Isifo sikashukela i-mellitus sihambisana nokukhuphuka kweglucose yegazi. I-glucose inomphumela olimazayo odongeni lwemithambo yegazi nemithambo yezinzwa.
Ngenxa yokuhlinzekwa kwegazi okunganele kanye nokungahambi kahle kokufakwa emaphethelweni aphansi, i-neuropathy iba njengengxaki yesifo sikashukela.
Isici esibonakalayo se-neuropathy ukukhula kwezilonda ezingalapheki kahle. Ezimweni zokuwa okungatheleleki, ukuntuleka kokudla kwezicubu, ukutheleleka kuyajoyina. Ezimweni ezisezingeni eliphakeme, isakazekela emathanjeni amathambo kanye ne-osteomyelitis.
Izimbangela ze-Osteomyelitis
I-neuropathy ephansi yomzimba kanye nokwakhiwa konyawo lwesifo sikashukela kuyinkinga evamile yesifo sikashukela. Ngokuvamile kwenzeka emva kweminyaka engama-5-7 kusukela ekuqaleni kwalesi sifo ngohlobo lokuqala lwesifo sikashukela. Uhlobo lwesibili sikashukela luhamba kancane futhi izinkinga zingakhula ngokuhamba kwesikhathi.
Isizathu esikhulu sokuthuthukiswa kwezinkinga zesifo sikashukela isinxephezelo se-glucose ephansi. Lokhu kungenzeka ngesimo esibi sesi sifo noma ukunganaki izincomo ze-endocrinologist. Ukugcwala okukhulu kwe-glucose egazini, futhi izinguquko zayo ezibukhali ziphazamisa udonga lwe-vascular futhi zonakalise imicu yezinzwa.
Ngokuncipha kokuhlinzekwa kwegazi nokushukunyiswa yizinzwa, izicubu zilahlekelwa umuzwa wazo nekhono lokululama ekulimaleni. Noma yimuphi umonakalo omncane noma ukuqhekeka kwesikhumba kungaholela ekwakhekeni kwezilonda zesifo sikashukela. Zilapha kancane, zivame ukutheleleka.
Unyawo lwesifo sikashukela lubonakala kuma-syndromes ambalwa:
- Ukuphazamiseka kwemithambo yemithambo emincane nemikhulu (angiopathy)
- Ukulimala kwamathambo kanye namathambo.
- Yehlise ukungazetheki.
- Ukutheleleka nge-ulcer.
Ngokuya ngokwanda kokuphazamiseka kwemizwa noma yemithambo yegazi, ifomu le-neuropathic noma le-ischemic lonyawo lwesifo sikashukela lihlukaniswa. Kepha lokhu kuhlukaniswa kuyangqubuzana kakhulu, ngoba imvamisa lezi zinto ezimbili zisebenza ngasikhathi sinye.
Ngakho-ke, ifomu elixutshwe kakhulu.
Izimpawu nokuxilongwa kwe-osteomyelitis
Unyawo lwesifo sikashukela lungaboniswa ukwephulwa kobuhlungu noma ukuzwela kokushisa kwamaphethelo aphansi, isikhumba esomile somile, imifantu, ukuvuvukala, ukuwohloka okujwayelekile konyawo. Ngale kwalokhu kulimala, izilonda zesikhumba ziyavela.
Izilonda ezenegciwane elikhulu ngokubhujiswa kwezicubu ezithambile eziya ethanjeni ziyinkimbinkimbi ngokuvuvukala kwezicubu zamathambo, i-periosteum kanye nomongo wamathambo. Kulokhu, i-osteomyelitis evelayo kunzima ukuyelapha ngemithi futhi imvamisa kuholela kwisidingo sokunqunywa kwemikhawulo ephansi.
I-Osteomyelitis ingaba yinkinga yanoma yiziphi izilonda ezijulile noma ezinkulu ezinde. Ukuthuthukiswa kwe-osteomyelitis kuboniswa yizimpawu ezinjalo:
- Isilonda asiphili ezinyangeni ezimbili zokwelashwa ngezidakamizwa.
