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Uchungechunge lweeKlinikhi

Back Clinical Case Series. Uluhlu lweemeko zeklinikhi Lolona hlobo olusisiseko loyilo lofundo, apho abaphandi bachaza amava eqela labantu. Uthotho lwezehlo luchaza abantu abathi baphuhlise isifo okanye imeko ethile entsha. Olu hlobo lophononongo lunokubonelela ngofundo olunyanzelisayo kuba lunika ingxelo eneenkcukacha ngamava ezonyango kwizifundo zomntu ngamnye. UDkt Alex Jimenez uqhuba uchungechunge lwakhe lwezifundo.

I-case study yindlela yophando edla ngokusetyenziswa kwinzululwazi yezentlalo. Sisicwangciso sophando esiphanda into ethile ngaphakathi kwimeko yokwenyani. Zisekelwe kuphando olunzulu lomntu omnye, iqela, okanye isiganeko sokuphonononga indlela yeengxaki / oonobangela. Ibandakanya ubungqina bobungakanani kwaye ixhomekeke kwimithombo emininzi yobungqina.

Uphononongo lwezifundo luyirekhodi exabisekileyo yezenzo zeklinikhi zomsebenzi. Ababoneleli ngesikhokelo esicacileyo solawulo lwezigulane ezilandelelanayo kodwa ziyirekhodi yokusebenzisana kwekliniki enceda ukuqulunqa imibuzo kwizifundo zeklinikhi eziyilwe ngokungqongqo. Babonelela ngemathiriyeli yokufundisa exabisekileyo, ebonisa ulwazi lwakudala nolungaqhelekanga olunokujongana neengcali. Nangona kunjalo, uninzi lonxibelelwano lweklinikhi lwenzeka ebaleni kwaye kuxhomekeke kwingcali ukuba irekhode kwaye idlulise ulwazi. Izikhokelo zenzelwe ukuncedisa umbhali, ingcali, okanye umfundi ukuba aqhubele phambili isifundo ukuya kupapasho.

Uthotho lwe-Case luyilo oluchazayo kwaye luthotho lweemeko zaso nasiphi na isifo esithile okanye ukungangqinelani kwesifo umntu anokuthi akubone kunyango lwezonyango. Ezi meko zichazwe ukuba zicebise eyona hypothesis. Nangona kunjalo, akukho qela lokuthelekisa ngoko ke akunakubakho izigqibo ezininzi malunga nesifo okanye inkqubo yesifo. Ke ngoko, malunga nokuvelisa ubungqina malunga nemiba eyahlukeneyo yenkqubo yesifo, oku kungaphezulu kwesiqalo. Ngeempendulo kuyo nayiphi na imibuzo onokuba nayo nceda ufowunele uDkt Jimenez kwi-915-850-0900

I-Arterbral Artery Dissection Efunyanwe Ngethuba leMvavanyo yeChiropractic

by UGqr Alex Jimenez | Chiropractic, Iingxelo zeNtsholongwane yezonyango, Uchungechunge lweeKlinikhi, LweMpilo

Ukwamkela ulwazi olulandelayo olungezantsi, abantu abangaphezu kwezigidi ezili-2 balimala ngeengozi zemoto ngamnye kunyaka kunye nakwezinye iziganeko, uninzi lwabantu ababandakanyekayo bafumaneka nge-whiplash kunye / okanye ukulimala kwentanyeni ngumqeqeshi wezempilo. Xa isakhiwo esiyinkimbinkimbi sentamo sixinzeleleka, umonakalo wezinto kunye nezinye iingxaki zonyango zingenzeka. Umthambo we-vertebral dissection, okanye i-VAD, ibonakaliswe ngothutho olunjenge-flap-in-like in the lining inside of the vertebral artery in charge of supply blood to the brain. Emva kokulila, igazi lingangena eludongeni lobungqina kwaye lenze i-clot yegazi, lugqithise udonga lwe-artery kwaye luvame ukuphazamisa ukuhamba kwegazi.

Ukutyhubela iminyaka yamava esenza ukhathalelo lwe-chiropractic, i- VAD inokuhlala ilandela emva koxinzelelo entanyeni, njengaleyo yenzeka kwingozi yemoto, okanye ukwenzakala kwe-whiplash. Iimpawu ze-artebral artery dissection zibandakanya iintlungu zentloko kunye nentamo kunye neempawu zestroke okanye ezingapheliyo, ezinje ngobunzima bokuthetha, ukungahambelani kakuhle kunye nokulahleka kombono. I-VAD, okanye i-artebral artery dissection, ifunyaniswa ngokubanzi ine-CT okanye iMRI yokujonga okwahlukileyo.

Abstract

Umfazi oneminyaka engama-30 ubudala waziswa kwisebe likaxakeka ngesiquphe sokuphulukana okwethutyana kombono wasekhohlo. Ngenxa yembali yentloko ye-migraine, wakhululwa ngokuxilongwa kwe-migraine ye-migraine. Kwiintsuku ezimbini kamva, wafuna ukhathalelo lwe-chiropractic ngenxa yeempawu eziphambili zentlungu ebuhlungu entanyeni. I-chiropractor ikrokrela ukuba kunokwenzeka ukuba i-vertebral artery dissection (VAD). Akukho buqhetseba obenziweyo; Endaweni yoko, i-MR angiography (MRA) yentamo yafunyanwa, etyhila i-VAD ekhohlo ekhohlo kunye nokwakheka kwangoko kwe-thrombus. Isigulana sabekwa kunyango lweasprini. Phinda i-MRA yentamo ye-3? Kwiinyanga kamva iveze isisombululo se-thrombus, ngaphandle kokuqhubela phambili ukubetha. Eli tyala libonisa ukubaluleka kwabo bonke ababoneleli bezempilo ababona izigulana zineentlungu zentamo kunye nentloko ukuba ziqwalasele ukubonakaliswa kweempawu zeVAD enokwenzeka.

imvelaphi

I-Vertebral artery dissection (VAD) ekhokelela ekubethweni yinto engaqhelekanga kodwa enokuba sisifo esibi. Iziganeko zestroke ezinxulumene nenkqubo ye-vertebrobasilar iyahluka ukusuka kwi-0.75 ukuya kwi-1.12 / 100? Inkqubo ye-pathological kwi-VAD ihlala ibandakanya ukusasazeka kodonga lwe-artery elandelwa ngamanye amaxesha emva kokumiliselwa kwe-thrombus, enokuthi ibangele ukuvaleka komzimba okanye ikhokelele ekubambeni, kubangele ukuvalelwa kwelinye okanye nangaphezulu amasebe akude kumthambo we-vertebral, kubandakanya ne-basilar umthambo, onokuba yintlekele. I-VAD idla ngokwenzeka kwizigulana ezinobuntu, ubuthathaka bokwexeshana eludongeni lwemithambo. Ubuncinane i-000% yamatyala, iimpawu zokuqala zibandakanya iintlungu zentamo kunye okanye ngaphandle kwentloko.

Izigulane ezininzi ezine-VAD zingasetyenziswa kwizigaba zakuqala ziza kubakhuthaza befuna ukuxhamla intlungu yentloko kunye nentloko, ngaphandle kokuqonda ukuba bafumana i-VAD. Kwiinkoliso ezininzi, isigulane esilandelayo siphinde siphumelele. Kuze kube kutshanje, kwacatshulwa ukuba i-dissection (kunye ne-stroke elandelayo) yabangelwa unyango lwe-cervical manipulative (CMT). Nangona kunjalo, nangona uphando lwexesha lokuqala lufumene ubudlelwane phakathi kokutyelela kwi-chiropractor kunye nesifo sohlangothi esilandelayo ku-VAD, idatha yakutshanje ibonisa ukuba olu lwalamano aluyiyo i-causal.

