《皮肤美容技术》课件-ENG 腰椎间盘突出症

《临床疾病概要》康复治疗技术专业教学资源库职业教育SummaryofClinicalDiseasesSubject：Lumbardischerniation

1Definition,etiologyandpathologyoflumbardischerniation2Clinicalmanifestationsandimagingoflumbardischerniation3Diagnosisandtreatmentoflumbardischerniationcatalogue4Preventionandhealthcareoflumbardischerniation1.1DefinitionoflumbardischerniationLumbardischerniation,isakindofclinicalsyndromecausedbylumbardiscdegeneration,annularrupture,stimulationoftheprotrudingnucleuspulposustissueorcompressionoftheduralsac,nerveroot,Caudaequina.Itisoneofthecommoncausesoflumbarandlegpain,andbelongstothecategoryof"lowbackpain"intraditionalChinesemedicine.1.1ThecoreofdefinitiondenaturationbreakprotrudingoppresssymptomDefinitionoflumbardischerniation1.1Definitionoflumbardischerniation

Asyndromecharacterizedbyintervertebraldiscdegeneration,ruptureoffibrousring,protrusionofnucleuspulposus,stimulationorcompressionofnerverootsandcaudaequinanerve.Itisacommoncauseoflowerbackandlegpain.1.2TheetiologyoflumbardischerniationTheintervertebraldiscisthecartilagediscconnectingthetwoadjacentlumbarvertebrae.Themiddlepartofthediscisasoftandelasticjellymaterial,calledthenucleuspulposus.Thesurroundingpartisalayeroffibrocartilagearrangedinconcentriccircles,calledtheannulusfibrosus,whichconnecttheupperandlowervertebraeandrestrictthenucleuspulposustoprotrudingoutward.Undertheactionofinducement,nucleuspulposusexpansionorevenrupture,colloidalnucleuspulposusprotrusion,stimulationorcompressionofthecorrespondinglevelofnerveroot,cancausenerveinflammationandedema,thatis,localanddistalcorrespondingpositionofpain,numbnessandotheruncomfortablesymptoms.1.2TheetiologyoflumbardischerniationThemaincausesoflumbarintervertebraldischerniationare:harmDegenerativecoldstimulationlumbardischerniation1.3PathologicalclassificationoflumbardischerniationAccordingtothedegreeofnucleuspulposusherniation,thelumbardisccanbedividedintothreetypes:degeneration,prolapse,extrusionandsequestration:2.1Symptomsoflumbardischerniation(1)LowbackpainLowbackpainisoftenanearlysymptomoflumbardischerniation.Thepainismainlylocatedinthelumbosacralandsacroiliacareas.Itisalocalizedorgeneralizeddullpain,aggravatedwhenactivityorabdominalpressureincreases.Severesymptoms,severewaistpain,accompaniedbyrootlowerlimbpain.2.1Symptomsoflumbardischerniation(2)RootneuralgiaTheintervertebraldiscsinL2~L3andL3~S4protrudeand

compressnerverootsofL3andL4,whichcausefemoralnervecompressionsymptoms,andappearradiationpain

alongthemedialthigh,medialkneejoint,medialcalfradiationandfoot.TheintervertebraldiscbetweenL4~L5protrudesand

compressesnerverootofL5,withobvious

commonperonealnervecompressionsymptoms,andthepainradiatingtotheanterolateralcalf,dorsalsideofthefootandtoe.2.1Symptomsoflumbardischerniation(2)RootneuralgiaTheintervertebraldiscbetweenL5~S1protrudesand

compressesnerverootofS1,whichcausesthetibialnervecompressionsymptoms,andpainradiatingtotheposterolateralcalf,heel,medialmalleolus,plantarpart,andsmalltoes.Highlumbardischerniation(L1~L2、L2~L3、L3~L4)involvesthefemoralnerve,andthepainradiatestotheanterolateralthigh,proniculate,andanteromedialcalf,buttheincidenceislessthan5%.Thepainismainlyunilateralrootlowerextremitypain.

