腰椎间盘突出症的解剖学基础课件

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edit Master title style,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/9/14,#,腰椎间盘突出症,（lumbar intervertebral disc herniation）,腰椎间盘突出症,1,classicalsymptom,lumbar intervertebral disc herniation,classicalsymptomlumbar interv,2,Contents,腰椎间盘突出症的概念,Add,Add Your Text in here,腰椎间盘突出症的病因,腰椎间盘突出症的发病机制,腰椎间盘突出症解剖学基础,腰椎间盘突出症临床分型,Contents 腰椎间盘突出症的概念AddA,3,腰椎间盘突出症概念,腰椎间盘突出症,是指：腰椎间盘发生退行性改变以后，在外力的作用下，纤维环部分或全部破裂，单独或者连同髓核、软骨终板向外突出，刺激或压迫窦椎神经和神经根引起的以腰腿痛为主要症状的一种病变。腰椎间盘突出症是引起,腰腿痛的最常见原因,。,腰椎间盘突出症概念腰椎间盘突出症是指：腰椎间盘发生退行性改变,4,腰椎间盘突出症解剖学基础,一、腰椎的形态结构,二、腰段椎管,三、椎骨间连结,六、脊神经,五、肌肉和筋膜,四、脊柱的血供,腰椎间盘突出症解剖学基础 一、腰椎的形态结构,5,一、腰椎的形态结构,一、腰椎的形态结构,6,椎骨的形态结构,横突,椎弓,椎体,棘突,下关节突,上关节突,椎孔,椎弓根,(pedicle,P),椎弓板,(lamina,L),Vertebral body,Vertebral arch,Transverse process,spinous process,Inferior articular process,Superior articular process,Vertebral foramen,）,椎骨的形态结构横突椎弓椎体棘突下关节突上关节突椎孔椎弓根(p,7,腰椎的形态结构（前面观）,腰椎的形态结构（前面观）,8,腰椎的形态结构（上面观）,乳突,副突,腰椎的形态结构（上面观）乳突副突,9,腰椎前后面观,腰椎前后面观,腰椎前后面观腰椎前后面观,10,腰椎侧面观,腰椎侧面观,11,腰椎间盘突出症的解剖学基础课件,12,腰椎间盘突出症的解剖学基础课件,13,二、腰段椎管,二、腰段椎管,14,1.,腰椎椎孔的形状,L,12,L,34,L,5,1. 腰椎椎孔的形状L12L34L5,15,腰椎孔（管）的形状,L,4,L,3,L,5,腰椎孔（管）的形状L4L3L5,16,腰段的椎管,前界：为椎体、椎间盘和前纵韧带；,后界：为椎弓板、棘突基底和黄韧带；,两侧界：为椎弓根和椎间孔；,后外侧界：为关节突关节。,椎管分为中央椎管（为硬膜囊占据的部位）和侧椎管（为神经根通道的神经根管部分）。,腰段的椎管前界：为椎体、椎间盘和前纵韧带；,17,椎管：中央椎管和侧椎管（侧隐窝）,椎管：中央椎管和侧椎管（侧隐窝）,18,神经根管,侧隐管：即侧椎管，前为椎体后缘，后为上关节突前面与椎弓根和椎弓板连结处，外为椎弓根的内面。其内侧入口相当于上关节突前缘平面。,神经根管侧隐管：即侧椎管，前为椎体后缘，后为上关节突前面与,19,神经根管,上关节突旁沟：腰神经向外经上关节突小面内缘所形成的沟。