ʻO ka maʻi kekahi o nā pilikia koʻikoʻi loa ma hope o ke pani ʻana i nā hui hana, ʻaʻole ia e lawe wale mai i nā hahau ʻoki he nui i nā maʻi, akā e hoʻopau pū ana hoʻi i nā kumuwaiwai lapaʻau he nui. I nā makahiki he 10 i hala iho nei, ua emi nui ka nui o ka maʻi ma hope o ke pani ʻana i nā hui hana, akā ʻo ka nui o ka ulu ʻana o nā maʻi e hana ʻia ana i ke pani ʻana i nā hui hana ua ʻoi aku ka nui ma mua o ka emi ʻana o ka nui o ka maʻi, no laila ʻaʻole pono e hoʻowahāwahā ʻia ka pilikia o ka maʻi ma hope o ke kāpili ʻana.
I. Nā kumu o ka maʻi
Pono e noʻonoʻo ʻia nā maʻi hoʻololi hui ma hope o ke kāwili ʻana he mau maʻi i loaʻa i ka haukapila me nā meaola kumu kūʻē i ka lāʻau. ʻO ka staphylococcus ka mea maʻamau, e helu ana no 70% a 80%, nā bacilli gram-negative, anaerobes a me nā streptococci non-A group he mea maʻamau nō hoʻi.
II Pathogenesis
Ua māhele ʻia nā maʻi i ʻelua mau ʻano: ʻo kekahi ka maʻi mua a ʻo kekahi ka maʻi hope a i ʻole i kapa ʻia he maʻi hoʻomaka hope. Hoʻokumu ʻia nā maʻi mua e ke komo pololei ʻana o ka bacteria i loko o ka hui i ka wā o ke ʻoki ʻana a ʻo ia hoʻi ʻo Staphylococcus epidermidis. Hoʻokumu ʻia nā maʻi hoʻomaka hope e ka hoʻoili ʻana i ke koko a ʻo ia hoʻi ʻo Staphylococcus aureus. ʻOi aku ka nui o ka maʻi o nā hui i ʻoki ʻia. No ka laʻana, aia he 10% ka nui o ka maʻi i nā hihia o ka hoʻoponopono hou ʻana ma hope o ka hoʻololi hui artificial, a ʻoi aku ka kiʻekiʻe o ka nui o ka maʻi i ka poʻe i loaʻa ka pani hui no ka rheumatoid arthritis.
ʻO ka hapa nui o nā maʻi e kū mai i loko o kekahi mau mahina ma hope o ke ʻoki ʻana, hiki ke ʻike mua ʻia i loko o nā pule ʻelua mua ma hope o ke ʻoki ʻana, akā hiki nō hoʻi i kekahi mau makahiki ma mua o ka puka ʻana mai o nā hōʻike mua o ka pehu ʻana o nā hono, ka ʻeha a me ke kuni, pono e hoʻokaʻawale ʻia nā hōʻailona kuni mai nā pilikia ʻē aʻe, e like me ka maʻi pneumonia postoperative, nā maʻi ʻōpū urinary a pēlā aku.
I ke ʻano o ka maʻi mua, ʻaʻole wale ka mahana o ke kino e hoʻōla ʻia, akā piʻi aʻe i ʻekolu lā ma hope o ke ʻoki ʻana. ʻAʻole wale ka ʻeha o nā hono e emi mālie, akā e hoʻonui mālie, a aia ka ʻeha ʻūlū i ka wā e hoʻomaha ai. Aia ka wai kahe a i ʻole ka huna ʻana mai ka ʻoki ʻia. Pono e nānā pono ʻia kēia, a ʻaʻole pono e hoʻopili maʻalahi ʻia ke kuni i nā maʻi postoperative ma nā wahi ʻē aʻe o ke kino e like me nā māmā a i ʻole ke ala mimi. He mea nui hoʻi ʻaʻole e hoʻokuke wale i ka wai kahe ʻoki ʻia e like me ka wai kahe maʻamau e like me ka liquefaction momona. He mea nui hoʻi e ʻike inā aia ka maʻi ma nā ʻiʻo superficial a i ʻole hohonu a puni ka prosthesis.
