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脊柱外科学(第3版)
$67.40
《美国骨科医师学会:脊柱外科学(第3版)》是美国骨科医师学会(AAOS)的经典脊柱外科学教科书。它用*言简意赅的语言描述了一种疾病从发病情况、发病机制、临床特点、诊断与鉴别诊断,以及治疗方法等各方面内容。有助于读者迅速了解一种疾病的全貌。 《美国骨科医师学会:脊柱外科学(第3版)》不仅包含了脊柱外科基础和临床的各个领域,还增加了药物、介入、康复和心理治疗等方面的内容以及脊柱外科的新进展。 书中引用了大...
《美国骨科医师学会:脊柱外科学(第3版)》是美国骨科医师学会(AAOS)的经典脊柱外科学教科书。它用*言简意赅的语言描述了一种疾病从发病情况、发病机制、临床特点、诊断与鉴别诊断,以及治疗方法等各方面内容。有助于读者迅速了解一种疾病的全貌。 《美国骨科医师学会:脊柱外科学(第3版)》不仅包含了脊柱外科基础和临床的各个领域,还增加了药物、介入、康复和心理治疗等方面的内容以及脊柱外科的新进展。 书中引用了大量文献,并应用循证医学的方法为读者呈现较为客观的数据以供参考。
部分 基础知识第1章 人类脊柱与神经系统的胚胎发育第2章 解剖第3章 脊柱生物力学第4章 椎间盘退变性疾病和相关症状的病理生理第5章 病史和体格检查第6章 脊柱影像学:X线片、CT和MRI第7章 介人性诊断影像第8章 临床神经生理学第9章 脊柱疾病的鉴别诊断第10章 命名及编码原则第11章 骨科结果评估的重要性:综述第12章 残障评估第二部分 疼痛治疗与康复第13章 慢性疼痛患者的药物治疗进展第14章 手法治疗第15章 腰痛的治疗:全面康复计划第16章 诊断性和治疗性脊椎注射第17章 腰椎手术失败综合征疼痛治疗进展第18章 社会心理护理第19章 功能恢复第20章 脊髓损伤的康复治疗第三部分 成人疾患第21章 脊柱外伤的初步评估和治疗第22章 颈椎骨折第23章 胸腰椎创伤第24章 骶骨骨折第25章 急性颈痛和颈椎间盘突出第26章 脊髓型颈椎病:包括后纵韧带骨化第27章 脊髓疾病第28章 运动员头颈损伤第29章 退变性胸椎疾病第30章 急性腰痛第31章 腰椎间盘突出症第32章 腰椎管狭窄和退变性腰椎滑脱第33章 成人峡部病损的脊椎滑脱第34章 椎间盘源性腰痛第35章 成人脊柱侧凸第36章 炎性脊柱关节炎第37章 脊柱良性和恶性病变第38章 脊柱感染性疾病第39章 骨质疏松性椎体压缩骨折的治疗第40章 脊柱手术并发症第四部分 儿童疾患第41章 儿童颈椎创伤第42章 儿童颈椎第43章 儿童及青少年腰痛第44章 儿童和青少年脊椎崩裂和脊椎滑脱第45章 先天性脊柱侧凸第46章 婴幼儿、少年和青少年特发性脊柱侧凸第47章 神经肌肉型脊柱侧凸第48章 休门病第五部分 未来发展第49章 促进脊柱融合的生物学方法第50章 椎间盘的修复第51章 微创脊柱手术第52章 运动保留技术第53章 脊髓功能的恢复索引
