Matenda ndi amodzi mwazovuta kwambiri pambuyo polowa m'malo mwa zojambulajambula, zomwe sizingobweretsa zopaka zambiri kwa odwala, komanso zimadyanso zamankhwala. Kwa zaka 10 zapitazi, kuchuluka kwa matenda opatsirana pambuyo pogwiritsira ntchito zojambula zomwe zawonongeka kwambiri, koma kukula kwazinthu zomwe zimachitika mopitirira muyeso zomwe zimachitika mopitilira muyeso, motero vuto la matenda a postoperative siyenera kunyalanyazidwa.
I. Zoyambitsa Morbidity
Matenda ophatikizika a pambuyo pake ayenera kuonedwa ngati matenda opezeka kuchipatala ndi zolengedwa zosagwirizana ndi mankhwala osokoneza bongo. Chofala kwambiri ndi staphyloccus, yowerengera 70% mpaka 80%, gram-grom-startives ndipo osakhala gulu la gulu la gululi limafalanso.
Ii pathogenesis
Matendawa amagawidwa m'magulu awiri: imodzi imayamba kubadwa koyambirira ndipo inayo imayamba kuseta kapena kutchedwa matenda owiritsa. Matenda oyambilira amayambitsidwa ndi kulowa mwachindunji kwa mabakiteriya pakuchita opaleshoni pochita opaleshoni ndipo nthawi zambiri amatulutsa eyobococcus epidermidisis. Matenda osinthika oyambitsidwa ndi omwe amayamba chifukwa cha kufala kwa magazi ndi magazi ndipo nthawi zambiri amakhala a Aumuyloccus Aureus. Malumikizidwe omwe achitiridwa opareshoni amatha kutenga kachilomboka. Mwachitsanzo, pali kuchuluka kwa mankhwala okwanira 10% nthawi yosinthiratu pambuyo polumikizirana ndi zojambulazo, ndipo kuchuluka kwa matendawa kumapezekanso kwa anthu omwe alowa m'malo mwa nyamakazi ya rheumatoid.
Matenda ambiri m'miyezi ingapo atachitidwa opareshoni, oyambirirawo amatha kupezeka pazaka ziwiri zoyambirira pambuyo potupa, zopweteka ndi matenda am'mimba ziyenera kuchitika.
Pankhani ya matenda oyambilira, kutentha kwa thupi sikungochira, koma kumabweretsa masiku atatu atachitidwa opaleshoni. Kupweteka kolumikizira sikumangochepetsa pang'onopang'ono, koma pamawuma pang'ono pang'onopang'ono. Pali oozing ozizira kapena katulutsidwe kuchokera kuzolowera. Izi zikuyenera kuyang'aniridwa mosamala, ndipo kutentha sikuyenera kufotokozedwa mosavuta matenda ena amthupi monga mapapu kapena kwamikodzo. Ndikofunikanso kuti tisangoikapo nkhawa kwambiri ngati ooziya wamba monga mowa wamafuta. Ndikofunikanso kudziwa ngati matendawa ali ndi minofu yazokwezeka kapena mozama kuzungulira prosthesis.
Odwala omwe ali ndi matenda ochulukirachulukira, ambiri mwa omwe adachoka kuchipatala, kutupa limodzi, kupweteka, ndi malungo sikungakhale koopsa. Hafu ya odwala mwina alibe malungo. Staphylococcus epidermidis imatha kuyambitsa matenda opanda chopweteka ndi sewero loyera la magazi mu 10% yokha ya odwala. Kudula magazi kwakwezeka kwambiri koma osatinso mwachindunji. Ululu nthawi zina umasiyidwa kuti umamasulidwa, wotsiriza kukhala ululu wogwirizana ndi kayendedwe kamene kayenera kupumula ndikupumula, komanso kupweteka kwa kutupa komwe sikutsitsidwa ndi kupumula. Komabe, zanenedwa kuti chomwe chimayambitsa ma prostote chomasulira chimachedwa kudwala.
