發(fā)布時間：2018-06-22 00:33

  本文選題：Bending位平片 + 退變性脊柱側凸�。� 參考：《東南大學》2015年碩士論文

【摘要】：目的：評價術前Bending位平片對退變性脊柱側凸(degenerative scoliosis,DS)術后矯形效果的預測能力,并比較Bending位片對預測單純后路矯形與后路截骨矯形手術效果的差異。方法：65例接受脊柱矯形手術的DS患者納入研究,選取每位患者的站立位全脊柱正位片、Bending位片,術后立位全脊柱正位片,分別在以上三種平片上測量側凸主彎的Cobb角,分析術前Bending位片Cobb角與術后立位片Cobb角及彎曲柔韌性(BF)與矯形率(CR)的相關性；根據是否行截骨術,將65例患者分為37例單純后路矯形組與28例伴截骨矯形組,分別分析兩組術前Bending位片Cobb角與術后立位片Cobb角以及BF與CR的相關性。結果：(1)65例患者術前Bending位片Cobb角與術后立位片Cobb角具有明顯相關性(r=0.652,p0.001),BF與CR的具有明顯相關性(r=0.451,p0.001),平均CR為62.22±14.50%：(2)37例單純后路矯形患者術前Bending位片Cobb角與術后立位片Cobb角具有明顯相關性(r=0.772,p0.001),BF與CR的具有明顯相關性(r=0.729,p0.001),平均CR為60.36±14.98%;28例伴有截骨矯形患者術前Bending位片Cobb角與術后立位片Cobb角具有相關性(r--0.596,p=0.001),BF與CR相關性差(r=0.237,p=0.225),平均CR為64.66+13.73%。結論：術前Bending位平片可以預測退變性脊柱側凸術后矯形效果,其預測單純后路矯形效果的能力明顯優(yōu)于后路截骨矯形效果的能力。目的：探究椎間盤退變程度對退變性腰椎側凸(degenerative lumbar scoliosis,DLS)脊柱柔韌性的影響。方法：回顧性分析2008年5月至2014年2月66例診斷為DLS患者的一般資料,其中男性10例,女性56例,平均年齡58.4歲(45-70歲),所有患者均具備完整的影像學資料,包括術前立位全脊柱正位片、Bending位片、胸腰椎磁共振(MRI)等,分別測量術前立位全脊柱正位片主彎Cobb角和椎間角,Bending位片主彎Cobb角和椎間角,根據椎間盤Pfirrmann分級評估記錄主彎區(qū)間各個椎間盤退變等級,計算脊柱整體柔韌性與各節(jié)段柔韌性,分析椎間盤退變等級與脊柱整體柔韌性以及節(jié)段柔韌性的相關性。結果：(1)66例DLS患者術前立位片平均主彎Cobb角為35.53�！�13.32。,Bending位片平均Cobb角為20.54�！�11.42。,平均柔韌性為45.32%±14.97%；共評估記錄268個椎間盤的退變等級,其中I級8個,II級68個,Ⅲ級83個,Ⅳ級91個,V級18個；(2)主彎跨度內椎間盤平均退變等級與脊柱整體的柔韌性具有顯著相關性(r=-0.727,p0.001)；(3)各節(jié)段椎間盤退變等級與相應節(jié)段柔韌性具有顯著相關性(p0.01)；(4)頂椎區(qū)椎間盤相對于其他椎間盤退變程度嚴重(p0.001),其節(jié)段柔韌性也最差(p0.001)。結論：椎間盤退變程度與DLS脊柱柔韌性密切相關,即椎間盤退變越嚴重,脊柱的柔韌性越差。目的：比較退變性胸腰椎后凸(DTK)與陳舊性胸腰椎骨折后凸(PTK)矢狀面代償模式的差異。方法：回顧性分析2010年6月至2015年2月在我科門診或在院接受診療的32例DTK患者和28例PTK患者一般資料,并納入30例健康成人作為對照組,90例研究對象中男性42例,女性48例,平均年齡47.2歲(30-70歲),所有研究對象均拍攝立位全脊柱正、側位平片等相關影像學檢查。分別測量三組研究對象矢狀位后凸角(KA),胸椎后凸角(TK),腰椎前凸角(LL),骨盆入射角(PI),骨盆傾斜角(PT),骶骨傾斜角(SS)以及矢狀位平衡(SVA),比較三組之間以上脊柱骨盆參數的差異。結果：(1)DTK組、PTK組和對照組平均年齡分別為56.0±7.3歲、39.04±8.5歲和45.5±5.5歲,DTK組年齡顯著大于其他兩組(P0.001)；(2)DTK組TK明顯大于PTK組(26.5°±5.8°vs 23.3°±7.8°,P0.05),而DTK組與對照組TK(26.0°±6.3°)無顯著差異(P0.05)；(3)DTK組LL、SS(分別23.1°±12.4°,20.4°±7.7°)均明顯小于PTK組(分別43.4°±7.8°,30.4°±6.6°)(P0.001);DTK組SVA、PT(分別62.7±17.5mmm,26.1°±11.9°)均明顯大于PTK組(分別16.7±7.1mmm,16.7°±8.6°)(P0.001),而PTK組與對照組SVA、PT(分別15.8±7.4mmm,15.4°±6.6°)無顯著差異(P0.05)；(4)DTK組與PTK組KA(分別46.7°±12.8°,46.0°±13.8°)無顯著差異(P0.05)；DTK組、PTK組和對照組三組PI(分別45.5°±9.7°,46.1°±8.8°,45.1°±8.8°)無顯著差異(P0.05)。結論：本組退變性胸腰椎后凸患者表現為腰椎前凸減小,骨盆后旋轉,并最終出現軀干前傾的矢狀面失代償；陳舊性胸腰椎骨折后凸患者僅表現為TK減小、骨折椎體為中心的局部后凸,而未發(fā)生整體脊柱骨盆參數的代償。
[Abstract]:Objective: To evaluate the predictive ability of preoperative Bending position for the correction of degenerative scoliosis (DS) after surgery, and to compare the difference of the effect of Bending tablet in predicting the effect of simple posterior orthopedics and posterior osteotomy. 