Kwandura ni kimwe mu bibazo bikomeye cyane nyuma yo gusimbuza ingingo z’ubukorano, ibyo bikaba bitatera abarwayi gukubitwa inshuro nyinshi gusa, ahubwo binatwara ubuvuzi bwinshi. Mu myaka 10 ishize, igipimo cy’ubwandu nyuma yo gusimbuza ingingo z’ubukorano cyaragabanutse cyane, ariko igipimo cy’ubwiyongere bw’abarwayi basimbuza ingingo z’ubukorano cyarenze cyane igipimo cy’igabanuka ry’ubwandu, bityo ikibazo cy’ubwandu nyuma yo kubagwa ntikigomba kwirengagizwa.
I. Impamvu zitera indwara
Indwara zo gusimbuza ingingo nyuma y’ubukorano zigomba gufatwa nk’indwara ziterwa n’ibitaro zifite udukoko turwanya imiti. Ikunze kugaragara cyane ni staphylococcus, ingana na 70% kugeza kuri 80%, bacilli za gram-negative, anaerobes na streptococci zitari iza groupe A nazo zirakunze kugaragara.
II Pathogenesis
Indwara zigabanyijemo ibice bibiri: kimwe ni ubwandu bw’ibanze n’ikindi ni ubwandu bw’igihe gito cyangwa cyitwa ubwandu bw’igihe gito. Indwara z’igihe gito ziterwa no kwinjira mu ngingo mu buryo butaziguye kwa bagiteri mu gihe cyo kubagwa kandi akenshi ni Staphylococcus epidermidis. Indwara z’igihe gito ziterwa no kwandura amaraso kandi akenshi ni Staphylococcus aureus. Ingorane zakoreweho ziba zishobora kwandura. Urugero, hari igipimo cya 10% cy’ubwandu mu gihe cyo gusubiramo ingingo nyuma yo gusimbuza ingingo z’ubukorano, kandi igipimo cy’ubwandu kiri hejuru no mu bantu bakorewe ingingo zisimbuzwa ingingo z’amagufwa.
Inyinshi mu ndwara ziba mu mezi make nyuma yo kubagwa, ubwa mbere zishobora kugaragara mu byumweru bibiri bya mbere nyuma yo kubagwa, ariko kandi mu myaka mike mbere yuko hagaragara ibimenyetso by’ingenzi byo kubyimba ingingo, ububabare n’umuriro, ibimenyetso by’umuriro bigomba gutandukanywa n’izindi ngorane, nka pneumonia nyuma yo kubagwa, indwara zo mu nzira y’inkari n’ibindi.
Mu gihe umuntu yanduye hakiri kare, ubushyuhe bw'umubiri ntibukira gusa, ahubwo buzamuka nyuma y'iminsi itatu yo kubagwa. Ububabare bw'ingingo ntibugabanuka buhoro buhoro, ahubwo bugenda bwiyongera buhoro buhoro, kandi hari ububabare bukabije mu gihe aruhutse. Hari ibintu bidasanzwe biva mu gucibwa cyangwa gusohora amaraso mu gice cy'inkari. Ibi bigomba gusuzumwa neza, kandi umuriro ntugomba kwitwa ko uterwa n'indwara zandurira mu bindi bice by'umubiri nko mu bihaha cyangwa mu nzira y'inkari. Ni ngombwa kandi kudafata gusa gucibwamo nk'ibintu bisanzwe bikunze kugaragara nko gushonga kw'ibinure. Ni ngombwa kandi kumenya niba ubwandu buri mu ngingo zo hejuru cyangwa mu gice cy'inganda.
Ku barwayi bafite ubwandu bukomeye, abenshi muri bo bavuye mu bitaro, kubyimba ingingo, ububabare, n'umuriro bishobora kuba bidakabije. Kimwe cya kabiri cy'abarwayi bashobora kuba badafite umuriro. Staphylococcus epidermidis ishobora gutera ubwandu budakabije, bigatuma umubare w'uturemangingo tw'amaraso tw'umweru wiyongera kuri 10% gusa by'abarwayi. Kugabanuka kw'amaraso mu maraso bikunze kugaragara ariko nanone ntabwo ari ikintu cyihariye. Hari igihe ububabare bufatwa nk'uburekura bw'inyongera, ubwa nyuma bukaba ububabare bujyanye no kugenda bugomba kugabanuka no kuruhuka, n'ububabare buterwa n'ububyimba budakira no kuruhuka. Ariko, byavuzwe ko impamvu nyamukuru ituma inyongera zigabanuka ari ubwandu budakira.
