

10、gaments above theankle joint. In an ankle syndesmosis injury, at least one of the ligaments connecting thetibiaandfibulabones (the lower leg bones) is sprained. Recovering from even mild injuries of this type takes at least twice as long as from a typical ankle sprain.踝關(guān)節(jié)扭傷的患者的指南第17頁有一個(gè)嚴(yán)重踝關(guān)節(jié)扭傷，又稱踝關(guān)節(jié)

11、下脛腓聯(lián)合損傷，累及踝關(guān)節(jié)其它支持韌帶。這種類型踝關(guān)節(jié)扭傷又稱高位踝關(guān)節(jié)扭傷，因?yàn)樗奂绊g帶位于踝關(guān)節(jié)上方。踝關(guān)節(jié)下脛腓聯(lián)合損傷發(fā)生時(shí)，最少有一條連接脛腓骨遠(yuǎn)端韌帶發(fā)生拉傷或撕裂，即使是輕微下脛腓聯(lián)合損傷，其恢復(fù)時(shí)間最少是普通踝關(guān)節(jié)扭傷兩倍。踝關(guān)節(jié)扭傷的患者的指南第18頁踝關(guān)節(jié)扭傷的患者的指南第19頁Symptoms癥狀What does an ankle sprain feel like?踝關(guān)節(jié)扭傷后有哪些表現(xiàn)？踝關(guān)節(jié)扭傷的患者的指南第20頁踝關(guān)節(jié)扭傷的患者的指南第21頁Initially the ankle is swollen, painful, and may turnecchymot

12、ic(bruised). The bruising and swelling are due to ruptured blood vessels from the tearing of the soft tissues. Most of the initial swelling is actually bleeding into the surrounding tissues. The ankle swells as extra fluid continues to leak into the tissues over the 24 hours following the sprain.踝關(guān)節(jié)

13、扭傷的患者的指南第22頁 踝關(guān)節(jié)扭傷發(fā)生后，最初癥狀是腫脹、疼痛、淤青，這是因?yàn)樗毫衍浗M織內(nèi)血管發(fā)生破裂，進(jìn)而血液滲出到踝關(guān)節(jié)周圍所致。伴隨扭傷后24小時(shí)或更長(zhǎng)時(shí)間，額外液體不停滲漏入組織，踝關(guān)節(jié)發(fā)生腫脹。踝關(guān)節(jié)扭傷的患者的指南第23頁P(yáng)eople who have sprained an ankle often end up spraining the ankle again. If the ankle keeps turning in with activity, the condition is calledankle instability. Patients who have ank

14、le instability lose confidence in their ankle to support them, especially on uneven ground. They often have swelling around the ankle that doesnt go away. Pain and swelling in a joint can cause a reflex where the body turns off the muscles around the joint. This can cause times when the ankle feels

15、like it is going to give way, meaning it may have a tendency to twist again very easily.踝關(guān)節(jié)扭傷的患者的指南第24頁 一旦踝關(guān)節(jié)發(fā)生過一次扭傷，就很輕易再次發(fā)生扭傷。假如踝關(guān)節(jié)重復(fù)屢次扭傷，這被稱之為“踝關(guān)節(jié)不穩(wěn)”，這種情況會(huì)造成患者對(duì)他們踝關(guān)節(jié)功效失去信心，尤其是在凹凸不平路面行走時(shí)。這類患者踝關(guān)節(jié)總是重復(fù)腫脹而不能消退。關(guān)節(jié)疼痛和腫脹會(huì)反射性地使大家不使用關(guān)節(jié)周圍肌肉。這會(huì)不時(shí)地讓大家感覺踝關(guān)節(jié)似乎將要垮掉了，也說是說踝關(guān)節(jié)更輕易再次扭傷。踝關(guān)節(jié)扭傷的患者的指南第25頁P(yáng)eople who have

16、had several mild ankle sprains or one severe sprain are prone to impingement problems in the ankle. The ligaments that were sprained may become irritated and thickened, causing them to get pinched near the edge of the ankle joint. 重復(fù)屢次輕度踝關(guān)節(jié)扭傷或一次嚴(yán)重踝關(guān)節(jié)扭傷均可造成踝關(guān)節(jié)撞擊綜合征。扭傷韌帶會(huì)發(fā)炎并增厚，造成在踝關(guān)節(jié)邊緣附近出現(xiàn)撞擊。踝關(guān)節(jié)扭傷的患者的

