突如其来的四川芦山特大地震给灾区广大人民群众带来了深重灾难。

突如其来的四川芦山特大地震给灾区广大人民群众带来了深重灾难.

　　中国康复研究中心主任、北京博爱医院院长、已经进驻地震灾区的国家康复医疗队队长李建军教授说：“地震伤员在伤后面临的问题是，怎样避免出现残疾或怎样避免轻度残疾发展为严重残疾。地震伤员康复的基本原则是早期介入、减少残疾、预防并发症，最大限度地开发应用其所有的残存功能。在地震伤员的抢救中，早期康复的介入应越早越好。”

中国康复研究中心主任/Beijing fraternity hospital/Has been in the earthquake zone of national rehabilitation medical team captain, said professor soloing:"After the earthquake victims in the injury of the problem is,How to avoid disability or how to avoid a mild disability development for seriously disabled.The basic principles of earthquake victims recover is early intervention/Reduce the disability/To prevent complications,Maximize the development and application of all its remaining functions.In the earthquake rescue of the wounded,Early rehabilitation intervention should be the sooner the better."

　　四川芦山地震发生后，中国康复研究中心北京博爱医院康复专家，第一时间写就地震中常见的脊髓损伤、四肢骨折、脑外伤等主要伤残的康复与护理文章，帮助伤者尽快从伤痛中恢复过来，提高他们生活的信心和自理能力，为他们将来回归家庭和社会奠定良好的基础。

四川芦山地震发生后,China rehabilitation research center of Beijing fraternity hospital rehabilitation specialists,The first write common spinal cord injury in the earthquake/Extremities fractures/Brain injury rehabilitation and nursing of disability such as the articles,To help the injured to recover from injury as soon as possible,Improve their confidence and ability to care for life,For they will return to the family and society to lay the good foundation.

　　

骨折后注意防肌肉萎缩 Pay attention to prevent muscle atrophy after fracture

　　中国康复研究中心北京博爱医院骨科主任医师 崔寿昌

中国康复研究中心北京博爱医院骨科主任医师 崔寿昌

　　四肢骨折是在地震、塌方等灾难中最常见的创伤。骨折后的功能锻炼非常重要，保守治疗和手术后的病人应该进行早期功能锻炼，这样能促进骨折愈合，缩短骨折愈合时间，防止关节粘连、肌肉萎缩等，减少残疾。

Extremities fractures是在地震/The most common trauma landslides disaster.Functional exercise after the fracture is very important,Patients after conservative treatment and operation should be performed early functional exercise,It can promote the fracture healing,Shorten fracture healing time,Prevent articular adhesion/Muscle atrophy, etc.,Reduce the disability.

　　

骨折早中后期的锻炼重点 The focus of fracture later period early exercise

　　骨折早期(伤后1-2周内)伤肢较肿胀疼痛，主要锻炼方法是肌肉舒张、收缩活动，原则上除骨折部上下关节暂不活动外，身体其他关节都应适当活动。上肢肌肉的锻炼是用力握拳和屈伸活动手指，反复进行。下肢肌肉的锻炼是收缩和放松大腿肌肉，勾脚踝和活动脚趾，能帮助消肿。

骨折早期(Within 1-2 weeks after injury)Leg swelling and pain,Main is muscle relaxation exercise method/Contraction in activity,In principle, in addition to the fracture of upper and lower joint temporarily inactive,Other joints of the body should be appropriate activities.Exercise upper limb muscles are hard fingers fisting and flexion activities,repeated.Lower limb muscle exercise is to contract and relax the thigh muscle,Hook ankle and toes,Can help reduce the swelling.

　　骨折中期(2周后)伤肢肿胀消退，局部疼痛逐渐消失，应继续肌肉的舒缩活动，同时逐步活动骨折上下关节，动作应缓慢，活动范围由小到大，逐步加大活动力量和范围，要特别注意的是关节活动不能太剧烈，同时应询问医生哪些活动不能做。

骨折中期(After 2 weeks)Leg swelling subsided,Local pain gradually disappear,The muscle during contraction continues,At the same time gradually fractures and joints,Action should be slow,Range from small to large,Gradually increase the power and scope of activities,Pay special attention to is the joint activities can't be too severe,At the same time should ask the doctor which activities can be done.