Ingxelo yolu hlobo ibonisa imeko apho isigulane esinokungazifumani kwi-VAD ekuziphendukeleni kwintsebenziswano kwintetho ye-chiropractor yentlungu yentloko kunye nentloko. Emva kwembali epheleleyo kunye noviwo, i-chiropractor igxeka i-VAD kwaye ayizange yenze i-CMT. Endaweni yoko, isigulane sathunyelwa ukuphonononga okuqhutywe phambili, okufumanisa ukuba i-VAD iyaqhubeka. Ukucatshungulwa kokukhawuleza kunye ne-antiticoagulant unyango kwakucatshangelwe ukuba kuye kwayeka ukuqhubela phambili kwintlungu.

Ukunikezelwa kweNkundla

Umfazi oneminyaka eyi-30 kungenjalo umfazi ophilileyo waya kwi-chiropractor (DBF), enika ingxelo ngentlungu esekunene yentamo kwingingqi ye-suboccipital. Isigulana sixele ukuba, kwiintsuku ezi-3 ezidlulileyo, wayeye kwisebe lezonyango elingxamisekileyo (ED) ngenxa yokulahleka ngesiquphe kombono wasekhohlo. Iimpawu ezibonakalayo ziphazamise ukukwazi kwakhe ukubona ngamehlo asekhohlo; Oku kwakukhatshwa bubuninzi '' kwinkophe yakhe yasekhohlo. Malunga neeveki ezi-2 ngaphambi kolu tyelelo lwe-ED, wayenamava esihlungu sentamo emacala asekhohlo ngentloko ebukhali ekhohlo. Uye wachaza nembali yentloko ye-migraine ngaphandle kweprodrome. Ukhululwe kwi-ED ngoxilongo lwe-migraine ye-ocular. Wayengazange afunyanwe ngaphambili ene-ocular migraine, kwaye wayengazange afumaneke nakuphi na ukuphazamiseka okubonakalayo kunye ne-migraines yakhe yangaphambili.

Kungekudala emva kokuba iimpawu zamehlo ezisekhohlo zisonjululwe, ngequbuliso waba neentlungu zentamo esekunene ngaphandle kokucaphuka, awayefuna unyango lwe-chiropractic. Uye waxela nesiqendu sethutyana sokuphazamiseka kwembono esekunene esenzeka kwangalo mini. Oku kwachazwa njengokufiphala ngesiquphe okwethutyana kwaye kwasonjululwa kwangoko kwangoko ngemini yokubonisa kwakhe uviwo lwe-chiropractic. Xa wazisa kuvavanyo lokuqala lwe-chiropractic, wakhanyela ukuphazamiseka okwangoku okubonakalayo. Uye wathi akakhange afumane nakuphi na ukuba ndindisholo, iparaesthesia okanye ilahleko yemoto kwiindawo eziphezulu okanye ezisezantsi. Waphika i-ataxia okanye ubunzima ngokulinganisela. Imbali yezonyango yayimangalisa xa kuzalwa iinyanga ezi-2 ngaphambi kokubonisa okokuqala. Utshilo ukuba iintloko zakhe zazinxulunyaniswa nokuya kwakhe exesheni. Imbali yosapho yayimangalisa ngokunyuka okuzenzekelayo kwe-thoracic aortic aneurysm kudadewabo omdala, owayeneminyaka engama-30 ubudala xa i-aneurysm yakhe yenzekile.

uphando

Ngokusekwe kwimbali yokuvela ngesiquphe kwentlungu ephezulu yomlomo wesibeleko kunye nentloko enophazamiso olubonakalayo kunye ne-ocular numbness, i-DC yayixhalabile malunga nokuba kunokwenzeka kwe-VAD kwangoko. UMr angiography ongxamisekileyo (MRA) wentamo nentloko, kunye neMRI yentloko, wayalelwa. Akukho luvavanyo lomlomo wesibeleko okanye ubuqhetseba obenziwa ngenxa yokusola ukuba iintlungu zentamo zazinxulumene ne-VAD endaweni yesifo se-chanmechanical somlomo wesibeleko.

I-MRA yentamo ibonakalise ukuba umthambo we-vertebral wasekhohlo wawumncinci kwaye ungahambelani kulungelelwaniso, ususela kwinqanaba le-C7 cephalad ukuya kwi-C2, ngokuhambelana nokusasazeka. Kwakukho i-patent lumen eyinyani kunye nekhofu ejikelezileyo ye-T1 hyper-intensity, ehambelana nokusasazeka kunye ne-subintimal thrombus ngaphakathi kwe-lumen yamanga (Amanani 1 kunye? 2). I-MRI yentloko kunye nangaphandle kokungafaniyo, kunye ne-MRA yentloko ngaphandle kokuthelekisa, zombini zazingamangalisi. Ngokukodwa, kwakungekho ukwandiswa okungafunekiyo kwe-dissection okanye ubungqina be-infarction. MF perfusion yengqondo ayibonisanga kuphazamiseka kugxilwe kugwenxa.

Umzobo we-1 ye-Axial Proton Density Image - Image 1

Umzobo 1: Umfanekiso we-Axial proton yesisindo ubonisa ubukhulu be-hyper-intensity ejikeleze umzobo we-vertebral (omele i-lumen yamanga). Inqaku liye linciphisa umlenze wokwenyaniso (ukungafi mnyama) ngokubhekiselele kumzobo ophezulu we-vertebral.

Umzobo 2 Umfanekiso we-Axial ovela kwiXesha lesiBini leXesha leNdiza-I-2 yoMfanekiso

Umzobo 2: Umfanekiso we-Axial ukusuka kwi-MRA yexesha elinesithathu-ye-flight MRA ibonisa i-T1 hypointense dissection flap eyahlula i-lumen yangempela (yangaphambili) kwi-lumen yamanga (ephakathi). IMRA, MR engiography.

Ukuxilongwa ngokungafani

U-ED ukhuphe isigulana ngoxilongo lwe-migraine ye-ocular, ngenxa yembali yakhe yentloko ye-migraine. Nangona kunjalo, isigulana sathi iintloko zentloko ekhohlo zazingafani nento endakha ndayibona ngaphambili. Imigraines yakhe yangaphambili yayinxulunyaniswa nomjikelo wakhe wokuya esikhathini, kodwa hayi ngalo naluphi na utshintsho olwenzekayo. Wayengazange afunyaniswe ngaphambili ene-ocular migraine. I-MRA yommandla womlomo wesibeleko ityhile ukuba isigulana eneneni sinesibetho esibuhlungu esenziwe nge-thrombus kumthambo we-vertebral wasekhohlo.

impatho

Ngenxa yesifo esibuhlungu esinokubakho esayanyaniswa ne-VAD ebukhali kunye nokwakheka kwe-thrombus, isigulana samkelwa kwinkonzo ye-neurology ye-stroke yokujonga esondeleyo imithambo-luvo. Ngexesha lokwamkelwa kwakhe, isigulana asikhange siphinde sibuyekezwe kukusilela kwemithambo-luvo kwaye zaphucuka iintloko. Ukhutshiwe ngosuku olulandelayo ngokuxilongwa kwe-VAD yasekhohlo kunye nohlaselo lwexeshana lwe-ischemic. Wayeyalelwe ukuba aphephe ukuzilolonga ngamandla kunye nentlungu entanyeni. I-aspirin yemihla ngemihla (i-325? Mg) yamiselwa, ukuba iqhubeke kangangesithuba seenyanga ezi-3 6 emva kokukhutshwa.

