頸椎椎板夾角測(cè)量與發(fā)育性椎管狹窄的相關(guān)性及在脊髓型頸椎病中的價(jià)值
發(fā)布時(shí)間：2019-06-17 21:51
【摘要】：目的:測(cè)量頸椎椎板夾角,探討其差異性及與發(fā)育性頸椎管狹窄和脊髓型頸椎病的相關(guān)性,以及在伴有發(fā)育性頸椎管狹窄的脊髓型頸椎病中的應(yīng)用價(jià)值及臨床意義,尋找另一種判斷脊髓型頸椎病椎管狹窄程度的測(cè)量指標(biāo),為臨床評(píng)價(jià)脊髓型頸椎病病人脊髓的功能以及手術(shù)治療提供參考。方法:1選取C3-C6干燥標(biāo)本10個(gè),CT掃描并重建,測(cè)量其上、下椎板夾角,行單樣本komogorov-smimov檢驗(yàn)是否為正態(tài)分布,并與測(cè)得的椎管矢狀徑/椎體矢狀徑及椎管矢狀徑做線性雙變量Pearson或Spearman相關(guān)性分析;2測(cè)量15例“正常人”C3-C6椎板夾角、X線椎管矢狀徑/椎體矢狀徑、CT椎管矢狀徑/椎體矢狀徑及CT椎管矢狀徑,其中男性8例,女性7例,年齡35-76歲之間,平均56.1歲,行單樣本komogorov-smimov檢驗(yàn)是否為正態(tài)分布,行椎板夾角與X線椎管矢狀徑/椎體矢狀徑、CT椎管矢狀徑/椎體矢狀徑及CT椎管矢狀徑線性雙變量Pearson或Spearman相關(guān)性分析,椎板夾角性別差異性分析行Levene檢驗(yàn)?zāi)�、女椎板夾角均數(shù)方差齊性檢驗(yàn)并行單樣本均數(shù)t檢驗(yàn),單因素方差分析每節(jié)段椎板夾角的差異性并兩兩比較;3測(cè)量60例脊髓型頸椎病患者C3-C6椎板夾角、X線椎管矢狀徑/椎體矢狀徑、CT椎管矢狀徑/椎體矢狀徑及CT椎管矢狀徑,其中男性32例,女性28例,年齡33-73歲之間,平均54.05歲,行單樣本komogorov-smimov檢驗(yàn)是否為正態(tài)分布,行椎板夾角與X線椎管矢狀徑/椎體矢狀徑、CT椎管矢狀徑/椎體矢狀徑及CT椎管矢狀徑線性雙變量Pearson或Spearman相關(guān)性分析,椎板夾角性別差異性分析行Levene檢驗(yàn)?zāi)�、女椎板夾角均數(shù)方差齊性檢驗(yàn)并行單樣本均數(shù)t檢驗(yàn),行線性雙變量Pearson或Spearman相關(guān)性分析分析椎板夾角與JOA的相關(guān)性;4行總體(“正常人”+脊髓型頸椎病患者)采用Levene檢驗(yàn)椎板夾角均數(shù)方差齊性檢驗(yàn)并行性別差異性單樣本均數(shù)t檢驗(yàn);“正常人”與脊髓型頸椎病患者之間的差異性單樣本均數(shù)t檢驗(yàn),以CT比值為自變量、椎板夾角為因變量直線回歸分析病人、正常人的椎板夾角與CT比值的線性關(guān)系;5所有數(shù)據(jù)均采用SPSS19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理,所有數(shù)據(jù)采用均數(shù)x±標(biāo)準(zhǔn)差s表示,確定P0.05為差異有顯著性。結(jié)果:1標(biāo)本測(cè)量結(jié)果:CT椎管矢狀徑/椎體矢狀徑a/b=0.978±0.035,CT線椎管矢狀徑a=14.220±0.369,上椎板夾角α1=96.630°±2.691°、下椎板夾角α2=86.545°±5.444°及均值α=91.588°±3.385°;其中a/b與α2、α呈負(fù)相關(guān),r分別為-0.947、-0.903,接近1,可信度較高。2“正常人”測(cè)量結(jié)果:X線椎管矢狀徑/椎體矢狀徑a/b=0.945±0.059,CT椎管矢狀徑/椎體矢狀徑a/b=0.840±0.059,CT椎管矢狀徑a=13.593±1.144,椎板夾角α=97.103°±2.364°;X線比值a/b、CT比值a/b、CT椎管a與α均呈負(fù)相關(guān),r值分別為-0.843、-0.751、-0.33,但CT線椎管矢狀徑a與椎板夾角α相關(guān)系數(shù)r絕對(duì)值0.33小于0.4,可信度不高。男、女α均數(shù)分別為97.43°±2.22°、96.73°±2.50°,椎板夾角差異性比較P=0.252,男女無(wú)顯著性差異。C3-6椎板夾角單因素方差分析P于0.428與1之間,無(wú)顯著性差異。3脊髓型頸椎病患者測(cè)量結(jié)果:X線椎管矢狀徑/椎體矢狀徑a/b=0.780±0.092,CT椎管矢狀徑/椎體矢狀徑a/b=0.689±0.084,CT椎管矢狀徑a=11.784±1.189,椎板夾角α=109.534°±7.921°;X線比值a/b、CT比值a/b、CT椎管a與α均呈負(fù)相關(guān),r值分別為-0.724、-0.690、-0.698。男、女α均數(shù)分別為109.16°±8.03°、109.97°±7.81°,椎板夾角差異性比較P=0.431,男女無(wú)顯著性差異。JOA評(píng)分為11.067±2.493,α與JOA評(píng)分呈負(fù)相關(guān),r值為-0.785。4總體(“正常人”+脊髓型頸椎病患者)男女板夾角均值分別為106.81°±8.64°、107.32°±8.84°,P=0.617,男女無(wú)顯著性差異。病人、正常人夾角均數(shù)分別為109.53°±7.92°、97.10°±2.36°,P=0,病人椎板夾角度數(shù)大于正常人椎板夾角度數(shù)。脊髓型頸椎病患者、正常人的椎板夾角與CT比值的線性關(guān)系經(jīng)Pearson檢驗(yàn),P均為0,線性方程分別為y°=-64.961x+154.276°,y°=-29.546x+121.922°。結(jié)論:1椎板夾角α與X線比值、CT比值均呈負(fù)相關(guān),可以定量的反映椎管狹窄的程度;2椎板夾角α與CSM患者JOA評(píng)分呈負(fù)相關(guān),其對(duì)CSM患者的脊髓功能的評(píng)價(jià)亦有重要的臨床意義;3CSM患者、正常人的椎板夾角與CT比值均有直線關(guān)系,對(duì)頸椎后路開(kāi)門(mén)手術(shù)有一定的指導(dǎo)作用。但本研究仍有不足之處,仍需進(jìn)一步探討研究。
[Abstract]:Objective: To study the angle of the cervical lamina of the cervical spine, to study the difference and the relationship with the development of cervical spinal stenosis and cervical spondylotic myelopathy, and to the value and clinical significance of the application of the cervical spondylotic myelopathy with the development of cervical spinal stenosis. In order to provide a reference for the clinical evaluation of the function of the spinal cord and the surgical treatment of the cervical spondylotic myelopathy. Methods:10 samples of C3-C6 dried specimen were selected, CT was scanned and reconstructed, the included angle of the upper and lower lamina was measured, and the single-sample komogorov-smimpov was examined for normal distribution, and the linear bivariate Pearson or Spearman-related analysis was performed with the measured sagittal diameter and the sagittal diameter of the vertebral body and the sagittal diameter of the vertebral canal. 