Ukosuleleka yenye yezona ngxaki zinzima emva kokutshintshwa ngokudibeneyo, okungagcini nje ukuzisa izibetho ezininzi zotyando kwizigulana, kodwa kudla izixhobo ezinkulu zonyango. Kule minyaka ili-10 idlulileyo, izinga losulelo emva kokutshintshwa kwejoyinti eyenziweyo lehlile kakhulu, kodwa izinga lokukhula langoku lezigulane ezithatha indawo yejoyinti eyenziweyo ligqithise kakhulu izinga lokuhla kwezinga losulelo, ngoko ke ingxaki yosulelo emva kotyando kufuneka ingahoywa.
I. Oonobangela bokugula
Usulelo lwe-post-artificial joint replacement kufuneka luthathwe njengosulelo olufunyenwe esibhedlele kunye ne-causative organisms enganyangekiyo ngamachiza. Eyona nto ixhaphakileyo yi-staphylococcus, ithatha i-70% ukuya kwi-80%, i-gram-negative bacilli, i-anaerobes kunye ne-non-A group streptococci nazo zixhaphakile.
II Pathogenesis
Usulelo lohlulwe lwaziindidi ezimbini: olunye lusulelo kwangoko kwaye olunye lusulelo kade okanye lubizwa ngokuba lusulelo oluqala emva kwexesha. Usulelo lwakwangoko lubangelwa kukungena ngokuthe ngqo kwebhaktheriya kwilungu ngexesha lotyando kwaye ngokuqhelekileyo iStaphylococcus epidermidis. Usulelo olufika emva kwexesha lubangelwa kukudluliselwa kwegazi kwaye amaxesha amaninzi iStaphylococcus aureus. Amalungu enziwe utyando kunokwenzeka ukuba osuleleke. Umzekelo, kukho i-10% yezinga losulelo kwiimeko zohlaziyo emva kokutshintshwa kwejoyinti eyenziweyo, kwaye izinga losulelo liphezulu kubantu abaye bafumana indawo edibeneyo ye-rheumatoid arthritis.
Uninzi losulelo lwenzeka kwiinyanga ezimbalwa emva koqhaqho, olokuqala lunokuvela kwiiveki ezimbini zokuqala emva koqhaqho, kodwa nasemva kweminyaka embalwa ngaphambi kokuvela kweempawu eziphambili zokudumba kwamalungu, iintlungu kunye nomkhuhlane. , iimpawu zomkhuhlane kufuneka zihlulwe kwezinye iingxaki, ezifana nenyumoniya emva kokuhlinzwa, izifo ze-urinary tract kunye nokunye.
Kwimeko yokusuleleka kwangaphambili, ukushisa komzimba akugcini nje kuphela, kodwa kuphakama iintsuku ezintathu emva kokuhlinzwa. Intlungu edibeneyo ayigcini nje ukunciphisa ngokuthe ngcembe, kodwa iyancipha ngokuthe ngcembe, kwaye kukho intlungu ebuhlungu ekuphumleni. Kukho ukugobhoza okungaqhelekanga okanye ukukhuselwa ukusuka kulwakhiwo. Oku kufanele kuhlolisiswe ngenyameko, yaye umkhuhlane akufanele kubalelwe ngokulula usulelo lwasemva kotyando kwamanye amalungu omzimba anjengemiphunga okanye umjelo womchamo. Kukwabalulekile ukuba ungavele ukhabe ngokuchasa ukugobhoza okusikekileyo njengesiqhelo ukuqukuqela okuqhelekileyo okufana nokunyibilika kwamafutha. Kwakhona kubalulekile ukuchonga ukuba usulelo lubekwe kwizihlunu ezingaphezulu okanye nzulu malunga neprosthesis.
Kwizigulana ezinosulelo oluhambele phambili, uninzi lwazo luphumile esibhedlele, ukudumba kwamalungu, iintlungu, kunye nomkhuhlane usenokuba ungabi qatha. Isiqingatha sezigulana sinokungabinafiva. I-Staphylococcus epidermidis inokubangela usulelo olungenabuhlungu ngokunyuka kwenani leeseli ezimhlophe zegazi kwi-10% kuphela yezigulane. Ukunyuka kwe-sedimentation yegazi kuxhaphake kakhulu kodwa kwakhona akucaci. Ubuhlungu ngamanye amaxesha buchazwa ngokungafanelekanga njengento yokukhulula i-prosthetic, intlungu yokugqibela ehambelana nokunyakaza okufuneka kukhululwe ngokuphumla, kunye neentlungu ezivuthayo ezingenakunqanyulwa kukuphumla. Nangona kunjalo, kuye kwacetyiswa ukuba oyena nobangela wokukhulula iprosthesis kukulibaziseka usulelo olungapheliyo.