I nā poʻe maʻi me nā maʻi holomua, ʻo ka hapa nui o lākou ua haʻalele i ka haukapila, ʻaʻole paha e koʻikoʻi ka pehu ʻana o nā hono, ka ʻeha, a me ke kuni. ʻAʻohe paha e loaʻa i ka hapalua o nā maʻi ke kuni. Hiki iā Staphylococcus epidermidis ke hana i kahi maʻi ʻeha ʻole me ka hoʻonui ʻia o ka helu o nā keʻokeʻo koko keʻokeʻo i ka 10% wale nō o nā maʻi. ʻOi aku ka maʻamau o ka hoʻonui ʻia ʻana o ke koko akā ʻaʻole kikoʻī. I kekahi manawa ua kuhihewa ʻia ka ʻeha ma ke ʻano he wehe ʻana o ka prosthetic, ʻo ka mea hope loa he ʻeha e pili ana i ka neʻe ʻana e pono e hoʻomaha ʻia e ka hoʻomaha, a me ka ʻeha mumū i hoʻomaha ʻole ʻia e ka hoʻomaha. Eia nō naʻe, ua manaʻo ʻia ʻo ke kumu nui o ka wehe ʻana o ka prosthesis ʻo ia ka maʻi mau i hoʻopaneʻe ʻia.
III. Hōʻike Manaʻo
1. Hoʻokolokolo Haematological:
ʻO ka hapa nui e hoʻokomo i ka helu o nā keʻena 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 hoʻi ka hoʻokō ʻana i nā pono o ka hoʻokolokolo hematological, a hiki ke loaʻa koke nā hopena; He haʻahaʻa ka kikoʻī o ESR a me CRP; He waiwai nui ʻo IL-6 i ka hoʻoholo ʻana i ka maʻi periprosthetic i ka wā mua ma hope o ke ʻoki ʻana.
2. Hoʻokolokolo kiʻi:
ʻO ke kiʻiʻoniʻoni X-ray: ʻaʻole koʻikoʻi a ʻaʻole kikoʻī hoʻi no ka ʻike ʻana i ka maʻi.
ʻO ke kiʻi X-ray o ka maʻi pani kuli
ʻO Arthrography: ʻo ka hana nui ma ka ʻike ʻana i ka maʻi, ʻo ia ke kahe ʻana o ka wai synovial a me ka abscess.
CT: ʻike maka ʻana i ke kahe ʻana o ke hono, nā ala sinus, nā abscesses o nā ʻiʻo palupalu, ka ʻino ʻana o ka iwi, ka resorption iwi periprosthetic.
MRI: koʻikoʻi loa no ka ʻike mua ʻana i ka wai hui a me nā abscesses, ʻaʻole i hoʻohana nui ʻia i ka ʻike ʻana i nā maʻi periprosthetic.
Ultrasound: hōʻiliʻili wai.
3. Lāʻau lapaʻau nukelea
ʻO 33% ka ʻike o ka scan iwi Technetium-99 a me 86% ka kikoʻī no ka ʻike ʻana i nā maʻi periprosthetic ma hope o ka arthroplasty, a ʻoi aku ka waiwai o ka indium-111 leukocyte scan no ka ʻike ʻana i nā maʻi periprosthetic, me ka ʻike o 77% a me ka kikoʻī o 86%. Ke hoʻohana pū ʻia nā scan ʻelua no ka nānā ʻana i nā maʻi periprosthetic ma hope o ka arthroplasty, hiki ke hoʻokō ʻia kahi ʻike kiʻekiʻe, kikoʻī a me ka pololei. ʻO kēia hoʻāʻo ke kūlana gula i ka lāʻau lapaʻau nukelea no ka ʻike ʻana i nā maʻi periprosthetic. Fluorodeoxyglucose-positron emission tomography (FDG-PET). ʻIke ia i nā cell mumū me ka hoʻonui ʻia o ka glucose uptake ma kahi i loaʻa i ka maʻi.
4. Nā ʻenehana biology molekala
PCR: ʻike kiʻekiʻe, nā hopena wahaheʻe
ʻEnehana ʻāpana gene: kahua noiʻi.
