腰腿痛和颈肩病.pptx

概论概论 腰腿痛和颈肩病是一组临腰腿痛和颈肩病是一组临床多见症状，其病因复杂，以床多见症状，其病因复杂，以损伤为多。损伤为多。第1页/共26页 腰腿痛：是指下腰、腰骶、骶髂、臀部等处的疼痛，可伴有一侧或两侧下肢痛、马尾神经症状。颈肩病：是指颈、肩、肩胛等处疼痛，有时伴有一侧或两侧上肢痛、颈脊髓神经症状。定定 义义第2页/共26页 腰椎盘突出症腰腿痛的代表腰腿痛的代表第3页/共26页 因椎间盘变性，纤维环破裂，骨核突出刺激或压迫神经根，马尾神经可表现的一种综合征是腰腿痛最为常见的原因。以L4-5，L5S1间隙发病率最高，占90-96%。椎间盘突出症的定义椎间盘突出症的定义第4页/共26页 椎间盘退行性病积累性损伤遗传因素妊娠椎间盘突出症病因椎间盘突出症病因第5页/共26页 v 膨隆型v 突出型v 脱垂游离型椎间盘突出症分型椎间盘突出症分型第6页/共26页 多发生于男性中壮年，有长期弯腰劳动或坐位工作史，弯腰持重或突然扭腰动作是首发诱因。椎间盘突出症临床表现椎间盘突出症临床表现第7页/共26页 v 腰痛v 坐骨神经痛v 马尾神经受压椎间盘突出症症状椎间盘突出症症状第8页/共26页 腰椎侧突 腰部活动受限 压痛及骶棘肌痉挛 直腿抬高试验及加强试验阳性 神经系统症状椎间盘突出症体征椎间盘突出症体征第9页/共26页 X线平片：发现退行性变，并排除其它疾患。X线造影：间接显示有无椎间盘突出及突出程度。B型超声检查CT和MRI：可显示椎管形态，椎间盘突出的大小和方向肌电图：协助确定神经损害范围及程度椎间盘突出症特殊检查椎间盘突出症特殊检查第10页/共26页 非手术治疗指征非手术治疗指征 年轻、初发、病程短、休息后症状可自行缓解者，X线检查无椎管狭窄。椎间盘突出症的治疗椎间盘突出症的治疗第11页/共26页 非手术治疗方法非手术治疗方法绝对卧床休息，三周后带腰围起床活动持续牵引（骨盆牵引）两周理疗和推拿按摩皮质激素硬膜外注射髓核化学溶解法经皮髓核抽吸术（介入治疗）椎间盘突出症的治疗椎间盘突出症的治疗第12页/共26页 手术治疗手术治疗指征：经严格非手术治疗无效，马尾神经受压方法：髓核摘除术手术并发症：椎间盘感染、血管或神经损伤、术后粘连症状复发椎间盘突出症的治疗椎间盘突出症的治疗第13页/共26页 v 减少积累伤v 正确坐位姿势v 加强腰背肌训练椎间盘突出症的预防椎间盘突出症的预防第14页/共26页 颈 椎 病颈肩病的代表颈肩病的代表第15页/共26页 泛指颈椎间盘退行性变，继发脊髓、神经、血管损害而表现的相应症状。颈椎病的定义颈椎病的定义第16页/共26页 颈椎间盘退行性变 急性和慢性损伤 颈椎先天性椎管狭窄颈椎病的病因颈椎病的病因第17页/共26页 神经根型颈椎病（占60%）脊髓型颈椎病 交感神经型颈椎病 椎动脉型颈椎病颈椎病的临床表现颈椎病的临床表现 第18页/共26页 病因、体检、神经系统检查、X片（正侧位、斜位、过伸及过屈位），辅以脊髓造影，椎动脉造影，CT、MRI及核医学等特殊检查。颈椎病的诊断颈椎病的诊断第19页/共26页 非手术治疗非手术治疗v 颌枕带牵引、颈托和围领v 理疗、推拿和按摩v 自我保健疗法v 药物治疗（消炎药、肌松弛剂、镇 静剂、皮质类固醇制剂）v 硬膜外注射激素颈椎病的治疗颈椎病的治疗第20页/共26页 手术治疗指征手术治疗指征v 非手术治疗无效（诊断明确）v 反复发作者v 脊髓型颈椎病症状进行性加重颈椎病的治疗颈椎病的治疗第21页/共26页 手术治疗方法手术治疗方法前路及前外侧手术前路及前外侧手术 适合于切除突出之椎间盘、椎体后方骨赘及钩椎关节骨赘，以解除对脊髓、神经根和椎动脉的压迫。颈椎病的治疗颈椎病的治疗第22页/共26页 手术治疗方法手术治疗方法后路手术后路手术 主要是通过椎板切除，或椎板成形术达到对脊髓的减压。颈椎病的治疗颈椎病的治疗第23页/共26页 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mXp!s&w)z0C4F7IaMdPhSkVnZqx+B2E6H9KcOf第25页/共26页感谢您的观看！第26页/共26页