Uvavanyo oluLungeleleneyo oluLungisiweyo

Iklinikhi yangasemva eLawulwayo ngokuLawulwa ngokuKhethekileyo kweChiropractic kunye neQela leMithi eliSebenzayo. Uphononongo apho abathathi-nxaxheba bahlulwe ngamathuba ngamaqela ahlukeneyo athelekisa unyango oluhlukeneyo okanye ezinye iindlela zokungenelela. Ukusebenzisa ithuba lokwahlula abantu ngokwamaqela kuthetha ukuba amaqela aya kufana kwaye iziphumo zonyango abalufumanayo zinokuthelekiswa ngokufanelekileyo.

Ngexesha lolingo, akwaziwa ukuba loluphi unyango olungcono. A Uvavanyo oluLungeleleneyo oluLungisiweyo okanye (RCT) ukuyila ngokuzenzekelayo ukwabela inxaxheba kwiqela lokulinga okanye iqela lokulawula. Njengoko kuqhutyelwa isifundo, ulwahlulo olulindelekileyo kuphela ukusuka kulawo maqela kunye nokuvavanya kwilingo elilawulwa ngokungenamthetho (RCT) isifundo sotshintsho sisenziwa.

eziluncedo

Ilula ukuphoqa imfama / i-mask kunokuba uphucule izifundo
I-randomization elungileyo ihlamba nayiphi na i-bias yabemi
Abantu abachaphazelekayo bayaboniswa ngokucacileyo
Iziphumo zingahlaziywa ngezixhobo ezichanekileyo izixhobo

nezingeloncedo

Ngaba ayibonakalisi ibangela
Ixabiso kakhulu ngexesha kunye nemali
Ukulahlekelwa ukulandelwa kubangelwa unyango
Amavolontiya angabonakaliyo: abantu abathatha inxaxheba bangabonakali bonke

Ngeempendulo kuyo nayiphi na imibuzo onokuba nayo nceda ufowunele uDkt Jimenez kwi-915-850-0900

I-Discs ye-Herniated ne-Sciatica yokungasebenzi kakubi e-El Paso, TX

by iicrosoft | Iimeko eziPhathwayo, Disc Disc, Uvavanyo oluLungeleleneyo oluLungisiweyo, Izifundo zoPhando, Sciatica, Unyango lokuthotywa koMnqonqo, Unyango

I-disc ye-herniated, eyaziwa ngokuba yidiski edibeneyo okanye ephuhliweyo, imeko yonyango eyenzekayo xa ikhefu kwi-disc yangaphandle ye-disc intervertebral ibangela ukuba isahlulo sayo esincinci, esisisiseko siphume kwi-cartilage ejikelezile. Iingxoxo ze-Disc zivame ngenxa yokuchithwa kwetambo yangaphandle ye-disvertebral disc, eyaziwa ngokuba yi-anulus fibrosus. Ingxaki, ukuphakanyiswa okanye ukuxinwa kungabangela i-disc. Ukuqhekeka kwidiski ye-intervertebral kungabangela ukukhululwa kweekhemikhali ezinokubangela ukucasuka kwaye ekugqibeleni zibe Isizathu esicacileyo sobuhlungu obubuhlungu, nangaphandle koxinzelelo lweengcambu.

Iingxoxo ze-Disc zivame ukuphuhlisa emva kokukhutshwa kwidiski ekhoyo ngaphambili, imeko yonyango apho iindawo ezikude ze-anulus fibrosus zihlala zihambelanisiweyo, nangona kunjalo, ezi zinokukhupha xa i-disc ibeka phantsi koxinzelelo. Ngokungafani ne-disc ye-disc, akukho nxalenye yecandelo le-gel eliphunyukayo kwi-disvertebral disc. Iidiski ze-Herniated zihlala ziziphilisa zodwa kwiiveki ezimbalwa. Iingcingo ezinzima zeentambo zingadinga ukutyunjwa, nangona kunjalo, uphando lweentlobo ezahlukeneyo luye lwabonisa ukuba unyango olungasebenziyo lunokunceda ekuphuculeni nasekulawuleni inkqubo yokubuyiselwa kwidiski ye-herniated ngaphandle kwemfuneko yokungenelelo ngoncedo.

UkuPhepha nokuThatyathwa kweNkunkuma yeLumbar Disk Herniation Ukusebenzisa iziPhumo zeziGulane zeziThamo UkuPhendwa koPhando (SPORT): Uvavanyo oluLungeleleneyo

Name: El Paso Back Clinic | Spine Specialists - El Paso, TX
Price range: $$

Abstract

Umxholo: I-Lumbar diskectomy yindlela ephambili yokuhlinzwa eyenziwa kwimpawu zeemva kunye nemilenze kwizigulane zase-US, kodwa ukuphumelela kwenkqubo enxulumene nokunyamekela kwabangasebenzi kungabangela ingxabano.
Injongo: Ukuvavanya ukuphumelela kokuhlinzwa kwi-disk herniation ye-interbrate intervertebral.
Ukuyila, Ukubeka, kunye neziguli: Iziphumo zoMonde zoMonde Iziphumo zoPhando, uvavanyo lwezonyango olungapheliyo olubhalisa izigulane phakathi kuka-Matshi 2000 noNovemba 2004 kwii-13 zeeklinikhi ezininzi zemigudu kwi-11 US. Izigulane zabaviwa be-501 (iminyaka yobudala, iminyaka eyi-42; i-42% yabesetyhini) kunye ne-imaging-yaqinisekiswa i-disk-disk herniation kunye neempawu eziqhubekayo kunye neempawu ze-radiculopathy ubuncinane kwiiveki ze-6.
Amanyathelo: I-diskectomy evulekile evulekileyo ngokuchasene nomntu ongekho nonyango kwisigulane.
Izisiphumo eziphambili zeziphumo: Iziphumo eziziiprayimari zazingu tshintsho ukusuka kwisiseko sokuPhononongwa kweziPhulo zeZonyango I-36-into eFutshane yeFom ye-Survey yeengxaki zomzimba kunye nezikali zomsebenzi kunye ne-Index yase-Oswestry yokukhubazeka (i-American Academy of Orthopedic Surgeons version MODEMS) kwiiveki ze-6, iinyanga ze-3, iinyanga ze-6, kunye ne-1 kunye ne-2 iminyaka ukusuka kubhaliso. Iziphumo eziqhelekileyo zibandakanya ubunzima be-sciatica njengoko zilinganiswa yi-Sciatica Bothersomeness Index, ukwaneliseka ngeempawu, ukuphuculwa kwengxelo ngokwayo, kunye nendawo yengqesho.
iziphumo: Ukumelana nokunikezelwa unyango kwakucacisiwe: I-50% yezigulane ezinikezelwe unyango oye wafumana unyango phakathi kweenyanga ze-3 zobhaliso, ngelixa i-30% yabanikezelwe unyango olungenalo unyango ngexesha elifanayo. Ukuhlalutya ukufuna ukunyanga kubonisa ukuphucula okukhulu kuzo zonke iziphumo eziphambili kunye nezizibini kumacandelo amayeza. Ukwahlukana phakathi kweqela phakathi kwenkqubo yokuphucula kwakunjalo ngokuya kutyunjwa kuwo onke amaxesha kodwa yayincinci kwaye ingabalulekanga kwiziphumo eziphambili.
Izigqibo: Izigulane zombini uphando kunye namaqela angaphathi unyango aphucule kakhulu kwixesha le-2 iminyaka. Ngenxa yeenani elikhulu lezigulana eziwela kuzo zombini izikhokelo, izigqibo malunga nokuphakama okanye ukulingana kwezonyango aziqinisekanga ngokusekelwe kuhlalutyo lokufuna ukunyanga.
UkuBhaliswa koMvavanyo: klinikhi.gov I sazisi: NCT00000410

I-Lumbar diskectomy yindlela ephambili yokuhlinzwa eyenziwa eUnited States kwizigulane ezinempawu zomlenze kunye nomlenze; Uninzi lweenkqubo zikhethileyo. Nangona kunjalo, i-lumbar disk herniation ivame ukubonwa kwizifundo zokucinga ngokungabikho kwezibonakaliso [1,2] kwaye ziyakwazi ukuxininisa ngokuhamba ixesha ngaphandle kokuhlinzwa. [3] Kuze kufike kwi-15 ngokuphindaphindiweyo kwee-diskectomy rates e-United States [4] kunye namazinga aphantsi ukuphakamisa imibuzo ngamazwe malunga nokufaneleka kwamanye okuhlinzwa. [5,6]

Ucwaningo oluninzi luqhathanise ukugqitywa nokungasebenzi impatho zezigulane disk, kodwa ulwahlulo olusisiseko phakathi kwamaqela ezonyango, ubuncinane beesampula, okanye ukungabi nanyathelo lweziphumo eziqinisekisiweyo kwezi zifundo zithintela izigqibo ezisekelwe kwisiseko ngokuphathelele unyango olululo. [7-12] Iziphumo zoMonde eziPhezulu Iziphumo zoPhando (SPORT) zaqaliswa ngoMatshi 2000 ukuya ukuthelekisa iziphumo zokunyangwa nokungasebenzi ngokungenakunyango kwe-disk herniation, i-spinal stenosis, okanye i-spondylolisthesis enokuphulukisa. [13] Uvavanyo lwalubandakanya zombini iqela elingabonakaliyo kunye neqela elikhangeleleneyo elinqabileyo lokuba lithengelelanise ukukhetha ukonyango lwabo kodwa zonke ezinye iinkqubo zokubandakanywa kwaye bavuma ukulandela ngokulandela inkqubo efanayo. Eli nqaku libika iziphumo zokusondeza iinjongo eziyiminyaka eyi-2 kwiqela elihleliweyo.

tindlela

IsiCwangciso soFundo

I-SPORT yaqhutyelwa kwi-13 iinkqubo ezininzi zemigudu e-11 yase-US (eCalifornia, eGeorgia, e-Illinois, eMaine, eMichigan, e-Missouri, e-Nebraska, eNew York, e-New Hampshire, e-Ohio, ePennsylvania). Ikomidi yezifundo zabantu kwiziko ngalinye elibandakanyekayo livumile inkqubo ehambelanayo. Zonke izigulane zinikwe imvume ebhaliweyo. Ibhodi ejongene neenkcukacha ezizimeleyo kunye nokukhusela ukhuseleko kuhlolisise uvavanyo kwiinyanga ezili-6. [13]

Abemi abagulayo

Izigulane zacatshangelwa ukuba zibandakanywe ukuba ziyiminyaka eyi-18 kwaye zikhulile kwaye zafunyaniswa ngabagqirha abathatha inxaxheba ngexesha lokubhaliselwa kweso sifundo njengokwenza i-disk herniation kunye neempawu ezingapheliyo nangona kungekho unyango olungenalo unyango ubuncinane kwiiveki ze-6. Umxholo wokunakekelwa kwangaphambili wokunakekelwa kwemisebenzi awuzange ubekwe ngokucacileyo kwiprothotho kodwa kubandakanya imfundo / ukululekwa (71%), unyango lomzimba (67%), i-injection epidural (42%), unyango lwe-chiropractic (i-32%), imishanguzo echasayo (61% ), kunye nee-analgesics ze-opioid (40%).

Iikhrayitheriya ezithile zokufakwa kubhaliso yayiyintlungu engathethekiyo (ngezantsi kwedolo ngenxa ye-lumbar herniation esezantsi, ethangeni langaphambili le-lumbar herniation) kunye nobungqina bokucaphuka kweengcambu kunye nophawu oluqinisekileyo lokuqina kwengcambu (umlenze othe tye uphakamisile phakathi kwe-30 kunye ne-70 okanye uphawu oluqinisekileyo lokuqina kobufazi) okanye intsilelo ehambelana ne-neurologic (isymmetrical deplex reflex, ukuncipha kovalo kusasazo lwedermatomal, okanye ubuthathaka kusasazo lwe-myotomal). Ukongeza, bonke abathathi-nxaxheba babengabagqatswa abagqityiweyo abafumene i-vertebral imaging ephambili (i-97% yemagneti yokujonga umfanekiso, i-3% ikhompyuter yecomputer) ebonisa idiski herniation (ukukhupha, ukukhupha, okanye iqhekeza elithathiweyo) [14] kwinqanaba nakwicala elihambelana neempawu zeklinikhi. . Izigulana ezinee-heniation ezininzi zazibandakanyiwe ukuba ngaba yenye yeempawu ezazithathwa njengeempawu zempawu (okt, ukuba ngaba bekucwangcisiwe ukuba kwenziwe enye).

Iikhrayitheriya zokukhutshwa zibandakanya utyando lwangaphambi kwe-lumbar, i-cauda equina syndrome, i-scoliosis enkulu kune-15 , ukungazinzi ngokwamacandelo (> 10 motion angular motion okanye> 4-mm translation), ukwaphuka kwamathambo omqolo, usulelo lomqolo okanye ithumba, ukudumba kwespondyloarthropathy, ukukhulelwa, iimeko ezichaseneyo , okanye ukungakwazi / ukungafuni ukwenza utyando kwisithuba seenyanga ezi-6.

Iingenelo zokuFunda

Ukuhlinzwa kwakuyi-diskectomy evulekile evulekile ngokuhlolwa kweengcambu zentsholongwane. [15,16] Inqubo evunyelwene ngawo onke amaziko athatha inxaxheba yenziwa phantsi kwe-anesthesia jikelele okanye yendawo, kunye nezigulane ezisezantsi okanye ezigodini. Abagqirha babakhuthazwa ukuba basebenzise ukukhulisa i-loupe okanye i-microscope. Ukusebenzisa ukuchithwa kwe-midline ebonisa izihlunu eziphambene nezidumbu, indawo yangaphakathi yayingeniswe njengoko kuchazwe nguDelamarter noMcCullough. [15] Kwezinye iimeko umda ophakathi komgca ophezulu ususwe ukubonelela ngokucacileyo imbono yengcambu echaphazelekayo. Ukusebenzisa isixhobo esincinci se-annular, isiqhekeza sediski sasuswa njengoko kuchazwa ngu-Spengler. [16] Umngcipheko wawuhlolwe kwaye i-foramen isetyenziselwa i-disk yesibongo okanye i-bony pathology. Ingcambu yesondlo yaxinwa, yashiya ihamba ngokukhululeka.

Iqela lonyango elingasebenziyo lifumene ukhathalelo lwesiqhelo, kunye nenkqubo yokufunda icebisa ukuba unyango oluncinci lonyango alubandakanyi unyango olusebenzayo, imfundo / ingcebiso ngemiyalelo yokuziqeqesha ekhaya, kunye neziyobisi ezichasayo ezingezizo, ukuba ziyanyamezelwa. Olunye unyango olungasebenziyo lwadweliswa, kwaye oogqirha bakhuthazwa ukuba bazenzele unyango kwisigulana; Zonke iindlela zonyango ezingasebenziyo zilandelelwe ngokufanelekileyo. [13,17]

Imilinganiselo yoFundo

Imilinganiselo ephambili yayiyiSifundo seZiphumo seZonyango i-36-Item Surf Form Form Survey (SF-36) intlungu yomzimba kunye nezikali zomzimba [18-21] kunye ne-American Academy ye-Orthopedic Surgeons I-MODEMS version ye-Oswestry Disability Index (ODI). [22] Njengoko kuchazwe kwiprothotho yesilingo, iziphumo eziphambili zatshintshwa ukusuka kwisiseko kumanqanaba e-6 iiveki, iinyanga ze-3, iinyanga ze-6, kunye ne-1 iminyaka kunye ne-2 iminyaka kubhaliso.

Amanyathelo eSibini aquka ukuphuculwa kwengxelo ngokuzimela, isimo somsebenzi, kunye nokwaneliseka ngempawu zangoku kunye nokunyamekela. [23] Ubunzima beSmptom bubekwe nguSciatica Bothersomeness Index (udidi, i-0-24; amanqaku aphezulu amelela iimpawu ezimbi). [24,25]

UkuBhaliswa, UkuBhaliswa, kunye neRandomization

Umongikazi wophando kwiziko ngalinye elichongiweyo abanokuthi bathathe inxaxheba kwaye baqinisekise ukufaneleka. Ukuqashwa kunye nolwazi olunolwazi, iipototapes ezisekelwe kubungqina zichaze iinkonzo zokugonywa kunye nokungabikho komsebenzi kunye neenzuzo ezilindelekileyo, ingozi kunye nokungaqiniseki. [26,27] Abathathi-nxaxheba banikezelwa ukubhaliswa kwimizingo elandelelweyo okanye iqela elikhangelelanayo, iziphumo zichazwe kwinqaku lomhlobo.

Ubhaliso lwaqala ngoMatshi 2000 kwaye lwaphela ngoNovemba 2004. Iziphumo eziphambili zenziwa ziqokelelwe ngaphambi kokuhlaziya. Izigulane zizenzele ubuhlanga kunye nobuhlanga basebenzisa iiNational Institutes of Health categories.

Isabelo esenziwe ngokukhawuleza ngekhompyutheni esekelwe kwiibhloko ezivunyelwe (i-6, 8, 10, kunye ne-12). [28] ngaphakathi kwamasayithi zenzeke emva kokubhalisa nge-automated system kwiziko ngalinye, ukuqinisekisa ukugcinwa kwesabelo esifanelekileyo. Amanyathelo okufunda aqokelelwa kwisiseko kunye nokutyelela ngokulandelelanayo okulandelelweyo. Ukutyelelwa kwexesha elifutshane kulandelwa kwiiveki ze-6 kunye neenyanga ze-3. Ukuba utyando lwabambezeleka ngaphaya kweeveki ze-6, iinkcukacha ezongezelelweyo zokulandelelwa zafunyanwa iiveki ze-6 kunye neenyanga ze-3 emva kokusebenza. Ukutyelelwa kwexesha elide kwenzeka kwiinyanga ze-6, unyaka we-1 kubhaliso, kwaye emva koko emva koko.

Uhlalutyo lweSatisati

Ekuqaleni sasizimisele ubungakanani besampulu yezigulana ezingama-250 kwiqela ngalinye lonyango ukuba zanele (ngenqanaba elibalulekileyo elisecaleni le-.2 kunye ne-05% yamandla) ukufumana umahluko wamanqaku ali-85 kwiintlungu zomzimba ze-SF-10 kunye nezikali zokusebenza komzimba okanye ubungakanani besiphumo esifanayo kwi-ODI. Lo mahluko ungqinelane neengxelo zezigulana zokuba "ngcono kancinci" kwi-Maine Lumbar Spine Study (MLSS). [36] Ubungakanani besampulu yokubala kuvunyelwe ukuya kuthi ga kwi-29% yedatha elahlekileyo kodwa ayiphendulanga kuwo nawaphi na amanqanaba okungahambelani.

Uhlalutyo lweziphumo eziziiprayimari neziziisekondari zisebenzise yonke idatha ekhoyo ngexesha ngalinye kwisiseko sonyango. Amanqaku okugqitywa kwangaphambili kwesifundo afaka iziphumo kwiiveki ezi-6, kwiinyanga ezi-3, kwiinyanga ezi-6, kunyaka omnye, nakwiminyaka emi-1. Ukulungelelanisa iziphumo ezinokubakho zedatha elahlekileyo kwiziphumo zophando, uhlalutyo lweenguqulelo zotshintsho kwiziphumo eziqhubekayo zenziwa kusetyenziswa uqikelelo oluphezulu lweemodeli zeempembelelo ezixubeneyo eziphantsi kokuphoswa kukucinga okungalunganga kunye nokubandakanya ixesha kwiziko lonyango. Uhlalutyo lokuthelekisa lwenziwa kusetyenziswa iindlela zokumisela ezizodwa zexabiso lesiseko eliqhutyelwe phambili kunye nexabiso lokugqibela eliqhutyelwe phambili, kunye nemodeli exutyiweyo yokulawula ii-covariates ezinxulunyaniswa notyelelo oluphosakeleyo. [2]

Imiphumo yesibini yamabhinari, imodeli yokuguqulwa kwexesha elide yayisetyenziselwa ukusebenzisa i-equity estimation equations [31] njengoko iphunyezwe kwinkqubo ye-PROC GENMOD ye-SAS version 9.1 (iSAS Institute Inc, Cary, NC). Imiphumo yonyango yaqikelelwa njengento eyahlukileyo kwizinga eliqhelekileyo kumaqela enyango ye-2.

P <.05 (2-emacaleni) yayisetyenziselwa ukumisela ukubaluleka kweenkcukacha manani. Kwiziphumo eziphambili, i-95% yamathuba okuzithemba (i-CI) kwiziphumo zonyango ezichaziweyo zabalwa kwindawo nganye ebekiweyo. Uvavanyo lwehlabathi lwe-hypothesis edibeneyo yokungabikho kwempembelelo kunyango nangaliphi na ixesha elichongiweyo lwenziwa kusetyenziswa iimvavanyo zeWald [32] njengoko kwenziwe kwi-SAS. Ezi mvavanyo zilungiselela ulungelelwaniso lwangaphakathi ngenxa yokulinganisa okuphindaphindiweyo ngokuhamba kwexesha. [32]

Ukungahambelani kunyango olunikezelwe ngokungacwangciswanga kunokuthetha ukuba uhlalutyo olunenjongo yokunyanga luthatha kancinci isibonelelo sonyango. [33,34] Njengoluhlalutyo olucwangcisiweyo lobuntununtunu, siqikelele uhlalutyo lwe- as-unyango- longitudinal olusekwe kuthelekiso nezo ngenene uphathwe ngotyando nangaphandle kokusebenza. Amanyathelo aphindaphindiweyo eziphumo asetyenziswa njengezinto ezixhomekekileyo, kwaye unyango olufunyenweyo lwabandakanywa njenge-covariate eyahluka-hlukeneyo. Uhlengahlengiso lwenziwe ngexesha lotyando ngokubhekisele kumhla wokuqala wobhaliso ukuqikelela amaxesha amiselweyo okulandelwa. Izinto eziguquguqukayo ezisisiseko ezifunyenwe ngokukodwa ekuchazeni idatha engekhoyo okanye unyango olufunyenwe kunyaka we-1 zibandakanyiwe ukuze zilungelelanise ukuphazamiseka okunokwenzeka.

iziphumo

I-SPORT ifinyelele ukubhaliswa ngokupheleleyo, kunye ne-501 (25%) yezigulane ezifanelekile ze-1991 ezibhalise kwisilingo esicwangcisiweyo. Ingqungquthela yabathathi-nxaxheba be-472 (i-94%) yagqitywa ubuncinane ukutyelela kwe-1 kwaye yafakwa kuhlalutyo. Iinkcukacha zifumaneke phakathi kwe-86% kunye ne-73% yezigulane kwixesha elilandelelweyo lokulandelela (Umfanekiso 1).

Umfanekiso we-1 Flow Diagram ye-RCT ye-SPORT ye-Disc Herniation

Umzobo 1: Umzobo ohambayo we-SPORT Uhlolo olulawulwayo olungaphenduliweyo lwe-Disk Herniation: Ukukhutshwa, ukuBhaliswa, ukuHlanywa koLuntu kunye nokuLandela.

Iimpawu zoMonde

Impawu zesigulane sesigulane ziboniswa kwiThebhile 1. Ngokubanzi, uluntu lwabafundi lune minyaka engama-42 eneminyaka engama-70 ubudala, kunye nezona zikhulu zindoda, ezimhlophe, eziqeshwe, kwaye ziye zangena kwiikholeji ezithile; I-16% yayifumana imbuyekezo yokukhubazeka. Zonke izigulane zineentlungu ezinzima zomlenze, i-97% kwi-classic dermatomal distribution. Uninzi lwama-herniations lwaluyi-L5-S1, i-posterolateral, kwaye yayingenwe yi-criteria ye-imaging. [14] Amaqela angama-2 anamaqela athile afana nesiseko.

Unyango lweZonyango

Iinkqubo ezahlukeneyo zonyango ezazisetyenziswanga ngexesha lokufunda (Itheyibhile 2). Uninzi lwezigulane zifumana imfundo / iingcebiso (i-93%) kunye neyeza-anti-inflammatory (61%) (izidakamizwa ezichasene nezidakamizwa, i-cyclooxygenase 2 inhibitors, okanye i-oral steroids); I-46% ithole i-opiates; ngaphezu kwe-50% yamkela iigciwane (umzekelo, i-epidural steroids); kwaye i-29% yayinqunyiwe yomsebenzi wokuthintela. Amaphesenti anesine anesine athola unyango olusebenzayo ngexesha lovavanyo; nangona kunjalo, i-67% yayifumene ngaphambi kokubhalisa.

Ukunyangwa koPhando kunye neengxaki

Itheyibhile 3 inikeza iimpawu zonyango lophuhliso kunye neengxaki. Isikhathi sokugula sasingumzuzu we-75 (udidi lwe-interquartile, i-58-90), kunye nokulahleka kwegazi kwe-49.5 mL (u-interquar-tile range, 25-75). Kuphela i-2% idinga ukumpontshelwa. Kwakungekho nto yokufa kwabasebenzi; Isigulane se-1 safa ngenxa yeengxaki zokubeletha kweenyanga ze-11 emva kokubhalisa. Inkcenkcesha eqhelekileyo ye-intraoperative yayiyinkqonkqoza yezantathu (4%). Kwakungabikho nkxalabo yokuhamba emva kwe-95% yezigulane. Ukuqhutyelwa komsebenzi kwenzeka kwi-4% yezigulane zonyaka we-1 wovavanyo lokuqala; ngaphezu kwe-50% yendlela yokuphinda iqhutywe ngayo yinto yokuphindaphinda rhoqo kwizinga elifanayo.

Ukunganyaniseki

Ukungahambelani nolwabiwo lonyango kuwachaphazele omabini la maqela, okt, ezinye izigulana kwiqela lotyando zikhethe ukulibazisa okanye ukuncipha utyando, kwaye ezinye kwiqela elinganyangekiyo lonyango ziye zafumana utyando (Umzobo 1). Iimpawu zezigulana ze-crossover ezahlukileyo ngokweenkcukacha-manani kwizigulana ezingazange ziwele ziboniswe kwiTheyibhile 4. Abo kunokwenzeka ukuba bawelele ukufumana utyando bathande ukufumana umvuzo omncinci, iimpawu ezisisiseko ezimbi, ukukhubazeka okungaphezulu kwesiseko kwi-ODI, kwaye kunokwenzeka ukuba bavavanye iimpawu zabo njengobubi ngakumbi kubhaliso kunezinye izigulana ezifumana unyango olungasebenziyo. Abo banethuba lokuwela ukuze bafumane ukhathalelo olungasebenziyo bebekhulile, benemivuzo ephezulu, babenethuba lokufumana i-disk lniar herniation ephezulu, ubuncinci bokufumana isiphumo sokuvavanywa komlenze othe tye, babenentlungu encinci, ukusebenza ngcono komzimba, kuncinci ukukhubazeka kwi-ODI, kwaye bekunokwenzeka ukuba bazilinganise iimpawu zabo njengokufumana ngcono kubhaliso kunezinye izigulana zotyando.

