Chinyorwa
Majekiseni emethylene blue emarwadzo emusana anobva mudhisiki: zvakawanikwa nezviedzo
Marwadzo echikamu chezasi chemusana chiratidzo, kwete kuongororwa kunoratidza chikonzero chawo. Musiyano iwoyo ndiwo unosarudza kana kutaura pamusoro pemethylene blue nokuda kwemarwadzo emusana kuine zvakunoreva.
Marwadzo mazhinji emusana haana chikamu chimwe chete chemuviri chinogona kunzi ndicho chikonzero nechivimbo. Kuti marwadzo anobva mudhisiki kutaura kwakanyatsoganhurirwa. Zvinoreva kuti marwadzo anobva kumigumo yetsinga iri mukati medhisiki rimwe chete riri pakati pemapfupa emusana, kazhinji panenge pakatsemuka mhete yekunze inonzi annulus, zvichiita kuti tsinga diki nezviratidzo zvekuzvimba zvipinde mukati. Pfungwa iyi iri nyore kutsanangura asi yakaoma kuratidza, nokuti madhisiki mazhinji akasakara anoonekwa paMRI haakonzere marwadzo zvachose. Mufananidzo wekuongorora chete haugoni kuratidza dhisiki riri kukonzera marwadzo.
Ndokusaka zviedzo zviviri zvinokurukurwa pano zvakatanga nediscography inoitwa kuti imutse marwadzo. Pachishandiswa fluoroscopy, tsono inoiswa munucleus iri pakati pedhisiki rinofungidzirwa kuti ndiro rine dambudziko, chinhu chinobatsira kuona pamufananidzo chinobaiwa pachidzorwa dzvinyiriro, uye chiremba anobvunza mubvunzo uri nyore: kudzvinyirira dhisiki iri kunodzosa marwadzo ako aunowanzoita here? Dhisiki rimwe chete kana kupfuura riri pedyo rinoongororwawo kuti rienzaniswe naro, uye harifaniri kukonzera marwadzo. Varwere vane dhisiki rinoburitsa marwadzo avo enguva dzose chete, pamwe nedhisiki rekuenzanisa risingarwadzi, ndivo vanoenderera mberi. Iri idanho rekusarudza varwere rinoda kupinza tsono mumuviri, uye rinoumba zvose zvinozotevera.
Vaverengi vasati vajairana nezvakaita methylene blue sechinhu chemakemikari dzimwe nguva vanofunga kuti jekiseni rakadzidzwa muzviedzo izvi rine chekuita nekunwa mvura yebhuruu. Hazvina kudaro. Jekiseni remethylene blue mukati medhisiki rinoisa inenge 10 mg yedhayi zvakananga mudhisiki rimwe rinenge ratowanikwa kuti rinorwadza. Pfungwa yaiedzwa yaiva yekushanda panzvimbo iyoyo chete: dhayi iyi yaigona kuparadza kana kunyaradza migumo yetsinga diki iri pakatsemuka annulus uye kuderedza kuzvimba panzvimbo iyoyo. Mashandiro iwayo, kana aripo, anoenderana nekusangana kwayo zvakananga nezviri mukati medhisiki iroro.
Maitiro akashandiswa muzviedzo zviviri izvi
Nzira inobatsira kufungidzira izvi kufunga nezvekamuri kakavharwa kane nzira imwe chete yekupinda. Kamuri kacho idhisiki. Nzira yekupinda itsono inotungamirirwa nefluoroscopy, kazhinji ichipinda nechekumashure padivi. Kana nzvimbo yetsono yasimbiswa, mvura iri kuedzwa inobaiwa zvishoma nezvishoma munucleus.
Zviedzo zviviri izvi zvakaisawo chimwe chinhu mukati medhisiki. Chiedzo chekutanga chakapa 1 mL yemethylene blue ye1 muzana, ichiteverwa ne1 mL yelidocaine ye2 muzana. Chiedzo chakazotevera chakapa 1 mL yemethylene blue ine 10 mg pa mL pamwe ne0.5 mL yelidocaine ye2 muzana uye 0.5 mL yechinhu chinobatsira kuona pamufananidzo. Saka kuenzanisa kwacho hakuna kumbova pakati pekubaiwa jekiseni nekusaitwa chero maitiro. Mapoka ose ari maviri akaiswa tsono, akadzvinyirirwa dhisiki, uye akaiswa mushonga unodzima kunzwa panzvimbo iyoyo mukati medhisiki. Musiyano mumwe chete wakarongwa waiva methylene blue ichienzaniswa nemvura ine munyu. Mashoko pamusoro pemashandiro emethylene blue mumasero anobatsira kutsanangura nei vaongorori vaifunga kuti kushanda kwayo panzvimbo iyoyo kwaigoneka, asi kuti chinhu chinogona kuitika hakusi uchapupu.
