I-Needle yeQuincke: Indlela esebenzayo yokwenza i-Lumbar Puncture

Indlela ekhombisa i-anatomy: Indlela okuyinto yama-Quincke needle okuyinto yokuqeqeshwa kwe-bevel ukusiza ukuthi kufinyelele kwe-dura ngokujabulisayo

Ukubalwa kwe-bevel nokuxhumana kwe-tissue: Kungani ukuthi ukushisa nokuxhumana kuyinto kwi-L3–L4/L4–L5

Isikhombisa se-Quincke sisebenzisa indlela yokufinyelela kwe-dura ngokuhambisana—kungakho nokuthi kuthwala—izihlangothi zezinkampani zomkhakha we-ligamentum flavum ne-dura mater. Lokhu kunciphisa ukuguqula kwesithunzi nesixhobo sokufinyelela. Kukhulu kakhulu, umlando wokubhevela kuyimfuneko yokubhekana kwezihlangothi zedura: uma kubhekana ngokuparalela nendlela yokuqonda yedura (ngokuvamile ngokubhekana kuma-lateral noma ku-cephalad), isikhombisa sibheka izihlangothi ngaphandle, sibuyisa ubukhulu bakho nesikhundla sokuthi kungabikho ukugcina kwe-cerebrospinal fluid (CSF). Isithunzi esishisayo esihlukile sisibonisa ukufinyelela kwe-dura—ngokuvamile kude kwe-5–7 cm abantu abadala—sibonisa umbuzo wokusho okuphelele. Ukufaka isikhombisa ngokuphakama kwe-20–40° kusobala kwi-interlaminar window, kungavunywa ukuthi kuboneke kwezinkampani, kanye nokuthuthukisa ukufinyelela okuphelele kwezinhlobo zezinkampani.

Isivumelwano se-biomechanical: Ukufinyelela okuphelele kwe-CSF nganti yokuthi kungabi nesiphetho sokuthwala kwe-dura noma ukuthwala kwezindawo zezinyawo

Umbono wokuphatha kwe-Quincke uyathumela ukuphatha kwendlela efanele kwe-dura ngokushesha nokubuyela kwe-CSF ngokushesha—kukhulisa ukudiagnostics futhi ukunciphisa isikhathi sokuphatha. Ukuncipha kwezindawo zokufaka kunciphisa ubuzwe bocansi nokuqondwa kwe-needle. Kodwa lokhu kubonakala kusenzo lomlando: isibezo esisheshayo sithula indlela yokuqondwa kwe-dura engasifanisi ngokuzenzakale, kuvuseka isibopho sokuphatha kwe-lumbar (PLPH) nokubaleka kwe-leak. Uma isibezo siphumelela ku-nerve root—ikakhulu uma kufakwa ngokuphakanyiswa okuphezulu noma ngokuchangeza kwe-anatomy—kungabangela ubuzwe obusheshayo bocansi noma ukuthwasa kwe-nerve ngokugcwele. Lokhu kunciphiselwa ngokuphatha kwezindlela ezilungile: ukuphatha kwezindawo zokufaka ngokucophelela, ukubona ngokushesha ukuthwasa kwe-stylet nokubona ukuthwasa kwe-fluid column, futhi ukubeka impilo kwe-tactile feedback yendlela yokuphatha. Ngeminye iminyaka, ukusheshayo kwe-Quincke akayi isibopho kodwa isibonelo sokuphatha ngokuphelele nokuphatha ngokuphelele.