IsiPhumo kunye nokuLandela

Emva kokukhutshwa kwinkonzo yokubetha, isigulana asiphindanga saphazamiseka entlokweni okanye ukuphazamiseka okubonakalayo, kwaye iimpawu zentlungu yasemva kwentsimbi zisonjululwe. Ukuphindaphinda ukucinga kwenziwa kwiinyanga ezi-3 emva kokunikezelwa, okwabonisa ukuphuculwa komgangatho wesibeleko somthambo oshiyekileyo we-vertebral ngesisombululo se-thrombus ngaphakathi kwe-lumen false (Umzobo 3). Ukulinganisa kwegumbi lokungasebenzi kakuhle kuhlala kuyinto eqhelekileyo, ngaphandle kobungqina bethuba lokuphumla okanye i-perfusion asymmetry.

Umzobo we-3 Ubunzulu boqikelelo lwe-MIP Imifanekiso-Imifanekiso 3

Umzobo 3: Ubuninzi bokubaluleka kweemifanekiso (MIP) kwimifanekiso esuka kwi-MRA yexesha-ntathu ye-MRA (umfanekiso wesobunxele ngexesha lokubonisa kunye nomfanekiso ochanekileyo kwi-3-inyanga yokulandelelana kweenyanga). Imifanekiso yokuqala ibonisa umlinganiselo omncinci we-arterbral artery

ingxoxo

Inkqubo ye-pathophysiological ye-VAD icingelwa ukuba iqale ngokudodobala kwezicubu kumda we-medial-adventitial we-artebral artery, ekhokelela kuphuhliso lwe-microhaematomata ngaphakathi kodonga lwe-artery kwaye, ekugqibeleni, iinyembezi. Oku kunokukhokelela ekuvuzeni kwegazi eludongeni lwe-arterial, kubangele ukubonwa kwe-lumen kunye nokwakheka kwe-thrombus kunye nokudityaniswa, okukhokelela ekubetheni okunxulumene nelinye lamasebe omthambo we-vertebral. Le nkqubo ye-pathological iyafana naleyo ye-carotid artery dissection, i-thoracic aortic dissection kunye ne-coronary artery dissection. Zonke ezi meko zihlala zikhona kubantu abadala abancinci kwaye abanye bacinge ukuba banokuba yinxalenye yenkqubo yesiqhelo ye-pathophysiological. Iyaphawuleka kule meko kukuba udade osele ekhulile wesigulana wayenamava we-thoracic aortic aneurysm (mhlawumbi idiski) kubudala obufanayo (30? Iminyaka) njengoko esi sigulana besinamava e-VAD yakhe.

Nangona i-dissection idla ngokukhawuleza, i-compromin lumine kunye neengxaki ze-VAD zingahlakulela ngokukhawuleza iimpawu ezibonakalayo kunye nokubonisa, kuxhomekeke kwisigaba sesifo. I-dissection ngokwayo, eyenza ixesha elithile ngaphambi kokuqala kwe-neural ischaemia, inokubangela ukuvuselela i-nociceptive receptors ngaphakathi kwintsimbi, ukuvelisa intlungu edlalwa yintsimi yomlomo okanye intloko. Kuphela emva kokuba inkqubo ye-pathophysiological iqhubekela phambili kwinqanaba lokuzaliswa kwamagqabantshintshi okanye ukubunjwa kwe-thrombus nge-embalisation ye-distal yenza ukubonakaliswa ngokupheleleyo kwe-infarction. Nangona kunjalo, njengoko kuboniswe kulo mzekelo, iimpawu zengqondo zingathuthuka ekuqaleni kwenkqubo, ingakumbi kwiimeko apho i-lumen yangempela ibonisa ukukhanya okubalulekileyo kunciphisa okwesibini ukuya koxinzelelo.

Zininzi izinto ezinomdla kweli tyala. Okokuqala, kugxininisa ukubaluleka kweeklinikhi zomgogodla ukuba ziqaphele ukuba into enokubonakala ngathi iyinyani ye-chanmechanical yentlungu kunokuba yinto enokuba yingozi ngakumbi, njenge-VAD. Ukuqala ngesiquphe kwentlungu yesifo se-suboccipital, kunye okanye ngaphandle kwentloko, kunye nokuhamba ne-brainstem enxulumene neempawu zengqondo, kuya kufuneka ulumkise ugqirha malunga ne-VAD. Njengoko kwimeko echazwe apha, izigulane ezinembali ye-migraine ziya kuchaza ngokuqhelekileyo iintloko zentloko ezahlukileyo kwi-migraine yazo yesiqhelo. Uvavanyo olunonophelo lwe-neurological kufuneka lwenziwe, kukhangelwa ukusilela kwe-neurological efihlakeleyo, nangona uvavanyo lwe-neurological luza kuhlala lubi kumanqanaba okuqala e-VAD.

Okwesibini, intlungu yeempawu eziphakamisa inkxalabo yokuba isigulane sinokufumana i-VAD eqhubekayo. I-symptom triad ibandakanya: (1) ukuqala ngokukhawuleza kwentlungu ebuhlungu yengqondo yomlomo; (I-2) intloko ekhutheleyo eyayihluke ngokuthe ngqo kwintsholongwane yesigulane ye-migraine; kunye (kunye ne-3) iimpawu ze-brain-related neurological (ngesimo sokuphazamiseka kwexesha elibonakalayo). Kucacile, ukuhlolwa ngokunyamekela kweengxaki zegazi kwakungekho nto. Nangona kunjalo, imbali yayinokhathalela ngokwaneleyo ukunyusa uphando ngokukhawuleza.

Xa kukhankanywa i-VAD kodwa akukho zibonakaliso ezingenangqiqo ezikhoyo, ukubonakaliswa kwe-vascular immediate is shown. Nangona uvavanyo lokujonga i-VAD luhlala luphikisana, i-MRA okanye i-CTA yizo zifundo zokuxilonga ezikhethiweyo zanikezela i-anatomic ecacileyo kunye nokukwazi ukuvavanya iingxaki (kubandakanya ukungena kwintsholongwane kunye nokutshintshwa kweengcamango zengqondo). Abanye baxhasa ukusetyenziswa kwe-Doppler ultrasound; Nangona kunjalo, uncedo olungapheliyo lunikezelwa kwinqanaba le-vertebral umthamo entanyeni kunye nokuvavanywa okuncinci kwemithambo ye-vertebral cephalad ukuya kwimvelaphi. Ukongezelela, ukubonakalisa i-ultrasound akunakwenzeka ukuba uvumele ukubonwa kwe-dissection ngokwayo kwaye ngoko kungabikho ukungabikho kokubakho kwamathuba omzimba.

Okwesithathu, eli tyala linomdla ekukhanyeni kwempikiswano malunga nokuphathwa komlomo wesibeleko njengonobangela we-VAD. Ngelixa iingxelo zamatyala zibonise abaguli abanamava okuhlaselwa sisifo sokubethwa okunxulumene ne-VAD emva kokunyanzelwa komlomo wesibeleko, kwaye izifundo zolawulo zifumene umbutho wobalo phakathi kokundwendwela iingcali zonyango kunye nokubetha okunxulumene ne-VAD, uphando olwenziweyo lubonakalisile ukuba umbutho awungonobangela. UCassidy okqhubekayo wafumanisa ukuba isigulana esifumana ukubethwa sisifo ngokubhekisele kwi-VAD kunokwenzeka ukuba sityelele ugqirha wokuqala wokutyelela i-chiropractor ngaphambi kokuba sibethwe. Ababhali bacebise ukuba eyona nkcazo inokubakho yokuhlangana kwamanani phakathi kotyelelo lwee-chiropractors kunye ne-VAD elandelayo kukuba isigulana esidibana neempawu zokuqala ze-VAD (iintlungu zentamo kunye okanye ngaphandle kwentloko) kufuna unyango kwezi mpawu (kwi-chiropractor, iprayimari ugqirha, okanye olunye uhlobo lwengcali), emva koko ufumana ukubetha, ngokuzimeleyo kulo naliphi na inyathelo elithathiweyo ngugqirha.

