Enesifumbu - kuyini? kwezinso Sinzima umgogodla

Malformation yomgogodla, okuyinto kungase kuhambisane iziyaluyalu emgogodleni, - Spina bifida. Ayini amandla layo, lapho kuphakama izimo, ukuze abanye abahluphayo umzimba kungaholela - izimpendulo zale mibuzo kuyotholakala esihlokweni sethu. Nokho, ngenxa ukuqonda isithombe emitholampilo ye isifo Kuyadingeka ukuqonda umqondo womuntu isimiso sezinzwa esiyinhloko, isakhiwo yokwakheka yomgogodla spinal cord imisebenzi.

Umqondo we isimiso sezinzwa esiyinhloko

Central nervous system - ingxenye eyinhloko uhlelo womuntu sezinzwa. Umelelwa ubuchopho futhi umgogodla nentambo yakhiwa izinzwa kanye nomgudu walo. CNS kwakhiwa izigaba zezizwe ezintathu: ephansi kanye nephakathi nendawo ephakeme. Ngoba noma eziphakathi nendawo kukhona emgogodleni, le oblongata medulla, le ubuchopho obuphakathi, le ephakathi futhi cerebellum. Lezi zingxenye lokulawula umsebenzi kwezitho ngabanye, ukusungula therebetween uxhumano, ukuqinisekisa ubuqotho umzimba esebenza ngayo. CNS Ephakeme qanda amakhulu kakhulu ahlukanisiwe emelelwa ama- cerebral futhi okusebenza unikeza ukuxhumana nge imvelo.

Umsebenzi oyinhloko isimiso sezinzwa esiyinhloko - ukuqaliswa ukusabela elula eziyinkimbinkimbi - ikhaliphe. Kumiswa isimiso sezinzwa esiyinhloko is emavikini ekucala yokukhulelwa ngenxa isakhiwo ekhethekile - le yi-ectoderm. Uma division okungalungile nokuthuthukiswa ka ezinzwa kuphakama kwemizwa tube isici kulo, kamuva kuholela ukuthuthukiswa pathologies umgogodla.

emgogodleni - kwemizwa uhlelo isitho elise umsele umgogodla. umngcele esinikelweko phakathi emgogodleni ubuchopho agcinwe endaweni interleaving pyramidal zesivikelo sesifuba. Futhi ikhanda nomgogodla zihlobene imvilophi, ehlanganisa izingqimba ezintathu: okuqinile, spider futhi semithambo. Kusukela zangaphandle ukulimala kobuchopho ivikela Yekhanda, emgogodleni - yomgogodla.

Isakhiwo ikholomu vertebral

Emgogodleni - isisekelo lwamathambo omuntu lwakhiwa amathambo, phakathi lapho amadiski intervertebral - ungqimba uqwanga. Ezisebenza, amadrayivu ukunikeza nezimo of yomgogodla. 33-34 endaweni vertebra labantu, kunemibandela zenziwe izigaba: wesibeletho, thoracic, lumbar, sacral, coccyx.

kwakhiwa vertebra ngamunye umzimba arc nezinqubo. Umzimba kanye arc bakha izinqubo yezilwane ezinomgogodla kokuvula amathambo exhunywe nomunye futhi enze umsebenzi ukunamathela imisipha. Ngo nomzimba womuntu enempilo izimbobo amathambo uhlangane ku umsele olulodwa vertebral, okuyilokho, eqinisweni, iyona ndawo umgogodla intambo indawo. Kodwa kunezimo sokugembula lapho kukhona igebe ithambo - ". Enesifumbu" lesi simo sibizwa ngokuthi

Emgogodleni inikeza zokuxhumana zobuchopho ne-peripheral nervous system. Central isiteshi - umgodi ngaphakathi nomgogodla. umgogodla, kanye ekhanda, has a ulwelwesi emithathu ungqimba phakathi laphakathi eliqukethe cerebrospinal fluid. Ithambo amathambo futhi udonga lwangaphandle emgogodleni ukwakha phakathi kwabo isikhala epidural egcwele okunamafutha kwezicubu anezikhala emithambo yegazi.

Enesifumbu: kuyini?