III. Gusuzuma indwara
1. Isuzuma ry'amaraso:
Ahanini harimo umubare w’uturemangingo tw’amaraso twera hamwe n’ibyiciro, interleukin 6 (IL-6), poroteyine ya C-reactive (CRP) n’igipimo cy’amaraso ya erythrocyte sedimentation (ESR). Ibyiza byo gusuzuma amaraso biroroshye kandi byoroshye kubigeraho, kandi ibisubizo bishobora kuboneka vuba; ESR na CRP bifite umwihariko muto; IL-6 ifite akamaro kanini mu kumenya ubwandu bwa periprosthetic mu ntangiriro z’igihe cyo kubagwa.
2. Isuzuma ry'amashusho:
Filimi ya X-ray: ntabwo igaragara cyangwa ngo imenyekane neza indwara.
Agapira ka X-ray kerekana indwara yandurira mu ivi
Arthrography: imikorere y'ingenzi mu gusuzuma ubwandu ni ugusohoka kw'amazi ya synovial n'igisebe.
CT: kureba uko ingingo zisohoka, inzira z'utuzuru, ibibyimba by'uturemangingo tworoshye, kwangirika kw'amagufwa, kongera gutonyanga amagufwa mu buryo bwa periprosthetic.
MRI: ifasha cyane mu gupima hakiri kare amazi n'ibibyimba mu ngingo, ntabwo ikoreshwa cyane mu gusuzuma indwara zandurira mu ngingo.
Ultrasound: gukusanya amazi.
3. Ubuvuzi bwa kirimbuzi
Isuzuma ry'amagufwa rya Technetium-99 rifite ubushobozi bwo kumenya indwara zandura zifata uburozi nyuma yo gupimwa, naho isuzuma rya leukocyte rya indium-111 rifite agaciro kanini mu gusuzuma indwara zandura zifata uburozi, rifite ubushobozi bwo kumenya indwara zandura zifata uburozi nyuma yo gupimwa, rishobora kugerwaho neza cyane. Iki kizamini kiracyari cyo gipimo cya zahabu mu buvuzi bwa nucleotique mu gusuzuma indwara zandura zifata uburozi. Isuzuma rya fluorodeoxyglucose-positron emission tomography (FDG-PET). Rigaragaza uturemangingo tw’ububyimbirwe hamwe n’ubwiyongere bw’isukari mu gace kanduye.
4. Ubuhanga bwa biology ya molekile
PCR: ubushobozi bwo kuvura indwara nyinshi, ibimenyetso bitari byo
Ikoranabuhanga rya gene chip: icyiciro cy'ubushakashatsi.
5. Arthrocentesis:
Isuzuma rya cytological ry'amazi yo mu ngingo, imiterere ya bagiteri n'isuzuma ry'uburyo imiti ishobora kwanduzwa.
Ubu buryo ni bworoshye, bwihuse kandi bufite ishingiro
Mu ndwara zo mu kibuno, umubare w'uturemangingo tw'amaraso mu ngingo uri hejuru ya 3.000/ml hamwe n'ubwiyongere bwa ESR na CRP ni cyo gipimo cyiza cyo kumenya niba hari indwara zo mu kibuno.
6. Indwara yo mu gihe cyo kubagwa vuba mu gihe cyo gukonjesha mu gihe cyo kubagwa
Igice cyakonjeshejwe cyihuse cy'ingingo ya periprosthetic mu gihe cyo kubaga ni bwo buryo bukunze gukoreshwa cyane mu gihe cyo kubaga mu gusuzuma histopathological. Ibipimo bya Feldman byo gusuzuma, ni ukuvuga birenga cyangwa bingana na neutrophils 5 kuri buri vugururwa ryinshi (400x) mu busitani 5 butandukanye bwa mikorosikopi, bikunze gukoreshwa ku bice byakonjeshejwe. Byagaragaye ko ubushobozi n'ubushobozi bw'ubu buryo bizarenga 80% na 90%, uko bikurikirana. Ubu buryo ni bwo buryo bukoreshwa cyane mu gusuzuma indwara mu gihe cyo kubaga.
