ʻO keʻano o nā hoʻopiʻi koʻikoʻi nui loa ma hope o ka hoʻololiʻana i nā mea hoʻokūkū koʻikoʻi,ʻaʻole wale ke lawe i nā mea he nui i ka maʻi he nui. Ma nā makahiki 10 i hala iho nei, ua emi ka hopena o ka maʻi me ka emiʻana o keʻano o ka maʻiʻoi aku ka nui o ka hopena o ka hopena o ka nui o ka maʻi.
I. Nā kumu o ka morbitity
Pono e noʻonoʻoʻia nā maʻi hoʻohuihui post-artificial ʻO ka maʻamau maʻamauʻo Staphylococcus, ka helu kālā no 70% a 80%, GRAM-maikaʻiʻole BACILL
Ii pathogenesis
Ua māheleʻia nā maʻi i nā'āpanaʻelua ʻO nā pilikia mua e hoʻokumuʻia e ke komo pololeiʻana o nā balena i loko o ka huiʻana i ka wā o nā mea hana a he maʻamau staphylococcus epidermidis. ʻO nā maʻi hope-onset e hanaʻia e ka laweʻana i ke koko-borne e lawe a loaʻa pinepine i ka Arupylococcus Auureus. Nā hui i hanaʻia e hanaʻia ma luna o nā mea hou aʻe e lilo i maʻi. ʻO ka'ōmaʻomaʻo, aia kekahi kiʻekiʻe he 10% o ka kaulike o ka hoʻoponoponoʻana, a kiʻekiʻe nā kiʻekiʻe o ka poʻe i loaʻa ma Rheumatadida.
ʻO ka hapa nui o nā maʻi e hele mai ana i loko o kahi mau mahina ma hope o ka hanaʻana, hiki i ka nui o nā hōʻike ma mua o ka wā e hiki mai ana.
I ka hihia o ka maʻi mua,ʻaʻole i ola ke kino o ke kino, akā ua hala nā lāʻekolu ma hope o ka hanaʻana. ʻAʻole e hōʻemi iki kaʻehaʻeha o kaʻeha, akā, a me ka huhū nui, a aia i laila e hoʻolei ana i kaʻeha ma ka hoʻomaha. Aia ka Offine OOZING a iʻole ka hōʻikeʻana mai ka incision. Pono e nānā ponoʻia kēia, aʻaʻole pono e maʻalahi keʻano o ka maʻi i nā hopena postoperative i nā'āpana'ē aʻe i nā'āpana o ke kino e like me nā māmā a me nā'āpana paha. He mea nui iaʻaʻole ia e haʻalele wale i ka weheʻana i keʻano o keʻano maʻamau e like me ka maʻamau maʻamau e like me ka wai momona. He mea nui ia eʻike inā aia ke loaʻaʻana o ka maʻi ma nāʻano superficial a iʻole ka hohonu a puni ka prosthesis.
I nā maʻi maʻi me nā maʻi ulu mua, ka hapa nui o nā mea i haʻalele i ka haukapila, huiʻino,ʻaʻole iʻehaʻeha, a me ke kuni, aʻaʻole paha. Hapalua o nā maʻi maʻi maʻi maʻi maʻi. Hiki i ka Epidermicccus Epidermidis i ka maʻi hōʻehaʻeha me ka nui o ke koko koko keʻokeʻo i ka 10% o nā maʻi. ʻOi aku ka nui o ke koko e hāpai houʻia akāʻaʻole ia e pili hou. ʻO kaʻeha kekahi mea kuhi hewa i like me ka halaʻole o Prosthetic, kaʻeha hope e pili ana i ka neʻeʻana, e hoʻomahaʻia e ka hoʻomaha no ke hoʻomahaʻole. Eia nō naʻe, ua manaʻoʻia ua hiki ke hoʻopauʻia ke kumu nui o ke kumu o ka prosthes e hoʻokuʻu i ka maʻi maʻi maʻi.
III. Nā Dnangsis
1.
ʻO ka helu nui i ka helu o ke kahe koko keʻokeʻo e helu ai, interleukin 6 (Il-6) He maʻalahi maʻalahi ka hoʻomaʻamaʻaʻana o ka hoʻokolohua haole he maʻalahi a e maʻalahi e hoʻokuʻu i nā hopena; Esr a he nui nāʻanoʻelua; Il-6ʻO ka waiwai nui o ka hoʻoholoʻana i ka maʻi pertiprosthetic ma ka manawa postoperative mua.
