Isihloko
Imijovo ye-methylene blue yobuhlungu beqolo obuvela kudiski: okwatholwa izivivinyo
Ubuhlungu engxenyeni engezansi yeqolo buyisibonakaliso, hhayi ukuxilongwa. Lowo mehluko yiwo onquma ukuthi noma yisiphi isimangalo nge-methylene blue yobuhlungu beqolo sinengqondo yini.
Ubuhlungu obuningi beqolo abunaso isakhiwo esisodwa esingasolwa ngokuqiniseka. Ubuhlungu obuvela kudiski buyisimangalo esiqondiswe kakhulu. Sithi ubuhlungu buvela eziphethweni zemizwa ngaphakathi kwediski eyodwa ethile ephakathi kwamathambo omgogodla, ngokuvamile lapho indandatho engaphandle ebizwa ngokuthi i-annulus inemifantu khona, ivumela imizwa emincane ukuba ikhule ingene ngaphakathi kanye nezimpawu zokuvuvukala. Lo mqondo kulula ukuwuchaza kodwa kunzima ukuwufakazela, ngoba amadiski amaningi abonakala ewohlokile ku-MRI awabangeli buhlungu nhlobo. Isithombe sokuhlola sisodwa asikwazi ukukhomba imbangela.
Yingakho zombili izivivinyo okuxoxwa ngazo lapha zaqala nge-discography evusa ubuhlungu. Ngaphansi kokuqondiswa yi-fluoroscopy, inaliti ifakwa engxenyeni emaphakathi, i-nucleus, yediski esolwayo, kujovwe uketshezi olugqamisa isithombe ngaphansi kwengcindezi elawulwayo, bese udokotela ebuza umbuzo olula: ingabe ukufaka ingcindezi kule diski kubuyisa ubuhlungu ojwayele ukubuzwa? Okungenani idiski eyodwa eseduze nayo iyahlolwa ukuze iqhathaniswe futhi kufanele ingabangeli buhlungu. Kuphela iziguli ezinediski ebangela ubuhlungu obufana nobazo kanye nediski yokuqhathanisa engabangeli buhlungu eziqhubekela phambili. Lesi yisinyathelo sokukhetha esidinga ukungena emzimbeni, futhi sinomthelela kukho konke okulandelayo.
Abafundi abasanda kufunda ukuthi iyini i-methylene blue ngokwesakhiwo sayo samakhemikhali ngezinye izikhathi bacabanga ukuthi umjovo owahlolwa kulezi zivivinyo uhlobene nokuphuza uketshezi oluluhlaza okwesibhakabhaka. Akunjalo. Umjovo we-methylene blue ngaphakathi kwediski ufaka cishe 10 mg wodayi ngqo ngaphakathi kwediski eyodwa esivele ikhonjwe njengebangela ubuhlungu. Umbono owawuhlolwa wawumayelana nomphumela kuleyo ndawo: udayi ungase ubhubhise noma uthulise iziphetho zemizwa ezincane emifantwini ye-annulus futhi unciphise ukuvuvukala kuleyo ndawo. Leyo ndlela yokusebenza, uma ikhona, incike ekuthintaneni ngqo ngaphakathi kwaleyo diski.
Inqubo eyasetshenziswa kuzo zombili izivivinyo
Indlela ewusizo yokukucabanga iyigumbi elivaliwe elinendawo eyodwa yokungena. Igumbi liyidiski. Indawo yokungena iyinaliti eqondiswa yi-fluoroscopy, ngokuvamile engena ngasemuva eceleni. Uma indawo yenaliti isiqinisekisiwe, uketshezi locwaningo lujovwa kancane ku-nucleus.
Zombili izivivinyo zafaka nokunye ngaphakathi kwediski. Isivivinyo sokuqala sanikeza 1 mL we-methylene blue engu-1 phesenti, elandelwa ngu-1 mL we-lidocaine engu-2 phesenti. Isivivinyo sakamuva sanikeza 1 mL we-methylene blue enomthamo ongu-10 mg nge-mL, kanye no-0.5 mL we-lidocaine engu-2 phesenti no-0.5 mL woketshezi olugqamisa isithombe. Ngakho ukuqhathanisa kwakungakaze kube phakathi kokujova nokungenzi nqubo nhlobo. Womabili amaqembu afakelwa inaliti, afakelwa ingcindezi kudiski, futhi afakelwa isibulala-zinzwa sendawo ngaphakathi kwediski. Umehluko owodwa kuphela owawuhleliwe kwakuyi-methylene blue uma iqhathaniswa namanzi anosawoti. Imininingwane yendlela i-methylene blue esebenza ngayo kumaseli isiza ukuchaza ukuthi kungani abacwaningi babecabanga ukuthi umphumela wendawo wawungenzeka, kodwa ukuthi into ingenzeka akubona ubufakazi.
