Mgbu neuropathic mgbu mgbe ọ gasịrị bụ nsogbu nkịtị, ọ bụrụgodị na onye ọrịa nọ n'ọnọdụ kacha mma.Dị ka ụdị nhụjuanya nhụjuanya ndị ọzọ, nhụjuanya neuropathic mgbe ịwachara ahụ siri ike ịgwọ ma na-adaberekarị na analgesics adjuvant, dị ka antidepressants na anticonvulsants, na ndị na-egbochi akwara.M mepụtara ọgwụgwọ site na iji hyaluronic acid cross-linked (Restylane na Juvéderm), nke na-enye enyemaka dị ogologo oge na-enweghị mmetụta ọ bụla.
A na-eji hyaluronic acid jikọtara cross-linked maka oge mbụ iji gwọọ mgbu neuropathic na 2015 Nzukọ Kwa Afọ nke American Academy of Pain Medicine na National Harbor, Maryland.1 N'ime nyocha nlele anya nke ọnwa 34, ndị ọrịa nhụjuanya neuropathic 15 (ụmụ nwanyị 7, ụmụ nwoke 8) na 22 na-amụ ihe mgbu.Nkezi afọ nke ndị ọrịa bụ afọ 51 na nkezi oge mgbu bụ ọnwa 66.Ọnụ ọgụgụ mgbu na-ahụ anya (VAS) tupu ọgwụgwọ bụ isi 7.5 (site na 10).Mgbe ọgwụgwọ gasịrị, VAS gbadara na 10 isi (site na 1.5), na nkezi oge remission bụ ọnwa 7.7.
Ebe ọ bụ na m webatara ọrụ mbụ m, a gwọọla m ndị ọrịa 75 nwere ụdị mgbu mgbu (ya bụ, post-herpetic neuralgia, ọwara carpal na ọrịa ọwara tarsal, tinnitus nke paralytic Bell, isi ọwụwa, wdg).N'ihi usoro omume enwere ike na-arụ ọrụ, ahọpụtara m ọgwụgwọ a dị ka analgesia neural matrix analgesia (XL-NMA).2 M na-enye akụkọ ikpe nke onye ọrịa nwere olu na-adịgide adịgide na mgbu aka mgbe ịwa ahụ cervical spine.
Hyaluronic acid (HA) bụ proteoglycan, linear anionic polysaccharide 3 mejupụtara nkeji ugboro nke glucuronic acid na N-acetylglucosamine.Ọ na-adịkarị na matrix extracellular (ECM) (56%) nke anụ ahụ, anụ ahụ jikọtara 4, anụ ahụ epithelial na anụ ahụ akwara.4,5 N'ime anụ ahụ dị mma, ịdị arọ molekụla ya bụ 5 ruo 10 nde daltons (Da)4.
Cross-linked HA bụ ihe ịchọ mma azụmahịa nke FDA kwadoro.A na-ere ya n'okpuru ụdị Juvéderm6 (nke Allergan rụpụtara, ọdịnaya HA 22-26 mg / mL, ịdị arọ molecular 2.5 nde daltons) 6 na Restylane7 (nke Galderma rụpụtara), yana ọdịnaya HA bụ 20 mg / Milliliters, ịdị arọ molecular bụ 1 nde Dalton.8 Ọ bụ ezie na ụdị HA na-abụghị nke na-ejikọta ya bụ mmiri mmiri na metabolized n'ime otu ụbọchị, njikọ molecular crosslinks nke HA na-ejikọta ụdọ polymer nke ọ bụla ma na-etolite hydrogel viscoelastic, ya mere ndụ ọrụ ya (6 ruo ọnwa 12) na ike ịmị mmiri. nwere ike ịmịkọrọ mmiri ugboro 1,000 arọ ya.5
Otu nwoke dị afọ 60 bịara n'ọfịs anyị n'April 2016. Mgbe ọ natachara C3-C4 na C4-C5 n'azụ cervical decompression, n'azụ fusion, mpaghara autotransplantation na azụ segmental n'ime ime fixation, olu gara n'ihu Na bilateral mgbu mgbu.Ịkpọsasị mma na C3, C4, na C5.Ihe mmerụ ahụ n'olu ya mere n'April 2015, mgbe ọ dara azụ na-arụ ọrụ mgbe o jiri isi ya kụọ olu ya ma nwee mmetụta n'olu ya.
Mgbe a wachara ya ahụ, ihe mgbu na nhụjuanya ya bịara na-akawanye njọ, na-enwekwa mgbu na-ere ọkụ na-aga n'ihu n'azụ aka na olu ya (Njirimara 1).Mgbe ọ na-emegharị olu ya, ọkụ eletrik siri ike na-esi n'olu ya na ọkpụkpụ azụ ruo n'akụkụ aka ya elu na nke ala.Mgbe ị dinara n'akụkụ aka nri, ọnụọgụ nke aka kacha njọ.
