Maofesi a pafupi ndi nthambi ali ndi malo ofunikira mankhwala opweteka kumbuyo. Malingana ndi E-Medicine , akatswiri ambiri amakhulupirira kuti mavuto omwe ali nawo m'gululi amakhala ovuta kwambiri pamtima (mwina 80%).
Kumvetsa kutengera kwanu kungakhale kothandiza kumvetsetsa kupweteka kwa ululu ndi mankhwala ake. Choyamba, dziwani kuti chigawo chophatikizana ndi chimene chimapangitsa mgwirizano wa msana kumakhala panthawi imodzimodzi ndikuthandizira mitundu ina.
Zimatchedwanso zygapopseseal, komanso Z-joint. Mitsempha yam'kati imakhala kunja kwina ndipo imakhala yosavomerezeka. Imodzi mwa nthambi zitatu za mitsempha yambiri yomwe imatchedwa dorsal ramus, yomwe ndi yoyamba yogawidwa mitsempha yochokera ku mitsempha ya msana. Kumbukirani, kubwezera kumatanthauza kubwerera ndi ramus kutanthauza nthambi.
Mitsempha itatu yomwe imayambira kuchokera ku dorsal ramus imagwira ntchito zambiri, kuphatikizapo mitsempha ya kumbuyo. Nthambi yeniyeni makamaka imakhudza mbali yodziphatikiza yokha komanso minofu yakuya monga interspinales , multifidus , ndi ena ochepa. Nthambi yamakono imatha kufika pamtunda umodzi umodzi (zozizwitsa) komanso mwina ziwiri (ligamentum flavum).
Kodi Maofesi a Nthambi Zakale Ndi Chiyani?
Pamene muli ndi malo osungirako nthambi, mankhwala am'deralo monga lidocaine amalowetsedwa mu mitsempha yamkati ya gululi. Kujambulira minofu ya m'mimba kumathandiza madokotala kuzindikira matenda opweteka.
Ngati jekeseniyo imachepetsa kupweteka kwafupipafupi kwapakati pa 50%, dokotala wanu angatsimikizire kuti ululu umabwera kuchokera ku chigawochi ndikupatsanso njira yowonjezereka ya mankhwalawa. Zida zamagulu zamkati zimagwiritsidwanso ntchito pozindikira kupweteka kwajambulidwa kwa sacroiliac.
Mukhoza kukhala ndi nthambi yapakati pa mbali imodzi yokhayoyi kapena awiriwo.
Pamene mbali zonsezi zikuchiritsidwa, zimatchedwa jekeseni ya bi-lateral.
Nthambi Zamkatikati kapena Zironda Zosakaniza
Jekeseni wina womwe umapezeka kuti umamva ululu wammbuyo ndi injection ya intra-articular. Kujambulidwa kumeneku kumadutsa mu malo ozungulira omwe ali pafupi ndi kapule wopangidwa ndi minofu yolimba. Phunziro lina la 2016 lofalitsidwa mu magazini ya Pain Physician , mwa zina, kuti bungwe pakati pa nthambi yapakati ndilolumikizana bwino lingakhale lalikulu kuposa injini ya intra-articular ndi chithandizo. Izi zati, olemba amayitanitsa maphunziro apamwamba apamwamba kuti achite pa phunziroli asanatsimikizire izi.
Nthambi Yachiwiri Imakhala Ngati Matenda
Kodi mabungwe a nthambi zamkati angagwiritsidwe ntchito ngati mankhwala? Ndipotu, amachepetsa ululu, chabwino?
Ngakhale kuti nthawi zambiri nthambi yamakono imaperekedwa kuti ipeze matenda, nthawi zina imagwiritsidwa ntchito ngati mankhwala, koma imagwira ntchito bwino bwanji?
Phunziro la 2013 lomwe linasindikizidwa mu Annals of Medicine Rehabilitative Medicine linapeza kuti anthu omwe ali ndi nthambi yapakati amayesetsa kupweteka kwapakati pa matenda osteoporotic omwe akutsatiridwa ndi mankhwala a vertebroplasty kapena mankhwala osamala, zotsatira zake zinali zabwino kwa chaka.
Olembawo amanena kuti nthambi yanthambi yapakati imapereka mpumulo wopweteka komanso opaleshoni ya odwalawa.
Koma kafukufuku wa 2012 yemwe adafufuza njira zosiyanasiyana zochiritsira zothandizana ndi ma thoritic, amapeza umboni wokwanira wa nthambi yomwe imakhala ngati njira yochepetsera ululu wosatha m'deralo. Izi zinati, ofufuza sadatha kufanizitsa nthambi zamakono ndi jekeseni za intra-articular, chifukwa panalibe umboni uliwonse wa mankhwala ochiritsira. Ndipo maphunziro a PM & R omwe tatchulidwa pamwambapa, ndiye umboni wochepa wokha umene unapezeka chifukwa cha mpweya wabwino wa mpweya. Kugwiritsiridwa ntchito kwa pulogalamu ya pulogalamu ya radiofrequency ndi / kapena neurotomy kumakhala kofala kwambiri pa matenda opatsirana opweteka kwambiri kusiyana ndi nthambi yamkati.
