| Dr.
Miguel B. Royo Salvador
Wamwrika-vijfana ki salyacikiwsa aur reedh ki haddee |
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<< Syringomyelia | |
<< Arnold Chiari I vikruti | |||||||||||||
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"Scoliosis, syringomyelia aur Arnold Chiari I vikruti ko roka jaa sakta hai." |
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SCOLIOSIS
Institut Neurològic de Barcelona ne scoliosis ke bare mein kaunsi nayi baat batayi hai?.
Scoliosis ya vikrut reedh ki haddi 2 pratishat jansankhya ko prabhavit karta hai aur Hippocrates ne do hazaar chaar sao saal pehle uska
pehli baar varnan kiya. Usne jo bhi kaha tha usme mushkil se kuch parivartan hua hai.
Vartamaan mein, prakaashit anusandhan adhyayan ke anuroop, scoliosis aisi bimaari hai jo filum terminale, jaise ki asthibandh ( jo baalig
insaanon mein koi karya nahi kartein,) dwara reedh ki haddi ke tethering se hoti hai.
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Aakruti teen : .- ghatna 3: unnees saal ke mareez ko idiopathic scoliosis tha. a. preoperation eks-re adtees ansh. b. postoperation, filum terminale ko kaatne ke nau mahine baad, ekattees ansh. c. preoperation dorsolumber MRI, reedh ki haddi ek intrathecal guhika (cavity) se doosri tak jaati hai.
Kya Ye scoliosis ko samajhna mareez ke liye upyogi hai?
Bilkul.Asthibandh (Ligament) ki aasaan kataai se merurajju par dabaav bandh ho jaata hai aur phir flexion banaane waale uddeepann
(stimuli) merudand ko preyshit (sent) hona bandh ho jaate hai aur scoliosis ki pragati bandh ho jaati hai.
Kya filum terminale ki katai vikrut reedh ki haddi ko phir se seedha kar sakti hai?
Agar manushya ki reedh ki haddi mein spring ki sughatyata aur lacheelapan hota ya rabad ka bana hota toh woh phir se apni prarambhik
seedhe mudra par pahunch jaati. Par reedh ki haddi teevra dabaav mein viksit hui hai aur haddiyon, jod, aur asthibadh ko saalon tak
moda hua hai.jab yah dabaav se chutkaara mil jaata hai, uska swaasth laabh uske sughatyata ki maatra par aadhaarit hai, jo mareez ke
umar, patraik (genes), dabaav ki prabalta aur samay par aadhaarit hai.
Phir asthibandh ko kaatne ka faayda kya hai?
Pehli cheez jo filum terminal ko kaatne se praapt hoti hai, woh hai mukhya dabaav jis se bimaari
ki pragati hoti hai, usko ghataana. Is tarah jab scoliosis ki sheeghra pragati ho rahi hoti hai
tab bimaari ka vikaas adhiktar roka jaata hai.
Kai baar jab operation purva star (level) par kiya jaata hai tab filum terminale ki kataai ke baad
merudand svabhaavikta thodi maatra se seedha ho jaata hai. Agar sahi neurorehabilitation ho to aur sudhar aasakta hai.
Agar operation scoliosis ke viksit star(stage) mein kiya jaaye to filum terminale ka flexion paida karnewale dabaav ko ghatane ke
baavajood corset ya shalya chikitsa ke saath manka (vertebral) fixation paddhati ke kaaran manke ka asantulan khud ek aur flexion
paida karne wala dabaav banjaata jise teevra neurorehabilitation kaarya ki jaroorat hoti hai. Har sthiti mein filum terminale ki
kataai ki salaah di jaati hai taaki koi bhi upchaaraatmak asar ko sudhaarne ke liye karyaklaap liye jaaye aur reedh ki haddi ko
kheechte samay corsets ya shalyak sahi karne wale karvai (measure) ki prachandata kam kar dee jaaye.
Filum Terminale ki shalyak (surgical) kataai kya hoti hai?