7. Uburyo bagiteri zitera indwara mu mubiri
Uburyo bagiteri zikoreshwa mu gupima ingirabuzimafatizo zifite umwihariko wo gupima ubwandu kandi byafashwe nk'icyitegererezo cyiza cyo gupima ubwandu buterwa n'imiti, kandi bishobora no gukoreshwa mu gupima ubukana bw'imiti.
IV. Gusuzuma indwara zitandukanyes
Indwara z’ingingo zikozwe mu buryo bw’ubukorano ziterwa na Staphylococcus epidermidis ziragoye cyane gutandukanya no kurekura ingingo. Bigomba kwemezwa hakoreshejwe X-rays n'ibindi bizamini.
V. Ubuvuzi
1. Uburyo bworoshye bwo kuvura antibiyotike mu buryo butaziguye
Tsakaysma na se,gawa bashyize mu byiciro indwara za nyuma yo kuvura indwara zo mu bwoko bwa arthroplasty mu moko ane, ubwoko bwa mbere butagira ibimenyetso, umurwayi aba ari mu ivuriro ry’imitsi isanzwe igaragara ko ifite bagiteri, kandi nibura ingero ebyiri zakuwemo bagiteri imwe; ubwoko bwa kabiri ni ubwandu bwa mbere, bubaho mu kwezi kumwe nyuma yo kubagwa; ubwoko bwa kabiri ni ubwandu bwatinze; naho ubwoko bwa kane ni ubwandu bwandu bwandu bwavuye mu maraso. Ihame ryo kuvura antibiyotike ni ryiza, rihagije kandi rihagije. Kandi gutobora ingingo mbere yo kubagwa no gutobora ingingo mu gihe cyo kubagwa ni ingenzi cyane mu guhitamo neza antibiyotike. Niba bagiteri ari nziza ku bwandu bwa ubwoko bwa mbere, gukoresha imiti yica udukoko mu gihe cy’ibyumweru 6 bishobora gutanga umusaruro mwiza.
2. Gufata poroteyine, kuyikuraho no kuyisukura, kubaga kuhira imiyoboro
Ingingo yo gukoresha ingamba zo kuvura ihungabana ni uko iyo prosthesis ihoraho kandi yandura mu buryo bwihuse. Umubiri wanduye urasobanutse neza, bagiteri ifite ubukana buke kandi hari imiti yica udukoko ishobora gusimburwa, kandi agace k'inyuma cyangwa agace k'inyuma gashobora gusimburwa mu gihe cyo gusukura. Ibisobanuro byatanzwe ni 6% gusa iyo ukoresheje imiti yica udukoko gusa na 27% iyo ukoresheje imiti yica udukoko hamwe n'imiti igabanya udukoko no kuyirinda.
Ikwiriye kwandura mu gihe cyo hambere cyangwa kwandura indwara zituruka mu maraso zikabije hamwe no gufata neza ibyuma; kandi, biragaragara ko ubwandu ari ubwandu buke bwa bagiteri buterwa n’imiti irwanya udukoko. Ubu buryo bugizwe no gusukura neza, gusukura no gusohora amazi mu miyoboro y’amaraso (igihe cy’ibyumweru 6), no gukoresha imiti irwanya udukoko mu mitsi nyuma yo kubagwa (igihe cy’ibyumweru 6 kugeza ku mezi 6). Ingaruka mbi: igipimo cyo gutsindwa cyane (kugeza kuri 45%), igihe kirekire cyo kuvurwa.
3. Kubaga mu cyiciro kimwe (one etape revision medication)
Ifite ibyiza byo kudakomereka cyane, kumara igihe gito mu bitaro, ikiguzi gito cyo kwivuza, inkovu nke z'ibikomere no gukomera kw'ingingo, ibyo bikaba byorohereza imikorere y'ingingo nyuma yo kubagwa. Ubu buryo bukwiriye cyane cyane mu kuvura indwara zandura hakiri kare n'indwara zituruka ku kuva amaraso mu buryo bwihuse.
