Septic Arthritis vs Gout Flare: Chifukwa Chake Kutentha Kwambiri, Kutupa Mgwirizano Umodzi Ndi Fever Ndi Nthawi Yadzidzidzi ya Cartilage ya Maola 24¶

Kutentha kwambiri, kufiyira, kutupa, komanso kupweteka kwambiri (acute monoarthritis), komwe kumakhudza kwambiri bondo, m'chiuno, paphewa, pamkono, kapena m'bowo, ndi imodzi mwazovuta kwambiri zadzidzidzi zamankhwala. Ngakhale crystal-induced arthritis flakes (acute gout kuchokera ku monosodium urate crystals kapena pseudogout / CPPD kuchokera ku calcium pyrophosphate crystals) imayambitsa kutupa kwambiri komwe kumayenderana ndi mankhwala odana ndi kutupa, acute bacterial septic arthritis (infectious nyamakazi) ndi njira yowona mafupa ndi mabakiteriya omwe amatseka mabakiteriya otsekedwa mkati mwa mabakiteriya a synocytes. (matrix metalloproteinases ndi neutrophil elastase) zomwe zimagaya mosasinthika ndikuwononga avascular articular hyaline cartilage mkati mwa maola 24 mpaka 48, ndikunyamula 10 mpaka 15 peresenti ya kufa m'chipatala kuchokera pakupita patsogolo mpaka sepsis ndi septic shock. Choyipa kwambiri ndi chakuti gout ndi septic nyamakazi zimatha kukhala nthawi imodzi pamalo olumikizirana ndendende, ndipo kuwala kwa krustalo kokha kumayambitsa kutentha thupi mpaka madigiri 38.9 Celsius (102 degrees Fahrenheit). Chifukwa palibe kuyezetsa magazi, X-ray, kapena kuyezetsa magazi komwe kungathetseretu matenda pawokha, chinthu chilichonse chotentha kwambiri, chotupa chosadziwika bwino chimayenera kupangidwa ndi singano yofulumira (arthrocentesis) musanamwe mankhwala opha maantibayotiki kapena intra-articular steroids. Ngati munthuyo ayamba kutentha thupi kwambiri chifukwa cha kuuma, chisokonezo, kupuma mofulumira, chizungulire, khungu lokhala ndi timadontho, kapena kulephera kudzuka, imbani nambala yanu yadzidzidzi yapafupi nthawi yomweyo (911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom) kapena onani bukhu lathu la manambala angozi. Pazadzidzidzi zokhudzana ndi matenda opatsirana komanso minofu ndi mafupa, werengani malangizo athu kuzindikira sepsis ndi septic shock, Kutupa kwa cellulitis, erysipelas, lymphangitis red streaking, ndi zilonda zam'mimba,ndi mapewa osokonekera, chipewa cha bondo, ndi kusokonekera kwa mafupa.

