Indima ye-Radiology kwi-Emergency Trauma

Ingxaki yomgudu iqukethe imfucuza yomgudu, okanye izidumbu zomthumbu, yaye ukulimala kwentambo yomgogodla. Iimeko ze-12,000 ze-traum trains zichazwe e-United States minyaka yonke. Nangona iimeko ezibangeleyo zentambo yomgogodla kunye neentambo zentlambo zengozi yemoto kunye nokuwa, ukuxhamla komgudu kungaphinda kubangelwe ukuhlaselwa, ukulimala kwezemidlalo kunye neengozi ezihlobene nomsebenzi. Ukuxilongwa kweengxaki zomgudu kubandakanya ukucinga kunye nokuvavanya komsebenzi wamanzi, njengengcamango, imoto kunye nokuvakalelwa. Inqaku elilandelayo lixubusha indima ye-radiology engxamisekileyo kwimfudu yesigxina. Ukunyamekela kwe-Chiropractic kunokukunceda ukubonelela ukuvavanya ukuhlolwa kwengxaki yomgudu.

Abstract

Umonzakalo womqolo kukwenzakala rhoqo ngobunzima obahlukeneyo kunye ne-prognosis eyahluka ukusuka kwimeko ye-asymptomatic ukuya kwi-neurological dysfunction yethutyana, intsilelo ekugxilwe kuyo okanye isiganeko esibulalayo. Abona nobangela baphambili bomonzakalo womqolo kukuwa ngamandla aphezulu naphantsi, iingozi zendlela, imidlalo kunye nefuthe elibi. I-radiologist inendima yoxanduva olukhulu lokuseka ubukho okanye ukungabikho kwezilonda, ukucacisa iimpawu, ukuvavanya impembelelo ye-prognostic kwaye ngoko unyango. Ukufanekisa kunendima ebalulekileyo ekulawuleni ukuxhatshazwa komgogodla. Injongo yeli phepha yayikukuchaza: iziganeko kunye nohlobo lwe-vertebral fracture; isibonakaliso somfanekiso kunye nezikhokelo zokwenzakala komlomo wesibeleko; isibonakaliso somfanekiso kunye nezikhokelo ze-thoracolumbar trauma; i-multidetector CT isalathiso kwi-trauma spine; Isibonakaliso se-MRI kunye neprotocol ye-trauma spine.

intshayelelo

I-trauma yomqolo inzima kakhulu kuhlahlo lwabiwo-mali lophuhliso lwentlalo noqoqosho loluntu lwethu. E-USA, iimeko ze-15-40 kwisigidi sabantu abane-12,000 iimeko ze-paraplegia minyaka yonke, ukufa kwe-4000 ngaphambi kokungeniswa kunye nokufa kwe-1000 ngexesha lokulaliswa esibhedlele kuqikelelwa. Ulutsha oluninzi ngabona luhlala lubandakanyeka kwiingozi zendlela, lulandelwa ngabo basekhaya nasemsebenzini, kunye nokuxhaphaka kokuwa ngenxa yokwenzakala okuphezulu kunye nokwenzakala kwezemidlalo.1

Ukucingela kunendima ebalulekileyo ekulawuleni umgudu womgudu. Ulawulo olukhawulezileyo nolungileyo lwezigulane ezinexinzelelo, ukususela kwiintsholongwane ukuya kwonyango, kunokuthetha ukunciphisa umonakalo we-neurolo ebaluleke kakhulu kwixesha elizayo lomguli. Iingcali ze-Radiologists zinendima enkulu yoxanduva lokuseka ubukho okanye ukungabikho kwezilonda, ukuchaza iziganeko, ukuvavanya impembelelo yokuxela kwaye ngoko unyango.

Injongo yaleli phepha kukuchaza:

• iziganeko kunye nohlobo lwentsimbi yokutshatyalaliswa
• uphawu lweengcinga kunye nezikhokelo zentlungu yomlomo wesibeleko
• isalathiso kunye nekhokelo ze-thoracolumbar
• umzekelo wesifo se-CT (MDCT) se-traum spine
• I-MRI iphethini yesifo somnxeba.

