Ukwelashwa kwe-Migraine Headache: I-Atlas Vertebrae Realignment
Izinhlobo eziningana zekhanda elibuhlungu zingathinta umuntu ojwayelekile futhi ngayinye ingase ibangele ngenxa yokulimala okuhlukahlukene kanye / noma izimo, noma kunjalo, ubuhlungu bekhanda be-migraine buvame ukuba nesizathu esiyinkimbinkimbi kakhulu ngemuva kwabo. Ochwepheshe abaningi bezokunakekelwa kwempilo kanye nezifundo eziningi zocwaningo ezisekelwe ebufakazini baye baphetha ngokuthi i-subluxation entanyeni, noma ukungahambi kahle kwe-vertebrae emgodleni womlomo wesibeletho, isizathu esivame kakhulu sekhanda lekhanda le-migraine. I-Migraine ibonakala ngobuhlungu obukhulu bekhanda obuvame ukuthinta uhlangothi olulodwa lwekhanda, okuhambisana nesicanucanu nokuphazamiseka kokubona. Ubuhlungu bekhanda be-Migraine bungase buqede amandla. Ulwazi olungezansi luchaza ucwaningo lwecala mayelana nomphumela we-atlas vertebrae realignment kuziguli ezine-migraine.
Umthelela We-Atlas Vertebrae Reignment Ezifundweni ezine-Migraine: Ucwaningo Lokuhlola Lokuhlola
abstract
Isingeniso. Esifundweni se-migraine case, izimpawu zekhanda zehla kakhulu ngokunyuka okuhambisanayo nenkomba yokuhambisana ne-intracranial elandela ukulungiswa kwe-atlas vertebrae. Lolu cwaningo lokuhlola umshayeli lulandele i-neurologist eyishumi nanye ithole izihloko ze-migraine ukuze zinqume ukuthi ukutholakala kwecala kwakuphindaphindiwe yini ekuqaleni, isonto lesine, nesonto lesishiyagalombili, kulandela ukungenelela kwe-National Upper Cervical Chiropractic Association. Imiphumela yesibili yayihlanganisa ikhwalithi eqondene ne-migraine yezinyathelo zokuphila. Izindlela. Ngemva kokuhlolwa udokotela wezinzwa, amavolontiya asayine amafomu emvume futhi agcwalisa imiphumela eqondile ye-migraine eqondile. Ukuba khona kokungahambi kahle kwe-atlas kuvumele ukufakwa kocwaningo, okuvumela ukuqoqwa kwedatha ye-MRI eyisisekelo. Ukunakekelwa kwe-Chiropractic kwaqhubeka amasonto ayisishiyagalombili. I-Postintervention reimaging yenzeke ngesonto lesine nesonto lesishiyagalombili lihambisana nesilinganiso semiphumela eqondene ne-migraine. Ezenye. Izifundo ezinhlanu kweziyishumi nanye zibonise ukwanda komphumela oyinhloko, ukuhambisana ne-intracranial; nokho, ushintsho olushoyo lulonke alubonisanga ukubaluleka kwezibalo. Ukuphela kocwaningo kusho izinguquko ekuhloleni komphumela othize we-migraine, umphumela wesibili, wembula ukuthuthukiswa okuphawulekayo emtholampilo kwezimpawu ngokuncipha kwezinsuku zekhanda. Ingxoxo. Ukuntuleka kokwenyuka okuqinile kokuthobela kungase kuqondwe ngemvelo ye-logarithmic kanye ne-dynamic ye-intracranial hemodynamic kanye nokugeleza kwe-hydrodynamic, okuvumela izingxenye ngazinye ezihlanganisa ukuthobelana ukuze ziguquke kuyilapho sekukonke kungazange. Imiphumela yocwaningo iphakamisa ukuthi ukungenelela kokuhlelwa kabusha kwe-atlas kungase kuhlotshaniswe nokunciphisa imvamisa ye-migraine kanye nokuthuthukiswa okuphawulekayo kwekhwalithi yokuphila okunikeza ukunciphisa okuphawulekayo kokukhubazeka okuhlobene nekhanda njengoba kubonakala kuleli qembu. Ucwaningo lwesikhathi esizayo olunezilawuli luyadingeka, nokho, ukuze kuqinisekiswe lokhu okutholakele. Inombolo yokubhalisa ye-Clinicaltrials.gov ithi NCT01980927.
Isingeniso
Kuye kwahlongozwa ukuthi i-atlas vertebra engalungile idale ukuhlanekezela komgogodla okuphazamisa ukuhamba kwe-neural ye-brain stem nuclei ku-medulla oblongata ehlanganisa i-physiology evamile [1�4].
Inhloso ye-National Upper Cervical Chiropractic Association (NUCCA) eyakhiwe inqubo yokulungiswa kwe-atlas ukubuyiselwa kwezakhiwo zomgogodla ezingaqondile ku-axis mpo noma umugqa we-gravity. Okuchazwa ngokuthi �umgomo wokubuyisela,� ukuqondisa kabusha kuhlose ukuvuselela ubudlelwano obujwayelekile besiguli be-biomechanical bomgogodla ongaphezulu womlomo wesibeletho ku-eksisi eqondile (umugqa wamandla adonsela phansi). Ukubuyisela kubonakala njengokulinganisela ngokwezakhiwo, ukukwazi ukunyakaza okungakhawulelwe, nokuvumela ukwehla okukhulu kwengcindezi yamandla adonsela phansi [3]. Ukulungiswa kwe-theoretically kususa ukuhlanekezela kwentambo, okudalwe i-atlas misalignment noma i-atlas subluxation complex (ASC), njengoba kuchazwe ngokuqondile yi-NUCCA. Umsebenzi we-neurologic uyabuyiselwa, okucatshangwa ukuthi use-brain stem autonomic nuclei, ethinta uhlelo lwe-cranial vascular oluhlanganisa i-Cerebrospinal Fluid (CSF) [3, 4].
Inkomba ye-intracranial compliance index (ICCI) ibonakala iwukuhlola okubucayi kakhulu kwezinguquko ezenziwe ezindaweni ze-craniospinal biomechanical ezigulini ezinezimpawu kunemingcele yendawo ye-hydrodynamic ye-CSF flow velocities kanye nezilinganiso zokususwa kwentambo [5]. Ngokusekelwe kulolo lwazi, ubudlelwano obubonwe ngaphambili bokwanda kokuthotshelwa kwe-intracranial ekunciphiseni okuphawulekayo kwezimpawu ze-migraine kulandela ukulungiswa kabusha kwe-atlas kunikeze isikhuthazo sokusebenzisa i-ICCI njengomphumela oyinhloko wocwaningo.
I-ICCI ithinta ikhono le-Central Nervous System (CNS) ukuze ihambisane nokuguquguquka kwevolumu ye-physiologic okwenzekayo, ngaleyo ndlela igweme i-ischemia yezakhiwo ze-neurologic ezingaphansi [5, 6]. Isimo sokuhambisana okuphezulu kwe-intracranial senza noma yikuphi ukukhuphuka kwevolumu kwenzeke endaweni ye-CNS ye-intrathecal ngaphandle kokubangela ukwanda kwengcindezi ye-intracranial okwenzeka ngokuyinhloko ngokungena kwe-arterial ngesikhathi se-systole [5, 6]. Ukuphuma kwenzeka endaweni ephansi ngemithambo ye-jugular yangaphakathi noma uma imile, nge-paraspinal noma i-venous drainage yesibili. Le plexus ebanzi ye-venous ayina-valve futhi i-anastomotic, ivumela igazi ukuthi ligeleze libheke emuva, liye ku-CNS ngezinguquko ze-postural [7, 8]. I-venous drainage idlala indima ebalulekile ekulawuleni uhlelo lwe-intracranial fluid [9]. Ukuthobelana kubonakala kusebenza futhi kuncike ekuphumeni mahhala kwegazi ngalezi zindlela zokudonsa amanzi emithanjeni ye-extracranial [10].
Ukulimala kwekhanda nentamo kungadala ukusebenza okungavamile kwe-plexus ye-venous yomgogodla engase iphazamise ukugeleza kwe-venous yomgogodla, mhlawumbe ngenxa yokungasebenzi kahle kwe-autonomic yesibili ku-spinal cord ischemia [11]. Lokhu kunciphisa ukuguquguquka kwevolumu ngaphakathi kwe-cranium okudala isimo sokuncipha kokuthobelana kwe-intracranial.
U-Damadian no-Chu bachaza ukubuya kokuphuma okujwayelekile kwe-CSF okukalwe maphakathi no-C-2, okubonisa ukuncishiswa kwe-28.6% kwe-gradient ye-CSF elinganiselwe esigulini lapho i-atlas iqondiswe kabusha kahle [12]. Isiguli sabika ukukhululeka ezimpawini (i-vertigo kanye nokuhlanza lapho i-recumbent) ehambisana ne-atlas esele ihambisana.
Ucwaningo lwe-hypertension olusebenzisa ukungenelela kwe-NUCCA lubonisa ukuthi indlela engenzeka ngayo ukwehla komfutho wegazi ingaba umphumela wezinguquko zokujikeleza kobuchopho ngokuphathelene nesikhundla se-atlas vertebrae [13]. Kumada et al. uphenye indlela ye-trigeminal-vascular in brain stem control control blood pressure [14, 15]. I-Goadsby et al. baye banikeza ubufakazi obuqand' ikhanda bokuthi i-migraine iqala ngesistimu ye-trigeminal-vascular mediated ngokusebenzisa isiqu sobuchopho kanye nomgogodla womlomo wesibeletho ongenhla [16�19]. Ukubhekwa okunamandla kuveza ukunciphisa okukhulu kokukhubazeka kwekhanda leziguli ze-migraine ngemuva kokusetshenziswa kokulungiswa kwe-atlas. Ukusebenzisa izifundo ezixilongwa yi-migraine kubonakala kulungele ukuphenya izinguquko ezihlongozwayo zokujikeleza kwe-cerebral kulandela ukulungiswa kabusha kwe-atlas njengoba kwakucatshangelwe ekuqaleni eziphethweni zocwaningo lwe-hypertension futhi okubonakala sengathi kusekelwa ubuchopho obungenzeka ukuxhumana kwe-trigeminal-vascular. Lokhu kuzoqhubeka nokuqhubekisela phambili i-hypothesis esebenzayo ye-pathophysiologic ye-atlas misalignment.
