Kutenga kachilomboka ndi chimodzi mwazovuta kwambiri pambuyo polowa m'malo opangira, zomwe sizimangobweretsa nkhonya zingapo za opaleshoni kwa odwala, komanso zimadya zida zazikulu zamankhwala. Pazaka 10 zapitazi, chiwerengero cha matenda pambuyo yokumba olowa m`malo chachepa kwambiri, koma panopa kukula kwa odwala akukumana yokumba olowa m`malo kuposa mlingo wa kuchepa mlingo wa matenda, choncho vuto la postoperative matenda sayenera kunyalanyazidwa.
I. Zomwe zimayambitsa matenda
Matenda olowa m'malo opangidwa pambuyo pochita kupanga ayenera kutengedwa ngati matenda obwera m'chipatala omwe ali ndi tizilombo toyambitsa matenda. Chofala kwambiri ndi staphylococcus, yomwe imatenga 70% mpaka 80%, bacilli gram-negative, anaerobes ndi non-A group streptococci nawonso amapezeka.
II Pathogenesis
Matenda agawika m'magulu awiri: imodzi ndi yoyambilira pomwe ina ndi yochedwa kapena imatchedwa matenda ochedwa. Matenda oyamba amayamba chifukwa cha kulowa mwachindunji kwa mabakiteriya olumikizana panthawi ya opaleshoni ndipo nthawi zambiri ndi Staphylococcus epidermidis. Matenda omwe amayamba mochedwa amayamba chifukwa cha kufalikira kwa magazi ndipo nthawi zambiri ndi Staphylococcus aureus. Mafupa omwe achitidwa opareshoni amatha kutenga kachilomboka. Mwachitsanzo, pali chiwopsezo cha 10% cha matenda akamasinthidwa pambuyo polowa m'malo opangira, ndipo kuchuluka kwa matendawa kumakhalanso kwakukulu mwa anthu omwe adalowa m'malo mwa nyamakazi.
Ambiri mwa matenda kumachitika mkati mwa miyezi ingapo pambuyo opaleshoni, oyambirira akhoza kuonekera mu masabata awiri oyambirira pambuyo opaleshoni, komanso mochedwa zaka zingapo pamaso zikamera wa oyambirira mawonetseredwe chachikulu cha pachimake olowa kutupa, ululu ndi malungo. , zizindikiro za kutentha thupi ziyenera kukhala zosiyana ndi zovuta zina, monga chibayo cha postoperative, matenda a mkodzo ndi zina zotero.
Pankhani ya matenda oyambirira, kutentha kwa thupi sikumangokhalira kuchira, koma kumatuluka patatha masiku atatu opaleshoni. Kupweteka kwa olowa sikungochepetsa pang'onopang'ono, koma kumawonjezera pang'onopang'ono, ndipo pali kupweteka kwapang'onopang'ono pakupuma. Pali kutulutsa kwachilendo kapena kutulutsa kuchokera pakudulidwa. Izi ziyenera kufufuzidwa mosamala, ndipo malungowo sayenera kunenedwa mosavuta chifukwa cha matenda obwera pambuyo pa opaleshoni m’zigawo zina za thupi monga m’mapapo kapena m’mikodzo. Ndikofunikiranso kuti musamangochotsa kutuluka m'thupi monga momwe zimakhalira nthawi zonse monga kutulutsa mafuta. Ndikofunikiranso kuzindikira ngati matendawa ali m'matumbo owoneka bwino kapena akuya mozungulira prosthesis.
Odwala omwe ali ndi matenda aakulu, omwe ambiri mwa iwo achoka m'chipatala, kutupa, kupweteka, ndi kutentha thupi sikungakhale koopsa. Theka la odwala sangakhale ndi malungo. Staphylococcus epidermidis imatha kuyambitsa matenda osapweteka ndi kuchuluka kwa maselo oyera amagazi mwa odwala 10% okha. Kuchuluka kwa sedimentation ya magazi kumakhala kofala kwambiri koma osati mwachindunji. Ululu nthawi zina umaganiziridwa molakwika ngati prosthetic kumasula, chotsiriziracho ndi ululu wokhudzana ndi kuyenda komwe kuyenera kumasulidwa ndi kupuma, ndi kupweteka kotupa komwe sikumatsitsimutsidwa ndi kupuma. Komabe, akuti chifukwa chachikulu cha prosthesis kumasuka ndi kuchedwa matenda aakulu.
