中英文的頸椎病

CategoryandtreatmentofCervicalSpondylosis

頸椎病的分型與治療

2021/3/29星期一1Definition

頸椎病的定義Cervicalspondylosis.Itisduetocervicaldiscdegeneration,neckinjuryormechanics

dysequilibriumcausedbylong-termmuscularstrain.Italsobecauseconstrictorirritatecervicalnerveroot,spinalcord,vertebralarteryorsympatheticnerve.Thesecauseswillleadneck,shoulder,backandarmpainandnumbness,evenleadparalysisandso:aseriesofclinicalsymptoms.頸椎病又稱頸椎綜合癥，是由于頸椎間盤退行性改變，頸部損傷或長期勞損造成頸脊柱內(nèi)外力平衡失調(diào)，壓迫或刺激頸神經(jīng)根、脊髓、椎動脈或交感神經(jīng)，引起頸部及肩背手臂的麻木疼痛，甚至癱瘓等一系列臨床癥狀的綜合病癥。2021/3/29星期一2Thisdiseaseismorecommonintheelderly.Theircervicaldiscdegeneration,cervicalosteoarthritisandotherpathologicalchanges,leadingtoconstrictandirritatecervicalnerveroot,spinalcordorvertebralartery,thenCervicalspondylosisappears.本病多見于中老年人，由于頸椎間盤發(fā)生退行性改變、頸椎骨質(zhì)增生等病變，導(dǎo)致頸部神經(jīng)根、脊髓或椎動脈受到壓迫或刺激，出現(xiàn)本病。2021/3/29星期一3DiagnosisandCategory

診斷與分型Cervicalspondylosisclassifyfourcategories:1.Cervicalspondyloticradiculopathy2.Cervicalspondyloticmyelopathy3.Vertebralarterytypeofcervicalspondylosis4.SympatheticcervicalspondylosisBecausedifferentplacesofcervicaldischerniation,constrictioncausedifferenttypesclinicalsymptoms.頸椎病由于頸椎間盤突出，壓迫的部位不同而造成不同的臨床癥狀，以此分為神經(jīng)根型、脊髓型、椎動脈型和交感型頸椎病。2021/3/29星期一4MassageTreatment

推拿治療Relieveneckmusclespasm,adjustcervicalsegmentalunusualangulardisplacement,reducediscburden;releasenervesandvascularmechanicalconstrictionandirritation.

Acupoints:occiputposterior,neck,scapularregion,chestandback,Fengchi(GB20),

CervicalJiaji(EX-B2),Jianjing(GB21)，Tianzhong(SL11),cashipointetcApproach:OnefingerZenpushing,pressuremanipulation,tractionmanipulation,pushingmanipulation,graspingmanipulation,cervicalpullingmanipulation.治則:緩解頸肌痙攣，調(diào)整頸椎節(jié)段異常位移或成角，降低椎間盤負(fù)荷；減少，消除神經(jīng)、血管機(jī)械性壓迫和刺激。取穴:枕后部、頸項部、肩胛部、胸背部，風(fēng)池、頸夾脊、肩井、天宗、阿是穴等。手法:一指禪推法、按壓法、拔伸法、推法、拿法、頸椎扳法等。2021/3/29星期一51.cervicalspondyloticradiculopathy

神經(jīng)根型頸椎病Symptom:neckunilateralpain,presentselectricshock-likeradiating

fromnectroottotheshoulder,toupperarmandforearmandfingerwithnumbnessfeelling.Armfeelingofheaviness,numbness,holdthingseasytofall.Patients’neckwithoutpainfeeling.Limitedmobilityandstiffnessintheneck;cervicalvertebrae

transverseprocess

anteriorwithradioactivetenderness,andscapulainteriortenderness.此型多表現(xiàn)為頸部單側(cè)疼痛、可呈電擊樣，由頸根部向肩、上臂、前臂和手指放射，且有麻木感。上肢沉重，酸軟無力，持物易墜落?；颊哳i部可無疼痛感。頸部活動受限、僵硬，頸椎橫突前側(cè)有放射性壓痛，肩胛骨內(nèi)側(cè)壓痛。2021/3/29星期一6

Brachialplexustractiontestpositive,orholesamongcervicalvertebrasextrusiontestpositive.Medicalimageologytest:X-rayshows:cervicalvertebraesanduncovertebraljointhyperplasia,discspacenarrow,reducecervicallordosis,disappear,oranti-bow體格檢查的表現(xiàn)：臂叢神經(jīng)牽拉試驗陽性，頸椎間孔擠壓或叩頂試驗陽性。影像學(xué)檢查：X線示：頸椎椎體及鉤椎關(guān)節(jié)增生，椎間隙變窄，頸椎生理曲度減小、消失或反弓。2021/3/29星期一7MassageTreatment

推拿治療Treatment:relymainlyonrelievingnerverootconstriction,andcirclemassagewithgentleapproachalongtheradioactivenervepainplacetoeasethepain.Approach:Keepapatientseated,relaxtheneckmuscles.Doctor’stwohandspresspatient’sforeheadandmastoidposteriorborder,upwardstrainpatient’sheadandneckforawhile,thencervicalstretchandflexionslowly5-10times.治療：以神經(jīng)根減壓為主，以輕柔手法沿放射性神經(jīng)疼痛部位循經(jīng)推拿，緩解疼痛。手法：患者坐于凳上，頸部肌肉放松。術(shù)者立于其背后，兩手分別抵住患者額部及乳突后緣，兩手協(xié)調(diào)將患者頭頸上提片刻，再緩慢屈伸頸部5-10次。2021/3/29星期一82.cervicalspondyloticmyelopathy

