Ukunyamekelwa kwe-Chiropractic yindlela ekhethwa yonyango eyaziwayo eqhelekileyo ekusebenziseni ukunyanga iimpawu ze-sciatica. Sciatica ibonakaliswa njengentlungu ephuma kumqolo ongaphantsi ohamba phantsi emacaleni kunye nasezintanyeni emlenzeni nasezinyaweni ngenxa yokunyanzeliswa kwesibindi se-sciatic. Iimpawu zikhula ngokubanzi kwicala elilodwa lomzimba, nangona kunjalo, i-sciatica iyakwenzeka kumacala omabini omzimba womntu. Iintlungu zesifo se-sciatic ziyakwazi ukuhluka ngokuphindaphindiweyo kunye nokunyaniseka ukusuka kumntu ukuya kumntu kwaye ngokuqhelekileyo zichazwa njengezikhonkwane ezibukhali, ezibukhali, kunye neenaliti ezinjengeentlanzi zombane.

Ezinye iimpawu zibandakanya, ukutshisa, ukuphazamisa kunye nokuva. Izifo eziqhelekileyo eziyaziwayo ukuba zenze intlungu ye-ncitic, i-piriformis syndrome okanye ukuxinzezeleka okubangelwa ukuvuvukala kwemisipha ye-piriformis, ukuhluthwa okanye ukungahambisani nokungahambanga kakuhle kwemisipha ye-lumbar, i-bulging okanye i-disnied discs, ukukhulelwa, izixhamlo kunye nezifo ezingenasipelini ezifana nesifo sikashukela nokuqhaqha. Ngenxa yokuba iingxaki ezininzi zingabangela i-sciatica, ukuxilongwa ngokufanelekileyo komthombo weempawu zomntu ngamnye kubalulekile kuzo zonke iimfuno zonyango. Ukuvavanya ukuxilongwa kweentlungu ze-nerve kubandakanya i-x-ray, i-MRI, i-CT scan kunye / okanye i-electrodiagnostic tests. Ezi mviwo zinokukunceda ukucacisa ukuba kunokwenzeka ukunyanzeliswa kwe-chiropractic.

Ukunyamekela kwe-Chiropractic kugxile ekuxilongweni, unyango kunye nokuthintela ukonakaliswa kweemeko ezahlukeneyo kunye / okanye iimeko ezichaphazela inkqubo ye-musculoskelet and nervous ngokubuyisela ngokugqibeleleyo ukulungelelaniswa kokuqala komgudu ngokusebenzisa ukuguqulwa komgudu kunye nokusetyenziswa kwamanyathelo, phakathi kwezinye iindlela zokwelapha . Injongo yokhathalelo lwe-chiropractic kukuba ngokwemvelo ukwandise amandla omzimba womntu ukuba aziphilise ngaphandle kwemfuno yeziyobisi / amachiza kunye / okanye utyando. I-chiropractor inganika iindlela ezahlukeneyo zonyango ngokuxhomekeke kwimvelaphi yesifo somlwelwe wesigulane. Isicwangciso sonyango esifanayo intlungu ye-nerve eyenziwa ngu-chiropractor ingabandakanya ukulungiswa komgudu kunye nokunyanzeliswa kwemigaqo, imichiza ye-ice / ebandayo yokunciphisa ukuvuvukala, i-ultrasound ukwenzela ukunyuka kwee-TENS okanye i-transcutaneous nerve stimulation kunye nokuguqulwa kwendlela yokuphila, njengengcebiso enesondlo, iingcebiso zezempilo kunye nokucwangcisa ubuthongo. Ezinye iindlela zonyango eziqhelekileyo ezisetyenziselwa ukwenziwa kwe-chiropractor ukuphatha i-sciatica zibandakanya, unyango lwe-flexion-distraction, unyango lwe-spinning decompress kunye ne-McKenzie unyango.

Ukwelashwa kwe-Flexion-ukuphazamiseka yinkqubo enyantyenziswano eyenziwa ngentlungu kunye nentwasa yangemuva eyenza ukuphakama kwediski ye-intervertebral ukuphakamisa, ukuvumela i-disc nganye ukuba ithathe isikhundla sayo esisisiseko ukuze kunciphise ukuxhatshazwa, kunciphisa ukucaphuka komlenze womgudu nokuphucula ukujikeleza. Ukwelashwa kwe-Flexion-ukuphazamiseka kunokubuyisela imisebenzi yomzimba kwakunye nokunciphisa intlungu. Ulwaphulo lwe-decompression unyango luquka ukunweba phakathi komgudu ngendlela elawulwayo usebenzisa itafile yokulandelela okanye ifowuni efana neyolo ukudala uxinzelelo olubi lwe-intradiscal ukwenzela ukuphelisa intlungu emva kunye / okanye ukugqithisa intlungu ngokukhuthaza indlela yokuphilisa izondlo kwi-disc kunye nokubonelela indawo engcono yokuphilisa i-disc okanye i-disnied discs. Kwaye ekugqibeleni, unyango lweMcKenzie luyindlela ehambelana nokuhlola kunye nokunyangwa kwe-sciatica. Inkqubo yokwelapha idinga isigulane ukuba ithathe inxaxheba kwizinto eziphathekayo ukwenzela ukuvavanya impendulo yesigulane yesigulane kunye nokuchonga umba wezempilo. Ulwaphulo lweMcKenzie ke lusebenzisa olo lwazi ukuphucula umgangatho wokuzivocavoca ngokujolise ekunciphiseni iimpawu ezibuhlungu.

