I-Disc Bulge kunye ne-Herniation Chiropractic Care Overview

I-Disc bulge kunye ne-disc herniation zezinye zeemeko eziqhelekileyo ezichaphazela umqolo wabaguli abancinci nabaneminyaka ephakathi. Kuqikelelwa ukuba malunga ne-2.6% yabemi base-US ngonyaka batyelela ugqirha ukunyanga ukuphazamiseka komgogodla. Malunga ne-7.1 yeebhiliyoni zeedola iyodwa ilahlekile ngenxa yexesha elikude nomsebenzi.

I-Disc herniation xa yonke okanye inxalenye ye-nucleus pulposus ikhutshwe ngokukrazula okanye ubuthathaka obungaphandle be-annulus fibrosus ye-intervertebral disc. Oku kwaziwa nangokuthi i-disc edibeneyo kwaye iyenzeka rhoqo kumqolo osezantsi, ngamanye amaxesha ikwachaphazela ummandla womlomo wesibeleko. I-Herniation ye-disc intervertebral disc ichazwa njengento yokufuduka kwendawo yediski kunye ne-25% okanye ngaphantsi kwe-disc circumference kwi-MRI scan, ngokutsho kweNorth American Spine Society 2014. I-herniation ingaba ne-nucleus pulposus, i-annulus fibrosus, i-apophyseal bone. okanye i-osteophytes, kunye ne-vertebral endplate cartilage ngokungafaniyo ne-disc bulge.

Kukwakho ikakhulu iintlobo ezimbini zedisc herniation. I-Disc protrusion xa i-focal okanye i-symmetrical extension ye-disc iphuma kwiindawo zayo kwi-intervertebral space. Ifumaneka kwinqanaba le-intervertebral disc, kwaye imicu yayo yangaphandle ye-annular ihambelana. I-disc extrusion xa i-disc intervertebral iqhubela phezulu okanye ngaphantsi kwe-vertebrae esondeleyo okanye i-endplates kunye neenyembezi ezipheleleyo ze-annular. Kulo hlobo lwe-disc extrusion, intamo okanye isiseko sincinci kune-dome okanye i-herniation.

I-disc bulge kuxa iifayili zangaphandle ze-annulus fibrosus zisuswa kwimida yemizimba ye-vertebral esondeleyo. Apha, ukufuduka kungaphezulu kwe-25% ye-circumference ye-disc intervertebral disc. Kananjalo ayinwebeki ngaphantsi okanye ngaphezulu kwemida yediski ngenxa yokuba i-annulus fibrosus attachment iyayikhawulela. Ihluke kwi-disc herniation kuba ibandakanya ngaphantsi kwe-25% ye-circumference disc. Ngokuqhelekileyo, i-disc bulge yinkqubo encinci kwaye ibanzi. I-disc bulge inokwahlulwa ibe ziindidi ezimbini. Kwi-bulge ejikelezayo, yonke i-disc circumference ibandakanyeka. Ngaphezulu kwe-90 degrees of the rim ibandakanyeka ngokulinganayo kwi-asymmetrical bulging.

I-Anatomy eqhelekileyo ye-Intervertebral Disc

Ngaphambi kokungena kwiinkcukacha malunga nenkcazo ye-disc ye-disc kunye ne-disc bulge, kufuneka sijonge i-disc intervertebral disc. Ngokwezikhokelo zomqolo kwi-2014, i-disc esemgangathweni yinto enemilo yeklasiki ngaphandle kobungqina bokutshintsha kwe-disc degenerative. Iidiski ze-Intervertebral zijongene nesinye kwisithathu ukuya kwisine sokuphakama komqolo womgogodla.

I-disc ye-intervertebral enye i malunga ne-7 -10 mm ubukhulu kwaye ilinganisa i-4 cm kwi-anterior-posterior diameter kwi-lumbar area of ​​the spine. Ezi diski zomgogodla ziphakathi kwemizimba emibini esondeleyo ye-vertebral. Nangona kunjalo, akukho diski inokufumaneka phakathi kwe-atlas kunye ne-axis kunye ne-coccyx. Malunga neediski ze-23 zifumaneka kumqolo, ezinesithandathu kwi-spine yomlomo wesibeleko, i-12 kwi-thoracic spine, kunye ne-XNUMX kuphela kwi-lumbar spine.

Iidiski ze-Intervertebral zenziwe nge-fibro cartilages, zenza i-fibrocartilaginous joint. Indandatho yangaphandle yediski ye-intervertebral yaziwa ngokuba yi-annulus fibrosus, ngelixa i-gel yangaphakathi-efana nesakhiwo esiphakathi yaziwa ngokuba yi-nucleus pulposus. I-cartilage endplates sandwich i-nucleus pulposus ephezulu kwaye ingaphantsi. I-annulus fibrosus iquka i-collagen fiber sheets edibeneyo ehlelwe kwi-radial tire-like structure kwi-lamellae. Iifiber zifakwe kwii-endplates ze-vertebral kwaye zijoliswe kwii-angles ezahlukeneyo. Ngenxalenye yabo ye-cartilaginous, i-endplates igxininise iidiski kwindawo yazo efanelekileyo.

I-nucleus pulposus yenziwe ngamanzi, i-collagen, kunye ne-proteoglycans. Iiproteoglycans zitsala kwaye zigcina umswakama, zinika i-nucleus pulposus i-hydrated gel-like consistency. Okubangel’ umdla kukuba, imini yonke, isixa samanzi esifumaneka kwinucleus pulposus siyahluka ngokwezinga lomsebenzi womntu. Olu phawu kwi-disc intervertebral lusebenza njenge-cushion okanye i-spinal shock-absorbing system ukukhusela i-vertebra esondeleyo, i-spinal nerve, intambo yomgogodla, ingqondo kunye nezinye izakhiwo ezichasene nemikhosi eyahlukeneyo. Nangona ukunyakaza komntu ngamnye kwiidiski ze-intervertebral kunqunyelwe, uhlobo oluthile lwe-vertebral motion efana ne-flexion kunye nokwandiswa kusenokwenzeka ngenxa yeempawu ze-disc intervertebral.

Iziphumo ze-Intervertebral Disc Morphology kulwakhiwo nomsebenzi

Uhlobo lwamacandelo akhoyo kwi-disc intervertebral disc kunye nendlela elungiselelwe ngayo ichaza i-morphology ye-disc intervertebral. Oku kubalulekile kwindlela idiski eyenza ngayo umsebenzi wayo ngokufanelekileyo. Njengoko i-disc iyona nto ibaluleke kakhulu ethwele umthwalo kwaye ivumela ukunyakaza kwi-spine eqinile, i-constituents eyenziwe ngayo inomthwalo obalulekileyo.

Ubunzima be-lamellae buyanda ngokukhula kweminyaka ngenxa yempendulo yokwenziwa kweeseli ze-intervertebral disc ukuya kwiinguqu kumthwalo womatshini. Olu tshintsho kwi-lamellae kunye ne-bifurcations eninzi, i-interdigitation kunye nobukhulu obungaqhelekanga kunye nenani leebhendi ze-lamellar ziya kukhokelela ekutshintsheni ukuthwala ubunzima. Oku kwakhona kuseka umjikelo wokuphazamiseka oqhubekayo okhokelela ekutshatyalalisweni kweediski ze-intervertebral. Yakube iqalisiwe le nkqubo ayinakuguqulwa. Njengoko kukho inani elongezelelweyo leeseli, isixa sesondlo esifunwa yi-disc siphinde sitshintshe i-gradient yoxinzelelo oluqhelekileyo lwe-metabolites kunye nezondlo. Ngenxa yokunyuka kwemfuno, iiseli zinokufa ngokwandayo nge-necrosis okanye i-apoptosis.

Ii-discs eziphakathi kwezidalwa zabantu zi-avascular kwaye ke ngenxa yoko izakhamzimba ziyahanjiswa kwimithambo yegazi ekufuphi kumda we-disc. Izondlo eziphambili; Ioksijini kunye neglucose ifikelela kwiiseli ezikwi-disc ngokusebenzisa ukungqinelana ngokomgangatho omiselwe ngumgangatho wokuthuthwa ukuya kwiiseli ngokusebenzisa izicubu kunye nenqanaba lokufunwa. Iiseli kwakhona zikhula ngokuvelisa i-lactic acid njengemveliso yokuphela kwe-metabolic. Oku kususwe ngokuhanjiswa kwee-capillaries kunye nee-venols ezibuyela umjikelezo.

Ekubeni ukusasazwa kuxhomekeke kumgama, iiseli ezilele kude kwii-capillaries zegazi zinokuba noxinzelelo oluncitshisiweyo lwezondlo ngenxa yokubonelela okuncitshisiweyo. Ngeenkqubo zesifo, i-disc ye-avascular intervertebral disc eqhelekileyo ingaba yi-vascular and innervated in degeneration kunye neenkqubo zezifo. Nangona oku kunokunyusa i-oksijeni kunye nokunikezelwa kwezondlo kwiiseli kwi-disc, oku kunokunika ezinye iintlobo ezininzi zeeseli eziqhelekileyo ezingafumanekiyo kwi-disc kunye nokuqaliswa kwe-cytokines kunye nezinto zokukhula.

I-morphology ye-disc ye-intervertebral kwiindawo ezahlukeneyo zomgudu iphinda ihluke nangona oogqirha abaninzi basekela iingcamango zeklinikhi ngokusekelwe ekucingeni ukuba zombini i-disc yomlomo wesibeleko kunye ne-lumbar intervertebral discs inesakhiwo esifanayo. Ukuphakama kwediski kwakubuncinci kwinqanaba le-T4-5 lekholomu ye-thoracic mhlawumbi ngenxa yokuba iidiski ze-thoracic intervertebral zinemilo engaphantsi kwe-wedge kunezo zemimandla yomlomo wesibeleko kunye ne-lumbar spinal.

Ukususela kwi-cranial ukuya kwi-caudal direction, indawo enqamlezayo yomqolo yanda. Ngoko ke, ngenqanaba le-L5-S1, i-nucleus pulposus yayihlala kwindawo ephezulu yendawo ye-disc intervertebral. Iidiski zomlomo wesibeleko zinemilo ye-elliptical kwi-cross-section ngelixa iidiski ze-thoracic zinesimo sesetyhula. Iidiski ze-lumbar nazo zinemilo ye-elliptical nangona iyancipha ngakumbi okanye iphinde ingene ngasemva.

Yintoni i-Disc Bulge?

I-disc ye-bulging xa i-disc ivele ikhuphe ngaphandle kwendawo yediski ye-intervertebral ngokuqhelekileyo ihlala ngaphandle kokuphuka kwe-fibrosus yangaphandle ye-annulus. Indawo ekhukhulayo inkulu kakhulu xa ithelekiswa nediski ye-herniated. Ngaphezu koko, kwi-disc ye-herniated, i-annulus fibrosus iqhekeza okanye iqhekeza. Nangona i-disc bulging ixhaphake kakhulu kune-disc herniation, ibangela intlungu encinci okanye akukho ntlungu kumguli. Ngokwahlukileyo, i-disc ye-herniated ibangela intlungu eninzi.

