Mndandanda wa Milandu Yachipatala

Back Clinical Case Series. Mndandanda wa zochitika zachipatala Ndi mtundu wofunikira kwambiri wa mapangidwe a maphunziro, momwe ofufuza amafotokozera zomwe gulu la anthu linakumana nalo. Nkhani zotsatizanazi zimafotokoza za anthu omwe amayamba matenda kapena matenda enaake. Maphunziro amtunduwu atha kupereka kuwerenga kochititsa chidwi chifukwa amafotokoza mwatsatanetsatane zochitika zachipatala za anthu omwe amaphunzira payekha. Dr. Alex Jimenez amadzipangira yekha mndandanda wa maphunziro.

Phunziro lachidziwitso ndi njira yofufuzira yomwe imagwiritsidwa ntchito kwambiri mu sayansi ya chikhalidwe cha anthu. Ndi njira yofufuzira yomwe imafufuza zochitika mkati mwazochitika zenizeni. Zimakhazikitsidwa pakufufuza mozama kwa munthu m'modzi, gulu, kapena chochitika kuti mufufuze momwe mavuto / zoyambitsa zimakhalira. Zimaphatikizapo umboni wochuluka ndipo zimadalira magwero angapo a umboni.

Zofufuza ndi mbiri yamtengo wapatali ya zochitika zachipatala za ntchito. Sapereka chitsogozo chachindunji cha kasamalidwe ka odwala otsatizanatsatizana koma ndi mbiri ya zochitika zachipatala zomwe zimathandiza kupanga mafunso a maphunziro azachipatala opangidwa mokhazikika. Amapereka maphunziro ofunikira, omwe amawonetsa chidziwitso chakale komanso chachilendo chomwe angakumane nacho ndi dokotala. Komabe, zochitika zambiri zachipatala zimachitika m'munda ndipo zimatengera dokotala kulemba ndikudziwitsa zambiri. Malangizo apangidwa kuti athandize wachibale, wolemba, katswiri, kapena wophunzira kuti ayendetse bwino phunzirolo mpaka kufalitsidwa.

A Case series ndi kamangidwe kofotokozera ndipo ndi mndandanda wa matenda aliwonse kapena kusiyana kwa matenda komwe munthu angawone kuchipatala. Milandu iyi ikufotokozedwa kuti ikupereka lingaliro labwino kwambiri. Komabe, palibe gulu loyerekeza kotero sipangakhale zifukwa zambiri za matendawa kapena ndondomeko ya matenda. Choncho, ponena za kupanga umboni wokhudzana ndi zochitika zosiyanasiyana za matenda, izi ndizoyambira. Kuti mupeze mayankho a mafunso aliwonse omwe mungakhale nawo chonde imbani Dr. Jimenez pa 915-850-0900

Chithandizo cha Mutu wa Migraine: Kusintha kwa Atlas Vertebrae

by Dr Alex Jimenez | Chiropractic, Kuchiza Mankhwala, Malipoti a Nkhani Zachipatala, Mndandanda wa Milandu Yachipatala, Ntchito Yothandizira, Mutu & Chithandizo, Migraine

Mitundu yambiri ya mutu imatha kukhudza munthu wamba ndipo aliyense akhoza chifukwa cha kuvulala kosiyanasiyana komanso / kapena mikhalidwe, komabe, mutu wa migraine ukhoza kukhala ndi chifukwa chovuta kwambiri kumbuyo kwawo. Akatswiri ambiri azachipatala komanso kafukufuku wochuluka wokhudzana ndi umboni wa kafukufuku apeza kuti kugwedezeka kwa khosi, kapena kusalongosoka kwa vertebrae mu msana wa khomo lachiberekero, ndiye chifukwa chofala kwambiri cha mutu wa migraine. Migraine imadziwika ndi kupweteka kwa mutu kwambiri komwe kumakhudza mbali imodzi ya mutu, limodzi ndi nseru komanso kusawona bwino. Mutu wa Migraine ukhoza kufooketsa. Zomwe zili pansipa zikufotokoza kafukufuku wokhudza zotsatira za kusintha kwa ma atlas vertebrae kwa odwala omwe ali ndi migraine.

Zotsatira za Atlas Vertebrae Reignment in Subjects with Migraine: An Observational Pilot Study

Name: El Paso Back Clinic | Spine Specialists - El Paso, TX
Price range: $$

Kudalirika

Chiyambi. Mu phunziro la migraine, zizindikiro za mutu zinachepa kwambiri ndi kuwonjezeka kotsatira ndondomeko yotsatizana ndi intracranial kutsatira ma atlas vertebrae realignment. Kafukufuku woyendetsa ndegeyu adatsata akatswiri khumi ndi amodzi omwe adapeza kuti ali ndi mutu wa migraine kuti adziwe ngati zomwe zapezedwazo zimabwerezedwanso kumayambiriro, sabata zinayi, ndi sabata zisanu ndi zitatu, kutsatira National Upper Cervical Chiropractic Association. Zotsatira zachiwiri zinali ndi mikhalidwe ya moyo ya migraine. Njira. Pambuyo poyang'aniridwa ndi katswiri wa zamaganizo, odzipereka adasaina mafomu ovomerezeka ndikumaliza zotsatira zoyambira zokhudzana ndi migraine. Kukhalapo kwa kusalongosoka kwa ma atlas kumalola kuphatikizidwa kwamaphunziro, kulola kusonkhanitsa deta ya MRI yoyambira. Chisamaliro cha Chiropractic chinapitilira kwa milungu isanu ndi itatu. Reimaging postintervention inachitika pa sabata zinayi ndi sabata zisanu ndi zitatu zogwirizana ndi zotsatira za migraine. Results. Maphunziro asanu mwa khumi ndi amodzi adawonetsa kuwonjezeka kwa zotsatira zoyambirira, kutsata kwapang'onopang'ono; komabe, kusintha kwakukulu sikunasonyeze tanthauzo lachiwerengero. Kumapeto kwa phunziro kumatanthauza kusintha kwa zotsatira za zotsatira za migraine, zotsatira zachiwiri, zawonetsa kusintha kwakukulu kwachipatala kwa zizindikiro ndi kuchepa kwa masiku a mutu. Kukambirana. Kuperewera kwa kuwonjezereka kwamphamvu pakutsatiridwa kumatha kumvetsetsedwa ndi logarithmic ndi dynamic chikhalidwe cha intracranial hemodynamic ndi hydrodynamic flow, kulola kuti magawo omwe akuphatikizapo kutsata kusintha pomwe sizinali choncho. Zotsatira za phunziroli zimasonyeza kuti kusintha kwa ma atlasi kungagwirizane ndi kuchepa kwafupipafupi kwa mutu wa migraine komanso kusintha kwabwino kwa moyo kumapereka kuchepetsa kwakukulu kwa kulemala kwa mutu monga momwe tawonera m'gululi. Kufufuza kwamtsogolo ndi zowongolera ndikofunikira, komabe, kuti mutsimikizire zopezazi. Nambala yolembetsa ya Clinicaltrials.gov ndi NCT01980927.

Introduction

Zanenedwa kuti atlas vertebra yolakwika imapangitsa kusokonezeka kwa msana kusokoneza ma neural traffic nuclei ya ubongo mu medulla oblongata yomwe imayambitsa physiology yabwino [1�4].

Cholinga cha National Upper Cervical Chiropractic Association (NUCCA) chinapanga ndondomeko yokonza ma atlasi ndikubwezeretsanso mapangidwe a msana olakwika kumalo ozungulira kapena mphamvu yokoka. Kutanthauzidwa ngati mfundo yobwezeretsa, � kukonzanso cholinga chake ndi kukhazikitsanso ubale wabwinobwino wa wodwalayo wa msana wa khomo lachiberekero kupita ku vertical axis (mzere wa mphamvu yokoka). Kubwezeretsa kumadziwika ngati kukhala wokhazikika mwamapangidwe, kukhala wokhoza kuyenda mopanda malire, komanso kulola kuchepa kwakukulu kwamphamvu yokoka [3]. Kuwongolera mwachidziwitso kumachotsa kusokonezeka kwa chingwe, komwe kumapangidwa ndi ma atlas misalignment kapena atlas subluxation complex (ASC), monga momwe tafotokozera ndi NUCCA. Ntchito ya neurologic imabwezeretsedwa, makamaka yomwe imaganiziridwa kuti ili mu ubongo tsinde la autonomic nuclei, yomwe imakhudza mitsempha ya mitsempha yomwe imaphatikizapo Cerebrospinal Fluid (CSF) [3, 4].

The intracranial compliance index (ICCI) ikuwoneka ngati kuyesa kovutirapo kwa kusintha komwe kumachitika mu craniospinal biomechanical katundu mwa odwala omwe ali ndi zizindikiro kuposa magawo am'deralo a hydrodynamic a CSF flow velocities ndi miyeso ya kusamuka kwa chingwe [5]. Kutengera chidziwitso chimenecho, maubale omwe adawonedwa kale akuwonjezeka kwa kutsata kwapang'onopang'ono kuti achepetse zizindikiro za migraine potsatira kukonzanso kwa ma atlas kumapereka chilimbikitso chogwiritsa ntchito ICCI monga cholinga chophunzirira choyambirira.

ICCI imakhudza kuthekera kwa Central Nervous System (CNS) kuti igwirizane ndi kusinthasintha kwa ma physiologic komwe kumachitika, potero kupewa ischemia yamagulu oyambira a neurologic [5, 6]. Mkhalidwe wotsatiridwa kwambiri wa intracranial umapangitsa kuti kuwonjezeka kwa voliyumu kuchitike mu intrathecal CNS space popanda kuchititsa kuwonjezereka kwamphamvu kwapakhungu komwe kumachitika makamaka ndi kulowetsedwa kwapakati pa systole [5, 6]. Kutuluka kumachitika pamtunda kudzera m'mitsempha yamkati ya jugular kapena yowongoka, kudzera mumtsinje wa paraspinal kapena wachiwiri. Mitsempha yambiri ya venous iyi imakhala yopanda valavu komanso ya anastomotic, yomwe imalola magazi kuyenda mobwerera kumbuyo, kulowa mu CNS kupyolera mu kusintha kwa postural [7, 8]. Kutulutsa kwa venous kumagwira ntchito yofunika kwambiri pakuwongolera dongosolo lamadzimadzi lamkati [9]. Kutsata kumawoneka ngati kogwira ntchito komanso kumadalira kutuluka kwa magazi kwaulere kudzera munjira za extracranial venous drainage [10].

Kuvulala kwamutu ndi khosi kumatha kupangitsa kuti msana wamtsempha wa venous plexus uwonongeke, mwina chifukwa cha kusayenda bwino kwachiwiri kwa msana wa ischemia [11]. Izi zimachepetsa kusinthasintha kwa voliyumu mkati mwa cranium ndikupanga mkhalidwe wocheperako wotsatira.

Damadian ndi Chu akufotokoza za kubwereranso kwa CSF yachibadwa yoyezedwa pakati pa C-2, kusonyeza kuchepetsedwa kwa 28.6% kwa CSF kupanikizika kwa gradient mu wodwalayo kumene ma atlasi adasinthidwa bwino [12]. Wodwalayo adanena kuti alibe zizindikiro (vertigo ndi kusanza pamene akugona) mogwirizana ndi ma atlasi omwe atsalira.

Kafukufuku wa matenda oopsa kwambiri pogwiritsa ntchito njira ya NUCCA akuwonetsa kuti njira yomwe ingachepetse kuthamanga kwa magazi ingakhale chifukwa cha kusintha kwa ubongo wa ubongo mogwirizana ndi malo a atlas vertebrae [13]. Kumada et al. adafufuza njira ya trigeminal-vascular muubongo kuwongolera kuthamanga kwa magazi [14, 15]. Goadsby et al. apereka umboni wokwanira wosonyeza kuti migraine imachokera ku trigeminal-vascular system yolumikizidwa kudzera mu tsinde laubongo ndi msana wam'mwamba wa khomo lachiberekero [16�19]. Kuwona mwachidziwitso kumasonyeza kuchepa kwakukulu kwa mutu wa mutu wa migraine odwala pambuyo pogwiritsira ntchito kukonzanso ma atlas. Kugwiritsa ntchito anthu omwe adapezeka ndi mutu waching'alang'ala kumawoneka ngati kwabwino pakufufuza zomwe zasintha muubongo potsatira kusinthika kwa ma atlas monga momwe adanenera poyambira pakufufuza kwa matenda oopsa komanso zikuwoneka kuti zimathandizidwa ndi kulumikizana kwaubongo kwa trigeminal-vascular. Izi zitha kupititsa patsogolo chitukuko cha pathophysiologic hypothesis ya kusalumikizana bwino kwa ma atlas.

Zotsatira zochokera ku phunziro loyambirira zawonetsa kuwonjezeka kwakukulu kwa ICCI ndi kuchepa kwa zizindikiro za mutu wa migraine potsatira kukonzanso kwa ma atlas a NUCCA. Mnyamata wina wazaka 62 yemwe ali ndi matenda a ubongo adapezeka kuti ali ndi migraine yosatha anadzipereka kuti ayambe kufufuza pambuyo pochitapo kanthu. Pogwiritsa ntchito Phase Contrast-MRI (PC-MRI), kusintha kwa cerebral hemodynamic ndi hydrodynamic flow parameters kunayesedwa poyambira, maola a 72, ndiyeno masabata anayi pambuyo pa kulowererapo kwa ma atlas. Njira yomweyi yokonzanso ma atlasi yomwe imagwiritsidwa ntchito pofufuza matenda oopsa idatsatiridwa [13]. Maola a 72 pambuyo pophunzira adawonetsa kusintha kwakukulu mu ndondomeko ya intracranial compliance index (ICCI), kuchokera ku 9.4 mpaka 11.5, mpaka 17.5 pa sabata inayi, atatha kulowererapo. Kuwona kusintha kwa venous outflow pulsatility komanso kutulutsa kwapang'onopang'ono kwapang'onopang'ono kwapang'onopang'ono kunapangitsa kuti kufufuza kwina kulimbikitse kuphunzira kwa mutu wa migraine munkhani ino.

Zotsatira zomwe zingatheke chifukwa cha kusokonezeka kwa ma atlasi kapena ASC pamtsinje wa venous sizikudziwika. Kufufuza mosamalitsa kutsata kwa intracranial mogwirizana ndi zotsatira za kulowetsedwa kolakwika kwa ma atlas kungapereke chidziwitso cha momwe kuwongolera kungakhudzire mutu wa mutu wa migraine.

Pogwiritsa ntchito PC-MRI, cholinga chachikulu cha phunziroli, ndi zotsatira zake zoyambirira, kuyeza kusintha kwa ICCI kuchokera kumayambiriro mpaka masabata anayi ndi asanu ndi atatu pambuyo pa kulowerera kwa NUCCA m'gulu la akatswiri a ubongo omwe amasankha maphunziro a migraine. Monga momwe tawonera mu phunziro la phunziroli, lingalirolo linkaganiza kuti ICCI ya phunziro idzawonjezeka potsatira kulowerera kwa NUCCA ndi kuchepa kofanana kwa zizindikiro za migraine. Ngati zilipo, kusintha kulikonse komwe kumawonedwa mu venous pulsatility ndi njira yotulutsa madzi kunayenera kulembedwa kuti tifananizenso. Kuti ayang'ane kuyankha kwa zizindikiro za migraine, zotsatira zachiwiri zinaphatikizapo zotsatira za odwala kuti ayese kusintha kulikonse kokhudzana ndi Umoyo Wokhudzana ndi Umoyo Wamoyo (HRQoL), womwe umagwiritsidwa ntchito mofananamo mu kafukufuku wa migraine. Panthawi yonse yophunzira, anthu adasunga zolemba zamutu zomwe zikuwonetsa kuchepa (kapena kuwonjezeka) kwa masiku a mutu wa mutu, mphamvu, ndi mankhwala omwe amagwiritsidwa ntchito.

Kuchita zochitika zowonera izi, kafukufuku woyendetsa ndege, adalola kufufuzidwa kowonjezereka pazotsatira zomwe tafotokozazi pazachilengedwe pakupititsa patsogolo lingaliro logwira ntchito mu pathophysiology ya ma atlas misalignment. Deta yofunikira kuti muyese kukula kwa zitsanzo zachiwerengero ndi kuthetsa mavuto okhudzana ndi ndondomeko idzapereka chidziwitso chofunikira kuti mupange ndondomeko yoyengedwa bwino kuti muyese kuyesa kwa migraine, komwe kumayendetsedwa ndi placebo pogwiritsa ntchito NUCCA kukonza njira.

Njira

Kafukufukuyu adasungabe chikalata cha Helsinki Declaration pofufuza za anthu. Yunivesite ya Calgary ndi Alberta Health Services Conjoint Health Research Ethics Board inavomereza ndondomeko yophunzirira ndi fomu yololeza yodziwitsidwa, Ethics ID: E-24116. ClinicalTrials.gov inapereka nambala NCT01980927 pambuyo polembetsa kafukufukuyu (clinicaltrials.gov/ct2/show/NCT01980927).

