Kev kis kab mob yog ib qho teeb meem loj tshaj plaws tom qab kev sib koom tes sib koom ua ke, uas tsis yog tsuas yog ua rau ntau qhov kev phais mob rau cov neeg mob, tab sis kuj siv cov khoom siv kho mob loj. Tshaj li 10 xyoo dhau los, tus kab mob kis tau tom qab kev sib koom tes sib koom ua ke tau txo qis, tab sis qhov kev loj hlob tam sim no ntawm cov neeg mob uas tau txais kev sib koom tes sib koom ua ke tau dhau mus deb tshaj qhov txo qis ntawm tus kab mob, yog li qhov teeb meem ntawm kev kis kab mob tom qab yuav tsum tsis txhob cuam tshuam.
I. Ua rau mob
Cov kab mob tom qab kev sib koom ua ke hloov pauv yuav tsum tau suav tias yog cov kab mob hauv tsev kho mob tau txais nrog cov tshuaj tiv thaiv kab mob. Feem ntau yog staphylococcus, suav txog 70% mus rau 80%, gram-negative bacilli, anaerobes thiab non-A pab pawg streptococci kuj tshwm sim.
II Pathogenesis
Kev kis kab mob tau muab faib ua ob pawg: ib qho yog kab mob ntxov thiab lwm yam yog kab mob lig lossis hu ua kab mob lig. Cov kab mob thaum ntxov yog tshwm sim los ntawm cov kab mob nkag mus rau hauv kev sib koom tes thaum phais thiab feem ntau yog Staphylococcus epidermidis. Kev kis kab mob lig yog tshwm sim los ntawm kev sib kis los ntawm cov ntshav thiab feem ntau yog Staphylococcus aureus. Cov pob qij txha uas tau ua los ntawm cov khoom muaj feem yuav kis tau. Piv txwv li, muaj 10% tus kab mob kis tau tus mob nyob rau hauv cov ntaub ntawv kho dua tom qab kev sib koom ua ke hloov, thiab tus kab mob no kuj siab dua nyob rau hauv cov neeg uas tau muaj kev sib koom tes hloov rau rheumatoid mob caj dab.
Feem ntau ntawm cov kab mob tshwm sim nyob rau hauv ob peb lub hlis tom qab kev ua haujlwm, qhov ntxov tshaj plaws tuaj yeem tshwm sim thawj ob lub lis piam tom qab kev ua haujlwm, tab sis kuj yog lig li ob peb xyoos ua ntej qhov tshwm sim ntawm qhov tshwm sim thaum ntxov ntawm mob pob qij txha, mob thiab kub taub hau. , cov tsos mob ua npaws yuav tsum sib txawv ntawm lwm yam teeb meem, xws li mob ntsws tom qab phais, kab mob urinary thiab lwm yam.
Nyob rau hauv cov ntaub ntawv ntawm tus kab mob thaum ntxov, lub cev kub tsis tsuas yog tsis zoo, tab sis nce peb hnub tom qab kev phais. Kev mob pob qij txha tsis tsuas yog maj mam txo, tab sis maj mam ua kom hnyav dua, thiab muaj qhov mob throbbing thaum so. Muaj oozing txawv txav los yog secretion los ntawm qhov incision. Qhov no yuav tsum tau ua tib zoo tshuaj xyuas, thiab qhov kub taub hau yuav tsum tsis txhob yooj yim vim tias muaj kab mob tom qab phais hauv lwm qhov hauv lub cev xws li lub ntsws lossis cov zis. Nws tseem yog ib qho tseem ceeb kom tsis txhob cia li tso tseg incisional oozing li ib txwm oozing xws li roj liquefaction. Nws tseem yog ib qho tseem ceeb kom paub seb tus kab mob no puas nyob hauv cov ntaub so ntswg los yog tob ib ncig ntawm lub prosthesis.
