VascularClaudicationvsLumbarStenosisHK中英文

Vascular Claudication,Helen Challinor 2011,血管性跛行,Synonyms,Peripheral Vascular Disease (PVD)周围血管疾病Peripheral Arterial Disease (PAD)周围动脉血管疾病Peripheral Arterial Occlusive Disease (PAOD)周围动脉闭塞性疾病Lower Extremity Arterial Disease (LEAD)下肢动脉血管疾病Chronic Arterial Occlusive Disease慢性动脉闭塞性疾病Arteriosclerosis Obliterans (ASO)动脉硬化闭塞症Atherosclerotic Disease动脉硬化症,同义词,Case Study 1,67岁 男性BMI指数：21糖尿病 冠状动脉搭桥术生活自理右腿步行时疼痛臀部，大腿，小腿步行200米开始发病休息3-4分钟症状缓解行走距离递减,案例分析1,History,Concurrent vascular disease并发血管疾病Risk factors危险因素Lifestyle limitation生活限制Claudication distance跛行距离Walking distance步行距离Rest time休息时间Pain疼痛,病史,Risk Factors,Diabetes糖尿病Hyperglycaemia高血糖Hypertension高血压Hypercholesterolaemia高胆固醇血症Smoking吸烟Obesity,危险因素,Risk Factors,肥胖Lifestyle factors (nutrition and exercise)生活方式因素（营养和运动）Haemodynamic forces血流动力学方面Inflammatory and immunological factors炎症和免疫学因素,危险因素,Prevalence,Increases with risk factors危险因素增加Associated with ageing与年龄增长相关Present at autopsy in nearly all people over the age of 60尸检报告中，几乎所有超过60岁的人都存在May occur at earlier ages可能年轻化,患病率,Pathophysiology,病理生理学,Before Internal Iliac Artery髂内动脉前Internal Iliac Artery髂内动脉External Iliac Artery髂外动脉Superficial Femoral Artery股浅动脉,主动脉,Classification,Fontaine SystemStage 1 asymptomatic第一阶段 无症状Stage 2 - intermittent claudication第二阶段 间歇性跛行Stage 3 - severe, persistent rest pain第三阶段 严重，持续性休息痛Stage 4 - rest pain, ulcers, gangrene第四阶段 休息痛，溃疡，坏疽,等级,Examination,Observe foot colour, nail growth, oedema观察足部颜色，指甲生长情况，水肿Pulses脉搏Femoral股骨Posterior tibial胫后Dorsalis pedis足背Vascular Stress test血管压力测试Repeated heel raise反复踮起足跟Hand held Doppler手持式多普勒ABPI臂踝血压比,观察,Femoral Pulse,股动脉,股三角,股静脉,长收肌,缝匠肌,股外侧肌,股内侧肌,股动脉搏动,Distal Pulses,Dorsalis Pedis 足背,Posterior Tibial 胫后,远端搏动,ABPI,Systolic blood pressure of arm (brachial artery)前臂收缩压（肱动脉）Systolic blood pressure of ankle at踝部收缩压在Dorsalis pedis足背Posterior tibial胫后ABPI臂踝血压比 = P(leg) P(arm)Normal 正常= 1.0-1.4PAD外周动脉阻塞性疾病 = 50年龄50,症状,Provocation Relief,Standing站立Walking步行Time dependant 时间依赖,Sitting坐Squatting下蹲Supermarket trolley超市手推车Can cycle骑车Walk uphill走上坡路Flexion not rest,加重,缓解,Pathophysiology,Vascular challenge of lumbosacral nerve roots 2 to compression by:腰骶神经根血管受压受到以下结构的压迫：Disc椎间盘Facet hypertrophy小关节增生Ligamentum flavum黄韧带Osteophytes骨赘,病理生理,Pathophysiology,病理生理,Examination,Gait步态Lower motor neurone examination下运动神经元检查Pedal pulses踏板脉冲Tibialis Posterior胫后Dorsalis Pedis足背Repeated calf raise x 30小腿重复抬高x30Upper motor neurone examination下运动神经元检查,检查,Investigation,MRIWeight bearing AP & Lateral X-Ray负重下前后位和侧位x光检查CT MyelogramCT脊髓造影Vascular studies血管的研究,检查,Treatment,Threshold / indications for surgery阈值/手术的适应征Recovery复原Outcomes结局,治疗,Differential Diagnoses,Vascular Claudication血管性跛行Radiculopathy神经根型Cervical Myelopathy脊髓型颈椎病Peripheral Neuropathy周围神经病变,鉴别诊断,Vascular Claudication 血管性跛行,Spinal Stenosis 椎管狭窄,Worse walking uphill爬坡困难Walking provokes步行困难Walking distance reduces步行距离减少Eased by rest休息后缓解Repeated heel raise test positiveRisk factors/concurrent vascular disease危险因素/并发血管疾病Peripheral pulses reduced/absent外周脉搏减少/缺乏,Better walking uphill爬坡改善Walking & standing provokes步行&站立困难