Imiphumela evela ocwaningweni lwecala lokuqala ibonise ukwanda okukhulu kwe-ICCI ngokuncipha kwezimpawu zekhanda le-migraine kulandela ukulungiswa kwe-atlas ye-NUCCA. Owesilisa oneminyaka engu-62 ubudala one-neurologist wathola ukuthi i-migraine engapheli ivolontiya ukuze kwenziwe isifundo secala ngaphambi kokungenelela. Ukusebenzisa i-Phase Contrast-MRI (i-PC-MRI), izinguquko kumingcele ye-cerebral hemodynamic kanye ne-hydrodynamic flow zilinganiswa ekuqaleni, amahora angu-72, bese kuthi ngemva kwamasonto amane ukungenelela kwe-atlas. Inqubo efanayo yokulungiswa kwe-atlas esetshenziswe esifundweni somfutho wegazi ophezulu yalandelwa [13]. Amahora we-72 ngemuva kocwaningo lwembula ushintsho oluphawulekayo ku-intracranial compliance index (ICCI), kusukela ku-9.4 kuya ku-11.5, kuya ku-17.5 ngesonto lesine, ngemuva kokungenelela. Izinguquko eziphawulekayo ekuphumeni kwe-venous outflow pulsatility kanye ne-venous secondary drainage evelele endaweni ephansi kwaqinisekisa uphenyo olwengeziwe oluqhubekayo nokukhuthaza ucwaningo lwezihloko ze-migraine kulolu chungechunge lwamacala.
Imiphumela engaba khona ye-atlas misalignment noma i-ASC ku-drainage ye-venous ayaziwa. Ukuhlolwa ngokucophelela kokuthotshelwa kwe-intracranial ngokuphathelene nemiphumela yokungenelela kokungahambi kahle kwe-atlas kungase kunikeze ukuqonda ukuthi ukulungiswa kungase kuthinte kanjani ikhanda le-migraine.
Ukusebenzisa i-PC-MRI, inhloso eyinhloko yalolu cwaningo lwamanje, nomphumela oyinhloko, ukulinganisa i-ICCI ishintsha kusukela kwesisekelo kuya emasontweni amane nesishiyagalombili kulandela ukungenelela kwe-NUCCA eqenjini le-neurologist elikhethiwe izihloko ze-migraine. Njengoba kuphawulwe esifundweni secala, i-hypothesis icabanga ukuthi i-ICCI yesifundo izokhula ngokulandela ukungenelela kwe-NUCCA ngokuncipha okuhambisanayo kwezimpawu ze-migraine. Uma zikhona, noma yiziphi izinguquko eziphawuliwe ku-venous pulsatility kanye nomzila wokudonsa amanzi kufanele zibhalwe phansi ukuze kuqhathaniswe okwengeziwe. Ukuqapha impendulo yezimpawu ze-migraine, imiphumela yesibili yayihlanganisa nesiguli esibikiwe imiphumela yokulinganisa noma yikuphi ukuguqulwa okuhlobene ku-Health Related Quality of Life (HRQoL), okusetshenziswe ngokufanayo ocwaningweni lwe-migraine. Kulo lonke ucwaningo, izihloko zagcina idayari yekhanda elibhala ukwehla (noma ukwanda) ngenani lezinsuku zekhanda elibuhlungu, ukuqina, kanye nemithi esetshenzisiwe.
Ukuqhuba lolu chungechunge lwamacala okubuka, isifundo somshayeli, kuvunyelwe uphenyo olwengeziwe emiphumeleni ye-physiologic eshiwo ngenhla ekuthuthukisweni okuqhubekayo kwe-hypothesis esebenzayo ku-pathophysiology yokungahambi kahle kwe-atlas. Idatha edingekayo ukuze kulinganiswe usayizi wesampula wesifundo esibaluleke kakhulu kanye nokuxazulula izinselele zenqubo izohlinzeka ngolwazi oludingekayo lokuthuthukisa iphrothokholi ecwengisisiwe ukuze kuqhutshwe isilingo se-migraine esiphuphuthekile, esilawulwa yi-placebo sisebenzisa ukungenelela kokulungiswa kwe-NUCCA.
izindlela
Lolu cwaningo lugcine ukuhambisana neSimemezelo sase-Helsinki sokucwaninga ngezihloko zabantu. Ibhodi leNyuvesi yaseCalgary kanye ne-Alberta Health Services Conjoint Health Research Ethics Board ligunyaze umthetho olandelwayo wocwaningo kanye nefomu lemvume elaziswa ngesihloko, i-Ethics ID: E-24116. I-ClinicalTrials.gov inikeze inombolo ethi NCT01980927 ngemva kokubhaliswa kwalolu cwaningo (clinicaltrials.gov/ct2/show/NCT01980927).
Ukuqashwa kwesihloko kanye nokuhlolwa kwenzeke oHlelweni Lokuhlola Nokuphathwa Kwekhanda laseCalgary (CHAMP), umtholampilo wokudlulisela onguchwepheshe osuselwe kwi-neurology (bona Umfanekiso 1, Ithebula 1). I-CHAMP ihlola iziguli ezimelana ne-pharmacotherapy ejwayelekile kanye nokwelashwa kwekhanda le-migraine elingasanikezi ukukhululeka kwezimpawu ze-migraine. Odokotela bomndeni kanye nokunakekelwa okuyisisekelo bathumele izifundo ezingase zifundwe ku-CHAMP okwenza ukukhangisa kungenasidingo.
Umfanekiso 1: Isimo sesifundo nokugeleza kwesifundo (n = 11). I-GSA: I-Gravity Stress Analyzer. I-HIT-6: Isivivinyo Somphumela Wekhanda Elibuhlungu-6. I-HRQoL: Ikhwalithi Yempilo Ehlobene Nezempilo. I-MIDAS: I-Migraine Disability Assessment Scale. I-MSQL: Ikhwalithi Ye-Migraine-Specific of Life Measure. I-NUCCA: I-National Upper Cervical Chiropractic Association. I-PC-MRI: I-Phase Contrast Magnetic Resonance Imaging. I-VAS: I-Visual Analog Scale.
Ithebula 1: Imibandela yokufakwa/yokukhishwa kwesihloko. Izihloko ezingase zibe khona, eziye ekunakekelweni kwe-chiropractic yomlomo wesibeletho, zibonise phakathi kwezinsuku eziyishumi nezingamashumi amabili nesithupha zekhanda elibuhlungu ngenyanga ezizibikayo ezinyangeni ezine ezedlule. Okudingekayo kwakuyizinsuku okungenani eziyisishiyagalombili zekhanda ngenyanga, lapho ukuqina kwafinyelela okungenani ezine, esikalini sobuhlungu se-Visual Analog Scale (VAS) esiyiziro kuya kweshumi.
Ukufakwa kocwaningo kudinga amavolontiya, phakathi kweminyaka yobudala ye-21 kanye neminyaka engu-65, eyanelisa indlela ethile yokuxilonga yekhanda le-migraine. Isazi sezinzwa esinamashumi eminyaka ambalwa esipiliyoni se-migraine sihlole abafakizicelo abasebenzisa i-International Classification of Headache Disorders (ICHD-2) ukuze kufakwe isifundo [20]. Izifundo ezingase zibe khona, ezibhekene nokunakekelwa kwe-chiropractic yomlomo wesibeletho, kumele zibonise ngokuzibika phakathi kwezinsuku eziyishumi nezingamashumi amabili nesithupha zekhanda elibuhlungu ngenyanga ezinyangeni ezine ezedlule. Okungenani izinsuku eziyisishiyagalombili zezinhlungu zekhanda ngenyanga kwakufanele zifinyelele amandla okungenani amane esikalini sobuhlungu be-VAS eziro kuya kweziyishumi, ngaphandle kwalapho zelashwa ngempumelelo ngomuthi oqondene ne-migraine. Okungenani iziqephu ezine zekhanda ezihlukene ngenyanga ezihlukaniswe okungenani isikhawu samahora angu-24 esingenabuhlungu sasidingeka.
Ukuhlukumezeka kwekhanda noma intamo okuphawulekayo okwenzeka kungakapheli unyaka owodwa ngaphambi kokungenela ukutadisha akubandakanyi abantu abazobhapathizwa. Ezinye izindlela zokukhishwa zihlanganisa ukusetshenziswa ngokweqile kwemithi, umlando we-claustrophobia, isifo senhliziyo nemithambo yegazi noma i-cerebrovascular, nanoma yisiphi isifo se-CNS ngaphandle kwe-migraine. Ithebula 1 lichaza imibandela ephelele yokufakwa kanye nokukhishwa ecatshangelwayo. Ukusebenzisa i-neurologist eqinisekisiwe yebhodi ukuze ihlole izihloko ezingase zibe khona ngenkathi ibambelela ku-ICHD-2 futhi iqondiswa indlela yokufaka / yokukhishwa, ukukhishwa kwezifundo ngeminye imithombo yekhanda elibuhlungu njengokucindezeleka kwemisipha kanye nemithi ebuhlungu ekhanda elibuhlungu eliphindaphindiwe kungandisa amathuba okuphumelela. ukuqashwa kwezifundo.
Lezo zinqubo zokuqala zomhlangano zasayina imvume enolwazi futhi zabe seziqedela I-Migraine Disability Assessment Scale (MIDAS) eyisisekelo. I-MIDAS idinga amasonto ayishumi nambili ukukhombisa ushintsho olubalulekile emtholampilo [21]. Lokhu kwavumela ukuthi kudlule isikhathi esanele ukuze kubonakale noma yiziphi izinguquko ezingenzeka. Ezinsukwini ezilandelayo ze-28, abazobhapathizwa barekhoda idayari yekhanda elinikeza idatha eyisisekelo ngenkathi beqinisekisa inani lezinsuku zekhanda elibuhlungu kanye nokuqina okudingekayo ukuze kufakwe. Ngemuva kwamasonto amane, ukuqinisekiswa kokuhlolwa kwedayari kuvumele ukuphathwa kwezinyathelo ezisele zesisekelo ze-HRQoL:
- Ikhwalithi Ekhethekile Ye-Migraine Yokukala Ukuphila (MSQL) [22],
- Ukuhlolwa Komphumela Wekhanda Elibuhlungu-6 (HIT-6) [23],
- Isihloko sokuhlolwa komhlaba wonke kwamanje kobuhlungu bekhanda (VAS).
Ukudluliselwa kudokotela we-NUCCA, ukuze kunqunywe ukuba khona kokungahambi kahle kwe-atlas, isidingo esiqinisekisiwe sokungenelela ekuphothuleni ukufakwa kocwaningo lwesifundo?ukukhishwa. Ukungabi bikho kwezinkomba zokungahambi kahle kwe-atlas bekungabandakanyi amakhandidethi. Ngemuva kokuhlela ukuqokwa kokungenelela nokunakekelwa kwe-NUCCA, izihloko ezifanelekayo zithole izinyathelo eziyisisekelo ze-PC-MRI. Umfanekiso 1 ufingqa isimo sesifundo kulo lonke ucwaningo.
