Ko te mate tetahi o ngā raruraru tino kino i muri i te whakakapinga hononga horihori, e kore e pā mai he maha ngā whiunga pokanga ki ngā tūroro, engari he nui hoki ngā rauemi hauora e pau ana. I roto i ngā tau 10 kua pahure ake nei, kua tino heke te auau mate i muri i te whakakapinga hononga horihori, engari ko te auau tipu o nāianei o ngā tūroro e whakakapia ana ki te hononga horihori kua nui ake i te auau hekenga o te auau mate, nō reira kaua e warewarehia te raruraru o te mate i muri i te pokanga.
I. Ngā take o te mate
Me whakaaro ko ngā mate urutā i muri i te whakakapinga hononga horihori he mate i riro mai i te hōhipera me ngā rauropi ātete-rongoa. Ko te mea tino kitea ko te staphylococcus, e 70% ki te 80% te nui, he mea noa anō hoki ngā bacilli gram-negative, ngā anaerobes me ngā streptococci non-A group.
II Te Mate Pūngao
E rua ngā wāhanga o ngā mate urutā: ko tētahi he mate wawe, ko tētahi he mate tōmuri, e kiia ana ko te mate tīmatanga tōmuri. Ko ngā mate tōmuri ka puta mai i te urunga tika mai o ngā huakita ki roto i te hononga i te wā pokanga, ā, ko te nuinga o te wā ko Staphylococcus epidermidis. Ko ngā mate tīmatanga tōmuri ka puta mai i te tuku toto, ā, ko te nuinga o te wā ko Staphylococcus aureus. Ko ngā hononga kua pokangahia he nui ake te tūponotanga ka pangia. Hei tauira, he 10% te auau mate i roto i ngā take whakatikatika i muri i te whakakapinga hononga horihori, ā, he teitei ake hoki te auau mate i roto i te hunga kua whakakapia ngā hononga mō te rumatiki rheumatoid.
Ko te nuinga o ngā mate ka puta i roto i ētahi marama i muri i te pokanga, ko ngā wā tōmua ka puta i roto i ngā wiki tuatahi e rua i muri i te pokanga, engari tae noa ki ngā tau torutoru i mua i te putanga mai o ngā tohu matua tōmua o te pupuhi o ngā hononga, te mamae me te kirika, me wehewehe ngā tohu kirika mai i ētahi atu raruraru, pērā i te niumōnia i muri i te pokanga, ngā mate mimi me ētahi atu.
Mēnā ka pāngia wawetia, kāore te pāmahana o te tinana e ora ake, engari ka piki ake i ngā rā e toru i muri i te pokanga. Kāore te mamae o ngā hononga e heke haere ana, engari ka piki haere, ā, ka pāngia e te mamae i te wā e okioki ana. He rerenga rerekē, he rerenga rānei mai i te tapahi. Me āta tirotirohia tēnei, ā, kaua te kirika e kīia ngāwari he mate urutā i ētahi atu wāhanga o te tinana i muri i te pokanga pērā i te pukahukahu, i te ara mimi rānei. He mea nui anō hoki kia kaua e whakakorea noa te rerenga tapahi hei rerenga noa pērā i te waimeha o te ngako. He mea nui anō hoki kia tautuhia mēnā kei roto i ngā kiko o waho te mate, kei roto rānei i te taha hohonu o te prosthesis.
Mō ngā tūroro kua pāngia e ngā mate urutā, ā, ko te nuinga kua wehe atu i te hōhipera, kāore pea e tino kaha te pupuhi, te mamae, me te kirika o ngā hononga. Tērā pea kāore he kirika o te haurua o ngā tūroro. Ka taea e te Staphylococcus epidermidis te whakaputa i tētahi mate kore mamae me te pikinga o te maha o ngā toto toto mā i roto i te 10% noa iho o ngā tūroro. He mea noa ake te pikinga o te toto toto engari kāore anō kia motuhake. I ētahi wā ka hē te tautuhi i te mamae hei wetekina o te hononga prosthetic, ko te mamae whakamutunga ko te mamae e pā ana ki te nekehanga me whakaora mā te okioki, me te mamae mumura kāore e whakaora mā te okioki. Heoi, kua whakaarohia ko te tino take o te wetekina o te hononga prosthetic ko te mate mau tonu kua roa.