65 cases of DS patients receiving spinal orthopedic surgery were included in the study to select each patient. The standing total spinal column, Bending position, and orthostatic full spine position after operation were used to measure the Cobb angle of the main bending of scoliosis on the above three plain films, and the correlation between the Cobb angle of Bending position and the postoperatively the Cobb angle and the flexural flexibility (BF) and the orthopedic rate (CR) was analyzed. According to whether or not osteotomy was performed, the patients were divided into 37 simple cases. In the posterior orthopedics group and 28 cases with osteotomy, the correlation between the Cobb angle of Bending position before operation and the Cobb angle of the postoperatively, and the correlation between BF and CR were analyzed. Results: (1) there was a significant correlation between the Cobb angles of Bending position and the Cobb angle of the postoperatively in 65 cases (r=0.652, p0.001), and the significant correlation between BF and CR. The average CR was 62.22 + 14.50%: (2), 37 cases of simple posterior orthopedic patients had significant correlation (r=0.772, p0.001) in the Cobb angle of Bending position tablet before operation. BF and CR had a significant correlation (r=0.729, p0.001) and the average CR was 60.36 + 14.98%. 28 cases with osteotomy orthopedics were accompanied by preoperative radiographs and postoperative orthostatic tablets. The angle has correlation (r--0.596, p=0.001), the correlation between BF and CR (r=0.237, p=0.225), the average CR is 64.66+13.73%. conclusion: preoperative Bending bit flat can predict the effect of orthopedic effect after degenerative scoliosis, and its ability to predict simple posterior orthopedic effect is obviously superior to the ability of posterior osteotomy effect. The effect of degree on the flexibility of degenerative lumbar scoliosis (DLS). Methods: a retrospective analysis of 66 cases of DLS from May 2008 to February 2014 was reviewed, including 10 males and 56 females, with an average age of 58.4 years (45-70 years old). All patients had complete imaging data, including preoperative erect. The total spinal column, Bending position, and the thoracolumbar magnetic resonance (MRI) were used to measure the main bend Cobb angle and intervertebral angle of the anterior vertical position of the spinal column, the Cobb angle and the intervertebral angle of the main curve of the Bending position. The degeneration grade of the intervertebral disc in the main bend section was recorded according to the Pfirrmann grading of the intervertebral disc, and the overall flexibility of the spine and the flexiacity of each segment were calculated. The correlation between intervertebral disc degeneration grade and spinal integrity flexibility and segmental flexibility. Results: (1) the average main bend Cobb angle of the preoperative orthostatic film in 66 cases of DLS was 35.53. + 13.32., the average Cobb angle of Bending bit was 20.54. + 11.42. and the average flexibility was 45.32% + 14.97%. The regression grade of 268 intervertebral discs was recorded, of which I was recorded. Grade 8, II level 68, grade