1 -
Ukunyuka kwekhanda kwiimpawu zeRadioculopathyI-radiculopathy yesibeleko ingaba ngumlomo ukuba uthethe, kodwa ukuba uye waziva, uyazi kakuhle iimpawu zayo. Ezi ziquka intlungu, ubuthathaka, ukuphazamiseka kunye / okanye ukuvakalelwa kombane okuhla kweyalo.
I-radiculopathy yentsholongwane yimeko apho enye okanye ngaphezulu yengcambu yomgudu entanyeni yakho iyacaphuka okanye icinezelwe. Ingabangela i-disc, i-arthritis okanye isifo se-stenosis okanye ezinye iimeko.
Iingcambu zesisu zomgulane ziyimithwalo yemibindi ye-nervous ephuma kwi-spinal cord. Kukho enye ngapha nangapha kwinqanaba lomgca wesipelini. Ukusuka kwingcambu, iingcingo zepheripha zixhamla kuzo zonke iindawo zomzimba ukuthumela imiyalezo yeentlungu kunye nokuhamba.
Ngaba udinga utyando lwe-radiculopathy yomlomo wesibeleko?
Impendulo emfutshane mhlawumbi, nangona ngokucubungulwa kwe-radiologypathy yesibeleko ka-2011, eyapapashwa yiSibhedlele soPhengululo olukhethekileyo (kwiphepha labo) ixesha elininzi, izigulane ziphucula ngaphandle kwayo.
Ababhali bachaza ukuba zombini izigulane ezingabonakaliyo kunye nezisebenzayo zingabancedisa izigulane ukuba ziphephe iinkqubo ezingenayo.
Kodwa, bathi, utyando lungafuneka xa i-radiculopathy yakho ihambelana nokukhubazeka okanye ukunyamezeleka okungaphenduliyo, okanye ukuhamba kwexesha.
Ezinye izizathu zokuba utyando, abalobi bavuma, xa izibonakaliso ze-radiculopathy zikhubaza kwaye intamo yakho ayizinzile.
Ukuba kukho naziphi na iziganeko zichaza amava akho, unokufuna ukwazi ukuba ziphi iintlobo zokuhlinzwa eziqhelekileyo kubantu abane-radiculopathy yomlomo wesibeleko. Ukuhlaziywa okukhankanywe ngasentla kuchaza ezimbini iintlobo zeenkqubo eziphazamisayo. Ezi zixutyushwa kamva kweli nqaku.
Uhlobo lwesithathu lotyando, i-disc arthroplasty, lutsha, kodwa lubonisa isithembiso esiningi. Siza kuthetha ngaleyo elandelayo.
2 -
I-Disc Arthroplasty - Ngaba Ufanele Ukulondoloze Ukuhamba Kwakho Emgodleni?I-disc arthroplasty, enye yamagama amaninzi anikezelwe ngophenyo lokuguqulwa kwendawo yesipelingi, yindlela entsha yenkqubo yokunciphisa iimpawu ze-radiculopathy. Isetyenziswe ngakumbi entanyeni kunokuba umva ophantsi, nangona ukuveliswa kweediski zokufakelwa kwee-artificial kwi-back down kwakhona kwimboni enamandla. Mhlawumbi isizathu sokuba i-disc i-arthroplasties iyenziwa entanyeni kunokuba kwinqanaba eliphantsi kukuba intamo iboleka kwi-anterior, okanye ngaphambili, indlela abadokotela abaninzi abayithandayo. (Oku kuxutyushwa ngokubanzi kwinqanaba elilandelayo.)
Njengoko igama libonisa, kwindlela yokubuyisela i-disc, iprothesis eyenzelwe ukulinganisa indlela kunye nokusebenza kwidiski yemvelo efakwe kuyo ukuze ithathe indawo esikhundleni esiphelile. Ngokuqinisekileyo idiski endala isusiwe, kwaye indawo iyacocwa ngaphambi kokuba kufakwe ingqalelo.
I-disc arthroplasty ibizwa nangokuthi "ukunyanzeliswa kokunyanzeliswa kwempepha." Uhlobo olusisiseko olumiselweyo luquka ukufakela indawo, ekhupha ithuba lokushenxisa loo ndawo kwakhona, emva kokuba inkqubo iphelele.
Kodwa ngediski yokufakelwa, isicatshulwa sifanele sigcinwe. Kodwa ngokwenene ukuqonda izibonelelo zokulondoloza ukunyuswa okuzithembisayo akusisilumko sobubungqina, kwaye kuya kwenzeka ukuba ungene lo msebenzi kwaye uphume kuyo awukwazi ukuhambisa intamo yakho.