Kuperewera kwa mankhwala ndi njira yowonongeka yomwe imatentha kutentha kwa mitsempha yoyandikana nayo, kupha maselo. Pakapita nthawi, thupi limalowetsa maselo a mitsempha yakufa ndi minofu yofiira. Ngakhale kuti kuperewera kwa mpweya woopsa kumatengedwa ngati kutsutsana, kupatsirana m'magazi angapangitse kupweteka kwanthawi yaitali kuposa m'madera ena a msana. Phunziro la 2015 lomwe linafalitsidwa mu International Journal of Anesthetics ndi Anesthesiology, linapeza kuti zaka ziwiri zitakhala kuti zimapangitsa kuti anthu asamawonongeke, odwala amatha kupwetekedwa bwino, amatha kugwira ntchito komanso mankhwala omwe amafunikira kwambiri.
Mu mpweya wabwino, mtundu womwewo wa kutentha-kuchokera mafunde a wailesi-amagwiritsidwa ntchito kuti athetsere kupweteka kwa kanthaŵi kochepa. Phunziro la 2012 lomwe linatulutsidwa mu nyuzipepala ya PM & R ( Physical Medicine and Rehabilitation ) inapeza kuti mpumulo wa kupweteka chifukwa cha kupweteka kwa mpweya woipa kwambiri unatenga pakati pa miyezi 7 mpaka 9 kwa odwala ambiri, ndipo izi zinali zowona ngati malo ochiritsidwa anali m'khosi kapena kumbuyo.
Kodi N'chiyani Chimachitika M'kati mwa Nthambi Yakale?
Ngati mukuyenera kukhala ndi nthambi yamalonda, kodi mungayembekezere chiyani?
Ndondomekoyi idzachitika mchipatala ndipo simudzagona, koma izi nzabwino! Dokotala amayamba kukupatsani mfuti ya mankhwala am'deralo kuti asokoneze khungu lanu ndi minofu pafupi ndi mbaliyi. Mudzagona pamimba kuti dokotala adziwe mbali zanu, zomwe ziri kumbuyo kwa mzere wa msana.
Kenaka iye adzaika singano yomwe imayendetsedwa ndi kamera yotchedwa fluoroscope kumalo ozungulira mbali. Kupyolera mu singano, dye wosiyana adzajambulidwa m'deralo. Izi zimapangitsa dokotala kuona ngati wothandizira amene akugwiritsidwa ntchito akugwiritsira ntchito chigawo chonse chozungulira mbaliyi. Kenaka, mankhwala amadzimadzi amadzipangidwira mkati.
Dokotala atakulowetsani, akhoza kukutsogolerani kuti azichita zofanana zomwe zimabweretsa ululu kapena zizindikiro zanu. Malinga ndi Anthony Vaccaro, MD, pulofesa wa matenda a ubongo ndi opaleshoni ya mafupa ku yunivesite ya Thomas Jefferson ku Philadelphia ndi mkulu wa Spinal Cord Kuvulaza, pakati pa 50% ndi 75% kupweteka kwapweteka kudzapatsa dokotala chifukwa chokutsimikizira kuti ndiwe wobwerera kwanu ululu ukubwera kuchokera ku chigawo chanu pamodzi ndi / kapena mitsempha yanu yanthambi yapakati.
Chifukwa chigawo chilichonse chophatikizidwa chimaperekedwa ndi mitsempha iwiri ya nthambi (imodzi kuchokera ku vertebra pamwamba ndi imodzi kuchokera ku vertebra ili m'munsimu) mungalandire zipolopolo ziwiri za kupweteka kwa mankhwala pa chigawo chilichonse cholemba chizindikiro cha mankhwala.
Izi zingachititse chisokonezo pankhani yodalirana ndi kulemba. Ndipotu, m'zaka zaposachedwapa, mavuto omwe ali ndi majekeseni omwe amagwiritsidwa ntchito poyambitsa jekeseni amachititsa kukhala ndi mankhwala ambiri a Medicare.
Medicare Zopanda Nkhanza ndi Nkhanza Zogwirizana ndi Zowonongeka Zachigawo
Lipoti la 2008 lolembedwa ndi Health and Human Services Office la Inspector General linapeza kuwonjezeka kwa 76% mu madera a Medicare chifukwa cha mbali ya pakati pa zaka za 2003 ndi 2006. Olembawo anapeza kuti mwa izi, 63% zolemba zolakwika (82% mwa izi zinapangitsa kuti kulipira malipiro a Medicare) ndi / kapena osati mankhwala.