Idata e la hlekile

Iirhafu zeenkcukacha ezilahlekileyo zilingana phakathi kwamaqela ngexesha ngalinye kwinqanaba, kungabikho ubungqina bokulahla ngokuhlukileyo ngokubhekiselele kwonyango olwenziwe. Iziganeko zezigulane ezihambileyo ziye zafana kakhulu nazo zonke ezinye iqela ngaphandle kokuba izigulane ezineenkcukacha ezilahlekileyo zingenakunokwenzeka ukuba zitshatile, zinokufumana umvuzo wokukhubazeka, mhlawumbi ukutshaya, mhlawumbi ukubonisa ubuthathaka bokuqala , kwaye unesicatshulwa esezantsi esicatshulwa ngokwezibalo zesishwankathelo kwiSF-36.

Iinjongo zokuThengisa

Itheyibhile 5 ibonisa utshintsho olulinganiselweyo olususela kwisiseko nakwiziphumo zonyango (umahluko kutshintsho olususela kwisiseko phakathi kwamaqela onyango) kwiinyanga ezi-3, unyaka omnye, kunye neminyaka emi-1. Kwinqanaba ngalinye nakwinqanaba ngalinye, isiphumo sonyango sithanda utyando. Iziphumo zonyango kwiziphumo eziphambili zazincinci kwaye zingabalulekanga ngokwezibalo nakwezinye iindawo. Njengoko kubonisiwe kwi Umzobo 2, omabini la maqela onyango abonise ukuphucuka okunamandla kumaxesha alandelayo okulandela, kunye nezibonelelo ezincinci zotyando. Nangona kunjalo, kwisiphumo sokuqala ngasinye kuvavanyo oludibeneyo lwehlabathi kuwo nawuphi na umahluko nangaliphi na ixesha alubalulekanga ngokwezibalo. Olu vavanyo lunika ulungelelwaniso lwangaphakathi njengoko kuchaziwe kwicandelo ethIindlela zendlela.

Umzobo 2: Kuthetha amaxesha angaphezu kwexesha kwi-SF-36 Ubuhlungu bobuhlungu kunye neMisebenzi yePhysical Scales ne-Index ye-Disability Disability Index.

Itheyibhile ye-5 Impatho yeZonyango kwiziphumo eziPrayimari neziPhezulu

Ithebula 5: Iziphumo zonyango kwiZiphumo eziPrayimari neziPhezulu ngokuSebenzisa ukuThengisa ukuThengisa ukuThengisa *

Kwiziphumo zesibini zokubandezeleka kwe-sciatica, iTheyibhile 5 kwaye Umzobo 3 bonisa ukuba kukho uphuculo olukhulu kwiSciatica Bothersomeness Index kwiqela lotyando ngalo lonke ixesha lokulandelwa: iinyanga ezi-3 (isiphumo sonyango,? 2.1; 95% CI,? 3.4 ukuya ku-0.9), unyaka omnye (isiphumo sonyango,? 1; 1.6% CI,? 95 ukuya ku-2.9), kunye neminyaka emi-0.4 (isiphumo sonyango,? 2; 1.6% CI,? 95 kuye ku-2.9), neziphumo Uvavanyo lwe-hypothesis lwehlabathi lubalulekile ngokwezibalo (P = .0.3). Ukwaneliseka kwesigulana ngeempawu kunye nonyango kubonise iziphumo ezincinci ekuthandeni utyando ngelixa imeko yengqesho ibonakalisa iziphumo ezincinci kukhathalelo lokungasebenzi, kodwa akukho nanye kolu tshintsho ebelubalulekile ngokwezibalo. Inkqubela phambili yokuzikala ibonakalise into encinci ebalulekileyo kubalo lotyando (P = .003).

Umzobo 3: Imilinganiselo yokuhamba kwexesha le-Sciatica Bothersomeness Index, Isimo sengqesho, Ukwaneliseka ngeZimpawu, Ukwaneliseka ngononophelo, kunye nokuPhuculwa koMgangatho.

Uhlalutyo olunyangiweyo olusekwe kunyango olufunyenweyo lwenziwa ngohlengahlengiso ngexesha lotyando kunye nezinto ezichaphazela unyango kunye nedatha elahlekileyo. Ezi zivelise iziphumo ezahluke kakhulu kunoluhlalutyo lokufuna ukunyanga, kunye nezibonelelo ezinamandla, ezibalulekayo ezibonwayo zotyando ngalo lonke ixesha lokulandela ukuya kwiminyaka emi-2. Umzekelo, kunyaka we-1 iziphumo zonyango eziqikelelweyo ze-SF-36 iintlungu zomzimba kunye nezikali zomzimba, i-ODI, kunye nemilinganiselo ye-sciatica yayiyi-15.0 (95% CI, 10.9 ukuya ku-19.2), 17.5 (95% CI, 13.6 ukuya ku-21.5 ?, 15.0 (95% CI,? 18.3 ukuya ku-11.7), kunye no-3.2 (95% CI,? 4.3 ukuya ku-2.1), ngokulandelelana.

Uhlalutyo lobuthathaka lwenzelwa iindlela ezi-4 zokuhlalutya zokujongana nedatha engekhoyo. Enye indlela yayisekwe kutshintsho olulula lokuthetha kuzo zonke izigulana ezinedatha ngexesha elinikiweyo kungekho luhlengahlengiso olulodwa lwedatha elahlekileyo. Iindlela ezimbini ezisetyenzisiweyo zendlela yokuchwetheza ixabiso elisisiseko liqhubele phambili laze ixabiso lokugqibela laqhubela phambili. [32] Le ndlela yokugqibela isebenzise imodeli efanayo yokuxubusha ukuqikelela utshintsho olwenziweyo njengoko kubonisiwe kwiTheyibhile 5 kodwa ikwahlengahlengisiwe kwizinto ezichaphazela ukubakho kwedatha elahlekileyo. Uqikelelo lwempembelelo kunyango kunyaka omnye ukusuka ku-1 ukuya ku-1.6 kwinqanaba le-SF-2.9 yomzimba wentlungu, i-36 ukuya kwi-0.74 yokulinganisa ukusebenza komzimba, i-1.4 ukuya kwi-2.2 ye-ODI, kunye ne-3.3 ukuya kwi-1.1 yamanyathelo e-sciatica. Ukunikezelwa kolu luhlu, kubonakala ngathi akukho mahluko mkhulu phakathi kwezi ndlela.

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Iimpawu ze-disc ze-Herniated ziyahluka kwiindawo zendawo kunye nakumathishini amancinci ajikelezileyo. I-Lumbar disc herniations, enye yeyona ndawo eqhelekileyo yeediskiti ze-herniated ziza kwenzeka, zibonakaliswa nokunyanzeliswa kweengcambu zentsholongwane ngaphantsi komqolo kwaye zingabangela impawu ze-sciatica. Uphando luyacetyiswa ukuba uphathe unyango lwe-disc, nangona kunjalo, iindlela ezininzi zokonyango zinokukunceda ukulawula imeko ngaphandle kwemfuneko yokungenelela. Ucwaningo olwenziwa kwi-sciatica olubangelwa yi-disniated discs lucacise ukuba malunga ne-73 ipesenti yabathathi-nxaxheba bafumana uphuculo lweempawu ezingenalo unyango. Iziphumo zale nqaku zaphetha ukuba unyango olungasebenziyo lunokusebenza ngokufanelekileyo njengonyango ekwonyango kwama-discs.

amagqabantshintshi

Izibini zombini eziqhutywe kwaye ezingasebenziswanga ne-disk-disk herniation zithuthuke kakhulu kwixesha le-2. Uhlalutyo lokufuna ukunyanga kulolu vavanyo alubonisi iziphumo zonyango ezibalulekileyo kwiziphumo eziphambili; iinkqubo zesibini ze-sciatica ubundlobongela kunye neenkqubela ezizenzekelayo zibonise iingenelo ezibalulekayo zokuhlinzwa. Ezi ziphumo kufuneka zijongwe kumxholo wezinga eliphezulu lokungabinaki ukunikezelwa unyango. Umzekelo wokungahloneli nto ukhangeleka kuba, ngokungafani nezifundo ezininzi zokugqirha, amaqela atyhutyayo kunye nabangasebenziyo athatyathwa. [35] Uvavanyo olulinganayo oludlulileyo [8] lwaba ne-26% crossover ukuya kwi-1 kunyaka, kodwa kuphela i-2% lotyando. Ukuxutywa kwezonyango ngenxa ye-crossover kunokulindelwa ukudala i-bias kwi-null. [34] Imiphumo emikhulu ebonwe kuhlalutyo oluphethwe ngokufanelekileyo kunye neempawu zezigulane zogqirha zibonisa ukuba uhlalutyo lokufuna ukunyanga lugxininisa impembelelo yokuhlinzwa.

IZIFUNDO zeziphumo zihambelane namava eokliniki kuloo ntlungu yentlungu yinto yokuphucula kunye nokuqhubekayo nokuphuculwa. Kubaluleke kakhulu, zonke izigulane kule tyala zinentlungu yomlenze kunye nokuhlolwa kweempawu kunye nokufundwa kweengcamango eziqinisekisile i-disk herniation. Kwakungekho ubungqina obunobungozi kwindlela yokwelashwa. Akukho zigulane kwiqela elilodwa lenze i-cauda syndrome; I-95% yezigulane ezigqityiweyo zazingenazo iingxaki ezibangelwa yi-intraoperative. Inkcenkcesha eqhelekileyo, ukusila kweentlanga, zenzeke kwi-4% yezigulane, ezifana ne-2% ukuya kwi-7% ephawulwe ngongoma-mvavanyo nguHoffman et al, 7 2.2% ebone kwi-MLSS, [29] kunye ne-4% Iziqulatho zakutshanje ezisuka eStanford. [36]

Enye imingcele yintlupheko yokungakwazi ukumelela izigulane ezivuma ukuba zenziwe ngolu hlobo okanye zonyango; Nangona kunjalo, iziganeko zezigulane ezivuma ukuthatha inxaxheba kwi-SPORT zifana kakhulu nakwezinye izifundo. [29,36] Iminyaka yobudala ye-42 iminyaka yayifana nexesha elide kwi-MLSS, [29] uchungechunge lweSpangfort, [37] kunye novavanyo lwe-Iber, [8] kwaye lukhulile kakhulu kunezo zikhankanyiweyo zakutshanje ukusuka eStanford (iminyaka ye-37.5). [36] Inani lezigulane ezifumana umvuzo wemisebenzi kwi-SPORT (i-16%) yayifana nesilinganiso Inani labantu baseStanford (19%) kodwa ngaphantsi kwelo lilonke labantu be-MLSS (35%), elaligqithise ngokugqithiseleyo izigulane ezifumana umvuzo. Isimo sokusebenza esisiseko saso sasifana, kunye ne-ODI yesiseko esicwangcisiweyo ye-46.9 kwi-SPORT vs 47.2 kwichungechunge lweStanford, kunye nesiseko esicwangcisiweyo sF-36 yomsebenzi womzimba we-39 kwi-SPORT vs 37 kwi-MLSS.

Inkqubo efanelekileyo yokufaneleka, nangona kunjalo, inokunciphisa ukuzaliseka kwezi ziphumo. Izigulane ezingakwazi ukunyamezela iimpawu zeeveki ze-6 kwaye zifuna ukungenelela kwangaphambili kwangaphawulekanga, kwaye akukho zigulane ezingenazo iimpawu ezicacileyo kunye neempawu ze-radiculopathy kunye nomfanekiso wokuqinisekisa. Asinakufumana izigqibo malunga nokusebenza kotyando kula maqela. Nangona kunjalo, iindlela zethu zokungena zilandelwe izikhokelo ezipapashwe ngokukhetha isigulane kwi-diskectomy ekhethiweyo, kwaye iziphumo zethu kufuneka zisetyenziswe kwininzi yezigulane ezijongene nesigqibo sokugqeba. [38,39]

Ukuqonda ngokupheleleyo isiphumo sonyango lotyando xa kuthelekiswa nonyango olungasebenziyo, kufanelekile ukuba uqaphele ukuba iqela ngalinye liqhuba njani. Ukuphuculwa kotyando kwi-SPORT kwakufana nokuya kuthotho lwangaphambili kunyaka we-1: ye-ODI, amanqaku e-31 vs amanqaku e-34 kuthotho lweStanford; yenqanaba lomzimba elibuhlungu, amanqaku angama-40 vs 44 kwi-MLSS; kunye nokukhathazeka kwe-sciatica, amanqaku ali-10 vs 11 kwi-MLSS. Kwangokunjalo, u-Weber [8] uxele i-66% izinto ezilungileyo kwiqela lotyando, xa kuthelekiswa ne-76% yokunika ingxelo kuphucuka okukhulu kunye ne-65% yanelisekile ziimpawu zabo kwi-SPORT.

Uqwalaselo lwentsebenzo lwentsebenziswano olwenziwe ngaphandle kwe-SPORT lwalukhulu kunabo baseMLSS, okubangelwa yinkqubo encinci yonyango. Ukuphuculwa komsebenzi we-37, i-35, kunye ne-9 ngamaphuzu emzimbeni, umsebenzi womzimba, kunye ne-sciatica ephazamisayo, ngokulandelanayo, yayininzi kunokuba kuphuculwe i-20, i-18, kunye neengxelo ze-3 ezichazwe kwi-MLSS. Ukuphuculwa okukhulu kunye nokunyanga okungekho unyango kwi-SPORT kunokunxulumana nenani elikhulu lezigulane (43%) oye wahlinzwa kulo qela.

Owona mda uphambili we-SPORT linqanaba lokungahambelani kunyango olungenamkhethe. Ngenxa yeli nqanaba le-crossover, akunakulindeleka ukuba uhlalutyo lokwenza unyango lube sisiseko soqikelelo olusemthethweni lwenyani yonyango. Uhlalutyo lwe- as-unyango kunye nohlengahlengiso olunokubakho kubaphazamisi lubonise iziphumo ezinkulu kakhulu kunyango lonyango. Nangona kunjalo, le ndlela ayinalo ukhuseleko olomeleleyo ngokuchasene nokudideka okunikezelwa ngokungahleliwe. Asinakho ukubekela ecaleni into yokuba umahluko osisiseko phakathi kwamaqela anyangwa njengonyango, okanye ukhetho olukhethiweyo kodwa hayi ezinye izigulana ezinokuwela uye kuqhaqho, zinokuba nefuthe kwezi ziphumo, kwanasemva kolawulo lwee-covariates ezibalulekileyo. Ngenxa yezithintelo ezibonakalayo kunye nokuziphatha, olu phononongo aluzange lusongelwe ngokusetyenziswa kweenkqubo ze-sham. Ke ngoko, nakuphi na ukuphucula okubonwayo ngotyando kunokubandakanya inqanaba elithile le-effectplacebo effect

Omnye umda wokuba unyulo kukuba ukunyanga kwamayeza angasebenziyo kwakunokuqonda kwonyango kunye nesigulane. Nangona kunjalo, unikezwa ubungqina obuncitshiweyo malunga nokuphumelela kwinkqubo enkulu yokwelashwa kwe-lumbar disk kunye nokuhlukahluka komntu ngamnye ekuphenduleni, ukudala umgaqo-nkqubo ongancinci, ongenamanyathelo wokunyanga ongekho unyango olungenakwenzeka okanye olungenakwenzeka. Ukunyanga okungekho unyango olusetyenziswayo kwakuhambelana nezikhokelo ezipapashwe. [17,38,39] Ukuthelekiswa ne-MLSS, SPORT yayinomsebenzi ophantsi wokunciphisa umsebenzi, ukunyanzelisa umgudu, ukuvuselela umgudu wamagesi, kunye ne-corsets, kunye namazinga aphezulu epilural steroid injections kunye nokusetyenziswa kwezidakamizwa analgesics. Lo mgaqo-nkqubo ongenamsebenzi ongeyena osebenzayo wawunezinto ezintle zokuzikhethela komntu ngokwazo ezikhethwa ngokunyamezela isigulane ekukhetheni ukwelashwa okungenakusebenza kunye nokubonakalisa ukusetyenziswa kwangoku phakathi kweendlela ezininzi zemigudu. Nangona kunjalo, asikwazi ukwenza nasiphi na isigqibo malunga nemiphumo yokuhlinzwa ngokubhekiselele kwonyango olungenakusebenza. Ngokufanayo, asikwazi ukuvavanya ngokwaneleyo ukusetyenziswa kohlobo lwaluphi na ukungafani kwindlela yokuhlinzwa.

isiphelo

Izigulane kwezo zombini zonyango kunye namaqela angonyango aphuculiyo aphucule kakhulu kwiminyaka yokuqala ye-2. Ukwahlukana phakathi kweqela phakathi kwenkqubo yokuphucula kwakunjalo ngokuthanda ukuhlinzwa kuzo zonke iziphumo nakwixesha elizeleyo kodwa zincinci kwaye zingabalulekanga ngokukodwa ngaphandle kwamanyathelo esibini kunye nokuphuculwa komgangatho. Ngenxa yeenombolo eziphakamileyo zezigulana eziwela kuzo zombini izikhokelo, izigqibo malunga nokuphakama okanye ukulingana kwezonyango azivumelekanga ngokusekelwe kuhlalutyo lokufuna ukunyanga kuphela.

Imibulelo kunye nemibhalo engezantsi

Ncbi.nlm.nih.gov/pmc/articles/PMC2553805/

Ukusetyenziswa okanye iMicdiskectomy yeSciatica? IsiFundo seKlinikhi esiPhambili

Abstract

Injongo: Injongo yale sifundo yayikuthelekisa ukwenziwa kweeklinikhi ekusebenziseni umgudu ngokubhekiselele kwi-microdiskectomy kwizigulane ezine-sciatica ezisekondari kwi-lumbar disk herniation (LDH).

Iindlela: Izigulane ezilikhulu ezimashumi amabini ezenza ngokudluliselwa okukhethiweyo ngamagqirha okunyamekela asemgangathweni kwizigulane zogqirha zogqirha zechungechunge zihlolwe ngokulandelelweyo iimpawu ze-radiologypathy ezingalindelekanga kwi-LDH kwiL3-4, L4-5, okanye i-L5-S1. Izigulane ezilandelelanayo ezilandelelanayo ezingamashumi amane ezilandelelanayo (izigulane kufuneka ziphumelele ubuncinane kwiinyanga ze-3 zokulawulwa okungabambiswanga kubandakanya ukwelashwa kunye nama-analgesics, ukuguqulwa kwendlela yokuphila, i-physiotherapy, i-massage therapy, kunye / okanye i-acupuncture) yayingabonakaliyo kwi-microdiskectomy okanye kwi-chiropractic spinal manipulation. I-Crossover kwilinye unyango yavunyelwa emva kweenyanga ze-3.

iziphumo: Ukuphuculwa okubalulekileyo kumacandelo amayeza athathelekiswa kumanqaku athile ngokugqithiseleyo kwexesha kuboniswe kuzo zonke iziphumo zempatho. Emva komnyaka we-1, uhlalutyo olwenziwe ngokulandelelisela ukunyanga aluzange lubonakalise umahluko kwisiphumo esekelwe kwonyango lokuqala. Nangona kunjalo, izigulane ze-3 zawela ngaphaya kwindlela yokuhlinzwa zenza ukunyanzelisa umgudu kwaye zahluleka ukufumana uphuculo olungakumbi. Izigulane ezisibhozo zawela ukusuka ekugqithiseni umgogodla ukuya kwindawo yokuhlinzwa kwaye ziphuculwe kwizinga elifanayo njengabadlali bokuqala bokupanda.

Izigqibo: Amaphesenti anesithandathu kwizigulane ezine-sciatica eziye zahluleka abanye abaphathi bezonyango baxhamla ngokunyanzeliswa komgogodla kwinqanaba elifanayo ngokungathi banokungenelela. I-40% ishiywe inganelisekanga, ukungenelela okutyathwayo okulandelayo kunika isiphumo esihle kakhulu. Izigulane ezineempawu ze-LDH ezingekho phantsi kolawulo lwezonyango kufuneka ziqwalasele ukunyanzeliswa kwemisipha kulandelwa utyando xa kuqinisekisiwe.

Ekugqibeleni, idiski ye-herniated ibangela isahluko esincinci, esiyinxalenye yediski ye-intervertebral ukukhupha ingqungquthela yayo yangaphandle, i-ring fibrous ngenxa yokuguga, ukuphazamiseka, ukuphakanyiswa okanye ukuxhatshazwa. Uninzi lweengcungcuthe zokuzikhupha lunokuziphilisa ngokwabo kodwa abo babecingelwa ukuba banzima bangadinga ukungenelela okunyanga ukunyanga. Uphando lwezophando, njengolu lukhankanywe ngentla, lubonise ukuba unyango olungenalo unyango lunokukunceda ukubuyiswa kwidiski ye-herniated ngaphandle kwemfuneko yokuhlinzwa. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela 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. Intlungu ebuyayo yinkxalabo eqhelekileyo enokubangelwa ngenxa yeemeko ezahlukeneyo kunye / okanye iimeko. Ngokuphindaphindiweyo amaxesha, ukuguqulwa kwemvelo komgudu kunye nomdala kunokubangela intlungu emva. Iidiski ze-Herniated zenzeka xa i-disc, i-gel-like centre ye-disc intervertebral iqhubezela ukulila kwiindawo ezijikelezileyo, zingaphandle kwe-cartilage, icinezela kwaye ivuselele iingcambu zeengcambu. 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.

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

ISIHLOKO ESIBALULEKILEYO: I-EXTRA EXTRA: Ungcono!

EZINYE IINGCUKACHA EZIBALULEKILEYO: UKWENZISA: Ukulimala kwezemidlalo? | Vincent Garcia | Umonde | El Paso, TX I-Chiropractor

Ngenanto

Ucaphulo

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Vala i-Accordion

I-Migraine Pain kunye neLumbar Herniated Treatment Treatment e-El Paso, TX

by iicrosoft | Ucwaningo lwaBasebenzi, Disc Disc, Migraine, Uvavanyo oluLungeleleneyo oluLungisiweyo, Unyango lokuthotywa koMnqonqo, Unyango

Enye yezona zinto ezibangeleyo zentlungu ephantsi ye-back and sciatica inokubangelwa ukunyanzeliswa kweengcambu zeembilini kwi-back back kwi-disc ye-lumbar herniated, okanye i-dis ruptured in the lumbar spine. Iimpawu eziqhelekileyo zedisk herniated discs ziquka ubunzima obuhlukahlukeneyo beentlungu, ukuxhamla kwemisipha okanye ukunyanzelisa, ukunyanzeliswa kwamathambo kunye nokulahleka komlenze kunye nokulahlekelwa komsebenzi wemilenze efanele. Nangona ezi zinto zingabonakali zihambelana ngokusondelene, i-disc ye-herniated disc ingasichaphazela umgudu womlomo wesibeleko, ubonakalisa iimpawu ze-migraine kunye nentloko. Injongo yamanqaku alandelayo kukufundisa izigulane kwaye zibonise ubudlelwane phakathi kwentlungu ye-migraine kunye ne-lumbar disniated disc, ngokuqhubekayo kuxubusha unyango kwezi zimbini.

Ukuhlaziywa Okubalulekileyo Kwonyango Lonyango Ukusetyenziswa Kweengxaki Zentloko: Ukukhawuleza, Iiprofayili, Iinjongo, uLonxibelelwano kunye nokuPhumela okuZibhaliweyo

Abstract

imvelaphi

Nangona ukwandiswa kwezonyango zonyango kwintsholongwane, abaninzi abanezifo eziqhelekileyo eziqhelekileyo zintsholongwane zifuna uncedo ngaphandle kwezicwangciso zonyango. Injongo yaleli phepha kukuvavanya uphando lwezophando malunga nokuxhaphaka kokusetyenziswa kwezigulane zonyango zokwenza unyango lweentloko kunye nezinto eziphambili ezihambelana nesi si gulane.

tindlela

Ukuhlaziywa okubalulekileyo kweencwadi eziphindiweyo zontanga ezichongiweyo zephepha ze-35 ezifunyenweyo zifunyenwe ngophando olutsha olusisigxina malunga nokuxhaphaka, iiprofayili, izizathu, ukunxibelelana kunye nokusebenza ngokuzenzekelayo kwindlela yokusetyenziswa kweyonyango phakathi kwabo baneengxaki zentloko.

iziphumo

Nangona iilwazi ezifumanekayo zazincitshiswa kwaye izifundo zazinemiqathango eninzi yeendlela, ukusetyenziswa kwonyango olusesikweni kubonakala lulona lugqirha lonyango olungasetyenziselwa ukulawula iintloko eziqhelekileyo eziqhelekileyo. Isizathu esiqhelekileyo sokukhetha olu hlobo lwonyango lwalufuna ukukhululeka kwentlungu. Nangona ipesenteji ephezulu zezi gulane mhlawumbi ziqhubeka nokunyamekelwa ngonyango ngokufanayo, malunga nesiqingatha kungenokuba ziveze ukusetyenziswa kolu unyango kumgqirha wazo.

izigqibo

Kukho isidingo sokuba uphando olongezelelekileyo lwempilo kunye neenkonzo zempilo zezempilo ukwenzela ukuvavanya indima, ukhuseleko, ukusetyenziswa kunye neendleko zemali ezinxulumene nophatho lwezonyango olusesikweni. Abanikezeli bokunakekelwa kwempilo yeprayimari kufuneka baqikelele ukusebenzisa le ndlela eyaziwayo kakhulu ekulawuleni ikhanda ukwenzela ukuncedisa ukulungiselela ukunakekelwa okukhuselekileyo, okufanelekileyo kunye nokulungelelaniswa.

Internet: Intloko, i-Migraine, Intloko yesifo, intloko yesifo sekhanda, Ulwaphulo lwe-Manual, unyango lwezilwanyana, i-Chiropractic, i-Osteopathy, i-Massage

imvelaphi

I-co-occurrence ye-tension headache kunye ne-migraine iphezulu kakhulu [1]. Ngokulandelelanayo, zizifo zesibini kunye nesithathu ezixhaphakileyo kwihlabathi jikelele kunye ne-migraine ranking njengeyona sizathu sesixhenxe esiphezulu sokukhubazeka kwihlabathi jikelele [2] kunye neshumi elinesithandathu kwiimeko eziqhelekileyo zokuxilonga e-US [3]. Ezi ziphazamiso ziqhelekileyo zentloko zibeka umthwalo omkhulu kwimpilo yomntu, imali kunye nemveliso yomsebenzi yabantu abanale ngxaki [3�5] kunye ne-migraine entsonkothileyo ngakumbi kukudityaniswa kwe-cardiovascular and psychiatric co-morbidities [6, 7].

Ukuthintela unyango lweziyobisi lwe-migraine lubandakanya i-analgesics, i-anticonvulsants, i-antidepressants kunye ne-beta-blockers. Unyango lwamachiza othintelo kwiintloko zohlobo lwengcinezelo lunokuquka iipilisi zokuthomalalisa iintlungu, ii-NSAID, iziphumlisi zemisipha kunye netyhefu ye-botulinum kunye namayeza okuthomalalisa kunye nee-antidepressants. Ngelixa unyango lwamachiza othintelo luyimpumelelo kwinani elikhulu labagulayo, ukuphazamiseka kwentloko kusachazwa njengokungafunyaniswanga kwaye kunyangwa ngaphantsi kwezicwangciso zonyango [8�16] kunye nezinye izifundo ezixela ukuba abaguli banokuyeka ukuqhubeka namayeza okuthintela intloko ixesha elide [9] 17, XNUMX].