Ingxaki yomzimba, kuquka ukuhlukana komgudu kunye nokulimala kwentambo yomgogodla, ibonisa malunga neepesenti ze-3 kwi-6 yepesenti yazo zonke izilonda zamathambo. Uvavanyo lokuxilonga luyisiseko ekuxilongeni oluxakekisayo lwentlungu yomgudu. Nangona i-radiografi ecacileyo yindlela yokuqala yokuxilonga esetyenziselwa ukuphazamiseka kwemihlathi kunye / okanye ukulimala kwentambo yomgudu, i-CT kunye ne-MRI inokukunceda nokuxilongwa. Njenge-ofisi yokunakekelwa kwe-chiropractic, sinokunika iimvavanyo zokuxilonga, ezifana ne-X-rays, ukunceda ukufumana unyango olungcono.

UDkt Alex Jimenez DC, i-CCST

Ulawulo lweZilaphulo zoLwaphulo kunye nokuBaliswa koMfanekiso kunye noVavanyo

Isizathu sokucinga ngomgudu wengqondo yomzimba kukuba:

• Ukuxilonga ukungaqhelekanga okungaqhelekanga kwaye ubonakalise uhlobo lokulimala.
• Ukuqikelela ubukhali, ukungazinzi komgogodla okanye ukuzinza okonakalisiweyo kunye okanye ngaphandle kwe-neurological lesion ehambelanayo, ukuze ugweme ukunyanzeliswa kwe-neurological ngomcimbi wezomthetho wezonyango.
• Ukuvavanya imeko yomgudu womgogodla kunye nezakhiwo ezizungezile (UM MR ngulo lugangatho lwegolide).

Uvavanyo lweklinikhi olubandakanya iingcali ezahlukeneyo-amayeza kaxakeka, utyando lokwenzakala, i-orthopaedics, i-neurosurgery kunye ne-radiology okanye i-neuroradiology-kunye nolwazi lokwenzakala yeyona ngongoma ibalulekileyo ukuze kuthathwe isigqibo nini kwaye loluphi uhlobo lobuchule bokucinga oluboniswayo.2

Umbuzo oqhelekileyo kwizigulane ezineengxaki zengxondorha yilo: ngaba kusekho indima kwi-X-ray yefilimu ecacileyo xa kuthelekiswa ne-CT?

Ukuze kucacise ukuba nini kwaye yintoni efanelekileyo ngakumbi yokugulisa umgudu, izikhokelo ezahlukeneyo zapapashwa ngokuhlukanisa izinga lomlomo wesibeleko kunye ne-thoracolumbar.

Ingxaki yomhlaza wesibeletho: I-X-Ray eqhelekileyo kunye ne-MultiDetector CT Indication

Kwinqanaba lomlomo wesibeleko, ingxabano iyaqhubeka malunga nenkqubo efanelekileyo kunye neyobuchule phakathi kwe-X-ray yomlomo wesibeleko kunye nemiboniso emithathu yefilimu (i-anteroposterior and lateral view kunye nombono ovulekileyo womlomo) kunye ne-MDCT.

I-X-ray ngokuqhelekileyo igcinelwe ukuvavanya izigulane ezikrokrelwayo zokulimala komlomo wesibeleko kunye nezo zonzakele kwiindawo ze-thoracic kunye ne-lumbar apho ukukrokrelwa kokulimala kuphantsi. Ngaphandle kokungabikho kovavanyo olulawulwa ngokungenamkhethe kwaye ngenxa yomgangatho ophezulu kunye nokusebenza kwe-MDCT kunye ne-post-processing (ukwakhiwa ngokutsha kwe-multiplanar kunye nokunikezelwa komthamo we-dimensional ezintathu), ukuphakama kwe-CT yomlomo wesibeleko (CCT) xa kuthelekiswa nomgangatho we-X-reyi yomlomo wesibeleko. ukufumanisa ukulimala komgogodla womlomo wesibeleko kubonakaliswe kakuhle.

