Kulumikizana kwa chiuno ndi mgwirizano wa mpira ndi socket wopangidwa ndi mutu wa femur ndi socket, yomwe ili mbali ya chiuno. Labrum ndi mphete ya cartilage pazitsulo zazitsulo za m'chiuno zomwe zimathandiza kusunga madzi olowa mkati kuti zitsimikizire kuyenda kosasunthika ndi kugwirizanitsa panthawi yoyenda. Kung'ambika kwa labral m'chiuno ndi kuvulala kwa labrum. Kukula kwa kuwonongeka kungasiyane. Nthawi zina, labrum ya m'chiuno imatha kukhala ndi misozi yaying'ono kapena kuphulika m'mphepete, nthawi zambiri chifukwa cha kung'ambika pang'onopang'ono. Nthawi zina, gawo la labrum limatha kupatukana kapena kung'ambika kuchokera ku fupa la socket. Kuvulala kwamtunduwu nthawi zambiri kumachitika chifukwa cha zoopsa. Pali mayesero owonetsetsa a chiuno cha labral kuti adziwe mtundu wa kuvulala. Gulu la Injury Medical Chiropractic ndi Functional Medicine Clinic lingathandize.
zizindikiro
Zizindikiro zimakhala zofanana mosasamala kanthu za mtundu wa ng'anjo, koma kumene zimveka zimadalira ngati misozi ili kutsogolo kapena kumbuyo. Zizindikiro zofala monga:
Kupweteka kwa chiuno, chiuno, kapena matako, makamaka poyenda kapena kuthamanga.
Kusapeza bwino kwa usiku ndi zizindikiro zowawa pogona.
Misozi ina singayambitse zizindikiro ndipo imatha kukhala yosazindikirika kwa zaka zambiri.
Mayeso a Hip Labral Misozi
Kuphulika kwa labral m'chiuno kumatha kuchitika paliponse pambali pa labrum. Atha kufotokozedwa ngati anterior kapena posterior, kutengera gawo lomwe lakhudzidwa:
Misozi ya m'chiuno mwala: Mtundu wodziwika kwambiri wa chiuno cha labral misozi. Misozi imeneyi imapezeka kutsogolo kwa chiuno.
Misozi ya posterior hip labral: Mtundu uwu umawonekera kumbuyo kwa ntchafu.
Kuyezetsa
Mayeso odziwika kwambiri a hip labral tear ndi awa:
Mayeso a Hip Impingement
Mayeso Okweza Miyendo Yowongoka
The CHAKUDYA Mayeso - amayimira Flexion, Abduction, and External Rotation.
The CHITATU Mayeso - amayimira Hip Internal Rotation with Distraction.
Mayeso a Hip Impingement
Pali mitundu iwiri ya mayeso olowera m'chiuno.
Anterior Hip Impingement
Kuyezetsa kumeneku kumaphatikizapo wodwalayo atagona chagada ndi bondo lake atawerama pa madigiri 90 ndikuzungulira mkati molunjika ku thupi.
Ngati pali ululu, mayesero amaonedwa kuti ali abwino.
Posterior Hip Impingement
Kuyezetsa kumeneku kumaphatikizapo wodwala atagona chagada ndi chiuno chake chotambasula ndipo bondo lawo likugwedezeka ndi kupindika pa madigiri a 90.
Kenako mwendo umazunguliridwa kunja kutali ndi thupi.
Ngati zimabweretsa ululu kapena mantha, zimaonedwa kuti ndi zabwino.
Roanna M. Burgess, Alison Rushton, Chris Wright, Cathryn Daborn, Kutsimikizika ndi kulondola kwa mayesero achipatala omwe amagwiritsidwa ntchito kuti azindikire matenda a labral m'chiuno: Kubwereza mwadongosolo, Manual Therapy, Volume 16, Issue 4, 2011, Masamba 318-326 , ISSN 1356-689X, doi.org/10.1016/j.math.2011.01.002 (www.sciencedirect.com/science/article/pii/S1356689X11000038)
Su, Tiao, et al. "Kuzindikira ndi kuchiza misozi ya labral." Magazini yachipatala yaku China vol. 132,2 (2019): 211-219. doi:10.1097/CM9.0000000000000020
Wilson, John J, and Masaru Furukawa. "Kuwunika kwa wodwala yemwe ali ndi ululu wa m'chiuno." Dokotala waku America vol. 89,1 (2014): 27-34.
Kodi zizindikirozo zikuipiraipira pa nthawi inayake ya tsiku?
Dokotala adzayang'ana zofooka pakuyenda komanso madera anthenda ya palpate. Ambiri Matenda angayambitse zizindikiro zofanana, kotero dokotala adzayang'ana kuti awone ngati ululu kapena kusowa kwa kuyenda kumagwirizana ndi ankylosing spondylitis. Chizindikiro cha ankylosing spondylitis ndi ululu ndi kuuma kwa mafupa a sacroiliac. Malumikizidwe a sacroiliac amakhala kumunsi kumbuyo, komwe kumunsi kwa msana ndi pelvis zimakumana. Dokotala adzawona zovuta zina za msana ndi zizindikiro:
Zizindikiro za ululu wammbuyo chifukwa cha - kuvulala, machitidwe, ndi / kapena malo ogona.
Ma antibodies a nyukiliya, kapena ANA, amapita pambuyo pa mapuloteni omwe ali mu phata la selo, ndikuwuza thupi kuti maselo ake ndi adani.
Izi zimayambitsa chitetezo cha mthupi chomwe thupi limalimbana kuti lichotse.
Kafukufuku adawonetsa kuti ANA imapezeka mu 19% ya anthu omwe akudwala ankylosing spondylitis ndipo ndi yayikulu mwa amayi kuposa amuna.
Kuphatikizidwa ndi mayeso ena, kupezeka kwa ANA kumapereka chidziwitso china cha matenda.
Kutha Matenda
The microbiome m'matumbo imagwira ntchito yofunika kwambiri poyambitsa chitukuko cha ankylosing spondylitis ndi chithandizo chake.
Kuyeza kuti adziwe thanzi la m'matumbo kungapatse dokotala chithunzi chonse cha zomwe zikuchitika m'thupi.
