中医骨科学外文版 (45).ppt

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1、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 ner

2、ve 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 sho

3、wn 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.OverviewTendonsinjuryofneckAnatomyofcervicalvertebraePh

4、ysiologicalanteflexionMorphologyofvertebralbodyTendonsinjuryofneckAnatomyofcervicalvertebraeLuschkajoint:TheupperlateralmarginofC3-7vertebralbodyprotrudesupwarduncuscorporisvertebrae,andconnectswiththeanteriorandposteriorlipsoftheuppervertebralbodytoformtheluschkajointTendonsinjuryofneckAnatomyofcer

5、vicalvertebraeVertebralarteryVertebralartery:C6-1passesthrough the vertebral artery,and there is a transversegrooveforvertebralarteryontheposteriorarchofatlasTendonsinjuryofneckAnatomyofcervicalvertebraeLig.longitudinaleposterius:Posteriorlongitudinalligamentisrelativelywide,anditsmiddlepartisthicka

6、ndsolid,sotheprotrusionoftheposteriorintervertebraldiscisless,butitispronetodegenerationandcalcificationTendonsinjuryofneckEtiologyandpathologyofcervicalspondylosis(1)DegenerativechangesofcervicalvertebraHypertrophy of Lig.longitudinale posteriusHypertrophy of longitudinal ligamentSpinal stenosis ne

7、rve compressionTendonsinjuryofneckEtiologyandpathologyofcervicalspondylosis(2)TheelasticityofcervicalintervertebraldiscdecreasedandprotrudedbackwardSpinalstenosisnervecompressionArticularprocesshyperplasiaTendonsinjuryofneckEtiologyandpathologyofcervicalspondylosis(3)Luschkajointhyperplasiaandverteb

8、ralarteryforamenhyperplasiaresultininsufficientbloodsupplytovertebraAClassification(1)Nerveroottype(2)Vertebralarterytype(3)Sympatheticnervetype(4)Spinalcordtype(5)Hybridtype(6)NecktypeCervicalspondyloticradiculopathyRefers to the degenerative changesofcervicalintervertebraldiscanditssubsequentpatho

9、logicalchanges,which oppress and stimulate thenerverootsandeventhecorrespondingnervedistributionpain:TendonsinjuryofneckDiagnosticpointsofcervicalspondylosis(1)Mainmanifestations:ShoulderandarmpainandnumbnessAggravatingfactors:Neckextension,cough,stool(increasedabdominalpressure)Accompanyingsymptoms

10、:Limitedneckmovement,muscularatrophy,decreasedmusclestrength,anddullfeelingoffingersCT,MRI1.Nerveroottype(arthralgiatype)PhysicalexaminationForcedductiontest-Thenumbnesscausedbyradiationpainisaggravated(nerverootpressingintervertebralforamen)Spurlingtest-Cervicalpain,radiationpain(intervertebralfora

11、menpressingnerveroot)X-rayfilm-Foraminalstenosisandhyperplasiaofbonepuncture-Thereisadefinitediagnosis,anditisofdiagnosticsignificance.GapnarrowingandformationofosteophyteDermalsegmentspositioningCervicalNerveRootCompressionandCorrespondingManifestationsCervicalspondyloticmyelopathyThe original lesi

12、ons are caused by the degeneration ofintervertebral disc,reactive synoviae and ligament thickening,resultinginincreaseddiameteroftissuearoundtheintervertebraldisc,andtheosteophyteformationintheposteriormarginofthevertebralbodyandprotrudingbackwardintothevertebralcanal,reducingtheavailablespaceofthes

13、pinalcordanditssupplyvessels.Duetothenarrowingofintervertebraldiscandtheproximityofadjacentvertebralbodies,thepressureofluschkajointsandfacetjointsincreases,andtheoccurrenceofbonyjointsfurtherreducesthespaceofspinalcanalandnerverootcanal.Inelasticligamentscanalsoenterthespinalcanaltocompressthespina

14、lcordTendonsinjuryofneckDiagnosticpointsofcervicalspondylosis(2)2.Spinalcordtype(paralysistype)Earlystage:Numbnessandweaknessoflowerlimbs(singleordouble),feelingofmissingstepswhenlandingontheground,girdlesensationinchestandbackDevelopment:Upperlimbnumbness(poorfinemovements),weakhandgrip(easytofallo

