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Transcript of Lekts4
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A.Áàëæèííÿì MD., PhDÑýðãýýí çàñàõ àíàãààõ óõààíû òýíõèì
ÀÓÑ, ÝÌØÓÈÑ
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Á¿ñýëõèé íóðóóíû àíàòîìè, êèíåçèîëîãè
¯éë àæèëëàãààíû íýãæ2 íóãàëàì, äèñê
Íóãàëàì õîîðîíäûí äèñêAnnular fibrosus
Ìóêîïîëèñàõàðèä Êîëëàãåí øèðõýã
Nucleus pulposus Ïðîòåîãëèêàí Ãèäðîôèëèê øèíæòýé
Òýæýýë ìóóòàéÀ÷ààëàë äèñêèéí äîòîîä
äàðàëò ýíý ¿åä áóë÷èí àãøèõ áîëîâ÷ Ẻìºíöºð äýýð à÷ààëàë î÷äîãã¿é
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¯éë àæèëëàãààíû íýãæ
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Íóðóóíû àðûí á¿òýö
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Íóðóóíû ëèãàìåíòLigamentum flavum
80% elastin20% collagen
Supraspinous ligInterspinous ligALLPLLMultifidus triangle
FacetsFacet innervationTransverse liQuadratus lumborum
muscleIliolumbar lig
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Íóðóóíû áóë÷èíErector spinae muscleIntersegmental muscle-
short intersegmental muscles, interspinals & intertransversalis
Quadratus lumborun muscle- originates & insert 12th rib, iliac crest transverse process
Multifidus
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ªâäºëò ¿¿ñãýõ ýä¿¿ä 1. Íóðóóíû óðä áîëîí àðûí óðò ëèãàìåíò -¿ðýâñýæ ãýìòýõ ýñâýë
öî÷èðñîí ¿åä íóðóó ºâääºã. 2. Íóрууны ÿñ- íóðóóíû íóãàëàìûí ÿñíû õóãàðàë, áîäèñûí
ñîëèëöîîíû ýìãýã, õàâäàðûí ¿åä íóðóóíû ºâäºëò ¿¿ñäýã. 3. Íóðóóíû íóãàëàì õîîðîíäûí æèéðãýâ÷ - äèñêèéí ººðèéí ãýìòýë,
ýñâýë ãàäàãø ö¿ëõèéæ ºâäºëò ¿¿ñãýõ ýä¿¿äèéã öî÷èðîîñíîîñ íóðóóíû ºâäºëò ¿¿ñäýã.
4. Íóðóóíû ìýäðýëèéí ÿçãóóð - ãàäíàõ á¿ðõ¿¿ë íü Luscka-ãûí ìýäðýëèéí ñàëààãààð ìýäðýëæ¿¿ëýãääýã áºãººä èéìýýñ òàòàãäàæ, öî÷èðñíîîñ íóðóóíû ºâäºëò ¿¿ñäýã.
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ªâäºëò ¿¿ñãýõ ýä¿¿ä 5. Ñýðòýí õîîðîíäûí ëèãàìåíò - íü ºâäºëò äàìæóóëàõ ÷àäâàð
á¿õèé ìýäðýëýýð ìýäðýëæ¿¿ëýãääýã. Èéìýýñ òàòàãäàæ, öî÷ðîõ ýñâýë ãýìòâýë íóðóóíû ºâäºëò ¿¿ñäýã.
6. Íóðóóíû ôàñåò ¿å íü àðûí àíõäàã÷ ìýäðýëèéí ¿åíèé ñàëààãààð áîëîí ñèìïàòèê ìýäðýëýýð ìýäðýëæ¿¿ëýãääýã ó÷èð ¿ðýâñýæ ãýìòýæ, öî÷èðñîí ¿åä íóðóó ºâäºõ øàëòãààí áîëäîã.
