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Ukuhlinzwa Kwamathambo Ezimpawu Ze-RadiculopathyI-radiculopathy yomlomo wesibeletho ingaba nomlomo ongakusho, kodwa uma uke wazibonela, cishe uyazi kahle izimpawu zayo. Lezi zihlanganisa ubuhlungu, ubuthakathaka, ukuphazamiseka kanye / noma izinzwa zombane eziwela phansi ingalo eyodwa.
I-radiculopathy yomlomo wesibeletho yisimiso lapho umuthi oyedwa noma ngaphezulu wezimpande ezisuka entanyeni yakho ucasuliwe noma ucindezelekile. Kungase kubangelwe i-disc yakhe, i-arthritis yomgogodla noma i-stenosis noma ezinye izimo.
Izimpande zemijovo yomgogodla ziyizicucu zezintambo zamagciwane ezivela emthonjeni omkhulu wokugcoba. Kukhona omunye ohlangothini olulodwa kuwo wonke amazinga omgogodla. Ukusuka emmpandeni, izinzwa zomzimba zihamba kuzo zonke izindawo zomzimba ukuthumela imiyalezo yokuzwa kanye nokuhamba.
Udinga ukuhlinzekwa kwe-radiculopathy yomlomo wesibeletho?
Impendulo emifushane mhlawumbe, nakuba ngokubuyekezwa kuka-2011 kwe-radiculopathy yomlomo wesibeletho, eshicilelwe yiSibhedlela Sokuhlinzwa Okukhethekile (encwadini yabo) isikhathi esiningi, iziguli ziba ngcono ngaphandle kwalo.
Abalobi babika ukuthi kokubili izindlela zokwelashwa ezingahambisani nokusebenza ezingasetshenziswa kungasiza iziguli zigweme izinqubo ezingenayo.
Kodwa, bathi, ukuhlinzwa kungase kudingekile uma i-radiculopathy yakho ihambisana nokukhubazeka noma ukucindezeleka okuphazamisayo okungaphenduli ekunakekeleni okungahleliwe, noma ngokuhamba kwesikhathi.
Ezinye izizathu zokuhlinzwa, abalobi bayavuma ukuthi, lapho izimpawu ze-radiculopathy zikhubaza futhi intamo yakho nayo ihlale ingazinzile.
Uma noma yikuphi kulezi zimo kuchaza okuhlangenwe nakho kwakho, ungase ufune ukwazi ukuthi yiziphi izinhlobo zokuhlinzwa ezivame ukwenziwa kubantu abane-radiculopathy yomlomo wesibeletho. Ukubuyekezwa okukhulunywe ngaye ngenhla kuchaza izinhlobo ezimbili zezinqubo eziphazamisayo. Lokhu kuxoxwa kamuva kulesi sihloko.
Uhlobo lwesithathu lokuhlinzwa, i-disc arthroplasty, lusha, kodwa lubonisa isithembiso esiningi. Sizokukhuluma ngalokhu okulandelayo.
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I-Disc Arthroplasty - Ingabe Kufanele Ugcine Ukunyakaza Emgodleni Wakho?I-disc arthroplasty, elinye lamagama amaningi anikezwe ukuhlinzwa okwenziwa esikhundleni sokugaya umgogodla, uhlobo olusha lwenqubo yokunciphisa izimpawu ze-radiculopathy. Isetshenziswe ngaphezulu entanyeni kunemuva ephansi, nakuba ukukhiqizwa kwamadivaysi e-distifia asezindaweni ezisezingeni eliphansi nakho kuyimboni eqinile. Mhlawumbe isizathu sokuthi i-arthroplasties eyengeziwe iyenziwa entanyeni kunasekugcineni okuphansi ukuthi intamo ixhomeke ekuhloleni kwangaphambili, noma ngaphambili, lapho abahlinzayo abaningi bekhetha khona. (Lokhu kuxoxwa ngokuningiliziwe esigabeni esilandelayo.)
Njengoba igama libonisa, kwindlela yokubuyisela i-disc, i-prosthesis eklanyelwe ukulingisa ukuma nokusebenza kwidiski yemvelo efakwe ukuze ithathe isikhundla sayo esiphelile. Ngokuqinisekile i-disc endala isusiwe, futhi indawo iyahlanzwa ngaphambi kokuba kufakwe okufakwayo.
I-disc arthroplasty nayo ibizwa nangokuthi "ukuhlinzeka ngokunyanyiswa kwezimpande." Izinhlobo eziningi zokuhlinzekwa ezivame ukubandakanya ukufakela indawo, okususa amathuba okuba aphinde ahambise leyo ndawo futhi, uma inqubo isiphelile.
