本文選題：內(nèi)鏡 + 磁共振成像��； 參考：《濟(jì)寧醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:通過(guò)磁共振成像(Magnetic Resonance Imaging,MRI)測(cè)量正常成年人與腰椎間盤突出癥(Lumbar Intervertebral Disc Herniation,LDH)患者的腰4(L4)神經(jīng)根與腰5(L5)上關(guān)節(jié)突尖部之間的距離,探討經(jīng)皮椎間孔入路椎間孔鏡下手術(shù)(Percutaneous Endoscopic Lumbar Discectomy,PELD)治療L4/5椎間盤突出的安全性,為臨床應(yīng)用PELD提供準(zhǔn)確的影像學(xué)參考數(shù)據(jù)。方法:收集2016年6月至2016年12月于我院MRI室行腰椎MRI檢查患者共68例。將患者按照有無(wú)L4/5間盤突出分為突出組和正常組�；颊吣挲g在20-40歲范圍內(nèi),腰椎MRI圖像無(wú)異常側(cè)凸及后凸,橫斷面圖像平行于上下終板。使用PACS(Picture Archiving and Communication Systems)系統(tǒng)軟件測(cè)量,首先測(cè)量腰4/5終板間隙高度,然后使用標(biāo)記筆在電子計(jì)算機(jī)屏幕上標(biāo)記L5上關(guān)節(jié)突尖部,測(cè)量下終板、椎間隙中間層面、上終板層面神經(jīng)根與標(biāo)記點(diǎn)之間的距離,記錄數(shù)據(jù)。根據(jù)勾股定理計(jì)算標(biāo)記點(diǎn)與神經(jīng)根之間距離,并用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:終板間隙高度正常組均值為8.66?0.65mm,椎間盤突出組均值為5.91mm?0.40mm,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。正常組標(biāo)記點(diǎn)與下終板層面神經(jīng)根距離左側(cè)4.29±1.36mm,右側(cè)4.45±1.57mm;椎間隙中間層面左側(cè)7.03±1.41mm,右側(cè)7.15±1.41mm;上終板層面左側(cè)11.48±1.16mm,右側(cè)11.42±1.27mm。突出組標(biāo)記點(diǎn)與下終板層面神經(jīng)根距離癥狀側(cè)4.58±1.98mm,無(wú)癥狀側(cè)4.72±1.80mm;中間層面癥狀側(cè)7.35±1.72mm,無(wú)癥狀側(cè)7.18±1.77mm;上終板層面癥狀側(cè)12.07±2.06mm,無(wú)癥狀側(cè)11.72±2.10mm,以上差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:1、腰椎間盤突出可導(dǎo)致椎間隙高度降低,但腰4/5椎間盤突出不會(huì)造成神經(jīng)根明顯移位。2、年齡在20-40歲L4/5椎間盤1區(qū)和2區(qū)突出患者中,上關(guān)節(jié)突尖部與神經(jīng)根之間距離大于工作通道半徑,可以嘗試沿上關(guān)節(jié)突尖部滑入椎管內(nèi),另外,行椎間孔成型時(shí)亦不會(huì)損傷出口根。
[Abstract]:Objective: to measure the distance between the L4 nerve root of normal adults and the Lumbar Intervertebral Disc herniation of lumbar intervertebral disc herniation (L5) by magnetic Resonance imaging (MRI). To investigate the safety of percutaneous transhepatic Endoscopic Lumbar discectomytomy (PELDD) in the treatment of L4 / 5 disc herniation, and to provide accurate imaging data for clinical application of PELD. Methods: from June 2016 to December 2016, 68 patients underwent lumbar MRI examination in our MRI room. Patients were divided into protrusion group and normal group according to L 4 / 5 disc herniation. In the age range of 20-40 years, MRI images of lumbar vertebrae showed no abnormal scoliosis and kyphosis, and the cross-sectional images were parallel to the upper and lower endplates. PACS(Picture Archiving and Communication Systems) software was used to measure the height of the lumbar 4 / 5 endplate gap, and then the upper articular process tip of L5 was marked on the computer screen with a marker pen, and the lower end plate and intervertebral space were measured. The distance between the nerve root and the labeled point in the upper endplate was recorded. The distance between marker points and nerve roots was calculated according to Pythagorean theorem, and the statistical analysis was carried out with SPSS17.0 software. Results: the mean value of intervertebral disc herniation was 5.91 mm 0.40 mm in the normal group and 0.65 mm in the disc herniation group. The difference was statistically significant (P 0.05). In the normal group, the distance between the labeled point and the nerve root of the inferior endplate was 4.29 鹵1.36 mm on the left side and 4.45 鹵1.57 mm on the right side, 7.03 鹵1.41 mm on the left side and 7.15 鹵1.41 mm on the middle layer of the intervertebral space, and 11.48 鹵1.16 mm on the upper end plate and 11.42 鹵1.27 mm on the right side. In the protruding group, the distance between the marked point and the nerve root in the inferior endplate was 4.58 鹵1.98 mm and 4.72 鹵1.80 mm in the asymptomatic side, 7.35 鹵1.72 mm and 7.18 鹵1.77 mm in the medial side, 12.07 鹵2.06 mm and 11.72 鹵2.10 mm in the upper end plate, respectively. Conclusions 1, lumbar disc herniation may lead to the reduction of intervertebral space height, but lumbar 4 / 5 disc herniation does not cause obvious displacement of nerve root. The distance between the superior articular process tip and the nerve root is larger than the working channel radius, so we can try to slide into the spinal canal along the superior articular process tip. In addition, the outlet root will not be damaged when the intervertebral foramen is formed.
【學(xué)位授予單位】：濟(jì)寧醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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本文編號(hào)：1889237