Utachiona ndechimwe chezvinhu zvakakomba mushure mekutsiva kwekunyepedzera, izvo zvisingabude zvakazara zvekuvhiya, asi zvakare zvinopedza zviwanikwa zvikuru zvekurapa. Kwemakore gumi apfuura, huwandu hwehutachiona mushure mekutsiva kwekunyepedzera zvakadziva zvakanyanya, asi huwandu hwekukura kwemaronda
I. ZVINOKOSHA ZVOKUDZIDZA
Post-official kubatana kutapudza kunofanirwa kutariswa sechipatara-chakawana hutachiona hwechipatara chine zvinodhaka zvinodhaka zvisikwa. Izvo zvinonyanya kujairika,
II Pathogeneis
Utachiona hwakakamurwa muzvikamu zviviri: Imwe yekutanga hutachiona uye imwe inononoka kutapukirwa kana kunzi inonoka-kutanga hutachiona. Zvinotapukirwa pakutanga zvinokonzerwa nekupinda zvakananga kwehutachiona mumubatanidzwa panguva yekuvhiya uye zvinowanzoita staphyloccuccus epidermidis. Kutakura-kwezvitendero kunokonzerwa nekukonzerwa neropa-kutakurwa neropa uye kazhinji kazhinji staphyloccus aureus. Majoini akanyorwa pane anokwanisa kutapukirwa. Semuenzaniso, pane 10% yehutachiona hwehutachiona hwekudzokorora mushure mekudzoreredza kwekunyora, uye huwandu hwehutachiona hwakanyanya kukwirisa muvanhu vakabatanidzwa neRheumatoid arthritis.
Zvizhinji zvehutachiona zvinoitika mukati memwedzi mishoma mushure mekuvhiyiwa kwemavheni.
Panyaya yekutapukirwa kwekutanga, tembiricha yemuviri haingopora chete, asi inosimuka mazuva matatu mushure mekuvhiyiwa. Kusungwa marwadzo kwete chete hakuderedze zvishoma nezvishoma, asi zvishoma nezvishoma anowedzera, uye pane kurwadzisa kurwadziwa pazororo. Pane zvisina kujairika oozing kana secretion kubva mukukasira. Izvi zvinofanirwa kunyatsoongororwa, uye fivha haifanire kufungidzirwa kutapukirwa kutapurirana mune zvimwe zvikamu zvemuviri senge mapapu kana uremu turakiti. Izvo zvakakoshawo kuti usangodzinga inconsaal oozing seyakajairwa kujairika yakaenzana semafuta liquefaction. Zvakakoshawo kuziva kuti utachiona huri muzvipfuyo zvepamusoro kana zvakadzika zvakakomberedza prosthesa.
Mune varwere vane hutachiona hwepamberi, vazhinji vavo vakasiya chipatara, kuzvimba, kurwadziwa, uye fivha kunogona kunge kusiri kukuru. Hafu yevarwere vanogona kunge vasina fivha. Staphylococcuccus Epidermiding inogona kukonzera hutachiona husina hurwi hune kune yakawedzera chena yeropa cell cell cell kuverenga mune gumi muzana yevarwere chete. Yakakwidziridzwa ropa rakakwiridzirwa rakajairika asi zvakare kwete zvakananga. Kurwadziwa dzimwe nguva kusasvina kusasunungurwa seprosteretic, iyo yekupedzisira ichirwadza yakabatana nekufamba kunofanirwa kusunungurwa nekuzorora, uye kurwadziwa kusarwadzisa izvo hazvizorodze nekuzorora. Nekudaro, zvakakurudzirwa kuti chikonzero chikuru chekusunungura prostises kunonoka kutapukirwa kusingaperi.
III. Kuongororwa
1. Kuongororwa kweHematological:
Inonyanya kusanganisira chena yeropa cell Cell Cell Cell Cell Cell Zvakanakira kuongorora kweHaematological zviri nyore uye nyore kuita, uye mhedzisiro yacho inogona kuwanikwa nekukurumidza; Esr uye CRP ine yakaderera chokwadi; Il-6 inokosha kwazvo mukusarudza hutachiona hwePeriprotic mune yekutanga postoperative nguva.
