坐骨神经痛的治疗.doc

坐骨神经痛 （sciatica）是指坐骨神经病变，沿坐骨神经通路即腰、臀部、大腿后、小腿后外侧和足外侧发生的疼痛症状群。坐骨神经由腰5骶3神经根组成。按病损部位分根性和干性坐骨神经痛两种，前者多见根性坐骨神经痛病变位于椎管内，病因以腰椎间盘突出最多见，其次有椎管内肿瘤、腰椎结核、腰骶神经根炎等。干性坐骨神经痛的病变主要是在椎管外坐骨神经行程上，病因有骶骼关节炎、盆腔内肿瘤、妊娠子宫压迫、臀部外伤、梨状肌综合征、臀肌注射不当以及糖尿病等。坐骨神经痛运动疗法坐骨神经痛多发于单侧 ,夜间加重 ,咳嗽、大便时加重。坐骨神经痛分为原发性和继发性两种。原发性的主要是由于坐骨神经炎症病变引起 ;继发性的则多由腰椎间盘突出症、腰椎增生、腰和臀部的软组织损伤以及盆腔、椎管内病变引起。患者除避免着凉外 ,适当加强腰腿部功能锻炼 ,会获得良好效果。一、左右摆腿。站立位 ,双手扶墙 ,轮流向左右方向摆腿 ,摆动时足部不触地面。二、交替直腿上抬运动。仰卧位 ,轮流将在、右腿伸直后抬起 ,经常锻炼可逐渐提高抬举角度。三、踏自行车运动。仰卧位 ,两下肢像骑车般轮番踩踏 ,踩踏幅度可逐渐增加。四、正坐举腿。坐位 ,两腿紧靠或夹上一本厚书 ,直膝 ,脚跟着地 ,手握凳边 ,抬腿过脐 ,随即放下。开始时患腿未必抬得很高 ,坚持锻炼后患腿的抬高程度会逐渐增加。五、平坐推腿。坐位 ,足跟着地 ,足尖跷起 ,两手平放大腿上 ,随即向前弯腰 ,两手同时推向足部。初练时两手很难推到足部 ,坚持一段时间会收到良好的效果。六、蹲跳。双手扶凳 ,左腿屈膝下蹲 ,右腿尽量向右侧伸直 ,如此左右交替进行。坐骨神经痛的预防常识：许多坐骨神经痛的患者都可清楚地诉述发病是与一次突然的腰部“扭伤”有关，如发生于拎举重物，扛抬重物，长时间的弯腰活动或摔跌后。因此，当需要进行突然的负重动作前，应预先活动腰部，尽量避免腰部“扭伤”，平时多进行强化腰肌肌力的锻炼，并改善潮湿的居住环境，常可降低本病的发病率。本病患者急性期应及时就医，卧床休息，并密切配合诊治，预后通常是好的。坐骨神经痛急性期的处理：1、应针对病因治疗。腰椎间盘脱出急性期卧硬板床休息12周常可使症状稳定。2、对症治疗，疼痛可用扑热息痛加可待因30mg，34次/d，以及其他非甾体类镇痛药，如异丁苯乙酸、萘普生等。肌肉痉挛可用安定510mg口服，3次/d；或环苯扎林10mg口服，3次/d，可能有效。3、严重病例可用地塞米松1015mg/d，静脉滴注，710天；一般可口服泼尼松10mg，每日34次，1014次为一疗程。也可用12普鲁卡因或加泼尼松龙各1ml椎旁封闭。可配合针灸和理疗，保守疗法多可缓解。疗效不佳时可用骨盆牵引或泼尼送龙硬脊膜外注射，个别无效或慢性复发病例可考虑手术治疗。坐骨神经疼痛的认识误区：许多医药说明书、广告或科普读物，将坐骨神经痛作为一种病，与腰椎间盘突出症、腰椎管狭窄症、急性腰扭伤、慢性腰肌劳损等病相提并论。我们骨科专业人员认为：这不但不严谨，还会对患者产生误导，因而有必要为它“正名”。坐骨神经是人体内最长的一根神经，从脊髓腰段的神经根发出，由臀部的梨状肌下方穿出，分布于大腿后方以及小腿、足部，指挥肌肉运动，传导皮肤感觉。正常人左右两侧各有一根。人体五个腰椎中，以下面的第四、五腰椎负担最重，活动度最大，容易发生退变老化。长期劳损或突然扭伤，可使腰椎间盘向侧后方突出。腰椎间盘突出后，压迫坐骨神经根，引起充血、水肿以至粘连等病理变化。突出的一侧腰部疼痛，经臀部向大腿后方放射，直到小腿和足部，有时还有麻木，咳嗽时加重。这种症状就是坐骨神经痛。它如同发热一样，只是一种症状。腰椎间盘突出症或腰椎管狭窄症等病理变化是引起坐骨神经痛的原因，正如引起发热的原因是感冒、肺炎或脑膜炎等等一样。引起坐骨神经痛的原因虽多，但其中最为常见的，是腰椎间盘突出症，且多为第45腰椎间盘或第5腰椎骶骨间的椎间盘突出。因而，在绝大多数情况下，坐骨神经痛可能就是腰椎间盘突出症。在骨科门诊，我们发现：除了腰椎间盘突出可以引起坐骨神经痛以外，还有不少疾病也可以引起这种症状。比较常见的有腰椎管狭窄症、腰椎滑脱症、梨状肌综合征、强直性脊柱炎和腰椎管肿瘤等等。但有些时候，有些医院、非骨科专业的医师对于有坐骨神经痛症状的患者，匆匆下一个“坐骨神经痛”的诊断后就盲目对症治疗，而不去追究深层的病理原因来对因治疗，其实是不科学的，也是不负责任的。所以病人到医院就诊骨科时，骨科医师应该亲手为病人作详细的体格检查，并辅助以X线片、CT、MRI（核磁共振）等，对病情作出合理的病理学诊断，才能做到对因治疗，真正消除患者痛苦。需要指出的是：腰椎间盘突出症并不见得一定表现为坐骨神经痛。人体共有五个腰椎，与此相对应，有五对腰神经根，部分第4腰神经根、第5腰神经根与第1、2、3骶神经根组成坐骨神经，而第2、3神经根和第4腰神经部分纤维，只参与组成分布于大腿前方的股神经，不参加坐骨神经组成，因而第12或第23或第34腰椎间盘突出症，可能引起股神经受压迫的症状。通常表现为抬腿无力，大腿前方或内侧皮肤感觉迟钝；还有些腰5骶1椎间盘突出病人，并无坐骨神经痛。有的发病早期或整个发病过程可能仅表现为腰痛，还有的表现为间歇性跛行，走几百米路，就觉得下肢酸胀无力，必须休息或弯腰下蹲一会儿才能继续行走；有的病人仅感到肢体发凉；个别严重的出现瘫痪，下肢不能活动，大小便失禁。Sciatica (sciatica) is the sciatic nerve, along the nerve pathways that waist, hip, thigh, posterolateral calf and foot pain that occurred outside the group. Sciatic nerve from the lumbar 5 to sacral nerve root component 3. Lesion site divided by root and trunk sciatica two, the former more common radicular sciatica with lesions in the spinal canal, the most common cause for lumbar disc herniation, followed by a spinal cord tumor, spinal tuberculosis, lumbosacral nerve roots go far. Dry sciatica spinal lesions are mainly outside the sciatic nerve in the itinerary, the cause of a sacroiliac arthritis, pelvic tumors, pregnant uterus oppression, hip trauma, piriformis syndrome, gluteal muscle injection of