Chiropractic kuchengetedza inonyanya kuzivikanwa nzira yekurapa inoshandiswa inowanzoshandiswa kurapa zviratidzo zve sciatica. Sciatica rinoratidzika sehuturu hunotangira hunobva mumucheto wezasi uyo unofamba uchidzika pasi mahudyu uye mahudyu mumakumbo netsoka semugumisiro wekumanikidzwa kweropa redu. Zviratidzo zvinowanzoitika kune rumwe rutivi rwemuviri, zvisinei, sciatica inogona kuitika kumativi maviri omumuviri womunhu. Sciatic nerve pain can vary in frequency and intensity from person to person and it is generally described as a dull, sharp, pin and needle sensation similar to shock electric.

 

Zvimwe zviratidzo zvinosanganisira, kupisa, kupera uye kushungurudzika. Matambudziko anowanzozivikanwa kuti anoita kuti sciatic nerve pain inosanganisira, piriformis syndrome kana kukanganiswa kunokonzerwa nekuputika kwemuviri wepiriformis, kubudiswa kana kusakanganiswa kwema-lumbar spine, kubvongodza kana kuti herniated diss, pamuviri, kumarara uye kusina-musana kwemagunha sechirwere cheshuga uye kuvimbiswa. Nokuti kushungurudzwa kwakawanda kunogona kukonzera sciatica, kukodzera kuongororwa kwechiratidzo chezviratidzo zveumwe neumwe kunokosha kumurwere wese anorwara. Kuongororwa kuongorora sciatic nerve pain you include x-ray, MRI, CT scan and / or electrodiagnostic tests. Izvi zviongorori zvinogona kubatsira kuona kuti zvinogona kuitika kune chiropractic.

 

 

Chiropractic inotarisa pane kuongororwa, kurapwa nekudzivirira kwekukuvara kwakasiyana-siyana uye / kana mamiriro ezvinhu anokonzera musikisiki uye urongwa hwehutano nekudzorera zvakanyatsogadziriswa kwepakutanga kwemupaka kuburikidza nekushandura kwepelinha nekugadzirisa manyorerwo, pakati pezvimwe nzira dzokurapa . Chinangwa chechiropractic kuchengetedza ndezvekuita kuti muviri wemunhu uwedzere kukwanisa kuzvirapa pachawo pasina chidimbu chemishonga / mishonga uye / kana kuvhiyiwa. A chiropractor anogona kupa nzira dzakasiyana-siyana dzokurapwa zvichienderana nehutano hwehutano hwehutano hwemurwere. Chirongwa chinowanzoitwa kurapwa sciatic nerve pain inoshandiswa nechiropractor ingasanganisira kushandiswa kwepelinha uye kugadziriswa kwebhuku, mazai echando / kutonhora kuderedza kuputika, ultrasound kuti kuwedzere kupararira, TENS kana transcutaneous magetsi nerve kukurudzira uye mararamiro ekugadzirisa, zvakadai sezano rekudya, mazano ekufananidzira uye kuronga kurara. Dzimwe nzira dzokurapa dzinowanzoshandiswa nechiropractor kurapa sciatica dzinosanganisira, maruva-kuvhiringidzika remapiritsi, chirwere chepinal decompression therapy uye McKenzie therapy.

 

 

 

 

Kutsemuka-kukanganiswa kwehutachiona hunyoro hutano hunoshandiswa pamarwadzo emutsipa uye kumashure hunoita kuti intervertebral disc kure, hubvumira dhayi rimwe nerimwe kuti rive nechinzvimbo chayo chepamusoro kuitira kuti kuderedze kusagadzikana, kubvisa kutsamwa kwemutsipa wesipinha nekuvandudza kupararira. Kufungidzirwa-kukanganisa kurapwa kunogona kudzorera muviri kushanda uye kubvisa marwadzo. Chirwere chekupedzesera kwepasiporesi chinosanganisira kutenderera kwepakati pemugwagwa nenzira yakarongeka uchishandisa tafura yekutengesa kana imwe yakagadzirwa motorized device kuti iite intradiscal inomanikidza kuitira kuti isunungure kurwadziwa shure uye / kana kupisa marwadzo kuburikidza nekusimudzira rutivi rwekuporesa mishonga mu disc uye kupa iri nani kuporesa mamiriro ezvinhu ekudurudza kana kuti herniated discs. Uye pakupedzisira, therapy McKenzie inzira yakarongeka kune zvose kuongorora nekurapa sciatica. Nzira yekurapa inoda murwere kuti atore mitezo yezviitiko zvemuviri kuitira kuti aongorore marwadzo omurwere uye aone hutano hwehutano. The McKenzie therapy zvino inoshandisa iyo ruzivo kuti iwedzere tsika yehutano nechinangwa chekudzivirira zviratidzo zvinorwadza.

 

Kunyange zvazvo chiropractic kuchengetedza yakachengeteka uye inobudirira mamwe mushonga mushonga unowanzoshandiswa pakurapa zviratidzo zve sciatica, sciatica inogona kukonzerwa nekusawirirana kupfuura chikamu chechiropractic care. Kana chiremba wechiropractic, kana chiropractor, anoratidza kuti chirwere cherwere chinoda kurapwa kubva kune rumwe ruzivo rweyanyanzvi, vanogona kutumira munhu kune mumwe wehutano hwehutano kuti awedzere kurapwa. Muzviitiko zvakasiyana, chiropractor iri kureva inogona kuramba ichirapa chiropractic apo iri kubatanidza kurapa kwechiremba nemumwe muongorori. Uyezve, chinangwa chenyaya inotevera ndechekuratidzira zvakasiyana-siyana zvekurapa mazano pamusoro pekuongororwa uye kurapa sciatica. Zvisinei, nokuti ruzivo pamusoro pekupararira kwezvakabva sciatica uye kupindura kwaro nzira dzakasiyana-siyana dzokurapa hakushayiwi, zvidzidzo zvekare zvinowanzodiwa kuti uone kushanda kwemashoko ekurapa anotaurwa pasi apa.

