《cpm应用》ppt课件.ppt
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1、CPM 理论和应用,Objectives Objectives Objectives Objectives Objectives Objectives Objectives,Present the history of CPM CPM 的历史 Explain the clinical and physiological benefits of CPM 临床治疗应用的解释 Indications & contraindications of CPM 临床适应症禁忌症 Traditional therapy vs. CPM 传统理论和CPM理论的比较 Demonstrate types and c
2、linical cases of CPM CPM的示范,Definition定义, Passive joint motion is defined as any motion that is “produced by an external source” ,Traditional teaching post trauma or surgery: 创伤或手术的传统教育,Enforced强制限制 Uninterrupted不间断 Prolonged长期的,Immobilization 固定,Effects of Immobilization 制动的影响,Inhibit the circulati
3、on of Synovial Fluid 制约滑液的循环 Starve joint cartilage of Nutrients 阻止关节软骨面的营养供给 Promote the development of Adhesions 促进粘连的发展 Neuromuscular Degeneration 肌肉神经退化,20th Century Research 20世纪的研究,1919 Willem Preservation of septic joints by drainage and immediate motion 1970 Salter Healing effects of CPM on
4、rabbit joint cartilage 1973 Kleinert Early Passive Motion following tendon repair 1982 Gelberman Effects on CPM on tendon healing,动物实验研究,Used rabbits 用家兔 Full thickness defects 全层软骨损伤 Intra-articular fractures 关节内骨折 Acute Septic arthritis 急性化脓性关节炎 Partial thickness tendon laceration 部分肌腱损伤,Benefits
5、of CPM to healing cartilage CPM对软骨愈合的好处,Enhanced nutrition and metabolic activity 促进营养供给和代谢水平 Accelerated healing of articular tissues 加速关节组织的愈合 Regeneration of cartilage 重建软骨面,Jama, 6 Nov. 1981 Vol. 246, N. 18,Rabbits with full thickness cartilage defects divided into three groups: 兔子全层软骨损伤分三组(,):
6、Immobilization with cast 石膏固定组 Intermittent Active Motion (Cage activity) 间歇性主动运动组 CPM regimen:Treatment initiated immediately post operatively 组:术后马上治疗,动物实验研究,动物实验研究,Benefits of CPM to Healing Tendons CPM对肌腱愈合的好处,Restoration of the tendons gliding surface 重建肌腱表面 Greater mean breaking strength of th
7、e tendon Synovial diffusion may enhance intrinsic healing 滑液的扩散增强康复 Prevention of adhesion formation 制止粘连的产生,Benefits of CPM to Healing Ligaments CPM对韧带愈合的优点,Maintenance of collagen matrix organization 维持胶原蛋白组织 Normalized collagen concentration 提高胶原蛋白排列整齐 Maintenance and increased strength 维持和增强强度,B
8、enefits of CPM to Skin Healing CPM对皮瓣愈合的好处,Edema reduction减少水肿 Decrease Scar formation减少疤痕形成 No disruption of the graft (after 7th day) No disruption of the incision Improved elasticity改良弹性 CPM is effective in maintaining and restoring ROM有效维持和恢复关节活动度 CPM doesnt cause pain in excess of routine thera
9、py日常治疗中CPM不会导致疼痛 “Motion gained should never be lost”,Clinical Benefits of CPM CPM的临床好处,Maintain and Increase of ROM 维持和增强关节活动度 Decrease pain, swelling, stiffness 减少疼痛、肿胀和僵硬 Increase rate of recovery 增加痊愈的比例 Shorten hospital stay 减少住院时间,Physiological Benefits of CPM 生理学上的好处,Reduce adhesions 减少粘连 Enh
10、ance nutrition 增强营养供给 Promote wound healing 促进伤口愈合 Improve venous dynamics 增强血管动力,Contra-indications 禁忌症,Unstable fractures 不牢固的骨折 Active infection 感染病人 Precautions防范 Vascular status 血管状况 Loss of sensation 失去感觉,Clinical Applications 临床应用,ORIF of intra-articular fractures 关节内骨折切开复位内固定 ORIF of peri-ar
11、ticular fractures关节周围骨折切开复位内固定 Arthroplasties关节成型术 Flexor/Extensor tendon repair腱修补 Replants, reattachments (extremities, digits)末端关节移植和重建 Crush injuries关节变形损伤 Capsulotomy关节囊切开术 Tenolysis腱松解术 Dupuytrens contracture掌腱膜挛缩症,Clinical Applications 临床应用,Colles fractures桡骨下端骨折 Elbow fractures, release肘关节骨折
12、,松解 Rotator cuff repairs 肩袖缝补 Humeral head fractures 肩部骨折 Synovectomy 滑膜切除术 Post removal of Heterotopic Ossification防止术后软组织异位骨化 Surgical release of contracture挛缩的手术松解 Burns烧伤病人 RSD反射性交感神经营养不良综合征,CPM is an adjunct to therapy CPM是治疗的辅助 It will not replace the therapist but it will enhance the Rehabili
13、tation outcome. CPM不可能替代医生但可以加强康复效果,Length of use for CPM 使用CPM的时间,Animal/Experimental models 24 hrs/day 动物/实验模型24小时/天 Patient use at home 6-8hrs / day 病人在家里使用6-8小时/天 Burns (post release) 4-6 weeks 烧伤病人4-6周,Patient Assessment病人评估,History and mechanism of injury and repair are vitally important 损伤和修复
14、的历史至关重要 How, where and when ? 如何,哪里什么时候? Vascular status 血管状况 Neurologic status 神经状况 Wound location, size 伤口-地方,大小 Joints and injuries above and below the affected area 关节和损伤区域,Benefit of CPM 使用CPM 的优点,一、Painless 无痛苦。 不影响患者正常生活,患者乐于接受。CPM的“疼痛闸门学说”解释;使用CPM装置后,手术伤口和关节疼痛缓解或消失,尤其是术后前三天。一般在伤口愈合,关节内创伤修复后停
15、机,不会出现疼痛。,二、Swelling 消肿快。 CPM装置符合生理要求,促进手术部位血液和关节滑液的循环,利于水肿或肿胀消退。相反制动影响血液循环,局部张力增加,进一步限制静脉回流,使局部肿胀呈恶性循环。,Benefit of CPM 使用CPM 的优点,三、Heal up wound 伤口愈合快。 缝合时注意克服切口张力,CPM装置活动时不增加手术切口的张力,血液循环增加,处于切口早期愈合。切口的抗张力和修复肌健的抗拉力明显优于制动处理。,Benefit of CPM 使用CPM 的优点,四、Improve ROM 消除关节粘连,改善ROM。 CPM装置克服关节手术和肢体制动造成的关节粘
16、连、关节僵硬、肌肉萎缩、退行性和创伤性关节炎的发生,并可缩短住院时间。,Benefit of CPM 使用CPM 的优点,五、Scar down Tendons and Ligaments 促进关节软骨损伤的自身修复。 关节骨折或小的关节软骨损伤,通过CPM装置的活动,刺激关节软骨的细胞增生,分泌和合成软骨基质,也可使软骨下骨组织中血液未分化细胞发生软骨样改变,避免或减轻创伤性关节炎的发生。,Benefit of CPM 使用CPM 的优点,MOVEMENT OF THE ANATOMY:解剖运动方式 the movement of the unit should be very simila
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