Iimpazamo zesigulana esityandwayo kunye nendawo esikuyo zinkulu kwaye zinokuthintelwa. Ngokutsho kweJoint Commission on Accreditation of Healthcare Organisations, ezo mpazamo zinokwenziwa ukuya kuthi ga kwi-41% yotyando lwamathambo/lwabantwana. Kutyando lomqolo, impazamo yendawo esikuyo xa i-vertebral segment okanye i-lateralization ingalunganga. Ukongeza ekungajonganeni neempawu kunye ne-pathology yesigulana, iimpazamo ze-segmental zinokukhokelela kwiingxaki ezintsha zonyango ezifana nokuwohloka kwediski ngokukhawuleza okanye ukungazinzi komqolo kwiindawo ezingaqhelekanga okanye eziqhelekileyo.
Kukwakho nemiba yezomthetho enxulumene neempazamo zecandelo kutyando lomqolo, kwaye uluntu, iiarhente zikarhulumente, izibhedlele, kunye neentlangano zoogqirha botyando azizinyamezeli kwaphela ezo mpazamo. Utyando oluninzi lomqolo, olufana ne-discectomy, i-fusion, i-laminectomy decompression, kunye ne-kyphoplasty, lwenziwa kusetyenziswa indlela engasemva, kwaye indawo efanelekileyo ibalulekile. Nangona ubuchwepheshe bokufota bukhona, iimpazamo zecandelo zisaqhubeka, kunye namazinga okuvela aqala kwi-0.032% ukuya kwi-15% exeliweyo kwiincwadi. Akukho sigqibo sokuba yeyiphi indlela yokuchaza indawo echanekileyo.
Iingcali ezivela kwiSebe lezoNyango lwamathambo kwiSikolo sezonyango saseMount Sinai, eMelika, zenze uphando lwemibuzo ekwi-intanethi olubonisa ukuba uninzi loogqirha botyando lomqolo basebenzisa iindlela ezimbalwa kuphela zokufumana indawo, kwaye ukucaciswa kwezizathu eziqhelekileyo zeempazamo kunokuba luncedo ekunciphiseni iimpazamo zotyando lwecandelo, kwinqaku elapapashwa ngoMeyi 2014 kwiSpine J. Olu phononongo lwenziwe kusetyenziswa umbuzo othunyelwe nge-imeyile. Olu phononongo lwenziwe kusetyenziswa ikhonkco elithunyelwe nge-imeyile kwimibuzo ethunyelwe kumalungu eNorth American Spine Society (kuquka oogqirha botyando lwamathambo kunye noogqirha be-neurosurgeons). Umbuzo uthunyelwe kube kanye kuphela, njengoko kucetyisiwe yiNorth American Spine Society. Oogqirha abangama-2338 bafumene, abangama-532 bavula ikhonkco, kwaye abali-173 (izinga lempendulo elingu-7.4%) bagqibezela umbuzo. Amashumi asixhenxe anesibini ekhulwini labo bagqibileyo yayingoogqirha botyando lwamathambo, ama-28% yayingoogqirha botyando lwamathambo, kwaye ama-73% ayengoogqirha bomqolo abasaqeqeshwayo.
Le mibuzo yayinemibuzo esi-8 iyonke (Umzobo 1) equka iindlela ezisetyenziswa kakhulu zokufumana indawo (zombini iimpawu zomzimba kunye nendawo yokujonga imifanekiso), ukwenzeka kweempazamo zotyando lwecandelo, kunye nonxulumano phakathi kweendlela zokufumana indawo kunye neempazamo zecandelo. Le mibuzo ayizange ivavanywe okanye iqinisekiswe njengovavanyo. Le mibuzo ivumela ukhetho lweempendulo ezininzi.
Umfanekiso 1 Imibuzo esibhozo evela kwimibuzo. Iziphumo zibonise ukuba i-fluoroscopy ngexesha lotyando yeyona ndlela isetyenziswa kakhulu yokwahlulahlula umqolo kwi-posterior thoracic kunye ne-lumbar spine surgery (89% kunye ne-86%, ngokulandelelana), kulandele ii-radiographs (54% kunye ne-58%, ngokulandelelana). Oogqirha abangama-76 bakhethe ukusebenzisa indibaniselwano yezi ndlela zombini zokwahlulahlula umqolo. Iinkqubo ze-spinous kunye ne-pedicles ezihambelanayo zezona zinto zisetyenziswa kakhulu kwi-anatomic surgery kwi-thoracic kunye ne-lumbar spine surgery (67% kunye ne-59%), kulandele iinkqubo ze-spinous (49% kunye ne-52%) (Umfanekiso 2). Ama-68% oogqirha bavumile ukuba benze iimpazamo ze-segmental localization emsebenzini wabo, ezinye zazo zalungiswa ngexesha lotyando (Umfanekiso 3).
Umzobo 2 Iindlela zokubonisa imifanekiso kunye neendlela zokufumana indawo yesakhiwo se-anatomical ezisetyenzisiweyo.
Umzobo 3 Ugqirha kunye nokulungiswa kweempazamo zecandelo lotyando ngexesha lotyando.
Kwiimpazamo zendawo, ama-56% aba gqirha basebenzise ii-radiographs zangaphambi kotyando kwaye ama-44% asebenzise i-fluoroscopy yangaphakathi kotyando. Izizathu eziqhelekileyo zeempazamo zokubeka ngaphambi kotyando yayikukungaphumeleli ukubona indawo eyaziwayo yokubhekisa (umz., umqolo we-sacral wawungafakwanga kwi-MRI), utshintsho lwe-anatomical (i-lumbar displaced vertebrae okanye iimbambo zeengcambu ezili-13), kunye nokungacaci kwecandelo ngenxa yemeko yomzimba yesigulana (ukuboniswa kwe-X-ray okungenamsebenzi). Izizathu eziqhelekileyo zeempazamo zokubeka emva kotyando ziquka unxibelelwano olunganelanga ne-fluoroscopist, ukungaphumeleli kokubeka kwakhona emva kokubeka (ukushukuma kwenaliti yokubeka emva kwe-fluoroscopy), kunye neendawo zokubhekisa ezingachanekanga ngexesha lokubeka (i-lumbar 3/4 ukusuka kwiimbambo ukuya ezantsi) (Umfanekiso 4).
Umzobo 4 Izizathu zeempazamo zokubekwa kwindawo ngaphambi kotyando kunye nangaphambi kotyando.
Iziphumo ezingentla zibonisa ukuba nangona zininzi iindlela zokufumana indawo, uninzi loogqirha basebenzisa ezimbalwa kuphela zazo. Nangona iimpazamo zotyando lwecandelo zinqabile, ngokuqinisekileyo azikho. Akukho ndlela iqhelekileyo yokususa ezi mpazamo; nangona kunjalo, ukuthatha ixesha lokwenza indawo kunye nokuchonga izizathu eziqhelekileyo zeempazamo zokubeka indawo kunokunceda ukunciphisa ukwanda kweempazamo zotyando lwecandelo kumqolo we-thoracolumbar.
Ixesha leposi: Julayi-24-2024