5. ʻO ke kuni ʻana o ka ʻāʻī:
Ka nānā ʻana o Cytological o ka wai hui, ka moʻomeheu bacteria a me ka hoʻāʻo ʻana i ka ʻike lāʻau.
He maʻalahi, wikiwiki a pololei hoʻi kēia ʻano hana
I nā maʻi ʻūhā, ʻo ka helu leucocyte wai hui ma mua o 3,000/ml i hui pū ʻia me ka hoʻonui ʻia o ka ESR a me CRP ka mea kūpono loa no ke alo o ka maʻi periprosthetic.
6. ʻO ka histopathology ʻāpana hau wikiwiki intraoperative
ʻO ka ʻāpana paʻa wikiwiki o ka ʻiʻo periprosthetic intraoperative ka ʻano hana intraoperative i hoʻohana pinepine ʻia no ka hoʻokolokolo histopathological. ʻO nā pae hoʻohālikelike a Feldman, ʻo ia hoʻi, ʻoi aku ka nui a like paha me 5 neutrophils no kēlā me kēia hoʻonui kiʻekiʻe (400x) ma ka liʻiliʻi he 5 mau kahua microscopic kaʻawale, hoʻopili pinepine ʻia i nā ʻāpana paʻa. Ua hōʻike ʻia e ʻoi aku ka ʻike a me ke kikoʻī o kēia ʻano hana ma mua o 80% a me 90%. ʻO kēia ʻano hana i kēia manawa ke kūlana gula no ka hōʻoia intraoperative.
7. Ka moʻomeheu bacteria o nā ʻiʻo pathological
He kiʻekiʻe ke ʻano kūikawā o 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 ʻike lāʻau.
IV. Ka hōʻailona ʻokoʻas
ʻOi aku ka paʻakikī o ka hoʻokaʻawale ʻana i nā maʻi hono prosthetic ʻeha ʻole i hoʻokumu ʻia e Staphylococcus epidermidis mai ka wehe ʻana o nā hono prosthetic. Pono e hōʻoia ʻia e nā X-ray a me nā hoʻokolohua ʻē aʻe.
V. Lapaʻau
1. Lapaʻau maʻalahi antibiotic conservative
Ua hoʻokaʻawale ʻo Tsakaysma lāua ʻo se,gawa i nā maʻi ma hope o ka arthroplasty i ʻehā mau ʻano, ʻano I asymptomatic type, ʻo ka mea maʻi wale nō i loko o ke ʻoki kino hoʻoponopono i ʻike ʻia he ulu bacteria, a ʻo ka liʻiliʻi he ʻelua mau specimens i mahi ʻia me ka bacteria like; ʻo ke ʻano II kahi maʻi mua, e kū mai ana i loko o hoʻokahi mahina o ke ʻoki kino; ʻo ke ʻano IIl kahi maʻi mau i hoʻopaneʻe ʻia; a ʻo ke ʻano IV kahi maʻi haematogenous koʻikoʻi. ʻO ke kumumanaʻo o ka mālama ʻana i ka antibiotic he naʻau, lawa ka nui a me ka manawa. A ʻo ka puncture cavity joint preoperative a me ka moʻomeheu ʻiʻo intraoperative he mea nui loa ia no ke koho pololei ʻana o nā antibiotics. Inā maikaʻi ka moʻomeheu bacteria no ka maʻi type I, hiki i ka hoʻopili maʻalahi ʻana o nā antibiotics naʻau no 6 mau pule ke loaʻa nā hopena maikaʻi.
2. Ka paʻa ʻana o ka prosthesis, ka debridement a me ka hoʻokahe ʻana, ke ʻoki ʻana i ka wai o ka paipu
ʻO ke kumu o ka hoʻohana ʻana i ke kumu o ka mālama ʻana i ka prosthesis e paʻa ana i ka trauma, ʻo ia ka prosthesis he paʻa a he maʻi koʻikoʻi. Ua maopopo ka meaola hoʻopili, ua haʻahaʻa ka virulence bacteria a loaʻa nā antibiotics koʻikoʻi, a hiki ke hoʻololi ʻia ka liner a i ʻole ka spacer i ka wā o ka debridement. ʻO nā helu ho'ōla o 6% wale nō me nā antibiotics wale nō a me 27% me nā antibiotics me ka debridement a me ka mālama ʻana i ka prosthesis ua hōʻike ʻia ma nā palapala.
