Matšoao le kalafo ea disc ea herniated intervertebral ea lesapo la mokokotlo

Sesepa sa Herniated sa mokokotlo oa mokokotlo - ho senyeha ha disc ea intervertebral ea vertebra ea thoracic (ICD-10 M51). E khetholloa ka bohloko, ho se utloisisehe ha letlalo le mathata a somatic. Ts'oaetso e etsoa motheong oa sete ya data: liphetho tsa tlhahlobo ea litho le litsamaiso ho khetholla mafu ka mabaka a mang, le MRI. Li-disc tsa li-vertebrae tse tlase tsa thoracic (Th8-Th12) li amehile haholo.

Kalafo e boloka mekhoa e metle ebile ea sebetsa. Hernia ea shmorl ea mokokotlo oa mokokotlo ke ho phatloha ha hernial 'meleng oa vertebra e phahameng kapa e tlase ka lebaka la ho phatloha ha lisele tsa lefufuru la disc ea intervertebral. Ha ho hlokahale kalafo ea ho buoa.

Mabaka

Etiology ea lefu lena e ipapisitse le lits'ebetso tse lebisang petsong le ho fokotseha ha matla a annulus fibrosus:

• ho lula fatše;
• meroalo e matla ea nako e telele e sa fetoheng le e sa fetoheng e matla;
• ho sithabela maikutlo;
• osteochondrosis ea mokokotlo oa mokokotlo;
• mathata a dysmetabolic;
• maloetse a ikemetseng.

Ho iphetola ha lintho ha hernial protrusion

Kholisong ea bona, li-prolaps li feta mekhahlelo e mengata:

1. Tsamaiso e ka thoko ea disc ho fihlela 1-5 mm le ho boloka lera le kantle la annulus fibrosus. E bitsoa protrusion.
2. Ho qhekella kapa ho theha hernia ka tlolo ea bots'epehi ba lesale le ho phatloha ha 5-8 mm.
3. Sequestration e khetholloa ka aseptic necrosis le sehlopha sa lisele tsa hernia (boholo ba eona hangata bo fetang 8 mm), e lateloe ke ho falla ha bona mokokotlong oa mokokotlo, o nang le mathata a holofatsang.

Ho latela boemo ba ho fokotseha ha kanale ea mokokotlo, li-protheine tsa hernial li arotsoe ka tse nyane (0-10%), tse mahareng (10-20%) le tse kholo (> 20%).

Matšoao le phapang ea tšoaetso

Li ikemiselitse ka boits'oaro ba hernia, sebaka sa eona sa lehae le boemo ba protrusion. Sena e ka ba khatello ea metso ea methapo ea mokokotlo kapa ntho ea mokokotlo oa mokokotlo. Ho ipapisitsoe le maemo a sebopeho sa lefats'e, ho itsamaisa ke:

• lateral,
• ventral (e emela kotsi e nyane haholo);
• bohareng (bohareng kapa morao), e kotsi ka ho fetisisa bakeng sa mathata a eona;
• setsebi sa bongaka.

Lingaka tse ling tsa methapo ea kutlo li khetholla mokokotlo, bohare (joalo ka phetoho ea mokokotlo), selikalikoe, ventral le libaka tsa foraminal.

Mabapi le likarolo tsa mokokotlo - thoracic e holimo, e bohareng le e tlase.

Hape:

• Ka sebaka se bohareng, mokokotlo oa mokokotlo oa mokokotlo o bonoa, o tsamaisana le nts'etsopele ea khatello ea kelello ea myelopathy e nang le ponahalo ea spastic mono- kapa papararesis e tlase, le mathata a pelvic.
• Ka sebaka sa morao-rao, matšoao a rarahaneng a khatello ea metso ea mokokotlo a hlaha kaholimo ho mathata:
  • kutloisiso ea maikutlo sefubeng;
  • somatic innervation ha hernia e ama makala a visceral, a bakang liphetoho tse sebetsang mosebetsing oa litho tsa ka hare.

Mathata a ho hlahlojoa a bakoa ke ho khetholla ha matšoao a lefu lena. Phallo, ho latela sebaka, e khona ho etsisa matšoao a mafu a thoracic le a mpeng. Ka hona, ho netefatsa lefu lena, ngaka ea methapo e ka kenyelletsa litsebi tse ikhethang.

