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1、脊柱与四肢骨关节慢性病损手法治疗前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后影像学检查病例(bngl)(bngl)分析分析the case analysis of the imageological examination before and after massage the case analysis of the imageological examination before and after massage treatments which are the chronic diseases of the spine and limbs of the treatments
2、 which are the chronic diseases of the spine and limbs of the osteoarticular osteoarticular 广西中医药大学附属广西中医药大学附属广西中医药大学附属广西中医药大学附属(fsh(fsh)瑞康医院瑞康医院瑞康医院瑞康医院 韦贵康韦贵康韦贵康韦贵康RuiKang RuiKang HHospital ospital Affiliated to Guangxi University of Affiliated to Guangxi University of Chinese Medicine Wei Gui kan
3、gChinese Medicine Wei Gui kang第一页，共四十三页。n n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，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，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，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（合理使用影像学（合理使用影像学（合理使用影像学（XX线、线、线、线、CTCT、MRIMRI）检查，作为检查常规）检查，作为检查常规）检查，作为检查常规）检查，作为检查常规(chnggu)(chnggu)，对提高诊断准确率及提高疗效很有帮助。现将一些，对提高诊断准确率及提高疗效很有帮
4、助。现将一些，对提高诊断准确率及提高疗效很有帮助。现将一些，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：典型的病例分折如下：典型的病例分折如下：典型的病例分折如下：n nWhile we are researching the treatment to the While we are researching the treatment to the chronic chronic diseases of the spine and limbs of the diseases of the spine and limbs of the osteoarticularosteo
5、articular,its helpful for us to use,its helpful for us to use imageological examinationimageological examination(X-(X-rays,CT,MRI)reasonablyrays,CT,MRI)reasonably to increase the accuracy to increase the accuracy rate of diagnosis and therapy.Now we share some rate of diagnosis and therapy.Now we sh
6、are some typical examples for you:typical examples for you:第二页，共四十三页。微屈前推法、园筒整复法治疗微屈前推法、园筒整复法治疗(zhlio)(zhlio)颈曲变直病例颈曲变直病例第三页，共四十三页。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(ji(ji nch)nch)颈曲有改善。Example 1:Mr.Wu,male,31years old,he had Example 1:Mr.Wu,male,31years old,he had already fel
7、t the neck stiff and pain and dizziness already felt the neck stiff and pain and dizziness for half a year.X-rays reported:the curve of the for half a year.X-rays reported:the curve of the neck became straightened.He accepted the neck became straightened.He accepted the massage once in two days.Afte
8、r 5 times,he felt massage once in two days.After 5 times,he felt better and the symptom disappeared.X-rays better and the symptom disappeared.X-rays reported that the curve of the neck became reported that the curve of the neck became better.better.第四页，共四十三页。颈曲变直手法治疗颈曲变直手法治疗(zhlio)(zhlio)后改善后改善A Aft
9、er the massage,the curve of the neck became betterfter the massage,the curve of the neck became better治疗(zhlio)前before the treatment治疗(zhlio)后after the treatment第五页，共四十三页。n n例例2 2、李、李x x，女，女3333岁，颈痛伴上肢麻痛岁，颈痛伴上肢麻痛3 3个月，个月，x x线片线片提示提示(tsh)(tsh)：颈曲变直。手法治疗：颈曲变直。手法治疗2 2天天1 1次，次，4 4次后颈痛次后颈痛伴上肢麻痛消失，伴上肢麻痛消失
