【摘要】：目的:通過(guò)對(duì)國(guó)人L4-S1椎進(jìn)行影像學(xué)的測(cè)量與數(shù)據(jù)分析,探討L4-S1軸向固定單向鎖定的可行性及安全性。方法:隨機(jī)選取湖南省衡陽(yáng)市南華大學(xué)附屬第一醫(yī)院于2013年3月至2014年3月我院門(mén)診腰骶尾椎64排螺旋CT((Philip Brilliance 64,Philips Medical Systems,Netherland)資料,共兩百例,分別選取男女性病人各一百例,患者年齡要求在18-60歲之間,排除發(fā)育異常、先天性變異、側(cè)彎畸形、結(jié)核、外傷、腫瘤、手術(shù)史等。對(duì)CT資料行三維重建,通過(guò)三維重建軟件在三維空間中分別在椎弓根鎖定平面及在椎體正中矢狀面確定理想的鎖定通道及軸向固定通道。通過(guò)平移、選擇、切割等方法在二維空間上測(cè)量L4S1椎體相關(guān)數(shù)據(jù):L4鎖定平面椎體寬度(線AB)、S1鎖定平面椎體寬度(線DE)、L4鎖定點(diǎn)與L4上終板長(zhǎng)度(線GC)、L4鎖定點(diǎn)與S1鎖定點(diǎn)的長(zhǎng)度(線CF)、S1鎖定點(diǎn)與軸向螺釘進(jìn)針點(diǎn)的距離(線FJ)、L4椎弓根的寬度(線MN)、S1椎弓根的寬度(線XY)、L4椎弓根高度(線UV)、S1椎弓根高度(線WZ)、L4椎弓根鎖定釘在矢狀面的頭傾角(角α)、L4鎖定釘?shù)耐鈧?cè)角(角γ)、S1椎弓根鎖定釘在矢狀面的頭傾角(角β),S1鎖定釘外展角(角δ),測(cè)量軟件對(duì)兩點(diǎn)之間距離及兩線之間長(zhǎng)度進(jìn)行測(cè)量,所有數(shù)據(jù)通過(guò)SPSS19.0進(jìn)行統(tǒng)計(jì)分析,檢查各數(shù)據(jù)是否服從正態(tài)分布,比較男女之間是否存在差異。結(jié)果:男女兩組所有測(cè)量的指標(biāo)通過(guò)統(tǒng)計(jì)學(xué)分析示均服從正態(tài)分布,男女兩組同一指標(biāo)比較,顯示AB、DE、GC、CF、FJ、MN、XY、UV、WZ各數(shù)值存在顯著性統(tǒng)計(jì)學(xué)差異,男女兩組內(nèi)線AB與DE、MN與XY、UV與WZ存在顯著統(tǒng)計(jì)學(xué)差異。線DE、線GC、線CF、線FH、線MN的95%可信區(qū)間為男女分別為31.59?32.293、29.32?29.98、11.33?12.18 10.52?11.20、60.85?62.54、58.57?59.95、16.84?19.23、14.97?16.20、1 2.52.?12.86、10.66?11.01。角α、角β、角γ、角δ各數(shù)值無(wú)明顯統(tǒng)計(jì)學(xué)差異。故男女?dāng)?shù)據(jù)合并統(tǒng)計(jì)。角α、角β、角γ、角δ最佳角度分別為85.6?90.1、113.7?115.2、45.2?46.3、71.4?72.7。單向鎖定螺釘?shù)拇笮〖伴L(zhǎng)度設(shè)計(jì)提供參考依據(jù)。結(jié)論:只要單向鎖定螺釘經(jīng)過(guò)椎弓根峽部中點(diǎn)對(duì)相應(yīng)椎體中心進(jìn)行鎖定,L4-S1軸向固定單向鎖定是安全可行的。通過(guò)統(tǒng)計(jì)學(xué)分析確定的數(shù)據(jù)能夠?yàn)長(zhǎng)4-S1軸固定螺釘及
[Abstract]:Objective: to investigate the feasibility and safety of axial fixation of L4-S1 vertebrae in Chinese by imaging measurement and data analysis. Methods: two hundred cases of lumbosacral caudate vertebra (64-slice spiral CT (Philip Brilliance 64, Philips Medical Systems,Netherland) were randomly selected from March 2013 to March 2014 in the first affiliated Hospital of Nanhua University, Hengyang City, Hunan Province. One hundred male and female patients with age between 18 and 60 years old were selected, excluding developmental abnormalities, congenital variation, lateral bending malformation, tuberculosis, trauma, tumor, surgical history and so on. Three-dimensional reconstruction of CT data was performed. In three-dimensional space, the ideal locking channel and axial fixation channel were determined in the pedicle locking plane and the median sagittal plane of vertebral body respectively by three-dimensional reconstruction software. L4S1 vertebral body related data were measured in two dimensional space by translation, selection, cutting and other methods: L4 locking plane width (line AB), S1 locking plane width (line DE), L4 locking point and L4 upper end plate length) (line GC),) The length of the L4 locking point and the S1 locking point (the distance between the line CF), S1 locking point and the axial screw entry point (the width of the linear FJ), L4 pedicle (the width of the linear MN), S1 pedicle (the height of the linear XY), L4 pedicle (line UV),) The height of S1 pedicle (angle 偽) of WZ), L4 locking screw on sagittal plane, the lateral angle of L4 locking nail (angle 緯), the head inclination angle of S1 pedicle locking nail on sagittal plane (angle 尾), the outward angle of S1 locking nail (angle 未), the height of S1 pedicle screw (angle 偽), the lateral angle (angle 緯) of L4 locking nail, the angle 尾 of S1 pedicle locking nail in sagittal plane. The distance between two points and the length between two lines were measured by measuring software. All the data were statistically analyzed by SPSS19.0 to check whether the data obeyed normal distribution and to compare the differences between men and women. Results: all the measured indexes in male and female groups obeyed normal distribution by statistical analysis. Compared with the same indexes in male and female groups, there were significant differences in AB,DE,GC,CF,FJ,MN,XY,UV,WZ values between male and female groups. There was significant difference between male and female in AB, DE,MN, XY,UV and WZ. Line DE, Line GC, Line CF, Line FH, The 95% confidence interval (CI) of the line MN was 31.59 脳 32.293,29.32 / 29.98, 11.33 / 12.18 10.52 / 11.20, 60.85 / 62.54, 58.57 / 59.95,16.84 / 19.23, 14.97 / 16.20, 1,2.52 /? 12.86,10.66?11.01. There was no significant difference in angle 偽, angle 尾, angle 緯 and angle 未 values. Therefore, the combination of male and female data statistics. The optimum angles of angle 偽, angle 尾, angle 緯 and angle 未 were 85.6? 90.1113.7? 115.2, 45.2? 46.3, 71.4? 72.7, respectively. The design of the size and length of unidirectional locking screw provides reference basis. Conclusion: L4-S1 axial fixation is safe and feasible as long as unidirectional locking screws lock the corresponding vertebral center through the midpoint of the pedicle isthmus. The data determined by statistical analysis can be used for L4-S1 shaft fixation screws and
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

【共引文獻(xiàn)】

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