脊柱退行性疾病-英文

脊柱退行性疾病Spinaldegenerativediseases长治医学院附属和平医院骨科裴卫卫Whatiscalleddegeneration?Wealsofoundotherphenomenon.SomePeopleareonly40yearsold,butlookslike60yearsofageortheopposite。影响因素influencefactors过度负荷overload不良体位poorposture慢性劳损chronicstrain外伤injury慢性炎症chronicinflammation先天因素congenitalfactorsAnatomyoftheSpineSagittalViewAP-viewLordosisKyphosisLordosisDevelopmentofDiscandSpinalCurvatureNewborn25years4years-nosignificantcurvature-DiscHeight=VertebralBodyHeight-Double-Scurvature-DiscHeight=40%ofVBH-biconcave-biconvexshapeofintervertebralspace-DiscHeight=25%ofVBHIntervertebraldiscAnulusfibrosusNucleusPulposusNewborn65yearsNovascularisationofdisc7years70years30yearsWatercontentinthenucleuspulposusdecreasedwithageFacetJointsCervicalvertebrae——slopingThoracicvertebrae——coronalLumbarvertebrae——sagittalLigamentsAnteriorlongitudinalligamentPosteriorlongitudinalligamentBloodSupplyLoadTransfer80%20%TheFUNCTIONALUNITofthespineComprisedof:TwoadjacentvertebraeIntervertebraldiscConnectingligamentsTwofacetjointsandcapsulesIntradiscalPressureBiomechanics18,31,24,62,75,011,011,023,017,0颈椎退行性疾病cervicaldegenerativedisease包括：一、颈椎病二、颈椎管狭窄症三、颈椎间盘突出症四、颈椎后纵韧带骨化including一、Cervicalspondylosis二、Cervicalcanalstenosis三、Cervicaldischerniation四、Ossificationofcervicalposteriorlongitudinalligament一、颈椎病Cervicalspondylosis发病率随着年龄的增加而显著提高40～50岁的发病率为20％，60岁以上者达50％，70岁以上则更高。目前发病年龄趋于年轻化定义Concept颈椎间盘退变及其继发性改变，刺激或压迫相邻脊髓、神经、血管等组织，并引起相应的症状或体征者，称为颈椎病。Cervicalspondylosisisadisorderinwhichthereisabnormalwearonthecartilageandbonesoftheneck.分型Classification脊髓型CervicalSpondyloticMyelopathyCSM神经根型CervicalSpondyloticRadiculopathyCSR交感神经型SympatheticCervicalSpondylosisSCS椎动脉型CervicalSpondylosisofVertebralarterytype其它（食道压迫型、颈型、混合型）CSM以颈脊髓受损为主要临床表现的颈椎病。主要表现为走路不稳、四肢麻木、大小便困难等。Mainclinicalmanifestations:Cervicalspinalcordinjury，suchasunsteadywalk,numbnessoflimbs,micturitionanddefecationdifficultiesCSR1.多见于30岁以上者Morecommoninpeopleover30yearsold2.起病缓慢、病程长，反复发作。Slowonset,longcourseofdisease,recurrentseizures.3.颈肩部疼痛，下颈椎病变可向前臂放射。Neckandshoulderpain,somecanradiatetothearmSCS主要表现为头晕、眼花、耳鸣、手麻、心动过速、心前区疼痛等一系列症状。X线片有失稳或退变，椎动脉造影阴性。Mainclinicalmanifestations:dizziness,tinnitus,numbnessofhand,heartbeattachycardia,precordialpain.X-ray:degenerationofcervicalvertebra.Vertebralarteryangiographynegative.CervicalSpondylosisofVertebralarterytype以椎基底动脉供血不足为主要临床表现的颈椎病。主要表现为头痛，头晕，黑朦等症状，与颈部旋转有关。Mainclinicalmanifestations:vertebralbasilararteryinsufficiency，suchasheadache,dizzinessandamaurosis,relatetotheneckrotation.