III. Te Tātaritanga
1. Whakamātautau toto:
Kei roto i ngā whakamātautau te tatau toto mā me te whakarōpūtanga, te interleukin 6 (IL-6), te pūmua C-reactive (CRP) me te tere o te whakatōnga toto whero (ESR). He māmā noa iho ngā painga o te whakamātautau toto, ā, ka taea te tiki tere i ngā hua; he iti te motuhaketanga o te ESR me te CRP; he mea nui te IL-6 ki te whakatau i te mate periprosthetic i te wā tōmua i muri i te pokanga.
2. Whakamātautau whakaahua:
Kiriata hihi-X: kāore i te tairongo, kāore hoki i te motuhake mō te tautuhi i te mate.
Kiriata X-ray o te mate whakakapinga turi
Ko te whakaahua wheua: ko te mahi matua e whakaatu ana i te mate ko te rere o te wai synovial me te whewhe.
CT: te tirohanga o te rerenga mai o ngā hononga, ngā ara sinus, ngā whewhe kiko ngohengohe, te horo o te wheua, te mimiti o te wheua periprosthetic.
MRI: he tino tairongo mō te kitenga wawe i te wai o te hononga me ngā whewhe, kāore i te whakamahia whānuitia hei tautuhi i ngā mate periprosthetic.
Ultrasound: te kohikohinga wai.
3. Rongoā karihi
Ko te aro o te matawai wheua Technetium-99 he 33% me te motuhaketanga o te 86% mō te tātaritanga o ngā mate periprosthetic i muri i te arthroplasty, ā, he nui ake te uara o te matawai leukocyte kua tohua ki te indium-111 mō te tātaritanga o ngā mate periprosthetic, me te aro o te 77% me te motuhaketanga o te 86%. Ina whakamahia ngātahitia ngā matawai e rua mō te tirotiro i ngā mate periprosthetic i muri i te arthroplasty, ka taea te whakatutuki i te aro, te motuhaketanga me te tika teitei ake. Ko tēnei whakamātautau tonu te paerewa koura i roto i te rongoā karihi mō te tātaritanga o ngā mate periprosthetic. Ko te tomography tuku fluorodeoxyglucose-positron (FDG-PET). Ka kitea e ia ngā pūtau mumura me te pikinga o te tango huka i roto i te wāhi pangia.
4. Ngā tikanga koiora ngota
PCR: tairongo nui, hua teka
Hangarau maramara ira: wāhanga rangahau.
5. Te Whakapūtanga o te Pona:
Te whakamātautau cytological o te wai o te hononga, te ahurea kitakita me te whakamātautau aro ki ngā rongoā.
He māmā, he tere, he tika hoki tēnei tikanga
I roto i ngā mate hope, ko te maha o ngā leukocytes wai hononga neke atu i te 3,000/ml me te pikinga o te ESR me te CRP te paearu pai rawa atu mō te aroaro o te mate periprosthetic.
6. Te tirotiro i te wāhanga tio tere i te wā o te pokanga
Ko te wāhanga tere tio o te kiko periprosthetic i te wā o te pokanga te tikanga e whakamahia whānuitia ana mō te tirotiro histopathological i te wā o te pokanga. Ko ngā paearu tātaritanga a Feldman, arā, he nui ake i te 5 neutrophils ia whakanui teitei (400x) i roto i te iti rawa 5 ngā mara moroiti motuhake, ka whakamahia pinepine ki ngā wāhanga tio. Kua whakaaturia ko te aro me te motuhaketanga o tēnei tikanga ka neke atu i te 80% me te 90%. Ko tēnei tikanga te paerewa koura mō te tātaritanga i te wā o te pokanga.
