骨科常见疾病护理常规

骨科常见疾病护理常规 骨科疾病护理常规 第一节 牵引术 一、保持患者舒适。头部稍抬高，腰部可适当垫软枕，冬季注意保暖。 二、注意倾听患者主诉，观察患肢血液循环、肢端皮肤颜色、温度、动脉搏动及患肢肢体活动情况 三、经常检查牵引带是否松散或脱落，防止牵引锤接触地面、牵引绳断裂或滑脱，保持患肢处于正常的牵引体位;牵引重量适度。 四、行皮肤牵引时，注意牵引部位皮肤有无炎症或水疱;检查胶布是否脱落。 五、骨牵引时应保持钉或针眼处的清洁干燥，保持皮肤及床铺的清洁，不要触摸或移动牵引针，每日在牵引针孔处滴75,酒精两次。 六、防止关节强直及肌肉萎缩。教会患者有规律的功能锻炼，如手指、足趾、踝关节及股四头肌运动。 七、防止足下垂。可用托脚板托起。 八、加强基础护理，防止并发症。经常按摩受压部位;鼓励患者深呼吸及用力咳嗽;多饮水，多吃水果和粗纤维食物并指导按摩腹部，增加肠蠕动，必要时遵医嘱给予缓泻剂;定时活动肢体，促进静脉血回流，防止血栓性静脉炎。 第二节 石膏固定术 advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijing-Tianjin-Tangshan area, targeted investment promotion several times. Industry-led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic development through scientific and technological innovation, improve product value-added and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced technology to increase the added value of their products to ensure that introduction of transforming scientific and technological achievements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, meet social development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the introduction of talent to meet the need. Third, we must rely on ... ... Post-doctoral workstation, ... ... Food research station platform, to the XX University to find experts 一、抬高患肢，以利静脉血液和淋巴回流，减轻肢体肿胀。 二、认真听取患者主诉，检查肢端温度、颜色、肿胀、感觉及运动情况，发现异常及时报告。经常检查石膏边缘及骨突处，防止受压。 三、石膏未干时勿搬动、勿按压，石膏完全干固后应按其凸凹 的形状垫好枕头。 四、手术后及有创口的患者，如发现石膏被血或脓液浸透，应 及时处理。 五、保持石膏清洁，防止石膏被水、尿、粪便等分泌物浸渍和 污染。 六、注意功能锻炼，提醒或指导患者作石膏内固定肢体的等长肌肉收缩运动，情况许可时，鼓励下床活动。 第三节 脊柱骨折合并脊髓损伤 一、平卧硬板床，垫软褥或气垫床。搬动时固定颈部、腰部，保持脊柱生理曲度，呈轴线翻身。 二、严密观察生命体征、肢体感觉及四肢肌力、截瘫平面情况。 三、保持呼吸道通畅 1、指导患者进行呼吸锻炼，增加胸壁运动。 2、及时清除气道内分泌物，鼓励患者每日主动咳嗽、深呼吸，指导有效咳嗽，防止肺部感染。因呼吸肌麻痹所致呼吸困难时，可用呼吸机辅助呼吸，给予高浓度氧气吸入。 nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragicity's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Riveesearch station platform, to the XX University to find expertsdoctoral workstation, ... ... Food r-such as the introduction of talent to meet the need. Third, we must rely on ... ... Post ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me: first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basr. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifieto increase the added value of their products to ensure that introduction of transforming scientific and technological achiev 2 四、防止深静脉血栓形成。避免在下肢静脉输液;适当抬高床脚，协助患者每日行下肢被动运动。 五、大便每周少于2次时给予缓泻剂，促进肠蠕动及训练排便反射。腹胀所致肺膨胀不全时，遵医嘱行胃肠减压。 六、预防泌尿系感染。留置导尿者保持尿管通畅，鼓励患者多饮水，受伤两周后间断放尿，每4小时放尿1次，及时更换尿管和引流袋。观察并记录尿量及性质，尿道口消毒每日2次，3周后拔除尿管。 七、建立翻身卡，每2小时翻身1次，帮助关节被动活动，保持重要关节的活动范围及肢体功能位，预防肌肉萎缩、压疮及失用性骨质疏松的发生。翻身时病床两侧安放护栏防止坠床。 八、伤后2周内吃易消化的食物，2周后多吃高营养食物、水果。 九、加强与患者沟通，给予正确的康复指导，给予鼓励及心理疏导。 康复训练及功能管理。 肢瘫痪时1、早期急性不稳定期(脊髓损伤后2-4周):此期患者生命体征不稳定，应绝对卧床，保持尿管持续开放，2周后改为间歇性开放，3,4小时排尿1次。行四肢被动运动，避免发生肌肉萎缩及肌力下降。瘫痪肢体置于功能位，下肢瘫痪时可用垂足板，使踝关节保持中立位，防止足下垂。 2、早期急性稳定期(急性不稳定期后4-8周):此期病情相对稳定，康复内容主要是增加床上支撑训练，由于患者年龄、体质、脊髓损伤水平不同，因此训练内容、强度也不同。训练过程中应注 strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we muste yeaadded value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo actient, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-ion of talent to meet the need. Third, we must rely on ... ... Postroductneeds to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development rpris3 意患者心肺功能，防止发生体位性低血压，并确保脊柱稳定性。 3、中后期康复:此期是对有恢复行走能力可能的患者进行站立和步行训练。一是卧位练习，包括床上翻身、挪动身体及在床上或沿床边坐起的练习。二是坐位练习，包括在椅子上坐稳坐直及保持平衡的练习。用哑铃或拉力器锻炼上肢背部肌群，每日帮助患者做向心性肌肉按摩4,6次，为扶双拐做准备。三是站立练习，包括从坐位站起，从蹲位站起及站立平衡的练习。四是原地踏步及步行练习。 第四节 颈椎骨折并截瘫 一、平卧硬板床，床头抬高15,30厘米。保持床铺平整、舒适。使用气垫床。 二、头后仰，恢复颈椎生理曲度。 三、保持牵引方向与脊柱在一条直线上，翻身时勿使颈部扭曲。 四、保持骨折部位稳定，搬动时保持颈椎生理曲度。 五、根据患者的耐受力和一般状况调节牵引重量，随时观察牵引是否有效。 六、针眼处每日点滴75,酒精l,2次。 七、每2小时翻身1次，翻身时勿扭转躯干。 八、观察患者触觉、温度觉及各种反射的恢复程度，检查肢体活动范围，做好记录。 九、截瘫患者按瘫痪护理常规(见第一章第十节)。 十、康复训练指导 向患者及家属讲明功能锻炼的重要性。瘫 : first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basr. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifieto increase the added value of their products to ensure that introduction of transforming scientific and technological achiev nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragicity's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Riveesearch station platform, to the XX University to find expertsdoctoral workstation, ... ... Food r-such as the introduction of talent to meet the need. Third, we must rely on ... ... Post ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me4 痪肢体置于功能位，下可用垂足板，使踝关节保持中立位，防止足下垂;膝关节做伸屈被动活动;上肢能活动的病人，可指导利用哑铃或拉力器锻炼上肢背部肌群，为扶双拐做准备，每日帮助病人做向心性肌肉按摩，每日4,6次，按摩时要掌心用力，手法正确。 第五节 颈椎骨折 一、 术前护理 1、心理护理:针对患者出现的心理反应进行护理，帮助其树立战胜疾病的信心和勇气。 2、遵医嘱做好术前准备，术日晨禁食水。 二、 术前训练 1.床上肢体功能锻炼 主要有上、下肢的伸屈，持重上举及手足活动。 2床上大小便 在床上进行适应性训练，以减少术后因不能卧床排便而发生尿潴留及便秘。 3.气管食管推移训练 患者仰卧位，将枕头垫于肩下，头稍后仰。训练者站在患者右侧，用左手拇指外的其余四指指端沿患者气管右侧，将气管、食管持续向左侧推移，开始时用力尽量缓和，推移5,8分钟后，用力稍加强，尽量把气管和食管推移超过中线。 4.呼吸功能训练 指导患者进行深呼吸及有效咳嗽。 5.俯卧位卧床训练 颈后路手术患者俯卧位的时间较长，易引起呼吸道受阻，术前必须认真训练以便其能够适应，要循序渐进，开始每次10,30分钟，每日2,3次，以后逐渐增至每次2,4小 needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development rprisstrengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we muste yeaadded value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo actient, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-ion of talent to meet the need. Third, we must rely on ... ... Postroduct5 时，每日2,3次。 三、 术后护理 1、必备物品 吸引器、吸痰盘、气管切开包、沙袋 2、密切观察病情变化，每半小时测量呼吸、血压、脉搏，连测四小时后改每小时1次，平稳后改2,4小时1次。 3、因术中失血量多可致血容量不足，应根据病情调节输液、输血速度。 4、保持呼吸道通畅 术后严密观察患者的呼吸频率、节律及面色变化，必要时吸痰。痰液粘稠、喉头水肿者予以雾化吸入。若患者出现乏力、嗜睡、恶心等症状时，要警惕睡眠呼吸暂停综合征的发生(即在睡眠时出现呼吸暂停或低通气现象)，发现异常及时告知医师，做好气管切开和气管插管的准备。 5、观察伤口敷料及引流液的变化 正常情况下，术后24小时内切口引流液量应少于100ml，若引流液过多、色鲜红，切口敷料渗血多，周围局部隆起，颈部增粗，患者自觉呼吸费力，提示有活动性出血，应及时报告医师并配合抢救。 6、术后饮食护理 术后以冷流质饮食为主，3天后改冷半流质并逐步到普食。冷流质的目的主要避免加重食管因术中牵拉后水肿反应，温热饮食可导致食管损伤，加重食管的水肿反应，并可加重颈部切口的出血。 7、颈托固定 佩戴前后两片式普通颈托可以限制颈部过度活动，帮助颈部伤口愈合以及促进植骨的融合。 8、体位 搬动患者时应维持头部脊柱中立位，切忌过屈、过伸、扭转，24小时内应尽可能减少颈部的活动次数及幅度，局部制 ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me: first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basr. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifieto increase the added value of their products to ensure that introduction of transforming scientific and technological achiev nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragicity's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Riveesearch station platform, to the XX University to find expertsdoctoral workstation, ... ... Food r-such as the introduction of talent to meet the need. Third, we must rely on ... ... Post6 动可减少出血，还可防止植骨块的滑脱。 九、加强基础护理，预防术后并发症。 十、功能锻炼 术后功能的恢复和重建与其功能锻炼有直接关系，应指导患者按照以下方法进行锻炼。术后第一天做手指、腕关节、足趾及踝关节活动，术后第2天协助患者做肢体抬高和关节被动活动，3天后指导帮助患者做四肢被动活动和主动活动锻炼。对有不完全瘫痪的患者，在做被动锻炼的同时进行四肢肌肉按摩。3周后在颈部固定良好的情况下协助患者下床活动(钢板内固定者术后第二天即可下床)。术后1个月开始在颈围保护下练习颈背肌，防治失用性萎缩，有利于改善颈部劳损等症状。 第六节 胸腰椎骨折 一、 术前护理 1、做好心理护理，稳定其情绪。 2、晚间注意观察患者的睡眠情况，注意保暖，避免感冒，并注意监测血压及体温。 3、术前禁食8小时，禁水4,6小时，有糖尿病及高血压病患者术晨继续服用药物，以避免手术刺激导致血糖及血压升高，服用时用5ml的水将药物吞下即可，最好在术前2,3小时服用。 4、遵医嘱做好术前准备。 二、 术后护理 1、术后去枕平卧6小时，头偏向一侧，保持呼吸道通畅，给 予高流量氧气吸入。 rprisstrengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we muste yeaadded value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo actient, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-ion of talent to meet the need. Third, we must rely on ... ... Postroductneeds to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development 7 2、密切观察体温、脉搏、呼吸、血压等生命体征的变化。 3、引流管的护理 注意负压引流的观察，由于胸腰椎手术创伤较大，术中出血多，术后切口处放置引流负压吸引24,48小时，保持引流管通畅、固定。观察记录引流量及性质，若2小时引流量达到200ml或24小时达到400ml，说明手术部位有活动性出血，应及时处理;若引流液淡红或清亮可能是脑脊髓漏，应改负压吸引为正压，并采取头低脚高位，密切观察患者双下肢感觉及运动情况。 4、加强基础护理，预防并发症。 5、术后康复锻炼 术后当天即可自主屈伸四肢运动及翻身，术后3天可开始锻炼四头肌及小腿三头肌肌力，手术后1周指导患者进行腰背肌锻炼，术后4周后可在床上坐起，适当活动(如扩胸运动)。预防卧床并发症，鼓励咳嗽，定时轴线翻身，多饮水。 6、健康教育 出院后继续卧床休息，避免弯腰活动，伤后3个月来医院复查拍片，如骨痂生长良好稳固可佩戴腰围下地活动，半年内禁止重体力劳动，一年后根据情况取出内固定钢板。 第七节 股骨骨折 一、 术前护理 1、严密观察生命体征的变化，及时测量体温、脉搏、呼吸、血压，如有异常及时报告医师。 2、选择和准备合适的托马斯氏架，以便于牵引。 et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me: first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basr. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifieto increase the added value of their products to ensure that introduction of transforming scientific and technological achiev nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragicity's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Riveesearch station platform, to the XX University to find expertsdoctoral workstation, ... ... Food r-such as the introduction of talent to meet the need. Third, we must rely on ... ... Post ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,8 3、硬板床位，保持患肢外展30度中立位，可穿丁字鞋以防外旋致骨折断端移位。 4、调整好体位及牵引方向，按牵引术护理常规。。 5、注意全身皮肤情况，特别是髋部周围的皮肤情况，勤擦洗，勤翻身。 6、观察足趾主动活动与趾端感觉情况。 7、指导患者正确使用便盆;嘱患者多饮水，预防泌尿系感染。 8、做好心理护理。 9、按医嘱做好术前准备。 二、 术后护理 1、全麻术后去枕平卧6小时，头偏向一侧，直至清醒，6小时内禁食禁水。 2、密切观察生命体征及血氧饱和度。 3、抬高患肢，注意肢体感觉情况，适度活动患肢，促进血液循环，预防肢体僵硬。 4、观察伤口渗血情况，如渗血较多，应立即通知医师给予处理。 5、检查各管道是否有压迫、扭曲或反折，保持引流的持续通畅。 6、预防褥疮。牵引期间，每2小时更换体位一次，夜间亦每3,4小时更换体位一次。按摩骶尾部，改善局部血液循环，以预防褥疮发生。 7、预防便秘，注意饮食调节，多吃新鲜蔬菜及含纤维素多的食物，保持每1,2天排便一次。 rprisstrengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we muste yeaadded value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo actient, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-ion of talent to meet the need. Third, we must rely on ... ... Postroductneeds to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development 9 8、预防关节挛缩，卧床期间保持适当的床上运动锻炼，预防肢体废用性萎缩及关节挛缩。注意保持各关节功能位置，患肢应始终处在功能状态。 9、预防坠积性肺炎。在帮助患者翻身时，还要帮助拍背，并鼓励患者作深呼吸，增加肺活量，便于痰液排出，保持呼吸道通畅，防止肺炎发生。 10、预防泌尿系感染。鼓励患者多喝水，每日摄入2000毫升以上，增加排尿量，清洁尿道，预防感染。 11、健康教育 室内应经常通风换气，保持空气清新，讲究个人卫生，防止感冒。指导患者站立时进行肌肉和关节训练及负重，逐渐增加训练时间和强度。 术后根据情况，指导患者行走时由双拐逐渐过渡至单拐助行，最后改为弃拐杖，使用拐杖时尽量不要单独活动，应有家人在旁边保护安全。尽量避免进行剧烈的运动，避免屈髋下蹲，尽量减轻患髋的负重度及各侧方应力。侧卧时两腿间应放厚12CM以上的垫枕以防髋内翻。术后6个月内双腿不交叉，不盘腿，避免内收和内旋动作。利用双上肢及健肢的支撑直行上、下床。正确更衣、穿袜、穿鞋。注意合理调节饮食，保证营养，避免体重过度增加，戒烟戒酒。继续加强功能锻炼，指导患者正确使用双拐，教会患者膝关节功能疗法。 功能锻炼用力应适度，活动范围应由小到大，循序渐进，且不可操之过急，每次应以不感到疲劳为度，以免给骨折愈合带来不良影响。2,3个月后拍片复查。若骨折已骨性愈合，可酌情使用单拐而后弃拐行走。 to increase the added value of their products to ensure that introduction of transforming scientific and technological achiev nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragicity's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Riveesearch station platform, to the XX University to find expertsdoctoral workstation, ... ... Food r-such as the introduction of talent to meet the need. Third, we must rely on ... ... Post ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me: first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basr. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifie10 第八节 骨盆骨折 一、绝对卧床休息。 二、密切观察生命体征，监测血压、脉搏、呼吸、血氧饱和度等，注意休克征象，观察有无其他脏器损伤的症状。 三、迅速建立输液通道，抢救休克。 四、病情平稳后坚持上身锻炼和下肢按摩。 五、加强基础护理，积极预防并发症。 1、鼓励咳嗽及深呼吸，保持呼吸道通畅，预防肺部并发症。 2、鼓励多饮水，预防泌尿系感染。 3、注意营养，多食新鲜蔬菜及水果，保持大便通畅。 4、保持床单位整洁，按摩局部受压部位，预防褥疮。 六、功能锻练 术后麻醉消褪后，即应指导患者行股四头肌、腓肠肌等长收缩及踝关节、足趾的屈伸运动。术后第二周开始指导患者床上进行髋、膝关节的运动，可有护士协助患者行屈膝屈髋练习，每组十次，每天三到四组。两周拆线后可逐渐增加关节活动范围和强度，以患者不感到疲劳为宜。术后三到四周进行屈髋和外展肌群的锻炼，并可行不负重关节主动活动。8~12周逐渐开始扶拐暂不负重行走。12周后完全负重行走。交代患者每隔1~2月复查一次X线片。 第九节 髋关节置换 一、做好心理护理，消除紧张情绪。 e yeaadded value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo actient, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-ion of talent to meet the need. Third, we must rely on ... ... Postroductneeds to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development rprisstrengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we must11 二、加强营养，多食高蛋白、高维生素、粗纤维食物。 三、术前练习床上大小便，并保持大小便通畅。 四、按医嘱做好术前准备。 五、术后患肢保持外展中立位。 六、保持伤口引流管通畅，防止扭曲、脱落，观察引流物颜色、 性质及量，做好记录。 七、加强基础护理，预防各种并发症。 八、功能锻炼 1、第一阶段功能锻炼(术后1,3天)，主要以肌肉的静力收缩运动和远端关节的运动为主。股四头肌等长收缩锻炼:仰卧位，下肢伸直不离床，股四头肌主动收缩向近端牵拉髌骨，缓慢运动，每次持续5—10秒，然后休息5分钟，每天90次左右。踝关节运动:仰卧位，主动地进行足趾伸屈运动，踝关节跖屈、背伸，每个动作保持10秒，再放松，每天90次左右。臀肌收缩运动:患者仰卧位伸直腿，上肢舒适地放在身体的两侧，收缩臀部肌肉，保持10秒，放松，每天60次左右。髌骨推移运动:仰卧位，陪护人员轻轻推动髌骨上、下、左、右活动，每天30次左右。 2、第二阶段功能锻炼(术后4-10天)，主要是加强肌肉的等张收缩和关节运动。直腿抬高运动:仰卧位，下肢伸直抬高，要求足跟离床20厘米，在空中停顿2,3秒，以后停顿时间逐步增加，每天90次左右。屈髋屈膝运动:仰卧位，陪护人员一手托在患者膝下，一手托住足跟，在不引起疼痛的情况下行屈髋、屈膝运动，但屈髋角度不宜大，应小于45?，每天30次左右。 ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me: first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basr. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifieto increase the added value of their products to ensure that introduction of transforming scientific and technological achiev nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragicity's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Riveesearch station platform, to the XX University to find expertsdoctoral workstation, ... ... Food r-such as the introduction of talent to meet the need. Third, we must rely on ... ... Post12 3、第三阶段功能锻炼(术后11天至1个月)，以离床训练为主。卧位外展:仰卧位，下肢伸直外展，每天120次左右。卧位到坐位训练:双手撑起，患肢外展，利用双手和健腿支撑力将患肢移至床边，每天30次左右。坐位到站立、扶拐训练:患者移至床边，健腿先着地，患肢后触地，拄双拐，利用健腿和双拐支撑力站立，开始训练站立2分钟即可，以防止体位性低血压，以后逐渐增加。站立到扶拐行走的训练:患肢不负重，扶拐行走时必须有陪护人员保护，以免发生意外，时间根据患者体力而定，一般每次不超过15分钟，每天3次。 4、第四阶段功能锻炼(术后1个月)，屈髋练习:站立位，双手拄双拐或助行器，健侧单腿站立，身体保持与地面垂直。患侧屈髋屈膝，屈髋以90度为限，加强髂腰肌肌力。伸膝练习:站立位，双手拄双拐或助行器，健侧单腿站立，身体保持与地面垂直。患侧下肢直腿抬高，加强股四头肌肌力。髋外展练习:体位与上面相同，患侧髋关节外展，以40度为限，加强臀外展肌肌力。 5、第五阶段功能锻炼(术后2个月)，可使用静止自行车锻炼。开始踏脚踏板时，先向后踏，当觉得向后踏动作已很轻松、舒服时，再向前踏。当动作连贯后，再加大踏脚次数及频率，每日2次，每次15分钟，逐步增加到每日3次，每次20,30分钟。 6、第六阶段功能锻炼(术后3个月)， 此期患肢可逐渐负重，逐步由双拐一单拐一弃拐杖。髋关节置换术的患者应该做到3个月内不侧卧，卧床时只取平卧，避免重体力劳动及剧烈的体育活动。一定要做到“四不”即:不用力屈患髋下蹲、不盘腿、不坐矮板凳、不跷“二郎腿”。上楼时健肢先上，患肢后上，下楼时患肢先下， ion of talent to meet the need. Third, we must rely on ... ... Postroductneeds to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development rprisstrengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we muste yeaadded value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo actient, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-13 健肢后下。6个月后可选择散步进行日常锻炼，不宜登山、高抬腿跑、快跑及长途跋涉。 第十节 膝关节半月板损伤 一、 术前护理 1、心理护理 加强术前宣教，讲解手术的意义及注意事项，消除患者的顾虑;告之微创手术的特点、临床经验，以增强其对手术的信心。 2、术前准备 入院后进行全面的术前检查(血常规、血型、凝血功能、肝功能、肾功能、肝炎、梅毒、心电图及相应的X线、MR等影像学检查);术区备皮;禁食12小时，禁水8小时;指导患者练习在床上排便;术前应向患者说明膝部肌肉萎缩对疗效的影响，并以健肢做示范指导患者熟悉和掌握各项康复训练，内容包括股四头肌等长收缩、髌骨活动、踝部运动、直腿抬高训练、压膝运动、渐进抗阻训练等练习。 二、 术后护理 1、按麻醉术后护理常规，腰麻或硬膜外麻醉去枕平卧及禁食水6小时，头偏一侧防止呕吐引起窒息;检查麻醉穿刺处有无渗出。 2、观察生命体征变化，给予心电监护。 3、患肢抬高3O?，观察敷料渗血情况及患肢末梢血运及足趾活动，如有异常及时报告医师处理。 4、疼痛的护理 若是切口痛指导患者做深呼吸运动，听音乐、看电视分散注意力，必要时遵医嘱给予镇痛剂;若是绷带包扎过紧 et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me: first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basr. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifieto increase the added value of their products to ensure that introduction of transforming scientific and technological achiev nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragicity's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Riveesearch station platform, to the XX University to find expertsdoctoral workstation, ... ... Food r-such as the introduction of talent to meet the need. Third, we must rely on ... ... Post ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,14 引起，止痛剂疗效不佳，应通知医师检查术区，若张力过高，须松解绷带，观察患肢血液循环，疼痛可迅速缓解。 5、功能锻炼 膝关节损伤在组织学的纤维化出现较早，如不及早活动，4天左右就会出现关节活动受限，损伤的关节固定2周就会导致结缔组织纤维融合，使关节丧失功能。因此，早期功能锻炼非常重要。术后麻醉药消退后即指导患者做股四头肌等长收缩及踝部运动。 1(股四头肌运动训练 将大腿平放于床上，大腿肌肉绷紧，坚持l0,15秒后放松，l0次,组，3,4组,天，以促进患肢静脉血回流，减轻下肢肿胀，降低静脉栓塞发生率。训练勿过量，避免引起患者疼痛。 2(踝部运动 踝关节背伸，膝关节伸直，收缩股四头肌。有效的指标是髌骨有向上运动的动作，持续3,5秒后放松1次，10次,组，3,4组,天，以增强患肢肌力，促进血液循环。 3(直腿抬高运动 术后第1天开始，患者平卧位，健侧膝关节屈曲，患侧膝关节伸直，踝关节保持功能位，慢慢抬高使腿与床面成30,4O?、空中停顿3,5秒，20,30次,组，3,4组,天。三项运动交替进行，反复练习，逐渐增加运动量至5,6组,天，并持续进行至康复。 4(术后第3天去掉加压包扎绷带，开始进行膝关节屈曲运动，即患者坐在床边，双腿自然下垂，将健侧腿置患侧小腿前方，轻轻用力向后压，逐渐增加屈曲角度，以能忍受为度，一般屈曲>100?即可，维持l分钟或更长时间，以避免关节僵直。 5(术后第4天下地行走练习 先迈健肢，再迈患肢，用股四头 ent, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-ion of talent to meet the need. Third, we must rely on ... ... Postroductneeds to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development rprisstrengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we muste yeaadded value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo acti15 肌的力量带动大腿行走，屈膝时则尽量屈膝。在疼痛可耐受时拄双拐站立并下床近距离行走，但行走时间开始应?5m分钟，以后逐渐增加至10分钟，循序渐进，以促进局部血液循环。但术后1周内24小时总行走时间不宜>20分钟，以免关节腔内创面出血。 六、健康教育 1、术后第8天至2个月继续巩固住院期间进行的各项功能练习并逐渐增加患肢的活动量及负重能力。 2、大部分患者术后2周可基本恢复膝关节的活动，4,6周可完全恢复。此期间鼓励患者尽可能地进行原地行脚踏车、散步、游泳等锻炼，但在膝关节功能完全恢复前，不能进行跑、跳活动。6,8周后可以进行各项适量体育活动，运动员术后3个月可以开始训练 。 3、合理安排作息时间，注意劳逸结合，避免过度劳累引起关节腔内积液。 4、多食高蛋白(如奶制品、豆制品、肉类等)、高钙(海产品)食品。 第十一节 髌骨骨折 一、 术前护理 1、做好心理护理。 2、遵医嘱做好术前准备。 