Myelomeningocele

I-Myelomeningocele sisiphene sokuzalwa apho umqolo kunye nomjelo womqolo ungavali ngaphambi kokuzalwa.

Imeko yoluhlobo lwespina bifida.

Ngokwesiqhelo, ngenyanga yokuqala yokukhulelwa, amacala omabini omqolo wosana (okanye umqolo womqolo) ayadibana ukuze agubungele umnqonqo, imithambo-luvo, kunye neentsini (izicwili ezigubungele intambo yomqolo). Ingqondo ekhulayo kunye nomqolo okwangoku kuthiwa yityhubhu ye-neural. I-Spina bifida ibhekisa kuso nasiphi na isiphene sokuzalwa apho ityhubhu ye-neural kwindawo yomqolo isilela ukuvala ngokupheleleyo.

I-Myelomeningocele sisiphene se-neural ityhubhu apho amathambo omqolo engasebenzi ngokupheleleyo. Oku kukhokelela kumjelo womqolo ongaphelelanga. Intambo yomgogodla kunye ne-meninges iphuma ngasemva komntwana.

Le meko inokuchaphazela kangangoku-1 kwaba-4 000 kwiintsana.

Eminye imeko ye-spina bifida ixhaphake kakhulu:

• I-Spina bifida occulta, imeko apho amathambo omqolo angavali khona. Intambo yomgogodla kunye neebhloko zihlala endaweni kwaye ulusu luhlala lusigubungela isiphene.
• I-Meningoceles, imeko apho i-meninges iphuma khona kwisiphene somnqonqo. Intambo yomqolo ihlala isendaweni.

Ezinye iingxaki zokuzalwa okanye iziphene zokuzalwa zinokubakho kumntwana one-myelomeningocele. Isibhozo kwabantwana abalishumi abanale meko bane-hydrocephalus.

Ezinye iingxaki zentambo yomgogodla okanye inkqubo ye-musculoskeletal inokubonakala, kubandakanya:

• ISyringomyelia (umjelo ogcwele ulwelo ngaphakathi kwithambo lomqolo)
• Ukwahlukana kwe-Hip

Unobangela we-myelomeningocele awaziwa. Nangona kunjalo, amanqanaba asezantsi e-folic acid emzimbeni womfazi ngaphambi kwaye ngexesha lokukhulelwa kwasekuqaleni kubonakala ngathi badlala indima kolu hlobo lwesiphene sokuzalwa. I-acid ye-Folic (okanye i-folate) ibalulekile kuphuhliso lobuchopho kunye nentambo yomqolo.

Ukuba umntwana uzelwe ene-myelomeningocele, abantwana bexesha elizayo kolo sapho banomngcipheko ophezulu kunabantu ngokubanzi. Nangona kunjalo, kwiimeko ezininzi, akukho nxibelelwano losapho. Izinto ezinje ngeswekile, ukutyeba kakhulu, kunye nokusetyenziswa kwamayeza okulwa ukuxhuzula kunina kunokwandisa umngcipheko wale ngxaki.

Usana olusandul 'ukuzalwa olunale ngxaki luya kuba nendawo evulekileyo okanye ingxowa egcwele ulwelo embindini ukuya ezantsi.

Iimpawu zingabandakanya:

• Ukuphulukana nesinyi okanye ukulawula amathumbu
• Inxalenye okanye ukungabikho ngokupheleleyo kwemvakalelo
• Ukukhubazeka ngokukodwa okanye okupheleleyo kwemilenze
• Ubuthathaka bethanga, imilenze, okanye iinyawo zosana olusandul 'ukuzalwa

Ezinye iimpawu kunye / okanye iimpawu zingabandakanya:

• Iinyawo okanye imilenze engaqhelekanga, efana neenyawo
• Ukwakhiwa kolwelo ngaphakathi kolukakayi (i-hydrocephalus)

Ukuvavanywa ngaphambi kokubeleka kunokunceda ekufumaneni le meko. Ngexesha lekota yesibini yesibini, abasetyhini abakhulelweyo banokuvavanywa igazi ekuthiwa yi-quadruple screen. Olu vavanyo luvavanyelwa i-myelomeningocele, i-Down syndrome, kunye nezinye izifo zokuzalwa komntwana. Uninzi lwabasetyhini abathwele umntwana onespina bifida baya kuba nenqanaba elonyukayo leprotein ebizwa ngokuba ngumama obelekisa i-alpha fetoprotein (AFP).

