Ukutheleleka kungenye yezinkinga ezinkulu kakhulu ngemva kokufakelwa kwamalunga okwenziwa, okungagcini nje ngokuletha ukushaywa kaningi kokuhlinzwa ezigulini, kodwa futhi kudla izinsiza ezinkulu zezokwelapha. Eminyakeni eyi-10 edlule, izinga lokutheleleka ngemva kokufakelwa kwamalunga okwenziwa lehle kakhulu, kodwa izinga lokukhula kwamanje kweziguli ezifakelwa kwamalunga okwenziwa liye ladlula kakhulu izinga lokwehla kwesilinganiso sokutheleleka, ngakho-ke inkinga yokutheleleka ngemva kokuhlinzwa akufanele inganakwa.
I. Izimbangela zokugula
Ukutheleleka kokufakelwa kwamalunga ngemva kokwenziwa kufanele kubhekwe njengokutheleleka okutholakala esibhedlela okunezinhlobo ezibangela izifo ezingamelani nemithi. Okuvame kakhulu yi-staphylococcus, ebalelwa ku-70% kuya ku-80%, ama-bacilli angenayo i-gram, ama-anaerobes kanye ne-non-A group streptococci nakho kuvamile.
II I-Pathogenesis
Ukutheleleka kuhlukaniswe ngezigaba ezimbili: esinye ukutheleleka kwasekuqaleni kanti esinye ukutheleleka kwasekupheleni noma okubizwa ngokuthi ukutheleleka kokuqala kwesikhathi. Ukutheleleka kwasekuqaleni kubangelwa ukungena ngqo kwamagciwane esilungwini ngesikhathi sokuhlinzwa futhi kuvame ukuba yi-Staphylococcus epidermidis. Ukutheleleka kokuqala kwesikhathi eside kubangelwa ukudluliselwa kwegazi futhi kuvame ukuba yi-Staphylococcus aureus. Amalunga ahlinzwe anamathuba amaningi okutheleleka. Isibonelo, kunezinga lokutheleleka elingu-10% ezimweni zokubuyekezwa ngemva kokufakwa esikhundleni kwamalunga okwenziwa, futhi izinga lokutheleleka liphakeme nakubantu abaye bafakwa esikhundleni samalunga ngenxa yamathambo e-rheumatoid arthritis.
Iningi lezifo zenzeka zingakapheli izinyanga ezimbalwa ngemva kokuhlinzwa, okokuqala kungabonakala emavikini amabili okuqala ngemva kokuhlinzwa, kodwa futhi eminyakeni embalwa ngaphambi kokuvela kwezibonakaliso zokuqala zokuvuvukala kwamalunga, ubuhlungu kanye nomkhuhlane, izimpawu zomkhuhlane kumele zihlukaniswe kwezinye izinkinga, njenge-pneumonia yangemva kokuhlinzwa, izifo zomgudu womchamo nokunye.
Uma kwenzeka ukutheleleka kusenesikhathi, izinga lokushisa lomzimba aligcini nje ngokuphola, kodwa liyakhuphuka ezinsukwini ezintathu ngemva kokuhlinzwa. Ubuhlungu bamalunga abugcini nje ngokuncipha kancane kancane, kodwa buyanda kancane kancane, futhi kukhona ubuhlungu obuhlabayo lapho uphumule. Kukhona ukuphuma noma ukukhishelwa okungavamile okuvela ekusikweni. Lokhu kufanele kuhlolwe ngokucophelela, futhi umkhuhlane akufanele ubhekwe kalula njengezifo ezithathelwanayo ngemva kokuhlinzwa kwezinye izingxenye zomzimba njengemaphaphu noma indlela yomchamo. Kubalulekile futhi ukungamane ulahle ukuphuma kokusika njengokuphuma okuvamile okuvamile njengokuncibilika kwamafutha. Kubalulekile futhi ukuthola ukuthi ukutheleleka kutholakala ezicutshini ezingajulile noma ezijulile eduze kwe-prosthesis.
