1. Early stage: inflammatory reaction period (0- 1 week)

Objective: To relieve pain and swelling; Early muscle strength exercise; Exercise the range of activities as early as possible to avoid adhesion and muscle atrophy.

In the early and early stage of functional exercise, due to the low level of muscle strength, there is obvious inflammatory reaction in the tissue, and the connection of broken bones is still fragile. Therefore, static exercise (joint inactivity, maintaining a certain posture until muscle fatigue) is the main method. Gradually increase the endurance exercise with small load, that is, choose light load (the load that feels tired after completing 30 movements), 30 times/group, rest for 30 seconds between groups, and practice 2-4 groups continuously until fatigue. Peking University Third Hospital Rehabilitation Medicine Center Zheng Lu

Put the affected limb in abduction neutral position: avoid hip adduction (crossing legs, etc.). )! When lying on your back, put a pillow between your legs so that your legs can't be together. Don't turn to the affected side! When turning over to the healthy side, you should protect your leg to keep your hips slightly exposed during the whole exercise! After lying on your side, put a pillow between your legs and keep your hips slightly spread out!

Don't walk too much! Walking on crutches, never let your legs bear the burden! Walking should not be used as a practice method!

After operation, straighten the affected limb, and put a pillow under the leg to raise the affected limb and prevent swelling.

(1) After anesthesia subsides, toes and ankles will move. If possible, start the ankle pump movement: promote blood and lymph through the squeezing effect of calf muscle contraction and relaxation. 5 points/group, 1 group/hour. This exercise is of great significance to prevent swelling and deep vein thrombosis and promote blood circulation of the affected limb, so it should be practiced seriously.

(2) Isometric contraction exercises of quadriceps femoris and hamstring muscles: more than 300 times/day. Do as much as possible without increasing the pain.

(3) 3 days after operation: Start CPM exercise.

CPM, twice a day, 30 minutes/time, ice for 30 minutes immediately after the exercise (the angle gradually increases without or with slight pain), completed under the guidance of medical staff. Keep hip abduction neutral throughout the exercise!

After ice for about 20 minutes, immediately carry out joint activities, such as moving freely. If the joints have obvious fever and swelling at ordinary times (after standing and walking), ice 3-5 times/day.

2. Initial stage: (2-4 weeks)

Objective: To strengthen the exercise of joint mobility and muscle strength. It is absolutely forbidden to sit up in a normal posture before the hip flexion angle reaches 90! Can only sit up (that is, lie down and sit down)!

(1) Start straight leg muscle strength training;

Each group 10-20 times a day 1-2 groups.

(2) Start active joint flexion and extension (on the premise of no or slight pain and stable fracture):

Active hip flexion and extension: sit down and keep your feet on the bed. Bend your knees and hips slowly and forcefully to the maximum, and slowly straighten out after 10 seconds. Each group 10-20 times a day 1-2 groups. See appendix 1- figure 13.

(3) Increase CPM practice angle:

If the fracture healed well, the knee flexion reached 65438+020 in about 4 weeks, and the hip flexion angle was close to 90.

(4) Start walking on crutches: If there is no pain, the affected leg can bear some weight (less than 1/4 weight), so pay attention to protection! Don't fall!

3. Mid-term: (5 weeks -3 months)

Objective: To strengthen the range of motion of joints. Enhance muscle strength and improve joint stability. Step by step, try to improve your gait by putting a load on the affected leg. X-ray to determine whether loading can start!

(1) Weight-bearing and balance exercise: (The degree of fracture healing must be the premise)

Load and balance:

With the firm degree of fracture healing, the load gradually transited from: 1/4 body weight-1/3 body weight-1/2 body weight -2/3 body weight -4/5 body weight-100% body weight. You can put the affected leg on the flat health scale to clarify the feeling of partial load bearing. Gradually, you can stand with a full load on one leg of the affected side. 5 points/time, 2 times/day.

