Intloko yesiseko ibonakala njengeentlungu zentloko ezibangwa yintlungu yesifo ngokwaso. Ezi zintathu iintlobo zeengxaki eziphambili zentloko ziquka, neyamenza, iintlobo zentlungu kunye neentloko zentloko. Intlungu yentloko yimbozi ebuhlungu kunye neyoxinzelelo enokuthi ibe khona ngenxa yesinye isizathu esibangela. Intloko yesibini ibonakala njengeentlungu zentloko ezenzeka ngenxa yokulimala kunye / okanye imeko. Ukungahambisani nokugqithiswa kwemigulane, okanye ukuhluthwa kwemithi, kunye nomlenze womlomo wesibeleko, okanye intamo, ngokuqhelekileyo idibene neentlobo zempawu zentloko.

 

Intloko ye-Cervicogen iyintloko yesibini eyabangela ukulimala kunye / okanye imeko echaphazela izakhiwo ezijikelezileyo zentambo yomlomo, okanye intamo. Abaninzi abanonophelo lwezempilo baya kuncomela ukusebenzisa iziyobisi / amachiza ukunceda ukuphucula intloko, nangona kunjalo, unyulo oluninzi lwezonyango lungasetyenziswe ngokufanelekileyo kwaye luphumelele ukuphatha intloko yesibini. Injongo yale nqaku ilandelayo kukubonisa impembelelo yokunyanzeliswa komlomo wesibeleko kunye nokuphezulu kwe-thoracic ngokumalunga nokukhuthaza nokuzilolonga kwizigulane ezinentloko yomlomo.

 

Umgudu ophezulu weNtsholongwane kunye noPhakamiso oluPhakamileyo lweTrracic Versus and Exercise and Exercise in Patients with Cervicogenic headache: i-Multi-Center Randomized Clinical Trial

 

Abstract

 

• imvelaphi: Nangona kungenelelo oluqhelekileyo olusetyenziswayo, akukho zifundo eziye zafanisa ngokuthe ngempumelelo ukusebenza kobubele besibeleko kunye neentlobo zentsimbi ekubambiseni nasekusebenziseni umsebenzi kubantu abaneentloko zentliziyo (CH). Injongo yale sifundo yayikuthelekisa imiphumo yokuxhaphaza kunye nokuzilolonga kubantu abane-CH.
• Iindlela: Abathathi-nxaxheba abalikhulu elineshumi (n? =? 110) kunye ne-CH babengenangqondo yokufumana ukunyanzeliswa komlomo wesibeleko kunye ne-thoracic (n? =? 58) okanye ukuhlanganisa kunye nokuzivocavoca (n? =? 52). Isiphumo esiphambili sasinamandla entloko njengoko kulinganiswa neNqanaba leNqanaba lePain yeNumeric (NPRS). Iziphumo zesekondari zibandakanya ukuphindaphindeka kwentloko, ubude beentloko, ukukhubazeka njengoko kulinganiswa yi-Neck Disability Index (NDI), ukuthatha amayeza, kunye noVavanyo lweHlabathi loTshintsho (GRC). Ixesha lonyango yayiziiveki ze-4 kunye novavanyo lokulandelela kwiveki ye-1, iiveki ze-4, kunye neenyanga ze-3 emva kweseshoni yokuqala yonyango. Injongo ephambili yavavanywa ngeendlela ezi-2 zokuxubusha imodeli yohlalutyo (ANOVA), kunye neqela lonyango (ubuqhetseba xa kuthelekiswa nokuhlanganisa kunye nokuzilolonga) njengezinto eziguqukayo kunye nexesha (isiseko, iveki e-1, iiveki ezi-4 kunye neenyanga ezi-3) njenge ngaphakathi kwizifundo eziguqukayo.
• iziphumo: I-2X4 ANOVA ibonakalise ukuba abantu abane-CH abafumene ukuphathwa komlomo wesibeleko kunye ne-thoracic bafumana amava okuphungula okukhulu kwintloko yamandla (p?
• Izigqibo: Iiseshoni ezisibhozo ezisibhozo ze-colervical upper and thoracic manipulation zaboniswa ukuba zisebenze ngakumbi kunokwenziwa kunye nokuzilolonga kwizigulane ezine-CH, kwaye iziphumo zagcinwa kwiinyanga ze-3.
• Ukubhaliswa kovavanyo: NCT01580280 Epreli 16, 2012.
• Internet: Intloko ye-Cervicogenic, Ukunyanzelisa umlenze, Ukuxhaswa, ukuphakama okukhulu kwe-amplitude

 

Insight of Dr. Alex Jimenez

Xa kuthelekiswa nentloko eyintloko, njengaye neyamenza, intloko yesifo kunye nentloko yeentlobo zentlungu, intloko yesibini ibonakala njengentlungu yentloko ebangelwa esinye isifo okanye ingxaki yomzimba. Kwimeko intloko cervicogenic, unobangela intlungu entloko ngenxa yokwenzakala kunye / okanye imeko ecaleni emqolo wesibeleko kunye nezakhiwo eziyingqongileyo, kubandakanywa amalungu omqolo, IiCD intervertebral kunye kwizihlunu ezithambileyo. Ukongezelela, abaninzi abanonophelo bezempilo bayakholelwa ukuba intloko yesifo esintloko sinokudityaniswa nemicimbi yempilo kwintsipho yomlomo, okanye intanyeni. Ulwaphulo lwentloko lwe-Cervicogenic lufanele lujolise kumthombo weempawu kwaye luyahlukahluka kuxhomekeke kwisigulane. Ukunyamekela kwe-Chiropractic isebenzisa ukulungiswa kwemisipha kunye nokusetyenziswa kwezinto eziphambili ukubuyisela ngokusisiseko isakhiwo kunye nomsebenzi wesiqulatho, kunceda ukunciphisa uxinzelelo kunye noxinzelelo ukuze kuphuculwe iimpawu zentloko, phakathi kolunye uhlobo lweentloko. Ukhathalelo lwe-Chiropractic lungasetyenziselwa ukunceda unyango lwentloko, njengemigraines.

 

imvelaphi

 

Ukwahlula-hlula kwamazwe onke ukuphazamiseka kwentloko kuchaza i-cervicogenic headache (CH) njenge, ache intloko ebangelwa kukungalungelelani komqolo womlomo wesibeleko kunye ne-bony, disc, kunye / okanye izihlunu ezithambileyo, zihlala kodwa zingahambi rhoqo neentlungu zentamo. [1 ] (iphe. 760) Ukuxhaphaka kwe-CH kuye kwaxelwa ukuba kuphakathi kwe-0.4 kunye ne-20% yenani lentloko [2, 3], kwaye liphezulu njenge-53% kwizigulana ezinentloko emva kokulimala kwe-whiplash [4]. Iimpawu eziphambili ze-CH zihlala zibandakanya: ukungahambelani kwentlungu yentloko ngaphandle kokutshintsha-cala, ukunyusa iintlungu ngoxinzelelo lwangaphandle entanyeni ye-ipsilateral, uluhlu olulinganiselweyo lwesibeleko sokuhamba, kunye nokuxhokonxwa kohlaselo ngeentshukumo ezahlukeneyo ezomeleleyo okanye eziqhubekayo zentamo [4, 5].