Chitani izi tsopano¶

1. Pitani kuchipatala mwamsanga ngati cholowa chimodzi chatupa mwadzidzidzi, kutentha, ndi kutsekeka pamene mukuyenda: Musadikire usiku wonse kuti muwone ngati bondo, ntchafu, akakolo, mkono, kapena phewa likuyenda bwino palokha, makamaka ngati munthuyo ali ndi malungo, kuzizira, matenda a shuga, nyamakazi, rheumatoid arthritis, immunosuppression, jekeseni waposachedwapa, kapena jekeseni wamakono mgwirizano**). Mu bakiteriya septic nyamakazi, **chiwopsezo chamuyaya cha cartilage chimayamba mkati mwa maola 24 ** chiyambireni chizindikiro.
2. Yesani chosiyanitsa chofunika kwambiri cha pambali pa bedi: yang'anani pang'onopang'ono ngati cholowacho chingathe kupirira ngakhale madigiri a 5 a kusuntha kwapang'onopang'ono (micromotion): Pamene wodwala akumasula minofu yake kwathunthu, modekha yesetsani kusinthasintha kapena kuzungulira mfundo yomwe yakhudzidwayo ndi madigiri 5 mpaka 10 okha. Pamatenda apakhungu (prepatellar bursitis kapena cellulitis pamwamba pa olowa), kuyenda pang'ono pang'onopang'ono kwa olowa sikumakhala kowawa mpaka khungu litatambasuka mwamphamvu. Mu ** zoonadi intra-articular septic arthritis ** (ndi crystal flares kwambiri), kapisozi yonse yolumikizana imayikidwa pansi pa kuthamanga kwambiri kwa hydraulic: wodwalayo akugwira mgwirizano wolimba mu ** malo ake olemera kwambiri a capsular volume ** (kwa bondo, 15 mpaka 30 madigiri a kupindika pang'ono; chifukwa m'chiuno, kusinthasintha, kukugwedezani, kukugwedezani, kukugwedezani, ndikukuchotsani kunja) ngakhale madigiri 5**.
3. Musamamwe maantibayotiki otsala achipatala asanayambe kulumikiza singano yamadzimadzi (arthrocentesis): Pokhapokha ngati wodwalayo ali pachiswe Septic shock kwa maola ambiri kuchokera ku chipatala, osameza maantibayotiki akunyumba dokotala asanayambe kumwa madzi otuluka m'malo otupa. Mlingo umodzi wapakamwa wa amoxicillin, cephalexin, doxycycline, kapena ciprofloxacin sungathe kulowa m'malo olowa malo odzaza mafinya kuti apulumutse chichereŵechereŵe, koma amachotsa chikhalidwe chamadzimadzi a synovial, kubisa mabakiteriya oyambitsa matendawa ndikusiya madokotala akhungu kuti adziwe ngati wodwala akufunika milungu inayi yomwa mankhwala opha tizilombo toyambitsa matenda kapena kulowetsedwa m'mitsempha.
4. Musalole kuti kuchipatala kubayire cortisone (corticosteroids) m'malo otentha kwambiri, otupa olowa m'maselo a synovial fluid ndi madontho a Gram kuletsa matenda: Ngati wodwala matenda a nyamakazi kapena gout apempha chipatala kuti amuwombere mwachangu "cortisone kuwombera" munjira yatsopano yotentha, ndikutumiza bondo lotupa ndi kutupa. Staphylococcus aureus mabakiteriya, intra-articular steroids amapundula maselo oyera amwazi am'deralo ndikupangitsa kuwonongeka kwa mafupa, osteomyelitis, ndi kufatal bacteremia m'masiku ochepa.
5. ** Limbikitsani NPO mwamphamvu (palibe kanthu pakamwa, kuphatikizapo chakudya, madzi, kapena mapiritsi opweteka) pamene mukupita ku dipatimenti yodzidzimutsa: ** Ngati arthrocentesis imatsimikizira mafinya a bakiteriya mkati mwa mgwirizano waukulu (makamaka chiuno, phewa, kapena prosthetic bondo / chiuno), madokotala ochita opaleshoni amatengera wodwalayo ku chipinda chopangira opaleshoni ** opaleshoni ya opaleshoni kapena opaleshoni kusokoneza (kutsuka pamodzi) ** pansi pa anesthesia wamba kapena msana. Pewani kupereka ma NSAID pakamwa (ibuprofen, naproxen) kapena acetaminophen (paracetamol) pasadakhale, kuti m'mimba musakhale opanda kanthu chifukwa cha opaleshoni komanso kupewa kubisa kutentha thupi pakutha msinkhu.
6. ** Gwirani ndi kusasunthika cholumikizira mumayendedwe ake achilengedwe ndikutsitsa zolemera zonse:** Musakakamize kutupa, bondo lopindika kapena ntchafu yowongoka. Thandizani bondo kapena bondo lopweteka pa pilo ndi ndodo kapena njinga ya olumala kotero kuti zero bodyweight imakanikiza zigawo zofewa za cartilage pamodzi, ndikuthandizira phewa kapena dzanja lopweteka poponyera bwino.

