Ngā werohanga puru metilīni mō te mamae tuara nō te kōpae: ngā kitenga o ngā whakamātautau

He tohumate te mamae o te tuararo, ehara i te whakatau mate. Mā taua wehewehenga e mōhiotia ai mēnā he tikanga tō tētahi kerēme mō te puru metilīni hei āwhina i te mamae tuara.

Mō te nuinga o te mamae tuara, kāore he hanganga kotahi ka taea te kī pū koia te pūtake. He kerēme whāiti ake te mamae nō te kōpae. E kī ana tēnei nō ngā pito io i roto i tētahi kōpae motuhake i waenga i ngā pūiwi te mamae. Ko te tikanga, kei tētahi wāhi kua kapiti te mowhiti o waho, arā te annulus, ā, kua āhei ngā io iti ki te tipu whakaroto, me ngā tohu kakātanga ki te kuhu whakaroto. He ngāwari te whakapuaki i tēnei whakaaro, engari he uaua te whakamātau i tōna pono, nā te mea he maha ngā kōpae kua heke te kounga ka kitea i te MRI, kāore rawa e mamae. E kore te whakaahua anake e tautuhi i te pūtake.

Koia i tīmata ai ngā whakamātautau e rua e kōrerohia ana i konei ki te whakaahua kōpae hei whakaoho mamae. Mā te whakaahua hihirangi haere tonu e ārahi te whakauru i tētahi ngira ki te karihi i waenganui o te kōpae e whakapaetia ana. Ka werohia he wai whakakite i raro i te pēhanga e whakahaeretia ana, ā, ka pātai te rata i tētahi pātai māmā: ka whakahoki mai rānei te whakapēhanga i tēnei kōpae i tō mamae o mua? Ka whakamātauria kia kotahi neke atu te kōpae tata hei whakataurite, ā, me noho mamae kore taua kōpae. Ko ngā tūroro anake e mamae ana te kōpae i runga i te āhua o tō rātou mamae o mua, ā, e mamae kore ana te kōpae whakataurite, ka anga whakamua. He mahi kuhu ki roto i te tinana tēnei hei kōwhiri tūroro, ā, ka whakaawe i ngā mahi katoa ka whai mai.

I ētahi wā ka whakaaro ngā kaipānui kātahi anō ka ako he aha te puru metilīni i te taumata matū, he pānga tō te werohanga i rangahaua i ēnei whakamātautau ki te inu wai puru. Kāore. Mā te werohanga puru metilīni ki roto i te kōpae ka tukuna tika atu te āhua 10 mg o te waikano ki roto i tētahi kōpae kua tautuhia kētia he kōpae mamae. He whakapae ā-rohe te whakapae: tērā pea ka whakangaro, ka whakatau rānei te waikano i ngā pito io iti i ngā kapiti o te annulus, ka whakaiti hoki i te kakātanga o taua wāhi. Ki te tū taua tukanga, ka whakawhirinaki ki te pā tika o te waikano ki roto i taua kōpae.

Te tukanga i whakamahia i ngā whakamātautau e rua

He tauira whaihua hei whakaaro ake, he rūma hiritia kotahi noa tōna tomokanga. Ko te kōpae taua rūma. Ko te tomokanga he ngira e ārahina ana mā te whakaahua hihirangi haere tonu, mā tētahi ara nō muri, nō te taha hoki i te nuinga o te wā. Kia whakaūngia te tūnga, ka āta werohia te wai rangahau ki te karihi.

I hoatu hoki e ngā whakamātautau e rua tētahi atu mea ki roto i te kōpae. I te whakamātautau tōmua i hoatu te 1 mL o te puru metilīni 1 ōrau, whai muri ko te 1 mL o te lidocaine 2 ōrau. I te whakamātautau o muri i hoatu te 1 mL o te puru metilīni, 10 mg mō ia mL, me te 0.5 mL o te lidocaine 2 ōrau me te 0.5 mL o te wai whakakite. Nō reira, ehara rawa te whakataurite i te werohanga ki te kore tukanga. I whakaurua he ngira ki ngā rōpū e rua, i whakapēhangatia te kōpae, ā, i hoatu he matū whakamoe ā-rohe ki roto i te kōpae. Ko te rerekētanga anake i whakamaheretia ko te puru metilīni ki te wai tote. Ka āwhina ngā taipitopito mō te mahi a te puru metilīni i roto i ngā pūtau ki te whakamārama i te whakaaro o ngā kairangahau tērā pea he pānga ā-rohe tōna, engari ehara te āhua whai take o tētahi whakaaro i te taunakitanga.

