[Uphononongo lwe-JBJS] Isishwankathelo seziphumo zophando olubalulekileyo lwezonyango kuqhaqho lomqolo kunyaka ophelileyo

Isifo somlomo wesibeleko

I-Compound spinal stenosis ibhekisela kumonakalo kububanzi bomgudu womgogodla ubuncinane kwiindawo ezimbini ezahlukeneyo zomnqonqo, ngokuqhelekileyo kubandakanya i-cervical and lumbar stenosis. Kwizigulane ezineempawu, utyando lokuthomalalisa luyacetyiswa. U-Ahorukomeye et al wenze uphononongo olucwangcisiweyo loncwadi malunga nesiteji kunye nonyango lotyando oluhambelanayo lwezigulane ezine-spinal stenosis. Uphononongo lubandakanya izigulane ze-831 kwaye alufumananga mahluko ubalulekileyo ekulahlekeni kwegazi, inqaku le-mJOA, i-ODI, kunye nebakala le-Nurick phakathi kwamaqela ahleliweyo kunye namaqela otyando ngaxeshanye. Iziphumo zophononongo zibonisa ukuba utyando oluqhutywa ngokwezigaba kunye nolwexeshanye luneziphumo ezifanayo ezisebenzayo kunye ne-neurologic, kunye notyando lwangaxeshanye olunexesha elifutshane lokutyanda. Nangona kunjalo, imida yokufunda ibandakanya i-bias enokwenzeka kwizigulane ezinesimo esingcono sempilo, echaphazela ingxelo yamazinga obunzima. Ngoko ke, utyando ngaxeshanye kwizigulane ezikhethwe ngononophelo lunokunceda ukunciphisa utyando oludibeneyo kunye nexesha lokubuyisela.

Ukuwohloka komlomo wesibeleko i-spondylotic myelopathy

I-myelopathy yomlomo wesibeleko i-degenerative yenye yezona zinto zibangela ukukhubazeka kwentambo yomgogodla kubantu abadala, kwaye iziganeko zayo ziya kuqhubeka zikhula njengoko ubudala belizwe. Uxinzelelo lotyando lolona nyango luphambili, kodwa kutsha nje kuye kwakho umdla okhulayo kwiCerebrolysin njengonyango olongezelelweyo. Uphononongo lufumanise ukuba ukusetyenziswa kwexesha elifutshane kweCerebrolysin emva kotyando kunokunceda izigulane ezine-cervical spondylotic myelopathy ziphinde zisebenze ngaphandle kokusabela kakubi. Kuphononongo olubandakanya izigulane ze-90, iqela le-cerebrolysin lalinamanqaku aphezulu kakhulu asebenzayo kunye nokuphuculwa okukhulu kwe-neurological kuneqela le-placebo ekulandeleni konyaka omnye. Ezi ziphumo zibonisa ukuba ukusetyenziswa kwexesha elifutshane le-cerebrolysin kunokuba lunyango oluthembisayo lokuncedisa emva kotyando lokuthotywa kwe-myelopathy yomlomo wesibeleko.

I-Ossification ye-posterior longitudinal ligament (OPLL)

Unyango lokunyanzeliswa kwentambo yomgogodla obangelwa yi-ossification ye-posterior longitudinal ligament (OPLL) iphikisana phakathi kweengcali zotyando. Uphononongo olulindelekileyo lwe-RCT luthelekisa ukuphumelela kwe-anterior cervical en bloc resection kunye ne-laminectomy yangasemva kunye nokudibanisa kwizigulane ezine-ossification ye-posterior longitudinal ligament (OPLL). Iziphumo zophando zibonise ukuba izigulane ezine-K-lines> i-50% okanye i-negative, utyando lwangaphambili lubonise amanqaku aphezulu e-JOA kunye namazinga okubuyisela kwiminyaka emibini yokuqala emva kokuhlinzwa. Kwizigulane ezinomlinganiselo we-50% okanye i-K-line yayilungile, kwakungekho nantlukwano ephawulekayo phakathi kweendlela ezimbini zokuhlinzwa ngokubhekiselele ekusebenzeni, ukuhamba komlomo wesibeleko, kunye neengxaki kwiminyaka eyi-2.

