Paravertebral blockade - chii?

Kubviswa lumbar radicular marwadzo uye mamwe localization zvino sechinoitika kunorwadza, asi chinonyanya kukosha mabasa. Zvepasi regression kurwadziwa, unogona tigumise pamusoro Kururama mishonga akasarudzwa. Maererano ano pfungwa Spine, kurwadziwa akazviratidza dzakaderera makumbo kana musana anofanira kubviswa nokukurumidza sezvinobvira. In kuchinja mamiriro echirwere rebipolar angava psychogenic. Ivo layering pamusoro zvakajairika zviratidzo, tunodzivisa kurapa uye yekudyidzana achiipa yacho fungidziro. Nezvenyaya iyi, nyanzvi vanovavarira kuti kukwanisa kushandisa sezvo pfupi sezvinobvira uye panguva imwe chete dzinobudirira. Mumwe paravertebral blockade kwakadaro. Chii, sei voitakura kunze - iri pashure munyaya.

tsananguro

Kuchirapa blockade vanonzi inonyatsobudirira nzira marwadzo Kutarisira, uye dzimwe kuratidzwa chetsinga pathologies. The nzira dzinobva pakatanga chirwere kupinda nepakati zvinodhaka. Kana ichienzaniswa nedzimwe nzira kurapwa (masaja, panyama kurapa, kunwa mushonga, jekiseni, Chinyorwa kurapa), kuti blockade zvinodhaka rinoshandiswa kudaro kare - kwete anopfuura zana nemakore. Zvisinei, nguva dzose ichi nzira vakaratidza kuva inoshanda chaizvo nzira kubvisa kurwadziwa. Ndicho chinangwa blockade. Kurwadziwa inofanira kugadziriswa zvakaenzana nokukurumidza, ane zvishoma parutivi kwemigumisiro, nguva uye zvinhu mari. Izvi zvinhu kutevedzera zvizere chaizvo nzira dzokurapwa blockade.

tsananguro

Blockade ndiyo kwekanguva shutdown rimwe Links ari riemukaari marwadzo apindure. Uyezve kuchirapa, nzira iyi ine chirwere ukoshi. Mune zvimwe zviitiko, nyanzvi anowana zvakaoma kuti kuongororwa zvakarurama. Izvi zvingava nokuti kuti kurapwa kuratidzwa vari kudzokororwa kana kwete pachena kuchengetwa ukama pakati zviratidzo uye chinangwa mashoko. Dzimwe nguva zvinoitika kuti chetsinga zviratidzo havasi kwakaitika MRI. Kana, nekusiyana, zvairatidza CT kana rinobva resonance kuri haisi akaora anoruramiswa. Pakadaro, rubatsiro zvikuru pave kuongororwa zvakarurama vachagara anyatsosarudza blockade.

Features

Kana marwadzo ipfupi pachishandiswa yokutindivadza-zvakananga anatomical zvivako, ichi kunoratidza kuti ndivo honzeri marwadzo. Vamwe jekiseni vanosarudza rinoitwa pane chimwe chikamu. Izvi zvinoita vemo rufimbi tsinga kuti anopa chaiyo nzvimbo. Thrust anogona kuitwa uye mukati mugove anatomical, semuenzaniso, vadyi Kamudzira kana rwakashodoka. Somugumisiro makavhara nociceptors mu mapazi ichi. Kana, kuwedzera kune yomunzvimbo rufimbi kwakawedzera corticosteroids, jekiseni zvokusarudza Muzviitiko zvakadaro kunogona kugovera rebei kuchirapa mugumisiro yokutindivadza. Intraarticular jekiseni steroids kunoderedza kuzvimba uye kuderedza kunetseka chokuita nayo. majekiseni kwakadaro anoshandiswa kana majoini havapinduri nezvaiitwa zvinokonzerwa - zororo, mishonga, kurovedza kurapa. The blockade chinoshanda myositis, radiculitis, neuralgia, sympathalgia. Kunze kuti yacho marwadzo, kwakaratidzwa kuvandudza neuro-trophic ushande.

zvakanakira nzira

Rapid kutanga kuzorodzwa inopiwa rakananga kupinda zvinodhaka kupinda pathological chinangwa uye matambudziko zvinodhaka kuguma uye waya, kupararira marwadzo. Munguva nzira mukana wokuti nemishonga iri kushoma. Izvi imhaka yokuti kamwe zvakare kuti mushonga chinopinda kutanga zvokurwara wechoto, uye ipapo chete - kupinda systemic riparadzirwe. Mumwe mutsva exacerbation ari chirwere zvingashandiswa kakawanda wakakombwa. Practice chigaro chakanaka kuchirapa mugumisiro jekiseni. Kuburikidza kushandiswa blockade zvinoderedza tsandanyama makakatanwa, vascular spasm, kubvisa anogumbura mhinduro iri kurwadziwa uye kuzvimba muchaenga.