2.Kutsvaga kuongororwa:
X-ray firimu: kana nyatsotarisa kana kunyorwa kana kuongororwa kwehutachiona.
X-Ray firimu rebvi kutsiva utachiona
Arthrography: Iyo huru inomiririra kuita mukuongororwa kwehutachiona ndiko kubuda kweiyo synovial fluid uye abscess.
CT: Kuona kwekuona kwekubatana, maturakiti assus, maturakiti akapfava anoshamisa, kurira kwepa pfupa, periprosthetic pfupa rekudzora.
MRI: yakanyanya kutaridzika kwekutanga kwekuonekwa kwemvura ine majoini uye kusanzwisisika, kusashandiswa zvakanyanya mukuongororwa kwehutachiona hwehutachiona.
Ultrasound: Fluid kuwanda.
3.nuclear mushonga
TechinNetium-99 Bone Scan ine pfungwa ye36% uye yakajeka yechiitiko cheKuongorora kweRuttroltHextHextheni Hutachiona hwenyika, nekunzwa kwe77% uye chokwadi che86%. Kana zvigunwe zviviri zvacho zvinoshandiswa pamwe nekuongororwa kwehutachiona hwePeriprosticle mushure meArthroplasty, kunzwa kwakanyanya, chokwadi uye chokwadi chingaitika. Iyi bvunzo ichiri iyo goridhe chiyero mumushonga wenyukireya kune kuongororwa kwehutachiona hwehutachiona. Fluorodeoxyglucose-Positron emission tomography (FDG-PET). Iyo inoona masero anopisa ane kuwedzera glucose anokwira munzvimbo ine hutachiona.
4. Molecular Biology Technices
Pcr: yakakwirira kunzwa, nhema positives
Gene chip tekinoroji: Tsvagurudzo.
5. Arthrocentesis:
Cytological kuongororwa kwejointa fluid, hutachiona hwehutachiona uye kuongorora kwezvinodhaka.
Iyi nzira iri nyore, nekukurumidza uye yakarurama
Muchiuno, chiunganidziri chehunhu hwechiuno, chiuru chimwe chete cheLucoccyte kuverenga> zviuru zvitatu
6. Intrapioperative rapid yechando chikamu Chekunze Hertopathology
Kurumidza Intrapaerative chikamu chechando chePeriprosthetic tishu ndiyo inonyanya kushandiswa kushandiswa nzira yekubvunzira yeFortopathological bvunzo. Feldman's Diginic Deferia, kureva kuti, yakakura kupfuura kana yakaenzana ne5 neutrophils per high kukura (400x) muminda inosvika mashanu emagetsi, inowanzoshandiswa kune zvikamu zvechando. Izvo zvakaratidzwa kuti kunzwira tsitsi uye chokwadi chenzira iyi kuchapfuura 80% uye 90%, zvichiteerana. Iyi nzira parizvino ndiyo goridhe chiyero chekunzwa kuongororwa kwekunyepedzera.
7. Chikanganiso chehutachiona hwechipatara tishu
Tsika yehutachiona hwePeriprosthetic tishu ine yakakwirira kufungidzirwa nezvekunetseka uye yakaonekwa segoridhe yegoridhe yekuongorora njodzi, uye inogona kushandiswawo kune bvunzo dzekunzwa zvinodhaka.
Iv. Dzakasiyana diagnosis
Hutachiona hwePROSTHETION SHANDISE ZVINOKOSHA ZVINOGONESWA NASTaphyloccuccus Epidermidis zvakanyanya kuoma kusiyanisa kubva pakusashanda prosthetic. Inofanira kusimbiswa ne x-rays uye mimwe miedzo.