- Isilonda sijule futhi ithambo libonakala ngezansi, noma linganqunywa uphenyo.
- Isilonda esithintekile sivuthiwe futhi sibomvu.
- Egazini, izinga leukocytes lenyuka, i-ESR ingaphezu kuka-70 mm / ihora.
- Lapho wenza ukuhlolwa kwe-x-ray noma i-MRI, ukubhujiswa kwamathambo ngaphansi kwesilonda kwatholakala.
Isibonakaliso esiyinhloko sokuxilonga i-biopsy (ukuhlolwa kwezicubu) zethambo.
Esikhathini sikashukela i-mellitus, ukubhujiswa kwamathambo kubangela isifo sikashukela se-dieoictheoos (inyawo likaCharcot). Lesi simo sikhula ku-neuropathy yesifo sikashukela esibi. Inqubo yokuvuvukala yenzeka ngaphandle kokutheleleka. Esigabeni esibuhlungu, kukhula i-edema engafani yonyawo. Isikhumba sibomvu, silukhuni futhi sishisa, sinezindawo zokuvuvukala.
Isikhathi sokuvuvukala okunamandla singangena enkambweni engapheli yokwelapha. Dislocations, fractures kungenzeka emalungeni, amathambo akhubazekile. Ngokuhamba kwesikhathi, lesi sifo singafakwa yinkimbinkimbi yi-osteomyelitis.
Inkambo ye-osteoarthropathy yesifo sikashukela ihamba ngezigaba eziningana:
- Isigaba esibuhlungu: i-edema yonyawo, ubomvu nomkhuhlane. Ezithombeni - i-osteoporosis (izicubu zamathambo ezingatholakali).
- Isigaba se-Subacute: akukho ukuvuvukala, unyawo lubolile, ithambo libhujiswe ezithombeni.
- Isigaba esingamahlalakhona: unyawo lonakele, lufana ne- "sheetweight", dislocations and fractures of bones.
- Isigaba esinezinkinga: izilonda ezingapheli, i-osteomyelitis.
Ukwelashwa kwe-Osteomyelitis
Isigaba esibuhlungu se-osteoarthropathy siphathwa ngokulayisha ngokuphelele umlenze. Kulokhu, kusetshenziswa izinto zokwenza umsebenzi wamathambo: ama-orthoses, abafundisi, izicathulo zamathambo.
Uma lokhu akwanele futhi isilonda singapholi, khona-ke kunconywa umngcele ophelele wokunyakaza - ukuphumula kombhede okuqinile. Ukwelashwa kwezidakamizwa, amaqembu alandelayo wezidakamizwa asetshenziswa:
- Ukuvimbela ukubhujiswa kwamathambo - i-Alendronate, Pamidronate.
- Ekwakhekeni kwezicubu ezintsha zamathambo - ama-anabolic steroid mahormone (Methandrostenolone, Retabolil), amalungiselelo e-calcium ne-Vitamin D3.
- Ama-Painkiller - Analgin, Ketanov, Nalbufin.
- Izidakamizwa ezingezona ezokwehlisa ukuvuvukala - i-Nimesulide, Diclofenac, Revmoxicam.
- I-Diuretics - iFurosemide, iHypothiazide.
Kunezimo zokuthuthuka ngemuva kokwelashwa kwe-x-ray.
Esigabeni esingamahlalakhona, kulungiswa amavithamini kanye ne-calcium. Ingxenye yethambo elonakalisiwe lapho kungekho ukuvuvukala ingasuswa ngokuhlinzwa. Ukugqoka izicathulo zamathambo kuyakhonjiswa.
Ngokuthuthukiswa kwe-osteomyelitis, umsebenzi oyinhloko ukukhethwa kokunye ukwelashwa - umuthi noma ukuhlinzwa.
Ngokwelashwa okuhlinzwa, ukunqunywa komunwe noma ingxenye yonyawo nokukhuthaza ukuphulukiswa kwenxeba kukhonjisiwe. Uma ukutheleleka kungaqali ngemuva kokuhlinzwa, khona-ke kukhona ithuba lokululama nokubuyela empilweni esebenzayo. Ukwelashwa ngokuhlinzwa akusona isiqinisekiso sokulwa nokukhula kwezilonda ezintsha nokuphulukiswa ngokuphelele kwamanxeba. Kwezinye izimo, ukunqunywa okuphindaphindiwe kuyenziwa.