Hauv cov neeg mob uas muaj kab mob siab heev, feem ntau ntawm cov neeg tau tawm hauv tsev kho mob, kev sib koom ua ke o, mob, thiab kub taub hau yuav tsis mob hnyav. Ib nrab ntawm cov neeg mob yuav tsis kub taub hau. Staphylococcus epidermidis tuaj yeem ua rau mob tsis muaj mob nrog cov ntshav dawb ntau ntxiv hauv 10% ntawm cov neeg mob. Kev nce ntshav sedimentation ntau dua tab sis dua tsis meej. Kev mob qee zaum raug kuaj pom tsis raug raws li kev xoob xoob xoob xoob xoob, qhov kawg yog qhov mob cuam tshuam nrog kev txav mus los uas yuav tsum tau txo qis los ntawm kev so, thiab qhov mob inflammatory uas tsis tau so los ntawm so. Txawm li cas los xij, nws tau raug pom tias qhov ua rau lub ntsiab ntawm cov prosthesis loosening yog ncua kev kis kab mob.
III. Kev kuaj mob
1. Hematological kuaj:
Feem ntau suav nrog cov qe ntshav dawb suav nrog kev faib tawm, interleukin 6 (IL-6), C-reactive protein (CRP) thiab erythrocyte sedimentation rate (ESR). Qhov zoo ntawm kev kuaj hematological yog qhov yooj yim thiab yooj yim rau kev ua, thiab cov txiaj ntsig tuaj yeem tau txais sai; ESR thiab CRP muaj qhov tshwj xeeb tsawg; IL-6 yog qhov muaj txiaj ntsig zoo hauv kev txiav txim siab tus kab mob periprosthetic nyob rau lub sijhawm tom qab ua haujlwm ntxov.
2. Kev ntsuam xyuas duab:
X-ray zaj duab xis: tsis rhiab lossis tshwj xeeb rau kev kuaj mob.
X-ray zaj duab xis ntawm lub hauv caug hloov kab mob
Arthrography: tus neeg sawv cev tseem ceeb hauv kev kuaj mob yog qhov tawm ntawm cov kua dej synovial thiab abscess.
CT: pom kev sib koom ua ke effusion, sinus tracts, cov nqaij mos abscesses, pob txha yaig, periprosthetic pob txha resorption.
MRI: rhiab heev rau kev tshawb pom ntxov ntawm cov kua dej sib koom ua ke thiab abscesses, tsis yog siv dav hauv kev kuaj mob periprothetic.
Ultrasound: ua kua dej.
3. Nuclear tshuaj
Technetium-99 pob txha scan muaj qhov rhiab heev ntawm 33% thiab qhov tshwj xeeb ntawm 86% rau kev kuaj mob ntawm periprosthetic kab mob tom qab arthroplasty, thiab indium-111 sau npe leukocyte scan muaj txiaj ntsig zoo dua rau kev kuaj mob periprosthetic, nrog rau rhiab ntawm 77% thiab ib tug specification ntawm 86%. Thaum ob qhov kev tshuaj ntsuam xyuas tau siv ua ke rau kev kuaj mob periprosthetic tom qab arthroplasty, qhov siab dua, qhov tshwj xeeb thiab qhov tseeb tuaj yeem ua tiav. Qhov kev sim no tseem yog tus qauv kub hauv cov tshuaj nuclear rau kev kuaj mob periprothetic. Fluorodeoxyglucose-positron emission tomography (FDG-PET). Nws kuaj pom cov kab mob inflammatory nrog cov piam thaj nce ntxiv hauv thaj chaw muaj kab mob.
4. Molecular biology cov txheej txheem
PCR: siab rhiab heev, cuav zoo
Gene chip technology: kev tshawb fawb theem.
5. Arthrocentesis:
Kev soj ntsuam cytological ntawm cov kua dej sib koom ua ke, kab lis kev cai kab lis kev cai thiab tshuaj rhiab heev kuaj.