Kulemba anthu ndi kuwunika kunachitika ku Calgary Headache Assessment and Management Program (CHAMP), chipatala chotumizira akatswiri a minyewa (onani Chithunzi 1, Table 1). CHAMP imayesa odwala omwe amatsutsana ndi mankhwala ochiritsira komanso chithandizo chamankhwala cha mutu waching'alang'ala chomwe sichimaperekanso mpumulo wa zizindikiro za migraine. Madotolo apabanja ndi osamalira makolo adatumiza maphunziro omwe angaphunzire ku CHAMP kupangitsa kutsatsa kukhala kosafunika.

Chithunzi 1 Kachitidwe ka Mutu ndi Kuyenda kwa Phunziro

Chithunzi 1: Mayendedwe a phunziro ndi kuyenda kwamaphunziro (n = 11). GSA: Gravity Stress Analyzer. HIT-6: Kupweteka kwa Mutu Mayeso-6. HRQoL: Moyo Wokhudzana ndi Zaumoyo. MIDAS: Migraine Disability Assessment Scale. MSQL: Migraine-Specific Quality of Life Measure. NUCCA: National Upper Cervical Chiropractic Association. PC-MRI: Phase Contrast Magnetic Resonance Imaging. VAS: Visual Analog Scale.

Table 1 Kuphatikizika kwa Mutu ndi Zofunikira Zopatula

Gulu 1: Kuphatikizika kwa mutu / kusapezekanso. Nkhani zomwe zingatheke, zokhala ndi chisamaliro chapamwamba cha khomo lachiberekero, zimasonyeza pakati pa masiku khumi ndi makumi awiri ndi asanu ndi limodzi pamutu pa mwezi zomwe zimadziwonetsera okha miyezi inayi yapitayo. Zofunikira zinali zosachepera masiku asanu ndi atatu amutu pamwezi, pomwe kulimba kumafikira anayi, pa zero mpaka khumi pa Visual Analog Scale (VAS) pain scale.

Kuphatikizidwa kwamaphunziro kumafunikira odzipereka, azaka zapakati pa 21 ndi 65, omwe amakwaniritsa njira zodziwira matenda a mutu wa migraine. Katswiri wa zamaganizo yemwe ali ndi zaka zambiri za migraine adawonetsa olemba ntchito pogwiritsa ntchito International Classification of Headache Disorders (ICHD-2) kuti alowe nawo maphunziro [20]. Anthu omwe angakhalepo, omwe ali ndi chisamaliro chapamwamba cha chiropractic, ayenera kuti adadziwonetsera okha pakati pa masiku khumi ndi makumi awiri ndi asanu ndi limodzi amutu pa mwezi pa miyezi inayi yapitayi. Osachepera masiku asanu ndi atatu pamutu pa mwezi amayenera kufika ku mphamvu ya osachepera anayi pa zero mpaka khumi pa VAS kupweteka kwa sikelo, pokhapokha atachiritsidwa bwino ndi mankhwala okhudzana ndi migraine. Zosachepera zinayi zosiyana za mutu wamutu pamwezi wolekanitsidwa ndi osachepera maola a 24 opanda nthawi yopweteka ankafunika.

Kuvulala kwakukulu kwa mutu kapena khosi komwe kumachitika mkati mwa chaka chimodzi musanalowe nawo maphunziro sikunaphatikizepo ofuna. Njira zodzipatula zinaphatikizapo kugwiritsa ntchito mankhwala mopitirira muyeso, mbiri ya claustrophobia, matenda amtima kapena cerebrovascular, kapena matenda aliwonse a CNS kupatula mutu waching'alang'ala. Table 1 ikufotokoza njira zonse zophatikizira ndi kuchotsera zomwe zikuganiziridwa. Pogwiritsa ntchito katswiri wodziwa bwino zachipatala kuti awonetsere zomwe zingatheke pamene akutsatira ICHD-2 ndikutsogoleredwa ndi njira zophatikizira / kuchotsedwa, kuchotsedwa kwa maphunziro omwe ali ndi zifukwa zina za mutu monga kupweteka kwa minofu ndi mankhwala osokoneza bongo kungapangitse mwayi wopambana. kulemba anthu ntchito.

Zoyambira zomwe zidakumana nazo zidasaina chilolezo chodziwitsidwa ndikumaliza Migraine Disability Assessment Scale (MIDAS). MIDAS imafuna masabata khumi ndi awiri kuti awonetse kusintha kwakukulu kwachipatala [21]. Izi zinapangitsa kuti padutse nthawi yokwanira kuti muzindikire kusintha kulikonse. Pamasiku otsatirawa a 28, olembawo adalemba diary ya mutu yopereka deta yoyambira pamene akutsimikizira chiwerengero cha masiku a mutu ndi mphamvu yofunikira kuti ikhalepo. Pambuyo pa milungu inayi, zolemba zowunikira zowunikira zidaloleza kuwongolera njira zotsalira za HRQoL:

Migraine-Specific Quality of Life Measure (MSQL) [22],
Kupweteka kwa Mutu Mayeso-6 (HIT-6) [23],
Kuwunika kwaposachedwa kwapadziko lonse lapansi kwa kupweteka kwa mutu (VAS).

Kutumiza kwa NUCCA practitioner, kuti adziwe kupezeka kwa ma atlas misalignment, anatsimikizira kufunika kochitapo kanthu pomaliza kuphatikizidwa kwa phunziro? Kusakhalapo kwa zizindikiro zosokoneza ma atlas sikunaphatikizepo ofuna. Pambuyo pokonzekera kusankhidwa kwa NUCCA kulowererapo ndi chisamaliro, anthu oyenerera adapeza njira zoyambira za PC-MRI. Chithunzi 1 chikufotokozera mwachidule momwe phunziroli likukhalira.

Kulowetsedwa koyambirira kwa NUCCA kunkafuna maulendo atatu otsatizana: (1) Tsiku Loyamba, kufufuza kolakwika kwa ma atlas, ma radiographs asanayambe kukonza; (2) Tsiku Lachiwiri, kuwongolera kwa NUCCA ndikuwunika pambuyo pa kuwongolera ndi ma radiographs; ndi (3) Tsiku Lachitatu, kubwereza kukonzanso pambuyo pake. Chisamaliro chotsatira chinachitika mlungu uliwonse kwa milungu inayi, kenako milungu iwiri iliyonse kwa nthawi yotsala ya phunzirolo. Paulendo uliwonse wa NUCCA, anthu adamaliza kufufuza kwaposachedwa kwa ululu wa mutu (chonde yesani kupweteka kwa mutu wanu pafupipafupi pa sabata yapitayi) pogwiritsa ntchito mzere wolunjika ndi pensulo polemba mzere wa 100?mm (VAS). Patangotha sabata imodzi kuchitapo kanthu koyambirira, ophunzirawo adamaliza kufunsa mafunso akuti �Possible Reaction to Care. Kuunikaku kwakhala kukugwiritsidwa ntchito poyang'anira bwino zochitika zoyipa zokhudzana ndi njira zosiyanasiyana zowongolera khomo lachiberekero [24].

Pa sabata inayi, deta ya PC-MRI inapezedwa ndipo maphunziro anamaliza MSQL ndi HIT-6. Mapeto a kafukufuku wa PC-MRI adasonkhanitsidwa pa sabata lachisanu ndi chitatu kutsatiridwa ndi kuyankhulana kwapadera kwa katswiri wa zamaganizo. Apa, maphunziro adamaliza zotsatira zomaliza za MSQOL, HIT-6, MIDAS, ndi VAS ndi zolemba zamutu zidasonkhanitsidwa.

Paulendo wa mlungu wa 8 wa akatswiri a zamitsempha, maphunziro awiri ofunitsitsa adapatsidwa mwayi wotsatira nthawi yayitali kwa nthawi yonse yophunzira ya masabata a 24. Izi zinaphatikizapo kuwunikanso kwa NUCCA mwezi uliwonse kwa masabata a 16 mutatha maphunziro oyambirira a masabata a 8. Cholinga cha kutsatiridwaku chinali kuthandiza kudziwa ngati kusintha kwa mutu kumapitirirabe pokonzekera kugwirizanitsa kwa ma atlas pamene akuyang'ana zotsatira za nthawi yaitali za chisamaliro cha NUCCA pa ICCI. Ophunzira omwe akufuna kutenga nawo mbali adasaina chilolezo chachiwiri chodziwitsidwa pa gawoli la phunziroli ndikupitilira chisamaliro cha mwezi uliwonse cha NUCCA. Kumapeto kwa masabata a 24 kuchokera ku ma atlasi oyambirira, phunziro lachinayi la kujambula kwa PC-MRI linachitika. Pamafunso otuluka a neurologist, zotsatira zomaliza za MSQOL, HIT-6, MIDAS, ndi VAS ndi zolemba zamutu zidasonkhanitsidwa.

Njira yofananira ya NUCCA monga momwe idafotokozedwera kale idatsatiridwa pogwiritsira ntchito ndondomeko yokhazikitsidwa ndi miyezo ya chisamaliro yomwe inakhazikitsidwa kudzera mu NUCCA Certification kuti iwonetsedwe ndi kukonzanso ma atlas kapena kukonza ASC (onani Zithunzi ?Figures22�5) [2, 13, 25]. Kuwunika kwa ASC kumaphatikizapo kuyang'ana kusiyana kwa kutalika kwa mwendo ndi Supine Leg Check (SLC) ndi kufufuza kwa postural symmetry pogwiritsa ntchito Gravity Stress Analyzer (Upper Cervical Store, Inc., 1641 17 Avenue, Campbell River, BC, Canada V9W 4L5 ) (onani Zithunzi ?Zithunzi22 ndi 3(a)�3(c)) [26�28]. Ngati kusagwirizana kwa SLC ndi postural kuzindikirika, kuyezetsa kwa radiographic katatu kumawonetsedwa kuti adziwe mawonekedwe amitundu yambiri komanso kuchuluka kwa craniocervical misalignment [29, 30]. Kusanthula kozama kwa radiographic kumapereka chidziwitso chodziwitsa mutu, njira yabwino yowongolera ma atlasi. Sing'anga amapeza zizindikiro za anatomic kuchokera mndandanda wazithunzi zitatu, kuyeza mawonekedwe ndi magwiridwe antchito omwe apatuka pamiyezo yokhazikitsidwa ya orthogonal. Mlingo wa kusalongosoka ndi mawonekedwe a ma atlas amawululidwa mumiyeso itatu (onani Zithunzi 4(a)�4(c)) [2, 29, 30]. Kuyanjanitsa zida za radiographic, kuchepetsa kukula kwa doko la collimator, kuphatikizika kwazithunzi zothamanga kwambiri zamakanema, zosefera zapadera, ma gridi apadera, ndi zotchingira zotsogola zimachepetsa kukhudzana ndi ma radiation. Pakafukufukuyu, avereji yoyezetsa Kuwonetsedwa Kwa Khungu Lakulowa kwa anthu omwe adasinthidwa pambuyo pa kuwongolera ma radiographic anali 352 millirads (3.52 millisieverts).

Chithunzi 2: Supine Leg Check Screening Test (SLC). Kuyang'ana kwa "mwendo wamfupi" wowoneka kukuwonetsa kuthekera kolakwika kwa ma atlas. Izi zikuwoneka ngakhale.

Chithunzi 3: Gravity Stress Analyzer (GSA). (a) Chipangizocho chimasankha postural asymmetry ngati chizindikiro china cha kusalongosoka kwa ma atlas. Zotsatira zabwino mu SLC ndi GSA zikuwonetsa kufunikira kwa NUCCA radiographic series. (b) Wodwala wathanzi wopanda postural asymmetry. (c) Ma hip calipers omwe amagwiritsidwa ntchito poyeza chiuno.

Chithunzi 4: NUCCA radiograph mndandanda. Mafilimuwa amagwiritsidwa ntchito kuti azindikire zolakwika za ma atlas ndikupanga njira yowongolera. Ma radiographs owongolera pambuyo pake kapena ma postfilms amatsimikizira kuti kuwongolera kwabwino kwachitika pamutuwu.

Chithunzi 5 Kupanga Kuwongolera kwa NUCCA

Chithunzi 5: Kupanga kukonza kwa NUCCA. Wothandizira wa NUCCA amapereka kusintha kwa triceps kukoka. Thupi la sing'anga ndi manja ake amalumikizidwa kuti apereke kuwongolera kwa ma atlas motsatira njira yabwino kwambiri yolumikizira mphamvu pogwiritsa ntchito zidziwitso zopezeka ku ma radiograph.

Kulowetsedwa kwa NUCCA kumaphatikizapo kuwongolera pamanja kwa kusamvetsetsana kwa radiographically mu kapangidwe ka anatomical pakati pa chigaza, atlas vertebra, ndi khomo lachiberekero. Pogwiritsa ntchito mfundo za biomechanical zochokera pa lever system, dokotala amapanga njira yoyenera

kuika mutu,
udindo wa akatswiri,
kakamiza vekitala kuti akonze zolakwika za ma atla.

Mitu imayikidwa patebulo lokhala pambali ndi mutu wokhazikika makamaka pogwiritsa ntchito njira yothandizira mastoid. Kugwiritsa ntchito chida chodziwikiratu champhamvu chowongolera kuwongoleranso chigaza ku ma atlas ndi khosi kumtunda wolunjika kapena pakati pa mphamvu yokoka ya msana. Mphamvu zowongolera izi zimayendetsedwa mozama, mayendedwe, liwiro, ndi matalikidwe, ndikupanga kuchepetsedwa kolondola komanso kolondola kwa ASC.

Pogwiritsa ntchito fupa la pisiform la dzanja lolumikizana, dokotala wa NUCCA amalumikizana ndi njira yodutsa ma atlas. Dzanja lina limazungulira dzanja la dzanja lolumikizana, kuwongolera vekitala ndikusunga kuya kwa mphamvu yomwe imapangidwa pogwiritsira ntchito njira ya �triceps pull (onani Chithunzi 5) [3]. Pomvetsetsa ma biomechanics a msana, thupi ndi manja a dokotala zimalumikizana kuti apange ma atlas kuwongolera panjira yoyenera kwambiri. Mphamvu yoyendetsedwa, yosasunthika imagwiritsidwa ntchito potsata njira yochepetsera yomwe idakonzedweratu. Ndizodziwika bwino momwe zimakhalira komanso kuya kwake kuti zithandizire kuchepetsa kuchepa kwa ASC kutsimikizira kuti palibe kutsegulira kwa mphamvu zogwira ntchito za minofu ya khosi potengera kusintha kwa biomechanical. Zimamveka kuti kuchepetsedwa kwabwino kwa kusalongosoka kumalimbikitsa kukonza kwa nthawi yayitali komanso kukhazikika kwa msana.

Pambuyo pa nthawi yochepa yopuma, ndondomeko yowunika pambuyo pake, yofanana ndi kuyesa koyambirira, ikuchitika. Kuyeza kwa radiograph kwa postcorrection kumagwiritsa ntchito malingaliro awiri kutsimikizira kubwerera kwa mutu ndi khomo lachiberekero kuti zikhale bwino kwambiri. Maphunziro amaphunzitsidwa m'njira zotetezera kuwongolera kwawo, motero kupeŵa kusalongosoka kwina.

Maulendo otsatila a NUCCA anali ndi zolemba za mutu wa mutu komanso kufufuza kwaposachedwa kwa ululu wa mutu (VAS). Kusagwirizana kwa kutalika kwa miyendo ndi postural asymmetry yambiri kunagwiritsidwa ntchito pozindikira kufunikira kwa njira ina ya ma atlas. Cholinga cha kuwongolera bwino ndikuti mutuwu ukhalebe ndikusinthanso kwautali momwe kungathekere, ndi ma atlas ochepa kwambiri.

Muzotsatira za PC-MRI, zowonetsera zosiyana sizigwiritsidwa ntchito. Njira za PC-MRI zinasonkhanitsa ma data awiri omwe ali ndi mphamvu zosiyana siyana zothamanga zomwe zimapezedwa pokhudzana ndi ma gradient awiriawiri, omwe amatsitsa motsatizana ndikusintha ma spins panthawi yotsatizana. Deta yaiwisi kuchokera kumagulu awiriwa imachotsedwa kuti awerengere kuchuluka kwa kayendedwe.

Ulendo wapamalo wa MRI Physicist unapereka maphunziro kwa MRI Technologist ndipo njira yotumizira deta inakhazikitsidwa. Kusanthula kangapo ndi kusamutsa deta kunachitika kuti zitsimikizire kuti kusonkhanitsa deta kukuyenda bwino popanda zovuta. Chojambulira cha 1.5-tesla GE 360 Optima MR scanner (Milwaukee, WI) pa malo owerengera (EFW Radiology, Calgary, Alberta, Canada) adagwiritsidwa ntchito pojambula ndi kusonkhanitsa deta. Koyilo yamutu ya 12-gawo, 3D magnetization-yokonzekera mwachangu-acquisition gradient echo (MP-RAGE) sequency idagwiritsidwa ntchito pojambula ma anatomy. Deta yodziwika bwino yoyenda idapezedwa pogwiritsa ntchito njira yolumikizirana (iPAT), acceleration factor 2.