Ukuze kuncitshiswe ukuchayeka kwemisebe ye-patient, kubalulekile ukuzimisela nokukhetha izigulane ezifuna ukucinga ngeengcamango kunye nabangenayo, ngokuvavanywa kweklinikhi kunye nokunokwenzeka kokulimala komlomo, ukusebenzisa i-MDCT kuphela kwisigulane esifanelekileyo njengoko ukucoca ngempumelelo.3

Okokuqala, kuyimfuneko ukuhlukanisa uhlobo loxinzelelo:

• ixinzelelo elincinci (isigulane esisigxina, uqaphile ngengqondo, kungekhona ngaphantsi kwefuthe lotywala okanye ezinye iziyobisi kwaye ongenalo imbali okanye iziphumo ezibonakalayo ezibonisa ukulimala kwentamo)
• i-trauma enkulu kunye neyobunzima (i-multitrauma, isigulane esingazinzanga kunye ne-neurological dysfunction elula yesikhashana, kunye ne-focal neurological deficit okanye kunye nembali okanye indlela yokulimala eyaneleyo ukuba idlule uluhlu lwe-physiologic of motion).

Okwesibini, kubalulekile ukubeka ukuba ingozi yomngcipheko izipho zifana nezi:

• ubundlobongela bokwenzakala: ukuwa kwamandla aphezulu (umngcipheko omkhulu) okanye ukuwa kwamandla aphantsi (umngcipheko ophantsi)
• Ubudala besigulana: <5iminyaka ubudala,>iminyaka engama-65 ubudala�
• izilonda ezinxulumene nazo: intloko, isifuba, isisu (i-multitrauma) njl.
• iimpawu zeklinikhi: I-Glasgow Coma Scale (GCS), i-neurological deficit, i-vertebral deformation.

Ukudibanisa ezi zinto, izigulane zingohlulwa zibe �eziphantsi
ingozi � kunye �nomngcipheko omkhulu� wokwenzakala komlomo wesibeleko.

Iqela lokuqala liqulethwe zizigulane ezivukile (i-GCS 15), isilumkiso, intsebenziswano kunye nokungabinxila ngaphandle kokulimala.

Iqela lesibini liqukethe izigulane ezingenangqondo, ezinxilisayo, ezinxilisayo okanye ezingabambisaniyo okanye abo banomonakalo ophazamisayo okanye isimo sengqondo esitshintshileyo (GCS, 15) kunye ne-5% yengozi yokulimala komlomo wesibeleko.3,4

I-CCT inesibonakaliso esibanzi kune-X-ray kwizigulane ezisengozini enkulu yokulimala komlomo wesibeleko (i-trauma enkulu okanye i-multitrauma). Akukho bungqina bubonisa i-CCT endaweni ye-X-ray kwisigulane esinomngcipheko ophantsi wokulimala komlomo wesibeleko.5

Ngo-2000, uphononongo lwe-National Emergency X-Radiography Utilization (NEXUS), ehlalutya izigulane ezingama-34,069, luseke iindlela ezinomngcipheko ophantsi wokuchonga izigulane ezinokwenzakala okuphantsi komgogodla womlomo wesibeleko, ezithe ngenxa yoko zafuna ingcinga yomqolo wesibeleko. Ukuhlangabezana nemigaqo ye-NEXUS, isigulane kufuneka sibe nezi meko zilandelayo:

1. kungabi namfesane kwimizuzu engaphantsi komqolo wesibeleko
2. kungekho ntsalela ye-neurological focal
3. umgangatho oqhelekileyo wokuphaphama
4. akukho bungqina bokuxhatshazwa
5. akukho kwenzakala okubonakalayo okubuhlungu okunokuphazamisa isigulane kwintlungu yokulimala komqolo wesibeleko.6

Ukuba zonke ezi zikhundla zikhona, isigulane asiyidingi i-X-ray ngenxa yokuba inokuba yinto encinci yokuba nenxeba yomlenze wesibeleko kunye nobutyebi be99% kunye ne-12.9% .7

