1、大家好大家好1慢性软组织损伤之 腰肌劳损腰肌劳损 strain of the lumbar muscles主讲人：夏婼 2概念概念 又称功能性腰痛、腰背肌筋膜炎 主要指腰背部肌肉、筋膜、韧带等软组主要指腰背部肌肉、筋膜、韧带等软组织的织的慢性慢性、疲劳性、疲劳性损伤损伤，导致局部无菌，导致局部无菌性性炎症炎症，引起腰背部一侧或两侧的弥漫，引起腰背部一侧或两侧的弥漫性疼痛的一种病症。性疼痛的一种病症。为腰痛常见的原因3病因病因长期过度负重长期过度负重脊柱结构失稳脊柱结构失稳长期弯腰工作长期弯腰工作其他其他45 病理生理病理生理肌肉、筋膜及韧带持续受到牵拉时，肌肉内的压力增加，血供受阻，肌纤维在收
2、缩时消耗的能源得不到补充，产生大量乳酸，加之代谢产物不能得到及时清除，积聚过多而引起炎症、粘连，如此反复可导致组织变性、增厚及痉挛，并刺激相应的神经引起慢性腰痛 6 临床表现临床表现症状症状无明显诱因的慢性腰部或腰骶部疼痛，反复发作，疼痛随气候变化或劳累程度而变化，时轻时重，迁延不愈呈钝性胀痛或酸痛不适，休息、适当活动或经常改变体位姿势可使症状减轻。腰部喜热怕冷，局部皮肤感觉迟钝或粗糙感。腰部活动：有时在活动时有牵掣不适感。不耐久坐久站，不能胜任弯腰工作，弯腰稍久，便直腰困难急性发作时，可有明显的肌痉挛，甚至出现腰脊柱侧弯，下肢牵擎作痛等症状。7体征体征l 压痛压痛：腰背部固定压痛点，多在骶髂
3、关节背面、骶骨背面和腰椎横突等处。轻者压痛多不明显。常被迫伸腰双手捶击或叉腰等动作，以减轻疼痛，这是与深部骨骼疾患的区别之一 l 放射痛放射痛：不同压痛点产生不同部位放射痛，临床常据此对腰部损伤与椎间盘突出症进行鉴别诊断 l骶棘肌痉挛征骶棘肌痉挛征：为腰部劳损所致，有单侧或双侧骶棘肌痉挛征，肌收缩隆起，由于患侧腰肌收缩，骨盆倾斜，腰部显得板硬，起卧床较费力8 辅助检查辅助检查X线检查多无异常，少数可有骨质增生或脊柱畸形；年老或骨质疏松病人，可选择ECT检查或骨密度检查9nursing diagnosis Pain related to tissue chronic injury The lac
4、k of knowledge related to lack of functional exercise and disease prevention Anxiety related to recurrent episodes of disease10principle of managementTo eliminate the cause:Improve your position,posture,and avoid bending over long Use the waistline,take it off when rest,lest the secondary apraxia of
5、 muscle atrophy Always move the waist and avoid prolonged periods in the same position11 Avoid damp,cold Sleep hard bed Make the waist posture compatible with biomechanics When the disease is heavier,bed rest is appropriate and the bed position is often changed12Comprehensive treatment:Physical ther
6、apy:waxing,electrotherapy,Medical massage,acupuncture cuppingDrug therapy:The pain point is feasible for adrenal corticosteroid injection.When the pain in the waist is obvious,you can take NSAID to relieve muscle pain,but not long-term13Functional exercise Quadriceps muscle contraction practice:5-10
7、 minutes each time,3-4 times a day Back muscle practice:The flying swallow is supported by five-point,1-2 weeks and then the 3-point support method,3-4 times a day,50 times each time1415Nursing measuresRelieves pain:Create a quiet,comfortable hospital environment,distract the attention of patient an
8、d guide it.When the pain is apparent,you can take NSAID to relieve muscle pain.Psychological care16Health guide:Explain the etiology,pathology,treatment and prevention of diseases,rehabilitation training methods and precautions The waistline method and the use time Keep proper posture in your daily work life,keep warm and avoid the cause of the disease1718