inappropriate and diabetes. Sciatica exercise therapy Sciatica prone to side, aggravated at night, cough, increased bowel movements. Sciatica is divided into two types of primary and secondary. Primarys mainly due to lesions caused by sciatic nerve inflammation; secondary in nature are often run by lumbar disc herniation, lumbar hyperplasia, waist and hips and pelvic soft tissue injury, caused by spinal lesions. In addition to avoiding cold patients, the appropriate functional training to strengthen the Department of waist and legs will get good results. 1, left and right leg swing. Standing position, hands on the wall, turn to the left and right leg swing, swing when the foot does not touch the ground. Second, alternating straight leg raise movement. Supine position, rotation will be, after the right leg straight up, regular exercise can gradually improve the lifting angle. Three step cycling. Supine position, the two leg-like turns as the bike pedal, pedal rate will gradually increase. 4, riding a leg raise. Seat, legs close or folder on a thick book, straight knee, heel, hand stool side, lift the leg over the umbilicus, then down. Legs may not carry the start of a very high risk, and exercise the leg elevated level of future trouble will gradually increase. 5, push legs sit flat. Seats, followed by foot, the toe Qiao Qi, hands flat to enlarge the legs, then bending forward, both hands simultaneously into the foot. Initial training is difficult when the two-handed push to the foot that persist for some time to receive good results. 6, squat jump. Hands on bench, left leg knee squat, right leg stretched to the right as far as possible, so left and right alternately. Sciatica prevention knowledge: Many patients with sciatica can be clearly described complaint is a sudden onset of lower back sprain relevant, such as occurred in carry her heavy lifting, carry heavy lifting, long after bending activities or wrestling. Therefore, when the need for sudden load movement, should pre-activity waist, waist to avoid hurt to spend more to strengthen the psoas muscle exercise, and improve the living conditions of wet, often can reduce the incidence of this disease. The patients in acute stage should be timely medical treatment, bed rest, and closely with the treatment, the prognosis is good. Treatment of acute sciatica: 1, should be treated for the cause. Acute lumbar disc prolapse rest for 1-2 weeks lying on a hard Banchuang symptoms can often stable. 2, symptomatic treatment, the pain can paracetamol plus codeine 30mg ,3-4 times / d, as well as other non-steroidal analgesics, such as iso-acid, naproxen, etc. Muscle spasms can be stable 5-10mg orally, 3 times / d; or ring benzene Danza 10mg orally, 3 times / d, may be effective. 3, severe cases can dexamethasone 10-15mg / d, intravenous infusion of 7-10 days; generally oral prednisone 10mg, 3-4 times a day for 10-14 course. 