(2) Continue to strengthen the exercise of joint mobility: (It must be on the premise that the degree of fracture healing allows)

Sit down and hold your legs:

Measure the distance between heel and hip before departure, and gradually shorten it to the same angle as the healthy leg. Keep it at the place where the hip joint feels pain for 5- 10 minutes/time, 1-2 times/day.

(3) If conditions permit, you can start to fix the bicycle movement, from light load to heavy load, and gradually reduce the height of the seat. 20-30 minutes/time, twice/day.

(4) Start leg muscle strength exercises.

Leg lifting exercise:

30 times/group, 4-6 groups in a row, rest for 30 seconds between groups, 2-3 times/day.

Bending resistance in prone position:

10 times/group, 10- 15 seconds/group, with an interval of 5 seconds each time. 4-6 groups practice continuously, and rest for 30 seconds between groups.

Resistance knee extension exercise:

Use sandbags or rubber bands as the load of painless range of motion of hip joint. 10 times/group, 10- 15 seconds/group, with an interval of 5 seconds each time. 4-6 groups practice continuously, and rest for 30 seconds between groups.

(5) lift heel exercise: 2 minutes/time, rest for 5 seconds, 3-5 times/group, 2-3 groups/day.

4. Late stage: (4 months to 6 months)

Objective: To enhance muscle strength and joint stability. Fully resume all activities of daily life. If the fracture is completely healed and has enough firmness, you can start the following exercises.

(1) Static Squat Exercise:

With the increase of strength, the squat angle is gradually increased (less than 90), 2 minutes/time, 5 seconds apart, 5- 10 continuous/group. 2-3 groups/day.

(2) Step exercises:

Step forward, step back, step aside.

Including front and back, side stride exercises, 20 times/group, rest for 45 seconds between groups, continuous exercises for 4-6 groups, 2-4 times/day.

(3) One-leg squat exercise on the affected side:

Requirements are slow, hard and controlled (no shaking). 20-30 times/group, interval between groups is 30 seconds, 2-4 times/day.

Rehabilitation scheme of femoral neck fracture (conservative treatment of tibial tubercle bone traction)

1. fixation period: bone traction stage (about 8- 10 weeks depending on the healing of the broken end).

Objective: To relieve pain and swelling; Early isometric muscle strength exercise.

(1) Move toes and ankles. If the pain permits, start ankle pump practice.

Promote blood and lymphatic return through the squeezing effect of calf muscle contraction and relaxation. 5 points/group, 1 group/hour. This exercise is of great significance to prevent swelling and deep vein thrombosis and promote blood circulation of the affected limb, so it should be practiced seriously.

(2) isometric contraction exercises of quadriceps femoris and hamstring muscles:

That is, the tension and relaxation of the muscles before and after the thigh. When practicing, you must ensure the position of traction, and you can't move your limbs or bend your knees. More than 300 times per day. Do as much as possible without increasing the pain.

2. Early stage: after bone extraction and traction.

Objective: To start the exercises of flexibility and muscle strength of knee and hip joints.

It is absolutely forbidden to sit up in a normal posture before the hip flexion angle reaches 90! Can only sit up (that is, lie down and sit down)!

(1) Start straight leg muscle strength training;

After stretching the knee, the straight leg is raised to the heel at 15㎝ off the bed, and slowly straightened after 10 seconds. Each group 10-20 times a day 1-2 groups.

(2) Start active joint flexion and extension exercises:

On the premise of no or slight pain and stable fracture, the range of motion at the beginning of the exercise can not reach the angle shown in the figure, and the angle must be gradually increased. Bend your knees and hips slowly and forcefully to the maximum, and slowly straighten out after 10 seconds. Each group 10-20 times a day 1-2 groups. If the fracture healed well, the knee flexion reached 65438+020 in about 6-8 weeks, and the hip flexion angle was close to 90.

(3) If possible, you can practice the angle with CPM:

If the fracture healed well, the knee flexion reached 65438+020 in about 6-8 weeks, and the hip flexion angle was close to 90.

(4) Start walking with crutches:

If there is no pain, the affected leg can bear part of the weight (less than 1/4 weight), so pay attention to protection! Don't fall!

