Spina bifida - ke eng? Malformation ea mokokotlo

Malformation la mokokotlo, o ka tsamaea le mafu a ea thapo lesapo la mokokotlo, - mo holofalitseng mokokotlo. ke eng e, eo ho eona Maemong a hlaha, ho ba bang ba meferefere 'meleng ho ka fella - ho likarabo tsa lipotso tsena li tla fumanoa sehloohong rona. Leha ho le joalo, bakeng sa kutloisiso ea setšoantšong ea tleleniki ea lefu lena le ke e boetse e ho hlokahala hore ho utloisisa khopolo ea batho tsamaiso ea methapo e bohareng, mohaho anatomical ba lesapo la mokokotlo le mesebetsi lesapong la mokokotlo.

Khopolo ea ho tsamaiso ea methapo e bohareng

Central tsamaiso ea methapo - karolo e khōlō ea tsamaiso ea methapo ea batho. E emeloang ke boko le lesapong la mokokotlo 'me e entsoe ka methapo ea kutlo le dithulaganyo tsa bona. CNS thehoa likarohano tse tharo: a tlaase, mahareng le e phahameng. Bakeng sa e ka tlaase 'me bohareng ke thapo lesapo la mokokotlo, le medulla oblongata, ho midbrain, ho midbrain le cerebellum. dikarolo tsena laola mosebetsi oa makala a motho, theha mabapi therebetween, ho etsa bonnete ba botšepehi ba ka phelang ho sebetsa. Phahame CNS aroloa emeloang hemispheres bokong le ka tshebediso e fana ka sebelisana le tikoloho.

Mosebetsi o ka sehloohong oa ho tsamaiso ea methapo e bohareng - ho kenngwa tshebetsong a itšoare ka tsela e itekanetseng le e rarahaneng - reflexes. The tsamaiso ea methapo e bohareng Ho thehoa ka libeke tse pele a bokhachane ka lebaka la ho sebopeho khethehileng - the ectoderm. Haeba karohano fosahetseng le ntshetsopele ea lisele methapo ea kutlo ho hlaha ka neural tube, sekoli, eo hamorao e etsa hore tsoelo-pele ea pathologies lesapo la mokokotlo.

Lesapong la mokokotlo - tsamaiso ea methapo lekala sebakeng sa kanale lesapo la mokokotlo. Balletsweng moeli o pakeng tsa khoele lesapo la mokokotlo le boko e neng e tšoaretsoe sebakeng se interleaving likhoele pyramidal. Le hlooho le lesapong la mokokotlo li phuthetsoe enfelopo, e bopilweng ka le dikarolo tse tharo: a tiileng, sekho le vascular. From tshenyo Link boko sireletsa lehata, le lesapong la mokokotlo - lesapo la mokokotlo.

Sebopeho sa karolong e ngotsoeng vertebral

Lesapo la mokokotlo - motheo oa masapo batho e na le vertebrae, pakeng tsa eo intervertebral disks - the lefufuru lera. Ka tshebediso, kganna le fana ka fetoha le maemo la mokokotlo. 33-34 ka vertebra batho, ba tlas'a maemo a ho kopantswe ka likarolo: cervical, thoracic, lumbar, sacral, coccyx.

E mong le e vertebra Ho thehoa 'mele segopo le dithulaganyo. Le 'mele le e selikalikoe etsa vertebrate bula dithulaganyo vertebrae amanang le mong le e tse ling le ho phetha ho sebetsa ha re inehele ho mesifa ena. Ka 'mele oa ka bophelo bo botle ba batho vertebrae mekoti kopane ka e le' ngoe vertebral kanale, eo, ha e le hantle, ke sebaka sa ka lesapo la mokokotlo khoele sebaka. Empa ho na le maemo pathological eo ho eona ho ke lekhalo ka lesapo la - ". Mo holofalitseng mokokotlo" ketsahalo ena e bitsoa

Thapo lesapo la mokokotlo e fana ka le puisano e sa boko le tsamaiso ea methapo pheriferale. Central le kanaleng - e cavity hara khoele lesapo la mokokotlo. Lesapong la mokokotlo, hammoho le hlooho, e na le tse tharo-lera lera pakeng tsa le dikarolo e nang le mokelikeli cerebrospinal. The lesapo la vertebrae le khetla tsa ka ntle tsa khoele lesapo la mokokotlo eaba ba etsa pakeng tsa bona le sebaka epidural tletse mafura dinama tse nyenyane tse le letlooeng venous.

