Kutapukirwa ndeimwe yematambudziko makuru mushure mekutsiviwa kwemajoini ekugadzira, izvo hazvingogumiri pakuvhiyiwa kakawanda kuvarwere, asiwo zvinodya mari yakawanda yekurapa. Mumakore gumi apfuura, huwandu hwehutachiona mushure mekutsiviwa kwemajoini ekugadzira hwakaderera zvakanyanya, asi huwandu hwekuwedzera kwevarwere vari kutsiviwa kwemajoini ekugadzira hwakapfuura zvakanyanya huwandu hwehutachiona, saka dambudziko rehutachiona mushure mekuvhiyiwa harifanirwe kufuratirwa.
I. Zvinokonzera kurwara
Utachiona hwemajoini hunowanikwa mushure mekugadzirwa hunofanira kuonekwa sehutachiona hunowanikwa muchipatara hune utachiona husingapindi mishonga. Hunonyanya kuzivikanwa istaphylococcus, inoumba 70% kusvika 80%, gram-negative bacilli, anaerobes uye non-A group streptococci zvakajairikawo.
II Pathogenesis
Utachiona hwakakamurwa muzvikamu zviviri: chimwe chirwere chepakutanga uye chimwe chirwere chekupedzisira kana kuti chirwere chekupedzisira. Utachiona hwekutanga hunokonzerwa nekupinda zvakananga kwebhakitiriya mujoini panguva yekuvhiyiwa uye kazhinji iStaphylococcus epidermidis. Utachiona hwekupedzisira hunokonzerwa nekutapurirana kweropa uye kazhinji iStaphylococcus aureus. Majoini akavhiyiwa ane mukana wekutapukirwa nechirwere. Semuenzaniso, kune huwandu hwe10% hwehutachiona muzviitiko zvekuvandudzwa mushure mekutsiviwa kwemajoini ekugadzira, uye huwandu hwehutachiona hwakakwirawo kune vanhu vakatsiviwa majoini nerheumatoid arthritis.
Zvizhinji zvezvirwere zvinoitika mukati memwedzi mishoma mushure mekuvhiyiwa, zvekutanga zvinogona kuonekwa mumavhiki maviri ekutanga mushure mekuvhiyiwa, asiwo mumakore mashoma zvisati zvaonekwa zviratidzo zvikuru zvekuzvimba kwakanyanya kwemajoini, kurwadziwa nefivha, zviratidzo zvefivha zvinofanira kusiyaniswa nezvimwe zvinetso, zvakaita sepneumonia mushure mekuvhiyiwa, hutachiona hwemunzira yeweti nezvimwewo.
Kana paine hutachiona hwepakutanga, tembiricha yemuviri haingodzokeri chete, asi inokwira mazuva matatu mushure mekuvhiyiwa. Marwadzo emajoini haangodziki zvishoma nezvishoma, asi anotowedzera zvishoma nezvishoma, uye kune marwadzo anorwadza panguva yekuzorora. Pane kubuda kwemvura kana kubuda kwechinhu chisina kujairika kubva pakachekwa. Izvi zvinofanirwa kuongororwa nokungwarira, uye fivha haifanirwe kunzi inokonzerwa nehutachiona hwepashure pekuvhiyiwa mune dzimwe nzvimbo dzemuviri dzakadai semapapu kana nzira yeweti. Zvakakoshawo kuti usangosiya kubuda kwechinhu chakachekwa sechinowanzoitika sekubuda kwemafuta. Zvakakoshawo kuona kana hutachiona huri munyama yepamusoro kana kuti hwakadzika zvakakomberedza prosthesis.
Muvarwere vane hutachiona hwakanyanya, vazhinji vavo vakabuda muchipatara, kuzvimba, kurwadziwa, uye fivha zvinogona kunge zvisina kunyanya kuipa. Hafu yevarwere vanogona kunge vasina fivha. Staphylococcus epidermidis inogona kukonzera hutachiona husingarwadzi nekuwedzera kwehuwandu hwemasero machena eropa mu10% chete yevarwere. Kuwanda kweropa kwakajairika asi zvakare hazvisi zvakananga. Dzimwe nguva marwadzo anotsanangurwa zvisizvo sekusununguka kweprosthetic, kwekupedzisira kuri marwadzo ane chekuita nekufamba kunofanira kubviswa nekuzorora, uye marwadzo ekuzvimba asingabviswi nekuzorora. Zvisinei, zvakataurwa kuti chikonzero chikuru chekusunungurwa kweprosthesis ihutachiona hunogara kwenguva refu.
