Ukutheleleka kungenye yezinkinga ezimbi kakhulu ngemva kokushintshwa kwamalungu okwenziwa, okungagcini nje ngokuletha amagalelo amaningi okuhlinzwa ezigulini, kodwa futhi kudla izinsiza ezinkulu zezokwelapha. Eminyakeni eyi-10 edlule, izinga lokutheleleka ngemva kokushintshwa kwamalunga okwenziwa liye lehla kakhulu, kodwa izinga lamanje lokukhula kweziguli ezishintshwa amalunga okwenziwa lidlule kude izinga lokuncipha kwezinga lokutheleleka, ngakho inkinga yokutheleleka kwangemva kokuhlinzwa akufanele ishaywe indiva.
I. Izimbangela zokugula
Izifo zokushintshwa kwamalunga ngemuva kokwenziwa kufanele kubhekwe njengezifo ezitholwa esibhedlela ezinezifo ezingazweli emuthini. Okuvame kakhulu i-staphylococcus, ibalwa ku-70% kuya ku-80%, i-bacilli e-gram-negative, i-anaerobes kanye ne-non-A group streptococci nazo zivamile.
II Pathogenesis
Amagciwane ahlukaniswe izigaba ezimbili: eyodwa ingeyokutheleleka kusenesikhathi kanti enye ingeyokutheleleka sekwephuzile noma okubizwa ngokuthi ukutheleleka kwangemva kwesikhathi. Ukutheleleka kwasekuqaleni kubangelwa ukungena ngokuqondile kwamagciwane ejoyintini ngesikhathi sokuhlinzwa futhi ngokuvamile yi-Staphylococcus epidermidis. Izifo ezifika sekwephuzile zibangelwa ukusulelana ngegazi futhi ngokuvamile kuvame ukuba yi-Staphylococcus aureus. Amalunga ahlinziwe maningi amathuba okuthi angenwe yilesi sifo. Isibonelo, kukhona izinga lokutheleleka elingu-10% ezimeni zokubuyekezwa ngemva kokushintshwa kwamalunga okwenziwa, futhi izinga lokutheleleka liphakeme kubantu abaye bashintshaniswa ngokuhlanganyela kwe-arthritis ye-rheumatoid.
Izifo eziningi zenzeka phakathi nezinyanga ezimbalwa ngemva kokuhlinzwa, ezakuqala zingavela emasontweni amabili okuqala ngemva kokuhlinzwa, kodwa futhi ngemva kweminyaka embalwa ngaphambi kokuba kuvele ukubonakaliswa kokuqala okuyinhloko kokuvuvukala okukhulu kwamalunga, ubuhlungu kanye nomkhuhlane. , izimpawu zomkhuhlane kumele zihlukaniswe kwezinye izinkinga, njengenyumoniya yangemva kokuhlinzwa, izifo zomgudu womchamo nokunye.
Endabeni yokutheleleka kwasekuqaleni, izinga lokushisa lomzimba aligcini nje ngokululama, kodwa likhuphuka ezinsukwini ezintathu emva kokuhlinzwa. Ubuhlungu obuhlangene abunciphisi kancane kancane, kodwa bukhula kancane kancane, futhi kukhona ubuhlungu obuhlabayo ekuphumuleni. Kukhona ukugeleza okungavamile noma ukukhishwa okuvela ekusikeni. Lokhu kufanele kuhlolwe ngokucophelela, futhi imfiva akufanele kuthiwe ibangelwa izifo zangemva kokuhlinzwa kwezinye izingxenye zomzimba njengamaphaphu noma umgudu womchamo. Kubalulekile futhi ukuthi ungamane uchithe ukugeleza kwe-incision njengokuphuma okujwayelekile okujwayelekile njengokuncibilika kwamafutha. Kubalulekile futhi ukukhomba ukuthi ukutheleleka kutholakala ezicutshini ezingaphandle noma ekujuleni eduze kwe-prosthesis.