Mtengo wachigamulo: kutentha kwambiri, kutupa limodzi (monoarthritis) triage¶

flowchart TD
    Start["Kutentha Kwambiri, Kufiyira, Kutupa, Kapena Kupweteka Pamodzi Pamodzi (Bondo, M'chiuno, Mphewa, Bondo, Dzanja, Kapena Kuphazi)"] --> CheckSepsis{"1. Mbendera Zofiira Zonse za Sepsis: Chisokonezo, Zovuta, BP Drop, Kuthamanga kwa Mtima> 110, kapena Kupuma Mofulumira?"}

    CheckSepsis -->|"INDE: Systemic Sepsis kapena Septic Shock"| Call911["IMMEDIATE 911 / 112 / 999 SEPSIS PROTOCOL: 1. Itanani Ambulansi Mwamsanga Kuti Muyendere Chipatala Chofulumira 2. Jambulani Zikhalidwe Zamagazi + Chitani Zadzidzidzi Zogwirizana Pabedi Pamodzi 3. Yambani Ma Antibiotics a Broad-Spectrum IV Mkati mwa Ola la 1 la Triage"]

    CheckSepsis -->|"NO: Hemodynamically Stable"| CheckChildHip{"2. Kodi Wodwalayo Ndi Mwana Amene Mwadzidzidzi Wakana Kulemera Pamwendo Umodzi Kapena Kusuntha Mchiuno?"}

    CheckChildHip -->|"INDE: Chiuno Chosautsa Ana"| KocherCheck["PEDIATRIC KOCHER ZINTHU ZOCHITIKA ZOCHITIKA ZOCHITIKA: 1. Pitani molunjika ku Dipatimenti ya Zadzidzidzi za Ana (Keep Child NPO) 2. Yang'anani 4 Kocher Predictors: Non-Weight-Bearing, Fever>38.5 C (101.3 F), ESR>40 mm/hr, WBC>12.ounds 3 Necrosis mkati mwa maola"]

    CheckChildHip -->|"AYI: Kufotokozera kwa Akuluakulu"| CheckBursaVsJoint{"3. Kodi Kutupa Kumatuluka Panja Pa Kneecap / Elbow Tip Ndi Pain-Free 10-Degree Micromotion, KAPENA M'kati mwa Kapsule Yogwirizana Kwambiri?"}

    CheckBursaVsJoint -->|"Kwambiri Pa Kneecap / Olecranon; Micromotion Zosawawa"| SepticBursitis["OGANIZIWA SEPTIC BURSITIS KAPENA OVERLYING CELLULITIS: 1. Osadutsanso Singano Kupyolera Pakhungu Lofiyira Lopatsirana Pamalo Ozama Opanda Matenda 2. Kuwunika Kwachipatala Kwachangu kwa Bursal Aspiration kapena Systemic Antibiotics"]

    CheckBursaVsJoint -->|"Mgwirizano Wakuya Wotsekedwa motsutsana ndi 5-Degree Passive Motion"| UrgentTap["ZOYENERA KULIMBITSA ZOCHITIKA ZOCHITIKA ARTHROCENTESIS: 1. Khalani Oleza Mtima NPO; OSATI Kutenga Oral Antibiotics kapena Cortisone Shots Pamaso pa Tap 2. Aspirate Synovial Fluid for WBC Count, % PMNs, Gram Stain, Culture, ndi Polarized Light Crystal Exam 3. Kumbukirani: Kukhalapo kwa Gout / CPPD Crystals Sikulamulira Kugwirizana kwa Septic Arthritis"]

Chifukwa chiyani mafinya a bakiteriya amawononga mgwirizano mkati mwa maola 24 mpaka 48¶

Mosiyana ndi khungu, minofu, kapena fupa, ** articular hyaline cartilage ** (galasi-yosalala, phokoso lotsika kwambiri lomwe limaphimba mapeto a mafupa mkati mwa mgwirizano wa synovial) uli ndi ** mitsempha yamagazi, zero mitsempha, ndi zero lymphatic drainage **. Pamene chichereŵechereŵe chachikulire chawonongeka, sichingathe kuyambiranso.

