课件：踝关节扭伤的患者指南.pptx

踝关节扭伤患者指南,胜利油田中心医院 手外科、足踝外科 姜剑魁,踝关节扭伤患者指南,Ankle Sprain 踝关节扭伤 A Patients Guide to Ankle Sprain 踝关节扭伤患者指南 Introduction 简介,An ankle sprain is a common injury and usually results when the ankle is twisted, or turned in (inverted). The term sprain signifies injury to the soft tissues, usually the ligaments, of the ankle. 踝关节扭伤是生活中很常见的损伤，通常是由于踝关节内翻损伤所导致。术语“扭伤”一般指的是软组织的损伤，在踝关节，通常指的是韧带损伤。,This guide will help you understand how an ankle sprain occurs how doctors diagnose the condition what can be done to treat a sprain 本指南旨在帮助你了解 踝关节扭伤是怎样发生的 如何诊断踝关节扭伤 如何治疗踝关节扭伤,Anatomy 解剖 What part of the ankle is involved? 踝关节包括哪些结构？,Anatomy 解剖 What part of the ankle is involved? 踝关节包括哪些结构？,Ligaments are tough bands of tissue that help connect bones together. Three ligaments make up the lateral ligament complex on the side of the ankle farthest from the other ankle. They are theanterior talofibular ligament (ATFL),the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL).The common inversion injury to the ankle usually involves two ligaments, the ATFL and CFL. Normally, the ATFL keeps the ankle from sliding forward, and the CFL keeps the ankle from rolling inward on its side.,韧带是一种致密的带状组织，它把相邻骨关节连接在一起。踝关节外侧韧带复合体由三条韧带组成：距腓前韧带、跟腓韧带、距腓后韧带。踝关节内翻扭伤通常累及其中两条韧带：距腓前韧带和跟腓韧带。距腓前韧带防止踝关节前移，跟腓韧带防止踝关节过度内收。,A ligament is made up of multiple strands of connective tissue, similar to a nylon rope. A sprain results in stretching or tearing of the ligaments. Minor sprains only stretch the ligament. A tear may be either a complete tear of all the strands of the ligament or a partial tear of only some of the strands. The ligament is weakened by the injury; how much it is weakened depends on the degree of the sprain.,韧带是由多股束带状结缔组织组成，很像是一股尼龙绳。扭伤会导致韧带的拉伤或撕裂。轻微扭伤仅仅导致韧带的拉伤。严重扭伤会导致韧带撕裂，而韧带撕裂既可能是韧带内全部束带的断裂，也可能是部分束带的断裂。韧带损伤后，其力量会减弱，具体减弱的程度取决于扭伤的程度。,The lateral ligaments are by far the most commonly injured ligaments in a typical inversion injury of the ankle. In an inversion injury the ankle tilts inward, meaning the bottom of the foot angles toward the other foot. This forces all the pressure of your body weight onto the outside edge of the ankle. As a result, the ligaments on the outside of the ankle are stretched and possibly torn.,踝关节外侧韧带损伤最常见于踝关节内翻损伤。何谓踝关节内翻损伤？就是发生扭伤时，扭伤的这只脚的足底朝向另外一只脚，这样全身的重量都集中于踝关节的外侧，结果导致了踝关节外侧韧带的拉伤或撕裂。,A severe form of ankle sprain, called an ankle syndesmosis injury, involves damage to other supportive ligaments in the ankle. This type of injury is sometimes called a high ankle sprain because it involves the ligaments above theankle joint. In an ankle syndesmosis injury, at least one of the ligaments connecting the tibia and fibula bones (the lower leg bones) is sprained. Recovering from even mild injuries of this type takes at least twice as long as from a typical ankle sprain.,有一种严重的踝关节扭伤，又称踝关节下胫腓联合损伤，累及踝关节的其他支持韧带。这种类型的踝关节扭伤又称高位踝关节扭伤，因为它累及的韧带位于踝关节上方。踝关节下胫腓联合损伤发生时，至少有一条连接胫腓骨远端的韧带发生拉伤或撕裂，即使是轻微的下胫腓联合损伤，其恢复时间至少是普通踝关节扭伤的两倍。