Scientific name of western medicine: bone spur; Scientific name of traditional Chinese medicine: bone arthralgia; Orthopedics: Surgery-Orthopedics; Onset site: joint; Main symptoms: pain and numbness; Main reasons: degeneration and fatigue; Multiple groups: middle-aged people and the elderly; Infectious: non-infectious; Whether to enter medical insurance: Yes;
abstract
Bone spur, commonly known as hyperosteogeny, is a common and frequently-occurring disease in middle-aged and elderly people. The name of this disease has not been unified at home and abroad. It mostly occurs in middle-aged and elderly people over 45 years old, with more men than women. It is very easy for heavy manual workers and athletes who often use their waist to get this disease. Knee, hip, lumbar, cervical and elbow joints are the most common.
Etiology and pathology
The cause of disease
Bone spur belongs to the category of "arthralgia syndrome" in traditional Chinese medicine, also known as "bone arthralgia" Traditional Chinese medicine believes that this disease is related to trauma, strain, blood stasis blocking collaterals, cold and dampness, phlegm and dampness blocking collaterals, liver and kidney deficiency and hyperosteogeny.
1. Pathology: Irregular cartilage injury, subchondral sclerosis, cyst, marginal osteophyte hyperplasia, increased blood flow in metaphysis, synovitis in different degrees in weight-bearing area.
2. Histology: early cartilage surface fragmentation, chondrocyte proliferation, longitudinal crack of cartilage surface, crystal deposition, cartilage repair and osteophyte proliferation; In the late stage, the cartilage was completely destroyed, which showed cartilage sclerosis, cartilage disappearance and subchondral focal osteonecrosis.
3. Biomechanics: The ductility, compression resistance, shear resistance and cartilage permeability of articular cartilage decreased. Cartilage moisture increased, excessive swelling, subchondral bone sclerosis.
4. Biochemical changes: the content (concentration) of proteoglycan decreased, its molecular size and aggregation degree changed, the size and arrangement of collagen fibers and the synthesis and degradation of matrix macromolecules changed abnormally.
5. Nutrition: The root cause of bone spur is lack, mainly the result of stress reaction.
pathology
Osteowart is a phenomenon accompanied by spinal degeneration. With the increase of age, the structure of the human spine will also deteriorate. When the place adjacent to the bone and soft tissue is subjected to pressure, tension and injury for a long time, the cartilage between the spine will gradually lose moisture and elasticity, leading to degenerative changes in the bone. This degenerative change of bone will lead to hyperosteogeny and form osteopetrosis. In addition, repeated activities or inappropriate exercise often lead to excessive wear of bones and soft tissues at joints, resulting in bone spurs.
symptom
Basic symptoms
Osteowart does not necessarily produce symptoms, depending on whether it is compressed to the nerve root or the spine. If not, there will be no uncomfortable symptoms. On the contrary, if the bone spur just compresses the nearby nerve root or spine, symptoms such as body stiffness, pain, redness, paralysis, joint deformation and muscle weakness may occur.
The human spine is prone to degeneration after long-term repeated use. Because of age, middle-aged and elderly people are more prone to bone spurs than ordinary young people. However, with the change of life and work style, some working groups, such as housewives, teachers, financial workers, computer families, factory workers and so on. People who have to sit for a long time, stand for a long time, keep the same posture or use joints incorrectly for a long time may cause excessive wear and tear of bones and soft tissues at joint parts due to overuse and improper use. So bone spurs can be said to happen to everyone.
The joints of human body are prone to pathological changes after long-term activities. Osteowarts usually occur in joints with frequent activities. Because these joints are used repeatedly for a long time, they are easy to wear and degrade. The places where the body is easy to induce the growth of bone spurs are cervical vertebrae, lumbar vertebrae, knee joints and heels. In addition, fingers and elbows are also prone to bone spurs.
Osteowart can cause sciatica, disc herniation, lumbar spinal stenosis, degenerative knee arthritis and other complications, leading to discomfort in patients' lives and even affecting their quality of life. For minor complications, you can rest or follow the advice of the rehabilitation teacher and do some physical therapy to relieve the symptoms. However, when the complications are serious, further surgery is needed.
common symptom
Bone spurs are more common than middle age. It is generally believed that it is due to physical weakness and degradation after middle age; Standing or walking for a long time and maintaining a certain posture for a long time, due to muscle traction or tearing, bleeding, hematoma organization, forming spiny or labial hyperostosis; Bone spurs cause mechanical stimulation and soft tissue injury, bleeding and swelling after trauma.
1. Symptoms of cervical spine spur: Clinical manifestations: strong neck sensation, limited movement, clicking sound in neck movement, pain often radiating to shoulders and upper limbs, numbness and electric shock in hands and fingers, and neck movement can be aggravated. Different lesions involving different parts will lead to different symptoms, which can lead to later paralysis. Severe cervical hyperosteogeny can also cause cervical spondylosis, hypertension, cardiovascular and cerebrovascular diseases, gastritis, angina pectoris and dysphagia.