2. The included angle of 15 cases of "normal person" C3-C6, the sagittal diameter of the vertebral canal of the X-ray, the sagittal diameter of the vertebral body, the sagittal diameter of the vertebral canal of the vertebral canal, the sagittal diameter of the vertebral body and the sagittal diameter of the vertebral canal of the CT were measured. The included angle of the lamina and the sagittal diameter of the X-ray, the sagittal diameter of the vertebral body, the sagittal diameter of the vertebral canal of the CT, the sagittal diameter of the vertebral body, the linear bivariate Pearson or Spearman correlation between the sagittal diameter of the vertebral canal and the sagittal diameter of the CT, the gender difference of the angle between the vertebral plates and the Levene test male, The included angle of the women's lamina was the same as that of the parallel single-sample, and the difference of the included angle of each section of the single-factor analysis of variance was compared with that of each section. The included angle of the C3-C6, the sagittal diameter of the X-ray and the sagittal diameter of the vertebral body were measured in 60 cases of cervical spondylotic myelopathy. The sagittal diameter of the vertebral canal and the sagittal diameter of the vertebral body and the sagittal diameter of the CT vertebral canal,32 of the male and 28 in the female, and the age of 33 to 73 years, were the average of 54.05 years. The single-sample komogorov-smimov test was normal, and the included angle of the lamina and the sagittal diameter of the X-ray vertebral canal and the sagittal diameter of the vertebral body were determined. The analysis of the correlation between the sagittal diameter of the vertebral canal and the sagittal diameter of the vertebral body and the linear double-variable Pearson or Spearman in the sagittal diameter of the CT, the analysis of the gender difference of the lamina angle, the level of the included angle of the female and the laminae were examined by the parallel single-sample averaging t. A linear bivariate Pearson or Spearman correlation analysis was performed to analyze the correlation between the angle of the lamina and the JOA, and the four-line overall ("normal person" + cervical spondylotic myelopathy) used the Levene to test the mean square angle of the lamina to test the average number of samples of the parallel sex difference. The difference between the "normal person" and the patients with cervical spondylotic myelopathy is t-tested, the CT ratio is the independent variable, the angle of the lamina is the linear regression of the variable, the linear relationship between the angle of the lamina of the normal person and the CT ratio is analyzed, and all the data is subjected to statistical processing by using the SPSS19.0 software. All data were expressed by mean-number x-standard deviation s, and it was determined that the difference was significant. Results:1 The results of the measurement: The sagittal diameter of the vertebral canal/ the sagittal diameter of the vertebral body is a/ b = 0.978-0.035, the sagittal diameter of the CT line is a = 14.220-0.369, the included angle of the upper lamina is 1 = 96.630 擄, 2.691 擄, the angle of the lower lamina is 2 = 86.545 擄, 5.444 擄, and the mean value is 91.588 擄 and 3.385 擄; where a/ b is negatively related to the ratio of 2 and 2, r is-0.947,-0.903, close to 1, the confidence is high.2. "normal person" measurement results: the sagittal diameter of the X-ray vertebral canal/ the sagittal diameter of the vertebral body