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Clinical Case Series

Back Clinical Case Series. A Clinical case series Ndiyo inonyanya kukosha yemhando yekudzidza, umo vatsvakurudzi vanotsanangura ruzivo rweboka revanhu. Nyaya dzakatevedzana dzinotsanangura vanhu vanogadzira chimwe chirwere chitsva kana mamiriro. Rudzi urwu rwekudzidza runogona kupa kuverenga kunomanikidza nekuti vanopa nhoroondo yakadzama yeruzivo rwekiriniki rwezvidzidzo zvega zvega. Dr. Alex Jimenez anoita nyaya yake yezvidzidzo zvidzidzo.

Chidzidzo chenyaya inzira yekutsvagisa inowanzoshandiswa musainzi yemagariro. Iri izano rekutsvaga rinoongorora chiitiko mukati memamiriro chaiwo. Dzinobva pakuferefeta kwakadzama kwemunhu mumwechete, boka, kana chiitiko chekuongorora kuti sei matambudziko/zvikonzero. Inosanganisira humbowo hwehuwandu uye inotsamira pane akawanda masosi ehumbowo.

Zvidzidzo zvenyaya irekodhi yakakosha yemakiriniki maitiro ebasa. Havapi hutungamiriri hwehutungamiri hwevarwere vanotevedzana asi irekodhi yekudyidzana kwekiriniki iyo inobatsira kugadzira mibvunzo yezvidzidzo zvekiriniki zvakagadziridzwa. Vanopa zvinhu zvakakosha zvekudzidzisa, izvo zvinoratidza zvese zvechinyakare uye zvisina kujairika ruzivo runogona kutarisana nemudzidzi. Nekudaro, kuwanda kwekudyidzana kwekiriniki kunoitika mumunda uye saka zviri kumurapi kunyora uye kupfuudza ruzivo. Nhungamiro dzakagadzirirwa kubatsira hama yemunyori, nyanzvi, kana mudzidzi kuti afambise chidzidzo ichi kusvika pakuburitswa.

A Case series idhizaini yekudzidza inotsanangura uye ingori nhevedzano yezviitiko zvechero chirwere kana kusawirirana kwechirwere izvo munhu angango cherechedza mukuita kwekiriniki. Mhosva idzi dzinotsanangurwa kuti dzinokurudzira zvakanyanya hypothesis. Zvisinei, hapana boka rekuenzanisa saka hapagoni kuva nemhedziso dzakawanda pamusoro pechirwere kana chirwere chechirwere. Naizvozvo, maererano nekugadzira humbowo hunoenderana neakasiyana maitiro echirwere, ichi chinenge chiri chekutanga. Kuti uwane mhinduro kumibvunzo ipi yaungave unayo ndapota fonera Dr. Jimenez pa915-850-0900

Vertebral Arteri Dissection Yakawanikwa MuChiropractic Examination

by Dr Alex Jimenez | Chiropractic, Clinical Case Reports, Clinical Case Series, Functional Medicine

Kubvuma inotevera ruzivo pazasi, vanhu vanopfuura mamiriyoni eE2 vanokuvadzwa mumatambudziko emotokari gore negore uye pakati pezviitiko izvi, vazhinji vevanhu vanobatanidzwa vanoonekwa kuti vane whiplash uye / kana kukuvadzwa kwemutsipa nenyanzvi yehutano. Apo hutano hwakaoma hwemutsipa hunosangana nekushungurudzika, kukanganisa kwenyama uye zvimwe zvinetso zvezvehutano zvinogona kuitika. Vertebral artery dissection, kana VAD, inoratidzirwa nemapuranga-akafanana nemakumbo mukati memucheka wemukati weertebral artery inotarisira kupa ropa kuuropi. Mushure mekuchema, ropa rinokwanisa kupinda murusvingo rwekugadzirisa uye ropa ropa rinoputika, rinowedzera rusvingo rwemaseri uye rinowanzoita kuti ropa riyerere.

Kuburikidza nemakore echiitiko achishandisa chiropractic kuchengetedza, VAD inogona kazhinji kutevera mushure mekutambudzika kumutsipa, senge izvo zvinoitika mutsaona yemotokari, kana whiplash kukuvara. Zviratidzo zvetebralral arteri dissection inosanganisira kurwadziwa kwemusoro nemutsipa pamwe neanopindirana kana anogara aripo zviratidzo zvekurohwa, sekuoma kutaura, kutadza kufambidzana uye kurasikirwa kwemaonero. VAD, kana vertebral artery dissection, inowanzoonekwa iine musiyano-inowedzerwa CT kana MRI scan.

ngovepo

Mukadzi ane makore makumi matatu-makumi matatu akaburitswa kune dhipatimendi rekukurumidzira nekutanga kamwe kamwe kwekurasikirwa kwenguva pfupi kwekuruboshwe kwemashure ekuona. Nekuda kwenhoroondo yemusoro wemusoro, akasunungurwa aine chirwere cheocular migraine. Mazuva maviri gare gare, akatsvaga chiropractic kuchengetwa kwechiratidzo chikuru chekurwadziwa kwakanyanya kwemutsipa. Iyo chiropractor yaifungidzira mukana we vertebral artery dissection (VAD). Hapana kubiridzira kwakaitwa; pachinzvimbo, MR angiography (MRA) yemutsipa yakawanikwa, iyo yakaratidza yakanyanya kuruboshwe VAD nekutanga thrombus kuumbwa. Murwere akaiswa pamushonga weaspirin. Dzokorora MRA yemutsipa 30? Mwedzi yakazotevera yakaratidza resolution yeiyo thrombus, pasina kufambira mberi kwekurohwa. Iyi kesi inoratidza kukosha kune vese vanopa hutano vanoona varwere vane kurwadziwa kwemutsipa uye nemusoro kuti vateerere kuchiratidzo chechiratidzo cheVAD inogona kuitika.

kumashure

Vertebral artery dissection (VAD) inotungamira kune sitiroko isingawanzo asi chirwere chinogona kunge chakakomba. Iko kuitika kwesitiroko kwakabatana neiyo vertebrobasilar system inosiyana kubva pa0.75 kusvika 1.12 / 100? 000 munhu-makore. Maitiro ekurwara muVAD anowanzo sanganisira kupatsanurwa kwemadziro etsinga inoteverwa imwe nguva gare gare nekuumbwa kwetrombus, izvo zvinogona kukonzeresa kuvhara kana kutungamira mukuzadzikiswa, zvichikonzera kuvharwa kweimwe kana akawanda ematavi ari kure kubva parevertral artery, kusanganisira basilar arteri, inogona kuva nenjodzi. VAD inowanzoitika kune varwere vane hunhu, hushoma hushoma mune arterial madziro. Mune angangoita makumi masere muzana ezviitiko, ekutanga zviratidzo zvinosanganisira kurwadziwa kwemutsipa kana kana pasina musoro.

Varwere vakawanda vane VAD vangave mumatanho ekutanga vanopa chiropractors vachitsvaka rubatsiro kubva mukurwadziwa kweutsipa uye kuora musoro, vasingazivi kuti vari kutarisana neVAD. Muzvizhinji zvezviitiko izvi, murwere anotevera chirwere. Kusvikira munguva pfupi yapfuura, zvaifungidzirwa kuti kuputika (uye kusangana kwakagadzikana) kwakakonzerwa nekervical manipulative therapy (CMT). Zvisinei, apo zvidzidzo zvepakutanga zvakawana kushamwaridzana pakati pekushanyira chiropractor uye chirwere chinotevera chakakonzerwa neVAD, data yapfuura inoratidza kuti ukama uhwu hahuna kukonzera.

