Ponseti njira clubfoot

The njira Ponseti, amene ntchito pa matenda a ana obadwa nawo clubfoot wamng'ono, lero chimatengedwa ngati zothandiza kwambiri ndi wofatsa thanzi mwana. Mu dziko imene analandira monga "golide muyezo" mankhwala a clubfoot.

Tanthauzo la clubfoot kobadwa nako

Kobadwa nako clubfoot - zovuta matenda kapangidwe ndi ntchito ya phazi ndi mwendo m'munsi. Kuphwanya alipo osati mafupa, mafupa ndi minofu, komanso tendons ndi, molekezera mitsempha ndi mitsempha ya magazi.

Malinga ndi kafukufuku, clubfoot opezeka mu 5% a ana akhanda. Clubfoot aumbike mwa Milungu yoyambirira ya mimba, chifukwa mulibe atsimikiza. Malinga ndi ena mfundo, zimachitika chifukwa cha chibadwa zoipa, T. Kwa. Pamaso pa matenda choncho kholo limodzi Mwina wa matenda ndi chinawonjezeka ndi 4%.

Kobadwa nako Clubfoot ndi one- kapena awiri amaganiza, ndipo ambiri mwa anyamata. matenda ndi kukula pathological wa zimakhala connective, chifukwa cha zomwe zikuchitika ndi mabasi mapindikidwe. Mu minofu imeneyi adzafupikitsidwa kukhala pafupi ndi okutira mkati kumbuyo ndi pamwamba mkati phazi. The mwana yekha sadzakhoza kuika phazi mu udindo yachibadwa.

Standard njira amachitira clubfoot

Kale, patsogolo njira ndi anayamba kugwiritsa ntchito Ponseti, chilema kudzudzulidwa anapanga kudzera mwa pulasitala bandeji amakonza ndipo kenako opaleshoni anali wapansi, pa zimene elongation ndi crosslinking tendons angapo minofu, Mitsemphayi mapazi intersect olowa wasokoneza. Panali milandu kuja zokhudza mafupa phazi pa ntchito.

The njira mwachizolowezi wa clubfoot ikukhudza zotsatirazi:

• Chithandizo imayamba ndi mwana 1-sabata zakubadwa;
• zofikisa poyamba kuchitikira (masabata 1-2);
• alternating amatulutsa ndi ntchito paraffin, zomwe zimachititsa kuti kutalika kwa nthawi, kwa miyezi ingapo zaka 2, malingana ndi kuopsa kwa matenda;
• kuponyera yomaliza ya miyezi 5;
• pa mogwira otsika mankhwala pa zaka 2 mwana akale kuchita opaleshoni (Z woboola pakati pulasitiki Achilles tendon).

Powerengera, njira muyezo wa dzuwa mankhwala 58%.

Kodi njira ya Ponseti

Ignacio Ponseti - yotamandika kwambiri American mafupa dokotala, zomwe zakonzedwa 1950-60 chithandizo watsopano clubfoot. Bukuli lili ndi kuphunzira zambiri phazi dongosolo mwanayo ndi kusintha kwake pathological. Mosiyana ndi mankhwala chikhalidwe, njira imeneyi zimathandiza inu kuti kukonza m'malo mofulumira: miyezi 1,5-2 zapatsidwa kwa uphunguwo zonse, koma nkhani za chiyambi yake ya gypsum.

Ponseti njira amalola kukonza deformities phazi ndiwofatsa njira, kupewa amamuyambitsa timabala kwa malo, zimathandiza kusunga mphamvu injini ya phazi ndi minofu.

The chikhalidwe zofunika kwambiri Mwachangu mkulu wa njira imeneyi - ndi matenda oyambirira a matenda (sabata loyamba la moyo), mpaka mafupa mwanayo ndi minofu ndi elasticity mkulu. Chithandizo ayenera kuyamba pa zaka masabata 1-2 moyo mwana, onetsetsani kuyamba kuyenda.

Ngati mapindikidwe ndi wapezeka kenako, chithandizo ndi Ponseti n'zothekanso Komabe, ndi nthawi chilema kudzudzulidwa ndi zambiri kwambiri ndiponso chokhalitsa.

Masitepe a mankhwala ndi njira Ponseti

Chithandizo cha clubfoot Ponseti njira tichipeza magawo angapo a mankhwala:

1. mapindikidwe kudzudzulidwa ntchito pulasitala chitaya, zomwe ziyenera kusintha masiku 6-7. Mwendo wa mwana kwathunthu gypsum ku zala za ntchafu chapamwamba. Aliyense chigamba ali pamalo ena, wakupatsani kusintha mawonekedwe a phazi ndipo ngakhale mafupa. Zonse zofunika kuchita 4-7 njira gypsum miyendo, koma chiwerengero chawo zimatengera mwachindunji pa mlingo wa kukula kwa matendawa ndi m'badwo wa mwanayo.
2. Siteji yotsatira - achillotomy, ie, kutalikitsa ndi Achilles tendon, amene nthawi zonse pa clubfoot adzafupikitsidwa ... Nthawi zambiri anachita opareshoni pafupi pansi mankhwala oletsa ululu pamalopo (ana mpaka zaka 2). Pambuyo pa opaleshoni, kupanga gypsum kwa masabata 3 kukonza chifukwa.
3. Zofunika gawo lotsiriza - kugwiritsa ntchito kulimba ongokhala nsapato awiri yakwera wapadera kutsetsereka mbale.

