Disc Bulge & Herniation Chiropractic Kutarisirwa Kuongorora

by Dr Alex Jimenez | Kudzorera Pain, Chiropractic, Chiropractic Examination, Dzose Kudzorera Painini, chisingaperi Pain, Mamiriro Ekutongwa, Functional Medicine, utano, Herniated Disc, Holistic Medicine, Pasi Pasi Pain, Natural Health, Neck Pain, Neck Pain Treatments, Sciatica, Sciatica Nerve Pain, Spinal Decompression Treatments, Spine Care, Mishonga, Wellness

Disc bulge uye disc herniation mamwe emamiriro ezvinhu akajairika anokanganisa musana wevarwere vechidiki uye vepakati. Inofungidzirwa kuti inenge 2.6% yevanhu veUnited States gore negore vanoshanyira chiremba kuti varape zvirwere zvemusana. Inosvika $7.1 bhiriyoni chete inorasika nekuda kwenguva yekusashanda.

Disc herniation ndeye apo iyo yose kana chikamu chenyuchi pulposus inoputika kuburikidza nekubvaruka kana kupera simba kunze annulus fibrosus ye intervertebral disc. Izvi zvinozivikanwawo sedhisiki yakatsvedza uye inowanzoitika muzasi kumashure, dzimwe nguva inokanganisa nharaunda yekervical. Herniation ye intervertebral disc inotsanangurwa senzvimbo yakagadziriswa ye disc disc ne 25% kana pasi pe disc circumference pane MRI scan, maererano neNorth American Spine Society 2014. Iyo herniation inogona kusanganisira nucleus pulposus, annulus fibrosus, apophyseal bone. kana osteophytes, uye vertebral endplate cartilage mukusiyana ne disc bulge.

Iko kunewo kunyanya maviri marudzi e disc herniation. Disc protrusion apo iyo yakatarisa kana symmetrical yekuwedzera ye disc inobuda kunze kwayo mukati me intervertebral space. Iri panzvimbo ye intervertebral disc level, uye mafibisi ayo ekunze ane annular akasimba. A disc extrusion ndiyo iyo intervertebral disc inotambanudzira kumusoro kana pasi peiyo vertebrae yakatarisana kana endplates ine yakazara annular misodzi. Mumhando iyi ye disc extrusion, mutsipa kana chigadziko chakamanikana kupfuura dome kana herniation.

A disc bulge ndeye apo mafiibhi ekunze e annulus fibrosus anobviswa kubva kumucheto kwemitumbi yevertebral iri padyo. Pano, kutama kunopfuura 25% yedenderedzwa re intervertebral disc. Iyo zvakare haina kuwedzera pazasi kana pamusoro pemigero ye disc nekuti iyo annulus fibrosus attachment inoimisa. Iyo inosiyana ne disc herniation nekuti inosanganisira isingasviki 25% yedhisiki yedenderedzwa. Kazhinji, iyo disc bulge inotora zvishoma nezvishoma uye yakafara. Iyo disc bulge inogona kukamurwa kuita marudzi maviri. Mune denderedzwa bulge, iyo yose disc circumference inobatanidzwa. Kupfuura 90 madhigirii erimu anobatanidzwa asymmetrically mune asymmetrical bulging.

Zvakajairika Intervertebral Disc Anatomy

Tisati taenda kune tsanangudzo pamusoro petsanangudzo ye disc herniation uye disc bulge, tinofanira kutarisa pane yakajairwa intervertebral disc. Zvinoenderana nemusana nhungamiro muna 2014, dhisiki yakajairwa chinhu chine chimiro chekare pasina humbowo hwekuchinja kwe disc. Intervertebral discs inokonzera chikamu chimwe chete kubva muzvitatu kusvika kune chimwe chechina chekukwirira kwemutsara wepinini.

Imwe intervertebral disc inenge 7 -10 mm gobvu uye inoyera 4 cm mu anterior-posterior diameter munharaunda ye lumbar yemuzongoza. Aya maspinal discs ari pakati pemiviri miviri yakatarisana yevertebral. Nekudaro, hapana madhisiki anogona kuwanikwa pakati peatlas uye axis uye coccyx. Inenge 23 discs inowanikwa mumuzongoza, ine matanhatu mumutsipa wekervical, 12 mu thoracic spine, uye mashanu chete mu lumbar spine.

Intervertebral discs inogadzirwa nefibro cartilages, ichigadzira fibrocartilaginous joint. Mhete yekunze ye intervertebral disc inozivikanwa se annulus fibrosus, nepo mukati-senge gel-yakafanana chimiro pakati inozivikanwa seyo nucleus pulposus. Iyo cartilage endplates sandwich iyo nucleus pulposus yepamusoro uye yakaderera. Iyo annulus fibrosus inosanganisira concentric collagen fiber mapepa akarongwa mune radial tire-senge chimiro mu lamellae. Iyo fiber inosungirirwa kune vertebral endplates uye inotungamirwa pamakona akasiyana. Nechikamu chadzo checartilaginous, ma-endplates anosimbisa madhisiki panzvimbo yawo chaiyo.

Iyo nucleus pulposus inoumbwa nemvura, collagen, uye proteoglycans. Proteoglycans inokwezva uye inochengeta unyoro, ichipa nucleus pulposus hydrated gel-kufanana kuwirirana. Zvinofadza kuti zuva rose, kuwanda kwemvura inowanikwa munucleus pulposus inosiyana zvichienderana nehuwandu hwekuita kwemunhu. Ichi chinhu chiri mu intervertebral disc chinoshanda semukushi kana musana wemusana-absorbing system kuchengetedza iri pedo vertebra, musana wetsinga, musana, uropi, uye zvimwe zvimiro zvinopesana nemasimba akasiyana. Kunyange zvazvo kufamba kwega kwega kwe intervertebral discs kune zvishoma, imwe nzira ye vertebral motion yakafanana nekuputika uye kuwedzera kuchiri kuitika nekuda kwezvikamu zve intervertebral disc.

Mhedzisiro yeIntvertebral Disc Morphology paSakhiwo uye Basa

Mhando yezvikamu zviripo mu intervertebral disc uye kuti yakarongeka sei inogadzirisa morphology ye intervertebral disc. Izvi zvakakosha mukuti zvinobudirira sei disc inoita basa rayo. Sezvo dhisiki ndiyo inonyanya kukosha iyo inotakura mutoro uye inobvumira kufamba mune imwe nzira yakaoma musana, izvo zvinoumbwa zvinoumbwa zvine zvakakosha.

Kuoma kwe lamellae kunowedzera nekukura kwekukura semugumisiro wekugadzirisa kwekuita kwe intervertebral disc masero kune kusiyana kwemutoro wemagetsi. Idzi shanduko mu lamellae ine bifurcations yakawanda, interdigitation uye hukuru husina kukwana uye nhamba yemabhandi emalamellar ichatungamirira kune kuchinjwa kwekutakura uremu. Izvi zvinobva zvaita kuti munhu azviparadzire anogara achivhiringa kutenderera kunoita kuparadzwa kwe intervertebral discs. Kana chirongwa ichi changotanga hachidzoreki. Sezvo kune nhamba yakawedzera yemasero, chiyero chekudya chinodiwa ne diski chiri kuwedzerawo kuchinja kwemaitiro ekugadzirisa gradient yezvose metabolites uye zvinovaka muviri. Nekuda kwekuwedzera uku kudiwa, maseru anogona zvakare kufa zvakanyanya necrosis kana apoptosis.

Mavhiza emukati mevanhu anogadzikana uye nekudaro izvo zvinogadzirwa zvinosunganidzwa kubva kumidzi yeropa iri padyo mumucheto we disc. Izvo zvakakosha zvinovaka muviri; oksijeni neglucose inosvika mumasero mu disc kuburikidza nekuparadzanisa zvinoenderana neyakagwinya yakatarwa nehuwandu hwekufambisa kuenda kumasero kuburikidza netutsipa uye chiyero chekuda. Masero anowedzerawo kugadzira lactic acid seye metabolic end chigadzirwa. Izvi zvinobviswawo kuburikidza ne capillaries uye venums back kune kutenderera.

Sezvo kupararira kunoenderana nechinhambwe, masero akarara kure neropa capillaries anogona kuve nekuderedzwa kwekudya kunovaka nekuda kwekuderedzwa kwekupa. Nemaitiro echirwere, iyo inowanzo avascular intervertebral disc inogona kuva vascular uye isina kuvharwa mukuderera uye mune zvirwere. Kunyange zvazvo izvi zvingawedzera okisijeni uye kudya kunovaka muviri kumasero ari mudhisiki, izvi zvinogonawo kupa mamwe marudzi akawanda emasero asingawanzowaniki mu diski nekuiswa kwe cytokines uye kukura kwezvinhu.

Iyo morphology ye intervertebral disc muzvikamu zvakasiyana-siyana zvemuzongoza zvakare inopesana kunyange zvazvo vanachiremba vakawanda vanogadzirisa dzidziso dzekiriniki zvichienderana nekufungidzira kuti zvose cervical uye lumbar intervertebral discs zvine chimiro chakafanana. Kureba kwedhisiki kwaive kwakaderera muchikamu cheT4-5 chechikamu chethoracic zvichida nekuda kwekuti thoracic intervertebral discs haina kuderera-yakafanana neiyo yekervical uye lumbar spinal regions.

Kubva ku cranial kusvika kune caudal direction, nzvimbo yemuchinjikwa-sectional yemuzongoza yakawedzera. Nokudaro, nezinga reL5-S1, nucleus pulposus yakanga ichitora chikamu chepamusoro che intervertebral disc area. Ma cervical discs ane elliptical shape pa cross-section ukuwo thoracic discs aive ne more denderedzwa shape. Iyo lumbar discs inewo chimiro cheelliptical kunyangwe ichinyanya kupepetwa kana kupindazve kumashure.

Chii chinonzi Disc Bulge?