V. Kurapa
1. Nyaradzo Antibiotic Conservative Kurapa
Tsakaysma uye Se, Gawa Classified Post Huttroplast muTratroplasty Type Type II idambudziko rekutanga, rinoitika mukati memwedzi mumwe wekuvhiyiwa; Type iil inhema kusingaperi utachiona; uye nyora IV ndeye acute haematatoous utachiona. Iyo nheyo yemishonga inorwisa mabhakitiriya inonzwa, zvakakwana huwandu uye nguva. Uye preeperative Joint cavity puncture uye intraoperative tishu tsika ndeye kukosha kukuru kwekusarudzwa kwakakodzera kwemishonga inorwisa mabhakitiriya. Kana tsika yehutachiona yakanaka mhando yandinotapukira, iri nyore kushandiswa kwemaitiro antibioty mishonga yemavhiki matanhatu anogona kuwana mibairo yakanaka.
2. Kuchengeta prosthesis, kushomoka uye kudhirowa, tube inodiridza kuvhiya
Chimiro chekutora chimbo chekutamba kwekutambudzika kuchengeta prosthing kurapwa ndiko kuti prosthesis yakagadzikana uye inotapukira hutachiona. Chikanganiso chinotapukira chakajeka, hutachiona hwehutachiona hwakanyanya uye hunonzwisisika mishonga inorwisa mabhakitiriya, uye chigunwe kana spacer chinogona kutsiviwa panguva yekubiwa. Kurapa mitengo ye6% chete nemishonga inorwisa mabhakitiriya chete uye 27% ine mishonga inorwisa mabhakitiriya pamwe nekuchengetedzwa kwemadhiri uye prosthesis yekuchengetedza yakataurwa mumabhuku.
Izvo zvakakodzera kutapukirwa kwekutanga kwekutapukirwa kana acute haematasous kutapukirwa neakanaka prosthisis gadziriso; Zvakare, zviri pachena kuti hutachiona hwakanyanya hutachiona hwehutachiona hwehutachiona hunonzwisisika kurapa kurapwa. Maitiro acho ane madhiri akanyorova, antimicrobial kupenya uye kudhirowa (nguva yemavhiki matanhatu), uye postoperative systemic intravenous antimicrobials (duration 6 vhiki kusvika 6 mwedzi). Zvinokuvadza: Yakakura kukundikana chiyero (kusvika 45%), nguva yakareba yekurapa.
3. Imwe nhanho yekuvhiya yekuvhiya
Izvo zvine zvakanakira kushoma kushungurudzika, kupopotedzana kwechipatara. Iyi nzira inonyanya kukodzera kurapwa kwekutapukirwa kwekutanga uye acute haematatoous utachiona.
Imwe-nhanho kutsiva, ie, iyo nzira imwe-nhanho, inoganhurirwa kune yakaderera-hutachiona, kushomeka, bhekiti remishonga inorwisa mabhakitiriya, uye kuwanikwa kwemasangano anonzwa anonzwa. Zvichienderana nemhedzisiro yeiyo intraoperative tisue chikamu chando, kana paine isingasviki 5 leukocytes / high okundificy munda. Izvo zvinopokana nehutachiona hwehutachiona hwehutachiona. Mushure mekushomekana kwakazara imwe nhanho imwe arthroplasty uye pakanga pasina kudzokorora kwehutachiona.
Mushure mekushomekana kwakazara, prostistsis yakangoere kutsiviwa pasina kudikanwa kwehurongwa hwakavhurika. Izvo zvine zvakanakira trauma shoma, nguva pfupi yekurapa uye mutengo wakaderera, asi huwandu hwekudzokorora hweutachiona hwehutachiona hwakakwira, hunenge 23% ~ 73% maererano nehuwandu. Imwe-stage prosthising inonyanya kukodzera varwere vakwegura, vasina kusanganisa chero chinotevera: (1) nhoroondo yekuvhiya kwakawanda pane yekutsiva. (2) Sinus turakiti yekuumbwa; . (4) Kubiridzira kusakwana kwekushungurudzika kwechikamu chasara chasara; (5) X-ray zvinongedzo zveOsteomyelitis; (6) kuremara kwepfupa kunoda kuba pfupa; . (8) kurasikirwa kwepa pfupa kunoda kuba pfupa; (9) Kurasikirwa kwepa pfupa kunoda kuba pfupa; uye (10) mabara epa anoda kubhuroka kwepafupi. Streeptocccus d, Gram-isina kunaka mabhakitiriya, kunyanya pseudomonas, nezvimwewo), kana fungul utachiona, hutachiona hweMycobacterial; (8) tsika yehutachiona haina kujeka.