Gusimbuza igice kimwe, ni ukuvuga uburyo bwo gutera intambwe imwe, bigarukira gusa ku ndwara zidahumanya cyane, gusukura neza, sima y'amagufwa ya antibiyotike, no kuboneka kwa antibiyotike zikomeye. Hashingiwe ku bisubizo by'itsinda ryakonjeshejwe mu gihe cyo kubagwa, niba hari leukocytes ziri munsi ya 5 / ahantu ho kongera ubwinshi bw'uturemangingo. Bigaragaza ko hari ubwandu budakomeye cyane. Nyuma yo gusukura neza, hakozwe arthroplasty y'icyiciro kimwe kandi nta bwandu bwongeye kugaruka nyuma yo kubagwa.
Nyuma yo gukurwaho neza, iyi prosthesis ihita isimburwa nta mpamvu yo kuyifungura. Ifite ibyiza byo gukomereka gato, igihe gito cyo kuvurwa no kugabanuka kw'ibiciro, ariko igipimo cyo kongera kwandura nyuma yo kubagwa kiri hejuru, kingana na 23% ~ 73% nk'uko imibare ibigaragaza. Gusimbuza iyi prosthesis y'icyiciro kimwe ahanini birakwiriye abarwayi bageze mu za bukuru, hatabayeho guhuza ibi bikurikira: (1) amateka yo kubagwa kenshi ku ngingo isimbura; (2) gushinga inzira ya sinus; (3) kwandura cyane (urugero: septic), ischemia no gucika kw'inkovu ku ngingo ziyikikije; (4) gukuraho burundu ihungabana hasigaye sima igice; (5) X-ray igaragaza osteomyelitis; (6) inenge z'amagufwa zisaba guterwa amagufwa; (7) kwandura indwara zitandukanye cyangwa bagiteri zitera ubukana bwinshi (urugero: Streptococcus D, bagiteri za Gram-negative); (8) gutakaza amagufwa bisaba guterwa amagufwa; (9) gutakaza amagufwa bisaba guterwa amagufwa; na (10) guterwa amagufwa bisaba guterwa amagufwa. Streptococcus D, bagiteri za Gram-negative, cyane cyane Pseudomonas, nibindi), cyangwa indwara z'ibihumyo, indwara za mycobacteria; (8) Imiterere ya bagiteri ntabwo isobanutse neza.
4. Kubaga mu cyiciro cya kabiri cy'ubuvuzi
Mu myaka 20 ishize, yakunze gukoreshwa n'abaganga b'inzobere mu kubaga kubera ibimenyetso byinshi (ibipimo bihagije by'amagufwa, ingirangingo zoroshye ziboneka mu gice cy'umubiri) ndetse n'umuvuduko wo kurandura indwara.
Udukoresho two gupima imiti, udukoko dutwara imiti igabanya ubukana, udukoko dufata imiti igabanya ubukana
Uko uburyo bwo gutandukanya imiti bukoreshwa, ni ngombwa gushyiramo imiti igabanya ubukana bw’imiti igabanya ubukana bw’imiti igabanya ubukana bw’imiti mu ngingo no kongera umubare w’imiti ivura indwara. Imiti ikoreshwa cyane ni tobramycin, gentamicin na vancomycin.
Umuryango mpuzamahanga w’abaganga b’amagufwa wemeje uburyo bwiza bwo kuvura indwara zimbitse nyuma yo gushwanyagurika kw’imitsi. Ubu buryo bugizwe no gusukura neza, gukuraho insimburangingo n’umubiri w’umunyamahanga, gushyiramo agace k’ingingo, gukomeza gukoresha imiti yica udukoko mu mitsi byibuze ibyumweru 6, hanyuma nyuma yo kugenzura neza ubwandu, kongera gushyiramo insimburangingo.
Ibyiza:
Igihe gihagije cyo kumenya ubwoko bwa bagiteri n'imiti irwanya udukoko ishobora gukoreshwa neza mbere yo kubagwa.