Nangona ukhathalelo lwe-chiropractic yindlela ekhuselekileyo yendlela yokwenza unyango oluqhelekileyo olusetyenziselwa ukunyanga iimpawu ze-sciatica, i-sciatica ibangelwa ziziintlupheko ezingaphezu komda wokunyamekela kwe-chiropractic. Ukuba ugqirha we-chiropractic, okanye i-chiropractor, unquma ukuba isifo sesigulane sidinga unyango oluvela kwelinye uhlobo lweengcali, zingabhekisela omnye umntu kwizonyango zonyango ukuze zonyango. Kwiimeko ezininzi, i-chiropractor ekubhekiselele inokuqhubeka nokunyamekela ngonyango xa ilawula ukunyanga kwesigulane nenye ingcali. Ukongezelela, injongo yolu nqaku lulandelayo kukubonisa izikhokelo ezahlukeneyo zonyango malunga nokuxilongwa nokunyangwa kwe-sciatica. Nangona kunjalo, ngenxa yokuba ulwazi malunga nokusabalalisa komthombo we-sciatica kunye nokuphendula kwayo kwiindlela ezithile zonyango kunqongophala, uphando olongezelelweyo luphinda lufuneka ukuba lunqume ukusebenza kakuhle kwezikhokelo zonyango ezikhankanywe ngezantsi.

Ukuxilongwa kunye noTyango lweSciatica

I-Sciatica ithinta abantu abaninzi. Iimpawu ezibalulekileyo zibangela ukuba intlungu yomlenze kunye nokukhubazeka okuhlobene. Izigulane zivame ukuphathwa kunyango lokuqala kodwa inxalenye encinci ibhekiswa kwinkathalelo yesibini kwaye ekugqibeleni inokuhlinzwa. Uninzi lweentetho ze-sciatica zivela kwiincwadi, ezinjenge-lumbosacral radicular syndrome, i-ischias, intlungu yesisu, kunye neengcambu zengcambu.

Isishwankathelo Amaphupha

• Uninzi lwezigulane ezine-sciatica eziqatha zibonisa ukulungelelanisa kodwa malunga ne-20% -30% ineengxaki eziqhubekayo emva kweminyaka emibini okanye emibini
• Ukuxilongwa kusekelwe kwimbali ethatha kunye nokuhlolwa komzimba
• Ukufanekisa kuboniswa kuphela kwizigulane ezineemeko zeflegi ebomvu okanye apho utyando lwediski luqwalaselwa
• Ukuphumla (ukuphumla kwesibhedlele) unyango luye latshintshwa ngokunyanga ngakumbi
• Ukuvunyelwene kukuba unyango lokuqala luyalondolozwa malunga nee-6-8 iiveki
• Utyando lwe-disc lunokunika uncedo olukhawulezayo lwentlungu yomlenze ngaphandle kokunyamekela okuzinzileyo kodwa akukho mvelaphi ecacileyo ifumaneke emva kweyodwa okanye emibini iminyaka

Ngokumalunga ne-90% yeemeko ze-sciatica zibangelwa i-disc ye-herniated kunye noxinzelelo lweengcambu ze-nerve, kodwa i-lumbar stenoses kunye (kancinci kaninzi) i-tumor zizizathu ezinokwenzeka. Ukuxilongwa kwe-sciatica kunye nolawulo lwayo kuyahluka kakhulu ngaphakathi naphakathi kwamazwe-ngokomzekelo, amazinga otyando lwe-lumbar discectomy ayahluka kakhulu phakathi kwamazwe.[w1] Ukupapashwa kwamva nje kuqinisekisile le ntlukwano enkulu kwi-disc operation, nakwamanye amazwe.[1] Oku kunokuthi kubangelwa ukungabikho kobungqina kwixabiso lokuxilonga kunye nokungenelela kwonyango kunye nokungabikho kwezikhokelo ezicacileyo zekliniki okanye ukubonakalisa ukungafani kwiinkqubo zonyango kunye ne-inshurensi. Olu phononongo lubonisa imeko yangoku yesayensi yokuxilongwa kunye nokunyangwa kwe-sciatica.

Imithombo kunye neCandelo lokukhetha

Siqaphele ukuphononongwa ngokuchanekileyo kwiLibrari yaseCochrane ukuvavanya ukusebenza kobuchule bokungenelela kunye nocwangco kwi-sciatica. I-Medline ifuna ukususela ngoDisemba i-2006 eyenziwa ukufumana ezinye iimviwo ezichanekileyo malunga nokuxilongwa nokunyangwa kweentlungu eziphantsi. Amagama angundoqo ayenayo i-sciatica, i-hernia nuclei pulposi, i-ischias, i-root entrapment, i-review review, i-meta-analysis, i-diagnostic, kunye neyeza. Ukongezelela sasebenzise iifayile zethu zezinye iinkcukacha, kubandakanywa iimpapasho zoluvavanyo lwangoku nje. Ekugqibeleni sahlola ukufumaneka kwezikhokelo zeklinikhi.

