ʻO ka Osteomyelitis o ka wāwae i ka maʻi mellitus o ka maʻi: ka mālama ʻana o nā manamana lima a me nā iwi

Hoʻonui pū ʻia ka maʻi diabetes mellitus me ka hoʻonui o ka glucose koko. He hopena poino ka kulu ma nā paia o nā moku koko a me nā kinipona nerve.

Ma muli o ka lawa ʻole o ke koko a me ka hoʻowalewale i loko o nā puʻu haʻahaʻa, e ulu ana ka neuropathy me kahi hoʻopiʻi o ka maʻi maʻi.

ʻO kekahi hiʻohiʻona hiʻohiʻona o ka neuropathy ʻo ia ka hoʻomohala ʻana i nā pōpoki hoʻomaikaʻi maikaʻi ʻole. I nā kūlana o kahi hāʻule i ka pale ʻole, nele ka nui o nā meaʻai o nā ʻiʻo. I nā kūlana holomua, ua pālahalaha i ka iwi o ka iwi a loaʻa ka osteomyelitis.

Nā kumu o Osteomyelitis

ʻO ka neuropathy haʻahaʻa haʻahaʻa me ke kūkulu ʻana o ka wāwae maʻi maʻi maʻamau kahi mea hoʻopiʻi maʻamau o ka maʻi maʻi. Loaʻa ia ma hope o 5 -7 mau makahiki mai ka hoʻomaka ʻana o ka maʻi i ka ʻano maʻi maʻi mua. ʻO ke ʻano o ka maʻi maʻi lua e lohi a hiki i nā hoʻopiʻi ke hoʻomohala nui.

ʻO ke kumu nui no ka hoʻomohala ʻana i ka hoʻopiʻi maʻi maʻi haʻahaʻa he uku haʻahaʻa haʻahaʻa. Hiki i kēia ke hana me kahi ʻano koʻikoʻi o ka maʻi a i ʻole mālama i nā ʻōlelo manaʻo o ka endocrinologist. ʻO ke kao nui o ka glucose i loko o ke koko, a me kāna mau hoʻololi koʻikoʻi e hoʻonāukiuki i ka paia vascular a luku i nā fibers nerve.

Me ka hoʻohaʻahaʻa ʻana i ke kahe o ke koko a me ka hoʻoulu ʻana i ka aʻalupā, e nalowale ana nā ʻōpili a i ko lākou ʻike a hiki ke hoʻi hou mai i nā hōʻeha. ʻO kekahi hōʻeha liʻiliʻi a i ʻole ke kahakaha ʻana o ka ʻili e hiki ke alakaʻi i ka hoʻokumu ʻana i nā maʻi ulia. Ho'ōla lohi lākou, kani pinepine ka maʻi.

Hōʻike ka wāwae Diabetic iā ia iho i kekahi mau syndromes:

• ʻO nā maʻi maʻi ma nā pā liʻiliʻi a me nā ipu nui (angiopathy)
• Hoʻokomo ka iwi a me ka osteoporosis.
• Hoʻoholo i ka pale ʻole.
• ʻ .lelo maʻi ʻōpio.

Aia ma kahi o ka maʻamau o ka pilikia o ka neurological a i ʻole vascular maʻi, kahi ʻano neuropathic a ischemic o ka wāwae maʻi. Akā, he hewa maoli kēia hoʻokaʻawale ʻana, ʻoiai ka mea maʻamau e hana i kēia mau ʻano ʻelua i ka manawa like.

No laila, ʻo ka palapala hoʻohana maʻamau maʻamau.

Nā hōʻailona a me nā hopena maʻi o osteomyelitis

Hiki ke hōʻike ʻia ka wāwae Diabetic e ka pale hewa ʻana o ka hōʻeha a me ka mālama ʻana i ke ʻano o nā haʻahaʻa haʻahaʻa, ʻoi aku ka nui o ka ʻili maloʻo, nā pākaukau, ka ʻūhā, nā ʻano hoʻohālikelike o ka wāwae. Aia i kēia mau hōʻeha, hoʻomohala nā ʻōpū o ka ʻili.

ʻO nā ʻōpū a me ka maʻi palupalu me ka luku ʻana i nā ʻiole palupalu i ka iwi ua paʻakikī i ka huhū o ka iwi iwi, periosteum a me ka iwi momona. Ma kēia hihia, pilikia ka puka ʻana o ka osteomyelitis e mālama i ka lāʻau lapaʻau a alakaʻi pinepine i ka pono no ka ʻokiʻoki i nā haʻahaʻa haʻahaʻa.

