Jekeseni wa methylene blue mkati mwa disiki pa ululu wa msana: kuyerekezera mayesero

Ululu wa m'munsi mwa msana ndi chizindikiro, osati dzina la matenda otsimikiziridwa. Kusiyanitsa kumeneku n'kumene kumatsimikizira ngati zonena zilizonse zokhudza methylene blue pa ululu wa msana zili ndi tanthauzo.

Pa ululu wambiri wa msana, palibe gawo limodzi la thupi limene linganenedwe motsimikiza kuti ndilo likuchititsa ululuwo. Kunena kuti ululu ukuchokera ku disiki ndi kunena za chinthu chenicheni kwambiri. Kumatanthauza kuti ululuwo ukuchokera ku malekezero a mitsempha ya kumva mkati mwa disiki imodzi yeniyeni yomwe ili pakati pa mafupa a msana. Nthawi zambiri zimenezi zimachitika pamene mphete yakunja, yotchedwa annulus, yang'ambika, n'kulola mitsempha yaing'ono ndi zizindikiro zoyambitsa kutupa kulowa mkati. Mfundo imeneyi ndi yosavuta kufotokoza koma yovuta kutsimikizira, chifukwa madisiki ambiri owonongeka amene amaoneka pa MRI sapweteka n'komwe. Chithunzi chokha sichingazindikire disiki yomwe ikuchititsa ululuwo.

N'chifukwa chake mayesero onse awiri amene tikukambirana pano anayamba ndi discography yoyambitsa ululu kuti azindikire gwero lake. Pogwiritsa ntchito fluoroscopy, yomwe imasonyeza zithunzi za X-ray pamene ntchitoyo ikuchitika, singano imayikidwa mu nucleus, pakati pa disiki yomwe ikuganiziridwa kuti ndi gwero la ululu. Kenako amabaya madzi osonyeza bwino pa X-ray ndi kuthamanga kolamulidwa, ndipo dokotala amafunsa funso losavuta: kodi kuwonjezera kuthamanga mkati mwa disiki imeneyi kukuyambitsa ululu umene mumamva nthawi zonse? Disiki imodzi kapena kuposerapo yapafupi imayesedwanso ngati yoyerekezera, ndipo iyenera kukhala yosapweteka. Odwala okhawo amene disiki yowawa imayambitsa ululu wawo wanthawi zonse, pamene disiki yoyerekezera sipweteka, ndi amene amapitiriza. Iyi ndi njira yosankha odwala yomwe imalowa m'thupi, ndipo imakhudza zonse zimene zimatsatira.

Owerenga amene sadziwa bwino kuti methylene blue ndi chiyani pa nkhani ya kapangidwe kake ka mankhwala nthawi zina amaganiza kuti jekeseni wophunziridwa m'mayesero amenewa ndi wofanana ndi kumwa madzi abuluu. Si choncho. Jekeseni wa methylene blue mkati mwa disiki umayika pafupifupi 10 mg ya utoto mwachindunji mkati mwa disiki imodzi yomwe yadziwika kale kuti imapweteka. Lingaliro loyesedwa linali lokhudza malo amenewo okha: utotowo ungawononge kapena kuchepetsa kugwira ntchito kwa malekezero aang'ono a mitsempha ya kumva m'ming'alu ya annulus, ndi kuchepetsa kutupa komweko. Njira imeneyi, ngati ilipo, imadalira kukhudzana mwachindunji mkati mwa disiki imeneyo.

Njira yomwe inagwiritsidwa ntchito m'mayesero onse awiri

Njira yothandiza kumvetsa zimenezi ndi kuganizira chipinda chotsekedwa chokhala ndi khomo limodzi. Chipindacho ndi disiki. Khomo lake ndi singano yowongoleredwa ndi fluoroscopy, yomwe nthawi zambiri imalowa kuchokera kumbuyo ndi kumbali. Akatsimikizira kuti singanoyo ili pamalo oyenera, madzi omwe akuyesedwa amabayidwa pang'onopang'ono mu nucleus.