Iii. Kufufuza
1. Kuyesedwa kwa Haemitological:
Makamaka kuchuluka kwa khungu la magazi kuphatikiza, interleunin 6 (Il-6), p-6), p-6), p-6 Ubwino wa Kuyesedwa modekha ndikosavuta komanso kosavuta kuchita, ndipo zotsatira zake zitha kupezeka mwachangu; ESR ndi CRP ili ndi mawonekedwe otsika; Il-6 ndi yamtengo wapatali posankha matenda osokoneza bongo a nthawi yoyambirira.
Kuyesedwa:
Kanema wa X-ray: Palibe mwanzeru kapena mwachindunji pakuzindikira matenda.
Mafilimu a X-ray a bondo
Arthrography: Kuimira kwakukulu pakuzindikira matenda opatsirana ndi kutuluka kwa synovial madzimadzi ndi thumba.
CT: Kuwona Zogwirizana ndi Zogwirizana, matrakiti a sinus, minofu yofewa ya minofu, kukokoloka kwa mafupa, kusinthika kwa mafupa.
MRI: Yabwino kwambiri pakuzindikira madzimadzi ophatikizira ndi ma abscesses, osagwiritsidwa ntchito kwambiri pakuzindikira matenda osokoneza bongo.
Ultrasound: kudzikundikira kwamadzi.
3. mankhwala osaya
Technetium-99 Mphepo ili ndi chidwi cha 33% ndi mtundu wa 86% pozindikira matenda osokoneza bongo a ETOROCLAST, ndi chidwi cha 77% ndi mtundu wa 86%. Mitundu iwiriyo ikagwiritsidwa ntchito limodzi kuti muyesedwe matenda opatsirana osokoneza bongo atatha, chidwi chachikulu, mwachindunji ndi kulondola kungathe kutheka. Kuyezetsa kumeneku kudakali muyeso wa golide mankhwala anyukiliya pozindikira matenda osokoneza bongo. Fluorodeoccucose. Imakhala ndi kutupa maselo ochulukirapo ndi kuchuluka kwa shuga komwe kumapezeka mu malo omwe ali ndi kachilombo.
4.. Maluso a Molecular Biology
PCR: chidwi chachikulu, chabwino
Gene Chim Technoloje: Gawo.
5. Arthroces:
Kuyesedwa kwa kwazirona kwa madzi ophatikizira, mabakiteriya komanso kuyeserera kwa mankhwala osokoneza bongo.
Njirayi ndi yosavuta, yosathamanga komanso yolondola
Mu matenda opatsirana m'chiuno, 3,000 / Ml yophatikizidwa ndi ESR ndi CRP ndiyo njira yabwino kwambiri yopezera matenda osokoneza bongo.
6. Kukula kwamphamvu kozizira kozizira
Gawo lowopsa lambiri la minofu yopanda zotupa ndi njira yomwe imagwiritsidwa ntchito kwambiri yopenda histopathy mayeso. Miyezo ya Fedleman, ie, wamkulu kuposa kapena wofanana ndi 5 neutrophils pakulu pamtunda (400x) osachepera 5 osiyana microscopic, nthawi zambiri imagwiritsidwa ntchito ndi zigawo zachisanu. Zawonetsedwa kuti chidwi ndi tanthauzo la njirayi chidzapitilira 80% ndi 90%, motsatana. Njirayi ndi muyeso wa Gold ndi gawo la Gold.
7.
Maganizo a mabakiteriya a minyewa yopanda matenda ali pachibwenzi kwambiri pakuzindikira matenda ndipo amawonedwa ngati muyezo wa golide wopeza matenda osokoneza bongo, ndipo amathanso kugwiritsidwa ntchito poyesa kugwiritsa ntchito mankhwala osokoneza bongo.
Iv. Matenda osiyanasiyanas
Matenda opanda ululu opweteka obwera chifukwa cha staphylococcus epidermudis ndizovuta kwambiri kusiya kumasula koyenera. Iyenera kutsimikiziridwa ndi ma X-ray ndi mayesero ena.