Kuyeza kuthamanga kwa magazi kupita ndi kuchokera ku chigaza cha chigaza, ma scan awiri a retrospectively gated, velocity-encoded cine-phase-contrast scans anachitidwa monga momwe amachitira ndi kugunda kwa mtima kwa munthu payekha, kusonkhanitsa zithunzi makumi atatu ndi ziwiri pamtima. Ma encoding othamanga kwambiri (70? cm / s) omwe amadziwika kuti kuthamanga kwa magazi kwapamwamba kwambiri paziwiya pa C-2 vertebra mlingo kumaphatikizapo mitsempha yamkati ya carotid (ICA), mitsempha ya vertebral (VA), ndi mitsempha yamkati ya jugular (IJV). ). Deta yachiwiri ya mitsempha ya mitsempha ya vertebral (VV), mitsempha ya epidural (EV), ndi mitsempha yakuya ya chiberekero (DCV) inapezedwa pamtunda womwewo pogwiritsa ntchito encoding yotsika kwambiri (7�9?cm / s).

Deta yamutu idazindikirika ndi ID ya Phunziro la Mutu ndi tsiku lowerengera lojambula. Kafukufuku wa neuroradiologist adawunikiranso kutsatizana kwa MR-RAGE kuti apewe zovuta zapathological. Zozindikiritsa nkhani zidachotsedwa ndikupatsidwa chizindikiritso chololeza kusamutsa kudzera pa IP protocol yotetezedwa kwa wasayansi kuti aunike. Pogwiritsa ntchito mapulogalamu amtundu wa volumetric magazi, mafunde a Cerebrospinal Fluid (CSF) ndi magawo omwe adachokera adatsimikiziridwa (MRICP version 1.4.35 Alperin Noninvasive Diagnostics, Miami, FL).

Pogwiritsa ntchito gawo la pulsatility-based segmentation of lumens, nthawi yodalira ma volumetric mayendedwe amawerengedwa mwa kuphatikizira maulendo othamanga mkati mwa zigawo zowunikira pazithunzi zonse makumi atatu ndi ziwiri. Kuthamanga kwapakati kumapezedwa pamitsempha ya khomo lachiberekero, ngalande yoyambira ya venous, ndi njira zachiwiri za venous drainage. Kuthamanga kwathunthu kwa magazi muubongo kunapezedwa ndi kuphatikizika kwa izi.

Tanthauzo losavuta la kutsata ndi chiŵerengero cha voliyumu ndi kusintha kwamphamvu. Kutsata kwapamtima kumawerengedwa kuchokera ku chiŵerengero cha maximal (systolic) intracranial volume change (ICVC) ndi kusinthasintha kwa kuthamanga panthawi ya mtima wamtima (PTP-PG). Kusintha kwa ICVC kumachokera ku kusiyana kwakanthawi pakati pa kuchuluka kwa magazi ndi CSF kulowa ndikutuluka mu cranium [5, 31]. Kusintha kwamphamvu pamayendedwe amtima kumachokera ku kusintha kwa CSF pressure gradient, yomwe imawerengedwa kuchokera ku zithunzi za MR zojambulidwa ndi liwiro la CSF, pogwiritsa ntchito ubale wa Navier-Stokes pakati pa zotumphukira za ma velocities ndi kuthamanga kwapakati [5, 32] ]. Intracranial compliance index (ICCI) imawerengedwa kuchokera ku chiŵerengero cha ICVC ndi kusintha kwamphamvu [5, 31�33].

Kusanthula kwachiwerengero kunaganizira zinthu zingapo. Kusanthula kwa deta ya ICCI kunaphatikizapo kuyesa kwa chitsanzo chimodzi cha Kolmogorov-Smirnov kuwonetsa kusowa kwachigawenga mu data ya ICCI, zomwe zinafotokozedwa pogwiritsa ntchito mtundu wapakati ndi interquartile (IQR). Kusiyana pakati pa zoyambira ndi kutsata kumayenera kuyesedwa pogwiritsa ntchito kuyesa kwapawiri.

Zowunikira za NUCCA zidafotokozedwa pogwiritsa ntchito mean, median, ndi interquartile range (IQR). Kusiyana pakati pa zoyambira ndi zotsatila zidawunikidwa pogwiritsa ntchito mayeso a t.

Malingana ndi muyeso wa zotsatira, zoyambira, sabata zinayi, sabata zisanu ndi zitatu, ndi sabata khumi ndi ziwiri (MIDAS zokha) zotsatiridwa zomwe zimatsatiridwa pogwiritsa ntchito njira yosiyana ndi yosiyana. Deta ya MIDAS yomwe idasonkhanitsidwa pakuwunika koyambirira kwa neurologist inali ndi gawo limodzi lotsatira kumapeto kwa masabata khumi ndi awiri.

Kusiyanasiyana kuchokera kumayendedwe oyambira kupita kotsatira kulikonse kunayesedwa pogwiritsa ntchito kuyesa kwapawiri. Izi zidabweretsa ma p values ambiri kuchokera pamaulendo awiri otsatizana pazotsatira zilizonse kupatula MIDAS. Popeza cholinga chimodzi cha woyendetsa uyu ndi kupereka ziwerengero za kafukufuku wamtsogolo, kunali kofunika kufotokoza kumene kusiyana kunachitika, m'malo mogwiritsa ntchito njira imodzi ya ANOVA kuti ifike pa mtengo umodzi wa p pa muyeso uliwonse. Chodetsa nkhawa ndi kufananitsa kotereku ndikuwonjezeka kwa chiwopsezo cha Type I.

Kuti mufufuze deta ya VAS, maphunziro aliwonse adayesedwa payekha ndiyeno ndi mzere wodutsa mzere womwe umagwirizana mokwanira ndi deta. Kugwiritsiridwa ntchito kwa ma multilevel regression model omwe ali ndi zolowera mwachisawawa komanso otsetsereka mwachisawawa amapereka mzere wobwerera payekha woyenerera wodwala aliyense. Izi zinayesedwa ndi chitsanzo cha intercept-only, chomwe chimagwirizana ndi mzere wodutsa mzere wokhala ndi malo otsetsereka a maphunziro onse, pamene mawu odutsa amaloledwa kusiyana. Chitsanzo chachisawawa cha coefficient chinatengedwa, popeza panalibe umboni wosonyeza kuti kutsetsereka kwachisawawa kumapangitsa kuti chiwerengerocho chikhale chokwanira (pogwiritsa ntchito chiwerengero cha chiŵerengero cha mwayi). Kuti awonetse kusiyana kwa zodutsazo koma osati pamtunda, mizere yobwereranso payekha inajambulidwa kwa wodwala aliyense yemwe ali ndi mzere wokhazikika wodutsa pamwamba.

Results

Kuchokera pakuwunika koyambirira kwa akatswiri amisala, odzipereka khumi ndi asanu ndi atatu anali oyenerera kuphatikizidwa. Pambuyo pomaliza zolemba zoyambirira za mutu wa mutu, osankhidwa asanu sanakwaniritse zofunikira zophatikizira. Atatu analibe masiku ofunikira amutu pamabuku oyambira kuti aphatikizidwe, wina anali ndi zizindikilo zachilendo zamanjenje ndi dzanzi losalekeza, ndipo wina anali kutenga chotchinga cha calcium. Katswiri wa NUCCA adapeza anthu awiri osankhidwa kukhala osayenerera: wina analibe ma atlas molakwika ndipo wachiwiri anali ndi vuto la Wolff-Parkinson-White komanso kusokoneza kwambiri kwa postural (39�) ndikuchitapo kanthu posachedwa pa ngozi yagalimoto yoopsa kwambiri ndi whiplash (onani Chithunzi 1) .

Maphunziro khumi ndi limodzi, akazi asanu ndi atatu ndi amuna atatu, zaka zapakati pa zaka makumi anayi ndi chimodzi (zoyambira 21�61 zaka), oyenerera kuphatikizidwa. Mitu isanu ndi umodzi idapereka mutu waching'alang'ala, womwe umafotokoza masiku khumi ndi asanu kapena kuposerapo pamutu pa mwezi, ndi mutu khumi ndi umodzi womwe umatanthauza masiku a mutu wa 14.5 pamwezi. Kutalika kwa chizindikiro cha Migraine kuyambira zaka ziwiri mpaka makumi atatu ndi zisanu (kutanthauza zaka makumi awiri ndi zitatu). Mankhwala onse adasungidwa osasinthika kwa nthawi yophunzira kuti aphatikizepo machitidwe awo a migraine prophylaxis monga momwe adanenera.

Pazifukwa zochotseratu, palibe maphunziro omwe anaphatikizidwa omwe adalandira matenda a mutu chifukwa cha kuvulala koopsa kwa mutu ndi khosi, kugwedezeka, kapena kupweteka kwa mutu kosalekeza komwe kumatchedwa whiplash. Mitu isanu ndi inayi inanena za mbiri yakale yakutali, yopitilira zaka zisanu kapena kupitilira apo (pafupifupi zaka zisanu ndi zinayi) asanawonedwe ndi katswiri waubongo. Izi zinaphatikizapo kuvulala pamutu zokhudzana ndi masewera, kugwedezeka, ndi / kapena chikwapu. Maphunziro awiri sanawonetsere kuvulala kwamutu kapena khosi kusanachitike (onani Gulu 2).

Table 2 Mutu Intracranial Compliance Index Data ya ICCI

Gulu 2: Deta ya intracranial compliance index (ICCI) (n = 11). PC-MRI6 inapeza deta ya ICCI1 yomwe inafotokozedwa kumayambiriro, sabata zinayi, ndi sabata zisanu ndi zitatu zotsatira za NUCCA5. Mizere yotchingidwa imasonyeza mutu wokhala ndi njira yachiwiri ya venous. MVA kapena mTBI idachitika zaka zosachepera 5 isanayambe kuphatikizidwa, pafupifupi zaka 10.

Payekha, maphunziro asanu adawonetsa kuwonjezeka kwa ICCI, mfundo zitatu zamaphunziro zidakhalabe zofanana, ndipo atatu adawonetsa kuchepa kuchokera pazoyambira mpaka kumapeto kwa miyeso yophunzirira. Kusintha kwakukulu pakutsata kwa intracranial kumawoneka mu Table 2 ndi Chithunzi 8. Miyezo yapakati (IQR) ya ICCI inali 5.6 (4.8, 5.9) poyambira, 5.6 (4.9, 8.2) pa sabata zinayi, ndi 5.6 (4.6, 10.0) pa sabata eyiti. Kusiyana sikunali kosiyana mowerengera. Kusiyana kwakukulu pakati pa chiyambi ndi sabata lachinayi kunali ?0.14 (95% CI?1.56, 1.28), p = 0.834, ndipo pakati pa chiyambi ndi sabata eyiti inali 0.93 (95% CI?0.99, 2.84), p = 0.307. Maphunziro awiriwa a 24-sabata ya ICCI zotsatira za phunziro akuwoneka mu Table 6. Mutu 01 unawonetsa kuwonjezeka kwa ICCI kuchokera ku 5.02 pachiyambi mpaka 6.69 pa sabata 24, pamene pa sabata la 8, zotsatira zinatanthauzidwa ngati zosagwirizana kapena zotsalira. Mutu 02 udawonetsa kuchepa kwa ICCI kuyambira pa 15.17 mpaka 9.47 pa sabata 24.

Chithunzi cha 8 Phunziro la ICCI Data Poyerekeza ndi Zomwe Zafotokozedwa M'mabuku

Chithunzi 8: Phunzirani zambiri za ICCI poyerekeza ndi zomwe zidanenedwa kale m'mabuku. Miyezo ya nthawi ya MRI imayikidwa pazoyambira, sabata 4, ndi sabata 8 pambuyo pochitapo kanthu. Miyezo yoyambira ya kafukufukuyu ikufanana ndi zomwe Pomschar ananena pamitu yongoperekedwa ndi mTBI yokha.

Table 6 24 Week Intracranial Compliance Index Data ICCI

Gulu 6: Zotsatira za 24 za ICCI zomwe zikuwonetsa kuchulukirachulukira pamutu 01 pomwe kumapeto kwa phunziro (sabata 8), zotsatira zidatanthauziridwa kukhala zosagwirizana kapena kukhalabe chimodzimodzi. Mutu 02 udapitilira kuwonetsa kuchepa kwa ICCI.

Table 3 ikuwonetsa kusintha kwa NUCCA. Kusiyana kwapakati kuyambira kale mpaka pambuyo pochitapo kanthu ndi motere: (1) SLC: 0.73 mainchesi, 95% CI (0.61, 0.84) (p <0.001); (2) GSA: 28.36 mfundo zazikulu, 95% CI (26.01, 30.72) (p <0.001); (3) Atlas Laterality: 2.36 madigiri, 95% CI (1.68, 3.05) (p <0.001); ndi (4) Kuzungulira kwa Atlas: 2.00 madigiri, 95% CI (1.12, 2.88) (p <0.001). Izi zitha kuwonetsa kuti kusintha kotheka kunachitika potsatira kulowererapo kwa ma atlas motengera kuwunika kwa phunziro.

Table 3 Ziwerengero Zofotokozera za NUCCA Assessments

Gulu 3: Ziwerengero zofotokozera [kutanthauza, kupotoza koyenera, pakati, ndi interquartile range (IQR2)] ya NUCCA1 mayesero asanayambe kuchitapo kanthu (n = 11).

Zotsatira za diary ya mutu zimafotokozedwa mu Gulu 4 ndi Chithunzi 6. Pa maphunziro oyambirira anali ndi masiku a mutu wa 14.5 (SD = 5.7) pa mwezi wa 28. M'mwezi woyamba wotsatira kuwongolera kwa NUCCA, kutanthauza masiku amutu pa mwezi adatsika ndi masiku a 3.1 kuchokera pachiyambi, 95% CI (0.19, 6.0), p = 0.039, ku 11.4. M'mwezi wachiwiri masiku a mutu wamutu adatsika ndi masiku a 5.7 kuyambira pachiyambi, 95% CI (2.0, 9.4), p = 0.006, mpaka masiku 8.7. Pa sabata lachisanu ndi chitatu, zisanu ndi chimodzi mwa maphunziro khumi ndi limodzi adachepetsedwa> 30% m'masiku amutu pa mwezi. Pamasabata a 24, phunziro la 01 linanena kuti palibe kusintha kwa masiku a mutu pamene mutu wa 02 unachepetsedwa tsiku limodzi la mutu pamwezi kuchokera pa phunziro loyamba la asanu ndi awiri mpaka kumapeto kwa malipoti a masiku asanu ndi limodzi.

Chithunzi cha 6 Masiku Opweteka Mutu ndi Kupweteka kwa Mutu Kupweteka Kwambiri kuchokera ku Diary

Chithunzi 6: Masiku amutu ndi kupweteka kwa mutu kuwonjezereka kuchokera ku diary (n = 11). (a) Chiwerengero cha masiku a mutu pamwezi. (b) Kupweteka kwamutu kwapakati (pamasiku amutu). Circle imasonyeza tanthauzo ndipo bala imasonyeza 95% CI. Mabwalo ndi zigoli pamutu pawokha. Kutsika kwakukulu kwa masiku a mutu pamwezi kunawonedwa pa masabata anayi, pafupifupi kuwirikiza pa masabata asanu ndi atatu. Mitu inayi (#4, 5, 7, ndi 8) inawonetsa kuchepa kwakukulu kwa 20% kwa kupweteka kwa mutu. Kugwiritsa ntchito mankhwala nthawi imodzi kungafotokozere kuchepa kwapang'ono kwa kupweteka kwa mutu.

Pachiyambi, kutanthauza kupweteka kwa mutu pamasiku omwe ali ndi mutu, pamlingo wa zero mpaka khumi, anali 2.8 (SD = 0.96). Kupweteka kwamutu kumatanthawuza kuti sikunawonetse kusintha kwakukulu pazinayi (p = 0.604) ndi masabata asanu ndi atatu (p = 0.158). Mitu inayi (#4, 5, 7, ndi 8) inawonetsa kuchepa kwakukulu kwa 20% kwa kupweteka kwa mutu.

Ubwino wa moyo ndi miyeso yolemala ya mutu ikuwoneka mu Table 4. Zomwe zimapangidwira HIT-6 pazigawo zoyambirira zinali 64.2 (SD = 3.8). Pa sabata inayi pambuyo pa kukonzedwa kwa NUCCA, kuchepa kwa chiwerengero kunali 8.9, 95% CI (4.7, 13.1), p = 0.001. Ziwerengero za masabata asanu ndi atatu, poyerekeza ndi zoyambira, zimasonyeza kuchepa kwa 10.4, 95% CI (6.8, 13.9), p = 0.001. M'gulu la masabata a 24, phunziro la 01 linasonyeza kuchepa kwa mfundo za 10 kuchokera ku 58 pa sabata 8 mpaka 48 pa sabata 24 pamene phunziro 02 linatsika mfundo za 7 kuchokera ku 55 pa sabata 8 mpaka 48 pa sabata 24 (onani Chithunzi 9).

Chithunzi 9 24 Week HIT 6 Scores mu Long Term Follow Up Mitu

Chithunzi 9: 24-masabata a HIT-6 muzotsatira zanthawi yayitali. Ziwerengero za mwezi uliwonse zidapitilira kuchepa pambuyo pa sabata 8, kutha kwa phunziro loyamba. Kutengera Smelt et al. Zolinga, zikhoza kutanthauziridwa kuti mkati mwa munthu kusintha kochepa kofunikira kunachitika pakati pa sabata 8 ndi sabata 24. HIT-6: Mutu Wokhudza Mayeso-6.