III. Kuongororwa kwechirwere
1. Kuongororwa kweropa:
Zvikuru zvinosanganisira kuwanda kwemasero machena eropa pamwe nekupatsanurwa, interleukin 6 (IL-6), C-reactive protein (CRP) uye erythrocyte sedimentation rate (ESR). Zvakanakira zvekuongorora ropa zviri nyore uye zviri nyore kuita, uye mhedzisiro yacho inogona kuwanikwa nekukurumidza; ESR neCRP hazvina kunyatsojeka; IL-6 inokosha zvikuru pakuona hutachiona hweperiprosthetic munguva yekutanga mushure mekuvhiyiwa.
2. Kuongorora mifananidzo:
Firimu reX-ray: harina kubatwa zvakanyanya kana kuti harina kunyatsojeka pakuongorora hutachiona.
Firimu reX-ray rehutachiona hwekutsiva ibvi
Arthrography: chinhu chikuru chinoratidza hutachiona ndiko kubuda kwemvura ye synovial uye bundu.
CT: kuona kubuda kwemajoini, ma sinus tracts, maronda enyama yakapfava, kuputsika kwemapfupa, kusvetwa kwemapfupa nepaburi reprosthetic bone.
MRI: inonyatsoona mvura nemapundu mumajoini nekukurumidza, isingashandiswi zvakanyanya pakuongorora hutachiona hweperiprosthetic.
Ultrasound: kuunganidzwa kwemvura.
3. Mushonga wenyukireya
Kuongororwa kwemapfupa eTechnetium-99 kune kunzwisiswa kwe33% uye 86% chaiyo pakuongorora hutachiona hweperiprosthetic mushure me arthroplasty, uye indium-111 labeled leukocyte scan inonyanya kukosha pakuongorora hutachiona hweperiprosthetic, ine kunzwisiswa kwe77% uye 86%. Kana ma scan maviri aya ashandiswa pamwe chete pakuongorora hutachiona hweperiprosthetic mushure me arthroplasty, kunzwisiswa kwakanyanya, kutsanangurwa uye kururama kunogona kuwanikwa. Kuongororwa uku kuchiri chiyero chegoridhe mukurapa kwenyukireya pakuongorora hutachiona hweperiprosthetic. Fluorodeoxyglucose-positron emission tomography (FDG-PET). Inoona masero ekuzvimba ane huwandu hwakawanda hweglucose inotorwa munzvimbo ine hutachiona.
4. Maitiro ebiology yemamorekuru
PCR: kunzwa kwakanyanya, zviratidzo zvenhema
Tekinoroji yeGene chip: danho rekutsvagisa.
5. Kubata kwemapfupa:
Kuongororwa kwemasero eropa, tsika yemabhakitiriya, uye bvunzo yekunzwa kwemishonga.
Nzira iyi iri nyore, inokurumidza uye yakarurama
Muzvirwere zvehudyu, huwandu hwema leukocyte emumajoini hunosvika 3,000/ml pamwe chete nekuwedzera kweESR neCRP ndiyo nzira yakanakisisa yekuratidza kuti hutachiona hwe periprosthetic hunowanikwa.
6. Kuvhiyiwa kwechikamu chechando nekukurumidza kuburikidza nekurapwa kwemwana
Chikamu chekukurumidza chakaomeswa nechando cheperiprosthetic tissue panguva yekuvhiyiwa ndiyo nzira inonyanya kushandiswa mukati mekuvhiyiwa pakuongorora histopathological. Maitiro ekuongorora aFeldman, kureva, anopfuura kana akaenzana ne5 neutrophils pakukura kwakanyanya (400x) muminda mishanu yakasiyana ye microscopic, anowanzo shandiswa kuzvikamu zvakaomeswa nechando. Zvakaratidzwa kuti kunzwisisika uye kujeka kwenzira iyi kuchapfuura 80% ne90%, zvichiteerana. Iyi nzira parizvino ndiyo mwero wepamusoro wekuongorora mukati mekuvhiyiwa.
