中英文的颈椎病PPT课件.ppt

Category and treatment of Cervical Spondylosis 颈椎病的分型与治椎病的分型与治疗1.Definition 颈椎病的定椎病的定义lCervicalspondylosis.Itisduetocervicaldiscdegeneration,neck injury or mechanics dysequilibriumcaused by long-term muscular strain.It also becauseconstrict or irritate cervical nerve root,spinal cord,vertebral artery or sympathetic nerve.These causes willlead neck,shoulder,back and arm pain and numbness,evenleadparalysisandso:aseriesofclinicalsymptoms.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。2.lThisdiseaseismorecommonintheelderly.Theircervicaldiscdegeneration,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。3.Diagnosis and Category 诊断与分型断与分型lCervicalspondylosisclassifyfourcategories: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，以此分为神经根型、脊髓型、椎动脉型和交感型颈椎病。4.Massage Treatment 推拿治推拿治疗lRelieveneckmusclespasm,adjustcervicalsegmentalunusualangulardisplacement,reducediscburden;releasenervesandvascularmechanicalconstrictionandirritation.Acupoints:occiputposterior,neck,scapularregion,chestandback,Fengchi(GB20),CervicalJiaji(EX-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、拿法、颈椎扳法等。5.1.cervicalspondylotic radiculopathy 神神经根型根型颈椎病椎病lSymptom:neckunilateralpain,presentselectricshock-likeradiatingfromnectroottotheshoulder,toupperarmandforearmandfingerwithnumbnessfeelling.lArmfeelingofheaviness,numbness,holdthingseasytofall.Patientsneckwithoutpainfeeling.lLimitedmobilityandstiffnessintheneck;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。6.lBrachialplexustractiontestpositive,orholesamongcervicalvertebrasextrusiontestpositive.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。7.Massage Treatment 推拿治推拿治疗lTreatment:relymainlyonrelievingnerverootconstriction,andcirclemassagewithgentleapproachalongtheradioactivenervepainplacetoeasethepain.lApproach:Keepapatientseated,relaxtheneckmuscles.Doctorstwohandspresspatientsforeheadandmastoidposteriorborder,upwardstrainpatientsheadandneckforawhile,thencervicalstretchandflexionslowly5-10times.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。8.2.cervical spondylotic myelopathy 脊髓型脊髓型颈椎病椎病lPatientsshowslowlyprogressivelowerextremitynumbness,chills,pain。lUnsteadygait,weakness,tripovereasily,unabletooverobstacles,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。9.lPhysicalexamination：muscletensionincreases.tendonhyperreflexia,pyramidaltractsignspositivelMedicalimageologytest：X-rayresultssimilarwiththatofthenerveroottypecervicalspondylosis.CTshowscervicaldiscdegeneration.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。10.Massage treatment 推拿治推拿治疗lTreatment：mainpurposeistorelievespinalconstrictionlNote: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。11.3.Vertebral arterial insufficiency of cervical spondylosis 椎椎动脉型脉型颈椎病椎病lPatientsshowsaunilateraloccipitalnuchalorneckandshoulderparoxysmalpain,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。12.lMedicalimageologytest：detectionofvertebralarterybloodflowandcarotidarteryangiographycanindicatewhetherthebloodpressure,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。13.Massage Treatment 推拿治推拿治疗lmainlypurposeistorelievecompressionofthevertebralartery.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。14.4.Sympathetic type of cervical spondylosis 交感神交感神经型型颈椎病椎病lPatientswillfeelheadache,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头颈部转动时症状可明显加重。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。16.Massage Treatment 推拿治推拿治疗lThepurposeistoremovethesympatheticnervestimulation.onefingerzenpushingandpokingchannelsmanipulationintheneckwithneckextensionmotiontorelievemusclespasm.lIfthepatientfeelheadacheisthemainsymptom:adoptpressBaihui(DU20)Taiyang(EX-HN5),Shuigu(GB8).Ifdecreasedvisionisthemainsymptom:tostimulatethetwotheorbitaledgeandtwosidefengchi.Ifchesttightness,heartpalpitationsisthebasesymptom: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。17.18.wThankyou.w谢谢19.segmental control of skin by spinal cord 脊髓脊髓对皮肤的皮肤的节段性支配段性支配Spinal segment脊髓节段Skin area皮肤区域C23C34C5C67C8T1occipital and neck枕部及颈部neck and shoulder颈部及肩部arm facies lateralis臂外侧面Forearm and hand facies lateralis前臂和手的外侧面Forearm and hand facies medialis手和前臂的内侧面20.Cervical curvature X-RAY 颈椎曲度的椎曲度的X片表片表现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21.颈椎脊髓受椎脊髓受压的的MRI表表现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22.2/27/202423.