椎管狭窄症可因神经根刺激或受压引起坐骨神经痛。椎管狭窄症的典型症状是在行走时沿坐骨神经走行放射到腿部的坐骨神经痛，当坐下休息后坐骨神经痛症状可缓解。当治疗因椎管狭窄症引起的坐骨神经痛时，脊柱专家会鼓励屈曲练习（向前弯腰）。弯腰时神经通道的管径增加，使神经刺激受圧症状缓解。这就是为什么患者腰椎管狭窄的病人感觉向前弯腰时（比如倚靠手杖、助行器或购物车）比站直时症状减轻。
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Sciatica Exercises for Spinal Stenosis
椎管狭窄症引起的坐骨神经痛锻炼方法
For many people with spinal stenosis, the idea is trying to get flexion restored into your lower spine. A gentle way to do that is begin lying on your back and pulling your knees up to your chest slowly until you feel a light stretch in your low back and hold that about thirty seconds and then release the legs. Notice when I pull my legs up, I like to pull one leg up at a time for added comfort to your low back.
对于椎管狭窄症的人们来说，理念上应尽力保留腰椎的屈曲功能。为达到这样的目的，温和的方式是以仰卧开始，将膝盖缓慢地向胸部靠近，直到感觉腰部有轻微的伸展，保持这个姿势约30秒，然后将腿放下。注意，当我将腿抬起时，我喜欢一次抬起一条腿，以使腰部更加舒适。
Back Flexion Exercises 背部屈曲练习
Another way of adding more flexion to your spine is beginning on hands and knees and sitting back on your heels while your arms stay stretched out, low chest towards the floor. This is a very comfortable stretch and should not be painful. The key here is to make sure your hips remain low to the ground and you don’t reach forward with your hands. Keep your hips back and your head and chest down. Again hold approximately thirty seconds then come back to hands and knees.
另一个增加脊柱屈曲的方法是以手和膝盖着地开始，将背部座落于脚后跟上，将胳膊向前伸展，压低胸部，靠近地板。这样的屈曲是非常舒适的，不应该有疼痛。这一动作的关键点是确保髋部压低靠近地面，不将手向前伸出。保持髋部在后方，头和胸部压低。这样也保持30秒左右，然后再回到手和膝盖支持的姿势。
How to Perform a Pelvic Tilt 如何进行骨盆倾斜练习？
The first thing that’s quite important to learn is a proper way to perform a pelvic tilt. Tilting the pelvis is very important because you need to be able to move the pelvis separate from the spine. So, the easiest way to do this is lying on your back with your knees bent up and think about pulling your bellybutton down towards your spine. Don’t think so much about flattening the back against the floor, but more try to pull the bellybutton towards the spine and your back will automatically flatten towards the floor. So as you pull your bellybutton in, your pelvis will actually roll up towards your chest. This is a position you should hold while you are performing many of these exercises.
首先需要学习的很重要的事是正确进行骨盆倾斜练习。倾斜骨盆是非常重要的，因为您需要活动骨盆使之从脊柱上分开。因此，最简单的方法是仰卧，将双膝弯曲，想像将你的肚脐眼朝脊柱方向压低。不要太多考虑将背平贴着地面，而是更多地尽力将肚脐眼靠近脊柱，背部自然而然地平贴于地面。因此当你将肚脐眼收拢时，骨盆实际上就向胸部卷曲。当你做很多这些练习时，都需要保持这样的姿势。
Hook Lying March Exercise钩状平卧行进练习
Again, begin by performing a pelvic tilt and now slowly raise one leg at a time, only an inch or two, and back down, back and forth. The goal here is to do this without rolling your pelvis side to side and if you lock your pelvis in position, it should stay fairly strait. You should be able to speak while doing these exercises so you are not overworking yourself. Once this exercise is done correctly, you can add a combination. Again, lock your pelvis into position and as you raise your left leg, drop your right arm down over your head. And then alternate back and forth. Here what you don’t want to do is let your pelvis tilt back up and arch your back, so your back should stay relatively still while performing these exercises.
再次以骨盆倾斜练习开始，然后，每次缓慢地抬起一条腿，仅1至2英寸，然后放下，放下后再抬起。其目的是这样做时不要将骨盆卷向任何一侧，似乎您将骨盆锁定在这个位置一样，它能处的位置是很狭窄的。当做这些练习的时候，您可以讲话，这样您就不会做得过度。一旦这些练习做对了，您可以增加一个组合练习。再次将你的骨盆锁定在一个位置，当你抬起左腿，将右手落下高于头部。然后前后交换。这里，你不希望使骨盆倾斜向背上以及将背拱起，因此，当您做这些练习时，背部应该保持相对地静止。
Abdominal Curl-up Exercises 卷腹练习
For strengthening the abdominal muscles, start in the hook lying position, cross your arms over chest, again roll your pelvis backwards to gently flatten the back, and raise your head and shoulders while keeping your belly pulled in. It’s best to move slowly and note we are only coming several inches off the floor. For more of the lower abdominals, lock your pelvis into position, straighten out one knee, and gently raise it six to eight inches off the floor. Avoid arching your back when your leg is flat. And then repeat with the other leg.