III. Uxilongo
1. Uvavanyo lwegazi:
Ikakhulu ibandakanya ukubalwa kweeseli ezimhlophe zegazi kunye nokuhlelwa, i-interleukin 6 (IL-6), iprotheni ye-C-reactive (CRP) kunye ne-erythrocyte sedimentation rate (ESR). Izibonelelo zovavanyo lwe-hematological zilula kwaye kulula ukuzisebenzisa, kwaye iziphumo zinokufumaneka ngokukhawuleza; I-ESR kunye ne-CRP zineenkcukacha eziphantsi; I-IL-6 inexabiso elikhulu ekunqumeni ukusuleleka kwe-periprosthetic kwixesha lokuqala emva kokusebenza.
2. Uvavanyo lomfanekiso:
Ifilimu yeX-reyi: ayikhathali kwaye ayichanekanga ekufunyanisweni kosulelo.
Ifilimu ye-X-ray yosulelo lokutshintshwa kwamadolo
I-Arthrography: ummeli oyintloko wokusebenza ekuxilongeni usulelo kukuphuma kwe-synovial fluid kunye ne-abscess.
C.
I-MRI: inovakalelo oluphezulu ekubhaqweni kwangaphambili kolwelo oludibeneyo kunye namathumba, angasetyenziswanga kakhulu ekuxilongeni usulelo lweperiprosthetic.
I-Ultrasound: ukuqokelelana kwamanzi.
3.Amayeza enyukliya
I-Technetium-99 i-bone scan inovakalelo lwe-33% kunye neenkcukacha ze-86% zokuxilongwa kwezifo ze-periprosthetic emva kwe-arthroplasty, kunye ne-indium-111 ebhalwe i-leukocyte scan ibaluleke kakhulu ekuxilongweni kwezifo ze-periprosthetic, kunye novakalelo lwe-77% kunye into ethile yama-86%. Xa izikena ezibini zisetyenziselwa uviwo losulelo lwe-periprosthetic emva kwe-arthroplasty, uvakalelo oluphezulu, ukuchaneka kunye nokuchaneka kunokufezekiswa. Olu vavanyo lusengumgangatho wegolide kumayeza enyukliya ekuxilongeni usulelo lweperiprosthetic. I-Fluorodeoxyglucose-positron emission tomography (FDG-PET). Ifumanisa iiseli ezivuthayo kunye nokunyuka kwe-glucose kwindawo echaphazelekayo.
4. Ubuchule bebhayoloji yeemolekyuli
I-PCR: uvakalelo oluphezulu, iimpawu zobuxoki
Iteknoloji ye-Gene chip: isigaba sophando.
5. I-Arthrocentesis:
Uvavanyo lwe-Cytological of joint fluid, inkcubeko yebhaktheriya kunye novavanyo lobuzaza beziyobisi.
Le ndlela ilula, ikhawuleza kwaye ichanekile
Kwizifo ze-hip, i-joint fluid leucocyte count> 3,000 / ml ngokudibanisa ne-ESR eyandisiweyo kunye ne-CRP iyona nto ibhetele yobukho bosulelo lwe-periprosthetic.
6. Utyando olukhawulezayo olunomkhenkce lwecandelo le-histopathology
Utyando olukhawulezayo lwecandelo lomkhenkce lwethishu yeperiprosthetic yeyona ndlela ixhaphakileyo esetyenziswa kuqhaqho kuvavanyo lwe-histopathological. Iikhrayitheriya zokuxilonga zika-Feldman, okt, ezinkulu okanye ezilingana nee-neutrophils ezi-5 ngokukhuliswa okuphezulu (400x) ubuncinane kwiinkalo ezi-5 ezihlukeneyo ze-microscopic, zihlala zisetyenziswa kumacandelo omkhenkce. Kuye kwaboniswa ukuba uvakalelo kunye neenkcukacha zale ndlela ziya kudlula i-80% kunye ne-90%, ngokulandelanayo. Le ndlela okwangoku ingumgangatho wegolide wokuxilongwa kwe-intraoperative.