　　骨折后期(骨折愈合后)主要是加强伤肢各关节的主动活动锻炼，使关节能迅速恢复正常的活动范围。对活动受限的关节要特别加强锻炼。

骨折后期(After fracture healing)Mainly is to strengthen leg of each joint exercise initiative activity,The activities of the joint can quickly returned to normal.Take special exercise of restricted movement joints.

　　

常见骨折的功能锻炼方法 Common functional exercise methods of fracture

　　1、上臂骨折(肱骨干骨折)骨折固定后，开始练习指、掌、腕关节活动，并收缩上臂肌肉，不要旋转上臂，不要提东西。2-3周后练习肩、肘关节活动，骨折后期全面练习肩肘关节：如用伤肢摸对侧肩部，摸后脑、划船动作等。

1/Upper arm fractures(Humeral fractures)Fracture fixation after,Practice refers to/palm/Wrist joint activities,Upper arm muscle and contraction,Don't rotate the upper arm,Please don't mention anything.Exercise the shoulder after 2-3 weeks/Elbow movement,Comprehensive practice shoulder elbow late fracture:If use leg touched the contralateral shoulders,Touch back/Rowing motion, etc..

　　2、前臂骨折(尺桡骨骨折)初期可练习手臂的肌肉活动，用力握拳，用力伸开手指。2-3周后开始练习肩肘腕等关节活动，范围和力量逐步增加，不要做前臂旋转活动，后期可练习前臂旋转活动，充分练习各关节活动。

2/The forearm fractures(Ulnar radial fractures)Early can exercise the muscles of the arm,Hard hand clenched,Push open fingers.2-3 weeks after the start practicing shoulder elbow wrist joint activities,Gradually increase the range and power,Don't do the forearm rotation,Late may practice the forearm rotation,Fully practice activities of each joint.

　　3、下肢骨折(股骨骨折、胫腓骨骨折)手术固定后，早期抬高伤肢，做大腿肌肉收缩活动，根据医生指导活动膝关节等关节，什么时候下地听从医生指导。下地后开始不能完全用力，应使用双拐或单拐，用单拐时拐应放在好腿的一边。骨折完全愈合后，可以完全用力。

3/Lower limb fractures(Femoral fractures/Tibiofibula fracture)After the fixed surgery,Early up leg,Do the thigh muscle contraction,According to the guidance of activity knee joints, etc,When down to listen to the guidance.After the fields began to not completely hard,Crutch or single-throw should be used,With single-throw turn when the good should be on one side of the leg.After the fractures healed completely,Can fully exert oneself to do.

　　总之，功能锻炼以肌肉关节的主动活动为主，被动活动为辅，主动的肌肉和关节活动可以防止肌肉萎缩，增加关节的活动范围。加强重点关节的锻炼时，也不能忽视周围的关节，如腕关节骨折，既要活动腕关节，也要注意活动手指关节和肩、肘关节。功能锻炼应在医生的指导下进行，因为每个病人的伤情、年龄、身体条件、营养状态都不一样。功能锻炼从手术后一直到完全恢复应贯穿始终，这是一个长期的过程，不能半途而废。如有明显不适，应找医生指导。

总之,Mainly on muscle joints active functional exercise,Passive activity is complementary,Active muscles can prevent muscle atrophy and joint activities,Increase the joint range of motion.To strengthen the key joint exercise,Also cannot ignore the surrounding joints,Such as wrist fractures,Both activities wrist joints,Also must pay attention to the activity finger joint and shoulder/elbow.Functional exercise should be performed under the guidance of a doctor,Because each patient's condition/age/Physical condition/Nutritional status.Functional exercise until fully recovered from the surgery should be used throughout,This is a long-term process,Don't give up.If there are any obvious discomfort,Should see a doctor guidance.

