頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件

(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展濱醫(yī)煙臺(tái)附院疼痛科孫雪華(》州學(xué)院炮臺(tái)屬選院1(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity內(nèi)容提要定義及流行病學(xué)頸部解剖發(fā)病機(jī)制的魯臨床表現(xiàn)治療(》州學(xué)院炮臺(tái)屬選院2(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity定義頸椎小關(guān)節(jié)源性疼痛(cervicalfacetpain,CFP)因外傷或脊柱退行性變、小關(guān)節(jié)骨質(zhì)增生、骨質(zhì)疏松、頸椎間隙變窄、或頸肌筋膜攣縮等,導(dǎo)致頸椎小關(guān)節(jié)變形牽拉、壓迫或刺激了脊神經(jīng)后支,而引起的頸項(xiàng)部及頭部、肩部、胸背部放射痛,通稱(chēng)為頸椎小關(guān)節(jié)源性疼痛。(》州學(xué)院炮臺(tái)屬選院3(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity流行病學(xué)·慢性頸痛(伴或不伴上肢痛、損傷)是人類(lèi)的常見(jiàn)病,而小關(guān)節(jié)功能紊亂約占頸痛的5%成年人頸痛的發(fā)病率為12.1~71,5%,平均年發(fā)病率為30-~50%(美國(guó))全球頸痛發(fā)病約為4.9%頸痛是世界第四大致殘因素ervicalZygapophysial(FacetJointPain:EffectivenessofInterventionalManagementStrategies.PostgradMed,2019:12841:54-68(》州學(xué)院炮臺(tái)屬選院4(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity解剖前結(jié)節(jié)后結(jié)節(jié)齒狀突關(guān)節(jié)面上關(guān)節(jié)面前結(jié)節(jié)后結(jié)椎板下面觀上面觀寰椎(》州學(xué)院炮臺(tái)屬選院5(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity椎體側(cè)塊齒狀突關(guān)節(jié)面下關(guān)節(jié)面橫突前面觀后面觀側(cè)齒間隙寰樞關(guān)節(jié)寰樞外側(cè)關(guān)節(jié)側(cè)樞外緣側(cè)樞內(nèi)緣(》州學(xué)院炮臺(tái)屬選院6(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity椎脊神經(jīng)溝體橫突上關(guān)節(jié)椎孔椎板分又的棘突橫斷位(》州學(xué)院炮臺(tái)屬選院7(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity椎動(dòng)脈椎動(dòng)脈可分為五段,前四段為顱外段,第五段為顱內(nèi)段:Ⅵ段(橫突孔段:是椎動(dòng)脈在第6-2頸椎橫突孔內(nèi)上升的一段V2段(橫段:指椎動(dòng)脈穿出樞椎橫突孔后,橫行向外的一段V3段〔寰椎段):指從樞椎外端彎曲向上,再垂直上行至寰椎橫突孔為止的一段V4段(枕骨大孔段:指自椎動(dòng)脈V3段上端水平向內(nèi)行一小段后,再?gòu)澫蛏洗怪鄙闲腥胝砉谴罂椎囊欢蜼巧5段(顱內(nèi)段):指椎動(dòng)脈入枕骨大孔后,斜向中線上行與對(duì)側(cè)同名動(dòng)脈匯合成基底動(dòng)脈前的一段椎動(dòng)脈(》州學(xué)院炮臺(tái)屬選院8(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity椎動(dòng)脈(》州學(xué)院炮臺(tái)屬選院9(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity神經(jīng)支配小關(guān)節(jié)滑膜面和關(guān)節(jié)囊分布有豐富的神經(jīng)末梢,感受和傳遞疫痛信息每個(gè)C門(mén)都被相應(yīng)脊神經(jīng)后支所支配,每條神經(jīng)至少分布到同一平面和下一平面的兩個(gè)C,而每個(gè)C至少受兩個(gè)節(jié)段的神經(jīng)支配,例如C5C6關(guān)節(jié)突關(guān)節(jié)即同時(shí)受到C5和C6兩個(gè)節(jié)段的神經(jīng)支配(》州學(xué)院炮臺(tái)屬選院10頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件11頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件12頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件13頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件14頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件15頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件16頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件17頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件18頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件19頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件20頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件21頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件22頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件23頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件24頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件25頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件26頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件27頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件28頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件29頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件30頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件31頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件32頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件33頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件34頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件35頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件36頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件37頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件38頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件39頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件40頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