Straipsnis (pdf / 591 KB) - Lietuvos chirurgija

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suþinodavo tik ið atliktø rentgenogramø (5 pav.). Traumuotos dengiamosios kremzlinës plokðtelës ir tarpslankstelinio disko átaka nugaros skausmams ðiuo metu intensyviai tiriama naudojant BMR technikà [38]. Bendras JAV populiacijos NASS skausmo / negalios skalës vidurkis yra 86,7, o neurologinës skalës – 85,7 [40]. Serganèiøjø stuburo degeneracine liga skausmo / negalios vidurkis svyruoja nuo 46 iki 50, neurologinës skalës – nuo 49 iki 58 [31]. Mûsø tyrimo pagal NASS klausimynà rezultatai geresni uþ lëtiniais nugaros skausmais besiskundþianèiø ligoniø duomenis, bet nesiekia JAV gyventojø norminiø rodikliø. Roland-Morriso klausimyno vidurkis 5,9 atitinka literatûroje skelbiamus rezultatus, kurie svyruoja nuo 4,5 iki 8,4 [25, 41, 42]. Dël kultûriniø ir kalbiniø skirtumø tiesioginiø iðvadø ið ðiø palyginimø daryti negalime, taèiau galime teigti, kad metus po stuburo traumos 25,0% pacientø vargina nuolatiniai nugaros skausmai, ribojantys kasdienæ veiklà. Mûsø duomenimis, vidutiniðkai 32,4% prieð traumà dirbusiø ligoniø po stuburo lûþio operacijos vienerius metus yra nedarbingi. Kadangi daugelis autoriø darbingumo gráþimà, kuris svyruoja nuo 61% iki 82% [41, 43–45], vertino po dvejø metø, galima tikëtis, kad mûsø tyrime dalyvavusiø ligoniø nedarbin- Stuburo krûtininës ir juosmeninës dalies lûþiø operacinio gydymo rezultatai 199 5 pav. Metalo konstrukcijø nuovargio lûþis be aiðkaus deformacijos progresavimo. Dël nestabilaus B1.2.1+A3.1.1 tipo Th12 slankstelio lûþio su ryðkia kifozine deformacija (a) operuoto ligonio pooperacinëse rentgenogramose (b) matyti puiki slankstelio kûno repozicija ir kifozës korekcija. Po 18 mën. atliktose kontrolinëse rentgenogramose (c) konstatuotas besimptomis virðutinio sraigto nuovargio lûþis ir 6° segmento kifozës progresavimas dël Th11-Th12 tarpslankstelinio disko susiaurëjimo gumas ilgainiui maþës. Vertëtø paminëti ir tai, kad ið 34-iø prieð traumà dirbusiø ligoniø 14(41,2%) buvo gydomi nuo dauginiø suþalojimø, kurie taip pat turëjo átakos darbingumo gráþimui. Prieð traumà nedirbusiø pacientø labai prastà, tik 18,2% siekiantá, darbingumo gráþimo rodiklá bûtø galima paaiðkinti dviem, daugiau socialinio pobûdþio prieþastimis: 1) bedarbiui susirasti darbà po traumos yra gerokai sudëtingiau; 2) invalidumo iðmokos (visi tapo antros arba treèios grupës invalidais) neigiamai veikia darbingumo gráþimo rodiklius [43]. Nors komplikacijø bûta nemaþai, dauguma pacientø buvo labai patenkinti arba patenkinti gydymo rezultatais (3 lentelë). Iðanalizavus vieno labai nepatenkinto ligonio rentgeninius ir klausimynø duomenis, sunku paaiðkinti toká jo vertinimà. Ðio, niekur dël savo bûklës nesikreipianèio ligonio sprendimui galëjo turëti átakos gretutinës traumos (abiejø kulnakauliø lûþiai) padariniai, sukelæ invalidumà. Iðvados Nestabiliems sprogstamiesiems lûþiams gydyti trumpos transpedikulinës fiksacijos ir uþpakalinës spondilodezës nepakanka. Jei slankstelio kûno kompresija didelio laipsnio, indikuojama papildoma priekinës stuburo kolonos rekonstrukcija ir spondilodezë.
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