7. Íóðóóíû áóë÷èíãèéí ñïàçì. ªâäºëò ¿¿ñãýäýã ýä¿¿ä ¿ðýâñýæ, ãýìòýí öî÷èðâîë õàìãààëàõ çîðèëãîîð áóë÷èí ðåôëåêñýýð ÷àíãàð÷ àãøäàã áºãººä ¿¿íèéã “õàìãààëàõ ñïàçì” ãýäýã. Ýíý íü íóðóóíû ºâäºëòèéã èõýñãýí ýöýñòýý ººðºº íóðóó ºâäºõ áèå äààñàí øàëòãààí áîëäîã.
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Цочмог өвдөлтХөлрүү дамжиж өвдөх өвдөлттэй хавсарч
болноӨвдөлт хөлрүү дамжих нь диск цүлхийсэн
эсвэл радикулопати гэсэн үг бишДиск цүлхийсэн ихэнхи тохиолдолд мэс
засал эмчилгээ хийдэггүй. Гэхдээ өвдөлт хөлрүү дамжиж байгаа
тохиолдолд эдгэрэлт удаан, тавилан муу байх магадлалтай
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Цочмогдуу өвдөлтМэдрэлийн гаралтай өвдөлт
Диск цүлхийсэнтэй холбоотой радикулопатиMRI, EMG
Бүтцийн өөрчлөлттэй холбоотой өвдөлтSI, facet, spondylolisthesis, biomechanical
dysfunction Structural asymmetries, muscle imbalance,
disalignments Миофасцийн өвдөлт
Rheumatologic, fibromyalgia, autoimmune, metabolic, endocrine source?
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Архаг өвдөлтГурван P’s
PainPathologyPerformance
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Ñòàòèê íóðóóÁèåèéí áàéðøèë
Ýð¿¿ë õ¿í ýãö çîãñîæ áàéõàä äýëõèéí òàòàõ õ¿÷íèé øóãàì Ñ1-Ñ7-ûí íóãàëàìûí èõ áèåýð Ò10 õ¿ðòýë ÿâæ, á¿ñýëõèé-óóöíû õîëáîîñîîð äàìæèí ò¿íõíèé ¿åýð ýñâýë áàãà çýðýã àðààð íü ÿâäàã. Òýãýýä óóö-ñ¿¿æíèé ¿åýð áîëîí ºâäºãíèé ¿åíèé óðäóóð ÿâæ øàãàéí ¿åíèé óðä õýñýãò î÷èæ äóóñäàã
4 ôèçèîëîãèéí ìóðóé
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Ëîðäîç
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Õýò ãýäèéõ õºäºë㺺í
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Íóðóóíû õºäºë㺺íèé ìåõàíèçì
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Íóðóó ºâòãºõ ýðñäýëò õ¿÷èí ç¿éëñÍóðóóíû ºâäºëòòýé õàìààðàëòàé
Òîäîðõîéã¿é Íóðóóíû ºâäºëòòýé õàìààðàëã¿é
Íàñ ÒàìõèäàëòÑýòãýöèéí áàéäàë
• Ñòðåññ• Ò¿ãø¿¿ð • Ñýòãýë ãóòðàë
ÆèðýìñëýëòÑêîëèîç Çàðèì íýãýí ñïîðòûí òºðºë
Òàðãàëàëò Áóë÷èíãèéí õ¿÷Áèå áÿëäðûí õºãæèë
Óäàìøèë Õ¿éñªíäºðÁèåèéí æèíÁèåèéí ãàëáèð Õºëíèé óðò áîãèíîÕºäºë㺺íèé ÷àäâàðÓÿí õàòàí ÷àíàðÇàðèì íýãýí ñïîðò
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Àæèë ìýðãýæèëÍóðóóíû ºâäºëòòýé õàìààðàëòàé
Òîäîðõîéã¿é
Áèåèéí õ¿÷íèé õ¿íä àæèëÎëîí äàõèí áºõèéõ, ýðãýõ õºäºë㺺íÕ¿íä þì ºðãºäºã, ò¿ëõäýã, òàòäàãÄîðãèîí Ñýòãýöèéí áàéäàë
• àæèëäàà ñýòãýë õàíàìæòàé ýñýõ• õàìò îëíû õàðüöàà• óéòãàðòàé
Õºäºë㺺í áàãàòàé àæèë
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Ýì÷èëãýýíèé çàð÷èìÌýñ çàñàë÷ õóòãà, äîòðûí ýì÷ ýì, ñýòãýöèéí
ýì÷ àìàà ýì÷èëãýýíä àøèãëàäàã áîë ñýðãýýí çàñàë÷ õ¿íèéã àøèãëàäàã.
