ʻO ka ʻae ʻana o ka poʻe loea e pili ana i ka maʻi a me ka mālama ʻana no ka degenerative lumbar spinal stenosis

I ka makahiki o ka heluna kanaka, ua lilo ka degenerative lumbar spinal stenosis (DLSS) i kekahi o nā kūlana orthopedic maʻamau, e hoʻopilikia nui ana i ka maikaʻi o ke ola a me ke olakino kino a me ka noʻonoʻo o ka poʻe waena a me ka poʻe ʻelemakule.

Hoʻopaʻapaʻa mau ka ʻike a me ka mālama ʻana i ka DLSS. No kēia kumu, ua hoʻokumu ka North American Spine Society (NASS) i nā alakaʻi no ka hōʻailona a me ka mālama ʻana i ka DLSS ma 2011, a ua paʻi ʻia ka Chinese Expert Consensus on Surgical Treatment Specification for Lumbar Spinal Stenosis ma 2014. I nā makahiki i hala iho nei, me ka puka ʻana a me ka hoʻomohala ʻana i nā ʻenehana diagnostic a me nā ʻano lapaʻau liʻiliʻi a me ka manaʻo o ka hoʻihoʻi wikiwiki ʻana ma hope o ka ʻoki ʻana (ERAS), ua loli nui ka maʻi a me ka mālama ʻana i ka DLSS, a he pono e hoʻohui a hoʻonui i nā alakaʻi diagnostic a me ka mālama ʻana a i ʻole ka ʻae ʻana. Hoʻomaka ʻia e ka Osteoporosis Prevention and Rehabilitation Committee o ka Chinese Society of Rehabilitation Medicine a me ka Orthopedic Minimally Invasive Branch o ka China Geriatrics and Healthcare Association, ua hoʻokumu ʻia kahi nīnau nīnau ma o ka hoʻohana ʻana i ke ʻano noiʻi noiʻi Delphi i hoʻololi ʻia a me ka loiloi palapala, a me nā mea i loko. ʻO ka nīnau nīnau i loaʻa i ka ʻae ʻia o ka ʻoi aku ma mua o 75% o ka poʻe loea (me ka ʻaelike a me ka ʻaelike kumu) ua hoʻokomo ʻia i loko o ka ʻae ʻae ʻana e nā poʻe loea home kaulana i ka ʻoki ʻoki ʻana ma hope o ʻelima mau pōʻai o ke kūkākūkā hālāwai a me ke koho balota. Ua kākau ʻia ka ʻaelike ma muli o kēia ʻae.

10 manaʻo paipai:

Manaʻo 1: ʻO ka DLSS e pili ana i nā hōʻailona kūpono i hana ʻia e ka stenosis o ke kuamoʻo, nā ʻaoʻao ʻaoʻao a me ke aʻa aʻa aʻa ma muli o nā maʻi degenerative, me ka ʻole o ka stenosis i hana ʻia e ka lumbar disc herniation, lumbar instability, lumbar spondylolisthesis or scoliosis.

Manaʻo 2: Hoʻokumu ʻia ka hōʻailona o DLSS ma luna o ① lumbar, ʻūhā a me ka ʻeha haʻahaʻa a i hele pū ʻia me nā hōʻailona lumbar stiffness a me cauda equina me nā hōʻailona claudication intermittent maʻamau; ② nā haʻawina kiʻi e hōʻike ana i ka stenosis canal spinal, stenosis radicular nerve canal, lateral saphenous fossa stenosis a me nā loli ʻē aʻe; ③ nā hōʻailona lapaʻau, nā hōʻailona a me nā hōʻailona o ka stenosis segmental canal.

Manaʻo 3: Selective nerve root block he auxiliary diagnostic percutaneous puncture technique, hiki ke hoʻomaʻamaʻa i ka pūnaewele stenosis kuleana a loaʻa ka waiwai noiʻi lapaʻau maikaʻi, a hiki ke koho koho ʻia i nā haukapila me nā kūlana.

Manaʻo 4: Pono e mālama ʻia nā maʻi me DLSS e koho i ka lāʻau lapaʻau ʻole me nā lāʻau anti-inflammatory, analgesic, vasodilator a me nā lāʻau hānai nerve, a e loiloi ʻia ka maikaʻi ma hope o 3 mau mahina o ka lāʻau lapaʻau maʻamau.

Manaʻo 5: ʻO ka decompression maʻalahi o ka spinal canal ke ʻano o ka koho no ka mālama ʻana i ka DLSS, me ka nui o ka wehe ʻana o ka lamina a me ka synovium i hoʻoholo ʻia e ke kiʻekiʻe o ka spinal stenosis a me ka hyperplasia synovial.

Manaʻo 6: ʻO ka wehe ʻana i ka spinal decompression ke kaʻina hana nui no ka mālama ʻana i ka lumbar spinal stenosis. Ma muli o ka wahi o ka stenosis, pono e koho ʻia kahi manawa hana ʻoi aku ka liʻiliʻi o ka invasive, pōkole o ka hana a me ka wikiwiki o ka hoʻihoʻi ʻana i ka postoperative inā hiki.

Manaʻo 7: Minimally invasive spinal decompression he hana hoʻomaʻamaʻa maikaʻi no ka mālama ʻana i ka DLSS, me nā mea maikaʻi o ka trauma haʻahaʻa, haʻahaʻa postoperative ʻeha, haʻahaʻa haʻahaʻa i ka lumbar stability, etc. Pono e hāʻawi i ka mea nui i ka liʻiliʻi invasive spinal decompression. Manaʻo 8: No nā poʻe maʻi me ka lumbar instability preoperative a i ʻole intraoperative decompression e hiki ke alakaʻi i ka segmental instability, lumbar fixation a me fusion pono e hana i hiki i nā ʻāpana fused ke mālama i ka paʻa mīkini lōʻihi, a me ka pono e hoʻoholo i nā ʻāpana fused e like me nā hōʻailona lapaʻau a me ka laulā decompression. Manaʻo 9: ʻO ka hoʻoponopono kūloko lumbar e hāʻawi koke i ka stabilization ma hope o ka decompression o ka spinal canal. Hoʻoholo ʻia nā ʻāpana hoʻoponopono kūloko e like me ka nui o ka decompression a me ka instability e hoʻonui i ka hopena fusion o ke kaʻina hana.

Manaʻo Manaʻo 10: Pono ka hoʻokele perioperative RAS no DLSS e hoʻoikaika a maʻamau: ka loiloi kūpono ma mua o ka hana, ka hoʻolālā ʻana i ka ʻokiʻoki pololei, ka analgesia prophylactic a me ka hoʻonaʻauao maʻi; ka hoʻomaʻamaʻa haʻahaʻa intraoperative, ka pale neural a me ka palupalu a me ka emi ʻana o ke koko; Pono e hāʻawi ʻia ka analgesia multimodal postoperative a pono e paipai ʻia nā poʻe maʻi e hana i nā hoʻomaʻamaʻa hoʻomaʻamaʻa mua no ka hoʻokō ʻana i ka wikiwiki.