Txoj kev no yooj yim, ceev thiab raug
Hauv cov kab mob hauv lub duav, qhov sib koom ua ke ntawm cov kua dej leucocyte suav > 3,000 / ml ua ke nrog nce ESR thiab CRP yog qhov zoo tshaj plaws rau kev muaj kab mob periprosthetic.
6. Intraoperative ceev khov seem histopathology
Kev nrawm nrawm nrawm ntawm qhov khov ntawm cov ntaub so ntswg periprosthetic yog feem ntau siv intraoperative txoj kev rau kev kuaj histopathological. Feldman cov txheej txheem kuaj mob, piv txwv li, ntau dua lossis sib npaug ntawm 5 neutrophils ib qhov kev nthuav dav siab (400x) hauv tsawg kawg yog 5 qhov sib cais microscopic, feem ntau siv rau cov seem khov. Nws tau raug pom tias qhov rhiab heev thiab qhov tshwj xeeb ntawm txoj kev no yuav dhau 80% thiab 90%, feem. Txoj kev no yog tam sim no tus qauv kub rau kev kuaj mob intraoperative.
7. Kab mob kab mob ntawm cov ntaub so ntswg pathological
Kab lis kev cai kab lis kev cai ntawm cov ntaub so ntswg periprosthetic muaj qhov tshwj xeeb rau kev kuaj kab mob thiab tau raug suav tias yog tus qauv kub rau kev kuaj mob periprosthetic, thiab nws kuj tuaj yeem siv rau kev sim tshuaj rhiab heev.
IV. Differential kev kuaj mobs
Kev mob ntawm cov pob qij txha tsis mob tshwm sim los ntawm Staphylococcus epidermidis yog qhov nyuaj rau kev sib txawv ntawm cov pob qij txha. Nws yuav tsum tau lees paub los ntawm X-rays thiab lwm yam kev ntsuam xyuas.
V. Kev kho mob
1. Tej yam yooj yim tshuaj tiv thaiv kab mob
Tsakaysma thiab se,gawa cais cov kab mob tom qab arthroplasty rau plaub hom, hom I asymptomatic hom, tus neeg mob tsuas yog nyob rau hauv kev kho dua tshiab cov ntaub so ntswg kab lis kev cai pom tias muaj kab mob loj hlob, thiab tsawg kawg yog ob tus qauv coj los ntawm tib cov kab mob; Hom II yog ib qho kab mob ntxov, uas tshwm sim hauv ib lub hlis ntawm kev phais; Hom IIl yog tus kab mob ncua ntev; thiab hom IV yog ib qho mob haematogenous. Lub hauv paus ntsiab lus ntawm kev kho cov tshuaj tua kab mob yog rhiab heev, txaus tus nqi thiab sijhawm. Thiab preoperative leeg kab noj hniav puncture thiab intraoperative cov ntaub so ntswg kab lis kev cai yog qhov tseem ceeb heev rau kev xaiv kom raug cov tshuaj tua kab mob. Yog tias kab mob kab mob zoo rau tus kab mob hom I, kev siv cov tshuaj tua kab mob yooj yim rau 6 lub lis piam tuaj yeem ua tiav cov txiaj ntsig zoo.
2. Prosthesis retention, debridement thiab kua, raj irrigation phais
Lub hauv paus ntsiab lus ntawm kev siv lub hauv paus ntawm kev raug mob tuav prosthesis yog tias cov prosthesis ruaj khov thiab mob hnyav. Cov kab mob kis tau meej meej, cov kab mob virulence yog tsawg thiab muaj cov tshuaj tua kab mob rhiab heev, thiab cov liner lossis spacer tuaj yeem hloov tau thaum lub sij hawm debridement. Kev kho tus nqi tsuas yog 6% nrog cov tshuaj tua kab mob ib leeg thiab 27% nrog cov tshuaj tua kab mob ntxiv rau cov khoom pov tseg thiab kev khaws cia cov khoom siv tau raug tshaj tawm hauv cov ntaub ntawv.