He kūpono ia no ka maʻi mua o ka pae a i ʻole ka maʻi haematogenous koʻikoʻi me ka hoʻopaʻa ʻana o ka prosthesis maikaʻi; eia kekahi, ua maopopo he maʻi bacteria haʻahaʻa ka virulence i maʻalahi i ka lāʻau antimicrobial. ʻO ke ʻano hana e pili ana i ka debridement piha, ka holoi ʻana i ka antimicrobial a me ka hoʻokahe ʻana (lōʻihi o 6 mau pule), a me nā antimicrobial intravenous systemic postoperative (lōʻihi o 6 mau pule a 6 mau mahina). Nā hemahema: kiʻekiʻe ka nui o ka hāʻule ʻana (a hiki i ka 45%), lōʻihi ka manawa mālama.
3. ʻO ke ʻoki hoʻoponopono hoʻokahi pae
Loaʻa iā ia nā pono o ka emi ʻana o ka ʻeha, ka pōkole o ka noho ʻana ma ka haukapila, ka haʻahaʻa o ke kumukūʻai lapaʻau, ka emi ʻana o ka ʻeha a me ka ʻoʻoleʻa o nā hono, kahi mea e kōkua ai i ka hoʻōla ʻana o ka hana hui ma hope o ke ʻoki ʻana. He kūpono kēia ʻano hana no ka mālama ʻana i ka maʻi mua a me ka maʻi haematogenous koʻikoʻi.
ʻO ke pani hoʻokahi-paepae, ʻo ia hoʻi, ke ʻano hana hoʻokahi-paepae, ua kaupalena ʻia i nā maʻi haʻahaʻa-ʻawahia, ka debridement piha, ka sima iwi antibiotic, a me ka loaʻa ʻana o nā antibiotics koʻikoʻi. Ma muli o nā hopena o ka ʻāpana paʻa o ka ʻiʻo intraoperative, inā he emi ma mua o 5 leukocytes/kahua hoʻonui kiʻekiʻe. He hōʻike ia o kahi maʻi haʻahaʻa-ʻawahia. Ma hope o ka debridement piha, ua hana ʻia kahi arthroplasty hoʻokahi-paepae a ʻaʻohe hoʻi hou ʻana o ka maʻi ma hope o ka hana.
Ma hope o ka debridement piha, ua hoʻololi koke ʻia ka prosthesis me ka ʻole o ka pono no kahi hana wehe. Loaʻa iā ia nā pono o ka trauma liʻiliʻi, ka manawa mālama pōkole a me ke kumukūʻai haʻahaʻa, akā ʻoi aku ka kiʻekiʻe o ka helu hoʻi hou ʻana o ka maʻi postoperative, ʻo ia hoʻi ma kahi o 23% ~ 73% e like me nā helu helu. ʻO ka hoʻololi prosthesis hoʻokahi kahua ka mea kūpono loa no nā poʻe maʻi ʻelemakule, me ka ʻole o ka hui pū ʻana i kekahi o kēia mau mea: (1) mōʻaukala o nā ʻokiʻoki he nui ma ka hui pani; (2) ka hoʻokumu ʻana o ke ala sinus; (3) ka maʻi koʻikoʻi (e laʻa me ka septic), ischemia a me ka ʻeha o nā ʻiʻo a puni; (4) debridement piha ʻole o ka trauma me ke koena hapa o ka sima; (5) X-ray e hōʻike ana i ka osteomyelitis; (6) nā kīnā iwi e pono ai ke kāpili iwi; (7) nā maʻi i hui pū ʻia a i ʻole nā bacteria virulent loa (e laʻa me Streptococcus D, Gram-negative bacteria); (8) ka nalowale o ka iwi e pono ai ke kāpili iwi; (9) ka nalowale o ka iwi e pono ai ke kāpili iwi; a me (10) nā kāpili iwi e pono ai ke kāpili iwi. ʻO Streptococcus D, nā bacteria Gram-negative, ʻoi aku hoʻi ʻo Pseudomonas, etc.), a i ʻole ka maʻi fungal, ka maʻi mycobacterial; (8) ʻAʻole maopopo ka moʻomeheu bacteria.