Nyaya iyi yenyaya inomiririra mamiriro ezvinhu umo murwere ane VAD asingazivikanwi mukushanduka-shanduka akabvunza chiropractor yemarwadzo emutsipa uye musoro. Mushure mokunge nhoroondo yakazara uye kuongororwa, chiropractor yakambofungidzirwa VAD uye haina kuita CMT. Pane kudaro, murwere akaendeswa kune imwe nzvimbo yekuongorora, izvo zvakaona kuti VAD iri kufambira mberi. Kuongororwa nokukurumidza uye anticoagulant kurapwa kwaifungidzirwa kuti yakadzivisa kufambira mberi kune chirwere.

Case Presentation

Mumwe ane makore makumi matatu-ane makore ane hutano mukadzi akabvunza chiropractor (DBF), achitaura nezve kurudyi-sided kurwadziwa kwemutsipa mudunhu re suboccipital. Murwere akataura kuti, 30? Mazuva apfuura, anga aenda kuchipatara chemunharaunda chipatara dhipatimendi (ED) nekuda kwekuerekana kwaitika kurasikirwa kwekuruboshwe kwemashure ekuona. Zviratidzo zvinoonekwa zvakakanganisa kugona kwake kuona kuburikidza neziso rake reruboshwe; izvi zvaiperekedzwa ne numbness muziso reruboshwe. Anenge mavhiki maviri? Pamberi pekushanya kweEED, akange aona chiitiko chemarwadzo emutsipa akasara-kuruboshwe nemusoro wakakombama kuruboshwe. Akarondedzerawo nhoroondo yemigraine musoro isina prodrome. Akaburitswa kubva kuED pamwe nehutachiona hwekuongorora ocular migraine. Akanga asati amboonekwa kuti ane ocular migraine, uye aive asati amboona mhirizhonga yekuona pamwe neyekare migraines.

Nguva pfupi mushure mekuruboshwe-kwese maziso maziso akagadziriswa, akangoerekana atanga kurudyi-sided marwadzo emutsipa pasina kutsamwa, kwaakatsvaga kurapwa kwechiropractic. Akashumawo chikamu chenguva pfupi yekukanganisa-kwakatarisana nekukanganisa kunoitika nezuva rimwe chetero zvakare. Izvi zvakatsanangurwa sekukanganiswa kamwe kamwe kwakange kuri kwenguva pfupi uye kwakagadziriswa nekukasira pakutanga kwezuva rehurukuro yake yechiropractic kuongorora. Paakapa bvunzo yechiropractic yekutanga, akaramba kusagadzikana kwekuona kwazvino. Akataura kuti anga asiri kuwana chiveve, paraesthesia kana kurasikirwa nemota munzvimbo dzepamusoro kana dzepasi. Akaramba ataxia kana kunetseka nebhalansi. Nhoroondo yezvechiremba yaishamisa pakuzvara kwemwedzi 2 pamberi pekutanga kuratidzwa. Akataura kuti kurwadziwa kwake kwemusoro kwakabatana nekuenda kwake kumwedzi. Nhoroondo yemhuri yaive yakashamisa nekukwira nekukasira kunokwira thoracic aortic aneurysm mune hanzvadzi yake yechikuru, angave angave makumi matatu? Makore ekuberekwa apo aneurysm yake yaitika.

kuferefeta

Kubva pane nhoroondo yekuerekana kwoitika kwekutambudzika kwepamusoro kwechibereko uye kurwadziwa nemusoro nekukanganiswa kwekuona uye ocular chiveve, iyo DC yaive neshungu nezve mukana wekutanga VAD. Inokurumidza MR angiography (MRA) yemutsipa nemusoro, pamwe neMRI yemusoro, yakarairwa. Hapana chepervical spine kuongorora kana kumanikidza kwakaitwa nekuda kwekufungidzira kuti kurwadziwa kwemutsipa kwakabatana neVAD pane kuita mechanical remuromo chirwere.

MRA yemutsipa yakaratidza kuti arteri vertebral artery yaive diki uye isina kujairika mune caliber, ichibuda kubva paC7 level cephalad kuenda kuC2, inoenderana ne dissection. Paive nechiratidziro lumen yechokwadi ine cuff yakapoteredzwa yeT1 hyper-intensity, inoenderana nekisipiti ine subintimal thrombus mukati meye nhema lumen (Mifananidzo 1 uye? 2). MRI yemusoro pamwe uye pasina musiyano, uye MRA yemusoro pasina musiyano, zvese zviri zviviri hazvishamise. Kunyanya, pakanga pasina kuwedzera kwekusagadzikana kwekusatsemura kana humbowo hwe infarction. MR perfusion yehuropi yakaratidza kwete yakakosha perfusion kusagadzikana.

Mufananidzo 1 Axial Proton Density Image - Image 1

Mufananidzo 1: Axial proton density chimiro chinoratidza kukanganisa kwe-hyper-intensity yakakomberedza mutsara wekervical vertebral artery (inomirira nhema lumen). Nhepfenyuro yakaderera zvinyorwa zvechokwadi lumen (kusvibiswa kwerima pasina) nekuremekedza kodzero yakarurama yemasiti.

Mufananidzo 2 Axial Image kubva paTatu Dhigirii Time yeFree MRA - Mufananidzo 2

Mufananidzo 2: Axial image kubva ku-tatu-dimensional time-of-flight MRA inoratidza T1 hypointense dissection flap inoparadzanisa chokwadi chenyu (lateral) kubva kune nhema nhema (mukati). MRA, MR angiography.

Kusiyanisa Kuziva

Iyo ED yakaburitsa murwere nehutachiona hwekuongorora ocular migraine, nekuda kwenhoroondo yake yemigraine misoro. Nekudaro, murwere akataura kuti musoro wekuruboshwe-kuruboshwe waive senge chinhu chandisina kumbobvira ndamboona. ake epamberi migraines aibatanidzwa nekuenda kwake kumwedzi, asi kwete nechero chiratidzo chinoshanduka. Akanga asati amboonekwa aine ocular migraine. MRA yedunhu remuromo wechibereko yakaratidza kuti murwere aive nechirwere chakakomba pamwe nekuumbwa kwetrombus muruboshwe rwevertebral arteri.

mabatiro

Nekuda kwekugona kwekurohwa kwakabatana kwakabatana neAVAD yakaoma ine thrombus fomati, murwere akagamuchirwa kuurourology sitiroko sevhisi yekuvharisisa kwepfungwa. Panguva yekubvumidzwa kwake, murwere haana kuona kudzokoroka kwekushomeka kwemitsipa uye nemusoro wake wakavandudzwa. Akaburitswa zuva raitevera aine hutachiona hweVAD yekuruboshwe uye yekupedzisira ischemic kurwisa. Akarairwa kuti adzivise kurovedza muviri zvine simba uye kushungurudzika kumutsipa. Daily aspirin (325? Mg) yakatemwa, kuti ienderere mberi kwemwedzi mitatu nehafu mushure mekubuda.