件41頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件42頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件43頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件44頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件45頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件46頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件47(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展濱醫(yī)煙臺(tái)附院疼痛科孫雪華(》州學(xué)院炮臺(tái)屬選院48(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity內(nèi)容提要定義及流行病學(xué)頸部解剖發(fā)病機(jī)制的魯臨床表現(xiàn)治療(》州學(xué)院炮臺(tái)屬選院49(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity定義頸椎小關(guān)節(jié)源性疼痛(cervicalfacetpain,CFP)因外傷或脊柱退行性變、小關(guān)節(jié)骨質(zhì)增生、骨質(zhì)疏松、頸椎間隙變窄、或頸肌筋膜攣縮等,導(dǎo)致頸椎小關(guān)節(jié)變形牽拉、壓迫或刺激了脊神經(jīng)后支,而引起的頸項(xiàng)部及頭部、肩部、胸背部放射痛,通稱(chēng)為頸椎小關(guān)節(jié)源性疼痛。(》州學(xué)院炮臺(tái)屬選院50(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity流行病學(xué)·慢性頸痛(伴或不伴上肢痛、損傷)是人類(lèi)的常見(jiàn)病,而小關(guān)節(jié)功能紊亂約占頸痛的5%成年人頸痛的發(fā)病率為12.1~71,5%,平均年發(fā)病率為30-~50%(美國(guó))全球頸痛發(fā)病約為4.9%頸痛是世界第四大致殘因素ervicalZygapophysial(FacetJointPain:EffectivenessofInterventionalManagementStrategies.PostgradMed,2019:12841:54-68(》州學(xué)院炮臺(tái)屬選院51(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity解剖前結(jié)節(jié)后結(jié)節(jié)齒狀突關(guān)節(jié)面上關(guān)節(jié)面前結(jié)節(jié)后結(jié)椎板下面觀上面觀寰椎(》州學(xué)院炮臺(tái)屬選院52(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity椎體側(cè)塊齒狀突關(guān)節(jié)面下關(guān)節(jié)面橫突前面觀后面觀側(cè)齒間隙寰樞關(guān)節(jié)寰樞外側(cè)關(guān)節(jié)側(cè)樞外緣側(cè)樞內(nèi)緣(》州學(xué)院炮臺(tái)屬選院53(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity椎脊神經(jīng)溝體橫突上關(guān)節(jié)椎孔椎板分又的棘突橫斷位(》州學(xué)院炮臺(tái)屬選院54(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity椎動(dòng)脈椎動(dòng)脈可分為五段,前四段為顱外段,第五段為顱內(nèi)段:Ⅵ段(橫突孔段:是椎動(dòng)脈在第6-2頸椎橫突孔內(nèi)上升的一段V2段(橫段:指椎動(dòng)脈穿出樞椎橫突孔后,橫行向外的一段V3段〔寰椎段):指從樞椎外端彎曲向上,再垂直上行至寰椎橫突孔為止的一段V4段(枕骨大孔段:指自椎動(dòng)脈V3段上端水平向內(nèi)行一小段后,再?gòu)澫蛏洗怪鄙闲腥胝砉谴罂椎囊欢蜼巧5段(顱內(nèi)段):指椎動(dòng)脈入枕骨大孔后,斜向中線上行與對(duì)側(cè)同名動(dòng)脈匯合成基底動(dòng)脈前的一段椎動(dòng)脈(》州學(xué)院炮臺(tái)屬選院55(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity椎動(dòng)脈(》州學(xué)院炮臺(tái)屬選院56(》州學(xué)院炮臺(tái)屬選院YantaiAfiliatedHospitalofBinzhouMedicalUniversity神經(jīng)支配小關(guān)節(jié)滑膜面和關(guān)節(jié)囊分布有豐富的神經(jīng)末梢,感受和傳遞疫痛信息每個(gè)C門(mén)都被相應(yīng)脊神經(jīng)后支所支配,每條神經(jīng)至少分布到同一平面和下一平面的兩個(gè)C,而每個(gè)C至少受兩個(gè)節(jié)段的神經(jīng)支配,例如C5C6關(guān)節(jié)突關(guān)節(jié)即同時(shí)受到C5和C6兩個(gè)節(jié)段的神經(jīng)支配(》州學(xué)院炮臺(tái)屬選院57頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件58頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件59頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件60頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件61頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件62頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件63頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件64頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件65頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件66頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件67頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件68頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件69頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件70頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件71頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件72頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件73頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件74頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件75頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件76頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件77頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件78頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件79頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件80頸椎小關(guān)節(jié)源性疼痛診治進(jìn)展課件81頸椎小關(guān)