Zvinokonzera Piriformis Syndrome uye Sciatica

Piriformis musungo inowanzozivikanwa pakati pevatambi uye vashandi vehutano sehunhu hunokosha mumashure ekupedzisira. Iyi musuru inoshanda kuti itungamirire hup joint rotation uye kubviswa uye iyo inogonawo kusvibiswa musumbu nekuda kwekutsvaira kwechiito chekuita. Piriformis musumbu inomutsa zvakare kuziva kune zvikonzero zvakasiyana-siyana zve piriformis syndrome, mamiriro ezvinhu akafungidzirwa kuti angave anokonzera kurwadziwa uye kusagadzikana, kwete chete nevatambi, asiwo muhuwandu hwevanhu pamwe chete.

Anatomy yePiriformis Muscle

 

 

Mushonga wepiriformis unobva pane imwe nzvimbo yapasi ye sacrum uye unonyatsochengetwa nawo nezvisungo zvitatu zvinowanikwa pakati pekutanga, yechipiri, chechitatu nechina yechina anterior sacral foramina. Dzimwe nguva, mhedzisiro yaro inogona kuva yakakura kwazvo zvokuti inosangana ne capsule yejojo ​​ye sacroiliac ne sacrotuberous uye / kana sacrospinous ligament. Mushonga wepiriformis isimbi yakasimba uye ine simba inofamba ichibva kunze kwebhandi kuburikidza nehukuru hwakakura hwemaoko, kugovera inamen mu suprapiriform uye infra-piriform foramina. Sezvo inotanga kuburikidza ne-sciatic foramen yakakura, musimba unoderera kusvika pane imwe nzvimbo iyo inoumba tambo inosungirirwa kune yakakwirira-yepamusoro-soro ye trocanter yakakura, inowanzobatanidza ne tendon ye obturator internus uye gemelli miscle.

Mitsipa nemidziyo yeropa inowanikwa mukati me suprapiriform foramen inozivikanwa seyepamusoro gluteal tsinga nemidziyo, uye ayo anowanikwa mune infra-piriforma fossa anozivikanwa seakaderera gluteal tsinga nemidziyo, kusanganisira iyo sciatic nerve. Nekuda kwehukuru hwayo hwakakura mune yakakura sciatic foramen, iri panjodzi midziyo yakawanda uye tsinga dzinobuda muchiuno dzinogona kumanikidzwa.

Iko piriformis muscle inonyatsobatanidzwa nedzimwe nhepfenyuro dzakaputika dzehuputi, zvakare, zvakadai segemellus yakakwirira, obturator internus, pasi pfupi gemellus uye obturator panze. Mhedzisiro yakakura pakati pemisungo iyi nemamwe mavarai mafupi ndeyekubatanidza kwayo kune mutsara. Mushonga wepiriformis unopfuura mushure mutsara apo vamwe rotator vanopfuura mberi kwawo.

 

 

Anatomical Variants

Misiyano yakasiyana-siyana yakasiyana-siyana yakave yakamboonekwa mune piriformis muscle. Chokutanga, pangave kune zvimwe zvinyorwa zvepakati pekutanga nechechishanu sacral vertebrae uye ne coccyx. Chechipiri, tendon inogona kuwirirana ne gluteus medius kana minimus kana ne gemellus. Uyewo, mune zvishoma kudarika 20 muzana yematambudziko, musisita wepiriformis unogona kugoverwa muzvikamu zviviri zvakasiyana, kuburikidza nechikamu chipi zvacho kana kuti nhengo dzose dzakagadzikana dzinogona kufamba. Zvadaro, mutsara unogona kuwirirana nehutachire hweputika hup joint capsule sejoka rakabatanidzwa ne obturator internus. Uyezve, kusanganiswa kwemavara emusana wepiriformis kwakaratidzwa kunopesana muchiyero uye chinzvimbo panzvimbo ye supero-medial ye trocanter yakakura. Inokwanisa kutambanudza kusvika 25 kusvika ku64 muzana yehupamhi hwepastern-posterior pamwe nehukuru hukuru, uye 57 muzana yaro inobatanidza zvakapfuura uye 43 muzana inowedzera mberi. Pakupedzisira asi kwete zvishoma, vatsvakurudzi vakaongorora nheyo yacho yekuwedzera uye vakaona kuti mavara mana eokuisa akange aripo uye aya aive akajeka maererano nehukama ne obturator internus. Kusiyana kwekuiswa uye upamhi hwekusanganiswa kwemavara emusana wepiriformis kunogona kukanganisa kubudirira kwechirevo chinozivikanwa sekudziviswa kwechiito.

