Work description

In the first century n. e. Celsius offered to carry out limb amputation within healthy tissues, pour the bone above the soft tissues, and vessels
pack over to stop bleeding ligature.
However, the work of Celsius was not seen by contemporaries. These deals are made only in the 16th century. In particular, the ligature for the dressing of the vessels revived Ambroaz Pares.
Since that time, amputation of the truncation of the limb steel intensively
develop and improve.

Introduction ................................................................................. ..... 3
Chapter 1. Concept of amputation ........................................................... 5
1.1.The etiology and pathogenesis of amputations ................................... ........................... .....five
1.2 Clinical manifestations of injury ............................... ........................ 11
Chapter 2. Therapeutic physical culture in the complex treatment of patients with the amputation of the limbs ............. .....................................................................................
2.1. Clinical and physiological substantiation of therapeutic use of medicinal physical culture .............................................................. 14
2.2. Tasks and foundations of the methodology of therapeutic physical culture ........................ 15
2.3 Features of the technique after amputation of the upper and lower extremities ... 17
2.4 Accounting for the effectiveness of therapeutic physical culture .................................... 22
Conclusions ................................................................................... ..................... 29
List of literature used ...................... .. ......... ... .. 31

Files: 1 file

Fig. 7 Learning using a prosthesis after the amputation of the lower limb

In amputation of the upper limbs in the acute postoperative period (first period), classes of therapeutic physical culture begin a few hours after surgery. In classes include general-genuine exercises that ensure the stimulation of all vegetative functions (according to the mechanism of motor-visceral and visceral visceral reflexes), exercises that contribute to the formation of household compensation (turns on the side, transitions in the position of sitting on the bed and rode from different positions without support with hands , meals, wash, dressing, combing one upper limb). All these exercises in combination with walking reduce the dysfunction of homeostasis and promote the fight against hypodynamics. The intensity and timing of the activation of the motor regime are determined by clinical data (the severity of the effect of mechanical, burn or electrician and operational intervention, complications in the postoperative period, etc.).

2.4 Accounting for the effectiveness of therapeutic physical culture

From the 30th day, the voltages and relaxation of the muscles of the preserved segments of the amputated limb and the truncated muscles (pulsed gymnastics) are turned on, as well as cautious movements inhaling and movement in the free joints of the cult. They contribute to a decrease in postoperative edema of the cult, prevention of the formation of contractures and muscle atrophy. From the 5-6th day, painless movements in the joints of the amputated limb can be performed with an extremely large amplitude.

Therapeutic physical culture in the period from the time of the removal of the seams before using the training and trained prosthesis (second period) should provide: maximum mobility in all preserved truncated felts; Correction of emerging posture defects Increasing the strength of muscles, carrying out the movements of the cultures and movement in all joints of the amputated limb; Preparation of the skin of the cult and the above arranged segments of limb and torso to the mechanical effects of the sleeve, fasteners and the prosthesis; normalization of muscular-articular, tactile, temperature and other types of sensitivity on a truncated limb, improving the coordination of movements and active relaxation of muscles of amputated limb and body; expansion of motor compensation providing self-service; Formation of free gait.

After removal of the seams, they are trained by the exciting of various objects of the cult. It is advisable at this time to use working devices in the form of various cuffs, clamps. Motor compensation formation greatly facilitates patient care and favorably affects the state of his psyche.

In the third period, depending on the design of the prosthetic, exercise are used for the following purposes:

During traction prosthesis in prosthetic with pneumatic reception - the objectives of strengthening the muscles and improve the muscular and articular sensitivity and coordination of the movements that are necessary for using the prosthesis;

With cobwebs with motonic in bioelectric control - in order to teach isolated and dosed in the intensity of muscle stresses and muscle strengthening, with which the prosthesis is controlled;

With prostheses, in which several energy sources are simultaneously used (a combination of traction and bioelectric, traction and petonic, traction and pneumatic drive, etc.), - in order to solve the tasks listed in the complex.

After amputation of the upper limbs in the third period, first of all, learn to wear a prosthesis. In all cases, in addition to the extracts of the limbs in the shoulder joints, the patient must wear a prosthetic independently. With one-sided amputation, the prosthesis is put on with a healthy hand. With bilateral amputations, prostheses are put on a longer culture, then to a shorter, or at the same time. You can remove the prostheses by any most convenient way for the patient.

When the prosthesis, the prosthetic is consistently mastered: "Disclosure" of the brush and subsequent closure of the fingers, flexion and extension in the elbow joint, the simplest movements in the preserved joints in combination with the prosthetic performed; necessary household movements and actions (moving various objects, eating, dressing); Comparatively complex motor actions, including a gaming nature (Fig. 8). In classes include the exercises of the second period, complicating them and increasing the load. The nature of the motion depends on the nature of amputation and the prosthesis used. For example, prostheses after the elimination of the shoulder amputation allow the following movements: a) flexion in the elbow hinge, b) fixation of the forearm in relation to the shoulder at different angles of bending, c) "disclosure" of fingers, d) rotation of the brush, d) shoulder rotation. In the forearm prosthesis, "disclosure" of fingers and passive rotation of the brush are possible.

Fig. 8 Learning using prostheses after amputation of the upper extremities

You can train movements at two prosthesis as separately and together. Initially, it is advisable to teach and hold the items, standing, then sitting (items are first on the edge of the table, then closer to the middle of the table), later - form skills in food, letter, paint, drawing, drawing. With the supply of disabled people not only with prostheses, but also working adaptations (cuffs, hooks, locksters), motor compensation for household movements (food, closing and opening doors, valves, locks) and complex motor acts (letter, drawing, drawing) are formed (Fig. 9 ).

Fig. 9 Model exercises in the second period after amputation of the upper extremities

In teaching the use of the prosthetic of the upper limb, it is necessary to observe the following sequence: movement in proximal "joints" (hinge connections of prostheses), then in distal. For example: lifting hands on the sides, forward, bringing the brush to mouth, the head of the head, the "disclosure" of the brush, holding the spoon, forks, pencil, other items transfer them, letter, drawing, throwing and catching the ball, rearrange chess figures.

Reconstructive operational interventions in the amputations of the upper limbs (the deepening of the axillary depression, the lengthening of the short shoulder and so on) provide the possibility of better prosthetics and more advanced subsequent mastering with a prosthesis or allow you to do without prostheses, for example, after splitting the cult of the forearm in Krokenberg (Fig. 10 ), Falangizations of the first metatar bone (Fig. 11). Therapeutic physical culture in the preoperative period contributes to the functional best intervention, and in the postoperative period - a speedy formation of a cult in more advanced motor compensation.

It should be noted that the formation of the skill of the use of prostheses, as well as motor skills, is three stages: the first is characterized by insufficient coordination and stiffness of movements, which is due to the irradiation of nervous processes; In the second, as a result of repeated repetitions of the exercise of motion, they become coordinated, less compound, the skill stabilizes; In the third - movement automate. When training, the first stage is required to use special attention, since it is during this period a large number of unnecessary, unnecessary movements are observed, which in the stabilization stage are fixed and in the future corrected with great difficulty.

Fig. 10 Typical exercises after splitting of the forearm in Krokenberg

Fig. 11 Typical exercises after the phalanxing of the first Metal bone

In classes with patients after amputation of the limbs, along with well-known gymnastic inventors (printed balls, basketball, volleyball and tennis balls, gymnastic sticks, walls, benches, etc.), it is necessary to use special equipment: goals, portable barriers, crutches, simple and sliding Canes, cane dynamometers, devices and devices for the development of "reference" of cultures, strength, endurance, muscular and articular sensitivity, coordination of movements, prevention of contractures. In the office of therapeutic physical culture should be measuring instruments for monitoring the level of development of motor qualities in the process of occupying, large mirrors installed on opposite walls, for controlling movements and posture during the use of prostheses, metronome, or tape recorder for rhythmic walking, tracks Various widths with paint trails for the work out of the steps are the same length. The floor in the office should be smooth, deck type.