Iindleko-ukusebenza kwe-Anterior Cervical Spine Surgery

Ulingo lwe-Dutch Neck Kinetics (NECK) luqhube uhlalutyo lweendleko-eziluncedo ngokuthelekisa i-discectomy yangaphambili yomlomo wesibeleko, i-discectomy yangaphambili yomlomo wesibeleko kunye ne-fusion (ACDF), kunye ne-arthroplasty ye-cervical disc arthroplasty (ACDA) yonyango lweengcambu zomlomo wesibeleko. iziphumo zesifo. Iziphumo zesigulane. Ngokwendlela yenzuzo yenetha, akukho ntlukwano ebalulekileyo kwiminyaka yobomi ehlengahlengisiweyo (QALYs) phakathi kwezicwangciso ezintathu zonyango. Nangona iindleko zonyango zizonke kunyaka wokuqala ziphezulu kakhulu kwiqela le-ACDA, kwakungekho nantlukwano ebalulekileyo kwiindleko zentlalo zizonke phakathi kwezicwangciso ezintathu. I-ACDF ithathwa njengeyona ndlela ineendleko eziphezulu kwimiqobo yokuvuma ukuhlawula, ngenxa yeendleko zayo zokuqala zotyando kuneendleko ezilandelayo.

Isifo seLumbar degenerative

Imfuneko kunye nohlobo lokudibanisa kunyango lwe-spondylolisthesis ehlayo ihlala iphikisana. Izifundo zamva nje zibonise ukuba i-laminectomy kunye ne-fusion iphucula intlungu emva kokuhlinzwa kunye nokukhubazeka kodwa yandisa ixesha lokusebenza kunye nokuhlala esibhedlele xa kuthelekiswa ne-laminectomy yodwa. Olunye uphononongo alufumananga ntlukwano ebalulekileyo kwiziphumo ezixelwe ngesigulane phakathi kwamaqela adibeneyo kunye namaqela angenawo i-instrumented kulingo olulawulwa ngokungahleliwe eScandinavia, kodwa iqela elingenazo izixhobo lalinamazinga aphezulu okungaxutywa kunye nokusebenza kwakhona. Amazinga otyando aphantsi. phezulu. Ezi zifundo zixhasa indlela yokudibanisa isixhobo kunyango.

Ukukhutshwa kwamanzi emva kokuhlinzwa kwe-lumbar

Kuyinto eqhelekileyo ukusebenzisa i-drain emva kokuhlinzwa ukunciphisa iziganeko ze-hematoma emva kokusebenza. Okwangoku, akukho bungqina bubambekayo bokuxhasa ukusetyenziswa kwe-drain ngexesha lotyando lwe-lumbar spine oluwohlokayo ukuphepha iingxaki. Kwilingo elilawulwa ngokungahleliwe le-multicenter, uMolina et al ijolise ekuvavanyeni iziphumo zeklinikhi, iingxaki, amanqanaba e-hematocrit, kunye nobude bokuhlala kwizigulane emva kokuhlanganiswa kwe-lumbar kunye okanye ngaphandle kwe-drainage. Izigulane ezingamashumi asithoba anesithathu eziye zafikelela kumanqanaba amathathu e-lumbar fusion zabelwa ngokungaqhelekanga kwiqela kunye okanye ngaphandle kwe-drainage emva kokusebenza kunye nokulandelwa kokugqibela kwinyanga enye emva kokuhlinzwa. Akukho mahluko kwiingxaki ezifunyenweyo. Ababhali baphetha ngokuthi emva kokungabandakanyi izigulane ezinobungozi obuphezulu, izigulane ezingenayo i-drain zinexesha elifutshane lokuhlala esibhedlele, amanqaku eziphumo ezingcono, kunye namazinga afanayo anzima.

Ulawulo lwasemva kotyando

Uphononongo olwenziwe nguSaleh et al. Uphononongo lufumene ukuba i-perioperative supplement supplement inokunciphisa kakhulu iziganeko zeengxaki ezincinci kunye namazinga okusebenza kwakhona kwizigulane ezingondlekanga ngexesha lotyando lomqolo. Ngaphezu koko, i-RCT ephindwe kabini eyimfama ngu-Hu et al ibonise ukuba ukuxhaswa kwansuku zonke kwe-600 mg calcium citrate kunye ne-800 IU vitamin D3 kwizigulane ezenza utyando lwe-lumbar fusion mfutshane ixesha lokudibanisa kunye nokunciphisa amanqaku eentlungu. Ukongezelela, uphando olwenziwa ngu-Iyer et al lubonise ukuba i-ketorolac ye-intravenous ilawulwa kwiiyure ze-48 emva kokunciphisa ukusetyenziswa kwe-opioid kunye nokuhlala esibhedlele. Ekugqibeleni, isifundo sovavanyo lwezilwanyana nguKaramian et al. Uphononongo lufumene ukuba i-varenicline inokunciphisa impembelelo embi ye-nicotine kumazinga e-postoperative fusion, ebonisa ukubaluleka kokulawula ukusetyenziswa kwe-nicotine kunye nesimo sesondlo ngexesha le-perioperative yokuhlinzwa komgogodla.

