ʻO ka maʻi maʻi kekahi o nā hoʻopiʻi koʻikoʻi ma hope o ka hoʻololi ʻana i ka hui pū ʻana, ʻaʻole ia e lawe wale mai i nā maʻi maʻi he nui i nā maʻi, akā hoʻopau pū kekahi i nā kumuwaiwai olakino. I loko o nā makahiki he 10 i hala iho nei, ua emi nui ka maʻi ma hope o ka hoʻololi ʻana i ka hui ʻana, akā ʻo ka ulu ʻana o nā maʻi e hana ana i ka hui pū ʻana i kēia manawa ua ʻoi aku ma mua o ka nui o ka emi ʻana o ka maʻi maʻi, no laila ʻaʻole pono e mālama ʻia ka pilikia o ka maʻi postoperative.
I. Na kumu o ka mai
Pono e noʻonoʻo ʻia nā maʻi ma hope o ka hui pū ʻana ma ke ʻano he maʻi i loaʻa i ka haukapila me nā mea kumu kumu kūʻai lāʻau. ʻO ka mea maʻamau ka staphylococcus, helu no 70% a 80%, gram-negative bacilli, anaerobes a me nā streptococci hui ʻole he mea maʻamau.
II Pathogenesis
Hoʻokaʻawale ʻia nā maʻi i ʻelua ʻāpana: ʻo ka maʻi maʻi mua a ʻo ka maʻi lohi a i kapa ʻia ʻo late-onset infection. Hoʻokumu ʻia nā maʻi mua ma muli o ke komo pololei ʻana o ka bacteria i loko o ka hui i ka wā o ke kaʻa ʻana a ʻo ia ka Staphylococcus epidermidis. ʻO nā maʻi ma hope o ka hoʻomaka ʻana ma muli o ka lawe ʻana i ke koko a ʻo ia ka Staphylococcus aureus. ʻO nā hui i hana ʻia e ʻoi aku ka maʻi. No ka laʻana, he 10% ka nui o ka maʻi i nā hihia o ka hoʻoponopono hou ʻana ma hope o ka hoʻololi ʻana i ka hui ʻana, a ʻoi aku ka kiʻekiʻe o ka maʻi i nā poʻe i loaʻa i kahi pani pani no ka rheumatoid arthritis.
ʻO ka hapa nui o nā maʻi i loaʻa i loko o kekahi mau mahina ma hope o ka hana ʻana, hiki ke ʻike mua ʻia i nā pule ʻelua ma hope o ka hana ʻana, akā e like me ka hopena o kekahi mau makahiki ma mua o ka puka ʻana mai o nā hōʻike mua o ka pehu a me ka ʻeha a me ke kuni. , Pono e ho'oka'awale 'ia nā hō'ailona kuni mai nā pilikia 'ē a'e, e like me ka ma'i ma'i ma hope o ka hana 'ana, nā ma'i ma'i mimi a pēlā aku.
I ka hihia o ka maʻi maʻi mua, ʻaʻole e ola wale ka mahana o ke kino, akā piʻi aʻe i ʻekolu mau lā ma hope o ke kaʻina. ʻAʻole e emi iki ka ʻeha o ka hui, akā e hoʻonui mālie, a aia ka ʻeha throbbing i ka hoʻomaha. Loaʻa ka oozing a i ʻole ka huna ʻana mai ka ʻoki. Pono e nānā pono ʻia kēia, a ʻaʻole hiki ke hoʻopili maʻalahi ʻia ke kuni i nā maʻi postoperative ma nā wahi ʻē aʻe o ke kino e like me ka māmā a me ka ʻāpana mimi. He mea nui nō hoʻi ʻaʻole e hoʻokuʻu wale i ka hoʻoheheʻe ʻana e like me ka oozing maʻamau e like me ka liquefaction momona. He mea nui nō hoʻi e ʻike inā aia ka maʻi i loko o nā ʻiʻo papa a i ʻole hohonu a puni ka prosthesis.
