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作者:杜通 来源:原创 发布日期:09-23

大学生调查报告3000字

腰肌劳损和腰椎间盘突出有什么区别?

????简单讲,如果把腰部平衡看作一个系统,那么腰肌主要负责动态平衡,而腰椎间盘是静态平衡的一部分。动态失衡(腰肌劳损)大多症状较轻而且可以逆转,而静态失衡(腰突症)却会引起更持久的症状而难以逆转。几乎每个上班族都曾饱受腰痛的困扰。当腰痛来袭,站也不是,坐也不是,走几步就“腰部发沉”,坐久了就“直不起腰”,越想尽快缓解它,它就越是如影随形。这种慢性易复发的不适大大影响了我们的工作状态,破坏了我们日常生活的质量。腰部除了承担和维持身体重力以外,还要适应各种活动下动态的变化,这些稳定性和灵活性兼具的协调任务,主要由腰肌来担当,但人体结构在解剖上,总存在诸多限制。如果急性腰部扭伤或长期累积的腰肌劳损,如果未及时获得恰当的治疗,就会发展成慢性腰肌筋膜问题,肌纤维和筋膜在自我修复中,容易产生瘢痕和粘连,加之扭伤伴随的疼痛影响了我们活动发力的范围,久而久之就会造成身体两侧腰肌力量减弱或者失衡。肌纤维粘连另外很大一部分慢性腰部劳损,是来自于“量变到质变”,长期久坐伏案工作(学生、白领)、长期弯腰低头工作(厨师、工厂工人)、反复弯腰发力(农民、手术医生)等不良体位和错误姿势引起的应力累积,就容易造成疲劳创伤。不同姿势发力下腰部受力的差别肌肉软弱不能维持正常腰部功能和位置,使深部韧带受到牵扯,导致周围的神经和血管受到挤压,影响营养供给,腰椎附近炎症物质在脊柱周围肌肉缝隙间形成“堰塞湖”,积聚而无法排出,于是就产生了压痛点。患者因为怕痛,在活动中总是有意无意地避免使用这部分的肌群,肌肉长期不使用,就会发生萎缩,加之周围炎症物质的堆积,肌纤维之间还会互相粘连,肌肉的弹性大不如前,而影响腰部的活动有赖于多种肌群的协调配合,当一组肌群发生问题时,整个动态平衡的体系也会发生“蝴蝶效应”。同样的情况在韧带层面也有发生,一侧韧带和软组织随着劳损减小强度和张力而松弛,而另一侧则因张力过大而缩短,平衡失调,疼痛扩散,牵扯上下肢在各种活动中都出现不稳定的姿态,韧带的动态失衡,常常会影响椎体之间的平衡。如果以上的文字理解起来有些吃力,可以直接看下图,如果说脊柱是一艘帆船的桅杆和船体,那么脊柱周围的肌肉韧带就像缆绳。动态平衡系统和静态平衡系统肌肉力量失调、肌肉痉挛和肌肉挛缩是形成慢性腰痛的“三重前奏”,而作为“主旋律”的腰椎间盘突出和椎管狭窄,一般都在腰部肌群出现问题之后,没有得到及时纠正,不良刺激始终贯穿,旧的创伤和新的损伤交杂,才逐渐从肌群的动态失衡转变为腰椎间盘突出等静态的结构失衡。「椎间盘突出」微观看在大嚼羊蝎子和牛尾的时候,好吃的源头来自于这两个部位之间的「软骨」特别「薄脆」但又很有嚼劲的口感。羊的脊柱——“羊蝎子”掰开来可以看到脊柱中的椎间盘当我们仔细看的时候,会发现这两部分的软骨并不与喝骨头汤时候啃骨表面的软骨一样。它们就像年轮一样,一层包着一层,紧密又富有弹性。这就是椎间盘独有的结构——纤维软骨(Fibro cartilages)。椎间盘由这些纤维软骨在外层形成厚实的「纤维环」(Annulus,拉丁语,Anus是“环”的意思),这些富有弹性又牢固的纤维环一层层包围着椎间盘中间一块像果冻一样的结构——「髓核」(Nucleus pulposus)。前后左右都由纤维环紧紧围绕,而上下两个部分就由两块被称为「软骨终板」(Cartilage endplates)的结构像三明治一样紧紧的夹住髓核。对,这就是大家一直听到也总是会吃但很少仔细观察的「椎间盘」。他的结构就像芝麻汤团一样,厚实的糯米(纤维软骨)包裹着流体的芝麻馅儿(髓核)。在实验室,我们会把动物的脊柱包在石蜡块里,然后把这块类似琥珀的东东在切片机下切成平均5微米的薄片,放在载玻片上,染上想要的颜色,在显微镜下就可以看到更微观的结构了。这种蓝色的染色是甲苯胺蓝(Toluidine Blue),因为其中的阳离子有染色作用,所以能与组织细胞里的酸性物质结合现出颜色。在椎间盘中,纤维环的「胶原纤维」和其中活动的「软骨细胞」都可以看得非常清楚。根据这两张染色片,我们可以清楚地观察到椎间盘的纤维环其实是一层一层平行排列的胶原纤维组成的,大约15-25层左右。而在正面观察,每一层的胶原纤维走向又是各不相同,相邻之间的斜角大约60度。这样一个15-25层各不相同夹角的纤维环,椎间盘外围就像建筑工地上的「脚手架」,作为第一层屏障,来抵御脊柱轴向(沿着脊柱)的压缩和拉伸以及左右弯折和旋转所带来的外力冲击。当外力逐渐增大,纤维环吸收外力冲击的同时也会发生形变,主要表现是逐渐向两侧弯曲,这也是大部分影像报告上所提到的「椎间盘膨出」。如果减少局部的外力,纤维环的形变会慢慢恢复,所以「椎间盘膨出」是可逆的。均匀分布在胶原纤维上的软骨细胞,为胶原纤维提供足够的营养并不断加固它们。如果局部位置细胞数量减少,这片纤维环就会变得脆弱并在外力作用下发生撕裂。为了更清楚地观察蛋白多糖分布,我们采用Safrainin O/fast green的染色方法,胶原及蛋白多糖丰富的部分被染成不同层级的橙红色,而骨骼部分则是蓝绿色。根据这张染色片,很清楚的就可以看到椎间盘这个汤团切开之后到底是怎么样的。图中红色透亮区域就是椎间盘中心的「髓核」。它主要由放射状的分布着弹性纤维(elastin fibres)和外层随机分布的胶原蛋白(collagen fibres)组成。弹性纤维主要由含水量非常高的蛋白聚糖(Aggrecan)组成,通过液体的渗透压(Osmotic pressure)成为第二成屏障,来吸收脊柱传来的外来冲击。一个思考:如果纤维环撕裂了,含水量巨大的髓核流出来怎么办?当髓核顺着纤维环撕裂的缝隙一点一点的流出来,流到外面,随着水分的脱干,结构也会越变越硬,当流出椎间盘的时候,髓核已几乎成为了固体,这就是「椎间盘突出」。椎间盘突出主要的危害就是压迫到附近的神经或者脊髓组织,造成慢性压迫的二次损伤,平时的手麻、脚麻以及其他一些神经放射症状都是因为突出的椎间盘压迫到神经根。而严重的情况下,当椎间盘压迫到脊髓,会出现更多感觉和运动障碍(冷热觉不敏感、精细活动障碍)。根据这个过程,椎间盘突出一旦形成是无法逆转恢复回去的,即使微创手术可以把突出物消融,可以把纤维环修复完整,但是这一块椎间盘里的髓核是缺少的。即使水平再高超的手术医生,都无法让第一层防护纤维环的结构完全恢复成原状,更无法在髓核内补充足够的蛋白多糖,因为治疗手段的局限,这个方法可以改善因为椎间盘突出的使得这一段椎间盘承重的能力也会大不如前。另一个思考:椎间盘退变是不是和椎间盘突出很有关联?40岁之后,超过60%的人在MRI影像上会发现椎间盘退行性改变(退变)。而退变直接发生在椎间盘对抗外力的两层防护上,所以可以说,椎间盘退变很大程度上会加大椎间盘突出的风险。 图中发黑部分的那一段椎间盘就是退变的椎间盘且正在突出。椎间盘退变主要分为两步走:1. 随着年龄增大,椎间盘中间的髓核脱水,蛋白多糖开始分解; 2. 随着劳损积累,椎间盘周围纤维环排列出现紊乱及撕裂。在染色切片中,我们就可以看到,相比于正常椎间盘,退变的椎间盘内部的结构显得更加紊乱,椎间盘纤维环之间存在多处撕裂的缺口。