Usulelo lolunye lwezona ngxaki zinzima emva kokutshintshwa kwamalungu okwenziwa, olungagcini nje ngokubangela iingxaki ezininzi zotyando kwizigulana, kodwa lukwasebenzisa izixhobo zonyango ezininzi. Kwiminyaka eli-10 edlulileyo, izinga losulelo emva kokutshintshwa kwamalungu okwenziwa liye lehla kakhulu, kodwa izinga lokukhula ngoku lezigulana ezitshintshelwa amalungu okwenziwa liye ladlula kakhulu izinga lokwehla kwamanqanaba osulelo, ngoko ke ingxaki yosulelo emva kotyando akufuneki ingananzwa.
I. Izizathu zokugula
Usulelo olungenamalungu emva kokwenziwa kufuneka luthathwe njengosulelo olufunyanwa esibhedlele olunezidalwa ezibangela izifo ezinganyangekiyo ngamayeza. Olona luxhaphakileyo yi-staphylococcus, ebalelwa kwi-70% ukuya kwi-80%, ii-gram-negative bacilli, ii-anaerobes kunye ne-non-A group streptococci nazo zixhaphakile.
II I-Pathogenesis
Usulelo lwahlulwe lwahlulwe lwangamacandelo amabini: olunye lusulelo lwasekuqaleni kwaye olunye lusulelo lwasemva kwexesha okanye olubizwa ngokuba lusulelo lwasemva kwexesha. Usulelo lwasekuqaleni lubangelwa kukungena ngokuthe ngqo kwebhaktheriya kwilungu ngexesha lotyando kwaye ludla ngokuba yiStaphylococcus epidermidis. Usulelo lwasemva kwexesha lubangelwa kukudluliselwa kwegazi kwaye ludla ngokuba yiStaphylococcus aureus. Amalungu atyandiweyo anamathuba amaninzi osulelo. Umzekelo, kukho izinga losulelo le-10% kwiimeko zokuhlaziywa emva kokutshintshwa kwamalungu okwenziwa, kwaye izinga losulelo liphezulu nakubantu abaye batshintshwa amalungu ngenxa ye-rheumatoid arthritis.
Uninzi lwezifo zenzeka kwiinyanga ezimbalwa emva kotyando, ezona ziqala ukubonakala kwiiveki ezimbini zokuqala emva kotyando, kodwa emva kweminyaka embalwa ngaphambi kokuba kuvele iimpawu zokuqala zokudumba kwamalungu, iintlungu kunye nomkhuhlane, iimpawu zomkhuhlane kufuneka zahlulwe kwezinye iingxaki, ezifana ne-pneumonia emva kotyando, izifo zomchamo njalo njalo.
Kwimeko yosulelo lwasekuqaleni, ubushushu bomzimba abupheleli nje ekupholeni, kodwa bunyuka emva kweentsuku ezintathu emva kotyando. Intlungu yamalungu ayipheleli nje ekunciphiseni kancinci kancinci, kodwa iyanda kancinci kancinci, kwaye kukho intlungu ebuhlungu xa uphumle. Kukho ukuphuma okungaqhelekanga okanye ukukhupha okuphumayo kwinxeba. Oku kufuneka kuhlolwe ngononophelo, kwaye umkhuhlane akufuneki ubangelwe lula zizifo emva kotyando kwezinye iindawo zomzimba ezifana nemiphunga okanye indlela yomchamo. Kubalulekile nokuba ungawuthathi lula umchamo ophumayo njengesifo esiqhelekileyo esifana nokuncibilika kwamafutha. Kubalulekile nokuchonga ukuba isifo sikwizicubu ezingaphezulu okanye nzulu ezijikeleze i-prosthesis.