Ezigulini ezinokutheleleka okuthuthukile, iningi lazo eliye laphuma esibhedlela, ukuvuvukala kwamalunga, ubuhlungu, nomkhuhlane kungase kungabi kubi kakhulu. Ingxenye yeziguli ingase ingabi nawo umkhuhlane. I-Staphylococcus epidermidis ingabangela ukutheleleka okungenabuhlungu ngokukhuphuka kwesibalo samangqamuzana egazi amhlophe ku-10% kuphela yeziguli. I-sedimentation yegazi ephakeme ivame kakhulu kodwa futhi ayicacisi. Ubuhlungu ngezinye izikhathi abubonwa kahle njengokuxega kokufakelwa, ubuhlungu obuhlobene nokunyakaza okufanele buqedwe ukuphumula, kanye nobuhlungu obuvuvukalayo obungaqediwe ukuphumula. Kodwa-ke, kuye kwaphakanyiswa ukuthi imbangela eyinhloko yokuxegiswa kwe-prosthesis ukubambezeleka kokutheleleka okungamahlalakhona.
III. Ukuxilongwa
1. Ukuhlolwa kwegazi:
Ikakhulukazi i-white blood cell count plus classification, interleukin 6 (IL-6), C-reactive protein (CRP) kanye ne-erythrocyte sedimentation rate (ESR). Izinzuzo zokuhlolwa kwe-hematological zilula futhi kulula ukuzifeza, futhi imiphumela ingatholakala ngokushesha; I-ESR ne-CRP inokucaciswa okuphansi; I-IL-6 inenani elikhulu ekunqumeni ukutheleleka kwe-periprosthetic esikhathini sokuqala sokuhlinzwa.
2. Ukuhlolwa kwesithombe:
Ifilimu ye-X-ray: ayizweli futhi ayicacisi ekuhlonzweni kokutheleleka.
Ifilimu ye-X-ray yokutheleleka kwedolo esikhundleni
I-Arthrography: ukusebenza kommeleli oyinhloko ekuxilongweni kokutheleleka ukuphuma kwe-synovial fluid kanye nethumba.
I-CT: ukubonakala kwe-joint effusion, amapheshana e-sinus, amathumba ezicubu ezithambile, ukuguguleka kwamathambo, i-periprosthetic bone resorption.
I-MRI: izwela kakhulu ukuze kutholwe ngokushesha uketshezi oluhlangene namathumba, okungasetshenzisiwe kakhulu ekuxilongeni izifo ze-periprosthetic.
I-Ultrasound: ukuqoqwa koketshezi.
3.Imithi yenuzi
I-Technetium-99 bone scan inokuzwela okungama-33% kanye nokucaciswa okungu-86% kokuxilongwa kwezifo ze-periprosthetic ngemva kwe-arthroplasty, futhi i-indium-111 ebhalwe ukuthi i-leukocyte scan ibaluleke kakhulu ekuxilongweni kwezifo ze-periprosthetic, nokuzwela okungama-77% futhi ukucaciswa okungu-86%. Uma izikena ezimbili zisetshenziswa ndawonye ukuze kuhlolwe izifo ze-periprosthetic ngemva kwe-arthroplasty, ukuzwela okuphezulu, ukucacisa nokunemba kungafinyelelwa. Lokhu kuhlola kuseyindinganiso yegolide emithini yenuzi ekuxilongeni izifo ze-periprosthetic. I-Fluorodeoxyglucose-positron emission tomography (FDG-PET). Ithola amangqamuzana avuvukalayo ngokukhuphuka kwe-glucose endaweni ethelelekile.
4. Amasu ebhayoloji yamangqamuzana
I-PCR: ukuzwela okuphezulu, amanga angamanga
Ubuchwepheshe be-Gene chip: isigaba socwaningo.
5. I-Arthrocentesis:
Ukuhlolwa kwe-Cytological of joint fluid, isiko lebhaktheriya kanye nokuhlolwa kokuzwela kwezidakamizwa.