,椎弓根下沟：椎间盘明显退变缩窄时，可使上一椎体连同椎弓根下降，后者与椎间盘侧方膨出形成一沟，可使通过的神经根发生扭曲。,神经根管上关节突旁沟：腰神经向外经上关节突小面内缘所形成的,20,椎间管,前为椎体后面及椎间盘，后为黄韧带和椎间关节，上下分别为椎上、下切迹。,椎间管前为椎体后面及椎间盘，后为黄韧带和椎间关节，上下分别,21,腰椎间盘突出症的解剖学基础课件,22,三、椎骨之间的连结,三、椎骨之间的连结,23,三、椎骨间的连,结,黄韧带,椎间关节,（关节突关节）,前纵韧带,后纵韧带,髓核,纤维环,椎间盘,三、椎骨间的连结黄韧带椎间关节前纵韧带后纵韧带髓核纤维环椎间,24,三、椎骨间的连结,前纵韧带,Anterior longitudinal ligament,后纵韧带,Posterior longitudinal ligament,椎间盘,Intervertebral disc,黄韧带,Ligamenta flava,棘上韧带,Supraspinous ligament,棘间韧带,Interspinous ligament,三、椎骨间的连结前纵韧带后纵韧带椎间盘黄韧带棘上韧带Supr,25,横突间韧带,横突间韧带,横突间韧带,棘上韧带,黄韧带,横突间韧带横突间韧带横突间韧带棘上韧带黄韧带,26,椎骨间连结,椎骨间连结,27,椎骨间连,结,椎骨间连结,28,前纵韧带,分为三层，即浅层越过,34,个椎体，中层越过,23,个椎体，深层越过,12,个椎体。,借纤维束紧密附着于各椎体边缘，与椎体疏松相连。,在胸部较腰部宽而坚强。,前纵韧带分为三层，即浅层越过34个椎体，中层越过23个椎,29,上起枢椎，与覆膜延续；下达骶骨。,宽窄不齐，不能完全遮盖椎体的后部和椎间盘。,深层纤维为齿状，与椎体疏松相连，其间隔以静脉丛。,在胸部较腰部宽而坚强。,后纵韧带,上起枢椎，与覆膜延续；下达骶骨。后纵韧带,30,腰椎间盘突出症解剖学基础,椎间盘结构组成,纤维环,髓核,软骨终板,腰椎间盘突出症解剖学基础椎间盘结构组成纤维环,31,腰椎间盘,纤维环,髓核,腰椎间盘纤维环髓核,32,纤维环,髓 核,椎间盘,后纵韧带,前纵韧带,软骨板,骺 环,椎间盘,纤维环髓 核椎间盘后纵韧带前纵韧带软骨板骺 环椎间盘,33,髓核的可塑性,髓核的可塑性,34,髓核突出的方向,髓核突出的方向,35,黄韧带,黄韧带：正常厚度,24mm,，由上向下逐渐增加。除椎间孔和后方正中线的小裂隙（有小静脉通过，并有脂肪填充）外，几乎充满整个椎弓间隙。,黄韧带黄韧带：正常厚度24mm，由上向下逐渐增加。除椎间孔,36,黄 韧 带,由薄而坚韧的黄色弹性纤维构成。,在上附着于上一椎板下缘的前面，向外至同一椎骨的下关节突的根部，直至横突根部；在下附着于下一椎板上缘的后面及上关节突前上缘的关节囊；彼此呈叠瓦状排列。,屈曲时，可使相邻椎弓板稍分开，黄韧带紧张；过伸时可稍缩短，但不皱折突入椎管。,外伤或其它原因，黄韧带变厚（可达,816mm,）为纤维组织，失去正常柔软并能折叠，可引起椎管狭窄及神经根的压迫症状，通常易发生在第,4,、,5,腰椎椎弓板之间。,黄 韧 带由薄而坚韧的黄色弹性纤维构成。,37,关节突关节（椎间关节）和黄韧带,关节突关节（椎间关节）和黄韧带,38,四、,脊柱的血供,四、脊柱的血供,39,四、脊柱的血供,四、脊柱的血供,40,四、脊柱的血供,四、脊柱的血供,41,椎间盘的血液供应,胎儿时期和幼儿：有起自背内侧椎体动脉的轴向椎间盘动脉，邻近脊索。