为强化腹部肌肉，以钩状卧位开始，在胸前交叉双臀，再将骨盆向后卷曲，轻柔地放平背部，在保持腹部收紧同时将头和肩抬起。最好缓慢地活动，并注意我们仅抬离地板几英坟。为进一步练习下腹部，将骨盆锁定在位，伸直一侧膝关节，并将之轻柔地抬离地面6~8英寸。当腿放平时，避免将背部拱起。然后另一条腿重复练习。
（胡佰文 译）
A3型题 以下提供若干个案例，每个案例下设若干道考题。请根据答案所提供的信息，在每一道考题下面的A、B、C、D、E五个备选答案中选择一个最佳答案。
1~3题共用题干 35岁女性，步行中后仰跌倒，右手掌撑地伤后1小时，右肩痛，不敢活动。检查：右肩方肩畸形，Dugas征(+)。
1.临床诊断首先考虑
A.右肩周软组织损伤
B.右肩关节前脱位
C.肱骨外科颈骨折
D.肱骨解剖颈骨折
E.肩锁关节脱位
2.需要对右肩关节做的辅助检查是
A.X线正位平片
B.X线正侧位平片
C.X线正位及穿胸位平片
D.CT
E.肩关节镜
3.最常见的合并损伤是
A.关节盂骨折
B.肱骨大结节撕脱骨折
C.腋神经损伤
D.腋部动静脉损伤
E.肱骨干骨折
4~6题共用题干 一中年男性，因车祸导致右胫骨中下1/3骨折，行超膝长腿管型石膏固定，一个月后出现右足背感觉减退，背伸无力
4.考虑其原因最有可能是下列哪项损伤
A.胫神经损伤
B.腓总神经损伤
C.腓浅神经损伤
D.胫后神经损伤
E.腓肠神经损伤
5.3个月后行骨折X片复查，骨折无明显移位，但无明显骨痂形成，考虑其原因最可能是
A.骨折处无血供
B.骨折处软组织嵌入
C.石膏较松，骨折处有较大活动度
D.患者进行了局部理疗
E.患者没有进行右下肢负重
6.有关下列骨折中，哪项是错误的
A.胫骨平台骨折易导致创伤性关节炎
B.胫腓骨中段骨折易发生小腿骨筋膜室综合征
C.腓骨小头骨折易损伤腓总神经
D.距骨骨折多发生于距骨颈部
E.胫骨中下1/3骨折常不易发生骨折不愈合
7~8题共用题干男性，26岁，外伤致肱骨中下1/3骨折，来院检查时发现有垂腕征，垂指畸形。
7.该患者合并哪条神经损伤
A.尺神经损伤
B.臂丛神经损伤
C.正中神经损伤
D.桡神经损伤
E.正中、尺神经同时损伤
8.该患者选择哪种治疗方法痛苦小，稳妥
A.立即切开复位，内固定，同时探查并修复损伤神经
B.骨牵引治疗
C.手法复位，夹板固定
D.手法复位，石膏管型固定
E.手法复位，悬垂石膏固定，观察2月，垂腕、垂指无恢复，再行手术治疗
9~13题共用题干 男性，45岁，近3个月来觉头晕，低头以及头部旋转时明显，门诊就诊
9.怀疑颈椎不稳，下列哪项检查有助于确诊
A.颈椎MRI
B.正侧位X线片
C.颈椎CT
D.过伸过屈位X线片
E.脊髓造影
10.患者既往有高血压史5年，1个月前曾晕厥一次，若住院检查，还应行下列哪项检查
A.头颅MRI
B.心电图平板试验
C.脑血流图
D.前庭功能
E.前四项
11.若上述检查均未见异常，下列哪项检查最有助于确诊
A.颈椎MRI
B.颈椎CT
C.颈椎MRA
D.椎动脉造影
E.脊髓造影
12.查体发现患者旋颈试验阳性，四肢感觉运动均未见异常，最可能的诊断是
A.脊髓型颈椎病
B.椎动脉型颈椎病
C.交感型颈椎病
D.混合型颈椎病
E.美尼尔病
13.该患者首选的治疗方案
A.颈椎牵引
B.颈椎按摩
C.手术治疗
D.药物治疗
E.颈托固定
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