Uma uthola ukuhlinzwa emuva, ukuqagela kwami ukuthi uma sekuphelile, into yokugcina oyilindele enye inkinga. Ngeshwa, cishe noma yikuphi ukuhlinzeka kwenzeka ngengozini yezinkinga , okungeke kube khona ukunika ubuhlungu noma ezinye izimpawu ngemuva kweqiniso. Enye yezinkinga ezinjalo zokuhlinza umgogodla yi-epidural fibrosis, noma ukukhishwa kwendawo yokuhlinzwa.
Sibutsetelo
I-epidural fibrosis yigama elinikezwe ukuhluleka okwenzeka ngemva kokuhlinzwa okuqhubekayo.
Kungenye yezimbangela eziningana zezimo ezibizwa ngokuthi yi-syndrome ehluleka ukuhlinzwa emuva (isichazamazwi: i-FBSS.) I-Epidural fibrosis mhlawumbe imbangela evamile kakhulu kubo bonke; kwenzeka kuma-91 amaphesenti abaguli bokuhlinzwa ngemuva kokubuyela emuva.
Kodwa kunezindaba ezinhle: i-Epidural fibrosis ayiphumeli njalo ebuhlungu noma ezinye izimpawu. Eqinisweni, kwabanye abantu, akuthinti impilo yabo yansuku zonke noma amazinga okubuhlungu nhlobo. Ukutadisha kuka-2015 okushicilelwe encwadini ye- Insights Imaging ithola ukuthi umbuzo wokuthi ngabe izimpawu zivela noma cha zingase zihlotshaniswe nokuthi ukusakazeka kwande kangakanani.
Olunye ukufundwa kuka-2015, ngalesi sikhathi lanyatheliswa ku- Asian Spine Journal, lithole ukuthi i-epidural fibrosis ingabangela ubuhlungu kubantu abangamaphesenti angu-36 abane-syndrome yokuhlukumeza emuva emuva. Futhi nakuba amaphesenti angu-36 ayiyingxenye enkulu yeziguli, sekude kakhulu kumaphesenti angu-91.
I-epidural fibrosis iyafana nokuxilongwa okuhluke ngokuphelele kune- arachnoiditis .
Okokuqala, i-epidural fibrosis ithinta isembozo sangaphandle somgogodla (umlenze ohlala isikhathi eside), kanti i-arachnoiditis iya endaweni engaphezulu kwendwangu eluhlaza. Njengomlenze wokugcina ongaphezulu kwawo (futhi ibuye ibuye ngaphansi) i-arachnoid ejikelezayo futhi ivikela izinzwa ezibucayi eziqukethe intambo yomgogodla.
Omunye umehluko wukuthi i-epidural fibrosis ibangelwa ukuhlinzwa emuva; kodwa ukuhlinzwa emuva kungenye yezimbangela eziningi ze-arachnoiditis. Futhi ekugcineni, ukuvuvukala kungaba yilokho okubangela ukuba izicubu ezibomvu zenzeke, okungaholela ekutheni ukugulisa umgogodla-isimo esibuhlungu kakhulu futhi esinzima sokwelapha.
Ukufometha
Yini eyenzeka ngempela emgodleni wakho lapho uthola i-epidural fibrosis? Le mpendulo, ngokujwayelekile, ihlobene nendawo yomgogodla wakho obizwa ngokuthi izimpande zomgogodla.
Ukuhlinzwa okuningi okwenzelwe ubuhlungu bomhlane nasemlenzeni kungukuthi i- laminectomy (ebizwa nangokuthi ukuhlinzwa ngokucindezela ) noma i- discectomy . Zombili izinqubo zenzelwe ukunciphisa ingcindezi emmpandeni wamasipha omgogodla njengoba iphuma emthonjeni womgogodla. (Ukulimala okunjenge -disc herniated , kanye nezinguquko eziguqukayo ezihlahleni zomzimba ngokwayo kungabangela izakhiwo ezihlukahlukene-njengokuhlukaniswa kwezingcezu noma ama-bone spurs okucindezelayo, nokucasula, izimpande zesisindo.)
