REHABILITATION TECHNIQUE FOLLOWING WHIRLBONE CHONDROEPIPHYSISECTOMY AND FORMATION OF RETAINING NEOARTHROSIS IN HIP JOINT (VV MALOVICHKO'S METHOD)

摘要

FIELD: medicine.;SUBSTANCE: invention refers to medicine area, namely to traumatology, orthopaedics and rehabilitation. The patient remains at bed rest in early postoperative period up to 10 days with one operated lower limb abducted on the bed plane and with foot fixed in a derotation brace in functionally neutral position. Herewith the patient takes therapeutic exercises including isometrics for muscles of the operated lower limb and passive-active flexions in knee joint 3 times a day. Starting from the 3^rd day, the patient is seated in bed, then in early postoperative period from 10 to 20^th day, the patient while sitting in bed lowers a healthy foot on a chair. The therapeutic exercises are taken 3 times a day. They are combined with flexion-extension trunk movements, then in early postoperative period the patient makes active flexions in knee joint of the operated lower limb and active tearing of the extended operated lower limb from bed. Besides, the patient while sitting in bed with the lowered feet abducts the operated lower limb aside. Then in late postoperative period, number of active extensions in knee joint of the operated lower limb is increased, and the patients makes active tearing of the extended operated lower limb from bed and active abduction and flexion in hip joint of the operated lower limb 3 times a day. Then the patient gets up and stands at bed with using the crutches, sits down and gets up from a chair without assistance by 3 times day. The patient learns the crutch ambulation by 3 times a day. The out-patient therapeutic course includes 3-month feet isometrics by 500 exercises a day in lying position, tearing of the extended operated lower limb from bed plane in lying position, active extension of the operated lower limb in knee joint in lying position, trunk flexion and extension in lying position, active flexion of the operated lower limb in knee joint in upright position, active abduction of the operated lower limb in upright position, crutch ambulation no more than 1.5-2 hours a day with increasing load on the operated lower limb every month with crutch ambulation duration increased by 30 min every month, application of walking stick, continuation of therapeutic exercises, massage and swimming. In early postoperative period up to 10 days after surgical procedure, the patient additionally performs unlimited isometrics for muscles of the healthy lower limb and sparing passive-active flexions in knee joint of the operated lower limb within 5-10 minutes. Starting from the 2^nd-3^rd day after surgical procedure, the patient carries out trunk flexion at the angle 20-30 degrees with using a Balkan frame and a trapeze, attempts to lift the extended operated lower limb with simultaneous foot rotation inwards, and also attempts to tear pelvis from bed plane without hand assistance by leaning on extended lower limb and scapula, abducts and adduce the operated lower limb with the fixed foot, and also takes exercises to strengthen the muscles of superior shoulder girdle and healthy lower limb. Then in early postoperative period from 10 to 20 day after surgical procedure, intensity and duration of all medical and physical exercises taken are increased in 2-3 times to 15-25 minutes. Additionally, with using the Balkan frame and the trapeze, the patient makes trunk flexion and extension 50-100 times a day. The wound suturing is removed for 12^th-14^th day after surgical procedure. Starting from 20^th day after surgical procedure up to discharge, the patient with the operated lower limb released from derotation brace learns to get up from bed, to sit down on a chair without assistance and to walk in common footwear with using crutches with toe-touching on the operated lower limb. Axial load on the operated lower limb does not exceed 10-20% of the norm. The patient increases duration and number of dynamic therapeutic exercises to 25-30 min 3 times a day. In lying position, the patient takes active flexion in knee joint of the operated lower limb 100-200 times a day, abduction and adduction of the operated lower limb with the fixed foot, and also attempts to tear it actively from bed plane with simultaneous foot rotation inwards. In upright position, the patient makes active tearing of the operated lower limb from floor plane 100-200 times a day and flexion in knee and hip joints with simultaneous foot rotation inwards, abduction and adduction of the operated lower limb with the fixed foot, and also abduction of the operated lower limb to the outside and suspension. After the patient is discharged from the hospital for 30-32 day after surgical procedure and to 3 months after the discharge, the out-patient therapeutic course involves active tearing of the extended operated limb from bed plane with foot rotation inwards in lying position by 300 times a day, active flexion of the operated limb in knee joint, and trunk flexion and extension. In upright position the patients performs active tearing of the operated lower limb from floor plane by 300 times a day with flexion in knee and hip joints with simultaneous foot rotation inwards, abduction and adduction of the operated lower limb with the fixed foot, and also abduction of the operated lower limb to the outside and its suspension. Simultaneously during this period, the patient practises crutch ambulation leaning on the operated lower limb with load increased by 20% of the norm every month. By the end of this period the patient makes crutch ambulation with load on the operated lower limb to 80-100% of the norm.;EFFECT: method allows using possibility to reduce rehabilitation period for the bed-ridden patients, to provide sufficient reliability of restoration of locomotive functions in the operated hip joint of the patient, to reduce rehabilitation time for the ambulatory patients if crutch ambulation is required, and also to walk without footwear tips on the abducted operated limb of the patient.;2 ex