Thenatureofacupunctureorburningpain,oftenaccompaniedbynumbness.Afewpatientshavebilaterallowerextremitypain.2.1Symptomsoflumbardischerniation(3)MovementdisordersThewaistandlowerlimbsarestiffandweak.

Theaffectedlimbcannotcross-leggedwhensitting.

Theaffectedlimbisnotflexibleandslowwhenwalking.

About1/3ofthepatientshaveintermittentclaudication.2.1Symptomsoflumbardischerniation(4)SensorydisordersThewaistandcalffrontside,footbackandotherplacesoftenhaveabnormalburningsensationandothersensorydisorders.

Thecompressionsideofnerverootoftenhavelowerlimbnumbness.Centralorfreelumbardischerniationcancausecaudaequinasyndrome,manifestedaslowbackpainwithrootpainonbothsidesoronesideofthelowerlimbs.

Whilethesensorydisorderareaisextensivethatcaninvolvethebuttocks,lateralthigh,calf,footandsaddlearea,andappearsphincterfunctionandsexualdysfunction.(5)AutonomicnervedysfunctionCompressionofhorudaequinanervecausessphincterdysfunctionandsexualdysfunction.2.2Signsoflumbardischerniation(1)PosturalchangeThechangeofspinalcurvatureisanimportantsignoflumbardischerniation,amongwhichscoliosisisthemostcommon,convextothehealthysideortheaffectedside,accountingforabout65%ofthesickpopulation.

Itmayalsocauselumbarcurvebecomestraightoreveninversion.Bothsidesofthepelvisareuneven.

Patientoften

putstheaffectedleginfront,bendstheknee

torelievepaininstandingposition

,namelytheso-called"escapingposture".2.2Signsoflumbardischerniation(2)LumbartendernessandradiationpainThereistendernessonthelaminarspace,spinousspaceorspinousprocess,inwhichthetendernesspointofthelaminarspaceoftenindicatesthelocationofthelesion,whichcancauserootlowerlimbpainintheacutestage,andthepainradiatestothehiponthesamesideorthesciaticnerveduringpressureorpercussion.2.2Signsoflumbardischerniation(3)Skinsensation,musclestrength,andtendonreflexchangesWhen

L3~L4discherniation,thepainofthefrontsideofthethighandtheanteromedialsideofthecalfdecreased,thekneemusclestrengthweakened,thekneetendonreflexweakenedordisappeared;WhenL4~L5disc

herniation,theanterolateralsideofthecalf,themedialsideofthefoot,andthebackextensormuscleofthefoottoeareweakened;

WhenL5~S1discherniation,thepainof

thecalf、posterolateralfoot

andplantarddecreased,andthetendonreflexisweakenedordisappeared.Thesechangesareimportantsignstodeterminethesiteanddegreeofprominence,buttheyarenotspecificandcannotbeusedasadiagnosticbasis.2.2Signsoflumbardischerniation(4)lumbarmovementdisordersThelumbarspineislimitedinalldirections,withmoresevere

onbackwardextensionandforwardflexion.(5)GaitchangeGaitpresentsaslimping,alsoknownasapain-reducinggait.(6)SpecialtestStraightlegelevationtestandstrengtheningtestpositive,neckflexiontestpositive,supinetestpositive,hiptestpositive(femoralnervepulltestpositive),coughsign

positive,etc.2.3Imagemanifestation

oflumbardischerniation（1）X线2.3（2）CTImagemanifestation

oflumbardischerniation2.3（3）MRImagemanifestation

oflumbardischerniation2.3（3）MRImagemanifestation

oflumbardischerniation3.1DiagnosisoflumbardischerniationDiagnose:Symptoms:①Legpainismoreseverethanlowbackpain.Itisatypicalareaofsciaticnervedistribution;②Feelingnumbnessaccordingtotheskininthe