7. Te ahurea huakita o te kiko mate
He tino motuhake te ahurea huakita o ngā kiko periprosthetic mō te tautuhi i te mate, ā, kua kiia koinei te paerewa koura mō te tautuhi i ngā mate periprosthetic, ā, ka taea hoki te whakamahi mō te whakamātautau aro ki te rongoā.
IV. Tātaritanga rerekētangas
He uaua ake te wehewehe i ngā mate hononga prosthetic kore mamae i puta mai i te Staphylococcus epidermidis mai i te wetekina o ngā hononga prosthetic. Me whakaū mā te hihi-X me ētahi atu whakamātautau.
V. Maimoatanga
1. Maimoatanga ārai mate pāwera māmā
E whā ngā momo mate urutā i muri i te pokanga, arā, te momo I kāore he tohu, ko te tūroro anake i roto i te pokanga whakatikatika ka kitea he tipu huakita, ā, kia rua pea ngā tauira kua whakatōngia ki te huakita kotahi; ko te momo II he mate wawe, ka puta i roto i te kotahi marama o te pokanga; ko te momo IIl he mate mau tonu kua whakaroa; ā, ko te momo IV he mate toto toto nui. Ko te kaupapa o te maimoatanga paturopi he tairongo, he nui te nui me te wā e tika ana. Ā, he mea nui te wero i te pokanga hononga i mua i te pokanga me te ahurea kiko i roto i te pokanga mō te whiriwhiri tika i ngā paturopi. Mena he pai te mate momo I i roto i te ahurea huakita, mā te whakamahi noa i ngā paturopi tairongo mō ngā wiki e 6 ka taea te whakatutuki i ngā hua pai.
2. Te pupuri i ngā porotiti, te tango i ngā niho me te tango wai, te pokanga whakamakuku ngongo
Ko te whakaaro matua mō te whakamahi i te whakaaro matua mō te tiaki i ngā whara o te prostesis, he pumau te prostesis, ā, he mate urutā nui. He mārama te rauropi pangia, he iti te kaha o te huakita, ā, he tairongo ngā paturopi, ā, ka taea te whakakapi i te arai, te āputa rānei i te wā e tangohia ai te kiri. Ko ngā reiti whakaora o te 6% anake me ngā paturopi anake, me te 27% me ngā paturopi me te tango i te kiri me te tiaki i ngā prostesis kua pūrongohia i roto i ngā tuhinga.
He pai mō te mate urutā i te wā tōmua, te mate toto toto nui rānei me te pai o te whakapiringa o te prosthesis; he mārama hoki ko te mate he mate huakita iti te kaha e pāngia ana e te rongoā patu huakita. Ko te huarahi ko te tango i te kiri maroke, te horoi i te kiri huakita me te tango i te wai (6 wiki te roa), me ngā rongoā patu huakita ā-roto i muri i te pokanga (6 wiki ki te 6 marama te roa). Ngā ngoikoretanga: he nui te tere o te korenga o te mahi (tae atu ki te 45%), he roa te wā maimoatanga.
3. Pokanga whakatikatika kotahi te wāhanga
He pai ngā painga o tēnei tikanga, arā, he iti ake te whara, he poto ake te noho hōhipera, he iti ake te utu hauora, he iti ake te koha o te patunga me te pakari o ngā hononga, ā, he mea pai tēnei mō te whakaora i te mahi a ngā hononga i muri i te pokanga. He pai rawa atu tēnei tikanga mō te rongoā i te mate wawe me te mate toto nui.
