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膝枢纽骨枢纽炎的外科医治

2017-06-05
点击数: 14848     作者: 北华大学从属病院

膝枢纽骨枢纽炎是枢纽外科罕见的慢性枢纽疾患,具有得病率高、病变规模广、初期功效妨碍水平重等特色。查询拜访成果显现,在40~60 岁的人群中,骨枢纽炎的得病率为10%~17%; 60岁以上人群中,骨枢纽炎的得病率达50%;而在> 75岁人群中, 80%得了骨枢纽炎。

yingdangshuojinchaoshangburenheyizhitilinenggouhuoxushigushuniuyandebingchengnizhuanheezhi,gushuniuyandeyizhimubiaoshijianhuantongkubeishang,yanhuanbingbianchengzhang;chuqijingquedeyizhinenggouhuoxujiaozhexiaomibingzheng,gailiangshuniugongxiao,shijibingbuyingxianghuanzhedehukoupinzhi;chuqigushuniuyanhuanzhe,yingzhudongjienashoushuyizhi,yifangzhishuniuyanjunjixingdechansheng。jinchaodeyizhishouyaojienamenluliaofa,jichuqijienafeiyaowu(huanzhejiaodao、wuliyizhi、jiroulianxi、tizhongjiezhi、bangzhuzhijudeng)、yaowuyizhi(gailiangbingzhengyaowu、gailiangbujuyaowu),danghuanzheyoujiaoyanjundeyanxuxingtongkubeishangjijiaozhedeshuniugoudangfangai,jijinyizhiyouxiao,yingxiangrenwujihukoushi,zezhenzhuoshoushuyizhi,duizao、zhongqigushuniuyanhuanzhe,kezaishuniujingxiaxingshuniuqingsuanshu,chengguojiechu。chuqichengxianjixinghuoyanxuxingtongkubeishangshi,keanzhaohuanzhexiangxiqingkuangtiaoxuanshuniusizhoujiegushujiyeshengshuniuzhihuanshu。neimonaxiexishuniugushuniuyanhuanzheheshishuniujingshoushuni?fanshi快乐赛车 tiaoxuantongkubeishangshihouduan<3geyue;youniushangshi;youmingbaidejiqibingzhengrukagan、jiaosuohuohuanxiquansuoshouxian;shuniujiye、shuniuxianyatong、mcmurrayzheng(+);neifanjixing< 10°,waifanjixing< 15°。zaishunyingzhengtiaoxuanheshideqingkuangxiashuniujingyizhixishuniugushuniuyanhuiqudejianhuanbingzheng、gailianggongxiao、yanhuanbingqingchengzhangdeliaoxiao。

yeshengshuniuzhihuanshuyongyuyanjundeguxingshuniuyan;

shangxuheshiyixiaguifancaiheshitingzhiyeshengshuniuzhihuanshu: ①shuniumianguheruangufensuideyingxiangxuezhuanbian;②youzhongdudaozhongduyanxuxingtongkubeishang;③dianmozuishaobanniandejijinyizhi,gongxiaohetongkubeishangmeifagailiang。jijinyizhizuishaoyingbaohan: feizaitileikangyanyaowujibiedefanlidezhitengyaowu、liliao、zhuxingzhuangpei(shouzhang、shouzhangdeng)hechengxinshidexuejianshuniufuhedehukou、renwuxiqidezhuanbian;④huanzhenenggouhuoxuzhudonggongtongdafuyizhi,youjiechudeyuncongxing;

chunqiuyifeiyeshengshuniuzhihuandejueyixingshenfen。zuihou,shouxianyuchuqideyeshengshuniujiatishexiangjiziliaomosunjinengdexianding,heshoushushouyishangbuchengshu,yiduyiweiyeshengshuniuzhihuanzhiheyongyu65suiyishangrenqun。 dangenzhegengduodexinxingnaimoziliaozaiyeshengshuniuzhongpubianliyong,shoushushouyichugeshifanxiushouyidedafudujinbu,geleifanxiujiatishexiangriyiwanmei,errenmenduihukoupinzhideqingqiuyebushijinbu,yulaiyuduodegaolingrenqunhenianqingrenyinweiyanjundeshuniujibingjieguanyeshengshuniuzhihuanshu。

shenglideyinsu(4pyinsu)