MSQL zikutanthauza kuti gawo loyambira linali 38.4 (SD = 17.4). Pa sabata inayi mutatha kuwongolera, ziwerengero za maphunziro onse khumi ndi limodzi zidawonjezeka (zowonjezereka) ndi 30.7, 95% CI (22.1, 39.2), p <0.001. Pofika sabata yachisanu ndi chitatu, kutha kwa maphunziro, zikutanthawuza kuti ziwerengero za MSQL zawonjezeka kuchokera pachiyambi ndi 35.1, 95% CI (23.1, 50.0), p <0.001, mpaka 73.5. Nkhani zotsatiridwazo zinapitiriza kusonyeza kusintha kwina ndi kuchuluka kwa ziwerengero; Komabe, ziwerengero zambiri zidakhalabe zofanana kuyambira sabata 8 (onani Zithunzi 10(a)�10(c)).

Chithunzi 10 24 Sabata MSQL Scores mu Long Term Tsatirani p Mitu

Chithunzi 10: ((a)�(c)) Zotsatira za MSQL za masabata 24 m'mitu yotsatiridwa nthawi yayitali. (a) Mutu 01 wakula pambuyo pa sabata 8 mpaka kumapeto kwa phunziro lachiwiri. Mutu 02 ukuwonetsa ziwerengero zikuchulukirachulukira pakapita nthawi zikuwonetsa kusiyana kofunikira pang'ono kutengera Cole et al. zofunikira pa sabata 24. (b) Maphunziro a maphunziro akuwoneka kuti akukwera kwambiri pa sabata la 8 ndi maphunziro onsewa akuwonetsa zofanana zomwe zafotokozedwa pa sabata 24. (c) Maphunziro a 2 amakhalabe osagwirizana mu phunziro lonse pamene phunziro la 01 likuwonetsa kusintha kosasintha kuyambira pachiyambi mpaka kumapeto kwa phunziroli. sabata 24. MSQL: Migraine-Specific Quality of Life Measure.

Kutanthauza kuti chiwerengero cha MIDAS pa chiyambi chinali 46.7 (SD = 27.7). Pakatha miyezi iwiri pambuyo pa kukonzedwa kwa NUCCA (miyezi itatu ikutsatira ndondomeko yoyamba), kuchepa kwapakati pa maphunziro a MIDAS anali 32.1, 95% CI (13.2, 51.0), p = 0.004. Mitu yotsatiridwayo idapitilira kuwonetsa kusintha ndikuchepera kwa ziwerengero ndi mphamvu zowonetsa kusintha pang'ono (onani Zithunzi 11(a)�11(c)).

Chithunzi 11 24 Mlungu wa MIDAS Zochita mu Nkhani Zotsatiridwa Zanthawi Yaitali

Chithunzi 11: 24-masabata a MIDAS muzotsatira zanthawi yayitali. (a) Ziwerengero zonse za MIDAS zidapitilirabe kutsika pakanthawi yophunzira yamasabata 24. (b) Kuchulukira kupitilira patsogolo. (c) Ngakhale kuti maulendo a masabata a 24 anali apamwamba kuposa sabata ya 8, kusintha kumawoneka poyerekeza ndi chiyambi. MIDAS: Migraine Disability Assessment Scale.

Kuwunika kwa kupweteka kwa mutu wamakono kuchokera ku deta ya VAS scale ikuwoneka mu Chithunzi 7. Chitsanzo chotsatira cha multilevel linear regression model chinawonetsa umboni wa zotsatira zosasinthika (p <0.001) koma osati pamtunda (p = 0.916). Chifukwa chake, njira yotsatsira mwachisawawa imayesa njira yosiyana kwa wodwala aliyense koma otsetsereka wamba. Kutsetsereka kwa mzerewu kunali? Chiwerengero choyambira chinali 0.044, 95% CI (0.055, 0.0326). Kusanthula kwachisawawa kwawonetsa kusiyanasiyana kwakukulu pazoyambira (SD = 0.001). Monga momwe zimagawidwira mwachisawawa zimagawidwa, izi zikuwonetsa kuti 0.44% yazolowera zotere zili pakati pa 10 ndi 0.001 zomwe zimapereka umboni wa kusiyana kwakukulu pazikhalidwe zoyambira kwa odwala. Zotsatira za VAS zinapitiriza kusonyeza kusintha kwa masabata a 5.34-masabata awiri otsatila gulu (onani Chithunzi 95).

Chithunzi 7 Mutu Padziko Lonse Kuunika kwa Mutu wa VAS

Chithunzi 7: Kuwunika kwapadziko lonse lapansi kwa mutu (VAS) (n = 11). Panali kusiyana kwakukulu paziwerengero zoyambira pakati pa odwalawa. Mizere ikuwonetsa kukwanira kwa mzere kwa odwala khumi ndi m'modzi. Mzere wakuda wamadontho wokhuthala umayimira pafupifupi odwala onse khumi ndi amodzi. VAS: Visual Analog Scale.

Chithunzi 12 24 Mlungu Wotsatira Gulu Padziko Lonse Kuunika kwa Mutu wa VAS

Chithunzi 12: Gulu la 24-sabata lotsatila gulu lonse la mutu wa mutu (VAS). Pamene anthu adafunsidwa, �chonde ganizirani kupweteka kwa mutu wanu pafupipafupi sabata yapitayi.

Zomwe zimawonekera kwambiri pakuchitapo kanthu kwa NUCCA ndi chisamaliro chomwe anthu khumi anali nacho chinali kusokonezeka kwa khosi, kuwerengetsa pafupifupi atatu mwa khumi pa kuyesa ululu. M'mitu isanu ndi umodzi, ululu unayamba maola oposa makumi awiri ndi anayi pambuyo pa kukonzedwa kwa ma atlas, kupitirira maola makumi awiri ndi anayi. Palibe mutu womwe unanena kuti zimakhudza kwambiri zochita zawo zatsiku ndi tsiku. Mitu yonse inanena kuti ikukhutira ndi chisamaliro cha NUCCA patatha sabata imodzi, mapepala apakatikati, khumi, paziro mpaka khumi.

Dr Jimenez White Coat

Kuzindikira kwa Dr. Alex Jimenez

“Ndakhala ndikudwala mutu waching’alang’ala kwa zaka zingapo tsopano. Kodi pali chifukwa chomwe mutu wanga ukupweteka? Kodi ndingatani kuti ndichepetse kapena kuchotsa zizindikiro zanga?”�Mutu wa Migraine umakhulupirira kuti ndi mtundu wovuta wa kupweteka kwa mutu, komabe, chifukwa chake ndi chofanana ndi mtundu wina uliwonse wa mutu. Kuvulala koopsa kwa msana wa khomo lachiberekero, monga chikwapu kuchokera ku ngozi ya galimoto kapena kuvulala kwa masewera, kungayambitse kusokonezeka kwa khosi ndi kumtunda, zomwe zingayambitse mutu wa migraine. Kaimidwe kosayenera kungayambitsenso nkhani zapakhosi zomwe zingayambitse mutu ndi kupweteka kwa khosi. Katswiri wazachipatala yemwe amagwira ntchito pazaumoyo wamsana amatha kudziwa komwe kumayambitsa mutu wanu wa migraine. Kuphatikiza apo, katswiri wodziwa bwino komanso wodziwa zambiri amatha kusintha kusintha kwa msana komanso kuwongolera pamanja kuti athandizire kukonza zolakwika zilizonse za msana zomwe zingayambitse zizindikirozo. Nkhani yotsatirayi ikufotokoza mwachidule kafukufuku wokhudzana ndi kusintha kwa zizindikiro pambuyo pa kusintha kwa ma atlas vertebrae mwa omwe ali ndi migraine.

Kukambirana

Mu gulu lochepa la anthu khumi ndi limodzi a migraine, panalibe kusintha kwakukulu mu ICCI (zotsatira zoyambirira) pambuyo pa NUCCA. Komabe, kusintha kwakukulu kwa zotsatira zachiwiri za HRQoL kunachitika monga momwe tafotokozera mu Table 5. Kusasinthika kwa kukula ndi kuwongolera kwa kusintha pamiyeso yonse ya HRQoL kumasonyeza chidaliro pakupititsa patsogolo thanzi la mutu pa phunziro la miyezi iwiri potsatira nthawi yoyambira ya masiku 28. .

Gulu 5 Mwachidule Kufananitsa Zotsatira Zoyezedwa

Gulu 5: Kufananiza Chidule cha Zotsatira Zoyezedwa

Kutengera zotsatira za kafukufukuyu, kafukufukuyu adawonetsa kuwonjezeka kwakukulu kwa ICCI pambuyo pa atlas kulowererapo zomwe sizinawonedwe. Kugwiritsa ntchito PC-MRI kumalola kuwerengera kwa ubale wamphamvu pakati pa kutulutsa kwamphamvu, kutuluka kwa venous, ndi CSF kuyenda pakati pa cranium ndi ngalande ya msana [33]. Intracranial compliance index (ICCI) imayesa kuthekera kwaubongo kuyankha magazi omwe amalowa mkati mwa systole. Kutanthauzira kwakuyenda kwamphamvuku kumayimiridwa ndi ubale womwe ulipo pakati pa voliyumu ya CSF ndi kukakamiza kwa CSF. Ndi kutsata kowonjezereka kapena kuwonjezereka kwa intracranial, komwe kumatanthauzidwanso ngati malo abwino obwezera, magazi omwe amalowa amatha kuthandizidwa ndi zomwe zili mkati mwa ubongo ndi kusintha kwakung'ono kwa kuthamanga kwa intracranial. Ngakhale kusintha kwa voliyumu ya intracranial kapena kupanikizika kungatheke, kutengera kufotokozera kwa mgwirizano wa mphamvu ya voliyumu, kusintha kwa ICCI pambuyo pochitapo kanthu sikungatheke. Kusanthula kwapamwamba kwa deta ya MRI ndi kufufuza kwina kumafunika kuti muwonetsere zofunikira zomwe zingatheke kuti zigwiritsidwe ntchito ngati cholinga chofuna kulemba kusintha kwa thupi potsatira kukonzanso ma atlas.

Koerte et al. malipoti a odwala omwe ali ndi mutu wa migraine amawonetsa kuchuluka kwamadzi am'magazi amtundu wachiwiri (paraspinal plexus) pamalo apamwamba poyerekeza ndi zaka ndi zowongolera zofananira ndi jenda [34]. Maphunziro anayi akuwonetsa ngalande yachiwiri ya venous ndi atatu mwa maphunzirowa akuwonetsa kuwonjezeka kwa kutsata pambuyo pochitapo kanthu. Kufunika sikudziwika popanda kuphunzira kwina. Mofananamo, Pomschar et al. adanenanso kuti anthu omwe ali ndi vuto lopweteka kwambiri muubongo (mTBI) amawonetsa kuchuluka kwa madzi kudzera munjira yachiwiri ya venous paraspinal [35]. The mean intracranial compliance index ikuwoneka yotsika kwambiri mu gulu la mTBI poyerekeza ndi zowongolera.

Malingaliro ena angapezeke poyerekeza ndi deta ya ICCI ya phunziroli kwa anthu omwe adanenedwa kale komanso omwe ali ndi mTBI omwe akuwonetsedwa pa Chithunzi 8 [5, 35]. Zochepa ndi zowerengeka za maphunziro omwe aphunziridwa, kufunikira kwa zomwe apeza pa kafukufukuyu angakhale nazo pokhudzana ndi Pomschar et al. sizikudziwikabe, zomwe zimangopereka malingaliro a kuthekera kwa kufufuza kwamtsogolo. Izi zimakhala zovuta kwambiri chifukwa cha kusintha kosagwirizana kwa ICCI komwe kumawonedwa m'mitu iwiri yotsatiridwa kwa masabata a 24. Nkhani yachiwiri yokhala ndi njira yachiwiri yamadzimadzi idawonetsa kuchepa kwa ICCI potsatira kulowererapo. Chiyeso chachikulu cholamulidwa ndi placebo chokhala ndi kukula kwachitsanzo chowerengeka chikhoza kuwonetsa kusintha kotsimikizika kwa physiologic pambuyo pogwiritsira ntchito ndondomeko yokonza NUCCA.

Miyezo ya HRQoL imagwiritsidwa ntchito kuchipatala kuti awone momwe njira yochiritsira imathandizira kuchepetsa ululu ndi kulemala kokhudzana ndi mutu wa migraine. Zimayembekezeredwa kuti chithandizo chothandizira chimapangitsa wodwalayo kumva ululu ndi kulemala koyesedwa ndi zidazi. Miyezo yonse ya HRQoL mu phunziroli inawonetsa kusintha kwakukulu komanso kwakukulu pa sabata inayi kutsatira kulowerera kwa NUCCA. Kuyambira sabata zinayi mpaka sabata zisanu ndi zitatu zosintha zazing'ono zokha zidadziwika. Apanso, zosintha zazing'ono zokha zidadziwika m'mitu iwiri yomwe idatsatiridwa kwa masabata a 24. Ngakhale kuti phunziroli silinapangidwe kuti liwonetsere chifukwa cha kulowerera kwa NUCCA, zotsatira za HRQoL zimapanga chidwi chofuna kuphunzira.

Kuchokera ku mutu wa mutu, kuchepa kwakukulu kwa masiku a mutu pamwezi kunawonedwa pa masabata anayi, pafupifupi kuwirikiza kawiri pa masabata asanu ndi atatu. Komabe, kusiyana kwakukulu kwa kupweteka kwa mutu pakapita nthawi sikunadziwike kuchokera ku deta iyi ya diary (onani Chithunzi 5). Ngakhale kuti chiwerengero cha mutu chinachepa, anthu adagwiritsabe ntchito mankhwala kuti apitirizebe kupweteka kwa mutu pamiyeso yolekerera; motero, akuyenera kuti kusiyana kwakukulu kwa chiwerengero cha kupweteka kwa mutu sikungadziwike. Kusasinthika kwa manambala a tsiku la mutu omwe amapezeka mu sabata la 8 m'mitu yotsatira akhoza kutsogolera phunziro lamtsogolo kuti adziwe pamene kusintha kwakukulu kumachitika kuti athandize kukhazikitsa NUCCA muyezo wa chisamaliro cha migraine.

Kusintha koyenera kwachipatala mu HIT-6 ndikofunikira kuti mumvetsetse zotsatira zomwe zawonedwa. Kusintha kwatanthauzo kwachipatala kwa wodwala payekha kumatanthauzidwa ndi kalozera wa ogwiritsa ntchito a HIT-6 monga ?5 [36]. Coeytaux et al., pogwiritsa ntchito njira zinayi zowunikira, akuwonetsa kuti kusiyana pakati pamagulu mu HIT-6 mayunitsi a 2.3 pakapita nthawi kumatha kuonedwa kuti ndi kofunikira kwambiri [37]. Smelt et al. adaphunzira chisamaliro choyambirira cha odwala migraine popanga malingaliro omwe aperekedwa pogwiritsa ntchito kusintha kwa HIT-6 pazachipatala ndi kafukufuku [38]. Kutengera zotsatira zobwera chifukwa cha zabwino zabodza kapena zoyipa, kusintha kwamkati mwamunthu kofunikira pang'ono (MIC) pogwiritsa ntchito �njira yosinthira �kuyerekezedwa kukhala mfundo za 2.5. Mukamagwiritsa ntchito �receiver operating characteristic (ROC) curve analysis� kusintha kwa mfundo 6 kumafunika. Kusiyanitsa pakati pamagulu ocheperako (MID) ndi 1.5 [38].

Pogwiritsa ntchito �njira yosinthira,� mitu yonse koma imodzi inanena za kusintha (kuchepa) kwakukulu kuposa ?2.5. Kusanthula kwa �ROC� kunawonetsanso kusintha kwa maphunziro onse koma imodzi. "mutu umodzi" uwu unali munthu wosiyana pakuwunika kulikonse. Kutengera Smelt et al. Zofunikira, maphunziro otsatiridwa adapitilira kuwonetsa mkati mwamunthu kusintha kofunikira pang'ono monga momwe tawonera pa Chithunzi 10.

Maphunziro onse koma awiri adawonetsa kusintha pamlingo wa MIDAS pakati pazotsatira zoyambira ndi miyezi itatu. Kukula kwa kusinthaku kunali kolingana ndi gawo loyambira la MIDAS, ndi maphunziro onse koma atatu akuwonetsa kusintha kwa makumi asanu kapena kupitilira apo. Nkhani zotsatiridwazo zinapitiriza kusonyeza kusintha monga momwe zikuwonekera pakupitiriza kuchepa kwa masewera ndi sabata 24; onani Zithunzi 11(a)�11(c).

Kugwiritsa ntchito HIT-6 ndi MIDAS pamodzi monga zotsatira zachipatala kungapereke kuwunika kokwanira kwa zinthu zolemala zokhudzana ndi mutu [39]. Kusiyanitsa pakati pa miyeso iwiri kungathe kufotokozera kulemala kuchokera ku kupweteka kwa mutu ndi kupweteka kwa mutu pafupipafupi, popereka zambiri zokhudzana ndi kusintha komwe kunanenedwa kusiyana ndi zotsatira zomwe zimagwiritsidwa ntchito zokha. Ngakhale kuti MIDAS ikuwoneka kuti ikusintha kwambiri ndi mutu wafupipafupi, kupweteka kwa mutu kumawoneka kuti kumakhudza chiwerengero cha HIT-6 kuposa MIDAS [39].