V. Chithandizo
1. Mankhwala osavuta a maanibiotic
Tsakaysma ndi Se, GAWA Class Extroplasty matenda mumitundu inayi, mtundu wa ma opareshoni, wodwalayo osachepera kukula kwa mabakiteriya; Mtundu II ndi matenda oyambilira, omwe amapezeka mwezi umodzi wa opaleshoni; Mtundu wa IIL ndi matenda ochedwetsa; ndipo lembani IV ndi kachilombo ka HAMEAOATENOOSOOOSOOOSLOOOS. Mfundo ya mankhwalawa imatha, yokwanira komanso nthawi. Ndipo wothandizirana ndi kholo lolumikizana ndi zikhalidwe zowoneka bwino ndizofunikira kwambiri pakusankha koyenera kwa maantibayotiki. Ngati mabakiteriya ndi abwino kwambiri mtundu wa matenda a matenda, kugwiritsa ntchito kosavuta kwa maantibayotiki ang'onoang'ono kwa milungu isanu ndi umodzi kumatha kupeza zotsatira zabwino.
2. Prosthesis posungira, kuwonongeka ndi ngalande, chubu chothirira opaleshoni yothirira
MPHAMVU YOPHUNZITSIRA KULIMBITSA KWAULERE KULIMA PROSTITIS ndikuti ma prosthesis ndi okhazikika komanso matenda osokoneza bongo. The infecting organism is clear, the bacterial virulence is low and sensitive antibiotics are available, and the liner or spacer can be replaced during debridement. Chiritsani mafinya 6% okha okhala ndi maantibayotiki okha ndi 27% okhala ndi maantibayotiki kuphatikiza zinyalala ndi prosthesis kutetezedwa m'mabuku.
Ndioyenera matenda oyambilira kapena kuyika matenda a hamatototonous ndi matenda a prostatis; Komanso, zikuwonekeratu kuti matendawo ndi matenda osokoneza bongo omwe amakhudzidwa ndi antimicrobial mankhwala. Njirayi imakhala yotsetsa yotsekemera bwino, mantimicrobial flushing ndi ngalande (nthawi yayitali 6), ndipo postoperative sysraveous antimicrobials (nthawi 6 milungu mpaka miyezi 6). Zovuta: Kulephera kwakukulu (mpaka 45%), nthawi yayitali chithandizo.
3. Kubwezeretsanso kwa opaleshoni imodzi
Ili ndi zabwino zoperewera pang'ono, chipatala chofupika chija, mtengo wotsika wacipatala, mtengo wochepera kapena kuwuma kochepa, komwe kumapangitsa kuti abweze ntchito atachita opareshoni. Njirayi ndiyoyenera mankhwalawa matenda oyambilira komanso matenda ang'onoatous informaus.
Imodzi yaikulu, mwachitsanzo, njira imodzi yokhayo, imangokhala ndi matenda oopsa, kutsekeka bwino, simenti yamagetsi yamatsenga, komanso kupezeka kwa maantibayotiki. Kutengera ndi zotsatira za minofu yazisanu yowuma, ngati pali gawo lochepera 5 leukocytes / gawo lalikulu. Ikufotokozerani matenda oopsa. Pambuyo pakudalitsa mokwanira gawo limodzi la arthroplasty linachitidwa ndipo panalibe matenda opatsirana post.