Ko te whakakapinga kotahi-wāhanga, arā, te tikanga kotahi-wāhanga, e herea ana ki ngā mate pāwera iti-paitini, te tango paitini tino pai, te sima wheua paturopi, me te wātea o ngā paturopi tairongo. I runga i ngā hua o te wāhanga kiko tio i te wā o te pokanga, mēnā he iti iho i te 5 ngā leukocyte/mara whakanui teitei. He tohu tēnei mō te mate pāwera iti-paitini. Whai muri i te tango paitini tino pai, i mahia he arthroplasty kotahi-wāhanga, ā, kāore i hoki anō te mate i muri i te pokanga.
I muri i te tangohanga tino pai, ka whakakapia tonutia te prosthesis me te kore e hiahiatia he tikanga tuwhera. He painga ōna, he iti noa te whara, he poto te wā maimoatanga, ā, he iti te utu, engari he teitei ake te auau hokinga mai o te mate i muri i te pokanga, arā, tata ki te 23%~73% e ai ki ngā tatauranga. Ko te whakakapinga prosthesis kotahi-wāhanga he mea pai mō ngā tūroro kaumātua, me te kore e whakakotahi i tētahi o ēnei e whai ake nei: (1) he hītori o ngā pokanga maha ki te hononga whakakapinga; (2) te hanganga o te ara sinus; (3) te mate kino (hei tauira, te septic), te ischemia me te whara o ngā kiko e karapoti ana; (4) te tangohanga kāore i oti o te whara me te toenga o te sima; (5) te hihi-X e tohu ana i te osteomyelitis; (6) ngā hapa wheua e hiahia ana ki te hono wheua; (7) ngā mate whakauru, ngā huakita tino kaha rānei (hei tauira, te Streptococcus D, ngā huakita Gram-negative); (8) te ngaronga wheua e hiahia ana ki te hono wheua; (9) te ngaronga wheua e hiahia ana ki te hono wheua; me (10) ngā hono wheua e hiahia ana ki te hono wheua. Streptococcus D, ngā huakita Gram-kino, inā koa ko Pseudomonas, me ētahi atu), te mate harore rānei, te mate mycobacteria; (8) Kāore i te mārama te ahurea huakita.
4. Pokanga whakatikatika wāhanga tuarua
Kua tino paingia tēnei e ngā taote pokanga i ngā tau 20 kua pahure ake nei nā te whānuitanga o ngā tohu (he nui te papatipu wheua, he momona ngā kiko ngohengohe periarticular) me te tere teitei o te whakakore i te mate.
Ngā mea whakawātea, ngā kaikawe paturopi, ngā paturopi
Ahakoa te tikanga whakawātea e whakamahia ana, me whakapiripiri ki ngā paturopi hei whakanui ake i te kukū o ngā paturopi ki roto i te hononga, hei whakanui ake hoki i te tere whakaora o te mate. Ko ngā paturopi e whakamahia whānuitia ana ko te tobramycin, gentamicin me te vancomycin.
Kua whakaaetia e te hapori orthopedic o te ao te maimoatanga tino whai hua mō te mate hohonu i muri i te arthroplasty. Ko te huarahi ko te tango i te kiri pakaru, te tango i te prosthesis me te mea ke, te whakanoho i te mokowā hononga, te whakamahi tonu i ngā rongoā paturopi tairongo-ā-uaua mō te iti rawa o te 6 wiki, ā, i muri i te whakahaere pai o te mate, ka whakahokia te prosthesis.
Ngā Painga:
He wā e rawaka ana hei tautuhi i ngā momo kitakita me ngā rongoā paturopi tairongo, ka taea te whakamahi whai hua i mua i te pokanga whakahou.
Ka taea te rongoā i te huinga o ētahi atu aronga pūnaha o te mate i te wā tika.
E rua ngā whai wāhitanga mō te tango i te kiriuhi hei tango i ngā kiko necrotic me ngā mea ke atu i te tinana, ka whakaiti nui i te auau o te hokinga mai o ngā mate urutā i muri i te pokanga.
Ngā ngoikoretanga:
Ka nui ake te mōrearea i te wā e whakamoea ana me te pokanga.