For the purpose of successful labor rehabilitation of persons after an amputation of the limbs, they must be involved after teaching the use of a prosthesis in sports. Experience has shown that a person who uses a prosthesis can engage in any sport accessible to him. Amputation people usually experience great pleasure from what can swim, skiing, ride a bike, take part in competitions.

when studying scientific and educational and methodological literature and medical practice, it was found that the amputation of the limbs is made in severe damage, frostbumps, the rod, as well as in diseases, sharply disturbing blood supply and tissue trophic (endarterite, atherosclerosis, etc.), with malignant tumors ( Sarcoma, Cancer and others) and rarely for other reasons. It was also found that the greatest number of amputations is in military time.

The study of medical practice shows that a consultation of doctors should be involved in solving the issue of amputation, and the consent of the patient and relatives should be obtained for the operation.

Amputations (truncations) and the extinction of individual limbs and limb segments are generally produced in severe damage, frostbizes and burns, with diseases, sharply violate blood supply and tissue trophics (endarterite, atherosclerosis, etc.), with malignant tumors (sarcoma, cancer, etc. ) and (rarely) for other indications.

All readings to amputation or examination can be divided into two

groups: absolute and relative.

By N.A. Kupriyanov All indications for amputation are divided into three groups:

The first group is: primary amputations

Second group: secondary amputation

Third Group: Repeated, Rather Reamparation.

Depending on the general state of the affected, degree and nature of changes in the tissues of the segment to be truncated, various causes of amputations are applied. The most common patchwork method. The method is less common, the most complete variant of which is the cone-circular when costeglastic methods.

After amputation, prosthetics is carried out by artificial limbs. Upper prostheses in the lower extremities on purpose and design differ significantly from each other. Upper limb prostheses are divided into: a) active - traction and external energy sources, b) household and working devices, c) cosmetic. Prostheses of the lower limbs are simpler in design. Their main purpose is to compensate for lost standing and walking functions.

In the process of studying therapeutic physical culture after amputation of limbs, the mechanisms of the tonic and trophic effects of physical exercises are used primarily. Passing with a prosthesis is carried out by the mechanism for the formation of compensation.

In the method of therapeutic physical culture after amputation, three periods are distinguished: the early postoperative (from the date of operation before removing the seams), the period of preparation for prosthetics (from the date of the removal of the seams before obtaining a permanent protege) and the period of mastering the prosthesis (from the date of receiving a permanent prosthesis before the development of it) .

When teaching the use of lower extremities (temporary and constant) prostheses, first of all, it is correct to choose crutches and canes. For walking on prostheses, the ability to maintain balance is of great importance. Therefore, before allowing the patient to move, you need to teach it stand straight, distributing the body weight on both legs.

In teaching the use of the prosthetic of the upper limb, it is necessary to observe the following sequence: movement in proximal "joints" (hinge connections of prostheses), then in distal.

For the purpose of successful labor rehabilitation, the person needs to be involved after training the use of a prosthesis in sports. The experience of Paschal, that a person who enjoys a prosthesis can engage in any sport (as an example of Paralympic games).

Amputation people usually experience great pleasure from what can swim, skiing, ride a bike and not feel inferior.

bibliography

1. White N.A. Medical massage: educational and methodical manual. -M. Soviet Sport, 2001
2. Belousov P.I. Increased motor function after limb amputation. L., 1968.
3. Dvindenko V.A., Shafransky L.V. Therapeutic physical culture after the amputation of the limbs. Mn., 1988.
4. Dubrovsky V.I. Medical physical culture: textbook for university students. - M.: Vlados, 2004
5. Therapeutic physical culture in surgery. Ed. Dobrovolsky V.K. -L., 1970
6. Healing Fitness. Ed. V.E. Vasilyeva.- M., 1970
7. Medical physical culture: directory. Ed. V.A. Pyfanova M.: Medicine, 1987
8. Medical Physical Culture: Textbook for IFC / Ed. S.N. Popova. - M.: FIS, 1988
9. Medical physical culture: textbook for university students. - 3rd ed., Fixed and supplemented. - M.: Vlados.2004
10. N.A. Bellia Medical Physical Culture, 2001
11. Pustovochtenko V.T. Therapeutic gymnastics after the amputation of the thigh and the shin. Mn., 2000 ..
12. Textbook instructor on therapeutic physical culture. Ed. VP Rlavosudova
13. Textbook instructor on therapeutic physical culture. Ed. Dobrovolsky V.K. - M.: FIS, 1974
14. Physiotherapy, Medical Physical Culture, Massage.I.V. Lukuksky, E.E. Susthech, V.S. Craftsman. - MN: Higher School, 1998
15. Surgical diseases: benefit / Ministry of Education of the Republic of Belarus, BGPU. Compiled by V.I.Soklakov, M.P.Doroshevich, V.V. Koljuzhny. - MN, 2006
16. Shengin Yu.V., Shenkhin A.V. Health gymnastics Theory and technique. Publishing for universities of physical culture. - Rostov N / D: Phoenix, 2002

The burning in the legs below the knee periodically disturbing a certain part of the population. A discomfort in the lower limbs can accompany a huge list of pathological conditions, so it is important to determine the cause and pass therapy in a timely manner.

Estimations

The causes of pain and burning in the lower limbs, both below and above the knee, can become different endo- and exofactors - from carrying uncomfortable shoes, hypodynamic lifestyles to serious violations in the work of visceral organs and systems. Often wears symptomatic nature and develops due to physiological transformation

Ham impairment

The uncomfortable sensations may be associated with the disorder of blood circulation processes in the lower limbs. Thrombophlebitis, varicose disease, violation of venous outflow in the zone of the knee articular compound may become provoking the development factors of the pathological process.

The uncomfortable feeling is complemented as well:

• A feeling of burning venous vessels on the legs and drinking them above the surface of the skin;
• numbness, lowering sensory indicators;
• hyperemia of the dermal surface;
• development of seals, tumor formations in the area of \u200b\u200bdamaged areas of the lower extremities.

Pathology of endocrine organs

The feeling of burning in muscle groups of lower extremities, it can be a consequence of the progression of pathologies of the endocrine system of character, which are accompanied by a general weakness, increased fatigue, damage to the articular joints. With endocrine disorders, the lower limbs preferably "bake" and "twist" at night or after physical loads.

Cardioneral diseases

The feeling of tingling and burning in the legs often arise due to the disorder of the functioning of the nervous system and the vascular network. The latter lead to the development of dystrophy due to insufficient blood circulation.

For neuro-vascular diseases, the following manifestations are characterized:

• feeling of "goosebumps";
• dermal itching;
• instability of blood pressure indicators;
• emotional instability and depressive states;
• sleep disorder;
• reduced Miotonia.

Due to the progression of the disease, the patient becomes sluggish, apathetic.

Diseases of the musculoskeletal system

These pathprocesses are able to cause a feeling of burning in the right either the left femoral area, the zone of the knee and ankle art stretch, fingers. The uncomfortable symptoms are caused by pathologies accompanied by degenerative transformations of osteo-chondral tissue, muscle-ligament fibers.

Destroyed articular components irritate neuroconse, and it provokes the development of a feeling of burning. In pathprocesses in the motor system, discomfort is mainly localized in the right either the left limb, generating from the femur to the foot.

