Inqaku
Iinaliti ze-methylene blue zentlungu yomqolo evela kwidiski: oko kwafunyanwa zizilingo
Intlungu emazantsi omqolo luphawu, ayiloxilongo. Lo mahluko ugqiba ukuba naliphi na ibango nge-methylene blue yentlungu yomqolo linentsingiselo na.
Kwiimeko ezininzi zentlungu yomqolo, akukho sakhiwo sinye somzimba esinokuchongwa ngokuqinisekileyo njengonobangela. Intlungu evela kwidiski libango elithe ngqo ngakumbi. Lithi intlungu ivela kwiziphelo zemithambo-luvo ngaphakathi kwidiski enye ethile ephakathi kwamathambo omqolo, ngokuqhelekileyo apho iringi engaphandle ebizwa ngokuba yi-annulus ineentanda ezivumele imithambo-luvo emincinci neempawu zokudumba ukuba zikhulele ngaphakathi. Le ngcamango kulula ukuyichaza kodwa kunzima ukuyingqina, kuba iidiski ezininzi ezonakeleyo ezibonwa kwi-MRI azibangeli ntlungu kwaphela. Umfanekiso wovavanyo uwodwa awunakuchonga eyona diski ibanga intlungu.
Kungenxa yoko le nto zombini izilingo ekuxoxwa ngazo apha zaqala ngovavanyo lwe-discography olujolise ekuvuseni intlungu. Kusetyenziswa i-fluoroscopy, inaliti ifakwa kumbindi wediski ekrokrelwayo, kutofwe ulwelo olwenza idiski ibonakale emfanekisweni phantsi koxinzelelo olulawulwayo, aze ugqirha abuze umbuzo olula: ngaba ukunyusa uxinzelelo kule diski kuyayivelisa intlungu oqhele ukuba nayo? Ubuncinane idiski enye ekufutshane nayo iyavavanywa njengolawulo kwaye kufuneka ingabangeli ntlungu. Zizigulana kuphela ezinediski evelisa intlungu yazo eqhelekileyo nediski yolawulo engavelisi ntlungu eziqhubela phambili. Eli linyathelo lokukhetha elingena ngaphakathi emzimbeni, kwaye libumba yonke into elandelayo.
Abafundi abaqala ukufunda ukuba yintoni i-methylene blue ngokwemichiza ngamanye amaxesha bacinga ukuba inaliti efundwe kwezi zilingo inxulumene nokusela ulwelo oluluhlaza okwesibhakabhaka. Akunjalo. Ukutofa i-methylene blue ngaphakathi kwidiski kubeka malunga ne-10 mg yedayi ngqo ngaphakathi kwidiski enye esele ichongiwe njengebangela intlungu. Ingcamango yayijolise kuloo ndawo: idayi yayinokutshabalalisa okanye ithomalalise iziphelo ezincinci zemithambo-luvo kwiintanda ze-annulus, ize inciphise ukudumba kuloo ndawo. Loo ndlela yokusebenza, ukuba ikhona, ixhomekeke ekudibaneni ngqo ngaphakathi kuloo diski.
Inkqubo eyasetyenziswa kuzo zombini izilingo
Indlela eluncedo yokuyicinga ligumbi elivaliweyo elinendawo enye yokungena. Igumbi yidiski. Indawo yokungena yinaliti ekhokelwa yi-fluoroscopy, ngokuqhelekileyo ingena kwicala elingasemva. Xa kuqinisekisiwe ukuba inaliti ikwindawo efanelekileyo, ulwelo lwesifundo lutofwa kancinci kumbindi wediski.
Zombini izilingo zanika nenye into ngaphakathi kwidiski. Isilingo sokuqala sanika i-1 mL ye-methylene blue ene-1 pesenti, ilandelwa yi-1 mL ye-lidocaine ene-2 pesenti. Isilingo samva sanika i-1 mL ye-methylene blue ene-10 mg nge-mL nganye, kunye ne-0.5 mL ye-lidocaine ene-2 pesenti ne-0.5 mL yolwelo olwenza idiski ibonakale emfanekisweni. Ngoko uthelekiso aluzange lube phakathi kokutofa nokungayenzi kwaphela inkqubo. Omabini amaqela afakelwa inaliti, anyuselwa uxinzelelo kwidiski, aza anikwa iyeza elibulala uvakalelo kuloo ndawo ngaphakathi kwidiski. Umahluko ekuphela kwawo owawucwangcisiwe yayiyi-methylene blue xa ithelekiswa nesisombululo setyuwa. Iinkcukacha zendlela i-methylene blue esebenza ngayo kwiiseli zinceda ukucacisa ukuba kutheni abaphandi babecinga ukuba impembelelo kwindawo ethile yayinokwenzeka, kodwa ukuba nokwenzeka asibobungqina.