Nws yog tsim rau cov kab mob thaum ntxov los yog mob haematogenous kab mob nrog zoo prosthesis fixation; kuj, nws yog tseeb hais tias tus kab mob yog ib tug tsawg virulence kab mob uas yog rhiab heev rau antimicrobial kho. Txoj hauv kev muaj xws li kev tshem tawm tag nrho, tshuaj tua kab mob tua kab mob thiab tso kua dej (ntev sijhawm 6 lub lis piam), thiab tom qab kev siv tshuaj tua kab mob hauv cov hlab ntsha (ntev sijhawm 6 lub lis piam mus rau 6 lub hlis). Qhov tsis zoo: qhov tsis ua haujlwm siab (txog 45%), lub sijhawm kho ntev.
3. Ib theem kho kev phais
Nws muaj qhov zoo ntawm kev raug mob tsawg dua, nyob hauv tsev kho mob luv dua, txo nqi kho mob, tsawg dua qhov txhab caws pliav thiab pob qij txha, uas yog qhov zoo rau kev rov ua haujlwm ntawm kev sib koom tes tom qab kev phais. Txoj kev no tsuas yog tsim nyog rau kev kho mob thaum ntxov thiab mob haematogenous kab mob.
Ib-theem hloov, piv txwv li, ib-kauj ruam txoj kev, yog txwv rau cov kab mob toxicity tsawg, kev debridement, tshuaj tua kab mob pob txha cement, thiab muaj cov tshuaj tua kab mob rhiab heev. Raws li cov txiaj ntsig ntawm cov ntaub so ntswg khov, yog tias muaj tsawg dua 5 leukocytes / siab magnification teb. Nws qhia tau hais tias tus kab mob toxicity tsawg. Tom qab tag nrho cov debridement ib theem arthroplasty tau ua thiab tsis muaj rov tshwm sim ntawm tus kab mob postoperatively.
Tom qab tag nrho cov debridement, lub prosthesis yog tam sim ntawd hloov tsis tau rau ib tug qhib txoj kev. Nws muaj qhov zoo ntawm kev raug mob me me, lub sijhawm kho luv luv thiab tus nqi qis, tab sis tus nqi rov qab ntawm tus kab mob tom qab phais yog siab dua, uas yog kwv yees li 23% ~ 73% raws li kev txheeb cais. Ib-theem prosthesis hloov yog feem ntau haum rau cov neeg laus cov neeg mob, tsis muaj combining ib yam ntawm cov nram qab no: (1) keeb kwm ntawm ntau yam kev phais nyob rau hauv lub hloov ob leeg; (2) sinus tract tsim; (3) mob hnyav (xws li septic), ischemia thiab caws pliav ntawm cov ntaub so ntswg; (4) kev puas tsuaj tsis tiav ntawm kev raug mob nrog ib feem ntawm cov cement seem; (5) X-ray qhia txog osteomyelitis; (6) pob txha tsis xws luag yuav tsum tau pob txha grafting; (7) cov kab mob sib xyaw los yog cov kab mob uas muaj kab mob siab heev (xws li Streptococcus D, Gram-negative bacteria); (8) pob txha poob yuav tsum tau pob txha grafting; (9) pob txha poob yuav tsum tau pob txha grafting; thiab (10) pob txha grafts yuav tsum tau pob txha grafting. Streptococcus D, Gram-negative kab mob, tshwj xeeb tshaj yog Pseudomonas, thiab lwm yam), los yog kab mob fungal, kab mob mycobacterial; (8) Kab lis kev cai kab lis kev cai tsis meej.
4. Kev phais thib ob
Nws tau txais kev pom zoo los ntawm cov kws phais mob dhau 20 xyoo dhau los vim nws qhov ntau yam ntawm cov cim qhia (cov pob txha txaus, cov nqaij mos periarticular nplua nuj) thiab tus nqi siab ntawm kev tshem tawm cov kab mob.
