颈椎腰椎退行性疾病

单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/4,*,单击此处编辑母版标题样式,LOGO,颈椎病,Cervical spondylosis,颈椎管狭窄症,Cervical canal stenosis,颈椎间盘突出症,Cervical disc herniation,颈椎后纵韧带钙化,Ossification of cervical,posterior / ongitudina / ligament,2020/11/4,1,颈椎病,Cervical spondylosis,颈椎间盘退变 压迫或刺激脊髓、神经、血管、食管 症状和体征,Cervical disc degeneration compression of the spinal cord,、,nerve,、,vessels,、,esophagus,Sympton and sign,2020/11/4,2,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,2020/11/4,3,临床表现,Clinical finding,1.,神经根型,Cervical radiculopathy,神经根性症状、体征,2.,脊髓型,Cervical myelopathy,脊髓受压或缺血 脊髓功能障碍,2020/11/4,4,临床表现,Clinical finding,3.,椎动脉型,Vertebroarterial spondylosis,椎动脉受压或刺激 椎基底动脉供血不全,4.,交感型,Sympathetic spondylosis,颈交感神经受刺激,2020/11/4,5,影像学检查,imaging examination,.,ray,显示颈椎曲度，椎间隙变化,.,显示颈椎管径，椎间盘突出及钙化,.,显示椎间盘信号，硬膜束间隙变化,2020/11/4,6,治疗,Treatment,.,保守治疗,conserative,treatment,traction physical,therapy,.,手术治疗,surgical treatment,decompression fusion,2020/11/4,7,颈椎管狭窄,cervical canal stenosis,颈椎管容积变小,压迫颈髓 产生神经症状、体征,2020/11/4,8,病理,athology,颈椎管狭窄：,.,原法性（,rimary,tenosis,）：先天发育性,desplasia,.,继发性（,secondary,stenosis,）：退变性,degeneration,2020/11/4,9,临床表现,Clinical finding,1.,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,2020/11/4,10,临床表现,Clinical finding,.,ray,a,：颈椎矢状径：临界值,mm,b,：,avlov,比值：颈椎管矢状径,颈椎体矢状径,.,、,2020/11/4,11,治疗,reatment,Surgical treatment: 1. cervical canal decompression,2.cervical canaloplasty,2020/11/4,12,颈椎间盘突出症,cervical disc herniation,颈椎间盘退变 椎间盘突出 脊髓、神经根受压,2020/11/4,13,病理,athology,Cervical disc degenertion fibrosas annulus rupture nucleus pulposus:,a. extrusion,b. prolapse pinch,、,nerve,c. sequestration,2020/11/4,14,临床表现,clinical finding,1.sympton: necl pain should pain weakiness,2.examination: movement,、,sensation,、,reflex,3.imagin examination: CT,、,MRI,2020/11/4,15,治疗,treatment,conservative: traction,，,physical therapy,surgical: discectomy,，,decompression,intervertebral fusion,2020/11/4,16,颈后纵韧带骨化,Ossification of the posterior longitudinal ligament,Opll compression of the spinal Cord,fysfunction of the nerve,2020/11/4,17,临床表现,clinical finding,1.sympton and sign:,头颈痛，感觉，运动障碍，二便障碍,.,、：连续型，节段型，局灶型，混合型,2020/11/4,18,治疗,treatment,1.conservative: traction physical therapy,2.surgical: anterior decompression and,fusion posterior canaloplasty,2020/11/4,19,腰椎退变性疾病,Lumbar degenerative disease,2020/11/4,20,腰椎间盘突出症,Lumbar disc herniation,病因病理：,Etiology pathology,1.,外伤,injury,2.,退变,degeneration,2020/11/4,21,病理生理,pathophysiology,1.disc herniation compression of nerve low back pain leg pain,2.mechanism of pain: a mechanical compression,b chemical irritation,c autoimmunization,2020/11/4,22,类型,classification,1.,膨出,bulge,2.,突出,extrusion,3.,脱突,prolapse,4.,游离,sequestration,2020/11/4,23,临床表现,Clinical finding,.,症状,symptom:,a.,下腰痛,low back pain,low back pain radiating into leg,b.,坐骨神经痛,sciatica,The lumbar nerve root syndrome,C.,麻木,numbness,瘫痪,paralysis,d.,马尾综合征,cauda equina syndrome:,会阴麻木，双下肢不全瘫痪，二便功能障碍,2020/11/4,24,临床表现,Clinical finding,2.,体征,sign :,a,脊柱畸形,spinal deformity,b,压痛,palpatometry,c,腰痛，活动受限：,restriction of lumbar movement, flexion, extension, lateral flexion , rotation,2020/11/4,25,临床表现,Clinical finding,d.,感觉，运动，发射异常,sense test, musculotonic test, reflex,e.,特殊体症,special sign,直腿抬高试验,lesegus test,健肢抬高实验,fajerstajn test,直腿抬高加强试验,bragard test,2020/11/4,26,影像学检查,image examination,1. X-ray,2. CT,、,MRI,2020/11/4,27,治疗,treatment,1.,保守治疗,conservation:,Bed test, traction, physical therapy,3-4w,2.,手术治疗,surgical,2020/11/4,28,腰椎管狭窄症,The lumbar canal stenosis,病因,etiology:,1.,先天性腰椎管狭窄,congenital lumbar canal stenosis,2.,继发性腰椎管狭窄,secondary lumbar canal stenosis degenerative,traumatic,2020/11/4,29,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,compression tranmatic inflammation,2.,神经血运障碍：缺血、静脉回流受阻,ischemia,2020/11/4,30,分型,classification,1.,中央型,central:,绝对狭窄,10mm,相对狭窄,10,13mm,2.,神经根管型,nerve root canal:,a.,盘黄间隙,disc flavum space,b.,侧隐窝,laterral recess,c.,椎间孔,intervertebral faramer,2020/11/4,31,临床表现,clinical finding,特点：症状重、体征轻、间隙性跛行,1.,症状,symptom:,下肢痛,leg pain,下肢麻木,leg numbness,乏力,weakness,排尿困难,bladder dysfunction,下腰痛,low back pain,2020/11/4,32,临床表现,clinical finding,2.,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 ,2020/11/4,33,影像学检查,imgain examination,1.X-ray:,intervertebralspace,lordosis,osteophyte,2.CT,、,MRI:,a.,间盘突出,disc herniation,b.,侧隐窝矢状径,3mm sagittal lateral recess,c.,椎管矢状径,10mm sagittal vertebral canal,2020/11/4,34,治疗,treatment,1.,保守治疗,consavertive,bed rest,physical therapy,2.,手术治疗,surgical,a.,减压术,decompression,间盘切除,Discectomy,椎间孔切开,foraminotomy,椎板切除术,faminactomy,b.,融合术,spinal fusion,2020/11/4,35,