2.ʻO ka hoʻokolokolo:
X-ray kiʻi kiʻi:ʻaʻole iʻike aʻikeʻoleʻia no keʻano o ka maʻi maʻi.
X-ray kiʻi kiʻi kiʻi o ke kuli
ʻO Artrrography:ʻO ka hana koʻikoʻi nui i ka maʻi o ka maʻi o ka maʻi o ke kaheʻana o keʻano o keʻano synovial a me ka abscess.
CT: Hōʻikeʻike o ka effition hui pūʻana, Sinus Tracts, Fart Sisses escesses, BOW ERiprosotic Bone Ronding.
MRU:ʻoi loa i kaʻike mua o kaʻike muaʻana o ka wai o ka huiʻana a me ka huhū,ʻaʻole i hoʻohana nuiʻia i ka maʻi maʻi o nā maʻi perfertistic.
Ultrasoud: Ka hōʻiliʻiliʻana.
3. lāʻau lapaʻau
ʻO ka Scan Acneetium-99ʻO Scan Scan he mea ikaika o 33% a me kahi kiko'ī o 86% no ka mahaloʻana i nā maʻi perphrosthest. Ke hoʻohanaʻia nā scansʻelua no ka hoʻokolokoloʻana o nā maʻi perphrosthetic ma hope o ka artroplasty Aia nō kēia hōʻike i ke kūlana gula ma ka lāʻau lapaʻau nuklea no ka maʻi maʻi o nā maʻi pericrosthetic. Florrodeoxlucose-positeron emission domiskition (fdg-pet). ʻIke ia i nā pahu maʻi me ka piʻiʻana o ka glucose uptake ma ka wahi i hoʻopiliʻia.
4.
PCR:ʻO keʻano kiʻekiʻe, nā manaʻo maikaʻiʻole
ʻO Gene Chip Technology: Ke kahua noiʻi.
5.
ʻO ka nānāʻana o ka cytological o nā wai hui pūʻana,ʻo ka moʻomeheu moʻomeheu a me nā lāʻau lapaʻau lāʻau lapaʻau.
He maʻalahi kēiaʻano, wikiwiki a pololei
I nā maʻi hip, kahi wai wai wai e helu ai i ka lepacocyte counter> 3,000 / ml i ka hoʻohuiʻana i ka nui o ka maʻi pererrosthetic.
6.
ʻO REPID INTRAPOGRATRATRATER BROTRAPERRATER o TERIPROSTHTAT TISSUSUTER ka hana maʻamau maʻamau i hoʻohana pinepineʻia no ka hōʻikeʻo GetPeat. ʻO nā criters diagnostic o Feldman,ʻo ia hoʻi,ʻoi aku ka nui a iʻole ma mua o 5 mau neutrophic o nā mahina kiʻekiʻe. Ua hōʻikeʻiaʻo ia keʻano o ka naʻau a me keʻano o kēiaʻano eʻoi aku ma mua o 80% a me 90%, e pili ana. ʻO kēiaʻano keʻano o keʻano gula i ke gula no ka maʻi maʻi intraperativa.
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ʻO ka moʻomeheu bacterers o nāʻili o peruprosthetic ua kiʻekiʻe loa no ka maʻi maʻi a ua manaʻoʻia he mau maʻi gula no ka maʻiʻana i ka maʻi lāʻau lapaʻau.
IV. ʻO nā diagnosis
ʻO nā mea i hōʻehaʻia e nā mea i halaʻoleʻia e nā mea i hanaʻia e Staphylococcus epidermidis eʻoi aku ka paʻakikī o ka hoʻokaʻawaleʻana mai ka prosthetic. Pono e hōʻoiaʻia e X-rays a me nā hoʻokolohua'ē aʻe.
V. KA MANAWA
1.