Mayesero onse awiri anaperekanso chinthu china mkati mwa disiki. Mayesero oyambirira anapereka 1 mL ya methylene blue ya 1 peresenti, kenako 1 mL ya lidocaine ya 2 peresenti. Mayesero otsatirawo anapereka 1 mL ya methylene blue yokhala ndi 10 mg pa mL, kuphatikiza 0.5 mL ya lidocaine ya 2 peresenti ndi 0.5 mL ya madzi osonyeza bwino pa X-ray. Choncho kuyerekezerako sikunali pakati pa kubaya jekeseni ndi kusachita chilichonse. Magulu onse awiri anaikidwa singano, anawonjezeredwa kuthamanga mkati mwa disiki, ndipo anapatsidwa mankhwala ochititsa dzanzi mkati mwa disiki. Kusiyana kokha komwe kunakonzedwa kunali methylene blue poyerekeza ndi madzi amchere. Zambiri za mmene methylene blue imagwirira ntchito m'maselo zimathandiza kufotokoza chifukwa chake ofufuza anaganiza kuti ingakhudze malo amenewo mwachindunji, koma kuoneka kuti n'zotheka si umboni.

Zimenezi n'zofunika pomvetsetsa kusintha kwa gulu loyerekezera. Kusintha kulikonse m'gulu loyerekezera pano kumaphatikiza zomwe zimachitika pozungulira njira yochitidwa pa msana, lidocaine, kusintha kwachibadwa kwa ululu, ndi chiyembekezo choti ululu uchepa.

Mayesero oyambirira amene anapeza zotsatira zabwino

Mayesero a 2010 a Peng ndi anzake, omwe anagawa odwala m'magulu mwamwayi, analembetsa akuluakulu 72 omwe anali ndi ululu wokhalitsa wa m'munsi mwa msana pakatikati, popanda ululu wa mitsempha ya m'miyendo. Zizindikiro zawo zinali zitapitirira miyezi 6 ngakhale atalandira chithandizo cha zolimbitsa thupi pamodzi ndi mankhwala ochepetsa kutupa kapena mankhwala a opioid. MRI inasonyeza kuwonongeka kwa disiki koma kutalika kwake kunali kosungidwa; sanachitidwepo opaleshoni ya m'munsi mwa msana; ndipo discogram inayambitsa ululu m'disiki yomwe inkayesedwa koma osati m'disiki yapafupi yoyerekezera. Anthu makumi atatu ndi asanu ndi limodzi analandira methylene blue pamodzi ndi lidocaine mkati mwa disiki. Ena makumi atatu ndi asanu ndi limodzi analandira madzi amchere pamodzi ndi lidocaine. Odwala ndi anthu oyeza zotsatira sanadziwe kuti wodwala aliyense anali m'gulu liti. Munthu wobaya jekeseni sakanabisidwa zimenezi chifukwa utotowo ndi wabuluu.

Kuwunika kotsatira kunachitika kwa nthawi yaitali: pa miyezi 6, 12, ndi 24. Zotsatira zoyezedwa zinali ululu pa sikelo ya manambala kuchokera pa 0 kufika pa 100, kulephera kuchita zinthu pa Oswestry Disability Index ya 0 kufika pa 100, komanso kukhutira, kugwiritsa ntchito mankhwala ochepetsa ululu, ndi zovuta. Zotsatira zofalitsidwa zinasonyeza kusintha kwakukulu kosazolowereka. Pa miyezi 24, avareji ya ululu inatsika kuchokera pafupifupi 72 kufika pafupifupi 20 m'gulu la methylene blue, pamene m'gulu loyerekezera inasintha kuchokera pafupifupi 67 kufika pafupifupi 60. Kulephera kuchita zinthu kunatsika kuchokera pafupifupi 48 kufika pafupifupi 13 ndi methylene blue, poyerekeza ndi kusintha kochepa kwambiri m'gulu loyerekezera. Pa miyezi 24, odwala 33 mwa 36 omwe analandira chithandizo ananena kuti anali okhutira kapena okhutira kwathunthu, poyerekeza ndi 5 mwa 35 a m'gulu loyerekezera. Odwala ambiri omwe analandira chithandizo ananena kuti sanagwiritse ntchito mankhwala ochepetsa ululu. Palibe matenda obwera chifukwa cha tizilombo m'disiki kapena kuvulala kwa mitsempha komwe kunanenedwa panthawi ya kuwunika kotsatira. Olembawo anafotokoza chithandizochi ngati chotetezeka, chogwira ntchito, komanso chosalowerera kwambiri m'thupi mu lipoti lawo loyerekezera ndi placebo.

Zotsatira zazikulu chonchi, zochokera ku malo amodzi ndi odwala 72 osankhidwa, ndi mtundu wa zotsatira umene umafunikira mayesero obwerezedwa ndi ofufuza ena odziyimira pawokha.