Uyezve, kubatana pakati pepiriformis mhasuru uye iyo sciatic nerve kwave kuri kupokana kukuru. Izvo zvakambopedzwa kuti kune akati wandei anatomical misiyano pakati pepiriformis mhasuru uye kubatana kwayo kune sciatic nerve. Iwo madiki-marudzi eiyi misiyano anosanganisira: mhando 1-A, uko tsandanyama iri peya rakaumbwa neine tsinga inomhanya nechemberi uye yakaderera kune izvi, inowanikwa mu70 kusvika 85 muzana yematambudziko; Type 2-B, uko iyo piriformis mhasuru yakakamurwa kuita zvikamu zviviri neyakajairika peroneal tsinga inomhanya pakati pezvikamu zviviri uye tibial tsinga inofamba nechekunze uye pazasi, inowanikwa mune gumi kusvika makumi maviri muzana emakesi; mhando 10-C, uko chikamu chega chega chinotenderera pamusoro pemhasuru uye chikamu chetibial chinowanikwa pazasi, chinowanikwa mu20 kusvika ku3 muzana yematambudziko; uye mhando 2-D, uko iyo isina kukamurwa tsinga inopfuura nepiriformis mhasuru, inowanikwa mune ingangoita 3 muzana yematambudziko.

 

 

Uyezve, inofungidzirwawo kuti dzimwe mbiri, kusiyana kunowanzoitika kunogona kuitika, kuratidzwa netsamba E uye F mumufananidzo. Nyora 1-A ndiyo yakasiyana-siyana, kuratidza sciatic nerve sezvo inopfuura pasi piriformis muscle.

Basa rePiriformis Muscle

Izvo zvinokosha zvinoshanda zvemuviri wepiriformis ndeyekupa hup kunze kwekuzungunuka uye kubvumira kubatwa paC90 digiri dzekuputika kwechiuno. Panguva yekutakura, mutsipa wepiriformis unoita kuti chikadzi chemukati chifambe mukati mechikamu chekufamba uye kushanda. Uyewo, inobatsira vhudzi shomanana vesimbi mukudzvinyirira kubatana kwechiuno uye kuchigadzirisa. Nemhaka yokuti inogona kushandisa simba reblique pa sacrum, inogona kuunza simba rakasimba rekuveura pamusangano we sacroiliac. Zvimwe zvisingaiti, izvi zvinogona kubvisa chikamu chepamusoro che sacrum mberi uye chidimbu che sacrum kumashure.

Sezvo piriformis muscle ndiyo yakasara mushure mekuputika kwekunze kwevatori vemasvingo nekuda kwekubatanidza kwayo pane imwe nzvimbo yepasi ye sacrum, ine simba guru rekushandisa kushanduka kwehutano pamubatanidzwa wehudyu. Dzimwe nguva, nyanzvi dzehutano dzakawana nyaya ne piriformis muscle apo inoratidzika kunge yakaoma uye hypertonic, nepo imwe huru pfupi yehup rotator iyo inowanikwa pedyo neanoshanduka yekutenderera inodziviswa uye hypotonic.

Inversion yezviito

Kunyanya kukakavadzana kunokonzera kushanda kwemuviri wepiriformis ndiyo inoshanduka-ye-basa basa, inonyanya kutaurwa sekudengenyeka kwechiito chekuita. Vatsvakurudzi vakaratidza kuti sezvo chiuno chinosvika kumangwanani e60 kusvika kune 90 digrii uye zvakanyanya, tambo ye piriformis muscle shifts pane guru trochanter. Somugumisiro, mutsara wayo wekudhonza unenge usingabatsiri semuchengeterori wekunze wekunze, zvisinei, unobatsira kuti mukati mekuputika hup. Nemhaka yeiyo, inoshandura kushanduka kwayo basa pamakumbo marefu.

