Izithiyo zamagatsha eziphakathi zinezindawo ezibalulekile emndenini wezinhlungu emuva. Ngokombiko we- E-Medicine , ochwepheshe abaningi bakholelwa ukuthi izinkinga ezihlangene nazo zihlanganisa ubuhlungu obukhulu obubhekene nomhlane (cishe 80%).
Ukuqonda isisu sakho kungasiza ekuqondeni ubuhlungu obubuhlungu kanye nokuphathwa kwawo. Okokuqala, yazi ukuthi ukuhlanganiswa kwesibalo yilokho okunikeza ikholomu yomgogodla ukuzinza ngenkathi ngesikhathi esifanayo ehambisa izinhlobo ezithile zokuhamba.
Kuyaziwa nangokuthi i-zygapopsese, kanye nokuhlanganiswa kweZ. I-nerve medial ihlala nje ngaphandle futhi ingenasidingo esihlangene nesici. Ibuye futhi elinye lamagatsha amathathu enzwa enkulu ebizwa ngokuthi i-dorsal ramus, okuyiyona nzwa yokuqala ehlukaniswe emsuka wezimpande zomgogodla. Khumbula, i-dorsal isho emuva futhi i-ramus kusho igatsha.
Lezi zinzwa ezintathu ezivela e-dorsal ramus zisebenza ezindaweni eziningi, kufaka phakathi izihluthulelo zomhlane eziphambili. Igatsha eliphakathi kakhulu lithinta ukuhlanganiswa kwesici kanye nemisipha ejulile efana ne- interspinales , i- multifidus , nabanye abambalwa. Igatsha eliphakathi nalo lifinyelela okungenani elilodwa lomgogodla (i-interspinous) futhi mhlawumbe amabili (i-ligamentum flavum kanye).
Yiziphi Izithiyo Zegatsha Eziphakathi?
Uma unesivimbela segatsha eliphakathi, ukuhlinzekwa kwezinzwa zendawo ezifana ne-lidocaine kujojowe emgodleni womzimba we-facet joint. Ukujova ukuhlinzekwa kwezidakamizwa zendawo endaweni yesiguli kungasiza odokotela ukuxilonga ubuhlungu be-back.
Uma umjovo ukhulula okungenani u-50% wezihlungu zakho ezijwayelekile zomhlane, udokotela wakho cishe uzoqinisekisa ukuthi ubuhlungu buvela ohlangothini lwe-facet futhi buncoma ukukhishwa kwe-radiofrequency njengoba ukwelashwa. Izithiyo zamagatsha eziphakathi nazo zisetshenziselwa ukuxilonga ubuhlungu obuhlangene be-sacroiliac.
Ungaba nesigcawu segatsha eliphakathi komunye ohlangothini olulodwa lwe-facet noma kokubili.
Uma izinhlangothi zombili ziphathwa, kuthiwa yi-bi-lateral injection.
Izivimbe zegatsha eziphakathi noma izijovo zangaphakathi
Olunye uhlobo lomjovo osetshenziselwa ukuxilonga ubuhlungu be-back is injection ye-intra-articular. Lo mjovo ungena esikhaleni esivumelwaneni sezinhlangothi ezizungezwe i- capsule eyenziwe ngezicubu ezinzima. Ucwaningo olwenziwa ngo-2016 olwanyatheliswa kuyi-Journalist Pain Physician , phakathi kwezinye izinto, ukuthi inhlangano ephakathi kwegatsha eliphakathi nokuvimbela ukwelashwa okuhlanganyelwe yi-facet ingaba mkhulu kuneyodwa phakathi kwe-intra-articular injection kanye nokwelashwa okuphumelelayo. Lokho kusho ukuthi abalobi bacela izifundo ezengeziwe zekhwalithi eziphezulu ukuze zenziwe ngale ndaba ngaphambi kokuba ziqinisekise lokhu okutholayo.
