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胸腰椎退行性变_胸腰椎退行性改变 - Thoracolumbar degeneration-Thoracolumbar degenerative change

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胸腰椎退行性改变相信很多人都不知道它的发病原因,也不知道这种疾病的表现症状,所以我们应该要多了解一些相关的医学知识。胸腰椎退行性改变是指腰椎出现了自然老化以及退化的症状,这种症状一般是出现在老年人的身上,会导致我们出现活动不便以及腰椎站立时间较短等,影响我们的生活质量。

胸腰椎退行性变_胸腰椎退行性改变 - Thoracolumbar degeneration-Thoracolumbar degenerative change

腰椎退行性病变是指腰椎自然老化、退化的生理病理过程。腰椎是人体躯干活动的枢纽,而所有的身体活动都无一不在增加腰椎的负担,随着年龄的增长,过度的活动和超负荷的承载,使腰椎加快出现老化。严重的腰椎退行性病变可以引起腰腿痛甚至神经损害,影响工作能力和生活质量。

病因

1.腰椎间盘纤维环的退变

椎间盘组织承受人体躯干及上肢的重量,在日常生活和劳动中劳损较其他组织为重。腰椎间盘经有少量血液供应,营养极为有限,从而极易退变。研究证明,接近20岁的椎间盘已经有退变,20~30岁间有的已经明显退变,纤维环出现了裂痕。而30岁以上的椎间盘均有退变。随着年龄的增长,椎间盘纤维环出现网状变性和玻璃样变,失去原来的层次和韧性,产生不同裂痕,继而完全破裂。

胸腰椎退行性变_胸腰椎退行性改变 - Thoracolumbar degeneration-Thoracolumbar degenerative change

2.椎间盘髓核的退变

椎间盘髓核是富含水分、有小分子弹性粘糖蛋白的组织,内含软骨细胞和纤维母细胞,幼年是含水量可达80%以上,随年龄的增长而下降,老年时可达70%,椎间盘含水量的多少决定了其内在压力水平和弹性状态。髓核的退变多在骨关节和纤维环退变的基础上发生的。在腰椎负荷量加大的时候,椎间隙压力增高而椎间盘变性加速,纤维环的裂隙加深,变性的髓核沿着裂隙而突向边缘,这形成了腰椎间盘突出。

3.软骨终板的退变

椎间盘的软骨终板会随年龄的增加而变薄、钙化和不完整,并产生囊性变和软骨细胞坏死,纤维环的附着点松弛,伴随髓核水分减少,软骨终板不能再生修复。软骨终板的退变会使椎间盘体液交换的半透明膜作用减少,加速腰椎间盘退变。

胸腰椎退行性变_胸腰椎退行性改变 - Thoracolumbar degeneration-Thoracolumbar degenerative change

4.腰椎椎体的退行性变

腰椎表面受损后,骨膜上下血肿形成,纤维母细胞开始活跃,并逐渐长如血肿中,以肉芽组织取代血肿。随着血肿的机化和钙化沉积,最后形成突向椎管或突出于椎体的骨赘(骨刺)。骨赘的形成是机体的一种保护性措施,能起到稳定椎节、避免异常活动和增加负重平面的作用。但是骨赘椎管内和椎弓根发展就会对脊神经和硬膜囊的压迫产生不同的神经根压迫症状。

5.腰椎小关节的退行性变

椎间盘和小关节构成椎体间的一个三角形的支架结构,以稳定椎体间的关系。当腰椎退变或者椎体间关节受损后,小关节的稳定性遭到破坏而发生病理改变。出现腰椎关节稳定性下降,关节间隙狭窄和椎间孔狭窄,压迫神经根而出现症状。

6.黄韧带的退行性变

黄韧带是椎管内的主要韧带,正常人的厚度为2~4cm,增生时可达6~8cm以上。正常黄韧带是松弛的,是有弹性的。在发生退变和损伤时候,黄韧带处于紧张状态,逐渐增生肥厚,弹性减低,并出现钙化和骨化,压迫椎管硬膜囊,产生继发性椎管狭窄。

7.其他韧带的退变

椎体前、后纵韧带对稳定腰椎有重要作用,如果出现纤维增生和硬化从而限制腰椎的运动

8.骨质增生

骨质增生的产生是增强稳定性和对抗腰椎压力的一种反应。椎间盘突出后,纤维环松弛,椎间盘抗压性和稳定性均减弱,因而出现骨质增生。即是五椎间盘突出,只要腰椎退变椎体的稳定性发生改变,也会产生骨质增生。

9.退行性椎管狭窄

椎管狭窄按照病因分类为先天性椎管狭窄和继发性椎管狭窄。椎管狭窄是指椎管、神经根管、椎间孔狭窄引起的神经根、马尾神经等压迫综合征。当椎间盘。纤维环、关节突和韧带退变等,均有可能压迫椎管而致椎管的管径变小而狭窄。


Introduction to Articles

Thoracolumbar degenerative changes believe that many people do not know the cause of the disease, nor the symptoms of the disease, so we should know more about the relevant medical knowledge. Thoracic and lumbar degenerative changes refer to spontaneous aging and degenerative symptoms of the lumbar spine. These symptoms usually occur in the elderly, which can lead to inconvenience in movement and shorter standing time of the lumbar spine, and affect our quality of life.