He roa te wā maimoatanga me te utu nui ake.
He ngoikore, he puhoi hoki te whakaoranga mahi i muri i te pokanga.
Te Whakatōtōrangapū: He pai mō ngā mate pūmau kāore e aro ki te maimoatanga, mō ngā hapa wheua nui rānei; ka whakawhāiti te āhua o te tūroro i te korenga o te mahi tāpui anō me te hanga anō. Te mamae tonu i muri i te pokanga, te hiahia mō te whakamahinga roa o ngā whītiki hei āwhina i te nekenekehanga, te kore pumau o ngā hononga, te whakapoto o ngā peka, te pānga mahi, he iti noa te whānuitanga o te tono.
Te pokanga wheua: te maimoatanga tuku iho mō ngā mate urutā i muri i te pokanga, me te pumau pai i muri i te pokanga me te whakamamae i te mamae. Ko ngā ngoikoretanga ko te whakapoto o te peka, te mate haere me te ngaronga o te nekenekehanga o ngā hononga.
Tāpaetanga: Koinei te huarahi whakamutunga mō te rongoā i te mate urutā hohonu i muri i te pokanga. He pai mō: (1) te ngaronga nui o te wheua, ngā hapa kiko ngohengohe; (2) te kaha o te kaha o te huakita, ngā mate urutā whakauru, kāore e whai hua te rongoā paturopi, ka hua ake he paitini pūnaha, ka morearea te ora; (3) he hītori o te maha o ngā korenga o te pokanga whakahou o ngā tūroro kua pangia e te mate mau tonu.
VI. Te Ārai
1. Ngā āhuatanga i mua i te pokanga:
Whakapai ake i te āhua o te tūroro i mua i te pokanga, ā, me rongoā ngā mate katoa i mua i te pokanga. Ko ngā mate toto e tino kitea ana ko ērā mai i te kiri, te ara mimi, me te ara manawa. I roto i te pokanga hope, i te turi rānei, me noho tonu te kiri o ngā pito o raro. Ko te bacteriuria kore tohu, he mea noa i roto i ngā tūroro kaumātua, kāore e hiahiatia kia rongoātia i mua i te pokanga; ina puta ngā tohu, me rongoā wawe. Me whakakore ngā wāhi mate o te rohe mō ngā tūroro e pangia ana e te tonsillitis, ngā mate ara manawa o runga, me te tinea pedis. Ko ngā pokanga niho nui ake he pūtake pea o te mate toto, ā, ahakoa te karo, ki te hiahiatia ngā pokanga niho, e taunakitia ana kia mahia aua tikanga i mua i te pokanga. Ko ngā tūroro he mate kino te āhua whānui pērā i te anemia, te hypoproteinemia, te mate huka whakakotahi me ngā mate ara mimi mau tonu me rongoā wawe kia pai ai te mate tuatahi ki te whakapai ake i te āhua pūnaha.
2. Te whakahaere i roto i te pokanga:
(1) Me whakamahi hoki i ngā tikanga me ngā taputapu tino ārai-mate i roto i te huarahi rongoā noa mō te pokanga wheua.
(2) Me whakaiti te whakaurunga ki te hōhipera i mua i te pokanga hei whakaiti i te mōrearea ka noho te kiri o te tūroro ki ngā momo kitakita i riro mai i te hōhipera, ā, me whakahaere te maimoatanga auau i te rā o te pokanga.
(3) Me whakarite pai te wāhi i mua i te pokanga mō te whakarite kiri.
(4) He whai hua ngā kākahu pokanga, ngā kopare kanohi, ngā pōtae, me ngā whare pokanga rere-whakarewa ki te whakaiti i ngā huakita e rere ana i te hau i roto i te whare pokanga. Mā te mau karapu takirua ka taea te whakaiti i te tūponotanga o te pa o te ringa i waenga i te taote pokanga me te tūroro, ā, ka taea te taunaki.
