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农科院现在也搞月季育种了啊-这个流羽看着还行啊

髌腱修复术后康复指南 # 髌腱修复术后康复指南 **三军联合术后康复指南（Tri-Service Post-Operative Rehabilitation Guidelines）** **2020年5月发布** --- ## 资助与声明本工作由**统一服务大学**（Uniformed Services University） **物理医学与康复科** **作战准备肌肉骨骼损伤康复研究项目**（MIRROR, HU00011920011）资助。文中所述观点和主张仅代表作者，**不代表统一服务大学或*的官方政策或立场。 --- ## 批准人 | 姓名 | 军衔 | 军种 | 职务 | |------|------|------|------| | B. KYLE POTTER | 上校，军医（COL, MC） | 陆军 | 陆军骨科顾问 | | GEORGE P. NANOS III | 海军上校，军医（CAPT, MC） | 海军 | 海军骨科顾问 | | JOSEPH J. STUART | 空军中校，军医（Lt Col, MC） | 空军 | 空军骨科顾问 | | JASON L. SILVERNAIL | 上校，物理治疗师（COL, SP） | 陆军 | 陆军物理治疗顾问 | | LESLIE C. HAIR | 海军中校，医疗支援 corps（CDR, MSC） | 海军 | 海军物理治疗顾问 | | JAMES E. SHIELDS | 上校，生物医学科学 corps（Col, BSC） | 空军 | 空军物理治疗顾问 | --- ## 支持单位 - **健康科学统一服务大学**

髌腱/股四头肌腱修复术后康复方案 # 髌腱/股四头肌腱修复术后康复方案 **麻省总医院布里格姆运动医学中心（Massachusetts General Brigham Sports Medicine）** 本方案旨在为临床医生提供髌腱/股四头肌腱修复术后的康复指导。该方案基于**时间进程**（依赖组织愈合）和**达标标准**双重原则制定。具体干预措施应根据患者个体需求进行调整，并结合查体结果与临床判断。本指南中所列预期恢复时间可能因主刀医生偏好、是否合并其他手术或术后并发症等因素而有所不同。若临床医生在术后患者康复进展中遇到困难，应咨询转诊外科医生。本方案所列治疗干预**并非详尽清单**，实际治疗应根据患者恢复情况由临床医生灵活增减和调整。 --- ## 术后髌腱/股四头肌腱康复注意事项多种因素影响术后康复效果，包括**组织质量**和**修复强度**。建议临床医生与转诊医师密切沟通，了解修复的完整性及是否需要调整康复计划。 ### 术后注意事项如出现以下症状，请立即联系医生： - 发热 - 小腿剧烈疼痛 - 切口处异常渗液 - 疼痛无法控制 - 其他令您担忧的症状 --- ## 第一阶段：术后早期（术后 0–14 天） ### 康复目标 - 保护修复部位 - 减轻术后疼痛 - 控制术后水肿 - 预防长期制动引起的并发症 - 预防并早期识别感染迹象 ### 注意事项 - **铰链式膝关节支具**必须**锁定在伸直位**，并**全天佩戴**（行走、睡眠、站立等） - **禁止主动膝关节伸展** - **禁止被动膝关节屈曲超过 60°** — 此阶段不得强行增加活动度 ### 负重情况 - **可耐受负重（Weight Bearing as Tolerated）**，佩戴支具并锁定在伸直位 ### 干预措施 #### 消肿管理 - 冰敷、加压、抬高患肢 - 向心性按摩（retrograde massage） - 踝泵运动 #### 关节活动度 / 活动性训练 - 被动活动度（PROM） - 毛巾辅助脚跟滑动 - 低强度、长时间伸直拉伸：俯卧悬吊、足跟垫高 - 坐位腘绳肌 / 小腿拉伸 - 轻柔髌股关节松动术 #### 肌力训练 - 提踵（小腿抬高） - 股四头肌等长收缩（Quad sets） - 臀肌收缩（Glute set） ### 进入下一阶段标准 - 术后满 2 周 - 膝关节被动伸直至 0°（完全伸直） --- ## 第二阶段：术后中期（术后 2–6 周） ### 康复目标 - 继续减轻术后疼痛与水肿 - 逐步增加膝关节被动屈曲活动度 - 过渡至**完全负重**状态（佩戴锁定支具） - 开始近端（髋、腰背、腹部）与远端（踝）肌群的强化训练 ### 负重情况 - 可耐受负重，佩戴支具锁定在伸直位 → **目标在第6周前实现完全负重（FWB）** ### 注意事项 - **被动膝屈活动度（PROM）从第2周开始，起始目标为 50°** - 仅允许轻柔加压进行PROM - 每周增加约 10°，直至达到 90°： - 第2周末：≤ 60° - 第3周末：≤ 70° - 第4周末：≤ 80° - 第5周末：≤ 90° - 支具在**站立、行走、睡眠时保持锁定在伸直位** - 夜间佩戴支具至第6周，除非外科医生另有指示 - 坐位或卧位时可解锁支具（角度不超过当前PROM范围） - 根据需要使用助行器具 ### 干预措施（*继续第一阶段内容*） #### 关节活动度 / 活动性训练 - 髌股关节松动术 - 逐步增加被动屈曲（轻柔加压） - 被动伸直（必要时加压） - 脚跟滑动 - 坐位膝关节屈曲（超过当前ROM） - 足跟垫高拉伸 #### 心肺训练 - 上肢功率车（Upper body ergometer） #### 肌力训练 - 直腿抬高（SLR）—— **要求无伸膝滞后** - 侧卧髋外展/内收、俯卧直腿抬高 - 站立位髋外展/内收/后伸 - 臀桥（双腿伸直，脚抬高置于椅子上） - 提踵训练 - 核心训练：平板支撑（以不引起膝部不适为前提），腹横肌激活进阶 #### 平衡 / 本体感觉训练 - 站立位重心转移 ### 进入下一阶段标准 - 被动膝伸直至 0°（完全伸直） - 被动膝屈达 90° - 在支具保护下完全负重且无痛 - 主动伸膝至 0°（配合股四头肌收缩） --- ## 第三阶段：术后晚期（术后 6–15 周） ### 康复目标 - 逐步停用助行器具（如仍在使用） - 恢复膝关节完全主动/被动屈曲活动度 - 在条件允许时开始固定自行车训练 - 开始渐进性股四头肌负荷与抗阻训练 - 恢复静态单腿平衡能力 - 继续加强近端与远端肌群力量 ### 负重情况 - **铰链支具解锁用于行走（0–60°活动范围）**，前提是患者在站立相中表现出足够的股四头肌控制，防止膝关节打软 - 支具使用至**第8周**，除非外科医生另有指示 - 停用支具前需确认：股四头肌控制良好、负重耐受、单腿稳定性达标 ### 注意事项 - **术后8周前禁止在屈膝 >90° 时负重** - 术后12周前，主动/被动活动度（A/PROM）**每周进展不超过10°** - 避免激进的股四头肌拉伸 - **术后16周前禁止股四头肌最大自主收缩**（禁止徒手肌力测试或手持测力计测试） ### 干预措施（*继续第一、二阶段内容*） #### 关节活动度 / 活动性训练 - 髌股关节松动术 - 被动屈曲（可加压） - 脚跟滑动 - 坐位膝关节屈曲 #### 心肺训练 - 上肢功率车 - **固定自行车**： - 初始：小幅度蹬车，低阻力 - 待获得全范围活动后，逐步增加时间与阻力 - **椭圆机**： - 可开始使用的条件： - 主动膝屈 ≥ 120° - 可完成10次无滞后直腿抬高 - 步态正常，无需助行器具 #### 肌力训练 > *逐步增加强度，避免引起膝前疼痛。以下多数训练需在8–10周或更晚开始* ##### 健身房器械训练 - 腿推举机 - 坐姿腘绳肌屈曲机 - 腿部内收/外展机 - 髋伸展机 - 罗马椅 - 坐姿提踵机 > *逐步提升训练强度（力量）与持续时间（耐力）* ##### 功能性训练（强调近端稳定性与控制） - 坐姿深蹲（Squat to chair） - 侧向弓步（Lateral lunges） - 罗马尼亚硬拉（单/双侧） - 站立位三重伸展抗阻训练 - 单腿进阶训练： - 部分负重单腿推举 - 上台阶 + 抬腿 - 滑板弓步（前后、侧向） - 侧向台阶 - 单腿深蹲 - 单腿靠墙滑行 - 侧向下台阶 > **股四头肌伸展机（Knee Extension Machine）使用说明（术后16周起）**： > 若股四头肌力量仍显著受限，影响康复进展，可在**无膝前疼痛或不适**的前提下开始使用。 ##### 近端肌群强化 - 双腿臀桥 - 脚放于平衡球上的臀桥 - 单腿臀桥 - 弹力带侧向行走（Lateral band walk） - 站立蚌式/狗狗抬腿（Clamshell/Fire hydrant） - 腘绳肌行走训练（Hamstring walkout） - 上肢/下肢协同的腹横肌激活训练（TA brace progression） #### 平衡 / 本体感觉训练 - 单腿站立进阶训练（包括扰动训练） ### 进入下一阶段标准 - 股四头肌力量良好恢复： - 可完成 **10次单腿深蹲至60°** - 手持测力计测量股四头肌力量 ≥ 健侧 **70%**（若按标准时间线且修复无延迟，可在第16周测试） - 或股四头肌等长收缩压力 ≥ 健侧100%（使用血压计测量，单位 mmHg）¹ - 被动膝屈 ≥ 120° - 患侧单腿站立 ≥ 30秒，无明显代偿动作 - 步态对称，无需助行器具 - 上下楼梯对称，无需上肢辅助 --- ## 第四阶段：过渡期（术后 4–6 个月） ### 康复目标 - 恢复股四头肌全长与全范围活动度 - 恢复股四头肌力量（推荐使用“股四头肌指数”评估） - 恢复单腿动态平衡与离心控制能力（推荐Y平衡测试） - 在耐受情况下启动慢跑/跑步康复计划 - 恢复近端与远端肌群力量，达到双侧对称 ### 注意事项 - 避免运动中或运动后出现**超出延迟性肌肉酸痛（DOMS）范围的疼痛**，尤其是膝前部/伸膝装置区域 ### 干预措施（*继续第一至三阶段内容*） - 开始**矢状面为主的亚最大运动专项训练** - 从**双侧部分负重增强式训练**逐步过渡至**完全负重增强式训练** - 进入**增强式与敏捷性训练计划**（如处方使用功能性支具，则佩戴使用） #### 增强式与敏捷性训练 - 间歇跑训练计划 - **慢跑回归计划（Return to Running Program）启动条件**： - 全范围活动度 - 肿胀已消退 - 行走无痛 - 手持测力计测量下肢力量对称性 ≥ 80% - 可完成单腿跳跃（SL hop）且动作标准 ### 进入下一阶段标准 - **股四头肌指数 ≥ 90%**（首选手持测力计；若无，可用血压计替代，但建议转至具备测力设备的诊所进行测试） > *等速测力计测试应推迟至术后6个月，仅用于需高水平重返运动者* - 腘绳肌与髋部肌群力量对称（推荐测力计评估） - Y平衡测试 ≥ 健侧90% - 慢跑时步态对称 --- ## 第五阶段：渐进式重返运动（术后 6–8 个月） ### 康复目标 - 推进跑步/冲刺训练 - 提升多方向动态动作能力及加减速控制 - 增强增强式训练中的爆发力与落地控制 - 恢复完全股四头肌力量 - 以最低再损伤风险重返运动或比赛 ### 干预措施（*继续第二至四阶段内容*） - 根据患者目标运动项目加入**专项训练** - 如参与**变向/冲刺类运动**，应加强快速加减速训练与变向练习，逐步提高训练强度与不可预测性 ### 重返运动标准 - 通过 **MGB 下肢重返运动功能性测试** 全部项目 - **股四头肌指数 ≥ 90%**（测力计测量，等速测力计为首选） --- > **修订日期：2021年10月** --- ## 联系方式如有本方案相关问题，请发送邮件至： 📧 [[email protected]](mailto:[email protected]) --- ## 参考文献 1. Mondin D, et al. Front Physiol. 2018;9:1702. doi:10.3389/fphys.2018.01702 2. Sinacore JA, et al. J Orthop Sports Phys Ther. 2017;47(2):97-107. doi:10.2519/jospt.2017.6651 3. Seo D, et al. Reliability of the one-repetition maximum test... 4. Kongsgaard M, et al. Acta Physiol. 2007;191(2):111-121. 5. Couppé C, et al. J Appl Physiol. 2008;105(3):805-810. doi:10.1152/japplphysiol.90361.2008 6. Verdano MA, et al. :7. 7. Bhargava SP, et al. Injury. 2004;35(1):76-79. doi:10.1016/S0020-1383(03)00069-X 8. Bushnell B, et al. J Knee Surg. 2010;21(02):122-129. doi:10.1055/s0030-1247806 9. Mille F, et al. Eur J Orthop Surg Traumatol. 2016;26(1):85-92. doi:10.1007/s00590-015-1710-6 10. EL-Zahaar MS. J Nuerol Orthop Med Surg. 1995;16:132-136. 11. Puranik GS, Faraj A. Acta Orthop Belg. 2006;72:3. 12. Veselko M, Kastelec M. JBJS Essent Surg Tech. 2005;os87(1_suppl_1):113-121. doi:10.2106/JBJS.D.02631 13. El-Desouky I, et al. J Knee Surg. 2013;27(03):207-214. doi:10.1055/s-0033-1360655 14. Reidler JS, et al. In: Operative Techniques: Knee Surgery. Elsevier, 2018. 15. Marder RA, Timmerman LA. Am J Sports Med. 1999;27(3):304-307. doi:10.1177/03635465990270030601 16. Belhaj K, et al. Ann Phys Rehabil Med. 2017;60(4):244-248. doi:10.1016/j.rehab.2016.10.003 17. Langenhan R, et al. Knee Surg Sports Traumatol Arthrosc. 2012;20(11):2275-2278. doi:10.1007/s00167-012-1887-8 18. Konrath GA, et al. J Orthop Trauma. 1998;12(4):273-279. doi:10.1097/00005131-199805000-00010 19. Serino J, et al. Injury. 2017;48(12):2793-2799. doi:10.1016/j.injury.2017.10.013 20. West JL, et al. Am J Sports Med. 2008;36(2):316-323. doi:10.1177/0363546507308192 > ¹ 股四头肌等长收缩压力测试方法：使用血压计袖带包裹股四头肌，患者最大等长收缩时记录压力值（mmHg），与健侧对比。 [原文](http://tieba.baidu.com/mo/q/checkurl?url=https%3A%2F%2Fwww.massgeneral.org%2Fassets%2Fmgh%2Fpdf%2Forthopaedics%2Fsports-medicine%2Fphysical-therapy%2Frehabilitation-protocol-for-patella-quad-tendon.pdf&urlrefer=ea54634d08fedef47a7e9abb3b4f3bc5) ```text Massachusetts General Brigham Sports Medicine Rehabilitation Protocol for Patella/Quad Tendon Repairs This protocol is intended to guide clinicians through the post-operative course for Patella/Quad Tendon repairs. This protocol is time based (dependent on tissue healing) as well as criterion based. Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making. The timeframes for expected outcomes contained within this guideline may vary based on surgeon’s preference, additional procedures performed, and/or complications. If a clinician requires assistance in the progression of a post-operative patient, they should consult with the referring surgeon. The interventions included within this protocol are not intended to be an inclusive list. Therapeutic interventions should be included and modified based on the progress of the patient and under the discretion of the clinician. Considerations for the Post-operative Patella/Quad Tendon Many different factors influence the post-operative patella/quad tendon rehabilitation outcomes, including tissue quality and strength of repair. It is recommended that clinicians collaborate closely with the referring physician regarding integrity of repair and any changes to protocol. Post-operative considerations Post-operative considerations If you develop a fever, intense calf pain, excessive drainage from the incision, uncontrolled pain or any other symptoms you have concerns about you should call your doctor. PHASE I: IMMEDIATE POST-OP (0-14 DAYS AFTER SURGERY) Rehabilitation Goals • Protect repair • Minimize post-operative pain • Minimize post-operative edema • Prevent complications from prolonged immobilization • Prevent and recognize early signs of infection Precautions • Hinged knee brace should be locked in extension and worn at all times (ambulating, sleeping, standing, etc.) • No active knee extension • No passive knee flexion beyond 60 degrees- Do not push motion at this point Weight Bearing • Weight Bearing as tolerated with hinged knee brace locked in extension Intervention Swelling Management • Ice, compression, elevation • Retrograde massage • Ankle pumps Range of motion/Mobility • PROM • Heel slides with towel • Low intensity, long duration extension stretches: prone hang, heel prop • Seated hamstring/calf stretch • Gentle patellafemoral joint mobilization Strengthening • Calf raises • Quad sets • Glute set Massachusetts General Brigham Sports Medicine 2 Criteria to Progress • 2 weeks post-op • Knee extension to 0 deg PHASE II: INTERMEDIATE POST-OP (2-6 WEEKS AFTER SURGERY) Rehabilitation Goals • Continued minimization of post-operative pain/edema • Progress knee flexion PROM • Progress to full weight bearing status with use of locked brace • Initiate proximal/distal strengthening (hip, back, abdominals, ankle) Weight Bearing • Weight Bearing as tolerated with hinged knee brace locked in extension, should be full weight bearing by 6 weeks Precautions • Knee flexion PROM starts at 50 degrees week 2 o Light overpressure only for PROM • Progress 10 degrees/week until 90 degrees achieved o 60 degree maximum end of week 2 o 70 degree maximum end of week 3 o 80 degree maximum end of week 4 o 90 degree maximum end of week 5 • Hinged brace locked in extension for standing/walking/sleeping o Brace worn at night until week 6 unless otherwise specified by surgeon o Can unlock for sitting/laying (brace angle can be unlocked to available PROM, but not to exceed PROM progression noted above) • Assistive device for ambulation as needed Additional Intervention *Continue with Phase I interventions Range of motion/Mobility • Patellofemoral Joint Mobilization • Gradual flexion PROM with light overpressure per above • Extension PROM with overpressure as needed • Heel Slide • Sitting knee flexion to above ROM • Heel prop Cardio • Upper body ergometer Strengthening • Straight leg raise *without lag • Side lying hip abduction and adduction, prone leg extension • Standing hip abduction, adduction and extension • Glute bridge with legs straight elevated on a chair • Calf raise • Core strengthening: Plank as able without discomfort in knee, TA brace progression Balance/proprioception • Standing weight shifts Criteria to Progress • Full passive knee extension PROM • Passive knee flexion to 90 degrees • FWB in brace with no pain • Active knee extension to 0 degrees with quad set PHASE III: LATE POST-OP (6-15 WEEKS AFTER SURGERY) Rehabilitation Goals • Wean assistive devices if any are still used • Restore full A/PROM of knee flexion • Begin stationary bike when able • Initiate progressive quadriceps loading/resistance exercises • Restore static single leg balance • Continue to progress proximal/distal strengthening Massachusetts General Brigham Sports Medicine 