,Symptoms 症状 What does an ankle sprain feel like? 踝关节扭伤后有哪些表现？,Initially the ankle is swollen, painful, and may turnecchymotic (bruised). The bruising and swelling are due to ruptured blood vessels from the tearing of the soft tissues. Most of the initial swelling is actually bleeding into the surrounding tissues. The ankle swells as extra fluid continues to leak into the tissues over the 24 hours following the sprain.,踝关节扭伤发生后，最初的症状是肿胀、疼痛、淤青，这是由于撕裂的软组织内血管发生破裂，进而血液渗出到踝关节周围所致。随着扭伤后24小时或更长时间，额外的液体不断渗漏入组织，踝关节发生肿胀。,People who have sprained an ankle often end up spraining the ankle again. If the ankle keeps turning in with activity, the condition is called ankle instability. Patients who have ankle instability lose confidence in their ankle to support them, especially on uneven ground. They often have swelling around the ankle that doesnt go away. Pain and swelling in a joint can cause a reflex where the body turns off the muscles around the joint. This can cause times when the ankle feels like it is going to give way, meaning it may have a tendency to twist again very easily.,一旦踝关节发生过一次扭伤，就很容易再次发生扭伤。如果踝关节反复多次扭伤，这被称之为“踝关节不稳”，这种情况会导致患者对他们的踝关节的功能失去信心，尤其是在凹凸不平的路面行走时。这类患者的踝关节总是反复肿胀而不能消退。关节的疼痛和肿胀会反射性地使人们不使用关节周围的肌肉。这会不时地让人们感觉踝关节似乎将要垮掉了，也说是说踝关节更容易再次扭伤。,People who have had several mild ankle sprains or one severe sprain are prone to impingement problems in the ankle. The ligaments that were sprained may become irritated and thickened, causing them to get pinched near the edge of the ankle joint. 反复多次的轻度踝关节扭伤或一次严重的踝关节扭伤均可导致踝关节撞击综合征。扭伤韧带会发炎并增厚，导致在踝关节边缘附近出现撞击。,Diagnosis 诊断 How do doctors diagnose the condition? 医生是如何诊断踝关节扭伤的,The diagnosis of an ankle sprain is usually made by examination of the ankle and X-rays to make sure that the ankle is not fractured. A physical examination is used to determine which ligament has been injured. The doctor will move your ankle in different positions in order to check the ligaments and other soft tissues around the ankle. Some tests place stress directly on the ankle ligaments to see if the ankle has become unstable and to find out if one or more ligaments has been partially or completely torn.,踝关节扭伤的诊断通常是通过体格检查，然后拍摄X片排除踝关节骨折。体格检查可以判断哪一根韧带发生损伤。你的医生会在不同方向活动你的踝关节，以检查踝关节韧带和周围软组织。一些特殊的体检试验，直接把应力施加于踝关节韧带，通过踝关节的稳定程度来判断是否有韧带损伤，一根或多跟韧带损伤，是部分还是全部撕裂。,If a complete rupture of the ligaments is suspected, your doctor may order stress X-rays as well. These X-rays are taken while the ligaments are placed in a stretched position. The X-ray will show a slight tilt in the ankle bone if the ligaments have been torn.,如果你的医生怀疑你的韧带全部撕裂，他会建议你去拍摄一个应力位的X片。所谓应力位X片即你拍片时，你的踝关节会被施加一个外力，以使得韧带处于张力状态。如果存在韧带撕裂，那么在X片上会表现出踝关节骨头的轻度倾斜。,Treatment治疗 What can be done for the problem? 如何治疗踝关节扭伤？ Nonsurgical Treatment,非手术治疗 Nonsurgical treatment options depend on whether your problem is an ankle sprain or ankle instability. 非手术治疗的选择取决于你遭受是踝关节扭伤还是踝关节不稳。