15、ff),unstablegait(easytofall,unabletocrossobstacles)Severe:Quadriplegia,difficultyinurineandstool(retention)PhysicalexaminationHyperphysiologicalreflexofupperandlowerextremitiesLeadtopathologicalreflexX-ray film:Intervertebral disc degeneration and hyperplasia ofposteriormarginofvertebralbodyMRI:The

16、spinal cord is wavy impression,which is thinner inseverecases,showingprotrusionofintervertebraldiscSignsofspinalcordcervicalspondylosisSignsofspinalcordcervicalspondylosisSignsofspinalcordcervicalspondylosisSignsofspinalcordcervicalspondylosisSignsofspinalcordcervicalspondylosisSignsofspinalcordcerv

17、icalspondylosisMRImanifestationSpinalcordcompressionProtrusionofintervertebraldiscprotrusionandossificationofLig.longitudinaleposteriusCervicalspinalstenosisDuetocervicalvertebradegeneration,especiallyLuschka joint degeneration,and stimulation orsympathetic nerve compression at intervertebralforamen

18、 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

19、,vomiting,blurredvision,eyeswelling,arrhythmia,abnormalsweatingofhead,neckandlimbs,tinnitusDizziness,nasalcongestion,bradycardia,bloodpressuredrop,flatulenceExcitationofsympatheticnerves:Inhibitionofsympatheticnerves:Duetovariousfactorsofcervicalvertebradegeneration,the vertebral artery is tortuous,

20、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

21、 certainposition.Theneckrotationtestmaybepositive.VertebralarterytypecervicalspondylosisVertebralarterytypeThemainsymptoms,rotation,floatingorshaking,areaggravatedwhentheheadmovesCausedbyinsufficientbloodsupplytothevertebralbaseanddilatationofcollateralcirculationvessels.Distendingpainintheoccipital

22、,parietalandtemporalareasDizziness,vertigoheadacheVertebralarterytypesignSuddenamblyopiaandcanrecoverautomaticallyinashorttimeCausedbyvertebralarteryspasmandstimulation,usuallyoccurswhentheheadsuddenlyrotatesorbendsandstretches,andcancontinuetomovenormallywhenstandingupSensoryandmotordysfunction,men

23、talsymptomsblurringofvisioncataplexyothersNecktypeNeck and shoulder often suffer from pain,fatigue,soreness;Itiseasytoneckstiffness,hasspasmofneckmuscles,andtendernesspoints;X-ray films show changes inphysiologicalcurvatureofthecervicalspineandunstableperformance.TendonsinjuryofneckTreatmentpointsof

24、cervicalspondylosis(1)ThetechniqueoftendonsregulationOcciputandjawtractionMedicationSurgicaltreatmentAcupuncturetreatmentItissuitablefornerveroottypeandpartialvertebralarterytypeItissuitableformostnerveroottypesandsomevertebralarterytypes.Cervicaltractionisaroutineandwidelyusedmethod.Somepatientssim

25、plyusethismethodtotreatcervicalspondylosis,56%ofthepatientsarecuredand15%areobviouslyimproved.Thismethodissuitableforalltypesofcervicalspondylosis,especiallynerveroottype,sympathetictypeandvertebralarterytype.SeebelowfordetailsThosepatients,afterineffectivesystemicconservativetreatment,withdefinitec

26、ompressionorspace-occupyinglesionsintheCTandMRI,aggravatedsymptoms,andreducedqualityoflife,withoutsurgicalcontraindicationscanconsidersurgicaltreatment:AnteriordecompressionandfixationIt is effective for some cases with obvious muscular atrophy.(1)Mechanismofcervicaltraction:Limitecervicalvertebramo

27、vementandfacilitatetheresolutionofcongestionandedemaRelieveneckmusclespasmandreducethepressureonintervertebraldisc;Enlargetheintervertebralspaceandintervertebralforamen,andrelievethestimulationandcompressionsufferebynerverootsAndreleasetheadhesionbetweennerverootandsurroundingtissue;Bufferthepressur

28、eoftheintervertebraldisctissueonthesurroundingarea,Ansbenefittheretractionoftheannularfibroustissueprotrudingoutwards;Restorethevertebralarteryfoldedbetweenthetransverseforamen;Distractthesynoviumembeddedinthezygapophysialjoint.Tractionwithclothband(occipitaljawtraction)(2)Method(3)Position:Sittingo

