Kutenga matenda ndi chimodzi mwa mavuto aakulu kwambiri pambuyo posintha mafupa opangidwa ndi opaleshoni, zomwe sizimangobweretsa mavuto ambiri kwa odwala opaleshoni, komanso zimawononga ndalama zambiri zachipatala. M'zaka 10 zapitazi, kuchuluka kwa matenda pambuyo posintha mafupa opangidwa ndi opaleshoni kwatsika kwambiri, koma kuchuluka kwa odwala omwe akusinthidwa mafupa opangidwa ndi opaleshoni kwapitirira kuchuluka kwa kuchepa kwa matenda, kotero vuto la matenda pambuyo pa opaleshoni siliyenera kunyalanyazidwa.
I. Zomwe zimayambitsa matenda
Matenda opatsirana omwe amalowa m'malo mwa mafupa opangidwa pambuyo pa opaleshoni ayenera kuonedwa ngati matenda omwe amapezeka kuchipatala omwe ali ndi tizilombo toyambitsa matenda tosagwira mankhwala. Ofala kwambiri ndi staphylococcus, omwe ndi 70% mpaka 80%, mabakiteriya opanda gram, ma anaerobes ndi ma streptococci omwe si a gulu la A nawonso ndi ofala.
Matenda a II
Matendawa amagawidwa m'magulu awiri: limodzi ndi matenda oyamba ndipo lina ndi matenda ochedwa kapena otchedwa matenda ochedwa kuyamba. Matenda oyamba amayamba chifukwa cha kulowa mwachindunji kwa mabakiteriya m'malo olumikizirana mafupa panthawi ya opaleshoni ndipo nthawi zambiri amakhala Staphylococcus epidermidis. Matenda oyamba kumayambiriro amayamba chifukwa cha kufalikira kwa magazi ndipo nthawi zambiri amakhala Staphylococcus aureus. Mafupa omwe adachitidwa opaleshoni amakhala ndi mwayi waukulu wotenga kachilomboka. Mwachitsanzo, pali chiŵerengero cha matenda cha 10% pazochitika zokonzanso pambuyo posinthana mafupa, ndipo chiŵerengero cha matenda chimakhala chokwera kwambiri mwa anthu omwe adasinthidwa mafupa chifukwa cha nyamakazi.
Matenda ambiri amapezeka mkati mwa miyezi ingapo opaleshoni itatha, oyamba kuonekera m'masabata awiri oyamba opaleshoni itatha, komanso mochedwa ngati zaka zingapo zizindikiro zazikulu za kutupa, kupweteka ndi malungo zisanawonekere, zizindikiro za malungo ziyenera kusiyanitsidwa ndi zovuta zina, monga chibayo pambuyo pa opaleshoni, matenda a mkodzo ndi zina zotero.
Pankhani ya matenda oyamba, kutentha kwa thupi sikumangochira, komanso kumakwera masiku atatu mutachita opaleshoni. Ululu wa mafupa sumangochepa pang'onopang'ono, komanso umakula pang'onopang'ono, ndipo ululu umapweteka kwambiri munthu akapuma. Pali kutuluka thukuta kapena kutuluka kwa ntchofu kuchokera ku chovulalacho. Izi ziyenera kufufuzidwa mosamala, ndipo malungo sayenera kuonedwa ngati matenda opatsirana pambuyo pa opaleshoni m'madera ena a thupi monga mapapo kapena njira ya mkodzo. Ndikofunikiranso kuti musamangonyalanyaza kutuluka thukuta ngati kutuluka thukuta kofala monga kutulutsa mafuta. Ndikofunikiranso kudziwa ngati matendawa ali m'minofu ya pamwamba kapena mozungulira chogwiriracho.