Mhedzisiro nekutevera

Mushure mekuburitswa kubva pakurohwa nesitiroko, murwere haana kudzokazve kwemusoro kana kusagadzikana kwekuona, uye ake ekupedzisira kurwadziwa kwemutsipa zviratidzo zvakagadziriswa. Kudzokorora kufungidzira kwakaitwa 3? Mwedzi mushure mekuratidzwa, iyo yakaratidza yakavandudzwa caliber yemuromo wechibereko yakasiya vertebral arteri nekugadziriswa kweiyo thrombus mukati memanyepo lumen (Mufananidzo 3). Kufungidzira kwekamuri risingabvumirwe kwakaramba kwakajairika, pasina humbowo hwekupindirana kwepakati kana perfusion asymmetry.

Mufananidzo 3 Maximum Maximum Projection MIP Images - Image 3

Mufananidzo 3: Maximum intensist projection (MIP) mifananidzo kubva ku-matatu-dimensional time-of-flight flight MRA (mufananidzo uri kuruboshwe uri panguva yekuratidzwa uye mufananidzo wakarurama uri pa 3-mwedzi kutevera). Mifananidzo yekutanga inoratidzira zvakajeka zvishoma nezvishoma zvezverinbral artery

hurukuro

Iyo pathophysiological maitiro eVAD inofungidzirwa kuti inotanga nekudzikira kwemasuru pamuganhu wepakati-wekutanga weiyo vertebral artery, zvichitungamira mukuvandudzwa kwe microhaematomata mukati memadziro eteri uye, pakupedzisira, arterial misodzi. Izvi zvinogona kutungamira mukudonha kweropa mukati memadziro emadziro, zvichikonzera kuvharika kwechiedza pamwe neanotevera thrombus kuumbwa uye kuisirwa, zvichikonzera kurohwa kwakabatana nerimwe rematavi eterterral arteri. Maitiro ehurwere akafanana neayo eakaerekana carotid arteri dissection, inongoitika yega thoracic aortic dissection uye yakasarudzika coronary artery dissection. Aya ese mamiriro ezvinhu anowanzoitika kune vechidiki vakuru uye vamwe vakafungidzira kuti vanogona kuve chikamu cheyakajairika nhaka nhaka pathophysiological maitiro. Chinozivikanwa mune iyi kesi ndechekuti hanzvadzi yakura yemurwere yakanga yawana chakangoerekana chaitika thoracic aortic aneurysm (pamwe dissection) pazera rakaenzana (30? Makore) semurwere uyu paakaona VAD yake.

Kunyange zvazvo kupesana kwacho kuchiwanzoitika kamwe-kamwe, kukanganisa kwechiedza uye zvinetso zveVAD zvinogona kukura zvishoma nezvishoma zvichiita kuti zviratidzo zvakasiyana-siyana uye mharidzo zvivepo, zvichienderana nechikamu chechirwere chacho. Kuputika kwega, iyo inotanga nguva isati yasvika yekutanga kweyeurusiya ischaemia, inogona kukonzera kukurudzira kwema-nociceptive receptors mukati meyeri, zvichiita marwadzo anowanzoonekwa mukati memusoro wepervical spine kana musoro. Kana mushure mokunge chirwere chepathophysiology chinopfuurira kusvika pakuguma kwemasimba ekupedzisira masikati kana kuti thrombus kugadzirwa nekutenderera kwekudzivirira kunoita zviratidzo zvakakwana zveparction inoitika. Zvisinei, sezvinoratidzwa munyaya ino, zviratidzo zvehutano zvinogona kukurumidza kutanga, kunyanya mumamiriro ezvinhu umo lumeni yechokwadi inoratidza hukuru hwechipiri huchiderera kuchipiri kune kuwedzera.

Pane zvinoverengeka zvinonakidza zvinhu kune iyi kesi. Kutanga, inosimbisa kukosha kwevarapi vemuzongoza vachichenjerera mukana wekuti izvo zvingaratidzika kunge zviripo mechanical kurwadziwa kwemutsipa kungave chinhu chingangoita chinotyisa, senge VAD. Iko kungoerekana kwaitika kwekutambudzika kwakanyanya kwecoccipital, uine kana usina musoro, uye kuperekedza brainstem inoenderana nezviratidzo zvetsinga, inofanirwa kuzivisa chiremba nezve mukana weVAD. Sezvazviri mune zvakataurwa pano, varwere vane nhoroondo yemigraine vanowanzo tsanangura musoro sewakasiyana neyakajairwa migraine. Kunyatso kuongororwa kweurourological kunofanirwa kuitiswa, kutsvaga zvingangoita zvisina tsarukano zvetsinga, kunyangwe kuongororwa kwetsinga kunowanzo kuve kwakashata mumatanho ekutanga eVAD.

Chechipiri, chitatu chezviratidzo zvakasimudza kufunganya kuti murwere angave ari kutarisana neVAD iri mberi. Chiratidzo che triad chaisanganisira: (1) inotanga kusangana nematambudziko makuru ekurwadziwa kwekervical pain; (2) musoro wakanyanya musoro wakanga wakasiyana zvakasiyana nemukati wemagaraine musoro; uye (3) uropi-hunobata zviratidzo zvehutano hwepfungwa (nenzira yechinguva chekuvhiringidzika kwekuona). Zvinonzwisisika, kuongororwa kweutano hwepfungwa kwakanga kusina kunaka. Kunyange zvakadaro, nhoroondo yacho yakakosha zvakakwana kukurudzira kunyatsoongorora.

Apo VAD inenge ichifungidzirwa asi hapana zviratidzo zvisinganzwisisiki zvekurohwa zviripo, pakarepo vascular imaging inoratidzwa. Kunyange zvazvo zvakanakisisa kufungidzira kuongorora kweVAD kuchiri kukakavadzana, MRA kana CTA ndiyo dzidzo yekuongororwa yekusarudzwa yakapiwa yakanakisisa anatomic delineation uye kukwanisa kuongororwa nokuda kwezvinetso (kusanganisira infarction uye kuchinja muhutano kukanganisa). Vamwe vanotsigira kushandiswa kweDoppler ultrasound; zvisinei, iyo inoshandiswa zvishoma iyo yakapiwa muitiro wezvinyorwa zvechimiro mumutsipa uye zvishoma nezvishoma kuongororwa kwe vertebral arteri cephalad kune yakabva. Uyezve, imaging ultrasound haigoni kubvumira kuratidzwa kwekuparadzana kwayo uye naizvozvo inogona kuva isina kunaka mukusavapo kwekukosha kwekuita masikati.

Chechitatu, iyi nyaya inonakidza tichifunga nezvekupokana pamusoro pekubatira kwechibereko sechinhu chinokonzeresa cheVAD. Nepo nyaya dzenyaya dzakapa varwere vakawana sitiroko ine hukama neVAD mushure mekunyorwa kwechibereko, uye zvidzidzo zvecontontrol zvakawana musangano wehuwandu pakati pekushanya kuchiropractors uye sitiroko ine hukama neVAD, kumwe kuferefeta kwakaratidza kuti musangano hausi wekukonzeresa. Cassidy et al akawana kuti murwere anowana sitiroko ine hukama neVAD angangove akashanyira chiremba wekutanga sekushanyira chiropractor asati abatwa nesitiroko. Vanyori vakaratidza kuti ingangodaro tsananguro yesangano rekuverengera pakati pekushanyira chiropractors uye inotevera VAD ndeyekuti murwere anowana zviratidzo zvekutanga zveVAD (kurwadziwa kwemutsipa pamwe kana asina musoro) anotsvaga kurapwa kwezviratidzo izvi (kubva kuchiropractor, primary muchengeti, kana imwe mhando yechiremba), zvobva zvasangana nesitiroko, yakazvimiririra pane chero chiito chinotorwa nachiremba.

