Iibhloko zesebe eziphakathi zineendawo ezibalulekileyo kwiyeza zentlungu. Ngokutsho kwe- E-Medicine , iingcali ezininzi zikholelwa ukuba iingxaki kwi-facet zidibeneyo ziphantsi kwezona zihlandlo zentlungu engaphantsi kwemizimba (mhlawumbi i-80%).
Ukuqonda kakuhle indlela enokuyenza ngayo kunokunceda ekuqondeni le ntlungu ebuhlungu kunye nonyango lwayo. Okokuqala, yazi ukuba i-facet edibeneyo yintoni eyenza ugcino lomgcini ozinzileyo luzinzile ngexesha elifanayo ukuququzelela iintlobo ezithile zokuhamba.
Kukwaziwa nangokuthi yi-zygapopsese, kunye ne-Z-joint. Umgca wecala uhlala ngaphandle ngaphandle kwaye ungabonakali ngokubambisana. Kwakhona elinye lamagatsha amathathu enesibindi esikhulu esabizwa ngokuthi i-dorsal ramus, yinto yokuqala yegalelo elivela kumgca weengcongolo. Khumbula, i-dorsal ithetha kwakhona kwaye i-ramus ithetha itsha.
Ezi zintathu izibilini ezivela kwi-ramor ramus zikhonza indawo ezininzi, kubandakanywa izihlunu zangemva. Isebe eliphambili elichaphazelekayo lithinta i-facet ngokudibeneyo kunye neentsimbi ezinzulu ezinjenge- interspinales , i- multifidus , kunye nabanye abambalwa. Isebe eliphakathi nalo lifikelela ubuncinane omnye umgudu womgudu (interspinous) kwaye mhlawumbi ezimbini (i-ligamentum flavum kunye).
Ziziphi iibhloko zesebe eliphakathi?
Xa unesibonda sesebe, u-anesthetic wendawo efana ne-lidocaine ifakwe kwi-neral medial. Ukujoba i-anesthetic yangaphakathi kwindawo yesalathisi kunceda oogqirha baxilonge intlungu.
Ukuba i-injection iyanciphisa ubuncinane i-50% yeentlungu zakho zangasemva, ugqirha wakho uya kuqinisekisa ukuba intlungu ivela kwi-facet edibeneyo kwaye icebise i-radiation frequency as treatment. Iibhloko zesebe eziphakathi nazo zisetyenziselwa ukufumanisa intlungu ye-sacroiliac.
Unokuba necandelo legatsha eliphakathi kwecala elilodwa lombutho odibeneyo okanye zombini.
Xa amabini omabili aphathwe, kuthiwa yi-injection bi-lateral.
Iibhloko zesebe eziphakathi okanye ii-Injections ze-intra-Articular
Olunye uhlobo lomjovo olusetyenziselwa ukuxilonga ubuhlungu be-back is injection intra-articular. Le injection iya ngqo kwindawo edibeneyo ye-facet ejikelezwe yi- capsule eyenziwa ngamathambo enesibindi. Ucwaningo lwango-2016 olupapashwe kwiphepha le- Pain Physician elifunyenweyo, phakathi kwezinye izinto, ukuba ubudlelwane phakathi kwesebe kunye nokuphumelela unyango oluhlangeneyo lunokuba lukhulu kunalo phakathi kwe-injection intra-articular kunye nophando oluphumelelayo. Oko kwathiwa, abalobi bacela ukuqhutyelwa izifundo ezongezelelweyo zekhwalithi eziphezulu ukuba zenziwe ngolu hlobo ngaphambi kokuba ziqinisekise oku kufunyanwa.
Iibhloko zesebe eliphakathi njengezonyango
Ngaba iibhloko zesebe zamaphakathi zingasetyenziswa njengonyango? Emva koko konke, banciphisa intlungu, kunene?
Nangona ininzi yexesha ibhanki yesebe yecala linikezelwa ngenjongo yokuxilonga, ngamanye amaxesha kusetyenziswa njengonyango, kodwa lisebenza kakuhle kangakanani?
Uphando lwe-2013 olupapashwe kwi- Annals of Medicine Rehabilitation (Medicine Rehabilitative Medicine) lubonise ukuba abantu abanobukhulu bamasebe bethintela iintlungu ezingapheliyo ezinxulumene ne-osteoporotic fracture elandelayo okanye i-vertebroplasty okanye unyango olulondolozayo, iziphumo zilungele ukunyanga kwithuba.
Ababhali bathi i-block block yesigxina inokuphucula intlungu kunye nokubuyisela ukusebenza kwezi gulane.
