I-2 Back Surgery
Ukuhlaziywa kwemisebenzi yengqumbo kungabonakala kuyimfuneko ngugqirha wakho (okanye wena) ukuba unayo impawu emva kwenkqubo yokuqala, okanye ukuba unempawu ezintsha. Kodwa uyayazi njani ukuba ufuna ngokwenene ukuhlinzwa okwe-2? Hlola olu luhlu ukuqala uphando lwakho.
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Ukuhlaziywa kwamaDivhuUkuba, emva kokugqithisileyo, uphinde ube ne-sciatica, intlungu phantsi kweengalo zakho, okanye ezinye iimpawu ze-disniated, ungase ube ne-herniation ephindaphindiweyo. Ukunikezelwa kwidiski ephindaphindiweyo ngokuphindaphindiweyo ukuphinda kwengxaki eyabangela ukuhlinzwa kuqala.
Ezihambelanayo: Iimpawu zeCervical Radiculopathy
I-discectomy iyakususa kuphela loo maqhekeza e-disk (ezibizwa ngokuba ngamaqhekeza) eziye zahlukana ngokupheleleyo okanye zachithwa ngokupheleleyo kwi-disc enkulu. Usenayo i-diski yakho, kwaye kusenokwenzeka ukuhlawula inxalenye eyishiywe.
Idibeneyo: Iyintoni iSahlulo seDiski?
UDkt. Joshua D. Auerbach, oyiNtloko yeZonyango zoBuqhwala kwiBonx-Lebanon Hospital Centre e-New York City, ufanisa ukungakwazi ukutya isahlulo se-cheesecake, ingakumbi kulabo abanomdla ngale ndlela yokudla.
Nangona uhlala ujongene nelo xesha elihle, uthi, amathuba okuba i-cheesecake iya kwahlula kwiqhekeza eliphambili. Abanye baya kuhlabeka kwi-plate, abanye bangase bafike emkhatsini weplates, kwaye abanye basenokuwela ngokupheleleyo. Kule meko, uninzi lwabantu luya kulahla ezo ziqhekeza eziwela kwi-plate, kodwa qhubeka udla isigaqa esona sikhulu.
Ukufaniswa kwe-discectomy kusebenza ngokufanayo: Iziqwenga ezingasetyenziswanga zisuswe kwisakhiwo esinqununu, zishiye lonke idiski yakho, okanye iqhekeza lekhekhe, lihambelane.
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PseudoarthrosisI-Pseudoarthrosis ligama elichaza ukungabikho kwe-bone fusion engadlulanga kunyaka omnye emva kokuhlinzwa kokugulisa umthambo.
I-Pseudoarthrosis ixhaphake kakhulu, ivela kwi-68% ye-lumbar fusions, ngokwe-Auerbach. Kule ndawo, phakathi kwe-6 no-36% idinga ukuqhutyelwa kwakhona, utsho.
Ezinye izinto ezinokudlala indima ekuphuhliseni i-pseudoarthrosis emva kokuhlinzwa kwakho kokuqala kubandakanya:
- Ubume bokuxilongwa kwakho kwangaphambili
- Uhlobo lwe-hardware (okanye ukungabikho kwalo) olufakwe
- Uluhlu lwesitrafti , ukuba lukhona, luyasetyenziswa
- Impilo yakho nemeko. Ngokomzekelo, ukuba ubhema okanye uthathe i- corticosteroids , ingozi yakho ye-pseudoarthrosis inganyuswa.
- Ukuba une-fusion fusion apho kungekho zicwecwe, i-screws okanye enye i-hardware efakwe.
Kwisesahluko sakhe malunga nokuhlaziywa kwengqungquthela yokuguliswa kwenkcazo yecandelo lezokwelapha elinesihloko esithi I-Bookbook ye-Spinal Surgery, i-3rd Edition , i-Auerbach icacisa izifundo ezibonisa ukuxuba ngaphandle kokufakelwa kwe-hardware kunokunyusa umngcipheko we-pseudoarthrosis ngo-70%. Leyo nani incinci kakhulu - i-10% - ngenxa yokuxhamla umgudu apho i-hardware ifakwe khona, ubika.
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ISigaba seNtsholongwaneI-ASD, okanye ukuguqulwa kwesigaba esiseduze, yimeko apho utshintsho lwe-anatomical luvela kwiindawo zomgcini ezisentla kunye / okanye ngaphantsi kwendawo yokuhlinzwa ngokutsha.
I-Auerbach ithi xa i-ASD ivela, ngokuqhelekileyo yenza njalo emva kweminyaka emibili okanye ngaphezulu engenabuhlungu.
Idibeneyo: Ziyiphi iCandelo elongezelelweyo lokuqulunqa?