 

Kuongorora nekurapa kweSciatica

 

Sciatica inobata vanhu vakawanda. Zvinonyanya kukosha zviratidzo zvinokonzera marwadzo omumakumbo nekuremara kwakabatana. Varwere vanowanzobatwa mukutarisirwa kwepamusoro asi chikamu chiduku chinoshandiswa kuchikoro chechipiri uye pakupedzisira chinogona kuvhiyiwa. Nhamba dzakawanda dzinofanirwa sciatica dzinowanikwa mumabhuku, akadai se lumbosacral radicular syndrome, ischias, kurwadziwa kwemishu, uye nervous root entrapment.

 

Summary Points

 

• Vakawanda varwere vane sciatica yakaoma vane chirevo chakanaka asi pamusoro pe20% -30% vane zvinetso zvinoramba zvichiitika pashure pemakore maviri kana maviri
• Kuongororwa kunobva pane zvakaitika kare nekuongorora mumuviri
• Kufananidza kunoratidzwa chete kuvarwere vane red mureza mamiriro kana mukati mavo kuvhiyiwa kwedhisiki kunoonekwa
• Passive (kurazorora pamubhedha) kurapwa kwakatsiviwa nemishonga yakawanda
• Kubvumirana ndeyokuti kutanga kurapwa kwakachengeteka kwemavhiki e6-8
• Kuvhiyiwa kwechirongwa kunogona kupa kukurumidza kusunungurwa kwemarwadzo emakumbo kudarika kutarisirwa kwekuchengetedza asi hapana kusiyana kwakajeka kwakawanikwa pashure pemakore maviri kana maviri

 

Mune angangoita makumi mapfumbamwe muzana ezviitiko sciatica inokonzereswa neherniated disc ine tsinga midzi yekumanikidza, asi lumbar stenoses uye (kashoma kazhinji) mamota zvinokonzeresa. Kuongororwa kweiyo sciatica uye manejimendi ayo anosiyana zvakanyanya mukati nepakati penyika, semuenzaniso, zviyero zvekuvhiyiwa kwe lumbar discectomy zvinosiyana zvakanyanya pakati penyika. [W90] Chinyorwa chenguva pfupi chakasimbisa uyu musiyano muhombe mukuvhiyiwa kwedisiki, kunyangwe mukati medunhu. [1] Izvi zvinogona kunge zvichikonzerwa nekushaikwa kweuchapupu pakukosha kwekurapa uye nzira dzekurapa uye kushomeka kwemakiriniki akajeka kana kuratidza kusiyana kwehutano uye einishuwarenzi. Kuongorora uku kunopa mamiriro azvino esainzi ekuongororwa uye kurapwa kweiyo sciatica.

 

 

Zvinyorwa uye Kusarudzwa Mazano

 

Takaona maitiro anogadziriswa muChechirane Library kuongorora kubudirira kwebasa rekuchengetedza uye rekuporesa sciatica. Medline yakatsvaga kusvika muna December 2006 yakaitwa kuti iwane mamwe maitiro akakodzera anogadziriswa pamusoro pekuongororwa uye kurapwa kwekunzwa kurwadziwa kwakanyanya. Mashoko ekuti sciatica, hernia nuclei pulposi, ischias, nerve root entrapment, systematic review, meta-analysis, diagnosis, uye kurapwa. Mukuwedzera tinoshandisa mafaira edu kune zvimwe zvinyorwa, kusanganisira mabhuku emangwana maitiro emakiriniki ekupedzisira. Pakupedzisira takaongorora kuwanikwa kwekliniki yekufambisa.

 

Dr. Alex Jimenez's Insight

Sciatica inorondedzerwa semishonga seboka rose rezviratidzo, panzvimbo yekukuvara kamwe uye / kana chimiro, chinowanzozivikanwa nekupinza marwadzo pamusana pembeu yakasara mumusana wezasi, iyo inotsika pasi pamakumbo uye mumakumbo ose nemakumbo. Sciatica inowanzoitika kune rumwe rutivi rwemuviri, kunyange zvisingagoni kuchinja mativi maviri emuviri womunhu. Slicatic nerve pain can show as a result of a variety of injuries and / or conditions, such as bulging or herniated disc, izvo zvinogona kuita kuti zvive nyore kune vashandi vezvehutano kuti vatarise zvakanaka. Basa rechiropractor ndekutsvaga chikonzero chechirwere chechirwere kuitira kuti ashandise nzira yakanakisisa yokurapa yehutano hwakakosha. A chiropractor, kana chiremba wechiropractic, anowanzoshandisa kushandiswa kwepelinha uye nzira dzekushandisa, pakati peimwe nzira dzokurapa, kunyatsogadzirisa kuvimbika kwepakutanga kwemutsara uye kuvandudza zviratidzo zve sciatica. Kuchengetedza chiropractic kunogona kuwedzera kukwanisa kwemuviri wemunhu wega kuzviraramisa pachako.

 

Ndiani Anowana Sciatica?