Tsakaysma a me Se, GAW i hoʻopaʻaʻia i nāʻano o nāʻano heʻehā, e like me ka mea i loaʻa i ka mea maʻi type II he maʻi maʻi mua, e hiki mai ana i loko o hoʻokahi mahina o ka hanaʻana; type Iil he mea maʻi lohi; A type IV kahi maʻi maʻi maʻi maʻi maʻi. ʻO ke kumu o ka mālamaʻana o ka hoʻomaʻamaʻa antibiotic he mea naʻauao, kūpono a me ka manawa kūpono. A me ka hoʻopaʻi muaʻana o ka puncy pastrity a me ka moʻomeheu intraperative a me ka moʻomeheu nui loa no ka koho kūpono o nā antibiotika kūpono. Inā maikaʻi ka moʻomeheu bacterial no keʻano o ka maʻi a me keʻano maʻalahi o nā lāʻau lapaʻau maʻalahi no ka 6 mau wiki e hiki ai ke loaʻa nā hopena maikaʻi.
2.ʻO ka mālamaʻana i ka Distthesis
ʻO ka Premise o ka hāpaiʻana i ka premise o ka trauma e mālama ana i ka mālamaʻana i ka prosthesis prosthesis e kū pono ana i ka prosthesis. Ua maopopo keʻano o ka maikaʻi o ka maikaʻi, he haʻahaʻa ka momona a me ka palupalu a me nā mea antibiotics. ʻO nā kumukūʻai o ka 6% wale nō me nā antibiotics wale nō a me 27% me nā antibiotics a me ka mālamaʻana i ka mālamaʻana i ka hana.
He kūpono kūpono no ka maʻi maʻamau a iʻole ka maʻi hamatovisnois me ka hoʻoponopono prosthes maikaʻi; Eia kekahi, ua maopopo ia ka nui o ka maʻi maʻi he haʻahaʻa haʻahaʻa haʻahaʻa ʻO ke ala e kū ai i ka lepo i ka lepo antimirrobial, antimicrobial fllus a me ka drainage (duration 6 mau wiki), a me nā mahina 6 mau mahina). Loaʻa i nā hemahema:ʻO ka ukuʻole kiʻekiʻe (a hiki i 45%), lōʻihi ka manawa hoʻomaha lōʻihi.
3. Hoʻokahi papa hana hou
Loaʻa iā ia nā pōmaikaʻi o nā trauma liʻiliʻi He kūpono kēiaʻano hana no ka mālamaʻana i ka maʻi mua a me ka maʻi hamatognois maʻi.
ʻO kahi koho hoʻokahi,ʻo ia hoʻi,ʻo ia ka hana hoʻokahi, ua kaupalenaʻia i nā maʻi haʻahaʻa haʻahaʻa, antibiotic iwi antibitility Kuhiʻia ma nā hopena o ka Pauku Pūnaewele Intraperative Tiszen He manaʻo manaʻo ia o kahi maʻi haʻahaʻa haʻahaʻa haʻahaʻa. Ma hope o ka hoʻokaʻawaleʻana i kahi papa inoa o kahi papa inoaʻo Artrorplasty i hanaʻia aʻaʻohe mea houʻole o ka nui postoperatively.
Ma hope o ka Dradement SPANDEMENT, ua hoʻololi kokeʻia ka prosthesis me kaʻole o ka pono no ke kaʻina hana wehe. Loaʻa iā ia nā mea pono o ka trauma liʻiliʻi ʻO kahi mea e kūpono ai keʻano o ka hanaʻana o hoʻokahi papa hana no nā mea maʻi heldery. (2) hanaʻino hewa; (3)ʻO ka maʻi koʻikoʻi (4)ʻO ka hanaʻinoʻole o ka trauma me ka'āpana'āpana; (5) X-ray manaʻo o ka osteomylitis; (6) iwi iwi e koi ana i ka iwi i hopuʻia; (7) i hui pūʻia a iʻole nā maʻi maʻi a iʻole ka wahine wahine maikaʻi loa (e like me Straptococcus d, Gram-maikaʻiʻole); (8) lilo iwi nalowale i koi ana i ka iwi hū; (9) lilo iwi nalowale i koi ana i ka iwi ke kālaiʻia; a (10) iwi nā iwi e koi ana i kaʻoki poepoe. Streptococccus d, gem-maikaʻi-maikaʻiʻole (8)ʻaʻole maopopo ka moʻomeheu bacterer.
4.
Ua makemakeʻia e nā mea hana ma mua o 20 mau makahiki i hala aku nei ma muli o kona mau hōʻailona nui o nā hōʻailona he nui.