4. Chechipiri-Stage Kudzokorora Kuvhiya
Iyo yakafarirwa nevanovhiya pamakore makumi maviri apfuura nekuda kwehuremu hwayo hwezviratidzo (hwakakwana pfupa, hwakapfuma pertiarticular nyoro tishu) uye huwandu hwakanyanya hwekubvisa hutachiona hwehutachiona.
Spacers, Antibiotic anotakura, mishonga inorwisa mabhakitiriya
Pasinei neiyo spacter maitiro anoshandiswa, gadziriso yemishonga inorwisa mabhakitiriya inodiwa kuti uwedzere kusunganidzwa kwemishonga inorwisa mabhakitiriya mubatanidzwa uye kuwedzera hutachiona hwehutachiona. Inowanzo shandiswa kurwisa mabhomba ndeye tobramycin, genanicin uye vancomycin.
Nharaunda yepasi rose yeOrthopedi yakazivisa kurapwa kwakanyanya kurapwa kwakadzama mushure mekurarama kwakadzama mushure meArthroplasty. Maitiro acho ane manyoro akanyorova, kubviswa kwemuviri uye kuiswa kwemuviri, kuiswa kweshoko rakabatana
Zvakanakira:
Nguva yakakwana yekuziva mhando dzehutachiona uye dzinonamira antimicrobial vamiriri, izvo zvinogona kushandiswa zvinobudirira usati wavhiya.
Iko kusanganiswa kweimwe systemic focic yehutachiona kunogona kurapwa nenzira yakakodzera.
Pane mikana miviri yekushomeka kubvisa necototic tishu uye miviri yekune dzimwe nyika yakanyatso kuderedza chiyero chekudzokorora kutapurirana.
Zvinokuvadza:
Re-anesthesia uye kuvhiya kunowedzera njodzi.
Kwenguva refu yekurapa nguva uye mutengo wepamusoro wekurapa.
Postopengerative inoshanda kupora haina kunaka uye inononoka.
Arthroplasty: Inokodzera kutapurira hutachiona husingabvumire kurapwa, kana kuremara pfupa hombe; mamiriro emurwere anogumira kudzoreredza uye kutadza kuvaka. Kurwadziwa kwasara kurwadzisa, kudiwa kwekushandiswa kwenguva refu kuti ubatsire kusunganidzwa, kusunganidzwa kusunganidzwa, mitezo kupfupika, kuita basa rekushandisa.
Arthroplasty: Kurapa kwechinyakare kwehutachiona hwekushanduka, nekugadzikana kwakanaka kwekutadza uye kuzorora kwekurwadziwa. Zvinokanganisika zvinosanganisira kupfupisa kwegumbo, gait kusagadzikana uye kurasikirwa kwekufamba kwekufamba.
Kukundwa: Ndiyo yekupedzisira yekutandarira yekurapa kwehutachiona hwehutachiona. Yakakodzera kuti: (1) isinganzwisisike mapfupa mapfupa, zvinyoro nyoro zvinorema; . .
