Utachiona nderimwe rematambudziko akakomba mushure mekugadzirisa majoini, izvo zvisingangounzi kurova kwakawanda kwekuvhiya kuvarwere, asi zvakare zvinopedza zviwanikwa zvekurapa zvakakura. Mumakore gumi apfuura, huwandu hwehutachiona mushure mekugadziriswa kwemajoini hwakadzikira zvakanyanya, asi kukura kuri kuitika kwevarwere vari kuchinjwa majoini kwakapfuura nekure kuderera kwehuwandu hwehutachiona, saka dambudziko rehutachiona mushure mekuvhiyiwa harifanirwe kufuratirwa.
I. Zvikonzero zvekurwara
Zvirwere zvepashure zvekugadzira majoints zvinofanirwa kutorwa sehosha dzinowanikwa muchipatara dzine zvipembenene zvinorwisa mishonga. Inonyanya kuzivikanwa ndeye staphylococcus, inoverengera 70% kusvika 80%, gram-negative bacilli, anaerobes uye non-A group streptococci inowanikwawo.
II Pathogenesis
Hutachiona hwakakamurwa muzvikamu zviviri: chimwe hurwere hwekutanga uye humwe hutachiona hwekunonoka kana hunonzi hutachiona hwekunonoka. Zvirwere zvepakutanga zvinokonzerwa nekupinda zvakananga kwebhakitiriya mujoint panguva yekuvhiyiwa uye kazhinji Staphylococcus epidermidis. Zvirwere zvekunonoka kutanga zvinokonzerwa nekutapurirwa kweropa uye kazhinji Staphylococcus aureus. Majoini akavhiyiwa ane mikana yakawanda yekutapukirwa. Semuenzaniso, kune 10% yehutachiona hwehutachiona muzviitiko zvekudzokorora mushure mekugadzirisa majoini ekugadzirisa, uye chiyero chetachiona chakakwirirawo muvanhu vakave nekubatana kwekutsiva rheumatoid arthritis.
Zvizhinji zvehutachiona hunoitika mukati memwedzi mishoma mushure mekuvhiyiwa, yekutanga inogona kuoneka mumavhiki maviri ekutanga mushure mekuvhiyiwa, asi zvakare mushure memakore mashoma kusati kwabuda kwekutanga kuratidzwa kukuru kwekuzvimba kwemajoini, kurwadziwa uye fivha. , zviratidzo zvefivha zvinofanira kusiyaniswa kubva kune mamwe matambudziko, akadai se postoperative pneumonia, urinary tract infections nezvimwe zvakadaro.
Panyaya yehutachiona hwepakutanga, kutonhora kwemuviri hakusi kungopora, asi kunomuka mazuva matatu mushure mekuvhiyiwa. Kurwadza kwemajoini kwete chete hakuiti zvishoma nezvishoma kuderedza, asi zvishoma nezvishoma kuwedzera, uye pane throbbing marwadzo pakuzorora. Pane kuyerera kusingaite kana kuvharika kubva mukuchekwa. Izvi zvinofanira kunyatsoongororwa, uye fivha yacho haifaniri kunzi inokonzerwa nehosha dzepashure mumamwe mativi omuviri akadai semapapu kana kuti weti. Izvo zvakakoshawo kuti usangobvisa incisional kuyerera seyakajairwa kuyerera kwakadai semafuta liquefaction. Izvo zvakakoshawo kuti uone kana hutachiona huri mumatishu epamusoro kana kudzika kwakatenderedza prosthesis.
Muvarwere vane utachiona hwepamusoro, vazhinji vavo vakabuda muchipatara, kuzvimba kwemajoini, kurwadziwa, uye fivha zvingasava zvakanyanya. Hafu yevarwere inogona kunge isina fivha. Staphylococcus epidermidis inogona kukonzera utachiona husingarwadzi nekuwedzera kwemasero machena eropa muchikamu che10% chevarwere. Kuwedzera kweropa sedimentation kunowanzoonekwa asi zvakare kwete zvakananga. Marwadzo dzimwe nguva anoonekwa zvisiri izvo seprosthetic kusunungura, iyo yekupedzisira iri kurwadziwa kunobatanidza nekufamba kunofanira kusunungurwa nekuzorora, uye kurwadziwa kwekuputika kusingasunungurwi nekuzorora. Zvisinei, zvave zvichinzi chikonzero chikuru chekusunungura prosthesis kunonoka kwechirwere chisingaperi.