Iyo bulging disc ndiyo iyo dhisiki inongoputika kunze kweiyo intervertebral disc nzvimbo iyo inowanzogara pasina kuputika kwekunze annulus fibrosus. Iyo nzvimbo inoputika yakakura kwazvo kana ichienzaniswa nedhisiki reherniated. Uyezve, mu disc herniated, annulus fibrosus inoputika kana kuputika. Kunyange zvazvo disc bulging yakawanda kupfuura disc herniation, inokonzera zvishoma kana kusarwadziwa kumurwere. Kusiyana neizvi, herniated disc inokonzera marwadzo akawanda.

Zvikonzero zveDisc Bulging

A bulging disc inogona kukonzerwa nezvikonzero zvakawanda. Inogona kuitika nekuda kwekuchinja kwakabatana nezera senge kunoonekwa mu degenerative disc chirwere. Kuchembera kunogona kutungamirira kukuchinja kwemaitiro uye biochemical mu intervertebral discs uye kutungamirira kumvura yakaderedzwa mu nucleus pulposus. Shanduko idzi dzinogona kuita kuti murwere ave panjodzi ye disc bulges nekushungurudzika kudiki chete. Mamwe mararamiro asina kunaka akadai semararamiro ekugara uye kusvuta anogona kugonesa kuita uku uye kuunza shanduko dzakanyanya nekuderera kwe disc.

General kupfeka uye kubvarura nekuda kwekudzokororwa microtrauma inogonawo kunetesa disc uye kupa mukana we disc bulging. Izvi zvinodaro nekuti kana ma discs achinge akaomarara, zvakajairika kugoverwa kwekuremerwa uremu kunochinja. Yakakwiridzirwa micro-trauma pamusoro penguva yakareba inogona kuitika mukutya kwakashata. Kusimudzika kwakaipa kana ugere, umire, wakarara, uye uchishanda unogona kuwedzera kudzvinyirira mune zvemukati medhisheni.

Kana munhu akachengetedza kumira kumberi kwekukotama, zvinogona kutungamirira kune kuwedzeredza uye pakupedzisira kushaya simba kwechikamu chemashure che annulus fibrosus. Nokufamba kwenguva, intervertebral disc inogona kubuda shure. Mumabasa anoda kugara uye kudzokorora kusimudza, kumira, kutyaira, kana kukotama, iyo bulging disc inogona kunge iri njodzi pabasa. Kusimudza zvinhu zvisina kunaka, uye kutakura zvisina kunaka kwezvinhu zvinorema zvinogonawo kuwedzera kudzvanywa pamuzongoza uye kutungamirira kune disc bulges pakupedzisira.

Iyo inoputika intervertebral discs inowanzoitika kwenguva yakareba. Nekudaro, ma discs anogona kubhuroka nekuda kwekushungurudzika kwakanyanya. Izvo zvisingatarisirwi zvakangoerekana zvaitika zvinogona kukuvadza dhisiki zvichikonzera micro-misodzi. Mushure metsaona, dhisiki inogona kupera simba inokonzera kwenguva refu microdamage pakupedzisira inotungamira kukuputika kwe diski. Panogonawo kunge paine genetic chikamu kune disc bulging. Munhu wacho anogona kunge ane density yakaderedzwa ye elastin mu annulus fibrosus nekuwedzera kwekunzwa kune zvirwere zve disc. Zvimwe zvezvakatipoteredza chokwadi zvinogona kuitawo chikamu mukuita kwechirwere ichi.

Zviratidzo zveDisc Bulging

Sezvambotaurwa, bulging discs haakonzeri marwadzo uye kunyangwe vakaita kuomarara kwakapfava. Munharaunda yekervical, chirwere chinokonzera marwadzo anoyerera mumutsipa, kurwadziwa kwakadzika munharaunda yefudzi, kurwadziwa kunopenya nepamusoro peruoko, uye forearm kusvika kuminwe.

Izvi zvinogona kukonzera kunetseka kwekuongorora kuti murwere ari kurwara nemweya here infaration sesaiti yekurwadziwa inotaurwa uye radiation yakafanana. Kuvhiringidza kunzwa pamutsipa kunogona kuitikawo nekuda kweiyo bulging disc.

Munharaunda ye thoracic, panogona kuva nemarwadzo kumusana wepamusoro unopenya kuchipfuva kana nzvimbo yepamusoro yedumbu. Izvi zvinogona zvakare kupa pfungwa yekumusoro gastrointestinal, mapapu, kana cardiac pathology nekudaro unofanirwa kungwarira paunenge uchiongorora zviratidzo izvi.

Ma bulging discs e lumbar mudunhu anogona kuvapo sekudzikira kumashure kurwadziwa uye kudhonza kunzwa mudiki kumashure eshure kwemuzongoza. Iyi ndiyo inonyanya kuzivikanwa nzvimbo ye disc disc bulge sezvo nzvimbo ino inobata uremu hwemuviri wepamusoro. Iko kurwadziwa kana kusagadzikana kunogona kupararira kuburikidza ne gluteal nzvimbo, matako, uye kusvika kutsoka. Ikoko kunogona kuve nekushaya simba kwemhasuru, kuonda kana kunzwa kwekutiza. Kana iyo disc ichimanikidza pane spinal tambo, iyo Reflexes yemakumbo ese maviri inogona kuwedzera inotungamira kune spasticity.

Vamwe varwere vanogona kutoita mitezo kubva muchiuno zvichidzika. Kana iyo bulging disc ikamanikidza pane cauda equine, dundira uye ura mashandiro anogona zvakare kuchinja. Iyo bulging disc inogona kudzvanya pane sciatic nerve inotungamira kune sciatica uko marwadzo anopenya mugumbo rimwe kubva kumashure zvichidzika kutsoka.

Kurwadziwa kubva ku bulging disc kunogona kuwedzera panguva dzezviitiko sezvo bulge inogona kumanikidza pane dzimwe nerve. Zvichienderana nezve iyo nerve inokanganiswa, iyo kiriniki maitiro anogona zvakare kusiana.

Kuongororwa kweDisc Bulging

Kuongororwa kunogona kunge kusingaoneki kubva munhoroondo yekiriniki nekuda kwekutaura kwakafanana mumatambudziko akakura. Asi chimiro chisingaperi chechirwere chinogona kupa mamwe maitiro. Nhoroondo izere uye kuongororwa kwemuviri kunoda kuitirwa kutonga myocardial infarction, gastritis, gastro-oesophageal Reflux chirwere, uye chisingaperi mapapu pathology.

MRI yeDhis Bulge

Kuferefeta kunodiwa pakuongororwa. X-ray musana inoitwa kuti itarise gross pathology kunyangwe inogona kusaratidza bulging disc zvakananga. Panogona kunge kune zvisizvo zvakawanikwa zve disk degeneration senge osteophytes mumagumo ekupedzisira, gasi mu disc nekuda kwevacuum phenomenon, uye kurasikirwa kwekukwirira kwe intervertebral disc. Panyaya yezvipembenene zvine mwero, dzimwe nguva zvingaita sezvisina-focal intervertebral disc zvinhu zvinoputika kunze kwemiganhu ye vertebra iyo yakafara-based, circumferential, uye symmetrical.

Magnetic resonance imaging kana MRI inogona kunyatsotsanangura anatomy ye intervertebral discs kunyanya nucleus pulposus uye hukama hwayo. Zvakawanikwa zvekutanga zvakaonekwa paMRI mu disc bulging zvinosanganisira kurasikirwa kwemaitiro akajairika eiyo posterior disc. Iwo mabulges anogona kuonekwa seakafara-based, circumferential, uye symmetrical nzvimbo. Mukudzika kwakadzikama, dhisiki zvinhu zvichabuda kunze kwemiganhu ye vertebrae nenzira isiri-yakatarisa. Ct myelogram inogonawo kupa yakadzama disc anatomy uye inogona kubatsira mukuongororwa.

Kurapa kweDisc Bulging

Kurapa kweiyo bulging disc kunogona kuve kwakaomesesa, asi dzimwe nguva kuvhiya kunodikanwa.

Kurapa kwekuchengetedza

Kana iyo disc bulging iri asymptomatic, murwere haadi chero kurapwa sezvo isingaisi mungozi yakawedzera. Nekudaro, kana murwere ari chiratidzo, manejimendi anogona kuiswa mukudzora zviratidzo. Iko kurwadziwa kunowanzogadziriswa pamwe nenguva. Kusvika panguva iyoyo, mhondi dzinorwadza dzinouraya dzakadai sedzisiri -idalidal anti-immune mishonga senge ibuprofen inofanira kuiswa. Mukurwadziwa kusingagadzirisike, steroid majekiseni anogona zvakare kupihwa kune yakakanganisika nzvimbo uye kana ichiramba kushanda, iyo lumbar inonzwira tsitsi block inogona kutongwa mumatare akanyanya.

Murwere anogonawo kupihwa sarudzo yekusarudza mamwe marapirwo akadai sehunyanzvi hwekuita masaja, kurapwa kwemuviri, ice packs, uye mapedhi ekudziya izvo zvinogona kuderedza zviratidzo. Kuchengeta chimiro chakarurama, matepi, kana mabhureshi ekutsigira musana anoshandiswa nerubatsiro rwefiziotherapist. Izvi zvinogona kusungira nzira yekudzorera kuburikidza nekudzivisa kuwedzera kukuvadza uye kuchengetedza tambo dzakakuvadzwa kana dzakabvaruka mu intervertebral disc pasina kubuda kwechikamu chemvura che disc. Izvi zvinobatsira kuchengetedza yakajairika chimiro che annulus uye inogona kuwedzera chiyero chekudzorera. Kazhinji, zviratidzo zvinorwadza zvinotanga zvinogadziriswa nekufamba kwenguva uye hazvikonzere kurwadziwa. Zvisinei, kana zviratidzo zvikaramba zvichiwedzera, murwere angada kuvhiyiwa

Kana zviratidzo zvikagadziriswa, physiotherapy inogona kushandiswa kusimbisa tsandanyama dzemashure nekushandiswa kwekurovedza muviri. Zvishoma nezvishoma kurovedza muviri kunogona kushandiswa kudzoka kwebasa uye mukudzivirira kudzokorora.