I nā poʻe maʻi me nā maʻi maʻi nui, ʻo ka hapa nui o lākou i haʻalele i ka haukapila, ʻaʻole nui ka pehu a me ka ʻeha a me ke kuni. ʻAʻohe kuni ka hapalua o nā maʻi. Hiki i ka Staphylococcus epidermidis ke hoʻoulu i kahi maʻi ʻehaʻeha me ka piʻi ʻana o ka helu keʻokeʻo keʻokeʻo i loko o 10% wale nō o nā maʻi. ʻOi aku ka maʻamau o ka sedimentation koko kiʻekiʻe akā ʻaʻole kikoʻī hou. ʻO ka ʻeha i kekahi manawa ke kuhi hewa ʻia e like me ka wehe ʻana i ka prosthetic, ʻo ia ka ʻeha e pili ana i ka neʻe ʻana e hoʻomaha ʻia e ka hoʻomaha, a me ka ʻeha ʻeha i hoʻomaha ʻole ʻia e ka hoʻomaha. Eia naʻe, ua manaʻo ʻia ʻo ke kumu nui o ka wehe ʻana i ka prosthesis ʻo ia ka lohi ʻana i ka maʻi maʻi.
III. ʻIkepili
1. Nānā Haematological:
ʻO ka nui o ka helu o ke koko keʻokeʻo me ka hoʻokaʻawale ʻana, interleukin 6 (IL-6), C-reactive protein (CRP) a me ka erythrocyte sedimentation rate (ESR). He maʻalahi a maʻalahi ka maikaʻi o ka hoʻokolokolo haematological, a hiki ke loaʻa koke nā hopena; He haʻahaʻa haʻahaʻa ka ESR a me CRP; He waiwai nui ka IL-6 i ka hoʻoholo ʻana i ka maʻi periprosthetic i ka wā postoperative mua.
2. Nānā kiʻi:
Kiʻiʻoniʻoni X-ray: ʻaʻole paʻakikī a kikoʻī ʻole no ka ʻike ʻana o ka maʻi.
X-ray kiʻiʻoniʻoni o ke kuli pani pani
ʻO Arthrography: ʻo ka hana nui o ka ʻelele i ka ʻike ʻana i ka maʻi ʻo ka puka ʻana o ka wai synovial a me ka abscess.
CT: ka ʻike ʻana i ka hoʻoheheʻe ʻana o ka hui, nā ʻāpana sinus, nā abscesses ʻiʻo palupalu, ka ʻāʻī ʻana o ka iwi, ka hoʻihoʻi ʻana o ka iwi periprosthetic.
MRI: paʻakikī loa no ka ʻike mua ʻana i ka wai hui a me nā abscesses, ʻaʻole i hoʻohana nui ʻia i ka ʻike o nā maʻi periprosthetic.
Ultrasound: hōʻiliʻili wai.
3. ʻO ka lāʻau nuclear
Technetium-99 iwi scan he sensitivity o 33% a he kiko'ī o 86% no ka hōʻoia o periprosthetic maʻi ma hope o arthroplasty, a me ka indium-111 leukocyte scan ua oi waiwai no ka ike o periprosthetic maʻi, me ka sensitivity o 77% a he kiko'ī o 86%. Ke hoʻohana pū ʻia nā scan ʻelua no ka nānā ʻana i nā maʻi periprosthetic ma hope o ka arthroplasty, hiki ke loaʻa ka ʻike kiʻekiʻe, kikoʻī a me ka pololei. ʻO kēia hoʻāʻo ʻo ia ke kūlana gula i ka lāʻau nuklea no ka ʻike ʻana i nā maʻi periprosthetic. Fluorodeoxyglucose-positron emission tomography (FDG-PET). ʻIke ʻo ia i nā cell inflammatory me ka hoʻonui ʻana i ka glucose i loko o ka wahi i maʻi ʻia.
4. Nā ʻenehana biology molekula
PCR: ka naʻau kiʻekiʻe, nā hopena maikaʻi ʻole
ʻenehana chip Gene: pae noiʻi.
5. Arthrocentesis:
ʻO ka hoʻokolohua cytological o ka wai hui, ka moʻomeheu bacteria a me ka hoʻāʻo ʻana i ka naʻau lāʻau.