Ezigulini ezinezifo ezithelelekile, iningi lazo eliphumile esibhedlela, ukuvuvukala kwamalunga, ubuhlungu, kanye nomkhuhlane kungase kungabi kubi kakhulu. Ingxenye yeziguli kungenzeka ingabi nomkhuhlane. I-Staphylococcus epidermidis ingabangela ukutheleleka okungenabuhlungu kanye nenani lamaseli amhlophe egazi elikhuphukile ku-10% kuphela weziguli. Ukwanda kokusatshalaliswa kwegazi kuvame kakhulu kodwa futhi akucaci. Ubuhlungu ngezinye izikhathi buhlonzwa kabi njengokukhululeka kokufakelwa, lokhu kokugcina kungubuhlungu obuhambisana nokunyakaza okufanele kuqedwe ngokuphumula, kanye nobuhlungu bokuvuvukala obungaqedwa ngokuphumula. Kodwa-ke, kuye kwaphakanyiswa ukuthi imbangela eyinhloko yokukhululeka kokufakelwa ukutheleleka okungapheli okubambezelekile.
III. Ukuxilongwa
1. Ukuhlolwa kwe-Haematological:
Ngokuyinhloko faka inani lamaseli amhlophe egazi kanye nokuhlukaniswa, i-interleukin 6 (IL-6), iphrotheni ephendulayo ye-C (CRP) kanye nesilinganiso se-erythrocyte sedimentation (ESR). Izinzuzo zokuhlolwa kwe-hematological zilula futhi kulula ukuzenza, futhi imiphumela ingatholakala ngokushesha; i-ESR ne-CRP zinobungcweti obuphansi; i-IL-6 ibaluleke kakhulu ekunqumeni ukutheleleka kwe-periprosthetic esikhathini sokuqala ngemva kokuhlinzwa.
2. Ukuhlolwa kwezithombe:
Ifilimu ye-X-ray: ayizweli futhi ayiqondile ekuxilongweni kokutheleleka.
Ifilimu ye-X-ray yokutheleleka kokufakwa esikhundleni kwedolo
I-Arthrography: ukusebenza okuyinhloko okumele ekuxilongweni kokutheleleka ukuphuma koketshezi lwe-synovial kanye nethumba.
I-CT: ukubona ngeso lengqondo ukuphuma kwamalunga, ama-sinus tract, amathumba ezicubu ezithambile, ukuguguleka kwamathambo, ukumuncwa kwamathambo ngapandle kokufakelwa.
I-MRI: ezwela kakhulu ekutholakaleni kokuqala koketshezi lwamalunga kanye namathumba, ayisetshenziswa kabanzi ekuxilongweni kwezifo ezithinta amalunga.
I-Ultrasound: ukuqongelela koketshezi.
3. Umuthi wenyukliya
Ukuskena kwamathambo kwe-Technetium-99 kunokuzwela okungu-33% kanye nokucaciswa okungu-86% ekuxilongweni kwezifo ze-periprosthetic ngemuva kwe-arthroplasty, kanti ukuskena kwe-leukocyte okubhalwe nge-indium-111 kuyigugu kakhulu ekuxilongweni kwezifo ze-periprosthetic, ngokuzwela okungu-77% kanye nokucaciswa okungu-86%. Uma ukuskena okubili kusetshenziswa ndawonye ekuhlolweni kwezifo ze-periprosthetic ngemuva kwe-arthroplasty, ukuzwela okuphezulu, ukucaciswa kanye nokunemba kungafinyelelwa. Lokhu kuhlolwa kuseyindinganiso yegolide kwezokwelapha zenuzi ekuxilongweni kwezifo ze-periprosthetic. I-Fluorodeoxyglucose-positron emission tomography (FDG-PET). Ithola amangqamuzana okuvuvukala ngokumuncwa kwe-glucose okwandisiwe endaweni ethelelekile.
4. Amasu ebhayoloji yama-molecule
I-PCR: ukuzwela okuphezulu, imiphumela engamanga
Ubuchwepheshe be-Gene chip: isigaba socwaningo.
5. Ukwelashwa kwe-Arthroscopy:
Ukuhlolwa kwe-cytological koketshezi lwamalunga, isiko lamagciwane kanye nokuhlolwa kokuzwela kwemithi.
