腰肌勞損 外科護(hù)理學(xué)

慢性軟組織損傷之腰肌勞損strain

of

the

lumbar

muscle主講人：夏婼?概念又稱功能性腰痛、腰背肌筋膜炎主要指腰背部肌肉、筋膜、韌帶等軟組織的慢性、疲勞性損傷，導(dǎo)致局部無菌性炎癥，引起腰背部一側(cè)或兩側(cè)的彌漫性疼痛的一種病癥。為腰痛常見的原因?病因長期過度負(fù)重脊柱結(jié)構(gòu)失穩(wěn)長期彎腰工作其他病理生理肌肉、筋膜及韌帶持續(xù)受到牽拉時，肌肉

內(nèi)的壓力增加，血供受阻，肌纖維在收縮

時消耗的能源得不到補充，產(chǎn)生大量乳酸，加之代謝產(chǎn)物不能得到及時清除，積聚過

多而引起炎癥、粘連，如此反復(fù)可導(dǎo)致組

織變性、增厚及痙攣，并刺激相應(yīng)的神經(jīng)

引起慢性腰痛臨床表現(xiàn)癥狀無明顯誘因的慢性腰部或腰骶部疼痛，反復(fù)發(fā)作，疼痛隨氣候變化或勞累程度而變化，時輕時重，遷延不愈呈鈍性脹痛或酸痛不適，休息、適當(dāng)活動或經(jīng)常改變體位姿勢可使癥狀減輕。腰部喜熱怕冷，局部皮膚感覺遲鈍或粗糙感。腰部活動：有時在活動時有牽掣不適感。不耐久坐久站，不能勝任彎腰工作，彎腰稍久，便直腰困難急性發(fā)作時，可有明顯的肌痙攣，甚至出現(xiàn)腰脊柱側(cè)彎，下肢牽擎作痛等癥狀。體征壓痛：腰背部固定壓痛點，多在骶髂關(guān)節(jié)背面、骶骨背面和腰椎橫突等處。輕者壓痛多不明顯。常被迫伸腰雙手捶擊或叉腰等動作，以減輕疼痛，這是與深部骨骼疾患的區(qū)別之一放射痛：不同壓痛點產(chǎn)生不同部位放射痛，臨床常據(jù)此對腰部損傷與椎間盤突出癥進(jìn)行鑒別診斷骶棘肌痙攣征：為腰部勞損所致，有單側(cè)或雙側(cè)骶棘肌痙攣征，肌收縮隆起，由于患側(cè)腰肌收縮，骨盆傾斜，腰部顯得板硬，起臥床較費力輔助檢查X線檢查多無異常，少數(shù)可有骨質(zhì)增生或脊柱畸形；年老或骨質(zhì)疏松病人，可選擇ECT檢查或骨密度檢查nursing

diagnosisPain

related

to

tissue

chronic

in

The

lack

of

knowledge

related

tolack

of

functional

exercise

anddisease

prevention

Anxiety

related

to

recurrentepisodes

of

diseaseprinciple

of

managementTo

eliminate

the

cause:

Improve

your

position,

posture,

and

avobending

over

long

Use

the

waistline,

take

it

off

when

reslest

the

secondary

apraxia

of

muscleatrophy

Always

move

the

waist

and

avoidprolonged

periods

in

the

same

positionAvoid

damp,

coldSleep

hard

bed

Make

the

waist

posture

compatiblewith

biomechanics

When

the

disease

is

heavier,

bed

restis

appropriate

and

the

bed

position

isoften

changedComprehensive

treatment:Physical

therapy:

waxing,

electrotherapMedical

massage,

acupuncture

cuppingDrug

therapy:

The

pain

point

is

feasible

for

adrenalcorticosteroid

injection.

When

the

pain

in

the

waist

is

obvious,you

can

take

NSAID

to

relieve

musclepain,

but

not

long-termFunctional

exercise

Quadriceps

muscle

contractionpractice:

5-10

minutes

each

time,

3-4times

a

day

Back

muscle

practice:

The

flyingswallow

is

supported

by

five-point,,

1-weeks

and

then

the

3-point

supportmethod,

3-4

times

a

day,

50

times

eachtimeNursing

measuresRelieves

pain:

Create

a

quiet,

comfortable

hospitalenvironment,

distract

the

attention

ofpatient

and

guide

it.

When

the

pain

is

apparent,

you

can

takeNSAID

to

relieve

muscle

pain.Psychological

careHealth

guide:

Explain

the

etiology,

pathology,treatment

and

prevention

of

diseases,rehabilitation

training

methods

andprecautionsThe

waistline

method

an