Ua li cas koj thiaj paub qhov mob radicular, qhuav thiab pawg?

Lumbosacral paj hauv paus los ntawm tus txha caj qaum mus rau hauv lub sacral plexus, thiab kev sau ntawm lub paj hlwb sciatic, yog li thaum ib qho ntawm peb koom nrog, nws tuaj yeem ua rau qee cov tsos mob thiab cov tsos mob zoo sib xws. Feem ntau manifested nyob rau hauv lub duav thiab ceg mob, loog loog, txav thiab reflex dysfunction thiab ib tug zoo ncaj ceg tsa ceg, thiab lwm yam., ib co ntawm cov nta yog feem ntau nyuaj rau beginners paub, ua rau misdiagnosis. Qhov tseeb, qhov chaw pathoanatomical thiab cov yam ntxwv ntawm peb qhov txhab tsis zoo ib yam. Nrog rau qhov tsis tshua muaj tshwm sim uas muaj ob lossis peb qhov tshwm sim ib txhij, cov yam ntxwv no feem ntau yog cov lus thiab sib txawv.

Qhov mob radicular feem ntau yog txuam nrog lumbar disc herniation, lumbar spinal stenosis (xws li lateral fossa stenosis), thiab lumbar spinal hlav.

(1) Paravertebral mob: Cov yam ntxwv tseem ceeb ntawm qhov mob radicular yog qhov mob paravertebral thiab hluav taws xob mus rau hauv cov ceg qis vim muaj kev koom tes ib txhij ntawm dorsal thiab lateral ceg ntawm tus txha caj qaum cov hauv paus hniav ntawm ntu cuam tshuam. Qhov mob qhuav thiab mob pawg tsis feem ntau tshwm sim nrog mob radicular.

(2) Kev txwv ntawm lumbar spine txav: Lumbar spinal stenosis feem ntau txwv rov qab txuas ntxiv, thaum lub lumbar disc teeb meem yuav txwv lub lumbar rov qab txuas ntxiv, rau pem hauv ntej flexion, thiab cuam tshuam sab flexion. Intradural qog kuj tseem tuaj yeem ua rau ntau qib ntawm lumbar txha caj qaum txav txwv ntawm ntau theem ntawm tus kab mob. Txawm li cas los xij, qhov mob qhuav thiab mob plexiform tsis pom qhov no.

(3) Cervical flexion test: Zhao Dinglin li al. tau ua qhov kev ntsuam xyuas lub ncauj tsev menyuam rau ntawm 200 tus neeg mob uas muaj mob radicular, thiab tus nqi zoo yog tshaj 95%. Qhov no yog vim lub ncauj tsev menyuam nqaj qaum yog nyob rau hauv lub xeev ntawm pem hauv ntej flexion, uas ua rau kom nruj thiab siab ntawm cov hlab ntsha cuam tshuam los ntawm lub dural sac thiab cag cuff, exacerbating qhov mob. Txoj kev tshawb nrhiav pom tsis muaj pov thawj ntawm qhov mob qhuav lossis mob plexiform.

(4) Cov tsos mob ntawm tus txha caj qaum hauv paus hauv paus cheeb tsam: Qhov kev xav, txav mus los, thiab kev cuam tshuam ntawm tus txha caj qaum cov hauv paus hniav muaj cov yam ntxwv meej hauv zos nyob ntawm tus txha caj qaum ganglia. Piv txwv li, lub dorsal ntawm daim tawv nqaij ntawm thawj thiab thib ob ntiv taw ntawm ko taw yog tsuas yog innervated los ntawm lub lumbar hlab ntsha hauv paus, thaum lub lateral ntug ntawm ko taw thiab tus ntiv taw me ntsis yog innervated los ntawm sacral 1 paj paj. Radicular mob, tsis hnov ​​​​tsw, thiab reflexes koom nrog ntau dua li qhov mob qhuav thiab mob pawg.

Yav dhau los, kev kuaj mob ntawm qhov mob qhuav feem ntau hu ua 'sciatica' lossis 'sciatic neuritis'. Txawm li cas los xij, cov nyiaj pab kev kawm tsis ntev los no qhia tau tias cov kab mob ntawm lub plab hauv plab ntawm lub paj hlwb sciatic, xws li qog, adhesions, pudendal leeg compression, thiab inflammatory stimulation, yog thawj qhov ua rau mob qhuav. Cov yam ntxwv tseem ceeb ntawm qhov mob qhuav tsis cuam tshuam los ntawm kev ntsuas cov ntsiab lus thiab yog tus cwj pwm los ntawm qhov tsis muaj dej noo.

