Kwandura ni kimwe mubibazo bikomeye nyuma yo gusimburwa hamwe, ntabwo bizana gusa abarwayi gusa, ariko nanone bimara ubuvuzi bunini. Mu myaka 10 ishize, igipimo cyanduye nyuma yo gusimburwa hamwe nacyo cyagabanutse cyane, ariko umubare witerambere ryubu uhagarikwa kure cyane umaze guhumbuye kure cyane, ikibazo cyanduye nyuma ntigikwiye kwirengagizwa.
I. Impamvu zo Kwiba
Indwara zihuriweho nyuma yubukorikori zigomba gufatwa nkibibazo byabonye ibitaro bibangamira ibinyabuzima birwanya ibiyobyabwenge. Ibisanzwe ni staphylococcus, ibaruramari kuri 80% kugeza 80%, Gramu-mbi-Ibibi na bacilli, Anaerobes hamwe nitsinda rifite itsinda riri risanzwe.
II PATHOTASIS
Indwara zigabanijwemo ibyiciro bibiri: imwe yanduye hakiri kare kandi irindi yatinze kwandura cyangwa yitwa indwara yatinze. Indwara zambere ziterwa no kwinjira muri bagiteri mu buryo butaziguye mu gihe cyo kubagwa kandi bikunze kugaragara staphylococcus epidermidis. Indwara zatinze-onset ziterwa no kwanduza amaraso kandi akenshi wa staphylococcccus. Ingingo zabajijwe birashoboka cyane ko zandura. Kurugero, hari umubare wanduye 10% mugihe cyo gusubiramo nyuma yo gusimburwa hamwe, kandi igipimo cyanduye nacyo kiri hejuru kubantu bagize uruhare runini kuri rubagimpande rwa rubagimpande.
Inzitizi nyinshi zibaho mugihe cyamezi make nyuma yicyumweru bibiri cyambere nyuma yikindi kibazo cyambere cyo kubyimba guhubuka, kuba umurwayi wa posita, nkangiza inkari ndwara nibindi.
Kubijyanye no kwandura hakiri kare, ubushyuhe bwumubiri ntabwo bukira gusa, ariko bukazura nyuma yiminsi itatu nyuma yo kubagwa. Ububabare buhuriweho ntabwo bugabanuka buhoro buhoro, ariko buhoro buhoro, kandi hariho ububabare buruhutse. Hano hari oozing idasanzwe cyangwa gusohora. Ibi bigomba gusuzumwa neza, kandi umuriro ntugomba guterwa byoroshye kwandura nyuma mu tundi turere two mu mubiri nkahaha cyangwa agapapuro kikarishye. Ni ngombwa kandi kutirukana gusa oozing nka oozing isanzwe nko mu binure. Ni ngombwa kandi kumenya niba infe ziherereye mu ngingo zidasanzwe cyangwa ndende hafi ya prostrasi.
Mu barwayi bafite indwara ziteye imbere, benshi muri bo bakaba bavuye mu bitaro, kubyimba, kubabara, n'umuriro ntibishobora kuba bikomeye. Kimwe cya kabiri cyabarwayi ntirushobora kugira umuriro. Staphylococcus irashobora gutera kwandura kutababaza hamwe na selile yera yuzuye amaraso yemerewe na 10% gusa. Gukarura amaraso yamenetse birasanzwe ariko nanone ntabwo byihariye. Ububabare rimwe na rimwe buvuga nabi nka prosthetic, aba nyuma ububabare bujyanye no kugenda bugomba kubozwa mu buruhukiro, kandi ububabare bukabije burimo kuruhuka. Ariko, byasabwe ko impamvu nyamukuru itera prothèse irekura yatinze kwandura karayika.
III. Kwisuzumisha
1. Ikizamini cya Haematologiya:
Ahanini ushizemo selile yera yamaraso yongeyeho yo hejuru, interleukin 6 (il-6), poroteyine ya C-6), CRP) nigipimo cya erythyte (esr). Ibyiza byikizamini cya Haematologique byoroshye kandi byoroshye gukora, kandi ibisubizo birashobora kuboneka vuba; ESR na CRP bafite umwihariko muto; Il-6 ifite agaciro gakomeye muguhitamo kwandura periprosthe mu gihe cyo gutangirwa mbere.
2.Umusabane:
X-Ray Filime: Ntabwo byoroshye cyangwa byihariye kugirango usuzume kwandura.