Izvi zvakakosha pakunzwisisa zvakaitika muboka rekuenzanisa. Kuvandudzika kupi nokupi muboka rekuenzanisa pano kunosanganisira maitiro ose ekurapwa pamusana, lidocaine, kushanduka kwemarwadzo sezvaanoita ega, uye kutarisira kuti marwadzo aderere.
Chiedzo chekutanga chakawana mhedzisiro yakanaka
Chiedzo cha2010 chaPeng nevamwe, chakagovera varwere mumapoka zvisina kurongwa kuti ndiani aipinda muboka ripi, chakanyoresa vanhu vakuru 72 vane marwadzo asingaperi ari pachikamu chezasi chemusana pasina marwadzo etsinga anoenda kumakumbo. Zviratidzo zvacho zvaiva zvagara kupfuura 6 mwedzi pasinei nekupihwa physiotherapy pamwe nemishonga inoderedza kuzvimba kana maopioid. Vaiva nezviratidzo zvekusakara kwedhisiki paMRI asi kukwirira kwedhisiki kusati kwaderera, vasina kumbovhiyiwa muchikamu chezasi chemusana, uye discogram yavo yairatidza dhisiki rinorwadza pamwe nedhisiki rekuenzanisa raiva pedyo risingarwadzi. Makumi matatu nevatanhatu vakapiwa methylene blue pamwe nelidocaine mukati medhisiki. Makumi matatu nevatanhatu vakapiwa mvura ine munyu pamwe nelidocaine. Varwere nevaya vaiyera migumisiro havana kuziviswa kuti ndiani aiva muboka ripi. Munhu aibaya jekiseni aisagona kuvanzirwa izvozvo nokuti dhayi yacho ndeyebhuruu.
Kutevera varwere kwakatora nguva refu: 6, 12, uye 24 mwedzi. Zviyero zvemigumisiro zvaiva marwadzo pachiyero chenhamba che0 kusvika 100, kusakwanisa kuita mabasa paOswestry Disability Index ye0 kusvika 100, pamwe nekugutsikana, kushandisa mishonga inoderedza marwadzo, uye matambudziko. Mhedzisiro yakabudiswa yaiva yakakura zvisingawanzoitiki. Avhareji yemarwadzo yakaderera kubva painenge 72 kusvika painenge 20 muboka remethylene blue pa24 mwedzi, asi muboka rekuenzanisa yakabva painenge 67 kusvika painenge 60. Kusakwanisa kuita mabasa kwakaderera kubva painenge 48 kusvika painenge 13 nemethylene blue, zvichienzaniswa nekusachinja kunenge kuripo muboka rekuenzanisa. Pa24 mwedzi, 33 pavarwere 36 vakarapwa vakati vakagutsikana kana kuti vakagutsikana zvizere, zvichienzaniswa ne5 pavanhu 35 veboka rekuenzanisa. Varwere vakawanda vakarapwa vakati vakanga vasingashandisi mishonga inoderedza marwadzo. Hapana hutachiona mudhisiki kana kukuvadzwa kwetsinga kwakashumwa panguva yekutevera varwere. Vanyori vakatsanangura kurapwa uku sekwakachengeteka, kunoshanda, uye kusingapindi zvakanyanya mumuviri mumushumo wavo wechiedzo chine placebo yekuenzanisa.
Mhedzisiro yakakura kudaro, inobva panzvimbo imwe chete nevarwere 72 vakasarudzwa, ndiyo chaiyo mhedzisiro inoda kudzokororwa nevamwe vaongorori vakazvimirira.