(5) Kua whakamātauhia i roto i te rongoā he nui ake te tūponotanga o te mate i te whakamahinga o te prosthesis e ārai ana i te hononga, inā koa he hononga, i te arthroplasty turi katoa kāore e ārai ana nā te mea he paru whakarewa e whakaiti ana i te mahi phagocytosis, nō reira me karo i te whiriwhiri prosthesis.
(6) Whakapai ake i te tikanga pokanga a te kaiwhakahaere, ā, whakapotoa te roa o te pokanga (<2.5 h mēnā ka taea). Mā te whakapoto i te roa o te pokanga ka taea te whakaiti i te wā e pāngia ana e te hau, ā, ka taea hoki te whakaiti i te wā e whakamahia ai te tourniquet. Āta karohia te pokanga uaua i te wā pokanga, ka taea te whakamakuku i te patunga i ngā wā maha (ko te pū whakamakuku te mea pai rawa atu), ā, ka taea te rumaki i te kohu-iodine mō ngā tapahi e whakapaetia ana kua poke.
3. Ngā āhuatanga i muri i te pokanga:
(1) Ka puta te ātete ki te insulin i ngā whiunga pokanga, ka arahi pea ki te hyperglycemia, he āhuatanga ka mau tonu mō ētahi wiki i muri i te pokanga, ā, ka whakararu i te tūroro ki ngā raruraru e pā ana ki te patunga, ā, ka puta anō hoki i roto i ngā tūroro kāore i te mate huka. Nō reira, he mea nui anō hoki te aroturuki i te huka toto i muri i te pokanga.
(2) Ka whakanui ake te totohu o te uaua hōhonu i te mōrearea o te haematoma me ngā raruraru e pā ana ki te patunga. I kitea i roto i tētahi rangahau whakahaere-take he pai te whakamahinga o te heparin ngota iti i muri i te pokanga hei ārai i te totohu o te uaua hōhonu ki te whakaiti i te tūponotanga o te mate.
(3) Ko te rerenga wai kua kati he tomokanga pea mō te mate, engari kāore anō kia rangahaua tōna hononga ki ngā reiti mate patunga. E whakaatu ana ngā hua tuatahi ko ngā katitere hononga-honohono e whakamahia ana hei whakahaere i ngā rongoā mamae i muri i te pokanga ka pāngia pea e te mate patunga.
4. Te ārai i ngā paturopi:
I tēnei wā, ko te whakamahinga haumanu auau o ngā horopeta ārai mate o ngā paturopi e tukuna ana i roto i te uaua i mua atu, i muri hoki i te pokanga ka whakaiti i te tūponotanga o te mate i muri i te pokanga. Ko ngā Cephalosporins te nuinga o te wā e whakamahia ana i roto i te haumanu hei paturopi whiriwhiri, ā, he hononga kōpiko āhua-U i waenga i te wā whakamahinga paturopi me te tere o ngā mate i te wāhi pokanga, me te nui ake o te tūponotanga o te mate i mua atu me muri i te wā tino pai mō te whakamahinga paturopi. I kitea i roto i tētahi rangahau nui tata nei ko ngā paturopi i whakamahia i roto i te 30 ki te 60 meneti i mua i te tapahi te iti rawa o te mate. He rerekē, i whakaatuhia e tētahi atu rangahau nui mō te arthroplasty hope katoa te iti rawa o te mate me ngā paturopi i tukuna i roto i te 30 meneti tuatahi o te tapahi. Nō reira, ko te wā whakahaere e kiia ana ko te 30 meneti i mua i te pokanga, me ngā hua pai rawa atu i te wā e whakaohohia ana te mate whakamoe. Ko tētahi atu horopeta ārai mate o ngā paturopi ka hoatu i muri i te pokanga. I Uropi me te Hononga o Amerika, ka whakamahia ngā paturopi tae noa ki te rā tuatoru i muri i te pokanga, engari i Haina, e kīia ana ka whakamahia tonutia mō te 1 ki te 2 wiki. Heoi, ko te whakaaro whānui ko te karo i te whakamahinga roa o ngā paturopi kaha whānui-ahurea mēnā kāore he āhuatanga motuhake, ā, mēnā e tika ana te whakamahinga roa o ngā paturopi, he mea tika kia whakamahia ngā rongoā harore me ngā paturopi hei ārai i ngā mate harore. Kua whakaatuhia te whai huatanga o te Vancomycin ki ngā tūroro mōrearea nui e mau ana i te Staphylococcus aureus ātete-methicillin. Me whakamahi i ngā horopeta teitei ake o ngā paturopi mō ngā pokanga roa, tae atu ki ngā pokanga rua, inā koa he poto te haurua-ora o te paturopi.
