intlungu Knee yinto echaphazelekayo yempilo phakathi kwabadlali kunye nabemi ngokubanzi. Nangona iimpawu zeentlungu zamadolo zingadala kwaye ziphazamisekile, ubuhlungu beendolo kaninzi buyinkathazo enempilo kakhulu. Ibundu liyinkqubo eyinkimbinkimbi eyenziwe ngamathambo amathathu: icandelo elincinane lesithanga, ummandla ophezulu weshinqa, kunye ne-kneecap.
Amancuba athambileyo anamandla, afana neetoni kunye nemigqa yamadolo kunye ne-cartilage phantsi kwe-kneecap naphakathi kwamathambo, zibambe ezi zakhiwo ukuze zizinze kwaye zixhase idolo. Nangona kunjalo, iintlobo ezahlukeneyo zokulimala kunye / okanye iimeko ziya ekugqibeleni zikhokele ekubuhlungu kweendolo. Injongo yeli nqaku apha ngezantsi ukuhlola izigulane ngeentlungu.
Contents
Abstract
Oogqirha bosapho bahlala behlangana nezigulana ezineentlungu emadolweni. Ukuchongwa ngokuchanekileyo kufuna ulwazi lwe-anatomy yedolo, iipateni zentlungu eqhelekileyo kumanxeba edolo, kunye neempawu zokuhlangana rhoqo nezizathu zentlungu yamadolo, kunye nezakhono ezithile zovavanyo lomzimba. Imbali kufuneka ibandakanye iimpawu zentlungu yesigulana, iimpawu zoomatshini (ukutshixa, ukuphuma, ukunika indlela), ukudityaniswa ngokudibeneyo (ixesha, isixa, ukuphindaphinda) kunye nendlela yokwenzakala. Uvavanyo lomzimba kufuneka lubandakanye ukuhlolwa ngononophelo kwamadolo, ukubetheka kwithenda yenqaku, ukuvavanywa kokudityaniswa ngokudibeneyo, ukuvavanywa kokuhamba-hamba, ukuvavanywa kwemigqa yokulimala okanye ukungakhathali, kunye novavanyo lwe-menisci. IiRadiographs kufuneka zifunyanwe kwizigulana ezinesithambiso patellar okanye ukuthamba kwentloko ye-fibula, ukungakwazi ukuthwala ubunzima okanye ukuguqula idolo ukuya kuma-90 degrees, okanye ubudala obungaphezulu kweminyaka engama-55. (NdinguGqirha weNdawo u-2003; 68: 907-12. Ilungelo lokushicilela 2003 Isikolo saseMelika soGqirha boSapho.)
intshayelelo
Iintlungu zedolo zibalelwa malunga nesinye kwisithathu seengxaki ze-musculoskelet ezibonwa kwiindawo zokunakekelwa kweprayimari. Esi sikhalazo sixhaphake kakhulu kwizigulane ezisebenzayo ngokwasemzimbeni, kunye neepesenti ze-54 zabadlali abaneentlungu ezithile zedolo ngonyaka. .
Idolo liyindawo eyinkimbinkimbi (umfanekiso we-1), i-2 kunye nokuvavanya kwayo kungabangela umngeni kumgqirha weentsapho. Ukuxilongwa ngokuhlukana kweentlungu zamadolo kuninzi kodwa kunokunciphisa imbali enenkcazo, uvavanyo olubonakalayo olubonakalayo kwaye, xa kuboniswe, ukusetyenziswa ngokukhethekileyo kweengcamango ezifanelekileyo kunye nezifundo zelabhoratri. Icandelo I kweli nqaku leenxalenye ezimbini libonelela ngendlela echanekileyo yokuphonononga idolo, kwaye inxalenye ye-II3 ixoxa ngokuxilongwa ngokuhlukileyo kweentlungu.
imbali
Iimpawu zobunzima
Inkcazo yesigulana yeentlungu zedolo iluncedo ekugxininiseni ukuxilongwa okwahlukileyo.4 Kubalulekile ukucacisa iimpawu zentlungu, kubandakanywa nokuqala kwayo (ngokukhawuleza okanye ngokufihlakeleyo), indawo (yangaphambili, i-medial, i-lateral, okanye idolo elingasemva), ubude bexesha, ubukhali, kunye nomgangatho (umzekelo, buthuntu, bubukhali, bubuhlungu). Iimeko eziya ziba mandundu nezinciphisa nazo kufuneka zichongwe. Ukuba iintlungu zedolo zibangelwa yingozi enkulu, ugqirha kufuneka azi ukuba isigulane sakwazi ukuqhubeka nomsebenzi okanye sithwale ubunzima emva kokulimala okanye unyanzelekile ukuba ayeke imisebenzi ngokukhawuleza.