Ukungenelela kokuqala kwe-NUCCA kwakudinga ukuvakashelwa okuthathu okulandelanayo: (1) Usuku Lokuqala, ukuhlolwa kokungahambi kahle kwe-atlas, ama-radiographs ngaphambi kokulungiswa; (2) Usuku Lwesibili, ukulungiswa kwe-NUCCA nokuhlolwa kokulungiswa ngemva kokulungiswa ngama-radiographs; kanye (3) Nosuku Lwesithathu, ukuhlolwa kabusha ngemva kokulungiswa. Ukunakekelwa kokulandelela kwenzeka masonto onke amasonto amane, bese kuba njalo emavikini amabili ngesikhathi esisele socwaningo. Ekuvakasheni ngakunye kwe-NUCCA, izihloko zaqeda ukuhlolwa kwamanje kobuhlungu bekhanda (sicela ulinganise ubuhlungu bakho bekhanda ngokwesilinganiso phakathi nesonto eledlule) usebenzisa umkhawulo oqondile kanye nepensela ekumaka umugqa we-100?mm (VAS). Iviki elilodwa ngemva kokungenelela kokuqala, izifundo zagcwalisa uhlu lwemibuzo �Impendulo Engenzeka Ekunakekelweni. Lokhu kuhlola sekuke kwasetshenziselwa ukuqapha ngempumelelo izehlakalo ezimbi ezihlobene nezinqubo ezihlukahlukene zokulungiswa komlomo wesibeletho [24].
Ngesonto lesine, idatha ye-PC-MRI yatholwa futhi izifundo zaqeda i-MSQL ne-HIT-6. Ukuphela kocwaningo lwedatha ye-PC-MRI yaqoqwa ngeviki lesishiyagalombili kulandelwa i-interview yokuphuma kwe-neurologist. Lapha, izifundo ziqedele i-MSQOL yokugcina, i-HIT-6, i-MIDAS, ne-VAS imiphumela kanye namadayari ekhanda aqoqwe.
Ohambweni lukadokotela wezinzwa lwesonto-8, izifundo ezimbili ezizimisele zanikezwa ithuba lokulandela lesikhathi eside sesikhathi esiphelele sokufunda samaviki angama-24. Lokhu kuhilela ukuqhubeka nokuhlolwa kabusha kwe-NUCCA njalo ngenyanga ngamaviki e-16 ngemuva kokuphothulwa kwesifundo sokuqala seviki le-8. Inhloso yalokhu kulandelela kwakuwukusiza ukunquma ukuthi ukuthuthukiswa kwekhanda kuyaqhubeka yini kuncike ekugcinweni kokulungiswa kwe-atlas ngenkathi kubukwa noma yimuphi umphumela wesikhathi eside wokunakekelwa kwe-NUCCA ku-ICCI. Izihloko ezifisa ukubamba iqhaza zisayine imvume yesibili enolwazi yalesi sigaba sokufunda futhi zaqhubeka nokunakekelwa kwanyanga zonke kwe-NUCCA. Ekupheleni kwamaviki e-24 kusukela ekungeneleleni kokuqala kwe-atlas, isifundo sesine se-PC-MRI imaging senzeke. Engxoxweni yokuphuma kwe-neurologist, i-MSQOL yokugcina, i-HIT-6, i-MIDAS, ne-VAS imiphumela kanye namadayari ekhanda aqoqwe.
Inqubo efanayo ye-NUCCA njengoba kubikwe ngaphambilini yalandelwa kusetshenziswa iphrothokholi esungulwe kanye nezindinganiso zokunakekelwa ezithuthukiswe nge-NUCCA Certification yokuhlola nokulungiswa kabusha kwe-atlas noma ukulungiswa kwe-ASC (bheka Amanani ?Figures22�5) [2, 13, 25]. Ukuhlola kwe-ASC kufaka phakathi ukuhlolwa kokusebenza kokungalingani kobude bomlenze nge-Supine Leg Check (SLC) kanye nokuhlolwa kwe-postural symmetry kusetshenziswa i-Gravity Stress Analyzer (Upper Cervical Store, Inc., 1641 17 Avenue, Campbell River, BC, Canada V9W 4L5 ) (bheka Izibalo ?Imifanekiso22 kanye no-3(a)�3(c)) [26�28]. Uma i-SLC kanye nokungalingani kwe-postural kutholwa, ukuhlolwa kwe-radiographic yokubuka kathathu kuboniswa ukuze kunqunywe ukuqondiswa kwe-multidimensional kanye nezinga lokungalungi kahle kwe-craniocervical [29, 30]. Ukuhlaziywa kwe-radiographic okuphelele kunikeza ulwazi lokunquma isihloko esiqondile, isu elilungile lokulungisa i-atlas. Udokotela uthola izimpawu zendawo ze-anatomic ochungechungeni lokubuka okuthathu, ukulinganisa ama-engeli esakhiwo nawokusebenza achezukile kumazinga amisiwe we-orthogonal. Izinga lokungaqondani kahle nokuma kwe-atlas libe selivezwa ngezilinganiso ezintathu (bona Izibalo 4(a)�4(c)) [2, 29, 30]. Ukuqondanisa imishini ye-radiographic, ukuncishiswa kosayizi wembobo ye-collimator, izinhlanganisela zesikrini sefilimu esinesivinini esikhulu, izihlungi ezikhethekile, amagridi akhethekile, nokuvikela umthofu kunciphisa ukuchayeka emisebeni. Kulolu cwaningo, isilinganiso esiphelele esilinganisiwe Sokuchayeka Kwesikhumba Sokungena ezihlokweni kusukela ochungechungeni lwe-radiographic yangaphambi kokulungiswa lwalungu-352 millirads (3.52 millisieverts).
Umfanekiso 2: I-Supine Leg Check Screening Test (SLC). Ukubhekwa komlenze "omfishane" obonakalayo kubonisa ukuthi kungenzeka ukungahambi kahle kwe-atlas. Lezi zivela ngokulinganayo.
Umfanekiso 3: I-Gravity Stress Analyzer (GSA). (a) Idivayisi inquma i-postural asymmetry njengenkomba eyengeziwe yokungahambi kahle kwe-atlas. Okutholakele okuhle ku-SLC naku-GSA kukhombisa isidingo sochungechunge lwe-radiographic ye-NUCCA. (b) Isiguli esinokulinganisela esingenayo i-postural asymmetry. (c) Ama-hip caliper asetshenziselwa ukukala i-pelvis asymmetry.
Umfanekiso 4: Uchungechunge lwe-radiograph lwe-NUCCA. Lawa mafilimu asetshenziselwa ukunquma ukungahambi kahle kwe-atlas nokuthuthukisa isu lokulungisa. Ama-radiographs ngemva kokulungiswa noma amafilimu eposi aqinisekisa ukuthi ukulungiswa okungcono kakhulu kwenziwe kuleso sihloko.
Umfanekiso 5: Ukwenza ukulungiswa kwe-NUCCA. Udokotela we-NUCCA uletha ukulungiswa kokudonsa kwe-triceps. Umzimba kanye nezandla zikadokotela ziqondaniswe ukuze zilethe ukulungiswa kwe-atlas ngokuhambisana ne-vector yamandla afanele kusetshenziswa ulwazi olutholwe kuma-radiographs.
Ukungenelela kwe-NUCCA kuhilela ukulungiswa okubhaliwe kokungalungi kahle kwe-radiographically esakhiweni se-anatomical phakathi kwe-skull, i-atlas vertebra, nomgogodla womlomo wesibeletho. Esebenzisa izimiso ze-biomechanical ezisekelwe ohlelweni lwe-lever, udokotela wenza isu elifanele
- ukuma kwesihloko,
- isimo somsebenzi,
- phoqa i-vector ukulungisa ukungahambi kahle kwe-atlas.
Izihloko zibekwe etafuleni lokuma ohlangothini nekhanda eliboshwe ngokuqondile kusetshenziswa uhlelo lokusekela lwe-mastoid. Ukusetshenziswa kwevekhtha yamandla alawulwayo enqunywe kusengaphambili ukuze kulungiswe kuqondisa kabusha ugebhezi ku-atlas nentamo ku-eksisi eqondile noma isikhungo sokuqina komgogodla. Lawa mandla okulungisa alawulwa ngokujula, isiqondiso, isivinini, kanye ne-amplitude, akhiqiza ukuncishiswa okunembile nokunemba kwe-ASC.
Esebenzisa ithambo le-pisiform lesandla sokuxhumana, udokotela we-NUCCA uthinta inqubo ye-atlas transverse. Esinye isandla sizungeza isihlakala sesandla esithintanayo, ukulawula i-vector ngenkathi kugcinwa ukujula kwamandla akhiqizwa ekusetshenzisweni kwenqubo ye-�triceps pull� (bona Umfanekiso 5) [3]. Ngokuqonda i-spinal biomechanics, umzimba kadokotela nezandla ziqondaniswe ukuze kukhiqizwe ukulungiswa kwe-atlas eduze kwevector yamandla alungile. Amandla alawulwayo, angagxili asetshenziswa endleleni yokunciphisa enqunywe kusengaphambili. Iqondile ekuqondeni kwayo nasekujuleni kokwandisa ukuncishiswa kwe-ASC kuqinisekisa ukuthi akukho ukusebenza kwamandla asebenzayo emisipha yentamo ekuphenduleni ushintsho lwe-biomechanical. Kuyaqondwa ukuthi ukunciphisa okuhle kokungahambi kahle kukhuthaza ukugcinwa kwesikhathi eside nokuzinza kokuqondisa komgogodla.
Ukulandela isikhathi esifushane sokuphumula, inqubo yokuhlola ngemva kwalokho, efana nokuhlola kokuqala, iyenziwa. Ukuhlolwa kwe-radiograph yangemuva kokulungiswa kusebenzisa ukubukwa okubili ukuze kuqinisekiswe ukubuya kwekhanda nomgogodla womlomo wesibeletho kubhalansi ye-orthogonal enkulu. Izifundo zifundiswa ngezindlela zokulondoloza ukulungiswa kwazo, ngaleyo ndlela kuvinjwe okunye ukungahambi kahle.
Ukuvakasha kwe-NUCCA okwalandela kwakuhlanganisa ukuhlolwa kwedayari yekhanda kanye nokuhlolwa kwamanje kobuhlungu bekhanda (VAS). Ukungalingani kobude bomlenze kanye ne-asymmetry ye-postural ngokweqile kwasetshenziswa ekunqumeni isidingo sokunye ukungenelela kwe-atlas. Inhloso yokwenza ngcono kakhulu ukuthi isihloko sigcine ukulungiswa kabusha isikhathi eside ngangokunokwenzeka, ngenombolo embalwa yokungenelela kwe-atlas.
Ngokulandelana kwe-PC-MRI, imidiya yokuqhathanisa ayisetshenziswa. Izindlela ze-PC-MRI ziqoqe amasethi edatha amabili anamanani ahlukene okuzwela kokugeleza atholwe ngokuphathelene namapheya e-gradient, ahlehlisa ngokulandelana futhi ahlehlise ama-spins phakathi nokulandelana. Idatha eluhlaza evela kumasethi amabili iyasuswa ukuze kubalwe izinga lokugeleza.