17、指南第26頁Diagnosis診療How do doctors diagnose the condition?醫(yī)生是怎樣診療踝關(guān)節(jié)扭傷踝關(guān)節(jié)扭傷的患者的指南第27頁The diagnosis of an ankle sprain is usually made by examination of the ankle and X-rays to make sure that the ankle is not fractured. A physical examination is used to determine which ligament has been injured. The doc

18、tor will move your ankle in different positions in order to check the ligaments and other soft tissues around the ankle. Some tests place stress directly on the ankle ligaments to see if the ankle has become unstable and to find out if one or more ligaments has been partially or completely torn.踝關(guān)節(jié)扭

19、傷的患者的指南第28頁踝關(guān)節(jié)扭傷診療通常是經(jīng)過體格檢驗(yàn)，然后拍攝X片排除踝關(guān)節(jié)骨折。體格檢驗(yàn)?zāi)軌蚺袛嗄囊桓g帶發(fā)生損傷。你醫(yī)生會(huì)在不一樣方向活動(dòng)你踝關(guān)節(jié)，以檢驗(yàn)踝關(guān)節(jié)韌帶和周圍軟組織。一些特殊體檢試驗(yàn)，直接把應(yīng)力施加于踝關(guān)節(jié)韌帶，經(jīng)過踝關(guān)節(jié)穩(wěn)定程度來判斷是否有韌帶損傷，一根或多跟韌帶損傷，是個(gè)別還是全部撕裂。踝關(guān)節(jié)扭傷的患者的指南第29頁If a complete rupture of the ligaments is suspected, your doctor may orderstress X-raysas well. These X-rays are taken while the l

20、igaments are placed in a stretched position. The X-ray will show a slight tilt in the ankle bone if the ligaments have been torn.踝關(guān)節(jié)扭傷的患者的指南第30頁 假如你醫(yī)生懷疑你韌帶全部撕裂，他會(huì)提議你去拍攝一個(gè)應(yīng)力位X片。所謂應(yīng)力位X片即你拍片時(shí)，你踝關(guān)節(jié)會(huì)被施加一個(gè)外力，以使得韌帶處于張力狀態(tài)。假如存在韌帶撕裂，那么在X片上會(huì)表現(xiàn)出踝關(guān)節(jié)骨頭輕度傾斜。踝關(guān)節(jié)扭傷的患者的指南第31頁Treatment治療 What can be done for the probl

21、em?怎樣治療踝關(guān)節(jié)扭傷？Nonsurgical Treatment 踝關(guān)節(jié)扭傷的患者的指南第32頁非手術(shù)治療Nonsurgical treatment options depend on whether your problem is an ankle sprain or ankle instability. 非手術(shù)治療選擇取決于你遭受是踝關(guān)節(jié)扭傷還是踝關(guān)節(jié)不穩(wěn)。踝關(guān)節(jié)扭傷的患者的指南第33頁Ankle Sprain踝關(guān)節(jié)扭傷踝關(guān)節(jié)扭傷的患者的指南第34頁The best results after an ankle sprain come when treatment is started

22、 right away. Treatments are used to stop the swelling, ease pain, and protect how much weight is placed on the injured ankle. A simple way to remember these treatments is by the letters in the wordRICE.These stand for rest, ice, compression, and elevation.踝關(guān)節(jié)扭傷的患者的指南第35頁在扭傷發(fā)生后馬上開始治療，這有利于取得最好結(jié)果。治療方法包

23、含：減輕腫脹、緩解疼痛、控制患足負(fù)重。有一個(gè)簡(jiǎn)單記住這些治療伎倆方法，即單詞“大米”（RICE），它代表著踝關(guān)節(jié)扭傷治療方法：休息（rest）、冰敷（ice）、加壓包扎（comprssion）、抬高患肢（elevation）踝關(guān)節(jié)扭傷的患者的指南第36頁Rest: The injured tissues in the ankle need time to heal. Crutches will prevent too much weight from being placed on the ankle.Ice: Applying ice can help ease pain and may r