Oonobangela bokuDlwengulwa

I-disc bulging ingaba ngenxa yezizathu ezininzi. Inokuthi yenzeke ngenxa yeenguqu eziqhelekileyo ezinxulumene nobudala ezifana nezo zibonwa kwisifo se-disc degenerative. Inkqubo yokuguga inokukhokelela ekutshintsheni kwesakhiwo kunye ne-biochemical kwiidiski ze-intervertebral kwaye zikhokelela ekunciphiseni umthamo wamanzi kwi-nucleus pulposus. Olu tshintsho lunokwenza isigulane sisengozini kwi-disc bulges kunye ne-trauma encinci kuphela. Eminye imikhwa engafanelekanga yokuphila njengokuhlala uhleli kunye nokutshaya inokubangela le nkqubo kwaye ibangele utshintsho olubi ngakumbi ngokuncipha kwediski.

Ukunxiba ngokubanzi kunye nokukrazula ngenxa yemicrotrauma ephindaphindiweyo kunokuyenza buthathaka i-disc kwaye kunike i-disc bulging. Kungenxa yokuba xa iidiski zixinekile, ukuhanjiswa okuqhelekileyo kokulayisha ubunzima. I-Micro-trauma efunyenweyo ngaphezulu kwexesha elide inokwenzeka kwisithuba esibi. Ukuma okungalunganga xa uhleli, umile, ulele, kwaye usebenza kunganyusa uxinzelelo kwii-disc zangaphakathi.

Xa umntu egcina i-posture yokugoba phambili, kunokukhokelela ekugqithiseni kwaye ekugqibeleni ubuthathaka becandelo elingasemva le-annulus fibrosus. Ngokuhamba kwexesha, i-disc ye-intervertebral inokugquma ngasemva. Kwimisebenzi efuna ukuphakanyiswa rhoqo kunye nokuphindaphindiweyo, ukuma, ukuqhuba, okanye ukugoba, i-disc bulging ingaba yingozi emsebenzini. Ukunyuswa okungafanelekanga kwezinto, kunye nokungahambi kakuhle kwezinto ezinzima kunokunyusa uxinzelelo kumqolo kwaye kukhokelela kwi-disc bulges ekugqibeleni.

I-discs intervertebral bulging ngokuqhelekileyo iyenzeka kwixesha elide. Nangona kunjalo, iidiski zinokuthi ziqhume ngenxa yokwenzakala okukhulu. Umthwalo ongalindelekanga womatshini ongalindelekanga ungonakalisa idiski ekhokelela kwiinyembezi ezincinci. Emva kwengozi, i-disc ingaba buthathaka ibangele i-microdamage yexesha elide ekugqibeleni iholele ekuqhumeni kwe-disc. Kusenokubakho icandelo lofuzo kwi-disc bulging. Umntu unokuba noxinzelelo oluncitshisiweyo lwe-elastin kwi-annulus fibrosus kunye nokunyuka kwe-susceptibility kwizifo ze-disc. Ezinye iinyani zokusingqongileyo zinokudlala indima kule nkqubo yesifo.

Iimpawu ze-Disc Bulging

Njengoko bekutshiwo ngaphambili, i-bulging discs ayibangeli ntlungu kwaye nokuba benza ubukhali buthambile. Kwindawo yomlomo wesibeleko, esi sifo siya kubangela intlungu ehamba phantsi entanyeni, intlungu enzulu kwingingqi yegxalaba, intlungu ephuma kwingalo ephezulu, kunye ne-forearm ukuya kwiminwe.

Oku kunokukhokelela kwingxaki yokuxilonga ukuba ngaba isigulana siphethwe sisifo se-myocardial infosation njenge ndawo yentlungu ekhutshelweyo kunye neradi iyafana. Ukurhawula ukuziva usemqaleni kunokubakho ngenxa ye-bulging disc.

Kwingingqi ye-thoracic, kunokubakho intlungu kumqolo ongaphezulu ophuma kwisifuba okanye kwindawo ephezulu yesisu. Oku kunokuphinda kucebise i-gastrointestinal ephezulu, imiphunga, okanye i-cardiac pathology kwaye kufuneka ulumke xa uhlalutya ezi mpawu.

Iidiski ezinobundlobongela zommandla we-lumbar zinokubonakalisa njengobuhlungu obuphantsi ngasemva kunye nokuziva uziva umda kwindawo engezantsi yomqolo. Le yeyona ndawo iqhelekileyo yee-disc bulges kuba le ndawo ibambe ubunzima bomzimba wangaphezulu. Intlungu okanye ukungaphatheki kakuhle kungasasazeka ngommandla we gluteal, amathanga, nasezinyaweni. Kusenokubakho nobuthathaka bemisipha, ukuba ngundindisholo okanye ukuziva uvakalelo. Xa i-disc icinezela intambo yomgogodla, i-reflexes kuyo yomibini imilenze inokunyusa ikhokelela kwi-spasticity.

Ezinye izigulana zinokude zibe nokukhubazeka ukusuka esinqeni ukuhla. Xa i-disc bulging ixinzelela kwi-cauda equine, isinyi kunye nemisebenzi yamathumbu nayo inokutshintsha. I-disc bulging inokucinezela kwi-nerve ye-sciatic ekhokelela kwi-sciatica apho iintlungu ziphuma emlenzeni omnye ukusuka ngasemva ukuya ezinyaweni.

Intlungu evela kwi-bulging disc inokuba nzima ngakumbi ngexesha lemisebenzi njengoko ibhulethi inokucinezela kwezinye zeziphene. Kuxhomekeka kwinto yiphi na imithambo echaphazelekayo, iimpawu zekliniki nazo zinokwahluka.

Ukuxilongwa kwe-Disc Bulging

Ukuchonga kusenokwenzeka ukuba kungabonakali kwimbali yezonyango ngenxa yokubonisa okufanayo kwiingxaki ezinkulu. Kodwa imeko engapheliyo yesi sifo inokunika imikhondo ethile. Imbali egcweleyo kunye novavanyo lomzimba kufuneka lwenziwe ukuze kukhethwe i-myocardial infarction, isifo sephepha, isifo se-gastro-oesophageal Reflux, kunye ne-lung pathology engapheliyo.

I-MRI ye-Disc Bulge

Uphando luyimfuneko ukuze kufunyanwe isifo. Umqolo we-X-ray wenziwa ukujonga i-gross pathology nangona ingenakubonisa i-disc bulging ngqo. Kunokubakho ukufunyaniswa okungathanga ngqo kwe-disk degeneration ezifana ne-osteophytes kwii-endplates, i-gas kwi-disc ngenxa ye-vacuum phenomenon, kunye nokulahlekelwa kokuphakama kwe-disc intervertebral. Kwimeko ye-bulges ephakathi, ngamanye amaxesha inokuthi ibonakale njengento engabonakaliyo ye-intervertebral disc ekhutshwe ngaphaya kwemida ye-vertebra esekelwe ngokubanzi, i-circumferential, kunye ne-symmetrical.

I-imaging resonance magnetic okanye i-MRI inokuchaza ngokucacileyo i-anatomy ye-intervertebral discs ngakumbi i-nucleus pulposus kunye nobudlelwane bayo. Ukufunyaniswa kwangaphambili okubonwa kwi-MRI kwi-disc bulging kubandakanya ukulahlekelwa kwe-concavity eqhelekileyo yediski yangasemva. Amaqhuma angabonwa njengeendawo ezisekelwe ngokubanzi, ezijikelezayo, kunye ne-symmetrical. Kwi-bulging ephakathi, i-disc material iya kuphuma ngaphaya kwemida ye-vertebrae ngendlela engabonakaliyo. I-Ct myelogram inokunika iinkcukacha ze-disc anatomy kwaye inokuba luncedo kuxilongo.

Unyango lwe-Disc Bulging

Unyango lwe-bulging disc luyakwazi ukunyanzela, kodwa ngamanye amaxesha utyando luyimfuneko.

Unyango lwe-Conservative

Xa i-disc bulging i-asymptomatic, isiguli asifuni naluphi na unyango kuba alubeki mngcipheko unyukayo. Nangona kunjalo, ukuba isigulana sinempawu, abaphathi banokubhekiswa ekunciphiseni iimpawu. Intlungu ihlala isonjululwa nexesha. Ukuza kuthi ke, ukubulawa kweentlungu ezinamandla njengeziyobisi ezingezizo i-anti -idalidal anti-inflammatory njenge ibuprofen kufuneka kumiselwe. Kwintlungu engasonjululwanga, ii-inshurensi ze-steroid nazo zinokunikwa kwindawo echaphazelekayo kwaye ukuba ayisebenzi, iblatha enovelwano olunokuvavanywa kwiimeko ezinzima kakhulu.

Isigulana sinokunikwa ukhetho lokukhetha ezinye iindlela zonyango ezifana nokuthanjiswa kobugcisa, unyango lomzimba, iipakethe zomkhenkce, kunye neepads zokufudumeza ezinokunciphisa iimpawu. Ukugcina i-posture echanekileyo, ii-tapes, okanye i-braces ukuxhasa umqolo isetyenziswe ngoncedo lwe-physiotherapist. Oku kunokukhawuleza inkqubo yokubuyisela ngokuphepha umonakalo ongaphezulu kunye nokugcina iifayili ezonakalisiweyo okanye ezikrazukileyo kwi-disc intervertebral ngaphandle kokuvuza kwenxalenye ye-fluid ye-disc. Oku kunceda ukugcina isakhiwo esiqhelekileyo se-annulus kwaye kunokunyusa izinga lokubuyisela. Ngokuqhelekileyo, iimpawu ezibuhlungu ezikhoyo ziqale zisonjululwe ngokuhamba kwexesha kwaye zikhokelela ekubeni kungabikho ntlungu. Noko ke, ukuba iimpawu ziba mandundu ngokuthe ngcembe, isigulane sinokufuna utyando

Ukuba iimpawu zisonjululwe, i-physiotherapy inokusetyenziselwa ukomeleza izihlunu zangemva ngokusebenzisa imithambo. Ukuzivocavoca ngokuthe ngcembe kunokusetyenziselwa ukubuya komsebenzi kunye nokukhusela ukuphindaphinda.