Uruvange rw'ibindi bice by'umubiri by'ubwandu rushobora kuvurwa ku gihe.
Hari amahirwe abiri yo gukuraho neza ingirabuzimafatizo n'imibiri y'abanyamahanga, ibi bigabanya cyane umuvuduko wo kongera kwandura nyuma yo kubagwa.
Ibibi:
Kongera gusinziriza no kubagwa byongera ibyago.
Igihe kirekire cyo kuvurwa n'ikiguzi cyo kwivuza kiri hejuru.
Gukira kw'imikorere nyuma yo kubagwa biragabanuka kandi biragabanuka.
Arthroplasty: Ikwiriye indwara zidakira zidakira iyo umuntu avuwe, cyangwa ku busembwa bunini bw'amagufwa; imiterere y'umurwayi igabanya kubagwa no kunanirwa kongera kwiyubaka. Ububabare busigaye nyuma yo kubagwa, gukenera gukoresha imigozi igihe kirekire kugira ngo ifashe umuntu kugenda, kudakomera neza mu ngingo, kugabanya amaguru, ingaruka ku mikorere, n'uburyo bwo kuyikoresha ni buke.
Arthroplasty: uburyo busanzwe bwo kuvura indwara zandura nyuma yo kubagwa, butuma umuntu ahora ahagaze neza nyuma yo kubagwa kandi bugatuma ububabare bugabanuka. Ingorane zirimo kugabanya amaguru n'amaboko, indwara zo kugenda no kubura uburyo bwo kugenda.
Gucibwamo ibice: Ni bwo buryo bwa nyuma bwo kuvura indwara zandurira mu mubiri nyuma yo kubagwa. Bikwiriye: (1) gutakaza amagufwa bikomeye bidakira, inenge z'ingingo zoroshye; (2) kwandura cyane kwa bagiteri, kwandura indwara zitandukanye, kuvura mikorobe ntibigira icyo bitanga, bigatera uburozi mu mubiri, bikangiza ubuzima; (3) kubaga abarwayi banduye indwara zidakira byarananiranye kenshi.
VI. Kwirinda
1. Ibintu bibanziriza kubagwa:
Mbere yo kubagwa, indwara zose zisanzwe zigomba gukira mbere yo kubagwa. Indwara zikunze kwandurira mu maraso ni izituruka ku ruhu, inzira y'inkari, n'inzira y'ubuhumekero. Mu gihe cyo kuvura indwara yo mu kibuno cyangwa mu ivi, uruhu rw'inyuma rugomba kuguma rudacitse. Bacteriuria idatanga ibimenyetso, ikunze kugaragara ku barwayi bageze mu zabukuru, ntabwo ikeneye kuvurwa mbere yo kubagwa; iyo ibimenyetso bigaragaye bagomba kuvurwa vuba. Abarwayi ba tonsillitis, indwara zo mu myanya y'ubuhumekero yo hejuru, na tinea pedis bagomba gukurwaho aho indwara ziherereye. Kubaga amenyo manini ni isoko y'indwara zo mu maraso, kandi nubwo birinzwe, niba ari ngombwa kubaga amenyo, ni byiza ko bikorwa mbere yo kuvura indwara yo mu maraso. Abarwayi bafite indwara mbi nka anemia, hypoproteinemia, diyabete ivanze n'indwara zidakira zo mu nzira y'inkari bagomba kuvurwa cyane kandi hakiri kare kugira ngo indwara y'ibanze irusheho kunoza imiterere y'umubiri.
2. Imicungire y'abakozi mu gihe cy'ubutabazi:
(1) Uburyo n'ibikoresho bidasesenguye neza bigomba gukoreshwa mu buryo busanzwe bwo kuvura arthroplasty.
(2) Kwinjira mu bitaro mbere yo kubagwa bigomba kugabanywa kugira ngo bigabanye ibyago by'uko uruhu rw'umurwayi rushobora kwibasirwa n'udukoko twa bagiteri twandujwe mu bitaro, kandi hagomba gukorwa ubuvuzi busanzwe ku munsi wo kubagwa.
