急性腰扭伤课件

急性腰扭伤Acutelumbarsprain,LIMCHIANGHOU18/7/2013,目录,一、解剖Anatomy二、急性腰扭伤Acutelumbarsprain,（1）椎体及关节突,解剖,脊柱椎体的宽度、高度和前后径从头端到尾端逐渐增大，以适应从上到下逐渐增大的压力。身体80%的轴向负荷力由脊柱的椎体及椎间盘负载。,小关节在脊柱的稳定性上起着重要作用。腰椎的关节面是矢状位的，其解剖是限制旋转的范围，但不限制屈伸和侧弯活动。所以小关节的损伤或退变可导致腰椎运动阶段的异常。,（2）韧带及间盘,前纵韧带后纵韧带黄韧带棘上韧带棘间韧带椎体侧方韧带横突间韧带髂腰韧带关节囊韧带,椎间盘是由软骨板、纤维环和髓核三部分构成。,急性腰扭伤AcuteLumbarSprain,急性腰扭伤,腰部承担着人体1/2以上的体重，腰部活动度大，活动灵活，但其结构相对薄弱，其前方为腹腔，其附近只有一些肌肉、筋膜和韧带，无其它骨性结构保护，故在运动及负重时极易遭到损伤。本病多见于青壮年体力劳动者，但也见于缺乏体育锻炼者。90%以上的病人发生在腰骶部(L5/S1)，两侧骶棘肌和骶髂关节处。,由搬持重物姿势不正确，或以重误轻、以轻误重而用力不当所致者称为闪腰由抬持重物左右歪斜所致者为扭腰由压砸或跌打而致伤者为挫伤,损伤与症状：,直腰搬持重物时常损伤腰骶关节，多表现为前屈功能受限。斜身搬持重物常损伤骶髂关节，多表现为翻身转侧不利。尤其变换体位时产生疼痛。,手法TuinaManipulation,在诊治急性腰扭伤时，要注意“辩位、辩因”相结合,辨位,认清损伤的具体部位,辨因,明确疾病受伤时体位和损伤力的作用方向,腰部筋伤特色手法,a.检查手法ExaminationManipulationsb.理筋手法RelaxingSinewManipulationsc.分步斜板法Step-by-stepObliquePullingManipulationd.弯腰挺立法(改善前屈受限)e.滚床法(改善后伸受限)f.摇晃屈戳法(骶髂关节),a.检查手法ExaminationManipulations,病人俯卧于床上，放松腰部肌肉。检查者站在病人一侧，以双手拇指指腹沿腰后五条线：腰正中线（腰椎棘突）、左右腰旁线（腰正中线旁开2cm，两侧小关节突位置）及左右骶棘肌外缘线（腰正中线旁开5cm，相当于腰椎横突附近）自上而下按压。a.双手拇指指腹并拢沿正中线检查各个棘突的位置有无异常，棘突间有无压痛，包括腰骶关节；b.双手拇指指腹先后分开在左右腰旁线及左右骶棘肌外缘线按压触诊，重点包括第三腰椎横突处及两侧骶髂关节，检查软组织的肌肉紧张度情况及病变结节或条索；然后自上而下用掌根叩诊，检查有无叩痛，两侧对比，确定病变的位置。,a.检查手法ExaminationManipulations,Thepatientisproneonthebedandrelaxinghis/hermuscles.Aphysicianshallstandonthesideandcheckthefiveslinesalongthewaistofthepatientbyusingtwothumbsfromuptodown.Thefivelinesare:1.Lumbarmidline(spinousprocess)2.BothLeftandrightlumbarline(2cmadjacenttolumbarmidline,wherebothsidefacetjointslocated)3.Bothleftandrightlateraledgeofsacralspinalmuscleline(5cmadjacenttolumbarmidline,approximatetolumbartransverseprocess)a.Boththumbsclosetogethertopressandcheckthelumbarmidlineifthereisanydislocation,tendernesspointineachspinousprocessincludingthelumbosacraljoint.b.Boththumbspressseparatelyandgentlyonbothleftandrightlumbarline,andlateraledgeofsacralspinalmuscleline.Payattentiontotheareaofthirdlumbartransverseprocess.Thismethodistocheckthetensionlevelofsofttissuemuscles,andpresenceoflesionnodulesorcord.Afterthat,tapthewaistbyusingpalmroottocheckifthereanypercussionpain,comparingitwiththeoppositesidetoconfirmthelocationofdisorder.,b.理筋手法RelaxingSinewManipulations,b.理筋手法RelaxingSinewManipulations,a.PalmpressingmanipulationSupressthesacralspinalmuscleverticallyfromuptodownwithbothstackingpalmsroot,withgraduallyforce,repeatfor5timesandeachtime3minutes.Itistorelievepainandinvigorateblood.b.Waist-rotatingManipulationPlacebothpalmsatthewaistandhips,thenpushandshakethebodyofpatientinordertoswingthebodyforappropriately3minutes.Doadvicethepatienttorelaxhimself/herself.Itistorelaxthesuperficialmuscleslayeroflumbarandsacral.c.ThumbKneadingManipulationUsethumbtopressandkneadtheaffectedregionincircleclockwiseandanticlockwise.Applysmallamplitudekneadingwithgentleforceatthelesionandmisalignmentregionofrearsidejointcapsuleandarticularprocessforappropriately10minutes,untilthepainisrelieved.Thismethodrelaxesthesuperficialmusclespasm,tendonandinvigoratesbloodoftheaffectedregion.,d.Shoulder-pullingandWaist-pressingManipulationForinstance,whenpullingtherightshoulderandpressingtherightwaist,thephysicianshallstandontheleftsideofpatient.PutyourlefthandontherightanteriorsideofGlenohumeraljoint,andrighthandpalmrootonthecontralateralsideof7ththoracicspinousprocessofthepatient.PulltheGlenohumeraljointtotheangleof30-40degreeandpressthespinousprocessfrom7ththoracicspinousprocessto3rdlumbarspinousprocesssimultaneously.Repeatfor3times,eachfor30seconds.e.Thigh-pullingandWaist-pressingManipulationForinstance,whenpullingtherightthighandpressingtherightwaist,thephysicianshallstandontheleftsideofthepatient.Putyourlefthandpalmrootontheaffectedlumbarsacralareaandrighthandon3cmaboveofthekneejointofthepatient.Pullthethightotheangleof45-50degreeandpressthelumbarsacralareasimultaneously.Repeatfor3times,eachfor30seconds.,c.分步斜扳法Step-by-stepObliquePullingManipulation,c.分步斜扳法Step-by-stepObl