,发生中椎间盘：有背侧、腹侧和轴向椎间盘动脉供应，并在透明软骨板区内互相吻合。,成人椎间盘：几乎完全无血管，仅纤维环周围有小血管穿入，其营养主要靠锥体内血管经软骨板弥散而来。,退行性的椎间盘有血管浸润现象。,椎间盘的血液供应胎儿时期和幼儿：有起自背内侧椎体动脉的轴向椎,42,五、肌肉和筋膜,五、肌肉和筋膜,43,五、肌肉和筋膜,五、肌肉和筋膜,44,五、肌肉和筋膜,五、肌肉和筋膜,45,肌肉和筋膜,肌肉和筋膜,46,肌肉和筋膜,肌肉和筋膜,47,六、脊神经,六、脊神经,48,腰神经后支,在横突间肌的内侧分为内、外侧支。,内侧支在靠近关节突处分布于多裂肌。,外侧支支配骶棘肌。,上,3,个腰神经后支的外侧支，在骶棘肌外侧缘穿背阔肌的腱膜，跨髂嵴后份，分布于臀部皮肤，又称臀上皮神经。,腰神经后支在横突间肌的内侧分为内、外侧支。,49,脊神经后支,脊神经后支,50,窦椎神经（脊膜支）,组成：由脑脊根（起自脊神经或脊神经节）和交感根（起自后交通支或脊神经节）组成，,纤维成分：感觉纤维（传导痛觉和本体感觉）和交感纤维。,行程：经椎间孔返回椎管，向上围绕椎弓根基底，行向椎管前面中线。,分布：发支至后纵韧带、骨膜、硬膜外间隙的血管及硬脊膜，并发支至椎间盘，但是否进入纤维环尚存在不同意见。脊膜支受刺激时可引起腰部及股后肌群反射性痉挛及腰腿痛。,切断脊膜支可使椎间盘、后纵韧带、硬脊膜的本体感觉丧失。,窦椎神经（脊膜支）组成：由脑脊根（起自脊神经或脊神经节）和交,51,脊柱的神经分布,脊柱的神经分布,52,脊神经的脊膜支,脊神经的脊膜支,53,髓核的疝出,髓核的疝出,54,髓核脱出与椎间盘脱出症,椎间盘向后外侧疝出压迫神经根,髓核脱出与椎间盘脱出症椎间盘向后外侧疝出压迫神经根,55,病因,病因,椎间盘退变是,根本原因,损伤,积累损伤是椎间盘退变的,主要原因,妊娠,韧带松弛，腰骶部承受应力大,遗传因素,有色人种发病率较低,发育异常,腰椎骶化、骶椎腰化、关节突不对称等先天发育异常,纤维环、髓核含水量下降,髓核失去弹性,髓核张力下降，椎间盘变薄,软骨板囊性增生,病因纤维环、髓核含水量下降,56,发病机制,发病机制,椎间盘结构组成,椎间盘承受躯干及上肢重量，易劳损；椎间盘仅有少量血液供应，主要营养来源于软骨终板渗透，较为有限，极易发生退变,椎间盘生化组成,纤维环,髓核,软骨终板,胶原 （椎间盘退变时，,型胶原增加，型胶原减少）,蛋白多糖 （椎间盘退变时，蛋白多糖含量下降）,弹性蛋白 （椎间盘退变时，弹性蛋白含量明显减少）,水 （随年龄增长，髓核含水量由出生时的90%下降到30岁的70%，至老年保持较稳定状态）,发病机制纤维环胶原 （椎间盘退变时，型胶原增加，型胶原减,57,腰椎间盘突出症常见的几种分型,腰椎间盘突出症常见的几种分型,58,59,写在最后,成功的基础在于好的学习习惯,The foundation of success lies in good habits,59写在最后成功的基础在于好的学习习惯,谢谢聆听,学习,就是,为了达到一定目的而努力去干,是,为一个目标去战胜各种困难的过程,这个过程会充满压力、痛苦和,挫折,Learning Is To Achieve A Certain Goal And Work Hard, Is A Process To Overcome Various Difficulties For A Goal,谢谢聆听Learning Is To Achieve A C,60,