1、CategoryandtreatmentofCervicalSpondylosis颈椎病的分型与治疗颈椎病的分型与治疗2021/3/29星期一1Definition 颈椎病的定义颈椎病的定义lCervical spondylosis.It is due to cervical disc degeneration,neckinjuryormechanicsdysequilibriumcausedbylong-termmuscular strain.It also because constrict or irritate cervicalnerveroot,spinalcord,vertebra
2、larteryorsympatheticnerve.Thesecauseswillleadneck,shoulder,backandarmpainandnumbness,even lead paralysis and so:a series of clinicalsymptoms.l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星期一2lThisdiseaseismorecommonintheelderly.Theirce
3、rvicaldiscdegeneration,cervicalosteoarthritisandotherpathologicalchanges,leadingtoconstrictandirritatecervicalnerveroot,spinalcordorvertebralartery,thenCervicalspondylosisappears.l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星期一3Diagnosis and Category 诊断与分型诊断与分型lCervicalspon
4、dylosisclassifyfourcategories:1.Cervicalspondyloticradiculopathy2.Cervicalspondyloticmyelopathy3.Vertebralarterytypeofcervicalspondylosis4.SympatheticcervicalspondylosisBecausedifferentplacesofcervicaldischerniation,constrictioncausedifferenttypesclinicalsymptoms.l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
5、经根型、脊髓型、椎动脉型和交感型颈椎病。2021/3/29星期一4Massage Treatment 推拿治疗推拿治疗lRelieveneckmusclespasm,adjustcervicalsegmentalunusualangulardisplacement,reducediscburden;releasenervesandvascularmechanicalconstrictionandirritation.Acupoints:occiputposterior,neck,scapularregion,chestandback,Fengchi(GB20),CervicalJiaji(EX
6、-B2),Jianjing(GB21),Tianzhong(SL11),cashipointetclApproach:OnefingerZenpushing,pressuremanipulation,tractionmanipulation,pushingmanipulation,graspingmanipulation,cervicalpullingmanipulation.l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。l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。l手法:一指禅推法、按压法、拔伸法、推法
7、、拿法、颈椎扳法等。2021/3/29星期一51.cervicalspondylotic radiculopathy 神经根型颈椎病神经根型颈椎病lSymptom:neckunilateralpain,presentselectricshock-likeradiatingfromnectroottotheshoulder,toupperarmandforearmandfingerwithnumbnessfeelling.lArmfeelingofheaviness,numbness,holdthingseasytofall.Patientsneckwithoutpainfeeling.lLim
8、itedmobilityandstiffnessintheneck;cervicalvertebraetransverseprocessanteriorwithradioactivetenderness,andscapulainteriortenderness.l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。l上肢沉重,酸软无力,持物易坠落。患者颈部可无疼痛感。l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 lBrachialplexustractiontestpositive,orholesamongcerv
9、icalvertebrasextrusiontestpositive.lMedicalimageologytest:X-rayshows:cervicalvertebraesanduncovertebraljointhyperplasia,discspacenarrow,reducecervicallordosis,disappear,oranti-bowl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。l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星期一7Massage Treatment 推拿治疗推拿治疗lTre
10、atment:relymainlyonrelievingnerverootconstriction,andcirclemassagewithgentleapproachalongtheradioactivenervepainplacetoeasethepain.lApproach:Keepapatientseated,relaxtheneckmuscles.Doctorstwohandspresspatientsforeheadandmastoidposteriorborder,upwardstrainpatientsheadandneckforawhile,thencervicalstret
11、chandflexionslowly5-10times.l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。l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.cervical spondylotic myelopathy 脊髓型颈椎病脊髓型颈椎病lPatientsshowslowlyprogressivelowerextremitynumbness,chills,pain。lUnsteadygait,weakness,tripovereasily,una
12、bletooverobstacles,patientmayfeel“feetsteponcotton”l患者多表现为缓慢进行性双下肢麻木、发冷、疼痛。l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 lPhysicalexamination:muscletensionincreases.tendonhyperreflexia,pyramidaltractsignspositivelMedicalimageologytest:X-rayresultssimilarwiththatofthenerveroottypecervicalspondylosis.CT