Le ndlela ilula, iyashesha futhi inembile
Ezifweni ze-hip, inani elihlangene le-leukocyte le-fluid> 3,000/ml lihlanganiswe ne-ESR ekhuphukile kanye ne-CRP yiyona ndlela engcono kakhulu yokuba khona kwe-periprosthetic infection.
6. I-intraoperative yesigaba esiqandisiwe esisheshayo se-histopathology
Isigaba esiqandisiwe esisheshayo esifakwa ngaphakathi kokuhlinzwa kwezicubu ze-periprosthetic kuyindlela evame ukusetshenziswa kakhulu yokuhlinzwa yokuhlolwa kwe-histopathological. Imibandela yokuxilonga ka-Feldman, okungukuthi, ama-neutrophil amakhulu noma alingana nama-neutrophils angu-5 ngokukhuliswa okuphezulu ngakunye (400x) okungenani ezinkambu ezincane ezihlukene ezi-5, ngokuvamile asetshenziswa ezigabeni eziqandisiwe. Kuye kwaboniswa ukuthi ukuzwela nokucaciswa kwale ndlela kuzodlula ama-80% no-90%, ngokulandelana. Le ndlela okwamanje iyindinganiso yegolide yokuxilongwa kwe-intraoperative.
7. Isiko lebhaktheriya lezicubu ze-pathological
Isiko lebhaktheriya lezicubu ze-periprosthetic linokucaciswa okuphezulu kokuhlonza ukutheleleka futhi lithathwe njengezinga eligolide lokuxilonga izifo ze-periprosthetic, futhi lingasetshenziselwa ukuhlola ukuzwela kwezidakamizwa.
IV. Ukuxilongwa okuhlukiles
Izifo ezihlangene zokufakelwa ezingenabuhlungu ezibangelwa i-Staphylococcus epidermidis kunzima kakhulu ukuhlukanisa nokuxegiswa kwe-prosthetic. Kumele kuqinisekiswe ngama-X-ray nokunye ukuhlola.
V. Ukwelashwa
1. Ukwelashwa okulula kwama-antibiotic
I-Tsakaysma kanye ne-se,gawa ihlukanisa izifo ze-post arthroplasty zibe izinhlobo ezine, uhlobo lwe-I olungenayo izimpawu, isiguli sisesikweni lokuhlinzwa lokubukeza kuphela elitholakala likhula amagciwane, futhi okungenani izibonelo ezimbili ezikhuliswe ngamagciwane afanayo; uhlobo II ukutheleleka kwangaphambi kwesikhathi, okwenzeka phakathi nenyanga eyodwa yokuhlinzwa; uhlobo IIl ukutheleleka okungapheli okubambezelekile; futhi uhlobo IV ukutheleleka nge-haematogenous acute. Isimiso sokwelashwa kwama-antibiotic sibucayi, inani elanele nesikhathi. Futhi ukubhoboza imbobo yamalunga ngaphambi kokuhlinzwa kanye nesiko lezicubu ze-intraoperative kubaluleke kakhulu ekukhethweni okufanele kwemithi elwa namagciwane. Uma isiko lebhaktheriya livuma ukutheleleka kohlobo I, ukusetshenziswa okulula kwama-antibiotics abucayi amasonto ayi-6 kungazuza imiphumela emihle.
2. Ukugcinwa kwe-Prosthesis, ukuchithwa kanye nokukhipha amanzi, ukuhlinzwa kwe-tube ngenkasa
Isisekelo sokwamukela isisekelo sokuhlukumezeka kokugcina ukwelashwa kwe-prosthesis ukuthi i-prosthesis izinzile futhi i-acute infection. Isilwane esithelelanayo sicacile, ubungozi bebhaktheriya buphansi futhi ama-antibiotics azwelayo ayatholakala, futhi i-liner noma i-spacer ingashintshwa ngesikhathi sokukhishwa. Amazinga okwelapha angu-6% kuphela ngama-antibiotics kuphela kanye nama-27% anemithi elwa namagciwane kanye nokugcinwa kwe-debridement kanye nokugcinwa kwe-prosthesis kuye kwabikwa ezincwadini.
