頸痛是常見的都市病

脊椎痛症在大多數工作人群中廣泛地發生著，影響我們的日常生活與工作。現在大多數人的工作都要面對電腦，在閒暇時又常常玩智能手機，所以我們的頸部常常處於向前傾的狀態，很容易造成肌肉緊張。

最近，我接觸到幾個病人都不約而同地對我說：有人說我的頸後方有一塊骨頭腫了。經過我的臨床診斷，他們只是有一定程度的頸椎勞損。那麼那個頸後方的腫塊是甚麼呢？

這不是一個明顯的骨折，所以常常被誤認為扭傷，要做出正確的骨折診斷要照X光。由於此類型之骨折處，血液循環比較差，如果骨折處理得不好，癒合的情況往往不理想，造成慢性痛症。

頸痛原因

有時候輕微的痛症未必可以找到具體的原因，也不必一定要找出其原因，然而如果用一些似是而非的症斷去告訴病人，反而令他們情緒、工作都受到影響，骨科醫生需要教導病人做適當的運動去放鬆或加強肌肉，有需要的話配合一定的藥物治療，就可提升頸部的健康。

頸痛治療

當醫生要向病人解釋一些病徵或狀況的時候，通過細緻的檢查去排除痛症是由腫瘤、感染、嚴重的神經障礙等引起的，這些是比較少發生，但非常重要的原因。除此之外，骨科醫生需要做的就是安慰病人，教他們改善生活習慣，注意姿勢等等，許多痛症都會迎刃而解。

手術治療

一般的頸痛大多數都不需要手術治療；除非是頸的神經或脊髓神經受壓，醫生才會建議手術。

北京當地人說有一種戶外的運動對頸部健康很好，就是放風箏。因為放風箏的動作可以有效地放鬆頸部肌肉。

參考資料:  www.ispine.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的骨科醫生查詢，而不應單倚賴以上提供的資料。

退化性關節炎

中老年人有關節痛是常見的，特別是在膝蓋，人們常稱為風濕，但是這並不等於西醫中的類風濕關節炎，大部分的成因是退化性關節炎。造成退化性關節炎的原因是我們的關節每天都在活動，久而久之關節中的軟骨會變薄、變弱，進而慢慢磨損。

當你感到膝前痛，特別是下樓梯時，這就是個信號告訴你，你的膝蓋軟骨開始變弱了。當膝關節的軟骨變薄、變弱的時候，就會造成痛症，而骹膜會增厚，骨增生或骨刺，發炎、腫脹等等，這樣的退化在每個人身上都有發生，但是對人的影響則因人而異，但這並不代表我們要避開日常的活動與運動，而是要去訓練肌肉，特別是四頭肌，去減少膝蓋的壓力。怎樣才是正確的訓練方法，就需要請教骨科醫生或物理治療師。

退化性關節炎治療

如果有比較嚴重的痛症發生，可以利用關節炎藥，如消炎止痛藥去止痛，並且用拐杖助行。

如果痛症嚴重得會影響行走及日常生活，經骨科醫生適當的診斷後，有些情況可以用骨科手術去改善，例如膝蓋內有碎骨及半月板損傷，可選擇內窺鏡手術。如果痛症情況更嚴重，則需要考慮全膝關節更換手術。至於何時需要更換關節，並不取決於X光片，而是取決於痛的程度，及它對生活的影響，以及其他治療效果。

參考資料: www.ispine.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的香港骨科醫生查詢，而不應單倚賴以上提供的資料。

發炎性關節炎

老人家經常會受關節痛的困擾，人們常說那是風濕，但是風濕就等於關節痛嗎？其實，我們中國人講的「風濕」與西醫中的關節炎有很大的區別。

關節炎成因

 多數患者的關節痛都是退化性關節炎，成因為關節內軟骨開始磨損而引起的發炎，多數在活動或站立時才會出現疼痛。

關節炎種類

 關節炎主要分為退化性關節炎與發炎性關節炎。簡單來說，發炎性關節炎會有比較明顯的紅腫發熱，退化性關節炎則較輕。

發炎性關節炎 - 常見的分為以下幾類

細菌性關節炎。細菌直接感染關節，引發嚴重發炎，患者的關節會劇痛，身體會發熱或發冷，這些炎症會很快破壞軟骨、韌帶等，細菌甚至會入血，造成休克及生命危險，這是一個緊急情況，必須盡快注射抗生素及進行除創手術。