Kuyafana nezinye iinkqubo zomgudu, ukutshintshwa kwediski kusetyenziselwa ukujongana ne-radiculopathy yomlomo kunye nentlungu ye-discogenic. Ziye zisetyenziselwa ukuhlolwa ngokutsha.
I-Disc Arthroplasty Inokuthelekiswa njani ne-More Commonly Given Surgery?
Ingaba i-dis arthroplasty yindlela ephakamileyo yokuzama kunye nokwenene?
I-jury isaphuma kuloo nto, kodwa iingcali kwiNgxelo yeMedscape ukuba, ngo-2014, akukho bungqina bokuba kukho ukugcina intshukumo-inzuzo enkulu eyenziwa ngabameli-iziphumo ekuthintelo, okanye ukunciphisa utshintsho olusenokuba lukhuni ngasentla nangaphantsi kwe indawo yokuhlinzwa.
Olu hlobo lokuguqulwa lubizwa ngokuba yi- ORD , kunye nomngcipheko wenkalo yokunamathela kwezinye iintlobo zokuhlinzwa. Ukunciphisa amathuba okuba i-ASD ibonakaliswe kumalungu angentla okanye ngaphantsi kwesayithi lokuqala lokususa umgudu, ngokutsho kweengxoxo zokubuyisela i-disc, isizathu sokuthi i-disc arthroplasty yaphuhliswa kwindawo yokuqala.
Ukususela ngeli xesha, uphando olongezelelweyo nophando lwezifundo lukhutshwe. Uphando olwenziwe kwixesha elide le- disc arthroplasty epapashwe ngo-Juni 2016 umkhuhlane we- Spine wafumanisa ukuba kwiminyaka eyi-7 kunye ne-10 ephuma kwinkqubo, izixhobo zisasebenza kwaye iziphumo ze-arthroplasty zafaniswa nezo ziqhelekileyo kwinkqubo ye-ACDF ye-radiculopathy iimpawu, ngexesha elifanayo.
Olunye uphando olwenziwa ngu-Shangguan, olupapashwe ngo-Matshi 2017 lwe- PLoS One , lwafumanisa ukuba i-disc arthroplasty iyancishisa ixesha ixesha lokuba izigulane zenziwe ngophando, kwaye kwaphumela ekuphuculeni ukunyuswa kwesayithi kwindawo yokuhlinzwa.
Ngaphandle kwale miqathango emibini, iziphumo zokuqhutyelwa kweediski zokutshintshwa kwezixhobo zazifana okanye zifana nezo zivela kwi-ACDF, kodwa ingcono. Amanyathelo anjalo afaka ukuba igazi lilahleka kangakanani kwenkqubo, intamo kunye nentlungu yesandla emva kweendlela zokusebenza, kunye neengxaki, ezibizwa ngokuba "iziganeko ezimbi" ezitshala emva koko, kwakhona emva kokusebenza.
Kwaye ekugqibeleni, ngezinye iinkcukacha akulula nje ngokuba ne-disc eyodwa. Ngokuqhelekileyo abantu abane-radiculopathy yomlomo wesibeleko okanye intlungu ye-discogenic badinga ukulungiswa kwizinga elingaphezu kweyodwa.
Uhlalutyo lwe-meta-2017 olupapashwe kwi- European Spine Journal edibanisa i-disc arthroplasty kunye ne-ACDF kumanqanaba amabini athile afumaneke ukuba inkqubo iya kuba malunga ngokulinganayo kwiziphumo ezigqithisileyo. Oko kwathiwa, izigulane zeendlela ezihambayo zincinci kangcono kulabo ababenesithuba se-disks.
Kodwa nangaloo miphumo, ababhali bayalumkisa ukuba ukusetyenziswa kwetayiti engaphezu kweyodwa kwintsimi kubonwa "ngxabano."
3 -
Interior Discerctomy kunye ne-without FusionInterior Cervic Discectomy
Eyokuqala, kwaye mhlawumbi iyona eqhelekileyo, utyando lweempawu ze-radiculopathy zesifo somlomo ngu-decompression yangaphambili yomlomo wesizwe, aka ACD. Kulo msebenzi, i-disc isuswe ukunceda ukuxinzelela uxinzelelo kwimpundu yomgca.
Kwaye njengoko siza kuthetha ngezantsi, ukuhlanganiswa kwakhona kwenziwa nge-ACD kwaye kwimeko apho, isichazi si-ACDF.