Ukuchacha ngokukhawuleza emva kokuhlinzwa

Kwiminyaka yakutshanje, kuye kwaqhubeka umdla we-scholarly kwiindlela zeklinikhi kunye neendlela zokunyamekela ezenzelwe ukukhuthaza ukubuyiswa kweentlungu, ukulahleka kwegazi, kunye nokunciphisa ukusebenza emva kokuhlinzwa kwe-lumbar spine kunye nokunciphisa impembelelo yokungenelela ngokuhlinzwa. I-Contartese et al yenza uphononongo olucwangcisiweyo oluvavanya impembelelo yeeprotocol ezikhawulezayo kwizigulane ezenza utyando lomqolo. Uphononongo lufumene ukuba izinto eziqhelekileyo ezikhawulezayo zibandakanya imfundo yesigulane, i-multimodal analgesia, i-thromboprophylaxis kunye ne-antibiotic prophylaxis, enokunceda ukunciphisa ukuhlala esibhedlele kunye nokunciphisa ukusetyenziswa kwe-opioid. Iziphumo zibonisa ukuba utyando lomqolo olukhawulezayo lunxulunyaniswa nokuhlala esibhedlele okufutshane kunye nokuchacha ngokukhawuleza kokusebenza kodwa akunyusi iingxaki okanye amazinga okufunda. Iimvavanyo ezinkulu ezilindelekileyo ezilawulwa ngokungenamkhethe ziyafuneka ukuze kuqinisekiswe ngakumbi izigqibo.

Ukubuyisela emva kokuhlinzwa

Uphando lubonisa ukuba inkqubo yokuvuselela edibanisa umthambo kunye nonyango lokuziphatha inokusebenza ekuphuculeni umsebenzi kwizigulane emva kokuhlinzwa kwe-lumbar fusion. Uphononongo lwe-RCT olwenziwa ngu-Shaygan et al lubandakanya izigulane ze-70 eziye zafumana i-fusion yezinga elilodwa kwi-lumbar stenosis kunye / okanye ukungazinzi, kunye neqela lokungenelela lifumene i-60- kwi-90-minute-postoperative training sessions training sessions. Uhlalutyo lwe-multivariate yeentlungu ezibuhlungu, ukuxhalaba kunye namanqaku okukhubazeka okusebenzayo abonisa ukungafani okukhulu phakathi kwamaqela okungenelela kule mimandla (p

Ukukhubazeka komqolo omdala

Ukukhethwa kwesigulane esifanelekileyo, ukulungelelaniswa kwangaphambili, kunye nokunciphisa umngcipheko wengxaki kuqhubeka kugxininiso lweencwadi zokukhubazeka komgogodla omdala kunyaka odlulileyo. Uphononongo oluhlaziyiweyo luthelekisa iCharlson Comorbidity Index (CCI) kunye neSeattle Spine Score (SSS), i-Adult Spinal Deformity Comorbidity Score (ASD-CS), kunye ne-5-item Frailty Index (mFI-5) elungisiweyo. Xa isetyenziswe kwangaphambili, i-mFI-5 ifunyenwe iphezulu kuneCCI ekuqikeleleni iingxaki emva kokuhlinzwa komntu omdala wokukhubazeka. Ngoko ke, ukuhlolwa kobuthathaka kwangaphambili kunokuzuza ukhetho lwesigulane kunye nokunyamekela, kwaye olu pho nonongo longeza kwiincwadi ezixhasa ukusetyenziswa kobuthathaka njenge-predictor yesiphumo sotyando.

Olunye uphando lusebenzise idatha evela kwi-Adult Symptomatic Lumbar Scoliosis Phase I (ASLS-1) ilingo lokuvavanya ukungaphumeleli koxhulumaniso olusondeleyo emva kokuhlinzwa kwi-symptomatic lumbar scoliosis kubantu abadala. Uphononongo lufumene ukuba i-index mass body index, i-preoperative thoracic kyphosis, kunye ne-angle ye-preoperative ephantsi yokudibanisa i-angle yayidibene nomngcipheko okhulayo wokungaphumeleli koqhagamshelwano olusondeleyo. Nangona kunjalo, ukusetyenziswa kwamagwegwe kwinqanaba eliphezulu lesixhobo somqolo kunciphisa kakhulu umngcipheko wokungaphumeleli koxhulumaniso olusondeleyo. Ukongezelela, uhlalutyo lwe-meta lufumene ukuba i-kyphosis ye-proximal junctional idibaniswe ne-T-score ye-T-score ye-vertebral ephantsi kunye / okanye imilinganiselo yeyunithi ye-Hounsfield yomqolo ongentla. Ke ngoko, ukulungiswa kwangaphambili kokuxinana kwamathambo kunokuncedisa ukunciphisa umngcipheko wokungaphumeleli kokudityaniswa kwexesha elide.

