本文選題：腰椎間盤突出癥 + Wallis�。� 參考：《桂林醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的:通過CT掃描三維重建技術(shù)探討腰椎棘突間相關(guān)區(qū)域間接測量方法及其臨床意義,為棘突間動(dòng)態(tài)穩(wěn)定系統(tǒng)置入治療國人腰椎退行性疾病提供參考數(shù)據(jù)及臨床可行性;探討棘突間動(dòng)態(tài)穩(wěn)定系統(tǒng)(Wallis)置入治療單純性腰椎間盤突出癥的可行性、手術(shù)技巧及臨床效果分析。方法:(1)利用美國GE64排CT通過對(duì)52例非腰椎退行性疾病患者掃描成像進(jìn)行形態(tài)學(xué)測量,男性26名,女性26名,均無外傷、腫瘤及腰椎畸形,年齡24-50歲(平均34±4歲),利用PACS系統(tǒng)通過多方位對(duì)腰椎棘突間距、棘突頂距、棘突基底高度、棘突上緣厚度、棘突中央厚度、棘突下緣厚度進(jìn)行測量,以最佳測量角度取值為準(zhǔn),各測量數(shù)據(jù)均測量三次并取其均值,通過統(tǒng)計(jì)學(xué)軟件SPSS15.0對(duì)所得數(shù)據(jù)進(jìn)行正態(tài)性檢驗(yàn)、T檢驗(yàn);(2)2011年9月~2012年9月收治的腰椎間盤突出癥患者10例,10例LDH患者均行腰椎后路開窗髓核摘除術(shù)并植入Wallis棘突間動(dòng)態(tài)穩(wěn)定系統(tǒng)固定治療,觀察術(shù)前、術(shù)后情況并進(jìn)行VAS評(píng)分、下腰痛JOA評(píng)分及Oswestry功能障礙指數(shù)變化。結(jié)果:(1)棘突基底高度(H)、棘突上緣厚度(TS)及棘突中央厚度(TC)P值均小于0.05,男女之間均有統(tǒng)計(jì)學(xué)意義;棘突間距(DB)男女之間無統(tǒng)計(jì)學(xué)意義(P0.1);棘突頂距(DA)中L45節(jié)段(P=0.370.1),男女差異無統(tǒng)計(jì)學(xué)意義;L2椎體和L5椎體的棘突下緣厚度(TI)(P=0.630.1,P=0.280.1)男女無統(tǒng)計(jì)學(xué)意義。男性DB以L23節(jié)段距離最大(11.3±2.63mm),L45節(jié)段距離最小(7.83±0.92mm),女性以L12節(jié)段距離最大(8.63±1.57mm),L34節(jié)段距離最小(6.34±1.63mm);男女性DA和H均呈先增大后減小的趨勢(shì),男女性DA均以L12節(jié)段距離最大,男性H以L3最高(24.38±2.17mm),女性以L4最高(19.52±2.06mm);男女棘突的厚度均呈TITCTS,男性女性,且每一棘突的下緣厚度均值較相對(duì)應(yīng)的下一棘突上緣厚度大;(2)10例患者均獲得隨訪,隨訪時(shí)間3~13個(gè)月(平均9±2個(gè)月)。術(shù)后患者疼痛消失,癥狀與體征均有明顯改善。治療后視覺模擬VAS評(píng)分較術(shù)前明顯降低(P0.01),下腰痛JOA評(píng)分較術(shù)前顯著增加(P0.01),ODI評(píng)分較術(shù)前顯著降低(P0.01)。結(jié)論:(1)各組測量數(shù)據(jù)值經(jīng)檢驗(yàn)均呈正態(tài)性分布,男性棘突間距、棘突頂距、棘突基底高度及棘突厚度均較女性數(shù)值大,說明女性棘突和男性棘突相比較具有矮、薄的特點(diǎn);基本反映了國人腰椎棘突相關(guān)區(qū)域的解剖特點(diǎn),同時(shí)也為棘突間動(dòng)態(tài)穩(wěn)定系統(tǒng)的應(yīng)用提供了參考數(shù)據(jù);(2)Wallis棘突間動(dòng)態(tài)穩(wěn)定系統(tǒng)置入治療單純性腰椎間盤突出癥的臨床效果良好。
[Abstract]:Objective: to explore the indirect measurement method and its clinical significance of interspinous process related area of lumbar spine by three-dimensional CT scan, and to provide reference data and clinical feasibility for interspinous dynamic stabilization system in the treatment of lumbar degenerative diseases in Chinese. To investigate the feasibility, surgical technique and clinical effect of interspinous dynamic stabilization system (Wallis) in the treatment of simple lumbar disc herniation. Methods the morphology of 52 patients with non-lumbar degenerative diseases was measured by GE64 slice CT scan. There were 26 males and 26 females without trauma, tumors and lumbar deformities. Aged 24-50 years (mean 34 鹵4 years old), the distance between spinous process, apical distance of spinous process, basal height of spinous process, thickness of superior edge of spinous process, central thickness of spinous process and thickness of inferior edge of spinous process were measured by PACS system. All the measured data were measured three times and their mean values were taken. 10 patients with lumbar disc herniation admitted from September 2011 to September 2012, 10 patients with LDH underwent posterior fenestration of lumbar vertebrae and Wallis interspinous process implantation. Dynamic stabilization system fixation, The changes of VAS score, low back pain JOA score and Oswestry dysfunction index were observed before and after operation. Results the basal height of spinous process, the thickness of superior margin of spinous process and the central thickness of spinous process were lower than 0.05, and there was statistical significance between male and female. There was no statistical difference between male and female (P 0.1), and there was no significant difference between male and female in L45 segment (P < 0. 370.1). There was no significant difference between male and female. There was no significant difference in the thickness of spinous process between male and female, the thickness of spinous process was 0. 630.1 (P = 0. 280.1). The maximum distance between L23 segment and L45 segment was 11.3 鹵2.63 mm in males and 7.83 鹵0.92mm-1 in L12 segment, and the smallest distance was 6.34 鹵1.63 mm in L12 segment in male and female segment, the DA and H of male and female increased first and then decreased, the maximum distance of male and female was L12 segment. The highest value of H in male was L3 (24.38 鹵2.17mm-1) and that in female (L4) was 19.52 鹵2.06mm.The thickness of spinous process was TITCTS in male and female, and the mean thickness of lower edge of each spinous process was higher than that of the corresponding upper edge of spinous process. The follow-up time was 3 ~ 13 months (mean 9 鹵2 months). Postoperative pain disappeared, symptoms and signs improved significantly. After treatment, visual analog VAS score was significantly lower than that before operation (P 0.01), and low back pain JOA score was significantly increased compared with that before operation (P 0.01). Conclusion (1) the measured data were positively distributed in each group. The distance between spinous process, the apical distance of spinous process, the height of spinous process base and the thickness of spinous process were larger in male than in female, indicating that the spinous process of female was shorter and thinner than that of male. It reflects the anatomical characteristics of spinous process in Chinese and provides reference data for the application of interspinous process dynamic stabilization system. The clinical effect of Wallis interspinous process dynamic stabilization system in the treatment of simple lumbar intervertebral disc herniation is good.
【學(xué)位授予單位】：桂林醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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本文編號(hào)：1907101