Enesifumbu - lokhu ukonakala yomgogodla (enesifumbu), avamise yashubisa ngumuntu zokugula - hypoplasia ka emgogodleni. Lokhu kungapheleli iqala ukuzibonakalisa kusaqalwa ekhulelwe kanti kungukuchotshozwa ukwakheka kwe-neural tube. Neural tube - isakhiwo elisezweni izigaba kamuva yokukhulelwa kwakhiwa i-embryo ibizwa isimiso sezinzwa esiyinhloko - ubuchopho nomgogodla. izindaba eziningi iziguli izifo Spina bifida ukunikeza isizathu zokuhlukanisa ezithile zokugula at ngokuhambisana kobukhulu kombungu:

• amafomu kunemibandela omnene: esicashile Spina bifida, meningocele, lipomeningotsele;
• Inzima myelomeningocele; myelomeningocele, iphimbo inkimbinkimbi.

Enesifumbu itholwa ngesikhathi magnetic resonance imaging noma nejrosonografii.

Izibalo zibonisa ukuthi kukhona isifo ezinsaneni 1-2 e 1000. I zokugula kuyinto zofuzo, ngoba kuze kube 8% ezizalwa okuphindaphindiwe ekugcineni kwatholakala ukuthi nginesifo Spina bifida. Odokotela bathi kungenzeka ukwenzeka izingane ezizalwa omama abaneminyaka. Nokho, 95% izingane enesifumbu uphethwe avele abazali abaphilile musa uhlushwa isifo efanayo.

amafomu Ezintsha ka Spina bifida

Hidden Spina bifida (occulta) - ifomu omnene kakhulu lesi sifo, ngoba lapho kukhona nokungathuthuki, ngokungathi ngesikhala esivulwe elincane amathambo. Ngokuvamile kwenzeka lumbar noma emgogodleni sacral. Lokhu zokugula ihlanganisa kuphela izicubu emgogodleni amathambo akuphazamisi isakhiwo umgogodla. Lesi sifo ngokulinganisela sizibonakalise, futhi ngokuvamile akusho ukuzibonakalisa izimpawu okungenzeka ziphazamise umuntu. Iziguli eziningi ezinalesi sifo futhi abazi izifo zabo. izimpawu yesilinganiso lubonakale izifo kule osanda kuzalwa kungaba kweqembu izinwele, ngokuvamile encane; isikhwama amafutha; ukucindezeleka noma umkhangu endaweni zokugula.

Kuphela ezimweni ezimbalwa (1 aphume amacala 1,000 ifomu okucashile ka Spina bifida) angahlangani kuholela thuthuva ukusebenza ngomgudu womchamo, wamathumbu, ukuba buthakathaka kwezicubu yezingalo nemilenze aphansi, ukuze ugobile yomgogodla. inombolo ethile of amathambo nomgogodla ngokuvamile kukhonjisiwe irekhodi yezokwelapha isiguli, lapho kwakukhona egunjini lokuhlolwa kwezifo. Ngokwesibonelo, kwesithi "Spina bifida posterior S1" ibonisa izinkinga wokuqala vertebra sacral emgogodleni.

Meningocele - ezihlukahlukene enesifumbu, lapho ngaphezu umuntu angakwazi umnkantsha emgodleni zokuzivikela ingaba njengesihluthulelo iqhubu noma amaphilisi ngokusebenzisa i slot ekhona. Ngokuvamile, umgogodla nentambo ezinzwa izinqubo ngaphandle pathologies noma zinokukhubazeka okuncane. Ezimweni eziningi, le capsule imbozwe isikhumba, okuyinto evamile ivikela elikuqukethe. Nokho, ngisho le nkinga ezincane zidinga ukwelashwa kuhlinzwa ukulungisa ukukhubazeka yezimonyo.