is a/ b = 0.945-0.059, the sagittal diameter of the CT vertebral canal/ the sagittal diameter of the vertebral body is a/ b = 0.840-0.059, the sagittal diameter of the CT vertebral canal is a = 13.593-1.144, the angle of the lamina is equal to 97.103--2.364-degree, and the X-ray ratio a/ b, There was a negative correlation between CT ratio a/ b and CT spinal canal a. The r value was-0.843,-0.751,-0.33, but the absolute value of the correlation coefficient r between the sagittal diameter a and the lamina angle of the CT line was less than 0.4 and the reliability was not high. The mean number of female and female was 97.43 擄, 2.22 擄, 96.73 擄 and 2.50 擄 respectively. The difference of the angle of the lamina was P = 0.252, and there was no significant difference between men and women. There was no significant difference between the angle of the C3-6 lamina and the one-factor analysis of variance, P was between 0.428 and 1. The results of the measurement of the cervical spondylotic myelopathy were as follows: the sagittal diameter of the X-ray vertebral canal/ the sagittal diameter of the vertebral body a/ b = 0.780-0.092, the sagittal diameter of the vertebral canal of the CT and the sagittal diameter of the vertebral body a/ b = 0.689-0.084, the sagittal diameter of the CT vertebral canal a = 11.784-1.189, The angle of the lamina was 109.534 擄 and 7.921 擄, the ratio of the X-ray a/ b, the CT ratio a/ b and the CT-spinal canal a were negative and the r-value was-0.724,-0.690,-0.698, respectively. The mean number of female and female was 109.16 擄, 8.03 擄, 109.97 擄 and 7.81 擄 respectively. The difference of the angle of the lamina was P = 0.431, and there was no significant difference between men and women. The mean value of JOA was 11.067-2.493, with a negative correlation with the JOA score, and the r-value of-0.785.4 (normal person "+ cervical spondylotic myelopathy) was 106.81 擄, 8.64 擄, 107.32 擄, 8.84 擄, P = 0.617, and there was no significant difference between men and women. The included angle of the patient and the normal person was 109.53 擄, 7.92 擄, 97.10 擄 and 2.36 擄, P = 0, and the angle of the included angle of the patient was greater than that of the normal persons. The linear relationship between the angle of the lamina and the CT ratio of the patients with cervical spondylotic myelopathy was examined by Pearson, P was 0, and the linear equation was y 擄 =-64.96x + 154.276 擄, y 擄 =-29.546x + 121.922 擄, respectively. Conclusion: There is a negative correlation between the angle of lamina and the ratio of X-ray and the ratio of CT, which can reflect the degree of spinal stenosis quantitatively. The angle of the lamina of lamina is negatively correlated with the score of JOA in CSM. It is also of great clinical significance to the evaluation of the function of the spinal cord in CSM. There is a linear relationship between the angle of the lamina and the CT ratio of the normal person, and it can guide the operation of the posterior open-door of the cervical vertebra. However, there is still some deficiency in this study and still need to be further explored.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.3
本文編號(hào)：2501290
