手杖、拐杖和助行器：哪一侧、哪条腿、哪一步

🧠 为什么重要

手杖要握在强侧，将手杖和弱侧腿一起移动，然后移动强侧腿；手柄应到达腕横纹处，肘部微微弯曲。拐杖的垫应位于腋下2到3指宽处，重量由双手承担，绝不能由腋窝承担，以防止臂丛神经损伤。常见步态包括四点步态（双腿都能负重，最稳定）、三点步态（一条腿不能负重：两根拐杖和患侧腿一起移动）、二点步态和摆过步态。使用拐杖或手杖上下楼梯时，上楼时强侧腿先上，拐杖随后带着弱侧腿跟上；下楼时拐杖和弱侧腿先下。助行器要向前抬起或滚动约6到8 inches，然后迈弱侧腿，再迈强侧腿；肘部弯曲约15到30度。对于所有器具，早期训练时都要穿防滑鞋、保持地面无障碍物，并使用步态带。

CANE: hold it on the STRONG side, move the cane and the WEAK leg together, then the strong leg; the handle should reach the wrist crease with the elbow slightly bent. CRUTCHES: the pads sit 2 to 3 finger widths below the axilla and the weight is borne on the HANDS, never the armpits, to prevent brachial plexus injury. Common gaits: four-point (both legs bear weight, most stable), three-point (one leg cannot bear weight: both crutches and the affected leg move together), two-point, and swing-through. STAIRS with crutches or a cane: going UP, the strong leg goes first and the crutches follow with the weak leg; going DOWN, the crutches and weak leg go first. WALKER: lift or roll it forward about 6 to 8 inches, then step the weak leg, then the strong leg; elbows bent about 15 to 30 degrees. For all devices, non-skid shoes, clear floors and a gait belt during early training.

🏥 真实场景

🪜 一名左踝骨折的患者正在学习用拐杖上下楼梯。上楼：右（强侧）腿先上，然后是拐杖和左腿。下楼：拐杖和左腿先下，然后是右腿。他还抱怨走了一段长路后手指刺痛；护士发现拐杖太高，患者正靠在垫子上。调整两inches就能防止神经损伤。

🪜 A client with a fractured left ankle is learning stairs with crutches. Up: right (strong) leg first, then crutches and left leg. Down: crutches and left leg first, then right leg. He also complains of tingling fingers after a long walk; the nurse finds the crutches too tall and the client leaning on the pads. Two inches of adjustment prevents a nerve injury.

📌 要点总结

• 手杖：放在强侧，与弱侧腿一起移动Cane: strong side, moves with the weak leg
• 拐杖：位于腋下两到三指宽处；重量由双手承担Crutches: two to three finger widths below the axilla; weight on the hands
• Up with the good, down with the bad（上楼用好腿，下楼用坏腿）Up with the good, down with the bad

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