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脊柱与四肢骨关节慢性病损手法治疗前后影像学检查病例分析thecaseanalysisoftheimageologicalexaminationbeforeandaftermassagetreatmentswhicharethechronicdiseasesofthespineandlimbsoftheosteoarticular广西中医药大学附属瑞康医院韦贵康RuiKangHospitalAffiliatedtoGuangxiUniversityofChineseMedicineWeiGuikang
1我们在深入研究脊柱与四肢骨关节慢性病损手法治疗过程中，合理使用影像学（X线、CT、MRI）检查，作为检查常规，对提高诊断准确率及提高疗效很有帮助。现将一些典型的病例分折如下：Whileweareresearchingthetreatmenttothechronicdiseasesofthespineandlimbsoftheosteoarticular,it'shelpfulforustouseimageologicalexamination(X-rays,CT,MRI)reasonablytoincreasetheaccuracyrateofdiagnosisandtherapy.Nowwesharesometypicalexamplesforyou:
2微屈前推法、园筒整复法治疗颈曲变直病例
3例1、吳X，男，31岁，颈僵痛伴眩晕半年，x线片提示：颈曲变直。手法治疗2天1次，5次后颈僵痛眩晕消失，x线片检查颈曲有改善。Example1:Mr.Wu,male,31yearsold,hehadalreadyfelttheneckstiffandpainanddizzinessforhalfayear.X-raysreported:thecurveoftheneckbecamestraightened.Heacceptedthemassageonceintwodays.After5times,hefeltbetterandthesymptomdisappeared.X-raysreportedthatthecurveoftheneckbecamebetter.
4颈曲变直手法治疗后改善 Afterthemassage,thecurveoftheneckbecamebetter治疗前beforethetreatment治疗后afterthetreatment
5例2、李x，女33岁，颈痛伴上肢麻痛3个月，x线片提示：颈曲变直。手法治疗2天1次，4次后颈痛伴上肢麻痛消失，x线片检查颈曲有改善。Example2:Mrs.Li,female,33yearsold,shehadalreadyfelttheneckpainandupperlimbsnumbfor3months.X-raysreported:thecurveoftheneckbecamestraightened.Sheacceptedthemassageonceintwodays.After4times,shefeltbetterandthesymptomdisappeared.X-raysreportedthatthecurveoftheneckbecamebetter.
6治疗前beforethetreatment治疗后afterthetreatment
7按语：1、40岁以前颈椎疾病伴有颈曲变直，通过手法、练功等方法，颈曲有不同程庋恢复，有利了临床症的消除或缓解。Note:1、Ifyouhavesomediseasesaboutcervicalvertebrawiththecurveoftheneckstraightenedbefore40yearsold,wecanusemassage、practiceandsoontorecoverthecurveoftheneck.Throughthisway,thesymptomscanbeeliminatedorrelieved.
82、中年老年人，不强求颈曲恢复，应进行综后分析，对因治疗。2、Themiddleandtheolddon'tneedtorecoverthecurveoftheneck,theyshouldanalyzesyntheticallyandthenchoosetherightwayfortreatment.
9俯卧均衡牵引架﹙自制专利产品﹚加手法治疗：症状伴有腰曲变直、或脊柱侧弯畸形、或骨盆两侧不等高随着症状消除或改善，复查x线片原异常者得到相应改善。Prostratebalancedtractionframe(homemadepatentproduct)withmassagecanbeused:Thecurveoflumbarbecomestraightened、thelateralbendingofspinebecomeabnormalorthebothsidesofpelvisbecomedifferent.Whilethosesymptomswereeliminatedorrelieved,theytookX-raysanditreportedthatthepatientsbecamebetterthanbefore.
10
11提法
12左右摆法
13腰曲治疗前Thecurveoflumbarbeforethetreatment腰曲治疗后Thecurveoflumbarafterthetreatment
14治疗前后beforeandafterthetreatment
15动态推拉法
16摆动整复法
17侧弯治疗前thelateralbendingbeforethetreatment侧弯治疗后thelateralbendingafterthetreatment
18
19闭孔小治疗前obturatorformamenbeforethetreatment闭孔小治疗后obturatorformamenafterthetreatment
20手法治疗髋关节半脱位：顺向牽拉，反向复位。如患下肢外旋变长，采用下肢外展外旋、屈曲内收内旋伸直。Themassagetreatscoxaesubluxation:Followthedirectiontopull、reversethedirectiontorestoration.Ifthelegsexternalrotationbecomelong,weshouldadoptabductionandexternalrotation、flexionadductionandinternalrotationandtostraightenit.