,Ankle Sprain 踝关节扭伤,The best results after an ankle sprain come when treatment is started right away. Treatments are used to stop the swelling, ease pain, and protect how much weight is placed on the injured ankle. A simple way to remember these treatments is by the letters in the word RICE. These stand for rest, ice, compression, and elevation.,在扭伤发生后立即开始治疗，这有助于取得最好的结果。治疗方法包括：减轻肿胀、缓解疼痛、控制患足的负重。有一个简单的记住这些治疗手段的方法，即单词“大米”（RICE），它代表着踝关节扭伤的治疗方法：休息（rest）、冰敷（ice）、加压包扎（comprssion）、抬高患肢（elevation）,Rest: The injured tissues in the ankle need time to heal. Crutches will prevent too much weight from being placed on the ankle. Ice: Applying ice can help ease pain and may reduce swelling. Compression: Gentle compression pushes extra swelling away from the ankle. This is usually accomplished by using an elastic wrap. Elevation: Supporting your ankle above the level of your heart helps control swelling.,休息：损伤的组织需要时间恢复，使用拐杖有助于减少患足的负担。 冰敷：冰敷有助于缓解疼痛、减轻肿胀。 加压包扎：适当的加压包扎可以减轻踝关节的肿胀，通常是使用弹力绷带进行加压包扎 抬高患肢：将患肢抬高超过心脏水平，可以控制肿胀。,Your doctor may also prescribe medications. Mild pain relievers help with the discomfort. Anti-inflammatory medications can help ease pain and swelling and get people back to activity sooner after an ankle sprain. These medications include common over-the-counter drugs such as ibuprofen. But newer anti-inflammatory medicines called COX-2 inhibitors show promising results and dont seem to cause as much stomach upset and other intestinal problems.,你的医生也会给你开一些药物。一些止痛药可以缓解不适。消炎镇痛药物可以缓解疼痛减轻肿胀，可以让患者尽快的返回的到日常活动中去。这些药物包括常见的非处方药如布洛芬（芬必得）。还有一类新型的消炎镇痛药，属于COX-2抑制剂，具有更好的疗效，且不会引起胃部不适及一些其他的消化道问题。,As treatment progresses, it is helpful to gradually begin putting weight through the joint. Casts have fallen out of favor because soft tissues weaken when they are kept immobile. But braces that can be worn to support the ankle, but still allow weight bearing, are the most popular treatment for helping reduce strain on the healing tissues.,随着治疗的进行，患足逐步负重是有利于恢复的。石膏固定会减弱软组织的力量，所以一般不建议使用。佩戴踝关节支具既可以保护踝关节又可以允许患足负重，是帮助减少恢复中的组织扭伤的流行治疗方法。,Healing of the ligaments usually takes about six weeks, but swelling may be present for several months. Your doctor may suggest that you work with a physical therapist to help you regain full range of ankle motion, improve balance, and maximize strength.,韧带损伤的恢复通常需要六周时间，但肿胀可能会持续数月之久。你的医生会建议你与理疗师多接触，以帮助你重获踝关节的活动度、提高踝关节的平衡性及恢复踝关节的肌力。,Ankle Instability 踝关节不稳定,If the ankle ligaments do not heal adequately, you may end up with ankle instability. This can cause the ankle to give way and feel untrustworthy on uneven terrain. If your ankle ligaments do not heal adequately following an ankle sprain, your doctor may suggest several things.,如果踝关节扭伤没有得到充分的恢复，将会导致踝关节不稳。这会造成患者在凹凸不平的路面行走时，会感觉踝关节崩溃不值得信融赖。如果在踝关节扭伤后，踝关节韧带并未充分愈合，你的医生会给你以下几个建议：,Changes in your footwear may be prescribed to help keep your ankle from turning in. Placing a heel wedge under the outer half of your heel blocks the ankle from rolling, as does a flared heel built into your shoe. In extreme cases, doctors may prescribe a plastic brace, called an orthosis, to firmly hold your ankle from rocking side to side. Some patients feel a sense of steadiness from wearing high-topped shoes. Patients with ankle instability should avoid wearing high-heeled shoes.,首先是改变你的鞋，以防止你的踝关节总是处于内翻状态。