Mu 2006, Medicare anapereka ndalama zokwana madola 81 miliyoni kwa madokotala omwe sanali olembedwa bwino kapena osatchulidwa konse. Lipotili linanena kuti ngakhale zina mwazipepala zosayenera zinali zochokera ku zolemba zolembedwa, ena mwina adakhalapo ndi jekeseni zomwe sizinachitike nkomwe. Malinga ndi lipotili, nthawi zambiri, madokotala odwala amapereka mankhwala odwala kwa Medicare, koma nthawi zina, iwo sanachite ngakhale kuti adalipidwa.
Zina mwa zolakwika m'mabuku operekedwa kwa Medicare zidaphatikizapo kufotokozedwa kwa ndondomeko yomwe yachitidwa, kapena kusowa mfundo, mwachitsanzo, kudziwika kwa msana wam'mimba ndi / kapena mbali ya kumbuyo (ie, kumanzere, kumanzere kapena onse) omwe analandira jekeseni .
Ndondomeko zowonjezera ndalama zomwe zikuyenera kuwonetsa majekesiti (mwachitsanzo, kuwombera mbali zonse za gawo lanu pamodzi) kunabweretsa malipiro 50% kuposa momwe Medicare akanayenera kulola, lipoti likunena. Olemba a lipoti amanena kuti ngakhale zina mwa zolakwikazi mwinamwake mwangozi, ena mwina zizindikiro zachinyengo mwadala.
Lipotili linanenanso kuti madokotala omwe amapita kuchipatala amatha kuchita zolakwika ngati zimenezi komanso / kapena kuchita chinyengo kusiyana ndi omwe amapita kuchipatala. Kuyerekeza kunali 71% ya majekiti opangira jekeseni operekedwa ku ofesi kwa 51% kwa omwe amaperekedwa ku chipatala monga chipatala.
Mwina zifukwa zoipitsitsazo ndizo zomwe anazipereka zomwe sizinali zofunikira kuchipatala. Malinga ndi lipotili, chiwerengero cha chinyengochi chinali $ 17 miliyoni.
> Zotsatira:
> Bentin, C. kwa AMA. Kuwonetsera kosavomerezeka kwa ofesi ya nthambi: Zovuta zapamwamba zowonongeka Zomwe Zapezeka Pa Kugonjetsa Kufufuza Zomwe Akufufuza AscReview Website. Sept 2010.
> Holz, S., Sehgal, N. Kodi Chigwirizano Chotani pakati pa Zophatikizira Zowonjezera Zowonongeka Pamodzi ndi Kuyankha kwa Zomwe Zimagwirizanitsa Nthambi Zakale? Pain Physician. March 2016. http://www.ncbi.nlm.nih.gov/pubmed/27008290.
> Malanga, GMD, Young, CMD ndi. Al Lumbosacral Facet Syndrome. E-Medicine Medscape Website. Sept 2015. https://emedicine.medscape.com/article/94871-overview#a6.
> Manchikanti K., Atluri S., Singh V., Geffert S., Sehgal N., Falco F. Chotsitsimutso cha Kuunika kwa Zochitika Zachilendo Zochiritsira. Pain Physician. July-Aug 2012. http://www.ncbi.nlm.nih.gov/pubmed/22828694.
> McCormick, Z., Benjamin Marshall, B., Jeremy Walker, J., Robert McCarthy, R., Walega, D. Ntchito ya Nthawi Zakale, Zowawa ndi Zamagwiritsidwe Ntchito Zopangira Mafilimu Omwe Amagwiritsidwa Ntchito Momwe Amagwiritsire Ntchito Lumbar Facet Syndrome. Int J Anesth Anesth. April 2015.
> Park, K. MD, Jee, H. PhD, Nam, H., MD, Cho, S., MD. Kim, H., MD, Park, Y., MD, Lim, O., MD. Zotsatira za Nthambi Yakale Imakhala Yovuta Kwambiri Kuphatikizika Kwapakati pa Kutha Kuthana Kwambiri kwa Osteoporotic: Phunziro Loyamba la Zomwe Mwapindula. Ann Rehabil Med. April 2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660479/.
> Smuck M., Crisostomo R., Trivedi K., Agrawal D. Kupambana kwa Zoyamba ndi Zomwe Zachiwiri Zachigawo Zowonjezera Zomwe Zikugwiritsidwa Ntchito Zygapophysial Paint Pain: Review Review. PM R. September 2012.
> Vaccaro, A. Spine: Chidziwitso Chachikulu mu Orthopedics. Mosby. 2005. Philadelphia. Pp 63-64.