24、educe swelling.Compression: Gentle compression pushes extra swelling away from the ankle. This is usually accomplished by using an elastic wrap.Elevation: Supporting your ankle above the level of your heart helps control swelling.踝關(guān)節(jié)扭傷的患者的指南第37頁休息：損傷組織需要時(shí)間恢復(fù)，使用拐杖有利于降低患足負(fù)擔(dān)。冰敷：冰敷有利于緩解疼痛、減輕腫脹。加壓包扎：適當(dāng)加壓

25、包扎能夠減輕踝關(guān)節(jié)腫脹，通常是使用彈力繃帶進(jìn)行加壓包扎抬高患肢：將患肢抬高超出心臟水平，能夠控制腫脹。踝關(guān)節(jié)扭傷的患者的指南第38頁Your doctor may also prescribe medications. Mild pain relievers help with the discomfort. Anti-inflammatory medications can help ease pain and swelling and get people back to activity sooner after an ankle sprain. These medications in

26、clude common over-the-counter drugs such as ibuprofen. But newer anti-inflammatory medicines calledCOX-2 inhibitorsshow promising results and dont seem to cause as much stomach upset and other intestinal problems.踝關(guān)節(jié)扭傷的患者的指南第39頁你醫(yī)生也會(huì)給你開一些藥品。一些止痛藥能夠緩解不適。消炎鎮(zhèn)痛藥品能夠緩解疼痛減輕腫脹，能夠讓患者盡快返回到日?；顒?dòng)中去。這些藥品包含常見非處方藥如

27、布洛芬（芬必得）。還有一類新型消炎鎮(zhèn)痛藥，屬于COX-2抑制劑，含有更加好療效，且不會(huì)引發(fā)胃部不適及一些其它消化道問題。踝關(guān)節(jié)扭傷的患者的指南第40頁As treatment progresses, it is helpful to gradually begin putting weight through the joint. Casts have fallen out of favor because soft tissues weaken when they are kept immobile. But braces that can be worn to support the an

28、kle, but still allow weight bearing, are the most popular treatment for helping reduce strain on the healing tissues.踝關(guān)節(jié)扭傷的患者的指南第41頁 伴隨治療進(jìn)行，患足逐步負(fù)重是有利于恢復(fù)。石膏固定會(huì)減弱軟組織力量，所以普通不提議使用。佩戴踝關(guān)節(jié)支具既能夠保護(hù)踝關(guān)節(jié)又能夠允許患足負(fù)重，是幫助降低恢復(fù)中組織扭傷流行治療方法。踝關(guān)節(jié)扭傷的患者的指南第42頁Healing of the ligaments usually takes about six weeks, but swell

29、ing may be present for several months. Your doctor may suggest that you work with a physical therapist to help you regain full range of ankle motion, improve balance, and maximize strength.踝關(guān)節(jié)扭傷的患者的指南第43頁 韌帶損傷恢復(fù)通常需要六周時(shí)間，但腫脹可能會(huì)連續(xù)數(shù)月之久。你醫(yī)生會(huì)提議你與理療師多接觸，以幫助你重獲踝關(guān)節(jié)活動(dòng)度、提升踝關(guān)節(jié)平衡性及恢復(fù)踝關(guān)節(jié)肌力。踝關(guān)節(jié)扭傷的患者的指南第44頁Ankle I

30、nstability踝關(guān)節(jié)不穩(wěn)定踝關(guān)節(jié)扭傷的患者的指南第45頁If the ankle ligaments do not heal adequately, you may end up with ankle instability. This can cause the ankle to give way and feel untrustworthy on uneven terrain. If your ankle ligaments do not heal adequately following an ankle sprain, your doctor may suggest severa

31、l things.踝關(guān)節(jié)扭傷的患者的指南第46頁 假如踝關(guān)節(jié)扭傷沒有得到充分恢復(fù)，將會(huì)造成踝關(guān)節(jié)不穩(wěn)。這會(huì)造成患者在凹凸不平路面行走時(shí)，會(huì)感覺踝關(guān)節(jié)瓦解不值得信融賴。假如在踝關(guān)節(jié)扭傷后，踝關(guān)節(jié)韌帶并未充分愈合，你醫(yī)生會(huì)給你以下幾個(gè)提議：踝關(guān)節(jié)扭傷的患者的指南第47頁Changes in your footwear may be prescribed to help keep your ankle from turning in. Placing a heel wedge under the outer half of your heel blocks the ankle from rollin