Kunyange zvakadaro, zvidzidzo zvenguva pfupi zvakaitwa kuburikidza nekuputika kwemaitiro zvakaratidza kuti kusungirirwa kwemuviri wepiriformis kune guru guru rinogona kuchinja uye, pane dzimwe nguva, inogona kuisa panzvimbo iyo iyo inogona kusakwanisa kudzosa basa rayo, somuenzaniso, mune imwe nzvimbo yakanyatsoiswa mushure. Nokudaro, kutambanudza mishonga yepiriformis kuenda kune imwe kunze kuchinja kana chiuno chichigadziriswa kupfuura 90 degrees, zvichibva pakudengenyeka kwechiito chekuita, chingave chisingabatsiri sekurapa kana kutsausa semhando yekuongorora.

Basa remhasuru yepiriformis pamakona akati wandei akabatanidzwa yakakosha kutariswa kwevashandi vezvehutano vanoongorora nekurapa zvikonzero zvepiriformis syndrome. Kazhinji, zvinokurudzirwa kutambanudza hudyu mukubhururuka, kuburitsa uye kutenderera kwekunze kutambanudza piriformis mhasuru pamusoro peiyo glutes nekushandisa kuchinjika kweyekuita pfungwa.

MSK Dysfunction and Causes of Piriformis Syndrome

Makumi makumi emakore apfuura, zvakataurwa kuti mune zvimwe zviitiko, zviratidzo zveSciatica zvinogona kutanga kunze kwemuzongoza semhedzisiro yemhasuru yepiriformis. Iyi fungidziro yakatsigirwa munguva pfupi yapfuura apo nyanzvi dzakabudirira kugadzirisa zviratidzo zveumwe weiyo sciatica nekuvhiya kupatsanura piriformis mhasuru. Kubva pane cadaver anatomical dissection, ivo vaongorori vakatenda kuti kupaza kwemhasuru yepiriformis kunogona kukonzera kutsamwa kweiyo sciatic nerve.

Izwi rezvokurapa izwi repiriformis syndrome rakazobatana nezviratidzo zve sciatica, inotendwa inokonzerwa nechinowanzosemesa chisingaoneki mumushonga wepiriformis nechinangwa chekutonga zvimwe zvinowanzokonzera sciatica, zvakadai sehutano hwekushungurudzika kwekenza kunokonzerwa ne disc disc. Izvozvo zvakabva zvangova shanduro yakagamuchirwa asi pasina kubvumirana pamusoro pechiratidzo chekuchirapa uye kuongororwa kwekutsanangurira kusiyanisa kubva kune dzimwe nzvimbo dze sciatica.

Kunzwisisa Zvinokonzera Piriformis Syndrome

Piriformis syndrome inogona kutsanangurwa sekudyidzana pakati pepiriformis mhasuru uye iyo sciatic nerve, uko izvi zvinogona kutsamwisa tsinga uye kukudziridza kumashure kwemashure ehudyu nekutenderera kure kuresa pasi pechidya chemberi, kufanana nezviratidzo zvechokwadi sciatica. Kusiyanisa kukuvara kwenzvimbo ino kunowanzo tevera kusarudzika kwezvikonzero zvinonyanya kuzivikanwa zve sciatica uye kurwadziwa kwematako.

Kunyanya zvakanyanya, mishumo yekurwadziwa kwematako pamwe nekuendesa kure kwezviratidzo hazvisi zvega kune zvikonzero zve piriformis syndrome. Zviratidzo zvakafanana zvinowanda pamwe neakanyanya kurapwa marapirwo ekudzokera kumashure syndromes uye pelvic dysfunctions. Naizvozvo, kuongororwa kwakazara kwenzvimbo idzi kunofanirwa kuitwa kutonga kunze kwechero hutachiona. Izvo zvave zvataurwa kuti izvo zvinokonzeresa piriformis syndrome inogona kuve nemhosva kune angangoita mashanu kusvika matanhatu muzana ezviitiko zve sciatica Muzviitiko zvakawanda, inokura muvanhu vane makore ari pakati nepakati, avhareji kana makore makumi matatu nemasere uye yakajairika pakati pevakadzi.

Pathogenesis yePiriformis Syndrome

 

 

Zvinokonzera Piriformis syndrome zvinogona kubatanidzwa kune zvitatu zvinokonzera zvinokonzera: Kutanga, kurwadziwa kunorwadza kunogona kuva mugumisiro wemyofascial trigger points. Chechipiri, kusungirwa kwemasuru kunopesana nemafuta emhando yepamusoro apo inopfuura neyo infrapiriform fossa kana mukati mehupenyu hwepiriformis. Uye chechitatu, sangano re sacroiliac rinokonzera kusagadzikana kunokonzera piriformis misuli spasms.