Ukuphatha Kweminyaka: Ukuphatha Kwe-Quincke Ngokuphelele Ukuthola Isiphumo Sokuphatha Kwe-Lumbar

Umthwalo wokufaka ngamaphuzu: Ukubonakalisa amathuba, isihlangu, ubude, nokubona ngokushesha kwe-CSF

Qala ngokufaka kahle—ngokulwa ngokuphambili noma ngokuhlala ngokuphambili kakhulu kwe-lumbar—ukuthi uhlakuleke kakhulu isikhundla phakathi kwe-spinous. Thola amasiko ase-ilium ukuze ubone isikhundla phakathi kwe-L3–L4 noma L4–L5. Emva kokuchitha iskin noma ukubeka isifuba sokuvula, funda igunyana ngaphakathi kwe-midline, ngokuthi i-bevel iyahlala ngokuparalela ne-dural fibers (kubizwa kangangokuhamba ngokuphambili noma ngokwesidlanga). Funda ngokuphambili ngokugcina isikhundla ngokuphambili ngokuphakeme kakhulu kwe-10–15°, ngokuthi uyishele ku-umbilicus. Kunezindlela eziqinisekileyo: ukusebenzisa isifuba sokuvula ngokuphambili kusiza kakhulu ukuthi ufake ngokuqala. Umnyango wokuvula owa-2020 wabonisa ukuthi ukusebenzisa igunyana eliyi-27G ezinga le-Quincke nesifuba sokuvula sibona ukuthi kufakwa ngokuqala kwe-dural ngokuphambili kwe-93.3%—ngaqinga kwe-72.1% ngezindlela zokuvula ngokuzenzakalela (P=0.019)—futhi sibeka isikhundla sokuvula ngaphakathi kwe-gunyana (8.9% vs. 30.2%) nokungapheleli kwesikhundla sokuvula. Ukusebenzisa isifuba sokuvula kusiza futhi ukuthi isikhundla sokuvula sibe ngaphansi kakhulu, okusho ukuthi kubonwa ngokuthe ngaphambi ukuthi igunyana ifike emaphakathini. Uma i-CSF ibonakala, kufanele ibe yisikhundla esihlukile ngokuphambili; uma isikhundla sibonakala ngokuphambili kakhulu, ukuzingela igunyana ngokuphambili kwe-90° kusiza ukuthi i-bevel ibe ngokuparalela ne-dural fiber orientation.

Ukuqondisa imiphumela eyinkimbinkimbi: Ukuthatha isithelo esisilile, ukuthatha isithelo esinamapho, nokulungisa indawo ngokusebenzisa i-Quincke needle

Ukukhupha okushisile kumele kubonisa ukuthi ubunyathelo bawebhile ngokungafanele kwe-nerve root noma ukuthi kwenziwe ngaphandle kwe-dura. Ukususa okuncane futhi ukufaka kabusha ngokugcina okuncane kumele kuzivikela lokho—ikakhulu lapho kubhekwa ngokuvumela ukuthi kubhalelwe. Umgcino wokuvumela wokwakhiwa kweminyaka yami-2020 wabonisa ukuthi abantu abasebenzisa ukuphuma kwebhola kubedala izikhathi eziningi futhi kubedala ukufaka kude kakhulu, kuyavumela ukuthi ukuvumela kusebenza njengokuvikela ukuthi kubhekelwe ngokungafanele ukuthi kufakwe kude kakhulu. Ukukhupha okubhacwe kumele kubonisa ukuthi kubhakwe i-venous plexus; uma i-CSF ayiklare ngaphandle kwe-3–5 mL, suse futhi faka kabusha emsebenzini esibeni. Kabantu abanemithambo yabo yinkulu, abanemiphumela yezindaba zokugqaza kwe-spine, noma abanenkinga yokuhamba, ukunquma kwe-hip futhi ukudibanisa ukuthi kubhekelwe ngokucacile kusiza ukuthi kufakwe phakathi kwe-spinous. I-Quincke needle ene-bevel enenhloko—ekubonisiwe ngokuvumela—iyasiza ukuthi kubhekwe phakathi kwe-true subarachnoid entry ne-extradural placement, kuyavumela ukuthi kungafakwanga kancane futhi kungavikeleke izinkinga eziphambili.