Cov tshuaj tua kab mob, tshuaj tua kab mob, tshuaj tua kab mob
Txawm hais tias siv cov txheej txheem spacer, cemented fixation nrog tshuaj tua kab mob yog tsim nyog los ua kom cov concentration ntawm cov tshuaj tua kab mob nyob rau hauv kev sib koom tes thiab ua rau kom tus nqi kho mob. Cov tshuaj tua kab mob feem ntau siv yog tobramycin, gentamicin thiab vancomycin.
Lub zej zog orthopedic thoob ntiaj teb tau lees paub qhov kev kho mob zoo tshaj plaws rau kev sib sib zog nqus kis kab mob tom qab arthroplasty. Txoj hauv kev muaj kev sib tw kom zoo, tshem tawm cov prosthesis thiab txawv teb chaws lub cev, muab tso rau hauv qhov sib koom ua ke, txuas ntxiv siv cov tshuaj tua kab mob hauv cov hlab ntsha tsawg kawg yog 6 lub lis piam, thiab thaum kawg, tom qab tswj tau zoo ntawm tus kab mob, rov ua dua tshiab ntawm prosthesis.
Qhov zoo:
Lub sijhawm txaus los txheeb xyuas cov kab mob thiab cov tshuaj tiv thaiv kab mob rhiab heev, uas tuaj yeem siv tau zoo ua ntej kev phais kho dua tshiab.
Kev sib xyaw ua ke ntawm lwm cov kab mob foci ntawm tus kab mob tuaj yeem kho tau raws sijhawm.
Muaj ob txoj hauv kev rau kev debridement kom tshem tawm cov ntaub so ntswg necrotic thiab lub cev txawv teb chaws ntau dua, uas txo qis tus nqi ntawm kev rov ua dua ntawm cov kab mob tom qab phais.
Qhov tsis zoo:
Re-anaesthesia thiab phais ua rau muaj kev pheej hmoo.
Lub sijhawm kho mob ntev thiab tus nqi kho mob ntau dua.
Kev ua haujlwm tom qab ua haujlwm rov qab ua haujlwm tsis zoo thiab qeeb.
Arthroplasty: Haum rau cov kab mob tsis tu ncua uas tsis teb rau kev kho mob, lossis rau cov pob txha loj; Tus neeg mob tus mob txwv tsis pub rov ua haujlwm thiab rov tsim kho tsis ua haujlwm. Cov tsos mob tom qab phais tas, qhov xav tau rau kev siv lub sij hawm ntev ntawm cov braces los pab kev txav mus los, tsis muaj kev sib koom ua ke tsis zoo, cov ceg tawv luv luv, kev ua haujlwm tsis zoo, cov peev txheej ntawm daim ntawv thov raug txwv.
Arthroplasty: kev kho mob ib txwm muaj rau cov kab mob tom qab kev phais, nrog kev ua haujlwm zoo tom qab kev ruaj ntseg thiab mob nyem. Cov kev tsis zoo muaj xws li kev txo qis ntawm cov ceg tawv, kev tsis sib haum xeeb thiab poob ntawm kev sib koom ua ke.
Amputation: Nws yog qhov chaw kawg rau kev kho mob tom qab kis kab mob sib sib zog nqus. Haum rau: (1) irreparable loj pob txha poob, mos mos tsis xws luag; (2) Cov kab mob muaj zog muaj zog, sib xyaw ua ke, kev kho mob antimicrobial tsis muaj txiaj ntsig, ua rau muaj kev phom sij rau lub cev, ua rau muaj kev phom sij rau lub neej; (3) muaj keeb kwm ntawm ntau yam tsis ua haujlwm ntawm kev kho dua tshiab ntawm cov neeg mob uas muaj mob ntev.