Utyando loPhando

Xa unyango lokugcina ngokukhuselekileyo lungasebenzi ngeenyanga ezimbalwa zonyango, unyango olunokuqwalaselwa lungaqwalaselwa. Uninzi luza kukhetha ukuhlinzwa kancinci kancinci okusebenzisa ubuchwephesha obuphambili ukulungisa i-disc ye-intervertebral disc ngaphandle kokukhupha ngokupheleleyo umva. Ezi nkqubo ezinje nge-microdiscectomy inexesha lokubuyisela elingaphantsi kwaye zinciphise umngcipheko wokubakho kwesikhafu, ukulahleka kwegazi okukhulu, kunye nomothuko kwizakhiwo ezikufutshane xa kuthelekiswa nokuhlinzwa okuvulekileyo.

Ngaphambili i-laminectomy kunye ne-discectomy iyeyona nto iphambili kunyango. Nangona kunjalo, ngenxa yokonakala kwenkqubo kwaye ngenxa yomonakalo owandayo kwiinkonzo ezi nkqubo ngoku zishiywe ziiklinikhi ezininzi zokwenza i-disc bulging.

I-disc bulging kwi-thoracic spine iphathwa ngokungaqhelekanga kunye ne -ototransversectomy apho icandelo lenkqubo enqamlezayo iphinde yenziwa ukuvumela ukufikelela kwi-disc ye-intervertebral. Intambo yomgogodla kunye ne-spinal nerves igqitywa ngokusebenzisa i-thoracic decompression ngokususa inxalenye yomzimba we-vertebral kunye nokwenza ukuvulwa okuncinci. Isigulana sinokufuna ukudityaniswa komgogodla kamva ukuba ngaba umzimba osusiweyo ubalulekile.

Utyando lwe-thoracoscopic oluncediswa yividiyo lunokusetyenziswa kwakhona apho kunqunyulwa kancinci kwaye ugqirha unokwenza utyando ngoncedo lwekhamera. Ukuba inkqubo yotyando ibandakanya ukususa inxalenye enkulu yethambo lomgogodla kunye ne-disc, kunokukhokelela ekungazinzi komgogodla. Oku kunokufuna ukuxhunyelelwa kwethambo ukuze kufakwe iipleyiti kunye nezikrufu endaweni yaloo ndawo ilahlekileyo.

Yintoni i-Disc Herniation?

Njengoko kukhankanyiwe kwicandelo lokuqala leli nqaku, i-disc herniation yenzeka xa kukho iindawo ekuchithelwa kuzo izinto ezingaphaya kwemida ye-disc ye-intervertebral. Indawo ye-disc inee-endplates zemizimba ye-vertebral ngokugqamileyo nangaphantsi ngelixa imiphetho yangaphandle yeefophyses zangaphandle zibandakanya umda womda. I-osteophytes ayiqwalaselwanga njengengqamaniso yediski. Kunokubakho ukucaphukisa okanye ukunyanzeliswa kweengcambu ze-nerve kunye ne-dural sac ngenxa yomthamo wezinto ze-herniated ezikhokelela kwintlungu. Xa oku kusenzeka kwingingqi ye-lumbar, oku kuyaziwa ngokuba yi-sciatica. Le meko ikhankanywe ukususela kumaxesha amandulo nangona unxibelelwano phakathi kwe-disc herniation kunye ne-sciatica lwenziwa kuphela kwi-20^th kwinkulungwane. I-Disc herniation yenye yezona zinto zixhaphakileyo zokuxilonga ezibonwa kumqolo ngenxa yeenguqu eziguqukayo kwaye yimbangela eqhelekileyo yotyando lomqolo.

Ukwahlulahlula kwe-Disc Herniation

Kukho iindidi ezininzi malunga ne-intervertebral disc herniation. Kwi-focal disc herniation, kukho ukufuduka kwendawo yendawo ye-disc kwi-horizontal okanye i-axial plane. Kulo hlobo, kuphela ngaphantsi kwe-25% ye-circumference ye-disc echaphazelekayo. Kwi-wide-based disc herniation, malunga ne-25 - 50% ye-disc circumference is herniated. I-disc bulge xa ​​i-50 - 100% yezinto zediski zandiswa ngaphaya kwemida eqhelekileyo yendawo ye-intervertebral. Oku akuqwalaselwa njengendlela ye-disc herniation. Ngaphezu koko, i-intervertebral disc deformities ehambelana neemeko ezinzima ze-scoliosis kunye ne-spondylolisthesis azihlelwanga njenge-herniation kodwa kunoko utshintsho oluguquguqukayo lwe-contour ye-disc ngenxa yokukhubazeka okukufutshane.

Kuxhomekeka kumda wezinto ezishenxisiweyo, iidiski ze-herniated zinokuhlelwa ngakumbi njenge-protrusions kunye ne-extrusions. Kwi-disc protrusion, umgama olinganiswe nakweyiphi na indiza ebandakanya imiphetho yento ye-disc ngaphaya kwendawo ye-disc ye-disc (umda ophezulu uthathwa) ungaphantsi komgama olinganiswe kwindiza efanayo phakathi kwemiphetho yesiseko.

Ukuxeliswa kungabonisa ukungcungcutheka njengongenelelo kwicandelo elithe tyaba nanjengendawo ethe gabalala ngenxa yento yokuba indawo engemva yendawo emide inemathiriyeli ye-disc esuswe ngasemva. Emva koko i-herniation kufuneka ithathelwe ingqalelo njenge-extrusion. Ngamanye amaxesha i-intervertebral disc herniation inokuthi yenzeke kwi-craniocaudal okanye kwicala elithe nkqo ngesiphene kumzimba ophelileyo we-vertebral. Olu hlobo lwe-herniation lwaziwa ngokuba yi-intravertebral herniation.

I-disc protrusion inokwahlulwa ibe yi-focal protrusion kunye ne-wide-based protrusion. Kwi-focal protrusion, i-herniation ingaphantsi kwe-25% ye-circumference ye-disc kanti, kwi-protrusion ebanzi, i-disc ye-herniated iqukethe i-25 - 50% ye-circumference ye-disc.

Kwi-disc extrusion, kufunyaniswa ukuba nayiphi na imilinganiselo emibini elandelayo iyaneliswa. Eyokuqala ithi; ukuba umgama olinganiswe phakathi kwemida yezinto zediski ezingaphaya kwendawo yediski ye-intervertebral inkulu kunomgama olinganiswe kwindiza efanayo phakathi kwemida yesiseko. Owesibini ngulo; ukuba izinto ezibonakalayo kwi-intervertebral disc space kunye nezinto eziphathekayo ngaphaya kwendawo ye-intervertebral disc inokungabikho kokuqhubekayo.

Oku kunokuphawulwa ngakumbi ngokuhlanjwa ngokutsha okulugcino lwento ekukhutshelwe kuyo. Ibizwa ngokuba yi-disc yokufuduka xa iidiski zishukuxwa kude nendawo yokukhuphela ngaphandle kokujonga ukuba kukho ukuqhubeka kwe-disc okanye hayi. Eli gama liluncedo ekutolikeni iindlela zokucinga njengoko kuhlala kunzima ukubonakalisa ukuqhubeka komfanekiso ngqondweni.

I-disc ye-intervertebral disc herniation inokuqhubeka ngakumbi ihlelwe njengee-discs kunye ne-discs ezingachazwanga. Isigama esine-disc sisetyenziselwa ukubhekisa kwingqibelelo ye-peripheral annulus fibrosus egubungela i-intervertebral disc herniation. Xa ulwelo lufakwe ngaphakathi kwi-disc ye-intervertebral disc, ukugcwala akungeni kwi-vertebral canal kwi-herniations equlathe.

Ngamanye amaxesha kukho iziqwengana ze disc ezihluthwe ezibonakalayo njengezisimahla. Nangona kunjalo, akufuneki kubekho ukuqhubekeka phakathi kwento ye-disc kunye nesiqwenga kunye ne-disc ye-intervertebral disc yakhe ukuze ibizwe ngokuba sisiqwenga samahhala okanye esidlulileyo. Kwidiski efudukayo kunye nesiqwenga esifuduselwe, kukho ukongezwa kwezinto zediski ngokuvula kwilungu le-annulus fibrosus ngokufuduswa kwezinto zediski kude nomphengululi.

Nangona ezinye iziqwenga ezifudukayo zinokuthi zihlulwe igama elifudukayo lithetha nje kwindawo kwaye alibhekiselwanga ekuqhubekeni kwediski. Izinto eziphathekayo ze-disc intervertebral disc zingachazwa ngokuqhubekayo malunga ne-posterior longitudinal ligament njenge-submembranous, i-subcapsular, i-subligamentous, i-ligamentous eyongezelelweyo, i-transligamentous, i-subcapsular, kunye ne-perforated.

Umsele womgogodla unokuchaphazeleka yi-intervertebral disc herniation. Oku kulungelelaniswa komjelo kunokuthi kuhlelwe njengento ethambileyo, ephakathi, kwaye inzima ngokuxhomekeke kwindawo eyonakaliswayo. Ukuba umjelo welo candelo usesichengeni kuphela ngaphantsi kwesinye esithathwini, ubizwa ngokuba bubulali ngelixa ukuba uchaphazeleke kuphela ngaphantsi kwesibini esithathwini nangaphezulu kwesinye esithathwini uthathwa njengophakathi. Kwi-compromise enzima, ngaphezu kweyesibini kwisithathu somgudu womgogodla uchaphazelekayo. Ukubandakanyeka kwe-foraminal, le nkqubo yokuhlela ifanayo ingasetyenziswa.

Izixhobo ezishenxisiweyo zingabizwa ngokwendawo ukuba zikwindiza ye-axial ukusuka kwiziko ukuya kwindawo yangasemva ekunene. Zibizwa ngokuba sisembindini, osekunene embindini, ekunene ngokungaphantsi, ekunqamlezweni kwesokudla, kunye naselunxwemeni ekunene. Ubume bezinto eziguqukayo zangaphakathi kwe-disc zinokuhlelwa ngakumbi njenge-gaseous, i-alcohol, i-desiccated, i-scarf, i-calcified, i-bony, i-bony, i-nyukliya kunye ne-cartilaginous.

Ngaphambi kokungena kwiinkcukacha zokufumana isifo kunye nokunyanga i-disc herniation ye-intervertebral disc, masihlukanise umohluko wesibeleko i-herniation yahluka njani kwi-lumbar herniation kuba yeyona mimandla iqhelekileyo yokwenza i-herniation.

I-Cervical Disc Herniation vs Thoracic Disc Herniation vs Lumbar Disc Herniation

I-Lumbar disc herniation yolona hlobo luqhelekileyo lwe-herniation olufunyenwe kumqolo omalunga ne-90% yetotali. Nangona kunjalo, i-cervical disc herniation inokuthi yenzeke malunga nesinye kwishumi lezigulane. Lo mahluko ikakhulu ngenxa yokuba i-lumbar spine inoxinzelelo olungakumbi ngenxa yomthwalo owandisiweyo. Ngaphezu koko, inezixhobo ezinkulu ze-intervertebral disc. Iindawo eziqhelekileyo ze-intervertebral disc herniation kwingingqi ye-lumbar yi-L 5 - 6, kwingingqi yeCervical phakathi kwe-C7, kunye nommandla we-thoracic T12.

