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,*,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,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,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,conserative,treatment,traction physical,therapy,.,手术治疗,surgical treatment,decompression fusion,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,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,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,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,.,、,治疗,reatment,Surgical treatment: 1. cervical canal decompression,2.cervical,canaloplasty,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,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,治疗,treatment,conservative: traction,，,physical therapy,surgical:,discectomy,，,decompression,intervertebral,fusion,颈后纵韧带骨化,Ossification of the posterior longitudinal ligament,O,pll,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,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,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,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,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,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,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,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,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,