在纤维环构成的一条条路径上分布的细胞变得更少,加固工程越来越懈怠,使得椎间盘纤维环的胶原越来越脆弱,这就是退变的椎间盘难以承受外力引起突出的主要因素。似乎无论我们如何努力,都无法抵御岁月在我们身上刻下的印记。所幸我们还有肌肉和韧带,它们是脊柱抵御外力冲击的另外两层防护,而这两层防护真的可以做到“事在人为”的。「腰肌劳损」微观看腰肌是一组非常复杂的肌肉系统,竖脊肌虽然只是冰山一角,但它们的形态特征和功能表现是整组腰肌的典型代表。 这是菜场里我们可以看到的竖脊肌因为需要“跨过”多个脊柱节段,所以腰肌一般比较长,而且呈“条束状”。这是在腰椎MRI里我们可以看到的竖脊肌位于脊柱椎体棘突的两侧后方,因为日常姿势与行为习惯,两侧截面积往往会有不对称。虽然MRI是平躺中检查的,肌肉截面积大小不足以证明肌肉力量和弹性,但是有经验的医生还是可以通过两侧肌肉的灰度和大小来推测病人日常活动的习惯。这是实验室切片里看到的竖脊肌肌纤维横截面通过这一系列不同尺度的观察,作为有科研素养有临床经验的医疗工作者,可以获得什么启发并应用于实际呢?首先,结合第一类直观的肌肉形态和弹性,医生在查体时候可以直接通过触觉获得日常肌肉运动的情况; 其次,根据MRI影像,医生可以通过视觉,观察两侧肌肉的灰度和大小来推测病人日常活动的习惯; 最后,医生可以通过深度触诊感受到位于肌肉深部的炎症,然后调出大脑中丰富的解剖和运动学知识,来推测哪一部分肌肉在运动中发生了急性或慢性的损伤 腰部不适的原因各种各样,但是人们总是特别在意“腰椎间盘突出”,大部分的问题也都集中于“我的腰椎间盘突出还能回去吗?”—— 其实,除了椎间盘突出以外,脊柱周围软组织和肌群的炎症和痉挛也是引起腰痛的一个重要原因。腰部肌群由许许多多像“里脊肉”一样的条束状肌肉共同组成,它们互相交错、协同配合,一起帮助脊柱和椎间盘来支撑直立时候的体重,并且让身体可以自由地弯腰、伸腰和旋转。日常腰肌劳损怎么自查?大部分人的腰痛并不太严重,日常活动时不会感到疼痛,发力也不会受到影响,远端下肢更不会出现麻木无力的神经放射症状,但当他们跑去做手法推拿的时候,治疗师手指对腰部做的深层按压,会引起非常严重的酸胀疼痛感。造成这些症状的问题,不在腰部肌群,也不在腰椎关节和椎间盘,而是在肌肉表面覆盖的肌筋膜。「肌筋膜炎」,就是引起腰部按压酸胀感最常见的一种软组织损伤,主要发生在各种肌群叠加在一起协同发力的部位,如颈部、肩部、腰部和臀部。许多人或多或少都会在这些部位上受到挤压,会有酸胀感,甚至剧烈疼痛会被一触即发,这些敏感的按压区域我们称之为称为“激痛点”,是肌筋膜炎特有的现象。这些“激痛点”主要分布在肌筋膜和骨相连的部位,众多肌肉的肌腱从连接的骨表面开始束状分支,也是受力最集中的区域,肌肉劳损和拉伤所产生的炎症物质也会积蓄在这里,当按压时,肌肉受到牵拉、更多炎症物质接触到神经末梢、有陈伤的肌筋膜等软组织被进一步牵拉,都会引起局部疼痛刺激,但并不会沿着神经分布形成进一步的放射症状。除了按压会引发酸痛感以外,潮湿阴冷的天气变化,也会通过让肌肉痉挛而使肌筋膜积聚炎症物质,造成粘连和增生。这些皮下肌肉间的粘连物用手指按压可以感觉到,条索状半游移的形态,是受损的肌肉纤维和周围脂肪组织聚合而成的纤维性组织。针对颈腰不适所做的手法治疗或小针刀治疗,治疗原则就是“撕开”这些多余粘连,用短期的疼痛难忍来交换未来功能的改善。和慢性劳损的肌筋膜炎症压痛不同,活动量较大的青壮年大多是腰椎活动过度引起的摩擦和牵拉,以第3节腰椎的横突最常见,因此也被称为“第三腰椎横突综合征”。第3节腰椎两侧横突特别长,水平向两侧延伸,横突周围有血管和神经交叉经过,还有较多腰椎两侧肌群的筋膜附着。同时,第3腰椎正好在腰椎生理前凸弧度的顶点,恰好经过躯干的重心线,是承受重力并传递负荷的重要结构。腰椎结构图示活动中身体侧向发力时,连接横突的一侧椎旁肌收缩,对侧横突就会因为杠杆作用而上撬,活动范围比较大,需要通过腰椎周围各种肌群协作才能维持平衡,如果缺少其他肌群协作,仅靠一侧椎旁肌收缩产生活动,容易造成对侧单一肌群过度牵拉损伤,肌纤维撕裂后出血、粘连和筋膜挛缩,使周围血管神经受到摩擦、刺激和压迫,由此产生症状。与肌筋膜炎不同的是,腰三横突综合征和受到的外力作用关系很大,常常在运动或工作中发力不当,而产生或者加重症状,主要表现出来的疼痛,除了集中在单侧或者两侧以外,还会扩散到臀部、大腿后侧、腹部等处,但不会影响走路姿势。因为病变部位仅在腰椎周围软组织,几乎不伴有腰椎结构的异常改变,因此非手术治疗(封闭注射、物理治疗、推拿手法)就足以缓解症状。如果不及时积极治疗,放任其粘连和疼痛不断加重,就容易引起腰椎和椎间盘等静力平衡结构的变化。其实,引起腰痛除了腰肌劳损、腰椎间盘突出、腰肌筋膜炎,腰椎间关节紊乱和腰椎终板炎也同样会引起更反复的腰痛。因此更精准的评估和诊断比全方位的治疗更重要。相关内容还可以移步阅读,并关注我的专栏——孙悦礼:腰椎也会得关节炎吗??zhuanlan.zhihu.com孙悦礼:椎间盘突出的东东到底长啥样??zhuanlan.zhihu.com孙悦礼:小蛮腰的正确使用方法?zhuanlan.zhihu.com也可以关注我的Live,里面有更详细的答疑和讲解——重新认识腰椎病?www.zhihu.com颈腰椎病治疗的利弊和选择?www.zhihu.com

jian dan jiang, ru guo ba yao bu ping heng kan zuo yi ge xi tong, na me yao ji zhu yao fu ze dong tai ping heng, er yao zhui jian pan shi jing tai ping heng de yi bu fen. dong tai shi heng yao ji lao sun da duo zheng zhuang jiao qing er qie ke yi ni zhuan, er jing tai shi heng yao tu zheng que hui yin qi geng chi jiu de zheng zhuang er nan yi ni zhuan. ji hu mei ge shang ban zu dou ceng bao shou yao tong de kun rao. dang yao tong lai xi, zhan ye bu shi, zuo ye bu shi, zou ji bu jiu" yao bu fa chen", zuo jiu le jiu" zhi bu qi yao", yue xiang jin kuai huan jie ta, ta jiu yue shi ru ying sui xing. zhe zhong man xing yi fu fa de bu shi da da ying xiang le wo men de gong zuo zhuang tai, po huai le wo men ri chang sheng huo de zhi liang. yao bu chu le cheng dan he wei chi shen ti zhong li yi wai, hai yao shi ying ge zhong huo dong xia dong