腰椎间盘突出怎么治疗坐骨神经痛的原因腰椎病腰椎间盘突出能治好吗腰间盘突出的症状腰突症腰椎键盘突出症椎间盘突出症治颈椎病腰椎键盘突出椎间盘突出怎么治疗中医治疗腰椎间盘突出症治疗颈椎病颈椎突出腰突颈椎病治疗腰椎间盘突出症的治疗方法颈椎腰椎盘突出治疗方法腰椎盘突出怎么治疗
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脊柱疾病

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脊椎疾病(一)bull授課老師:沈戊忠bull中國醫藥學院附設醫院bull放射線部目錄:脊椎疾病(一)LumbarHIVDspondylosisCervicalHIVDspondylosisSpinalinjury脊椎疾病(二)SpinaltumorsSpinalinfectiousdiseasesandinflammatorydisea
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脊柱疾病
脊柱疾病
脊柱疾病
脊柱疾病
脊柱疾病
脊柱疾病
脊柱疾病  脊椎疾病(一)bull授課老師:沈戊忠bull中國醫藥學院附設醫院bull放射線部目錄:脊椎疾病(一)LumbarHIVDspondylosisCervicalHIVDspondylosisSpinalinjury脊椎疾病(二)SpinaltumorsSpinalinfectiousdiseasesandinflammatorydiseasesCongenitalanomaliesofspineLumbarHIVDSpondylosisNormalanatomyoflumbarspineSpinalcanal脊椎腔Neuroforamen神經孔bonediscDuralsacLumbarHIVD:LumbarHIVD:CT:FocalbulgingoutofdiscObliterationofipsilateralepiduralfatandnerverootDeformityofduralsacLSSnSnFBigHIVDinleftsideofLS,compressingtheleftSnerveLSSnLnCT:FocalbulgingoutofdiscObliterationofipsilateralepiduralfatandnerverootDeformityofduralsacMHIVDinRtsideofLSlevel,compressingRtSnerveHIVDinRtsideofL,compressingtheRtLnerveLLnLSSnSnMHIVD,Rt,withcaudalmigrationinLSlevelLSFPosteriocentralHIVDinLPosteriorcentralHIVDMLateralHIVD,L,compressingtheleftneuroforamen,compressingtheLnerveLnLateralHIVDintheneuroforamenFHIVDwithcephalicmigrationinLSLSLSTWITWITWIMHIVDinLLLLLLLFBigHIVDinLSLSLSMLateralHIVD,L,compressingtherightneuroforamen,compressingtheLnerveDegenerativelumbarspondylosis:Degenerativelumbarspondylosis:BonyspursScoliosisDiscnarrowingEburnationofboneDegenerativespondylosisoflumbarspineBulgingdiscSpinalcanalstenosisFDegenerativespondylosisoflumbarspineLLSLSLLSLLSLSLFDegenerativespondylosisoflumbarspineSLLLspine:degenerativespondylosiswithspurs,narrowingofdiscofLDegenerativediscwithbulgingoutandvacuumDJDofbilfacetjoints,causingspinalcanalstenosisSeveredegenerativespondylosiswithbonyspurs,narrowingofdiscspaces,scoliosisTTSeveredegenerativespondylosiswithbonyspurs,mildoldcompressionfractureOfTCT:DJDofRtFacetjoint(whitearrow)Anteriorspur(redarrow)BulgingvacuumofdiscBonyspurofvertebralbodyLLSSpinalcanalstenosisduetobulgingdisc,DJDoffacetjointsDJDoffacetjointsspinalcanalstenosisneuroforamenstenosisBonyspurinLSlevelwithbulgingdiscspurbulgingdiscFSpinalcanalstenosisinL,duetohypertrophyofligamentflava,andbulgingdischypertrophyofligflavabulgingvacuumofdiscLLLLLLLLDegenerativespondylosiswithspinalcanalstenosisinL,L,duetobulgingoutofdiscs,DJDoffacetjointsLLLLLSpondylolysisoflaminaofLwithspondylolisthesisofLonLFSpondylolysisofLcausingspondylolisthesisofLonSLLLSCervicaldegenerativespondylosis:Degenerationof:bullvertebralbodiesspursbulldiscbulgingout,HIVDbullfacetjointsspurs,hypertrophybullligmentumhypertrophy,calcification,ossificationNormalcervicalspinediscSpinalcordGraymatterCSFspaceneuroforamenCervicaldegenerativespondylosis:causingstenosisof:bullneuroforaminaradiculopathy(CSR)bullspinalcanalmyelopathyorradicuomylopathy(CSM,CSRM)CervicalradiculopathyCervicalmyelopathyStenosisoftheleftneuroforamen,duetobonyspurfromtheuncinateprocessStenosisoftherightneuroforamenofC,duetobonyspurfromtheuncinateprocess,causingrightsideradiculopathyPosteriorbulgingdiscinClevel,compressingthespinalcord,causingmyelopathyCCStenosisoftherightneuroforamen,duetobonyspurfromtheuncinateprocess,causingrightsideradiculopathyStenosisoftheleftneuroforamen,duetobonyspurfromtheuncinateprocess,causingleftsideradiculopathyMHIVDofC,compressingtheleftsideCnerve,causingleftradiculopathyCCCervicalHIVD:bullcompressingthespinalcord(myelopathy)bullcompressingthenerveroot(radiculopathy)CCHIVDinC,C,compressingthespinalcord,causingmyelopathyHIVDinCBulgingoutofdiscinCHIVDinC,C,compressingthespinalcord,causingmyelopathyMCervicalspondylosiswithtraumaticHIVDsinC,CStenosisofbilateralneuroforaminainCduetobonyspursCCCCCCCMOPLL,COPLL:ossificationofposteriorlongitudinalligmentumCCCCCCTWIT*WIXrayCTOPLL:ossificationofposteriorlongitudinalligmentumSpinalInjuryFractureSubluxationEpiduralorsubduralhematomaSpinalcordedemaandhemorrhageMyelomalasiaofthespinalcordTraumaticHIVDDiagnostictools:PlainfilmsCTMRILBurstfractureofL,thebonyfragementsinsertingintothespinalcanalEpiduralhematomaisseeninLlevels(redarrow)LLMAcuteburstfractureofL,causingseverestenosisofspinalcanalXrayCTDMTypeIIIcompressionfractureofC,withanteriorsubluxationofodontoidprocessXrayCTDFCtypeIIIfractureCTDDFCtypeIIIfracturewithcordcontusionedemaTWIT*WIFSevereCsubluxation,compressingthespinalcordCCCCCCTWIT*WIXraySevereCsubluxation,andepiduralhematomaC,duetoacutetraumaCOdontoidprocessofCCMAcuteepiduralhematomaintheCandposteriorfossa,duetotraumaCTTWIMSpinalinjurywithfractureofT,acuteepiduralhematomainTLTTTTTWIT*WILLMSpinalinjurywithfractureofT,acuteepiduralhematomainTLMSpinalinjurywithfractureofT,acuteepiduralhematomainTLLLTFAcutespinalinjurywithtraumaticHIVD,whichcompressingthespinalcord,withcordedemaTraumaticHIVDCCCCMCspineinjuryatMay,withquadriplegia,MRI:twomyelomalaciawithcordatrophyCCCCTWIT*WIXrayLLLLLTTLLLLMultiplecompressionfracturesduetoosteoporosiswithspinalinjuryLLLLOldcompressionfractureofL,withoutsignalchangeofbonemarrowNewcompressionfractureofL,withsignallossofbonemarrow,inTWITWIT*WI 95%的人还看了:   脊椎疾病 (一)   ?授課老師: 沈 戊 忠   ?中國醫藥學院 附設醫院 ?放 射 線 部   目錄:   脊椎疾病 (一)   1. Lumbar HIVD & spondylosis 2. Cervical HIVD & spondylosis 3. Spinal injury   脊椎疾病 (二)   4. Spinal tumors 5. Spinal infectious diseases and inflammatory diseases 6. Congenital anomalies of spine   1    Lumbar HIVD & Spondylosis   2    Normal anatomy of lumbar spine   3    disc   bone   Spinal canal 脊椎腔 Neuroforamen 神經孔 Dural sac   4    HIVD (椎間盤疝出症): (herniation of intervertebral disc, herniation of nucleus pulposus). 85% occurs in the L4-5, L5-Sl level. 85% are posterio-lateral herniation: HIVD in L4-5: compressing the L5 nerve root. HIVD in L5-Sl: compressing the Sl nerve root.   5    Lumbar HIVD:   Clinical symptoms:   Sciatica (坐骨神經痛) low back pain   Severe HIVD:   claudication (跛行) caudal equinal syndrome   6    CT:   Lumbar HIVD:   1. Focal bulging out of disc 2. Obliteration of ipsilateral epidural fat and nerve root 3. Deformity of dural sac   S1 n S1 n   L5-S1   7    CT:   1. Focal bulging out of disc 2. Obliteration of ipsilateral epidural fat and nerve root 3. Deformity of dural sac   F/59 Big HIVD in left side of L5-S1, compressing the left S1 nerve   L5n   S1n   L5-S1   8    M/37 HIVD in Rt. side of L5-S1 level, compressing Rt. S1 nerve HIVD in Rt. side of L4-5, compressing the Rt. L5 nerve   L5 n S1 n S1 n   L5-S1   L4-5   9    M/43 HIVD,Rt, with caudal migration in L5-S1 level.   