I-Cervical disc herniation inokwenzeka ngokuxhaphakileyo kuba umqolo wesibeleko usebenza njengendawo yokubambisa entloko kwaye iyindawo enobungozi kumngcipheko kwaye ngenxa yoko uthambekele ekonakaleni kwi-disc. I-Thoracic disc herniation ivela rhoqo kunakuqala kwezi zimbini. Oku kungenxa yokuba i-thoracic vertebrae inamathele kwiimbambo kunye nentambo ye-thoracic ethintela ububanzi bokuhamba komgogodla we-thoracic xa kuthelekiswa ne-disc yomlomo wesibeleko kunye ne-lumbar. Nangona kunjalo, i-thoracic intervertebral disc herniation isenokwenzeka.

I-Cervical disc herniation ibangela intlungu yentamo, intlungu yegxalaba, intlungu ephuma entanyeni ukuya kwingalo, ukubetha, njl njl. amalungu. I-Thoracic disc herniation inokubangela intlungu kumqolo ongaphezulu osasaza kwi-torso.

Epidemiology

Nangona i-disc herniation ingenzeka kuwo onke amaqela eminyaka ubudala, iyenzeka kakhulu phakathi kweshumi lesine kunye nelesihlanu leminyaka yobomi kunye nobudala beminyaka eyi-37. Kukho iingxelo eziqikelela ukuxhaphaka kwe-intervertebral disc herniation ibe yi-2 - 3% yabantu bonke. Ixhaphake kakhulu ukubonakala kumadoda angaphezulu kweminyaka engama-35 kunye nokuxhaphaka kwe-4.8% kwaye ngelixa kwabasetyhini eli nani limalunga ne-2.5%. Ngenxa yokuxhaphaka kwayo okuphezulu, ithathwa njengengxaki yehlabathi lonke njengoko ikwayanyaniswa nokukhubazeka okubonakalayo.

Izinto zobungozi

Kwiimeko ezininzi, i-disc ye-herniated ivela ngenxa yenkqubo yokuguga kwendalo kwi-disc intervertebral disc. Ngenxa yokutshatyalaliswa kwediski, inani lamanzi elalibonwe ngaphambili kwi-disc intervertebral liyomiswa likhokelela ekunciphiseni i-disc kunye nokunciphisa indawo ye-intervertebral. Olu tshintsho lubonakala ngokuphawulekayo kwisifo se-disc degenerative. Ukongeza kolu tshintsho ngokuthe ngcembe ngenxa yokugqoka kunye nokukrazula okuqhelekileyo, ezinye izinto zinokuthi zibe negalelo ekwandiseni umngcipheko we-intervertebral disc herniation.

Ukutyeba ngokugqithisileyo kunokunyusa umthwalo kumqolo kwaye kwandise umngcipheko we-herniation. Ubomi bokuhlala phantsi bunonyusa umngcipheko kwaye ke indlela yokuphila esebenzayo iyacetyiswa ekuthinteleni le meko. Ukuma okungahambi kakuhle ngokuhlala ixesha elide, ukuhlala, kwaye ngakumbi ukuqhuba kunokubeka uxinzelelo kwiidiski eziphakathi ngenxa yongcakazo olongezelelekileyo olusuka kwinjini yemoto ekhokelela kwi-microtrauma kunye nokugabha kwi-disc. Imisebenzi efuna ukugoba rhoqo, ukujijeka, ukutsala nokuphakamisa inokubeka uxinzelelo ngasemva. Iindlela zokuphakamisa ubunzima ngokungafanelekanga sesinye sezizathu eziphambili.

Xa izihlunu zangasemva zisetyenziselwa ukuphakamisa izinto ezinzima endaweni yokuphakamisa ngemilenze kunye nokuguqula ngelixa ukuphakamisa kunokwenza i-lumbar discs ibe sengozini ngakumbi kwi-herniation. Ngoko ke izigulane kufuneka zihlale zicetyiswa ukuba ziphakamise iintsimbi ngemilenze yazo kungekhona ngasemva. Ukutshaya kuye kwacatshangelwa ukuba kwandisa i-disc herniation ngokunciphisa ukunikezelwa kwegazi kwi-disc intervertebral ekhokelela ekutshintsheni okuguquguqukayo kwediski.

Nangona ezi zinto zilapha ngasentla zihlala zithathwa njengezona zinto zibangela i-disc herniation, ezinye izifundo zibonise ukuba umahluko womngcipheko umncinci kakhulu xa kuthelekiswa la maqela alawula amaqela aqhelekileyo.

Ziliqela iindidi zophando ezenziweyo kubuchwephesha be-genetic kunye ne-intervertebral disc herniation. Ezinye iintlobo zofuzo eziphembeleleke kwesi sifo zibandakanya ivithamini D receptor (VDR) oluyiikhowudi zekhowudi kwiipolypeptides zekollagen ebalulekileyo ebizwa ngokuba yi-collagen IX (COL9A2).

Olunye uhlobo olubizwa ngokuba yi-genre de genrean gene (i-AGC) lukwanyanzeliswa njengoko iikhowudi zeproteoglycans iyeyona proteni ibaluleke kakhulu ifunyenwe kwi-cartilage. Ixhasa umsebenzi we-biochemical and mechanic we-cartilage tishu kwaye ke xa olu hlobo lwenzala lunesiphene, lunokumisela umntu umntu ukuba enze i-discvernibral disc herniation.

Ngaphandle kwezi, kukho ezinye iigenes ezininzi eziphandwayo ngenxa yobudlelwane phakathi kwe-disc herniation efana ne-matrix metalloproteinase (MMP) i-cartilage intermediate layer protein, i-thrombospondin (THBS2), i-collagen 11A1, i-carbohydrate sulfotransferase, kunye ne-asporin (ASPN). Basenokujongwa njengabamakishi bemfuza abanokubakho kwi-lumbar disc isifo.

I-pathogenesis ye-Sciatica kunye ne-Disc Herniation

Iintlungu ze-sciatic zivela kwi-nucleus pulposus ekhutshweyo eyenza iziganeko ezahlukeneyo. Inokucinezela ngokuthe ngqo iingcambu zemithambo-luvo ezikhokelela kwi-ischemia okanye ngaphandle kwayo, ngomatshini ivuselele iziphelo zemithambo-luvo yenxalenye yangaphandle yeringi ye-fibrous kwaye ikhuphe izinto ezivuthayo ezibonisa imvelaphi yayo emininzi. Xa i-disc ye-disc ibangela ukunyanzeliswa komatshini weengcambu ze-nerve, i-membrane ye-nerve ivakaliswa kwiintlungu kunye nezinye izinto ezibangelwa yi-ischemia. Kuye kwaboniswa ukuba kwiingcambu ze-nervous sensitized kunye ne-compromised, i-threshold ye-neuronal sensitization ijikeleze isiqingatha se-root ye-nerve eqhelekileyo kunye ne-non-compromised.

I-infiltration cell cell infiltration ihluke kwiidiski ezikhutshiweyo kunye neediski ezingenayo. Ngokuqhelekileyo, kwiidiski ezingenayo i-extruded, ukuvuvukala kuncinci. I-disc ye-disc ekhutshweyo ibangela ukuba i-posterior longitudinal ligament igqabhuke ebonisa inxalenye ye-herniated kwibhedi ye-vascular of the space epidural. Kukholelwa ukuba iiseli ezivuthayo zivela kule mithambo yegazi ehlala kwindawo engaphandle ye-intervertebral disc.

Ezi seli zinokunceda izinto ezifihlakeleyo ezibangela ukuvuvukala kunye nokucaphukisa iingcambu zethambo ezibangela iintlungu zesayensi. Ke ngoko, i-herniations ekhutshelweyo inokwenzeka ukuba ibangele intlungu kunye nokukhubazeka kweklinikhi kunezo ziqulathwe. Kwii-herniations eziqulathweyo, ukusebenza komatshini kubaluleke kakhulu ngelixa lingachazwanga okanye i-discs ekhutshiweyo ifuthe lokuvuvukala likhona ngaphambili.

I-Clinical Disc Herniation kunye nokuba ujonge ntoni kwiMbali

Iimpawu ze-disc ze-disc zingahluka kakhulu kuxhomekeke kwindawo yentlungu, uhlobo lwe-herniation, kunye nomntu. Ngoko ke, imbali kufuneka igxininise kuhlalutyo lwesikhalazo esiphambili phakathi kwezinye iimpawu ezininzi.

Isikhalazo esiyintloko sinokuba yintlungu yentamo kwi-cervical disc herniation kwaye kunokugqithiselwa intlungu kwiingalo, amahlombe, intamo, intloko, ubuso, kunye nommandla osezantsi. Nangona kunjalo, idla ngokubizwa ngokuba yi-interscapular region. Imitha yeentlungu ingenzeka ngokwenqanaba kwi-herniation eyenzekayo. Xa iingcambu ze-nerve zommandla womlomo wesibeleko zichaphazelekayo kwaye zixinzelelwe, kunokubakho i-sensory, kunye neenguqu zemoto kunye neenguqu kwi-reflexes.

Intlungu eyenzeka ngenxa yokunyanzeliswa kweengcambu ze-nerve ibizwa ngokuba yi-radicular pain kwaye inokuchazwa njengento enzulu, ebuhlungu, evuthayo, ebuhlungu, e-achy, kunye nombane ngokuxhomekeke ekubeni kukho ukungasebenzi kwemoto okanye ukungasebenzi kakuhle kweemvakalelo. Kwilungu eliphezulu, intlungu ye-radicular inokulandela i-dermatomal okanye i-myotomal pattern. I-Radiculopathy ngokuqhelekileyo ayihambi kunye neentlungu zentamo. Kunokubakho iimpawu ezimacala omabini kunye namacala omabini. Ezi zimpawu zinokuthi zenziwe zibe nzima ngemisebenzi eyandisa uxinzelelo ngaphakathi kweediski ze-intervertebral ezifana ne-Valsalva maneuver kunye nokuphakamisa.

Ukuqhuba kwakhona kunokunyusa intlungu ngenxa ye-disc herniation ngenxa yoxinzelelo ngenxa ye-vibration. Olunye uphononongo lubonise ukuba ukulayisha umothuko kunye noxinzelelo olusuka kwi-vibration kunokubangela ukuba amandla omatshini enze mandundu ama-herniations amancinci kodwa i-flexible posture ayinayo impembelelo. Ngokufanayo, imisebenzi enciphisa uxinzelelo lwe-intradiscal inokunciphisa iimpawu ezifana nokulala phantsi.