Kuyeza kwa magazi kwa ankylosing spondylitis ndi matenda ena otupa kumadalira kwambiri pakuphatikiza mayeso osiyanasiyana pamodzi ndi mayeso azachipatala ndi kujambula.
Zoyambitsa, Zizindikiro, Matenda, ndi Chithandizo
Zothandizira
Cardoneanu, Anca, et al. "Makhalidwe a intestinal microbiome mu ankylosing spondylitis." Mankhwala oyesera ndi achire vol. 22,1 (2021): 676. doi:10.3892/etm.2021.10108
Prohaska, Et al. “Antinukleäre Antikörper bei Spondylitis ankylosans (Morbus Bechterew)” [Antinuclear antibodies in ankylosing spondylitis (author's transl)]. Wiener klinische Wochenschrift vol. 92,24 (1980): 876-9.
Sheehan, Nicholas J. "Zotsatira za HLA-B27." Journal of the Royal Society of Medicine vol. 97,1 (2004): 10-4. doi:10.1177/014107680409700102
Xu, Yong-Yue, et al. "Udindo wa gut microbiome mu ankylosing spondylitis: kusanthula kwamaphunziro m'mabuku." Discovery medicine vol. 22,123 (2016): 361-370.
The Adams patsogolo bend mayeso ndi njira yosavuta yowunikira yomwe ingathandize ndi matenda a scoliosis ndikuthandizira kupanga ndondomeko ya chithandizo. Mayesowa amatchulidwa pambuyo pa Dokotala wa Chingerezi William Adams. Monga gawo la kuyezetsa, dokotala kapena chiropractor adzayang'ana kupindika mbali ndi mbali mumsana.
Kuzindikira kwa Scoliosis
Kuyesa kwa Adams kutsogolo kungathandize kudziwa ngati pali zizindikiro za scoliosis.
Sichidziwitso chovomerezeka, koma zotsatira zake zingagwiritsidwe ntchito ngati poyambira.
Mayeso amachitidwa ndi msinkhu wa sukulu ana pakati pa 10 ndi 18 kuti azindikire wachinyamata idiopathic scoliosis kapena AIS.
Mayeso abwino ndi asymmetry yodziwika bwino m'nthiti ndi kupindika patsogolo.
Ikhoza kuzindikira scoliosis kumbali iliyonse ya msana, makamaka pakatikati pa thoracic ndi kumtunda.
Mayeso si a ana okha; scoliosis imatha kukula pazaka zilizonse, kotero imathandizanso kwa akuluakulu.
Mayeso a Adams Forward Bend
Mayeso ndi ofulumira, osavuta, komanso osapweteka.
Matenda a Scheuermann ndi mtundu wa kyphosis pomwe vertebrae ya thoracic imatha kukula mosiyanasiyana panthawi yakukula ndikupangitsa kuti vertebrae ikhale yofanana ndi mphero.
Glavaš, Josipa et al. "Udindo wamankhwala akusukulu pakuzindikira koyambirira ndi kasamalidwe ka adolescent idiopathic scoliosis." Wiener klinische Wochenschrift, 1–9. 4 Oct. 2022, doi:10.1007/s00508-022-02092-1
Grossman, TW et al. "Kuwunika kwa Adams forward bend test ndi scoliometer mu scoliosis school screening." Journal of Pediatric Orthopedics vol. 15,4 (1995): 535-8. doi:10.1097/01241398-199507000-00025
Letts, M ndi al. "Computerized ultrasonic digitization muyeso wa kupindika kwa msana." Msana vol. 13,10 (1988): 1106-10. doi:10.1097/00007632-198810000-00009
Senkoylu, Alpaslan, et al. "Njira yosavuta yowunika kusinthasintha kwa adolescent idiopathic scoliosis: mayeso opindika kutsogolo a Adam." Kuwonongeka kwa msana vol. 9,2 (2021): 333-339. doi:10.1007/s43390-020-00221-2
Kupweteka kwapang'onopang'ono ndi chimodzi mwa matenda omwe amapezeka kwa anthu omwe amapita kwa dokotala kapena chipatala mwamsanga. Pamene ululu wammbuyo umakhala wovuta kwambiri, ukhoza kukupangitsani kuganiza kuti pali vuto lalikulu ndi nsana wanu. Dokotala akhoza kupereka x-ray kapena MRI scan kuti muchepetse nkhawa zanu.
Mwamwayi, nthawi zambiri zowawa zam'mbuyo, ngakhale zowawa kwambiri, zimasintha mkati mwa masiku kapena masabata angapo. Milandu yambiri imakonzedwa ndi chiropractic, chithandizo chamankhwala, kutentha / ayezi, ndi kupuma. Ndipo zambiri mwazochitikazi sizifuna kujambulidwa kwamtundu uliwonse. Komabe, ndichifukwa chake X-ray, MRI, ndi CT scans ndizofunikira kuti mudziwe zomwe zikuchitika.
Minofu yopsinjika
Mtsempha wosweka
Kusasintha kosauka
Zomwe zimayambitsa kupweteka kwa msana zimakhala zowawa komanso kuchepetsa ntchito.
Ululu Wobwerera Mmbuyo Wotalika Kuposa Masabata a 2/3
Kupweteka kwapang'onopang'ono kumatenga pakati pa 4 ndi masabata a 12, pamene kupweteka kwa msana kumatenga miyezi itatu kapena kupitirira. Izi sizizindikiro za vuto lalikulu la msana.
Pansi pa 1% ya anthu omwe ali ndi ululu wochepa wammbuyo amapezeka kuti ali ndi vuto lomwe lingafunike opaleshoni ya msana:
Dokotala amagwiritsa ntchito zotsatirazi kuti adziwe ngati kujambula kwa msana kuli kofunikira, pamodzi ndi mtundu wa kuyesa kujambula, x-ray, kapena MRI ndi nthawi yotsimikizira kuti ali ndi matenda.
