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  本文選題：腰椎椎板　切入點：形態(tài)學(xué)　出處：《重慶醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的 通過對無明顯脊柱癥狀成人的腰椎椎板計算機斷層掃描（CT）圖像進行多平面及三維立體重建，并對L1-L5椎板的各項相關(guān)形態(tài)學(xué)參數(shù)進行測量并進行數(shù)據(jù)分析，從而進一步完善腰椎椎板解剖形態(tài)學(xué)的定量研究。然后選取性別間無差異的部分參數(shù)進行實體腰椎椎板的測量，所得出的各項參數(shù)的實際測量數(shù)值與CT所測數(shù)值進行比較，以驗證實際數(shù)據(jù)與CT測量數(shù)據(jù)是否存在統(tǒng)計學(xué)差異。 本實驗內(nèi)容包括以下兩個部分： 第一部分：無明顯脊柱相關(guān)癥狀成人腰椎椎板形態(tài)學(xué)參數(shù)的CT定量測量。 第二部分：實體干燥脊柱標本腰椎椎板形態(tài)學(xué)參數(shù)的實際測量，并與CT測量值的統(tǒng)計學(xué)比較。 方法 1.無明顯脊柱相關(guān)癥狀成人腰椎椎板形態(tài)學(xué)參數(shù)的CT定量測量。選取100例無明顯脊柱癥狀成年人的腰椎CT圖像，按性別分為兩組，每組各50例。調(diào)取被測量者的腰椎CT圖像，用GE公司的64排CT系統(tǒng)對腰椎圖形進行多平面重建，把相關(guān)圖像導(dǎo)入比利時Materialise公司設(shè)計的Mimics10.0軟件，用軟件相關(guān)工具對被測量者的腰椎CT多平面斷層圖像進行三維重建，并在多平面斷層圖像及三維重建圖像上對腰椎椎板（L1-L5）相關(guān)形態(tài)學(xué)參數(shù)進行測量。測量數(shù)據(jù)主要包括：1.椎板寬度；2.椎板厚度；3.椎板夾角；4.椎管矢狀（前后）徑；5.椎管橫徑；6.棘突長度；7.椎板傾斜角；8.棘突高度；9.棘突傾斜角；10.椎板高度。得出的數(shù)據(jù)用統(tǒng)計學(xué)軟件SAS8.0進行重復(fù)測量設(shè)計的方差分析，，以P0.05為具有統(tǒng)計學(xué)意義。 2.對實體干燥脊柱標本腰椎椎板形態(tài)學(xué)參數(shù)的進行實際測量，并將實際測量值與CT測量值進行統(tǒng)計學(xué)比較。選取20具干燥脊柱腰椎標本，用游標卡尺（日本藤原工業(yè)級數(shù)顯卡尺）及數(shù)顯角度尺（開拓工具（國際）集團）分別選取部分無性別差異的腰椎椎板相關(guān)形態(tài)學(xué)參數(shù)進行測量并記錄數(shù)據(jù)。然后將實體標本進行CT多平面重建及三維重建，用同實驗第一部分的方法進行相關(guān)參數(shù)的測定，得出的CT測量值與實際測量值用統(tǒng)計學(xué)軟件SPA8.0進行統(tǒng)計學(xué)分析，從而得出可靠性分析結(jié)果。 1.無明顯脊柱相關(guān)癥狀成人腰椎椎板形態(tài)學(xué)參數(shù)的CT定量測量。 通過對本實驗椎板相關(guān)形態(tài)學(xué)參數(shù)測量數(shù)據(jù)的分析，發(fā)現(xiàn)對于腰椎椎板夾角、椎管矢狀徑、椎板傾斜角、棘突傾斜角同一腰椎節(jié)段之間無明顯性別差異，但同一性別中不同腰椎節(jié)段之間存在顯著性差異（P0.05），椎板夾角和椎管矢狀徑均表現(xiàn)為以L3最小，椎板傾斜角表現(xiàn)為以L3為最大，而棘突傾斜角則表現(xiàn)為L1最大，L5最小。椎板寬度同一性別不同腰椎節(jié)段比較呈現(xiàn)以L1-L5遞增趨勢，且同一腰椎節(jié)段性別間比較有顯著差異，統(tǒng)一表現(xiàn)為男性女性�？傮w上看，對于椎板厚度、椎板橫徑、棘突高度在同一性別不同腰椎節(jié)段間存在顯著性差異，表現(xiàn)出以L1-L5遞減的趨勢，而這些參數(shù)在同一腰椎節(jié)段有顯著性別差異，除了椎管橫徑顯示出女性男性外，其余參數(shù)均顯示為男性女性。對于椎體高度來說同一性別中不同腰椎節(jié)段椎板高度有顯著性差異，但在男性和女性都存在L1與L2之間相比無顯著性差異的結(jié)果。不同性別，相同節(jié)段腰椎椎板高度比較除了L2之間存在顯著性差異外，其余節(jié)段腰椎椎板高度無顯著性差異，男性和女性中均以L3椎板高度為最高（男性平均值為22.92mm，女性平均值為22.70mm）。 2.腰椎椎板形態(tài)學(xué)參數(shù)實體測量數(shù)值與CT測量數(shù)值之間比較。選取實驗第一部分性別之間無差異的部分參數(shù)進行實體與CT數(shù)值的測量，兩組之間信度相關(guān)系數(shù)（Cronbach α系數(shù)）均0.8，顯示出CT測量數(shù)值與實體實際測量數(shù)值具有較高的一致性。 結(jié)論 1.通過對椎板相關(guān)形態(tài)學(xué)參數(shù)進行研究，進一步完善了椎板形態(tài)學(xué)解剖的相關(guān)數(shù)據(jù)，為人工椎板的設(shè)計提供了更加完善的解剖學(xué)基礎(chǔ)，也可使人工椎板設(shè)計更具性別化、個體化。 2.通過對實體干燥脊柱標本腰椎椎板形態(tài)學(xué)參數(shù)測量值與CT多平面及三維重建層面測量結(jié)果進行統(tǒng)計學(xué)分析后顯示CT測量值有較高的真實可靠性。 3.測量數(shù)據(jù)有較高的準確性，可通過各參數(shù)測量數(shù)據(jù)進行新型人工腰椎椎板的初步構(gòu)建。
[Abstract]:objective
The obvious symptoms of adult spinal lumbar laminae of computed tomography (CT) images of multiplanar and three-dimensional reconstruction, and the related morphological parameters of L1-L5 lamina were measured and the data were analyzed, and further improve the lumbar vertebral anatomy. Quantitative study on morphological measurement and then select parameters have no differences between the sexes are the actual measurement of the lumbar vertebral entity, numerical simulation and the parameters of CT derived from the measured values are compared to verify the actual measurement data and CT data is statistically significant.
