本文選題：矢狀位　切入點(diǎn)：平衡　出處：《皖南醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的引起脊柱-骨盆矢狀位失衡的原因有很多種,其中包括骨質(zhì)疏松癥為基礎(chǔ)所致的椎體壓縮性骨折(致胸、腰椎段骨折)等,嚴(yán)重的脊柱-骨盆結(jié)構(gòu)損壞會破壞脊柱-骨盆矢狀位平衡,對于由以上原因所致的脊柱-骨盆矢狀位失衡,經(jīng)皮椎體成形術(shù)(percutaneous vertebroplasty,PVP)來重新建立椎體的各面之間的平衡,特別是矢狀位上的平衡關(guān)系,目前在臨床上應(yīng)用比較廣泛,本研究通過比較PVP手術(shù)前后患者脊柱-骨盆矢狀位平衡參數(shù)及相關(guān)量表數(shù)值的差異,探討脊柱矢狀位平衡重建對PVP術(shù)后患者功能恢復(fù)的影響。方法運(yùn)用回顧性對照的方法分析皖南醫(yī)學(xué)院第一附屬醫(yī)院脊柱骨科2014年04月~2015年11月所選取的52個病例(男性12人,女性40人,平均年齡為68.25歲,年齡范圍58歲~85歲)PVP手術(shù)前后患者頸椎前凸角(CL)、胸椎后凸角(TK)、腰椎前凸角(LL)、脊柱矢狀位平衡(SVA)、骨盆入射角(PI)、骨盆傾斜角(PT)、骶骨傾斜角(SS)、下腰痛JOA評分、Oswestry腰背下肢功能障礙評分、VAS疼痛評分等指標(biāo)的變化差異,52個病例中,胸段骨折21人,腰段骨折31人。結(jié)果52例患者手術(shù)均順利完成,無手術(shù)或圍手術(shù)期死亡病例出現(xiàn),術(shù)后隨訪時(shí)間1~6個月,平均時(shí)間4.5個月。術(shù)前CL9.212°±30.499°、TK41.385°±27.957°、LL59.135°±36.367°、SVA20.692mm±85.861mm、PI71.614°±35.303°、PT30.635°±19.811°、SS54.700°±31.944°、JOA評分8.385±2.162、Oswestry評分34.808±3.042、VAS評分6.808±0.971。術(shù)后CL9.077°±16.384°、TK24.635°±13.233°、LL42.865°±8.765°、SVA-20.962mm±47.397mm、PI38.173°±7.326°、PT14.000°±3.492°、SS34.519°±5.497°、JOA評分24.058±2.118、Oswestry評分12.539±1.787、VAS評分1.712±0.696。脊柱—骨盆矢狀位參數(shù)指標(biāo)CL值在手術(shù)前后比較,其差異無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后TK、LL、SVA、PI、PT、SS等測量參數(shù)與術(shù)前比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);VAS評分、JOA評分、ODI評分與術(shù)前比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);CL與PI及PT之間密切相關(guān)(P0.01,CL與PI比較;P0.05,CL與PT比較);TK與PT之間密切相關(guān)(P0.01);PI與PT之間密切相關(guān)(P0.01)。結(jié)論脊柱的平衡包括水平面上、冠狀面上的以及矢狀位上的平衡,由于人類脊柱生理彎曲的存在,使得脊柱矢狀位平衡在維持人體正常姿勢中起到極為重要的作用;脊柱-骨盆系統(tǒng)作為一個整體,任何一方的結(jié)構(gòu)損傷及破壞都會引起相關(guān)聯(lián)的一系列脊柱矢狀位參數(shù)的改變,各參數(shù)之間關(guān)系密切;因各種原因?qū)е碌募怪?骨盆矢狀位失衡,采用經(jīng)皮椎體成形術(shù)重建脊柱-骨盆的平衡可以取得良好的臨床療效,不僅表現(xiàn)為相關(guān)參數(shù)的恢復(fù)正�；蚪咏�,也表現(xiàn)為相關(guān)評估量表的改善;PVP術(shù)后患者脊柱-骨盆矢狀位參數(shù)的重建對患者術(shù)后恢復(fù)及生活質(zhì)量的改善有重要的促進(jìn)作用,臨床醫(yī)生應(yīng)當(dāng)更加重視脊柱-骨盆矢狀位參數(shù)評價(jià)體系在臨床上應(yīng)用。
[Abstract]:Objective there are many causes of spinal and pelvic sagittal imbalance, including vertebral compression fractures (thoracolumbar fractures) based on osteoporosis. Severe structural damage to the spine and pelvis can destroy the sagittal balance of the spine and pelvis, and for the spinal and pelvic sagittal imbalance caused by the above reasons, percutaneous vertebroplasty (PVP) is used to re-establish the balance between the different sides of the vertebra. Especially the balance relationship in sagittal position is widely used in clinic at present. The purpose of this study was to compare the spinal and pelvic sagittal balance parameters and relevant scale values before and after PVP operation. To investigate the effect of sagittal balance reconstruction on the functional recovery of patients after PVP methods 52 cases (12 males) from April 2014 to November 2015 in Department of Spinal Orthopaedics, first affiliated Hospital of Southern Anhui Medical College, were analyzed retrospectively. 