Inshinge za methylene blue ku bubabare bw’umugongo buturuka muri disiki: ibyo igerageza ryagaragaje

Ububabare bwo mu mugongo wo hasi ni ikimenyetso, si indwara yamaze gusuzumwa. Iryo tandukaniro ni ryo rigena niba ibivugwa kuri methylene blue mu kuvura ububabare bw’umugongo bifite icyo bivuze.

Ububabare bwinshi bw’umugongo ntibushobora kwitirirwa igice kimwe cy’umubiri mu buryo bwizewe. Kuvuga ko ububabare buturuka muri disiki ni ukwemeza ikintu cyihariye kurushaho. Bisobanura ko ububabare buturuka ku mpera z’imyakura ziri muri disiki imwe yihariye iri hagati y’ingingo z’uruti rw’umugongo, akenshi aho igice cy’inyuma kimeze nk’impeta, cyitwa annulus, cyasadutse maze kikemerera imyakura mito n’ibimenyetso by’ububyimbirwe gukwirakwira imbere muri disiki. Icyo gitekerezo kiroroshye kugisobanura ariko kiragoye kucyemeza, kuko disiki nyinshi zangiritse zigaragara kuri MRI zitera ububabare na buke. Ishusho yonyine ntishobora kugaragaza disiki ibutera.

Ni yo mpamvu amagerageza yombi avugwa hano yatangiranye no gusuzuma disiki haterwamo umuti kugira ngo harebwe niba ibyutsa ububabare, uburyo bwitwa provocative discography. Hifashishijwe amashusho ya fluoroscopy, urushinge rushyirwa mu ntima iri hagati muri disiki ikekwa, hagaterwamo umuti utuma igaragara neza ku mashusho ku muvuduko ugenzurwa, maze umuganga akabaza ikibazo cyoroshye: gushyira iyi disiki ku gitutu biragarura ububabare usanzwe wumva? Nibura disiki imwe iri hafi yayo irasuzumwa kugira ngo igereranywe na yo, kandi ntigomba kubyutsa ububabare. Abarwayi bafite gusa disiki ibyutsa ububabare busanzwe bababara hamwe na disiki yo kugereranya itabubyutsa ni bo bakomeza. Iyi ni intambwe yo guhitamo abarwayi isaba kwinjira mu mubiri, kandi igena ibikurikiraho byose.

Abasomyi batangiye kumenya icyo methylene blue ari cyo mu rwego rwa shimi rimwe na rimwe bakeka ko inshinge zasuzumwe muri aya magerageza zifitanye isano no kunywa amazi y’ubururu. Si ko biri. Gutera methylene blue muri disiki bishyira hafi 10 mg z’irangi imbere muri disiki imwe yamaze kugaragazwa ko itera ububabare. Igitekerezo cyari gishingiye ku ngaruka zaho honyine: irangi ryashoboraga kwangiza cyangwa kugabanya ibikorwa by’impera nto z’imyakura ziri mu bisate by’igice cy’inyuma cya disiki, kandi rikagabanya ububyimbirwe bwaho. Ubwo buryo bwo gukora, niba bubaho, bushingiye ku kuba irangi rihura mu buryo butaziguye n’ibiri imbere muri iyo disiki.

Uburyo bwakoreshejwe mu magerageza yombi

Uburyo bworoshye bwo kubyumva ni ugutekereza icyumba gifunze gifite inzira imwe yo kwinjiramo. Icyo cyumba ni disiki. Inzira yo kwinjiramo ni urushinge ruyoborwa n’amashusho ya fluoroscopy, akenshi runyuze inyuma no ku ruhande. Iyo bimaze kwemezwa ko urushinge ruri ahakwiye, amazi akoreshwa mu bushakashatsi aterwa buhoro mu ntima ya disiki.

Amagerageza yombi yanashyize ikindi kintu muri disiki. Igerageza rya mbere ryatanze 1 mL ya methylene blue ya 1 ku ijana, ikurikirwa na 1 mL ya lidocaine ya 2 ku ijana. Igerageza ryakurikiyeho ryatanze 1 mL ya methylene blue irimo 10 mg kuri mL, hamwe na 0.5 mL ya lidocaine ya 2 ku ijana na 0.5 mL y’umuti utuma disiki igaragara neza ku mashusho. Bityo, nta na rimwe hagereranyijwe guterwa urushinge no kutagira igikorwa na kimwe gikorerwa umurwayi. Amatsinda yombi yashyiriweho urushinge, disiki zishyirwa ku gitutu, kandi ziterwamo umuti wo gutera ikinya aho hantu. Itandukaniro ryonyine ryari riteganyijwe ryari methylene blue ugereranyije n’amazi arimo umunyu. Ibisobanuro birambuye by’uko methylene blue ikora mu turemangingo bifasha kumva impamvu abashakashatsi batekerezaga ko yashoboraga kugira ingaruka zaho honyine, ariko kuba ikintu gishoboka si ikimenyetso cy’uko kibaho.

