Pehea ʻoe e ʻike ai i ka ʻeha radicular, maloʻo a me ka cluster?

ʻO ke aʻa aʻalolo Lumbosacral mai ke kuamoʻo i loko o ka plexus sacral, a me ka hōʻiliʻili ʻana o ke kumu aʻalolo sciatic, no laila ke komo kekahi o nā mea ʻekolu, hiki ke hana i kekahi mau hōʻailona like a me nā hōʻailona. Hōʻike nui ʻia i ka ʻeha o ka pūhaka a me ka wāwae, ka numbness, ka neʻe a me ka reflex dysfunction a me ka hoʻāʻo ʻana i ka hoʻokiʻekiʻe wāwae pololei, a me nā mea ʻē aʻe. ʻO ka ʻoiaʻiʻo, ʻaʻole kūlike nā wahi pathoanatomical a me nā hiʻohiʻona o nā liona ʻekolu. Me ka ʻokoʻa o nā hihia kakaʻikahi e hiki mai ana ʻelua a ʻekolu paha i ka manawa like, ʻokoʻa a ʻokoʻa kēia mau hiʻohiʻona.

Hoʻopili pinepine ʻia ka ʻeha Radicular me ka lumbar disc herniation, lumbar spinal stenosis (me ka lateral fossa stenosis), a me lumbar spinal tumors.

(1) Paravertebral pain: ʻO nā hiʻohiʻona nui o ka ʻeha radicular ka ʻeha paravertebral a me ka radiation i nā lālā haʻahaʻa ma muli o ke komo like ʻana o nā lālā hope a me nā ʻaoʻao o nā aʻa aʻalolo spinal o ka ʻāpana i hoʻopilikia ʻia. ʻAʻole ʻike pinepine ʻia ka ʻeha maloʻo a me ka ʻeha pūpū me ka ʻeha radicular.

(2) Ka palena o ka neʻe ʻana o ka spine lumbar: ʻO ka lumbar spinal stenosis ka mea nui e kaupalena i ka hoʻonui ʻana i hope, ʻoiai nā pilikia lumbar disc hiki ke kaupalena i ka hoʻonui ʻana i ka lumbar back extension, ka flexion i mua, a me ka flexion ʻaoʻao i pili. Hiki i nā maʻi maʻi intradural ke kumu i nā pae like ʻole o ka palena o ka neʻe ʻana o ka lumbar spine ma nā pae like ʻole o ka maʻi. Eia naʻe, ʻaʻole hōʻike ka ʻeha maloʻo a me ka ʻeha plexiform i kēia hiʻohiʻona.

(3) Ka ho'āʻo hoʻololi o ka cervical: Zhao Dinglin et al. Ua hana ʻia kahi hoʻāʻo ʻana o ka cervical flexion ma luna o 200 mau maʻi me ka ʻeha radicular, a ʻoi aku ka maikaʻi ma luna o 95%. ʻO kēia no ka mea aia ka spine cervical i kahi ʻano o ka flexion i mua, kahi e hoʻonui ai i ka ʻeha a me ke kaomi ʻana i nā aʻa aʻalolo i hoʻopilikia ʻia ma o ka ʻeke dural a me ka cuff aʻa, e hoʻonui ana i ka ʻeha. ʻAʻole i loaʻa i ka haʻawina kahi hōʻike o ka ʻeha maloʻo a i ʻole ka ʻeha plexiform.

(4) Nā hōʻailona o ke aʻa aʻa aʻa spinal: ʻO ka manaʻo, ka neʻe ʻana, a me nā reflexes o nā aʻa aʻalolo spinal loaʻa nā hiʻohiʻona localization ma muli o ka ganglia spinal. No ka laʻana, ʻo ke ʻano o ka ʻili hope o nā manamana wāwae mua a me ka lua o ka wāwae e hoʻopili ʻia e ke aʻa aʻalolo lumbar, ʻoiai ʻo ka ʻaoʻao ʻaoʻao o ka wāwae a me ka manamana wāwae liʻiliʻi e hoʻokomo ʻia e ke aʻa aʻalolo sacral 1. ʻOi aku ka nui o ka ʻeha Radicular, sensory disorder, a me nā reflexes ma mua o ke ʻano o ka ʻeha maloʻo a me ka ʻeha cluster.