© Alexandr Mitiuc - stock.adobe.com. Setšoantšo sa Schematic sa sebaka sa hernia mokokotlong oa thoracic.

Liteko tsa Nitroglycerin kapa Corvalol li ka thusa ho khetholla phallo ea disc ho tloha ponahalong ea matšoao a rarahaneng a angina pectoris, moo bohloko bo bakoang ke khatello ea methapo ea methapo bo ke keng ba emisoa.

Ha o etsa phapang e fapaneng ea discogenic pathogenesis (disc protrusion) le maloetse a mala, ho lokela ho hopoloa hore bohloko bo ka mpeng ha bo amane le ho ja lijo.

Matšoao a ka fapana ho basali le banna. E ka 'na eaba e fokolitse ho se sebetse ha libido le erectile. Basali ba ka hlaseloa habonolo ke mafu a mahe a bomme, ho se sebetse ka nako ea ho ilela khoeli, e leng ho lebisang ho fokotseheng ha monyetla oa ho emoloa, bohloko bo sebakeng sa libaka tse atisang ho ferekanngoa le ho qala ha mastitis (tšoaetso ea matsoele).

Litlhahlobo

Tlhahlobo e ipapisitse le:

1. litletlebo tse tloaelehileng tsa mokuli (tšitiso ea karoloana ea likarolo tse hlokolosi le tsa makoloi, liphetoho tse amanang le ts'oaetso mosebetsing oa litho tsa ka hare, tse senngoeng ke kutu ea methapo e hatelitsoeng);
2. data ea tlhahlobo ea methapo le setšoantšo sa bongaka sa lefu lena;
3. Liphetho tsa MRI (ka li-contraindication tse tobileng, ka mohlala, boteng ba pacemaker ea maiketsetso, CT ea mokokotlo e ka sebelisoa, empa ho nepahala ha thuto ho tlase ho MRI);
4. Lintlha tse tsoang liphuputsong tsa laboratori, tlhahlobo ea lisebelisoa le lipuisano tsa litsebi tse amanang le tsona, ho lumella tlhahlobo ea phapang (ho thusa ho netefatsa hernia le ho qhekella angina pectoris, pokello ea nalane e qaqileng, tlhaiso-leseling ea ECG le liteko tsa ts'ebetso tse bonts'ang ho ba sieo ha myocardial ischemia li tla thusa).

Mathata a ho etsa ts'oaetso a ka bakoa ke mafu a sa tšoaneng. Mokuli a kanna a tšoenngoa ke thoracalgia le angina e ikitlaetsang ka matla ea mokokotlo oa mokokotlo o teng mokokotlong oa thora. Hape, hernia e ka tsosa tlhaselo ea angina pectoris.

Mekhoa ea phekolo e ka khethoa ke litsebi tse peli - ngaka ea methapo le setsebi (kapa setsebi sa lefu la pelo).

Kalafo

E arotsoe ka mokhoa oa ho itšireletsa le oa ho buoa. Phekolo ea Conservative e etsoa maemong a bakuli le malapeng, ho fana ka mehato e reretsoeng ho:

• ho felisa kapa ho fokotsa thoracalgia;
• thibelo ea kholo ea protrusion.

Phekolo ea lithethefatsi

E kenyelletsa ho khethoa:

• Li-NSAID (Naproxen, Ibuprofen, Celecoxib, Ketoprofen, Carprofen, jj.);
• corticosteroids (metipred);
• li-blockade tsa lehae (anesthetics + corticosteroids);
• mesifa e khathollang e nang le lefu le matla la spastic (Tolperisone, Mydocalm, Sirdalud);
• li-chondroprotectors (Glucosamine, Aorta - li sebelisetsoa ho ntlafatsa trophism ea nucleus pulposus, li bonts'a bokhoni bo phahameng sethaleng sa protrusion ea disc ea intervertebral);
• Li-vithamine tsa B (B1 le B6, tse hlohlelletsang ho khutlisoa ha likhoele tsa methapo).

Mokhoa oa lithethefatsi o u lumella ho emisa bohloko ba bohloko le ho theha semelo se setle sa ts'ebeliso ea mekhoa e meng ea kalafo e tloahelehileng.