 

Abantu ngabanye abane-CH bahlala bephathwa ngonyango olusisigxina lomlenze kubandakanya ukuhlanganiswa kunye nokuphathwa [6]. Ukuhlanganiswa komgudu kubandakanya iindlela ezincitshisiweyo, eziyingqiqo, ezizenzekelayo. [7] Kuhlalutyo olusandul 'ukuhlaziywa kwangoko, iBronfort kunye noogxa baxelele ukuba unyango olusisigxina lomlenze (kokubili ukugqugquzela nokuphathwa) lwalusebenza kakuhle ekulawuleni abantu abadala abane-CH [8]. Nangona kunjalo, abazange babike ukuba ukunyanzeliswa kwabangela ukuba iziphumo eziphezulu ziqhathaniswa nokuququzelela ulawulo lwaba bantu.

 

Izifundo ezininzi ziye zaphanda umphumo wokunyanzeliswa komgogodla kulawulo lwe-CH [9-13]. Haas okqhubekayo. [10] iphande ukusebenza ngokunyanzelwa komlomo wesibeleko kwizifundo ze-CH. Jull okqhubekayo. [11] ubonakalise ukusebenza ngokukuko kunyango olusebenzayo kunye / okanye umthambo kulawulo lwe-CH. Nangona kunjalo iqela lonyango elikhohlisayo libandakanya ubuqhetseba kunye nokuhlanganisa ngenxa yoko ayinakugqitywa ukuba isiphumo esiyinzuzo sisisiphumo sokuxhaphaza, ukuhlanganisa okanye ukudibanisa.

 

Izifundo ezimbalwa ziye zavavanya izibonelelo zokuxhaphaza ngokuchasene nokuququzelela ulawulo lwentlungu yentliziyo kunye okanye ngaphandle kokuzivocavoca [14-16]. Nangona kunjalo, akukho zifundo ziye zathelekisa ngokuthe ngqo iimpembelelo zokuxhaphaza xa kuthelekiswa nokuhlanganisa kunye nokuzilolonga kwizigulana ezine-CH. Ukuqwalaselwa kwemingcipheko yokunyanzeliswa [17], kubalulekile ukufumanisa ukuba ngaba ukunyanzelwa kukhokelela kwiziphumo eziphuculweyo xa kuthelekiswa nokuququzelela ulawulo lwezigulana ezine-CH. Ke ngoko, injongo yolu vavanyo lweklinikhi olungenamsebenzi yayikukuthelekisa iimpembelelo zokuchasana nokugaya kunye nokuzilolonga kwizigulana ezine-CH. Siye sagxininisa ukuba izigulana ezifumana ukwenzakaliswa kwisithuba seeveki ezi-4 zonyango ziya kuba nokuncipha okukhulu kwintloko ebuhlungu, ukuphindaphindeka kwentloko, ubude bentloko, ukukhubazeka, kunye nokuthatha amayeza kunyango olulandelayo lweenyanga ezi-3 kunezigulana ezifumana ukuhlanganiswa komlomo wesibeleko kunye ne-thoracic kudityaniswa nokuzilolonga .

 

tindlela

 

nxaxheba

 

Kolu vavanyo lweklinikhi olunamaziko amaninzi, izigulana ezilandelelanayo ezine-CH ezibonisa i-1 kwezi-8 zeeklinikhi zonyango zonyango ezivela kwiindawo ezahlukeneyo (Arizona, Georgia, New York, Ohio, Pennsylvania, South Carolina) zaqeshwa ngaphezulu kwenyanga engama-29. ixesha (ukusukela ngo-Epreli 2012 ukuya ku-Agasti 2014). Ukuze izigulane zifaneleke, kwafuneka zibonise ukuxilongwa kwe-CH ngokwemiqathango ehlaziyiweyo yokuxilonga [5] eyenziwe yiCervicogenic Headache International Study Group (CHISG) [5, 18, 19]. I-CH yahlelwa ngokwe- major criteria (ingabandakanyi ubungqina obuqinisekisayo ngovavanyo lwe-anesthetic blockades) kunye neempawu zentloko yentloko ye-CHISG. Ke ngoko, ukuze zibandakanywe kufundo, abaguli kuye kwafuneka babonakalise zonke ezi ndlela zilandelayo: (1) ukungathandani kwentlungu entloko ngaphandle kwecala, ukuqala entanyeni engasemva engaphezulu okanye kwingingqi ye-occipital, ekugqibeleni ukusasazeka kwindawo ye-oculofrontotemporal Icala elibonakalisayo, (2) intlungu ebangelwa ukunyakaza kwentamo kunye / okanye izikhundla ezixhasayo, (3) ukunciphisa inani lokunyakaza kwintlambo yomlomo wesibeleko [20] (oko kukuthi, ngaphantsi okanye ulingana no-32 wokujikeleza kwesokudla okanye kwesobunxele kwi-rotation Uvavanyo lwe-Flexion-Rotation Test [21-23], (4) iintlungu ezibangelwa luxinzelelo lwangaphandle okungenani elinye lamalungu aphezulu omlomo wesibeleko (C0-3), kunye (5) nokumodareyitha ukuya kubuhlungu, ukungabethi kunye nentlungu engathandekiyo. Ukongeza, abathathi-nxaxheba kuye kwafuneka ukuba babe nesifo sokuqaqanjelwa yintloko ubuncinci nge-1 ngeveki ubuncinci beenyanga ezi-3, ubuncinci benqaku lokuqaqanjelwa yintloko yamanqaku amabini (0 10 kwisikali se-NPRS), inqaku lokukhubazeka elincinci lama-20% okanye enkulu (okt, amanqaku ali-10 okanye ngaphezulu kwinqanaba le-0 NDI50 NDI), kwaye ube phakathi kwe-18 kunye ne-65 ewe rs yobudala.

 

Izigulane zazingabandakanywa ukuba zibonise ezinye iintloko eziphambili (oko kukuthi, i-migraine, i-TTH), iqhutywe kwiintsholongwane zombini, okanye ibonisa iiplagigi ezibomvu (oko kukuthi, isifo, isifo, isifo, isifo se-rheumatoid, i-osteoporosis, ukuphucula uxinzelelo lwegazi ngaphezu kwe-140 / 90 mmHg, imbali eqhubekayo yokusetyenziswa kwe-steroid, njl.), eboniswe ngeempawu ezibini okanye ngaphezulu ezinomdla ezihambisana nexinzelelo yengcambu yesisu (ubunzima be-muscle obubandakanya iqela elikhulu le-muscle lomgca ophezulu, linciphisa umgca ophezulu ongathandabuzekiyo we-tendon reflex, okanye ukuncipha okanye ukungabikho ukupakisha kunoma yiphina impendulo ephezulu), eboniswe ukuxilongwa kwentsholongwane yomlomo wesibeleko, yabonisa iimpawu eziphezulu ezisemgangathweni, yayinobungqina bendlela yokubandakanyeka kwenkqubo ye-nervous (hyperreflexia, ukuphazamiseka kwengqondo esandleni, ukungahlali kakuhle kwezandla, ukungahlali ngexesha lokuhamba , i-nystagmus, ukulahleka kwezinto ezibonakalayo, ukukhathazeka okungabonakaliyo ubuso, ukuguqulwa kwintliziyo, ubukho bentlalo es), waba imbali yokwenzakala whiplash phakathi kweeveki 6 edlulileyo, kwafuneka utyando phambi entloko okanye emqaleni, wafumana unyango ngenxa entloko okanye emqaleni buhlungu nawuphi na umlondolozi ngaphakathi kwinyanga edlulileyo, wafumana unyango ngokwasemzimbeni okanye unyango kwamathambo yintloko okanye intlungu yentamo kwiinyanga ze-3 zangaphambili, okanye isenzo somthetho esilindile malunga nentlungu okanye intamo yentlungu.