tai de bian hua, zhei xie wen ding xing he ling huo xing jian ju de xie tiao ren wu, zhu yao you yao ji lai dan dang, dan ren ti jie gou zai jie pou shang, zong cun zai zhu duo xian zhi. ru guo ji xing yao bu niu shang huo chang qi lei ji de yao ji lao sun, ru guo wei ji shi huo de qia dang de zhi liao, jiu hui fa zhan cheng man xing yao ji jin mo wen ti, ji xian wei he jin mo zai zi wo xiu fu zhong, rong yi chan sheng ban hen he zhan lian, jia zhi niu shang ban sui de teng tong ying xiang le wo men huo dong fa li de fan wei, jiu er jiu zhi jiu hui zao cheng shen ti liang ce yao ji li liang jian ruo huo zhe shi heng. ji xian wei zhan lian ling wai hen da yi bu fen man xing yao bu lao sun, shi lai zi yu" liang bian dao zhi bian", chang qi jiu zuo fu an gong zuo xue sheng bai ling chang qi wan yao di tou gong zuo chu shi gong chang gong ren fan fu wan yao fa li nong min shou shu yi sheng deng bu liang ti wei he cuo wu zi shi yin qi de ying li lei ji, jiu rong yi zao cheng pi lao chuang shang. bu tong zi shi fa li xia yao bu shou li de cha bie ji rou ruan ruo bu neng wei chi zheng chang yao bu gong neng he wei zhi, shi shen bu ren dai shou dao qian che, dao zhi zhou wei de shen jing he xue guan shou dao ji ya, ying xiang ying yang gong ji, yao zhui fu jin yan zheng wu zhi zai ji zhu zhou wei ji rou feng xi jian xing cheng" yan sai hu", ji ju er wu fa pai chu, yu shi jiu chan sheng le ya tong dian. huan zhe yin wei pa tong, zai huo dong zhong zong shi you yi wu yi di bi mian shi yong zhe bu fen de ji qun, ji rou chang qi bu shi yong, jiu hui fa sheng wei suo, jia zhi zhou wei yan zheng wu zhi di dui ji, ji xian wei zhi jian hai hui hu xiang zhan lian, ji rou de tan xing da bu ru qian, er ying xiang yao bu de huo dong you lai yu duo zhong ji qun de xie tiao pei he, dang yi zu ji qun fa sheng wen ti shi, zheng ge dong tai ping heng de ti xi ye hui fa sheng" hu die xiao ying". tong yang de qing kuang zai ren dai ceng mian ye you fa sheng, yi ce ren dai he ruan zu zhi sui zhe lao sun jian xiao qiang du he zhang li er song chi, er ling yi ce ze yin zhang li guo da er suo duan, ping heng shi tiao, teng tong kuo san, qian che shang xia zhi zai ge zhong huo dong zhong dou chu xian bu wen ding de zi tai, ren dai de dong tai shi heng, chang chang hui ying xiang zhui ti zhi jian de ping heng. ru guo yi shang de wen zi li jie qi lai you xie chi li, ke yi zhi jie kan xia tu, ru guo shuo ji zhu shi yi sou fan chuan de wei gan he chuan ti, na me ji zhu zhou wei de ji rou ren dai jiu xiang lan sheng. dong tai ping heng xi tong he jing tai ping heng xi tong ji rou li liang shi tiao ji rou jing luan he ji rou luan suo shi xing cheng man xing yao tong de" san chong qian zou", er zuo wei" zhu xuan lv" de yao zhui jian pan tu chu he chui guan xia zhai, yi ban dou zai yao bu ji qun chu xian wen ti zhi hou, mei you de dao ji shi jiu zheng, bu liang ci ji shi zhong guan chuan, jiu de chuang shang he xin de sun shang jiao za, cai zhu jian cong ji qun de dong tai shi heng zhuan bian wei yao zhui jian pan tu chu deng jing tai de jie gou shi heng. zhui