paravertebral blockade

Pfungwa iyi inofanira kuonekwa pamwe. Izwi rinoratidza chete kuti jekiseni rinoitwa ari kunharaunda musana mbiru. An jekiseni zvinogona intradermal, subcutaneous, perineural, intramuscular kana radicular. Mune zvimwe zviitiko, paravertebral blockade rakaiswa pamusoro ganglia ari tsitsi hunde pamuganhu. Somuenzaniso, mumwe murwere flattened disk. It rinozivikanwa convergence kuti pedyo vertebrae uye rutapudzo wehunyambiri dhayamita ari intervertebral foramen. The Anterior mativi aro ukoshi kunowedzera nokuda pave osteophytes nezvimwe mapfupa growths. Kuderedza dhayamita wetsime kunoitika munguva kukura spondylarthrosis, thickening yero, interarticular nemarunda nemamwe maitiro nokuda osteochondrosis. Nokuti kuti anotungamirira hunhu chetsinga zvirwere panguva imwe chete riri compression uye akashatirwa kuti tambo, asi haana chirwere uye anogumbura siyana membranes uye midzi, pfungwa iyi inonzi funikulitom zvokurwara. Based izvi blockade rikashandiswa paravertebral funikulyarnogo. Medicaments raitongwa aine tsono chokunze mumakomba ari zvekufuga mapazi tambo, asi kwete musana mudzi.

kupatsanura

Kuchirapa majekiseni akakamurwa mhando maererano kushandiswa kwezvinodhaka uye chokupfeka nharaunda. Saka, pane:

• Paravertebral blockade pakati ari remuromo nomuzongoza.
• Majekiseni pamwechete intercostal neuralgia.
• Thoracal paravertebral blockade.
• Piriformis.
• Panguva lumbosacral chechetere.
• Sciatic tsinga uye nevamwe.

Kushandiswa glucocorticoids

Paravertebral ne blockage "diprospanom" kushandiswa systemic collagenosis. Mishonga iri cellular vanochiva Unotsigira kuzvimba kukura. Asati Kutarisirwa nharaunda pedyo spinous muitiro kubvisa dzokutindivadza: zvinodhaka "lidocaine" kana "Novocaine". Zvadaro, tsono kuchatsiviwa refu uye mukobvu uye kubereka analgesia kune vertebral chematenga. Zvadaro, musanganiswa akanga jekiseni ane rufimbi zvinodhaka "Diprospan". Contraindications nokuti nzira zvinosanganisira chirwere cheshuga, thrombosis, osteoporosis kunoratidzwa panguva, psychosis, hypersensitivity, rwarisa zvokurwara.

Kushandiswa rufimbi

Paravertebral novocaine nechigumbuso ari muitiro, musimboti chiri kuzozivisa mushonga kupinda mapazi kurwadziwa mukurusa. Zvakananga, dzakadaro inosanganisira rukungiso pfungwa apo migweje majoini uye kusvinwa tsandanyama, tsinga vanopfuura nzvimbo uye nzvimbo plexuses dzavo. Paravertebral blockade kushandisa rufimbi zvinogona kupa pfupi (maminitsi 20-30). Zvisinei, kunyange panguva ino yava zvokuti Activate hwandaiva Matauriro spastic tsandanyama.

Kubudirira nzira uye contraindications

Kubudirira achibvisa spasm kwakaratidzwa yose tsandanyama faibha kuwedzera Vhoriyamu injini ari muhudyu, kuderedza marwadzo utetsa munharaunda kuchinyanya kana mugove etsinga mudzi innervation. Not varumbidzwa paravertebral blockade unyanzvi izvo zvichashandiswa kurondedzerwa pazasi zvakaoma. bradycardia chirwere simba iri sinus raiva pedyo nebundu, atrioventricular nechigumbuso wechipiri / madhigirii rechitatu (kunze kuva zviitiko apo kuti ventricular pacing wakapinda vachiongorora), cardiogenic kuvhunduka, hypotension (akazivisa), hypersensitivity . Contraindications zvinosanganisira Kuwanikwa mashoko pamusoro epileptiform nokugwinha munhau kushatiriswa dzokutindivadza, uyewo kutyora chiropa chaitika.

Development of nzira

paravertebral blockade sei? waivako chidobi kunosanganisira kuita manipulations nenzira yakananga kutevedzana. The murwere wokutanga wakaiswa pamusoro mudumbu. palpation nzira yakajeka chikamu kunonyanyisa marwadzo. Kazhinji, nharaunda iyi rinoenderana fungidziro yacho tambo, vari vazhinji sei. Aishandiswa chetsinga miedzo kubatsira kumisa nzvimbo achava paravertebral blockade. Jekiseni chidobi inofanira kukudziridzwa zvakanaka nokuda nyanzvi.