1. Momwe mabakiteriya amalowera m'malo otsekedwa olowa¶

** synovial membrane ** yomwe ili mkati mwa kapisozi yolumikizana imakhala ndi mitsempha yambiri, yomwe imapangitsa kuti ikhale fyuluta yoyamba ya mabakiteriya omwe amayendayenda m'magazi, koma modabwitsa ** ilibe nembanemba yapansi yoteteza **. Mabakiteriya amalowa m'malo olowa m'njira zitatu: 1. Mbeu za hematogenous (70 mpaka 80 peresenti ya milandu): Pakachitika matenda osakhalitsa kapena ochulukirapo (bacteremia) ochokera pakhungu lakutali, kukanda, matenda a mkodzo, chibayo, kugwiritsa ntchito mankhwala osokoneza bongo, endocarditis, kapena njira ya mano/catheter, mabakiteriya amadutsa mu synovial-catheter kudzera mu synovial-catheter. synovium mu madzi olowa. 2. Kulowetsa mwachindunji (15 mpaka 20 peresenti): Mabakiteriya amakankhidwira mwachindunji m'mphako ndi kuvulala kolowera (munga, msomali, kulumidwa ndi mphaka, kapena nkhonya yomenyetsa "kulumana" kumenyetsa dzino pamphuno), kusabereka intra-articular corticosteroid kapena jekeseni kapena jekeseni posachedwapa kapena hyaluronic acid. 3. Kufalikira kwapang'onopang'ono (5 mpaka 10 peresenti): Matenda oyandikana nawo (acute osteomyelitis) amadutsa mu cortex kupita kumalo olowa, omwe amadziwika kwambiri ndi makanda ndi ana aang'ono, kumene mitsempha ya magazi imadutsa mbale ya kukula (physis) m'chiuno, phewa, chigongono, ndi bondo.

2. The enzymatic cartilage kusungunuka kugwa¶

Kamodzi mabakiteriya monga Staphylococcus aureus (kuphatikiza MRSA, omwe ali ndi matenda opitilira 50 peresenti), Streptococcus mitundu, Neisseria gonorrhoeae (mwa achinyamata omwe akugonana nawo), kapena Gram-negative bacilli (*Pseudomonas, Eruginosa aeruginoa akuluakulu achikulire) odwala immunocompromised, kapena IV ogwiritsa ntchito mankhwala osokoneza bongo) amalowa m'thupi la synovial fluid: - Ola 0 mpaka 12 (Neutrophil Invasion & Pressure Surge): Neutrophil Invasion & Pressure Surge): Neutrophil Invasion & Pressure Surge) imasefukira pabowo ndi ma polymorphonuclear neutrophils (ma cell oyera amagazi) ndi madzimadzi. Chifukwa kapisozi wa fibrous joint capsule sangathe kukula mosavuta, intra-articular hydrostatic pressure skyrockets, kukanikiza kumatseka mitsempha yaying'ono ya epiphyseal yomwe imapereka fupa lakumunsi (makamaka mkati mwa ball-and-socket chiuno cholumikizira **, kuchititsa ** avascular necrosis yautu wa chikazi ). - **O 12 mpaka 24 (Kutayika kwa Proteolytic Glycosaminoglycan): Mabakiteriya onse (kudzera mwa bakiteriya Chondroitinasedi poizoni) komanso maselo oyera a magazi omwe ali ndi mantha a wodwalayo amatulutsa kuchuluka kwa lysosomal proteases, collagenases, ndi matrix metalloproteinase(MMPs) Mkati mwmaola 24, ma enzymeswa amachotsa mpaka 40 peresenti ya matrix a proteoglycan (glycosaminoglycan) a cartilage. - Ola la 24 mpaka 48+ (Irreversible Collagen Scaffolds Collapse): Khushoni ya proteoglycan ikasungunuka, ma meshwork amtundu wa Type II collagen wa chichereŵecheretsa amasweka chifukwa cha kukanikiza kwa mafupa. Ngakhale mankhwala opha mabakiteriya atapha mabakiteriya onse pa Tsiku 4, chichereŵechereŵecho chimakhala kale chosungunuka mpaka fupa, ndikusiya wodwala kukhala ndi nyamakazi yopunduka fupa kapena mafupa (ankylosis).

Kuyerekeza mbali ndi mbali: Septic Arthritis vs Acute Gout vs Pseudogout (CPPD) vs Septic Bursitis¶

Kusanthula kwamadzimadzi a Synovial: kutanthauzira kuponyedwa kwa singano mwadzidzidzi (arthrocentesis)¶

Chifukwa kuyezetsa thupi ndi kuyezetsa magazi (serum uric acid, maselo oyera*, ESR, ndi CRP) zimayenderana kwambiri pakati pa nyamakazi ya septic ndi crystal arthritis, madokotala odzidzimutsa amadalira **kusanthula kwamadzimadzi ** kotengedwa kudzera mwa wosabala arthrocentesis monga muyezo wagolide:

Matenda a nyamakazi a m'chiuno: njira yadzidzidzi ya Kocher¶

Mwa makanda, ana aang'ono, ndi ana, acute bacterial septic arthritis of the hip ndi imodzi mwazochitika zadzidzidzi za opaleshoni ya ana. Chifukwa mitsempha yamagazi yomwe imasunga mutu wa chikazi wa mwanayo (**retinacular mitsempha ya lateral epiphyseal artery **) imayenda molunjika mkati mwa capsule yolimba ya m'chiuno, mafinya amawunjikana pansi pa kupanikizika mkati mwa chiuno cha mwana ** amasokoneza magazi pamwamba pa chikazi mkati mwa 6 mpaka maola 12, kuchititsa limbre, hip-length discs, kuchititsa kuti pakhale chiuno, chiuno ndi chiuno. kulumala kwa moyo wonse.

1. Momwe khanda kapena mwana wokhala ndi chiuno cha septic amagwirira mwendo wake ("The Fabere Posture")¶

Mwana wamng'ono kapena mwana yemwe ali ndi kutupa m'chiuno mwadzidzidzi ** amakana kuyimirira, kuyenda, kapena kulemera pa mwendo umodzi ** (kapena mwana amalira mosatonthozeka panthawi iliyonse ya kusintha kwa diaper). Onani momwe mwanayo amagwirizira mwendo womwe wakhudzidwa atagona chagada: - Chiuno chimagwiridwa ** Chopindika (chopindika m'mwamba), Kubedwa (kuponyedwa kunja kumbali ngati mwendo wa chule), ndi Kuzungulira Kunja (phazi kutembenukira kunja) **. - Chifukwa chiyani? Chifukwa ichi ** FABERE kaimidwe ** imakulitsa kuchuluka kwa mkati mwa kapisozi wa m'chiuno ndikuchepetsa kupsinjika kwa intra-articular. Kuyesera kulikonse kuwongola mwendo wa mwanayo kapena kugubuduza ntchafu mkati kumayambitsa kukuwa nthawi yomweyo.

2. The 4 Kocher Criteria: kusiyanitsa Mvuu Ya Septic ku Benign "Transient Synovitis"¶

Chifukwa chakuti kutukusira kwa chiuno kodziletsa, komwe kumatchedwa transient synovitis ("toxic synovitis") nthawi zambiri kumapangitsa ana azaka zapakati pa 3 mpaka 8 kuti azidumphira patangotha ​​masiku ochepa chimfine, madokotala a ana ndi opaleshoni ya mafupa amagwiritsa ntchito njira zovomerezeka za Kocher Criteria (kuphatikizapo puloteni ya C-reactive) kuti adziwe kutheka kwa bakiteriya.

Mitundu yapadera yokhala pachiwopsezo chachikulu: Matenda a Gonococcal, Matenda a Nyamakazi a Lyme, ndi Sternoclavicular Sepsis¶

Sikuti ziwalo zonse zomwe zili ndi kachilombo zimakhala ngati Staphylococcus aureus mawondo sepsis. Khalani tcheru ndi ma syndromes atatu apadera omwe amafunikira kuyesedwa mwapadera:

1. Kufalikira kwa Gonococcal Infection (DGI / Gonococcal Arthritis-Dermatitis Syndrome):
2. Chimene chimamukhudza: Choyambitsa #1 cha nyamakazi yopatsirana kwambiriachinyamata ndi achinyamata omwe amagonana nawo (makamaka azimayi achichepere panthawi ya kusamba kapena kukhala ndi pakati).
3. Classic Triad: Musanakhazikike m'magulu amodzi kapena awiri (nthawi zambiri bondo, mkono, kapena akakolo), DGI imapereka (1) polyarthralgias yosamukira (ululu wolumpha kuchokera ku bondo kupita ku dzanja kupita ku bondo), (2) tenosynovitis (kutupa kofiira m'mbali mwa ntchafu, msana, m'chiuno, m'chiuno, m'chiuno kapena m'chiuno). (3) zotupa pakhungu zosapweteka kapena zokhetsa magazi (tizifuti ting'onoting'ono 5 mpaka 20 patsinde lofiira pamwamba pa zala, zikhato, m'manja, kapena akakolo).
4. Kuzindikira Matenda: Zikhalidwe za synovial fluid zimakula Neisseria gonorrhoeae zosakwana 50 peresenti ya nthawiyo, ndipo ma synovial WBC count imatha kukhala 20,000 mpaka 40,000 ma cell/uL. Madokotala ayenera kusonkhanitsa mayeso a nucleic acid amplification (NAAT / PCR swabs) kuchokera mkodzo / khomo lachiberekero, rectum, ndi mmero (pharynx) pamodzi ndi magazi ndi zikhalidwe zolumikizana, ndikuchiza ndi mtsempha waceftriaxone.
5. Matenda a Lyme Monoarthritis (Borrelia burgdorferi):**
6. Zowonetsera: Patatha milungu ingapo kupita miyezi ingapo atalumidwa ndi nkhupakupa zosadziŵika m'zigawo zomwe zafala kwambiri (Northeast, Mid-Atlantic, ndi Upper Midwest United States; Central ndi Northern Europe), wodwalayo amatupa bondo lotupa kwambiri ("baker's-balloon knee effusion") zomwe zimakhala zopweteka kwambiri* zopweteka kwambiri Mosiyana ndi nyamakazi ya Staph septic, wodwala nyamakazi ya bondo ya Lyme nthawi zambiri sakhala ndi** malungo** ndipo amathabe kupita ku chipatala ali ndi kulemera kwakukulu ngakhale kuti mawondo ake akuthamanga kwambiri. Kuzindikiridwa kudzera mu seramu yamagulu awiri Lyme ELISA/Western blot ndi synovial fluid Lyme PCR; Analandira chithandizo cha masiku 28 a oral doxycycline kapena amoxicillin osafunikira kusambitsidwa pamodzi.
7. Sternoclavicular ndi Sacroiliac Joint Septic Arthritis:
8. Ngati mwadzidzidzi, kutupa kwakukulu, kufiira, ndi kukhudzika kwa mafupa kumawonekera pa sternoclavicular joint (pomwe fupa lamkati lamkati limakumana ndi pamwamba pa fupa la pachifuwa pamunsi pa khosi), kukayikira hematogenous septic arthritis (yomwe imayamba chifukwa cha Staphylococcus aureus kapena Pseudomonas, makamaka kwa odwala omwe ali ndi matenda a shuga, matenda a shuga apakati, IV). Chifukwa mgwirizano wa sternoclavicular umakhala kutsogolo kwa subclavia vein, brachiocephalic artery, and superior mediastinum, chiphuphu cha sternoclavicular chopanda chithandizo chimaphulika kumbuyo mu chifuwa (**kutsika necrotizing mediastinitis **) ndipo imafuna CT / MRI imaging ndi drainal cardiothopedic suture.

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

• United States ndi Canada: Imbani 911 ngati malo otentha, otupa olowa limodzi ndi kutentha thupi kwambiri, kuuma, chisokonezo, chizungulire, kapena kulephera kuyimirira. Apo ayi, pitani mwachindunji ku Dipatimenti Yodzidzimutsa Zachipatala (osati chipatala chogulitsira mankhwala kapena kuyenda-mchisamaliro chachangu chomwe chilibe zinthu zosabala za arthrocentesis, ma microscopy a polarized, ndi opaleshoni ya mafupa oyimba foni).
• United Kingdom: Imbani 999 kuti mupeze sepsis yomwe mukukayikira kapena pitani kuchipatala chapafupi Dipatimenti ya A&E. Pansi ** British Society for Rheumatology (BSR) ndi British Orthopedic Association (BOA) Guidelines for the Hot Swollen Joint **, nyamakazi iliyonse yopweteka kwambiri iyenera kuyanjana ndi ma microscopy, synovial cell count, ndi chikhalidwe chisanayambe chithandizo cha maantibayotiki, ndikuwunikiridwa mwamsanga kwa mafupa kuti azitsuka pamodzi.
• European Union: Imbani 112 kuti muyendere ma ambulansi mwadzidzidzi kapena mupite ku dipatimenti yodzidzimutsa kuchipatala potsatira European Alliance of Associations for Rheumatology (EULAR) njira zowopsa za monoarthritis.
• Australia ndi New Zealand: Imbani 000 ku Australia kapena 111 ku New Zealand, kapena perekani nthawi yomweyo kuDipatimenti Yodzidzimutsa kuchipatala chaboma kapena payekha kuti mukambirane mwachangu ndi arthrocentesis ndi mafupa.
• India ndi Asia-Pacific: Imbani 112 kapena 108 ku India, 995 ku Singapore, 119 ku Japan ndi South Korea, kapena 999 ku Hong Kong ndi Malaysia.

