Ukwelashwa Kwesibili Emuva
Ukubukeza ukuhlinzwa komgogodla kungase kubonakale kunesidingo ngudokotela wakho (noma wena) uma usenayo izimpawu ngemuva kwenqubo yokuqala, noma uma unezimpawu ezintsha. Kodwa wazi kanjani ukuthi udinga ngempela ukuhlinzwa oku-2 emuva? Hlola lolu hlu ukuze uqale ucwaningo lwakho.
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Ukuhlonishwa kwama-Disc DisclaimerUma, emva kwe-discectomy, uphinde ube ne-sciatica, ubuhlungu phansi ingalo yakho, noma ezinye izimpawu ze-disc, ungase ube nesimiso esivamile. Ukukhipha i-disc okuphindaphindiwe ngokuyinhloko kuyaphinda kwenkinga eholele ekuhlinzekeni kuqala.
Okuhlobene: Izimpawu Ze-Radiculopathy Yesibeletho
I-discectomy iyakhipha kuphela lezo izingcezu ze-disk material (ezibizwa ngokuthi izingcezu) eziye zahlukaniswa ngokugcwele noma ngokugcwele kusukela ku-disc enkulu. Usenayo i-diski yakho, futhi kusengenzeka ukuthi imise ingxenye eyashiywe.
Okuhlobene: Iyini i-Disc Fragment?
UDkt. Joshua D. Auerbach, uMqondisi wezokwelapha eNdlini yaseBronx-Lebanon esibhedlela eNew York City, ufanisa i-discectomy yokudla ucezu lwe-cheesecake, ikakhulukazi kulabo abathandekayo ngalolu daba.
Ngenkathi ugxile ekujabuleleni okuhlangenwe nakho, uthi, amathuba amancane we-cheesecake azohlukaniswa nesigaba esiyinhloko. Abanye bazohlala epulangwe, abanye bangase bafike emgqeni wepuleti, kanti abanye bangase bawa ngokuphelele. Kulesi simo, iningi labantu lizolahla lezo zingcezu eziwela epuleti, kodwa qhubeka udla isakhi esikhulu.
I-analogy ye-discectomy isebenza ngendlela efanayo: Izitshalo ezingasetshenzisiwe zisusiwe esakhiweni esiyinhloko, zishiya lonke i-diski yakho, noma ucezu lwekhekhe, lihambelana.
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PseudoarthrosisI-Pseudoarthrosis yigama elichaza ukungabi nalutho lwe-bone fusion kungakapheli unyaka owodwa ngemuva kokuhlinzwa kokugaya umgogodla.
I-Pseudoarthrosis ivame kakhulu, eyenzeka ngamaphesenti angama-68% ama-lumbar fusions, ngokusho kwe-Auerbach. Kulaba, phakathi kuka-6 no-36% kudinga ukusebenza kabusha, usho kanje.
Ezinye izinto ezingase zibe nendima ekuthuthukiseni i-pseudoarthrosis ngemuva kokuhlinzwa kwakho kokuqala kufaka:
- Imvelo yokuxilongwa kwakho kwangempela
- Uhlobo lwe-hardware (noma ukuntuleka kwalo) olufakiwe
- Uhlobo lwethefu lokufakelwa , uma likhona, lisetshenzisiwe
- Imikhuba yakho yezempilo nesimo. Isibonelo, uma ubhema noma uthatha i- corticosteroids , ingozi yakho ye-pseudoarthrosis inganda.
- Uma une-fusion yomgogodla lapho kungekho amapuleti, izikuluzi noma enye i-hardware efakiwe.
Esahlukweni sakhe mayelana nokuvuselelwa kokusebenza komzimba we-medical text ethi I-Textbook of Spinal Surgery, i-3rd Edition , i-Auerbach cites izifundo ezibonisa ukuxuba okwenziwe ngaphandle kokufakwa kwe-hardware kungandisa ingozi yakho ye-pseudoarthrosis ngo-70%. Leyo nombolo iphansi kakhulu - i-10% - ngenxa yezifutho zomgogodla lapho i-hardware ifakwa khona, kubika.
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Isifo Sengxenye EseduzeI-ASD, noma ukuguqulwa kwesigaba esiseduze, yisimo lapho izinguquko zesimo somzimba zenzeka emathanjeni omgogodla ngenhla kanye / noma ngaphansi kwendawo yokuhlinzwa emuva.
I-Auerbach ithi uma i-ASD ivela, ngokuvamile yenza kanjalo ngemva kweminyaka emibili noma ngaphezulu engenabuhlungu.
Okuhlobene: Iyini Ukuguqulwa Kwezingxenye Ezizenzekelayo?
Ochwepheshe abazi ngokugcwele uma kungukuhlinzwa emuva noma ukuqhubeka kwemvelo kwezinguquko ezishintshayo emgodleni onesibopho se-ASD.
