腰脱怎样治疗

腰脱如何治疗配图，仅供参考

TREATMENT
Most patients with LDH will relieve their symptoms over time. Therefore,an individualized treatment regimen should be taken according to the course,clinical manifestations,the location of the disc herniation and the severity of the corresponding nerve root compression. The routine strategies used for LDH treatment include general treatment,drug treatment,minimally invasive treatment,surgery and rehabilitation.
Nonsurgical treatment should be taken as the first-line treatment for most patients with LDH (recommended level A). Generally,conservative treatment should last for at least 4-6 wk (recommended level A),including rest,physical therapy,traction,acupuncture and medication. Although most patients with LDH benefit from conservative treatment,evidence suggests that patients receiving minimally invasive interventional therapy at the early stage can achieve superior outcomes compared with those who undergo long-term conservative treatment in pain relief and functional recovery (recommended level B,level of evidence 2b).
# General treatment
Bed rest is required during the acute episode,but long-term bed rest is not recommended. Patients should be encouraged to carry out appropriate and regular daily activities and to wear a back support belt during activities. General treatments such as traction and massage may be suggested according to the condition. In addition,proper health education can help in preventing recurrence and relieving symptoms.
# Drug treatment
Acetaminophen,nonsteroidal anti-inflammatory drugs (ibuprofen,celecoxib,etoricoxib,etc.,recommended level A,level of evidence 1b),ion channel modulators (gabapentin,pregabalin,etc.),tramadol,opioids (oxycodone,fentanyl,buprenorphine,etc. recommended level B,level of evidence 2),dehydration drugs (mannitol),glucocorticoids,central muscle relaxants (eperisone,chlorzoxazone,etc.),neurotrophic agents,microcirculation improvement and traditional Chinese medicines all have an effect on LDH to a certain degree and should be used according to the clinical situation.
# Minimally invasive surgery and treatment
Soft tissue lysis surgery: The needle-knife can loosen adhesive tissues,improve the blood supply of the soft tissue and reduce nerve compression. Internal heat needle and silver needle can improve LDH symptoms to varying degrees and should be performed clinically if appropriate.
Injection treatment: Including epidural injection,selective nerve root injection,sacral canal injection,lumbar sympathetic ganglion injection,etc. (1) Epidural injection: Drugs can be administrated around the root of the affected nerve by approaches like anatomic localization or image-guided operations via foramina,an interlaminar approach (including lateral recess approach) or sacral hiatus puncture. Epidural steroid injection,which can relieve the symptoms of low back pain in patients with sciatica in the short term,should be taken into consideration (recommendation level A,evidence level 1b). During epidural steroid injection treatment,glucocorticoids should be administrated in small doses at the beginning. A higher dose is not equal to a better clinical efficacy,and epidural steroid injection is associated with serious complications,especially spinal cord injury and cerebral infarction caused by granular glucocorticoids. The incidence of complications in the waist region is lower than that of the neck area (recommended level B,level of evidence 2b). Local injections of hyaluronic acid and cytokine inhibitors in patients with LDH and radicular pain require more high-quality randomized controlled trial research evidence; (2) Selective nerve root injection: LDH patients receive selective root injection of glucocorticoids that can reduce the inflammation of compressed nerve roots and surrounding tissues and attenuate pain on most clinical occasions. Long-term pain control can be achieved in some patients,providing support that this method should be considered as the preferred treatment (recommended level A,evidence level 1a); (3) Sacral canal injection: Sacral injection (which can also be performed under ultrasound guidance) can help to relieve the pain of lumbosacral root compression in patients with LDH; (4) Lumbar sympathetic ganglia injection: Lumbar sympathetic nerve injections are usually L2 and L3 sympathetic nerve injections,which can treat sympathetic nerve-related pain in the lower limbs caused by LDH (recommended level B,evidence level 2a); and (5) Injection of the posterior branch of the lumbar spinal nerve: When lumbar and sacral areas are affected by LDH,chronic strain,edema of the intervertebral foramina or spinal canal tissue,narrowing of the intervertebral aperture,inflammation of the tendon and ligament and facet joint disorder can cause the stimulation of the posterior branch of the spinal nerve in the corresponding segment. It causes symptoms such as soreness,stiffness,pain and limitation of activity in the local or adjacent tissues. Injection of the posterior branch of the spinal nerve is an effective treatment method,and it should be performed under the guidance of images such as ultrasound.
