2022年医学专题—外伤科主治医师要领(1).pptVIP免费

SpinalandspinalcordSpinalandspinalcord外傷科主治外傷科主治(zhǔzhì)(zhǔzhì)醫師醫師HsinglinHsinglin第一页，共二十八页。第一页，共二十八页。LowbackpainandradiculopathyImagingstudiesandfurthertestingnothelpfulthefirst4weeksReliefofdiscomfortwithmedsandspinalmanipulationBedrestbeyond4daysmaybemoreharmful89-90%lowbackpainimprovewithin1month第二页，共二十八页。第二页，共二十八页。80%sciaticaeventuallyrecover1%havenerve-rootsymptoms1-3%havelumberdischerniation85%nospecificdiagnosismade第三页，共二十八页。第三页，共二十八页。definitions/classificationsRadiculopathy:dysfunctionofnerveroot(pain,sensorydisturbances,weakness)Mechanicallowbackpain:strainofparaspinalmuscles,ligament,irritationoffacetjoints第四页，共二十八页。第四页，共二十八页。InitialassessmentofpatientHistory:age,weightloss,cancerorinfection,usedofdrug,duringofS/S,trauma,caudaequinasyndrome,workstatusPE:fever,vertebraltenderness,limitedrangeofspinalcordDorsiflexationofankleandbigtoe–L5,4Achillesreflex–S1LighttouchSLRtext第五页，共二十八页。第五页，共二十八页。FurtherevaluationofpatientsEMG:neuropathy,myopathy,myelopathy,unreliable<3-4weeksSEPs(somatosensoryevokedpotential):spinalstenosis,orspinalmyelopathyNCVs(nerveconductionvelocity):entrapmentneuropathiesthatmimicradiculopathy第六页，共二十八页。第六页，共二十八页。LSX-rayrecommendationage>70yrs,or<20yrssystemicallyillpatientstemp.38°CHistoryofmaligancyRecentinfectionCaudaequinasyndromeHeavyalcoholordrugabusersDM第七页，共二十八页。第七页，共二十八页。Immunosupressedpatients(steroid)RecenttraumaRecenturinarytractorspinalsurgeryUnrelentingpainatrestPersistentpainmorethan4weeksUnexplainedweightloss第八页，共二十八页。第八页，共二十八页。TreatmentConservativetreatment:1.activitymodification:˼Bedrest:nomorethan4days˼Activitymodification:heavylifting,totalbodyvibration,asymmetricpostures,sustainedforlongperiods˼Exercise:walking,bicycling,orswimming第九页，共二十八页。第九页，共二十八页...