32、g, as does a flared heel built into your shoe. In extreme cases, doctors may prescribe a plastic brace, called anorthosis, to firmly hold your ankle from rocking side to side. Some patients feel a sense of steadiness from wearing high-topped shoes. Patients with ankle instability should avoid wearin

33、g high-heeled shoes.踝關(guān)節(jié)扭傷的患者的指南第48頁 首先是改變你鞋，以預(yù)防你踝關(guān)節(jié)總是處于內(nèi)翻狀態(tài)。在你足跟底部外側(cè)半放置足跟墊，能夠阻止踝關(guān)節(jié)內(nèi)翻，或穿一雙足跟外展鞋也能夠起到一樣效果。對(duì)一些嚴(yán)重踝關(guān)節(jié)不穩(wěn)患者，醫(yī)生可能會(huì)推薦使用塑料支具，即所謂矯正器，它能夠牢牢固定踝關(guān)節(jié)，預(yù)防踝關(guān)節(jié)晃動(dòng)。一些患者能夠穿高幫鞋，這有利于提升踝關(guān)節(jié)穩(wěn)定性。踝關(guān)節(jié)不穩(wěn)患者應(yīng)該防止穿高跟鞋。踝關(guān)節(jié)扭傷的患者的指南第49頁P(yáng)hysical therapy treatments will likely be initiated to help restore joint range of moti

34、on, strength, and joint stability. 理療有利于恢復(fù)踝關(guān)節(jié)活動(dòng)度，增強(qiáng)踝關(guān)節(jié)肌力及提升踝關(guān)節(jié)穩(wěn)定性。踝關(guān)節(jié)扭傷的患者的指南第50頁Small nerve sensors inside the ligament are injured when a ligament is stretched or torn. These nerve sensors give your brain information about the position of your joints, a sensation calledposition sense. For example,

35、 nerve sensors in your arm andhandgive you the ability to touch your nose when your eyes are closed. 踝關(guān)節(jié)扭傷的患者的指南第51頁The ligaments in the ankle work the same way. They send information to your nervous system to alert you about the position of your ankle joint. A physical therapist will help you retra

36、in this sensation as a way to steady the ankle joint and protect you from spraining your ankle again.踝關(guān)節(jié)扭傷的患者的指南第52頁當(dāng)踝關(guān)節(jié)韌帶拉傷或撕裂時(shí)，其內(nèi)一些小神經(jīng)感受器也會(huì)發(fā)生損傷。這些感受器用來幫助大腦確定關(guān)節(jié)位置，這叫本體感覺。比如，你胳膊和手里位置感受器能讓你在閉眼時(shí)候也能很準(zhǔn)確摸到自己鼻子。踝關(guān)節(jié)韌帶里位置感受器也起著一樣作用，它們會(huì)告訴大腦踝關(guān)節(jié)位置。理療師會(huì)幫助你重建本體感覺以穩(wěn)定踝關(guān)節(jié)并預(yù)防踝關(guān)節(jié)再次扭傷。踝關(guān)節(jié)扭傷的患者的指南第53頁Many people who ha

37、ve ankle instability have weakness in the muscles along the outside of the leg and ankle. These are called theperoneal muscles. Strengthening these muscles may help control the ankle joint and improve joint stability.踝關(guān)節(jié)扭傷的患者的指南第54頁很多踝關(guān)節(jié)不穩(wěn)患者，其小腿及踝關(guān)節(jié)腓側(cè)肌肉肌力會(huì)下降，這些肌肉普通指是腓骨長(zhǎng)短肌。加強(qiáng)這些肌肉肌力有利于增強(qiáng)患者對(duì)踝關(guān)節(jié)控制并提升踝關(guān)節(jié)

38、穩(wěn)定性。踝關(guān)節(jié)扭傷的患者的指南第55頁Surgery 手術(shù)治療踝關(guān)節(jié)扭傷的患者的指南第56頁Surgeons will occasionally do procedures right away in athletes who tear a lateral ankle ligament. In most other cases of torn ankle ligaments, surgeons will try nonsurgical treatments before doing reconstructive surgery of the ligaments.踝關(guān)節(jié)扭傷的患者的指南第57頁對(duì)