Kodwa nge-disc yokufakelwa, ukunyakaza kufanele kugcinwe. Kodwa empeleni ukuqaphela izinzuzo zokulondolozwa kwezinyathelo ezithembisiwe akuyona ubufakazi obuyisiwula, futhi kungenzeka ukuthi ungene kulokhu kuhlinzeka futhi uphume kuwo awukwazi ukuhambisa intamo yakho.
Ngokufanayo nezinye izinqubo zomgogodla, ukushintshwa kwe-disc kusetshenziselwa ukubhekana nokusabalalisa komlomo wesibeletho nobuhlungu be-discogenic. Zisetshenziselwa ukuhlinzwa okubukezwayo.
I-Disc Arthroplasty Iqhathanisa Kanjani Nezikhwama Ezivamile Ezihlinzekwa?
Ingabe i-disc arthroplasty iyindlela engcono kakhulu yokuzama izinqubo zomgogodla?
Ijaji lisekho kulokho, kepha ochwepheshe eMidscape umbiko wokuthi, kusukela ngo-2014, abukho ubufakazi obukhona bokuthi ukulondoloza ukunyakaza - inzuzo enkulu eyenziwa ngabameli - imiphumela ekuvinjeni, noma ukunciphisa izinguquko eziguqukayo ngaphezulu nangaphansi indawo yokuhlinzwa.
Lolu hlobo lokuguqulwa lubizwa ngokuthi ukuguqulwa kwesigaba esiseduze noma i-ASD , futhi ingozi yinkomba yokunamathela kwezinye izinhlobo zokuhlinzwa. Ukunciphisa ukuthi kungenzeka ukuthi i-ASD ekhonjiswe ngamalungu angaphezulu noma ngaphansi kwesayithi lokuqala lokuxuba umgogodla, ngokusho kwama-rep replacement advocates, isizathu sokuthi i-disc arthroplasty yasungulwa kuqala.
Kusukela ngaleso sikhathi, kukhishwe izinhlelo zocwaningo eziningi nokubuyekezwa kwezifundo. Ukutadisha ngemiphumela yesikhathi eside ye- disc arthroplasty eshicilelwe ku-June 2016 inkinga ye- Spine ithola ukuthi eminyakeni engu-7 no-10 ephuma enkambisweni, amadivayisi ayesebenza futhi umphumela we-arthroplasty wawufana nalokho okwenziwe i-ACDF inqubo ye-radiculopathy izimpawu, ngesikhathi esifanayo.
Olunye ucwaningo olwenziwa ngu-Shangguan, olwanyatheliswa ngo-March 2017 lwe- PLoS One , lathola ukuthi i-disc arthroplasty yenza kufinyelelwe isikhathi iziguli zahlinzwa, futhi zaholela ekuthuthukeni okungcono kwesayithi.
Ngaphandle kwalezi zinyathelo ezimbili, imiphumela ye-disc yokuhlinzwa yokushintshwa yayifana noma iyafana nalabo abavela ku-ACDF, kodwa hhayi kangcono. Izinyathelo ezinjalo zihlanganisa ukuthi igazi lilahleka kangakanani ngesikhathi senqubo, izintambo nobuhlungu besikalo ngemuva kokusebenza, nezinkinga, ezibizwa ngokuthi "izenzakalo ezimbi" ezivuna kamuva, futhi emva kokusebenza.
Futhi ekugcineni, ngezinye izikhathi akulula njengokungathi kuvele idiski eyodwa kuphela. Ngokuvamile abantu abane-radiculopathy yomlomo wesibeletho noma ubuhlungu be-discogenic badinga ukulungiswa ezingeni elilodwa.
Ucwaningo lwe-2017 olwanyatheliswa kuyi- European Spine Journal oluqhathanisa i-disc arthroplasty ne-ACDF emazingeni amabili alondelene atholakale ukuthi izinqubo zilingana ngokulingana nemiphumela eminingi yokuhlinzwa. Lokho kusho ukuthi iziguli zezinyathelo ezihamba phambili zazingcono kakhulu kulabo ababenemoto yabo.
Kodwa ngisho nalezi ziphumo, abalobi baqaphele ukuthi ukusetshenziswa kwe-disc esikhundleni sokungenani kwezinga elilodwa lomgogodla kubhekwa "okuphikisanayo."
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I-Disterctomy engaphakathi kwe-Cervical ne-ngaphandle kwe-FusionI-Disterctomy engaphakathi kwe-Cervical
Okokuqala, futhi cishe okuvame kakhulu, ukuhlinzekwa kwezibonakaliso ze-radiculopathy yomlomo wesibeletho kungukudonswa komlomo wesibeletho sangaphambili, i-ACD. Kulesi ukuhlinzwa, i-disc isusiwe ukusiza ukukhulula ukucindezela emmpandeni we-spinal nerve.
Futhi njengoba sizokhuluma ngezansi, ukuhlanganiswa kuyenziwa nge-ACD futhi uma kunjalo, isichazamazwi ngu-ACDF.