Iimpawu zoMatshini
Isigulane sifanele sibuzwe malunga neempawu zombane, njengokuvala, ukuphuma okanye ukunika indlela emadolweni. Imbali yokuvala iziqwenga ziphakamisa intlungu. Ivakalelo lokuphuma ngexesha lokulimala libonisa ukulimala okubi, mhlawumbi ukugqitywa kwe-ligament (i-tear-tear tear). Iziphasana zokunikezela zihambelana neqondo elithile lokungazinzi kwamadolo kwaye zingabonakalisa i-patellar sub-luxation okanye i-ligamentous break.
Ukususwa
Ixesha kunye nomlinganiselo wokuxuba okuhlangeneyo kubalulekile ukuba kuhlolwe. Ukuqala ngokukhawuleza (kwiiyure ezimbini) kweso sikhulu esikhulu, siphumelelo sikhombisa ukugqithwa kwegridi ye-anterior engxenyeni okanye i-fracture ye-plateau ye-tibial ene-hemarthrosis eyiphumela, kanti i-24 ukuya kwii-36 iiyure ezihamba ngokukhawuleza zihamba ngendlela ehambelanayo. ukulimala kwamadoda okanye i-ligamentous sprain. Ukutshatyalaliswa kwamadolo okuphindaphindiweyo emva komsebenzi kuhambelana nokulimala kwamadoda.
Indlela yoKhuseleko
Isigulane sifanele sibuze malunga neenkcukacha ezithile zengozi. Kubalulekile ukwazi ukuba isigulane sagxothwa ngqo emadolweni, ukuba unyawo lwahlwayelwa ngexesha lokulimala, ukuba isigulane sagxotha okanye siyeka ngokukhawuleza, ukuba isiguli sasingena kwi-jump, icandelo lokulimala, kwaye ukuba kwenzeka ingozi ye-hyperextension.
Ukubethelwa ngqo kumadolo kungabangela ukulimala kakhulu. Amandla angaphaya asetyenziswe kwi-tibia ehamba phambili kunye negulo ekuphambeni (umz., Xa idolo lishaya ideshibhodi kwimoto yengozi) kunokubangela ukulimala kwimeko engaphaya komzimba. I-ligament ye-collateral ligament ixhaphake kakhulu ngenxa yesigxina esisigxina esisisigxina emadolweni (umz., Ukutsalwa kwebhola); eli galelo lidala umthwalo wecala kwixolo kunye kwaye kunokubangela ukugqithwa kwe-collateral ligament. Ngapha koko, ukuqhuma komzimba okwenza umthwalo we-varus ungalimaza i-latal collateral ligament.
Amandla okungahambelani nawo ayibangela ebangela ukulimala kwamadolo. Ukuyeka okukhawulezileyo kunye nokucima okubukhali okanye ukujika kudala amandla amakhulu okunciphisa angakwazi ukuphazamisa okanye ukuphulukana nomgudu ongezantsi. I-Hyperextension inokubangela ukulimala kwi-ligament ephazamisayo yangaphambili okanye i-posterior cruciate ligament. Ukuphazamiseka ngokukhawuleza okanye ukuhamba ngokukhawuleza kwenza imikhosi ye-shear engalimaza i-meniscus. Inhlanganisela yemikhosi inokubakho kanyekanye, kubangela ukulimala kwizakhiwo ezininzi.
Imbali Yonyango
Imbali yokulimala kwamadolo okanye utyando lubalulekile. Isigulane kufuneka sibuzwe malunga nemizamo yangaphambili yokunyanga iintlungu zamadolo, kubandakanywa nokusetyenziswa kwamayeza, izixhobo ezixhasayo, kunye nonyango lomzimba. Ugqirha ukwafanele abuze ukuba ngaba umguli unembali yegout, ipseudogout, isifo samathambo, okanye ezinye izifo eziwohlokayo zamalungu.
