OSTEOATHRITIS (OA)ni indwara isanzwe ihuriweho itera umutwaro uremereye abarwayi, imiryango na societe.Gusuzuma no kuvura bisanzwe bya OA bifite akamaro kanini mubikorwa byubuvuzi niterambere ryimibereho.Ivugurura ry’ubuyobozi ryayobowe n’ishami ry’ubumenyi bw’imyororokere ry’Abashinwa, ishami ry’imyororokere ya orthopedic arthritis ishami ry’ubuvuzi bw’amagufwa ry’ishyirahamwe ry’ubuvuzi ry’Abashinwa, Ikigo cy’ubushakashatsi cy’ubuvuzi bw’ubuvuzi bw’abasaza (ibitaro bya Xiangya) n’ishami ry’ubwanditsi bw’ikinyamakuru cy’amagufwa cy’Ubushinwa.Gutanga ibyifuzo Isuzuma, Iterambere n'Isuzuma (Grade) sisitemu yo gutanga amanota hamwe nubuyobozi mpuzamahanga bufatika (RAPORO ITEMS Muri Healthca) RE, BIKURIKIRA) Hitamo ibibazo 15 byubuvuzi amavuriro y’amagufwa ahangayikishijwe cyane, Amaherezo, hashyizweho ibyifuzo 30 by’ubuvuzi bishingiye ku bimenyetso kugira ngo bitezimbere siyanse yo gusuzuma OA kandi amaherezo izamura ireme rya serivisi z'ubuvuzi zishingiye ku barwayi.
Sobanura neza gusuzuma no gusuzuma byuzuye: OA gusuzuma no gusuzuma ibyifuzo bijyanye
OA isanzwe mubafite imyaka ≥40, abagore, umubyibuho ukabije (cyangwa umubyibuho ukabije), cyangwa amateka y’ihungabana.Kugaragara cyane kwa clinique ni ububabare hamwe nibikorwa hamwe.Gutomora isuzumabumenyi ni ikintu cy'ingenzi gisabwa kugira ngo hashyizweho gahunda yo kuvura indwara.Kubakekwaho OA abarwayi, umurongo ngenderwaho urasabwa guhitamo ibizamini bya X -ray.Nibiba ngombwa, CT, MRI, na ultrasound birashobora gukorwa kugirango turusheho gusobanura aho kwangirika no kurwego rwo kwangirika no gukora isuzuma ritandukanye.Yagaragaje kandi ko indwara zigomba kumenyekana na OA zirimo: arthritis, arthritis yanduye, gout, pseudo -gout, hamwe no gukomeretsa hamwe indwara ziterwa na autoimmune.Isuzuma rya laboratoire ntabwo ari ngombwa mu gusuzuma indwara ya OA, ariko niba ivuriro ry’umurwayi kwigaragaza ntabwo bisanzwe cyangwa ntibishobora gukuraho izindi ndwara, urashobora gutekereza guhitamo ikizamini cya laboratoire kugirango umenye indwara.
Nyuma yo gusuzuma OA, hagomba gukorwa isuzuma ryuzuye ry’abarwayi kugira ngo hategurwe gahunda yo kuvura abarwayi.Ubuyobozi bwerekanye ko gusuzuma indwara z’abarwayi ba OA bigomba kuba bikubiyemo indwara zitandukanye, urugero rw’ububabare, hamwe n’indwara zihuza.Ntabwo bigoye kubona uhereye kuri OA gusuzuma no gusuzuma igishushanyo mbonera.Gusuzuma neza no gusuzuma byuzuye nibisabwa byingenzi kugirango bivurwe OA.
Intambwe, ubuvuzi bwihariye: Ibyifuzo byo kuvura OA
Ku bijyanye no kuvura, umurongo ngenderwaho uvuga ko kuvura OA bigomba gushingira ku mahame yo kuzamura urwego no kuvura umuntu ku giti cye kugira ngo agere ku ntego yo kugabanya ububabare, kunoza cyangwa kugarura imikorere ihuriweho, kuzamura imibereho y’abarwayi, kudindiza iterambere ry’indwara, no byakosowe nabi.Ubuvuzi bwihariye bukubiyemo ubuvuzi bwibanze, kuvura ibiyobyabwenge, gusana no kuvura.