7. Inkcubeko yebhaktheriya yezicubu ze-pathological
Inkcubeko yebhaktiriya yezicubu ze-periprosthetic inomgangatho ophezulu wokuxilonga usulelo kwaye ithathwe njengomgangatho wegolide wokufumanisa usulelo lwe-periprosthetic, kwaye ingasetyenziselwa uvavanyo lobuzaza beziyobisi.
IV. Uxilongo olwahlukileyos
Usulelo olungenantlungu lwe-prosthetic ebangelwa yi-Staphylococcus epidermidis kunzima kakhulu ukwahlula kwi-prosthetic yokukhulula. Kufuneka ingqinwe ngeX-reyi nezinye iimvavanyo.
V. Unyango
1. Unyango olulula lwe-antibiotics
I-Tsakaysma kunye ne-se, i-gawa ihlelwa usulelo lwe-post arthroplasty kwiintlobo ezine, uhlobo lwe-asymptomatic uhlobo lwe-I, isigulane kuphela kwinkcubeko yokuhlaziya utyando lwethishu lufunyenwe lukhula lwebhaktiriya, kunye nemizekelo emibini ekhuliswe kunye neebhaktheriya ezifanayo; uhlobo lwe-II lusulelo lwakwangoko, olwenzeka kwinyanga enye yotyando; uhlobo IIl lusulelo olubambezelekayo olungapheliyo; kunye nohlobo lwe-IV lusulelo olubukhali lwe-haematogenous. Umgaqo wonyango lwe-antibiotics unovelwano, umlinganiselo owaneleyo kunye nexesha. Kwaye i-preoperative joint puncture kunye ne-intraoperative tissue culture zibaluleke kakhulu kukhetho oluchanekileyo lwe-antibiotics. Ukuba inkcubeko yebhaktheriya ilungile kwintsholongwane yohlobo lwe-I, ukusetyenziswa okulula kwee-antibiotics ezibuthathaka kwiiveki ezi-6 kunokufezekisa iziphumo ezilungileyo.
2. Ukugcinwa kweprosthesis, ukuchithwa kunye nokukhupha amanzi, utyando lokunkcenkceshela ityhubhu
Isiseko sokwamkela isiseko somonzakalo ogcina unyango lweprosthesis kukuba iprothesis izinzile kwaye usulelo olubukhali. I-organism eyosulelayo icacile, i-bacterial virulence iphantsi kwaye i-antibiotics ebuthathaka iyafumaneka, kwaye i-liner okanye i-spacer inokutshintshwa ngexesha lokuchithwa. Amazinga okuphilisa kuphela i-6% kunye ne-antibiotics yodwa kunye ne-27% kunye ne-antibiotics kunye nokuchithwa kunye nokugcinwa kweprosthesis kuye kwabikwa kwiincwadi.
Ilungele ukosuleleka kwisigaba sakwangoko okanye usulelo oluqatha lwe-haematogenous kunye nokulungiswa kakuhle kwe-prosthesis; kwakhona, kucacile ukuba usulelo lusulelo oluphantsi lwentsholongwane yentsholongwane enovakalelo kunyango lwe-antimicrobial. Indlela yokwenza iquka ukuchithwa ngokucokisekileyo, ukugungxulwa kwe-antimicrobial kunye ne-drainage (ixesha leeveki ezi-6), kunye ne-postoperative systemic intravenous antimicrobials (ubude beeveki ezi-6 ukuya kwiinyanga ezi-6). Ukungalungi: izinga eliphezulu lokungaphumeleli (ukuya kwi-45%), ixesha elide lonyango.
3. Utyando lokuhlaziya inqanaba elinye
Ineenzuzo zokwenzakala okuncinci, ukuhlala esibhedlele okufutshane, iindleko zonyango eziphantsi, isilonda esincinci senxeba kunye nokuqina kwamalungu, okulungele ukubuyiswa komsebenzi odibeneyo emva kokuhlinzwa. Le ndlela ifaneleka ikakhulu kunyango losulelo lwakwangoko kunye nosulelo oluqatha lwe-haematogenous.