Vamwe vatsvakurudzi vakapa imwe nhamba yezvikonzero zvinokonzera zvinokonzera piriformis syndrome sezvinotevera: gluteal trauma mu sacroiliac kana gluteal nzvimbo, matomical variations, myofascial trigger points, hypertrophy yemasipirformis muscle, zvishoma kune chirwere chepereformis semaraminectomy, nzvimbo inobata zvipembenene zvakadai seyeoplasm, bursitis, abscess uye myositis, injection inowedzera uye kusangana kwevakadzi.

zviratidzo

Zviratidzo zvakajairika zvinotsanangurwa nezvakakonzeresa piriformis syndrome zvinosanganisira: kushushikana kana kupwanya muhudyu uye / kana musambo, kurwadziwa kwakanyanya kusvika 98 muzana yematambudziko, calf pain inosvika ku59 muzana yematambudziko, kuwedzera kuburikidza nekugara uye kusvetuka kana hunde yakamirira kumberi kana gumbo rakayambuka pamusoro pegumbo risina kubatika uye zvinogona kuitika zviratidzo zvetsinga dzakadai sekurwadziwa uye paresthesia kumusana, kugomera, magaro, perineum uye kumashure kwehudyu kusvika ku82 muzana yematambudziko.

Zvitsva zvepanyama uye miedzo

Izvo zvakakosha kuti urambe uchifunga kuti hudyu kutenderera nekushanduka kwekunze kutenderera kana kungoita mukati kutenderera kunogona kuwedzera zviratidzo zvekusagadzikana. Zvimwe zvakawanikwa zvezvakakonzereswa zvikonzero zve piriformis syndrome zvakaratidza yakanaka SLR iri pasi pe15 degrees padivi rakajairika. Dzimwe bvunzo dzinoshandiswa kuongorora izvo zvinokonzeresa piriformis syndrome inosanganisira, yakanaka Freiberg signs chiratidzo, inoshandiswa mu32 kusvika 63 muzana yematambudziko, inosanganisira kubereka kwekutambudzika pane kusingamanikidzwe kwemukati kutenderera kwechiuno munzvimbo yepamusoro, inotendwa kukonzeresa kungotambanudza kwepiriformis mhasuru uye kumanikidza kweiyo sciatic nerve pane iyo sacrospinous ligament. Pacers chiratidzo, chinoshandiswa mu30 kusvika ku74 muzana yematambudziko, inosanganisira kubereka marwadzo uye kushaya simba pakuramba kubatwa uye kutenderera kwekunze kwehudyu munzvimbo yakagara. Marwadzo munzvimbo yeFIRIR inoshandiswa kuongorora kusagadzikana, inosanganisira kubereka kwekutambudzika kana gumbo rikabatwa mukutenderera, kuburitsa uye kutenderera kwemukati. Uyezve, iyo yakasimbiswa lumbar lordosis uye hip flexor tightness inokonzeresa munhu kuti awedzere kumanikidza kweiyo sciatic nerve inopesana nesciatic notch nepfupi piriformis. Electro-yekuongorora bvunzo inogona zvakare kuratidza kunobatsira kuongorora piriformis tsandanyama matambudziko.

Kana chipfupa chinoputika mukati mehutano hwepiriformis chakakomberedza ichiitika uye kune obturator internus marwadzo uye kunze kwekunzwira tsitsi pamusoro pezvinyorwa zvinoshamisa, zvinowanikwa munenge ma 59 kusvika ku92 muzana yematambudziko, munhu wacho anofanira kuita Sims nzvimbo yekutsvaga kuongorora. Mutsara wepiriformis unofanirwa kuvhara muganhu wepamusoro wepiriformis muscle uye kutambanudza pakarepo kubva kumusoro kweche troterter yakakura kumuganhu weCephalic we-sciatic foramen pa sacrum. Iko kuongorora kuchaenderera mberi apo mutsara wacho ugoverwa muhutano hwevatatu. Chigunwe chakanyatsoshandiswa chinosungiridza pane chinangwa chekugadzirisa-kunhu hunyoro, izvo zvinowanzowanikwa kungowanikwa pane zvakakosheswa kwepakati uye zvekupedzisira zvitatu zvezera.

kuferefeta

Kufananidza kwepachirongwa, kwakadai se-X-ray, CT scan uye MRI, inowanzove isina kubudirira pakutsvaga kuvapo uye zvinokonzera piriformis syndrome. Zvisinei, zvimwe kukosha kunogona kuitika mukutsvaga-kuongorora kuongorora. Chinangwa chekuedza uku ndechekuwana zvikanganiso zvekutengesa mumutsipa wakananga. Zvitsva zvakadai serefu-latency zvinogona, semuenzaniso H kufungidzira kwehutial nerve uye / kana mutezo weponeoneal, inogona kuva yakasununguka pazororo asi inononoka mune zvigaro apo mhepo yakadzika yekunze yakasimbiswa.