Ilungele ukutheleleka kwesigaba sokuqala noma ukutheleleka nge-acute haematogenous ngokulungiswa okuhle kokwenziwa; futhi, kusobala ukuthi ukutheleleka kuyisifo esiphansi se-bacterial virus esizwela ekwelashweni kwe-antimicrobial. Le ndlela ihlanganisa ukuchithwa okuphelele, ukuguquguquka kwe-antimicrobial kanye nokukhipha amanzi (ubude besikhathi samaviki angu-6), kanye nama-postoperative systemic intravenous antimicrobials (ubude bamasonto angu-6 kuya ezinyangeni ezingu-6). Ukungalungi: izinga eliphezulu lokuhluleka (kufika ku-45%), isikhathi eside sokwelashwa.
3. Ukuhlinzwa okubukeziwe kwesiteji esisodwa
Inezinzuzo zokuhlukumezeka okuncane, ukuhlala isikhathi esifushane esibhedlela, izindleko zokwelashwa eziphansi, isibazi senxeba esincane nokuqina kwamalunga, okusiza ukululama kokusebenza kwamalunga ngemva kokuhlinzwa. Le ndlela ifaneleka kakhulu ekwelapheni ukutheleleka kusenesikhathi kanye ne-acute hematogenous infection.
Ukushintshwa kwesigaba esisodwa, okungukuthi, indlela yesinyathelo esisodwa, kunqunyelwe ezifweni ezinobuthi obuphansi, ukuchithwa ngokuphelele, usimende wamathambo obulala ama-antibiotic, kanye nokuba khona kwemithi elwa namagciwane ebucayi. Ngokusekelwe emiphumeleni yesigaba esiqandisiwe sezicubu ze-intraoperative, uma kukhona ama-leukocyte angaphansi kwama-5/inkambu yokukhulisa kakhulu. Kusikisela ukutheleleka okunobuthi obuphansi. Ngemuva kokuchithwa okuphelele kwenziwa i-arthroplasty yesiteji esisodwa futhi akuzange kuphinde kwenzeke ukutheleleka ngemva kokuhlinzwa.
Ngemuva kokuchithwa okuphelele, i-prosthesis ishintshwa ngokushesha ngaphandle kwesidingo senqubo evulekile. Inezinzuzo zokuhlukumezeka okuncane, isikhathi sokwelashwa esifushane kanye nezindleko eziphansi, kodwa izinga lokuphindaphinda kokutheleleka kwangemva kokuhlinzwa liphezulu, okungaba ngu-23% ~ 73% ngokusho kwezibalo. Isiteji esisodwa sokufakelwa kwe-prosthesis kufaneleka ikakhulukazi ezigulini esezikhulile, ngaphandle kokuhlanganisa noma yikuphi okulandelayo: (1) umlando wokuhlinzwa okuningi ekuhlanganyeleni esikhundleni; (2) ukwakheka kwepheshana le-sinus; (3) ukutheleleka okukhulu (isb. i-septic), i-ischemia kanye nezibazi zezicubu ezizungezile; (4) ukuchithwa okungaphelele kokuhlukumezeka okusele ingxenye yesimende; (5) I-X-ray ephakamisa i-osteomyelitis; (6) ukukhubazeka kwamathambo okudinga ukuxhunyelelwa; (7) izifo ezixubile noma amagciwane ayingozi kakhulu (isb. i-Streptococcus D, i-Gram-negative bacteria); (8) ukulahleka kwamathambo okudinga ukuxhunyelelwa; (9) ukulahleka kwamathambo okudinga ukuxhunyelelwa; kanye (10) nokuxhunyelelwa kwamathambo okudinga ukuxhunyelelwa amathambo. I-Streptococcus D, amagciwane e-Gram-negative, ikakhulukazi i-Pseudomonas, njll.), noma ukutheleleka kwefungal, ukutheleleka kwe-mycobacterial; (8) Amasiko amagciwane awacacile.