Kurapa Kwokuvhiya

Kana kurapwa kwekuchengetedza kusingashande nemwedzi mishoma yekurapa, kurapwa kwekuvhiya kunogona kutariswa. Vazhinji vangada zvishoma kuvhiringidza zvinokuvadza izvo zvinoshandisa advanced technology kugadzirisa iyo intervertebral disc pasina kusanganisa zvakanyanya dissect kumashure. Aya maitiro akadai se microdiscectomy ane nguva yekudzikama yekudzora uye akaderedza njodzi yekuumbwa kweshungu, kurasikirwa kukuru kweropa, uye kushungurudzika kuzvivakwa zvakapatsanurwa kana zvichienzaniswa nekuvhiya kwekuvhiya.

Pakutanga, laminectomy uye discectomy yanga iri nzira huru yekurapa. Nekudaro, nekuda kwekupindirana kwemaitiro uye nekuda kwekuwedzera kukuvadzwa kwemitsipa nzira idzi dzakasiiwa nevarapi vazhinji nekuda kwe disc bulging.

Disc bulging mune iyo thoracic spine iri kurapwa zvakaipisisa neyeototransversectomy apo chikamu cheiyo chinotenderera chinogadziriswazve kubvumidza kupinda kweiyo intervertebral disc. Iyo tambo yemuzongoza nemitsipa yemuzongoza inodzvanywa nekushandisa thoracic decompression nekubvisa chikamu chemuviri vertebral muviri uye kuita diki rekuvhura. Murwere angangodawo spinal fusion gare gare kana iyo yakabviswa spinal body yaive yakakosha.

Vhidhiyo-inobatsira thoracoscopic kuvhiyiwa inogonawo kushandiswa apo kungoita chidimbu chiduku chinoitwa uye chiremba anovhiya anogona kuita kuvhiyiwa nerubatsiro rwekamera. Kana chirongwa chekuvhiya chaisanganisira kubvisa chikamu chikuru chemusana wepelinha uye disc zvinhu, zvinogona kutungamirira kumusana wekusagadzikana. Izvi zvingada kubatanidza bhonzo kuti utsive chikamu chakarasika nemapureti uye screws kuti zvibate panzvimbo.

Chii chinonzi Disc Herniation?

Sezvakataurwa muchikamu chekutanga chechinyorwa chino, disc herniation inoitika kana paine disc zvinhu zvinodzingwa kupfuura miganhu yeiyo intervertebral disc zvakananga. Iyo disc nzvimbo ine inopedzisirana yeiyo vertebral miviri yakakwirira uye yakaderera zvakanyanya nepo kunze ekunze kwe vertebral apophyses kune chikamu cheparutivi. Iwo osteophytes haaonekwe seji wedhara. Iko kunogona kuve nekutsamwa kana kumanikidza kwemidzi yemidzi uye dural sac nekuda kwehukuru hweiyo herniated zvinyorwa zvinotungamira kurwadziwa. Kana izvi zvikaitika mudunhu rakasarudzika, izvi zvinowanzozivikanwa sainzi sciatica. Aya mamiriro akataurwa kubva panguva dzekare kunyangwe kubatana pakati pe disc herniation uye sciatica kwakaitwa chete mune iyo makumi maviri^th zana remakore. Disc herniation ndechimwe chezvirwere zvinowanzoonekwa mumusana nekuda kwekushanduka kwekuchinja uye ndicho chikonzero chinowanzokonzera kuvhiyiwa kwemusana.

Kugadziriswa kweDisc Herniation

Pane zvakawanda zvakarongwa maererano ne intervertebral disc herniation. Mufocal disc herniation, pane kusimuka kwenzvimbo kweiyo disc zvinhu mune yakatwasuka kana axial ndege. Mune rudzi urwu, chete pasi pe25% ye denderedzwa ye disc inobatanidzwa. Mu-broad-based disc herniation, inenge 25 - 50% ye disc circumference is herniated. Iyo disc bulge ndeye apo 50 - 100% yedhisiki zvinhu inotambanudzirwa kupfuura iyo yakajairwa inovhara ye intervertebral space. Izvi hazvionekwi sechimiro che disc herniation. Uyezve, iyo intervertebral disc deformities inobatanidza nezviitiko zvakakomba zve scoliosis uye spondylolisthesis haisati yarongerwa se-herniation asi pane kugadzirisa kuchinja kwekontari ye disc nekuda kwekuremara kwepedyo.

Zvichienderana neyakaganhurwa yezvinhu zvakadzingwa, ma-herniated disc anokwanisa kuverengerwazve senge protrusion uye extrasion. Mune disc protrusion, daro rakayerwa mune chero ndege inobatanidza kumucheto kwe disc chinhu chinopfuura nepakati peververtebral disc space (chiyero chepamusoro chinotorwa) chakaderera pane iyo kureba kuyerwa mune imwechete ndege pakati pemupendero wechigadziko.

Kufungidzira kunogona kuratidza kurasirwa nzvimbo sekuratidzika pachikamu chakakomberedza uye sekuwedzera pane chikamu chesagittal nekuda kwekuti posterior longitudinal ligament ine iyo disc zvinhu izvo zvinodzingwa shure. Ipapo iyo herniation inofanira kufananidzwa nekuwedzera. Dzimwe nguva iyo intervertebral disc herniation inogona kuitika mucraniocaudal kana yakatwasuka gwara kuburikidza nehurema mune vertebral body endplates. Iyi mhando ye-herniation inozivikanwa seye intravertebral herniation.

Iyo disc protrusion inogona zvakare kukamurwa kuita maviri focal protrusion uye yakafara-based protrusion. Muchidimbu chepamusoro, iyo herniation iri pasi pe25% yedenderedzwa ye diski asi, mu-broad-based protrusion, iyo herniated disc ine 25 - 50% yedenderedzwa re diski.

Mu disc extrusion, inoongororwa kana imwe yeiyi mbiri inotevera inogutsikana. Chekutanga ndechekuti; kuti chinhambwe chinoyerwa pakati pemicheto yedhisiki zvinhu zviri mhiri kwe intervertebral disc space yakakura kudarika chinhambwe chinoyerwa mundege imwechete pakati pemicheto yechigadziko. Wechipiri ndouyu; kuti zvinhu zviri mu intervertebral disc space uye zvinhu zviri kunze kwe intervertebral disc space ine kushaya kuenderera mberi.

Izvi zvinogona kuitwazve seyakagadziriswa ino iri subtype yeakawedzera disc. Iyo inonzi disc inofamba kana diski zvinhu zvasundidzirwa kure kubva kunzvimbo yekuwedzera pasina kufunga kana paine kuenderera kwe disc kana kwete. Izwi iri rinobatsira mukududzira kufungidzira modalities sezvo kazhinji kuchinetsa kuratidza kuenderera mukufungidzira.

Iyo intervertebral disc herniation inogona kuverengerwa sezvakange zvine disc uye ma discs ayo asina kufananidzwa. Izwi iri rine disc rinoshandiswa kureva kutendeseka kweiyo inoparara annulus fibrosus iyo iri kuvhara iyo intervertebral disc herniation. Kana muto wacho uchinge wapinda mune iyo intervertebral disc, iyo fluid haibudi muye vertebral canal mune herniations iri mukati.

Dzimwe nguva pane zvimedu zvinodzingwa disc zvinoratidzwa semahara. Nekudaro, hapafanire kuve nekuenderera mberi pakati pe disc zvinhu uye chidimbu uye chepakutanga chinonzi discvertibral disc kuti icho chinodaidzwa kuti chidimbu chemahara kana chakateedzeredzwa chimwe. Mune disc inotamiswa uye mune yakatenderera fafitera, pane kuwedzerwa kwe disc zvinhu kuburikidza nekuvhura mune yean annusus fibrosus nekubviswa kwechinhu che disc kubva kure kune annulus.

Kunyangwe zvimwe zvimedu zvinotamiswa zvinogona kuteedzerwa izwi rakatamiswa rinoreva kungoenda pachinzvimbo uye harina kutaurwa kuenderera mberi kwedhisiki. The displaced intervertebral disc material inogona kutsanangurwa zvakare maererano ne posterior longitudinal ligament se submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, uye perforated.

Iyo musana canal inogonawo kukanganiswa ne intervertebral disc herniation. Uku kukanganisika kwemugero kunogonawo kurongedzerwa sekupfava, kuri pakati nepakati, uye kwakaomarara zvichienderana nenzvimbo inenge yakanganiswa. Kana mugero uri pachikamu ichocho ukakanganiswa chete pasi pechikamu chimwe chete muzvitatu, unonzi wakapfava nepo ukangokanganiswa pasi pezvikamu zviviri kubva muzvitatu uye unopfuura chikamu chimwe muzvitatu unoonekwa sewepakati. Mukukanganisa kwakanyanya, zvinopfuura zvikamu zviviri kubva muzvitatu zvemugero wepelinha zvinokanganiswa. Nekubatanidzwa kweforaminal, iyi imwechete grading system inogona kushandiswa.

Iyo yakabviswa midziyo inogona kutumidzwa maererano nenzvimbo yekuti ivo vari mune axial ndege kubva pakati kusvika kurudyi inotevera nzvimbo. Ivo vanonzi sepakati, nechepakati pakati, kurudyi subarticular, kurudyi foraminal, uye kurudyi extraforaminal. Iyo yakasiyiwa yekubatanidza discvertebral disc kugadzirwa kwemukati inogona kuverengerwa seyakagwinya, yakanyoroveswa, yakabviswa, yakakuvadzwa, yakagadziriswa, kubviswa, bony, nyukiliya uye cartilaginous.

Tisati tapinda mune zvakadzama nzira yekuongorora uye kubata intervertebral disc herniation, ngatisiyanisei musiyano wekuti cervical disc herniation inosiyana sei kubva kune lumbar herniation sezvo iwo akajairwa matunhu kuzviita herniation.

Cervical Disc Herniation vs Thoracic Disc Herniation vs Lumbar Disc Herniation

Lumbar disc herniation ndiyo inonyanya kuzivikanwa mhando yeherniation inowanikwa mumuzongoza iyo inenge 90% yehuwandu. Zvisinei, cervical disc herniation inogonawo kuitika munenge chikamu chegumi chevarwere. Iyi misiyano inonyanya kukonzerwa nekuti iyo lumbar spine ine yakanyanya kudzvanywa nekuda kwekuwedzera kwemutoro. Uyezve, ine yakakura yakaenzana intervertebral disc material. Nzvimbo dzinowanzozivikanwa dze intervertebral disc herniation munharaunda ye lumbar ndeye L 5 - 6, munharaunda yeCervical pakati peC7, uye munharaunda ye thoracic T12.