Izvo zvakakosha kuti uzive kuti, nepo paine zvataurwa zviitiko zvecarotid artery dissection mushure mekunyorwa kwechibereki, zvidzidzo zvecontontrol hazvina kuwana musangano uyu. Zviratidzo zvekutanga zvecarotid dissection (zviratidzo zvetsinga, nemutsipa uye kurwadziwa kwemusoro kushoma pane VAD), aortic dissection (kutanga kamwe kwekutambudzika kwakanyanya, kurumuka) uye coronary artery dissection (kurwadziwa kwakanyanya kwepfupa, ventricular fibrillation) zvinogona kukonzera kuti munhu wacho akurumidze kutsvaga rubatsiro rweEED, pane kutsvaga chiropractic kuchengetedza. Zvisinei, VAD inoratidzika kunge inotyisa zviratidzo zvekutanga marwadzo emutsipa uye kurwadziwa kwemusoro- izvo zviri zviratidzo zvinowanzo kukonzera varwere kutsvaga kurapwa kwechiropractic. Izvi zvinogona kutsanangura kuti sei VAD chete inosanganisirwa nekushanya kuchiropractors, nepo aya mamwe marudzi edziviriro asiri; varwere vane iyi mimwe mamiriro, ayo ane akawanda anotyisa zviratidzo, haangounze kune chiropractors.

Iyi kesi muenzaniso wakanaka wemurwere ane VAD iri kuenderera mberi ichiratidza kune chiropractor nechinangwa chekutsvaga zororo kubva pakurwadziwa kwemutsipa. Neraki, iyo chiropractor yaive nehungwaru zvakakwana kuti ione kuti zviratidzo zvevarwere zvaive zvisina kuratidza mechanical remuromo musana chirwere, uye kwakakodzera kuongororwa kuongororwa kwakaitwa. Zvisinei, dai kumanikidza kwainge kwaitwa, iyo VAD yakanga yatove mberi kubva munhoroondo yezvisikwa ingangodaro yakapihwa mhosva yekubiridzira, mushure mekuonekwa paMRA imaging. Neraki, mune iyi kesi, iyo chiropractor yakakwanisa kubatsira nekukurumidza kuona uye kurapwa, uye zvichizotevera sitiroko ingangodaro yakadziviswa.

Kudzidza Mazano

Mhosva inowanikwa umo murwere akaona chiropractor, achitsvaga kurapwa kwemarwadzo emutsipa, uye nhoroondo yakamutsa kufunganya kwezvinoita kuti munhu ave nemasitori akazvidzivirira (VAD).
Panzvimbo pokupa kurapwa, chiropractor yakataura nezvechirwere chekufungidzira, izvo zvakasimbisa kuonekwa kweVAD.
Nyaya yacho inoratidza kukosha kwekutarisa kwezvinhu zvisingaoneki zvakaitika kare kune varwere vane VAD.
Inoshandawo somuenzaniso wevarwere vane VAD vari kuramba vachitsvaka mabasa echiropractor nokuda kwekutanga zviratidzo zvechirwere.
Muchiitiko ichi, kuonekwa kwokutanga kwekuputika kwakaitika uye murwere aive nekugadzirisa zvakakwana pasina chirwere chinotevera.

Kutenda

Vanyori vangada kubvuma rubatsiro rwaPeter Cote, DC, PhD, kuti abatsirwe nekuongororazve zvinyorwa izvi.

Mashoko Omuzasi

Vabatsiri: Vose vanyori vanobvuma kuti vakapa zvirevo zvinotevera kune kuiswa kwebhuku iri: kubata uye kugadzira, kunyorwa kwezvinyorwa zvemashoko, kutsanangurwa kunotsanangurwa kwemavara, kuongorora mabhuku uye zvinyorwa, uye kuverenga kwehuwandu hwezvinyorwa zvekupedzisira.

Kukwikwidzana: Hapana chakaziviswa.

Kubvumirwa nemwoyo murefu: Akawanikwa.

Provenance uye peer review: Haana kutumirwa; kunze kwezera rekuongorora.

Mashoko anotsanangurwa kubva kuNational Center for Biotechnology Information (NCBI). Kuwanda kweruzivo rwedu kunogumira kune chiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota ivai vakasununguka kubvunza Dr. Jimenez kana kuti tibvunzei kwatiri 915-850-0900 .

Yakataurwa naDkt Alex Jimenez

Zvimwe Zvinyorwa: Wellness

Utano hwakakwana uye hutano hwakakosha pakuchengetedza kukodzera kwakanaka kwepfungwa nemuviri mumuviri. Kubva pakudya kudya kunovaka muviri pamwe nekudzidzira nekuita mabasa epanyama, kurara nguva yakawanda nguva dzose, kutevera hutano hwakanaka uye hutano hwakanaka hunokwanisa kuguma nekubatsira kuchengetedza hupenyu huno. Kudya michero yakawanda uye miriwo zvinogona kufamba nenzira yakareba pakubatsira vanhu kuva noutano hwakanaka.

blog chinyorwa chekartoon paperboy makuru makuru

NHAURWA INOKOSHA: KUDZIDZISA KWENYAYA: Kurapa Sciatica Pain

Hazvina kuchena

References

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8. Rothwell DM, Bondy SJ, Williams JI. Chiropractic manipulation uye stroke: vanhu-based case-control study.Kurohwa2001;32: 1054-60. doi: 10.1161 / 01.STR.32.5.1054 [PubMed]

9. Smith WS, Johnston SC, Skalabrin EJ et al. Chirwere chepineti manipulative itachiona chega chinokonzerwa neuttebral artery dissection.Neurology2003;60: 1424-8. doi: 10.1212 / 01.WNL.0000063305.61050.E6[PubMed]

10. Volker W, Besselmann M, Dittrich R et al. Arteriopathy inowanikwa muzvirwere mune varwere vane kervical artery dissection.Neurology2005;64: 1508-13. doi: 10.1212 / 01.WNL.0000159739.24607.98 [PubMed]

11. Evangelista A, Mukherjee D, Mehta RH et alYakanyanya intramural hematoma ye aorta: chakavanzika mukushanduka-shanduka.Circulation2005;111: 1063-70. doi: 10.1161 / 01.CIR.0000156444.26393.80 [PubMed]

12. Tweet MS, Hayes SN, Pitta SR et al. Zviratidzo zvemupiro, kutungamira, uye kufungidzira kwechirwere chekodonary chinopesana.Circulation2012;126: 579-88. doi: 10.1161 / CIRCULATIONAHA.112.105718[PubMed]

13. Choi S, Boyle E, Cote P et al. A-based case-series of Ontario varwere vanovaka vertebrobasilar artery stroke mushure mekuona chiropractor.J Manipulative Physiol Ther2011;34: 15-22. doi: 10.1016 / j.jmpt.2010.11.001 [PubMed]

