Lumbar disc herniation generally occurs in the direction of spinal canal (that is, backward), and the direction of vertebral body (that is, upward or downward) is rare. The herniated nucleus pulposus is called "protrusion" when it stops in front of the posterior longitudinal ligament, and it is called "protrusion" when it passes through the posterior longitudinal ligament and enters the spinal canal. According to the direction of nucleus pulposus protrusion, it can be divided into: ① unilateral type, which generally produces only one symptom of lower limbs. (2) Bilateral type, which will produce symptoms of bilateral lower limbs. ③ Central type, which can compress cauda equina nerve, showing perineal paralysis and dysuria.
After lumbar disc herniation, a series of changes such as rational lordosis straightening or scoliosis, spinal nerve root injury, narrowing of intervertebral space, hyperosteogeny at the edge of vertebral body, intervertebral joint degeneration, spinal canal stenosis and so on can occur, which leads to repeated symptoms in many patients.
Generally speaking, the prominent nucleus pulposus can be recovered or partially recovered in the early stage, which is more likely to happen in young patients with better intervertebral disc elasticity. However, more patients further show self-healing defensive reaction, such as fibrosis or atrophy of nucleus pulposus; But it is also possible to ossify on the basis of the above changes, and even lead to the formation of osteophyte at the edge of vertebral body.
How to treat lumbar disc herniation-drug collection
Analgesic medicine for treating lumbar disc herniation
Drug therapy can play an auxiliary role in the symptomatic treatment of lumbar disc herniation.
The severe pain caused by lumbar disc herniation not only brings unbearable pain to patients, but also affects sleep and rest, and even causes some physiological obstacles to patients. Therefore, appropriate analgesic drugs can be taken before definite treatment. Representative drugs are: Le Song, celebrex, Qiangtongding and tramadol.
Le Song and celebrex are new NSAIDs. Because it greatly reduces the adverse reactions to kidney and stomach, and retains good analgesic and anti-inflammatory effects, it is welcomed by more patients. Le Song imported drugs from Japan. In Japan, 800,000-900,000 people use Le Song every day, and it has become the most commonly used anti-inflammatory and analgesic drug. It is characterized by rapid pain relief. However, if it is a patient with severe cardiac and renal insufficiency, serious blood system diseases and peptic ulcer, please do not use it.
Celecoxib is a new class of anti-inflammatory and anti-rheumatic drugs. It can be used with many antihypertensive drugs and diabetes drugs without obvious interaction. Safe and effective to use.
You may not be familiar with ibuprofen, but you may not be familiar with its sustained-release capsule Fenbid. Its powerful effect of relieving joint pain and neuralgia and slight side effects make it popular with patients. In addition to sustained-release capsules, ibuprofen also provides tablets, granules and oral solutions. Use with caution in patients with gastric ulcer and duodenal ulcer.
Lumbar disc herniation mostly occurs in middle-aged and elderly people and people who keep a fixed posture for a long time, such as office workers, computer operators, accountants, typists, teachers and drivers. Due to the long-term lack of physical exercise, these people are weak and their lumbar vertebrae are in a state of static pressure for a long time. According to Huang Jiasi's surgical introduction, when the human body leans forward 20 degrees, the pressure on the lumbar intervertebral disc is the greatest. Therefore, the lumbar vertebrae of the "left race" population are prone to pathological changes. Then the lumbar vertebrae of workers who have been engaged in heavy physical labor or in cold and humid environment for a long time are also prone to pathological changes.
Lumbar disc herniation is more common in people aged 20-50, accounting for about 80% of patients, with more males than females and more rural than urban. Women are more likely to have sudden low back pain after pregnancy and childbirth, and have obstacles in activities. Lumbar disc herniation is common in young people, especially manual workers or workers who sit for a long time. There is no significant difference in the incidence between men and women.
Except for a few young adults who are caused by trauma, most of them are due to people's lack of health care knowledge and lack of attention to rest, which leads to physical strain. In particular, some drivers and copywriters often have symptoms such as neck and shoulder discomfort, low back pain, leg pain and numbness of limbs due to incorrect sitting posture or sedentary, which eventually leads to lumbar diseases.
According to the investigation and statistics of the Orthopedic Disease Prevention and Control Committee of China Medical Care Association for the Promotion of International Exchange, the incidence of spinal diseases among primary and secondary school students has increased rapidly, and the incidence rate in 2000 samples is 12%. 59. 1% of people aged 30-40 suffer from cervical and lumbar spondylosis; Among people aged 50-60, patients account for 71%; The incidence of people over 60 years old is as high as 82%.
This clinical statistical result has sounded the alarm for people, and lumbar spondylosis is quietly coming to young people.
