Thoracolumbar and lumbar lordosis disappeared
Introduction
Introduction Acute lumbar sprains are commonly known as flashing waists in the folk, and are more common in clinical practice, especially in manual laborers; those who occasionally participate in sports or labor without prior preparation for physical activity are more likely to occur. Sitting in the office all the year round. Imaging examination of acute lumbar sprain The X-ray film mainly shows the disappearance of the lordosis and lateral curvature of the lower thoracic and lumbar spine, generally without other changes.
Cause
Cause
The cause of the disappearance of thoracolumbar and lumbar lordosis
1. Unprepared activities: Whether it is physical labor or various competitive activities, if the spine and limbs can be prepared from slow to fast, from small to large, before the official start, it is not easy to cause damage (including the lower back). sprain). Conversely, sudden increase in spinal load during unprepared activities can easily cause sprains and ligament tears. In severe cases, fractures can occur (compared with transverse process fractures), especially during weekdays without physical labor and physical exercise. By.
2. Improper posture: All sports have their own scientific training procedures, coaches and athletes should pay attention to and operate according to procedures, which can greatly reduce the incidence of waist injuries. However, in daily labor, especially in the family or mental workers who have a rare opportunity to carry out heavy physical work on a regular basis, when they encounter a heavier object to move, they are often not used to moving the body forward and kneeling. Flexing the hip, holding the object again, and lifting the (lifting) while the knee and hip joints are gradually straightening this normal step, resulting in improper force, sprained the lower back.
3. Improper labor mode: In addition to the difficulty of correcting the forced labor position caused by different working conditions, some workers cannot master the correct labor mode, such as when driving the cart to pick up the patient, if not using "push" Instead, the "pull" method is used, which is likely to cause sprains in the lower back due to the greater exertion of the longitudinal muscles of the paravertebral. Actions such as these are very common in everyday life and work.
4. Improper cooperation: In the competition of labor or sports events in which two or more people participate together, if one of the actions is uncoordinated, the other person's back sprain or other parts may be damaged due to the deviation of gravity. This is especially true when mental and physical preparation is insufficient.
5. Other reasons: including falling from a height, slipping on the ground, traffic accidents or accidents in life, can cause sprains in the lower back.
Examine
an examination
Related inspection
CT examination of bone and joint soft tissue
Examination of thoracolumbar and lumbar lordosis
1. Forced position: The most common, and the degree is different, and severe cases can be bedridden. In general, cases of sprained back and back can get up and down, but the thoracolumbar and lumbar lordosis disappeared due to the muscle fiber spasm of the affected side, and the forced position to flexion to the affected side was presented. This is actually a defensive reflex of the body to protect the affected muscles from the continuation of tensile stress.
2. Pain: Because most of them are sudden injuries, the patient's conscious local pain is very intense, and it is aggravated with local activities and vibrations, and can be alleviated after lying down. The pain points are relatively fixed and consistent with the part of the muscle tear. It is more common in the posterior superior iliac spine and the thoracolumbar spine, and can also be seen in the paravertebral transverse process. The tenderness point is obvious and limited, and sometimes it can be radiated from the pain point to the back of the thigh and is aggravated with the increase of abdominal pressure. Conductive pain was mostly negative and had no significant relationship with lower limb lift (in bed examination). Pain can be alleviated after partial closure.
3. Restricted activity: The lumbar back activity is obviously limited by the increase of the tensile stress of the damaged tissue, which is especially limited by the lateral bending, rotation and flexion to the healthy side. When bending to the affected side, small-scale activities can still be performed because the damaged tissue can be relaxed.
4. Muscle spasm: The damaged muscles have reflexive sputum due to pain and various other pathological factors, and are touched by hand and are generally obvious. Muscles in a state of paralysis, due to the frequent contraction of muscle fibers, increase their metabolites, which can aggravate the pain and re-inflame muscles, resulting in a vicious circle, so try to block it.
5. Others: In addition to paying attention to the positive signs and symptoms, the disease is easily confused with lumbar disc herniation, so it should pay attention to the negative signs that are not easy to appear in this disease, such as the neck test, lower leg straight leg raising test, Abnormalities in lower limb reflexes should be checked.
1. History of trauma: The back muscle sprain should of course have the basic condition of traumatic history. However, in addition to the obvious trauma, it is easy to be noticed by the patient. Some minor injuries, such as improper force when the bed is turned over, excessive force when standing up from a sitting position or a position, or a posture imbalance when taking objects from a height, are easily Neglect or forget, so you should pay attention to the inquiry.
2. Clinical manifestations: including the above-mentioned forced position, pain, tenderness, limited mobility and low back tendon, etc., should be carefully examined and judged.
3. Closure test: Take 0.5% to 1% procaine 10-20ml to seal the pain point. Local pain (including radiation pain behind the thigh) immediately after injection was significantly reduced or disappeared, which was positive; no significant change was negative. This can be used not only for the diagnosis of sprained back, but also for identifying the lumbar disc herniation. The lower extremity radiation pain caused by lumbar disc herniation is radiated along the sciatic nerve, and there is no change after closure. In the case of sprained back muscles, some cases may have similar lower extremity radiation pain, but it is reflective, with a small range, without the signs of sciatic nerve being pulled, and disappears after being closed.
4. Imaging examination: X-ray plain film mainly shows the disappearance of the lordosis and lateral curvature of the lower chest and lumbar vertebrae, generally without other changes. MRI examination can show the extent and extent of damage to the muscle group, which can be used as appropriate. CT examination is only used for those with bone and joint injuries.
Diagnosis
Differential diagnosis
Thoracic and lumbar segments and lumbar lordosis disappeared easily confused symptoms
The physiological anterior protrusion of the female lumbosacral sac is obvious: the physiological anterior protrusion of the female lumbosacral sac is obvious at the beginning Initial: Lower extremity swelling and fatigue are the most common early symptoms. The affected limb has only mild edema, especially when standing for a long time and sedentary. Female lumbosacral sacral anterior protrusion is obvious, and the left lower limb will have a menstrual period similar to "adolescent lymphedema." Ferri had 3 patients with long-standing left lower extremity edema, and the angiography proved to be caused by compression of the left iliac vein. In 1993, Sloame et al studied 215 elderly people and found that the lower extremity can be concave 3mm deep edema in 88 cases, the left side is 34.5%, the right side is 6.9%, and it is believed that the left lower extremity edema is likely to be right common iliac artery compression. Left common iliac vein and associated lymphatic vessels. Therefore, for lower extremity edema without other reasons, it should be possible to have this possibility. Female patients may have prolonged menstrual period and increased menstrual flow, as well as symptoms such as swelling of the lower extremities due to pelvic visceral congestion and increased venous pressure during menstruation.
Adolescent scoliosis: adolescent idiopathic scoliosis idiopathic scoliosis is relatively common, with a prevalence of 2% to 4% in adolescents in the 10-16 age group, with a small degree of scoliosis. In patients with scoliosis around 20°, the ratio of male to female is basically equal; in the crowd of scoliosis greater than 20°, female: male exceeds 5:1. The fact that women with scoliosis are more severe suggests that female scoliosis may be more progressive and that they need treatment more than boys.
Compensatory lumbar lordosis: The clinical manifestations of osteoarthritis are mainly hip pain. When the condition develops seriously, hip flexion adduction, compensatory lumbar lordosis, lower back pain, and even walking.