Izvo zvakasimbiswa kuti iyo tibial kupatsanurwa kweiyo sciatic nerve inowanzo kuponeswa, yakaderera gluteal tsinga iyo inopa iyo gluteus maximus inogona kukanganiswa uye mhasuru inogona kuve isina simba. Nekudaro, kuyedzwa kweiyo yegaoneone kunogona kupa mhedzisiro mhedzisiro sezvo ivo vangangoita chikamu chinokanganiswa cheiyo sciatic nerve. Iyo H-wave inogona kushomeka panguva yechinorwadza chinzvimbo chekumanikidzwa kutora-mukati kutenderera kwegumbo rakabatwa.

Piriformis Syndrome Nhema

Vatsvakurudzi vakurukura kuti piriformis syndrome izwi rinowanzoshandiswa kushandiswa kurondedzera chero zvisiri izvo zvakanyanyisa kuratidza tsitsi nekurwadziwa kwemakumbo. Yakanga ichitaurirana kuti muzviitiko zvisingashamisi pfuformis muscle inobatanidzwa muhutano hwehutano hwehutachiona hunogona kuve yakakosha seimwe yezvinokonzera piriformis syndrome. Izvo zvakataurwa kuti kune humwe uchapupu hushoma uye zviitiko apo kuongororwa kwezvinokonzera piriformis syndrome kunogona kuitwa, kunyanya, apo pane kukanganisa kunokonzera mutsara wakagadzikana nemuseve wepiriformis. Mune zvidzidzo zvakasiyana-siyana, sciatic nerve yakaratidzwa kuva yakamanikidzwa nemuseve wepiriformis mumamiriro ezvinhu akadai se hypertrophy yemuseve, zvinowanzoita zvisiri izvo zvakadai seBidid piriformis muscle uye nekuda kwekunyorwa kwezvikwata zve fibrous.

Uyewo, kushungurudzika uye kushaya piriformis musungo kunogona kusanganisira mutsara. Zvinokwanisika kuti zviitiko zvisingaiti zvechokwadi piriformis syndrome zvakakonzerwa nekushungurudzika kwakakomba kumusana wepiriformis nekuda kwekushungurudzika kwakanyanya kumusana. Izvi zvinonzi se-post-traumatic piriformis syndrome.

Vatsvakurudzi vakatsigira nharo iyi nekutaura kuti zvinowanzoitika kuti, zvichipiwa hukama hweatomical hwepiriformis mhasuru kumitsipa dzakasiyana siyana munzvimbo yakadzika yegute, iro gumbo pain may inogona kukonzerwa nekuvharirwa kwetsinga dzinobwinya uye marwadzo ekurwadziwa. kuve nekuda kwekubatwa kweiyo yepashure yekucheka tsinga yehudyu, pane kusunga kweiyo sciatic nerve chete. Izvi zvinoratidza mamiriro ezvinhu akaongororwa zvechiremba mukushayikwa kwemasaini esisitimu etsinga dzetsinga. Kunyangwe iyo piriformis mhasuru ndiyo chikonzero chekumanikidza haina kunyatso kusimbiswa. Zvinogoneka kuti iyo obturator internus / gemelli yakaoma ndiyo imwe nzira yekukonzeresa yekumanikidza. Vatsvakurudzi vakaratidza kushandisa izwi rakadzika gluteal syndrome pane piriformis syndrome.

mabatiro

Apo chimwe chezvikonzero zvinokonzera piriformis syndrome zvinowanikwa uye muongorori wehutano anonzwa kuti zvakakodzera kufungidzirwa zvakaitwa, kurapwa kunowanzoenderana nechikonzero chinokonzera kusakosha. Kana chirwere chepiriformis chiri chakasimba uye chinopisa, zvino pakutanga kurapwa kwekuchengetedza kuchaisa pfungwa pakurongedza uye kuisa muviri musungo wakasimba kuti ubvise piriformis muscle kubva pakuva marwadzo emarwadzo. Kana izvi zvikakundikana, zvinotevera zvakataurwa uye zvinogona kuedzwa: nzvimbo yekunetseka, iyo inowanzoitwa neanesthesiologist ine unyanzvi mukugadzirisa marwadzo uye mukuita zvirwere zvehutano; steroid majoko mukati me piriformis muscle; botulinum inxin injection mu piriformis muscle; uye chirurgic neurolysis.