Insight of Dr. Alex Jimenez

I-Sciatica ichazwa ngokuchanekileyo njengeqela elidibeneyo leempawu, kunokuba yingozi enye okanye / okanye imeko, eyaziwayo ngokugqithisa intlungu kwi-nerve ye-sciatic engaphantsi, ehamba phantsi emacaleni nasemilenzeni nasemilenzeni. I-Sciatica ngokuqhelekileyo ivela ngapha kwelinye icala lomzimba nangona ayisoloko ichaphazela emacaleni omabini omzimba womntu. Intlungu ye-nerve ye-sciatic ingabonakalisa ngenxa yeemeko ezinobungozi kunye / okanye iimeko, ezifana ne-bulging okanye i-disniated disc, enokukwenza kube nzima kubaqeqeshi bezempilo ukuba baphathe kakuhle. Indima ye-chiropractor kukubona umthombo wesigulane sogulane ukuze usebenzise indlela engcono yokonyango kwimiba ethile yempilo. I-chiropractor, okanye ugqirha we-chiropractic, uya kusebenzisa ngokutshintshwa kwe-spinal kunye neendlela zokunyanga, phakathi kwezinye iindlela zokonyango, ukubuyisela ngokugqibeleleyo intembeko yangaphambili yomgudu nokuphucula iimpawu ze-sciatica. Ukunyamekela kwe-Chiropractic kunokunyusa umzimba womntu ukuba uphilise ngokwasemvelo.

Ngubani Ofumana iSciatica?

Idatha echanekileyo kwiimeko kunye nokusabalalisa kwe-sciatica ayinakho. Ngokubanzi ukuqikelelwa kwe-5% -10% yezigulane ezineentlungu eziphantsi kwe-back sciatica, kanti ubude bexesha elibiweyo lobunzima beentlungu ezibuhlungu ukusuka kwi-49% ukuya ku-70%. [W2] Ukwanda kobungakanani be-sciatica edibeneyo kubantu bonke Uqikelele kwi-2.2%. [2] Iimbalo ezimbalwa zengxaki zomntu kunye nezomsebenzi zakwa-sciatica ziye zabikwa, kubandakanywa ubudala, ukuphakama, uxinzelelo lwengqondo, ukutshaya ugwayi, kunye nokuxhamla kwizithuthi. [2, 3, w2] Ubungqina bombutho phakathi kwe-sciatica kunye nesondo okanye ukuqina komzimba kuphikisana. [2, 3, w2]

Izinto ezinobungozi kwiSciatica eqhelekileyo [3, w2]

Izinto zobuqu

• Ubudala (i-45-64 iminyaka)
• Ukwanda kwengozi ngokuphakama
• ukutshaya
• Ukukhathazeka kwengqondo

Izinto zokusebenza

• Umsebenzi onzima womzimba�umzekelo, ukuphakamisa rhoqo, ngakumbi ngelixa ugoba kwaye ujija
• Ukuqhubela phambili, kuquka ukuguqulwa komzimba wonke

I-Sciatica ichongwa njani?

I-Sciatica ixilongwa ngokubanzi ngembali kunye nokuhlolwa kwangokwenyama. Ngengcaciso yezigulane zikhankanya intlungu ebangelwa ngumlenze. Basenokucelwa ukuba babike ukusabalalisa intlungu kwaye ingaba kukhanya ngaphantsi kweedolo kunye nemidwebo ingasetyenziselwa ukuvavanya ukusasazwa. I-Sciatica ibonakala ngokugqithisa intlungu elandela umzekelo wesondlo. Izigulana nazo ziyakuchaza iimpawu zengqondo.

Uvavanyo lomzimba ubukhulu becala luxhomekeke kuvavanyo lwemithambo-luvo. Olona phando lusetyenziswayo luvavanyo lokuphakamisa umlenze othe ngqo okanye uphawu lukaLas'gue. Izigulane ezine-sciatica zinokuba neentlungu ezisezantsi kodwa oku kudla ngokuba nzima kakhulu kuneentlungu zomlenze. Ixabiso lokuxilonga kwimbali kunye nokuhlolwa komzimba akuzange kufundwe kakuhle.[4] Akukho zinto zembali okanye iimvavanyo zovavanyo lomzimba zinovakalelo oluphezulu kunye nokucaciswa okuphezulu. Uvakalelo oludityanisiweyo lovavanyo lokuphakamisa umlenze othe ngqo luqikelelwa ukuba luyi-91%, kunye neenkcukacha ezidityanisiweyo ezihambelanayo ze-26%. Uvavanyo kuphela oluneenkcukacha eziphezulu luvavanyo lokuphakamisa umlenze othe tye, kunye neenkcukacha ezihlanganisiweyo ze-5% kodwa uvakalelo lwe-88% kuphela. Ngokubanzi, ukuba isigulane sichaza intlungu eqhelekileyo emlenzeni omnye idibene nesiphumo esihle kwisinye okanye iimvavanyo ezininzi ze-neurological ezibonisa ukunyanzeliswa kweengcambu ze-nerve okanye i-neurological deficit ukuxilongwa kwe-sciatica kubonakala kulungile. Ngezantsi kubonisa iimpawu kunye neempawu ezinceda ukwahlula phakathi kwe-sciatica kunye neentlungu ezingabonakaliyo ezisezantsi.

Iimpawu zeSciatica [w5]

• Unilateral intlungu yomlenze omkhulu kuneentlungu ezisezantsi
• Ubunzima buya kuhamba ngeenyawo okanye ezinzwaneni
• Ubungqina kunye neparesthesia kwindawo efanayo
• Ukuvavanywa komlenze ochanekileyo kukhuthaza intlungu yomlenze
• I-neurology yasekhaya-oko kukuthi, kuphela kwingcambu yemithambo-luvo enye

Yiyiphi ixabiso leeMifanekiso?