He maʻalahi kēia ala, wikiwiki a pololei
I nā maʻi ʻāʻī, ʻo ka helu leucocyte wai hui ʻoi aku ma mua o 3,000/ml i hui pū ʻia me ka hoʻonui ʻia ʻana o ESR a me CRP ka hōʻailona maikaʻi loa no ka loaʻa ʻana o ka maʻi periprosthetic.
6. Intraoperative wikiwiki pa'ū pauku histopathology
ʻO ka ʻāpana paʻa paʻa wikiwiki o ka ʻiʻo periprosthetic ka hana maʻamau i hoʻohana ʻia no ka nānā ʻana i ka histopathological. Hoʻohana pinepine ʻia nā pae hoʻohālikelike o Feldman, ʻo ia hoʻi, ʻoi aku ka nui ma mua a i ʻole like me 5 neutrophils no ka hoʻonui kiʻekiʻe (400x) ma ka liʻiliʻi loa 5 mau māla microscopic kaʻawale. Ua hōʻike ʻia ʻo ka naʻau a me ka kikoʻī o kēia ʻano e ʻoi aku ma mua o 80% a me 90%, kēlā me kēia. ʻO kēia ʻano hana i kēia manawa ke kūlana gula no ka maʻi intraoperative.
7. Moʻomeheu bacterial o ke kino pathological
He kūlana kiʻekiʻe ka moʻomeheu bacteria o nā ʻiʻo periprosthetic no ka ʻike ʻana i ka maʻi a ua manaʻo ʻia ʻo ia ke kūlana gula no ka ʻike ʻana i nā maʻi periprosthetic, a hiki ke hoʻohana ʻia no ka hoʻāʻo ʻana i ka lāʻau.
IV. ʻO ka ʻike ʻokoʻas
ʻOi aku ka paʻakikī o ka hoʻokaʻawale ʻana i nā maʻi hui prosthetic ʻole i hana ʻia e Staphylococcus epidermidis. Pono e hōʻoia ʻia e nā X-ray a me nā hoʻokolohua ʻē aʻe.
V. Lapaau
1. ʻO ka mālama ʻana i nā lāʻau antibiotic maʻalahi
Tsakaysma a me se,gawa hoʻokaʻawale post arthroplasty maʻi i loko o eha ano, type I asymptomatic type, ka mea maʻi wale i loko o ka hōʻano hou 'ana o kaʻiʻo moʻomeheu i loaʻa i ka ulu bacteria, a ma ka liʻiliʻi loa elua specimens moʻomeheu me ka ia bacteria; ʻO ke ʻano II he maʻi maʻi mua, i loaʻa i loko o hoʻokahi mahina o ke kaʻina; ʻO ke ʻano IIl kahi maʻi maʻi lohi; a ʻo ke ʻano IV he maʻi haematogenous acute. ʻO ke kumu o ka lāʻau antibiotic he maʻalahi, lawa ka nui a me ka manawa. A he mea koʻikoʻi nui ka hoʻopaʻa ʻana i ka lua a me ka moʻomeheu intraoperative no ke koho pololei ʻana i nā lāʻau antibiotic. Inā maikaʻi ka moʻomeheu bacteria no ka maʻi ʻano I, hiki i ka hoʻohana maʻalahi o nā lāʻau antibiotic maʻalahi no 6 mau pule ke loaʻa nā hopena maikaʻi.
2. Hoʻopaʻa ʻia ka prosthesis, debridement a me ka hoʻoheheʻe ʻana, ka ʻoki ʻana i ka wai
ʻO ka manaʻo o ka lawe ʻana i ka manaʻo o ka mālama ʻana i ka trauma mālama prosthesis ʻo ia ka paʻa o ka prosthesis a me ka maʻi ʻeha. ʻIke ʻia ka mea maʻi maʻi, haʻahaʻa ka virulence bacteria a loaʻa nā lāʻau antibiotic maʻalahi, a hiki ke pani ʻia ka liner a i ʻole spacer i ka wā debridement. Ua hōʻike ʻia ka nui o ka mālama ʻana i nā lāʻau lapaʻau me 6% wale nō me nā lāʻau lapaʻau wale nō a me 27% me nā lāʻau lapaʻau me ka debridement a me ka mālama prosthesis.