7. Kukura kwebhakitiriya muzvinyama zvinorwara
Kuumbwa kwemabhakitiriya mumatishu eperiprosthetic kune hunyanzvi hwakanyanya hwekuongorora hutachiona uye kwave kuchionekwa senzira yepamusoro yekuongorora hutachiona hweperiprosthetic, uye inogonawo kushandiswa pakuyedzwa kwekunzwa kwemishonga.
IV. Kuongororwa kwemhando dzakasiyana dzezvirweres
Utachiona hwemajoini ekugadzira husingarwadzi hunokonzerwa neStaphylococcus epidermidis hwakaoma kusiyanisa nekurerukirwa kwemajoini ekugadzira. Zvinofanira kusimbiswa neX-ray nedzimwe bvunzo.
V. Kurapa
1. Kurapa kuri nyore kwemishonga inorwisa mabhakitiriya inochengetedza hutano
Tsakaysma naSe,Gawa vakaisa hutachiona hwe post arthroplasty mumhando ina, rudzi rwekutanga rusina zviratidzo, murwere ari muchirongwa chekuvandudza matishu emuviri akawanikwa aine kukura kwebhakitiriya, uye sampuli mbiri dzakakura nehutachiona humwe chete; rudzi rwechipiri hutachiona hwepakutanga, hunoitika mukati memwedzi mumwe chete wekuvhiyiwa; rudzi rwechipiri hutachiona hwenguva refu hunononoka; uye rudzi rwechina hutachiona hweropa hunokonzera kubuda ropa zvakanyanya. Nheyo yekurapa mabhakitiriya inonzwisisika, yakawanda uye nguva yakakwana. Uye kubvoorwa kwemajoini mudumbu usati wavhiyiwa uye hunyanzvi hwemuviri mukati mekuvhiyiwa zvakakosha zvikuru pakusarudzwa kwakakodzera kwemishonga inorwisa mabhakitiriya. Kana hutachiona hwebhakitiriya huine hutachiona hwerudzi rwekutanga, kushandiswa nyore kwemishonga inorwisa mabhakitiriya inonzwisisika kwemavhiki matanhatu kunogona kuwana mhedzisiro yakanaka.
2. Kuchengetedzwa kweprosthesis, kubviswa kwetsvina uye kudhonza mvura, kuvhiyiwa kwekudiridza machubhu
Pfungwa yekuti kurapa prosthesis kuchengetedzeke pakukuvara kuitike ndeyekuti prosthesis yacho inogara kwenguva refu uye ine hutachiona hwakanyanya. Chipenyu chinotapukira chakajeka, hutachiona hwebhakitiriya hushoma uye mishonga inorwisa mabhakitiriya inowanikwa, uye muchina wekubvisa mabhakitiriya unogona kutsiviwa panguva yekubvisa mabhakitiriya. Mwero wekurapa we6% chete nemishonga inorwisa mabhakitiriya chete uye 27% nemishonga inorwisa mabhakitiriya pamwe nekubvisa mabhakitiriya uye kuchengetedza prosthesis wakanyorwa mumabhuku.
Yakakodzera hutachiona hwepakutanga kana hutachiona hweropa hunokonzera kubuda ropa nekukurumidza uye ine hutachiona hwakanaka hwekugadzira; zvakare, zviri pachena kuti hutachiona ihutachiona husina simba rakawanda hunogona kubatwa nehutachiona husingakuvadzi. Nzira iyi inosanganisira kubvisa tsvina zvakakwana, kubvisa hutachiona uye kubvisa mvura (kwemavhiki matanhatu), uye mishonga inorwisa utachiona mushure mekuvhiyiwa (kwemavhiki matanhatu kusvika kumwedzi mitanhatu). Zvakashata: mwero wekukundikana kwakanyanya (kusvika 45%), nguva refu yekurapwa.
3. Kuvhiyiwa kwekugadzirisa danho rimwe chete
Ine zvakanakira zvekusava nekukuvara kwakanyanya, kugara muchipatara kwenguva pfupi, mari shoma yekurapwa, mavanga emaronda mashoma uye kuomarara kwemajoini, izvo zvinobatsira kuti mashandiro emajoini adzoke mushure mekuvhiyiwa. Nzira iyi inonyanya kukodzera kurapa hutachiona hwepakutanga uye hutachiona hweropa hunokonzera kubuda ropa zvakanyanya.
