《外科学教学ppt课件：腰腿痛和颈肩痛.ppt》由会员分享，可在线阅读，更多相关《外科学教学ppt课件：腰腿痛和颈肩痛.ppt（64页珍藏版）》请在taowenge.com淘文阁网|工程机械CAD图纸|机械工程制图|CAD装配图下载|SolidWorks_CaTia_CAD_UG_PROE_设计图分享下载上搜索。
1、腰腿痛和颈肩痛IndexnLumbar disc herniation(腰椎间盘突出）nLumbar spinal stenosis（腰椎管狭窄）nAdult Isthmic Spondylolisthesis and Degenerative Spondylolisthesis（椎弓峡部裂及退变性滑脱）IndexnCervical degenerative diseasesnCervical spondylosis（颈椎病）nCervical spinal stenosis(颈椎管狭窄）nCervical disc herniation（颈椎间盘突出）nHypertrophy and oss
2、ification of the Posterior longitudinal ligament in cervical spine（颈椎后纵韧带骨化）Essentialn发病率很高nAccount for 50%of out patientsnInevitable to everyone多种因素致病Adult Spine 脊柱结构）nAxial skeleton=33 vertebraen24 movablen9 fusednHeight=discs vertebraePosterior view:straight C,L:LordosisLateral view T,S:Kyphosis颈
3、椎与腰椎结构不同nC1C7 transverse foramen and vertebral arterynUncovertebral joint(钩椎关节)：next to the intervertebral foramennThickened PLL and Ligamentum Nuchae(项韧带)nSympathetic ganglion(交感神经节)nC1-4 cervical plexus，C5T1 brachial plexus（臂丛）腰椎运动单位腰椎运动单位椎间盘结构The collagen fibres of the inner two-thirds of the anu
4、lus 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.椎间盘结构三部分nAF:concentric rings of fibrocartilaginous tissue,thicker anteriorly;nNP:a loose,nonoriented,collagen fibril f
5、ramework supporting a network of cells resembling fibrocytes and chondrocytes-embedded in a gelatinous matrix of various glucosaminoglycans,water,and salts.nCartilage endplate（终板）The innervation of the anterior spinal structures日常生活椎间盘载荷分布nStanding 100nSitting 150nStanding while forward leaning 210n
6、Sitting while forward leaning 270颈椎病n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 nCervical spondylotic radiculopathy（神经根型）Cervical spondylotic myelopathy(脊髓型）nArteria vertebralis type（椎动脉型）nSympathetic type（交感型）颈椎间盘突出n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n中年发病多nC4-5，C5-6最多n颈部痛，上肢放射痛，手部无
7、力n压迫脊髓时可有四肢不同感觉及运动障碍影像学检查nX-raynCTnMRIDifferential Diagnosis nMyelopathy with amyotrophic lateral sclerosis(肌萎缩型侧索硬化)and syringomyelia(脊髓空洞)nRadiculopathy with peripheral compression syndrome(thoracic outlet syndrome,carpal tunnel syndrome,and cubital tunnel syndrome)n颈椎管狭窄症Conservative treatmentnCo
8、nservative treatment:rest,massage,ice and aspirin.The position of the neck for comfort is essential for relief of pain.Cervical traction nCervical braces and more frequent changes in position and changes in the work area to prevent fatique and encourage good posture.SurgerynSurgery indication:failur
9、e of conservative therapy,increasing neurological deficit and cervical myelopathynanterior or posterior approach and discectomy and fusion and internal fixationCervical canal stenosis（颈椎管狭窄）nCongenital or secondarynDegenerative stenosis most commonly in C4/5,C5/6,C6/7treatmentnSimilar to cervical sp
10、ondylosisnPosterior decompression,laminectomy腰椎间盘突出症 hernia of intervertebral discsn因椎间盘变性，纤维环破裂，髓核突出刺激或压迫神经根、马尾神经所表现的一种综合征。病因 n椎间盘退变n损伤n遗传因素n发育异常n妊娠病理 n机械压迫n炎症反应分型nBulge（膨出）nProtrusion（突出）nExtrusion（脱出）nSequestration（游离）nschmorl结节及经骨突出症状nLower back painnUnilateral sciatica accompanied by sensory or
11、 motor disturbances（坐骨神经痛）ncauda equina syndrome体征n腰椎侧凸n活动受限n腰椎压痛n直腿抬高试验n神经症状：感觉、运动反射异常nStraight leg raisenFemoral nerve stretch影像学检查nX-RAYnMRInCTn造影检查诊断与鉴别诊断n腰肌劳损n第三腰椎横突综合征n椎管狭窄n椎弓峡部裂n腰椎其它疾病：结核、肿瘤、炎症n盆腔疾病Non-op treatmentnRestnice and massage over spasm muscle,nNAISDneducation in proper posturen phy
12、sical therapy,traction,back braces and ultrasound diathermy,epidural steroidsInterlaminar Epidural Steroid InjectionsSurgery IndicationnAcute:Cauda Equina syndromen腰腿痛反复发作半年以上非手术治疗无效，影像工作生活n神经功能损害者手术nChemonucleolysisnPercutaneous discectomynArthroscopic microdiscectomy(微创手术）nMicrolumbar discectomyn传
13、统手术n人工椎间盘n融合手术椎管狭窄nMiddle aged and older adults with back and lower extremity pain precipitated by standing and walking and aggravated by hyperextension.nCentral,lateral recess,foraminal,and far-out types(extraforaminal)腰椎管狭窄nSup.articular facetsnCalcification and hypertrophy of the ligamentum flavu
14、m and venous hypertensionSymptoms(1)nNeurogenic claudication:back pain relieved by rest and increased by activity.Most pain centers in the buttocks and thigh,eased with sitting or recumbency and increased with standing and walking.-D.D.with vascular claudication-positive“stoop test”Symptoms(2)nModer
15、ate lateral recess stenosis and foraminal stenosis may mimic osteoarthritis of the hipLumbar canal stenosisnTrefoil like(三叶草型)L3-L5 vertebral foramennCentral type stenosis 15mmnLateral recess stenosis nSagittal diam 3mmnIntervertebral foramen stenosisLumbar spondylolisthesisnClassification:nDysplasticnIsthmicnDegenerativenTraumaticnpathologicaltreatmentnObservationnoperation:nDecompressionnReductionnfusionWhat do we learn?n定义n症状体征n手术适应症