III. Kuongororwa
1. Hematological kuongorora:
Zvikuru zvinosanganisira masero machena eropa kuverenga pamwe nekupatsanurwa, interleukin 6 (IL-6), C-reactive protein (CRP) uye erythrocyte sedimentation rate (ESR). Zvakanakira zvehematological kuongororwa zviri nyore uye zviri nyore kuita, uye mhedzisiro inogona kuwanikwa nekukurumidza; ESR uye CRP vane yakaderera chaiyo; IL-6 inokosha zvikuru pakugadzirisa chirwere cheperprosthetic munguva yekutanga ye postoperative.
2.Imaging kuongorora:
X-ray firimu: hainzwisisike kana yakananga yekuongororwa kwehutachiona.
X-ray firimu yehutachiwana hwekuchinja kwemabvi
Arthrography: mumiririri mukuru wekuita mukuongororwa kwehutachiona ndiko kubuda kwe synovial fluid uye abscess.
CT: kuona kwekubatana kwekubatana, sinus maturakiti, zvinyoro zvinyoro zviputi, kuputika kwepfupa, periprosthetic bone resorption.
MRI: inonzwisisika zvakanyanya pakuonekwa kwekutanga kwemvura yakabatana uye abscesses, isingashandisi zvakanyanya mukuongororwa kwehutachiona hwehutachiona.
Ultrasound: kuunganidzwa kwemvura.
3.Mushonga weNuclear
Technetium-99 bone scan ine sensitivity ye33% uye yakananga 86% yekuongororwa kwehutachiona hweperiprosthetic mushure me arthroplasty, uye indium-111 yakanyorwa leukocyte scan inonyanya kukosha pakuongororwa kwehutachiona hweperiprosthetic, nekunzwa kwe77% uye chaiyo ye86%. Kana zviyero zviviri izvi zvichishandiswa pamwe chete kuongororwa kwehutachiona hwehutachiona mushure me arthroplasty, kunzwisiswa kwepamusoro, kunyatsojeka uye kurongeka kunogona kuwanikwa. Muedzo uyu uchiri chiyero chegoridhe mumishonga yenyukireya yekuongororwa kwehutachiona hweperiprosthetic. Fluorodeoxyglucose-positron emission tomography (FDG-PET). Inoona masero ekuputika nekuwedzera kweglucose kutora munzvimbo ine utachiona.
4. Molecular biology maitiro
PCR: high senitivity, nhema positives
Gene chip tekinoroji: danho rekutsvaga.
5. Arthrocentesis:
Cytological kuongorora yejoint fluid, bhakitiriya tsika uye zvinodhaka senitivity test.
Iyi nzira iri nyore, inokurumidza uye yakarurama
Muhudyu zvirwere, kusanganiswa kwemvura leucocyte count> 3,000/ml pamwe chete nekuwedzera kweESR uye CRP ndiyo inonyanya kukosha yekuvapo kwechirwere cheperprosthetic.
6. Intraoperative kukurumidza chando chikamu histopathology
Rapid intraoperative yechando chikamu che periprosthetic tissue ndiyo inonyanya kushandiswa intraoperative nzira ye histopathological examination. Feldman's diagnostic criteria, kureva, yakakura kudarika kana yakaenzana ne5 neutrophils pakukwirira kwepamusoro (400x) mune inokwana 5 madiki madiki minda, anowanzo shandiswa kune zvikamu zvakaomeswa nechando. Zvave zvichiratidzwa kuti kunzwisiswa uye zvakananga nzira iyi ichapfuura 80% uye 90%, maererano. Iyi nzira parizvino ndiyo chiyero chegoridhe chekuongorora intraoperative.