(3) Ahantu mbere yo kubagwa hagomba kuba hateguwe neza kugira ngo hategurwe uruhu.
(4) Amakanzu yo kubaga, udupfukamunwa, ingofero, n'ibyumba byo kubaga bifite akamaro mu kugabanya bagiteri zo mu kirere mu byumba byo kubaga. Kwambara uturindantoki tubiri bishobora kugabanya ibyago byo gukoranaho n'umurwayi mu ntoki kandi bishobora no kubazwa.
(5) Byagaragaye ko gukoresha poroteyine igabanya cyane cyane ifata amagufwa, bifite ibyago byinshi byo kwandura kurusha poroteyine igabanya ubukana bw'amavi yose bitewe n'imyanda y'icyuma igabanya imikorere ya phagocyte, bityo ikaba igomba kwirindwa mu guhitamo poroteyine.
(6) Kunoza uburyo bwo kubaga bw'umuganga no kugabanya igihe cyo kubaga (
3. Ibintu nyuma yo kubagwa:
(1) Gukubitwa n'ibinure mu kubagwa bitera ubudahangarwa bwa insuline, bishobora gutera hyperglycaemia, ikintu gishobora kumara ibyumweru byinshi nyuma yo kubagwa kandi kigatera umurwayi kugira ibibazo bijyanye n'ibikomere, kandi, ndetse, bibaho no ku barwayi batari diyabete. Kubwibyo, gukurikirana isukari mu maraso nyuma yo kubagwa ni ingenzi cyane.
(2) Gutera imitsi mu mitsi miremire byongera ibyago byo kwandura amaraso ndetse n'ibibazo bifitanye isano n'ibikomere. Inyigo yo kugenzura ikibazo yakozwe yasanze gukoresha heparin nke nyuma yo kubagwa kugira ngo hirindwe kotera imitsi mu mitsi miremire byari ingirakamaro mu kugabanya ibyago byo kwandura.
(3) Imiyoboro ifunze ni inzira ishobora kwinjiramo kwandura, ariko isano iri hagati yayo n'umuvuduko w'ubwandu bw'ibikomere ntirasuzumwa neza. Ibisubizo by'ibanze bigaragaza ko catheters zo mu mutwe zikoreshwa mu gutanga imiti igabanya ububabare nyuma yo kubagwa nazo zishobora kwandura ibikomere.
4. Kurinda imiti igabanya ubukana bw'ibiyobyabwenge:
Muri iki gihe, gukoresha imiti igabanya ubukana bw’imiti igabanya ubukana bw’imiti igabanya ubukana bw’imiti ikoreshwa mu mitsi mbere na nyuma yo kubagwa bigabanya ibyago byo kwandura nyuma yo kubagwa. Cephalosporins ikoreshwa cyane mu buvuzi nk’imiti ikoreshwa mu buvuzi, kandi hari isano iri hagati y’igihe cyo gukoresha imiti igabanya ubukana n’umuvuduko w’indwara zo mu gace ko kubagwa, hamwe n’ibyago byinshi byo kwandura mbere na nyuma y’igihe cyiza cyo gukoresha imiti igabanya ubukana. Ubushakashatsi buherutse gukorwa bwagaragaje ko imiti igabanya ubukana ikoreshwa mu minota 30 kugeza kuri 60 mbere yo gukata yari ifite igipimo cyo hasi cyo kwandura. Mu buryo bunyuranye, ubundi bushakashatsi bukomeye ku ndwara zose zo mu kibuno bwagaragaje igipimo cyo hasi cyo kwandura hakoreshejwe imiti igabanya ubukana itangwa mu minota 30 ya mbere yo gukata. Kubwibyo, igihe cyo gutanga imiti muri rusange gifatwa nk’iminota 30 mbere yo kubagwa, kandi umusaruro mwiza mu gihe cyo gutera ikinya. Indi miti igabanya ubukana itangwa nyuma yo kubagwa. Mu Burayi na Leta Zunze Ubumwe za Amerika, imiti igabanya ubukana ikoreshwa kugeza ku munsi wa gatatu nyuma yo kubagwa, ariko mu Bushinwa, bivugwa ko ikoreshwa buri gihe mu gihe cy’icyumweru 1 kugeza kuri 2. Ariko, muri rusange bemeranya ko gukoresha imiti yica udukoko ikomeye mu buryo bwagutse (broad spectrum antibiyotike) mu gihe kirekire bigomba kwirindwa keretse iyo hari impamvu zidasanzwe, kandi niba ari ngombwa gukoresha imiti yica udukoko igihe kirekire, ni byiza gukoresha imiti yica udukoko hamwe na miti yica udukoko kugira ngo hirindwe indwara z’udukoko. Vancomycin byagaragaye ko igira akamaro ku barwayi bafite ibyago byinshi byo kwandura Staphylococcus aureus idakira methicillin. Ingano nyinshi ya miti yica udukoko igomba gukoreshwa mu kubagwa igihe kirekire, harimo no kubagwa impande zombi, cyane cyane iyo igice cy’ubuzima cya miti yica udukoko ari gito.