Isikhalazo esikhulu kwi-lumbar disc herniation yintlungu ephantsi. Ezinye iimpawu ezihambelanayo zingaba yintlungu ethangeni, ezinqeni, kunye nommandla we-anogenital onokuthi uphume ezinyaweni nasezinzwaneni. I-nerve ephambili echaphazelekayo kulo mmandla yi-nerve ye-sciatic ebangela i-sciatica kunye neempawu zayo ezihambelanayo ezifana nentlungu ebuhlungu kwi-buttocks, intlungu yomlenze, ubuthathaka bemisipha, ukuphazamiseka, ukuphazamiseka kwemvakalelo, ukutshisa kunye nokutshisa okanye ukubetha kwemilenze, ukungasebenzi kwe-gait. , ukukhubazeka kwe-reflexes, i-edema, i-dysesthesia okanye i-paresthesia kwimilenze ephantsi. Nangona kunjalo, i-sciatica inokubangelwa yizizathu ngaphandle kwe-herniation efana ne-tumor, ukusuleleka, okanye ukungazinzi okufuneka kukhutshwe ngaphambi kokuba kufike ukuxilongwa.

I-disc ye-herniated inokukwanyanzelela kwithambo lobufazi kwaye inokunika iimpawu ezinjengobungqindilili, ukuva imvakalelo kumlenze omnye okanye omabini, kunye nokuziva okutsha emilenzeni nasezinkalweni. Ngokwesiqhelo, iingcambu zethambo ezichaphazelekayo kwi-herniation kwingingqi ye-lumbar zezona ziphumayo zingezantsi kwe-disc ye-intervertebral. Kucingelwa ukuba inqanaba lokucaphuka kweengcongconi libonisa ukuhanjiswa kwentlungu yomlenze. Kwi-herniations kwinqanaba lesithathu kunye nelesine le-lumbar vertebral, intlungu inokuthi ikhanyise ithanga elingaphandle okanye kwigreyini. Kwi-radiculopathy kwinqanaba le-vertebra yesihlanu ye-lumbar, intlungu inokuthi yenzeke kwindawo yecala lomva kunye ne-anterior. Kwi-herniations kwinqanaba le-oblium yokuqala, intlungu inokuthi yenzeke emazantsi onyawo kunye nethole. Kunokubakho ubungqindilili kunye nokuva ukurhabalaka okwenzeka kwindawo enye yosasazo. Ubuthathaka kwezihlunu busenokungakwazi ukubonwa xa iintlungu zinzima.

Xa utshintsha isikhundla isiguli sihlala sikhululeka kwintlungu. Ukugcina isigxina sombuso kunye nemilenze ephakanyisiweyo inokuphucula iintlungu. Ukukhululeka kobuhlungu obufutshane kunokuziswa kukuhamba ngokufutshane ngexesha lokuhamba ixesha elide, ukuma ixesha elide, kwaye ukuhlala ixesha elide njengokuqhuba kunokubangela intlungu.

I-disc herniation ye-lateral ibonwa kwi-foraminal kunye ne-extraforaminal herniations kwaye baneempawu ezahlukeneyo zeklinikhi kune-medial disc herniation ebonwe kwi-subarticular and central herniations. I-heral ye-intervertebral disc herniations xa ithelekiswa ne-medial herniations icaphukisa ngokuthe ngqo kwaye ngoomatshini icinezele iingcambu ze-nerve eziphumayo kunye neqela leengcambu ze-dorsal gangalions ngaphakathi komsele omxinwa we-spinal.

Ke ngoko, i-herniation ye-lateral ibonwa rhoqo kubudala obukhulu kunye nentlungu e-radicular ngakumbi kunye nokusilela kwemithambo-luvo. Kukho kwakhona ukuqaqanjelwa ngumlenze okungakumbi kunye ne-disc ye-disc ye-intervertebral disc kumanqanaba amaninzi kumaqela alandelayo xa kuthelekiswa ne-medial disc herniations.

I-disc ye-herniated kwingingqi ye-thoracic inokuthi ingabonakali ngentlungu emva kwayo yonke into. Endaweni yoko, kukho iimpawu eziphambili ngenxa yeentlungu ezigqithisiweyo kwi-thorax ngenxa yokucaphuka kwemithambo-luvo. Kusenokubakho iintlungu ezibalaseleyo emzimbeni ohamba uye emilenzeni, ukuntyiloza kweemvakalelo kunye nokuba ndindisholo komnye okanye yomibini imilenze, ubuthathaka bemisipha, kunye ne-spasticity yomnye okanye yomibini imilenze ngenxa ye-reflexes ebaxiweyo.

Ugqirha kufuneka ajonge iinkcazo-ntetho ezingaqhelekanga njengoko kunokubakho olunye uxilongo olwahlukileyo. Ukuqala kweempawu kufuneka kubuzwe malunga nokuqinisekisa ukuba isifo sibukhali, sincinci, okanye sihlala sihlala sikhona. Imbali yonyango yexesha elidlulileyo kufuneka ibuzwe malunga neenkcukacha ukuba ingabandakanyi iimpawu zeflegi ebomvu njengentlungu eyenzeka ebusuku ngaphandle komsebenzi onokuthi ubonakale kuxinzelelo lwe-pelvic vein, kunye neentlungu ezingezizo ezomatshini ezinokubonwa kwiithumba okanye izifo.

Ukuba kukho ukusilela kwemithambo-luvo okuqhubekayo, ukubandakanyeka kwamathumbu kunye nesinye, kukho into ebonwa njengengxamiseko yemithambo-luvo kwaye iphandwe ngokukhawuleza ngenxa yokuba isifo se-cauda equine syndrome sinokuthi kwenzeke xa singalungiswa

Ukufumana imbali eneenkcukacha kubalulekile ukubandakanya umsebenzi wesigulana kuba ezinye izinto ezenziwayo emsebenzini zinokuzonyanyisa iimpawu zesigulana. Isigulana kufuneka sivavanywe malunga nokuba yeyiphi na imisebenzi kunye nezinto ezingakwaziyo ukuzenza.

Ukuxilongwa ngokungafani

• Isifo se-disgenerative
• Iintlungu zoomatshini
• Ubuhlungu be-Myofascial ekhokelela ekuphazamiseni kwemvakalelo kunye nentlungu yekhaya okanye edlulisiweyo
• IHematoma
• I-cyst ekhokelela kwiimeko ezithile zokusilela kwemoto kunye nokuphazamiseka kwento
• I-Spondylosis okanye i-spondylolisthesis
• I-Discitis okanye i-osteomyelitis
• Isibindi, i-neurinoma okanye i-lesion ebangela i-atrophy yemisipha yamathanga, i-glutei
• I-spinal stenosis ibonwa ikakhulu kwingingqi ye-lumbar ine-low low back back, deficits motor, and pain in one or both maoto.
• Ithumba le-epidural linokubangela iimpawu ezifana neentlungu ezibuhlungu ezibandakanya i-spinal disc herniation
• I-Aortic aneurysm enokubangela iintlungu ezisezantsi zomqolo kunye nentlungu yomlenze ngenxa yoxinzelelo olunokuthi luphinde lube nokukhokelela kwi-hemorrhagic shock.
• I-Hodgkin's lymphoma kumanqanaba aphambili angakhokelela kwizilonda ezihlala kwindawo kwikholam ekhokelela kwiimpawu ezinje nge-intervertebral disc herniation
• Izidumbu
• I-endometriosis yePelvic
• I-hypetrophy yento
• Iingcambu ze-lumbar nerve ingcambu
• Ukosuleleka kwe-Herpes zoster kubangela ukuvuvukala kunye neengcambu ze-nerve okanye ze-lumbosacral nerve

Uvavanyo lwe-Disc Herniation

Uvavanyo olupheleleyo lomzimba luyimfuneko ukuze kufunyanwe imeko ye-disc ye-intervertebral disc herniation kwaye kungabandakanywa okunye ukuxilongwa okubalulekileyo. Uluhlu lwenyathelo luye kuvavanywa kodwa lunokungahambelani kakuhle kunye ne-disc herniation njengoko kuncitshiswa ikakhulu kwizigulana ezalupheleyo ezinesifo esiwohlokayo nangenxa yesifo samalungu.

Uvavanyo olupheleleyo lwemithambo-luvo lusoloko luyimfuneko. Oku kufuneka kuvavanye ubuthathaka bemisipha kunye nobuthathaka beemvakalelo. Ukuze ubone ubuthathaka bemisipha kwiinzwane ezincinci, isigulane sinokucelwa ukuba sihambe nge-tiptoe. Ukomelela kwezihlunu nako kusenokuvavanywa ngokuthelekisa amandla nalawo ogqirha. Kusenokubakho ilahleko yenzwa yedermatomal ebonisa ukubandakanyeka kweengcambu zemithambo-luvo. Ii-reflexes zinokuba zibaxekile okanye ngamanye amaxesha zingabikho.

Kukho iindlela ezininzi zokuhlola i-neurologic ezichazwe ngokumalunga ne-intervertebral disc herniation ezifana ne-Braggart sign, flip isibonakaliso, i-Lasegue rebound sign, i-Lasegue differential sign, i-Mendel Bechterew uphawu, i-Deyerle isayine imilenze yomibini okanye uvavanyo lwe-Milgram, kunye nomlenze womlenze okanye uvavanyo lwe-Fajersztajin. Nangona kunjalo, zonke ezi zisekwe kuvavanyo lwe-sciatic nerve root tension ngokusebenzisa imigaqo efanayo kuvavanyo lokuphakamisa umlenze othe tye. Ezi mvavanyo zisetyenziselwa iimeko ezithile zokubona iiyantlukwano ezifihlakeleyo.

Phantse zonke zazo zixhomekeka kwintlungu evezise umlenze kwaye ukuba kwenzeka ngaphezulu kwedolo kucingelwa ukuba kungenxa yesilonda esineuronal kwaye ukuba iintlungu zihamba ngezantsi kwedolo, kuthathwa ngokuba kungenxa yoxinzelelo ingcambu yenzululwazi yenzululwazi. Ukufunyanwa kwe-lumbar disc herniation, olona vavanyo luqwalaselweyo luthathwa njengobuhlungu bomsipha obuvela emlenzeni ngenxa yokuqunjelwa.

Kuvavanyo lokuphakamisa umlenze othe tye obizwa ngokuba ngumqondiso weLasegue, isigulane sihlala emqolo kwaye sigcina imilenze ngqo. Ugqirha ke uphakamisa imilenze ngokuguqula i-hip ngelixa egcina idolo ngokuthe ngqo. I-angle apho isigulane siva intlungu ehla emlenzeni ngaphantsi kwedolo iqatshelwe. Kumntu oqhelekileyo onempilo, isigulane sinokutshintsha i-hip kwi-80-90? ngaphandle kokuba naziphi na iintlungu okanye ubunzima.