The contents of this experiment include the following two parts:
Part one: quantitative CT measurement of the morphological parameters of the lumbar vertebral lamina without obvious spinal related symptoms in adults.
The second part: the actual measurement of the morphological parameters of the lumbar vertebral lamina of solid dry spine specimens and compared with the measured values of CT.
Method
The quantitative measurement of CT 1. had no obvious symptoms of adult lumbar spinal lamina morphological parameters. Selected lumbar CT images of 100 patients with no obvious symptoms of adult spine, divided into two groups by gender, 50 cases in each group. The lumbar CT image retrieval measure, multiplanar reconstruction of lumbar geometry with 64 row CT system of GE company the design of the image into the Belgian Materialise company Mimics10.0 software, using software tools to measure the lumbar CT multiplanar images were 3D reconstruction, and multiplanar images and three-dimensional reconstruction images of lumbar lamina (L1-L5) of the related parameters were measured. The measurement data mainly includes: 1. lamina width 2.; lamina thickness; 3. lamina angle; 4. vertebral canal sagittal diameter (before and after) 5.; spinal canal diameter; 6. spine length; 7. lamina angle; 8. spinous process; 9. spinous process vertebral angle; 10. The height of the board. The data obtained by the statistical software SAS8.0 were used for the analysis of the variance of the repeated measurement design, with the statistical significance of P0.05.
The actual measurement of the 2. entity dry spine specimens of lumbar laminae of morphological parameters, and the measured values were compared with the value of CT. Select 20 dry lumbar specimens, using vernier caliper (Japan Fujiwara industrial series caliper) and digital display protractor (open extension tools (International) group) were selected for lumbar lamina some related morphological parameters no gender differences were measured and recorded data. Then the real samples were CT multiplanar reconstruction and three-dimensional reconstruction, determination of related parameters using the same method in the first part of the CT, the measured values were statistically analyzed using statistical software SPA8.0 and the actual measured value, so that the reliability of the analysis results.
1. CT quantitative measurement of the morphological parameters of the lumbar vertebral lamina of adults without obvious spinal related symptoms.
Based on the analysis of the experimental data to measure the morphological parameters related to laminectomy, found for lumbar vertebral angle, sagittal diameter of spinal canal, posterior tilt, tilt angle between the spinous process of lumbar segment with no significant gender differences, but there are significant differences between the same gender in different lumbar segment (P0.05), and the lamina angle sagittal diameter of spinal canal were performed with L3 minimum, laminar slope angle performance of the L3 is the largest, while the spinous process tilt angle showed the maximum L1, L5 minimum. The width of the same gender different posterior lumbar segment is presented in L1-L5 increasing trend, and the same lumbar segment between the sexes is significant difference unified performance for men and women. On the whole, the lamina lamina thickness, transverse diameter, there is a significant difference between the spinous process of different height in the same sex lumbar, to L1-L5 showed a decreasing trend, and these parameters are significant in the same segment The gender difference, in addition to spinal canal diameter showed a female male, the rest of the parameters are shown as men and women. For the same gender vertebral height in different lumbar segment vertebral height has significant differences, but in both men and women between L1 and L2 showed no significant difference. The results of different gender. The same segment of lumbar vertebral height in addition to significant differences between L2 and other segments of the lumbar vertebral height had no significant difference between male and female L3 are the highest laminar height (male average was 22.92mm, the average woman value is 22.70mm).
The comparison between the 2. lumbar lamina morphological parameters and CT measurement entity numerical value. The difference between the measurement of selected parameters of the first part of the experiment, sex numerical entities and CT, the correlation coefficient between the two groups of reliability (Cronbach coefficient) were 0.8, showing consistency with the actual measured value entity has a high CT value measurement.
conclusion
1., through studying the related morphological parameters of laminae, we further improve the related data of lamina morphology and anatomy, provide a better anatomical basis for the design of artificial lamina, and make the design of artificial lamina more gender and individuation.
2., through statistical analysis of the measured values of lumbar vertebral lamina morphology parameters and CT multiplanar and three-dimensional reconstruction levels, we can see that CT measurement has high reliability.
3. the measured data have high accuracy, and the preliminary construction of a new type of artificial lumbar vertebral lamina can be carried out through the measurement of data.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R816.8

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