Pambuyo pakuchepetsa bwino, ma prostafesi amasinthidwa nthawi yomweyo osafunikira njira yotsegulira. Ili ndi zopweteka zazing'ono, nthawi yayifupi ya mankhwala ndi mtengo wochepa, koma kubwezeretsanso matenda opatsirana kwa posta otalika ndikokwera, komwe kuli pafupifupi 23% ~ 73% malinga ndi ziwerengero. Malo amodzi a prostateris amalowa m'malo mwake makamaka oyenera odwala okalamba, osaphatikizanso zotsatirazi: (1) Mbiri ya maopaleshoni angapo pamalo olumikizirana; (2) Thupi la Trusus; (3) matenda oopsa (mwachitsanzo septic), ischemia komanso minofu yozungulira; (4) Kupumula kosakwanira kwa zowawa ndi simenti yotsalira; (5) X-ray ikusonyeza kuti osteomyelitis; (6) Mavuto mafupa amafunikira magetsi; . (8) Kutaya fupa kumafuna kupanikizidwa kwa mafupa; (9) Kutaya fupa kumafuna kupanikizidwa kwa mafupa; ndi (10) Kulumikiza mafupa kumafuna kukonzekera fupa. Streptocococcus D, mabakiteriya olakwika, makamaka pseudomonas, etc.), kapena matenda oyamba ndi matenda a mycobacteal; (8) Chikhalidwe cha bakiteriya sichimveka.
4. Kukonzanso opaleshoni yachiwiri
Amakondwera ndi opaleshoni pazaka 20 zapitazi chifukwa cha zisonyezo zake (mafupa okwanira, zonunkhira zofewa) ndi kuchuluka kwakukulu kwa matenda.
Spacers, zonyamula maantibiotic, maantibayotiki
Mosasamala za luso la malo omwe amagwiritsidwa ntchito, kukhazikitsidwa kwa maantibayotiki ndikofunikira kuti muwonjezere maantibayotiki polumikizana ndikuwonjezera chithandizo chamankhwala. Maantibayotiki omwe ambiri amagwiritsidwa ntchito ndi tobramycin, AmincomCocycin.
Anthu apadziko lonse lapansi azindikira chithandizo chothandiza kwambiri chifukwa cha matenda am'mimba atadwala. Njirayi imakhala yotchinga bwino, kuchotsedwa kwa prosthes ndi thupi lakunja, kuyika kwa mantimini ophatikizika kwa masabata osachepera 6, kenako ndikugwiritsa ntchito njira yothetsera matendawa, kugwirizanitsa kachilomboka kwa prostate.
Ubwino:
Nthawi yokwanira kuti mudziwe mtundu wa bakiteriya komanso ma antimicrobial othandizira, omwe amatha kugwiritsidwa ntchito bwino asanakonzedwe opaleshoni.
Kuphatikiza kwa malingaliro ena okhudzana ndi matendawa kumatha kuthandizidwa munthawi yake.
Pali mwayi wofewetsa minyewa yochotsa minyewa ya necrotic komanso zachilendo kwambiri, zomwe zimachepetsa kwambiri kuchuluka kwa matenda obwera pambuyo pake.
Zovuta:
Kugulitsanso opaleshoni ndi opaleshoni kumawonjezera chiopsezo.
Nthawi yayitali chithandizo chamankhwala ndi mtengo wazachipatala.
Kubwezeretsa kogwiritsa ntchito sikuyenera kukhala wosauka komanso wosakwiya.
Arthroplasty: yoyenera matenda osamala omwe samayankha chithandizo, kapena kuti mafupa akuluya akulu; Matenda a wodwala amachepetsa kubwezeretsansonso. Zowawa zotsalira, kufunika kogwiritsa ntchito braces nthawi yayitali kuthandiza kusuntha, kukhazikika kosavomerezeka, miyendo ikufupikitsa, njira yogwiritsira ntchito, mawonekedwe a ntchito ndi ochepa.
Arthroplasty: Chithandizo chachikhalidwe cha matenda a pambuyo postoperative matenda, mokhazikika pazinthu zabwino ndi zowawa. Zovuta zimaphatikizapo kufupikitsa kwa dzanja, zovuta za gait ndi kutayika kwa cholowa.
Kudula: Ndi njira yomaliza yochizira matenda opatsirana. Zoyenera: (1) kusataya mtima kwambiri kwa mafupa, minofu minofu; . (3) ali ndi mbiri ya kulephera kwakukulu kwa opaleshoni yambiri ya odwala omwe ali ndi kachilomboka.
