發(fā)布時間：2018-03-13 08:00

  本文選題：腰椎滑脫　切入點：脊柱骨盆參數(shù)　出處：《鄭州大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的對比分析正常成人與腰椎滑脫患者手術(shù)前后脊柱骨盆矢狀位參數(shù)的影像學特點以及各參數(shù)在術(shù)前術(shù)后與正常成人之間的差異,分析術(shù)后各參數(shù)變化對手術(shù)療效的影響,為臨床手術(shù)治療峽部裂性腰椎滑脫提供一定的參考。方法收集2014年9月-2016年9月鄭州大學一附院手術(shù)治療的腰椎滑脫患者58例,分別測量術(shù)前脊柱-骨盆參數(shù)并記錄,作為腰椎滑脫術(shù)前組;測量術(shù)后脊柱-骨盆參數(shù)并記錄,作為腰椎滑脫術(shù)后組;同時門診選取60例無腰椎滑脫的脊柱骨盆曲線作為正常對照組。對術(shù)前組和術(shù)后組做Oswestry評分調(diào)查,并分別測量術(shù)前組、術(shù)后組和對照組的脊柱骨盆參數(shù)。測量的數(shù)據(jù)包括以下幾個參數(shù):PI—骨盆入射角、PT—骨盆傾斜角、SS—骶骨傾斜角、LL—腰椎前凸角、TK—胸椎后凸角、SVA—矢狀面平衡、LSJA-腰骶部關(guān)節(jié)角。根據(jù)術(shù)后Oswestry評分調(diào)查將手術(shù)患者分為兩組:低改善率組(改善率小于50%)與高改善率組(改善率大于50%)。術(shù)前組、術(shù)后組患者與對照組之間脊柱-骨盆參數(shù)的對比分析采用t檢驗;術(shù)前組和術(shù)后組的對比分析用配對t檢驗;并用Pearson相關(guān)系數(shù)來評估各參數(shù)的相關(guān)性;低改善率組與高改善率組之間的對比分析用t檢驗;改善率和各參數(shù)之間的關(guān)系分析采用線性回歸分析;P0.05被認為差異有統(tǒng)計學意義。所有數(shù)據(jù)采用SPSS18.0做統(tǒng)計處理。結(jié)果1.腰椎滑脫術(shù)后組PT、SS、LL、TK、SVA、LSJA與術(shù)前組有明顯差異(P0.01),術(shù)后組PT、TK高于術(shù)前組,LL、SS、LSJA、SVA低于術(shù)前組;術(shù)前組與正常對照組之間有明顯差異(P0.01),術(shù)前組PI、LL、SS、PT、SVA、LSJA均高于正常對照組,而TK低于正常對照組(見表2、3)。2.術(shù)前組與正常對照組相比,PI值有明顯差異,且術(shù)前組PI值高于對照組,而術(shù)前組和術(shù)后組的PI值無差異(見表2、3)。3.通過術(shù)前組、術(shù)后組及正常對照組骨盆參數(shù)的相關(guān)性分析:(1)正常對照組各參數(shù)相關(guān)性分析:PI與SS、PT、LL、LSJA有相關(guān)性;SS與LL、PT、SVA和LSJA有相關(guān)性(見表4)。(2)術(shù)前組各參數(shù)相關(guān)性分析:PI與PT、SS、LL及LSJA有相關(guān)性,其中與SS、LL及LSJA相關(guān)性顯著;LSJA與SS、PT和LL相關(guān),SVA與PT、LL和TK相關(guān)(見表4)。(3)術(shù)后組各參數(shù)相關(guān)性分析:PI與SS、PT和LL相關(guān),SS與LSJA、PT和LL相關(guān),SVA與TK和LSJA相關(guān)。其中SS與LSJA有顯著相關(guān)性(見表4)。4.高改善率組SS、LL、LSJA、SVA低于低改善率組(P0.05),而PT、TK高于低改善率組(P0.05)(見表5)。Oswestry評分改善率與各參數(shù)相關(guān)性分析得出:SS、LL、LSJA與Oswestry評分改善率有顯著相關(guān)性,其中LSJA的相關(guān)性最顯著(見表6)。結(jié)論1.脊柱骨盆矢狀位多個參數(shù)異常的共同作用,影響著峽部裂性腰椎滑脫的發(fā)生及進展。2.高PI值和LSJA值可能為峽部裂腰椎滑脫的重要病因與進展誘因。3.手術(shù)能改善患者的脊柱平衡狀態(tài),PT、LL、LSJA與Oswestry評分改善率有顯著相關(guān)性。因此術(shù)前應(yīng)對這幾個參數(shù)進行評估,術(shù)中應(yīng)注意對上述參數(shù)進行調(diào)整,達到最好手術(shù)效果,術(shù)后可以用這幾個參數(shù)的改善情況對患者的預(yù)后進行預(yù)測。
[Abstract]:Objective to compare the imaging characteristics of sagittal parameters of spine and pelvis between normal adults and patients with lumbar spondylolisthesis before and after operation, and to analyze the effect of the parameters on the curative effect. Methods from September 2014 to September 2016, 58 patients with lumbar spondylolisthesis who were treated by operation in a affiliated hospital of Zhengzhou University were collected, and the parameters of spine and pelvis before operation were measured and recorded. As the preoperative group of lumbar spondylolisthesis, the spinal and pelvic parameters were measured and recorded as the postoperative group of lumbar spondylolisthesis. At the same time, 60 cases of spine and pelvis curve without lumbar spondylolisthesis were selected as the normal control group. The Oswestry scores of the preoperative group and the postoperative group were investigated, and the preoperative group were measured respectively. Parameters of the spine and pelvis in the postoperative group and the control group. Data measured include the following parameters: PI- pelvic incidence angle PT- pelvis tilt angle SS-sacral tilt angle LL- lumbar kyphosis angle TK- thoracic kyphosis angle SVA- sagittal balance of LSJA-lumbosacral joint. Angle. According to the postoperative Oswestry score, the patients were divided into two groups: low improvement rate group (improvement rate less than 50%) and high improvement rate group (improvement rate more than 50%). T test was used to compare the parameters of spine and