A Low Back X-ray / MRI
Kujambula kwa X-ray kwa msana kumazindikira bwino zovuta zamafupa koma ndi osati kwambiri ndi kuvulala kwa minofu yofewa. Mndandanda wa X-ray ukhoza kuchitidwa kuti azindikire fractures ya vertebral compression.
zapambuyo
Zapanja
Malingaliro apambuyo
MRI ndi mayeso opanda ma radiation. MRIs kupanga Mawonedwe a anatomical a 3-D a mafupa a msana ndi minyewa yofewa. Mtundu wosiyana ngati gadolinium amagwiritsidwa ntchito kupititsa patsogolo ndi kupititsa patsogolo zithunzi. Kusiyanitsa kumabayidwa kudzera m'mitsempha m'manja mwanu kapena pamkono musanayambe kapena panthawi ya mayeso. An MRI imatha kuwunika zizindikiro zam'mitsempha, monga kupweteka kotulutsa kapena ululu umene umayamba pambuyo pozindikira khansa.
Zizindikiro, Zomwe Zilipo Zachipatala Zomwe Zilipo, ndi Zomwe Zingafunikire Kujambula kwa Msana
Zizindikiro zamitsempha
Ululu wammbuyo womwe umatuluka, mafani kunja, kapena kutsika mpaka matako, miyendo, ndi mapazi
Kusokonezeka kwachilendo m'munsi mwa thupi kungasonyeze kusokonezeka kwa mitsempha
Kutentha kwa thupi lanu lonse kumayesedwa kudzera mu millisievert (mSv), yomwe imadziwikanso kuti mlingo wogwira mtima. Mlingo wa radiation ndi wofanana nthawi iliyonse mukakumana ndi x-ray. Pamene akuchitidwa X-ray, ndi Ma radiation osayamwa ndi thupi amapanga chithunzicho.
Mlingo wogwira mtima umathandiza dokotala kuyeza chiwopsezo cha zotheka chithunzi cha radiographic:
Ma CT scans amagwiritsanso ntchito ma radiation
Ziwalo za m'thupi ndi ziwalo za m'munsi zimakhudzidwa ndi kukhudzidwa kwa ma radiation, monga ziwalo zoberekera.
MRI singagwiritsidwe ntchito kwa odwala onse chifukwa cha luso lamphamvu la maginito. Amayi apakati kapena anthu omwe ali ndi zitsulo mkati mwa thupi lawo, monga chotsitsimutsa cha msana, pacemaker ya mtima, ndi zina zotero, sangathe kufufuzidwa ndi MRI.
Kuyeza kwa MRI nakonso kumakhala kokwera mtengo; madokotala sakufuna kulembera mayeso osafunika omwe amawonjezera ndalama. Kapena chifukwa cha tsatanetsatane wabwino umene MRIs amapereka, nthawi zina vuto la msana likhoza kuwoneka lovuta koma silili.
Chitsanzo: MRI ya m'munsi kumbuyo imasonyeza a herniated disc mwa wodwala wopanda ululu wammbuyo / mwendo kapena zizindikiro zina.
Ichi ndichifukwa chake madokotala amabweretsa zonse zomwe apeza monga zizindikiro, kuyezetsa thupi, ndi mbiri yachipatala kuti atsimikizire za matendawo ndikupanga dongosolo lamankhwala lokhazikika.
Imaging Test Takeaways
Ngati kupweteka kwa msana kumapweteka kwambiri, mvetserani zomwe adokotala akulangiza. Iwo sangayitanitsa lumbar x-ray kapena MRI nthawi yomweyo koma kumbukirani zomwe tazitchula pamwambapa, monga zizindikiro za minyewa ndi matenda omwe alipo. Koma mayesowa amathandiza kudziwa chomwe chimayambitsa ululu. Kumbukirani kuti izi ndikuthandizira odwala kuti akhale ndi thanzi labwino komanso opanda ululu.
Imaging diagnostics ndichinthu chofunikira pakuwunika kuvulala kwa msana. Kusintha kofulumira kwa ukadaulo wojambula zithunzi kwasintha kwambiri kuyesa ndi chithandizo cha kuvulala kwa msana. Kuzindikira kojambula pogwiritsa ntchito CT ndi MRI, pakati pa ena, kumathandiza pazovuta komanso zosatha. Kuvulala kwa msana ndi minofu yofewa kumayesedwa bwino ndi kujambula kwa magnetic resonance, kapena MRI., pomwe computed tomography scanning kapena CT scans amawunika bwino kuvulala kwa msana kapena kusweka kwa msana.
Nthawi zina pamakhala zovuta za msana ndipo zimapangitsa kuti ma curvatures achilengedwe asokonezeke kapena zopindika zina zitha kukokomeza. Izi zopindika mwachibadwa za msana zimadziwika ndi zikhalidwe zitatu zaumoyo zomwe zimatchedwa lordosis, kyphosis, ndi scoliosis.
Sichilinganizidwa kukhala chopindika mwachibadwa, chopindika, kapena chopindika. Chikhalidwe chachilengedwe cha msana wathanzi ndi wowongoka pang'ono ndi zokhotakhota pang'ono zothamangira kutsogolo kupita kumbuyo kuti mawonekedwe am'mbali awawululire.
Kuyang'ana msana kuchokera kumbuyo, muyenera kuwona china chosiyana kwambiri - msana womwe umayenda molunjika pansi, pamwamba mpaka pansi popanda mbali yokhotakhota. Izi sizichitika nthawi zonse.
Msanawu umapangidwa ndi ma vertebrae, mafupa ang'onoang'ono omwe amayikidwa pamwamba pa wina ndi mzake ndi ma disc omwe amawongolera pakati pa aliyense. Mafupawa amakhala ngati mfundo, zomwe zimathandiza kuti msanawo upinde ndi kupindika m'njira zosiyanasiyana.
Amapindika pang'onopang'ono, kutsetsereka pang'ono mkati pang'ono kumbuyo, komanso pang'ono pakhosi. Kukoka kwa mphamvu yokoka, pamodzi ndi kayendetsedwe ka thupi, kungapangitse kupsinjika kwakukulu pa msana ndipo ma curve ang'onoang'onowa amathandiza kuyamwa zina mwazotsatira.