Ukuba uvavanyo lwe-quadruple screen luchanekile, uvavanyo oluthe kratya luyafuneka ukuqinisekisa isifo.

Olu vavanyo lunokubandakanya:

• Ukukhulelwa kwe-ultrasound
• Amniocentesis

I-Myelomeningocele inokubonwa emva kokuba umntwana ezelwe. Uvavanyo lwe-neurologic lunokubonisa ukuba umntwana uphulukene nemisebenzi enxulumene nemithambo-luvo engezantsi kwesiphene. Umzekelo, ukujonga indlela usana oluphendula ngayo kwimikhonto kwiindawo ezahlukeneyo kunokuchaza apho umntwana angaziva khona.

Uvavanyo olwenziwe kumntwana emva kokuzalwa lunokubandakanya i-x-reyi, i-ultrasound, i-CT, okanye i-MRI yendawo yomqolo.

Umboneleli wezempilo unokucebisa ngokucebisa ngemfuzo. Utyando lwangaphakathi lokuvala isiphene (ngaphambi kokuba umntwana azalwe) lunokunciphisa umngcipheko weengxaki ezithile kamva.

Emva kokuba umntwana wakho ezelwe, utyando lokulungisa isiphene luhlala lucetyiswa kwiintsuku zokuqala zobomi. Phambi kotyando, usana kufuneka luphathwe ngononophelo ukunciphisa ukonakaliswa kwethambo lomqolo elivelileyo. Oku kunokubandakanya:

• Unonophelo olukhethekileyo kunye nokubekwa kwindawo
• Izixhobo zokukhusela
• Utshintsho kwiindlela zokuphatha, ukondla nokuhlamba

Abantwana abane-hydrocephalus banokufuna i-ventriculoperitoneal shunt ebekwe. Oku kuya kunceda ukukhupha ulwelo olongezelelekileyo olusuka kwimingxunya (kwingqondo) uye kwisiphelo se peritoneal (esiswini).

I-Antibiotic ingasetyenziselwa ukunyanga okanye ukuthintela usulelo olunjenge-meningitis okanye usulelo lwe-urinary tract.

Uninzi lwabantwana luya kufuna unyango lwempilo yonke ngenxa yeengxaki ezibangelwa ngumonakalo kumqolo womqolo kunye neethambo zomqolo.

Oku kubandakanya:

• Iingxaki zesinyi kunye nezibilini - Uxinzelelo olungezantsi lokuthintela isinyi kunokunceda ukukhupha isinyi. Iityhubhu zokuhambisa amanzi, ezibizwa ngokuba zii-catheters, zisenokufuneka nazo. Iinkqubo zokuqeqesha amathumbu kunye nokutya okuphezulu okunefayibha kunokuphucula ukusebenza kwamathumbu.
• Iingxaki zemisipha kunye nokudibanisa- Unyango lwamathambo okanye unyango lomzimba lunokufuneka ukunyanga iimpawu ze-musculoskeletal. Izikhuselo zingafuneka. Uninzi lwabantu abane-myelomeningocele ikakhulu basebenzisa isitulo esinamavili.

Iimviwo zokulandelela ngokubanzi ziyaqhubeka kubomi bomntwana. Oku kwenziwa kwi:

• Jonga inkqubela phambili yophuhliso
• Phatha naziphi na iingxaki zengqondo, zemithambo-luvo, okanye zomzimba

Abongikazi abatyelelayo, iinkonzo zentlalo-ntle, amaqela enkxaso, kunye neearhente zalapha ekhaya zinokubonelela ngenkxaso yeemvakalelo kwaye zincedise kukhathalelo lomntwana one-myelomeningocele oneengxaki okanye usikelwe umda.

Ukuthatha inxaxheba kwiqela lokuxhasa i-spina bifida kunokuba luncedo.

I-myelomeningocele ihlala ilungiswa ngotyando, kodwa imithambo-luvo echaphazelekayo isenokungasebenzi ngendlela eqhelekileyo. Indawo ephezulu yesiphene kumqolo wosana, kokukhona iintlungu ziya kuchaphazeleka.

Ngonyango lwakwangoko, ubude bobomi abuchaphazelekanga. Iingxaki zezintso ngenxa yokungabikho kakuhle komchamo sesona sizathu sokufa.