Hiki i ka Osteomyelitis ke hoʻopiʻi i nā ulia lōʻihi a lōʻihi ʻole paha. Hōʻike ʻia ka hoʻomohala ʻana o ka osteomyelitis e kēlā mau hōʻailona:

1. ʻAʻole kahi mea maʻi e mālama nei i nā malama ʻelua.
2. Hohonu ka ʻōpala a ʻike ʻia kahi iwi ma lalo, a i ʻole hiki ke hoʻoholo ʻia e ka ʻimi.
3. Ua ʻakaʻaka a ʻulaʻula hoʻi ka lālā i hoʻopilikia ʻia.
4. I loko o ke koko, hoʻonuiʻia ke kiʻekiʻe o leukocytes, ʻoi aku ka nui o ka nui o ESR ma mua o 70 mm / hola.
5. Ke hana nei i kahi hōʻike x-ray a i ʻole MRI, ua ʻike ʻia ka luku ʻana ma nā iwi ma lalo o kahi ulia.

ʻO ka hōʻailona nui diagnostic kahi maʻi biopsy (ka nānā ʻana o ka iwi) o ka iwi.

Ma ka maʻi mellitus, make ka iwi no ka maʻi o ka maʻi podeoarthropathy maʻi (wāwae o Charcot). Hoʻokumu kēia kūlana i ka neuropathy diabetic koʻikoʻi. Ke hele nei kahi hanana maʻi me ka ʻole o ka maʻi. I ka ʻāʻī o mua, ua ulu ʻia ka edema unilateral o ka wāwae. ʻĀmaʻomaʻo ka ʻili, paʻakikī a paʻakikī i nā wahi o ka mumū.

Hiki i ka manawa o ka mumū ke hele i kahi papa koi. Hiki i nā hōʻalau, hiki ke hele i nā pōkole i nā ʻōpū, hana nā iwi. ʻO ka lōʻihi o ka wā, hiki ke pilikia ka maʻi e ka osteomyelitis.

ʻO ke ala o ka maʻi maʻi osteoarthropathy e hele i nā manawa he nui:

• ʻ stagelelo huapalapala: edema o ka wāwae, ʻulaʻula a me ke kuni. I nā kiʻi - nā osteoporosis.
• Palapala Subacute: ʻaʻohe mea hoʻonā, ʻaʻe ka wāwae, hoʻopau ʻia ka iwi i nā kiʻi.
• Kūʻai ikaika: like ka wāwae, like me ka "pepa", ʻala a me nā haʻalulu o nā iwi.
• Kūleʻa me nā hoʻopiʻi: nā ʻeha maʻi, osteomyelitis.

Hoʻohana ʻia ka maʻi Osteomyelitis

Hoʻohana ʻia ke kahua kaulike o ka osteoarthropathy me ka hoʻoiho piha ʻana i ka wāwae. No kēia, hoʻohana nā mea hoʻohana orthopedic: nā orthoses, nā mea aʻo, nā kāmaʻa Orthopedic.

Inā lawa ʻole kēia a ʻaʻole hoʻōla i ka ulia, a laila akae ʻia kahi laʻa o ke neʻe - ua hoʻomaha paʻa i kahi moe. No ka lāʻau lapaʻau, hoʻohana ʻia nā pūʻulu o nā lāʻau lapaʻau e:

1. I mea e pale ai i ka luku ʻana i nā iwi - Alendronate, Pamidronate.
2. No ka hoʻokumuʻana o ka iwi iwi hou - nā anabolic steroid anabolic (Methandrostenolone, Retabolil), nā kōlepa a me ka hoʻomākaukau o ka vitamin D3.
3. Kaomi ʻeha - Analgin, Ketanov, Nalbufin.
4. Nā lāʻau lapaʻau anti-inflammatory nonsteroidal - Nimesulide, Diclofenac, Revmoxicam.
5. Diuretics - Furosemide, Hypothiazide.

Aia nā hihia e holomua ma hope o ka x-ray therapy.

Ma ke kūlana maʻi, ua kauoha ʻia nā huaora a me nā calcium. ʻO ka ʻāpana ʻānai o ka iwi ma ka pau ʻana o ka huhū hiki ke hoʻokaʻawale i ka ʻoihana. Hōʻike ʻia nā kāmaʻa orthopedic.

Me ka hoʻomohala ʻana o ka osteomyelitis, ke hana nui ke koho ʻana i nā lāʻau lapaʻau hou - ʻo ka lāʻau lapaʻau a me ka ʻoi paha.

Me ka lāʻau lapaʻau, ʻike ʻia ka amputation o kahi manamana lima a i ʻole ʻāpana o ka wāwae a me ka hoʻoulu ʻana i ka hōʻeha o ka hōʻeha. Inā ʻaʻole e ulu ka maʻi ma hope o ka hoʻomaʻamaʻa ʻana, a laila aia kekahi manawa o ka hoʻihoʻi ʻana a hoʻi hou i kahi ola hoʻoikaika. ʻAʻole ʻo ka lāʻau lapaʻau ka mea e hōʻoia ai e pili ana i ka hoʻomohala ʻana i nā ʻeha hou a me ka hoʻōla piha ʻana i nā hōʻeha. I kekahi mau hihia, hana ʻia nā amputation e hana hou ʻia.