Oku kubalulekile xa kufundwa impendulo yeqela lolawulo. Nakuphi na ukuphucuka kwiqela lolawulo apha kuquka amava enkqubo eyenziwa kumqolo, i-lidocaine, indlela intlungu etshintsha ngayo ngokwendalo, nokulindela isiqabu.
Isilingo sokuqala esafumana iziphumo ezilungileyo
Isilingo sika-2010 esabela izigulana kumaqela ngokungenamkhethe, esenziwa nguPeng noogxa bakhe, sabhalisa abantu abadala abangama-72 ababenentlungu engapheliyo emazantsi omqolo ngaphandle kwentlungu yemithambo-luvo emilenzeni. Iimpawu zabo zazithathe ngaphezu kweenyanga ezi-6 nangona babefumene unyango lwe-physiotherapy kunye namayeza anciphisa ukudumba okanye ii-opioid; babeneempawu zokonakala kwediskhi kwi-MRI kodwa ukuphakama kwediskhi kugciniwe; babengazange batyandwe emazantsi omqolo; kwaye uvavanyo lwe-discography lwavelisa intlungu kwidiski ekrokrelwayo kodwa aluzange luyivelise kwidiski yolawulo esecaleni. Abangamashumi amathathu anesithandathu bafumana i-methylene blue kunye ne-lidocaine ngaphakathi kwidiski. Abangamashumi amathathu anesithandathu bafumana isisombululo setyuwa kunye ne-lidocaine. Izigulana nabavavanyi beziphumo babengazi ukuba sisiphi isigulana esifumene luphi unyango. Umntu otofayo wayengenakungayazi loo nto kuba idayi iluhlaza okwesibhakabhaka.
Ulandelelo lwalude: iinyanga ezi-6, ezi-12 nezingama-24. Iziphumo ezalinganiswayo yayiyintlungu kwisikali samanani esisuka ku-0 ukuya ku-100, ukuphazamiseka kokukwazi ukwenza imisebenzi kwi-Oswestry Disability Index esuka ku-0 ukuya ku-100, kunye nokwaneliseka, ukusetyenziswa kwamayeza eentlungu, neengxaki. Isiphumo esapapashwayo sasisikhulu ngokungaqhelekanga. Intlungu engumndilili yehla ukusuka malunga nama-72 ukuya malunga nama-20 kwiqela le-methylene blue kwiinyanga ezingama-24, ngoxa kwiqela lolawulo yatshintsha ukusuka malunga nama-67 ukuya malunga nama-60. Ukuphazamiseka kokusebenza kwehla ukusuka malunga nama-48 ukuya malunga nama-13 nge-methylene blue, xa kuthelekiswa neqela lolawulo elaphantse langatshintshi. Kwiinyanga ezingama-24, izigulana ezingama-33 kwezingama-36 ezafumana unyango zaxela ukuba zanelisekile okanye zanelisekile ngokupheleleyo, xa kuthelekiswa nezi-5 kwezingama-35 kwiqela lolawulo. Uninzi lwezigulana ezafumana unyango lwaxela ukuba alusebenzisi mayeza eentlungu. Akuzange kuxelwe usulelo kwidiski okanye ukonzakala kwemithambo-luvo ngexesha lolandelelo. Ababhali baluchaza unyango njengolukhuselekileyo, olusebenzayo, nolungena emzimbeni kancinane kwingxelo yabo ethelekisa unyango ne-placebo.
Isiphumo esikhulu kangako, esivela kwiziko elinye nakwizigulana ezikhethiweyo ezingama-72, kanye luhlobo lwesiphumo esifuna ukuba isilingo siphindwe ngabaphandi abazimeleyo.