Mayesero obwereza a m'malo angapo

Kafukufuku wa IMBI wa Kallewaard ndi anzake anakonzedwa kuti abwereze mayeserowo m'malo anayi ku Netherlands. Odwala makumi asanu ndi atatu mphambu anayi analembetsedwa, ndipo 81 anapereka deta yotheka kusanthula atagawidwa m'magulu mwamwayi: 40 analandira methylene blue, ndipo 41 analandira placebo. Kusankha odwala kunafunanso ululu wokhalitsa pakatikati pa msana wogwirizana ndi ululu wochokera ku disiki. Panthawiyi, ankafunika kukhala atamva ululu kwa miyezi 6 kapena kuposerapo, chithandizo chopanda opaleshoni chosathandiza mokwanira, ululu pokhala pansi wa osachepera 5 pa 10, ndi MRI yochitidwa m'chaka chapitacho yomwe inachotsa odwala amene kutalika kwa disiki kunatsika kwambiri, kupitirira 50 peresenti. Choyamba odwala anabayidwa mankhwala oletsa kumva ululu pamfundo za facet kuti atsimikizire kuti ululu sunachokere kumfundo zimenezo. Kenako anachitidwa discography yofanana kwa onse, yokhala ndi kuthamanga kolamulidwa, disiki yapafupi yoyerekezera, ndi malire omveka a kuthamanga. Njirayi inachitidwa m'chipinda cha opaleshoni, ndi mankhwala opha mabakiteriya oteteza ku matenda, komanso kubaya pang'onopang'ono pa liwiro lolamulidwa. Gulu loyerekezera linalandiranso madzi amchere pamodzi ndi lidocaine ndi madzi osonyeza bwino pa X-ray.

Chotsatira chachikulu choyezedwa chinali kupambana kwa chithandizo pa miyezi 6. Izi zinatanthauzidwa ngati kuchepa kwa osachepera 30 peresenti pa avareji ya miyeso ya ululu yosonkhanitsidwa m'masiku anayi, pamodzi ndi mmene wodwala anaonera kusintha kwake konse. Miyeso ina inaphatikiza kulephera kuchita zinthu kwa Oswestry, masikelo a moyo wabwino, mtundu wa ululu, kugwiritsa ntchito mankhwala ochepetsa ululu, ndi zochitika zovulaza. Odwala a placebo omwe ankamvabe ululu akanatha kulandira methylene blue pambuyo pa miyezi 6. Choncho kuyerekeza kosasokonezedwa kwa magulu omwe anagawidwa mwamwayi kumathera pa miyezi 6, m'malo mopitiriza kufika pa miyezi 12 kapena 24.

Pa miyezi 6, avareji ya ululu inatsika ndi mapointi 1.4 pa sikelo ya 0 kufika pa 10 ndi methylene blue, ndipo ndi mapointi 1.2 m'gulu loyerekezera, ndi mtengo wa p wa 0.671 poyerekeza maguluwo. Chiwerengero cha odwala amene anakwaniritsa muyezo wa kusintha chinali 35.0 peresenti poyerekeza ndi 26.8 peresenti, p inali 0.426. Kulephera kuchita zinthu kunachepa ndi mapointi 7.8 poyerekeza ndi mapointi 5.5, p inali 0.459. Chiwerengero cha odwala amene anaona kusintha kwabwino konse chinali pafupifupi chofanana. Zochitika zosakhalitsa, monga kuwonjezeka kwa ululu kwa kanthawi kapena ululu wofalikira kumadera ena, zinachitika m'magulu onse awiri popanda kusiyana kwakukulu mwa ziwerengero pakati pa maguluwo. Olembawo anamaliza mu lipoti lawo la mayesero a m'malo angapo kuti detayo sinapereke umboni wothandizira kulangiza jekeseni wa methylene blue mkati mwa disiki pa ululu wokhalitsa wochokera ku disiki.