4. ʻO ke ʻoki hoʻoponopono lua-paepae
Ua makemake nui ʻia e nā kauka ʻokiʻoki i nā makahiki he 20 i hala iho nei ma muli o kona ākea o nā hōʻailona (ka nui o ka iwi, nā ʻiʻo palupalu periarticular momona) a me ke kiʻekiʻe o ka hoʻopau ʻana i ka maʻi.
Nā mea hoʻokaʻawale, nā mea lawe antibiotic, nā antibiotic
Me ka nānā ʻole i ke ʻano hana spacer i hoʻohana ʻia, pono ka hoʻopaʻa ʻana me nā antibiotics e hoʻonui i ka nui o nā antibiotics i loko o ke hui a hoʻonui i ka helu ho'ōla o ka maʻi. ʻO nā antibiotics i hoʻohana pinepine ʻia ʻo tobramycin, gentamicin a me vancomycin.
Ua ʻike ke kaiāulu orthopedic honua i ka lāʻau lapaʻau kūpono loa no ka maʻi hohonu ma hope o ka arthroplasty. ʻO ke ʻano hana e pili ana i ka debridement piha, ka wehe ʻana i ka prosthesis a me ke kino haole, ke kau ʻana i kahi spacer hui, ka hoʻomau ʻana i ka hoʻohana ʻana i nā antimicrobials intravenous sensitive no ka liʻiliʻi he 6 mau pule, a ʻo ka hope loa, ma hope o ka kaohi pono ʻana i ka maʻi, ka hoʻokomo hou ʻana i ka prosthesis.
Nā Pōmaikaʻi:
Ua lawa ka manawa e ʻike ai i nā ʻano bacteria a me nā mea antimicrobial koʻikoʻi, hiki ke hoʻohana pono ʻia ma mua o ke ʻoki hoʻoponopono.
Hiki ke mālama ʻia ka hui pū ʻana o nā foci systemic ʻē aʻe o ka maʻi i ka manawa kūpono.
ʻElua mau manawa kūpono no ka debridement e wehe pono i nā ʻiʻo necrotic a me nā kino ʻē, kahi e hoʻemi nui ai i ka nui o ka hoʻi hou ʻana o nā maʻi postoperative.
Nā hemahema:
Hoʻonui ka reanesthesia a me ke ʻoki ʻana i ka pilikia.
Ka lōʻihi o ka manawa lapaʻau a me ke kumukūʻai lapaʻau kiʻekiʻe.
He haʻahaʻa a lohi hoʻi ka hoʻōla ʻana o nā hana ma hope o ke ʻoki ʻana.
Arthroplasty: Kūpono no nā maʻi hoʻomau ʻaʻole i pane i ka lāʻau lapaʻau, a i ʻole no nā kīnā iwi nui; kaupalena ke kūlana o ka mea maʻi i ka hana hou ʻana a me ka hana hou ʻana. ʻEha postoperative koena, ka pono no ka hoʻohana lōʻihi ʻana i nā braces e kōkua i ka neʻe ʻana, kūpaʻa maikaʻi ʻole o nā hono, pōkole o nā lālā, hopena hana, ua kaupalena ʻia ka laulā o ka noi.
ʻO ka Arthroplasty: ka lāʻau kuʻuna no nā maʻi postoperative, me ka paʻa maikaʻi postoperative a me ka hōʻoluʻolu ʻeha. ʻO nā hemahema e komo pū ana me ka pōkole o ka lālā, nā maʻi hele wāwae a me ka nalowale o ka neʻe ʻana o nā hono.
ʻO ke ʻoki ʻana: ʻO ia ke ala hope loa no ka mālama ʻana i ka maʻi hohonu postoperative. Kūpono no: (1) ka nalowale nui o ka iwi, nā kīnā palupalu o nā ʻiʻo; (2) ka ikaika o ka bacterial virulence, nā maʻi i hui pū ʻia, ʻaʻole pono ka mālama antimicrobial, e hopena ana i ka ʻona systemic, hoʻoweliweli i ke ola; (3) he mōʻaukala o ka hāʻule pinepine ʻana o ke ʻoki hoʻoponopono o nā maʻi maʻi mau.