脊髓型頸椎病Patientsshowslowlyprogressivelowerextremitynumbness,chills,pain。Unsteadygait,weakness,tripovereasily,unabletooverobstacles,patientmayfeel“feetsteponcotton”患者多表現(xiàn)為緩慢進(jìn)行性雙下肢麻木、發(fā)冷、疼痛。走路欠穩(wěn)、無力、易絆倒，不能跨越障礙物，訴“腳踩棉花”感。2021/3/29星期一9

Physicalexamination：muscletensionincreases.tendonhyperreflexia,pyramidaltractsignspositiveMedicalimageologytest

：X-rayresultssimilarwiththatofthenerveroottypecervicalspondylosis.CTshowscervicaldiscdegeneration.MRIexaminationshowsconstrictivesegmentspinalcordhassignalchanges,itswave-likepressuretrace.體格檢查：肌張力增高，腱反射亢進(jìn)，錐體束征陽性。影像學(xué)檢查：X線結(jié)果類似于神經(jīng)根型頸椎病。CT可見頸椎間盤變性。MRI檢查顯示受壓節(jié)段脊髓有信號改變，脊髓受壓呈波浪樣壓跡。2021/3/29星期一10Massagetreatment

推拿治療Treatment：mainpurposeistorelievespinalconstrictionNote:treatmentonlytorelieveneckmuscletension,becarefultouseheavymanipulation,suchaspullingmanipulation,pullingoutmethod,etc.治療：以脊髓減壓為主要治療目的。注意，治療時以單純緩解頸部肌肉緊張痙攣為主，慎用重手法，如扳法、拔伸等。2021/3/29星期一113.Vertebralarterialinsufficiencyofcervicalspondylosis

椎動脈型頸椎病Patientsshowsaunilateraloccipitalnuchalorneckandshoulderparoxysmalpain,vertigo,andvisionweek,tinnitus,etc.Positionalvertigo,thatiswhentheheadmovetoaposition,inducingvertigo,oreasytosuddenlyfall.患者多表現(xiàn)出單側(cè)枕項部或頸肩部發(fā)作性疼痛，伴眩暈及視力減弱、耳鳴等。體位性眩暈，即常因頭部活動到某一位置時誘發(fā)眩暈，易猝然摔倒。2021/3/29星期一12

Medicalimageologytest

：detectionofvertebralarterybloodflowandcarotidarteryangiographycanindicatewhetherthebloodpressure,tortuous,thinningorblock.X-raycanshowvertebraeunstableandluschkajointsidehyperplasia影像學(xué)檢查：椎動脈血流檢測及頸動脈造影可提示有無血管壓迫、迂曲、變細(xì)或阻滯。X線可顯示椎節(jié)不穩(wěn)定及鉤椎關(guān)節(jié)側(cè)方增生。2021/3/29星期一13MassageTreatment

推拿治療mainlypurposeistorelievecompressionofthevertebralartery.Approach:pressuremanipulationtostimulatethepatient’sFengfu,(DU16)bilateralFengchi(GB20).Cervicalstretchandflexionandlateralbendingeach3-5times.以解除椎動脈扭曲為主要治療目的。手法：以按揉手法刺激患者風(fēng)府穴，雙側(cè)風(fēng)池穴。頸椎屈伸和左右側(cè)屈扳法各操作3-5次。2021/3/29星期一144.Sympathetictypeofcervicalspondylosis

交感神經(jīng)型頸椎病Patientswillfeelheadache,nausea,dizziness,vomitingandothersymptoms.Ptosis,pupildilationormyosis,blurredvision;tinnitus,hearingloss;praecordiapersistentpressurepain,cardiacarrhythmia,tachycardia.

Thosesymptomswillbemoreseriouswhenturnheadandneck.患者以頭痛，伴有惡心、眩暈、嘔吐等癥狀。眼瞼下垂，瞳孔擴(kuò)大或縮小，視物模糊；耳鳴，聽力減退；心前區(qū)持續(xù)性壓迫痛，心律不齊，心跳過速。頭頸部轉(zhuǎn)動時癥狀可明顯加重。2021/3/29星期一15

Medicalimageologytest

：X-raycanshowvertebraeinstabilityanduncovertebraljointedgehyperplasia,andphysiologicalcurvaturereducesorreverses.影像學(xué)檢查：X線檢查可顯示椎節(jié)不穩(wěn)及鉤椎關(guān)節(jié)側(cè)方增生，生理曲度減小或反弓。2021/3/29星期一16MassageTreatment

推拿治療Thepurposeistoremovethesympatheticnervestimulation.onefingerzenpushingandpokingchannelsmanipulationintheneckwithneckextensionmotiontorelievemusclespasm.Ifthepatientfeelheadacheisthemainsymptom:adoptpressBaihui(DU20)Taiyang(EX-HN5),Shuigu(GB8).Ifdecreasedvisionisthemainsymptom:tostimulatethetwotheorbitaledgeandtwosidefengchi.Ifchesttightness,heartpalpitationsisthebasesymptom:canstimulatemusclegroupofcorseletsandeachintercostalmuscles,andfingerpointingNeiguan(PC6)andShanzhong(RN17).以解除交感神經(jīng)刺激為目的。以一指禪推法和彈撥法在頸部操作，配合頸部后伸動作，緩解痙攣的肌群。若患者以頭痛為主要癥狀，配合按壓百會、太陽、率谷。若以視力下降為主，刺激兩眼眶內(nèi)緣及兩側(cè)風(fēng)池穴。若以胸