急性腰扭傷-Acute-Lumbar-Sprain課件

最新版整理ppt1急性腰扭傷

Acutelumbarsprain林江豪LIMCHIANGHOU18/7/2013最新版整理ppt2目錄一、解剖Anatomy二、急性腰扭傷Acutelumbarsprain最新版整理ppt3（1）椎體及關(guān)節(jié)突解剖最新版整理ppt4

脊柱椎體的寬度、高度和前后徑從頭端到尾端逐漸增大，以適應(yīng)從上到下逐漸增大的壓力。

身體80%的軸向負(fù)荷力由脊柱的椎體及椎間盤(pán)負(fù)載。最新版整理ppt5小關(guān)節(jié)在脊柱的穩(wěn)定性上起著重要作用。腰椎的關(guān)節(jié)面是矢狀位的，其解剖是限制旋轉(zhuǎn)的范圍，但不限制屈伸和側(cè)彎活動(dòng)。所以小關(guān)節(jié)的損傷或退變可導(dǎo)致腰椎運(yùn)動(dòng)階段的異常。最新版整理ppt6（2）韌帶及間盤(pán)最新版整理ppt7前縱韌帶后縱韌帶黃韌帶棘上韌帶棘間韌帶椎體側(cè)方韌帶橫突間韌帶髂腰韌帶關(guān)節(jié)囊韌帶最新版整理ppt8

椎間盤(pán)是由軟骨板、纖維環(huán)和髓核三部分構(gòu)成。最新版整理ppt9急性腰扭傷

AcuteLumbarSprain最新版整理ppt10急性腰扭傷腰部承擔(dān)著人體1/2以上的體重，腰部活動(dòng)度大，活動(dòng)靈活，但其結(jié)構(gòu)相對(duì)薄弱，其前方為腹腔，其附近只有一些肌肉、筋膜和韌帶，無(wú)其它骨性結(jié)構(gòu)保護(hù)，故在運(yùn)動(dòng)及負(fù)重時(shí)極易遭到損傷。本病多見(jiàn)于青壯年體力勞動(dòng)者，但也見(jiàn)于缺乏體育鍛煉者。90%以上的病人發(fā)生在腰骶部(L5/S1)，兩側(cè)骶棘肌和骶髂關(guān)節(jié)處。最新版整理ppt11由搬持重物姿勢(shì)不正確，或以重誤輕、以輕誤重而用力不當(dāng)所致者稱為閃腰由抬持重物左右歪斜所致者為扭腰由壓砸或跌打而致傷者為挫傷最新版整理ppt12損傷與癥狀：直腰搬持重物時(shí)常損傷腰骶關(guān)節(jié)，多表現(xiàn)為前屈功能受限。斜身搬持重物常損傷骶髂關(guān)節(jié)，多表現(xiàn)為翻身轉(zhuǎn)側(cè)不利。尤其變換體位時(shí)產(chǎn)生疼痛。最新版整理ppt13手法TuinaManipulation最新版整理ppt14在診治急性腰扭傷時(shí)，

要注意“辯位、辯因”相結(jié)合辨位認(rèn)清損傷的具體部位辨因明確疾病受傷時(shí)體位和損傷力的作用方向最新版整理ppt15腰部筋傷特色手法a.檢查手法ExaminationManipulations

b.理筋手法RelaxingSinewManipulationsc.分步斜板法Step-by-stepObliquePullingManipulationd.彎腰挺立法(改善前屈受限)e.滾床法(改善后伸受限)f.搖晃屈戳法(骶髂關(guān)節(jié))最新版整理ppt16a.檢查手法

ExaminationManipulations

病人俯臥于床上，放松腰部肌肉。檢查者站在病人一側(cè)，以雙手拇指指腹沿腰后五條線：腰正中線（腰椎棘突）、左右腰旁線（腰正中線旁開(kāi)2cm，兩側(cè)小關(guān)節(jié)突位置）及左右骶棘肌外緣線（腰正中線旁開(kāi)5cm，相當(dāng)于腰椎橫突附近）自上而下按壓。a.雙手拇指指腹并攏沿正中線檢查各個(gè)棘突的位置有無(wú)異常，棘突間有無(wú)壓痛，包括腰骶關(guān)節(jié)；b.雙手拇指指腹先后分開(kāi)在左右腰旁線及左右骶棘肌外緣線按壓觸診，重點(diǎn)包括第三腰椎橫突處及兩側(cè)骶髂關(guān)節(jié)，檢查軟組織的肌肉緊張度情況及病變結(jié)節(jié)或條索；然后自上而下用掌根叩診，檢查有無(wú)叩痛，兩側(cè)對(duì)比，確定病變的位置。最新版整理ppt17a.檢查手法