Nā hale hana, nā mea lawe antibiotic, antibiotics
E pili ana i ka hoʻohanaʻana i keʻano spacer i hoʻohanaʻia, e hoʻoponoponoʻia ana ka hoʻoponoponoʻana me nā antibiotics e hoʻonui ai i keʻano o ka lāʻau lapaʻau. Hoʻohana pinepineʻiaʻo Antibiotics i nā thebramycin, a me ke mele a me ka vancomycin.
Uaʻike kaʻike o ka International Orthopedic Community i ka hoʻomaʻamaʻa maikaʻi loa no ka maʻi nui ma hope o ka artroplasty. ʻO ke ala e kū ana i kaʻona nui, e lawe ana i ka kino o ka prosthesis a me nā mea'ē aʻe, e hoʻomau i ka mana o ka maʻi.
Pono:
ʻO ka manawa kūpono eʻike ai i nā mea bacteries a me nā mea hoʻokūkū antimicrobial a me nā mea e pono ai, hiki ke hoʻohanaʻia ma mua o ka hoʻoponoponoʻana i ka hana houʻana.
ʻO ka hui pūʻana o nā'ōnaehana'ōnaehana o ka maʻi o ka maʻi maʻi hiki ke mālamaʻia i kahi manawa kūpono.
ʻElua mau manawa kūpono no ka Drasidement e wehe i nā'āpana Necrotic a me nā kino'ē aʻe, e hōʻemi nui i ka helu o nā maʻi postoperative.
Loaʻa i nā hemahema:
E hoʻonui houʻo Astheshia a me nā hana hana i ka pilikia.
ʻO ka lōʻihi o ka mālamaʻana i ka mālamaʻana a me ke kumukūʻai olakino kiʻekiʻe.
ʻO ka ho'ōla hana postoperative Friend a lohi.
ʻO'Akuhi ʻO keʻano o keʻano o keʻano o keʻano o ka mea maʻi a me ka hana houʻole. ʻO kaʻeha o ka postoperative ma hope,ʻo ka pono no ka hoʻohanaʻana i ka lōʻihi o nā braces e kōkua ai i keʻano, hana maikaʻi, nā mea hana kūponoʻole, nā mea hana kūpono.
Arthroplasty:ʻO ka hana moʻomeheu no nā maʻi postoperative, me ka kūpaʻa postoperative maikaʻi a me ke kaumaha. Loaʻa i nā hemahema e pili ana i ka pōkole o ka lime, nā mea kīnāʻole a me ka nalowale o ka neʻeʻana o ka hui pūʻana.
Amputation:ʻO ia ka hope hope loa no ka mālamaʻana i ka maʻi postoperative. He kūpono no: (1) nā iwi ikaika nui, nā palupalu palupalu palupalu; (2)ʻO ka maʻiʻehaʻeha ikaika, hoʻohuiʻia,ʻaʻohe mea lapaʻau ho'āla, ka hopena o ka polokalamu'ōnaehana o ka polokalamu, me ka hoʻoweliweli; (3) He moʻolelo o ka loaʻaʻole o ka hikiʻole o ka hoʻoponopono houʻana i nā mea maʻi maʻi maʻi.
VI. Kinohi
1.
E hoʻolālā i ke kūlana preoperative mua a me nā maʻi āpau e pono e ho'ōlaʻia nā maʻi āpau. ʻO nā koko koko maʻamau loa nā mea maʻi no kaʻili,ʻo ka pā hale, a me nā pā. I ka hip a iʻole kuli ʻO Asymptomatic Bacteriuria,ʻo ia ka mea maʻamau i nā maʻi kahiko,ʻaʻole pono e mālamaʻia i mua; i hoʻokahi mau hōʻailona e hele pono ai lākou e hana kokeʻia. Nā mea maʻi me nā kaukani,ʻoi aku ka nui o nā maʻi refpiratory ʻO nā hana niho nui loa he kumu kūpono loa o ka maʻi koko, a he aha nā hana a pau, inā he hana nā mea hoʻonaninani, inā e hanaʻia e like me ka athrolasty. ʻO nā maʻi me nā kino hanaʻilihune e like me Anemia,ʻo Hypoproteemia, huiʻiaʻo ka maʻi maʻi maʻa o ka maʻi maʻamau e hoʻomaikaʻi ai i keʻano o ka'ōnaehana.