　　

年轻脑外伤患者更易康复 Young patients with traumatic brain injuries are more likely to recover

　　中国康复研究中心北京博爱医院主任医师 张通 副主任医师 张皓

中国康复研究中心北京博爱医院主任医师 张通 副主任医师 张皓

　　颅脑外伤的临床症状表现是由受伤的轻重程度决定的，轻微颅脑外伤仅有头皮血肿，而严重脑外伤则可出现头痛、恶心、呕吐、嗜睡、昏睡、昏迷等。其他表现如头晕目眩、耳鸣、记忆力减退、易疲劳、失眠等也很常见。

颅脑外伤的临床症状表现是由受伤的轻重程度决定的,Only the scalp hematoma mild traumatic brain injury,While severe brain trauma, can appear have a headache/nausea/vomiting/drowsiness/lethargy/In a coma, etc..Other performance such as dizziness/Ringing in the ears/Memory loss/fatigue/Insomnia, etc are also common.

　　多年的康复治疗经验告诉我们，年轻脑外伤患者的康复价值更大，经过正规有效的康复治疗，常常会出现一些意想不到的效果。脑外伤的康复内容包括卧床期的良肢位摆放、关节活动度训练、翻身、起坐、平衡训练、站立训练、步行训练、语言训练、认知训练、心理辅导以及进食、穿衣、大小便护理、呼吸和皮肤管理等日常生活能力训练。

多年的康复治疗经验告诉我们,Young patients with brain injury rehabilitation value is bigger,After a formal and effective rehabilitation,Will often appear some unexpected results.Rehabilitation of brain injury include bed put good limb position/Training of motion/Roll over/since坐/Balance training/To stand the training/Training on foot/Language training/Cognitive training/Psychological counseling and eating/dress/Relieve oneself care/Respiratory and skin management and so on daily life ability training.

　　

正确的卧床姿势很重要 Correct posture is very important in bed

　　脑外伤早期常常要有一定的卧床时间，长期卧床会出现一定的肌肉萎缩、关节僵硬变形、骨质疏松、坐起时头晕等症状，严重影响将来的功能恢复。病情稳定后要尽量减少卧床时间，防止功能废用。卧床时保持正确的姿势非常重要，推荐侧卧位，并且定时翻身、拍背。

脑外伤早期常常要有一定的卧床时间,Lie in bed for a long time can cause certain muscle atrophy/Stiff joints deformation/osteoporosis/坐since时头晕等症状,Serious impact on functional recovery in the future.Try to minimize time in bed after in a stable condition,Prevent function disuse.When in bed to keep correct posture is very important,Recommend the lateral position,And regularly turn/Take back.

　　

发病初期每2小时翻身1次 At the turn 1 every 2 hours

　　长期卧床会出现多种并发症，及时翻身的主要目的是防止出现褥疮。发病初期肢体无法活动的病人要每2小时翻身1次。长期卧床的病人也要及时进行翻身。

长期卧床会出现多种并发症,The main purpose of the timely turn is to prevent bedsore.Body can't activities in the early years of the onset of the patient to turn 1 every 2 hours.Long-term bedridden patients also want to in a timely manner.

　　

长期卧床后坐起时要缓慢 长期卧床后坐since时要slow

　　发病后早期初次坐起或长期卧床要坐起时，为避免产生体位性低血压，应采用逐渐增加角度的被动坐起方法。可先将床头摇起15度至30度，休息3-5分钟，逐渐加大角度，每次增加10-15度，增加坐位时间5-10分钟，争取经过2-3天的练习，在床上坐直达到90度位。当病人可坐直90度并能保持30分钟后，即可开始练习独立坐位及转移动作等。

发病后早期初次坐since或长期卧床要坐since时,In order to avoid producing orthostatic hypotension,应采用逐渐增加角度的被动坐since方法.可先将床头摇since15度至30度,3-5 minute break,Gradually increase the Angle,Every time add 10 to 15 degrees,Increase the seat for 5-10 minutes,For after 2-3 days of practice,To sit up in bed up to 90 degrees.When a patient is sitting up straight 90 degrees and can be kept for 30 minutes,That is可开始练习独立坐位及转移动作等.