VI. Kev tiv thaiv
1. Cov yam ntxwv ua ntej:
Ua kom zoo rau tus neeg mob qhov mob ua ntej thiab tag nrho cov kab mob uas twb muaj lawm yuav tsum tau kho ua ntej. Cov kab mob uas muaj ntshav ntau tshaj plaws yog cov kab mob ntawm daim tawv nqaij, qhov tso zis, thiab ua pa. Nyob rau hauv lub duav los yog lub hauv caug arthroplasty, daim tawv nqaij ntawm lub qis extremities yuav tsum nyob twj ywm unbroken. Asymptomatic bacteriuria, uas yog tshwm sim nyob rau hauv cov neeg mob laus, tsis tas yuav kho preoperatively; Thaum cov tsos mob tshwm sim lawv yuav tsum tau kho tam sim ntawd. Cov neeg mob uas muaj tonsillitis, kab mob ua pa sab sauv, thiab tinea pedis yuav tsum muaj cov foci hauv zos ntawm kev kis kab mob. Kev kho hniav loj dua yog qhov muaj peev xwm ntawm cov kab mob hauv cov hlab ntsha, thiab txawm hais tias zam, yog tias tsim nyog kev kho hniav, nws raug nquahu kom ua cov txheej txheem ua ntej arthroplasty. Cov neeg mob uas muaj kev tsis zoo xws li anemia, hypoproteinemia, ua ke nrog ntshav qab zib thiab mob urinary kab mob yuav tsum tau kho mob hnyav thiab ntxov rau thawj tus kab mob txhawm rau txhim kho cov kab mob hauv lub cev.
2. Intraoperative tswj:
(1) Ua tiav aseptic cov tswv yim thiab cov cuab yeej yuav tsum tau ua haujlwm nyob rau hauv txoj kev kho niaj hnub mus rau arthroplasty.
(2) Kev mus pw hauv tsev kho mob ua ntej yuav tsum tau txo qis kom txo tau qhov kev pheej hmoo uas tus neeg mob daim tawv nqaij tuaj yeem ua rau cov kab mob hauv tsev kho mob tau txais, thiab kev kho mob niaj hnub yuav tsum tau ua rau hnub ntawm kev phais.
(3) Qhov chaw ua ntej yuav tsum tau npaj kom zoo rau kev npaj daim tawv nqaij.
(4) Cov ris tsho phais, lub qhov ncauj qhov ntswg, lub kaus mom, thiab laminar khiav khiav ua yeeb yam tau zoo los txo cov kab mob hauv huab cua hauv kev ua yeeb yam. Kev hnav ob lub hnab looj tes tuaj yeem txo qhov kev pheej hmoo ntawm kev sib cuag ntawm tes ntawm tus kws phais thiab tus neeg mob thiab tuaj yeem pom zoo.
(5) Nws tau raug pov thawj hauv kev kho mob tias kev siv cov kev txwv ntau dua, tshwj xeeb tshaj yog hinged, prosthesis muaj kev pheej hmoo ntawm kev kis kab mob ntau dua li tsis muaj kev txwv tag nrho lub hauv caug arthroplasty vim yog cov khoom siv hlau abrasive uas txo cov kev ua ntawm phagocytosis, thiab yog li ntawd yuav tsum tau zam hauv kev xaiv cov khoom siv prosthesis. .
(6) Txhim kho cov txheej txheem phais ntawm tus neeg teb xov tooj thiab txo lub sijhawm ua haujlwm (<2.5 h yog tias ua tau). Lub sijhawm luv luv ntawm kev phais tuaj yeem txo lub sijhawm ntawm kev raug huab cua, uas nyob rau hauv lem tuaj yeem txo lub sijhawm ntawm kev siv tourniquet. Tsis txhob ua haujlwm hnyav thaum lub sijhawm phais, lub qhov txhab tuaj yeem rov ua dej ntau dua (pulsed irrigating rab phom yog qhov zoo tshaj), thiab iodine-vapor immersion tuaj yeem coj mus rau incisions xav tias yuav kis tau.