2. Symptoms of lumbar spine spur: Clinical manifestations: The most common parts are waist 3 and waist 4. Pain, swelling, stiffness, fatigue and even limited bending of waist and soft tissue often occur in clinic. If the adjacent nerve roots are compressed, it can cause corresponding symptoms, such as local pain, stiffness, posterior root neuralgia, numbness and so on. If the sciatic nerve is compressed, it can cause sciatica, leading to severe numbness, burning pain, throbbing pain and string pain in the affected limb, and radiating to the whole lower limb.
3. Symptoms of hyperosteogeny of knee joint: Clinical manifestations: The pain of knee joint in patients with slow onset is not serious at the initial stage, but there is persistent dull pain, which is aggravated when the temperature drops, which is related to climate change. After getting up in the morning, I began to exercise, walked for a long time, exercised vigorously or sat for a long time, and my knee joint was painful and stiff, but it got better after a little exercise, and it was difficult to go up and down the stairs. When I went downstairs, my knee joint was weak and easy to fall. When squatting, the pain is stiff. In severe cases, the joints are sore and limping. Rheumatism patients' joints are swollen and deformed, and their functions are limited. There is a click in flexion and extension. Some patients can see joint effusion, and some have obvious swelling and compression.
4. Symptoms of heel spur: Clinical manifestations: Its symptoms are tenderness at the foot root, pain at the sole of the foot, heavy in the morning and light in the afternoon, unbearable pain at the first step of getting up and going to the ground, light and heavy, afraid to use the heel when walking, and feeling of stoning and acupuncture. Symptoms are relieved after exercise, and there are long bone spurs at the calcaneus, which are more common in middle-aged and elderly people.
diagnostic method
Hospital diagnosis
To diagnose whether it is a bone spur, you can go to the hospital to take an X-ray (CT is not necessary).
self-diagnostic
Judging from personal feelings. Bone spurs mostly occur in cervical vertebrae and lumbar vertebrae, but also in fingers, knees and heels. Cervical hyperplasia has symptoms in the head and upper limbs, and may also affect the whole body, especially the upper limbs. There are no obvious symptoms in this part of the cervical spine, but the symptoms in the upper limbs are obvious. Generally, hyperplasia occurs on one side (left or right), and muscle pain, swelling and numbness may occur from one side to the upper arm and from the lower arm to the fingers.
When this symptom appears in the right arm, if the head leans to the right, the symptom will be aggravated. Symptoms in muscles have nothing to do with weather changes, but only with activities. When the hyperplasia site is in the waist, its symptoms are not in the waist, but start from the sciatic nerve of the hip and reflect along the sciatic nerve to the heel, especially the calf muscles. This shows that it is caused by hyperosteogeny compressing nerves, which can basically be diagnosed. If it appears at a local point, especially only at the joints, it should not be regarded as hyperplasia (except knee joint hyperplasia), and it is best to do rheumatism examination first.
Pain in other muscle parts is different from that caused by bone spurs. Other pains can have symptoms of redness, swelling and fever at the same time, while spur pain does not produce any other symptoms, but is swelling and pain, which is sometimes heavy and sometimes light, with a long course of disease and getting heavier and heavier over the years.
nurse
Emotional nursing
The cause of this disease is deficiency of kidney-qi, stagnation of qi and blood, imbalance of internal and external yin and yang, resulting in pain, inability to move freely, recurrent attacks, easy to make patients feel anxious, lose confidence in curing the disease, and directly affect the therapeutic effect. Nurses should be enthusiastic, so that patients can fully understand the treatment principle and nursing points, so that they can eliminate their worries, stabilize their emotions and establish confidence in overcoming diseases. Can actively cooperate with the treatment, actively enhance functional exercise, and strive for an early recovery.
Diet nursing
Chinese medicine says that the spleen and stomach are the foundation of the day after tomorrow, and diet is closely related to diseases. Eating disorders affect the generation of qi and blood in human body, leading to deficiency of qi and blood and dystrophy of bones and muscles. During the treatment, many drugs were used to promote blood circulation and dredge collaterals. Patients should be instructed to eat more vegetables, fruits and foods containing crude fiber, often eat nuts, pay attention to nutritional supplements, avoid spicy and irritating foods, ban smoking and alcohol, and develop good eating habits.
Matters needing attention
Pay attention to keep warm in the treatment room, and protect the exposed parts of patients during the nursing process to avoid feeling cold. The temperature of fumigation should be suitable for the patient's skin. In particular, it is pointed out that the skin sensitivity of the elderly is reduced, and attention should be paid to avoiding burns during treatment and nursing.
prevent
Precautionary principle
One of the most concerned questions for the elderly with bone spurs is: can you exercise after getting this disease, and how?