Kukho inani leendlela ezingezizo iziyobisi ezisetyenziselwa ukuthintela intloko ebuhlungu. Ezi ziquka unyango lwezengqondo ezifana nonyango lokuziphatha kwengqondo, uqeqesho lokuphumla kunye ne-EMG (electromyography) biofeedback. Ukongezelela, kukho i-acupuncture, ukongezwa kwesondlo (kubandakanya i-magnesium, i-B12, i-B6, kunye ne-Coenzyme Q10) kunye nonyango lomzimba. Ukusetyenziswa konyango lomzimba lubalulekile, ngophando lwamva nje lwehlabathi oluxela unyango lomzimba njengolona lusetyenziswa rhoqo �olulolunye okanye unyango oluncedisayo’ kwiziphazamiso zentloko kumazwe amaninzi [18]. Olona ngenelelo luxhaphakileyo lonyango lonyango lolawulo lwentloko lunyango lwezandla (MT), [19�21] esiluchaza apha njengonyango olubandakanya �ukuxhaphazwa komqolo (njengoko kuqhele ukwenziwa ngabanyangi be-chiropractors, i-osteopaths, kunye nonyango lomzimba), ijoyinti kunye nomqolo. ukuhlanganisa, ukuphululwa konyango, kunye nolunye unyango olukhohlisayo kunye nolwesekwe emzimbeni [22].

Iziphumo ezintle ziye zaxelwa kwizilingo ezininzi zeklinikhi ezithelekisa iMT nolawulo [23�27], olunye unyango lwenyama [28�30] kunye nemiba yokhathalelo lwezonyango [31�34]. Uphando oluphezulu oluphezulu luyafuneka nangona kunjalo ukuvavanya ukusebenza kwe-MT njengonyango lweentloko eziqhelekileyo eziqhelekileyo. Uphononongo olutshanje olucwangcisiweyo lwezilingo zeklinikhi zeMT zokuthintela ingxelo ye-migraine inani leendlela ezimfutshane ezimfutshane kunye nesidingo sophando oluphezulu oluphezulu ngaphambi kokuba kwenziwe izigqibo eziqinileyo [35, 36]. Uphononongo lwakutsha nje lwezilingo ze-MT zohlobo loxinzelelo lwentloko kunye nentloko ye-cervicogenic zilumkile ekuxeleni iziphumo ezilungileyo kunye nesidingo esinamandla sophando olomeleleyo [37�41]. Nangona ubungqina bekliniki obunqamlekileyo bekungekho ukuhlaziywa okubalulekileyo kokusetyenziswa okubalulekileyo kwe-MT ngabantu beentloko.

tindlela

Injongo yale sifundo kukunika ingxelo evela kwincwadi yokuphononongwa ngontanga; 1) ukuxhaphaka kwe-MT ukusetshenziswa kwonyango lweenwele eziqhelekileyo eziqhelekileyo kunye ne-2) ezichaphazelekayo kunye nokusetyenziswa kwezihloko eziphambili. Uphononongo olongezelelweyo lubonisa indawo eziphambili ezifanelwe uphando oluthe gqolo ukuze kuphuculwe iinkqubo zeklinikhi, ootitshala kunye nomgaqo-nkqubo wezempilo kule ndawo.

uyilo

Uphando olubanzi lwamanqaku ahlaziywe ngoontanga apapashwe ngesiNgesi phakathi kwe-2000 kunye ne-2015 enika ingxelo entsha yophando olufunyenweyo kwiinkalo eziphambili zokusetyenziswa kwe-MT phakathi kwezigulane ezine-migraine kunye ne-non-migraine disorder disorders yenziwa. Iidatabase ezikhangelweyo zaziyi-MEDLINE, AMED, CINAHL, EMBASE kunye ne-EBSCO. Amagama angundoqo kunye namabinzana asetyenzisiweyo ngala: �intloko�, �migraine�, �intloko ebuhlungu�, �cephalgia�, �intloko engapheliyo� KUNYE � nonyango lwezandla�, �ukuxhaphazwa komqolo�, �i-manipulative, unyango �chiropractic�, �osteopathy�, �massage�, �unyango lomzimba� okanye �physiotherapy� KWAYE ke �ukuxhaphaka�, �ukusetyenziswa� okanye �iprofayile� yasetyenziswa kukhangelo olongezelelweyo ngokuchasene namagama angaphambili. Uphando lwedatha lukhatshwa kukusetshwa ngesandla kweejenali ezibalaseleyo eziphononongwe ngoontanga. Bonke ababhali bafikelele kuncwadi oluhlaziyiweyo (idatha) kwaye banikezela ngegalelo kuhlalutyo.

Ngenxa yokujoliswa kokuhlaziywa, uvavanyo lweencwadi zonxibelelwano ezingapheliyo kunye nokucwangciswa kophando olulinganayo lwezonyango aluzange lubekelwe ngaphandle njengamaphepha athatyathwa njengaleta, iibhalelwano, i-editorials, ingxelo zeengxelo kunye namazwana. Uphando olongezelelweyo lwenziwa kwiibriographies kwiincwadi ezichongiweyo. Zonke iicatshulwa ezikhethiweyo zihlolwe kwaye kuphela abo babika iziphumo ezintsha zokufumana iziphumo kwi-MT ukusetshenziswa kwintloko yesifo kubantu abadala baqukwa ekuhlaziyweni. Amanqaku atyunjiwe kwaye akhethiweyo ukuhlaziywa kwakuyi-manuscripts ikakhulu kwimigqaliselo ye-epidemiological kunye nezoqoqosho lwezoqoqosho. Ukuhlaziywa kubandakanya amaphepha okunika ingxelo yokusetyenziswa kwe-MT kunye nokusetyenziswa kwezinye iindlela zokwelapha, kodwa kuphela apho izigulane ze-MT ziquka inxalenye enkulu (njengoko kuchaziwe) yoluntu olubandakanyiweyo. Iziphumo zazingeniswa kwi-Endnote X7 kunye nezicatshulwa zisuswe.

Iziphumo zophando, Uhlalutyo kunye noVavanyo lweMgangatho

Umzobo 1 uchaza inkqubo yokukhangela uncwadi. Ukukhangela kokuqala kuchonge amanqaku e-3286, i-35 edibene nemilinganiselo yokubandakanywa. Ulwazi oluvela kwinqaku ngalinye luhlelwe kwitheyibhile yokuhlaziya (Itheyibhile 1) ukushwankathela iziphumo zamaphepha afakiweyo. Ulwazi luxelwa phantsi kwamaqela amabini akhethiweyo entloko kunye nakumsebenzi ngamnye weMT - chiropractic, physiotherapy, osteopathy kunye nonyango lwe-massage � apho iinkcukacha ezaneleyo zazifumaneka.

Umzobo we-1 Isatifiketi sokuhamba kweSifundo seSifundo

Umzobo 1: Isatifiketi sokuhamba koKhetho lokuFundisisa.

Itheyibhile ye-1 Uvavanyo olusekelwe kuPhando lweeNcwadi zoLwazi Ukusetyenziswa

Ithebula 1: Uphando olusekelwe kuphando olwenziwe ngonyango lwezonyango lweengxaki zentloko.

Uvavanyo lomgangatho wamanqaku achongiweyo ukuba ahlaziywe luqhutywe kusetyenziswa inkqubo yokulinganisa umgangatho (Itheyibhile 2) ephuhliswe ukuvavanya okubalulekileyo koncwadi lwezempilo olusetyenziselwa ukuxhaphaka kunye neziganeko zeengxaki zempilo [42] eguqulelwe kwizifundo ezifanayo [43�45] . Le nkqubo yokubeka amanqaku yayisebenza kuninzi lwezoyilo zophando ezibandakanya uphando kunye nodliwano-ndlebe olucwangcisiweyo olusekelwe kwisaveyi (29 yamaphepha e-35) kodwa yayingasetyenziswanga kwinani elincinci lezifundo ezibandakanyiweyo ezisekelwe kwiirekhodi zeklinikhi, uhlalutyo lwesibini okanye iimpawu zengcali.

Abalobi ababini abahlukeneyo (i-CM kunye ne-JA) bafuna uphando ngokuzimeleyo kwaye bafumana amanqaku. Iziphumo zamaphuzu zaqhathaniswa kwaye naluphi na ulwahlulo oluthe lwaxoxwa ngalo kwaye lucwangciswa ngabo bonke ababhali. Amanqaku omgangatho wecandelo ngalinye elifanelekileyo lichazwe kwiThebhile 3.

iziphumo

Iziphumo eziphambili zamanqaku e-35 zahlanganiswa kwaye zavavanywa kusetyenziswa indlela yokuphonononga ebalulekileyo eguqulelwe kuphando lwangaphambili [46, 47]. Ngokusekelwe kulwazi oluncinci olukhoyo kwezinye iintlobo zentloko, ukufunyaniswa kokuxhaphaka kuxelwe kwelinye lamacandelo amabini - mhlawumbi njenge-"migraine" yamaphepha engxelo yezifundo apho abantu babebaninzi okanye benziwe ngokupheleleyo kwizigulane ze-migraine okanye "njengentloko" kumaphepha apho inani labantu abaphononongayo lalinolunye uhlobo lwentloko (kubandakanywa yintloko ye-tension-type, i-cluster headaches, intloko ye-cervicogenic) kunye / okanye apho uhlobo lwentloko lwalungachazwanga ngokucacileyo. Amaphepha alishumi achaze iziphumo ezivavanya amazinga okuxhaphaka kwisigaba �migraine� yedwa, amaphepha e-18 achaze iziphumo zokuvavanya ukuxhaphaka kwecandelo le-"headache" yodwa kunye namaphepha e-3 abike iziphumo kuzo zombini iindidi. Ngokusekelwe kubume bolwazi olukhoyo, ukusetyenziswa okuxhaphakileyo kwahlulwa ngababoneleli bonyango lwezandla. Idatha ekhutshiweyo emva koko yahlalutywa kwaye yadityaniswa kwiindidi ezine ezinezihloko: ukuxhaphaka; iprofayili kunye nezizathu zokusetyenziswa kweMT; ukusetyenziswa kunye kunye nomyalelo wokusetyenziswa kwababoneleli beentloko; kunye novavanyo oluzibikayo lweziphumo zonyango lweMT.

Ukusetyenziswa kweMT

Amanqaku angamashumi amathathu ananye ahlaziywayo kunye nobukhulu obuncinci besampula (> 100) ingxelo efunyenweyo malunga nokuxhaphaka kokusetyenziswa kweMT. Ukuxhaphaka kokusetyenziswa kwe-chiropractic kulabo abane-migraine ukusuka kwi-1.0 ukuya kwi-36.2% (ithetha: i-14.4%) phakathi kwabantu bonke [19�21, 48�52] kwaye ukusuka kwi-8.9 ukuya kwi-27.1% (ithetha: 18.0%) ngaphakathi kwentloko-ikliniki abantu abagulayo [53, 54]. Ukuxhaphaka kokusetyenziswa kwe-chiropractic kulabo baxelwe njengentloko bevela kwi-4 ukuya kwi-28.0% (ithetha: i-12.9%) phakathi kwabantu bonke [20, 48, 51, 55�57]; ukusuka kwi-12.0 ukuya kwi-22.0% (ithetha: i-18.6%) ngaphakathi kwentloko / intlungu yekliniki yabantu abagulayo [58�60] kunye ne-1.9 ukuya kwi-45.5% (ithetha: i-9.8%) ngaphakathi kwezigulane ze-chiropractic [61�69].

Ukusetyenziswa kokuxhaphaka kwe-physiotherapy kulabo abane-migraine bavela kwi-9.0 ukuya ku-57.0% (ithetha: 24.7%) phakathi kwabantu bonke [19, 20, 48, 52] kunye ne-4.9 ukuya kwi-18.7% (ithetha: 11.8%) ngaphakathi kwintloko-kliniki abantu abanezigulane [54, 70]. Ukusetyenziswa kwe-physiotherapy kulabo bavakaliswe njengeentloko zivela kwi-12.2 ukuya kwi-52.0% (ithetha: 32.1%) phakathi koluntu jikelele [20, 48] kunye ne-27.8 ukuya kwi-35.0 %% (ithetha: 31.4%) ngaphakathi kwintloko / iintlungu zekliniki [60, 70].

Ukusetyenziswa kwe-massage yonyango kulabo abane-migraine ukusuka kwi-2.0 ukuya kwi-29.7% (ithetha: i-15.6%) phakathi kwabantu bonke [49, 50, 71] kunye ne-10.1 ukuya kwi-56.4% (ithetha: 33.9%) ngaphakathi kwentloko-ikliniki yabantu [53, 54, 72, 73]. Ukusetyenziswa kwe-massage / acupressure kulabo baxelwe njengentloko ngaphakathi kwentloko / intlungu yekliniki izigulane zabantu zivela kwi-12.0 ukuya kwi-54.0% (ithetha: 32.5%) [58�60, 70].

Ukusetyenziswa kwe-osteopathy kwalabo abane-migraine kuthiwa yi-1% phakathi kwabantu bonke [49]; njenge-2.7% ngaphakathi kwintsholongwane-i-klinikhi yesigulane isiguli [53] kunye ne-1.7% kwisigulane sesigulana se-osteopathy [74]. I-headache ubukhulu be-9% ngaphakathi kwintloko yesifo / intlungu yeklinikhi yoluntu [60] kwaye yahlukana ukusuka kwi-2.7 ukuya kwi-10.0% (ithetha: 6.4%) kwisifo sengqondo se-osteopathy [74, 75].

Ukulingana kwezinga lokusetyenziswa kwe-MT kuzo zonke i-MT professions kubabo abane-migraine bavela kwi-1.0 ukuya ku-57.0% (bathetha: 15.9%) phakathi kwabantu bonke; zivela kwi-2.7 ukuya kwi-56.4% (ithetha: 18.4%) ngaphakathi kwintloko yesigulane kunye nezigidi zabantu kwaye zichazwe njenge-1.7% kwisibalo esisodwa seM MT. Ukulingana kwesantya sokusetyenziswa kweMT kuzo zonke i-MT professions kulabo bachazwa njengeentloko zivela kwi-4.0 ukuya kwi-52.0% (ithetha: 17.7%) phakathi kwabantu bonke; ukusuka kwi-9.0 ukuya kwi-54.0% (ithetha: i-32.3%) ngaphakathi kwintloko-kliniki yezigulane zabantu kunye ne-1.9 ukuya kwi-45.5% (ithetha: 9.25%) ngaphakathi kwe-MT yeziguli.

Iphrofayili kunye nezikhuthazo zokusetyenziswa kweMT

Ngelixa iiprofayili zesigulana zentlalo yoluntu zingakhange zixelwe phakathi kwabantu bentloko ebebesebenzisa iMT kuphela, izifundo ezininzi zixela ezi ziphumo apho abasebenzisi beMT benze ipesenti enkulu yonyango olungelulo lwezonyango olusetyenziswa ngabantu bophononongo (uluhlu lwama-40% � 86% : kuthetha 63%). Ngelixa iziphumo zahlukeneyo kwinqanaba lengeniso [58, 70] kunye nenqanaba lemfundo, [70, 72, 73] eli qela lesigulane lalinokuthi libe lidala [70, 72], female [20], linomlinganiselo ophezulu we-comorbid. iimeko [58, 70, 76] kunye nezinga eliphezulu lokutyelela kwangaphambili kwezonyango [20, 58, 70] xa kuthelekiswa neqela elingelona lomsebenzisi. Ngokubanzi, eli qela laxelwa ukuba linezinga eliphezulu leentloko ezingapheliyo okanye ukukhubazeka kwentloko kunabasebenzisi abangasebenzisi [20, 54, 58, 70, 72, 77].

Izifundo ezininzi ngaphakathi kwentloko-ikliniki yabemi bachaza izigulane ezikhuthazayo zokusetyenziswa kwonyango oluhambelanayo kunye nolunye unyango lwentloko apho abasebenzisi beMT benza inxalenye ebalulekileyo yabemi bophononongo (uluhlu lwe-40% � 86%: kuthetha i-63%) [58, 70, 72, 78]. Ukususela kolu phando eyona mpembelelo ixhaphakileyo echazwe zizigulana zophononongo yayikukufuna isiqabu kwiintlungu zentloko ezibalelwa kwi-45.4% � 84.0% (ithetha: 60.5%) yeempendulo. Eyesibini eyona nto ixhaphakileyo yayiyinkxalabo yesigulane malunga �ukhuseleko okanye iziphumo ebezingalindelekanga � yonyango lwentloko yonyango, ibalwa kwi-27.2% � 53.0% (ithetha: 43.8%) yeempendulo [58, 70, 72]. �Ukungoneliseki ngokhathalelo lwezonyango� kubalelwe kwi-9.2% � 35.0% (ithetha: 26.1%) yeempendulo [58, 70, 72].

Inani elilinganiselweyo lamaphepha ahlaziywayo (onke avela eItali) ingxelo malunga nomthombo wokuthunyelwa okanye isincomo kwi-MT yonyango lwentloko [53, 58, 59]. Ukususela kwezi zifundo, ukuthunyelwa kwi-GP ukuya kwi-chiropractor ukusuka kwi-50.0 ukuya kwi-60.8% (ithetha: i-55.7%), ngelixa ukuthunyelwa kubahlobo / izalamane zivela kwi-33.0 ukuya kwi-43.8% (ithetha: 38.7%) kunye nokuzincoma ukusuka kwi-0 ukuya 16.7% (ithetha: 5.6%). Ukufumana unyango lwe-massage, ukuthunyelwa kwi-GP ukusuka kwi-23.2 ukuya kwi-50.0% (ithetha: i-36.6%), ngelixa ukuthunyelwa kubahlobo / izalamane zivela kwi-38.4 ukuya kwi-42.3% (ithetha: 40.4%) kunye nokuzincoma ukusuka kwi-7.7 ukuya kwi-38.4% ( kuthetha: 23.1%). Ukufumana i-acupressure, ukuthunyelwa kwi-GP ukusuka kwi-33.0 ukuya kwi-50.0% (ithetha: i-41.5%), ngelixa ukuthunyelwa kubahlobo / izalamane kwabikwa njenge-50% kunye nokuzincoma ukusuka kwi-0 ukuya kwi-16.6% (ithetha: 8.3%). Olunye uphando luchaze ukufunyaniswa kwe-osteopathy apho ukuthunyelwa kwii-GP kunye nabahlobo / izalamane kwaxelwa njenge-42.8% kwaye ukuzincoma kuye kwabikwa njenge-14.4%. Ngokubanzi, umlinganiselo ophezulu wokudluliselwa phakathi kwezi zifundo wawusuka kwi-GPs ukuya kwii-chiropractors zentloko engapheliyo ye-tension-type (56.2%), i-cluster headache (50%) kunye ne-migraine (60.8%).

Ukusetyenziswa ngokufanayo kunye neNkundla yokuSebenza kwabaNika iNtloko kunye noNxibelelwano oludibeneyo lwaBasebenzisi baseMT

Izifundo ezininzi zinika ingxelo malunga nokusetyenziswa kwangaxeshanye ukuphathwa kweentloko zonyango kunye nonyango olongezelelweyo kunye nolunye unyango. Kwezo zifundo apho ipesenti enkulu yezigulane zingabasebenzisi be-MT�s (uluhlu lwe-57.0% � 86.4%: luthetha i-62.8%), [58, 70, 78] ukusetyenziswa okufanayo kwonyango phakathi kwe-29.5% kunye ne-79.0% ( kuthetha: i-60.0%) yabantu abaneentloko zesigulane.

Ezi zifundo ziqhubeka zinika ingxelo malunga nenqanaba lesigulane esingachaziyo kubaboneleli bezonyango malunga nokusetyenziswa kweMT ngenxa yentloko. I-Non-disclocation iphakathi kwe-25.5 kunye ne-72.0% (ithetha: i-52.6%) yabantu besigulane, kunye nesizathu esiqhelekileyo sokungabonakali sichazwe njengogqirha �akazange abuze, ukusuka kwi-37.0 ukuya kwi-80.0% (ithetha: 58.5%). . Oku kwalandelwa yinkolelo yesigulana yokuba �ayibalulekanga into yokuba ugqirha azi � okanye �akukho nalinye ishishini likagqirha�, ukusuka kwi-10.0 ukuya kwi-49.8% (intsingiselo: 30.0%). Oku kwalandelwa yinkolelo yokuba "ugqirha akayi kuqonda" okanye "angadikibali" ezi zonyango, ukusuka kwi-10.0 ukuya kwi-13.0% (ithetha: 11.5%) [53, 77].

Omnye uphando olubanzi lwamazwe ngamazwe luchaze ukulungiswa komboneleli oqhelekileyo wokunyamekela intloko ngokuthelekisa iziphumo phakathi kwamazwe amaninzi kwizigulana ze-migraine [21]. Abanikezeli bokunakekelwa kweprayimari ezilandelwa ngamagqabantshintshi babecelwa njengababoneleli bokuqala nabesibini unyango lwe migraine phantse onke amazwe ahlolwe. Okukuphela kweAustralia, apho abo abanomdlavuza ongapheli bakhetha i-chiropractors njengababoneleli abaqhelekileyo kwixesha elilinganayo kuma-neurologists (i-14% bobabini) ngelixa i-episodic migraine ekhethiweyo i-chiropractors ephindaphindiweyo kwiiurologists (13% ngokubhekiselele kwi-5%). Ngokwahlukileyo, iingcali zonyango zikhethwe njengomniki-mboleko kulabo abane-migraine engapheliyo yi-10% e-USA naseKhanada, i-1% eJamani kunye ne-0% ye-UK neFransi. Iingcali zonyango zikhethwe njengomniki-mboleko kulabo abane-episodic migraine nge-7% e-USA, i-6% eJamani, i-4% eCanada kunye ne-1% e-UK naseFransi.

Ukusebenza ngokuzimeleyo kweziphumo zeziphumo zonyango

Izifundo ezininzi zentloko kunye neentlungu zeklinikhi zabemi zibonelela ngeziphumo zokuzichaza ngokusebenza konyango lwentloko yeMT. I-chiropractic, isigulane sokuzixela ngokufanelekileyo okanye ngokufanelekileyo ngokupheleleyo ukukhululeka kwentloko ukusuka kwi-27.0 ukuya kwi-82.0% (ithetha: 45.0%) [53, 58�60, 78]. Ngonyango lwe-massage, isigulane esizixelayo ngokukhululeka kwentloko ngokuyinxenye okanye esebenzayo ngokupheleleyo ukusuka kwi-33.0 ukuya kwi-64.5% (ithetha: 45.2%) [53, 58, 60, 73, 78], kwaye ngenxa ye-acupressure le isuka kwi-33.4 ukuya kwi-50.0%. (ithetha: 44.5%) [53, 58, 59]. Kwi-osteopathy kunye ne-physiotherapy, uphando oluthile luchaze ukusebenza njenge-17 kunye ne-36% ngokulandelanayo [60].

Xa iziphumo zidityanisiwe kuzo zonke iiprofessional zeMT ukunikezelwa kwengxelo yeMT ngokuyinxenye okanye ngokupheleleyo isusela kwi-17.0 ukuya kwi-82.0% (ithetha i-42.5%) [53, 58�60, 73, 78]. Ukongezelela, uphando oluthile lwabantu ngokubanzi lubonelela ngokufunyaniswayo ngokusebenza ngokuzixelayo kwi-chiropractic kunye ne-physiotherapy kwi-25.6 kunye ne-25.1% ngokulandelanayo kwabo banentloko engapheliyo kunye ne-38 kunye ne-38% ngokulandelanayo kwabo banentloko yesibini engapheliyo [79].

ingxoxo

Eli phepha linikeza ukuhlaziywa kokubaluleka kokuqala kokubaluleka kokubaluleka kunye nezinto eziphambili ezichaphazelekayo nokusetyenziswa kwe-MT unyango lweentloko ngaphakathi kwincwadi ehlaziywe ngontanga. Nangona ulwahlulo lweendlela zokufunda kunye nokungafumaneki kwedata kuthintela izigqibo eziqinileyo, ezi ziphumo ziphakamisa ulwazi malunga nemibandela ebaluleke kubaququzeleli-nkqubo, ootitshala, abanikiweyo bentloko kunye nophando olusasa.

Uphononongo lwethu lufumene ukuba ukusetyenziswa kwe-MT kwakuphezulu kakhulu ngaphakathi kwentloko yezonyango-ikliniki yabantu xa kuthelekiswa nabantu ngokubanzi. Nangona kunjalo, ukusetyenziswa kwababoneleli beMT ngamnye kuyahluka phakathi kwemimandla eyahlukeneyo kwaye oku kunokwenzeka ngenxa yezinto ezininzi ezibandakanya ukuhluka kokufikelela koluntu, inkxaso-mali yezempilo kunye nokufumaneka kwababoneleli beMT. Ngokomzekelo, ukusetyenziswa kwe-physiotherapy kwezinye iintlobo zentloko kunokuba phezulu kwiindawo zaseYurophu [20, 60] ngelixa ukusetyenziswa kwe-chiropractors kwezinye iintlobo zentloko kunokuba phezulu e-Australia nase-USA [19, 21]. Ngokubanzi, ukuxhaphaka kokusetyenziswa kwe-MT ngenxa yentloko kubonakala kuninzi kwaye kubonakala ukuba lolona hlobo luqhelekileyo lonyango lomzimba olusetyenziselwa intloko kumazwe amaninzi [19�21, 49]. Izifundo zomgangatho ophezulu we-epidemiological ziyafuneka ukulinganisa ukuxhaphaka kokusetyenziswa kwe-MT kwiintlobo ezahlukeneyo zeentloko kunye neentlobo ezincinci, zombini phakathi kwabantu ngokubanzi kunye nabemi bekliniki.

Ngaphandle kwexesha elibanzi, idatha ingaphelelanga malunga nokuba ngubani, njani kwaye kutheni izigulane zentloko zifuna uMT. Ukusuka kolwazi olukhoyo, nangona kunjalo, iimfuno zonyango lwe-MT izigulane zentloko zinokuba nzima kakhulu kwaye zininzi zoluleko ngokumalunga nalabo phantsi koononyango lwonyango kuphela. Iziphumo zentlalo-manani zibonisa ukuba abasebenzisi be-MT kunye nezinye iindlela zokuqulunqa kunye neendlela ezingaphezulu zinezinga eliphezulu lokukhubazeka kwentloko kunye nokungaxhatshali xa kuthelekiswa nabangewona abasebenzisi. Oku kufunyaniswayo kungahambelana nokuphakama okuphezulu kwabasebenzisi be-MT ngaphakathi kwintloko-klinikhi yabantu kunye nembali yezonyulo zonyango. Oku kunokuba nefuthe kwixesha elizayo lwe-MT ukuyila iindleko zombini ngokubhekiselele ekukhetheni izifundo zesilingo ezivela ngaphakathi ngaphakathi nangaphandle kwezicwangciso ze-MT kunye nesigqibo sokuvavanya ukungenelela kwe-MT kunye ne-MT ngokudibanisa namanye amanyathelo.