III. Matenda
1. Kuyeza magazi:
Makamaka muphatikizepo kuwerengera kwa maselo oyera amagazi kuphatikiza, interleukin 6 (IL-6), C-reactive protein (CRP) ndi erythrocyte sedimentation rate (ESR). Ubwino wa kuyezetsa magazi ndi osavuta komanso osavuta kuchita, ndipo zotsatira zake zitha kupezeka mwachangu; ESR ndi CRP ndizochepa; IL-6 ndi yamtengo wapatali pozindikira matenda a periprosthetic kumayambiriro kwa nthawi ya postoperative.
2. Kujambula zithunzi:
Kanema wa X-ray: osakhudzidwa kapena mwachindunji pakuzindikiritsa matenda.
Filimu ya X-ray ya matenda olowa m'malo a mawondo
Arthrography: woimira wamkulu ntchito mu matenda a matenda ndi outflow wa synovial madzimadzi ndi abscess.
CT: mawonekedwe a kuphatikizika kwa mgwirizano, mathirakiti a sinus, abscesses minofu yofewa, kukokoloka kwa mafupa, periprosthetic bone resorption.
MRI: tcheru kwambiri kuti azindikire msanga zamadzimadzi ndi zithupsa, zomwe sizimagwiritsidwa ntchito kwambiri pozindikira matenda a periprosthetic.
Ultrasound: kuchuluka kwamadzimadzi.
3.mankhwala a nyukiliya
Kujambula kwa mafupa a Technetium-99 kumakhala ndi chidwi cha 33% ndi kutsimikizika kwa 86% kwa matenda a periprosthetic pambuyo pa arthroplasty, ndi indium-111 yotchedwa leukocyte scan ndi yofunika kwambiri pa matenda a periprosthetic, ndi kukhudzika kwa 77% ndi chiwerengero cha 86%. Pamene ma scan awiriwa amagwiritsidwa ntchito palimodzi pofufuza matenda a periprosthetic pambuyo pa arthroplasty, kukhudzidwa kwakukulu, kutsimikizika ndi kulondola kungapezeke. Mayesowa akadali muyeso wagolide wamankhwala a nyukiliya pakuzindikiritsa matenda a periprosthetic. Fluorodeoxyglucose-positron emission tomography (FDG-PET). Imazindikira ma cell otupa ndi kuchuluka kwa glucose m'dera lomwe lili ndi kachilomboka.
4. Njira zamamolekyulu a biology
PCR: kukhudzika kwakukulu, zabwino zabodza
Ukadaulo wa gene chip: gawo lofufuza.
5. Arthrocentesis:
Cytological kufufuza madzimadzi olowa, chikhalidwe bakiteriya ndi mankhwala tilinazo mayeso.
Njirayi ndi yosavuta, yachangu komanso yolondola
M'matenda a m'chiuno, chiwerengero cha leukocyte chamadzimadzi chophatikizana> 3,000/ml pamodzi ndi kuwonjezeka kwa ESR ndi CRP ndicho chiyeso chabwino kwambiri cha kukhalapo kwa matenda a periprosthetic.
6. Intraoperative mofulumira mazira gawo histopathology
Chigawo chozizira chofulumira cha minofu ya periprosthetic ndiyo njira yomwe imagwiritsidwa ntchito kwambiri pakuwunika kwa histopathological. Njira zodziwira matenda a Feldman, mwachitsanzo, zazikulu kuposa kapena zofanana ndi ma neutrophils 5 pakukulitsa kwakukulu (400x) m'magawo asanu ang'onoang'ono ang'onoang'ono, nthawi zambiri amagwiritsidwa ntchito pazigawo zachisanu. Zasonyezedwa kuti kukhudzidwa ndi kutsimikizika kwa njirayi kudzapitirira 80% ndi 90%, motero. Njira imeneyi panopa ndi muyezo golide kwa intraoperative matenda.