UFrank Cammisa, Jr., MD, uMphathi weNsizakalo Yesihlwathi esibhedlela esibhedlela Sokuhlinza Okukhethekile eNew York, uthi ezinye izinto ngaphandle kwenqubo yokuhlinzeka zingase zisebenze ekuthuthukiseni izinguquko ezishintshayo esizibiza nge-ASD. "Izikhathi eziningi, i-ASD ibhekene necala lokuthi isiguli sinomfutho; noma ngabe isiguli singakaze sithole i-fusion singase sithuthukise izinguquko ezishintshayo kwenye izinga."
Ucwaningo olwenziwa ngu-Song, et. al, esithi "Isifo esiphezulu se-degenerative segciwane: ingabe kungenxa yokuqhubeka kwezifo noma into ehambisana nokuhlanganiswa kwe-fusion? Ukuqhathaniswa phakathi kwamagceke eduze kwezingxenye ezingenakunyanyisiwe," enyatheliswa ngo-November 2011, i-European Spine Journal ithola ukuthi " isifo esithile esiseduze sinomphumela womlando wemvelo we-spondylosis yomlomo wesibeletho kunokuba khona kwe-fusion. "
Okuhlobene: Yini i-Spondylosis yamaCervical?
I-Auerbach ithi izifundo ze-biomechanical zibonisa ukucindezeleka okungaphezulu emazingeni aseduze eduze kwe-fusion. Ngenxa yokuthi ukuxuba kuvame ukwandisa ukuphakama kwe-angle phakathi kwamathambo amabili okuhlangene kwe- intervertebral , indlela umgogodla wakho ohamba ngayo cishe uyoshintshwa. Lokhu kungabeka ukucindezelwa okwengeziwe ezindaweni ezithile zokujoyina.
Uthi kimi: "Ama-discs athatha ukukhipha," usho kanje.
Ngokusho kwe-Auerbach nabanye, lolu hlobo lokucindezeleka olwengeziwe luyisizathu esikhulu esenza abaningi embonini baqhubekele ekuthuthukiseni amasu namadivayisi okuhlinzeka ngokunyakaza . Intuthuko kwezobuchwepheshe - isibonelo, ukushintshwa kwe-disc totali - kunika odokotela ukuthi baphathe le nkinga ngaphandle kokudela ukunyakaza endaweni ephethwe.
Uma kwenzeka uyazibuza, kunezifundo ezibonisa ukuthi kunenzuzo yokuba ne-disc esikhundleni somswakama wamagogasi, nakuba kungewona yonke imibuzo ephendulwe (ngo-2016). Isibonelo, ekuhlaziyweni kwezifundo ezintathu eziqhathaniswa nemiphumela yokukhishwa kwe-disc yomlomo wesibeletho ngomfutho we-spinal eminyakeni emibili ngemuva kwenqubo, abacwaningi bathola ukuthi abantu abane-arthroplasty (i-disc replacement) babengama-44% angaphansi kokudinga ukwelashwa kwesibili. Lolu cwaningo aluzange lubike nganoma iyiphi inzuzo ebalulekile ye-arthroplasty yokunciphisa noma ukugwema i-ASD, noma kunjalo.
Ukuhlinzwa ukushintshwa kwama-disc kuxoxwa ngokujulile esihlokweni sami: Ukushintshwa kweDiskhi yeCervical
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Buyekeza i-TDRUkuguqulwa kwe-disc okuphelele, okuvame ukubizwa nge-TDR okwesikhashana, kuyindlela entsha yokuhlinza (e-United States, okungenani) ebonwa abanye ochwepheshe be-spine njengendlela ehlukile yokuhlinzeka ngokuhlinzwa komgogodla. Ukushintshwa kweDis kwenzelwe eYurophu okwesikhashana, kodwa i-US iyamukela kancane kancane lobu buchwepheshe.
Ngenxa yokuthi ukushintshwa kwe-disc kuyinto entsha kuleli zwe, nginombono wami wokuthi abakhiqizi bezinsimbi kanye nodokotela abasebenzisa amasu okuhlinza amaphayona basasebenza ngemininingwane. Lokhu kungandisa ingozi yenkinga eyodwa noma ngaphezulu eyenzeka ngenxa yokushintshwa kwediski.
I-Auerbach ithi kuphela ama-0-5% weziguli ezibhekiswe ekuhlinzekeni kocingo kufana nemigomo yenqubo ephelele ephephile yokubuyisela ama-disc. Uma ungewona ozobhapathizwa, kodwa unayo noma kunjalo, uthi, ungase ube nezinkinga.