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“Red flags”Адуун сүүл дарагдах: булчингийн хүч
хурдацтайгаар сулрах, давсаг гэдэсний үйл ажиллагаа алдагдах, мэдэрхүй алдагдах
Хорт хавдарХалдвар :diskitis, osteomyelitis, abscessХалдварын бус гаралтай үрэвслийн эмгэг
(spondyloarthropathy)Цочмог гэмтэл
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“Yellow flags”Архагших, чадвар алдагдах өндөр эрсдэлтэй Сэтгэц-нийгмийн саад
биеийн Ажлын байрны хүчин зүйл
хувь хүний нас, хүйс, боловсролын түвшин, гэрлэлтийн
байдал, биеийн байршил, галбир, булчингийн хүч, бие бялдрын хөгжил, уян хатан байдал, тамхи татдаг эсэх
сэтгэцийн Сэтгэл гутрал, түгшүүр, айдас
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Ýì÷èëãýýíèé ¿å øàòóóä
ªâäºëò íàìäààõÝì÷èëãýýíèé
äàñãàëÒîãòâîðæóóëàõ
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ªâäºëò íàìäààõ ¿å øàòÕºäºë㺺í õÿçãààðëàõ
Ìàø õ¿íä òîõèîëäîëä äýýä òàë íü 2-3 ºäºð Áèåä ýâòýéõýí áàéðëàë Áóë÷èíãèéí ñïàçì áàãàñãàõ õ¿éòýí ýñâýë äóëààíû ýì÷èëãýý
Ýì÷èëãýýíèé äàñãàë Ãýäèéõ íü ìýäðýëèéí ÿçãóóðûí òàòàãäëûã áàãàñãàñíààð
ºâäºëò íàìäààäàã. Ãýäèéõýä ºâäºëò èõñýæ áàéâàë: íóðóóíû ñóâãèéí íàðèéñàë
ýñâýë äèñê ö¿ëõèéñýí áàéæ ìàãàäã¿é òóë çîãñîîõ õýðýãòýé. Íóðóóíû òàòëàãà, óëüòðàçâóê, ìàññàæ, TENS
Ýìèéí ýì÷èëãýý: ÍÑÏÂÏ, áóë÷èí ñóëðóóëàã÷, ñýòãýë ãóòðàëûí ýñðýã ýì, êîðòèêîñòåðîéä
Àæëûí öàãèéã õîðîãäóóëàõ
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ªâäºëò íàìäààõ ¿å øàòÕÿçãààðëàõ õºäºë㺺í
Ýð÷èì èõòýé äàñãàë õèéõã¿é áàéõ10 êã-ààñ èë¿¿ à÷àà ºðãºõã¿é áàéõÎëîí äàõèí äàâòàí áºõèéõã¿é áàéõÎëîí äàõèí äàâòàí ýðãýõ, ìóøãèõ õºä õèéõã¿é áàéõÓäààí çîãñîæ, ñóóõã¿é áàéõ
4 äîëîî õîíîãò ºâäºëò íàìäàõã¿é áîë → MRI
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Áàéðëàë, õºäºë㺺íèé ¿åä á¿ñýëõèé íóðóóíä èðýõ à÷ààëàë (L3 )
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Ýì÷èëãýýíèé äàñãàëûí ¿å øàòÁèîìåõàíèêèéã ñýðãýýõÓÿí õàòàí ÷àíàðûã ñàéæðóóëàõÁóë÷èí, ëèãàìåíòèéí õ¿÷èéã ñàéæðóóëàõÑóíãàõ äàñãàë
Paraspinalis, iliopsoas, hamstrings, hip rotators, quadriceps
Õ¿÷íèé äàñãàëSpinal extensor, abdominal
Àåðîáèê äàñãàë
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Ýì÷èëãýýíèé äàñãàëûí ¿å øàòÃýäèéõ äàñãàë