Mechanical action

One of the causal factors can be a mechanical impact, or traumatic damage. Such a clinical picture is characterized by bruises, stretching, fractures, which manifest themselves during the first day immediately after injury

Discomfort is accompanied by:

• expressed edema;
• hematomas, hemorrhages;
• intense painful damaged leg syndrome;
• deformation.

Exchange Diseases - Sugar Diabetes

Diabetic diseases can be a causing factor in the development of uncomfortable burning in the limbs. Also help such diseases are diagnosed and:

• student urination;
• frequent feeling of thirst;
• disorder of the erectile ability of men;
• hand and feet swelling;
• ulcerative damage to the skin.

Having revealed at least part of the listed manifestations, immediately refer to a specialist to clarify the diagnosis and subsequent adequate therapy.

Pregnancy

Pregnant women often make complaints of the painful sensation and swelling of the entire lower limb - both above the knee, and below it. In accordance with the statement of specialists, discomfort develops due to the transformation of the hormonal background and the lack of potassium in the body. The burning feeling in muscle groups occurs due to convulsive syndrome, the disorder of the hemform of the lower extremities.

Diagnostics and therapeutic tactics

Diagnosing with such discomfort is always characterized by complexity:

• electromyographic examination;
• laboratory analysis of urine and blood;
• estimation estimate;
• Ultrasound examination;
• CT and MRI.

According to the results of the instrumental research, the doctor will expose the corresponding diagnosis.

Therapeutic tactics depends entirely on basic pathology provoked a uncomfortable feeling. Therapeutic complex consists of medicinal therapy, physiotherapy procedures, LFC. And in particularly severe options, sometimes resort to surgical intervention aimed at eliminating the causal factor.

1. Medications. Depending on the type of causal pathology, it is possible to use the following ledges:
   • venotonics (preparations based on horse chestnut) and angioprotectors;
   • NSAID (IBUPROFEN, MOLOV, etc.);
   • antioxidant preparations (mexideol);
   • complexes of vitamins and minerals.

   Additional means are drugs for external use (ointment, gels), which also contain the above components.

   In the case of a specific causal factor (diabetes mellitus, etc.), drugs are used to treat these diseases precisely.

2. Physiotherapy. With vascular diseases, neural disorders, the pathologies of the bone-muscular apparatus, physiotherapeutic procedures (electrophoresis, magneto, cryo-, laser therapy, phonophoresis, appliques with medicinal mud) are shown in patient.

Massage and LFK

Important elements of the therapeutic complex is massage and leaf. Such procedures are normalized by the process of hemforming in the legs and increase the Miotonus.

• What can be caused by pain in the cervical spine?
• Manifestations and treatment of false joint hip neck
• Manifestations and therapy of discogenic myelopathy
• Causes of development, symptoms and treatment of osteoarthrosis of the shoulder joint
• We estimate the safety of summer shoes

• Arthrosis and Periarty
• Video
• Spinal hernia
• Dorsopathy
• Other diseases
• Diseases of the spinal cord
• Diseases of joints
• Kyphosis
• Miosit
• Neuralgia
• Tumors of the spine
• Osteoarthrosis
• Osteoporosis
• Osteochondrosis
• Prudrunza
• Radiculitis
• Syndromes
• Scoliosis
• Spondylose
• Spondylolistis
• Products for the spine
• Spine injuries
• Exercises for the back
• It is interesting

October 23, 2018.
• Pain in the neck, gives in the heart and shoulder - what surveys are needed?
• How to be treated with this conclusion of X-ray?
• After classes in the gym there was discomfort in the lower back
• After the biopsy of the stomach appeared pain in the back of the head - what to do?
• How dangerous is the operation to remove the cyst Tarlov?

Catalog of the spinal treatment clinic

List of drugs and medicines

2013 - 2018 Vashaspina.ru | Sitemap | Treatment in Israel | Feedback | About site | User Agreement | Privacy Policy
The information on the site is provided solely in popular-familiarization purposes, does not claim for reference and medical accuracy, is not a guide to action. Do not self-medicate. Consult your attending physician.
The use of materials from the site is allowed only if there is a hyperlink to the site vashaspina.ru.

Complaints of pain in the legs used to hear only from the elderly. But now the disease is younger. Complain that feet sick from the knee to the feet, maybe even a child. The reasons for these unpleasant sensations are different, depend on age and associated pathologies.

Causes of painful sensations

Bolt in the field of shin may arise due to overwork or diseases. To correctly recognize the cause, you need to navigate in the variety of symptoms. Paints occur often due to the following reasons:

1. Muscle defeat. This state is manifested after severe physical overloads, in which muscle lesion occurs. The patient concerns the strong pulling pain in the legs, spasms. If muscular fibers are stretched, caviar swell, painfully every movement. It is impossible to step on the leg.
2. Damage to tendons and ligaments. Defeats may be different. With excessive loads, stretching can occur right up to the rupture. Often inflammation of tendons. Torn ligaments are considered the hardest damage. After the maximum voltage, there is a sharp pain in the leg from the knee to the foot. There is a limitation of mobility, the tumor grows. Hematoma and redness can develop.
3. Defeatness of the joints and bones. Diseases are different - it is rickets, cracks, fractures, osteomyelitis, osteoarthritis, tumors, dislocations, etc. The patient is concerned about pain, redness, an increase in temperature at the localization site of the lesion. In injuries, swelling can occur and the formation of fabrics.
4. Diseases of vessels and nerves. With sharp moves, physical exertion may be damaged nerve endings. In thrombosis, the narrowing of the arteries and veins arise pain. There is a sense of numbness, itching in the field of shin, the parotid feeling of burning on the skin. Acute pain can develop even at rest. There are nunning pains on the outer and inner surfaces of the legs from the knee to the foot. The overall condition of the patient is worsening, there are complaints about weakness.
5. Pain for other reasons. The uncomfortable sensations may occur during pregnancy, being a symptom of radiculitis or metabolic disorders (obesity, diabetes). Icres can be sick for natural reasons after sports. Also on pain in the legs are complaining of children during the period of intensive growth.

Only a doctor can define the exact cause of pain.

Diseases with a characteristic symptom

The lower limbs carry an increased load, therefore diseases that cause discomfort, a lot. It:

• injuries - fractures, cracks of mulobers and tibial bones, stretching muscles and ligaments, dislocation of knee and ankle joints;
• atherosclerosis of the arteries below the knees;
• arthritis, Arthrosis, osteoporosis;
• flatfoot and other deformations of the feet;
• arteries and vein thrombosis, varicose veins, lymphostasis;
• polyneuropathy;
• osteomyelitis, myozit;
• microelements deficiency;
• tumors of soft tissues and leg bones.

Alternatively, only the diagnosis, the definition of the nature and intensity of pain, its localization (from the inner or outer side, in front or behind, in depth or outside) will help to identify pathology.

Who to contact and how to treat?

With first-emerged pains in the leg, it is necessary to turn to the traumatologist first. If injuries have not been identified, you should go to the therapist or general practitioner, which will appoint analyzes and additional surveys. According to their results, the patient is sent to treat a narrow specialist.

If the legs lie due to the pathology of the vessels, the patient will undergo therapy at the Vascular Surgeon. In the diseases of the nerves - at the neurologist. Diseases of the joints should be treated by a rheumatologist or orthopedic. If there is a suspicion of the malignant process, you need to turn to the oncologist. Treatment will depend on the diagnosis and can be drug, operational, inclusion of FFCs and physiotherapy.

Conservative therapy with drugs will depend on the disease that caused a uncomfortable feeling in the legs, and may include:

• NSAIDs;
• antibiotics;
• chondroprotectors;
• anticoagulants and vetonic;
• vitamins and calcium preparations;
• medicines that improve tissue trophics;
• cheeteropreparations to combat oncology.