Zosiyanasiyana zamitundu yosiyanasiyana ya ma curvatures a msana
Scoliosis akadali chinsinsi pang'ono kwa madokotala. Sakudziwa chomwe chimayambitsa mtundu wofala kwambiri wa scoliosis womwe umapezeka mwa ana ndi achinyamata. Zina mwa zifukwa zomwe adazifotokoza ndi izi:
Cholowa, chimakhala ndi chizolowezi chothamangira m'mabanja
Kutenga
Chilema chobadwa nacho
kuvulazidwa
Kusokonezeka kwa Msana ndi Chiropractic
Kuwongolera kwa msana pazovuta za curvature ya msana zawonetsedwa kuti ndizothandiza kwambiri. Chiropractic imathandizira kubwezeretsa bwino kwachilengedwe kwa msana ngakhale wodwalayo atakhala ndi mitundu iyi.
Pali zowonera kupezeka kwa ana ndi akulu kuti azindikire zopindika zilizonse za msana m'magawo awo oyambilira kudzera mwa chiropractor wanu. Kuzindikira msanga za matendawa ndikofunikira kwambiri kuti muwazindikire asanakhale ovuta kwambiri.
Personalized Spine & *SCIATICA TREATMENT* | El Paso, TX (2019)
Akuti scoliosis imakhudza paliponse kuchokera ku 2 mpaka 3 peresenti ya ana ndi akuluakulu ku United States. Izi ndi anthu pafupifupi 30,000 mpaka 38,000 miliyoni. Ngakhale kuti zimawoneka kuti zimakula kwambiri m'mibadwo yosiyana ya anyamata ndi atsikana, zimathanso kukula akadali wakhanda. Chaka chilichonse, ana pafupifupi XNUMX amaikidwa ndi scoliosis back brace pamene anthu a XNUMX amachita opaleshoni ya msana kuti athetse vutoli. Kuwunika kwa Scoliosis kungakhale ndi phindu lalikulu pozindikira zonse zomwe zingayambitse scoliosis ndi kulola chithandizo chamankhwala mwamsanga.
Scoliosis nthawi zambiri imayamba ali mwana. Kwa atsikana, zimachitika pakati pa zaka 7 ndi 14. Anyamata amakula pambuyo pake, azaka zapakati pa 6 ndi 16.
Chiropractic yasonyezedwa kuti imathandizira scoliosis, monga kutambasula, masewera olimbitsa thupi apadera, ndi chithandizo chamankhwala. Pali kusintha kwa msana komwe akatswiri a chiropractors amachita zomwe zimagwirizana ndi chithandizo cha scoliosis.
Mukathana ndi vutoli msanga, mbali ya Cobb imatha kuyimitsidwa kuti isapitirire komanso kuchepetsedwa kuti msana ukhale wopindika wachilengedwe. Thandizo lopanda opaleshoni limakhala lothandiza kwambiri m'magawo oyambirira a scoliosis, kotero kuti kuzindikira koyambirira ndi matenda oyambirira n'kofunika kwambiri.
Kuzindikira milandu yomwe ili pachiwopsezo chachikulu msanga kumatha kuthana ndi mavuto omwe alipo komanso kupewa mtsogolo.
Madokotala amatha kuzindikira zina mwazowopsa za scoliosis mwa ana mkhalidwewo usanachitike. Kuwunika kwa scoliosis kumawalola kuwona kupsinjika mu a msana wa mwana � chizindikiro chodziwika kuti apanga scoliosis.
Makolo akazindikira kuti mwana wawo ali m'gulu la anthu omwe ali pachiwopsezo chachikulu chotenga scoliosis, amatha kuchitapo kanthu poyang'anira kunyumba za zizindikiro za scoliosis komanso kutsatira njira zowunikira. Adzadziwa kuyang'ana zizindikirozo ndipo akhoza kuthana nazo mwamsanga kuti chithandizo chiyambike mwamsanga.
Thandizani ofufuza ndi madokotala kukhala ogwira mtima pochiza scoliosis.
Magawo oyambirira ndi chitukuko cha scoliosis akadali obisika kwa ofufuza ndi madokotala. Ngakhale kuti pakhala kupita patsogolo kwakukulu pakumvetsetsa bwino mkhalidwewo, padakali zambiri zoti tiphunzire.
Pakhala pali maphunziro ambiri omwe athandizira madotolo kuzindikira ana omwe ali pachiwopsezo chachikulu komanso kupanga matenda oyambira, monga momweNgongole ya bondo ndi phazi zimalumikizidwa ndi scoliosis. Komabe, kuyezetsa, kuzindikira, ndi chithandizo ndikofunikira kuti zisungidwe za data kuti maphunziro ochulukirapo achitidwe komanso kafukufuku wochulukirapo.
Kuwunika kowonjezereka kumatanthauza kuzindikira matenda ambiri a scoliosis koyambirira. Izi zingakhale ndi zotsatira ziwiri pa kafukufuku. Zingapereke zambiri kuti ziwonedwe ndi kuphunziridwa, ndipo zingapangitse chidwi pa chikhalidwecho pamene zochitika zambiri za scoliosis zoyamba zimapezeka. Izi zitha kupititsa patsogolo kafukufuku.
Pafupifupi anthu 1.5 miliyoni ku United States ali ndi nyamakazi ya nyamakazi. nyamakazi, kapena RA, ndi matenda aakulu, omwe amadziwika ndi ululu ndi kutupa kwa ziwalo. Ndi RA, chitetezo chamthupi, chomwe chimateteza thanzi lathu polimbana ndi zinthu zakunja monga mabakiteriya ndi ma virus, chimawononga mafupa molakwika. Matenda a nyamakazi nthawi zambiri amakhudza manja, mapazi, manja, zigongono, mawondo ndi akakolo. Akatswiri ambiri azachipatala amalimbikitsa kuti azindikire msanga ndi kulandira chithandizo cha RA.
