Чрезвертельный перелом бедра – это повреждение кости в области бедра, нарушение целостности вертельной части. Кость бедра – это наибольшая трубчатая кость в теле человека. С возрастом риск такой травмы увеличивается, и по статистике более 60% пожилых пациентов попадают в стационар именно с переломами бедра.
Причины и симптомы
Причин травмы много, зачастую это внешние факторы:
- Падение на твердую поверхность.
- Падение с перекрученной ногой.
- Удар тяжелым предметом.
- Участие в ДТП.
- Зажатие бедренной кости с двух сторон.
Сопутствующим фактором является болезнь суставов. Это может быть остеопороз или артроз. Также количество таких травм увеличивается с возрастом, когда суставы стираются и кости становятся слабее. С возрастом становится сложнее переносить травмы суставов: с возрастом обменные процессы замедляются, соответственно, регенерация слабее. У пожилых пациентов часто имеются сопутствующие патологии, что усложняет лечени.
Для справки! Чрезвертельный перелом бедра у молодых людей чаще всего встречается вследствие тяжелой травмы или ДТП.
Существуют закрытые и открытые переломы. Лучше переносится закрытый тип, потому что в случае такой травмы кровотечение слабое.
Могут проявиться такие признаки чрезвертельного перелома:
- Болезненность травмированного сустава и области вокруг него.
- Гематома (синяк).
- Отечность.
- Нарушение двигательных функций (прилипшая пятка).
- Повернутая нога.
- Укорочение поломанной ноги.
- Болезненность при осмотре и ощупывании.
Могут присутствовать не все симптомы, а лишь часть.
Виды переломов
Чрезвертельный перелом – это трещина в кости малого и большого вертела. При сильной травме вертела бедренной кости могут не выдержать напряжения и сломаться. Таким образом, возникнет перелом.
Чрезвертельный перелом бедра со смещением
Такой тип встречается чаще всего. При травме пострадавший страдает от кровопотери и повреждения тканей мышц из-за чего возникает большая гематома в области поражения.
Человек чувствует себя плохо, нога вывернута наружу. Характерной особенностью такого вида перелома является изменение положения шейки бедра, смещение его в сторону. Также блокируется движение ноги в бок. Это очень тревожные симптомы.
Важно! Закрытый чрезвертельный перелом левой бедренной кости со смещением укоротит левую ногу на несколько сантиметров и вывернет ее во внешнюю сторону.
Подвертельный перелом
Подвертельный перелом бедра является травмой немного ниже малого вертела бедренной кости (3-4 см). Этот участок кости является хрупким, не переносящим больших нагрузок. При таком типе перелома возникает деформация ягодиц и ступни. Симптомы те же, но мышцы поражаются больше.
Такой перелом бедра у пожилых людей встречается чаще, нежели у молодых. Эта травма случается вследствие падения на бок, что в молодом возрасте случается редко, зачастую из-за ДТП или падения с большой высоты. В старом возрасте достаточно обычного падения с высоты роста, поскольку суставы ослаблены.
Подвертельный перелом чреват развитием дальнейших патологий и осложнений. При такой травме врач должен назначить различные обследования, чтобы убедиться, что не пострадали внутренние органы и спинной мозг.
Также существует смежный тип: чрезвертельно подвертельный перелом правой бедренной кости (или левой). Такой тип будет характеризоваться смешением симптомов травм обоих видов, что усложняет диагностику и лечение.
Перелом вколоченный
Отличается вколачиванием разбитых частей бедра друг в друга. Случается в случае падения на выпрямленную ногу, травмируется большой вертел бедра. При травме бедро отводится в бок. Отличается малым укорочением ноги и слабыми симптомами.
Такой тип перелома включает в себя перелом шейки бедра. Травма опасная, но при правильном и заблаговременном лечении кости срастаются хорошо. Поддается быстрому лечению. Чаще встречается у лиц, возрастом 50-60 лет.
Перелом межвертельный
Трещина кости находится между бедренными вертелами. Чаще всего травма происходит как следствие падения. Удар в таком случае приходится на вертел или ось бедра.
Для справки! Травма может быть со смещением или большим разбросом мелких частей кости.
Отличается такими симптомами:
- болезненность;
- отсутствие подвижности;
- большая гематома в месте удара;
- нога укорочена;
- кровоизлияние;
- вывернутая стопа;
- отек или припухлость.
Также перелом может захватить костный диафиз, травмировав и его.