I-Diagnostic imaging iluncedo kuphela ukuba iziphumo zinefuthe kulawulo olongezelelweyo. Kwi-sciatica ebukhali ukuxilongwa kusekelwe kwimbali yokuthatha kunye nokuhlolwa komzimba kunye nonyango olulondolozayo (olungenalo utyando). Ukufanekisa kunokuboniswa kweli nqanaba kuphela ukuba kukho izibonakaliso okanye "iiflegi ezibomvu" ukuba i-sciatica inokubangelwa zizifo eziphantsi (izifo, izifo ezinobungozi) kunokuba i-disc herniation.

Ukucatshulwa kweso sifo kungabonakaliswa kwizigulane ezineempawu ezinzima ezingaphenduliyo kwiinkathazo ze-6-8. Kule meko ukuhlinzwa kunokuqwalaselwa kunye nokucinga okusetyenziswayo ukuchonga ukuba i-disc ye-herniated enexinzelelo yeengcambu ikhona kunye nendawo yayo kunye nobukhulu bayo. Kubalulekile njengenxalenye yesigqibo sokusebenza ukuba iziphumo zeekliniki kunye neempawu zihambelana kakuhle neziphumo zokukhangela. Oku kubaluleke ngakumbi kuba iirekhodi ezichongiweyo zibonakaliswe i-tomography okanye i-magnetic imagination resonance (20% -36%) kubantu abangenayo impawu abangenayo i-sciatica. [6, w3] Kubantu abaninzi abaneempawu zekliniki ze-sciatica i-disc ye-disc ikhona kwi-scans. [7, 8] Okwangoku akukho hlobo lunye lendlela yokucambula ibonisa inzuzo ecacileyo kwabanye. Nangona abanye ababhali bethanda ukuboniswa kwemifanekiso emagqabini ngaphezu kwamanye amacandelo okucinga, kuba i-tomography ekhompyutheni inomthamo ophezulu ophezulu wamayeza okanye ukuba izicubu ezinomsoco zibonakaliswa bhetele, ubungqina bokuba [9, 10] bubonisa ukuba bobabini bachanile ngokuchanekileyo ekufumaneni i-disc. ukuxilongwa kwe-lumbar disc herniation ayikhuthazwa kuba iidiski azikwazi ukuboniswa x ray. [11]

Ziyintoni i-Prognosis?

Ngokuqhelekileyo inkqubo yeklinikhi ye-sciatica enzima iyanceda kwaye intlungu eninzi kunye nokukhubazeka okuhambelanayo kusombulula kwiiveki ezimbini. Umzekelo, kwisilingo esingenakulinganiswayo esithelekisa izidakamizwa ezingekho-steroidal ezichasayo kunye ne-placebo ze-sciatica eziphambili kwiinkathalo eziphambili 60% yezigulane zifunyenwe kwisithuba seenyanga ezintathu kunye ne-70% kwiinyanga ze-12. [12] Mayelana ne-50% yezigulane ezinzima i-sciatica efakwe kumaqela e-placebo kwizilingo ezingekho ngophakanyiso zokungenelela kungaboniswa ngcono kwiintsuku ze-10 kwaye malunga ne-75% yabika ukuphuculwa emva kweeveki ezine. [13] Kwizona zigulane ngoko ke isigulane sisilungile, kodwa ngelo xesha ixabiso eliphezulu (up ku-30%) uyaqhubeka enentlungu omnye okanye ngaphezulu. [12, 13]

Ziziphi iiNkqubo zoLoQoqosho lweZonyango kwiSciatica?

Unyango olulondolozo lwe-sciatica lujoliswe ngokutsha ekunciphiseni ubuhlungu, mhlawumbi ngo-analgesics okanye ngokunciphisa uxinzelelo kwiingcambu zenzwa. Uhlolo olutshanje olutshanje lufumene ukuba unyango olulondolozayo aluphuculanga ngokucacileyo inkqubela yemvelo ye-sciatica kwizigulane ezininzi okanye ukunciphisa iimpawu. [14] Ngokucacileyo ukuxelela izigulane malunga nezizathu kunye nokulindela okulindelekileyo kunokuba yinxalenye ebalulekileyo yesicwangciso solawulo. Nangona kunjalo, ukufundisa izigulane malunga ne-sciatica akukaphenywanga ngokuthe ngqo kwiilingo ezilawulwa ngokungenamthetho.

Ulwazi olungezantsi lushwankathela ubungqina bokusebenza kunyango oluqhelekileyo olufumanekayo lwe-sciatica, kubandakanywa unyango lwe-injection. Ubungqina obunamandla bempumelelo abukho kuninzi lwamangenelo akhoyo. Umehluko omncinci kwimpembelelo kwintlungu kunye nesimo sokusebenza sibonakaliswe phakathi kokuphumla kombhede kunye neengcebiso ngokuhlala usebenza.[15] Ngenxa yoku kufunyaniswa, ukuphumla ebhedini ixesha elide eyona nto iphambili yonyango lwe-sciatica ayisacetyiswa ngokubanzi.[w2, w4] I-Analgesics, iziyobisi ezingekho-steroidal ezichasana nokudumba, kunye neziphumlisi zemisipha azibonakali ngathi zinjalo. isebenza ngakumbi kune-placebo ekunciphiseni iimpawu. Ubungqina be-opioids kunye namachiza adibeneyo ahlukeneyo abukho. Uphononongo olucwangcisiweyo luchaze ukuba akukho bungqina bukhoyo bokutsalwa, amachiza angeyo-steroidal achasene nokudumba, i-intramuscular steroids, okanye i-tizanidine yongamile kune-placebo.[13] Olu phononongo lucebise ukuba inaliti ye-epidural ye-steroid inokusebenza kwizigulana ezine-acute sciatica.[13] Nangona kunjalo uphononongo olucwangcisiweyo lwamva nje lwenani elikhulu lolingo olungenamkhethe luchaze ukuba akukho bungqina beziphumo ezihle zexesha elifutshane lenaliti ye-corticosteroid kwaye iziphumo zexesha elide zazingaziwa.[14] Uphononongo olufanayo olucwangcisiweyo luchaze ukuba unyango olusebenzayo lomzimba (ukuzivocavoca) alubonakali lungcono kunokungasebenzi (ukuphumla kwebhedi) unyango kunye nolunye unyango olulondolozayo, olufana nokutsalwa, ukuguqulwa, iipakethi ezishushu, okanye ii-corsets).[14]