Kutsiva nedanho rimwe chete, kureva, nzira yedanho rimwe chete, kunogumira pahutachiona husina chepfu yakawanda, kubviswa kwetsvina zvakakwana, simende yemapfupa inorwisa mabhakitiriya, uye kuwanikwa kwemishonga inorwisa mabhakitiriya inonzwisisika. Zvichibva pamhedzisiro yechikamu chechando chemukati mekuvhiyiwa, kana paine nzvimbo iri pasi pe5 leukocytes/munda wekuwedzera wakakwira. Zvinoratidza kuti hutachiona hune chepfu shoma. Mushure mekubviswa kwetsvina zvakakwana, arthroplasty yedanho rimwe chete yakaitwa uye hapana kudzoka kwehutachiona mushure mekuvhiyiwa.
Mushure mekubviswa kwemasero emuviri zvakanaka, jira rekugadzira rinotsiviwa pakarepo pasina chikonzero chekuvhiyiwa kwakavhurika. Rine zvakanakira kukuvara kudiki, nguva pfupi yekurapwa uye mutengo wakaderera, asi huwandu hwekudzoka kwehutachiona mushure mekuvhiyiwa hwakakwira, hunova hunenge 23% ~ 73% zvichienderana nehuwandu. Kutsiva jira rekugadzira rimwe chete kwakakodzera varwere vakwegura, pasina kusanganisa chero chipi zvacho chezvinotevera: (1) nhoroondo yekuvhiyiwa kwakawanda pajoini rekutsiva; (2) kuumbwa kwenzira ye sinus; (3) hutachiona hwakakomba (semuenzaniso septic), ischemia uye mavanga enyama dzakapoteredza; (4) kubviswa kwekukuvara kusina kukwana nekusara kwesimende shoma; (5) X-ray inoratidza osteomyelitis; (6) zvikanganiso zvemapfupa zvinoda kuiswa mapfupa; (7) hutachiona hwakasanganiswa kana mabhakitiriya ane simba rakawanda (semuenzaniso Streptococcus D, mabhakitiriya eGram-negative); (8) kurasikirwa nemapfupa kunoda kuiswa mapfupa; (9) kurasikirwa nemapfupa kunoda kuiswa mapfupa; uye (10) kuiswa mapfupa kunoda kuiswa mapfupa. Streptococcus D, mabhakitiriya eGram-negative, kunyanya Pseudomonas, nezvimwewo), kana hutachiona hwefungus, hutachiona hwe mycobacterial; (8) Kukura kwebhakitiriya hakuzivikanwi.
4. Kuvhiyiwa kwechipiri kwekugadzirisa
Yave ichifarirwa navanachiremba vezvekuvhiya kwemakore makumi maviri apfuura nekuda kwezviratidzo zvayo zvakasiyana-siyana (mapfupa akakwana, nyama dzakapfava dzakapfuma dzeperiarticular) uye mwero mukuru wekubvisa hutachiona.
Zvishandiso zvemagetsi, zvinotakura mishonga inorwisa mabhakitiriya, mishonga inorwisa mabhakitiriya
Pasinei nenzira inoshandiswa yekuparadzanisa masero, kusungirirwa kwakasimba nemishonga inorwisa mabhakitiriya kunodiwa kuti huwandu hwemishonga inorwisa mabhakitiriya mujoini huwedzere uye kuwedzera mwero wekurapa hutachiona. Mishonga inorwisa mabhakitiriya inowanzo shandiswa ndeiyi tobramycin, gentamicin uye vancomycin.
Veruzhinji vezvemapfupa pasi rose vaona kurapa kwakanakisisa kwehutachiona hwakadzika mushure me arthroplasty. Nzira iyi inosanganisira kubvisa tsvina yakakwana, kubvisa prosthesis nemuviri wekunze, kuisa muchina wekubatanidza majoini, kuramba uchishandisa mishonga inorwisa utachiona inonzwa mutsinga kwemavhiki matanhatu, uye pakupedzisira, mushure mekudzora hutachiona zvinobudirira, kuisazve prosthesis.
Zvakanakira:
Nguva yakakwana yekuziva mhando dzebhakitiriya uye mishonga inorwisa utachiona, iyo inogona kushandiswa zvinobudirira usati wavhiyiwa.
Kusanganiswa kwezvimwe zvirwere zvinogona kurapwa nekukurumidza.
