本文關(guān)鍵詞： 神經(jīng)纖維瘤病性脊柱側(cè)彎 椎弓根 形態(tài)學 置釘準確性 3維重建　出處：《廣西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：[目的](1)通過CT三維重建測量、分析NF性脊柱側(cè)彎患者椎弓根形態(tài)、置釘準確性、椎弓根畸形程度、三維Cobb角等數(shù)據(jù);(2)通過CT三維重建測量、分析特發(fā)性脊柱側(cè)彎患者椎弓根形態(tài)、置釘準確性、椎弓根畸形程度、三維Cobb角等數(shù)據(jù);(3)運用統(tǒng)計學的方法將兩組結(jié)果分析,對比,評估兩者之間療效及其他形態(tài)學差別;(4)嘗試著歸納總結(jié)神經(jīng)纖維瘤病患者的特點,術(shù)中術(shù)后需要注意的要點。[方法](1)收集2008年5月到2016年12月我院診治的276例脊柱側(cè)彎患者,其中特發(fā)性脊柱側(cè)彎221例,神經(jīng)纖維瘤病性脊柱側(cè)彎16例。選擇16例特發(fā)性側(cè)彎患者與神經(jīng)纖維瘤病患者相匹配,將術(shù)后的CT資料進行三維重建,測量指標包括:椎弓根形態(tài)、椎弓根橫徑、椎弓根一肋骨聯(lián)合體橫徑、三維冠狀面Cobb角及糾正率等;(2)將兩組數(shù)據(jù)進行統(tǒng)計學分析,比較NF患者與AIS患者椎弓根形態(tài)學、置釘準確性、治療效果之間的差異;[結(jié)果](1)NF患者中嚴重畸形的椎弓根較特發(fā)性脊柱側(cè)彎多,兩者之間的差異有統(tǒng)計學意義(2)置入NF組患者的142枚螺釘中,88顆螺釘位置良好,其余54枚屬于螺釘誤置,螺釘誤置率=38.02%,置釘滿意率=61.98%。在特發(fā)性脊柱側(cè)彎患者置入的111枚螺釘中86顆螺釘位置良好,25顆螺釘屬于2級或3級,螺釘誤置率=22.52%,置釘滿意率=77.48%。(3)AIS組患者椎弓根橫徑測量結(jié)果椎弓根橫徑在2.73~8.33 mm之間,其數(shù)值因節(jié)段而變化,凹側(cè)最小橫徑僅為1.77 mm。凹側(cè)椎弓根橫徑明顯小于凸側(cè)。胸椎椎弓根一肋骨聯(lián)合體橫徑測量結(jié)果,橫徑為10.04—14.91 mm。從T1向T5逐漸縮小,變化與胸椎節(jié)段有關(guān)。而NF患者胸椎椎弓根橫徑在1.37mm~8.21mm之間,胸椎椎弓根一肋骨聯(lián)合體橫徑較特發(fā)性脊柱側(cè)彎患者少,為8.43—14.55mm。(4)NF患者冠狀面治療效果評估(見表4),術(shù)前主彎冠狀面Cobb角46°—126°(平均68.6°),術(shù)后及時查平片4—58°(平均28.8°),術(shù)后矯正率34%—92.5%,平均矯正率58.8%,末次隨訪時,末次隨訪時神經(jīng)纖維瘤病組患者主彎Cobb角4°—62°,矯正率34%—92.5,平均矯正率55.3%。術(shù)后矯正療效確切,且存在矯正丟失的情況。[結(jié)論]1、神經(jīng)纖維瘤病性脊柱側(cè)彎患者椎弓根畸形率高,畸形比特發(fā)性脊柱側(cè)彎患者嚴重臨床有,兩者的差別有統(tǒng)計學意義;2、后路椎體融合術(shù)對糾正神經(jīng)纖維瘤病性脊柱側(cè)彎患者在冠狀面Cobb角上療效確切,但較特發(fā)性脊柱側(cè)彎患者差,差異有統(tǒng)計學意義;3、神經(jīng)纖維瘤病性脊柱側(cè)彎患者椎弓根較小,置釘難度更高,螺釘誤置率更高,手術(shù)風險更高。
[Abstract]:[objective] to analyze the pedicle shape, screw placement accuracy, pedicle deformity degree and Cobb angle of pedicle in patients with NF scoliosis by CT 3D reconstruction. To analyze the data of pedicle shape, nail placement, pedicle deformity and three-dimensional Cobb angle in patients with idiopathic scoliosis. To evaluate the curative effect and other morphological differences between the two groups. (4) to summarize the characteristics of neurofibromatosis patients and the main points needing attention during and after operation. [methods] A total of 276 patients with scoliosis were collected from May 2008 to December 2016 in our hospital. There were 221 cases of idiopathic scoliosis and 16 cases of neurofibromatosis scoliosis. Sixteen cases of idiopathic scoliosis and neurofibromatosis were selected to match with the patients with neurofibromatosis. The transverse diameter of pedicle, the transverse diameter of pedicle to rib union, the Cobb angle of three-dimensional coronal plane and the correction rate were analyzed statistically. The morphology of pedicle and the accuracy of screw insertion were compared between NF patients and AIS patients. [results] there were more pedicle deformities in patients with NF than in idiopathic scoliosis, and the difference was statistically significant (P < 0.05) 88 screws out of 142 screws in NF group were in good position. The remaining 54 screws were misplaced, the screw misplacement rate was 38.02 and the satisfaction rate of screw placement was 61.98. 86 of 111 screws placed in idiopathic scoliosis had a good position and 25 screws belonged to grade 2 or grade 3. The rate of screw misplacement was 22.52%, the satisfaction rate of screw placement was 77.48.AIS group. Results the transverse diameter of pedicle was between 2.73 and 8.33 mm, and its value varied with the segment. The minimum transverse diameter of the concave side was only 1.77 mm. the transverse diameter of the concave pedicle was obviously smaller than that of the convex side. The transverse diameter of thoracic pedicle-rib union was 10.04-14.91 mm. from T1 to T5, the transverse diameter decreased gradually. The transverse diameter of thoracic pedicle in NF patients was between 1.37 mm and 8.21 mm, and the transverse diameter of thoracic pedicle and rib union was less than that of idiopathic scoliosis. To evaluate the effect of coronal treatment in patients with NF from 8.43 to 14.55 mm. (see Table 4, Cobb angle 46 擄-126 擄(mean 68.6 擄) on the main curved coronal plane before operation, 4-58 擄(mean 28.8 擄) in time after operation, 34 -92.5% after operation, 58.8% at the last follow-up. At the last follow-up, the Cobb angle of the main curvature was 4 擄-62 擄, the correction rate was 34 擄-92.5, the average correction rate was 55.3%. The effect of postoperative correction was accurate, and there was a case of correction loss. [conclusion] 1. The rate of pedicle deformity was high in patients with neurofibromatosis scoliosis. There were severe clinical manifestations in patients with malformed bit scoliosis, and the difference was statistically significant. Posterior vertebrae fusion was effective in correcting neurofibromatosis scoliosis in coronal Cobb angle. But compared with idiopathic scoliosis, the difference was statistically significant. The pedicle of neurofibromatosis patients was smaller, the difficulty of screw placement was higher, the rate of screw misinsertion was higher, and the risk of surgery was higher.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3;R596

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