Lokhu kubalulekile lapho kufundwa impendulo yeqembu lokuqhathanisa. Noma yikuphi ukuthuthuka kuleli qembu lapha kuhlanganisa okuhlangenwe nakho kwenqubo yomgogodla, i-lidocaine, inkambo yemvelo yobuhlungu, kanye nokulindela ukukhululeka.
Isivivinyo sokuqala esathola umphumela omuhle
Isivivinyo sango-2010 sikaPeng nozakwabo, lapho iziguli zabelwa amaqembu ngokungahleliwe, sabhalisa abantu abadala abangu-72 ababenobuhlungu obungapheli engxenyeni engezansi yeqolo, obugxile emgogodleni, ngaphandle kobuhlungu bemizwa emilenzeni. Izimpawu zabo zazihlale ngaphezu kwezinyanga ezingu-6 naphezu kokwelashwa ngokuzivocavoca nokunyakaza komzimba kanye nemithi yokunciphisa ukuvuvukala noma ama-opioid. Babenezimpawu zokwewohloka kwediski ku-MRI kodwa ukuphakama kwediski kusagcinekile, bengakaze bahlinzwe engxenyeni engezansi yomgogodla, futhi i-discogram yabo yayivuse ubuhlungu kuyilapho idiski eseduze esetshenziselwa ukuqhathanisa ingabuvusanga. Abangu-36 bathola i-methylene blue ngaphakathi kwediski kanye ne-lidocaine. Abangu-36 bathola amanzi anosawoti kanye ne-lidocaine. Iziguli nabahloli bemiphumela babengazi ukuthi umuntu useqenjini liphi. Owayejova wayengeke afihlelwe lokho ngoba udayi uluhlaza okwesibhakabhaka.
Ukulandelela kwathatha isikhathi eside: izinyanga ezingu-6, 12, no-24. Imiphumela elinganiswayo kwakuwubuhlungu esikalini sezinombolo esisuka ku-0 kuya ku-100, ukukhubazeka ku-Oswestry Disability Index esuka ku-0 kuya ku-100, kanye nokwaneliseka, ukusetshenziswa kwemithi yokudambisa ubuhlungu, nezinkinga ezibangelwa ukwelashwa. Umphumela owashicilelwa wawumkhulu ngokungavamile. Isilinganiso sobuhlungu sehla sisuka cishe ku-72 saya cishe ku-20 eqenjini le-methylene blue ezinyangeni ezingu-24, kuyilapho iqembu lokuqhathanisa lasuka cishe ku-67 laya cishe ku-60. Ukukhubazeka kwehla kusuka cishe ku-48 kuya cishe ku-13 nge-methylene blue, kuyilapho cishe kungazange kube noshintsho eqenjini lokuqhathanisa. Ezinyangeni ezingu-24, iziguli ezingu-33 kwezingu-36 ezazelashiwe zabika ukuthi zanelisekile noma zanelisekile ngokuphelele, uma kuqhathaniswa nezingu-5 kwezingu-35 eqenjini lokuqhathanisa. Iziguli eziningi ezazelashiwe zabika ukuthi azisebenzisi mithi yokudambisa ubuhlungu. Akuzange kubikwe ukutheleleka kwediski noma ukulimala kwemizwa ngesikhathi sokulandelela. Ababhali bachaza ukwelashwa njengokuphephile, okusebenzayo, nokungadingi ukungena kakhulu emzimbeni embikweni wabo owawuqhathanisa ukwelashwa ne-placebo.
Umphumela omkhulu ngaleyo ndlela, ovela esikhungweni esisodwa nasezigulini ezikhethiwe ezingu-72, uwuhlobo lomphumela oludinga ukuphindwa ngabacwaningi abazimele.