 

Dhiyabhorosi chaiyo pamusoro pezvakaitika uye kupararira kwe sciatica inoshaikwa. Nenzira yakawanda inofungidzirwa kuti 5% -10% yevarwere vane marwadzo ekudzokera shure vane sciatica, asi huwandu hwoupenyu hwehupenyu hunotapukira hutsika huri kubva ku49% kusvika ku70%. [W2] Kuwandisa kwegore negore sciatica dzine chokuita nevanhu vakawanda inofungidzirwa pa 2.2%. [2] Zvishomanana zvemunhu oga uye zvebasa zvinokonzera sciatica zvakashumwa, kusanganisira makore, kureba, kushungurudzika mupfungwa, kusvuta fodya, uye kusvibiswa kudengenyeka kubva mumotokari. [2, 3, w2] Uchapupu hwehukama pakati peSciatica uye zvepabonde kana muviri mumuviri zvinopesana. [2, 3, w2]

 

Ngozi Dambudziko reAcute Sciatica [3, w2]

 

Zvimwe Zvimwe

 

• Age (peak 45-64 makore)
• Kuwedzera mungozi nekukwirira
• kusvuta
• Kuzvidya mwoyo mupfungwa

 

Occupational Factors

 

• Basa rinonetesa physical semuenzaniso, kusimudza kazhinji, kunyanya uchikotama nekumonyoroka
• Kutyaira, kusanganisira kudengenyeka kwemuviri wose

 

Sciatica Anozivikanwa sei?

 

Sciatica inonyanya kuongororwa nenhoroondo inotora uye kuongorora mumuviri. Neshoko vatendi vanotaura nezvekurwadziwa kwemajenya muhudyu. Vanogona kubvunzwa kuti vaudze kuparadzirwa kwemarwadzo uye kana inopenya pasi pemabvi uye mifananidzo ingashandiswa kuongorora kugoverwa. Sciatica inoratidzirwa nekupisa marwadzo anotevera dermatomal pattern. Varwere vanogonawo kuratidza zviratidzo zvekunzwa.

 

Kuongorora kwepanyama kunowanzoenderana nekuongororwa kwenzwa. Iyo yakanyanya kuferefetwa kuongororwa ndeye yakatwasuka gumbo yekusimudza bvunzo kana chiratidzo chaLas gue. Varwere vane sciatica vanogona zvakare kuve nemarwadzo ekudzokera kumashure asi izvi zvinowanzo kuve zvisina kusimba pane kurwadziwa kwegumbo. Iko kukosha kwekuongorora kwenhoroondo uye kuongororwa kwemuviri hakuna kunyatso kufundwa. [4] Hapana zvinhu zvezvakaitika kare kana bvunzo dzepanyama zvine zvese zvinonzwisisika uye zvakakwirira kutaurwa. Iko kusanzwisisika kwekusanzwisisika kwekuyedzwa kwekusimudza gumbo kwakatarwa kunofungidzirwa kuve 91%, iine huwandu hwakaenzana hwakaunganidzwa hwe26%. [5] Chiyero chega chakanangana nehukuru hwepamusoro ndiko kuyambuka bvunzo yakatwasuka yekusimudza gumbo, ine huwandu hwakasanganiswa hwe88% asi kunzwisisika kwe29% chete. [5] Pakazara, kana murwere akataura maringe neanopenya marwadzo mune rimwe gumbo pamwe chete nemhedzisiro yakanaka pane imwe kana yakawanda bvunzo dzemitsipa inoratidza kusagadzikana kwemitsipa kana kushomeka kwemitsipa kuongororwa kwesciatica kunoita kunge kwakakodzera. Pazasi panoratidza zviratidzo nezviratidzo zvinobatsira kusiyanisa pakati peiyo sciatica uye isiri-yakatarwa yakaderera musana marwadzo.

 

Zviratidzo zveSciatica [w5]

 

• Unilateral kurwadziwa kwemakumbo makuru kudarika marwadzo ekudzokera shure
• Urombo hunoyerera kune tsoka kana zvigunwe
• Numbness uye paraesthesia mubasa rakafanana
• Kururamisa kwemakumbo kunokonzera kurwadziwa kwemakumbo akawanda
• Localized neurology ndiko kuti, inogumira kune imwe tsinga midzi

 

Chii Chinokosha Chokufungidzira?

 

Kuongorora kwekufungidzira kunongobatsira chete kana mhedzisiro ichikurudzira kumwezve manejimendi. Mune acute sciatica kuongororwa kunoenderana nekutora nhoroondo uye kuongorora kwepanyama uye kurapwa kuri kuchengetedza (kusiri-kuvhiya). Kufungidzira kunogona kuratidzwa panguva ino chete kana paine zviratidzo kana mireza yakatsvuka- iyo iyo sciatica inogona kukonzerwa nechirwere chepasi (hutachiona, malignancies) pane disc herniation.