Kubalulekile ukuba uqaphele ukuba, ngelixa bekuxeliwe imeko ye-carotid artery dissection emva kokunyanzelwa komlomo wesibeleko, izifundo ze-case control azifumananga lo mbutho. Iimpawu zokuqala ze-carotid dissection (iimpawu ze-neurological, kunye nentamo kunye nentloko engaphantsi kwe-VAD), i-aortic dissection (ukuqala ngokukhawuleza kwentlungu, i- ingaring pain) kunye ne-coronary artery dissection (ubuhlungu obukhulu besifuba, i-ventricular fibrillation) kubangela ukuba umntu afune kwangoko ukhathalelo lwe-ED, endaweni yokufuna ukhathalelo lwe-chiropractic. Nangona kunjalo, i-VAD ineempawu zokuqala ezibonakala zinobungozi iintlungu zentamo kunye nentloko-ezizimpawu ezo ezibangela ukuba abaguli bafune ukhathalelo lwe-chiropractic. Oku kunokuchaza ukuba kutheni i-VAD kuphela inxulunyaniswa notyelelo koochwephesha, ngelixa ezinye iintlobo zesahlulo zingenjalo; abaguli abanezinye iimeko, ezineempawu ezoyikisayo, ababonakalisi kugqirha bezonyango.

Eli tyala ngumzekelo omhle wesigulane kunye ne-VAD eqhubekayo ebonisa i-chiropractor ngenjongo yokufuna ukukhululeka kwiintlungu zentamo. Ngethamsanqa, i-chiropractor yayinobuqili ngokwaneleyo ukuqinisekisa ukuba iimpawu zesigulana azizange zibonise ukuba "umatshini" wengxaki yomlomo wesibeleko, kwaye uphando olufanelekileyo lwenziwa. Nangona kunjalo, ukuba ukukhwabanisa kuye kwenziwa, i-VAD esele iqhubekile ukusuka kwimbali yendalo inokuthi ityholwe ngokukhohlisa, emva kokuba ifunyenwe kwi-MRA imaging. Ngethamsanqa, kule meko, i-chiropractor yakwazi ukuncedisa ekubhaqweni kwangaphambili kunye nonyango, kwaye emva koko i-stroke yayinokuthi ithintelwe.

Amaphuzu okuFunda

Ityala linikezelwa apho isigulane sibona ityropratri, ngelixa lifuna unyango intlungu yentamo, kwaye imbali yaphakamisa inkxalabo malunga ne-artebral artery dissection (VAD).
Esikhundleni sokubonelela unyango oluthile, i-chiropractor ibhekisele isigulane kwisithombe esiphezulu, esiqinisekisileyo ukuxilongwa kwe-VAD.
Icala libonisa ukubaluleka kokunikela ingqalelo kwiimeko ezizifihlakeleyo zembali kwizigulane ezine-VAD.
Ikwasebenza njengomzekelo wesigulane nge-VAD ekuqhubekeni ekufuneni iinkonzo ze-chiropractor malunga neempawu zokuqala zesifo.
Kule meko, ukufumanisa kwangaphambili ukusabalalisa kwenzeka kwaye isigulane sinokubuyiselwa ngokupheleleyo ngaphandle kwesifo esilandelayo.

Imibulelo

Ababhali bangathanda ukuvuma ukuncedwa nguPeter Cote, DC, PhD, ngoncedo lwakhe ngokuhlolisisa le ngqangi.

Imihlathi

Abaxhasi: Bonke abalobi bayavuma ukuba bancedise oku kulandelayo ekungenisweni kwalo mbhalo: umklamo kunye nokuyila, ukuyila umbhalo wesandla, ukuhlaziywa okubalulekileyo kwincwadi yesandla, ukuphononongwa kwincwadi kunye neenkcukacha, nokufunda ubungqina bombhalo wokugqibela.

Injongo yokunyanzela: Akukho nto ipapashwe.

Imvume yomonde: Ku funyenwe.

Iprovenance kunye nokuhlolwa koontanga: A nga thunyelwa; uhlolo lwangaphandle.

Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa mba, nceda uzive ukhululekile ukubuza Dr. Jiménez okanye uqhagamshelane nathi 915-850-0900 .

Ikhankanywe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Ubungakanani

Impilo kunye nokuphila kakuhle kubalulekile ekugcineni ukulinganisela kwengqondo kunye nomzimba emzimbeni. Ukutya ukutya okunokulinganisela kunye nokuthatha inxaxheba kwimisebenzi engokwenyama, ukulala ixesha elinempilo ngokuqhelekileyo, ukulandela iziphumo ezingcono zezempilo kunye neempilweni zokugcina unokukunceda ekugcineni ulondoloze impilo yonke. Ukutya ezininzi iziqhamo nemifuno kunokuhamba ixesha elide ekuncedeni abantu ukuba baphile.

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

INGXELO EBALULEKILEYO: UKUPHATHA KWE-EXTRA: Ukunyanga i-Sciatica Pain

Ngenanto

Ucaphulo

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8. Rothwell DM, Bondy SJ, Williams JI.�Ukunyanzeliswa kwe-Chiropractic kunye nokushaywa kwesibalo: isifundo sokulawulwa kwamatyala esisiseko sabantu. StrokeNgo-2001;32: 1054 60. I-doi: 10.1161 / 01.STR.32.5.1054 [PubMed]

9. Smith WS, Johnston SC, Skalabrin EJ et al.�Ulwaphulo olusisigxina olusisigxina luyimpembelelo eyimingcipheko yecala lokutshatyalaliswa kwemithambo. NeurologyNgo-2003;60: 1424 8. I-doi: 10.1212 / 01.WNL.0000063305.61050.E6[PubMed]

10. UVolker W, Besselmann M, Dittrich R et al.�I-arteriopathy eziqhelekileyo kwizigulane ezine-artery disease dissection. NeurologyNgo-2005;64: 1508 13. I-doi: 10.1212 / 01.WNL.0000159739.24607.98 [PubMed]

11. Umvangeli A, Mukherjee D, Mehta RH et al.�I-hematoma ye-hemomoma eqhelekileyo ye-aorta: imfihlelo ekuziphendukeleni kwemvelo. UkuhambaNgo-2005;111: 1063 70. I-doi: 10.1161 / 01.CIR.0000156444.26393.80 [PubMed]

12. Tweet UMS, uHayes SN, uPitta SR et al.�Impawu zonyango, ulawulo, kunye nokuxela kwe-aronary coronary artery dissection. UkuhambaNgo-2012;126: 579 88. I-doi: 10.1161 / ICIRCULATIONAHA.112.105718[PubMed]

13. Choi S, Boyle E, Cote P et al.�Izigulane ze-Ontario-based series of patients who develop a vertebrobasilar artery stroke emva kokubona i-chiropractor. J Uluhlu lwePhysiol TherNgo-2011;34: 15 22. I-doi: 10.1016 / j.jmpt.2010.11.001 [PubMed]