Kwizigulane ezinezifo eziqhubekekayo, uninzi lwazo oluye lwaphuma esibhedlele, ukudumba kwamalungu, iintlungu, kunye nomkhuhlane kusenokungabi nzima kakhulu. Isiqingatha sezigulane zisenokungabi namkhuhlane. I-Staphylococcus epidermidis inokubangela usulelo olungenabuhlungu kunye nokwanda kwenani leeseli ezimhlophe zegazi kwi-10% kuphela yezigulane. Ukunyuka kwe-sedimentation yegazi kuxhaphake kakhulu kodwa kwakhona akucaci. Ngamanye amaxesha iintlungu zichongwa gwenxa njengokukhululeka kwe-prosthetic, oku kokugqibela yintlungu enxulunyaniswa nokuhamba okufanele kuncitshiswe kukuphumla, kunye nentlungu yokudumba engancitshiswe kukuphumla. Nangona kunjalo, kucetyiswa ukuba imbangela ephambili yokukhululeka kwe-prosthesis kukulunywa okungapheliyo okulibazisekileyo.
III. Uxilongo
1. Uvavanyo lwe-Haematological:
Ngokuyintloko bandakanya inani leeseli ezimhlophe zegazi kunye nokuhlelwa, i-interleukin 6 (IL-6), iprotheyini ephendulayo ye-C (CRP) kunye nesantya se-erythrocyte sedimentation (ESR). Iingenelo zovavanyo lwe-hematological zilula kwaye kulula ukuzenza, kwaye iziphumo zinokufunyanwa ngokukhawuleza; i-ESR kunye ne-CRP zincinci; i-IL-6 ibaluleke kakhulu ekumiseleni usulelo lwe-periprosthetic kwixesha lokuqala emva kotyando.
2. Uvavanyo lomfanekiso:
Ifilimu ye-X-reyi: ayibalulekanga kwaye ayibalulekanga ekuxilongweni kosulelo.
Ifilimu ye-X-ray yosulelo lokutshintshwa kwedolo
I-Arthrography: eyona nto iphambili ekuxilongweni kosulelo kukuphuma kolwelo lwe-synovial kunye nethumba.
I-CT: ukubona ukuchitheka kwamalungu, iindlela ze-sinus, amathumba ezicubu ezithambileyo, ukukhukuliseka kwamathambo, ukufunxwa kwamathambo ngaxeshanye.
I-MRI: ikhawuleza kakhulu ukubonwa kolwelo lwamalungu kunye namathumba, ayisetyenziswa kakhulu ekuxilongweni kwezifo ezibangelwa yi-periprosthesis.
I-Ultrasound: ukuqokelelana kolwelo.
3. Amayeza enyukliya
I-Technetium-99 bone scan inovakalelo lwe-33% kunye nolwazo lwe-86% ekuxilongweni kwezifo ze-periprosthetic emva kwe-arthroplasty, kwaye i-indium-111 labeled leukocyte scan ixabiseke ngakumbi ekuxilongweni kwezifo ze-periprosthetic, kunye nolwazo lwe-77% kunye nolwazo lwe-86%. Xa ezi scan zimbini zisetyenziswa kunye ekuxilongweni kwezifo ze-periprosthetic emva kwe-arthroplasty, ulwazo oluphezulu, ukucaca kunye nokuchaneka kunokufezekiswa. Olu vavanyo lusengumgangatho wegolide kwiyeza lenyukliya ekuxilongweni kwezifo ze-periprosthetic. I-Fluorodeoxyglucose-positron emission tomography (FDG-PET). Ifumanisa iiseli ezivuthayo ezinokwanda kokuthathwa kweglucose kwindawo enesifo.
4. Iindlela zebhayoloji yemolekyuli
I-PCR: uvakalelo oluphezulu, iziphumo ezingezizo
Itekhnoloji ye-Gene chip: inqanaba lophando.
5. I-Arthroscopy:
Uvavanyo lwe-cytological lolwelo lwamalungu, inkcubeko yebhaktheriya kunye novavanyo lobuthathaka kwiziyobisi.