He kūpono ia no ka maʻi maʻi mua a i ʻole ka maʻi haematogenous acute me ka hoʻoponopono prosthesis maikaʻi; no hoi, ua maopopo ka maʻi he haʻahaʻa virulence bacterial maʻi maʻi maʻi i ka antimicrobial therapy. ʻO ke ala e pili ana i ka debridement piha, ka holoi ʻana i ka antimicrobial a me ka hoʻokahe wai (lōʻihi 6 pule), a me nā antimicrobial intravenous postoperative systemic (lōʻihi 6 pule a 6 mahina). Nā hemahema: ka nui o ka hāʻule ʻole (a hiki i 45%), ka lōʻihi o ka mālama ʻana.
3. Hoʻokahi papa hana hoʻoponopono hou
Loaʻa iā ia nā pōmaikaʻi o ka liʻiliʻi o ka trauma, ka noho ʻana i ka haukapila pōkole, ke kumu kūʻai lapaʻau haʻahaʻa, ka liʻiliʻi o ka ʻeha a me ka ʻoʻoleʻa hui, kahi mea e kōkua ai i ka hoʻihoʻi ʻana i ka hana hui ma hope o ke ʻoki ʻana. He kūpono kēia ʻano no ka mālama ʻana i ka maʻi mua a me ka maʻi haematogenous acute.
ʻO ka hoʻololi ʻana i hoʻokahi pae, ʻo ia hoʻi, ʻo ke ʻano ʻanuʻu hoʻokahi, ua kaupalena ʻia i nā maʻi ʻawaʻawa haʻahaʻa, ka hoʻomaʻemaʻe piha ʻana, ka sima iwi lāʻau antibiotic, a me ka loaʻa ʻana o nā lāʻau antibiotic maʻalahi. Ma muli o nā hopena o ka ʻāpana paʻa paʻa intraoperative, inā he emi ma mua o 5 leukocytes/kiʻekiʻe kiʻekiʻe kiʻekiʻe. Hōʻike ia i kahi maʻi ʻawaʻawa haʻahaʻa. Ma hope o ka hoʻomaʻemaʻe piha ʻana, ua hana ʻia kahi arthroplasty hoʻokahi pae a ʻaʻohe hoʻi hou ʻana o ka maʻi ma hope o ka hana.
Ma hope o ka hoʻopau piha ʻana, hoʻololi koke ʻia ka prosthesis me ka ʻole o ke kaʻina hana wehe. Loaʻa iā ia nā pōmaikaʻi o ka trauma liʻiliʻi, ka manawa mālama pōkole a me ke kumukūʻai haʻahaʻa, akā ʻoi aku ka kiʻekiʻe o ka hoʻihoʻi hou ʻana o ka maʻi postoperative, ʻo ia ka 23% ~ 73% e like me ka helu. Hoʻokahi-pae prosthesis ka mea maʻamau no nā poʻe maʻi ʻelemakule, me ka hui ʻole ʻana i kekahi o kēia mau mea: (1) ka mōʻaukala o nā ʻokiʻoki he nui ma ka hui pani; (2) hoʻokumu ʻana i nā ʻāpana sinus; (3) ka ma'i ma'i nui (e like me ka septic), ka ischemia a me ka ma'i ma'i o ke kino a puni; (4) hoʻopau piha ʻole o ka ʻeha me ka ʻāpana sima i koe; (5) X-ray manaʻo o osteomyelitis; (6) nā hemahema iwi e pono ai ke kālai iwi; (7) nā maʻi i hui ʻia a i ʻole nā hua bacteria ʻino loa (e laʻa me Streptococcus D, Gram-negative bacteria); (8) ka poho iwi e pono ai ke grafting iwi; (9) ka poho iwi e pono ai ke grafting iwi; a me (10) grafts iwi e koi ana i ka iwi grafts. Streptococcus D, Gram-negative bacteria, ʻoi aku ka Pseudomonas, etc.), a i ʻole maʻi fungal, mycobacterial maʻi; (8) ʻAʻole maopopo ka moʻomeheu bacteria.