胸腰椎退行性变_胸腰椎退行性改变 - Thoracolumbar degeneration-Thoracolumbar degenerative change

Lumbar degenerative diseases refer to the physiological and pathological process of spontaneous aging and degeneration of the lumbar spine. Lumbar spine is the hub of human trunk activity, and all physical activities are increasing the burden of the lumbar spine. With the growth of age, excessive activity and overload of the load make the lumbar spine aging faster. Severe degenerative lumbar diseases can cause lumbago, leg pain and even nerve damage, affecting work ability and quality of life.

Pathogeny

1. Degeneration of lumbar disc annulus fibrosus

The intervertebral disc tissues bear the weight of the trunk and upper limbs of the human body, and are more severely damaged in daily life and labor than other tissues. The lumbar intervertebral disc has a small amount of blood supply and very limited nutrition, which makes it very easy to degenerate. Studies have shown that the intervertebral discs near the age of 20 have degenerated, some between the age of 20 and 30 have obviously degenerated, and the annulus fibrosus has cracked. The intervertebral discs over 30 years old had degeneration. With the increase of age, the annulus fibrosus of intervertebral disc appears reticular degeneration and vitreous degeneration, losing its original layers and toughness, producing different fissures, and then completely ruptured.

胸腰椎退行性变_胸腰椎退行性改变 - Thoracolumbar degeneration-Thoracolumbar degenerative change

2. Degeneration of nucleus pulposus of intervertebral disc

The nucleus pulposus of intervertebral disc is a tissue rich in water and small molecule elastic mucoprotein. It contains chondrocytes and fibroblasts. The water content in the nucleus pulposus of intervertebral disc can reach more than 80% in infancy, which decreases with age and reaches 70% in old age. The water content of intervertebral disc determines its internal pressure level and elastic state. The degeneration of nucleus pulposus usually occurs on the basis of degeneration of bone, joint and annulus fibrosus. When the load of lumbar spine increases, the pressure of intervertebral space increases, the degeneration of intervertebral disc accelerates, the fissure of annulus fibrosus deepens, and the degenerated nucleus pulposus protrudes along the fissure to the edge, which forms the protrusion of lumbar intervertebral disc.

3. Degeneration of cartilage endplate

The cartilage endplate of intervertebral disc will become thinner, calcified and incomplete with the increase of age, and produce cystic degeneration and chondrocyte necrosis. The attachment point of fibrous ring is relaxed. With the decrease of water in nucleus pulposus, the cartilage endplate can not be regenerated and repaired. The degeneration of cartilage endplate will reduce the translucent membrane of disc fluid exchange and accelerate the degeneration of lumbar intervertebral disc.

胸腰椎退行性变_胸腰椎退行性改变 - Thoracolumbar degeneration-Thoracolumbar degenerative change

4. Degenerative degeneration of lumbar vertebrae

After the surface of the lumbar spine was damaged, the hematoma above and below the periosteum formed, the fibroblasts began to be active, and gradually grew into the hematoma, replacing the hematoma with granulation tissue. With the accumulation of hematoma and calcification, osteophytes (spines) protruding toward the vertebral canal or protruding from the vertebral body are finally formed. Osteophyte formation is a protective measure of the body, which can stabilize the vertebral segment, avoid abnormal activities and increase the load-bearing plane. However, the development of osteophytes in the spinal canal and pedicle will produce different symptoms of nerve root compression on the spinal nerve and dural sac.

5. Degeneration of lumbar facet joint

The intervertebral disc and facet joints form a triangular framework between the vertebral bodies to stabilize the relationship between the vertebral bodies. When the lumbar degeneration or the intervertebral joint is damaged, the stability of the facet joint is destroyed and pathological changes occur. The stability of lumbar joint decreased, joint space narrowed and foramen narrowed, nerve root compression and symptoms appeared.

6. Degeneration of ligamentum flavum

The ligamentum flavum is the main ligament in the spinal canal. The thickness of the ligament is 2-4 cm in normal people, and it can reach 6-8 cm when it proliferates. Normal ligamentum flavum is relaxed and elastic. In the event of degeneration and injury, the ligamentum flavum is in a tense state, gradually proliferating and hypertrophic, decreasing elasticity, calcification and ossification, compressing the dural sac of the spinal canal, resulting in secondary spinal stenosis.

7. Degeneration of other ligaments

The anterior and posterior longitudinal ligaments of the vertebral body play an important role in stabilizing the lumbar spine. If fibrosis and sclerosis occur, the movement of the lumbar spine is limited.

8. Osteoplasia

Proliferation of bone is a response to increased stability and resistance to lumbar vertebral pressure. After the herniation of intervertebral disc, the annulus fibrosus is relaxed, the compressive strength and stability of intervertebral disc are weakened, and thus bone hyperplasia occurs. If the stability of degenerative lumbar vertebrae changes, it will also produce bone hyperplasia.

9. Degenerative spinal stenosis

Spinal stenosis is classified as congenital and secondary spinal stenosis according to etiology. Spinal canal stenosis refers to the compression syndrome of nerve root and cauda equina caused by spinal canal, nerve root canal and intervertebral foramen stenosis. When the intervertebral disc. Fiber ring, articular process and ligament degeneration may compress the spinal canal and cause the diameter of the spinal canal to become smaller and narrow.

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