Vi. Kudzivirira
1. Preeperative zvinhu:
Simbisa mamiriro ekurwara nemurwere uye hutachiona hwese huripo hunofanirwa kurapwa. Ropa rakawanda kwazvo rinotakura hutachiona ndevaya kubva paganda, urini turakiti, uye turakiti rekufema. Muchiuno kana ibvi Arthroplasty, ganda remigumo yezasi inofanira kuramba isina kurovedzwa. Asymptomatic Bacriauriki, inozivikanwa nevarwere vakwegura, haidi kubatwa chaizvo; Kamwe zviratidzo zvinoitika ivo vanofanirwa kurapwa nekukurumidza. Varwere vane tonssillitis, yepamusoro yekufema turakiti hutachiona, uye Tinea Pedis inofanira kuve neyemunharaunda yeutachiona yakabviswa. Mashandiro makuru emazino inguva inokwanisika yejasi rekutapukirwa, uye kunyangwe kudzivirirwa, kana mashandiro emazino anodikanwa, zvinokurudzirwa kuti maitiro akadaro anoitwa asati atanga kuArthroplasty. Varwere vane midziyo mizhinji mamiriro akadai saAnemia, Hypoproteinaemia, yakasanganiswa chirwere cheshuga uye chirwere chisingaperi chirwere chekutadza chinofanira kubatwa nehasha uye chirwere chepakutanga chekuvandudza hurongwa hwemamiriro ezvinhu.
2. Intrapaepaperating manejimendi:
.
(2.
(3) Nzvimbo yekunyepedzera inofanira kuve yakagadzirirwa zvakanaka kugadzirira kweganda.
. Kupfeka magurovhosi maviri kunogona kuderedza njodzi yekubatana ruoko pakati pekuvhiya uye murwere uye inogona kukurudzirwa.
.
. Kupfupika kwekuvhiya kwekuvhiya kunogona kuderedza nguva yekuwisirwa mhepo, iyo inoshanduka inogona kuderedza nguva yeTourniquet Shandisa. Dzivisa kushanda kwakashata panguva yekuvhiya, ronda rinogona kudzokororwazve (rakadururwa rinorova pfuti rakanakisa), uye Ioodin-vapor kunyudzwa kunogona kuiswa kuti zvisvibiswe.
3. Postoperative zvinhu:
. Naizvozvo, Cliniki Postopengerative Ropa Glucose yekutarisa yakaenzanawo.
. Chidzidzo cheChiyedzo-Control chakawana kuti postoperative application ye lowocular heparin yekudzivirira yakadzika vein thrombosis yaibatsira mukuderedza mukana wekutapudza.
. Migumisiro migumisiro inoratidza kuti intra-artular vatinoshandiswa zvinoshandiswa sekutungamira kutonga kweAnalgesics kunogona kuve zvakare kuve nekukasirwa kutapukirwa kwaronda.
4. Antibiotic Prophylaxis:
Parizvino, maitiro ekiriniki ekushandisa kweProphylactic Doses emishonga yeMishonga Inorwisa mabhakitiriya Systems yakagoverwa zvisati zvaitika uye mushure mekuvhiyiwa kunoderedza njodzi yehutachiona hwehutachiona hwehutachiona hwekutengesa. CEPhaloporins inonyanya kushandiswa kiritiki semishonga inorwisa mabhakitiriya, uye kune hukama hwepfungwa pakati pekushandiswa kwemishonga inorwisa mabhakitiriya uye huwandu hwehutachiona hwepamberi uye mushure mekunyora nguva yekushandisa kurwisa mabhakitiriya ekushandisa mishonga inorwisa mabhakitiriya. Chidzidzo chikuru chichangobva kuitika chakawana kuti mishonga inorwisa mabhakitiriya inoshandiswa mukati memakumi matatu kusvika makumi matanhatu emaminitsi isati yave neyakaderera hutachiona. Mukupesana, chimwezve kudzidza kukuru kwehudyu yehukuru Arthroplasty yakaratidza huwandu hwakadzika hwehutachiona hwematambudziko emishonga inorwisa mabhakitiriya anovharirwa mukati memaminitsi makumi matatu ekutanga. Naizvozvo nguva yekutonga inowanzoonekwa seyamakumi matatu emaminitsi usati washanda, nemhedzisiro yakanakisa panguva yekunyepedzera kweanesthesia. Imwe prophylactic dosi yemishonga inorwisa mabhakitiriya inopihwa mushure mekuvhiyiwa. MuEurope neUnited States, mishonga inorwisa mabhakitiriya inowanzo shandiswa kusvika pazuva rechitatu redzimba, asi muChina, zvinonzi zvinowanzoshandiswa zvichiramba kwemavhiki maviri kusvika maviri. Nekudaro, kubvumirana kwakawanda kuri kushandiswa kwenguva refu mishonga yakaipa-scriptrum Vancomycin yakaratidzwa kuti ibudirire mumarwere ane njodzi yepamusoro akatakura methicillin-anoramba staphyloccus aureus. Madhiri epamusoro emishonga inorwisa mabhakitiriya inofanira kushandiswa kuvhiya kwenguva refu, kusanganisira bilateral yekuvhiya, kunyanya kana iyo mishonga inorwisa mabhakitiriya ipfupi.