He mea nui tēnei i te pānui i te urupare o te rōpū whakataurite. Kei roto i ngā whakapaitanga o te rōpū whakataurite i konei ngā tikanga o tētahi tukanga ki te tuaiwi, te lidocaine, te haere māori o te mamae, me te tūmanako ka māmā ake.

Te whakamātautau tōmua i kitea ai he painga

I whakauru te whakamātautau matapōkere a Peng me ōna hoa i te tau 2010 i ngā pakeke 72 e mauroa ana te mamae o te tuararo i tōna tuaka, kāore he mamae io o te waewae. Neke atu i te 6 marama ngā tohumate ahakoa te haumanu whakapakari tinana me te maimoatanga whakaiti kakātanga, maimoatanga opioid rānei. I kitea i te MRI he hekenga o te kounga o te kōpae engari e mau tonu ana tōna teitei, kāore he hītori pokanga ki te tuaiwi o raro, ā, i whakaoho mamae te whakaahua kōpae, engari kāore te kōpae whakataurite tata i whakaoho mamae. Toru tekau mā ono i whiwhi i te puru metilīni me te lidocaine ki roto i te kōpae. Toru tekau mā ono i whiwhi i te wai tote me te lidocaine. Kāore ngā tūroro me ngā kaiaromatawai putanga i mōhio ko tēhea maimoatanga i hoatu. Kāore i taea te huna tēnei i te kaiwhakawero nā te mea he puru te waikano.

He roa te aroturuki: 6, 12, me te 24 marama. Ko ngā putanga ine ko te mamae i runga i tētahi tauine tau mai i te 0 ki te 100, te hauātanga i runga i te Taupū Hauātanga Oswestry mai i te 0 ki te 100, me te pai ki te maimoatanga, te whakamahi rongoā whakamāmā mamae, me ngā raruraru. He rahi rerekē te hua i whakaputaina. I heke te mamae toharite mai i te āhua 72 ki te āhua 20 i te rōpū puru metilīni i te 24 marama, engari i neke te rōpū whakataurite mai i te āhua 67 ki te āhua 60. I heke te hauātanga mai i te āhua 48 ki te āhua 13 mā te puru metilīni, engari kāore i tino rerekē i te rōpū whakataurite. I te 24 marama, 33 o ngā tūroro 36 i whiwhi i te maimoatanga i pūrongo i tō rātou pai, tino pai rānei ki te maimoatanga, engari 5 o ngā tūroro whakataurite 35 i pūrongo pēnei. I pūrongo te nuinga o ngā tūroro i whiwhi i te maimoatanga kāore rātou i whakamahi rongoā whakamāmā mamae. Kāore he pokenga kōpae, he wharanga io rānei i pūrongotia i te wā aroturuki. I whakaahua ngā kaituhi i te maimoatanga hei mea haumaru, whai hua, he iti hoki te kuhunga ki te tinana i tā rātou pūrongo i whakatauritea ki te maimoatanga horihori.

Ko tētahi hua pēnei te rahi, nō te pokapū kotahi me ngā tūroro 72 i kōwhiria, te momo hua e tika ana kia tukuruatia motuhaketia.