Kwi-2001, i-Canadian C-spine rule (CCSR) iphuhlise umgaqo wesibini wesigqibo usebenzisa umngcipheko we-trauma: iindlela ezintathu ezinobungozi obuphezulu (iminyaka eyi-$ 65 iminyaka, indlela eyingozi kunye ne-paraesthesias kwimida), imilinganiselo emihlanu yengozi ephantsi. (ukungqubuzana kwemoto yangasemva, indawo yokuhlala kwisebe likaxakeka, i-ambulensi nangaliphi na ixesha, ukulibaziseka kwentlungu yentamo kunye nokungabikho kwe-midline yomlomo wesibeleko somlomo wesibeleko) kunye nokukwazi kwesigulane ukujikeleza ngokunyanisekileyo intamo yakhe ukuze ibone isidingo kwiradiography yomqolo wesibeleko. Enyanisweni, ukuba enye yale mingcipheko ikhona, isigulane kufuneka sivavanye umfanekiso. Ngakolunye uhlangothi, ukuba izinto ezinobungozi azikho, ukusetyenziswa kweekhrayitheriya ze-NEXUS kunye novavanyo olusebenzayo lomgudu womlomo wesibeleko lufunekayo (ukujikeleza komlomo wesibeleko ngasekhohlo nasekunene .45�); ukuba olu vavanyo lusebenzayo lunokwenzeka, umfanekiso awuyomfuneko. Ukuba kukho ukunyakaza okungaphelelanga komlomo wesibeleko, ngoko isigulane kufuneka sihlolwe nge-imaging. Iziphumo zibonise imilinganiselo yokuba novakalelo ukuya kuthi ga kwi-100% kunye ne-specific ukuya kwi-42.5%.8

Ukusetyenziswa kwezi ngqinisiso, phambi kobuncwane bomfanekiso wesibeletho, abalobi babika ukwehla kwe-23.9% kwinani le-CCT engafanelekanga, kunye nokusebenzisa i-NEXUS eninzi yokubaluleka kweenkqubo ezibandakanya ubukho okanye ukungabikho kweentlungu, ukunyuka kwesantya okanye u-posterolateral tender tenderness, baxela ukuhla kwe-20.2% kwinani leengcamango ezimbi.2

Ukuba le miqathango yeklinikhi ayinakusetyenziswa, iCCT kufuneka yenziwe.

Izigulana ezinkulu kunye neengxaki zicela ukuhlolwa kwe-CCT ngokuthe ngqo, ngokukodwa kuba kukho izilonda ezinxulumene nazo, ngokubhekiselele kwimigangatho ephezulu yengozi eyenziwa nguBlackmore noHanson ukuchonga izigulane ezixinzelelekileyo ezibangelwa yingozi enkulu yengozi ye-c-spine abaya kuzuza kwi-scanning CT uphando oluphambili lwe-radiological9 Umfanekiso 1.

I-Thoracolumbar I-Trained Trauma: I-Standard X-Ray kunye ne-MultiDetector CT Indication

Kwinqanaba le-thoracolumbar, i-MDCT luvavanyo olungcono lokubonisa ukuphuka komqolo kune-radiography eqhelekileyo. Ibonisa ngokubanzi ukuxilongwa kwezigulane ezine-thoracolumbar trauma yokuvavanya amathambo. Ikhawuleza ngaphezu kwe-X-ray, i-e-ethe-encencence, ngenxa ye-multiplanar reformatted okanye i-volume-rendering reconstruction ibona ukuphuka kwe-cortical encinci, kunye nokulungelelaniswa kwe-sagittal kunokuhlolwa kunye novavanyo lwecandelo elibanzi.10

Inokuthi ithathe indawo ye-radiografi eqhelekileyo kwaye ingenziwa yedwa kwizigulane eziye zazinyamezela kakhulu.10

Enyanisweni, i-thoracolumbar yokulimala kwintlungu ingabonwa ngexesha le-CT ejoliswe kwi-visceral.