3 Weight Bearing • Hinged brace unlocked for ambulation (0-60 degrees) provided patient demonstrates sufficient quad control during stance to prevent buckling o Use brace until week 8 unless otherwise specified by surgeon o Patient should demonstrate sufficient quad control, weight bearing tolerance and single limb stability prior to discharge of brace. Precautions • No weight bearing with flexion >90 deg until after 8 weeks • A/PROM should be cautioned not to progress faster than 10 degrees per week before 12 weeks post-op • Avoid aggressive quad stretching • No maximal voluntary contraction of the quadriceps until week 16 (No manual muscle test or handheld dynamometer testing). Additional Intervention *Continue with Phase I-II Interventions Range of motion/Mobility • Patellofemoral Joint Mobilization • Flexion PROM with overpressure • Heel Slide • Sitting knee flexion Cardio • Upper body ergometer • Stationary bicycle- Begin with partial rotations minimal resistance and gradually progress time and resistance once full motion is achieved. • Elliptical- may begin once active knee flexion motion reaches at least 120 degrees, able to perform 10 straight leg raises without lag, and gait is normalized without assistive device Strengthening *Progress strength gradually as appropriate avoiding anterior knee pain, many of the below exercises will not begin until 8-10 weeks or later • Gym equipment: leg press machine, seated hamstring curl machine and hamstring curl machine, hip abductor and adductor machine, hip extension machine, roman chair, seated calf machine Progress intensity (strength) and duration (endurance) of exercises as appropriate *The following exercises to focus on proper control with emphasis on good proximal stability • Squat to chair • Lateral lunges • Romanian deadlift (single and double leg) • Resisted triple extension in standing • Single leg progression: partial weight bearing single leg press, step ups and step ups with march, slide board lunges: retro and lateral, lateral step-ups, single leg squats, single leg wall slides, lateral step down o Knee Extension machine at 16 weeks: If quad strength continues to be significantly limited, limiting further progression, may begin using knee extension machine as long as there is no anterior knee discomfort or pain • Proximal Strengthening: Double leg bridge, bridge with feet on physioball, single leg bridge, lateral band walk, standing clamshell/fire hydrant, hamstring walkout, TA brace with UE and LE progression Balance/proprioception • Progress single limb balance including perturbation training Massachusetts General Brigham Sports Medicine 4 Criteria to Progress • Good recovery of quadriceps strength o Ability to perform 10 single leg squats to 60 degrees o Quad strength of at least 70% on handheld dynamometer: If following standard timeline, and timeline not delayed due to integrity of repair, can test quad strength at week 16 o Or 100% quad set compared to contralateral side (measured by sphygmomanometer in mmHg)1 • Knee flexion PROM to at least 120 degrees • Single leg stance to 30 seconds on involved side with no significant compensatory pattern • Symmetrical gait pattern without use of assistive device • Symmetrical stair negotiation without reliance on UE PHASE IV: TRANSITIONAL (4-6 MONTHS AFTER SURGERY) Rehabilitation Goals • Restore full ROM and muscle length of quadriceps • Restore quadriceps strength (quad index preferred) • Restore single leg dynamic balance/eccentric control (Y balance preferred) • Initiate return to jog/run protocol as tolerated • Restore proximal/distal strength to symmetry with contralateral side Precautions • Avoid pain more than delayed onset muscle soreness (DOMS) during or following exercise especially in the anterior knee/extensor mechanism Additional Interventions *Continue with Phase I-III interventions • Begin sub-max sport specific training in the sagittal