Ubunzima bomzimba luyimpikiswano yempilo echaphazelekayo engabangelwa kukulimala kwezemidlalo, ukulimala kwengozi yemoto, okanye ngenxa yenkxalabo yempilo, njenge-arthritis. Iimpawu eziqhelekileyo zokulimala kwamadolo ziquka intlungu kunye nokungahambi kakuhle, ukuvuvukala, ukuvuvukala nokuqina. Ngenxa yokuba unyango lweentlungu zamadolo luyahlukahluka ngenxa yeso sizathu, kubalulekile ukuba umntu athole ukuxilongwa ngokufanelekileyo kwiimpawu zakhe. Ukunyamekela kwe-Chiropractic yindlela ekhuselekileyo neyenzayo, indlela yokwenza unyango engakunceda ukuphatha ubuhlungu beendolo, phakathi kwezinye izinto zempilo.
UDkt Alex Jimenez DC, i-CCST Insight
Uvavanyo lweMvelo
Uhlolo kunye nendawo
Ugqirha uqala ngokuthelekisa idolo elibuhlungu kunye nelolo elimnyama kunye nokuhlola idolo elimele ngenxa ye-erythema, ukuvuvukala, ukunyunyuza kunye nokuguqulwa. Inkundla kufuneka ilandelelanise ngokubanzi. Ngokukodwa, i-vastus medialis obliquus ye-quadriceps kufuneka ihlolwe ukuba ibone ukuba ibonakala iqhelekileyo okanye ibonisa iimpawu ze-atrophy.
Emva koko idolo liyacolwa lize lijongwe ukuba akukho ntlungu na, ubushushu kunye nokuphuma kwamanzi. Ithenda yenqaku kufuneka ifunwe, ngokukodwa kwi-patella, i-tubercle ye-tibial, i-tendon patellar, i-quadriceps tendon, i-anterolateral kunye ne-anteromedial joint line, i-medial joint line, kunye ne-lateral joint line. Ukuhambisa idolo lesigulana kwi-arc emfutshane yokunyakaza kunceda ukuchonga imigca edibeneyo. Uluhlu lwentshukumo kufuneka luhlolwe ngokwandisa kunye nokuguquguquka kwedolo kangangoko kunokwenzeka (uluhlu oluqhelekileyo lokunyakaza: ulwandiso, idigri zero; i-flex-ion, i-135 degrees).5
Uvavanyo lwePatellofemoral
Uvavanyo lokusasazeka kufuneka lwenziwe kunye nesigulane esiphezulu kunye negama elimazileyo. I-porapatellar pouch kufuneka ibanjwe ukuba ibone ukuba ikhona into ekhoyo.
Ukulandelwa kwePatellofemoral kuhlolwa ngokuqwalasela i-patella ngokunyakaza ngokukhawuleza ngelixa isigulane sivumelanisa i-quadriceps muscle. Ubungqina be-crepitus maziqatshelwa ngexesha lokutsalwa kwe patella.
I-angle ye-quadriceps (i-angle engama-Q) ichazwe ngokukraba umgca owodwa ukusuka kwinqanaba elingaphambili lomlenze we-aliac phakathi kwipatella kunye nomgca wesibini phakathi kwipatella ngokusebenzisa isifo sofuba (Umfanekiso 2) .6 AQ engaphezulu kwe-15 idigri yinto ebangela ukuba i-patellar subluxation (oko kukuthi, ukuba i-angle engama-Q iyanda, ukunyanzeliswa okunamandla kwemisipha ye-quadriceps kunokubangela ukuba i-patella ibe ne-sublux kamva).
Uvavanyo lokuxhalaba kwe patellar lwenziwa emva koko. Ngeminwe ebekwe kwicala eliphakathi le patella, ugqirha uzama ukuthoba i-patella kamva. Ukuba le ndlela iphinda ivelise iintlungu zesigulana okanye indlela yokupha, i-patellar subluxation ingoyena nobangela weempawu zesigulana. .