jian pan tu chu wei guan kan zai da jue yang xie zi he niu wei de shi hou, hao chi de yuan tou lai zi yu zhe liang ge bu wei zhi jian de ruan gu te bie bao cui dan you hen you jue jin de kou gan. yang de ji zhu" yang xie zi" bai kai lai ke yi kan dao ji zhu zhong de zhui jian pan dang wo men zi xi kan de shi hou, hui fa xian zhe liang bu fen de ruan gu bing bu yu he gu tou tang shi hou ken gu biao mian di ruan gu yi yang. ta men jiu xiang nian lun yi yang, yi ceng bao zhe yi ceng, jin mi you fu you tan xing. zhe jiu shi zhui jian pan du you de jie gou xian wei ruan gu Fibro cartilages. zhui jian pan you zhei xie xian wei ruan gu zai wai ceng xing cheng hou shi de xian wei huan Annulus, la ding yu, Anus shi" huan" de yi si, zhei xie fu you tan xing you lao gu de xian wei huan yi ceng ceng bao wei zhe zhui jian pan zhong jian yi kuai xiang guo dong yi yang de jie gou sui he Nucleus pulposus. qian hou zuo you dou you xian wei huan jin jin wei rao, er shang xia liang ge bu fen jiu you liang kuai bei cheng wei ruan gu zhong ban Cartilage endplates de jie gou xiang san ming zhi yi yang jin jin de jia zhu sui he. dui, zhe jiu shi da jia yi zhi ting dao ye zong shi hui chi dan hen shao zi xi guan cha de zhui jian pan. ta de jie gou jiu xiang zhi ma tang tuan yi yang, hou shi de nuo mi xian wei ruan gu bao guo zhe liu ti de zhi ma xian er sui he. zai shi yan shi, wo men hui ba dong wu de ji zhu bao zai shi la kuai li, ran hou ba zhe kuai lei si hu po de dong dong zai qie pian ji xia qie cheng ping jun 5 wei mi de bao pian, fang zai zai bo pian shang, ran shang xiang yao de yan se, zai xian wei jing xia jiu ke yi kan dao geng wei guan de jie gou le. zhe zhong lan se de ran se shi jia ben an lan Toluidine Blue, yin wei qi zhong de yang li zi you ran se zuo yong, suo yi neng yu zu zhi xi bao li de suan xing wu zhi jie he xian chu yan se. zai zhui jian pan zhong, xian wei huan de jiao yuan xian wei he qi zhong huo dong de ruan gu xi bao dou ke yi kan de fei chang qing chu. gen ju zhe liang zhang ran se pian, wo men ke yi qing chu di guan cha dao zhui jian pan de xian wei huan qi shi shi yi ceng yi ceng ping xing pai lie de jiao yuan xian wei zu cheng de, da yue 1525 ceng zuo you. er zai zheng mian guan cha, mei yi ceng de jiao yuan xian wei zou xiang you shi ge bu xiang tong, xiang lin zhi jian de xie jiao da yue 60 du. zhe yang yi ge 1525 ceng ge bu xiang tong jia jiao de xian wei huan, zhui jian pan wai wei jiu xiang jian zhu gong di shang de jiao shou jia, zuo wei di yi ceng ping zhang, lai di yu ji zhu zhou xiang yan zhe ji zhu de ya suo he la shen yi ji zuo you wan zhe he xuan zhuan suo dai lai de wai li chong ji. dang wai li zhu jian zeng da, xian wei huan xi shou wai li chong ji de tong shi ye hui fa sheng xing bian, zhu yao biao xian shi zhu jian xiang liang ce wan qu, zhe ye shi da bu fen ying xiang bao gao shang suo ti dao de zhui jian pan peng chu. ru guo jian shao ju bu de wai li, xian wei huan de xing bian hui man man hui fu, suo yi zhui jian pan peng chu shi ke ni de. jun yun fen bu zai jiao yuan xian wei shang de