Mapeji emagetsi emagetsi ane nzvimbo inokosha mumishonga inorwadza shure. Maererano neE-Medicine , nyanzvi dzinoverengeka dzinofunga kuti matambudziko ari munyaya iyi anowirirana nematambudziko akawanda ekurwadziwa kwepamusoro (zvichida 80%).
Kunzwisisa maitiro ako kunogona kubatsira pakunzwisisa kurwadziwa uku kwemuviri uye kurapwa kwayo. Chokutanga, ziva kuti chidimbu chakabatana ndicho chinopa musana wemusana wemadziro kusimba panguva imwe chete zvichiita kuti mamwe mararamiro aende.
Iyo inozivikanwawo se zygapopsese, pamwe chete neZ-joint. Mutsipa wemukati unogara kunze kwega uye unongotarisa chikamu chakabatanidzwa. Iyo imwewo yematavi matatu emutsara mukuru unonzi dorsal ramus, iyo ndiyo yekutanga yakagadzikana mutsara inobva kumutsipa wesiperesi midzi. Yeuka, dorsal zvinoreva shure uye ramus zvinoreva bazi.
Idzo nhatu nhatu dzinoshandiswa kubva kune dorsal ramus dzinoshumira nzvimbo dzakawanda, kusanganisira midzi yakadzoka shure. Dare remukati rinonyanya kukanganisa chikamu chakabatana pachavo pamwe nekudzika kwemashure zvakadai se interspinales , multifidus , uye vamwe vashomanana. Dare remukati rinosvikawo mune imwechete yepelinal ligament (interspinous) uye zvichida maviri (iro ligamentum flavum pamwe chete).
Chii Chinonzi Miti YeMagetsi?
Paunenge uine muzinda webazi, imwe nzvimbo inofanirwa kunetseka yakadai seydocaine inoshandiswa mujinga remukati webato rinobatanidzwa. Injecting anesthetic yomukati munharaunda yepakati inobatsira vanachiremba kuti vaongorore kurwadziwa shure.
Kana mujoyi uchinge unotapudza 50% yemarwadzo ako ose anowanzosuruvara, chiremba wako angangodaro anoratidza kuti marwadzo ari kuuya kubva pachikamu chekubatana uye anokurudzira kuperesa kwehuwandu hwemhepo sekurapa. Mapeji emagetsi anoverengeka anoshandiswawo kuongorora chirwere chejojo sacroiliac.
Iwe unogona kuva nebazi rebazi remukati kune rumwe rutivi rwechikwata chakabatanidzwa kana pazvose.
Kana mativi maviri akabatwa, inonzi bi-lateral injection.
Dare reMedhi Rinodzivirira kana Intra-Articular Injections
Imwe mhando yejojo inoshandiswa kuongororwa marwadzo kumashure ndeyo injiramu ye intra-articular. Iri jira rinopinda munzvimbo yakabatana yechipfuva iyo yakakomberedzwa ne capsule yakagadzirwa nehutano hwemagetsi. Chidzidzo che 2016 chakabudiswa mupepanhau Pain Physician akawana, pakati pezvimwe zvinhu, kuti sangano iri pakati pebazi remukati rinovhara uye chibudiro chakabatanidzwa pamwe chete chinogona kuve chakakura kudarika iyo iri pakati pejekiti ye intra-articular uye kubudirira. Izvozvo zvakati, vanyori vanodana kuwedzera huwandu hwekutsvakurudza kwepamusoro kuti zviitwe pane nyaya vasati vangavimbisa izvi kuwanikwa.
Dare Remukati Rinodzivirira Sezvirapa
Ko mapeji emukati anokwanisa here kushandiswa semushonga? Mushure mezvose, vanobvisa kurwadziwa, zvakarurama?
Kunyange zvazvo yakawanda yenguva iyo mubazi rebazi remunharaunda inopiwa nokuda kwekuongororwa, zvinowanzoshandiswa sechirapa, asi inoshanda zvakadini?
Chidzidzo che2013 chakabudiswa muAnals of Rehabilitative Medicine chakawana kuti kune vanhu vaiva nebazi remukati vanovhara maitiro asingagumi marwadzo anowirirana ane chokuita newasteoporotic kuputsika shure kana vertebroplasty kana kurapwa kwakachengetedza, zvibereko zvaive zvakanaka gore rinopinda mujeri.
Vanyori vanotaura kuti bhidhiro rebazi remukati rinounza marwadzo ekurwadziwa uye kushandiswa kwehutano hwevarwere ava.