Ukuvakasha endaweni okwenziwa yi-MRI Physicist kunikeze ukuqeqeshwa kwe-MRI Technologist futhi kwasungulwa inqubo yokudlulisa idatha. Ukuskena okuningana nokudluliswa kwedatha kwenziwa ukuze kuqinisekiswe ukuqoqwa kwedatha kuphumelela ngaphandle kwezinselele. Iskena se-1.5-tesla GE 360 Optima MR (Milwaukee, WI) esikhungweni sokucabanga socwaningo (EFW Radiology, Calgary, Alberta, Canada) sasetshenziswa ekuthwebuleni nasekuqoqweni kwedatha. Ikhoyili yekhanda lesigaba esinezigaba eziyi-12, ukulandelana kwe-3D okulungiselelwe ukuzibuthe okulungiselelwe ukutholwa kwe-gradient echo (MP-RAGE) kusetshenziswe ukulandelana kwe-anatomy. Idatha ebucayi yokugeleza itholwe kusetshenziswa indlela yokutholwa ehambisanayo (iPAT), i-acceleration factor 2.
Ukuze kulinganiswe ukugeleza kwegazi ukuya nokusuka kusisekelo sogebhezi, amaskena amabili afakwe ku-cine-phase-contrast afakwe ngekhodi yesivinini afakwe isivinini njengoba kunqunywa ukushaya kwenhliziyo ngakunye, kuqoqwe izithombe ezingamashumi amathathu nambili ngomjikelezo wenhliziyo. I-high-velocity encoding (70?cm/s) enesivinini esiphezulu sokugeleza kwegazi okuhambisana nemikhumbi ezingeni le-C-2 vertebra ihlanganisa i-carotid arteries yangaphakathi (ICA), i-vertebral arteries (VA), kanye ne-jugular veins yangaphakathi (IJV). ). Idatha yesibili ye-venous flow ye-vertebral veins (VV), i-epidural veins (EV), ne-deep cervical veins (DCV) itholwe ekuphakameni okufanayo kusetshenziswa ukulandelana kwe-low-velocity encoding (7�9?cm/s).
Idatha yesihloko ikhonjwe nge-ID Yesifundo Sesihloko kanye nedethi yokufunda yesithombe. I-neuroradiologist yocwaningo ibuyekeze ukulandelana kwe-MR-RAGE ukuze kukhishwe izimo ze-pathologic ezingafakwanga. Izihlonzi zesihloko zibe sezikhishwa futhi zabelwa i-ID enekhodi evumela ukudluliswa ngephrothokholi ye-IP yomhubhe ovikelekile kuchwepheshe wefiziksi ukuze ahlaziywe. Kusetshenziswa igazi le-volumetric yesofthiwe yobunikazi, amafomu esilinganiso sokugeleza kwe-Cerebrospinal Fluid (CSF) kanye nemingcele etholiwe kuye kwanqunywa (inguqulo ye-MRICP 1.4.35 Alperin Noninvasive Diagnostics, Miami, FL).
Ngokusetshenziswa kwesegmentation esekelwe ku-pulsatility-based of lumens, amazinga okugeleza kwevolumu ancike esikhathini abalwe ngokuhlanganisa isivinini sokugeleza ngaphakathi kwezindawo eziphambanayo zokukhanya kuzo zonke izithombe ezingamashumi amathathu nambili. Amazinga okugeleza amaphakathi atholwa emithanjeni yomlomo wesibeletho, ukugeleza kwe-venous okuyinhloko, kanye nezindlela zokuphuma kwe-venous yesibili. Isamba sokugeleza kwegazi lobuchopho satholwa ngokuhlanganisa lawa mazinga okugeleza amaphakathi.
Incazelo elula yokuthobela isilinganiso somthamo noshintsho lwengcindezi. Ukuthobelana kwe-intracranial kubalwa kusukela kusilinganiso sokushintsha kwevolumu ye-intracranial maximal (systolic) (ICVC) kanye nokuguquguquka kwengcindezi phakathi nomjikelezo wenhliziyo (PTP-PG). Ushintsho ku-ICVC lutholakala ngokuhlukana kwesikhashana phakathi kwevolumu yegazi ne-CSF engena futhi ephuma ku-cranium [5, 31]. Ukushintsha kwengcindezi phakathi nomjikelezo wenhliziyo kususelwa ekushintsheni kwe-CSF pressure gradient, ebalwa kusukela ezithombeni ze-MR ezifakwe isivinini sokugeleza kwe-CSF, kusetshenziswa ubuhlobo be-Navier-Stokes phakathi kokuphuma kokuphuma kwesivinini kanye ne-gradient yokucindezela [5, 32]. ]. Inkomba ye-intracranial compliance (ICCI) ibalwa kusukela kusilinganiso se-ICVC kanye nezinguquko zengcindezi [5, 31�33].
Ukuhlaziywa kwezibalo kucabangele izici ezimbalwa. Ukuhlaziywa kwedatha ye-ICCI kwakuhilela ukuhlolwa kwesampula eyodwa ye-Kolmogorov-Smirnov eveza ukuntuleka kokusabalalisa okuvamile kudatha ye-ICCI, ngakho-ke eyachazwa kusetshenziswa ububanzi be-median ne-interquartile (IQR). Umehluko phakathi kwesisekelo kanye nokulandelela bekumele uhlolwe kusetshenziswa ukuhlolwa kuka-t okubhangqiwe.
Idatha yokuhlola ye-NUCCA ichazwe kusetshenziswa i-mean, median, ne-interquartile range (IQR). Umehluko phakathi kwesisekelo kanye nokulandelela uhlolwe kusetshenziswa ukuhlolwa kwe-t okubhangqiwe.
Ngokuya ngesilinganiso somphumela, isisekelo, isonto lesine, isonto lesishiyagalombili, nesonto leshumi nambili (MIDAS kuphela) amanani okulandelela achazwe kusetshenziswa ukuchezuka kwesilinganiso nokujwayelekile. Idatha ye-MIDAS eqoqwe ekuhlolweni kokuqala kwe-neurologist ibe nephuzu elilodwa lokulandelela ekupheleni kwamasonto ayishumi nambili.
Umehluko kusukela kusisekelo ukuya ekuvakasheni ngakunye kokulandelela uhlolwe kusetshenziswa ukuhlolwa kuka-t okubhangqiwe. Lokhu kubangele amanani amaningi we-p kusukela ekuvakasheni okubili kokulandelela kumphumela ngamunye ngaphandle kwe-MIDAS. Njengoba inhloso eyodwa yalokhu kuhlola iwukunikeza izilinganiso zocwaningo lwangomuso, bekubalulekile ukuchaza lapho umehluko wenzeke khona, kunokusebenzisa i-ANOVA yendlela eyodwa ukuze ufike enanini elingu-p lesilinganiso ngasinye. Ukukhathazeka ngokuqhathanisa okuningi okunjalo ukukhuphuka kwezinga lephutha loHlobo I.
Ukuze kuhlaziywe idatha ye-VAS, amaphuzu esifundo ngasinye ahlolwa ngawodwana bese kuba ngomugqa wokuhlehla olingana kahle nedatha. Ukusetshenziswa kwemodeli yokuhlehla kwamaleveli amaningi kukho kokubili ukungenelela okungahleliwe kanye nemithambeka engahleliwe kunikeze umugqa wokuhlehla ngamunye ofakwe isiguli ngasinye. Lokhu kuhlolwe ngemodeli yokunqamuka okungahleliwe kuphela, elingana umugqa wokuhlehla womugqa onethambeka elivamile lazo zonke izifundo, kuyilapho amatemu okuthika avunyelwe ukuhluka. Imodeli ye-coefficient engahleliwe yamukelwe, njengoba abukho ubufakazi bokuthi imithambeka engahleliwe ithuthukise ngokuphawulekayo ukulingana kwedatha (kusetshenziswa izibalo zesilinganiso sokungenzeka). Ukubonisa ukuhluka kwezindlela zokunqanda kodwa hhayi emthambekeni, imigqa yokuhlehla ngabanye yenziwe igrafu yesiguli ngasinye ngomugqa wokuhlehla ophakathi obekiwe phezulu.
Imiphumela
Kusukela ekuhlolweni kokuqala kwe-neurologist, amavolontiya ayishumi nesishiyagalombili afanelekile ukufakwa. Ngemuva kokuphothulwa kwedayari yekhanda eliyisisekelo, abakhethiweyo abahlanu abazange bahlangabezane nemigomo yokufakwa. Abathathu babengenazo izinsuku zekhanda ezidingekayo kumadayari ayisisekelo okufanele afakwe, omunye wayenezimpawu ezingavamile zezinzwa ezinobunzima obuqhubekayo obungahlangene, kanti omunye wayethatha isivimbeli sesiteshi se-calcium. Udokotela we-NUCCA uthole abantu ababili abazobhapathizwa bengafanelekile: oyedwa wayengenakho ukungahambi kahle kwe-atlas kanti eyesibili enesimo se-Wolf-Parkinson-White kanye nokuhlanekezela okukhulu kwe-postural (39�) ngokubandakanyeka kwakamuva engozini yemoto enamandla kakhulu ene-whiplash (bona Umfanekiso 1) .
Izifundo eziyishumi nanye, abesifazane abayisishiyagalombili nabesilisa abathathu, isilinganiso seminyaka engamashumi amane nanye (ibanga leminyaka engu-21�61), abafanelekele ukufakwa. Izihloko eziyisithupha zethule i-migraine engapheli, zibika izinsuku eziyishumi nanhlanu noma ngaphezulu zekhanda ngenyanga, nengqikithi yesihloko esiyishumi nanye sezinsuku zekhanda le-14.5 ngenyanga. Ubude bezimpawu ze-Migraine babusukela eminyakeni emibili kuya kwengamashumi amathathu nanhlanu (okusho iminyaka engamashumi amabili nantathu). Yonke imithi igcinwe ingashintshiwe isikhathi sokufunda ukuze ifake imishanguzo yabo ye-migraine prophylaxis njengoba kunqunyiwe.
Ngokwemibandela yokukhishwa, azikho izifundo ezifakiwe ezithole ukuxilongwa kwekhanda elibangelwa ukulimala okubuhlungu ekhanda nasentanyeni, ukungqubuzana, noma ikhanda elibuhlungu eliqhubekayo okuthiwa i-whiplash. Izifundo eziyisishiyagalolunye zibike umlando okude kakhulu odlule, omkhulu kuneminyaka emihlanu noma ngaphezulu (isilinganiso seminyaka eyisishiyagalolunye) ngaphambi kwesikrini se-neurologist. Lokhu kwakuhlanganisa ukulimala kwekhanda okuhlobene nezemidlalo, ukungqubuzana, kanye/noma i-whiplash. Izifundo ezimbili azizange zibonise ukulimala kwekhanda noma intamo ngaphambili (bheka Ithebula 2).