7. Bacterial tsika ye pathological tissue
Bhakitiriya tsika ye periprosthetic tishu ine hunyanzvi hwekuongorora hutachiona uye yave ichionekwa seyegoridhe chiyero chekuongorora hutachiona hwehutachiona, uye inogona zvakare kushandiswa pakuongorora manzwiro ezvinodhaka.
IV. Differential diagnosiss
Zvirwere zvisingarwadzi zveprosthetic joint zvinokonzerwa neStaphylococcus epidermidis zvinonyanya kuoma kusiyanisa kubva kune prosthetic loosening. Inofanira kusimbiswa neX-rays uye mamwe maedzo.
V. Kurapa
1. Mushonga unorwisa mabhakitiriya uri nyore
Tsakaysma uye se,gawa Classified post arthroplasty zvirwere mumarudzi mana, mhando I asymptomatic mhando, murwere chete ari dzokororo kuvhiyiwa zvinyama tsika akawanikwa ane utachiona kukura, uye kanenge maviri ezvienzaniso cultured pamwe chete utachiona; mhando II chirwere chepakutanga, chinoitika mukati memwedzi mumwe wekuvhiyiwa; Type IIl chirwere chisingaperi chinononoka; uye Type IV chirwere chehamatogenous chirwere chakakomba. Nheyo yemishonga inorwisa mabhakitiriya inonzwa, yakakwana chiyero uye nguva. Uye preoperative joint cavity puncture uye intraoperative tissue culture zvakakosha zvikuru pakusarudza kwakaringana kwemishonga inorwisa mabhakitiriya. Kana tsika yebhakitiriya yakanaka kune hutachiona hwemhando I, kushandisa nyore kwemishonga inorwisa mabhakitiriya kwemavhiki matanhatu kunogona kuwana mhedzisiro yakanaka.
2. Kuchengetedzwa kweprosthesis, kusvibiswa uye mvura, kuvhiyiwa kwekudiridza kwechubhu
Chirevo chekutora chirevo chekushungurudzika kuchengetedza kurapwa kweprosthesis ndechekuti prosthesis yakagadzikana uye hutachiona hwehutachiona. Chipenyu chinotapukira chakajeka, hutachiona hwehutachiona hwakaderera uye maantibioti ane hunyanzvi aripo, uye liner kana spacer inogona kutsiviwa panguva yekubvisa. Kurapa mitengo ye6% chete nemishonga inorwisa mabhakitiriya chete uye 27% nemishonga inorwisa mabhakitiriya pamwe nekusvibiswa uye kuchengetedza prosthesis yakashumwa mumabhuku.
Inokodzera hutachiona hwekutanga kana kuti acute haematogenous infection ine good prosthesis fixation; wo, zviri pachena kuti utachiona ari yakaderera virulence bhakitiriya utachiona kuti anonzwira antimicrobial kurapwa. Nzira yacho inosanganisira kusvibiswa kwakakwana, antimicrobial flushing uye mvura (nguva yemavhiki matanhatu), uye postoperative systemic intravenous antimicrobials (nguva yemavhiki matanhatu kusvika kumwedzi mitanhatu). Zvakaipa: kutadza kwakanyanya (kusvika ku45%), nguva refu yekurapa.
3. Imwe danho rekudzokorora kuvhiyiwa
Iine zvikomborero zvekushungurudzika kuduku, kupfupika kwekugara muchipatara, kuderera kwemari yekurapa, kuderera kwevanga remaronda uye kuoma kwemajoini, izvo zvinobatsira pakudzorerwa kwebasa rekubatana mushure mekuvhiyiwa. Iyi nzira inonyanya kukodzera kurapwa kwekutanga kwehutachiona uye acute haematogenous infection.
