颈椎腰椎退行性疾病

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 posterior / ongitudina / ligament 颈椎病颈椎病 Cervical spondylosisCervical 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 、 ner

2、ve 、 vessels 、esophagus Sympton and sign 病理病理 PathophysiologyPathophysiology 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 临床表现临床表现 Clinical findingClinical finding 1.神经根型 Cervical radiculopathy 神经根性症状、体征 2.脊髓型 Cervical myelopathy 脊髓受压或缺血 脊髓功能障碍 临床表现临床表现 Clinical findingCl

3、inical 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 影像学检查影像学检查 imaging examinationimaging 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 治疗治疗 TreatmentTreatment .保守治疗conserativetreatment traction physicaltherapy .手术治疗surgical t

4、reatment decompression fusion 颈椎管狭窄颈椎管狭窄 cervical canal stenosiscervical canal stenosis 颈椎管容积变小,压迫颈髓 产生神经症状、体征 病理病理athologyathology 颈椎管狭窄： .原法性（rimarytenosis）：先天发育性desplasia .继发性（secondarystenosis）：退变性degeneration 临床表现临床表现 Clinical findingClinical finding 1.症状 sympton : 四肢麻木，乏力，活动不灵 2.检查 examination

5、:感觉、运动障碍，反射异常 临床表现临床表现 Clinical findingClinical finding .raya：颈椎矢状径：临界值mm b：avlov 比值：颈椎管矢状径 颈椎体矢状径 .、 治疗治疗reatmentreatment Surgical treatment: 1. cervical canal decompression 2.cervical canaloplasty 颈椎间盘突出症颈椎间盘突出症 cervical disc herniationcervical disc herniation 颈椎间盘退变 椎间盘突出 脊髓、神经根受压 病理病理athologyath

6、ology Cervical disc degenertion fibrosas annulus rupture nucleus pulposus: a. extrusion b. prolapse pinch、nerve c. sequestration 临床表现临床表现clinical findingclinical finding 1.sympton: necl pain should pain weakiness 2.examination: movement、sensation、reflex 3.imagin examination: CT、MRI 治疗治疗treatmenttrea

7、tment 1.conservative: traction，physical therapy 2.surgical: discectomy，decompression intervertebral fusion 颈后纵韧带骨化颈后纵韧带骨化 Ossification of the posterior longitudinal ligamentOssification of the posterior longitudinal ligament Opll compression of the spinal Cord fysfunction of the nerve 临床表现临床表现clinic

8、al findingclinical finding 1.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 治疗治疗treatmenttreatment 1.conservative: traction physical therapy 2.surgical: anterior decompression and fusion posterior canaloplasty 腰椎退变性疾病 Lumbar degenerative disease 腰椎间盘突出症腰椎间盘突出症 Lumbar disc herniationLumbar disc

9、 herniation 病因病理：Etiology pathology 1.外伤injury 2.退变degeneration 病理生理病理生理pathophysiologypathophysiology 1.disc herniation compression of nerve low back pain leg pain 2.mechanism of pain: a mechanical compression b chemical irritation c autoimmunization 类型类型classificationclassification 1.膨出bulge 2.突出e

10、xtrusion 3.脱突prolapse 4.游离sequestration 临床表现临床表现Clinical findingClinical finding .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 临床表现临床表现Clinical findingCl

11、inical finding 2.体征sign : a 脊柱畸形spinal deformity b 压痛palpatometry c 腰痛，活动受限：restriction of lumbar movement, flexion, extension, lateral flexion , rotation 临床表现临床表现Clinical findingClinical finding d. 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fajerst

12、ajn test 直腿抬高加强试验bragard test 影像学检查影像学检查image examinationimage examination 1. X-ray 2. CT、MRI 治疗治疗treatmenttreatment 1.保守治疗conservation: Bed test, traction, physical therapy,3-4w 2.手术治疗surgical 腰椎管狭窄症腰椎管狭窄症 The lumbar canal stenosisThe lumbar canal stenosis 病因 etiology: 1.先天性腰椎管狭窄 congenital lumbar

13、canal stenosis 2.继发性腰椎管狭窄 secondary lumbar canal stenosis degenerative,traumatic 病理病理 PathologyPathology 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 inflammation 2.神经血运障碍：缺血、静脉回流受阻 ischemia 分型分型 classificationclassification 1.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 dis

14、c flavum space b.侧隐窝 laterral recess c.椎间孔 intervertebral faramer 临床表现临床表现 clinical findingclinical 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 临床表现临床表现 clinical findingclinical finding 2.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 影像学检查影像学检查 imgain examinationimgain examination 1.X-ray: intervertebralspace,lordosis,osteophyte 2.CT、MRI: a.间盘突出 disc herniation b.侧隐窝矢状径3mm sagittal