Siyabulela iteknoloji ye-multidetector, ukulungiswa kwemifanekiso usebenzisa i-algorithm ethambileyo kunye nenkundla yokubonisa indawo ebanzi ebandakanya isisu esisetyenziswayo ngokusetyenziswa kwe-XLUMX-mm collimation yecandelo le-visceral. Imifanekiso ephindaphindiweyo yokuguqulwa yenziwa ngaphandle kokwenza uvavanyo olutsha lwe-CT kwaye ngaphandle kokunyuka kwimizi ye-radio dose1.5 Umfanekiso we-11.

Kwi-MDCT akukho lwazi malunga nobume bentambo yomgogodla okanye i-ligament lesion okanye i-epidural hematoma ebukhali; inokuvavanya kuphela imeko yamathambo. Ukulimala komgogodla kukrokrelwa kuphela ngedatha yeklinikhi.

I-CCT icetyiswa ngokuthe ngqo kwizigulane ezichaphazelekayo ngenxa yokulimala koluhlaza. Zomibini izilonda zinokubambisana ngokuqhelekileyo kwaye ngokubanzi; ukuhlukana kolawulo lokusebenzisana ukukhuphela i-brain lesion esiswini kunye nokuphulwa komlomo akudingeki.10

I-Magnetic resonance imaging, okanye i-MRI, yindlela yovavanyo lokuxilongwa kwezonyango esetyenziswa kwi-radiology ukwenza imifanekiso ye-anatomy kunye nenkqubo ye-physiological yomzimba womntu. Ngaphandle kwe-radiography kunye ne-CT scans, i-MRI ingaba luncedo ekuxilongweni kwe-spinal trauma, kubandakanywa ukuphulwa komgogodla kunye nokulimala kwentambo yomgogodla. I-imaging ye-magnetic resonance isenokungabi yimfuneko kuzo zonke iimeko ze-spinal trauma. Nangona kunjalo, inokunika ulwazi oluneenkcukacha kwezinye izihlunu ezithambileyo zomqolo.�

UDkt Alex Jimenez DC, i-CCST

I-Traumatic Trauma neMRI

Nangona i-MDCT yindlela yokuqala yokucinga kwisigulane esine-trauma, i-MRI ibalulekile kuvavanyo oluthambileyo lwe-ligament, i-muscle okanye intambo yomgogodla, intambo yomgogodla, i-disc, i-ligaments kunye ne-neural elements, ngokukodwa ukusebenzisa i-T2 ukulandelelana kwesisindo kunye nokunciphisa amafutha okanye I-T2 i-tau short inversion recovery (STIR) ulandelelwano.12 I-MRI iphinda isetyenziswe ukuhlukanisa ukuphuka kwe-fracture, ukufumana ulwazi malunga nesimo se-posterior ligamentous complex, isigxininiso esibalulekileyo sokubonakaliswa kokuhlinzwa nangona ukuxilongwa kokulimala kwe-ligament kuhlala kunzima, kunye nebakala layo. iphinda ijongelwe phantsi ngokusebenzisa i-MRI.13 ephezulu

Ekulawuleni izigulane ezine-polytrauma, i-MDCT i-scan-body scan iyimfuneko kwimeko engxamisekileyo, kwaye i-MRI i-spine-spine indication ikwinqanaba lesibini kwisimo sonyango lwesigulane: i-spinal cord compression syndrome Umfanekiso we-3�5�iprothokholi zeMRI ezicetyiswayo. izigulane ezichaphazelekayo ngokulimala komgogodla kunye nokulimala zezi zilandelayo: 13,14

