Causes of left hip pain:
Degradation is the basic factor.
With the increase of age, the water content of annulus fibrosus and nucleus pulposus gradually decreases, which reduces the tension of nucleus pulposus and thins the intervertebral disc. At the same time, hyaluronic acid and keratinized sulfate decreased, low molecular weight glycoprotein increased, fibrosis and collagen fiber deposition increased, nucleus pulposus lost elasticity, intervertebral disc structure relaxed, cartilage plate cystic change. Nuclear magnetic resonance (MRI) confirmed that intervertebral disc degeneration can occur in adolescents aged 15.
2. Damage
The accumulated injury force is the main cause of intervertebral disc degeneration and the inducement of intervertebral disc herniation. In the cumulative injury, repeated bending and twisting actions are most likely to cause disc injury, so this disease is closely related to some occupations and types of work.
3. Genetic factors
The incidence of colored people is low; About 32% of adolescent patients under the age of 20 have a positive family history.
Step 4 get pregnant
Common inducing factors
① Increased abdominal pressure, such as severe cough and forced defecation during constipation.
② When the posture is improper and the waist is in flexion position, sudden rotation is easy to induce nucleus pulposus protrusion.
(3) Sudden load, in the absence of adequate preparation, suddenly increase the waist load, which is easy to cause nucleus pulposus protrusion.
(4) Lumbar trauma, acute trauma can spread to fibrous ring, cartilage plate and other structures, and promote the degeneration of nucleus pulposus protrusion.
⑤ Occupational factors, such as long-term sitting and bumping, are easy to induce disc herniation.
⑥ Height and weight.
⑦ Environmental factors, such as cold and wet cold.
Treatment:
Non-surgical treatment:
There are various non-surgical treatments for low back pain and leg pain, ranging from simple bed rest to the use of expensive traction equipment. All these treatments have reported exciting cure rates, but unfortunately, most of them have not been scientifically demonstrated. (Campbell) Its purpose is to accelerate the regression of inflammatory edema in the protruding part of intervertebral disc and stimulated nerve root, so as to relieve or relieve the stimulation or oppression on nerve root. Non-surgical treatment is mainly suitable for: ① young, first attack, short course of disease; ② those whose symptoms can be relieved by themselves after rest; ③X-ray examination showed no spinal stenosis.
(1) Stay in bed
① The simplest treatment for acute low back pain is rest. It is better to stay in bed for two days than to stay in bed for a long time. Lying on your side with your knees bent and your hips bent, and putting a pillow between your legs can obviously reduce the pressure on the intervertebral disc and nerve roots. (Campbell)
(2) Absolute bed rest, emphasizing not to get out of bed or sit up when urinating or defecating, getting up in bed for 3 weeks, and not bending down to take things for 3 months.
(2) drug therapy:
① Drugs for relaxing muscles and tendons, relieving pain and calming can be selected, and traditional Chinese medicine preparations for relaxing muscles and promoting blood circulation can also be applied. (Applied Osteology) ② There are many kinds of drugs used to treat lumbocrural syndrome with different curative effects. At present, in the treatment of outpatients, strong anesthetics and muscle relaxants are generally not used, especially for patients with chronic low back pain, because drug treatment often leads to addiction and aggravates depressive symptoms. Short-term oral hormones can be as helpful as oral anti-inflammatory drugs. It is suggested to use non-steroidal drugs (such as diclofenac sodium sustained-release capsules and celecoxib capsules), muscle relaxants (such as eperisone hydrochloride tablets), and others, such as compound capsaicin cream and voltarin.
(3) Traction:
① Pelvic traction is adopted, with the traction weight between 7 ~ 15 kg according to individual differences, and the foot of the bed is raised for reverse traction for ***2 weeks. Spinal spondylolisthesis, active hepatitis, pregnant women, hypertension and heart disease patients are prohibited.
② Intermittent traction, twice a day, each time 1 ~ 2 hours.