Cervical disc herniation inogona kuitika zvinowanzoitika nekuti cervical spine inoita senge pivoting nzvimbo yemusoro uye inzvimbo isina njodzi yekunetseka uye nekudaro inowanzoita kukuvadza mu disc. Thoracic disc herniation inoitika zvakanyanya kupfuura chero ipi neipi yeaviri. Izvi zvinokonzerwa nekuti iyo thoracic vertebrae yakasungirirwa pambabvu uye thoracic cage iyo inoderedza huwandu hwekufamba mune ye thoracic musana kana ichienzaniswa neyechibereki uye lumbar spinal discs. Nekudaro, thoracic intervertebral disc herniation inogona kuitika.

Cervical disc herniation inopa marwadzo emutsipa, kurwadziwa kwepfudzi, kurwadziwa kunopenya kubva pamutsipa kusvika kuruoko, kurira, etc. Lumbar disc herniation inogona kukonzera marwadzo emusana pamwe chete nemarwadzo, kurira, kupera, uye kushaya simba kwemhasuru kunoonekwa muzasi. mitezo. Thoracic disc herniation inogona kupa marwadzo kumusana wepamusoro unopenya kumutumbi.

Epidemiology

Kunyange zvazvo disc herniation inogona kuitika mumapoka ose emakore, inowanzoitika pakati pechina uye yechishanu makore ehupenyu nehuwandu hwemakore e37. Pakave nemishumo inofungidzira kuwanda kwe intervertebral disc herniation kuva 2 - 3% yehuwandu hwevanhu. Inonyanya kuonekwa muvarume vanopfuura makore makumi matatu nemashanu uye huwandu hwe35% uye kuvakadzi nhamba iyi inosvika 4.8%. Nekuda kwekuwanda kwayo, inoonekwa sedambudziko repasi rose sezvo ichibatanidzwa nekuremara kwakanyanya.

Risk Factors

Muzviitiko zvakawanda, herniated disc inoitika nekuda kwekuchembera kwechisikigo mu intervertebral disc. Nekuda kweiyo disc degeneration, kuwanda kwemvura yakamboonekwa mu intervertebral disc inoomeswa zvichitungamira mukuderera kweiyo disc nekuderera kweiyo intervertebral space. Shanduko idzi dzinoonekwa zvakanyanya mu degenerative disc chirwere. Mukuwedzera kune izvi zvishoma nezvishoma kuchinja nekuda kwekupfeka uye kubvarura, zvimwe zvikonzero zvinogonawo kuwedzera njodzi ye intervertebral disc herniation.

Kuve wakanyanyisa kuneta kunogona kuwedzera mutoro kumuzongoza uye kuwedzera njodzi ye-herniation. Kurarama hupenyu hwekugara kunogona zvakare kuwedzera njodzi uye nekudaro mararamiro anoshanda anokurudzirwa mukudzivirira mamiriro aya. Kusagadzikana kwekumira nekumira kwenguva yakareba, kugara, uye kunyanya kutyaira kunogona kuisa dhiri pane discvertebral discs nekuda kwekuwedzera vibration kubva injini yemotokari inotungamira microtrauma uye makaki mu disc. Mabasa ayo anoda kugara achikotama, kusvetuka, kudhonza uye kusimudza kunogona kuisa dhadha kumusana. Isina tsarukano masimiriro ekusimudza maronda ndechimwe chezvikonzero zvikuru.

Kana mhasuru dzemusana dzichishandiswa mukusimudza zvinhu zvinorema pane kusimudza nemakumbo uye kumonyoroka uchisimudza zvinogona kuita kuti lumbar discs riwedzere kubatwa neherniation. Naizvozvo varwere vanofanira kugara vachirairwa kusimudza masimbi nemakumbo avo kwete kumashure. Kusvuta kwave kuchifungidzirwa kuti kunowedzera disc herniation nekuderedza kugoverwa kweropa kune intervertebral disc inotungamirira kukuchinja kwekuchinja kwe disc.

Kunyangwe izvo zvinhu zviri pamusoro zvinowanzo fungidzirwa kuti ndizvo zvinokonzeresa disc herniation, zvimwe zvidzidzo zvakaratidza kuti mutsauko panjodzi uri mudiki chaizvo kana ichi chahwo vanhu vachienzaniswa nemapoka ekutonga ehwo hwakajaira.

Pave paine akati wandei emhando dzekutsvaga dzakaitwa pane genetic predisposition uye intervertebral disc herniation. Mamwe emadzinza akaomeserwa muchirwere ichi anosanganisira vhitamini D receptor (VDR) ino iri gene iyo inotsigira ma polypeptides epollagen anokosha anonzi collagen IX (COL9A2).

Rimwe gene rinodaidzwa kuti genes rean genrean gene (AGC) rakaomerwazve sezvo richitungamira proteinoglycans inova inonyanya protein protein inowanikwa mu cartilage. Iyo inotsigira biochemical uye mehendi basa reiyo cartilage tishu uye nekudaro kana iyi gene ikaremara, inogona kufungidzira munhu kune yekudyidzana intervertebral disc herniation.

Kunze kweizvi, kune mamwe majini akawanda ari kuongororwa nekuda kwekubatana pakati pe disc herniation yakadai sematrix metalloproteinase (MMP) cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, uye asporin (ASPN). Vanogonawo kuonekwa sevanokwanisa gene markers kune lumbar disc chirwere.

Pathogenesis yeSciatica uye Disc Herniation

The sciatic pain yakabva kune extruded nucleus pulposus inducing zvakasiyana-siyana. Inogona kudzvanya zvakananga midzi yetsinga inotungamira kune ischemia kana isina iyo, inosimudzira tsinga magumo ekunze kwechikamu chefibrous ring uye kuburitsa zvinoputika zvinhu zvichiratidza mavambo ayo akawanda. Kana iyo disc herniation inokonzera mechanical compression yetsinga midzi, nerve membrane inonzwisiswa kumarwadzo uye zvimwe zvinokonzera nekuda kweischemia. Zvave zvichiratidzwa kuti mumidzi yetsinga dzakanzwisiswa uye dzakakanganisika, chikumbaridzo chekunzwa kweneuronal chinosvika hafu yeiyo yakajairika uye isina-kukanganisa tsinga midzi.

Iyo inoputika sero infiltration yakasiyana mune extruded discs uye isina-extruded discs. Kazhinji, mu-non-extruded discs, kuzvimba kuduku. Iyo extruded disc herniation inokonzera kuti posterior longitudinal ligament iparadze iyo inoratidzira chikamu cheherniated kumubhedha wevascular we epidural space. Zvinotendwa kuti masero ekuputika ari kubva mumitsipa iyi yeropa iri munzvimbo yekunze ye intervertebral disc.

Aya masero anogona kubatsira zvakavanzika zvinhu zvinokonzera kuzvimba uye kutsamwisa kwemidzi nerve inokonzeresa kurwadziwa kwechivanhu. Naizvozvo, herniations dzakawedzerwa dzinogona kukonzera kurwadziwa uye kukonzeresa kwekiriniki pane izvo zvirimo. Mune yaive herniations, the mechanic effect inonyanya kuvepo panguva isinga tsanangurwe kana yakadzoserwa discs yekurapa inonyanya kuitika.

Clinical Disc Herniation uye Zvekutarisira Munhoroondo

Zviratidzo zve disc disc herniation zvinogona kusiyanisa zvakanyanya zvichienderana nenzvimbo yemarwadzo, rudzi rwechirwere, uye munhu. Nokudaro, nhoroondo inofanira kutarisa kuongororwa kwekunyunyuta kukuru pakati pezvimwe zviratidzo zvakawanda.

Chichemo chikuru chinogona kuva kurwadziwa kwemutsipa mucervical disc herniation uye kunogona kutumirwa marwadzo mumaoko, mapepa, mutsipa, musoro, chiso, uye kunyange nzvimbo yezasi. Zvisinei, inowanzonzi interscapular region. Iyo mwaranzi yemarwadzo inogona kuitika zvichienderana nenhanho pane iyo herniation iri kuitika. Kana midzi yetsinga yenharaunda yekervical inobatwa uye yakamanikidzwa, panogona kuva nekunzwa, uye kuchinja kwemotokari nekuchinja kwemafungiro.

Marwadzo anoitika nekuda kwetsinga midzi compression inonzi radicular pain uye inogona kutsanangurwa seyakadzama, kurwadza, kupisa, kugomara, achy, uye magetsi zvichienderana nekuti pane kunyanya kusashanda kwemota kana kusanzwa zvakanaka. Muchikamu chepamusoro, kurwadziwa kwakanyanya kunogona kutevera dermatomal kana myotomal pattern. Radiculopathy kazhinji haifambidzani nemarwadzo emutsipa. Panogona kuva neunilateral uyewo zviratidzo zviviri. Zviratidzo izvi zvinogona kuwedzerwa nemabasa anowedzera kudzvinyirira mukati me intervertebral discs yakadai seValsalva maneuver uye kusimudza.

Kutyaira kunogonawo kuwedzera marwadzo nekuda kwe disc herniation nekuda kwekunetsekana nekuda kwekudengenyeka. Zvimwe zvidzidzo zvakaratidza kuti kuvhunduka uye kushushikana kubva pakudengenyeka kunogona kukonzera simba remuchina kuti riwedzere diki herniation asi chimiro chakachinjika chaive chisina simba. Saizvozvo, zviitiko zvinoderedza intradiscal pressure zvinogona kuderedza zviratidzo zvakaita sekurara pasi.