Ukuphindwa kwesilingo kumaziko amaninzi
Isifundo se-IMBI sikaKallewaard noogxa bakhe sacwangciswa njengophindo kumaziko amane aseNetherlands. Kwabhaliswa izigulana ezingamashumi asibhozo anesine, kwaye ezingama-81 zanika idatha enokuhlalutywa emva kokwabelwa amaqela ngokungenamkhethe: ezingama-40 kwiqela le-methylene blue, ezingama-41 kwiqela le-placebo. Ukukhethwa kwakhona kwakufuna intlungu engapheliyo yomqolo ehambelana nentlungu evela kwidiski, ngeli xesha ithathe ubuncinane iinyanga ezi-6, ingancedwanga ngokwaneleyo lunyango olungatyandiyo, intlungu xa uhleli eyi-5 kwi-10 ubuncinane, ne-MRI ethathwe kunyaka ongaphambili engabonisi kulahleka okukhulu kokuphakama kwediskhi okungaphezu kwama-50 pesenti. Izigulana zaqala ngokufumana inaliti yokuthintela imiqondiso yeentlungu kumalungu e-facet ukuze kuqinisekiswe ukuba intlungu ayiveli kuloo malungu, zaza zavavanywa nge-discography esemgangathweni enoxinzelelo olulawulwayo, kusetyenziswa idiski yolawulo esecaleni nemida yoxinzelelo echazwe ngokucacileyo. Inkqubo yenziwa kwigumbi lotyando, kusetyenziswa amayeza okubulala iintsholongwane ukuthintela usulelo nesantya sokutofa esicothayo nesilawulwayo. Izigulana zeqela lolawulo zaphinda zafumana isisombululo setyuwa kunye ne-lidocaine kunye nolwelo olwenza idiski ibonakale emfanekisweni.
Isiphumo esiphambili esasilinganiswa yayiyimpumelelo yonyango kwiinyanga ezi-6, echazwa njengokwehla okungama-30 pesenti ubuncinane kumanqaku entlungu angumndilili aqokelelwe kwiintsuku ezine, kunye novavanyo lotshintsho ngokubanzi. Imilinganiselo eyongezelelweyo yayiquka ukuphazamiseka kokusebenza ngokwe-Oswestry, izikali zomgangatho wobomi, uhlobo lwentlungu, ukusetyenziswa kwamayeza eentlungu, neziganeko ezingafunekiyo. Izigulana ze-placebo ezazisenentlungu zazinokufumana i-methylene blue emva kweenyanga ezi-6, ngoko uthelekiso oluthe ngqo lwamaqela abelwe ngokungenamkhethe luphela kwiinyanga ezi-6 kunokuba luqhubeke ukuya kwiinyanga ezili-12 okanye ezingama-24.
Kwiinyanga ezi-6, intlungu engumndilili yehla ngamanqaku ayi-1.4 kwisikali esisuka ku-0 ukuya ku-10 nge-methylene blue, nangamanqaku ayi-1.2 kwiqela lolawulo, inexabiso le-p phakathi kwamaqela elingu-0.671. Amazinga abo bafikelela kumlinganiselo wokuphucuka ayengama-35.0 pesenti xa kuthelekiswa nama-26.8 pesenti, i-p ilingana no-0.426. Ukuphazamiseka kokusebenza kwaphucuka ngamanqaku ayi-7.8 xa kuthelekiswa namanqaku ayi-5.5, i-p ilingana no-0.459. Amazinga okuphucuka ngokubanzi ayephantse afane. Iziganeko ezidlulayo ezifana nokwanda kwentlungu okwethutyana okanye intlungu esasazeka kwezinye iindawo zenzeka kuwo omabini amaqela, kungekho mahluko ubalulekileyo phakathi kwamaqela. Ababhali bagqiba kwingxelo yabo yesilingo samaziko amaninzi ukuba idatha yayingakuxhasi ukunconywa kwe-methylene blue efakwa ngaphakathi kwidiski ngenxa yentlungu engapheliyo evela kwidiski.