Kwa odwala omwe ali ndi matenda opatsirana kwambiri, ambiri mwa iwo atuluka kuchipatala, kutupa, kupweteka, ndi kutentha thupi kungakhale kosakhala kwakukulu. Theka la odwalawo sangakhale ndi malungo. Staphylococcus epidermidis ingayambitse matenda osapweteka omwe amachititsa kuti maselo oyera a m'magazi achuluke mwa odwala 10% okha. Kuchuluka kwa madzi m'magazi kumakhala kofala kwambiri koma sikudziwika bwino. Nthawi zina ululu umaganiziridwa molakwika ngati kumasuka kwa ma prosthetic, kupweteka komwe kumakhudzana ndi kuyenda komwe kuyenera kuchepetsedwa ndi kupuma, ndi ululu wotupa womwe sungachepetsedwe ndi kupuma. Komabe, akuti chifukwa chachikulu cha kumasuka kwa ma prosthetic ndi matenda ochedwa.
III. Kuzindikira Matenda
1. Kuyezetsa magazi:
Makamaka kuphatikiza kuchuluka kwa maselo oyera amagazi kuphatikiza magulu, interleukin 6 (IL-6), C-reactive protein (CRP) ndi erythrocyte sedimentation rate (ESR). Ubwino wa kuyezetsa magazi ndi wosavuta komanso wosavuta kuchita, ndipo zotsatira zake zimapezeka mwachangu; ESR ndi CRP zili ndi kutsimikizika kochepa; IL-6 ndi yofunika kwambiri pozindikira matenda a periprosthetic kumayambiriro kwa opaleshoni.
2. Kufufuza zithunzi:
Filimu ya X-ray: si yodziwika bwino kapena yeniyeni yodziwira matenda.
Filimu ya X-ray ya matenda olowa m'malo mwa bondo
Arthrography: ntchito yaikulu yodziwira matenda ndi kutuluka kwa madzi a synovial ndi abscess.
CT: kuwona momwe mafupa amatuluka, njira za sinus, zilonda za minofu yofewa, kukokoloka kwa mafupa, kulowetsedwa kwa mafupa m'malo olumikizirana mafupa.
MRI: ndi yothandiza kwambiri kuzindikira msanga madzi ndi zithupsa m'mafupa, ndipo siigwiritsidwa ntchito kwambiri pozindikira matenda opatsirana m'mafupa.
Ultrasound: kuchulukana kwa madzi m'thupi.
3. Mankhwala a nyukiliya
Kujambula mafupa kwa Technetium-99 kumakhala ndi mphamvu ya 33% ndi mphamvu ya 86% pozindikira matenda opatsirana pogwiritsa ntchito njira ya periprosthetic pambuyo pa arthroplasty, ndipo kujambulidwa kwa leukocyte kolembedwa ndi indium-111 ndikothandiza kwambiri pozindikira matenda opatsirana pogwiritsa ntchito njira ya periprosthetic, komwe kumakhala ndi mphamvu ya 77% ndi mphamvu ya 86%. Pamene kujambulidwako kumagwiritsidwa ntchito pamodzi pofufuza matenda opatsirana pogwiritsa ntchito njira ya periprosthetic pambuyo pa arthroplasty, mphamvu ya padera, yeniyeni, ndi yolondola ikhoza kupezeka. Kuyesedwa kumeneku kudakali muyezo wagolide mu mankhwala a nyukiliya pozindikira matenda opatsirana pogwiritsa ntchito njira ya periprosthetic. Fluorodeoxyglucose-positron emission tomography (FDG-PET). Kumazindikira maselo otupa omwe ali ndi mphamvu ya glucose yomwe imalowa m'dera lomwe lili ndi kachilomboka.
4. Njira za sayansi ya mamolekyulu
PCR: kukhudzidwa kwambiri, zotsatira zabodza
Ukadaulo wa jini chip: gawo lofufuza.
5. Kuchuluka kwa mafupa:
Kufufuza kwa cytological kwa madzimadzi a m'mafupa, chikhalidwe cha mabakiteriya ndi mayeso okhudzana ndi mankhwala.
