中英文的颈椎病

CategoryandtreatmentofCervicalSpondylosis

颈椎病的分型与治疗

2021/3/29星期一1Definition

颈椎病的定义Cervicalspondylosis.Itisduetocervicaldiscdegeneration,neckinjuryormechanics

dysequilibriumcausedbylong-termmuscularstrain.Italsobecauseconstrictorirritatecervicalnerveroot,spinalcord,vertebralarteryorsympatheticnerve.Thesecauseswillleadneck,shoulder,backandarmpainandnumbness,evenleadparalysisandso:aseriesofclinicalsymptoms.颈椎病又称颈椎综合症，是由于颈椎间盘退行性改变，颈部损伤或长期劳损造成颈脊柱内外力平衡失调，压迫或刺激颈神经根、脊髓、椎动脉或交感神经，引起颈部及肩背手臂的麻木疼痛，甚至瘫痪等一系列临床症状的综合病症。2021/3/29星期一2Thisdiseaseismorecommonintheelderly.Theircervicaldiscdegeneration,cervicalosteoarthritisandotherpathologicalchanges,leadingtoconstrictandirritatecervicalnerveroot,spinalcordorvertebralartery,thenCervicalspondylosisappears.本病多见于中老年人，由于颈椎间盘发生退行性改变、颈椎骨质增生等病变，导致颈部神经根、脊髓或椎动脉受到压迫或刺激，出现本病。2021/3/29星期一3DiagnosisandCategory

诊断与分型Cervicalspondylosisclassifyfourcategories:1.Cervicalspondyloticradiculopathy2.Cervicalspondyloticmyelopathy3.Vertebralarterytypeofcervicalspondylosis4.SympatheticcervicalspondylosisBecausedifferentplacesofcervicaldischerniation,constrictioncausedifferenttypesclinicalsymptoms.颈椎病由于颈椎间盘突出，压迫的部位不同而造成不同的临床症状，以此分为神经根型、脊髓型、椎动脉型和交感型颈椎病。2021/3/29星期一4MassageTreatment

推拿治疗Relieveneckmusclespasm,adjustcervicalsegmentalunusualangulardisplacement,reducediscburden;releasenervesandvascularmechanicalconstrictionandirritation.

Acupoints:occiputposterior,neck,scapularregion,chestandback,Fengchi(GB20),

CervicalJiaji(EX-B2),Jianjing(GB21)，Tianzhong(SL11),cashipointetcApproach:OnefingerZenpushing,pressuremanipulation,tractionmanipulation,pushingmanipulation,graspingmanipulation,cervicalpullingmanipulation.治则:缓解颈肌痉挛，调整颈椎节段异常位移或成角，降低椎间盘负荷；减少，消除神经、血管机械性压迫和刺激。取穴:枕后部、颈项部、肩胛部、胸背部，风池、颈夹脊、肩井、天宗、阿是穴等。手法:一指禅推法、按压法、拔伸法、推法、拿法、颈椎扳法等。2021/3/29星期一51.cervicalspondyloticradiculopathy

神经根型颈椎病Symptom:neckunilateralpain,presentselectricshock-likeradiating

fromnectroottotheshoulder,toupperarmandforearmandfingerwithnumbnessfeelling.Armfeelingofheaviness,numbness,holdthingseasytofall.Patients’neckwithoutpainfeeling.Limitedmobilityandstiffnessintheneck;cervicalvertebrae

transverseprocess

anteriorwithradioactivetenderness,andscapulainteriortenderness.此型多表现为颈部单侧疼痛、可呈电击样，由颈根部向肩、上臂、前臂和手指放射，且有麻木感。上肢沉重，酸软无力，持物易坠落。患者颈部可无疼痛感。颈部活动受限、僵硬，颈椎横突前侧有放射性压痛，肩胛骨内侧压痛。2021/3/29星期一6

Brachialplexustractiontestpositive,orholesamongcervicalvertebrasextrusiontestpositive.Medicalimageologytest:X-rayshows:cervicalvertebraesanduncovertebraljointhyperplasia,discspacenarrow,reducecervicallordosis,disappear,oranti-bow体格检查的表现：臂丛神经牵拉试验阳性，颈椎间孔挤压或叩顶试验阳性。影像学检查：X线示：颈椎椎体及钩椎关节增生，椎间隙变窄，颈椎生理曲度减小、消失或反弓。2021/3/29星期一7MassageTreatment

推拿治疗Treatment:relymainlyonrelievingnerverootconstriction,andcirclemassagewithgentleapproachalongtheradioactivenervepainplacetoeasethepain.Approach:Keepapatientseated,relaxtheneckmuscles.Doctor’stwohandspresspatient’sforeheadandmastoidposteriorborder,upwardstrainpatient’sheadandneckforawhile,thencervicalstretchandflexionslowly5-10times.治疗：以神经根减压为主，以轻柔手法沿放射性神经疼痛部位循经推拿，缓解疼痛。手法：患者坐于凳上，颈部肌肉放松。术者立于其背后，两手分别抵住患者额部及乳突后缘，两手协调将患者头颈上提片刻，再缓慢屈伸颈部5-10次。2021/3/29星期一82.cervicalspondyloticmyelopathy

