Tikanga Ponseti o clubfoot

Te tikanga Ponseti, whakamahia nei i roto i te maimoatanga o congenital clubfoot tamariki taitamariki, ka mohiotia e tenei ra rite te whai hua tino me ngawari hoki hauora o pēpi. I roto i te ao kei te manakohia ai rite te "paerewa koura" maimoatanga o clubfoot.

Whakamāramatanga o te clubfoot congenital

clubfoot congenital - whakararuraru, matatini o te hanganga me te mahi o te waewae, me te waewae o raro. e kitea i roto i te wheua, hononga, me uaua e kore anake, engari ano hoki i roto i te tendons, mutunga karere me oko toto maumaui.

E ai ki ngā tatauranga, kitea clubfoot te i roto i te 5% o nga tamariki whanau hou. i hanga Clubfoot te i roto i te wiki tuatahi o te hapūtanga, e kore kua te take reira i whakaritea. E ai ki etahi whakapae, tupu te reira no te mea o te whakapapa kino, t. Ki. I roto i te aroaro o te mate taua i roto i te kotahi matua nui haere te tūponotanga o te mate e 4%.

Clubfoot congenital Ko te pütahitanga e rua-taha ranei, a he ake noa i roto i te mau tamaroa. Ko te mate, ko te tupu pathological o kopa tūhonohono, no te mea o te mea kei te tupu, me te mutu deformation. I roto i tenei uaua poroa riro piri me te tākainga roto te hiku, me te mata i roto o te waewae. Ko te tamaiti anake e kore e taea ki te hoatu i te waewae ki te tūranga tonu.

tikanga Paerewa o te rongoā clubfoot

I mua, i mua i tīmata te tikanga kei te whakamahi i Ponseti, hira te ako i hanga e te tikanga o te raima takai fakatonutonu, me te ka kawea te mahi i roto i runga i te waewae, i nei te elongation me crosslinking e rave rahi tendons uaua, here waewae whakawhiti te tahi rawekehia. He nga take auau o e pā me wheua i roto i te waewae i roto i te mahi.

Ko te tikanga mua o clubfoot tā te whai i ēnei:

• haamata Maimoatanga ki te pēpē 1-wiki-tawhito;
• massages tuatahi whakahaere (1-2 wiki);
• tauutuutu paru me tono parawini, e hanga hoki he roa nui o te wā, i te marama torutoru ki te 2 tau, i runga i te pakeke o te mate rānei;
• te whakaitinga whakamutunga o te wā o te 5 marama;
• i te whai huatanga iti o te maimoatanga i te tau o te 2 tau tamaiti tau mahi pokanga (Z-āhua kirihou Achilles iohere).

Tauanga, ko te tikanga paerewa o te maimoatanga tōtika ko 58%.

He aha te mea te tikanga o Ponseti

Ignacio Ponseti - he tākuta orthopedic American tino, whakawhanakehia i roto i te 1950-60 te maimoatanga hou mō te clubfoot. Kei te hāngai te reira i runga i te ako taipitopito o te hanganga waewae o te tamaiti, me ona huringa pathological. Rerekē maimoatanga tuku iho, ka taea tenei tikanga ki a koutou te hanga i te ako, kaua hohoro: homai 1,5-2 marama te ki te ako tonu, engari i raro ki te tīmatanga wā o te gypsum.

Ponseti tikanga e āhei ki te whakatika i deformities waewae tikanga momo, faka'ehi'ehi mei scarring ki te hononga, e tauturu te reira ki te pupuri i te kaha nekeneke o te waewae me nga uaua.

Ko te huru tino nui mo te tōtika tiketike o tenei tikanga - he tātaritanga wawe o te mate (te wiki tuatahi o te ora), tae noa ki hononga me uaua o te tamaiti i te elasticity nui. kia timata Treatment i te tau o 1-2 wiki o te ora tamaiti, kia mohio ki te tīmata haere.

Ki te kitea te deformation te muri, he taea ano hoki te maimoatanga e Ponseti, Heoi, i te wa e nui atu mea pumau tonu te ako koha.

Nga hikoinga o te maimoatanga i te tikanga o Ponseti

Maimoatanga o te clubfoot tikanga Ponseti ngā o te maha ngā wāhanga o te maimoatanga:

1. te ako deformation whakamahi paru te raima, e me puta ke nga 6-7 ra. Waewae o te tamaiti tino gypsum i te matimati ki te huha o runga. Ko ia papaki i roto i te tetahi tūranga, tuku ki a koutou te whakatika i te āhua o te waewae, me te noa wheua. tika katoa ki te kawe i roto i 4-7 waewae ngā tukanga gypsum, engari tei hāngai ratou tokomaha i runga i te tohu o te pakeke o te mate, me te tau o te tamaiti.
2. Ko te atamira i muri - achillotomy, arā, tawharara o te iohere Achilles, i te mea tonu i te clubfoot poroa ... Nuinga o ngā wā mahi mahi tata i raro i rehunga rohe (mō ngā tamariki ki runga, ki te 2 tau). I muri i te pokanga, kia gypsum mo 3 wiki ki te whakatika i te hua.
3. Ko te atamira nui whakamutunga - i te whakamahi o te awhi arā o rua hu eke i runga i te paraharaha retireti motuhake.

Hei kī mahi nui, me te ora i te mate o te faufaa nui ko te tohu tiketike o te tākuta e mahi ana i te tukanga.

tikanga raima

Gypsum i tikanga Ponseti whakahaere wiki, me i reira he whakakorenga o etahi momo o deformation o te waewae i roto i ia tono ngā o gypsum. A, no te kopaki mo takai tākuta wāhi nei hāngai tika te waewae, me te kaiāwhina mahi tonu gypsum.

