外科学教学课件：腰腿痛和颈肩痛
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Posterior longitudinal ligament in cervical spine（颈椎后纵韧带骨化）
Essential
发病率很高 Account for 50% of out patients Inevitable to everyone
多种因素致病
Adult Spine 脊柱结构）
Conservative treatment: rest, massage, ice and aspirin. The position of the neck for comfort is essential for relief of pain. Cervical traction
Cervical braces and more frequent changes in position and changes in the work area to prevent fatique and encourage good posture.
Cartilage endplate（终板）
The innervation of the anterior spinal structures
日常生活椎间盘载荷分布
Standing 100％ Sitting 150％ Standing while forward leaning 210％ Sitting while forward leaning 270％
椎间盘结构三部分
AF: concentric rings of fibrocartilaginous tissue, thicker anteriorly;
NP: a loose, nonoriented, collagen fibril framework supporting a network of cells resembling fibrocytes and chondrocytes---embedded in a gelatinous matrix of various glucosaminoglycans, water, and salts.
源自文库
颈椎病
颈椎间盘及继发性椎间关节退变所致的脊髓、 神经、血管损害而表现的相应的症状和体征。
Classification
Cervical spondylotic radiculopathy（神经根型） Cervical spondylotic myelopathy(脊髓型）
Arteria vertebralis type（椎动脉型） Sympathetic type（交感型）
Axial skeleton= 33 vertebrae 24 movable 9 fused Height= ¼ discs ¾ vertebrae
Posterior view: straight C, L: Lordosis
Lateral view T, S:Kyphosis
颈椎与腰椎结构不同
腰腿痛和颈肩痛
Index
Lumbar disc herniation(腰椎间盘突出） Lumbar spinal stenosis（腰椎管狭窄） Adult Isthmic Spondylolisthesis
and Degenerative Spondylolisthesis （椎弓峡部裂及退变性滑脱）
Index
Cervical degenerative diseases
Cervical spondylosis（颈椎病） Cervical spinal stenosis(颈椎管狭窄） Cervical disc herniation（颈椎间盘突出） Hypertrophy and ossification of the
Surgery
Surgery indication: failure of conservative therapy, increasing neurological deficit and cervical myelopathy
Radiculopathy with peripheral compression syndrome(thoracic outlet syndrome, carpal tunnel syndrome, and cubital tunnel syndrome)
颈椎管狭窄症
Conservative treatment
plexus（臂丛）
腰椎运动单位
椎间盘结构
The collagen fibres of the inner two-thirds of the anulus fibrosus sweep around into the vertebral end plate and form its fibrocartilaginous component. The peripheral fibres of the anulus are anchored into the bone of the ring apophysis.
C1－C7 transverse foramen and vertebral artery
Uncovertebral joint(钩椎关节)：next to the intervertebral foramen
Thickened PLL and Ligamentum Nuchae(项韧带)
Sympathetic ganglion(交感神经节) C1-4 cervical plexus，C5－T1 brachial
颈椎间盘突出
颈椎间盘退变基础上因多种所致的椎间盘突 出造成脊髓和神经根受压的一组病症
临床表现
中年发病多 C4-5，C5-6最多 颈部痛，上肢放射痛，手部无力 压迫脊髓时可有四肢不同感觉及运动障碍
影像学检查
X-ray CT MRI
Differential Diagnosis
Myelopathy with amyotrophic lateral sclerosis (肌萎缩型侧索硬化)and syringomyelia(脊髓空洞)
Essential
发病率很高 Account for 50% of out patients Inevitable to everyone
多种因素致病
Adult Spine 脊柱结构）
Conservative treatment: rest, massage, ice and aspirin. The position of the neck for comfort is essential for relief of pain. Cervical traction
Cervical braces and more frequent changes in position and changes in the work area to prevent fatique and encourage good posture.
Cartilage endplate（终板）
The innervation of the anterior spinal structures
日常生活椎间盘载荷分布
Standing 100％ Sitting 150％ Standing while forward leaning 210％ Sitting while forward leaning 270％
椎间盘结构三部分
AF: concentric rings of fibrocartilaginous tissue, thicker anteriorly;
NP: a loose, nonoriented, collagen fibril framework supporting a network of cells resembling fibrocytes and chondrocytes---embedded in a gelatinous matrix of various glucosaminoglycans, water, and salts.
源自文库
颈椎病
颈椎间盘及继发性椎间关节退变所致的脊髓、 神经、血管损害而表现的相应的症状和体征。
Classification
Cervical spondylotic radiculopathy（神经根型） Cervical spondylotic myelopathy(脊髓型）
Arteria vertebralis type（椎动脉型） Sympathetic type（交感型）
Axial skeleton= 33 vertebrae 24 movable 9 fused Height= ¼ discs ¾ vertebrae
Posterior view: straight C, L: Lordosis
Lateral view T, S:Kyphosis
颈椎与腰椎结构不同
腰腿痛和颈肩痛
Index
Lumbar disc herniation(腰椎间盘突出） Lumbar spinal stenosis（腰椎管狭窄） Adult Isthmic Spondylolisthesis
and Degenerative Spondylolisthesis （椎弓峡部裂及退变性滑脱）
Index
Cervical degenerative diseases
Cervical spondylosis（颈椎病） Cervical spinal stenosis(颈椎管狭窄） Cervical disc herniation（颈椎间盘突出） Hypertrophy and ossification of the
Surgery
Surgery indication: failure of conservative therapy, increasing neurological deficit and cervical myelopathy
Radiculopathy with peripheral compression syndrome(thoracic outlet syndrome, carpal tunnel syndrome, and cubital tunnel syndrome)
颈椎管狭窄症
Conservative treatment
plexus（臂丛）
腰椎运动单位
椎间盘结构
The collagen fibres of the inner two-thirds of the anulus fibrosus sweep around into the vertebral end plate and form its fibrocartilaginous component. The peripheral fibres of the anulus are anchored into the bone of the ring apophysis.
C1－C7 transverse foramen and vertebral artery
Uncovertebral joint(钩椎关节)：next to the intervertebral foramen
Thickened PLL and Ligamentum Nuchae(项韧带)
Sympathetic ganglion(交感神经节) C1-4 cervical plexus，C5－T1 brachial
颈椎间盘突出
颈椎间盘退变基础上因多种所致的椎间盘突 出造成脊髓和神经根受压的一组病症
临床表现
中年发病多 C4-5，C5-6最多 颈部痛，上肢放射痛，手部无力 压迫脊髓时可有四肢不同感觉及运动障碍
影像学检查
X-ray CT MRI
Differential Diagnosis
Myelopathy with amyotrophic lateral sclerosis (肌萎缩型侧索硬化)and syringomyelia(脊髓空洞)