At present, the imaging examinations for clinical diagnosis of disc herniation include lumbar CT film, MRI and special contrast examination of spinal canal.
A, magnetic resonance imaging examination:
The shape of the protruding nucleus pulposus (flat, round, oval or irregular) can be clearly displayed. On the sagittal image, we can see that the prominent nucleus pulposus is obviously separated from dura mater and fat, and there is a narrow neck between the prominent nucleus pulposus and the non-prominent nucleus pulposus.
Second, the CT film:
The posterior edge of intervertebral disc is deformed or has local protruding shadow; The displacement of dura mater and fat, on the plane of disc rupture, the contrast between the two sides is asymmetric; There are soft tissue density shadows in dura mater and space; The dural sac was deformed, and oval and crescent impressions appeared. Nerve roots are compressed and displaced; Nucleus pulposus calcification; There is vacuum in the spinal canal.
All the previous treatment measures: physical therapy, massage, acupuncture, massage, sealing, traction, atomization, western medicine and so on. To some extent, it has played a role in promoting blood circulation, removing blood stasis, dredging collaterals, diminishing inflammation and relieving pain, but it has never "eliminated bone spurs". Therefore, these measures are all temporary solutions, not permanent solutions.
Now (aminoglycoside drug treatment) is accepted by the medical community. The principle of this treatment is to repair cartilage by supplementing the raw materials of cartilage. Years of practice have proved that the effect is very good ~!
In addition, physical therapy can also be used to assist.
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. 1 once a day or every other day. 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.
Pay attention to the posture of sitting and standing at ordinary times.