Ukutshintshwa kwenqanaba elinye, oko kukuthi, indlela yenyathelo elinye, ilinganiselwe kwizifo ezinobungozi obuphantsi, ukutshatyalaliswa ngokucokisekileyo, i-antibiotic bone cement, kunye nokufumaneka kwee-antibiotics ezinovakalelo. Ngokusekelwe kwiziphumo zecandelo le-intraoperative tissue efriziwe, ukuba kukho ngaphantsi kwe-5 leukocytes / intsimi yokukhulisa okuphezulu. Icebisa usulelo olunetyhefu ephantsi. Emva kokucocwa ngokucokisekileyo kwenziwa i-arthroplasty yenqanaba elinye kwaye akuzange kuphinde kubekho usulelo emva koqhaqho.
Emva kokutshatyalaliswa ngokucokisekileyo, i-prosthesis iguqulwa ngokukhawuleza ngaphandle kwesidingo senkqubo evulekileyo. Ineenzuzo zentlungu encinci, ixesha elifutshane lonyango kunye neendleko eziphantsi, kodwa izinga lokuphindaphinda ukusuleleka emva kokuhlinzwa liphezulu, elimalunga ne-23% ~ 73% ngokwezibalo. Ukutshintshwa kwe-prosthesis yesigaba esisodwa kubaluleke kakhulu kwizigulane ezisebekhulile, ngaphandle kokudibanisa nayiphi na kwezi zilandelayo: (1) imbali yotyando oluninzi kwindawo yokutshintshwa; (2) ukubunjwa kwendlela yesono; (3) usulelo oluqatha (umz. i-septic), ischemia kunye nokukrala kwezicubu ezingqongileyo; (4) i-debridement engaphelelanga yokwenzakala kunye nesamente inxalenye eseleyo; (5) I-X-reyi ibonisa i-osteomyelitis; (6) iziphene zamathambo ezifuna ukufakelwa amathambo; (7) izifo ezixubeneyo okanye iibhaktheriya eziyingozi kakhulu (umz. iStreptococcus D, i-Gram-negative bacteria); (8) ukulahleka kwethambo kufuna ukuxhunyelelwa; (9) ukulahleka kwethambo kufuna ukuxhunyelelwa; kunye (10) nokufakelwa kwamathambo afuna ukufakelwa amathambo. I-Streptococcus D, ibhaktheriya ye-Gram-negative, ngakumbi i-Pseudomonas, njl.), okanye ukusuleleka kwefungal, ukusuleleka kwe-mycobacterial; (8) Inkcubeko yebhaktheriya ayicacanga.
4. Utyando oluhlaziyiweyo lwenqanaba lesibini
Ithandwa ngoogqirha kwiminyaka engama-20 edlulileyo ngenxa yoluhlu olubanzi lwezibonakaliso (ithambo elaneleyo, izicubu ezithambileyo ze-periarticular) kunye nezinga eliphezulu lokupheliswa kosulelo.
Spacers, abathwali antibiotic, antibiotics
Nokuba yeyiphi na inkqubo ye-spacer esetyenzisiweyo, ukulungiswa kwesamente ngamayeza okubulala iintsholongwane kuyafuneka ukunyusa ukuxinana kwamayeza okubulala iintsholongwane kwindawo edibeneyo kunye nokunyusa izinga lokunyanga usulelo. Ii-antibiotics ezisetyenziswa ngokuqhelekileyo yi-tobramycin, i-gentamicin kunye ne-vancomycin.
Uluntu lwezizwe ngezizwe lwamathambo luqaphele olona nyango lusebenzayo losulelo olunzulu emva kwe-arthroplasty. Le ndlela ibandakanya ukutshatyalaliswa ngokucokisekileyo, ukususwa kweprosthesis kunye nomzimba wangaphandle, ukubekwa kwe-joint spacer, ukuqhubeka nokusetyenziswa kwe-intravenous antimicrobials ubuncinane kwiiveki ezi-6, kwaye ekugqibeleni, emva kokulawulwa okusebenzayo kosulelo, ukubuyisela i-prosthesis.
Izinto eziluncedo:
Ixesha elaneleyo lokuchonga iintlobo zebhaktheriya kunye nee-antimicrobial agents ezibuthathaka, ezinokuthi zisetyenziswe ngokufanelekileyo phambi kokuhlinzwa ngokutsha.
Ukudibanisa enye i-systemic foci yokusuleleka kunokunyangwa ngexesha elifanelekileyo.
Kukho amathuba amabini okutshatyalaliswa ukususa izicubu ze-necrotic kunye nemizimba yangaphandle ngokucokisekileyo, nto leyo inciphisa kakhulu izinga lokuphindaphinda ukusuleleka emva kokuhlinzwa.
