1. Etiology
Cervical spondylosis is mostly caused by degeneration, aging and secondary changes of cervical intervertebral disc, stimulation or compression of nerve roots and spinal cord or influence of blood supply of vertebral artery. This is related to many factors, so the condition is complicated. Cervical spondylosis is a common disease in people over 50 years old.
The cervical vertebra is located between the upper skull and thoracic vertebra, and the structure of cervical intervertebral disc is similar to that of lumbar intervertebral disc. Thick partition and wide range of activities. Among them, 1 and the second cervical vertebra mainly move in rotation, and the parts below the third cervical vertebra move back and forth more, and the fifth and sixth cervical vertebrae move back and forth most during flexion and extension. The cervical spine has the greatest mobility, so the chances of injury to its intervertebral disc and surrounding ligaments increase. At the same time, with the increase of age and the accumulation of injury, cervical intervertebral disc has also undergone degenerative changes, gradually aging, decreased elasticity and increased brittleness. If the injury continues, the periosteum of the vertebral body will be pulled and squeezed, resulting in a repair reaction after the injury, forming a proliferative osteophyte, forming a protrusion with the ruptured intervertebral disc tissue, and compressing the adjacent tissues. If the protrusion protrudes outward, it can compress the nerve root, leading to the symptoms of nerve root being compressed or stimulated; If the process protrudes backward, compressing the spinal cord can produce symptoms of spinal cord compression; If the process protrudes to the side, it can stimulate the sympathetic nerve; If the vertebral artery is compressed, it will cause the symptoms of insufficient blood supply to the vertebral artery In addition, when the cervical intervertebral disc in young adults has not degenerated, it may rupture due to obvious trauma, resulting in acute cervical disc herniation. Symptoms are similar to cervical spondylosis, but there is no hyperosteogeny. Rarely seen.
2. Nursing diagnosis
Patients with cervical spondylosis mainly have the following characteristics:
More common in men over middle age, often unilateral and occasionally bilateral.
(1) nerve root type is a symptom caused by compressing or stimulating nerve roots on one or both sides of spinal canal. The patient developed neck and shoulder pain, neck stiffness and recurrent attacks. It is usually caused by fatigue, cold, poor sleep or long working hours at the desk. It gets worse when you look up, cough and sneeze. Pain radiates to the upper arm, forearm, hand and finger along the nerve root control area, and the neck movement is limited. Sometimes there may be scalp pain, tinnitus and dizziness. In severe cases, the fingers are numb and the movements are invalid.
(2) Spinal cord type is common in middle-aged people aged 40 -60, and is caused by pressing or stimulating the spinal cord. Early symptoms are weakness, numbness and even difficulty walking in one or both lower limbs. Feet feel like stepping on cotton, and chest or waist feels tied. There is little pain, followed by numbness of upper limbs and weakness of hand muscles. In severe cases, it develops into quadriplegia and dysfunction of urination and defecation.
(3) Vertebral artery type The vertebral artery running along the brain begins to pass through the transverse foramen of the sixth cervical vertebra. When the lesion occurs near the transverse foramen of cervical vertebra, the carotid artery is compressed or stimulated. In addition to the general symptoms of cervical spondylosis such as neck tenderness and limited activity, it can sometimes be manifested as headache, dizziness, dizziness, blurred vision, nausea, vomiting, tinnitus, deafness and other symptoms, and even collapse. Its symptoms are often transient ischemia or spinal cord ischemia. Posture changes, blood supply is restored, and symptoms are alleviated.
(4) Sympathetic cervical spondylosis can cause headache, dizziness, tinnitus, deafness, occipital pain, tenderness of foramen magnum, blurred vision, eye socket swelling pain, nystagmus, tears, nasal congestion, accelerated or slowed heartbeat, arrhythmia, increased or decreased blood pressure, cold limbs, itchy skin, numbness, hyperhidrosis or hypohidrosis, etc.
3. Nursing measures
(1) Let patients know about cervical spondylosis, improve their awareness of disease prevention, enhance their confidence in treatment, and master rehabilitation methods. Observe the psychological and emotional changes of patients in the process of treatment, adjust psychological and emotional, and maintain mental health.
(2) Correct and effective traction to relieve mechanical compression. Pay attention to the posture, position and weight of traction, and find out the reactions during traction in time, such as dizziness, nausea and palpitation. Because the patient's neck is fixed, local irritation should be alleviated. Correct application of physical therapy, massage, drugs and other comprehensive therapies to relieve pain. Correctly guide the patient's head and neck function exercise, adhere to the neck exercise, and the methods include forward, backward, left and right activities and left and right rotation activities, guide the patient's hands to do rubber ball or towel kneading training, and various finger movements.
(3) Pay attention to the changes of pain parts and numbness and weakness of limbs during non-surgical treatment. Measure temperature, pulse, respiration and blood pressure on time. Long-term bedridden patients should pay attention to the prevention and observation of bedridden complications. Patients' bony processes, such as sacrum, coccyx, heel, medial ankle and lateral ankle, are often massaged with 50% safflower alcohol. Massage upper and lower limb muscles to encourage patients to actively strengthen joint activities.
4. Treatment and first aid
(1) Cervical spondylosis of nerve root type and sympathetic nerve type can be treated by non-surgical therapy. Non-surgical therapy is also the basis of surgical treatment and the basic method to treat cervical spondylosis. It can relieve, improve and cure the symptoms of cervical spondylosis, especially for early patients. Measures such as head traction, physical therapy, local braking and drug therapy are often used.
(2) The head is pulled with carved pillow suspenders, sitting or supine position, with the head leaning forward 15 degrees and weighing 4 kg -6 kg, 1 time -2 times a day, each time lasting 25 minutes -30 minutes, and 1 time is1course of treatment. You can continue traction for 3 courses and rest for 2 weeks. You can pull it again if necessary.
(3) Massage combined with traction therapy can accelerate the regression of inflammatory edema and improve the blood supply of nerves after traction. Massage can improve local blood supply, relax muscle spasm, relieve pain and relieve symptoms.
(4) Those with mild local braking symptoms do not need to brake, and anti-inflammatory and analgesic drugs and traditional Chinese medicines for relaxing muscles and activating blood circulation can be used. In severe cases, a cardboard shell, foam plastic strip or plaster strip can be used for simple local braking around the neck, or a neck brace can be used for braking.
(5) Strengthen neck exercise. After the pain gets better, gradually move the neck in all directions to enhance the muscle strength of the neck. Usually pay attention to the posture of lying position and the height of pillow, and the pillow should not be too high when lying on your back; When lying on your side, the pillow can be a little higher, so that the neck and trunk keep a line and will not lean to one side.