[Abstract]:Objective: To study the angle of the cervical lamina of the cervical spine, to study the difference and the relationship with the development of cervical spinal stenosis and cervical spondylotic myelopathy, and to the value and clinical significance of the application of the cervical spondylotic myelopathy with the development of cervical spinal stenosis. In order to provide a reference for the clinical evaluation of the function of the spinal cord and the surgical treatment of the cervical spondylotic myelopathy. Methods:10 samples of C3-C6 dried specimen were selected, CT was scanned and reconstructed, the included angle of the upper and lower lamina was measured, and the single-sample komogorov-smimpov was examined for normal distribution, and the linear bivariate Pearson or Spearman-related analysis was performed with the measured sagittal diameter and the sagittal diameter of the vertebral body and the sagittal diameter of the vertebral canal. 2. The included angle of 15 cases of "normal person" C3-C6, the sagittal diameter of the vertebral canal of the X-ray, the sagittal diameter of the vertebral body, the sagittal diameter of the vertebral canal of the vertebral canal, the sagittal diameter of the vertebral body and the sagittal diameter of the vertebral canal of the CT were measured. The included angle of the lamina and the sagittal diameter of the X-ray, the sagittal diameter of the vertebral body, the sagittal diameter of the vertebral canal of the CT, the sagittal diameter of the vertebral body, the linear bivariate Pearson or Spearman correlation between the sagittal diameter of the vertebral canal and the sagittal diameter of the CT, the gender difference of the angle between the vertebral plates and the Levene test male, The included angle of the women's lamina was the same as that of the parallel single-sample, and the difference of the included angle of each section of the single-factor analysis of variance was compared with that of each section. The included angle of the C3-C6, the sagittal diameter of the X-ray and the sagittal diameter of the vertebral body were measured in 60 cases of cervical spondylotic myelopathy. The sagittal diameter of the vertebral canal and the sagittal diameter of the vertebral body and the sagittal diameter of the CT vertebral canal,32 of the male and 28 in the female, and the age of 33 to 73 years, were the average of 54.05 years. The single-sample komogorov-smimov test was normal, and the included angle of the lamina and the sagittal diameter of the X-ray vertebral canal and the sagittal diameter of the vertebral body were determined. The analysis of the correlation between the sagittal diameter of the vertebral canal and the sagittal diameter of the vertebral body and the linear double-variable Pearson or Spearman in the sagittal diameter of the CT, the analysis of the gender difference of the lamina angle, the level of the included angle of the female and the laminae were examined by the parallel single-sample averaging t. A linear bivariate Pearson or Spearman correlation analysis was performed to analyze the correlation between the angle of the lamina and the JOA, and the four-line overall ("normal person" + cervical spondylotic myelopathy) used the Levene to test the mean square angle of the lamina to test the average number of samples of the parallel sex difference. The difference between the "normal person" and the patients with cervical spondylotic myelopathy is t-tested, the CT ratio is the independent variable, the angle of the lamina is the linear regression of the variable, the linear relationship between the angle of the lamina of the normal person and the CT ratio is analyzed, and all the data is subjected to statistical processing by using the SPSS19.0 software. All data were expressed by mean-number x-standard deviation s, and it was determined that the difference was significant. Results:1 The results of the measurement: The sagittal diameter of the vertebral canal/ the sagittal diameter of the vertebral body is a/ b = 0.978-0.035, the sagittal diameter of the CT line is