Le ndlela ilula, iyashesha futhi inembile
Ekuthelelekeni kwe-hip, inani lama-leukocyte oketshezi oluhlangene > 3,000/ml lihlanganiswe ne-ESR ekhuphukile kanye ne-CRP kuyindlela engcono kakhulu yokuba khona kokutheleleka kwe-periprosthetic.
6. I-Histopathology yesigaba esiqandisiwe ngokushesha ngesikhathi sokuhlinzwa
Ingxenye eqandisiwe esheshayo yezicubu ezihambisana nokufakelwa iyindlela evame ukusetshenziswa kakhulu ngesikhathi sokuhlinzwa ekuhlolweni kwe-histopathological. Izindlela zokuxilonga zikaFeldman, okungukuthi, ezinkulu noma ezilingana nama-neutrophil ama-5 ngokukhuliswa okuphezulu (400x) okungenani emasimini ama-5 ahlukene amancane, zivame ukusetshenziswa ezingxenyeni eziqandisiwe. Kuye kwaboniswa ukuthi ukuzwela kanye nokucaciswa kwale ndlela kuzodlula u-80% no-90%, ngokulandelana. Le ndlela okwamanje iyindinganiso yegolide yokuxilonga ngesikhathi sokuhlinzwa.
7. Isiko lamagciwane ezicubu ezibangela izifo
Ukukhuliswa kwamagciwane kwezicubu ezisebenzisa ama-periprosthetic kunendlela ekhethekile yokuxilonga ukutheleleka futhi kuye kwabhekwa njengendinganiso yegolide yokuxilonga ukutheleleka okusebenzisa ama-periprosthetic, futhi kungasetshenziswa nasekuhlolweni kokuzwela kwemithi.
IV. Ukuxilongwa okuhlukiles
Ukutheleleka kwamalunga okufakelwa okungenabuhlungu okubangelwa yi-Staphylococcus epidermidis kunzima kakhulu ukukuhlukanisa nokuxega kokufakelwa. Kumelwe kuqinisekiswe nge-X-ray nezinye izivivinyo.
V. Ukwelashwa
1. Ukwelashwa okulula kwama-antibiotic okulondolozayo
I-Tsakaysma kanye ne-se,gawa bahlukanisa ukutheleleka kwe-post arthroplasty ngezinhlobo ezine, uhlobo lwe-1 olungenazimpawu, isiguli sisesikhungweni sezicubu zokuhlinzwa esibuyekeziwe esitholakale sinokukhula kwamagciwane, futhi okungenani amasampula amabili akhuliswe ngamagciwane afanayo; uhlobo lwesibili luwukutheleleka kwasekuqaleni, okwenzeka phakathi nenyanga eyodwa yokuhlinzwa; uhlobo lwesibili luwukutheleleka okungapheli okubambezelekile; kanti uhlobo lwesine luwukutheleleka okubangelwa ukuphuma kwegazi okukhulu. Isimiso sokwelashwa ngama-antibiotic sibucayi, sinobuningi nesikhathi esanele. Futhi ukubhoboza ingaphakathi lamalunga ngaphambi kokuhlinzwa kanye nokukhuliswa kwezicubu zangaphakathi kokuhlinzwa kubaluleke kakhulu ekukhetheni ama-antibiotic ngendlela efanele. Uma ukukhuliswa kwamagciwane kukuhle ekuthelelekeni kohlobo lwe-1, ukusetshenziswa okulula kwama-antibiotic abucayi amasonto ayi-6 kungaletha imiphumela emihle.
2. Ukugcinwa kwe-prosthesis, ukususwa kwemfucuza kanye nokukhipha amanzi, ukuhlinzwa kokunisela ngamapayipi
Isisekelo sokwamukela isisekelo sokwelashwa kwe-prosthesis egcina ukulimala ukuthi i-prosthesis izinzile futhi ithelelekile ngokushesha. I-prosthesis ethelelanayo icacile, i-bacterial virulence iphansi futhi ama-antibiotic azwelayo ayatholakala, futhi i-liner noma i-spacer ingashintshwa ngesikhathi sokususwa kwe-debride. Amazinga okuphulukisa angu-6% kuphela ngama-antibiotic kuphela kanye no-27% ngama-antibiotic kanye nokususwa kwe-debride kanye nokugcinwa kwe-prosthesis kubikiwe ezincwadini.