Chichemo chikuru mu lumbar disc herniation inorwadza kumashure. Zvimwe zviratidzo zvinobatanidzwa zvinogona kuva marwadzo muhudyu, mabheti, uye anogenital region iyo inogona kupenya kusvika kutsoka nechigunwe. Nhunga huru inobatwa munharaunda iyi ndeye sciatic nerve inokonzera sciatica uye zviratidzo zvayo zvinosanganiswa zvakadai sekurwadziwa kwakanyanya mumagaro, kurwadziwa kwemakumbo, kushaya simba kwemhasuru, kupera simba, kukanganisa kwekunzwa, kupisa uye kupisa kana kurira kwekunzwa mumakumbo, kusashanda kwekufamba. , kukanganisa kwe reflexes, edema, dysesthesia kana paresthesia mumakumbo ezasi. Zvisinei, sciatica inogona kukonzerwa nezvimwe zvikonzero kunze kwekutsvaira zvakadai semamota, utachiona, kana kusagadzikana kunoda kubviswa kunze kwekusvika pakuongororwa.

Iyo herniated disc inogonawo kumanikidza pane rechikadzi nervete uye inogona kupa zviratidzo zvakadai sekusindimara, kunzwa kurira mukati merimwe kana makumbo ese, uye kunzwa kupisa mumakumbo nemuchiuno. Kazhinji, iyo nerve midzi inokanganiswa mu herniation mudunhu lumbar ndiyo inobuda pazasi peiyo intervertebral disc. Iyo inofungidzirwa kuti mwero weiyo nerve midzi yekukasira inosarudza kugoverwa kwekurwadziwa kwegumbo. Mune herniations panguva yechitatu neyechina lumbar vertebral mazinga, kurwadziwa kunogona kupenya kune yekunze chidya kana girini. Mu radiculopathy pazinga rechishanu lumbar vertebra, kurwadziwa kunogona kuitika munharaunda inotevera uye yeanterouse chidimbu. Mune herniations pazinga rekutanga rebumum, kurwadziwa kunogona kuitika pasi petsoka nemhuru. Iko kunogona zvakare kuvesa uye kunzwa kwekutiza kuchiitika munzvimbo imwechete yekuparadzira. Iko kushaya simba kwemumhasuru kunogona kunge kusiri kukwanisa kucherechedzwa kana kurwadziwa kwakanyanya.

Pakushandura chinzvimbo murwere anowanzo bvisirwa kurwadziwa. Kuchengeta chinzvimbo chepamusoro nemakumbo akasimudzwa kunogona kugadzirisa marwadzo. Kuporeswa kwekurwadziwa kwepfupi kunogona kuunzwa nekufamba kwenguva pfupi uchifamba kwenguva refu, kumira kwenguva refu, uye kugara kwenguva yakareba sekunge uchityaira kunogona kuwedzera kurwadziwa.

Iyo yakazotevera disc herniation inoonekwa foraminal uye extraforaminal herniations uye ivo vane akasiyana ehutano maitiro kune iyo ye medial disc herniation inoonekwa mune subarticular uye yepakati herniations. Iyo yakazopindirana nepakati discvernibral disc herniations inogona kana ichienzaniswa nemedical herniations zvakanyanya kutsamwisa uye nekugadzira compress yemidzi midzi iyo iri kubuda uye dorsal midzi ganglions iri mukati yakamanikana spinal canal.

Naizvozvo, yakazotevera herniation inoonekwa kazhinji muukweguru neakanyanya radicular pain uye neurological deficits. Kune zvakare kuwedzera kupisa kwegumbo kurwadza uye intervertebral disc herniations mumakaka mazhinji mumapoka anozotevera kana ichienzaniswa medial disc herniations.

Iyo herniated disc munharaunda ye thoracic inogona kusavapo nemarwadzo ekudzokera shure zvachose. Pane kudaro, pane zviratidzo zvakakura nekuda kwemarwadzo anorehwa muthorax nekuda kwekushatirwa kwetsinga. Panogona zvakare kuve nekurwadziwa kwakanyanya mumuviri kunofamba kuenda kumakumbo, kurira kwekunzwa uye kusanzwa mune rimwe kana makumbo ese, kushaya simba kwemhasuru, uye spasticity yeimwe kana makumbo ese nekuda kwekuwedzeredza reflexes.

Murapi anofanirwa kutarisa kune atypical mharidzo sezvo panogona kuve nekumwe kusiyanisa kuongororwa. Kutanga kwezviratidzo kunofanirwa kubvunzwa nezve kuona kana chirwere ichi chiri acute, sub-acute, kana chisingaperi mukutanga. Nhoroondo yezvehutano yakapfuura inofanirwa kubvunzurudzwa nezve zvakadzama kuti isabatanidze zviratidzo zvemureza dzvuku sekurwadziwa kunoitika husiku pasina chiitiko chinogona kuoneka mu pelvic tsinga yekutsikirira, uye marwadzo asiri emuchina anogona kuonekwa mumapundu kana utachiona.

Kana paine kusakwana kwekushanduka kwemutsipa, nekukanganisa uye kubatikana kwechironda ipapo, zvinoonekwa senge kurwara kwemhirizhonga uye nekukurumidza kuferefetwa nekuti cauda equine syndrome inogona kuitika iyo kana ikasarapwa, inogona kutungamira mukushomeka kwemitsipa.

Kuwana nhoroondo yakadzama kwakakosha kusanganisira kugara kwemurwere sezvo zvimwe zviitiko zviri pabasa zvinogona kunge zvichawedzera zviratidzo zveurwere. Murwere anofanirwa kuongororwa kuti ndeapi mabasa aanogona uye asingakwanisi kuita.

Kusiyanisa Kuziva

• Degenerative disc disc
• Kurapa kwechimiro
• Kurwadziwa kweMyofascial kunotungamira kwepfungwa yekuvhiringidza uye kurwadziwa kwenzvimbo kana kutumirwa
• Hematoma
• Cyst inotungamira kune imwe nguva yekushomeka kwemotokari uye kukanganisa kwepfungwa
• Spondylosis kana spondylolisthesis
• Discitis kana osteomyelitis
• Malignancy, neurinoma kana misa lesion inokonzeresa atrophy yemhapa mhasuru, glutei
• Spinal stenosis inoonekwa zvakanyanya munharaunda ye lumbar ine hunyoro hwakaderera kumashure kurwadziwa, kukanganisika kwemotokari, uye kurwadziwa mune imwe kana makumbo maviri.
• Epidural abscess inogona kukonzera zviratidzo zvakafanana nekurwadziwa kwakanyanya kunosanganisira spinal disc herniation
• Aortic aneurysm iyo inogona kukonzera yakaderera kumashure kurwadziwa uye gumbo kurwadziwa nekuda kwekumanikidza kunogona zvakare kuputika uye kutungamira kune hemorrhagic kuvhunduka.
• Hodgkin's lymphoma mumatanho epamberi inogona kutungamira kune-nzvimbo-yekugara maronda emutsara wepelinha anotungamira kune zviratidzo zvakaita seiyo intervertebral disc herniation
• Tumor
• Pelvic endometriosis
• Facet hypertrophy
• Lumbar nerve midzi schwannoma
• Herpes zoster kutapukira kunoguma nekuzvimba pamwe nemidzi yemasidhi kana lumbosacral nerve midzi

Kuongororwa muDisc Herniation

Kuongorora kwakakwana kwemuviri kunodiwa kuti uongorore intervertebral disc herniation uye usabvisa zvimwe zvakakosha kusiyanisa kuongororwa. Rudzi rwekufamba rwunofanirwa kuongororwa asi rwunogona kunge rusina kugadziridzika pamwe chete ne disc herniation sezvo ichideredzwa zvakanyanya muvarwere vakwegura vane chirwere chekuderera uye nekuda kwechirwere chemajoini.

Kuongororwa kwetsinga kwakakwana kunowanzodikanwa. Izvi zvinofanirwa kuyedza kushaya simba kwemhasuru uye kushaya simba kwekunzwa. Kuti aone kushaya simba kwemhasuru muzvigunwe zvidiki zvigunwe, murwere anogona kukumbirwa kufamba patiptoe. Kusimba kwetsandanyama kunogonawo kuongororwa nekuenzanisa simba neremurapi. Panogona kunge paine dermatomal sensory kurasikirwa inoratidzira iyo yakasarudzika nerve midzi kubatanidzwa. Mafungiro anogona kunge achiwedzeredzwa kana dzimwe nguva angave asipo.

Kune dzakawanda neurologic kuongorora maitiro anotsanangurwa maererano ne intervertebral disc herniation yakadai seBraggart sign, flip the sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign makumbo ose kana Milgram test, uye tsime gumbo kana Fajersztajin test. Nekudaro, zvese izvi zvakavakirwa pakuyedza iyo sciatic nerve root tension nekushandisa iwo masimidhi akafanana muyedzo yekusimudza gumbo. Miedzo iyi inoshandiswa kune chaiwo mamiriro kuona misiyano isina kujeka.

Vanenge vangangoita vese vanoenderana nekurwadziwa kunopenya pasi pegumbo uye kana zvikaitika pamusoro pebvi inofungidzirwa kuti inokonzeresa nekuda kweanoronal inomhanyisa lesion uye kana kurwadziwa kwacho kuchidzika pasi pebvi, kunoonekwa kunge kuri nekuda kwekumanikidza kwe iyo inonzi sciatic nerve midzi. Yekuongororwa kwe lumbar disc herniation, iyo inonyanya kuomesesa bvunzo inoonekwa kunge iri kupisa marwadzo ichiitika pasi pegumbo nekuda kwekutsamwa.

Muyedzo yekusimudza gumbo rakatwasuka inonziwo chiratidzo cheLasegue, murwere anogara kumusana wake uye anochengeta makumbo akatwasuka. Chiremba anobva asimudza makumbo nekukwenya chiuno achichengeta ibvi rakati twasu. Kona iyo murwere anonzwa kurwadziwa ichidzika negumbo pasi pebvi inocherechedzwa. Mumunhu ane hutano hwakanaka, murwere anogona kushandura hudyu kusvika ku80-90? pasina kurwadziwa kana kuomerwa.

