本文選題：腰椎間盤突出癥 + 椎間盤��； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:對腰椎間盤突出癥患者腰椎行雙源CT連續(xù)動態(tài)掃描觀察腰椎間盤突出與腰椎椎間孔的變化情況。方法:選擇40名常規(guī)CT已經(jīng)確診L4-5節(jié)段腰椎間盤突出癥的患者利用雙源CT(Siemens somatom definition flash CT)采用VPC Dynmuti 4D方式掃描得到腰椎從屈曲位20度到背伸位20度運動過程中不同時間分辨率的DICOM圖像文件。將圖像導(dǎo)入Inspace工作站后以L4-5節(jié)段矢狀位Cobb角的測量方法確定腰椎進(jìn)行連續(xù)動態(tài)掃描過程中腰椎的曲度,分別測量L4-5椎體在運動過程中和靜止仰臥位椎間盤突出情況和椎間孔面積,并分析在運動過程中椎間孔和椎間盤突出的改變情況和兩者的相互關(guān)系。結(jié)果:1.40名腰椎間盤突出患者在進(jìn)行從屈曲位到背伸位運動過程中,L4-5椎間盤后緣突出程度逐漸增加,從中立位向過屈位運動時L4-5節(jié)段椎間盤突出程度變化更加明顯(Table 1)。腰椎屈曲運動過程中每屈曲10°椎間盤突出減少約0.87±0.26mm;腰椎伸展運動過程中每伸展10°椎間盤突出增加約1.24±0.45mm。2.40名患者全部診斷為L4-5腰椎間盤突出癥,測量其L4-5節(jié)段不同曲度變化時的椎間孔面積情況(Table 2)。腰椎運動過程中,每伸展10°其椎間孔面積比仰臥位靜態(tài)掃描時平均減小約8.02±0.34 mm2;屈曲運動時腰椎屈曲10°位置時90%患者椎間孔面積比常規(guī)仰臥位掃描時減小約6.72±0.23mm2;屈曲20°時,82%患者L4-5節(jié)段椎間孔面積比靜態(tài)掃描時大約7.02±0.15 mm2;18%患者在屈曲20°時椎間孔面積沒有變化。從腰椎不同曲度椎間孔面積可知突出的椎間盤在腰椎進(jìn)行屈伸運動時對椎間孔的影響是有差異的,伸展位可造成椎間孔變小,但向過屈位運動時可能會造成椎間孔面積變大或變小。結(jié)論:1.雙源CT腰椎連續(xù)動態(tài)掃描可以應(yīng)用于腰椎間盤突出癥常規(guī)CT掃描陰性的患者或者是常規(guī)CT掃描結(jié)果與臨床癥狀差異較大的患者。2.腰椎間盤突出患者在腰椎在屈曲位時,其椎間盤突出程度要小于中立位時的程度,而腰椎在伸展位時其椎間盤突出程度大于中立位時,可以通過腰椎不同曲度對腰椎間盤突出情況做盡可能準(zhǔn)確的判斷,而且對于腰椎間盤突出癥責(zé)任椎的確定也有指導(dǎo)意義。3.雙源CT腰椎連續(xù)動態(tài)掃描能夠更準(zhǔn)確的顯示出腰椎椎間盤突出和腰椎神經(jīng)、血管和椎間孔改變以及三者直接的解剖關(guān)系,對腰椎間孔狹窄的變化情況評估也更全面、更直觀,也為對腰椎退行性疾病進(jìn)行治療時選擇植入人工間盤或腰椎融合術(shù)時植入的Cage的高度以恢復(fù)相對正常的椎間孔面積和椎間相對正常的高度提供了參考依據(jù),可以更深入的認(rèn)識腰椎間盤突出癥,并且可以對腰椎間盤突出癥手術(shù)進(jìn)行術(shù)前更合理的規(guī)劃。
[Abstract]:Objective: to observe the changes of lumbar intervertebral disc herniation and intervertebral foramen in lumbar disc herniation patients with lumbar disc herniation. Methods: 40 patients with L4-5 segment lumbar intervertebral disc herniation diagnosed by conventional CT were examined by dual source CT Siemens somatom definition flash and VPC Dynmuti 4D method was used to obtain lumbar vertebrae motion from flexion position 20 degree to back extension position 20 degree motion at different time. Resolution of the DICOM image file. After the image was imported into Inspace workstation, the curvature of lumbar spine during continuous dynamic scanning was determined by measuring the Cobb angle of L4-5 segment sagittal position. The intervertebral disc herniation and intervertebral foramina area were measured in the motion and static supine position of L4-5 vertebrae, and the changes of intervertebral foramen and intervertebral disc herniation were analyzed. Results during the motion from flexion position to dorsal extension position, the posterior edge of L4-5 disc herniation increased gradually in 1.40 patients with lumbar intervertebral disc herniation, and the change of L4-5 segment disc herniation degree was more obvious when moving from neutral position to overflexion position. During lumbar flexion exercise, 10 擄lumbar disc herniation was reduced by 0.87 鹵0.26 mm, and 1. 24 鹵0.45mm.2.40 per 10 擄lumbar disc herniation was diagnosed as L4-5 lumbar disc herniation. The area of intervertebral foramen was measured with different curvature of L4-5 segment. During lumbar movement, The area of intervertebral foramen decreased by about 8.02 鹵0.34mm-2 per extension of 10 擄, and the area of intervertebral foramen was decreased by 6.72 鹵0.23mm2 in 90% of patients with flexion at 10 擄of lumbar flexion, and by 6.72 鹵0.23 mm-2 at 20 擄flexion in 82% of patients with L4-5 segment. The area of intervertebral foramen was not changed at 20 擄flexion in 18% of the patients with intervertebral foramina, which was about 7.02 鹵0.15 mm ~ 2 ~ (-1) compared with that of static scanning. According to the area of intervertebral foramen of different curvature of lumbar vertebrae, the effect of intervertebral disc on intervertebral foramen is different when the lumbar vertebrae is flexion and extension, and the extension position can cause the intervertebral foramen to become smaller. However, the area of intervertebral foramen may become larger or smaller when it moves to flexion position. Conclusion 1. Dual-source CT continuous dynamic scanning of lumbar spine can be used in patients with lumbar disc herniation with negative conventional CT scan or in patients with different clinical symptoms. The degree of lumbar disc herniation in flexion position of lumbar disc herniation was lower than that in neutral position, and the degree of disc herniation in extension position was greater than that in neutral position. Lumbar disc herniation can be judged as accurately as possible by different curvature of lumbar vertebrae, and the determination of responsibility vertebrae of lumbar disc herniation is of guiding significance. Dual-source CT continuous dynamic scanning of lumbar spine can more accurately display lumbar disc herniation, lumbar nerve, vascular and intervertebral foramen changes and the direct anatomical relationship among them, and evaluate the changes of lumbar intervertebral foramen stenosis more comprehensively and intuitively. It also provides a reference for selecting the height of Cage implanted in artificial disc or lumbar fusion in order to restore the relative normal area of intervertebral foramina and the relative normal height of intervertebral body when treating lumbar degenerative diseases. More in-depth understanding of lumbar disc herniation and more rational preoperative planning for lumbar disc herniation.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R681.5

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本文編號：2030487