　　

每天做2次关节活动度训练 Do 2 times a day practicing training

　　对于卧床病人，应进行维持和改善关节活动范围的练习。关节活动范围练习可每天做2次，每个关节10次左右，手法要轻柔、缓慢。

对于卧床病人,Should be to maintain and improve the joint activities of practice.Joint activities practice can do 2 times a day,Each joint around 10 times,Approach to soft/slow.

　　

亲情呼唤有助觉醒 The family calls for help to awakening

　　脑外伤病人经常存在意识障碍、不清醒、主动运动差等情况，给予适当的感觉刺激有促进觉醒、诱发运动的作用。感觉刺激包括触觉、视觉、听觉、嗅觉、味觉等。可以通过洗澡、翻身、做运动、按摩等给病人以触觉、深感觉刺激；与病人说话、亲情呼唤、听收音机、看电视、看照片等刺激，有一定促醒作用。

脑外伤病人经常存在意识障碍/Don't awake/Active movement etc,Give appropriate sensory stimuli have promote awakening/Induced movement.Sensory stimuli including the sense of touch/visual/auditory/The sense of smell/Taste, etc..Can take a shower/Roll over/Do sports/Massage, to touch to a patient/Deep sensory stimuli;Talking with the patient/The family called/Listen to the radio/Watching TV/See photos, etc,Have certain effect on promoting wake up.

　　

不要急于下地走路 Don't walk

　　步行练习包括迈步练习、使用手杖及助步器步行、使用矫形器步行等。脑外伤病人步行训练首先要做好心理准备，要能坐稳、能站起及站稳，同时患腿能迈步、重心转移到患腿、患腿支撑、健腿跟上，才能完成一个步行周期。否则不要急于过早下地走路。早期应在平衡杠内步行，逐渐过渡到平地步行训练。

步行练习包括迈步练习/Use walking stick and the step walk/Used orthoses on foot, etc.Brain trauma patients walking training to prepare first,Need to be able to secure/能站since及站稳,With legs can move at the same time/Shift to the legs/Suffering from leg support/The healthy leg to keep up with,To complete a walk cycle.Don't rush to walk too soon.Early within the balance bar should walk,Training gradually transition to the ground to walk.

　　

不可忽视听力损伤 Hearing impairment cannot ignore

　　中国残疾人辅具中心主任医师 陈振生

中国残疾人辅具中心主任医师 陈振生

　　由于听觉器官的大部分包埋在头颅中，因此在地震造成的伤残中，听力损伤往往与颅脑外伤合并存在。这类损伤的早期往往被脑外伤的其他症状所掩盖，不容易被发现。待脑外伤危险期过后，才表现出相应的症状，例如耳鸣、耳聋、眩晕，部分有颞骨骨折的病人会出现面部肌肉的完全或不完全瘫痪。

由于auditory器官的大部分包埋在头颅中,So in the disability caused by the earthquake,Hearing loss is often merged with craniocerebral trauma.Early of this kind of damage is often concealed by other symptoms of brain injury,Not easy to be found.For crisis after traumatic brain injury,To show the corresponding symptoms,Such as tinnitus/deafness/vertigo,Some patients with temporal bone fractures will be complete or incomplete paralysis of facial muscles.