Zvisinei, kana kona iri 30 -70 chete? madhigirii, inoratidzira lumbar intervertebral disc herniation paL4 kune S1 nerve midzi mazinga. Kana kona yehudyu inoputika pasina marwadzo isingasviki madhigirii makumi matatu, inowanzoratidza zvimwe zvikonzero zvakadai sebundu re gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, uye protrusion, malingering murwere, uye acute kuzvimba kwe dura mater. Kana kurwadziwa kwehudyu kuchinjika kunoitika pane anopfuura 30 madhigirii, zvinogona kunge zvichikonzerwa nekuomarara kwemhasuru dzakadai segluteus maximus uye hamstrings, kusimba kwekapisi yejojo ​​rehudyu, kana pathology yesacroiliac kana majoini ehudyu.

Iyo reverse yakatwasuka yegumbo yekusimudza bvunzo kana hudyu yekuwedzera bvunzo inogona kushandiswa kuyedza yakakwira lumbar maronda nekutambanudza tsinga midzi yefemoral nerve iyo yakafanana neiyo yakatwasuka gumbo kusimudza bvunzo. Mumutsipa wekervical spine, kuitira kuti uone stenosis yeforamina, muedzo weSpurling unoitwa uye hauna kujeka kune cervical intervertebral disc herniation kana tension yetsinga midzi. Iyo Kemp bvunzo ndiyo inofananidzira bvunzo munharaunda yelumbar yekuona foraminal stenosis. Matambudziko anokonzerwa ne disc herniation anosanganisira kunyatsoongorora nzvimbo yehudyu, digital rectal examination, uye urogenital kuongorora kunodiwa.

Kuongorora kweDisc Herniation

Nekuongororwa kwe intervertebral disc herniation, miedzo yekuongorora yakadai seMagnetic resonance imaging (MRI), Computed tomography (CT), myelography, uye plain radiography inogona kushandiswa iri yoga kana pamwe chete nedzimwe nzira dzekufungidzira. Chinangwa chekutsvaga kwe disc herniation chakakosha nokuti mushure mekutsvaga kwakadaro kupindira kwekuvhiya kunotofungidzirwa. Serum biochemical bvunzo senge prostate-specific antigen (PSA) level, Alkaline phosphatize kukosha, erythrocyte sedimentation rate (ESR), weti yekuongorora yeBence Jones protein, serum glucose level, uye serum protein electrophoresis inogona zvakare kudiwa mumamiriro ezvinhu anotungamirwa nenhoroondo. .

Magnetic Resonance kuri (MRI)

MRI inoonekwa seyakanakisa kufungidzira modation mune varwere vane nhoroondo uye yekuongororwa kwepanyama zvinowanikwa zvinofungidzira zve lumbar disc herniation yakabatana ne radiculopathy maererano neNorth American Spinal Society nhungamiro muna 2014. Iyo anatomy yeiyo herniated nucleus pulposus uye hukama hwayo hwakabatana nehutu hwakapfava padyo nzvimbo dzinogona kududzirwa zvisina kujairika neMRI munzvimbo dzemuchibereko, thoracic, uye lumbosacral. Pamusoro pezvisungo zvegore, iyo inonzi herniated nucleus inogona kuoneka seyakatarisana, asymmetric disc zvinhu protrusion paMRI.

Pane sagittal T2 yakaremerwa mifananidzo, iyo yekumashure annulus inowanzoonekwa seyakakwira chiratidzo chiratidzo nzvimbo nekuda kwekubuditsa radial annular kubatana neiyo herniation ye disc kunyangwe iyo inonzi herniated nucleus iyo pachayo ndeye hypointense. Hukama pakati peiyo herniated nucleus uye yakasvibiswa zviso nemidzi yetsinga iyo iri kubuda kuburikidza neural foramina yakanyatsorongedzwa pamifananidzo yeSagittal yeMRI. Zvidimbu zvepachena zve intervertebral disc zvinogonawo kusiyaniswa kubva kuMRI mifananidzo.

Ikoko kunogona kunge kune zviratidzo zvinosanganiswa zve intervertebral disc herniation paMRI yakadai semisodzi ye radial pane annulus fibrosus iyo iriwo chiratidzo chekuora mwoyo kwechirwere. Panogona kunge paine zvimwe zviratidzo zvinotaurira sekurasikirwa kwedisiki kureba, bulging annulus, uye shanduko mumaplateti. Zviratidzo zveAtypical zvinogonawo kuonekwa neMRI zvakadai sezvisina kujairika disc nzvimbo, uye maronda anowanikwa zvachose kunze kwe intervertebral disc space.

MRI inogona kuona kukanganisa mu intervertebral discs yepamusoro kune dzimwe nzira kunyange zvazvo kufungidzira kwepfupa kwaro kuri kuderera zvishoma. Nekudaro, pane zvinogumira neMRI muvarwere vane simbi yekuisa midziyo senge pacemaker nekuti iyo electromagnetic munda inogona kutungamirira kukusashanda zvakanaka kwema pacemaker. Muvarwere vane claustrophobia, zvinogona kuita dambudziko kuenda kumugero wakamanikana kunoongororwa nemuchina weMRI. Kunyangwe mamwe mayuniti aine MRI yakavhurika, ine simba remagineti shoma uye nekudaro inotsanangura kushomeka kwemhando yekufungidzira.

Iri idambudziko zvakare muvana uye varwere vanonetsekana vari kuita MRI nekuti kunaka kwemufananidzo kunoenderana nemurwere anoramba akamira. Vanogona kuda sedation. Musiyano unoshandiswa muMRI inova gadolinium inogona kukonzera nephrogenic systemic fibrosis kune varwere vaive nechirwere chetsvo chisati chavapo. MRI inowanzodziviswa pakubata pamuviri kunyanya mukati memavhiki gumi nemaviri ekutanga kunyangwe isina kuratidzwa nekiriniki kuti ine njodzi kumwana. MRI hainyanyi kubatsira kana bundu rine calcium uye mukusiyanisa edema fluid kubva bundu tishu.

Yakagadziriswa Tomography (CT)

CT scanning inonziwo imwe nzira yakanaka yekuongorora spinal disc herniation kana MRI isipo. Inokurudzirwawo sekutsvaga kwekutanga kune varwere vasina kugadzikana vane kubuda ropa kwakanyanya. CT scanning yakakwirira kune myelography kunyange kana maviri asanganiswa, inokunda ese ari maviri. CT scans inogona kuratidza calcification zvakajeka uye dzimwe nguva kunyange gasi mumifananidzo. Kuti uwane hutano hwepamusoro hwekufungidzira, kufungidzira kunofanirwa kutariswa panzvimbo yehutachiona uye zvikamu zvitete zvakatorwa kuti zvinyatsoona kuwanda kweiyo herniation.

Zvisinei, CT scan yakaoma kuti ishandiswe kune varwere vakatoitwa kuvhiyiwa kwelaminectomy nokuti kuvapo kwevanga remavanga uye fibrosis kunokonzera kuzivikanwa kwezvivakwa zvakaoma kunyange zvazvo kuchinja kwebhoni uye kuremara mutsinga dzetsinga zvinobatsira pakuita chirwere.

Iyo herniated intervertebral discs mune cervical disc inogona kuoneka nekudzidza iyo isina kurongeka maitiro. Iyo inowanzofungidzirwa kumashure uye kumashure kune iyo intervertebral discs uye zvakanyanya kune vertebral miviri. Iyo yekusagadziriswa maitiro anoitika sclerosis, uye hypertrophy kana paine hukama husina kunaka pakati pekusagadziriswa maitiro uye zvakatarisana nezvimiro sekuonekwa mune degenerative disc chirwere, chakamonana disc nzvimbo yakatetepa, uye general kupfeka uye kubvaruka.

Myelopathy inogona kuitika kana musana wemusana unokanganiswa nekuda kwechirwere che disc. Saizvozvowo, apo neural foramina inobatanidzwa, radiculopathy inoitika. Kunyangwe madhisiki madiki eherniated uye protrusions anogona kukonzera kupindira kweiyo dural sac nekuti cervical epidural space yakamanikana zvakasikwa. Iyo intervertebral discs ine attenuation yakakura zvishoma pane sac inoratidzwa muCT scan.

Munharaunda ye thoracic, CT scan inogona kuongorora intervertebral disc herniation zviri nyore nekuda kwekuti kune kuwedzera kwe calcium inowanikwa mu thoracic discs. Pamberi kune dural sac, iyo herniated disc material inogona kuonekwa paC CT sehuwandu hunotsanangurwa zvakajeka iyo yakakomberedzwa nemafuta epidural. Kana paine kushayikwa kwemafuta epidural, iyo disc inoratidzika seyepamusoro attenuated mass ichienzaniswa neyakakomberedza.

Radiography

Plain radiography haidiwi pakuongorora herniation ye intervertebral discs, nokuti plain radiographs haigoni kuona disc uye naizvozvo inoshandiswa kusabvisa mamwe mamiriro akadai semamota, zvirwere, uye kuputsika.

Mune myelography, panogona kuve nekuremara kana kusimuka kweiyo extradural musiyano-yakazadzwa thecal sac inoonekwa mu herniation ye disc. Panogonawo kunge paine zvimiro mutsinga yakakanganisika senge edema, kukwira, kutsauka, uye kudimburwa kwetsinga inoonekwa pamufananidzo wemyelography.

Diskography

Mune iyi yekufungidzira modness, iyo yakasarudzika kati inoiswa mukati meiyo disc kuitira kuti iongorore disc morphology. Kana marwadzo akaitika akatevera jekiseni iro rakafanana nere discogenic pain, zvinoratidza kuti disc irori ndiko kunobva kurwadziwa. Kana iyo CT scan ichiitwa zvakare nekukurumidza mushure me discography, zvinobatsira kusiyanisa anatomy uye pathological shanduko. Nekudaro, sezvo iri maitiro anopinda muropa, zvinongoratidzwa mumamiriro ezvinhu akakosha apo MRI neCT dzakatadza kuburitsa etiology yekurwadziwa kwemashure. Iyo ine mhedzisiro yakati wandei senge musoro, meningitis, kukuvara disc, discitis, intrathecal hemorrhage, uye kuwedzera kurwadziwa.