X-Ray Filime yanduye ivi
Arthrography: Imikorere nyamukuru ihagarariye mu gusuzuma kwandura ni ugusohoka k'amazi ya sinoviya n'ibiro.
CT: Gutekereza Kumurongo uhuriweho, udupapuro twa sinus, ibisasu byoroshye, isuri, isuri, isuri ya periprosthe.
MRI: Byumva cyane Kumenya hakiri kare amazi hamwe nibibi, ntibikoreshwa cyane mugupima indwara za periprosthest.
Ultrasound: kwirundanya amazi.
3.Nuturo
Technetium-99 scan amagufwa afite ubushishozi 33% nuburyo 86% yo gusuzuma indwara za periprosthest nyuma yo gusuzuma indwara za periprosthest, hamwe nubushishozi bwa 77% na 86% bya 86%. Iyo inkoni zombi zikoreshwa hamwe kugirango usuzume indwara za periprosthetic nyuma ya arthroplasty, kumva neza, umwihariko kandi ukuri kandi birashobora kugerwaho. Iki kizamini kiracyari gipimo cya zahabu mumiti ya kirimbuzi kugirango isuzume indwara za periprosthetic. FluorodeoxyglucocoClucoClucoso-Position Oxnas yohereza Tomography (FDG-Pet). Ivuga selile zatewe na glucose hejuru ya glucose mukarere kanduye.
4. Ubuhanga bwa MoleCumilleGy
PCR: Sinutivite yo hejuru, ibyiza byibinyoma
Ikoranabuhanga rya Gene: Icyiciro cy'ubushakashatsi.
5. Arthrocentes:
Isuzuma rya cyntologiya ryamazi, umuco wa bagiteri hamwe nibizamini byumva ibiyobyabwenge.
Ubu buryo bworoshye, bwihuse kandi bwukuri
Mu kwandurwa kw'ibinyabuzima, ibinure byamazi ya metero 3000
6. Kubona byihuse IGICE CY'IGIHUGU CIETOTHOOLY
IBIKORWA BY'IMIKORESHEREZE FOMEN FICEN igice cya periprosthetic tissue nuburyo bukunze gukoreshwa muburyo bwo kubona ibintu bya hertophologi. Ibipimo bya Felmansia, ni ukuvuga, birenze cyangwa bingana na neutrofifiya 5 kuringaniza (400x) byibuze microscopique 5 itandukanye. Byarewe ko kumva no gusobanura ubu buryo bizarenza 80% na 90%. Ubu buryo kuri ubu ni urugero rwa zahabu rwo gusuzuma.
7. Umuco wa bagiteri wa tissue ya pato
Umuco wa bagiteri wibikoresho bya periprosthetic bifite umwihariko wo gusuzuma kandi ufatwa nkibisanzwe bya zahabu kugirango usuzumwe indwara za peteroli, kandi irashobora kandi gukoreshwa mugupima imiti.
IV. Diagnosi idasanzwes
Indwara ya prostanti yububabare yatewe na staphylococccus epidermidis biragoye gutandukanya na prostatheque. Igomba kwemezwa na X-Imirasire nibindi bizamini.
Cuti
1. Kuvura ibintu byoroshye antibiotic
Tsakaysma na SE, Gawa yashyize mu gaciro post ya Arthroplasty ku bwoko bune, andika ubwoko bw'ibitekerezo, umurwayi ari mu myidagaduro yo kubaga, kandi byibura ingendo ebyiri zifite imihango ibiri ya bagiteri; Ubwoko bwa II ni indwara yanduye, ibaho mugihe cyukwezi kubagwa; Andika Iil ni indwara yatinze; Kandi andika IV ni infectogon ya auteetoous. Ihame rya antibiyotike ni umubare uhagije nigihe gihagije. Kandi umuco wa kaviconike hamwe no gucuranganya hamwe numuco wo mumico idahwitse bifite akamaro gakomeye kugirango uhitemo antibiotike. Niba umuco wa bagiteri ufite ubwoko bwanduye, uburyo bworoshye bwo kuri antibiyotike yibyumweru 6 burashobora kugera kubisubizo byiza.
2. Kugumana Prosthous, Debridement hamwe na Steriage, kubaga ubwasohowe
Ikibanza cyo gufata ikirego cy'ihungabana kigumana ubuvuzi bwa Prosthosse nuko prostrasi ihamye kandi ikaze. Ibinyabuzima byanduye birasobanutse, virusi yinkunga ya bagiteri ni antibiyotike nke kandi yoroshye irahari, kandi liner cyangwa spacer irashobora gusimburwa mugihe cya debridement. Ibipimo byakira bya 6% gusa na antibiyotike byonyine na 27% hamwe na antibiyotike wongeyeho kuri debridement na prostasi batangajwe no kubungabunga festas byatangajwe no kubungabunga.