13、showscervicaldiscdegeneration.MRIexaminationshowsconstrictivesegmentspinalcordhassignalchanges,itswave-likepressuretrace.l体格检查:肌张力增高,腱反射亢进,锥体束征阳性。l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星期一10Massage treatment 推拿治疗推拿治疗lTreatment:mainpurposeistorelievespinalconstriction
14、lNote:treatmentonlytorelieveneckmuscletension,becarefultouseheavymanipulation,suchaspullingmanipulation,pullingoutmethod,etc.l治疗:以脊髓减压为主要治疗目的。l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.Vertebral arterial insufficiency of cervical spondylosis 椎动脉型颈椎病椎动脉型颈椎病lPatientsshowsaunilateraloccipital
15、nuchalorneckandshoulderparoxysmalpain,vertigo,andvisionweek,tinnitus,etc.lPositionalvertigo,thatiswhentheheadmovetoaposition,inducingvertigo,oreasytosuddenlyfall.l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。l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 lMedicalimageologytest:detectionofvertebralarterybloodflo
16、wandcarotidarteryangiographycanindicatewhetherthebloodpressure,tortuous,thinningorblock.X-raycanshowvertebraeunstableandluschkajointsidehyperplasial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星期一13Massage Treatment 推拿治疗推拿治疗lmainlypurposeistorelievecompressionofthevertebralarte
17、ry.lApproach:pressuremanipulationtostimulatethepatientsFengfu,(DU16)bilateralFengchi(GB20).Cervicalstretchandflexionandlateralbendingeach3-5times.l以解除椎动脉扭曲为主要治疗目的。l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.Sympathetic type of cervical spondylosis 交感神经型颈椎病交感神经型颈椎病lPatientswillfeelheada
18、che,nausea,dizziness,vomitingandothersymptoms.lPtosis,pupildilationormyosis,blurredvision;tinnitus,hearingloss;praecordiapersistentpressurepain,cardiacarrhythmia,tachycardia.Thosesymptomswillbemoreseriouswhenturnheadandneck.l患者以头痛,伴有恶心、眩晕、呕吐等症状。l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。l头颈部转动时症
19、状可明显加重。2021/3/29星期一15 lMedicalimageologytest:X-raycanshowvertebraeinstabilityanduncovertebraljointedgehyperplasia,andphysiologicalcurvaturereducesorreverses.l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星期一16Massage Treatment 推拿治疗推拿治疗lThepurposeistoremovethesympatheticnervestimulation.onefingerzenp
20、ushingandpokingchannelsmanipulationintheneckwithneckextensionmotiontorelievemusclespasm.lIfthepatientfeelheadacheisthemainsymptom:adoptpressBaihui(DU20)Taiyang(EX-HN5),Shuigu(GB8).Ifdecreasedvisionisthemainsymptom:tostimulatethetwotheorbitaledgeandtwosidefengchi.Ifchesttightness,heartpalpitationsist
21、hebasesymptom:canstimulatemusclegroupofcorseletsandeachintercostalmuscles,andfingerpointingNeiguan(PC6)andShanzhong(RN17).l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。l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。若以胸闷、心悸为主,可刺激胸前肌群和各个肋间,点按内关、膻中。2021/3/29星期一172021/3/29星期一18wThankyou.w谢谢2021/3/29星
22、期一19segmental control of skin by spinal cord 脊髓对皮肤的节段性支配脊髓对皮肤的节段性支配Spinalsegment脊髓节段Skinarea皮肤区域C23C34C5C67C8T1occipitalandneck枕部及颈部neckandshoulder颈部及肩部armfacieslateralis臂外侧面Forearmandhandfacieslateralis前臂和手的外侧面Forearmandhandfaciesmedialis手和前臂的内侧面2021/3/29星期一20Cervical curvature X-RAY 颈椎曲度的颈椎曲度的X片表现
23、片表现NormalCervicalcurvatureCervicalcurvaturebecomestraightX片显示未见异常的颈椎曲度X片显示的变直的颈椎曲度2021/3/29星期一21颈椎脊髓受压的颈椎脊髓受压的MRI表现表现lMRIshowsitsnormallMRI显示未见颈椎明显异常的lMRIshowsitsconstrictionlikewaveindentationlMRI显示颈椎脊髓受压迫呈波浪样压迹2021/3/29星期一22畅想网络畅想网络Imagination Network感感谢观看!看!文章内容来源于网文章内容来源于网络,如有侵,如有侵权请联系我系我们删除。除。2021/3/29星期一23