Njira iyi ndi yosavuta, yachangu komanso yolondola
Mu matenda a m'chiuno, kuchuluka kwa leukocyte m'mafupa olumikizirana mafupa> 3,000/ml kuphatikiza ndi kuchuluka kwa ESR ndi CRP ndiye muyezo wabwino kwambiri wodziwira kupezeka kwa matenda opatsirana m'mimba.
6. Kuchiza matenda a m'mimba mwa opaleshoni yofulumira yozizira
Gawo lozizira mofulumira la minofu ya periprosthetic mkati mwa opaleshoni ndiyo njira yogwiritsidwa ntchito kwambiri mkati mwa opaleshoni pofufuza histopathological. Njira zodziwira matenda za Feldman, zomwe ndi zazikulu kuposa kapena zofanana ndi ma neutrophils 5 pa kukula kwakukulu (400x) m'magawo osachepera asanu osiyana a microscopic, nthawi zambiri zimagwiritsidwa ntchito ku magawo ozizira. Zawonetsedwa kuti kukhudzidwa ndi kudziwika kwa njira iyi kudzapitirira 80% ndi 90%, motsatana. Njira iyi pakadali pano ndiye muyezo wagolide wodziwira matenda mkati mwa opaleshoni.
7. Chikhalidwe cha bakiteriya cha minofu yodwala
Kukula kwa mabakiteriya m'maselo a periprosthetic kumakhala ndi njira yapadera yodziwira matenda ndipo kwawonedwa ngati muyezo wabwino kwambiri wodziwira matenda a periprosthetic, ndipo kungagwiritsidwenso ntchito poyesa kukhudzidwa ndi mankhwala.
IV. Kuzindikira matenda osiyanasiyanas
Matenda opangidwa ndi ziwalo zolumikizirana mafupa osapweteka omwe amayamba chifukwa cha Staphylococcus epidermidis ndi ovuta kusiyanitsa ndi kumasuka kwa ziwalo zolumikizirana mafupa. Ayenera kutsimikiziridwa ndi ma X-ray ndi mayeso ena.
V. Chithandizo
1. Chithandizo chosavuta choteteza maantibayotiki
Tsakaysma ndi se,gawa adagawa matenda a post arthroplasty m'magulu anayi, mtundu woyamba wopanda zizindikiro, wodwalayo ali mu chikhalidwe cha minofu ya opaleshoni yokonzedwanso yomwe yapezeka kuti ili ndi kukula kwa bakiteriya, ndipo zitsanzo ziwiri zokha zomwe zalimidwa ndi mabakiteriya omwewo; mtundu wachiwiri ndi matenda oyamba, omwe amapezeka mkati mwa mwezi umodzi kuchokera pamene opaleshoni yachitidwa; mtundu wachiwiri ndi matenda osatha omwe amachedwa; ndipo mtundu wachinayi ndi matenda opatsirana kwambiri. Mfundo yogwiritsira ntchito maantibayotiki ndi yofatsa, yokwanira komanso nthawi yokwanira. Ndipo kubowola m'mimba mwa mafupa musanachite opaleshoni ndi chikhalidwe cha minofu mkati mwa opaleshoni ndizofunikira kwambiri pakusankha bwino maantibayotiki. Ngati chikhalidwe cha bakiteriya chili ndi kachilombo ka mtundu woyamba, kugwiritsa ntchito mosavuta maantibayotiki ofatsa kwa milungu 6 kungapangitse zotsatira zabwino.
2. Kusunga pulasitiki, kuchotsa zinyalala ndi kuchotsa madzi m'thupi, opaleshoni yothirira m'machubu
Mfundo yoti munthu agwiritse ntchito njira yochizira matenda opweteka kwambiri ndi yakuti njira yochizira matendawo ndi yokhazikika komanso yowopsa. Kachirombo komwe kamayambitsa matendawa n'komveka bwino, mphamvu ya bakiteriya ndi yochepa ndipo maantibayotiki ndi osavuta kuwagwiritsa ntchito, ndipo cholumikizira kapena cholumikizira chingasinthidwe panthawi yochotsa mabakiteriya. Chiwerengero cha machiritso ndi 6% yokha ndi maantibayotiki okha ndi 27% ndi maantibayotiki kuphatikiza kuchotsa mabakiteriya ndi kusunga mabakiteriya agwiritsidwa ntchito m'mabuku.
