Amaphutha esiguli esihlinzwayo kanye nendawo angathi sína futhi angavinjelwa. Ngokusho kwe-Joint Commission on Accreditation of Healthcare Organizations, amaphutha anjalo angenziwa ku-41% wokuhlinzwa kwamathambo/kwabantwana. Ekuhlinzweni komgogodla, iphutha lendawo yokuhlinzwa lenzeka lapho ingxenye yomgogodla noma ukwakheka kwengxenye engezansi kungalungile. Ngaphezu kokwehluleka ukubhekana nezimpawu kanye nesifo sesiguli, amaphutha engxenye angaholela ezinkingeni ezintsha zezokwelapha ezifana nokuwohloka kwediski okusheshayo noma ukungazinzi komgogodla ezindaweni ezingabonakali noma ezivamile.
Kukhona futhi izinkinga zomthetho ezihambisana namaphutha okuhlukanisa umgogodla, futhi umphakathi, izinhlangano zikahulumeni, izibhedlela, kanye nemiphakathi yodokotela abahlinzayo abawabekezeleli nhlobo amaphutha anjalo. Ukuhlinzwa okuningi komgogodla, njenge-discectomy, i-fusion, i-laminectomy decompression, kanye ne-kyphoplasty, kwenziwa kusetshenziswa indlela yangemuva, futhi indawo efanele ibalulekile. Naphezu kobuchwepheshe bezithombe bamanje, amaphutha okuhlukanisa asenzeka, kanti amazinga okwanda asukela ku-0.032% kuya ku-15% abikiwe ezincwadini. Akukho siphetho sokuthi iyiphi indlela yokuhlukanisa enembile kakhulu.
Izazi ezivela eMnyangweni Wezokuhlinzwa Kwamathambo eMount Sinai School of Medicine, e-USA, zenze ucwaningo lwemibuzo oluku-inthanethi olusikisela ukuthi iningi lodokotela abahlinzayo bomgogodla basebenzisa izindlela ezimbalwa kuphela zokuthola indawo, nokuthi ukucaciswa kwezimbangela ezivamile zamaphutha kungasebenza kahle ekunciphiseni amaphutha okuhlinzwa, esihlokweni esanyatheliswa ngoMeyi 2014 ku-Spine J. Ucwaningo lwenziwe kusetshenziswa uhlu lwemibuzo oluthunyelwe nge-imeyili. Ucwaningo lwenziwe kusetshenziswa isixhumanisi se-imeyili semibuzo ethunyelwe kumalungu eNorth American Spine Society (kufaka phakathi odokotela abahlinzayo bamathambo kanye nodokotela abahlinzayo bemizwa). Lolu hlu lwemibuzo luthunyelwe kanye kuphela, njengoba kunconywe yiNorth American Spine Society. Odokotela abangu-2338 balutholile, abangu-532 bavula isixhumanisi, kwathi abangu-173 (isilinganiso sempendulo esingu-7.4%) bagcwalisa uhlu lwemibuzo. Amaphesenti angamashumi ayisikhombisa nambili abaqedile babengabahlinzayo bamathambo, abangu-28% babengabahlinzayo bemizwa, kanti abangu-73% babengabahlinzayo bomgogodla ababeqeqeshwa.
Uhlu lwemibuzo lwaluqukethe imibuzo engu-8 iyonke (Umfanekiso 1) ehlanganisa izindlela ezisetshenziswa kakhulu zokuthola indawo (kokubili izimpawu zokwakheka komzimba kanye nokuthola indawo ngezithombe), ukwenzeka kwamaphutha okuhlinzwa kwesigaba, kanye nobudlelwano phakathi kwezindlela zokuthola indawo kanye namaphutha okuhlukanisa. Uhlu lwemibuzo aluzange luhlolwe noma luqinisekiswe njengokuhlola. Uhlu lwemibuzo luvumela ukukhetha izimpendulo eziningi.
Isithombe 1 Imibuzo eyisishiyagalombili evela kuhlu lwemibuzo. Imiphumela ikhombisile ukuthi i-fluoroscopy yangaphakathi kokuhlinzwa yayiyindlela evame ukusetshenziswa kakhulu yokuhlukanisa indawo yokuhlinzwa komgogodla wesifuba ongemuva kanye nomgogodla we-lumbar (89% kanye no-86%, ngokulandelana), kulandelwe ama-radiograph (54% kanye no-58%, ngokulandelana). Odokotela abangu-76 bakhethe ukusebenzisa inhlanganisela yalezi zindlela zombili zokuhlukanisa indawo. Izinqubo ze-spinous kanye nama-pedicle ahambisanayo kwakuyizimpawu ezivame ukusetshenziswa kakhulu zokuhlinzwa komgogodla wesifuba kanye nomgogodla we-lumbar (67% kanye no-59%), kulandelwe izinqubo ze-spinous (49% kanye no-52%) (Isithombe 2). Odokotela abangu-68% bavumile ukuthi benze amaphutha okuhlukanisa indawo ezingxenyeni zomsebenzi wabo, amanye awo alungiswa ngesikhathi sokuhlinzwa (Isithombe 3).
Isithombe 2 Izindlela zokudweba izithombe kanye nokwakheka kwezimpawu ezisetshenziswayo.
Isithombe 3 Udokotela kanye nokulungiswa kwamaphutha esigaba sokuhlinzwa ngesikhathi sokuhlinzwa.
Ngamaphutha okuthola indawo, ama-56% alab’ odokotela asebenzise ama-radiograph angaphambi kokuhlinzwa kanti ama-44% asebenzise i-fluoroscopy yangaphakathi kokuhlinzwa. Izizathu ezivamile zamaphutha okubeka indawo ngaphambi kokuhlinzwa kwakuwukwehluleka ukubona iphuzu lokubhekisela elaziwayo (isb., umgogodla we-sacral wawungafakiwe ku-MRI), ukuhlukahluka kokwakheka komzimba (i-lumbar displaced vertebrae noma izimbambo ezinezimpande ezingu-13), kanye nokungacaci kwezingxenye ngenxa yesimo somzimba sesiguli (ukuboniswa kwe-X-ray okungafanele). Izimbangela ezivamile zamaphutha okubeka indawo ngesikhathi sokuhlinzwa zifaka phakathi ukuxhumana okunganele nodokotela we-fluoroscopist, ukwehluleka kokubeka kabusha indawo ngemva kokubeka (ukunyakaza kwenaliti yokubeka ngemva kwe-fluoroscopy), kanye namaphoyinti okubhekisela angalungile ngesikhathi sokubeka (i-lumbar 3/4 kusukela ezimbanjeni phansi) (Isithombe 4).
Umfanekiso 4 Izizathu zamaphutha okuthola indawo ngaphambi kokuhlinzwa kanye nangaphambi kokuhlinzwa.
Imiphumela engenhla ikhombisa ukuthi nakuba kunezindlela eziningi zokuthola indawo, iningi lodokotela abahlinzayo basebenzisa ezimbalwa kuphela zazo. Nakuba amaphutha okuhlinzwa kwesigaba engavamile, okungcono kakhulu ukuthi awatholakali. Ayikho indlela ejwayelekile yokususa la maphutha; nokho, ukuthatha isikhathi sokwenza indawo nokuhlonza izimbangela ezivamile zamaphutha okubekwa kwesigaba kungasiza ekunciphiseni ukwanda kwamaphutha okuhlinzwa kwesigaba emgogodleni we-thoracolumbar.
Isikhathi sokuthunyelwe: Julayi-24-2024
