Osteotomy - ndi chiyani ichi?

Osteotomy - ndi opaleshoni yomwe cholinga kubwezeretsa zotayika ntchito locomotor kudzera yokumba kung'ambika fupa. Nthawi zambiri ntchito kuchotsa nthambi mapindikidwe, amene amalola mubwerere luso wodwalayo kudzimvera chisamaliro ndi kuyenda.

Zikhulupiriro General

Opaleshoni osteotomy imagwiridwa ndi anthu kwambiri aluso zoopsa opaleshoni. Koyamba zikuoneka kuti alowererepo ndi zovuta kumafuna nthawi kuchira wodwala Komabe, mogwirizana ndi malangizo adokotala adzaukitsa mtima mapazi ake mofulumira.

Osteotomy - opareshoni yomwe ikuchitika mwa zida wapadera - osteotomes, Gigli macheka, macheka magetsi ndi akupanga zipangizo. Amathandiza kuti tizibowo zikunena malo ndi kudula fupa. Pambuyo kusonkhanitsa zidutswa zinyalala fupa ndi kuliika ndi zomangira, masingano, mbale. Mosiyana fractures mwachisawawa, pulasitala kuponya umagwiritsidwa ntchito kawirikawiri, pofuna kupewa zotheka chitukuko cha contractures mu malo.

Gawo

Malinga ndi chikhalidwe cha mwayi ntchito zotsatirazi mitundu osteotomy:

1. Open - amafuna kupeza fupa. Pambuyo pa khungu ang'ambe thupilo, subcutaneous minofu ndi minofu zida, raspatory anapambulwa periosteum, fupa kenako kuligaŵa. zinyalala The chili mu udindo thupi, pamwamba - chosungunula.
2. Tatseka - imachitika kudzera kupeza masentimita angapo. Minofu ali sanadulidwe ndi magawo kuti ndi fupa. Pogwiritsa ntchito chisel anapambulwa periosteum ndi zikoti zingapo nyundo pa chogwirira dissect fupa. Mitsempha ndi misempha ali anakankhira ndipo anakakonza ndi zipangizo wapadera kupewa kuwononga iwo. Nthawi zambiri ntchito osteotomy yopingasa.

Mawonekedwe a odulidwa akutsatira zikunena:

• lateral;
• staircase;
• oblique;
• yokhotakhota;
• swivel (ozungulira, arcuate, mphero woboola pakati, angularly).

Malinga cholinga, opaleshoni mitundu zotsatirazi:

• kukonza osteotomy;
• derotation;
• umalimbana kusintha kutalika kwa nthambi;
• Ndi Cholinga kusintha thandizo ntchito.

Zikuonetsa kuti alowererepo

Osteotomy - ndi mafupa opaleshoni, amene anachita milandu izi si amenable mankhwala ndiwofatsa:

• kobadwa nako kapena kugula kuvutika ndi fupa mapindikidwe, digiri wamkulu wa yaitali mafupa tubular (m'chiuno, phewa, ntchafu);
• ankylosis - n'zosatheka ntchito olowa chifukwa kukhalapo kwa adhesions connective minofu, chichereŵechereŵe kapena fupa khalidwe la kali articular;
• kobadwa nako m'chiuno dysplasia (dislocation);
• fractures kuti molondola zinaphatikizidwa;
• osteomyelitis;
• kukhalapo kwa zotupa kapena metastases;
• zotsatira za rickets m'mbiri;
• atagwira arthroplasty;
• ena kuvutika kobadwa nako a dongosolo minofu ndi mafupa.

opaleshoni ntchito m'munda zodzikongoletsera: osteotomy wa mphuno, kukonza contours nkhope, ntchito kutanganidwa la nsagwada za.

contraindications

Pali zinthu zingapo, pamaso pa zomwe opaleshoni anachedwa:

• matenda a chikhalidwe opatsirana pa nthawi imene chofunika osteotomy fupa kapena masabata awiri asanachite opareshoni;
• matenda a dongosolo la kupuma ndipo mtima decompensated;
• shuga;
• nthawi gestation wa mwanayo;
• aimpso kapena kwa chiwindi kuwonongeka;
• pamaso pa purulent totupa kapena chikhalidwe ena malo komwe kuli kofunikira kuchita pa mzere mwayi.

Ubwino ndi kuipa

lothandiza alowererepo ndi easing ululu (ngati) ndi kukonzanso ntchito za galimoto. Mwachitsanzo, osteotomy wa bondo adzachotsa kupweteka pa kayendedwe, kuyambiranso flexor ndi extensor ntchito, kuchotsa adhesions wa pamalo articular. matenda mabasi kupitilira ake.

The sangathe ndi kuthekera zithunzi asymmetry wa miyendo kapena mafupa. Komanso ngati wodwala kukhala ndi olowa m'malo arthroplasty, kudzakhala kovuta kwambiri kuchita pambuyo osteotomy lapansi.

zosokonezeka zotheka

Osteotomy - opareshoni limene kwa zaka zambiri bwino kuchepetsa chiopsezo cha matenda oyamba postoperative. Komabe, kulowerera aliyense zinthu zina mu thupi la munthu ndi gwero la ngozi, chifukwa kuwonjezera pa ayenerere zikugwira ntchito katswiri, tikulankhula za makhalidwe munthu wodwala.

