脊椎病与腿痛

发布时间:2019-09-25 21:07

 颈椎病是中、老年人的常见病之一。颈椎在长期的生活工作中受到各种因素的刺激,如颈椎部受风寒、外伤、老化及劳损和不正确的睡眠姿势、工作姿势等,都可导致颈椎生理曲度改变和颈椎间盘、关节、韧带等组织的退行性变化,刺激或压迫了颈神经根、脊髓、椎动脉和颈部的交感神经等组织而出现一系列相应的症状。由于颈椎病分型很多,不同类型颈椎病的症状亦不尽相同。这里仅介绍一种可引起腿痛的脊髓型颈椎病。   
       脊髓型颈椎病是指颈椎间盘向后突出,椎体后缘骨刺,黄韧带肥厚,椎管狭窄,椎体滑移等原因对脊髓的直接压迫,或者由于交感神经的刺激,导致脊髓血管痉挛等因素造成脊髓变性坏死,并由此引起的以肢体功能障碍为特点的症候群。脊髓型颈椎病中又分为中央型和周围型两种,中央型的发病从上肢开始,向下肢发展;周围型的发病是从下肢开始,向上肢发展。为此不难看出,脊髓型颈椎病中的周围型是引起腿痛的根本原因。因其脊髓双侧受压,故其临床表现主要是缓慢的进行性双下肢麻木、发冷、疼痛和走路不稳、步态笨拙、发抖、无力等。
       有的患者诉说如“踩棉花感”,头重脚轻、摇摇欲倒。发病初期常是间歇性,劳累行走过多等可使症状加剧。少数病人猛然仰头时感到全身麻木,双腿发软,甚至摔倒。随着病程发展,症状可逐渐加剧并转为持续性,表现为不全痉挛性瘫痪,以致卧床不起,甚至呼吸困难。膀胱、直肠括约肌症状也较常见,多表现为尿急、尿频、排尿无力、大便无力,个别病人有性功能障碍,亦可表现为四肢瘫、三肢瘫、偏瘫、交叉瘫等多种亚型。    
       脊髓型颈椎病的发病率占各型颈椎病的10%—15%。临床上不是每例颈椎病都会发展为脊髓型,况且大部分脊髓型颈椎病也是可以治疗的。但发病期间要防止走不稳而摔伤。脊髓型颈椎病引发双腿痛,根据间歇跛行,主诉与客观检查不相符,颈部后伸受限及疼痛三大特点,本病可明确诊断,个别困难者可做CT扫描、核磁共振或脊髓造影检查,便可一目了然。   
       本病治疗以手术方法为主,如能早期治疗其效果一般满意。如病程较长,脊髓出现变性或已有蛛网膜炎形成者,效果则差。


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