nervedistributionarea;Signs:①Straightlegelevationtestdecreasedby50%thannormal,andhavehealthylegelevationtest

positive;②Twoofthefourneurologicalsignsappear(muscleatrophy,motorweakness,hypoesthesiaandreducedreflexes);Imaging:Imagingfindingsareconsistentwithclinicalexaminations,includinglumbarCT,MRIetc.3.1Diagnosisoflumbardischerniationdifferentialdiagnosis:1.LumbarmusclestrainMiddleagedpeoplearemorepronetothiscondition,whichisrelatedtomaintainingaconsistentworkingpostureforalongtime.Chronicpainwithoutobviouscausesisthemainsymptom,whilelowerbackpainischaracterizedbysorenessandswelling,whichcanberelievedafterrest.Therearefixedtendernesspointsinthepainarea,andtappingatthetendernesspointsactuallyreducesthepain.Thestraightlegelevationtestisnegative,andthereisnosignofnerveinvolvementinthelowerlimbs.Localclosureofpainpointshasagoodeffect.2.PiriformissyndromeThepatientmainlypresentswithpaininthebuttocksandlowerlimbs,andtheappearanceandaggravationofsymptomsaremainlyrelatedtoexercise.Restcansignificantlyalleviatethesymptoms.3.1Diagnosisoflumbardischerniationdifferentialdiagnosis:3.lumbarspinalstenosisThemainsymptomsofpatientsarelowerbackpain,caudaequina,andcompressionofthelumbarnerve,characterizedbyintermittentneurogenicclaudication.Symptomcharacteristicsandimagingexaminationsareimportantcriteriafordifferentiation.4.SpinetuberculosisAhistoryofunexplainedfever,nightsweating,fatigue,weightloss,andothertoxicsymptomsinthepast,withobviousnocturnalorpersistentpain.Imagingexaminationshowsthatlumbarintervertebralspacedestructionisthemainmanifestation,whichcanformkyphoticdeformitiesorpoorsequenceofcervicallesions.3.2Non-surgicaltreatment:Treatmentoflumbardischerniation1,Bedrest,generallystrictbedrestfor3-4weeks,waistprotection,andappropriategroundmobility;2.Non-steroidalanti-inflammatoryandanalgesicdrugstreatment;3,intravenousinfusionofmannitoltoalleviatenerverootedematreatment3.2Non-surgicaltreatment:Treatmentoflumbardischerniation4.Massagemassage:itcanreducemusclespasmandimprovelocalbloodcirculation.Softtechnique,including:rollingmethod,four-fingerpush,take,press,shake,etc.Acupuncturepoints:Shenshupoint,Dachangshupoint,Yaoyangguanpoint,Huantiaopoint,Weizhongpointetc.3.2Non-surgicaltreatment:Treatmentoflumbardischerniation5.Acupunctureandmoxibustion:filiformneedle,skinneedle,earacupuncture,electroacupuncture,pointinjection,etc.Acupuncturepoints:Shenshupoint,Dachangshupoint,Yaoyangguanpoint,Huantiaopoint,Weizhongpointetc.3.2Non-surgicaltreatment:Treatmentoflumbardischerniation5.Physiotherapy:itcanimprovebloodcirculationinthewaistandlegs,andrelaxmuscles.Ionintroduction,ultrashortwave,paraffintherapy,TDPtreatment,etc.3.2Operativetreatment:TreatmentoflumbardischerniationSurgicalindications:·Symptomsoflumbarandlegpainaresevere,recurrent,ineffectivenon-surgicaltreatmentaftermorethanthreemonths,andtheconditiongraduallyworsens,seriouslyaffectingworkandlife;·Peoplewithobviousnerveinvolvement,suchasdecreasedmusclestrengthintheinnervationarea,footdrop,etc.;·Peoplewithcaudaequinasyndr