The type of operational intervention also depends on the diagnosis. With the damage to the joints, they are replaced, with thromboosis carried out thrombectomy. In varicose disease, phlebectomy is carried out. If the pain is caused by the fracture of bones with the displacement, the branches are reposition. The oncological process requires complete removal of the affected area, sometimes even amputation of the limb.

Physiotherapy

From physiotherapeutic treatment methods can be assigned:

• phonophoresis;
• mud;
• parafinotherapy;
• electrophoresis;
• magnetic therapy.

Other methods of treatment

Therapeutic physical education is carried out under the guidance of the instructor. If the leg is less than physical loads, it is useful to conduct massage courses 2 times a year.

If the pain in the leg is caused by injury (dislocation, injury, stretching), you need to fix the damaged limb, ensure a motion of several days. Cold compress is applied to the place of damage. To remove the painful syndrome, the leg is tightly interbated. When the recovery process begins, you can make warm baths and compresses. It is useful to carry out light massage and careful movements for the development of the limb.

With initial manifestations of atherosclerosis, discomfort in the legs is practically not disturbed, but with the progression of pathology, pain intensity and worried even at rest. In the treatment of atherosclerosis, observance of a diet with a reduced cholesterol content is important. In the hospital, droppers are appointed with Actovegin, Iluedin. To reduce cholesterol levels, Kwantalan, Kevestrand, Coleband may be appointed.

In varicose veins of the lower extremities, constant use of compression knitwear is required. To increase the tone of the veins, such as Venarus, Rutin, Eskusan, etc. There is a method of treatment as sclerotherapy - the introduction of a special bonding drug into the affected veins. But the main method is operational intervention. Now it is possible to remove veins with a laser.

With pain caused by polyneropathy, drug therapy is assigned. Reception of painkillers, magnesium preparations, glucocorticoids, vitamin complexes, immunosuppressants are required.

How to remove pain

To provide first aid with pain in the legs, it is required to approximately determine the cause.

If it is an injury, then the affected limb is required to immobilize, attach a cold compress to it. You can take existing painkillers (ketorol, ibuprofen, holy, etc.).

If the legs are nesting from overwork, you need to lie down and put them on the exaltation.

If the cause of pain has become exercise, you need to take a warm shower, and then make a massage of the shins (in the event that you can exclude injury).

In spasms in caviar during pregnancy, it is necessary to sit down and with force to praise the muscles reduced.

With a sharply arising intensive pain in the legs of the self-medication, it is not worth practicing, it is better to consult a doctor as soon as possible.

Prevention

To prevent the occurrence of pathologies that cause pain in the legs, it is required to conduct a healthy lifestyle, follow weight, eat correctly. You need to take vitamin and mineral complexes 2 times a year. Do not allow hypodynamine, to carry charging every day, but avoid large loads. Daily in the evening rest with legs raised above my legs. If close relatives have varicose veins, we recommend that compression stocking is recommended.

Igor Petrovich Vlasov

• site `s map

• Diagnostics
• Bones and joints
• Neuralgia
• Spine
• Preparations
• Bundles and muscles
• Injuries

Exactuculation and amputation limbs: indications, technique, complications

One of the most unpleasant and complex operations in surgical practice is the amputation limbs. Very often, this term is confused with an examination, although in fact these concepts are not equivalent.

We will understand what is between them the difference when medical testimony requires such radical measures and how long the rehabilitation period lasts.

Amputation and examination: concept and difference

By amputation, they understand the truncation of the limb (legs or hands) throughout the bone. Exactuculation is the exhaustion of the limb in the joint. Thus, the examination is one of its kind one of the amputation.

Every time there is a need for such interference, the question of the place of the section and the method of operation is solved by the doctor individually, based on the nature of injury or disease, as well as the patient's condition.

Most often, the final decision on amputation is accepted only after consulting an orthopedic.

Indications for radical measures

Medical practice distinguishes absolute and relative readings to the removal of part or the entire limb. All of them must be justified in the medical documents of the patient.

Absolute readings:

• malignant tumors;
• hangrogen of arbitrary origin (diabetes, thrombosis, electrician, as a result of burn, etc.);
• the separation of the limb (at the same time the connection of tendons or bridges from the skin is preserved);
• severe infection, threatening patient's life, such as sepsis;
• open injuries with bone fragmentation;
• injuries with a rupture of trunk vessels and nerve trunks;
• injuries with muscle schedral.

Relative readings:

• strong defects of bone tissue, excluding the possibility of prosthetics;
• chronic osteomyelitis with amyloidosis;
• continuously existing trophic ulcer treatable
• congenital limbs, eliminating the possibility of prosthetics;
• irreparable paralytic or post-traumatic changes in limbs.

During operation planning, the doctor should also take into account the possibility of subsequent prosthetics of the damaged limb.

Types of operation

There are several main varieties of amputation:

1. Primary. It is also called amputation on primary indications. It is performed as primary injury processing. In this case, the surgeon quickly and clearly removes a non-visual limb. The operation is carried out in the shortest time after the injury, when the clinical signs of infection have not yet been developed. The specific level of cut-off is chosen individually, based on the overall state of the wounded, as well as the location of the wound.
2. Secondary amputation is made in cases where conservative treatment methods have already shown their ineffectiveness. The operation is performed in the case of the development of complications that threaten the patient's life at any stage of treatment.
3. Late amputation is made as a result of prolonged treatment of osteomyelitis, when he is already beginning to threaten the reincarnation of the organs. It is carried out due to continuously non-healing injuries and fistulas, as well as on a non-functioning limb in the presence of multiple ankyloses. Simple words, late amputation is made during prolonged treatment that does not give a positive result.
4. Reasupation. The re-operation, which is made in cases where the previous truncation did not provide due results. Most often, it is made at vicious crops that do not allow prosthetics, in the event of tissue necrosis after surgery due to ganglenes and in other such cases.

Preparation for the operation

First of all, even before all procedures, doctors should establish the severity of the injury and appreciate the opportunity to save the limb. In some cases, it is possible to restore blood flow, if there were previously timely and competent measures to restore vessels.

Also, as part of the preparation for the operation, doctors conduct measures to combat shock until the condition of the victim stabilizes. In diabetes, the alend is corrected.

With a local infection, the operation is delayed as possible, and with a wet gangrene, the degree of distribution is trying to reduce the laying of the legs of the ice.

Anesthesia is also introduced as a patient. Most often in its role uses spinal anesthesia, but infiltration, inhalation or conductor anesthesia can be used separately.

Technique and stages of trile procedure

During the operation, the patient is placed on the edge of the table, the striking limb is the most removing: the hand is pulled out, the leg is lifted to strengthen the outflow of blood. Following the harness depending on the place of the defeat. An exception is atherosclerosis, as in this case the blood flow in the cult will worsen.

In the case of small amputations, the skin on the damaged limb is treated with an antiseptic, the elastic bandages are superior to the base of the fingers. In the case of an amputation of the leg above the knee or hand above the elbow, the limb is wrapped with a sterile film.

The main rule with a truncation is the rule of preserving the largest length. In the case of lower extremities, exceptions are possible, but the doctor will always try to keep the knee.

At the same time, due to the characteristics of blood circulation, supermarket amputation is often carried out. It is performed as quickly as possible and provides subsequent healing in a short time. The most complex are extremely aluminous and knee exploitation, which makes it difficult to further fasten the prosthesis.