Uthelekiso lwezilingo
| Uphawu | Peng 2010, iziko elinye | IMBI 2019, amaziko amane |
|---|---|---|
| Izigulana ezahlalutywayo | Ezingama-72 zabelwa amaqela ngokungenamkhethe, ezingama-71 zagqiba iinyanga ezingama-24 | Ezingama-84 zabhaliswa, ezingama-81 zahlalutywa ukuya kwiinyanga ezi-6 |
| Ukukhethwa kwezigulana | Intlungu engapheliyo yomqolo engaphezu kweenyanga ezi-6, i-physiotherapy namayeza zingancedanga, kungekho ngxaki yengcambu yomthambo-luvo, kungekho tyando lwangaphambili, ukuphakama kwediskhi kugciniwe, i-discogram evelisa intlungu nediski yolawulo esecaleni engayivelisiyo | Intlungu engapheliyo yomqolo yeenyanga ezi-6 okanye ngaphezulu, unyango olungatyandiyo lungancedanga, intlungu xa uhleli eyi-5 kwi-10 okanye ngaphezulu, ukulahleka kokuphakama kwediskhi kungama-50 pesenti okanye ngaphantsi, uvavanyo lokuthintela intlungu ye-facet lungabonisanga ukuba ivela apho, i-discography esemgangathweni enoxinzelelo olulawulwayo nediski yolawulo |
| Unyango lweqela lolawulo | Ukuhlatywa kwediskhi kunye ne-1 mL yesisombululo setyuwa kunye ne-1 mL ye-lidocaine ene-2 pesenti | Ukuhlatywa kwediskhi kunye ne-1 mL yesisombululo setyuwa kunye ne-0.5 mL ye-lidocaine ene-2 pesenti kunye ne-0.5 mL yolwelo olwenza idiski ibonakale emfanekisweni |
| Unyango oluvavanywayo | I-1 mL ye-methylene blue ene-1 pesenti, i-10 mg, kunye ne-1 mL ye-lidocaine ene-2 pesenti | I-1 mL ye-methylene blue ene-10 mg nge-mL nganye kunye ne-0.5 mL ye-lidocaine ene-2 pesenti kunye ne-0.5 mL yolwelo olwenza idiski ibonakale emfanekisweni |
| Iziphumo ezilinganiswayo | Isikali samanani entlungu esisuka ku-0 ukuya ku-100, i-Oswestry esuka ku-0 ukuya ku-100, ukwaneliseka, amayeza eentlungu, iingxaki | Impumelelo njengokwehla kwentlungu ngama-30 pesenti okanye ngaphezulu kunye novavanyo ngokubanzi kwiinyanga ezi-6, kunye ne-Oswestry, umgangatho wobomi, amayeza eentlungu, iziganeko ezingafunekiyo |
| Ulandelelo | Iinyanga ezi-6, ezi-12 nezingama-24, uthelekiso lwamaqela abelwe ngokungenamkhethe lugciniwe | Uthelekiso lwamaqela abelwe ngokungenamkhethe ukuya kwiinyanga ezi-6, kuvunyelwe ukutshintshela kolunye unyango emva koko |
| Isiphumo esingundoqo | Intlungu isuka malunga nama-72 ukuya kuma-20 xa kuthelekiswa nama-67 ukuya kuma-60 kwiinyanga ezingama-24, ukuphazamiseka kokusebenza kusuka malunga nama-48 ukuya kuma-13 xa kuthelekiswa nokungabikho kotshintsho olunentsingiselo, abangama-91.6 pesenti banelisekile xa kuthelekiswa nabangama-14.3 pesenti | Intlungu yehla nge-1.4 xa kuthelekiswa ne-1.2 kwi-10 kwiinyanga ezi-6, abafikelela kumlinganiselo wokuphucuka bangama-35.0 pesenti xa kuthelekiswa nama-26.8 pesenti, akukho mahluko ubalulekileyo |
Enye inkcukacha eyongezelelweyo ithintela ukudideka. Ezinye izishwankathelo zidibanisa umda webakala le-Pfirrmann nezi zilingo. Loo mda wawusuka kwisifundo esincinci sovavanyo lokuqala saseNetherlands, kungekhona kwimigaqo yokufaneleka yesinye kwezi zilingo zimbini zokwabela amaqela ngokungenamkhethe zishwankathelwe ngasentla.
Indlela yokuyiqonda le mpikiswano yeziphumo
Izilingo ezibini ezenziwe ngokunyaniseka zinokungavumelani kungakhange kubekho buqhetseba kwesinye sazo. Umahluko obalulekileyo kukuchaneka kokukhetha izigulana, ukwenziwa kweenkqubo ngendlela efanayo, imida yokufihla ukuba ngubani ofumana luphi unyango, ubungakanani besampulu, nendlela esichazwa ngayo isiphumo esilinganiswayo.
UPeng wakhetha iqela elikhethekileyo kwiziko elinye waza walilandela iminyaka emibini ngaphandle kokutshintsha unyango. Oku kwenza kube lula ukubona impembelelo enkulu, kodwa kukwenza kube lula ukuyibaxa ukuba ukukhethwa kwezigulana, unyango oluhamba nalo, okanye ulindelo lwahlukile phakathi kwamaqela ngeendlela ezingabhalwanga kwingxelo. Umntu otofayo wayesazi ukuba sisiphi isigulana esifumana luphi unyango; oku akunakuphepheka ngedayi eluhlaza okwesibhakabhaka, kodwa kusebubuthathaka. I-IMBI yasebenzisa amaziko amaninzi, imiqathango engqongqo yoxinzelelo, uvavanyo lwamalungu e-facet, isantya sokutofa esifanayo, nenkcazelo emiselwe kwangaphambili yokuba ngubani ofikelele kumlinganiselo wokuphucuka kwiinyanga ezi-6. Olu cwangciso alufane luvelise isiphumo esigqithisileyo ngamabona-ndenzile, kodwa lukwaphendula umbuzo wexesha elifutshane. Alutsho nto eqinisekiswe ngokuqinileyo ngeziphumo zamaqela abelwe ngokungenamkhethe kwiinyanga ezingama-24, kuba iqela lolawulo lalivunyelwe ukutshintshela kolunye unyango emva kweenyanga ezi-6.