Mo holofalitseng mokokotlo: ke eng?

Mo holofalitseng mokokotlo - sena degeneration ea lesapo la mokokotlo (mo holofalitseng mokokotlo), e leng ba atisa ho exacerbated ke bolwetse e - hypoplasia ea thapo lesapo la mokokotlo. sekoli ena qala ho iponahatsa ka methati ea pele ea bokhachane 'me ke boemo boo ka ho sebopeho sa tube neural. Tube neural - sebōpeho sa e ka mekhahlelo e hamorao ba boimana ba embryo Ho thehoa e tsamaiso ea methapo e bohareng - bokong le lesapong la mokokotlo. lipale tse ngata tsa bakuli ba mafu a mo holofalitseng mokokotlo fa lebaka la ho go arologana mefuta e itseng ea bolwetse ka ho ya ka ho tiea tsa malformations:

• liforomo tlas'a maemo a bonolo: latent mo holofalitseng mokokotlo, meningocele, lipomeningotsele;
• haholo: myelomeningocele; myelomeningocele, hydrocephalus rarahaneng.

Mo holofalitseng mokokotlo e lemoha nakong litšoantšo khoheli gomoso kapa nejrosonografii.

Lipalo-palo li bontša hore ho na le lefu ka masea a 1-2 ka 1000. The bolwetse ke liphatsa tsa lefutso, hobane ho fihlela ho 8% ea tsoalo pheta lipheletsong na le boloetse ba mo holofalitseng mokokotlo. Lingaka li re ho ka etsahala hore li etsahale ka bana ba tsoalloa basali ba lilemo li. Leha ho le joalo, ea 95% ea masea le phumano mo holofalitseng mokokotlo hlaha batsoali ba bophelo bo botle ba sa le bothata ba ho e boloetse tšoanang.

liforomo bonolo ba mo holofalitseng mokokotlo

Patiloeng mo holofalitseng mokokotlo (occulta) - foromo ho fetisisa maikutlo a ya lefu lena le, e leng seo ho na le ntshetsopele e fokolang, lekhalo nyenyane vertebrae ena. Hangata ka ho fetisisa e le hlaha ka lumbar kapa sacral lesapo la mokokotlo. bolwetse ena e akaretsa feela mokokotlo lesapo dinama tse nyenyane tse 'me ha e ame ho sebopeho lesapo la mokokotlo. Lefu lena le e tekano a bontša, 'me hangata ha ho iponahatsa ke matšoao a hore e ka sitisa motho eo. Bakuli ba bangata ba nang le lefu lena le ke hlokomele lefu bona. matšoao pono bonahaleng tsa lefu ka ho sa tsoa tsoaloa e ka ba e tetemang ea moriri, hangata nyane; mafura a mokotla; ho tepella maikutlo kapa birthmark sebakeng sa malwetse.

Feela Maemong a seng makae (about 1 tsoa Maemong a 1,000 ka ikhakanya foromo ya mo holofalitseng mokokotlo) sa tloaelehang isang meferefere tshebetso ka pampitšana mosese, mantle a, mesifa bofokoli ba maoto le matsoho e ka tlaase, ho kotlobane la mokokotlo. nomoro ho khetheha ba vertebrae la mokokotlo e hangata ho bontšitsoe tlalehong ea tsa bongaka ea mamello, eo ho eona e ne e le malwetse. Ka mohlala, ho kena "mo holofalitseng mokokotlo kamorao S1" e bontša mathata a pele vertebra sacral lesapo la mokokotlo.

Meningocele - mefuta e fapaneng mo holofalitseng mokokotlo, eo ho eona ho phaella ho degeneration tsa lesapo moko selateng sireletsang ka sebetsa jwalo ka e bulge kapa capsules ka e sekotjana teng. Hangata ka le lesapong la mokokotlo 'me methapo ea kutlo e hlophisitsweng, ntle pathologies kapa le likoli tse fokolang. Maemong a mangata, komiki e koahetsoe ke letlalo, e leng conventionally sireletsa litaba tsa eona. Leha ho le joalo, esita le hona sekoli nyane hloka kalafo ho buoa ho lokisa mefokolo setlolo.