Birakwiriye kwandura hakiri kare cyangwa kwandura haetetoogoous hamwe na prosthesi nziza; Kandi, biragaragara ko kwandura ari indwara ntoya ya bagiteri yunvikana na therapy antimichail. Uburyo bugizwe na debridement yoroshye, arwanya antimichail no kumeneka (igihe ibyumweru 6), hamwe na sisitemu yo gutangiza ihererekanyabubasha igabanya ubukana (igihe ibyumweru 6). Ibibi: Igipimo cyo kunanirwa cyane (kugeza kuri 45%), igihe kirekire cyo kuvura.
3. Kubaga kimwe cyo gusubiramo
Ifite ibyiza byihungabana, ibitaro bigufi, ibiciro byoroheje byubuvuzi, inkovu nkeya no gukomera hamwe, bikaba byiza cyane kugarura imikorere ihuriweho nyuma yo kubagwa. Ubu buryo burakwiriye cyane cyane kuvurwa kwandura hakiri kare no kwandura haetetooge.
Gusimbuza kimwe, ni ukuvuga uburyo bumwe, bugarukira gusa ku ndwara z'ubuherozi buke, kubara neza, no kumenya amagufwa ya antibiyotic, kandi kuboneka kwa antibiyotike yoroshye. Ukurikije ibisubizo byimiterere yumurimo ikonje igice, niba hari munsi ya 5 leukocytes / umurima munini. Bitanga urugero rwanduye uburozi buke. Nyuma yo guhanagura neza ahanini arthroplasy imwe yakozwe kandi nta byaha bivuguruzanya.
Nyuma yo guhanura neza, prostrasi ihita isimburwa adakeneye inzira ifunguye. Ifite ibyiza byihungabana rito, igihe gito cyo kuvura no gutanga gake, ariko igipimo cyo kwandura nyuma yinyuma kiri hejuru, kigera kuri 23% ~ 73% ukurikije imibare. Umusimbura umwe wa prosthos ubereye cyane cyane abarwayi bageze mu zabukuru, utiriwe uhuza ibintu byose bikurikira: (1) Amateka yo kubagwa byinshi kumusimbura; (2) uburyo bwa sinus; . (4) guhanagura guha imbaraga ihahamuka hamwe na sima zisigaye; (5) x-ray yerekana osteomieltis; (6) Inenge zamagufwa zisaba amagufwa; . (8) Gutakaza amagufwa bisaba gufata amagufwa; (9) Gutakaza amagufwa bisaba gufata amagufwa; na (10) Amagufwa asaba amagufwa. Streptococcus d (8) Umuco wa bagiteri ntabwo usobanutse.
Kubagwa kabiri-Icyiciro cyo Gusubiramo
Yatoneshwaga n'abaganga mu myaka 20 ishize kubera ibimenyetso byinshi byerekana (misa ihagije, imyenda yoroshye ya periartticular) n'ikibazo kinini cyo kurandura ubwandu bwandura.
Umwanya, abatwara antibiyotike, antibiyotike
Tutitaye ku buhanga bwo mu kirere bwakoreshejwe, bwashimangiye ko antibiotique ari ngombwa kongera ibitekerezo bya antibiyotike mu ngingo no kongera igipimo cyo gukiza. Bikunze gukoreshwa antibiyotique ni Tobramycin, Candamicin na Vancomycin.
Umuryango mpuzamahanga w'amagufwa watabaye uburyo bwiza bwo kwivuza kwandura cyane nyuma ya arthroplasy. Uburyo bugizwe na debridement yoroshye, gukuraho prostèse hamwe n'umubiri w'amahanga, gushyira mu bikorwa byo kwivuza bikabije, nyuma yo kugenzura neza indwara neza, yongeye kugenzura neza indwara.
Ibyiza:
Igihe gihagije cyo kumenya amoko ya bagiteri hamwe nabakozi barwanya ubudahangawe, bushobora gukoreshwa neza mbere yo kubagwa.
Ihuriro ryizindi for sisitemu yanduye irashobora kuvurwa mugihe gikwiye.
Hariho amahirwe abiri yo guhanagura ingirabuzimafatizo n'amahanga n'amahanga n'amahanga byose, bikaba bigabanye igipimo cyo kwisubiraho kwandura nyuma.