Kwisigulana okanye kugqirha, eyona ndlela yokuzifunda ezi ziphumo kukulumka. Isilingo sokuqala esincinci safumana inzuzo enkulu kakhulu nehlala ixesha elide. Uphindo olukhulu nolwenziwe ngendlela efanayo lwafumana kuphela ukuphucuka okuncinci, okungabalulekanga ngokwezibalo, ngaphezu kweqela lolawulo elafumana inkqubo eyayisele iquka i-lidocaine. Le ndlela yeziphumo iyenza buthathaka intembelo kunokuba iqinisekise ukusebenza konyango. Nabani na onikwa ithuba lokutofelwa i-methylene blue kwidiski kufuneka abuze ukuba zeziphi iindlela zokukhetha ezisetyenziswa yikliniki, ukuba i-discography nediski yolawulo ziyafuneka na, ukuba yintoni etofwa kunye nayo, ukuba leliphi izinga lempumelelo elibangwa yikliniki kwiinyanga ezi-6 kusetyenziswa inkcazelo yentlungu emiselwe kwangaphambili, nokuba iingxaki nolandelelo zilandelwa njani. Kufanelekile ukufunda ulwazi olusisiseko ngemibuzo yokhuseleko enxulumene nokusetyenziswa kwe-methylene blue ngaphambi kokucwangcisa nayiphi na inkqubo engena ngaphakathi emzimbeni, kwakunye nomxholo obanzi woko uphando lwezonyango nge-methylene blue lukubonisileyo nolungakubonisanga.
Isizathu sokuba oku kungaxhasi amathontsi okanye iilekese ezithambileyo ezityiwa ngomlomo
Indlela yokuyifaka emzimbeni iyinxalenye yonyango oluvavanywayo. Ezi zilingo zavavanya idayi efakwe ngaphakathi kwidiski ekhethiweyo. I-methylene blue eginyiweyo idlula emathunjini iye kujikelezo lwegazi lomzimba wonke, ize ifike kwizicubu ngoxinano oluphantsi kakhulu nolungajoliswanga kangako kwindawo ethile. Akukho mlinganiselo kwezi zilingo obonisa ukuba isixa esithathwa ngomlomo sivelisa uxinano olufanayo okanye ixesha elifanayo lokuhlala ngaphakathi kwidiski enye emazantsi omqolo. Nokuba impembelelo yangaphakathi kwidiski ibiqinisekiswe ngokucacileyo sisilingo esiphindiweyo, ibingayi kusebenza ngokuzenzekelayo kwisiselo, kwithontsi, okanye kwilekese ethambileyo ngaphandle kwesilingo esahlukileyo esisebenzisa loo ndlela yokuyifaka emzimbeni, eso sixa, nelo qela labantu abanentlungu.
Nokhuseleko aludluliselwa ngokuzenzekelayo. Ukufikelela komchiza kumzimba wonke kuzisa ukusebenzisana namanye amayeza kuwo wonke umzimba, kuquka ukusebenzisana okubhalwe kakuhle namayeza achaphazela i-serotonin. Inkqubo eyenziwa kwidiski ethile nokuyithatha ngomlomo yonke imihla zizindlela ezahlukeneyo zokuchanabeka, ezinemingcipheko eyahlukileyo. Le ngongoma ichazwe nzulu ngakumbi kubungqina bokusebenzisana kwe-methylene blue namanye amayeza.
Isigqibo sinomda ocacileyo. Isilingo sokuqala sokutofa i-methylene blue kwidiski saxela isiqabu esiphawulekayo esaqhubeka iminyaka emibini. Uphindo lwamva olwenziwa kumaziko amaninzi lwaza lwathelekiswa ne-placebo aluzange luphinde lufumane eso siphumo kwiinyanga ezintandathu. Akukho nasinye kwezi ziphumo esibubungqina bokuba i-methylene blue ethathwa ngomlomo iyanceda kwintlungu yomqolo.