 

Uncwadi olutshanje lubonisa ukuba ukuvavanywa kwangaphambili kweengxaki zomlomo wesibeleko akukwazi ukufumanisa abo bantu basengozini yokuxhatshazwa kweengculaza ukusuka kwimizimba yomlomo wesibeleko [24, 25], kunye naziphi na iimpawu ezifunyenweyo ngexesha lokuvavanywa kwangaphambili kunokusenokungahambelani neenguqu zokuhamba kwegazi umthambo we-vertebral [26, 27]. Ngenxa yoko, ukuhlolwa kobunzima bokubeletha komlomo kwangaphambili akuzange kwenziwe kulolu cwaningo; Nangona kunjalo, imibuzo yokujonga i-artery disease artery kufuneka ibe yinto engalunganga [24, 28, 29]. Olu pho nonongo luvunyiwe yiBhodi yokuHlola yeziNtu e-Long Island University, eBrooklyn, NY. Uhlolisiso lubhaliswe kwi-www.clinicaltrials.gov kunye ne-trial identifier NCT01580280. Zonke izigulane zaziswa ukuba ziya kufumana ukuphathwa okanye ukuxhotyiswa kunye nokuzivocavoca kwaye zinikeze imvume enolwazi phambi kobhaliso lwabo kwisifundo.

 

Ukunyanga ama-Therapists

 

Iingcali zonyango ezilishumi elinambini (iminyaka yobudala engama-36.6, i-SD 5.62) ithathe inxaxheba kunikezelo lonyango kwizigulana kolu phononongo. Babenomndilili we-10.3 (i-SD 5.66, iminyaka engama-3 20) yamava onyango, kwaye bonke babegqibe inkqubo ye-60 h yokuthweswa isidanga emva koqeqesho ebandakanya uqeqesho olusebenzayo kubuchwephesha bobuchwephesha kubandakanya ukusetyenziswa komlomo wesibeleko kunye ne-thoracic manipulation. Ukuqinisekisa ukuba zonke iimviwo, ukuvavanywa kweziphumo, kunye neenkqubo zonyango zazimiselwe emgangathweni, bonke abanyangi abathatha inxaxheba emzimbeni kwakufuneka ukuba bafunde incwadi yemigaqo yokusebenza kwaye bathathe inxaxheba kwiseshoni yoqeqesho eyi-4 kunye nomphenyi oyintloko.

 

Iinkqubo zokuHlola

 

Zonke izigulana zibonelele ngolwazi lwedemokhrasi, zalinda iphepha lemibuzo leNeck Pain Medical Screening Questionnaire, zaza zagqitywa iindlela zokuzixela, ezilandelwa yimbali emiselweyo kunye novavanyo lomzimba kwisiseko. Amanyathelo okuzixela abandakanya ukuqina kwentloko njengoko kulinganiswa yi-NPRS (0-10), i-NDI (0-50), ukuphindaphindeka kwentloko (inani leentsuku ezineentloko kwiveki ephelileyo), ubude beentloko (iiyure ezipheleleyo zentloko kwilixa lokugqibela iveki), kunye nokutya amayeza (inani lamaxesha isiguli sithathe iyeza lokuthomalalisa iintlungu okanye i-counter-the-counter kwiyeza elidlulileyo kwiveki ephelileyo).

 

Uviwo standardised emzimbeni wawungapheleliselwanga, kodwa zaqukwa imilinganiselo C1-2 (atlanto-yezihlunu joint) ilungelo eyimpumelelo ekhohlo ukujikeleza ROM usebenzisa Flexion-Ukujikeleza Uvavanyo (FRT). Ukuthembeka kwe-FRT kuye kwafunyaniswa kukuhle kakhulu (ICC: 0.93; 95% CI: 0.87, 0.96) [30].

 

Izisiphumo

 

Esona siphumo siphambili sokusetyenziswa kolu phononongo yayikukuqina kwentloko yesigulana njengoko kulinganiswa yi-NPRS. Izigulana zacelwa ukuba zibonise ubungakanani beentlungu zentloko kwiveki ephelileyo zisebenzisa inqanaba le-11 ukusuka kwi-0 ('akukho ntlungu') ukuya kwi-10 ('iintlungu ezimbi ezinokucingelwa') kwisiseko, i-1-iveki, i-1-inyanga, kunye neenyanga ezi-3 emva kweseshoni yokuqala yonyango [31]. I-NPRS sisixhobo esithembekileyo nesisebenzayo sokuvavanya ubunzima beentlungu [32-34]. Nangona kungekho datha ikhoyo kwizigulana ezine-CH, i-MCID ye-NPRS ibonakalisiwe ukuba yi-1.3 kwizigulana ezineentlungu zentamo [32] kunye ne-1.74 kwizigulana ezineemeko ezahlukeneyo zentlungu engapheliyo [34]. Ke ngoko, sikhethe ukubandakanya kuphela izigulana ezinamanqaku e-NPRS enamanqaku ama-2 (20%) okanye ngaphezulu.

 

Amanyathelo esiphumo sesibini afaka i-NDI, uVavanyo lweHlabathi loTshintsho (i-GRC), ukuphindaphindeka kwentloko, ubude beentloko, kunye nokutya amayeza. I-NDI sesona sixhobo sisetyenziselwa ukuvavanya ukukhubazeka okuzimeleyo kwizigulana ezinentlungu yentamo [35-37]. I-NDI yincwadi yemibuzo yokuzixela ene-10-izinto ezilinganiswe ukusuka kwi-0 (akukho kukhubazeka) ukuya ezintlanu (ukukhubazeka ngokupheleleyo) [38]. Iimpendulo zamanani zento nganye zishwankathelwe amanqaku apheleleyo aphakathi kwe-0 kunye ne-50; Nangona kunjalo, abanye abavavanyi bakhethe ukuphindaphinda amanqaku aluhlaza ngamabini, emva koko banike ingxelo nge-NDI kwisikali se-0 100% [36, 39]. Amanqaku aphezulu abonisa ukwanda kwenqanaba lokukhubazeka. I-NDI ifunyenwe ineziphumo eziqinisekileyo zokuvavanywa kokuvavanywa kwakhona, ukuthembeka kokwakha okuqinisekileyo, ukungaguquguquki kwangaphakathi kunye nokuphendula okuhle kuvavanyo lokukhubazeka kwizigulana ezineentlungu zentamo [36], i-radiculopathy yomlomo wesibeleko [33, 40], isifo esihambelana ne-whiplash [38, I-41, i-42], kunye neentlungu zentamo ezingacaciswanga [43, 44]. Nangona kungekho zifundo ziye zavavanya iipropathi ze-psychometric ye-NDI kwizigulana ezine-CH, sikhethe ukubandakanya kuphela izigulana ezinamanqaku e-NDI ngamanqaku alishumi (20%) okanye ngaphezulu, kuba la manqaku asikiweyo athatha i-MCID ye-NDI, ethi kuye kwaxelwa ukuba kuthelekiswe amanqaku amane, asibhozo, kunye alithoba (0 50) kwizigulana ezinentlungu engafaniyo yentamo [44], iintlungu zentamo yomatshini [45], kunye ne-radiculopathy yomlomo wesibeleko [33], ngokwahlukeneyo. Ukuhamba rhoqo kwentloko kwakulinganiswa njengenani leentsuku ezinentloko kwiveki ephelileyo, ukusukela kwi-0 ukuya kwiintsuku ezisi-7. Ubude beentloko bulinganiswa njengeeyure ezipheleleyo zentloko kwiveki ephelileyo, ngamanqanaba amathandathu anokwenzeka: (1) 0 5 h, (2) 6 10 h, (3) 11 15 h, (4) 16-20 h, (5) 21 25 h, okanye (6) 26 okanye ngaphezulu iiyure. Ukutya amayeza kwakulinganiswa njengenani lamaxesha apho isigulana sithathe amayeza okanye amayeza e-anti-inflammatory kwiveki ephelileyo yeentloko zabo, ngeendlela ezintlanu: (1) hayi kwaphela, (2) kanye nge iveki, (3) kanye ngeentsuku ezimbalwa, (4) kanye okanye kabini ngemini, okanye (5) kathathu okanye nangaphezulu ngemini.