下胸椎和上腰椎区脊髓的主要血液供应来源于大前根动脉或根动脉。80%的病人的这条动脉发自左侧肋间下动脉,进入椎间孔邻近肋横突关节,与T9-T12腹侧神经根伴行。其他时候这条动脉可发自上腰动脉,然后可以从T5-L5的任何地方进入椎管。大前根动脉几乎是前髓下三分之二的主要血液供应。为了减小损伤这条动脉和伴行的动脉的风险,在前路手术时应该避免结扎靠近椎间孔的血管,并且在去肋横突关节和肋椎关节的时候应该格外小心。 根动脉起自主动脉发出的节段血管,向外进入椎间孔并且向后下走行,位于脊神经根下方和下位椎体上关节突的外侧。这些动脉分出的外侧支和中间支进入背部肌肉,内侧支紧邻峡部与对侧棘突后方的动脉相交通。节段静脉与动脉伴行。 随着椎间盘置换手术的普及,腰骶部前路手术相应增加。但是前方入路有损伤多个神经血管结构的风险,需要充分显露椎间隙。腹主动脉通常在L4中线的左侧分成脏支、壁支和终末分支,以及左、右髂总动脉和骶正中动脉。腹主动脉分叉部位存在变异,可以发生在L3到L5下缘的任何部位。左侧髂总静脉距离中线平均12mm,距离右侧髂总动脉33.5mm。骶正中动脉平均直径2.5mm,由于其位置变异大,不宜作为L5-Sl中线的解剖标志。一条或多条髂腰静脉引流下腰椎的静脉血,然后经过腰大肌后方进入髂总静脉,在前路显露L4-5时,可以作为系带。手术显露时常需要结扎这些静脉,但是结扎这血管的时候有损伤闭孔神经的风险,闭孔神经位置浅表,大约在髂总静脉外侧1.5~2.76cm,而腰骶干的位置则更深、更靠外侧约2.5cm处,但也有些病人则可能位于1cm以内。 共有31对脊神经,颈椎8对、胸椎12对、腰椎5对、骶椎5对、尾椎1对。脊神经为混合神经,由背侧的感觉神经纤维和腹侧的运动神经纤维组成。混合神经的前主干(腹侧支)和后主干(背侧支)、脊膜返支(窦椎神经)和沿交感神经系统分布的感觉神经纤维为脊柱各单元提供感觉。在手术显露的过程中有损伤神经和神经丛的风险。 颈椎前路手术中容易损伤的是喉返神经和喉上神经。喉返神经是迷走神经(第10对脑神经)在颈动脉鞘外的内侧分支。左侧喉返神经在主动脉弓下方转出后走行于气管食管沟内。右侧喉返神经变异较多,通常从锁骨下动脉下方绕过,很有可能穿过手术野。50%的病人的右侧喉返神经在C5-6水平到达气管食管沟。损伤喉返神经或迷走神经可导致声带麻痹,但通常表现为一过性的声音嘶哑。喉上神经起自迷走神经颈动脉鞘内颈动脉分叉近端平均20mm(5~32mm)处,走行大约15mm(3~20mm)后分叉为内侧支(感觉支)和外侧支(运动支)。在远端,内侧支位于C3-4水平附近,走行靠近喉上动脉,并在动脉上方1cm以内穿人甲状舌骨膜。该神经末梢分布于喉的黏膜,有重要的感觉反射功能,能够防止肺的误吸。 准确地了解颈椎神经根背支的解剖有助于在颈椎后路手术时避免意外的神经损伤。C3-C8脊神经背支分出的内侧支经过侧块关节后外侧的一个解剖管道。管道的基底是由相邻侧块形成的骨槽,顶部是头半棘肌肌腱。神经分支在这个管道中是松弛的,经常容易发生医源性损伤。背支的皮肤分支可见于C2以下双侧棘突附近,C5或C6以下很少能见到可辨别的更大的皮神经。除了C2枕大神经(C2内侧支)和第3枕神经(C3浅表内侧支)外,C3以下棘突的皮神经直径也都小于2mm。皮神经很可能由于后正中切口而被切断。肌间的内侧支的分支走行于椎旁肌中,可由于肌肉间的剥离而损伤。术中剥离椎旁肌显露侧块外侧时会在术野中直接遭遇内侧支的主干。与内侧支伴行的有血管,用电凝止血时会不经意地损伤内侧支的神经鞘。 ……
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