• I-Sagittal T1 inobunzima, i-T2 ilinganiswe kunye nolandelelwano lwe-STIR kumongo wethambo kunye nokulimala kwentambo yomnqonqo okanye uvavanyo loxinzelelo lwentambo ngenxa ye-epidural hematoma okanye i-traumatic herniated disc
• I-Sagittal gradient echo T2* ulandelelwano lovavanyo lokuphuma kwegazi kwintambo yomqolo okanye kwindawo ye-epidural�subdural space
• I-Sagittal diffusion-weighted imaging iluncedo xa uvavanya ukwenzakala komnqonqo, ukwahlula i-cytotoxic kwi-vasogenic�oedema, inceda ekufumaniseni ukopha kwe-intramedullary. Inokukunceda ukuvavanya iqondo le-spinal cord ecinezelekileyo.
• I-Axial T1 ine-weighted kunye ne-T2 yolandelelwano lwe-weighted yendawo echanekileyo yokulimala. Kungekudala, kwizigulane ezichatshazelwe yintlungu ebuhlungu kunye nokulimala komgogodla womlomo wesibeleko, ulandelelwano lwe-axial T2 olunesisindo lubonakaliswe lubalulekile kwiziphumo zokubikezela i-trauma. Kwi-axial T2 yokucinga enesisindo, iipateni ezintlanu zokuguqulwa kwesignali ye-intramedullary spinal cord inokwahlulwa kwindawo yokwenzakala. Amaxabiso e-Ordinal ukusuka kwi-0 ukuya kwi-4 anokwabelwa kwezi patheni njenge-Brain and Spinal Injury Centre amanqaku, aquka i-spectrum ye-spinal cord yokulimala kobunzima obuhambelana neempawu ze-neurological kunye ne-MRI axial T2 imaging. Eli nqaku liphucula kwiinkcazo ze-MRI ezisekelwe kwi-prognostic yangoku yokulimala kwentambo yomgogodla ngokubonakalisa iipatheni ezisebenzayo kunye ne-anatomically ebalulekileyo ye-intramedullary T2 yesignali engaqhelekanga kwi-axial plane.15

I-MRI nayo inendima ebalulekileyo kwimeko yokungahambelani phakathi kwemeko yeklinikhi kunye ne-CT imaging. Xa kungekho fracture ye-vertebral, izigulana zinokubandezeleka ngenxa yeentlungu zangasemva ezinganyangekiyo kunyango lwezonyango ngenxa yomongo wethambo i-edema ebuhlungu enokubonwa kuphela ngokusebenzisa ulandelelwano lwe-STIR kwi-MRI Umfanekiso 6.

Ngomonakalo wentambo yomgudu ngaphandle kwe-radiologic (SSC-WORA), i-MRI yiyo kuphela imodeli yokucinga ekwazi ukubona i-intramedullary okanye i-extramedullary pathologies okanye ibonise ukungabi nantlungu yokungahambi kahle kwezinto.16 SCIWORA ibhekisela kukulimala emgogodini, okuqhelekileyo kummandla wesibeleko, ukungabikho kwebony ebonakalayo okanye ukulimala kwegilenti ngokugqibeleleyo, ngokwaneleyo, kwi-rayographs ecacileyo okanye kwi-CT. I-SCIWORA ifanele ikhunjulwe kwizigulane ezithotyelwe kukukhathazeka ngokukhawuleza ezichaza iimpawu zangaphambili okanye ezidlulileyo ze-neurologic orficor or who have foundings in the initial assessment.17

Uhlobo lweNtluko yoLwaphulo kunye noHlelo

Isizathu sokucinga sizahlula uhlobo lohlobo lwe-vertebral fracture kumaqela amabini:

� Ukwaphuka koxinzelelo lwe-vertebral njengokwaphuka komzimba we-vertebral
ukuchukumisa i-cortex yangaphambili, ukukhawulela umgangatho ophakathi
iikholomu ezidibeneyo okanye ezingekho ngekyphosis
� Ukugqabhuka kokwaphuka njengoko kusenzeka ukwaphuka komzimba we-vertebral
ukwandisa kuzo zombini ii-endplates eziphezulu kunye nezingaphantsi kunye ne-kyphosis okanye ukufuduka ngasemva kwethambo kwi-canal. kunye nokwahlula ukuba loluphi uhlobo lonyango olufunwa ngumguli; ngokwenza umfanekiso, kuyenzeka uhlele izahlulo zibe kukwaphuka okuzinzile okanye okungazinzanga, ukunika isalathiso kunyango lolondolozo okanye lotyando.