L5-S1   10    F/62 Posterio-central HIVD in L4-5   Posterior central HIVD   11    M/30 Lateral HIVD, L4-5, compressing the left neuroforamen, compressing the L4 nerve   L4n   Lateral HIVD in the neuroforamen   12    F/36 HIVD with cephalic migration in L5-S1   L5 S1   L5 S1   T1WI   T2WI   T2WI   13    M/52 HIVD in L4-5   L4 L5   L4 L5   L4 L5   14    L5   S1   L5   S1   F/59 Big HIVD in L5-S1.   15    M/30 Lateral HIVD, L4-5, compressing the right neuroforamen, compressing the L4 nerve   16    Degenerative lumbar spondylosis:   Degenerative change of : ? Vertebral bodies.......spurs. ? Disc....... bulging out, vacuum, decreased height. ? Facet joints......DJD with spurs, subluxation. ? Lamina.......inward displacement.   17    Degenerative lumbar spondylosis:   The above lesions causes: ? Stenosis of central spinal canal.......low back pain, claudication, caudal equinal syndrome. ? Stenosis of lateral recess or neuroforamina........root pain.   18    Degenerative spondylosis of lumbar spine   Eburnation of bone   Bony spurs   Bulging disc   Disc narrowing Spinal canal stenosis   Scoliosis   19    L4--5   L4   L5-S1 L5 L5   S1   S1   F/68 Degenerative spondylosis of lumbar spine   20    L4--5   L4   F/70 Degenerative spondylosis of lumbar spine   L5   S1   L5-S1   21    3   4   L3-4   5   S1 L-spine: degenerative spondylosis with spurs, narrowing of disc of L4-5. Degenerative disc with bulging out and vacuum; DJD of bil. facet joints, causing spinal canal stenosis.   L4-5   22    Severe degenerative spondylosis with bony spurs, narrowing of disc spaces, scoliosis   23    T12   T12   Severe degenerative spondylosis with bony spurs, mild old compression fracture Of T12 CT: DJD of Rt. Facet joint (white arrow) Anterior spur (red arrow)   24    L4--5   L5-S1   Bony spur of vertebral body   Bulging & vacuum of disc   25    Spinal canal stenosis due to bulging disc, DJD of facet joints   neuroforamen stenosis   spinal canal stenosis   DJD of facet joints   26    Bony spur in L5-S1 level with bulging disc   bulging disc spur   27    F/63 Spinal canal stenosis in L4-5, due to hypertrophy of ligament flava, and bulging disc bulging & vacuum of disc   hypertrophy of lig. flava   28    L3-4   L3   L4   L3   L4   L4-5 L5   L5   Degenerative spondylosis with spinal canal stenosis in L3-4, L4-5, due to bulging out of discs, DJD of facet joints   29    L3   Spondylolysis of lamina of L3 with spondylolisthesis of L3 on L4   L3 L4   L3   L3   30    L5   L5 S1   L5   F/45 Spondylolysis of L5 causing spondylolisthesis of L5 on S1   31    Cervical degenerative spondylosis:   Degeneration of: ? vertebral bodies....spurs. ? disc.......bulging out, HIVD. ? facet joints.......spurs, hypertrophy. ? ligmentum.......hypertrophy, calcification, ossification.    Normal cervical spine   disc   neuroforamen CSF space   Spinal cord   Gray matter    Cervical degenerative spondylosis:   causing stenosis of: ?neuroforamina.......radiculopathy (CSR). ?spinal canal........myelopathy or radicuomylopathy ( CSM, CSR & M).    