10、，x x线片检查颈曲有改善。线片检查颈曲有改善。Example 2:Mrs.Li,female,33years old,she had already felt Example 2:Mrs.Li,female,33years old,she had already felt the neck pain and upper limbs numb for 3 months.X-the neck pain and upper limbs numb for 3 months.X-rays reported:the curve of the neck became rays reported:the c
11、urve of the neck became straightened.She accepted the massage once in two straightened.She accepted the massage once in two days.After 4 times,she felt better and the symptom days.After 4 times,she felt better and the symptom disappeared.X-rays reported that the curve of the neck disappeared.X-rays
12、reported that the curve of the neck became better.became better.第六页，共四十三页。治疗(zhlio)前before the treatment治疗(zhlio)后after the treatment第七页，共四十三页。n n按语：按语：n n1 1、4040岁以前颈椎疾病伴有颈曲变直，通过手法、练岁以前颈椎疾病伴有颈曲变直，通过手法、练功功(lin gng)(lin gng)等方法，颈曲有不同程庋恢复，有利了临床等方法，颈曲有不同程庋恢复，有利了临床症的消除或缓解。症的消除或缓解。n nNote:n n1、If you hav
13、e some diseases about cervical vertebra with the curve of the neck straightened before 40 years old,we can use massage、practice and so on to recover the curve of the neck.Through this way,the symptoms can be eliminated or relieved.第八页，共四十三页。n n2、中年老年人，不强求颈曲恢复(huf)(huf)，应进行综后分析，对因治疗。n n2、The middle a
14、nd the old dont need to recover the curve of the neck,they should analyze synthetically and then choose the right way for treatment.第九页，共四十三页。俯卧均衡牵引架俯卧均衡牵引架自制专利产品自制专利产品加手法治疗：症状伴有腰曲变加手法治疗：症状伴有腰曲变直、或脊柱侧弯畸形、或骨盆直、或脊柱侧弯畸形、或骨盆(g(g pn)pn)两侧不等高随着症状消除两侧不等高随着症状消除或改善，复查或改善，复查x x线片原异常者得到相应改善。线片原异常者得到相应改善。P Pros
15、trate balanced traction framerostrate balanced traction frame(homemade patent product)(homemade patent product)with massage can be used:The curve of lumbar become with massage can be used:The curve of lumbar become straightenedstraightened、the lateral bending of spine become the lateral bending of s
16、pine become abnormal or the both sides of pelvis become abnormal or the both sides of pelvis become different.While those symptoms were eliminated or different.While those symptoms were eliminated or relieved,they took X-rays and it reported that the patients relieved,they took X-rays and it reporte
17、d that the patients became better than before.became better than before.第十页，共四十三页。第十一页，共四十三页。提法(t f)(t f)第十二页，共四十三页。左右(zuyu)(zuyu)摆法第十三页，共四十三页。腰曲治疗(zhlio)前The curve of lumbar before the treatmentThe curve of lumbar before the treatment腰曲治疗(zhlio)后The curve of lumbar after the treatmentThe curve of l
18、umbar after the treatment第十四页，共四十三页。治疗(zhlio)(zhlio)前后 before and after the treatment第十五页，共四十三页。动态(dngti)(dngti)推拉法第十六页，共四十三页。摆动(bidng)(bidng)整复法第十七页，共四十三页。侧弯治疗(zhlio)前the lateral bending the lateral bending before the treatmentbefore the treatment侧弯治疗(zhlio)后the lateral bending the lateral bending
19、after the treatmentafter the treatment第十八页，共四十三页。第十九页，共四十三页。闭孔小治疗(zhlio)前obturator formamen before before the treatmentthe treatment 闭孔小治疗(zhlio)后obturator formamen after the after the treatmenttreatment 第二十页，共四十三页。手法治疗髋关节半脱位(tu wi)(tu wi)：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。The massage treats coxa