Mgbe emechara nyocha ihe omimi (CT) myelography na redio (CR), a hụrụ ọnya cervical na C5-C6 na C6-C7, nke ga-akwado ihe mgbu na-aga n'ihu n'aka yana ụdị ọrụ oge ụfọdụ nke ngbanwe olu mgbu (ya bụ, neuropathic nke abụọ na ọnọdụ mgbu azụ na nnukwu C6-C7 radiculopathy).
Ọnya a kapịrị ọnụ na-emetụta mgbọrọgwụ akwara dị n'akụkụ yana akụkụ azụ azụ metụtara n'ihu, gụnyere:
Dọkịta na-awa ọkpụkpụ azụ nakweere ndụmọdụ ahụ, ma chere na ọ dịghị ihe ọ bụla a ga-enye maka ịwa ahụ ọzọ.
N'ọgwụgwụ Eprel 2016, aka nri onye ọrịa natara ọgwụgwọ Restylane (0.15 ml).A na-eme ntụtụ ahụ site n'itinye ọdụ ụgbọ mmiri nwere agịga nlele 20, wee tinye microcannula nlele 27 (DermaSculpt) nke nwere ọnụ na-enweghị isi.Maka ntụnyere, a na-emeso aka ekpe ya na ngwakọta nke 2% lidocaine dị ọcha (2 mL) na 0.25% bupivacaine dị ọcha (4 ml).Ọgwụ kwa otu saịtị bụ 1.0 ka 1.5 ml.(Maka ntuziaka nzọụkwụ site na usoro a, lee sidebar.) 9
Site na mgbanwe ụfọdụ, usoro ịgba ntụtụ ahụ yiri ngọngọ akwara nkịtị na ọkwa nkwojiaka nke akwara etiti (MN), akwara ulnar (UN), na akwara radial elu (SRN) na ọkwa anatomical.Igbe snuff - akụkụ triangular nke aka kpụrụ n'etiti mkpịsị aka na etiti.Awa iri abụọ na anọ ka a rụchara ọrụ ahụ, onye ọrịa ahụ hụrụ nhụsianya na-aga n'ihu n'ọbụ aka nke anọ na nke ise nke aka nri mana ọ nweghị ihe mgbu.Ọtụtụ n'ime nhụjuanya na mkpịsị aka nke mbụ, nke abụọ na nke atọ kwụsịrị, ma a ka nwere mgbu na mkpịsị aka.Akara mgbu, 4 ruo 5).Mmetụta ọkụ dị n'azụ aka ebelatala kpamkpam.N'ozuzu, ọ nwere mmetụta mmụba nke 75%.
Na ọnwa 4, onye ọrịa ahụ chọpụtara na mgbu aka nri ya ka na-akawanye mma site na 75% ruo 85%, na njedebe nke mkpịsị aka 1 na 2 na-anabata ya.Enweghị mmeghachi omume ọjọọ ma ọ bụ mmetụta.Rịba ama: Akwụsịla enyemaka ọ bụla sitere na nkụnwụ mpaghara na aka ekpe 1 izu mgbe ọrụ ahụ gasịrị, ihe mgbu ya laghachiri na ọkwa ntọala nke aka ahụ.N'ụzọ na-akpali mmasị, onye ọrịa ahụ chọpụtara na ọ bụ ezie na mgbu na-ere ọkụ na nhụjuanya dị n'elu aka ekpe mgbe ịgbanye ọgwụ anestetiiki mpaghara ahụ ebelatala, ọ bụ ihe na-adịghị mma ma na-ewe iwe dochie ya.
Dị ka e kwuru na mbụ, onye ọrịa ahụ kọrọ na mgbe ọ natara XL-NMA, nhụjuanya neuropathic dị n'aka nri na-eme ka ọ dịkwuo mma.Onye ọrịa ahụ gara ọzọ na mbubreyo August 2016, mgbe ọ kọrọ na mmelite ahụ malitere ibelata na mbubreyo July 2016. Ọ tụrụ aro ka emewanyewanye XL-NMA aka nri aka nri, yana ọgwụgwọ XL-NMA maka aka ekpe na cervical. -brachial area-bilateral, proximal ubu, C4 mpaghara na C5-C6 larịị.
Onye ọrịa ahụ gara ọzọ n'etiti October 2016. Ọ kọrọ na mgbe ntinye aka na August 2016, ihe mgbu ya na-ere ọkụ na mpaghara niile na-egbu mgbu na-adịgide adịgide ma na-ekpochapụ kpamkpam.Mkpesa ndị bụ isi ya bụ ihe mgbu na-adịghị mma / oke mgbu n'elu nkwụ na azụ nke aka (mmetụta mgbu dị iche iche-ụfọdụ dị nkọ ma ụfọdụ na-agwụ ike, dabere na eriri akwara metụtara) na njigide gburugburu nkwojiaka.Esemokwu ahụ bụ n'ihi mmebi nke mgbọrọgwụ akwara nke spain cervical ya, bụ nke gụnyere eriri ndị na-emepụta irighiri akwara atọ (SRN, MN, na UN) n'aka.