Lokho kusho ukuthi isikhathi esiningi, udokotela ohlinzayo uzosebenza eduze nendawo yezimpande zakho zezinzwa. Ngenxa yokuthi uzogxila ekukhipheni izinto (izingcezu ze-disc ezingezona ezikhona noma izifuba zethambo eziseduze kakhulu nesibindi), ngokuqinisekile uzobabeka phambili ngokusebenza ngokuphumelelayo.
Ngenxa yalokhu, isilonda sizokwenziwa njengengxenye yokuhlinzwa kwakho.
Ukwehlukanisa kuyinto impendulo yemvelo kunoma yiluphi uhlobo lwesilonda eliphazamisa isakhiwo somzimba, futhi indawo ezungeze izimpande zakho zomgogodla ngesikhathi sokuhlinzwa akuhlukile. Inqubo ifana nalokhu okwenzekayo uma uguqa ngamadolo; Ngamanye amazwi, ukuthuthukiswa kwe-epidural fibrosis kufana nokulingana okufakwe emadolweni emva kokulimala kokuqala. I-scab, ne-epidural fibrosis, yizinqubo zokuphulukisa zemvelo.
I-epidural ishiya ngokuvamile phakathi kwamasonto ayisithupha nambili emva kokuhlinzwa.
Inqubo
Ake sijule kancane ukuze siqonde le nqubo yokuphulukisa njengoba isebenza ku-disectomy yakho noma i-laminectomy.
Ngemuva kokuhlinzwa emuva, inombolo yezinto zingenzeka ngaphansi kwe-hood, okushoyo.
Okokuqala, enye yezingubo ezintathu zomgogodla wakho (isembozo sangaphandle esibizwa ngokuthi "uhlala isikhathi eside") singacindezelwa. Okwesibili, eyodwa noma ngaphezulu yezimpande zakho zezinzwa zingase zibe "zinyunyiswe" (okungukuthi, ziboshwe.) Okwesithathu, ngenxa yezinto ezimbili noma ezimbili zombili, igazi elidluliselwe emzimbeni wesibindi kanye / noma cerebral fluid umgogodla livinjelwa. I-cerebrospinal fluid, eyaziwa nangokuthi i-CSF, iwuketshezi olucacile, lwamanzi aluhamba phakathi kobuchopho nomgogodla emkhatsini we-arachnoid mater kanye ne-mater. Umsebenzi wayo ukuvikela nokuvikela izakhiwo zesimiso sezinzwa (esenziwa kuphela ubuchopho nomgogodla) kusuka emthethweni.
Kusukela ngo-2016, abacwaningi basaphikisana kanjani nokuthi, noma ngabe, ukuchotshozwa eduze noma eduze kwemisipha yomgogodla kufana nobuhlungu nezinye izimpawu ongatshela udokotela wakho mayelana nokuhlinzwa kwakho emuva. I-athikili e- Asian Spine Journal okukhulunywe ngenhla ithole ukuthi abanye abalobi bokutadisha bathi cha-laba ababili abakushoyo. Kodwa abanye, i- Asian Spine Journal ibika, baye baphetha ngokuthi ukusabalalisa okubanzi nokuzungeza izimpande zesisindo (ngokungafani nezintambo ezichazwe endaweni eyodwa kuphela) zinobudlelwane nezimpawu nobuhlungu.
Ether indlela, uma izibazi zakha, ayikho imithi yokwelapha yangempela. Udokotela wakho ohlinzayo angase afune ukubuyela futhi aphule izibazi nge-endoscope, kodwa empeleni kungabangela ukuhlukumeza okuningi kanye ne-epidural fibrosis.
Ngenxa yalesi sizathu, indlela engcono kakhulu yokwelapha i-epidural fibrosis ukuwuvimbela, noma okungenani ukunciphisa ukwakheka kwesikhala.