Enye yezinkinga ezivame kakhulu eziholela ku-TDR yokubuyekeza (njengokuthi ukuhlinzwa okuphindwe kabili ukubizwa ngokuthi i-disc) kuthiwa ukuhluleka kwedivayisi. Izibonelo zokuhluleka kwedivaysi zifaka ukungasebenzi kahle kwe-disc prosthetic efaka umgogodla wakho, noma uma idivayisi ishintsha isikhundla sayo (ukuxoshwa).
UCammisa uyanezela ukuthi ngenxa yokuthi ukushintshwa kwediski kugcina ukunyakaza, izinguquko ezijwayelekile zokuguga zingahle zivele ezinhlanganisweni zezinhlangothi. Uma lesi senzo siba buhlungu kakhulu, uthi, udokotela wakho angase akhombise ukufiphaza komgogodla njengokuhlinzwa kwakho okubukezwayo.
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Izinkinga nge-Hardware eyakhiweNgokungajwayelekile, ungase ungene ezinkingeni nge-hardware eyasungulwa emgodleni wakho. Lokhu kubandakanya ama-discstic disks, njengoba kukhonjisiwe ngenhla, kanye ne-hardware esetshenziselwa ukuhlanganiswa komgogodla nezinye izinhlobo zokuhlinzwa emuva. I-instrumentation, njengoba kubizwa ngezinye izikhathi, ingase iphule, noma udokotela ohlinzayo kungenzeka ukuthi uyifake endaweni engafanele ngesikhathi senqubo.
Uhlobo olulodwa lwenkinga ye-hardware olutholakala ekuhlinzekeni kwangemuva yi-syndrome eyaziwa ngokuthi "i-hardware ebuhlungu." Kulesi simo, izinto ezifakiwe zivele zingakhululekile, i-Auerbach ithi.
UCamissa uthi ubuhlungu ngenxa yesifo se-hardware syndrome ngokuvamile kuvela ezicubu ezithambile (okungukuthi imisipha yakho, i-ligaments, i-tendon ne-fascia).
Ukukhuluma nge-hardware syndrome ebuhlungu ngezinye izikhathi kudinga ukuhlinzekwa ukususa izinto ezicasulayo. I-Cammisa ingitshela ukuthi ukuhlolwa kabusha kokuhlinzwa kwe-hardware syndrome kuvame ukufakwa kwe-hardware, hhayi idivayisi ngokwayo. "Kuyinto engavamile kakhulu ukususa i-instrumentation ngenxa yobuhlungu obangelwa yidivayisi," uCammisa uqinisekisa.
Ukuhlinzwa okubukezwayo kwe-hardware ebuhlungu kuvame kwenziwa ngokushesha.
Imithombo:
I-Auerbach, J., MD. Chief of Spine Surgery, Isikhungo Sezibhedlela saseBronx-Lebanon, uMsizi oPhezulu wezokwelapha, u-Albert Einstein College of Medicine. Ifoni Ingxoxo. Mashi 2012.
I-Auerbach JD, Kuklo TR. Buyekeza ukuhlinzekwa kwe-Lumbar Spine Surgery. Ku: Bridwell KH, DeWald R, ama-eds. I-Bookbook of Surgery Spinal, u-3rd Edition. Philadelphi., Lippincott 2011.
Benglis, D., et al. Ukubuyekezwa okunzulu kwephrofayli yokuphepha yamaprotheni we-bone morphogenetic ekuhlinzeni umgogodla. I-Neurosurgery 62. 5 (Supply 2) (2008).
UCammisa, F., MD, uMphathi Wezinsizakalo Zezibhedlela eSibhedlela Sokuhlinzwa Okukhethekile. I-New York. I-imeyili Ingxoxo. Mashi 2012.
U-Etminan M, Girardi FP, Khan SN, Cammisa FP Jr. Amasu okubukeza we-lumbar pseudarthrosis.Orthop Clin North Am 2002; 33: 381-392.
I-Patel AA, i-Spiker WR. Ukuvuselela ekuxilongweni nasekwelashweni kwama-nonunion lumbar. I-Semin Spine Surg 2008; 20: 20-26.
Ingoma, K., et. al. Isifo esiphezulu sesifo sokuguga: ingabe kungenxa yokuqhubekela kwesifo noma into ehlobene nokuhlanganiswa? Ukuqhathanisa phakathi kwamagceke eduze kwezingxenye ezifakiwe nezingezange fused. I-Eur Spine J. Nov 2011. Itholekele ngo-Jan 2016.
I-Upadhyaya, et al. Imiphumela ehlanganisiwe ye-3 IDE yase-US engahlolwayo nge-Cervical Arthroplasty Trials With 2-Years of Follow-up: 923. Ukuhlinzekela ngegazi: August 2010 - Umqulu 67 - Issue 2. ini: 10.1227 / 01.NEU.0000386995.74131.4B