Ithebula 2: Idatha yesihloko sokuthobela i-intracranial compliance (ICCI) (n = 11). I-PC-MRI6 ithole idatha ye-ICCI1 ebikwe ekuqaleni, isonto lesine, nesonto lesishiyagalombili kulandela ukungenelela kwe-NUCCA5. Imigqa egqamile isho isihloko ngomzila wesibili wokukhipha umthambo. I-MVA noma i-mTBI yenzeka okungenani iminyaka emi-5 ngaphambi kokufakwa kocwaningo, isilinganiso seminyaka eyi-10.
Ngamunye, izifundo ezinhlanu zibonise ukwanda kwe-ICCI, amanani ezifundo ezintathu ahlala efana ngokuyisisekelo, futhi ezintathu zibonise ukwehla ukusuka kwesisekelo kuya ekupheleni kwezilinganiso zocwaningo. Izinguquko sezizonke ekuthotshelweni kwe-intracranial zibonwa kuThebula 2 nakuMfanekiso 8. Amanani amaphakathi (IQR) e-ICCI ayengu-5.6 (4.8, 5.9) ekuqaleni, 5.6 (4.9, 8.2) ngeviki lesine, kanye no-5.6 (4.6, 10.0) ku-baseline. isonto lesishiyagalombili. Umehluko ubungahlukanga ngokwezibalo. Umehluko omaphakathi phakathi kwesisekelo nesonto lesine kwakungu-?0.14 (95% CI ?1.56, 1.28), p = 0.834, futhi phakathi kwesisekelo nesonto lesishiyagalombili kwaba ngu-0.93 (95% CI ?0.99, 2.84), p = 0.307. Imiphumela yalezi zifundo ezimbili ze-ICCI yamaviki angu-24 ibonakala kuThebula 6. Isihloko esingu-01 sibonise ukuthambekela okukhulayo ku-ICCI kusuka ku-5.02 ekuqaleni kuya kokungu-6.69 ngeviki 24, kanti ngeviki lesi-8, imiphumela yatolikwa njengengaguquguquki noma ihlala ifana. Isihloko se-02 sibonise inkambiso enciphayo ku-ICCI kusukela kusisekelo se-15.17 kuya ku-9.47 ngeviki 24.
Umfanekiso 8: Ucwaningo lwedatha ye-ICCI uma kuqhathaniswa nedatha ebikwe ngaphambilini ezincwadini. Amanani wesikhathi se-MRI anqunyelwe ekuqaleni, isonto le-4, nesonto le-8 ngemuva kokungenelela. Amanani ayisisekelo alolu cwaningo awela ngokufana nedatha ebikwe yi-Pomschar ezihlokweni ezethula kuphela nge-mTBI.
Ithebula 6: Okutholwe yi-ICCI yamaviki angu-24 okubonisa ukuthambekela okukhulayo esihlokweni esingu-01 kuyilapho ekupheleni kocwaningo (isonto lesi-8), imiphumela yahunyushwa njengokungaguquguquki noma ukuhlala okufanayo. Isihloko se-02 siqhubekile nokubonisa inkambiso enciphayo ku-ICCI.
Ithebula le-3 libika izinguquko ekuhloleni kwe-NUCCA. Umehluko ojwayelekile kusukela ngaphambili kuya ngemva kokungenelela umi kanje: (1) SLC: 0.73 amayintshi, 95% CI (0.61, 0.84) (p <0.001); (2) GSA: 28.36 amaphuzu esikali, 95% CI (26.01, 30.72) (p <0.001); (3) I-Atlas Laterality: 2.36 degrees, 95% CI (1.68, 3.05) (p <0.001); kanye (4) ne-Atlas Rotation: 2.00 degrees, 95% CI (1.12, 2.88) (p <0.001). Lokhu kuzobonisa ukuthi ushintsho olungenzeka lwenzeke ngemva kokungenelela kwe-atlas njengokusekelwe ekuhlolweni kwesihloko.
Ithebula 3: Izibalo ezichazayo [incazelo, ukuchezuka okujwayelekile, i-median, ne-interquartile range (IQR2)] yokuhlola kwe-NUCCA1 ngaphambi-ngemuva kokungenelela kokuqala (n = 11).
Imiphumela yedayari yekhanda elibuhlungu ibikwa ku Ithebula 4 kanye nomfanekiso 6. Ezifundweni eziyisisekelo zazinezinsuku zekhanda le-14.5 (SD = 5.7) ngenyanga ye-28. Ngenyanga yokuqala elandela ukulungiswa kwe-NUCCA, izinsuku ezibuhlungu zekhanda ngenyanga ziyancipha ngezinsuku ze-3.1 kusukela ekuqaleni, i-95% CI (0.19, 6.0), p = 0.039, kuya ku-11.4. Ngenyanga yesibili izinsuku zekhanda lekhanda lehle ngezinsuku ezingu-5.7 kusukela ekuqaleni, i-95% CI (2.0, 9.4), p = 0.006, kuya ezinsukwini ezingu-8.7. Ngesonto lesishiyagalombili, izifundo eziyisithupha kweziyishumi nanye ziye zancishiswa> 30% ezinsukwini zekhanda ngenyanga. Emavikini e-24, isihloko se-01 sibike ukuthi alukho ushintsho ezinsukwini zekhanda ngenkathi isihloko se-02 sinokuncishiswa kosuku olulodwa lwekhanda ngenyanga kusukela ekuqaleni kocwaningo lwesikhombisa kuya ekupheleni kwemibiko yokutadisha yezinsuku eziyisithupha.
Umfanekiso 6: Izinsuku zokukhanda ikhanda kanye nokuqina kobuhlungu bekhanda kusuka kwidayari (n = 11). (a) Inani lezinsuku zekhanda ngenyanga. (b) Ukuqina kwekhanda elimaphakathi (ngezinsuku zekhanda elibuhlungu). Umbuthano ukhombisa incazelo kanye nebha ikhombisa i-CI engama-95%. Imibuthano amaphuzu esifundo ngasinye. Ukwehla okuphawulekayo kwezinsuku zekhanda ngenyanga kwaqashelwa emasontweni amane, cishe kabili emasontweni ayisishiyagalombili. Izifundo ezine (#4, 5, 7, and 8) zibonise ukwehla okukhulu kuno-20% ekuqineni kwekhanda. Ukusetshenziswa kanyekanye kwemithi kungase kuchaze ukwehla okuncane kokuqina kwekhanda.
Ekuqaleni, ukuqina kwekhanda elikushoyo ngezinsuku ezinekhanda elibuhlungu, esikalini se-zero kuya kweshumi, kwakuyi-2.8 (SD = 0.96). Ukuqina kwekhanda elikushoyo akubonisi ushintsho oluphawulekayo lwezibalo kumaviki amane (p = 0.604) namaviki ayisishiyagalombili (p = 0.158). Izifundo ezine (#4, 5, 7, and 8) zibonise ukwehla okukhulu kuno-20% ekuqineni kwekhanda.
Ikhwalithi yokuphila kanye nezinyathelo zokukhubazeka kwekhanda kubonakala kuThebula 4. Isilinganiso sesilinganiso se-HIT-6 ekuqaleni sasingu-64.2 (SD = 3.8). Ngesonto lesine ngemuva kokulungiswa kwe-NUCCA, ukuncipha kwesilinganiso samanani kwaba ngu-8.9, 95% CI (4.7, 13.1), p = 0.001. Amaphuzu eviki lesishiyagalombili, uma kuqhathaniswa nesisekelo, aveze ukwehla kwesilinganiso ngo-10.4, 95% CI (6.8, 13.9), p = 0.001. Eqenjini lamasonto angama-24, isihloko se-01 sibonise ukwehla kwamaphuzu we-10 kusuka ku-58 ngeviki lesi-8 kuya ku-48 ngeviki lama-24 ngenkathi isihloko se-02 sehle amaphuzu angu-7 sisuka ku-55 ngeviki lesi-8 saya ku-48 ngeviki le-24 (bheka Umfanekiso 9).
Umfanekiso 9: Izikolo ze-HIT-24 zamaviki angu-6 ezifundweni zokulandelela zesikhathi eside. Izikolo zanyanga zonke zaqhubeka zehla ngemva kwesonto lesi-8, ukuphela kwesifundo sokuqala. Ngokusekelwe ku-Smelt et al. imibandela, ingahunyushwa ukuthi inguquko engaphakathi komuntu ebaluleke kancane yenzeke phakathi kweviki lesi-8 neviki lama-24. I-HIT-6: Isivivinyo Somphumela Wekhanda Elibuhlungu-6.
Isilinganiso sesisekelo se-MSQL sisho amaphuzu angu-38.4 (SD = 17.4). Ngesonto lesine ngemva kokulungiswa, amaphuzu asho kuzo zonke izifundo eziyishumi nanye akhuphuke (athuthukisiwe) ngo-30.7, 95% CI (22.1, 39.2), p <0.001. Ngesonto lesishiyagalombili, ekupheleni kocwaningo, kusho ukuthi amaphuzu e-MSQL anyukile ukusuka kwesisekelo ngo-35.1, 95% CI (23.1, 50.0), p <0.001, kuya ku-73.5. Izifundo ezilandelwayo ziqhubekile nokubonisa ukuthuthuka okuthile ngamaphuzu akhulayo; kodwa-ke, amaphuzu amaningi akhuphuke ahlala efana kusukela ngeviki lesi-8 (bona iMifanekiso 10(a)�10(c)).
Umfanekiso 10: ((a)�(c)) Izikolo ze-MSQL zamaviki angu-24 ezifundweni zokulandelela zesikhathi eside. (a) Isihloko 01 siye sakhula ngemva kwesonto lesi-8 kuze kube sekupheleni kocwaningo lwesibili. Isihloko esingu-02 sibonisa izikolo ezikhuphukayo ngokuhamba kwesikhathi ebonisa umehluko obaluleke kancane ngokusekelwe ku-Cole et al. inqubo ngeviki 24. (b) Izikolo zesihloko zibonakala ziphakeme ngeviki lesi-8 kuzo zombili izifundo ezibonisa amaphuzu afanayo abikwe ngeviki 24. (c) Izibalo zesihloko se-2 zihlala zingashintshi phakathi nocwaningo kuyilapho isihloko se-01 sibonisa ukuthuthukiswa okuqhubekayo kusukela kwesisekelo kuze kube sekupheleni iviki 24. MSQL: Migraine-Specific Quality of Life Measure.
