颈椎腰椎退行性疾病
颈椎退行性疾病Cervical degenerative disease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 cervicalposterior / ongitudina / ligament颈椎病 Cervical 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 、 vessels 、 esophagusSympton and sign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 Clinical finding1.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 Clinical 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 imaging 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 Treatment.保守治疗 conserative treatment traction physical therapy.手术治疗 surgical treatmentdecompression fusion颈椎管狭窄 cervical canal stenosis颈椎管容积变小,压迫颈髓 产生神经症状、体 征 病理 athology颈椎管狭窄：.原法性（rimary tenosis）：先天发育性 desplasia.继发性（secondary stenosis）：退变性 degeneration临床表现 Clinical 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 Clinical finding. ray a：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 reatmentSurgical treatment: 1. cervical canal decompression2.cervical canaloplasty颈椎间盘突出症 cervical disc herniation颈椎间盘退变 椎间盘突出 脊髓、神经根受压病理 athologyCervical disc degenertion fibrosas annulus rupture nucleus pulposus:a. extrusionb. prolapse pinch、nervec. sequestration临床表现 clinical finding1.sympton: necl pain should pain weakiness2.examination: movement、sensation、reflex3.imagin examination: CT、MRI治疗 treatmentvconservative: traction，physical therapyvsurgical: discectomy，decompressionintervertebral fusion颈后纵韧带骨化 Ossification of the posterior longitudinal ligamentOpll compression of the spinal Cord fysfunction of the nerve 临床表现 clinical finding1.sympton and 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 treatment1.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 Lumbar disc herniation病因病理：Etiology pathology1.外伤 injury2.退变 degeneration病理生理 pathophysiology1.disc herniation compression of nerve low back pain leg pain2.mechanism of pain: a mechanical compressionb chemical irritationc autoimmunization类型 classification1.膨出 bulge 2.突出 extrusion 3.脱突 prolapse 4.游离 sequestration临床表现 Clinical finding.症状 symptom: a.下腰痛 low back pain,low back pain radiating into leg b. 坐骨神经痛 sciaticaThe lumbar nerve root syndrome C. 麻木 numbness, 瘫痪 paralysisd. 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 Clinical finding2.体征 sign :a 脊柱畸形 spinal deformityb 压痛 palpatometryc 腰痛，活动受限：restriction of lumbar movement, flexion, extension, lateral flexion , rotation临床表现 Clinical findingd. 感觉，运动，发射异常sense test, musculotonic test, reflex e. 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 image examination1. X-ray2. CT、MRI治疗 treatment1.保守治疗 conservation:Bed test, traction, physical therapy,3- 4w2.手术治疗 surgical腰椎管狭窄症 The lumbar canal stenosis病因 etiology: 1.先天性腰椎管狭窄 congenital lumbar canal stenosis 2.继发性腰椎管狭窄 secondary lumbar canal stenosis degenerative,traumatic病理 Pathology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 classification1.中央型 central:绝对狭窄10mm 相对狭窄1013mm 2.神经根管型 nerve root canal:a.盘黄间隙 disc flavum spaceb.侧隐窝 laterral recessc.椎间孔 intervertebral faramer临床表现 clinical 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 clinical 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 imgain examination1.X-ray: intervertebralspace,lordosis,osteophyte 2.CT、MRI:a.间盘突出 disc herniationb.侧隐窝 矢状径3mm sagittal lateral recessc.椎管矢状径10mm sagittal vertebral canal治疗 treatment1.保守治疗 consavertive bed rest,physical therapy 2.手术治疗 surgicala.减压术 decompression间盘切除 Discectomy椎间孔切开 foraminotomy椎板切除术 faminactomyb.融合术 spinal fusion
