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单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,LOGO,颈椎退行性疾病,Cervical degenerative disease,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,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,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 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,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,治疗 Treatment,.保守治疗conserativetreatment,traction physicaltherapy,.手术治疗surgical treatment,decompression fusion,病理athology,颈椎管狭窄：,.原法性（,rimary,tenosis）：先天发育性desplasia,.继发性（secondarystenosis）：退变性degeneration,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,治疗reatment,Surgical treatment:1.cervical canal decompression,2.cervical canaloplasty,病理athology,Cervical disc degenertion fibrosas annulus rupture nucleus pulposus:,a.extrusion,b.prolapse pinch、nerve,c.sequestration,临床表现clinical finding,1.sympton:necl pain should pain weakiness,2.examination:movement、sensation、reflex,3.imagin examination:CT、MRI,颈后纵韧带骨化,Ossification of the posterior longitudinal ligament,Opll compression of the spinal Cord,fysfunction of the nerve,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,治疗treatment,1.conservative:traction physical therapy,2.surgical:anterior decompression and,fusion posterior canaloplasty,腰椎退变性疾病,Lumbar degenerative disease,腰椎间盘突出症,Lumbar disc herniation,病因病理：Etiology pathology,1.外伤injury,2.退变degeneration,类型classification,1.膨出bulge,2.突出extrusion,3.脱突prolapse,4.游离sequestration,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,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,影像学检查image examination,1.X-ray,2.CT、MRI,治疗treatment,1.保守治疗conservation:,Bed test,traction,physical therapy,3-4w,2.手术治疗surgical,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,分型 classification,1.中央型 central:绝对狭窄,10mm,相对狭窄1013mm,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,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,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,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,治疗 treatment,1.保守治疗 consavertive,b,ed 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,
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