Nangona kunjalo, ukuba i-engile yi-30 -70 nje? idigri, iphakamisa i-lumbar intervertebral disc herniation kwi-L4 ukuya kwi-S1 amanqanaba engcambu ye-nerve. Ukuba i-angle ye-hip flexion ngaphandle kwentlungu ingaphantsi kwama-30 degrees, ngokuqhelekileyo ibonisa ezinye izizathu ezifana ne-tumor ye-gluteal region, i-gluteal abscess, i-spondylolisthesis, i-disc extrusion, kunye ne-protrusion, i-malingering isigulane, kunye nokuvuvukala okukhulu kwe-dura mater. Ukuba intlungu kunye ne-hip flexion ivela ngaphezu kwe-70 degrees, ingaba ngenxa yokuqina kwemisipha efana ne-gluteus maximus kunye ne-hamstrings, ukuqina kwe-capsule ye-joint hip, okanye i-pathology ye-sacroiliac okanye i-hip joints.

Uvavanyo lokuphakamisa umlenze othe tye okanye uvavanyo lokwandiswa kwe-hip lungasetyenziselwa ukuvavanya izilonda eziphezulu ze-lumbar ngokuzolula iingcambu ze-nerve ze-nerve ye-femoral efana novavanyo lokuphakamisa umlenze othe tye. Kwintambo yomlomo wesibeleko, ukuze kubonwe i-stenosis ye-foramina, uvavanyo lwe-Spurling lwenziwa kwaye aluchanekanga kwi-disc ye-intervertebral disc herniation okanye ukunyanzeliswa kweengcambu ze-nerve. Uvavanyo lwe-Kemp luvavanyo olufanayo kwingingqi ye-lumbar ukufumanisa i-foraminal stenosis. Iingxaki ngenxa ye-disc herniation zibandakanya ukuhlolwa ngokucophelela kwingingqi ye-hip, ukuhlolwa kwe-digital rectal, kunye nokuhlolwa kwe-urogenital kuyadingeka.

Ukuphandwa kwe-Disc Herniation

Ukuxilongwa kwe-intervertebral disc herniation, iimvavanyo zokuxilonga ezifana ne-Magnetic resonance imaging (MRI), i-Computed tomography (CT), i-myelography, kunye ne-radiography ecacileyo ingasetyenziswa nokuba yodwa okanye idibene nezinye iindlela zokucinga. Ukufunyaniswa kwenjongo ye-disc herniation kubalulekile kuba kuphela emva kokufumana okunjalo ukungenelela kokuhlinzwa kuqwalaselwa. Iimvavanyo ze-Serum biochemical ezifana nenqanaba le-prostate-specific antigen (PSA), ixabiso le-Alkaline phosphatize, izinga le-erythrocyte sedimentation (ESR), uhlalutyo lomchamo we-Bence Jones iprotheni, i-serum glucose level, kunye ne-serum protein electrophoresis inokufuneka kwakhona kwiimeko ezithile ezikhokelwa yimbali. .

Ukujonga umfanekiso weMagnetic Resonance (MRI)

I-MRI ithathwa njengeyona ndlela intle yokulinganisa kwizigulana ezinembali kunye novavanyo lomzimba ezifumanekayo ezichazayo ze-lumbar disc herniation ezihambelana ne-radiculopathy ngokwezikhokelo ze-American American Spinal Society ngo-2014. Iindawo zinokuchazwa ngokugqibeleleyo yi-MRI kwiindawo zesibeleko, zecacac, kunye ne-lumbosacral. Ngaphandle kwemida ye-annulus, i-nucleus ye-herniated inokubonwa njengogxila, i-asymmetric disc protrusion ye-MRI.

Kwimifanekiso enesisindo se-sagittal T2, i-poster yangaphandle ihlala ibonwa njengendawo ephezulu kakhulu yomqondiso ngenxa yokugqabhuka kwento ene-radial annular enxulunyaniswa ne-herniation ye-disc nangona i-nucleus ye-herniated ngokwayo i-hypointense. Ubudlelwane phakathi kwenowuthi ye-herniated kunye neempawu ezibuthathaka kunye neengcambu ze-nerve eziphuma ngenxa ye-neural foramina zikhethwe kakuhle kwimifanekiso ye-sagittal ye-MRI. Iziqwenga zasimahla ze-disc ezihlangeneyo ziyahlula phakathi kwimifanekiso ye-MRI.

Kukho iimpawu ezihambelanayo ze-intervertebral disc herniation kwi-MRI ezifana neenyembezi ze-radial kwi-annulus fibrosus ekwangumqondiso wesifo se-disc degenerative. Kunokubakho ezinye iimpawu ezixelayo ezifana nokulahlekelwa kobude bediski, i-bulging annulus, kunye notshintsho kwii-endplates. Iimpawu ze-Atypical nazo zingabonwa nge-MRI njengeendawo ezingaqhelekanga zediski, kunye nezilonda ezifumaneka ngokupheleleyo ngaphandle kwendawo ye-intervertebral disc.

I-MRI inokubona izinto ezingaqhelekanga kwiidiski ze-intervertebral eziphakamileyo kunezinye iindlela nangona umfanekiso wayo wamathambo ungaphantsi kancinci. Nangona kunjalo, kukho imida kwi-MRI kwizigulana ezinezixhobo zokufakelwa kwentsimbi ezifana ne-pacemakers kuba indawo ye-electromagnetic inokukhokelela ekusebenzeni okungaqhelekanga kwee-pacemakers. Kwizigulane ezine-claustrophobia, inokuba yingxaki ukuya kumjelo omxinwa ukuze uhlolwe ngumatshini we-MRI. Nangona ezinye iiyunithi ziqulethe i-MRI evulekileyo, inamandla amancinci amancinci kwaye yiyo loo nto ichaza umfanekiso ongaphantsi komgangatho ophezulu.

Oku kuyingxaki kubantwana kunye nezigulane ezixhalabileyo eziphantsi kwe-MRI kuba umgangatho omhle womfanekiso uxhomekeke kwisigulana esihlala sihleli. Basenokufuna ukuthomalalisa. Umahluko osetyenziswa kwi-MRI oyi-gadolinium unokubangela i-nephrogenic systemic fibrosis kwizigulane ezinesifo sezintso esele sikhona. I-MRI ikwathintelwa ngokubanzi ekukhulelweni ngakumbi kwiiveki zokuqala ezili-12 nangona ingakhange ingqinwe ngokweklinikhi ukuba iyingozi kusana olungekazalwa. I-MRI ayiloncedo kakhulu xa i-tumor iqulethe i-calcium kunye nokwahlula ulwelo lwe-edema kwi-tumor tissue.

IComputer Tomography (EC)

I-CT scanning nayo ithathwa njengenye indlela efanelekileyo yokuvavanya i-spinal disc herniation xa i-MRI ingafumaneki. Ikwacetyiswa njengophando lokuqala kwizigulane ezingazinzanga nezopha kakhulu. I-CT scanning iphezulu kwi-myelography nangona xa ezi zimbini zidibene, ziphakamileyo zombini. I-CT scans ingabonisa i-calcification ngokucacileyo kwaye ngamanye amaxesha kunye negesi kwimifanekiso. Ukuze ufezekise umgangatho ophezulu wokucinga, umfanekiso kufuneka ugxininise kwindawo ye-pathology kunye namacandelo amancinci athathiweyo ukuze anqume kakuhle ubungakanani be-herniation.

Nangona kunjalo, i-CT scan inzima ukuba isetyenziswe kwizigulane esele zenziwe i-laminectomy iinkqubo zotyando ngenxa yokuba ubukho be-scar tissue kunye ne-fibrosis kubangela ukuchongwa kwezakhiwo ezinzima nangona utshintsho lwamathambo kunye nokukhubazeka kwi-nerve sheath luncedo ekwenzeni ukuxilongwa.

I-disc ye-herniated intervertebral disc kwi-cervical disc inokuchongwa ngokufunda inkqubo yokungasebenzi. Idla ngokuqikelelwa emva nasemva koko kwii-discs eziphakathi kunye nangaphezulu kwimizimba ye-vertebral. Inkqubo yokungamanyani ingena kwis sclerosis, nakwihypertrophic xa kukho ubudlelwane obungaqhelekanga phakathi kwenkqubo yokungafundisi kunye nezixhobo ezikufuphi njengoko kubonwa kwisifo se disc esibuthathaka, ukunqamleza indawo phakathi kwe disc.

I-Myelopathy ingenzeka xa umgudu womgogodla uchaphazelekayo ngenxa yesifo se-disc. Ngokufanayo, xa i-neural foramina ibandakanyeka, i-radiculopathy iyenzeka. Nokuba iidiski ezincinci ze-herniated kunye ne-protrusions zinokubangela ukunyanzeliswa kwe-dural sac kuba indawo yomlomo wesibeleko iyancipha ngokwemvelo. Iidiski ze-intervertebral zine-attenuation encinci enkulu kune-sac ebonakaliswe kwi-CT scan.

Kwingingqi ye-thoracic, i-CT scan inokufumanisa i-intervertebral disc herniation ngokulula ngenxa yokuba kukho inani elongezelelweyo le-calcium efunyenwe kwiidiski ze-thoracic. Emva kwe-dural sac, i-disc ye-herniated ingabonwa kwi-CT njengobunzima obucacileyo obujikelezwe ngamafutha e-epidural. Xa kukho ukungabikho kwamafutha e-epidural, i-disc ibonakala njengobunzima obukhulu obuncitshisiweyo xa kuthelekiswa nokujikelezayo.

Yezigulanaa

I-radiography ecacileyo ayidingeki ekuxilongeni i-herniation ye-intervertebral discs, kuba i-radiographs ecacileyo ayikwazi ukubona i-disc kwaye ngoko isetyenziselwa ukungabandakanyi ezinye iimeko ezifana ne-tumor, izifo, kunye nokuphuka.

Kwi-myelography, kunokubakho ukukhubazeka okanye ukufuduka kwe-extradural-contradural-filled recal sac ebonwa kwi-herniation ye-disc. Kusenokubakho iimpawu kwi-nerve echaphazelekayo efana ne-edema, ukuphakama, ukutenxa, kunye nokunqunyulwa kwengcambu ye-nerve ebonwe kumfanekiso we-myelography.

I-Diskography

Kule modelling yokucinga, umahluko ophakathi ufakwa kwi-disc ukuze kuhlolwe i-disc morphology. Ukuba iintlungu zenzeka emva kwenaliti efanayo nentlungu ye-discogenic, oko kuphakamisa ukuba i-disc ngumthombo wentlungu. Xa iskena se-CT senziwa ngokukhawuleza emva kwembali, kuyanceda ukwahlula i-anatomy kunye notshintsho lwendalo. Nangona kunjalo, kuba kuyinkqubo yokuhlaselayo, ibonakaliswa kuphela kwiimeko ezizodwa xa i-MRI kunye ne-CT behlulekile ukuveza i-etiology yentlungu yangasemva. Ineziphumo ezahlukeneyo ezinjengeentloko eziqaqanjelwa yintloko, meningitis, umonakalo kwi-disc, discitis, intrathecal hemorrhage, kunye nentlungu eyandayo.