Ukuchazwa Okubaseka kwezindlela Zokufunda: Amaphutha e-Quincke noma amaphutha e-Atraumatic kuziphakamiso zokufunda zezinye zezindawo zemithi yomphakathi

Izilingo zokuphakamisa izihlalo zemithi yomphakathi (PLPH): Ukubala ukugcina phakathi kwesikhundla sokusebenza nokucinga ngokungafanele kokubonakaliswa

Amaphutha e-Quincke ayisisekelo esikhulu ngokupheleleyo ngokuba kuyabona izilingo zokuphakamisa izihlalo zemithi yomphakathi (PLPH) kunezamaphutha e-atraumatic (ezingaphansi kwezincwadi)—lokhu kubhekene nezindlela zokuphakama kwezindawo zemithi yomphakathi. Umkhosi woku-2017 we-Cochrane wabeka isiphumo sokuthi izihlalo zokuphakama kwezincwadi zizokuphakama ngokulingana ne-60–70% kuzo zonke izigaba. Isihlalo se-Quincke sibhala kuzo zonke izihlalo, sibhala isikhundla esikhulu esingasemthethweni esikhiyela ukukhala kwe-CSF. Ngaphandle kwalokho, izihlalo zezincwadi ziyahlanganisa izihlalo ngaphandle kokubhala, futhi ziyakhala kusho kusasa.

Ngaphandle kwalokho ukuphulukana, isikhombisa se-Quincke sisebenza kakhulu emsebenzini: ukubonakala kwakho okuhle kwezinto ezihlukene nokubonakala okuhle kwe-CSF kususa inani lezizindleko—lobuthi obuyiwe ngokwesibonelo sokuthi kungahleli kwezinkinga zokuthi kuzoba ne-PLPH. Ngakho-ke, isikhombisa se-Quincke esisodwa ngokupheleleyo singaba nenzima encane yezinkinga ngokujulile kunamazindleko amaningi angafaneli nesikhombisa esingasithi ngokuphambili ekunqamlezweni oluncane.

Kuphi u-Quincke uyabhekana: Izinqumo eziphathelene nokusebenzisa isikhombisa esisodwa (isibonelo, ububi bezinkundla, izinkundla eziyisiliva, ububi bephansi kwe-CSF)

Izimpumelelo zesikhombisa se-Quincke ziyabhekana kumazindleko amathathu amahle emsebenzini:

• Ububi bezinkundla (BMI > 35): Amaphakathi amaningi wezinkundla azimisa ukubonakala kwakho kwezikhombisa esingasithi ngokuphambili, ngakho-ke isikhombisa se-Quincke sibeka isiphephelo esihle futhi sibuka isiphetho se-CSF esihle.
• Izinkundla eziyisiliva noma eziyisikhalo : Ukufibra, ukusikhalo, noma ukugcina kwesikhombisa sesinye kusindisa ukuphambuka kwezikhombisa ezingasithi ngokuphambili; u-Quincke uyakhuluma ngamandla amancane kwezifunda, ukuncima izinkinga zokuthi kuzoba nezinkinga zocauda equina ngokuphambuka kwezinkinga.
• Izimo eziphansi kwe-CSF : Kusenzo esikhathini sokugcina kwezinye izinto, noma ukugcina kakhulu kwemithambo, isivinini esincane sesifuba sokubhala kusindisa ukuthi inqubo yokuqonda iyakwenzeka ngokungafani—kepha i-Quincke iyakubonisa ngokushesha ukuthi inqubo yisifuba ngokufika kwezinye izinto.
• Izimo ezingazimisekile noma ezingaqondi kakhulu : Kusenzo lwesibhakabhaka sokubhala kwezinye izinto, noma ukubhala kwezinye izinto, ikakhulu uma kunezinkinga zokuzimiseka noma ukuguqula kwezinye izinto, umphumela wokusebenza kwe-Quincke ngokuphelele uyakuncima ukuzimiseka kokuzwa nokungasebenzi kwezinye izinto.