 

Kuona kufungidzira kunogona kuratidzwawo kune varwere vane zviratidzo zvakakomba vanokundikana kupindura kuchengetedza kwemasvondo e6-8. Muzviitiko izvi chirwere chinogona kufungidzirwa uye kufungidzira kushandiswa kuziva kana dhayi rehaniated rine nerve root compression iripo uye inzvimbo uye chiyero. Zvakakosha sechikamu chechisarudzo chekushanda icho kliniki yekuwana uye zviratidzo zvinowirirana zvakanaka nekutora kuwanikwa. Izvi zvinonyanya kukosha nokuti disc herniations inowanikwa nekambani tomography kana magnetic resonance imaging yakawanda kwazvo (20% -36%) kune vanhu vasina zviratidzo vasina sciatica. [6, w3] Muvanhu vakawanda vane zviratidzo zvekurapia zve sciatica no lumbar kudzivisa zvinyorwa zviripo pane zvinyorwa. [7, 8] Panguva ino hakuna rumwe rudzi rwekufungidzira nzira inoratidza kujekesa kwakanaka pamusoro pevamwe. Kunyange zvazvo vamwe vanyori vanofarira magnetic resonance imaging pamusoro peimwe nzira dzekufungidzira nokuti computed tomography ine yakanyanya mazai emagetsi kana kuti zvinyoro zvinyoro zviriko zviri nani, [9, 10] uchapupu hunoratidza kuti zvose zviri zviviri zvakajeka pakutsvaga lumbar disc herniation. [11] Radiography for kuongororwa kwe lumbar disc herniation hakukurudzirwi nokuti madhikoni haagoni kutaridzirwa ne-ray. [11]

 

Chii chinonzi Prognosis?

 

Muzhinji kliniki yehutachiwana sciatica inofadza uye hutambudzo hwakawanda uye hurema hunobatana hunogadzirisa mukati memavhiki maviri. Semuenzaniso, mumutambo unongoratidzika wakaenzanidza kwete-steroidal anti-inflammatory drugs ne placebo yeacute sciatica muhutano hwepakutanga 60% yevarwere vakadzorerwa mukati memwedzi mitatu uye 70% mukati memwedzi ye12. [12] Pamusoro pe50% yevarwere vane acute sciatica yakabatanidzwa mumapoka e placebo mumatambudziko akaoma ekupindira kwekusava kupora yakashuma kubudirira mukati mezuva re10 uye nezve 75% yakashuma kubudirira pashure pemavhiki mana. [13] Muvarwere vakawanda saka kuraira kwakanaka, asi panguva imwechete chikamu chikuru (up kusvika ku30%) inoramba ichirwadziwa kwegore rimwe kana kupfuura. [12, 13]

 

Chii chinonzi Efficacy yeCervervative Treatments yeSciatica?

 

Kuchengetedza chirwere che sciatica chinonyanya kurongerwa kunorwadza kunorwadza, zvichienderana neanorgesics kana nekuderedza kusvitsa pamutsipa wemidzi. Kuongororwa kwekugadziriswa kwemazuva ano kwakaratidza kuti kurapwa kwakachengetedza hakuiti kujekesa zvakajeka mararamiro emasikirini emaswere vakawanda kana kuderedza zviratidzo. [14] Kunyatsoudza varwere nezvezvinokonzera uye kutarisira kufungidzira kungava chikamu chinokosha cherongwa hwekuita. Zvisinei, kudzidzisa varwere pamusoro peSciatica hazvina kuongororwa zvakananga mumatambudziko akachengetedzwa nemaitiro.

 

Ruzivo ruri pazasi runopfupikisa humbowo hwekushanda kweanowanzo kuwanikwa marapirwo ekuchengetedza sciatica, kusanganisira jekiseni kurapwa. Humbowo hwakasimba hwekushanda hwunoshaikwa kune akawanda marapiro aripo. Musiyano mushoma mukurwadziwa uye chinzvimbo chinoshanda chakaratidzirwa pakati pekuzorora pamubhedha uye mazano ekugara wakashanda. [15] Nekuda kwekutsvaga uku, kurara kwemubhedha kwenguva yakareba iyo mainstay yekurapa sciatica is haichakurudzirwe zvakanyanya. inoshanda kupfuura placebo mukuderedza zviratidzo. Uchapupu hweopioid uye akasiyana makomputa madhiragi ari kushomeka. Kuongorora kwakarongeka kwakaratidza kuti hapana humbowo huripo hwekudhonza, isiri-steroidal anti-anogumbura zvinodhaka, intramuscular steroids, kana tizanidine iri pamusoro pe placebo. [2] Ongororo iyi yakaratidza kuti majekiseni epidural e steroid anogona kunge achishanda muvarwere vane acute sciatica. [4] Nekudaro imwe yazvino yakarongeka kuongororwa kwehuwandu hukuru hweyedzo dzakasarudzika dzakaratidza kuti pakanga pasina humbowo hweakanaka epfupi mhedzisiro mhedzisiro yemajekiseni e corticosteroid uye kuti mhedzisiro yenguva refu yakanga isingazivikanwe. [13] Ongororo imwe chete yakarongeka yakataura kuti kurapa kwekuita (kurovedza muviri) kwakaratidzika kunge kusiri nani pane kurapwa (kwekuzorora kwemubhedha) uye kumwe kurapa kwakachengetedza, sekukweva, kubata, mapakeji anopisa, kana corsets. [13]

 

Nhamba dzeUchapupu hweMishonga inogadziriswa yeSciatica

 

• Kurara kwevheche (kushambadzira)
• Kuramba wakashinga, kusiyana nemubhedha wokuzorora (zvichida kuva wakakosha)
• Analgesics kana kuti kwete-steroidal anti-inflammatory drugs, acupuncture, epidural steroid injection, spinal manipulation, traction therapy, chirwere chepanyama, maitiro ekubata, maitiro akawanda ekudzivirira (kusagadzikana kusingazivikanwi)

 

Ndeipi Basa reUkuvhiya muSciatica?