Ulwazi oluncinci lubonisa ukuba iindlela ezininzi malunga nokusetyenziswa kwezonyango kunye nononyango lwezonyango ezifana ne-MT ziqhelekileyo. Nangona iziphumo zibonisa ukuba i-MT ifunwa kaninzi ngenxa yezizathu zokufuna ukuphulwa kwentloko, ubungqina bokuxhasa ukuphumelela kwe-MT yokuncediswa kwentloko kuyaqhubeka. Ababoneleli beMT kufuneka bahlale bekhumbula umgangatho wobungqina obunikwe ingenelelo ngoncedo olunikwe intloko yesifo kunye nokwazisa izigulane apho kungenelela ngoncedo olululo okanye olukhuselekileyo kunyango. Uphando oluninzi lufunekayo ukuvavanya ezi zonyango ngokwahlukeneyo kunye neendlela ezininzi zokufunda kunye nezifundo ukuba zibandakanye ukulandelelwa kwexesha elide.

Ulwazi olungapheliyo e-Itali, lubonisa ukuhanjiswa kwe-GPs kwi-MT unyango lwentloko lunokuqhelekileyo kwezinye iindawo, ngelixa le nto ingenakwenzeka ukuba isasazeke ngokugqithiseleyo kwimeko yesigulana esingabonakali kwiingcali zoogqirha malunga nokusetyenziswa kolu unyango kwezinye izifundo. Ubunonophelo bempilo esemgangathweni obuninzi bufuna uxhulumano oluvulekileyo nolusisiseko phakathi kwezigulane kunye nababoneleli kunye naphakathi kwababoneleli ngokwabo. Ukungabonakali kungonakalisa kakubi ukulawulwa kwezonyango ukuba izigulane ezingaphenduliyo zifuna uphando olongezelelweyo lwe-diagnostic [80] okanye ukuphunyezwa kweendlela eziphambili zolawulo lweentloko [81] okanye ukuthintela ingxoxo kwiimeko apho i-MT ingatsholwa khona [82]. Abanikezeli beentloko zaseprayimari banokuzuza ngokunikela ingqwalasela ethile ingxaki yokungabonakali kwezonyango zonyango ezingenalo unyango. Ingxoxo evulekileyo phakathi kwababoneleli kunye nezigulane malunga nokusetyenziswa kwe-MT yentloko kunye neziphumo ezinxulumene nazo zinokuphucula ukunakekelwa kwegulane jikelele.

Uphando lwexesha elizayo

Nangona kunesidingo esinamandla sokwenza uphando olongezelelweyo oluphezulu ukuhlola ukuphumelela kwe-MT njengonyango lweentloko, ukusetyenziswa ngokubanzi kwe-MT kubeka ingqwalasela kwimfuno yoluntu lwempilo yoluntu kunye nophando lweenkonzo zezempilo kule ndawo yokuphathwa kwintloko. Isidingo salolu hlobo lophando sagqitywa kwingxelo yehlabathi yakutshanje malunga nokusetyenziswa kwezinto eziphathekayo zonyango [18]. Ukuqhubela phambili olu lwazi kunokukhokelela ekuphuculweni komgaqo-nkqubo wezempilo kunye nokunikezelwa kweenkonzo zonyango.

Ukusetyenziswa kakhulu kwezonyango ezifana ne-MT kuye kwaxelwa ngaphantsi kophando lwesizwe oluchaza ukusetyenziswa kwezempilo ezinxulumene nentloko [3, 5, 83�85]. Kungakhathaliseki ukuba, indima yonyango lomzimba ekulawuleni intloko yentloko iyaqhubeka nokuvavanywa, ngokuphindaphindiweyo ngaphakathi kweendlela eziqhelekileyo kunye nezicwangciso zokulawulwa kweentloko [86�89]. Ukuqhubela phambili olu phando lunokuqhubela phambili ukuqonda kwethu ukusebenza kunye neziphumo ezinxulumene neendlela ezininzi zokulawula intloko.

Ukuqhubela phambili kwesi sifundo sokwenza uphando olongezelelweyo ukuqonda indlela yokusetyenziswa kwezempilo ehambelana nezi gulane ezisebenzisa i-MT kwi-headache management. Incinci iyaziwa malunga nemvelaphi yoluntu, iintlobo zeentloko, inqanaba lokukhubazeka kwentloko kunye neentlobo eziqhelekileyo eziqhelekileyo kwesi si gulane. Ngaloo nto, ulwazi olunjalo lunokunika iinkcazelo ezingabalulekanga kumniki-kliniki nokwenza imfundo.

Imida

Uyilo kunye neziphumo zophononongo lwethu zinenani lemida. Uyilo lophononongo luthintelwe kukhangelo kwiijenali zolwimi lwesiNgesi kuphela. Ngenxa yoko, olunye uphando malunga nesi sihloko lunokuthi luphoswe. Nangona inkqubo yokulinganisa umgangatho eyamkelwe kolu hlaziyo ifuna ukuqinisekiswa okungakumbi, idatha esiyiqokelele yayikhawulelwe ngumgangatho ophantsi ukuya kumodareyithwa wamaphepha akhoyo aphakathi kwe-6.4 kumanqaku e-10 (Itheyibhile 3). Amanqaku asezantsi kakhulu ngenxa yemibandela ebalulekileyo yendlela yokusebenza kunye nobungakanani besampulu encinci ehambelana namaphepha amaninzi aqokelelweyo. Uninzi lwedatha malunga nesi sihloko yayingafani ngokwendalo (imfonomfono, uphando ngeposi kunye nodliwano-ndlebe lobuso ngobuso). Bekukho ukunqongophala kwemibuzo yogqirha kunye nezigulane eziqinisekisiweyo zokunika ingxelo ngeziphumo, njengemibuzo malunga nokuxhaphaka, apho amaxesha asetyenzisiweyo ahluka phakathi �ngoku�, �iinyanga ezili-12 ezidlulileyo & � ngonaphakade�.

Idata ngokubaluleka kokusetyenziswa kwe-MT yamakhanda entloko yayingancinci ngokukodwa kumntu ngamnye we-MT xa kuthelekiswa nedata efunyenwe ngaphakathi kubantu abanzi kunye nentloko ye-kliniki. Izifundo ezininzi zavavanya ukusetyenziswa kwe-MT yentloko ngaphandle kokuchonga iintlobo zeentloko. Uphando olulodwa ngaphakathi kwe-MT labantu luchaze ipesenteji yezigulane ezisekho ngenxa yezigulana zodwa (i-osteopathy). Ukuxhaphaka kwe-MT ukusetshenziswa kwintloko yaxelwa kakhulu kwiiprogram zezigulane zezigulane, kodwa nangona ulwazi lucacisiwe kwiintlobo zentloko. Asifumananga uphando olwenziwe malunga nokusabalalisa kwezigulane zentloko ngaphakathi kwe-physiotherapy okanye ukuxilisa izigulane zezigulane kwizigulane usebenzisa iziphumo zethu zokukhangela.

Ukungabikho kwedatha yezihloko ezithile kwakudinga ukubonelela ngeziphumo ezifunyenwe nabasebenzisi bezinye iinkonzo ezingabangezifo zonyango. Idata phakathi kweendawo ezininzi zendawo yayingqongqo kunye neyona nkcukacha eyingcipheko yayisisiseko sokudluliselwa kwi-MT abahlinzeki bamakhanda entloko (amaphepha amathathu ase-Italia kuphela). Le mingcele ixhasa umnxeba wophando olungakumbi ukuba lujoliswe kuphela kwizikhundla ze-MT kunye nemimandla eyahlukileyo kwimimandla ngaphambi kokuba izigqibo ezigqithisileyo zingathathwa.

isiphelo

Iimfuno zalabo abaneentloko ezibuhlungu zinokuba nzima kwaye zininzi zoluleko kwindalo. Ngaphandle kophando lwezonyango, umgangatho ophezulu wophando lwezempilo lukawonke-wonke kunye neenkonzo zempilo ziyafuneka ukulinganisa nokuphonononga inani lemiba ebalulekileyo ekuhanjisweni nasekusetyenzisweni kweMTs kulawulo lwentloko. Ngeemfuno ezingafezekiyo eziseleyo kwabaninzi abaphathwa yintloko ephindaphindiweyo, oogqirha kufuneka bahlale bekuqonda ukusetyenziswa kwe-MTs kwaye bahlale bevulekile ukuxoxa ngale ndlela yokulawula intloko ukuze kuqinisekiswe ukhuseleko olukhulu, ukusebenza kunye nokulungelelaniswa kokhathalelo lwentloko.

Imibulelo

Ayingeni.

Inkxaso

Olu phando alufumananga nkxaso-mali ithile evela kuyo nayiphi na i-arhente yenkxaso-mali kuluntu, kushishino okanye kumacandelo angenzi nzuzo ngelixa umbhali wokuqala kweli phepha efumana i-PhD yokufunda eyenziwe yafumaneka yi-Australian Chiropractors� Association.

Ukufumaneka kweDatha kunye neZiko

Akusebenzi (yonke idatha ichazwe kwinqaku).

Imirhumo yabalobi

I-CM, i-JA kunye ne-DS yenzele iphepha. I-CM yenza uphando lweencwadi, ukuqokelela idatha kunye nokukhethwa. I-CM kunye ne-DS banikeze uhlalutyo nokutolika. I-CM kunye ne-JA babhala iirejista. Bonke ababhali babenegalelo ekuhlaziyweni olubukhali kunye nomxholo wengqondo. Bonke abalobi bafunde kwaye bavumile umbhalo wesigqi wokugqibela.

Ukugqithisa inzala

Ababhali bavakalisa ukuba abanalo inxaxheba.

Imvume yokupapashwa

Ayingeni.

UkuVunywa kweMigaqo kunye neMvume yokuBamba iqhaza

Ayingeni.

Inqaku loMpapashi

Uhlobo lwe-Springer luhlala lungathathi hlangothi malunga namabango asemagqabini kwimpapasho epapashwe kunye namaziko eziko.

izifinyezo

MT Unyango lwemiqulu
EMG Electromyography

I ngcaciso

Ncbi.nlm.nih.gov/pmc/articles/PMC5364599/

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

I-15% yabantu abaxhamlileyo banesifo se-migraines, imeko ephosakeleyo ebangela ukuba umntu akwazi ukwenza imisebenzi yansuku zonke. Nangona ngokungaqondwa ngokubanzi ngophando namhlanje, ndiyakholelwa ukuba intlungu ye-migraine ingabonakalisa uphawu lwezempilo enkulu. Ii-discs ze-Lumbar ze-herniated, okanye i-disc ruptured kwi-lumbar spine, yinto eqhelekileyo yokubandezeleka kwe-back back and sciatica. Xa i-soft-gel-like-center ye-lumbar disniated disc igxininisa iingcambu zentliziyo ye-back back, ingabangela iimpawu zentlungu kunye nokuphazamiseka, ukuphazamiseka kunye nobuthathaka kwimida ephantsi. Ngaphezu koko, i-disc ye-lniar herniated ingakwazi ukungalingani isakhiwo kunye nomsebenzi walo lonke umgudu, ukukhuthaza iimpawu kunye nomlenze wesibeletho oza kudala ekugqibeleni i-migraines. Abantu abahlala bevalelwa intlungu ye-migraine kufuneka bahambe ngokunyanisekileyo malunga nosuku lwabo benethemba lokuphepha umbane wesinye isiqhelo esibuhlungu. Ngethamsanqa, ezininzi iintlungu ze-migraine kunye nezindlela zokunyuselwa kwiinkcukacha ze-disniate ze-discs zifumaneka ukuze zincede ukuphucula kunye nokulawula iimpawu. Ezinye iindlela zokonyango ziyakucingelwa kwakhona phambi kokungenelela kokugonywa.

I-Treatment against Versus Operative Treatment for Lumbar Disc Herniation: Iziphumo ezi-8 zeMigangatho yeziGulane zeziThamo Iziphumo zoPhando (SPORT)

Abstract

IsiCwangciso soFundo

Iimeko eziqhelekileyo eziza kulandelwa ngokulandelelana kunye nokuhlola okuqhelekileyo.

injongo

Ukuvavanya iziphumo ze-8 zeminyaka yokuhlinzwa kunye nokunakekelwa kwabangasebenzi.

Isishwankathelo seNkcazelo yedatha

Nangona izilingo ezingenamsebenzi zibonise ukungafani kwexesha elifutshane malunga nokuhlinzwa, iziphumo zexesha elide ukuthelekisa ukutyunjwa kwonyango olungasebenziyo kuyaqhubeka kungqubuzana.

tindlela

Abaviwa abagqityiweyo abanokucinga-baqinisekisile ukudibanisa i-disvertebral disniniation intlanganiso Intlanganiso yokufaneleka yokuphuhliswa kwe-SPORT ebhaliswe kubafundi abathathi-nxaxheba (abaxhamli be-501) kunye nabaqashi be-Observatory (i-743 participants) kwii-clinics ze-13 zemigudu kwi-11 US. Ukungenelela kwakuyi-discectomy evulekileyo ngokuqhelekileyo ngokubhekiselele ekunyamekelweni kokungekho kokusebenza. Amanyathelo omphumo oyintloko aguquka ukusuka kwisiseko kwi-SF-36 Bodily Pain (BP) kunye ne-Physical Function (PF) izikali kunye ne-Oswestry Disability Index (i-ODI-AAOS / i-modems version) ehlolwe kwii-6 iiveki, iinyanga ze-3 kunye ne-6, kwaye ngonyaka emva koko.

iziphumo

Izibonelelo zabonwa ngotyando kuhlalutyo lwenjongo-yokunyanga yeqela elingenamsebenzi kuzo zonke iziphumo zokuqala nezesekondari ngaphandle kwenqanaba lomsebenzi; Nangona kunjalo, ngokunganyamekeli kakhulu kunikezelo lonyango (i-49% yezigulana ezinikezelwe kunyango olungasebenziyo ezifumana utyando ngokuchasene ne-60% yezigulana ezabelwe utyando) ezi ziphumo ziye zabonwa zincinci kwaye zingabalulekanga ngokwezibalo kwiziphumo zokuqala (BP, PF, ODI ). Ngokubalulekileyo, uthelekiso lulonke lweziphumo eziziisekondari lwalukhulu kakhulu ngoqhaqho kuhlalutyo lokufuna ukunyanga (i-sciatica bothersomeness [p> 0.005], ukoneliseka ziimpawu [p> 0.013], kunye nokuziphucula ngokwakho [p> 0.013]) ekulandeleleni ixesha elide. Uhlalutyo olunyangiweyo lubonakalisa unyango olunempembelelo kunyango lweziphumo zesiphumo esiphambili (kuthetha utshintsho Uqhaqho ngokuchasene nokungasebenzi, isiphumo sonyango; 95% CI): BP (45.3 vs. 34.4; 10.9; 7.7 ukuya kwi-14); PF (42.2 vs. 31.5; 10.6; 7.7 ukuya ku-13.5) kunye ne-ODI (? 36.2 vs.? 24.8;? 11.2;? 13.6 ukuya ku-9.1).

isiphelo

Izigulane ezikhethwe ngokucophelela eziye zenziwa ukuhlinzwa kwi-disc ye-lumbar ziphucuke kakhulu kunezigulane ezingaphelelanga; kwakungekho ncinane ekungcoleni iziphumo kwiqela (ukusetyenziswa kunye nokungasebenzi) ukusuka kwi-4 ukuya kwi-8 iminyaka.

Internet: I-SPORT, i-disvertebral disniation, ukuhlinzwa, ukungabikho kokusebenza, iziphumo

intshayelelo

I-Lumbar discectomy yokunceda i-sciatica kwizigulane ezine-intervertebral disc herniation (IDH) luphawu oluphandwe kakuhle kunye noluqhelekileyo lotyando lomqolo, kodwa amaxabiso olu tyando abonisa ukuhluka okukhulu kwendawo. Izilingo ezininzi ezingahleliwe kunye namaqela amakhulu alindelekileyo ziye zabonisa ukuba utyando lubonelela ngokukhawuleza kwiintlungu kunye nokubuyiswa okubonakalayo kwizigulane ezine-disc ye-herniated.

Kwi-RCT ye-classic yokuvandlakanywa kokuhlinzwa ngokungahambisani nonyango lwe-IDH, i-Weber et al. ibonise ukuphucula okukhulu kwiqela lokuhlinzwa kwi-1 kunyaka obalaseleyo; Kwakukho uphuculo olongezelelekileyo lotyando lwe-4 iminyaka, nangona kungabonakali ngokubalulekayo, kodwa akukho mvelaphi ebonakalayo kwiziphumo kwiminyaka ye-10. [2] Nangona kunjalo, inani lezigulane kwiqela elingasebenziyo ekugqibeleni liye lahlinzwa ngaphaya kwelo xesha, luyinkimbinkimbi ukuchazwa kweziphumo zexesha elide. I-Maine Lumbar Spine Study, iqela elikhangelelanayo, lifumene uphuculo olungakumbi ngonyaka omnye kwiqela lokuhlinzwa elincinci ngaphezu kwexesha, kodwa lahlala likhulu kakhulu kwiqela eligqityiweyo le-sciatica eliphazamisayo, umsebenzi osebenzayo kunye nokwaneliseka, kodwa akukho nto eyahlukileyo kumsebenzi okanye iziphumo zokukhubazeka. [3] Eli phepha libika iziphumo zonyaka we-8 kwiziphumo zoPhando lweziPhumo zoPhando (SPORT) ngokusekelwe ekulandelelweni okuqhubekayo kweengxoxo ze-disni ze-randnized and randomized cohorts.

tindlela

IsiCwangciso soFundo

I-SPORT lulingo olungenamkhethe kunye neqela lokujonga ngokufanayo eliqhutywe kwii-11 zase-US kumaziko ezonyango ze-13 ezineendlela ezininzi ze-spine. Iikomiti zezifundo zabantu kwiziko ngalinye elithatha inxaxheba ziphumeze iprothokholi esemgangathweni yawo omabini amaqela oqwalaselo kunye namaqela angenamkhethe. Iikhrayitheriya zokubandakanywa kwezigulana kunye nokungabandakanywa, ungenelelo lokufunda, imilinganiselo yeziphumo, kunye neenkqubo zokulandelela eziye zaxelwa ngaphambili.[5�8]

Abemi abagulayo

Amadoda nabasetyhini bafanelekile ukuba baneempawu kunye neempawu eziqinisekisayo ze-radiculopathy ye-lumbar eqhubekayo ubuncinane kwiiveki ezintandathu, i-disc herniation kwinqanaba elihambelanayo kunye necala kwi-imaging, kwaye babebhekwa njengabaviwa bokuhlinzwa. Umxholo wokubhaliswa kwangaphambili kokhathalelo olungasebenzisiyo awuzange uchazwe ngaphambili kwiprothokholi.[5�7] Ukubhaliswa okuthe ngqo kunye neendlela zokukhutshwa zichazwe kwenye indawo.[6,7]

Umongikazi wophando kwiziko ngalinye labathathi-nxaxheba abachongiweyo, baqinisekiswe ukufaneleka kwaye basebenzise isinqumo sokwabelana ngokubambisana nge-uniformity of registration. Abathathi-nxaxheba banikezelwa ukubhaliswa kwilingo le-randomized or group observation. Ubhaliso lwaqala ngoMatshi we-2000 kwaye lwaphela ngoNovemba ka-2004.

Iingenelo zokuFunda

Utyando lwaluyi-discectomy evulekileyo eqhelekileyo kunye novavanyo lwengcambu yemithambo-luvo ebandakanyekayo. -i-steroidal anti-inflammatory drugs ukuba iyanyamezelwa. Unyango olungasebenzisiyo lwalulungiselelwe umntu ngamnye kwisigulana ngasinye kwaye lulandelelwa ngokufanelekileyo.[7,9�5]

Imilinganiselo yoFundo

Iiphelo zokugqibela zasePrayimari zaseBloly Pain (BP) kunye nePhysical Function (PF) izikali ze-SF-36 Health Survey [10] kunye ne-AAOS / Modems version ye-Oswestry Disability Index (ODI) [11] njengoko kulinganiswa kwiiveki ze-6, i-3 kunye neenyanga ze-6, kwaye ngonyaka emva koko. Ukuba utyando lwabambezeleka ngaphaya kweeveki ezintandathu, idatha eyongezelelweyo yokulandelelwa yafunyanwa iiveki ze-6 kunye neenyanga ze-3 emva kokusebenza. Iziphumo eziqhelekileyo zibandakanya ukuphuculwa kwengxelo ngokuzimela; isimo somsebenzi; ukwanelisa iimpawu zangoku kunye nokunyamekela; [12] kunye ne-sciatica yobunzima njengoko kulinganiswa yinkcazo ye-sciatica ephazamisayo. [13,14] Impembelelo yonyango yachazwa njengomdahluko kwiinguqu zentsingiselo ukusuka kwinqanaba lokuqala phakathi kwamaqela okugula kunye nabangasebenzi.

Ukuqwalaselwa kwezibalo

Uhlalutyo lokuqala uthelekiso lweendlela kunye nobungakanani beempawu zesigulana esisiseko phakathi kwamaqela angacwangciswanga kunye nokujonga naphakathi kweengalo zokuqala zonyango zomntu ngamnye kunye neqela elidibeneyo. Ubungakanani bedatha elahlekileyo kunye nepesenti yezigulana ezenziwa utyando zabalwa ngengalo yonyango kulandelelwano ngalunye olucwangcisiweyo. Ukuxelwa kwangaphambili kwesiseko sexesha kude kube kunyango lonyango (kubandakanya nonyango olwenziweyo) kuzo zombini ii-cohorts zichongiwe ngemodeli yengozi yokuhlengahlengiswa kwemodeli yokulinganisa kunye nenqobo yokufaka ye-p <0.1 yokungena kunye p> 0.05 ukuphuma. Abaxeli bokungabikho kotyelelo olulandelayo olwenzeka rhoqo kwisithuba seminyaka esi-8 babekwa bucala ngokwahlulahlulwahlulwa kwempahla. Iimpawu ezisisiseko ezichaze utyando okanye utyelelo oluphosakeleyo ngalo naliphi na ixesha-lamaxesha emva koko zangena kwiimodeli ezinde zeziphumo zokuqala. Ezo zihlala zibalulekile kwiimodeli ezide zesiphumo zibandakanyiwe njengokuhlengahlengisa ii-covariates kuzo zonke iimodeli zokuhlengahlengiswa kwexesha elide ukuze zilungelelanise ukuphazamiseka okunokubakho ngenxa yokhetho lokhetho kunyango kunye neepateni zedatha ezingekhoyo. [15] Ukongeza, iziphumo ezisisiseko, iziko, ubudala kunye nesini zibandakanyiwe kuzo zonke iimodeli zesiphumo sobude.

Uhlalutyo oluphambili luqhathaniswa nophatho olusakhulayo kunye nolusetyenziswayo olusebenzisa utshintsho ukusuka kwisiseko kumlandelelwano ngalunye, kunye nemiphumo edibeneyo yokuguqula imodeli kubandakanye nomphumo ngamnye wokungahambi ngokukhawuleza ukulungiselela ukulungelelaniswa phakathi kokulinganisa okuphindaphindiweyo phakathi kwabantu. Iqela elingazange lihlaziywe lihlaziywe ngokusesikweni kwisiseko sokunyanga. [6] Ngenxa yokuwela, ukuhlaziywa okongeziweyo kwenziwe ngokusekelwe kwonyango olwenziweyo. Kule zihlalutyo eziphathiswe ngokukhawuleza, isibonakaliso sonyango sisisigxina sexesha, sivumela ukuba ixesha lotyando litshintshile. Ixesha lokulandelela lilinganiselwe kubhaliso lweengcebiso zokufuna ukunyanga, ngelixa uhlalutyo oluphathwa ngolu hlobo lwamaxesha okulandelwa ayenziwa ukusuka ekuqaleni kokonyango (oko kukuthi ixesha lotyando lweqela elisebenzayo kunye nexesha ubhaliso lweqela elingasebenziyo), kunye nee-covariates ezisisiseko zahlaziywa ekulandeleni ngokukhawuleza kwandulela ixesha lotyando. Le nkqubo inempembelelo yokuquka zonke iinguqu ezivela kwisiseko phambi kotyando kwiingqikelelo zempembelelo yokungahambi kokusebenza kunye nazo zonke iinguqu emva kokuhlinzwa kwiingqikelelo zempatho. Iziphumo zesithandathu ze-sciatica kunye neziphumo zobunqunu zihlalutywe ngeendlela ezinomlinganiselo osusela kuma-equation equation equations [16] kunye nemisebenzi eqhelekileyo kunye ne-logit ngokulandelanayo, usebenzisa iinjongo ezifanayo zokuphatha kunye nokulungiswa kweenkcazo zokuhlaziywa njengendlela yeziphambili. Nganye yahlaziywa ukuze kuveliswe ukulinganiswa okuhlukileyo okuphathwa ngonyango. Ezi ziphumo ziqhathaniswa nokusebenzisa uvavanyo lwe-Wald kunye nokuvavanya onke amaxesha okutyelela okulandelelanayo kwimilinganiselo yeziphumo zonyango ezicatshangelwayo phakathi kwama-cohorts amabili. [15] Ukuhlalutya kokugqibela kudibanisa ama-cohorts.

Ukuphonononga iimbali zombini zonyango kuwo onke amaxesha, ixesha elilinganiselwayo leemiphumo (indawo engaphantsi kwekhalo) kwinqanaba ngalinye lonyango lalingeniswa ngokusebenzisa ukuqikelela kwixesha ngalinye kwixesha elide lokuguqula kunye nokuthelekisa ukusebenzisa i-Wald test [15]

U-Kaplan-Meier uqikelele ukuhlaziywa kwemilinganiselo kwiminyaka ye-8 ibingeniswe kwii-cohorts ezingaqhelekanga kunye nokuqhathaniswa nokuqhathaniswa nokuhlolwa kwe-log-rank. [17,18]

Iikhompyuter zenziwe kusetyenziswa iinkqubo ze-SAS PROC MIXED yedatha eqhubekayo kunye ne-PROC GENMOD kwiziphumo zesibini kunye nezingaqhelekanga (SAS version 9.1 Windows XP Pro, Cary, NC). Ukubaluleka kwesitatisti kuchazwe njenge-p <0.05 esekwe kuvavanyo lwamacala amabini obungenalo uhlengahlengiso olwenziwe kuthelekiso oluninzi. Idatha yolu hlalutyo yaqokelelwa ngoFebruwari 4, 2013.

iziphumo

Ngokubanzi, abathathi-nxaxheba be-1,244 SPORT kunye ne-lumbar disvertebral disniation babhalisiwe (i-501 kwiqela elincinciweyo, kunye ne-743 kwinqanaba elibukeleyo) (Umfanekiso 1). Kwinqanaba elincinane, i-245 yabelwa ukonyango kunye ne-256 kwonyango olungasebenzi. Kulabo bantu abangazange baqhutywe ngokuhlinzwa, i-57% yahlinzwa ngo-1 ngonyaka kunye ne-60% ngeminyaka eyi-8. Kwinqanaba elingenanto yokunyamekela, i-41% yezigulane zahlinzwa ngo-1 ngonyaka kunye ne-48% ngeminyaka eyi-8. Kwinqanaba lokuqwalasela, izigulane ze-521 zaqala ukukhetha ukuhlinzwa kwaye izigulane ze-222 zanyula ukhetha ukunakekelwa kwabangasebenzi. Kulabo baqala ukukhetha ukuhlinzwa, i-95% yafumana utyando nge-1 ngonyaka; Kwi-8 iminyaka i-12 ezongezelelweyo izigulane ziye zahlinzwa ngokusisiseko. Kulabo banyulwa unyango olungasebenziyo, i-20% yahlinzwa ngo-1 ngonyaka kunye ne-25% ngeminyaka eyi-8. Kwizibini zombini ezidibeneyo, izigulane ze-820 zanikwa utyando ngexesha elithile kwi-8 iminyaka yokuqala; I-424 (34%) yahlala ingasebenzi. Ngaphezulu kweminyaka eyi-8, i-1,192 (i-96%) yabhaliso lwangaphambili lwagqitywa ubuncinane ukutyelela kwe-1 kwaye zibandakanywe kuhlalutyo (iqela elihle: i-94% kunye neqela elikhangelelanayo 97%); I-63% yabhalisi bokuqala abanikezelwa ngeminyaka kwi-8 iminyaka kunye nokulahlekelwa ngenxa yokulahla, ukutyelelwa okungekho, okanye ukufa (Umfanekiso 1).