plane • Bilateral PWB plyometrics progressed to FWB plyometrics Progress to plyometric and agility program (with functional brace if prescribed) • Agility and Plyometric Program Interval running program • Return to Running Program • Must have full ROM, resolved swelling, no pain with walking, at least 80% limb symmetry on handheld dynamometer, and ability to perform SL hop with good form prior to initiating jogging progression Criteria to Progress • Quad index of at least 90% (handheld dynamometry preferred, if not sphygmomanometer is acceptable, but consider referring to clinic with dynamometry available for testing) o Isokinetic dynamometry should be held until 6 months and reserved for cases where advanced return to sport/activity is needed • Symmetrical strength measures in hamstrings and hip (dynamometry preferred) • Y balance test within 90% of contralateral side • Symmetry in gait while jogging PHASE V: PROGRESISVE RETURN TO SPORT (6-8 MONTHS AFTER SURGERY) Rehabilitation Goals • Progress running/sprinting program • Improve multidirectional dynamic movements and control of acceleration/deceleration • Improve power in plyometrics and landing mechanics • Restore full quadriceps strength • Return to sport/competition with minimal risk of re-injury Additional Interventions *Continue with Phase II-IV interventions • Add sport specific exercises based on patient’s desired sport goals o If participating in a cutting/sprinting sport, increased focus on rapid acceleration/deceleration activities and change of direction drills gradually increasing demand and predictability of drill Criteria to Progress • Pass all criteria of the MGB Lower Extremity Return to Sport Functional Testing • Quad index of at least 90% (measured by dynamometry, isokinetic preferred) Revised 10/2021 Massachusetts General Brigham Sports Medicine 5 Contact Please email [email protected] with questions specific to this protocol References: Mondin D, Owen JA, Negro M, D’Antona G. Validity and Reliability of a Non-invasive Test to Assess Quadriceps and Hamstrings Strength in Athletes. Front Physiol. 2018;9:1702. doi:10.3389/fphys.2018.01702 Sinacore JA, Evans AM, Lynch BN, Joreitz RE, Irrgang JJ, Lynch AD. Diagnostic Accuracy of Handheld Dynamometry and 1-Repetition-Maximum Tests for Identifying Meaningful Quadriceps Strength Asymmetries. J Orthop Sports Phys Ther. 2017;47(2):97-107. doi:10.2519/jospt.2017.6651 Seo D, Kim E, Fahs CA, Rossow L, Young K, Fergu SL. Reliability of the one-repetition maximum test based on muscle group and gender. :5. Kongsgaard M, Reitelseder S, Pedersen TG, et al. Region specific patellar tendon hypertrophy in humans following resistance training. Acta Physiol. 2007;191(2):111-121. Couppé C, Kongsgaard M, Aagaard P, et al. Habitual loading results in tendon hypertrophy and increased stiffness of the human patellar tendon. J Appl Physiol. 2008;105(3):805-810. doi:10.1152/japplphysiol.90361.2008 Verdano MA, Zanelli M, Aliani D, Corsini T, Pellegrini A, Ceccarelli F. Quadriceps tendon tear rupture in healthy patients treated with patellar drilling holes: clinical and ultrasonographic analysis after 36 months of follow-up. :7. Bhargava SP, Hynes MC, Dowell JK. Traumatic patella tendon rupture: early mobilisation following surgical repair. Injury. 2004;35(1):76-79. doi:10.1016/S0020-1383(03)00069-X 13. Bushnell B, Tennant J, Rubright J, Creighton R. Repair of Patellar Tendon Rupture Using Suture Anchors. J Knee Surg. 2010;21(02):122-129. doi:10.1055/s0030-1247806 Mille F, Adam A, Aubry S, et al. Prospective multicentre study of the clinical and functional outcomes following quadriceps tendon repair with suture anchors. Eur J Orthop Surg Traumatol. 