 

Izigulana zibuyiselwe kwi-1-iveki, iiveki ze-4, kunye ne-3-iinyanga zokulandelelana apho iziphumo zengxelo ezikhankanywe ngasentla zaqokelela kwakhona. Ukongeza, kwi-1-iveki, ii-4-iiveki kunye ne-3-iinyanga ezilandelelanayo, izigulane zigqibe umbuzo we-GRC we-15-point based on the scale described by Jaeschke et al. [46] ukulinganisa umbono wabo wokuphucula umsebenzi. Amanqanaba okulinganisa ukusuka kwi-7 (into eninzi kakhulu kakhulu) ukuya kwi-zero (ngokufanayo) ukuya kwi-7 (into eninzi kakhulu). Izichasiselo ezingapheliyo zokuhlaselwa okanye ukuphucula zinikwe ixabiso ukusuka -1 ukuya kwi-6 kunye ne-1 ukuya kwi-6, ngokulandelanayo. I-MCID ye-GRC ayikwabikwa ngokukodwa kodwa amanqaku e-4 kunye ne-5 sele ebonisa ukuba utshintsho olulinganisiweyo kwisimo sengqondo (46]. Nangona kunjalo, kufuneka kuqatshelwe ukuba kungekudala uSchmitt no-Abbott babike ukuba i-GRC inokuthi ingayinxulumani neenguqu kwimisebenzi kubantu abanokulimala kwe-hip kunye ne-ankle [47]. Zonke izicwangciso zempatho ziqokelelwa ngumhloli ongenabonelelo kwisabelo seqela.

 

Kutyelelo lokuqala izigulana zigqibe onke amanyathelo eziphumo zaza zafumana iseshoni yokuqala yonyango. Izigulana zigqibe iiseshoni zonyango ze-6 8 zokunyanzelwa okanye ukuhlanganiswa kudityaniswa nokuzilolonga ngaphezulu kweeveki ezi-4. Ukongeza, izifundo zacelwa ukuba zikhe zehlelwa naziphi na iziganeko ezimbi ze- major [48, 49] (ukubetha okanye ukusilela ngokusisigxina kwemithambo-luvo) kwixesha ngalinye lokulandela.

 

Randomization

 

Ukulandela uvavanyo olusisiseko, abaguli babelwa ngokungacwangciswanga ukuba bafumane ukuphathwa okanye ukuhlanganiswa kunye nokuzilolonga. Ulwabiwo olufihliweyo lwenziwa kusetyenziswa itafile eyenziweyo eyenziwe ngamakhompyutha eyenziwe ngumntu ongabandakanyekanga ekugayeni abaguli ngaphambi kokuqala kwesifundo. Ngamnye, amakhadi esalathiso alandelwe ngokulandelelana kunye nokunikezelwa okungacwangciswanga kwalungiselelwa indawo nganye kwezisi-8 zokuqokelela idatha. Amakhadi esalathiso asongwa abekwa kwiimvulophu ze-opaque ezitywiniweyo. Imfama kuviwo olusisiseko, ugqirha onyangayo wavula imvulophu kwaye waqhubeka nonyango ngokwendlela elabelwe ngayo iqela. Izigulana ziyalelwe ukuba zingathethi ngenkqubo ethile yonyango efunyenwe nonyango oluvavanyayo. Ugqirha ovavanyayo uhlala eyimfama kwisabelo seqela lonyango ngalo lonke ixesha; Nangona kunjalo, ngokusekwe kubume bongenelelo kwakungenakwenzeka kwizigulana ezingaboniyo okanye ukunyanga abanyangi.

 

Iqela lokuPhatha

 

Ukunyanzeliswa kokujolisa ekunene nasekhohlo kwi-C1-2 articulations and bilateral T1-2 articulations were done on a least one of 6 8 treatment sessions (Amakhiwane. 1 no? No2) .2). Kwezinye iiseshoni zonyango, abanyangi baphindaphinde i-C1-2 kunye / okanye i-T1-2 yokukhohlisa okanye bajolise kwezinye iindlela zomqolo (okt, C0-1, C2-3, C3-7, T2-9, ribs 1 9) besebenzisa ubuqhetseba. . Ukukhethwa kwamacandelo omgogodla ekujoliswe kuwo kwashiywa kwingqondo yonyango kwaye yayisekwe kwindibaniselwano yeengxelo zesigulana kunye novavanyo lwencwadi. Kuzo zombini izibeleko eziphezulu zomlomo wesibeleko kunye neziphezulu, ukuba akukho kuphuma okanye kuvakala isandi kwisilingo sokuqala, ugqirha wabeka isigulana endaweni yesibini kwaye wenza unyanzeliso lwesibini. Ubuninzi beenzame ze-2 zenziwa kwisigulana ngasinye esifana nezinye izifundo [14, 50-53]. Oogqirha bayalelwa ukuba ubuqhetseba kunokwenzeka ukuba buhambisane nezandi ezininzi ezivakalayo ezivakalayo [54-58]. Izigulana zakhuthazwa ukuba zigcine imisebenzi yesiqhelo ngaphakathi kwemida yentlungu; Nangona kunjalo, ukuhlanganiswa kunye nokuchongwa kwemithambo, okanye nakuphi na ukusetyenziswa kwezinye iindlela, khange kunikezwe kweli qela.

