Amayeza okuTshintshwa kweKnee

Umxholo

• Ukubulawa ngexesha lotyando
• Ukulawula iintlungu
• Amayeza omlomo obuhlungu
• Iimpompo ezilawulwa zizigulana (PCA)
• Iibhloko zemithambo
• Liposomal bupivacaine
• Ukuthintela amahlwili egazi
• Ukuthintela usulelo
• Amanye amayeza
• Yise kude

Ngethuba lokutshintshwa kwamadolo ngokupheleleyo, ugqirha uya kususa izicubu ezonakalisiweyo kwaye afake idolo lokufakelwa.

Utyando lunokunciphisa iintlungu kwaye lonyuse ukuhamba ixesha elide, kodwa iintlungu ziya kubakho kwangoko emva kwenkqubo nangexesha lokuchacha.

Abantu bahlala beziva bekhululekile kwakhona emva kweenyanga ezi-6 ukuya kunyaka.Okwangoku, amayeza angabanceda bakwazi ukulawula iintlungu.

Ukubulawa ngexesha lotyando

Uninzi lwabantu luye lwenziwa endaweni yokuhlinzwa emadolweni phantsi kwe-anesthetic ngokubanzi.

Nangona kunjalo, ukusukela kwixesha lokuvuka kwabo, baya kufuna ukukhululeka kwentlungu kunye nezinye iintlobo zamayeza ukubanceda baphathe ukungonwabi kunye nokunciphisa umngcipheko weengxaki.

Amayeza emva kotyando olwenziwe ngamadolo anokukunceda:

• ukunciphisa intlungu
• phatha isicaphucaphu
• thintela amahlwili egazi
• ukunciphisa umngcipheko wosulelo

Ngonyango olufanelekileyo kunye nonyango lomzimba, abantu abaninzi bayachacha emadolweni kwaye bayakwazi ukubuyela kwimisebenzi yabo yemihla ngemihla kwiiveki.

Ukulawula iintlungu

Ngaphandle kolawulo olululo lweentlungu, unokuba nobunzima ukuqala ukubuyisela kwimeko yesiqhelo kunye nokuhamba emva kotyando.

Ukuvuselelwa kunye nokuhamba kubalulekile kuba kuphucula amathuba eziphumo ezilungileyo.

Ugqirha wakho unokukhetha kwizinto ezahlukeneyo, kubandakanya:

• iiopioids
• iibhloko zemithambo-luvo
• acetaminophen
• gabapentin / pregabalin
• i-non-steroidal anti-inflammatories (ii-NSAID)
• I-COX-2 inhibitors
• ketamine

Fumanisa okungakumbi malunga nonyango lweentlungu endaweni yokutshintsha kwamadolo ngokupheleleyo.

Amayeza omlomo obuhlungu

Iiopioids zinokuthomalalisa iintlungu ezilinganiselweyo. Ugqirha uhlala ebamisela ecaleni kwezinye iindlela.

Imizekelo ibandakanya:

• Imofini
• i-hydromorphone (iDilaudid)
• i-hydrocodone, ekhoyo eNorco naseVicodin
• i-oxycodone, ekhoyo kwiPercocet
• meperidine (iDemerol)

Nangona kunjalo, ukuthatha amayeza amaninzi opioid kunokubangela:

• ukuqhina
• ukozela
• isicaphucaphu
• ukuphefumla okucothayo
• ukudideka
• ilahleko eseleyo
• indlela engazinzanga

Banokuba likhoboka. Ngesi sizathu, ugqirha akazukuyalela amayeza opioid ixesha elide kunokuba ufuna.

Iimpompo ezilawulwa zizigulana (PCA)

Iimpompo ezilawulwa zizigulana (PCA) zihlala zinamayeza eentlungu opioid. Lo matshini uya kukuvumela ukuba ulawule idosi yonyango lwakho.

Xa ucinezela iqhosha, umatshini ukhupha amayeza amaninzi.

Nangona kunjalo, impompo ilawula idosi ngokuhamba kwexesha. Icwangcisiwe ukuze ingakwazi ukuhambisa kakhulu. Oku kuthetha ukuba awukwazi ukufumana ngaphezulu kwesixa esithile samayeza ngeyure.

Iibhloko zemithambo

Ibhloko ye-nerve ilawulwa ngokufaka i-intravenous (IV) catheter kwiindawo zomzimba kufutshane nemithambo-luvo eya kuthumela imiyalezo yeentlungu kwingqondo.

Oku kwaziwa ngokuba yi-anesthesia yengingqi.

Iibhloko zemithambo yenye yeempompo ze-PCA. Emva kosuku olunye ukuya kwezimbini, ugqirha wakho uyakususa i-catheter, kwaye ungaqala ukuthatha amayeza entlungu ngomlomo ukuba uyawafuna.

Abantu abafumene iibhloko zemithambo-luvo banolwaneliseko oluphezulu kunye neziganeko ezimbi ezimbalwa kunabo basebenzise impompo ye-PCA.

Nangona kunjalo, iibhloko zemithambo-luvo zisenokubandakanya umngcipheko othile.

Ziquka:

• usulelo
• impendulo engavumiyo
• ukopha

Ibhloko ye-nerve inokuchaphazela izihlunu kumlenze ongezantsi. Oku kunokunciphisa unyango lwakho lomzimba kunye nokukwazi ukuhamba.

Liposomal bupivacaine

Eli liyeza elitsha lokuphucula iintlungu ugqirha azifaka kwindawo yotyando.