Therapist-inotungamirwa kupindira, senge kutambanudza kwepiriformis mhasuru uye yakananga trigger poindi masaji, inogona zvakare kushandiswa sekurapa. Izvo zvakakurudzirwa kuti piriformis mhasuru yakatambanudzwa inoitwa munzvimbo dzechiuno kutenderera yakakura kupfuura 90 madhigirii, kuburitsa uye kutenderera kwekunze kuti ishandise kupindurwa kwechiito mhedzisiro yemushure wepiriformis kupatsanura kutambanudza kune uyu mhasuru wakasununguka kune imwe chiuno chekunze rotator. .

Zvisinei, uchapupu huchangobva kuwanikwa hunoshandiswa pakuongorora kwakaitwa ultrasound hwakaratidza kuti pakanga pasina kuwirirana pakati pekuputika kwemaoko uye kubwinya kwepiriformis muscle tendon mune zvose mukati uye mushure mekukwikwidza kwehup kutenderera, izvo zvinoreva kuti piriformis muscle haigadziri chiito chacho. Uyezve, vatsvakurudzi vakaita sadaveric zvigumisiro vakapedzisa kuti piriformis musungo kuiswa kwakasiyana uye yakaoma zvikuru kupfuura yakatanga kutendwa. Zvinokwanisika kuti piriformis musumbu inogona kuvhara chiito chayo kune vamwe vanhu asi kwete mune vamwe.

Saizvozvowo nekuda kwekusawirirana uye kuvhiringidzika pamusoro penyaya yekushandurwa kwezviito, zvinokurudzirwa kuti vashandi vezvehutano vanofanirwa kuita misiyano miviri yepiriformis mhasuru yakatambanuka: kutambanudza mukufamba, kuburitsa uye kutenderera kwekunze uye kutambanudza mukufamba, kuburitsa uye kutenderera kwemukati.

Njiwa Tsvaira kuruboshwe piriformis muscle: hip kuruka, kutora maitiro nekutakura uye hupenzi hup kunze kwekuzungunuka.

 

 

Tambanudzira kuruboshwe rwemiridzo yepiriformis: hip iri mukutenderera, kusatenderera kwekutakura uye kuwandisa kwekunze kwekunze.

 

 

Mhemberero shomanana mushure meketani yakasununguka yakatambanudzira kurudyi kwepiriformis muscle: hip iri mu 90 degree kuruka, kutengesa uye kutenderera kwekutenderera.

 

 

Trigger Points uye Massage

 

 

Chirevo chinonyanya kukodzera kuti palpate piriformis muscle trigger points iri munzvimbo inotevera yakakurudzirwa. Mumamiriro aya, muchengeti wehutano anogona kunzwa nekuda kwepiriformis muscle trigger points uye kushandisa nguva dzose kuomeswa kuti abvise matanho ekutsvaira uyewo kushandisa kushambadza kwemafupa kumusana munzvimbo ino. Munzvimbo iyi, guru gluteus maximus rakasununguka uye zviri nyore kunzwa zvakadzama piriformis muscle.

Piriformis muscle inonyanya kumira mushure mutsva iyo inotomically yakafanana neyesungano ya sacroiliac uye sciatic nerve. Iyo musungo inobata sehukuru hup rotator uye stabilizer, ine purojekiti yekuderedza uye kuva hypertonic. Nokuda kwechikonzero ichocho, maitiro ekutambisa uye kushambadza anoshandiswa zvakanakisisa uye anowanzokurudzirwa kuderedza inzwi kuburikidza nemisumbu. Mukupedzisa, yave ichitaurawo mukudzvinyirira uye kutsamwiswa kwehutano hwesimbi, inowanzotumidzwa sepiriformis syndrome.

Kuti uwane mamwe mashoko, ndapota ivai vakasununguka kubvunza Dr. Jimenez kana kuti tibatane nesu pa 915-850-0900 .

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NaDkt Alex Jimenez