Indlela yePonseti yokuPhatha iClubfoot

Indlela yePonseti, esetyenziselwa ukuphatha i-clubfoot yokuzalwa yabantwana abancinci, ngoku iyabonwa njengeyona ndlela iphumelelayo kwaye ingenayo impilo yengane. Ehlabathini iyakwamukelwa njenge "standard standard" yokunyangwa kwe-clubfoot.

Inkcazo yeClubital Clubfoot

Ibhola ye-congenital clubfoot yinkqubo ephuculweyo yendlela kunye nomsebenzi wonyawo kunye nomlenze ophantsi. Ukuphazamiseka akukhona nje ngamathambo, amaqabane kunye nezihlunu, kodwa nakwiintlobo, ukuphela kwezibilini okanye izitya.

Ngokwezibalo, i-clubfoot ifumaneka kwi-5% yabantwana abasandul 'ukuzalwa. I-clubfoot yenziwa kwiiveki zokuqala zokukhulelwa, isizathu sayo asikabikwa. Ngokwezinye iingcamango, oku kubangelwa kwi-heredity embi, kuba phambi kwesi sifo kwelinye labazali ithuba lokubonakaliswa kwesifo luyanda ngo-4%.

I-clubfoot ye-Congenital enye-okanye i-side-side kwaye iqheleke kubafana. Kwintliziyo yesi sifo kukusasazeka kweentsholongwane zezicubu ezixhumeneyo, yintoni ebangela ukunyuswa kweenyawo. Oku kunciphisa izihlunu, kukho ukuguqulwa kunye nokufaka ngaphakathi ngaphakathi nangaphakathi lwendawo. Umntwana ngokwakhe akasoze akwazi ukubeka unyawo kwindawo eqhelekileyo.

Izindlela eziqhelekileyo zokonyango kwe-clubfoot

Ngaphambili, ngaphambi kokuba indlela yasePonseti isetyenziswe, ukulungiswa kwe-clubfoot kwenzelwa ukulungiswa kwe-gypsum, kwaye kwenzelwa ukusebenza kwinqanaba, apho i-elongation kunye nokubethelwa kweentlobo zeemisipha ezininzi zenzeke, i-ligaments of foots intersect kwaye idibeneyo ivuliwe. Iimeko ezichaphazelayo namathambo enyawo ngexesha lotyando lwamaxesha amaninzi.

Indlela eqhelekileyo yokuphatha i-clubfoot ibandakanya amanyathelo alandelayo:

• Unyango luqala nge-1-week-old baby;
• Okokuqala, kukho iiseshoni zokuxilisa (iiveki 1-2);
• Ukusetyenziswa kwezinye izinto zokugqoka kunye neeparafini, ezenziwa ngexesha elide: ukusuka kwiinyanga eziliqela ukuya kwiminyaka emi-2, kuxhomekeke kububungqina bentsholongwane;
• Isicelo sokugqibela sebhanti ye-plaster kwisithuba seenyanga ezi-5;
• Ngempumelelo ephantsi kwonyango eneminyaka engama-2 ubudala, umntwana uqhutyelwa ukuhlinzwa (iPlastiki eyenziwe nge-plastiki ye-Achilles).

Ngokwezibalo, ukuphumelela kwonyango ngokweendlela eziqhelekileyo ngu-58%.

Iyiphi indlela yePonseti?

U-Ignacio Ponseti - oyedwa ovelele waseMelika, ophuhliswe ngo-1950-60 yindlela entsha yokuphatha i-clubfoot. Usekelwe kuphando olusisiseko malunga nesakhiwo senyawo lomntwana kunye noshintsho lwentlalo. Ngokungafani neendlela zamandulo zonyango, le ndlela ikuvumela ukuba wenze ulungiso ngokukhawuleza: iinyanga ezi-1.5-2 zabelwe ukulungiswa okupheleleyo, kodwa ngexesha elifikeleleko le-gypsum.

Indlela yePonseti ikuvumela ukuba ulungelelanise ukulungiswa kweenyawo ngendlela egciniweyo, ukuphepha ukutshintshwa kwezinto ezincinci kumalungu, kunceda ukugcina amandla okuhamba kwenyawo kunye nesisipha.

Ubume obaluleke kakhulu ekusebenzeni okuphezulu kwendlela, ukuxilongwa kwangaphambili kwesi sifo (ngeveki yokuqala yobomi), ngelixa iimbumba kunye neemisipha zomntwana zinamazinga aphezulu. Qala unyango kufuneka ube kwiintsuku ezi-1-2 zobomi bentsana, qiniseka ukuba uqale ukuhamba.