5. Te whakamahinga o ngā paturopi me te sima wheua:
I whakamahia tuatahitia hoki te sima i whakakīia ki te paturopi i roto i te pokanga wheua i Nōwei, i reira i whakaatuhia ai i te tuatahi e tētahi rangahau a te Norwegian Arthroplasty Registry ko te whakamahinga o te huinga o te paturopi IV me te sima (te whakakotahitanga o te prosthesis paturopi) i whakaiti i te tere o te mate hohonu i te tikanga kotahi anake. I whakaūhia tēnei kitenga i roto i tētahi raupapa o ngā rangahau nui i roto i ngā tau 16 e whai ake nei. I tae atu tētahi rangahau Finnish me te Australian Orthopaedic Association 2009 ki ngā whakatau ōrite mō te tūranga o te sima i whakakīia ki te paturopi i roto i te pokanga wheua tuatahi me te whakatikatika. Kua whakaaturia hoki kāore ngā āhuatanga koiora o te sima wheua e pāngia ina tāpirihia te paura paturopi ki ngā horopeta kāore e neke atu i te 2 karamu ia 40 karamu o te sima wheua. Heoi, kāore e taea te tāpiri i ngā paturopi katoa ki te sima wheua. Ko ngā paturopi ka taea te tāpiri ki te sima wheua me whai i ēnei āhuatanga e whai ake nei: te haumaru, te pumau wera, te hypoallergenicity, te wairewa pai ki te wai, te whānuitanga o te antimicrobial, me te rauemi paura. I tēnei wā, ko te vancomycin me te gentamicin te mea e whakamahia whānuitia ana i roto i te mahi haumanu. I whakaarohia mā te werohanga o te paturopi ki roto i te sima ka piki ake te mōrearea o ngā mate pāwera, te putanga mai o ngā momo ātete, me te wetekina o te prosthesis, engari tae noa ki tēnei wā kāore anō kia kitea he taunakitanga hei tautoko i ēnei āwangawanga.
VII. Whakarāpopototanga
Ko te tautuhi tere me te tika mā te hītori, te whakamātautau tinana me ngā whakamātautau tāpiri he mea nui mō te maimoatanga angitu o ngā mate hononga. Ko te whakakore i te mate me te whakaora i te hononga horihori kore mamae, e mahi pai ana te kaupapa matua o te maimoatanga o ngā mate hononga. Ahakoa he māmā, he iti hoki te utu mō te maimoatanga paturopi mō te mate hononga, ko te whakakore i te mate hononga me whakamahi i te nuinga o ngā tikanga pokanga. Ko te mea nui ki te whiriwhiri i te maimoatanga pokanga ko te whakaaro ki te raruraru o te tango i te prosthesis, koinei te wāhanga matua o te whakahaere i ngā mate hononga. I tēnei wā, ko te whakamahinga ngātahi o ngā paturopi, te tango i te kiri me te arthroplasty kua noho hei maimoatanga whānui mō te nuinga o ngā mate hononga uaua. Heoi, me whakapai tonu, me whakapai ake.
Wā tuku: Mei-06-2024