Igatsha Eliphakathi Kakhulu Njengamaphilisi
Kungenzeka yini ukuthi izakhi zamagatsha eziphakathi zingasetshenziswa njengokwelashwa? Ngemuva kwalokho konke, kunciphisa ubuhlungu, akunjalo?
Ngenkathi iningi le-block block eliphakathi linikezelwa ngezinhloso zokuxilonga, ngezinye izikhathi liyasetshenziswa njengendlela yokwelashwa, kodwa isebenza kahle kangakanani?
Ucwaningo lwango-2013 lwanyatheliswa ku- Annal of Medicine Rehabilitative lwathola ukuthi kubantu abaphethe igatsha eliphakathi livimbela ubuhlungu obuhlangene bobuhlungu obuhlangene obuhlobene ne-osteoporotic fracture elandelayo noma i-vertebroplasty noma ukwelashwa okulondolozayo, imiphumela yalungile ngomjovo wokuthunyelwa ngonyaka.
Abalobi bathi igatsha lamagatsha eliphakathi lenza ukukhululeka kobuhlungu kanye nokululala ukusebenza kweziguli.
Kodwa ukuhlolwa kuka-2012 okuhlolisisa izindlela ezihlukahlukene zokwelashwa ezihlangene ze-thoracic kutholakala ubufakazi obuhle bokuthi ama-branch blocks avela njengendlela yokukhulula ubuhlungu obungapheli kulowo mkhakha. Lokho kusho ukuthi abacwaningi babengakwazi ngisho ukuqhathanisa amabhulogi avamile namagciwane we-intra-articular, ngoba kwakungekho nhlobo ubufakazi bokuphathwa kwe-intra-articular. Futhi ucwaningo lwe- PM & R olukhulunywe ngenhla ngaseceleni, ubufakazi obukhawulelwe kuphela bufunyenwe nge-radiofrequency neurotomy. Ukusetshenziswa kwe-radiofrequency ablation kanye / noma i-neurotomy kuvame kakhulu ukwelashwa komzimba ohlangene kunama-block blocks.
Ukukhishwa kwe-radiofrequency yindlela yokwelapha lapho kusetshenzwa khona ukushisa emiseleni ehlangene ne-facet joint, ebulala amangqamuzana. Ngokuhamba kwesikhathi, umzimba ubeka amangqamuzana e-nerve afile aphethwe izicubu ezibomvu. Ngisho noma ukukhishwa kwe-radiofrequency kubhekwa njengokwelashwa okuphikisanayo, ukuxhumeka kwamalungu e-facet lumbar kungase kuhlinzeke ukuphumula okuhlala isikhathi eside kunakwezinye izindawo zomgogodla. Ucwaningo lwe-2015 olunyatheliswa kuyi- International Journal of Anesthetics ne-Anesthesiology lithole ukuthi eminyakeni emibili i-post i-lumbar igxilile ukukhishwa kwe-radioprequency, iziguli zenza kahle ngokuphathwa kobuhlungu, ikhono lokusebenza nokuthi ziningi kangakanani imithi ebuhlungu abayidingayo.
Nge-neurotomy, uhlobo olufanayo lokushisa-kusuka emagagasi omsakazo-lisetshenziselwa ukuxazulula okwesikhashana ubuhlungu. Ucwaningo lwe-2012 lwanyatheliswa emaphepheni we- PM & R ( Physical Medicine nokuvuselelwa ) lathola ukuthi ukuphumula kobuhlungu obubangelwa yi-radiofrequency neurotomyqubo kwaqhubeka phakathi kwezinyanga ezingu-7 kuya kwezingu-9 ezigulini eziningi, futhi lokhu kuyiqiniso ukuthi indawo ephathwayo yayisezintanyeni noma ephansi.
Kwenzekani Esigabeni Segatsha Esiphakathi?
Uma uhlelwe ukuthi ube nesigceme segatsha eliphakathi, yini ongayilindela?
