Ponseti indlela kokukhubazeka

I Ponseti indlela, okuyinto esetshenziswa ekwelashweni kwe-azalwa naso kokukhubazeka izingane ezincane, namuhla neyaziwayo njengoba esebenza kahle kakhulu mnene impilo kwengane. Ezweni kwamukeleka njengoba "izinga legolide" ekwelapheni kokukhubazeka.

Definition of kokukhubazeka azalwa naso

kokukhubazeka azalwa naso - disorder eyinkimbinkimbi isakhiwo kanye umsebenzi unyawo nomlenze aphansi. Ukwephulwa abakhona hhayi kuphela amathambo, amalunga nemisipha, kodwa futhi imisipha, kwalapho kuhlangana khona imizwa nemithambo yegazi.

Ngokwezibalo, kokukhubazeka itholakala 5% izinsana. kwakhiwa kokukhubazeka is emavikini okuqala okukhulelwa, isizathu esiye kunqunywa. Ngokwezazi ezithile ezicatshangwayo, kuyenzeka ngenxa ufuzo ezimbi, t. Ukuze. Phambi leso sifo kwelinye umzali ematfuba isifo luyanda 4%.

Kokukhubazeka azalwa naso kuba ngomhlangano noma amabili emaceleni, futhi Kwande ebafaneni yini ukwedlula. Lesi sifo ukukhula sokugembula kwezicubu zezinzwa, ngenxa okwenzekayo futhi eyeka ukusonteka. Kulesi imisipha mfushane kusisondeza futhi Ukugoqa ngaphakathi langemuva kanye ebusweni engaphakathi unyawo. Ingane wedwa abasoze bakwazi ukubeka unyawo sesimweni esivamile.

izindlela Standard kokuphatha kokukhubazeka

Ngaphambili, phambi Indlela ukuqalisa usebenzisa Ponseti, deformity ukulungiswa wenza esebenzisa usimende ngebhandeshi zokulungisa bese ukusebenza wenziwa unyawo, lapho ukunwebeka futhi crosslinking imisipha eziningana imisipha, nemisipha izinyawo aphambana joint kuphazanyiswe. Kwakukhona kaningi ezithinta namathambo onyaweni ngesikhathi ukusebenza.

Indlela evamile kokukhubazeka kuhilela izinyathelo ezilandelayo:

• Ukwelashwa iqala ingane isonto 1 ubudala;
• ukubhucungwa okokuqala olwenziwa (amasonto 1-2);
• kushintshana ukhonkolo kanye nezicelo upharafini, okwenza ngobude okukhulu kwesikhathi, kusuka ezinyangeni ezimbalwa iminyaka engu-2, kuncike ngobucayi isifo;
• ukulahlwa kokugcina kwenkathi izinyanga 5;
• ngesikhathi ukusebenza ongaphakeme yokwelashwa eneminyaka engu-iminyaka engu-2 ingane endala ukwenza ukuhlinzwa (Z emise plastic Achilles umsipha).

Wezibalo, indlela ejwayelekile yokwelashwa kahle kuyinto 58%.

Iyini inqubo Ponseti

Ignacio Ponseti - ovelele American udokotela ohlinzayo olungisa amathambo, ithuthukiswe 1950-60 ukwelashwa entsha ngoba kokukhubazeka. Kusekelwe ukutadishwa onyawo isakhiwo wengane futhi izinguquko zalo sokugembula. Ngokungafani imithi yesintu, le ndlela ikuvumela ukuba wenze ukulungiswa kunalokho ngokushesha: izinyanga 1,5-2 kunikezwa ukulungiswa egcwele, kodwa kuncike kuqale ngesikhathi esifanele Gypsum.

Ponseti ndlela ivumela ukulungisa unyawo sengozini ngendlela ngoludala, ukugwema nezibazi ukuba emalungeni, kuyasiza ukuqhubeka motor amakhono ezinyaweni imisipha.

Isimo esibaluleke kakhulu ukuze kahle eliphezulu le ndlela - i ekuhlonzweni lesi sifo (ngesonto lokuqala ekuphileni), kuze amalunga omzimba wengane nemisipha abe kuyaqina okusezingeni eliphezulu. Ukwelashwa kufanele aqale lapho eneminyaka engu-1-2 emasontweni zokuphila umntwana, qiniseka ukuqala ukuhamba.

