第三讲神经意阻滞疗法.pptVIP

腰背痛 腰背痛的原因 椎间盘源性 纤维环破裂 髓核压迫纤维环内的c纤维 炎性因子刺激神经 临床特点 腰背痛的原因 小关节源性 小关节功能紊乱 小关节退行性变 小关节的神经支配 脊神经背支内侧支 临床表现 小关节源性腰背疼痛的疼痛分布范围 腰背痛的神经阻滞疗法 ESI 椎间盘源性腰背痛 腰椎小关节注射、内侧支阻滞 腰椎小关节注射、内侧支阻滞 骶髂关节综合症 背痛 臀部大腿部疼痛 偶尔有类似坐骨神经痛现象 不能长时间保持某一坐姿 症状复杂，诊断困难 骶髂关节体格检查 Gaenslens test is performed with the patient supine (on the back). The hip joint is maximally flexed on one side and the opposite hip joint is extended. This maneuver stresses both sacroiliac joints simultaneously. 骶髂关节体格检查 Yeomans test stresses the sacroiliac joint by extending the leg and rotating the ilium. A positive test produces pain over the back of the sacroiliac joint. 骶髂关节体格检查 Patricks test stresses the hip and sacroiliac joints. A positive test produces back, buttocks, or groin pain. 骶髂关节阻滞 腰腿痛的神经阻滞治疗 椎间盘突出 脊神经根受刺激 腰神经根受压的疼痛分布 腰腿痛的神经阻滞治疗 ESI 椎旁神经阻滞 选择性神经根阻滞selective nerve root block S1block 椎管狭窄、椎间孔狭窄 椎体滑脱 梨状肌综合症 神经损毁 目的 外周神经损毁 物理损毁 射频 化学损毁 无水酒精、酚 * * * * * * * * The lateral branches supply the Sacrospinalis. The upper three give off cutaneous nerves which pierce the aponeurosis of the Latissimus dorsi at the lateral border of the Sacrospinalis and descend across the posterior part of the iliac crest to the skin of the buttock (Fig. 801), some of their twigs running as far as the level of the greater trochanter Introduction In the first part of the 20th century, sacroiliac joint (SI joint) syndrome was the most common diagnosis for low back pain, or lumbago. Before 1932, SI joint syndrome was a particularly popular diagnosis. It was actually called the Era of SI Joint because so many physicians felt that the SI joint was the cause of most back problems. Any pain in the low back, buttock or adjacent leg was usually referred to as SI joint syndrome. In 1932, the discovery of the herniated (or ruptured) disc led many physicians to assume that most pain in the back was the result of this new problem. Thus was born the Dynasty of the Disc, and the SI joint was