He pilikia maʻamau ka ʻeha neuropathic postoperative, ʻoiai inā ʻoi aku ka maikaʻi o ka mea maʻi.E like me nā ʻano ʻeha ʻeha ʻē aʻe, paʻakikī ka mālama ʻana i ka ʻeha neuropathic ma hope o ke ʻoki ʻana a hilinaʻi maʻamau i nā analgesics adjuvant, e like me nā antidepressants a me nā anticonvulsants, a me nā nerve blockers.Ua hoʻomohala au i kahi lapaʻau me ka hoʻohana ʻana i ka waikawa hyaluronic cross-linked (Restylane a me Juvéderm) i kūʻai ʻia ma ke kūʻai ʻana, e hāʻawi ana i kahi hōʻoluʻolu lōʻihi me ka ʻole o nā hopena ʻaoʻao.
Ua hoʻohana ʻia ka waikawa hyaluronic cross-linked no ka manawa mua e mālama i ka ʻeha neuropathic ma ka 2015 Annual Meeting o ka American Academy of Pain Medicine ma National Harbor, Maryland.1 Ma kahi 34-mahina retrospective chart review, 15 neuropathic pain maʻi (7 wahine, 8 kāne) a me 22 pain syndromes ua aʻo ʻia.ʻO ka awelika o nā makahiki o ka poʻe maʻi he 51 mau makahiki a ʻo ka lōʻihi o ka ʻeha he 66 mahina.ʻO ka awelika visual analog scale (VAS) ʻeha ma mua o ka mālama ʻana he 7.5 mau helu (mai ka 10).Ma hope o ka mālama ʻana, ua hāʻule ka VAS i 10 mau helu (mai ka 1.5), a ʻo ka awelika o ke kala ʻana he 7.7 mahina.
Mai koʻu hoʻokomo ʻana i kaʻu hana mua, ua mālama au i nā maʻi he 75 me nā maʻi ʻeha like (ʻo ia hoʻi, post-herpetic neuralgia, carpal tunnel a me tarsal tunnel syndrome, Bell's paralytic tinnitus, headache, etc.).Ma muli o ke ʻano o ka hana ma ka hana, ua koho au i kēia lāʻau lapaʻau ma ke ʻano he cross-linked neural matrix analgesia (XL-NMA).2 Hāʻawi au i ka hōʻike hihia o ka mea maʻi me ka ʻeha mau o ka ʻāʻī a me ka ʻeha lima ma hope o ke ʻoki ʻana i ka iwi kuamoʻo.
ʻO ka Hyaluronic acid (HA) he proteoglycan, he linear anionic polysaccharide 3 i haku ʻia me nā hui hou o ka glucuronic acid a me ka N-acetylglucosamine.Aia maoli ia i loko o ka extracellular matrix (ECM) (56%) o ka ʻili, 4 mea hoʻohui, ʻiʻo epithelial a me nā ʻiʻo nerve.4,5 I loko o nā ʻiʻo olakino, ʻo kona kaumaha molekala he 5 a 10 miliona daltons (Da)4.
ʻO ka HA i hoʻopili ʻia he mea hoʻonaninani kalepa i ʻae ʻia e ka FDA.Ua kūʻai ʻia ma lalo o nā brand Juvéderm6 (hana ʻia e Allergan, HA maʻiʻo 22-26 mg/mL, molecular kaumaha 2.5 miliona daltons)6 a me Restylane7 (hana ʻia e Galderma), a ʻo ka ʻike HA he 20 mg/ Milliliters, ʻo ke kaumaha molecular. 1 miliona Dalton.8 ʻOiai ʻo ke ʻano maoli non-crosslinked o HA he wai a ua hoʻololi ʻia i loko o hoʻokahi lā, ua hui pū nā molecular crosslinks o HA i kāna mau kaulahao polymer a hana i kahi hydrogel viscoelastic, no laila kona ola lawelawe (6 a 12 mau mahina) a me ka hiki ke hoʻoheheʻe ʻia. hiki ke komo i 1,000 manawa o kona kaumaha o ka wai.5
Ua hele mai kahi kanaka 60 makahiki i ko mākou keʻena ma ʻApelila 2016. Ma hope o ka loaʻa ʻana o C3-C4 a me C4-C5 hope o ka cervical decompression, hope fusion, autotransplantation kūloko a me posterior segmental internal fixation, ua hoʻomau ka ʻāʻī A me ka ʻeha lima bilateral.ʻO nā wili maikaʻi ma C3, C4, a me C5.Ua hōʻeha ʻia kona ʻāʻī ma ʻApelila 2015, i ka wā i hāʻule ai ʻo ia i hope i ka hana i ka wā i paʻi ai ʻo ia i kona ʻāʻī me kona poʻo a ʻike ʻo ia i ke kuʻi ʻana o kona ʻāʻī.