2..
(1)ʻO nā hana hana aseptitic piha a me nā mea hana e hana pūʻia ma ka hana maʻamau ma keʻano o keʻano o ka hana maʻamau.
(2) Pono e hōʻemiʻia ka hale hoʻokipa preocerative e hōʻemi i ka hōʻeha o ka mea maʻi, e laweʻia i ka hana o ka haukapila.
(3) Pono e hoʻomākaukauʻia ka wahi preoperative i hoʻomākaukauʻia no ka hoʻomākaukauʻana o kaʻili.
(4) Nā Goagrical Gowns,ʻO Masks, Hats Hiki i ke kāʻeiʻana i nā mea kanuʻelua e hōʻemi i ka hopena o ka pilina lima ma waena o ke kiʻi a me ka mea maʻi a hiki ke manaʻoʻia.
(5) Ua hōʻoiaʻia ka meaʻoi aku ka hoʻohanaʻana o ka hoʻohanaʻana,ʻoi aku ka kiʻekiʻe o ka maʻi kīwī ma mua o ka nui o ka maʻi kīpīʻole.
(6) E hoʻomaikaʻi i keʻano hana o ka hana o ka mea hana a pōkole i ka lōʻihi o ka hana (<2.5 h inā hiki). Hiki i ka wā pōkole o ka lōʻihi o ka lōʻihi e hōʻemi ai i ka manawa o ka hoʻolahaʻana i ka lewa, e hiki ai i ka huli ke hōʻemi i ka manawa o Tourniquet. Hōʻalo i ka hana paʻakikī i ka wā o ka hanaʻana, hiki ke hoʻopauʻia kaʻeha ma ka nui o ka Gun e hiki ai ke laweʻia no nā hanana.
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(1) nā mea e hoʻonani ai i ka paleʻana i ka insulin insulin, hiki ke alakaʻi i ka hyperglycaemia, kahi mea maʻi maʻi maʻiʻole. No laila, he mea nui kūponoʻo Christpo postpirative ke koko koko Gluconoperative ke nānā aku nei.
(2) Hoʻonui ka trimbosis hohonu i ka hopena o Hematoma a me nā pilikia e pili ana i nā pilikia. Ua loaʻa kahi noiʻi pilikino i kēlā noi postoperative o ka molela haʻahaʻa e pale ai i keʻano o ka thromboris i ka hopena o ka maʻi maʻi.
(3)ʻO ka brainage paniʻia he waihona kūpono o ke komoʻana no ka maʻi maʻi, akāʻaʻole i aʻoʻia kona pilina e hōʻehaʻia. Hōʻike nā hopena mua i nā hopena i hoʻohanaʻia e nā mākaʻi i hoʻohanaʻia e like me kaʻoihana postoperative e hoʻopiʻiʻia e nā maʻi hōʻeha.
4. Antibionic Prophylaxis:
I kēia manawa,ʻoi aku ka noiʻana o ka Clintical Clinical o nā Pehu Prophylactic ʻO nā Cuphalotshins maʻamau i hoʻohana nuiʻia e like me ka antibiotic o ke kohoʻana, a aia he pilina pili i waena o ka nui o ka hana ma mua a ma hope o ka hana kūpono loa. Ua loaʻa kahi haʻawina nui hou e hoʻohanaʻia i loko o nā antibiotics i hoʻohanaʻia i loko o 30 a 60 min ma mua o ka hikiʻana i ka nui o ka hopena haʻahaʻa. I ka hoʻohālikelikeʻana,ʻoi aku kahi haʻawina nui o ka nui o ka hitrotropy i hōʻikeʻia i ka hopena haʻahaʻa loa i mālamaʻia i loko o ka nui o 30 min of incision. No laila he mau manawa'āpono ka manawa hoʻokolokoloʻia e lilo i 30 min ma mua o ka hana, me nā hopena maikaʻi loa ma kaʻano o ka hana kolohe. Hāʻawiʻia kekahi papa prophylactic'ē aʻe o nā antibiotics antibiotics ma hope o ka