食管型颈椎病EsophagustypecervicalspondylosisAspecialtypeofCSThroatdiscomfort,foreignbodysensationisanearlysymptomLatemanifestationsisdysphagiaOftenaccompaniedbysymptomsofothercervicalspondylosis颈型Necktypecervicalspondylosis以颈部酸、痛、麻、僵为主要临床表现或颈项部压迫感的颈椎病，症状集中在颈部，转动不灵活。Mainclinicalmanifestations:aciddistention、pain、numbnessandstiffintheneck.Mixedtypeofcervicalspondylosis具备以上两种或两种以上的表现者，即可确诊。Withtwoormorethantwokindsofperformanceabove.DiagnosisMustbehavethreeconditions:CervicaldegenerativechangesRelevantclinicalmanifestationsRelevantclinicalmanifestationsareconsistentwithimagingfindingsTreatmentIndicatioMildsymptomsCannottolerateoperationMethodsCorrectbadpostureTractionMassage—cautiouslyusePhysiotherapyMedicationsexpectanttreatmentsurgicaltherapyIndicatioFormalexpectanttreatmentfor3~6monthsisinvalidSymptomofCSMaggravateprogressivelyorsuddenlyorMRIshowedthatthecervicalspinalcordsignalchangesSymptomofCSRimpactqualityoflife手术方式手术目的surgicalpurpose彻底减压Completedecompression重建脊柱稳定性Reconstructionofspinalstability开放式：Openoperation前路—直接减压Anteriorcervicaloperation—Directdecompression后路—间接减压Posteriorcervicaloperation—Indirectdecompression微创式：MicroinvasiveoperationCase1颈前路椎间盘摘除、取自体髂骨椎间植骨融合、内固定术Case2颈前路椎间盘摘除、椎间融合器植骨融合、内固定术Case3颈前路椎体次全切除、椎间钛笼植骨融合、内固定术Case4颈后路单开门椎管扩大成形术Case5颈后路单开门椎管扩大成形后路支撑钢板内固定术Case5颈椎人工间盘置换术颈椎管狭窄症CervicalcanalstenosisEtiologyandpathologyCongenitaldevelopmentalCCSDegenerativeoriatrogenicCCSCCScanbesingleormultisegmentalstenosis,commonintheC4,5andC6,7segmentsClinicalmanifestationSymptomsaresimilartothesymptomsofCSX-rayCTMRIA:椎管失状径A≥13mm正常A＜13mm相对狭窄A＜10MM绝对狭窄B:椎体中失状径A:B＜0.75狭窄椎管正中失状径≥13mm正常＜13mm相对狭窄＜10mm绝对狭窄CervicalintervertebraldiscdegenerationExternalforcecauseruptureofannulusfibrosusandlongitudinalligamentNucleuspulposusprotrudeintospinalcanalThepainofnerverootandsignsofspinalcompression.颈椎间盘突出症CervicaldischerniationRelationshipbetweenCDHandCS颈椎间盘突出症是颈椎病发病过程的病理变化之一CDHisoneofthepathologicalchangesinthepathogenesisofCS颈椎间盘突出症的致压物只能是突出的髓核，而颈椎病可以是髓核以外的其他组织Inducedpressurecanonlybeprotrudingnucleuspulposus，howeveritcanbeothertissuesexceptthenucleuspulposus男性，40岁，煤矿工人，既往无四肢麻木、无力病史，摔伤后出现颈部不适伴双上肢放射性麻木、行走不稳1个月，经颈围制动、脱水、激素及神经营养治疗效果不佳。颈椎后纵韧带骨化症Ossificationofcervicalposteriorlongitudinalligament颈椎后纵韧带异常增殖并骨化，压迫脊髓和神经根，产生感觉、运动功能障碍。Cervicalposteriorlongitudinalligamentabnormallyproliferateandossify，whichcanconstrictthespinalcordandnerveroot，andthenleadtoparalysisEtiologyTheexactmechanismisnotclear，butthereareseveralhypothesisTheoryofheredityMechanicaldamagethe