⑷ Physical therapy: It should be used with caution, and the content of exercise should be suitable for patients' symptoms, rather than forcing patients to carry out a series of unchanging activities. Any exercise that will aggravate the pain should be stopped. Lower limb exercise can increase muscle strength and relieve back tension, but it may also aggravate the symptoms of lower limb arthritis. The real benefit of these treatments lies in improving the posture and mechanical function of patients, rather than increasing muscle strength.
5. Massage: There are many specific methods. There are many employees in this field in China, and the level is uneven, so the curative effect is very different. It should be noted that violent massage often does more harm than good.
[6] Epidural injection of hormone: Epidural injection of hormone in lumbar spine obviously has a certain clinical trend.
① When the patient has nerve root injury accompanied by disc herniation or lateral spinal stenosis, a successful injection through intervertebral foramen can relieve the symptoms of lower limb radiation pain, even if it is temporary; However, this kind of patients have a good effect in treating nerve root pain through surgery.
② Patients with ineffective puncture treatment and patients with root pain for at least 12 months have poor surgical results.
③ Patients with acute low back pain (less than 3 months) responded well to epidural corticosteroid injection. Unless there is definite re-injury leading to acute disc or nerve root injury, patients will not respond well to epidural hormone injection after operation.
④ Intervertebral approach: 2ml betamethasone sodium phosphate (6mg/ml) was injected slowly.
⑤ transforaminal approach: 0.75% lidocaine 1ml, betamethasone sodium phosphate (6mg/ml) 1ml, and slowly inject 2ml of liquid.
⑥ Tail injection: 3ml of 1% lidocaine, 3 ml of betamethasone sodium phosphate (6 mg/ml) and 4ml of sterile saline, and slowly inject *** 10ml of liquid.
⑦ Common long-acting corticosteroids and 2% lidocaine were injected into epidural space every 7 ~ 10 day/time, and 3 times was 1 course of treatment. After an interval of 2 ~ 4 weeks, another course of treatment can be used. If it doesn't work, this method is not needed. If there is no basis, it is not appropriate to add other drugs at will to avoid adverse reactions.
Surgical therapy
When non-surgical treatment fails, surgical treatment should be considered. Before the operation, the doctor must ensure the correct diagnosis, and the patient must confirm the degree of pain and the nerve injury that needs surgery. Surgeons and patients should know that the purpose of surgery is not to cure, but to relieve symptoms. Surgery can neither terminate the pathological process leading to disc herniation nor restore the waist to its previous state. It is still necessary to maintain good posture and mechanical state after operation, and do not do actions such as bending over, twisting the waist and lifting heavy objects during spinal flexion. If you want to prolong the pain relief period, the patient's lifestyle needs to be adjusted permanently.
⑴ The most suitable patients for surgery are those whose leg pain or pain is mainly concentrated on one side, the pain is below the knee joint, the symptoms last for more than 6 weeks, and they are relieved by rest, anti-inflammatory treatment or epidural hormone treatment; After at least 6 ~ 8 weeks of non-surgical treatment, the symptoms recurred to the initial severity.
⑵ Only when cauda equina syndrome is accompanied by obvious neurological deficit, especially the dysfunction of urination and defecation, it is necessary to remove the intervertebral disc surgically and need emergency surgery. In other cases, discectomy should be an optional operation.
⑶ No matter which method is chosen to treat disc herniation, patients should know that the purpose of the operation is to relieve the symptoms of leg pain, and the main pain of patients with low back pain may not be relieved after operation.
⑷ Operation principle: With minimal trauma, completely remove all substances that cause stress, and less damage the stable structure of the spine, so that patients can recover in the shortest time. 5. Choice of surgical methods: upgrade from small to large. Its order: open the window? Enlarge the window? Hemilaminectomy? Total laminectomy.
Minimally invasive surgery is the development direction of surgery today. With the fast-paced and efficient development of social activities, patients with lumbar disc herniation have higher requirements, that is, minimal trauma, pain relief in the shortest time and rehabilitation. With the development of high technology, minimally invasive surgery of lumbar intervertebral disc makes this wish come true.