Kodwa uphando olwenziwe ngo-2012 oluvandlakanyo lweentlobo ezahlukeneyo zonyango oluhlangeneyo lufunyenwe ubungqina obungqina bendawo yamasebe njengendlela yokunciphisa ubuhlungu obungapheliyo kuloo ndawo. Oko kwathiwa, abaphandi babengenakukwazi ukuthelekisa iibhloko zecala kunye neenjini zangaphakathi, ngenxa yokuba bekungekho ubungqina kuwo wonke unyango lwangaphakathi. Kwaye isifundo se- PM & R esichazwe ngentla ngasentla, ubungqina obunqununu kuphela bufunyenwe kwi-radiofrequency neurotomy. Ukusetyenziswa kwe-radiofrequency ablation kunye / okanye i-neurotomy yinto eqhelekileyo kwi-facet unyango lwentlungu ehlanganyelweyo ngaphandle kweebhloko zesebe.
Ukuphulukiswa kwexesha eliqhelekileyo yinkqubo yokuphulukiswa kwesifo apho kusetshenziselwa ukufudumala kwiimbulunga ezijikelezayo kwi-facet edibeneyo, ukubulala iiseli. Ngokuhamba kwexesha, umzimba uthatha iiseliti zesifo ezifayo ngeesisindo ezinqabileyo. Nangona i-radiofrequency ablation ingathathwa njengengxaki ephikisanayo, ukuxhoxiswa kwamalungu e-lumbar facet kunokubonelela ngokukhululeka kwentlungu kunokuba kwezinye iindawo zomgudu. Ucwaningo lwe-2015 olupapashwe kwi- International Journal ye-Anesthetics kunye ne-Anesthesiology luboniswe ukuba iminyaka emibili emva kokuba i-lumbar igxiliswe ngokukhawuleza kwegazi, izigulane zenza kakuhle ngokulawulwa kwintlungu, ukukwazi ukusebenza kunye nokuba zingaphi imishanguzo enzima.
Kwi-neurotomy, uhlobo olufanayo lweshushu-ukusuka kumaza-ramsholo-lusetyenziselwa ukwenzela ukunciphisa intlungu. Uphando lwe-2012 olupapashwe kwiphepha le- PM & R (I- Medicine Physical and Rehabilitation ) lufumene ukuba ukuphulukana kwentlungu ngenxa ye-radiofrequency neurotomy inkqubo yahlala phakathi kweenyanga ezi-7 ukuya kwezi-9 kwizigulane ezininzi, kwaye oku kwakunyaniseki ukuba indawo ephathwayo yayise entanyeni okanye ephantsi.
Yintoni eyenzekayo kwiCandelo loLuntu loLuntu?
Ukuba ucebelwe ukuba ube necandelo legatsha eliphakathi, ungalindela ntoni?
Inkqubo iya kuba yinto enokuthi iqhutywe kwiziko lonyango kwaye awuyi kulala, kodwa oko kulungile! Ugqirha uya kuqala ngokukunika udonga lwe-anesthétic yangaphakathi ukuze unqabise isikhumba sakho kunye nezicubu ezikufuphi. Uya kulala esiswini sakho ukwenzela ugqirha ukuba afumane amaqabane akho, afunyanwa ngasemva komqolo womgcini.
Emva koko uza kufaka inaliti eqhutywe kwikhamera ebizwa ngokuba yi-fluoroscope kwindawo edibeneyo yombutho. Ngokusebenzisa inaliti, idayi eyahlukileyo iya kujoba kwindawo. Oku kwenza ukuba ugqirha abone ukuba ngaba i-agent agent engasetyenzisiweyo isetyenziselwa ukuba ilandele yonke indawo ekudibeneyo. Emva koko, i-anesthetic ifakwe kwi-joint.
Emva kokuba i-anesthetic ijojowe, ugqirha wakho unokukuqondisa ukuba wenze uhambo olufanayo oluvame ukuzisa intlungu okanye iimpawu zakho. Ngokutsho kuka-Anthony Vaccaro, MD, unjingalwazi we-neurosurgery kunye nokuhlinzwa kwamathambo kwiYunivesithi yaseTomas Jefferson eFiladelphia kunye nomqondisi-nqo we-Spinal Cord Injury, phakathi kwe-50% kunye ne-75% yokuphulukana kwentlungu kuya kunika ugqirha wakho isizathu sokuqinisekisa ukuba ungumva wakho Intlungu ivela kwi-facet edibeneyo kunye / okanye i-neral branch nererve.
Ngenxa yokuba idibaniso ngalinye lixhaswa ngamagatya amabini (elinye elivela kwi-vertebra elingentla kunye nelinye kwi-vertebra elingezantsi) uya kufumana izibhengezo ezimbini ze-anesthetic kuzo zonke izidibaniso ezibanjelwe unyango.
Oku kunokukwenza ukudideka xa kuziwa kwi-coding yezokwelapha kunye nokuhlawula. Enyanisweni, kwiminyaka yakutshanje, iingxaki zeengxowankulu zamagciwane ezixhasayo zikhokelela kwiqondo eliqingqiweyo lokukhwabanisa kwe-Medicare.
I-Medicare Inkohliso kunye nokuShatshazwa ngokubhekiselele kwiiNtsholongwane
Ingxelo ka-2008 ekhutshwe yi-Ofisi yezeMpilo kunye neeNkonzo zoMhloli woMhloli-Jikelele yafumana ukunyuka kwama-76% kwiintlawulo ze- Medicare kwiibhloko ze-facet phakathi kweminyaka ka-2003 no-2006. Ababhali befumene ukuba kula ma-63% i-coded engafanelekanga (82% yezi zinto kubangele ukuhlawulwa kwemali ye-Medicare) kunye / okanye kungekho mfuneko yempilo.
