Ponseti nzira clubfoot

The Ponseti nzira, iyo inoshandiswa pakurapa vachiberekwa clubfoot vana vaduku, nhasi azivikanwa inonyatsobudirira uye munyoro kuti utano vomwana. Munyika chipo chinogamuchirwa se "ndarama mureza" Mabatirwo clubfoot.

Definition of vachiberekwa clubfoot

Vachiberekwa clubfoot - kunzwisisa kukanganisika marongerwo uye kushanda rutsoka uchingodzikira gumbo. Kutyorwa varipo kwete mapfupa, mapfundo tsandanyama, asiwo nemarunda, tsinga harinzwi nemidziyo ropa.

Maererano nenhamba, clubfoot inowanikwa 5% kwevana vacheche. Clubfoot achiumbwa kutanga vhiki pamuviri, chikonzero haisati kutsunga. Maererano nedzimwe zvekungofungira, zvinoitika nemhaka yedzinza zvakaipa, t. To. In paine chirwere chakadaro mumwe mubereki mukana zvirwere iri yakawedzera 4%.

Vachiberekwa Clubfoot ari one- kana maviri-madziro, uye zvakawanda nevakawanda vakomana. The chirwere ndiye pathological kuwedzera connective nyama, nokuti chii chiri kuitika uye kudzivirira deformation. In ichi Wakafupisa tsandanyama kuva pedyo uye wrapping mukati neshure uye yomukati pechiso rutsoka. Mwana woga havazombokwanisi kuisa rutsoka mugomba hwandaiva chinzvimbo.

Standard nzira kurapa clubfoot

Kare, pamberi nzira iri kushandisa Ponseti, wakarebesa kururamiswa chakaitwa pachishandiswa nesuko bhandiji kwokururamisa uye zvadaro nokushanda akanga akatakurwa ari netsoka, uko elongation uye crosslinking akawanda tsandanyama nemarunda, nemarunda tsoka piringisha vagari kutambwa. Paiva kakawanda zviitiko kukanganisa uye mapfupa ari rutsoka panguva oparesheni.

Zvatinosiita nzira clubfoot hunosanganisira anotevera:

• Treatment chinotanga mwana 1-vhiki-kare;
• pakutanga vakaperekedza kukwizwa (1-2 masvondo);
• rakatumbuka Unobudisa uye Paraffin mafomu, izvo zvinoita kuti kureba kwazvo nguva, kubva mwedzi mishoma kuti 2 years, zvichienderana kwokuomerwa hosha;
• yokupedzisira kukanda nguva 5 months;
• yakaderera kubudirira kurapwa pazera 2 years mwana akwegura kuita kuvhiya (Z-zvakaumbwa mapurasitiki achilles mudzira).

Statistically, mureza nzira kurapa kunyatsoshanda ndiyo 58%.

Chii Nzira pamusoro Ponseti

Ignacio Ponseti - chinoshamisa American Wemabhonzo, yakatanga muna 1950-60 kurapa itsva clubfoot. It chakavakirwa hwakadzama kudzidza mwana rutsoka marongerwo wayo Kumwe kuchinja kunotanga. Kusiyana Marapiro, nzira iyi kunoita kuti uite kururamiswa asi nokukurumidza: 1,5-2 mwedzi anopiwa zvizere kururamiswa, asi pasi nenguva kutanga gypsum.

Ponseti nzira kunoita kugadzirisa rutsoka deformities kuchinja nenzira, tichidzivisa scarring kuti majoini, zvinobatsira kuchengeta injini nezvaanogona norutsoka uye tsandanyama.

Chinonyanya kukosha ezvinhu vapamatunhu kunyatsoshanda kuti nzira iyi - tanga chirwere chirwere (vhiki yokutanga muupenyu), kusvikira mwana wacho mapfundo tsandanyama vane mukuru elasticity. Kurapwa kunofanira kutanga pazera vhiki 1-2 upenyu mwana, iva nechokwadi kuti ufambe.