Asi chidzidzo che2012 chakaongorora hutano hwakasiyana-siyana hwehutano hwakagadzikana hunowana humwe uchapupu hwakanaka hwemukati webazi hunovhara senzira yekuregedza kurwadziwa kusingaperi munzvimbo iyoyo. Izvozvo zvakati, vatsvakurudzi vakanga vasina kukwanisa kuenzanisa mapazi ebazi mukati majekiseni e-intra-articular, nokuti kwakanga kusina uchapupu zvachose pamishonga inonzi intra-articular. Uye iyo PM & R yekudzidza yakataurwa pamusoro apa, uchapupu hushoma hunowanikwa hwehuwandu hwemhepo hutachiona. Kushandiswa kwehuwandu hwemhepo yakagadziriswa uye / kana neurotomy kunowanzoshandiswa nehutano hwehutano hwehutano huri nani kupfuura hutano hwebazi.
Rodofrequency frequency ablation is outpatient process in which heat is applied to the nerves around the facet joint, killing the cells. Nokufamba kwenguva, muviri unotsiva masero emasitema akafa ane tsvina. Kunyange zvazvo kubuda kwemaawa kunofungidzirwa kuti kunopesana, kurasikirwa kwezvikamu zvinokonzera marwadzo kunogona kupa kuponeswa kunogara kwenguva refu kupfuura mune dzimwe nzvimbo dzomukaka. Chidzidzo che2015 chakabudiswa mu International Journal of Anesthetics neAnesthesiology chakawana kuti makore maviri apera kuti vasafambisa huwandu hwemhepo, varwere vari kuita zvakanaka maererano nehutano hwekugadzirisa, kukwanisa kushanda uye marwadzo akawanda anorwadza aidiwa.
Muhutano hwehutano, rudzi rumwechete rwehuni-kubva kumafungu eredhiyo-rinoshandiswa kuitira kuti zvigadzirise kwenguva pfupi marwadzo. Chidzidzo che2012 chakabudiswa mumagazini ( PM & R) ( Physical Medicine and Rehabilitation ) chakawana kuti kupumbuka kwepfungwa kunokonzerwa nehutachiona hwehutachiona hwehutachiona hwakagara pakati pemwedzi 7 kusvika ku 9 kuvarwere vakawanda, uye izvi zvaiva zvechokwadi kana nzvimbo yakarapwa yaiva mumutsipa kana pasi.
Chii Chinoitika Munharaunda YeMagetsi?
Kana iwe wakarongerwa kuti uve nebazi rebazi, unogona kutarisira chii?
Iyi nzira inogona kuitika munzvimbo yakabuda kunze uye iwe haugone kurara, asi izvi zvakanaka! Chiremba achatanga nekupa pfupa yekunetseka kwepachipfupa kunopedza ganda rako uye mhuka dziri pedyo nechokubatana. Iwe uchanyarara pamudumbu mako kuitira kuti chiremba asvike pazvikwata zvako, izvo zviri kumashure kwemutsara wepelinha.
Zvadaro iye achaisa nheyo iyo yakagadzirirwa kune khamera inonzi fluoroscope muchikamu chakabatana. Kuburikidza nesingano, dhayi yakasiyana ichaiswa muhara. Izvi zvinoita kuti chiremba aone kuti kana kwete iyo mumiririri wechinosha anoshandiswa anoshandisa nzvimbo yose yakapoteredza chikamu chakabatanidzwa. Zvadaro, iyo inofungidzira inoshandiswa mujoka.
Kana imwechete iyo inetemikirwo yakave yakakonzerwa, chiremba wako anogona kukuraira kuti uite zvakafanana zvinowanzoita kuti uwedzere kurwadziwa kana zviratidzo. Maererano naAnthony Vaccaro, MD, purofesa wehutachiona uye chirwere chezvemapfupa paTeast Jefferson University muPhiladelphia uye mutungamiri mukuru weSpinal Cord Injury, pakati pe50% uye 75% kununurwa kunorwadza kuchapa chiremba chikonzero chekusimbisa iwe uri shure kwako marwadzo ari kuuya kubva pachikwata chenyu pamwe uye / kana mutsara wako webazi.
Nokuti chikamu chimwe nechimwe chakabatanidzwa chinopiwa nemaviri emagetsi emagetsi (imwe kubva kumiti yepamusoro kumusoro uye imwe kubva kune vertebra iri pasi) iwe ungangodaro unogamuchira mapfupa maviri ekugunun'una kwezvikamu zvose zvakabatana zvakarongerwa kurapwa.
Izvi zvinogona kugadzirisa kuvhiringidzika kana zvasvika kune coding yezvechiremba uye kubhadhara. Zvechokwadi, mumakore achangobva kupfuura, chikwata chakabatanidzwa chirongwa chekujekesa matambudziko chakakonzera kuwanda kwechirwere cheMedare.