Momwe mutu wa mutu wa migraine umakhudzira ndi kuchepetsa odwala omwe amawoneka kuti akugwira ntchito tsiku ndi tsiku amanenedwa ndi MSQL v. 2.1, m'madera atatu a 3: gawo loletsa (MSQL-R), kuteteza udindo (MSQL-P), ndi kugwira ntchito kwamaganizo (MSQL-E). Kuwonjezeka kwa ziwerengero kumasonyeza kuwongolera m'maderawa ndi makhalidwe kuyambira 0 (osauka) mpaka 100 (zabwino).

MSQL miyeso yodalirika yowunika ndi Bagley et al. lipoti zotsatira kuti zigwirizane kwambiri ndi HIT-6 (r = ?0.60 mpaka ?0.71) [40]. Phunziro la Cole et al. amafotokoza kusiyana kofunikira (MID) kusintha kwachipatala pa domain iliyonse: MSQL-R = 3.2, MSQL-P = 4.6, ndi MSQL-E = 7.5 [41]. Zotsatira kuchokera ku lipoti la topiramate lipoti munthu aliyense wofunikira pang'ono (MIC) kusintha: MSQL-R = 10.9, MSQL-P = 8.3, ndi MSQL-E = 12.2 [42].

Maphunziro onse kupatula amodzi adakumana ndi kusintha kofunikira kwachipatala kwa MSQL-R kuposa 10.9 pakutsata kwa sabata eyiti ku MSQL-R. Mitu yonse koma iwiri inanena za kusintha kwa mfundo zoposa 12.2 mu MSQL-E. Kupita patsogolo kwa kuchuluka kwa MSQL-P kudakwera ndi mfundo khumi kapena kupitilira apo m'maphunziro onse.

Kusanthula kwachidziwitso cha VAS kwa nthawi yayitali kunawonetsa kusintha kwakukulu kwa mzere pa miyezi ya 3. Panali kusiyana kwakukulu paziwerengero zoyambira pakati pa odwalawa. Kusiyanasiyana kocheperako komwe kunawonedwa pamlingo wowongolera. Izi zikuwoneka ngati zofanana ndi zomwe zaphunziridwa kwa masabata a 24 monga momwe tawonera pa Chithunzi 12.

Dr Jimenez amagwira ntchito pakhosi la wrestler

Kafukufuku wambiri wogwiritsa ntchito mankhwala opangira mankhwala awonetsa zotsatira zazikulu za placebo kwa odwala omwe ali ndi migrainous people [43]. Kuzindikira zotheka kusintha kwa migraine kwa miyezi isanu ndi umodzi, pogwiritsa ntchito njira ina komanso osachitapo kanthu, n'kofunika kuti mufanane ndi zotsatira. Kafukufuku wokhudza zotsatira za placebo nthawi zambiri amavomereza kuti kulowererapo kwa placebo kumapereka mpumulo wazizindikiro koma sikusintha njira za pathophysiologic zomwe zimayambitsa vutoli [44]. Zolinga za MRI zingathandize kuwulula zotsatira za placebo mwa kusonyeza kusintha kwa physiologic kuyeza kwa magawo othamanga omwe amachitika pambuyo pa kulowetsedwa kwa placebo.

Kugwiritsa ntchito maginito atatu a tesla posonkhanitsa deta ya MRI kungapangitse kudalirika kwa miyeso mwa kuwonjezera kuchuluka kwa deta yomwe imagwiritsidwa ntchito popanga kuyenda ndi kuwerengera kwa ICCI. Ichi ndi chimodzi mwazofufuza zoyamba pogwiritsa ntchito kusintha kwa ICCI monga zotsatira poyesa kulowererapo. Izi zimabweretsa zovuta pakutanthauzira kwa MRI yomwe idapeza deta kuti ikwaniritse ziganizo zoyambira kapena kuwonjezereka kwamalingaliro. Kusiyanasiyana kwa maubwenzi pakati pa kutuluka kwa magazi kupita ndi kuchokera ku ubongo, kuyenda kwa CSF, ndi kugunda kwa mtima kwa magawo enaake awa akuti [45]. Kusiyanasiyana komwe kunachitika mu phunziro laling'ono laling'ono lazinthu zitatu mobwerezabwereza kwapangitsa kuti zidziwitso zomwe zasonkhanitsidwa kuchokera pamilandu iliyonse zimatanthauziridwa mosamala [46].

Zolembazo zimafotokozanso m'maphunziro akulu kudalirika kwakukulu pakutolera ma MRI awa adapeza ma data a volumetric flow. Wentland et al. inanena kuti kuyeza kwa ma liwiro a CSF mwa odzipereka aumunthu komanso kusinthasintha kwa phantom velocities sikunasiyana kwambiri pakati pa njira ziwiri za MRI zomwe zimagwiritsidwa ntchito [47]. Koerte et al. adaphunzira magulu awiri a maphunziro omwe amajambulidwa m'malo awiri osiyana okhala ndi zida zosiyanasiyana. Iwo adanena kuti intraclass coefficients coefficients (ICC) inasonyeza kudalirika kwakukulu kwa intra- and interrater kwa PC-MRI volumetric flow rate miyeso yotsalira popanda zida zogwiritsidwa ntchito ndi luso la woyendetsa [48]. Ngakhale kusiyanasiyana kwa ma anatomiki kulipo pakati pa maphunziro, sikunaletse maphunziro a odwala ochulukirapo pofotokoza zotheka "zabwinobwino" kutuluka [49, 50].

Chifukwa chokhazikika pamalingaliro omvera odwala, pali zolepheretsa kugwiritsa ntchito zotsatira zomwe zanenedwa za odwala [51]. Chilichonse chomwe chimakhudza momwe wophunzirayo alili pa moyo wawo akhoza kukhudza zotsatira za kuunika kulikonse komwe akugwiritsidwa ntchito. Kupanda tsatanetsatane wa zotsatira pofotokozera zizindikiro, malingaliro, ndi kulumala kumachepetsanso kutanthauzira kwa zotsatira [51].

Kuyerekeza ndi kusanthula kwa data ya MRI kumalepheretsa kugwiritsa ntchito gulu lowongolera, kuletsa kufalikira kulikonse kwa zotsatirazi. Kukula kwachitsanzo chokulirapo kungalole kuti ziganizo zotengera mphamvu zowerengera ndikuchepetsa zolakwika za Type I. Kutanthauzira kufunikira kulikonse muzotsatirazi, ndikuwulula zomwe zingatheke, zimakhalabe zongopeka. Zosadziwika zazikulu zikupitirirabe kuti zosinthazi zikugwirizana ndi kulowererapo kapena zotsatira zina zomwe sizikudziwika kwa ofufuza. Zotsatirazi zimawonjezera chidziwitso cha zomwe sizinafotokozedwe kale zomwe zingatheke kusintha kwa hemodynamic ndi hydrodynamic pambuyo pa NUCCA kulowererapo, komanso kusintha kwa migraine HRQoL wodwala anafotokoza zotsatira monga momwe tawonera mu gulu ili.

Miyezo ya zomwe zasonkhanitsidwa ndi kusanthula zikupereka chidziwitso chofunikira pakuyerekeza kukula kwachiwerengero chamitu yofunikira pakufufuza kopitilira. Kuthetsa zovuta zoyendetsera ntchito yoyendetsa ndege zimalola kuti protocol yoyengedwa bwino kwambiri ikwaniritse bwino ntchitoyi.

Mu phunziro ili, kusowa kwa kuwonjezereka kowonjezereka kwa kutsatiridwa kungamvetsetsedwe ndi logarithmic ndi chikhalidwe champhamvu cha intracranial hemodynamic ndi hydrodynamic flow, kulola kuti zigawo zapakati zomwe zimaphatikizapo kutsata kusintha pamene sizinali choncho. Kuchitapo kanthu koyenera kuyenera kupititsa patsogolo ululu wopweteka ndi kulemala wokhudzana ndi mutu wa migraine monga momwe zida za HRQoL zimagwiritsidwa ntchito. Zotsatira za phunziroli zimasonyeza kuti kusintha kwa ma atlas kungathandizenso kuchepetsa nthawi zambiri za mutu wa migraine, kuwonetsetsa kusintha kwa moyo wabwino kumapereka kuchepa kwakukulu kwa kulemala kwa mutu monga momwe tawonera mu gulu ili. Kuwongolera kwa zotsatira za HRQoL kumapangitsa chidwi chofuna kuphunzira mopitilira, kutsimikizira zomwe zapezazi, makamaka ndi dziwe lalikulu la maphunziro ndi gulu la placebo.

Kuvomereza

Olembawo amavomereza Dr. Noam Alperin, Alperin Diagnostics, Inc., Miami, FL; Kathy Waters, Wotsogolera Maphunziro, ndi Dr. Jordan Ausmus, Wogwirizanitsa Radiography, Britannia Clinic, Calgary, AB; Sue Curtis, MRI Technologist, Elliot Fong Wallace Radiology, Calgary, AB; ndi Brenda Kelly-Besler, RN, Research Coordinator, Calgary Headache Assessment and Management Program (CHAMP), Calgary, AB. Thandizo lazachuma limaperekedwa ndi (1) Hecht Foundation, Vancouver, BC; (2) Tao Foundation, Calgary, AB; (3) Ralph R. Gregory Memorial Foundation (Canada), Calgary, AB; ndi (4) Upper Cervical Research Foundation (UCRF), Minneapolis, MN.

achidule

ASC: Atlas subluxation complex
CHAMP: Calgary Headache Assessment and Management Program
CSF: Cerebrospinal Fluid
GSA: Gravity Stress Analyzer
HIT-6: Kupweteka kwa Mutu Mayeso-6
HRQoL: Moyo Wokhudzana ndi Zaumoyo
ICCI: Intracranial compliance index
ICVC: Kusintha kwa voliyumu mkati mwa cranial
IQR: Mtundu wa interquartile
MIDAS: Migraine Disability Assessment Scale
MSQL: Migraine-Specific Quality of Life Measure
MSQL-E: Migraine-Specific Quality of Life Measure-Emotional
MSQL-P: Migraine-Specific Quality of Life Measure-Physical
MSQL-R: Migraine-Specific Quality of Life Measure-Restrictive
NUCCA: National Upper Cervical Chiropractic Association
PC-MRI: Phase Contrast Magnetic Resonance Imaging
SLC: Supine Leg Check
VAS: Visual Analog Scale.

Kusamvana kwa Zosangalatsa

Olembawo akulengeza kuti palibe ndalama kapena zokonda zina zotsutsana zokhudzana ndi kufalitsidwa kwa pepalali.

Mphatso ya Olemba

H. Charles Woodfield III adapanga phunziroli, adathandizira kwambiri pakupanga kwake, kuthandizira kugwirizana, ndipo anathandizira kulemba pepala: mawu oyamba, njira zophunzirira, zotsatira, zokambirana, ndi mapeto. D. Gordon Hasick adayang'ana maphunziro kuti aphunzire kuphatikizidwa / kuchotsedwa, kupereka njira za NUCCA, ndikuyang'anira maphunziro onse pazotsatira. Anagwira nawo ntchito yopanga maphunziro ndi kugwirizanitsa maphunziro, kuthandizira kulemba Mawu Oyamba, Njira za NUCCA, ndi Kukambitsirana kwa pepala. Werner J. Becker adayang'ana maphunziro kuti aphunzire kuphatikizidwa / kuchotsedwa, adatenga nawo mbali pakupanga maphunziro ndi kugwirizana, ndipo adathandizira kulemba pepala: njira zophunzirira, zotsatira ndi zokambirana, ndi mapeto. Marianne S. Rose anachita kusanthula kwa chiwerengero cha deta yophunzira ndipo anathandizira kulemba pepala: njira zowerengera, zotsatira, ndi zokambirana. James N. Scott adagwira nawo ntchito yopanga maphunziro, adakhala ngati mlangizi wojambula zithunzi akuwunika ma scans a matenda, ndipo adathandizira kulemba pepala: njira za PC-MRI, zotsatira, ndi zokambirana. Olemba onse adawerenga ndikuvomereza pepala lomaliza.

Pomaliza, kafukufuku wokhudzana ndi kusintha kwa zizindikiro za mutu wa mutu wa migraine potsatira kusintha kwa ma atlas vertebrae kunawonetsa kuwonjezeka kwa zotsatira zoyamba, komabe, zotsatira za kafukufuku wa kafukufuku zinasonyezanso kuti palibe tanthauzo lachiwerengero. Zonsezi, kafukufukuyu adapeza kuti odwala omwe adalandira chithandizo chamankhwala a atlas vertebrae adawona kusintha kwakukulu kwa zizindikiro ndi kuchepa kwa masiku a mutu. Zambiri zomwe zatchulidwa kuchokera ku National Center for Biotechnology Information (NCBI). Kuchuluka kwa chidziwitso chathu kumangokhala kwa chiropractic komanso kuvulala kwa msana ndi mikhalidwe. Kuti tikambirane nkhaniyi, chonde omasuka kufunsa Dr. Jimenez kapena tilankhule nafe pa 915-850-0900 .

Wosankhidwa ndi Dr. Alex Jimenez

Mitu Yowonjezera: Kupweteka kwa Pakhosi

Kupweteka kwapakhosi ndi kudandaula kofala komwe kungayambitse chifukwa cha kuvulala kosiyanasiyana ndi / kapena mikhalidwe. Malingana ndi ziwerengero, kuvulala kwa ngozi ya galimoto ndi kuvulala kwa whiplash ndi zina mwa zifukwa zomwe zimayambitsa kupweteka kwa khosi pakati pa anthu ambiri. Panthawi ya ngozi ya galimoto, zotsatira zadzidzidzi zomwe zinachitikazi zingachititse kuti mutu ndi khosi zigwedezeke modzidzimutsa m'mbuyo-ndi-kunja kumbali iliyonse, kuwononga mapangidwe ovuta ozungulira msana wa khomo lachiberekero. Kupwetekedwa kwa minyewa ndi mitsempha, komanso minofu ina yapakhosi, kungayambitse kupweteka kwa khosi ndi zizindikiro zowoneka m'thupi lonse la munthu.

chithunzi cha blog cha cartoon paperboy nkhani zazikulu

MUTU WOFUNIKA: ZOWONJEZERA: Kukhala Wathanzi Inu!

ZINTHU ZINTHU ZOFUNIKA KWAMBIRI: ZOWONJEZERA: Kuvulala pamasewera? | | Vincent Garcia | Wodwala | El Paso, TX Chiropractor

Palibe kanthu

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Tsekani Accordion

Chiropractic Spinal Manipulative Therapy for Migraine

by Dr Alex Jimenez | Chiropractic, Malipoti a Nkhani Zachipatala, Mndandanda wa Milandu Yachipatala, Zinthu Zinachitiridwa, Ntchito Yothandizira, Migraine, Migraines, Kukhazikitsanso Thupi

Kupweteka kwamutu kumatha kukhala vuto lalikulu kwambiri, makamaka ngati izi zimayamba kuchitika pafupipafupi. Komanso, mutu ukhoza kukhala vuto lalikulu pamene mtundu wamba wa mutu umakhala mutu waching'alang'ala. Kupweteka kwamutu nthawi zambiri kumakhala chizindikiro chifukwa cha kuvulala kwakukulu ndi / kapena chikhalidwe cha msana wa khomo lachiberekero, kapena kumtunda kwa msana ndi khosi. Mwamwayi, njira zosiyanasiyana zochiritsira zilipo kuti zithandize kupweteka mutu. Chisamaliro cha Chiropractic ndi njira yodziwika bwino yochizira yomwe imalimbikitsa kupweteka kwa khosi, mutu komanso mutu waching'alang'ala. Cholinga cha kafukufuku wotsatira ndikuwona momwe chiropractic spinal manipulative therapy imathandizira migraine.

Chiropractic Spinal Manipulative Therapy for Migraine: a Study Protocol of single-Blinded Placebo-Controlled Randomized Clinical Trial

Kudalirika

Introduction

Migraine imakhudza 15% ya anthu, ndipo imakhala ndi thanzi labwino komanso ndalama zachuma. Kuwongolera kwa Pharmacological ndi chithandizo choyamba. Komabe, mankhwala owopsa komanso / kapena prophylactic sangalekeredwe chifukwa cha zovuta kapena zotsutsana. Choncho, tikufuna kuyesa mphamvu ya chiropractic spinal manipulative therapy (CSMT) kwa migraineurs mu mayesero amodzi osawona a placebo-controlled randomized clinical trial (RCT).