The procedure itself takes place in several stages:

• formation of skin flaps;
• muscle fibers;
• dissection of periosteum and subsequent shifting on the parties;
• pumping bone and treatment of sleep;
• supporting vessels;
• suppression of nerves;
• sewing and processing wound.

In the case of an amputation of the leg below the knee, the rule of the largest length is not used due to the subsequent difficulties of adaptability to the prosthesis.

The front edge of the large beritic bone is mounted, it allows you to create a long flap capable of covering the bone and provide the zone of the damage to sufficient blood circulation.

The optimal dice of a truncation is from 12 to 18 cm. When disarcticulation of the knee, the surgeons are trying to preserve a small cult, which will help attach the prosthesis. Small bark is amputated above the big bertova, since it will not be able to put pressure protester.

From other features of the procedure:

1. With amputation, the hands of the doctors try to leave the postoperative scar. This will allow you to attach the prosthesis on the lateral surface.
2. For the cover of a cult with small operations, sole or palm flaps are cut.
3. With a truncation of the foot of the foot, cuts are used in the form of a racket, which allow to highlight the tie bones. In case of amputation of the fingers, similar cuts are used to save the length. This version of the cut is very shortening his hand or leg, but gives limbs as aesthetic appearance.
4. Arteries and veins are contacted separately.
5. Nerves are trying to cross as much as possible.

Rehabilitation period

Upon completion of the surgery, a vita-gauze bandage is superimposed. At first to the decline of the swelling, it is required to change once a day. Initially, the cult is raised on the pillows, and lower after 1-2 days. Another 2-3 days rehabilitation gymnastics begins.

In the case of guillotine amputation, special care is used. In particular, peripheral exhaust is superimposed on the damaged area, after which the edges are tightened with skin transplantation.

It is very important how soon the rehabilitation care can be started - this will reduce the term of the post-scooting depression.

The temporary prosthesis is installed immediately after removing the seams. This will reduce pain after a truncation, and also accelerate healing. In addition, such an approach helps to reduce the number of psychological problems and helps the patient as early as possible to return home and to work. If a timely fitting of the prosthesis was not carried out, the doctor appoints a special exercise course.

Possible complications

Among the most frequent complications should be distinguished pain, the swelling of the cult and suppuration. These early symptoms are associated with the wound healing process and the postoperative period.

It is worth remembering that this period flows in the hospital, so that the prevention of complications is a clear consequence of the doctor's instructions. Patients are quite thoroughly performing prescriptions, as well as consult yourself before the actions performed.

Later complications, including phantom pain, resistant swelling of the cult and the like, are most often treated with medicine or therapeutic physical education. Cases of re-amputation is quite rare.

Today, as many years ago, amputation is a serious operation. However, modern medicine reduces negative consequences for the body, and the surgical intervention itself is performed operational and most often painlessly. In case of due suggestion, the instructions of the doctors postoperative period and disability also occurs in the shortest possible time.

After lower limb amputations classes LFKyou must start a few hours after surgery (first period). In the classes should include breathing exercises and exercises for hands, torso and a healthy lower limb. This ensures the intensification of vegetative functions, preventing complications from the lung, cardiovascular system, gastrointestinal tract and urinary organs, tonic effect on the central nervous system, preventing disorders in the homeostasis. The patient is trained in elementary movements necessary during self-service (lifting the pelvis, turns on the side, etc.). Cautious movements are added from the 3-5th day, rhythmically replaced voltages and relaxation of truncated (pulse gymnastics) and muscles of the preserved segments of a truncated limb, etc.

Exercises for the cult contribute to a decrease in postoperative edema. From the 5-6th day, in the absence of contraindications, the patient is allowed to get up. In classes include exercises in equilibrium, exercises that prepare a healthy limb to the upcoming high loads, exercises performed in the initial position standing, exercises for posture. The patient is studying walking with two crutches. Movements in all joints of the truncated limb should be performed with a maximum possible amplitude. In combination with removable gypsum flares, stretching, various "styling", these exercises prevent the formation of contractures.

After removing the seams (second period), the overall load (in classes and during walking with crutches) significantly increase. Use exercises with gradually increasing pressure on certain areas of the surface of the cult (with the exception of the distal end and the area on which the skin seam is located) in order to prepare the skin of the crop to the pressure of the prosthesis sleeve. The movements in all joints of a truncated limb are widely used for the prevention of contractures and equilibrium production ( fig. 52.). 2-3 days before the use of the training prosthetic prosthetic include exercises in a light pressure at the end of the cult. In case of bonepoplastic amputations, the preparation of "reference" of the cult should be carried out taking into account the stimulating effect of exercises on the fighting processes described with a transplant ( fig. 53.).

Fig. 52. Model exercises in the second period of occupations after amputation of the lower extremities.

Fig. 53. Typical exercises in the second period of classes after amputation of the lower extremities.

During the use of the training prosthesis, exercises are performed in the standing position on it with gradually increasing pressure on the cult, exercises in motion with prosthesis, standing on a healthy foot, exercises in equilibrium, standing on a prosthesis and healthy leg, training walking on a prosthesis ( fig. 54.). Technique walking and teaching technique It is determined by the design of the prosthesis, the peculiarities of the amputation made, the condition of the patient and the degree of "maturation" of the cult. Both in communal exercises and in special load gradually increase. Fig. 54. Model exercises in the second period of classes on temporary gypsum prosthesis.

When conducting classes with patients after lower limb amputations Regtering endarterity, diabetes; Atherosclerosis and other diseases, as well as in old age, it is necessary to accurately carefully and consistently increase the load, controlling the reaction from the cardiovascular system; avoid static stresses; more often change the initial positions; alternate active movements with passive; Include more breathing exercises and exercises for relaxation, classes with patients of young and middle-aged can include elements of sports exercises and games performed without a prosthesis and with a prosthesis.

During the preparation of a permanent prosthesis and mastering a full walking (third period), the focus of improving the walking technology and training in the conditions as close as possible to the natural one should be given the focus.

In this final period, the classes are held at the training platform, which should have: asphalt, sandy, cumen tracks and a track with obstacles. The paint tracks of steps are applied on the asphalt track with different distances between them. Between the sandy cobblestones, the railing of different heights is set for those who first can not do without an additional support. For learning, the rise and descent on the inclined plane at the training site should be a small slide with various steepness slopes, and to train the entrance and exit from the tram, trolley buses and the buses - the dumplings with steps and railings (Fig. 55). Fig. 55. Training site for training walking on prostheses.

Getting Started to train walking on prostheses (temporary and constant), it is necessary to correctly pick up crutches, canes and teach them to use them. Incorrectly selected crutches and canes have adversely affect the production of motor skills (walking), on posture, distort the gait, require extra effort. In addition, the inept use of crutches may be the cause of a number of complications - hydroenets, scuffs, and even a pan of differ limbs: the length of the crutch is determined in the standing position at the distance from the axillary depression to the floor. The handle should be located at the level of a large spit, so that in the support on the brush, the axillary depressions are released from a large load. The length of the cane can be determined in two ways: the distance from the large spit to the floor or from the brush to the floor with a bent elbow joint at an angle of 135 °. A cane enjoy from a healthy lower limb or more full-fledged cult.

Training with the use of prostheses begins with the wear of prostheses. Prostheses after amputation of the legs put on sitting; After the hip amputation - standing and sitting; After the amputation of both hips is lying and sitting. A wool cover or stockings without seams and folds are put on the cult. The prosthesis sleeve must make a tight reliever. For walking on prostheses, the ability to maintain balance is of great importance. Therefore, before allowing the patient to move, you need to teach it stand straight, distributing the body weight on both legs. First steps need to be done only in a straight line, they must be small and equal length. To work out rhythmic gait, it is recommended to train walking to music or metronome. It is necessary to pay attention to the patient for individual elements of the step: transfer of the severity of the body on ahead standing leg (or prosthesis) and then, due to the pendulum movement, the prosthesis in combination with the active movement of the cult, remove the proven forward (avoiding movement through the side).