Kudalirika
Rheumatoid nyamakazi ndi matenda a nyamakazi omwe amapezeka kwambiri. Azimayi, osuta fodya, ndi omwe ali ndi mbiri ya banja la matendawa nthawi zambiri amakhudzidwa. Njira zodziwira matenda ndi monga kukhala ndi mfundo imodzi yokhala ndi kutupa kotsimikizika komwe sikunafotokozedwe ndi matenda ena. Kuthekera kwa matenda a nyamakazi kumawonjezeka ndi kuchuluka kwa ziwalo zing'onozing'ono zomwe zimakhudzidwa. Wodwala nyamakazi yotupa, kupezeka kwa rheumatoid factor kapena anti-citrullinated protein antibody, kapena kuchuluka kwa mapuloteni a C-reactive kapena kuchuluka kwa erythrocyte sedimentation kukuwonetsa kuti ali ndi nyamakazi. Kuunika koyambirira kwa labotale kuyeneranso kuphatikizira kuwerengera kwathunthu kwa magazi ndi kusiyanasiyana komanso kuwunika kwa aimpso ndi chiwindi. Odwala omwe amamwa mankhwala a biologic ayenera kuyezetsa matenda a chiwindi a B, hepatitis C, ndi chifuwa chachikulu. Kuzindikira koyambirira kwa nyamakazi ya nyamakazi kumalola chithandizo cham'mbuyomu ndi antirheumatic agents. Kuphatikizana kwa mankhwala nthawi zambiri kumagwiritsidwa ntchito poletsa matendawa. Methotrexate nthawi zambiri ndi mankhwala oyamba a nyamakazi ya nyamakazi. Mankhwala a biologic, monga tumor necrosis factor inhibitors, nthawi zambiri amatengedwa ngati othandizira pamzere wachiwiri kapena akhoza kuwonjezeredwa ku chithandizo chapawiri. Zolinga za chithandizo zimaphatikizapo kuchepetsa kupweteka kwa mafupa ndi kutupa, kupewa kuwonongeka kwa radiographic ndi kupunduka kowonekera, ndi kupitiriza ntchito ndi zochita zaumwini. Kulowa m'malo ophatikizana kumasonyezedwa kwa odwala omwe ali ndi kuwonongeka kwakukulu kwamagulu omwe zizindikiro zawo sizimayendetsedwa bwino ndi chithandizo chamankhwala. (Am Fam Physician. 2011;84(11):1245-1252. Copyright � 2011 American Academy of Family Physicians.)
Rheumatoid arthritis (RA) ndi matenda opweteka kwambiri a nyamakazi, omwe amakhala ndi moyo mpaka 1 peresenti padziko lonse lapansi. 1 Kuyamba kumatha kuchitika pa msinkhu uliwonse, koma nsonga zapakati pa 30 ndi zaka 50. 2 Kulemala ndi kofala komanso kofunikira. M'gulu lalikulu la US, 35 peresenti ya odwala omwe ali ndi RA anali ndi chilema chogwira ntchito pambuyo pa zaka 10
Etiology ndi Pathophysiology
Mofanana ndi matenda ambiri a autoimmune, etiology ya RA ndi multifactorial. Chiwopsezo cha chibadwa chikuwonekera m'magulu a mabanja ndi maphunziro a mapasa a monozygotic, ndi 50 peresenti ya chiopsezo cha RA chifukwa cha majini. Kafukufuku wa 4 Genome-wide association apeza zizindikiro zowonjezera za majini zomwe zimawonjezera chiopsezo cha RA ndi matenda ena omwe amachititsa kuti thupi liziyenda bwino, kuphatikizapo STAT45 jini ndi CD1 locus.6,7 Kusuta ndiko kuyambitsa kwakukulu kwa chilengedwe kwa RA, makamaka kwa omwe ali ndi chibadwa.4 Ngakhale kuti matenda ikhoza kuwonetsa kuyankha kwa autoimmune, palibe tizilombo toyambitsa matenda tatsimikiziridwa kuti timayambitsa RA.40 RA imadziwika ndi njira zotupa zomwe zimapangitsa kuti maselo a synovial achuluke m'magulu. Kupanga kwa pannus kumatha kupangitsa kuti chichereŵechereŵe chiwonongeke komanso kukokoloka kwa mafupa. Kuchulukitsa kwa ma cytokines oyambitsa kutupa, kuphatikizapo chotupa cha necrosis factor (TNF) ndi interleukin-5, kumayendetsa njira yowononga.8
Zowopsa
Ukalamba, mbiri ya banja la matendawa, ndi kugonana kwachikazi kumagwirizanitsidwa ndi chiopsezo chowonjezereka cha RA, ngakhale kuti kusiyana kwa kugonana sikudziwika kwambiri kwa odwala okalamba.1 Kusuta fodya kwamakono komanso koyambirira kumawonjezera chiopsezo cha RA (chiwopsezo chachibale [RR]) = 1.4, mpaka 2.2 kwa anthu osuta fodya zaka zoposa 40) .11 Mimba nthawi zambiri imayambitsa kukhululukidwa kwa RA, mwinamwake chifukwa cha kulekerera kwa immunologic.12 Kugwirizana kungakhale ndi zotsatira zokhalitsa; RA sapezeka mwa amayi omwe ali ndi vuto lochepa kusiyana ndi amayi omwe ali ndi nulliparous (RR = 0.61) .13,14 Kuyamwitsa kumachepetsa chiopsezo cha RA (RR = 0.5 mwa amayi omwe amayamwitsa kwa miyezi 24), pamene kusamba koyambirira�(RR = 1.3 kwa omwe akutha msinkhu ali ndi zaka 10 kapena aang'ono) komanso kusamba kosasintha kwambiri (RR = 1.5) kumawonjezera chiopsezo.14 Kugwiritsa ntchito mapiritsi oletsa kulera pakamwa kapena vitamini E sikumakhudza chiopsezo cha RA.15
Matendawa
Ulaliki Wodziwika
Odwala omwe ali ndi RA nthawi zambiri amakhala ndi ululu komanso kuuma kwa mafupa angapo. Mawondo, ma proximal interphalangeal joints, ndi metacarpophalangeal joints ndizofala kwambiri. Kuuma kwa m'mawa kumatenga nthawi yopitilira ola limodzi kumawonetsa kutupa kwa etiology. Kutupa kwa boggy chifukwa cha synovitis kumatha kuwoneka (Chithunzi 1), kapena makulidwe obisika a synovial amatha kukhala omveka pakuwunika pamodzi. Odwala amathanso kukhala ndi arthralgias yosasamala isanayambike kutupa komwe kumawonekera kwachipatala. Zizindikiro zodziwika bwino za kutopa, kuchepa thupi, komanso kutentha thupi pang'ono zimatha kuchitika ndi matenda ogwira ntchito.