Kudzokorora chiedzo munzvimbo dzakawanda
Chidzidzo cheIMBI chaKallewaard nevamwe chakarongwa sekudzokorora chiedzo munzvimbo ina muNetherlands. Varwere makumi masere nevana vakanyoreswa, uye 81 vakapa mashoko aigona kuongororwa kubva mumapoka avakanga vagoverwa zvisina kurongwa: 40 vemethylene blue, 41 veplacebo. Kusarudza varwere kwaidazve marwadzo asingaperi ari pamusana aienderana nemarwadzo anobva mudhisiki. Panguva ino, marwadzo aifanira kunge agara kweinenge 6 mwedzi, kurapwa kusingadi kuvhiyiwa kusina kubatsira zvakakwana, marwadzo pakugara aine chiyero chinosvika 5 pa10 kana kupfuura, uye MRI yakaitwa mukati megore rakapfuura isingaratidzi kuderera kwakanyanya kwekukwirira kwedhisiki kunopfuura 50 muzana. Varwere vakatanga vapihwa jekiseni rinodzima kunzwa pamajoini efacet kuti zvionekwe kuti marwadzo akanga asingabvi mumajoini iwayo. Zvadaro vakaitwa discography yakafanana kune vose, ine dzvinyiriro inodzorwa, dhisiki rekuenzanisa riri pedyo, uye miganhu yedzvinyiriro yakajeka. Maitiro acho akaitwa mukamuri yekuvhiyira, paine mishonga inodzivirira hutachiona uye jekiseni richibaiwa zvishoma nezvishoma pamwero unodzorwa. Boka rekuenzanisa rakapiwazve mvura ine munyu pamwe nelidocaine uye chinhu chinobatsira kuona pamufananidzo.
Chiyero chikuru chemigumisiro chaiva kubudirira kwekurapwa pa6 mwedzi, kwaitsanangurwa sekuderera kweinenge 30 muzana muavhareji yezviyero zvemarwadzo zvakaunganidzwa mumazuva mana, pamwe nekuona kushanduka kwacho kwose. Zvimwe zviyero zvaisanganisira kusakwanisa kuita mabasa kweOswestry, zviyero zvehupenyu hwakanaka, rudzi rwemarwadzo, kushandisa mishonga inoderedza marwadzo, uye zviitiko zvisingadiwi. Varwere veplacebo vainge vachiri kurwadziwa vaigona kupihwa methylene blue mushure me6 mwedzi, saka kuenzanisa kwakajeka kwemapoka akagoverwa zvisina kurongwa kunopera pa6 mwedzi pane kuenderera kusvika pa12 kana 24 mwedzi.
Pa6 mwedzi, avhareji yemarwadzo yakaderera ne1.4 pachiyero che0 kusvika 10 nemethylene blue uye ne1.2 muboka rekuenzanisa, paine ukoshi hwep pakati pemapoka hwe0.671. Huwandu hwevarwere vakasvika pachiyero chekuvandudzika hwakanga huri 35.0 muzana zvichienzaniswa ne26.8 muzana, p iri 0.426. Kusakwanisa kuita mabasa kwakavandudzika ne7.8 zvichienzaniswa ne5.5, p iri 0.459. Huwandu hwekuvandudzika kwose hwakanga hwakada kufanana. Zviitiko zvenguva pfupi zvakadai sekuwedzera kwemarwadzo kwechinguvana kana marwadzo anopararira kune dzimwe nzvimbo zvakaitika mumapoka ose pasina musiyano wakakosha pakati pemapoka. Vanyori vakapedzisa mumushumo wavo wechiedzo chemunzvimbo dzakawanda kuti mashoko acho aisatsigira kukurudzira methylene blue mukati medhisiki nokuda kwemarwadzo asingaperi anobva mudhisiki.