Ifanele ukutheleleka kwesigaba sokuqala noma ukutheleleka okubangelwa ukuphuma kwegazi okukhulu ngokufakwa kahle kwe-prosthesis; futhi, kusobala ukuthi ukutheleleka kuyigciwane elincane elinamandla elinolaka ekwelashweni ngama-antimicrobial. Le ndlela ihlanganisa ukuhlanza ngokuphelele, ukuhlanza nokuchitha amanzi ngama-antimicrobial (isikhathi esingamaviki ayi-6), kanye nemithi yokulwa namagciwane efakwa emthanjeni ngemva kokuhlinzwa (isikhathi esingamaviki ayi-6 kuya ezinyangeni eziyi-6). Okubi: izinga eliphezulu lokwehluleka (kufika ku-45%), isikhathi eside sokwelashwa.
3. Ukuhlinzwa kokubuyekezwa kwesigaba esisodwa
Inezinzuzo zokuthi ayilimalanga kakhulu, ihlala isikhathi esifushane esibhedlela, izindleko zezokwelapha eziphansi, izibazi zamanxeba kanye nokuqina kwamalunga, okusiza ekuvuseleleni ukusebenza kwamalunga ngemva kokuhlinzwa. Le ndlela ifaneleka kakhulu ekwelapheni ukutheleleka kwasekuqaleni kanye nokutheleleka okubangelwa ukuphuma kwegazi okukhulu.
Ukufakwa esikhundleni kwesigaba esisodwa, okungukuthi, indlela yesinyathelo esisodwa, kukhawulelwe ekuthelelekeni okunobuthi obuphansi, ukususwa ngokuphelele kwezicubu, i-antibiotic bone cement, kanye nokutholakala kwama-antibiotic abucayi. Ngokusekelwe emiphumeleni yesigaba esiqandisiwe sezicubu ngesikhathi sokuhlinzwa, uma kune-leukocytes engaphansi kwama-5/insimu yokukhulisa ephezulu. Kusikisela ukutheleleka okunobuthi obuphansi. Ngemva kokususwa ngokuphelele kwezicubu, kwenziwa i-arthroplasty yesigaba esisodwa futhi akukho ukuphinda kuvele kokutheleleka ngemva kokuhlinzwa.
Ngemva kokususwa ngokuphelele kwezicubu, i-prosthesis ishintshwa ngokushesha ngaphandle kwesidingo senqubo evulekile. Inezinzuzo zokulimala okuncane, isikhathi esifushane sokwelashwa kanye nezindleko eziphansi, kodwa izinga lokuphindaphinda kokutheleleka ngemva kokuhlinzwa liphakeme, okungaba ngu-23% ~ 73% ngokusho kwezibalo. Ukufakwa kwezicubu ze-prosthesis zesigaba esisodwa kufaneleka kakhulu ezigulini ezikhulile, ngaphandle kokuhlanganisa noma yikuphi okulandelayo: (1) umlando wokuhlinzwa okuningi endaweni yokufakwa kwezicubu; (2) ukwakheka kwe-sinus tract; (3) ukutheleleka okukhulu (isb. i-septic), ischemia kanye nezibazi zezicubu ezizungezile; (4) ukususwa okuphelele kwezicubu ze-trauma okusele ngesamente engaphelele; (5) i-X-ray ebonisa i-osteomyelitis; (6) amaphutha ethambo adinga ukufakelwa kwamathambo; (7) ukutheleleka okuxubile noma amabhaktheriya anamandla kakhulu (isb. i-Streptococcus D, amabhaktheriya angenayo i-Gram); (8) ukulahleka kwamathambo okudinga ukufakelwa kwamathambo; (9) ukulahleka kwamathambo okudinga ukufakelwa kwamathambo; kanye (10) ukufakelwa kwamathambo okudinga ukufakelwa kwamathambo. I-Streptococcus D, amabhaktheriya angenayo i-Gram, ikakhulukazi i-Pseudomonas, njll.), noma ukutheleleka ngesikhunta, ukutheleleka kwe-mycobacterial; (8) Ukukhuliswa kwamabhaktheriya akucaci.