14. Naggara O, Louillet F, Touze E et alYakawedzerwa kukosha kwepamusoro-resolution MR imaging mukutaridzika kwetterbral artery dissection.AJNR Am J Neuroradiol2010;31: 1707-12. doi: 10.3174 / ajnr.A2165 [PubMed]

15. Haynes MJ, Vincent K, Fischhoff C et alKuongorora njodzi yekurohwa kubva pamutsipa kushandiswa: kurongeka kwakarongeka.Int J Clin Pract2012;66: 940-7. doi: 10.1111 / j.1742-1241.2012.03004.x[PMC free article] [PubMed]

16. Nebelsieck J, Sengelhoff C, Nassenstein I et alKunzwisisa kwehutano hwehutachiona hwehutachiona hwehutachiona hwekutsvaga kwechirwere chepervical dissection.J Clin Neurosci2009;16: 79-82. doi: 10.1016 / j.jocn.2008.04.005 [PubMed]

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18. Murphy DR. Nzwisiso yezvino yehukama pakati pekudzivirira kwechibereki nekurohwa: zvinorevei kune chiropractic basa? Chiropr Osteopat2010;18: 22 doi:10.1186/1746-1340-18-22[PMC free article] [PubMed]

19. Engelter ST, Grond-Ginsbach C, Metso TM et al. Cervical artery dissection: trauma uye zvimwe zvinogona kugadzirisa zviitiko zvinokonzera.Neurology2013;80: 1950-7. doi:10.1212/WNL.0b013e318293e2eb [PubMed]

20. Peters M, Bohl J, Th mke F et al. Kugadziriswa kwemukati karotid arteri mushure mekugadzirwa kwechiropractic yemutsipa.Neurology1995;45: 2284-6. doi: 10.1212 / WNL.45.12.2284 [PubMed]

21. Nadgir RN, Loevner LA, Ahmed T et alPamwechete maitiro emakatikiti emukati uye vertebral artery dissection inotevera chiropractic manipulation: case report uye kugadziriswa kwemabhuku.Neuroradiology2003;45: 311-14. doi: 10.1007 / s00234-003-0944-x [PubMed]

22. Dittrich R, Rohsbach D, Heidbreder A et alDild mechanical traumas inokonzerwa nengozi dzinokonzerwa nekervical artery dissection.Cerebrovasc Dis2007;23: 275-81. doi: 10.1159 / 000098327 [PubMed]

23. Chung CL, Cote P, Stern P et al. Kushamwaridzana pakati pekudzivirira kwepervical spine manipulation uye carotid arteri dissection: kugadziriswa kwekuongorora mabhuku.J Manipulative Physiol Ther2014; doi: 10.1016 / j.jmpt.2013.09.005 doi: 10.1016 / j.jmpt.2013.09.005 [PubMed]

24. Thomas LC, Rivett DA, Attia JR et al. Zvinokonzera njodzi uye kliniki zvinokonzerwa nekuputika kweganiocervical arterial dissection.Man Ther2011;16: 351-6. doi: 10.1016 / j.math.2010.12.008 [PubMed]

25. Klineberg E, Mazanec D, Orr D et alKuvhara: kurapa kunokonzera marwadzo ekudzokera shure.Cleve Clinic J Med2007;74: 905-13. doi: 10.3949 / ccjm.74.12.905 [PubMed]

Close Accordion

Ndeapi maKesi Nyaya & Nyaya Dzakateedzana?

by Dr Alex Jimenez | Clinical Case Reports, Clinical Case Series, Functional Medicine

Kuongororwa kwezvirwere zvakasiyana-siyana kwakanyatsogadziriswa kuburikidza nehutachiona uye dhigiridzo. Kutsvakurudza kwekutsvakurudza kunopa ruzivo rwakakosha pamusoro pepathogenesis yemamiriro akawanda ezvo uye kazhinji ndiyo inonyanya kukosha kwemashoko pamusoro pezvirwere kana mamiriro matsva. Nyaya dzenyaya uye nyaya dzenyaya dzinotanga kuongorora zvidzidzo zvekutsvakurudza, kupa maonero ekutanga pane imwe nharo yehutano kuburikidza nehupenyu hweumwechete kana vanhu vakawanda vane chirwere kana mamiriro. Nyaya inotevera inotsanangura chinangwa chemhosva uye nyaya dzenyaya, uye kuti dzinopa sei chirongwa chekliniki uye yekuedza.

Zvidzidzo zvekudzidza

1. Nyaya dzemhosva uye nyaya dzakasanangurwa dzinotsanangura zvakaitika kune mumwe kana vanhu vakawanda vane chirwere.
2. Nyaya dzemhosva uye nyaya dzenyaya dzinowanzova yekutanga dheedhi kuratidza chirwere chitsva kana chimiro.
3. Nyaya dzemhosva uye nyaya dzenyaya dzinenge dzisina kukwana:

a. Kusava ne denominator kuverenga kuwanda kwezvirwere
b. Pasina boka rekuenzanisa
c. Kusarudza zvidzidzo zvevanhu
d. Sampling kusiyana

Case Reports uye Case Series

Nyaya dzemhosva uye nyaya dzenyaya dzinomiririra mhando yepamusoro yekunyora kushandiswa, umo vanotsvakurudza vanotsanangura zvakaitika kune mumwe chete (nyaya yemhosva) kana boka revanhu (case series). Kazhinji, nyaya dzenyaya uye nyaya dzenyaya dzinotsanangura vanhu vanokura chirwere chitsva kana chimiro. Nyaya dzemhosva uye nyaya dzenyaya dzinogona kupa zvinokumanikidza kuverenga nokuti vanopa nhoroondo yakazara yehutano hwechipatara hwezvidzidzo zvega. Kusiyana neizvi, zvidzidzo zvinotarisa nhamba huru yevanhu vanowanzopfupisa dhesi vachishandisa zviyero zvinyorwa, zvakadai senzira uye zviyero.

Muenzaniso 3.1. Chiitiko chinyorwa chinotsanangura vechidiki vechidiki vechi15 vanova nekenza yemazamu; 9 yevakadzi ava inoshuma kanenge kamwe chete kwevhiki kwekudya kwezvokudya zvakaiswa neestrogenic chemical bisphenol A (BPA). Urine kuongorora kunosimbisa kuvapo kweBPA pakati pevakadzi vapfumbamwe vechikadzi.

Iko kuedza kutsvaga kubva kune idzi data iyo BPA inogona kuenzaniswa nekenza yepabonde. Zvisinei, nyaya dzenyaya / nyaya dzakakosha dzine zviremera zvakakosha izvo zvinorega kutaurirana kweukama hwechikonzero.

Kutanga, nyaya dzemhosva / nyaya dzenyaya dzisina dhinator data dzinofanirwa kuverenga chiyero chechirwere. Iro denominator inoreva vanhu vanobva pane izvo nyaya dzine chirwere dzakasimuka. Somuenzaniso, kuverenga chiitiko chiyero kana chiitiko chekushaya kenza yepamuviri pakati pevakadzi vakaratidzirwa kuBPA, chiwandu chevakadzi vakatarisana neBPA kana kuti nhamba yevanhu-vari mumatambudziko inodiwa.