Umzobo-I-1-Ukungabhaliseki-UkuBhaliswa-UkuHlulwa kweNkcitho-nokuLandela

Umzobo 1: Ukukhutshwa, ukubhaliswa, ukulandelelaniswa nokulandelelwaniswa kwabathathi-nxaxheba.

Iimpawu zoMonde

Iimpawu ezisisiseko ziye zaxelwa ngaphambili kwaye zishwankathelwa kwiThebhile 1. [5,6,8] Amaqela adityanisiweyo ayenomlinganiselo weminyaka eyi-41.7 kunye namadoda angaphezulu kancinci kunabasetyhini. Ngokubanzi, amaqela angabonakaliyo kunye nokuqwalasela ayefana. Nangona kunjalo, izigulane ezikwiqela lokujonga zineziphene ezisisiseko (amanqaku aphezulu e-ODI), babenokuthanda utyando, badla ngokuyilinganisa ingxaki yabo njengento eyandayo, kwaye babenokuthi babe nentsilelo yeemvakalelo. Izifundo ezafumana utyando ngexesha lokufunda yayizi: zincinci; kuncinci ukusebenza; kunokwenzeka ukuba axele ukuba unembuyekezo yabasebenzi; wayenentlungu engaphezulu yesiseko kunye nokunciphisa ukusebenza; amanxeba ambalwa kunye nezinye izifo ezidibeneyo; ukunganeliseki okukhulu ngeempawu zabo; badla ngokuyilinganisa imeko yabo njengesiya isiba mandundu ekubhaliseni; kwaye bebethanda kakhulu utyando. Izifundo ezifumana utyando zikwalindeleke ngakumbi ukuba zibe novavanyo oluqinisekileyo lomlenze othe ngqo, kunye ne-neurologic, i-sensory, kunye nokusilela kwemoto rhoqo. Ngokwe-Radiographically, i-herniations yabo yayinokwenzeka ngakumbi ukuba ibe kumanqanaba e-L4�5 kunye ne-L5-S1 kwaye ibe yi-posterolateral kwindawo.

Itheyibhile ye-1 Izigulane zoLuntu lweeNkcukacha zoLuntu, iMirbidities kunye neMeko yeNqanaba leMpilo

Ithebula 1: Izigulana zokubala zabantu, izigulane kunye neendlela zempilo ngokwemigangatho yokufunda kunye nokwamkelwa kwonyango.

Ukunyangwa koPhando kunye neengxaki

Utyando olubanzi kunye noxinzelelo lwangokufanayo phakathi kweentlobo ezimbini (iThebhile 2). Ixesha lokupasa eliqhelekileyo lalingamaxesha ambalwa kwiqela elincinci (i-80.5 imizuzu engqinelanayo nemizuzu ye-74.9 yokuqwalasela, p = 0.049). Ilahleko lokulahleka kwegazi ngu-75.3cc kwinqanaba elingafaniyo ne-63.2cc ekuqwalaseleni, p = 0.13. Kuphela izigulane ze-6 zizonke ezifunekayo zokumpontshelwa kwe-intra-operative. Kwakungekho nto yokufa kwabantu. Inkxalabo eqhelekileyo yokuqhawula isalathiso sasemaphandleni (kunye ne-3% yamatyala). Ukusebenza kwakhona kwenzeka kwi-11% yamatyala ngama-5 iminyaka, i-12% ngama-6 iminyaka, i-14% ngeminyaka eyi-7, kunye ne-15% ngeminyaka eyi-8 emva kokuhlinzwa. Amanani okuphinda asebenze ayengafani nakakhulu phakathi kwama-cohort. Amashumi asibhozo anesibhozo kwi-119 imisebenzi kwakhona yaphawula uhlobo lokuphinda lusebenze; malunga ne-85% yalezi (74 / 87) zifakwe kwiimpawu eziphindaphindiweyo kwinqanaba elifanayo. Ukufa omnye kwenzeka phakathi kweentsuku ze-90 emva kokuhlinzwa ngokuphathelele ukuhlinzwa kwentliziyo kwenye iziko; ukufa kwagwetywa ukuba akuhambelani kwaye kwaxelwa kwiBhodi yokuHlola yeziNtu kunye neBhodi kunye neNgcaciso yoLondolozo loKhuseleko.

U mnqamlezo

Ukungabambelelwanga kwintsebenzo yesicatshulwa kuthintela zombini iingalo zonyango: izigulane zakhetha ukulibaziseka okanye ukuncipha ukuhlinzwa kwiingalo zokugqithisa kwaye zawela ekuqhutyweni kwindlela engasebenziyo. (Umzobo we-1) Ulwahlulo oluninzi lwezigulana eziwela ngaphaya kokunakekelwa kokungabikho kokusebenza phakathi kwe-8 iminyaka yobhaliso kukuba babekhulile, baneemali eziphezulu, abanelisekanga ngaphantsi kweempawu zabo, mhlawumbi babe ne-disniation kwizinga eliphezulu, kunokwenzeka ukuba ubonise ukhetho olusisiseko lokunyamekela okungekho emsebenzini, ubuncinci bokubona ukuba iimpawu zabo ziba zibi nakwinqanaba, kwaye zineentlungu ezingaphantsi kunye nokukhubazeka (Itheyibhile 3). Izigulana eziwela ngaphaya koovulindlela ngaphakathi kwe-8 iminyaka zazinganelisekanga ngeempawu zabo kwisiseko; bekunokwenzeka ukuba baqonda ukuba bebenzima nakakhulu kwisiseko; kunokwenzeka ukuba ubonise ukhetho olusisiseko lokuhlinzwa; kwaye wayenomsebenzi obaluleke kakhulu owenziwe ngomzimba kunye nokukhubazeka okungakumbi.

Itheyibhile 3 Isitatimende esibalulekileyo sokuQinisekisa kunyango

Ithebula 3: Iziganeko ezibalulekileyo zokubambelela unyango phakathi kwezigulane ze-RCT.

Impembelelo Eyona Ngundoqo Yonyango

Injongo yokuThatha uhlalutyo Uhlalutyo lwenjongo yokuphathwa kweqela elingahleliweyo, onke amanyathelo kwi-8 iminyaka yokuhlinzwa okhethwayo kodwa kwakungekho nemiphumo ebalulekileyo yonyango kwiziphumo eziphambili zempembelelo (Itheyibhile 4 kunye ne-2 Figure). Kwimilinganiselo eninzi yokuphatha iinjongo phakathi kwamaqela amabini okhathalelo ngexesha (indawo-phantsi kwekhava), iziphumo ezizimbini ziphezulu kakhulu kunye nokuhlinzwa ngokucwangcisa ukufuna ukuphathwa (i-sciatica ephazamisayo (p = 0.005), ukwaneliseka (p = 0.013), kunye nophuculo oluzimeleyo (p = 0.013)) (Umfanekiso we-3) Ukuphuculwa kwenkcazo ye-sciatica ephazamisayo ibonakaliswe ngokubalulekayo ekuncedeni ukuhlinzwa ngokuthelekiswa kwexesha elide (nangona kungabalulekanga kwiminyaka eyi-6 kunye 7) (Itheyibhile 4).

Umzobo-I-2-Iziphumo eziPrayimari-kwi-Randomized-and-Observational-Cohorts

Umzobo 2: Iziphumo eziphambili (iSF-36 Ubuhlungu Bodily kunye neMisebenzi yePhysical, kunye ne-Index ye-Disability Disability Index) kuma-cohorts angabonakaliyo kunye nokuqwalasela ngexesha le-8 yeminyaka yokulandelelana.

Umzobo-I-3-Iziphumo eziPhezulu-kwi-Rand-based-Observational-Cohorts.

Umzobo 3: Iziphumo ezisesekondari (iSciatica Bothersomeness, Ukwaneliseka ngeZimpawu, kunye nokuziPhucula iNkqubo yoPhuculo loPhuculo loMhlaba) kwii-cohorts ezingabonakaliyo kunye nokuqwalasela ngexesha le-8 yeminyaka yokulandelelana.

Itheyibhile ye-4 Iziphumo eziPhambili zokuHlola kwi-1 kwi-8

Ithebula 4: Uhlalutyo lweprayimari lubangela iminyaka 1 kwi-8. Injongo yokuphulukisa iqela elingalindelekanga kunye nokuhlaziywa * ngokuhlalutya ngokunyangwa kwonyango olwenziwe ngolu hlobo oluhlangeneyo.

Uhlalutyo olwenziweyo Iziphumo zokunyanga ezihlengahlengisiweyo ezibonwe kulungelelwaniso kunye nokujonga ziyafana. Ngokuhambelana, ii-cohorts zidityanisiwe kuhlalutyo lokugqibela. Iziphumo zonyango kwiziphumo eziphambili kuhlalutyo oluhlangeneyo lokuphathwa njengonyango lwalunentsingiselo kwaye lubalulekile ukuya kwiminyaka eyi-8: SF-36 BP 10.9 p <0.001 (95% CI 7.7 to 14); I-SF-36 PF 10.6 p <0.001 (95% CI 7.7 ukuya kwi-13.5); I-ODI? 11.3 p <0.001 (95% CI? 13.6 kuye ku-9.1) (Itheyibhile 4). Umbhalo osemazantsi weTheyibhile 4 uchaza uhlengahlengiso lwee-covariates ezikhethelwe imodeli yokugqibela.

Iziphumo ezivela kwiinjongo zokuphatha kunye nokuphathwa ngokucatshulwa kwala ma-cohorts zifaniswa kuMzekeliso 2. Kuhlalutyo oludibeneyo, imiphumo yonyango yayibonakaliswe ngokubalulekayo ekuthandweni kwazo zonke izicwangciso zephondo eziphambili kunye nesekondari (ngaphandle kwemeko yomsebenzi engazange ihluke phakathi kwamaqela enyango) ngexesha ngalinye (Itheyibhile 4 kunye ne-3).

Ukulahlekelwa-Ukulandelwa

Kwi-8-year-follow-up, i-63% yabhalisi bokuqala abanikezelwe ngedatha, ngokulahlekelwa ngenxa yokulahla, ukutyelelwa okungekho, okanye ukufa. Itheyibhile 5 isishwankathela impawu ezisisiseko zalabo abalahlekelwe ukulandelelana ngokumalunga nezo zigcinwe kwisifundo kwi-8-iminyaka. Abo bahlala kwisifundo kwi-8 iminyaka babesele badala; kunokwenzeka ukuba ngumfazi, umhlophe, ufundiswe kwiikholeji, kwaye usebenze kwisiseko; kuncinci ukukhubazeka, ukufumana umvuzo okanye ukutshaya; uphawu olungaphantsi kwesiseko kunye nosizi olungaphantsi komzimba, umsebenzi osebenza kakuhle, ukukhubazeka okuphantsi kwe-ODI, impilo engcono yengqondo, kunye ne-sciatica encinci. Ezi ntlukwano zincinci kodwa zibalulekileyo. Itheyibhile 6 isishwankathela iziphumo zexeshana ngexesha leminyaka yokuqala ye-2 kulabo bagcinwa kwisifundo kwi-8 iminyaka xa kuthelekiswa nezo zilahlekile ukulandelelana. Abo balahlekelwe ukulandelelana babe nemiphumo emibi ngokwemyinge; nangona kunjalo le nto yayiyinyaniso kumaqela atyunjiweyo kunye angabandakanyekanga kunye neengxaki ezingekho ngundoqo kwimiphumo yonyango. Iziphumo zexesha elide ngoko ke zinokwenzeka ukuba zithembeke ngokwemilinganiselo kumabini omabini, kodwa ukuthelekiswa phakathi kweziphumo zokugonywa kunye nokungabikho komsebenzi kubonakala kungenakucala ngaphandle kokulahleka kwexesha elide ukulandelwa.

Itheyibhile ye-5 Izigulane zoLuntu lweeNkcukacha zoLuntu, iMirbidities kunye neMeko yeNqanaba leMpilo

Ithebula 5: Iimpawu zokubala zabantu abathintekayo, izigulane, kunye nemilinganiselo yezinga lempilo ngokubhekiselele kwisimo sokulandelelana kwesigulane njenge-02 / 01 / 2013 xa idatha ye-IDH8yr ifakwe.

Itheyibhile ye6 Ixesha elixinekile Umyinge weempatho zonyango

Ithebula 6: I-average average average treatment of effects in the year 2 (AUC) kwii-cohorts eziphathekayo eziphathekayo ezinokulandelelana ezihlangeneyo zidibanise uhlalutyo lweziphumo eziphambili, ngokutsho kwonyango olwamkelweyo kunye nesimo sokulandelwa kwesigulane.

ingxoxo

Kwi zi gulane ezine disc disc Ukuqinisekiswa ngumbono kunye neempawu zomlenze eziqhubekayo ubuncinane ubuncinane kwiiveki ze-6, unyango lwaluphezulu kunonyango olungasebenziyo ekunciphiseni iimpawu kunye nokuphucula umsebenzi. Kuhlalutyo oluphathwa ngolu hlobo, unyango lwonyango lotyando lwabonwa nje ngeeveki ze-6, zabonakala zifikelele kwii-6 ngeenyanga kwaye zaqhubeka zingaphezu kwe-8 iminyaka; Kuphawuleka ukuba iqela elingasebenziyo liye laphucula kakhulu kwaye ukuphuculwa kwaqhubeka nokunciphisa ukuphulwa kwemiphumela kwiqela (ukusebenza kunye nokungasebenzi) phakathi kwe-4 kunye ne-8 iminyaka. Uhlalutyo lwengqondo olude lwexesha, zonke iziphumo zabonisa inzuzo encinci yokuhlinzwa, kodwa kuphela iziphumo zesibini ze-sciatica eziphazamisayo, ukwanelisa iimpawu kunye nokuphuculwa kwezinto ezizimeleyo zazibalo. Inzuzo encinane yokuqhubekayo kwiqela lotyando emva kwexesha liye lenza intlaniso-jikelele yokuphatha iinjongo zibaluleke kakhulu ngexesha elide nangona amanqanaba aphezulu okuwela. Imiphumo emikhulu ebonwe kuhlalutyo oluqhutywe ngolu hlobo emva kokuba utshintsho lweempawu zezigulane ze-crossover zibonisa ukuba uhlalutyo lokufuna ukunyanga luyakunciphisa umphumo wokwenyuka kokuhlinzwa ngenxa yokuba ukuxuba unyango ngenxa ye-crossover kulindeleke ukuba kuhlaziywe Ukungafihli ukulandelelaniswa phakathi kwezigulane ezona zibi nakwizinga elisezantsi kwaye iziphumo ezigqithisileyo zisesigxina mhlawumbi zikhokelela kwiziphumo ezide ziqikelelwa kwixesha elide ekugqibeleni kunye nokungabikho amaqela asebenzayo kodwa iingqikelela ezingenakulungelelaniswa kweziphumo zonyango.

Ukuthelekisa kwezinye iZifundo

Azikho ezinye izifundo zexesha elide ezingacwangciswanga ezibika imilinganiselo yeziphumo eziphambili njenge-SPORT. Iziphumo zeziphumo eziphambili ze-SPORT kwiminyaka eyi-2 zifana kakhulu nezo ze-Peul et al kodwa ukulandelela ixesha elide kwisifundo se-Peul kuyimfuneko yokuthelekisa ngakumbi. IMIDLALO phakathi kwamaqela onyango yahlala ingatshintshi phakathi kwe-4,20 kunye ne-1 iminyaka yokulandela. Enye yezinto ezikulo mahluko inokuba buvelwano lwemilinganiselo yesiphumo � umzekelo, i-sciatica bothersomeness, eyahluke kakhulu kwiminyaka eyi-8 ngenjongo yokunyanga, ingaba ngumqondiso obuthathaka ngakumbi wokuphumelela kwonyango kunokuba ngokubanzi. umlinganiselo wesiphumo osetyenziswa ngu Weber et al. [8]

Iziphumo zexesha elide ze-SPORT ziyafana neMaine Lumbar Spine Study (MLSS). [21] I-MLSS inike ingxelo yokuphuculwa kweenkcukacha-manani kakhulu kwiminyaka eli-10 kwi-sciatica ephazamisayo kwiqela lotyando (? 11.9) xa kuthelekiswa namaqela angenzelelo (? 5.8) enefuthe lonyango? 6.1 p = 0.004; kwi-SPORT ukuphuculwa kwe-sciatica ephazamisayo kwiqela lokuhlinzwa kwiminyaka eyi-8 yayifana nesiphumo seminyaka eli-10 kwi-MLSS (? 11) nangona iqela elingasebenziyo kwi-SPORT lenze ngcono kunabalingane babo be-MLSS (? 9.1) nangona kunjalo IMIDLALO, ngelixa incinci, ihlala ibalulekile ngokweenkcukacha manani (? 1.5; p <0.001) ngenxa yesayizi enkulu kakhulu yesampulu. Uphuculo olukhulu kwii-cohorts ezingasebenziyo phakathi kwe-SPORT kunye ne-MLSS zinokunxulumana nokwahluka kunyango olungasebenziyo ekuhambeni kwexesha, iyantlukwano phakathi kwamaqela amabini ukusukela kwi-MLSS kwaye ayifuni mfanekiso-ngqondweni we-IDH.

Ngaphezulu kweminyaka ye-8 kwakukho ubungqina obuncinane bokulimala ukusuka kwonyango. Ireyithi ye-8 yonyaka yokuvuselela kwakhona yayiyi-14.7%, ephantsi kwe-25% ebikwe yi-MLSS kwiminyaka ye-10. [22]

Imida

Nangona iziphumo zethu zilungelelaniswa kwiimpawu zokuwela phezu kwezigulane kunye nolawulo lwe-covariates ebalulekileyo yesiseko, uhlalutyo olubonakalisiweyo olubonakalisiweyo alubelani ngokhuseleko oluluqilima ekudidekeni olukhoyo kuhlalutyo lwenjongo yokunyanga.[4�6] Nangona kunjalo, Nangona kunjalo, uhlalutyo lweenjongo zokunyanga luyaziwa ngokuba lucalucalulo phambi kokungahambelani kwinqanaba elibonwe kwi-SPORT, kwaye uhlalutyo lwethu oluhlengahlengisiweyo njengoko luhlalutyelwe lubonakaliswe ukuvelisa iziphumo ezichanekileyo phantsi kweengcinga ezifanelekileyo malunga nokuxhomekeka kokuthotyelwa kweziphumo zexesha elide. .[23] Olunye uthintelo olunokubakho luyi-heterogeneity, yongenelelo lonyango olungasebenzisiyo, njengoko kuxoxwe ngalo kumaphepha ethu angaphambili. idatha kwiminyaka eyi-5,6,8 kunye nelahleko ngenxa yokuyeka, ukutyelelwa, okanye ukufa; ngokusekelwe kuhlalutyo olusisiseko kunye nolandelelwano lwexeshana elifutshane, oku kunokukhokelela kwiziphumo eziqikelelweyo zexesha elide eziqikelelweyo zexesha elide kuwo omabini amaqela onyango kodwa uqikelelo olungakhethi cala lonyango lotyando.

izigqibo

Ukuhlalutya kwenjongo yokwenza unyango, ezincinci, izibalo ezingabalulekanga zonyango zonyango ziye zabonwa kwiziphumo eziphambili kodwa iziphumo ezinokubaluleka kwe-sciatica eziphazamisayo, ukwanelisa iimpawu kunye nokuphuculwa kwezinto ezizimeleyo kuboniswe kwiminyaka eyi-8 nangona amazinga aphezulu enyango ukuwela. Uhlalutyo oluphathiswe ngolu hlobo oludibanisa i-cohorts engabonakaliyo kunye neyokuqwalasela, elawulwa ngokucophelela ukuze kuphazamise izinto ezisemgangathweni, ibonise ukuphucula okukhulu kwintlungu, umsebenzi, ukwaneliseka kunye nenkqubela yokuzimelela kwiminyaka ye-8 xa kuthelekiswa nezigulane eziphathwa ngokungasebenzi. Nangona kunjalo, iqela elingasebenziyo, nangona kunjalo, libonise uphuculo olungaphezulu kwexesha, kunye ne-54% yokunika ingxelo ngokwaneliso zabo kunye ne-73% yanelisekile ngonakekelo lwabo emva kweminyaka eyi-8.

Imibulelo

Iziko leSizwe leArthritis kunye neMusculoskeletal and Skin Diseases (U01-AR45444; P60-AR062799) kunye neOfisi yoPhando ngeMpilo yabaseTyhini, amaZiko eSizwe ezeMpilo, kunye neZiko leSizwe loKhuseleko lweMisebenzi kunye neMpilo, amaZiko eSifo. Iimali zegranti yoLawulo noThintelo zafunyanwa ukuxhasa lo msebenzi. Imisebenzi efanelekileyo yezemali ngaphandle komsebenzi ongenisiweyo: iingcebiso, izibonelelo, amasheya.

Olu pho nonongo luye lwaziswa kwiBrieanna Weinstein noHarry Herkowitz, iinkokheli ngamalungelo abo, ezenza umhlaba ube yindawo engcono.

Imihlathi

Ezinye izidakamizwa zibandakanya: i-stroke, isifo sikashukela, i-osteoporosis, umhlaza, i-fibromyalgia, i-CTS, i-PTSD, utywala, ukuxhomekeka kweziyobisi, intliziyo, imiphunga, isibindi, iinjongo, isitya segazi, isimiso se-nervous, i-blood pressure, i-migraine, ixhala, isisu, isisu

Ekugqibeleni, abantu abachaphazelekayo ngenxa yeentlungu zamagraine bafuna uhlobo olunyangekileyo lwenyango ukuze bancedise ukuphucula kunye nokulawula iimpawu zabo, ingakumbi ukuba i-migraines yabo ifunyenwe kwi-disc ye-lniar herniated disc. Injongo yamanqaku alandelayo kwakufuneka ukudibanisa le mibini miba kunye kunye nokubonisa iziphumo zophando apha ngasentla. Iinketho ezahlukeneyo zonyango zinokuqwalaselwa ngaphambi kokuba utyunjelwe intlungu ye-migraine kunye nokuphathwa kwe-disniated disc. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Intlungu Yentambo

Intlungu yesikhumba isishalazo esiqhelekileyo esinokubangelwa ngenxa yeemeko ezahlukeneyo kunye / okanye iimeko. Ngokwezibalo, ukulimala kwengozi yemoto kunye nokulimala kwe-whiplash zizinye zezona zinto zixhaphake iintlungu phakathi kwabantu bonke. Ngethuba lengozi yengozi, igalelo elizenzekelayo elivela kweso siganeko kunokubangela ukuba intloko nentamo iqhume ngokukhawuleza emva kwanoma iyiphi na indlela, eyonakalise izakhiwo eziyinkimbinkimbi ezungeze umgudu wesibeleko. Ixinzelelo kumathambo kunye nemigqa, kunye neyezinye izicubu entanyeni, kunokubangela iintlungu zentamo kunye nokubonakalisa imiqondiso emzimbeni womntu.

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

ISIHLOKO ESIBALULEKILEYO: I-EXTRA EXTRA: Ungcono!

EZINYE IINGCUKACHA EZIBALULEKILEYO: UKWENZISA: Ukulimala kwezemidlalo? | Vincent Garcia | Umonde | El Paso, TX I-Chiropractor

Ngenanto

Ucaphulo

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Vala i-Accordion

Ngenanto

Ucaphulo

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Vala i-Accordion

Imithi ye-Migraine kunye neCervic Herniation Treatment e-El Paso, TX

by iicrosoft | Disc Disc, Migraine, Ukubuyiswa komzimba, Uvavanyo oluLungeleleneyo oluLungisiweyo, Unyango

Migraine yimeko ebuthathakayo ebonakaliswe yintloko yeentlobo ezihlukeneyo, ezihlala zihamba kunye neentlanzi kunye nobuzwe bokukhanya kunye nesandi. Nangona abaphandi banamhlanje bengayiqondi isizathu esiyiyo esi siyizifo eziphambili zentloko, oogqirha abaninzi bezempilo bayakholelwa ukuba ukungahambi kakuhle komgudu wesibeleko kungakhokelela ekufuduleni. Nangona kunjalo, uphando olutsha olusisiseko-uphando luye lwafumanisa ukuba ukukhutshwa kwetranshini ye-cervical, umba wezempilo ochaphazelekayo kunye ne-disvertebral diss yesigxina esingaphezulu, kunokubangela intlungu yentloko. Injongo yale nqaku ilandelayo kukufundisa izigulane nokubanceda baqonde umthombo weempawu zabo kunye nokubonakalisa iintlobo ezininzi zonyango olusebenzayo kwi-migraine kunye ne-disc.

