脊柱区颈段断层解剖学.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,-,*,一、脊柱区的一般结构,1,-,椎骨的一般形态,横突,椎弓,椎体,棘突,下关节突,上关节突,椎孔,椎弓根,(pedicle,P),椎弓板,(lamina,L),Vertebral body,Vertebral arch,Transverse process,spinous process,Inferior articular process,Superior articular process,Vertebral foramen）,2,-,（一）脊柱前部,椎体,椎间盘,前纵韧带,后纵韧带,3,-,1.椎体,4,-,纤维环,髓 核,椎间盘,后纵韧带,前纵韧带,软骨板,骺环,2.椎间盘 intervertebral disc,(透明软骨终板),5,-,椎骨的发育,6,-,2.椎间盘,腰骶椎间盘,胸腰椎间盘,颈胸椎间盘,第1胸椎间盘,第1颈椎间盘,第1腰椎间盘,7,-,髓核突出的方向,8,-,椎间盘疝出,9,-,腰椎间盘,A.椎体终板星状骨折,B.X线图片未显示终板骨折,C.上终板凹陷,髓核突入椎体内,内层纤维环塌陷并凸突入髓核内,后侧纤维环像发卡样弯曲.,D.髓核通过终板突入椎体内.,E.纤维环膨出超过椎体后侧边界.,赵凤东等主译腰痛的生物力学,10,-,腰椎间盘,A.髓核向左后外侧脱出,B.纤维环放射状裂缝,终板骨折,血液渗出,E.上终板凹陷,髓核突入椎体内,内层纤维环塌陷并凸突入髓核内,后侧纤维环像发卡样弯曲.,F.髓核向后脱出至后纵韧带下方.,赵凤东等主译腰痛的生物力学,11,-,腰椎间盘突出,12,-,髓核脱出与椎间盘脱出症,椎间盘向后外侧疝出压迫神经根,13,-,Figure 1a.MR images of the lumbar spine in a 32-year-old woman with discogenic low back pain demonstrate the criteria used to identify mild endplate abnormalities.Sagittal(a)T1-weighted(700/12)and(b)T2-weighted(5,000/112)turbo spin-echo MR images demonstrate a small band of increased signal intensity(arrowheads)of bone marrow(cranial or caudal extent 25%of the vertebral height as measured on a midsagittal image)adjacent to the upper endplate at the intervertebral disk level of L5(,5,)to S1(,1,)(type II endplate abnormality).There is grade 3 degeneration at the L5-to-S1 intervertebral disk level with disk bulging and grade 4 degeneration of the intervertebral disk at L4(,4,)to L5 with disk bulging.,14,-,3.前纵韧带 4.后纵韧带,前纵韧带,后纵韧带,15,-,3.前纵韧带4.后纵韧带,棘间韧带,Interspinous lig.,16,-,（二）脊柱后部,椎弓,关节突关节,韧带,椎间孔,(,椎间管,),17,-,1.椎弓2.关节突关节,椎板间隙,关节突间隙,(峡部),18,-,3.椎弓间的韧带,19,-,3.椎弓间的韧带,项韧带,棘上韧带,棘间韧带,20,-,3.椎弓间的韧带,黄韧带,21,-,3.椎弓间韧带,横突间韧带,横突间韧带,棘上韧带,黄韧带,22,-,椎下切迹,椎上切迹,4.椎间孔(管),胸腰椎间孔,颈胸椎间孔,腰骶椎间孔,23,-,经第3腰椎椎弓根CT图像,24,-,黄韧带,经第3腰椎椎间盘CT图像,25,-,颈椎间孔,26,-,颈椎前后位X线像,钩椎关节,27,-,(三)椎管及其内容,28,-,脊髓的被膜及其间隙,29,-,脊髓和脊神经,30,-,（三）椎静脉系,椎外静脉丛前部,椎外静脉丛后部,椎内静脉丛前部,椎内静脉丛后部,椎体静脉,椎间静脉,31,-,后斜角肌,中斜角肌,前斜角肌,颈长肌,头长肌,(四)椎旁软组织,32,-,头夹肌,颈夹肌,头半棘肌,头后小直肌,头后大直肌,头后上斜肌,头后下斜肌,(四)椎旁软组织,33,-,枕下神经,枕下神经,头下斜肌,头上斜肌,头半棘肌,头后大直肌,第3枕神经,第2颈神经后支,枕大神经,颈棘间肌,(四)椎旁软组织,34,-,二、脊柱区颈段,35,-,1.颈,椎的形态结构,结节间板,前根,后根,脊神经沟,前结节,后结节,椎体钩,36,-,(C3C7),钩椎关节（Luschka关节）,颈动脉结节,关节突关节,37,-,颈椎侧位X片,38,-,颈椎间盘,39,-,第4、5颈椎椎间盘CT图像,40,-,第5、6颈椎椎间盘CT图,41,-,UTAC,复合体,42,-,3.颈椎管及其内容,43,-,颈神经与椎动脉,44,-,4.椎间孔(椎间管)和神经根,枕下神经,枕大神经,第3枕神经,45,-,46,-,47,-,48,-,第4、5,颈椎间盘的横断面标本和MRIT1,49,-,第4、5颈椎间盘的横断面标本和MRIT1,50,-,51,-,52,-,颈椎椎间孔的矢状面,椎间盘萎缩椎间孔狭窄,正常椎间孔,53,-,颈椎旁正中矢状断面图像,54,-,经椎间孔的斜断面标本和,MRI,T1,55,-,经椎动脉的斜断面标本和,MRI,T1,56,-,经椎间孔长轴的斜断面标本和,MRI,T1,57,-,经椎间孔的冠状断面标本和MRIT1,58,-,5.寰枢关节,59,-,5.寰枢关节,十字韧带,翼状韧带,齿突尖韧带,寰椎横韧带,纵束,60,-,寰枕关节和寰枢关节X图像,61,-,头长肌13,茎突8,齿突15,横突孔及其椎动、静脉18,脊髓19头最长肌17,头夹肌21,头后大直肌23,头半棘肌24,经寰椎横断面CT图,62,-,咽隐窝11,腮腺12,头长肌13,颈内动脉14,齿突15,颈内静脉16,椎动、静脉18,脊髓19,头夹肌21,头后小直肌22,头半棘肌24,经寰椎横断面MRIT2WI图,63,-,咽隐窝11,腮腺12,头长肌13,颈内动脉14,齿突15,颈内静脉16,椎动、静脉18,脊髓19,头夹肌21,头半棘肌24,经寰椎横断面MRIT2WI图,64,-,65,-,66,-,67,-,寰枢正中关节,68,-,颈椎正中矢状面,69,-,颈椎正中矢状断面图像,70,-,颈椎管狭窄,图所示为中年男性患者，黄韧带骨化致颈椎管狭窄。,71,-,图所示为老年女性患者，颈椎退行性变致颈椎管狭窄，箭头所指部位颈椎曲度明显异常。,72,-,