本文選題：Denis三柱理論胸 + 腰椎結(jié)核胸��； 參考：《遵義醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的:探討Denis三柱理論評(píng)價(jià)胸、腰椎結(jié)核穩(wěn)定性的可行性研究,從而指導(dǎo)臨床工作。方法:選取(2013年1月至2015年1月)在我科住院治療的胸、腰椎結(jié)核患者共102例,并收集其臨床資料(影像學(xué)資料:CT、X片、MRI,術(shù)后病理結(jié)果等),以每例患者單個(gè)病變椎及其下位椎間盤(pán)(共268個(gè)節(jié)段)為研究對(duì)象,根據(jù)Denis三柱分類,1.統(tǒng)計(jì)268個(gè)病變節(jié)段前柱、中柱、后柱、前中柱、前中后柱、前后柱、中后柱分別的破壞情況;2.統(tǒng)計(jì)不穩(wěn)節(jié)段前柱、中柱、后柱、前中柱、前中后柱、前后柱、中后柱分別的破壞情況;3.分析不穩(wěn)節(jié)段與三柱破壞之間的關(guān)系;4.使用χ2檢驗(yàn),比較一柱、兩柱、三柱受破壞后與不穩(wěn)節(jié)段量是否有統(tǒng)計(jì)學(xué)差異,計(jì)算r了解破壞柱數(shù)與不穩(wěn)節(jié)段量的相關(guān)性。結(jié)果:1.據(jù)統(tǒng)計(jì)在268個(gè)病變節(jié)段中,前柱破壞21個(gè)、中柱破壞5個(gè)、后柱破壞1個(gè)、前中柱破壞216個(gè)、前中后柱破壞23個(gè)、前后柱破壞1個(gè)、中后柱破壞1個(gè);2.據(jù)統(tǒng)計(jì)不穩(wěn)定節(jié)段共92個(gè),其中前中柱破壞76個(gè)、前中后柱破壞16個(gè),前柱、中柱、后柱、前后柱及中后柱未發(fā)現(xiàn)不穩(wěn)定節(jié)段,92個(gè)不穩(wěn)節(jié)段中均累積中柱,且至少破壞兩柱;3.據(jù)統(tǒng)計(jì)破壞一柱的病變節(jié)段27個(gè),無(wú)不穩(wěn)定節(jié)段,破壞兩柱的病變節(jié)段218個(gè),其中不穩(wěn)定節(jié)段76個(gè),不穩(wěn)定節(jié)段占病變節(jié)段的35%,破壞三柱的病變節(jié)段23個(gè),其中不穩(wěn)定節(jié)段16個(gè),不穩(wěn)定節(jié)段占病變節(jié)段的70%;4.根據(jù)統(tǒng)計(jì)學(xué)結(jié)果(P=0.001)P0.05,差異有統(tǒng)計(jì)學(xué)意義,可認(rèn)為一柱、兩柱、三柱受破壞后與不穩(wěn)節(jié)段量不全相同,(r=0.236)0r1,可認(rèn)為破壞柱數(shù)與不穩(wěn)節(jié)段量有關(guān)聯(lián)且呈正相關(guān)。結(jié)論:1.中柱在胸、腰椎結(jié)核穩(wěn)定性方面起到重要作用;2.單純中柱受損并不能確定造成胸、腰椎結(jié)核不穩(wěn)定;3.胸、腰椎結(jié)核破壞兩柱或三柱后出現(xiàn)潛在不穩(wěn)或不穩(wěn)節(jié)段;4.用Denis三柱理論能較好判斷胸、腰椎結(jié)核穩(wěn)定性。
[Abstract]:Objective: to study the feasibility of Denis three-column theory in evaluating the stability of thoracic and lumbar tuberculosis. Methods: from January 2013 to January 2015, 102 patients with lumbar spine tuberculosis were treated in our department. The clinical data were collected (imaging data:% CTX, MRI, postoperative pathological results, etc.). Each patient with a single lesion vertebra and its lower intervertebral disc (totally 268 segments) was selected as the study object, and was classified according to Denis three-column classification. The destruction of the anterior column, the middle column, the posterior column, the anterior column and the posterior column in 268 lesion segments were analyzed. The failure of the anterior column, the middle column, the posterior column, the front column, the back column, the front column and the back column in the unstable segment were calculated. The relationship between unstable segments and failure of three columns is analyzed. 蠂 2 test was used to compare whether there was statistical difference between one column, two columns and three columns after failure, and to calculate the correlation between the number of damaged columns and the number of unstable segments. The result is 1: 1. According to statistics, 21 of 268 lesion segments were damaged in anterior column, 5 in middle column, 1 in posterior column, 216 in anterior and middle column, 23 in anterior and posterior column, 1 in anterior column and 1 in posterior column. According to statistics, there are 92 unstable segments, including 76 anterior and middle columns, 16 anterior, middle and posterior columns, 16 anterior column, middle column, posterior column, front column and middle column, no unstable segment, and at least two columns are destroyed in 92 unstable segments. According to statistics, there were 27 lesions in one column, no unstable segments, 218 lesions in two columns, 76 unstable segments, 35 unstable segments and 23 lesion segments in three columns. There were 16 unstable segments and 70% unstable segments. According to the statistical results (P0. 001) P0. 05, the difference is statistically significant. It can be concluded that the number of damaged columns is positively correlated with the number of unstable segments, and the quantity of unstable segments is not all the same after the destruction of one column, two columns and three columns are destroyed, (rn 0. 236) 0 r1.The results show that there is a positive correlation between the number of damaged columns and the number of unstable segments. Conclusion 1. The middle column plays an important role in the stability of thoracic and lumbar tuberculosis. Simple injury of the middle column can not be identified as the cause of thoracic and lumbar tuberculosis instability. The potential instability or instability of thoracic or lumbar tuberculosis after the destruction of two or three columns. The stability of thoracolumbar tuberculosis can be well judged by Denis three-column theory.
【學(xué)位授予單位】：遵義醫(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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