Iingcali azizi kakuhle ukuba ngaba yindlela yokuhlinzwa yangasemva okanye ukunyuka kwendalo kwenguqu eguqayo kwisigodlo esiphezulu se-ASD.
UFrank Cammisa, Jr., MD, oyiNtloko yeNkonzo yeNtsana kwi-Hospital for Surgery Special in New York, uthi izinto ezingekho kwenkqubo yokuhlinzwa zingabakho emsebenzini ekuphuculweni kweenguqu ezichithwayo ezibizwa ngokuba yi-ASD. "Amaninzi amaninzi, i-ASD ichazwa ukuba isigulane sinomngcipheko; nokuba kunjalo, nokuba isigulane asizange senze ukuxuba singakwazi ukuhlakulela utshintsho olunezilungelo kwelinye izinga."
Uphononongo olwenziwa yiNgoma, kunye. i-intanethi, inesihloko esithi, "Isigaba esicacileyo sesifo esiyingozi: ngaba kungenxa yokuqhubela kwesifo okanye into ehambelana ne-fusion? Ukuthelekiswa phakathi kwamacandelo athelelwe kumacandelo angenakufudelwa," epapashwe ngoNovemba ka-2011 ye-European Spine Journal yafumanisa ukuba " isifo sesigxina sisisiphumo sembali yendalo yomlomo wesibeletho sentsholongwane kunokuba ubukho befusion. "
Ezihlobene: Yintoni i-Cervical Spondylosis?
I-Auerbach ithi izifundo ze-biomechanical zibonisa ukuxinezeleka okuthe xaxa kumanqanaba asondeleyo emva kwe-fusion. Ngenxa yokuba ukuxuba kukhulisa ukunyuka kwe-angle phakathi kwamathambo amabini endibaniselwano , uhambo lwakho lwesigxina luya kutshintshwa. Oku kunokumisela uxinzelelo olongezelelweyo kwezinye iindawo ezidibeneyo.
Uthi undixelele, "Iidiski zithatha i-slack".
Ngokutsho kwe-Auerbach nabanye, olu hlobo loxinzelelo olubalulekileyo lunesizathu esikhulu sokuba abaninzi kwi-shishini baxhaswa ukuphuhliswa kwezindlela zokulondolozwa kwesindululo zobugcisa kunye nezixhobo . Ukuqhubela phambili kwezobugcisa - umzekelo, ukutshintshwa kwetayiti ye-disc - yenza ukuba oogqirha baphathe ingxaki ngaphandle kokubingelela ukunyakaza kwendawo echaphazelekayo.
Xa ukhe uzibuza, kukho izifundo ezibonisa inzuzo yokuba ne-disk substitution phezu kwe-spinal fusion, nangona engekho yonke imibuzo iphendulwe (ngo-2016). Ngokomzekelo, ekuhlalutheni kwezifundo ezintathu ukuthelekisa iziphumo zentshukumo yentsholongwane yomlomo wesibeleko kunye nomswakama-spinal iminyaka emibini emva kwenkqubo, abaphandi bafumene ukuba abantu abane-arthroplasty (i-disque substitution) babengama-44% ubuncinane abafuna ukuhlinzwa okwesibini. Isifundo esifanayo asizange sichaze nayiphina inzuzo ebalulekileyo ye-arthroplasty yokunciphisa okanye ukuphepha i-ASD, nangona kunjalo.
Ingxoxo yokutshintsha ingxoxo ixoxwa ngokucacileyo kwinqaku yam: Ukutshintshwa kweDiskhi yeCervical
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Hlaziya i-TDRUkutshintshwa kwe-disc totali, ekuthiwa yi-TDR ngcaciso emfutshane, yindlela yokuhlinzwa ngokutsha (e-United States, ubuncinane) ebonwa ngumbutho wezilwanyana zengqungquthela njengendlela efanelekileyo yokuhlinzwa. Ukutshintsha i-Disc kwenzelwe iYurophu kwithuba elithile, kodwa i-US iyamkela le teknoloji ngokukhawuleza.
Ngenxa yokuba utshintshi lwentsha lutsha kweli lizwe, ngoluvo lwam lokuba abavelisi bezixhobo kunye noogqirha abaphangeli abasebenzisa ubugcisa banobuchule basebenzela iinkcukacha. Oku kunokunyusa umngcipheko wenkcitho enye okanye ngaphezulu eyenzekayo ngenxa yesithuba sokutshintsha.
I-Auerbach ithi kuphela malunga ne-0-5% yezigulane ezibhekiselelwe ekusebenziseni umgudu ngokusemgangathweni kufanelana nemigaqo yokufumana inkqubo yokubuyisela i-disc epheleleyo. Ukuba awuyena umviwa, kodwa unomnye, uthi, unokufumana ubunzima.
