颈椎腰椎退行性疾病-PPT课件.ppt

1、 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颈椎病颈椎病 Cervical spondylosisCervical 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、vessel

2、s、esophagus Sympton and sign病理病理 PathophysiologyPathophysiology 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临床表现 Clinical findingClinical 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临床表现 Clinical findingClinical finding3

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影像学检查 imaging examinationimaging 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治疗 TreatmentTreatment.保守治疗conserativetreatment traction physicaltherapy.手术治疗surgical treatment decompression f

4、usion颈椎管狭窄颈椎管狭窄 cervical canal stenosiscervical canal stenosis颈椎管容积变小,压迫颈髓 产生神经症状、体征 病理病理athologyathology颈椎管狭窄：.原法性（rimarytenosis）：先天发育性desplasia .继发性（secondarystenosis）：退变性degeneration临床表现临床表现 Clinical findingClinical finding1.症状 sympton:四肢麻木，乏力，活动不灵2.检查 examination:感觉、运动障碍，反射异常临床表现临床表现 Clinical fi

5、ndingClinical finding.raya：颈椎矢状径：临界值mmb：avlov 比值：颈椎管矢状径 颈椎体矢状径.、治疗治疗reatmentreatmentSurgical treatment:1.cervical canal decompression 2.cervical canaloplasty颈椎间盘突出症颈椎间盘突出症 cervical disc herniationcervical disc herniation颈椎间盘退变 椎间盘突出 脊髓、神经根受压病理病理athologyathologyCervical disc degenertion fibrosas annu

6、lus rupture nucleus pulposus:a.extrusion b.prolapse pinch、nerve c.sequestration临床表现临床表现clinical findingclinical finding1.sympton:necl pain should pain weakiness2.examination:movement、sensation、reflex3.imagin examination:CT、MRI治疗治疗treatmenttreatmentvconservative:traction，physical therapyvsurgical:dis

7、cectomy，decompression1.intervertebral fusion颈后纵韧带骨化颈后纵韧带骨化Ossification of the posterior longitudinal ligamentOssification of the posterior longitudinal ligament Opll compression of the spinal Cord fysfunction of the nerve 临床表现临床表现clinical findingclinical finding1.sympton and sign:头颈痛，感觉，运动障碍，二便障碍.、：

8、连续型，节段型，局灶型，混合型治疗治疗treatmenttreatment1.conservative:traction physical therapy2.surgical:anterior decompression and fusion posterior canaloplasty腰椎退变性疾病Lumbar degenerative disease腰椎间盘突出症腰椎间盘突出症Lumbar disc herniationLumbar disc herniation病因病理：Etiology pathology1.外伤injury2.退变degeneration病理生理病理生理pathoph

9、ysiologypathophysiology1.disc herniation compression of nerve low back pain leg pain2.mechanism of pain:a mechanical compression b chemical irritation c autoimmunization类型类型classificationclassification1.膨出bulge2.突出extrusion3.脱突prolapse4.游离sequestration临床表现临床表现Clinical findingClinical finding.症状sympt

10、om: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临床表现Clinical findingClinical finding2.体征sign:a 脊柱畸形spinal deformityb 压痛palpatometryc 腰痛，活动受限：restriction of lumbar move

11、ment,flexion,extension,lateral flexion,rotation临床表现临床表现Clinical findingClinical findingd.感觉，运动，发射异常sense test,musculotonic test,reflexe.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影像学检查影像学检查image examinationimage examination1.X-ray2.CT、MRI 治疗治疗treatmenttreatment1.保守

12、治疗conservation:Bed test,traction,physical therapy,3-4w2.手术治疗surgical腰椎管狭窄症腰椎管狭窄症The lumbar canal stenosisThe lumbar canal stenosis病因 etiology:1.先天性腰椎管狭窄 congenital lumbar canal stenosis2.继发性腰椎管狭窄 secondary lumbar canal stenosis degenerative,traumatic病理病理 PathologyPathology椎管容积缩小 椎管内压力增加1.神经受压、损伤性炎症

13、compression tranmatic inflammation2.神经血运障碍：缺血、静脉回流受阻 ischemia分型分型 classificationclassification1.中央型 central:绝对狭窄10mm 相对狭窄1013mm2.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临床表现临床表现 clinical findingclinical finding特点：症状重、体征轻、间隙性跛行1.症状 symptom:下肢痛

14、 leg pain 下肢麻木 leg numbness 乏力 weakness 排尿困难 bladder dysfunction 下腰痛 low back pain临床表现临床表现 clinical findingclinical finding2.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 影像学检查影像学检查 imgain examinationimgain examination1.X-ray:intervertebralspace,lordosis,osteophyte2.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治疗治疗 treatmenttreatment1.保守治疗 consavertive bed rest,physical therapy2.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