4. Ukuhlinzwa okubukeziwe kwesigaba sesibili
Kuye kwathandwa odokotela abahlinzayo eminyakeni engu-20 edlule ngenxa yohlu olubanzi lwezinkomba (isisindo samathambo esanele, izicubu ezithambile ze-periarticular) kanye nezinga eliphezulu lokuqedwa kokutheleleka.
Ama-Spacers, abathwali be-antibiotic, ama-antibiotics
Kungakhathalekile ukuthi iyiphi indlela ye-spacer esetshenzisiwe, ukulungiswa okufakwe usimende ngama-antibiotic kuyadingeka ukuze kwandiswe ukugcwala kwama-antibiotics ejoyintini futhi kwandise izinga lokwelapha ukutheleleka. Amagciwane asetshenziswa kakhulu yi-tobramycin, i-gentamicin ne-vancomycin.
Umphakathi wamathambo wamazwe ngamazwe ukubonile ukwelashwa okuphumelelayo kakhulu kokutheleleka okujulile ngemva kwe-arthroplasty. Le ndlela ihlanganisa ukuchithwa okuphelele, ukususwa kwe-prosthesis kanye nomzimba wangaphandle, ukubekwa kwe-spacer ehlangene, ukuqhubeka nokusetshenziswa kwama-antimicrobial azwelayo emithanjeni okungenani amasonto angu-6, futhi ekugcineni, ngemva kokulawula ngempumelelo ukutheleleka, ukubuyisela kabusha i-prosthesis.
Izinzuzo:
Isikhathi esanele sokuhlonza izinhlobo zebhaktheriya kanye nama-antimicrobial agents azwelayo, angasetshenziswa ngempumelelo ngaphambi kokuhlinzwa okubukeziwe.
Inhlanganisela yezinye i-systemic foci yokutheleleka ingelashwa ngesikhathi esifanele.
Kunamathuba amabili okukhishwa kwe-debride ukususa izicubu ze-necrotic kanye nemizimba yangaphandle ngokucophelela, okunciphisa kakhulu izinga lokuphindaphinda kwezifo zangemva kokuhlinzwa.
Ububi:
Ukuphinda ubulale izinzwa nokuhlinzwa kwandisa ingozi.
Isikhathi sokwelashwa eside kanye nezindleko zokwelashwa eziphakeme.
Ukubuyisela ukusebenza kwangemva kokuhlinzwa kubi futhi kuhamba kancane.
I-Arthroplasty: Ifanele izifo eziqhubekayo ezingaphenduli ekwelashweni, noma ukukhubazeka okukhulu kwamathambo; isimo sesiguli sikhawulela ukusebenza kabusha kanye nokwehluleka ukwakhiwa kabusha. Ubuhlungu obusele ngemuva kokuhlinzwa, isidingo sokusetshenziswa isikhathi eside kwama-braces ukusiza ukuhamba, ukuzinza okuhlangene okungalungile, ukunciphisa izitho, umthelela wokusebenza, ububanzi besicelo bunqunyelwe.
I-Arthroplasty: ukwelashwa kwendabuko kwezifo zangemva kokuhlinzwa, ngokuzinza okuhle kwangemva kokuhlinzwa kanye nokukhululeka kobuhlungu. Ukungalungi kuhlanganisa ukufinyezwa kwesitho, ukuphazamiseka kokuhamba nokulahlekelwa ukuhamba kwamalunga.
Ukunqunywa: Kuyindlela yokugcina yokwelapha isifo esijulile sangemva kokuhlinzwa. Ifanele: (1) ukulahlekelwa okukhulu kwamathambo okungenakulungiseka, ukukhubazeka kwezicubu ezithambile; (2) i-bacterial virulence eqinile, izifo ezixubile, ukwelashwa kwe-antimicrobial kungasebenzi, okuholela ebuthi besistimu, obusongela ukuphila; (3) inomlando wokuhluleka okuningi kokuhlinzwa okubukeziwe kweziguli ezinezifo ezingelapheki.