Indlela engenziwa ngayo njengamanje, ngo-2016, esebenza ezikoleni zocwaningo, ikakhulukazi ezilwaneni kunabantu. Lezi zifundo zivivinya izidakamizwa noma izinto ezisetshenziswayo ikakhulukazi kumagundane, bese uqhathanisa nezicubu nalabo beqembu elilawulayo (amakhophu angatholi izidakamizwa noma izinto ezisetshenziswayo.)
I-Degree
Into eyodwa isayensi ehambelana nezimpawu nobuhlungu yizinga le-fibrosis. I-Epidural fibrosis ingafakwa kusuka ku-0, emele izicubu ezijwayelekile ezingenalo ukuhluleka nakancane eGreyi 3. Ibanga lesi-3 liyi-fibrosis enamandla, enezicubu ezinobumba ezithatha ngaphezu kwezingu-2/3 zendawo eqhutshwa kuyo ( esimweni se-laminectomy.) Isikali seBanga lesi 3 singase siphumelele nasezimpandeni zemisipha, kanti amaGreyidi 1 no-2 awenzi. Amakhanda eBanga 3 ahambisana nezimpawu nobuhlungu ngaphezu kwamaBanga 1 no-2.
Amabanga eBanga 1 avame ukuba abumnene, futhi ahlanganiswe nezinsimbi ezincane ezifakwe emgqeni wokugcina, okuyiwona ongaphezulu komgogodla ovelele ochazwe ngenhla. Amacembe e-Grade 2 ayenamathele, aqhubekayo, futhi athatha okungaphansi kuka-2/3 endaweni ye-laminectomy. Uma isikebhe sesifikile ebangeni lesi-2, liqhubeka, okusho ukuthi bambalwa uma kukhona izintambo zomuntu ezibonakalayo.
Ukuxilongwa
Udokotela wakho angalayela i-MRI ukuthi ixilonge noma iyiphi i-epidural fibrosis ongayithola. Inkinga, izikhathi eziningi, ukubhula akukwazi ukubonwa ngalolu hlobo lokuhlolwa kwe-imaging yokuxilonga. Ngakho uma unezimpawu, futhi i-MRI ibuyele engalungile, ungase udingeke uthole i-epiduroscopy.
I-epiduroscopy iyilinga lapho ipulazi, noma ububanzi, lingeniswa khona endaweni enokukhathazeka ukuvumela udokotela wakho ohlinzayo ukuba abone ukuthi kwenzekani ezincandeni zakho zezinzwa. Kubalulekile ukuthatha inqubo yokuxilonga ngalokhu ngoba ubuhlungu bakho kungenzeka empeleni kungenxa yesinye isitifiketi, kunokuba i-epidural fibrosis. Kulesi simo kungenzeka ukuthi udinga olunye ukuhlinzwa ; kodwa uma imiphumela ye-epiduroscopy ibonakala ilula, futhi ukushaywa yilokho okubangela izimpawu zakho, amathuba akudingeki ukuthi uhlinzekwe ngu-2.
Ukwelapha
Ungase uzibuze: Uma ukuhlinzwa okulandelwayo kungenakwenzeka ukukhulula ubuhlungu obukhulu be-epdiural fibrosis, wenzani?
Njengoba ngishilo ekuqaleni kwalesi sihloko, ososayensi nodokotela abakaze baphethwe ukwelashwa okuphumelelayo kwalesi sizathu sokwehluleka kokuhlinzwa emuva kwe-back back. Nokho, ngokuvamile, imithi inikezwa ekuqaleni-ngokuvamile ngokuhambisana nokwelapha ngokomzimba. Imithi ingasiza ekuhluphekeni kanye nokuzivocavoca. Imithi enikezwa ihlanganisa iTylenol (i-acetaminophen,) i-NSAID (imithi engeyona isifo sobuhlungu elwa nobuhlungu), i-gabapentinoids, nezinye.
Ukwelashwa ngokomzimba kuklanyelwe ukukugcina uhamba futhi kungase kuhlanganise nokuqiniswa, ukwelula nokusebenza okuyisisekelo. Ukuhlala mobile kumajoyini akho kungasiza ukukhawulela ukwakhiwa kwezicubu ezibomvu .