Lipomeningotsele

Lipomeningotsele - le ponahalo ea mo holofalitseng mokokotlo, eo ho nkoa ka tsela e itekanetseng malwetse. Ka moriana, tlōlo e classified e le e symbiosis thehoa hernias lesapo la mokokotlo le lipomas - nang kotsi lihlahala. kgoreletsego sena sebopeho neural tube, le hlaha ka nako ya pele matsatsi a 20 la ho ima. Lipomeningotsele le sekoli e ka etsa hore tsoelo-pele ea pathologies methapo ea kutlo 'me e etsa hore mafu a tebileng ea tsamaiso genitourinary, mala - adipose dinama tse nyenyane tse le fana ka khatello e ka khoele lesapo la mokokotlo. Fanoeng histori ea bakuli ba mafu a lipomeningotsele, ka tlas'a maemo a arotsoe ka lihlopha tse 'nè tsa liponahatso pathological lefu lena:

• ntle le maloetse a methapo ea kutlo, pelvic le masapo;
• bonolo paresis tsa maoto, maoto deformation;
• ka matla haholo, litsebeng dilenaneo mosebetsi, kotlobane la mokokotlo, pelvic mokatong mafu a;
• leoto deformities, haholo pelvic malwetse.

Ka lebaka leo, feela le kalafo ho fetisisa bakeng sa lefu lena e nkoa e le hang-hang, mathoasong a kenella ho buoa. Hammoho le ho buuoa ho tlosa mekotla e mafura a ka ho phethahatsoa polasetiki hernia hekeng.

Myelomeningocele - e haholo ea mofuta o mo holofalitseng mokokotlo

The matla ka ho fetisisa mofuta o mong oa lefu, e leng le hlaha ka 75% ea linyeoe kaofela degeneration tsa vertebrae e - myelomeningocele (Cystica mo holofalitseng mokokotlo). ha e le eng? Encephalocele - e elements Thapo eo protrudes ka o inkela sekoli ho mokokotlo. Ka linako tse ling komiki ho thapo lesapo la mokokotlo e sirelelitsoe ke letlalong, maemong a mang, boko dinama tse nyenyane tse le hlaha methapo ea kutlo tsoa. Ka mofuta ona oa lefu ke keng ea qojoa methapo ea kutlo maloetse. Tekanyo ea mafu a joalo e tla laolwang ke ho tiea ha sekoli sa thapo lesapo la mokokotlo 'me karolo lesapo la mokokotlo, eo ho eona ho hatakela le hlahile. Ha lefu lena le ama qetellong ea thapo lesapo la mokokotlo, le mathata a amang tsamaiso genitourinary le mala, ka tlaase leoto shoele litho se hlahile.

Hangata, hernias lesapo la mokokotlo li etsahale ka lesapo la mokokotlo lumbosacral. Maemong a ha bolwetse develops ka boemo ba thoracic kapa cervical lesapo la mokokotlo, Leha ho le joalo, a kopana ka ikwetlisetse bongaka. Ka bomalimabe, neural tube, sekoli boo hangata tsamaea le tlōlo e 'ngoe - hydrocephalus kapa Chiari anomaly bakoa ke boemo boo ba sebopeho sa cavities hara lehata bo tahang.

Hydrocephalus le Chiari anomaly

Hydrocephalus (metsi ka boko) - e malwetse a bakoang ke ho bokella mokelikeli cerebrospinal ka ventricles ea boko. Cerebrospinal mokelikeli - joala - e sa khaotse a ajoa tsamaisong ea ventricular.

Moqolo oa ho hlokahala hore mokelikeli cerebrospinal ka di kentswe ka litsela tse peli:

• lisele tse glandular hlahiswa lijana ka ventricles boko;
• propotevanie thehoa ka lebaka la ho lero la mali mali ka leboteng vascular.

Cerebrospinal mokelikeli o potoloha ho tloha ventricles ho boko le lesapo la mokokotlo subarachnoid sebaka ea boko. Intracranial le lesapo la mokokotlo bo tahang libaka 'meleng le bophelo bo botle ba kopantswe. Ha lumbar herniated, thehoa ho buisana hydrocephalus. bokella itlhomme mokelikeli ho eketsehileng khatello ea intracranial, leng isang fokotseha pono, le ketsahalo e ea sethoathoa, strabismus, bofokoli ba mesifa ea lipheletsong ka holimo le tlaase. meferefere joalo baka maloetse haholo methapo ea kutlo, ho lahleheloa ke bokhoni ba kelello, e leng lefu.

Anomaly Arnold Chiari - ya bolwetse eo amygdala theolela ho fihlela boemong ba pele 'me ea bobeli vertebrae cervical, ka tsela eo thibela ho ajoa ha mokelikeli cerebrospinal.