 

 

 

Ukujolisa okujolise kwi-C1-2 kwenziwa kunye nesigulana kwi-supine. Kule ndlela, isigulana sashiya i-atlas yangasemva ye-atlas yaqhakamshelaniswa nenxalenye yecala eliphambili le-phaphalx yonyango lwesobunxele ngomnwe wesibini usebenzisa i-adcradle hold . Ukwenza indawo ibekwe kumlo wasekhohlo we-C1-2, isigulana sasibekiwe sisebenzisa ulwandiso, ukutshintsha okungasemva (i-PA), ukugoba kwicala elingaphandle kunye nokutshintsha-tshintsha kwecala. Ngelixa sigcina esi sikhundla, i-Therapist yenze i-velocity eyodwa, i-low-amplitude thrust manipulation kwi-atlanto-axial ngokudibeneyo isebenzisa ujikelezo lwasekunene kwi-arc ejongene neliso elingaphantsi kunye nokuguqulela kwitafile (Ikhiwane. 1). Oku kuye kwaphindaphindwa kusetyenziswa inkqubo efanayo kodwa yajongwa kumgaqo olungileyo we-C1-2.

 

Ukujolisa okujolise kwi-T1-2 kwenziwa kunye nesigulana kwi-supine. Kule ndlela, isiguli sasimbambe / iingalo kunye neengalo zakhe esifubeni kunye neengqini ezihambelanayo nesikhokelo esiphezulu. Ingcali yonyango yaqhakamshelana neenkqubo ezinqamlezileyo zomqolo ongezantsi wecandelo lokunyakaza ekujoliswe kulo kunye nokuphakama kwangoko kunye ne-phalanx ephakathi yedigri yesithathu. I-lever ephezulu yafakwa kwindawo yentshukumo yokujolisa ngokudibanisa ukujikeleza kude kunye nokugoba kwicala kwicala lonyango ngelixa isandla esingaphantsi sisebenzisa ukubizwa kunye nokuphambuka kwe-radial ukufezekisa ukujikeleza ukuya kwicala lokugoba, ngokulandelelana. Isithuba esingaphantsi kwenkqubo ye-xiphoid kunye nomda we-costochondral womgqirha wasetyenziswa njengendawo yokunxibelelana ngokuchasene nezigulana zesigulana sokuhambisa ubuqhetseba ngaphambili ukuya kwicala elingasemva elijolise kwi-T1-2 kumazwe amabini (Ikhiwane. 2).

 

UkuQinisa kunye neQela lokuSebenza

 

Ukuhanjiswa okujolise ekunene nasekhohlo kwi-C1-2 articulations kunye ne-T1-2 articulations zenziwa ubuncinci kwiseshoni enye ye-6 8 yonyango. Kwezinye iiseshoni zonyango, abanyangi baphindaphinde i-C1-2 kunye / okanye i-T1-2 yokuhambisa okanye ukujolisa kwezinye iindlela zomqolo (okt, C0-1, C2 / 3, C3-7, T2-9, ribs 1 9) besebenzisa ukugaya. . Ukukhethwa kwamacandelo omgogodla ekujoliswe kuwo kwashiywa kwingqondo yonyango kwaye yayisekwe kwindibaniselwano yeengxelo zesigulana kunye novavanyo lwencwadi. Nangona kunjalo, ukuthintela 'ukunxibelelana' okanye 'isiphumo sokuqwalaselwa' xa kuthelekiswa neqela elikhohlisayo, abanyangi bayalelwa ukuba badibanise icandelo elinye lomlomo wesibeleko (okt ekunene nasekhohlo) kunye necandelo elinye le-thoracic okanye ubambo oluchazayo kwiseshoni nganye yonyango.

 

Ukubambisana okujoliswe kwi-C1-2 ukuchazwa kwenzelwe. Kule ndlela, umgqirha wenza enye ye-30 yokuphelela kwe-grade ye-grade engasemva kwesigxina se-PA kwi-C1-2 yesigaba sokunyuswa njengoko ichazwe nguMaitland [7]. Le nkqubo inye yaphindwa kwakhona kwi-bout ye-30 enye ukuya kwi-joint-axial joint joint. Ukongezelela, kwaye ubuncinane kwiseshoni enye, ukuhlanganiswa okubhekiselele kwisigxina esiphezulu se-thoracic (T1-2) kunye nesigulane esilungileyo esenziwa. Ngenxa yale nqubo, uphando lwenza enye ye-30 ye-grade cent ye-grade IV ye-PA mobilizations kwi-T1-2 inxalenye yesiphakamiso njengoko kuchazwe nguMaitland [7]. Ngoko ke, sasebenzisa i-180 (oko kukuthi, i-30 s bouts) malunga ne-2 Hz). Ngokucacileyo, akukho bungqina obuphezulu bokubakho ukuza kuthi ukuba ixesha elidlulileyo lokubambisa luchukumisa ukunciphisa ubuhlungu ngaphezu kwexesha elifutshane okanye ama-dosage of mobilisation [59, 60].

 

Ukuziqhelanisa ne-cranio-cervical flexion exercises [11, 61-63] zenziwa kunye nesigulana kwi-supine, amadolo egobile kunye nokuma kwentloko emiselweyo ngokubeka i-craniocervical kunye ne-spines spines kwindawo esembindini, enje ngokuba umgca phakathi Ngaphambili ibunzi nesilevu zazithe tyaba, kwaye umgca othe tyaba usuka kwitrgus yendlebe wahlula intamo ixesha elide. I-unit ye-biofeedback yoxinzelelo lomoya (i-Chattanooga Group, Inc., i-Hixson, i-TN) ibekwe ecaleni kwesigulana emva kwentamo yesigulana kwaye yaxhonywa ngaphambili kwisiseko se-20 mmHg [63]. Ukuzivocavoca okuhleliweyo, izigulana zacelwa ukuba zenze inyathelo le-craniocervical flexion action (noda nod of the head, similar to showing yes ) [63] kunye nokuzama ukujolisa ekujongeni uxinzelelo lwe-22, 24, 26, 28, kunye ne-30 mmHg ukusuka isiseko sokuphumla se-20 mmHg kwaye sibambe isikhundla sizinzile nge-10 s [61, 62]. Intshukumo yokunqwala intloko yenziwa ngendlela ethambileyo kwaye ecothayo. Ukuphumla kwe-10 kwavunyelwa phakathi kwezilingo. Ukuba uxinzelelo luye lwaphambuka ngaphantsi koxinzelelo ekujoliswe kulo, uxinzelelo lwalungagcinwanga luzinzile, endaweni yezithambisi ezingaphezulu (i-sternocleidomastoid okanye i-anterior scalene) yenzekile, okanye ukurhoxiswa kwentamo kwaqatshelwa ngaphambi kokugqitywa kwe-10 s isometric hold, yathathwa njengokungaphumeleli [63]. Uxinzelelo ekujoliswe kulo lokugqibela olusebenzayo lwalusetyenziselwa ukumisela inqanaba lokuzivocavoca kwesigulana ngasinye apho iiseti ze-3 zokuphindaphinda kwe-10 nge-10 s isometric hold zenziwa. Ukongeza ekuvuseleleni nasekusebenziseni umthambo we-cranio-wesibeleko, izigulana zacelwa ukuba zenze i-10 min yemithambo eqhubekayo yokuxhathisa (okt, ukusebenzisa iTherabands okanye iintsimbi zasimahla) kwimisipha yebhanti yegxalaba ngexesha leseshoni yonyango nganye, kunyamezelwano lwabo, kunye egxile ngokukodwa kwi-trapezius esezantsi kunye ne-serratus yangaphambili [11].