7. Bakiteriya chikhalidwe cha pathological minofu
Chikhalidwe cha mabakiteriya a minofu ya periprosthetic chimakhala chodziwika bwino chodziwira matenda ndipo chimawonedwa ngati muyezo wagolide wodziwira matenda a periprosthetic, komanso chitha kugwiritsidwa ntchito poyesa kukhudzidwa kwa mankhwala.
IV. Kuzindikira kosiyanas
Matenda ophatikizika osapweteka omwe amayamba chifukwa cha Staphylococcus epidermidis ndi ovuta kusiyanitsa ndi kumasuka kwa prosthetic. Iyenera kutsimikiziridwa ndi ma X-ray ndi mayeso ena.
V. Chithandizo
1. Chithandizo chosavuta cha antibiotic
Tsakaysma ndi se,gawa m'gulu matenda pambuyo arthroplasty mu mitundu inayi, mtundu ine asymptomatic mtundu, wodwala yekha mu kukonzanso opaleshoni minofu chikhalidwe anapeza kuti bakiteriya kukula, ndi zitsanzo osachepera awiri otukuka ndi mabakiteriya omwewo; mtundu II ndi matenda oyambirira, omwe amapezeka mkati mwa mwezi umodzi wa opaleshoni; mtundu IIl ndi kuchedwa matenda aakulu; ndi mtundu IV ndi pachimake haematogenous matenda. Mfundo ya mankhwala opha maantibayotiki ndi tcheru, yokwanira kuchuluka ndi nthawi. Ndipo kuphatikizika kwa mafupa asanachitike opaleshoni ndi chikhalidwe cha minofu yophatikizika ndizofunikira kwambiri pakusankha koyenera kwa maantibayotiki. Ngati chikhalidwe cha bakiteriya chili chabwino pa matenda a mtundu woyamba, kugwiritsa ntchito maantibayotiki osavuta kwa masabata asanu ndi limodzi kumatha kukhala ndi zotsatira zabwino.
2. Prosthesis posungira, debridement ndi ngalande, chubu ulimi wothirira opaleshoni
Mfundo yotengera lingaliro la kuvulala kosunga chithandizo cha prosthesis ndikuti prosthesis ndi yokhazikika komanso yowopsa. Tizilombo toyambitsa matenda timadziwikiratu, kachilombo ka bakiteriya kamakhala kochepa ndipo maantibayotiki odziwika bwino alipo, ndipo liner kapena spacer imatha kusinthidwa panthawi yowononga. Machiritso a 6% okha ndi maantibayotiki okha ndi 27% okhala ndi maantibayotiki kuphatikiza kuwononga ndi kusungidwa kwa prosthesis zafotokozedwa m'mabuku.
Ndi oyenera siteji oyambirira matenda kapena pachimake haematogenous matenda ndi zabwino prosthesis fixation; Komanso, n'zoonekeratu kuti matenda ndi otsika virulence bakiteriya matenda amene tcheru mankhwala antimicrobial. Njirayi imakhala ndi kuwononga bwino, kutsekemera kwa antimicrobial ndi madzi (nthawi ya masabata a 6), ndi postoperative systemic intravenous antimicrobials (nthawi ya masabata 6 mpaka miyezi 6). Zoyipa: kulephera kwakukulu (mpaka 45%), nthawi yayitali ya chithandizo.
3. One siteji kukonzanso opaleshoni
Zili ndi ubwino wa kupwetekedwa pang'ono, kukhala pafupi ndi chipatala, kutsika mtengo kwachipatala, kuchepa kwa chilonda ndi kuuma kwa mgwirizano, zomwe zimathandiza kuti ayambe kuchira pambuyo pa opaleshoni. Njira imeneyi makamaka abwino zochizira matenda oyambirira ndi pachimake haematogenous matenda.
M'malo mwa gawo limodzi, mwachitsanzo, njira imodzi, imangokhala ndi matenda a kawopsedwe pang'ono, kuwononga bwino, simenti ya mafupa a maantibayotiki, ndi kupezeka kwa maantibayotiki omwe akhudzidwa. Kutengera zotsatira za intraoperative minofu mazira gawo, ngati pali zosakwana 5 leukocytes/mkulu magnification munda. Zikuwonetsa matenda a kawopsedwe kochepa. Pambuyo powonongeka bwino gawo limodzi la arthroplasty linachitidwa ndipo panalibe kuyambiranso kwa matenda pambuyo pa opaleshoni.