a = 14.220-0.369, the included angle of the upper lamina is 1 = 96.630 擄, 2.691 擄, the angle of the lower lamina is 2 = 86.545 擄, 5.444 擄, and the mean value is 91.588 擄 and 3.385 擄; where a/ b is negatively related to the ratio of 2 and 2, r is-0.947,-0.903, close to 1, the confidence is high.2. "normal person" measurement results: the sagittal diameter of the X-ray vertebral canal/ the sagittal diameter of the vertebral body is a/ b = 0.945-0.059, the sagittal diameter of the CT vertebral canal/ the sagittal diameter of the vertebral body is a/ b = 0.840-0.059, the sagittal diameter of the CT vertebral canal is a = 13.593-1.144, the angle of the lamina is equal to 97.103--2.364-degree, and the X-ray ratio a/ b, There was a negative correlation between CT ratio a/ b and CT spinal canal a. The r value was-0.843,-0.751,-0.33, but the absolute value of the correlation coefficient r between the sagittal diameter a and the lamina angle of the CT line was less than 0.4 and the reliability was not high. The mean number of female and female was 97.43 擄, 2.22 擄, 96.73 擄 and 2.50 擄 respectively. The difference of the angle of the lamina was P = 0.252, and there was no significant difference between men and women. There was no significant difference between the angle of the C3-6 lamina and the one-factor analysis of variance, P was between 0.428 and 1. The results of the measurement of the cervical spondylotic myelopathy were as follows: the sagittal diameter of the X-ray vertebral canal/ the sagittal diameter of the vertebral body a/ b = 0.780-0.092, the sagittal diameter of the vertebral canal of the CT and the sagittal diameter of the vertebral body a/ b = 0.689-0.084, the sagittal diameter of the CT vertebral canal a = 11.784-1.189, The angle of the lamina was 109.534 擄 and 7.921 擄, the ratio of the X-ray a/ b, the CT ratio a/ b and the CT-spinal canal a were negative and the r-value was-0.724,-0.690,-0.698, respectively. The mean number of female and female was 109.16 擄, 8.03 擄, 109.97 擄 and 7.81 擄 respectively. The difference of the angle of the lamina was P = 0.431, and there was no significant difference between men and women. The mean value of JOA was 11.067-2.493, with a negative correlation with the JOA score, and the r-value of-0.785.4 (normal person "+ cervical spondylotic myelopathy) was 106.81 擄, 8.64 擄, 107.32 擄, 8.84 擄, P = 0.617, and there was no significant difference between men and women. The included angle of the patient and the normal person was 109.53 擄, 7.92 擄, 97.10 擄 and 2.36 擄, P = 0, and the angle of the included angle of the patient was greater than that of the normal persons. The linear relationship between the angle of the lamina and the CT ratio of the patients with cervical spondylotic myelopathy was examined by Pearson, P was 0, and the linear equation was y 擄 =-64.96x + 154.276 擄, y 擄 =-29.546x + 121.922 擄, respectively. Conclusion: There is a negative correlation between the angle of lamina and the ratio of X-ray and the ratio of CT, which can reflect the degree of spinal stenosis quantitatively. The angle of the lamina of lamina is negatively correlated with the score of JOA in CSM. It is also of great clinical significance to the evaluation of the function of the spinal cord in CSM. There is a linear relationship between the angle of the lamina and the CT ratio of the normal person, and it can guide the operation of the posterior open-door of the cervical vertebra. However, there is still some deficiency in this study and still need to be further explored.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.3
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