14. UNaggara O, uLouillet F, uTouze Et al.�Ixabiso elongeziweyo le-MR-imaging high resolution resolution in the diagnosis of vertebral artery dissection. AJNR Am J NeuroradiolNgo-2010;31: 1707 12. I-doi: 10.3174 / ajnr.A2165 [PubMed]

15. Haynes MJ, Vincent K, Fischhoff C et al.�Ukuvavanya umngcipheko wokubetha kwintambo yokunyakaza kwentamo: ukuhlolwa kwakhona. Int J Clin PractNgo-2012;66: 940 7. I-doi: 10.1111 / j.1742-1241.2012.03004.x[Inkcazelo yamahhala ye-PMC] [PubMed]

16. Nebelsieck J, Sengelhoff C, Nassenstein I et al.�Ukuvakalelwa kwe-ultrasound ye-neurovascular ukuze kutholakale i-artery cervical dissection. J Clin NeurosciNgo-2009;16: 79 82. I-doi: 10.1016 / j.jocn.2008.04.005 [PubMed]

17. Bendick PJ, uJackson VP.�Ukuvavanywa kwemithambo ye-vertebral ne-sonplex sonography. J Vasc Surg1986;3: 523 30. doi:10.1016/0741-5214(86)90120-5 [PubMed]

18. UMurphy DR.�Ukuqonda kwangoku ubudlelwane phakathi kokunyanzeliswa komlomo wesibeleko kunye nokushaywa ngxabano: kuthini ukuthini ukuqeqeshwa kwe-chiropractic? Chiropr OsteopatNgo-2010;18:22�doi:10.1186/1746-1340-18-22[Inkcazelo yamahhala ye-PMC] [PubMed]

19. Engelter ST, Grond-Ginsbach C, Metso TM et al.�Umthambo wesifo somlomo wesibeleko: ukuxhwaleka kunye nezinye iziganeko zokuqala eziphambili. NeurologyNgo-2013;80: 1950 7. doi:10.1212/WNL.0b013e318293e2eb [PubMed]

20. Peters M, Bohl J, Th�mke F et al.�Ukuchithwa kwe-artery carotid yangaphakathi emva kokuphathwa kwe-chiropractic entanyeni. NeurologyNgo-1995;45: 2284 6. I-doi: 10.1212 / WNL.45.12.2284 [PubMed]

21. Nadgir RN, Loevner LA, Ahmed T et al.�I-carotid yangaphakathi kunye ne-vertebral dissection elandela ukuphathwa kwe-chiropractic: ingxelo yengxelo kunye nokuhlaziywa kweencwadi. Neuroradiology2003;45: 311 14. I-doi: 10.1007 / s00234-003-0944-x [PubMed]

22. Dittrich R, Rohsbach D, Heidbreder A et al.�Iimpawu ezinobungozi ezinobungozi zingabangela umngcipheko we-artery dissection. Cerebrovasc DisNgo-2007;23: 275 81. i-doi: 10.1159 / 000098327 [PubMed]

23. Chung CL, Cote P, Stern P et al.�Ubudlelwane phakathi kokunyanzeliswa kwemisipha yomnyoba kunye ne-carotid artery dissection: uhlaziyo oluchanekileyo lwencwadi. J Uluhlu lwePhysiol Ther�2014; doi:10.1016/j.jmpt.2013.09.005�I-doi: 10.1016 / j.jmpt.2013.09.005 [PubMed]

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25. Klineberg E, Mazanec D, Orr D et al.�Masquerade: izizathu zonyango zentlungu emva. Cleve kliniki J Med2007;74: 905 13. I-doi: 10.3949 / ccjm.74.12.905 [PubMed]

Vala i-Accordion

Zithini iiNgxelo zeNkundla kunye noThotho lweeNkundla?

by UGqr Alex Jimenez | Iingxelo zeNtsholongwane yezonyango, Uchungechunge lweeKlinikhi, LweMpilo

Ukuxilongwa kwezifo ezahlukahlukeneyo kuye kwachongwa ngokufanelekileyo ngedatha yeklinikhi kunye nolwazi. Uphando olwenziwe ngophando lubonelela ngolwazi oluxabisekileyo kwi-pathogenesis yeemeko ezininzi kwaye kaninzi luyimthombo oyintloko wolwazi malunga nezifo okanye iimeko ezintsha. Iingxelo zengxelo kunye neenkalo zecandelo zifundo zokuqala zophando, zinika ingcaciso ebalulekileyo kwinkalo ethile yempilo ngokwenzeka kumava okanye omnye umntu onesifo okanye imeko. Inqaku elilandelayo lichaza injongo yeengxelo zeemeko kunye nezicwangciso zeemeko, nokuba zibonelela njani iinkcukacha zeklinikhi kunye nolwazi.

Iinjongo zokuFunda

1. Imibiko yecala kunye neenkalo zecandelo zichaza amava omnye okanye abantu abaninzi abanesifo.
2. Iingxelo zeemeko kunye noluhlu lweefowuni zihlala ziqala idatha echazela kwisifo esitsha okanye imeko.
3. Iingxelo zeemeko kunye neenkalo zecala zinemiqathango ethile:

a. Ukungabikho kweedominator ukubala iirhafu zesifo
b. Ukungabi neqela lokuthelekisa
c. Ukukhetha abantu abafundayo
d. Ukutshintshwa kwesampula

IiNgxelo zeeNgxelo kunye nochungechunge lweCase

Iingxelo zeemeko kunye neenkalo zecandelo lubonisa uhlobo oluphambili lwesakhiwo sokufunda, apho abaphandi bachaza amava omntu oyedwa (ingxelo yecala) okanye iqela labantu (i-series series). Ngokuqhelekileyo, iingxelo zeemeko kunye neenkalo zecandelo zichaza abantu abaphuhlisa isifo esithile okanye imeko. Iingxelo zeemeko kunye neengxelo zecala zinganika ukufunda okuphosakeleyo kuba zibonisa i-akhawunti eneenkcazo malunga namava eekliniki zezifundo zezifundo ngamnye. Ngokwahlukileyo, izifundo ezivandlakanyo manani amaninzi abantu zifingqa ngedatha ngokusebenzisa amanyathelo amanani, njengendlela kunye neenani.

Umzekelo 3.1. Icandelo leetyala lichaza i-15 abasetyhini abasetyhini abanomdlavuza webele; I-9 yala mabhinqa ibika okungenani kanye nokutya kwiveki nganye yokutya ehlanganiswe ne-isrogenic khemikhali ye-bisphenol A (BPA). Uvavanyo lwee-urine luqinisekisa ubungqina be-BPA phakathi kwabo bonke abesithoba abasetyhini abasetyhini.

Kuzama ukugqithisa kule nkcukacha ukuba i-BPA inokuthi ibhekane nomdlavuza wesibele. Nangona kunjalo, iingxelo zeemeko / iimeko zecala zinemida ebalulekileyo enqanda ulwahlulo lwentsebenziswano.

Okokuqala, iingxelo zeengxelo / iimeko zecala zineenkcukacha zeedominator eziyimfuneko zokubala isantya sesifo. I-denominator ibhekisela kubemi ukusuka kuyo izihloko ezigulayo. Ngokomzekelo, ukubala i-incidence isilinganiso okanye i-incidence rate ye-cancer yombele phakathi kwabasetyhini abonakaliswe kwi-BPA, inani labasetyhini abaye babhalwa kwi-BPA okanye inani elipheleleyo lomntu osengozini kufuneka.