Pambuyo pakuwonongeka kokwanira, prosthesis imasinthidwa nthawi yomweyo popanda kufunikira kwa njira yotseguka. Zili ndi ubwino wa zoopsa zazing'ono, nthawi yochepa ya chithandizo ndi mtengo wotsika, koma kubwereza kwa matenda opatsirana pambuyo pa opaleshoni ndi apamwamba, omwe ali pafupifupi 23% ~ 73% malinga ndi ziwerengero. Gawo limodzi la prosthesis m'malo mwake ndiloyenera makamaka kwa odwala okalamba, popanda kuphatikiza chimodzi mwa zotsatirazi: (1) mbiri ya maopaleshoni angapo pamagulu olowa m'malo; (2) kupangidwa kwa sinus thirakiti; (3) matenda oopsa (monga septic), ischemia ndi mabala a minyewa yozungulira; (4) kuwononga kosakwanira kwa zoopsa ndi simenti yotsalira; (5) X-ray zosonyeza osteomyelitis; (6) kupunduka kwa fupa kumafuna kumezanitsa mafupa; (7) matenda osakanikirana kapena mabakiteriya owopsa kwambiri (mwachitsanzo Streptococcus D, mabakiteriya a gram-negative); (8) kuwonongeka kwa fupa kumafuna kumezanitsidwa kwa mafupa; (9) kuwonongeka kwa fupa kumafuna kumezanitsa mafupa; ndi (10) kumezanitsa mafupa ofuna kulumikiza mafupa. Streptococcus D, mabakiteriya a Gram-negative, makamaka Pseudomonas, etc.), kapena matenda a fungal, matenda a mycobacterial; (8) Chikhalidwe cha mabakiteriya sichidziwika bwino.
4. Opaleshoni yokonzanso gawo lachiwiri
Amayamikiridwa ndi madokotala ochita opaleshoni m'zaka zapitazi za 20 chifukwa cha zizindikiro zake zambiri (mafupa okwanira, minofu yofewa ya periarticular) komanso kuchuluka kwa kuthetsa matenda.
Spacers, onyamula ma antibiotic, ma antibiotic
Mosasamala kanthu za njira ya spacer yomwe imagwiritsidwa ntchito, kukonza simenti ndi maantibayotiki ndikofunikira kuti muwonjezere kuchuluka kwa maantibayotiki olowa ndikuwonjezera machiritso a matenda. Maantibayotiki omwe amagwiritsidwa ntchito kwambiri ndi tobramycin, gentamicin ndi vancomycin.
Magulu a mafupa padziko lonse lapansi azindikira chithandizo chothandiza kwambiri cha matenda ozama pambuyo pa arthroplasty. The njira tichipeza bwinobwino debridement, kuchotsa prosthesis ndi thupi lachilendo, masungidwe a olowa spacer, anapitiriza ntchito mtsempha tcheru antimicrobials kwa osachepera 6 milungu, ndipo potsiriza, pambuyo mphamvu kulamulira matenda, reimplantation wa prosthesis.
Ubwino:
Nthawi yokwanira yodziwira mitundu ya mabakiteriya komanso ma antimicrobial agents, omwe angagwiritsidwe ntchito bwino musanakonzenso opaleshoni.
Kuphatikizana kwazinthu zina zamtundu wa matenda kumatha kuthandizidwa munthawi yake.
Pali mipata iwiri yowonongeka kuti ichotse minofu ya necrotic ndi matupi akunja bwino kwambiri, zomwe zimachepetsa kwambiri chiwerengero cha kubwereza kwa matenda a postoperative.
Zoyipa:
Kubwerezanso opaleshoni ndi opaleshoni kumawonjezera chiopsezo.
Nthawi ya chithandizo chanthawi yayitali komanso mtengo wokwera wamankhwala.
Kuchira kwa postoperative ndikosavuta komanso kochedwa.