VI. Kāohi ʻana
1. Nā kumu ma mua o ke ʻoki ʻana:
E hoʻomaikaʻi i ke kūlana ma mua o ke ʻoki ʻana o ka mea maʻi a pono e hoʻōla ʻia nā maʻi āpau i loaʻa ma mua o ke ʻoki ʻana. ʻO nā maʻi maʻamau i lawe ʻia e ke koko, ʻo ia nā mea mai ka ʻili, ke ala mimi, a me ke ala hanu. I ka arthroplasty hip a kuli paha, pono e noho ʻole ka ʻili o nā lālā haʻahaʻa. ʻAʻole pono e mālama ʻia ka bacteriuria asymptomatic, ka mea maʻamau i nā poʻe maʻi ʻelemakule, ma mua o ke ʻoki ʻana; ke ʻike ʻia nā hōʻailona, pono e mālama koke ʻia. Pono e hoʻopau ʻia nā maʻi me ka tonsillitis, nā maʻi ala hanu kiʻekiʻe, a me ka tinea pedis. ʻO nā hana niho nui aʻe kahi kumu kūpono o ka maʻi koko, a ʻoiai ua pale ʻia, inā pono nā hana niho, ua ʻōlelo ʻia e hana ʻia kēlā mau kaʻina hana ma mua o ka arthroplasty. Pono e mālama ikaika ʻia a hiki i ka wā mua nā maʻi me nā kūlana maikaʻi ʻole e like me ka anemia, hypoproteinaemia, ka maʻi diabetes i hui pū ʻia a me nā maʻi ala mimi mau no ka maʻi mua e hoʻomaikaʻi i ke kūlana systemic.
2. Ka hoʻokele intraoperative:
(1) Pono e hoʻohana ʻia nā ʻano hana a me nā mea hana aseptic piha i ke ʻano lapaʻau maʻamau i ka arthroplasty.
(2) Pono e hoʻemi ʻia ka hoʻokipa ʻana ma mua o ke ʻoki ʻana e hōʻemi i ka pilikia o ka ʻili o ka mea maʻi e noho pū me nā ʻano bacteria i loaʻa i ka haukapila, a pono e hana ʻia ka mālama maʻamau i ka lā o ke ʻoki ʻana.
(3) Pono e hoʻomākaukau pono ʻia ka wahi ma mua o ke ʻoki ʻana no ka hoʻomākaukau ʻana i ka ʻili.
(4) He kūpono nā ʻaʻahu ʻoki, nā pale maka, nā pāpale, a me nā keʻena hana laminar flow i ka hōʻemi ʻana i nā bacteria ea i loko o ke keʻena hana. ʻO ke komo ʻana i nā mīkina lima pālua hiki ke hōʻemi i ka pilikia o ka pili lima ma waena o ke kauka ʻoki a me ka mea maʻi a hiki ke ʻōlelo ʻia.
(5) Ua hōʻoia ʻia ma ke ʻano lapaʻau ʻo ka hoʻohana ʻana i ka prosthesis ʻoi aku ka paʻa, ʻoi aku ka hinged, ʻoi aku ka nui o ka maʻi ma mua o ka non-restrictive total knee arthroplasty ma muli o nā ʻōpala metala abrasive e hōʻemi ana i ka hana phagocytosis, a no laila e pale ʻia i ke koho ʻana o ka prosthesis.
(6) E hoʻomaikaʻi i ke ʻano hana o ka mea hana a hoʻopōkole i ka lōʻihi o ke hana (<2.5 h inā hiki). ʻO ka hoʻopōkole ʻana i ka lōʻihi o ke ʻoki ʻana hiki ke hōʻemi i ka manawa o ka ʻike ʻana i ka ea, kahi e hiki ai ke hōʻemi i ka manawa o ka hoʻohana ʻana i ka tourniquet. E pale i ka hana ʻino i ka wā o ke ʻoki ʻana, hiki ke hoʻoinu pinepine ʻia ka ʻeha (ʻoi aku ka maikaʻi o ka pū hoʻoinu pulsed), a hiki ke lawe ʻia ka hoʻokomo ʻana i ka iodine-vapor no nā ʻoki i manaʻo ʻia ua haumia.
