胸椎管狭窄症课件.ppt

continuous OPLL extending from C3 to T7, with a severe canal stenosis at the C7–T2 level * 胸椎管狭窄症的诊断与治疗原则 冯世庆 天津医科大学总医院 Tianjin, 10/7/2013 A Typical Case A 50-year-old man Chief illness: slight numbness of the lower extremities and back pain persisting for 10 years, the numbness of his right leg had deteriorated for 6months Past history: a volleyball player at school and had played volleyball until recently Physical examination: Romberg signs (+); Deep tendon reflexs of lower extremities exaggerated; Below T12 bilaterally: vibration, position, pain and temperature sensation diminished A Typical Case Arai A, Aihara H, Miyake S, Hanada Y, Kohmura E. Syringomyelia due to thoracic spinal stenosis with ossified ligamentum flavum--case report. Neurol Med Chir (Tokyo). 2011;51(2):157-9. 概念 胸椎管狭窄症是由发育性因素或由椎间盘退变突出、椎体后缘骨赘及小关节增生、韧带骨化等因素导致胸椎管或神经根管狭窄引起相应脊髓、神经根受压的疾病 胸椎黄韧带骨化症（OLF） 胸椎间盘突出症(TDH） 后纵韧带骨化症（OPLL） 硬膜骨化 其他少见原因：弥漫性骨肥厚症、强直性脊柱炎、氟骨症、胸椎椎体后缘骨软骨结节、关节突内聚 病因 流行病学 Aizawa T, Sato T, Sasaki H, Matsumoto F, Morozumi N, Kusakabe T, Itoi E,Kokubun S. Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients. J Neurosurg Spine. 2007 Jul;7(1):13-20. OLF: 胸椎黄韧带骨化症 OPLL: 后纵韧带骨化症 SP：胸椎椎体后缘骨软骨结节 HE：胸椎间盘突出 下胸椎（T9-T12)最多见 ， 好发于40～60岁成年人 病理机制 应力刺激可诱发黄韧带细胞向骨化方向转化【1】 成骨蛋白（Bone morphogenetic protein） 和 转化生长因子-b（transforming growth factor-b）【1,2】 【1】Li M, Wang Z, Du J, Luo Z, Wang Z. Thoracic myelopathy caused by ossification of the ligamentum flavum: a retrospective study in Chinese patients. J Spinal Disord Tech. 2013 Feb;26(1):E35-40. 【2】Hoshi K, Amizuka N, Sakou T, et al. Fibroblasts of spinal ligamentspathologically differentiate into chondrocytes induced by recombinanthuman bone morphogenetic protein-2: morphological examinations for ossification of spinal ligaments. Bone. 1997;21:155–162 临床表现 症状 胸脊髓或神经根受累的相应症状和体征，相互间并无显著区别 OLF和OPLL：胸背部疼痛症状不突出 TDH：胸背部疼痛 脊髓源性间歇性跛行: 早期仅感觉行走一段距离后,下肢无力、发僵、发沉、不灵活等，休息片刻又可继续行走。 临床表现 体征 典型表现：脊髓上运动神经元性损害为