VI. Ukuvimbela
1. Izici zangaphambi kokuhlinzwa:
Lungiselela isimo sesiguli sangaphambi kokuhlinzwa futhi zonke izifo ezikhona kufanele zelashwe ngaphambi kokuhlinzwa. Izifo ezitholakala kakhulu egazini yilezo eziphuma esikhunjeni, emgudwini womchamo, nasemgudwini wokuphefumula. Ku-hip noma i-knee arthroplasty, isikhumba semikhawulo ephansi kufanele sihlale singapheli. I-Asymptomatic bacteriuria, evamile ezigulini esezikhulile, ayidingi ukwelashwa ngaphambi kokuhlinzwa; uma kuvela izimpawu kufanele belashwe ngokushesha. Iziguli ezine-tonsillitis, izifo zepheshana eliphezulu lokuphefumula, kanye ne-tinea pedis kufanele kususwe i-foci yendawo yokutheleleka. Ukuhlinzwa kwamazinyo okukhudlwana kuwumthombo ongase ube nokutheleleka kwegazi, futhi nakuba kugwenywe, uma ukuhlinzwa kwamazinyo kudingekile, kunconywa ukuthi izinqubo ezinjalo zenziwe ngaphambi kwe-arthroplasty. Iziguli ezinezimo ezingezinhle ezivamile ezifana ne-anemia, i-hypoproteinaemia, isifo sikashukela esihlangene kanye nezifo ezingelapheki zomgudu womchamo kufanele zelashwe ngonya futhi kusenesikhathi ukuze isifo esiyinhloko sithuthukise isimo sesistimu.
2. Ukuphathwa kwe-intraoperative:
(1) Amasu namathuluzi aphelele ngokuphelele kufanele asetshenziswe endleleni yokwelapha evamile ye-arthroplasty.
(2) Ukulaliswa esibhedlela ngaphambi kokuhlinzwa kufanele kuncishiswe ukuze kuncishiswe ingozi yokuthi isikhumba sesiguli singase sigcwale amagciwane atholakala esibhedlela, futhi ukwelashwa okuvamile kufanele kwenziwe ngosuku lokuhlinzwa.
(3) Indawo yangaphambi kokuhlinzwa kufanele ilungiselelwe kahle ukulungiswa kwesikhumba.
(4) Izingubo zokuhlinza, izifihla-buso, izigqoko, nezindawo zemidlalo yaseshashalazini ezisebenza nge-laminar ziyasebenza ekwehliseni amagciwane ahamba emoyeni endaweni yokuhlinza. Ukugqoka amagilavu amabili kunganciphisa ubungozi bokuxhumana kwezandla phakathi kukadokotela ohlinzayo nesiguli futhi kunganconywa.
(5) Kuye kwafakazelwa ngokomtholampilo ukuthi ukusetshenziswa kwe-prosthesis evimbela kakhulu, ikakhulukazi e-hinged, kunengozi enkulu yokutheleleka kune-arthroplasty ephelele yamadolo engavimbeli ngenxa yemfucumfucu yensimbi elimazayo enciphisa umsebenzi we-phagocytosis, ngakho-ke kufanele igwenywe ekukhethweni kwe-prosthesis. .
(6) Thuthukisa indlela yokuhlinza yomqhubi futhi unciphise ubude besikhathi sokuhlinza (<2.5 h uma kungenzeka). Ukufinyezwa kwesikhathi sokuhlinzwa kunganciphisa isikhathi sokuchayeka emoyeni, okungase kunciphise isikhathi sokusetshenziswa kwe-tourniquet. Gwema ukuhlinzwa okubuhlungu ngesikhathi sokuhlinzwa, isilonda singaniselwa ngokuphindaphindiwe (isibhamu sokuchelela esiphundu singcono kakhulu), futhi ukucwiliswa komhwamuko we-iodine kungathathwa ukuze kunqunywe imicu okusolakala ukuthi ingcolile.
