本文選題：腰椎椎弓根 + CT重建��； 參考：《西南醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:觀察下腰椎(L_(3-5))椎弓根最狹窄處椎弓根高度(Pedicle Outer Height,POH)與椎弓根寬度(Pedicle Outer Width,POW)差值(Pedicel Difference,PD)、椎弓根冠狀面長軸與正中矢狀面夾角(Coronal inclination,CI)的變化規(guī)律,探討下腰椎椎弓根螺釘置釘與椎弓根形態(tài)的匹配性。方法:選取西南醫(yī)科大學(xué)附屬醫(yī)院脊柱外科2015年7月1日~2015年9月30日在我院放射科行全腹增強(qiáng)CT及腰部CT+三維重建的人群作為測(cè)量對(duì)象,最終選取115例共690個(gè)椎弓根,男80例,女35例,男性組,年齡18~78歲平均48.4±14.2歲;身高145~178cm平均167.2±6.1cm;體重44~86kg平均63.7±10.0kg。女性組,年齡18~82歲平均48.20±14.4歲;身高141~163cm平均154.4±4.5cm;體重38~71kg平均54.3±8.9kg。均采用64排螺旋CT從L_3-S1連續(xù)掃描,掃描的原始圖像傳至圖像后處理ADW4.4工作站中,運(yùn)用多平面重建(multiplanar reconstruction,MPR)技術(shù)獲得椎弓根峽部的橫斷面和冠狀面形態(tài),在其最佳層面觀察測(cè)量L_3到L_5椎弓根最窄處POW、POH,計(jì)算PD,測(cè)量CI值。將性別分為男、女兩組;年齡分為≤60歲、60歲兩組;身高分為≤160cm、160cm兩組;體重指數(shù)(Body Mass Index,BMI)分24、≥24兩組。觀察每組各脊椎椎弓根高度與寬度及其差值、椎弓根最窄處冠狀面軸線與矢狀中線的夾角(ci)的變化規(guī)律;每個(gè)脊椎椎弓根對(duì)應(yīng)的高度與寬度差值(pd)0mm百分比;椎弓根寬度或高度7mm的百分比。運(yùn)用microsoftofficeexcel2003和spss17.0軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析,各脊椎椎弓根高度與寬度差值間、椎弓根冠狀面軸線夾角間的對(duì)比分析采用兩兩比較q檢驗(yàn)和單因素方差分析(one-wayanalysisofvariance,anova)。結(jié)果:本研究收集115例共690個(gè)椎弓根,其中男性80例480個(gè)椎弓根、女性35例210個(gè)椎弓根。統(tǒng)計(jì)結(jié)果顯示各對(duì)應(yīng)脊椎從l3到l5左右兩側(cè)poh、pow、pd及ci均無顯著性差異(p0.05)。(1)患者下腰椎(l3-5)各對(duì)應(yīng)脊椎poh分別為:l3(12.5±1.4mm)、l4(11.1±1.5mm)、l5(10.4±1.5mm),l3l4l5。pow分別為:l3(8.3±1.6mm)、l4(10.1±1.7mm)、l5(14.1±2.2mm),l3l4l5。pd分別為:l3(4.1±1.9mm)、l4(0.9±1.9mm)、l5(-3.8±2.2mm),最大值在l3:9.1mm;最小值在l5:-12.2mm,l3l4l5。ci分別為:l3(18.1±9.8°)、l4(36.5±9.6°)、l5(43.3±6.5°),最大值在l5:66.2°;最小值在l3及l(fā)4:0°,l3l4l5。(2)椎弓根高度與寬度差值(pd)0mm的百分比從l3到l5依次為:2.6、28.3、96.1。(3)從l3到l5脊椎所有poh均大于7mm,pow7mm的百分比從l3到l5依次為:男性:10.3、1.7、0。女性:14.2、2.7、0。在性別、年齡、身高、體重指數(shù)分組中,男性各脊椎pd值均小于女性,男性ci平均值均大于女性,但無顯著性差異(p≥0.05);pd及ci與性別、年齡、身高、體重相關(guān)性無統(tǒng)計(jì)學(xué)意義(p≥0.05),椎節(jié)間差異明顯,從l3到l5各對(duì)應(yīng)脊椎pd、ci經(jīng)兩兩比較,有統(tǒng)計(jì)學(xué)差異(p0.05)。結(jié)論:1、下腰椎椎弓根PD從L_3到L_5分別為:L_3(4.1±1.9mm)、L_4(0.9±1.9mm)、L_5(-3.8±2.2mm);L_3L_4L_5,且女性PD均大于男性,整體表明在下腰椎女性的POH與POW的變異較男性大。PD與年齡、身高、體重均無明顯相關(guān)性,椎節(jié)是影響PD的重要因素。2、在下腰椎CI分別為:L_3(18.1±9.8°)、L_4(36.5±9.6°)、L_5(43.3±6.5°),L_3L_4L_5,CI與性別、年齡、身高、體重均無明顯相關(guān)性,椎節(jié)是影響CI的重要因素。3、椎弓根高度與寬度差值(PD)0mm的百分比從L_3到L_5逐漸增大分別為:2.6、28.3、96.1,當(dāng)該差值0mm時(shí),選擇螺釘直徑應(yīng)以椎弓根高度為準(zhǔn)。4.本研究發(fā)現(xiàn)從L_3到L_5脊椎所有POH均大于7mm,POW7mm的百分比從L_3到L_5依次為:12.3、2.2、0。POW小于7mm的比例,女性明顯多于男性。
[Abstract]:Objective: To observe the variation of the difference between the pedicle height (Pedicle Outer Height, POH) and the width of the pedicle (Pedicle Outer Width, POW) (Pedicel Difference, PD) and the angle between the long axis of the pedicle and the median sagittal plane of the pedicle of the lower lumbar pedicle (L_ (3-5)), and to explore the pedicle screw and the vertebral arch of the lower lumbar vertebrae. Methods: in the Department of spinal surgery of the Affiliated Hospital of Southwest Medical University in July 1, 2015 ~2015 September 30th ~2015 years in the Department of Radiology, the total abdominal enhancement of CT and the 3D reconstruction of CT+ in the waist were taken as the measurement object. Finally, 115 cases of 690 pedicles were selected, including 80 males, 35 females, male groups, and the average age of 48.4 + 14.2 years old. The average height of 145~178cm was 167.2 + 6.1cm, the average weight of 44~86kg was 63.7 + 10.0kg., the average age was 48.20 + 14.4 years old, the average height 141~163cm was 154.4 + 4.5cm, the average weight 38~71kg was 54.3 + 8.9kg., and 64 rows of spiral CT were scanned from L_3-S1 continuous. The original image of the scan was transmitted