IiNyango zoLondolozo lweeNtsholongwane eziPhezulu eziSisigxina: UkuHlola okuSingqinisiso lweeLingo eziLawuliweyo ezingapheliyo

Abstract

Oku kulwazi lwethu uphononongo lokuqala olucwangcisiweyo malunga nokusebenza konyango lwe-manual izilingo zeklinikhi (RCT) kwiintloko ezingapheliyo. Uphando olubanzi lweencwadi zesiNgesi kwi-CINHAL, Cochrane, Medline, Ovid kunye nePubMed ezichongiweyo ze-6 RCTs zonke eziphanda intloko engapheliyo ye-tension-type (CTTH). Olunye uphononongo lusebenzise unyango lwe-massage kunye nezifundo ezihlanu zisebenzisa iphysiotherapy. Izifundo ezine zathathwa njengomgangatho olungileyo wemethodi kwisikali se-PEDro. Zonke izifundo zaziyi-pragmatic okanye zingasetyenziswanga unyango njengeqela lokulawula, kwaye izifundo ezimbini kuphela zigweme ukungenelela ngokubambisana, oku kunokukhokelela ekuthandeni okunokwenzeka kwaye kwenza ukuchazwa kweziphumo kube nzima ngakumbi. Ii-RCTs zibonisa ukuba i-massage kunye ne-physiotherapy zikhetho zonyango olusebenzayo kulawulo lwe-CTTH. Enye ye-RCTs ibonise ukuba i-physiotherapy iyanciphisa ukuphindaphinda kwentloko kunye nokuqina kwezibalo ezibaluleke ngakumbi kunokunyamekela okuqhelekileyo ngugqirha jikelele. Ukusebenza kwe-physiotherapy emva kokunyanga kunye nokulandelwa kweenyanga ze-6 kufana nokusebenza kwe-tricyclic antidepressants. Ubungakanani bempembelelo ye-physiotherapy yaya kuthi ga kwi-0.62. I-RCTs yonyango lwexesha elizayo iyacelwa ukuba ijongane nokusebenza kakuhle kwi-migraine engapheliyo kunye nangaphandle kokusetyenziswa kakubi kweyeza. Ii-RCT zexesha elizayo malunga nentloko kufuneka zihambelane nezikhokelo ze-International Headache Society's izilingo zeklinikhi, oko kukuthi i-frequency njenge-primary end-point, ngelixa ubude kunye nokuqina kufuneka kube yindawo yokugqibela, ukuphepha ukungenelela ngokubambisana, kubandakanya ubungakanani besampulu eyaneleyo kunye nokulandelwa. ixesha ubuncinane iinyanga ezi-6.

Internet: Izilingo zonyango ezingapheliyo, i-headache ephambili ye-Primary, i-Manual guitar, i-massage, i-Physiotherapy, i-Chiropractic

intshayelelo

Iintloko eziphambili ezingapheliyo, oko kukuthi okungapheliyo kwe-migraine (i-CM), iintloko ezingapheliyo zentloko (i-CTTH) kunye neentloko ezingapheliyo zentloko zineendleko ezibonakalayo kwezempilo, ezoqoqosho nezentlalo. Malunga ne-3% yabemi ngokubanzi banesifo esinganyangekiyo kwintloko yabasetyhini [1]. Ukwahlula-hlula kwaMazwe ngaMazwe kweengxaki zeNtloko ye-III? (ICDH-III?) Ichaza i-CM njenge-15 yeentsuku zentloko / inyanga ubuncinci iinyanga ze-3 ezineempawu ze-migraine kwi? Iintsuku ze-8 / inyanga, i-CTTH ichazwa ngokomndilili? Iintsuku ze-15 / inyanga ene-tension-type headache ubuncinci Iinyanga ezi-3, kunye nentloko engapheliyo yeentloko njengokuhlaselwa ubuncinci yonke imihla ngaphezulu konyaka omnye ngaphandle kokuxolelwa, okanye uxolelo oluhlala ixesha elide <inyanga enye [1].

Ngokumalunga ne-80% bathetha nodokotela wabo oyintloko kwi-headache engapheliyo ye-head [3], kwaye ulawulo lwe-pharmacological luqwalaselwa kuqala kumgca wonyango. Nangona kunjalo, umngcipheko kukuba kungabangela ukusetyenziswa ngokugqithiseleyo kwemithi yamakhanda entloko ngenxa yokuhlaselwa kwentloko. I-47% yalabo abanesifo esiyintloko esisifo esingapheliyo kwintsholongwane yabantu baseNorway basebenzise imithi yamakhanda entloko [1,4]. Ukuqwalasela ukusetyenziswa kakubi kweyeza ezinzima, zombini imithi yeprophylactic kunye nolawulo olungezo-pharmacological kufuneka ke lucatshangelwe kulawulo [5,6]. Iyeza zeprolactic zisetyenziswe kuphela yi-3% kubantu baseNorway ngokubanzi, ngelixa i-52% iye yazama u-physiotherapy kwaye i-28% iye yazama unyango lwe-chiropractic unyango olusisigxina [3]. Ulawulo olungekho phantsi kwe-pharmology luye lwaba luncedo lweziganeko ezimbalwa eziqhelekileyo eziqhelekileyo eziqhelekileyo eziqhelekileyo kwaye akukho mveliso yezolimo / i-7].

Ukuphononongwa okucwangcisiweyo kwangaphambili kugxile kwii-RCT ze-headache-type headache, i-migraine kunye / okanye i-headervogenic headache, kodwa kungekhona ekusebenzeni kakuhle kwintloko yesifo esiyintloko (5,6,8-11]. Ulwaphulo lwencwadi luyonyango olwenziwe ngamaziko e-physiotherapists, i-chiropractors, i-osteopath kunye nezinye iingcali zokunyanga iintlungu kunye nokukhubazeka, kwaye kubandakanya unyango lwe-massage, ukuhlanganiswa kunye kunye nokuphathwa [12].

Oku kulwazi lwethu lokuqala lokuhlaziywa olufanelekileyo lokuvavanya ukuphumelela kwezixhobo zonyango ezilawulwa ngandlela-thile (RCT) ze-headaches ezingapheliyo zintsholongwane usebenzisa ubuhlungu bentloko njengesiphelo sokugqibela kunye nobude bentloko kunye nobukhulu njengamaphuzu okugqibela.

Review

tindlela

Uphando loncwadi lwesiNgesi lwenziwa kwi-CINHAL, Cochrane, Medline, Ovid kunye nePubMed. Phendla amagama aye; i-migraine, i-migraine engapheliyo, i-headache-type-headache, intloko engapheliyo yohlobo lwe-tension, intloko ye-cluster, intloko ye-cluster engapheliyo kunye namagama; unyango lwe-massage, i-physiotherapy, i-spinal mobilization, unyango lwe-manipulative, unyango lwe-spinal manipulative, unyango lwe-osteopathic okanye i-chiropractic. Sichonge izifundo ngophando olubanzi lwekhompyuter. Uphononongo olufanelekileyo luhlolwe kwii-RCT ezongezelelweyo ezifanelekileyo. Ukukhethwa kwamanqaku kwenziwa ngababhali. Zonke ii-RCT ezibhalwe ngesiNgesi zisebenzisa nayiphi na i-manual therapy ye-CM, i-CTTH kunye / okanye i-headache ye-cluster engapheliyo ihlolwe. Izifundo ezibandakanya iintlobo zentloko edibeneyo ngaphandle kweziphumo ezithile ze-CM, i-CTTH kunye / okanye i-headache ye-cluster engapheliyo yayingabandakanywa. Uphononongo lubandakanya i-RCTs yonyango lwe-manual ebonisa ubuncinane enye yeeparamitha ezisebenzayo ezilandelayo; Ukuphindaphinda kwentloko, ubude bexesha kunye nokuqina kweentlungu ze-CM, CTTH kunye / okanye intloko engapheliyo yentloko njengoko kucetyiswa yi-International Headache Society's izikhokelo zolingo lwezonyango [13,14]. I-frequency ye-headache iyindawo ephambili yokuphela, ngelixa ubude kunye nobukhulu bentlungu ziindawo zokugqibela zesibini. Ukuxilongwa kwentloko kwahlelwa ngokukhethiweyo ngokwemiqathango ye-ICHD-III? okanye amahlelo angaphambili [2,15-17]. Umgangatho we-methodological we-RCTs ezibandakanyiweyo zavavanywa kusetyenziswa isikali se-PEDro, iThebhile 1[18]. I-RCT yayithathwa njengomgangatho ophezulu ukuba inqaku le-PEDro laliyi-?6 yamanqaku aphezulu e-10. Umgangatho we-methodological we-RCTs uhlolwe yi-AC. Uluhlu lokutshekisha lwe-PRISMA 2009 lwenziwe kolu hlaziyo lucwangcisiweyo. Ubungakanani besiphumo bubalwe xa kunokwenzeka. Ubungakanani bempembelelo ye-0.2 ithathwa njengento encinci, i-0.5 njengephakathi kunye ne-0.8 enkulu [19].

Ithebula 1: Amanqaku ePEDro ewe okanye hayi izinto.

Ukuhlaziywa okucwangcisiweyo kwenziwa ngokukodwa ngokusekelwe kwii-RCT ezifumanekayo kwaye azibhaliswanga njengeprotocol.

iziphumo

Uphando lweencwadi lubhengeze ii-RCT ezi-6 ezidibene neenkqubo zethu zokubandakanya. Olunye uphando olwenziwe lusetyenziselwa unyango lwe-massage (MT) kunye nezifundo ezintlanu ezisetyenziselwa i-physiotherapy (PT) [20-25]. Zonke iingcaphephe zihlolwe i-CTTH, ngelixa kungekho zifundo zivavanya i-CM okanye i-headset cluster headache.

Umgangatho wendlela Itheyibhile 2 ibonisa ukuba amanqaku e-PEDro yee-RCT afakwe kwi-1 ukuya kwi-8. Ii-RCT ezine zacatshangwa ngekhwalithi efanelekileyo yeendlela, ngelixa ii-RCT ezimbini zineziphumo eziphantsi.

Itheyibhile 2 I-PEDro Score ye-RCT efakwe

Ithebula 2: Amanqaku e-PEDro yeendlela zokwenziwa kwezilingo ezilawulwa ngandlela-thile (RCTs).

Izilingo ezilawulwa ngokungapheliyo (RCT) Itheyibhile 3 ibonisa uluntu lwabafundi, ukungenelela kunye nokusebenza kweeRCT ezintandathu.

Iziphumo ze-3 Iziphumo zonyango lwe-RCT ye-CTTH

Ithebula 3: Iziphumo zonyango olusesikweni olulinganiselwe (RCTs) lwe-headset-type headache (CTTH).

Ukunyanga kwamayeza Ugqirha we-physiotherapist waseSpain wenza i-2-exhobile i-crossover RCT ngokuthelekisa ngokuthe ngcembe kunye nemilinganiselo yeziphumo ezingaboniyo [20]. Uphononongo lubandakanya abathathi-nxaxheba abane-CTTH abafunyaniswe ngugqirha wemithambo-luvo. Iikhrayitheriya ze-ICHD-II ze-CTTH zatshintshiwe kancinane, okt ubunzima beentlungu buchazwe njenge-5 kwinqanaba le-0-10 yamanani okulinganisa iintlungu, kunye neempawu ezihamba kunye ne-photophobia, i-phonophobia okanye isicaphucaphu esingemninzi zazingavunyelwe [16]. Iindawo zokugqibela kunye nezesekondari azichazwanga. Iziphumo zibonisiwe kwiTheyibhile 3.

Physiotherapy I-RCT yaseMelika eyi-3 exhobileyo yayinemilinganiselo yesiphumo esingasimfamekiyo [21]. Iikhrayitheriya zokuxilonga zaziyi-25 iintsuku zentloko / inyanga> iinyanga ze-6 ngaphandle kweempawu ezinxulumene ne-nausea, ukuhlanza, i-photo- kunye ne-phonophobia, kodwa kunye nezihlunu zethenda, oko kukuthi i-CTTH ene-periranial tenderness. Abathathi-nxaxheba abaneentloko ze-cervicogenic okanye iziphumo ze-neurological zazingabandakanywa. Amanqaku okugqibela aphambili kunye nesekondari awazange achazwe kwangaphambili, kodwa isalathisi sentloko, esichazwe apha njengesiqhelo sentloko � ubukhali, yayiyi-end-point evandlakanyo.

Uphononongo lwaseTurkey luqhube i-RCT exhobileyo ye-2 kunye nemilinganiselo yeziphumo ezingabonakaliyo [22]. Abathathi-nxaxheba bafunyaniswa ukuba bane-CTTH ngokwe-ICHD-I [15]. Abathathi-nxaxheba abaneentloko ezixubileyo, i-neurological and systemic aliment, okanye abathathi-nxaxheba abaye bafumana i-physiotherapy kwiinyanga ze-6 ngaphambi kokuba isifundo sifakwe ngaphandle. Amanqaku okugqibela aphambili yayiyisalathisi sentloko esichazwa njengesiqhelo � ubungqongqo.

Isifundo saseDenmark siqhube i-2-exhobile i-RCT eneziphumo ezingaboniyo [23]. Abathathi-nxaxheba bafumanisa ukuba i-CTTH yi-neurologist ngokwemiqathango ye-ICHD-I [15]. Abathathi-nxaxheba ngezinye iintloko eziphambili, i-neuralgia, i-neurological, i-systemic okanye i-psychiatric ukuphazamiseka okanye ukusetyenziswa gwenxa kweyeza kuchazwe njenge> 100 iipilisi ze-analgesic okanye> iidosi ezi-2 zeetriptans kunye neergotamine ngenyanga azifakwanga. Indawo yokuphela ephambili yayihamba rhoqo entloko, kwaye amanqaku okuphela kwesibini yayilixesha lokuqaqanjelwa yintloko kunye namandla. Iziphumo eziboniswe kwiTheyibhile 3 azikhange ziphenjelelwe kukuthamba kwemisipha ye-pericranial.

Uphando lwe-Dutch lwenza i-2-enezixhobo ezixhobileyo, i-RCT eninzi kunye nemilinganiselo yempembelelo eyimpumputhe [24]. Abathathi-nxaxheba bafumene i-CTTH ngugqirha ngokwe-ICHD-I [15]. Abathathi-nxaxheba abaneentlobo ezininzi zeentloko okanye abo bafumene i-physiotherapy kwiinyanga ezidlulileyo ze-6 babengabandakanywa. Amaphuzu okuphela kweprayimari ayimvama yeentloko ngelixa ubude kunye nobukhulu bezinto eziphambili.

Ucwaningo lwe-2nd lwesiDatshi luqhube i-2-enezixhobo ezizixhobileyo ze-RCT, i-RCT eninzi kunye neendawo zokugqibela ezizimeleyo kunye nezesekondari, oko kukuthi i-headache frequency, ubude kunye nobukhulu [25]. Abathathi-nxaxheba bafumaniswe ngugqirha ngokwemiqathango ye-ICHD-II [16]. Abathathi-nxaxheba abane-arthritis ye-rheumatoid, isifo esicatshulwayo, ukukhulelwa, abangathethi isiDatshi, abo bafumene i-physiotherapy kwiinyanga ezidlulileyo ze-2, i-triptan, i-ergotamine okanye i-opiods abasebenzisi abangekho ngaphandle.

ingxoxo

Uhlolo lokuhlalutyo olukhoyo lwenkqubo oluhlola ukuphumelela kwonyango olusesikweni kwii-RCT zezintloko zintsholongwane ezingapheliyo zikhetha kuphela i-RCT ephathwa nge-CTTH. Ngaloo ndlela, ukuphumelela kweCM kunye nesifo sentloko esingaqhelekanga asiyi kuhlolwa kule ngxelo.

Iingqinisiso zendlela Umgangatho wendlela yezifundo ezivavanya unyango olusebenzayo lokuphazamiseka kwentloko zihlala zigxekwa ngokuba ziphantsi kakhulu. Ngamaxesha athile kufanelekile, kodwa uhlala esenza uyilo lwendlela kuthintela izifundo zonyango zonyango ukuba zingafikeleli kumgangatho wegolide kwii-RCTs zeekhemesti. Umzekelo, unyango lwe-placebo kunzima ukuseka ngelixa umphandi engenakumfanyekiswa ngongenelelo olwenziweyo. Amanqaku aphakathi kwezifundo ezibandakanyiweyo yayingama-5.8 (SD 2.6) amanqaku kunye nezifundo ezine ezazithathwa njengomgangatho olungileyo. Zonke ii-RCTs ziye zasilela ukubandakanya ubungakanani besampula? 50 kwiqela elincinci. Ubungakanani besampulu eyoneleyo ngokubalwa kwamandla ngaphambili kubalulekile ukuthintela iimpazamo zohlobo 2. Izifundo ezithathu azikhange zichaze indawo zokugqibela nezisekondari, eziphazamisa ukubala kobungakanani, kunye nomngcipheko wohlobo lwe-2 iimpazamo ezivela kumanyathelo amaninzi [20-22]. Ukuqhuba unyango lwe-RCT yesandla ixesha kunye neendleko ezichithayo, ngelixa ukumfamekisa kuhlala kunzima njengoko kungekho nyango lunye luqinisekisiweyo olunokusetyenziswa njengeqela lolawulo ukuza kuthi ga ngoku. Ke ngoko, zonke izifundo ezibandakanyiweyo zazingumqobo okanye zingasebenzisi nyango njengeqela lolawulo.

Ngaphandle kwabathathi-nxaxheba kwisifundo esiphenduleyo [21], bonke abathathi-nxaxheba bafunyaniswa ngugqirha okanye kwi-neurologist. Udliwano-ndlebe ngongxowankulu ngumgangatho wegolide, ngelixa uphando lwemibuzo kunye neendlebe zabavuni bezonxibelelwano zixhobo ezichanekileyo zokuxilonga malunga nokuphazamiseka kwengqondo [26].

Ulungelelwano lwentsebenziswano lwalugcinwe kuphela kwizifundo ezimbini [22,20]. Izifundo ezimbini zenze uhlalutyo lwenjongo yokunyanga okucetyiswayo ukukhusela kwimilinganiselo engapheliyo kunye nokugcina ukulinganiswa kokuqala (24,25,27].

iziphumo Ukuqhutyelwa kwe-massage yophando kwakubandakanye abathathi-nxaxheba be-11 kuphela, kodwa iqela le-massage liye linciphisa kakhulu ubuhlungu beentloko kuneqela elincinci le-ultrasound [20].

I-54%, i-82% kunye ne-85% yabathathi-nxaxheba kwii-RCT ezintathu ze-physiotherapy zine-50% yokunciphisa i-? -phezulu [23]. Oku kuthelekiswa ne-25-6% yabathathi-nxaxheba abaneempembelelo ezifanayo usebenzisa i-tricyclic antidepressants [24,25]. Isiphumo se-tricyclic sibonakala siphucula ngokuhamba kwexesha, okt emva kweenyanga ezingaphezu kwe-40 zonyango [70]. Nangona kunjalo, i-tricyclic antidepressants inoluhlu lweziphumo ebezingalindelekanga ngokuchasene nephysiotherapy, ngelixa unyango lwezandla lufuna ukubonisana ngakumbi. Izifundo ezibini zivavanye isalathisi sentloko esichazwa njengentloko ephindaphindiweyo � ukuqina [28,29]. Zomibini izifundo zibonise ukuphuculwa okukhulu emva kokunyanga kunye nenyanga ye-6 kunye neenyanga ze-29 ngokulandelanayo.

Iziphumo ezine ze-10.1 zithetha iminyaka elineentloko, ngaloo ndlela, isiphumo esicatshulwayo sinokubangelwa yimpembelelo yonyango kunokuba uphucule ngokukhawuleza okanye ukunyanzeliswa kwintetho [21-23,25].

Amachiza aphezulu entloko aqhelekileyo asetyenziswa kwiintsholongwane eziphambili, kwaye ukuba i-headache iphindwe kaninzi, kunomngcipheko okwandisiweyo weyeza unyango olubi kakhulu. Ukusetyenziswa ngokunyanga kwamayeza enkqubo yeprophylactic kuye kwacetyiswa ekulawuleni izikhwebu eziphambili ezingapheliyo [3]. Ekubeni imilathiso yonyango ibonakala ibe nenzuzo efana neempembelelo zamachiza e-prophylactic [28,29], ngaphandle kwemiphumo yecandelo lezonyango, imirhumo yonyango kufuneka iqwalaselwe kwinqanaba elilinganayo njengezicwangciso zolawulo lwe-pharmacy.

Ubungakanani besiphumo bunokubalwa kwii-RCT ezintathu kwezintandathu. Ubungakanani bempembelelo kwi-headache frequency ukuya kwi-0.62, ngelixa yayingaphantsi malunga nobude kunye nokuqina, ngelixa i-headache index (i-frequency � intensity) ifikelele kwi-0.37 (iThebhile 3). Ngaloo ndlela, ubungakanani obuncinci ukuya kobuphakathi bunokuthi bube bukhulu kumntu ngamnye, ngokukodwa ngokuqwalasela ukuba phantse yonke imihla intloko ithetha ukuba iintsuku ze-12 / 14 zincitshisiwe ukuba zithetha iintsuku ze-3 / 14 [25], ezilingana ne-75% yokunciphisa ukuphindaphinda kwentloko. Ngokuqhelekileyo ukunciphisa i-50% ngokuqhelekileyo kusetyenziswa kwiintlungu zentlungu, kodwa ngokuqwalasela ukuba i-CTTH inzima ukuyiphatha, abanye abaphandi basebenza nge-?30% yokuphucula i-primary efficacy parameter xa kuthelekiswa ne-placebo [30].

Imida Uphononongo lwangoku lunokuba luncedo. Omnye wabo ukhangelelwano lwentengiso njengoko abalobi abazange bazame ukufumanisa i-RCT engashicilelwa. Nangona senza uphando olunzulu, siyavuma ukuba kungenzeka ukuphosa enye i-RCT okanye embalwa, ngakumbi i-RCT engesiNgesi.

isiphelo

Ukunyangwa kwonyango kunendlela efanelekileyo ekulawuleni i-CTTH elingana namayeza eprophylactic ne-tricyclic anti-depressant. Okwangoku akukho zifundo zonyango olusesikweni isifo esingenasiphelo semigraine okanye isigxina esingasigxina. Iingcebiso zonyango zexesha elizayo I-RCT kwi-primary headache isifo esifanelekileyo kufuneka ihambisane nesinconywa soMbutho weNtloko weSizwe, oko kukuthi ekupheleni kokuphela kwintloko yesiseko kunye neendawo zokugqibela eziphambili zixesha kunye nobukhulu. Izifundo zonyango lwexesha elizayo kwi-CM kunye nangaphandle kokusetyenziswa kakubi kweyeza kunyanzeliswa, ekubeni iingcali ezinjalo azikho namhlanje.

Ukugqithisa inzala

Ababhali bavakalisa ukuba abanalo inxaxheba.

Igalelo lababhali

I-AC ilungiselele uxwebhu oluqulunqiweyo kwaye yenza uvavanyo lwendlela yokufunda. I-MBR inengcamango yokuqala yocwaningo, icebo loyilo lonke kwaye luhlaziyiweyo umbhalo wesandla. Bobabini abalobi baye bafunda baze bavunywa umbhalo wesigqi wokugqibela.

Ababhali� Ulwazi

U-Aleksander Chaibi yi-BPT, uMChiro, umfundi we-PhD kunye noMichael Bj'rn Russell ngunjingalwazi, MD, PhD, DrMedSci.

Imibulelo

Isibhedlele sase-Akershus University, eNorway, ngokuqinisekileyo sinikezela ngezixhobo zophando.

Inkxaso: Olu phofu lufumene inkxaso-mali evela ku-Extrastiftelsen, iNorway Chiropractic Association eNorway naseYunivesithi yase-Oslo.

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Ukukhulelwa kwetambo lomlomo wesibeleko kuyinto eqhelekileyo eyenzekayo xa i-disc intervertebral entanyeni, okanye umlenze wesibeleko, iphuka kunye ne-gel-like center iphuma emgodini womgudu, yongeza uxinzelelo kwiingcambu zomlenze. Iidiski ze-cervical herniated zingabangela iimpawu zentlungu, ukuxinwa kunye nobuthathaka entanyeni, emagxeni, esifubeni, kwizandla nangezandla kwakunye nokubonakalisa imiqondiso kwimida ephantsi. I-Migraine nayo ingabonakalisa iimpawu ezinxulumene nee-diski ze-herniated entanyeni. Njengoko sikhulile, i-intervertebral discs ngokwemvelo iqala ukuhlakala, ibenze ibe yingozi yokulimala okanye ukulimala. Izizathu eziqhelekileyo zokukhutshwa kwetayitila yomlomo ziquka ukunxiba kunye nokukhawuleza, ukunyakaza okuphindaphindiweyo, ukuphakanyiswa okungafanelekanga, ukulimala, ukukhuluphala kunye nemfuza.

Ukulandelelana kwexesha elide leNkcazo yeCervical Intervertebral Herniation kwizigulane ezithatyathwa kunye neMicrothelo eDityanisiweyo kunye neNyango.

Abstract

imvelaphi

I-Symptomatic disvertebral disniation (IDH) ebonisa intlungu yentamo ehambisana neentlungu zengalo yintlungu eqhubekayo yokukhula kwayo, kwaye isisizathu esiqhelekileyo sokunakekelwa kwezilwanyana ezingasetyenziswayo usebenzisa i-CAM) eKorea. Nangona kunjalo, uphando kwixesha elide luchukumiseka.

tindlela

Izigulane ze-165 ezipheleleyo ze-IDH zentsholongwane zivunyelwe phakathi kweJanuwari 2011 kunye noSeptemba 2014 kwisibhedlele esinika unyango oluqhelekileyo kunye nolwaseKorea olubandakanya unyango kunye neCAM njengoko imodareyitha esemgangathweni yaboniswa kwisifundo sokuqwalasela. Izigulane zenziwa unyango lwe-CAM olulawulwa ngabagqirha bamayeza aseKorea (i-KMDs) ngokuhambelana nomgaqo-nkqubo olungiselelwe ukuhlala ixesha lokuhlala esibhedlele, kunye nolunye unyango oluqhelekileyo ngabagqirha bezonyango (MDS) njengoko kubhekiswe yi-KMD. Iziphumo zexeshana ezifutshane zihlolwe ukukhutshwa kunye nokulandelwa kwexesha elide zenziwa ngudliwano-ntanethi emva kokukhutshwa. Isilinganiselo semilinganiselo yamanani (NRS) yentamo kunye nentlungu yeengalo, ukutshatyalaliswa kwentamo yokukhubazeka (NDI), i-5-point point-patient impact of change (PGIC), kwaye izinto ezichaphazela ixabiso elide elide lokuneliseka kwi-PGIC zihlolwe.

iziphumo

Kwizigulane ezili-165 ezifumene unyango lwezigulana ezilaliswayo kwiintsuku ezingama-20.8? Umahluko kwi-NRS phakathi kokungeniswa kunye nokukhutshwa kwixesha elide lokulandela iqela (n? =? 11.2) ngu-117 (625.36% CI, 196.7, 117) ngenxa yentlungu yentamo, i-2.71 (95% CI, 2.33, 3.09) ngenxa yeentlungu zengalo. , kunye ne-NDI 2.33 (95% CI, 1.9, 2.77), kunye namanqaku ahambelanayo kwiqela elingeyona ixesha elide lokulandelelana (n? =?14.6) yi-95 (11.89% CI, 17.32, 48) ngenxa yentlungu yentamo , 2.83 (95% CI, 2.22, 3.45) ngenxa yeentlungu zengalo, kwaye i-NDI yayingu-2.48 (95% CI, 1.84, 3.12). Ukwahluka kwixesha elide le-NRS yeentlungu zentamo kunye neentlungu zengalo ukusuka kwisiseko yi-14.86 (95% CI, 10.41, 19.3), kunye ne-3.15 (95% CI, 2.67, 3.64), ngokulandelanayo. I-PGIC ixelwe ukuba �yanelisayo� okanye ingaphezulu kwi-2.64% yezigulane kulandelelo lwexesha elide.

izigqibo

Nangona ukujonga okwenziwa kwesi sifundo kusenza sikwazi ukugqiba isigqibo esiphezulu, ezi ziphumo zibonisa ukuba unyango oludibeneyo olujoliswe kwi-CAM kwi-IDH yesifo sengqondo sesifo somlomo luyakwazi ukufumana iziphumo ezilungileyo kwiintlungu kunye nokuphucula ukusebenza.