ExaminationManipulations

Thepatientisproneonthebedandrelaxinghis/hermuscles.Aphysicianshallstandonthesideandcheckthefiveslinesalongthewaistofthepatientbyusingtwothumbsfromuptodown.Thefivelinesare:1.Lumbarmidline(spinousprocess)2.BothLeftandrightlumbarline(2cmadjacenttolumbarmidline,wherebothsidefacetjointslocated)3.Bothleftandrightlateraledgeofsacralspinalmuscleline(5cmadjacenttolumbarmidline,approximatetolumbartransverseprocess)a.Boththumbsclosetogethertopressandcheckthelumbarmidlineifthereisanydislocation,tendernesspointineachspinousprocessincludingthelumbosacraljoint.b.Boththumbspressseparatelyandgentlyonbothleftandrightlumbarline,andlateraledgeofsacralspinalmuscleline.Payattentiontotheareaofthirdlumbartransverseprocess.Thismethodistocheckthetensionlevelofsofttissuemuscles,andpresenceoflesionnodulesorcord.Afterthat,tapthewaistbyusingpalmroottocheckifthereanypercussionpain,comparingitwiththeoppositesidetoconfirmthelocationofdisorder.最新版整理ppt18b.理筋手法RelaxingSinewManipulations

最新版整理ppt19b.理筋手法RelaxingSinewManipulations

a.Palmpressingmanipulation

Supressthesacralspinalmuscleverticallyfromuptodownwithbothstackingpalmsroot,withgraduallyforce,repeatfor5timesandeachtime3minutes.Itistorelievepainandinvigorateblood.b.Waist-rotatingManipulation

Placebothpalmsatthewaistandhips,thenpushandshakethebodyofpatientinordertoswingthebodyforappropriately3minutes.Doadvicethepatienttorelaxhimself/herself.Itistorelaxthesuperficialmuscleslayeroflumbarandsacral.c.ThumbKneadingManipulation

Usethumbtopressandkneadtheaffectedregionincircleclockwiseandanticlockwise.Applysmallamplitudekneadingwithgentleforceatthelesionandmisalignmentregionofrearsidejointcapsuleandarticularprocessforappropriately10minutes,untilthepainisrelieved.Thismethodrelaxesthesuperficialmusclespasm,tendonandinvigoratesbloodoftheaffectedregion.最新版整理ppt20最新版整理ppt21d.Shoulder-pullingandWaist-pressingManipulation

Forinstance,whenpullingtherightshoulderandpressingtherightwaist,thephysicianshallstandontheleftsideofpatient.PutyourlefthandontherightanteriorsideofGlenohumeral

joint,andrighthandpalmrootonthecontralateralsideof7ththoracicspinousprocessofthepatient.PulltheGlenohumeraljointtotheangleof30-40degreeandpressthespinousprocessfrom7ththoracicspinousprocessto3rdlumbarspinousprocesssimultaneously.Repeatfor3times,eachfor30seconds.

e.Thigh-pullingandWaist-pressingManipulation

Forinstance,whenpullingtherightthighandpressingtherightwaist,thephysicianshallstandontheleftsideofthepatient.Putyourlefthandpalmrootontheaffectedlumbarsacralareaandrighthandon3cmaboveofthekneejointofthepatient.Pullthethightotheangleof45-50degreeandpressthelumbarsacralareasimultaneously.Repeatfor3times,eachfor30seconds.最新版整理ppt22c.分步斜扳法Step-by-stepObliquePullingManipulation

最新版整理ppt23c.分步斜扳法Step-by-stepObliquePullingManipulation

最新版整理ppt24最新版整理ppt25最新版整理ppt26最新版整理ppt27最新版整理ppt28d.彎腰挺立