Kuyerekezera mayesero

Mbali	Peng 2010, malo amodzi	IMBI 2019, malo anayi
Odwala omwe deta yawo inasanthulidwa	72 anagawidwa m'magulu mwamwayi, 71 anamaliza miyezi 24	84 analembetsedwa, 81 anasanthulidwa mpaka miyezi 6
Kusankha odwala	Ululu wokhalitsa pakatikati pa msana wopitirira miyezi 6, zolimbitsa thupi ndi mankhwala sizinathandize, palibe vuto la mizu ya mitsempha, palibe opaleshoni yam'mbuyomu, kutalika kwa disiki kosungidwa, discogram yoyambitsa ululu ndi disiki yapafupi yoyerekezera yosapweteka	Ululu wokhalitsa pakatikati pa msana wa miyezi 6 kapena kuposerapo, chithandizo chopanda opaleshoni sichinathandize, ululu pokhala pansi wa 5 pa 10 kapena kuposerapo, kutalika kwa disiki kwatsika ndi 50 peresenti kapena kucheperapo, kubaya mankhwala pa facet sikunachepetse ululu, discography yofanana kwa onse yokhala ndi kuthamanga kolamulidwa ndi disiki yoyerekezera
Chithandizo cha gulu loyerekezera	Kuboola disiki kuphatikiza 1 mL ya madzi amchere ndi 1 mL ya lidocaine ya 2 peresenti	Kuboola disiki kuphatikiza 1 mL ya madzi amchere, 0.5 mL ya lidocaine ya 2 peresenti, ndi 0.5 mL ya madzi osonyeza bwino pa X-ray
Chithandizo choyesedwa	1 mL ya methylene blue ya 1 peresenti, 10 mg, kuphatikiza 1 mL ya lidocaine ya 2 peresenti	1 mL ya methylene blue ya 10 mg pa mL kuphatikiza 0.5 mL ya lidocaine ya 2 peresenti ndi 0.5 mL ya madzi osonyeza bwino pa X-ray
Zotsatira zoyezedwa	Sikelo ya manambala ya ululu ya 0 kufika pa 100, Oswestry ya 0 kufika pa 100, kukhutira, mankhwala ochepetsa ululu, zovuta	Kupambana monga kuchepa kwa ululu ndi 30 peresenti kapena kuposerapo pamodzi ndi mmene wodwala anaonera kusintha kwake konse pa miyezi 6, kuphatikiza Oswestry, moyo wabwino, mankhwala ochepetsa ululu, zochitika zovulaza
Kuwunika kotsatira	Miyezi 6, 12, ndi 24, kuyerekeza magulu ogawidwa mwamwayi kunapitiriza popanda kusintha	Kuyerekeza magulu ogawidwa mwamwayi mpaka miyezi 6, pambuyo pake kusintha chithandizo kunaloledwa
Chotsatira chachikulu	Ululu kuchokera pafupifupi 72 kufika pa 20 poyerekeza ndi 67 kufika pa 60 pa miyezi 24, kulephera kuchita zinthu kuchokera pafupifupi 48 kufika pa 13 poyerekeza ndi kusasintha kwenikweni, 91.6 peresenti anakhutira poyerekeza ndi 14.3 peresenti	Ululu unachepa ndi 1.4 poyerekeza ndi 1.2 pa 10 pa miyezi 6, odwala amene anakwaniritsa muyezo wa kusintha anali 35.0 peresenti poyerekeza ndi 26.8 peresenti, palibe kusiyana kwakukulu mwa ziwerengero

Mfundo ina imathandiza kupewa chisokonezo. Zifupikitso zina zimagwirizanitsa mayesero amenewa ndi malire a giredi ya Pfirrmann. Malire amenewo anachokera ku kafukufuku waung'ono woyambirira ku Netherlands, osati ku malamulo oyenerera kulowa m'mayesero aliwonse mwa awiri ogawa odwala mwamwayi omwe afotokozedwa pamwambapa.

Mmene tingamvetsere kusagwirizana kwa zotsatirazi

Mayesero awiri ochitidwa moona mtima angapeze zotsatira zosagwirizana popanda kuti lililonse likhale lachinyengo. Kusiyana kofunika ndi kulondola kwa kusankha odwala, kugwiritsa ntchito njira zofanana pochita chithandizo, malire a kubisa gulu limene munthu ali, chiwerengero cha odwala, ndi mmene zotsatira zoyezedwa zinatanthauzidwira.

Peng anasankha gulu lokhala ndi zofunikira zenizeni ku malo amodzi ndipo analiwunika kwa zaka ziwiri popanda kulola kusintha chithandizo. Zimenezi zimathandiza kuona kusintha kwakukulu mosavuta, koma zingapangitsenso kukokomeza kusinthako ngati kusankha odwala, mankhwala ena operekedwa nawo, kapena ziyembekezo zinasiyana pakati pa magulu m'njira zimene lipotilo silinasonyeze. Munthu wobaya jekeseni ankadziwa gulu limene wodwala aliyense anali. Zimenezi sizingapeweke ndi utoto wabuluu, koma ndi chofooka cha mayeserowo. IMBI inagwiritsa ntchito malo angapo, malamulo okhwima kwambiri a kuthamanga mkati mwa disiki, kuunika mfundo za facet, liwiro lofanana la kubaya jekeseni, ndi tanthauzo lokonzedweratu la wodwala amene wakwaniritsa muyezo wa kusintha pa miyezi 6. Kapangidwe kameneka kamachepetsa mwayi wopeza zotsatira zazikulu kwambiri mwamwayi, koma kamayankhanso funso la nthawi yaifupi. Sikanena chilichonse motsimikiza za zotsatira za magulu ogawidwa mwamwayi pa miyezi 24, chifukwa gulu loyerekezera linaloledwa kusintha chithandizo pambuyo pa miyezi 6.