Lipomeningotsele

Lipomeningotsele - uhlobo Spina bifida, okuyinto kubhekwa zokugula ngokulinganisela. Kwezokwelapha, ukuhlukumeza ubhekwa njengesilwane esisengcupheni Symbiosis kwakhiwa hernias umgogodla futhi lipomas - izimila ingozi. Lokhu ukuphazamiseka e kwemizwa tube kumiswa kwenzeka phakathi nezinsuku zokuqala 20 okukhulelwa. Lipomeningotsele isici ukuthi kungabangela ukuthuthukiswa pathologies zezinzwa kuholela ezifweni eziyingozi kohlelo genitourinary, amathumbu - izicubu adipose ucindezela emgogodleni. Banikezwe umlando iziguli izifo lipomeningotsele, kungenziwa kunemibandela zihlukaniswe ngamaqembu amane ukubonakaliswa sokugembula lesi sifo:

• ngaphandle iziyaluyalu esithinta izinzwa, okhalo kanye wamathambo;
• paresis omnene imilenze, izinyawo ukusonteka;
• kanzima kahle motor umsebenzi, ugobile umgogodla, iziyaluyalu floor kwezitho zangasese;
• esitho sengozini, ezinzima zokugula okhalo.

Ngakho-ke, kuphela kanye ukwelashwa okungcono lesi sifo ubhekwa ngokushesha ezivimbayo futhi zilekelele masinya kuhlinzwa. Ngokuhlanganyela ukuhlinzwa ukhishwe izikhwama amafutha theka plastic hernia esangweni.

Myelomeningocele - ifomu okunzima Spina bifida

Ifomu olunzima kunalo lonke ake isifo, okuyinto eyenzeka ngo-75% wabo bonke amacala angakwazi amathambo - myelomeningocele (Cystica enesifumbu). Kuyini lokhu? Encephalocele - isici intambo okuyinto kuphuma ngokusebenzisa isici yomgogodla. Kwesinye isikhathi capsule ukuze emgogodleni ivikelwe isikhumba, kwezinye izimo, ubuchopho izicubu ngamangqamuzana ezinzwa amahlumela ephuma. Kuleli fomu yesifo akunakugwenywa iziyaluyalu zezinzwa. Izinga zalezi zinkinga izonqunywa kobukhulu ukungapheleli emgogodleni ingxenye umgogodla, lapho ukwephulwa iphutha. Uma lesi sifo sihlasela ekupheleni emgogodleni, izinkinga ezithinta uhlelo genitourinary namathumbu, ephansi esitho ukukhubazeka kwenzeka.

Ngokuvamile, hernias umgogodla zenzeka yomgogodla lumbosacral. Ezimweni lapho zokugula eba ezingeni yomgogodla thoracic noma wesibeletho, Nokho, ihlangabezane zokwelapha. Ngeshwa, kwemizwa tube isici ngokuvamile ehambisana nobutha omunye ukwephulwa - iphimbo noma Chiari anomaly kubangelwa kuwukwephula kumiswa izimbotshana ngaphakathi oludakayo Yekhanda.

Iphimbo kanye Chiari anomaly

Iphimbo (amanzi kobuchopho) - a zokugula okubangelwa ekuqongeleleni cerebrospinal fluid ku ventricles zobuchopho. cerebrospinal fluid - yotshwala - ngokuqhubekayo lalikhona uhlelo ventricular.

Umqulu edingekayo of cerebrospinal fluid kungenziwa amisiwe ngezindlela ezimbili:

• amaseli yezindlala ekhiqizwa izitsha ku ventricles ingqondo;
• propotevanie kwakhiwa ngenxa oketshezini olungenambala lwegazi ogangeni semithambo.

cerebrospinal fluid ukhiphela kusukela ventricles ebuchosheni umgogodla isikhala subarachnoid zobuchopho. Intracranial spinal izikhala sotshwala umzimba ophilile sekuhlanganisiwe. Lapho lumbar herniated, kwakhiwa ukuxhumana iphimbo. ukunqwabelana imikhondo uketshezi lenyuka ingcindezi intracranial, okuholela kwehle umbono, okuvela kuyo sokuwa strabismus, ubuthakathaka imisipha wemikhawulo yasenhla nemithombo yasenzansi. iziphazamiso ezinjalo kuholele iziyaluyalu zezinzwa ezinzima, ukulahlekelwa amakhono engqondo, ukufa.