3. Cov yam ntxwv tom qab:
(1) Kev phais mob ua rau cov tshuaj insulin tsis kam, uas tuaj yeem ua rau hyperglycemia, qhov tshwm sim uas tuaj yeem tshwm sim rau ob peb lub lis piam tom qab kev phais thiab ua rau tus neeg mob ua rau muaj teeb meem ntawm qhov txhab, thiab qhov twg, ntxiv rau, tshwm sim hauv cov neeg mob uas tsis muaj ntshav qab zib thiab. Yog li ntawd, kev soj ntsuam cov ntshav qabzib hauv ntshav qab zib yog qhov tseem ceeb sib npaug.
(2) Cov hlab ntsha sib sib zog nqus ua rau muaj kev pheej hmoo ntawm hematoma thiab cov teeb meem cuam tshuam txog qhov txhab. Ib txoj kev tshawb fawb tswj tau pom tias tom qab kev siv cov tshuaj heparin qis molecular los tiv thaiv cov hlab ntsha sib sib zog nqus yog qhov muaj txiaj ntsig zoo hauv kev txo qis qhov tshwm sim ntawm tus kab mob.
(3) Kaw cov kua dej yog qhov muaj peev xwm nkag mus rau kev kis tus kab mob, tab sis nws txoj kev sib raug zoo rau qhov txhab kab mob tsis tau kawm tshwj xeeb. Cov txiaj ntsig ua ntej qhia tau hais tias cov catheters intra-articular siv los ua kev tswj hwm kev noj qab haus huv ntawm cov tshuaj analgesics kuj tseem tuaj yeem ua rau kis kab mob.
4. Tshuaj tiv thaiv kab mob:
Tam sim no, niaj hnub kev kho mob daim ntawv thov ntawm prophylactic koob tshuaj ntawm cov tshuaj tua kab mob systemically muab intravenously ua ntej thiab tom qab kev phais yuav txo tau txoj kev pheej hmoo ntawm tus kab mob postoperative. Cephalosporins feem ntau yog siv nyob rau hauv kev kho mob raws li cov tshuaj tua kab mob ntawm kev xaiv, thiab muaj ib tug U-shaped nkhaus kev sib raug zoo ntawm lub sij hawm ntawm kev siv tshuaj tua kab mob thiab tus nqi ntawm cov kab mob ntawm qhov chaw phais, muaj kev pheej hmoo ntawm kev kis kab mob ob qho tib si ua ntej thiab tom qab lub sij hawm zoo rau cov tshuaj tua kab mob. siv. Ib txoj kev tshawb fawb loj tsis ntev los no tau pom tias cov tshuaj tua kab mob siv li ntawm 30 mus rau 60 feeb ua ntej qhov kev phais muaj tus kab mob tsawg tshaj plaws. Nyob rau hauv sib piv, lwm txoj kev tshawb fawb loj ntawm tag nrho cov hip arthroplasty pom qhov qis tshaj ntawm tus kab mob nrog cov tshuaj tua kab mob siv nyob rau hauv thawj 30 min ntawm incision. Yog li lub sij hawm ntawm kev tswj hwm feem ntau suav hais tias yog 30 min ua ntej kev ua haujlwm, nrog cov txiaj ntsig zoo tshaj plaws thaum lub sij hawm induction ntawm tshuaj loog. Lwm koob tshuaj tiv thaiv kab mob yog muab tom qab phais. Hauv Tebchaws Europe thiab Tebchaws Meskas, cov tshuaj tua kab mob feem ntau yog siv mus txog rau hnub thib peb tom qab phais, tab sis hauv Suav teb, tau tshaj tawm tias lawv feem ntau siv tsis tu ncua rau 1 mus rau 2 lub lis piam. Txawm li cas los xij, qhov kev pom zoo dav dav yog tias kev siv cov tshuaj tua kab mob ntev ntev yuav tsum tau zam tshwj tsis yog tias muaj xwm txheej tshwj xeeb, thiab yog tias siv cov tshuaj tua kab mob ntev ntev, nws raug nquahu kom siv cov tshuaj tua kab mob ua ke nrog tshuaj tua kab mob los tiv thaiv kab mob fungal. . Vancomycin tau pom tias muaj txiaj ntsig zoo rau cov neeg mob uas muaj kev pheej hmoo siab nqa methicillin-resistant Staphylococcus aureus. Kev siv tshuaj tua kab mob ntau dua yuav tsum tau siv rau kev phais ntev, suav nrog kev phais ob sab, tshwj xeeb tshaj yog thaum cov tshuaj tua kab mob ib nrab-lub neej luv.