Äèñêèéí äîòîîä äàðàëòûã áóóðóóëíànucleus pulposus óðàãøàà øèëæèíýÌýäðýëèéí ¸çîîðûí á¿ðõ¿¿ëèéí òàòàãäàë áóóðíà
Õýâëèéä èâýýñ õèéõÝñðýã çààëò
Íóðóóíû íóãàëàì õýò èõ õºäºë㺺íòýé, òîãòâîðã¿éÈõ õýìæýýíèé äèñêèéí ö¿ëõèéëòÌýäðýëèéí øèíæ 2 òàëä èëýð÷ áàéãààÌýäðýëèéí ¸çîîð òàòàãäëûí øèíæ èõñýæ áàéãàà
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Ýì÷èëãýýíèé äàñãàëûí ¿å øàòÁºõèéõ äàñãàë
Èõýâ÷ëýí íóðóóíû àðûí õýñãèéí ºâäºëòòýé ¿åä õèéíý Ôàñåò ¿åí äýýðõ à÷ààëàë áóóðíà Íóðóóíû øóëóóí áóë÷èí, ëèãàìåíò, ìèîôàñöè ñóíàíà
Çààëò Äèñê òºâèéí ÷èãëýëä ö¿ëõèéñýí Ôàñåòûí ãàðàëòàé ºâäºëò Íóðóóíû íóãàëìûí ñòåíîç
Äàñãàëûí õýëáð¿¿ä Ààðöàã ýðã¿¿ëýõ, ºâäºã öýýæð¿¿ òàòàõ, õýâëèéí
òàòàëò ãìÝñðýã çààëò
Íóðóóíû íóãàëàì òîãòâîðã¿é, õýò õºäºë㺺íòýé Ðàäèêóëÿð ºâäºëò èõñýæ áàéãàà ¿åä
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Äèíàìèê ñòàáèëèçàöè (ABCD зарчим)o This position – greatest
functional stability, decreasing tension on ligaments and spinal neural elements while allowing a more balanced segmental force distribution between the disk and facet joints
o Least painful and most biomechanically advantageous position
o Lifting, bending pushing pulling
• Contraindicationo Spinal segmental
hypermobility, instability, radicular pain
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Áèåèéí áàéðøèë çàñàõ
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Ýì÷èëãýýíèé äàñãàëûí ¿å øàòÇ¿ðõ ñóäàñíû ¿éë àæèëëàãààã ñàéæðóóëàõ
àåðîáèê äàñãàëo Ýíäîðôèíèé íºëººãººð ºâäºëò íàìäàíào Ýäèéí ýäãýðýëò ò¿ðãýñýíýo Òýñâýð íýìýãäýíýo Ìýäðýë áóë÷èíãèéí òîãòîëöîîíû ¿éë àæèëëàãàà
ñàéæèðíà
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Òîãòâîðæóóëàõ ¿å øàò
ªâ÷òºíèé õàðèóöëàãûã ñàéæðóóëàõ, äýìæèõÃýðèéí íºõöºëä äàñãàë õèéõÕºäºë㺺íèé çºâ àðãà áàðèëûã ýçýìøèõÒàìõè òàòàõã¿é áàéõ
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Back schoolÇîðèëãî
ºâäºëò òýñâýðëýõ ÷àäâàðûã íýìýãä¿¿ëýõ¿éë àæèëëàãààíû ÷àäâàðûã ñàéæðóóëàõдàõèëòààñ ñýðãèéëýõ
Íóðóóíû àíàòîìèÏàòîôèçèîëîãè Áèîìåõàíèê Äàñãàë, хөдөлгөөн хийх Ñýòãýë ç¿éí õ¿÷èí ç¿éëèéã òîäîðõîéëîõ
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Back school
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Back school