 

Kupindira kwekushandura kwe sciatica kunonyanya kutarisa kubviswa kwe disc disclaimer uye pakupedzisira chikamu che disc kana kuti foraminal stenosis, nechinangwa chokubvisa kukanganiswa kwechikonzero che sciatica. Mishonga inotarisirwa kugadzirisa marwadzo emakumbo uye zviratidzo zvinoenderana uye kwete nekuderedza marwadzo ekudzokera shure. Kubvumirana ndechokuti chikara chekuda equina chiratidzo chakanaka chekuvhiya nekukurumidza. Kusarudzwa kwechisarudzo ndicho chisarudzo cheunilateral sciatica. Kusvikira munguva pfupi ichangopfuura imwe yero yakareba yekare yakarongwa yakawanikwa apo yakaenzanisa kupindira kwekuvhiya nekuchengetedza kurapa kwevarwere vane sciatica. [16] Ongororo iyi yakaratidza kuti kupindira kwekupora kwaive nemigumisiro iri nani mushure megore rimwe chete, asi shure kwechina uye 10 makore ekutevera pasina Kusiyana kwakawanikwa. [16]

 

Kubvunzurudzwa kweCochrane kwakapfupikisa zvinowanikwa mumakiriniki ekuedza kuongorora chirwere che disc uye chemonucleolysis. [17] Mu chemonucleolysis mu enzyme chymopapain inorowa mu discus nechinangwa chokuderedza nucleus pulposus. Kudzokorora kwakaburitsa mhinduro dzakanaka nekuvhiyiwa kwebhuku kupfuura chemonucleolysis muvarwere vane sciatica yakaoma yenguva yakareba yakasiyana kubva pane vhiki dzinopfuura mana kusvika kumwedzi mina. Chemonucleolysis yakashanda kupfuura placebo. Nokusaziva saka kubvunzurudzwa kunoratidzira kuti chirwere chepachi chinoshanda zvakanyanya pane placebo. Pamusoro pezvinyorwa kubva kumitatu mitatu vanyori vakagumisa kuti uchapupu hwakawanda kwazvo kuti chirwere chinonzi discectomy chinopa rubatsiro rwekliniki inobudirira yevanyori vakasarudzwa nevarwere vane sciatica sechikonzero che lumbar disc prolapse iyo inokundikana kugadzirisa nekuchengetedza kwakachengeteka. Kuongororwa kwechangobva kuitika kwakasvika pakuguma kwakafanana. [18] Ongororo yeCochrane yakagumisa zvakare kuti nguva yakareba inoguma yekupindira kwekuvhiya haina kunyatsojeka uye kuti uchapupu panguva yakanakisisa yekuvhiya inoshaikwa zvakare. [17]

 

Randomized Controled Trials Hatisati Yakabatanidzwa Mukugadziriswa Kwakarongeka

 

Mimwe miviri miviri yakarongedzwa yakaongororwa yakave yakabudiswa kuenzaniswa nekuvhiyiwa kwechirwere nekuchengetedzwa kwekuchengetedza. Chimwe chiedzo (n = 56) chakaenzanisa microdiscectomy nekuchengetedza kurapwa kune varwere vakanga vambova nesciatica kwemavhiki matanhatu kusvika ku12. [19] Pasi rose, hapana kusiyana kwakasiyana-siyana kwakakonzerwa nemarwadzo emakumbo, kurwadziwa shure, uye kuremara kwepamusoro pemakore maviri ekutevera- up. Zvisinei, kurwadziwa kwegumbo, zvisinei, kwakaratidza kuti pakutanga kunowedzera nekukurumidza kune varwere mu discectomy boka. Mukuru wevarwere vechipfuva anowedzera kutsvakurudza mutsva (chirongwa chisinganzwisisiki) uye kuenzanirana kwekucherechedza boka rekuongorora kwakaitwa kuUnited States. [20, 21] Varwere vane sciatica kwemavhiki masere uye vakatsigisa rutsigiro rwakakokwa kuti vabatanidzwe mune rimwe randomized kuedza kana kuongorora kuongorora boka. Varwere vari mukutongwa vaisarudzwa kuti vavhiwe nehana kana kuti kuchengetedzeka. Vashandi vari muboka rekutora vakagamuchira kuvhiyiwa dare kana kuchengetedzwa kwakachengeteka zvichienderana nezvavanoda. Mumutambo we randomized (n = 501) mapoka maviri ekurapwa akavandudza zvakapfuura makore maviri kuti zvikamu zvose zvepakutanga uye zvechipiri zviitike. Kusiyana kwakakura kwakawanikwa mukufarira boka rekuvhiya, asi izvi hazvina kunyanya kukosha kune zvidzidzo zvinotanga kuitwa. Chengetani 50% yevarwere vakashandurwa pakuvhiyiwa kwakagadzirwa kuvhiyiwa mukati memwedzi mitatu yekubatanidzwa kana ichienzanisa ne30% randomized to caring care. Pashure pemakore maviri ekutevera 45% yevarwere muboka rekuchengetedza rekuchengetedza rakaitwa chirwere ichienzaniswa ne60% muboka rekuvhiya. [20]

 

Ikokucherechedza boka rinosanganisira varwere ve743. Mapoka maviri aya akavandudzika kwenguva refu, asi boka rekuvhiya rakaratidza migumisiro yakanakisisa yekutambudzika uye basa nekuenzaniswa neboka rakachengetedza. Vanyori vakataura nezvekuchenjerera mukududzira zvitsva nekuda kwekuvhiringidzika nekuratidzwa uye nekuti zviyamupinzo zvingangove zvakataurwa. [21]

