中医骨科学外文版 (45).ppt
Tendons injury of neckCervicalspondylosisTendonsinjuryofneckDefinitionofcervicalspondylosisCommon diseases,mostly in 40-50 years old middle-aged people.Definition:A series of syndromes with shoulder and arm pain,numbness,dizziness and gait instability caused by the compression of cervical spinal nerve root,spinal cord,vertebral artery and sympathetic nerve due to chronic strain of the neck.Also known as neck-shoulder syndrome.1.Since 1948,cervical spondylosis has been gradually identified internationallyAs an independent disease.The discussion of cervical spondylosis in Chinese medicine is shown in the items of bi syndrome,flaccidity syndrome,headache,dizziness,stiff neck,cramped cervical muscle,etc.2.Age:Mostly in over 30 years old.3.Location:C5,6,7 are more.4.Treatment:Comprehensive treatment.5.Prognosis:It can recur after fatigue.OverviewTendonsinjuryofneckAnatomyofcervicalvertebraePhysiologicalanteflexionMorphologyofvertebralbodyTendonsinjuryofneckAnatomyofcervicalvertebraeLuschkajoint:TheupperlateralmarginofC3-7vertebralbodyprotrudesupwarduncuscorporisvertebrae,andconnectswiththeanteriorandposteriorlipsoftheuppervertebralbodytoformtheluschkajointTendonsinjuryofneckAnatomyofcervicalvertebraeVertebralarteryVertebralartery:C6-1passesthrough the vertebral artery,and there is a transversegrooveforvertebralarteryontheposteriorarchofatlasTendonsinjuryofneckAnatomyofcervicalvertebraeLig.longitudinaleposterius:Posteriorlongitudinalligamentisrelativelywide,anditsmiddlepartisthickandsolid,sotheprotrusionoftheposteriorintervertebraldiscisless,butitispronetodegenerationandcalcificationTendonsinjuryofneckEtiologyandpathologyofcervicalspondylosis(1)DegenerativechangesofcervicalvertebraHypertrophy of Lig.longitudinale posteriusHypertrophy of longitudinal ligamentSpinal stenosis nerve compressionTendonsinjuryofneckEtiologyandpathologyofcervicalspondylosis(2)TheelasticityofcervicalintervertebraldiscdecreasedandprotrudedbackwardSpinalstenosisnervecompressionArticularprocesshyperplasiaTendonsinjuryofneckEtiologyandpathologyofcervicalspondylosis(3)LuschkajointhyperplasiaandvertebralarteryforamenhyperplasiaresultininsufficientbloodsupplytovertebraAClassification(1)Nerveroottype(2)Vertebralarterytype(3)Sympatheticnervetype(4)Spinalcordtype(5)Hybridtype(6)NecktypeCervicalspondyloticradiculopathyRefers to the degenerative changesofcervicalintervertebraldiscanditssubsequentpathologicalchanges,which oppress and stimulate thenerverootsandeventhecorrespondingnervedistributionpain:TendonsinjuryofneckDiagnosticpointsofcervicalspondylosis(1)Mainmanifestations:ShoulderandarmpainandnumbnessAggravatingfactors:Neckextension,cough,stool(increasedabdominalpressure)Accompanyingsymptoms:Limitedneckmovement,muscularatrophy,decreasedmusclestrength,anddullfeelingoffingersCT,MRI1.Nerveroottype(arthralgiatype)PhysicalexaminationForcedductiontest-Thenumbnesscausedbyradiationpainisaggravated(nerverootpressingintervertebralforamen)Spurlingtest-Cervicalpain,radiationpain(intervertebralforamenpressingnerveroot)X-rayfilm-Foraminalstenosisandhyperplasiaofbonepuncture-Thereisadefinitediagnosis,anditisofdiagnosticsignificance.GapnarrowingandformationofosteophyteDermalsegmentspositioningCervicalNerveRootCompressionandCorrespondingManifestationsCervicalspondyloticmyelopathyThe original lesions are caused by the degeneration ofintervertebral disc,reactive synoviae and ligament thickening,resultinginincreaseddiameteroftissuearoundtheintervertebraldisc,andtheosteophyteformationintheposteriormarginofthevertebralbodyandprotrudingbackwardintothevertebralcanal,reducingtheavailablespaceofthespinalcordanditssupplyvessels.Duetothenarrowingofintervertebraldiscandtheproximityofadjacentvertebralbodies,thepressureofluschkajointsandfacetjointsincreases,andtheoccurrenceofbonyjointsfurtherreducesthespaceofspinalcanalandnerverootcanal.InelasticligamentscanalsoenterthespinalcanaltocompressthespinalcordTendonsinjuryofneckDiagnosticpointsofcervicalspondylosis(2)2.Spinalcordtype(paralysistype)Earlystage:Numbnessandweaknessoflowerlimbs(singleordouble),feelingofmissingstepswhenlandingontheground,girdlesensationinchestandbackDevelopment:Upperlimbnumbness(poorfinemovements),weakhandgrip(easytofalloff),unstablegait(easytofall,unabletocrossobstacles)Severe:Quadriplegia,difficultyinurineandstool(retention)PhysicalexaminationHyperphysiologicalreflexofupperandlowerextremitiesLeadtopathologicalreflexX-ray