Ibibi:
Ongera anesthesia no kubaga byongera ingaruka.
Igihe kirekire cyo kuvura no gutanga ubuvuzi bwo hejuru.
Gusubizwa nyuma yo gukira ni bibi kandi biratinda.
Arthroplasty: Birakwiriye kwandura bidasubirwaho bidasubiza ubuvuzi, cyangwa kubwubugome bunini bwamagufwa; Imiterere yumurwayi igabanya no kwiyubaka. Ububabare bwa nyuma bwa posita, hakenewe gukoresha igihe kirekire kugirango dufashe kugenda, gushikama duhuje hamwe, ingingo igabanya, ingaruka zikora, urugero rwa porogaramu ni ntarengwa.
Arthroplasty: Guvuza gakondo kwandura abasaruro, hamwe nubutaka bwiza bwa nyuma no gutabara ububabare. Ibibi birimo kugabanya ingingo, kugendana ibibazo no gutakaza ingendo ihuriweho.
Gucibwa: Nubushake bwa nyuma bwo kuvura indwara yandura yanduye. Bikwiye kuri: (1) Gutakaza amagufwa akomeye, inenge yoroheje ya tissue; . (3) Ifite amateka yo kubagwa byinshi kunanirwa kwibasirwa nabarwayi banduye banduye.
Vi. Gukumira
1.
Kunoza imiterere yumurwayi wibanze hamwe nindwara zose zisanzwe zigomba gukira biteganijwe. Indwara zisanzwe zamaraso ni abo mu ruhu, agapapuro kikarishye, nubuhumekero. Muri hip cyangwa ivi yinyenzi, uruhu rwo hasi rugomba gukomeza kutavunika. Bagiteri ya asmpmoduatia, zisanzwe mu barwayi bageze mu zabukuru, ntikeneye gufatwa mbere; Ibimenyetso bimaze kubaho bagomba kuvurwa vuba. Abarwayi bafite tonillitis, indwara zubuhumekero rwo hejuru, na tinea pedis bagomba kugira impfumyi yaho. Ibikorwa binini by'amenyo ni isoko ishobora kwandura amaraso, kandi nubwo iririndwaga, niba ibikorwa by'inamirwa bikenewe, birasabwa ko inzira nk'izo zikorwa mbere ya arthroplasty. Abarwayi bafite imiterere rusange muri make nka anemia, Hypopropinaemia, bahujwe na diyabete hamwe no gutoranya indwara zidakira bigomba kuvurwa gukabije no hakiri kare ku ndwara y'ibanze kunoza uburyo bwa sisitemu.
2. Ubuyobozi buhiga:
.
.
(3) Agace ko mbere kagomba kwitegura neza kwitegura uruhu.
. Kwambara uturindantoki ebyiri birashobora kugabanya ibyago byo guhuza amaboko hagati yo kubaga no kwihangana kandi birashobora gusabwa.
.)
(6) Kunoza tekinike yo kubaga umukoresha no kugabanya igihe cyo gukora (<2.5 h niba bishoboka). Kugabanya igihe cyo kubaga birashobora kugabanya igihe cyo guhura numwuka, nacyo gishobora kugabanya igihe cya Tounquit. Irinde ibikorwa bitoroshye mugihe cyo kubaga, igikomere gishobora kuhiga inshuro nyinshi (gusiga imbunda kuhira), kandi imyumbati-imyuka-imyuka irashobora gufatwa kubikorwa bakekwaho kubanduzwa.
3. Ibintu byasubiye inyuma:
. Kubwibyo, amaraso yamabara ya glucose afite akamaro kanini.
. Ubushakashatsi bwo kugenzura gahunda bwasanze gukoresha amacakubiri ya heparin yo hasi ya heparin kugirango wirinde Verrombose yimbitse yangiriye akamaro mu kugabanya amahirwe yo kwandura.
. Ibisubizo byibanze byerekana ko abatabazi bakomeye bakoreshwa nkibikorwa byinyuma bya antsiges byabyo bishobora no kongera kwandura.