To increase the motor functions of patients and the development of skills for using artificial limbs, along with a well-known gymnastic inventory (printed balls, gymnastic sticks, walls, benches, etc.), it is necessary to use special equipment: goals, canes simple and sliding, portable barriers, crutches and canes -dinomometers; Instruments and devices for the development of the terminal leaning of the cultures, strength, endurance, muscular and articular sensitivity, coordination of movements, prevention of contractures, flat-refining and disorders of the posture caused by amputation.

To control the level of development of motor qualities, it is necessary to have appropriate measuring instruments, allowing to determine: the strength of the muscles of the cult, endurance, the end reference, deviations in the posture, the degree of load on the cane or crutch during the use of them. In addition, in the hospital of therapeutic physical culture should be: two large mirrors (on opposite walls) to control the movements and posture during the training of the use of prostheses; metronome or tape recorder for rhythmic walking; The tracks of various widths with paint trails (to work out the steps of the same length and restrictions on the widespread feet when walking on the prostheses after the amputation of both hips). The floor should be smooth, not slippery, wooden or cork.

The low limb amputation is always accompanied by a large mental injury, which must be taken into account in order to increase the psychic tone and creating confidence that everyone can learn how to use the prosthesis.

Of great importance in the social adaptation of patients after amputation of the upper limbs, physical rehabilitation has the opportunity to prepare a patient for prosthetics, and further avoid complications associated with the use of a prosthesis. After the operation, which is carried out under general anesthesia, typical postoperative complications are possible: congestive phenomena in the lungs; violated cardiovascular system; Thrombosis and thromboembolism. There is an atrophy of the muscles of the cult, caused by the fact that the muscles lose the dots of the distal attachment, as well as the cut of vessels and nerves.

After the operation, due to pain syndrome, the mobility of the preserved limb joints is limited, in the future interfering with prosthetics. With amputation, the forearms arise a contracture in the elbow and shoulder joints, muscle atrophy of the forearm. In the upper thoracic spine, curvature is observed, which is associated with the shift of the twist upwards on the side of the amputation.

LFK after amputation of the upper extremities.

After the amputation of the limbs in the leaf method, three main periods are distinguished :

· Early postoperative (from the date of the operation before removing the seams);

· The period of preparation for prosthetics (from the moment of removal of seams before obtaining a permanent prosthesis);

· The period of mastering the prosthesis.

Early postoperative period. During this period, the following tasks of the LFC are solved.

· Prevention of postoperative complications (stagnant pneumonia, intestinal atonia, thrombosis, embolism);

· Improving blood circulation in a cult;

· Warning of culture muscle atrophy;

· Stimulation of regeneration processes.

Contraindications for the purpose of the exhibition of LFK: a sharp inflammatory process in a cult; common severe condition of the patient; Height body temperature; Danger of bleeding. LH classes must begin in the first day after the operation. They include breathing exercises, exercises for healthy limbs. Since 2--3, isometric voltages are performed for the preserved segments of amputated limb and truncated muscles; Lightweight movements in the immobilization of the joints of the cult Apply phantom gymnastics (mental performing movements in the missing joint), which is very important for the prevention of contractures, reduce pain and muscle atrophy of the cult. After amputation of the upper limb of the patient can sit down, get up, walk. After removal of the seams begins the 2nd period - the period of preparation for prosthetics. At the same time, the focus is on the formation of the cult: it must be a correct (cylindrical) form, painless, looser, strong, hardy to the load. First restore mobility in the preserved joints of the amputated limb. As pain decreases and the increase in mobility in these joints in the classes include the exercises for the muscles of the cult. They carry out uniform strengthening of the muscles that determine the correct form of the cult, which is necessary for a dense fit of the prosthesis sleeve. LH includes active movements in the distal joint, performed by the patients first with the support of the cult, and then independently and with the resistance of the instructor's hands. Training of the culture on the productivity is pressed by its end first on a soft pillow, and then on the pillows of various density (stuffed with cotton, hair, felt) and in exercises with the support of the croes on a special soft stand. Begin such training with 2 minutes and bring it up to 15 minutes and more. For the development of the muscular and articular sense and coordination of movements, exercises should be used in the exact reproduction of a given amplitude of the movements without vision control.

After amputation of the upper limb (and especially both), much attention is paid to the development of the skills of the self-service of the cults - with the help of such simplest devices, as a rubber cuff, worn to a cult, which is inserted with a pencil, spoon, plug, etc. The amputation of the limbs leads to the disorders of the posture, so in the LH complex, the corrective exercises should be included. With amputation of the upper limb - in connection with the shift of the adapter on the side of amputation upwards, ahead, as well as the development of "walled blades" - against the background of overall exercises for the shoulder belt, movements are used to lower the adapters and the reduction of the blades. Scoliotic curvature can develop compensatory in the opposite side in the chest and cervical spine.

At the final stage of reducing treatment after the amputation of the limb, therapeutic gymnastics is aimed at developing the skills of using prostheses. Training depends on the type of prosthesis. For thin work (for example, letters), a prosthesis with passive capture is used, for a coarsame physical work, a prosthesis with an active finger capture is used due to the traction of the muscles of the shoulder belt. Recently, bioelectric dentures with active finger grip are widely used, based on the use of currents arising in the moments of muscle voltage.

The LFC with reconstructive operations on the trees of the upper limbs is used in the pre-and postoperative period and contributes to the speedy formation and improvement of motor compensation. Preoperative preparation of the cult of the forearm consists of massage of the muscles of the cult, pulling out the skin (due to the lack of it with local plastic at the time of the form of fingers), restoring with the help of passive and active movements of the Pronation and Supposition of the forearm. After the operation, the goal of the treatment gymnastics is to develop capture due to the information and breeding of newly formed fingers of the forearm. This movement is missing in normal conditions. In the future, the patient is trained in the letter, and first a specially adapted handle (thicker, with deepening for the elbow and radiation finger). After cleavage of the forearm in the cosmetic purposes of patients with a prosthesis of hand.

Massage after amputation of the upper extremities.

Massage technique .

In the early postoperative period, segmental and reflex effects in the field of relevant parasertebral zones are used.

Cold massage can be started after removing the operating seams. Healing by secondary tension, the presence of a granulating wound surface, even the presence of fistulas at normal temperature, the absence of a local inflammatory reaction, as well as pathological blood changes is not a contraindication for massage. From massage techniques, various types of stroking, rubbing and light kneading (spiral-like in the longitudinal direction) are used.

In the first week there should be an array near the postoperative seam until it is strengthened. In the presence of scar formations, soldered with the treasures of the cult, massage is an excellent means to remove these battles. In such cases, various methods of kneading are applied (shifting of the scar, etc.). To develop the repair of the cult in the area of \u200b\u200bthe distal end, vibration is used in the form of tendering, sings, quenching.

Special attention to the mass production of an amputated limb should be turned to the muscles that have survived after the operation and should contribute to the restoration of normal movements. So, after amputation in the region of the middle third of the hip, it is recommended to strengthen the adductors and extensors of the thigh as much as possible.

After amputation below the knee joint, special attention should be paid to strengthening the four-headed muscle. After amputation in the middle third, the shoulder selectively strengthen the abductors and muscles carrying out the outer rotation of the shoulder. Exercises in abduccia (leading limb to side) shoulder prevent atrophy of the deltoid and supervolor muscle (strengthening muscles, showering shoulder) and atrophy of the sibwise and small round muscles (muscles that rotate the shoulder duck).