3. Mid-term: After X-ray inspection, determine whether the load can be started.

Objective: To strengthen the range of motion of joints. Enhance muscle strength and improve joint stability. Step by step, try to improve your gait by putting a load on the affected leg.

(1) Weight-bearing and balance exercises:

It must be carried out on the premise that the degree of fracture healing allows. The load changes gradually from 1/4 to 1/3 to 1/2 to 2/3 to 4/5 to 100%. 5 minutes each time, 2-3 times a day.

(2) Continue to strengthen the exercise of joint mobility: (It must be on the premise that the degree of fracture healing allows)

Sit down and hold your legs:

Measure the distance between heel and hip before departure, and gradually shorten it to the same angle as the healthy leg. Keep it at the place where the hip joint feels pain for 5- 10 minutes/time, 1-2 times/day.

If conditions permit, you can practice with a fixed bicycle, from small load to large load, and gradually reduce the height of the seat. 20-30 minutes/time, twice/day.

(3) Start leg muscle strength exercises:

Leg lifting exercise:

Straighten the affected leg, then lift the toe to 5cm 1 time, 30 times/group, 4-6 groups in a row, rest for 30 seconds between groups, and practice 2-3 times/day.

Bending resistance in prone position:

10 times/group, 10- 15 seconds/group, with an interval of 5 seconds each time. 4-6 groups practice continuously, and rest for 30 seconds between groups. And gradually transition to "standing knee flexion".

Resistance knee extension exercise:

Use sandbags or rubber bands as the load of painless range of motion of hip joint. 10 times/group, 10- 15 seconds/group, with an interval of 5 seconds each time. 4-6 groups practice continuously, and rest for 30 seconds between groups.

Lift heel exercises:

2 minutes/time, rest for 5 seconds, 3-5 times/group, 2-3 groups/day.

4. Late stage: After the fracture is completely healed and has enough firmness, you can start the following exercises.

Objective: To enhance muscle strength and joint stability. Fully resume all activities of daily life.

(1) Static Squat Exercise

With the increase of strength, gradually increase the squat angle (always less than 90), 2 minutes/time, 5 seconds apart, 5- 10 continuous/group. 2-3 groups/day.

(2) Step exercises

Including front and back, side stride exercises, 20 times/group, rest for 45 seconds between groups, continuous exercises for 4-6 groups, 2-4 times/day.

(3) Squat exercises with one leg on the affected side

Requirements are slow, hard and controlled (no shaking). 20-30 times/group, interval between groups is 30 seconds, 2-4 times/day.

The quadriceps femoris (1) should be shoulder width, with all feet on the ground and upper body straight. Then, when the knees are bent to the lowest point, stand up slowly and forcefully. When standing, press your hands on the upper and middle thighs respectively, and exert appropriate force. When the legs and body are completely straight, the quadriceps femoris on the front side of the thigh will contract and tense, pause, relax the muscles and squat down again. Exhale when squatting, and inhale when standing up. 15-20 times is 1 group, and 3-4 groups can be repeated. You can also do it with a load behind your neck and shoulders. (2) Half squat. Feet shoulder-width apart. Kneel down until the thighs are parallel to the ground, and put your hands on your legs naturally. The upper body is in a posture of holding out the chest and crouching. Hold this position for a while. When the leg muscles are sore and swollen, stand up and rest for a few seconds and do it again. During the half squat, you can breathe freely. I set my own amount of exercise according to my physical strength.

Gastrocnemius, soleus. The training method is the same as exercising quadriceps femoris, but standing on tiptoe instead. You can put your hands on the wall or back of the chair. After squatting and standing up, make the gastrocnemius and soleus muscles behind the calf contract, pause, and resume redo. Training 10- 15 times is 1 group, and 3-4 groups can be repeated.

This paper (including: neck unarmed exercise, arm unarmed exercise, pectoralis major unarmed exercise, abdominal unarmed exercise and leg unarmed exercise) provides the number of exercises and groups for reference only. Novices should increase or decrease according to their own specific conditions. Practice a stage. After you increase your physical strength, you should increase your exercise.