Unyango lwe-Herniated Disc

Unyango kufuneka lubonwe ngokommiselo okhokelwa sisigulana ngokwembali, uvavanyo lomzimba, kunye nophando. Kwiimeko ezininzi, isiguli ngokuthe ngcembe siphucuka ngaphandle kokufuna ungenelelo ngakumbi kwiinyanga ezintathu ukuya kwezine. Ke, isigulana sifuna kuphela unyango olunyanyekayo ngeli xesha. Ngenxa yesi sizathu, zininzi iindlela zonyango ezingasebenziyo eziye zavela zibonisa isisombululo sendalo seempawu zeso sifo. Ke ngoko, unyango lwe-Conservative kufuneka lusekelwe kubungqina.

Unyango lwe-Conservative Therapy

Ukusukela ukuba i-herniation ye-disc ine-benign course, injongo yonyango kukuvuselela ukuvuselelwa komsebenzi we-neurological, ukunciphisa iintlungu, kunye nokwenza lula ukubuyela emsebenzini kunye nemisebenzi yokuphila kwemihla ngemihla. Izibonelelo eziphambili zonyango olondolozekayo kwizigulana ezincinci ezine-hernias ezilungelelaniswe kakuhle kunye nakwizigulana ezinesiphene esibuthathaka se-neurological ngenxa ye-disc hernias encinci.

Ukuphumla kombhede kudala kuthathwa njengokhetho lonyango kwi-herniation ye-disc. Nangona kunjalo, kubonakaliswe ukuba ukuphumla kwebhedi akunampembelelo ngaphaya kwe-1 okanye iintsuku ezimbini zokuqala. Ukuphumla kwebhedi kuthathwa njengento echaseneyo emva kweli xesha lexesha.

Ukuze kuncitshiswe intlungu, kunokusetyenziswa amayeza omlomo angeyo-steroidal achasene nokudumba okufana ne-ibuprofen kunye ne-naproxen. Oku kunokuphelisa intlungu ngokunciphisa ukudumba okuhambelana nomthambo ovuthayo. I-analgesics efana ne-acetaminophen nayo ingasetyenziswa nangona ingenayo i-anti-inflammatory effect ebonwa kwii-NSAID. Iidosi kunye neziyobisi kufuneka zifaneleke iminyaka kunye nobukhulu bentlungu kwisigulane. Ukuba iintlungu azilawulwa ngamayeza angoku, ugqirha kufuneka ahambe inyathelo elinye phezulu kwileli ye-WHO ye-analgesics. Nangona kunjalo, ukusetyenziswa kwexesha elide le-NSAID kunye ne-analgesics kunokukhokelela kwizilonda zesisu, isibindi, kunye neengxaki zezintso.

Ukunciphisa ukuvuvukala, ezinye iindlela ezinje ngokufaka umkhenkce kwixesha lokuqala kwaye ukutshintshela ekusebenziseni ubushushu, iigels, kunye neearubs kunokuncedisa kwintlungu kunye nokuqaqamba kwemisipha. Ukuhlaziya imisipha yomlomo kungasetyenziswa ekunciphiseni imisipha yemisipha. Amanye amachiza abandakanya i-methocarbamol, carisoprodol, kunye ne-cyclobenzaprine.

Nangona kunjalo, basebenza ngokuphakathi kwaye babangela ukunxila kunye nokuxineka kwizigulana kwaye ayisebenzi ngokuthe ngqo ukunciphisa umsipha we-muscle. Ikhosi emfutshane ye-steroids yomlomo efana ne-prednisolone ixesha leentsuku ezi-5 kulawulo lokuchwetha inokunikwa ukunciphisa ukudumba kunye nokuvuvukala kwimithambo-luvo. Inokubonelela ngokuphumla kwintlungu kwangexesha iiyure ezingama-24.

Xa iintlungu zingasonjululwanga ngokwaneleyo kunye needosi eziphezulu ezisebenzayo, isigulane sinokuqwalaselwa ngokunika inaliti ye-steroid kwindawo ye-epidural. Olona phawu luphambili lwenaliti ye-steroid kwindawo ye-periradicular kukucinezelwa kwe-discal kubangela iintlungu ezibuhlungu ezixhathisayo kunyango oluqhelekileyo. Uvavanyo olucokisekileyo kunye ne-CT okanye i-MRI scanning iyafuneka ukuba ungabandakanyi ngononophelo izizathu ezongezelelweyo ze-dical zentlungu. Ukuchasana kolu nyango kubandakanya abaguli abanesifo seswekile, ukukhulelwa, kunye nezilonda zesisu. I-epidural puncture ichasene nezigulane ezineengxaki ze-coagulation kwaye ngoko ke indlela ye-foraminal isetyenziswe ngononophelo xa kuyimfuneko.

Le nkqubo yenziwa phantsi kwesikhokelo se-fluoroscopy kwaye ibandakanya ukujova ii-steroid kunye ne-analgesic kwindawo yendawo engqamene ne-disc ye-intervertebral disc echaphazelekayo yokunciphisa ukuvuvukala kunye nokuvuvukala kweeseli ngqo kwindawo yokuphuma. Ukuya kuthi ga ngoku ngama-50% ezigulana zinokufumana isiqabu emva kwenaliti nangona kuyinto yethutyana kwaye zinokufuna ukuphinda zithunyelwe kathathu ngeveki ukufikelela kwiziphumo ezilungileyo. Ukuba le modular yonyango iphumelela, ukuya kuma-2 inaliti yesifo se-pesural yesifo sinokunikwa ngonyaka.

Unyango lomzimba lunokunceda isigulana ukuba sibuyele kubomi bangaphambili ngokulula nangona singayiphuculi i-disc ye-herniated. Unyango ngokwasemzimbeni unokuyalela isigulana ngendlela yokugcina imeko echanekileyo, ukuhamba, kunye neendlela zokuphakamisa kuxhomekeka kwisakhono somguli sokusebenza, ukushukuma kunye nokuguquguquka.

Ukuzivocavoca umzimba kunokuphucula ukuguquguquka komqolo ngelixa ukuqinisa umzimba kunokunyusa amandla emisipha yomqolo. Imisebenzi enokunyusa imeko yediski ye-herniated iyalelwa ukuba igwenywe. Unyango lomzimba lwenza utshintsho ukusuka kwi-intervertebral disc herniation ukuya kwindlela yokuphila esebenzayo egudileyo. Iinkqubo zokuzilolonga zinokugcinwa ubomi bonke ukuphucula impilo-ntle jikelele.

Olona nyango lusebenzayo lonyango olunokubaluleka olusekelezwe kubungqina kukujonga kunye nokulimala kwenaliti yesifo setyhefu sokukhululeka kwentlungu kwixesha elifutshane. Nangona kunjalo, ukuba ngaba abaguli banqwenela kangaka banokusebenzisa unyango olupheleleyo olukhethiweyo babo nge-acupuncture, i-acupressure, izongezo zesondlo, kunye ne-biofeedback nangona bungekho bungqina-bungqina. Akukho bungqina bunyanzelisa ukusetyenziswa kwe-trans yombane nerve stimulation (Tens) njengendlela yokunceda kwintlungu.

Ukuba akukho phuculo kwintlungu emva kweenyanga ezimbalwa, utyando lunokucingelwa kwaye isiguli kufuneka sikhethwe ngononophelo kwiziphumo ezifanelekileyo.

Unyango lonyango

Injongo yonyango lokunyanga kukususa iingcambu zethambo kunye nokunciphisa uxinzelelo. Kukho iimpawu ezibonelela ngonyango olunokuhlinzwa lulandelayo.

Iimpawu ezibonakalayo zibandakanya i-cauda equina syndrome okanye i-paresis ebalulekileyo. Ezinye izikhombisi zihambelana nokusilela kwemoto ezinkulu kunebanga lesithathu, i-sciatica engaphenduliyo ubuncinci kwiinyanga ezintandathu zonyango lolondolozo, i-sciatica isithuba esingaphezulu kweeveki ezintandathu, okanye iintlungu zeengcambu zenhliziyo ngenxa yethambo lomtshato.

Kubekho iingxoxo ezininzi kule minyaka imbalwa idlulileyo malunga nokuba kunyangwa i-herniation yesifo se-discververbral disc ngonyango olugcina ixesha elide okanye unyango lwakwangoko. Uphando oluninzi sele lwenziwe malunga noku kwaye uninzi lwazo lubonisa ukuba iziphumo zokugqibela zeklinikhi emva kweminyaka emi-2 ziyafana nangona ukubuyela ngokukhawuleza kukhawuleze kwenziwe utyando. Ke ngoko, kucetyiswa ukuba kuqhaqho kwangoko kunokuba kufanelekile njengoko kunceda isigulana ukuba sibuyele emsebenzini kwangoko kwaye ngokoqoqosho kunokwenzeka.

Abanye oogqirha basenokuthi basebenzise i-discectomy yendabuko nangona abaninzi basebenzisa iindlela zokuhlinzwa ezincinci kwiminyaka yamuva. I-Microdiscectomy ithathwa njengesiqingatha phakathi kweziphelo zombini. Kukho iindlela ezimbini zotyando ezisetyenziswayo. Utyando olungenelelayo oluncinci kunye neenkqubo ze-percutaneous zezona zisetyenziswayo ngenxa yoncedo olunxulumeneyo. Akukho ndawo yenkqubo yotyando yesintu eyaziwa ngokuba yi-laminectomy.

Nangona kunjalo, kukho izifundo ezibonisa ukuba i-microdiscectomy ithandeka ngakumbi ngenxa yeenzuzo zayo zombini ixesha elifutshane kunye nexesha elide. Ngexesha elifutshane, kukho ubude obuncitshisiweyo bokusebenza, ukunciphisa ukopha, ukukhululeka kweempawu, kunye nokunciphisa izinga lobunzima. Obu buchwephesha busebenze nasemva kweminyaka eli-10 yokulandelwa kwaye ke yeyona ndlela ithandwayo nangoku. Izifundo eziye zenziwa ukuthelekisa ubuchule obuncinci kunye ne-microdiscectomy ibangele iziphumo ezahlukeneyo. Abanye baye basilela ukuseka umahluko omkhulu ngelixa isifundo solawulo esingenamkhethe sakwazi ukufumanisa ukuba i-microdiscectomy yayithandeka ngakumbi.

Kwi-microdiscectomy, kuphela i-incision encinci eyenziwa ngokuncediswa yi-microscope yokusebenza kunye nenxalenye yeqhekeza le-herniated intervertebral disc ephazamisa i-nerve isuswe yi-hemilaminectomy. Enye inxalenye yethambo iphinda isuswe ukwenzela ukuba kube lula ukufikelela kwingcambu ye-nerve kunye ne-intervertebral disc. Ubude bexesha lokuhlala esibhedlele buncinci ngokuhlala ubusuku bonke kunye nokuqwalaselwa kuba isigulane sinokukhutshwa ngobuhlungu obuncinci kunye nokukhululeka okupheleleyo kweempawu.