Njira ndi Kusanthula

Malingana ndi mawerengedwe a mphamvu, otsogolera a 90 akufunika mu RCT. Ophunzira adzasinthidwa kukhala gulu limodzi mwamagulu atatu: CSMT, placebo (kugwiritsa ntchito sham) ndi kuwongolera (kawirikawiri kasamalidwe kopanda manja). RCT ili ndi magawo atatu: 1?month run-in, 3?months intervention and follow-up analysiss at the end of intervention and 3, 6 and 12?months. Pamapeto pake ndi nthawi ya migraine, pamene nthawi ya migraine, migraine intensity, mutu wa mutu (frequency x duration x intensity) ndi kumwa mankhwala ndizo mapeto achiwiri. Kusanthula koyambirira kudzayesa kusintha kwafupipafupi kwa migraine kuyambira pachiyambi mpaka kumapeto kwa kuthandizira ndi kutsata, kumene magulu a CSMT ndi placebo ndi CSMT ndi kulamulira kudzafaniziridwa. Chifukwa cha kufananitsa kwamagulu awiri, ma p omwe ali pansi pa 0.025 adzaonedwa kuti ndi ofunika kwambiri. Pamapeto onse achiwiri ndi kusanthula, mtengo wa ap pansi pa 0.05 udzagwiritsidwa ntchito. Zotsatira zidzaperekedwa ndi ma p values ofanana ndi 95% CIs.

Ethics ndi Kufalitsa

RCT idzatsatira malangizo achipatala kuchokera ku International Headache Society. Komiti ya Chigawo cha Norway ya Medical Research Ethics ndi Norwegian Social Science Data Services avomereza ntchitoyi. Ndondomeko idzachitidwa molingana ndi chilengezo cha Helsinki. Zotsatira zidzasindikizidwa pamisonkhano yasayansi komanso m'magazini owunikiridwa ndi anzawo.

Nambala Yolembetsa Yoyeserera

NCT01741714.

Keywords: Ziwerengero & Njira Zofufuzira

Mphamvu ndi Zolepheretsa za Phunziroli

Phunziroli lidzakhala loyamba la zida zitatu zogwiritsira ntchito mankhwala osokoneza bongo (RCT) kuyesa mphamvu ya chiropractic spinal manipulative therapy motsutsana ndi placebo (sham manipulation) ndi kulamulira (kupitirizabe kasamalidwe ka mankhwala popanda kulandira chithandizo chamanja) kwa migraineurs.
Kutsimikizika kwamphamvu kwamkati, popeza chiropractor m'modzi azichita zonse.
RCT ili ndi mwayi wopereka chithandizo chopanda mankhwala kwa odwala migraine.
Chiwopsezo cha osiya maphunziro chikuwonjezeka chifukwa chotsatira malamulo okhwima komanso nthawi ya miyezi 17 ya RCT.
Malo ovomerezeka ovomerezeka sanakhazikitsidwe kuti agwiritsidwe ntchito pamanja; motero, pali chiopsezo cha khungu losapambana, pamene wofufuza yemwe amapereka zothandizira sangathe kuchitidwa khungu pazifukwa zoonekeratu.

Background

Migraine ndi vuto lodziwika bwino lathanzi lokhala ndi thanzi komanso ndalama zambiri pazachuma. Pa kafukufuku waposachedwa wa Global Burden of Disease, mutu waching'alang'ala udawerengedwa kuti ndi wachitatu kwambiri. [1]

Chithunzi cha mayi yemwe ali ndi mutu waching'alang'ala wowonetsedwa ndi mphezi yotuluka m'mutu mwake.

Pafupifupi 15% ya anthu ambiri amakhala ndi mutu waching'alang'ala. [2, 3] Mutu waching'alang'ala nthawi zambiri umakhala wosagwirizana ndi mutu womwe ukugunda ndi kugunda pang'ono/kupweteka kwamutu komwe kumakulirakulira chifukwa chochita masewera olimbitsa thupi nthawi zonse, ndipo kumatsagana ndi photophobia ndi phonophobia, nseru komanso kusanza.[4] Migraine ilipo m'njira ziwiri zazikulu, migraine yopanda aura ndi migraine yokhala ndi aura (pansipa). Aura ndi kusinthika kwa ubongo kusokonezeka kwa masomphenya, kumva ndi / kapena kulankhula, zomwe zimachitika mutu usanachitike. Komabe, kusiyanasiyana kwapang'onopang'ono kuchokera pakuwukira mpaka kuwukira kumakhala kofala. [5, 6] Chiyambi cha migraine chimatsutsana. Zopweteka zowawa zimatha kuchokera ku mitsempha ya trigeminal, pakati ndi / kapena njira zotumphukira [7, 8] Zomwe zimamva kupweteka kwapakhosi zimaphatikizapo khungu, minofu, mitsempha, periosteum ndi mafupa. Khungu limamva zowawa zamtundu uliwonse, pomwe minofu yakanthawi ndi ya m'khosi imatha kukhala magwero a ululu ndi kukoma mtima kwa mutu waching'alang'ala.[9�11] Mofananamo, mitsempha yakutsogolo ya supraorbital, yapang'onopang'ono, yakumbuyo ndi ya occipital imamva kupweteka. [ 9, 12 ]

zolemba

The International Classification of Headache Disorders-II Diagnostic Criteria for Migraine

Migraine popanda Aura

A. Kuukira kosasachepera kasanu kukwaniritsa mfundo za B�D
B. Kupweteka kwa mutu kwa 4�72?h (osalandira chithandizo kapena osachita bwino)
C. Mutu uli ndi makhalidwe osachepera awiri mwa izi:
1. Malo amodzi
2. Pulsating khalidwe
3. Kupweteka kwapakatikati kapena koopsa
4. Kumakulitsidwa kapena kupangitsa kupeŵa kuchita masewera olimbitsa thupi nthawi zonse
D. Pamutu pamutu chimodzi mwa zotsatirazi:
1. Mseru ndi/kapena kusanza
2. Photophobia ndi phonophobia
E. Osati chifukwa cha vuto lina
Migraine ndi aura
A. Zowukira zosachepera ziwiri zikukwaniritsa zofunikira B�D
B. Aura yopangidwa ndi chimodzi mwa izi, koma palibe kufooka kwagalimoto:
1. Zizindikiro zowoneka bwino zosinthika kuphatikiza zabwino (mwachitsanzo, nyali zothwanima, mawanga kapena mizere) ndi/kapena zoyipa (ie, kutayika kwa maso). Kupweteka kwapakatikati kapena koopsa
2. Zizindikiro za zomverera zosinthika kwathunthu kuphatikiza zabwino (ie, mapini ndi singano) ndi/kapena zoyipa (ie, dzanzi)
3. Kusokonezeka kwathunthu kwa mawu a dysphasic
C. Pafupifupi ziwiri mwa izi:
1. Zizindikiro zodziwika bwino komanso / kapena zomverera zapamodzi
2. Chizindikiro chimodzi cha aura chimayamba pang'onopang'ono kupitirira ?mphindi zisanu ndi/kapena zizindikiro za aura zosiyanasiyana zimachitika motsatizana kupitirira mphindi zisanu?
3. Chizindikiro chilichonse chimakhala ?5 ndi ?60?mphindi
D. Mutu kukwaniritsa zofunikira BD kwa 1.1 Migraine popanda aura imayamba panthawi ya aura kapena ikutsatira aura mkati mwa 60?
E. Osati chifukwa cha vuto lina

Pharmacological management ndiyo njira yoyamba yochizira migraineurs. Komabe, odwala ena samalekerera mankhwala osokoneza bongo komanso / kapena prophylactic chifukwa cha zotsatirapo kapena zotsutsana chifukwa cha kusagwirizana kwa matenda ena kapena chifukwa chofuna kupewa mankhwala pazifukwa zina. Kuopsa kogwiritsa ntchito mankhwala mopitirira muyeso chifukwa cha kugwidwa kwaching'alang'ala kawirikawiri kumaimira ngozi yaikulu ya thanzi yokhala ndi nkhawa zachindunji komanso zosalunjika. Kuchuluka kwa mankhwala opweteka mutu (MOH) ndi 1�2% mwa anthu onse, [13�15] ndiko kuti, pafupifupi theka la anthu omwe akudwala mutu (masiku 15 a mutu kapena kuposerapo pamwezi) amakhala ndi MOH.[16] Migraine imayambitsa kutayika kwa masiku 270 ogwira ntchito pachaka pa anthu 1000 pa anthu wamba. [17] Izi zikufanana ndi zaka za ntchito za 3700 zomwe zatayika pachaka ku Norway chifukwa cha migraine. Mtengo wachuma pa migraineur unkawoneka kuti ndi $ 655 ku USA ndi �579 ku Ulaya pachaka. [18, 19] Chifukwa cha kufalikira kwa mutu waching'alang'ala, ndalama zonse pachaka zinali $ 14.4 biliyoni ku USA ndi �27] mabiliyoni m'maiko a EU, Iceland, Norway ndi Switzerland panthawiyo. Migraine imawononga ndalama zambiri kuposa matenda a minyewa monga dementia, multiple sclerosis, matenda a Parkinson ndi sitiroko. [20] Chifukwa chake, njira zamankhwala zopanda mankhwala ndizoyenera.

Njira ya Diversified ndi njira ya Gonstead ndiyo njira ziwiri zomwe zimagwiritsidwa ntchito kwambiri ndi chiropractic manipulative therapy mu ntchito, zomwe zimagwiritsidwa ntchito ndi 91% ndi 59%, motero, [21, 22] pamodzi ndi njira zina zothandizira pamanja ndi zopanda pamanja, ndiko kuti, zofewa. njira za minofu, kulimbikitsana kwa msana ndi zotumphukira, kukonzanso, kuwongolera kwapambuyo ndi masewera olimbitsa thupi komanso zakudya zambiri komanso malangizo okhudza kudya.

Mayesero ochepa a spinal manipulative therapy (SMT) omwe amagwiritsidwa ntchito mwachisawawa (RCTs) pogwiritsa ntchito njira zosiyanasiyana zakhala zikuchitika chifukwa cha migraine, zomwe zimasonyeza kuti zimakhudza nthawi zambiri za migraine, nthawi ya migraine, mphamvu ya migraine komanso kumwa mankhwala. Ma RCTs ndi zolakwika za njira monga kuzindikiritsa mutu molakwika, ndiko kuti, kufufuza kwa mafunso omwe amagwiritsidwa ntchito ndi osadziwika bwino, [23] kusakwanira kapena palibe njira yowonongeka, kusowa kwa gulu la placebo, ndi mfundo zoyambirira ndi zachiwiri zomwe sizinatchulidwe. , Ma RCT am'mbuyomu sanatsatire malangizo ovomerezeka achipatala kuchokera ku International Headache Society (IHS) [26, 27] Pakalipano, palibe RCTs yomwe yagwiritsira ntchito njira ya Gonstead chiropractic SMT (CSMT). Choncho, poganizira zolakwika za njira mu RCTs zam'mbuyomu, RCT yoyendetsedwa ndi placebo yomwe ili ndi njira yabwino yopitira patsogolo imayenera kuchitidwa kuti migraine iwonongeke.

Njira ya SMT yochitira migraine sichidziwika. Akuti mutu wa migraine ukhoza kuchokera ku zovuta za nociceptive afferent mayankho okhudzana ndi msana wam'mimba (C1, C2 ndi C3), zomwe zimatsogolera ku hypersensitivity state ya trigeminal pathway yopereka chidziwitso cha nkhope ndi mutu wambiri. , 34] Kafukufuku wasonyeza kuti SMT ikhoza kulimbikitsa machitidwe oletsa mitsempha pamagulu osiyanasiyana a msana, ndipo akhoza kuyambitsa njira zosiyanasiyana zochepetsera zotsika kwambiri. [35�36] njira zina zosawerengeka zomwe zingafotokoze zotsatira za SMT pakumva ululu wamakina.

Chithunzi chachiwiri cha mkazi yemwe ali ndi mutu waching'alang'ala ndi chithunzi chosonyeza ubongo waumunthu panthawi ya migraine.

Cholinga cha phunziroli ndikuwunika momwe CSMT imayendera motsutsana ndi placebo (kugwiritsa ntchito sham) ndikuwongolera (pitilizani kasamalidwe ka mankhwala popanda kulandira chithandizo chamanja) kwa odwala migraine mu RCT.

Njira ndi Mapangidwe

Iyi ndi RCT yoyendetsedwa ndi placebo yokhala ndi khungu limodzi yokhala ndi magulu atatu ofanana (CSMT, placebo ndi control). Lingaliro lathu lalikulu ndiloti CSMT imapereka osachepera 25% kuchepetsa chiwerengero cha masiku a migraine pamwezi (30? masiku / mwezi) poyerekeza ndi placebo ndi kulamulira kuyambira pachiyambi mpaka kumapeto kwa kulowererapo, ndipo tikuyembekeza kuchepetsa komweko kudzakhala. kusungidwa pakutsatira kwa miyezi 3, 6 ndi 12. Ngati chithandizo cha CSMT chili chothandiza, chidzaperekedwa kwa omwe adalandira placebo kapena kuwongolera pambuyo pomaliza maphunziro, ndiko kuti, pambuyo pakutsatira kwa miyezi 12. Kafukufukuyu azitsatira malangizo ovomerezeka achipatala ochokera ku IHS,32 33 ndi malangizo a methodological CONSORT ndi SPIRIT.[41, 42]

Odwala Odwala

Otenga nawo mbali adzalembedwa mu Januware mpaka Seputembala 2013 kudzera mu Chipatala cha Akershus University, kudzera mwa akatswiri azachipatala komanso zotsatsa zapa media, ndiye kuti, zikwangwani zokhala ndi chidziwitso chonse zidzayikidwa m'maofesi azachipatala komanso zidziwitso zapakamwa m'maboma a Akershus ndi Oslo. , Norway. Otenga nawo mbali alandila zambiri za polojekitiyo ndikutsatiridwa ndi kuyankhulana kwafupi patelefoni. Omwe atengedwa kuchokera kumaofesi a ma general practitioners'ayenera kulumikizana ndi wofufuza zachipatala yemwe mauthenga ake aperekedwa pazikwangwani kuti adziwe zambiri za kafukufukuyu.

Oyenerera ali ndi zaka zapakati pa 18 ndi 70 ndipo amadwala mutu waching'alang'ala kamodzi pamwezi. Otenga nawo mbali amapezedwa motsatira njira zodziwira matenda a International Classification of Headache Disorders (ICHD-II) ndi katswiri wa zaubongo pachipatala cha Akershus University.[43] Amangololedwa kukhala ndi zochitika zamtundu wa kupsinjika kwa mutu osati mutu wina woyamba.

Njira zodzipatula ndizotsutsana ndi SMT, radiculopathy ya msana, mimba, kuvutika maganizo ndi CSMT mkati mwa miyezi yapitayi ya 12? Ophunzira omwe pa RCT amalandira chithandizo chilichonse chamankhwala ndi physiotherapists, chiropractors, osteopaths kapena akatswiri ena azaumoyo kuti athe kuchiza ululu wa minofu ndi kulumala, kuphatikizapo kupaka minofu, kulimbikitsana pamodzi ndi kugwiritsira ntchito, [44] anasintha mankhwala awo a mutu wa prophylactic kapena mimba idzachotsedwa. amaphunzira nthawi imeneyo ndipo amawonedwa ngati osiya maphunziro. Amaloledwa kupitiliza ndikusintha mankhwala awo anthawi zonse a migraine panthawi yonse yoyeserera.

Poyankha kukhudzana koyambirira, omwe akukwaniritsa zofunikira zophatikizira adzaitanidwa kuti apitirize kuunika ndi wofufuza wa chiropractic. Kuwunika kumaphatikizapo kuyankhulana ndi kufufuza thupi ndi kutsindika kwapadera pa mzere wonse wa msana. Zolemba zapakamwa ndi zolembedwa za polojekitiyi zidzaperekedwa pasadakhale ndipo chilolezo chapakamwa ndi cholembedwa chidzaperekedwa kwa onse omwe amavomerezedwa panthawi yofunsa mafunso komanso wofufuza zachipatala. Mogwirizana ndi machitidwe abwino azachipatala, odwala onse adzadziwitsidwa za kuvulaza ndi ubwino wake komanso zovuta zomwe zingatheke chifukwa chakuchitapo kanthu makamaka kuphatikizapo kukoma mtima ndi kutopa kwapafupi pa tsiku la chithandizo. Palibe zovuta zowopsa zomwe zanenedwa pa njira ya chiropractic Gonstead. [45, 46] Otsatira omwe amangochitika mwachisawawa muzochitika zogwira ntchito kapena za placebo adzayang'aniridwa ndi msana wonse wa radiographic ndipo adzakonzekera magawo a 12. Gulu lolamulira silidzawonetsedwa kuwunikaku.

Clinical RCT

RCT yachipatala imakhala ndi 1?mwezi wothamanga ndi 3?miyezi yothandizira. Mbiri ya nthawi idzawunikidwa kuyambira pachiyambi mpaka kumapeto kwa kutsata mfundo zonse zomaliza (Chithunzi 1).

Chithunzi 1 Tchati cha Kuyenda kwa Phunziro

Chithunzi 1: Tchati chamayendedwe ophunzirira. CSMT, chiropractic spinal manipulative therapy; Placebo, chinyengo; Kuwongolera, pitilizani kuyang'anira zamankhwala mwachizolowezi popanda kulandira chithandizo chamanja.