Arthroplasty: Oyenera kudwala matenda osachiritsika omwe samayankha chithandizo, kapena kuwonongeka kwakukulu kwa mafupa; matenda a wodwalayo amachepetsa reoperation ndi kulephera kumanganso. Kupweteka kotsalira pambuyo pa opaleshoni, kufunikira kwa kugwiritsidwa ntchito kwa nthawi yaitali kwa zingwe kuti zithandize kuyenda, kusasunthika kosasunthika kwa mgwirizano, kufupikitsa miyendo, kukhudzidwa kwa ntchito, kuchuluka kwa ntchito kumakhala kochepa.
Arthroplasty: chithandizo chachikhalidwe cha matenda obwera pambuyo pa opaleshoni, kukhazikika kwabwino kwapambuyo komanso kuchepetsa ululu. Zoipa zimaphatikizapo kufupikitsa mwendo, kusokonezeka kwa gait ndi kutayika kwa mgwirizano.
Kudulidwa: Ndi njira yomaliza yochizira matenda obwera pambuyo pa opaleshoni. Oyenera: (1) kuwonongeka kwakukulu kwa mafupa, kuwonongeka kwa minofu yofewa; (2) amphamvu bakiteriya virulence, matenda osakanikirana, mankhwala antimicrobial n'kosathandiza, chifukwa zokhudza zonse kawopsedwe, kuopseza moyo; (3) ali ndi mbiri yakulephera kangapo kwa opaleshoni yokonzanso odwala omwe ali ndi kachilomboka.
VI. Kupewa
1. Zinthu zomwe zisanachitike opaleshoni:
Konzani bwino momwe wodwalayo alili komanso matenda onse omwe alipo ayenera kuchiritsidwa asanachite opaleshoni. Matenda ofala kwambiri m’magazi ndi amene amatuluka pakhungu, m’mikodzo ndi m’mapapo. Mu chiuno kapena mawondo arthroplasty, khungu la m'munsi liyenera kukhala losasweka. Asymptomatic bacteriuria, yomwe imakhala yofala kwa odwala okalamba, safuna kuthandizidwa asanachite opaleshoni; zizindikiro zikawoneka ziyenera kuthandizidwa mwamsanga. Odwala zilonda zapakhosi, matenda am`mwamba kupuma thirakiti, tinea pedis ayenera kuchotsedwa m`deralo foci wa matenda. Maopaleshoni akuluakulu a mano ndi omwe angayambitse matenda a m'magazi, ndipo ngakhale kuti amapewedwa, ngati opaleshoni ya mano ndi yofunika, ndi bwino kuti njira zoterezi zichitike asanayambe opaleshoni. Odwala omwe ali ndi vuto la kuchepa kwa magazi monga kuchepa kwa magazi m'thupi, hypoproteinemia, matenda a shuga ophatikizana komanso matenda amkodzo amkodzo amayenera kuthandizidwa mwachangu komanso koyambirira kuti matendawo asinthe.
2. Kasamalidwe ka opaleshoni:
(1) Njira ndi zida zonse za aseptic ziyeneranso kugwiritsidwa ntchito munjira yochizira yanthawi zonse ya arthroplasty.
(2) Kugonekedwa m'chipatala asanachite opaleshoni kuyenera kuchepetsedwa kuti achepetse ngozi yomwe khungu la wodwalayo limatha kukhala ndi mabakiteriya omwe amapezeka m'chipatala, ndipo chithandizo chanthawi zonse chiyenera kuchitika patsiku la opaleshoni.
(3) Malo opangira opaleshoni ayenera kukonzedwa bwino pokonzekera khungu.
(4) Zovala zopangira opaleshoni, masks, zipewa, ndi malo opangira ma laminar flow amathandizira kuchepetsa mabakiteriya obwera ndi mpweya m'malo opangira opaleshoni. Kuvala magolovesi awiri kungachepetse chiopsezo chokhudzana ndi manja pakati pa opaleshoni ndi wodwala ndipo akhoza kulimbikitsidwa.
(5) Zatsimikiziridwa mwachipatala kuti kugwiritsa ntchito zoletsa kwambiri, makamaka zokhotakhota, prosthesis imakhala ndi chiopsezo chachikulu cha matenda kusiyana ndi osagwirizana ndi mawondo a arthroplasty chifukwa cha zinyalala zachitsulo zomwe zimachepetsa ntchito ya phagocytosis, choncho ziyenera kupewedwa posankha prosthesis. .