Важно! Чтобы точно определить тип перелома, следует провести рентген травмированной области. От вида травмы зависит дальнейшее лечение.
Чаще всего встречаются закрытые переломы, с отеком и гематомой. Из-за большой кровопотери вследствие травмы у пациента может наблюдаться анемия (особенно в пожилом возрасте). Может случиться потеря более пол-литра крови.
Первая помощь и лечение
При подозрении на чрезвертельный перелом следует вести себя определенным образом:
- Обездвижить полностью человека, бедро должно быть в состоянии полного покоя.
- Вызвать скорую помощь. Если нет возможности, следует как можно быстрее перевезти пострадавшего самостоятельно, полностью обездвижив нижнюю часть тела.
- Прием обезболивающих препаратов пострадавшим человеком.
Чрезвертельный перелом встречается довольно часто, он поддается лечению и не угрожает жизни человека. В молодом возрасте кость срастается в течение месяца или немного дольше. Лечение может быть оперативным и консервативным.
Нюанс! В пожилом возрасте заживление длится больше времени, до трех месяцев (в зависимости от перелома и организма).
Консервативное лечение
Такое лечение представляет собой обездвиживание сустава человека, пока кость не срастется.
При долгом нахождении человека в лежачем положении существует риск развития сопутствующих заболеваний, например, пролежней. И, поскольку кости не срастаются за неделю, консервативный метод лечения проводится только тогда, когда невозможно оперативное вмешательство. Это может быть из-за таких болезней:
- сердечная недостаточность;
- диабет;
- порок сердца;
- подагра.
Консервативное лечение начинается с вытяжения сустава. Сразу после травмы к больной ноге цепляют груз весом около 3 кг, увеличивая со временем до 6 кг. В пожилом возрасте вес груза может быть меньше. Такая методика проводится до того момента, пока все части кости не встанут на место (для подтверждения проводится рентген).
После снятия груза (когда проходит около 2 месяцев после травмы) на поврежденный сустав накладывается гипс. Еще 3 месяца человек должен ходить только на костылях, не напрягая ногу.
Если кости плохо срастаются, то на 10 дней накладывается специальный сапожок, который помогает избежать осложнений.
Для справки! Полностью поврежденный сустав восстанавливается в течение 5 месяцев. В сложных случаях восстановление длится более 6 месяцев.
Оперативное лечение
Хирургическое вмешательство предпочтительнее. Такой метод лечения позволяет быстро вернуть кости на прежнее место, что позволяет встать на ноги уже через полторы недели. После этого запрещены нагрузки на ноги в течение 3 месяцев (речь идет о чрезмерных нагрузках: переносе тяжестей, спорте).
При оперативном лечении проводится операция, во время которой хирург закрепляет кость и осколки в правильном положении специальными пластинами. Пластины должны быть металлические, изготавливаются по индивидуальным меркам.
Для восстановления поврежденного сустава также используют такие методики:
- специальные упражнения;
- массаж поврежденной ноги;
- дыхательные упражнения;
- физиотерапия.
Следует заниматься профилактикой любых травм. Нужно следить за состоянием суставов и костей, пить витаминные комплексы. Обязательно быть аккуратным, чтобы свести падения и травмы к минимуму.
Травмы в любом случае вредят здоровью, существует малый процент летального исхода. Летальный исход возможен у пожилых людей, которые не могут перенести операцию. Также увеличивается риск при несоблюдении режима.
Мы будем очень благодарны, если вы оцените ее и поделитесь в социальных сетях
Травмы бедренной кости случаются довольно часто, но одно из самых тяжелых и серьезных повреждений – чрезвертельный перелом бедренной кости. При таком поражении повреждается участок костной ткани, который соединяет шейку бедра и его предвертельную часть. Кроме этого страдают мягкие ткани, возникает значительная кровопотеря в области повреждения. Врачи отмечают, что чрезвертельный перелом бедра диагностируют в среднем у каждого пятого человека, доставленного в травматологическое отделение с переломом конечностей, причем большинство таких пострадавших – люди преклонного возраста. Если же говорить о гендерных особенностях повреждения, то мужчины подвергаются этой травме чаще в молодом возрасте, а женщины – в зрелом, но у людей до 50 лет процесс срастания костей при переломе происходит гораздо быстрее, а реабилитация по времени укорачивается.
