12腰腿痛和颈肩痛.ppt

启发提问 50岁男性患者，腰痛半年，加重1月。问诊和查体时应该重点包括哪些内容？ 参考资料 1．Principles of Orthopedic Pratice。Dee Hust, Gruber Kottmeier。世界图书出版公司，1997 2．颈椎病的诊断与治疗（VCD）。华中科技大学。人民卫生出版社；2004 3．腰椎间盘突出症（VCD）。天津医科大学。人民卫生出版社；2004 颈椎退行性疾病的分类 颈椎病 颈椎管狭窄症 颈椎间盘突出症 其他 颈椎病 病因：退变 分类 神经根型颈椎病 脊髓型颈椎病 椎动脉型颈椎病 交感型颈椎病 影像学检查 X片检查 正侧位，左右斜位 CT MRI 治 疗 非手术治疗 理疗 封闭 药物对症治疗 手术治疗 脊髓型颈椎病 颈椎管狭窄症 病因与病理 原发性 继发性 临床表现 脊髓症状 椎管失状径减小 Pavlov比值小于0.75 治 疗 手术治疗 脊髓减压 椎管扩大成形 椎管减压技术 椎管减压技术 椎管减压技术 椎管减压技术 颈椎间盘突出症 临床表现 颈痛 神经根症状体征 脊髓症状体征 影像学改变 治 疗 非手术治疗 牵引，理疗，局部用药 手术治疗 椎间盘摘除术，非常成熟 其他，有待验证 The surgery is done while the patient is deep asleep and pain-free (general anesthesia). For the neck (cervical spine), an incision may be made either in the back of the neck (posterior cervical) or in the front side of the neck (anterior cervical), depending on the location of the problem. The bone that curves around and covers the spinal cord (lamina) is removed (laminectomy) and the tissue that is causing pressure on the nerve or spinal cord is removed. The hole through which the nerve passes can be enlarged to prevent further pressure on the nerve. If an intervertebral disc herniation is present, the intervertebral disc is removed. Sometimes, a piece of bone (bone graft) or metal rods (such as Harrington rods) may be used to strengthen the area of surgery. Depending on the disease present and the surgery performed, mobility of the cervical spine may be limited after cervical spine surgery. Physical therapy is often indicated after surgery. 多节段颈椎椎间盘突出症的外科治疗方法 多节段颈椎椎间盘突出症的外科治疗方法 本次课内容回顾 腰腿痛 一、腰腿痛的病因、检查、处理原则二、腰椎间盘的解剖，椎间盘变性进程与椎间盘脱出症的病因、病理特点，诊断、治疗、手术适应证三、腰椎管狭窄症的病因、临床表现及诊断、治疗四、腰椎滑脱的特点、治疗与防治 本次课内容回顾 颈肩痛 一、解剖生理概要二、颈椎病病因、分类、临床表现及诊断、治疗，防治 临床表现 特点：中老年，重体力劳动者。长期下腰痛。症状重，体征轻 症状 间歇性跛行 体位性跛行 缺血性跛行 体征 腰5、骶1神经分布区混合症状 影像学检查 X线片 CT MRI Axial computed tomographic (CT) scan at a single lumbar vertebral level following injection of intrathecal contrast medium. Note the lumbar canal narrowing produced by hypertrophic lamina and pedicles. Posterolatera