Anomaly Arnold Chiari - a zokugula lapho amygdala sehliselwe phansi ezingeni amathambo lokuqala nelesibili wesibeletho, kanjalo uvimba kunyatheliswa i-cerebrospinal fluid.

ukuphathwa Steel ka myelomeningocele

Ingozi embi kunazo zonke ekuphileni olusana nge myelomeningocele igebe hernia sac kanye nezifo kokungena ngaphakathi elikuqukethe. yezinkinga ezithathelwanayo, decompensation iphimbo - imbangela eyinhloko okusezingeni eliphezulu mayelana nokufa kwezinsana, kwatholakala ukuthi nginesifo Spina bifida. liquorrhea Uma Kutholwe - I-cerebrospinal fluid - Kwenziwa ukuhlinzwa eziphuthumayo ukususa umbhunu umgogodla.

Kuze kube manje, indlela elilungile ukuqeda lezi pathologies iye yasetshenziswa ngempumelelo emhlabeni wonke, kuba ukuba afeze ukususwa kokubeletha ka hernia umgogodla. Wathi kohlobo oluthile kuhlinzwa kuvimbela ukuthuthukiswa iphimbo kanye Chiari anomaly e seziguli ezisencane; ukugwema eziyingozi futhi kuphila kwetfu engotini, kanye okwalandela ukuhlinzwa dlula. Manipulation ngenhla ukunikeza amathuba kuzalwa for ezingeni evamile yentuthuko kanye nezinga lempilo.

Uma ukuhlinzwa ngesikhathi esifanele fetus ngasizathu simbe engakaze kwenziwe, yakhetha shunt ukuhlinzwa, okuyinto normalizes inani cerebrospinal fluid. Ngokuvamile, lo msebenzi wenziwa ngezigaba ezimbili. Emgogodleni Umtholampilo - isikhungo sezokwelapha focus ewumngcingo, ngokuvamile ukusiza ukuxazulula izinkinga eziningi ezihlobene pathologies umgogodla.

ukuhlola

Ngo inqubo yokwelapha yesimanje, Spina bifida sitholakale kusaqalwa sokukhulelwa. Ngakho-ke, abazali abazoba naso isikhathi uphethwe nokuqaphela ukulungiselela ngokwengqondo sokubelethisa izici. Ngakolunye uhlangothi, nazo ziba isikhathi ithuba lokuthatha isinqumo non-ukongiwa umbungu.

Ngesikhathi ekhulelwe (amasonto 16-18), omama abakhulelwe ibhekane screening test, esekelwe ukuhlolwa igazi. Indlela liqukethe kokuhlola lokuhlushwa amaprotheni-embryonic, okuyinto ngokuhamba evamile yokukhulelwa lithela e esincane. Ephambi kwezinduna isimiso sezinzwa esiyinhloko, angelasici AFP lokuhlushwa anda. Kukhona izici isivivinyo. Ngenxa nesenzakalo okungenzeka amaphutha lapho ehumusha imiphumela ukuhlaziywa kumele ilandelwe ngokucophelela zeminye imithetho:

• ukusungula sokukhulelwa olunembile kakhulu;
• uma kungaba ukuthi ukukhulelwa kuphazamisa kwande, it has lapho ethola ukuthi unesifo ngesikhathi.

Enye indlela uphethwe kuyinto ultrasound kokubeletha olwenziwa emazingeni athile yokukhulelwa, ukunika amandla ukuthola egunjini lokuhlolwa kwezifo. Le ndlela ikuvumela ukuba ngeso lengqondo ubuchopho, umgogodla, ikholomu vertebral futhi uphethwe ngendlela esifike ngesikhathi. Nokho, kumelwe sikhumbule ukuthi zinokukhubazeka ezincane (ezifihliwe Spina bifida) angahlangani ayikwazi ukutholwa.

Amniocentesis - lubhoboze amniotic fluid - enye indlela uphethwe. It ligijima inaliti esikhulu ngokuqinile kuphela ngaphansi kokulawula ultrasound. Le ndlela isetshenziswa lapho ukuhlaziywa igazi yembula lokuhlushwa okwedlula i-AFP, futhi uphethwe ultrasonic ka pathologies abaziwa. Liquid seqophelweni legazi, lwahlolwa ukuze amaprotheni lokuhlushwa esingesihle, okwedlula okhombisa khona yokuphazamiseka ukuthuthukiswa ikholomu umgogodla.

zokuvimbela

Yiqiniso, azikho ngochwepheshe kungaqinisekisa ukuthi uma zonke izinyathelo ezidingekile kanye ukungabikho engcupheni owaziwayo abazali enempilo okuzelwe ingane ephile saka. Ngeshwa, ngezinye izikhathi isimo elahla ngenye kunomuntu eqala. Kodwa amandla komama esizayo nawobaba ukwenza esiphezulu ukuze kuncishiswe ubungozi kungenzeka kube kuncane uphinde unciphise amathuba kokuba ingane enesifumbu zokugula cishe zero. Sikhuluma izinyathelo.

