[Ortho] Ï å ð è à ö å ò à á ó ë ÿ ð í à ÿ Á å ð í ñ ê à ÿ (Ga nz) î ñ ò å &#23

[Djoldas Kuldjanov, M.D.]

Ó êîãî åñòü îïûò
âûïîëåíåíèÿ
ïåðèàöåòàáóëÿðíîé
îñòåîòîìèè
> ïî Ganz
èçèëèîíãâèíàëüíîãîäîñòóïà?
Îñîáåííîñòè?
Îïàñíîñòè?
> Íàìíîãî ëè ñëîæíåíèå
èëèîôåìîðàëüíîãî?
Êîãäà ïåðåøëè
> íàóíãâèíàëüíûé
(ïîñëå ñêîëüêè
îñòåîòîìèé èç
ôåìîðàëüíîãî?)
> Ñïàñèáî,

×åì ïåðåäíèé Smith Petersen
äîñòóï íå óñòðàåâàåò?

Èëèîèíãâèíàëüíûé
äîñòóï ñ ñàìîãî íà÷àëà
ïðèìåíÿëñÿ Jeff Mast&Reinhold Ganz
äëÿ îðèãèíàëüíîé
Áåðíñêîé
ïåðèàöåòàáóëÿðíîé
îñòåîòîìèè.

Ó Ilio-inquinal äîñòóïà Letournel
èìååòñÿ øèðîêèé îáçîð
â êâàäðèëàòåðàëüíóþ
ïîâåðõíîñòü è
ñåäàëèùíóþ ÷àñòü
ïåðèàöåòàáóëÿðíîé
îñòåîòîìèè ìîæíî
ñäåëàòü èçíóòðè òàçà
ïî÷òè ïîä ïðÿìîé
óêëàäêîé îñòåîòîìà íà
ñåäàëèùíóþ.
Ïðè ýòîì íåîáõîäèìî
ñäåëàòü ñèëüíóþ
ôëåêöèþ
òàçîáåäðåííîãî
ñóñòàâà è ðóêîÿòêà
îñòåîòîìà îáû÷íî
äàâèò íà ôåìîðàëüíóþ
àðòåðèþ è âåíó.
Ó ìíîãèõ áûëè òðîìáîçû
ñîñóäîâ ñâÿçàííûå
ìàíèïóëÿöèÿìè,
îñîáåííî ó æåíùèí petit
êîìïëåêöèåé.

Ó ìåíÿ ó äâîèõ áîëüíûõ
áûëè îñëîæíåíèÿ,
äèñòàëüíóþ èøåìèþ
îïîçíàëè âîâðåìÿ è
ñìîãëè îêàçàòü
ñâîåâðåìåííóþ ïîìîùü.
 òî âðåìÿ îïåðàöèþ
ïðîâîäèëè ïîä
ìîíèòîðèíãîì íåðâà è
ñðî÷íî ïðèãëàøåííûé
ñîñóäèñòûé õèðóðã
ñïàñ íàñ îò
êàòàñòðîôû.

Ïîýòîìó ñ 1994-95 ãîäîâ
àâòîðû
ïåðèàöåòàáóëÿðíîé
îñòåîòîìèè Mast è Ganz
ïåðåøëè íà ìåíåå
òðàâìàòè÷íûé
ïåðåäíèé Smith Petersen äîñòóï.

Äîñòóï äàåò õîðîøèé
îáçîð ê ëîííîé è
ïîäâçäîøíóþ êîñòü,
èç-çà îòñóòñòâèÿ
îáçîðà ñåäàëèùíûé
êîìïîíåíò îñòåîòîìèè
ïðèõîäèòñÿ äåëàòü
âñëåïóþ.
Îñòåîòîì
óêëàäûâàåòñÿ ïîä
ðåíòãåí êîíòðîëåì
ìåäèàëüíî
ýêñòðàêàïñþëàðíî è
ïîëîâèí÷àòûé ñðåç
ñåäàëèùíîé
äîáèâàþòñÿ çàêðûòî.
Íåìíîãî çàòðóäíåí
îñòåîòîìèÿ ëîííîé
êîñòè ñãèáàíèÿ ò/á
ñóñòàâà ïîìîãàåò.

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