3. Izinto zangemva kokuhlinzwa:
(1) Amagalelo okuhlinzwa adala ukumelana ne-insulin, okungase kuholele ku-hyperglycemia, isenzakalo esingase siqhubeke amasonto ambalwa ngemva kokuhlinzwa futhi senze isiguli sibe nezinkinga ezihlobene namanxeba, futhi, ngaphezu kwalokho, okwenzeka nasezigulini ezingezona ezinesifo sikashukela. Ngakho-ke, ukuqapha kweglucose yegazi kwangemva kokuhlinzwa kubaluleke ngokufanayo.
(2) I-Deep vein thrombosis yandisa ingozi ye-hematoma kanye nezinkinga ezihlobene nesilonda. Ucwaningo lokulawulwa kwecala lwathola ukuthi ukusetshenziswa kwangemva kokuhlinzwa kwe-heparin yamangqamuzana aphansi ukuze kuvinjelwe i-thrombosis yemithambo ejulile kwakunenzuzo ekwehliseni amathuba okutheleleka.
(3) I-drainage evaliwe iyindawo yokungena ekuthelelekeni, kodwa ubudlelwano bayo nezinga lokutheleleka kwezilonda abukahlolisiswanga ngokuqondile. Imiphumela yokuqala iphakamisa ukuthi ama-catheter angaphakathi kwe-intra-articular asetshenziswa njengokuphathwa kwangemva kokuhlinzwa kwama-analgesics angase abe sengozini yokutheleleka kwenxeba.
4. I-antibiotic prophylaxis:
Njengamanje, ukusetshenziswa okujwayelekile komtholampilo kwemithamo ye-prophylactic yemithi elwa namagciwane elawulwa ngokohlelo ngaphambi nangemva kokuhlinzwa kunciphisa ingozi yokutheleleka kwangemva kokuhlinzwa. I-Cephalosporins isetshenziswa kakhulu emtholampilo njenge-antibiotic ekhethwayo, futhi kunobudlelwano bejika obumise oku-U phakathi kwesikhathi sokusetshenziswa kwemithi elwa namagciwane kanye nezinga lokutheleleka endaweni okuhlinzelwa kuyo, nengozi enkulu yokutheleleka ngaphambi nangemva kwesikhathi esifanele somuthi obulalayo. sebenzisa. Ucwaningo olukhulu lwakamuva luthole ukuthi ama-antibiotic asetshenziswe phakathi kwemizuzu engama-30 kuya kwengama-60 ngaphambi kokusikwa anezinga eliphansi lokutheleleka. Ngokuphambene, olunye ucwaningo olukhulu lwe-hip arthroplasty ephelele lubonise izinga eliphansi kakhulu lokutheleleka ngama-antibiotic alawulwa phakathi kwemizuzu yokuqala engama-30 yokusika. Ngakho-ke isikhathi sokuphatha ngokuvamile sibhekwa njengemizuzu engama-30 ngaphambi kokuhlinzwa, nemiphumela engcono kakhulu ngesikhathi sokufakwa kwe-anesthesia. Omunye umthamo we-prophylactic wama-antibiotic unikezwa ngemva kokuhlinzwa. EYurophu nase-United States, ama-antibiotics avame ukusetshenziswa kuze kube usuku lwesithathu lwangemva kokuhlinzwa, kodwa e-China, kubikwa ukuthi ngokuvamile asetshenziswa ngokuqhubekayo evikini elingu-1 kuya kwangu-2. Kodwa-ke, ukuvumelana okujwayelekile ukuthi ukusetshenziswa kwesikhathi eside kwemithi elwa namagciwane enamandla amakhulu kufanele kugwenywe ngaphandle uma kunezimo ezikhethekile, futhi uma ukusetshenziswa isikhathi eside kwemithi elwa namagciwane kudingekile, kuhle ukusebenzisa izidakamizwa ezilwa nesikhunta kanye nemithi elwa namagciwane ukuvimbela izifo zefungal. . I-Vancomycin ikhonjiswe ukuthi iyasebenza ezigulini ezisengozini enkulu ezithwala i-Staphylococcus aureus emelana ne-methicillin. Imithamo ephezulu yemithi elwa namagciwane kufanele isetshenziselwe ukuhlinzwa isikhathi eside, okuhlanganisa nokuhlinzwa kwezinhlangothi zombili, ikakhulukazi uma uhhafu wempilo ye-antibiotic imfushane.