4. Ukuhlinzwa kokubuyekezwa kwesigaba sesibili
Ithandwa kakhulu odokotela abahlinzayo eminyakeni engama-20 edlule ngenxa yezinkomba zayo eziningi (ubuningi bamathambo obanele, izicubu ezithambile ezicebile ze-periarticular) kanye nesilinganiso esiphezulu sokuqeda ukutheleleka.
Ama-spacer, abathwali bama-antibiotic, ama-antibiotic
Kungakhathaliseki ukuthi kusetshenziswa yiphi indlela yokuhlukanisa, ukuqinisa okuqinile ngama-antibiotic kuyadingeka ukuze kwandiswe ukugcwala kwama-antibiotic emalungeni futhi kwandiswe izinga lokwelapha ukutheleleka. Ama-antibiotic asetshenziswa kakhulu yi-tobramycin, i-gentamicin kanye ne-vancomycin.
Umphakathi wamazwe ngamazwe wamathambo uqaphele ukwelashwa okuphumelelayo kakhulu kokutheleleka okujulile ngemva kwe-arthroplasty. Le ndlela ihlanganisa ukususwa okuphelele kwe-prosthesis kanye nomzimba wangaphandle, ukubekwa kwe-spacer yamalunga, ukuqhubeka nokusebenzisa imithi yokulwa namagciwane ethinta imithambo okungenani amasonto ayisithupha, futhi ekugcineni, ngemva kokulawulwa ngempumelelo kokutheleleka, ukufakelwa kabusha kwe-prosthesis.
Izinzuzo:
Isikhathi esanele sokuhlonza uhlobo lwebhaktheriya kanye nama-antimicrobial agents azwelayo, angasetshenziswa ngempumelelo ngaphambi kokuhlinzwa kokulungisa.
Ukuhlanganiswa kwezinye izifo ezithathelwanayo kungalashwa ngesikhathi esifanele.
Kunezindlela ezimbili zokususa ngokuphelele izicubu ezifile kanye nemizimba yangaphandle, okunciphisa kakhulu izinga lokuphindeka kwezifo ngemva kokuhlinzwa.
Okubi:
Ukuhlinzwa kabusha kanye nokuhlinzwa kwandisa ingozi.
Isikhathi sokwelashwa eside kanye nezindleko zezokwelapha eziphakeme.
Ukululama kokusebenza ngemva kokuhlinzwa akubi futhi kuhamba kancane.
I-Arthroplasty: Ifanelekela izifo ezingapheli ezingaphenduli ekwelashweni, noma izinkinga ezinkulu zamathambo; isimo sesiguli sinciphisa ukuhlinzwa kabusha kanye nokwehluleka kokwakha kabusha. Ubuhlungu obusele ngemva kokuhlinzwa, isidingo sokusetshenziswa kwesikhathi eside kwezinsimbi zokusiza ukuhamba, ukuqina kwamalunga okungekuhle, ukufinyezwa kwezitho, umthelela wokusebenza, ububanzi bokusetshenziswa bulinganiselwe.
I-Arthroplasty: ukwelashwa kwendabuko kwezifo zangemuva kokuhlinzwa, okunokuqina okuhle kwangemuva kokuhlinzwa kanye nokuqeda ubuhlungu. Okubi kufaka phakathi ukufinyezwa kwesitho, ukuphazamiseka kokuhamba kanye nokulahlekelwa ukuhamba kwamalunga.