Filum Terminale ki shalyak kataai reedh ki haddi ke ant mein sacrum par chota cheera karne se ki jaati hai
taaki reedh ki prakriya mein koi antar nahi aaye, filum terminale ko microsurgery takneek se dekh kar kaata
jaata hai. Yeh sab sirf aadhe ghante mein kiya jaata hai aur mareez ko aspataal mein ek din se bhi kam rehna padta hai.
Iss Asthibandh (Ligament) ko kaatne ke pareenaam kya hote hai?
Filum Terminale merurajju ke nichle prushtth ya lumbosacral kshetra ke khali dhakkan ka parinaam hai. Manav bhroon
(embryo) mein merudand (vertebral column) aur uske andar merurajju ki lambai samaan hoti hai aur unke darmiyan Jhilliyan
(membranes) hoti hain , jaise ki dura mater, arachnoid mater and pia mater . Vyakti ki samanya vikaas ke saath saath reedh ki
haddi merurajju se bees centimeter zyaada lambi ho jaati hai. Jo parat merurajju ko reedh hi haddi ke nichle prushtth bhaag se
alag karte hain unme ab merurajju nahi rehta aur woh ek reshedaar rajju (cord) ki tarah mud jaati hai aur yeh filum terminale banta hai
; yah merurajju ka bhaag ek mozey ki bhaanti hota hai jise hamney pehena hua ho, aur kheench kar aadhe pair par se utaar dein, woh bhaag
jisme pair nahi hai use pair ko koi nuksaan pahunchaaey bina kaata jaa sakta hai. Usi tarah filum terminale ko bhi bina kisi nuksaan ke kaata
jaa sakta hai.
Kya shalyak chikitsa kisi bhi scoliosis ghatna mein upyogi hai?
Filum terminale ki shalyak chikitsa sirf idiopathic scoliosis ya anjaan kaaran se hua scliosis ke liye hi uchit hai. Baaki sab
ghatna jaise Apkarshak (degenerative) scoliosis, neoplasa ya cancer se hua scoliosis, paralytic scoliosis aadi ke liye uchit nahi hai.
Kya reedh ki haddi ki tethering ka koi asar dimaag par hota hai?
Filum terminale par dabaav (strain) reedh ki haddee ko mud ne ke liye majboor karne ke alaava is dabaav se bachne ke liye ,
dimaag ki nichle bhaag (jise cerebellar tonsils kehte hai) ko neechey ki aur, foramen occipitalis, jo khopdi ko reedh ki
haddi se jodta hai), ke andar kheecha jaata hai jis se Arnold Chiari vikrut rachna (malformation) hoti hai. Yeh bimaari
sao saal par bayan ki gayi thi aur iska kaaran aaj tak agyaat hai.
Arnold Chirai Vikruti (malformation) ke liye filum terminale ki shalyak kataai se neeche ki aur jaata hua dabaav
cerebellar tonsils ke liye gayab ho jaata hai. Woh unhe takleef nahin honey deta hai kyun ki ab woh apne aap ko
foramen occipitalis ke andar daman (oppress) nahi karte. Shalyak Chikitsa kaafi bimaari ke aasaaron ko sudhar
ta hai aur cerebellar tonsils ko upar ki taraf hilne nahi deta kyun ki woh vikrut hai aur unme lacheelapan kam hai.
Kya reedh ki haddi tethering ke kaaran peesit (suffer) hoti hai?
Jaanvaron par saunshodhan aur jaanch se saabit hua hai ki reedh ki haddi ki halki tethering ke kaaran nakaafi khoon
ke sanchaar se gyan-tantu(neurons) ka karya bandh ho jaata hai.
Insaanon mein teevra Tethering se reedh ke haddi ke andar khoon ka sanchaar kam ho jaata hai kyun ki wahan
reedh ki haddi ke liye mahatvapurna rudhir-vahini nalika (arteries) hoti hain aur yeh bahar se andar jaati
hain khaas kar ke Cervical bhaag mein kyun ki nichey ki taraf jaane par bandish hoti. Khoon sancharan ki kami
se merurajju ke kuch hisse mar ya sadd jaate hai aur phir woh reedh ki haddi mein se Interstitial paani khench
kar merurajju ke beech guhika (cyst) banata hai. Ise syringomyelic cavity, syrinx ya Syringomyelia kehte hai.