4. ʻO ka hoʻoponopono hou ʻana o ka lua
Ua makemake nui ʻia e nā kauka lapaʻau i nā makahiki he 20 i hala iho nei ma muli o ka laulā o nā hōʻailona (ka nui o ka iwi nui, nā ʻiʻo palupalu periarticular waiwai) a me ke kiʻekiʻe o ka hoʻopau ʻana i ka maʻi.
Spacers, lawe lāʻau antibiotic, antibiotics
Ma waho aʻe o ka ʻenehana spacer i hoʻohana ʻia, pono ka hoʻopaʻa ʻana i ka cemented me nā lāʻau lapaʻau e hoʻonui i ka neʻe ʻana o nā lāʻau antibiotic i ka hui a hoʻonui i ka lāʻau lapaʻau o ka maʻi. ʻO nā lāʻau lapaʻau maʻamau ka tobramycin, gentamicin a me vancomycin.
Ua ʻike ke kaiāulu orthopedic honua i ka lāʻau maikaʻi loa no ka maʻi hohonu ma hope o ka arthroplasty. ʻO ka hoʻokokoke ʻana o ka debridement piha, ka wehe ʻana i ka prosthesis a me ke kino ʻē, ka hoʻokomo ʻana i kahi spacer hui, hoʻomau i ka hoʻohana ʻana i nā antimicrobial sensitive intravenous no ka liʻiliʻi o 6 mau pule, a ma hope, ma hope o ka mālama pono ʻana i ka maʻi, reimplantation o ka prosthesis.
Pono:
ʻO ka manawa kūpono e ʻike ai i nā ʻano bacteria a me nā mea antimicrobial koʻikoʻi, hiki ke hoʻohana maikaʻi ʻia ma mua o ka hoʻoponopono hou ʻana.
Hiki ke mālama ʻia ka hui pū ʻana o nā foci systemic o ka maʻi i ka manawa kūpono.
ʻElua mau manawa no ka debridement e wehe pono i ka ʻiʻo necrotic a me nā kino ʻē aʻe, kahi e hōʻemi nui ai i ka helu o ka hoʻi hou ʻana o nā maʻi postoperative.
Nā hemahema:
Hoʻonui ka hoʻomaʻamaʻa hou ʻana a me ke ʻoki ʻana i ka pilikia.
ʻO ka lōʻihi o ka lāʻau lapaʻau a ʻoi aku ke kumukūʻai olakino.
He pōʻino a lohi ka hoʻihoʻi ʻana o ka hana ma hope.
ʻO Arthroplasty: He kūpono no nā maʻi hoʻomau i pane ʻole i ka lāʻau lapaʻau, a i ʻole no nā kīnā iwi nui; ʻO ke kūlana o ka mea maʻi e kaupalena i ka hana hou ʻana a me ke kūkulu hou ʻana. ʻO ke koena o ka ʻeha postoperative, ka pono no ka hoʻohana lōʻihi o nā braces e kōkua i ka neʻe ʻana, ka paʻa ʻole o ka hui pū ʻana, ka pōkole o nā lālā, ka hopena hana, ua kaupalena ʻia ke ʻano o ka noi.
ʻO Arthroplasty: ka mālama maʻamau no nā maʻi postoperative, me ke kūpaʻa maikaʻi postoperative a me ka hoʻomaha ʻeha. ʻO nā hemahema ʻo ia ka pōkole o ka lālā, nā maʻi hele a me ka nalowale o ka neʻe ʻana.
ʻO ka ʻoki ʻana: ʻO ia ke ala hope loa no ka mālama ʻana i ka maʻi hohonu postoperative. He kūpono no: (1) hiki ʻole ke hoʻoponopono hou ʻia ka nalo iwi koʻikoʻi, nā kīnā ʻiʻo palupalu; (2) ikaika bacterial virulence, huikau maʻi, antimicrobial lāʻau 'aʻole pono, ka hopena i ka systemic toxicity, ola-hoʻoweliweli; (3) he moʻolelo o ka hemahema o ka hoʻoponopono hou ʻana o nā maʻi maʻi maʻi.
