八年制颈椎病.pptVIP

* Nowadays, neck problem, for example, cervical spondylosis, is a very common condition, men and women are almost equeally affected.In China, medical scientists have found that the prevalence of cervical spondylosis has reached 20% in rencent years.Most patients are not the old people but the young adults in their forties or even in their thirties.Unlike low back problem which is more common in blue collar individuals. cervical spondylosis usually affect the white collar class, especially teachers,accountants and secreteries.The society, the media and the public pay much attention to this disease.It is funny that today, having cervical spondylosis even become a fasion. However，the scientific understanding of this disease has not become a fasion. Many many people do not know exactly what is on earth cervical spondylosis. You are brilliant medical students, I hope after this class, you are able to understand this disease correctly. * * * * 交感神经兴奋 动脉痉挛 VBI 椎动脉型颈椎病 椎动脉受机械 压迫牵拉、扭曲 诊断 X-ray： 颈椎钩椎关节增生(Lushca关节) 颈椎节段不稳(过伸过屈片) 高位硬膜外封闭 : 进针部位: C7-T1,进入硬膜外腔,向上放管5cm 注入药物: 1%利多卡因5ml (0.5% 10ml) , 可以置留管,2小时可重复一次 目的: 了解交感及其他颈椎病症状变化情况 MRA、椎动脉造影、椎动脉动力位B超 颈性眩晕要与其他多科的眩晕相鉴别 重点鉴别: 美尼尔氏病 内耳、前庭功能障碍 脑血管病 青光眼 药物性眩晕 交感型颈椎病、椎动脉型颈椎病属于“排除诊断” 鉴别诊断 Treatment 非手术治疗 Conservative treatment 休息 牵引 颈部制动 按摩 理疗 药物 适应征（indication）：绝大多数的CSR、交感型颈椎病，椎动脉型颈椎病 Treatment 手术治疗 前路（Anterior）： ﹡椎间盘切除（Discectomy）或椎体次全切除（Corpectomy ） +椎体间植骨融合（Fusion） ﹡人工椎间盘置换术（artificial disc replacement） 后路（Posterior）： ﹡椎管扩大成形术（Laminoplasty）：单开门、双开门 ﹡椎扳切除术 一期前后路联合手术 手术目的 充分减压 恢复颈椎生理曲度 重建颈椎的稳定 手术指征（indication） 脊髓型一旦确诊应当积极手术 其他各型出现以下情形者考虑手术： --保守治疗无效或反复发作 --症状明显并严重影响患者生活和工 作 --出现严重的神经根损害 术式选择标准 前路减压+椎体间植骨 1或2个节段的椎间盘突出 1或2个节段退变性颈椎管狭窄 孤立型后纵韧带骨化 颈椎后凸畸形或明显的节段性不稳定 ACDF 术式选择标准 椎体次全切除+椎体间植骨融合术 局限性椎管狭窄 局限性OPLL 术式选择标准 后路椎管扩大成形术（单开门