Ma hope o ka hana ʻana, ua ʻoi aku ka nui o kona ʻeha a me ka ʻeha, a ua mau ka ʻeha wela ma hope o kona mau lima a me kona ʻāʻī (Figure 1).I ka wā o kona ʻāʻī, ua hoʻomālamalama ʻia nā haʻalulu uila nui mai kona ʻāʻī a me ka iwi kuamoʻo i kona mau lālā luna a lalo.I ka moe ʻana ma ka ʻaoʻao ʻākau, ʻoi aku ka nui o ka ʻeha o nā lima.
Ma hope o ka hana ʻana i ka myelography computed tomography (CT) myelography a me radiography (CR), ua loaʻa nā ʻeha o ka cervical segmental ma C5-C6 a me C6-C7, e kākoʻo ana i ka ʻeha mau i nā lima a me ke ʻano mechanical o ka ʻāʻī flexion Pain (ie, ʻO ka neuropathic lua a me ka ʻeha o ke kuamoʻo a me ka radiculopathy C6-C7).
Hoʻopilikia nā ʻeha kikoʻī i nā aʻa aʻalolo bilateral a me nā ʻāpana spinal cord pili i mua, me:
Ua ʻae ke kauā spine i ke kūkākūkā ʻana, akā ua manaʻo ʻo ia ʻaʻohe mea e hāʻawi aku no kahi hana ʻē aʻe.
I ka hopena o ʻApelila 2016, ua loaʻa i ka lima ʻākau o ka mea maʻi ka lāʻau Restylane (0.15 mL).Hana ʻia ka injection ma ke kau ʻana i kahi awa me kahi nila 20 gauge, a laila e hoʻokomo i kahi microcannula 27 gauge (DermaSculpt) me kahi kihi blunt.No ka hoʻohālikelike, ua mālama ʻia ka lima hema me ka hui ʻana o 2% lidocaine maʻemaʻe (2 mL) a me 0.25% bupivacaine maʻemaʻe (4 mL).ʻO ka nui o kēlā me kēia pūnaewele he 1.0 a 1.5 mL.(No ka ʻōlelo aʻo ʻana i kēlā me kēia ʻanuʻu no kēia kaʻina hana, e ʻike i ka ʻaoʻao ʻaoʻao.) 9
Me kekahi mau hoʻololi, ua like ke ʻano o ka injection me ke aʻalolo maʻamau ma ka pae lima o ke aʻalolo waena (MN), ke aʻalolo ulnar (UN), a me ke aʻalolo radial superficial (SRN) ma ka pae anatomical.ʻO ka pahu snuff - ka ʻāpana triangular o ka lima i hana ʻia ma waena o ka manamana lima a me ka manamana waena.He iwakāluakūmāhā mau hola ma hope o ka hana ʻana, ua ʻike ka mea maʻi i ka ʻeha mau ma nā poho lima o ka lima a me ka ʻehā o ka lima ʻākau akā ʻaʻohe ʻeha.Ua nalowale ka hapa nui o nā manamana lima mua, ʻelua a me ke kolu, akā mau nō ka ʻeha ma nā manamana lima.Ka helu ʻeha, 4 a 5).Ua pau loa ka wela o ke kua o ka lima.Ma ka holoʻokoʻa, ua manaʻo ʻo ia i ka hoʻomaikaʻi ʻana o 75%.