Myth 1: tolerance and accommodation, muddle along.
Lumbar spondylosis is a common and frequently-occurring disease. Many high-risk groups aged 20-50 think they are in their prime of life, and they don't pay attention to their "minor ailments" at all, nor do they pay attention to the discomfort of the waist, and they don't prevent or treat them. In fact, at this time, your waist has become ill unconsciously. When it affects work and life, it is difficult to do CT, check and find an expert. It is difficult to treat at this time.
Myth 2: take a lot of medicine and inject.
At present, drug therapy is the first choice for most patients with lumbar disc herniation. However, as far as the pathogenesis of lumbar disc herniation is concerned, the compression of nucleus pulposus and nerve roots can not be relieved, and drug treatment is not a permanent cure, but can only temporarily relieve the pain of patients. The result is a lifelong commitment, which will happen if you stop taking the medicine. However, all drugs have different degrees of toxic and side effects and should not be taken for a long time.
"Nucleolysis" uses injected protease drugs. Although the nucleus pulposus disappeared, it was at the cost of accelerating degeneration, which made the intervertebral disc lose its elasticity, and the upper and lower vertebral bodies collapsed together, which increased wear and easily produced hyperosteogeny. In addition, other vertebral bodies will bear greater pressure and accelerate the degeneration of other intervertebral discs. After a long time, it is easy to cause other disc lesions.
Myth 3. Thorough surgical treatment
According to experts, surgical treatment of lumbar disc herniation is not the first choice. Generally speaking, surgery is needed only when conservative treatment is ineffective, unable to solve the patient's pain and seriously affecting work and life. Moreover, surgery has strict indications and contraindications, and there are many complications. Lumbar spine is a part with more activities in one's life. After the operation, these parts will become relatively fragile, prone to degeneration and more fragile.
Myth 4: Once the pain is massaged, it will be fine.
Patients with lumbar disc herniation will have a history of pain for a certain period. Because the symptoms are mild at first, many people are used to using massage to relieve pain when they are in pain. In fact, massage can only relieve the disease, but it can't eradicate the root cause. Moreover, many people who massage and massage lack sufficient understanding of lumbar disc herniation, which often aggravates the condition and even causes accidents. Therefore, experts suggest that doctors who choose to implement traction massage therapy should first have a certain understanding of lumbar disc herniation and the onset stage of the disease. It is not that the longer the massage time, the more obvious the curative effect, but the massage technique and intensity are also very important.
First, traction treatment of lumbar disc herniation
Traction treatment of lumbar disc herniation is a method to achieve the therapeutic purpose by using the relationship between acting force and reaction force in mechanics and through special traction device.
Main functions:
(1) plays the role of fixing and braking the waist: during traction, under the balance of acting force and reaction force, the pulled waist is in a relatively fixed normal alignment state, and the range and amplitude of movement of the waist are further limited compared with those when resting in bed and threading the waist line, thus alleviating or eliminating local inflammatory reactions such as congestion, exudation and edema.
(2) Back muscle relaxation: Lumbar disc herniation, due to the compression or stimulation of spinal nerves, is often accompanied by back muscle spasm, which not only leads to pain symptoms in the waist, but also constitutes the alignment of the lumbar spine. Traction therapy can gradually relax back muscles and relieve muscle spasms.
(3) Restore the normal alignment of the lumbar spine: If the lumbar spine of the patient is in a physiological curve shape during traction, with the extension of traction time, the phenomenon of improper alignment can gradually return to normal.
(4) Improve the relationship between protrusion and nerve: For patients with mild or early lumbar disc herniation, traction therapy can gradually lengthen the intervertebral space, which is beneficial to the recovery of protrusion. For patients with a relatively long course of disease, pulling adhesion tissue, contracture ligament and joint capsule can widen the space of spinal canal correspondingly, and at the same time, it can also pull the narrow intervertebral foramen on both sides, thus reducing or eliminating the oppression and stimulation to nerve roots, which has a good effect on relieving numbness and pain of lower limbs.
Second, physical therapy for acute lumbar disc herniation
Physiotherapy commonly used in acute phase includes:
(1) Short-wave and ultrashort-wave therapy: In the early stage of the disease, in order to improve the blood circulation of the affected part, eliminate inflammatory reactions such as exudation and edema, and relieve the pain caused by nerve root compression or stimulation, short-wave and ultrashort-wave electrotherapy are generally used. During the treatment, the two polar plates can be opposite at the lumbosacral part, or they can be juxtaposed at the lumbosacral part and the back of the affected leg. Temperature and heat, daily 1 time, 20-40 minutes each time. The multiple of 15-20 is 1.