Возможные причины повреждения
Переломы чрезвертельных бедренных костей могут возникнуть по следующим причинам:
- гипокальциемия, спровоцированная приемом некоторых препаратов, патологиями щитовидной железы, нехваткой магния, хронической почечной недостаточностью и т. д.;
- несбалансированное питание (дефицит в рационе молочных продуктов и белков, сезонный дефицит витаминов);
- заболевания костной системы, приводящие к ломкости костей (например, костный туберкулез);
- транспортные аварии;
- падение человека со значительной высоты на бедро;
- эффект скручивания ног – мобильность в области вертела при неподвижной нижней части;
- остеопороз (уменьшение плотности костной ткани);
- действие ударной силы, приложенное в проекции на большой вертел;
- беременность (перераспределения кальция в организме матери в пользу плода);
- естественное старение, в результате чего вымывается кальций из костей, и они становятся хрупкими.
Разновидности чрезвертельных переломов
В медицине существует несколько подходов к классификации повреждения бедренной кости. В отношении чрезвертельных переломов разработана так называемая таблица Эванса, согласно которой их разделяют на стабильные и нестабильные.
- Стабильный – при этом виде травмы бедренной кости повреждается минимально. Это позволяет делать репозицию костей путем вправления, обычно такие процедуры проходят без последствий.
- Нестабильный – такой перелом осложняется повреждением кортикального слоя, в результате чего срастить фрагменты кости бывает очень трудно, положительный исход терапии не гарантируется. Например, таким нестабильным сложным чрезвертельным переломом считается повреждение кости с обратной косой линией.
Существует также иная классификация, которая гласит, что чрезвертельные повреждения бывают:
- вколоченными, не сопровождающимися смещением обломков кости;
- вколоченными со смещением;
- не вколоченный без смещения;
- не вколоченный, сопровождающийся смещением;
- диафизарный со значительным смещением костных отломков;
- межвертельный перелом бедра – между большим и малым вертелом.
Традиционно межвертельный перелом бедренной кости делится на открытый и закрытый. Закрытый перелом переносится намного легче и не грозит жизни пациента, а при открытых травмах пострадавшие могут испытывать значительные кровопотери.
Характерные проявления
Симптоматика чрезвертельного перелома во многом схожа с переломом шейки бедра. При повреждении конечности принимает неестественное для нее положение, а если кости смещены, то одна нога выглядит явно короче другой. Характерным симптомом является признак «прилипшей пятки» – больной в этом случае не может удерживать ногу на весу и оторвать ее от пола.
В результате чрезвертельного перелома человек ощущает резкую боль в области поражения, он не может пошевелить ногой, а любые попытки привести ее в движение вызывают боль. При закрытых переломах на месте ушиба возникает гематома, ткани отекают. Если перелом открытый, характерный признак – разрыв мягких тканей, массивное кровотечение, осколочный фрагмент кости виден сквозь раневую поверхность. К тяжелым симптомам приводит чрезвертельный диафизарный перелом по причине большой потери крови: у пациента бледнеет кожа, лицо покрывается холодным потом, дыхание становится поверхностным, падает давление, пульс еле прощупывается, больного лихорадит, его состояние приближается к шоковому. Любое движение ногой может спровоцировать приступ сильнейшей боли и привести к потере сознания.
Методы диагностики
Первичная диагностика чрезвертельного перелома – это осмотр и пальпация конечности. При транспортировке пациента в медицинское учреждение не стоит пытаться сместить ногу от первоначального положения конечности, получившегося в результате повреждения. Это не только помешает диагностике перелома бедра, но и может привести к перемещению фрагментов костей вглубь полости. Нередко именно некорректные действия, проведенные над нижней конечностью в первые моменты после травмы, могут стать причиной дальнейшей инвалидности пациента.
Окончательный диагноз ставится по результатам рентгеновского исследования, на котором можно четко увидеть степень поражения кости. При подозрении на оскольчатый вколоченный перелом врач дополнительно проведет компьютерную томографию, поскольку глубоко вошедшие осколки на рентгеновском снимке могут не выявляться.
Основные варианты лечения
При лечении чрезвертельного перелома выбор способов терапии определяется исключительно характером травмы. Традиционно, есть два подхода в терапии подобных повреждений – консервативный и хирургический. После прохождения каждого из них необходима реабилитация.
