本文選題：軟骨終板　切入點(diǎn)：退變性腰椎滑脫　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的通過磁共振成像研究退變性腰椎滑脫患者椎間盤軟骨終板的改變,比較正常人與退變性腰椎滑脫患者相同階段椎間盤軟骨終板的差異,并且分析椎間盤軟骨終板的退變與退變性腰椎滑脫的關(guān)系。方法選取臨床影像學(xué)檢查(X線、CT、磁共振)確診為L4或L5腰椎椎體滑脫的患者82例,年齡45~65歲,分為L4前滑脫組和L5前滑脫組(L4滑脫組60例,L5滑脫組22例);其中男18例,女64例。同時(shí)選取30例腰椎結(jié)構(gòu)及功能完好的正常體檢者組成對(duì)照組,其中男性7名,女性23名,年齡45~65歲,既往身體健康,均無腰椎疾病,且無慢性全身性疾病�；颊呓M與正常組之間性別、年齡比較無統(tǒng)計(jì)學(xué)差異。對(duì)所有受檢者的L4/L5、L5/S1椎間盤行正中矢狀位T2加權(quán)磁共振掃描,本實(shí)驗(yàn)共掃描椎間盤224個(gè),軟骨終板448個(gè),用Carestream放射成像軟件對(duì)掃描圖像進(jìn)行放大、增強(qiáng),并且測量每位被掃描者椎間盤軟骨終板前半終板傾角及后半終板傾角。計(jì)算出前半傾角與后半傾角的比值作為該終板的變異率。分別比較滑脫組與正常組對(duì)應(yīng)階段的椎間盤軟骨終板變異率的差異。實(shí)驗(yàn)采用MS Excel 365進(jìn)行數(shù)據(jù)整理與繪圖,IBM SPSS 22.0進(jìn)行數(shù)據(jù)分析,分類資料比較用x2,計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差(`x±s)表示,對(duì)各指標(biāo)進(jìn)行正態(tài)性檢驗(yàn),結(jié)果均較好,兩組間正態(tài)分布計(jì)量資料均值比較采用獨(dú)立樣本t檢驗(yàn),自身兩組指標(biāo)對(duì)比采用配對(duì)t檢驗(yàn),α=0.05為檢驗(yàn)水準(zhǔn);三組參數(shù)間的差異比較采用方差分析。結(jié)果L4滑脫組:L4/L5椎間盤上、下終板變異率與正常組之間差異均有統(tǒng)計(jì)學(xué)意義;但L5/S1椎間盤上、下終板變異率與正常組之間差異均無統(tǒng)計(jì)學(xué)意義。L5滑脫組:L4/L5椎間盤上、下終板變異率與正常組之間差異均有統(tǒng)計(jì)學(xué)意義;L5/S1椎間盤上、下終板變異率與正常組之間差異均有統(tǒng)計(jì)學(xué)意義�；摻M椎間盤上、下終板的自身對(duì)比:L4滑脫組中,L4/L5椎間盤上終板與下終板之間有統(tǒng)計(jì)學(xué)差異,L5/S1椎間盤上終板與下終板之間無統(tǒng)計(jì)學(xué)差異;L5滑脫組中,L4/L5椎間盤上終板與下終板之間有統(tǒng)計(jì)學(xué)差異,L5/S1上終板與下終板之間有統(tǒng)計(jì)學(xué)差異。正常組椎間盤上、下終板自身對(duì)比:L4/L5椎間盤上、下終板之間有統(tǒng)計(jì)學(xué)差異;L5/S1椎間盤上、下終板之間無統(tǒng)計(jì)學(xué)差異。結(jié)論退變性腰椎滑脫可致滑脫階段軟骨終板退變,且同一軟骨終板前、后半終板的退變程度不對(duì)稱:椎間盤上終板的后半終板退變程度比前半終板嚴(yán)重,而下終板的前半終板退變程度比后半終板嚴(yán)重;退變性腰椎滑脫對(duì)非滑脫階段椎間盤軟骨終板的退變無明顯影響。
[Abstract]:Objective to study the changes of cartilage endplate in degenerative lumbar spondylolisthesis by magnetic resonance imaging (MRI), and to compare the difference of cartilage endplate between normal and degenerative lumbar spondylolisthesis at the same stage. Methods 82 patients with L4 or L5 lumbar spondylolisthesis, aged 45 to 65 years, were diagnosed as L4 or L5 lumbar spondylolisthesis by magnetic resonance imaging (MRI), and the relationship between degeneration of intervertebral cartilage endplate and degenerative lumbar spondylolisthesis was analyzed. The patients were divided into two groups: L4 group (n = 60) and L5 group (n = 60), including 18 males and 64 females. 30 normal subjects with intact structure and function of lumbar vertebrae were selected as control group, including 7 males and 23 females. Age 45 to 65 years old, health, no lumbar disease, no chronic systemic disease. Sex between patient group and normal group. There was no significant difference in age. All the intervertebral discs of L 4 / L 5 and L 5 / S 1 were scanned by T 2 weighted magnetic resonance imaging with median sagittal position. In this experiment, 224 discs and 448 cartilage endplates were scanned. The scanning images were amplified and enhanced by Carestream radiography software. The inclination angle of anterior end plate and posterior end plate of intervertebral disc were measured. The ratio of anterior half angle to posterior half angle was calculated as the rate of variation of the end plate. The corresponding order between the slippage group and the normal group was compared. The variation rate of endplate of intervertebral disc cartilage was analyzed by MS Excel 365. The standard deviation (`x 鹵s) and the mean value (x 鹵s) were used to compare the classified data. The results of normality test for each index were satisfactory. The comparison of the mean values of the normal distribution data between the two groups was carried out by independent sample t test. Two groups of indexes were compared by paired t test with 偽 -0. 05 as the test level, and the differences among the three groups were analyzed by ANOVA. Results the variation rate of upper and lower endplate in L4 slippage group was significantly higher than that in normal group. However, there was no significant difference in the rate of variation of the inferior endplate between the L5/S1 disc and the normal group. There was no significant difference between the L5 / L4 / L5 intervertebral disc and the L5 / S1 intervertebral disc in the L5 / L5 slippage group, and there was significant difference between the L5 / S1 intervertebral disc and the lower endplate variation rate in the normal group. The rate of variation of inferior endplate was significantly different from that of normal group. Comparison of the inferior endplate in the L4 / L4 slippage group there was a statistical difference between the superior endplate and the inferior endplate of the L4 / L5 intervertebral disc. There was no statistical difference between the superior endplate and the inferior endplate of the L5 / S1 intervertebral disc. There was no statistical difference between the upper endplate and the inferior endplate in the L5 slippage group. There was statistical difference between L5 / S1 superior endplate and inferior endplate. There was statistical difference between the lower end plate and the lower end plate. Conclusion the degenerative lumbar spondylolisthesis can result in the degeneration of the cartilage endplate in the spondylolisthesis stage, and the same end plate is present in the same cartilage endplate, and there is no statistical difference between the lower end plate and the lower end plate. The degree of degeneration of the posterior endplate was asymmetric: the degree of degeneration of the posterior endplate of the superior endplate of intervertebral disc was more serious than that of the anterior endplate, while the degree of degeneration of the anterior endplate of the lower endplate was more serious than that of the posterior endplate. Degenerative lumbar spondylolisthesis had no significant effect on degenerative cartilage endplate in non-spondylolisthesis stage.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R681.5

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