Onye ọrịa ahụ hụrụ mmụba nke 50% na mgbatị cervical spine rotational range of movement (ROM), na mbelata 50% na cervical na mgbu ogwe aka na mpaghara C5-C6 na C4 proximal ubu.Ọ tụpụtara XL-NMA mmụba nke bilateral MN na SRN- UN na mpaghara brachial olu nọgidere na-akawanye mma n'enweghị ọgwụgwọ.
Tebụl 1 na-achịkọta usoro ihe omume multifactorial atụpụtara.A na-ahọpụta ha dabere na nso nso ha na mgbochi-nociception na-agbanwe oge-site na mmetụta kachasị kpọmkwem na nkeji 10 mbụ mgbe ịgba ọgwụ mgbochi ahụ ruo na enyemaka na-adịgide adịgide na ogologo oge a hụrụ n'ọnọdụ ụfọdụ otu afọ ma ọ bụ karịa.
CL-HA na-arụ ọrụ dị ka ihe mgbochi nchebe anụ ahụ, na-akpụ akụkụ, na-ebelata mmeghari nke ihe omume ozugbo na C fiber na Remak bundle afferents, yana ephapse ọ bụla na-adịghị mma.10 N'ihi ọdịdị polyanionic nke CL-HA, nnukwu ụmụ irighiri ihe ya (500 MDA ruo 100 GDa) nwere ike imebi ike ya kpamkpam n'ihi ịdị ukwuu nke ụgwọ ọjọọ ya ma gbochie nnyefe ọ bụla.Ndozi LMW/HMW na-adaba na-eduga na mbufụt mpaghara protein 6 na-akpali TNFa.Nke a na-eme ka ọ kwụsie ike ma na-eweghachi nsogbu akwara ozi nke na-alụso ọrịa ọgụ na ọkwa nke matrix extracellular neural, ma na-egbochi isi ihe ndị a kwenyere na ha na-ebute mgbu na-adịghị ala ala.11-14
N'ụzọ bụ isi, mgbe mmerụ ahụ ma ọ bụ mmerụ ahụ extracellular neural matrix (ECNM), a ga-enwe nnukwu akụkụ mbụ nke mbufụt ụlọ ọgwụ pụtara ìhè, na-esonyere ọzịza anụ ahụ na ịgbalite Aδ na C fiber nociceptors.Otú ọ dị, ozugbo ọnọdụ a na-adịghị ala ala, mbufụt anụ ahụ na mgbochi akwara crosstalk ga-anọgide na-adịgide adịgide ma subclinical.Chronicization ga-eme site na ntinyeghachi na nzaghachi nzaghachi dị mma, si otú ahụ na-edobe na ịnọgide na-enwe pro-inflammatory, ọnọdụ mgbu mgbu, na igbochi ịbanye n'ime usoro ọgwụgwọ na mgbake (Table 2).N'ihi na LMW/HMW-HA adịghị mma, ọ nwere ike ịdị na-akwado onwe ya, nke nwere ike ịbụ nsonaazụ nke CD44/CD168 (RHAMM) aberrations gene.
N'oge a, ntụtụ nke CL-HA nwere ike imezi LMW / HMW-HA mismatch ma mee ka nkwụsị nke ọbara, na-ekwe ka interleukin (IL) -1β na TNFa mee ka TSG-6 gbanwee mbufụt, site n'ịhazi na ịchịkwa LMW- HA na CD44.Nke a na-enye ohere ịga n'ihu na-aga n'ihu na ECNM mgbochi mkpali na analgesic oge, n'ihi na CD44 na RHAMM (CD168) na-enwe ike imekọrịta ihe na HMW-HA ugbu a.Iji ghọta usoro a, lee Tebụl 2, nke na-egosi cytokine cascade na neuroimmunology metụtara mmerụ ECNM.