Yeh bimari paanch sao saal pehle bayaan ki gayi thi lekin aaj tak is ki wajah nahi malum hai.
Kya iska matalab hai ki syringomyelia ka bhi vahi shalyak chikitsa se ilaaj kiya jaa sakta
hai , jiska scoliosis ke ilaaj mein kiya jaata hai?
Scolosis ki tarah hi Syringomyelia mein filum terminal ki kataayi bimaari ko rok deta hai. Sadan se hui guhika(cyst)
samaan hi rehti hai lekin mumkin hai ki woh gaayab ho jaaye jab reedh ki haddi ki aazu baazu ki jagah swabhavik roop
se khul jaaye ya beech ki aur khule jahaan ependymal nalika hai jo reedh ki haddi ke Kendra ko dimagi guhika (cavity)
ko jodta hai. Is bimaari ke aasaar tantu mrutyu aur guhika (cyst) ke gaanth jaisey asar ke kaaran hotein hain. Filum
ki kataayi ke do laabhprad asar hain : reedh ki haddi ki dabaav ki kaaran tantu ki mrutyu kko rokta hai aur guhika(cyst)
ke gaanth ki bhaanti asar ko kam karta hai kyun ki woh reedh ki haddi ko shithil (relax) kar deta hai.
Kya ye ilaaj mareezon par istemaal kiya gaya hai?
Ye teen beemarion (scoliosis, Arnold Chiari malformation, aur syringomyelia) key mareezon ka operation kiya gaya hai.
Kai mareez ko teeno beemaria thi aur kai mareezon mein aakasmik fayda hua.
Kya aap udaharan de sakte hai?
Ek adtaalis saal ki aurat ko bohot bura scoliosis tha. Use chaudah baras ki umar se peeth mein dard hota tha.
Woh jis bhi mudre (position) mein hoti ( palang mein leti hui ya utthte hue yaa aavarti (rolling) karte samay )
uske peetth ka dard kabhi bhi nahi jaata. 34 saal tak uska dard ruka nahi. Uska saat mahine pehle shaliya chikitsa
(operation) kiya gaya tha aur tab se use koi dard nahi hua.
Syringomeyelia ki ek ghatna: ek pachchees baras ke yuvak purush ko uske shareer ke baanyi aur taapmaan ka koi anubhav nahi
tha aur usko reedh ki haddi ke kendra mein ek badi guhika(cyst) thi (case 2 of publication 3). Shaliya chikitsa ke chhe ghante
baad vishesh jaankaar ne bataya ki mareez ke sparsh gyaan ka pura swathya laabh (recovery) hogaya, sudhaar aaj paanch saal baad tak chala.
Yeh mareez ab Galicia mein ek maal godaam (warehouse) mein kaam kar raha hai jab ki doosre vishesh jaankaron ney uske ghor ghaavon ko dekh kar
purvanumaan lagaya tha ki woh syringomyelia ke nidaan (diagnose) ke do saal baad poori tarah vikalaang (disable) ho jaaega.
Bibliography
1. Siringomielia, escoliosis y malformación de Arnold-Chiari
idiopáticas, etiología común (PDF).
2. Platibasia, impresión basilar, retroceso odontoideo y kinking
del tronco cerebral, etiología común con la siringomielia,
escoliosis y malformación de Arnold-Chiari idiopáticas (PDF).
3. Nuevo tratamiento quirúrgico para la siringomielia, la escoliosis,
la malformación de Arnold-Chiari, el kinking del tronco cerebral,
el retroceso odontoideo, la impresión basilar y la platibasia idiopáticas
(PDF).
4. "Results of the section of the filum terminale in 20 patients
with syringomyelia, scoliosis and Chiari malformation". Acta Neurochir
(Wien). 2005 Feb 24 (PDF).
5. "Aportación a la etiología de la siringomielia".
PhD thesis (PDF).