ImageVerifierCode 换一换
格式:PPT , 页数:29 ,大小:1.54MB ,
资源ID:244675      下载积分:10 文钱
快捷下载
登录下载
邮箱/手机:
温馨提示:
快捷下载时,用户名和密码都是您填写的邮箱或者手机号,方便查询和重复下载(系统自动生成)。 如填写123,账号就是123,密码也是123。
特别说明:
请自助下载,系统不会自动发送文件的哦; 如果您已付费,想二次下载,请登录后访问:我的下载记录
支付方式: 支付宝    微信支付   
验证码:   换一换

加入VIP,省得不是一点点
 

温馨提示:由于个人手机设置不同,如果发现不能下载,请复制以下地址【https://www.wenke99.com/d-244675.html】到电脑端继续下载(重复下载不扣费)。

已注册用户请登录:
账号:
密码:
验证码:   换一换
  忘记密码?
三方登录: QQ登录   微博登录 

下载须知

1: 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。
2: 试题试卷类文档,如果标题没有明确说明有答案则都视为没有答案,请知晓。
3: 文件的所有权益归上传用户所有。
4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
5. 本站仅提供交流平台,并不能对任何下载内容负责。
6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。

版权提示 | 免责声明

本文(DegenerativeScoliosis退变性脊柱侧凸.ppt)为本站会员(h****)主动上传,文客久久仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对上载内容本身不做任何修改或编辑。 若此文所含内容侵犯了您的版权或隐私,请立即通知文客久久(发送邮件至hr@wenke99.com或直接QQ联系客服),我们立即给予删除!

DegenerativeScoliosis退变性脊柱侧凸.ppt

1、Degenerative Scoliosis,Wang Xuepeng M.D.Hangzhou First Peoples Hospital,Epidemiology,can be differentiated into two major groups, i.e., primary degenerative scoliosis or de novo scoliosis and secondary degeneration of adult idiopathic scoliosisthe prevalence of scoliosis in patients older than 50 ye

2、ars is about 6%,the average age of those seeking medical care is in the sixties.there is a potential for curve progression with an average of 3.3 one year,Pathogenesis,the asymmetric degeneration of the disc and the facet joint leads to an asymmetric loading of the spinal segment and consequently an

3、 asymmetric deformity, i.e., scoliosis or kyphosisthe formation of osteophytes at the facet joint (spondylarthritis) and at the vertebral endplates (spondylosis) contributes to the increasing narrowing of the spinal canal together with the hypertrophy and calcification of the ligamentum flavumand jo

4、int capsules, creating central and recessal spinal stenosis,Classification,the classification of Lenkes may be able to cover the adult idiopathic scoliosis group with secondary degeneration but is not necessarily adequate for the primary degenerative scoliosis type,Classification,Schwab distinguishe

5、d three groups based on measurements of the endplate obliquity of L3 in the frontal plane, and of the lumbar lordosis measured between the L1 and S1 superior endplates in the sagittal plane,Classification,Cardinal Symptoms,Back Painis the most frequent clinical problem of adult scoliosispatients oft

6、en complain of axial back pain due to segmental instabilityat the site of the curve can be localized either at the apex or in its concavityunbalanced, overloaded and stressed paravertebral back muscles may become very sore and in return will not contribute to balance, consequently becoming part of a

7、 vicious circle,Spinal Claudicationis the second most important symptom of adult degenerative scoliosis and may express itself as: radicular claudication central claudicationthe roots are compressed not necessarily on the concave side due to a narrow foramen, but often on the convex side,Neurologica

8、l Compromiseneurological deficits occur lateis the third most important clinical presentation and may include individual roots, several roots or the whole cauda equina with apparent bladder and rectal sphincter problems,Increasing Deformityosteoporosis accelerates curve progressionlarger curves tend

9、 to progress faster than small curves for biomechanical reasons,Physical Findings,Standard Radiographs,full body standing radiographs are indispensableradiographs sometimes exhibit clues to the etiology of the curve (primary vs. secondary)important to look at earlier radiographs to understand the na

10、tural history and therefore the etiology of the curve,Magnetic Resonance Imaging,is the imaging modality of choice to explore neural compromise and disc degeneration,Computed Tomography,computed tomography with or without a myelogram is the diagnostic imagingmethod of choice in the case of diagnosti

11、c uncertainties related to the three dimensional,Interventional Radiological Procedure,in the context of the evaluation of the pain source, spinal injection studies are especially helpful since their findings may change the therapeutic approach,Additional Diagnostic Tools,temporary immobilization ca

12、st in the form of a thoracolumbar orthosis (TLO) or thoracolumbosacral orthosis (TLSO) to see whether an overall stabilization and fusion of the whole scoliotic spinal area could be beneficialneurophysiologic studies may be helpful to identify the responsible levelosteodensitometry (DEXA) is indicat

13、ed whenever there is a suspicion of osteoporosis because of the implications with regard to curve progression and potential spinal fixation,Non-operative Treatment,The non-surgical treatment options basically consist of: non-steroid anti-inflammatory drugs (NSAIDs) muscular relaxation pain medicatio

14、n muscle exercises gentle traction (in selected cases) spinal injection studies orthosis,Non-operative Treatment,manipulations and physical activation should be avoided because they may increase the paintherapeutic epidural and selective nerve root blocks as well as facet joint blocksmay help to con

15、trol the pain temporarily. a well-fitted brace to support the painful spine area may be necessary,Operative Treatment,Correction Procedures,whether or not a degenerative scoliosis should be corrected remains a crucial and complex question.the treatment of a degenerative scoliosis has different goals

16、 than the treatment of adolescent scoliosis. It depends on several factors:,Correction Procedures,Sagittal balance is most important,Surgical Techniques,debate continues on the indications for a lumbosacral fusion in young patients with secondary degenerative scoliosis, it is better to omit L5/S1 fr

17、om fusion whenever possible in order to prevent iliosacral joint degeneration or an early hip problem. It is also usually preferable to stop at L4 in a lumbar curve whenever possibleHowever, a fusion to the L5 vertebra is necessary when the condition of the L4/5 facet joint is poor,Surgical Techniques,Take Home Messages,Thank You!,

Copyright © 2018-2021 Wenke99.com All rights reserved

工信部备案号浙ICP备20026746号-2  

公安局备案号:浙公网安备33038302330469号

本站为C2C交文档易平台,即用户上传的文档直接卖给下载用户,本站只是网络服务中间平台,所有原创文档下载所得归上传人所有,若您发现上传作品侵犯了您的权利,请立刻联系网站客服并提供证据,平台将在3个工作日内予以改正。