Na nchịkọta, CL-HA nwere ike were dị ka nnukwu nnukwu Dalton ụdị HA.Ya mere, ọ na-emewanyewanye ma jikwaa mgbake HMW-HA nke anụ ahụ yana ọrụ ọkọlọtọ usoro ihe ọmụmụ ihe ndụ, gụnyere:
Mgbe mụ na ndị ọrụ ibe m na-ekwurịta akụkọ ikpe a, a na-ajụkarị m, "Ma olee otú mmetụta ahụ si agbanwe na ọgwụgwọ akụkụ dị anya site n'ọnya olu?"N'okwu a, ọnya a ma ama nke CR na CT myelography Recognition na ọkwa nke akụkụ azụ azụ C5-C6 na C6-C7 (C6 na C7 mgbọrọgwụ akwara, n'otu n'otu).Ọnya ndị a na-emebi mgbọrọgwụ akwara na akụkụ ihu nke ọkpụkpụ azụ, ya mere, ha bụ akụkụ dị nso nke ebe a maara nke mgbọrọgwụ akwara radial na ọkpụkpụ azụ (ya bụ, C5, C6, C7, C8, T1).Na, n'ezie, ha ga-akwado mgbu na-ere ọkụ mgbe niile na azụ aka.Otú ọ dị, iji ghọtakwuo nke a, a ghaghị ịtụle echiche nke mbata.16
Afferent neuralgia dị nnọọ mfe, "... N'agbanyeghị mbelata ma ọ bụ enweghị mmetụta nke mkpali na-adịghị mma nke mpụga (hypoalgesia ma ọ bụ analgesia) na akụkụ ahụ, nnukwu mgbu na-apụtaghị ìhè na akụkụ ahụ dị anya nke mmerụ ahụ."16 Ọ nwere ike ịkpata ya site na mmebi ọ bụla nke usoro ụjọ ahụ, ma etiti ma nke dị n'akụkụ, gụnyere ụbụrụ, ọkpụkpụ azụ, na irighiri akwara.A na-eche na akwara afferent bụ n'ihi mfu nke ozi sitere na mpụta ruo n'ụbụrụ.Kpọmkwem, enwere nkwụsịtụ na ozi mmetụta uche nke na-erute cortex site na traktị spinothalamic.Ngalaba nke ngwugwu a gụnyere nnyefe nke mgbu ma ọ bụ ntinye nociceptive gbadoro ụkwụ na thalamus.Ọ bụ ezie na usoro a ka na-aghọtachaghị nke ọma, ihe nlereanya ahụ dabara nke ọma maka ọnọdụ dị n'aka (ya bụ, mgbọrọgwụ akwara ndị a na akụkụ ọkpụkpụ azụ adịghị emetụta akwara radial).
Ya mere, itinye ya na mgbu na-ere ọkụ n'azụ aka onye ọrịa, dị ka usoro 3 dị na Tebụl 1 si dị, mmerụ ahụ aghaghị ịmalite ịmalite pro-inflammatory, pre-noxious ọnọdụ nke cytokine cascade (Table 2).Nke a ga-abịa site na mmebi anụ ahụ nke mgbọrọgwụ akwara emetụtara na akụkụ ọkpụkpụ azụ.Otú ọ dị, ebe ọ bụ na ECNM bụ ihe na-aga n'ihu ma na-agbasa neuroimmune nke gbara gburugburu akụkụ akwara niile (ya bụ, ọ bụ ihe dum), ụbụrụ sensory emetụtara nke C6 na C7 mgbọrọgwụ akwara na akụkụ ọkpụkpụ azụ na-aga n'ihu na kọntaktị Limb na kọntaktị neuroimmune na. azụ aka abụọ.
Ya mere, mmebi ahụ dị n'ebe dị anya bụ n'ezie ihe sitere na mmetụta dị ịtụnanya nke ECNM dị nso n'ebe dị anya.15 Nke a ga-eme ka CD44, CD168 (RHAMM) chọpụta HATΔ, ma hapụ IL-1β, IL-6 na TNFa cytokines na-egbuke egbuke, nke na-arụ ọrụ ma nọgide na-arụ ọrụ nke eriri C distal na Aδ nociceptors mgbe kwesịrị ekwesị (tebụl 2, #3) .Site na mmebi nke ECNM gburugburu SRN distal, XL-NMA nwere ike iji mee ihe nke ọma maka ntinye aka na ọnọdụ iji nweta CL-HA LMW / HMW-HA mismatch mgbazi na ICAM-1 (CD54) ụkpụrụ mbufụt (Table 2, # 3- #5 okirikiri).
Ka o sina dị, ọ bụ ihe na-enye obi ụtọ n'ezie ịnweta enyemaka na-adịgide adịgide site na mgbaàmà siri ike na nke isi ike site na ọgwụgwọ adịghị mma na nke dị ntakịrị.Usoro a na-adịkarị mfe ịrụ ọrụ, na akụkụ kacha sie ike nwere ike ịbụ ịchọpụta irighiri akwara, netwọk akwara, na mkpụrụ nke a ga-agbanye gburugburu ebe ebumnuche.Otú ọ dị, site na nhazi nkà na ụzụ na-adabere na ngosipụta ụlọ ọgwụ nkịtị, nke a adịghị esi ike.
Oge nzipu: Ọgọst-12-2021