最新颈椎腰椎退行性疾病.ppt

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1、颈椎病Cervicalspondylosis颈椎管狭窄症Cervicalcanalstenosis颈椎间盘突出症Cervicaldischerniation颈椎后纵韧带钙化Ossificationofcervicalposterior/ongitudina/ligament颈椎病Cervicalspondylosis颈椎间盘退变压迫或刺激脊髓、神经、血管、食管症状和体征Cervicaldiscdegenerationcompressionofthespinalcord、nerve、vessels、esophagusSy

2、mptonandsign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Clinicalfinding1.神经根型Cervicalradiculopathy神经根性症状、体征2.脊髓型Cervicalmyelopathy脊髓受压或缺血脊髓功能障碍临床表现Clinicalfinding3.椎动脉型Vertebroarterialspondylosis椎动脉受压或刺激椎－基底动脉供血不全4.交感型Sy

3、mpatheticspondylosis颈交感神经受刺激影像学检查imagingexamination１.　Ｘ－ray　显示颈椎曲度，椎间隙变化２.　ＣＴ　　显示颈椎管径，椎间盘突出及钙化３.　ＭＲＩ　显示椎间盘信号，硬膜束间隙变化治疗Treatment１.保守治疗　conserative　treatmenttractionphysical　therapy２.手术治疗　surgicaltreatmentdecompressionfusion颈椎管狭窄cervicalcanalstenosis颈椎管容积变小,压迫颈髓产生

4、神经症状、体征病理　Ｐathology颈椎管狭窄：１.原法性（ＰrimaryＳtenosis）：先天发育性　desplasia２.继发性（secondary　stenosis）：退变性　degeneration临床表现Clinicalfinding1.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Clinicalfinding３.　Ｘ－ray　a：颈椎矢状径：临界值　１３mmb：Ｐavlov比值：　颈椎管矢状径颈椎体矢状径４.　ＣＴ、ＭＲＩ治疗　Ｔreat

5、mentSurgicaltreatment:1.cervicalcanaldecompression2.cervicalcanaloplasty颈椎间盘突出症cervicaldischerniation颈椎间盘退变椎间盘突出脊髓、神经根受压病理　ＰathologyCervicaldiscdegenertionfibrosasannulusrupturenucleuspulposus:a.extrusionb.prolapsepinch、nervec.sequestration临床表现　clinicalfinding1.

6、sympton:neclpainshouldpainweakiness2.examination:movement、sensation、reflex3.imaginexamination:CT、MRI治疗　　treatmentconservative:traction，physicaltherapysurgical:discectomy，decompressionintervertebralfusion颈后纵韧带骨化OssificationoftheposteriorlongitudinalligamentOpllco

7、mpressionofthespinalCordfysfunctionofthenerve临床表现　clinicalfinding1.symptonandsign:　头颈痛，感觉，运动障碍，二便障碍２.ＣＴ、ＭＲＩ：连续型，节段型，局灶型，混合型治疗　treatment1.conservative:tractionphysicaltherapy2.surgical:anteriordecompressionandfusionposteriorcanaloplasty腰椎退变性疾病Lumbardegenerativedi

8、sease腰椎间盘突出症Lumbardischerniation病因病理：Etiologypathology1.外伤　injury2.退变　degeneration病理生理　pathophysiology1.discherniationcompressionofnervelowbackpainlegpain2.mechanismo