film:Intervertebral disc degeneration and hyperplasia ofposteriormarginofvertebralbodyMRI:The spinal cord is wavy impression,which is thinner inseverecases,showingprotrusionofintervertebraldiscSignsofspinalcordcervicalspondylosisSignsofspinalcordcervicalspondylosisSignsofspinalcordcervicalspondylosisSignsofspinalcordcervicalspondylosisSignsofspinalcordcervicalspondylosisSignsofspinalcordcervicalspondylosisMRImanifestationSpinalcordcompressionProtrusionofintervertebraldiscprotrusionandossificationofLig.longitudinaleposteriusCervicalspinalstenosisDuetocervicalvertebradegeneration,especiallyLuschka joint degeneration,and stimulation orsympathetic nerve compression at intervertebralforamen or transverse foramen,the symptoms arethe most complicated,including retrobulbar pain,blurred vision,photophobia,tears,runny nose,cervicocardial syndrome caused by paroxysmalpalpitation,hot flush,facial sweating and othersymptomsSympatheticcervicalspondylosisSympathetictypeHeadache,dizziness,nausea,vomiting,blurredvision,eyeswelling,arrhythmia,abnormalsweatingofhead,neckandlimbs,tinnitusDizziness,nasalcongestion,bradycardia,bloodpressuredrop,flatulenceExcitationofsympatheticnerves:Inhibitionofsympatheticnerves:Duetovariousfactorsofcervicalvertebradegeneration,the vertebral artery is tortuous,narrow,crampandcompressed,whichcausesinsufficientbloodsupply to thevertebralartery.Patientswith insufficientblood supply to the inner ear and brain may haveheadache,dizziness(cervicalvertigo),visualdisturbance(visualcenterischemia)andsuddencollapse.Symptomsoften appear when the patients neck is in a certainposition.Theneckrotationtestmaybepositive.VertebralarterytypecervicalspondylosisVertebralarterytypeThemainsymptoms,rotation,floatingorshaking,areaggravatedwhentheheadmovesCausedbyinsufficientbloodsupplytothevertebralbaseanddilatationofcollateralcirculationvessels.Distendingpainintheoccipital,parietalandtemporalareasDizziness,vertigoheadacheVertebralarterytypesignSuddenamblyopiaandcanrecoverautomaticallyinashorttimeCausedbyvertebralarteryspasmandstimulation,usuallyoccurswhentheheadsuddenlyrotatesorbendsandstretches,andcancontinuetomovenormallywhenstandingupSensoryandmotordysfunction,mentalsymptomsblurringofvisioncataplexyothersNecktypeNeck and shoulder often suffer from pain,fatigue,soreness;Itiseasytoneckstiffness,hasspasmofneckmuscles,andtendernesspoints;X-ray films show changes inphysiologicalcurvatureofthecervicalspineandunstableperformance.TendonsinjuryofneckTreatmentpointsofcervicalspondylosis(1)ThetechniqueoftendonsregulationOcciputandjawtractionMedicationSurgicaltreatmentAcupuncturetreatmentItissuitablefornerveroottypeandpartialvertebralarterytypeItissuitableformostnerveroottypesandsomevertebralarterytypes.Cervicaltractionisaroutineandwidelyusedmethod.Somepatientssimplyusethismethodtotreatcervicalspondylosis,56%ofthepatientsarecuredand15%areobviouslyimproved.Thismethodissuitableforalltypesofcervicalspondylosis,especiallynerveroottype,sympathetictypeandvertebralarterytype.SeebelowfordetailsThosepatients,afterineffectivesystemicconservativetreatment,withdefinitecompressionorspace-occupyinglesionsintheCTandMRI,aggravatedsymptoms,andreducedqualityoflife,withoutsurgicalcontraindicationscanconsidersurgicaltreatment:AnteriordecompressionandfixationIt is effective for some cases with obvious muscular atrophy.