(6) Sinthani njira ya opaleshoni ya wogwiritsa ntchito ndikufupikitsa nthawi ya opaleshoni (<2.5 h ngati n'kotheka). Kufupikitsa nthawi ya opaleshoni kungachepetse nthawi yokhudzana ndi mpweya, zomwe zingathe kuchepetsa nthawi yogwiritsira ntchito maulendo oyendayenda. Pewani kuchitidwa opaleshoni movutikira, chilondacho chimatha kuthiriridwa mobwerezabwereza (mfuti yothirira pulsed ndi yabwino), ndipo kumizidwa ndi nthunzi ya ayodini kumatha kudulidwa podulira zomwe akuganiziridwa kuti zili ndi kachilombo.
3. Zinthu zomwe zimachitika pambuyo pa opaleshoni:
(1) Kukwapula kwa opaleshoni kumapangitsa kuti insulini isakane, zomwe zingayambitse hyperglycemia, chodabwitsa chomwe chingapitirire kwa milungu ingapo pambuyo pa opaleshoni ndikupangitsa wodwalayo ku zovuta zokhudzana ndi bala, komanso zomwe zimachitikanso kwa odwala omwe alibe matenda a shuga. Chifukwa chake, kuyang'anira shuga wamagazi pambuyo pa opaleshoni ndikofunikira.
(2) Kuthamanga kwa mitsempha yakuya kumawonjezera chiopsezo cha hematoma ndi mavuto okhudzana ndi bala. Kafukufuku wowongolera milandu adapeza kuti kugwiritsa ntchito heparin yocheperako pambuyo pa opaleshoni kuti muteteze kugunda kwa mtima kwa mitsempha yakuya kunali kothandiza kuchepetsa kuthekera kwa matenda.
(3) Ngalande yotsekedwa ndi njira yolowera ku matenda, koma ubale wake ndi ziwopsezo za matenda a zilonda sunaphunzire kwenikweni. Zotsatira zoyamba zikuwonetsa kuti ma catheter a intra-articular omwe amagwiritsidwa ntchito ngati ma analgesics pambuyo pa opaleshoni amathanso kutenga matenda a bala.
4. Chithandizo cha maantibayotiki:
Panopa, chizolowezi matenda ntchito prophylactic Mlingo wa mankhwala zokhudza zonse kutumikiridwa m`nsinga isanayambe kapena itatha opaleshoni amachepetsa chiopsezo postoperative matenda. Cephalosporins amagwiritsidwa ntchito kwambiri pachipatala ngati mankhwala osankhidwa, ndipo pali ubale wopindika ngati U pakati pa nthawi yogwiritsira ntchito maantibayotiki ndi kuchuluka kwa matenda omwe amapezeka pamalo opangira opaleshoni, zomwe zimakhala ndi chiopsezo chachikulu chotenga matenda nthawi isanakwane komanso itatha. ntchito. Kafukufuku wamkulu waposachedwa adapeza kuti maantibayotiki omwe amagwiritsidwa ntchito mkati mwa mphindi 30 mpaka 60 asanadulidwe anali ndi matenda otsika kwambiri. Mosiyana ndi zimenezi, kafukufuku wina waukulu wa arthroplasty wa chiuno chonse anasonyeza kuchepa kwa matenda ndi maantibayotiki omwe amaperekedwa mkati mwa mphindi 30 zoyambirira za kudulidwa. Choncho nthawi yoyendetsera nthawi zambiri imatengedwa kuti ndi 30 min isanayambe opaleshoni, ndipo zotsatira zake zimakhala zabwino kwambiri panthawi ya anesthesia. Mlingo wina wa prophylactic wa maantibayotiki umaperekedwa pambuyo pa opaleshoni. Ku Ulaya ndi ku United States, maantibayotiki amagwiritsidwa ntchito mpaka tsiku lachitatu la postoperative, koma ku China, akuti amagwiritsidwa ntchito mosalekeza kwa 1 mpaka milungu iwiri. Komabe, mgwirizano wa anthu onse ndi wakuti kugwiritsa ntchito mankhwala amphamvu kwambiri kwa nthawi yaitali kuyenera kupewedwa pokhapokha ngati pali zochitika zapadera, ndipo ngati kuli kofunika kugwiritsa ntchito mankhwala opha tizilombo kwa nthawi yaitali, ndi bwino kugwiritsa ntchito mankhwala ophera tizilombo pamodzi ndi maantibayotiki pofuna kupewa matenda oyamba ndi mafangasi. . Vancomycin yawonetsedwa kuti ndi yothandiza kwa odwala omwe ali pachiwopsezo chachikulu chotenga methicillin-resistant Staphylococcus aureus. Mlingo waukulu wa maantibayotiki uyenera kugwiritsidwa ntchito popanga maopaleshoni atali, kuphatikiza maopaleshoni apakati, makamaka ngati theka la moyo wa maantibayotiki ndi lalifupi.