Vi. Kulepheretsa
1..
Dzilimbikitseni zomwe wodwalayo anachita komanso matenda onse omwe alipo ayenera kuchiritsidwa. Matenda ofala kwambiri magazi kwambiri ndi omwe ali pakhungu, kwamikodzo thirakiti, komanso kupuma. M'chiuno kapena bondo arthroplasty, khungu la malekezero am'munsi liyenera kusokonekera. Asymptomatic Bacteriariatia, omwe amakhala odziwika kwambiri mwa okalamba odwala, safunikira kuchitiridwa chipongwe; Zikakhala kuti ziyenera kuthandizidwa mwachangu. Odwala omwe ali ndi Tonsillitis, matenda amtundu wapamwamba kwambiri, ndipo Tinea Pedis ayenera kukhala ndi malingaliro okhudzana ndi matenda omwe amachotsedwa. Ntchito zazikulu zamano ndizomwe zingatheke chifukwa cha matenda amtundu, ndipo ngakhale amapewedwa, ngati madongosolo akufunika chifukwa, ndikulimbikitsidwa kuti njira zotere zichitike asanachitike. Odwala omwe ali ndi vuto lalikulu monga anemia, hypophrotemaemia, matenda ashuga ndi matenda opatsirana amtundu wamtundu ayenera kuthandizidwa ndi matenda oyamba kuti azisintha mkhalidwe wazochitika.
2. Kuwongolera kopitilira:
.
.
(3) Malo otsogola ayenera kukonzedwa bwino kukonzekera pakhungu.
. Kuvala mabotolo awiri pawiri kungachepetse chiopsezo cholumikizana ndi dokotala komanso wodwala ndipo angalimbikitsidwe.
.
. Kufupikitsa kwa nthawi yayitali kumatha kuchepetsa nthawi yokhudza kuwonekera, komwe kumatha kuchepetsa nthawi ya ntchito ya alendo. Pewani Ntchito Yovuta Pa opaleshoni, chilondacho chimatha kuthirira mobwerezabwereza (chothira mfuti yothirira bwino), ndi ayodini-vaphror amatha kutengedwa kuti asokonezedwe.
3..
. Chifukwa chake, matenda opatsirana magazi a glucose amafunikanso.
. Phunziro la boma litapeza kuti postoperative kugwiritsa ntchito heparin kuti mupewe kupsinjika kwa nthochi sinali yopindulitsa pochepetsa kuthekera kwa matenda.
. Zotsatira zoyambilira zimasonyeza kuti mitsuko ya intra-yarticular yomwe imagwiritsidwa ntchito ngati postoperative makonzedwe a analgesics zitha kuphatikizidwanso ndi matenda opatsirana.
4. Antibiotic Prohylaxis:
Pakadali pano, momwe amagwiritsira ntchito mankhwala a prophylactic Mlingo wa maantibayotiki; CEPLSOROSONIS amagwiritsidwa ntchito kwambiri pachipatala monga mankhwalawa omwe amasankhidwa, ndipo pali ubale wowoneka bwino pakati pa nthawi yomwe amagwiritsa ntchito nthawi yogwiritsa ntchito mankhwalawa kale komanso mutatha nthawi yayitali yogwiritsa ntchito mankhwala osokoneza bongo. Kafukufuku wamkulu waposachedwa adapeza kuti maantibayotiki omwe amagwiritsidwa ntchito mkati mwa 30 mpaka 60 min musanayambe kutsika kwambiri. Mosiyana ndi zimenezo, kuphunzira kwina kwakukuru kwa arthroplasty ya m'chiuno kumawonetsa kuchepa kwa matenda omwe ali ndi maantibayotiki omwe amaperekedwa mkati mwa mphindi 30 zoyambirira. Chifukwa chake nthawi yoyang'anira nthawi zambiri imawerengedwa kuti ikhale 30 min isanachitike opareshoni, ndi zotsatira zabwino panthawi yochotsa opaleshoni. Mlingo wina wa