Ikwabizwa ngokuba yi-Exparel, ikhupha i-analgesic eqhubekayo yokuphelisa iintlungu ukuya kuthi ga kwiiyure ezingama-72 emva kwenkqubo yakho.

Ugqirha unokuyalela eli chiza kunye namanye amayeza eentlungu.

Ukuthintela amahlwili egazi

Emva kotyando olwenziwe ngamadolo, kukho umngcipheko wokuba negazi. Ihlwili kwimithambo yegazi enzulu ibizwa ngokuba yi-vein thrombosis (DVT). Ngokuqhelekileyo zenzeka emlenzeni.

Nangona kunjalo, iqabaka ngamanye amaxesha linokuqhekeka kwaye lijikeleze umzimba. Ukuba ifikelela emiphungeni, inokubangela ukubola kwemiphunga. Ukuba ifikelela kwingqondo, inokukhokelela kwistroke. Ezi zizinto ezingxamisekileyo ezisongela ubomi.

Kukho umngcipheko ophezulu we-DVT emva kotyando kuba:

• Amathambo akho kunye nezicubu ezithambileyo zikhupha iiproteni ezinceda ekunqandeni ngexesha lotyando.
• Ukungahambi ngexesha lotyando kunokunciphisa ukujikeleza kwegazi, kwandise amathuba okuba ihlwili likhule.
• Awuyi kuba nakho ukuhambahamba kakhulu okwexeshana emva kotyando.

Ugqirha wakho uya kukuyalela amayeza kunye nobuchule bokunciphisa umngcipheko wamahlwili egazi emva kotyando.

Oku kunokubandakanya:

• iisitokisi zokucinezela, ukunxiba kumathole okanye emathangeni akho
• izixhobo zokucinezela ezilandelelanayo, ezithi ngobunono zifinya imilenze yakho ukukhuthaza ukubuya kwegazi
• I-aspirin, i-pain-counter-counter-reliever ekhupha igazi lakho
• i-heparin enobunzima obusezantsi, onokuyifumana ngenaliti okanye ngokumnika okuqhubekayo kwe-IV
• amanye amayeza anticlotting, afana ne-fondaparinux (Arixtra) okanye i-enoxaparin (iLovenox)
• amanye amayeza omlomo afana ne-warfarin (Coumadin) kunye ne-rivaroxaban powder (Xarelto)

Izinketho ziya kuxhomekeka kwimbali yakho yonyango, kubandakanya nayiphi na i-aleji, nokuba ngaba unengozi yokopha.

Ukwenza imithambo ebhedini nokuhamba ngokukhawuleza emva kotyando lwedolo kunokunceda ukuthintela amahlwili egazi kunye nokwenza ukuba ubuye kwakhona.

Amahlwili egazi sesinye sezizathu zokuba kubekho iingxaki emva kotyando olwenziwe ngamadolo. Fumana okunye malunga nezinye iingxaki.

Ukuthintela usulelo

Usulelo yenye into enokuthi ivele ngexesha lotyando lokutshintsha.

Kwixesha elidlulileyo, abantu abajikeleze usulelo, kodwa izinga langoku lijikeleze iipesenti ezili-1.1. Kungenxa yokuba abagqirha ngoku banika i-antibiotics ngaphambi kokuhlinzwa, kwaye banokuqhubeka nokubanika iiyure ezingama-24 emva koko.

Abantu abanesifo seswekile, ukutyeba kakhulu, iingxaki zokujikeleza kwegazi, kunye neemeko ezichaphazela amajoni omzimba, njenge-HIV, banomngcipheko ophezulu wokufumana usulelo.

Ukuba usulelo luyakhula, ugqirha uya kumisela enye ikhosi ye-antibiotics.

Ukuba oku kuyenzeka, kubalulekile ukuba uthathe lonke unyango, nokuba uziva ubhetele. Ukuba uyeka ikhosi yezibulala-ntsholongwane, usulelo lungabuya.

Amanye amayeza

Ukongeza kumayeza okunciphisa iintlungu kunye nemingcipheko yamahlwili egazi emva kokutshintsha kwamadolo, ugqirha wakho unokuyalela ezinye iindlela zonyango zokunciphisa iziphumo ebezingalindelekanga zeyeza kunye neyeza zentlungu.

Kwisifundo esinye, malunga neepesenti ezingama-55 zabantu babefuna unyango lwesicaphucaphu, ukugabha, okanye ukuqhina emva kotyando.

Amayeza e-Antinausea abandakanya:

• I-ondansetron (iZofran)
• ipropethazine (iPhenergan)

Ugqirha wakho unokumisela amayeza okuqunjelwa okanye okuthambisa izitulo, anje ngala:

• I-sodium yeglasi (Colace)
• bisacodyl (iDulcolax)
• i-polyethylene glycol (MiraLAX)

Unokufumana amayeza ongezelelweyo ukuba uyawafuna. Oku kunokubandakanya isicatshulwa se-nicotine ukuba uyatshaya.

Yise kude

Ukuhlinzwa ngokutshintshwa kwamadolo kunokunyusa iintlungu okwexeshana, kodwa inkqubo inokuphucula iintlungu kunye nokuhamba kwinqanaba elide.

Amayeza anokunceda ukugcina iintlungu zincinci, kwaye oku kunokuphucula ukuhamba kwakho emva kotyando.

Ukuba ufumana naziphi na iimpawu okanye iziphumo ezibi emva kokutshintsha kwedolo, kungcono ukuthetha nogqirha. Bahlala behlengahlengisa idosi okanye batshintshe amayeza.