Isilinganiso se-MIDAS esimaphakathi ekuqaleni sasingu-46.7 (SD = 27.7). Ezinyangeni ezimbili ngemuva kokulungiswa kwe-NUCCA (izinyanga ezintathu ezilandela isisekelo), ukuncipha kwesilinganiso kumaphuzu we-MIDAS wesifundo kwaba ngu-32.1, 95% CI (13.2, 51.0), p = 0.004. Izifundo ezilandelwayo ziqhubekile nokubonisa ukuthuthuka ngamaphuzu anciphayo ngokushuba okubonisa ukuthuthukiswa okuncane (bona Izibalo 11(a)�11(c)).
Umfanekiso 11: Izikolo ze-MIDAS zamaviki angu-24 ezifundweni zokulandelela zesikhathi eside. (a) Isamba sesikolo se-MIDAS siqhubekile nokuthambekela okunciphayo phakathi nesikhathi sokufunda samaviki angama-24. (b) Ukuqina kwamaphuzu kuyaqhubeka nokwenza ngcono. (c) Nakuba imvamisa yamaviki angu-24 yayiphezulu kunesonto lesi-8, ukuthuthukiswa kuyabonakala uma kuqhathaniswa nesisekelo. I-MIDAS: I-Migraine Disability Assessment Scale.
Ukuhlolwa kobuhlungu bekhanda bamanje kusuka kudatha yesilinganiso se-VAS kubonakala ku-Figure 7. Imodeli yokunciphisa umugqa we-multilevel ibonise ubufakazi bomphumela ongahleliwe we-intercept (p <0.001) kodwa hhayi ku-slope (p = 0.916). Ngakho-ke, imodeli yokunqamula okungahleliwe eyamukelwayo yalinganisela ukuthinta okuhlukile kwesiguli ngasinye kodwa umthambeka ovamile. I-slope elinganiselwe yalo mugqa yayingu-?0.044, 95% CI (?0.055, ?0.0326), p <0.001, okubonisa ukuthi kube nokwehla okuphawulekayo kumphumela we-VAS we-0.44 ngezinsuku ezingu-10 ngemuva kwesisekelo (p <0.001). Isilinganiso samaphuzu ayisisekelo sasingu-5.34, 95% CI (4.47, 6.22). Ukuhlaziywa kwemiphumela engahleliwe kubonise ukuhluka okukhulu kumphumela wesisekelo (SD = 1.09). Njengoba ukungenelela okungahleliwe kuvame ukusatshalaliswa, lokhu kukhombisa ukuthi ama-95% anjalo aphakathi kuka-3.16 no-7.52 okunikeza ubufakazi bokuhluka okukhulu kumanani ayisisekelo kuzo zonke iziguli. Izikolo ze-VAS ziqhubekile nokubonisa ukuthuthukiswa eqenjini le-24-isonto lokulandela izifundo ezimbili (bheka Umfanekiso we-12).
Umfanekiso 7: Isihloko sokuhlolwa kwekhanda lomhlaba wonke (VAS) (n = 11). Kube nokuhluka okukhulu kwamaphuzu ayisisekelo kuzo zonke lezi ziguli. Imigqa ibonisa ukulingana komugqa ngakunye kwesiguli ngasinye kweziyishumi nanye. Ulayini omnyama onamachashazi awugqinsi umele isilinganiso sokulingana komugqa kuzo zonke iziguli eziyishumi nanye. I-VAS: I-Visual Analog Scale.
Umfanekiso 12: I-24-isonto lokulandela ukuhlolwa kweqembu lomhlaba jikelele kwekhanda elibuhlungu (VAS). Lapho izifundo zibuzwa, �sicela ukale ubuhlungu bekhanda lakho ngokwesilinganiso phakathi nesonto eledlule� Amaphuzu e-VAS aqhubekile abonisa ukuthuthuka eqenjini lamaviki angu-24 lokulandelela izifundo ezimbili.
Ukusabela okusobala kakhulu ekungeneleleni kwe-NUCCA nokunakekelwa okubikwe yizihloko eziyishumi kwakuwukungakhululeki kwentamo encane, kulinganiswe isilinganiso sokuthathu kwabayishumi ekuhloleni ubuhlungu. Ezifundweni eziyisithupha, ubuhlungu baqala amahora angaphezu kwamashumi amabili nane ngemva kokulungiswa kwe-atlas, okuhlala amahora angaphezu kwamashumi amabili nane. Asikho isihloko esibike umthelela obalulekile emisebenzini yabo yansuku zonke. Zonke izifundo zibike ukwaneliseka ngokunakekelwa kwe-NUCCA ngemuva kwesonto elilodwa, amaphuzu amaphakathi, ayishumi, esikalini sokulinganisa se-zero kuya kweziyishumi.
Ukuqonda kukaDkt Alex Jimenez
“Sekuyiminyaka eminingi ngiphathwa yikhanda elibuhlungu. Ingabe sikhona isizathu sobuhlungu bekhanda lami? Ngingenzani ukuze nginciphise noma ngiqede izimpawu zami?”�Ikhanda le-Migraine kukholakala ukuthi liwuhlobo oluyinkimbinkimbi lobuhlungu bekhanda, noma kunjalo, isizathu sazo siyafana nanoma yiluphi olunye uhlobo lwekhanda. Ukulimala okudabukisayo emgodleni womlomo wesibeletho, okufana ne-whiplash engozini yemoto noma ukulimala kwezemidlalo, kungabangela ukungahambi kahle entanyeni nangaphezulu, okungase kuholele ku-migraine. Ukuma okungafanele nakho kungabangela izinkinga zentamo ezingaholela ebuhlungu bekhanda nentamo. Uchwepheshe wezokunakekelwa kwempilo ogxile ezindabeni zempilo yomgogodla angaxilonga umthombo wekhanda lakho le-migraine. Ngaphezu kwalokho, uchwepheshe oqeqeshiwe futhi onolwazi angenza izinguquko zomgogodla kanye nokuxhaphaza ngesandla ukuze asize ukulungisa noma yikuphi ukungahambi kahle komgogodla okungase kubangele izimpawu. Isihloko esilandelayo sifingqa ucwaningo lwecala olusekelwe ekuthuthukisweni kwezimpawu ngemva kokulungiswa kabusha kwe-atlas vertebrae kubahlanganyeli abane-migraine.
Ingxoxo
Kuleli qembu elilinganiselwe lezihloko eziyishumi nanye ze-migraine, kwakungekho ushintsho oluphawulekayo lwezibalo ku-ICCI (umphumela oyinhloko) ngemuva kokungenelela kwe-NUCCA. Kodwa-ke, ushintsho olubalulekile emiphumeleni yesibili ye-HRQoL lwenzeka njengoba kufingqiwe kuThebula 5. Ukungaguquguquki kobukhulu kanye nesiqondiso sokuthuthukiswa kuzo zonke lezi zinyathelo ze-HRQoL kubonisa ukuzethemba ekuthuthukiseni impilo yekhanda phakathi nocwaningo lwezinyanga ezimbili olulandela isikhathi sokuqala sezinsuku ezingu-28. .
Ithebula 5: Ukuqhathaniswa Okufingqiwe Kwemiphumela Elinganisiwe
Ngokusekelwe emiphumeleni yocwaningo lwecala, lolu phenyo lubonisa ukwanda okuphawulekayo kwe-ICCI ngemuva kwe- ukungenelela kwe-atlas okungabonwanga. Ukusetshenziswa kwe-PC-MRI kuvumela ukulinganiswa kobudlelwano obunamandla phakathi kokungena kwe-arterial, ukuphuma kwe-venous, nokugeleza kwe-CSF phakathi kwe-cranium nomsele womgogodla [33]. Inkomba ye-Intracranial compliance (ICCI) ikala ikhono lobuchopho lokuphendula egazini le-arterial elingenayo ngesikhathi se-systole. Ukuhunyushwa kwalokhu kugeleza okuguquguqukayo kuvezwa ubudlelwano obubodwa obukhona phakathi kwevolumu ye-CSF nengcindezi ye-CSF. Ngokunyuka noma okuphezulu kokuthobelana kwe-intracranial, okubuye kuchazwe njengendawo eyisinxephezelo enhle, igazi elingenayo le-arterial lingakwazi ukufakwa okuqukethwe ngaphakathi kwe-intracranial ngoshintsho oluncane kungcindezi ye-intracranial. Nakuba ukuguqulwa kwevolumu ye-intracranial noma ingcindezi ingase yenzeke, ngokusekelwe esimweni esicacile sobudlelwane bokucindezela kwevolumu, ushintsho ku-ICCI ngemva kokungenelela kungase kungenzeki. Ukuhlaziywa okuthuthukisiwe kwedatha ye-MRI kanye nocwaningo olwengeziwe kuyadingeka ukuze kukhonjwe amapharamitha asebenzisekayo alinganisekayo ukuze asetshenziswe njengomphumela obucayi obucayi wokubhala ngoshintsho lwe-physiologic kulandela ukulungiswa kwe-atlas.
Koerte et al. imibiko yeziguli ezingapheli ze-migraine ibonisa isihlobo esiphezulu se-venous drainage (i-paraspinal plexus) endaweni ephansi uma kuqhathaniswa nokulawula okuhambisana nobudala nobulili [34]. Izifundo ezine zocwaningo zibonise ukugeleza kwe-venous yesibili ezintathu zalezo zifundo ezibonisa ukwanda okuphawulekayo kokuthobela ngemva kokungenelela. Ukubaluleka akwaziwa ngaphandle kocwaningo olwengeziwe. Ngokufanayo, uPomschar et al. babike ukuthi izihloko ezinokulimala okuncane kobuchopho (mTBI) zibonisa ukugeleza okukhulayo ngomzila wesibili we-venous paraspinal [35]. Inkomba emaphakathi yokuthobelana kwe-intracranial ibonakala iphansi kakhulu kuqoqo le-mTBI uma iqhathaniswa nezilawuli.
Omunye umbono ungase uzuzwe uma kuqhathaniswa nedatha ye-ICCI yalolu cwaningo ezifundweni ezijwayelekile ezibikwe ngaphambilini kanye nalezo ezine-mTBI ezibonwe kuMfanekiso 8 [5, 35]. Kukhawulelwe ngenani elincane lezifundo ezifundwayo, ukubaluleka kwalokhu okutholwe yilolu cwaningo okungenzeka kube nakho ngokuhlobene ne-Pomschar et al. kuhlala kungaziwa, kunikeza kuphela ukuqagela kwamathuba okuhlola okuzayo. Lokhu kuphinde kube nzima ngoshintsho lwe-ICCI olungaguquki olubonwe ezifundweni ezimbili ezilandelwe amasonto e-24. Isihloko sesibili esinephethini yesibili yokukhipha amanzi sibonise ukwehla kwe-ICCI kulandela ukungenelela. Isilingo esikhulu esilawulwa yi-placebo esinosayizi wesampula wesifundo esibalulekile ngokwezibalo singase sibonise ushintsho oluqondile olulinganiselwe lwe-physiologic ngemuva kokusetshenziswa kwenqubo yokulungisa ye-NUCCA.