Ukunqunywa kwezicubu: Kuyindlela yokugcina yokwelapha ukutheleleka okujulile ngemva kokuhlinzwa. Kufanelekela: (1) ukulahlekelwa amathambo okukhulu okungenakulungiswa, ukukhubazeka kwezicubu ezithambile; (2) ukuba khona kwamagciwane aqinile, ukutheleleka okuxubile, ukwelashwa ngama-antimicrobial akusebenzi, okuholela ebuthi emzimbeni, okusongela impilo; (3) kunomlando wokwehluleka kaningi kokuhlinzwa kokulungisa kabusha kweziguli ezinegciwane elingamahlalakhona.
VI. Ukuvimbela
1. Izinto ezibangela ukuhlinzwa:
Lungisa isimo sesiguli ngaphambi kokuhlinzwa futhi zonke izifo ezikhona kufanele zelashwe ngaphambi kokuhlinzwa. Izifo ezivame kakhulu ezithwalwa igazi yilezo ezivela esikhumbeni, emgudwini womchamo, kanye nasemzimbeni wokuphefumula. Ku-arthroplasty ye-hip noma yedolo, isikhumba semilenze engezansi kufanele sihlale singaphukile. I-bacteriuria engenazimpawu, evame ezigulini esezikhulile, ayidingi ukwelashwa ngaphambi kokuhlinzwa; uma kuvela izimpawu kumele zelashwe ngokushesha. Iziguli ezine-tonsillitis, izifo zomgudu wokuphefumula ophezulu, kanye ne-tinea pedis kufanele zisuswe i-foci yendawo yokutheleleka. Ukuhlinzwa kwamazinyo amakhulu kungumthombo ongase ube khona wokutheleleka kwegazi, futhi nakuba kugwenywe, uma ukuhlinzwa kwamazinyo kudingeka, kunconywa ukuthi izinqubo ezinjalo zenziwe ngaphambi kwe-arthroplasty. Iziguli ezinezimo ezivamile ezimbi njenge-anemia, i-hypoproteinaemia, isifo sikashukela esihlanganisiwe kanye nokutheleleka kwemigudu yomchamo okungapheli kufanele zelashwe ngobudlova futhi kusenesikhathi ukuze isifo esiyinhloko sithuthukise isimo somzimba.
2. Ukuphathwa Kwangaphakathi Kokuhlinzwa:
(1) Amasu namathuluzi angenamagciwane ngokuphelele kufanele asetshenziswe endleleni yokwelapha evamile ye-arthroplasty.
(2) Ukulaliswa esibhedlela ngaphambi kokuhlinzwa kufanele kuncishiswe ukuze kuncishiswe ingozi yokuthi isikhumba sesiguli singase sihlangane nezinhlobo zamagciwane ezitholwe esibhedlela, futhi ukwelashwa okuvamile kufanele kwenziwe ngosuku lokuhlinzwa.
(3) Indawo yangaphambi kokuhlinzwa kufanele ilungiselelwe kahle ukulungiselela isikhumba.
(4) Izingubo zokuhlinzwa, imaski, izigqoko, kanye nezindawo zokuhlinza ezigeleza amanzi abandayo ziyasebenza ekunciphiseni amagciwane aphuma emoyeni endaweni yokuhlinza. Ukugqoka amagilavu amabili kunganciphisa ingozi yokuxhumana ngesandla phakathi kodokotela ohlinzayo nesiguli futhi kunganconywa.
(5) Kuye kwafakazelwa ngokwezokwelapha ukuthi ukusetshenziswa kwe-prosthesis evimbela kakhulu, ikakhulukazi enezihibe, kunengozi enkulu yokutheleleka kune-arthroplasty yamadolo ephelele engavinjelwe ngenxa yemfucumfucu yensimbi ekhuhlayo enciphisa umsebenzi we-phagocytosis, ngakho-ke kufanele kugwenywe ekukhetheni i-prosthesis.
(6) Thuthukisa indlela yokuhlinzwa yomqhubi futhi unciphise isikhathi sokuhlinzwa (ngaphansi kwamahora angu-2.5 uma kungenzeka). Ukuncishiswa kwesikhathi sokuhlinzwa kunganciphisa isikhathi sokuchayeka emoyeni, okungenza ukuthi kuncishiswe isikhathi sokusetshenziswa kwe-tourniquet. Gwema ukuhlinzwa okunzima ngesikhathi sokuhlinzwa, inxeba linganiselwa ngokuphindaphindiwe (isibhamu sokunisela esivuvukile singcono kakhulu), futhi ukucwiliswa nge-iodine-vapor kungathathwa ukuze kutholakale izimbobo okusolwa ukuthi zingcolisiwe.