在你足跟底部外侧半放置足跟垫，可以阻止踝关节的内翻，或穿一双足跟外展的鞋也可以起到同样的效果。对一些严重踝关节不稳的患者，医生可能会推荐使用塑料支具，即所谓矫正器，它可以牢牢的固定踝关节，防止踝关节晃动。一些患者可以穿高帮鞋，这有助于提高踝关节的稳定性。踝关节不稳患者应该避免穿高跟鞋。,Physical therapy treatments will likely be initiated to help restore joint range of motion, strength, and joint stability. 理疗有助于恢复踝关节活动度，增强踝关节肌力及提高踝关节稳定性。,Small nerve sensors inside the ligament are injured when a ligament is stretched or torn. These nerve sensors give your brain information about the position of your joints, a sensation called position sense. For example, nerve sensors in your arm and hand give you the ability to touch your nose when your eyes are closed.,The ligaments in the ankle work the same way. They send information to your nervous system to alert you about the position of your ankle joint. A physical therapist will help you retrain this sensation as a way to steady the ankle joint and protect you from spraining your ankle again.,当踝关节韧带拉伤或撕裂时，其内的一些小的神经感受器也会发生损伤。这些感受器用来帮助大脑确定关节的位置，这叫本体感觉。比如，你胳膊和手里的位置感受器能让你在闭眼的时候也能很准确的摸到自己的鼻子。踝关节韧带里的位置感受器也起着同样的作用，它们会告诉大脑踝关节的位置。理疗师会帮助你重建本体感觉以稳定踝关节并防止踝关节再次扭伤。,Many people who have ankle instability have weakness in the muscles along the outside of the leg and ankle. These are called the peroneal muscles. Strengthening these muscles may help control the ankle joint and improve joint stability.,很多踝关节不稳的患者，其小腿及踝关节腓侧肌肉的肌力会下降，这些肌肉一般指的是腓骨长短肌。加强这些肌肉的肌力有助于增强患者对踝关节的控制并提高踝关节的稳定性。,Surgery 手术治疗,Surgeons will occasionally do procedures right away in athletes who tear a lateral ankle ligament. In most other cases of torn ankle ligaments, surgeons will try nonsurgical treatments before doing reconstructive surgery of the ligaments.,对于一些踝关节外侧韧带撕裂的运动员，外科医生会选择立即进行手术治疗，但对于其他普通人来说，在进行外科手术治疗之前，通常建议首先尝试非手术疗法。,Ligament Tightening Procedure 韧带紧缩术,Chronic ankle instability can happen when the lateral ankle ligaments are stretched or torn and the ankle keeps giving way. Surgery can be done to tighten the stretched ligaments and improve the stability of the ankle. The surgery usually involves the ATFL and the CFL.,当踝关节外侧韧带拉伤或撕裂时，会导致慢性踝关节不稳。可以将拉伤的韧带进行紧缩以提高踝关节的稳定性。手术通常是紧缩距腓前韧带和跟腓韧带。,In this procedure, an incision is made in the skin that lies over the lateral ligaments. Using a scalpel, the surgeon cuts the ATFL and CFL in half. 沿着踝关节外侧韧带表面取切口，切开后皮肤后，显露距腓前韧带和跟腓韧带，使用刀片自其中部切断。,Holes are drilled along the lower end of the fibula bone, the small bone of the lower leg. The two ends of the cut ligament are overlapped and sewn together. The surgeon uses the drill holes in the fibula to hold the stitches to the bone. 在腓骨（小腿的小骨头）远端钻孔，将切断的韧带两个断端重叠并缝合，通过腓骨远端的孔将韧带固定于腓骨。,A large band of connective tissue crosses the front of the ankle just below the lateral ligaments. This band, called the ankle retinaculum, holds the tendons in place. The surgeon pulls the top edge of the ankle retinaculum upward and sews it into the fibula. This helps reinforce the reconstructed ligaments.,踝关节下支持带，位于踝关节前方，恰好走形于踝关节外侧韧带的下方。