40 women, with an average age of 68.25 years, Age range 58 years and 85 years before and after PVP operation in patients with anterior cervical kyphoid angle, thoracic kyphoid angle TKN, lumbar spine anterior kyphoid angle, spinal sagittal balance sagittal balance, pelvic angle of incidence, pelvic obliquity angle, sacral obliquity angle, JOA score of lower back pain, and Oswestry loin and lower extremity score. The changes of VAS pain score were different in 52 cases. Results all the 52 patients were successfully operated, no operative or perioperative death occurred, and the follow-up time was 1 ~ 6 months. The mean time was 4.5 months. Preoperative CL9.212 擄鹵30.499 擄TK41.385 擄鹵27.957 擄L(fēng)L59.135 擄鹵36.367 擄SVA20.692mm 鹵85.861mm PI71.614 擄鹵35.303 擄PT30.635 擄鹵19.811 擄SS54.700 擄鹵31.944 擄JOA score 8.385 鹵2.162Oswestry score 34.808 鹵3.042VAS 6.808 鹵0.971.The postoperative CL9.077 擄鹵16.384 擄TK24.635 擄鹵13.233 擄L(fēng)L42.865 擄鹵8.765 擄SVA-20.96mm 鹵47.739mm P38.173 鹵7.326 擄TOA score before and after operation were compared with the score of 34.808 鹵3.042VAS (6.808 鹵0.971L) and the postoperative CL9.077 擄鹵16.384 擄TK24.635 擄鹵13.233 擄L(fēng)L42.865 擄鹵8.765 擄SVA-20.96mm 鹵47.739mm 鹵47.39mm P38.173 鹵7.326 擄TOA score before and after operation. There was no significant difference between the two groups (P 0.05), and there was no significant difference in the parameters of postoperative TKL, SVA, Pi, PTSS and before operation, the difference was statistically significant (P 0.05 VAS score, JOA score, ODI score and preoperative comparison), and there was no significant difference between before and after operation. There was a significant correlation between P0.05, Pi and PT. Conclusion the balance of spine includes horizontal balance, coronal balance and sagittal balance. Due to the existence of physiological curvature of the human spine, the sagittal balance of the spine plays an extremely important role in maintaining the normal posture of the human body. Structural damage and destruction on either side will result in a series of related changes in the sagittal position parameters of the spine, which are closely related to each other. Using percutaneous vertebroplasty to reconstruct the balance of spine and pelvis can obtain good clinical effect, not only for the related parameters to return to normal or close to normal. It also showed that the improvement of correlative assessment scale and the reconstruction of the sagittal position parameters of spine and pelvis after PVP had an important role in promoting the recovery and the improvement of quality of life after PVP. Clinicians should pay more attention to the clinical application of spinal-pelvic sagittal parameter evaluation system.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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