Ukuphindwa ezikhungweni eziningi
Ucwaningo lwe-IMBI lukaKallewaard nozakwabo lwahlelwa njengokuphindwa ezikhungweni ezine eNetherlands. Kwabhaliswa iziguli ezingu-84, futhi ezingu-81 zanikeza idatha eyayikwazi ukuhlaziywa ngemva kokwabelwa amaqembu ngokungahleliwe: ezingu-40 ze-methylene blue, ezingu-41 ze-placebo. Ukukhethwa kwaphinde kwadinga ubuhlungu obungapheli obugxile emgogodleni obuhambisana nobuhlungu obuvela kudiski. Kulokhu kwakudingeka okungenani izinyanga ezingu-6 zobuhlungu, ukunakekelwa okungahileli ukuhlinzwa okungazange kusize ngokwanele, ubuhlungu lapho umuntu ehlezi obungu-5 kokungu-10 okungenani, kanye ne-MRI eyenziwe phakathi nonyaka owandulele eyayikhipha iziguli ezinokuncipha okukhulu kokuphakama kwediski okungaphezu kwamaphesenti angu-50. Iziguli zaqala ngokufakelwa isibulala-zinzwa ezinzwaneni zamalunga e-facet ukuze kukhishwe ukuthi ubuhlungu buvela kulawo malunga, kwase kwenziwa i-discography enengcindezi elawulwayo ngendlela efanayo, kusetshenziswa idiski eseduze yokuqhathanisa kanye nemikhawulo yengcindezi ecacile. Inqubo yenziwa egumbini lokuhlinza, kunikezwa ama-antibiotic okuvimbela ukutheleleka futhi kujovwa kancane ngesivinini esilawulwayo. Iqembu lokuqhathanisa laphinde lathola amanzi anosawoti kanye ne-lidocaine noketshezi olugqamisa isithombe.
Umphumela oyinhloko owawulinganiswa kwakuyimpumelelo yokwelashwa ezinyangeni ezingu-6, eyachazwa njengokuncipha okungenani ngamaphesenti angu-30 esilinganisweni samaphuzu obuhlungu aqoqwe phakathi kwezinsuku ezine, kanye nombono jikelele woshintsho. Izilinganiso zesibili zazihlanganisa ukukhubazeka ngokwe-Oswestry, izikali zekhwalithi yokuphila, uhlobo lobuhlungu, ukusetshenziswa kwemithi yokudambisa ubuhlungu, nezehlakalo ezingathandeki. Iziguli ze-placebo ezazisenobuhlungu zazingathola i-methylene blue ngemva kwezinyanga ezingu-6, ngakho ukuqhathanisa okucacile kwamaqembu abelwe ngokungahleliwe kuphela ezinyangeni ezingu-6 kunokuba kuqhubeke kuye ezinyangeni ezingu-12 noma ezingu-24.
Ezinyangeni ezingu-6, isilinganiso sobuhlungu sehla ngamaphuzu angu-1.4 esikalini esisuka ku-0 kuya ku-10 nge-methylene blue nangamaphuzu angu-1.2 eqenjini lokuqhathanisa, inani le-p phakathi kwamaqembu lingu-0.671. Amazinga eziguli ezafinyelela ekuncipheni kobuhlungu okwakunqunyiwe ayengamaphesenti angu-35.0 uma kuqhathaniswa namaphesenti angu-26.8, i-p ilingana no-0.426. Ukukhubazeka kwathuthuka ngamaphuzu angu-7.8 uma kuqhathaniswa namaphuzu angu-5.5, i-p ilingana no-0.459. Amazinga okuthuthuka jikelele ayecishe afane. Izehlakalo ezidlulayo, njengokwanda kobuhlungu okwesikhashana noma ubuhlungu obusabalalela kwezinye izindawo, zenzeka kuwo womabili amaqembu ngaphandle komehluko obalulekile ngokwezibalo phakathi kwawo. Ababhali baphetha embikweni wabo wesivivinyo sezikhungo eziningi ngokuthi idatha ayizange isekele ukuncoma i-methylene blue ngaphakathi kwediski ngobuhlungu obungapheli obuvela kudiski.