Ukusebenzisa i-MDCT kunye ne-MRI, ngokubonga ngokusabalalisa i-morphology nokusabalalisa, iindlela ezahlukeneyo zokusetyenziswa ziye zazisetyenziselwa ukuchonga ezo nzakala ezifuna ukungenelela kwindlela yokuphaphaza, ukuhlukanisa phakathi kwezinto ezizinzileyo nezizinzileyo kunye neziqhekeza ezingenasicatshulwa.1

UDenis wenze isindululo �ingqikelelo yekholamu ezintathu�, eyahlula icandelo lomqolo libe ngamacandelo amathathu: ikholamu yangaphambili, ephakathi kunye neyangasemva. Ikholomu yangaphambili iquka i-anterior longitudinal ligament kunye nesiqingatha sangaphambili somzimba we-vertebral; ikholamu ephakathi iquka isiqingatha esingasemva somzimba we-vertebral kunye ne-posterior longitudinal ligament; kunye nekholomu yangasemva iquka i-pedicles, i-facet joints kunye ne-supraspinous ligaments. Ikholomu nganye inegalelo elihlukeneyo lokuzinza, kwaye umonakalo wabo unokuchaphazela uzinzo ngokwahlukileyo. Ngokuqhelekileyo, ukuba ezimbini okanye ngaphezulu kwezi zikholamu zonakaliswe, umqolo uba uzinzile.18

I-Magerl yahlula i-vertebral compression fracture (VCF) kwiintlobo ezintathu eziphambili ngokuxhomekeka koxinzelelo: (a) ukulimala, (b) ukulimala ukuphazamiseka kunye (c) nokulimala. Uhlobo lwe-A lubonisa ukuba unyango olusisigxina okanye olungagqityiyo lwangonyango lwe-mini.19

Inkqubo yokuhlelwa kokulimala kwe-thoracolumbar kunye namanqaku obunzima (TLICS) inika amanani amanani kwingozi nganye ngokusekelwe kwiindidi ze-morphology yokulimala, ukunyaniseka kwe-ligament yangasemva kunye nokubandakanyeka kwe-neurological. Iipateni zomonzakalo ezizinzileyo (TLICS,4) zinokunyangwa ngokungasebenziyo ngokunyanzeliswa kwebrace. Iipateni zokulimala okungazinzanga (TLICS.4) zinokuphathwa ngokusebenzayo kunye nemigaqo yokulungiswa kokukhubazeka, ukunyanzeliswa kwe-neurological decompression xa kuyimfuneko kunye nokuzinza komgogodla.20

Ulwahlulo lwe-Aebi lusekelwe kumaqela amathathu amakhulu: A = ukulimala kwekholomu yangaphambili yodwa ngokunyanzeliswa kwe-axial, B = ukuphazamiseka kwe-posterior ligament complex ngokuphazanyiswa ngasemva kunye ne-C = ehambelana neqela B kodwa ngokujikeleza. Kukho ubunzima okwandayo ukusuka ku-A ukuya ku-C, kwaye ngaphakathi kweqela ngalinye, ubunzima budla ngokunyuka ngaphakathi kwamacandelwana ukusuka kwi-1 ukuya kwi-3. Zonke ezi pathomorphologies zixhaswa yindlela yokulimala, ejongene nobukhulu bokulimala. Uhlobo lokulimala kunye namaqela alo kunye namaqela amancinci luyakwazi ukuphakamisa indlela yonyango.21

I-Thoracolumbar Fracture kunye neNkqubo yokuNyuka kweNdlela yokuNyuka kweNdlunkulu yokuNyuka kweNkcazo yokuNyuka kweNkcazo: UkuCwangcisa ukuThola

Kutshanje, iinkqubo ezahlukeneyo zokungenelela ezincinci ezibizwa ngokuba yi-aided-technical vertebroplasty (ibhaluni yekyphoplasty KP okanye ubuchule obufana ne-kyphoplasty) ziye zaphuhliswa ukuze kufumaneke isiqabu seentlungu kunye nolungiso lwe-kyphosis njengonyango olulolunye lonyango olungelulo utyando kodwa luphawu lokuqhekeka komqolo.