Mafunso omwe amafunsidwa pafupipafupi¶

Nchifukwa chiyani bondo lotupa, lotupa kapena ntchafu zimatengedwa ngati chithandizo chachipatala cha maola 24?¶

Mosiyana ndi khungu kapena minofu, cartilage yosalala ya hyaline yomwe imaphimba nsonga za mafupa mkati mwa cholumikizira ilibe magazi ndipo sichingapangidwenso ikawonongeka. Mabakiteriya akalowa m'malo otsekedwa (septic arthritis), poizoni wa bakiteriya ndi michere ya proteolytic yomwe imatulutsidwa ndi kuchuluka kwa maselo oyera amagazi amayamba kusungunula matrix a proteoglycan a cartilage mkati mwa maola 24 mpaka 48. Popanda kukhetsa kwa singano mwachangu, kutsukidwa kwapang'onopang'ono, ndi maantibayotiki olowa m'mitsempha, kuwonongeka kwa mafupa-pafupa kosatha kapena sepsis yoyika moyo ikhoza kuchitika mkati mwa masiku awiri.

Chifukwa chiyani sindiyenera kumwa maantibayotiki otsala kunyumba ndisanapite kuchipatala kuti ndikatupa?¶

Kumwa piritsi limodzi kapena awiri oletsa maantibayotiki dokotala asanayambe kumwa madzi olumikizana ndi singano (arthrocentesis) nthawi zambiri amalepheretsa labu ya microbiology kukulitsa mabakiteriya mu chikhalidwe ("chikhalidwe chabodza"), popanda kuchiritsa matenda olowa. Mkhalidwe wamadzimadzi olowa m'malo ophatikizika ndi mapiritsi obadwa msanga, madotolo sangathe kudziwa ngati muli ndi matenda ophatikizika a bakiteriya owopsa omwe amafuna kuti mupatsidwe opaleshoni komanso milungu inayi yamankhwala opha tizilombo toyambitsa matenda kapena zilonda zam'mimba, zomwe zimakakamiza kuti munthu agoneke m'chipatala kwanthawi yayitali pamankhwala am'mitsempha.

Kodi gout imatha kuyambitsa kutentha thupi, ndipo kodi mutha kukhala ndi gout ndi matenda olumikizana ndi bakiteriya nthawi imodzi?¶

Inde kwa onse awiri. Gout kapena pseudogout flare, makamaka pa mfundo zazikulu monga bondo kapena zolumikizira zingapo, zimatulutsa kuchuluka kwa beta ya interleukin-1 m'magazi, zomwe nthawi zambiri zimayambitsa kutentha kwa thupi mpaka madigiri 38.9 Celsius (102 degrees Fahrenheit) komanso kuchuluka kwa maselo oyera a magazi. Mosiyana ndi zimenezi, mpaka 5 peresenti ya odwala omwe ali ndi bakiteriya septic joint alinso ndi gout kapena pseudogout makhiristo omwe amawoneka mumtsuko wamadzimadzi omwewo chifukwa ma enzyme a bakiteriya omwe amagaya cartilage amagwedeza makhiristo omwe analipo kale. Kuwerengera kwathunthu kwa maselo a synovial fluid, banga la Gram, ndi chikhalidwe zimatha kusiyanitsa ziwirizi.

Nchifukwa chiyani kuli kowopsa kuwomberedwa kwa cortisone mu bondo lotupa kumene popanda kuyesa madzi olowa mgulu kaye?¶

Corticosteroids (monga triamcinolone kapena methylprednisolone) amagwira ntchito popondereza mwamphamvu maselo oyera a magazi ndi chitetezo chamthupi mkati mwa olowa. Ngakhale jakisoni wa steroid amachepetsa msanga matenda a nyamakazi kapena gout flare, kubaya cortisone mumgwirizano womwe umasunga mabakiteriya mobisa kumachotsa chitetezo chamthupi cham'deralo, kupangitsa kuti mabakiteriya azichulukirachulukira, kuwononga malo onse olumikizana, kuwononga fupa (osteomyelitis), ndikuyambitsa fatal septic shock.