20、e subluxation:Follow the direction to pull、reverse the direction to restoration.If the legs external rotation become long,we should adopt abduction and external rotation、flexion adduction and internal rotation and to straighten it.第二十一页，共四十三页。髋半脱治疗(zhlio)前coxae subluxation before the treatmentcoxae
21、subluxation before the treatment 第二十二页，共四十三页。半脱治疗(zhlio)后coxae subluxation after the treatmentcoxae subluxation after the treatment 第二十三页，共四十三页。髌骨髌骨髌骨髌骨(bng(bng)上移或下移测量法：髌股角测量上移或下移测量法：髌股角测量上移或下移测量法：髌股角测量上移或下移测量法：髌股角测量 法，正常值法，正常值法，正常值法，正常值100100110110，小于，小于，小于，小于100100为为为为 髌骨髌骨髌骨髌骨(bng(bng)下移，大于下移，大于
22、下移，大于下移，大于110 110 为髌骨为髌骨为髌骨为髌骨(bng(bng)上移。上移。上移。上移。髌骨下移手法一一收紧法髌骨下移手法一一收紧法髌骨下移手法一一收紧法髌骨下移手法一一收紧法 髌骨上移手法一一放松法髌骨上移手法一一放松法髌骨上移手法一一放松法髌骨上移手法一一放松法The way to measure The way to measure patellapatella to move up or down:The methods of to move up or down:The methods of patellofemoral angle,the normal range i
23、s 100110patellofemoral angle,the normal range is 100110.Below 100.Below 100 is is as as patellapatella to move down,above 110 to move down,above 110 is as is as patellapatella to move to move up.up.The massage to treat The massage to treat patellapatella to move down is called to move down is called
24、 一一一一一一一一Tightening Method Tightening Method The massage to treat patella to move up is called The massage to treat patella to move up is called 一一一一一一一一Relaxation MethodRelaxation Method第二十四页，共四十三页。正常(zhngchng)髌股角the normal patellofemoral anglethe normal patellofemoral angle第二十五页，共四十三页。髌骨(bng)上移pat
25、ellapatella to move up to move up第二十六页，共四十三页。髌骨(bng)正常与下移the normal the normal patellapatella and and patellapatella to move down to move down第二十七页，共四十三页。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。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(jinch)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
26、完全康复。1年观察，完全康复。Previously,the patient accepted the wrong diagnosis、wrong massage and acupuncture with no effect.After the surgery we used massage and heating with Chinese herbal medicine as treatment.Finally the patient was cured.Miss Zhang,female,12years old,she had already felt the neck pain for 3
27、 Miss Zhang,female,12years old,she had already felt the neck pain for 3 months.And the massage and months.And the massage and acupuncture didnt make effect for her.MRI MRI reported that it was spinal meningioma.Then she accepted the surgery.reported that it was spinal meningioma.Then she accepted th
28、e surgery.After the surgery she walked out of balance and her hands felt swollen.So After the surgery she walked out of balance and her hands felt swollen.So we used massage and heating with Chinese herbal medicine as treatment.After half a year she was cured.And we observed her a year,she was total
29、ly cured.第二十八页，共四十三页。手术(shush)前before the surgery第二十九页，共四十三页。正位(zhn wi)hemangioma横切transection第三十页，共四十三页。术后即照，行走(xngzu)稍失稳，两手有些账the picture was right after the surgery,she walked out of balance and she walked out of balance and her hands felt swollenher hands felt swollen 第三十一页，共四十三页。术后横切after the s