Answer affirmatively and responsibly: patients with bone spurs also need exercise, but this kind of exercise must be "moderate" and not too intense. In practice, many patients with bone spurs have no symptoms, which are mostly related to their regular labor and exercise. People who exercise regularly and take part in physical exercise can make their bones strong, even if they suffer from bone spurs, the pain is much more serious. People who don't exercise, lack of blood supply to muscles, often lead to muscle atrophy due to lack of nutrition, and the elasticity in muscles is reduced, which is particularly prone to bone spurs, and once infected, the pain is strong.
Pay attention to cold protection
In the recovery period, it is necessary to avoid the stimulation of environmental factors such as humidity and cold, because these adverse environmental factors can induce inflammation of joints, muscles, nerves and other tissues. If the patient works in a certain posture for a long time, he should pay attention to changing his posture during rest.
Daily health care
acute stage
(1) The pain is aggravated in acute phase, and the activity of the affected joint should be reduced as much as possible. Patients can rest in bed properly and reduce the mechanical stimulation to the affected joints through rest, which not only effectively prevents the aggravation of symptoms, but also creates good conditions for the dissipation of inflammation. It is necessary to take medicine as soon as possible and control the development of the disease through comprehensive treatment of oral and external drugs.
convalescence
(2) In the recovery period, we should avoid the stimulation of environmental factors such as humidity and cold, because these adverse environmental factors can induce inflammation of joints, muscles, nerves and other tissues, and also avoid overwork, which will stimulate the joints and surrounding tissues to become inflamed again, leading to the recurrence of the disease. In addition, outdoor activities and exercise can be appropriately increased to avoid long-term bed rest. For example, patients who work in a certain posture for a long time should pay attention to changing their posture during breaks.
Dietary precautions
balanced diet
Eat foods rich in antioxidants in a balanced diet, such as mango, papaya, melon, grapes, oranges, pineapples, bananas, strawberries, tomatoes, cabbages, potatoes, etc. Bioflavonoids can prevent the destruction of free radicals, slow down inflammatory reactions, accelerate the recovery of sports injuries, and strengthen the formation of colloid.
quick
The elderly should control their diet, maintain proper weight and avoid obesity. Clinically, it is found that obese patients usually have hyperosteogeny in the knee joint, which takes a long time to treat, and the recovery is slower than those with similar conditions and standard weight. The reason is very simple, that is, the weight of obese patients increases the burden on the knee joint, and the wear and damage of the joint is greater. Balanced diet and keeping weight are important links to prevent hyperosteogeny.
misunderstand
Misunderstanding 1
Joint swelling and pain is caused by bone spurs: some people think that bone spurs are the bone ends of nails, bamboo thorns and other deep tissues, which is wrong. Only by stimulating hyperosteogeny for a long time and producing aseptic inflammation around the spur will it cause pain and other symptoms.
Misunderstanding 2
The bigger the bone spur, the more severe the joint swelling and pain: clinically, it is often seen that some patients have bone spurs on both knees, one side is large, but the pain is light or even painless; The spur on the other side is small, but it hurts. This is because the big bone spur did not cause aseptic inflammation around the bone spur, but the small bone spur did. Therefore, the size of the bone spur is not directly related to the degree of pain.
Misunderstanding 3
More exercise will not lead to bone spurs: this understanding is only half right. Experiments show that long-term overload exercise or labor will not only aggravate the wear of articular surface, but also produce high stress on joints, stimulate bone remodeling, accelerate the formation of bone spurs and subchondral sclerosis, and aggravate cartilage degeneration. On the other hand, proper and correct exercise and labor can prevent or treat osteoarthritis. So sports and labor are a double-edged sword.
Misunderstanding 4
Specific drugs can eliminate bone spurs: the composition of bone spurs is the same as that of normal bone tissues. Some so-called specific drugs boast that they can dissolve or remove bone spurs, which is completely false. Although the spur can't be eliminated, the inflammation can subside. As long as the inflammation is eliminated, the pain will be relieved. Therefore, the key to treat hyperosteogeny is not to eliminate bone spurs, but to "permanently" eliminate inflammation caused by bone spurs.
Myth 5
Surgical treatment is superior to conservative treatment: although surgery can remove bone spurs, it should be limited to a few bone spurs that compress nerves, blood vessels and spinal cord, causing serious dysfunction and ineffective conservative treatment. Because the operation itself is a kind of trauma, it will cause aseptic inflammation to some patients and even stimulate bone hyperplasia more quickly. Up to 40% of patients will have bone spurs after 15 years. Therefore, surgical resection may not be able to cut the root.