甚麼是脊椎導航手術？

脊椎導航手術在2000年已開始推出市場，香港亦引入這種技術超過五年。其實類似的導航技術已在日常車輛駕駛、電子遊戲機（例如wii）中廣泛應用。脊椎導航技術能幫助骨科醫生提高脊椎手術的精確度，而且能減低手術中X光輻射攝取量。

 

手術前，骨科醫生會進行適當的診斷和評估病人是否適合脊椎導航手術。

- 除一般因脊椎受傷而需要進行手術的病人外，亦特別適合一些手術位置較微細的病人使用：

- 曾經接受脊椎手術而需要複修的病人；

- 因骨骼退化而骨骼較脆弱的病人，如骨質疏鬆症的病人；

- 受傷位置較難處理，手術風險難高的位置，如位置接近椎動脈的頸骨、嚴重變形的脊椎、椎弓根較狹窄等等。

- 手術前骨科醫生會為病人作3D影像掃描，然後將掃描的3D影像與病人脊椎位置進行電腦配對。手術期間，骨科醫生可透過導航技術，即時分析3D配對影像，提高手術的精確度，例如手術螺絲入骨的深度。

參考資料:  www.hkcos.org.hk , http://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。

Back pain - Physical therapy & Surgery

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.

Intervertebral Disc

The ANNULUS FIBROSUS makes up the outer part of the disc. It consists of collagen fibers containing significant amounts of water and proteoglycans. These fibers are arranged in concentric layers called LAMELLAE. The lamellae are thicker and more numerous in the anterior part of the disc.

Within each lamella, the collagen fibres are oriented obliquely about 30º to the horizontal. The orientation is reversed in each contiguous layer, resulting in a 120º change from layer to layer. This interstriation of fibers imparts great tensile strength and allows for multiplanar motion. The structure of the disc is similar to a radial automobile tire, which also has great strength and simultaneous compression and tension capabilities.

The NUCLEUS PULPOSUS is the internal substance of the disc. The inner fibers of the annulus fibrosus gradually blend with the nucleus pulposus.

The nucleus pulposus is more gelatinous than the annulus and has a higher water and proteoglycan content. The water content can be 85% in young people; in older people, the water content of the nucleus pulposus may be less than 25%. The nucleus pulposus acts to resist compression in axial loading forces.

Besides allowing for motion, the discs act as shock absorbers to prevent injury to the vertebral bodies and neurological struc-tures. However, the discs are so strong that in compression, the vertebral body will fail before the discs fail.

Reference information: 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 orthopedic doctors for diagnosis and treatment.

失去的骨質不能被替換

因為失去的骨質不能被替換，治療骨質疏鬆症主要集中於預防進一步的骨質流失。治療過程通常要由家庭或內科醫生，骨科醫生，婦科醫生和內分泌科醫生的通力合作。

 

運動和營養治療是整個骨質疏鬆症治療計劃的關鍵元素，不過也有其他的治療方法。

雌激素替代療法, Hormone Replacement Therapy, HRT,可用於骨質疏鬆症高危女性身上，避免骨質繼續流失及減少骨折的風險。當更年期開始時進行骨質密度檢查可幫助你決定是否需要ERT。雌激素同時減少 心臟病，改善腦部認知行為，而且改良泌尿的功能。但HRT並非沒有風險，包括增加乳癌的風險。你應該與你的醫生一起討論。

名為SERMs的新反雌激素也已經被引入。它可以增加骨質，減少脊柱骨折的風險，而且降低乳癌的風險。

降血鈣素,Calcitonin,是用來減少骨質流失的另一種藥物。它的噴鼻式配方治療可增加骨質，減少脊柱骨折，而且可能緩和一定程度的痛楚。雙磷酸化合物,Bisphosphonates，包括 Alendronate，可顯著地增加骨質及避免脊柱和髖部骨折。HRT，Alendronate，SERMs和降血鈣素都能幫助骨質疏鬆症患者，不單只增加骨質，也明顯地減少骨折風險。

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。

內側旁系韌帶(MCL)撕裂

如果內側旁系韌帶(MCL)只是部份撕裂, 通常保守治療已經可以。這是包括: 休息, 冰敷, 外壓和提高患處。

休息能給韌帶時間癒合。冰敷是應每次15到20分鐘, 每日二至三次。

外壓患處能控制腫脹。您可以用繃帶作外壓, 而外支架能給膝關節休息。

盡可能把膝蓋舉起。

為了有好康復, 您應該咨詢您的骨科醫生有關受傷後的康復療程。

如果旁系韌是完全的撕毀或無法癒合, 您可能需要動手術。

修複手術可以有好的復完, 能有好膝蓋穩定性。在康復療程後, 許多人能恢復他們先前的活動水平。

康復療程對十字韌帶或旁系韌帶的受傷是不可少的。療程多數包括:

• 被動的膝關節屈曲和伸展去計恢復靈活性。
• 用外支架來控制關節的活動。
• 四頭肌的加強運動。(肌肉力量能在膝蓋關節負重時提供最大支持和固定。)
• 其他的鍛煉運動有高位子腳踏車, 跟隨著是激烈的四頭肌鍛煉。

用枴杖和外支架的時間是跟據您膝蓋康復程度而決定的

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。