Izinto ezingeloncedo:
I-anaesthesia kwakhona kunye notyando kwandisa umngcipheko.
Ixesha elide lonyango kunye neendleko zonyango eziphezulu.
Ukubuyiswa komsebenzi wasemva kokuhlinzwa akubi kwaye kucotha.
I-Arthroplasty: Ifanelekile kwizifo eziqhubekayo ezingaphenduliyo kunyango, okanye iziphene ezinkulu zamathambo; imeko yesigulane imida yokusebenza ngokutsha kunye nokusilela ukwakhiwa kwakhona. Intlungu eshiyekileyo emva kokuhlinzwa, imfuno yokusetyenziswa kwexesha elide lokuncedisa ukuhamba, ukuzinza okungahambi kakuhle, ukunciphisa umlenze, impembelelo yokusebenza, umda wesicelo ulinganiselwe.
I-Arthroplasty: unyango lwesintu losulelo lwasemva kotyando, olunozinzo oluhle lwasemva kotyando kunye nokuthomalalisa iintlungu. Ukungalungi kubandakanya ukunciphisa umlenze, ukuphazamiseka kwe-gait kunye nokulahlekelwa ukuhamba kwamalungu.
Ukunqunyulwa amalungu: Licebo lokugqibela kunyango losulelo olunzulu lwasemva kotyando. Ifanele: (1) ukulahleka kwethambo okungenakulungiseka, iziphene ezithambileyo; (2) i-bacterial virulence eyomeleleyo, izifo ezixubileyo, unyango lwe-antimicrobial alusebenzi, olukhokelela kwi-systemic toxicity, esongela ubomi; (3) inembali yokungaphumeleli okuphindaphindiweyo kokuhlinzwa ngokutsha kwezigulane ezinesifo esingapheliyo.
VI. Uthintelo
1. Iimeko zangaphambi kotyando:
Lungiselela imeko yangaphambili yesigulana kwaye zonke izifo ezikhoyo kufuneka zinyangwe kwangaphambili. Ezona zifo zixhaphakileyo zihamba ngegazi zezo ziphuma esikhumbeni, kumzila womchamo nakwindlela yokuphefumla. Kwi-hip okanye i-knee arthroplasty, ulusu lweziphelo ezisezantsi kufuneka luhlale lungapheli. I-Asymptomatic bacteriuria, eqhelekileyo kwizigulane ezikhulileyo, ayifuni ukuphathwa kwangaphambili; zakuba zivele iimpawu kufuneka zinyangwe ngokukhawuleza. Izigulane ezine-tonsillitis, izifo zendlela yokuphefumula ephezulu, kunye ne-tinea pedis kufuneka zibe ne-foci yendawo yokusuleleka. Imisebenzi emikhulu yamazinyo ngumthombo onokuthi ubangele usulelo lwegazi, kwaye nangona kuphetshwa, ukuba ukuhlinzwa kwamazinyo kuyimfuneko, kucetyiswa ukuba iinkqubo ezinjalo zenziwe ngaphambi kwe-arthroplasty. Izigulane ezineemeko eziqhelekileyo eziqhelekileyo ezifana ne-anemia, i-hypoproteinaemia, isifo seswekile esidibeneyo kunye nezifo ezingapheliyo ze-urinary tract kufuneka ziphathwe ngokukhawuleza kwaye kwangethuba kwisifo sokuqala sokuphucula imeko yenkqubo.
2. Ulawulo lwangaphakathi:
(1) Ubuchule kunye nezixhobo ze-aseptic ngokupheleleyo kufuneka zisetyenziswe kwindlela yonyango yesiqhelo kwi-arthroplasty.
(2) Ukulaliswa esibhedlele kwangaphambi kotyando kufanele kuncitshiswe ukuze kuncitshiswe ingozi yokuba ulusu lomguli lusenokugqunywa ziintsholongwane ezifumaneka esibhedlele, yaye unyango oluqhelekileyo lufanele lwenziwe ngomhla wotyando.
(3) Indawo yangaphambili kufuneka ilungiswe ngokufanelekileyo ukulungiselela ulusu.
4 Ukugqoka iiglavu ezimbini kunokunciphisa umngcipheko wokuqhagamshelana nezandla phakathi kogqirha kunye nesigulane kwaye kunokucetyiswa.