Консервативный метод позволяет лечить неосложненные чрезвертельные переломы без операции, однако даже такое лечение подразумевает длительное пребывание пациента в клинике. С помощью консервативной терапии можно исправить вколоченные переломы, если болевой синдром средней силы, а также закрытый чрезвертельный перелом бедренной кости со смещением. Пациенту проводят вытяжение поврежденной ноги и полностью ее обездвиживают на значительный период времени, путем гипсования. Находиться в гипсе при травмах средней тяжести можно около 5 месяцев, а если чрезвертельный перелом бедра осложнен, и кости плохо срастаются, то лечение продлевают еще на некоторый период. Для людей пожилого возраста стараются минимизировать время скелетного вытяжения, при котором тело должно находиться в горизонтальном положении, и проводить данный этап не более 8 недель. На следующем этапе перелом бедра у пожилых людей выравнивают манжетным вытяжением, если только такая процедура позволена по состоянию здоровья пациента. Общее время лечения у пожилых людей начинается от шести месяцев, в ходе которого врач разрешает пациентам передвигаться на костылях.
Для части случаев чрезвертельных переломов консервативное лечение в силу своих особенностей не подходит, поэтому врачи прибегают к хирургическому вмешательству. Так, операции проводят людям старшего возраста, поскольку они не могут длительное время пребывать в лежачем положении из-за угрозы усугубления течения хронических недугов.
Основная цель операции – закрепить отломки кости и вправить фрагменты на свое место. Производится восстановление целостности кости с помощью специальных гвоздей, винтов или пластин, которые скрепляют костные части вместе. После проведения операции иммобилизация конечности не требуется. В зависимости от исхода процедуры такие пациенты встают на поврежденную ногу уже через 3 недели и передвигаются на костылях. Значительную часть нагрузки берут на себя пластины и винты, поэтому реабилитация проходит довольно быстро и эффективно.
Несмотря на кажущуюся легкость при проведении хирургического вмешательства, оно имеет ряд противопоказаний. Так, операция не проводится людям с тяжелыми хроническими заболеваниями: пороками сердца, почечной или сердечной недостаточностью, сахарным диабетом, атеросклерозом, тромбофлебитом и подагрой.
Чрезвертельный перелом бедра, лечение которого организовано неправильно или несвоевременно, может давать негативное последствие: некроз головки бедренной кости, тромбоз вен, артроз, образование ложного сустава. Осложнения могут возникнуть в том случае, если:
- есть заболевания костной ткани, мешающие сращению костей;
- при сборе фрагментов костей они установлены неправильно;
- недостаточна компрессия отломков костей;
- плохо формируется губчатая ткань в зоне срастания костей.
Предвидеть осложнения практически невозможно, однако врачи могут их устранить через время путем проведения повторного вмешательства.
Чрезвертельный перелом бедренной кости – это нарушение целостности кости в промежутке между основанием шейки и линии под вертелом. Бедренная кость является частью самого крупного сустава — тазобедренного, а на большом и малом трохантерах крепятся важные мышцы, управляющие движением нижних конечностей.
Строение бедра человека
Головка бедренной кости соединена с диафизом шейкой бедренной кости. Малый и большой вертел – это важные костные ориентиры проксимального отдела нижней конечности.
Подвздошно-поясничная мышца крепится к малому трохантеру, а вращатели бедра – к большому, выпирающему по боковой поверхности. К межвертельной линии прикрепляется головки четырехглавая мышца бедра – латеральная и медиальная широкие. К межвертельному гребню крепится квадратная мышца бедра, а к вертельной ямке – наружная запирательная.
Именно мышцы способствуют дополнительному кровоснабжению области и быстрому заживлению переломов (по сравнению с межкапсулярной частью шейки бедренной кости).
Кровоснабжение головки бедренной кости меняется во время роста скелета. До 4 лет область питают медиальные и боковые ветви глубокой бедренной артерии. В дальнейшем артерии, окружающие, обходят хрящевую зону роста.
В подростковый период возрастает роль метафизарных сосудов, расположение которых меняется, потому переломы бедра в это время чреваты развитием аваскулярного некроза и опасным осложнениям.
Частые причины возникновения переломов бедра
Основными причинами переломов являются:
- падения во время гололедов;
- стрессовые переломы при физических перегрузках (спортсмены и военные);
- нарушение кровоснабжения;
- избыточная масса тела.
Переломы чаще всего происходит в следующих обстоятельствах:
- Падение на бедро.
- Прямой удар по верхней части бедра.
- Двустороннее сдавление.
- Скручивание при авариях и спортивных травмах.