Amanqanaba oBungqina boNyango lweServatius for Sciatica

• Ukuphumla kwebhale (ukuhweba)
• Ukuhlala usebenzayo, ngokungafani nokuphumla kokulala (mhlawumbi kuya kunceda)
• Ama-analgesics okanye i-non-steroidal anti-inflammatory drugs, i-acupuncture, i-epidural steroid injections, i-spinal manipulation, i-traction yonyango, unyango lomzimba, unyango lokuziphatha, unyango oluninzi (ukungaziwa kakuhle)

Iyini indima yoBuloyiko kwiSciatica?

Ukungenelela kwindlela yokucwaninga kwi-sciatica kugxininise ekukhutshweni kwe-disc kunye nokugqitywa kwe-disc okanye kwi-staminosis ye-foraminal, ngenjongo yokuphelisa imbangela yokubanjelwa kwe-sciatica. Utyando lujoliswe ekunciphiseni ubuhlungu bomlenze kunye neempawu ezihambelanayo kwaye kungekhona ukunciphisa intlungu yangemva. Ukuvunyelwana kukuba i-cauda equina syndrome yinkcazo epheleleyo yokuhlinzwa ngokukhawuleza. Utyando olukhethiweyo lukhethiweyo lwe-unilateral sciatica. Kuze kube kutshanje nje kuphela uvavanyo olulandelelwano oludala olunokuthi lufumaneke xa kuthelekiswa ukungenelelo ngononophelo olulondolozo lwezigulane nge-sciatica. [16] Olu pho nonongo lubonise ukuba ukungenelela kokungaphazamiseka kwaba nemiphumo engcono emva konyaka owodwa, kanti emva kweminyaka emine kunye ne-10 yokulandelelana akukho kwahlukana. [16]

Ukuhlaziywa kweCochrane kusishwankathe uvavanyo olukhoyo olwenziwe ngeziphumo zonyango olucwangcisiweyo oluhlola ukuxilongwa kwediski kunye ne-chemonucleolysis. [17] Kwi-chemonucleolysis i-enzyme chymopapain ifakwe kwi-discus ngenjongo yokunciphisa i-nucleus pulposus. Ukuhlaziywa kubhengeze iziphumo ezingcono kwi-disc ukuhlinzwa ngaphandle kwe-chemonucleolysis kwizigulane ezine-sciatica ezinzima zobungakanani obude zihluka kwiiveki ezingaphezu kwezine ukuya kwiinyanga ezine. I-Chemonucleolysis yayisebenza ngakumbi kune-placebo. Ngendlela echanekileyo ke ukuhlaziywa kuphakanyiswe ukuba utyando lwe-disc lusebenza ngakumbi kune-placebo. Ngokweziseko zedatha kwizilingo ezintathu abalobi baphetha ngokuthi ubungqina buninzi bokuba i-discectomy ekhuselweyo inikezela ngokukhululeka kweekliniki kwizigulane ezikhethiweyo ngokuchanekileyo nge-sciatica ngenxa ye-lumbar disc eyenza ukuba ingakwazi ukujongana nokunyamekela. Ukuhlaziywa kwakutshanje kwafika kwisigqibo esifanayo. [18] Ukuhlaziywa kwe-Cochrane kuphinda kugqiba ukuba igalelo elide lexesha elide lokungenelela ngokugqithisileyo akucaci kwaye ubungqina besikhathi sokusebenza ngokugqithiseleyo asikho nto. [17]

Izilingo ezilawulwe ngokungaqhelekanga ezingakabandakanywa kwiZiko eziPhezulu

Uvavanyo olongezelelweyo olongezelelweyo olungaphendulwanga luye lwapapashwa ngokuqhathaniswa nokutyunjwa kwe-disc kunye nonyango olulondolozayo. Elinye ilingo (n = 56) lithelekisa i-microdiscectomy kunye neyeza ezinononophelo kwizigulane ezazingenayo i-sciatica ezintandathu ukuya kwii-12 iiveki. [19] Ngokubanzi, akukho nantlukwano ebalulekileyo ekufunyanwe yintlungu yomlenze, intlungu emva, phezulu. Noko ke, intlungu yomlenze, yabonakala iqalisa ngokukhawuleza kwizigulane kwiqela le-discectomy. Uvavanyo oluphezulu lwezigulane zeziphumo zesiganeko (uphando olungalindelekanga) kunye nolwazi oluthile oluhlolisayo lwamaqela aqhutyelwayo e-United States. [20, 21] Izigulane ezine-sciatica ubuncinane ubuncinane kwiiveki ezintandathu kwaye ziqinisekiswe ukuba zithatyathwa ukuba zithathe inxaxheba kwi-randomized isilingo okanye isifundo sokuhlolisisa amaqela. Izigulane kwilingo zazingenakucatshulwa kwi-disc okanye ukunyamekela. Izigulane kwisifundo seqela sanikwa utyando lwe-dis okanye ukunyamekela okulondoloziweyo ngokusekelwe kukhetho lwabo. Kwilingo le-randomized trial (n = 501) zombini amaqela okhathazwa aphuculwe ngaphezu kweminyaka emibili kuzo zonke iziphumo zephondo eziphambili neziphambili. Ulwahlulo oluncinci lufunyenwe ngokukhethekileyo iqela lokuhlinzwa, kodwa ezi zinto zazingabalulekanga kwiimpawu zephondo eziphambili. Kuphela i-50% yezigulane ezikhethiweyo zonyango ezifunyenwe ngunyango ngaphakathi kweenyanga ezintathu zokubandakanywa xa kuqhathaniswa ne-30% engenakucetyiswa ekunyamekelweni okuzinzileyo. Emva kweminyaka emibini yokulandelelana i-45% yezigulane kwiqela lokunyamekela elisebenzayo liye lahlinzwa ngokuqhathaniswa ne-60% kwiqela lokuhlinzwa. [20]