I nā mahina 4, ua ʻike ka mea maʻi i ka hoʻomaikaʻi ʻana o ka ʻeha ma kona lima ʻākau e 75% a i 85%, a ua ʻae ʻia ka helu ʻaoʻao o nā manamana lima 1 a me 2.ʻAʻohe hopena ʻino a hopena paha.Hoʻomaopopo: Ua hoʻoholo ʻia kekahi hōʻoluʻolu mai ka anesthesia kūloko ma ka lima hema i 1 pule ma hope o ka hana ʻana, a hoʻi hou kona ʻeha i ka pae kumu o kēlā lima.ʻO ka mea e mahalo ai, ua ʻike ka mea maʻi ʻoiai ua emi ka ʻeha wela a me ka helu ʻana ma ka piko o ka lima hema ma hope o ka hoʻokomo ʻana i ka lāʻau anesthetic kūloko, ua hoʻololi ʻia e kahi ʻano ʻoluʻolu a hoʻonāukiuki.
E like me ka mea i ʻōlelo ʻia ma mua, ua hōʻike ka mea maʻi ma hope o ka loaʻa ʻana o XL-NMA, ua hoʻomaikaʻi nui ʻia ka ʻeha neuropathic ma ka lima ʻākau.Ua kipa hou ka mea maʻi i ka hopena o ʻAukake 2016, i ka wā i hōʻike ai ua hoʻomaka ka hoʻomaikaʻi ʻana i ka emi ʻana i ka hopena o Iulai 2016. Ua noi ʻo ia i kahi hoʻopiʻi XL-NMA i hoʻonui ʻia no ka lima ʻākau, a me ka mālama ʻana o XL-NMA no ka lima hema a me ka cervical cervical. -ʻaoʻao brachial-bilateral, poʻohiwi proximal, ʻāpana C4 a me ka pae C5-C6.
Ua kipa hou ka mea maʻi i ka waena o ʻOkakopa 2016. Ua hōʻike ʻo ia ma hope o ka hana ʻana ma ʻAukake 2016, ua hoʻomau ʻia kona ʻeha wela ma nā wahi ʻeha a pau a hoʻomaha loa.ʻO kāna mau hoʻopiʻi nui, ʻo ia ka ʻeha ʻeha ma ka ʻili o ka pāma a me ke kua o ka lima (nā ʻeha ʻokoʻa - ʻoi aku kekahi a ʻoi aku kekahi, e pili ana i nā aʻalolo e pili ana) a me ka paʻa a puni ka pulima.ʻO ka haʻalulu ma muli o ka hōʻino ʻana i nā aʻa aʻalolo o kona kuamoʻo cervical, e pili ana i nā fibers e hana i nā aʻalolo nui 3 (SRN, MN, a me UN) ma ka lima.
Ua ʻike ka mea maʻi i ka piʻi ʻana o 50% o ka spine spine rotational range of motion (ROM), a he 50% ka emi ʻana o ka ʻeha cervical a me ka lima ma ka C5-C6 a me C4 proximal poʻohiwi.Ua noi ʻo ia i ka hoʻonui ʻia ʻana o XL-NMA o bilateral MN a me SRN-ua hoʻomau ʻia ka UN a me ka ʻāʻī-brachial wahi me ka ʻole o ka mālama ʻana.
Hōʻuluʻulu ka Papa 1 i ka manaʻo multifactorial i manaʻo ʻia.Hoʻonohonoho ʻia lākou e like me ko lākou pili ʻana i ka anti-nociception like ʻole o ka manawa-mai ka hopena pololei loa i nā minuke 10 mua ma hope o ka injection i ka hoʻomaha mau a me ka lōʻihi i ʻike ʻia i kekahi mau hihia i hoʻokahi makahiki a ʻoi aku paha.
