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被忽视的疼痛

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被忽视的疼痛

by jenius
September 14, 2019
in Highlight, Nutrition
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被忽视的疼痛
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股骨髋臼撞击综合症FAI

明杰一开始觉得髋部有点酸痛,但后来开始加强的痛感让他无法继续参与他最热爱的足球运动。直到他去医院问诊,骨科医生怀疑他可能患上股骨髋臼撞击综合症,希望他配合做更详尽的检查。

股骨髋臼撞击综合征(Femoroacetabular Impingement, FAI)的发生多数在中青年(年龄介于15至40岁人)身上。这个疾病之所以产生可能是因为患者自小在成长发育阶段,股骨与髋臼的构成异形所造成,而患者一般上会出现如髋部疼痛、僵硬、跛行等症状,长期下来,严重者可造成关节炎的问题。

然而,有些FAI患者可能完全不会有任何症状的出现。为了提高民众对FAI问题的醒觉意识,International Medical University(IMU)展开一项座谈会,其中骨科外科顾问Gandhi Nathan Solayar医生、物理治疗师Shailaja Tholkabian和中医师翁葹纭从不同的专业角度,分析他们在治疗FAI中所扮演的角色。

中医针灸 缓解疼痛

在面对疼痛时,其中一个缓解的方式就是通过中医的治疗。手术前,病人可能会面对疼痛问题,而针灸有助于疼痛管理,减低病人的痛楚,而术后,针灸也能帮助患者复原。

然而,在施针当下,一些患者可能会出现麻痹、疼痛等感觉,中医师翁葹纭表示这属于正常的现象。若施针后,病人感觉到尖锐的疼痛,那就必须告诉中医师,以让他们来进行调整。

针灸治疗管理

翁葹纭表示针灸其实是有效、也具安全性的治疗方式。它的副作用不但少之又少、没有毒性,也符合成本效益。一般上,中医师会决定治疗时间,而针灸过程用时会介于15分钟至一小时之间。

“针灸后的效果是要看个人的情况而定,有些人在针灸后可以马上缓解疼痛,而有些人的施针处会有点痛感,但过会儿就会有所好转。”

翁葹纭补充:“家长陪同孩子一起来会诊,能让我们理解病人的情绪,因为情绪也可能影响恢复的进度。因此,通过会诊,我们才能解释哪种治疗方案最适合患者。”—



针灸后的效果是要看个人的情况而定,有些人在针灸后可以马上缓解疼痛,而有些人的施针处会有点痛感,但过会儿就会有所好转。

医学检测

发现病灶

大多时候,常深蹲者或运动员会使FAI情况变得严重。不过,这并不表示运动会导致这个疾病的发生。骨科外科顾问Gandhi Nathan Solayar医生表示若想诊断自身是否面对FAI问题,那就必须从例行检查与病人的病史去做进一步的调查。

为了检测一个患者是否患上FAI,医生会通过两种方式进行检测:

. FADIR(Flexion,Adduction and

Internal Rotation)测试:

这是FAI的专有测试,具安全性,也拥有中等敏感度与独特性。

2. 影像(Imaging):

通过X-光、超声波、电脑断层扫描(CT)或核磁共振成像(MRI)来进行检测,而其中MRI是最能检测出FAI问题的测试,它让医生可以提前进行治疗,并减少并发症的发生。

医学治疗管理

在治疗FAI中,Gandhi医生指出保守治疗、医疗和手术是基本的管理方式。其中包括:

1. 保守治疗:

缓和活动、物理治疗和传统医疗来减轻痛感;

2. 医疗:

止痛药、关节内注射Intra-articular injection来缓解疼痛感;

3. 手术:

若上述方式都已尝试,均无效果,而患者情况也已严重,那将进行开放手术或关节镜手术 Arthrospic 的微创手术。

“一般上,FAI病患的手术至少需用时1小时,而面对较棘手的案例时,可能会用至2个小时。但医生会将手术时间控制在2小时内,最长也只能达致2个小时半,因为长时间的手术会导致神经受损的几率大大提高。”

因此,手术结束后,病人在当日感觉无碍便可出院。医生会在术后教导病人如何运用拐杖,并保护下肢承重,也会检查病人的伤口愈合程度,而一般上约10至14天便可复原。

—


物理治疗 帮助复原

物理治疗往往是术后恢复的关键一环。身为物理治疗师,Shailaja Tholkabian指出他们将会对患者进行的评估,其中包括了解病人的病史、病人面对疼痛问题已有多久、疼痛出现期间是否服用药物,再观察病人的姿势,若有异常,可能就会导致髋部疼痛的问题。

接着,他们会检查病人的肌肉紧绷处、关节僵直的部分,再进行特定评估。他们也会替病人检测关节移动的范围,最后会鉴定是否有肌肉萎缩的症状。

物理治疗师会提供病人一个调查问卷,即髋与腹股沟结果评分(Hip and Groin Outcome Score,HAGOS),针对病人当时的情况,了解症状、僵直程度、疼痛程度、日常身体活动和生活品质,以让病人的康复情况有更好的进展。

物理治疗管理

由于病患可能是年轻一辈,因此父母在孩子康复阶段中需陪伴他们、了解孩子的情况,并清楚康复治疗的步骤,以协助孩子恢复健康。在物理治疗方面,有几种治疗方式,其中包括:

• 电疗

• 肌肉效贴布(Kinesiology Taping)

• 拉伸与增强下肢的特定运动

• 水疗

• 热疗或冷冻治疗

• 软组织操作治疗

• 给予病人指导与教育

• 家里运动规划

在保守治疗中,病人会开始进行轻度拉伸运动来维持疼痛管理。接着,依据病人的进度,在2至3周间进行一些实用的活动训练。慢性疼痛也能运用这样的方式来管理痛楚,只是运用的时间相较久一些。

“术后康复治疗会依据病人的术后程序与复原进度来定制。”Shailaja解释道,并补充:“我们也会与中医和心理治疗部门配合,以提高病人治愈的几率。”

—


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