Ho buoa kalafo ya myelomeningocele

Kotsi ka ho fetisisa ho bophelo ba le sa tsoa tsoaloa le myelomeningocele ke lekhalo hernia karaoke tren le tšoaetso ea ho hare litaba tsa eona. mathata a tšoaetsanoang, decompensation hydrocephalus - sesosa se ka sehloohong sa ho shoa ha phahameng masea, na le boloetse ba mo holofalitseng mokokotlo. Hang lemoha liquorrhea - bakeng sa mokelikeli cerebrospinal - e etsoa opereishene tshohanyetso ho tlosa hernia lesapo la mokokotlo.

Ho fihlela joale, ho mokhoa homolog ho felisa pathologies tsena 'nile la sebelisoa ka katleho ho pholletsa le lefatše, ho ke ke ho phetha prenatal tlosa hernia lesapo la mokokotlo. O ile a re oa mofuta ofe ho kenella ho buoa thibela ntshetsopele ya hydrocephalus le Chiari anomaly bakuli mocha; ho qoba mathata tebileng 'me bophelo ba sokelang, hammoho le morago ga moo e ho buuoa kgaoleditse. The mellwane holimo fa menyetla ea sa tsoa tsoaloa o ka boemo ba tloaelehileng ea ntshetsopele le boleng ba bophelo.

Ha ka nako e loketseng fetal ho buuoa ka lebaka le itseng ha ea atlehe, resorted ho shunt buuoa, eo normalizes tjhelete ya mokelikeli cerebrospinal. Hangata, tshebetso ena e etsoa ka mekhahlelo e 'meli. Lesapo la mokokotlo Clinic - ya kalafi setheo moqotetsane a tsitsinkela, seo hangata se thusang ho rarolla mathata a mangata a amanang le pathologies lesapo la mokokotlo.

tlhathoba

Ka moriana ea kajeno, mo holofalitseng mokokotlo e fumanoa ka mekhahlelo ea pele ea bokhachane. Ka lebaka leo, batsoali ba ka moso ba le nako ea ho hlahloba le ho elelloa hore ho lokisetsa a kelello bakeng sa ho pelehi le makgetha a ho. Ka lehlakoreng le leng, ba boetse ba na le nako le monyetla oa ho etsa qeto ka bao e seng paballo ya tlhaka ya.

Nakong ea bokhachane (libeke tse 16-18), bo-'mè oa moimana feta liteko screening, e thehiloeng ka teko ea mali. mokhoa li entsoe ka ho hlahloba ea mahloriso ea protheine embryonic, eo ka tsela e tloaelehileng ea ho ima hlahisa litholoana ka e nyenyane. Ka ho ba teng ha bohareng tsamaiso ea methapo sekoli AFP mahloriso e ile ea eketseha. Ho na le makgetha a ho ya tekong. Ka lebaka la ho ketsahalo e sa khoneha tsa liphoso ha ho toloka liphello tsa and analysis lokela ho lateloa ka hloko ho ba bang ba melao eo:

• ho theha bokhachane nepahetseng ka ho fetisisa;
• ha bokhachane ke libuka, ho na le lokela ho fumanoa hore o tšoeroe ka nako.

E mong mokhoa oa tepelletse maikutlong ke prenatal oa ultrasound tšoareloa mekhahlelo e itseng ea bokhachane, e le hore ho lemoha malwetse. Mokhoa ona o lumella hore o mahlo a kelello boko, lesapong la mokokotlo, lenaneng la vertebral le tepelletse maikutlong ka tsela e loketseng. Leha ho le joalo, re lokela ho hopola hore le likoli tse nyenyane (patiloeng mo holofalitseng mokokotlo) sa tloaelehang e ke ke ea lemoha.

Amniocentesis - puncture le amniotic mokelikeli - mokhoa o mong oa ho fumanoe. Ho matha ka nale kgolo le ka tieo feela tlas'a taolo ea tsa ultrasound. Mokhoa ona o sebelisoa ha and analysis mali a senola mahloriso fetang AFP, le fumanoe tsa pathologies galena se tsejoa. Mokelikeli ka mali, diteko tsa protheine ea mahloriso rudimentary, fetang eo e bontša ho ba teng ha meferefere ea ntshetsopele ya lenaneng la lesapo la mokokotlo.

thibelo

Ke 'nete hore, ha ho le setsebi ya kalafi ka tiisa hore haeba mehato hlokahala tsohle le ho ba sieo ha lintlha tsebahalang kotsi ka batsoali ba ka bophelo bo botle e hlahile e le lesea le phetseng hantle. Ka bomalimabe, ka linako tse ling lintho tsa tlhaho le disposes ho seng joalo ho feta monna a kena. Empa matla a ho bo-'mè e tlang le bo-ntate hore ba etse se palo e kahodimodimo e le hore ho fokotsa likotsi tse ka khona ho fokotsa le ho fokotsa monyetla oa ho ba le ngoana ea nang le mo holofalitseng mokokotlo bolwetse hoo e batlang e lefela. Re bua ka mehato e thibelang.