I- discectomy yangaphambili yesibeleko yinkqubo apho ugqirha ugqirha entanyeni ukusuka ngaphambili (kwindawo yomqala, ukuba ube ngqo) ukufikelela kunye nokususa izinto eziphathekayo ze-disvertebral disc. Kwi-discectomy yangaphakathi yesibeleko, imisipha yentamo ishukunyiswa ukuba ibonakalise izakhiwo ezininzi, oko kukuthi, i-trachea, i-esophagus, i-disc, kunye namathambo omgulane.
Ababhali beengxelo ezikhankanywe ngasentla bathi ngokubanzi, oogqirha bakhetha ukukhetha indlela yangaphambili kuba kubonelela ngelithuba elihle lokubuyisela intambo yentamo yengqondo, ukuzinzisa umlanjana kunye nokucacisa ngokucacileyo ukucima umgca wegazi lomgcini.
Interior Discectomy ne-Fusion
Ukugqithiswa komlomo wesibeleko kwenziwa kwangaphandle kunye nokungenakusiza, kodwa abaninzi abagqirha banqwenela ukuxuba.
Oko kwathiwa, "ukuxhamla okanye ukungafaki" isigqibo se-ACD kwi-1 okanye kwi-2-level-level surgeries yinto ephikisanayo phakathi kweengcali zengqondo. Ucwaningo lwango-2016 olupapashwe kwiNcwadi ye-Neurosurgery: Isiqhamo sathola ukuba amanqanaba amaninzi ahlaziywa kwaye ahlanjululwa, umngcipheko omkhulu wokuba intamo yentsebenzo nentlungu yesandla kwakunye nezinye iingxaki.
Ukufakwa kwezinto ze-hardware, oko kukuthi, iiplati, amacwecwe, izikhonkwane kunye nokuthanda kwam amathuba akho ekuhlanganyeleni okuphumelelayo, ngokubhaliweyo. Ababhali bathi kwakhona i-hardware inokunceda ukunciphisa imiba yokupasa (i-kyphosis, ngokukodwa) kwakunye nezinye iintlobo zeengxaki ze-graft complications.
Ngokuqhelekileyo xa unamanqanaba angaphezu kweyodwa udibaniswa, ugqirha wakho uya kusebenzisa iplani yangaphakathi. Oku kukukhuseleko lwakho kunye nempumelelo yenkqubo.
Kodwa iingxaki ziyakwenzeka kwaye zenzeke. Kule meko ugqirha wakho unokubonisa ukuba ususwe kwi-hardware endala ukusuka kwi-ACDF yokuhlinzwa, okuya kufuna enye enye intshayelelo.
Ngaba Ngaba Uvumelekile kwi- Fusion ?
Lo ngumbuzo okhohlakeleyo oxhomekeka kwiimeko ezahlukeneyo. Kwakhona, ukuba ugqirha wakho osebenzayo kwizinga elingaphezu kweyodwa eliqulathe umgudu wakho, impendulo ibe nguwe ewe. Kodwa ukuhlaziywa kweencwadi ezipapashwe kwi- Open Orthopedic Journal kwango-2012 kufumene ubuncinane, ukuba ngaba nawuphi na umehluko phakathi kweziphumo ezivela kwi-ACD ne-ACDF. Abaphandi abafanayo bafumanisa ubungqina obunqununu bokuthi ukuhlanganiswa kunye ne-ACD (oko kukuthi, i-ACDF) yokuhlinzwa yayiphumelele iziphumo zokupasa kangcono kune-ACD epheleleyo.
Kungcono ukuxoxa ngeendlela ozikhethayo kunye nabagqirha bakho ngokugqibeleleyo, kwaye ufumane uluvo lwesibini ukuba unemibuzo okanye uxhalaba kule sigqibo esibalulekileyo.
4 -
I-Laminoforaminotmy ye-Radiculopathy SymptomsUvavanyo olulandelayo oluqhelekileyo lwe-radiculopathy yomlomo wesibeleko, olubizwa ngokuba yi-posterior lamaconaminaminomy, lusekho emva kokubuya, okanye ngasemva.
Mayelana neLaminoforaminotmy yeeNzululwazi zeRadioculopathy
Ngaphambi kokuba ubalekele eli xesha elikrakrayo, masihlukane ukuze siqonde ukuba yintoni inqubo. Njengoko sele sixoxe ngazo, ukuhamba kwangaphambili kubhekisela kwindlela esuka emva, kwaye intsholongwane ibhekise entanyeni yakho. Isisombululo-isisombululo sithetha ukunqunyulwa kodwa kungabi sisuse.