Kurapa kweHerniated Disc

Kurapa kwacho kunofanirwa kuve kwakafanana nemunhu zvichienderana nemurwere-anotungamirwa kuburikidza nenhoroondo, kuongororwa kwemuviri, uye kutsvaga kweongororo yekutsvaga. Muzhinji, murwere zvishoma nezvishoma anovandudza pasina kuda kupindira mukati memwedzi mitatu kusvika mina. Naizvozvo, murwere anongoda chete mushonga wekuchengetedza panguva ino nguva. Nekuda kweichi chikonzero, kune zvakawanda zvisingabatsiri pakurapa izvo zvakabuda nekufungidzira kusarudzika kwezviratidzo kwezviratidzo kune iro kurapa. Naizvozvo, kurapwa kwekuchengetedza kunoda kuve kunoratidza.

Kuchengetedza Therapy

Sezvo iyo herniation ye disc ine isina kunaka kosi, chinangwa chekurapa ndechekuvandudza kupora kweanoshanda emitsipa, kuderedza marwadzo, nekugonesa kudzokera pakutanga kubasa uye zviitiko zvekurarama kwezuva nezuva. Zvakanakisa zvezvirongwa zvekuchengetedza ndezvevarwere vadiki vane hernias zvinoteedzeredzwa uye mune varwere vane hunyoro hwemhedzisiro yekusagadzikana nekuda kweiyo diki disc hernias.

Kuzorora kwemubhedha kwakagara kuchionekwa sechisarudzo chekurapa mu herniation ye disc. Zvisinei, zvakaratidzwa kuti kuzorora kwemubhedha hakuna simba kunze kwekutanga 1 kana 2 mazuva. Kuzorora kwemubhedha kunoonekwa sekusingagoneki mushure menguva iyi yenguva.

Kuti uderedze marwadzo, oral non-steroidal anti-inflammatory drugs senge ibuprofen uye naproxen inogona kushandiswa. Izvi zvinogona kuderedza marwadzo nekuderedza kuzvimba kwakabatana netsinga inoputika. Analgesics yakadai seacetaminophen inogonawo kushandiswa kunyange zvazvo isina anti-inflammatory effect inoonekwa muNSAIDs. Mishonga uye mishonga inofanira kunge yakakodzera kune zera uye kuoma kwemarwadzo mumurwere. Kana kurwadziwa kukasadzorwa nemishonga iripo, murapi anofanira kuenda nhanho imwe kumusoro pamanera eWHO ekunatsa marwadzo. Zvisinei, kushandiswa kwenguva refu kweNSAIDs uye analgesics kunogona kutungamirira kumaronda emudumbu, chiropa, uye matambudziko etsvo.

Kuti uderedze kuzvimba, dzimwe nzira dzakaita senge kushandisa ice munguva yekutanga wobva wachinja kushandisa kupisa, gels, uye rubs zvinogona kubatsira nemarwadzo pamwe nekumarara kwemasuru. Oral mhasuru dzinozorodza rinogona zvakare kushandiswa mukudzikamisa mhasuru spasms. Mimwe yemishonga yacho inosanganisira methocarbamol, carisoprodol, uye cyclobenzaprine.

Nekudaro, ivo vanoita pakati pechikonzero uye vanokonzeresa uye kusimba mukati mevarwere uye hazviite zvakananga kuderedza tsandanyama. Iyo kosi kapfupi yemumuromo steroid yakadai senge prednisolone kwenguva yemazuva mashanu muhutongi hwepombi inogona kupihwa kudzikisa kuzvimba uye kuzvimba mukati mutsinga. Iyo inogona kugovera zororo rekurwadziwa munguva pfupi mukati meawa makumi maviri nemana.

Kana marwadzo asina kugadziriswa zvakakwana neakanyanya kushanda madosi, murwere anogona kutariswa nekupa steroid majekiseni munzvimbo yeepidural. Chiratidzo chikuru chejekiseni re steroid mu periradicular space is discal compression inokonzera kurwadziwa kwakanyanya kunopesana nekurapa kwakajairika. Kunyatsoongorora neCT kana MRI scanning inodiwa kuti unyatso kusabvisa zvimwe zvinokonzeresa marwadzo. The contraindications pakurapa uku zvinosanganisira varwere vane chirwere cheshuga, pamuviri, uye gastric maronda. Epidural puncture inopesana nevarwere vane coagulation disorders uye naizvozvo nzira yeforaminal inoshandiswa zvakanyatsonaka kana ichidiwa.

Maitiro aya anoitwa pasi pekutungamirirwa kweiyo fluoroscopy uye inosanganisira jekiseni steroid uye angesgesic munzvimbo yepasecial yakanangana neiyo yakakanganisika intervertebral disc kuderedza kuzvimba uye kuzvimba kwemitsipa zvakananga munzvimbo yekubuda. Zvinoda kusvika makumi mashanu muzana evarwere vanozorodzwa mushure mejekiseni kunyangwe iri pfupi uye vangangoda kudzokorora majekiseni panguva mbiri dzevhiki kuti uwane mibairo yakanaka. Kana iyi modical yekurapa ikabudirira, kusvika kumatatu epasurual steroidal majekiseni anogona kupihwa pagore.

Kurapa kwepanyama kunogona kubatsira murwere kuti adzokere kuupenyu hwake hwepakutanga nyangwe zvisiri kuvandudza herniated disc. Iyo inorapa yemuviri inogona kuraira murwere nezve maitiro ekuchengetedza maitiro, kufamba, uye nzira dzekusimudza zvichienderana nekugona kwemurwere kushanda, kufamba uye kushanduka kwezvinhu.

Kutambanudza maekisesaizi kunogona kuvandudza kuchinjika kwemusana ukuwo kusimbisa maekisesaizi kunogona kuwedzera simba remusana mhasuru. Izvo zviitiko zvinogona kuwedzera mamiriro eiyo herniated disc inorayirwa kuti idziviswa. Physical therapy inoita shanduko kubva kune intervertebral disc herniation kuenda kune inoshingaira mararamiro akatsetseka. Maekisesaizi ehurumende anogona kuchengetwa kwehupenyu hwese kuvandudza hutano hwakanaka.

Iyo inonyanya kushanda yekurapa yekurapa sarudzo iyo iri ufakazi-yakavakirwa ndeyekutarisa uye yepascinomaididididoni jekiseni rekupora kwemarwadzo mukati menguva pfupi. Nekudaro, kana varwere vachishuvira vanogona kushandisa mishonga yekurapa yezvavanosarudza neacupuncture, acupressure, hutano hwekuwedzeredza, uye biofeedback kunyangwe isiri chiratidzo-chakavakirwa. Iko zvakare kune humboo hwekupembedza shandisirwo yemagetsi transvection nerve kukurudzira (Tens) senzira yekurwadziwa yekurwadziwa.

Kana pasina kuvandudzika kwekurwadziwa mushure memwedzi mishoma, kuvhiyiwa kunogona kufungidzirwa uye murwere anofanirwa kusarudzwa zvine hungwaru kuitira mhinduro yakanyanya kunaka.

Kuvhiya Therapy

Chinangwa chechirongwa chekuvhiya ndechekudzikisa midzi yemitsipa uye kudzoreredza kusagadzikana. Kune anoverengeka maratidziro echiropractic kurapwa anova anotevera.

Mhedzisiro zviratidzo zvinosanganisira cauda equina syndrome kana yakakosha paresis. Zvimwe zviratidzo zvehukama zvinosanganisira kushomeka kwemotokari iyo yakakura kupfuura giredhi 3, sciatica iyo isiri kupindura inokwana mwedzi mitanhatu yekurapwa kwekuchengetedza, sciatica kweanopfuura mavhiki matanhatu, kana nerve midzi kurwadza nekuda kwe foraminal bone stenosis.

Pakave nekurukurirano dzakawanda mumakore mashoma apfuura pamusoro penzira yekurapa herniation ye discvertebral disc chirwere nekurapa kwenguva refu kwekuchengetedza kana yekutanga kurapwa. Tsvakiridzo zhinji dzakaitwa maererano nenyaya iyi uye vazhinji vacho vanoratidza kuti mhedzisiro yekupedzisira yekiriniki mushure memakore maviri yakafanana kunyangwe kupora kuchikurumidza nekuvhiyiwa kwekutanga. Naizvozvo, zvinokurudzirwa kuti kuvhiyiwa kwekutanga kuve kwakakodzera sezvo kuchigonesa murwere kuti adzokere kubasa nekukasira saka zvinoita zvehupfumi.

Vamwe vanachiremba vangangoshandisa tsika dzechinyakare discectomy kunyangwe vazhinji vari kushandisa mashoma invasive nzira dzekuvhiya mumakore achangopfuura. Microdiscectomy inoonekwa sepakati pakati pemigumo miviri. Pane nzira mbiri dzekuvhiya dziri kushandiswa. Minimally invasive kuvhiyiwa uye percutaneous maitiro ndiwo ari kushandiswa nekuda kwekunaka kwavo. Hapana nzvimbo yekuvhiya yechinyakare inozivikanwa selaminectomy.

Nekudaro, pane zvimwe zvidzidzo zvinoratidza kuti microdiscectomy inonyanya kufarirwa nekuda kwezvakanaka zvenguva pfupi uye zvenguva refu. Munguva pfupi, pane kureba kwekuvhiyiwa kwakaderedzwa, kuderera kweropa, kusununguka kwezviratidzo, uye kuderera kwehuwandu hwekuoma. Iyi tekinoroji yave ichishanda kunyangwe mushure memakore gumi ekutevera uye saka ndiyo inonyanya kufarirwa maitiro kunyangwe ikozvino. Zvidzidzo zvakaitwa kuenzanisa maitiro ekuita zvishoma uye microdiscectomy zvakaguma nemigumisiro yakasiyana. Vamwe vakakundikana kumisa mutsauko wakakura apo imwe ongororo yekuongorora yakakwanisa kuona kuti microdiscectomy yaive yakanaka.

Mu microdiscectomy, kuchekwa kudiki chete kunoitwa kuchibatsirwa nemaikorosikopu inoshanda uye chikamu che herniated intervertebral disc fragment icho chiri kupinza patsinga chinobviswa nehemilaminectomy. Chimwe chikamu chepfupa chinobviswawo kuti chifambise kupinda kune nerve root uye intervertebral disc. Nguva yekugara muchipatara ishoma nekungogara kwehusiku humwe chete nekutariswa nekuti murwere anogona kuburitswa nekunzwa kudiki uye kurerukirwa kwakakwana kwezviratidzo.