(5) Kuye kwaqinisekiswa ngokweklinikhi ukuba ukusetyenziswa kokuthintela ngakumbi, ngokukodwa i-henjisi, i-prosthesis inomngcipheko ophezulu wosulelo kune-arthroplasty engathintekiyo edolweni ngenxa ye-debris yensimbi ephazamisayo enciphisa umsebenzi we-phagocytosis, kwaye ngoko kufuneka igwenywe ekukhethweni kwe-prosthesis. .
(6) Ukuphucula ubuchule botyando bomqhubi kunye nokunciphisa ubude bokusebenza (<2.5 h ukuba kunokwenzeka). Ukunciphisa ixesha lotyando kunokunciphisa ixesha lokuvezwa emoyeni, oko ke kunokunciphisa ixesha lokusetyenziswa kwe-tourniquet. Kulumkele ukusebenza ngokurhabaxa ngexesha lotyando, inxeba linokunkcenkceshelwa ngokuphindaphindiweyo (umpu wokunkcenkceshela ipulsed yeyona ilungileyo), kwaye ukuntywiliselwa komphunga we-iodine kunokwenziwa ukuze kuthathwe imigubo ekurhaneleka ukuba inentsholongwane.
3. Izinto zasemva kotyando:
(1) Izithonga zotyando zibangela ukunganyangeki kwe-insulin, okunokukhokelela kwi-hyperglycaemia, into enokuthi iqhubeke iiveki ezimbalwa emva kokuhlinzwa kwaye ibeke isigulane kwiingxaki ezinxulumene nenxeba, kwaye, ngaphezu koko, kwenzeka nakwizigulane ezingenasifo seswekile. Ke ngoko, ukujongwa kweglucose yegazi emva kokuhlinzwa kubaluleke ngokulinganayo.
(2) I-thrombosis ye-vein deep inyusa umngcipheko we-hematoma kunye neengxaki ezinxulumene nesilonda. Uphononongo lolawulo lwamatyala lufumanise ukuba ukusetyenziswa kwe-postoperative ye-heparin ephantsi ye-molecular ukukhusela i-thrombosis enzulu ye-vein yayiluncedo ekunciphiseni ukusuleleka kwintsholongwane.
(3) I-draining evaliweyo yindawo yokungena kwintsholongwane, kodwa ubudlelwane bayo kunye namazinga osulelo lwamanxeba ayikaphononongwa ngokuthe ngqo. Iziphumo zokuqala zibonisa ukuba i-catheters ye-intra-articular esetyenziswa njengolawulo lwasemva kokusebenza kwe-analgesics inokuthi ichaphazeleke kwintsholongwane yesilonda.
4. I-Antibiotic prophylaxis:
Okwangoku, ukusetyenziswa kwesiqhelo kweklinikhi kweedosi zeprophylactic zamayeza okubulala iintsholongwane alawulwa ngokwenkqubo emithanjeni ngaphambi nasemva kotyando kunciphisa umngcipheko wokosuleleka emva kotyando. I-Cephalosporins isetyenziswa kakhulu eklinikhi njengeyeza lokubulala iintsholongwane elikhethiweyo, kwaye kukho ubudlelwane obumise okwe-U phakathi kwexesha lokusetyenziswa kwe-antibiotics kunye nesantya sosulelo lwendawo yotyando, kunye nomngcipheko omkhulu wosulelo phambi nasemva kwexesha elifanelekileyo le-antibiotic. sebenzisa. Uphononongo olukhulu lwakutsha nje lufumanise ukuba amayeza okubulala iintsholongwane asetyenziswa kwimizuzu engama-30 ukuya kuma-60 ngaphambi kokusikwa kwaba nelona zinga liphantsi losulelo. Ngokwahlukileyo koko, olunye uphononongo olukhulu lwe-hip arthroplasty lubonise elona zinga liphantsi losulelo kunye ne-antibiotics elawulwa ngaphakathi kwe-30 min yokuqala yokusikwa. Ngoko ke ixesha lolawulo ngokuqhelekileyo lithathwa njengemizuzu engama-30 ngaphambi kokusebenza, kunye nemiphumo emihle ngexesha lokufakwa kwe-anesthesia. Enye i-prophylactic dose ye-antibiotics inikezelwa emva kokuhlinzwa. EYurophu naseUnited States, i-antibiotics idla ngokusetyenziswa kude kube yimini yesithathu emva kokuhlinzwa, kodwa e-China, kuxelwe ukuba ngokuqhelekileyo isetyenziswa ngokuqhubekayo kwi-1 ukuya kwiiveki ezi-2. Nangona kunjalo, ukuvumelana ngokubanzi kukuba ukusetyenziswa kwexesha elide le-antibiotics enamandla ebanzi kufuneka kugwenywe ngaphandle kokuba kukho iimeko ezikhethekileyo, kwaye ukuba ukusetyenziswa kwexesha elide le-antibiotics kuyimfuneko, kuyacetyiswa ukuba kusetyenziswe iziyobisi ze-antifungal kunye ne-antibiotics ukukhusela izifo zefungal. . I-Vancomycin ibonakaliswe ukuba iyasebenza kwizigulana ezisemngciphekweni omkhulu ezithwala i-methicillin-resistant Staphylococcus aureus. Iidosi eziphezulu zamayeza okubulala iintsholongwane kufuneka zisetyenziselwe utyando olude, kubandakanywa uqhaqho lwamazwe amabini, ngakumbi xa isibulala-ntsholongwane sibubomi bufutshane.