Radiofrequency thermocoagulation: Radiofrequency thermocoagulation can be safely and effectively used in the treatment of LDH. Clinical applications should strictly adhere to the indications.
Percutaneous disc trioxide ablation: Percutaneous intervertebral disc trioxygen injection is an effective and safe method with a complication rate of around 0.1%. A cumulative effect induced by ganglion and epidural injections of glucocorticoids/local anesthetics may improve the overall treatment effect (recommended level C,level of evidence 4).
Percutaneous disc ablation: As a safe and effective LDH treatment technique,low-temperature plasma percutaneous discectomy should be taken into consideration (recommended level A,level of evidence 1a. It can significantly relieve pain and improve mobility. Clinical applications must strictly follow the indications. Low-temperature plasma radiofrequency can also be used in combination with ozone to treat LDH (recommended level B,level of evidence 2c).
Percutaneous low-energy laser disc repair: Percutaneous low-energy laser disc repair is an upgrading version of technology based on percutaneous laser disc decompression. A semiconductor laser with a wavelength of 970 nm is used to inject a small amount of isotonic or hypertonic saline into the disc during treatment.
Percutaneous disc collagenase chemical lysis: For patients whose diagnosis is accurate and conservative treatment is ineffective,collagenase injection treatment can be considered. It is easy to administer and has a remarkable effect (recommended level B,level of evidence 2b). Methods of collagenase injection can be divided into the intra-disc,extra-disc and combined method. Collagenase injection should avoid entering the subarachnoid space.
Percutaneous discectomy: Percutaneous discectomy is effective and can be used as a treatment for LDH with radiculopathy (recommended level B,level of evidence 2b),but the application is strictly limited to the indications.
Percutaneous spinal endoscopic lumbar discectomy: Compared with open surgery,percutaneous endoscopic lumbar discectomy has a shorter length of stay and shows better results in terms of pain relief and functional recovery (recommendation level B,level of evidence 2b). Percutaneous endoscopic lumbar discectomy contains two types of techniques: Percutaneous endoscopic transforaminal discectomy and percutaneous endoscopic interlaminar discectomy. Generally,percutaneous endoscopic transforaminal discectomy is suitable for scapular,central and recurrent LDH,whereas percutaneous endoscopic interlaminar discectomy is preferred for axillary and displaced intervertebral discs (recommended level A). Compared with open discectomy,percutaneous endoscopic lumbar discectomy has less bleeding and shorter in-hospital stays (recommended level A,level of evidence 1a).
# Surgical treatment
Surgical treatment should be considered if conservative treatment following a rigorous and strict protocol fails to achieve clinical efficacy. The aim of minimally invasive surgery is to relieve pain and/or symptoms of nerve damage instead of a curative effect on disc degeneration and reversing disc herniation.
# Rehabilitation treatment
Traction therapy: Lumbar traction is one of the commonly used conservative treatments for patients with LDH that can release intervertebral disc pressure,loosen adhesion tissues,relax ligaments,relieve muscle spasm,improve local blood circulation and address facet joint disorders.
Extracorporeal shock wave: Extracorporeal shock wave treatment can effectively reduce pain in patients with low back pain and improve their functional status and quality of life.
Medium- and low-frequency electrotherapy: Commonly used in clinical settings,low-frequency electrotherapy causes percutaneous nerve electrical stimulation (transcutaneous electrical nerve stimulation) and can interfere with electrotherapy. Transcutaneous electrical nerve stimulation can relieve pain,improve dysfunction,and uplift the grade of muscle activation in LDH patients. Of note,its curative effect has not been recognized.
High-intensity laser therapy: High-intensity laser therapy with anti-inflammatory,antitumor and analgesic effects can be used to reach lesions where low-power laser stimulation cannot,such as the deep areas of large and/or small joints.","department":"