Zvirwere zvirwere zvinodiwa kuti zvienzaniswe nehutano hwehutano hwehutano hwehutachiwana, kana nehuwandu hwehutano hweboka rakasarudzwa. Zvinosuruvarisa, kuwana dhiyabhorosi yedhizinesi inodiwa zvingasava nyore. Mumuenzaniso uyu, mamwe magwaro ezvinyorwa anodiwa kuti aone nhamba yose yevakadzi veBPA-vakapararira kubva kune avo vane kenza yepamvere yakabuda. Nyaya yedhepfenyuro yedare chete haigone kushandiswa kuverenga chiyero chekenza yebonde nokuti haisanganisi nhamba yose yevakadzi vakaratidzwa neBPA.

Chinetso chechipiri nemhosva yenyaya / nyaya dzenyaya dzenyaya dzinozivisa dambudziko ndekushaiwa kweboka rekuenzanisa. I60% kuwanda kwehuwandu hweBPA pakati pevakadzi vane kenza yemazamu inoratidzika zvikuru, asi chii chakawandisa kuonekwa kweBPA pakati pevakadzi vasina kenza yemazamu? Iyi kuenzanisira inokosha pakugadzirisa pfungwa yokuti BPA inogona kuva chikonzero chekenza yepamu.

Chechitatu chekuregererwa kwemhosva nyaya / nyaya dzakakonzerwa ndechokuti zvidzidzo izvi zvinowanzotsanangurira zvakanyanya kusarudza vanhu vangave vasingarevi vanhu vazhinji. Somuenzaniso, zvinogoneka kuti mishonga yekenza yeA15 yakabva kune imwe chipatara munharaunda ine uwandu hwakanyanya hwekusvibiswa kwemweya kana zvimwe zvinokonzerwa nemakemikari. Pasi pemamiriro ezvinhu aya, kuongororwa kwakanaka kwechiitiko chekenza yebonde pakati pevanhu vasiri BPA kwakaratidza kuti vakadzi vanobva munharaunda imwechete vaizodiwa kuti vaite kuti BPA inokonzera kenza yemazamu.

Chikamu chechina chemhosva inopomerwa / nyaya dzakakosha shanduro yakasiyana. Iyi pfungwa ichaongororwa zvakadzama gare gare mubhuku rino. Pfungwa huru ndeyokuti pane kuchinja kwakasiyana-siyana kwepanyama mukukura kwezvirwere mumunhu. Ichokwadi chokuti 9 yevakadzi veC15 vane kenza yemazamu yakashuma BPA kujekesa kunonakidza; zvisinei, nhamba iyi inogona kunge yakasiyana zvakanyanya mumatambudziko akazotevera evakadzi vane 15 vane kenza yemazamu chete nekuda kwechiitiko. Kuongororwa kwakajeka kwehuwandu hwechirwere, huchizvimiririra kubva pangozi, hunogona kuwanikwa chete nokuwedzera nhamba yezvidzidzo zvinorwara.

Yeuka mhando yezvinhu zvinoshandiswa kutonga kana chimwe chinogona kuva chinokonzera chirwere:

1. Randomised evidence
2. Strength of association
3. Ukama hwenguva pfupi pakati pekutsvaga uye kuguma
4. Dose-response association
5. Biological plausibility

Kazhinji, nyaya dzenhau / nyaya dzakateedzana dzinotendamira pane zvega zvega kuti vagadzire nyaya yavo yekukonzera. Kune iyo BPA uye kenza yemazamu nyaya dzakateedzana, hapana humbowo husingaenzaniswi, hapana chiyero chesimba rekubatana pakati peBPA nekenza yemazamu, hapana yakashumwa dose kupindirana mubatanidzwa, uye hapana humbowo hwekuti kuburitswa kweBPA kwakatangira kukura kwekenza yemazamu. Iko kuremerwa kwekukonzera kunowanikwa zvachose kubva kune yapfuura ruzivo rwehupenyu nezve iyo estrogenic mhedzisiro yeBPA.

Pasinei nekukanganisa kwenyaya dzenyaya dzedambudziko, dzinogona kunge dzakanyanyisa kufambidzana nesangano rinokosha, chirwere chetachiona, kana kuti chisingadikanwi nemigumisiro yemishonga kana kurapwa.

Muenzaniso 3.2. Muna 2007, nyaya yakateedzana yakatsanangura matatu emakesi echirume epreubertal gynecomastia. Chirevo ichi chaisanganisira ruzivo rwakadzama pane yega yega zera- zera, saizi yemuviri, maseru sero endogenous steroid, uye kufumurwa kunozivikanwa kune exogenous mahormone. Izvo zvakaonekwa kuti vese vatatu vakomana vane hutano vaive vakaoneswa kune chimwe chigadzirwa chine mafuta elavender (mafuta, sipo, sipo), uye kuti muchiitiko chimwe nechimwe, gynecomastia yakagadzirisa pakamiswa kwechigadzirwa. Yakazotevera in vitro zvidzidzo zvakaratidza endocrine-inokanganisa chiitiko chelavender mafuta. Iyi inoverengeka nyaya dzakateedzana data dzinogona kutungamira mukumwe kuferefeta kuti uone kana lavender mafuta, chinhu chinowanzoitika muzvigadzirwa zviripo mukutengesa, chingave chiri chikonzero che gynecomastia.

Muenzaniso 3.3. Mushonga wakagadzirirwa kudzivirira hutachiona hweR rotavirus hwakawanikwa huchikonzera kuora simba kwepachiviri mutsvuku mumhuka. Kutevera kusunungurwa kwechirwere ichi, nhamba yezviitiko zvekudzivirira (apo imwe chikamu chemuviri wechechi chinopinda mune chinotevera) chakataurwa kune vana vakagamuchira chirwere, pamwe nemamwe mhondi inouraya. Iyo yakasimba yezvinyorwa zvinokonzerwa nesangano iri, uye ruzivo rwekuti kutadza kunenge kusina kuwanana mumucheche, kwakanyanyisa kukurudzira ukama hwechikonzero uye chirwere chakabviswa pamusika.

Ruzivo rwunotsanangurwa kubva kuna B. Kestenbaum, Epidemiology uye Biostatistics: An Sumo yeKiriniki Yekutsvagisa, DOI 10.1007 / 978-0-387-88433-2_3, Springer Science + Bhizinesi Media, LLC 2009. Chiyero cheruzivo rwedu chinogumira kuchiropractic se pamwe nekukuvara kwemuzongoza uye mamiriro. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kutibata nesu pa 915-850-0900 .

Inotsanangurwa naDkt Alex Jimenez

Zvimwe Zvinyorwa: Wellness

NHAURWA INOKOSHA: KUDZIDZISA KWENYAYA: Kurapa Sciatica Pain

Manejimendi yeSciatica: Nonsurgical & Kuvhiya Therapies

by Dr Alex Jimenez | Chiropractic, Chiropractic Examination, Clinical Case Reports, Clinical Case Series, Functional Medicine, Sciatica

Chimbofunga zvinotevera, sciatica ishoko rechiremba rinoshandiswa kurondedzera boka rose rezviratidzo zvinokonzerwa nekutsamwa kana kukanganiswa kwemasero ane sciatic, kazhinji nekuda kwekukuvadzwa kana kuwedzera mamiriro ezvinhu. Sciatica inowanzozivikanwa nekupisa marwadzo pamusana wesimbi yakasakara, iyo inotsika pasi imwe kana makumbo maviri kubva kumucheto wezasi. Nyaya inotevera vignette inokurukura mamiriro aMuongorori weWinston, mutyairi webhasi weCXMUMX ane makore ane makore makumi maviri nemashanu, uyo akataura kuti ane chirwere chisingagumi, chakatsika shure uye gumbo chinosangana ne sciatica munguva ye50-vhiki. Ramya Ramaswami, MB, BS, MPH, Zoher Ghogawala, MD, naJames N. Weinstein, DO, inopa kuongororwa kwakajeka kwehutano hwakasiyana-siyana hunogona kuwanikwa mukurapa sciatica, kusanganisira iri kuitirwa chirwere chema lumbar disk uye kugamuchira chirwere chisina kuwanikwa.