通常，外科医生会将踝关节下支持带的上半部分缝合于腓骨远端，以加强重建韧带的力量。,The following images show each step of the ligament tightening procedure: 下图将描述韧带紧缩术的过程： 第一步：自韧带中部切断 第二步；腓骨远端钻孔 第三步：韧带缝合于腓骨 第四步：缝合踝关节下支持带。,Tendon Graft Procedure 肌腱移植术,Another type of reconstruction is done using a tendon graft. If your surgeon feels that the stretched and scarred ligaments are not strong enough to simply repair in a ligament tightening procedure, then the ligaments must be reinforced with a tendon graft.,另一种韧带重建术需要肌腱移植。如果外科医生认为将仅仅对拉伤或疤痕化的韧带进行紧缩重建，依然不够牢固，这时就需要移植肌腱来强化韧带。,In this procedure, the surgeon removes a portion of one of the nearby tendons to use as a tendon graft. The tendon most commonly used attaches the peroneus brevis muscle to the outside edge of the small toe. A section of this tendon is put in place of the torn lateral ligaments. 在这一手术过程中，术者会切取踝关节外侧临近肌腱的一部分进行移植。通常，会切取腓骨短肌腱的一部分，然后将其缝合于撕裂的外侧韧带。,After making the skin incision, the surgeon drills a hole in the fibula near the attachment of the original ligament. A second drill hole is made in the area where the ligament attaches on the talus (the anklebone). 完成皮肤切口后，术者在踝关节外侧韧带于腓骨远端及距骨的止点附近钻孔。,The tendon graft is then removed (or harvested) and woven between these holes to recreate the ligament complex. 然后切取腓骨短肌腱，穿过腓骨与距骨的钻孔，以重建外侧韧带复合体。,After surgery, you will probably be placed in a cast or brace for about six weeks to allow the tendon reconstruction to heal. Following removal of the cast, physical therapy will be required to regain full use of the ankle. 术后，踝关节需要使用石膏或支具固定六周，以使重建的韧带愈合。拆除石膏后，马上开始理疗，以获得踝关节功能完整的恢复。,康复 What will it take to make my ankle healthy again? 如何使踝关节重获健康。 Nonsurgical Rehabilitation 非手术治疗后的康复,Even if you dont need surgery, you may need to follow a program of rehabilitation and exercise. Doctors recommend that their patients work with a physical therapist for two to four weeks. Your therapist can create a program to help you regain ankle function. It is very important to improve strength and coordination in the ankle.,即使你没有接受手术治疗，你也需要接受一系列的康复锻炼计划。 医生会推荐你在康复师的指导下进行康复锻炼，这一般需要两到四周的时间。理疗师会帮你制定康复计划，以恢复恢复踝关节的功能。其中，最重要的是恢复踝关节的力量及协调性。,Swelling and pain are treated with ice and electrical stimulation. If swelling in the ankle is severe, therapists may also apply massage strokes from the ankle toward the knee with your leg kept in an elevated position. This helps get the swelling moving out of the ankle and back into circulation. Your therapist may issue a compression wrap and instruct you to wrap your ankle and lower limb and to elevate your leg.,肿胀和疼痛可以通过冰敷和电刺激疗法进行治疗。如果肿胀很严重，理疗师可能还会采用按摩疗法，将你的患肢抬高，然后自踝关节向膝关节进行按摩。这有助于踝关节的消肿，并促使渗液返回入循环系统。理疗师会对你进行加压包扎，并指导你如何包扎你的踝关节和小腿。