Ngo-2006, i-Medicare ikhokhe imali eyi-81 yezigidi zeenkonzo zonyango ezingazange zibhalwe kakuhle okanye zingabhalwanga nhlobo. Ingxelo ithi ngelixa ezinye zezi ntlawulo ezingalunganga zisekelwe kwiiposiso zamaphepha, abanye kungenzeka ukuba babekho iisenjini ezingazange zenzeke. Ngokombiko, ininzi yexesha, oogqirha bantoni babenayo irekhodi yesigulane kwi-Medicare, kodwa kwezinye iimeko, abazange benze njalo kwaye bahlawuliwe.
Ezinye zeephene kwiirekhodi ezithunyelwe kwi-Medicare ziquka iinkcazo ezingekho phantsi kwenkqubo eyenziweyo, okanye iinkcukacha ezingekho phantsi, umzekelo, ukuchongwa kwenqanaba lomgcini kunye / okanye icala langemuva (oko kukunene, ngakwesobunxele okanye bobabini) abafumene injola .
Iikhowudi ezongezelelweyo zokuhlawula iintlawulo ezifunekayo ukuba zibonise ii-injection zombini (oko kukuthi ukudubula kumacala omabini edibeneyo yakho) kubangele ukuhlawulwa kwe-50% ngaphezu kweMagare kufuneka ukuba vumele, ingxelo ithi. Ababhali bengxelo bathi ngelixa ezinye zezi mpazamo zenzeke ngengozi, abanye babesenokuba ngamatyala okukhwabanisa ngamabomu.
Ingxelo kwakhona yathi oogqirha kwiindawo zokuphulukana nezifo zangezinye iimeko zokuzenza iimpazamo ezinjalo kunye / okanye benze ubuqhetseba kunabo bahlala kwizibhedlele. Ukuthelekiswa kwakuyi-71% yeenkonzo zokuxilongwa kwe-facet ezinikezelwe kwi-ofisi ukuya kwi-51% kulabo banikwa kwisiko esibhedlele.
Mhlawumbi iziphoso ezibi kakhulu, kunjalo, ezo zijokelelo ezinikezelweyo ezazingekho mzimba. Ngokwe-ingxelo, i-alliance yale ngxelo yebuqhetseba yonyango yayiyi-$ 17 yezigidi.
> Imithombo:
> IBentin, C. i-AMA. Ukunika ingxelo yeCandelo eliPhezulu eliLungileyo: Ingxelo ephezulu yeNkqubo efunyenweyo ngexesha lokuPhathwa koPhicotho lweeNcwadi zoBuchule. Septemba 2010.
> Holz, S., Sehgal, N. Yintoni i-Correlation phakathi kwePhonet Joint Impact Radiofrequency Outcome kunye neempendulo kwiiNqobo zeeNqila eziPhakathi? Ugqirha wezinhlungu. Matshi 2016. http://www.ncbi.nlm.nih.gov/pubmed/27008290.
> Malanga, GMD, Young, CMD kunye. I-Lumbosacral Facet Syndrome. Iwebhusayithi ye-E-Medicine Medscape. Septemba 2015. https://emedicine.medscape.com/article/94871-overview#a6.
> Manchikanti K., Atluri S., Singh V., Geffert S., Sehgal N., Falco F. Uhlaziyo loVavanyo lwe-Thoracic Facet Ulungelelaniso oluhlangeneyo. Ugqirha wezinhlungu. Julayi-Agasti 2012. http://www.ncbi.nlm.nih.gov/pubmed/22828694.
> McCormick, Z., Benjamin Marshall, B., uJeremy Walker, J., uRobert McCarthy, R., Walega, D. Umsebenzi wexesha elide, ubuhlungu kunye neMithi Sebenzisa iziphumo zoMbane wokuThengiswa kwe-Lumbar Facet Syndrome. Int J Anesth Anesth. Epreli 2015.
> Ipaki, K. MD, Jee, H. PhD, Nam, H., MD, Cho, S., MD. Kim, H., MD, Park, Y., MD, Lim, O., MD. Impembelelo yeSebe eliMnyama liVimba kwi-Chronic Facet Paint Pain ye-Osteoporotic Compression Fracture. Ann Rehabil Med. Epreli 2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660479/.
> Smuck M., uCrisostomo R., Trivedi K., Agrawal D. Impumelelo yeCandelo leNqanaba eliPhezulu loLuntu oluPhezulu kunye neNtsholongwane yoLuntu oluPhezulu lweZygapophysial Joint Pain: Uhlolo lokuHlola. PM R. Septemba 2012.
> I-Vaccaro, A. I-Spine: Ulwazi olunzulu kwi-Orthopedics. Mosby. 2005. Philadelphia. Pp 63-64.