Massage amputation culture first should not last more than 5-10 minutes; Gradually, the duration of the massage procedure is adjusted to 15 - 20 minutes. For the development of the cult function, the mobility of the nearest joints is very important. In the process of massage, it is recommended to produce physical exercises that need to be started before.

These include the premise of motor pulses aimed at performing the movements of the cult in various directions. Such exercises contribute to the strengthening of crossed muscles, mobilizing the scarpets soldered with the bone and increase the tissue trophics. Exercises are produced daily 3-5 times a day. Exercises are also recommended for a healthy limb in all joints; Such exercises significantly contribute to the recovery process in the cult.

Next use exercises aimed at the development of its endurance: presses the end of the cult on special pads of various rigidity (cotton, sand, felt, wooden stand), the tendering of the stuff with a wooden hammer, covered with felt, etc. In order to educate coordination skills when standing and Wheatting with a prosthesis, as well as the restoration of tactile, muscular and articular feeling in the remaining part of the limb, it is recommended to combine massage with equilibrium development exercises: the slopes of the body, semi-manning and squatting on one leg with open and closed eyes. The skin care of the crop in the early postoperative period is also very important.

Physiotherapy after amputation of the upper extremities.

Phantom pains are a postoperative complication that manifests itself by the sensation of pain in the amputation limb can be combined with the pain of the culture itself. UFOs of the region of the cult of 5--8 biodox (only 8-10 irradiation) are used; diadynamic currents in the area of \u200b\u200bthe cult (10--12 procedures); Darsonvalization; Novocaine and iodine electrophoresis; Appliques of paraffin, ozokerite; Mud to the area of \u200b\u200bthe cult; General baths: pearl, radon, coniferous, hydrogen sulfide.

After amputation, as in other types of surgical interventions, the formation of infiltrate in the postoperative seam area is possible. In the treatment of infiltrate in the acute stage, the cold is used to limit its development and UFO. Used UHF for 10--12 min daily, CMV, ultrasound, indentoraterature, ozocertorate and paraffin applications on the infiltrate region, UFO. After 2--3 days after the sacrament of the islanding phenomena, they go to thermal procedures.

Also, the general contraindications for physiotherapy procedures remain unchanged:

The state of sharp depletion

Termination to bleeding

Disease blood

Malignant neoplasms

Sharply pronounced manifestations of system-organ failure (cardiovascular failure, respiratory failure, impaired kidney function).

In the absence of contraindications, physiotherapy is assigned to the earliest permissible time limits and is carried out for a long time, up to prosthetics.

In the method of using therapeutic physical culture, after amputation [i], there are three main periods: 1) immobilization of amputation cult, 2) the formation of the cult and preparation for prosthetics (the production of mobility, strength, reference function of the cult) and

1. the period of training a patient with a prosthesis.

The purpose of the medical gymnastics, held in the coming days after surgery (in peace of cultivation), is to improve the overall condition of the patient and impact on the course of reparative processes. The latter is achieved as a result of improving the metabolism, circulatory circulation in the field of cult, the reflexion neurotrophic action of the movements performed by a healthy foot, on the sore. With the position of the patient lying on the back, active exercises are used in the joints of the upper limbs and a healthy leg, exercises that expand the chest, movement of a small volume. These exercise, initially with a small total load on the patient's body, are made from 2-3rd days after surgery. Given the traumaticity of this chronomic intervention, in the first days after the operation of the driving conditions are not produced. The peace of the cult is ensured in terms of cases by imposing on a short term rear gypsum Longa. It is necessary, taking into account the trend towards the development of contractures (the SGBATIVE-discharge of the High Amplification of the Hip, the bending of the legislation of the leg). From the first days after surgery, give the cult

saw position. It should not be enclosed after amputation under the cult pillow, as this may be a story to the retraction of flexor muscles and the formation of bending contractures in the hip-beamed (knee) joint.
After 12-14 days after the operation, the second, most responsible period of rehabilitation treatment begins, the purpose of which is the formation of amputation and preparation of the patient for prosthetics. A group of stuffing and special exercises is used. The content of the complex of the lining exercises depends on the localization and level of amputation.
With bilateral imparation of the hips, it is necessary to achieve intensive strengthening of the muscles of the back, the brying press, the berous muscles and the muscles of the patient's hands (the latter is necessary for the patient in connection with the use in the future when walking for canes).
With one-sided amputation of the thigh and the shin, the muscles of the body should also strengthen the muscles and, which is especially important, the muscles of the intact lower limb. The most rational initial positions to strengthen the muscles of the back and abdomen are the positions lying and standing on all fours (leaning on the knee of a disabilities of the lower limb), and the most stable position for strengthening the upper extremities can serve as a position sitting on the floor. To increase the strength of the muscles of the hands, the shoulder belt uses exercises with dumbbells, medical practices, extenders, and to increase the power endurance of the muscles of the preserved lower limb - exercises with countering rubber ribbon, stands with rubber traction ("foot expander").
The strengthening of certain muscular groups of a healthy leg should be paid to especially much attention during the period of the patient's bed content due to the strengthening of the static load on the preserved lower limb during standing and walking.
According to literary data (N. B. Schmarevich, 1927; N. A. Shank, 1935; N. N. Privorov, 1941; M. N. Trainina, 1958) and our observations, flatfoot relatively often develops after one-sided amputation of the lower limb. In order to clarify this issue, we examined the feet in 198 persons with a unilateral amputation of the lower extremities (98 with the amputation of the thigh and 100 with the shini amputation). In the process of examining patients, in addition to the clinical inspection, measurement was made
heights of the longitudinal arch of M. O. Friedland and Plato-graphic, followed by graphic processing of footprint. Flatfoot was discovered in 81 patients.
According to our data, the main condition that affects the frequency of planes in persons with one-sided amputation of the lower extremities, in addition to the level of amputation, is the duration of use of crutches. Flatfoot is observed especially often in those patients with amputation, which used crutches for a long time (late prosthetized and not

Well
Fig. 39. Electritioninamographic curves that characterize the load on the heel region (/), internal (II) and outer (III) edges of the forefront of the head of the right leg when using crutches (dotted) and a prosthesis (solid line) in a patient with amputation crops of the left lower leg (period Double support).

prosthetized). Of the 118 patients who used crutches for more than 3 years, in 65 (55% of cases), expressed flatfoot (with a short one, the "crutzing" period of flatfoot was noted only in 20%); Of the 79 unconcentricated patients, 37 were observed flatfoot. This is explained by the fact that the nature of the load on the preserved lower limb in the unconcentuated patients other than those equipped with a prosthesis. This provision is confirmed by electrodynamographic studies. Below are the electrodynamographic curves of the patient with amputation cultures of the upper third of the left legs, characterizing the load on the various parts of the foot of the right lower limb (the heel region - I, the inner part of the front department - II, the external part - III) when using crutches and prosthesis (Fig. 39) . The dotted line shows the load curve on the right leg when using crutches, a solid line - when using a prosthesis (during the "double support").

