頸椎腰椎退行性疾病課件

頸椎退行性疾病Cervicaldegenerativedisease頸椎腰椎退行性疾病

頸椎病Cervicalspondylosis

頸椎管狹窄癥Cervicalcanalstenosis

頸椎間盤(pán)突出癥Cervicaldischerniation頸椎后縱韌帶鈣化Ossificationofcervicalposterior/ongitudina/ligament頸椎腰椎退行性疾病頸椎病

Cervicalspondylosis

頸椎間盤(pán)退變壓迫或刺激脊髓、神經(jīng)、血管、食管癥狀和體征

Cervicaldiscdegenerationcompressionofthespinalcord、nerve、vessels、esophagusSymptonandsign頸椎腰椎退行性疾病病理Pathophysiology

頸椎間盤(pán)退變：a.蛋白多糖、髓核水分減少纖維環(huán)裂隙髓核突出

b.生物力學(xué)發(fā)生改變繼發(fā)性病理變化后果：刺激、壓迫神經(jīng)、血管產(chǎn)生相關(guān)癥狀頸椎腰椎退行性疾病臨床表現(xiàn)Clinicalfinding

1.神經(jīng)根型Cervicalradiculopathy

神經(jīng)根性癥狀、體征

2.脊髓型Cervicalmyelopathy

脊髓受壓或缺血脊髓功能障礙頸椎腰椎退行性疾病臨床表現(xiàn)Clinicalfinding3.椎動(dòng)脈型Vertebroarterialspondylosis

椎動(dòng)脈受壓或刺激椎－基底動(dòng)脈供血不全4.交感型Sympatheticspondylosis

頸交感神經(jīng)受刺激頸椎腰椎退行性疾病影像學(xué)檢查imagingexamination１.Ｘ－ray顯示頸椎曲度，椎間隙變化２.ＣＴ顯示頸椎管徑，椎間盤(pán)突出及鈣化３.ＭＲＩ顯示椎間盤(pán)信號(hào)，硬膜束間隙變化頸椎腰椎退行性疾病治療Treatment１.保守治療conserative

treatment

tractionphysical

therapy２.手術(shù)治療surgicaltreatmentdecompressionfusion頸椎腰椎退行性疾病頸椎管狹窄

cervicalcanalstenosis頸椎管容積變小,壓迫頸髓產(chǎn)生神經(jīng)癥狀、體征

頸椎腰椎退行性疾病病理Ｐathology頸椎管狹窄：

１.原法性（Ｐrimary

Ｓtenosis）：先天發(fā)育性desplasia

２.繼發(fā)性（secondary

stenosis）：退變性degeneration頸椎腰椎退行性疾病臨床表現(xiàn)Clinicalfinding1.癥狀sympton:四肢麻木，乏力，活動(dòng)不靈2.檢查examination:感覺(jué)、運(yùn)動(dòng)障礙，反射異常頸椎腰椎退行性疾病臨床表現(xiàn)Clinicalfinding３.Ｘ－ray

a：頸椎矢狀徑：臨界值１３mm

b：Ｐavlov比值：頸椎管矢狀徑頸椎體矢狀徑４.ＣＴ、ＭＲＩ頸椎腰椎退行性疾病治療ＴreatmentSurgicaltreatment:1.cervicalcanaldecompression

2.cervicalcanaloplasty頸椎腰椎退行性疾病頸椎間盤(pán)突出癥

cervicaldischerniation頸椎間盤(pán)退變椎間盤(pán)突出脊髓、神經(jīng)根受壓頸椎腰椎退行性疾病病理ＰathologyCervicaldiscdegenertionfibrosasannulusrupturenucleuspulposus:a.extrusionb.prolapsepinch、nervec.sequestration頸椎腰椎退行性疾病臨床表現(xiàn)clinicalfinding1.sympton:neclpainshouldpainweakiness2.examination:movement、sensation、reflex3.imaginexamination:CT、MRI頸椎腰椎退行性疾病治療treatmentconservative:traction，physicaltherapysurgical:discectomy，decompressionintervertebralfusion頸椎腰椎退行性疾病頸后縱韌帶骨化