,Therapists also apply specialized hands-on treatment called joint mobilization to improve normal joint motion. These treatments restore the gliding motion within the ankle joint where the lower leg meets the talus bone. This form of treatment speeds healing after an ankle sprain, and it helps return people and players more quickly to their activity or sport.,理疗师还会采用特殊手动疗法，即所谓的关节活动疗法，用来提高踝关节的活动度。这些疗法可以提高胫距关节面的滑动度，加快踝关节扭伤后的康复速度，并使得普通患者和运动员更快的返回日常生活和运动中去。,An effective treatment for ankle sprains is disc training, which uses a circular platform with a small sphere under it. Patients place their feet on it while they sit or stand and work the ankle by tilting the disc in various positions. This form of exercise strengthens the muscles around the ankle, and it improves joint sense (mentioned earlier).,还有一种踝关节扭伤的锻炼方式，称为圆盘训练。使用一个底部有一个小球的圆盘，患者可取站立位或坐位，将脚放置于圆盘之上，然后往不同方向旋转圆盘。这种形式的锻炼可以加强踝关节周围肌肉的肌力，并提高踝关节的本体感觉。,When you get full ankle movement, your ankle isnt swelling, and your strength is improving, youll be able to gradually get back to your work and sport activities. An ankle brace may be issued for athletes who intend to return quickly to their sport.,当你的踝关节活动度得到完全的恢复，没有肿胀且肌力足够时，你就能逐步返回你的日常工作和运动中去。对于那些想尽快回到运动中去的运动员来说，最好穿戴踝关节支具。,After Surgery 手术后的康复,Patients usually take part in formal physical therapy after surgery. Rehabilitation after surgery can be a slow process. You will probably need to attend therapy sessions for two to three months, and you should expect full recovery to take up to six months.,接受手术治疗的患者术后通常会进行正式的理疗，术后的康复锻炼通常是一个缓慢的过程。你可能需要进行两到三个月的康复锻炼，而踝关节功能得到完全的恢复则需要半年时间。,Rehabilitation proceeds cautiously after reconstruction of the ankle ligaments. Most patients are prescribed an ankle brace to wear when they are up and about, and they are strongly advised to follow the recommendations about how much weight can be borne while standing or walking. You may be instructed to put little or no weight on your foot when standing or walking for up to 12 weeks. Your physical therapist will work with you to make sure you are using crutches safely and only bearing the recommended amount of weight on your foot.,踝关节韧带重建后的康复锻炼需要小心谨慎的进行。绝大多数的患者都需要穿戴踝关节支具，并且在站立或行走时，严格控制患足的负重量。术后12周内，确保你的患足不负重或轻微负重。你的理疗师会一直与你保持联系，以确保你能安全的使用拐杖，且患足承受适当负重量。,The first few physical therapy treatments are designed to help control pain and swelling from the surgery. Ice and electrical stimulation treatments may be used during your first few therapy sessions to help control pain and swelling. Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain.,首先开始的理疗主要是用于控制术后的疼痛和肿胀，这期间会采用冰敷和电刺激治疗。你的理疗师也会采用按摩或其他手法治疗来缓解肌肉痉挛和疼痛。,Treatments are also used to help improve ankle range of motion without putting too much strain on the healing ligaments. 一些其他的治疗方法也会使用，用于提高踝关节活动度，并且不会在重建韧带上施加太多的外力。,After about six weeks you may start doing more active exercise. Exercises are used to improve the strength in the peroneal muscles. Your therapist will also help you retrain position sense in the ankle joint to improve the stability of the joint.,一般六周后，你就可以开始进行适当的主动锻炼了，这些锻炼有助于提高腓侧肌肉的肌力。你的理疗师也会帮助你重建本体感觉以提高踝关节的稳定性。,The physical therapists goal is to help you keep your pain