One-stage replacement, kureva, one-step method, inongogumira kune-low-toxicity infections, kunyatsobvisa, antibiotic bone simenti, uye kuwanikwa kwemishonga inorwisa mabhakitiriya. Zvichienderana nemhedzisiro yechikamu chemukati mekushanda tishu chakaomeswa nechando, kana paine isingasviki 5 leukocytes/yakakwirira magnification ndima. Zvinoratidza hutachiona hwehupfu hwakadzika. Mushure mekunyatsogadziriswa imwe nhanho arthroplasty yakaitwa uye pakanga pasina kudzoka kwehutachiona mushure mekuvhiyiwa.
Mushure mekunyatsosvibiswa, prosthesis inotsiviwa pakarepo pasina kudiwa kwemaitiro akazaruka. Iine zvakanakira kushungurudza kudiki, nguva pfupi yekurapa uye mutengo wakaderera, asi chiyero chekudzoka kwehutachiona hwepashure chakakwirira, iyo inenge 23% ~ 73% maererano nehuwandu. Imwe-nhanho prosthesis replacement inonyanya kukodzera kuvarwere vakwegura, pasina kubatanidza chero ipi zvayo inotevera: (1) nhoroondo yekuvhiyiwa kwakawanda pamubatanidzwa wekutsiva; (2) kuumbwa kwe sinus tract; (3) utachiona hwakanyanya (semuenzaniso septic), ischemia uye mavanga enyama dzakapoteredza; (4) kukanganisa kusina kukwana kwekushungurudzika nechikamu chesimende chakasara; (5) X-ray inoratidza osteomyelitis; (6) kuremara kwebhonzo kunoda kubatanidza pfupa; (7) zvirwere zvakasanganiswa kana mabhakitiriya ane hutachiona zvakanyanya (eg Streptococcus D, Gram-negative bacteria); (8) kurasikirwa kwebhonzo kunoda kubatanidza pfupa; (9) kurasikirwa kwebhonzo kunoda kubatanidza pfupa; uye (10) kubatanidza mapfupa kunoda kubatanidza mapfupa. Streptococcus D, Gram-negative mabhakitiriya, kunyanya Pseudomonas, nezvimwewo), kana hutachiona hwehutachiona, mycobacterial infection; (8) Tsika dzeutachiona hadzina kujeka.
4. Chechipiri-danho rekudzokorora kuvhiyiwa
Yakave yakafarirwa nevarapi mumakore makumi maviri apfuura nekuda kwehuwandu hwezviratidzo (zvakakwana mapfupa emapfupa, hupfumi hweperiarticular soft tissues) uye nehuwandu hwekupedza hutachiona.
Spacers, mishonga inorwisa mabhakitiriya, mishonga inorwisa mabhakitiriya
Zvisinei nemaitiro emuchadenga anoshandiswa, simende kugadzirisa nemishonga inorwisa mabhakitiriya inodiwa kuti uwedzere kuwanda kwemishonga inorwisa mabhakitiriya mujoini uye kuwedzera huwandu hwekurapa kwehutachiona. Mishonga inorwisa mabhakitiriya inowanzoshandiswa tobramycin, gentamicin uye vancomycin.
Nharaunda yepasi rose yemapfupa yakaziva kurapwa kwakanyanya kwehutachiona hwakadzama mushure me arthroplasty. Nzira yacho inosanganisira kunyatsosvibiswa, kubviswa kweprosthesis uye muviri wekunze, kuiswa kwejoint spacer, kuenderera mberi kwekushandisa intravenous sensitive antimicrobials kwemavhiki matanhatu, uye pakupedzisira, mushure mekutonga kunobudirira kwehutachiona, kudzorerazve prosthesis.
Zvakanakira:
Nguva yakakwana yekuziva mabhakitiriya emhando uye anonzwa antimicrobial agents, ayo anogona kushandiswa nemazvo pamberi pekuvhiya kwekudzokorora.
Iko kusanganiswa kweimwe systemic foci yehutachiona inogona kurapwa panguva yakakodzera.
Pane mikana miviri yekusvibiswa kubvisa necrotic tishu uye miviri yekunze zvakanyatsonaka, izvo zvinoderedza zvakanyanya chiyero chekudzoka kwezvirwere zvepashure.
Zvakaipa:
Re-anesthesia uye kuvhiyiwa kunowedzera njodzi.