I- discectomy yomlomo wesibeletho yangaphakathi yinkqubo lapho udokotela ohlinzayo ewela entanyeni kusukela ngaphambili (endaweni yomphimbo, ukuze abe ngqo) ukuze afinyelele futhi asuse izinto ezidibeneyo ze-disvertebral disc. Ku-discectomy yangaphakathi yomlomo, imisipha yentamo isuswa ukuze ibonakale izakhiwo eziningana, okungukuthi, i-trachea, i-esophagus, i-disc, namathambo omgogodla.
Abalobi bokubukeza okukhulunywe ngaye ekuqaleni bathi ngokuvamile, odokotela abahlinzayo bakhetha indlela ehlukile ngoba inikeza ithuba elihle lokubuyisela ijika lentamo yemvelo, ukuzinzisa umgogodla nokucubungula ngokucacile izimpande zomgogodla.
I-Anterior Discectomy ye-Cervical ne-Fusion
Ukunciphisa komlomo wesibeletho kwenziwa kwangaphandle nangaphandle kwe-fusion, kodwa odokotela abaningi abahlinzayo bakhetha ukufiphaza.
Lokho kusho ukuthi, "ukuxoshwa noma ukungafaki" isinqumo sokuhlinzwa okungu-1 noma kwe-2-level ACD kuyinto isihloko esibucayi phakathi kochwepheshe bezinsipho. Ucwaningo olwenziwa ngo-2016 olwanyatheliswa kuyi- Journal of Neurosurgery: Isihlahla se-Spine sathola ukuthi amazinga amaningi ahlukumezeka futhi ahlanganiswa, ingozi enkulu yokuhlunguphazwa kwentamo nokuqina kwesandla kanye nezinye izinkinga.
Ukungena kwe-hardware, okungukuthi, amapuleti, amakheji, izigxobo kanye nanjengomsizi wami amathuba akho okuhlangana okuphumelelayo, ngokusho kwabalobi. Abalobi bathi futhi i-hardware ingasiza ekunciphiseni izinkinga zokumiswa (ukukhishwa kwengcindezi, ikakhulukazi) kanye nezinye izinhlobo zezinkinga zokufakelwa kwamathambo.
Ngokuvamile uma unezinga elingaphezu kweyodwa uhlanganiswa, udokotela wakho ohlinzayo uzosebenzisa ipuleti yangaphakathi. Lokhu kungukuphepha kwakho nokuphumelela kwenqubo.
Kodwa izinkinga zingenza futhi zenzeke. Kulesi simo udokotela wakho angase asikisele ukususwa kwe-hardware yakudala kusukela ekuhlinzekeni kwe-ACDF, okuzodinga enye inqubo engavamile.
Ingabe Kufanele Uvumelanise Ukuxolisa ?
Lo ngumbuzo okhohlisayo osuselwa ezinhlobonhlobo zezici. Nalapha, uma udokotela wakho ohlinzayo esebenza ezingeni elilodwa elizungezile lomgogodla wakho, impendulo ingase ibe yebo. Kodwa ukubuyekezwa kwezincwadi ze-2012 ezishicilelwe kwi- Open Orthopedic Journal zitholile kakhulu, uma kukhona umehluko phakathi kwemiphumela esuka ku-ACD ne-ACDF. Abacwaningi abafanayo bathola ubufakazi obukhawulelwe bokuthi ukuhlanganiswa kanye ne-ACD (okungukuthi, i-ACDF) ukuhlinzeka kwaba nemiphumela yokuhlinzeka kangcono kune-ACD ephelele.
Kungcono ukuxoxa ngokukhetha kwakho nabahlinzayo bakho, futhi uthole umbono wesibili uma unemibuzo noma ukukhathazeka ngalesi sinqumo esibalulekile.
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I-Laminoforaminotmy yezibonakaliso ze-Radiculopathy zesibelethoUkuhlinzwa okuvame kakhulu okwenziwe nge-radiculopathy yomlomo wesibeletho, okubizwa ngokuthi i-posterior emndenini laminoforaminotomy, kuthatha ukuhamba ngemuva, noma emuva.
Mayelana ne-Laminoforaminotmy yezibonakaliso ze-Radiculopathy zesibeletho
Ngaphambi kokuba ubalekele leli gama elibukeka kabi, ake silihlukane ukuze siqonde ukuthi inqubo yenzani. Njengoba sesivele sixoxile, ukuhamba ngemuva kubhekisela endleleni evela ngemuva, futhi umlomo wesibeletho ubhekisela entanyeni yakho. Izindlela ezilinganiselwe-eziyinkinga yokunquma kodwa hhayi ukususa ngempela.
