Zvikanganiso zvemurwere wekuvhiyiwa uye nzvimbo yacho zvakakomba uye zvinogona kudzivirirwa. Sekureva kweJoint Commission on Accreditation of Healthcare Organizations, zvikanganiso zvakadaro zvinogona kuitwa muzvikamu zvinosvika 41% zvekuvhiyiwa kwemapfupa/vana. Pakuvhiyiwa kwemusana, kukanganisa kwenzvimbo yekuvhiyiwa kunoitika kana chikamu chemusana kana mativi emusana asina kururama. Pamusoro pekukundikana kugadzirisa zviratidzo nezvirwere zvemurwere, zvikanganiso zvezvikamu zvinogona kutungamira kumatambudziko matsva ekurapa akadai sekukurumidzira kuora kwediski kana kusagadzikana kwemusana muzvikamu zvisingawanzoonekwi kana zvakajairika.
Kunewo nyaya dzemutemo dzine chekuita nekukanganisa kwezvikamu mukuvhiyiwa kwemusana, uye veruzhinji, masangano ehurumende, zvipatara, uye masangano evanachiremba vanovhiya havabvumiri zvikanganiso zvakadaro. Kuvhiyiwa kwemusana kwakawanda, kwakadai se discectomy, fusion, laminectomy decompression, uye kyphoplasty, kunoitwa uchishandisa nzira yekumashure, uye nzvimbo yakakodzera yakakosha. Pasinei netekinoroji yemifananidzo iripo, zvikanganiso zvezvikamu zvichiri kuitika, nehuwandu hwezviitiko zvinotangira pa0.032% kusvika 15% zvinotaurwa mumabhuku. Hapana mhedziso yekuti ndeipi nzira yekuisa nzvimbo yakarurama.
Nyanzvi dzinobva kuDhipatimendi reKuvhiya Mafupa paMount Sinai School of Medicine, USA, dzakaita ongororo yemibvunzo online dzichiratidza kuti vazhinji vevanachiremba vemapfupa emusana vanoshandisa nzira shoma dzekuziva nzvimbo, uye kuti kujekesa zvikonzero zvinowanzokonzera kukanganisa kunogona kushanda mukuderedza zvikanganiso zvechikamu chekuvhiya, munyaya yakaburitswa muna Chivabvu 2014 muSpine J. Chidzidzo ichi chakaitwa uchishandisa mibvunzo yakatumirwa neemail. Chidzidzo ichi chakaitwa uchishandisa link yakatumirwa neemail kuenda kumibvunzo yakatumirwa kunhengo dzeNorth American Spine Society (kusanganisira vanachiremba vemapfupa emusana nevanovhiya neurosurgeons). Mibvunzo yakatumirwa kamwe chete, sezvakakurudzirwa neNorth American Spine Society. Vanachiremba vanosvika 2338 vakaigamuchira, 532 vakavhura link yacho, uye 173 (7.4% response rate) vakapedza mibvunzo. Makumi manomwe nemaviri muzana evaya vakapedza vaiva vanachiremba vemapfupa emusana, 28% vaiva vanachiremba veuropi, uye 73% vaiva vanachiremba vemapfupa emusana vari kudzidziswa.
Mibvunzo iyi yaive nemibvunzo misere (Mufananidzo 1) inosanganisira nzira dzinonyanya kushandiswa dzekutsvaga nzvimbo (zvese zviratidzo zvemuviri uye nzvimbo yekufungidzira), kuwanda kwezvikanganiso zvezvikamu zvekuvhiya, uye hukama huripo pakati penzira dzekutsvaga nzvimbo nezvikanganiso zvezvikamu. Mibvunzo iyi haina kuongororwa kana kusimbiswa. Mibvunzo iyi inobvumira mhinduro dzakawanda.
Mufananidzo 1 Mibvunzo misere kubva mumubvunzo. Zvakabuda zvakaratidza kuti fluoroscopy panguva yekuvhiyiwa ndiyo nzira inonyanya kushandiswa yekuona nzvimbo yemurwere wekuvhiyiwa kwemusana wechipfuva nepamusana wechiuno (89% ne86%, zvichiteerana), ichiteverwa neX-ray (54% ne58%, zvichiteerana). Vanachiremba 76 vakasarudza kushandisa musanganiswa wenzira dzese dziri mbiri dzekuona nzvimbo. Maitiro espinous uye pedicles dzinoenderana ndiwo ainyanya kushandiswa pakuvhiyiwa kwemusana wechipfuva nepamusana wechipfuva (67% ne59%), ichiteverwa nemaitiro espinous (49% ne52%) (Mufananidzo 2). 68% yevanachiremba vakabvuma kuti vakaita zvikanganiso zvenzvimbo yemuviri mumabasa avo, zvimwe zvacho zvakagadziriswa panguva yekuvhiyiwa (Mufananidzo 3).
Mufananidzo 2. Nzira dzekufungidzira uye dzekutarisa nzvimbo dzemuviri dzinoshandiswa.
Mufananidzo 3. Chiremba uye kugadziriswa kwezvikanganiso zvechikamu chekuvhiya panguva yekuvhiyiwa.
Pakukanganisa kwenzvimbo, 56% yevanachiremba ava vakashandisa radiographs vasati vavhiyiwa uye 44% vakashandisa fluoroscopy mukati mekuvhiyiwa. Zvikonzero zvinowanzoitwa zvekukanganisa kwekuisa nzvimbo pamberi pekuvhiyiwa kwaive kutadza kuona nzvimbo inozivikanwa yekunongedzera (semuenzaniso, musana wesacral hauna kuiswa muMRI), kusiyana kwemaatomu (lumbar displaced vertebrae kana 13-root ribs), uye kusanzwisisika kwezvikamu nekuda kwemamiriro emuviri wemurwere (suboptimal X-ray display). Zvikonzero zvinowanzoitwa zvekukanganisa kwekuisa nzvimbo mukati mekuvhiyiwa zvinosanganisira kusakwanisa kutaurirana ne fluoroscopist, kutadza kuisa panzvimbo imwe mushure mekuiisa (kufamba kwetsono yekuisa nzvimbo mushure mekuiisa fluoroscopy), uye nzvimbo dzisina kururama dzekuisa panzvimbo panguva yekuiisa (lumbar 3/4 kubva kumbabvu zvichidzika) (Mufananidzo 4).
Mufananidzo 4. Zvikonzero zvekukanganisa kwenzvimbo yemuviri usati wavhiyiwa uye usati wavhiyiwa.
Zvakabuda pamusoro apa zvinoratidza kuti kunyangwe paine nzira dzakawanda dzekuziva nzvimbo, ruzhinji rwevanachiremba vanovhiya vanoshandisa shoma dzacho. Kunyangwe zvikanganiso zvekuvhiya zvikamu zvisingawanzoitiki, zvakanaka kuti zvisavepo. Hapana nzira yakajairika yekubvisa zvikanganiso izvi; zvisinei, kutora nguva yekuita zvikanganiso zvekuisa nzvimbo uye kuona zvikonzero zvinowanzoita zvikanganiso zvekuisa nzvimbo kunogona kubatsira kuderedza kuwanda kwezvikanganiso zvekuvhiya zvikamu mumusana we thoracolumbar.
Nguva yekutumira: Chikunguru-24-2024