Le ndlela ilula, iyakhawuleza kwaye ichanekile
Kwizifo ze-hip, inani le-leucocyte yolwelo oludibeneyo elingaphezulu kwe-3,000/ml xa lidibene ne-ESR eyonyukileyo kunye ne-CRP yeyona ndlela ilungileyo yokubonisa ukuba kukho usulelo olujikeleze i-periprosthetic.
6. I-Histopathology ye-Intraoperative Rapid Frozen Section
Icandelo eliqandisiweyo elikhawulezayo lezicubu ezingaphakathi kotyando yeyona ndlela isetyenziswa kakhulu ngexesha lotyando lovavanyo lwe-histopathological. Iikhrayitheriya zokuxilonga zikaFeldman, oko kukuthi, ezingaphezulu okanye ezilingana nee-neutrophils ezi-5 ngokukhulisa okuphezulu (400x) ubuncinane kwiindawo ezi-5 ezahlukeneyo ze-microscopic, zihlala zisetyenziswa kwiindawo eziqandisiweyo. Kuye kwaboniswa ukuba uvakalelo kunye nokuchaneka kwale ndlela kuya kudlula i-80% kunye ne-90%, ngokwahlukeneyo. Le ndlela okwangoku yeyona ndlela iphambili yokuxilongwa ngexesha lotyando.
7. Inkcubeko yeentsholongwane zezicubu ezibangela izifo
Inkcubeko yeentsholongwane zezicubu ezijikeleze iprosthetic inobuchule obuphezulu bokuxilonga usulelo kwaye ithathwa njengomgangatho ogqwesileyo woxilonga usulelo olujikeleze iprosthetic, kwaye ingasetyenziselwa uvavanyo lobuthathaka kumayeza.
IV. Ukuxilongwa okwahlukileyos
Usulelo lwamalungu olungenabuhlungu olubangelwa yi-Staphylococcus epidermidis kunzima ukuluhlula kwi-prosthetic loosening. Kufuneka kuqinisekiswe nge-X-ray kunye nezinye iimvavanyo.
V. Unyango
1. Unyango olulula lokubulala iintsholongwane olugcina ixesha elide
UTsakaysma kunye noSegwa bahlulahlula usulelo emva kwe-arthroplasty kwiintlobo ezine, uhlobo lwe-I olungenazimpawu, isigulane sikwi-revision surgery tissue culture kuphela efunyenwe inokukhula kwebhaktiriya, kwaye ubuncinane iisampuli ezimbini ezikhuliswe ngebhaktiriya efanayo; uhlobo lwe-II lusulelo lwasekuqaleni, oluvela kwinyanga enye emva kotyando; uhlobo lwe-IIl lusulelo oluhlala luhleli; kwaye uhlobo lwe-IV lusulelo olukhawulezileyo oluphuma igazi. Umgaqo wonyango lwe-antibiotic lunobuthathaka, ixesha elaneleyo. Kwaye ukubhoboza umngxuma wamalungu ngaphambi kotyando kunye ne-inclusive tissue culture zibaluleke kakhulu ekukhetheni ngokuchanekileyo ii-antibiotics. Ukuba i-bacterial culture ilungile kwi-type I sulelo, ukusetyenziswa ngokulula kwee-antibiotics ezinobuthathaka kwiiveki ezi-6 kunokufezekisa iziphumo ezilungileyo.
2. Ukugcinwa kweprosthesis, ukususwa kwenkunkuma kunye nokukhupha amanzi, utyando lokunkcenkceshela ngetyhubhu
Ingcamango yokwamkela ingcamango yonyango lwe-prosthesis yokugcina i-trauma kukuba i-prosthesis izinzile kwaye isulelekile ngokukhawuleza. I-organism eyosulelayo icacile, i-bacterial virulence iphantsi kwaye ii-antibiotics ezinobuthathaka ziyafumaneka, kwaye i-liner okanye i-spacer inokutshintshwa ngexesha lokususwa kwe-antibiotics. Amanqanaba okuphilisa ayi-6% kuphela ngee-antibiotics zodwa kunye ne-27% ngee-antibiotics kunye nokugcinwa kwe-debridement kunye ne-prosthesis kuye kwaxelwa kwiincwadi.