Kuenzanisa zviedzo
| Chinhu | Peng 2010, nzvimbo imwe chete | IMBI 2019, nzvimbo ina |
|---|---|---|
| Varwere vakaongororwa | 72 vakagoverwa mumapoka zvisina kurongwa, 71 vakapedza 24 mwedzi | 84 vakanyoreswa, 81 vakaongororwa kusvika pa6 mwedzi |
| Kusarudzwa kwevarwere | Marwadzo asingaperi ari pamusana kweinopfuura 6 mwedzi, physiotherapy nemishonga zvisina kubatsira, pasina radiculopathy, pasina kumbovhiyiwa, kukwirira kwedhisiki kusati kwaderera, discogram inoratidza marwadzo pamwe nedhisiki rekuenzanisa riri pedyo risingarwadzi | Marwadzo asingaperi ari pamusana kwe6 mwedzi kana kupfuura, kurapwa kusingadi kuvhiyiwa kusina kubatsira, marwadzo pakugara ari 5 pa10 kana kupfuura, kuderera kwekukwirira kuri 50 muzana kana pasi, jekiseni pafacet risingaratidzi kuti ndiko kunobva marwadzo, discography yakafanana kune vose ine dzvinyiriro inodzorwa nedhisiki rekuenzanisa |
| Kurapwa kweboka rekuenzanisa | Kubayiwa kwedhisiki pamwe ne1 mL yemvura ine munyu pamwe ne1 mL yelidocaine ye2 muzana | Kubayiwa kwedhisiki pamwe ne1 mL yemvura ine munyu pamwe ne0.5 mL yelidocaine ye2 muzana pamwe ne0.5 mL yechinhu chinobatsira kuona pamufananidzo |
| Kurapwa kuri kuedzwa | 1 mL yemethylene blue ye1 muzana, 10 mg, pamwe ne1 mL yelidocaine ye2 muzana | 1 mL yemethylene blue ine 10 mg pa mL pamwe ne0.5 mL yelidocaine ye2 muzana pamwe ne0.5 mL yechinhu chinobatsira kuona pamufananidzo |
| Zviyero zvemigumisiro | Chiyero chenhamba chemarwadzo che0 kusvika 100, Oswestry 0 kusvika 100, kugutsikana, mishonga inoderedza marwadzo, matambudziko | Kubudirira kuri kuderera kwemarwadzo kwe30 muzana kana kupfuura pamwe nekuona kushanduka kwose pa6 mwedzi, pamwe neOswestry, hupenyu hwakanaka, mishonga inoderedza marwadzo, zviitiko zvisingadiwi |
| Kutevera varwere | 6, 12, uye 24 mwedzi, kuenzanisa kwemapoka akagoverwa zvisina kurongwa kuchiramba kwakadaro | Kuenzanisa kwemapoka akagoverwa zvisina kurongwa kusvika pa6 mwedzi, kuchinjira kurimwe boka kuchibvumirwa gare gare |
| Mhedzisiro huru | Marwadzo kubva painenge 72 kusvika 20 zvichienzaniswa ne67 kusvika 60 pa24 mwedzi, kusakwanisa kuita mabasa kubva painenge 48 kusvika 13 zvichienzaniswa nekusachinja kune basa, 91.6 muzana vakagutsikana zvichienzaniswa ne14.3 muzana | Marwadzo aderera ne1.4 zvichienzaniswa ne1.2 pa10 pa6 mwedzi, vakasvika pachiyero chekuvandudzika vari 35.0 muzana zvichienzaniswa ne26.8 muzana, pasina musiyano wakakosha |
Pane chimwezve chinodzivirira kuvhiringidzika. Dzimwe pfupiso dzinobatanidza muganhu wegiredhi rePfirrmann nezviedzo izvi. Muganhu iwoyo wakabva muchidzidzo chidiki chekutanga chekuedza nzira muNetherlands, kwete pamitemo yekupinda mune chimwe chezviedzo zviviri zvakagovera varwere mumapoka zvisina kurongwa zvakapfupiswa pamusoro.
Kunzwisisa kusiyana kwemigumisiro
Zviedzo zviviri zvakaitwa nokutendeseka zvinogona kusawirirana pasina chimwe chazvo chakaitwa nounyengeri. Misiyano yakakosha ndeyekunyatsosarudza varwere, kuita maitiro akafanana kune vose, miganhu yekuvanza kuti munhu ari muboka ripi, huwandu hwevarwere, uye kutsanangurwa kwezviyero zvemigumisiro.
Peng akasarudza boka rakanyatsoganhurirwa repanzvimbo imwe chete ndokuritevera kwemakore maviri pasina kuchinjira kurimwe boka. Izvozvo zvinoita kuti mhedzisiro yakakura ive nyore kuona, asiwo nyore kuwedzeredza kana kusarudzwa kwevarwere, mamwe marapirwo aipihwa pamwe chete, kana tarisiro zvaiva zvakasiyana pakati pemapoka nenzira dzisina kubatwa nemushumo. Munhu aibaya jekiseni aiziva boka raiva nemurwere, izvo zvisingadzivisiki nedhayi yebhuruu asi zvichiri kushaya simba kwechidzidzo. IMBI yakashandisa nzvimbo dzakawanda, mitemo yakasimba yedzvinyiriro, kuongororwa kwemajoini efacet, kumhanya kwekubaya jekiseni kwakafanana kune vose, uye tsananguro yakafanosarudzwa yemurwere anenge avandudzika pa6 mwedzi. Kurongwa kwakadaro hakunyanyi kuburitsa mhedzisiro yakanyanyisa netsaona, asi kunopindurawo mubvunzo wenguva pfupi. Hakutaure chinhu chakasimba pamusoro pemigumisiro yemapoka akagoverwa zvisina kurongwa pa24 mwedzi, nokuti boka rekuenzanisa rakabvumirwa kuchinjira kurimwe boka mushure me6 mwedzi.