Pane mikana miviri yekubvisa tsvina kubva mudumbu nemuviri wekunze zvakakwana, izvo zvinoderedza zvakanyanya kudzoka kwezvirwere mushure mekuvhiyiwa.
Zvakashata:
Kudzokororwa kwemishonga yekunzwa kurwadziwa nekuvhiyiwa kunowedzera njodzi.
Nguva refu yekurapwa uye mari yakawanda yekurapwa.
Kupora kwemuviri mushure mekuvhiyiwa kwakashata uye kunononoka.
Arthroplasty: Yakakodzera hutachiona hunoramba huripo husingapindure pakurapwa, kana kune mapfupa akakura asina kunaka; mamiriro emurwere anodzivisa kuvhiyiwa zvakare uye kutadza kuvaka patsva. Marwadzo akasara mushure mekuvhiyiwa, kudiwa kwekushandisa mabraces kwenguva refu kubatsira kufamba, kusagadzikana kwemajoini, kupfupika kwemakumbo, kushanda nesimba, uye huwandu hwekushandiswa hwakaganhurirwa.
Arthroplasty: mushonga wechinyakare wehutachiona hwepashure pekuvhiyiwa, uine kugadzikana kwakanaka mushure mekuvhiyiwa uye kuderedza marwadzo. Zvakaipa zvinosanganisira kupfupika kwegumbo, matambudziko ekufamba uye kurasikirwa nekufamba kwemajoini.
Kucheka mapfupa: Ndiyo nzira yekupedzisira yekurapa hutachiona hwakadzika mushure mekuvhiyiwa. Yakakodzera: (1) kurasikirwa nemapfupa kwakanyanya, zvikanganiso zvenyama yakapfava; (2) hutachiona hwakasimba hwebhakitiriya, hutachiona hwakasiyana, kurapwa kwemishonga inorwisa mabhakitiriya hakushande, zvichikonzera chepfu mumuviri, zvinogona kuisa hupenyu panjodzi; (3) ine nhoroondo yekukundikana kakawanda kwekuvhiyiwa kwevarwere vane hutachiona kwenguva refu.
VI. Kudzivirira
1. Zvinhu zvinokonzeresa kuvhiyiwa:
Gadzirisa mamiriro emurwere asati avhiyiwa uye hutachiona hwese huripo hunofanira kurapwa usati wavhiyiwa. Utachiona hunonyanya kupararira muropa ndehweganda, nzira yeweti, uye nzira yekufema. Mu arthroplasty yehudyu kana ibvi, ganda remakumbo epasi harifanirwe kutyoka. Bacteriuria isingaperi, iyo inowanzoonekwa muvarwere vakwegura, haifanirwe kurapwa isati yavhiyiwa; kana zviratidzo zvangoonekwa, dzinofanira kurapwa nekukasika. Varwere vane tonsillitis, hutachiona hwepamusoro hwekufema, uye tinea pedis vanofanira kubviswa nzvimbo yehutachiona. Kuvhiyiwa kwemazino kwakakura kunogona kukonzera hutachiona muropa, uye kunyangwe kuchidzivirirwa, kana kuvhiyiwa kwemazino kuchidikanwa, zvinokurudzirwa kuti maitiro akadaro aitwe vasati vavhiyiwa. Varwere vane mamiriro asina kunaka akadai seanemia, hypoproteinaemia, chirwere cheshuga chakasanganiswa uye hutachiona hwenguva refu hweweti vanofanira kurapwa nekukurumidza kuti chirwere chekutanga chigadzirise mamiriro emuviri.
2. Kutarisirwa kwevashandi panguva yekuvhiyiwa:
(1) Matekiniki nematurusi asina utachiona anofanirwawo kushandiswa mukurapa kwe arthroplasty.
(2) Kurapwa muchipatara usati wavhiyiwa kunofanira kuderedzwa kuderedza njodzi yekuti ganda remurwere rinogona kuzara nemabhakitiriya anowanikwa muchipatara, uye kurapwa kwakajairika kunofanira kuitwa pazuva rekuvhiyiwa.
(3) Nzvimbo yekuvhiyiwa inofanira kunge yakagadzirirwa kugadzirira ganda zvakanaka.
(4) Magauni ekuvhiya, masiki, ngowani, uye nzvimbo dzekuvhiya dzinoyerera zvakanaka mukuderedza mabhakitiriya ari mumhepo munzvimbo yekuvhiya. Kupfeka magirovhosi maviri kunogona kuderedza njodzi yekubata ruoko pakati pemuvhiyi nemurwere uye zvinogona kukurudzirwa.