to the image post processing ADW4.4 workstation, and the multiplane reconstruction was used. (multiplanar reconstruction, MPR) technique obtained the transverse and coronal shape of the pedicle isthmus. At its best level, we measured the narrowest location of L_3 to L_5 pedicle POW, POH, and calculated PD, and measured the CI values. The sex was divided into male and female two groups; age was divided into less than 60 years, 60 years old and two groups; height was divided into 160cm, 160cm two groups; mass index (Body) BMI) was divided into groups of 24, 24 and two groups. The height and width of Shiumi Ne's spine in each group and the difference between the coronal axis and the sagittal line (CI) were observed, and the difference between the height and width of the spine (PD) 0mm in each spine, and the percentage of the width of Shiumi Ne (PD), and the percentage of 7mm in the width of Shiumi Ne were used. SPSS17.0 software was used for data statistical analysis, the difference between the vertebral pedicle height and width, and the comparative analysis of the angle between the pedicle coronal axis and the angle of the coronal axis of the vertebral arch by 22 comparison Q test and single factor analysis of variance (one-wayanalysisofvariance, ANOVA). Results: This study collected 690 pedicles, including 80 males and 480 pedicle roots. There were 210 vertebral pedicles in 35 cases. The statistical results showed that there were no significant differences in the corresponding vertebrae from L3 to about L5, pow, PD and CI (P0.05). (1) the lower lumbar vertebrae (L3-5) of the lower lumbar (L3-5) corresponding vertebra poh were L3 (12.5 + 1.4mm), L4 (8.3 + 10.4), 8.3 (10.1 +), 14.1 + L3 (4.1 + 1.9mm), L4 (0.9 + 1.9mm), L5 (-3.8 + 2.2mm), the maximum value in l3:9.1mm; the minimum value is l5:-12.2mm, and l3l4l5.ci is L3 (18.1 + 9.8 degrees), L4 (36.5 + 9.6), 43.3 + 6.5 degrees, and the minimum value of the difference between the height and width of the pedicle (2) All poh of 6.1. (3) from L3 to L5 were greater than 7mm, and the percentage of pow7mm from L3 to L5 was as follows: male: 10.3,1.7,0. female: 14.2,2.7,0. in sex, age, height, body mass index group, the PD value of all vertebrae in male is smaller than that of women, and the average value of male CI is greater than that of women, but there is no significant difference (0.05). There was no significant difference in weight correlation (P > 0.05), there was a significant difference in intervertebral space between L3 and L5, and there was a statistical difference between L3 and L5 (P0.05). Conclusion: 1, the PD from L_3 to L_5 in the lower lumbar vertebrae is L_3 (4.1 + 1.9mm), L_4 (0.9 +), and females are all larger than men, and the whole show in the lower lumbar spine The variation of POH and POW in women has no significant correlation with age, height and weight, and vertebra node is an important factor affecting PD,.2 in the lower lumbar CI: L_3 (18.1 + 9.8 degrees), L_4 (36.5 + 9.6 degrees), L_5 (43.3 + 6.5 degrees), L_3L_4L_5, CI and sex, age, height and weight, and vertebra node is an important factor affecting CI. The percentage of the height and width difference (PD) 0mm of the arch root gradually increased from L_3 to L_5, respectively: 2.6,28.3,96.1. When the difference was 0mm, the diameter of the screw should be determined by the height of the pedicle of the vertebral arch as a quasi.4.. All POH from L_3 to L_5 were larger than 7mm. More than men.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R687.3

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