E mong oa mehato e ka sehloohong ea ho thibela ho hlaha ha hlahloba tsoa tsoaloa "mo holofalitseng mokokotlo" ke thero ea hloko ho ba mokhachane. Ho etsa sena, e leng 'mè bokgoni ba le ntate oa pele ho emoloa ho hlokahala hore ho feta ke hore a hlahlobe tsa bongaka e tlamang ho tsamaea hore a rerisana ho liphatsa tsa lefutso. Mosali e mong nakong ea bokhachane ke ho hlokahala hore ho phela bophelo bo phetseng hantle, ho ba seli ho amohela anticonvulsants. Empa folic acid ho isa tekanyong ea ho hlokahala, ho fapana le hoo, e bontša ka nako ena. Linaheng tse ngata tse tsoetseng pele, sena ke ntlha e ka sehloohong ea lenaneo kgothaletswa ka ho ima Bophelo Organization.

E lokela ho a hopola hore e le lintho tse kotsi bakeng sa lefu ke lefutso liphatsa tsa lefutso; jere mafu a basali nakong ea bokhachane, tse kang e bitsoang rubella; sephetho sa tikoloho Link - mahlaseli, joala, lithethefatsi.

The litletlebo tsa ka sehloohong

Kahoo, ho araba potso «mo holofalitseng mokokotlo? - ke eng ena", o ka khetha lintlha tse khōlō. Mo holofalitseng mokokotlo - se bolwetse seo se etsahala ka utero, nakong ea libeke tse ea pele ea bokhachane. Tsela feela ea ho qoba lefu ka ngoana e - e rera ho ima, ho phethahatsa ditlhoko tsohle hlokahalang ea lingaka, 'mè ea lebeletseng ho phela bophelo ba phetse hantle, ho etsa ho fihlela ho hloka folic acid ka' mele.

Ha bolwetse e ntse fumanoa, pelehi o entsoe feela ka karolo Caesarean ho qoba ho lemala ho thapo lesapo la mokokotlo nakong temana ea lesea le ka kanale tsoalo.

Ho hlahloba lefu lena le, ho na le mefuta e fapaneng ya mekhoa - mali teko, oa ultrasound tlhathoba, amniocentesis. Haeba, leha ho le joalo, tlōlo ea fumanoa le phumano e entsoeng, ho ke ke ho hlokahala hore ho phetha ho buoa.

Popontshwa le mokhoa - ke ho tlosoa ha bolwetse intrauterine. E boetse e etsoa ka opereishene ka mor'a ho tsoaloa ha lesea e - ka ea pele matsatsi a mararo a bophelo ba hae. Ka tsela eo, e belaela ka sa tsoa tsoaloa mo holofalitseng mokokotlo ka etsa hore: lesapo la mokokotlo hernia, birthmarks kapa depressions ka e nngwe ya likarolo tse ling tsa letlalo, e sa tloaelehang moriri pelote. Ke 'nete hore tepelletse maikutlong ho qetela o entsoe ka mor'a lithuto tsa ka ho eketsehileng - CT, MRI.

Ho itšetlehile ka seo ba anngoeng lesapo la mokokotlo sebakeng diriswa, hammoho le mafu a amanang tshebetso, lefu lena le se classified ka leseli le mefuta e boima.

liforomo bonolo mo holofalitseng mokokotlo hangata u se ke ua etsa hore mefokolo e tebileng, bakuli ba tepelletse maikutlong ena sechabeng ikamahanya le maemo. Tabeng ea likoli tse matla - meningomyelocoele - qoba bokooa ke ke, esita le haeba ke buuoe e ile ea atleha.

Lesapo la mokokotlo Clinic - ea mofuta ofe setsing tlhokomelo ea bophelo, e leng e ho khetheha litšebeletsong tsa bophelo bo botle ba ho fana ka tlhokomelo ea bakuli ba nang le mafu a sa makala CNS. Ka lebaka leo, phumano ya mo holofalitseng mokokotlo - ho ke ke ha polelo. A ka le lokela ho phela ka eona.