Amagama athi "lamino" nelithi "foramino" abhekisela ezindaweni zethambo lomgogodla kanye / noma ikholomu.
I-lamina iyingxenye yendandatho yebony ngemuva kwe-vertebra ngayinye. I-lamina ivela ngemuva kwenqubo eguquguqukayo ngakolunye uhlangothi lwe-vertebra, kuya kwesisekelo, ngakolunye uhlangothi, lwenqubo ye-spinous ngemuva.
Igama elithi foramina lisho umgodi, futhi uma ukhuluma ngomgogodla, ubhekisela emigodini ehlangothini olulodwa lomkhola wamagogasi kuwo wonke amazinga, okwenziwe ngamabili amakhelwane, ahlanganiswe (1 phezulu nangaphezulu kwe-vertebrae).
Indlu ye-foramina izimpande zomgogodla, futhi i-lamina yingxenye yethambo ngalinye elenza uphahla kanye nesisekelo se-foramina.
Beka konke Kubuyela Kanye - Luyini i-Laminoforaminotomy?
Ukuyibuyisela ndawonye, i-term posterior lamaconforaminotomy ye-posterior isisetshenziswa lapho udokotela ohlinzayo engena ngemuva kwentamo ukuze anqunywe, kodwa hhayi ukususa eyodwa, kokubili noma kokubili kulezi zindawo zomgogodla; lokhu kuzoba yi-lamina, etholakala engxenyeni engemuva yethambo ngalinye, kanye neyodwa noma ngaphezulu kwezimbobo ohlangothini.
Le nqubo yenziwa ukwenza indawo yezinzwa. Umgomo wokuhlinzekwa ukuvumela ukuhamba kwemizwa ngokusebenzisa i-foramina ukuthi ingenzeki. Ngokususa amathambo ngaphakathi kwe-lamina kanye / noma i- foramina , umgogodla kuthiwa "udidekile."
Indlela Eyisendleleni Yokuhlinzwa Kwamathambo - Izinzuzo
Izinzuzo zokusebenzisa indlela ehamba phambili yilokho ukuhlanganiswa ngokuvamile akudingekile nokuthi udokotela ohlinzayo angakwazi ukugcina ibhalansi elungile kanye nokulungiswa.
Ukuphazamiseka ukuthi inani lokunciphisa okungenziwa kwindlela yokuhlinzwa njengalokhu kunqunyelwe. Ngenxa yalokho, ngokubukeza okukhulunywe ngenhla, ukusetshenziswa okungcono kakhulu kwendlela ehamba phambili kungase kube ukususa amadivaysi e-soft spy causing i-neuroforaminal spinal stenosis , isimo esingenza futhi senze ukuduma kwe- cervical radiosispathy.
Uma sekufika kuwo, ukukhetha kokuhlinzekwa kuhlobene kakhulu nokusetshenziswa kwamasu okuhlinza okuhlinzekwayo futhi ikhono lokugcina ukulungiswa komgogodla nokulinganisela ngesikhathi nangemva kwenqubo, ukubuyekezwa kuphetha.
Imithombo
Botelho, Richardo, V., et. al. Ukukhethwa Kokuhlinza Okuhle Kakhulu Ngemva Kwesilinganiso Esingaba Ngaphandle I-Disterctomy Yesibeletho Se-Cervical Spine: Isibuyekezo Esihlelekile. Vula i-Orthop J. Mashi 2012. Ifinyelele ngo-Jan 2016.
UCaridi, uJohn M., MD, uPumberger, uMatias, MD, uHughes, Alexander, P., MD Radiculopathy: Ukubuyekeza. Isibhedlela Sokuhlinzwa Okukhethekile. Sept. 2011. Kufinyelelwe ngo-Jan 2016.
> Imiphumela ye-Sasso W. Long-Term Clinical Imiphumela ye-Cervical Disc Arthroplasty: Isivivinyo Esibhekene Naso, Esihlelekile, Esilawulwayo. Isiphetho. Juni 2016. https://www.ncbi.nlm.nih.gov/pubmed/27333341
> Shangguan, L. Thola i-arthroplasty ye-cervical arthroplasty ngokumelene ne-discectomy yangomlomo wesibeletho kanye nokuhlanganiswa kwezifo ze-discs zesifo somlomo wesibeletho: Ukuhlaziywa kwe-meta. PLoS One. Mashi. 2017 https://www.ncbi.nlm.nih.gov/pubmed/28358860
> Zou, S. Anterior discectomy ye-cervical kanye ne-fusion (ACDF) ngokumelene ne-arthroplasty disc ye-cervical (CDA) yezinhlangothi ezimbili ezixubileyo izifo zesifo sokuguqula i-cervical: i-meta-analysis of trial trials. I-Eur Spine J. Ngo-April 2017 https://www.ncbi.nlm.nih.gov/pubmed/27314663