Чрезвертельные переломы часто встречаются при производственном травматизме, а также на фоне остеопороза у пожилых людей.
Контактные виды спорта, такие как футбол, регби и футбол, являются причиной большинства переломов бедра.
Под действием субмаксимального стресса происходит разрушение костей. При попытках регенерации остеокластическая активность преобладает над работой остеобластов. Когда к кости прикладываются большие силы, возникают переломы напряжения.
Типы переломов
Различают три типа переломов бедра, которые зависят от поврежденного части кости.
- Внутрикапсульный – происходит на уровне шейки и головки бедренной кости, что относится внутри мягкой суставной оболочки. Перелом на уровне шейки нарушает кровоснабжение кости.
- Межвертельный – происходит между шейкой и малым вертелом. Обычно они проходят между двумя трохантерами.
Переломы на уровне подвертельной линии также связаны с ограниченным питанием кости.
Классификация Эванса разделяет:
- стабильный перелом с незначительным повреждением кортикального слоя и легкой вправляемостью;
- нестабильный – с глубоким повреждением компактного костного вещества и плохими прогнозами для сращения фрагментов. Если линия разлома идет изнутри кнаружи, то перелом относится к нестабильным.
Типы чрезвертельных переломов различают в зависимости от типа травмы:
вколоченный перелом без смещения определяется по признакам: сохраняется отведение ноги в сторону, конечность укорачивается незначительно;- вколоченный чрезвертельный перелом бедренной кости со смещением: осколок шейки входит в бедренную трубчатую часть кости, формируя выраженное укорочение, иногда происходит раздробление большого трохантера;
- не вколоченный перелом со смещением (встречается редко);
- не вколоченный перелом без смещенных обломков (характеризуется винтообразной линией, но тоже происходит редко);
- чрезвертельный диафизарный сопровождается смещением нескольких осколков костей.
вколоченный перелом без смещения определяется по признакам: сохраняется отведение ноги в сторону, конечность укорачивается незначительно;Различают также межвертельный перелом бедра, закрытые и открытые травмы. Последние характеризуются высоким риском кровопотери из-за открытой раны.
Симптоматика
Основной признак перелома – нарастающая сильная боль, которая распространяется по всей конечности. Внешние симптомы:
- гематома в области верхней части бедра;
- отсутствие подвижности;
- разворот бедра наружу при не вколоченном переломе;
- укорочение конечности;
- сильная отечность.
Пострадавший не может поднять прямую ногу, согнуть колено. При нажатии на пятку боль увеличивается. При повреждении сосудов и кровотечении усиливается потливость, бледность, кожа над переломом становится холодной.
Диагностика
Окончательный диагноз чрезвертельного перелома шейки бедра устанавливается только с помощью рентгена. При первоначальном осмотре проводится опрос, определяются симптомы.
Пальпация позволяет выявить границы отечности, нарастание болезненности, температуру кожи.
На рентгенограмме определяется количество осколков и их смещение. МРТ требуется при гематомах и признаках внутреннего кровотечения, чтобы оценить необходимость в хирургическом вмешательстве.
Оказание первой помощи
Необходимо сразу вызвать бригаду скорой помощи, стараться не перемещать пострадавшего до фиксации конечности.
Шину накладывают по наружной поверхности бедра из подручных средств – доска, которая доходит до уровня подмышечной впадины. Доску крепко привязывают к туловищу и голени. Пострадавшему дают обезболивающее средство.
По приезду скорой помощи вводится мощный анальгетик внутримышечно, накладывается специальная шина для транспортировки в травматологический стационар.
Лечение
Применяемое лечение зависит от вида перелома, его сложности и возраста пациента.
Чаще всего используют вытяжение, гипсовую тазобедренную повязку и хирургическую фиксацию костей винтами.
Если невозможно использовать вытяжение и хирургическое вмешательство, сразу накладывают гипсовую повязку, которая охватывает таз и всю нижнюю конечность до паховой области.
При этом обломки могут срастаться неправильно, что влияет на восстановление двигательных функций. Но эта тактика позволяет снизить риск осложнений, связанных с обездвиживанием пациента.
Консервативное
Лечение проводится в стационаре, требует использование вытяжения с помощью груза. Вес определяется развитием и силой мышц, зависит от возраста.
Вытяжение без операции проводят на протяжении 1,5-2 месяцев, контролируя повторном рентгенограммой правильность расположения осколков. Вес груза начинается от 4-6 кг и постепенно повышается.
