He nui ngā hapa o te tūroro me te wāhi pokanga, ā, ka taea te ārai. E ai ki te Joint Commission on Accreditation of Healthcare Organizations, ka taea ēnei hapa te puta i roto i te 41% o ngā pokanga orthopedic/pediatric. Mō te pokanga tuaiwi, ka puta he hapa wāhi pokanga ina he te wāhanga tuaiwi, te lateralization rānei. Haunga te korenga e aro ki ngā tohu me te pathology o te tūroro, ka taea e ngā hapa wāhanga te arahi ki ngā raruraru hauora hou pērā i te tere o te pirau o te kōpae, te kore pumau rānei o te tuaiwi i roto i ngā wāhanga kāore he tohu, he wāhanga noa rānei.
He take ture anō hoki e pā ana ki ngā hapa wāhanga i roto i te pokanga tuaiwi, ā, kāore te marea, ngā tari kāwanatanga, ngā hōhipera, me ngā rōpū taote pokanga e aro ki ēnei hapa. He maha ngā pokanga tuaiwi, pērā i te discectomy, te fusion, te laminectomy decompression, me te kyphoplasty, e mahia ana mā te whakamahi i te huarahi posterior, ā, he mea nui te tūnga tika. Ahakoa te hangarau whakaahua o nāianei, kei te puta tonu ngā hapa wāhanga, me ngā reiti auau mai i te 0.032% ki te 15% i kōrerotia i roto i ngā tuhinga. Kāore he whakatau mō te tikanga o te localization te mea tino tika.
I whakahaerehia e ngā tohunga o te Tari Pokanga Orthopedic i te Kura Hauora o Mount Sinai, USA, tētahi rangahau pātai ipurangi e kī ana ko te nuinga o ngā taote pokanga tuaiwi e whakamahi ana i ētahi tikanga rapunga noa iho, ā, ko te whakamārama i ngā take noa o te hapa ka whai hua ki te whakaiti i ngā hapa wāhanga pokanga, i roto i tētahi tuhinga i whakaputaina i te marama o Mei 2014 i roto i te Spine J. I whakahaerehia te rangahau mā te whakamahi i tētahi pātai īmēra. I whakahaerehia te rangahau mā te whakamahi i tētahi hononga īmēra ki tētahi pātai i tukuna ki ngā mema o te North American Spine Society (tae atu ki ngā taote pokanga wheua me ngā taote pokanga roro). Kotahi noa te tukunga o te pātai, e ai ki te taunakitanga a te North American Spine Society. E 2338 ngā tākuta i whiwhi, e 532 i whakatuwhera i te hononga, ā, e 173 (7.4% te auau whakautu) i whakaoti i te pātai. E whitu tekau mā rua ōrau o ngā taote pokanga wheua, e 28% he taote pokanga roro, ā, e 73% he taote tuaiwi kei te whakangungu.
E waru ngā pātai katoa o te pātai (Pikitia 1) e kapi ana i ngā tikanga rapunga e whakamahia whānuitia ana (ngā tohu whenua me te rapunga whakaahua), te auau o ngā hapa wāhanga pokanga, me te hononga i waenga i ngā tikanga rapunga me ngā hapa wāhanga. Kāore te pātai i whakamatautauria, i whakamanahia rānei. Ka taea te whiriwhiri i ngā whakautu maha i roto i te pātai.
Pikitia 1 E waru ngā pātai mai i te pātai. I whakaatuhia e ngā hua ko te fluoroscopy i te wā o te pokanga te tikanga tino whakamahia mō te kimi i te wāhi tika mō te pokanga tuarā o muri o te uma me te hope (89% me te 86%, ia), ā, i muri mai ko ngā whakaahua X-ray (54% me te 58%). 76 ngā tākuta i whiriwhiri ki te whakamahi i te huinga o ngā tikanga e rua mō te kimi i te wāhi tika. Ko ngā tukanga spinous me ngā pedicles e rite ana ngā tohu anatomical tino whakamahia mō te pokanga tuarā o te uma me te hope (67% me te 59%), ā, i muri mai ko ngā tukanga spinous (49% me te 52%) (Pikitia 2). 68% o ngā tākuta i whakaae kua hē rātou i te kimi i te wāhi tika i roto i tā rātou mahi, ko ētahi i whakatikahia i te wā o te pokanga (Pikitia 3).
Pikitia 2 Ngā tikanga whakaahua me te tautuhi i ngā tohu whenua i whakamahia.
Pikitia 3 Te whakatikatika a te taote me te whakatikatika i ngā hapa wāhanga pokanga i te wā e pokanga ana.
Mō ngā hapa taunga, 56% o ēnei tākuta i whakamahi i ngā whakaahua X-ray i mua i te pokanga, ā, 44% i whakamahi i te fluoroscopy i te wā pokanga. Ko ngā take noa mō ngā hapa taunga i mua i te pokanga ko te korenga o te tirohanga i tētahi pūwāhi tohutoro e mōhiotia ana (hei tauira, kāore te tuaiwi sacral i whakaurua ki te MRI), ngā rerekētanga anatomical (ngā tuaiwi kua nekehia te lumbar, ngā rara 13-root rānei), me ngā koretake o ngā wāhanga nā te āhua tinana o te tūroro (te whakaaturanga X-ray kāore i te tino pai). Ko ngā take noa o ngā hapa taunga i te wā pokanga ko te koretake o te whakawhitiwhiti kōrero ki te fluoroscopist, te korenga o te taunga i muri i te taunga (te nekehanga o te ngira taunga i muri i te fluoroscopy), me ngā pūwāhi tohutoro hē i te wā o te taunga (3/4 lumbar mai i ngā rara ki raro) (Pikitia 4).
Pikitia 4 Ngā take mō ngā hapa taunga i mua i te pokanga me te wā o te pokanga.
E whakaatu ana ngā hua o runga ake nei ahakoa he maha ngā tikanga mō te kimi i te wāhi tika, he torutoru noa iho ngā tikanga e whakamahia ana e te nuinga o ngā taote pokanga. Ahakoa he onge ngā hapa wāhanga pokanga, ko te mea pai kia kore. Kāore he huarahi paerewa hei whakakore i ēnei hapa; heoi, mā te whai wā ki te mahi i te tūnga me te tautuhi i ngā take noa o ngā hapa tūnga ka āwhina i te whakaiti i te auau o ngā hapa wāhanga pokanga i roto i te tuaiwi thoracolumbar.
Te wā tuku: Hurae-24-2024