(2) Intermittent electrotherapy: the lumbosacral region and the walking area along the sciatic nerve can be treated point by point with small circular electrodes, and the waves are concentrated for 2-5 minutes; Sparse waves for 5 minutes; Five minutes of intermittent rising waves. 1-2 times a day, 15-20 times is 1 course of treatment.
(3) Hyperstimulation current therapy: Two electrodes with the size of 8 *12cm2 can be used, one is placed horizontally in the sacrum, and the other is placed vertically at the waist. After turning on the power supply, adjust the power to 8- 12 mA as soon as possible, and increase it to 18-23 within 2-7 minutes after the strong electrifying feeling disappears. Each treatment time is *** 15 minutes. Every day or every other day 1 time. If effective, you can continue the treatment for 6- 12 times. Three, western medicine treatment of lumbar disc herniation.
This kind of manual therapy is a kind of treatment method that the patient's joints are pushed, pulled and rotated by the operator's hands. It is based on the functional anatomy of bones and joints, guided by the biomechanical principles of bone and joint activities, and adopts corresponding massage techniques to improve the functions of bones and joints and relieve clinical symptoms.
For lumbar disc herniation, Western-style manipulations adopt different auxiliary actions or passive physiological actions, such as pushing and shaking lumbar spinous process or articular side, rotating and pulling lumbar spine. Several manipulations can be used at the same time, and four strength levels of 1, 2, 3 and 4 can be applied according to the patient's condition. Among them, light manipulation can be used for patients with acute lumbar disc herniation, severe pain and great pressure; Patients with chronic or impaired joint motor function should use heavy manipulation. Generally, the duration is 45 seconds, 60 seconds or 90 seconds, and the frequency is 1-2 times per second. The intensity and time can be appropriately selected. Each course of treatment is 5- 10 times, with a rest between two courses 10-20 days.
Fourth, drug treatment of lumbar disc herniation.
Drug treatment of lumbar disc herniation is generally only as an auxiliary treatment, with the main purpose of relieving symptoms.
(1) Patients with unbearable pain symptoms and unable to sleep on their back can take anti-inflammatory and analgesic drugs orally. Or topical antispasmodic analgesic tincture to relieve local pain. Minimizing the pain of patients is beneficial to the implementation of other rehabilitation treatment methods.
(2) In the acute stage of lumbar disc herniation, the edema of the sleeve of spinal nerve root is obvious, which is not only one of the main causes of severe pain, but also can cause secondary arachnoid adhesion. In order to eliminate local reactive edema, steroid drugs can be injected intravenously, diuretics such as dihydrocarburettor can be taken, and dehydrating agents such as mannitol can be pressurized intravenously.
(3) For patients with degenerative lumbar disc herniation, especially elderly patients, chondroitin sulfate A (Kangdeling) can be taken three times a day, 8- 12 tablets each time, about 1 month; Alternatively, compound chondroitin tablets can be used, in which the main components are chondroitin sulfate A75mg, aconite extract (equivalent to 250mg crude drug), Radix Paeoniae Alba extract (equivalent to 40mg crude drug) and licorice extract 20mg. Usage and dosage are the same as chondroitin sulfate A. If the patient has muscle atrophy in different degrees after lumbar disc herniation, vitamin E can be taken orally, 300 mg per day, once or three times per minute/kloc-0.
Five, local blocking therapy of lumbar disc herniation
There are two kinds of local blocking therapy for lumbar disc herniation: acupoint blocking and local area blocking.
(1) Acupoint blocking: It has the comprehensive therapeutic effect of acupuncture and drugs, so it has more obvious analgesic effect than acupuncture or drug treatment alone. Commonly used closed acupoints are Sanjiaoshu, Shenshu, Dachangshu, Fructus Aurantii Immaturus, Zusanli, Huantiao, Weizhong and Chengshan. Common methods: 1, 2% procaine hydrochloride injection 4 ml, prednisolone acetate 1 ml, mixed evenly, injected into the above 3-4 points respectively, and closed every 5-7 days 1 time. 3-5 times is 1 course of treatment. 2. Inject vitamin B 12 injection (1-3ml) into the above 3-4 acupoints. Closed every day 1 time. 10 is 1 course of treatment. 3. Inject 2-4 ml of 5% glucose or 30% Danshen solution into the above 3-4 acupoints respectively, and block them every day or every other day 1 time. 10- 15 times is 1 course of treatment. In addition, vitamin B 1 and compound angelica liquid were used as sealing liquid to seal the points of lumbar disc herniation.
(2) Local area closure: it can be divided into shallow closure and deep closure: 1. Shallow closure: the closure range includes the starting and ending points of lumbar fascia, psoas muscle, supraspinous ligament and interspinous ligament. Generally, it is required to combine tenderness points with accurate anatomical sites.
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