Izinyathelo ze-HRQoL zisetshenziswa emtholampilo ukuze kuhlolwe ukuphumelela kwesu lokwelapha ukunciphisa ubuhlungu nokukhubazeka okuhlobene nekhanda le-migraine. Kulindeleke ukuthi ukwelashwa okuphumelelayo kuthuthukisa ubuhlungu obubonwa isiguli nokukhubazeka kukalwa yilawa mathuluzi. Zonke izinyathelo ze-HRQoL kulolu cwaningo zibonise ukuthuthukiswa okuphawulekayo nokukhulu ngeviki lesine kulandela ukungenelela kwe-NUCCA. Kusukela evikini lesine kuya kwelesishiyagalombili kwaphawulwa kuphela ukuthuthukiswa okuncane. Futhi, ukuthuthukiswa okuncane kuphela okuphawulwe ezifundweni ezimbili ezilandelwe amasonto e-24. Nakuba lolu cwaningo lwalungahloselwe ukukhombisa i-causation evela ekungeneleleni kwe-NUCCA, imiphumela ye-HRQoL idala isithakazelo esicindezelayo sokufunda okuqhubekayo.
Kusukela kudayari yekhanda, ukwehla okuphawulekayo kwezinsuku zekhanda ngenyanga kwaqashelwa emasontweni amane, cishe kabili emasontweni ayisishiyagalombili. Kodwa-ke, umehluko omkhulu ekuqineni kwekhanda ngokuhamba kwesikhathi awuzange ubonakale kule datha yedayari (bheka Umfanekiso 5). Nakuba inani lekhanda elibuhlungu liyancipha, izihloko zisasebenzisa imithi ukuze zigcine ukuqina kwekhanda emazingeni abekezelelekayo; ngakho-ke, kucatshangwa ukuthi umehluko obalulekile ngokwezibalo ekuqineni kwekhanda alikwazanga ukunqunywa. Ukuvumelana kwezinombolo zosuku lwekhanda elibuhlungu okwenzeka ngesonto le-8 ezifundweni ezilandelwayo kungaqondisa ukugxila kocwaningo lwesikhathi esizayo ekunqumeni ukuthi ukuthuthukiswa okuphezulu kwenzeka nini ukuze kusize ekusunguleni izinga le-NUCCA lokunakekelwa kwe-migraine.
Ushintsho oluhlobene ngokomtholampilo ku-HIT-6 lubalulekile ukuze uqonde ngokuphelele imiphumela ephawuliwe. Ushintsho olubalulekile ngokomtholampilo lwesiguli ngasinye luchazwe umhlahlandlela wabasebenzisi be-HIT-6 ngokuthi ?5 [36]. U-Coeytaux et al., esebenzisa izindlela ezine zokuhlaziya ezihlukene, aphakamisa ukuthi umehluko ophakathi kweqembu kuzikolo ze-HIT-6 zamayunithi we-2.3 ngokuhamba kwesikhathi ungase ubhekwe njengobalulekile emtholampilo [37]. Smelt et al. wafunda ukunakekelwa okuyinhloko kweziguli ze-migraine ekuthuthukiseni izincomo eziphakanyisiwe zisebenzisa izinguquko ze-HIT-6 zokunakekelwa komtholampilo kanye nocwaningo [38]. Ngokuncika emiphumeleni ewumphumela wokuhle okungamanga noma okubi, ushintsho olubalulekile ngaphakathi komuntu (MIC) kusetshenziswa �indlela yoshintsho oluqondile� lulinganiselwe njengamaphoyinti angu-2.5. Uma usebenzisa �ukuhlaziya ijika le-receiver operating character (ROC)� ukuguqulwa kwamaphoyinti angu-6 kuyadingeka. Okunconyiwe phakathi kweqembu umehluko obaluleke kancane (MID) ngu-1.5 [38].
Ngokusebenzisa �indlela yokushintsha okushoyo,� zonke izifundo kodwa eyodwa ibike ushintsho (ukuncipha) olukhulu kuno-?2.5. Ukuhlaziya �ROC� kuphinde kwakhombisa ukuthuthuka kuzo zonke izifundo ngaphandle kwesisodwa. Lesi sihloko �sisodwa� bekungumuntu ohlukile ekuhlaziyeni ngakunye kokuqhathanisa. Ngokusekelwe ku-Smelt et al. imibandela, izifundo ezilandelwayo ziqhubekile nokubonisa ukuthuthukiswa okungabalulekile okubalulekile ngaphakathi komuntu njengoba kuboniswe kuMfanekiso 10.
Zonke izifundo kodwa ezimbili zibonise ukuthuthuka kumphumela we-MIDAS phakathi kwesisekelo sokuqala nemiphumela yezinyanga ezintathu. Ubukhulu boshintsho bebulinganiselwe kumphumela wesisekelo we-MIDAS, nazo zonke izifundo kodwa ezintathu zibika inani eliphelele lamaphesenti angamashumi amahlanu noma ushintsho olukhulu. Izihloko ezilandelwayo zaqhubeka zibonisa ukuthuthukiswa njengoba kubonakala ekunciphiseni okuqhubekayo kwamaphuzu ngeviki le-24; bheka Izibalo 11(a)�11(c).
Ukusetshenziswa kwe-HIT-6 ne-MIDAS ndawonye njengomphumela womtholampilo kungase kunikeze ukuhlolwa okuphelele kwezici zokukhubazeka ezihlobene nekhanda [39]. Umehluko phakathi kwezilinganiso ezimbili ungabikezela ukukhubazeka okuvela ekuqineni kobuhlungu bekhanda kanye nemvamisa yekhanda, ngokunikeza ulwazi olwengeziwe mayelana nezici ezihlobene nezinguquko ezibikiwe kunomphumela osetshenziswa yedwa. Ngenkathi i-MIDAS ibonakala ishintsha kakhulu ngokuvama kwekhanda, ukuqina kwekhanda kubonakala kuthinta amaphuzu we-HIT-6 ngaphezu kwe-MIDAS [39].
Ukuthi ubuhlungu bekhanda be-migraine buthinta kanjani futhi bukhawulela ukusebenza kwesiguli nsuku zonke kubikwa yi-MSQL v. 2.1, kuzo zonke izizinda ezintathu ze-3: ukuvimbela indima (MSQL-R), ukuvimbela indima (MSQL-P), nokusebenza ngokomzwelo (MSQL-E). Ukwenyuka kwamaphuzu kubonisa ukuthuthuka kulezi zindawo ngamavelu asuka ku-0 (ampofu) aye ku-100 (angcono kakhulu).
I-MSQL ikala ukuhlolwa kokwethembeka ngu-Bagley et al. bika imiphumela ukuze ihlobane ngokumaphakathi ne-HIT-6 (r = ?0.60 kuye ku-?0.71) [40]. Ifundwe nguCole et al. ibika umehluko obalulekile kancane (MID) wokushintsha komtholampilo wesizinda ngasinye: MSQL-R = 3.2, MSQL-P = 4.6, kanye ne-MSQL-E = 7.5 [41]. Imiphumela evela ocwaningweni lwe-topiramate ibika ushintsho lomtholampilo olubaluleke kancane (MIC): MSQL-R = 10.9, MSQL-P = 8.3, kanye ne-MSQL-E = 12.2 [42].
Zonke izifundo ngaphandle kwesisodwa zibe noshintsho lomtholampilo olubaluleke kancane lwe-MSQL-R olungaphezu kuka-10.9 ngokulandelwa kweviki lesishiyagalombili ku-MSQL-R. Zonke izifundo ngaphandle kwezimbili zibike izinguquko ezingaphezu kwamaphoyinti angu-12.2 ku-MSQL-E. Ukuthuthukiswa kwezikolo ze-MSQL-P kukhuphuke ngamaphuzu ayishumi noma ngaphezulu kuzo zonke izifundo.
Ukuhlaziywa kokuhlehla kwezilinganiso ze-VAS ngokuhamba kwesikhathi kubonise ukuthuthukiswa okuphawulekayo komugqa phakathi nenkathi yezinyanga ezingu-3. Kube nokuhluka okukhulu kwamaphuzu ayisisekelo kuzo zonke lezi ziguli. Ukuhluka okuncane noma okungekho kwabonwa ngezinga lokuthuthuka. Lo mkhuba ubonakala ufana ezifundweni ezifundwe amasonto angama-24 njengoba kubonakala kuMfanekiso 12.
Ucwaningo oluningi olusebenzisa ukungenelela kwemithi lubonise umphumela omkhulu we-placebo ezigulini ezivela kubantu abahlukunyezwayo [43]. Ukunquma ukuthuthukiswa okungenzeka kwe-migraine ngaphezu kwezinyanga eziyisithupha, usebenzisa okunye ukungenelela kanye nokungenelela, kubalulekile kunoma yikuphi ukuqhathaniswa kwemiphumela. Uphenyo ngemiphumela ye-placebo ngokuvamile luyakwamukela ukuthi ukungenelela kwe-placebo kunikeza ukukhululeka kwezimpawu kodwa akuguquli izinqubo ze-pathophysiologic ngaphansi kwesimo [44]. Izinyathelo ze-MRI ezihlosiwe zingasiza ekudaluleni umphumela onjalo we-placebo ngokubonisa ushintsho ezilinganisweni ze-physiologic zamapharamitha wokugeleza okwenzeka ngemva kokungenelela kwe-placebo.
Ukusebenzisa uzibuthe onama-tesla amathathu ekuqoqweni kwedatha ye-MRI kungakhuphula ukwethembeka kwezilinganiso ngokwandisa inani ledatha esetshenziselwa ukwenza ukugeleza nokubalwa kwe-ICCI. Lolu ngolunye lophenyo lokuqala olusebenzisa ushintsho ku-ICCI njengomphumela wokuhlola ukungenelela. Lokhu kudala izinselele ekuchazeni idatha etholwe yi-MRI ukuze kusekelwe iziphetho noma ukuthuthukiswa kwe-hypothesis eyengeziwe. Ukwehlukahlukana ebudlelwaneni phakathi kokugeleza kwegazi ukuya nokubuya ebuchosheni, ukugeleza kwe-CSF, kanye nezinga lenhliziyo lale mingcele eqondene nesihloko kuye kwabikwa [45]. Ukuhlukahluka okubonwe ocwaningweni oluncane lwezinyathelo ezintathu eziphindaphindiwe kuye kwaholela eziphethweni zokuthi ulwazi oluqoqwe emacaleni ngamanye lungahunyushwa ngokuqapha [46].