Nguva yakareba yekurapa uye mari yekurapa yakakwirira.
Postoperative functional recovery haina kunaka uye inononoka.
Arthroplasty: Inokodzera zvirwere zvinoramba zvichiitika zvisingapinduri kurapwa, kana kuti mapfupa makuru akaremara; Mamiriro emurwere anoganhurira kushandazve uye kukundikana kwekuvakazve. Marwadzo akasara epashure, kudiwa kwekushandiswa kwenguva refu kwezvisungo zvekubatsira kufamba, kusagadzikana kwemajoini, kupfupisa kwemakumbo, kushanda kwekushanda, chiyero chekushandiswa chishoma.
Arthroplasty: kurapwa kwechinyakare kwehutachiona hwepashure, nekugadzikana kwakanaka kwemashure uye kunyaradza kurwadziwa. Zvakaipa zvinosanganisira kupfupika kwenhengo, kusagadzikana kwekufamba uye kurasikirwa kwekubatana kwekufamba.
Kudimburwa: Ndiyo nzira yekupedzisira yekurapa hutachiona hwepashure. Inokodzera: (1) kurasikirwa kwakanyanya kwebhonzo kusingagadzirike, kuremara kwenyama yakapfava; (2) hutachiona hwakasimba hwehutachiona, hutachiwana hwakavhenganiswa, kurapwa kwemishonga inorwisa mabhakitiriya haibatsiri, zvichiita kuti systemic toxicity, kutyisa upenyu; (3) ine nhoroondo yekukundikana kwakawanda kwekuvhiyiwa kwekudzokorora kwevarwere vasingaperi vane hutachiona.
VI. Kudzivirira
1. Preoperative factor:
Gadzirisa mamiriro evarwere vasati vavhiyiwa uye hutachiona hwese huripo hunofanirwa kurapwa preoperative. Zvirwere zvinotapuriranwa neropa ndezviya zvinobva paganda, weti, uye nzira yekufema. Muhudyu kana mabvi arthroplasty, ganda rezasi rinofanira kuramba risina kuputsika. Asymptomatic bacteriuria, iyo inowanikwa muvarwere vakwegura, haifaniri kurapwa isati yatanga; kana zviratidzo zvangoitika zvinofanirwa kurapwa nekukasika. Varwere vane tonsillitis, utachiona hwepamusoro hwekufema, uye tinea pedis vanofanira kunge vane foci yemunharaunda yehutachiona yakabviswa. Kuvhiya mazino kwakakura ndiko kunogona kukonzera hutachiona hweropa, uye kunyangwe zvikadziviswa, kana kuvhiyiwa kwemazino kuchidikanwa, zvinokurudzirwa kuti maitiro akadaro aitwe pamberi pe arthroplasty. Varwere vane hurombo hwakanyanya hwakadai seanemia, hypoproteinaemia, chirwere cheshuga chakasanganiswa uye chirwere chisingaperi chine weti inofanirwa kurapwa zvine hukasha uye nekukasira kwekutanga chirwere chekuvandudza systemic mamiriro.
2. Intraoperative management:
(1) Akazara aseptic matekiniki uye maturusi anofanirwawo kushandiswa mune yenguva dzose nzira yekurapa kune arthroplasty.
(2) Kuiswa muchipatara kusati kwaitwa kuvhiyiwa kunofanira kudukupiswa kuderedza ngozi yokuti ganda romurwere ringangogara neutachiona hunobva kuchipatara, uye kurapwa kwenguva dzose kunofanira kuitwa pazuva rokuvhiyiwa.
(3) Nzvimbo yepreoperative inofanira kugadzirirwa zvakakodzera kugadzirira kweganda.
(4) Majasi ekuvhiya, masks, hati, uye laminar flow operating theatre zvinobudirira mukuderedza utachiona hwemhepo munzvimbo yekushanda. Kupfeka magirovhosi maviri kunogona kuderedza njodzi yekubata ruoko pakati pechiremba anovhiya uye murwere uye inogona kukurudzirwa.
5 .