Ukuqhathaniswa kwezivivinyo
| Isici | Peng 2010, isikhungo esisodwa | IMBI 2019, izikhungo ezine |
|---|---|---|
| Iziguli ezahlaziywa | Ezingu-72 zabelwa ngokungahleliwe, ezingu-71 zaqeda izinyanga ezingu-24 | Ezingu-84 zabhaliswa, ezingu-81 zahlaziywa kuze kube yizinyanga ezingu-6 |
| Ukukhethwa kweziguli | Ubuhlungu obungapheli obugxile emgogodleni ngaphezu kwezinyanga ezingu-6, ukwelashwa ngokuzivocavoca nokunyakaza komzimba nemithi kungazange kusize, kungekho ukuphazamiseka kwezimpande zemizwa, kungekho ukuhlinzwa kwangaphambilini, ukuphakama kwediski kugcinekile, i-discogram evusa ubuhlungu nediski eseduze yokuqhathanisa engabuvusi | Ubuhlungu obungapheli obugxile emgogodleni izinyanga ezingu-6 noma ngaphezulu, ukunakekelwa okungahileli ukuhlinzwa kungazange kusize, ubuhlungu lapho umuntu ehlezi bungu-5 kokungu-10 noma ngaphezulu, ukuncipha kokuphakama kungamaphesenti angu-50 noma ngaphansi, ukuhlolwa ngesibulala-zinzwa se-facet kungakhombisi ubuhlungu obuvela kulawo malunga, i-discography enengcindezi elawulwayo ngendlela efanayo nediski yokuqhathanisa |
| Ukwelashwa kweqembu lokuqhathanisa | Ukubhobozwa kwediski kanye no-1 mL wamanzi anosawoti no-1 mL we-lidocaine engu-2 phesenti | Ukubhobozwa kwediski kanye no-1 mL wamanzi anosawoti no-0.5 mL we-lidocaine engu-2 phesenti no-0.5 mL woketshezi olugqamisa isithombe |
| Ukwelashwa okuhlolwayo | 1 mL we-methylene blue engu-1 phesenti, 10 mg, kanye no-1 mL we-lidocaine engu-2 phesenti | 1 mL we-methylene blue engu-10 mg nge-mL kanye no-0.5 mL we-lidocaine engu-2 phesenti no-0.5 mL woketshezi olugqamisa isithombe |
| Imiphumela elinganiswayo | Isikali sezinombolo sobuhlungu esisuka ku-0 kuya ku-100, i-Oswestry esuka ku-0 kuya ku-100, ukwaneliseka, imithi yokudambisa ubuhlungu, izinkinga ezibangelwa ukwelashwa | Impumelelo njengokuncipha kobuhlungu ngamaphesenti angu-30 noma ngaphezulu kanye nombono jikelele ezinyangeni ezingu-6, kanye ne-Oswestry, ikhwalithi yokuphila, imithi yokudambisa ubuhlungu, izehlakalo ezingathandeki |
| Ukulandelela | Izinyanga ezingu-6, 12, no-24, ukuqhathanisa kwamaqembu abelwe ngokungahleliwe kugcinwa | Ukuqhathanisa kwamaqembu abelwe ngokungahleliwe kuze kube yizinyanga ezingu-6, kuvunyelwa ukushintshela kokunye ukwelashwa kamuva |
| Umphumela oyinhloko | Ubuhlungu busuka cishe ku-72 kuya ku-20 uma kuqhathaniswa no-67 kuya ku-60 ezinyangeni ezingu-24, ukukhubazeka kusuka cishe ku-48 kuya ku-13 uma kuqhathaniswa nokungabi noshintsho olunengqondo, amaphesenti angu-91.6 anelisekile uma kuqhathaniswa namaphesenti angu-14.3 | Ubuhlungu behla ngo-1.4 uma kuqhathaniswa no-1.2 kokungu-10 ezinyangeni ezingu-6, abafinyelela ekuncipheni okunqunyiwe ngamaphesenti angu-35.0 uma kuqhathaniswa namaphesenti angu-26.8, akukho mehluko obalulekile ngokwezibalo |
Omunye umniningwane uvimbela ukudideka. Ezinye izifinyezo zihlobanisa lezi zivivinyo nomkhawulo webanga le-Pfirrmann. Lowo mkhawulo wavela ocwaningweni oluncane lokuqala lwaseNetherlands, hhayi emithethweni yokufaneleka yanoma yisiphi kulezi zivivinyo ezimbili zokwabela amaqembu ngokungahleliwe ezifingqwe ngenhla.
Indlela yokufunda lokhu kungqubuzana
Izivivinyo ezimbili eziqotho zingathola imiphumela engavumelani ngaphandle kokuba esinye sazo sibe esokukhwabanisa. Umehluko obalulekile ukunemba kokukhetha, ukwenziwa kwezinqubo ngendlela efanayo, imikhawulo yokufihla ukuthi umuntu useqenjini liphi, ubukhulu besampula, kanye nencazelo yomphumela olinganiswayo.
UPeng wakhetha iqembu elinezidingo eziqondile esikhungweni esisodwa futhi walilandela iminyaka emibili ngaphandle kokushintshela kokunye ukwelashwa. Lokhu kwenza kube lula ukubona umphumela omkhulu, kodwa futhi kube lula ukuwenza ubonakale mkhulu ngokweqile uma ukukhethwa kweziguli, ukwelashwa okuhambisana nalokhu, noma okulindelwe kwakuhlukile phakathi kwamaqembu ngezindlela umbiko ongazange uziveze. Owayejova wayazi ukuthi isiguli sabelwe liphi iqembu, okuyinto engenakugwemeka ngodayi oluhlaza okwesibhakabhaka kodwa esalokhu iyiphuzu elibuthakathaka. I-IMBI yasebenzisa izikhungo eziningi, imibandela yengcindezi eqinile, ukuhlolwa kwamalunga e-facet, isivinini sokujova esifanayo, kanye nencazelo eyayinqunywe kusengaphambili yokuthi ubani ofinyelele ekuncipheni kobuhlungu ezinyangeni ezingu-6. Lolo hlelo lunamathuba amancane okukhiqiza umphumela oweqisayo ngenhlanhla, kodwa futhi luphendula umbuzo wesikhathi esifushane. Alusho lutho oluqinile ngemiphumela yezinyanga ezingu-24 yamaqembu abelwe ngokungahleliwe, ngoba iqembu lokuqhathanisa lalivunyelwe ukushintshela kokunye ukwelashwa ngemva kwezinyanga ezingu-6.