2016;26(1):85-92. doi:10.1007/s00590-015-1710-6 EL-Zahaar, MS. Spontaneous Rupture of the Quadriceps Tendon: Ten Case Reports and a Review of the Literature with a Hypothesis of a New Classification of Causes. J Nuerol Orthop Med Surg. 1995; 16: 132-136. Puranik GS, Faraj A. Outcome of quadriceps tendon repair. Acta Orthop Belg. 2006;72:3. Veselko M, Kastelec M. Inferior Patellar Pole Avulsion Fractures: Osteosynthesis Compared with Pole Resection. JBJS Essent Surg Tech. 2005;os87(1_suppl_1):113-121. doi:10.2106/JBJS.D.02631 El-Desouky I, Mohamed M, Al Assassi M. Primary Repair of Ruptured Patellar Tendon Augmented by Semitendinosus. J Knee Surg. 2013;27(03):207-214. doi:10.1055/s-0033-1360655 Reidler, J. S., Tanaka, M. J., & Cosgarea, A. J. (2018). Quadriceps tendon repair. In Operative Techniques: Knee Surgery: Second Edition (pp. 254-261). Elsevier Inc.. http://tieba.baidu.com/mo/q/checkurl?url=https%3A%2F%2Fdoi.org%2F10.1016%2FB978-0-323-46292-1.00027-7&urlrefer=9aade1f9f69c61b5f72c7fc030243dc4 Marder RA, Timmerman LA. Primary Repair of Patellar Tendon Rupture Without Augmentation. Am J Sports Med. 1999;27(3):304-307. doi:10.1177/03635465990270030601 Belhaj K, El Hyaoui H, Tahir A, et al. Long-term functional outcomes after primary surgical repair of acute and chronic patellar tendon rupture: Series of 25 patients. Ann Phys Rehabil Med. 2017;60(4):244-248. doi:10.1016/j.rehab.2016.10.003 Langenhan R, Baumann M, Ricart P, et al. Postoperative functional rehabilitation after repair of quadriceps tendon ruptures: a comparison of two different protocols. Knee Surg Sports Traumatol Arthrosc Off ESSKA. 2012;20(11):2275-2278. doi:10.1007/s00167-012-1887-8 Konrath GA, Chen D, Lock T, et al. Outcomes following repair of quadriceps tendon ruptures. J Orthop Trauma. 1998;12(4):273-279. doi:10.1097/00005131- 199805000-00010 Serino J, Mohamadi A, Orman S, et al. Comparison of adverse events and postoperative mobilization following knee extensor mechanism rupture repair: A systematic review and network meta-analysis. Injury. 2017;48(12):2793-2799. doi:10.1016/j.injury.2017.10.013 West JL, Keene JS, Kaplan LD. Early motion after quadriceps and patellar tendon repairs: outcomes with single-suture augmentation. Am J Sports Med. 2008;36(2):316-323. doi:10.1177/0363546507308192 ```

髌腱修复术后康复方案 # 髌腱修复术后康复方案以下为髌腱修复术后患者的康复方案。本方案的主要目标是在保护手术修复部位的同时，逐步恢复功能，最终达到术前活动水平。请注意，此方案仅为**指导性建议**。若患者同时接受其他手术（如副韧带修复、半月板修复等），康复进度可能有所不同。**应更重视各阶段的达标标准，而非时间表**。若患者在康复过程中出现疼痛或肿胀加重、关节活动度下降等情况，应立即减少活动量，待问题解决后再继续。 --- ## 术后第1–14天 - **伤口护理**： - 术后第1天（POD 1）：拆除部分敷料 - 术后第2天（POD 2）：更换敷料，保持伤口覆盖 - 术后第7–10天：拆除缝线，当关节积液消退后，停止使用抗血栓弹力袜（TED hose） - **支具使用**：共8周，**行走时锁定在伸直位** - **拐杖辅助**：部分负重（PWB） - **髌骨活动训练** - **小腿泵运动**（预防血栓） - **主动辅助活动度训练（AAROM）**：0–45°（被动伸直，主动屈曲，脚跟滑动） - **被动伸直训练**：足跟垫高仰卧或俯卧悬吊 - **电刺激治疗**：亚最大强度股四头肌等长收缩（用于肌肉再教育） - **股四头肌等长收缩（Quad sets）、股四头肌与腘绳肌共收缩** - **直腿抬高（SLR）**：站立位，4次/组（佩戴支具） - **轻柔腘绳肌拉伸** - **冰敷**：每次训练后，将冰袋置于膝关节完全伸直位 ### 目标 - 获得完全被动伸直 - 良好的股四头肌控制能力 - 疼痛与关节积液得到有效控制 --- ## 第2–4周 - **支具使用**：8周，行走时仍锁定在伸直位 - **拐杖辅助**：逐步过渡至**可耐受负重（WBAT）**，当步态正常后可停用拐杖 - 继续进行前期合适的训练 - **AAROM**：0–70°（被动伸直，主动屈曲） - **仰卧位直腿抬高（SLR）**：4次/组（佩戴支具） - **腘绳肌屈曲训练**：使用器械，0–45°，轻阻力 - **双侧脚跟抬起训练**（提踵） - **本体感觉训练**（佩戴支具）： - 在平行杠内单腿站立 - 双腿使用BAPS板进行重心转移训练 - **拉伸训练**：腘绳肌、髂胫束（ITB） ### 目标 - 关节活动度（ROM）：0–70° - 无伸膝滞后（无伸肌力量滞后） --- ## 第4–6周 - **支具使用**：8周，行走时锁定在 **0–30° 范围内** - 继续进行前期合适的训练 - **AAROM**：0–90°（被动伸直，主动屈曲） - **站立位直腿抬高（SLR）**：4次/组（佩戴支具），双侧使用弹力带（Theraband） - **腘绳肌屈曲训练**：使用器械，0–90°，轻阻力 - **前向、侧向、后向下台阶训练**（在平行杠内，佩戴支具，屈膝不超过45°） - 注意：使用小台阶，避免屈膝超过45° - **单腿脚跟抬起训练**（可在或不在支具中进行） - **椭圆机训练**（佩戴支具） ### 目标 - 步态正常 - 关节活动度（ROM）：0–90° --- ## 第6–8周 - **支具使用**：8周，逐步放开至可活动范围 - 继续进行前期合适的训练 - **AAROM / AROM**：全范围活动 - **无负重主动伸膝训练**（不佩戴支具） - **仰卧位直腿抬高（SLR）**：4次/组，膝下加轻重量（不佩戴支具） - **腿推举训练**：0–60°，轻阻力（不佩戴支具） - **迷你深蹲、靠墙深蹲**：0–60°（不佩戴支具） - **本体感觉训练**（佩戴支具）：单腿BAPS板、抛接球、Body Blade训练 - **固定自行车训练**（不佩戴支具）：逐步增加阻力和时间 - **跑步机训练**：向前及向后行走（佩戴支具） - **水中康复训练**：髋部主导的蛙泳踢腿（保持膝关节伸直） ### 目标 - 关节活动度（ROM）：0–110° --- ## 第8–12周 - **停止使用支具** - 继续前期合适的训练，以下训练均**不佩戴支具** - **被动活动度（PROM）、主动辅助活动度（AAROM）、主动活动度（AROM）**：争取恢复完全活动范围 - **短弧股四头肌训练**（Short Arc Quads） - **腘绳肌器械训练**：全范围，轻至中等阻力 - **腿推举训练**：0–90°，轻至中等阻力 - **髋部器械训练**：双侧，4组 - **健身球训练**（Fitter） - **滑板训练**（Slide Board） - **跑步机训练**：步行进阶计划 ### 目标 - 获得**完全关节活动度（Full ROM）** - 可以以 **15分钟/英里** 的速度步行 **2英里（约3.2公里）** --- ## 第3–4个月 - 继续进行前期合适的训练 - **膝关节伸展器械训练**：轻至中等阻力 - **功能性训练**：8字走、缓弯绕行、大Z字形移动 - **跑步机训练**：步行进阶计划 ### 目标 - 大腿围度与健侧相等 - 俯卧位腘绳肌柔韧性与健侧对称（脚跟贴近臀部） - 可轻松完成 **2英里跑步** --- ## 第4–6个月 - 继续进行前期合适的训练 - **敏捷性训练 / 增强式训练**（Plyometrics） - **仰卧起坐进阶训练** - **爬楼机训练**（Stairmaster） - **跑步进阶训练**，逐步过渡至跑道 - **过渡至家庭或健身房自主训练计划** ### 目标 - **恢复所有日常及运动活动** > ⚠️ **重要提示**：**术后6个月内禁止参与任何对抗性运动！