Ifanelekile kwisigaba sokuqala sosulelo okanye usulelo olukhawulezileyo oluphuma igazi kunye nokufakelwa kakuhle kweprosthesis; kwakhona, kuyacaca ukuba usulelo lusulelo olunentsholongwane encinci olunobuthathaka obuncinci olunovelwano lonyango lwe-antimicrobial. Le ndlela ibandakanya ukucoca ngokupheleleyo, ukucoca kunye nokukhupha amanzi amdaka (ixesha leeveki ezi-6), kunye ne-systemic intravenous antimicrobials emva kotyando (ixesha leeveki ezi-6 ukuya kwiinyanga ezi-6). Iingxaki: izinga eliphezulu lokungaphumeleli (ukuya kuthi ga kwi-45%), ixesha elide lonyango.
3. Utyando lokuhlaziya inqanaba elinye
Inezibonelelo zokuba akukho monakalo mkhulu, ukuhlala ixesha elifutshane esibhedlele, iindleko zonyango eziphantsi, akukho nxeba lincinci kunye nokuqina kwamalungu, nto leyo enceda ekubuyiseleni ukusebenza kwamalungu emva kotyando. Le ndlela ifanelekile kakhulu kunyango losulelo lwasekuqaleni kunye nosulelo olukhawulezileyo oluphuma igazi.
Ukutshintshwa kwenqanaba elinye, oko kukuthi, indlela yenyathelo elinye, kukhawulelwe kwiintsholongwane ezinobungozi obuphantsi, ukususwa ngokupheleleyo kwezicubu, isamente yamathambo e-antibiotic, kunye nokufumaneka kwee-antibiotics ezinobuthathaka. Ngokusekelwe kwiziphumo zecandelo eliqandisiweyo lezicubu ngexesha lotyando, ukuba kukho ngaphantsi kwe-5 leukocytes/intsimi yokukhulisa ephezulu. Oku kuthetha ukuba usulelo olunobungozi obuphantsi. Emva kokususwa ngokupheleleyo kwezicubu, kwenziwa i-arthroplasty yenqanaba elinye kwaye akuzange kubekho kuphinda kubekho usulelo emva kotyando.
Emva kokususwa ngokupheleleyo kwezicubu zomzimba, i-prosthesis itshintshwa ngoko nangoko ngaphandle kwemfuneko yenkqubo evulekileyo. Inezibonelelo zokulimala okuncinci, ixesha elifutshane lonyango kunye nexabiso eliphantsi, kodwa izinga lokuphinda kosulelo emva kotyando liphezulu, elimalunga ne-23% ~ 73% ngokwezibalo. Ukutshintshwa kwe-prosthesis yesigaba esinye kulungele kakhulu izigulane ezindala, ngaphandle kokudibanisa naziphi na kwezi zilandelayo: (1) imbali yotyando oluninzi kwilungu elitshintshiweyo; (2) ukwakheka kwendlela ye-sinus; (3) usulelo olunzima (umz. i-septic), ischemia kunye nokuqhekeka kwezicubu ezijikelezileyo; (4) ukususwa ngokupheleleyo kwezicubu zomzimba kunye nesamente engaphelelanga eseleyo; (5) i-X-ray ebonisa i-osteomyelitis; (6) iziphene zamathambo ezifuna ukufakelwa kwamathambo; (7) usulelo oluxutyiweyo okanye iintsholongwane ezinamandla kakhulu (umz. iStreptococcus D, iintsholongwane zeGram-negative); (8) ukulahleka kwamathambo okufuna ukufakelwa kwamathambo; (9) ukulahleka kwamathambo okufuna ukufakelwa kwamathambo; kunye (10) ukufakelwa kwamathambo okufuna ukufakelwa kwamathambo. I-Streptococcus D, iintsholongwane zeGram-negative, ingakumbi iPseudomonas, njl.njl.), okanye usulelo lwefungus, usulelo lwe-mycobacterial; (8) Inkcubeko yebhaktheriya ayicaci.
