Ukuvumelana kochwepheshe mayelana nokuxilongwa kanye nokwelashwa kwe-lumbar spinal stenosis ewohlokayo

Njengoba inani labantu likhula, i-lumbar spinal stenosis (DLSS) ewohlokayo (i-DLSS) isibe esinye sezimo zamathambo ezivame kakhulu, ezithinta kakhulu izinga lempilo kanye nempilo engokomzimba neyengqondo yabantu abaneminyaka ephakathi nasebekhulile.

Ukuxilongwa nokwelashwa kwe-DLSS kusalokhu kuyimpikiswano. Ngenxa yalesi sizathu, i-North American Spine Society (NASS) yenza iziqondiso zokuxilongwa nokwelashwa kwe-DLSS ku-2011, kanye ne-Chinese Expert Consensus on Surgical Treatment Specification for Lumbar Spinal Stenosis yanyatheliswa ku-2014. Eminyakeni yamuva, ngokuvela kanye ukuthuthukiswa kwamasu amancane okuxilonga nokwelapha kanye nomqondo wokusheshisa ukululama ngemva kokuhlinzwa (ERAS), ukuxilonga nokwelashwa kwe-DLSS kushintshe kakhulu, futhi kunesidingo sokwengeza nokuvuselela imihlahlandlela ekhona yokuxilonga nokwelashwa noma ukuvumelana. Iqalwe yiKomidi Lokuvimbela I-Osteoporosis and Rehabilitation Committee ye-Chinese Society of Rehabilitation Medicine kanye ne-Orthopedic Minimally Invasive Branch ye-China Geriatrics and Healthcare Association, uhlu lwemibuzo lwakhiwe ngokusebenzisa indlela yocwaningo lwe-Delphi eguquliwe kanye nokubuyekezwa kwezincwadi, kanye nokuqukethwe. yohlu lwemibuzo oluthole imvume yochwepheshe abangaphezu kuka-75% (okuhlanganisa isivumelwano nesivumelwano esiyisisekelo) bafakwe esigabeni sokuvumelana ngochwepheshe abaziwayo basekhaya ekuhlinzeni umgogodla ngemva kwemizuliswano emihlanu yengxoxo yomhlangano kanye nokuvota kocwaningo. Ukuvumelana kwalotshwa ngesisekelo salokhu kuvumelana.

Izincomo eziyi-10:

Isincomo se-1: I-DLSS ibhekisela ezimpawu ezihambisanayo ezibangelwa i-stenosis yomgogodla womgogodla, i-lateral recesses kanye ne-nerve root canal ngenxa yezifo eziwohlokayo, ngaphandle kwe-stenosis ebangelwa i-lumbar disc herniation, ukungazinzi kwe-lumbar, i-lumbar spondylolisthesis noma i-scoliosis.

Isincomo sesi-2: Ukuxilongwa kwe-DLSS kusekelwe ① ubuhlungu be-lumbar, i-hip kanye nemilenze ephansi noma kuhambisane nokuqina kwe-lumbar kanye nezimpawu ze-cauda equina ezinezimpawu ezijwayelekile ze-claudication; ② izifundo zokuthatha izithombe ezibonisa ukuqina kwe-canal stenosis, i-radicular nerve canal stenosis, i-lateral saphenous fossa stenosis nezinye izinguquko; ③ izimpawu zomtholampilo, izimpawu nezimpawu ze-canal canal segmental stenosis engaguquki.

Isincomo sesi-3: I-selective nerve root block iwuhlelo olusizayo lokuhlonza i-percutaneous puncture, olungacacisa indawo enesibopho se-stenosis futhi inenani elihle lesicelo somtholampilo, futhi ingasetshenziswa ngokukhetha ezibhedlela ezinemibandela.

Isincomo sesi-4: Iziguli ezine-DLSS ezikhetha ukwelashwa okungezona ukuhlinzwa kufanele zelashwe ngemithi elwa nokuvuvukala, i-analgesic, i-vasodilator neyondla izinzwa, futhi ukusebenza kahle kufanele kuhlolwe ngemva kwezinyanga ezingu-3 zemithi evamile.

Isincomo sesi-5: Ukucindezelwa okulula komgogodla womgogodla kuyindlela yokuzikhethela yokwelashwa kwe-DLSS, ngezinga lokususwa kwe-lamina ne-synovium enqunywe izinga lomgogodla we-spinal stenosis kanye ne-synovial hyperplasia.

Isincomo sesi-6: Ukuwohloka komgogodla ovulekile kuyindlela yokuhlinzwa eyinhloko yokwelashwa kwe-lumbar spinal stenosis. Ngokuya ngendawo ye-stenosis, isikhathi esincane sokusebenza, esifushane kanye nokululama ngokushesha ngemva kokuhlinzwa kufanele kukhethwe noma nini lapho kunokwenzeka.

Isincomo sesi-7: Ukunciphisa umgogodla ongenayo kancane kuyindlela yokuhlinzwa ephumelelayo yokwelashwa kwe-DLSS, enezinzuzo zokuhlukumezeka okuphansi, ubuhlungu obuphansi be-postoperative, ithonya eliphansi ekuzinzeni kwe-lumbar, njll Ngaphansi kwesisekelo sokuqonda ngokuqinile izinkomba, izibhedlela ezinalezi zimo. kufanele inikeze kuqala ukuwohloka komgogodla ongavamile.Isincomo sesi-8: Ezigulini ezinokungazinzi kwe-lumbar ngaphambi kokuhlinzwa noma ukuchithwa kwe-intraoperative okungase kubangele ukungazinzi kwesigaba, ukulungiswa kwe-lumbar kanye nokuhlanganiswa kufanele kwenziwe ukuze izingxenye ezihlanganisiwe zikwazi ukugcina ukuzinza kwemishini yesikhathi eside, futhi izingxenye ezihlanganisiwe kufanele zinqunywe ngokuvumelana nezimpawu zomtholampilo kanye nobubanzi bokunciphisa.Isincomo se-9: Ukulungiswa kwangaphakathi kwe-Lumbar kunikeza ukuqiniswa okusheshayo ngemva kokuwohloka komgogodla womgogodla. Amasegimenti okulungisa angaphakathi ngokuvamile anqunywa ngokuya ngezinga lokuwohloka nokungazinzi ukuze kwandiswe umphumela wokuhlanganisa wenqubo.

Izincomo ze-10: Ukuphathwa kwe-RAS ye-Perioperative ye-DLSS kufanele kusebenze futhi kube njalo: ukuhlolwa okufanele ngaphambi kokuhlinzwa, ukuhlela ukuhlinzwa okunembile, i-analgesia ye-prophylactic kanye nemfundo yesiguli; ukuxhashazwa okuthambile kwe-intraoperative, ukuvikelwa kwe-neural kanye nezicubu ezithambile kanye nokunciphisa ukopha; I-postoperative multimodal analgesia kufanele inikezwe futhi iziguli kufanele zikhuthazwe ukuba zenze izivivinyo zokuvuselela kusenesikhathi ukuze zithole ukululama ngokushesha.