Uma ukusonteka itholwa kamuva, lokwelashwa Ponseti zingenza, Nokho, ngesikhathi kulungiswa isici kuyoba sikhuthazela okuningi.

Izinyathelo yokwelashwa-indlela Ponseti

Ukwelashwa nokuvikelwa kokukhubazeka Ponseti indlela unezigaba eziningana ekwelashweni:

1. ukusonteka ukulungiswa usebenzisa usimende ukhonkolo, okuyinto ishintshwa njalo ezinsukwini ezingu-6-7. Umlenze wengane Gypsum ngokugcwele nezinzwane kwethanga engenhla. Isiyingi ngasinye kuba endaweni ethile, ukuvumela ukuba ulungise ukuma ngezinyawo ngisho amathambo. Zonke idingekile ukuze 4-7 izinqubo Gypsum imilenze, kodwa inani labo ngezinga of kobukhulu isifo futhi iminyaka yobudala abantu ingane kuncike ngokuqondile.
2. Esigabeni esilandelayo - achillotomy, ie ayewukela we Achilles umsipha, okuyinto njalo ngesikhathi kokukhubazeka efinyeziwe ... Ngokuvamile kwenziwa operation vala ngaphansi izinzwa wendawo (izingane kuze iminyaka 2). Ngemva kokuhlinzwa, wenze Gypsum amasonto 3 ukulungisa yi.
3. I last yisigaba esibaluleke - ukusetshenziswa umkaki ehlanganisa izicathulo ezimbili ogibele ipuleti ekhethekile beya.

Ukuze kuqinisekwe ukusebenza ephakeme yokutakula kusukela isifo kakhulu iyona ziqu eliphezulu udokotela kokwenza inqubo.

abaluphahleka amasu

Gypsum ngu Ponseti indlela olwenziwa masonto onke, futhi kukhona ukuqedwa kohlobo oluthile ukusonteka senyawo ngesikhathi ngasinye isicelo ezilandelanayo Gypsum. Lapho nekwendlala ngebhandeshi udokotela bazibandakanye ngubani kahle lungise ngezinyawo, kanye nomsizi ngokushesha wenza Gypsum.

Ukunqunywa Gypsum kuyinto ngesimo ebhuthini ku ubude lonke emlenzeni, kusale khulula kuphela ndlela yokuhlasela yokuhlanganisa izihlangu yeminwe ngomlenze wakhe ukulawula supply yegazi futhi zingaphinde Gypsum kinked.

Kukhona ezinye imithetho saziso okumele ilandelwe ngokuqinile ukuba awagweme amaphutha ekwelapheni:

• kuqala ashukumisa Gypsum sivuselela engela unyawo futhi ukujikeleza kwalo ngo yangaphakathi phambi ingxenye (cavus);
• lapho abaluphahleka kwedolo fixed esimweni bent, elizovimba ibhandishi futhi offset ukugwema bezihlikihla isikhumba obucayi wengane;
• lapho ngamunye unyawo zokuqaleka inqubo engela kufanele ibe ngaphansi degrees 15;
• lapho beshintsha olukhonkiwe stop akumelwe ibe khulula isikhundla 1 chasa;
• 2-4 ukwelashwa okuhloswe ngaso kokulungisa kuka ngaphakathi iminwe (varus deformity) nokususwa plantar eguqa;
• Isinyathelo 5 - ivumela ukulungisa isihoxiso esithendeni talus, udokotela kwenza nenkanuko edlulele senyawo esimweni evamile usebenzisa imilenze (ngaphandle kuka-ngeshumi iqakala ngenxa imisipha mfushane).

Isibalo izinqubo okufanele abe ngaphezulu 6. Ukulandelana isikimu bese Gypsum zokulungisa, okuncike indlela Ponseti, isithombe sibonisa kahle.