39、于一些踝關(guān)節(jié)外側(cè)韌帶撕裂運(yùn)動(dòng)員，外科醫(yī)生會(huì)選擇馬上進(jìn)行手術(shù)治療，但對(duì)于其它普通人來說，在進(jìn)行外科手術(shù)治療之前，通常提議首先嘗試非手術(shù)療法。踝關(guān)節(jié)扭傷的患者的指南第58頁Ligament Tightening Procedure韌帶緊縮術(shù)踝關(guān)節(jié)扭傷的患者的指南第59頁Chronic ankle instability can happen when the lateral ankle ligaments are stretched or torn and the ankle keeps giving way. Surgery can be done to tighten the stretche

40、d ligaments and improve the stability of the ankle. The surgery usually involves the ATFL and theCFL.踝關(guān)節(jié)扭傷的患者的指南第60頁當(dāng)踝關(guān)節(jié)外側(cè)韌帶拉傷或撕裂時(shí)，會(huì)造成慢性踝關(guān)節(jié)不穩(wěn)。能夠?qū)⒗瓊g帶進(jìn)行緊縮以提升踝關(guān)節(jié)穩(wěn)定性。手術(shù)通常是緊縮距腓前韌帶和跟腓韌帶。踝關(guān)節(jié)扭傷的患者的指南第61頁In this procedure, an incision is made in the skin that lies over the lateral ligaments. Using a scalpel

41、, the surgeon cuts the ATFL and CFL in half. 沿著踝關(guān)節(jié)外側(cè)韌帶表面取切口，切開后皮膚后，顯露距腓前韌帶和跟腓韌帶，使用刀片自其中部切斷。踝關(guān)節(jié)扭傷的患者的指南第62頁Holes are drilled along the lower end of the fibula bone, the small bone of the lower leg. The two ends of the cut ligament are overlapped and sewn together. The surgeon uses the drill holes in

42、the fibula to hold the stitches to the bone. 在腓骨（小腿小骨頭）遠(yuǎn)端鉆孔，將切斷韌帶兩個(gè)斷端重合并縫合，經(jīng)過腓骨遠(yuǎn)端孔將韌帶固定于腓骨。踝關(guān)節(jié)扭傷的患者的指南第63頁A large band of connective tissue crosses the front of the ankle just below the lateral ligaments. This band, called theankle retinaculum, holds the tendons in place. The surgeon pulls the top e

43、dge of the ankle retinaculum upward and sews it into the fibula.This helps reinforce the reconstructed ligaments.踝關(guān)節(jié)扭傷的患者的指南第64頁 踝關(guān)節(jié)下支持帶，位于踝關(guān)節(jié)前方，恰好走形于踝關(guān)節(jié)外側(cè)韌帶下方。通常，外科醫(yī)生會(huì)將踝關(guān)節(jié)下支持帶上半個(gè)別縫合于腓骨遠(yuǎn)端，以加強(qiáng)重建韌帶力量。踝關(guān)節(jié)扭傷的患者的指南第65頁The following images show each step of the ligament tightening procedure:下列圖將描述韌帶緊縮術(shù)過程：

44、 第一步：自韌帶中部切斷 第二步；腓骨遠(yuǎn)端鉆孔 第三步：韌帶縫合于腓骨 第四步：縫合踝關(guān)節(jié)下支持帶。踝關(guān)節(jié)扭傷的患者的指南第66頁踝關(guān)節(jié)扭傷的患者的指南第67頁踝關(guān)節(jié)扭傷的患者的指南第68頁Tendon GraftProcedure肌腱移植術(shù)踝關(guān)節(jié)扭傷的患者的指南第69頁Another type of reconstruction is done using a tendon graft. If your surgeon feels that the stretched and scarred ligaments are not strong enough to simply repair i

45、n a ligament tightening procedure, then the ligaments must be reinforced with a tendon graft.踝關(guān)節(jié)扭傷的患者的指南第70頁 另一個(gè)韌帶重建術(shù)需要肌腱移植。假如外科醫(yī)生認(rèn)為將僅僅對(duì)拉傷或疤痕化韌帶進(jìn)行緊縮重建，依然不夠牢靠，這時(shí)就需要移植肌腱來強(qiáng)化韌帶。踝關(guān)節(jié)扭傷的患者的指南第71頁In this procedure, the surgeon removes a portion of one of the nearby tendons to use as a tendon graft. The tend