IziLigamente eziPhambili
ILigament yesiGaba esiPhakathi. Kuvavanyo lwangaphambili lwe-drawer, isigulana sithatha indawo yokuma kunye nedolo elonzakeleyo eliguquguqukayo laya kwiidigri ezingama-90. Ugqirha ulungisa unyawo lwesigulana ngokujikeleza kwangaphandle okuncinci (ngokuhlala ngenyawo) emva koko ubeke oobhontsi kwisifuba se-tibial kunye neminwe kumathole angasemva. Xa izihlunu zesigulana zikhululekile, ugqirha utsala ngaphakathi kwaye avavanye ukufuduswa kwangaphandle kwe-tibia (uphawu lwangaphandle lwedrowa).
Uvavanyo lweLachman lenye enye indlela yokuvavanya ingqibelelo yecala eliphambene nomzila (Umzobo we3) .7 Uvavanyo luyenziwa ngesigulane kwindawo ephakamileyo kwaye idolo elimazi liguqule kwii-30 degrees. Ugqirha ugxininisa i-distal femur ngesandla esinye, uqokelela i-tibia ehamba phambili ngakolunye uhlangothi, kwaye uzama ukuxhomekeka kwi-tibia kwangaphambili. Ukungabi nendawo ecacileyo yokugqibela kubonisa ukuhlolwa okulungileyo kweLachman.
IsiLigament esiPhambeneyo. Kuvavanyo lwedrowa yangasemva, isigulana sithatha indawo yokuma phezulu ngamadolo aguquguqukayo aya kuma-90 degrees. Ngelixa umi ecaleni kwetafile yoviwo, ugqirha ujonga ukushenxiswa kwasemva kwesithuba se-tibia (uphawu lwasemva lwe-sag) .7,8 Emva koko, ugqirha ulungisa unyawo lwesigulana ngokujikeleza ngokungathathi hlangothi (ngokuhlala ngonyawo), izikhundla oobhontsi kwi-tubercle ye-tibial, kwaye ubeka iminwe kumathole angasemva. Ugqirha emva koko utyhala ngasemva kwaye avavanye ukufuduka kwangaphambi kwexesha kwitibia.
IiLigamente eziBambeneyo
Ligament Ligamental Ligament. Uvavanyo loxinzelelo lwe-valgus lwenziwa ngomlenze wesigulana othathiweyo. Ugqirha ubeka isandla esinye kwicala lokuhlangana kwamadolo kunye nelinye icala kwicala le-distal tibia. Okulandelayo, uxinzelelo lwevalgus lusetyenziswa emadolweni kuzo zombini iidigri zero (ulwandiso olupheleleyo) kunye ne-30 degrees of flexion (Umzobo 4) 7. Ngamadolo kwiidridi ze-zero (oko kukuthi, ukwandiswa okupheleleyo), i-ligament yangasemva ye-cruciate kunye nokuchazwa kweendlela zobufazi kunye ne-tibial plateau kufuneka zizinzise idolo; ngedolo kwiidigri ezingama-30 zokujika, ukusetyenziswa koxinzelelo lwe-valgus kuvavanya ukungakhathali okanye ingqibelelo yento ebambekayo yangaphakathi.
Ligamentary Ligamental Ligament. Ukwenza uvavanyo loxinzelelo lwe-varus, ugqirha ubeka isandla esinye kwindawo ephakathi kwedolo lesigulana kunye nesinye isandla kwicala elisecaleni le-distal fibula. Emva koko, uxinzelelo lwe-varus lusetyenziswa emadolweni, okokuqala ngokwandiswa ngokupheleleyo (oko kukuthi, i-degrees zero), emva koko idolo liguquguquke kwii-30 degrees (Umfanekiso 4) .7 Isiphelo esiqinileyo sibonisa ukuba i-collateral ligament ilungile, kanti i-soft. okanye indawo yokuphela engekhoyo ibonisa ukuphuka okupheleleyo (i-third-degree tear) ye-ligament.
Menisci
Izigulane ezinobungozi kumadoda ngokuqhelekileyo zibonisa ukunyameka kumgca odibeneyo. Uvavanyo lweMcMurray lwenziwa kunye nesigulane esilala i-supine9 (Umfanekiso we-5). Uvavanyo luchazwe ngokuthe ngqo kwiincwadi, kodwa umbhali ubonisa indlela elandelayo.