UkuBhaliswa koTyala

I-ClinicalTrials.gov Isazisi: I-NCT02257723. Ngo-Oktobha 2, 2014.

Internet: Ikhefu le-intervertebral disnibral, iyeza elongezelelweyo kunye nelinye, unyango oluhlanganyelweyo, unyango olulwelwe unyango

imvelaphi

Intlungu yentamo yinto ehambelanayo eqhelekileyo apho ukuxhaphaka kwayo kuqikelelwa kwi-10'18%, kunye nokuxhaphaka kwexesha lokuphila kufikelela kwi-30'50%. Ukuxhaphaka kweentlungu zentamo kubantu abaneminyaka eyi-40 okanye ngaphezulu malunga ne-20% [1, 2]. Intlungu yentamo ihambelana nokunyanzeliswa kwentamo [3], kwaye ihlala ihamba kunye nentloko, isiyezi, ukukhubazeka okubonakalayo, i-tinnitus, kunye ne-autonomic nervous system dysfunction [4, 5]. Iimpawu ezihamba rhoqo ziquka intlungu ephezulu kunye nokuphazamiseka kwe-neurological [6], kunye neempawu zentlungu zentamo nazo ziqhubeka kwiimeko ezininzi ezikhokelela ekulahlekelweni komsebenzi ngenxa yokungahambi kakuhle [7]. Ukukhubazeka okunxulumene nentamo ngokuqhelekileyo kubi kakhulu kwizigulane ezineentlungu ezikhuphayo kuneentlungu ezinqamlekileyo kwindawo yentamo [8, 9], kwaye uphawu oluphambili lwe-cervical intervertebral disc herniation (IDH) yintlungu yengalo kwingingqi engabonakaliyo kwinqanaba le-disc ye-herniated. kunye / okanye ingcambu ye-nerve ecinezelweyo [10, 11].

Uluhlu lonyango olukhoyo lwe-IDH yomlomo wesibeleko lukhulu, luthatha unyango olugcinayo kwiindlela ezahlukeneyo zotyando. Unyango olulondolozayo lubandakanya ii-NSAID, ii-oral steroids, iinaliti ze-steroid, imfundo yesigulana, ukuphumla, iikhola zikaThomas, kunye nonyango lomzimba [12�14]. Unyango lotyando lunokuqwalaselwa xa unyango olulondolozayo lungaphumeleli. I-neuropathy evela kuxinzelelo lwentambo yomgogodla luphawu olupheleleyo lotyando. Ezinye izibonakaliso ziquka iimpawu zokunyanzeliswa kweengcambu ze-nerve kunye ne-motor ehambelanayo kunye nokulahleka kweemvakalelo. Izibonakaliso ezihambelanayo zingabandakanya ukuhla komgangatho wobomi ngenxa yeentlungu ezingapheliyo [15]. Ngelixa unyango lotyando lunokunceda ezinye izigulana ezineempawu ezinzima ze-neurological, uninzi lwezifundo ngeentlungu ze-neuropathic zomnqonqo zichaza ukuba iziphumo zexesha elide azibalulekanga [16�20]. Nangona uphando malunga nomphumo wonyango olulondolozayo kwizigulane ze-IDH zomlomo wesibeleko ziye zaxelwa ngamanye amaxesha, nokuba ngaba zisebenzayo kusekho ingxabano, kwaye kukho ukungabikho kwezifundo kwisiphumo sonyango olongezelelweyo kunye nolunye unyango (CAM).

Ngokuxhamla kwiNzuzo yeZifo zeSifo seNtsholongwane ye-2013 yaseKorea ye-21, izigulane ze-5585 zanikwa unyango lweentsholongwane zentsholongwane zentsholongwane kwiintsuku ze-99,582 ekunyamekelweni kwabangaphandle, apho iintsuku ze-100,205 zifunyenwe yiNtsholongwane yeNtsholongwane yezezeMpilo, kunye neyonyango. iindleko zonyango ezifanele ukubuyisela imali kwi-5,370,217 yase-Korean Won, kunye ne-4,004,731 yase-Korean Won ehlawulwa. Iingxaki ze-disversion yecervical yi-12th yezizathu eziqhelekileyo zokungeniswa kwizibhedlele zamachiza aseKorea, kubonisa ukuba akuqhelekanga ukunyamekela unyango lwe-IDH yomlomo wesibeleko.

Ezi zonyango ze-CAM njenge-acupuncture, i-pharmacopuncture, imithi yamachiza, kunye nokunyango olusesikweni kufunwa kakuhle eKorea ngenjongo yokufumanisa indlela engaphantsi yokuphazamiseka, engeyiyo yokuhlinzwa. Isibhedlele saseJaseng seMoriya yaseKorea, isibhedlela saseKorea esibhedlele esivunywe yiNgqobhoko yezeMpilo yeNtlalo kunye neNtlalontle ukuze ikhethe ngokusemandleni empeni, iyakhathalela izifo zengxangxube ye-900,000 yezigulana zonyaka. Esi si bhedlele silawula izigulane ezineenkqubo zokudibanisa zisebenzisa iyeza eziqhelekileyo kunye neKorea, apho oogqirha abaqhelekileyo kunye noogqirha bamayeza aseKorea (KMDs) basebenzisana neziphumo zonyango olufanelekileyo. Oogqirha abaqhelekileyo bathathe inxaxheba ekuxilongeni ngokusebenzisa ubugcisa bezinto zobugcisa ezifana ne-X-ray kunye nee-MRIs, kwaye kunyango ngokunyamekela ipesenti yezigulane ezinokudinga ukunakekelwa okukhulu. I-KMD ilawula kwaye ilawula unyango oluphambili lwazo zonke izigulane, kwaye sinqume ukuba isigulane sidinga ukuxilongwa okongezelelweyo kunye nonyango ukusuka kwidrama eqhelekileyo. Izigulane ze-IDH zesifo seentloko zentlungu intlungu okanye umonakalo ongenakunceda ukufumana unyango olungalawulekiyo ngoko ke kunikwa unyango olunganyangekiyo lokudibanisa ngexesha lo kwamkelwa.

Nangona kusetyenziswe ukusasazeka kwonyango lwe-IDH yomlomo wesibeleko kuquka iinkqubo ezininzi zokonyango, iziphumo zonyango lwazo kwizigulane ezivunyelwe kwi-IDH yomlomo wesibeleko. Indlela yokuxhatshazwa kwezilwanyana ezingagxininiswa ngokujoliswe kwiCAM ayinakufumaneka ngokubanzi kwizigulane, kunye nenjongo yale sifundo kukuzazisa kwaye kuhlolisise ubuchule nokusebenza kwexesha elide lo mzekelo wonyango wokudibanisa kwizigulane kunye ne-IDH yesibeleko usebenzisa isicwangciso sokufunda ngokucwangcisekileyo.

tindlela

IsiCwangciso soFundo

Olu pho nonongo luyilo lokufunda. Siye sabona izigulane ezinezikhalazo eziphambili zentlungu yomsindo okanye intlungu yesalathisi ebonwa njenge-IDH yesibeleko kwaye yavunyelwa ukususela ngoJanuwari 2011 ukuya kuSeptemba 2014 kwisibhedlele saseJaseng seCroatia e-Korea esinika iinkonzo ezinxibeleleneyo eziqhelekileyo kunye neKorea kunye neCAM njengendlela yokuziphatha. Ababhali baqhuba ukulandelelana kwexesha elide ngoonxibelelwano lwefoni ngexesha le-Matshi 2015. Iziphumo zeengxelo ze-5: i-scale scale rating (NRS), inkcazo yokukhubazeka kwentamo (i-UN), isigulane sokuguquka komhlaba (PGIC), ukuhlinzwa rhoqo emva kokukhutshwa, kunye nonyango lwangoku.

Olu pho nonongo luyingxelo malunga nenxalenye yokubhalisa i-registry data kwi-intanethi edibeneyo yezigulane ze-musculoskeletal disorder (i-ClinicalTrials.gov Isazisi: i-NCT02257723). Umgaqo-nkqubo wokufunda uvunyiwe yiBhodi yokuHlola yeziNtu zeSibhedlele saseJaseng yeyeza laseKorea. Bonke abathathi-nxaxheba banikezela imvume ebhaliweyo enolwazi phambi kokuthatha inxaxheba.

nxaxheba

Izigulane zidibana neendlela ezilandelayo zifakiwe.

Ukwamkelwa ekwenzeni unyango lwentamo okanye ukutyumla intlungu
I-IDH yesibeletho iqinisekisile kwi-MRI
Ukuxilongwa yi-KMD eyona nto ibangela isikhalazo esiphambili (intlungu yentamo okanye ukutyumza intlungu) yi-IDH yomlomo wesibeleko

Izigulane ezidibeneyo zilandelayo zichazwe ngaphandle.

Isikhalazo esingundoqo ngaphandle kweentlungu zentlungu okanye intlungu
Isikhalazo esihambelana ne-musculoskeletal (umz.
Iintlungu zentlungu engenakulinganiswa ne-IDH yomlomo wesibeleko (umzekelo, isisu somzimba, ukukhulelwa, isifo se-rheumatoid arthritis)
Ukwenqaba ukuthatha inxaxheba kwisifundo okanye ukungavunyelwanga ukuqokelela kunye nokudalulwa kolwazi lomntu siqu ngenjongo yokufunda

I-KMD ihlolisise imbangela yentlungu yesentsi okanye impawu zentlungu ngokubhekiselele kwimiphumo yokuvavanya ngegazi (ukulahlekelwa kwintliziyo, ubuthathaka bemoto, kunye ne-tendon reflex) kunye nokufundwa kwe-MRI ngabachwepheshe be-radiology. Izigulane ezidibene neendlela ezicetywayo zokubandakanywa ziye zahanjelwa kwi-ward yesigulana ngosuku lokuqala lokungeniswa kovavanyo nge-KMD, kwaye lulandelwa ngokusebenzisa intsebenziswano efanayo kunye nenkqubo yophando xa ikhutshwa. Ukuba isigulane samkelwa ngamaxesha amaninzi ngexesha lokufunda, kuphela irekhodi lokuqala lokungeniswa liye lafundwa kwaye lifakiwe.

Ngoncedo

Nangona unyango lweprotocol wawuqulethwe unyango oluninzi lwezigulane ze-IDH zesigqirha, naziphi na zonke iindlela zokonyango ezingabandakanywa kwiprojekti yonyango zavunyelwa kwaye ziyafumaneka kuwo onke amagqirha kunye nezigulane kunye nokusetyenziswa kwezi zonyango (uhlobo kunye nobunzima) kubhalwe kwikhompyutha iirekhodi ezinzulu. Unonyango oluqhelekileyo olunjengamayeza enhlungu kunye neengxube ze-epidural (usebenzisa i-anesthetics yendawo efana ne-lidocaine, i-steroids, kunye ne-adhesion adhesion adjuvants) yayilawulwa yi-specialist rehabilitation specialist ngokusebenzisa ukuhanjiswa kwe-KMD. Ukunyanga okungekho unyango kuphela kuvunyelwe ngexesha lokumkelwa.

Iprogram yoNyango yoPhilo lweMithi

Amayeza emfuyo athathwe ngamaxesha e-3 / ngosuku kwipilisi (2 g) kunye nefomction ye-decoction (i-120 ml) (i-Ostericum koreanum, i-Eucommia ulmoides, i-Acanthopanax sessiliflorus, i-Achyranthes bidentata, i-Psoralea corylifolia, iSaposhnikovia divaricata, i-Cibotium barometz, i-Lycium chinense, i-Boschniakia rossica, Cuscuta chinensis, Glycine max, kunye ne-Atractylodes japonica). Ezi zityalo zikhethwe ngokuchanekileyo kwimifuno echazwe rhoqo kwi-IDH yonyango kwiMveli yeMichiza yaseChina naseKorea yeMicrosoft [22] kwaye umyalelo wenziwa ngokuphuhliswa ngokusetyenziswa kwekliniki [23]. Izithako eziphambili zonyango lwezityalo ezisetyenziswe kulolu cwaningo (Acanthopanax sessiliflorus Seem, Achyranthes japonica Nakai, Saposhnikovia divaricata Schischk, i-Cibotium barometz J. Smith, uGlycine max Merrill kunye no-Eucommia ulmoides u-Oliver) baye bafundiswa kwi-vivo nakwi-vitro njengeGCSB- I-5 ye-anti-inflammatory [24], kunye neentsimbi [25] kunye neziphumo ezikhuselekileyo zokukhusela [26], kunye neekliniki ngenxa yokungabi phantsi kwezokhuseleko kunye nokuphumelela xa kuthelekiswa neCelecoxib kunyango lwe-osteoarthritis [27].

I-acupuncture iqhutywe iiseshini ze-1�2 / ngosuku kwiindawo zomlomo wesibeleko ze-Ah-shi kunye namanqaku e-acupuncture aphathelene neentlungu zentamo. I-Ah-shi point acupuncture ibhekisa kwinaliti ye-acupuncture yeendawo ezibuhlungu okanye ze-pathological. Amanqaku e-Ah-shi awahambelani ncam namanqaku ethenda okanye i-Buding, amanqaku e-Tianying, kodwa ngokubanzi ahambelana namanqaku abangela ukuphumla okanye intlungu phezu kwe-palpation [28].

Isisombululo se-pharmacopuncture sasilungiselelwa ngezithako ezinjengeemithi zonyango ezilawulwa ngomlomo (Ostericum koreanum, Eucommia ulmoides, Acanthopanax sessiliflorus, Achyranthes bidentata, Psoralea corylifolia, Saposhnikovia divaricata, Cibotium barometz, Lycium chinense, Boschniakia rossica, Cuscuta chinensis, Glycine max, kunye ne-Atractylodes i-japonica) ngokususa i-decocting kunye nokukhenkcela, ukudibanisa i-powder elungiselelwe kunye ne-saline evamile kunye nokulungelelanisa i-asidi kunye ne-pH. I-Pharmacopuncture ilawulwa i-1 iseshoni / imini kwi-Hyeopcheok yomlomo wesibeleko (i-Huatuo Jiaji, i-EX B2) kunye ne-Ah-shi ifikelela kwi-1 cc isebenzisa izilingo zokuxhatshazwa (CPL, 1 cc, 26G x 1.5, i-Shinchang co.

I-Bee-venom pharmacopuncture isetyenziswe ukuba uvavanyo lwe-skin reaction kwi-bee-venom lwalungalunganga. Isisombululo esixutyiweyo se-bee-venom (exutywe ne-saline eqhelekileyo kumlinganiselo we-1000:1) satofwa kwi-4�5 yomlomo wesibeleko iHyeopcheok (Huatuo Jiaji, EX B2) kunye namanqaku e-Ah-shi ngokokubona kukagqirha. Inqaku ngalinye latofwa malunga ne-0.2 cc ukuya kuthi ga kwi-0.5�1 cc iyonke kusetyenziswa iinaliti zenaliti ezilahlwayo (CPL, 1 cc, 26G x 1.5 isirinji, Shinchang medical co. Korea)

I-Chuna spinal manipulation [29, 30], eyindlela yokukhohlisa yaseKorea edibanisa ubuchule obuqhelekileyo bokukhohlisa kunye nesantya esiphezulu, i-amplitude ephantsi etyhala kumalungu kancinane ngaphaya koluhlu lwentshukumo, kunye namandla okwenziwa ngesandla ngaphakathi koluhlu lwe-passive, lwenziwa 3� Iiseshoni ezi-5 / ngeveki.

Izisiphumo

Zonke iziphumo zavavanywa yi-KMD ezafunyanwa phambi koqeqesho kunye nemfundo. Iimpawu zokuziphatha zabantu nezempilo (ubulili, ubudala, umsebenzi, ukutshaya, ukusetyenziswa kotywala, kunye nesifo esingaphantsi kwesifo) zaqokelelwa ngosuku lokuqala lokungeniswa ngokusebenzisa uphando olutshanje kwiimvavanyo zamanqanaba kunye nokuhlolwa kweengqondo. Ukulandelwa kwaqhutyelwa kwiiveki ze-2 emva kokungena okanye emva kokukhutshwa kwaye emva kokukhutshwa.

I-NRS [31] isebenzisa isikali se-11-point ukuvavanya iintlungu zangoku zentamo kunye neentlungu ezikhuphayo apho kungekho ntlungu ibonakaliswe ngu-�0�, kunye neyona ntlungu ibuhlungu inokucingelwa ngu-�10�. I-NRS yavavanywa ekumkelwe, ukukhutshwa, kunye nokulandelwa kwexesha elide. Ngenxa yokungabikho kweereferensi kumahluko obalulekileyo obalulekileyo ekliniki (MCID) yeentlungu zentamo okanye iintlungu ezikhuphayo ze-NRS, i-MCID ye-analogue scale scale (VAS) yasetyenziselwa ukuvavanya ngakumbi kwe-NRS.

I-[[32] yi-10-into yophando ehlola iqondo lokukhubazeka kwi-0 ukuya kwi-5 ekufezeni imisebenzi yansuku zonke. Ixabiso lihlulwe yi-50, kwaye liphindwa li-100. I-NA yahlolwa kwi-admission and discharge.

I-PGIC [i-33] isetyenzisiwe ukuvavanya umlinganiselo wokwaneliseka wezigulane kwimeko yangoku emva kokungeniswa. Ukwaneliseka kwalinganiswa nekhawu le-5-point from eyanelisayo, eyanelisayo, eyanelisayo, enganelisekanga, kwaye enganelisekiyo ekukhutsheni nasekulandeleni ixesha elide.

Abathathi-nxaxheba bafumana uviwo lomzimba kunye ne-neurological ekwamkelwe kunye nokukhutshwa kwinjongo yemoto kunye novavanyo loluvo lwengingqi yomlomo wesibeleko. Uluhlu lokunyakaza (i-ROM) yokuguqulwa kwentamo kunye nokwandiswa, ukuphazamiseka, ukunyanzeliswa, i-Valsalva, i-Spurling, i-Adson's, kunye neemvavanyo zokugwinya, kunye neemvavanyo eziphezulu zemoto kunye neemvavanyo zoluvo kunye neemvavanyo ezinzulu ze-tendon reflex zenziwa.

Uvavanyo lwezoKhuseleko

Zonke iziganeko ezinobungozi ezinokuthi zibhekiselele kunyango, ukusuka kwesikhumba kunye neempendulo zendawo ukuya kwiinkqubo zenkqubo, kunye nokubandakanya utshintsho okanye ukuxhatshazwa kwiipatheni zentlungu zijongwe ngokucophelela, zirekhodwe kwaye zichazwe ngexesha lokungeniswa. Iziganeko ezimbi ezinxulumene nonyango lwe-bee-venom ziyaziwa ukusuka kwiimpendulo zesikhumba ukuya kwiimpendulo ezinzima ze-immunological, kwaye ngoko ke ukusabela okungalunganga kuquka ukusabela kwe-systemic immunological kufuna unyango olongezelelweyo (umz. i-antihistamineic agents) zibekwe esweni ngokusondeleyo. . Ukubalwa kweeseli zegazi, iimvavanyo zesibindi kunye ne-renal, kunye nokuhlolwa komsebenzi wokuvuvukala kuqhutywe kuzo zonke izigulane ekungenisweni, kwaye ukuba kukho ukufunyaniswa okungaqhelekanga okudinga ukulandelwa njengoko kuhlolwe yi-KMD kunye noogqirha abaqhelekileyo, amakishi afanelekileyo aphinde ahlolwe. Izigulane ze-46 zizonke zagwetywa ukuba zifuna ukulandelwa ekungenisweni yi-KMD kunye noogqirha abaqhelekileyo kwaye balandelwa ngokufanelekileyo ngexesha lokuhlala esibhedlele, apho izigulane ze-9 zibonise iziphumo ezingaqhelekanga ekusebenzeni kwesibindi ekungenisweni. Umsebenzi wesibindi walandelwa kwezi zigulana zisithoba. Ubukho bokulimala kwesibindi bukwalinganiswe ukuba kuhlolwe ukuba kunokwenzeka ukwenzakala kwesibindi okubangelwa ngamachiza ukusuka kwi-herbal okanye amayeza aqhelekileyo athathwe ngokusebenzisa inkcazo (a) ye-ALT okanye i-DB yokwanda kwe-2� okanye ngaphezulu komda ophezulu wesiqhelo (ULN) okanye (b) kudityanisiwe ukunyuka kwe-AST, ALP, kunye ne-TB, ngaphandle kokuba enye yazo ingaphezulu kwe-2?�?ULN.

Izindlela zokuSitatisti

Lonke uhlalutyo lwenziwa kusetyenziswa ubalo lwephakheji ye-SAS version 9.3 (IZiko le-SAS, iCary, NC, USA), kunye p?

iziphumo

Ngexesha lokufunda izigulana ezingama-784 ezinengxaki yentamo zamkelwa, kwaye kwezi, izigulana ezingama-234 zafunyaniswa zine-IDH yomlomo wesibeleko ngaphandle kwezikhalazo eziphambili ze-musculoskeletal. Kwizigulana ezingama-234 zomlomo wesibeleko ze-IDH, izigulana ezili-175 zazingenalo ixabiso elilahlekileyo kwi-NRS kunye ne-NDI ekwamkelweni nakwiiveki ezi-2 emva kokwamkelwa okanye ukukhutshwa (ukulandelwa kwexesha elifutshane). Izigulana ezilishumi zaphinda zamkelwa kwakhona kwaye emva kokufakwa kwedatha yokwamkelwa yokuqala ukuba ulwamkelo lokuqala lwalulithuba lokufunda, kwasala izigulana ezili-165. Uvavanyo lokulandelwa kwexesha elide lwenziwa kwizigulana ze-117. Kwiqela elingelide elide elilandelelweyo (n? =? 48), izigulana ezingama-23 khange ziyiphendule ifowuni, i-10 yenqabile ukuthatha inxaxheba kulandelo lwexesha elide, kwaye i-15 sele itshintshile inani okanye iifowuni ezingenayo zithintelwe ( Umzobo 1). Iimpawu ezisisiseko liqela lokulandelwa kwexesha elide kunye neqela elingelolide ixesha elide zidweliswe kwiTheyibhile 1. Nangona bekungekho enye umahluko ophawulweyo phakathi kwamaqela e-2, abaguli abangama-29 kwiqela lokulandela ixesha elide bacetyisiwe ukuba benze utyando (24.8%), ngelixa sisigulana se-1 kuphela kwiqela elilandelwayo (0.02%) elacetyiswayo.

Umzobo 1: Umzobo weMfuyo yeSifundo

Itheyibhile ye1 Isiseko seenkcukacha zobuntu

Ithebula 1: Iimpawu zokubala zabantu.

Ubude bomndilili wokuhlala esibhedlele yayiyi-20.8?�?11.2 iintsuku. Uninzi lwabathathi-nxaxheba bafumana unyango lwe-inpatient lugxile kumayeza aseKorea kunye neCAM. Iyeza lezityalo lithathwe ngokuhambelana nenkqubo yonyango kwi-decoction form yi-81.8 % yezigulane kunye nefom yepilisi kwi-86.1 %, kwaye ezinye izigulane zamiselwa amanye amayeza esintu ngokokubona kwe-KMD. Ukusetyenziswa konyango oluqhelekileyo olungachazwanga kwi-protocol yonyango ye-CAM, izigulane ze-18.2% zathatha amayeza e-analgesic okanye i-injection ye-intramuscular avareji amaxesha angama-2.7? �? ). Asizange sisebenzise izithintelo kunyango lwe-pharmacological ngeenjongo zokufunda, kwaye sivumele oogqirha bezonyango eziqhelekileyo inkululeko epheleleyo yokuvavanya nokumisela amayeza aqhelekileyo njengoko ugqirha ebona kuyimfuneko kwisigulane. I-NSAID, i-antidepressants, kunye ne-relaxants ye-muscle yayiyeyona mayeza asetyenziswayo, kwaye i-opioids ilawulwa kwixesha elifutshane kwizigulane ze-2.3 kuphela.

Itheyibhile 2 Ubude beBhedlele Ukuhlala kunye neNongenelelo eLawulayo ngexesha lokuhlala

Ithebula 2: Ubude bexesha lokuhlala esibhedlele kunye nokungenelelo okulawulwa ngexesha lokuhlala.

I-NRS yeentlungu zentamo, i-NRS yokuqaqanjelwa yintlungu, kunye ne-NDI zonke ziye zancipha kakhulu ekukhutsheni nasekulandeleni ixesha elide xa kuthelekiswa nesiseko (ukwamkelwa) (3 Table). Indawo ephambili yeentlungu zentamo kunye nokuqaqanjelwa kwengalo yengalo kubonise ukwehla okukhulu kune-MCID (ukwehla kwe-NRS kwe-2.5 okanye okukhulu kwintlungu yentamo okanye kwintlungu eqaqambayo), kwaye amanqaku e-NDI aphuculwe ngaphezulu kwenqaku le-MCID le-7.5 [34, 35]. Umahluko kwi-NRS ekuphumeni kwiqela lokulandela ixesha elide (n? =? 117) yayingu-2.71 (95% CI, 2.33, 3.09) yentlungu yentamo, i-2.33 (95% CI, 1.9, 2.77) yeentlungu zengalo, kunye ye-NDI, 14.6 (95% CI, 11.89, 17.32). Umahluko kwi-NRS ekulandeleleni ixesha elide kwintlungu yentamo kunye nentlungu yengalo ukusuka kwisiseko yayiyi-3.15 (95% CI, 2.67, 3.64) kunye ne-2.64 (95% CI, 1.99, 3.29), ngokwahlukeneyo. Umahluko kwi-NRS ekukhutshweni kwiqela elilandelelanayo lokulandela ixesha elide (n? =? 48) yayingu-2.83 (95% CI, 2.22, 3.45) wentlungu yentamo, i-2.48 yeentlungu zengalo (95% CI, 1.84, 3.12) , kwaye ye-NDI yayiyi-14.86 (95% CI, 10.41, 19.3). Umahluko phakathi kweqela phakathi kokungeniswa kunye nokukhutshelwa kwezigulana ezilandelelanayo zexesha elide bekungabalulekanga (i-NRS yentlungu yentamo: ixabiso le-p? =? 0.741; I-NRS yokuqaqanjiswa kwengalo: p-ixabiso? =? 0.646; Isalathiso sokukhubazeka kweNeck: p-value? =? 0.775).

Itheyibhile 3 Ukuthelekiswa kweNqaku lokuBaliswa kweNombolo, ukuSaxisa ubuhlungu besikhumba kunye neNeck Disability Index Score

Ithebula 3: Ukuthelekiswa kwamanani okulinganisa amanani entanyeni kunye neentlungu zengalo kunye nentonga yokukhubazeka kwentamo kwiqela elilandelelanayo elide kunye neqela elilandelelanga elide lokulandela.