29、rsupineposition,keeptheneckslightlyforwardatabout25.(4)Weight:about1/12ofbodyweight(variesfrompersontoperson)(5)Time:30-60minuteseachtime,onceortwiceaday.oTractioncourse:restforafewdaysbetween1-2coursesorlonger.(10daysasacourseoftreatment)AircushiontractionSkullTraction2.Manipulativetherapy(1)Muscle

30、tendonrelaxmethod(2)Graspingmethod(3)kneadingmethod(4)Rotationmethod(5)liftingandpivotingmethod(6)heatingacupointsandmusclesmethod(7)pattingandtappingmethod3.Drugtherapy(1)OraladministrationofTCMArthralgiatypeClearawayheatandremoveobstruction-GuizhiandGegenDecoctionorJuanbiDecoctionVertigotypeDefici

31、encyofQiInvigoratingthemiddleandtonifyingQi-BuzhongYiqiDecoctionOrBazhenDecoctionPhlegmstagnation-resolvingphlegmanddredgingcollaterals-WendanDecoctionApoplexy-nourishingliverwithkidney-water-QijuDihuangpillBloodstasisblock-resolvingbloodstasisanddredgingcollaterals-BuyangHuanwudecoctionQistagnation

32、duetocoldcongealing-WarmingYangfordredgingstagnation-YangHeTangplusParalysistype(2)ExternalapplicationofTCMApplywet-hotcompresseswithHaiTongPiTangorAbandonedStaffSan,AlsorubwithXuntongwineorShuhuoling.4.PhysicaltherapyMechanismofphysicaltherapy:(1)Eliminateinflammatoryedemaofnerverootsandsurrounding

33、tissues.(2)Improve the blood supply and nutritionalstatusofspinalnerverootandneck.(3)Relieve neck muscle spasm and enhancetractioneffect.(4)Delaying or alleviating the calcificationprocessofarticuliintervertebrales,articularcapsuleandligament.Commonphysicaltherapies:(1)InfraredradiationandTDPradiati

34、onmachine(2)High-frequencyelectrotherapy:Ultrashortwave,shortwave,etc.canimprovethebloodcirculationofspinalcord,nerveroot,vertebralarteryandothertissuesthroughdeepelectricheating.(3)Paraffinotherapy:Theheated paraffinwaxisappliedtotheaffectedarea,andafterthetissueisheated,localbloodvesselsdilate,cir

35、culationisaccelerated,cellpermeabilityisincreased,andedemaabsorptionispromoted.(4)Ion-introduction therapy:Various Chinese and westernmedicines(procainehydrochloride,potassiumiodide,maturevinegar,aceticacid,clematischinensis,etc.)areintroducedbydirectcurrenttotreatcervicalspondylosis,whichhasacertai

36、ntherapeuticeffect.5.AcupunctureCommonlyusedacupoints:Fengchi,Dazhui,Jianyu,Quepen,Jianjing,Fengfu,etc.6.FunctionalexerciseofneckandshoulderCando:WatchingthemoonandlookingintotheseaTransferpivotWindrockingaxisPracticeofrotatingshouldersandlooseningarms7.Surgicaltreatment(1)Surgicalindication:Patient

37、swith cervical spondylosisare ineffectiveaftersystematicnon-surgicaltreatment;Patients with progressive aggravation or recurrentsymptomsofnerveroot,vertebralarteryorspinalcordcompressionaffectingtheirworkandlife;Patientswithsuddenonsetofsymptoms,isdiagnosedascervical spondylosis,and dont respond to

38、short-termnon-surgicaltreatment,andwhosedailyworkandliveshavebeenaffected.(2)Surgicalmethods:Principlesofoperation:Autologousbonetransplantationisperformedonthebasisofdecompressiontostabilizethecervicalspine.Theanteriorapproachsinclude:A.Percutaneouscervicaldiscectomyandposteriorlumbarinterbodyfusio

39、n;B.Cervicalvertebradecompression;C.Cervicalvertebralbodyfenestration;D.Lateralanteriorcervicaldecompression;E.Anteriorwallresectionofcervicaltransverseprocessandvertebralarterydecompression;F.Excisionandreplacementofintervertebraldisc.Posteriorapproachsinclude:A.Opening of cervical articuli interve

40、rtebrales,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