Nangona kunjalo, ezinye iziguli ezingazinzanga zinokufuna ukwamkelwa kwexesha elide kwaye ngamanye amaxesha banokufuna i-fusion kunye ne-arthroplasty. Kuthelekelelwa ukuba malunga ne-80- 85% yezigulana ezangena kwi-microdiscectomy ziyalulama ngempumelelo kwaye uninzi lwazo ziyakwazi ukubuyela kwindawo yazo eqhelekileyo kwiiveki ezi-6.

Kukho ingxoxo malunga nokuba ukususa inxalenye enkulu yeqhekeza lediski kunye nokunyanga indawo yediski okanye ukususa kuphela iqhekeza le-herniated kunye nokuhlasela okuncinci kwendawo yediski ye-intervertebral. Izifundo ezininzi zicebise ukuba ukususwa ngokukrakra kweenqununu ezinkulu zediski kunokukhokelela kwiintlungu ezingaphezulu kunokuba xa unyango olulondolozayo lusetyenziswe kunye ne-28% ngokubhekiselele kwi-11.5%. Ingakhokelela kwisifo se-disc degenerative kwixesha elide. Nangona kunjalo, ngonyango olulondolozayo, kukho umngcipheko omkhulu wokuphindaphinda malunga ne-7% kwi-herniation ye-disc. Oku kunokufuna utyando olongezelelweyo olufana ne-arthrodesis kunye ne-arthroplasty ukuba lwenziwe kwixesha elizayo elikhokelela ekubandezelekeni okukhulu kunye nomthwalo wezoqoqosho.

Kutyando olungephi, ugqirha otyandayo udla ngokwenza i-incision encinci ngasemva ukuze abeke i-dilators kunye nokwandisa ububanzi ukuze kwandiswe itonela de lifike kwi-vertebra. Obu buchule bubangela ukwenzakala okuncinci kwizihlunu kunokuba kubonwe kwi-microdiscectomy yendabuko. Kuphela inxalenye encinci yediski isuswe ukuze iveze ingcambu ye-nerve kunye ne-intervertebral disc. Emva koko ugqirha unokususa i-disc ye-herniated ngokusebenzisa i-endoscope okanye i-microscope.

Ezi ndlela zotyando zingenelela kancinci zinenzuzo ephezulu yosulelo olusezantsi lwendawo yotyando kunye nokuhlala ixeshana esibhedlele. I-disc i-central decompressed okanye ikhemikhali okanye i-enzymatically kunye nokusetyenziswa kwe-chymopapain, i-laser, okanye i-plasma (igesi ionized) kunye ne-vaporization. Isenokuthotywa ngoomatshini ngokusebenzisa i-percutaneous lateral decompression okanye ngokurhalela nokumunca ngeshaver efana ne-nucleosome. I-Chemopapin ibonakaliswe ukuba inemiphumo emibi kwaye ekugqibeleni yahoxiswa. Uninzi lweendlela zobuchule zingentla zibonise ukusebenza kancinci kune-placebo. I-segmentectomy ekhokelwayo yiyo ebonise isithembiso ekusebenzeni ngokufana ne-microdiscectomy.

Kwi-spervical spine, ii-herniated intervertebral discs ziphathwa ngaphandle. Kungenxa yokuba i-herniation yenzeka ngaphandle nangaphandle kwaye ubuqhophololo bezentambo yomlomo wesibeleko bunganyamezelwa zizigulana. I-herniation ye-disc ebangelwa sisifo sokuqina stenosis kwaye ibanjelwe kwiforamu kuphela kwezi meko apho indlela yangaphambili icingelwayo.

Ubuncinci be-disc excision yenye indlela yendlela yomlomo wesibeleko engaphandle. Nangona kunjalo, ukuzinza kwe-disc ye-intervertebral emva kwenkqubo kuxhomekeke kwintsalela ye-disc. Intlungu yentamo inokuncitshiswa kakhulu ngokulandela inkqubo ngenxa yokukhutshwa koxinzelelo lwe-neuronal nangona kunjalo ukuphazamiseka okubalulekileyo kunokwenzeka ngentlungu eseleyo ye-axial yentamo. Olunye ungenelelo lwe-herniation yomlomo wesibeleko lubandakanya ukungalawuleki kwesibeleko somntu ngaphakathi. Ilunge ngakumbi kwizigulana ezinobunzima be-myelopathy enesifo se disc.

Iingxaki zoqhaqho

Nangona umngcipheko wokuhlinzwa uphantsi kakhulu, iingxaki zisenokwenzeka. Usulelo lwasemva kwonyango lolunye lwezona ngxaki zixhaphakileyo kwaye ke kufuneka ukuba luqhubeke ngakumbi nolawulo lweendlela zokuthintela usulelo kwindawo yemidlalo nakwiwadi. Ngexesha loqhaqho, ngenxa yendlela yokuhlinzwa engeyiyo, kunokuvela ukonakala kwemithambo. Ukuvuza okungaphakathi kunokubakho xa kuvulwa ngaphakathi kweengcambu zethambo kubangela ukuvuza kwamanzi okugcwala kwecarbrospinal okuhlamba iingcambu ze nerve. I-lining inokulungiswa ngexesha lokuhlinzwa. Nangona kunjalo, intloko ebuhlungu inokuthi yenzeke ngenxa yokulahleka kwe-cerebrospinal fluid kodwa ihlala iphucuka kunye nexesha ngaphandle komonakalo oshiyekileyo. Ukuba igazi lijikeleze iingcambu zenzalo emva koqhaqho, elo gazi linokukhokelela ekunyanzelisweni kwengcambu yenzala ekhokelela kwintlungu engathethekiyo eyayikho isigulana ngaphambili. Ukubuyiselwa rhoqo kwe-disc ye-intervertebral disc ngenxa ye-herniation yezinto zokwenza i-disc kwindawo enye kuyinto enobunzima obunzima obunokwenzeka ixesha elide. Oku kungalawulwa ngokuzinzileyo kodwa utyando lusenokuba yimfuneko ekugqibeleni.

Iziphumo zoqhaqho

Kukho uphando olubanzi olwenziwe malunga nesiphumo soqhaqho lwe-lumbar disc herniation. Ngokubanzi, iziphumo ezivela kuqhaqho lwe microdiscectomy zilungile. Kukho ukuphuculwa okungakumbi kwentlungu yomlenze kuneentlungu zangasemva kwaye ngenxa yoko olu tyando alucetyiswa kwabo baneentlungu zasemva kuphela. Izigulana ezininzi ziphucula iklinikhi kwiveki yokuqala kodwa zinokuphucuka kwiinyanga ezimbalwa ezilandelayo. Ngokwesiqhelo, iintlungu ziyanyamalala kwixesha lokubuyisela kwakhona kwaye kulandelwa ngokuphuculwa kwamandla emlenzeni. Ekugqibeleni, ukuphuculwa kweemvakalelo kwenzeka. Nangona kunjalo, abaguli banokukhalaza malunga nokuziva unesithukuthezi nangona kungekho ntlungu. Imisebenzi eqhelekileyo kunye nomsebenzi unokuphinda uqalise kwiiveki ezimbalwa emva koqhaqho.

Unyango lweNovel

Nangona unyango lokugcina ngokukhuselekileyo lolona hlobo lufanelekileyo lokunyanga abaguli, umgangatho okhoyo wokukhathalela awusiqwalaseli i-pathology ye-herniation ye-disc ye-intervertebral disc. Kukho iindlela ezahlukeneyo ezibandakanyekileyo kwi-pathogeneis ezinje ngokuvuvukala, umlo ophakathi, kunye neendlela zeproteyostiki.

Indima yabalamli abakhoyo ngoku iphantsi kophando kwaye kukhokelele kuphuhliso lonyango olutsha olujolise kwaba balamli bokudumba babangela ukonakala kweengcambu. Ii cytokines ezinje nge TNF? zibandakanyeka ikakhulu kulawulo lwezi nkqubo. Ubuntununtunu bentlungu buhambelana ne-serotonin receptor antagonists kunye ne-2 adrenergic receptor antagonists.

Ngoko ke, unyango lwe-pharmacological olujoliswe kula ma-receptors kunye nabalamli banokuchaphazela inkqubo yesifo kwaye bakhokelela ekunciphiseni iimpawu. Okwangoku, abachasi be-cytokine ngokuchasene ne-TNF? kunye ne-IL 1? bavavanyiwe. I-Neuronal receptor blockers ezifana ne-sarpogrelate hydrochloride njl ziye zavavanywa kuzo zombini iimodeli zezilwanyana kunye nezifundo zeklinikhi zonyango lwe-sciatica. Iimodyuli zomjikelo weseli ezijolise kwi-microglia ekucingelwa ukuba ziqalise ukudumba kwe-cascade ziye zavavanywa nge-neuroprotective antibiotic minocycline.

Kukho nophando lokuthintela i-NF- kB okanye indlela yeeprotein kinase mva nje. Kwixesha elizayo, unyango lwe-herniation ye-disc ye-intervertebral luya kuphuculwa ngakumbi enkosi ngophando oluqhubekayo. (Haro, Hirotaka)

 

 

I-disc bulge kunye / okanye i-herniated disc ngumcimbi wezempilo ochaphazela i-discs intervertebral disc ezifunyenwe phakathi kwe-vertebra nganye yomgogodla. Nangona ezi zinokwenzeka njengenxalenye yendalo yokuwohloka ngeminyaka, ukwenzakala okanye ukwenzakala kunye nokuphinda usetyenziswe kakhulu kunokubangela i-disc bulge okanye i-herniated disc. Ngokwengcali yezempilo, i-disc bulge kunye / okanye i-disc ye-herniated yenye yezona zinto ziqhelekileyo kwezempilo ezichaphazela umgogodla. I-disc bulge kuxa imicu yangaphandle ye-annulus fibrosus ikhutshiwe kwimigca yemizimba ye-vertebral esecaleni. I-disc ye-herniated kuxa inxenye okanye yonke ingqangi ye-nucleus pulposus ikhuselwa ngokusebenzisa iqhekeza okanye buthathaka yangaphandle i-annulus fibrosus ye-disc ye-intervertebral. Unyango lwale miba yezempilo igxile ekunciphiseni iimpawu. Olunye ukhetho lonyango, njengokukhathalela i-chiropractic kunye / okanye unyango lomzimba, lunokunceda ukunciphisa iimpawu. Utyando lunokusetyenziswa kwiimeko zeempawu ezinzima. -Gqr. Alex Jimenez DC, CCST Insight

Ikhutshwe nguGqr Alex Jimenez DC, CCST

 

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