(5) Zvave zvichiratidzwa kuti kushandiswa kweprosthesis ine muganho wakanyanya, kunyanya ine hinged, kune njodzi yakakura yekutapukirwa kupfuura non-restrictive total knee arthroplasty nekuda kwetsvina yesimbi inoderedza basa rephagocytosis, uye nekudaro inofanira kudzivirirwa pakusarudzwa kweprosthesis.
(6) Vandudza nzira yekuvhiya yemushandi uye pfupisa nguva yekuvhiya (<2.5 maawa kana zvichibvira). Kupfupisa nguva yekuvhiya kunogona kuderedza nguva yekusangana nemhepo, izvo zvinogona kuderedza nguva yekushandisa tourniquet. Dzivisa kuvhiya kwakaoma panguva yekuvhiya, ronda rinogona kudirwa kakawanda (pfuti yekudiridza inopushwa ndiyo yakanakisa), uye kunyudzwa kweiodine-vapor kunogona kutorwa kune mavanga anofungidzirwa kuti akasvibiswa.
3. Zvinhu Zvinokonzera Kuvhiyiwa:
(1) Kuvhiyiwa kunokonzera kuramba insulin, izvo zvinogona kukonzera hyperglycemia, chiitiko chinogona kuramba chiripo kwemavhiki akati wandei mushure mekuvhiyiwa uye chinogona kukonzera matambudziko ane chekuita nemaronda, uye zvakare, chinoitikawo kune varwere vasina chirwere cheshuga. Nokudaro, kuongororwa kweshuga muropa mushure mekuvhiyiwa kwakakosha zvakaenzana.
(2) Kuvharika kwetsinga dzeropa zvakanyanya kunowedzera njodzi yekuva neropa rakawanda uye matambudziko anokonzerwa nemaronda. Ongororo yekuongorora nyaya yakawana kuti kushandiswa kweheparin shoma mushure mekuvhiyiwa kudzivirira kuvharika kwetsinga dzeropa zvakanyanya kwaibatsira mukuderedza mukana wekutapukirwa.
(3) Kubuda kwemvura yakavharwa inzira inogona kupinda nayo hutachiona, asi hukama hwayo nehuwandu hwehutachiona hwemaronda hahuna kudzidzwa zvakananga. Zvakabuda pakutanga zvinoratidza kuti macatheter emukati mearticular anoshandiswa semushonga wekurwadziwa mushure mekuvhiyiwa anogonawo kubatwa nehutachiona hwemaronda.
4. Kudzivirira mabhakitiriya:
Parizvino, kushandiswa kwemishonga inorwisa mabhakitiriya nguva dzose mukurapa kunopihwa netsinga usati wavhiyiwa uye mushure mekuvhiyiwa kunoderedza njodzi yehutachiona mushure mekuvhiyiwa. Cephalosporins inonyanya kushandiswa mukurapa semushonga unorwisa mabhakitiriya, uye pane hukama hwakaita seU pakati penguva yekushandiswa kwemishonga inorwisa mabhakitiriya nehuwandu hwehutachiona hwenzvimbo yekuvhiyiwa, nenjodzi yakakura yehutachiona nguva isati yasvika uye mushure menguva yakakodzera yekushandiswa kwemishonga inorwisa mabhakitiriya. Ongororo huru ichangobva kuitwa yakawana kuti mishonga inorwisa mabhakitiriya inoshandiswa mukati memaminitsi makumi matatu kusvika makumi matanhatu isati yachekwa yaive nehuwandu hwakaderera hwehutachiona. Kusiyana neizvi, imwe ongororo huru ye total hip arthroplasty yakaratidza huwandu hwakaderera hwehutachiona nemishonga inorwisa mabhakitiriya inopihwa mukati memaminitsi makumi matatu ekutanga ekuchekwa. Saka nguva yekushandiswa inowanzoonekwa semaminitsi makumi matatu usati wavhiyiwa, nemhedzisiro yakanaka panguva yekutanga anesthesia. Imwe piritsi yekudzivirira yemishonga inorwisa mabhakitiriya inopihwa mushure mekuvhiyiwa. MuEurope neUnited States, mishonga inorwisa mabhakitiriya inowanzo shandiswa kusvika pazuva rechitatu mushure mekuvhiyiwa, asi muChina, zvinonzi inowanzo shandiswa nguva dzose kwevhiki imwe kusvika mbiri. Zvisinei, vanhu vazhinji vanobvumirana kuti kushandisa mishonga inorwisa mabhakitiriya ine simba kwenguva refu kunofanira kudzivirirwa kunze kwekunge paine mamiriro ezvinhu akakosha, uye kana kushandiswa kwemishonga inorwisa mabhakitiriya kwenguva refu kuchidikanwa, zvinokurudzirwa kushandisa mishonga inorwisa mabhakitiriya pamwe chete nemishonga inorwisa mabhakitiriya kudzivirira hutachiona hwefungus. Vancomycin yakaratidzwa kuti inoshanda kune varwere vane njodzi huru vane methicillin-resistant Staphylococcus aureus. Mishonga inorwisa mabhakitiriya yakawanda inofanira kushandiswa pakuvhiya kwenguva refu, kusanganisira kuvhiya kwemativi maviri, kunyanya kana hafu yehupenyu hwemishonga inorwisa mabhakitiriya iri pfupi.