Hana ʻo CL-HA ma ke ʻano he pale pale kino, e hana ana i kahi ʻāpana, e hoʻemi ana i ka hoʻāla ʻana o nā hana kuʻuna ma C fiber a me Remak bundle afferents, a me nā ephapse nociceptive abnormal.10 Ma muli o ke ʻano polyanionic o CL-HA, hiki i kona mau molekala nui (500 MDA a i 100 GDa) ke hoʻopau loa i ka hiki ke hana ma muli o ka nui o kāna uku ʻino a pale i ka hoʻouna ʻana i nā hōʻailona.ʻO ka hoʻoponopono kūpono ʻole LMW/HMW ke alakaʻi nei i ka TNFα-stimulated gene 6 protein regulation area inflammation.Hoʻopaʻa a hoʻihoʻi kēia i ka maʻi neural crosstalk immune ma ke kiʻekiʻe o ka matrix neural extracellular, a pale maoli i nā kumu i manaʻoʻiʻo ʻia ke kumu o ka ʻeha mau.11-14
ʻO ka mea nui, ma hope o ka hōʻeha a i ʻole ka hōʻeha ʻana o ka extracellular neural matrix (ECNM), e loaʻa kahi ʻāpana koʻikoʻi o ka ʻāʻī ʻana o ka maʻi maʻi, hele pū ʻia me ka pehu ʻiʻo a me ka hoʻōla ʻana o Aδ a me C fiber nociceptors.Eia nō naʻe, i ka wā e lilo ai kēia maʻi i mea maʻi, e hoʻomau ʻia ka ʻāʻī ʻana o ka ʻiʻo a me ke kamaʻilio ʻana o ke aʻalolo kūlohelohe akā subclinical.E hana ʻia ka Chronicization ma o ka hoʻokomo hou ʻana a me ka loop loop feedback, no laila e mālama a mālama i ka pro-inflammatory, pre-pain state, a me ka pale ʻana i ke komo ʻana i ka manawa ho'ōla a hoʻōla (Table 2).Ma muli o ka like ʻole o LMW/HMW-HA, hiki iā ia ke mālama iā ia iho, ʻo ia paha ka hopena o nā aberrations gene CD44/CD168 (RHAMM).
I kēia manawa, hiki i ka injection o CL-HA ke hoʻoponopono i ka LMW/HMW-HA mismatch a hoʻoneʻe i ke kahe o ke kahe, e ʻae ana i ka interleukin (IL) -1β a me TNFα e hoʻoulu i ka TSG-6 e hoʻoponopono i ka mumū, ma ka hoʻoponopono ʻana a me ka hoʻoponopono ʻana i ka LMW- HA a me CD44.ʻAe kēia i ka holomua maʻamau i ka ECNM anti-inflammatory a me analgesic phase, no ka mea hiki iā CD44 a me RHAMM (CD168) ke launa pū me HMW-HA me ka pololei.No ka hoʻomaopopo ʻana i kēia ʻano hana, e ʻike i ka Papa 2, e hōʻike ana i ka cytokine cascade a me ka neuroimmunology e pili ana i ka ʻeha ECNM.
I ka hōʻuluʻulu ʻana, hiki ke manaʻo ʻia ʻo CL-HA he ʻano Dalton nui loa o HA.No laila, ua hoʻonui pinepine a mālama i ke kino o ka HMW-HA ho'ōla a ho'ōla i nā hana maʻamau molecular biology, me:
I ke kūkākūkā ʻana i kēia hōʻike hihia me kaʻu mau hoa hana, ua nīnau pinepine ʻia au, "Akā, pehea ka loli ʻana o ka hopena i ka lāʻau peripheral mamao loa mai ka ʻāʻī ʻāʻī?"I kēia hihia, ʻike ʻia nā ʻeha o kēlā me kēia CR a me CT myelography Recognition ma ke kiʻekiʻe o nā ʻāpana spinal cord C5-C6 a me C6-C7 (C6 a me C7 aʻa aʻa, kēlā me kēia).Hoʻopilikia kēia mau maʻi i ke aʻa aʻalolo a me ka ʻaoʻao mua o ke kuamoʻo, no laila he ʻāpana kokoke lākou i ke kumu i ʻike ʻia o ke aʻa aʻa radial a me ke kuamoʻo (ie, C5, C6, C7, C8, T1).A, ʻoiaʻiʻo, e kākoʻo lākou i ka ʻeha ʻeha mau ma ke kua o nā lima.Eia naʻe, i mea e hoʻomaopopo hou ai i kēia, pono e noʻonoʻo ʻia ka manaʻo o ka komo ʻana.16