Te whakamātautau tukurua i ngā pokapū maha

I hangaia te rangahau IMBI a Kallewaard me ōna hoa hei whakamātautau tukurua i ngā pokapū e whā o Hōrana. Waru tekau mā whā ngā tūroro i whakaurua, ā, 81 i whakarato raraunga matapōkere ka taea te tātari: 40 mō te puru metilīni, 41 mō te maimoatanga horihori. I hiahiatia anō i te kōwhiringa he mamae mauroa i te tuaka o te tuara e hāngai ana ki te mamae nō te kōpae. I tēnei wā me 6 marama neke atu te mamae, kāore i rawaka te maimoatanga kore hāparapara, me 5 o te 10 neke atu te mamae i te noho, ā, me whai MRI i te tau o mua e whakakore ana i te hekenga nui o te teitei neke atu i te 50 ōrau. I whiwhi tuatahi ngā tūroro i te aukati io o ngā hononga facet hei whakakore i te mamae nō aua hononga. Whai muri ko te whakaahua kōpae paerewa, me te pēhanga e whakahaeretia ana, tētahi kōpae whakataurite tata, me ngā paenga pēhanga mārama. I mahia te tukanga i tētahi rūma pokanga, me te paturopi hei ārai pokenga me te tere werohanga pōturi e whakahaeretia ana. I whiwhi anō ngā tūroro whakataurite i te wai tote me te lidocaine me te wai whakakite.

Ko te putanga ine matua ko te angitu o te maimoatanga i te 6 marama. Ko tōna whakamāramatanga, kia 30 ōrau neke atu te hekenga o ngā kaute mamae toharite i kohia i ngā rā e whā, me tētahi aromatawai whānui o te panonitanga. Ko ngā ine tuarua ko te hauātanga Oswestry, ngā tauine kounga oranga, te āhua o te mamae, te whakamahi rongoā whakamāmā mamae, me ngā pānga kino. Ka taea e ngā tūroro maimoatanga horihori e mamae tonu ana te whiwhi i te puru metilīni i muri i te 6 marama. Nō reira, ka mutu te whakataurite matapōkere kāore anō kia whakawhitihia i te 6 marama, kaua e haere tonu ki te 12, ki te 24 marama rānei.

I te 6 marama i heke te mamae toharite mā te 1.4 ira i runga i tētahi tauine mai i te 0 ki te 10 mō te puru metilīni, mā te 1.2 ira hoki mō te rōpū whakataurite, ā, ko te uara p i waenga i ngā rōpū ko te 0.671. Ko ngā ōrau o te hunga i eke ki te paearu urupare ko te 35.0 ōrau ki te 26.8 ōrau, p he 0.426. I pai ake te hauātanga mā te 7.8 ira ki te 5.5 ira, p he 0.459. He tata ōrite ngā ōrau whakapaitanga whānui. I pā ngā āhuatanga poto, pēnei i te pikinga mamae mō te wā poto, i te mamae toro atu rānei, ki ngā rōpū e rua, kāore he rerekētanga whai tikanga ā-tatauranga i waenga i ngā rōpū. I whakatau ngā kaituhi i tā rātou pūrongo whakamātautau i ngā pokapū maha kāore ngā raraunga i tautoko i te taunaki i te puru metilīni ki roto i te kōpae mō te mamae mauroa nō te kōpae.

Te whakataurite i ngā whakamātautau

Mā tētahi taipitopito anō e ārai te rangirua. Ka hono ētahi whakarāpopototanga i tētahi paenga kōeke Pfirrmann ki ēnei whakamātautau. I ahu mai taua paenga i tētahi rangahau tōmua iti i Hōrana, kaua i ngā ture whakauru o tētahi o ngā whakamātautau matapōkere e rua kua whakarāpopototia i runga ake nei.

Te whakamāori i ngā kitenga taupatupatu

Ka taea e ngā whakamātautau pono e rua te whai kitenga rerekē, me te kore tētahi e tinihanga. Ko ngā rerekētanga hira ko te tika o te kōwhiringa, te whakarite paerewa mō te tukanga, ngā herenga o te huna maimoatanga, te rahi o te tīpako, me te whakamāramatanga o te putanga ine.

I kōwhiria e Peng tētahi rōpū whāiti nō te pokapū kotahi, ā, i aroturukihia mō ngā tau e rua kāore he whakawhiti maimoatanga. Mā tēnei e ngāwari ai te kite i tētahi tohu nui, engari e ngāwari ai hoki te whakanui rawa mēnā i rerekē te kōwhiri tūroro, ngā maimoatanga tāpiri, ngā tūmanako rānei i waenga i ngā rōpū, i ngā āhuatanga kāore i tuhia ki te pūrongo. I mōhio te kaiwhakawero ki te maimoatanga i tohaina. E kore tēnei e taea te karo me te waikano puru, engari he ngoikoretanga tonu. I whakamahia e IMBI ngā pokapū maha, ngā paearu pēhanga tōtika ake, te tirotiro hononga facet, te tere werohanga paerewa, me tētahi whakamāramatanga i whakaritea i mua mō te hunga e eke ana ki te paearu urupare i te 6 marama. He iti ake te tūponotanga ka puta he hua tino rahi i te tūpono noa mā taua hoahoa, engari he pātai mō te wā poto ake hoki tāna e whakautu ai. Kāore he kōrero pakari āna mō ngā putanga matapōkere i te 24 marama, nā te mea i whakaaetia te rōpū whakataurite kia whakawhiti maimoatanga i muri i te 6 marama.