Izincwadi ziqhubeka zibika ezifundweni ezinkulu ukwethembeka okubalulekile ekuqoqeni le MRI ithole idatha yokugeleza kwe-volumetric. Wentland et al. ibike ukuthi izilinganiso ze-CSF velocities kumavolontiya abantu kanye nama-phantom velocities aguquguqukayo ngokwe-sinusoid azizange zihluke kakhulu phakathi kwamasu amabili e-MRI asetshenzisiwe [47]. Koerte et al. ufunde amaqoqo amabili ezifundo afanekiselwa ezindaweni ezimbili ezihlukene ngemishini ehlukene. Babike ukuthi i-intraclass coefficients coefficients (ICC) ibonise ukwethembeka okuphezulu kwe-intra- kanye ne-interrater yezilinganiso ze-PC-MRI volumetric flow rate ezisele zizimele kumishini esetshenzisiwe kanye nezinga lekhono lomsebenzisi [48]. Nakuba ukuhlukahluka kwe-anatomic kukhona phakathi kwezifundo, akuzange kuvimbele izifundo zezibalo ezinkulu zeziguli ekuchazeni okungenzeka �okujwayelekile� ukuphuma kwamapharamitha [49, 50].
Ngokusekelwe kuphela emibonweni yesiguli, kukhona ukulinganiselwa ekusebenziseni imiphumela ebikiwe ngesiguli [51]. Noma yisiphi isici esithinta umbono wesifundo kukhwalithi yempilo yaso singase sibe nomthelela kumphumela wanoma yikuphi ukuhlola okusetshenzisiwe. Ukungabi nemiphumela eqondile ekubikeni izimpawu, imizwa, nokukhubazeka nakho kukhawulela ukuchazwa kwemiphumela [51].
Izindleko zokuhlaziywa kwedatha ye-imaging kanye ne-MRI zivimbe ukusetshenziswa kweqembu elilawulayo, zikhawulela noma yikuphi ukugcwaliseka kwale miphumela. Usayizi wesampula omkhulu ungavumela iziphetho ngokusekelwe emandleni ezibalo kanye nephutha elincishisiwe Lohlobo I. Ukuhunyushwa kwanoma yikuphi ukubaluleka kule miphumela, kuyilapho kuveza amathrendi angaba khona, kusalokhu kuwukuqagela okungcono kakhulu. Okungaziwa okukhulu kuyaqhubeka emathubeni okuthi lezi zinguquko zihlobene nokungenelela noma komunye umphumela ongaziwa ngabaphenyi. Le miphumela yengeza emzimbeni wolwazi lwezinguquko ezingenzeka ngaphambili ze-hemodynamic ne-hydrodynamic ezingabikwanga ngemuva kokungenelela kwe-NUCCA, kanye nezinguquko ku-migraine isiguli se-HRQoL sibike imiphumela njengoba ibonwe kuleli qembu.
Amanani edatha eqoqiwe nokuhlaziya ahlinzeka ngolwazi oludingekayo ukuze kulinganiswe amasampula ezifundo ezibalulekile ngokwezibalo ocwaningweni oluqhubekayo. Izinselele zenqubo ezixazululiwe kusukela ekuqhubeni umshayeli zivumela iphrothokholi ecwengisiswe kakhulu ukuze kufezwe ngempumelelo lo msebenzi.
Kulolu cwaningo, ukuntuleka kokwanda okuqinile kokuhambisana kungase kuqondwe yi-logarithmic kanye nemvelo eguquguqukayo ye-intracranial hemodynamic kanye nokugeleza kwe-hydrodynamic, okuvumela izingxenye zomuntu ngamunye ezihlanganisa ukuhambisana nokuguquka ngenkathi jikelele akuzange kwenzeke. Ukungenelela okuphumelelayo kufanele kuthuthukise ubuhlungu obubonakalayo nokukhubazeka okuhlobene nekhanda elibuhlungu njengoba kulinganiswa nalezi zinsimbi ze-HRQoL ezisetshenzisiwe. Le miphumela yocwaningo iphakamisa ukuthi ukungenelela kokulungiswa kabusha kwe-atlas kungase kuhlotshaniswe nokunciphisa imvamisa ye-migraine, ukuthuthukiswa okuphawulekayo kwekhwalithi yokuphila okunikeza ukunciphisa okuphawulekayo kokukhubazeka okuhlobene nekhanda njengoba kubonakala kuleli qembu. Ukuthuthukiswa kwemiphumela ye-HRQoL kudala intshisekelo ephoqelelayo ukuze kuqhutshekwe nocwaningo, ukuze kuqinisekiswe lokhu okutholakele, ikakhulukazi ngechibi lezifundo elikhudlwana kanye neqembu le-placebo.
Ukuvuma
Ababhali bavuma uDkt. Noam Alperin, Alperin Diagnostics, Inc., Miami, FL; U-Kathy Waters, Umxhumanisi Wokufunda, kanye noDkt. Jordan Ausmus, Umxhumanisi we-Radiography, i-Britannia Clinic, i-Calgary, AB; Sue Curtis, MRI Technologist, Elliot Fong Wallace Radiology, Calgary, AB; kanye noBrenda Kelly-Besler, RN, Umxhumanisi Wokucwaninga, Uhlelo Lokuhlola Nokuphathwa Kwekhanda laseCalgary (CHAMP), Calgary, AB. Usekelo lwezezimali luhlinzekwa yi-(1) Hecht Foundation, Vancouver, BC; (2) Isisekelo seTao, eCalgary, AB; (3) URalph R. Gregory Memorial Foundation (Canada), eCalgary, AB; kanye (4) ne-Upper Cervical Research Foundation (UCRF), iMinneapolis, MN.
Izifinyezo
- I-ASC: I-Atlas subluxation complex
- CHAMP: Calgary Headache Assessment and Management Programme
- I-CSF: I-Cerebrospinal Fluid
- I-GSA: I-Gravity Stress Analyzer
- I-HIT-6: Isivivinyo Somphumela Wekhanda Elibuhlungu-6
- I-HRQoL: Ikhwalithi Yempilo Ehlobene Nezempilo
- I-ICCI: Inkomba yokuhambisana ne-Intracranial
- I-ICVC: Ukushintsha kwevolumu ye-Intracranial
- I-IQR: Ibanga le-Interquartile
- I-MIDAS: I-Migraine Disability Assessment Scale
- I-MSQL: Ikhwalithi Ye-Migraine-Specific of Life Measure
- I-MSQL-E: Ikhwalithi Ye-Migraine-Specific Life Measure-Emotional
- I-MSQL-P: Ikhwalithi Eqondile Yempilo Ye-Migraine Measure-Physical
- I-MSQL-R: Ikhwalithi Ye-Migraine-Specific of Life Measure-Restrictive
- I-NUCCA: I-National Upper Cervical Chiropractic Association
- I-PC-MRI: I-Phase Contrast Magnetic Resonance Imaging
- I-SLC: I-Supine Leg Check
- I-VAS: I-Visual Analog Scale.
Ukungqubuzana kwezintshisekelo
Ababhali bayavuma ukuthi azikho izithakazelo zezezimali noma ezinye ezincintisanayo mayelana nokushicilelwa kwaleli phepha.
Umnikelo Wabalobi
H. Charles Woodfield III wakhulelwa lolu cwaningo, waba nesandla ekwakhiweni kwalo, wasiza ekuhlelweni, futhi wasiza ekubhaleni iphepha: isingeniso, izindlela zokutadisha, imiphumela, ingxoxo, nesiphetho. D. Gordon Hasick uhlole izifundo zokufakwa / ukukhishwa kocwaningo, wanikeza ukungenelela kwe-NUCCA, futhi waqapha zonke izifundo ekulandeleni. Ubambe iqhaza ekwakhiweni kocwaningo nasekudidiyeleni izifundo, esiza ekubhaleni isingeniso, Izindlela ze-NUCCA, kanye nengxoxo yephepha. U-Werner J. Becker uhlole izifundo zokufakwa / ukukhishwa kocwaningo, wabamba iqhaza ekwakhiweni kocwaningo nasekuxhumaneni, futhi wasiza ekubhaleni iphepha: izindlela zokufunda, imiphumela kanye nengxoxo, nesiphetho. U-Marianne S. Rose wenze ukuhlaziywa kwezibalo kudatha yocwaningo futhi wasiza ekubhaleni iphepha: izindlela zezibalo, imiphumela, nengxoxo. UJames N. Scott ubambe iqhaza ekwakhiweni kocwaningo, wasebenza njengomeluleki we-imaging obuyekeza izikena ze-pathology, futhi wasiza ekubhaleni iphepha: Izindlela ze-PC-MRI, imiphumela, nengxoxo. Bonke ababhali bafunde futhi bagunyaza iphepha lokugcina.
Ekuphetheni, isifundo secala mayelana nokuthuthukiswa kwezimpawu zekhanda le-migraine kulandela ukulungiswa kabusha kwe-atlas vertebrae kubonise ukwanda komphumela oyinhloko, noma kunjalo, imiphumela evamile yocwaningo locwaningo nayo ayizange ibonise ukubaluleka kwezibalo. Sekukonke, ucwaningo lwecala lwaphetha ngokuthi iziguli ezathola ukwelashwa kwe-atlas vertebrae realignment zithole ukuthuthukiswa okukhulu kwezimpawu ngezinsuku zekhanda elinciphile. Ulwazi olubalulwe ku-National Center for Biotechnology Information (NCBI). Ububanzi bolwazi lwethu bukhawulelwe ku-chiropractic kanye nokulimala komgogodla nezimo. Ukuze uxoxe ngesihloko, sicela ukhululeke ukubuza uDkt. Jimenez noma usithinte ku 915-850-0900 .
Ikhethwe nguDkt Alex Jimenez
Izihloko Ezengeziwe: Ubuhlungu Bentamo
Ubuhlungu bentamo yisikhalazo esivamile esingase sibangele ngenxa yokulimala okuhlukahlukene kanye / noma izimo. Ngokwezibalo, ukulimala kwengozi yemoto kanye nokulimala kwe-whiplash ngezinye zezimbangela ezivame kakhulu zobuhlungu bentamo phakathi kwabantu abaningi. Phakathi nengozi yemoto, umthelela ongazelelwe wesigameko ungabangela ikhanda nentamo ukuba zinyakaze ngokuzumayo emuva naphambili kunoma iyiphi indlela, kulimaze izakhiwo eziyinkimbinkimbi ezizungeze umgogodla womlomo wesibeletho. Ukuhlukumezeka kwemisipha kanye nemigqa, kanye nezinye izicubu entanyeni, kungabangela ubuhlungu bentamo kanye nezimpawu ezikhanyayo kuwo wonke umzimba womuntu.
ISIHLOKO ESIBALULEKILE: ENGEZIWEYO: Impilo Kahle Wena!
EZINYE IZIHLOKO EZIBALULEKILE: EZENGEZIWE: Ukulimala Kwezemidlalo? | Vincent Garcia | Isiguli | El Paso, TX Chiropractor