Izifo zentsholongwane zifunekayo xa kuthelekiswa nemilinganiselo yesifo esichazwe ngokomlando, okanye ngamaxabiso avela kwiqela elifanisayo. Ngelishwa, ukufumana idatha efunekayo yeedominator ingabi lula. Kule mzekelo, imithombo yolwazi eyongezelelweyo iyadingeka ukucacisa inani elipheleleyo labasetyhini abasetyhini abavela kuzo iingxaki zomhlaza webele. Icandelo lwedatha yedatha yedwa ayinakusetyenziswa ukubala isantya somhlaza wesifuba ngenxa yokuba ababandakanyi inani labasetyhini abachazwe kwi-BPA.

Ingxaki yesibini kwimeko yenkcazo / imeko yecala yenkcazo yedatha kukungabikho kweqela elifanisa. Ukukhula kwe-60% ye-BPA ukutyhila phakathi kwabasetyhini abaneengxaki zomhlaza wesibeleko kubonakala ngokuphakamileyo, kodwa yintoni na ukuxhaphaka kwe-BPA ukutyhila phakathi kwabasetyhini abangenayo umdlavuza webele? Lo mzekelo ubaluleke kakhulu ekujonganeni nengcinga yokuba i-BPA ingaba yimbangela yesifo somhlaza.

Icandelo lesithathu lokukhawulwa kweengxelo / iimeko zecala kukuba ezi zifundo zidla ngokucacileyo zikhetha abantu abanokuthi bangabonakali kubemi bonke. Ngokomzekelo, kunokwenzeka ukuba iziganeko zomhlaza webele ze-15 zivela kwisibhedlele esisodwa kwindawo ephakamileyo enezinga eliphezulu lokungcoliseka komoya okanye ezinye izifo zengqondo. Ngaphantsi kwezi meko, uqikelelo olulungileyo lwesiganeko somhlaza wesifuba phakathi kwabangewona i-BPA lubonakalisile abafazi besuka kuluntu olufanayo ukuba baxelele ukuba i-BPA ibangela umdlavuza webele.

Isithintelo sesine seengxelo / iimeko zeefowuni isampuli yesampuli. Le ngcamango iya kuphicothwa ngokucacileyo kamva kule ncwadi. Ingcamango eyintloko kukuba kukho ukuhlukahluka kwendalo kwintlupheko yesifo kubantu. Iqiniso lokuba i-9 yabasetyhini be-15 ngesifo somhlaza wesifuba ibhengeze i-BPA ukutshatyalaliswa kunomdla; nangona kunjalo, eli nani linokuhluke kakhulu kwimiba elandelayo yecala le-15 abafazi abanomdlavuza wesibele ngenxa nje yengozi. Uqikelelo oluchanekileyo lwesantya sesifo, oluzimeleyo ngethuba, lunokufumaneka kuphela ngokunyusa inani lezifo ezigulayo.

Khumbula uluhlu lwezinto ezisetyenziselwa ukugweba ukuba ingaba yinto ebangela isifo:

1. Ubungqina obuninzi
2. Amandla ombutho
3. Ubudlelwane bexeshana phakathi kokungcola kunye nesiphumo
4. Umbutho weempendulo
5. Ulwabiwo lwezinto eziphilayo

Ngokubanzi, iingxelo zetyala/uthotho lwamatyala luxhomekeke ngokukodwa kubukho bebhayoloji ukwenza imeko yabo ibe ngunobangela. Kuluhlu lwe-BPA kunye nomhlaza wamabele, akukho bungqina bungenamkhethe, akukho mlinganiso wamandla omanyano phakathi kwe-BPA kunye nomhlaza wamabele, akukho mbutho uxeliweyo 'wempendulo yethamo, kwaye akukho bungqina bokuba ukuvezwa kwe-BPA kwandulela ukukhula komhlaza wamabele. Inkcazo ye-causation iphuma ngokupheleleyo kulwazi lwebhayoloji yangaphambili malunga neziphumo ze-estrogenic ze-BPA.

Nangona kunqongopheko lweedatha zechungechunge lwentlupheko, banokuba neengcebiso ezinzulu zombutho omtsha, inkqubo yesifo, okanye umphumo ongenakulindelekanga weyeza okanye unyango.

Umzekelo 3.2. Kwi-2007, uchungechunge lwamatyala luchaze iimeko ezintathu ze-prepubertal gynecomastia yamadoda. Ingxelo iquka ulwazi oluneenkcukacha malunga nobudala besifundo ngasinye, ubungakanani bomzimba, amanqanaba e-serum ye-endogenous steroids, kunye nokuvezwa okwaziwayo kwiihomoni zangaphandle. Kwafunyaniswa ukuba omathathu amakhwenkwe asempilweni aye aboniswa kwimveliso ethile equlethe ioyile yelavenda (iloshini, ishampu, isepha), kwaye kwimeko nganye, i-gynecomastia isonjululwe ekuyekisweni kwemveliso. Izifundo ezilandelayo ze-in vitro zibonise umsebenzi ophazamisayo we-endocrine weoli ye-lavender. Olu luhlu lwedatha yetyala lenoveli lungakhokelela kuphando oluthe kratya ukufumanisa ukuba i-oyile yelavenda, isithako esiqhelekileyo kwiimveliso ezifumanekayo zorhwebo, inokuba ngunobangela we-gynecomastia.

Umzekelo 3.3. Isitofu sokugonywa ekwenzeni ukuthintela usulelo lwe-rotavirus lufunyenwe kubangela ukubuthathaka kwamathambo emathumbu emathunjini. Ukulandela ukukhululwa kwesigonyilo, inani lamatyala ekuhlaleni (xa esinye isahlulo sesilonda slide ukuya kwesilandelayo) saxelelwa kubantwana abafumene isitofu sokugonywa, kunye namanye amacala afayo. Ubungqina obunamandla be-biological obuphantsi kwesi sivumelwano sokuqala, kunye nolwazi lokuba ukungabikho kwintsholongwane engabonakaliyo kwiintsana, kwakuchukumisa kakhulu ubudlelwane obushushu kunye nesitofu sokugonywa kwi-market.

Ulwazi olubhekiselele kwi-B. Kestenbaum, i-Epidemiology kunye ne-Biostatistics: Intshayelelo yoPhando lwezonyango, i-DOI 10.1007/978-0-387-88433-2_3, � I-Springer Science+Business Media, LLC 2009. Ububanzi bolwazi lwethu bukhawulelwe kwi-chiropractic njengoko kunye nokulimala komqolo kunye neemeko. Ukuxoxa ngombandela, nceda uzive ukhululekile ukubuza uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

Echazwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Ubungakanani

INGXELO EBALULEKILEYO: UKUPHATHA KWE-EXTRA: Ukunyanga i-Sciatica Pain

Ulawulo lwe-Sciatica: Unyango lwe-Nonsurgical & Surgical Therapy

by UGqr Alex Jimenez | Chiropractic, Uvavanyo lweChiropractic, Iingxelo zeNtsholongwane yezonyango, Uchungechunge lweeKlinikhi, LweMpilo, Sciatica

Qwalasela oku kulandelayo, I-sciatica ligama lezonyango elisetyenziselwa ukuchaza iqela elihlangeneyo leempawu ezibangelwa ukucaphuka okanye ukunyanzeliswa kwe-nerve ye-sciatic, ngokuqhelekileyo ngenxa yokulimala okanye imeko enzima. I-Sciatica idla ngokubonakala ngokukhupha iintlungu kwi-nerve ye-sciatic, ehla imilenze enye okanye yomibini ukusuka kumqolo osezantsi. I-case vignette ilandelayo ixubusha imeko yezempilo kaMnu Winston, umqhubi webhasi oneminyaka engama-50 ubudala oye wabika ukuba ujongene nentlungu engapheliyo, ephantsi kunye nomlenze ohambelana ne-sciatica ngexesha leeveki ze-4. URamya Ramaswami, MB, BS, MPH, Zoher Ghogawala, MD, kunye noJames N. Weinstein, DO, babonelela ngohlalutyo olubanzi lweendlela ezahlukeneyo zonyango ezikhoyo ukunyanga i-sciatica, kubandakanywa utyando lwediski ye-lumbar kunye nokufumana unyango olungenamsebenzi.