Kwa wodwala kapena dokotala, kumvetsa zotsatirazi moyenera kumafuna kusamala. Mayesero ang'onoang'ono oyambirira amodzi anapeza phindu lalikulu kwambiri lokhalitsa. Mayesero obwereza okulirapo, ogwiritsa ntchito njira zofanana, anapeza kuwonjezeka kochepa kokha kosatsimikizika mwa ziwerengero kuposa gulu loyerekezera lomwe linachitidwa njira yomweyo ndipo linalandiranso lidocaine. Zotsatira zoterezi zimachepetsa chidaliro m'malo motsimikizira kuti chithandizocho chimagwira ntchito. Aliyense amene akupatsidwa mwayi wa jekeseni wa methylene blue mu disiki ayenera kufunsa kuti chipatalacho chimagwiritsa ntchito zofunikira zotani posankha odwala, ngati discography ndi disiki yoyerekezera n'zofunika, zinthu zina zimene zimabayidwa limodzi, chiwerengero cha kupambana chimene chipatalacho chimanena pa miyezi 6 pogwiritsa ntchito tanthauzo lokonzedweratu la ululu, ndi mmene zovuta ndi kuwunika kotsatira zimalembedwera ndi kutsatiridwa. Ndi bwino kuwerenga zokhudza mafunso a chitetezo pogwiritsa ntchito methylene blue musanakonze njira iliyonse yolowa m'thupi, komanso zambiri zokhudza zimene kafukufuku wachipatala wa methylene blue wasonyeza ndi zimene sunasonyeze.

Chifukwa chake zimenezi sizipereka umboni wothandizira madontho kapena maswiti ofewa omwedwa

Njira yoperekera chinthu ndi mbali ya chithandizocho. Mayesero amenewa anayesa utoto woikidwa mkati mwa disiki yosankhidwa. Methylene blue yomezedwa imadutsa m'matumbo n'kulowa m'magazi ozungulira thupi lonse, ndipo imafika m'minofu pa kuchuluka kochepa kwambiri komanso kosalunjika kwenikweni kumalo omwe akufuna. Palibe muyeso m'mayesero amenewa umene umasonyeza kuti mlingo womwedwa umapereka kuchuluka kapena nthawi yokhala mkati mwa disiki imodzi ya m'munsi mwa msana zofanana ndi za jekeseniyo. Ngakhale zotsatira za mkati mwa disiki zikanabwerezedwa momveka bwino, sizikanatanthauza kuti zakumwa, madontho, kapena maswiti ofewa zingagwire ntchito yomweyo popanda mayesero ena ogwiritsa ntchito njira imeneyo, mlingo umenewo, ndi gulu la odwala okhala ndi ululu umenewo.

Chitetezo nachonso sichingaganiziridwe kuti n'chofanana. Chinthu chikafalikira m'thupi lonse chimatha kugwirizana ndi mankhwala ena m'thupi lonse, kuphatikiza kugwirizana komwe kwalembedwa bwino ndi mankhwala okhudza serotonin. Njira yochitidwa pa disiki yokha ndi kugwiritsa ntchito pakamwa tsiku lililonse zimapangitsa thupi kukhudzidwa mosiyanasiyana ndipo zimakhala ndi mitundu yosiyanasiyana ya chiopsezo. Mfundo imeneyi yafotokozedwa mwatsatanetsatane mu umboni wa kugwirizana kwa methylene blue ndi mankhwala ena.

Mfundo yomaliza ndi yeniyeni komanso yopapatiza. Mayesero oyambirira a jekeseni wa methylene blue mu disiki ananena kuti ululu unachepa kwambiri mpaka zaka ziwiri. Mayesero obwereza otsatira a m'malo angapo, oyerekezera ndi placebo, sanapeze zotsatira zomwezo pa miyezi isanu ndi umodzi. Palibe mwa zotsatira ziwirizi chimene chili umboni wakuti methylene blue yomwedwa imathandiza pa ululu wa msana.