3、患肢护理 应尽量减少患肢的活动，使患肢高于心脏水平面 15,20 cm，以利静脉血液和淋巴血液的回流，需要移动时可用 -such as the introduction of talent to meet the need. Third, we must rely on ... ... Post ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me: first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basr. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifieto increase the added value of their products to ensure that introduction of transforming scientific and technological achiev nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragicity's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Riveesearch station platform, to the XX University to find expertsdoctoral workstation, ... ... Food r16 直夹板固定后再予以移动。术前教会患者练习股四头肌力量的 方法和在床上使用便器的方法，并告之患者术后有可能出现的 一些不适及对策。 二、 术后护理 1、按麻醉术后护理常规。腰麻或硬麻去枕平卧及禁食水6小时，头偏一侧，防止呕吐引起窒息。 2、密切观察生命体征的变化;密切观察患肢血运，皮肤温度、神经感觉、踝及足趾活动、末梢循环的充盈度、伤口渗血、患肢足背动脉博动情况。 3、疼痛的护理 区分是切口疼痛还是敷料包扎过紧引起的疼痛，若是切口痛指导患者做深呼吸运动，听音乐、看电视分散注意力，必要时遵医嘱给予镇痛剂并观察不良反应，如头晕、恶心、尿潴留等。若是绷带包扎过紧引起，止痛剂疗效不佳，应通知医师检查术区，若张力过高，须松解绷带，观察患肢血液循环。 4、引流管的护理 1(患者术毕回科妥善固定引流管，避免脱位或移出。 2(保持引流通畅避免引流管受压和扭曲;定时挤压引流管，防止。流堵塞。 3.注意保持引流管和伤口接触部位的清洁，以防感染。 4(观察引流液的颜色、性状及量，做好记录并及时报告医师。 5(2天后拔除引流管，伤口换药。 5、皮肤护理 术后6小时协助患者翻身按摩，预防压疮，保持床单位清洁干燥。 6、肢体护理 r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we muste yeaadded value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo actient, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-ion of talent to meet the need. Third, we must rely on ... ... Postroductneeds to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development rprisstrengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente17 1(给予患肢抬高，高于患者的心脏水平，利于血液循环，防止患肢肿胀。 2(嘱患者麻醉过后即开始进行踝部练习，防止深静脉血栓的发生。 7、预防伤口感染，注意患者的全身情况。对术后体温持续过高者，考虑伤口有感染的可能，立及时报告医师予以处理。注意观察伤口疼痛的性质、有无红肿等情况。 8、饮食护理 指导患者进食，多给其富含维生素和钙质的食物和高蛋白、高热量、高纤维素易消化饮食，加强营养，防止便秘的发生。 9、术后功能锻炼 1(麻醉消退后即可行患肢踝趾关节的趾屈、背伸锻炼，每小时1次，每次五分钟。还需即刻指导其行“股四头肌等长收缩”锻炼，先健肢训练，再患肢练习，每2小时一组，每组6,8次。术后2,3天，若伤口无并发症，可渐行膝关节主动及被动屈曲活动，逐渐增加活动量，注意避免患肢疲乏、疼痛。 2(骨折后期功能锻炼 指导患者进行患肢膝关节的主动伸屈锻炼，保证脚在床上滑动，尽量屈伸膝关节，可以从15,20度开始，连续30,40次屈伸活动，每天5,6组，逐渐增加活动范围;指导患者进行患肢“直抬腿训练”及“髌骨松动训练”每日3组，每次50,100次。2周后离床活动，扶拐下地负重行走。6周后可逐渐做下蹲动作，每组10,20次，每天2组。4,6周后外固定拆除，加强患肢的主动屈伸锻炼。 10、健康教育 doctoral workstation, ... ... Food r-such as the introduction of talent to meet the need. Third, we must rely on ... ... Post ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me: first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basr. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifieto increase the added value of their products to ensure that introduction of transforming scientific and technological achiev nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragicity's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Riveesearch station platform, to the XX University to find experts18 1. 定期门诊复查。 2(出院后坚持功能锻炼，如股四头肌舒缩锻炼，练习膝关节屈伸活动，有石膏外固定者行髌骨上下左右推移活动。术后6周内不宜行下蹲动作。 3(合理安排作息时间，注意劳逸结合，避免过度劳累。 4(术后视骨痂生长情况决定内固定物取出时间。 5(每日户外晒太阳1小时，不能到户外者可补充鱼肝油滴剂或维生素D等。 第十二节 胫腓骨骨折 一、加强心理护理。 二、按医嘱做好术前准备。 三、及时固定患肢，防止造成再骨折或脱位。 四、密切观察病情变化 1、观察生命体征变化。 2、观察伤口敷料渗血情况。 3、触摸足背动脉和胫后动脉，观察皮肤的颜色，测量患肢皮肤的温度及毛细血管反应。 4、耐心倾听患者的主诉，如患肢持续剧痛并且呈进行性加重、严重肿胀及麻木、皮肤稳定降低、足趾被动牵拉时剧痛、皮肤色泽苍白及足背动脉摸不清等，出现上诉症状应考虑骨筋膜室综合征。 五、抬高患肢，以促进血液循环，防止肿胀。 六、加强基础护理，预防并发症的发生。 r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we muste yeaadded value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo actient, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-ion of talent to meet the need. Third, we must rely on ... ... Postroductneeds to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development rprisstrengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente 19 七、功能锻炼 1、早期即进行股四头肌的等长收缩、足趾的主动屈伸和髌骨的被动活动。 2、内固定术后3天可作膝关节的屈曲活动，外固定术后5,7天可扶拐，患肢不负重下床活动，外固定取出后，充分练习各关节活动，逐渐负重活动。 3、禁止做患肢旋转活动，以免影响骨折端的稳定导致骨不连接。 八、健康教育 1、定期复查，发现患肢血液循环、感觉、运动异常，及时就医。 2、继续按时服用接骨续筋药物，直至骨折愈合牢固。 3、扶拐下床活动患侧肢体全脚着地，防止摔倒，加强患肢膝踝关节伸屈锻炼，如有踝关节功能障碍可做踝部旋转，斜坡练步等功能锻炼，踝关节强硬者，可做踝关节的下蹲背伸和站立屈膝背伸等。 4、加强营养，促进骨折愈合。 第十三节 腰椎间盘脱出 一、 术前护理 1、平卧硬板床，绝对卧床休息。 2、控制用力咳嗽、打喷嚏。 3、预防便秘。 r. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifieto increase the added value of their products to ensure that introduction of transforming scientific and technological achiev nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragicity's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Riveesearch station platform, to the XX University to find expertsdoctoral workstation, ... ... Food r-such as the introduction of talent to meet the need. Third, we must rely on ... ... Post ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me: first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the bas20 4、遵医嘱应用止痛剂。 5、术前3天训练床上大小便。 6、遵医嘱做好术前准备。 二、 术后护理 1、按麻醉术后护理常规。 2、麻醉消失后观察双下肢的运动、感觉及大小便情况，如出现双下肢运动障碍、感觉消失则怀疑脊髓受损，立即报告主管医师。 3、保持引流通畅，避免引流管扭曲、受压及脱出。负压应适当，切忌过大而加重伤口出血。记录引流液的颜色、性质、量，观察是否有脑脊液流出。 4、术后早期翻身时需由2人合作，保持脊柱在同一轴线上，避免扭曲。 5、观察敷料渗液情况，保证其固定牢固，及时换药。 6、诱导排尿，如听流水声、下腹部热敷、按摩等。诱导排尿无效时，在严格无菌操作下行导尿术，留置尿管12,24时。 7、术后7,10天开始采用”三点式”或“五点式”逐渐锻炼腰背肌。 8、补充营养、增强机体抵抗力。多食含纤维素丰富的食物，如蔬菜、水果，以促进肠蠕动。有规律地排便。 9、健康指导。 第十四节 膝关节置换 一、 按医嘱做好术前准备，做好心理护理，消除紧张情绪。 rprisstrengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we muste yeaadded value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo actient, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-ion of talent to meet the need. Third, we must rely on ... ... Postroductneeds to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development 21 二、 术前练习床上大小便，并保持大小便通畅。 三、 加强营养，多食高蛋白、高维生素、粗纤维食物。 四、 术后采取去枕平卧位，保持呼吸道通畅。 五、 保持引流管通畅，观察引流物颜色、性质及量，做好记录。 六、 加强基础护理，预防各种并发症。 七、 功能锻炼 1、术后前3 d，手术当日麻醉消失后即可指导患者做足趾、踝关节的屈伸运动。指导患者做足用力向上勾和下踩动作，下肢伸直，双足用力尽量向上勾，保持5,10 s，然后用力做往下踩的动作，每次保持5,10 s。直腿抬高:在床上伸直并绷紧单膝关节，用力将足抬离床面20 cm，并保持10 s，然后慢慢放下，每2 h做1组，每组3,5次或自我感觉大腿的肌肉疲劳为止，对患侧肢体做由足到大腿的按摩，每2 h按摩10 min，按摩时注意伤口的保护，以免加重伤口疼痛。 2、术后4,7 d，继续前3 d的锻炼内容，并增加以下练习:患者坐在病床上，双手抱住大腿下1/3段，缓慢用力将大腿向上提，使膝关节呈屈曲状态，每隔2 h练习5,10次。患者坐于床边，双侧小腿自然悬垂于床沿下，在训练过程中，如感觉剧烈疼痛，可在床边放一凳子，足置于凳子上，可以通过放置凳子的高度来调节膝关节屈曲的角度。当患者自然下垂小腿习惯以后，可以在坐位下练习屈曲关节。练习一:患者坐于床边，两腿自然下垂，健侧小腿放于手术侧足踝上(双侧手术患者由护士协助完成)，做向下悠压的动作。慢慢地尽量屈曲膝关节，在最大屈曲位时，保持5,10 s。练习二: esearch station platform, to the XX University to find expertsdoctoral workstation, ... ... Food r-such as the introduction of talent to meet the need. Third, we must rely on ... ... Post ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me: first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basr. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifieto increase the added value of their products to ensure that introduction of transforming scientific and technological achiev nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragicity's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Rive22 患者坐于床边，两小腿自然下垂，健侧足放于患侧足跟部，协助患侧小腿做向上抬的动作，对于双侧手术的患者由护士协助其完成，或者使用绷带，一头绑于足底部，一头牵于自己手中，自行牵引使小腿抬起膝关节伸直。适应性站起练习:在医护人员的保护下，下床做适应性站立练习，重心放在健侧肢体上，患肢不负重。双侧手术的患者下床时由两人搀扶，重心放在双上肢上，站立的时间随练习的增多逐渐延长。 3、术后8,14 d卧床直腿抬高练习:仰卧于床上，伸直并绷紧膝关节，然后用力将患肢抬高床面30?，保持5,10 s后慢慢放下，每天练习3组，每组练习20,30次。下蹲练习:在陪护人员的保护下，扶住栏杆，尽量往下蹲，同时脚跟不要离开地面，保持10,15 S后缓慢站起，每日做3组，每组20,30次，下蹲的程度逐渐增加。渐进式脚踝屈伸练习。练习一，坐在凳子上，两小腿自然放在地板上，缓慢地同时抬起双足跟，直到脚尖着地，保持5 s，然后放回直到脚跟着地。练习二，坐在凳子上，两小腿自然放在地板上，一足脚尖着地，另一足脚跟着地，保持3,5 s，两足交替进行。练习三，坐在凳子上，两脚稍分开，自然放在地板上，将一只脚拉向臀部方向，另一只脚用力向前伸，交替拉伸两腿，注意在整个过程中双脚掌不能抬离地面，并用力压地板，一定要有肌肉绷紧的感觉。练习四，在练习三的基础上，将1条腿向前伸，勾起足尖，整条腿伸直，抬离地面一段距离，保持5,10 s，然后慢慢放下，先足跟着地，后脚掌着地，慢慢拉回腿。行走练习:在陪护人员的保护下扶助行器练习平地行走。第一步:保持正确的站立姿势(抬头 strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we muste yeaadded value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo actient, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-ion of talent to meet the need. Third, we must rely on ... ... Postroductneeds to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development rpris23 挺胸收腹，伸膝屈髋)，将整体重量置于助行器上;第二步:将助行器移向前方，并确保放置平稳;第三步:迈出手术一侧肢体，将足放在助行器中间区域，使脚跟先着地，然后让整个脚掌着地;第四步:站稳后身体向前倾，再迈出健侧腿。行走练习时一定不要着急，并根据自己的情况调整行走的时间和速度，这个阶段行走时最好在平地上练习，练习时注意安全，避免摔跤等意外发生。 第十五节 膝关节前交叉韧带损伤 一、 心理护理 术前做好耐心细致的解释工作，使患者对所要进 行的手术有充分的认识。以消除顾虑和缓解紧张情绪。术后患 者因疼痛不敢活动，护士因及时给予安慰、解释。在进行功能 锻炼时，注意观察患者的心理反应，用鼓励性语言，对患者的 每一个动作都给予耐心的指导和肯定，使患者树立自信心，自 觉的进行锻炼。 二、 术前准备 入院后进行全面的术前检查(血常规、血型、凝 血功能、肝功能、肾功能、肝炎、梅毒、心电图及相应的X线、 MR等影像学检查);术区备皮;禁食12h，禁水8h;指导患者 练习在床上排便;术前应向患者说明膝部肌肉萎缩对疗效的影 响，并以健肢做示范指导患者熟悉和掌握各项康复训练，内容 包括股四头肌等长收缩、髌骨活动、踝泵运动、直腿抬高训练、 压膝运动、渐进抗阻训练等练习。 