Kumurwere kana chiremba, zvinobatsira kunzwisisa izvi nokungwarira. Chimwe chiedzo chidiki chekutanga chakawana kubatsirwa kwakakura zvikuru kwakagara kwenguva refu. Chiedzo chikuru chakadzokorora maitiro akafanana kune vose chakawana chete kuwedzera kudiki kusina kukosha pachiverengero pamusoro peboka rekuenzanisa rainge raitwawo maitiro uye ratova nelidocaine. Maitiro emigumisiro aya anoderedza chivimbo pane kusimbisa kuti kurapwa kunoshanda. Munhu wose anopihwa mukana wejekiseni remethylene blue mudhisiki anofanira kubvunza kuti kiriniki inoshandisa mitemo ipi yekusarudza varwere, kana discography nedhisiki rekuenzanisa zvichidikanwa, kuti chii chimwe chinobaiwa pamwe chete, kuti kiriniki inoti kurapwa kunobudirira pahuwandu hupi pa6 mwedzi ichishandisa tsananguro yemarwadzo yakafanosarudzwa, uye kuti matambudziko nekutevera varwere zvinoteverwa sei. Zvakakodzera kuverenga mashoko ezvekuchengeteka pakushandisa methylene blue usati waronga chero maitiro anopinda mumuviri, pamwe nemamiriro akakura ezvakaratidzwa nezvisina kuratidzwa netsvakurudzo yekurapa pamusoro pemethylene blue.
Nei izvi zvisingatsigiri madonhwe anonwiwa kana zvihwitsi zvinotsengwa
Nzira yekupinza chinhu mumuviri chikamu chekurapwa kwacho. Zviedzo izvi zvakaedza dhayi yakaiswa mukati medhisiki rakasarudzwa. Methylene blue yakamedzwa inopfuura nomuura ichipinda muropa rinotenderera mumuviri wose, ichisvika munyama dzemuviri iri muhuwandu hwakaderera zvikuru uye isina kunyatsonangidzirwa panzvimbo imwe. Hapana chakayerwa muzviedzo izvi chinoratidza kuti huwandu hunonwiwa hunodzokorora kuwanda kwayo kana nguva yainogara mukati medhisiki rimwe rechikamu chezasi chemusana. Kunyange dai kushanda kwayo mukati medhisiki kwakadzokororwa zvakajeka, izvozvo zvaisazoramba zvichishanda pachinwiwa, donhwe, kana chihwitsi chinotsengwa pasina chimwe chiedzo chinoshandisa nzira iyoyo, huwandu ihwohwo, uye boka iroro revanhu vane marwadzo.
Kuchengeteka hakufambiswiwo kubva kune imwe nzira kuenda kune imwe. Kusvika kwayo mumuviri wose kunounza kudyidzana nemimwe mishonga mumuviri wose, kusanganisira kudyidzana kwakanyatsoratidzwa nemishonga inokanganisa serotonin. Maitiro anoitwa padhisiki rimwe nekushandisa chinhu chinonwiwa mazuva ose inzira dzakasiyana dzekusangana nechinhu ichi, dzine njodzi dzakasiyana. Pfungwa iyi inokurukurwa zvakadzama muuchapupu hwekudyidzana kwemethylene blue nemimwe mishonga.
Mhedziso yacho yakaganhurirwa. Chiedzo chekutanga chejekiseni remethylene blue mudhisiki chakashuma kuderera kunoshamisa kwemarwadzo kwakagara kwemakore maviri. Chiedzo chakazotevera munzvimbo dzakawanda chine placebo yekuenzanisa hachina kudzokorora izvozvo pamwedzi mitanhatu. Hapana pamigumisiro iyi chiri uchapupu hwokuti methylene blue inonwiwa inobatsira marwadzo emusana.