Nekudaro, vamwe varwere vasina kugadzikana vangada kubvumidzwa kwenguva refu uye dzimwe nguva vangangoda fusion uye arthroplasty. Zvinofungidzirwa kuti vanosvika makumi masere - 80% evarwere vari pasi pe microdiscectomy vanopora nekubudirira uye vazhinji vavo vanogona kudzokera kubasa kwavo kwazvinoita mumavhiki matanhatu.

Pane kukurukurirana pamusoro pekubvisa chikamu chikuru chechidimbu che diski uye kuporesa nzvimbo ye disc kana kubvisa chete herniated fragment nekupinda zvishoma kwe intervertebral disc space. Zvidzidzo zvakawanda zvakaratidza kuti kubviswa kwehasha kwezvimedu zvakakura zve disc kunogona kutungamirira kumarwadzo akawanda kupfuura apo kurapa kwekuchengetedza kunoshandiswa ne 28% zvichienderana ne11.5%. Inogona kutungamirira kune degenerative disc chirwere munguva refu. Zvisinei, nekurapa kwekuchengetedza, kune ngozi huru yekudzoka kweanenge 7% mu herniation ye disc. Izvi zvingada kumwe kuvhiyiwa kwakadai seArthrodesis uye arthroplasty kuti iitwe mune ramangwana zvichikonzera kushushikana kukuru uye mutoro wehupfumi.

Mukuvhiyiwa kuduku, chiremba anovhiya anowanzo gadzira diki diki kumashure kuti aise dilators nekuwedzera dhayamita kuti akure mugero kusvika wasvika kune vertebra. Iyi nzira inokonzeresa kushomeka kune tsandanyama pane kana ichionekwa mune yechinyakare microdiscectomy. Chikamu chiduku chete che disc chinobviswa kuitira kuti chibudise midzi yetsinga uye intervertebral disc. Ipapo chiremba anovhiya anogona kubvisa herniated disc nekushandisa endoscope kana microscope.

Aya maitiro ekuvhiya ane zvishoma ane mukana wepamusoro wehutachiona hwepanzvimbo yekuvhiya uye kugara muchipatara kwenguva pfupi. Iyo disc inoderedzwa pakati pemakemikari kana enzymatically nekushandiswa kwechymopapain, laser, kana plasma (ionized gas) ablation uye vaporization. Inogona zvakare kuderedzwa nemakanika nekushandisa percutaneous lateral decompression kana nekushuvira nekuyamwa neshaver senge nucleosome. Chemopapin yakaratidzwa kuva nemigumisiro yakaipa uye pakupedzisira yakabviswa. Mazhinji emaitiro ari pamusoro aratidza kusashanda pane placebo. Directed segmentectomy ndiyo yakaratidza chimwe chivimbiso mukushanda senge microdiscectomy.

Mune cervical spine, iyo herniated intervertebral discs inobatwa kunze. Izvi zvinodaro nekuti herniation inoitika anteriorly uye iko kunyengera kwechikosoro chechikadzi hakubvumirwe nemurwere. Iyo disc herniation iyo inokonzeresa foraminal stenosis uye yakangosungirirwa foramen ndiyo chete zviitiko apo nzira yekumashure inofungidzirwa.

Iyo diki disc discision ndiyo imwe nzira kune iyo anterior cervical spine nzira. Nekudaro, iyo intervertebral disc yakagadzikana mushure mekemaji inotsamira pane yakasara disc. Iko kurwadziwa kwemutsipa kunogona kuderedzwa zvakanyanya ichitevera maitiro nekuda kwekubviswa kweanoronal compression kunyangwe kukanganisika kwakakosha kunogona kuitika nemanosara axial mutsipa kurwadziwa. Kumwe kupindira kwecervical disc herniation kunosanganisira anterior cervical interbody fusion. Inonyanya kukodzera kune varwere vane yakanyanya myelopathy ine degenerative disc chirwere.

Matambudziko Ekuvhiya

Kunyangwe njodzi yekuvhiyiwa iri shoma kwazvo, matambudziko anogona kuramba achiitika. Utachiona hwepashure pendangariro nderimwe hwezvinetso zvakanyanya uye nekudaro zvinoda mashandiro ekutapukira ekutapurirana hutachiona munzvimbo yemitambo uye muwadi. Munguva yekuvhiya, nekuda kwekusagadzikana nzira yekuvhiya, nerve kukuvara kunogona kuitika. Kusvetuka kwemukati kunogona kuitika kana kuvhurika mukati mekudzika kwemukati mutsipa kukonzera kuvuza kwecholebrospinal fluid iyo iri kugeza midzi yenzou. Iyo nheyo inogona kugadziriswa panguva yekuvhiya. Nekudaro, kutemwa nemusoro kunogona kuitika nekuda kwekushomeka kweCypbrospinal fluid asi kazhinji inovandudza nenguva pasina kukuvara kwakasara. Kana ropa rakakomberedza nemidzi yenzara mushure mekuvhiyiwa, ropa riya rinogona kutungamira kusvika pakamanikidzwa kweiyo nerve midzi inotungamira kumaricularular pain yaive ichionekwa nemurwere pakutanga. Kudzokorodza herniation yeiyo intervertebral disc nekuda kwekunetswa kwechinhu che disc mune imwechete saiti chinhu chinokuvadza chinogona kuitika kwenguva refu. Izvi zvinogona kurapwa zvichengetedzwe asi kuvhiyiwa kungave kuri madikanwa pakupedzisira.

Zvabudamo zveSurgery

Pave nekutsvaga kwakawanda kwakaitwa pamusoro pemhedzisiro yekuvhiyiwa kwe lumbar disc herniation. Kazhinji, mhedzisiro kubva kumacrodiscectomy kuvhiyiwa kwakanaka. Kune huwandu hwekuvandudzwa kwekurwadziwa kwemakumbo pane kurwadziwa shure uye saka kuvhiyiwa uku hakukurudzirwe kune avo vanongova nemarwadzo ekumusana. Varwere vazhinji vanovandudza kiriniki pamusoro pesvondo rekutanga asi vanokwanisa kuvandudza mumwedzi inoverengeka inotevera. Kazhinji, kurwadziwa kunonyangarika munguva yekutanga kupora uye kunoteverwa nekuvandudzwa musimba regumbo. Pakupedzisira, kugadzirisa kwekunzwa kunoitika. Nekudaro, varwere vanogona kunyunyuta nekunzwa kunzwa kusakwana kunyangwe pasina kurwadziwa. Izvo zvinoitwa uye basa rinogona kutangwazve mumavhiki mashoma mushure mekuvhiyiwa.

Kurapa Novel

Kunyangwe kuchengetedza kurapwa ndiyo nzira yakakodzera yekurapa pakurapa varwere, chiyero chezvino chekutarisira hachigadzirise pasi peiyo pathology ye herniation yeiyo intervertebral discs. Kune nzira dzakasiyana siyana dzinobatanidzwa pathogenesis dzakadai sekuputika, immune-mediated, uye proteinolytic nzira.

Basa revamiririri vekuputa parizvino riri pasi pekutsvaga uye zvakatungamira mukuvandudzwa kwemishonga mitsva inotungamirwa kune ava vamiririri vanopisa zvichikanganisa midzi yemitsipa. Iwo ma cytokines akadai seTNF? vari kunyanya kubatanidzwa mukugadzirisa maitiro aya. Iko kunzwisisika kwekutambudzika kunopindirana neserotonin receptor vanopikisa uye? 2 adrenergic receptor vanopikisa.

Naizvozvo, marapirwo emishonga anonangana neaya mareceptor nevayananisi anogona kukanganisa maitiro echirwere uye kutungamirira mukudzikira kwezviratidzo. Parizvino, cytokine vanopikisa TNF? uye IL1? vakaedzwa. Neuronal receptor blockers senge sarpogrelate hydrochloride nezvimwe zvakaedzwa mumhando dzose dzemhuka uye mune zvidzidzo zvekiriniki zvekurapa sciatica. Cell cycle modifiers inotarisa microglia iyo inofungidzirwa kuti itange iyo inoputika cascade yakaedzwa neurouroprotective antibiotic minocycline.

Kune zvakare kutsvagisisa nezvekudzivirira iyo NF- kB kana protein kinase nzira munguva pfupi yapfuura. Mune ramangwana, kurapwa kwe herniation yeiyo intervertebral disc ichave yakanyanya kuvandudzwa nekuda kwekutsvaga kuchiri kuenderera. (Haro, Hirotaka)

Dr Alex Jimenez DC, MSACP, RN, CCST

A disc bulge uye / kana herniated disc inyaya yehutano iyo inokanganisa iyo intervertebral discs inowanikwa pakati pega yega vertebra yemuzongoza. Kunyangwe izvi zvichigona kuitika sechinhu chechisikigo chekusaora nezera, kushungurudzika kana kukuvara pamwe nekudzokorora kunyanyisa kushandisa zvinogona kukonzeresa disc bulge kana herniated disc. Maererano nenyanzvi dzezvehutano, disc bulge uye / kana herniated disc ndiyo imwe yenyaya nyaya dzehutano dzinokanganisa musana. I-disc bulge ndipo apo iyo michero yekunze yean annusus fibrosus inobviswa kubva kumabibi emitezo ye vertebral yemukati. A herniated disc ndipo apo chikamu che kana iyo yakazara nucleus pulposus inoratidzwa kuburikidza rakabvaruka kana risina kusimba rekunze annulus fibrosus yeiyo intervertebral disc. Kurapa kweaya ehutano nyaya kunotarisana nekudzikisa zviratidzo. Dzimwe nzira dzekurapa dzakasarudzika, senge chiropractic kutarisirwa uye / kana kurapwa kwemuviri, zvinogona kubatsira kudzikisa zviratidzo. Kuvhiya kunogona kushandiswa muzviratidzo zvezviratidzo zvakakomba. - Dr. Alex Jimenez DC, CCST Insight

Yakanyorwa naDr. Alex Jimenez DC, CCST

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