maantibayotiki amapatsidwa opaleshoni. Ku Europe ndi United States, maantibayotiki nthawi zambiri amagwiritsidwa ntchito mpaka tsiku lachitatu postola, koma ku China, akuti nthawi zambiri amagwiritsidwa ntchito mosalekeza kwa milungu 1 mpaka 2. Komabe, mgwirizano waukuluwo ndi wogwiritsa ntchito nthawi yayitali maantibayotiki ochulukirapo ayenera kupewedwa pokhapokha ngati pali zochitika zapadera, ndipo ngati kugwiritsa ntchito mankhwala ochulukirapo ndikofunikira, ndikofunikira kugwiritsa ntchito mankhwala osokoneza bongo molumikizana ndi matenda oyamba ndi maantibiotic. Vancomycin yawonetsedwa kuti ikhale yothandiza odwala omwe ali pachiwopsezo chonyamula metaphyloccus areumu. Mlingo wapamwamba wa maantibayotiki ayenera kugwiritsidwa ntchito kwa maopaleshoni nthawi yayitali, kuphatikizapo maopaleshol a bilateral opaleshoni, makamaka pomwe antibayotiki ndi achidule.
5. Kugwiritsa ntchito maantibayotiki kuphatikiza ndi fupa la mafupa:
Chumenti ya antimasti ya antibatiki idagwiritsidwa ntchito koyamba kurthroplasty ku Northroplasty ku Norpahy Registry Phunziro la Aribosty linawonetsa kuti kugwiritsa ntchito matenda a antibiotic IV ndi sikisi) kulowetsedwa kwamphamvu kwambiri. Kupeza uku kunatsimikiziridwa m'maphunziro akulu akulu zaka 16 zotsatira. Phunziro la Chinema la ku Finland komanso malo oyanjana ndi Orthopedic Ogrian. Zawonetsedwanso kuti biomezacal katundu wa simenti yamafupa sizikhudzidwa mukafalikira mu Mlingo osapitirira 2 g pa 40 g wa mafupa a fupa. Komabe, si onse a maantibayotiki amatha kuwonjezeredwa ku fufu la mafupa. Maantibayotiki omwe amatha kuwonjezeredwa ku ma fu mafupa ayenera kukhala ndi zikhalidwe zotsatirazi: chitetezo, kukhazikika, hypoallergenicity, kusungunuka kosungunuka kosinthika, komanso antimicrobial spectrum, komanso zinthu zotsekemera. Pakadali pano, vancomycin ndi Aminmamicin amagwiritsidwa ntchito pochita zachipatala. Amaganiziridwa kuti jakisoni wa maantitani azikhala ndi chiwopsezo cha ngozi zomwe zimapangitsa kuti zitheke zisakhale, zimamera, komanso kutembenukira kwa prosthesis, koma pakadali pano palibe umboni wothandizira nkhawa izi.
VII. Chidule
Kuzindikira mwachangu komanso molondola kuzindikira kudzera m'mbiri, kuyesedwa kwakuthupi ndi kuyesa mayeso ndi chinthu chofunikira kwambiri kuti muchite bwino mankhwala opatsirana. Kulephera kwa matenda ndi kubwezeretsa kolumikizira kopweteka, kogwira ntchito bwino ndiye mfundo yoyambirira yochizira mauna. Ngakhale mankhwala ochepetsa mphamvu ndi osavuta komanso otsika mtengo, kuthekera kwa matenda ophatikizika makamaka kumafunikira kuphatikiza njira zochitira opaleshoni. Chinsinsi chosankha chithandizo chamankhwala ndikuwona vuto la Prostate Pakadali pano, kugwiritsa ntchito kophatikizidwa kwa maantibayotiki, kutsika ndi arthroplasty yakhala chithandizo chokwanira cha matenda ovuta kwambiri. Komabe, zimafunikirabe kusintha komanso kukwaniritsidwa.
Post Nthawi: Meyi-06-2024