Phello ea boikoetliso ba boikoetliso (kalafo ea boikoetliso)

Gymnastics ea kalafo e thusa ho eketsa phepelo ea mali, ho imolla li-spasms le ho theha corset ea mesifa, e thusang ho theola tsamaiso ea mesifa. Boikoetliso ba mokokotlo oa mokokotlo oa mokokotlo bo laeloa ka mokhoa o ikemetseng ka bo mong nakong ea ts'oarelo, hangata qalong ea lefu lena, kapa nakong ea phomolo ea kamora 'ts'ebetso. Ho ikoetlisa maemong a pele ho etsoa tlasa taolo ea morupeli setsing sa boikoetliso. Lihlopha tsa boikoetliso tse khothalletsoang li ka etsoa lapeng.

Acupuncture, reflexology

Li sebelisetsoa ho imolla bohloko le tsitsipano ea mesifa.

Phekolo ea matsoho le mokokotlo oa mokokotlo

Li sebelisetsoa ho eketsa sebaka se pakeng tsa 'mele ea lesea.

© Mulderphoto - stock.adobe.com. Ho otlolla mokokotlo.

Kameho ea ho silila

Ho silila ho laeloa ho fokotsa molumo o eketsehileng oa mesifa ea paravertebral. E sebelisetsoa ho phomola le ho ntlafatsa phepelo ea mali maemong a pele a lefu lena mohatong oa tšoarelo.

Physiotherapy

E sebelisetsoa ho fana ka phello ea mesifa e khathollang le e khahlanong le ho ruruha maemong ohle a hernia ho iphetola ha lintho nakong ea tšoarelo. E sebelisitsoe: ultraphonophoresis ea Hydrocortisone, electrophoresis, magnetotherapy le UHF.

Ha ho se na phello ea kalafo e tloahelehileng le / kapa ponahalo ea matšoao a myelopathy, ba khetha kalafo ea bongaka.

Phello e ntle ea ERT e netefalitsoe ka bongaka kamora ts'ebetso ho tloha qalong ea ho hlaphoheloa (linako tsa EHF, laser le magnetotherapy, electromyostimulation).

Mokhoa oa Moprofesa Bubnovsky

Dr. Bubnovsky o khothaletsa sete ea boikoetliso e shebaneng le ho otlolla mesifa ea mokokotlo:

• Ema o otlolohile 'me u behe maoto a hao bophara ba mahetla, u tlameha ho etsa hantle pele u kobeha, u leka ho kenya hlooho le matsoho lipakeng tsa mangole.

• Ho beha leoto la hao le otlolohileng ka morao setulong, o lokela ho leka ho beha mmele oa hau seropeng ha o ntse o tsoa, ​​o leka ho tšoara sokisi ka matsoho.

• O robala ka mpeng, otlolla matsoho pele, o phahamisa 'mele ebe o sutumetsa fatše ha o tsoa.

• Boemo bo eme, otlolla holimo, o leka ho phahamisa menoana ea hau holimo kamoo ho ka khonehang.

Phekolo

Ho bontšoa ka ho se sebetse ha mokhoa o tloahelehileng oa likhoeli tse 6. Mokhoa ona o kenyelletsa:

• laminotomy kapa laminectomy - resection e felletseng kapa e sa reroang ea mokokotlo oa lesapo la mokokotlo bakeng sa khatello ea maikutlo ea kotopo ea mokokotlo; hangata e kopantsoe le ho kopanya - ho tiisa li-vertebrae tse haufi bakeng sa fusion;
• laminoplasty - tomia ea mokokotlo oa mokokotlo e le ho eketsa sebaka se potileng metso le ho theha lesela;
• disc extirpation (microdiscectomy (e le khetho - endoscopic), discectomy).

Ka mor'a kalafo ea ho buuoa, mathata a ka khonahala:

• tšoaetsanoang - myelitis, mokokotlo oa arachnoiditis;
• e sa tšoaetsanoeng:
  • pele - ho tsoa mali, phetoho ea methapo ea mokokotlo kapa nako e telele;
  • morao - sebopeho sa ankylosis (fusion) ea 'mele ea vertebrae e haufi.