ruan gu xi bao, wei jiao yuan xian wei ti gong zu gou de ying yang bing bu duan jia gu ta men. ru guo ju bu wei zhi xi bao shu liang jian shao, zhe pian xian wei huan jiu hui bian de cui ruo bing zai wai li zuo yong xia fa sheng si lie. wei le geng qing chu di guan cha dan bai duo tang fen bu, wo men cai yong Safrainin O fast green de ran se fang fa, jiao yuan ji dan bai duo tang feng fu de bu fen bei ran cheng bu tong ceng ji de cheng hong se, er gu ge bu fen ze shi lan lv se. gen ju zhe zhang ran se pian, hen qing chu de jiu ke yi kan dao zhui jian pan zhe ge tang tuan qie kai zhi hou dao di shi zen me yang de. tu zhong hong se tou liang qu yu jiu shi zhui jian pan zhong xin de sui he. ta zhu yao you fang she zhuang de fen bu zhe tan xing xian wei elastin fibres he wai ceng sui ji fen bu de jiao yuan dan bai collagen fibres zu cheng. tan xing xian wei zhu yao you han shui liang fei chang gao de dan bai ju tang Aggrecan zu cheng, tong guo ye ti de shen tou ya Osmotic pressure cheng wei di er cheng ping zhang, lai xi shou ji zhu chuan lai de wai lai chong ji. yi ge si kao: ru guo xian wei huan si lie le, han shui liang ju da de sui he liu chu lai zen me ban? dang sui he shun zhe xian wei huan si lie de feng xi yi dian yi dian de liu chu lai, liu dao wai mian, sui zhe shui fen de tuo gan, jie gou ye hui yue bian yue ying, dang liu chu zhui jian pan de shi hou, sui he yi ji hu cheng wei le gu ti, zhe jiu shi zhui jian pan tu chu. zhui jian pan tu chu zhu yao de wei hai jiu shi ya po dao fu jin de shen jing huo zhe ji sui zu zhi, zao cheng man xing ya po de er ci sun shang, ping shi de shou ma jiao ma yi ji qi ta yi xie shen jing fang she zheng zhuang dou shi yin wei tu chu de zhui jian pan ya po dao shen jing gen. er yan zhong de qing kuang xia, dang zhui jian pan ya po dao ji sui, hui chu xian geng duo gan jue he yun dong zhang ai leng re jue bu min gan jing xi huo dong zhang ai. gen ju zhe ge guo cheng, zhui jian pan tu chu yi dan xing cheng shi wu fa ni zhuan hui fu hui qu de, ji shi wei chuang shou shu ke yi ba tu chu wu xiao rong, ke yi ba xian wei huan xiu fu wan zheng, dan shi zhe yi kuai zhui jian pan li de sui he shi que shao de. ji shi shui ping zai gao chao de shou shu yi sheng, dou wu fa rang di yi ceng fang hu xian wei huan de jie gou wan quan hui fu cheng yuan zhuang, geng wu fa zai sui he nei bu chong zu gou de dan bai duo tang, yin wei zhi liao shou duan de ju xian, zhe ge fang fa ke yi gai shan yin wei zhui jian pan tu chu de shi de zhe yi duan zhui jian pan cheng zhong de neng li ye hui da bu ru qian. ling yi ge si kao: zhui jian pan tui bian shi bu shi he zhui jian pan tu chu hen you guan lian? 40 sui zhi hou, chao guo 60 de ren zai MRI ying xiang shang hui fa xian zhui jian pan tui xing xing gai bian tui bian. er tui bian zhi jie fa sheng zai zhui jian pan dui kang wai li de liang ceng fang hu shang, suo yi ke yi shuo, zhui jian pan tui bian hen da cheng du shang hui jia da zhui jian pan tu chu de feng xian. tu zhong fa hei bu fen de na yi duan zhui jian pan jiu shi tui bian de zhui jian pan qie zheng