I-Lumbar spondylolisthesis ukushelela kwe-lumbar vertebra ehlobene ne-vertebra engezansi nje bese idonsa ngawo wonke umgogodla. Izinhlobo ezintathu ze-spondylolisthesis zihambisana nezimbangela ezintathu ezihlukene: ukuphindaphinda kokucindezeleka kwemishini emgogodleni, i-osteoarthritis yamalunga noma ukukhubazeka kokuzalwa. Ukuhlinzwa kunconywa kuphela uma kwenzeka ukwehluleka ukwelashwa noma ukuba khona kwe-neurological motor noma ukuphazamiseka kwe-sphincter.

Incazelo ye-spondylolisthesis

I-Lumbar spondylolisthesis ukushelela kwe-vertebra ye-lumbar ukuya phambili naphansi okuhlobene nomgogodla ongezansi nje bese uhudula wonke umgogodla ngawo. I-spondylolisthesis iveza izigaba ezine zokuqina okwandayo, ngokwedlulele, ukuwa kwe-vertebra ku-pelvis encane.

Izinhlobo ze-spondylolisthésis

Kunezinhlobo ezintathu ze-spondylolisthesis:

• I-Lumbar spondylolisthesis nge-isthmic lysis ithinta i-4 kuya ku-8% yabantu. Kuyinto yesibili ekuqhekekeni kwe-isthmus, ibhuloho lethambo elixhuma i-vertebra eyodwa kwenye. I-vertebra yesihlanu neyokugcina ye-lumbar (L5) ivame ukuthinteka. I-disc phakathi kwama-vertebrae amabili ichotshoziwe futhi iyancipha ukuphakama: sikhuluma ngesifo se-disc esihlobene;
• I-spondylolisthesis ye-lumbar degenerative noma i-osteoarthritis spondylolisthesis iyingxenye yokuthuthukiswa kwe-osteoarthritis yamalunga. I-vertebrae yesine neyesihlanu ye-lumbar ngokuvamile iyathinteka kodwa ukushelela ngokuvamile akubalulekile kakhulu. I-disc phakathi kwama-vertebrae amabili iyaguga futhi ichotshozwe futhi iyancipha ukuphakama, bese sikhuluma ngesifo se-disc esihlobene;
• I-dysplastic lumbar spondylolisthesis engavamile ingeyokuzalwa.

Izinkinga ze-spondylolisthesis

Ngokuphambene nenkolelo evamile, i-spondylolisthesis ye-lumbar nge-isthmic lysis ayibangelwa ukuhlukumezeka okukodwa ebuntwaneni noma ebusheni kodwa ukuphindaphinda ukucindezeleka kwemishini emgogodleni, okuholela "ekuqhekekeni kokukhathala" kwe-isthmus (ibhuloho lethambo phakathi kwama-vertebrae amabili) .

I-spondylolisthesis ye-lumbar degenerative noma i-arthritic spondylolisthesis, njengoba igama liphakamisa, ixhunywe ku-osteoarthritis yamalunga.

I-Dysplastic lumbar spondylolisthesis ilandela ukonakala komgogodla we-lumbar wokugcina one-isthmus emide ngendlela engavamile.

Ukuxilongwa kwe-spondylolisthesis

I-x-ray yomgogodla we-lumbar ivumela ukuxilongwa kohlobo lwe-spondylolisthesis kanye nokuhlolwa kokuqina kwayo ngokusekelwe ekusheleleni kwe-vertebra.

Ukuhlolwa kwe-radiological kuqedwa:

• Ukuskena komgogodla we-lumbar ukuze ubone ngeso lengqondo ukuphuka kwe-isthmus;
• I-Magnetic resonance imaging (MRI) ye-lumbar spine ivumela, uma kunesidingo, ukubonwa okungcono kwempande yenzwa ecindezelwe, ukuhlaziya ukucindezelwa kwe-dural fornix noma i-ponytail (ingxenye engezansi ye-dura equkethe izimpande motor kanye nezinzwa zezinzwa izitho ezimbili ezingezansi kanye nesinye kanye ne-rectal sphincters) nokuhlaziywa kwesimo se-intervertebral disc phakathi kwama-vertebrae amabili;
• I-Electromyography isetshenziselwa ukuhlola impilo yemisipha namaseli ezinzwa azilawulayo. Kwenziwa kuphela uma isiguli singenazo zonke izimpawu zesici se-spondylolisthesis noma uma izimpawu zithambile.

Abantu abathintekayo yi-spondylolisthesis

I-Lumbar spondylolisthesis nge-isthmic lysis ithinta i-4 kuya ku-8% yabantu. Kuvame ukubonwa kubasubathi bezinga eliphezulu abenza imisebenzi edinga ukujikeleza komgogodla njalo kanye nokuma kwe-arched.

I-Dysplastic lumbar spondylolisthesis ngokuvamile ithinta intsha kanye nabantu abadala.