Inqubo cishe izokwenzeka endaweni yokugula futhi ngeke ulale, kodwa kunjalo! Udokotela uzoqala ngokukudubula kwesifo sokubulala isikhumba sendawo ukuze unqande isikhumba sakho kanye nezicubu eziseduze ne-facet joint. Uzolala ngesisu sakho ukuze udokotela afinyelele amajoyini akho ekhanda, atholakala ngemuva kwekholomu lomgogodla.
Khona-ke uzofaka inaliti enobungozi ekhamera ebizwa ngokuthi i-fluoroscope endaweni ehlangene yezinhlangothi. Ngalesi sinaliti, umehluko wedayi uzofakwa endaweni. Lokhu kwenza udokotela abone ukuthi ngabe ummeleli omnyama ongasetshenziselwa ukusetshenziselwa yini uhlanganisa yonke indawo ehlangene ne-facet joint. Okulandelayo, i-anesthetic ifakwe ku-joint.
Uma nje ukujola umzimba kujojowe, udokotela wakho angakuqondisa ukwenza izinyathelo ezifanayo ezivame ukuletha ubuhlungu noma izimpawu zakho. Ngokusho kuka-Anthony Vaccaro, MD, uprofesa wezinzwa zegazi kanye nokuhlinzwa kwamathambo ku-Thomas Jefferson University eFiladelphia kanye nomqondisi we-Spinal Cord Injury, phakathi kuka-50% no-75% ukuphumula kobuhlungu kuzonikeza udokotela isizathu sokuqinisekisa ukuthi ungumhlane wakho ubuhlungu buvela ehlangothini lakho elihlangene kanye / noma lezinzwa zakho zamagatsha.
Ngenxa yokuthi izici ezimbili ezihlangene zihlinzekwa yizinzwa zombili zamagatsha (okuvela ku-vertebra ngenhla kanye nesinye esivela ku-vertebra ngezansi) cishe uzothola ama-shots amabili we-anesthetic kuwo wonke amaqoqo ahlanganisiwe amakwe ukwelashwa.
Lokhu kungenza kube ukudideka uma kuziwa ekukhokheni kwama-coding kanye nokukhokha. Eqinisweni, eminyakeni yamuva, izinkinga zamaphepha ezinjovo ezihlangene ziye zaholela ekuqhingeni okukhulu kweMedare.
I-Medicare Ukukhwabanisa Nokuhlukunyezwa Okuhlobene Nezifo Ezifakiwe
Umbiko wango-2008 okhishwe yiHhovisi lezeMisebenzi yoMnyango wezeMpilo noHulumeni we-Inspector General wathola ukukhushulwa kuka-76% emithwalweni ye-Medicare yezingqinamba zezinsizakalo phakathi kweminyaka ka-2003 no-2006. Abalobi bathole ukuthi kulezi zinsuku ezingamaphesenti angama-63, okukhokhwa ngokungalungile (82% kulawa akhiphe ukukhokhelwa ngokwezimali kukaMedare) kanye / noma kungadingeki ngokwemithi.
Ngonyaka ka-2006, iMedricare ikhokhelwe u-$ 81 million ukuze uthole izinsizakalo zodokotela ezingazange zibhalwe kahle noma zingabhalwanga nhlobo. Lo mbiko uthi ngenkathi ezinye zalezi zinkokhelo ezingalungile zisekelwe emaphutha amadokhumenti, abanye kungenzeka ukuthi bebelokhu beyizijova ezingakaze zenzeke. Ngokombiko, isikhathi esiningi, odokotela babethumela irekhodi yesiguli kuMedare, kodwa kwezinye izimo, abazange benze lokho futhi bahlala bakhokhelwa.
Ezinye zeziphambeko emarekhodi adluliselwe ku-Medicare zihlanganisa izincazelo ezilahlekile zenkambiso eyenziwe, noma imininingwane elahlekile, isibonelo, ukuhlonza izinga lomgogodla kanye / noma eceleni komhlane (okungukuthi, kwesokudla, kwesobunxele noma kokubili) owathola umjovo .