Ndi yoyenera matenda oyamba kapena matenda opatsirana kudzera m'magazi komanso kukhala ndi prosthesis yabwino; komanso, n'zoonekeratu kuti matendawa ndi matenda a bakiteriya omwe ndi oopsa kwambiri omwe amakhudzidwa ndi mankhwala opha tizilombo toyambitsa matenda. Njirayi imaphatikizapo kuchotsa poizoni m'thupi, kuchotsa mabakiteriya ndi kutulutsa madzi m'thupi (kwa milungu 6), komanso kugwiritsa ntchito mankhwala opha tizilombo toyambitsa matenda m'mitsempha pambuyo pa opaleshoni (kwa milungu 6 mpaka miyezi 6). Zoyipa zake: kulephera kwakukulu (mpaka 45%), nthawi yayitali yochizira.
3. Opaleshoni yokonzanso gawo limodzi
Ili ndi ubwino wochepa kuvulala, kukhala kuchipatala kwa nthawi yochepa, ndalama zochepa zachipatala, kuchepa kwa chilonda ndi kuuma kwa mafupa, zomwe zimathandiza kuti mafupa abwererenso kugwira ntchito bwino pambuyo pa opaleshoni. Njirayi ndi yoyenera kwambiri pochiza matenda oyamba komanso matenda opatsirana m'magazi.
Kubwezeretsa kwa gawo limodzi, mwachitsanzo, njira imodzi, kumangokhala matenda ochepa poizoni, kuchotsa kwathunthu poizoni, simenti ya mafupa opha tizilombo toyambitsa matenda, komanso kupezeka kwa maantibayotiki ofunikira. Kutengera zotsatira za gawo lozizira la minofu mkati mwa opaleshoni, ngati pali ma leukocyte ochepera 5/munda wokulitsa kwambiri. Zikusonyeza kuti matenda ochepa poizoni. Pambuyo pochotsa kwathunthu poizoni, arthroplasty ya gawo limodzi idachitika ndipo palibe kachilombo komwe kadabwereranso pambuyo pa opaleshoni.
Pambuyo pochotsa bwino, chogwiriracho chimasinthidwa nthawi yomweyo popanda kufunikira opaleshoni yotseguka. Chili ndi ubwino wa kuvulala pang'ono, nthawi yochepa yochizira komanso mtengo wotsika, koma kuchuluka kwa matenda obweranso pambuyo pa opaleshoni kumakhala kokwera, komwe kuli pafupifupi 23% ~ 73% malinga ndi ziwerengero. Kusintha chogwirira chimodzi cha gawo limodzi ndikoyenera makamaka kwa odwala okalamba, popanda kuphatikiza chilichonse mwa izi: (1) mbiri ya opaleshoni zingapo pa cholumikizira chosinthira; (2) kupangika kwa sinus tract; (3) matenda oopsa (monga septic), ischemia ndi zipsera za minofu yozungulira; (4) kuchotsedwa kwathunthu kwa kuvulala ndi simenti yochepa yotsala; (5) X-ray yosonyeza osteomyelitis; (6) zolakwika za mafupa zomwe zimafuna kuikidwa m'mafupa; (7) matenda osakanikirana kapena mabakiteriya oopsa kwambiri (monga Streptococcus D, mabakiteriya a Gram-negative); (8) kutayika kwa mafupa komwe kumafunikira kuikidwa m'mafupa; (9) kutayika kwa mafupa komwe kumafunikira kuikidwa m'mafupa; ndi (10) kuikidwa m'mafupa komwe kumafunikira kuikidwa m'mafupa. Streptococcus D, mabakiteriya opanda gramu, makamaka Pseudomonas, ndi zina zotero), kapena matenda a bowa, matenda a mycobacterial; (8) Kukula kwa mabakiteriya sikudziwika bwino.
