Download - CV 1 HD.pptx
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Hernia de disc lombara
Sef de Lucrari Dr. Cristina Daia
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VERTEBROM
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Segmentul anterior CVInelul fibroseste format din 44% colagen de tip I si 66% Colagen de tip II (rezistent)Inaltime aproximativ 1 mm (0,75 mm – 2,7 mm)Este o structura elastica, friabila
Nucleul pulpos Colagen tip I 90%Colagen tip II (rezistent) 10%-Se fragmenteaza in particare pot migraEste mobil, deformabil, incompresibil-Este imbibat hidric: 90% nou nascut, 80% la tanar, 70% la varstnicLungimea coloanei vertebrale este data in 35% de inaltimea DIV
DIV
LLA bandeleta
fibroasa care se intinde de la
occiput la vertebra a2a
sacrata
LLPeste plasat in
canalul rahidian pe fata posterioara a
corpilor intervertebrali si
DIV
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Segmentul posterior al CV
Posterior de LLP se afla canalul rahidian
in care se gaseste maduva spinarii (in sacul dural)
C3 L1-L2Care se continua cu coada de cal
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Segmentul posteriorPedicul vertebrali= structuri care unesc arcul vertebral de corpul vertebralLame vertebrale= continua arcul vertebral, se unesc posterior si definesc aceasta structura; pe marginea lor se insera ligamentele galbeneApofizele transverse (procesul transvers)= structura osoasa care poerneste de la locul de unire intre lamele vertebrale si pediculii vertebraliLa nivel cervical C3 – C6 apofizele transverse sunt perforate cranio-caudal formand canalul cervical in care se afla artera vertebrala si nervul Francois-Frank; acest tunel se afla la o distanta de 3-6 mm de articulatia unco-vertebrala si de 2-3 mm de articulatiile interapofizare a 2 vertebre vecine a a caror deformari artrozie genereaza manifestarile specifice spondiozei cervicale
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Segmentul posterior
Apofiza spinoasa (procesul spinos)Lama osoasa situata postero-median vertebral Apofiza spinoasa C7 este palpabila si constituie reper clinicProcesele spinoase sunt orientate aproape vertical la nivelul T6 – T9, au o orientare spre posterior C3-C7, oblica T1-T5, spre posterior T 10 – T12, la nivel lobar procesele spinoase sunt voluminoase, rezistente (L1)Articulatiile interapofizare posterioare se formeaza prin suprapunerea proceselor articulare superioare si inferioare a 2 vertebre supra si suadiacente; sunt articulatii cu capsulo-ligamentare, sinoviale, prezinta meniscuri
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Canalul rahidian = spatiu rezultat prin suprapunerea vertebrelor, delimitat intre corpul vertebral si arcul vertebral posterior, in care se gaseste maduva spinarii, respectiv radacina (ant si post) nervului spinalGaura de conjugare sau Foramen/ Canalul radicular = spatiu care se delimiteaza intre 2 pedicului vertebrali a doua vertebre supra si subiacente; prin acest spatiu iese pachetul vasculo-nervos din rahis, continand nervul rahidianLa iesirea din gaura de cojugare avem de a face cu nervul spinalReces lateral = spatiu aparut intre pedicul si corpul vertebral
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Hernia de discHD anterioara, laterala, posterioara
HD anterioara si posterioara -Inspre canalul rahidian intraspinala/rahidiana (subligamentara, extraligametara)-Intraforaminala (in gaura de conjugare)--extraforaminala (sub musculatura santurilor vb)--excluse
Definite
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Sindroamele clinice in HD
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Scolioza dorsala dr lombara stga Atitudine scoliotica lombara
Clinic
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Hernia de disc LombaraFazele HD
- Faza I: Anatomopatologic (dezorganizare DIV, IF), Clinic, Examen clinic obiectiv SV (S, D),
SML, SP- Faza II: Lumbago discogen Anatomoptologic (inclavere DIV in IF), Clinic , Examen clinic obiectiv SV (S, D), SML,
SD, SP- Faza III: Hernie de disc propriu-zisaStadiul I Iritatie radiculara : forma algica= durere pe traseu radicularStadiul II Compresie (Protruzie) radiulara: forma algo parestezica = durere si
parestezii pe traseu radicular (bipolar)Stadiul III Intrerupere radiculara: forma algo paretica sau algo plegica(paralizanta)=
durere, parestezii, deficit motor,Examen clinic obiectiv: 1)SV (S, D), 2)SML, 3)SD, 4) SNR 5)SP- Faza IV: Sechelara cronica Spondilo Discartroza = SPONDILOZA lombara
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Sindrom de coada de cal
• Deficit motor: parapareza flasca, spastica• Deficit senzitiv: anestezie in sa, parestezii• Tulburari sfincteriene: vezica neurogena de tio
incontinenta, intestine neurogene de tip retentie
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Paraclinic HD1. Radiografie coloana lombara (fata)
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RMN coloana lombara
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Indicatiile chirurgicale ale herniei de disc
1. Deficit motor recent instalat (24-48-72)2. Sindrom de coada de cal recent instalat3. Sindrom malingering
Terapie chirurgicala
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Tratament fiziatric hernia de disc
• Faza I, II : fizioterapie, medicatie: AIS, AINS, antialgice, miorelaxante, +/_ sedative
• Faza III: - Acut: Primele 7- 10 zile: repaus la pat, medicatie- Subacut: 10-21 de zile: fizioterapie, medicatie- Subcronic, cronic : kinetoterapie, fizioterapie,
medicatie• Faza IV: kinetoterapie, fizioterapie
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Abordare integrativa, anatomo-clinica si fizio-patologica, a tratamentului conservator in hernia de disc lombara; aspecte conceptuale si practice
(a) Initial MRI - C/H ratio = 51.6% (b) after 3 months - C/H ratio = 43.4%
(c) after 6 months - C/H ratio = 20.5%
Fig. 21
MRI objectified:
spontaneous involution of
herniated masses
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Abordare integrativa, anatomo-clinica si fizio-patologica, a tratamentului conservator in hernia de disc lombara; aspecte conceptuale si practice
Fig. 10 (a) Modificarile relative de presiune/incarcare (gravitationala
sau/si suplimentara) la nivelul celui de al treilea disc lombar -
determinate prin manometrie intradiscala -, in diverse pozitii (dupa Nachemson)
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KinetoterapieWilliams faza I si II