beograd, 5. okt obar 2010 dragan zari ć
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Beograd, 5. Okt obar 2010 Dragan Zari ć. PES EQUINOVARUS CONGENITUS PONSETI METOD – NEOPERATIVNO LEČENJE. PES EQUINOVARUS CONGENITUS -Dijagnostikuje se po rođenju -Najteži deformitet stopala -Karakterističan izgled -Potkolenica tanja i slabija -Kosti stopala pomerene medijalno - PowerPoint PPT PresentationTRANSCRIPT
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Beograd, 5. Oktobar 2010 Dragan Zarić
PES EQUINOVARUS CONGENITUSPONSETI METOD – NEOPERATIVNO LEČENJE
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PES EQUINOVARUS CONGENITUS-Dijagnostikuje se po rođenju-Najteži deformitet stopala-Karakterističan izgled-Potkolenica tanja i slabija-Kosti stopala pomerene medijalno
-equinus (stopalo oboreno naniže)-varus (taban okrenut ka drugom stopalu)-adduktus (prednji deo stopala uvrnut ka unutra)-excavatus (povišen svod stopala)
UZROCI NASTANKA-Embriološki-Mahanički-Neuromuskularni-Vaskularni-Koštane, mišićne i ligamentarne anomalije-Poligenetsko nasleđe
STATISTIČKI PODACI-Na 1000 novorođenčadi 1-2 sa PEV-2/3 dečaci 1/3 devojčice (2:1 dečaci)-2/3 obostran 1/3 jednostran (češće desni)-Jedan roditelj 3-4% šansi da dete nasledi-Oba roditelja 30% šansi da dete nasledi
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PEVC može biti samostalan ili udružen sa drugim anomalijama.
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-Dr Ignacio Ponseti-Pokreti zdravog stopala-Neoperativni metod-Minimum = Maksimum-Primenljiv po rođenju-Aplikacija gipsa 5-7 dana-Trajanje 5-8 nedelja-Dennis Brown bar
PONSETI METOD
Dr Ignacio Ponseti (1914-2009)
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PRIKAZ PONSETI METODA NA MODELUIzgled deformiteta i položaj kostiju stopala
Fleksija talusa i kalkaneusaAdukcija navikularne i kuboidne kosti
Adukcija metatarzalnih kostiju
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Ekstenzijom i supinacijom ispravlja se kavus
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Postepena korekcijaPritisak na spoljnu glavu talusa
Abdukcija stopala
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Kontra pritisak omogućava rotaciju zgloba
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Položaj kostiju kod potpune korekcije
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I akt- supinacija koriguje kavus
II-V akt- abdukcijuom prednjeg i srednjeg dela stopla korigujemo deformitet
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STOPALA PRE KOREKCIJE
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PRVA KOREKCIJA
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DRUGA KOREKCIJA
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TREĆA KOREKCIJA
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ČETVRTA KOREKCIJA
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PETA KOREKCIJA
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STOPALA POSLE KOREKCIJE
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DENNIS BROWN BAR
-Plasira se odmah posle korekcije-Održava elastičnost stopala-Nosi se 23h dnevno 3 meseca-14-16h dnevno 2-4 godine
OBOSTRANI DEFORMITET
-70° u polje 15°-20° dorzalna fleksija
JEDNOSTRANI DEFORMITET
-70° u polje 15°-20° dorzalna fleksija (lečeno stopalo)-45° u polje 15°-20° dorzalna fleksija (zdravo stopalo)
-Razmak između cipela za širinu ramena deteta
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STOPALO KROZ KOREKCIJE
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NA KRAJU
-DIJAGNOZA PO ROĐENJU-NAJTEŽI DEFORMITET-NEPOZNAT UZROK NASTANKA-POČETAK LEČENJA 5-10 DANA PO ROĐENJU-KOREKCIJA NA 5-7 DAN TOKOM 5-8 NEDELJA-DENNIS BROWN BAR 3 MESECA 23H 2-4 GODINE 16H-NORMALAN ŽIVOT I BAVLJENJE FIZIČKIM AKTIVNOSTIMA
ISHOD LEČENJA
-TEŽINA DEFORMITETA-ZDRAVSTVENE USTANOVE I OBUČENOSTI OSOBLJA-RODITELJA (NAJZNAČAJNIJI FAKTOR)
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HVALA NA PAŽNJI !