4. Opaleshoni yokonzanso gawo lachiwiri
Kwa zaka 20 zapitazi, yakhala ikukondedwa ndi madokotala ochita opaleshoni chifukwa cha zizindikiro zake zosiyanasiyana (mafupa okwanira, minofu yofewa yambiri ya periarticular) komanso kuchuluka kwa matenda omwe amabwera chifukwa cha matendawa.
Ma spacers, onyamula maantibayotiki, maantibayotiki
Mosasamala kanthu za njira yogwiritsira ntchito spacer, kulimbitsa ndi maantibayotiki ndikofunikira kuti maantibayotiki ambiri azikhala m'malo olumikizirana mafupa ndikuwonjezera kuchuluka kwa maantibayotiki omwe amachira. Maantibayotiki omwe amagwiritsidwa ntchito kwambiri ndi tobramycin, gentamicin ndi vancomycin.
Gulu la akatswiri a mafupa padziko lonse lapansi lazindikira njira yabwino kwambiri yothandizira matenda ozama pambuyo pa arthroplasty. Njirayi imaphatikizapo kuchotsa bwino ziwalo zoberekera, kuchotsa ziwalo zoberekera ndi thupi lachilendo, kuyika cholumikizira mafupa, kupitiriza kugwiritsa ntchito mankhwala ophera tizilombo toyambitsa matenda m'mitsempha kwa milungu yosachepera 6, ndipo pomaliza, pambuyo poletsa matendawa, kubwezeretsa ziwalo zoberekera.
Ubwino:
Nthawi yokwanira yodziwira mtundu wa mabakiteriya ndi mankhwala ophera tizilombo toyambitsa matenda omwe ali ndi vuto, omwe angagwiritsidwe ntchito bwino musanachite opaleshoni yokonzanso.
Kuphatikiza kwa matenda ena opatsirana m'thupi kumatha kuchiritsidwa mwachangu.
Pali mwayi woti kuchotsa minofu yotupa ndi matupi akunja bwino kwambiri, zomwe zimachepetsa kwambiri kuchuluka kwa matenda omwe amabweranso pambuyo pa opaleshoni.
Zoyipa:
Kubwereza opaleshoni ndi opaleshoni kumawonjezera chiopsezo.
Nthawi yayitali ya chithandizo komanso ndalama zambiri zachipatala.
Kuchira kwa ntchito pambuyo pa opaleshoni kumakhala kofooka komanso kochedwa.
Arthroplasty: Yoyenera matenda osatha omwe sayankha chithandizo, kapena matenda aakulu a mafupa; vuto la wodwalayo limalepheretsa opaleshoni kuyambiranso ndi kukonzanso. Ululu wotsala pambuyo pa opaleshoni, kufunika kogwiritsa ntchito zomangira zothandizira kuyenda bwino, kusakhazikika bwino kwa mafupa, kufupika kwa miyendo, kukhudzidwa kwa ntchito, komanso kuchuluka kwa momwe angagwiritsire ntchito ndi kochepa.
Arthroplasty: njira yachikhalidwe yothandizira matenda opatsirana pambuyo pa opaleshoni, yokhala ndi kukhazikika bwino pambuyo pa opaleshoni komanso kuchepetsa ululu. Zoyipa zake ndi monga kufupikitsa mwendo, matenda oyenda komanso kulephera kuyenda bwino kwa mafupa.
Kuduladula: Ndi njira yomaliza yochizira matenda ozama pambuyo pa opaleshoni. Yoyenera: (1) kutayika kwa mafupa kwakukulu kosatha, zolakwika za minofu yofewa; (2) kufalikira kwa mabakiteriya amphamvu, matenda osiyanasiyana, chithandizo cha maantibayotiki sichigwira ntchito, zomwe zimapangitsa kuti thupi liziwopse, komanso chiwopsezo cha moyo; (3) ali ndi mbiri yolephera mobwerezabwereza opaleshoni yokonzanso odwala omwe ali ndi matenda aakulu.