類風濕關節炎。它是由自我免疫系統引發的慢性疾病，會導致關節及頸椎發炎，在白人中比較常見，尤其是女性，亞洲人的病發率較低。要診斷類風濕關節炎需要符合一定的診斷標準，如：臨床檢查、驗血、X光、類風濕因子 (rheumatoid factor) 等等，所以真正患有類風濕關節炎的患者在所謂有”風濕”的人群中只占少數。

骨科醫生在治療類風濕關節炎上的責任是當病人的骨骼組織受到破壞時，幫病人做矯形手術。隨著醫療的發展，類風濕關節炎的治療方法已經進步了許多，風濕病科醫生會因應患者病情，利用藥物去幫病人控制痛楚及防止它破壞患者的骨骼組織，降低對生活的影響。

反應性關節炎。患者身體裡面其他部位有細菌感染，進而令關節發炎。它是短暫性的，單一關節的發炎。

    痛風。患者血液內的尿酸濃度突然上升或下降，令關節內的尿酸結晶體結晶或溶解，它來得很快，關節會紅腫得很嚴重，服用適當痛風藥物後，通常兩三天便會得到舒緩，所以得名痛風。

參考資料: www.ispine.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的骨科醫生查詢，而不應單倚賴以上提供的資料。

Physical therapy & Surgery - Back pain

A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will help prevent pain from returning.

Injections
If other measures don't relieve your pain and if your pain radiates down your leg, your doctor may inject cortisone — an anti-inflammatory medication — into the space around your spinal cord (epidural space).
Surgery
Types of back surgery include:

• Spine navigation surgery. It is a new techniques that can enhance the precision in the surgical regions, reduce the surgical time, reduce radiation exposures to patients and surgeon. Increase safety and accuracy through more precise screw placement and enables minimally invasive approaches.
• Partial removal of disk. If disk material is pressing or squeezing a nerve, your orthopaedics doctor may be able to remove just the portion of the disk that's causing the problem.
• Partial removal of a vertebra. If your spine has developed bony growths that are pinching your spinal cord or nerves, orthopaedics surgeons can remove a small section of the offending vertebra, to open up the passage.
• Fusion. This surgery involves joining two vertebrae to eliminate painful movement. A drawback to the procedure is that it increases the chances of arthritis developing in adjoining vertebrae.

Reference information: knowyourback.org, ispine.com.hk

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your personal physician.

Back pain Prevention

The prevention of back pain is, itself, somewhat controversial. It has long been thought that exercise and an all-around healthy lifestyle would prevent back pain. This is not necessarily true. In fact, several studies have found that the wrong type of exercise such as high-impact activities may increase the chance of suffering back pain. Nonetheless, exercise is important for overall health and should not be avoided. Low-impact activities such as swimming, walking, and bicycling can increase overall fitness without straining the low back.

·        Specific exercises: Talk to your doctor about how to perform these exercises.

Abdominal crunches, when performed properly, strengthen abdominal muscles and may decrease the tendency to suffer back pain.

·         Although not useful to treat back pain, stretching exercises are helpful in alleviating tight back muscles.

·       The pelvic tilt also helps alleviate tight back muscles.

·        Lumbar support belts: Workers who frequently perform heavy lifting are often required to wear these belts. There is no proof that these belts prevent back injury. One study even indicated that these belts increased the likelihood of injury.

• Standing: While standing, keep your head up and stomach pulled in. If you are required to stand for long periods of time, you should have a small stool on which to rest one foot at a time. Do not wear high heels.
• Sitting: Chairs of appropriate height for the task at hand with good lumbar support are preferable. To avoid putting stress on the back, chairs should swivel. Automobile seats should also have adequate low-back support. If not, a small pillow or rolled towel behind the lumbar area will provide adequate support.
• Sleeping: Individual needs vary. If the mattress is too soft, many people will experience backaches. The same is true for sleeping on a hard mattress. Trial and error may be required. A piece of plywood between the box spring and mattress will stiffen a soft bed. A thick mattress pad will help soften a mattress that is too hard.
• Lifting: Don't lift objects that are too heavy for you. If you attempt to lift something, keep your back straight up and down, head up, and lift with your knees. Keep the object close to you, don't stoop over to lift. Tighten your stomach muscles to keep your back in balance.

Reference information: knowyourback.org, ispine.com.hk

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your personal physician.