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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
2、、 vessels 、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
3、 finding3.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 decomp
4、ression fusion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
5、 Clinical findingClinical 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
6、 fibrosas annulus 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treatmenttreatment1.conservative: traction,physic
7、al therapy2.surgical: discectomy,decompression 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
8、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d
9、egeneration病理生理病理生理pathophysiologypathophysiology1.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 find
10、ingClinical 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临床表现Clinical findingClinical finding2.体征sign :a 脊柱畸形spinal deformityb 压痛palpatometryc
11、腰痛,活动受限:restriction of lumbar movement, 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 examinatio
12、n1. X-ray2. CT、MRI 治疗治疗treatmenttreatment1.保守治疗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
13、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 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 findin
14、gclinical 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:
15、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