中英文的颈椎病PPT课件.ppt

CategoryandtreatmentofCervicalSpondylosis颈椎病的分型与治疗 Definition颈椎病的定义 Cervicalspondylosis Itisduetocervicaldiscdegeneration neckinjuryormechanicsdysequilibriumcausedbylong 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 Thisdiseaseismorecommonintheelderly 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 DiagnosisandCategory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 MassageTreatment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 1 cervicalspondyloticradiculopathy神经根型颈椎病 Symptom neckunilateralpain presentselectricshock likeradiatingfromnectroottotheshoulder toupperarmandforearmandfingerwithnumbnessfeelling Armfeelingofheaviness numbness holdthingseasytofall Patients neckwithoutpainfeeling Limitedmobilityandstiffnessintheneck cervicalvertebraetransverseprocessanteriorwithradioactivetenderness 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 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 MassageTreatment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 2 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 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 Massagetreatment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 3 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 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 MassageTreatment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 4 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 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 MassageTreatment推拿治疗 Thepurposeistoremovethesympatheticnervestimulation onefingerzenpushingandpokingchannelsmanipulationintheneckwithneckextensionmotiontorelievemusclespasm Ifthepatientfeelheadacheisthemainsymptom adoptpressBaihui DU20 Taiyang EX HN5 Shuigu GB8 Ifdecreasedvisionisthemains