hanaʻana. MaʻEulopa a meʻAmelika Hui PūʻIa,ʻo Andibiotics e hoʻohana pinepineʻia a hiki i ke kolu o ka lā postoperative, akā ma Kina, akā, ua hōʻikeʻia lākou no ka 2 mau pule. Akā naʻe,ʻo kaʻae maʻamau ka hoʻohanaʻana o ka nui o nā maʻi lōʻihi o ka maʻi antibitum ākea,ʻaʻole pono e hoʻohana i nā lāʻau lapaʻau ma keʻano he lāʻau lapaʻau maikaʻi loa Ua hōʻikeʻiaʻo Vancomycin i kahi kūpono i nā mea maʻi kiʻekiʻe e lawe ana i nā mea maʻi kiʻekiʻe e hali ana i ke kūlana spuphylococus ateusus. Pono e hoʻohanaʻia nā kiʻekiʻe kiʻekiʻe o nā antibiotics no nā mea hana weliweli, e pili ana i ka bilateral a me ka biladeral
5. E hoʻohana i nā antibiotics i hui pū me nā iwi o ka iwi:
Ua hoʻohana muaʻiaʻo Antibiotic-infriotic-infrit i loko o ka artroplasty ma Norway, ma kahi o ka papa inoaʻo Antibolit Ua hōʻoiaʻia kēiaʻike i loko o kahi papa nui o nā haʻawina nui ma luna o nā makahiki 16 e hiki mai ana. ʻO kahi noiʻi Finnish a me ka Australia Otthoppedic Assodadic Assication 2009 i loaʻa i nā hopena likeʻole e pili ana i ka hana o ka antibionitic-infulflasty. Ua hōʻikeʻiaʻo ia e hoʻopiliʻia nā waiwai biomechicanical o keʻano o ka iwi o ka iwi i ka wā e hoʻohuiʻia ai ka pwdionitic pweser i nā'āpana 2 g no 40 g no 40 g no 40 g no 40 g no 40 g no 40 g no 40 g Eia naʻe,ʻaʻole hiki ke hoʻohuiʻia nā antibiotics āpau i ka sima. Hiki ke hoʻohuiʻia nā antibiotics e hoʻohuiʻia i kaʻaoʻao o ka iwi e loaʻa ana i kēia mau kūlana: palekana, ka paʻaʻana o ka mea kanu antimillebility I kēia manawa,ʻo Vancomycin a me ka maleʻana ma mua o ka hana maʻamau i hoʻohanaʻia ma ka hoʻomaʻamaʻa Clinical. Ua manaʻoʻiaʻo ia i ka hoʻohālikelikeʻana i ka cement e hoʻonui i ka hopena o nā hopena allergic, aʻaʻole iʻikeʻia kahi mea hōʻike e kākoʻo ai i kēia mau hopohopo.
VII. Hōʻaʻakeʻa
Ke hana nei i kahi maʻi wikiwiki a pololei i ka mōʻaukala ma o ka mōʻaukala,ʻo nā hōʻike kino kino a me nā hoʻokolohua amecillary no ka hoʻomaʻamaʻa maikaʻiʻana i nā maʻi o nā hui pūʻana. ʻO ka holoiʻana o ka maʻi maʻi a me ka hoʻihoʻiʻana i kahi mea hōʻeha maikaʻiʻole,ʻo ka hana maikaʻiʻole e hana nei i ka papa kumu maʻamau ʻOiaiʻo ka hoʻomaʻamaʻaʻana o ka antibiotic o ka maʻi o ka maʻi a me ka loaʻaʻole o ka neʻeʻana, ka pauʻana o keʻano o ka huiʻana o ka huiʻana i nāʻano hana hoʻololi. ʻO ke kī e koho ai i ka mālamaʻana i ka hanaʻoi aku ka noʻonoʻoʻana i ka pilikia o ka laweʻana i ka foreval,ʻo ia ka mea e pili ana i nā maʻi hoʻohui. I kēia manawa,ʻo ka noi huiʻana o nā antibiotics, e lilo i ka mea nui a me nā'ōlaʻi a me nā ahula nui i lilo i ka maʻi kūpono loa no ka nui o nā maʻi paʻakikī. Eia nō naʻe, pono nō e hoʻomaikaʻiʻia a hemoleleʻia.
POST manawa: Mei-06-2024