Igama elithi "lamino" nelithi "foramino" libhekisela kwimimandla yesifo somgudu kunye / okanye ikholam.
I-lamina inxalenye yendandatho yebony ngasemva kwe-vertebra nganye. I-lamina ihamba emva kwenkqubo ejikelezayo kwicala elinye le-vertebra, kwisiseko, kwicala elifanayo, kwenkqubo yokwenza i-spinous back.
Ixesha elithi foramina lithetha umgodi, kwaye xa uthetha ngomqolo, ubhekisela kwimingxuma ngapha nangapha kolunye umgca womgcini kumanqanaba onke, eyenziwe ngamabini omakhelwane, athathwe (1 ephezulu neyoku-1 ephantsi).
Indlu ye-olamini ingcambu yomgulane, kwaye i-lamina yinxalenye yethambo ngalinye elenza uphahla kunye nomgangatho we-foramina.
Yibeke yonke into ehamba kunye - Yintoni iLaminoforaminotomy?
Ukuyibuyisela kwakhona kwakhona, i-term posterior lamernforaminotomy yomlomo yinkqubo apho ugqirha ogqithisileyo angena emva kwentamo ukuze anqunywe, kodwa angabi kususa enye, ezimbini okanye zombini kule mimandla yomgudu; le nto yayiza kuba yi-lamina, efumaneka kwingxenyana yangasemva kwethambo ngalinye, kunye nenye okanye eminye imingxuma ecaleni.
Le nqubo yenziwa ukwenzela indawo yokwenza amazinyo. Injongo yokuhlinzwa kukuba kuvumeleke ukuhamba kweentsholongwane ngokusebenzisa i-foramina ukuba ingabikho. Ngokususa i-bone impahla kwi-lamina kunye / okanye i- foramina , umlenze uthi "uphazamisekile."
Indlela yokuPhambi kweNtshontsho yeekhanda - IiNzuzo
Iintlobo zokusebenzisa indlela engaphaya kwelo xesha kukuba ukuxuba akusoloko kuyimfuneko kwaye ukuba ugqirha unako ukugcina ulungelelwano lomgcini kunye nokulungelelanisa.
Umda kukuba umlinganiselo wokunciphisa okwenziwe kwindlela yokuhlinzwa njengolu hlobo. Ngenxa yoko, ngokuhlolisisa oku khankanywe ngasentla, ukusetyenziswa okusemgangathweni kwindlela engaphantsi kwayo kunokususa amaqhekeza adibeneyo awenza ukuba i- neuroforaminal spinal stenosis , imeko enokuyenza kwaye ibangele i-radiculopathy yomlomo wesibeleko.
Xa kuhla kuwo, ukhetho lotyando lunento eninzi yokwenza ngeteknoloji yokukhethwa kwabagqirha kunye nokukwazi ukugcina ukulungelelaniswa komgudu kunye nokulinganisela ngexesha kunye nangemva kwenkqubo, uhlolo luphetha.
Imithombo
Botelho, Richardo, V., kunye. al. Ukhetho Lokuhlinzwa Okugqithisileyo Emva Kwinqanaba Elilodwa Elingaphakathi I-Cervical Spine Discectomy: Uhlolo lokuHlola. Vula i-Orthop J. ngoMatshi 2012. Kufumaneka ngo-Jan 2016.
UCaridi, uJohn M., MD, uPumberger, uMatias, MD, Hughes, Alexander, P., MD I-Radiculopathy: I-Review. Isibhedlele soPhengululo olukhethekileyo. NgoSeptemba 2011. Kufumaneka ngo-Jan 2016.
> Iziphumo zesikliniki ze-Sasso W. Ixesha elide le-Arthroplasty: I-Arthroplasty ye-Arproplasty: i-Outlook, i-Randomized, i-Trial Trial. Isihlwele. Juni 2016. https://www.ncbi.nlm.nih.gov/pubmed/27333341
> Shangguan, L. Fumana i-disc ye-cervical disthctomy kunye ne-interior discectomy ne-fusion kwizifo zesifo se-cervical disab. PLoS One. EyoKwindla. 2017 https://www.ncbi.nlm.nih.gov/pubmed/28358860
> Zou, S. I-disterctomy ye-cervical discectomy kunye ne-fusion (ACDF) ngokuchasene ne-disc arthroplasty (CDA) yamanqanaba amabini adibanisa isifo se-diserving disorder: i-meta-analysis of trials. Eur Spine J. NgoAprili 2017 https://www.ncbi.nlm.nih.gov/pubmed/27314663