21髋半脱治疗前coxaesubluxationbeforethetreatment
22半脱治疗后coxaesubluxationafterthetreatment
23髌骨上移或下移测量法：髌股角测量法，正常值100～110°，小于100°为髌骨下移，大于110°为髌骨上移。髌骨下移手法一一收紧法髌骨上移手法一一放松法Thewaytomeasurepatellatomoveupordown:Themethodsofpatellofemoralangle,thenormalrangeis100~110°.Below100°isaspatellatomovedown,above110°isaspatellatomoveup.Themassagetotreatpatellatomovedowniscalled一一TighteningMethodThemassagetotreatpatellatomoveupiscalled一一RelaxationMethod
24正常髌股角thenormalpatellofemoralangle
25髌骨上移patellatomoveup
26髌骨正常与下移thenormalpatellaandpatellatomovedown
27误诊误用手法、针灸治疗无效，手术后手法外烫中药治疗，完全康复病例。张某，女，12岁，颈痛3个月，当地手法、针灸法疗3个月无效，来诊MRI检查为脊膜瘤，后手术治疗，术后行走失稳，两于发胀，采用手法、外烫中药，半年后完全康复。1年观察，完全康复。Previously,thepatientacceptedthewrongdiagnosis、wrongmassageandacupuncturewithnoeffect.AfterthesurgeryweusedmassageandheatingwithChineseherbalmedicineastreatment.Finallythepatientwascured.MissZhang,female,12yearsold,shehadalreadyfelttheneckpainfor3months.Andthemassageandacupuncturedidn'tmakeeffectforher.MRIreportedthatitwasspinalmeningioma.Thensheacceptedthesurgery.Afterthesurgeryshewalkedoutofbalanceandherhandsfeltswollen.SoweusedmassageandheatingwithChineseherbalmedicineastreatment.Afterhalfayearshewascured.Andweobservedherayear,shewastotallycured.
28手术前beforethesurgery
29正位hemangioma横切transection
30术后即照，行走稍失稳，两手有些账thepicturewasrightafterthesurgery,shewalkedoutofbalanceandherhandsfeltswollen
31术后横切afterthesurgerytransection术后手法加中药外烫，半年后MRI复查afterthesurgery,sheusedmassageandheatingwithChineseherbalmedicineastreatment.AfterhalfayearshetookMRI..
32手法后横切afterthemassagetransection手术后3年，各症全消除，能正常参加学校体育活动，复查X线片Afterthesurgery3years,allthesymptomsweredisappeared.Shecouldtakepartinactivities.ThiswasthepictureofX-rays
33误诊误用手法病例：例1、陈某，女，65岁，背痛2年，曾按一般背痛治疗无效，后MRI捡查为胸9椎体血管瘤手术治疗而愈。Theexampleofthewrongdiagnosisandwrongmassage:Example1、Mrs.Chen,female,65yearsold,backpain2years.Shehadalreadyacceptedsometreatmentsbuthadnoeffect.MRIreportedthatitwasthe9ththoracicvertebrahemangioma.Afterthesurgeryshewascured.
34胸椎体血管癅thoracicvertebrahemangioma
35椎体血管瘤centrumhemangioma
36例2、陈某，女，35岁，腰痛2年半，曾按腰椎间突出症采用手法、针灸、理疗等治疗无效，后MRI捡查为腰椎管脊膜瘤手术治疗而愈。Example2、Mrs.Chen,female,35yearsold,loinpaintwoandahalfyears.Shehadalreadyacceptedmassage、acupuncture、physiotherapyandsoonforprolapseofthelumbarintervertebraldisci.Buthadnoeffect.MRIreportedthatitwaslumbarspinalmeningioma.Afterthesurgeryshewascured.
37脊膜瘤spinalmeningioma
38讨论1、脊柱与四肢骨关节病损的诊治，要重视并合理选用影象学（X线、cT、MRI）检查，这对诊断、鉴别诊断与治疗方法的选用有重要意义。Discuss1、Thetreatmentsforspineandlimbsoftheosteoarticularshouldvalueandchooseimageologicalexamination(X-rays,CT,MRI)reasonably.It'ssignificantforustodiagnose、differentialdiagnosisandchoosetherapeuticmethods.
392、脊柱与四肢骨关节病损手法治疗，要重视结构改变，采用一些针对性手法，收到良好效果。但结构异常存在易留隐患，病情容易复发。2、Whenwetakemassageforspineandlimbsoftheosteoarticular,weshouldvaluethechangeofthestructureandusesometargetedapproaches.Itwillgetbetterresults.Buttheabnormalstructurewillexisthiddendangerandtheillnesseasilyreappears.
403、脊柱与四肢骨关节病损的非手术与手术治疗各有优势，应严格掌握各自适应症与禁忌症，治疗效果要重视功能与体能恢复。3、Thetreatmentsofnon-surgeryandsurgeryforspineandlimbsoftheosteoarticularbothhavetheadvantages.Weshouldfollowtheiradaptationandcontraindicationstrictly.Andweshouldvaluetherecoveryoffunctionandphysicalabilityfortheeffectofthetreatments.
41谢谢！谢谢！Thankyou!
