臂丛神经炎课件.ppt

MRI NCS +/- EMG Chest X Ray CT Generally favourable 总体良好 Soft disc herniation 软椎间盘突出症 spontaneous resolution, most within 3 months. 多数在3月内自发分解。 Hard disc combined with soft disc herniation 结合软椎间盘突出的硬椎间盘 less favourable resolution 极少自发分解 Conservative 保守治疗 Simple analgesics, NSAIDs, Gabapentin Amitriptyline, avoid prolonged narcotics 简单的止痛药，非甾体抗炎药，加巴喷丁阿米替林 ，避免长效麻醉品 Reassure and sit tight!重拾信心和坐稳 Watch for development of progressive motor deficit and myelopathy 注意运动系统方面的进展和脊髓病 Anterior: Anterior cervical discectomy and fusion 颈前椎间盘切除和融合 Anterior cervical discectomy and total disc replacement 颈前椎间盘切除和全椎间盘置换 Posterior: Posterior keyhole foramenotomy 后锁孔扩张 Mainly for laterally placed disc herniation or osteophytes 主要表现为侧部的椎间盘突出或骨赘 Root compression at C7/T1 C7/T1神经根受压 Multiple level root entrapment 多处神经根卡压 Radiculopathy 神经根型 Brachial Neuritis 臂丛神经炎 Cspine precipitation 颈椎渗液 Radicular pain distribution 神经根型疼痛 Sensory motor deficit 感觉障碍＞运动障碍 Dermatomal sensory loss Cspine ROM restricted 颈椎ROM限制 MRI findings MRi的表现 Pain reduces 6-12/52 疼痛减少 6-12/52 No precipitating factors 没有触发因素 Non-radicular distribution 非根性分布 Motor sensory deficit 感觉障碍＜运动障碍 Patchy sensory loss 区域感觉缺失 Cspine ROM Normal 颈椎ROM正常 MRI normal MRI正常 Pain reduces approx 4/52 疼痛减少约4/52 Thoracic Outlet Syndrome 胸腔出口综合征 Radiculopathy 神经根型 Chronic pain 慢性疼痛 Moderate, variable severity 适中的，变化性大 Roo’s sign positive Roo’s症阳性 Aggravated over-head 恶化严重 Cspine clear / non-provocative 颈段清晰/非激发性 Usually C8-T1 通常为C8-T1 Often clavicular pectoral pain 通常锁骨和胸肌疼痛 Acute pain 急性疼痛 Severe, constant 严重的，恒定的 Roo’s sign negative Roo’s 征阴性 Relieved over-head Cspine restricted / provocative 颈段限制/激发性 Usually C5-7 通常为C5-7 Rarely clavicular pectoral pain 很少锁骨和胸肌疼痛 Posterior interrosseous nerve motor innervation * 8+/10 in normally healthy person, go to AE so severe eases after 2+ weeks Paresis follows Normal radiological investigations Can be precipitated by innoculation (holiday/flu jab) or infection Dutch Study 246