VI. Kāohi
1. Nā kumu hana mua:
E hoʻomaikaʻi i ke kūlana o ka mea maʻi ma mua o ka hana ʻana a pono e hoʻōla ʻia nā maʻi āpau e loaʻa nei ma mua. ʻO nā maʻi maʻamau i lawe ʻia i ke koko, ʻo ia ka maʻi mai ka ʻili, ka ʻāpana mimi, a me ka ʻōpū hanu. I ka arthroplasty o ka ʻūhā a i ʻole ke kuli, pono e noho ʻole ka ʻili o nā ʻāpana haʻahaʻa. Asymptomatic bacteriuria, ka mea maʻamau i nā poʻe maʻi ʻelemakule, ʻaʻole pono e mālama mua ʻia; i ka wā e puka mai ai nā hōʻailona pono e mālama koke ʻia. ʻO nā maʻi me ka tonsillitis, nā maʻi o ka ʻōpū hanu luna, a me ka tinea pedis pono e hoʻopau ʻia nā wahi o ka maʻi. ʻO nā hana niho nui ke kumu o ka maʻi koko, a ʻoiai e pale ʻia, inā pono nā hana niho, pono e hana ʻia ia mau kaʻina hana ma mua o ka arthroplasty. ʻO ka poʻe maʻi me nā maʻi maʻamau e like me ka anemia, hypoproteinaemia, ka maʻi diabetes i hui pū ʻia a me nā maʻi maʻi urinary tract pono e mālama ʻia me ka ikaika a me ka hoʻomaka ʻana no ka maʻi mua e hoʻomaikaʻi i ke kūlana ʻōnaehana.
2. Ka hoʻokele intraoperative:
(1) Pono e hoʻohana ʻia nā ʻenehana aseptic holoʻokoʻa a me nā mea hana ma ke ʻano lapaʻau maʻamau i ka arthroplasty.
(2) Pono e hoʻemi ʻia ka hale maʻi ma mua o ka hana ʻana i mea e hōʻemi ai i ka pilikia o ka ʻili o ka mea maʻi e noho pū me nā maʻi bacterial i loaʻa i ka haukapila, a pono e mālama ʻia ka mālama maʻamau i ka lā o ke ʻoki.
(3) Pono e hoʻomākaukau pono ka wahi mua no ka hoʻomākaukau ʻana i ka ʻili.
(4) ʻO nā ʻaʻahu ʻokiʻoki, nā maka, nā pāpale, a me nā hale kiʻiʻoniʻoni holo laminar he mea maikaʻi i ka hōʻemi ʻana i ka maʻi bacteria i loko o ka hale hana. ʻO ke komo ʻana i nā mīkina lima ʻelua hiki ke hōʻemi i ka pilikia o ka pili lima ma waena o ke kaukō a me ka mea maʻi a hiki ke ʻōlelo ʻia.
(5) Ua hōʻike ʻia ʻo ka hoʻohana ʻana i nā mea ʻoi aku ka paʻa, ʻoi aku ka hinged, prosthesis i ʻoi aku ka nui o ka maʻi o ka maʻi ma mua o ka non-restrictive total knee arthroplasty ma muli o ka ʻōpala metala abrasive e hōʻemi ana i ka hana phagocytosis, a no laila e pale ʻia i ka koho prosthesis. .
(6) E hoʻomaikaʻi i ke kaʻina hana o ka mea hana a hoʻopōkole i ka lōʻihi o ka hana (<2.5 h inā hiki). ʻO ka pōkole o ka lōʻihi o ke kaʻina hana hiki ke hōʻemi i ka manawa o ka ʻike ʻana i ka ea, ʻo ia ka mea hiki ke hoʻemi i ka manawa o ka hoʻohana ʻana i ka tourniquet. E pale i ka hana ko'iko'i i ka wā o ke ka'i 'ana, hiki ke ho'ohāinu pinepine 'ia ka 'eha ('oi aku ka maika'i o ka pū 'ana i ka pu'upu'u), a hiki ke lawe 'ia ka ho'okomo 'ana i ka iodine no nā 'oki i mana'o 'ia he haumia.