Kwinqaku lomntu siqu, njengogqirha osebenzayo we-chiropractic, ukukhetha unyango oluchanekileyo naluphi na uhlobo lokulimala okanye imeko ingaba sisigqibo somntu kunye nesinzima. Ukuba iimeko ziyavuma, umguli usenokugqiba ukuba loluphi uhlobo lonyango olufanelekileyo kumbandela wabo wezonyango. Ngelixa iindlela zonyango ezingenanto, ezifana nokunyamekela kwe-chiropractic, zihlala zisetyenziselwa ukuphucula iimpawu ze-sciatica, iimeko ezinzima kakhulu ze-sciatica zingadinga ukungenelela kokuhlinzwa ukunyanga umthombo womcimbi. Kwiimeko ezininzi, unyango olungenalo utyando kufuneka luqwalaselwe kuqala, ngaphambi kokuba luguqukele kwiindlela zonyango zonyango lwe-sciatica.

Case Vignette

Indoda eneSciatica Eqwalasela uTyando lweLumbar Disk

URamya Ramaswami, MB, BS, MPH

UMnumzana Winston, umqhubi webhasi wase-50 oneminyaka engama-50 ubudala, wanikela kwiofisi yakho nge-4 yeveki yeembali zeentlungu ezisekhohlo zakhe kwaye ezantsi. Wachaza ukudibanisa kweentlungu ezibukhali kwaye ezibuhlungu ezivela kwisitye sakhe sasekhohlo kwaye zatshitshiswa kwisimo se-dorsolateral esikhwameni sakhe sobunxele, kunye nokugquma okungaqhelekanga phezu kwengcongolo engaphantsi. Ekuhloliseni, ukuphakanyiswa kwentloko ekhohlo kwinqanaba le-45 idigri kubangele ubuhlungu obukhulu obuye benza uphawu lwakhe oluphambili, kwaye intlungu yayinzima kangangokuthi awukwazi ukuphakamisa umlenze wakhe ngakumbi. Kwakungekho nweleka lomlenze okanye unyawo. Isalathisi somzimba wakhe (ubunzima kwiikhilogram ezahlulwe ngesikwere sokuphakama kwiimitha) yi-35, kwaye wayenezifo ezinokuphefumula ezingapheliyo zokuphefumula ngenxa yokubhema ipakethi enye yemigodi imihla ngemihla ye-22. UMnu Winston uthathe ikhefu lokungabikho emsebenzini wakhe ngenxa yeempawu zakhe. Unqume u-150 mg we-pregabalin ngosuku, okwenziwe ngokunyuka ukuya kwi-600 mg imihla ngemihla ngenxa yokuba iimpawu azizange zinciphise.

Ngoku, kwiiveki ezili-10 emva kokuqala kweempawu zakhe, ubuyela kuvavanyo. Iyeza linikeze ukuthomalalisa okuncinci kwintlungu yakhe ye-sciatic. Kufuneka abuyele emsebenzini kwaye uxhalabele amandla akhe okugqiba imisebenzi yakhe emsebenzini wakhe. Ufumana i-imaging resonance magnetic, ebonisa idiski ye-herniated kwicala lasekhohlo kwingcambu ye-L4�L5. Uxoxa ngeenketho zamanyathelo alandelayo ekulawuleni i-sciatica yakhe. Akaqinisekanga malunga neenkqubo ezihlaselayo ezifana nokuhlinzwa kwediski ye-lumbar kodwa uziva elinganiselwe ngeempawu zakhe zentlungu.

Izinyango Zonyango

Yikuphi kwezi zinto ezilandelayo ongasincoma kuMnu Winston?

Ngaphantsi kwe-disk ukuhlinzwa.
Ukufumana unyango olungenasigqeba.

Ukuncedisa ekwenzeni izigqibo, nganye yale ndlela ikhuselwe kwisicatshulwa esifutshane ngongcali entsimini. Ukunikezela ngolwazi lwakho ngesigulane kunye neengongoma ezenziwe yiingcali, yiyiphi ikhetho onokuyikhetha?

Option 1: Ngaphantsi kwe-Undergo Lumbar Disk Surgery
Option 2: Fumana unyango lwezonyango

1. Ngaphantsi kwe-Undergo Lumbar Disk Surgery

Zoher Ghogawala, MD

Ityala likaMnu Winston limele imeko eqhelekileyo ekulawuleni i-symptomatic lumbar disk herniation. Kule meko, iimpawu zesigulana kunye nokuhlolwa komzimba kuhambelana nokunyanzeliswa kwe-nerve-root kunye nokuvuvukala ngokuthe ngqo kwi-L4 L5 ye-herniated disk kwicala lakhe lasekhohlo. Isigulane asinakho ubuthathaka kodwa sinentlungu eqhubekayo kwaye asikwazanga ukusebenza kwiiveki ze-10 ezidlulileyo nangona sifumana i-pregabalin. Imibuzo emibini ivela: okokuqala, ngaba utyando lwe-lumbar disk (microdiskectomy) lubonelela ngeziphumo eziphezulu kunezo ziqhubeka nonyango olungasebenziyo kwizigulane ezineempawu ezingaphezu kweeveki ze-6; kwaye okwesibini, ngaba i-lumbar microdiskectomy iphucula amathuba okubuyela emsebenzini kwizigulane ezinezi mpawu?

Idatha ephezulu yeyona mxholo ivela kwiZiphumo zoPhando lweziPhumo zoPhando (SPORT). Iziphumo zoluvavanyo olulinganisiwe, olulawulwayo lunzima ukutolika kuba ukulandelelana kwesicwangciso sonyango esabelwe sisigxina. Ngesiqingatha sezigulane ezaziselwa ngesohlwayo iqela lotyando ngokwenene lafumana unyango phakathi kweenyanga ze-3 emva kokubhaliswa, kwaye i-30% yezigulane ezabelwe ukunyanga ezingekho nonyango zikhethe ukuwela kwiqela elisebenzayo. Kule sifundo, izigulane ezathi zenziwa ukuhlinzwa zineziphuculo ezinkulu kwiziphumo ezizaliswe zizigulane. Impembelelo yonyango ye-microdiskectomy yayingaphezulu kweyonyango engasebenziyo kwiinyanga ze-3, iminyaka ye-1, kunye ne-2 iminyaka. Ngaphezu koko, ekuhlalutyweni okuphenjisiweyo, iziphumo kwizigulane ezenza ukuhlinzwa zaziphezulu kunezo zigulane ezithe zafumana unyango olungasebenzi. Ngokubanzi, iziphumo ze-SPORT zixhasa ukusetyenziswa kwe-microdiskectomy kule meko.