Uma udokotela izinqubo, bese-ke kuyophathwa hhayi indlela American, futhi ingase ibe yingozi. Ezigabeni okwalandela kuyinto achillotomy kanye umkaki Ukukhetha.

achillotomy

Ukwelashwa nge-Ponseti indlela kuhilela, kwezinye izimo, ngaphambi 4 noma 5 Gypsum esiteji ubambe Achilles tenotomy, lapho:

• is okuhlanganisa umsipha calcaneal (operation percutaneous);
• wire nokugcinwa eziyimpumelelo nemisipha ezilimele;
• ukuhlinzwa kwenziwa ngaphansi izinzwa wendawo;
• ekupheleni ukusebenza eyenziwe Gypsum alandelayo amaviki 3.

Lo msebenzi zihluke kakhulu kokungenela ejwayelekile kuhlinzwa, okuyinto owawuseHholo ejwayelekile ukulungiswa indlela. Phakathi wakhe wengane akusilo ukubulawa kwezinzwa okuvamile futhi emva ishiywe isibazi big, okuyinto kamuva ngokuvamile kukhawulela ukuhamba ngezinyawo lesiguli.

Ukusebenzisa umkaki

Ponseti indlela kuhilela njengoba esigabeni sokugcina ogqoke umkaki, izicathulo ezikhethekile, okuyinto ungakwazi ukulungisa nge ubakaki ku isikhundla isikhundla izinyawo nemilenze ukugwema ukubuya kokukhubazeka. Shoes zikhethwa futhi yayala kusengaphambili.

Gqoka le umkaki kufanele kube cishe ubusuku nemini kuze kuphele izinyanga ezintathu ukudubula ngesikhathi ukugeza noma sigqoka kuphela.

Ngemva kwalokho, kufanele igqoke kuphela ngesikhathi sokulala (imini nobusuku) - kwesikhathi yokutakula ihlala iminyaka engu-2-4 ukuze ugweme kokwehluleka.

ukulinganiselwa

Izimpendulo ezivela kubazali abaye esetshenziswa ekwelashweni kwe-kokukhubazeka ingane Ponseti indlela, nebubi zimi kanje:

• the izicathulo zibiza kakhulu ekhethekile (umkaki), ezivame othengwe kusukela abakhiqizi eJalimane noma e-United States;
• isikhathi kwezidingo zayo kwamanye amazwe,
• le fragility eyisihlobo isakhiwo.

Eminyakeni yamuva, inkampani "Bear" laqala ukuthola nozakwabo ezifuywayo, ukuthengwa we umkaki kungenzeka ukuthenga kubo ngokusebenzisa Isikhwama umshuwalense social.

Izinzuzo indlela

Ukusebenza kahle eliphezulu indlela kokukhubazeka ukulungiswa kwafakazela imiphumela engu-50 ucwaningo isikhungo ezikhethekile uDkt Ponseti (Iowa State University, eU.SA), njengoba indlela ihlolwe ezikhungweni eziningi zokwelapha emhlabeni kanye.

Kuzo zonke ezinye izindlela, okuyinto iphathwa azalwa naso kokukhubazeka Ponseti indlela Ngakho kancane esibuhlungu, ephephile futhi akuxhomekile kobukhulu ubunzima lendabuko. ngenkathi ugqoke ukhonkolo incane kakhulu kuka nezinye izindlela. Ukuphumelela ekulungiseni deformity kuyinto 95% amacala.

Lapho ukwelashwa uphenyo olwenziwe kahle kwanoma iyiphi deformations okuphindiwe ingane ngeke: angakwazi ukugqoka izicathulo abavamile, azikho contraindications ezemidlalo kanye nemisebenzi ngokomzimba.

Ponseti Indlela: Izibuyekezo

Ukwahlulela ngokubukeka ukubuyekezwa sabazali ayephatha ngayo izingane kusukela azalwa naso kokukhubazeka indlela American, umphumela cishe zonke ezinhle. intshiseko ekhethekile uzwakalise umama owazama ekuphatheni izingane kuqala ngendlela esezingeni (massage + Gypsum), ngemva kwalokho ezinye iziguli cishe baba ekhubazekile. Ebhekisela kamuva izikhungo zokwelapha odokotela ngubani efanele ukusebenzisa Ponseti indlela yokwelashwa kokukhubazeka, abazali bakwazi ukwelapha izinyawo ukuze izingane zakho ngokugcwele.