Izinto ezivumela i-spondylolisthesis

I-Lumbar spondylolisthesis nge-isthmic lysis ithandwa yizici ezilandelayo:

• Imisebenzi yezemidlalo evamile ehlanganisa ukuzungezisa umgogodla okuvamile kanye nokuma kwe-arching okufana nokuzilolonga okunesigqi, ukudansa, imidlalo yokujikijela, ukugwedla noma ukugibela amahhashi;
• Izikhundla zomsebenzi ezidinga ukuma okuncike phambili;
• Ukuthwala okuvamile kwemithwalo esindayo noma ubhaka osindayo ezinganeni.

I-Degenerative lumbar spondylolisthesis ingathandwa yi:

• Ukunqamuka kokuya esikhathini ;
• I-osteoporosis.

Ubuhlungu obuphansi emuva

Ibekezelelwa isikhathi eside, i-spondylolisthesis ivame ukutholwa ngengozi ekuhlolweni kwe-X-ray ye-pelvis noma lapho usukhulile ngesikhathi sobuhlungu bokuqala obuphansi beqolo.

Ubuhlungu obuphansi emuva

Olunye uphawu lwe-spondylolisthesis ubuhlungu obuphansi be-back back, bukhululeka ngokuma okuya phambili futhi kube kubi kakhulu ngenxa ye-back back position. Amandla alobu buhlungu obuphansi emuva buyahlukahluka kusukela emuzweni wokungakhululeki emhlane ongezansi kuya ebuhlungwini obubukhali bokuqala kungazelelwe - ngokuvamile kulandela ukuthwala umthwalo osindayo - okuthiwa i-lumbago.

I-Sciatica kanye ne-cruralgia

I-spondylolisthesis ingaholela ekucindezelweni kwempande yenzwa lapho inzwa iphuma khona emgogodleni futhi ibangele ubuhlungu emlenzeni owodwa noma yomibili. I-Sciatica ne-cruralgia ngabameleli ababili.

Cauda equina syndrome

I-spondylolisthesis ingabangela ukucindezelwa kanye / noma ukulimala okungenakulungiseka ezimpandeni zemizwa ye-dural cul de sac. Le cauda equina syndrome ingabangela ukuphazamiseka kwe-sphincter, ukungabi namandla noma ukuqunjelwa isikhathi eside nokungavamile ...

Ukukhubazeka okuyingxenye noma okuphelele

I-spondylolisthesis ingabangela ukukhubazeka okuncane - ukuzwa ukudedela idolo, ukungakwazi ukuhamba ngozwane noma isithende sonyawo, umbono wokuthi unyawo lugwaza phansi lapho uhamba... umonakalo nomphumela wokugcina wokukhubazeka okuphelele.

Ezinye izimpawu

• I-Neurogenic claudication noma isibopho sokuma ngemuva kwebanga elithile elihambile;
• I-Paresthesias, noma ukuphazamiseka ngomqondo wokuthinta, njengokundikindiki noma ukuluma.

Ukwelashwa kwezokwelapha kunconywa lapho i-spondylolisthesis ibuhlungu kodwa asikho uphawu lwezinzwa olutholakalayo. Lokhu kwelashwa kuyehluka kuye ngobuhlungu:

• Ama-analgesics njengendlela yokwelapha eyisisekelo yobuhlungu be-lumbar obuhambisana nezidakamizwa ezingezona ukuvuvukala (ama-NSAID) izinsuku ezingu-5 kuya kwezingu-7 uma kwenzeka kunenkinga;
• Ukuvuselela okubandakanya ukuvivinya umzimba ukuqinisa imisipha yesisu kanye ne-lumbar;
• Uma kwenzeka ukuphuka kwakamuva kwe-isthmus noma ubuhlungu obukhulu obuphansi emuva, ukukhubazeka nge-Bermuda cast ehlanganisa ithanga ohlangothini olulodwa kuphela kungase kwelulekwe ukukhulula ubuhlungu.

Uma kwenzeka ukwehluleka kokwelashwa noma lapho kukhona ukuphazamiseka kwe-neurological motor noma i-sphincter, ukuhlinzwa kwe-spondylolisthesis kungase kudingeke. Kubandakanya ukwenza i-arthrodesis noma ukuhlanganiswa okuqondile kwama-vertebrae amabili abuhlungu. I-Arthrodesis ingahlotshaniswa ne-laminectomy: lokhu kuhlinzwa kuhlanganisa ukukhulula izinzwa ezicindezelwe. Lokhu kungenelela kungenziwa kancane kancane kusetshenziswa izicucu ezimbili ezincane ze-lateral, ngenzuzo yokunciphisa kakhulu ubuhlungu obuphansi be-postoperative.

Ezinye izinyathelo zokuphepha kufanele zithathwe ukugwema ukubukeka noma ukuwohloka kwe-spondylolisthesis:

• Cela ukujwayela umsebenzi uma kwenzeka imisebenzi enezingqinamba ezinamandla: isikhundla sokuncika ngokuphindaphindiwe, ukuthwala imithwalo esindayo, njll.
• Gwema imisebenzi yezemidlalo ku-hyper extension;
• Ungaphathi ojosaka abasindayo nsuku zonke;
• Ungaqedi umkhuba wezemidlalo yokuzilibazisa, okuphambene nalokho, uqinisa imisipha ye-lumbar nesisu. ;
• Yenza ukuqapha nge-radiographic njalo eminyakeni emihlanu.