疼痛学课件：疼痛相关解剖学概要.pptVIP

治疗后CT图象 提示椎间盘内出现空隙和椎间盘突出部分变化 腰椎间盘突出症的微创治疗： 腰椎间盘突出症的微创治疗 经卵圆孔入路三叉神经半月节射频 经卵圆孔入路三叉神经半月节射频 经卵圆孔入路三叉神经半月节射频 经圆孔入路三叉神经半月节射频毁损 经圆孔入路治疗第2支三叉神经痛 应用解剖学基础 1 眶下裂为一狭窄之骨性通道，其外侧为眶外侧壁，由颧骨和蝶骨构成，其内侧为上颌骨和上颌窦 上颌神经出圆孔后分出眶下神经，经眶下裂至眶下神经，再经眶下孔分布于面部 眶下裂内容物主要为眶脂体以及部分眶下神经走行 经圆孔入路治疗第2支三叉神经痛 圆孔与眶下裂（CT图像） 经圆孔入路治疗第2支三叉神经痛 圆孔应用解剖学基础 2 经圆孔入路治疗第2支三叉神经痛 单侧走行（与硬腭相比）自前向后斜行向上34%、向下43%、平行23%。 双侧自前向后呈外“八”字75%，内“八”字20%，接近平行5%。 应用解剖学基础 我们通过人体标本解剖发现，可通过眶下裂穿刺至圆孔，再经过圆孔穿刺到三叉神经半月节。 此穿刺入路上主要内容物为眶脂体和上颌神经走行，其他无重要血管、器官或组织，因而不损伤眶内重要内容物。 经圆孔入路治疗第2支三叉神经痛 神经毁损-腹腔神经丛 神经毁损-上腹下神经丛 神经毁损-奇神经节 鞘内药物输注系统 Life beyond pain! 这张图，示意了西乐葆的止痛机理。首先，也是最主要的，是在外周损伤组织周围消除导致疼痛的炎症因子，从而消炎镇痛。另外，新研究显示，手术等创伤能够在2－6个小时后，使中枢（脊髓背角、大脑）的COX-2表达上调，从而导致痛觉超敏，痛阈降低。而西乐葆在中枢也可抑制COX-2，从而抑制痛觉超敏，提高痛阈。从而使患者对疼痛的感受减少。 PURPOSE OF THE SLIDE To speak to plasticity within the pain system, specifically within the dorsal horn, that occurs following injury. KEY POINTS Sprouting of nociceptor axons occurs following injury (transection) such that Aβ neurons that synapsed in deeper laminae (III-V) now re-orient themselves to more superficial laminae (I-II) producing a reorganized somatotopic map.1,2 Injuries to peripheral nerves could potentially result in partial or total loss of motor, sensory and autonomic functions conveyed by the lesioned nerves to the denervated segments of the body.2 Injured axons may regenerate and reinnervate denervated targets, undamaged axons may reinnervate targets via collateral branching, and the circuitry may remodel itself in order to compensate for the functional deficits caused by axotomy. However, not all of these mechanisms lead to recovery; in fact, maladaptive changes such as neuropathic pain, hyperreflexia, and dystonia may result.2 In addition to structural reorganization, dorsal horn neurons may begin to fire spontaneously and at high frequencies due to dysfunctions in inhibitory interneurons (GABA-ergic cells) and/or descending modulatory neurons. This altered neuronal activity may contribute to central sensitization an