Thamangani-Mu

Ophunzirawo adzadzaza pepala lovomerezeka la mutu wa mutu diary 1 mwezi isanayambe kulowererapo yomwe idzagwiritsidwe ntchito ngati deta yoyambira kwa onse omwe atenga nawo mbali. [47, 48] Diary yovomerezeka imaphatikizapo mafunso okhudzana mwachindunji ndi mapeto oyambirira ndi achiwiri. Ma X-ray adzatengedwa poyimirira mu ndege za anterioposterior ndi lateral za msana wonse. Ma X-ray adzawunikidwa ndi wofufuza wa chiropractic.

Mwachisawawa

Maere osindikizidwa okonzedwa ndi njira zitatu, ndiko kuti, chithandizo chogwira ntchito, placebo ndi gulu lolamulira, zidzagawidwa m'magulu anayi malinga ndi zaka ndi jenda, ndiko kuti, 18�39 ndi 40�70?zaka zakubadwa ndi amuna ndi akazi, motsatana. Ophunzira agawidwa mofanana kumagulu atatuwa polola wophunzira kuti ajambule gawo limodzi lokha. The block randomisation idzayendetsedwa ndi gulu lophunzitsidwa kunja popanda kutenga nawo mbali kuchokera kwa wofufuza zachipatala.

Kupewera

Chithandizo chogwira ntchito chimakhala ndi CSMT pogwiritsa ntchito njira ya Gonstead, [21] ndiko kuti, kukhudzana kwapadera, kuthamanga kwapamwamba, kutsika kwambiri, kutsika kwapakati, msana waufupi wa lever popanda postadjustment recoil yopita ku spinal biomechanical dysfunction (njira ya msana wathunthu) monga momwe amazindikirira ndi muyezo. mayeso a chiropractic.

Kulowetsedwa kwa placebo kumapangidwa ndi chinyengo cha sham, ndiko kuti, kukhudza kotakata kosakhazikika, kutsika pang'ono, kutsika kwa matalikidwe a sham push maneuver mumzere wopanda dala komanso wosachiritsika. Onse omwe sali ochiritsira adzachitidwa kunja kwa msana ndi kutsetsereka kokwanira kwa mgwirizano komanso popanda kunyengerera kwa minofu yofewa kuti pasakhale ma cavitations olowa. M'magawo ena, wophunzirayo amagona pa benchi ya Zenith 2010 HYLO ndipo wofufuzayo atayima kudzanja lamanja la wophunzirayo ndikuyika chikhatho chake chakumanzere chakumanja kwa scapular ndi dzanja lina kulimbikitsa. M'magawo ena, wofufuzayo adzayimilira kumanzere kwa wophunzirayo ndikuyika chikhatho chake chamanja pamwamba pa scapular kumanzere kwa wophunzirayo ndikulimbitsa dzanja lamanzere, ndikupereka njira yosafuna dala. Mwinanso, wophunzirayo adagona pambali yofanana ndi gulu lachidziwitso logwira ntchito ndi mwendo wapansi wowongoka ndipo mwendo wapamwamba umasinthasintha ndi bondo lapamwamba pa bondo la mwendo wapansi, pokonzekera kusuntha kwa kachitidwe ka mbali, komwe kudzakhala. kuperekedwa ngati kukankhira kopanda dala kudera la gluteal. Njira zogwiritsira ntchito sham zidzasinthidwa mofanana pakati pa omwe atenga nawo mbali pa placebo malinga ndi ndondomeko pa nthawi ya chithandizo cha masabata a 12 kuti alimbikitse kutsimikizika kwa phunzirolo. Ogwira ntchito ndi magulu a placebo adzalandira kuwunika kofananira kwamapangidwe ndi kayendetsedwe kake isanayambe komanso ikatha. Palibe zowonjezera kapena upangiri womwe udzaperekedwa kwa otenga nawo mbali panthawi yoyeserera. Nthawi ya chithandizo idzaphatikizapo kukambirana kwa 12, ndiko kuti, kawiri pa sabata m'masabata atatu oyambirira ndikutsatiridwa kamodzi pa sabata m'masabata a 3 otsatira komanso kamodzi pa sabata lachiwiri mpaka masabata 2 afikira. Mphindi khumi ndi zisanu zidzaperekedwa pakukambirana kwa wophunzira aliyense. Njira zonse zidzachitikira ku Akershus University Hospital ndikuyendetsedwa ndi chiropractor wodziwa bwino ntchito (AC).

Chithunzi cha bambo wachikulire akulandira chithandizo cha chiropractic kuti athetse migraine.

Dr Jimenez amagwira ntchito pa wrestler's neck_preview

Gulu lolamulira lidzapitirizabe chisamaliro chanthawi zonse, ndiko kuti, kasamalidwe ka mankhwala popanda kulandira chithandizo chamanja ndi wofufuza zachipatala. Njira zochotseramo zomwezo zimagwiranso ntchito kwa gulu lolamulira panthawi yonse yophunzira.

Kupunduka

Pambuyo pa gawo lililonse la chithandizo, otenga nawo mbali omwe amalandira chithandizo chogwira ntchito kapena placebo adzalemba mafunso ochotsa khungu omwe amaperekedwa ndi gulu lodziyimira pawokha lophunzitsidwa kunja popanda kukhudzidwa ndi wofufuza zachipatala, ndiko kuti, kupereka yankho losiyana la "inde" kapena "ayi" monga ngati chithandizo chogwira ntchito chinalandiridwa. Yankho ili linatsatiridwa ndi funso lachiwiri lokhudzana ndi momwe iwo analiri otsimikiza kuti chithandizo chachangu chinalandiridwa pa 0�10 numeric rating rating scale (NRS), pamene 0 imayimira zosatsimikizika kwenikweni ndipo 10 imayimira kutsimikizika kotheratu. Gulu loyang'anira ndi wofufuza zachipatala akhoza pazifukwa zodziwikiratu kuti asachititsidwe khungu. [49, 50]

Londola

Kusanthula kotsatira kudzachitidwa pamapeto omaliza omwe ayesedwa pambuyo pa kutha kwa kulowererapo komanso pakutsata kwa miyezi 3, 6 ndi 12. Panthawi imeneyi, onse otenga nawo mbali adzapitirizabe kudzaza diary ya mutu wa mutu wa pepala ndikubwezeretsanso mwezi uliwonse. Pankhani ya diary yosabwezeretsedwa kapena ziwerengero zomwe zikusowa mu diary, otenga nawo mbali adzalumikizidwa nthawi yomweyo atazindikira kuti achepetse kukondera kwa kukumbukira. Otsatira adzayimbidwa ndi foni kuti atetezedwe.

Mapeto a pulayimale ndi sekondale

Mapeto a pulayimale ndi achiwiri alembedwa pansipa. Mfundo zotsirizira zimatsatira malangizo ovomerezeka a IHS oyesa chipatala. [32, 33] Timatanthauzira chiwerengero cha masiku a migraine monga mapeto oyambirira ndipo tikuyembekeza osachepera 25% kuchepetsa chiwerengero cha masiku kuyambira pachiyambi mpaka kumapeto kwa kulowererapo, ndi mlingo womwewo wa kuchepetsa ukusungidwa potsatira. Pamaziko a ndemanga zam'mbuyomu za mutu waching'alang'ala, kuchepetsa 25% kumaonedwa kuti ndiko kulingalira kokhazikika. [30] Kuchepetsa kwa 25% kumayembekezeredwanso kumapeto kwachiwiri kuyambira kumapeto mpaka kumapeto kwa kulowererapo, kusungabe kutsatiridwa kwa nthawi ya migraine, mphamvu ya migraine ndi mutu wa mutu, kumene ndondomekoyi imawerengedwa ngati masiku a migraine (masiku 30)) pafupifupi nthawi ya mutu waching'alang'ala (maola pa tsiku)�avereji yamphamvu (0�10 NRS). Kuchepetsa kwa 50% kwa kumwa mankhwala kuchokera pachiyambi mpaka kumapeto kwa kulowererapo ndi kutsatiridwa kumayembekezeredwa.

zolemba

Mapeto a pulayimale ndi sekondale

Mfundo Zomaliza Zoyambirira

1. Chiwerengero cha masiku a migraine mu chithandizo chogwira ntchito motsutsana ndi gulu la placebo.
2. Chiwerengero cha masiku a migraine mu chithandizo chogwira ntchito motsutsana ndi gulu lolamulira.

Mfundo Zomaliza Zachiwiri

3. Kutalika kwa Migraine mu maola mu chithandizo chogwira ntchito motsutsana ndi gulu la placebo.
4. Kutalika kwa Migraine mu maola mu chithandizo chogwira ntchito motsutsana ndi gulu lolamulira.
5. VAS yodziwonetsera yokha mu chithandizo chogwira ntchito motsutsana ndi gulu la placebo.
6. VAS yodziwonetsera yokha mu chithandizo chogwira ntchito motsutsana ndi gulu lolamulira.
7. Mutu wamutu (nthawi zambiri x nthawi x mphamvu) mu chithandizo chogwira ntchito motsutsana ndi gulu la placebo.
8. Mutu wamutu mu chithandizo chogwira ntchito motsutsana ndi gulu lolamulira.
9. Mlingo wamankhwala amutu pamankhwala othandizira motsutsana ndi gulu la placebo.
10. Mlingo wamankhwala amutu pamankhwala othandizira motsutsana ndi gulu lowongolera.

*Kusanthula kwa data kumatengera nthawi yothamangira ndi kutha kwa kulowererapo. Mfundo 11�40 idzakhala yofanana ndi mfundo 1�10 pamwamba pa kutsatiridwa kwa miyezi 3, 6 ndi 12 motsatira.

Data Processing

Tchati choyenda cha omwe atenga nawo mbali chikuwonetsedwa mu Chithunzi 2. Zoyambira zachiwerengero cha anthu ndi zachipatala zidzalembedwa ngati njira ndi ma SD pazosintha mosalekeza ndi kuchuluka kwake ndi magawo amitundu yosiyanasiyana. Lililonse la magulu atatu lidzafotokozedwa mosiyana. Mfundo zomalizira ndi zachiwiri zidzaperekedwa ndi ziwerengero zofotokozera zoyenera pagulu lililonse komanso nthawi iliyonse. Kukhazikika kwa mfundo zomaliza kudzawunikiridwa bwino ndipo kusintha kudzaganiziridwa ngati kuli kofunikira.

Chithunzi 2 Chiyembekezero cha Mayendedwe a Wotenga Mbali

Chithunzi 2: Chithunzi choyembekezeka cha otenga nawo mbali. CSMT, chiropractic spinal manipulative therapy; Placebo, chinyengo; Kuwongolera, pitilizani kuyang'anira zamankhwala mwachizolowezi popanda kulandira chithandizo chamanja.

Kusintha kwa mfundo zomaliza za pulayimale ndi zachiwiri kuyambira pachiyambi mpaka kumapeto kwa kulowererapo ndikutsatira kudzafanizidwa pakati pa magulu ogwira ntchito ndi a placebo ndi magulu ogwira ntchito ndi olamulira. The null hypothesis imanena kuti palibe kusiyana kwakukulu pakati pa magulu pakusintha kwapakati, pamene lingaliro lina likunena kuti kusiyana kwa osachepera 25% kulipo.

Chifukwa cha nthawi yotsatila, zojambulidwa mobwerezabwereza za mfundo zomaliza za pulayimale ndi zachiwiri zidzakhalapo, ndipo kusanthula kwazomwe zikuchitika kumapeto kwa pulayimale ndi sekondale kudzakhala kosangalatsa kwambiri. Malumikizidwe apakati pawokha (magulu amagulu) atha kukhalapo mu data yokhala ndi miyeso yobwerezabwereza. Zotsatira za Cluster zidzawunikidwa powerengera intraclass corelation coefficient kuwerengera kuchuluka kwa kusiyanasiyana komwe kumabwera chifukwa cha kusiyana kwapagulu. Zomwe zikuchitika kumapeto kwake zidzawunikidwa ndi mzere wokhotakhota wa data longitudinal (chitsanzo chosakanikirana cha mzere) kuti chiwerengere bwino momwe tingagwiritsire ntchito masango. Chitsanzo chosakanikirana chosakanikirana chimagwira ntchito zosawerengeka, zomwe zimathandiza kuti zidziwitso zonse zomwe zilipo kuchokera kwa odwala osadziwika kuti ziphatikizidwe, komanso kuchokera kwa osiya. Zitsanzo zochepetsera zokhala ndi zotsatira zokhazikika pa gawo la nthawi ndi kugawa kwamagulu komanso kuyanjana pakati pa awiriwo kudzayesedwa. Kuyanjanaku kudzawonetsa kusiyana komwe kungathe pakati pa magulu okhudzana ndi nthawi yomwe ili kumapeto ndikukhala ngati kuyesa kwa omnibus. Zotsatira zachisawawa kwa odwala zidzaphatikizidwa kuti zisinthe ziwerengero za mgwirizano wa intraindividual. Otsetsereka mwachisawawa adzaganiziridwa. Mitundu yosakanikirana yofananira idzayerekezedwa ndi njira ya SAS PROC MIXED. Mafananidwe awiriwa adzachitidwa popeza kusiyana kwa nthawi pakati pa gulu lirilonse ndi ma p values ofanana ndi 95% CIs.

Zonse ziwiri pa-protocol ndi zolinga zochitira chithandizo zidzachitidwa ngati n'koyenera. Kuwunika konse kudzachitidwa ndi wowerengera, wochititsidwa khungu pakugawika kwamagulu ndi otenga nawo mbali. Zotsatira zoyipa zonse zidzalembetsedwanso ndikuwonetseredwa. Ophunzira omwe akukumana ndi zovuta zilizonse panthawi yoyeserera adzakhala ndi ufulu kuyimbira wofufuza zachipatala pa foni yam'manja ya polojekiti. Deta idzawunikidwa ndi SPSS V.22 ndi SAS V.9.3. Chifukwa cha kufananitsa kwamagulu awiri pamapeto omaliza, ma p omwe ali pansi pa 0.025 adzaonedwa kuti ndi ofunika kwambiri. Pamapeto onse achiwiri ndi kusanthula, mulingo wofunikira wa 0.05 udzagwiritsidwa ntchito. Makhalidwe osowa amatha kuwoneka m'mafunso osakwanira, zolemba zamutu zosakwanira, magawo ophonya komanso/kapena chifukwa chosiya maphunziro. Chitsanzo cha kusowa chidzawunikidwa ndipo zosowa zidzasamalidwa mokwanira.

Kuwerengera Mphamvu

Zitsanzo zowerengera za kukula kwachitsanzo zimatengera zotsatira za kafukufuku waposachedwa wa gulu la topiramate.[51] Timalingalira kuti kusiyana kwapakati pa kuchepetsa chiwerengero cha masiku ndi mutu waching'alang'ala pamwezi pakati pa magulu omwe akugwira ntchito ndi a placebo ndi 2.5?day. Kusiyana komweku kumaganiziridwa pakati pa magulu ogwira ntchito ndi olamulira. SD yochepetsera gulu lililonse imaganiziridwa kukhala yofanana ndi 2.5. Pansi pa kuganiza kuti, pafupifupi, masiku a 10 migraine pamwezi poyambira pagulu lililonse ndipo palibe kusintha kwa gulu la placebo kapena gulu lolamulira panthawi yophunzira, kuchepetsa masiku a 2.5 kumagwirizana ndi kuchepetsa ndi 25%. Popeza kusanthula koyambirira kumaphatikizapo kufananitsa kwamagulu awiri, timayika mulingo wofunikira pa 0.025. Kukula kwachitsanzo kwa odwala 20 kumafunika pagulu lililonse kuti azindikire kusiyana kwakukulu pakati pa kuchepetsa 25% ndi 80% mphamvu. Kuti alole kusiya maphunziro, ofufuzawo akukonzekera kulemba anthu 120.

Dr Jimenez White Coat

Kuzindikira kwa Dr. Alex Jimenez

"Ndalangizidwa kuti ndipeze chithandizo cha chiropractic pamutu wanga wamtundu wa migraine. Kodi chiropractic spinal manipulative therapy imathandizira migraine? ”�Mitundu yambiri ya chithandizo chamankhwala chingagwiritsidwe ntchito pochiza migraine, komabe chisamaliro cha chiropractic ndi imodzi mwa njira zodziwika bwino zothandizira kuchiza migraine mwachibadwa. Chiropractic spinal manipulative therapy (Chiropractic spinal manipulative therapy) ndi njira yachikhalidwe yotsika kwambiri (HVLA). Amadziwikanso kuti kuwongolera kwa msana, chiropractor amachita njira iyi ya chiropractic pogwiritsa ntchito mphamvu yadzidzidzi yomwe imayendetsedwa pamgwirizano pomwe thupi limayikidwa mwanjira inayake. Malinga ndi nkhani yotsatirayi, chiropractic spinal manipulative therapy ingathandize kwambiri kuchiza mutu waching'alang'ala.