(6) Kuvandudza nzira yekuvhiya yemushandi uye kupfupisa nguva yekushanda (<2.5 h kana zvichibvira). Kupfupisa kwenguva yekuvhiya kunogona kuderedza nguva yekusangana nemhepo, iyo inogona kuderedza nguva yekushandiswa kwe tourniquet. Dzivisa kuvhiyiwa kwakashata panguva yekuvhiyiwa, ronda rinogona kudiridzwa kakawanda (pfuti yekudiridza yepulsed ndiyo yakanyanya kunaka), uye kunyudzwa kweiodine-mhute inogona kutorwa kuitira kuchekwa kunofungidzirwa kuti kwakasvibiswa.
3. Postoperative factor:
(1) Kurova kwekuvhiya kunokonzera insulin kushorwa, izvo zvinogona kutungamirira ku hyperglycaemia, chiitiko chinogona kupfuurira kwemavhiki akawanda mushure mekuvhiyiwa uye chinokonzera murwere kune zvinetso zvine chokuita nemaronda, uye izvo, zvakare, zvinoitika kune vasina chirwere cheshuga zvakare. Naizvozvo, kliniki postoperative blood glucose monitoring yakakosha zvakaenzana.
(2) Deep vein thrombosis inowedzera njodzi yehematoma uye zvinokonzeresa zvine chekuita nemaronda. Chidzidzo chekuongorora chiitiko chakawana kuti postoperative application ye low molecular heparin kudzivirira yakadzika vein thrombosis yaibatsira mukuderedza mukana wehutachiona.
(3) Mvura yakavharwa ndiyo inogona mukova wekupinda kwehutachiona, asi hukama hwayo nehuwandu hwehutachiona hwemaronda husati hwanyatsodzidza. Mhedzisiro yekutanga inoratidza kuti intra-articular catheters inoshandiswa se postoperative administration yeanalgesics inogonawo kubatwa nehutachiona hwemaronda.
4. Antibiotic prophylaxis:
Parizvino, kushandiswa kwemishonga yeprophylactic yemishonga inorwisa mabhakitiriya inorongwa netsinga vasati vavhiyiwa uye mushure mekuvhiyiwa kunoderedza njodzi yehutachiona hwepashure. Cephalosporins inonyanya kushandiswa kukiriniki semushonga unorwisa mabhakitiriya wesarudzo, uye kune hukama hwakaumbwa neU pakati penguva yekushandiswa kwemishonga inorwisa mabhakitiriya uye chiyero chehutachiona hwepanzvimbo yekuvhiyiwa, ine njodzi huru yekutapukirwa pamberi uye mushure menguva yakakwana yemishonga inorwisa mabhakitiriya. use. Ongororo huru ichangoburwa yakawana kuti mishonga inorwisa mabhakitiriya inoshandiswa mukati memaminitsi makumi matatu kusvika makumi matanhatu isati yaitwa incision yaive nehuwandu hwehutachiwana hwakaderera. Kusiyana neizvi, kumwe kuongorora kukuru kwehudyu arthroplasty yakaratidza kuderera kwehutachiona nemishonga inorwisa mabhakitiriya inotungamirirwa mukati memaminitsi makumi matatu ekutanga ekucheka. Nokudaro nguva yehutungamiri inowanzoonekwa se30 min isati yaitwa, nemigumisiro yakanakisisa panguva yekuiswa kweanesthesia. Imwe prophylactic dose yemishonga inorwisa mabhakitiriya inopiwa mushure mekuvhiyiwa. MuEurope neUnited States, mishonga inorwisa mabhakitiriya inowanzoshandiswa kusvikira zuva rechitatu rekuvhiyiwa, asi muChina, inonzi inowanzoshandiswa nguva dzose kwe1 kusvika kumavhiki maviri. Zvisinei, kubvumirana kukuru ndekwekuti kushandiswa kwenguva refu kwemishonga ine simba yakakura-yakakura kunofanira kudziviswa kunze kwekunge paine mamiriro ezvinhu, uye kana kushandiswa kwenguva refu kwemishonga inorwisa mabhakitiriya inodiwa, zvinokurudzirwa kushandisa mishonga inorwisa fungal pamwe chete nemishonga kudzivirira fungal zvirwere. . Vancomycin yakaratidzwa kuva inoshanda muvarwere vane njodzi yakakura vanotakura methicillin-resistant Staphylococcus aureus. Mishonga yakakwirira yemishonga inorwisa mabhakitiriya inofanira kushandiswa pakuvhiyiwa kwenguva refu, kusanganisira kuvhiyiwa kwemativi maviri, kunyanya kana mushonga unorwisa mabhakitiriya upfupi.