3. Nā kumu ma hope o ke ʻoki ʻana:
(1) Hoʻoulu nā hahau ʻoki i ke kū'ē ʻana o ka insulin, hiki ke alakaʻi i ka hyperglycaemia, kahi hanana e hiki ke hoʻomau no kekahi mau pule ma hope o ka hana a hoʻopilikia i ka mea maʻi i nā pilikia e pili ana i ka ʻeha, a ʻo ia hoʻi, e hana ʻia i nā poʻe maʻi ʻaʻole i loaʻa i ka maʻi diabetes. No laila, he mea nui like ka nānā ʻana i ka glucose koko ma hope o ka hana lapaʻau.
(2) Hoʻonui ka thrombosis vein hohonu i ka pilikia o ka hematoma a me nā pilikia e pili ana i ka ʻeha. Ua ʻike ʻia kahi noiʻi hihia-kaohi he pono ka hoʻopili ʻana o ka heparin molekala haʻahaʻa ma hope o ka hana ʻana e pale aku i ka thrombosis vein hohonu i ka hōʻemi ʻana i ka hiki ke loaʻa ka maʻi.
(3) ʻO ka hoʻokahe wai pani ʻia kahi puka komo no ka maʻi, akā ʻaʻole i aʻo pono ʻia kona pilina me nā helu maʻi ʻeha. Hōʻike nā hopena mua e hiki i nā catheters intra-articular i hoʻohana ʻia ma ke ʻano he lawelawe postoperative o nā analgesics ke maʻalahi i ka maʻi ʻeha.
4. Ka pale ʻana i nā lāʻau antibiotic:
I kēia manawa, ʻo ka hoʻopili maʻamau ʻana o nā lāʻau antibiotic prophylactic i hāʻawi ʻia ma ke ʻano intravenous ma mua a ma hope o ke ʻoki ʻana e hōʻemi ana i ka pilikia o ka maʻi postoperative. Hoʻohana nui ʻia nā Cephalosporins ma ke ʻano lapaʻau ma ke ʻano he antibiotic koho, a aia kahi pilina piʻo U-ʻano ma waena o ka manawa o ka hoʻohana ʻana i ka antibiotic a me ka nui o nā maʻi ma kahi ʻoki, me ka nui o ka pilikia o ka maʻi ma mua a ma hope o ka manawa kūpono no ka hoʻohana ʻana i ka antibiotic. Ua ʻike ʻia kahi noiʻi nui i hala koke nei ua loaʻa i nā antibiotics i hoʻohana ʻia i loko o 30 a 60 min ma mua o ka ʻoki ʻana ka nui o ka maʻi haʻahaʻa loa. I ka hoʻohālikelike ʻana, ua hōʻike kekahi noiʻi nui o ka arthroplasty hip holoʻokoʻa i ka nui haʻahaʻa loa o ka maʻi me nā antibiotics i hāʻawi ʻia i loko o 30 min mua o ka ʻoki ʻana. No laila, ʻo ka manawa o ka lawelawe ʻana ua manaʻo ʻia he 30 min ma mua o ke ʻoki ʻana, me nā hopena maikaʻi loa i ka wā o ka hoʻokomo ʻana o ka anesthesia. Hāʻawi ʻia kekahi lāʻau antibiotic prophylactic ma hope o ke ʻoki ʻana. Ma ʻEulopa a me ʻAmelika Hui Pū ʻIa, hoʻohana pinepine ʻia nā antibiotics a hiki i ke kolu o ka lā postoperative, akā ma Kina, ua hōʻike ʻia ua hoʻohana mau ʻia lākou no 1 a 2 mau pule. Eia nō naʻe, ʻo ka manaʻo like maʻamau, ʻo ia ka pale ʻana i ka hoʻohana lōʻihi ʻana i nā antibiotics ākea ikaika ke ʻole he mau kūlana kūikawā, a inā pono ka hoʻohana lōʻihi ʻana i nā antibiotics, he mea kūpono ke hoʻohana i nā lāʻau antifungal me nā antibiotics e pale aku i nā maʻi fungal. Ua hōʻike ʻia ʻo Vancomycin he pono i nā poʻe maʻi kiʻekiʻe e lawe ana i ka methicillin-resistant Staphylococcus aureus. Pono e hoʻohana ʻia nā dosis kiʻekiʻe o nā antibiotics no nā ʻoki lōʻihi, me nā ʻoki bilateral, ʻoiai inā pōkole ka hapalua ola antibiotic.