三、 术前宣传 根据腰麻或连硬外麻醉的要求做好常规宣教， : first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basr. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifieto increase the added value of their products to ensure that introduction of transforming scientific and technological achiev nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragicity's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Riveesearch station platform, to the XX University to find expertsdoctoral workstation, ... ... Food r-such as the introduction of talent to meet the need. Third, we must rely on ... ... Post ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me24 更主要的是必须详细做宣教、功能锻炼的知识。目的是患者了 解锻炼的内容和方法。为术后能进行良好的功能锻炼打好基础。 和患者和家属进行沟通并共同制定功能锻炼的计划，进行患者 被动或主动的功能锻炼，耐心向患者解释计划内容，给予必要 的演示。 四、 按麻醉术后常规护理，腰麻或硬麻去枕平卧及禁食水6小时 头偏一侧防止呕吐物引起窒息。 五、 严密观察病情，预防并发症。 六、 患肢用软枕抬高15度~30度，外展10~20中立位。关节适 当屈曲，方便膝关节处于松弛状态，利于血液回流，减轻术后 切口疼痛及患肢肿胀。 七、 功能锻炼 1、手术当天麻醉恢复后，行股四头肌的等长收缩的锻炼方法，方法为:患者仰卧位，膝关节静止不动，足跟用力下蹬，足背屈，嘱患者做股四头肌收缩，以手掌感觉到髌骨上下滑动为效，反复运动，每2小时一次，一次5~10分钟。 2、术后第一天开始直腿抬高练习，以增强股四头肌及腘绳肌的肌力，有利于增强患肢的稳定性。方法为:患者平卧，足尖朝上，伸膝关节并收缩股四头肌后抬高患肢，足跟据床面20cm，持续5~6秒，放下肢体，放松肌肉。 3、术后第三天，膝关节疼痛缓解后，开始终末伸膝锻炼，以增强股内侧肌肌力，对维持髌骨对线具有主要的作用，方法为患膝垫一枕头，保持屈膝约30?，然后使足跟抬离床面至患膝伸直，保持5~10秒，放下肢体，放松肌肉。 r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we muste yeaadded value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo actient, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-ion of talent to meet the need. Third, we must rely on ... ... Postroductneeds to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development rprisstrengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente25 4、膝关节活动范围的练习，以增加膝关节的活动范围。方法为:患者平卧，足尖朝上，直腿抬高离开床面，使肢体与床面成45?角，屈曲膝关节，再逐渐伸直膝关节，放下肢体，放松肌肉。此训练也可让患者坐于床边进行练习，膝关节位于床沿，两腿自然下垂，伸直膝关节，持续5~10秒，然后放松，使小腿自然下垂。 5、膝关节的被动练习 主要通过CPM进行，以缓解损伤和术后引起的疼痛，增加关节软骨的营养和代谢活动，消除关节粘连，改善关节活动角度，促进关节软骨损伤的自身修养，最终促进关节内的恢复。方法;术后3~5天可在CPM机上锻炼2次/天，30分钟/次。CPM能使肌体肌肉处于无收缩状态膝关节活动，加速关节骨液循环，消除肿胀，有可能获得透明软骨的再生修复。方法:患者取仰卧位，将患肢伸直放在活动器的架上并给予固定，调节膝关节活动范围至患者能够忍受屈膝的最大限度为宜，多在30?~90?，每次30分钟，2次/天。第2天对完全承受第1天的运动强度者，可以增加10?，对于不能承受者，则维持第一天的锻炼方法。以后逐渐增加度数，每天增加10?，直至90?，速度也逐渐增加。以患者达到疼痛和疲劳为度。2周内避免负重，第3周后可部分负重，第4周可全负重并弃拐，第4周屈膝90?，第5~6周屈膝超过90?。活动行膝支具保护3个月。患者尽量在出院前就进性渐进性抗阻锻炼以增强肌肉锻炼力量。 第十六节 髋关节脱位 一、 做好心理护理，及时给予患者精神安慰。 doctoral workstation, ... ... Food r-such as the introduction of talent to meet the need. Third, we must rely on ... ... Post ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me: first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basr. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifieto increase the added value of their products to ensure that introduction of transforming scientific and technological achiev nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragicity's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Riveesearch station platform, to the XX University to find experts26 二、 生活起居的护理，创造一个良好发的修养环境，帮助患者尽 快熟悉和适应环境。 三、 密切观察全身情况，对疼痛给予对症处理。 四、 牵引时患肢需保暖，并观察患肢血液循环情况及有无神经受 压症状。 五、 卧床期间，做好翻身、拍背及按摩，鼓励患者深呼吸及咳嗽， 防止坠积性肺炎、压疮的发生，多饮水以防止尿路感染的发生。 六、 复位后取仰卧位于硬板床，垫放便盆时要防拖拉并要减少移 动患肢，防止疼痛加剧，指导患者在床上侧身的方法。 七、 督促并正确指导患者进行髋关节的功能训练，复位后在皮牵 引固定下行双上肢及患肢踝关节的活动，3天后进行抬臀训练。 去除皮牵引后，指导患者用双拐练习步行。 八、 术后功能锻炼 1、 术后第一天开始进行患肢股四头肌静止性等长收缩，踝关节背伸跖屈及伸屈足趾。 2、 术后1周均能在床上进行伸屈膝和踝关节活动，均在术后2,3周出院，出院后一定要保证髋部的正确位置。 3、 3个月内做到双腿不交叉，不内收，侧卧时两腿之间放置枕头，不屈身向前，髋关节屈曲不宜超过45?以上。 第十七节 骨肉瘤 一、 做好心理护理，稳定其情绪。 二、 加强营养，多食高蛋白、高维生素、粗纤维食物。 needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development rprisstrengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we muste yeaadded value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo actient, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-ion of talent to meet the need. Third, we must rely on ... ... Postroduct27 三、 缓解疼痛，促进肌肉、关节功能。 四、 增强耐力，加强化疗护理。 五、 截肢术前的护理 1、做好心理护理，解除患者的焦虑情绪。 2、遵医嘱做好术前准备，术晨禁食水。 3、术前练习床上大小便，并保持大小便通。 4、遵医嘱应用止痛剂。 六、 术后护理 1、术后去枕平卧6小时，头偏向一侧，保持呼吸道通畅，给予高流量氧气吸入。 2、密切观察体温、脉搏、呼吸、血压等生命体征的变化。 3、引流管的护理 注意负压引流的观察，由于胸腰椎手术创伤较大，术中出血多，术后切口处放置引流负压吸引24,48小时，保持引流管通畅、固定。