颈椎腰椎退行性疾病

1、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 C

2、ervical 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

3、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.imagi

4、n 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

5、 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

6、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 etio

7、logy: 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

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