Zolakwika za odwala opaleshoni ndi malo ovulala ndi zazikulu ndipo zitha kupewedwa. Malinga ndi Joint Commission on Accreditation of Healthcare Organizations, zolakwika zotere zimatha kuchitika pa 41% ya opaleshoni ya mafupa/ana. Pa opaleshoni ya msana, cholakwika cha malo ovulala chimachitika pamene gawo la msana kapena lateralization si yolondola. Kuwonjezera pa kulephera kuthana ndi zizindikiro ndi matenda a wodwalayo, zolakwika za magawo zingayambitse mavuto atsopano azachipatala monga kuwonongeka kwa disc mwachangu kapena kusakhazikika kwa msana m'magawo omwe alibe zizindikiro kapena abwinobwino.
Palinso nkhani zamalamulo zokhudzana ndi zolakwika za msana pa opaleshoni ya msana, ndipo anthu onse, mabungwe aboma, zipatala, ndi mabungwe a madokotala opaleshoni salola zolakwika zotere. Maopaleshoni ambiri a msana, monga discectomy, fusion, laminectomy decompression, ndi kyphoplasty, amachitidwa pogwiritsa ntchito njira yolowera kumbuyo, ndipo malo oyenera ndi ofunikira. Ngakhale ukadaulo wamakono wojambulira zithunzi, zolakwika za msana zimachitikabe, ndipo kuchuluka kwa zochitika kuyambira 0.032% mpaka 15% zanenedwa m'mabuku. Palibe lingaliro loti ndi njira iti yodziwira malo yomwe ndi yolondola kwambiri.
Akatswiri ochokera ku Dipatimenti ya Opaleshoni ya Mafupa ku Mount Sinai School of Medicine, USA, adachita kafukufuku wa mafunso pa intaneti womwe ukusonyeza kuti madokotala ambiri a msana amagwiritsa ntchito njira zochepa chabe zodziwira komwe kuli, ndipo kuti kufotokozera zomwe zimayambitsa zolakwika nthawi zonse kungakhale kothandiza kuchepetsa zolakwika za opaleshoni, m'nkhani yomwe idasindikizidwa mu Meyi 2014 mu Spine J. Kafukufukuyu adachitika pogwiritsa ntchito mafunso otumizidwa ndi imelo. Kafukufukuyu adachitika pogwiritsa ntchito ulalo wotumizidwa ndi imelo ku mafunso otumizidwa kwa mamembala a North American Spine Society (kuphatikiza madokotala a mafupa ndi ma neurosurgeon). Mafunsowo adatumizidwa kamodzi kokha, monga momwe bungwe la North American Spine Society lidalimbikitsira. Madokotala onse 2338 adalandira, 532 adatsegula ulalowu, ndipo 173 (7.4% ya mayankho) adamaliza mafunsowo. Makumi asanu ndi awiri mphambu awiri pa zana a omwe adamaliza anali madokotala a mafupa, 28% anali madokotala a mitsempha, ndipo 73% anali madokotala a msana omwe anali mu maphunziro.
Mafunso onsewa anali ndi mafunso 8 (Chithunzi 1) okhudza njira zomwe zimagwiritsidwa ntchito kwambiri pofotokozera malo (zonse zizindikiro za thupi ndi malo ojambulira zithunzi), kuchuluka kwa zolakwika za opaleshoni m'magawo, komanso mgwirizano pakati pa njira zofotokozera malo ndi zolakwika za m'magawo. Mafunsowa sanayesedwe kapena kutsimikiziridwa mwachiyembekezo. Mafunsowa amalola mayankho angapo.
Chithunzi 1 Mafunso asanu ndi atatu ochokera mufunso. Zotsatira zake zasonyeza kuti fluoroscopy mkati mwa opaleshoni ndiyo njira yodziwika kwambiri yodziwira malo a opaleshoni ya msana wa posterior thoracic ndi lumbar (89% ndi 86%, motsatana), kutsatiridwa ndi x-ray (54% ndi 58%, motsatana). Madokotala 76 adasankha kugwiritsa ntchito njira zonse ziwiri kuti adziwe malo. Njira za spinous ndi pedicles zofanana ndizo zinali zizindikiro zodziwika kwambiri za anatomic pa opaleshoni ya msana wa thoracic ndi lumbar (67% ndi 59%), kutsatiridwa ndi njira za spinous (49% ndi 52%) (Chithunzi 2). Madokotala 68% adavomereza kuti adachita zolakwika za malo m'machitidwe awo, zina mwa izo zidakonzedwa mkati mwa opaleshoni (Chithunzi 3).
Chithunzi 2. Njira zojambulira ndi kutanthauzira malo a malo omwe agwiritsidwa ntchito.
Chithunzi 3 Dokotala ndi kukonza zolakwika za gawo la opaleshoni panthawi ya opaleshoni.
Pa zolakwika za malo, 56% ya madokotalawa adagwiritsa ntchito ma x-ray asanachite opaleshoni ndipo 44% adagwiritsa ntchito fluoroscopy mkati mwa opaleshoni. Zifukwa zomwe zimachitika nthawi zambiri zolakwika za malo ogwirira ntchito asanachite opaleshoni zinali kulephera kuwona malo odziwika bwino (monga, msana wa sacral sunaphatikizidwe mu MRI), kusintha kwa thupi (vertebrae yosunthika ya lumbar kapena nthiti za mizu 13), ndi kusamveka bwino kwa magawo chifukwa cha thanzi la wodwalayo (kuwonetseredwa kwa X-ray kosakwanira). Zomwe zimayambitsa zolakwika za malo ogwirira ntchito mkati mwa opaleshoni ndi monga kusalumikizana bwino ndi fluoroscopist, kulephera kuyikanso malo pambuyo poyika (kusuntha kwa singano yoyika pambuyo pa fluoroscopy), ndi malo olakwika ofotokozera panthawi yoyika (lumbar 3/4 kuchokera ku nthiti kupita pansi) (Chithunzi 4).
Chithunzi 4 Zifukwa za zolakwika za malo asanayambe opaleshoni ndi mkati mwa opaleshoni.
Zotsatira zomwe zili pamwambapa zikusonyeza kuti ngakhale pali njira zambiri zodziwira komwe kuli, madokotala ambiri amagwiritsa ntchito njira zochepa chabe. Ngakhale kuti zolakwika za opaleshoni ya m'magawo sizichitika kawirikawiri, makamaka sizipezeka. Palibe njira yodziwika bwino yochotsera zolakwikazi; komabe, kutenga nthawi yokonza malo ndi kuzindikira zomwe zimayambitsa zolakwika za m'magawo kungathandize kuchepetsa kuchuluka kwa zolakwika za opaleshoni ya m'magawo mu msana wa thoracolumbar.
Nthawi yotumizira: Julayi-24-2024
