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Metoda Ilizarowa – zastosowanie, zalety, możliwe powikłania

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Metoda Ilizarowa to postępowanie terapeutyczne, w którym wykorzystuje się zjawisko osteogenezy dystrakcyjnej. Znajduje ona zastosowanie w terapii wielu schorzeń i urazów układu kostnego. W jaki sposób przebiega terapia metodą Ilizarowa i jakie mogą być jej powikłania?

Działanie metody Ilizarowa

Metoda Ilizarowa polega na wykorzystaniu przestrzennego stabilizatora zewnętrznego (aparatu Ilizarowa) do wydłużania, scalania oraz korekcji kształtu kości. Aparat ma konstrukcję przestrzenną. Jest złożony z pierścieni lub półpierścieni, do których przytwierdzone są pręty (tzw. druty Kirschnera). Pierścienie połączone są teleskopowymi drutami. Pręty wprowadza się do przeciętej lub złamanej kości, co zapewnia jej stabilizację w trakcie terapii. Konstrukcja aparatu może być modyfikowana i rozbudowywana w wielu płaszczyznach i kierunkach.

W metodzie Ilizarowa wykorzystuje się zjawisko osteogenezy dystrakcyjnej. Kość unieruchomiona w aparacie Ilizarowa jest poddawana stałemu naprężaniu rozciągającemu. Miejsce urazu lub deformacji jest odciążone i ustabilizowane, co pozwala komórkom kościotwórczym stopniowo wypełnić lukę. Powstała w ten sposób nowa tkanka, czyli regenerat, uzyskuje taką samą strukturę, jak kość naturalna. Metoda Ilizarowa pozwala na maksymalne wykorzystanie zdolności regeneracyjnych tkanki, a jednocześnie nie prowadzi do uszkodzenia mięśni, nerwów i naczyń krwionośnych (wydłużają się one w miarę rozciągania kości).

Zastosowanie aparatu Ilizarowa

Metoda Ilizarowa znajduje szerokie zastosowanie w ortopedii i chirurgii rekonstrukcyjnej. Stosuje się ją w przypadku skomplikowanych, rozległych urazów kości i wadliwie wygojonych złamań, w terapii zapalenia szpiku kostnego, a także w leczeniu wielu schorzeń ortopedycznych, takich jak wrodzony deficyt długości kości, zniekształcenia stóp, karłowatość, przykurcze stawowe, stawy rzekome. Metodę Ilizarowa wykorzystuje się także w leczeniu ubytków pozostałych po usunięciu nowotworów kości.

Zalety metody Ilizarowa

Wśród najważniejszych zalet metody Ilizarowa w leczeniu urazów kości specjaliści wymieniają zachowanie ukrwienia i ciągłości okostnej, co umożliwia regenerację tkanek. Aparat zapewnia pełną stabilność kończynie, która uległa urazowi, a jednocześnie optymalnie rozkłada ciężar i napięcie. Dzięki temu możliwe jest zachowanie mobilności pacjenta. Już w drugiej dobie po operacji chory jest pionizowany i uczy się poruszać z pełnym obciążeniem zoperowanej kończyny. Zakres ruchów czynnych w stawach jest utrzymywany przez cały okres leczenia. Pozwala to na utrzymanie funkcjonalności mięśni i stawów.

Zapewnienie stabilnych warunków gojenia i ochrona przed dodatkowymi urazami powinny zapewnić szybsze gojenie i sprawniejszą rehabilitację. Umocowanie aparatu do kończyny jedynie za pomocą drutów redukuje ryzyko krwawienia, infekcji i uszkodzenia otaczających tkanek miękkich.

Możliwe powikłania leczenia metodą Ilizarowa

Leczenie metodą Ilizarowa to terapia cechująca się bardzo dużą inwazyjnością. W związku z tym mogą po nim wystąpić liczne powikłania. Wśród możliwych komplikacji leczenia tą metodą wymienia się ograniczenie ruchomości i przykurcze w stawach, przemieszczenie odłamów kostnych, przedwczesny lub opóźniony zrost, zagięcie lub złamanie regeneratu, stany zapalne tkanek miękkich i kości oraz obrzęki.

Źródła: https://emedicine.medscape.com/, https://www.ouh.nhs.uk/, http://aparatilizarowa.pl/, http://www.czytelniamedyczna.pl/

Przeczytaj także: Choroba Behceta – etiologia, kryteria rozpoznania, leczenie

50 thoughts on “Metoda Ilizarowa – zastosowanie, zalety, możliwe powikłania

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