zai tu chu. zhui jian pan tui bian zhu yao fen wei liang bu zou: 1. sui zhe nian ling zeng da, zhui jian pan zhong jian de sui he tuo shui, dan bai duo tang kai shi fen jie 2. sui zhe lao sun ji lei, zhui jian pan zhou wei xian wei huan pai lie chu xian wen luan ji si lie. zai ran se qie pian zhong, wo men jiu ke yi kan dao, xiang bi yu zheng chang zhui jian pan, tui bian de zhui jian pan nei bu de jie gou xian de geng jia wen luan, zhui jian pan xian wei huan zhi jian cun zai duo chu si lie de que kou. zai xian wei huan gou cheng de yi tiao tiao lu jing shang fen bu de xi bao bian de geng shao, jia gu gong cheng yue lai yue xie dai, shi de zhui jian pan xian wei huan de jiao yuan yue lai yue cui ruo, zhe jiu shi tui bian de zhui jian pan nan yi cheng shou wai li yin qi tu chu de zhu yao yin su. si hu wu lun wo men ru he nu li, dou wu fa di yu sui yue zai wo men shen shang ke xia de yin ji. suo xing wo men hai you ji rou he ren dai, ta men shi ji zhu di yu wai li chong ji de ling wai liang ceng fang hu, er zhe liang ceng fang hu zhen de ke yi zuo dao" shi zai ren wei" de. yao ji lao sun wei guan kan yao ji shi yi zu fei chang fu za de ji rou xi tong, shu ji ji sui ran zhi shi bing shan yi jiao, dan ta men de xing tai te zheng he gong neng biao xian shi zheng zu yao ji de dian xing dai biao. zhe shi cai chang li wo men ke yi kan dao de shu ji ji yin wei xu yao" kua guo" duo ge ji zhu jie duan, suo yi yao ji yi ban bi jiao chang, er qie cheng" tiao shu zhuang". zhe shi zai yao zhui MRI li wo men ke yi kan dao de shu ji ji wei yu ji zhu zhui ti ji tu de liang ce hou fang, yin wei ri chang zi shi yu xing wei xi guan, liang ce jie mian ji wang wang hui you bu dui chen. sui ran MRI shi ping tang zhong jian cha de, ji rou jie mian ji da xiao bu zu yi zheng ming ji rou li liang he tan xing, dan shi you jing yan de yi sheng huan shi ke yi tong guo liang ce ji rou de hui du he da xiao lai tui ce bing ren ri chang huo dong de xi guan. zhe shi shi yan shi qie pian li kan dao de shu ji ji ji xian wei heng jie mian tong guo zhe yi xi lie bu tong chi du de guan cha, zuo wei you ke yan su yang you lin chuang jing yan de yi liao gong zuo zhe, ke yi huo de shen me qi fa bing ying yong yu shi ji ne? shou xian, jie he di yi lei zhi guan de ji rou xing tai he tan xing, yi sheng zai cha ti shi hou ke yi zhi jie tong guo chu jue huo de ri chang ji rou yun dong de qing kuang qi ci, gen ju MRI ying xiang, yi sheng ke yi tong guo shi jue, guan cha liang ce ji rou de hui du he da xiao lai tui ce bing ren ri chang huo dong de xi guan zui hou, yi sheng ke yi tong guo shen du chu zhen gan shou dao wei yu ji rou shen bu de yan zheng, ran hou diao chu da nao zhong feng fu de jie pou he yun dong xue zhi shi, lai tui ce na yi bu fen ji rou zai yun dong zhong fa sheng le ji xing huo man xing de sun shang yao bu bu shi de yuan yin ge zhong ge yang, dan shi ren men zong shi te bie zai yi" yao zhui jian pan tu chu", da bu fen de wen ti ye dou ji zhong yu" wo de yao zhui jian pan tu chu hai neng hui qu ma?" qi shi, chu le zhui jian pan tu chu yi wai, ji zhu