I ka wā ma mua, ua kapa ʻia nā maʻi maʻi o ka ʻeha maloʻo he 'sciatica' a i ʻole 'sciatic neuritis'. Eia nō naʻe, ke hōʻike nei ka haʻawina hou i nā ʻeha o ka puka pelvic o ke aʻalolo sciatic, e like me nā ʻōpū, adhesions, pudendal muscle compression, a me ka hoʻoulu ʻana, ʻo ia ke kumu nui o ka ʻeha maloʻo. ʻAʻole pili ʻia nā hiʻohiʻona nui o ka ʻeha maloʻo e nā loiloi kumuhana a ʻike ʻia e ka nele o ka wai.

(1) Nā wahi kaomi: Aia kēia mau mea ma ka puka pelvic, e pili ana i ke kiko lele apo. Loaʻa ka ʻeha radioactive o ka lālā lalo ke hoʻohana ʻia ke kaomi hohonu kūloko, a ʻoi aku ka nui o kona ākea ma mua o ka ʻeha radicular. Ma kahi o 60% o ka ʻaoʻao maʻi e hele pū ʻia me ka rouge point (tibial nerve course) a me ka peroneal point (common peroneal nerve course) kaomi a me ka ʻeha radicular. ʻAʻole ʻike ʻia ke kaomi a me ka ʻeha percussion ma ka ʻāpana lumbar haʻahaʻa.

(2) ʻO ka hoʻāʻo ʻana o ka hoʻololi ʻana o nā lālā haʻahaʻa: He maikaʻi ka hoʻāʻo ʻana no ka hoʻololi ʻana i loko inā ma muli wale nō o ka hoʻopili ʻana i waho. Inā pili pū ka ʻiʻo pudendal, maikaʻi nō ka hoʻololi ʻana o waho.

Hōʻike ʻia nā hōʻailona o ka localization maloʻo e like me ka sensory, motor, a me ka reflex deficits i ke aʻalolo tibial a me ka wahi innervation nerve peroneal. ʻOi aku ka laulā o ke komo ʻana a kaupalena ʻia i nā aʻa aʻalolo spinal i loko o ka laulā o ka lumbar 4 a i ka sacral 2.

(4) ʻAʻole pili i nā maʻi ʻike aʻa i ka ʻāpana kanu āpau. Eia naʻe, e like me Zhao Dinglin a me nā helu helu ʻē aʻe, ʻoi aku ma mua o 90% o nā hihia ʻeha maloʻo e hōʻike ana i ka numbness plantar.

ʻO ka ʻeha Plexus: hiki ke hana ʻia e nā ʻōpū, ʻeha mau, a me nā maʻi adnexal i loko o ke pelvis, hiki ke hoʻopilikia i ka plexus sacral a hopena i nā hōʻailona. ʻO nā aʻalolo maʻamau i hoʻopili ʻia ʻo ia ke kumu aʻalolo sciatic, ʻo ke aʻalolo femoral, a me ke aʻalolo gluteal kiʻekiʻe.

(1) ʻEha o nā kumu he nui: Ma ka hihia hoʻokahi, hiki i ka sciatica, ka ʻūhā, ka ʻeha sacral a me ke kuli. Hiki i kēia mau hōʻailona ke loaʻa i ka manawa like a i ʻole nā ​​​​mea ʻē aʻe, e pili ana i ka paʻakikī o nā ʻeha. He ʻokoʻa paha ka pae o ke komo ʻana ma waena o nā kumu aʻalolo.

(2) Lumbosacral percussion test: ʻO ka ʻokoʻa ma waena o kēia hoʻāʻo a me ka ʻeha radicular ʻo ia ke hoʻohana ʻia ka percussion i ka ʻāpana lumbosacral, ʻaʻole ʻike wale ka mea maʻi i ka ʻeha akā ʻoluʻolu hoʻi. ʻO ka ʻokoʻa, ʻo nā ʻeha e noho ana i ka pelvic space-occupy lesions e hōʻeha pinepine ai.

(3) Nānā Pelvic: He mea maʻamau kaʻeha pelvic i nā maʻi wahine; no laila, pono ka hoʻokolokolo gynecological e haʻalele i nā maʻi gynecological ma mua o ka hana ʻana i kahi maʻi. Eia hou, no ka wehe ʻana i nā maʻi ʻaʻai, ka palpation pelvic a, inā pono, pono e hana ʻia ka anal. Pono e lawe ʻia nā Orthopantomograms a me nā kiʻi ʻoniʻoni o ke pelvis ma hope o ka hoʻomaʻemaʻe enema. Hiki ke hoʻohana ʻia ka barium enema a i ʻole cystography no ka poʻe i manaʻo ʻia he maʻi ʻōpū a i ʻole ka ʻāpana mimi.

(4) Hoʻololi hoʻololi: Hiki ke hoʻonāwaliwali a nalo paha ke kuli a me Achilles tendon reflex i ka manawa like.