3. Izici zangemva kokuhlinzwa:
(1) Ukushaywa ngokuhlinzwa kubangela ukumelana ne-insulin, okungaholela ekukhuphukeni kwe-glucose egazini, into engaphikelela amasonto amaningana ngemva kokuhlinzwa futhi ibeke isiguli esimeni sezinkinga ezihlobene namanxeba, futhi, ngaphezu kwalokho, ezenzeka ezigulini ezingenaso isifo sikashukela. Ngakho-ke, ukuqapha ushukela wegazi ngemva kokuhlinzwa kubaluleke ngokulinganayo.
(2) I-deep vein thrombosis yandisa ingozi ye-hematoma kanye nezinkinga ezihlobene namanxeba ezilandelanayo. Ucwaningo lokulawula amacala luthole ukuthi ukusetshenziswa kwe-heparin yama-molecule aphansi ngemva kokuhlinzwa ukuvimbela i-deep vein thrombosis kwakuzuzisa ekunciphiseni amathuba okutheleleka.
(3) Ukuphuma kwamanzi okuvaliwe kuyindlela yokungena kokutheleleka, kodwa ubudlelwano bayo namazinga okutheleleka kwamanxeba abuzange bufundwe ngokuqondile. Imiphumela yokuqala iphakamisa ukuthi ama-catheter angaphakathi kwe-articular asetshenziswa njengokuphathwa kwemithi yokunciphisa ubuhlungu ngemva kokuhlinzwa nawo angase abe sengozini yokutheleleka kwamanxeba.
4. Ukuvimbela ama-antibiotic:
Njengamanje, ukusetshenziswa njalo kwemithi yokuvimbela ama-antibiotic anikezwa ngendlela ehlelekile ngaphambi nangemva kokuhlinzwa kunciphisa ingozi yokutheleleka ngemva kokuhlinzwa. Ama-Cephalosporins asetshenziswa kakhulu emtholampilo njengemithi yokwelapha ekhethwayo, futhi kukhona ubudlelwano obufana no-U phakathi kwesikhathi sokusetshenziswa kwama-antibiotic kanye nesilinganiso sokutheleleka endaweni yokuhlinzwa, kanye nengozi ephezulu yokutheleleka kokubili ngaphambi nangemva kwesikhathi esifanele sokusetshenziswa kwama-antibiotic. Ucwaningo olukhulu lwamuva nje luthole ukuthi ama-antibiotic asetshenziswa kungakapheli imizuzu engama-30 kuya kwengama-60 ngaphambi kokusika ayenezinga eliphansi kakhulu lokutheleleka. Ngokuphambene nalokho, olunye ucwaningo olukhulu lwe-total hip arthroplasty lubonise izinga eliphansi kakhulu lokutheleleka ngama-antibiotic anikezwa kungakapheli imizuzu engama-30 yokuqala yokusika. Ngakho-ke isikhathi sokuphathwa ngokuvamile sibhekwa njengemizuzu engama-30 ngaphambi kokuhlinzwa, nemiphumela emihle kakhulu ngesikhathi sokuqaliswa kwe-anesthesia. Omunye umthamo wokuvimbela wama-antibiotic unikezwa ngemuva kokuhlinzwa. EYurophu nase-United States, ama-antibiotic avame ukusetshenziswa kuze kube usuku lwesithathu ngemuva kokuhlinzwa, kodwa eShayina, kubikwa ukuthi avame ukusetshenziswa njalo isonto eli-1 kuya kwengama-2. Kodwa-ke, ukuvumelana okuvamile ukuthi ukusetshenziswa kwesikhathi eside kwama-antibiotic anamandla e-broad-spectrum kufanele kugwenywe ngaphandle kokuthi kunezimo ezikhethekile, futhi uma ukusetshenziswa isikhathi eside kwama-antibiotic kuyadingeka, kuyalulekwa ukusebenzisa imithi yokubola kanye nama-antibiotic ukuvimbela ukutheleleka kwesikhunta. I-Vancomycin iboniswe ukuthi iyasebenza ezigulini ezisengozini enkulu ezine-methicillin-resistant Staphylococcus aureus. Imithamo ephezulu yama-antibiotic kufanele isetshenziswe ekuhlinzeni isikhathi eside, okuhlanganisa nokuhlinzwa okubili, ikakhulukazi lapho ingxenye yempilo yama-antibiotic imfushane.