Iziphumo zezilingo zeekliniki zisekelwe ekuthelekisweni kwonyango lwezonyango kwiindawo zokufunda kwaye zinokuthi zisebenze okanye zingenakwenzeka kwizigulane ngabanye. I-SPORT ayizange icacise ukuba luhlobo luni lwe-non-treatment. Ulwaphulo lwamaziko lwalusetyenziswa kwi-73% yezigulane, ii-injection epidural kwi-50%, kunye neyeza zonyango (umz., Iziyobisi ezingekho komlilo) ezingaphezu kwe-50%. Kwimeko kaMnumzana Winston, i-pregabalin iye yazama, kodwa unyango lomzimba kunye neenjini zangasese ze-glucocorticoid azange zenziwe. Nangona kusetyenziswe ukusetyenziswa kwonyango lonyango ekwenzeni unyango lwe-lumbar disk, ububungqina obuxhasa ukuphumelela kwayo akuhambelani, ngokwemiqathango epapashwe nguMbutho we-North American Spine Society. Ngakolunye uhlangothi, kukho ubungqina bokuthi i-transforaminal epidural glucocorticoid injection inikeza inkululeko yesikhashana (iintsuku ze-30) kwizigulane ezineempawu ezinengcambu ezihambelana ngqo nediski ye-herniated. Ngokubanzi, kukho ubungqina, ukusuka kwi-SPORT nakwiilingo ezingenangqondo ukusuka eNetherlands eshicilelwe kwiNcwadi, ukuba ukuhlinzwa kwangaphambili phakathi kwe-6 kunye ne-12 iveki emva kokuqala kweempawu kunceda kakhulu ukunciphisa intlungu yomlenze kunye nokuphuculwa kabuhlungu obukhulu kunokuba unyango olulondoloze ixesha elide.

Ukukwazi ukubuyela emsebenzini akuzange kufundwe ngokusemthethweni ngokuthelekiswa kokusebenza kunye nokunyanga okungekho unyango kwi-lumbar disk herniation. Idatha yeRejista evela kwi-NeuroPoint-SD yabonisa ukuba ngaphezu kwe-80% yezigulane ezazisasebenza ngaphambi kokuba i-disk herniation ibuyele emsebenzini emva kokuhlinzwa. Ukukwazi ukubuyela emsebenzini kunokuba kuxhomekeke kuhlobo lolwazi, kuba izigulane ezisebenzayo zingasebenzisa ixesha elingakumbi lokubuyisela ukunciphisa umngcipheko wokubuyiselwa.

Kuyaqondwa kakuhle ukuba izigulane ezininzi ezine-symptomatic lumbar disk herniation ziya kuphucula ngokukhawuleza kwiinyanga ezininzi. Utyando lunokunciphisa iimpawu ngokukhawuleza ngokukhawuleza ngokususa i-disk herniation ephosakeleyo kwingcambu ye-nerve echaphazelekayo. I-Risk Benefit equation iyakwahluka kwisigulana ngasinye. Kwimeko kaMnu Winston, ukukhuluphala kunye nesifo esincinci se-pulmonary kunokunyusa umngcipheko weengxaki ezivela kukuhlinzwa, nangona kwi-SPORT, i-95% yezigulane zokuhlinzwa zazingenayo nayiphi na ingxaki yokusebenza okanye emva kokuhlinzwa. KuMnu Winston, isigulane esinentlungu eqhubekayo ngaphezu kweeveki ze-6, i-microdiskectomy iyindlela enengqondo exhaswa bubungqina obuphezulu.

2. Fumana unyango lwezonyango

UJames N. Weinstein, WENZA

Eli tyala libandakanya umboniso oqhelekileyo weentlungu ezisezantsi eziphuma kwi-buttock kunye nethanga le-posterolateral elinokuthi libonise intlungu yomatshini okanye i-radiculopathy. I-radiculopathy ye-Classic ebangelwa ukunyanzeliswa kwe-root lumbar nerve root (L4, L5, okanye i-S1) ibangela intlungu ekhupha i-distal ukuya emadolweni kwaye ihlala ihamba nobuthathaka okanye ukuphazamiseka kwi-myotome okanye i-dermatome. Kule meko, intlungu isondele emadolweni kwaye ayihambelani nobuthathaka okanye ukuphazamiseka. Kwi-SPORT, utyando lubangele ukubuyiswa ngokukhawuleza kunye nenqanaba eliphezulu lokuphucula kunonyango olungasebenziyo kwizigulane ezinentlungu ekhupha i-distal emadolweni kwaye ihamba kunye neempawu ze-neurologic okanye iimpawu. Nangona kunjalo, ekubeni uMnumzane Winston akayi kuhlangabezana neendlela zokufakwa kwe-SPORT, iziphumo ze-diskectomy kule meko ziya kuba yinto engalindelekanga. Akanayo i-radiculopathy ephuma ngaphantsi kwedolo, kwaye ayinakho ubuthathaka okanye i-numbness; unyango olungasebenziyo lufanele lugqitywe ngaphambi kokuba naluphi na uqwalaselo lwenkqubo yotyando kwiimeko ezininzi aluzange luboniswe ukuba lusebenza kakuhle kwizigulane ezinolu hlobo lokubonisa. Kulo mbandela weJournal, uMathieson kunye noogxa bakhe babika iziphumo zovavanyo olungahleliwe, olulawulwayo olubonisa ukuba i-pregabalin ayizange inciphise kakhulu intlungu ehambelana ne-sciatica. UMnu Winston uye waphathwa kuphela nge-pregabalin; ngoko ke, ezinye iindlela zokulondoloza kufuneka zijongwe.

I-Saal kunye ne-Saal ibike ukuba ngaphezu kwe-80% yezigulane ezine-radiculopathy ezinxulumene ne-lumbar disk herniation ziye zaphuculwa kwimiba yeenyanga kunye nonyango olusekelwe kumzimba. Kwiqela le-SPORT elingasebenziyo, izigulane ziye zaphucula kakhulu ukusuka kwisiseko, kwaye malunga ne-60% yalabo abane-radiculopathy ye-classic abaqale bafumana unyango olungasebenziyo bagweme utyando. UMnu Winston uye wafumana unyango oluncinci kwaye uneempawu kwiiveki ze-10 kuphela. Kufuneka enze ikhosi yonyango lomzimba olusekelwe kwi-exercise kunye nolingo lweyeza elichasene ne-nonsteroidal antiinflammatory kwaye unokuqwalasela inaliti ye-lumbar epidural glucocorticoid. Nangona kukho ubungqina obuncinane bokusebenza kolu khetho lungasebenziyo lulodwa, indibaniselwano yolu nyango kunye nembali yendalo enobungozi yemeko yesigulana inokukhokelela ekuthotyweni okanye ekusonjululweni kweempawu. Ukuba olu ngenelelo � kunye nexesha � azizisombululi iimpawu zakhe, utyando lunokuthathwa njengokhetho lokugqibela, kodwa alunakusebenza ixesha elide kwaye lunokuthi ngokwalo lubangele ukwenzakala okungaphezulu kunokulunga. UMnu Winston unemingcipheko, njengokutyeba kakhulu kunye nembali yokutshaya, eziye zaboniswa ukuba negalelo kwiziphumo zotyando ezimbi zeenkqubo ezithile zomgogodla.

UMnu Winston unempawu zeentlungu ezithintekayo eziphazamisa umgangatho wobomi. Uya kufuneka ukuba aqonde, ngokwenza iinqunto ezenziwe ngokubambisana, ukuba indlela engabonakaliyo iyasebenza ngakumbi kunokuba utyunjiswe ngexesha.

Ulwazi olubhekiselele kwiZiko leSizwe loLwazi lwe-Biotechnology (NCBI) kunye neNew England Journal of Medicine (NEJM). Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nokulimala komgogodla kunye neemeko. Ukuxoxa ngombandela, nceda uzive ukhululekile ukubuza uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

Ikhankanywe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Ubungakanani

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