Uma isinqumo senziwa ekwelashweni okulondoloziwe, khona-ke kungakapheli amasonto ayisithupha kuthathwe imithamo ephezulu yemithi elwa namagciwane ebanzi: uCefazolin, Clindamycin, Meronem, Tienam, Ciprofloxacin. Imvamisa, izidakamizwa ziyalashwa, kepha uma ulashwa isikhathi eside kungenzeka ushintshe amafomu wethebhulethi.
P
basebenzisa ukwelashwa okuhlanganisiwe nezidakamizwa eziningana - I-Levofloxacin + Clindamycin, i-beta-lactam antibiotic - Amoxiclav, Augmentin, Trifamox nazo ziyasetshenziswa. Ngaphezu kwalokho, imithi elwa namagciwane ingalawulwa ngokuqondile, ngqo esilondeni usebenzisa ubuhlalu obukhethekile be-acrylate.
Ukwelashwa nge-antibiotic kunikeza imiphumela enhle ezigulini eziningi, kepha ku-mellitus yesifo sikashukela kuvame ukuba nokuntuleka kokuqina kwesibindi, okunomthelela ekuthuthukisweni okuvamile kwemiphumela emibi yokwelashwa okunjalo.
Isici esiyinhloko sokwelashwa ekwelashweni kwanoma yiziphi izifo ngokumelene nesifo sikashukela yinxephezelo sikashukela wegazi ophezulu ngokusetshenziswa kwezidakamizwa ukuze sinciphise - i-insulin noma amaphilisi.
Ngokwelashwa okuhlinzwa noma i-hyperglycemia enzima, iziguli zingadluliselwa zisuka kumathebulethi ziye kwi-insulin ngaphansi kokulawulwa koshukela. I-insulin inamandla okuqinisa izicubu zamathambo.
Ukuthuthukiswa kwe-osteomyelitis ku-mellitus yesifo sikashukela kungavinjelwa uma ulandela ukudla okune-carb ephansi kusifo sonke, phuza imishanguzo edamini elikhethiwe. Ukuze unciphise ubungozi bezinkinga zesifo sikashukela i-mellitus, kubalulekile ukugcina izinga le-glucose egazini kulawo mabanga: esiswini esingenalutho kuze kufike ku-6.4 mmol / l, ngemuva kokudla ngemuva kwamahora amabili, u-8.9 mmol / l, ngesikhathi sokulala, 6.95 mmol / l.
Amazinga we-glucose alinganiswa nsuku zonke ngephrofayili ye-glycemic. Ngaphezu kwalokho, kanye ezinyangeni ezintathu, zonke iziguli ezinesifo sikashukela ziboniswa ukunquma izinga le-hemoglobin ye-glycated.
Le nkomba ikhombisa isilinganiso esiphakathi soshukela wegazi ezinyangeni ezintathu ezedlule futhi ifundeka ngokwengeziwe ukuthola inani lesinxephezelo sikashukela. Izinga layo elilungile lifinyelela ku-7.5%.
I-metabolism yamafutha kufanele ibe ngaphakathi (ukukalwa ku-mmol / l) - cholesterol - 4.8;
I-LDL ingaphansi kune-3, i-HDL ingaphezulu kwe-1,2. Ngama-pathologies we-vascular, kubalulekile ukuvimbela ukungena kwama-carbohydrate alula ngokudla, kepha futhi nokunciphisa amafutha ezilwane ekudleni.
Kubalulekile futhi ukuthi uhlole futhi welaphe izilonda zesikhumba ukuze uvikele ukwakheka kwezilonda ezinesifo sikashukela. Uma usola ukwakheka konyawo lwesifo sikashukela, ukuqapha njalo yi-endocrinologist, neuropathologist, podologist kuyadingeka. Ividiyo ekulesi sihloko iyaqhubeka nesihloko sezinkinga zokulimala kwesifo sikashukela.