3. Nā kumu hana hope:
(1) Hoʻoulu ʻia ka hoʻopaʻa ʻana i ka insulin, hiki ke alakaʻi i ka hyperglycaemia, kahi ʻano e hiki ke hoʻomau i kekahi mau pule ma hope o ka hana ʻana a predispose i ka mea maʻi i nā pilikia pili i ka ʻeha, a ʻo ia hoʻi, loaʻa i nā maʻi maʻi maʻi ʻole. No laila, he mea koʻikoʻi ka nānā ʻana i ka glucose koko postoperative.
(2) Hoʻonui ka thrombosis vein hohonu i ka pilikia o ka hematoma a me nā pilikia pili i ka ʻeha. Ua ʻike ʻia kahi haʻawina hoʻopaʻa ʻana i ka hoʻohana ʻana o ka heparin haʻahaʻa haʻahaʻa e pale ai i ka thrombosis vein hohonu i ka hōʻemi ʻana i ka nui o ka maʻi.
(3) ʻO ka hoʻoheheʻe ʻana i pani ʻia he puka hiki ke komo i ka maʻi, akā ʻaʻole i aʻo pono ʻia kona pilina me nā maʻi ʻeha. Hōʻike nā hualoaʻa mua e hiki ke maʻalahi i nā catheters intra-articular i hoʻohana ʻia ma hope o ka hoʻokele ʻana i nā analgesics i ka maʻi ʻeha.
4. Hoʻopaʻa ʻana i ka lāʻau antibiotic:
I kēia manawa, ʻo ka hoʻohana ʻana i nā lāʻau lapaʻau prophylactic o nā lāʻau antibiotic me ka ʻōnaehana intravenously ma mua a ma hope o ke kaʻina e hōʻemi i ka hopena o ka maʻi postoperative. Hoʻohana nui ʻia ʻo Cephalosporins i ka lāʻau lapaʻau ma ke ʻano he lāʻau antibiotic i koho ʻia, a aia kahi pilina pili U-like ma waena o ka manawa o ka hoʻohana ʻana i ka lāʻau antibiotic a me ka nui o nā maʻi maʻi ma kahi o ke kaʻina hana, me ka piʻi ʻana o ka maʻi ma mua a ma hope o ka manawa kūpono no ka lāʻau antibiotic. hoʻohana. Ua ʻike ʻia kahi noiʻi nui hou i hoʻohana ʻia nā lāʻau antibiotic i loko o 30 a 60 mau minuke ma mua o ka ʻoki ʻana i ka haʻahaʻa o ka maʻi maʻi. I ka hoʻokaʻawale ʻana, ua hōʻike ʻia kahi noiʻi nui ʻē aʻe o ka nui o ka hip arthroplasty i ka haʻahaʻa haʻahaʻa o ka maʻi me nā lāʻau antibiotic i lawelawe ʻia i loko o ka 30 min mua o ka ʻoki. No laila, ʻo ka manawa o ka lawelawe ʻana he 30 mau minuke ma mua o ka hana, me nā hopena maikaʻi loa i ka wā o ka hoʻokomo ʻana o ka anesthesia. Hāʻawi ʻia kekahi maʻi prophylactic o nā lāʻau antibiotic ma hope o ke kaʻina. Ma ʻEulopa a me ʻAmelika Hui Pū ʻIa, hoʻohana mau ʻia nā lāʻau antibiotic a hiki i ke kolu o ka lā postoperative, akā ma Kina, hōʻike ʻia e hoʻohana mau ʻia lākou no 1 a 2 mau pule. Eia nō naʻe, ʻo ka manaʻo manaʻo nui e pale ʻia ka hoʻohana lōʻihi ʻana i nā lāʻau lapaʻau ākea ākea ke ʻole he mau kūlana kūikawā, a inā pono ka hoʻohana lōʻihi ʻana o nā lāʻau antibiotic, pono ia e hoʻohana i nā lāʻau antifungal i hui pū me nā lāʻau antibiotic e pale ai i nā maʻi fungal. . Ua hōʻike ʻia ka maikaʻi o Vancomycin i nā poʻe maʻi kiʻekiʻe e lawe ana i ka methicillin-resistant Staphylococcus aureus. Pono e hoʻohana ʻia nā mea ʻoi aku ka nui o nā lāʻau antibiotic no nā ʻoki lōʻihi, e komo pū ana me nā ʻokiʻoki bilateral, ʻoi aku hoʻi i ka wā pōkole o ka hapalua o ke ola antibiotic.
