درمان عفونت مفصل
عفونت مفصل چیست ؟ آیا مفصل دچار عفونت می شود ؟ علائم عفونت مفصل زانو چیست ؟ آیا کودکان هم دچار عفونت مفصلی می شوند و یا اینکه بهترین روش برای درمان عفونت مفصل چیست ؟ بیشتر افراد با عفونت مفصل آشنایی ندارند و در صورت بروز نمی توانند آن را تشخیص و یا درمان کنند . دکتر کریمی پور در بهترین مرکز فیزوتراپی در غرب تهران در رابطه با روش های تشخیص و درمان عفونت داخل مفصلی و یا آرتریت سپتیک صحبت می کنند .
آرتریت سپتیک ،همان عفونت داخل فضای مفصلی می باشد . باکتری ها به طور مستقیم ،به عنوان مثال از یک زخم نافذ به مفصل وارد می شوند ،یا این کار را با انتشار از راه خون از استئومیلیت مجاور یا پروتز های آلوده انجام می دهند . ورود باکتری به فضای مفصلی باعث بروز واکنش التهابی همراه با ترشح واسطه های التهابی و جذب گلبول های سفید به درون مفصل می شود . فعال شدن نوتروفیل ها و ماکروفاژ ها باعث ترشح آنزیم های پروتئولیتیک می شود که همراه با سموم باکتریایی غضروف مفصلی را تخریب می کنند . افزایش نفوذ پذیری و ترشح مایع ،باعث تجمع مایع در فضای مفصلی می شود که با افزایش فشار و کاهش خون رسانی فضای سینوویال ،ممکن است آسیب دیدگی مفصلی را تشدید کند . هنگام بهبود ،ترمیم سطح مفصلی آسیب دیده ،گاه به فیبروز و آنکیلوز استخوانی منجر می شود .
مهم ترین عامل میکروبی در افراد کوچکتر از 3 سال ،استافیلوکوک اورئوس ،هموفیلوس انفلوآنزا یا کولی فرم ها و در بزرگسالان استافیلوکوک اورئوس و نیسریا گونوره است .
عوامل خطر ساز در عفونت مفصلی
مبتلایان به دیابت ،مصرف کنندگان مواد مخدر تزریقی ،افراد با ضعف ایمنی و مبتلایان به بیماری های مزمن مفصل (مانند آرتریت روماتوئید ) بیشتر در خطر ابتلا به آرتریت سپتیک هستند .
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علائم عفونت مفصلی در افراد
درد در یک مفصل یا اندام ،احساس کسالت و تب از علائم شایع می باشد .
بیشتر یک مفصل بزرگ منفرد را مانند ران در شیر خواران و کودکان در گیر می کند که در آنان بیماری با لنگیدن و پرهیز از تحمل وزن تظاهر می کند . مفصل زانو بیشتر در کودکان بزرگ تر و بزرگسالان درگیر می شود اگر چه عفونت می تواند هر مفصلی را درگیر کند .
معاینه مفصل آسیب یده
مفصل قرمز و متورم
در صورت درگیری هیپ ،بیمار، پا را به حالت فلکسیون نگه داشته ،آن را اندکی به خارج می چرخاند (این کار لیگامان ها را شل و فشار مفصل را کاهش می دهد . )
حساسیت منتشر با کاهش شدید دامنه حرکتی مفصل به علت درد
در آرتریت گونوکوکی ممکن است نزدیک مفصل ،پوستول هایی دیده شود و شواهد ترشح از پیشابراه وجود داشته باشد .
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درمان عفونت مفصلی
درمان به دو صورت وجود دارد درمان با کمک جراحی و درمان به روش های غیر جراحی
درمان غیر جراحی
در ابتدا آنتی بیوتیک های وریدی به مدت 1 تا2 هفته تجویز می شود و سپس 4 تا 6 هفته دیگر ،درمان با آنتی بیوتیک خوراکی ادامه می یابد . باید برای بیمار مسکن تجویز کرد و مفصل مبتلا را ،برای کاهش درد ، با آتل بی حرکت کرد . برای پیشگیری از فیبروز و حفظ تحرک مفصل ،لازم است تا بیمار فیزیوتراپی شود .
فیزیوتراپی هم در روش غیر جراحی و هم در روش درمان با کمک جراحی مورد استفاده قرار می گیرد . بعد از جراحی برای بهبود عملکرد، فیزیوتراپی تجویز می گردد تا فرد طول دوره درمان خود را به نسبت کمتر کند .
درمان جراحی
در اکثر موارد ،شستشوی مفصل به روش جراحی ،برای خارج کردن چرک و مواد عفونی باید انجام شود . این کار را می توان با آرتروسکوپی یا روش باز (آرتروتومی ) انجام داد .درسپسیس مفصل مصنوعی ،پیش از آنکه ریشه کنی کامل عفونت ،ممکن شود ،باید پروتز را خارج کرد .
عوارض می تواند به صورت در رفتگی ناکامل یا کامل مفصل ،نکروز اواسکولار اپی فیز، اختلالات رشد ،انکیلوز ،تخریب مفصل یا استئوآرتریت باشد .
پیامد ها به ویرولانس میکروب ،طول مدت عفونت پیش از تشخیص ،بیماری های دیگر فرد مبتلا و مفصل درگیر بستگی دارد (پیامد های عفونت زانو بهتر از مچ پا است ). با درمان زود هنگام و مناسب ،پیش آگهی اغلب خوب است .
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