Zotsatira Zoganizira
Mu 2010, American College of Rheumatology ndi European League Against Rheumatism inagwirizana kuti ipange njira zatsopano zamagulu a RA (Table 1) .16 Njira zatsopanozi ndizoyesa kufufuza RA kale kwa odwala omwe sangakumane ndi 1987 American College of Rheumatology classification. mfundo. Njira za 2010 sizimaphatikizapo kukhalapo kwa tinthu tating'onoting'ono ta nyamakazi kapena kusintha kwa ma radiographic erosive, zonse zomwe sizingachitike kumayambiriro kwa RA. Symmetric arthritis sichifunikiranso muzotsatira za 2010, kulola kuti awonetsedwe koyambirira kwa asymmetric. Kuonjezera apo, ofufuza a ku Dutch apanga ndi kutsimikizira lamulo lolosera zachipatala kwa RA (Table 2) 17,18 Cholinga cha lamuloli ndikuthandizira kuzindikira odwala omwe ali ndi nyamakazi yosadziwika bwino yomwe imatha kupita patsogolo ku RA, ndi kutsogolera kutsata- mmwamba ndi kutumiza.
matenda Mayesero
Matenda a autoimmune monga RA nthawi zambiri amadziwika ndi kukhalapo kwa ma autoantibody. Rheumatoid factor sichiri yeniyeni ya RA ndipo ikhoza kupezeka mwa odwala omwe ali ndi matenda ena, monga a chiwindi C, ndi okalamba athanzi. Anti-citrullinated protein antibody ndi yodziwika bwino ya RA ndipo imatha kuyambitsa matenda.6 Pafupifupi 50 mpaka 80 peresenti ya anthu omwe ali ndi RA ali ndi rheumatoid factor, anti-citrullinated protein antibody, kapena onse awiri.10 Odwala omwe ali ndi RA angakhale nawo. zotsatira zabwino za antinuclear antibody test, ndipo kuyesa ndikofunika kwambiri kwa ana a matendawa. RA classification criteria.19 C-reactive protein levels and erythrocyte sedimentation rate ingagwiritsidwenso ntchito potsata ntchito za matenda ndi kuyankha mankhwala. Kuwerengera kwamagazi athunthu ndi kusiyanitsa komanso kuyeza kwa aimpso ndi kwa chiwindi ndikothandiza chifukwa zotsatira zake zitha kukhudza njira zamankhwala (mwachitsanzo, wodwala yemwe ali ndi vuto laimpso kapena thrombocytopenia yayikulu mwina sangapatsidwe mankhwala oletsa kutupa [NSAID]). Kuchepa kwa magazi m'thupi la matenda aakulu kumachitika 16 mpaka 33 peresenti ya odwala onse omwe ali ndi RA, 60 ngakhale kutaya magazi kwa m'mimba kuyenera kuganiziridwanso kwa odwala omwe amatenga corticosteroids kapena NSAIDs. Methotrexate imatsutsana ndi odwala omwe ali ndi matenda a chiwindi, monga hepatitis C, komanso odwala omwe ali ndi vuto lalikulu laimpso.20 Biologic therapy, monga TNF inhibitor, imafuna kuyesedwa koipa kwa tuberculin kapena chithandizo cha chifuwa chachikulu cha chifuwa chachikulu. Kutsegula kwa chiwindi cha chiwindi B kungathenso kuchitika pogwiritsa ntchito TNF inhibitor.21 Ma radiography a manja ndi mapazi ayenera kuchitidwa kuti ayese kusintha kwapadera kwa periarticular erosive, �zomwe zingakhale zisonyezero za RA yoopsa kwambiri.22
Kusiyanitsa kusiyana
Zotsatira zapakhungu zimawonetsa systemic lupus erythematosus, systemic sclerosis, kapena psoriatic nyamakazi. Polymyalgia rheumatica iyenera kuganiziridwa mwa odwala okalamba omwe ali ndi zizindikiro makamaka paphewa ndi m'chiuno, ndipo wodwalayo ayenera kufunsidwa mafunso okhudzana ndi matenda a arteritis osakhalitsa. Ma radiography pachifuwa ndi othandiza poyesa sarcoidosis ngati etiology ya nyamakazi.�Odwala omwe ali ndi zotupa zamsana, mbiri ya matenda otupa a matumbo, kapena matenda otupa a maso amatha kukhala ndi spondyloarthropathy. Anthu omwe ali ndi zizindikiro zosakwana masabata asanu ndi limodzi akhoza kukhala ndi tizilombo toyambitsa matenda, monga parvovirus. Kudziletsa kwapang'onopang'ono kwa kutupa m'malo olumikizirana mafupa kumawonetsa crystal arthropathy, ndipo arthrocentesis iyenera kuchitidwa kuti awone ngati makhiristo a monosodium urate monohydrate kapena calcium pyrophosphate dihydrate. Kukhalapo kwa mfundo zambiri zoyambitsa myofascial ndi zizindikiro za somatic zitha kutanthauza fibromyalgia, yomwe imatha kukhala limodzi ndi RA. Kuti athandize kutsogolera matenda ndi kudziwa njira ya chithandizo, odwala omwe ali ndi nyamakazi yotupa ayenera kutumizidwa mwamsanga kwa katswiri wa rheumatology.16,17
Nyamakazi, kapena RA, ndi mtundu wofala kwambiri wa nyamakazi. RA ndi matenda a autoimmune, omwe amayamba pamene chitetezo chamthupi, chitetezo cha mthupi, chikaukira ma cell ndi minofu yake, makamaka mafupa. Rheumatoid nyamakazi nthawi zambiri imadziwika ndi zizindikiro za ululu ndi kutupa, zomwe nthawi zambiri zimakhudza timagulu tating'ono ta manja, manja ndi mapazi. Malinga ndi akatswiri ambiri azachipatala, kuzindikira koyambirira ndi chithandizo cha RA ndikofunikira kuti tipewe kuwonongeka kwa mafupa ndikuchepetsa zizindikiro zowawa. Dr. Alex Jimenez DC, CCST Insight
chithandizo
RA atapezeka ndi kuyezetsa koyamba, chithandizo chiyenera kuyamba. Malangizo aposachedwa alankhula za utsogoleri wa RA,21,22 koma zokonda za odwala zimathandizanso kwambiri. Pali malingaliro apadera kwa amayi azaka zakubadwa chifukwa mankhwala ambiri amakhala ndi zotsatira zoyipa pamimba. Zolinga za chithandizo zimaphatikizapo kuchepetsa kupweteka kwapakati ndi kutupa, kuteteza kupunduka (monga kupatuka kwa ulnar) ndi kuwonongeka kwa radiographic (monga kukokoloka), kusunga moyo wabwino (waumwini ndi wantchito), ndi kulamulira mawonetseredwe owonjezera. Matenda-modifying antirheumatic drugs (DMARDs) ndiwo maziko a chithandizo cha RA.