** --- **修订日期：2019年4月** --- [原文](http://tieba.baidu.com/mo/q/checkurl?url=https%3A%2F%2Fwww.massgeneral.org%2Fassets%2Fmgh%2Fpdf%2Forthopaedics%2Fsports-medicine%2Fphysical-therapy%2Frehabilitation-protocol-for-patella-quad-tendon.pdf&urlrefer=ea54634d08fedef47a7e9abb3b4f3bc5) ```text Patella Tendon Repair Post-surgical Rehabilitation Protocol The following is a protocol for post-operative patients following patella tendon repair. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving pre-injury level of activity. Please note this protocol is a guideline. Patients with additional surgery (i.e. collateral ligament repair, meniscal repair) will progress at different rates. Achieving the criteria of each phase should be emphasized more than the approximate duration. If a patient should develop an increase in pain or swelling or decrease in motion at any time, activity should be decreased until problems are resolved. Post-op Days 1 – 14 • Dressing: - POD 1: Debulk dressing - POD 2: Change dressing, keep wound covered - POD 7-10: Sutures out, D/C TED hose when effusion resolved • Brace x 8 weeks – Locked in extension for ambulation. • Crutches – Partial weight bearing (PWB) • Patella mobilization • Calf pumping • AAROM 0-45 degrees (passive extension, active flexion, heel slides) • Passive extension with heel on bolster or prone hangs • Electrical stimulation – sub-maximal quad sets for muscle re-education • Quad sets, Co-contractions quads / hamstrings • Standing straight leg raise (SLR) x 4 (in brace) • Gentle hamstring stretch • Ice pack with knee in full extension after exercise Goals • Full passive extension • Good quad control • Pain / effusion controlled Weeks 2– 4 • Brace x8 weeks – Locked in extension for ambulation • Crutches – Weight bearing as tolerated (WBAT), D/C when gait is normal • Continue appropriate previous exercises • AAROM 0-70 degrees (passive extension, active flexion) • SLR x4 on mat (in brace) • Hamstring curls 0-45 degrees on weight machine with light resistance • Double leg heel raises • Proprioceptive training (in brace) - Single leg standing in parallel bars - Double leg BAPS for weight shift • Stretches – Hamstring , ITB Matthew D. Collard, D.O. Worker’s Compensation Arthroscopy/Sports Medicine Extremity Trauma Joint Replacement Surgery 2325 Dougherty Ferry Rd, Ste. 100 St. Louis, MO 63122 (314) 909-1359 Fax (314) 909-1370 http://tieba.baidu.com/mo/q/checkurl?url=http%3A%2F%2Fwww.stlorthospecialists.com&urlrefer=4075bdbfa2a5305656737f9322736504 2 Goals • ROM 0 – 70 degrees • No extensor lag Weeks 4 - 6 • Brace x 8 weeks – Locked at 0-30 degrees for ambulation • Continue appropriate previous exercises • AAROM 0-90 degrees (passive extension, active flexion) • Standing SLR x 4 (in brace) with Theraband bilaterally • Hamstring curls 0-90 degrees on weight machine with light resistance • Forward, lateral, and retro step downs in parallel bars (in brace 0-45 degrees) - No knee flexion past 45 degrees (small step) • Single leg heel raises (in or out of brace) • Elliptical trainer (in brace) Goals • Normal gait • ROM 0-90 degrees Weeks 6 - 8 • Brace x 8 weeks – Gradually open to available range • Continue appropriate previous exercises • AAROM, AROM through full range • Active knee extension without weight (no brace) • SLR x4 on mat with light weight below the knee (no brace) • Leg press 0-60 degrees – Light resistance (no brace) • Mini