Zano iri kubatwa doro kana ayodhini. Kushandisa tsono yakanaka kupinda mapazi richaitirwa jekiseni jekiseni rufimbi ( "Novocaine") kuumba "ndimu svuura". Nokuti rakada kuti chikamu tsono wechipiri tambo mbudo (yakareba) hunosumwa pedyo mutsara spinous pezvakaitwa (ari chinhambwe 3-4 cm) maererano achida penguva. Sezvo voitakura chiitiko Kubayiwawo jekiseni 0.5% mhinduro "Novocaine". The tsono akaiswa kusvikira yava neZvapupu chete transverse muitiro. Uyezve sangano akaenda pavaigona kutora chikepe chaienda kubva pasi kana kubva kumusoro nenzira kurutivi musana pa necheparutivi rworwendo 30. panyaya sagittal ndege. The tsono akaiswa nomumwe 2 cm yakadzika uye 10-20 ml ari rufimbi iri jekiseni kana hydrocortisone emulsion. Saka, vakawanda, vakabata paravertebral blockade. achiita chidobi zvinosanganisira kuisa tsono zvarwo 5-6 cm.

chenjera zviitiko

Kune nzira dzakawanda idzo vakatakura paravertebral blockade. Lumbosacral nharaunda iri kuonekwa nani matambudziko, kunyanya kurwadziwa uye kushaya zvakajeka monoradikulyarnogo syndrome. Munyaya iyi inoshanda jekiseni kubva matatu pfungwa. Nhanganyaya rinoitwa pakati vertebrae uye Liv Leviticus, Leviticus uye S1 munzvimbo yokutanga sacral buri. Kubayiwawo jekiseni zvinodhaka "Hydrocortisone" zviri munzvimbo idzi anokonzerwa rakajairika kukuvara musana mabote avo. Patient mativi paravertebral blockade anogona kupiwa. Lumbosacral kubvisa ichi nyaya nhanhatu pfungwa. Maererano mamiriro murwere, kusimba uye localization kurwadziwa yakasiyana mishonga yacho zvinodhaka "Hydrocortisone" rinoshandiswa. Paaipedzisa mumwe tambo (1 jekiseni) uchishandisa 10-30 MG. With zvakarurama Implementation pamusoro nzira ipfupi kana yakapedza marwadzo pakarepo pashure pakatanga medicament. Blockade zvinogona kudzokororwa kana zvakakodzera. Akadzokorora majekiseni rirege kwokutanga pane mazuva 2-3. Mushure nzira ndakarumbidzwa murwere mubhedha zororo.

Other unyanzvi

Murwere anotora nzvimbo avete mudumbu rake. musoro wake anofanira akatendeukira kune divi mumunda, apo ichava nguva paravertebral blockade. Remuromo nomuzongoza ichaongororwa kuti zvikuru kufambisa nzvimbo. Panyaya iyi, mapazi iri kazhinji kukuvara vamwe. Panguva nzira yakashandiswa 0.25% rufimbi mhinduro ari dose pamusoro 70-100 MG. tsono The jekiseni iri akaiswa perpendicular kuti ganda pamusoro pedyo rokunze muganhu extensor shure. Uyezve Bato kunoitika pamberi neVadzidzi hunenge vertebra kana transverse muitiro. The tsono runoita kuti 0.5-1 masendimita padivi. Tevera majekiseni vakatakudzwa kubva pane chinhambwe 1.5 masendimita kubva yapfuura vaya. Mune zvimwe zviitiko, musanganiswa zvinodhaka "Novocaine" uye "Hydrocortisone". Last kutora 50-75 MG uye vokutanga kumamiriro 100 ml.

Kushandisa wemisanganiswa Afonina

Ndiyo imwe nzira lumbosacral paravertebral blockade. To chikamu tambo mbudo rejeri (intervertebral) vari kutarisirwa 1.5-8 MG. The zvachose Vhoriyamu mhinduro anoda pakati 30-80 Rine mamiririta. The chipimo chemushonga kunoenderana nenhamba pfungwa wakashandiswa blockade. The kuchirapa kosi unosanganisira chete infiltration, kana mugumisiro auya nokukurumidza zvakakwana. Kana zvazviri sokuti zvishoma nezvishoma, ipapo kushandisa 2-4 blockade inodzokororwa. Mumwe nomumwe rinotevera jekiseni rinoitwa kwamazuva 5-6 mushure wokupedzisira. Kana raitongwa murwere tinganetseka nezvekufadza siyana ari innervation dzakasiyana etsinga fibers. Somuenzaniso, mumwe murwere anogona kugamuchira kunzwa waziya, paresthesia, kumanikidzwa, dzava marwadzo.