Ugqirha ubamba isithende sesigulana ngesandla esinye kunye nedolo ngesinye isandla. Isithupha sikagqirha sikumgca ohlangeneyo osecaleni, kwaye iminwe ikumgca we-medial joint. Ugqirha ke uguqula idolo lesigulana kakhulu. Ukuvavanya i-meniscus yecala, i-tibia ijikeleziswa ngaphakathi, kwaye idolo liyandiswa ukusuka kwi-flexion ephezulu ukuya kwi-90 degrees; ukunyanzeliswa okongeziweyo kwi-meniscus esecaleni kunokuveliswa ngokufaka uxinzelelo lwe-valgus kwi-joint joint ngelixa idolo lindiswa. Ukuvavanya i-meniscus ephakathi, i-tibia ijikeleziswa ngaphandle, kwaye idolo liyandiswa ukusuka kwi-flexion ephezulu ukuya kwi-90 degrees; ukunyanzeliswa okongeziweyo kwi-meniscus ephakathi kunokuveliswa ngokubeka uxinzelelo lwe-varus ngaphesheya kwedolo elihlangeneyo ngelixa idolo liyi-degrees of flexion. Uvavanyo oluhle luvelisa i-thud okanye ukucofa, okanye kubangela intlungu kwinxalenye ephindaphindayo yoluhlu lokunyakaza.
Ngenxa yokuba ezininzi izigulane ezinamahlombe emadolo zinobungozi obunzima bokuzilimala, i-film-clear radiographs ngokuvamile ayibonakalwanga. Imithetho yamadolo ase-Ottawa iyisikhokelo esiluncedo sokwenza i-radiographs ye knee10,11.
Ukuba i-radiographs iyadingeka, iimbono ezintathu zihlala zanele: i-anteroposterior view, i-lateral view, kunye nembono yoMthengisi (kwi-patellofemoral joint) . Umbono we-posteroanterior kunye nedolo eliguquguqukayo ukuya kuma-7,12 ukuya kuma-40 degrees). Lo mbono uyimfuneko ekuboneni i-radiolucencies ye-femoral condyles (ikakhulu) i-condyle ye-femoral ephakathi), ebonisa ubukho be-osteochondritis dissecans.50
Ii-radiographs kufuneka zihlolwe ngokukhawuleza ngenxa yeempawu zokuphuka, ngokukodwa ezibandakanya i-patella, i-tibial plateau, i-tibial spines, i-fibula ehamba phambili, kunye ne-femoral condyles. Ukuba i-osteoarthritis icingelwa, kufuneka ifunyenwe i-radiographs yokunyuka kwesisindo.
Izifundo zeLebhu
Ubukho bemfudumalo, ububele obuhle, ukuxhamla ubuhlungu, kunye nentlungu ephawulweyo kunye nendawo encinci yokunyakaza kwamadolo ahambisanayo ne-septic arthritis okanye i-arthropathy enobuhlungu. Ukongezelela ekufumaneni inani elipheleleyo legazi ngokungafani kunye ne-erythrocytes sedimentation rate (ESR), kufuneka i-arthro-centesis ifakwe. Umthamo ohlangeneyo kufuneka uthunyelwe kwibhubhoratri ngenani leeseli ngokwahlukileyo, i-glucose kunye neeprotheni, imilinganiselo ye-bhakteria kunye novelwano, kunye ne-microscopy yokukhanya elula.
Ngenxa yokuba idolo, elibuhlungu, elithukutheleyo lingabonisa umfanekiso ocacileyo weklinikhi, i-arthrocentesis ingadingeka ukuba ihlukanise ukuhluthwa okulula ukusuka ku-hemarthrosis okanye i-osteochondral fracture ye-occult.4 I-effusion edibeneyo ivelisa i-fluid transudative color color, ukulimala kwamadoda. I-Hemarthrosis ibangelwa iinyembezi zengqungquthela yangaphambili, i-fracture okanye, ngokungaqhelekanga, iinyembezi ezinzulu zengxenyana yangaphandle ye-meniscus. I-osteochondral fracture ibangela i-hemarthrosis, kunye namafutha e-globules agqityiweyo kwi-aspirate.
I-rheumatoid arthritis ingabandakanya ixolo elihlangeneyo. Ngenxa yoko, i-serum ESR kunye novavanyo lwe-rheumatoid zibonakalisa kwizigulane ezikhethiweyo.
Ababhali babonisa ukuba abanalo iimbambano zomdla. Imithombo yenkxaso: ayikho ingxelo.