5. Kushandiswa kwemishonga inorwisa mabhakitiriya musanganiswa nepafupa rechikadzi:
STEBIIOT-YAKAITWA STEMENT YAKABVUNZWA MUCHENGWA muNorway, kwaitanga kushandiswa kweNorthroplasti Kutsvaga uku kwakasimbiswa mune yakatevedzana yezvidzidzo zvikuru mumakore anotevera ane makore gumi nematanhatu anotevera. Chidzidzo cheFinnish neAustralia Orthopedic Songsation 2009 yakasvika mhedziso dzakafanana nezvebasa remishonga inorwisa mabhakitiresi munguva yekutanga uye nekudzokorora mabvani arthroplasty. Zvakaratidzwawo kuti Biomechanical zvivakwa zveProement haina kukanganiswa apo mishonga inorwisa mabhakitiriya inowedzerwa mune dope isingapfuure 2 g pa40 g yepafuro yepafu. Nekudaro, hazvisi zvese mishonga inorwisa mabhakitiriya inogona kuwedzerwa kune yepafuro simenti. Mishonga inorwisa mabhakitiriya inogona kuwedzerwa kune iyo BONE CEMENT inofanirwa kuve nemamiriro ezvinhu anotevera: kuchengeteka, hymarlergenius, yakanaka yekukwazisa, yakajeka antimicrobial spectrum, uye zvinhu zvakaipisisa. Parizvino, vancomycin uye Gentamicin inowanzo shandiswa mukuita kwekiriniki. Zvaifungidzirwa kuti kurwisa mishonga normisikisheni kuchawedzera njodzi yekusagadzikana kwekusagadzikana, kusunungurwa kwematambudziko ekudzivirira, uye kusunungura kusasunungurwa kweProstishing, asi kusvika parizvino hapana humbowo hwekutsigira izvi zvinetso izvi.
Vii. Pfupiso
Kugadzira nekukurumidza uye kwakakodzera kuongororwa kuburikidza nenhoroondo, kuongororwa kwepanyama uye kuongororwa kwenyika ndiko kwekutanga kwekubudirira kwekurapa kwehutachiona hwehukama hwehukama. Kubvisirwa kwehutachiona uye kudzoreredzwa kwemarwadzo-emahara, kushanda-kushanda kwekunyepedzera ndiyo nheyo yekutanga mukurapa kwehutachiona hwehukama hutachiona. Kunyangwe kurapwa kweanomushonga kweutachiona kwekubatana kuri nyore uye kusingadhuri, kutsvakwa kwehukutakura kwakabatana kwakanyanya kunoda kusanganiswa kwenzira dzekuvhiya. Kiyi yekusarudza kurapwa kwekuvhiya ndeyekufunga nezve dambudziko rekubvisa prosthesis, rinova chinhu chakakosha chekubata nehutachiona hwehukama. Parizvino, kushandiswa kwakabatanidzwa kwemishonga inorwisa mabhakitiriya, kushomekana uye kurapwa kwave kuita kurapwa kwakazara kwehutachiona hwakaoma. Nekudaro, izvo zvichiri kufanira kuvandudzwa uye vakakwana.
Kutumira Nguva: May-06-2024