脊髓型颈椎病Patientsshowslowlyprogressivelowerextremitynumbness,chills,pain。Unsteadygait,weakness,tripovereasily,unabletooverobstacles,patientmayfeel“feetsteponcotton”患者多表现为缓慢进行性双下肢麻木、发冷、疼痛。走路欠稳、无力、易绊倒，不能跨越障碍物，诉“脚踩棉花”感。2021/3/29星期一9

Physicalexamination：muscletensionincreases.tendonhyperreflexia,pyramidaltractsignspositiveMedicalimageologytest

：X-rayresultssimilarwiththatofthenerveroottypecervicalspondylosis.CTshowscervicaldiscdegeneration.MRIexaminationshowsconstrictivesegmentspinalcordhassignalchanges,itswave-likepressuretrace.体格检查：肌张力增高，腱反射亢进，锥体束征阳性。影像学检查：X线结果类似于神经根型颈椎病。CT可见颈椎间盘变性。MRI检查显示受压节段脊髓有信号改变，脊髓受压呈波浪样压迹。2021/3/29星期一10Massagetreatment

推拿治疗Treatment：mainpurposeistorelievespinalconstrictionNote:treatmentonlytorelieveneckmuscletension,becarefultouseheavymanipulation,suchaspullingmanipulation,pullingoutmethod,etc.治疗：以脊髓减压为主要治疗目的。注意，治疗时以单纯缓解颈部肌肉紧张痉挛为主，慎用重手法，如扳法、拔伸等。2021/3/29星期一113.Vertebralarterialinsufficiencyofcervicalspondylosis

椎动脉型颈椎病Patientsshowsaunilateraloccipitalnuchalorneckandshoulderparoxysmalpain,vertigo,andvisionweek,tinnitus,etc.Positionalvertigo,thatiswhentheheadmovetoaposition,inducingvertigo,oreasytosuddenlyfall.患者多表现出单侧枕项部或颈肩部发作性疼痛，伴眩晕及视力减弱、耳鸣等。体位性眩晕，即常因头部活动到某一位置时诱发眩晕，易猝然摔倒。2021/3/29星期一12

Medicalimageologytest

：detectionofvertebralarterybloodflowandcarotidarteryangiographycanindicatewhetherthebloodpressure,tortuous,thinningorblock.X-raycanshowvertebraeunstableandluschkajointsidehyperplasia影像学检查：椎动脉血流检测及颈动脉造影可提示有无血管压迫、迂曲、变细或阻滞。X线可显示椎节不稳定及钩椎关节侧方增生。2021/3/29星期一13MassageTreatment

推拿治疗mainlypurposeistorelievecompressionofthevertebralartery.Approach:pressuremanipulationtostimulatethepatient’sFengfu,(DU16)bilateralFengchi(GB20).Cervicalstretchandflexionandlateralbendingeach3-5times.以解除椎动脉扭曲为主要治疗目的。手法：以按揉手法刺激患者风府穴，双侧风池穴。颈椎屈伸和左右侧屈扳法各操作3-5次。2021/3/29星期一144.Sympathetictypeofcervicalspondylosis

交感神经型颈椎病Patientswillfeelheadache,nausea,dizziness,vomitingandothersymptoms.Ptosis,pupildilationormyosis,blurredvision;tinnitus,hearingloss;praecordiapersistentpressurepain,cardiacarrhythmia,tachycardia.

Thosesymptomswillbemoreseriouswhenturnheadandneck.患者以头痛，伴有恶心、眩晕、呕吐等症状。眼睑下垂，瞳孔扩大或缩小，视物模糊；耳鸣，听力减退；心前区持续性压迫痛，心律不齐，心跳过速。头颈部转动时症状可明显加重。2021/3/29星期一15

Medicalimageologytest

：X-raycanshowvertebraeinstabilityanduncovertebraljointedgehyperplasia,andphysiologicalcurvaturereducesorreverses.影像学检查：X线检查可显示椎节不稳及钩椎关节侧方增生，生理曲度减小或反弓。2021/3/29星期一16MassageTreatment

推拿治疗Thepurposeistoremovethesympatheticnervestimulation.onefingerzenpushingandpokingchannelsmanipulationintheneckwithneckextensionmotiontorelievemusclespasm.Ifthepatientfeelheadacheisthemainsymptom:adoptpressBaihui(DU20)Taiyang(EX-HN5),Shuigu(GB8).Ifdecreasedvisionisthemainsymptom:tostimulatethetwotheorbitaledgeandtwosidefengchi.Ifchesttightness,heartpalpitationsisthebasesymptom:canstimulatemusclegroupofcorseletsandeachintercostalmuscles,andfingerpointingNeiguan(PC6)andShanzhong(RN17).以解除交感神经刺激为目的。以一指禅推法和弹拨法在颈部操作，配合颈部后伸动作，缓解痉挛的肌群。若患者以头痛为主要症状，配合按压百会、太阳、率谷。若以视力下降为主，刺激两眼眶内缘及两侧风池穴。若以胸