46、on most commonly used attaches theperoneus brevismuscle to the outside edge of the small toe. A section of this tendon is put in place of the torn lateral ligaments. 在這一手術(shù)過程中，術(shù)者會(huì)切取踝關(guān)節(jié)外側(cè)臨近肌腱一個(gè)別進(jìn)行移植。通常，會(huì)切取腓骨短肌腱一個(gè)別，然后將其縫合于撕裂外側(cè)韌帶。踝關(guān)節(jié)扭傷的患者的指南第72頁After making the skin incision, the surgeon drills a hole i

47、n the fibula near the attachment of the original ligament. A second drill hole is made in the area where the ligament attaches on the talus (the anklebone). 完成皮膚切口后，術(shù)者在踝關(guān)節(jié)外側(cè)韌帶于腓骨遠(yuǎn)端及距骨止點(diǎn)附近鉆孔。踝關(guān)節(jié)扭傷的患者的指南第73頁The tendon graft is then removed (orharvested) and woven between these holes to recreate the li

48、gament complex. 然后切取腓骨短肌腱，穿過腓骨與距骨鉆孔，以重建外側(cè)韌帶復(fù)合體。踝關(guān)節(jié)扭傷的患者的指南第74頁After surgery, you will probably be placed in acastor brace for about six weeks to allow the tendon reconstruction to heal. Following removal of the cast, physical therapy will be required to regain full use of the ankle. 術(shù)后，踝關(guān)節(jié)需要使用石膏或支具固

49、定六周，以使重建韌帶愈合。拆除石膏后，馬上開始理療，以取得踝關(guān)節(jié)功效完整恢復(fù)。踝關(guān)節(jié)扭傷的患者的指南第75頁康復(fù)What will it take to make my ankle healthy again?怎樣使踝關(guān)節(jié)重獲健康。Nonsurgical Rehabilitation非手術(shù)治療后康復(fù)踝關(guān)節(jié)扭傷的患者的指南第76頁Even if you dont need surgery, you may need to follow a program of rehabilitation and exercise. Doctors recommend that their patients w

50、ork with a physical therapist for two to four weeks. Your therapist can create a program to help you regain ankle function. It is very important to improve strength and coordination in the ankle.踝關(guān)節(jié)扭傷的患者的指南第77頁 即使你沒有接收手術(shù)治療，你也需要接收一系列康復(fù)鍛煉計(jì)劃。醫(yī)生會(huì)推薦你在康復(fù)師指導(dǎo)下進(jìn)行康復(fù)鍛煉，這普通需要兩到四面時(shí)間。理療師會(huì)幫你制訂康復(fù)計(jì)劃，以恢復(fù)恢復(fù)踝關(guān)節(jié)功效。其中，最主

51、要是恢復(fù)踝關(guān)節(jié)力量及協(xié)調(diào)性。踝關(guān)節(jié)扭傷的患者的指南第78頁Swelling and pain are treated with ice andelectrical stimulation. If swelling in the ankle is severe, therapists may also apply massage strokes from the ankle toward thekneewith your leg kept in an elevated position. This helps get the swelling moving out of the ankle an

52、d back into circulation. Your therapist may issue a compression wrap and instruct you to wrap your ankle and lower limb and to elevate your leg.踝關(guān)節(jié)扭傷的患者的指南第79頁 腫脹和疼痛能夠經(jīng)過冰敷和電刺激療法進(jìn)行治療。假如腫脹很嚴(yán)重，理療師可能還會(huì)采取按摩療法，將你患肢抬高，然后自踝關(guān)節(jié)向膝關(guān)節(jié)進(jìn)行按摩。這有利于踝關(guān)節(jié)消腫，并促使?jié)B液返回入循環(huán)系統(tǒng)。理療師會(huì)對(duì)你進(jìn)行加壓包扎，并指導(dǎo)你怎樣包扎你踝關(guān)節(jié)和小腿。踝關(guān)節(jié)扭傷的患者的指南第80頁Therapi

53、sts also apply specialized hands-on treatment calledjoint mobilizationto improve normal joint motion. These treatments restore the gliding motion within the ankle joint where the lower leg meets the talus bone. This form of treatment speeds healing after an ankle sprain, and it helps return people a