Umyinge wexesha elisuka ekwamkelweni ukuya kulandelelwano lwexesha elide laliyi-625.36?�?196.7 iintsuku. Zonke izigulane eziyi-165 zaphendula i-PGIC xa zikhutshwa, kwaye kwezi zigulane i-84.2 % yaphendula ukuba imeko yabo "yanelisayo" okanye ngaphezulu. Izigulana ezili-117 zizonke ziphendule kwi-PGIC kulandelelo lwexesha elide, kwaye i-79.5% ilinganisele imeko yabo yangoku 'njengeyanelisayo' okanye ngaphezulu. I-PGIC ixelwe ukuba iyanelisa kakhulu kwizigulane ze-48 (41.0%), eyanelisayo kwi-45 (38.5%), iyanelisa kancinci kwi-18 (15.4%), kwaye ayinelisekanga kwi-6 (5.1%). Izigulane ezisithoba ziye zenziwa utyando (7.6 %), ngelixa izigulane ezingama-21 zaphendula ukuba kungokunje zifumana unyango. Kwizigulane eziphantsi konyango ngoku, izigulane ze-10 (8.5%) zaqhubeka zifumana i-CAM, izigulane ze-12 (10.3%) zikhethe unyango oluqhelekileyo, kwaye isigulane se-1 sasifumana zombini (iThebhile 4).

Itheyibhile ye-4 Ikhefu ukususela kuMhla wokungeniswa ukuya kwixesha elide elilandelayo kunye noMonde wokuTshintsho kweTshintsho

Ithebula 4: Ixesha lokungena kumhla wokungena kwixesha elide lokulandelelana, kunye nesigulane somhlaba jikelele wesiguqu, utshintsho lwangaphambili kunye nonyango lwangoku kwiqela elilandela ixesha elide.

Ukwabelana ngesondo, ubudala, kunye neentlungu ezingathandekiyo zangasese ziyaneliseka p?

Uluhlu lwe-5 Uvavanyo lwezinto eziPhambili zokuQala

Ithebula 5: Uvavanyo lwezinto eziphambili zokuqala ezihambelana nomlinganiselo wokwaneliseka.

Umsebenzi wesibindi wawulinganiswa kuzo zonke izigulane ezamkelwayo, kwaye izigulane ezithoba zine-enzyme yesibindi ezingavumelekanga xa zamkelwa zifunyenwe ukuhlolwa kwegazi ngokulandelwa. Amanqanaba e-enzyme yesibindi abuyele kwiimeko eziqhelekileyo kwizigulane ze-6, xa i-2 igcina i-enzyme yesibindi, kwaye i-1 isigulane yayinobungozi besibindi kunye nokuhlolwa okuqhubekayo kwafumanisa ukuba i-hepatitis esebenzayo ibonisa i-Hbs antigen kwaye i-Hbs antibody negative. Kwakungabikho imeko ye-systemic immunological reaction kwi-bee pharmacopuncture ye-venom efuna unyango olongezelelweyo kwaye akukho ziganeko ezimbi ezichaziweyo.

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Ezi ziphumo zibonisa ukuba unyango lwe-inpatient ngokuyinhloko lugxininise kwi-CAM lugcina iziphumo zexesha elide lokunciphisa intlungu kunye nokuphuculwa komsebenzi kwizigulane ze-IDH zomlomo wesibeleko ezineentlungu zentamo okanye iintlungu zengalo ezikhuphayo. Amanqaku e-NRS kunye ne-NDI ekukhutshweni nasekulandeleni ixesha elide zonke zibonise ukwehla okukhulu. Kwakhona, njengoko ukubaluleka kwamanani kunye nokubaluleka kweklinikhi kunokwahluka, sihlolisise i-MCID kwaye saqinisekisa ukuba amanqaku e-NRS kunye ne-NDI aphuculwe ngaphezu kwe-MCID. I-MCID ixelwe kwi-2.5 kwi-VAS ngenxa yentlungu yentamo kunye nentlungu yengalo evuthayo, kunye ne-7.5 kumanqaku e-NDI [34, 35]. Umyinge wophuculo kwiintlungu kunye nezikali zokusebenza zonke zigqithise i-MCID, kwaye ezi ziphumo zinokuthi zibonakaliswe kwizinga lokwaneliseka kwesigulane. Kwizigulane ezili-165, izigulane eziyi-128 (84.2%) zithelekelele imeko yazo yangoku 'njengeyanelisayo' okanye ngaphezulu xa zikhutshwa. Ngexesha elide lokulandelelana, i-9 (7.6%) kwizigulane ze-117 zaqinisekiswa ukuba zifumene utyando lwentamo, kwaye izigulane ezininzi zibonise ukuncipha okuqhubekayo kwi-NRS kunye ne-NDI. Ukongezelela, izigulane ze-96 (82.1%) okwangoku azizange zifumane unyango lweempawu zentlungu yentamo, kwaye izigulane ze-93 (79.5%) ziphendule ukuba imeko yabo "yanelisayo" okanye ngaphezulu. Njengoko uthelekiso lwentlukwano phakathi kweqela kwixesha elide lokulandelelana kunye nezigulane ezingapheliyo azizange zenzelwe i-priori, le datha inokuthathwa njengohlalutyo lwedatha ye-post hoc. Umahluko phakathi kweqela phakathi kwempembelelo phakathi kokungeniswa kunye nokukhutshwa kwixesha elide lokulandelelana kunye nezigulane ezingapheliyo zazingabalulekanga, kwaye kwi-MCID, enokuthi ithathelwe ingqalelo njengomlinganiselo weklinikhi, amaqela e-2 avelisa iziphumo ezifanayo. .

Nangona zonke izigulane zifumana unyango olunzulu lwezonyango zaseKorea ngexesha lokuhlala esibhedlele, akukho ziganeko ezimbi ezinxulumene nophatho lwangonyango, ezibonisa ukhuseleko lweyeza lokudibanisa ngokugxila kwi-CAM. Ababhali bebenze baqhuba isifundo esiphezulu sokuvavanya ukhuseleko lwezonyango kunye nokutya okudibeneyo kunye neyeza zokutya kunye neziqhelekileyo kwiziphumo zokuhlolwa kwemisebenzi yesibindi se-6894 kwizibhedlele ezibhedlele kwizibhedlele zamachiza aseKorea, kunye neziphumo zokuvavanya ikhefu lomhlaza wesibeleko Izigulana ezibandakanyiweyo kwisifundo samanje zichazwe [36].

Amandla amakhulu olu pho nonongo kukuba lubonisa ukusebenza kweklinikhi kunye neziphumo zibonakalisa unyango njengoko ngokwenene lwenziwa eKorea kwimimiselo yonyango yokudibanisa amayeza aqhelekileyo kunye namaKorea agxile kwi-CAM. Unyango lweprotokholi lwalulungelelaniswa kwaye luqulethwe ngamangenelelo okusebenza kwawo kuye kwaqinisekiswa kwizifundo zolingo kwaye zisetyenziswa rhoqo kwimisebenzi yeklinikhi, kodwa iprotocol nayo yavumela ukulungelelaniswa komntu ngamnye ngokweempawu zesigulane kunye neempawu njengoko zibonwa ziyimfuneko yi-KMDs, kunye nepesenti kunye nokuphindaphinda kwezi. ukutenxa kwarekhodwa. Izinga lokwaneliseka elivavanyiweyo ekukhutshelweni alibonisi nje isimo sengqondo sesigulane malunga nesiphumo sonyango, kodwa kunye neendleko zonyango ezibandakanyiweyo ngokubandakanywa kwonyango olwahlukeneyo. Uthathela ingqalelo into yokuba abathathi-nxaxheba kolu phononongo yayingezozigulane eziye zagaywa ngeentengiso, kodwa izigulane ezityelela isibhedlele samayeza e-Korea ngokuzikhethela ukuba azifumani mbuyekezo yezoqoqosho ngokuthatha inxaxheba kuphononongo, into yokuba uninzi lwezigulana-izinga lokwaneliseka laliphezulu iphawuleka ngakumbi. Iziphumo zolu phononongo zinegalelo kwisiseko sobungqina bokusebenza okuphezulu konyango oludibeneyo kunyango lomntu ngamnye kwizigulane ezifunyanwe nge-IDH yomlomo wesibeleko, kunye nokuqinisekisa ukuba kunokwenzeka ukuphunyezwa kweklinikhi ngokuqwalaselwa kweendleko zonyango ezidibeneyo.

Owona mda mkhulu kwisifundo sethu ngowona mgangatho wendalo wesifundo ekujongwa kuso eswele ulawulo. Asikwazi ukufikelela kwizigqibo zokuba ngaba unyango oluhlanganisiweyo lweCAM lungaphezulu kolawulo olusebenzayo (umzekelo, utyando, ungenelelo oluqhelekileyo olunganyangiyo) okanye ikhondo lesifo. Omnye umda kukungafani kwamaqela ezigulana kunye nonyango. Abathathi-nxaxheba babezigulana ze-IDH yomlomo wesibeleko ezineempawu ezahlukileyo, ubukhali kunye nokungagungqi ekuthi inkqubela phambili yabo yaziwe ngokubanzi ukuba yahlukile, kunye nongenelelo lubandakanya unyango oluqhelekileyo olunje ngenaliti ye-epidural okanye amayeza entlungu kwezinye iimeko. Ke ngoko kuya kuchaneka ngakumbi ekuchazeni ukuba ezi ziphumo zibe ziziphumo zonyango oluqhelekileyo kunye nenkqubo yonyango yokudibanisa amayeza eKorea kunaleyo yonyango oluhlanganisiweyo lweCAM. Umgangatho wokuthotyelwa kwe-74% (n? =? 175) kwiiveki ezi-2 emva kokwamkelwa okanye ukukhutshwa kwezigulana ezingama-234 ezamkelweyo ziphantsi, ngakumbi xa kuthathwa ixesha elifutshane lokulandela. Oku kuthotyelwa okuphantsi kunokunxulumana nesimo sengqondo sesigulana ngokubhekisele ekuthatheni inxaxheba kuthatho-nxaxheba Njengokuba abathathi-nxaxheba bengakhange bafumane mbuyekezo ngokuthe ngqo yokuthatha inxaxheba kwetyala, kusenokwenzeka ukuba baswele inkuthazo yokuqhubeka nokuthatha inxaxheba, kwaye kungenzeka ukuba izigulana ezingalwamkelanga uvavanyo lokulandelela bezingonelisekanga ngonyango lokwamkelwa kufuneka ziqwalaselwe. Uvavanyo lwexesha elide lwenziwa ngodliwanondlebe ngefowuni kwizigulana ezili-117 (70%) kuma-165 abasisiseko abathathi-nxaxheba ngokuyinxenye ngenxa yokuphelelwa lixesha, elinciphisa inani kunye nomgangatho wolwazi lwexesha elide olunokuqokelelwa kwaye lukhokelele ekulahlekelweni sisigulana ekuphulukaneni qhagamshelana.

Enye imingcele kukuba asiphumelelanga ukuqhuba uvavanyo olunzulu lwezonyango. Ngokomzekelo, nangona abathathi-nxaxheba befumanisa ukuba i-disc ye-disniation ibe yintsholongwane ephambili esekelwe kwiimvavanyo ze-MRI kunye neempawu ze-neurological by KMDs, ulwazi olongezelelweyo lweengcamango ezifana ne-disc pathological level kunye nobunzima be-herniation abuqokelelwanga. Kwakhona, iinkcukacha malunga nokuphindaphinda kwakhona, ubude bazo zonke iziqendu kunye nokuba ngaba ezinye ziphiliswe ngokupheleleyo zingabandakanyi ukuvavanywa kwexesha elide, ukunciphisa ukuhlolwa kwamanani amaninzi. Ukongezelela, ngelixa izi zigulane ze-IDH zentsholongwane zifuna ukufakwa ngenxa yentlungu eninzi nentsimbi yesigxina nokukhubazeka okusebenzayo, okokuba oku kwaba kukuhlaselwa kokuqala kwentlungu yentamo kubaninzi bekubangelwa yiphumo elihle.

Nangona kunjalo, impembelelo yokuthobela ukulandelelana kwexesha elide akuvumelekanga ukuba ifikeleleke kodwa ingaba inxulumene nokusebenza konyango olude. Njengoko umehluko kwiimpawu zezigulane ezilandelelanayo ezilandelelwano olude kunye nexesha elide lingabonakaliswa kwiziphumo zexesha elifutshane ezihlolwe ukukhutshwa kunye neentlobo kunye nemali yonyango olongezelelweyo, into yokuba olu phofu aluzange lucinge ngale iziphumo ngokusebenzisa uhlalutyo olongezelelweyo ngumlinganiselo owongezelelweyo wale sifundo.

Impikiswano isajikeleza ukusebenza konyango lwe-IDH yomlomo wesibeleko. Ngelixa iinaliti ze-epidural steroid yeyona ndlela ixhaphakileyo yonyango lolondolozo olusetyenziswa eUnited States [37] uphononongo olucwangcisiweyo olwahlukeneyo lubonisa ukuba iziphumo ziguquguquka kakhulu kwaye azigqibeli [38�44]. Iindlela ezimbini zisetyenziswa ngokubanzi kwiinaliti ze-epidural: iindlela ze-interlaminar kunye ne-transforaminal. Indlela ye-transforaminal iye yagxekwa ngenxa yeengozi zokhuseleko [45�50], kwaye nangona ikhuselekile kunendlela ye-transforaminal, indlela ye-interlaminar iphinda ibambe ingozi enokubakho [51�56]. Iingxelo malunga nokusebenza kweyeza eliqhelekileyo leentlungu ze-neuropathic zibonisa iziphumo eziphikisanayo [57�61], kwaye iziphumo zokufunda kunyango lomzimba nazo azihambelani [62�64].

Gebremariam et al. [65] yavandlakanya usebenzo lwezohlukeneyo zonyango lwe-IDH kwintsholongwane yakutsha nje, kwaye igqiba ukuba nangona uphando olulandelayo olupapashwe ngokunyango olulondolozo kunye nokuhlinzwa lwabonisa ukuba utyando lwabangelwa kwimiphumo engcono kunonyango olulondolozayo, ufumane uhlalutyo lwangaphakathi, abukho ubungqina obuxhasa ukuba olunye unyango luphezulu. Nangona iinqununu zonyango lokuqala kunye nolawulo, ezinye izigulana zingakhetha ukwenziwa ngonyango kwi-IDH yesibeleko kwinjongo ephambili yokunciphisa ubuhlungu obubangelwa yi-neuropathy nokukhusela ukuqhubela phambili komonakalo we-neurological myelopathy [66]. Nangona ubungqina bobuninzi bezobugqirha kunye nolugqirha lwezobugqirha kwi-IDH yesibeleko bunzima ukufumana izibonelelo kunye nezibi ziyanelisekanga, ummandla uye wafundwa ngokubanzi, ngelixa kukho uhlahlo olucacileyo lwee-correlative izifundo kwi-CAM.

UManchikati et al. [67] ixelwe kuphononongo olulandelelweyo lwe-2 lweminyaka ethelekisa unyango lwenaliti ye-epidural kunye ne-lidocaine kunye nomxube we-lidocaine kunye ne-steroids ye-IDH yomlomo wesibeleko ukuba i-NRS kwiqela le-lidocaine yayingu-7.9?�?1.0 kwisiseko, kunye ne-3.8? Ukulandelwa kweminyaka emi-1.6, ngelixa i-NRS kwiqela le-lidocaine kunye ne-steroid yayingu-2?�?7.9 kwisiseko, kunye ne-0.9?�? I-NDI kwiqela le-lidocaine laliyi-3.8?�?1.7 kwisiseko, kunye ne-2?�? 29.6 kulandelelwano lweminyaka emi-5.3. Xa kuthelekiswa nesifundo sethu, nangona ukuphuculwa kwe-NRS kukhulu kancinci kuphononongo olwenziwe nguManchikanti et al., Le ye-NDI iyafana. Isiseko se-NRS sasiphezulu kwi-13.7 kule sifundo sangaphambili, kwaye abazange bahlule phakathi kweentlungu zentamo kunye neentlungu ezikhuphayo kuvavanyo lwe-NRS.

Iziphumo zokulandela unyaka ze-1 ngokuthelekisa unyango olulondolozayo kunye ne-plasma disc decompression (PDD) ye-IDH yomlomo wesibeleko ibonisa ukuba amanqaku e-VAS anciphise i-65.73, ngelixa i-NDI yehle nge-16.7 kwiqela le-PDD (n? =? 61), kwaye amanqaku e-VAS ancipha nge-36.45 , kunye ne-NDI yehle nge-12.40 kwiqela lonyango elilondolozayo (n? =? 57) [68]. Nangona kunjalo, isifundo esifundwayo sasilinganiselwe kwi-IDH yomlomo wesibeleko, umlinganiso wesiphumo seentlungu yayiku-VAS ukuthintela ukuthelekisa ngokuthe ngqo, kwaye ixesha lokulandela lalifutshane kunesifundo sethu.

Imodeli yonyango oludityanisiweyo olusetyenziswa kwisibhedlele samayeza saseKorea sinokuhluka kakhulu kwiimodeli zonyango zeCAM ezisetyenziswa kumazwe aseNtshona. Nangona unyango lwe-CAM lufumana ukuthandwa ngokubanzi eNtshona, i-CAM idla ngokukhawulelwa �yokuncedisana� kunokuba �amayeza ahlukile, kwaye ngokuqhelekileyo iqhutyelwa ngabasebenzi abaqhelekileyo njengendlela yokuncedisa unyango oluqhelekileyo emva kwemfundo kwi-acupuncture / naturopathy / njl. okanye ngokuthunyelwa kwiingcali zeCAM, apho abanye abanalo ilungelo lokuziqhelanisa nomntu ngamnye. Kwelinye icala, iKorea ithatha inkqubo yezonyango ezimbini apho ii-KMD zibamba amalungelo alinganayo nabasebenzi abaqhelekileyo, kwaye ayisebenzisi inkqubo yonyango esekwe kusapho, evumela abaguli inkululeko yokhetho olusisiseko lonyango oluqhelekileyo okanye unyango lwaseKorea. . Abathathi-nxaxheba bolu pho nonongo babeyizigulane ezivakatyelwe kwaye zangeniswa kwisibhedlele samayeza aseKorea ukuze unyango lweyeza laseKorea lwe-IDH yomlomo wesibeleko, kwaye imodeli yonyango edibeneyo ephunyezwe kwesi sibhedlele sonyango saseKorea ayisebenzisi i-CAM njengomlinganiselo owongezelelweyo. Ngoko ke, unyango oluqulethwe unyango lwe-CAM olufana ne-acupuncture, iyeza le-herbal, i-Chuna manipulation, kunye ne-bee-venom pharmacopuncture kwizigulane ezininzi, kwaye unyango oluqhelekileyo lwalulawulwa ngoogqirha abaqhelekileyo ngokuthunyelwa kwiindawo ezimbalwa ezikhethiweyo. Iyonke i-18.2 % yezigulane ifumene imiyalelo yamayeza e-analgesic amaxesha angama-2.7 ngaphezu kwexesha eliqhelekileyo lokungeniswa kweentsuku ezingama-20.8, elilingana ne-1'2 yeentsuku ze-prescription (ezibalwe njengamaxesha e-2 / ngosuku), kunye ne-epidural injections zanikezelwa kuphela kwi-4.8 kuphela. %, ephantsi xa kucingwa ukuba ezi zigulane bezifuna ukwamkelwa. Kunokucingelwa ukuba injongo ephambili yokwamkelwa kunyango olulondolozayo kwizigulane ezininzi ze-IDH zomlomo wesibeleko kukunciphisa intlungu. Inyani yokuba izigulane ezininzi zibonise intlungu ebalulekileyo kunye nokuchacha kokusebenza kolu phononongo lubambe ukufaneleka kwizigulana eziqwalasela ukukhetha isibhedlele samayeza saseKorea sonyango olulondolozayo phezu kotyando. Kwakhona, izigulane zaqinisekiswa ukuba zigcine imeko yazo ephuculweyo kwixesha elide lokulandelelana, kwaye i-9 kuphela yafumana utyando kwizigulane ze-117 ezihlolwe ixesha elide.

Izigulane zahlukana ngamaqela e-2 ngokwanqanaba olwanelisayo njengoko livavanywa ekulandelelweni kwexesha elide kunye ne-PGIC, kunye nokuhlaziywa kweengxaki zokuguqulwa kwezinto eziphathekayo kuqhutyelwe kwimimiselo engundoqo ukuze kuhlolwe izinto ezinobungqina bokuneliseka nokunganeliseki. Ubudala obudala buhlanganiswe nezinga eliphezulu lokwaneliseka, kwaye ubuhlungu obukrakra obungabonakaliyo buboniswa ukuba budibene nezinga eliphezulu lokwaneliseka kunokuba kungabikho ubuhlungu. Ukongezelela, izigulane ezithotyelwa unyango lwe-CAM zidibaniswe kunye namaxabiso anelisekile kakhulu xa kuthelekiswa nabangenayo unyango. Oku kunokuba kuchazwe ngenye into yokuba izigulane ezithe zikhulile zingaba namazinga aphezulu entlungu kwaye zibe zigaba eziphambili ze-degeneration, ezibangele iziphumo zonyango ezihle kwaye ziyanelisayo. Ngokufanayo, izigulane ezinobunzima obubuhlungu obungabonakaliyo bubuhlungu bunzima bunokuba bunzima kakhulu kunezinto ezingenayo intlungu. Ukongezelela, izigulane eziqhubekayo zokufumana unyango lwe-CAM zingaba zilungele phambili kwi-CAM, okubangele ukwaneliseka kwezinga eliphezulu.

Nangona iindibano ezininzi ezijoliswe kwixesha elide ziqhutywe ekwenzeni unyango okanye unyango, abo baphathwa unyango lweCAM kunye nonyango oluncinane. Iziphumo zolu pho nonongo zifaniswa neziphumo zexesha elide lokunyanga kweyeza. Izifundo ezimbalwa ziye zenziwa ekwenzeni unyango kwizigulana ezineenkxalabo eziphambili ze-IDH yomlomo wesibeleko, ezinokuthi zidibene nomehluko kwiinkqubo zezempilo jikelele.

izigqibo

Ukuqukumbela, nangona uhlobo lokuqwalaselwa kolu phononongo lusithintele ekwenzeni izigqibo eziqinisekileyo ezingenalo ulawulo, iiveki ze-3-ukunyangwa kwe-inpatient inpatient equlethwe yi-CAM esetyenziswe kwizicwangciso zeklinikhi zangempela zingabangela iziphumo ezanelisayo kunye nentlungu kunye nokuphuculwa komsebenzi ogcinwe ixesha elide. ixesha kwintlungu yentamo okanye izigulane ezibuhlungu zengalo ezifunyaniswa ne-IDH yomlomo wesibeleko.

Imibulelo

Lo msebenzi wawuxhaswa nguJaseng Medical Foundation.

izifinyezo

IDH I-discvertebral disc herniation
CAM Iyeza elongezelelweyo nelinye
KMD Ugqirha waseKorea
NRS Isilinganiselo sokubala
NA Inkcazo yokukhubazeka
PGIC Impembelelo yomhlaba jikelele yokuguquka
MCID Ukwahlula okubalulekileyo klinikhi
VAS Isalathiso sokufanisa
i-ROM Ukuhamba kwesindululo
ULN Umda ophezulu oqhelekileyo
CI Ixesha lokuzithemba
OR Uhlobo lwamazinga
PDD Ukunciphisa idilesi yePlasma

Imihlathi

Injongo yokunyanzela: Ababhali bavakalisa ukuba abanalo inxaxheba.

Igalelo lababhali: SHB, JWO, JSS, JHL kunye neHH bafumana umxholo wokufunda kwaye baqulunqa lo mbhalo, kunye ne-SHB, MRK kunye ne-IHH babhala umbhalo wesigqi wokugqibela. I-SHB, i-JWO, i-YJA kunye ne-ARC ithathe inxaxheba ekuthengeni idatha, kwaye i-KBP yenza uhlalutyo lwamanani. I-YJL, i-MRK, i-YJA kunye ne-IHH inegalelo ekuhlaleni nasekuchazeni idatha. SHB, JWO, JSS, JHL, YJL, MRK, YJA, ARC, KBP, BCS, MSL kunye ne-IHH banegalelo ekuqulunqweni kokufunda kwaye benza iinguqulelo ezibalulekileyo. Bonke abalobi baye bafunda kwaye bavumile isicatshulwa sokugqibela.

Ulwazi lomxhasi: Ncbi.nlm.nih.gov/pmc/articles/PMC4744400/

Ekugqibeleni, unyango lwe-migraine kunye neyeza zokunyuselwa kwentsholongwane njengengcebiso yonyango kwakunye neyeza elongezelelweyo kunye nelinye liza kusebenza ekuphuculeni nasekulawuleni iimpawu zabo. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Iziphumo zophando apha ngasentla zisebenzisa iindlela ezahlukeneyo zokugqiba iziphumo zokugqibela. Nangona iziphumo ziboniswe ukuba ziyimpumelelo ye-migraine kunye neyonyango yokukhulelwa kwe-disc, kuqhutywe uphononongo olongezelelweyo olufunekayo ukuchonga ukusebenza kwabo kwenene. Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Intlungu Yentambo

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

ISIHLOKO ESIBALULEKILEYO: I-EXTRA EXTRA: Ungcono!

EZINYE IINGCUKACHA EZIBALULEKILEYO: UKWENZISA: Ukulimala kwezemidlalo? | Vincent Garcia | Umonde | El Paso, TX I-Chiropractor

Ngenanto

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Vala i-Accordion

Ngenanto

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IsiCwangciso soFundo

Abemi abagulayo

Iingenelo zokuFunda

Imilinganiselo yoFundo

UkuBhaliswa, UkuBhaliswa, kunye neRandomization

Uhlalutyo lweSatisati

iziphumo

Iimpawu zoMonde

Unyango lweZonyango

Ukunyangwa koPhando kunye neengxaki

Ukunganyaniseki

Idata e la hlekile

Iinjongo zokuThengisa

Insight of Dr. Alex Jimenez

amagqabantshintshi

isiphelo

Imibulelo kunye nemibhalo engezantsi

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Ngenanto

Ucaphulo

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imvelaphi

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iziphumo

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imvelaphi

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uyilo

Iziphumo zophando, Uhlalutyo kunye noVavanyo lweMgangatho

iziphumo

Ukusetyenziswa kweMT

Iphrofayili kunye nezikhuthazo zokusetyenziswa kweMT

Ukusetyenziswa ngokufanayo kunye neNkundla yokuSebenza kwabaNika iNtloko kunye noNxibelelwano oludibeneyo lwaBasebenzisi baseMT

Ukusebenza ngokuzimeleyo kweziphumo zeziphumo zonyango

ingxoxo

Uphando lwexesha elizayo

Imida

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Ukufumaneka kweDatha kunye neZiko

Imirhumo yabalobi

Ukugqithisa inzala

Imvume yokupapashwa

UkuVunywa kweMigaqo kunye neMvume yokuBamba iqhaza

Inqaku loMpapashi

izifinyezo

I ngcaciso

Insight of Dr. Alex Jimenez

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injongo

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iziphumo

isiphelo

intshayelelo

tindlela

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Iingenelo zokuFunda

Imilinganiselo yoFundo

Ukuqwalaselwa kwezibalo

iziphumo

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Ukunyangwa koPhando kunye neengxaki

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Impembelelo Eyona Ngundoqo Yonyango

Ukulahlekelwa-Ukulandelwa