zhou wei ruan zu zhi he ji qun de yan zheng he jing luan ye shi yin qi yao tong de yi ge zhong yao yuan yin. yao bu ji qun you xu xu duo duo xiang" li ji rou" yi yang de tiao shu zhuang ji rou gong tong zu cheng, ta men hu xiang jiao cuo xie tong pei he, yi qi bang zhu ji zhu he zhui jian pan lai zhi cheng zhi li shi hou de ti zhong, bing qie rang shen ti ke yi zi you di wan yao shen yao he xuan zhuan. ri chang yao ji lao sun zen me zi cha? da bu fen ren de yao tong bing bu tai yan zhong, ri chang huo dong shi bu hui gan dao teng tong, fa li ye bu hui shou dao ying xiang, yuan duan xia zhi geng bu hui chu xian ma mu wu li de shen jing fang she zheng zhuang, dan dang ta men pao qu zuo shou fa tui na de shi hou, zhi liao shi shou zhi dui yao bu zuo de shen ceng an ya, hui yin qi fei chang yan zhong de suan zhang teng tong gan. zao cheng zhei xie zheng zhuang de wen ti, bu zai yao bu ji qun, ye bu zai yao zhui guan jie he zhui jian pan, er shi zai ji rou biao mian fu gai de ji jin mo. ji jin mo yan, jiu shi yin qi yao bu an ya suan zhang gan zui chang jian de yi zhong ruan zu zhi sun shang, zhu yao fa sheng zai ge zhong ji qun die jia zai yi qi xie tong fa li de bu wei, ru jing bu jian bu yao bu he tun bu. xu duo ren huo duo huo shao dou hui zai zhei xie bu wei shang shou dao ji ya, hui you suan zhang gan, shen zhi ju lie teng tong hui bei yi chu ji fa, zhei xie min gan de an ya qu yu wo men cheng zhi wei cheng wei" ji tong dian", shi ji jin mo yan te you de xian xiang. zhei xie" ji tong dian" zhu yao fen bu zai ji jin mo he gu xiang lian de bu wei, zhong duo ji rou de ji jian cong lian jie de gu biao mian kai shi shu zhuang fen zhi, ye shi shou li zui ji zhong de qu yu, ji rou lao sun he la shang suo chan sheng de yan zheng wu zhi ye hui ji xu zai zhe li, dang an ya shi, ji rou shou dao qian la geng duo yan zheng wu zhi jie chu dao shen jing mo shao you chen shang de ji jin mo deng ruan zu zhi bei jin yi bu qian la, dou hui yin qi ju bu teng tong ci ji, dan bing bu hui yan zhe shen jing fen bu xing cheng jin yi bu de fang she zheng zhuang. chu le an ya hui yin fa suan tong gan yi wai, chao shi yin leng de tian qi bian hua, ye hui tong guo rang ji rou jing luan er shi ji jin mo ji ju yan zheng wu zhi, zao cheng zhan lian he zeng sheng. zhei xie pi xia ji rou jian de zhan lian wu yong shou zhi an ya ke yi gan jue dao, tiao suo zhuang ban you yi de xing tai, shi shou sun de ji rou xian wei he zhou wei zhi fang zu zhi ju he er cheng de xian wei xing zu zhi. zhen dui jing yao bu shi suo zuo de shou fa zhi liao huo xiao zhen dao zhi liao, zhi liao yuan ze jiu shi" si kai" zhei xie duo yu zhan lian, yong duan qi de teng tong nan ren lai jiao huan wei lai gong neng de gai shan. he man xing lao sun de ji jin mo yan zheng ya tong bu tong, huo dong liang jiao da de qing zhuang nian da duo shi yao zhui huo dong guo du yin qi de mo ca he qian la, yi di 3 jie yao zhui de heng tu zui chang jian, yin ci ye bei cheng wei" di san yao zhui heng tu zong he zheng". di 3 jie yao zhui liang ce heng tu te bie zhang, shui ping xiang liang ce yan