4. Utyando lokuhlaziya olukwinqanaba lesibini
Ithandwa kakhulu ngoogqirha botyando kwiminyaka engama-20 edlulileyo ngenxa yeempawu zayo ezahlukeneyo (ubunzima bamathambo obaneleyo, izicubu ezithambileyo ezityebileyo ze-periarticular) kunye nesantya esiphezulu sokupheliswa kosulelo.
Izithuba, abathwali bee-antibiotic, ii-antibiotics
Nokuba yeyiphi na indlela yokwahlulahlula esetyenzisiweyo, ukufakelwa okuqinileyo ngamayeza okubulala iintsholongwane kuyimfuneko ukwandisa uxinano lwamayeza okubulala iintsholongwane kwilungu kunye nokunyusa izinga lokunyanga usulelo. Amayeza okubulala iintsholongwane asetyenziswa kakhulu yi-tobramycin, i-gentamicin kunye ne-vancomycin.
Uluntu lwamazwe ngamazwe olujongene namathambo luqaphele unyango olusebenzayo kakhulu losulelo olunzulu emva kwe-arthroplasty. Le ndlela ibandakanya ukucoca ngokupheleleyo, ukususwa kwe-prosthesis kunye nomzimba wangaphandle, ukubekwa kwe-joint spacer, ukusetyenziswa rhoqo kwe-intravenous antimicrobials ubuncinane iiveki ezi-6, kwaye ekugqibeleni, emva kokulawulwa ngempumelelo kosulelo, ukufakelwa kwakhona kwe-prosthesis.
Iingenelo:
Ixesha elaneleyo lokuchonga uhlobo lwebhaktheriya kunye neearhente ezithintela iintsholongwane ezinobuthathaka, ezingasetyenziswa ngokufanelekileyo ngaphambi kotyando lokuhlaziya.
Ukudibana nezinye izifo ezibangelwa yinkqubo yomzimba kunokunyangeka ngexesha elifanelekileyo.
Kukho amathuba amabini okususa izicubu ezifileyo kunye nemizimba yangaphandle ngokupheleleyo, nto leyo enciphisa kakhulu izinga lokuphinda kuvele usulelo emva kotyando.
Iingxaki:
Ukuphinda utyando kunye nokuhlinzwa kwandisa umngcipheko.
Ixesha elide lonyango kunye neendleko zonyango eziphezulu.
Ukubuyela kwimeko yesiqhelo emva kotyando akusebenzi kakuhle kwaye kuhamba kancinci.
I-Arthroplasty: Ifanelekile kwiintsholongwane ezingapheliyo ezingaphenduliyo kunyango, okanye kwiziphene ezinkulu zamathambo; imeko yesigulana ithintela ukungasebenzi kwakhona kunye nokungaphumeleli kokwakhiwa kwakhona. Iintlungu eziseleyo emva kotyando, isidingo sokusetyenziswa kwexesha elide kwezixhobo zokuxhasa ukuhamba, ukuzinza kwamalungu okungekuhle, ukufinyezwa kwamalungu, ukusebenza kakuhle, umda wokusetyenziswa kwawo ulinganiselwe.
I-Arthroplasty: unyango lwendabuko lwezifo emva kotyando, olunezinzo ezilungileyo emva kotyando kunye nokunciphisa iintlungu. Iingxaki ziquka ukufinyela kwamalungu omzimba, ukuphazamiseka kwendlela yokuhamba kunye nokulahlekelwa kukuhamba kwamalungu.