1) Ubuvuzi bwibanze
Mu kuvura intambwe ya OA, umuyobozi arasaba ubuvuzi bwibanze bwatoranijwe.Kurugero, inyigisho zubuzima, kuvura imyitozo ngororamubiri, kuvura umubiri no gufasha ibikorwa.
Mu kuvura imyitozo, imyitozo yo mu kirere hamwe n’imyitozo y’amazi birashobora kunoza neza ibimenyetso byububabare nimirimo yumubiri yabarwayi bafite ivi hamwe nibibuno bya OA;imyitozo ngororamubiri y'intoki irashobora kugabanya neza ububabare no gukomera kw'abarwayi ba OA.Amavi apfukamye OA arashobora gutekereza gukoresha imiti ivura umubiri nko kuvura amashanyarazi akoreshwa nubuvuzi bwa pulse ultrasound ivura abarwayi bafite ibimenyetso byububabare.
2) Kuvura ibiyobyabwenge
Imiti yibanze itari steroidal anti -inflammatory (NSAIDS) irashobora gukoreshwa nkimiti yambere yo kuvura kubabara ivi OA, cyane cyane kubarwayi bafite indwara zifata igifu, indwara zifata umutima cyangwa intege nke.Abarwayi bafite ibimenyetso simusiga byububabare cyangwa ububabare buciriritse bwa OA basabwa gufata NSAIDS yo mu kanwa, ariko bakeneye kuba maso kubice byabo byigifu ndetse nibibazo bibi byumutima.
Uyu muyobozi yavuze ko OA idasabwa gukoresha imiti igabanya ubukana bwa opioid, kandi ko ari ngombwa gukoresha imiti igabanya ubukana nka Qu Maodo.Ku barwayi bafite -igihe kirekire, karande, ububabare bukabije na (cyangwa), abarwayi bafite depression barashobora gukoresha imiti igabanya ubukana nka Rostein.Ugereranije no kuvura glucocorticoide mu mwobo uhuriweho, sodium yo gutera arthrine irashobora kugabanya ububabare mu gihe gito, ariko umutekano ni mwinshi, kandi amabwiriza arasabwa uko bikwiye.Byongeye kandi, ubuvuzi bwabashinwa hamwe na acupuncture birashobora no gukoreshwa mu kuvura OA.
Ingaruka zo gutera inshinge
Incamake y'ibimenyetso: Glucocorticoide ikwiranye no kwiyongera gukabije k'ububabare bw'ivi, cyane cyane abarwayi ba Knee OA baherekejwe na effusion.Ingaruka zayo zirihuta, igihe gito -kugabanya ububabare ububabare burahambaye, ariko iterambere-ryigihe kirekire ryububabare nigikorwa cyububabare nigikorwa ntigaragara, kandi ugakoresha inshuro nyinshi ibyago byo kwihuta gutakaza igihombo cya karitsiye mugukoresha imisemburo.Birasabwa gukoresha inshinge glucocorticoide mumitsi ihuriweho.Kandi ntibirenza inshuro 2 kugeza kuri 3 kumwaka, kandi intera yo gutera inshinge ntigomba kuba munsi y'amezi 3 kugeza kuri 6.Byongeye kandi, usibye abarwayi ba OA barwayi bafite ububabare bukabije mu ntoki, ingingo zifatika muri rusange ntizifatwa kuvura ikiganza OA.Ku barwayi barwaye diyabete, cyane cyane abafite amaraso mabi ya glucose, bagomba kumenyesha inshinge zifata kanseri ya glucocorticoide kugira ngo byongere by'agateganyo ibyago byo kuba isukari mu maraso, kandi birasabwa ko ubu bwoko bw'abarwayi bugenzura urugero rw'isukari mu maraso muri 3 d nyuma yo gutera inshinge.