 

Zvigumisiro zvinoratidza kuti maviri ekuchengetedza kwekuchengetedza uye chirwere chekubudisa chinokodzera kurapwa kwevarwere vane sciatica yekusvitsa kwemavhiki masere. Kupindira kwekuvhiya kunogona kupa rubatsiro runokurumidza rwezviratidzo zvichienzaniswa nekuchengetedzwa kwekuchengetedza, asi hapana kusiyana kwakakura kwakawanikwa mukubudirira kwehuwandu mushure memakore maviri kana maviri ekutevera. Varwere uye vanachiremba vanogona kuongorora kubatsirwa uye kuipa kwezvinhu zvose zviri zviviri kusarudza munhu oga. Izvi zvinonyanya kukosha nokuti varwere 'sarudzo yekurapa inogona kunge ine simba rakananga kuhukuru hwehutano hwekurapa.

 

Ndezvipi Mapurisa muKliniki Guidelines?

 

Kunyangwe munyika zhinji maratidziro emakiriniki aripo ekutungamira kweasina-chaiwo marwadzo ekudzokera kumashure iyi haisi iyo sciatica. [22] Pazasi panoratidza kurudziro yesciatica (lumbosacral radicular syndrome) mumakiriniki mirau ichangoburwa neDutch College yeGeneral Practice. [W4] Mushure mekubvisa zvimwe zvirwere pahwaro hwemireza mitsvuku, sciatica inoonekwa pachishandiswa nhoroondo kutora uye kuongorora kwepanyama. . Chekutanga kurapwa kunochengetedza, nekutarisa kwakasimba pane dzidzo yemurwere, kuraira kwekugara uchishanda, kuenderera kwezviitwa zvezuva nezuva, uye kurapwa kwakakwana kwekurwadziwa. Muchikamu ichi imaging haina basa. Kuendeswa kuna chiremba wezvekurapa - semuenzaniso, chiremba wezveuropi, rheumatologist, musana wekuvhiya zvinoratidzwa kune varwere vane zviratidzo zvisingavandudzike mushure mekurapa kwekuchengetedza kweanenge mavhiki matanhatu kusvika matanhatu. Muzviitiko izvi zvinotaurwa kuvhiyiwa kunogona kutariswa. Kuendesa nekukurumidza kunoratidzwa mune zviitiko zvine cauda equina syndrome. Acute yakaoma paresis kana inofambira mberi paresis zvakare zvikonzero zvekutumira (mukati memazuva mashoma).

 

Clinical Guideline yekuongorora nekurapa kwaSciatica kubva kuDutch College yeGener Practice [w4]

 

kuongorora chirwere

 

• Chengetedza mutsvuku mamiriro ezvinhu, zvakadai se-malignancies, osteoporotic fractures, radiculitis, uye cauda equina syndrome
• Tora nhoroondo kuti uone kunzvimbo yako; kuoma; kurasikirwa kwesimba; kunetseka kwekunzwisisa; duration; course; simba rokukanganiswa, kuzorora, kana kufamba; uye migumisiro yemabasa ezuva nezuva
• Ita ongororo yemuviri, kusanganisira kuyedzwa kweiyo neurological somuenzaniso, yakatwasuka gumbo rekumutsa bvunzo (chiratidzo cheLas gue)
• Ita zvinotevera bvunzo muzviitiko zvine dermatomal pateni, kana mhedzisiro yakanaka pakatwasuka gumbo rekumutsa bvunzo, kana kurasikirwa kwesimba kana kunetseka kusagadzikana: mafungiro (Achilles kana mabvi tendon), kunzwisisika kwenzvimbo dzekutenderera uye dzepakati dzetsoka nezvigunwe, simba re chigunwe chikuru panguva yekuwedzera, kufamba pamusoro zvigunwe uye chitsitsinho (kuruboshwe-kurudyi misiyano), kuyambuka chiratidzo chaLas gue
• Kufananidza kana mabhizinesi ekuongororwa mutsara kunongoratidzwa chete muhope mutsvuku asi hahubatsiri mumamiriro ezvinhu ekufungidzirwa kuburitsa

 

mabatiro

 

• Tsanangura zvinokonzera zviratidzo uye kuvimbisa varwere kuti zviratidzo zvinowanzopera kudarika nguva pasina zviyero zvakananga
• Inokurudzira kuti ugare wakashanda uye uite mabasa ezuva nezuva; Maawa mashomanana ekuzorora pamubhedha angapa humwe hurumende yekusununguka asi haibvumi kukurumidza kupora
• Ipa zvinodhaka, kana zvichidikanwa, maererano nematanho mana: (1) paracetamol; (2) kwete-steroidal anti-inflammatory drugs; (3) tramadol, paracetamol, kana kuti kwete-steroidal anti-inflammatory drug pamwe ne codeine; uye (4) morphine
• Tarisa neurosurgeon pakarepo muzviitiko zve cauda equina syndrome kana kuti yakaoma kwazvo paresis kana kuti progressive paresis (mukati memazuva mashoma)
• Tarisa kune chirwere chinonzi neurologist, neurosurgeon, kana chirwere chechiremba kuti chiongorore kuvhiyiwa muzviitiko zvekushungurudzika kunokonzera kusuruvara (kwete kupindura morphine) kana kana kurwadziwa kusingaderedzi mushure mevhiki ya 6-8 yekuchengetedza kwakachengeteka

 

Mazano Anopikira

 