5. Ka hoʻohana ʻana i nā lāʻau antibiotic i hui pū ʻia me ka sima iwi:
Ua hoʻohana mua ʻia ka sima i hoʻokomo ʻia i ka antibiotic i ka arthroplasty ma Norewai, kahi i hōʻike mua ʻia ai kahi noiʻi Norwegian Arthroplasty Registry ua hōʻemi ka hoʻohana ʻana i ka hui pū ʻana o ka antibiotic IV a me ka sima (hui pū ʻia me ka antibiotic prosthesis) i ka nui o ka maʻi hohonu ma mua o kēlā me kēia ʻano hana wale nō. Ua hōʻoia ʻia kēia ʻike ma kahi moʻo o nā noiʻi nui i nā makahiki 16 e hiki mai ana. Ua hōʻea kahi noiʻi Finnish a me ka Australian Orthopaedic Association 2009 i nā hopena like e pili ana i ke kuleana o ka sima i hoʻokomo ʻia i ka antibiotic i ka arthroplasty kuli mua a me ka hoʻoponopono hou ʻana. Ua hōʻike ʻia hoʻi ʻaʻole i hoʻopilikia ʻia nā waiwai biomechanical o ka sima iwi ke hoʻohui ʻia ka pauka antibiotic i nā dosis ʻaʻole i ʻoi aku ma mua o 2 g no 40 g o ka sima iwi. Eia naʻe, ʻaʻole hiki ke hoʻohui ʻia nā antibiotic āpau i ka sima iwi. Pono nā antibiotics e hiki ke hoʻohui ʻia i ka sima iwi i nā kūlana penei: palekana, kūpaʻa thermal, hypoallergenicity, solubility wai maikaʻi, spectrum antimicrobial ākea, a me ka mea pauka. I kēia manawa, ʻoi aku ka hoʻohana pinepine ʻia o vancomycin a me gentamicin i ka hana lapaʻau. Ua manaʻo ʻia e hoʻonui ka hoʻokomo ʻana i ka antibiotic i loko o ka sima i ka pilikia o nā hopena aleri, ka puka ʻana mai o nā ʻano kūpaʻa, a me ka wehe ʻana o ka prosthesis i ka aseptic, akā a hiki i kēia manawa ʻaʻohe hōʻike e kākoʻo i kēia mau hopohopo.
VII. Hōʻuluʻulu Manaʻo
ʻO ka hana ʻana i kahi hōʻailona wikiwiki a pololei ma o ka mōʻaukala, ka hoʻokolokolo kino a me nā hoʻokolohua kōkua he mea pono ia no ka mālama pono ʻana i nā maʻi hui. ʻO ka hoʻopau ʻana i ka maʻi a me ka hoʻihoʻi ʻana i kahi hui hana hana ʻole me ka ʻeha ʻole ke kumu nui o ka mālama ʻana i nā maʻi hui. ʻOiai he maʻalahi a he ʻuʻuku ke kumukūʻai o ka mālama ʻana i ka maʻi hui me ka antibiotic, ʻo ka hoʻopau ʻana i ka maʻi hui e pono ai ka hui pū ʻana o nā ʻano hana ʻoki. ʻO ke kī i ke koho ʻana i ka mālama ʻoki ʻana, ʻo ia ka noʻonoʻo ʻana i ka pilikia o ka wehe ʻana i ka prosthesis, ʻo ia ke ʻano nui o ka mālama ʻana i nā maʻi hui. I kēia manawa, ua lilo ka hoʻopili pū ʻana o nā antibiotics, debridement a me ka arthroplasty i mea lapaʻau piha no ka hapa nui o nā maʻi hui paʻakikī. Eia nō naʻe, pono e hoʻomaikaʻi a hoʻomaikaʻi ʻia.
Ka manawa hoʻouna: Mei-06-2024