Ukuba i-deformity ifunyanwa kamva, unyango kunye nendlela yePonseti nayo inokwenzeka, kodwa ukulungiswa kwesiphene kuya kuba ixesha elide ngexesha.

Amanyathelo enyango ngokwemigaqo yePonseti

Unyango lwe-clubfoot yindlela yePonseti iqulethwe ngamanyathelo amanyathelo athatywayo:

1. Ukulungiswa kobuchopho kunye ne-plaster ehluthayo, emele ishintshwe rhoqo iintsuku ezingama-6-7. Umlenze womlenze womntwana ngokupheleleyo: ukusuka kwiminwe ukuya phezulu kwintambo. Ibhanki ngalinye lenziwa kwindawo ethile, kukuvumela ukuba ulungele ukuma kweenyawo kunye namathambo. Kuphela kubalulekile ukufeza iinkqubo ze-4-7 ze-gipsovaniyu imilenze, kodwa inani labo lixhomekeke ngokukhawuleza kwisibandezelo sesifo kunye nobudala bomntwana.
2. Isigaba esilandelayo yi-achillotomy, oko kukulinda kwethenda ye-Achilles, ehlala ifutshane ne-clubfoot. Into eqhelekileyo eyenziwa ngumsebenzi ovalwe phantsi kwe-anesthesia yendawo (kubantwana abangaphantsi kweminyaka emi-2 ubudala). Emva kokusebenza, ukubetha kwenziwa ngeeveki ezi-3 ukulungisa umphumo.
3. Isinyathelo sokugqibela esibalulekileyo kukusetyenziswa kweebhonki ezibandakanya izihlangu ezimbini kwi-bar ekhethiweyo.

Ukusebenza kakuhle nokuqinisekiswa kokunyanga kwesi sifo, uqeqesho oluphezulu logqirha owenza le nkqubo lubaluleke kakhulu.

Indlela yeGypsum

I-Gypsum yenziwe ngeendlela zePonseti yenziwa ngeveki, kwaye kunye nokusetyenziswa ngokulandelelana kwe-gypsum, uhlobo oluthile lolungiso lwenyawo lupheliswa. Xa ukugqoka kusetyenziswa, ugqirha olungelelanisa unyawo, kunye nomncedisi owenza ngokukhawuleza ukubetha, ukuthatha inxaxheba.

Ukusetyenziswa kwe-gypsum kwenziwe ngendlela yoqhopholo lonke ubude bomlenze, kuphela i-phalanges yezinzwane ezishiywe sikhululekile ukulawula ukunikezelwa kwegazi kwimikhumbi kunye nokuphepha i-gypsum ehamba nayo.

Kukho imithetho emininzi enyanzelisayo ekufuneka ilandelwe ngokukhawuleza ukuphepha amaphutha kunyango:

• Ukupaka kokuqala kuvumela ukubuyisela i-angle yokugxilwa kweenyawo kunye nokujika kwangaphakathi kwi-front (kavus);
• Xa ukugawula ixolo lugxininiswe kwisikhundla esifanelekileyo, okuya kuthintela ukuba ibhanti ihambe kwaye iphephe ukuxubha isikhumba esincinci somntwana;
• Ngendlela nganye, i-angle yokuphuma kweenyawo kufuneka ibe ngama-degrees angama-15;
• Xa utshintsha i-gypsum, unyawo akufanele lube kwindawo yokukhulula ngaphezu kweyure eli-1;
• Iinkqubo ezi-2-4 zijoliswe ekulungiseni ukuphambuka kwiminwe (ukuguqulwa kwe-varus) kunye nasekupheliseni i-foldar fold;
• Inyathelo 5 - likuvumela ukuba ulungise ukususwa kwesithende phezu kwethambo lesithambo, ngoxa ugqirha wenza ukulungiswa kweenyawo eziqhelekileyo kwiindawo ezifunayo ngoncedo lwe-langete (ngaphandle kohlobo olugqithiseleyo kwi-ankle ngenxa yesithoni esincinci).

Inani leenkqubo akufanele libe ngaphezu kwe-6. Ukulandelana kunye nenkqubo yokulungisa i-gypsum, ngokusekelwe kwindlela yePonseti, ifoto ibonisa ngokucacileyo.