DMARDs
Ma DMARD akhoza kukhala biologic kapena nonbiologic (Table 3) .23 Biologic agents amaphatikizapo ma antibodies a monoclonal ndi ma recombinant receptors kuti atseke ma cytokines omwe amalimbikitsa kuphulika kwa kutupa komwe kumayambitsa zizindikiro za RA. Methotrexate imalangizidwa ngati chithandizo choyamba kwa odwala omwe ali ndi RA yogwira ntchito, pokhapokha ngati akutsutsana kapena osaloledwa. Sulfasalazine (Azulfidine) kapena hydroxychloroquine (Plaquenil) yoletsa kutupa ngati monotherapy kwa odwala omwe ali ndi matenda ochepa-kapena opanda mawonekedwe osadziwika bwino (monga seronegative, non-erosive RA).21 Chithandizo chophatikizira chokhala ndi ma DMARD awiri kapena kupitilira kuposa monotherapy; komabe, zotsatirapo zoipa zingakhalenso zazikulu.21,22 Ngati RA sichiyendetsedwa bwino ndi DMARD yopanda biologic, biologic DMARD iyenera kukhazikitsidwa.24 TNF inhibitors ndi mankhwala oyamba a biologic ndipo ndi omwe amaphunzira kwambiri mwa othandizirawa. Ngati TNF inhibitors ilibe mphamvu, mankhwala owonjezera a biologic angaganizidwe. Kugwiritsa ntchito munthawi yomweyo mankhwala opitilira biologic (mwachitsanzo, adalimumab [Humira] wokhala ndi abatacept [Orencia]) sikuvomerezedwa chifukwa cha kuchuluka kosavomerezeka kwa zotsatira zoyipa.21,22
NSAIDs ndi Corticosteroids
Chithandizo chamankhwala cha RA chingaphatikizepo ma NSAID ndi oral, intramuscular, kapena intra-articular corticosteroids kuti athe kuwongolera ululu ndi kutupa. Moyenera, NSAIDs ndi corticosteroids amagwiritsidwa ntchito pokhapokha pakuwongolera kwakanthawi kochepa. DMARD ndi mankhwala omwe amakonda kwambiri.21,22
Thandizo Lothandizira
Njira zothandizira zakudya, kuphatikizapo zakudya zamasamba ndi za ku Mediterranean, zakhala zikuphunziridwa pochiza RA popanda umboni wokhutiritsa wa phindu. ndi RA.25,26 Kuonjezera apo, thermotherapy ndi mankhwala a ultrasound kwa RA sanaphunzire mokwanira.27,28 Ndemanga ya Cochrane ya mankhwala a zitsamba kwa RA inatsimikizira kuti gamma-linolenic acid (kuchokera madzulo primrose kapena black currant mafuta ambewu) ndi Tripterygium wilfordii (bingu god vine) ali ndi mapindu omwe angakhale nawo.29,30 Ndikofunika kudziwitsa odwala kuti zotsatira zoyipa zakhala zikudziwika pogwiritsa ntchito mankhwala azitsamba.31
Maseŵera olimbitsa thupi ndi Physical Therapy
Zotsatira za mayesero osankhidwa mwachisawawa zimathandizira masewera olimbitsa thupi kuti apititse patsogolo moyo ndi mphamvu za minofu kwa odwala omwe ali ndi RA.32,33 Mapulogalamu ochita masewera olimbitsa thupi sanawonetsedwe kuti ali ndi zotsatira zowononga pa ntchito ya matenda a RA, zowawa, kapena kuwonongeka kwa ma radiographic. 34 Tai chi yasonyezedwa kuti ikuwongolera kayendetsedwe kake ka anthu omwe ali ndi RA, ngakhale kuti mayesero osadziwika bwino ndi ochepa.
Nthawi ya Chithandizo
Kukhululukidwa kumapezeka mwa 10 mpaka 50 peresenti ya odwala omwe ali ndi RA, malingana ndi momwe kukhululukidwira kumatanthawuzira komanso mphamvu ya mankhwala. odwala omwe ali ndi zaka zoposa 10), omwe ali ndi nthawi yochepa ya matenda, ndi ntchito yochepetsetsa ya matenda, popanda kukwezedwa kwapamwamba kwambiri, komanso popanda zotsatira zabwino za rheumatoid factor kapena anti-citrullinated protein antibody. mpaka ndalama zochepa zofunika. Odwala adzafunika kuyang'anitsitsa pafupipafupi kuti atsimikizire kuti zizindikiro zokhazikika, ndipo kuwonjezereka kwamankhwala mwamsanga kumalimbikitsidwa ndi kuphulika kwa matenda.40
Zowonongeka Pamodzi
Kulowetsedwa kwamagulu kumasonyezedwa pamene pali kuwonongeka kwakukulu kwa mgwirizano ndi kulamulira kosakwanira kwa zizindikiro ndi chithandizo chamankhwala. Zotsatira za nthawi yayitali ndizothandizira, ndi 4 peresenti yokha ya 13 peresenti ya zowonjezera zowonjezera zomwe zimafuna kukonzanso mkati mwa zaka 10. 38 Mchiuno ndi bondo ndizo zomwe zimasinthidwa kwambiri.