Uninzi lwabantwana luya kuba nengqondo eqhelekileyo. Nangona kunjalo, ngenxa yomngcipheko we-hydrocephalus kunye ne-meningitis, uninzi lwaba bantwana luya kuba neengxaki zokufunda kunye nokuphazamiseka kokuthimba.

Iingxaki ezintsha ngaphakathi kwithambo lomqolo zinokukhula mva ebomini, ngakumbi emva kokuba umntwana eqale ukukhula ngokukhawuleza ngexesha lokufikisa. Oku kunokukhokelela ekuphulukaneni nomsebenzi ngakumbi kunye neengxaki zamathambo ezinje nge-scoliosis, unyawo okanye ukukhubazeka kweqatha, isinqe esisusiweyo, kunye nokuqina ngokudibeneyo okanye iikhontrakthi.

Uninzi lwabantu abane-myelomeningocele ikakhulu basebenzisa isitulo esinamavili.

Iingxaki zespina bifida zingabandakanya:

• Ukuzalwa okubuhlungu kunye nokuhanjiswa nzima kosana
• Izifo ezenzeka rhoqo kumchamo
• Ulwakhiwo lwamanzi kwingqondo (i-hydrocephalus)
• Ukuphulukana namathumbu okanye ulawulo lwesinyi
• Usulelo lobuchopho (meningitis)
• Ubuthathaka obungapheliyo okanye ukukhubazeka kwemilenze

Olu luhlu alunakubandakanywa konke.

Fowunela umnikezeli wakho ukuba:

• Ingxowa okanye indawo evulekileyo ibonakala emqolo wosana olusandul 'ukuzalwa
• Umntwana wakho uhambe kade okanye ekhasa
• Iimpawu zehydrocephalus zikhula, kubandakanya indawo ethambileyo, ukungakhathali, ukulala kakhulu, kunye nobunzima bokutya
• Iimpawu ze-meningitis zikhula, kubandakanya umkhuhlane, intamo elukhuni, ukucaphuka, kunye nokukhala okuphezulu

Izongezo ze-folic acid zinokunceda ukunciphisa umngcipheko weziphene ze-neural tube ezinje nge-myelomeningocele. Kuyacetyiswa ukuba nawuphina umntu obhinqileyo ocinga ukukhulelwa athathe i-0,4 mg ye-folic acid ngosuku. Abafazi abakhulelweyo abanomngcipheko omkhulu bafuna idosi ephezulu.

Kubalulekile ukukhumbula ukuba ukusilela kwe-folic acid kufuneka kulungiswe ngaphambi kokuba ukhulelwe, kuba iziphene zikhula kwangoko.

Abasetyhini abaceba ukukhulelwa banokuvavanywa ukumisela inani le-folic acid egazini labo.

IMeningomyelocele; Umqolo womqolo; Ukucoca umqolo; Isiphene se-tube ye-Neural (NTD); Isiphene sokuzalwa - myelomeningocele

• I-Ventriculoperitoneal shunt - ukukhutshwa

• Umqolo wesifuba
• Ispina bifida (isidanga sobukhali)

IKomiti yokuziQhelanisa nokubeleka, uMbutho woNyango lweMveku-Fetal. Ikholeji yaseMelika yoNyango kunye neeGynecologists. Uluvo lweKomiti ye-ACOG hayi. 720: utyando koomama-olungekazalwa olwenzelwe i-myelomeningocele. IGynecol ebambekayo. Ngo-2017; 130 (3): e164-e167. IINKCUKACHA: 28832491 pubmed.ncbi.nlm.nih.gov/28832491/.

Isalamane SL, uJohnston MV. Ukungafani okuzalwa kwenkqubo ye-nervous system. Ku: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, ii-eds. Incwadi kaNelson yeNcwadi yePediatrics. Umhla wama-21. IPhiladelphia, PA: Elsevier; 2020: isahluko 609.

I-Licci M, Guzman R, Soleman J. Maternal kunye neengxaki zokubelekisa kuqhaqho lomntwana ukulungiselela ukulungiswa kwangaphambi kokubeleka kwe-myelomeningocele: uphononongo olucwangcisiweyo.Ukugxila kwi-Neurosurg. Ngo-2019; 47 (4): E11. IINKCUKACHA: 31574465 pubmed.ncbi.nlm.nih.gov/31574465/.

UWilson P, uStewart J. Meningomyelocele (spina bifida). Ku: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, ii-eds. Incwadi kaNelson yeNcwadi yePediatrics. Umhla wama-21. IPhiladelphia, PA: Elsevier; 2020: isahl 732.