Lipapali bakeng sa ho putlama ha mokokotlo oa thora (lipapali tse lumelloang le tse thibetsoeng)

Mesebetsi ea lipapali e na le moeli. Mefuta e lumelletsoeng e kenyelletsa:

• aqua aerobics le ho sesa (joalo ka mekhoa ea kalafo le thibelo):
  • mesifa e phutholoha, mojaro mokokotlong oa fokotseha, li-ligamente le manonyeletso lia matlafatsoa;
  • ho matlafatsa tsamaiso ea ho hema, ho ntlafatsa phepelo ea mali.
• ho ikoetlisetsa ho ikoetlisa ka tlas'a taolo ea morupeli oa kalafo ea boikoetliso;
• Pilates;
• li-push up;
• boikoetliso le litlelase tsa yoga;
• ikoetlisa le li-simulators;
• ho lula holim'a bolo ea maoto;
• leketlileng ka bareng tshekaletseng;
• Ho palama baesekele ka lebelo la phomolo;
• squats (nakong ea tšoarelo).

E 'ngoe ea boikoetliso bo boletsoeng kaholimo e tlameha ho etsoa feela tlasa taolo ea setsebi. Ho ikoetlisa ho hlokang ho lula kapa ho ema ho lokela ho qojoa:

1. ho phahamisa litšepe;
2. ho qhomela holimo le ho telele;
3. bolo ea maoto, basketball, rugby, skiing;
4. ho matha ka lebelo;
5. lipapali tsa matla.

Mathata le litlamorao tsa ho putlama

Tsoelo-pele ea nosology e ka lebisa ho:

• intercostal neuralgia e boletsoeng;
• phetoho ea khatello ea mokokotlo oa mokokotlo (e 'ngoe ea litlamorao tse kotsi haholo):
  • paresis ea maoto le matsoho;
  • tahlehelo e felletseng ea mesebetsi ea litho tsa pelvic.
• litšitiso mosebetsing oa pelo le litho tsa ho hema (bohloko bo ka sefubeng le ho sitisoa ke mosebetsi oa pelo lia utloahala; phefumoloho e khutšoanyane e ba teng, ho ba thata ho hema);
• tsoelo-pele ea mafu a masapo (scoliosis, kyphosis);
• ho thehoa ha hernias ea li-intervertebral likarolong tse ling tsa mokokotlo - ka lebaka la ts'ebeliso ea mafu a mangata le ho mpefala ha lefu lena.

Ka lebaka la tlolo ea ts'ireletso, maikutlo a setho se seng kapa se seng sa visceral a na le bothata. Sistimi ea taolo ea eona e ikemetseng ea senyeha. Colon dyskinesia e ka fetoha colitis, mme mathata a sebetsang a manyeme a ka fetoha pancreatitis. Ho feta moo, ho senyeha ho ka lebisa mathateng a sokelang bophelo a methapo ea pelo (lefu le bohloko la pelo, lefu la angina le angina e sa tsitsang; ho ts'oaroa ha pelo ka tšohanyetso).

Thibelo

Sehlopha sa likotsi se kenyelletsa baemeli ba mesebetsi e khethehileng le mesebetsi e kenyang meroalo e melelele e melelele mokokotlong: lingaka tse buoang, baatlelete, barekisi, basebetsi ba liofising.

Ho thibela ho thehoa ha hernia ho bonolo haholo ho feta ho e phekola. Ho ikoetlisa letsatsi le leng le le leng ho tla u thusa ho e qoba. Mekhatlo e fapaneng ha e tlatse feela tlhahiso ea synovial fluid le hydration ea discs, empa hape le ho matlafatsa mesifa e tebileng ea mokokotlo, e fokotsang mojaro mokokotlong.

Ha o ikoetlisa ka mokhoa oa thibelo, ho bohlokoa ho hopola hore:

1. Li-discs li loketse mojaro o emeng hantle ho fapana le mejaro e otlolohileng kapa ea oblique. Sena se bolela hore ha o phahamisa ntho e boima, o lokela ho robala, empa o seke oa kobeha.
2. Ho etsa mosebetsi oa ho lula fatše, ho hlokahala hore o fetole boemo ba 'mele makhetlo a' maloa ka letsatsi, o ikoetlise ka mokhoa o thibelang, leka ho lula hanyane ka moo ho ka khonehang.
3. Li-aerobics tsa ho sesa le metsi li thusa haholo maemong a thibelo, hobane li u lumella ho matlafatsa corset ea mesifa, ha ka nako e tšoanang u kokobetsa mokokotlo.

Shebella video: How to Fix a Bulging Disc NO SURGERY! (November 2024).