VI. Kupewa
1. Zinthu zomwe zisanachitike opaleshoni:
Konzani bwino momwe wodwalayo alili asanachite opaleshoni ndipo matenda onse omwe alipo ayenera kuchiritsidwa asanachite opaleshoni. Matenda ofala kwambiri omwe amafalikira m'magazi ndi ochokera pakhungu, mkodzo, ndi njira yopumira. Pa opaleshoni ya m'chiuno kapena bondo, khungu la miyendo ya m'munsi liyenera kukhala losasweka. Bacteriuria yosaoneka bwino, yomwe imapezeka kwambiri mwa odwala okalamba, sikufunika kuchiritsidwa asanachite opaleshoni; zizindikiro zikayamba, ayenera kuchiritsidwa mwachangu. Odwala omwe ali ndi tonsillitis, matenda am'mimba, ndi tinea pedis ayenera kuchotsedwa matenda am'deralo. Opaleshoni zazikulu za mano ndi gwero lomwe lingayambitse matenda m'magazi, ndipo ngakhale kuti amapewa, ngati opaleshoni ya mano ndi yofunikira, tikukulimbikitsani kuti njira zotere zichitike asanayambe opaleshoni. Odwala omwe ali ndi matenda oopsa monga kuchepa kwa magazi m'thupi, hypoproteinaemia, matenda a shuga ophatikizana komanso matenda osatha amkodzo ayenera kuchiritsidwa mwachangu komanso mwachangu kuti matenda oyamba awongolere mkhalidwe wa thupi.
2. Kusamalira odwala panthawi ya opaleshoni:
(1) Njira ndi zida zosawononga konse ziyeneranso kugwiritsidwa ntchito pochiza matenda a arthroplasty.
(2) Kugonekedwa m'chipatala asanachite opaleshoni kuyenera kuchepetsedwa kuti pasakhale chiopsezo choti khungu la wodwalayo lingalowe m'malo mwa mabakiteriya omwe amabwera kuchipatala, ndipo chithandizo chanthawi zonse chiyenera kuchitika tsiku la opaleshoni.
(3) Malo oti khungu likonzedwe asanachite opaleshoni ayenera kukonzedwa bwino kuti akonzekeretsedwe.
(4) Zovala zochitira opaleshoni, zophimba nkhope, zipewa, ndi malo ochitira opaleshoni otseguka zimathandiza kwambiri kuchepetsa mabakiteriya owuluka mu chipinda chochitira opaleshoni. Kuvala magolovesi awiri kungachepetse chiopsezo cha kukhudzana ndi dzanja pakati pa dokotala ndi wodwala ndipo kungalimbikitsidwe.
(5) Zatsimikiziridwa kuti kugwiritsa ntchito njira zochepetsera kwambiri, makamaka zolumikizidwa, kuli ndi chiopsezo chachikulu chotenga matenda kuposa njira zochepetsera mawondo onse chifukwa cha zinyalala zachitsulo zomwe zimachepetsa ntchito ya phagocytosis, motero ziyenera kupewedwa posankha njira zochepetsera.
(6) Konzani njira yochitira opaleshoni ya wochita opaleshoni ndikufupikitsa nthawi ya opaleshoni (<2.5 maola ngati n'kotheka). Kufupikitsa nthawi ya opaleshoni kungachepetse nthawi yogwiritsidwa ntchito ndi mpweya, zomwe zingachepetse nthawi yogwiritsira ntchito tourniquet. Pewani opaleshoni yoopsa panthawi ya opaleshoni, bala likhoza kuthiriridwa mobwerezabwereza (mpu wothirira ndi wabwino kwambiri), ndipo kumiza ndi nthunzi ya ayodini kungatengedwe kuti mucheke mabala omwe akuganiziridwa kuti ali ndi kachilomboka.