Ko whakapanga o gypsum i te puka o te whawhai i runga i te roa katoa o te waewae, ka mahue te phalanx noa anake o maihao i runga i tona waewae ki te whakahaere i te supply o oko toto, me te ārai ratou gypsum kinked.

He te tahi mau ture whakahauanga e Me aru tino ki te karo i te mau hape i roto i te maimoatanga o:

• tuatahi faahouhia gypsum Kia whakahokia te koki o te waewae, me ona hurihanga i roto i te wahi mua ā-(cavus);
• ka raima te turi whakaritea i roto i te tūranga piko, e ka aukati i te tipare me Paraire ki te karo i komukumuku te kiri i ahuareka o te tamaiti;
• ka kia iti iho i te 15 nga nekehanga ia waewae withdrawal tukanga koki;
• ka huri te pani mutu kore kia i roto i te noa tūranga 1 chasa;
• 2-4 maimoatanga e hāngai ana ki te whakatikatika deflection roto maihao (varus hira) me te tango o te plantar piko;
• Hipanga 5 - taea ki te whakatika i te retraction o te rekereke o te talus, hanga te tākuta he warea o te waewae i roto i te tūnga tonu te whakamahi i kiri (ki te haunga o runga-puninga i roto i te pona e tika ana ki te tendons poroa).

kia te maha o ngā tukanga e kore ake atu i te 6. Ko te raupapa o te kaupapa me te gypsum fakatonutonu, e hāngai ana ki te tikanga Ponseti, whakaatu ana te whakaahua nehenehe.

Ki te e te tākuta atu ngā tukanga, ka ka kia kore tukinotia ai i runga i te tikanga American, a kia kia kino. I roto i te wāhanga o muri ko achillotomy me te Whītiki whiriwhiri.

achillotomy

Treatment i tikanga Ponseti tā, i roto i ētahi wā, i mua i 4 5 ranei atamira gypsum pupuri Achilles tenotomy, i roto i nei:

• Kei te here te iohere calcaneal (mahi percutaneous);
• waea kūmuri pupuri pakaru tuhonohono;
• mahia pokanga te i raro i rehunga rohe;
• i te mutunga o te mahi i hanga te o gypsum mo te muri 3 wiki.

He rerekē tino i te wawaotanga hāparapara paerewa, tū nei te i te tikanga ako paerewa tenei mahi. I roto i ia o te tamaiti e kore he rehunga whānui, me te i muri i te reira i mahue he nawe nui, e muri te tikanga tauwhāiti te nekeneke o te waewae o te manawanui.

Whakamahi o te Whītiki

Ko tā Ponseti tikanga rite te wā whakamutunga o mau te awhi, hu motuhake, e taea e koe te whakatika ki te taiapa ki te tūranga tūranga nga waewae, me waewae ki te karo i te hokinga mai o te clubfoot. E whiriwhiria a whakahau i roto i te mua hu.

Kakahu i te awhi kia tata a tawhio noa te karaka hoki ki te toru marama kopere i roto i kaukau tauiraa ranei anake.

I muri, kia mau ratou anake i roto i te moe (ra, me te po) - te wā whakaora pumau mo 2-4 tau i roto i te tikanga ki te karo matahoki.

whāititanga

Urupare i te mau metua e kua whakamahia i roto i te maimoatanga o te tamaiti clubfoot tikanga Ponseti, he kino e whai ake:

• te utu nui o te hu motuhake (Whītiki), e kua te tikanga hokona i kaiwhakanao i roto i Germany te United States ranei;
• te roanga o tona tuku ki ētahi atu whenua,
• te fragility whanaunga o te hanganga.

I roto i nga tau tata nei, te kamupene "Bear" tīmata te whakaputa ritenga kāinga, me he taea te ähua o te awhi ki te hoko a ratou i roto i te pūtea inihua pāpori.

painga o te tikanga

Ko te tōtika tiketike o te tikanga o te clubfoot ako whakamatauria nga hua o te 50 tau o te rangahau i roto i te pokapū motuhake o Dr. Ponseti (Iowa State University, USA), me te te tikanga i whakamatauria kua i roto i te maha pūtahi hauora i roto i te ao.

O te tahi atu tikanga katoa, tukinotia nei te congenital clubfoot tikanga Ponseti ko te kupu iti ngaukino, haumaru, me te kore e whakawhirinaki i runga i te pakeke o te matatu o te takenga. i te mau i te maka ko te nui iti iho i te tahi atu tikanga. Te tōtika i roto i te whakatikatika hira ko 95% o te wā.

A, no te kore e waiho maimoatanga tika whakahaere o tetahi deformations toutou o te tamaiti: e taea kakahu ia hu noa, i reira e kore contraindications ki hākinakina me ngā mahi tinana.

Ponseti Tikanga: arotake

Whakawa i nga arotake o te mau metua e tukinotia nga tamariki i te tikanga American clubfoot congenital, he tata pai katoa te pānga. ngākau Special faaite mama nei tamata ki te hamani tamariki tuatahi i roto i te ara paerewa (mirimiri + gypsum), i muri i nei tata ka monokia etahi tūroro. Ni'ai muri ki ngā pokapū hauora ki taote e whakamahi ngaio te tikanga Ponseti o te maimoatanga clubfoot, i taea ki te whakaora i te waewae ki o koutou tamariki tino mau metua.