Ingqiqo yalezi zindlela kukudibanisa umonakalo we-analgeic and vertebral effect of vertebroplasty kunye nokubuyiselwa kokuphakama komzimba komzimba we-vertebral owanqambileyo, ukunciphisa ukukhubazeka kwe-kyphotic yomzimba we-vertebral, ukuhambisa isitenti kumzimba we-vertebral ophuhliweyo. xa kuthelekiswa nonyango olulondolozayo (ukuphumla kombhede kunye neyeza lonyango) .22

Ukusuka kwimbono yongenelelo, ukucinga kunendima ebalulekileyo yokubonakaliswa kwonyango kunye novavanyo lweklinikhi. Zombini i-MDCT kunye ne-MRI zicetyiswa uMzobo we-7 kunye ne-8.

Enyanisweni, i-MDCT inenzuzo yokuxilonga i-VCF nge-kyphosis deformity ngokulula, ngelixa i-MRI kunye ne-STIR ukulandelelana luncedo ukuvavanya i-edema yamathambo, uphawu olubalulekileyo lwentlungu emva.

Izigulane ezichaphazelekayo nge-vertebral fracture ngaphandle kwe-bone marrow edema kwi-STIR ukulandelelana akuboniswanga kwinkqubo yokungenelela.

Ngokomfanekiso-ngqondweni, i-Magerl A1 yokwahlula i-fractures iyona nto ibonisa unyango.

Nangona kunjalo, unyango kufuneka lwenziwe kwiiveki ze-2�3 ukusuka kwintlungu ukwenzela ukuba ugweme impendulo yethambo le-sclerotic: i-fractures encinci, iziphumo ezingcono kwaye kulula unyango kunye ne-vertebral augmentation effect. Ukungabandakanyi i-sclerotic bone reaction, i-CT iyacetyiswa.

isiphelo

Ulawulo lwe-spinal trauma luhlala lunzima. I-MDCT inombonakaliso obanzi wokuvavanya amathambo kwizigulane ezichaphazelekayo ngenxa yokulimala okukhulu okanye izigulane ezinomngcipheko ophezulu wokulimala komgudu. I-MRI inombonakaliso omkhulu kwimeko yokulimala komgudu kunye nokungabikho kwethambo lethambo. Uvavanyo lokuxilonga lwe-spinal trauma, kubandakanywa i-radiography, i-CT scans, kunye ne-MRI zisisiseko ekuxilongweni kwe-spine fractures kunye nokulimala komgogodla wonyango. Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nokulimala komgogodla kunye neemeko. Ukuxoxa ngalo mbandela, nceda uzive ukhululekile ukubuza uGqr. Jimenez okanye uqhagamshelane nathi apha915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: I-Pain Back Pain

Umqolo obuhlunguSesinye sezona zizathu zixhaphakileyo zokukhubazeka kunye neentsuku eziphosiweyo emsebenzini kwihlabathi liphela. Iimpawu ezibuhlungu zangasemva kwisizathu sesibini esiqhelekileyo sokutyelelwa yi-ofisi kagqirha, ngaphezulu kwenani losulelo oluphezulu lokuphefumla. Phantse iipesenti ezingama-80 zabemi baya kufumana iintlungu zangasemva kube kanye ebomini babo. Umqolo sisakhiwo esintsonkothileyo esenziwe ngamathambo, amalungu, iigaments, kunye nezihlunu, phakathi kwezinye izicwili ezithambileyo. Ngenxa yoku, ukwenzakala kunye / okanye iimeko ezixineneyo, ezinje ngedisni, ekugqibeleni unokukhokelela kwiimpawu zentlungu. Ukulimala kwezemidlalo okanye ukulimala kwengozi yeemoto ngokuqhelekileyo kubangelwa yintlungu yokubuhlungu, kodwa ngamanye amaxesha ukuhamba kwezinto ezilula kunokuba neziphumo ezibuhlungu. Ngethamsanqa, ezinye iindlela zokhathalela unyango, ezifana nokunyamekelwa kwe-chiropractic, kunokunceda ukubuyisela intlungu emva kokusetyenziswa kwemilenze kunye nokunyanzeliswa kwemigaqo, ekugqibeleni ukuphucula intlungu.

 

ISIHLOKO ESIBALULEKILEYO: Sciatica Pain Chiropractic Therapy