5. Ukusetshenziswa kwama-antibiotics kanye ne-bone samente:
Isimende esifakwe ama-antibiotic saqala ukusetshenziswa e-arthroplasty eNorway, lapho ekuqaleni ucwaningo lwe-Norwegian Arthroplasty Registry lwabonisa ukuthi ukusetshenziswa kwenhlanganisela ye-antibiotic IV kanye ne-cement (i-combined antibiotic prosthesis) infusion kunciphisa izinga lokutheleleka okujulile ngempumelelo kakhulu kunanoma iyiphi indlela yodwa. Lokhu okutholakele kwaqinisekiswa ochungechungeni lwezifundo ezinkulu eminyakeni eyi-16 eyalandela. Ucwaningo lwaseFinland kanye ne-Australian Orthopaedic Association 2009 bafinyelele eziphethweni ezifanayo mayelana nendima yesimende esifakwe ama-antibiotic e-arthroplasty yamadolo okokuqala kanye nokubuyekezwa. Kuye kwaboniswa nokuthi izakhiwo ze-biomechanical ze-bone cement azithinteki lapho kufakwa i-antibiotic powder kumithamo engadluli ku-2 g nge-40 g yesimende samathambo. Kodwa-ke, akuwona wonke ama-antibiotic angangezwa esimendeni samathambo. Ama-antibiotic angangezwa esimendeni samathambo kufanele abe nalezi zimo ezilandelayo: ukuphepha, ukuzinza kokushisa, ukungazweli komzimba, ukuncibilika okuhle kwamanzi, ububanzi be-antimicrobial spectrum, kanye nezinto eziphuphu. Njengamanje, i-vancomycin ne-gentamicin zivame ukusetshenziswa kakhulu emtholampilo. Kwakucatshangwa ukuthi ukufaka ama-antibiotic kusimende kuzokwandisa ingozi yokusabela kokungezwani komzimba, ukuvela kwezinhlobo ezimelana namagciwane, kanye nokuxegiswa kwe-prosthesis okungekuhle, kodwa kuze kube manje abukho ubufakazi obusekela lokhu kukhathazeka.
VII. Isifinyezo
Ukwenza ukuxilongwa okusheshayo nokunembile ngomlando, ukuhlolwa ngokomzimba kanye nokuhlolwa okuhambisanayo kuyimfuneko yokwelashwa okuphumelelayo kwezifo zamalunga. Ukuqeda ukutheleleka kanye nokubuyiselwa kwelungu lokwenziwa elingenabuhlungu, elisebenza kahle kuyisimiso esiyisisekelo ekwelapheni izifo zamalunga. Nakuba ukwelashwa ngama-antibiotic ukutheleleka kwamalunga kulula futhi kungabizi, ukuqeda ukutheleleka kwamalunga kudinga kakhulu inhlanganisela yezindlela zokuhlinzwa. Isihluthulelo sokukhetha ukwelashwa kokuhlinzwa ukucabangela inkinga yokususwa kwe-prosthesis, okuyisici esiyinhloko sokubhekana nokutheleleka kwamalunga. Njengamanje, ukusetshenziswa okuhlangene kwama-antibiotic, ukususwa kwezicubu kanye ne-arthroplasty sekuyindlela yokwelapha ephelele yezifo eziningi zamalunga eziyinkimbinkimbi. Kodwa-ke, kusadingeka kuthuthukiswe futhi kuqedwe.
Isikhathi sokuthunyelwe: Meyi-06-2024