Inā hoʻoholo ʻia na ka mālama conservative, a laila i loko o ʻeono mau pule o nā maʻi kiʻekiʻe o nā palahalaha ākea i kuhikuhi ʻia aku ai: Cefazolin, Clindamycin, Meronem, Tienam, Ciprofloxacin. Hoʻopaʻa pinepine ʻia nā lāʻau maʻi maʻi, akā me ka lōʻihi o ke ʻano hiki ke hoʻololi i nā ʻano papa.

Phoʻohana lākou i ka mālama hui ʻana me kekahi mau lāʻau lapaʻau - ʻo Levofloxacin + Clindamycin, beta-lactam antibiotics - Amoxiclav, Augmentin, Trifamox ua hoʻohana ʻia. Eia kekahi, hiki ke hoʻokau ʻia ai nā antibiotika ma ke ʻano kuʻuna, pololei i ka hōʻeha ʻana me ka hoʻohana ʻana i nā bean acrylate kūikawā.

Hāʻawi ka lāʻau Antibiotic i nā hopena maikaʻi i ka hapanui o nā maʻi, akā ma ka maʻi mellitus i ka maʻamau o nā maʻiʻolima e pili ana i ka maʻi, ka mea i kōkua i ka hoʻomohala pinepine ʻana i ka hopena o nā hopena like.

ʻO ka mea nui ka hopena therapeutic i ka mālama ʻana i nā maʻi e kū kūʻē i ka maʻi maʻi i ka uku ʻana i ke kō koko nui me ka hoʻohana ʻana i nā lāʻau lapaʻau e hōʻemi iā ia - iʻa a i ʻole nā ​​papa.

Me ka hoʻomaʻamaʻa ʻana a i ʻole hyperglycemia koʻikoʻi, hiki ke neʻe i nā maʻi mai nā papa i ka insulin i lalo o ka kaohi o ke kō koko. Hiki i ka Insulin ke hoʻoikaika i ka iwi iwi.

ʻAʻole hiki ke pale ʻia ka hoʻomohala ʻana o ka osteomyelitis i ka mellitus maʻi mika inā e hahai ʻoe i kaʻai haʻahaʻa-kalo i loko o ka maʻi āpau, e lawe i nā lāʻau lapaʻau i loko o kahi koho i wae ʻia I mea e hōʻemi ai i ka hopena o nā hoʻopiʻi o ka maʻi mellitus, pono ia e mālama i ka pae o ka glucose i loko o ke koko i loko o ia mau kikoʻī: ma kahi ʻōpū ʻole i hala a hiki i ka 6.4 mmol / l, ma hope o ka ʻai ʻana ma hope o ʻelua mau hola, 8.9 mmol / l, i ka wā moe, 6.95 mmol / l.

Hoʻokaʻawale ʻia nā pae Glucose i kēlā me kēia lā me kahi kiʻi glycemic. Eia kekahi, hoʻokahi manawa i kēlā me kēia mahina ʻekolu, e hōʻike ʻia nā mea maʻi me ka maʻi diabetes e hoʻoholo i ke kiʻekiʻe o ka hemoglobin glycated.

Hōʻike kēia kuhikuhi i ka palena o ke kō o ke koko ma mua o nā mahina ʻekolu i hala aku nei a ʻoi aku ka ʻike i ke ʻano o ka uku hoʻāno no ka maʻi maʻi. ʻO kona pae kiʻekiʻe e piʻi aʻe i ka 7.5%.

Pono ka metabolism momona i loko (kahi ana i loko o mmol / l) - cholesterol - 4.8;

ʻOi aku ka LDL ma mua o 3, ʻoi aku ka kiʻekiʻe o ka HDL ma mua o 1.2. Me nā pathologies vascular, mea nui nā mea e pale i ka hoʻokomo ʻana ʻaʻole wale nā ​​kākoi maʻalahi me ka meaʻai, akā e hoʻohaʻahaʻa i nā momona holoholona i ka meaʻai.

He mea nui hoʻi ia e nānā a mālama i nā hōʻeha o ka ʻili i mea e pale ai i ka hoʻokumu ʻana o nā ʻōpū trophic i ka maʻi maʻi. Inā kānalua ʻoe i ka hoʻokumu ʻana o kahi wāwae maʻi, kiaʻi mau ʻia e ka endocrinologist, neuropathologist, pono iā podologist. Ke hoʻomau nei ke wikiō ma kēia ʻatikala i ke kumuhana o nā pilikia hōʻeha o ka maʻi diabetes.