Kuwunika Kwanthawi Yaitali
Ngakhale kuti RA imatengedwa kuti ndi matenda a mafupa, ndi matenda a systemic omwe amatha kuphatikizapo machitidwe ambiri a ziwalo. Mawonetseredwe owonjezera a RA akuphatikizidwa mu Table 4.1,2,10 Odwala omwe ali ndi RA ali ndi chiopsezo chowonjezereka cha lymphoma, chomwe chimaganiziridwa kuti chimayambitsidwa ndi njira yotupa, osati zotsatira za chithandizo chamankhwala. RA amakhalanso pachiwopsezo chowonjezereka cha matenda a mitsempha ya m'mitsempha, ndipo madokotala ayenera kugwira ntchito ndi odwala kuti asinthe zinthu zoopsa, monga kusuta, kuthamanga kwa magazi, ndi cholesterol.39 Class III kapena IV congestive heart failure (CHF) ndi zotsutsana ndi kugwiritsa ntchito TNF inhibitors, zomwe zingawononge zotsatira za CHF.40,41 Odwala omwe ali ndi RA ndi matenda opweteka, kusamala kumafunika ndi kupitiriza kugwiritsa ntchito DMARD, makamaka TNF inhibitors. Biologic DMARDs, methotrexate, ndi leflunomide sayenera kuyambitsidwa kwa odwala omwe ali ndi herpes zoster yogwira ntchito, matenda aakulu a fungal, kapena matenda a bakiteriya omwe amafunikira maantibayotiki.21 Zovuta za RA ndi mankhwala ake zalembedwa mu Table 21
Kuthamangitsani
Odwala omwe ali ndi RA amakhala zaka zitatu mpaka 12 zochepa kuposa anthu ambiri.40 Kuwonjezeka kwa imfa kwa odwalawa makamaka chifukwa cha matenda othamanga kwambiri a mtima, makamaka omwe ali ndi matenda aakulu komanso kutupa kosatha. Thandizo latsopano la biologic lingathe kusintha kukula kwa atherosulinosis ndikutalikitsa moyo mwa omwe ali ndi RA.41
Zotsatira Zopezeka: Kufufuza kwa PubMed kunamalizidwa mu Clinical Queries pogwiritsa ntchito mawu ofunikira a nyamakazi ya nyamakazi, mawonetseredwe owonjezera, ndi othandizira ochepetsa matenda. Kufufuzaku kunaphatikizapo kusanthula kwa meta, mayesero olamulidwa mwachisawawa, mayesero achipatala, ndi ndemanga. Anafufuzidwanso malipoti a Agency for Healthcare Research and Quality umboni, Clinical Evidence, database ya Cochrane, Essential Evidence, ndi UpToDate. Tsiku losakira: Seputembara 20, 2010.
Kuwulula kwa wolemba: Palibe mgwirizano wokhudzana ndi zachuma kuti aulule. Pomaliza, nyamakazi ya nyamakazi ndi matenda osachiritsika, omwe amayambitsa zizindikiro zowawa, monga kupweteka ndi kusapeza bwino, kutupa ndi kutupa kwa ziwalo, pakati pa ena. Kuwonongeka kolumikizana komwe kumadziwika kuti RA ndikofanana, kutanthauza kuti kumakhudza mbali zonse za thupi. Kuzindikira msanga ndi kofunikira pochiza RA. Kukula kwa chidziwitso chathu kumangokhala ku chiropractic ndi nkhani zaumoyo wa msana. Kuti mukambirane nkhaniyi, chonde muzimasuka kufunsa Dr. Jimenez kapena mutitumizireni pa�915-850-0900�. Wosankhidwa ndi Dr. Alex Jimenez
Nkhani Yowonjezera Yokambirana: Kuchepetsa Kupweteka kwa Bondo popanda Opaleshoni
Kupweteka kwa bondo ndi chizindikiro chodziwika bwino chomwe chitha kuchitika chifukwa cha kuvulala kosiyanasiyana kwa mawondo ndi / kapena mikhalidwe, kuphatikiza.zovulaza masewera. Bondo ndi limodzi mwa ziwalo zovuta kwambiri m'thupi la munthu monga momwe zimapangidwira ndi mafupa anayi, mitsempha inayi, mitsempha yosiyanasiyana, menisci iwiri, ndi cartilage. Malingana ndi American Academy of Family Physicians, zomwe zimayambitsa kupweteka kwa mawondo zimaphatikizapo patellar subluxation, patellar tendinitis kapena jumper's knee, ndi matenda a Osgood-Schlatter. Ngakhale kupweteka kwa mawondo kumachitika kawirikawiri mwa anthu opitirira zaka 60, kupweteka kwa mawondo kumatha kuchitikanso kwa ana ndi achinyamata. Kupweteka kwa bondo kumatha kuchiritsidwa kunyumba potsatira njira za RICE, komabe, kuvulala kwakukulu kwa mawondo kungafunike chithandizo chamankhwala mwamsanga, kuphatikizapo chisamaliro cha chiropractic.
1. Etiology ndi pathogenesis ya nyamakazi ya nyamakazi. Mu: Firestein GS, Kelley WN, ed. Kelley's Textbook of Rheumatology. 8 ed. Philadelphia, Pa.: Saunders/Elsevier; 2009:1035-1086. 2. Bathon J, Tehlirian C. Matenda a nyamakazi ndi ma laboratory mawonekedwe. Mu: Klippel JH, Stone JH, Crofford LJ, et al., ed. Choyamba pa Matenda a Rheumatic. 13 ed. New York, NY: Springer; 2008:114-121. 3. Allaire S, Wolfe F, Niu J, et al. Zowopsa zomwe zikuchitika pakulemala kwantchito zomwe zimagwirizanitsidwa ndi nyamakazi ya nyamakazi. Arthritis Rheum. 2009;61(3):321-328. 4. MacGregor AJ, Snieder H, Rigby AS, et al. Kufotokozera za kuchuluka kwa majini omwe amathandizira ku nyamakazi ya nyamakazi pogwiritsa ntchito deta ya mapasa. Arthritis Rheum. 2000; 43(1):30-37. 5. Orozco G, Barton A. Zosintha pa genetic risk factor for nyamakazi. Katswiri Rev Clin Immunol. 2010;6(1):61-75. 6. Balsa A, Cabezo?n A, Orozco G, et al. 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