ʻO ka neuralgia afferent ka mea maʻalahi, "… ʻOiai ka emi ʻana a i ʻole ka noʻonoʻo ʻana i nā mea hoʻoulu ʻino o waho (hypoalgesia a i ʻole analgesia) i ka ʻāpana kino, ʻeha nui i ka ʻāpana kino o ka ʻeha."16 Ma muli paha o ka pōʻino o ka ʻōnaehana nerve, waena a me ka ʻaoʻao, me ka lolo, ke kuamoʻo, a me nā aʻalolo āpau.Manaʻo ʻia ke aʻalolo afferent ma muli o ka nalowale o ka ʻike mai ka ʻaoʻao a hiki i ka lolo.ʻOi aku ke kikoʻī, aia kahi keakea i ka ʻike afferent sensory e hiki ai i ka cortex ma o ka ʻāpana spinothalamic.Aia i loko o kēia pū'olo ka ho'ouna 'ana i ka 'eha a i 'ole ke komo 'ana nociceptive i ka thalamus.ʻOiai ʻaʻole i hoʻomaopopo maikaʻi ʻia ka mīkini pololei, kūpono loa ke kŘkohu no ke kūlana ma ka lima (ʻo ia hoʻi, ʻaʻole pili loa kēia mau aʻa aʻa a me nā ʻāpana spinal cord i ke aʻalolo radial).
No laila, e pili ana i ka ʻeha wela ma ke kua o ka lima o ka mea maʻi, e like me ka mīkini 3 ma ka Papa 1, pono e hōʻeha ʻia e hoʻomaka i ka pro-inflammatory, pre-noxious state o ka cytokine cascade (Table 2).E loaʻa mai kēia mai ka pōʻino kino i nā aʻa aʻalolo i hoʻopilikia ʻia a me nā ʻāpana spinal cord.Eia nō naʻe, ʻoiai ʻo ECNM kahi ʻano neuroimmune hoʻomau a pālahalaha e hoʻopuni ana i nā hale neural āpau (ʻo ia hoʻi, he holoʻokoʻa), ʻo nā neurons sensory i hoʻopili ʻia o nā aʻa aʻa C6 a me C7 i hoʻopilikia ʻia a me nā ʻāpana spinal cord e hoʻomau ʻia a hoʻopaʻa ʻia ʻo Limb a me neuroimmune contact. ke kua o na lima elua.
No laila, ʻo ka pōʻino ma kahi mamao ka hopena o ka hopena ʻē aʻe o ka ECNM proximal ma kahi mamao.15 ʻO kēia ka mea e ʻike ai ʻo CD44, CD168 (RHAMM) i ka HATΔ, a hoʻokuʻu i nā cytokine inflammatory IL-1β, IL-6 a me TNFα, e hoʻāla a mālama i ka hoʻāla ʻana o nā fiber C distal a me nā nociceptors Aδ inā kūpono (papa 2, #3) .Me ka pōʻino o ECNM a puni ka SRN distal, hiki ke hoʻohana maikaʻi ʻia ʻo XL-NMA no ka hana in situ e hoʻokō i ka CL-HA LMW/HMW-HA mismatch hoʻoponopono a me ICAM-1 (CD54) ka hoʻoponopono ʻā ʻana (Table 2, # 3- #5 pōʻaiapuni).
Eia nō naʻe, ʻoliʻoli maoli ka loaʻa ʻana o ka hōʻoluʻolu mau loa mai nā hōʻailona koʻikoʻi a paʻakikī ma o ka mālama palekana a me ka liʻiliʻi loa.He mea maʻalahi ka hana, a ʻo ka mea paʻakikī loa ka ʻike ʻana i nā aʻalolo sensory, neural network, a me ka substrate e hoʻopili ʻia a puni ka pahu hopu.Eia nō naʻe, me ka hoʻohālikelike ʻenehana e pili ana i nā hōʻike lapaʻau maʻamau, ʻaʻole paʻakikī kēia.
Ka manawa hoʻouna: ʻAukake-12-2021