Kukambirana

Malingaliro a Methodological

Ma SMT apano a RCTs pa migraine akuwonetsa kuthandizira kwamankhwala okhudzana ndi pafupipafupi, nthawi ndi mphamvu ya migraine. Komabe, kutsimikizira kotsimikizika kumafuna ma RCTs oyendetsedwa ndi placebo osawona osawona omwe ali ndi zolakwika zochepa zaukadaulo. [30] Maphunziro oterowo ayenera kumamatira ku malangizo ovomerezeka a IHS oyesedwa ndi migraine pafupipafupi monga mapeto oyambirira ndi nthawi ya migraine, migraine intensity, mutu wa mutu ndi kumwa mankhwala monga mapeto achiwiri. [32, 33] Mutu wa mutu, komanso kuphatikiza pafupipafupi, nthawi ndi mphamvu, zimapereka chisonyezero cha kuchuluka kwa kuvutika. Ngakhale kuti palibe kuvomerezana, mutu wa mutu watsimikiziridwa ngati gawo lovomerezeka lachiwiri lakumapeto. [33, 52, 53] Mfundo zoyambirira ndi zachiwiri zidzasonkhanitsidwa mwachidwi mu diary yovomerezeka ya mutu wa mutu kwa onse omwe atenga nawo mbali kuti achepetse. kukumbukira kukondera. [47, 48] Monga momwe tikudziwira, iyi ndiyo njira yoyamba yothandizira pamanja mu RCT yokhala ndi zida zitatu zokhala ndi khungu limodzi lopangidwa ndi placebo kuti ichitidwe migraine. Mapangidwe a phunzirolo amatsatira malingaliro a pharmacological RCTs momwe angathere. Ma RCT omwe amaphatikizapo gulu la placebo ndi gulu lolamulira ndi opindulitsa kwa RCTs ya pragmatic yomwe imafanizira zida ziwiri zogwira ntchito zothandizira. RCTs imaperekanso njira yabwino kwambiri yopangira chitetezo komanso deta yogwira ntchito.

Chithunzi cha mayi yemwe ali ndi mutu waching'alang'ala atagwira mutu wake.

Kuchititsa khungu kosatheka ndi chiopsezo chotheka kwa RCT. Kuchititsa khungu nthawi zambiri kumakhala kovuta chifukwa palibe njira imodzi yovomerezeka yovomerezeka ya chiropractic sham yomwe ingagwiritsidwe ntchito ngati gulu lolamulira pa tsikuli. Komabe, ndikofunikira kuphatikiza gulu la placebo kuti mupange zotsatira zenizeni zakuchitapo kanthu. Mgwirizano wokhudza malo oyenera oyeserera a SMT pakati pa akatswiri oimira asing'anga ndi ophunzira, komabe, sikunafikidwe.[54] Palibe maphunziro am'mbuyomu omwe, monga momwe timadziwira, adatsimikizira kuchititsa khungu bwino kwa mayeso achipatala a CSMT ndi magawo angapo a chithandizo. Tikufuna kuchepetsa chiwopsezochi potsatira ndondomeko yomwe yaperekedwa ya gulu la placebo.

Mayankho a placebo ndi okwera kwambiri muzamankhwala ndipo amaganiziridwa mofananamo pamaphunziro osagwiritsa ntchito mankhwala; komabe, zitha kukhala zapamwamba kwambiri pakuchiritsa kwamanja kwa RCTs ndi chidwi komanso kukhudzana kumakhudzidwa. [55] Mofananamo, kukhudzidwa kwachirengedwe ponena za kukhudzidwa kwa chidwi kudzakhudzidwa ndi gulu lolamulira popeza silikuwoneka ndi aliyense kapena kusawoneka mochuluka ndi wofufuza zachipatala monga magulu ena awiri.

Nthawi zonse pamakhala zoopsa zosiya sukulu chifukwa cha zifukwa zosiyanasiyana. Popeza kuti nthawi yoyeserera ndi miyezi 17 yokhala ndi nthawi yotsatiridwa ndi miyezi 12, chiopsezo cha kutayika kotsatira chimakula. Kugwirizana kwazinthu zina zothandizira pamanja panthawi ya mayesero ndi chiopsezo china chotheka, monga omwe amalandira chithandizo kapena chithandizo chamankhwala chamanja kwina kulikonse panthawi ya mayesero adzachotsedwa pa phunziroli ndikuwonedwa ngati osiya maphunziro panthawi yophwanya.

Kutsimikizika kwakunja kwa RCT kungakhale kufooka popeza pali wofufuza m'modzi yekha. Komabe, tapeza kuti ndizopindulitsa kwa ofufuza angapo, kuti apereke chidziwitso chofanana kwa omwe akutenga nawo mbali m'magulu onse atatu ndikuthandizira pamanja mu CSMT ndi magulu a placebo. Choncho, tikufuna kuthetsa kusiyana pakati pa ofufuza omwe angakhalepo ngati pali ofufuza awiri kapena kuposerapo. Ngakhale kuti njira ya Gonstead ndiyo njira yachiwiri yomwe imagwiritsidwa ntchito kwambiri pakati pa akatswiri a chiropractors, sitiwona nkhani yodetsa nkhaŵa pankhani yowonjezereka ndi kutsimikizika kwakunja. Kuphatikiza apo, njira ya block randomisation ipereka chitsanzo chofanana m'magulu atatu.

Kutsimikizika kwamkati kumalimba, komabe, kukhala ndi dokotala m'modzi. Zimachepetsa chiopsezo cha zosankha zomwe zingatheke, zambiri komanso zoyesera. Kuphatikiza apo, kuzindikira kwa onse omwe atenga nawo mbali kumachitika ndi akatswiri odziwa za minyewa osati mwa mafunso. Kuyankhulana kwachindunji kumakhala ndi chidwi chambiri komanso tsatanetsatane poyerekeza ndi mafunso.[27] Zinthu zomwe zingakhudze malingaliro a wophunzirayo ndi zomwe amakonda popereka chithandizo zimachepetsedwa pokhala ndi wofufuza m'modzi. Kuonjezera apo, zovomerezeka zamkati zimalimbikitsidwanso ndi ndondomeko yobisika yovomerezeka ya randomisation. Popeza kuti msinkhu ndi jenda zingakhale ndi gawo pa mutu wa migraine, kutsekereza randomisation kunapezeka kuti n'koyenera kulinganiza mikono ndi zaka ndi jenda pofuna kuchepetsa zotheka zokhudzana ndi zaka komanso / kapena zokhudzana ndi kugonana.

Chithunzi cha X-ray chosonyeza kutayika kwa khomo lachiberekero lordosis monga chomwe chingayambitse mutu waching'alang'ala.

Ma X-ray omwe akuwonetsa kutayika kwa khomo lachiberekero lordosis monga chomwe chingayambitse mutu waching'alang'ala.

Kuchita ma X-ray musanayambe kuchitapo kanthu ndi placebo anapezeka kuti akugwira ntchito kuti awonetsetse kaimidwe, mgwirizano ndi disc umphumphu. kuwonetseredwa kunkaonedwa kuti ndi kochepa. [56, 57] Kufufuza kwa X-ray kunapezekanso kukhala kofunikira kuti adziwe ngati X-ray yonse ya msana ndi yothandiza pa maphunziro amtsogolo kapena ayi.

Popeza sitidziwa njira zomwe zingatheke, ndipo msana wa msana ndi njira zochepetsera zotsika pansi zakhala zikugwiritsidwa ntchito, sitiwona zifukwa zochotseratu njira yonse ya chithandizo cha msana kwa gulu lothandizira. Zanenedwanso kuti ululu m'madera osiyanasiyana a msana sayenera kuonedwa ngati matenda osiyana koma ngati chinthu chimodzi.[60] Mofananamo, kuphatikizapo njira yonse ya msana imachepetsa kusiyana pakati pa CSMT ndi magulu a placebo. Chifukwa chake, zitha kulimbikitsa mwayi wochita khungu bwino m'gulu la placebo lomwe likukwaniritsidwa. Kuonjezera apo, mauthenga onse a placebo adzachitidwa kunja kwa msana wa msana, motero kuchepetsa kuthekera kwa chingwe cha msana.

Mtengo Watsopano ndi Wasayansi

RCT iyi idzawunikira ndikutsimikizira Gonstead CSMT ya migraineurs, yomwe sinaphunzirepo kale. Ngati CSMT itsimikizira kuti ndi yothandiza, idzapereka njira yochiritsira yopanda mankhwala. Izi ndizofunikira makamaka chifukwa ena omwe ali ndi mutu wa migraine alibe mphamvu yogwiritsira ntchito mankhwala osokoneza bongo komanso / kapena prophylactic, pamene ena ali ndi zotsatira zosalekeza kapena zovuta za matenda ena omwe amatsutsana ndi mankhwala pamene ena amafuna kupewa mankhwala pazifukwa zosiyanasiyana. Choncho, ngati CSMT ikugwira ntchito, ikhoza kukhala ndi zotsatira pa chithandizo cha migraine. Phunziroli limagwirizanitsanso mgwirizano pakati pa chiropractors ndi madokotala, zomwe ndizofunikira kuti chithandizo chamankhwala chikhale choyenera. Pomaliza, njira yathu ingagwiritsidwe ntchito m'tsogolomu chiropractic ndi ma RCTs ena othandizira pamutu.

Ethics ndi Kufalitsa

Ethics

Kafukufukuyu wavomerezedwa ndi Norwegian Regional Committee for Medical Research Ethics (REK) (2010/1639/REK) ndi Norwegian Social Science Data Services (11�77). Kulengeza kwa Helsinki kumatsatiridwa mwanjira ina. Zonse sizidzadziwika pamene otenga nawo mbali ayenera kupereka chilolezo chapakamwa komanso cholembedwa. Inshuwaransi imaperekedwa kudzera mu �The Norwegian System of Compensation to Patients� (NPE), lomwe ndi bungwe ladziko loyima palokha lomwe lakhazikitsidwa kuti likonze zopempha za chipukuta misozi kuchokera kwa odwala omwe avulala chifukwa cha chithandizo chachipatala cha ku Norway. Lamulo loyimitsa linatanthauzidwa kuti anthu achotsedwe mu kafukufukuyu motsatira malingaliro a mu CONSORT yowonjezera ya Kufotokozera Bwino Zazoopsa.[61] Ngati wophunzira akuwuza chiropractor kapena ogwira ntchito ofufuza za chochitika chovuta kwambiri, iye adzachotsedwa pa phunziroli ndikupita kwa dokotala wawo wamkulu kapena dipatimenti yodzidzimutsa kuchipatala malinga ndi momwe chochitikacho chikuchitikira. Deta yomaliza idzapezeka kwa wofufuza zachipatala (AC), wowerengera wodziimira yekha ndi wakhungu (JSB) ndi Mtsogoleri Wophunzira (MBR). Zambiri zidzasungidwa mu kabati yotsekedwa ku Research Center, Akershus University Hospital, Norway, kwa zaka 5.

Kufalitsa

Ntchitoyi ikuyenera kumalizidwa patatha zaka 3 chiyambireni. Zotsatira zidzasindikizidwa m'magazini asayansi apadziko lonse omwe amawunikiridwa ndi anzawo malinga ndi CONSORT 2010 Statement. Zotsatira zabwino, zoyipa, komanso zosatsimikizika zidzasindikizidwa. Kuonjezera apo, chidule cholembedwa cha zotsatira chidzakhalapo kwa omwe akuphunzirapo ngati apempha. Olemba onse ayenera kukhala oyenerera kukhala olemba molingana ndi International Committee of Medical Journal Editors, 1997. Wolemba aliyense ayenera kutenga nawo mbali mokwanira pa ntchitoyi kuti atenge udindo wa anthu pazomwe zili. Chigamulo chomaliza pa dongosolo la wolemba chidzagamulidwa ntchitoyo ikamalizidwa. Zotsatira za phunziroli zikhozanso kuperekedwa ngati zikwangwani kapena zowonetsera pakamwa pamisonkhano yapadziko lonse ndi / kapena yapadziko lonse.

Kuvomereza

Chipatala cha Akershus University mokoma mtima chinapereka malo opangira kafukufuku. Chiropractor Clinic1, Oslo, Norway, adachita mayeso a X-ray.

Mawu a M'munsi

zothandizira: AC ndi PJT anali ndi lingaliro loyambirira la kafukufukuyu. AC ndi MBR adapeza ndalama. MBR inakonza dongosolo lonse. AC inakonza zolembera zoyamba ndipo PJT inafotokoza za ndondomeko yomaliza ya kafukufukuyu. JSB idachita zowerengera zonse. AC, JSB, PJT ndi MBR adagwira nawo ntchito yomasulira ndikuthandizira kukonzanso ndikukonzekera zolembazo. Olemba onse awerenga ndikuvomereza zolembedwa pamanja zomaliza.

Ngongole: Phunziroli lalandira ndalama kuchokera ku Extrastiftelsen (nambala ya chithandizo: 2829002), Norwegian Chiropractic Association (nambala ya chithandizo: 2829001), Chipatala cha Akershus University (nambala ya chithandizo: N / A) ndi University of Oslo ku Norway (nambala yothandizira: N / A) .

Zofuna zokakamiza: Palibe adanenedwa.

Chilolezo cha odwala: Zopezedwa.

Kuvomereza zamakhalidwe: Komiti ya Chigawo cha Norwegian ya Medical Research Ethics idavomereza pulojekitiyi (ID ya chivomerezo: 2010/1639/REK).

Chiyambi ndi kukambirana kwa anzawo: Osatumidwa; kunja kwapamwamba kukambirana.

Kuyesedwa Mosasinthika kwa Chiropractic Spinal Manipulative Therapy for Migraine

Kudalirika

Cholinga: Kuwunika momwe chiropractic spinal manipulative therapy (SMT) imathandizira pochiza migraine.

Kupanga: Kuyesa kosasinthika kwa miyezi 6. Mlanduwu unali ndi magawo atatu: miyezi 3 yosonkhanitsa deta (asanalandire chithandizo), miyezi iwiri ya chithandizo, ndi miyezi ina ya 2 yosonkhanitsa deta (pambuyo pa chithandizo). Kuyerekeza zotsatira kuzinthu zoyambira zoyambira zidapangidwa kumapeto kwa miyezi ya 2 kwa gulu la SMT ndi gulu lolamulira.

Kukhazikitsa: Chiropractic Research Center ya Macquarie University.

Ophunzira: Odzipereka zana limodzi ndi makumi awiri mphambu zisanu ndi ziwiri azaka zapakati pa 10 ndi 70 adalembedwa kudzera muzotsatsa zotsatsa. Kuzindikira kwa migraine kunapangidwa pamaziko a International Headache Society standard, ndi osachepera osachepera kamodzi pa mwezi.

Zothandiza: Miyezi iwiri ya chiropractic SMT (njira zosiyanasiyana) pamakonzedwe amtundu wa vertebral omwe amatsimikiziridwa ndi dokotala (kuchuluka kwa mankhwala a 16).

Zotsatira Zazikulu: Ophunzirawo adamaliza zolemba zodziwika bwino za mutu pa nthawi yonse yoyeserera ndikuzindikira pafupipafupi, kulimba (mawonekedwe a analogue), kutalika, kulemala, zizindikiro zofananira, komanso kugwiritsa ntchito mankhwala pagawo lililonse la migraine.

Results: Kuyankha kwapakati pa gulu lachipatala (n = 83) kunawonetsa kusintha kwakukulu kwa migraine pafupipafupi (P <.005), nthawi (P <.01), kulemala (P <.05), ndi kugwiritsa ntchito mankhwala (P <.001) ) poyerekeza ndi gulu lolamulira (n = 40). Anthu anayi analephera kumaliza mayesero chifukwa cha zifukwa zosiyanasiyana, kuphatikizapo kusintha kwa malo okhala, ngozi ya galimoto, komanso kuwonjezeka kwa migraine nthawi zambiri. Kufotokozera m'mawu ena, 22% ya ophunzira adanena zambiri kuposa 90% kuchepetsa migraines chifukwa cha miyezi ya 2 ya SMT. Pafupifupi 50% owonjezera omwe adatenga nawo gawo adanenanso zakusintha kwakukulu pazochitika zilizonse.

Kutsiliza: Zotsatira za phunziroli zimathandizira zotsatira zam'mbuyo zomwe zikuwonetsa kuti anthu ena amafotokoza kusintha kwakukulu kwa migraines pambuyo pa chiropractic SMT. Chiwerengero chachikulu (> 80%) cha omwe adatenga nawo mbali adanena kuti kupanikizika ndi chinthu chachikulu cha migraines. Zikuwoneka kuti chisamaliro cha chiropractic chimakhudza zochitika zakuthupi zokhudzana ndi kupsinjika maganizo komanso kuti mwa anthuwa zotsatira za migraine zimachepetsedwa.

Pomaliza, chiropractic spinal manipulative therapy ingagwiritsidwe ntchito bwino pothandizira kuchiza migraine, malinga ndi kafukufuku wofufuza. Kuphatikiza apo, chisamaliro cha chiropractic chinapangitsa kuti munthu akhale wathanzi komanso wathanzi. Ubwino wa thupi la munthu wonse umakhulupirira kuti ndi chimodzi mwa zifukwa zazikulu zomwe chisamaliro cha chiropractic chimakhala chothandiza kwa migraine. Zambiri zomwe zatchulidwa kuchokera ku National Center for Biotechnology Information (NCBI). Kukula kwa chidziwitso chathu kumangokhala kwa chiropractic komanso kuvulala kwa msana ndi mikhalidwe. Kuti tikambirane nkhaniyi, chonde omasuka kufunsa Dr. Jimenez kapena tilankhule nafe pa 915-850-0900 .

Wosankhidwa ndi Dr. Alex Jimenez

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