Ibi ni ingenzi mu gusoma ibisubizo by’itsinda ryo kugereranya. Igabanuka ry’ububabare iryo ari ryo ryose muri iryo tsinda rikubiyemo ingaruka zo gukorerwa igikorwa ku ruti rw’umugongo, iza lidocaine, uko ububabare busanzwe buhinduka uko igihe kigenda, n’icyizere cyo koroherezwa.

Igerageza rya mbere ryagaragaje ibisubizo byiza

Igerageza ryo mu 2010 rya Peng na bagenzi be, ryagabanyaga abarwayi mu matsinda ku buryo bwa tombola, ryitabiriwe n’abantu bakuru 72 bafite ububabare budakira bwo mu mugongo wo hasi bushingiye ku ruti rw’umugongo, nta bubabare bw’imyakura yo mu maguru. Ibimenyetso byari bimaze amezi arenga 6 nubwo bari barahawe ubuvuzi bwo kugorora no gukoresha umubiri hamwe n’imiti igabanya ububyimbirwe cyangwa imiti yo mu bwoko bwa opioid. Bari bafite ibimenyetso kuri MRI by’uko disiki yangiritse ariko igifite uburebure bwayo, nta kubagwa mu gice cyo hasi cy’uruti rw’umugongo bari barigeze bakorerwa, kandi isuzuma rya disiki ryabyutsaga ububabare, mu gihe disiki yegeranye yakoreshejwe mu kugereranya itabubyutsaga. Mirongo itatu na batandatu batewe methylene blue hamwe na lidocaine muri disiki. Mirongo itatu na batandatu batewe amazi arimo umunyu hamwe na lidocaine. Abarwayi n’abapimaga ibisubizo ntibari bazi itsinda buri murwayi arimo. Uwateye inshinge ntiyashoboraga kubihishwa kuko irangi ari ubururu.

Gukurikirana abarwayi byamaze igihe kirekire: amezi 6, 12, na 24. Ibipimo by’ibisubizo byari ububabare ku gipimo cy’imibare kuva kuri 0 kugeza kuri 100, kubangamirwa mu mikorere ku gipimo cya Oswestry Disability Index kuva kuri 0 kugeza kuri 100, hamwe no kunyurwa, gukoresha imiti igabanya ububabare, n’ibibazo byavutse. Ibisubizo byatangajwe byagaragaje impinduka nini zidasanzwe. Mu itsinda rya methylene blue, impuzandengo y’ububabare yagabanutse iva hafi kuri 72 igera hafi kuri 20 ku mezi 24, mu gihe mu itsinda ryo kugereranya yavuye hafi kuri 67 igera hafi kuri 60. Kubangamirwa mu mikorere kwagabanutse kuva hafi kuri 48 kugera hafi kuri 13 hamwe na methylene blue, mu gihe mu itsinda ryo kugereranya habaye impinduka hafi ya ntazo. Ku mezi 24, abarwayi 33 muri 36 bahawe methylene blue bavuze ko banyuzwe cyangwa banyuzwe rwose, ugereranyije na 5 muri 35 bo mu itsinda ryo kugereranya. Abenshi mu bahawe methylene blue bavuze ko batakoreshaga imiti igabanya ububabare. Nta kwandura kwa disiki cyangwa gukomereka kw’imyakura byatangajwe mu gihe cyo gukurikirana. Abanditsi bavuze ko ubwo buvuzi butekanye, bukora neza kandi busaba kwinjira mu mubiri ku rugero ruto muri raporo yabo yagereranyaga ubuvuzi n’umuti utagira ikigize kivura.

Igisubizo kinini bene ako kageni, kivuye mu kigo kimwe no ku barwayi 72 batoranyijwe, ni cyo rwose gisaba ko abandi bashakashatsi bigenga basubiramo igerageza.