Ukunqunyulwa kwethambo: Lilicebo lokugqibela lokunyanga usulelo olunzulu emva kotyando. Lifanelekile kwi: (1) ukulahleka kwamathambo okunzulu okungenakulungiseka, iziphene zezicubu ezithambileyo; (2) ukuba neentsholongwane ezinamandla, usulelo oluxutyiweyo, unyango lwee-antimicrobial alusebenzi, nto leyo ebangela ubuthi emzimbeni, isongela ubomi; (3) inembali yokungaphumeleli okuninzi kotyando lokuhlaziya izigulane ezinezifo ezingapheliyo.
VI. Uthintelo
1. Izinto ezibangela utyando:
Yenza imeko yesigulana ibe ngcono ngaphambi kotyando kwaye zonke izifo ezikhoyo kufuneka zinyangwe ngaphambi kotyando. Ezona zifo zixhaphakileyo zisasazeka ngegazi zezo zivela eluswini, kumchamo, nakwindlela yokuphefumla. Kwi-arthroplasty yesinqe okanye yedolo, ulusu lwemilenze esezantsi kufuneka luhlale lungaqhekekanga. I-bacteriuria engenazimpawu, exhaphakileyo kwizigulane ezindala, ayifuni kunyangwa ngaphambi kotyando; xa kuvela iimpawu kufuneka zinyangwe ngokukhawuleza. Izigulane ezine-tonsillitis, izifo zomchamo ophezulu, kunye ne-tinea pedis kufuneka zisuswe kwindawo yazo yosulelo. Utyando olukhulu lwamazinyo lunokuba ngumthombo wosulelo lwegazi, kwaye nangona luthintelwe, ukuba utyando lwamazinyo luyimfuneko, kuyacetyiswa ukuba iinkqubo ezinjalo zenziwe ngaphambi kwe-arthroplasty. Izigulane ezineemeko ezimbi ngokubanzi ezifana ne-anemia, i-hypoproteinaemia, isifo seswekile esidibeneyo kunye nosulelo olungapheliyo lomchamo kufuneka zinyangwe ngamandla nangokukhawuleza ukuze isifo sokuqala siphucule imeko yenkqubo yomzimba.
2. Ulawulo lwangaphakathi kotyando:
(1) Iindlela kunye nezixhobo ezingasebenzisi magciwane ngokupheleleyo kufuneka zisetyenziswe kwindlela eqhelekileyo yonyango lwe-arthroplasty.
(2) Ukulaliswa esibhedlele ngaphambi kotyando kufuneka kuncitshiswe ukuze kuncitshiswe umngcipheko wokuba ulusu lwesigulana lunokugcwala ziintsholongwane ezifunyenwe esibhedlele, kwaye unyango oluqhelekileyo kufuneka lwenziwe ngomhla wotyando.
(3) Indawo yangaphambi kotyando kufuneka ilungiselelwe kakuhle ukulungiselela ulusu.
(4) Iingubo zotyando, iimaski, iminqwazi, kunye neendawo zotyando ezihamba nge-laminar ziyasebenza ekunciphiseni iintsholongwane eziphuma emoyeni kwindawo yotyando. Ukunxiba iiglavu eziphindwe kabini kunokunciphisa umngcipheko wokudibana kwesandla phakathi kogqirha nomguli kwaye kunokucetyiswa.
(5) Kuye kwangqinwa ngokwezonyango ukuba ukusetyenziswa kweprosthesis ethintelayo ngakumbi, ingakumbi ene-hinged, kunomngcipheko ophezulu wokosuleleka kune-arthroplasty yedolo elipheleleyo elingathinteliyo ngenxa yenkunkuma yesinyithi erhabaxa enciphisa umsebenzi we-phagocytosis, kwaye ke ngoko kufuneka kuthintelwe ekukhetheni iprosthesis.