5. Kushandiswa kwemishonga inorwisa mabhakitiriya pamwe chete nesamende yebhonzo:
Simende yakaisirwa mishonga inorwisa mabhakitiriya yakatanga kushandiswa mu arthroplasty muNorway, uko pakutanga ongororo yeNorwegian Arthroplasty Registry yakaratidza kuti kushandiswa kwemusanganiswa wemishonga inorwisa mabhakitiriya IV nesamende (yakasanganiswa antibiotic prosthesis) infusion yakaderedza huwandu hwehutachiona hwakadzama zvakanyanya kupfuura chero nzira yega. . Kuwana uku kwakasimbiswa munhevedzano yezvidzidzo zvakakura mumakore gumi nematanhatu anotevera. Chidzidzo cheFinnish uye Australian Orthopedic Association 2009 yakasvika mhedziso dzakafanana nezve basa remishonga inorwisa mabhakitiriya-yakaiswa simende munguva yekutanga uye yekudzokorora mabvi arthroplasty. Yakave yakaratidzawo kuti biomechanical properties yebone simenti haigadziriswi kana antibiotic powder inowedzerwa mumadhora asingapfuuri 2 g pa 40 g yefupa simenti. Zvisinei, haasi ose mishonga inorwisa mabhakitiriya inogona kuwedzerwa kune simiti yemapfupa. Mishonga inorwisa mabhakitiriya inogona kuwedzerwa kumapfupa simende inofanira kuva nemamiriro ezvinhu anotevera: kuchengeteka, kugadzikana kwekushisa, hypoallergenicity, yakanaka aqueous solubility, yakakura antimicrobial spectrum, uye zvinhu zvehupfu. Parizvino, vancomycin uye gentamicin zvinonyanya kushandiswa mumakiriniki maitiro. Zvaifungidzirwa kuti jekiseni remishonga musimende raizowedzera njodzi yekusawirirana, kubuda kwekusagadzikana, uye kusunungurwa kweaseptic yeprosthesis, asi kusvika parizvino hapana humbowo hunotsigira izvi zvinonetsa.
VII. Summary
Kuita kukurumidza uye kwakaringana kuongororwa kuburikidza nenhoroondo, kuongororwa kwemuviri uye ancillary bvunzo chinhu chinodiwa kuti ubudirire kurapwa kwehutachiona hwemajoini. Kupedzwa kwehutachiona uye kudzorerwa kwehutano husina marwadzo, hunoshanda zvakanaka hwekugadzira mubatanidzwa ndiyo musimboti wekutanga mukurapa hutachiona hwemajoini. Kunyange zvazvo kurapwa kwemishonga inorwisa mabhakitiriya yejoints infection iri nyore uye isingadhuri, kupedzwa kweutachiona hwemajoini kunonyanya kuda kusanganisa nzira dzekuvhiya. Chinokosha pakusarudza kurapwa kwekuvhiya ndechekufunga nezvedambudziko rekubviswa kweprosthesis, iyo ndiyo inonyanya kukosha yekubata nehutachiona hwekubatana. Parizvino, kushandiswa kwakasanganiswa kwemishonga inorwisa mabhakitiriya, debridement uye arthroplasty yava mushonga wakakwana wezvirwere zvakawanda zvakaoma zvakabatana. Nekudaro, ichiri kuda kuvandudzwa uye kukwenenzverwa.
Nguva yekutumira: Chivabvu-06-2024