Iqela lokuqwalasela liquka izigulane ze-743. La mabini maqela athuthuke kakhulu kwixesha, kodwa iqela lotyando libonisa iziphumo ezingcono kakhulu zentlungu nomsebenzi xa kuthelekiswa neqela elilondolozayo. Ababhali bathetha ukuqaphela ekuchazeni iziphumo ngenxa yokuba kunokuphazamiseka ngumbonakaliso kwaye ngenxa yokuba iziphumo zempembelelo zazixeliwe. [21]

Iziphumo zibonisa ukuba unonophelo olunyamekileyo kunye nokuhlinzwa ngediski zikhetho ezifanelekileyo zokonyango kwizigulane ezine-sciatica ubuncinane ubuncinane beveki ezintandathu. Ingenelelo ngoncedo lunokunika uncedo olukhawulezayo lweempawu xa kuthelekiswa nokunyamekela, kodwa akukho mfahluko omkhulu ofunyenwe kwizinga lokuphumelela emva kweminyaka emibini okanye emibini yokulandelelana. Izigulane kunye noogqirha banokuthi banzima ubuncwane kunye neziphumo ezinokuzikhethela. Oku kubaluleke ngakumbi kuba ukhetho lwezigulane unyango lunokuba nomthelela othe ngqo kummandla wonyango.

Ziziphi iiNcomo kwiZikhokelo zeKlinikhi?

Nangona kumazwe amaninzi izikhokelo zeklinikhi ziyafumaneka ekulawuleni iintlungu ezingezizo ezikhethekileyo ezisezantsi oku akunjalo kwi-sciatica.[22] Ngezantsi kubonisa iingcebiso ze-sciatica (i-lumbosacral radicular syndrome) kwizikhokelo zekliniki ezisanda kukhutshwa yiKholeji yaseDutch ye-General Practice. . Unyango lokuqala luyi-conservative, lugxininise kakhulu kwimfundo yesigulane, iingcebiso zokuhlala zisebenza, ukuqhubeka nemisebenzi yemihla ngemihla, kunye nonyango olwaneleyo lwentlungu. Kwesi sigaba umfanekiso awunandima. Ukuthunyelwa kwingcali yezonyango-umzekelo, i-neurologist, i-rheumatologist, ugqirha wotyando-kuboniswa kwizigulane ezineempawu ezingaphucukanga emva konyango olulondolozayo ubuncinane kwiiveki ezi-4-6. Kwezi meko zigqithisiweyo utyando lunokuqwalaselwa. Ukuthunyelwa ngokukhawuleza kuboniswa kwiimeko ezine-cauda equina syndrome. I-acute i-acute paresis okanye i-progressive paresis zizizathu zokuthunyelwa (kwiintsuku ezimbalwa).

Isikhokelo soKlinikhi soNgcaciso kunye nokuPhathwa kweSciatica ukusuka kwiKholeji yaseDutch yokuSebenza jikelele [w4]

Ukuqondwa

• Khangela izibheno ezibomvu zeepaki, ezifana neziphambano, i-osteoporotic fractures, i-radiculitis, kunye ne-cauda syndrome
• Thatha imbali ukujonga indawo; bunzima; ukulahleka kwamandla; iziphazamiso zengqondo; ixesha; khosi; impembelelo yokukhwehlela, ukuphumla okanye ukuhamba; kunye nemiphumo yemihla ngemihla
• Yenza uvavanyo lomzimba, kubandakanywa novavanyo lwemithambo-luvo�umzekelo, uvavanyo lokuphakamisa umlenze othe ngqo (uphawu lukaLaségue)
• Yenza olu vavanyo lulandelayo kwiimeko ezinomzekelo we-dermatomal, okanye umphumo omuhle kuvavanyo lokuphakamisa umlenze othe tye, okanye ukulahleka kwamandla okanye ukuphazamiseka kwengqondo: i-reflexes (i-Achilles okanye i-knee tendon), uvakalelo lwamacala asecaleni kunye naphakathi kweenyawo kunye neenzwane, amandla inzwane enkulu ngexesha lokwandiswa, ukuhamba ngeenzwane kunye nesithende (umahluko wasekhohlo-ekunene), wawela uphawu lukaLasgue
• Ukucinga okanye iimvavanyo zokuxilongwa kweelabhu kuboniswa kuphela kwiimpawu zebhanki ezibomvu kodwa aziluncedo kwiimeko zokunqanda ukukhishwa kwe-disc