Ekugqibeleni, ubuhlungu beendolo ngumcimbi oqhelekileyo wempilo eyenzeka ngenxa yokwenyuka kweemeko kunye / okanye iimeko, ezifana nokulimala kwezemidlalo, izingozi zeemoto kunye ne-arthritis, phakathi kwezinye iingxaki. Unyango lweentlungu zamadolo luxhomeke kakhulu kwimvelaphi yeempawu. Ngoko ke, kubalulekile ukuba umntu afune unyango olusondeleyo ukuze athole ukuxilongwa.
Ukunyamekelwa kweChiropractic yindlela yonyango olulolunye olujolise kunyango lweentlobo ezahlukeneyo zokulimala kunye / okanye iimeko ezinxulumene ne-musculoskelet and nervous system. Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nemiba yempilo yomgogodla. Ukuxoxa ngalo mbandela, nceda uzive ukhululekile ukubuza uGqr. Jimenez okanye uqhagamshelane nathi apha915-850-0900 .
Ikhutshwe nguDkt. Alex Jimenez
Ingongoma eyongezelelweyo Ingxoxo: Ukuxoxisa ubuhlungu be-Knee Pain ngaphandle kokuPhenywa
Intlungu yedolo luphawu olwaziwayo olunokuthi lwenzeke ngenxa yeengozi zamadolo kunye / okanye iimeko, kubandakanya ukulimala kwezemidlalo. Amadolo ngenye yezona zinto ezinzima kakhulu emzimbeni womntu njengoko zenziwe yintlupheko yamathambo amane, iigamente ezine, iintlobo ezihlukahlukeneyo, i-menisci emibini, kunye ne-cartilage. Ngokwe-American Academy ye-Family Physicians, izizathu eziqhelekileyo zokubandezeleka kwamadolo zibandakanya i-patellar subluxation, i-patellar tendinitis okanye i-jumper, kunye ne-Osgood-Schlatter. Nangona ubuhlungu beentolo buya kwenzeka kubantu abantu abangaphezu kwe-60 ubudala, ubuhlungu beendolo buya kwenzeka kubantwana nakwishumi elivisayo. Iintlungu zesisu zingaphathwa ekhaya emva kweendlela ze-RICE, nangona kunjalo, ukulimala kwamadolo amakhulu kunokufuna ukunyangwa kwangoko kunyango, kubandakanya ukunakekelwa kwe-chiropractic.
I-EXTRA EXTRA | INGXELO EBALULEKILEYO: El Paso, TX I-Chiropractor Kunconywe
Ngenanto
Ucaphulo
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13. Schenck RC Jr, Goodnight JM. I-Osteochondritis. I-Bone Joint Surg [Am] 1996; 78: 439-56.
Vala i-Accordion
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I-ofisi yethu izamile ngokufanelekileyo ukubonelela ngeengcaphulo ezixhasayo kwaye ichonge uphando olufanelekileyo lophando okanye izifundo ezixhasa izithuba zethu. Sinikezela ngeekopi zophando ezixhasayo ezifumanekayo kwiibhodi ezilawulayo nakuluntu ngesicelo.
Siyaqonda ukuba sigubungela imicimbi efuna inkcazo eyongezelelweyo yokuba inganceda njani kwisicwangciso esithile sokhathalelo okanye inkqubo yonyango; ke, ukuqhubeka nokuxoxa ngombandela ongentla, nceda ukhululeke ukubuza UDkt Alex Jimenez, DC, okanye qha ga mshelana nathi 915-850-0900.
Silapha ukunceda wena kunye nosapho lwakho.
Iintsikelelo
UDkt Alex Jimenez D.C., I-MSACP, RN*, I-CCST, IFMCP*, I-CIFM*, I-ATN*
email: qeqeshi@elpasofunctionalmedicine.com
Ilayisenisi njengoGqirha weChiropractic (DC) kwi Texas & New Mexico*
Texas DC Ilayisensi # TX5807, New Mexico DC Ilayisensi # I-NM-DC2182
Unikwe Ilayisensi njengoMongikazi oBhalisiweyo (RN*) in Florida
Florida License RN Ilayisensi # I-RN9617241 (Nombolo yolawulo. 3558029)
Ubume obubambeneyo: ILayisensi yeeNkcazo ezininzi: Ugunyaziswe Ukuziqhelanisa I-40 States*
UGqr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
Ikhadi lam loShishino lweDijithali