观察记录引流量及性质，若2小时引流量达到200ml或24小时达到400ml，说明手术部位有活动性出血，应及时处理;若引流液淡红或清亮可能是脑脊髓漏，应改负压吸引为正压，并采取头低脚高位，密切观察患者双下肢感觉及运动情况。 4、 术后24,48小时应抬高患肢，预防肿胀。患肢抬高，每3,4小时20,30分钟并将残肢以枕头支托，压迫向下。 5、 患肢痛的护理 应用放松疗法等心理治疗逐渐消除患肢感，对疼痛持续时间长的患者，可轻叩残端，或用理疗、封闭、神经阻断的方法消除患肢痛。 6、 残肢功能锻炼 一般术后2周，伤口愈合后开始功能锻 炼。方法是用弹性绷带饭饭包扎，均匀压迫残端，促进软组织收 city's first resource, is the primary iadded and improve economic competitiveness, is the inevitable way to achieve leapfrog development. Talent is the city center -economic development through scientific and technological innovation, improve product valuenty's focus on the development of the kind of industries. Four stroke technology and science. Determinants of technology is the Couhas formed a kind of scale, need to bring in the kind of projects each town street has the kind of resources, what location, led unit and various town streets are developing detailed promotion plans, the basis of what is specific to each industry, -Tangshan area, targeted investment promotion several times. Industry-Tianjin-r Delta, Pearl River Delta, Shandong peninsula, Beijingadvantages, facing the Yangtze Riveesearch station platform, to the XX University to find expertsdoctoral workstation, ... ... Food r-such as the introduction of talent to meet the need. Third, we must rely on ... ... Post ial development needs to invest more in machinery, pharmaceutical manufacturing research and development in higher education,et socic demand of enterprise development. Then introduced a number of the county needed scarce education, health professionals, me: first, we must strengthen the cultivation of talent, efforts to increase vocational education and training and meet the basr. Inements during the year ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifieto increase the added value of their products to ensure that introduction of transforming scientific and technological achiev nologyng enterprises to actively undertake science and technology projects, strengthening research cooperation, using advanced techndustry development, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouragi28 缩，残端按摩、拍打及蹬踩，增加残端负重能力，鼓励尽早使用 临时义肢，为安装义肢做准备。 七、 加强基础护理，预防并发症。 added value of their products to ensure that introduction of transforming scientific and technological achievements during th vely undertake science and technology projects, strengthening research cooperation, using advanced technology to increase theo actient, and revitalization of the social protection. So, in terms of skills: to catch ... Competitive. Encouraging enterprises titable way to achieve leapfrog development. Talent is the city center city's first resource, is the primary industry developmadded and improve economic competitiveness, is the inev-ment through scientific and technological innovation, improve product valuent of the kind of industries. Four stroke technology and science. Determinants of technology is the County's economic developelopmed of scale, need to bring in the kind of projects each town street has the kind of resources, what location, focus on the devarious town streets are developing detailed promotion plans, the basis of what is specific to each industry, has formed a kinled unit and v-Tangshan area, targeted investment promotion several times. Industry-Tianjin-advantages, facing the Yangtze River Delta, Pearl River Delta, Shandong peninsula, Beijingdoctoral workstation, ... ... Food research station platform, to the XX University to find experts-ion of talent to meet the need. Third, we must rely on ... ... Postroductneeds to invest more in machinery, pharmaceutical manufacturing research and development in higher education, such as the inte development. Then introduced a number of the county needed scarce education, health professionals, meet social development rprisstrengthen the cultivation of talent, efforts to increase vocational education and training and meet the basic demand of ente r ... ... New research enterprises ... ... Home, creating innovative platforms ... ... Generic classifier. In: first, we muste yea29