5. Gukoresha imiti yica udukoko hamwe na sima y'amagufwa:
Sima irimo imiti yica udukoko nayo yakoreshejwe bwa mbere muri arthroplasty muri Noruveje, aho inyigo ya Noruveje ya Arthroplasty Registry yagaragaje ko gukoresha imiti ivanze ya antibiyotike IV na sima (imiti ivanze ya antibiyotike) byagabanyije igipimo cy'ubwandu bwimbitse kurusha uburyo ubwo aribwo bwose bwonyine. Ibi byemejwe mu bushakashatsi bwinshi bwakozwe mu myaka 16 yakurikiyeho. Ubushakashatsi bwakozwe n'Abanyafinlandi n'Ishyirahamwe ry'Abaganga b'Amagufwa ryo muri Ositaraliya ryo mu 2009 byageze ku mwanzuro nk'uwo ku ruhare rwa sima irimo imiti yica udukoko mu miti ivura amavi bwa mbere no mu ivugururwa. Byagaragaye kandi ko imiterere ya sima y'amagufwa itagira ingaruka iyo ifu ya antibiyotike yongewemo mu rugero rutarenze 2 g kuri 40 g ya sima y'amagufwa. Ariko, si antibiyotike zose zishobora kongerwa kuri sima y'amagufwa. Antibiyotike zishobora kongerwa kuri sima y'amagufwa zigomba kuba zifite ibi bikurikira: umutekano, ubushyuhe budahindagurika, kudatera ubwivumbure, gushonga neza mu mazi, ubushobozi bwo kurwanya udukoko twinshi, n'ibikoresho by'ifu. Muri iki gihe, vancomycin na gentamicin bikunze gukoreshwa mu buvuzi. Byatekerezwaga ko gutera imiti yica udukoko muri sima byongera ibyago byo kugira ubwivumbure, kugaragara kw'imiti idakira, no gucika intege kw'insimburangingo, ariko kugeza ubu nta bimenyetso bifatika bishyigikira ibyo bibazo.
VII. Incamake
Gusuzuma vuba kandi neza binyuze mu mateka, isuzuma ry’umubiri n’ibizamini by’inyongera ni ngombwa kugira ngo uvure neza indwara z’ingingo. Gukuraho ubwandu no gusubiza ingingo y’ubukorano idafite ububabare kandi ikora neza ni ihame ry’ibanze mu kuvura indwara z’ingingo. Nubwo kuvura indwara z’ingingo ziterwa na antibiyotike byoroshye kandi bihendutse, kurandura indwara z’ingingo ahanini bisaba uburyo bwo kubaga. Ikintu cy’ingenzi mu guhitamo uburyo bwo kubaga ni ukureba ikibazo cyo gukuraho insimburangingo, ari na cyo kintu cy’ingenzi mu guhangana n’indwara z’ingingo. Kuri ubu, gukoresha imiti igabanya ubukana, gusukura ingingo no gufunga umubiri byahindutse uburyo bwuzuye bwo kuvura indwara nyinshi zikomeye z’ingingo. Ariko, biracyakeneye kunozwa no kunozwa.
Igihe cyo kohereza: Gicurasi-06-2024
