外科学教学课件：疼痛治疗(Pain therapy).ppt

脊髓电刺激 调动内源性镇痛物质 抑制交感神经活动、抑制肌肉活动 增强神经机能、活化代谢状态 促进神经可塑性变化 降低脊髓后角兴奋性 什么是脊髓电刺激治疗 是一种硬膜外电刺激 原理主要是依据 Melzak Wall 于1965年提出的 疼痛的门控理论 (Gate Control Theory) 以一种麻刺感或异常感觉覆盖疼痛的区域 小针刀治疗的作用机制 利用小针刀的“刀”的作用，剥离粘连组织，松解肌肉的痉挛，减压疏通滑囊的闭锁，切碎瘢痕硬结，改善、恢复局部的血供，降低局部致痛物质，消除炎症而缓解疼痛。 小针刀的适应证 ·软组织慢性损伤性病变。如腱鞘炎，肌筋膜炎等。 常用的剥离方式有： 1）顺肌纤维、或肌腱分布方向做铲剥，使横向黏连的组织纤维断离、松解。 2）横向或扇形的针刀尖端的摆动动作 3）做斜向或不定向的针刀尖端划摆动作 切记不可幅度过大，以免划伤重要组织。 临床表现 马尾神经症状 腰部症状 神经根损害 与体位有关，尤其在咳嗽、打喷嚏、站立、弯腰及下蹲等动作时易诱发，卧位时可减轻或消失。 骶管囊肿 骶管囊肿MRI表现（左T1、右T2） A.造影后 B.生物蛋白胶注射后 操作要点 1.抽吸脑脊液时应缓缓的抽吸，过快则引起骶部疼痛，以不引起患者疼痛为原则。 2.注射速度过快，容易出现疼痛；过慢，则容易堵塞穿刺针。 手术并发症 1.脑脊液漏:头晕、头痛、恶心、呕吐 2.硬膜囊感染、颅内感染 3.发热 谢 谢！ * The physician inserts the needle using a paramedial approach at an angle of approximately 30°. CSF backflow and fluoroscopy are used to confirm needle location. Needle entry through the skin should be 1 to 1 1/2 vertebral levels below the intralaminar space and lateral to the spinous processes. [Point out the needle-insertion angle, the needle tip, and the catheter on the left picture.] Note the low angle on needle-entry. The needle tip is turned so that the opening is at the 12:00 position (which matches the needle stylet bevel). [Point out the pinch point for catheter damage on the right picture.] Midline needle placement subjects the catheter to damage from normal spinal flexing, and the catheter wall could be pinched between intervertebral tissue and ligaments. * The needle stylet is removed, then the catheter is threaded through the needle, advanced into the intrathecal space, and placed in the appropriate spinal location corresponding to the patients pain pattern. The physician may encounter resistance during catheter insertion when the tip of the catheter is advanced to the curved portion of the needle. The catheter guide wire should be completely seated, with the hub against the proximal end on the catheter. Retracting the catheter through the needle may damage or sheer off the catheter tip. Catheter position should be verified u