impatho

• Chaza imbangela yeempawu kwaye uqinisekise izigulane ukuba iimpawu zivame ukunciphisa ngokuhamba kwexesha ngaphandle kwemilinganiselo ethile
• Ukucebisa ukuba uhlale usebenza kwaye uqhubeke nemisebenzi yemihla ngemihla; Iiyure ezimbalwa zokuphumla komntu zokulala zingabonelela ngenye indlela ekhululekayo kodwa ayiphumeleli ngokukhawuleza
• Ukunikezela iziyobisi, ukuba kuyimfuneko, ngokwemanyathelo amane: (1) i-paracetamol; (2) izidakamizwa ezingekho-steroidal ezichasayo; (3) tramadol, i-paracetamol, okanye i-non-steroidal isalathisi esinokutsha ngokudibanisa ne-codeine; kunye (4) morphine
• Jonga kwi-neurosurgeon ngokukhawuleza kwiimeko ze-cauda syina syndrome okanye i-paresis enamandla okanye i-paresis eqhubekayo (kwiintsuku ezimbalwa)
• Jonga i-neurologist, i-neurosurgeon, okanye ugqirha wamazinyo ukuze uhlolisise utyando kwiimeko zeentlungu eziphazamisekayo ezingapheliyo (ezingaphenduliyo kwi-morphine) okanye ukuba intlungu ayifuni emva kweeyure ze-6-8 zokunyamekela

Uthembisa ukuphuhlisa

Ubungqina obuninzi obunikwe ulwazi luye lwafumaneka kwiinkqubela zokunyamekela ngophando oluqhathaniswa nokunyamekela ngokunyamekela izigulane ezine-sciatica. Nangona ubungqina buphelelanga, iziphumo zokuqala zibonisa ukuba akukho mvelaphi ebalulekileyo kwixesha elide (elilodwa okanye emibini) eliphakathi kwezi ndlela ezimbini. Oku kufunyanwe kungachazwa ngenye indlela ngezigulane ezathi zaqala ukunyamekelwa ngononophelo emva kokuhlinzwa. Kuzo zonke iziphumo ezikhoyo kubonakala ukuba ininzi yezigulane ziphucula ixesha elide. Oku kunyanzelekile kwizigulana ezithatha ukuhlinzwa okanye ukufumana unyameko. Izigulane ezithatha ukuhlinzwa kwi-disc ziyakwazi ukufumana uncedo olukhawulezayo lweempawu zomlenze kunezigulane ezithotywayo. Ukuba iimpawu aziphuculanga emva kwee-6-8 iiveki ezigulane zingakhetha ukuhlinzwa. Abo banqabileyo malunga nokuhlinzwa kwaye banokujamelana neempawu zabo banokukhetha ukunyamekela. Ukunyamekela umonde ngoko kubaluleke kakhulu kwinkqubo yesigqibo.

Ekubeni phakathi kwe-1990 ishintshi senzekile ekulawuleni i-sciatica ukusuka kwindlela yokunyanga, njengendlela yokuphumla kwebhedlele, kwindlela ekhutheleyo, kunye nezigulane zikwacetyiswa ukuba ziqhubeke nemisebenzi yazo yansuku zonke ngangokunokwenzeka.

Uphando lwexesha elizayo

Ulwazi oluninzi lufunekayo ngokubaluleka kweempawu kunye neempawu zekliniki zokugxekwa kwe-sciatica kunye nokuphendula kwonyango. Oku kubandakanya ukubaluleka kobukhulu kunye nendawo ye-disc, ukuxinwa kweengcambu ezibonakalayo, ukulandelelana, kunye neziphumo zembali ezithathayo kunye neemviwo zenyama kunye negazi. Uhlalutyo lwamagqabantshintshi kwilingo le-Finnish lubonise ukuba i-discectomy iphezulu kunonyango olulondolozayo kwizigulane ezine-disc ukunikezelwa kwe-L4-5. [23] Akukho bukho ubungqina obuchanekileyo obukhoyo okanye ngokuchasene nokusebenza kwamanyango amaninzi athatywayo. Inkqubela enkulu ingafumaneka apha. Imibuzo ihleli malunga nokuphumelela kwee-analgesics ze-sciatica kunye nexabiso leyeza kunyango kunye nemfundo yesigulane kunye nokucebisa. Akukho vavanyo liye lwavavanya ukuphumelela kwonyango lokuziphatha kunye neenkqubo ezininzi zonyango.

I-Tumor necrosis factor ? ichongiwe kwizilwanyana kunye nezifundo zabantu njengenye into ekuphuhlisweni kwe-sciatica. umchasi kwizigulane ezine-sciatica akafumananga siphumo esihle. [23]

Izibonelelo ezongezelelweyo zeMfundo

• I-BMJ Clinical Evidence (www.clinicalevidence.org)�Ubungqina obuhlaziyiweyo boogqirha malunga nezibonelelo kunye nomonakalo wonyango lwezifo ezahlukeneyo
• Iqela leComman Review Review (www.cochrane.iwh.on.ca)�Imisebenzi yeqela lokuphonononga elinoxanduva lokubhala uphononongo olucwangcisiweyo lweCochrane malunga nokusebenza konyango lweentlungu ezisezantsi kunye ne-sciatica.
• Intlungu ebuhlungu emva: izikhokelo zolawulo lwazo (www.backpaineurope.org)�Kutshanje kukhutshwe izikhokelo zolawulo lweentlungu ezisezantsi kunye ne-sciatica evela kwiKhomishini yoPhando yoPhando Jikelele yaseYurophu.