Ikirahuri cya sodiyumu kirashobora kunoza imikorere ihuriweho, igihe gito-kigabanya ububabare kandi kigabanya ingano yimiti igabanya ubukana, kandi ifite umutekano mwinshi.Irakwiriye abarwayi ba OA bafite gastrointestinal na (cyangwa) ibyago byindwara z'umutima-damura, ariko biri muruhare rwo kurinda karitsiye no gutinda indwara biracyavuguruzanya.Birasabwa gusaba nkuko bikwiye ukurikije imiterere yumurwayi.Iterambere ryikura hamwe na plasma ya platel birashobora kunoza igisubizo cyaho, ariko uburyo bwacyo, imikorere, numutekano bikenera igihe kirekire -kurikirana -kugerageza, ikizamini cyo kugenzura ibintu byinshi (RCT) kugirango gitange ibimenyetso byinshi.Byongeye kandi, ubushakashatsi mu mavuriro yo kuvura ingirabuzimafatizo OA bwakorewe no mu Bushinwa.
3) Gusana
Kubijyanye no gusana ubuvuzi, mbere ya byose, birakenewe ko twumva ko kubaga arthroscopie bigira akamaro muguhuza ivi OA hamwe nibimenyetso byububabare gusa, kandi nta tandukaniro rikomeye riri hagati yimikorere miremire nigihe kirekire no kuvura konservateur.Ivi rifatanije na OA hamwe nibimenyetso byo gufunga birashobora gukoreshwa mugutezimbere ibimenyetso byo kweza arthroscopie;izindi ngamba zo gutabara ntizemewe, kandi abarwayi bafite ingingo zintugu bitewe nimyaka, ibikorwa cyangwa ibyifuzo byawe ntibikwiriye guhuza ibitugu.Indorerwamo Qingli.
Byongeye kandi, icyumba cyububiko bwa tibia OA gifite imbaraga zidahwitse zivi, cyane cyane abarwayi bafite abasore bato n'abaciriritse kandi bafite ibikorwa binini, barashobora guhitamo tibial high -level amagufwa, gukata amagufwa yumugore, cyangwa kubaga amagufwa ya fibula;Ikibuno cyoroheje cya OA cyatewe na dysplasia ya acetabular acetike irashobora gutoranywa.
4) Kwiyubaka
Gusimburanya ibihimbano bikwiye kubarwayi ba OA bakomeye bafite ingaruka zigaragara zizindi ngamba zo gutabara.Ariko rero, ibintu byihariye, ubushake bufatika hamwe nibyifuzo byumurwayi nabyo bigomba gusuzumwa.
Ubundi bworoherane bwingingo zingingo zingingo zifatika zindi ngaruka zo kuvura, umurongo ngenderwaho wo guhitamo guhitamo guhuza imigabane yimigabane;tibia ububiko bwicyumba kimwe OA numurongo wingufu za 5 ° ~ 10 °, ligament yuzuye, flexion hamwe namasezerano ya flexion itarenze 15 °, birasabwa gusabwa Guhitamo umusimbura umwe.
OA, nk'indwara ihuriweho, ifite ubwiyongere rusange bwa OA mu bantu barengeje imyaka 40 mu gihugu cyanjye.Hamwe no gukaza umurego, ubwiyongere bwa OA buracyafite inzira yo kuzamuka.Ni muri urwo rwego, umuryango w’ubuvuzi washyize ahagaragara umurongo ngenderwaho / ubwumvikane bw’impuguke mu myaka yashize, harimo “Impuguke z’Ubwumvikane bw’ubuvuzi bwa Clinical Drug Therapy of orthopedic arthritis” na “Igitekerezo cy’inzobere mu micungire y’indwara zidakira za osteoarthritis” kugira ngo ziyobore kandi zipime isuzuma ry’amavuriro. no kuvurwa.Hamwe no gusohora andi mabwiriza nubushakashatsi, nizere ko bizamura ubuzima bw abarwayi ba OA kurushaho.
Ku barwayi ba OA, hashingiwe ku gusuzuma neza, hasabwa kandi gusuzuma indwara zuzuye.Ukurikije ihame ryintambwe -urwego rwihariye hamwe nubuvuzi bwihariye, ubuvuzi bwibanze, bufatanije nubuvuzi bwumubiri, gusana no kuvura ibyubaka, nibindi gahunda.
Ibiri muri iyi ngingo byongeye gusubirwamo, kandi ntidutanga ingwate iyo ari yo yose cyangwa yerekana ko ari ukuri, kwiringirwa cyangwa kuzuza ibikubiye muri iyi ngingo, kandi ntabwo dushinzwe ibitekerezo by'iyi ngingo, nyamuneka ubyumve.）
Igihe cyo kohereza: Gicurasi-11-2023