Gusubiramo igerageza mu bigo byinshi

Ubushakashatsi bwa IMBI bwa Kallewaard na bagenzi be bwateguwe nk’igerageza risubirwamo mu bigo bine byo mu Buholandi. Ab arwayi mirongo inani na bane bariyandikishije, kandi 81 batanze amakuru ashobora gusesengurwa nyuma yo kugabanywa mu matsinda ku buryo bwa tombola: 40 bahawe methylene blue, 41 bahabwa umuti utagira ikigize kivura. Guhitamo abarwayi na none byasabaga ububabare budakira bushingiye ku ruti rw’umugongo bujyanye n’ububabare buturuka muri disiki. Kuri iyi nshuro, byasabaga nibura amezi 6 y’ububabare, ubuvuzi budakoresha kubaga butatanze igisubizo gihagije, ububabare umuntu yicaye buri nibura kuri 5 kuri 10, na MRI yafashwe mu mwaka wari wabanje igaragaza ko nta kugabanuka gukabije k’uburebure bwa disiki kurenze 50 ku ijana. Abarwayi babanje guterwa umuti ubuza kumva ububabare mu ngingo nto z’uruti rw’umugongo zitwa facet, kugira ngo harebwe niba atari zo zibutera. Hanyuma bakorewe isuzuma rya disiki rikurikiza uburyo bumwe kandi rigenzura igitutu, hakoreshejwe disiki yegeranye yo kugereranya n’imipaka y’igitutu isobanutse. Icyo gikorwa cyakorewe mu cyumba cyo kubagiramo, hatangwa imiti irwanya bagiteri yo gukumira kwandura, kandi umuti uterwa buhoro ku muvuduko ugenzurwa. Itsinda ryo kugereranya na none ryahawe amazi arimo umunyu, lidocaine n’umuti utuma disiki igaragara neza ku mashusho.

Igipimo nyamukuru cy’ibisubizo cyari ukugera ku ntego y’ubuvuzi ku mezi 6, bisobanuwe nk’igabanuka rya nibura 30 ku ijana mu mpuzandengo y’ibipimo by’ububabare byakusanyijwe mu minsi ine, hamwe n’uko umurwayi yabonaga impinduka muri rusange. Ibipimo by’inyongera byarimo kubangamirwa mu mikorere ku gipimo cya Oswestry, ibipimo by’ubuzima bwiza, imiterere y’ububabare, gukoresha imiti igabanya ububabare, n’ibyabaye bitifuzwa. Abarwayi bahawe umuti utagira ikigize kivura bakomeje kubabara bashoboraga guhabwa methylene blue nyuma y’amezi 6. Bityo, kugereranya amatsinda yagabanyijwe ku buryo bwa tombola nta kuvanga ubuvuzi birangirira ku mezi 6 aho gukomeza kugera ku mezi 12 cyangwa 24.

Ku mezi 6, impuzandengo y’ububabare yagabanutseho amanota 1.4 ku gipimo kuva kuri 0 kugeza kuri 10 mu bahawe methylene blue, n’amanota 1.2 mu itsinda ryo kugereranya, agaciro ka p ko kugereranya amatsinda kakaba 0.671. Abageze ku gipimo cyari cyaragenwe cy’igabanuka ry’ububabare bari 35.0 ku ijana ugereranyije na 26.8 ku ijana, p ikaba 0.426. Kubangamirwa mu mikorere kwagabanutseho amanota 7.8 ugereranyije na 5.5, p ikaba 0.459. Igipimo cy’ababonye impinduka nziza muri rusange cyari hafi kimwe mu matsinda yombi. Ibyabaye bimara igihe gito, nko kwiyongera kw’ububabare by’igihe gito cyangwa ububabare bukwirakwira mu bindi bice, byabaye mu matsinda yombi nta tandukaniro rifite ubusobanuro mu ibarurishamibare. Muri raporo yabo y’igerageza ryo mu bigo byinshi, abanditsi banzuye ko amakuru atashyigikiraga gutanga inama yo gutera methylene blue muri disiki ku bubabare budakira buyiturukamo.

Kugereranya amagerageza

Hari ikindi gisobanuro kirinda kwitiranya ibintu. Incamake zimwe zivuga ko muri aya magerageza hakoreshejwe umupaka w’icyiciro ku gipimo cya Pfirrmann. Uwo mupaka waturutse mu bushakashatsi buto bw’ibanze bwo mu Buholandi, si mu mabwiriza yo kwemera abarwayi muri rimwe muri aya magerageza abiri yakoresheje igabanywa ku buryo bwa tombola yavuzwe haruguru.

Uko wasobanukirwa ibisubizo bivuguruzanya

Amagerageza abiri yakozwe mu bunyangamugayo ashobora kugira ibisubizo bitandukanye nta na rimwe ryabeshye. Itandukaniro ry’ingenzi ni ukuntu guhitamo abarwayi byari bisobanutse neza, gukurikiza uburyo bumwe mu bikorwa, imipaka yo guhisha amatsinda abarwayi barimo, umubare w’abitabiriye, n’uko ibipimo by’ibisubizo byasobanuwe.