Uhu humwe humwe uchapupu hwakagadzirwa huripo hunoonekwa pahutano hwekuchengetedzwa kwekuvhiya kana uchienzaniswa nekuchengetedzwa kwakachengeteka kune varwere vane sciatica. Kunyange zvazvo uchapupu hushoma, kuwanikwa kwokutanga kunoratidza kuti hapana kusiyana kwakakosha munguva yakareba (yakapera makore maviri kana maviri) pakati penzira idzi mbiri. Izvi zvinogona kunge zvichitsanangurwa nevarwere vakambotambira kuchengetedzwa kwakachengeteka mushure mekunge vachivhiyiwa nehana. Muzvidzidzo zvose zviripo zvinoratidzika kuti chikamu chikuru chevarwere chinowedzera nekufamba kwenguva. Izvi zvinotsigira kuvarwere vari kuvhiyiwa kana kugamuchira kutarisirwa kwekuchengetedza. Varwere vari kuitirwa chirwere chebhuku zvinowanzoita kuti vape kukurumidza kununurwa kwezviratidzo zvemagumbo pane varwere vanogadzirirwa kuchengetedzwa. Kana zviratidzo zvisingagadziri mushure mekunge vhiki ye6-8 vasarudza kusarudza kuvhiya. Vaya vanozeza nezvekuvhiyiwa uye vanogona kurarama nemararamiro avo vanogona kusarudza kuramba vachichengetedza. Saka murwere anonyanya kukoshesa chinhu chinokosha pakuita sarudzo.

 

Kubvira pakati pe-1990s shanduko yakaitika mukurayira kweSciatica kubva pamabasa ekurapa, zvakadai sokuzorora pamubhedha, kune imwe nzira inoshingaira, nevarwere vachirairwa kuti varambe vachiita mabasa avo ezuva nezuva sezvinogona.

 

Future Research

 

Mamwe mashoko anonyanya kukosha pamusoro pekukosha kwezviratidzo zvemakiriniki uye zviratidzo zvekutsvaga kwe sciatica uye kupindura kune kurapwa. Izvi zvinosanganisira kukosha kwehukuru nenzvimbo yedhaikisi yekuvhara, kuonekwa kwehutano hwemutsara, kugoverwa, uye migumisiro yehutori inotora uye kuongorora kwepanyama uye kwepfungwa. Kuongororwa kwechikamu chekuongorora muFinnish kwakaratidza kuti discectomy yaive yakakwirira kupfuura yekuchengetedza kurapwa kune varwere vane disc disclaimer paL4-5. [23] Hapana uchapupu hwakasimba huripo kana hunopesana nehutano hwehuwandu hwehutano huripo hunogadziriswa. Kufambira mberi kukuru kunogona kuwanikwa pano. Mibvunzo inoramba iri pamusoro pekubudirira kweanorganics ye sciatica uye kukosha kwehutano hwepanyama uye yehutano hwekudzidza nekupa mazano. Hapana chiedzo chakatarisa kubudirira kwehutano hwekuita uye zvirongwa zvakawanda zvekurapa.

 

Tumor necrosis chinhu? yakaonekwa muzvidzidzo zvemhuka uye zvevanhu sechimwe chinhu mukuvandudzika kweiyo sciatica. [23, 24] Yekutanga randomized kuyedza kuongorora bundu necrosis factor? anopikisana nevarwere vane sciatica havana kuwana mhedzisiro yakanaka. [25]

 

Zvimwe Zvidzidzo Zvidzidzo

 

• BMJ Clinical Evidence (www.clinicalevidence.org)Kusvikira parizvino humbowo hwevarapi pane zvakanakira uye zvinokuvadza zvekurapwa kwezvirwere zvakasiyana siyana
• Cochrane Back Review Group (www.cochrane.iwh.on.ca) Izviitwa zveboka rekudzokorora rinotarisira kunyora zvakarongeka maCochrane ongororo pahunoshanda hwekurapa kwekurwadziwa kwepashure uye sciatica
• Kutambudzika kwakadzoka shure: mirayiridzo yehutungamiri wayo (www.backpaineurope.org)Ichangobva kuburitsa nhungamiro yevatungamiriri vekurwadziwa kwepashure uye sciatica kubva kuEuropean Commission Research Directorate General

 

Pfungwa Yevarwere (A)

 

Mushure mechiitiko che lumbago munguva yezororo ndakaramba ndichinge ndava nemarwadzo ekurwadziwa uye ndakadzika tsoka kwemwedzi mipfumbamwe. Ipapo kamwe kamwe rutsoka rwangu rworudyi rwakatanga kukuvadza zvakaipa uye mushure mechinguva kurwadziwa kwakava kwakanyanya zvokuti ndakange ndisingakwanisi kubva mumba mangu. Nyanzvi iyi yakarayira MRI (magnetic resonance imaging) kuongorora uye yakaratidza huru lumbar disc herniation. Sezvo zvakanyanya kuipa shure kweizvozvo ndakasarudza kuvhiyiwa.

 

Mushure mokuvhiya ndakapora nokukurumidza uye kurwadziwa kweperi uye kurwadziwa kwemakumbo kwakanga kwaenda zvachose. Nenguva isipi ndakakwanisa kudzokera kubasa uye kuvakazve hupenyu hwangu hwemagariro evanhu. Zvinosuruvarisa mushure mekunge mwedzi mishomanana kurwadziwa kwakanyanya kwemuviri uye zvimwe zviratidzo zvinodzoka, kunyange zvazvo zvisina kuoma sezvakaitwa vasati vambovhiyiwa. A new MRI scan ikozvino yakaratidza maitiro maviri maduku ekutengesa uye mbiri dzakashata dzakasiyana-siyana. Nyanzvi yakandiudza kuti yakanga yakatotanga kusvika pakuvhiya kwechipiri.