Esigulini noma kumelaphi, indlela yokufunda lokhu ukuze kusetshenziswe ngokoqobo kufanele ibe ngeyokuqapha. Isivivinyo esisodwa esincane sokuqala sathola inzuzo enkulu kakhulu nehlala isikhathi eside. Ukuphindwa okukhulu okwenziwe ngendlela efanayo kwathola kuphela ukwengezeka okuncane okungabalulekile ngokwezibalo uma kuqhathaniswa neqembu elenziwa inqubo eyayivele ihlanganisa i-lidocaine. Leli phethini linciphisa ukwethembeka kunokuba liqinisekise ukusebenza kokwelashwa. Noma ubani onikezwa umjovo we-methylene blue kudiski kufanele abuze ukuthi umtholampilo usebenzisa miphi imibandela yokukhetha, ukuthi i-discography nediski yokuqhathanisa kuyadingeka yini, ukuthi yini ejovwa kanye nayo, ukuthi umtholampilo uthi liyini izinga lempumelelo ezinyangeni ezingu-6 uma kusetshenziswa incazelo yobuhlungu enqunywe kusengaphambili, nokuthi izinkinga nokulandelela kulandelwa kanjani. Kuyafaneleka ukufunda ulwazi ngemibuzo yokuphepha ehambisana nokusetshenziswa kwe-methylene blue ngaphambi kwanoma yiluphi uhlelo olungena emzimbeni, kanye nomongo obanzi walokho ucwaningo lwezokwelapha nge-methylene blue olukubonisile nalokho olungakakubonisi.
Kungani lokhu kungasekeli amaconsi aphuzwa ngomlomo noma amaswidi athambile
Indlela yokufaka into emzimbeni iyingxenye yokwelashwa okuhlolwayo. Lezi zivivinyo zahlola udayi ofakwe ngaphakathi kwediski ekhethiwe. I-methylene blue egwinyiwe idlula emathunjini ingene ekujikelezeni kwegazi kuwo wonke umzimba futhi ifinyelele ezicutshini ngokugxila okuphansi kakhulu nokungaqondiswanga endaweni ethile kangako. Asikho isilinganiso kulezi zivivinyo esibonisa ukuthi umthamo othathwe ngomlomo ufinyelela ekugxileni okufanayo noma uhlale isikhathi esifanayo ngaphakathi kwediski eyodwa engxenyeni engezansi yomgogodla. Ngisho noma umphumela wokufakwa ngaphakathi kwediski ubuphindeke ngokucacile, ubungeke udluliselwe esiphuzweni, econsini, noma kuswidi othambile ngaphandle kwesivivinyo esihlukile esisebenzisa leyo ndlela, lowo mthamo, kanye nalelo qembu labantu abanalolo hlobo lobuhlungu.
Ukuphepha nakho akudluliseki. Ukuchayeka kwawo wonke umzimba kule nto kuletha ukusebenzisana okwenzeka kuwo wonke umzimba, okuhlanganisa ukusebenzisana okubhalwe kahle nemithi ethinta i-serotonin. Inqubo yendawo kudiski nokusetshenziswa kwansuku zonke ngomlomo kuwukuchayeka okuhlukile, okunezinhlobo nezinga lobungozi ezihlukile, iphuzu elichazwe kabanzi ebufakazini bokusebenzisana kwe-methylene blue nemithi.
Isiphetho sigxile kulokhu kuphela. Isivivinyo sokuqala sokujova i-methylene blue kudiski sabika ukukhululeka okumangalisayo okwaqhubeka iminyaka emibili. Ukuphindwa kwaso kamuva ezikhungweni eziningi, kuqhathaniswa ne-placebo, akuzange kuwuthole lowo mphumela ezinyangeni eziyisithupha. Akukho nowodwa wale miphumela owubufakazi bokuthi i-methylene blue ethathwa ngomlomo isiza ngobuhlungu beqolo.