Mō te tūroro, mō te mātanga haumanu rānei, ko te whakamāoritanga whai take he mea tūpato. I kitea e tētahi whakamātautau iti tōmua he painga tino nui, toitū hoki. I kitea e tētahi whakamātautau tukurua nui ake, kua whakaritea ki te paerewa, he pikinga iti noa kāore i whai tikanga ā-tatauranga i tua atu i te tukanga whakataurite kua whai lidocaine kē. Ka whakaiti taua tauira i te whakapono, kaua e whakaū i te whai huatanga. Ko te tangata ka tukuna he werohanga puru metilīni ki te kōpae hei kōwhiringa, me pātai he aha ngā paearu kōwhiri a te whare haumanu, mēnā e hiahiatia ana te whakaahua kōpae me tētahi kōpae whakataurite, he aha ngā mea ka werohia ngātahitia, he aha te ōrau angitu e kerēmehia ana e te whare haumanu i te 6 marama mā tētahi whakamāramatanga mamae i whakaritea i mua, ā, me pēhea te whaiwhai i ngā raruraru me te aroturuki. He pai te pānui i ngā whakamārama mō ngā pātai haumaru e pā ana ki te whakamahi puru metilīni i mua i tētahi mahere kuhu ki te tinana. He pai hoki te pānui i te horopaki whānui mō ngā mea kua whakaaturia, kāore anō hoki kia whakaaturia, e te rangahau haumanu mō te puru metilīni.

Te take kāore tēnei e tautoko i ngā pata ā-waha, i ngā rare ngaungau rānei

He wāhanga te ara tuku nō te maimoatanga. I whakamātau ēnei rangahau i te waikano i tukuna ki roto i tētahi kōpae kua kōwhiria. Ka haere te puru metilīni kua horomia mā te whēkau ki te rerenga toto puta noa i te tinana, ā, ka tae ki ngā kiko i ngā kukūtanga tino iti iho, he iti iho hoki te arotahi ki te wāhi kotahi. Kāore he inenga i ēnei whakamātautau e whakaatu ana ka taea e tētahi rahinga ā-waha te whakahoki i taua kukūtanga, i taua wā noho rānei ki roto i tētahi kōpae o te tuaiwi o raro. Ahakoa i kitea anō taua pānga ki roto i te kōpae i te whakamātautau tukurua, e kore tonu e taea te whakawhiti atu ki te inu, ki te pata, ki te rare ngaungau rānei, me te kore whakamātautau motuhake e whakamahi ana i taua ara tuku, i taua rahinga, me taua momo taupori mamae.

Kāore hoki te haumaru e whakawhiti. Mā te pānga puta noa i te tinana ka puta ngā pāhekoheko puta noa i te tinana, tae atu ki te pāhekoheko kua tino tuhia ki ngā rongoā e pā ana ki te serotonin. He rerekē te pānga o tētahi tukanga ā-rohe ki te kōpae i tō te whakamahi ā-waha ia rā, he rerekē hoki ō rāua āhuatanga mōrea. Ka hōhonu ake te kōrero mō tēnei i ngā taunakitanga mō ngā pāhekoheko rongoā o te puru metilīni.

He whāiti te whakatau matua. I pūrongo tētahi whakamātautau tōmua o te werohanga puru metilīni ki te kōpae i tētahi whakamāmātanga tino nui mō ngā tau e rua. Kāore te whakamātautau tukurua o muri, i whakatauritea ki te maimoatanga horihori i ngā pokapū maha, i kite anō i taua hua i te ono marama. Ehara tētahi o aua hua i te taunakitanga ka āwhina te puru metilīni ā-waha i te mamae tuara.