诊断学教学课件 脊柱四肢及神经系统检查

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1、TheSpinal&ExtremitiesExamination脊柱四肢检查郑州大学第一附属医院呼吸暨重症医学科武静SpineExamination脊柱检查spinenormalcurvesanddeformities脊柱生理弯曲和病理变形spinemovement脊柱活动度vertebraltendernessandknockpain脊柱压痛与叩击痛specialtest特殊试验SpineNormalCurves脊柱生理弯曲Spineconsistsofcentrum,intervertebraldiscs,paravertebralligamentandmuscles脊

2、柱由椎体椎间盘椎旁韧带和肌肉组成Spinehavefourphysicalcurves脊柱有四个生理性弯曲Neckvertebralordosis颈椎向前凸Chestvertebrabackwardsprotruding胸椎向后凸Lumbarlordosis腰椎向前凸Sacralvertebrabackwardsprotruding骶椎向后凸PathologicDeformities病理性变形Kyphosis:abnormaloutwardhump胸椎后凸Lordosis:exaggeratedincurving腰椎前凸Scoliosis:lateralcurvatureo

3、fthespine脊柱侧凸Pokerbackspine:lossofallcurves直背综合征DeformitiesTypes病变类型ScoliosisKyphosisLordosis脊柱侧凸胸椎后凸腰椎前凸CommonDiseases常见病因Vertebral:bonedestruction,fracture椎体:骨质破坏骨折Intervertebral:protrusionofthedisc,jointdislocation椎间病变:椎间盘脱出椎间关节脱位Paravertebral:muscleandligamentinjury椎旁病变:肌肉韧带损伤OutwardHu

4、mp胸椎后凸KyphosisUniformitybackwardscurveinseatbutdisappearindorsalpositionseeninrachitis,agingandosteoporosis,poorpostureCamberoutwardhumpandfixationseeninankylosingspondylitisGibbousdeformity:spinaltuberculosis,fractureormetastaticdiseasetothespine驼背坐位均匀后弯仰卧消失佝偻病弧形后凸强直固定强直性脊柱炎成角畸形骨折胸椎结核脊柱代谢

5、性疾病LumbarLordosis腰椎前凸WheneverapatientmustrockbackwardstomaintainacenterofgravityIncreasedabdominalcontent:Pregnancy,ascites,largetumorHipsjointdisorders:flexioncontracturesortuberculosisatthehips,shortachillestendons腹腔内容物增多妊娠大量腹水巨大肿瘤髋关节病变关节结核先天性后脱位Scoliosis脊柱侧凸Posturalscoliosis:protrusiono

6、fintervertebraldisc,shortlegOrganicscoliosis:rickets,thoraxdeformity,pleuralthickening姿势性椎间盘脱出两下肢不等长姿势不端正器质性佝偻病胸廓畸形胸膜肥厚CheckMethod检查方法Pullspinousprocessdownwardatfulltiltusingthumbandobservethecongestmark用拇指沿棘突尖向下划压观察充血痕Measurespineusingdrooplinewithclog用带重物的垂线进行测量SpinalMobility脊柱活动度Motion

7、softhespine:forwardbending,extension,lateralbending,rotation脊柱运动:前屈后伸侧弯旋转Motionsextent:cervicalandlumbarvertebrae>thoracicvertebrae>sacrococcygealvertebrae运动幅度:颈腰椎最大胸椎较小骶尾椎无活动SpinalMobilityObstacle脊柱活动障碍CervicalvertebraeLimitationMusclefibrofascitisCervicalsyn