Pamusoro pezvinyorwa zvake, sechiremba anoita chiropractic, kusarudza kurapwa kwakakodzera kwemarudzi ose ekukuvadzwa kana chiitiko kunogona kuva chisarudzo chemunhu oga uye chakaoma. Kana mamiriro acho akanaka, murwere angasarudza kuti ndeipi nzira yakanakisisa yekurapa kune rudzi rwekurapa. Kunyange zvazvo vanachiremba vasina kurapa, zvakadai sechiropractic, vanogona kushandiswa pakuvandudza zviratidzo zve sciatica, zviitiko zvakaoma zve sciatica zvingada kubatsirwa kwekuvhiya kuporesa tsime remagazini. Muzviitiko zvizhinji, kurapwa kwemashure kunofanirwa kuonekwa sekutanga, tisati tashandura kurapa kurapwa kwe sciatica.

Case Vignette

Murume Aine Sciatica Ndiani ari kufunga nezveLumbar Disk Surgery

Ramya Ramaswami, MB, BS, MPH

Mr. Winston, mutyairi webhasi weC50 wemakore, akaendeswa kuhofisi yako ane 4-vhiki yezvakaitika kare yekutambudzika mukati megumbo rake rokuruboshwe uye kumashure. Akarondedzera kusanganiswa kwehurombo hwakakomba uye hunotyisa hwakatanga mumugwagwa wake wekupedzisira uye hunobudiswa kune dorsolateral muchikamu chake chekuruboshwe, pamwe nekuputika kusina kujeka pamusoro pemakumbo ezasi. Pamusoro pekuongororwa, kusimudzwa kwechikwata chake chekuruboshwe kubva patafura kusvika kuC45 degrees kwakakonzera kurwadziwa kukuru kwakagadzirisa chiratidzo chake chikuru, uye kurwadziwa kwakanyanya zvokuti iwe haugoni kusimudza gumbo rake mberi. Kwakange kusina gumbo kana rutsoka rwendo. Muenzaniso wake wemuviri (kurema kweiyo kilograms yakakamurwa nemakiromita ekukwirira mumamita) yaiva 35, uye akanga ane chirwere chisingaperi chisingavhiringidzi chinonzi pulmonary chikonzero nekuda kwekutsvaga imwe pota yefodya zuva rega rega kwemakore 22. VaWinston vakanga vatora nguva yekusiya basa ravo nekuda kwezviratidzo zvake. Iwe wakaraira 150 mg ye pregabalin zuva, izvo zvishoma nezvishoma zvakawedzerwa kuva 600 mg zuva nezuva nokuti zviratidzo zvakanga zvisati zvapera.

Zvino, vhiki gumi mushure mekutanga kwezviratidzo zvake, anodzoka kuti aongorore. Mushonga uyu wakapa kurerutsa kushoma kwekurwadziwa kwake kwakanyanya. Anofanira kudzokera kubasa uye ane hanya nekugona kwake kupedzisa mabasa ake kubasa kwake. Iye anoenda kune imagineti resonance imaging, iyo inoratidza herniated diski kuruboshwe kuruboshwe paL10 L4 mudzi. Iwe unokurukura sarudzo dzeanotevera matanho mukugadzirisa kwake sciatica. Haana chokwadi nezvekupinda kwemaitiro senge lumbar disk kuvhiyiwa asi anonzwa kushomeka nezviratidzo zvekurwadziwa.

Treatment Options

Ndeipi yeiyo inotevera inokurudzira kuna VaWinston?

Undergo lumbar disk surgery.
Gamuchira unrealurgical therapy.

Kuti ubatsire mukuita kwako zvisarudzo, imwe neimwe yemitambo iyi inodzivirirwa muhurukuro pfupi neanyanzvi mumunda. Zvichipa ruzivo rwako rwemu murwere uye pfungwa dzakagadzirwa nenyanzvi, ndeipi nzira yaungasarudza?

Pfungwa 1: Undergo Lumbar Disk Surgery
Pfungwa 2: Gamuchira Nonsurgical Therapy

1. Undergo Lumbar Disk Surgery

Zoher Ghogawala, MD

Nyaya yaVaWinston inomiririra chiitiko chakajairika mukutungamira kwechiratidzo lumbar disk herniation. Mune ino kesi chaiyo, zviratidzo zvevarwere uye kuongororwa kwepanyama kunoenderana ne-nerve-midzi kudzvinyirira uye kuzvimba zvakananga kubva kuL4 L5 herniated disk kuruboshwe kwake. Murwere haana kushaya simba asi ane kurwadziwa kunoramba kuripo uye anga asingakwanise kushanda kwemasvondo gumi apfuura kunyangwe achigamuchira pregabalin. Mibvunzo miviri inomuka: chekutanga, inoita lumbar disk kuvhiyiwa (microdiskectomy) inopa mhedzisiro iri pamusoro kune avo vanoramba vachirapa vasina kurapwa mune varwere vane anopfuura mavhiki matanhatu ezviratidzo; uye chechipiri, ko lumbar microdiskectomy inovandudza mukana wekudzoka kuzoshanda kune varwere vane zviratidzo izvi?

Nhamba yakakwirira yepamusoro yehurukuro inouya kubva kuPine Patient Outcomes Research Trial (SPORT). Migumisiro yechirangaridzo, yakatongerwa kuedza yakaoma kududzira nokuti kutevedzera kune zvakapiwa chirongwa chekurapa kwakange kuchida. Hafu chete yevarwere avo vakangoerekana vaendeswa kuboka rekuvhiyiwa zvechokwadi vakazovhiyiwa mukati memwedzi ye3 mushure mekunge vanyorwa, uye 30% yevarwere vakagoverwa kune vasingabatsiri vakasarudza kuyambukira kune boka rekuvhiya. Muchidzidzo ichi, varwere vakazovhiyiwa vakave nekuvandudza kukuru mumigumisiro yakagadzirirwa-varondedzerwa. Mushonga wokurapa we microdiskectomy wakanga wakanyanya kupfuura wekusava nemishonga pamwedzi we3, 1 negore, nemakore 2. Uyezve, mukuongorora kwakafanana, zvakaguma pakati pevarwere vakazovhiyiwa vakanga vakakwirira pane avo vari pakati pevarwere vakagamuchira kurapa kusingabatsiri. Kakawanda, migumisiro yeSPORT inotsigira kushandiswa kwe microdiskectomy munyaya iyi.