54、nd players more quickly to their activity or sport.踝關(guān)節(jié)扭傷的患者的指南第81頁 理療師還會(huì)采取特殊手動(dòng)療法，即所謂關(guān)節(jié)活動(dòng)療法，用來提升踝關(guān)節(jié)活動(dòng)度。這些療法能夠提升脛距關(guān)節(jié)面滑動(dòng)度，加緊踝關(guān)節(jié)扭傷后康復(fù)速度，并使得普通患者和運(yùn)動(dòng)員更加快返回日常生活和運(yùn)動(dòng)中去。踝關(guān)節(jié)扭傷的患者的指南第82頁An effective treatment for ankle sprains isdisc training, which uses a circular platform with a small sphere under it. Patients

55、 place their feet on it while they sit or stand and work the ankle by tilting the disc in various positions. This form of exercise strengthens the muscles around the ankle, and it improves joint sense (mentioned earlier).踝關(guān)節(jié)扭傷的患者的指南第83頁 還有一個(gè)踝關(guān)節(jié)扭傷鍛煉方式，稱為圓盤訓(xùn)練。使用一個(gè)底部有一個(gè)小球圓盤，患者可取站立位或坐位，將腳放置于圓盤之上，然后往不一樣方

56、向旋轉(zhuǎn)圓盤。這種形式鍛煉能夠加強(qiáng)踝關(guān)節(jié)周圍肌肉肌力，并提升踝關(guān)節(jié)本體感覺。踝關(guān)節(jié)扭傷的患者的指南第84頁When you get full ankle movement, your ankle isnt swelling, and your strength is improving, youll be able to gradually get back to your work and sport activities. An ankle brace may be issued for athletes who intend to return quickly to their sport

57、.踝關(guān)節(jié)扭傷的患者的指南第85頁當(dāng)你踝關(guān)節(jié)活動(dòng)度得到完全恢復(fù)，沒有腫脹且肌力足夠時(shí)，你就能逐步返回你日常工作和運(yùn)動(dòng)中去。對(duì)于那些想盡快回到運(yùn)動(dòng)中去運(yùn)動(dòng)員來說，最好穿戴踝關(guān)節(jié)支具。踝關(guān)節(jié)扭傷的患者的指南第86頁After Surgery 手術(shù)后康復(fù)踝關(guān)節(jié)扭傷的患者的指南第87頁P(yáng)atients usually take part in formal physical therapy after surgery. Rehabilitation after surgery can be a slow process. You will probably need to attend therapy

58、sessions for two to three months, and you should expect full recovery to take up to six months. 踝關(guān)節(jié)扭傷的患者的指南第88頁接收手術(shù)治療患者術(shù)后通常會(huì)進(jìn)行正式理療，術(shù)后康復(fù)鍛煉通常是一個(gè)遲緩過程。你可能需要進(jìn)行兩到三個(gè)月康復(fù)鍛煉，而踝關(guān)節(jié)功效得到完全恢復(fù)則需要六個(gè)月時(shí)間。踝關(guān)節(jié)扭傷的患者的指南第89頁Rehabilitation proceeds cautiously after reconstruction of the ankle ligaments. Most patients are pr

59、escribed an ankle brace to wear when they are up and about, and they are strongly advised to follow the recommendations about how much weight can be borne while standing or walking. You may be instructed to put little or no weight on your foot when standing or walking for up to 12 weeks. Your physic

60、al therapist will work with you to make sure you are using crutches safely and only bearing the recommended amount of weight on your foot.踝關(guān)節(jié)扭傷的患者的指南第90頁 踝關(guān)節(jié)韌帶重建后康復(fù)鍛煉需要小心慎重進(jìn)行。絕大多數(shù)患者都需要穿戴踝關(guān)節(jié)支具，而且在站立或行走時(shí)，嚴(yán)格控制患足負(fù)重量。術(shù)后12周內(nèi)，確保你患足不負(fù)重或輕微負(fù)重。你理療師會(huì)一直與你保持聯(lián)絡(luò)，以確保你能安全使用拐杖，且患足承受適當(dāng)負(fù)重量。踝關(guān)節(jié)扭傷的患者的指南第91頁The first few p