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星狀神經節阻斷療法對頸椎病有顯著效果
陳俊峰醫師專區 - 星狀神經節阻斷療法
週五, 04 六月 2010 00:48
2008/03/05 18:48

Stellate Ganglion Block for Cervical Syndrome
Setsuro OGAWA
Department of Anesthesiology, Surugadai Nihon University Hospital
 
     The effects of Stellate Ganglion Block (SGB) on the pain of cervical syndrome were analysed in seventy-three patients who visited our Pain Clinic during 1985 and 1993. In addition, the influences of SGB on the Sympathetic Skin Response (SSR), blood flow and deep body temperature on the hand in twenty-two patients with cervical syndrome were examined.
     It was observed that SGB worked effectively in the patients without any cervical root signs and that at least 10 times procedures were necessary to obtain good results. SSRs disappeared after SGB in the patients with good results, whose blood flows were increased significantly.
    The deep body temperatures and blood flow on the hand before SGB were relatively lower in the patient with SGB-effective group than in non- effective group although all of these patients in the both groups experienced Horner's syndrome after SGB, indicating that sympathetic hyperactivities might contribute to the existence of pain in SGB effective group.
     The author would like to conclude that SGB is effective in the patients with cervical pain which are not accompanied with cervical nerve root signs.
 
The Journal of the Japan Society of Pain Clinicians (JJSPC) Vol. 1 No. 1, 1994


Cervical syndrome:頸椎病或頸椎症候羣

*    頸椎病變的五種類型

頸椎病變所表現的症狀非常多樣,綜合中西醫的看法,可以大致分為五大類型,其中又以落枕型和神經根型最常見。

˙落枕型:這是體質衰弱的徵兆,也是頸椎病的最初階段。形成的原因可能是韌帶鈣化、椎間盤退化或關節囊鬆弛,引發頸部和背部反覆發作疼痛。

˙神經型:中醫所說的痹證,起因於神經根受風寒和勞累的傷害,同時有椎肩盤突出或骨刺壓迫,還是關節、韌帶的鬆脫或錯位,對頸部神經根形成壓迫或刺激,出現頭、頸、肩、臂、手指的疼痛、麻木,甚至萎縮。

˙脊髓型:中醫所說的萎證,顧名思義就是肝腎虛衰、筋骨失養、肌肉萎弱,漸漸變得肢體沉重、步履困難。這一型的症狀多由下肢麻木疼痛開始,逐漸向上半身發展,病情的發展緩慢,卻會造成大小便失禁等身體功能障礙,致殘率極高。從X光片可以看到典型的頸椎病理變化,從電腦斷層掃描和核磁共振造影能確認頸椎的椎管狹窄,損害脊髓。

˙椎動脈型:又稱眩暈昏厥型,容易被誤認為內耳的病變。患者莫名發作眩暈,感到頭重腳輕,有的同時伴隨偏頭痛,容易有耳鳴等聽力障礙,並且導致患者情緒不穩定、暴躁易怒。主要是因為椎動脈受壓迫或刺激引起血流障礙、腦部供血不足所導致。中醫認為此症多為腎氣虧損所致。

˙交感神經型:症狀多表現於感官的異常,因此又稱五官型。像是眼瞼無力、眼脹痛、耳鳴、咽喉部有異物感、汗如雨下或無汗、血壓異常等。這其實就是自律神經的功能錯亂,因為症狀多樣,容易被誤診。如有自律神經失調症狀,合併肩頸疼痛、眩暈、頭痛等椎動脈型症狀,加上頸部X光片有病理改變時,較容易做確診。

 

長期姿勢不良、交通工具劇烈晃動、飲食不調累積過多難以代謝的酸毒廢物沉積在肌肉關節組織裡,都可能招來頸椎病變。

頸椎病變過去約在四十五歲以後最常見,現在的患者平均年齡卻不斷提前,主要是長期伏案或打電腦太專注,未能適度休息,更換姿勢。最好是每二十至四十分鐘就做做舒緩姿勢,尤其萬萬不可持續兩小時以上,像尊雕像一樣不動如山,否則頸椎病變很快就會找上你。