5. Kev siv tshuaj tua kab mob ua ke nrog cov pob txha cement:
Antibiotic-infused cement kuj yog thawj zaug siv hauv arthroplasty hauv Norway, qhov twg thawj zaug Norwegian Arthroplasty Registry txoj kev tshawb fawb pom tau tias kev siv cov tshuaj tua kab mob IV thiab cov cement (combined antibiotic prosthesis) infusion txo tus nqi sib sib zog nqus kis tau zoo dua li ob txoj kev ib leeg. . Qhov kev tshawb pom no tau lees paub hauv cov kev tshawb fawb loj hauv 16 xyoo tom ntej. Ib txoj kev tshawb fawb Finnish thiab Australian Orthopedic Association 2009 tau txais cov lus xaus zoo sib xws txog lub luag haujlwm ntawm cov tshuaj tua kab mob hauv cov cement hauv thawj zaug thiab kho lub hauv caug arthroplasty. Nws kuj tau pom tias cov khoom siv biomechanical ntawm cov pob txha cement tsis cuam tshuam thaum cov tshuaj tua kab mob ntxiv hauv cov koob tshuaj tsis pub tshaj 2 g ib 40 g ntawm pob txha cement. Txawm li cas los xij, tsis yog txhua yam tshuaj tua kab mob tuaj yeem ntxiv rau cov pob txha pob txha. Cov tshuaj tua kab mob uas tuaj yeem ntxiv rau cov pob txha cement yuav tsum muaj cov hauv qab no: kev nyab xeeb, thermal stability, hypoallergenicity, zoo aqueous solubility, broad antimicrobial spectrum, thiab cov khoom siv hmoov. Tam sim no, vancomycin thiab gentamicin tau siv ntau dua hauv kev kho mob. Nws tau xav tias kev txhaj tshuaj tshuaj tua kab mob rau hauv cov cement yuav ua rau muaj kev pheej hmoo ntawm kev tsis haum tshuaj, qhov tshwm sim ntawm cov kab mob resistant, thiab aseptic loosening ntawm cov pob qij txha, tab sis tam sim no tsis muaj pov thawj los txhawb cov kev txhawj xeeb no.
VII. Cov ntsiab lus
Kev kuaj xyuas sai thiab meej los ntawm keeb kwm, kev kuaj lub cev thiab kev kuaj mob ntxiv yog qhov yuav tsum tau ua ua ntej rau kev kho mob ntawm kev sib koom ua ke. Kev tshem tawm ntawm kev kis kab mob thiab kev kho kom rov ua kom tsis muaj mob, ua haujlwm zoo sib koom ua ke yog lub hauv paus ntsiab lus hauv kev kho mob sib koom ua ke. Txawm hais tias kev kho tshuaj tua kab mob ntawm kev sib koom ua ke yog qhov yooj yim thiab pheej yig, kev tshem tawm cov kab mob sib koom ua ke feem ntau yuav tsum muaj kev sib txuas ntawm txoj kev phais. Lub ntsiab tseem ceeb ntawm kev xaiv kev kho mob phais yog xav txog qhov teeb meem ntawm kev tshem tawm prosthesis, uas yog lub hauv paus tseem ceeb ntawm kev sib koom tes sib kis. Tam sim no, kev sib xyaw ua ke ntawm cov tshuaj tua kab mob, debridement thiab arthroplasty tau dhau los ua kev kho mob rau feem ntau cov kab mob sib koom ua ke. Txawm li cas los xij, nws tseem yuav tsum tau txhim kho thiab ua kom zoo.
Post lub sij hawm: May-06-2024