(6) Phucula indlela yotyando yomqhubi kwaye unciphise ixesha lotyando (<2.5 hrs ukuba kunokwenzeka). Ukuncitshiswa kwexesha lotyando kunokunciphisa ixesha lokuvezwa emoyeni, nto leyo enokunciphisa ixesha lokusetyenziswa kwe-tourniquet. Kuphephe utyando olunzima ngexesha lotyando, inxeba lingankcenkceshelwa ngokuphindaphindiweyo (umpu wokunkcenkceshela otyhalwayo yeyona ilungileyo), kwaye ukuntywiliselwa komphunga nge-iodine kunokuthathwa kwiindawo ezirhanelwa ukuba zingcolisiwe.
3. Izinto ezenzeka emva kotyando:
(1) Ukubetheka ngotyando kubangela ukunganyangeki kwe-insulin, nto leyo enokukhokelela kwi-hyperglycemia, into enokuthi ihlale iiveki ezininzi emva kotyando kwaye ibeke umguli kwingxaki ezinxulumene namanxeba, kwaye, ngaphezu koko, iyenzeka nakwizigulana ezingenaso isifo seswekile. Ke ngoko, ukujonga iswekile yegazi emva kotyando kubaluleke ngokulinganayo.
(2) I-deep vein thrombosis inyusa umngcipheko we-hematoma kunye neengxaki ezinxulumene namanxeba ezilandela oko. Uphononongo lolawulo lwetyala lufumanise ukuba ukusetyenziswa kwe-heparin ephantsi yeemolekyuli emva kotyando ukuthintela i-deep vein thrombosis kwakuluncedo ekunciphiseni amathuba osulelo.
(3) Ukuphuma kwamanzi avaliweyo yindlela yokungena kosulelo, kodwa ulwalamano lwayo namazinga okosulela kwamanxeba alukafundwa ngokukodwa. Iziphumo zokuqala zibonisa ukuba ii-catheters zangaphakathi ezisetyenziswa njengonyango lwee-analgesics emva kotyando nazo zinokuba semngciphekweni wokosulelwa kwamanxeba.
4. Ukuthintela iintsholongwane:
Okwangoku, ukusetyenziswa rhoqo kwezonyango ngeedosi zokuthintela ii-antibiotics ezifakwa ngendlela efakwa emzimbeni ngaphambi nasemva kotyando kunciphisa umngcipheko wosulelo emva kotyando. IiCephalosporins zisetyenziswa kakhulu kwiklinikhi njenge-antibiotic ekhethwayo, kwaye kukho ubudlelwane obufana no-U phakathi kwexesha lokusetyenziswa kwee-antibiotics kunye nesantya sosulelo kwindawo yotyando, kunye nomngcipheko ophezulu wosulelo ngaphambi nasemva kwexesha elifanelekileyo lokusetyenziswa kwee-antibiotics. Uphononongo olukhulu lwakutshanje lufumanise ukuba ii-antibiotics ezisetyenziswa kwimizuzu engama-30 ukuya kwengama-60 ngaphambi kokusika zazinezinga losulelo eliphantsi. Ngokwahlukileyo koko, olunye uphando olukhulu lwe-total hip arthroplasty lubonise izinga eliphantsi losulelo ngee-antibiotics ezinikwa kwimizuzu engama-30 yokuqala yokusika. Ke ngoko ixesha lokusetyenziswa lidla ngokuthathwa njengemizuzu engama-30 ngaphambi kotyando, kunye neziphumo ezilungileyo ngexesha lokuqaliswa kwe-anesthesia. Elinye idosi yokuthintela yee-antibiotics linikwa emva kotyando. EYurophu nase-United States, ii-antibiotics zihlala zisetyenziswa kude kube lusuku lwesithathu emva kotyando, kodwa eTshayina, kubikwa ukuba zihlala zisetyenziswa rhoqo kangangeveki e-1 ukuya kweyesi-2. Nangona kunjalo, kuvunyelwene ngokubanzi ukuba ukusetyenziswa kwexesha elide kwee-antibiotics ezinamandla ze-broad-spectrum kufanele kuphetshwe ngaphandle kokuba kukho iimeko ezikhethekileyo, kwaye ukuba kuyimfuneko ukusebenzisa ii-antibiotics ixesha elide, kuyacetyiswa ukusebenzisa amayeza okubola kunye nee-antibiotics ukuthintela usulelo lwefungus. I-Vancomycin ibonakalisiwe ukuba iyasebenza kwizigulana ezisengozini enkulu ezine-methicillin-resistant Staphylococcus aureus. Iidosi eziphezulu zee-antibiotics kufuneka zisetyenziswe kwiindlela zotyando ezinde, kubandakanya utyando oluphakathi kwamacala omabini, ingakumbi xa i-antibiotic isiqingatha sobomi sifutshane.
