本文選題：腰椎 + 退變�。� 參考：《新疆醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：探討成人僵硬性退變性脊柱側(cè)凸的的影像學(xué)特征及截骨方式選擇。方法：收集我院于2011年1月至2014年9月收治的45例僵硬性成人退變性脊柱側(cè)凸行長節(jié)段固定截骨矯形的完整病例資料,按照截骨方式分為兩組。SPO組28例,男8例,女20例,年齡51～75歲,平均61.1歲,心血管疾病17例,呼吸系統(tǒng)疾病5例,糖尿病11例；PSO組17例,男6例,女11例,年齡50～73歲,平均62.5歲,心血管疾病6例,呼吸系統(tǒng)疾病3例,糖尿病7例。根據(jù)術(shù)前全脊柱X片、Bending像及CT三維重建判斷脊柱僵硬性及僵硬來源,選擇截骨方式,SPO或PSO,分析兩組術(shù)前及末次隨訪的脊柱影像學(xué)指標(biāo)及療效結(jié)果。結(jié)果：45例患者手術(shù)均順利完成,無死亡病例,術(shù)后隨訪6-45月,平均22.4月。兩組術(shù)前及末次隨訪的ODI及VAS評分有明顯統(tǒng)計學(xué)意義(P0.05),SPO組Cobb角改善率為69.33%,PSO組Cobb角改善率為76.14%,兩組重新獲得了脊柱冠矢狀面平衡,兩種截骨方式均取得良好的臨床療效。SPO組,手術(shù)時間155-290min,平均213min,出血量700-1550ml,平均1253m1,腦脊液漏5例,感染1例,內(nèi)固定松動1例；PSO組,手術(shù)時間160-320min,平均264min,出血量900-2200m1,平均1756m1,腦脊液漏4例,感染1例,無內(nèi)固定松動。結(jié)論：成人脊柱退變性側(cè)凸的截骨方式應(yīng)根據(jù)術(shù)前影像學(xué)資料進(jìn)行選擇,主要因素有局部角狀側(cè)后凸畸形、腰椎后凸、椎間隙骨化、僵硬及矢狀面失衡情況；盡量使用SPO解決脊柱退變性側(cè)凸的矯形問題,但嚴(yán)重脊柱畸形需要使用PSO進(jìn)行矯形；兩種截骨方式都取得良好的臨床和影像學(xué)療效。
[Abstract]:Objective: to investigate the imaging features and osteotomy of adult degenerative scoliosis. Methods: from January 2011 to September 2014, 45 cases of degenerative scoliosis with degenerative scoliosis treated in our hospital were collected. According to the osteotomy pattern, the patients were divided into two groups: 8 males and 20 females. There were 17 cases of cardiovascular disease, 5 cases of respiratory diseases, 11 cases of diabetes mellitus, 17 cases of PSO group, 6 males and 11 females, with an average age of 62.5 years, 6 cases of cardiovascular diseases and 3 cases of respiratory diseases. There were 7 cases of diabetes mellitus. According to preoperative X-ray radiography and CT 3D reconstruction to judge the origin of spinal stiffness and stiffness, SPO or PSO were selected to analyze the imaging indexes and curative effect of the two groups before and after the last follow-up. Results all the 45 cases were successfully operated without death. The follow-up period was 6 to 45 months with an average of 22.4 months. The ODI and VAS scores of the two groups before and at the last follow-up were statistically significant. The improvement rate of the Cobb angle in the P0.05 and SPO group was 69.33. The improvement rate of the Cobb angle in the PSO group was 76.14. The sagittal balance of the spine coronal was re-obtained in both groups. The operative time was 155-290 mins (mean 213min), bleeding volume was 700-1550ml (mean 1253ml), cerebrospinal fluid leakage (5 cases), infection (1 case) and loosening of internal fixation (1 case). The operative time was 160-320min (average 264min, 900-2200ml, average 1756ml), cerebrospinal fluid leakage (4 cases), infection (1 case) and loosening of internal fixation (1 case). Conclusion: the osteotomy of degenerative scoliosis in adults should be selected according to the preoperative imaging data. The main factors are local keratosis, lumbar kyphosis, ossification of intervertebral space, stiffness and sagittal imbalance. SPO was used to solve the problem of degenerative scoliosis, but PSO was needed for correction of severe degenerative scoliosis. Both osteotomy methods achieved good clinical and imaging results.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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