pelvis between postoperative group and control group, paired t test was used to evaluate the correlation between preoperative group and postoperative group, and Pearson correlation coefficient was used to evaluate the correlation of each parameter. T test was used to analyze the comparison between the low improvement rate group and the high improvement rate group. Linear regression analysis was used to analyze the relationship between the improvement rate and the parameters. All the data were treated with SPSS18.0. Results 1. There was significant difference between the postoperative group and the preoperative group (P 0.01). The PTT TK of the posterior group was higher than that of the preoperative group. There was a significant difference between the preoperative group and the normal control group (P 0.01). The preoperative group had higher PIL LSSN PTSVA LSJA, while TK was lower than the normal control group (see Table 2, 3. 2). There was a significant difference between the preoperative group and the normal control group, and the Pi value of the preoperative group was higher than that of the control group, and the Pi value of the preoperative group was higher than that of the control group. However, there was no difference in Pi between preoperative and postoperative groups (see Table 2 / 3. 3). Correlation analysis of pelvis parameters between postoperative group and normal control group (1) correlation analysis of each parameter in normal control group (P < 0.01). There was a correlation between SS and LSJA (see Table 4. 2) the correlation between Pi and LSJA was significant before operation, and there was a correlation between Pi and LSJA in the preoperative group, and there was no correlation between the parameters of the control group and the control group (see Table 4. 2) the correlation between the parameters of the control group and the control group was higher than that of the control group (P < 0.01). There was significant correlation between LSJA and SSPT and LL (see Table 4. 3). The correlation between SS and LSJA and LL correlation between SS and LSJAPT and LL were significantly correlated with TK and TK, and SS was significantly correlated with LSJA. Correlation (see table 4, p. 4). The improvement rate of SSLLLLSJASVA in the high improvement rate group was lower than that in the low improvement rate group (P 0.05), while the PTTK was higher than that in the low improvement rate group (see table 5, the improvement rate of the Oswestry score and the correlation between the parameters and the improvement rate of SSLLLSJA was significantly correlated with the improvement rate of the Oswestry score. The correlation of LSJA is the most significant (see Table 6). Conclusion 1. The joint action of multiple parameter anomalies in the sagittal position of the spine and pelvis, High Pi value and LSJA value may be the important cause and cause of spondylolisthesis of isthmus spondylolisthesis. 3. Operation can improve the balance of spine and improve the score of LSJA and Oswestry in patients with isthmic spondylolisthesis. There is a significant improvement rate of LSJA and Oswestry score in patients with isthmic spondylolisthesis. Therefore, these parameters should be evaluated before operation, The parameters mentioned above should be adjusted during the operation to achieve the best operative effect. The improvement of these parameters can be used to predict the prognosis of the patients after operation.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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