Negatively affect the state of the longitudinal arch of the foot of the healthy nickname and conditions such as, for example, is irrational, insufficiently enduring the cult and others.
These data emphasize the need for an amputation of the lower limb of measures, warning flatfoot: a lining gymnastics, which improves metabolic processes and impeding the body weight, exercises, muscles, sucking the foot and flexors, and strengthening the muscles of the entire lower limb. There is also a massage of the relevant departments of the goal - 1iu and foot.
A large prophylactic value is preparing a hard-to-support prosthetics. From the middle of the first month after the amputation of the lower limb until the moment of obtaining the prosthesis, a group of special measures aimed at the formation of rational cult is carried out. In terms of prosthetics, the following requirements are presented to the amputation cult of hips and lower legs: the cult should be the right shape, painless, looser and rigorous to the load, strong, the scar must be movable. To reduce the swelling of the cult and an increase in its mobility during the 3rd and 4th week after surgery (with the normal course of reparative processes), a "suction" massage and therapeutic gymnastics of a lightweight nature is carried out. Initially, the proximal departments of the lower limb using mainly taking strokes are massaged. By the end of the first and beginning of the second month after surgery, the tributes and shifting of the postoperative scar are gradually included, which prevent the battle with the surrounding tissues and the development of a coarse scar. The massage of amputation culture with cautious use of intake of kneading contributes to the elimination of tissue seals in the area of \u200b\u200bthe cult, improves blood circulation and the functional state of the preserved muscles. Therapeutic gymnastics includes a number of active movements performed first with the support of the operated lower limb by the methodologist, and then performed by patients independently. The PRP selection of physical exercises takes into account the development of culture in patients in patients (P. I. Belousov, 1965; Holmiau, 1941; Ma Chacek, 1961): High Hip Ampathy for Especially

It is hampered to produce the movements of bringing and begging in a hip joint, with an amputation of the shin - extension in the knee joint. The prevention of the development of the bending contract of the thigh culture helps the laying of the patient on the belly with the given cults and the cotton-mareling pillow under it, and the prevention of the SGN of the Sunbuilding Culture - the position of the patient on the SPPNE with a small cargo (sand bag) on \u200b\u200bthe knee joint.
The massage of the respective muscular groups also helps to differentiated muscle strengthening the muscles, the massage of the relevant muscular groups is also helped: with the amputation of the thigh - the berium muscles and the muscles leading the thigh, the Ringa Amputation is a four-headed muscle. For uniform strengthening of the muscles, which determine the correct cylindrical form of the cult, which is further needed for a dense fit of the sleeve, a prosthesis, is also used isometric muscle tension. For this, the patient mentally moves the amputated limb segment (N. N. Prikov, 1941). Due to the long-term preservation of old nervous bonds, this leads to the pavement of the corresponding muscle groups (for example, for the tension of the muscles of the star's crust, the patient mentally moves the lack of foot). Similar exercises are called "Phantom Gymnastics". For the remove of the prosthesis, at the time of walk, it is necessary to strengthen the muscles that determine the movements of the cult. For this, at a later stage of treatment, exercises with the resistance of the method of methodist or the counteraction of cargo may be used during classroom classes.
With the improvement of the state of the cult (the disappearance of swelling and pain, strengthening the scar), it is necessary to start training a stamina culture. For this purpose, some special exercises of therapeutic gymnastics and massage techniques are used. Training of a culture of a reference, which is especially shown after the operation of the costeplastic amputation, is pressed by the end of the cult first on a soft pillow and hand, and then on cushions of various density (stuffed with cotton, hair, felt) and walking with the support of the cubs on a special soft bench. Gradually, the duration of the training of a culture on the reference increases from 2-3 to

1. 15 minutes n more. Increase the proposocability of I.

strengthening the skin of the supporting surface of the cult is helped by such massage techniques, like light pinches, rubbing. It is desirable to train a patient with the receptions of self-massage of the cult (in order of care for the culture of the patient should produce massage before putting on the prosthesis and after removing it). The early use of the medical gypsum prosthesis (plaster sleeve reinforced with a wooden rack) has a particular importance for the education of the cult. The PPP of using a temporary prosthetic is faster than the swelling is eliminated, blood circulation is improved, the muscles are stronged, the crust

Fig. 40. Elimination of flexion contract culture hip with the help of the "lever".

males the right form, the development of contractures is prevented. Walking on a temporary prosthetic contributes to expressing stability, maintaining the right body position. A temporary prosthetic patient uses a special prosthetic ordered in the workshop.
RNa formed by the culture of culture, in addition to active exercises, passive movements are also used in the appropriate direction. For example, the PPP of the short thigh cult with inclination to the bending contracture of the patient laid on the stomach, the methodologist fixes the pelvis, the other exercises the extension of the cult in the hip joint. The PPP with a rapid contraction of the short thigh culture in the process of conducting therapeutic gymnastics is used, in addition, a special device is "lever" (Fig. 40). The loop of the lever is fed up to the cult, and the methodologist, resting a wide part of the lever in the pelvis, seeks to stretch the shortened soft tissues and bring the cult from the vicious position. Such a device can also be used to eliminate

flexing contracture short shinust culture (Hoffmann, 1917).
For the free use of a prosthesis, a group of exercises generating stability, equilibrium, the ability to balance (A. N. Krasovsky, 1932; Zurverth, 1940) is of great importance. With one-sided amputation of the lower limb to this group of exercises, you can attribute freestyle movements by the upper limbs in the stopp. Standing on a healthy leg, catching and throwing the ball (first leaving your back to the gymnastic wall and sticking to her with your hands), cocks on one leg. With the amputations of the lower limbs in young people in general strengthening of the muscles, the exercises of the courage and confidence play a large role that the exercises of a sports nature are played with a large role, such as parallel bars, gymnastic wall (stops, viscos), etc. (Dietze, 1961).
The final stage of reducing treatment after the amputation of the lower extremities is the training of a patient with a prosthesis. Before learning a sick walking, it is necessary to check the correctness of the prosthetic fit to the cult and the correctness of the landing. A number of rules are followed by a row. Training walking first is carried out between the handrails, without crutches, since otherwise the patient has a sense of uncertainty that interferes with the development of the prosthesis. The cane should be kept in hand from a healthy low-spirited limb to unload the severity of the body on the prosthesis and a cane. The first step is better to do a healthy foot, and then endure your foot in the prosthesis (F. A. Kopylov, M. S. Pevzner, 1962). Intowing the prosthesis forward, you need the severity of the body to move first on the heel so that the entire prosthesis of the prosthesis is pressed to the floor, then produce a carp in ankle hinge to a complete closure of the footsteps of the foot from the hinge; After that (at the time of step a healthy foot), there is a flow in the finger joint (V. A. Bethtin, 1944) (Fig. 41).
It is necessary to pay attention to the posture of the student walking. The case should be straight. He must not look at the nick, and go ahead. Learning to use the prosthesis with the amputa of the thigh in people of young and middle age, it is advisable to spend when the castle is open with a freely flexible knee, as it is very difficult to fall off with a closed lock. Session
training walking at first should be short, the use of prosthesis for the day should not exceed L "/ M-2 hours.
After learning, the main elements of the step move to walking with overcoming various obstacles (low barriers), produce a certain length of the step

Fig. 41. The sequential load scheme on the various deposits of the prosthesis of the prosthesis in MomaT walk.
(walking in the footsteps) and rhythm walk (P. I. Belousov,
N. V. Stakina, 1956; Kersten, 1961). The patient must be trained walking forward, sideways, in a circle of turns during walking. After the patient has learned to walk along the smooth floor, they start learning walking in a hill, on a flappiness and in the conditions of an open area - on asphalt, loose soil, stones. The patient, equipped with prostheses, should also master the use of urban transport, using at first a busement layouts, tram installed on the territory of the medical institution.
With one-sided amputation, the Goletsp patients often master the use of prosthesis without special training. With a unilateral amputation of the hip, the average duration of walking 2 "/ M-3 weeks, and during bilateral amputation requires a longer period. In addition to walking, the patient, equipped with two prostheses, should be trained to the independent lifting to his feet in case of falling, as well as the ability to" fall "Shocky the impetus due to bent hands.