Lezi zizindlela ziyabonisa ukuthi kuyisibalo sokuzimiseka: uma ubukhulu bakho bengasiza ukuthi kubhekwe ngokuphelele, umphumela wokusebenza kwe-Quincke uyakubonisa ukuthi kuyisibalo sokuzimiseka kwezinye izinto.

Isiqephu Sokukhetha Ngokuphelele: Ukulandela Amaphuzu Ama-Quincke Ku-Isipropo Noma Ku-Isilungu

Ukukhetha amaphuzu ase-Quincke ayisifanayo akudinga ukuthi amaphuzu ayilandelelwe ngokuphelele ngokuphatha kwezinye izinto noma ukuthi amaphuzu ayilandelelwe ngokuphelele ngokuphatha kwezinye izinto. Le tafula iyakubonisa izindlela ezinkulu zokukhetha ekhaya lokusebenza.

Kodwa ukukhetha isikhombisa kufuna ukubona ubunzima bokugcina, ubulungiselelo bezindawo, nokuthi sizifuna ukwenza ntoni—kungaba ukuthola isikhathi sokuvula, ukuthola izinkambo zezinhlobo zezinto, noma ukususa i-CSF ngokuthuluzela—kuyabonakala ukuthi kuzoba kumele kahle, futhi ukuthi kuzoba kuncipheka kwezinkinga. Ukusebenzisa ngokucophelela isikhombisa se-Quincke kuyabuyisa ukuthi ukuthatha i-lumbar puncture kusuka kwezindlela zokusebenza kusukela ekutheni kuyisikhathi sokuthi kuyasebenza ngokuphelele ngokubona izindawo zezindawo.

Imibuzo Evame Ukubuzwa

Kungani ubunzima bokubeka kubaluleke ngokuthatha i-lumbar puncture?

Ubunzima bokubeka buyachaza ukuthi amaphakathi ase-dura ayasuswa noma ayasahlukaniswa. Ukubeka ngokuphelele kwezindawo zezindawo zase-dura kungasiza ukuncipha ukuthi kuzobhekwa kwezindawo kanye nokuncipha ukuthi kuzobhekwa kwe-CSF.

Isikhombisa se-Quincke sibonakala njani kunezikhombisa ezizokungahloniphi ngokuthi kuzoba kuncipheka kwezinkinga zokuthatha i-lumbar puncture?

I-needle yeQuincke iyalinkisiwe nezinkinga zokugula isikhathi sokuphuma kwelungu (PLPH), ngoba isibezelo sakho esihlukanayo sisebenza kakhulu kubunzima be-dura ngokulingana nesibezelo esingasiza, esisepheka amafibra ngaphandle kokusila.

I-gauge ephakanyiswa kangakanani ekwenzeni kwelungu yokuzilonda?

Kwelungu yokuzilonda, izigauge ezifana ne-25G noma ne-27G ziyasebenzisa kakhulu ngoba zizimisa izinkinga zokugula isikhathi sokuphuma kwelungu (PLPH). Kodwa, izinhlobo ezingaphansi kakhulu zingaba yisimo esisiza ukususa umsindo wokufika kwe-cerebrospinal fluid.

Ukubanjwa kuyakuthinta njani indlela yokwenza kwelungu ngezinqamulelo zeQuincke?

Kwabasebenzi abanamandla, izinyathelo eziningi zemithambo yezindawo zingaba yisimo esisiza ukukhumbula ukuthi ubunzima bukhona. Izinqamulelo zeQuincke ziyasebenza kakhulu kulesi simo ngoba isibezelo sakho esishushu siyakubonisa ukuthi ubunzima bukhona ngokuphelele.

Kufanele kwenziwe njani uma kufika isikhathi esingasiza noma isikhathi esinamandla?

Uma kufika isikhathi esingasiza, kufanele kusukwe kancane kanye nokubuyisela inkampani ngokuguqula isikhundla. Uma kufika isikhathi esinamandla, kufanele kubuyiselwe emsebenzini wesinye uma umsindo wokufika kwe-cerebrospinal ayikwazi ukuvula ngaphandle kwe-3–5 mL.