30、urgery transection术后手法加中药(zhngyo)外烫，半年后MRI复查after the surgery,she used massage and heating with Chinese herbal medicine as treatment.After half a year she took MRI.第三十二页，共四十三页。手法(shuf)后横切after the massage transection手术后3年，各症全消除(xioch)，能正常参加学校体育活动，复查X线片After the surgery 3 years,all the symptoms were
31、disappeared.She could take part in activities.This was the picture of X-rays第三十三页，共四十三页。n n误诊误诊(w zhn)(w zhn)误用手法病例：误用手法病例：n n例例1 1、陈某，女，、陈某，女，6565岁，背痛岁，背痛2 2年，曾按一般背痛治年，曾按一般背痛治疗无效，后疗无效，后MRIMRI捡查为胸捡查为胸9 9椎体血管瘤手术治疗而愈。椎体血管瘤手术治疗而愈。n nThe example of The example of the wrong diagnosis and wrong massage:nE
32、xample 1、Mrs.Chen,female,65 years old,back pain 2 years.She had already accepted some treatments but had no effect.MRI reported that it was the 9th thoracic vertebra hemangioma.After the surgery she was cured.第三十四页，共四十三页。胸椎(xingzhu)体血管癅thoracic vertebra hemangioma第三十五页，共四十三页。椎体(zhu t)血管瘤centrum hema
33、ngioma第三十六页，共四十三页。例例2 2、陈某，女，、陈某，女，3535岁，腰痛岁，腰痛2 2年半，曾按腰椎间突出年半，曾按腰椎间突出症采用手法、针灸、理疗症采用手法、针灸、理疗(l(l lio)lio)等治疗无效，后等治疗无效，后MRIMRI捡捡查为腰椎管脊膜瘤手术治疗而愈。查为腰椎管脊膜瘤手术治疗而愈。nExample 2、Mrs.Chen,female,35 years old,loin pain two and a half years.She had already accepted massage、acupuncture、physiotherapy and so on for
34、 prolapse of the lumbar intervertebral disci.But had no effect.MRI reported that it was lumbar spinal meningioma.After the surgery she was cured.第三十七页，共四十三页。脊膜瘤spinal meningioma第三十八页，共四十三页。讨论讨论(toln)(toln)1、脊柱与四肢骨关节病损的诊治，要重视并、脊柱与四肢骨关节病损的诊治，要重视并合理选用影象学（合理选用影象学（X线、线、cT、MRI）检查，）检查，这对诊断、鉴别诊断与治疗这对诊断、鉴别诊断
35、与治疗(zhlio)(zhlio)方法的选方法的选用有重要意义。用有重要意义。Discuss Discuss1、The treatments for spine and limbs of limbs of the osteoarticularthe osteoarticular should value and choose should value and choose imageological examinationimageological examination(X-(X-rays,CT,MRI)reasonably.Its significant rays,CT,MRI)reaso
36、nably.Its significant for us to diagnosefor us to diagnose、differential diagnosis differential diagnosis and choose therapeutic methods.and choose therapeutic methods.第三十九页，共四十三页。2、脊柱与四肢骨关节病损手法治疗，要重视、脊柱与四肢骨关节病损手法治疗，要重视结构改变，采用一些结构改变，采用一些(yxi)(yxi)针对性手法，收到针对性手法，收到良好效果。但结构异常存在易留隐患，病良好效果。但结构异常存在易留隐患，病情容
37、易复发。情容易复发。2 2、When we take massage for spine and When we take massage for spine and limbs of the osteoarticular,we should value the change of the structure and use some targeted approaches.It will get better results.But the abnormal structure will exist hidden danger and the illness easily reappears
38、.第四十页，共四十三页。3、脊柱与四肢骨关节病损的非手术与手术、脊柱与四肢骨关节病损的非手术与手术治疗各有优势，应严格治疗各有优势，应严格(yng)(yng)掌握各自适应掌握各自适应症与禁忌症，治疗效果要重视功能与体能症与禁忌症，治疗效果要重视功能与体能恢复。恢复。3、The treatments of non-surgery and surgery for spine and limbs of the osteoarticular both have the advantages.We should follow their adaptation and contraindication s
39、trictly.And we should value the recovery of function and physical ability for the effect of the treatments.第四十一页，共四十三页。谢谢谢谢(xi xie)(xi xie)！谢谢！谢谢！Thank you!第四十二页，共四十三页。内容(nirng)总结脊柱与四肢骨关节慢性病损手法治疗前后(qinhu)影像学检查病例分析the case analysis of the imageological examination before and after massage treatments which are the chronic diseases of the spine and limbs of the osteoarticular。Thank you第四十三页，共四十三页。