Enye yeengxaki eziqhelekileyo ezikhokelela ekuhlaziyweni kwe-TDR (njengesiqhelo sesibini sokutshintshwa kwidiski ngamanye amaxesha esibizwa ngokuba yi-disable device). Imizekelo yokusilela kwefowuni iquka ukungasebenzi kwe-disc prosthetic engena emthonjeni, okanye xa ifowuni ishintsha isikhundla sayo (i-extrudes).
UCammisa uyongezela ukuba ngenxa yokutshintsha i-disc, ukuguqulwa kwezinto eziqhelekileyo kunokuvela kwiindawo ezinxulumene nazo. Ukuba le ntshukumo iya kuba buhlungu, uthi, ugqirha wakho unokubonisa ukuba u-spinal fusion uyindlela yokuhlaziywa kwakhona.
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Iingxaki ngeComputer HardwareOkunqabile kakhulu, unokuthi ungene kwiingxaki nge-hardware eyasungulwa emgodini wakho. Oku kubandakanya iidiski ze-prosthetic, njengoko kuchazwe ngasentla, kunye ne-hardware esetyenziselwa ukunyuka kwemfudu kunye nezinye iintlobo zokuhlinzwa. Ukusetyenziswa kwezixhobo, njengokuba kuthiwa ngezinye iindawo, kunokugqithisa, okanye ugqirha unokuyibeka kwindawo engafanelekanga ngexesha le nkqubo.
Olunye uhlobo lweengxaki ze-hardware ezibangelwa uphando lwangemuva lubizwa ngokuba yi-syndrome eyaziwa ngokuba yi "hardware ebuhlungu." Kule meko, izinto ezifakwe kwizinto ezixakile zithandekile, i-Auerbach ithi.
UCamissa uthi intlungu ngenxa yesifo se-hardware syndrome ngokuqhelekileyo ivela kwiisisu ezinqabileyo (oko kukuthi izihlunu zakho, iigaments, i-tendon kunye ne-fascia).
Ukujongana ne-hardware syndrome ngezinye iinkhathi kufuna ukuhlinzwa ukuze kususwe izinto eziphosakeleyo. UCammisa undixelela ukuba ukuhlaziywa kwengxaki ye-hardware syndrome ngokuqhelekileyo kubangelwa ukubekwa kwe-hardware, kungekhona idivayisi ngokwayo. "Kuyinto engaqhelekanga ukuba kususwe i-instrumentation ngenxa yentlungu ebangelwa yi sixhobo," uCammisa uyaqinisekisa.
Ukuhlaziywa kokuhlinzwa kwi-hardware ebuhlungu idla ngokukhawuleza.
Imithombo:
Auerbach, J., MD. I-Chief of Spine Surgery, iZiko leZibhedlele saseBronx-Lebanon, uNjingalwazi oPhezulu woPhepha, u-Albert Einstein College of Medicine. Ifowuni Ingxoxo. Matshi 2012.
Auerbach JD, Kuklo TR. Ukuhlaziya i-Lumbar Spine Surgery. Ku: UBrillll KH, DeWald R, ii-eds. Incwadi Yobunjineli be-Spinal Surgery, u-3rd Edition. Philadelphi., Lippincott 2011.
Benglis, D., et al. Ukuhlaziywa okubanzi kwiprogram yokukhusela kwiprotheni ye-bone morphogenetic kwi-spine chirurgical operation. I-Neurosurgery 62. 5 (iSibonelelo 2) (2008).
I-Cammisa, F., MD, oyiNtloko yeNkonzo yokuThabisa kwiSibhedlele soPhando oluthile. Inew york. I-Email Interview. Matshi 2012.
Etminan M, Girardi FP, Khan SN, Cammisa FP Jr. Izixhobo zokuhlaziya i-lumbar pseudarthrosis.Orthop I-Clin North Am 2002; 33: 381-392.
I-Patel AA, i-Spiker WR. Ukuhlaziywa kwi-diagnostic kunye nonyango lwee-nonunion lumbar. I-Semin Spine Surg 2008; 20: 20-26.
Ingoma, K., kunye. al. Isifo esichaphazelekayo sisifo esiyingozi: ingenxa yokuqhubela kwesifo okanye into ehambelana nefusion? Ukuthelekiswa phakathi kwamacandelo athile kumacandelo athileyo kunye namagqabi. I-Eur Spine J. NgoNovemba 2011. Kufumaneka ngo-Jan 2016.
Uadadaya, et al. Iziphumo ezidibeneyo ze-3 IDE ye-US e-Randomized Cervical Arthroplasty Elingama-2-Iminyaka yokulandelwa: 923. I-Neurosurgery: Agasti 2010 - Umqulu 67 - Inkcazo 2. i-doi: 10.1227 / 01.NEU.0000386995.74131.4B