Migumisiro yekurapa kwechiremba inobva mukuenzanisira kwezvokurapa mune zvidzidzo zvevanhu uye zvinogona kunge zvisingashandisi kune mumwe munhu varwere. SPORT haina kutsanangura kuti rudzi rwemishonga isingashandisirwi rwaifanira kushandiswa. Chirwere chepanyama chakashandiswa muC73% yevarwere, epidural injections mu 50%, uye mishonga yezvokurapa (semuenzaniso, maitiro asingashandisi zvinodhaka) mune zvinopfuura 50%. Muzvakaitika naVaWinston, pregabalin yave ichiedzwa, asi chirwere chepanyama uye epidural glucocorticoid injections hazvina kuedza. Pasinei nekushandiswa kwechirwere chemuviri kwekurapa lumbar disk herniation, humwe uchapupu hunotsigira kubudirira kwayo hahuna kufanira, maererano nemitemo yakabudiswa yeNorth American Spine Society. Kune rumwe rutivi, kune uchapupu hwokuti injandi ye transforaminal epidural glucocorticoid inopa rubatsiro rwemazuva mashomanana (30 mazuva) kune varwere vane zvirwere-musinga-zviratidzo zvakananga zvakananga ne diski yake. Pasi rose, kune uchapupu, kubva ku SPORT uye kubva kuongororo yakangotarisa kubva kuNetherlands yakabudiswa mumagazini, kuti kuvhiyiwa kwekutanga pakati pevhiki ne6 mushure mekutanga kwezviratidzo kunopa kuderedza kuderedza marwadzo emakumbo uye kupererwa kwakanyanya kwehutambudzo hwemarwadzo kupfuura kupora kwenguva refu.

Kukwanisa kudzokera kubasa hakuna kuongororwa zvakananga mukuenzanisa kwekushanda pamwe nemishonga isingashandi kune lumbar disk herniation. Registry data kubva kuNeuroPoint-SD yakaratidza kuti kupfuura 80% yevarwere vakanga vachishanda vasati vasvitsa mishonga vakadzokera kubasa mushure mekuvhiyiwa. Kukwanisa kudzokera kubasa kunogona kuvhiringidzwa nemhando yeruzivo, sezvo varwere vashandi vashandi vangave vachida nguva yakawanda yekudzoka kuti vaderedze njodzi yekuberekwa.

Zvinonyatso kuzivikanwa kuti varwere vazhinji vane chiratidzo lumbar disk herniation vanozove nekuvandudzika nekukasira pamwedzi yakati wandei. Kuvhiya kunogona kudzikisira zviratidzo nekukurumidza nekubvisa nekukanganisa diski herniation kubva kune yakakanganiswa nerve midzi. Iyo ngozi -bhenefiti equation ichasiyana pakati pevarwere vamwe. Panyaya yaVaWinston, kufutisa uye hunyoro hwemapapu chirwere zvinogona kuwedzera njodzi yezvinetso kubva pakuvhiyiwa, kunyangwe muSPORT, 95% yevarwere vekuvhiya vaisava necompact kana yekupedzisira kushanda Kuna Mr. Winston, murwere ane kurwadziwa kwakaramba kuripo kweanopfuura masvondo matanhatu, microdiskectomy isarudzo ine hungwaru inotsigirwa nehupupuriro hwemhando yepamusoro.

2. Gamuchira Nonsurgical Therapy

James N. Weinstein, DO

Iyi nyaya inosanganisira mharidzo yakafanana yekurwadziwa kwepamusoro kumapfupa kunokonzera kumucheka uye mushure mekudzivirira kwechirwere izvo zvinogona kureva zvinoreva kurwadziwa kwemagetsi kana radiculopathy. Chirwere chinonzi radiculopathy chinokonzerwa nekukanganiswa kwemuzasi kemarrasi midzi (L4, L5, kana S1) inoguma nemarwadzo anokonzera kupfugama kumabvi uye anowanzosangana neutera kana kushaya simba mukati mezvinyorwa zvangu kana dermatome. Muchiitiko ichi, marwadzo anowedzera kumabvi uye haabatanidzwi neutera kana kupera. MuSVORT, kuvhiyiwa kwakaguma nekukurumidza kupora uye kuwedzerwa kwakanyanya kudarika kusabatsiri kurapwa kune varwere vane marwadzo ayo akaparadzanisa nechemberi kumabvi uye ainge aine zviratidzo zveuropiki kana zviratidzo. Zvisinei, sezvo VaWinston vangadai vasati vasangana nemitemo yekubatanidzwa yeSPORT, migumisiro ye diskectomy munyaya iyi ingangove isingatarisirwi. Haana radiculopathy inowira pasi pebvi, uye haaine utera kana kupera; kurapwa kusingabatsiri kunofanira kupera kusati kwambofunga nezvekuvhiya iyo kakawanda isina kuonekwa kuti inoshanda kune varwere vane rudzi urwu rwekutaura. Mune nyaya ino yeMutauro, Mathieson nevamwe vanoshanda vanoparidzira migumisiro yechirangaridzo yakasarudzwa, yakarongedzwa iyo yakaratidza kuti pregabalin haina kunyanya kuderedza marwadzo ane chokuita nesciatica. VaWinston vakamborapwa chete ne pregabalin; saka, mamwe maitiro anochengetedza anofanira kuongororwa.

Saal naSaal vakataura kuti vanopfuura makumi masere muzana evarwere vane radiculopathy inosanganisirwa ne lumbar disk herniation yakagadziridzwa mune imwe mwedzi yemwedzi nekurovedza muviri. Mune isingashandi SPORT cohort, varwere vakave nekuvandudzwa kwakakura kubva kune yekutanga, uye vangangoita 80% yeavo vane yakasarudzika radiculopathy avo pakutanga vakagamuchira isingashande kurapwa vaidzivirira kuvhiyiwa. Mr. Winston anga aine kurapwa kushoma uye anga aine zviratidzo zvemasvondo gumi chete. Anofanirwa kuita kosi yekurovedza muviri-yakavakirwa yekurapa uye kuyedzwa kweiyo nonsteroidal antiinfigueatory mishonga uye anogona kufunga nezve lumbar epidural glucocorticoid jekiseni. Kunyangwe paine humbowo hushoma hwekushanda kwesarudzo dzisiri dzekuvhiya dzoga, kusanganiswa kweaya marapirwo uye neyakaipa nhoroondo yemamiriro emurwere zvinogona kukonzera kudzikisira kana kugadzirisa zviratidzo. Kana kupindira uku- uye nenguva - zvikasagadzirisa zviratidzo zvake, kuvhiyiwa kunogona kutariswa senzira yekupedzisira, asi inogona kunge isingakwanise kushanda kwenguva yakareba uye inogona mukati mayo uye ingangoita mukana wekukuvara kupfuura kunaka. VaWinston vane njodzi, senge kufutisa uye nhoroondo yekusvuta, izvo zvakaratidzirwa kuti zvinopa kusagadzikana kwekuvhiya mhedzisiro yemamwe maronda

VaWinston vane zviratidzo zvekurwadziwa shure shure kunopesana nehupenyu hwake. Aizoda kunzwisisa, kuburikidza kuburikidza nekugadzirisa kusarudzwa, kuti nzira isina kugadzirisa inogona kuva yakakosha kupfuura kuvhiyiwa kwenguva.

Mashoko anotsanangurwa kubva kuNational Center for Biotechnology Information (NCBI) uye New England Journal of Medicine (NEJM). Kuwanda kweruzivo rwedu kunogumira kune chiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota ivai vakasununguka kubvunza Dr. Jimenez kana kuti tibvunzei kwatiri 915-850-0900 .

Yakataurwa naDkt Alex Jimenez

Zvimwe Zvinyorwa: Wellness

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