1% -2% can also be used procaine plus prednisone or paravertebral closed the 1ml. Can acupuncture and physical therapy, conservative treatment can be alleviated more. Poor efficacy of pelvic traction available when sending or throwing Nepal Dragon epidural injection, individual invalid or chronic recurrent cases may consider surgery. Misunderstanding of sciatic pain: Many of the medical brochures, advertising or popular science books, will be sciatica as a disease, and lumbar disc herniation, spinal stenosis, acute lumbar sprain, chronic lumbar muscle strain and other diseases compared. We orthopedic professionals think: This will not only not rigorous, but also misleading to patients, it is necessary for its rectification of names. Sciatic nerve is the longest nerve in the body, from the lumbar spinal cord nerve roots issuing from below the hip piriformis piercing, located in the rear thigh and leg, foot, directing muscle movement, conduction skin feel. Normal people have a right and left sides. Five lumbar vertebrae in the human body, to the following fourth and fifth lumbar burden is heavy activity most prone to degeneration in aging. Long-term strain or sudden strain, can the rear disc prominent laterally. Lumbar disc, the oppression of the sciatic nerve root, causing congestion, edema and other pathological changes as well as adhesion. Striking the side of the waist pain, back radiation to the thigh by the hip until the leg and foot, and sometimes numbness, cough increased. This symptom is sciatica. It is the same as the fever is only a symptom. Lumbar disc herniation or spinal stenosis pathological disorders such changes are causes of sciatica, as the cause fever due to flu, pneumonia or meningitis, and so the same. Although many causes of sciatica, but most common is lumbar disc herniation, and more for the first 4 to 5 or 5 lumbar intervertebral disc between the disc sacrum. Thus, in most cases, sciatica may be the lumbar disc herniation. In the orthopedic clinic, we found: In addition to lumbar disc can cause sciatica, there are many diseases can also cause such symptoms. More common with spinal stenosis, spondylolisthesis, piriformis syndrome, ankylosing spondylitis and spinal tumor. But sometimes, some hospitals, non-orthopedic physician for the professional in patients with sciatica, the next rush, sciatica blind after the diagnosis of symptomatic treatment, not to investigate the underlying reasons for the pathological result of the treatment, in fact, is unscientific and irresponsible. So orthopedic patients to hospital, the orthopedic surgeon should personally make a detailed physical examination for patients and assist with X-ray, CT, MRI (magnetic resonance), etc., on the condition a reasonable pathological diagnosis can be due to treatment, patients really eliminate the pain. Be pointed out that: lumbar disc herniation might not be manifested as sciatica. The human body consists of five vertebrae, and this corresponds with five pairs of lumbar nerve roo