Kodi madokotala amasiyanitsa bwanji ntchafu ya septic ndi yopanda vuto "yosakhalitsa synovitis" mwa mwana yemwe mwadzidzidzi amakana kuyenda?¶

Madokotala azadzidzidzi a ana amawunika zofunikira zinayi za Kocher: (1) kukana kulemera pa mwendo, (2) kutentha thupi kuposa madigiri 38.5 Celsius (101.3 degrees Fahrenheit), (3) erythrocyte sedimentation rate (ESR) pa 40 mm/h (kapena CRP pa 2.0 mg/dL) pa cell cell yoyera ya 2.0 mg/dL), ndi (0000 mg / dL 4 cell cell cell) Mwana yemwe ali ndi ziro kapena muyezo umodzi pafupifupi nthawi zonse amakhala ndi kachilombo koyambitsa matenda a synovitis, pamene mwana yemwe ali ndi njira zitatu kapena zinayi ali ndi mwayi woposa 93 peresenti wa matenda a nyamakazi ya bakiteriya ndipo amafunikira mwamsanga ultrasound-guided hip aspiration ndi madzi opangira opaleshoni m'chipinda chopangira opaleshoni.

Ndi chiyani chomwe chingakhale chadzidzidzi ngati ndili ndi bondo lochita kupanga kapena kusintha m'chiuno (cholumikizira cholumikizira)?¶

Kupweteka kulikonse kwadzidzidzi kwatsopano, kutentha, kutupa, kufiira, kutuluka kwa mabala, kapena kutentha kosadziŵika kwa wodwala wokhala ndi bondo lonse, chiuno, kapena m'malo mwa mapewa ndizochitika mwadzidzidzi za mafupa, kaya opaleshoniyo inali masabata 2 apitawo kapena zaka 10 zapitazo. Tizilombo toyambitsa matenda timadutsa m'magazi kuchokera kumalo otsuka mano, kudulidwa khungu, kapena matenda a mkodzo amatha kuyika chitsulo ndi kupanga biofilm yosamva mankhwala m'masiku ochepa. Pitani ku dipatimenti yowona za ngozi zachipatala ndi chithandizo cha opareshoni ya mafupa ndipo musalole kuti achipatala agwire malo opangira opaleshoni kunja kwa matenda a mafupa.

Maupangiri ogwirizana¶

• Sepsis ndi septic shock kuzindikira ndi kuyankha mwadzidzidzi
• Cellulitis, erysipelas, lymphangitis red streaking, ndi zilonda zam'mimba
• Mapewa osokonekera, chipewa cha bondo, ndi kusasunthika kwa mafupa
• Mafupa osweka, fractures, ndi sprains kwambiri thandizo loyamba

Magwero ndi malangizo ovomerezeka¶

• British Society for Rheumatology (BSR), British Orthopedic Association (BOA), ndi Royal College of Emergency Medicine (United Kingdom): Guideline for Management of the Hot Swollen Joint in Adults (Arthrocentesis, Synovial Fluid Analysis, and Surgical Washout Standards).
• European Alliance of Associations for Rheumatology (EULAR): EULAR Remendations for Management of Early Arthritis, Acute Monoarthritis, Gout, ndi Calcium Pyrophosphate Deposition (CPPD) Matenda.
• Infectious Diseases Society of America (IDSA, United States): Malangizo Othandizira Othandizira Kuzindikira ndi Kuwongolera kwa Native Vertebral Osteomyelitis, Native Joint Septic Arthritis, ndi Prosthetic Joint Infection (PJI).
• American Academy of Orthopedic Surgeons (AAOS) ndi Pediatric Orthopedic Society of North America (POSNA): Malangizo Othandizira Achipatala pa Pediatric Septic Arthritis of the Hip (Kocher Criteria) ndi Acute Adult Septic Monoarthritis.
• American College of Rheumatology (ACR, United States): Malangizo a Kasamalidwe ka Gout (Acute Flare Colchicine/NSAID/Steroid Protocols and Concurrent Septic Arthritis Exclusion).