八年制带教颈椎病课件.ppt

1、Peking University Third Hospital2040岁岁教师、会计、文秘等教师、会计、文秘等得病治病成为时尚得病治病成为时尚科学还没成为时尚科学还没成为时尚Anatomy1Definition2Pathology3Diagnosis4Treatment5l颈椎的连接 l关节（5个）：l椎间盘l钩椎关节l侧块关节（关节突关节）l脊柱功能单位（functional spine unit，FSU）l韧带：l前纵韧带 Anterior longitudinal ligamentl后纵韧带 Posterior longitudinal ligament l项韧带（棘上韧带）l棘间韧带

2、l黄韧带 Ligamentum flavum病因病因发病机发病机制制退变退变压迫或刺激压迫或刺激病理改变对象病理改变对象脊髓受压脊髓受压神经根受压神经根受压神经根受压神经根受压静态压迫静态压迫 椎间盘突出椎间盘突出 骨赘骨赘椎体后缘椎体后缘钩椎关节钩椎关节 发育性椎管狭窄发育性椎管狭窄 后纵韧带骨化后纵韧带骨化动态压迫动态压迫运动运动外力外力颈椎不稳定颈椎不稳定*Radhakrishnan K,Litchy WJ,OFallon WM,et al.Epidemiology of cervical radiculopathy.A population-based study from Roche

3、ster,Minnesota,1976 through 1990.Brain,1994,117:325335.Dubuisson A,Lenelle J,Stevenaert A.Soft cervical disc herniation:a retrospective study of 100 cases.Acta Neurochirurgica,1993,125:115119.Kostova V,Koleva M.Back disorders(low back pain,cervicobrachial and lumbosacral radicular syndromes)and some

4、 related risk factors.Journal of the Neurological Sciences,2001,192:1725*Goldstein B.Anatomic issues related to cervical and lumbosacral radiculopathy.Phys Med Rehabil Clin N Am,2002,13:423-437.*Radhakrishnan K,Litchy WJ,OFallon WM,et al.Epidemiology of cervical radiculopathy.A population-based stud

5、y from Rochester,Minnesota,1976 through 1990.Brain,1994,117:325335.*Yoss RE,Corbin KB,Maccarty CS.Significance of symptoms and signs in localization of involved root in cervical disk protrusion.Neurology 1957;7:673683.交感型颈椎病交感型颈椎病有争议！有争议！椎动脉型颈椎病椎动脉型颈椎病适应征（适应征（indication）：绝大多数的）：绝大多数的CSRCSR、交感型颈椎病，椎动脉型颈椎病交感型颈椎病，椎动脉型颈椎病ACDF保守治疗？手术治疗？保守治疗？手术治疗？如选择手术治疗，何时干预恰当？如选择手术治疗，何时干预恰当？选择何种术式？微创？融合？非融合？选择何种术式？微创？融合？非融合？根据病程长短、症状的严重程度、对患者生活的影根据病程长短、症状的严重程度、对患者生活的影响，结合体格检查和影像学检查，采取个体化、阶响，结合体格检查和影像学检查，采取个体化、阶梯治疗策略梯治疗策略