頸椎腰椎退行性疾病

1、,頸椎病 Cervical spondylosis 頸椎管狹窄癥 Cervical canal stenosis 頸椎間盤突出癥 Cervical disc herniation頸椎后縱韌帶鈣化 Ossification of cervical posterior / ongitudina / ligament,頸椎病 Cervical s

2、pondylosis,頸椎間盤退變 壓迫或刺激脊髓、神經、血管、食管 癥狀和體征 Cervical disc degeneration compression of the spinal cord 、 nerve 、 vessels 、esophagus Sympton and sign,,,,,病理 Pathophysiology,頸椎間盤退變：a.蛋白多

3、糖、髓核水分減少 纖維環(huán) 裂隙 髓核突出 b.生物力學發(fā)生改變 繼發(fā)性病理變化 后果：刺激、壓迫神經、血管 產生相關癥狀,,,,臨床表現(xiàn) Clinical finding,1.神經根型 Cervical radiculopathy

4、 神經根性癥狀、體征 2.脊髓型 Cervical myelopathy 脊髓受壓或缺血 脊髓功能障礙,,臨床表現(xiàn) Clinical finding,3.椎動脈型 Vertebroarterial spondylosis 椎動脈受壓或刺激 椎－基底動脈供血不全4.交感型 Sympat

5、hetic spondylosis 頸交感神經受刺激,,影像學檢查 imaging examination,１.　Ｘ－ray　顯示頸椎曲度，椎間隙變化２.?。茫浴　★@示頸椎管徑，椎間盤突出及鈣化３.　ＭＲＩ　顯示椎間盤信號，硬膜束間隙變化,治療 Treatment,１.保守治療　conserative　treatment　 traction physical　t

6、herapy２.手術治療　surgical treatment decompression fusion,頸椎管狹窄 cervical canal stenosis,頸椎管容積變小,壓迫頸髓 產生神經癥狀、體征,,病理?。衋thology,頸椎管狹窄： １.原法性（Ｐrimary?。觮enosis）：先天發(fā)育性　desplasia ２.繼發(fā)性（s

7、econdary　stenosis）：退變性　degeneration,臨床表現(xiàn) Clinical finding,1.癥狀 sympton : 四肢麻木，乏力，活動不靈2.檢查 examination:　感覺、運動障礙，反射異常,臨床表現(xiàn) Clinical finding,３.　Ｘ－ray　a：頸椎矢狀徑：臨界值?。保砿m　　　　　　　b：Ｐavlov 比值：　頸椎管矢狀徑　　　　　　　　　　　　　　　　 頸椎體矢狀徑４.

8、?。茫浴ⅲ停遥?,治療?。詒eatment,Surgical treatment: 1. cervical canal decompression 2.cervical canaloplasty,頸椎間盤突出癥 cervical disc herniation,頸椎間盤退變 椎間盤突出

9、 脊髓、神經根受壓,,,病理?。衋thology,Cervical disc degenertion fibrosas annulus rupture nucleus pulposus: a. extrusion b. prolapse pinch、nerve c. sequestration,,,,臨床表現(xiàn)　clinical finding,1.sympton: ne

10、cl pain should pain weakiness2.examination: movement、sensation、reflex3.imagin examination: CT、MRI,治療　　treatment,conservative: traction，physical therapysurgical: discectomy，decompression intervert

11、ebral fusion,頸后縱韌帶骨化Ossification of the posterior longitudinal ligament,Opll compression of the spinal Cord fysfunction of the nerve,,,臨床表現(xiàn)　clinical finding,1.sympton and sign:　頭頸痛，感覺，運動障礙，二便障礙

12、２.ＣＴ、ＭＲＩ：連續(xù)型，節(jié)段型，局灶型，混合型,治療　treatment,1.conservative: traction physical therapy2.surgical: anterior decompression and fusion posterior canaloplasty,,腰椎退變性疾病Lumbar degenerative disease,腰椎間盤突出癥Lum

13、bar disc herniation,病因病理：Etiology pathology1.外傷　injury2.退變　degeneration,病理生理　pathophysiology,1.disc herniation compression of nerve low back pain leg pain2.mechanism of pain: a mechanical compression

14、 b chemical irritation c autoimmunization,,,類型　classification,1.膨出　bulge2.突出　extrusion3.脫突　prolapse4.游離　sequestration,臨床表現(xiàn)　Clinical finding,１.癥狀　symptom

15、: a.下腰痛 low back pain, low back pain radiating into leg b. 坐骨神經痛　sciatica The lumbar nerve root syndrome C. 麻木 numbness,　癱瘓　paralysis d. 馬尾綜合征　cauda equina syndrome: 會陰麻木，雙下肢不全癱瘓，二便功能障礙,臨

16、床表現(xiàn)　Clinical finding,2.體征　sign :a 脊柱畸形　spinal deformityb 壓痛　palpatometryc 腰痛，活動受限：restriction of lumbar movement, flexion, extension, lateral flexion , rotation,臨床表現(xiàn)　Clinical finding,d. 感覺，運動，發(fā)射異?！ense test, musculo

17、tonic test, reflexe. 特殊體癥　special sign 直腿抬高試驗　lesegus test 健肢抬高實驗　fajerstajn test 直腿抬高加強試驗　bragard test,影像學檢查　image examination,1. X-ray2. CT、MRI,治療　treatment,1.保守治療　conservation: Bed test, traction, p

18、hysical therapy,3-4w2.手術治療　surgical,腰椎管狹窄癥The lumbar canal stenosis,病因 etiology:1.先天性腰椎管狹窄 congenital lumbar canal stenosis2.繼發(fā)性腰椎管狹窄 secondary lumbar canal stenosis degenerative,traumatic,病理 Pathology,椎管容積縮

19、小 → 椎管內壓力增加1.神經受壓、損傷性炎癥 compression tranmatic inflammation2.神經血運障礙：缺血、靜脈回流受阻 ischemia,分型 classification,1.中央型 central:絕對狹窄＜10mm 相對狹窄10～13mm2.神經根管型 nerve root canal: a.盤黃間隙 disc fl

20、avum space b.側隱窩 laterral recess c.椎間孔 intervertebral faramer,臨床表現(xiàn) clinical finding,特點：癥狀重、體征輕、間隙性跛行1.癥狀 symptom: 下肢痛 leg pain 下肢麻木 leg numbness 乏力 weakness 排尿困難 bladder dysfunction 下腰痛 low

21、back pain,臨床表現(xiàn) clinical finding,2.體征 sign: 腰椎前凸減少 lordosis ↓ 前屈正常 flexion 后伸受限 extension 肌力減弱 myodynamia ↓,影像學檢查 imgain examination,1.X-ray: intervertebralspace↓,lordosis↓,osteophyte2.CT、MRI: a.間

22、盤突出 disc herniation b.側隱窩矢狀徑＜3mm sagittal lateral recess c.椎管矢狀徑＜10mm sagittal vertebral canal,治療 treatment,1.保守治療 consavertive bed rest,physical therapy2.手術治療 surgical a.減壓術 decompression 間盤切除