(1) Cov ntsiab lus siab: Cov no feem ntau yog nyob rau hauv lub qhov hluav taws xob pelvic, tshwj xeeb nyob ib ncig ntawm lub nplhaib dhia taw tes. Radioactive qis ceg mob tshwm sim thaum lub zos sib sib zog nqus siab yog siv, thiab nws qhov ntau yog pom tseeb loj dua qhov mob radicular. Kwv yees li 60% ntawm cov kab mob sab nraud yog nrog los ntawm rouge point (tibial paj hlwb) thiab peroneal point (feem ntau peroneal paj hlwb) siab thiab mob radicular. Tsis muaj qhov pom tseeb siab thiab mob percussion nyob rau hauv qis dua lumbar cheeb tsam.

(2) Kev ntsuas qis qis qis: Kev ntsuas rau kev sib hloov sab hauv yog qhov zoo yog tias nws tsuas yog tshwm sim los ntawm qhov hluav taws xob adhesion. Yog tias cov leeg pudendal tseem koom nrog, kev sib hloov sab nraud kuj zoo.

Cov tsos mob ntawm qhuav localization yog manifested li sensory, lub cev muaj zog, thiab reflex deficits nyob rau hauv tibial paj hlwb thiab peroneal paj innervation cheeb tsam. Qhov ntau ntawm kev koom tes yog dav dua thiab txwv rau cov paj hlwb txha caj qaum hauv thaj tsam ntawm lumbar 4 txog sacral 2.

(4) Plantar loog loog: Cov hauv paus kev hnov ​​​​mob feem ntau tsis cuam tshuam rau tag nrho thaj chaw cog. Txawm li cas los xij, raws li Zhao Dinglin thiab lwm yam kev txheeb cais, ntau dua 90% ntawm cov mob qhuav pom muaj mob loog.

Plexus mob : tuaj yeem tshwm sim los ntawm cov qog, mob ntev, thiab cov kab mob adnexal hauv lub plab, uas tuaj yeem cuam tshuam rau sacral plexus thiab ua rau cov tsos mob. Cov paj hlwb feem ntau cuam tshuam yog cov paj hlwb sciatic, lub paj hlwb femoral, thiab cov paj hlwb zoo tshaj gluteal.

(1) Kev mob ntau yam: Hauv tib qhov xwm txheej, sciatica, ncej puab, sacral thiab hauv caug mob tuaj yeem tshwm sim. Cov tsos mob no tuaj yeem tshwm sim ib txhij lossis hloov pauv, nyob ntawm qhov mob hnyav. Tej zaum yuav muaj qhov sib txawv ntawm qhov kev koom tes ntawm ntau lub paj hlwb.

(2) Lumbosacral percussion test: Qhov txawv ntawm qhov kev sim no thiab qhov mob radicular yog tias thaum percussion raug siv rau thaj tsam lumbosacral, tus neeg mob tsis tsuas yog tsis muaj qhov mob tab sis kuj xis nyob. Nyob rau hauv sib piv, pelvic chaw-nyob qhov txhab ua rau mob, feem ntau hnyav.

(3) Pelvic kuaj mob: mob plab feem ntau tshwm sim hauv cov poj niam cov neeg mob; Yog li ntawd, kev kuaj gynecological yog qhov tsim nyog los tshem tawm cov kab mob gynecological ua ntej kev kuaj mob. Tsis tas li ntawd, txhawm rau tshem tawm cov qog, pelvic palpation thiab, yog tias tsim nyog, yuav tsum tau kuaj qhov quav. Orthopantomograms thiab oblique films ntawm lub plab mog yuav tsum tau noj tom qab ib tug cleansing enema. Barium enema los yog cystography tuaj yeem siv rau cov neeg uas xav tias muaj cov kab mob hauv plab hnyuv los yog zis.

(4) Reflex hloov: Lub hauv caug reflex thiab Achilles tendon reflex tej zaum yuav tsis muaj zog lossis ploj mus ib txhij.