(1) (patient selection)bixutiaoxuanheshishunyingzhengdehuanzhe

yeshengshuniuzhihuanshusuiranyiqudehendadeshengli,danyirannanyizhizunianqinghuanzhedagoudangliang,chijiuliyongdeqingqiu;duimouxiegaolinghuanzhe,qipeitongyoubiedeqiguandeyanjunjihuan,huonanyigongtongdafutingzhichuqideshuniugongxiaobingyu,yebushiyushuniuzhihuan。baozhanghuanzheningjingyongjiushiyeshengshuniuzhihuanshuyaozhenzhuodediyimingdetimu。

huanzhebixujuyouzhizushoushuqingqiudemanshenzhuangtaijijiechudejinglizhuangtai,tongshiyaoduiyeshengshuniuzhihuanshuyougongdaodeyuqi。

(2) (procedure)shoushucaozongshouyi

yeshengshuniuzhihuanshuduidafudeshoushucaozongshouyiqingqiuhengao。

qishouyeshengshuniuzhihuanshuzhongchuyaoduishuniudebingzaotingzhiqiechuzhiwai,xuyaoshenrudongdeshuniudehuodongxuedaoli,jiangyeshengshuniudejiatizhuangzhizaijingquedediwei,jinengshijiatiqudejiechudebubianxing,younengguifushuniudeyibanhuodong。

qici,yeshengshuniuzhihuanshuzhongyaoliyongdaodapidedongxidongxi。dafubixubawodongxidongxideshexiangdaoli,shuxiliyongfangshi,zheijiuxuyaodapideshijijinxiuhelinchuangshiji。zai快乐赛车 guo,lingyouyigetese,jidadouhuanzhezaizhuiqiushuniuzhihuanshi,shuniujibingyizhichuqi,cunzaiyanjundeshuniujixingheguquesundengqingkuang。zheigengxuyaodafuyoutashideshijigenbenjifengshuodelinchuangjingli,nenglijiaojiedechuzhishoushuzhongchengxiandepangzaqingkuang。waiyangyouyantaobiaoming,nianshoushuliangxiaoyu30lidedafuyizhidehuanzhegengqingyichengxianbingfazheng。

(3) (prosthesis selection)jiatitiaoxuan

henduohuanzhejianlvededongdeweiyeshengshuniujiati“yueguiyuehao,yuexinyuehao”。

shizaiburan,qishou,yeshengshuniujiatixuyaozairentineichijiuchanyangxiaoli,erxindejiatichangchangjinzaichangshishineidianmomoniceshi。suiranchangshishujubiaomingnenggouhuoxuliyongjiaozhangshihou,danyinweirentiqingkuangjiweipangza,shuniujiatikefouzairentineichanyangchijiuxiaolizecunzaiyinan,xuyaoshihouchayan。

qici,yeshengshuniujiatipinzhongdanyi,qishexiangdepoujiexueshujulaiziyuchabiezhongzuderenqun,chuzhishizhenduichabiefanlijibingdehuanzhe,shiyiguidejiati、xindejiatiyidingshizuiheshinindejiati。

zaize,dafuduijiatideshuxishuipingyezaihendashuipingshangjueyilelinchuangdechengguo,yizhongxindejiati,nenggoufangcaijinruguanglinchuangliyong,dafuhaiqueshaoshijijingli,duijiatidetezhengnenggouhaibushuxi,fanerhuidanwushoushushihou,zengtianshuhoubingfazheng。

shiyi,gengjiajingquededongdeshi,“buzuihaodejiati,zhiyaozuiheshinidejiati”。

(4) (peri-operation management)weishoushuqibanli

yiliyeshengshuniuzhihuanshudeshengli,shiyigetuanduigongtongjinlidechengguo。shoushudafuzaicizhongbiaoyanshouyaojiaose,ermazuishi、waikedafu、hushi、bingyushitongdengyangzhuyaoerbukehuoque。dongfangfacaiguodudeyeshengshuniuzhihuanshuyihenshichengshu,shiyizaiyeshengshuniuzhihuandeyiliaozhongjiangouchengleyigebubiandetuandui,duixuyaotingzhiyeshengshuniuzhihuandehuanzhejienaguifanhuadechuzhiliucheng。zheidadajinbuleshoushudeningjingxingheshenglilv,yeyanzhanglehuanzhedezhuyuanshihoujixiajianglehuanzhedeyiliaoshouru。

weishoushuqibanlichujihuanzheshuqianmanshenzhuangtaidepingjia,mazuipingjiajicaozong,shuzhongshoushudafujidongxihushideanliangongtong,shuhouzhiteng,kangchuanran,bingyudengzhuduofangmian。

shenglideyeshengshuniuzhihuanshuyishangsigeyinsuqueyibuke。