Uphononongo lwezigulana ezili-157 ezenza utyando lokukhubazeka komnqonqo wabantu abadala lufumanise ukuba malunga nesiqingatha sezigulana ziye zafumana utyando oluhlala ixesha elide kwi-1 kunye ne-3 iminyaka, kunye nezinto eziphambili zokuxela kwangaphambili ezibandakanya ukuxubana kwe-pelvic, ukusonjululwa kokungahambi kakuhle kwe-lumbar, kunye nokuphazamiseka kotyando. Nangona kunjalo, malunga nesiqingatha sabemi bophononongo abazange bahlangabezane neziphumo zotyando oluhlala ixesha elide. Olunye uphononongo lwamazwe ngamazwe luthelekisa iindlela ezahlukeneyo zotyando zokuphumeza ulungelelwaniso olululo emva kokulungiswa kokukhubazeka kwaye lwafumanisa ukuba i-L5-S1 yangaphambili ye-lumbar interbody fusion ibe neziphumo ezingcono zohlengahlengiso oluntsonkothileyo kunye nokusilela konxibelelwano olusondeleyo, ngelixa i-TLIF kunye / okanye i-osteotomy enekholamu ezintathu inokubuyisela i-lordosis yomzimba kunye ne-pelvic. imbuyekezo.

Olunye uphando lwe-meta-analysis lufumene ukuba phakathi kwezigulane eziye zadibana ne-long-segment fusion, izinga lokungaphumeleli kwe-implant lifana phakathi kwabo baphathwa nge-screw fixation ye-iliac kunye ne-S2-wing-iliac (S2AI) ukulungiswa kwe-screw, kodwa iqela le-S2AI lineengxaki ezimbalwa zenxeba. Kungcono, i-screw protrusion kunye nereyithi yokuhlaziya ngokubanzi. Olunye uphando luthelekisa izigulane ezine-multi-rod (> 2) kunye nokucwangciswa kweentonga ezimbini kwaye zafumanisa ukuba iqela le-multi-rod linamazinga aphantsi okuhlaziya, iingxaki ezincinci zemishini, ukuphuculwa okukhulu komgangatho wobomi, kunye nokubuyiselwa okungcono kokulungelelaniswa kwe-sagittal. . Ezi ziphumo ziphinde zaqinisekiswa kolunye uphononongo olucwangcisiweyo, iziphumo ezingalindelekanga, kunye ne-Bayesian meta-analysis, ebonisa ukuba ukwakhiwa kwe-multirod kudibene namazinga aphantsi e-pseudarthrosis, ukuphuka kweentonga kunye nokusebenza kwakhona.

Unyango olungasebenzisi utyando

I-intravertebral nerve ablation yonyango lwentlungu engapheliyo ye-vertebral ephantsi, kwaye uvavanyo lwe-INTRACEPT lwenzelwe ukuvavanya ukusebenza kwayo kwizigulane ezine-Modic uhlobo lwe-I okanye uhlobo lwe-II utshintsho. Izigulane ze-140 zaye zahlulwa zibe ngamaqela amabini ukuze zithole i-nerve ablation kunye nokhathalelo oluqhelekileyo okanye ukhathalelo oluqhelekileyo lodwa. Uhlalutyo lwexeshana lubonise ukuba iqela le-nerve ablation lenze ngcono kakhulu kuneqela eliqhelekileyo lokunyamekela. Kwiqela le-spinal nerve ablation, lithetha ukuphuculwa kwe-ODI ngamanqaku angama-20.3 kunye namanqaku angama-25.7 kwi-3 kunye neenyanga ze-12, ngokulandelanayo, intlungu ye-VAS yancitshiswa nge-3.8 cm, kwaye i-29% yezigulane zichaze intlungu epheleleyo. Iziphumo zophononongo zibonisa ukuba i-spinal nerve ablation yindlela yonyango esebenzayo kwiintlungu ezingapheliyo ze-vertebral back back.

I-ESI yomlomo wesibeleko idlala indima ebalulekileyo kunyango lotyando lomgogodla, kodwa i-ESI ye-transforaminal inomngcipheko ophezulu weziganeko ezimbi. Uphononongo luka-Lee et al luthelekisa ukusebenza kunye nokukhuseleka kwe-ESI ye-transforaminal kunye ne-ESI ye-transforaminal kwaye yafumanisa ukuba ngokwemiqathango yokulawula intlungu, ii-ESI ezimbini zineziphumo ezifanayo kwi-1 inyanga kunye neenyanga ze-3, kodwa i-transforaminal ESI Hole ESI inenzuzo encinci kwiintlungu. ulawulo. Inyanga eyi-1. Iziganeko ezimbi zazifana kwaye zibandakanya ukuthatyathwa kwe-vascular of the difference material kunye nokwanda kwentlungu okwethutyana. Iziphumo zikhawulelwe bubungqina obusezantsi kwaye ukhetho lohlobo lwesitofu kufuneka luxoxwe phakathi koogqirha kunye nababoneleli bonyango.