颈椎腰椎退行性疾病参考课件

临床表现 Clinical finding
1.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
３. Ｘ－ray a：颈椎矢状径：临界值 １３mm b：Ｐavlov 比值： 颈椎管矢状径 颈椎体矢状径
2.脊髓型 Cervical myelopathy 脊髓受压或缺血 脊髓功能障碍
临床表现 Clinical finding
3.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
２.手术治疗 surgical treatment decompression 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 Ｐathology
颈椎管狭窄：
１.原法性（Ｐrimary Ｓtenosis）：先天发育性 desplasia ２.继发性（secondary stenosis）：退变性 degeneration
病理 Ｐathology
Hale Waihona Puke Baidu
Cervical disc degenertion fibrosas annulus rupture nucleus pulposus:
a. extrusion
b. prolapse
pinch、nerve
c. sequestration
临床表现 clinical finding
颈椎退行性疾病
Cervical degenerative disease
1
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 cervical
intervertebral fusion
颈后纵韧带骨化
Ossification of the posterior longitudinal ligament
Opll compression of the spinal Cord fysfunction of the nerve
临床表现 clinical finding
影像学检查 imaging examination
１. Ｘ－ray 显示颈椎曲度，椎间隙变化 ２. ＣＴ 显示颈椎管径，椎间盘突出及钙化 ３. ＭＲＩ 显示椎间盘信号，硬膜束间隙变化
治疗 Treatment
１.保守治疗 conserative treatment traction physical therapy
1.disc herniation compression of nerve leg pain
low back pain
2.mechanism of pain: a mechanical compression b chemical irritation c autoimmunization
类型 classification
posterior / 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 、esophagus
Sympton 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 finding
1.神经根型 Cervical radiculopathy 神经根性症状、体征
４. ＣＴ、ＭＲＩ
治疗 Ｔreatment
Surgical treatment: 1. cervical canal decompression 2.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
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 pathology 1.外伤 injury 2.退变 degeneration
病理生理 pathophysiology
1.sympton and sign: 头颈痛，感觉，运动障碍，二便障碍 ２.ＣＴ、ＭＲＩ：连续型，节段型，局灶型，混合型
治疗 treatment
1.conservative: traction physical therapy 2.surgical: anterior decompression and
1.膨出 2.突出 3.脱突 4.游离
bulge extrusion prolapse sequestration
临床表现 Clinical finding
１.症状 symptom: a.下腰痛 low back pain, low back pain radiating into leg b. 坐骨神经痛 sciatica The lumbar nerve root syndrome C. 麻木 numbness, 瘫痪 paralysis d. 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
1.sympton: necl pain should pain weakiness 2.examination: movement、sensation、reflex 3.imagin examination: CT、MRI
治疗 treatment
1. conservative: traction，physical therapy 2. surgical: discectomy，decompression