3. Zinthu zomwe zimachitika munthu akachita opaleshoni:
(1) Kuvulala kwa opaleshoni kumayambitsa kukana kwa insulin, komwe kungayambitse hyperglycemia, vuto lomwe limatha kupitirira kwa milungu ingapo pambuyo pa opaleshoni ndikupangitsa wodwalayo kukhala ndi mavuto okhudzana ndi mabala, komanso lomwe limapezekanso kwa odwala omwe si odwala matenda a shuga. Chifukwa chake, kuyang'anira shuga m'magazi pambuyo pa opaleshoni ndikofunikira kwambiri.
(2) Kutsekeka kwa mitsempha yamagazi (deep vein thrombosis) kumawonjezera chiopsezo cha haematoma ndi mavuto okhudzana ndi mabala. Kafukufuku wokhudza milandu adapeza kuti kugwiritsa ntchito heparin yochepa pambuyo pa opaleshoni kuti mupewe kutsekeka kwa mitsempha yamagazi (deep vein thrombosis) kunali kothandiza pochepetsa mwayi wopatsirana matenda.
(3) Kutsekeka kwa ngalande ndi njira yolowera matenda, koma ubale wake ndi kuchuluka kwa matenda m'mabala sunaphunziridwe mwapadera. Zotsatira zoyambirira zikusonyeza kuti ma catheter amkati mwa articular omwe amagwiritsidwa ntchito popereka mankhwala ochepetsa ululu pambuyo pa opaleshoni nawonso akhoza kukhala pachiwopsezo cha matenda m'mabala.
4. Kuteteza maantibayotiki:
Pakadali pano, kugwiritsa ntchito mankhwala oletsa maantibayotiki m'njira yodzitetezera m'thupi nthawi zonse asanayambe opaleshoni komanso atachitidwa opaleshoni kumachepetsa chiopsezo cha matenda opatsirana pambuyo pa opaleshoni. Cephalosporins nthawi zambiri amagwiritsidwa ntchito ngati mankhwala opha tizilombo, ndipo pali ubale wofanana ndi U pakati pa nthawi yogwiritsira ntchito mankhwala opha tizilombo ndi kuchuluka kwa matenda opatsirana pamalo opaleshoni, ndi chiopsezo chachikulu cha matenda onse asanayambe komanso atatha kugwiritsa ntchito mankhwala opha tizilombo. Kafukufuku waposachedwapa adapeza kuti mankhwala opha tizilombo omwe amagwiritsidwa ntchito mkati mwa mphindi 30 mpaka 60 asanadulidwe anali ndi chiwerengero chochepa kwambiri cha matenda opatsirana. Mosiyana ndi zimenezi, kafukufuku wina waukulu wa matenda onse a m'chiuno anasonyeza kuti chiwerengero chochepa kwambiri cha matenda opatsirana ndi maantibayotiki omwe amaperekedwa mkati mwa mphindi 30 zoyambirira za kudula. Chifukwa chake nthawi yoperekedwa nthawi zambiri imaonedwa kuti ndi mphindi 30 asanayambe opaleshoni, ndipo zotsatira zake zimakhala zabwino kwambiri panthawi yoyambitsa opaleshoni. Mlingo wina woletsa maantibayotiki umaperekedwa pambuyo pa opaleshoni. Ku Ulaya ndi ku United States, maantibayotiki nthawi zambiri amagwiritsidwa ntchito mpaka tsiku lachitatu pambuyo pa opaleshoni, koma ku China, akuti nthawi zambiri amagwiritsidwa ntchito mosalekeza kwa milungu 1 mpaka 2. Komabe, anthu ambiri amavomereza kuti kugwiritsa ntchito mankhwala amphamvu opha tizilombo toyambitsa matenda m'njira zosiyanasiyana kuyenera kupewedwa kwa nthawi yayitali pokhapokha ngati pali zifukwa zinazake, ndipo ngati kugwiritsa ntchito mankhwala opha tizilombo nthawi yayitali n'kofunikira, ndibwino kugwiritsa ntchito mankhwala opha tizilombo pamodzi ndi mankhwala opha tizilombo kuti tipewe matenda a bowa. Vancomycin yawonetsedwa kuti ndi yothandiza kwa odwala omwe ali pachiwopsezo chachikulu chokhala ndi Staphylococcus aureus yokana methicillin. Mankhwala opha tizilombo ayenera kugwiritsidwa ntchito pa opaleshoni yayitali, kuphatikizapo opaleshoni ya mbali zonse ziwiri, makamaka pamene theka la moyo wa mankhwala opha tizilombo ndi lalifupi.