Вытяжения отменяют, когда появляется костная мозоль. Затем накладывают гипс и позволяют пользоваться костылями.
Оперативное лечение
Тип операции определяется возрастом и состоянием больного. Открытый доступ к вертелу применяют для молодых людей.
Для фиксации обломков используют трехлопастные винты и пластину на кость, а также комбинированные конструкции для внутрикостного и накостного закрепления места перелома. Количество элементов зависит от тяжести повреждения.
Применяется два типа фиксаторов:
- динамические винты переносят часть нагрузки на кость при ходьбе;
- пластины забирают на себя всю нагрузку, деформируются, потому редко применяются в молодом возрасте и для спортсменов.
Большинство межвертельных переломов фиксируются либо с помощью компрессионного винта или интрамедуллярного гвоздя, что допускает удары по месту сращенного перелома. Винт вкручивается на внешней стороне кости в другой длинный штифт, проходящий через шейку и головку бедра.
Конструкция повышает стабильность, способствует заживлению. Интрамедуллярный гвоздь помещается в костный мозг через отверстие на вершине большого вертела. Затем через него проводят винт в шейку и головку бедренной кости.
В некоторых случаях применяют пластину с винтами, входящими в бедренную кость с боковой стороны. Один из них вводят в шейку и головку, а другие через пластину – в трубчатую часть.
Операции в пожилом возрасте проводятся через небольшие разрезы, используется фиксация штифтом, который устанавливают под контролем рентгеновского аппарата. После вмешательства бедро обездвиживают деротационным сапожком.
Реабилитацию начинают сразу после снятия швов.
Осложнения при использовании винтов
Операции с фиксации винтами могут привести к осложнениям, связанным с их неправильной установкой.
Иногда металлические элементы смещаются, а угловатые пластины приходят в негодность под весом пациента. В таких случаях операцию проводят повторно, формируя новые каналы под винты.
Особенности лечения у пожилых
Чрезвертельный перелом бедра у пожилых людей осложняется затрудненным сращением. Вытяжение продолжают до шести недель, затем применяют деротационное гипсование, чтобы позволить пациентам двигаться.
При медленном появлении мозоли вытяжение продлевают до двух месяцев, применяя наложение гипса на месяц. Восстановление продолжается до пяти месяцев, а в тяжелых случаях – более полугода.
Длительная иммобилизация чревата осложнениями: пролежнями, застойными пневмониями и сердечной недостаточностью, развитием инфекций мочеполовой сферы, обострением хронических болезней.
Потому травматологи чаще проводят хирургическое лечение, чтобы зафиксировать обломки и снизить риск осложнений.
Реабилитация
В комплекс реабилитации входят массажи и лечебная гимнастика. В первом периоде больного стараются вывести из депрессионного состояния, увеличить кровоснабжение в конечности.
Используют упражнения для диафрагмы и верхней части тела. Больного просят сгибать и разгибать пальцы и подошву на поврежденной конечности, выполняют движения надколенника, небольшие подъемы таза с опорой на стопу здоровой ноги и руки.
Иногда, спустя 14 дней вытяжение заменяют тазобедренной гипсовой повязкой. Пациента обучают поворачиваться на бок, сидеть на стороне неповрежденной ноги, ходить на костылях.
Под гипсом выполняется напряжение четырехглавой мышцы бедра. Гимнастику проводят 3-4 раза в сутки. Формирование костной мозоли занимает до 1,5-3 месяцев.
После снятия гипса
Второй период реабилитации начинают после снятия гипса, когда пациента обучают ходить самостоятельно.
Гимнастика направлена на восстановления движения в суставе пассивными и активными упражнениями, укрепление мышц поврежденной конечности с помощью эспандеров или утяжелителей.
Заново обучают координировать движение и держать равновесие. Упражнения выполняются на спине и на боку – подъемы таза и ног, а также стоя с опорой на стул или сидя с утяжелителями – разгибание колена, статическое удержание согнутого бедра.
Период продолжается до 2 месяцев и является важным для восстановления двигательной активности.
На третьем этапе больного обучают ходить без опоры, подниматься и спускаться по ступенькам. Молодым и спортсменам включают бег и прыжки, пожилым – упор на статику и привычные движения.
Заключение
Чрезвертельный перелом бедра — серьезная травма, требующая комплексной терапии и длительного периода восстановления. Часто не обойтись без хирургического вмешательства и длительного ношения гипса после него.
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