本文關(guān)鍵詞： 三維重建 腰椎間盤突出癥 可視化　出處：《吉林大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：腰椎間盤突出癥是脊柱外科最為常見、多發(fā)的疾病，自開展腰椎間盤摘除手術(shù)至今已有八十余年的歷史，脊柱外科醫(yī)生對腰椎間盤突出癥的診療水平不斷的提高，但有不少文獻(xiàn)報(bào)道提出腰椎間盤突出癥的誤診、二次手術(shù)或多次手術(shù)的臨床病例報(bào)告，對于腰椎間盤突出癥不同病理類型、不同臨床表現(xiàn)的治療原則、手術(shù)方案值得商榷，在診斷分型方面,國內(nèi)外學(xué)者提出了很多種方法，但都有一定的局限和誤差，需要一種先進(jìn)的技術(shù)去進(jìn)一步的完善，本文通過三維成像技術(shù)對腰椎間盤突出癥患者的原始影像學(xué)圖片進(jìn)行三維重建，在三維結(jié)構(gòu)下觀察突出間盤位置以及毗鄰神經(jīng)根的關(guān)系，并綜合一些分型、診斷的方法對腰椎間盤突出癥診斷臨床治療提供理論基礎(chǔ)。 方法：選取1例自2014年1月至2015年1月期間我院住院治療的腰椎間盤突出癥患者，將符合入選標(biāo)準(zhǔn)的腰椎間盤突出癥患者的原始CT、MRI圖像導(dǎo)入數(shù)字化三維醫(yī)學(xué)影像交互式處理系統(tǒng)17.0，通過選擇閾值、三維模型計(jì)算、分割、修整等一系列步驟，建立腰椎間盤突出癥患者的腰椎模型，根據(jù)我們提出的實(shí)驗(yàn)設(shè)計(jì)對腰椎間盤突出癥分型、突出間盤與神經(jīng)根的位置關(guān)系、神經(jīng)根發(fā)育異常分型等進(jìn)行觀測。選取1例符合標(biāo)準(zhǔn)的正常成年人CT、MRI原始圖片進(jìn)行三維重建，觀察兩組之間的差別。 結(jié)果：入選一例35歲男性腰椎間盤突出癥患者，突出節(jié)段為腰4/5，根據(jù)設(shè)計(jì)的腰椎間盤突出觀測流程圖對突出間盤進(jìn)行觀察、測量，首先進(jìn)行區(qū)域定位，間盤突出偏向右側(cè)，間盤的左右位置在中央管區(qū)、關(guān)節(jié)突下區(qū)，觀察到突出的間盤上下的位置在椎間盤水平，并觀察到神經(jīng)根與突出間盤的位置關(guān)系為腋部突出，觀察神經(jīng)根的走行未發(fā)現(xiàn)合并神經(jīng)根發(fā)育異常，我們測量得到突出物的矢狀徑為12.08mm和矢狀徑中點(diǎn)的橫徑為8.20mm，并在腰5椎體上測量椎管的最大矢狀徑為17.04mm，該矢狀徑中點(diǎn)的橫徑為24.22mm，，得到的椎間盤突出指數(shù)為0.24。符合正常組為一例年齡23歲男性，腰椎各節(jié)段未見明確間盤突出，神經(jīng)根發(fā)育未見異常。 結(jié)論：腰椎三維重建技術(shù)能夠清晰的顯示間盤突出與神經(jīng)根之間的位置關(guān)系，并且在腰椎間盤突出分型方面減少了以往二維層面診斷所帶來的誤差，更加清晰、直觀，由于三維的建立需要不斷的修整，本文僅對2例腰椎影像學(xué)圖片進(jìn)行三維重建、對比，我們需要進(jìn)一步結(jié)合腰椎間盤突出癥患者的臨床癥狀，對分型的內(nèi)容附加評分，在建模過程中，我們應(yīng)該增加韌帶、肌肉等其它組織，觀察對結(jié)構(gòu)造成的影響，使得模型更加完整,為腰椎間盤突出癥提供更加方便、實(shí)用的診斷和治療。
[Abstract]:Objective: lumbar disc herniation is the most common and frequent disease in spinal surgery. It has been more than 80 years since the operation of lumbar disc excision. The level of diagnosis and treatment of lumbar disc herniation has been continuously improved by spinal surgeons, but there are many reports of misdiagnosis of lumbar disc herniation, secondary operations or multiple operations. For different pathological types of lumbar disc herniation, different clinical manifestations of the treatment principles, surgical plans are open to question, in the diagnosis of classification, domestic and foreign scholars put forward a lot of methods. However, there are certain limitations and errors, need an advanced technology to further improve, this paper through three-dimensional imaging technology to the original image of lumbar disc herniation patients for three-dimensional reconstruction. The position of herniated disc and the relation of adjacent nerve root were observed under three dimensional structure. Some types and diagnostic methods were used to provide a theoretical basis for the diagnosis and treatment of lumbar disc herniation. Methods: a case of lumbar disc herniation was selected from January 2014 to January 2015. MRI image is imported into digital 3D medical image interactive processing system 17.0, through selecting threshold, 3D model calculation, segmentation, trimming and a series of steps. The lumbar vertebrae model of patients with lumbar disc herniation was established. According to the experimental design we proposed the classification of lumbar disc herniation and the position relationship between herniated disc and nerve root. The types of nerve root dysplasia were observed and the difference between the two groups was observed by using the original CT MRI images of one normal adult and three dimensional reconstruction. Results: a 35-year-old male patient with lumbar disc herniation was selected. The lumbar disc herniation was observed and measured according to the designed flow chart of lumbar disc herniation. First of all, the location of the intervertebral disc protruding to the right, the left and right position of the intervertebral disc was in the central canal area and the inferior articular process area, and the position of the upper and lower intervertebral disc was observed at the intervertebral disc level. The position relationship between nerve root and herniated disc was observed as axillary herniation, and no abnormal development of nerve root was found in the observation of nerve root. We measured the sagittal diameter of the protrusion 12.08 mm and the transverse diameter of the midpoint of the sagittal diameter 8.20mm, and the maximum sagittal diameter of the spinal canal measured on the lumbar 5 vertebrae was 17.04mm. The transverse diameter of the midpoint of the sagittal diameter was 24.22 mm, and the disc herniation index was 0.24 mm. There was no abnormal development of nerve root. Conclusion: Three-dimensional reconstruction of lumbar vertebrae can clearly display the position relationship between disc herniation and nerve root, and reduce the error caused by the previous two-dimensional diagnosis in the classification of lumbar disc herniation. More clear, intuitive, because the establishment of three-dimensional needs to constantly repair, this article only 2 cases of lumbar imaging images of three-dimensional reconstruction, contrast, we need to further combine the clinical symptoms of patients with lumbar disc herniation. In the process of modeling, we should increase ligaments, muscles and other tissues, observe the impact on the structure, make the model more complete, and provide more convenient for lumbar disc herniation. Practical diagnosis and treatment.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R681.53

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相關(guān)期刊論文 前1條

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