頸椎腰椎退行性疾病課件

頸椎退行性疾病Cervicaldegenerativedisease頸椎病Cervicalspondylosis頸椎管狹窄癥Cervicalcanalstenosis頸椎間盤突出癥Cervicaldischerniation頸椎后縱韌帶鈣化Ossificationofcervicalposterior/ongitudina/ligament頸椎病

Cervicalspondylosis頸椎間盤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臨床表現(xiàn)Clinicalfinding3.椎動脈型Vertebroarterialspondylosis椎動脈受壓或刺激椎－基底動脈供血不全4.交感型Sympatheticspondylosis頸交感神經(jīng)受刺激影像學(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，椎間盤突出及鈣化３.ＭＲＩ顯示椎間盤信號，硬膜束間隙變化頸椎管狹窄

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

病理Ｐathology頸椎管狹窄：

１.原法性（ＰrimaryＳtenosis）：先天發(fā)育性desplasia２.繼發(fā)性（secondarystenosis）：退變性degeneration臨床表現(xiàn)Clinicalfinding1.癥狀sympton:四肢麻木，乏力，活動不靈2.檢查examination:感覺、運(yùn)動障礙，反射異常治療ＴreatmentSurgicaltreatment:1.cervicalcanaldecompression

2.cervicalcanaloplasty頸椎間盤突出癥

cervicaldischerniation頸椎間盤退變椎間盤突出脊髓、神經(jīng)根受壓病理ＰathologyCervicaldiscdegenertionfibrosasannulusrupturenucleuspulposus:lapsepinch、nervec.sequestration治療treatmentconservative:traction，physicaltherapysurgical:discectomy，decompression

intervertebralfusion頸后縱韌帶骨化

OssificationoftheposteriorlongitudinalligamentOpllcompressionofthespinalCordfysfunctionofthenerve臨床表現(xiàn)clinicalfinding1.symptonandsign:頭頸痛，感覺，運(yùn)動障礙，二便障礙２.ＣＴ、ＭＲＩ：連續(xù)型，節(jié)段型，局灶型，混合型腰椎退變性疾病Lumbardegenerativedisease腰椎間盤突出癥

Lumbardischerniation病因病理：Etiologypathology1.外傷injury2.退變degeneration病理生理pathophysiology1.discherniationcompressionofnervelowbackpainlegpain2.mechanismofpain:amechanicalcompressionbchemicalirritationcautoimmunization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:會陰麻木，雙下肢不全癱瘓，二便功能障礙臨床表現(xiàn)Clinicalfinding2.體征sign:a脊柱畸形spinaldeformityb壓痛palpatometryc腰痛，活動受限：restrictionoflumbarmovement,flexion,extension,lateralflexion,rotation治療treatment1.保守治療conservation:Bedtest,traction,physicaltherapy,3-4w2.手術(shù)治療surgical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分型classification1.中央型central:絕對狹窄＜10mm相對狹窄10～13mm2.神經(jīng)根管型nerverootcanal:a.盤黃間隙discflavumspaceb.側(cè)隱窩laterralrecessc.椎間孔intervertebralfaramer臨床表現(xiàn)clinicalfinding特點：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↓影像學(xué)檢查imgainexamination1.X-ray:intervertebralspace↓,lordosis↓,osteophyte2.CT、MRI:a.間盤突出discherniationb.側(cè)隱窩矢狀徑＜3mmsagittallateralrecessc.椎管矢狀徑＜10mmsagittalvertebralcanal治療