Peng yatoranyije itsinda ryihariye cyane ryo mu kigo kimwe, arikurikirana imyaka ibiri nta guhindurirwa ubuvuzi. Ibyo bituma impinduka nini zoroha kubona, ariko nanone bigatuma zishobora guhabwa agaciro karenze ako zifite niba guhitamo abarwayi, ubundi buvuzi bwatangiwe hamwe n’ubwasuzumwaga, cyangwa ibyo bari biteze byari bitandukanye hagati y’amatsinda mu buryo raporo itagaragaje. Uwateye inshinge yari azi itsinda umurwayi arimo; ibyo ntibishobora kwirindwa iyo hakoreshejwe irangi ry’ubururu, ariko bikomeza kuba intege nke z’ubushakashatsi. IMBI yakoresheje ibigo byinshi, ibisabwa bikaze kurushaho ku gitutu, isuzuma ry’ingingo za facet, umuvuduko umwe uteganyijwe wo gutera umuti, n’igisobanuro cyagenwe mbere cy’umurwayi wageze ku gipimo cy’igabanuka ry’ububabare ku mezi 6. Iyo mitegurire igabanya amahirwe yo kubona igisubizo gikabije kubera impanuka gusa, ariko nanone isubiza ikibazo kireba igihe kigufi. Nta mwanzuro ukomeye itanga ku bisubizo by’amezi 24 by’amatsinda yagabanyijwe ku buryo bwa tombola, kuko itsinda ryo kugereranya ryemerewe guhindurirwa ubuvuzi nyuma y’amezi 6.

Ku murwayi cyangwa umuganga, uburyo bufatika bwo gusoma ibi bisubizo ni ukubigiramo ubushishozi. Igerageza rito rya mbere ryabonye inyungu nini cyane kandi irambye. Igerageza rinini kurushaho, ryasubiwemo rikurikiza uburyo bumwe, ryabonye gusa inyungu nto y’inyongera itari ifite ubusobanuro mu ibarurishamibare, ugereranyije n’itsinda ryakorewe igikorwa cyo kugereranya na cyo cyari kirimo lidocaine. Ibyo bigabanya icyizere aho kwemeza ko ubuvuzi bukora. Umuntu wese usabwe guterwa methylene blue muri disiki akwiye kubaza ibipimo ivuriro rikoresha mu guhitamo abarwayi, niba isuzuma rya disiki na disiki yo kugereranya bisabwa, indi miti iteranwa na yo, igipimo cy’abagera ku ntego ivuriro rivuga ku mezi 6 hashingiwe ku gisobanuro cy’ububabare cyagenwe mbere, n’uko ibibazo byavutse no gukurikirana abarwayi byandikwa. Ni byiza gusoma amakuru y’ibanze ku bibazo by’umutekano bijyanye no gukoresha methylene blue mbere yo guteganya igikorwa cyose gisaba kwinjira mu mubiri, kimwe n’amakuru yagutse ku byo ubushakashatsi bwo mu buvuzi kuri methylene blue bwagaragaje n’ibyo butagaragaje.

Impamvu ibi bidashyigikira ibitonyanga cyangwa bombo zoroshye bifatwa mu kanwa

Inzira umuti unyuramo ni igice cy’ubuvuzi busuzumwa. Aya magerageza yasuzumye irangi ryashyizwe imbere muri disiki yatoranyijwe. Methylene blue imizwe inyura mu rwungano ngogozi ikajya mu maraso atembera mu mubiri wose, maze ikagera mu nyama z’umubiri ku rugero ruto cyane kandi rudatumbiriye ahantu hamwe. Nta gipimo cyo muri aya magerageza kigaragaza ko ingano ifashwe mu kanwa itanga urugero cyangwa igihe cyo kuguma imbere muri disiki imwe yo mu mugongo wo hasi bingana n’iby’urushinge. Nubwo ingaruka zo gutera muri disiki zari gusubirwamo zikagaragara neza, ntizari guhita zikoreshwa ku kinyobwa, igitonyanga cyangwa bombo yoroshye hatabayeho irindi gerageza rikoresha iyo nzira, iyo ngano, n’iryo tsinda ry’abarwayi bafite ubwo bubabare.

Umutekano na wo ntuhita uba umwe. Kugera k’umuti mu mubiri wose kuzana imikoranire igira ingaruka ku mubiri wose, harimo imikoranire izwi neza n’imiti igira ingaruka kuri serotonin. Gukorera igikorwa kuri disiki imwe no gufata umuti mu kanwa buri munsi ni uburyo butandukanye bwo guhura n’umuti, bufite ibyago bitandukanye; iyi ngingo yasobanuwe mu buryo burambuye mu bimenyetso by’imikoranire ya methylene blue n’indi miti.

Umwanzuro ugarukira ku kintu cyihariye. Igerageza rya mbere ryo gutera methylene blue muri disiki ryagaragaje igabanuka rikomeye ry’ububabare ryagejeje ku myaka ibiri. Igerageza ryakurikiyeho, ryasubiwemo mu bigo byinshi kandi rikagereranya n’umuti utagira ikigize kivura, ntiryagaragaje ibyo bisubizo ku mezi atandatu. Nta na kimwe muri ibyo bisubizo ari ikimenyetso cy’uko methylene blue ifatwa mu kanwa igabanya ububabare bw’umugongo.