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[治疗方法] 腰椎管狭窄针刀治疗

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    发表于 2017-4-6 09:48:14 | 显示全部楼层 |阅读模式
    本病有三大特点:一是发病慢,中老年多见;二是常伴有间歇性跛行;三是主观症状严重,客观体征较少,腰部症状常缺如,直腿抬高试验常为阴性。
    主要症状有:神经源性间歇性跛行,下腰痛、不能负重、下肢麻木、无力感、坐骨神经痛、马尾神经压迫症等。
    腰椎管狭窄症与腰椎间盘突出症在病理与临床上有有许多不同之处,但二者之间又没有明确的界限,对某些病人确实难以判断,总结一表,以供鉴别诊断参考。
    微信图片_20170406090846.jpg

    临床上,除急性马尾压迫症外,所有椎管狭窄症均可行针刀闭合型手术治疗。
    俯卧位治疗,腹下垫枕,使腰椎变平或稍后凸。
    【体表标志】  
    腰椎棘突  
    髂嵴最高点连线  平第4腰椎棘突或第4、5棘间。

    【定点】
    微信图片_20170406091021.jpg
    按脊椎狭窄的节段不同做不同的定点,即定于椎管狭窄的相应节段。可定于L3-4、L4-5、L5-S1节段的下列各点:                                
    ①横突下缘点  松解横突间韧带和横突间肌。以上两项可谓横向松解,即椎体运动单位间的横向松解,可以达到脊柱纵向减压的目的。                        
    ②椎间管外口点  松解神经根外膜,以达到椎管内神经根延长的目的。
    ③黄韧带点  松解黄韧带,降低椎管内压。
    ④脊神经后支卡压点  解除合并症,消除脊神经后支卡压所致的疼痛。
    ⑤相应肌损伤点  依不同情况而定。
    微信图片_20170406091118.jpg

    【针刀操作】
    各点的针刀操作与腰椎间盘突出症的操作基本一致。须说明的有以下几点:
    ①因腰椎管狭窄多为多节段受累,在定点时,一次仅做一排往往无济于事;所以,第一次应定点2~3排,最多做3排。由于做了全面松解,可以取得较好疗效。
    ②第一次做针刀治疗,一般只做多排横向松解,以达到纵向减压的目的。
    ③如果第一次疗效欠佳,第二次针刀治疗,可进一步松解神经根外口。
    ④一般来说,经两次治疗应有一定疗效。如果尚有遗留顽固症状,可按其症状的神经定位进行椎管内松解,即做侧隐窝松解。因为侧隐窝操作比较复杂,一般一次只做一点,如须继续治疗,仍按神经定位定点治疗。
    微信图片_20170406091247.jpg

    【手法操作】
    如无脊柱侧凸或腰椎滑脱,则无须做手法治疗。
    如有脊柱侧凸,应在松解后行腰椎牵引,每天一次,每次20~40分钟。其牵引重量为体重的1/7,可根据病人的耐受程度适当增减。如有腰椎滑脱,则按腰椎滑脱给予团身复位法予以复位,再予腰椎牵引。



    本文源自:针刀临床实战AB班
    责任编辑:针刀李班长
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    发表于 2017-5-18 00:14:39 | 显示全部楼层

    teaching content and analysis

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    发表于 2017-6-6 19:41:43 | 显示全部楼层

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