Zimatsimikizira ntchito yapamwamba ndi kuchira ku matenda zofunika kwambiri ndi mkulu chiyeneretso cha dokotala kuchita ndondomeko.

njira kupaka pulasitala

Gypsum ndi Ponseti njira Imachitika mlungu uliwonse, ndipo pali Kupha mitundu ina ya mapindikidwe phazi panthawi iliyonse ntchito motsatizana gypsum. Pamene overlaying bandeji mtsikana dokotala amene bwino agwirizane phazi, ndi wothandizira yomweyo amachita gypsum.

Imposition wa gypsum ndi mu mawonekedwe a Nsapato kutalika lonse la mwendo, kusiya ufulu okha phalanx chala pa mwendo kulamulira mwa kundipatsako kwa mitsempha ndi kuwaletsa kinked gypsum.

Pali malamulo kuvomerezedwa kuti ayenera kutsata mosamalitsa kupewa mankhwalawa:

• choyamba yoyendetsa gypsum limabwezeretsa mbali phazi ndi kasinthasintha wake mkati gawo kutsogolo (cavus);
• pamene kupaka pulasitala bondo anakonza malo wopindidwa, umene kuteteza bandeji ndi kuchepetsa kupewa akusisita khungu yowawitsa ya mwanayo;
• pamene phazi lililonse achire ndondomeko ngodya ayenera kukhala osachepera madigiri 15;
• pamene kusintha siteji pulasitala ayenera kukhala mu ufulu udindo 1 chasa;
• 2-4 mankhwala umalimbana kukonza kuchimwa m'kati zala (varus chilema) ndi kuchotsa plantar kupinda;
• Gawo 5 - amalola kusintha Anabweza cha chidendene cha talus, adokotala akupanga fixation phazi mu malo yachibadwa ntchito splints (kupatulapo pa khola mu bondo chifukwa cha tendons adzafupikitsidwa).

chiwerengero cha njira sayenera kuposa 6. The ndondomeko ya chiwembu ndi kukonza gypsum, zomwe ndi zochokera njira Ponseti, chithunzi limasonyeza zokongola.

Ngati dotolo amachita njira zambiri, ndiye lidzachitiridwa osati pa njira American, ndipo zikhoza kukhala zoipa. Mu masiteji wotsatira ndi achillotomy ndi masankhidwe kulimba.

achillotomy

Chithandizo ndi Ponseti njira kumatanthauza zina, pamaso 4 kapena 5 siteji gypsum atagwira Achilles tenotomy, limene:

• chimalumikiza ndi calcaneal tendon (percutaneous ntchito);
• waya posungira mathero kuonongeka Mitsemphayi;
• opaleshoni chikuchitika padziko mankhwala oletsa ululu pamalopo;
• kumapeto kwa opaleshoni unapangidwa gypsum lotsatira masabata 3.

ntchito Izi ndi zosiyana kwambiri ndi phukusi muyezo opaleshoni yomwe imachitika pa njira muyezo uphungu. Pa ake a mwanayo si ambiri ochititsa dzanzi kenako yatsala chipsera chachikulu chomwe pambuyo zambiri zimasokoneza sayenda phazi la wodwalayo.

Ntchito kulimba kwa

Ponseti njira kumafuna monga chomaliza atavala kulimba, nsapato zapadera, lomwe mukhoza kukonza ndi bulaketi mu malo malo mapazi ndi miyendo kupewa adzabwerenso clubfoot. Nsapato amasankhidwa ndi analamula pasadakhale.

Kuvala kulimba ayenera kukhala pafupifupi usana ndi usiku kwa miyezi itatu kuwombera yekha pa akusamba kapena kuvala.

Zitatero, iwo ayenera ankavala yekha akagona (usana ndi usiku) - nthawi kuchira kumatenga zaka 2-4 pofuna kupewa kumwa.

zofooka

Feedback kwa makolo amene agwiritsapo ntchito pa matenda a clubfoot mwana Ponseti njira, kuipa ali motere:

• kukwera mtengo kwa nsapato zapadera (kulimba), omwe kawirikawiri anagula kwa opanga ku Germany kapena United States;
• nthawi ya kubala kwake kumayiko ena,
• ndi fragility wachibale wa kukonza.

M'zaka zaposachedwapa, kampani "Tengelelani" anayamba kubala Anzawo zoweta, ndi pa kugula kulimba ndi kugulira iwo mwa thumba inshuwalansi chikhalidwe.

Ubwino wa njira

Mwachangu mkulu wa njira clubfoot kudzudzulidwa zinali zotsatira za zaka 50 kafukufuku malo apadera Dr. Ponseti (Iowa University State, USA), komanso njira ya wayesedwa mabungwe ambiri zachipatala dziko.

Njira zina zonse, amene ankachita kobadwa nako clubfoot Ponseti njira Choncho zochepa zoopsa, otetezeka ndi sikudalira kuopsa kwa mavuto a chiyambi. atavala osewera ndi zochepa kwambiri kusiyana ndi njira zina. The mphamvu kukonza chilema ndi 95% ya milandu.

Pamene bwino imachitika chithandizo cha deformations aliyense mobwerezabwereza mwana Sadzathandiza: iye kuvala nsapato wamba, palibe contraindications kuti masewera ndi zinthu zakuthupi.

Ponseti Njira: Ndemanga

Kuweruza ndi ndemanga za makolo amene anachitira ndi ana kuchokera kobadwa nako clubfoot American njira, tingati ndi pafupifupi zonse zabwino. Changu Special anasonyeza amayi amene anayesa kuchitira ana oyamba mu njira muyezo (kutikita + gypsum), mpamene ena odwala pafupifupi anakhala wolumala. Ponena kenako malo zachipatala kwa madokotala amene mwaukadaulo ntchito njira Ponseti wa clubfoot chithandizo, makolo anatha kuchiza mapazi kwa ana anu mokwanira.