5. Kugwiritsa ntchito maantibayotiki pamodzi ndi simenti ya mafupa:
Simenti yolowetsedwa ndi maantibayotiki idagwiritsidwanso ntchito koyamba ku arthroplasty ku Norway, komwe poyambirira kafukufuku waku Norwegian Arthroplasty Registry adawonetsa kuti kugwiritsa ntchito kuphatikiza kwa maantibayotiki IV ndi simenti (kuphatikiza ma antibiotic prosthesis) kumachepetsa kuchuluka kwa matenda akuya bwino kwambiri kuposa njira iliyonse yokha. . Kupeza kumeneku kunatsimikiziridwa mndandanda wa maphunziro akuluakulu pazaka zotsatira za 16. Kafukufuku wa ku Finnish ndi Australian Orthopaedic Association 2009 adapezanso zofanana zokhudzana ndi ntchito ya simenti yopangidwa ndi maantibayotiki mu nthawi yoyamba ndi kukonzanso mawondo arthroplasty. Zasonyezedwanso kuti biomechanical katundu wa fupa simenti sizimakhudzidwa pamene antibiotic ufa anawonjezera Mlingo osapitirira 2 g pa 40 g wa fupa simenti. Komabe, si maantibayotiki onse omwe angathe kuwonjezeredwa ku simenti ya mafupa. Maantibayotiki omwe atha kuwonjezeredwa ku simenti ya mafupa ayenera kukhala ndi zinthu zotsatirazi: chitetezo, kukhazikika kwamafuta, hypoallergenicity, kusungunuka kwamadzi bwino, ma antimicrobial spectrum, ndi zinthu za ufa. Panopa, vancomycin ndi gentamicin amagwiritsidwa ntchito kwambiri m'zachipatala. Ankaganiziridwa kuti jekeseni wa maantibayotiki mu simenti angawonjezere chiopsezo cha ziwengo, kutuluka kwa mitundu yolimbana ndi tizilombo toyambitsa matenda, ndi kumasulidwa kwa aseptic kwa prosthesis, koma mpaka pano palibe umboni wotsimikizira izi.
VII. Chidule
Kupanga matenda mwachangu komanso molondola kudzera m'mbiri, kuyezetsa thupi ndi kuyezetsa kowonjezera ndikofunikira kuti muthe kuchiza bwino matenda olowa m'malo. Kuthetsa matenda ndi kubwezeretsedwa kwa cholumikizira chopanda ululu, chogwira ntchito bwino ndi mfundo yofunika kwambiri pochiza matenda olumikizana mafupa. Ngakhale kuti mankhwala opha tizilombo toyambitsa matenda olowa m'malo olumikizirana mafupa ndi osavuta komanso otsika mtengo, kuthetsa matenda olowa m'malo ambiri kumafuna njira zambiri zopangira opaleshoni. Chinsinsi chosankha chithandizo cha opaleshoni ndicho kuganizira za vuto la kuchotsa ma prosthesis, lomwe ndilo gawo lalikulu la kuthana ndi matenda olowa m'malo. Pakalipano, kugwiritsa ntchito mankhwala opha maantibayotiki, debridement ndi arthroplasty kwakhala chithandizo chokwanira cha matenda ambiri ovuta olowa. Komabe, ikufunikabe kuwongolera ndi kukonzedwanso.
Nthawi yotumiza: May-06-2024