shen, heng tu zhou wei you xue guan he shen jing jiao cha jing guo, hai you jiao duo yao zhui liang ce ji qun de jin mo fu zhuo. tong shi, di 3 yao zhui zheng hao zai yao zhui sheng li qian tu hu du de ding dian, qia hao jing guo qu gan de zhong xin xian, shi cheng shou zhong li bing chuan di fu he de zhong yao jie gou. yao zhui jie gou tu shi huo dong zhong shen ti ce xiang fa li shi, lian jie heng tu de yi ce chui pang ji shou suo, dui ce heng tu jiu hui yin wei gang gan zuo yong er shang qiao, huo dong fan wei bi jiao da, xu yao tong guo yao zhui zhou wei ge zhong ji qun xie zuo cai neng wei chi ping heng, ru guo que shao qi ta ji qun xie zuo, jin kao yi ce chui pang ji shou suo chan sheng huo dong, rong yi zao cheng dui ce dan yi ji qun guo du qian la sun shang, ji xian wei si lie hou chu xue zhan lian he jin mo luan suo, shi zhou wei xue guan shen jing shou dao mo ca ci ji he ya po, you ci chan sheng zheng zhuang. yu ji jin mo yan bu tong de shi, yao san heng tu zong he zheng he shou dao de wai li zuo yong guan xi hen da, chang chang zai yun dong huo gong zuo zhong fa li bu dang, er chan sheng huo zhe jia zhong zheng zhuang, zhu yao biao xian chu lai de teng tong, chu le ji zhong zai dan ce huo zhe liang ce yi wai, hai hui kuo san dao tun bu da tui hou ce fu bu deng chu, dan bu hui ying xiang zou lu zi shi. yin wei bing bian bu wei jin zai yao zhui zhou wei ruan zu zhi, ji hu bu ban you yao zhui jie gou de yi chang gai bian, yin ci fei shou shu zhi liao feng bi zhu she wu li zhi liao tui na shou fa jiu zu yi huan jie zheng zhuang. ru guo bu ji shi ji ji zhi liao, fang ren qi zhan lian he teng tong bu duan jia zhong, jiu rong yi yin qi yao zhui he zhui jian pan deng jing li ping heng jie gou de bian hua. qi shi, yin qi yao tong chu le yao ji lao sun yao zhui jian pan tu chu yao ji jin mo yan, yao zhui jian guan jie wen luan he yao zhui zhong ban yan ye tong yang hui yin qi geng fan fu de yao tong. yin ci geng jing zhun di ping gu he zhen duan bi quan fang wei de zhi liao geng zhong yao. xiang guan nei rong hai ke yi yi bu yue du, bing guan zhu wo de zhuan lan sun yue li: yao zhui ye hui de guan jie yan ma? zhuanlan. zhihu. com sun yue li: zhui jian pan tu chu de dong dong dao di zhang sha yang? zhuanlan. zhihu. com sun yue li: xiao man yao de zheng que shi yong fang fa zhuanlan. zhihu. com ye ke yi guan zhu wo de Live, li mian you geng xiang xi de da yi he jiang jie chong xin ren shi yao zhui bing www. zhihu. com jing yao zhui bing zhi liao de li bi he xuan ze www. zhihu. com

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白宫称特朗普签署预算和债务上限法案

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  新浪美股8月3日讯,美国总统唐纳德特朗普于周五签署法案盗墓笔记话剧_侠大资讯网,将暂停债务上限直到明年大选过后,同时柜中美人_侠大资讯网授权政府增加支出,最终确定了这项两党合作手机热点电脑能用多少_侠大资讯网达成的协议。一些保守派批评该协议将导致赤字严重膨胀。

  特朗普此前曾鼓励共和党议员支持这项由众议院议长南希佩洛西和财政部长史蒂文姆努钦磋商的协议。他在本周早些时候发央视深度财经_侠大资讯网推文称,这份协议“对我们伟大的军队,我们的退伍军人来说意义非凡,还有就业,就业,羊湖和纳木错哪个好_侠大资讯网就业!”

  “共和党人去支持它吧,总有足够的时间削减(债务)!”他写道。

  该协议在众议院以284-149票致命魔术百度云_侠大资讯网获得通过,在参议院以67-28票获得通过。白宫发言人周五表示, 特朗普已经签署相关法案。

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