Amakhodi wokufaka imali okukhokhiswayo okumele akhombise ukufakelwa kwamanye amazwe (okusho ukuthi ukudubula ohlangothini oluhlangene lwesigatshana sakho ohlangene) kuholele ekukhokhweni okungaphezulu kwama-50% kunokuba uMedare kufanele avumele, kusho umbiko. Abalobi balo mbiko bathi ngenkathi ezinye zalezi mphutha kungenzeka mhlawumbe ngengozi, abanye kungenzeka ukuthi babe nezimo zokukhwabanisa ngamabomu.
Lo mbiko wabuye wathi odokotela basezikhungweni eziphuthumayo babengase benze amaphutha anjalo futhi / noma benze ukukhwabanisa kunabo ababenzi ezibhedlela. Ukuqhathaniswa kwakungama-71% wezinsizakalo zomjovo wezinhlangothi ezinikezwe ehhovisi ku-51% kulabo abanikezwa esikhungweni esinjengesibhedlela.
Mhlawumbe izigameko ezimbi kunazo zonke yizo lezo zijovo ezinikezwa ezingekho izidingo zemithi. Ngokombiko, i-tally yale nguqulo yokukhwabanisa kwezokwelapha yayingu-$ 17 million.
> Imithombo:
> Bentin, C. for the AMA. Ukubika Okungalungile Kwegatsha Lokuphakathi: Ukuphulwa Okuphezulu Kwezinqubo Etholakala Ngesikhathi Sokuphathwa Kwezinhlungu Ukuhlolwa Kwezinkokhelo Abakwa-ASCReview Iwebhusayithi. Septemba 2010.
> Holz, S., Sehgal, N. Iyini Impumelelo Yobumbano phakathi kwe-facet Radiofrequency Outcome kanye neempendulo kuMabhuloki Amagatsha Aphakathi Kokulinganisa? Udokotela Wezinhlungu. Ngo-Mashi 2016. http://www.ncbi.nlm.nih.gov/pubmed/27008290.
> Malanga, GMD, Young, CMD kanye. I-Lumbosacral Facet Syndrome. Iwebhusayithi ye-E-Medicine Medscape. Sept 2015. https://emedicine.medscape.com/article/94871-overview#a6.
> Manchikanti K., Atluri S., Singh V., Geffert S., Sehgal N., Falco F. Isibuyekezo Sokuhlola Ukuhlinzekwa Okuhlanganyelwe Okuhambisana Nezobuciko ZeTraracic. Udokotela Wezinhlungu. Julayi-Aug 2012. http://www.ncbi.nlm.nih.gov/pubmed/22828694.
> McCormick, Z., Benjamin Marshall, B., Jeremy Walker, J., uRobert McCarthy, R., Walega, D. Umsebenzi Wesikhathi Eside, Ubuhlungu Nemithi Sebenzisa Imiphumela Ye-Radiofrequency Ablation ye-Lumbar Facet Syndrome. Int J J Anesth Anesth. April 2015.
> Park, K. MD, Jee, H. PhD, Nam, H., MD, Cho, S., MD. Kim, H., MD, Park, Y., MD, Lim, O., MD. Umthelela wegatsha eliphakathi livimbela ukuhlukunyezwa okuhlanganyelwe kwe-Facet Chronic Facet for Oracoporotic Compression Fracture. U-Ann Rehabil Med. April 2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660479/.
> Smuck M., uCrisostomo R., Trivedi K., Agrawal D. Ukuphumelela kwe-Branch Initial and Ephindaphindiwe Yegatsha Eliphakathi Kwamajosi E-Zygapophysial Joint: Ukubuyekezwa Okuhlelekile. PM R. Septemba 2012.
> I-Vaccaro, A. I-Spine: Ulwazi Oluyisisekelo kuma-Orthopedics. Mosby. 2005. Philadelphia. Pp 63-64.