5. Kushandiswa kwemishonga inorwisa mabhakitiriya pamwe chete nesimende yemapfupa:
Simende ine maantibiotic yakatanga kushandiswawo mu arthroplasty muNorway, uko pakutanga chidzidzo cheNorwegian Arthroplasty Registry chakaratidza kuti kushandiswa kwemusanganiswa we antibiotic IV nesimende (combined antibiotic prosthesis) infusion kwakaderedza mwero wehutachiona hwakadzika zvinobudirira kupfuura nzira dzese dziri mbiri chete. Kuwanikwa uku kwakasimbiswa muongororo dzakawanda mumakore gumi nematanhatu akatevera. Chidzidzo cheFinnish neAustralian Orthopaedic Association 2009 zvakasvika pamhedziso dzakafanana nezvebasa re antibiotic-infusion simende mu knee arthroplasty kekutanga uye revision. Zvakaratidzwawo kuti hunhu hwe biomechanical hwe bone cement hahukanganisike kana antibiotic powder ikawedzerwa mu doses isingapfuure 2 g pa 40 g yesimende yemapfupa. Zvisinei, haasi ese ma antibiotic anogona kuwedzerwa kusimende yemapfupa. Ma antibiotic anogona kuwedzerwa kusimende yemapfupa anofanira kunge aine zvinotevera: kuchengetedzeka, kugadzikana kwekupisa, kusarwara, kunyungudika kwakanaka kwemvura, broad antimicrobial spectrum, uye powdered material. Parizvino, vancomycin ne gentamicin zvinonyanya kushandiswa mukiriniki. Zvaifungidzirwa kuti kuisa mishonga inorwisa mabhakitiriya musimende kwaizowedzera njodzi yekusawirirana, kubuda kwemarudzi asingapindi mishonga, uye kusunungura kwenhengo dzekugadzira, asi kusvika pari zvino hapana humbowo hunotsigira izvi.
VII. Pfupiso
Kuongororwa nekukasika uye nemazvo kuburikidza nenhoroondo, kuongororwa kwemuviri uye bvunzo dzekuwedzera chinhu chinodiwa kuti hutachiona hwemajoini hubudirire. Kubvisa hutachiona uye kudzoreredza joini yekugadzira isingarwadzi uye inoshanda zvakanaka ndiyo musimboti mukuru mukurapa hutachiona hwemajoini. Kunyangwe kurapa hutachiona hwemajoini nemishonga inorwisa mabhakitiriya kuri nyore uye kwakachipa, kubvisa hutachiona hwemajoini kunowanzoda musanganiswa wenzira dzekuvhiya. Chinhu chikuru pakusarudza kurapwa kwekuvhiya ndechekufunga nezvedambudziko rekubvisa prosthesis, inova ndiyo chinhu chikuru pakubata hutachiona hwemajoini. Parizvino, kushandiswa pamwe chete kwemishonga inorwisa mabhakitiriya, kubvisa tsvina uye arthroplasty kwave kurapwa kwakazara kwehutachiona hwakawanda hwemajoini. Zvisinei, ichiri kuda kuvandudzwa uye kugadziriswa.
Nguva yekutumira: Chivabvu-06-2024