III 83, grade IV 91, and V grade 18; (2) the average degeneration level of intervertebral disc in the main curved span has significant correlation with the overall flexibility of the spine (r=-0.727, p0.001); (3) there is a significant correlation between the degeneration grade of the intervertebral disc and the corresponding segment flexibility (P0.01); (4) the intervertebral disc in the apical region is relative to the other intervertebral The degree of disc degeneration is severe (p0.001) and its segment flexibility is the worst (p0.001). Conclusion: the degree of disc degeneration is closely related to DLS spinal flexibility, that is, the more severe the disc degeneration is, the worse the flexibility of the spine. Objective: To compare the difference between the degenerative thoracolumbar kyphosis (DTK) and the old thoracolumbar fracture kyphosis (PTK) sagittal compensatory pattern. Methods: a retrospective analysis of the general data of 32 DTK patients and 28 cases of PTK patients received from June 2010 to February 2015 in our department or in our hospital, and 30 healthy adults as the control group, 90 subjects were male 42, 48 women, and the average age was 47.2 years (30-70 years). All the subjects photographed the orthostatic positive and lateral position of the spine. KA, posterior convex angle of thoracic vertebra (TK), lumbar anterior convex angle (LL), pelvis incidence angle (PI), pelvic inclination (PT), sacral inclination (SS) and sagittal balance (SVA) were measured in three groups of subjects. Results: (1) DTK, PTK and control groups were compared with those of the three groups. The average age was 56 + 7.3 years, 39.04 + 8.5 years and 45.5 + 5.5 years old. The age of DTK group was significantly greater than the other two groups (P0.001), and (2) DTK group TK was significantly greater than PTK group (26.5 + 5.8 / vs 23.3 + 7.8, P0.05), while DTK group and control group were not significantly different (P0.05). Less than group PTK (43.4 + 7.8, 30.4 + 6.6 degrees) (P0.001), SVA, PT (62.7 + 17.5mmm, 26.1 + 11.9 degrees) in group DTK were significantly greater than those in PTK group (16.7 + 7.1mmm, 16.7 + 8.6) (P0.001), while PTK group and control group were SVA, PT (15.8 +, 15.4, 6.6 degrees, respectively); There was no significant difference between 0 and 13.8 degrees (P0.05). There was no significant difference between group DTK, group PTK and control group of three groups (45.5 / 9.7, 46.1, 8.8, 45.1). Conclusion: degenerative thoracolumbar kyphosis showed the decrease of lumbar lordosis, posterior pelvis rotation, and final torso sagittal decompensation; obsolete thoracolumbar Vertebral fracture kyphosis patients showed only TK reduction, fracture vertebral centrally located kyphosis, and no overall spinal pelvic parameters compensation.
【學位授予單位】：東南大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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