 

Iye zvino hazvizivikanwi kwandiri izvo chiremba angaita sei pamusoro payo uye handizivi kunyange zviyero zvandinogona kutora ini. Kudzokera shure uye kurwadziwa kwemakumbo kunopindira zvikuru nebasa rangu uye hupenyu hwangu hwemagariro. Dzimwe nguva ndinonzwa semunhu akwegura nekuda kwekukundikana kwangu. Ndinoedza kugara ndakanaka, asi zvakaoma kurarama nekusava nechokwadi.

 

C Kutarisa, mukuru we32, Rotterdam

 

Pfungwa Yevarwere (B)

 

Zvichemo zvangu zvakatanga mwedzi mina yapfuura nekurwadziwa muzasi musana. Nguva pfupi mushure mekunge marwadzo apenya mumakumbo angu, ayo ini ndakaenda kuna chiremba wangu. Kuongorora kwake kwaisave herniated disc. Tsandanyama inozorodza pamwe nekusvitswa kuchipirotherotherapist inoderedza zviratidzo. Mavhiki matatu e physiotherapy akateverwa nemarapirwo akati wandei nechiropractor haana kupa chero zororo zororo. Muchokwadi zviratidzo zvakawedzera kunyanya kunyanya panguva yekufamba uye kumira. Kurara pasi uye kuchovha bhasikoro zvaive zvirinani kubvumidzwa. Zvimwe zvichemo zvakadzikiswa simba mugumbo rekuruboshwe, kusakwanisa kumira pachitsitsinho kana zvigunwe, kunzwa kunotonhora mugumbo repazasi pakupera kwezuva, nepo mangwanani zvaiita sekumira mune boka retsono.

 

Panenge mwedzi mumwe yapfuura nyanzvi yezveuropiyo yakagadziriswa dhiyeni yakaiswa kurutivi rworudyi inobva pane MRI scan yakatorwa. Zvisinei, izvi hazvigone kutsanangura zviratidzo zviri muhudyu wekurudyi. Zviratidzo mujoko roruboshwe zvingave zvichibva pamusana wepinini. Kunyunyuta kwacho kwakanga kusina kukwana kukurudzira kuvhiyiwa uye nyanzvi yehutano yakandiudza kuti kuvandudzwa kwakakura kwaifanira kutarisirwa mukati memwedzi ye3-4. Mazano ake aifanira kuramba achiita mabasa ezuva nezuva zvakanyanya. Panguva ino (mwedzi umwe gare gare) ndinonzwa kuchinjeka kwezviratidzo zvangu.

 

J Vreuls, akwegura 49, The Hague

 

Supplementary Material

 

Tsamba dzepaIndaneti: www.ncbi.nlm.nih.gov/pmc/articles/PMC1895638/bin/bmj_334_7607_1313__index.html

 

Notes

 

• Vabatsiri: BWK akanyora the first draft. MWvT uye WCP vakanyatsonzwisisa uye vakavandudza zvinyorwa. BWK is guarantor.
• Kukwikwidzana: Hapana chakaziviswa.
• Provenance uye peer review: Kutumirwa; vezera rinongororwa.

 

Mukupedzisa,Irchiropractic kuchengetedza ndiyo inozivikanwa nzira yekurapa sarudzo inowanzo shandiswa kurapa sciatica zviratidzo. Kunyange sciatic nerve pain inogona kuitika nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro, chinangwa chechiropractic kuchengetedza ndiko kuziva kunobva sciatica yemurwere kuitira kuti vabate zvakanaka zviratidzo zvavo vachishandisa nzira dzakasiyana dzekurapa. Chinyorwa chiri pamusoro apa chinoratidza akati wandei marapirwo ekurapa sciatica, zvisinei, zvimwe zvidzidzo zvekutsvagisa zvinodiwa. Ruzivo rwunotsanangurwa kubva kuNational Center yeBiotechnology Ruzivo (NCBI). Chiyero cheruzivo rwedu chinogumira kuchiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kutibata nesu pa 915-850-0900 .

 

Yakarongedzwa naDkt Alex Jimenez

 

 

 

Zvimwe Zvinyorwa: Kubva Painini

 

Maererano nehuwandu, inenge 80% yevanhu ichaona zviratidzo zvekurwadziwa shure shure kamwechete munguva yeupenyu hwavo hwose. Kutambudzika shure ndiko kunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Kazhinji kacho, kuora kwechimiro chemupaka nezera kunogona kukonzera marwadzo kumashure. Herniated discs inoitika apo ganda rakanyorova, segel-like re intervertebral disc rinodonha nekubvarura mukati maro, rinenge riri kunze kwekatekete, kubvongodza nekugumbura midzi midzi. Dhizinesi dzinozivikanwa dzinowanzoitika kumucheto kumashure, kana kuti nhengo dzomukati, asi dzinogonawo kuitika pamucheto wepervical, kana mutsipa. Kuiswa kwemitsipa inowanikwa mucheka shure nekuda kwekukuvara uye / kana mamiriro akaoma kunogona kutungamirira kune zviratidzo zve sciatica.

 

NHAURWA INOKOSHA INOKOSHA: Migraine Pain Treatment

 

 

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