中英文的颈椎病.ppt
Category and treatment of Cervical Spondylosis 颈椎病的分型与治疗,Definition 颈椎病的定义,Cervical spondylosis.It is due to cervical disc degeneration,neck injury or mechanics dysequilibrium caused by long-term muscular strain.It also because constrict or irritate cervical nerve root,spinal cord,vertebral artery or sympathetic nerve.These causes will lead neck,shoulder,back and arm pain and numbness,even lead paralysis and so:a series of clinical symptoms.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。,This disease is more common in the elderly.Their cervical disc degeneration,cervical osteoarthritis and other pathological changes,leading to constrict and irritate cervical nerve root,spinal cord or vertebral artery,then Cervical spondylosis appears.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。,Diagnosis and Category 诊断与分型,Cervical spondylosis classify four categories:1.Cervical spondylotic radiculopathy 2.Cervical spondylotic myelopathy 3.Vertebral artery type of cervical spondylosis 4.Sympathetic cervical spondylosis Because different places of cervical disc herniation,constriction cause different types clinical symptoms.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。,Massage Treatment 推拿治疗,Relieve neck muscle spasm,adjust cervical segmental unusual angular displacement,reduce disc burden;release nerves and vascular mechanical constriction and irritation.Acupoints:occiput posterior,neck,scapular region,chest and back,Fengchi(GB20),Cervical Jiaji(EX-B2),Jianjing(GB21)，Tianzhong(SL11),cashi point etc Approach:One finger Zen pushing,pressure manipulation,traction manipulation,pushing manipulation,grasping manipulation,cervical pulling manipulation.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。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。手法:一指禅推法、按压法、拔伸法、推法、拿法、颈椎扳法等。,1.cervicalspondylotic radiculopathy 神经根型颈椎病,Symptom:neck unilateral pain,presents electric shock-like radiating from nect root to the shoulder,to upper arm and forearm and finger with numbness feelling.Arm feeling of heaviness,numbness,hold things easy to fall.Patients neck without pain feeling.Limited mobility and stiffness in the neck;cervical vertebrae transverse process anterior with radioactive tenderness,and scapula interior tenderness.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。上肢沉重，酸软无力，持物易坠落。患者颈部可无疼痛感。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。,Brachial plexus traction test positive,or holes among cervical vertebras extrusion test positive.Medicalimageology test:X-ray shows:cervical vertebraes and uncovertebral jointhyperplasia,disc space narrow,reduce cervical lordosis,disappear,or anti-bow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。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。,Massage Treatment 推拿治疗,Treatment:rely mainly on relieving nerve root constriction,and circle massage with gentle approach along the radioactive nerve pain place to ease the pain.Approach:Keep a patient seated,relax the neck muscles.Doctors two hands press patients forehead and mastoid posterior border,upward strain patients head and neck for a while,then cervical stretch and flexion slowly 5-10 times.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。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。,2.cervical spondylotic myelopathy 脊髓型颈椎病,Patients show slowly progressive lower extremity numbness,chills,pain。Unsteady gait,weakness,trip over easily,unable to over obstacles,patient may feel“feet step on cotton”患者多表现为缓慢进行性双下肢麻木、发冷、疼痛。走路欠稳、无力、易绊倒，不能跨越障碍物，诉“脚踩棉花”感。,Physical examination：muscle tension increases.tendon hyperreflexia,pyramidal tract signs positiveMedicalimageology test：X-ray results similar with that of the nerve root type cervical spondylosis.CT shows cervical disc degeneration.MRI examination shows constrictive segment spinal cord has signal changes,its wave-like pressure trace.体格检查：肌张力增高，腱反射亢进，锥体束征阳性。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。,Massage treatment 推拿治疗,Treatment：main purpose is to relieve spinal constriction Note:treatment only to relieve neck muscle tension,be careful to use heavy manipulation,such as pulling manipulation,pulling out method,etc.治疗：以脊髓减压为主要治疗目的。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。,3.Vertebral arterial insufficiency of cervical spondylosis 椎动脉型颈椎病,Patients shows a unilateral occipital nuchal or neck and shoulder paroxysmal pain,vertigo,and vision week,tinnitus,etc.Positional vertigo,that is when the head move to a position,inducing vertigo,or easy to suddenly fall.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。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。,Medicalimageology test：detection of vertebral artery blood flow and carotid artery angiography can indicate whether the blood pressure,tortuous,thinning or block.X-ray can show vertebrae unstable and luschka joint side hyperplasia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。,Massage Treatment 推拿治疗,mainly purpose is to relieve compression of the vertebral artery.Approach:pressure manipulation to stimulate the patients Fengfu,(DU16)bilateral Fengchi(GB20).Cervical stretch and flexion and lateral bending each 3-5 times.以解除椎动脉扭曲为主要治疗目的。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。,4.Sympathetic type of cervical spondylosis 交感神经型颈椎病,Patients will feel headache,nausea,dizziness,vomiting and other symptoms.Ptosis,pupil dilation or myosis,blurred vision;tinnitus,hearing loss;praecordia persistent pressure pain,cardiac arrhythmia,tachycardia.Those symptoms will be more serious when turn head and neck.患者以头痛，伴有恶心、眩晕、呕吐等症状。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。头颈部转动时症状可明显加重。,Medicalimageology test：X-ray can show vertebrae instability and uncovertebral joint edge hyperplasia,and physiological curvature reduces or reverses.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。,Massage Treatment 推拿治疗,The purpose is to remove the sympathetic nerve stimulation.one finger zen pushing and poking channels manipulation in the neck with neck extension motion to relieve muscle spasm.If the patient feel headache is the main symptom:adopt press Baihui(DU20)Taiyang(EX-HN5),Shuigu(GB8).If decreased vision is the main symptom:to stimulate the two the orbital edge and two side fengchi.If chest tightness,heart palpitations is the base symptom:can stimulate muscle group of corselets and each intercostal muscles,and finger pointing Neiguan(PC6)and Shanzhong(RN17).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。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。,Thank you.谢谢,segmental control of skin by spinal cord 脊髓对皮肤的节段性支配,Cervical curvature X-RAY 颈椎曲度的X片表现,Normal Cervical curvature Cervical curvature become straight X片显示未见异常的颈椎曲度 X片显示的变直的颈椎曲度,颈椎脊髓受压的MRI表现,MRI shows its normalMRI显示未见颈椎明显异常的 MRI shows its constriction like wave indentationMRI显示颈椎脊髓受压迫呈波浪样压迹,