 

Usayizi wesampula

 

Ubungakanani besampula kunye nokubala kwamandla kwenzelwa ukusebenzisa iprojekthi ye-intanethi kwi-MGH Biostatistics Centre (eBoston, MA). Izibalo zisekelwe ekufumaneni u-2-point (okanye i-20%) umahluko kwi-NPRS (ubukhulu beentloko) kwiinyanga ze-3 ukulandelelana, kuthatha ukuphambukiswa okuqhelekileyo kwamanqaku amathathu, uvavanyo lwe-2-tailed, kunye ne-alpha level 0.05. Oku kwavelisa ubungakanani beesampula zezigulane ze-49 ngeliqela. Ukuvumela ukuba izinga lokulahla elilondolozo lwe-10%, siceba ukufumana izigulane ze-108 ubuncinane kwisifundo. Ubungakanani besampula bukhulule ngaphezu kwe-90% amandla okufumanisa utshintsho oluphawulekayo kwiimpawu ze-NPRS.

 

Uhlalutyo lweenkcukacha

 

Iinkalo ezichazayo, kubandakanywa amanqaku eenkcukacha zohlulo lwezigaba kunye namanyathelo okutyekela kunye nokusabalalisa ukuguquguquka okuqhubekayo kubalwa ukufingqa idatha. Iimpembelelo zonyango kwi-headache intensity kunye nokukhubazeka zihlolwe nganye nge-2-by-4 uhlalutyo lwemodeli yokuxhatshazwa (ANOVA), kunye neqela lonyango (ukuxhaphaza ngokubhekiselele ekukhuthazeni nasekusebenziseni umsebenzi) njengento ephakathi kwezifundo kunye nexesha (isiseko, Iveki ye-1, iiveki ze-4, kunye ne-3 inyanga ukulandelelana) njengezifundo ezikhoyo ngaphakathi. I-ANOVA ezahlukileyo zenziwa nge-NPRS (intloko yesisindo) kunye ne-(ukukhubazeka) njengento exhomekeke kuyo. Kwi-ANOVA nganye, ingcamango yenzalo yindlela yokusebenzisana kwe-2 (iqela ngexesha).

 

Uvavanyo oluzimeleyo t lwalusetyenziselwa ukumisela umahluko phakathi kweqela ngotshintsho lwepesenti ukusuka kwisiseko ukuya kwi-3-inyanga yokulandelelana kokubini kwentloko kunye nokukhubazeka. Ulwahlulo olwahlukileyo lweMannhitWhitney U lwenziwa rhoqo ngeentloko, i-GRC, ubude beentloko kunye nokutya amayeza njengokuhluka okuxhomekekileyo. Senze i-Little'ss Missing ngokupheleleyo kuVavanyo lwe-Random (MCAR) [64] ukumisela ukuba amanqaku eedatha alahlekileyo ahambelana nokuyeka kwabafundi abalahlekile ngokungahleliwe okanye alahlekileyo ngenxa yezizathu zenkqubo. Uhlalutyo olunomdla kunyango lwenziwa kusetyenziswa uLindelo-loMgangatho apho idatha engekhoyo ibalwa kusetyenziswa ukubuyiswa kwemilinganiselo. Ukuthelekiswa okucwangcisiweyo kokubini kwenziwa kwenzelwa ukuvavanya umohluko phakathi kwesiseko kunye nexesha lokulandelela phakathi kwamaqela kusetyenziswa ukulungiswa kweBonferroni kwinqanaba le-alpha le -05.

 

Senza izigulane zidibeneyo njengabaphenduli kwi-3-inyanga yokulandela emva kokusebenzisa amanqaku aphuculwayo okuphucula amaphuzu e-2 kwintloko yesifo njengentengo ye-NPRS. Amanani ayedinga ukuphatha (NNT) kunye ne-95% yexesha lokuzithemba (CI) nabo babalwa kwixesha le-3 lokulandelela kweenyanga basebenzisa ngasinye sale nkcazo ngemiphumo ephumelelayo. Uhlalutyo lwedatha lwenziwe nge-SPSS 21.0.

 

iziphumo

 

Izigulana ezingamakhulu amabini anamashumi mahlanu ananye ezinezikhalazo eziphambili zentloko ziye zavavanywa ukufaneleka. Izizathu zokungafaneleki zinokufumaneka kwi Ikhiwane. 3, umzobo wokuhamba wokugaywa kwesigulana kunye nokugcinwa. Kwizigulana ezingama-251 ezihloliweyo, izigulana ezili-110, ezineminyaka yobudala engama-35.16 (SD 11.48) kunye nobude beempawu zeminyaka emi-4.56 (SD 6.27), yanelisile iikhrayitheriya zokufaneleka, yavuma ukuthatha inxaxheba, kwaye yahlelwa ngendlela engekho mthethweni (n ? =? 58) kunye nokuhlanganisa kunye nokuzilolonga (n? =? 52) amaqela. Izinto eziguquguqukayo ezisisiseko kwiqela ngalinye zinokufumaneka kwiTheyibhile 1. Abalishumi elinambini bezonyango ezivela kwiiklinikhi zonyango zonyango ezingalaliswayo ezisisi-8, 25, 23, 20, 14, 13, 7 okanye ezi-6 ngokulandelelana; Ngapha koko, ngamnye wabanyangi abali-2 wanyanga malunga nomyinge olinganayo wezigulana kwiqela ngalinye. Kwakungekho mahluko ubalulekileyo (p? =? 12) phakathi kwenani leentsingiselo zeeseshoni zonyango ezigqityiweyo zeqela lokukhohlisa (0.227, SD 7.17) kunye nokuhlanganisa kunye neqela lokuzilolonga (0.96, SD 6.90). Ukongeza, inani elichaziweyo leeseshoni zonyango ezijolise kwi-C1.35-1 articulation yayiyi-2 (SD 6.41) yeqela lokukhohlisa kunye ne-1.63 (SD 6.52) yokuhlanganisa kunye neqela lokuzilolonga, kwaye oku bekungafani ngokwahlukileyo (p? =? 2.01). Amakhulu asixhenxe abaguli abangama-0.762 abagqibe onke amanyathelo eziphumo kwiinyanga ezi-110 (ukulandelelwa kwe-3%). Ukulahleka okuncinci ngokuPheleleyo kuvavanyo lweRandom (MCAR) kwakungabalulekanga ngokwezibalo (p? =? 97); Ke ngoko, sisebenzise ubuchwephesha bokulindela-bokwandisa ukubekwa endaweni yamaxabiso ashiyekileyo kunye namaxabiso aqikelelweyo kwiziphumo zeenyanga ezi-0.281 ezilahlekileyo.

 

 

 

Iqela lilonke ngokudibana kwexesha lesiphumo sokuqala sobunzima beentloko kwakubalulekile ngokwe-NPRS (F (3,106)? =? 11.196; p?

 

 

 

Kwiziphumo ezisekondari iqela elibalulekileyo ngokudibana kwexesha belikho kwi-NDI (F (3,106)? =? 8.57; p?

 

Uvavanyo lukaMann Whitney U lubonakalise ukuba abaguli abakwicandelo eliphezulu lomlomo wesibeleko kunye neqela eliphezulu lokuxhaphaza abanamava aqaqanjelwa yintloko rhoqo kwiveki e-1 (p?