Cervical radiculopathy   35    Cervical myelopathy   36    Stenosis of the left neuroforamen, due to bony spur from the uncinate process   37    C3-4   C4-5   Stenosis of the right neuroforamen of C3-4, due to bony spur from the uncinate process, causing right side radiculopathy Posterior bulging disc in C4-5 level, compressing the spinal cord, causing myelopathy 38    Stenosis of the right neuroforamen, due to bony spur from the uncinate process, causing right side radiculopathy Stenosis of the left neuroforamen, due to bony spur from the uncinate process, causing left side radiculopathy   39    C5   C6   M/40 HIVD of C5-6, compressing the left side C6 nerve, causing left radiculopathy    Cervical HIVD:   ?compressing the spinal cord (myelopathy). ?compressing the nerve root (radiculopathy).    3 4   5   3 4 5 C3-4   HIVD in C3-4, C4-5, compressing the spinal cord, causing myelopathy   C4-5    4 5 6   HIVD in C4-5   HIVD in C3-4, C4-5, compressing the spinal cord, causing myelopathy   Bulging out of disc in C5-6 43    C3 C4 C5 C6   C3-4   C4-5   C5-6   M/54 Cervical spondylosis with traumatic HIVDs in C3-4, C5-6; Stenosis of bilateral neuroforamina in C4-5 due to bony spurs44    C2 C3 C4 C3 C3 C4 M/43 OPLL, C2-4   OPLL: ossification of posterior longitudinal ligmentum   CT   X-ray   T1WI   T2*WI   45    OPLL: ossification of posterior longitudinal ligmentum    Spinal Injury   Fracture Subluxation Epidural or subdural hematoma Spinal cord edema and hemorrhage Myelomalasia of the spinal cord Traumatic HIVD   Diagnostic tools: Plain films CT MRI   47    L1   L2 Burst fracture of L1, the bony fragements inserting into the spinal canal. Epidural hematoma is seen in L2-5 levels (red arrow).   48    L3   CT   3-D   X-ray   M/43 Acute burst fracture of L3, causing severe stenosis of spinal canal   49    CT   2-D   X-ray   M/63 Type III compression fracture of C2, with anterior subluxation of odontoid process 50    F/40 C2 type III fracture   CT   2-D   51   3-D    T2*WI   F/40 C2 type III fracture with cord contusion edema T1WI   52    C1 C2   C1 C2   C1 C2   X-ray   T1WI   T2*WI   F/46 Severe C1-2 subluxation, compressing the spinal cord   53    C1   C3   Odontoid process of C2   Severe C1-2 subluxation, and epidural hematoma C2-6, due to acute trauma   54    CT   M/42 Acute epidural hematoma in the C1-2 and posterior fossa, due to trauma T1WI   55    T9 T10 L1   L1   T9   T10   T1WI   T2*WI   M/54 Spinal injury with fracture of T9,10; acute epidural hematoma in T8-L1.   56    M/54 Spinal injury with fracture of T9,10; acute epidural hematoma in T8-L1.   57    L1   L1   T8   M/54 Spinal injury with fracture of T9,10; acute epidural hematoma in T8-L1.   58    Traumatic HIVD   C4   C4 C5   C5   F/27 Acute spinal injury with traumatic HIVD, which compressing the spinal cord, with cord edema.   59    C3 C4   C3 C4   T1WI   X-ray   M/23 C-spine injury at May, with quadriplegia, MRI: two myelomalacia with cord atrophy   T2*WI   60    T11 L2 L3 L4 L3 T12 L1   L2   L3 L4 L5   Multiple compression fractures due to osteoporosis with spinal injury   61    T1WI   T2*WI   L3 L4   L3 L4   Old compression fracture of L3, without signal change of bone marrow New compression fracture of L4, with signal loss of bone marrow, in T1WI   62    。。。。。。。

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