4. Antibiotic Prophylaxis:
Kugeza ubu, igenamigambi rya dosiye risanzwe rya dosiye ya plephylactique ya antibiyotike yatunganijwe muburyo bubi mbere na nyuma yo kubaga igabanuka ryanduye nyuma yo kwandura nyuma. CephalHospine ikoreshwa cyane ugereranije nka antibiyotike yo guhitamo, kandi hariho umubano wa U-umeze hagati ya antibiyotike ya antibiyotike mbere na nyuma yigihe cyo gukoresha antibiotique. Ubushakashatsi bunini buherutse bwasanze antibiyotike ikoreshwa mu gihe 30 kugeza kuri 60 mbere yo gutemerwa yari ifite igipimo gito cyanduye. Ibinyuranye, ubundi bushakashatsi bwingenzi bwa hip arthplasty yose yagaragaje igipimo cyo hasi kwandura hamwe na antibiyotike itangwa muminota 30 yambere ya cmision. Igihe rero cyo gucunga ubuyobozi gifatwa nki 30 min mbere yibikorwa, hamwe nibisubizo byiza mugihe cyo kwinjiza anesthesia. Ubundi buryo bugaragara bwa antibiyotike butangwa nyuma yo kubaga. Mu Burayi na Amerika, antibiyotike isanzwe ikoreshwa kugeza umunsi wa gatatu nyuma yo gutabwa, ariko mu Bushinwa, bivugwa ko mubisanzwe bikoreshwa ubudahwema mubyumweru 1 kugeza 2. Icyakora, ubwumvikane bwa rukeli ni uko gukoresha igihe kirekire bya antibiyotike yagutse-spectrum bigomba kwirindwa keretse niba hari ibintu byihariye bikenewe, kandi niba ari byiza gukoresha ibiyobyabwenge bitemewe na antibiyotike kugirango wirinde indwara zidasanzwe. Vancomycin yerekanwe ko ari ingirakamaro mu barwayi bafite ibyago byinshi bitwaje Methicillin-irwanya staphylococccuc. Ibipimo byinshi bya antibiyotike bigomba gukoreshwa kubagwa igihe kirekire, harimo no kubaga byombi, cyane cyane iyo antibiyotike ya kera.
5. Gukoresha antibiyotike mu guhuza n'amagufwa:
Igenamigambi rya Antibiyotike naryo ryakoreshejwe bwa mbere muri ArtHroplaSty muri Noruveje muri Noruveje, hashyizweho proppesis ya arthpeplasty) neza ku buryo bwo kwandura indwara nyinshi kurushaho. Ibi bikunze byemejwe murukurikirane rwiga rinini mumyaka 16 iri imbere. Ubushakashatsi bwa Finilande hamwe n'ishyirahamwe ry'imyenda ya Australiya 2009 ryageze ku myanzuro isa ku ruhare rwa sibiyotike ya Antibiyotike mu gihe cyagenwe na Reviap arthroplasty. Yarekuwe kandi ko imiterere ya biomenical ya siveme idagira ingaruka mugihe ifu ya antibiyotike yongewemo muri dosiye itarenga 2 g kuri kaburimbo. Ariko, ntabwo antibiyotike zose zirashobora kongerwa na voine. Antibiyotike ishobora kongerwaho na vone ya magufwa bagomba kugira ibintu bikurikira: umutekano, umutekano, hypollergenity, byiza cyane. Kugeza ubu, Vancomycin na Candamicin bakunze gukoreshwa mumyitozo ya clinique. Byatekerejwe ko inshinge za antibiyotike muri sima ziyongera ibyago byo kumvikana kwa allergique, hagaragaye indwara irwanya, kandi ashishikaye kurekura prostrasi, ariko kugeza ubu nta kimenyetso cyo gushyigikira ibyo bibazo.
Vii. Incamake
Gusuzuma vuba cyane binyuze mumateka, ibizamini byumubiri nibizamini bipima ni ngombwa kugirango ukoreshe neza indwara zihuriweho. Kurandura infection no kugarura ingingo zidafite ububabare, imikorere yuburinganire ni ihame ryibanze mugukemura indwara zihuriweho. Nubwo kuvura antibiotique kwandura guhuriweho kandi bihendutse, kurandura kwandura hamwe cyane bisaba guhuza uburyo bwo kubaga. Urufunguzo rwo guhitamo kwivuza ni ugusuzuma ikibazo cya prosthos gukuraho prostès, kikaba ari ikintu cyibanze cyo guhangana nindwara zihuriweho. Kugeza ubu, ishyirwa mu bikorwa rya antibiotike, debridement na arthroplasty byahindutse uburyo bwuzuye bwo kwandura indwara zifatika. Ariko, biracyakeneye kunozwa no gutungana.
Igihe cya nyuma: Gicurasi-06-2024