5. Ukusetshenziswa kwama-antibiotics kuhlanganiswe nosimende wamathambo:
Usimende ofakwe ngama-antibiotic waphinde wasetshenziswa okokuqala e-arthroplasty eNorway, lapho ekuqaleni ucwaningo lwe-Norwegian Arthroplasty Registry lwabonisa ukuthi ukusetshenziswa kwenhlanganisela ye-antibiotic IV kanye nosimende (i-combined antibiotic prosthesis) kwehlisa izinga lokutheleleka okujulile ngempumelelo kunanoma iyiphi indlela yodwa. . Lokhu okutholakele kwaqinisekiswa ochungechungeni lwezifundo ezinkulu eminyakeni eyi-16 elandelayo. Ucwaningo lwase-Finnish kanye ne-Australian Orthopedic Association 2009 lufinyelele eziphethweni ezifanayo mayelana nendima kasimende ofakwe ngama-antibiotic ngesikhathi sokuqala kanye nokubukezwa kwe-knee arthroplasty. Kuye kwaboniswa futhi ukuthi izakhiwo ze-biomechanical ze-samente yamathambo azithinteki lapho i-antibiotic powder yengezwa ngemithamo engeqile ku-2 g nge-40 g ye-samente yamathambo. Nokho, akuwona wonke ama-antibiotic anganezelwa kusimende wamathambo. Ama-antibiotics angengezwa kusimende wamathambo kufanele abe nezimo ezilandelayo: ukuphepha, ukuzinza kokushisa, i-hypoallergenicity, i-solubility enhle ye-aqueous, i-spectrum ebanzi ye-antimicrobial, kanye nezinto eziyimpuphu. Njengamanje, i-vancomycin ne-gentamicin zisetshenziswa kakhulu emisebenzini yomtholampilo. Kwakucatshangwa ukuthi ukujova isibulala-magciwane kusimende kungakhuphula ingozi yokungezwani komzimba, ukuvela kwezinhlobo ezingazweli, kanye nokuxegiswa kwe-aseptic ye-prosthesis, kodwa kuze kube manje abukho ubufakazi obusekela lokhu kukhathazeka.
VII. Isifinyezo
Ukwenza ukuxilongwa okusheshayo nokunembile ngomlando, ukuhlolwa ngokomzimba kanye nokuhlolwa okuhambisanayo kuyisidingo sokwelashwa okuphumelelayo kwezifo ezihlangene. Ukuqedwa kokutheleleka nokubuyiselwa kwejoyinti lokwenziwa elingenabuhlungu, elisebenza kahle kuyisimiso esiyisisekelo ekwelapheni izifo ezihlangene. Nakuba ukwelashwa ngama-antibiotic okutheleleka ngokuhlanganyela kulula futhi kungabizi, ukuqedwa kokutheleleka ngokuhlanganyela ngokuvamile kudinga inhlanganisela yezindlela zokuhlinza. Isihluthulelo sokukhetha ukwelashwa kokuhlinzwa ukucabangela inkinga yokukhishwa kwe-prosthesis, okuyisici esiyinhloko sokubhekana nezifo ezihlangene. Njengamanje, ukusetshenziswa okuhlangene kwama-antibiotics, ukukhishwa kwe-debridement kanye ne-arthroplasty sekuye kwaba ukwelashwa okuphelele kwezifo eziningi ezihlangene ezihlangene. Nokho, kusadingeka ukuba kuthuthukiswe futhi kupheleliswe.
Isikhathi sokuthumela: May-06-2024