5. Kugwiritsa ntchito mankhwala opha tizilombo toyambitsa matenda pamodzi ndi simenti ya mafupa:
Simenti yopangidwa ndi maantibayotiki inagwiritsidwanso ntchito koyamba mu arthroplasty ku Norway, komwe poyamba kafukufuku wa Norwegian Arthroplasty Registry adawonetsa kuti kugwiritsa ntchito kuphatikiza kwa maantibayotiki IV ndi simenti (kuphatikiza maantibayotiki prosthesis) kunachepetsa kuchuluka kwa matenda ozama bwino kuposa njira iliyonse yokha. Kupeza kumeneku kunatsimikiziridwa mu kafukufuku wambiri pazaka 16 zotsatira. Kafukufuku waku Finland ndi Australian Orthopaedic Association 2009 adafika pamalingaliro ofanana okhudza ntchito ya simenti yopangidwa ndi maantibayotiki mu arthroplasty ya bondo yoyamba komanso yokonzanso. Zawonetsedwanso kuti mphamvu za biomechanical za simenti ya mafupa sizimakhudzidwa pamene ufa wa maantibayotiki wowonjezedwa mu mlingo wosapitirira 2 g pa 40 g ya simenti ya mafupa. Komabe, si maantibayotiki onse omwe angawonjezedwe ku simenti ya mafupa. Maantibayotiki omwe angawonjezedwe ku simenti ya mafupa ayenera kukhala ndi izi: chitetezo, kukhazikika kwa kutentha, kusayambitsa ziwengo, kusungunuka bwino kwamadzimadzi, ma antibayotiki ambiri, ndi zinthu zophikidwa. Pakadali pano, vancomycin ndi gentamicin zimagwiritsidwa ntchito kwambiri pazachipatala. Ankaganiza kuti kulowetsa mankhwala opha tizilombo mu simenti kungawonjezere chiopsezo cha ziwengo, kubuka kwa mitundu yolimbana ndi matenda, komanso kumasuka kwa ziwalo zoberekera, koma pakadali pano palibe umboni wotsimikizira izi.
VII. Chidule
Kupeza matenda mwachangu komanso molondola kudzera m'mbiri, kuyezetsa thupi, ndi mayeso ena ndi chinthu chofunikira kwambiri kuti chithandizo cha matenda a mafupa chikhale chopambana. Kuchotsa matenda ndi kubwezeretsa cholumikizira chopangidwa chopanda ululu komanso chogwira ntchito bwino ndiye mfundo yayikulu pakuchiza matenda a mafupa. Ngakhale kuti chithandizo cha maantibayotiki cha matenda a mafupa ndi chosavuta komanso chotsika mtengo, kuthetsa matenda a mafupa nthawi zambiri kumafuna njira zosiyanasiyana zochitira opaleshoni. Chofunika kwambiri posankha chithandizo cha opaleshoni ndikuganizira vuto la kuchotsa ziwalo zoberekera, lomwe ndi gawo lalikulu pothana ndi matenda a mafupa. Pakadali pano, kugwiritsa ntchito maantibayotiki, kuchotsa zinyalala ndi arthroplasty kwakhala chithandizo chokwanira cha matenda ambiri ovuta a mafupa. Komabe, chikufunikabe kukonzedwa bwino ndikukonzedwanso.
Nthawi yotumizira: Meyi-06-2024
