最新颈椎腰椎退行性疾病-PPT文档

颈椎病Cervicalspondylosis颈椎管狭窄症Cervicalcanalstenosis颈椎间盘突出症Cervicaldischerniation颈椎后纵韧带钙化Ossificationofcervicalposterior/ongitudina/ligament颈椎病Cervicalspondylosis颈椎间盘退变压迫或刺激脊髓、神经、血管、食管症状和体征Cervicaldiscdegenerationcompressionofthespinalcord、nerve、vessels、esophagusSymptonandsign病理Pathophysiology颈椎间盘退变：a.蛋白多糖、髓核水分减少纤维环裂隙髓核突出b.生物力学发生改变继发性病理变化后果：刺激、压迫神经、血管产生相关症状临床表现Clinicalfinding1.神经根型Cervicalradiculopathy神经根性症状、体征2.脊髓型Cervicalmyelopathy脊髓受压或缺血脊髓功能障碍临床表现Clinicalfinding3.椎动脉型Vertebroarterialspondylosis椎动脉受压或刺激椎－基底动脉供血不全4.交感型Sympatheticspondylosis颈交感神经受刺激影像学检查imagingexamination１.Ｘ－ray显示颈椎曲度，椎间隙变化２.ＣＴ显示颈椎管径，椎间盘突出及钙化３.ＭＲＩ显示椎间盘信号，硬膜束间隙变化治疗Treatment１.保守治疗conserativetreatmenttractionphysicaltherapy２.手术治疗surgicaltreatmentdecompressionfusion颈椎管狭窄cervicalcanalstenosis颈椎管容积变小,压迫颈髓产生神经症状、体征病理Ｐathology颈椎管狭窄：１.原法性（ＰrimaryＳtenosis）：先天发育性desplasia２.继发性（secondarystenosis）：退变性degeneration临床表现Clinicalfinding1.症状sympton:四肢麻木，乏力，活动不灵2.检查examination:感觉、运动障碍，反射异常临床表现Clinicalfinding３.Ｘ－raya：颈椎矢状径：临界值１３mmb：Ｐavlov比值：颈椎管矢状径颈椎体矢状径４.ＣＴ、ＭＲＩ治疗ＴreatmentSurgicaltreatment:1.cervicalcanaldecompression2.cervicalcanaloplasty颈椎间盘突出症cervicaldischerniation颈椎间盘退变椎间盘突出脊髓、神经根受压病理ＰathologyCervicaldiscdegenertionfibrosasannulusrupturenucleuspulposus:a.extrusionb.prolapsepinch、nervec.sequestration临床表现clinicalfinding1.sympton:neclpainshouldpainweakiness2.examination:movement、sensation、reflex3.imaginexamination:CT、MRI治疗treatment1.conservative:traction，physicaltherapy2.surgical:discectomy，decompressionintervertebralfusion颈后纵韧带骨化OssificationoftheposteriorlongitudinalligamentOpllcompressionofthespinalCordfysfunctionofthenerve临床表现clinicalfinding1.symptonandsign:头颈痛，感觉，运动障碍，二便障碍２.ＣＴ、ＭＲＩ：连续型，节段型，局灶型，混合型治疗treatment1.conservative:tractionphysicaltherapy2.surgical:anteriordecompressionandfusionposteriorcanaloplasty腰椎退变性疾病Lumbardegenerativedisease腰椎间盘突出症Lumbardischerniation病因病理：Etiologypathology1.外伤injury2.退变degeneration病理生理pathophysiology1.discherniationcompressionofnervelowbackpainlegpain2.mechanismofpain:amechanicalcompressionbchemicalirritationcautoimmunization类型classification1.膨出bulge2.突出extrusion3.脱突prolapse4.游离sequestration临床表现Clinicalfinding１.症状symptom:a.下腰痛lowbackpain,lowbackpainradiatingintolegb.坐骨神经痛sciaticaThelumbarnerverootsyndromeC.麻木numbness,瘫痪paralysisd.马尾综合征caudaequinasyndrome:会阴麻木，双下肢不全瘫痪，二便功能障碍临床表现Clinicalfinding2.体征sign:a脊柱畸形spinaldeformityb压痛palpatometryc腰痛，活动受限：restrictionoflumbarmovement,flexion,extension,lateralflexion,rotation临床表现Clinicalfindingd.感觉，运动，发射异常sensetest,musculotonictest,reflexe.特殊体症specialsign直腿抬高试验lesegustest健肢抬高实验fajerstajntest直腿抬高加强试验bragardtest影像学检查imageexamination1.X-ray2.CT、MRI治疗treatment1.保守治疗conservation:Bedtest,traction,physicaltherapy,3-4w2.手术治疗surgical腰椎管狭窄症Thelumbarcanalstenosis病因etiology:1.先天性腰椎管狭窄congenitallumbarcanalstenosis2.继发性腰椎管狭窄secondarylumbarcanalstenosisdegenerative,traumatic病理Pathology椎管容积缩小→椎管内压力增加1.神经受压、损伤性炎症compressiontranmaticinflammation2.神经血运障碍：缺血、静脉回流受阻ischemia分型classification1.中央型central:绝对狭窄＜10mm相对狭窄10～13mm2.神经根管型nerverootcanal:a.盘黄间隙discflavumspaceb.侧隐窝laterralrecessc.椎间孔intervertebralfaramer临床表现clinicalfinding特点：症状重、体征轻、间隙性跛行1.症状symptom:下肢痛legpain下肢麻木legnumbness乏力weakness排尿困难bladderdysfunction下腰痛lowbackpain临床表现clinicalfinding2.体征sign:腰椎前凸减少lordosis↓前屈正常flexion后伸受限extension肌力减弱myodynamia↓影像学检查imgainexamination1.X-ray:intervertebralspace↓,lordosis↓,osteophyte2.CT、MRI:a.间盘突出discherniationb.侧隐窝矢状径＜3mmsagittallateralrecessc.椎管矢状径＜10mmsagittalvertebralcanal治疗treatment1.保守治疗consavertivebedrest,physicaltherapy2.手术治疗surgicala.减压术decompression间盘切除Discectomy椎间孔切开foraminotomy椎板切除术faminactomyb.融合术spinalfusion