Medicare Kubiridzira nekushungurudzwa Kunosangana neCheet Injections
Mushumo wegore ra2008 wakabudiswa neHIV neHuman Services Office ye Inspector General yakawana huwandu hwe76% hwemari yeMedicare yezvikamu zvinodzivirira pakati pemakore a2003 na2006. Vanyori vakaona kuti pane izvi, 63% yejeri majeri akanga asina kunyorwa, zvisina kukodzera coded (82% yezvi izvi zvakaguma muMedare repayiridzo yepamusoro) uye / kana kwete mishonga inokosha.
Muna 2006, Medicare yakabhadhara madhora 81 mamiriyoni emabasa echiremba angave asina kunyatsoratidzwa kana kuti asina kunyorwa zvachose. Mushumo unoti kunyange zvazvo dzimwe dzezvikwereti izvi zvisina kukodzera zvaibva pane zvinyorwa zvisiri izvo, vamwe vangadaro vakave vari majekesiti asina kumboitika. Maererano nehupfumi, nguva zhinji, vanachiremba vangadai vakatumira ruregerero rweMurere kuMedare, asi mune dzimwe nguva, havana kumboita izvozvo uye vakaramba vachiripira.
Zvimwe zvezvikanganiso mune zvinyorwa zvakatumirwa kuMedare zvinosanganisira kusanzwisiswa kwemaitiro akaitwa, kana kushayiwa zvinyorwa, somuenzaniso, chiratidzo chemukati wepamuviri uye / kana rutivi rwemashure (kureva kurudyi, kuruboshwe kana kuti zvose) iyo yakagamuchira jekiseni .
Kuwedzera kuwedzerwa kwekodhi kunofanirwa kuratidzira majekiseni maviri (kureva kuti kuputika kumativi ose echikwata chako pamwe chete) kwakaguma nemari 50% yepamusoro kudarika Medicare inofanira kunge yakabvumira, iyo report inoti. Vanyori vemushumo vanoti kana dzimwe dzezvikanganiso izvi zvingangoerekana zvangoitika, vamwe vangave zviitiko zvekunyengedza nemaune.
Mharidzo yacho zvakare yakataura kuti vanachiremba vari kunze kwezvivako zvakange zvakanyanya kuita zvikanganiso zvakadaro uye / kana kuita hupombwe kupfuura avo vaiita muzvipatara. Kuenzanisa kwaiva 71% yezvikamu zvekudzivirira majekiseni zvakapiwa muhofisi kusvika 51% kune avo vakapiwa mune imwe nzvimbo sechipatara.
Zvichida zvikanganiso zvakanyanya, zvisinei, ndezviya majekiseni anopiwa izvo zvaisava zvakakosha mumuviri. Maererano nemushumo, chirevo chechirongwa chekubiridzira kwaiva $ 17 mamiriyoni.
> Sources:
> Bentin, C. yeAA. Nzira isina kukodzera Yomuganhu Webazi Kuvhara Kunyoresa: Nzira Yenzira Yakakwirira Inowanika Muhutano Hwakagadziriswa Audits Beckers ASCReview Website. Sept 2010.
> Holz, S., Sehgal, N. Chii chinonzi Correlation Between Facet Joint Radiofrequency Outcome uye Mhinduro kune Kuenzanisa Medial Branch Blocks? Pain Physician. March 2016. http://www.ncbi.nlm.nih.gov/pubmed/27008290.
> Malanga, GMD, Young, CMD et. Al Lumbosacral Facet Syndrome. E-Medicine Medscape Website. Sept 2015. https://emedicine.medscape.com/article/94871-overview#a6.
> Manchikanti K., Atluri S., Singh V., Geffert S., Sehgal N., Falco F. Chimwe Chinyorwa cheKutsvakurudza kweTraracutic Thoracic Facet Mazano Akabatanidzwa. Pain Physician. July-Aug 2012. http://www.ncbi.nlm.nih.gov/pubmed/22828694.
> McCormick, Z., Benjamin Marshall, B., Jeremy Walker, J., Robert McCarthy, R., Walega, D. Basa Rakareba kwenguva refu, kurwadziwa uye Mishonga Shandisa Migumisiro yeRadiofrequency Ablation yeLumbar Facet Syndrome. Int J Anesth Anesth. April 2015.
> Park, K. MD, Yee, H. PhD, Nam, H., MD, Cho, S., MD. Kim, H., MD, Park, Y., MD, Lim, O., MD. Migumisiro Yebazi Rekuvhara Muzvikamu Zvisingagumi Kuwirirana Kwemapfupa Osteoporotic Kushungurudzika Kwekuputika: Chimwe Chegore Chidzo Chekudzidza. Ann Rehabil Med. April 2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660479/.
> Smuck M., Crisostomo R., Trivedi K., Agrawal D. Kubudirira kwekutanga uye kwakadzokorora Medial Branch Neurotomy for Zygapophysial Joint Pain: A Reviewed System. PM R. September 2012.
> Vaccaro, A. Spine: Zivo yeCore muOrpopedics. Mosby. 2005. Philadelphia. Pp 63-64.