5. Ukusetyenziswa kwee-antibiotics kunye nesamente yethambo:
Isamente efakwe ama-antibiotic yaqala ukusetyenziswa kwi-arthroplasty eNorway, apho ekuqaleni uphando lweNorwegian Arthroplasty Registry lubonise ukuba ukusetyenziswa komxube we-antibiotic IV kunye nesamente (i-antibiotic prosthesis edibeneyo) ukuxutywa kunciphisa izinga losulelo olunzulu ngempumelelo ngakumbi kunendlela nganye yodwa. Olu phando luqinisekiswe kuthotho lwezifundo ezinkulu kwiminyaka eli-16 eyalandelayo. Uphononongo lwaseFinland kunye ne-Australian Orthopaedic Association ka-2009 bafikelele kwizigqibo ezifanayo malunga nendima yesamente efakwe ama-antibiotic kwi-knee arthroplasty yokuqala kunye nokuhlaziywa kwayo. Kukwaboniswe ukuba iipropati ze-biomechanical zesamente yamathambo azichaphazeleki xa umgubo we-antibiotic wongezwa kwiidosi ezingadluli kwi-2 g kwi-40 g yesamente yamathambo. Nangona kunjalo, ayizizo zonke ii-antibiotics ezinokongezwa kwisamente yamathambo. Ii-antibiotics ezinokongezwa kwisamente yamathambo kufuneka zibe nezi meko zilandelayo: ukhuseleko, uzinzo lobushushu, ukungabangeli ukungezwani komzimba, ukunyibilika kakuhle kwamanzi, ububanzi be-antimicrobial spectrum, kunye nezinto ezigutyungelweyo. Okwangoku, i-vancomycin kunye ne-gentamicin zisetyenziswa kakhulu kwizonyango. Kwakucingwa ukuba ukufaka amayeza okubulala iintsholongwane kwisamente kuya kwandisa umngcipheko weempembelelo ze-allergy, ukuvela kweentlobo ezichaseneyo, kunye nokukhululeka kwe-prosthesis engasebenzisi magciwane, kodwa okwangoku akukho bungqina buxhasa ezi nkxalabo.
VII. Isishwankathelo
Ukwenza uxilongo olukhawulezileyo noluchanekileyo ngembali, uvavanyo lomzimba kunye novavanyo oluncedisayo kuyimfuneko yonyango oluphumelelayo lwezifo zamalungu. Ukususa usulelo kunye nokubuyiselwa kwelungu lokwenziwa elingenantlungu, elisebenza kakuhle ngumgaqo osisiseko kunyango lwezifo zamalungu. Nangona unyango lwe-antibiotics losulelo lwamalungu lulula kwaye lungabizi kakhulu, ukuphelisa usulelo lwamalungu kufuna indibaniselwano yeendlela zotyando. Eyona nto ibalulekileyo ekukhetheni unyango lotyando kukuqwalasela ingxaki yokususwa kwe-prosthesis, eyona nto iphambili ekulweni nezifo zamalungu. Okwangoku, ukusetyenziswa ngokudibeneyo kwe-antibiotics, ukususwa kwezicubu kunye ne-arthroplasty kuye kwaba lunyango olupheleleyo kwiintsholongwane ezininzi zamalungu ezinzima. Nangona kunjalo, kusafuneka kuphuculwe kwaye kugqitywe.
Ixesha leposi: Meyi-06-2024