Kana deformation iri dzakaonekwa Papera, kurapa nokuda Ponseti Zvinogonekawo Zvisinei, pakazosvika nguva urema kururamiswa zvichava zvikuru husingagumi.

Nhambwe kurapwa pachishandiswa nzira Ponseti

Mabatirwo clubfoot Ponseti nzira inoumbwa anoverengeka zvokukura kurapwa:

1. deformation kururamiswa kushandisa varinamire anodyara, izvo zvinofanira kushandurwa ose 6-7 mazuva. Cherwendo mwana zvakazara gypsum kubva zvigunwe kusvika muchiuno. Mumwe chigamba iri imwe nzvimbo, vachibvumira kuti kuchinja chimiro tsoka uye kunyange mapfupa. All zvakakodzera kuti tiite 4-7 ezvinhu gypsum makumbo, asi nhamba yavo kunobva zvakananga pamusoro mwero kwokuomerwa chirwere uye makore mwana.
2. Akatevera Danho - achillotomy, kureva, nezvishoma pamusoro achilles mudzira, iyo iri clubfoot mupfupi nguva dzose ... Most kunowanzoitwa pedyo kushanda pasi zvomunharaunda yokutindivadza (vana anosvika 2 years). Pashure pokuvhiyiwa, kuti gypsum kuti 3 kwemavhiki kugadzirisa mugumisiro.
3. Wokupedzisira inokosha Danho - kushandiswa chibooreso zvinosanganisira shangu mbiri akatasva zvishoma nezvishoma mumatope ndiro chairo.

Kuti pave matunhu kuita uye kupora kubva chirwere zvikuru yakakwirira zvinodiwa ari chiremba kuita muitiro.

plastering chidobi

Gypsum kubudikidza Ponseti nzira inoitwa vhiki nevhiki, uye pane kubviswa mamwe deformation norutsoka panguva nomumwe anotevedzana chaikwo gypsum. Kana nemisoro bhandiji zvaisanganisira chiremba vanonyatsotarisira swatanudza tsoka, uye mutevedzeri pakarepo anoita gypsum.

Nokuiswa gypsum iri muchimiro shangu pane yose kureba gumbo, vachisiya vakasununguka chete phalanx minwe negumbo rake kudzora nerubatsiro tsinga uye kwakavatadzisa kinked gypsum.

Pane mitemo fanira kuti inofanira kutevedzerwa zvakasimba kusaita zvikanganiso pakurapa:

• kutanga actuating gypsum anodzosa pakona norutsoka wayo kutenderera ari womukati mugove pamberi (cavus);
• kana plastering ibvi yakatarwa ari hwakakungwa chinzvimbo, izvo zvichaita kuti mucheka nemichina kudzivisa vachidzipukuta akatunhidzwa paganda mwana;
• kana mumwe rutsoka kushaya nzira angled zvishoma pane madhigirii 15;
• kana kuchinja chemabhazi varinamire haafaniri kuva munhu akasununguka panzvimbo 1 chasa;
• 2-4 kurapwa zvainanga kururamisa Kutsauka nechomukati minwe (varus wakarebesa) uye kubviswa plantar vachikotama;
• Step 5 - anobvumira kuchinja yokururamisa pakati chitsitsinho talus, chiremba anoita Kuda kutamba norutsoka mune kuipa nzvimbo uchishandisa splints (kunze pamusoro-boka iri neketani nokuda Wakafupisa nemarunda).

Kuwanda maitirwo anofanira kuva kupfuura 6. kutevedzana kwezviitiko Zano uye kwokururamisa gypsum, iyo inotorwa Ponseti nzira, mufananidzo rinoratidza anonyatsotsanangura.