5. Ka hoʻohana ʻana i nā lāʻau antibiotic i hui pū ʻia me ka iwi sima:
Ua hoʻohana mua ʻia ka cement antibiotic-infused i ka arthroplasty ma Norewai, kahi i hōʻike mua ʻia ai kahi noiʻi Norewan Arthroplasty Registry i hōʻike ʻia ʻo ka hoʻohana ʻana i ka hui pū ʻana o ka antibiotic IV a me ka cement (hui pū ʻia antibiotic prosthesis) infusion i hōʻemi i ka nui o ka maʻi hohonu ma mua o kēlā me kēia ala wale nō. . Ua hoʻopaʻa ʻia kēia ʻike ma kahi ʻano o nā haʻawina nui i nā makahiki he 16 e hiki mai ana. Ua loaʻa i kahi noiʻi Finnish a me ka Australian Orthopedic Association 2009 i nā hopena like e pili ana i ke kuleana o ka cement antibiotic-infused i ka manawa mua a me ka hoʻoponopono hou ʻana i nā kuli arthroplasty. Ua hōʻike pū ʻia hoʻi ʻaʻole pili nā waiwai biomechanical o ka iwi sima ke hoʻohui ʻia ka pauka antibiotic i nā koina ʻaʻole iʻoi aku ma mua o 2 g no 40 g o ka sima iwi. Eia nō naʻe, ʻaʻole hiki ke hoʻohui ʻia nā lāʻau antibiotic a pau i ka sima iwi. ʻO nā lāʻau antibiotic i hiki ke hoʻohui ʻia i ka iwi sima pono e loaʻa i kēia mau kūlana: palekana, kūpaʻa wela, hypoallergenicity, solubility wai maikaʻi, spectrum antimicrobial ākea, a me nā mea pauda. I kēia manawa, hoʻohana pinepine ʻia ka vancomycin a me ka gentamicin i ka hana lapaʻau. Ua manaʻo ʻia ʻo ka hoʻokomo ʻana i nā lāʻau antibiotic i loko o ka sima e hoʻonui ai i ka hopena o ka maʻi maʻi, ka puka ʻana mai o nā maʻi kūpaʻa, a me ka wehe aseptic o ka prosthesis, akā i kēia manawa ʻaʻohe mea hōʻike e kākoʻo i kēia mau pilikia.
VII. Hōʻuluʻulu manaʻo
ʻO ka hana ʻana i kahi hōʻailona wikiwiki a pololei ma o ka mōʻaukala, ka hoʻokolokolo kino a me nā hoʻokolohua ancillary kahi mea e pono ai no ka mālama pono ʻana i nā maʻi hui. ʻO ka hoʻopau ʻana i ka maʻi a me ka hoʻihoʻi ʻana i kahi hui artificial me ka ʻole o ka ʻeha, hana maikaʻi ke kumu kumu i ka mālama ʻana i nā maʻi hui. ʻOiai he maʻalahi a maʻalahi ka hoʻomaʻamaʻa antibiotic o ka maʻi hui, ʻo ka hoʻopau ʻana i ka maʻi hui e koi nui i ka hui ʻana o nā ʻano hana ʻoki. ʻO ke kī i ke koho ʻana i ka lāʻau lapaʻau, ʻo ia ka noʻonoʻo ʻana i ka pilikia o ka wehe ʻana i ka prosthesis, ʻo ia ke kumu nui o ka hoʻoponopono ʻana i nā maʻi hui. I kēia manawa, ua lilo ka hoʻohana ʻana o nā lāʻau antibiotic, debridement a me ka arthroplasty i mea lapaʻau piha no nā maʻi hui paʻakikī. Eia nō naʻe, pono e hoʻomaikaʻi a hoʻomaikaʻi ʻia.
Ka manawa hoʻouna: Mei-06-2024