　　外耳的损伤一般不会造成听力下降。中耳损伤主要是鼓膜破裂和听骨链中断，听力的下降不会超过60分贝，大声说话可以听得见，也能听得清、听得懂。在护理时，注意在耳道口放置消毒棉球，防止灰尘和洗头洗脸水进入耳内，只要不出现感染，鼓膜穿孔大部分可以自动愈合。听骨链的中断日后可以通过手术修复，听力也就随之恢复，不会留下永久性的听力损伤。内耳、听神经和听觉中枢受伤导致听力损伤的主要特征是对言语声分辨能力的下降，伤员能听到人们说话声，但不能分辨其中的意思。这类听力损伤的康复措施是待听力损失稳定后，通过配戴助听器或植入人工耳蜗补偿已经损失的听力。对于言语没有发育完全的小儿来说，还要及时进行言语康复训练，防止语言障碍的发生。

外耳的损伤一般不会造成听力下降.Middle ear injury mainly eardrum rupture and auditory ossicle chain interruption,Decline in hearing can't more than 60 decibels,Speak loudly can hear,Can hear clearly/understand.At the time of care,Note that in ear crossing placed sterilized cotton ball,To prevent dust and water washing a face wash into the ear,As long as it doesn't appear,Most can self-seal tympanic membrane perforation.Auditory ossicle chain interruption by surgical repair in the future,Listening goes back,Don't leave permanent hearing loss.The inner ear/Auditory nerve and the auditory injury is the main characteristic of hearing impairment is the decline of speech sound resolution,The injured people can hear the voice,But unable to distinguish between the mean.Rehabilitation measures of this kind of hearing loss is to be stable after hearing loss,With wear hearing AIDS or cochlear compensation place is loss of hearing.For pediatric speech is not fully developed,Speech rehabilitation training from time to time,To prevent the happening of the language barrier.

　　

脊柱脊髓康复伤后即开始 脊柱脊髓康复伤后That is开始

　　中国康复研究中心北京博爱医院脊柱外科主任医师 洪毅

中国康复研究中心北京博爱医院脊柱外科主任医师 洪毅

　　脊柱脊髓损伤也是地震伤中最常见的疾病之一，其康复治疗从伤后第1天就应该开始。内容包括：重建脊柱稳定性，外固定、手术内固定、脊髓脱水治疗等。另外还要注意对全身的管理，防治多系统功能障碍，预防压疮、垂足、泌尿系感染等并发症。康复治疗包括三个时期：

脊柱脊髓损伤也是地震伤中最常见的疾病之一,The rehabilitation treatment should start from 1 day after injury.The content includes:Reconstruction of spinal stability,External fixation/Internal fixation surgery/Spinal cord dehydration treatment, etc.Also, pay attention to the management of the whole body,Prevention and treatment of multiple system dysfunction,Prevention of pressure ulcers/pedal/Complications such as urinary tract infection.Rehabilitation therapy, there are three periods:

　　1、急性不稳定期(损伤后或脊柱脊髓术后约2-4周)：在急性不稳定期，康复训练每日1-2次，训练强度不宜过量。

1/Acute instability(Injury or spinal cord after about 2 to 4 weeks after surgery):In the acute instability,Rehabilitation training 1-2 times a day,The training intensity shoulds not be too much.

　　这个时期康复训练的主要内容包括：关节活动度训练、肌力训练、呼吸功能训练、运动训练、膀胱功能训练。

这个时期康复训练的主要The content includes:Training of motion/Strength training/Respiratory function training/Sports training/Bladder function training.

　　2、急性稳定期(急性不稳定期后至伤后8周左右)：本时期应强化康复训练内容，每日康复训练时间总量应在2小时左右。此期临床主要治疗已基本结束，伤员脊柱与病情均已稳定，康复成为首位的或唯一的任务。

2/Acute period(Acute instability after eight weeks after the injury):This period should strengthen rehabilitation training content,Daily total rehabilitation training time should be around 2 hours.This period clinical main treatment has ended,The injured spine and are stable,Became the first or the only task of rehabilitation.

　　3、慢性期(伤后两个月以后)：在早期康复结束后，根据伤员情况可以进行一定时间的后期康复训练，其目的是引导伤员回归家庭和社会。(陈亚伟整理)

3/Chronic phase(Two months later after injury):At the end of the early rehabilitation,According to the situation of the wounded can be late for a certain time of rehabilitation training,Its purpose is to guide the wounded back to family and society.(Chen Yawei finishing)