Umbono weMonde (A)

Emva kwesiganeko se-lumbago ngexesha lekhefu ndandisoloko ndineentlungu ezisezantsi kunye neenyawo ezinqabileyo malunga neenyanga ezilisithoba. Emva kwangoko unyawo lwam kunene lwaqala ukulimaza kakubi kwaye emva kwexesha intlungu yaba nzima kangangokuba ndandingakwazi ukushiya indlu yam. Ingcali yayalela i-MRI (imagination magnontic resonance imaging) kwaye yachaza i-disc lniar disniation. Ekubeni kwande ngakumbi emva koko ndagqiba ekubeni ndisebenze utyando.

Emva komsebenzi ndafumana ngokukhawuleza kwaye intlungu yomva kunye nentlungu yomlenze yayiphelile. Ngokukhawuleza ndakwazi ukubuyela emsebenzini kwaye ndakha kabusha ubomi bam yentlalo. Ngelishwa emva emva kweenyanga ezimbalwa iintlungu ezisezantsi kunye nezinye iimpawu ezibuyiselwe, nangona zingekho ezinzima njengoko ngaphambili kokuhlinzwa. I-scan entsha ye-MRI ibonakalisile iimbonakaliso ezimbini ezincinci kunye nee-disc intervertebral ezimbini. Iingcali zandixelela ukuba kwakuselula kakhulu ukusebenza okwesibini.

Ngoku akucaci kum ukuba ugqirha unokukwenza ntoni kwaye andazi nawaphi na amanyathelo endinokuzenza. Ukuphindaphinda umva kunye nentlungu yomlenze kuphazamisa kakhulu umsebenzi wam kunye nobomi bentlalo. Ngamanye amaxesha ndivakalelwa njengomntu osekhulile ngenxa yamandla omzimba. Ndizama ukuhlala ndilungile, kodwa kunzima ukujamelana nokungaqiniseki.

C Penning, osekudala 32, Rotterdam

Umbono weMonde (B)

Izikhalazo zam zaqala malunga neenyanga ezine ezidlulileyo ngeentlungu kumqolo ongezantsi. Kungekudala emva kokuba iintlungu zangena emilenzeni yam, apho ndaya kugqirha wam jikelele. Uhlalutyo lwakhe lwalungekho i-disc ye-herniated. Ukuthomalalisa izihlunu kudityaniswe nokuthunyelwa kwiphysiotherapist kunokunciphisa iimpawu. Iiveki ezintathu ze-physiotherapy ezilandelwa unyango oluninzi yi-chiropractor aluzange lubonelele naluphi na uncedo lweempawu. Enyanisweni iimpawu ziye zaba mandundu ngakumbi ngexesha lokuhamba nokuma. Ukungqengqa nokukhwela ibhayisekile kwakunyamezela ngakumbi. Izikhalazo ezongezelelweyo zancitshiswa amandla emlenzeni osekhohlo, ukungakwazi ukuma kwisithende okanye iinzwane, ukuvakalelwa okubandayo emlenzeni ophantsi ekupheleni kosuku, ngelixa kusasa kwakufana nokuma kwintlambo yeenaliti.

Phantse inyanga enye edlulileyo i-neurologist ifumene i-disc ye-herniated ngakwesokunene esekelwe kwi-scan ye-MRI eyathathwa. Nangona kunjalo, oku akukwazanga ukuchaza iimpawu kumlenze wesobunxele. Iimpawu kumlenze wesobunxele zingabangelwa ngenxa yokuguliswa kwesisu. Izikhalazo zazingenakwaneleyo ukuncomela ukuhlinzwa kwaye i-neurologist yandixelele ukuba uphuculo oluninzi lwalukulindeleke kwiinyanga ze-3-4. Iseluleko sakhe kwakufuneka uqhubeke nemisebenzi yemihla ngemihla ngangokunokwenzeka. Okwangoku (inyanga enye emva koko) ndivakalelwa ukuphucula iimpawu zam.

J Vreuls, oneminyaka eyi-49, iHague

Izinto ezongezelelweyo

Iingxelo zewebhu: www.ncbi.nlm.nih.gov/pmc/articles/PMC1895638/bin/bmj_334_7607_1313__index.html

amaNqaku

• Abaxhasi: I-BWK yabhala iqulunqa lokuqala. I-MWvT kunye ne-WCP ngokukhawuleza zivezwe kwaye zaphucula lo mbhalo. BWK ngumgcini
• Injongo yokunyanzela: Akukho nto ipapashwe.
• Iprovenance kunye nokuhlolwa koontanga: Misele; oontanga bahlaziywa.

Ukuququmbela,Ukhathalelo lwe-chiropractic lukhetho lonyango olulolunye oludumileyo oludla ngokusetyenziswa ukunyanga iimpawu ze-sciatica. Nangona intlungu ye-nerve ye-sciatic ingenzeka ngenxa yokulimala okuhlukeneyo kunye / okanye iimeko, injongo yokunyamekela kwe-chiropractic kukufumanisa umthombo we-sciatica yesigulane ukuze uphathe ngokufanelekileyo iimpawu zabo usebenzisa iindlela ezahlukeneyo zonyango. Eli nqaku lingasentla libonisa izikhokelo ezininzi zonyango lwe-sciatica, nangona kunjalo, uphando olongezelelweyo lophando luyafuneka. Ulwazi olubhekiselele kwiZiko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nokulimala komgogodla kunye neemeko. Ukuxoxa ngombandela, nceda uzive ukhululekile ukubuza uDkt Jimenez okanye uqhagamshelane nathi 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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