Omunye izinyathelo main ukuvimbela ukuvela ukuxilongwa osanda kuzalwa 'enesifumbu "kuyinto ukuhlela ngokucophelela ukukhulelwa. Ukuze wenze lokhu, umama engaba nobaba ngaphambi nje ebamba isisu kuyadingeka ukuba kudlule lapho ngihlolwa Kuphoqelekile ukuya kokubonisana zofuzo. Owesifazane ngesikhathi sokukhulelwa kuyadingeka ukuze ahole indlela yokuphila enempilo, ukuze uqaphele ethola anticonvulsants. Kodwa i-folic acid ngokwezinga okudingeka senze ngalo, kunalokho, uboniswa kule nkathi. Emazweni amaningi athuthukile, nanti iphuzu eyinhloko esimisweni Kunconywa ekukhulelweni Health Organization.

Kumele kukhunjulwe ukuthi engcupheni yesifo kukhona ufuzo zofuzo; kwezifo ezithwalwa abesifazane ngesikhathi sokukhulelwa, ezifana ne-rubella; umthelela imvelo yangaphandle - ngemisebe, utshwala, izidakamizwa.

I iziphakamiso main

Ngakho, umbuzo «Spina bifida -? Kuyini lokhu", ungakhetha amaphuzu ayinhloko. Enesifumbu - a zokugula ezenzeka utero, phakathi namasonto okuqala okukhulelwa. Okuwukuphela kwendlela yokugwema lesi sifo ingane - ihlela ukukhulelwa, ukuze kugcwaliseke zonke izidingo ezidingekayo odokotela, umama okhulelwe ukuze ahole indlela yokuphila enempilo, kutakhela yokuntuleka folic acid emzimbeni.

Uma zokugula namanje wathola, ukulethwa yenziwa kuphela Ukubeletha ukugwema ngukulimala emgogodleni ngesikhathi ukudlula i-fetus ngokusebenzisa emgudwini wokuzala.

Ukuxilonga izifo, zikhona izindlela ezihlukahlukene - ukuhlolwa igazi, ultrasound ukuhlola, amniocentesis. Nokho, uma le ukuhlukumeza okutholakele futhi inkinga itholakala lapho, kubalulekile ukuba afeze ukuhlinzwa.

Indlela entsha yokuqeda ukwelashwa kwe-intrauterine. Kukhona nokungenelela kokusebenza ngemuva kokuzalwa kwengane - ezinsukwini ezintathu zokuqala zokuphila kwakhe. Ngendlela, ukusola kukaSpina bifida enganeni kungabangela: i-hernia emgodini, izikhumbuzo zokubeletha noma izigodi kwenye indawo yesikhumba, isikhwama esingavamile sezinwele. Ngokuqinisekile, ukuxilongwa okucacile kusungulwa ngemva kophenyo olwengeziwe - CT, MRI.

Kuye indawo yendawo ethintekile yomgogodla, kanye nokuphazamiseka okusebenzayo okuhambisanayo, lesi sifo sihlukaniswa sibe amafayili alula futhi alula kakhulu.

Izinhlobo ezikhanyayo zikaSpina bifida azivame ukuholela ezinkingeni ezimbi, iziguli ezixilongwa ngaleyo ndlela ziyashintsha emphakathini. Endabeni yokuhlukunyezwa okukhulu - ukukhubazeka kwe-meningomyelocele akukwazi ukugwema, noma ngabe ukusebenza kuphumelele.

Imitholampilo yomgogodla uhlobo lwesikhungo sezokwelapha esinobuchwepheshe bezokwelapha ukusiza iziguli ezinezinkinga ze-CNS. Ngakho-ke, ukuxilongwa kukaSpina bifida akuyona isinqumo. Ungakwazi futhi kufanele uphile nayo.