(1)Mechanismofcervicaltraction:LimitecervicalvertebramovementandfacilitatetheresolutionofcongestionandedemaRelieveneckmusclespasmandreducethepressureonintervertebraldisc;Enlargetheintervertebralspaceandintervertebralforamen,andrelievethestimulationandcompressionsufferebynerverootsAndreleasetheadhesionbetweennerverootandsurroundingtissue;Bufferthepressureoftheintervertebraldisctissueonthesurroundingarea,Ansbenefittheretractionoftheannularfibroustissueprotrudingoutwards;Restorethevertebralarteryfoldedbetweenthetransverseforamen;Distractthesynoviumembeddedinthezygapophysialjoint.Tractionwithclothband(occipitaljawtraction)(2)Method(3)Position:Sittingorsupineposition,keeptheneckslightlyforwardatabout25.(4)Weight:about1/12ofbodyweight(variesfrompersontoperson)(5)Time:30-60minuteseachtime,onceortwiceaday.oTractioncourse:restforafewdaysbetween1-2coursesorlonger.(10daysasacourseoftreatment)AircushiontractionSkullTraction2.Manipulativetherapy(1)Muscletendonrelaxmethod(2)Graspingmethod(3)kneadingmethod(4)Rotationmethod(5)liftingandpivotingmethod(6)heatingacupointsandmusclesmethod(7)pattingandtappingmethod3.Drugtherapy(1)OraladministrationofTCMArthralgiatypeClearawayheatandremoveobstruction-GuizhiandGegenDecoctionorJuanbiDecoctionVertigotypeDeficiencyofQiInvigoratingthemiddleandtonifyingQi-BuzhongYiqiDecoctionOrBazhenDecoctionPhlegmstagnation-resolvingphlegmanddredgingcollaterals-WendanDecoctionApoplexy-nourishingliverwithkidney-water-QijuDihuangpillBloodstasisblock-resolvingbloodstasisanddredgingcollaterals-BuyangHuanwudecoctionQistagnationduetocoldcongealing-WarmingYangfordredgingstagnation-YangHeTangplusParalysistype(2)ExternalapplicationofTCMApplywet-hotcompresseswithHaiTongPiTangorAbandonedStaffSan,AlsorubwithXuntongwineorShuhuoling.4.PhysicaltherapyMechanismofphysicaltherapy:(1)Eliminateinflammatoryedemaofnerverootsandsurroundingtissues.(2)Improve the blood supply and nutritionalstatusofspinalnerverootandneck.(3)Relieve neck muscle spasm and enhancetractioneffect.(4)Delaying or alleviating the calcificationprocessofarticuliintervertebrales,articularcapsuleandligament.Commonphysicaltherapies:(1)InfraredradiationandTDPradiationmachine(2)High-frequencyelectrotherapy:Ultrashortwave,shortwave,etc.canimprovethebloodcirculationofspinalcord,nerveroot,vertebralarteryandothertissuesthroughdeepelectricheating.(3)Paraffinotherapy:Theheated paraffinwaxisappliedtotheaffectedarea,andafterthetissueisheated,localbloodvesselsdilate,circulationisaccelerated,cellpermeabilityisincreased,andedemaabsorptionispromoted.(4)Ion-introduction therapy:Various Chinese and westernmedicines(procainehydrochloride,potassiumiodide,maturevinegar,aceticacid,clematischinensis,etc.)areintroducedbydirectcurrenttotreatcervicalspondylosis,whichhasacertaintherapeuticeffect.5.AcupunctureCommonlyusedacupoints:Fengchi,Dazhui,Jianyu,Quepen,Jianjing,Fengfu,etc.6.FunctionalexerciseofneckandshoulderCando:WatchingthemoonandlookingintotheseaTransferpivotWindrockingaxisPracticeofrotatingshouldersandlooseningarms7.Surgicaltreatment(1)Surgicalindication:Patientswith cervical spondylosisare ineffectiveaftersystematicnon-surgicaltreatment;Patients with progressive aggravation or recurrentsymptomsofnerveroot,vertebralarteryorspinalcordcompressionaffectingtheirworkandlife;Patientswithsuddenonsetofsymptoms,isdiagnosedascervical spondylosis,and dont respond to short-termnon-surgicaltreatment,andwhosedailyworkandliveshavebeenaffected.(2)Surgicalmethods:Principlesofoperation:Autologousbonetransplantationisperformedonthebasisofdecompressiontostabilizethecervicalspine.Theanteriorapproachsinclude:A.Percutaneouscervicaldiscectomyandposteriorlumbarinterbodyfusion;B.Cervicalvertebradecompression;C.Cervicalvertebralbodyfenestration;D.Lateralanteriorcervicaldecompression;E.Anteriorwallresectionofcervicaltransverseprocessandvertebralarterydecompression;F.Excisionandreplacementofintervertebraldisc.Posteriorapproachsinclude:A.Opening of cervical articuli intervertebrales,excision of osteophyte or discectomy ofintervertebraldiscnucleuspulposus;B.Extensive cervical vertebra decompressivelaminectomy;C.Cervicalspinalcanalexploration;D.Laminoplasty(orexpansivelaminoplasty).8.Prevention(1)Tendonself-regulation(2)Sleepingposture:KneadingDredgingthemeridianwithfourfingersLowpillowandheadover-extensionposition.(3)ThemedicateddietWarmingandreinforcingthetendonsandstrengtheningthebody