Kana chiremba anoita zvakawanda dzokuvhiya, ipapo zvichava kubatwa kwete American nzira, uye anogona kukuvadza. In tevera matanho ari achillotomy uye kusarudzwa chibooreso.

achillotomy

Treatment kubudikidza Ponseti nzira kunosanganisira, mune zvimwe zviitiko, asati 4 kana 5 Danho gypsum vakabata achilles tenotomy, umo:

• ari dzokubatanidza ari calcaneal mudzira (percutaneous oparesheni);
• waya chengetedzo harinzwi wakaremara nemarunda;
• Kuvhiya zvinoitwa pasi zvomunharaunda yokutindivadza;
• pakuguma hwokushanda chakagadzirwa gypsum inotevera 3 mavhiki.

oparesheni Izvi rakasiyana mureza kuvhiya kupindira, iyo yakaitirwa mureza kururamiswa nzira. Munguva yake mwana haasi vakawanda yokutindivadza uye pashure akasiiwa vanga guru, iyo gare gare kazhinji ichikutadzisa ari kufamba murwere rutsoka.

Kushandiswa chibooreso

Ponseti nzira kunosanganisira sezvo kwokupedzisira pavaipfuura akapfeka chibooreso, anokosha shangu, izvo unogona kugadzirisa aine chikomboredzo kupinda nzvimbo nzvimbo tsoka uye makumbo kudzivisa kudzoka clubfoot. Shoes vakasarudzwa uye akarayira pachine.

Apfeke chibooreso chinofanira anenge kumativi wachi kwemwedzi mitatu kupfura chete panguva yokugeza kana kupfeka.

Zvadaro, vanofanira zvaipfekwa chete pakurara (masikati nousiku) - yavaipora nguva inogara kwemakore 2-4 kuti vadzivise wava kusvutazve.

Nokuremara

Feedback kubva vabereki vakashandisa pakurapa clubfoot mwana Ponseti nzira, payakaipira ndeinotevera:

• Kurasikirwa anokosha shangu (chibooreso), izvo kazhinji akatengwa kubva vagadziri muGermany kana United States;
• nguva makurukuriro yayo dzimwe nyika,
• ari hama fragility yechivako chacho.

Mumakore achangopfuura, kambani "Bear" vakatanga kubudisa mumhuri dzomuzana, uye zvokuvakisa pamusoro chibooreso zvinogoneka kutenga kwavari kuburikidza evanhu inishuwarenzi Fund.

zvakanakira nzira

Yakakwirira kunyatsoshanda pamusoro nzira clubfoot kururamiswa kwakaratidza migumisiro makore 50 kutsvakurudza mune kushandiswa nechepakati Dr. Ponseti (Iowa State University, USA), uyewo nzira akaedzwa muzvinhu zvakawanda zvokurapa masangano munyika.

Nevamwe nzira, zvose izvo ikarapwa vachiberekwa clubfoot Ponseti nzira Saka zvishoma zvinorwadza, wakachengeteka uye hakubvi pasi kwokuomerwa pamusoro tisawirirane akabva. apo akapfeka chakakandirwa iri shoma zvikuru pane vamwe nzira. Kubudirira pakugadzirisa wakarebesa ndiyo 95% nyaya.

Kana zvakanaka inoitwa kurapwa chero kudzokororwa deformations mwana haangavi iye anogona kupfeka vanhuwo shangu, hapana contraindications kuti zvemitambo uye mumuviri mabasa.

Ponseti Method: wongororo

Kutonga nezvinooneka wongororo vabereki vakanga akaitira vana kubva vachiberekwa clubfoot American nzira, mugumisiro uri anenge zvose zvakanaka. Special kufarira akaratidza Amai vaiedza kutanga kubata vana mureza nzira (masaja + gypsum), pashure izvo vamwe varwere vanenge vakava vakaremara. Achitaura kwapera zvokurapa nzvimbo kune vanachiremba vakanga nenyanzvi kushandisa Ponseti nzira clubfoot kurapwa, vabereki vaikwanisa kurapa tsoka vana vako kwazvo.