OssificationoftheposteriorlongitudinalligamentOpllcompressionofthespinalCordfysfunctionofthenerve頸椎腰椎退行性疾病臨床表現(xiàn)clinicalfinding1.symptonandsign:頭頸痛，感覺(jué)，運(yùn)動(dòng)障礙，二便障礙２.ＣＴ、ＭＲＩ：連續(xù)型，節(jié)段型，局灶型，混合型頸椎腰椎退行性疾病治療treatment1.conservative:tractionphysicaltherapy2.surgical:anteriordecompressionandfusionposteriorcanaloplasty頸椎腰椎退行性疾病腰椎退變性疾病Lumbardegenerativedisease頸椎腰椎退行性疾病腰椎間盤(pán)突出癥

Lumbardischerniation病因病理：Etiologypathology1.外傷injury2.退變degeneration頸椎腰椎退行性疾病病理生理pathophysiology1.discherniationcompressionofnervelowbackpainlegpain2.mechanismofpain:amechanicalcompressionbchemicalirritationcautoimmunization頸椎腰椎退行性疾病類型classification1.膨出bulge2.突出extrusion3.脫突prolapse4.游離sequestration頸椎腰椎退行性疾病臨床表現(xiàn)Clinicalfinding１.癥狀symptom:a.下腰痛lowbackpain,lowbackpainradiatingintolegb.坐骨神經(jīng)痛sciaticaThelumbarnerverootsyndromeC.麻木numbness,癱瘓paralysisd.馬尾綜合征caudaequinasyndrome:會(huì)陰麻木，雙下肢不全癱瘓，二便功能障礙頸椎腰椎退行性疾病臨床表現(xiàn)Clinicalfinding2.體征sign:a脊柱畸形spinaldeformityb壓痛palpatometryc腰痛，活動(dòng)受限：restrictionoflumbarmovement,flexion,extension,lateralflexion,rotation頸椎腰椎退行性疾病臨床表現(xiàn)Clinicalfindingd.感覺(jué)，運(yùn)動(dòng)，發(fā)射異常

sensetest,musculotonictest,reflexe.特殊體癥specialsign

直腿抬高試驗(yàn)lesegustest

健肢抬高實(shí)驗(yàn)fajerstajntest

直腿抬高加強(qiáng)試驗(yàn)bragardtest頸椎腰椎退行性疾病影像學(xué)檢查imageexamination1.X-ray2.CT、MRI

頸椎腰椎退行性疾病治療treatment1.保守治療conservation:Bedtest,traction,physicaltherapy,3-4w2.手術(shù)治療surgical頸椎腰椎退行性疾病腰椎管狹窄癥

Thelumbarcanalstenosis病因etiology:1.先天性腰椎管狹窄

congenitallumbarcanalstenosis2.繼發(fā)性腰椎管狹窄

secondarylumbarcanalstenosisdegenerative,traumatic頸椎腰椎退行性疾病病理Pathology椎管容積縮小→椎管內(nèi)壓力增加1.神經(jīng)受壓、損傷性炎癥

compressiontranmaticinflammation2.神經(jīng)血運(yùn)障礙：缺血、靜脈回流受阻ischemia頸椎腰椎退行性疾病分型classification1.中央型central:絕對(duì)狹窄＜10mm

相對(duì)狹窄10～13mm2.神經(jīng)根管型nerverootcanal:a.盤(pán)黃間隙discflavumspaceb.側(cè)隱窩laterralrecessc.椎間孔intervertebralfaramer頸椎腰椎退行性疾病臨床表現(xiàn)clinicalfinding特點(diǎn)：癥狀重、體征輕、間隙性跛行1.癥狀symptom:

下肢痛legpain

下肢麻木legnumbness

乏力weakness

排尿困難bladderdysfunction

下腰痛lowbackpain頸椎腰椎退行性疾病臨床表現(xiàn)clinicalfinding2.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↓頸椎腰椎退行性疾病影像學(xué)檢查imgainexamination1.X-ray:intervertebralspace↓,lordosis↓,osteophyte2.CT、MRI:a.間盤(pán)突出discherniationb.側(cè)隱窩矢狀徑＜3mmsagittallateralrecessc.椎管矢狀徑＜1