Ngokuqondene nokuhlinzwa, isifundo esisodwa sibika ukuthi ngokuvamile sinamaphesenti angu-30 kuphela kuya ku-35% wezinga lokuphumelela. Akukhona lokho kuphela, kodwa isifundo esifanayo sithi izimpawu ezingamaphesenti angama-20 eziguli ziba zimbi nakakhulu. Lokho kusho ukuthi izindlela ezimbili zokwelashwa eziyinhloko ezinikezwa i-epidural fibrosis yi-adhesiolysis yocansi kanye ne-endoscopy yomgogodla.
Kuze kube manje, i-adhesiolysis ngayinye inezinkomba ezinhle kunazo zonke. Kule nqubo, okuyinto, ngokusebenzisa indlela, isetshenziselwa ezinye izimbangela ze-syndrome yokuhlinzwa emuva emuva kwehluleka, kanye nemithi, imithi kaningi isifo se-steroidal , ifakwe endaweni kule catheter efakwe. Futhi ngale nqubo, ukuphulwa komshini wezinhlamvu akudingekile ukuphumula kwezimpawu.
I-adhesiolysis engaphelele ixhaswa yi-Level I ubufakazi (izinga eliphakeme kakhulu) ngokusebenza kwayo ngenxa yezimpawu ze-syndrome zokuhluleka emuva kokuhlinzwa, okuhlanganisa i-epidural fibrosis.
Olunye ukwelashwa udokotela wakho angase aluphakamise ukuthi i-endoscopy yomgogodla. Kule nqubo, indawo evumela udokotela wakho ukuba acabange ukuthi le ndawo ifakiwe. Ngezinye izikhathi i- lasers isetshenziselwa ukuphatha izibazi ngenkathi ububanzi belapho. I-endoscopy yomgogodla ilinganiswa njengobufakazi be-Level II no-III, kanti isifundo esisodwa sitholile sathola ukuthi sibe nobufakazi "obuhle" bokukhulula izimpawu.
> Umthombo:
> Coskun E., Süzer T., Topuz O., Zencir M., Pakdemirli E., Tahta K. Ubudlelwane phakathi kwe-epidural fibrosis, ubuhlungu, ukukhubazeka, kanye nezimo ezingokwengqondo ngemuva kokuhlinzekwa kwe-lumbar disc. I-Eur Spine J. June 2000. https://www.ncbi.nlm.nih.gov/pubmed/10905440
> U-Helm S., u-Racz G., u-Gerdesmeyer L., uJustiz R., uHayek S., u-Kaplan E., u-Terany M., uKnezevic N. I-Percutaneous ne-Endoscopic Adhesiolysis ekuphatheni ubuhlungu obuphansi nobunzima obuphansi: Ukubuyekezwa kwesistimu kanye ne-Meta -ahlaziya. Udokotela Wezinhlungu. Feb. 2016. https://www.ncbi.nlm.nih.gov/pubmed/26815254
> UHel S. S., Hayek S., Colson J., Chopra P., Deer T., Justiz R., Hameed M., Falco F. Ukugcinwa kwe-spinal endoscopic adhesiolysis ekulandeleni ukuhlinzwa kwesifo esibuhlungu: ukubuyekezwa kobufakazi. Udokotela Wezinhlungu. Ngo-Ephreli 2013. https://www.ncbi.nlm.nih.gov/pubmed/23615889
> Masopust V., Häckel M., Netuka D., Bradác O., uRokyta R., Vrabec M. Postoperative epidural fibrosis. I-Clin J Pain. Sept. 2009. https://www.ncbi.nlm.nih.gov/pubmed/19692802
> Mohi E., Abdel R. Epidural Fibrosis emva kokuhlinzwa kwe-Lumbar Disc: Ukuvimbela kanye nokuPhumela kokuHlola. I-Asian Spine J. Jun 2015. https://www.ncbi.nlm.nih.gov/pubmed/26097652