5. Ukusetyenziswa kwamayeza okubulala iintsholongwane ngokudityaniswa nesamente yamathambo:
Isamente efakwe kwi-Antibiotic iye yasetyenziswa okokuqala kwi-arthroplasty eNorway, apho ekuqaleni uphando lwaseNorway lweArthroplasty Registry lubonise ukuba ukusetyenziswa kwendibaniselwano ye-antibiotic IV kunye nesamente (i-prosthesis edibeneyo ye-antibiotic) ukunyuswa kwehlise izinga losulelo olunzulu ngokusebenzayo ngakumbi kunendlela yodwa. . Oku kufunyanisiweyo kwaqinisekiswa kuthotho lwezifundo ezinkulu kule minyaka ili-16 izayo. Uphononongo lwaseFinland kunye ne-Australian Orthopedic Association 2009 yafikelela kwizigqibo ezifanayo malunga nendima ye-antibiotic-ifakwe isamente kwixesha lokuqala kunye nokuhlaziywa kwe-knee arthroplasty. Kwakhona kuye kwaboniswa ukuba iimpawu ze-biomechanical ze-samente yethambo azichaphazeli xa i-antibiotic powder yongezwa kwiidosi ezingadluli kwi-2 g nge-40 g yesamente yamathambo. Noko ke, asingawo onke amayeza okubulala iintsholongwane anokongezwa kwisamente yamathambo. I-antibiotics enokongezwa kwi-samente yethambo kufuneka ibe nezi meko zilandelayo: ukhuseleko, ukuzinza kwe-thermal, i-hypoallergenicity, i-solubility enhle yamanzi, i-spectrum ebanzi ye-antimicrobial, kunye ne-powdered material. Okwangoku, i-vancomycin kunye ne-gentamicin zisetyenziswa ngokuqhelekileyo kwiiklinikhi. Bekucingelwa ukuba inaliti yesibulala-zintsholongwane kwisamente ingawonyusa umngcipheko wokungaguquguquki, ukuvela kweentlobo ezixhathisayo, kunye nokukhululeka kwe-aseptic yeprosthesis, kodwa ukuza kuthi ga ngoku abukho ubungqina bokuxhasa ezi nkxalabo.
VII. Isishwankathelo
Ukwenza ukuxilongwa ngokukhawuleza kunye nokuchanekileyo ngembali, ukuhlolwa komzimba kunye neemvavanyo ezincedisayo kuyimfuneko yonyango oluyimpumelelo lwezifo ezidibeneyo. Ukupheliswa kokusuleleka kunye nokubuyiselwa kwentlungu engenabuhlungu, idibeneyo eyenziwe kakuhle ngumgaqo osisiseko kunyango lwezifo ezidibeneyo. Nangona unyango lwe-antibiotics losulelo oludibeneyo lulula kwaye lungabizi, ukupheliswa kosulelo oludibeneyo lufuna indibaniselwano yeendlela zotyando. Isitshixo ekukhetheni unyango lotyando kukuqwalasela ingxaki yokususwa kwe-prosthesis, eyona nto iphambili yokujongana nosulelo oludibeneyo. Okwangoku, ukusetyenziswa okudibeneyo kwe-antibiotics, i-debridement kunye ne-arthroplasty iye yaba yonyango olubanzi lwezifo ezininzi ezidibeneyo. Nangona kunjalo, kusafuneka iphuculwe kwaye igqibelele.
Ixesha lokuposa: May-06-2024