Ukuba uogqirha oya kwiinkqubo ezininzi, ke oku kuya kuhanjelwa kungekhona ngokwemigaqo yaseMelika kwaye inokuba yingozi. Kwinqanaba elilandelayo, i-achillotomy kunye nokukhethwa kwe-brace kwenziwa.

Achillotomy

Indlela yokwelapha ngokwemiqathango yePonseti inikezela, kwezinye iimeko phambi kwesigaba sesi-4 okanye sesihlanu sokubetha, i-achillotomy, apho:

• Ukuguquka kwethenda ye-calcaneal (operation subcutaneous);
• Ukulungiswa kokuphela kwezimila;
• Ukusebenza kwenziwa phantsi kwe-anesthesia yendawo;
• Ekupheleni komsebenzi, ukubetha kwenziwa ngeeveki ezilandelayo ezi-3.

Lo msebenzi uqheleke ngokusuka kumsebenzi oqhelekileyo owenziwe ngendlela efanelekileyo yokulungiswa. Ngethuba le nkqubo, umntwana akahambanga ne-anesthesia jikelele kwaye emva koko akukho nxeba enkulu ehlalayo, eyona nto ihlala ibeka umda wokuhamba kweenyawo zesigulane.

Ukusebenzisa i-brace

Indlela yePonseti inikezela, njengesigaba sokugqibela, ukugqoka i-braces, isihlangu esikhethekileyo esikuvumela ukuba ulungise indawo yeenyawo kunye nemilenze kwindawo efunwayo ngoncedo lweplanki ukuphepha ukubuyela kwi-clubfoot. Iibhothi zikhethiweyo kwaye ziyalelwe kwangaphambili.

Ukugqithisa iibrase kufuneka kube malunga neeyure kwiinyanga ezintathu, uthathe kuphela ngexesha lokuhlamba okanye ukutshintsha iimpahla.

Ngexesha elizayo, kuya kufuneka baditywe kuphela ngexesha lokulala (imini nobusuku) - ixesha lokubuyisela lihlala iminyaka emi-2 ukuya ku-4 ukuphepha ukuphinda ubaleke.

Iingxaki zendlela

Ngokutsho kwabazali abasebenzisa indlela yePonseti yokuphatha i-clubfoot, ukungonakali kuku:

• Iindleko eziphezulu zeengubo ezizodwa (i-brace), eziqhele ukuthengwa kubakhiqizi baseJamani okanye kwi-USA;
• Ubungakanani bokunikezelwa kwawo kwamanye amazwe,
• Ulwalamano olunxulumene nesakhiwo.

Kwiminyaka yakutshanje, inkampani ethi "Bear" iye yasungula ukuveliswa kwabalingani basekhaya, kunye nokuthengwa kweebhonti kukho ithuba lokuzithenga nge-inshurensi yengxowa-ntsapho.

Inzuzo

Inkqubo ephezulu ye-clubfoot yokulungiswa kwendlela ibonakaliswa yimiphumo yeminyaka engama-50 yophando kwiziko le-Ponseti Specialized (iYunivesithi yase-Iowa, eU.SA), kwaye ubugcisa buye lwavavanywa kumaziko amaninzi eyeza.

Kuzo zonke ezinye iinkqubo apho i-congenital clubfoot iphathwa ngayo, indlela yePonseti yinkcaso encinci, ikhuselekile kwaye ayixhomekeke kubunzima bemvelaphi yokukhubazeka. Ixesha lokugaya iphosa lingaphantsi kunezinye iindlela. Ukuphumelela ekulungiseni ukunyuswa kweenyawo kungama-95% ale matyala.

Ngonyango oluqhutywe kakuhle, ayiyi kuphinda ihlaziywe ngokuphindaphindiweyo kumntwana: unokugqoka izicathulo eziqhelekileyo, akukho zichasiselo zokusebenzisa nokusebenza ngokomzimba.

Indlela yePonseti: ukuphononongwa

Ukuqwalasela iimpendulo zabazali abaphatha abantwana kwi-congenital clubfoot kunye ne-American method, umphumo phantse konke okulungileyo. Inzondelelo ekhethekileyo iboniswa ngabamama abazama ukuphatha abantwana ekuqaleni kwindlela efanelekileyo (i-massage + gypsum), emva koko ezinye izigulane ziphantse ziphumele. Ukutshintshela kamva kumaziko ogqirha oogqirha abasebenzisa ngokufanelekileyo indlela yePonseti yokuphatha i-clubfoot, abazali bakwazi ukuphilisa imilenze yabo ngokupheleleyo.