Zovuta za osteotomy mtundu uliwonse angathe kukhala:

• matenda a chilonda opaleshoni - liyenela kuikidwa kwa Mlingo mantha mankhwala opha tizilombo;
• kuchepetsa zinyalala ndi fupa zidutswa - ikuchitika ndi zina muyike pena fixation;
• wosakwiya maphatikizidwe mafupa - yoikidwiratu maofesi multivitamin amene wapangidwa kufufuza mfundo zofunika (calcium, phosphorous, magnesium, nthaka);
• kupanga sustava- onyenga amafuna alowererepo zina;
• parestezii- kuphwanya khungu tilinazo ntchito malo chifukwa mphambano ya nthambi mitsempha (popanda mankhwala zina, limadzikonzera);
• kukana amadzala - m'malo olowa n'kofunika.

kukonza osteotomy

Pogwira ndondomeko otere ntchito mu cholakwika accrete wovulala, kobadwa nako zopindika fupa, chitukuko ankylosis kapena pseudoarthrosis, deformities mafupa phazi ndi mkhutu galimoto ntchito, kuthetsa zopindika zithunzi zodzikongoletsera.

Pamaso alowererepo pa ikuchitika X-ray bwinobwino zimene zimathandiza kuti musankhe malo a fupa, ikani tsogolo la kung'ambika, ndi akukhudzidwira fupa thanzi. Ngati ndi kotheka, kompyuta kapena MRIs. Onse a kafukufukuyu amapatsidwa payekha traumatologist.

opaleshoni imagwiridwa mu chipatala apadera. Kutalika kwa alowererepo - za 3-4 maola, malinga ndi buku la ndondomeko zofunika. Pambuyo kung'ambika makombo fupa ali mulibe Ilizarov (opaleshoni pa malekezero) kapena zipangizo wapadera zachitsulo amene jekeseni mwachindunji mu fupa (osteotomy phazi).

Ilizarov zida ndi dongosolo wapadera ntchito traumatology ndi zamafupa kwa chikukonzekera, psinjika kapena anatambasula zidutswa fupa mu malo anakhumba pa nthawiyo.

Pambuyo ntchito anatenga ulamuliro x-ray, kulola kuti chimatanthauza chikukonzekera zolondola.

Zovuta kukonza osteotomy

zosokonezeka kutheka pambuyo kuwukonza zinthu pathological monga:

• amphamvu ululu, osati cropped analgesics ochiritsira;
• kulephera kwa mbali kunja makina kapena nyumba zitsulo;
• chitukuko cha magazi;
• hematoma mapangidwe;
• kusamutsidwa fupa makombo wachibale wina ndi mnzake mu iliyonse ya ndege;
• zina mavuto ambiri.

Osteotomy m'munda wa mano ndi opaleshoni maxillofacial

M'munda mano a osteotomy anachita chibwano, amene akhoza kuchita monga opareshoni palokha kapena ngati siteji ya ndondomeko pa opaleshoni. Ntchito kapena fractures kuchepetsa, kukonza malocclusion. Amacheka anapangidwa pamodzi kutalika kwa molars pachibwano.

Pambuyo fixation mu thupi nsagwada malo superimposed compressive bandeji, kukonza masaya ndi chibwano m'deralo. Pomwepo yoikidwiratu maantibayotiki pofuna kupewa chitukuko cha suppuration ndi mapangidwe osteomyelitis. Pakati pa mano wokakamiza ena chingamu pamalo amene asunga katswiri tsiku. Stitches amachotsedwa pambuyo pa masabata 2, ndi zomangira akugwira nsagwada mu mwezi kukwanitsa gawo chithandizo akutsatiridwa ndi mankhwala orthodontic.

M'munda wa opaleshoni m'kamwa ndi maxillofacial ntchito osteotomy m'mphuno, omwe ali mbali ya rhinoplasty lapansi. Zimangosonyeza kuti:

• kwambiri kupotozedwa kwa amphuno mlatho;
• mkulu kusamvana mafupa;
• kufunika fupa kusamutsidwa mwachibale kwa amphuno septum.

Pogwira mphuno osteotomy dokotalayo kugona mavuto zokongoletsa: kutseka m'mphuno m'chipinda chotetezeka hump kuchotsa ndi kuwongola kupindika kwa backrest, ndi kuchepetsa makoma pambali. The katswiri ayenera kuganizira kuti kung'ambika minofu fupa zingakhudze patency wa airway chapamwamba Choncho, pa ntchito anagwira makhalidwe anatomical ndi thupi la wodwalayo makamaka.

Mitundu osteotomy m'mphuno:

• lateral (m'mphepete), wopereka perforation kapena mzere maziko;
• medial (Center);
• pamwamba;
• wapakatikati.

Mtundu wa alowererepo ntchito amusankha payekha, kutenga nkhani vuto wodwalayo, cholinga cha opaleshoni, boma la minofu fupa, zofunika buku la mankhwala opaleshoni.

osteotomy aliyense ayenera idzachitika atasankha mlingo wa chitetezo chokwanira. Ukhala ngati njira muyeso pa chitukuko cha matenda oyamba ndi kulenga zinthu wabwino ndi woyenerera fupa maphatikizidwe.