squats, wall squats 0-60 degrees (no brace) • Proprioceptive training (in brace) – Single leg BAPS, ball toss and body blade • Stationary bike (no brace) – Progressive resistance and time • Treadmill – Forwards and backwards walking (in brace) • Pool therapy (flutter kicks from hip with knee in extension Goal • ROM 0-110 degrees Weeks 8 - 12 • D/C brace • Continue appropriate previous exercises and following ex without brace • PROM, AAROM, AROM to regain full motion • Short arc quads • Hamstring curls on machine through full range – Light to moderate resistance • Leg Press 0-90 degrees – Light to moderate resistance • Hip weight machine x4 bilaterally • Fitter • Slide Board • Treadmill – Walking progression program Goals • Full ROM • Walk 2 miles at 15 min/mile pace 3 Months 3 – 4 • Continue appropriate previous exercises • Knee extension weight machine with light to moderate resistance • Functional activities – Figure 8’s, gentle loops, large zigzags • Treadmill – Walking progressive program Goals • Equal thigh girth • Equal quad flexibility in prone (heels to buttocks) • Run 2 miles at easy pace Months 4 – 6 • Continue appropriate previous exercises • Agility drills / Plyometrics • Sit-up progression • Stairmaster • Running progression to track • Transition to home / gym program Goal • Return to all activities *NO CONTACT SPORTS UNTIL 6 MONTHS POST-OP* Revised 4/2019 ```

成功培育了几个新品种，请大家点评

成功培育了几个新品种，请大家欣赏

月月粉的学名原来叫做 “浓香粉团蔷薇” 浓香粉团蔷薇 Rosa multiflora 'Strong Fragrance' 这个名字还挺不错的。

盆里长蘑菇(真菌)是否有利于月季生长？现在什么文字都会删啊，我怀疑试试现在发个帖子都要改n次才行，不知道哪里就会被过滤了

盆里长蘑菇是不是有利于月季的生长？现在什么文字都会删啊

盆里长蘑菇(真菌)是否有利于月季生长？看到有花友提到盆里长蘑菇后，月季长的快了。第一次听说，就在网上找了一下资料，大概根据我自己的理解翻译了一下，感兴趣的可以看看。 #真菌真菌是自然界中的主要分解者，有它们分解有机物，有机物才会被回收。很多地方提到真菌的分解有机物可以让土壤变肥沃。估计就是那些腐叶土的形成过程吧，把有机物分解成植物可以吸收的养分。 #蘑菇（mushroom）应该属于*真菌fungi*里面的*担子菌Basidiomycota*类的。露出地面伞状那个菇叫“子实体”，子实体是生殖器官，用来散播孢子繁殖用的，不是很懂这些，感觉作用有点类似 “花朵”之于植物。 #担子菌担子菌有30000种。很多种类可以分解木材和落叶，在自然界的碳循环中扮演着重要角色。对人类不好的地方是会破坏木房子结构等等。担子菌中的*共生菌Symbiotic Basidiomycota*（跟寄生类似吧）是重要的植物致病菌，比如*锈病菌 "rusts" (Uredinales)*和*黑粉菌"smuts" (Ustilaginales)*, 可以伤害小麦和其他作物。也有其他的共生担子菌会导致动物和人生病（脚癣那种就是真菌吧，但不知道是不是担子菌）。不是每种都会导致宿主严重伤害，担子菌中的*外生菌根菌 Ectomycorrhizal Basidiomycota*（有的菌根菌可以长在植物的体内根部里面，那叫内生吧）可以帮助宿主植物从土壤总吸收矿物质营养，作为回报它从植物的光合作用获取糖作为回报。也有的共生担子菌和昆虫一起共生的。 #菌根菌 Mycorrhizal fungi 专门生长于植物根部帮助植物吸收营养又从植物获取光合作用营养的真菌。 90%的植植物都有它的共生菌。共生菌利用地下的广大的菌丝网络和土壤大的接触面、把水和矿物质的从土壤导入植物，帮助植物吸收营养。作为回报植物会把光合作用的营养供应给菌根菌。 #有3种类型菌根菌: 1. 外生菌根菌有子囊菌类Ascomycota, 担子菌类Basidiomycota, 接合菌类Zygomycota三种 2. 内生菌根菌 endomycorrhizae，Glomeromycete fungi类的菌类直接把丛枝体插入植物根部细胞，作为菌类和宿主的共同新陈代谢的场所。 3. 兰科植物，兰科植物的种子很小不能存储多少养分，没有它的共生菌（通常是Basidiomycete担子菌）的帮助种子不会发芽。种子里面的养分消耗完了，共生的菌类会给种子提供碳水化合物和矿物质。有一些兰科植物一生都和它的共生菌共生。 #月季花的菌根菌搜索一下竟然奥斯汀有卖月季专用的菌根菌哦。 DAVID AUSTIN MYCORRHIZAL FUNGI http://tieba.baidu.com/mo/q/checkurl?url=https%3A%2F%2Fwww.davidaustinroses.co.uk%2Fdavid-austin-mycorrhizal-fungi&urlrefer=5d8e146a75454d0b7a3386e13b70b688 国内有人研究这个和月季的关系丛枝菌根真菌对月季扦插成活率及生长的影响 http://tieba.baidu.com/mo/q/checkurl?url=https%3A%2F%2Fwenku.baidu.com%2Fview%2F643491425f0e7cd18425367e.html&urlrefer=60ac844f5747b3dcf3626736ce735a4f #总结一下蘑菇或者说担子菌有的是植物的致病菌，有的是对植物有益的菌根菌。这个不知道谁能分别出哪种蘑菇是什么真菌，到底是有害还有有益的，反正我是不懂啦。谁要是能搞到好的月季花的菌根菌来试验一下就好了，不知道奥斯汀那个菌群怎么样

流花湖公园的绯扇开的超级大，在广州的朋友可以去看一下下午去看流花湖公园的月季园，开的很多。里面的绯扇和粉扇开的真是超级大，他说明说可以开到16cm到18cm，我用手机量了一下，确实有16+了。我看见过的最大的月季了，很多人都说这花好大，不知道人家怎么种植的。我自己也中了绯扇在花盆里面，开出来没法跟人家相比较。其他黄色品种有金凤凰，金徽章，黄色群开效果也很好看。剩下的法兰克福品种情侣之约，玫瑰岛好像不怎么样。树月和藤本效果也还没出来。关键时刻手机没电了，没拍到图片。

裸根苗怎么处理才能存活的比较久刚买了几株月季，想过年带回家里种。有大游行。没想到是这种大株，然后看上去没有什么根的那种，根部很少，只带了一点点土，然后整个用塑料薄膜缠起来。这种看上去比较难以成活啊，带土的小苗更好吧！还要5，6天才能回家过节，现在这个苗怎么处理好？要不要把塑料解开，不停喷水？还是搞个花盆暂时种下去，还是插水里？还是放着就可以了？怎么样处理能存活久一点，大家帮忙给点意见，我没什么经验

人好少啊！谁手上有最新的源码的 nimmd，这中网站也被墙了啊

编辑器bug 复制很多文字到空间编辑器的时，第一次总是只能显示少数字数，第二次粘帖才鞥显示正常。 chrome 浏览器。另外你们客服链接放到空间页面底下。但一拖下来，想点的时候，就自动加载新的内容，这很难点的到啊

在这种情况下怎么找回密码密码丢了的话，可以通过密码保护找回来。他是把密码发到注册时添的邮箱里的。可以如果这个邮箱由于某种原因也用不了，那就找不回来密码了。建议做成QQ的一样，可以根据正确的密码保护＋邮箱，改掉原来的登记时填的邮箱。或者直接就可以根据密码保护资料，就可以更改密码了，不需要到邮箱里去点链接，直接在网页上就能改。