 

Khange siqokelele nayiphi na idatha malunga neziganeko ezimbi ze- minor [48, 49] (iimpawu zexeshana zemithambo-luvo, ukwanda kokuqina, ukukhupha iintlungu, ukudinwa okanye enye into); Nangona kunjalo, akukho ziganeko ze- major ezimbi [48, 49] (ukubetha okanye ukusilela ngokusisigxina kwe-neurological) kwaxelwa elinye iqela.

 

ingxoxo

 

Ingxelo yeSigqeba esiPhezulu

 

Kulwazi lwethu, olu phononongo luvavanyo lokuqala lweklinikhi olungenakuthelekiswa nanto ngokuthelekisa ngokuthe ngqo ukusebenza kokubini komlomo wesibeleko kunye ne-thoracic ekuhlanganiseni nasekuzilolongeni kwizigulana ezine-CH. Iziphumo zicebisa iiseshoni ezi-6 ukuya kwezi-8 zokuxhaphaza ngaphezulu kweeveki ezi-4, ezijolise ikakhulu kumlomo wesibeleko (C1-2) kunye ne-thoracic ephezulu (T1-2) spines, kukhokelele kuphuculo olukhulu kwintloko, ukukhubazeka, ukuphindaphindeka kwentloko, ubude beentloko. , kunye nokutya amayeza kunokugaya ukudibanisa nokuzilolonga. Uqikelelo lwenqaku lokutshintsha kweqela phakathi kwentloko yamandla (amanqaku e-2.1) kunye nokukhubazeka (amanqaku e-6.0 okanye i-12.0%) idlulile kwii-MCID ezichaziweyo kuwo omabini la manyathelo. Nangona i-MCID ye-NDI kwizigulana ezine-CH ingekaphandwa, kufanele ukuba kuqatshelwe ukuba uqikelelo olusezantsi lwe-95% CI yokukhubazeka (amanqaku e-3.5) yayingezantsi kancinci (okanye yayiqikelelwa kumatyala amabini) i-MCID leyo kuye kwafunyanwa ukuba yi-3.5 [65], 5 [66], kunye ne-7.5 [45] amanqaku kwizigulana ezineentlungu zentamo, 8.5 [33] amanqaku kwizigulana ezine-radiculopathy yomlomo wesibeleko, kunye ne-3.5 [44] amanqaku kwizigulana ezinomxube, iintlungu zentamo ezingachazwanga. Nangona kunjalo, kufanele kuqatshelwe ukuba omabini la maqela enze ukuphuculwa kweklinikhi. Ukongeza, i-NNT icebisa ukuba zonke izigulana ezine ziphathwe ngokunyanzelwa, endaweni yokuhlanganisa, esinye isigulana sifezekisa ukuncitshiswa kwentlungu kwiinyanga ezintathu zokulandelwa.

 

Amandla kunye nobuthathaka beSifundo

 

Ukubandakanywa kwe-12 yokwelapha iipilisi zangasese ze-8 kwii-6 zizwe ezihlukeneyo zendawo ziphucula uwonke jikelele lweziphumo zethu. Nangona ukungafani okuphawulekayo kwaqatshelwa kwiinyanga ze-3, awaziwa ukuba ezi zinzuzo ziza kuzinyelwa kwixesha elide. Ukongezelela, sasebenzisa i-high-speed, ubuchule bokusetyenziswa kwezinto eziphantsi kwe-amplitude eziqeshisa i-bidirectional zitshintsha ngokujikeleza kunye nokuguqulela kanye kunye ne-Maitland esekelwe kwi-grade IV ye-AP; Ngaloo ndlela, asinakuqiniseka ukuba ezi ziphumo zizaliseka kwezinye iindidi zobugcisa bokunyanga. Abanye banokuba bathi iqela elifanisayo lingazange lifumane ukungenelela okwaneleyo. Sifuna ukulinganisela ukuqiniswa kwangaphakathi nangaphandle ukwenzela ukuba unyango olumiselweyo kumaqela amabini kwaye lunikezela inkcazo ecacileyo yeendlela ezisetyenzisiweyo eziza kuvumela ukuphindaphinda. Ukongezelela, asizange senze imilinganiselo embi embi kwaye sabuza kuphela malunga nezimbini ezinobungozi ezinkulu. Omnye umda wukuthi siquke iziphumo ezininzi zesibini. Ukukhethwa kwamathambo malunga nokuba yiyiphi inqubo abacinga ukuba iya kuba yinto ephakamileyo ayiqokelelwanga kwaye ingaba nefuthe kwiziphumo.

 

Amandla kunye nobuthathaka ngokuphathelele kwezinye izifundo: Ulwahlulo olubalulekileyo kwiziphumo

 

Jull et al. [I-11] yabonakalisa ukonyango ngonyango olwenziwe ngonyango kunye nokusebenza ngokulawulwa kwe-CH; Nangona kunjalo, le phakheji yonyango ibandakanya ukuhlanganiswa nokuphathwa. Uphononongo lwangoku lunokuba lunobungqina bokuba ukuphathwa kwezigulane ezine-CH kufuneka kufake uhlobo oluthile lokuxhaphaza nangona kunjalo kudla ukuba kucetyiswa ukuba ukuphathwa komlomo kuphephe ngenxa yemingcipheko yeziganeko ezimbi (67, 68]. Ukongezelela, kuboniswe ukuba abantu abafumana ukunyanzeliswa kwemisipha ngentlungu yentamo kunye neentloko ababa nako ukufumana unxephezelo lwe-vertebrobasilar kunokuba bafumana unyango ngugqirha wabo wezonyango [69]. Ukongezelela, emva kokuphonononga iingxelo ze-134, i-Puentedura et al. kugqiba ukuba ngokukhetha ngokufanelekileyo izigulane ngokujonga ngokucophelela iiflegi ezibomvu kunye nokuchasene, uninzi lweziganeko ezimbi ezinxulumene nokunyanzeliswa komlomo zingenakuthintela [70].

 

Iintsingiselo zezifundo: Iingcaciso ezikhoyo kunye nefuthe kwiiNtsholongwane kunye nabaPolisi

 

Ngokusekelwe kwiziphumo zeengcali zamatyala kufuneka ziqwalasele ukubandakanya ukunyanzeliswa komgudu wabantu abane-CH. Ukuphononongwa ngokutsha kwenkqubo ekhoyo kwangoko kufumaneke ukuququzelela kunye nokuphathwa kakuhle ukuba kusebenze ukuphathwa kwezigulane ezine-CH kodwa akakwazanga ukufumanisa ukuba yiyiphi indlela ephakamileyo [8]. Ukongezelela, izikhokelo zeklinikhi zichaze ukuba ukuphathwa, ukuxhotyiswa kunye nokusebenza konke kwakunempumelelo ekulawuleni izigulane ezine-CH; Nangona kunjalo, isikhokelo asizange senze iziphakamiso malunga nokuphakama kweendlela. [71] Iziphumo zangoku zinokunceda abalobi beengxelo ezichanekileyo kunye nezikhokelo zekliniki ekunikezeni iingcebiso ezithile malunga nokusetyenziswa kobuthakathaka bomgudu kule ndawo.

 

Imibuzo engaphenduliweyo kunye nophando lwexesha elizayo

 

Iindlela ezisisiseko zokuba kutheni ukuphathwa gadalala kunokuba neziphumo zophuculo olukhulu kuhlala kucacisiwe. Kuye kwacetyiswa ukuba ukufuduka kwe-velocity ephezulu ye-vertebrae kunye nexesha lokunyanzeliswa elingaphantsi kwama-200 ms linokutshintsha amazinga okukhutshwa afanelekileyo [72] ngokukhuthaza ama-mechanoreceptors kunye ne-proprioceptors, ngaloo ndlela utshintshe ama-alpha motorneuron amanqanaba okuxhamla kunye nemisebenzi ye-muscle elandelayo [72-74]. Ukunyanzeliswa kunokuphinda kukhuthaze ii-receptors kwimisipha enzulu ye-paraspinal, kunye nokuququzelela kunokuba nakho ukubhexesha ukwamkela izihlunu ezingaphezulu [75]. I-Biomechanical [76, 77], umnqonqo okanye i-segmental [78, 79] kunye nokuhla okuphakathi kwendlela yokuthintela iintlungu [80 83] ziimodeli ezichazayo ezinokubakho kwiziphumo ze-hypoalgesic eziqwalaselweyo emva kolawulo. Kutshanje, iimpembelelo ze-biomechanical of manipulation beziphantsi koqwalaselo lwenzululwazi [84], kwaye kuyacaca ukuba izibonelelo zeklinikhi ezifunyenwe kwisifundo sethu zinxulunyaniswa nempendulo ye-neurophysiological ebandakanya isishwankathelo semvakalelo yokwexeshana kwiphondo lomqolo wentambo yomqolo [78]; Nangona kunjalo, le modeli icetywayo ngoku ixhaswa kuphela kwiziphumo ezivela okwexeshana, iintlungu ezibangelwa luvavanyo kwizifundo ezisempilweni [85, 86], hayi abaguli abane-CH. Izifundo ezizayo kufuneka zivavanye iindlela ezahlukeneyo zonyango olusebenzisa iidosi ezahlukeneyo kwaye zibandakanye nokulandela unyaka omnye. Ngaphaya koko, izifundo ezizayo ezivavanya iimpembelelo ze-neurophysiological zoxinzelelo kunye nokuququzelela kuya kubaluleka ekumiseleni ukuba kutheni kunokubakho okanye kungabikho mahluko kwiziphumo zonyango phakathi kwezi zonyango zimbini.

 

isiphelo

 

Iziphumo zophononongo yangoku kwabonisa ukuba izigulane CH abafumene izakhi wesibeleko kunye thoracic abanamava izinciphiso kakhulu mkhulu ngamandla yintloko ebuhlungu, ukukhubazeka, intloko ebuhlungu kwamaza, ubude intloko ebuhlungu, kunye namayeza inani xa kuthelekiswa neqela ezafumana ukubizwa kunye nokusebenzisa; Ngaphezu koko, iziphumo zagcinwa kwiinyanga ze-3 zokulandela. Ucwaningo lwexesha elizayo lufanele luhlolisise ukusebenza kweentlobo ezahlukeneyo kunye nemilinganiselo yokuphathwa kunye nokuquka ukulandelelana kwexesha elide.

 

Imibulelo

 

Akukho namnye wabalobi abafumene naliphi na inkxaso-mali yale sifundo. Ababhali banqwenela ukubonga bonke abathathi-nxaxheba besifundo.

 

Imihlathi

 

• Injongo yokunyanzela: UDkt. James Dunning nguMongameli we-American Academy of Treatment Therapy (AAMT). I-AAMT inikeza iinkqubo zokuqeqesha i-postgraduate ku-spinal manipulation, u-spinal mobilization, ukunyanzelwa kwesigxina, ukuchithwa kwamagqabi, ukuququzelela ukuphela, ukuxhaswa kwezixhobo ezincedisayo kunye nokuzivocavoca kwezilwanyana eziphathekayo, i-osteopaths kunye noogqirha. Drs. UJames Dunning, uRaymond Butts, uThomas Perreault, kunye noFiras Mourad ngabaqeqeshi abaphezulu be-AAMT. Abanye abalobi bavakalisa ukuba abanalo inxaxheba.
• Igalelo lababhali: I-JRD ithathe inxaxheba ekukhuleni, ukuyila, ukufumana idatha, ukuhlalutya kwamanani kunye nokuqulunqwa kombhalo wesandla. I-RB kunye ne-IY bathathe inxaxheba ekudalweni, ukuqokelela idatha, ukuhlaziywa kwamanani kunye nokuhlaziywa kwincwadi yesandla. I-FM ithathe inxaxheba ekuvelweni, ukuhlalutya izibalo, ukuchazwa kwedatha nokuhlaziywa kwincwadi yesandla. UMH uthathe inxaxheba ekukhulelweni, ukuyila nokuhlaziywa kwembhalo. I-CF kunye no-JC babandakanyeka kuhlalutyo lwamanani, ukutolika kwedatha, nokuhlaziywa okubalulekileyo kwincwadi yesibrari ngokubaluleka kokubhaliweyo kwengqiqo. I-TS, i-JD, i-DB, kunye ne-TH babandakanyeka ekuqokelelwa kwedatha nokuhlaziywa kwincwadi yesandla. Bonke abalobi bafunde kwaye bavumile umbhalo wesigqi wokugqibela.

 

I ngcaciso

 

Ncbi.nlm.nih.gov/pmc/articles/PMC4744384/

 

Ukuququmbela,Intlungu yentloko ebangelwa yintloko yesibini ngenxa yemeko yezempilo ecaleni kwezakhiwo ezijikeleze umqolo wesibeleko, okanye intamo, kunokubangela iimpawu ezibuhlungu nezidimazayo ezinokuchaphazela umgangatho wobomi besigulana. Ukunyanzeliswa komgudu kunye nokuhlanganiswa kungasetyenziselwa ngokukhuselekileyo nangokufanelekileyo ukunceda ukuphucula iimpawu zentloko ye-cervicogenic. Ulwazi olukhankanyiweyo kwiZiko leLizwe leNgcaciso yeBiotechnology (NCBI). Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nokulimala komqolo kunye neemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukubuza uGqirha Jimenez okanye unxibelelane nathi ku 915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

 

 

 

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

 

Ngokwezibalo, malunga ne-80% yabantu baya kuba neempawu zentlungu emva koko kanye ngexesha lokuphila kwabo. Umqolo obuhlungu isikhalazo esiqhelekileyo esinokubangelwa ngenxa yeemeko ezahlukeneyo kunye / okanye iimeko. Ngokuphindaphindiweyo amaxesha, ukuguqulwa kwemvelo komgudu kunye nomdala kunokubangela intlungu emva. Iidiski zeHerniated kwenzeka xa i-disc, i-gel-like centre ye-disc intervertebral iqhubezela ngeengqungquthela kwijikelezo zayo zangaphandle, ukuxilisa nokucaphukisa izimpande zentliziyo. Iingxoxo ze-Disc zivame ukuqhutyelwa kwi-back back, okanye i-lumbar spine, kodwa nazo zingenzeka kunye nomlenze womlomo wesibeleko okanye intamo. Ukufakelwa kwamathambo afunyenwe kwinqanaba eliphantsi ngenxa yokulimala kunye / okanye imeko ehlaseleyo ingakhokelela kwimpawu ze-sciatica.

 

ISIHLOKO ESIBALULEKILEYO: Ukwelashwa kweMigraine Pain

 

 

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