發(fā)布時間：2018-05-19 14:52

  本文選題：青少年特發(fā)性脊柱側彎 + 主動脈　； 參考：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:1.探討青少年特發(fā)性脊柱側彎胸主動脈與鄰近椎體的相對位置關系,為臨床醫(yī)師術前評估提供相關信息及指導2.探究CT掃描對青少年特發(fā)性脊柱側彎術前檢查的應用價值方法:收集我院2015年12月至2016年12月期間來我院檢查、治療的Lenke1型青少年特發(fā)性脊柱側彎患者14例,先天性脊柱發(fā)育畸形、神經(jīng)肌肉病變或外傷致脊柱側彎的患者除外。所有患者均有較完整的臨床資料,均行站立位全脊柱正側位X線攝影、全脊柱CT掃描及三維重建。在站立位全脊柱正位X線影像上測量側彎脊柱的Cobb角,確定頂椎、上端椎、下端椎位置、明確Lenke分型;利用CT三維重建MPR技術重建頂椎椎弓根最粗的層面,以該層面為研究平面,分別過椎弓根軸線做兩條直線,交左、右側橫突與O、O’,鏈接OO’,以此為x軸,以O點為原點,作與x軸向垂直的直線為y軸,建立直角坐標系,連接O與主動脈中心A交主動脈后壁與B點,則OB為主動脈離原點最小距離,OB與y軸間的夾角為主動脈-椎體角,記為α;在原始圖像上定位頂椎位置,以頂椎層面椎管與椎體中心的連線與重垂線的夾角為椎體旋轉角度β。判斷不同性別組間主動脈-椎體角α、椎體旋轉角度β、OB值是否存在差異;分別判斷年齡與主動脈-椎體角α、椎體旋轉角度β、OB值之間是否存在相關性;分別判斷主動脈-椎體角α、椎體旋轉角度β、OB值與Cobb角之間是否具有相關性。結果:1.不同性別組間主動脈-椎體角α、椎體旋轉角度β、OB值的差別無統(tǒng)計學意義,P0.05。2.年齡與主動脈-椎體角α、OB值之間的無顯著相關性,年齡與椎體旋轉角度β存在輕度相關性。3.Cobb角與主動脈-椎體角α之間的無顯著相關性,與OB值之間存在輕度負相關,與椎體旋轉角度β中度正相關。結論:1.在Lenke1型青少年特發(fā)性脊柱側彎患者中,性別與胸主動脈位置無明顯相關;2.椎體旋轉角β和OB值可以作為臨床Cobb角測量的有效補充;3.CT掃描可以清楚顯示胸主動脈與椎體的相對位置關系,可在術前為臨床醫(yī)師提供手術風險評估及手術入路指導。
[Abstract]:Purpose 1. To explore the relationship between thoracic aorta and adjacent vertebrae in adolescent idiopathic scoliosis, and to provide relevant information and guidance for clinicians in preoperative evaluation. To explore the value of CT scan in preoperative examination of adolescent idiopathic scoliosis: 14 cases of Lenke1 type adolescent idiopathic scoliosis from December 2015 to December 2016 were collected. Patients with congenital spinal deformities, neuromuscular lesions or traumatic scoliosis are excluded. All the patients had complete clinical data. All patients underwent standing position axial and lateral radiography, CT scan and three-dimensional reconstruction. The Cobb angle of scoliosis was measured on the orthographic X-ray images of the standing whole spine, the position of the top, upper and lower vertebrae was determined, and the Lenke classification was determined, and the thickest plane of the pedicle was reconstructed by using the MPR technique of CT three-dimensional reconstruction. Taking this plane as the plane of study, two straight lines are made respectively across the axis of pedicle, the transverse processes of right and left are intersected with OOO, and the OOO is linked to OOO, which is taken as the x axis, with O as the origin, and as the straight line perpendicular to the x axis as y axis, the right angle coordinate system is established. Connecting the posterior wall of aorta with point B, the angle between OB and y axis is the angle of aorta-vertebral body angle, and the position of the parietal vertebrae is located on the original image, the angle between OB and y axis is the angle of aorta and vertebral body, and the position of the parietal vertebrae is located on the original image. The angle between the line between the vertebral canal and the center of the vertebral body and the heavy perpendicular line was taken as the rotation angle of the vertebral body 尾. To determine whether there are differences in Aortic-vertebral body angle 偽, vertebral rotation angle 尾 OB value between different sex groups, and to judge whether there is correlation between age and aortic vertebral body angle 偽, vertebral body rotation angle 尾 OB value, and to determine whether there is a correlation between age and aortic vertebral body angle 偽, vertebral body rotation angle 尾 OB value. The correlation between aorta-vertebral angle 偽, vertebral rotation angle 尾 -OB and Cobb angle was determined. The result is 1: 1. There was no significant difference in Aorta-vertebral body angle (偽) and vertebral rotation angle (尾 -OB) between different sex groups (P0.05.2). There was no significant correlation between age and Aorta-vertebral angle 偽 OB, but there was no significant correlation between age and vertebral rotation angle 尾. 3. There was no significant correlation between age and aorta-vertebral angle 偽, and there was a slight negative correlation between age and OB value. There was a moderate positive correlation with vertebral rotation angle 尾. Conclusion 1. There was no significant correlation between sex and thoracic aortic position in Lenke1 type adolescent idiopathic scoliosis. Vertebral rotation angle 尾 and OB value can be used as an effective supplement for clinical Cobb angle measurement. Ct scan can clearly show the relative position of thoracic aorta and vertebral body, and can provide preoperative risk assessment and surgical approach guidance for clinicians.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R726.8;R816.8

【參考文獻】

相關期刊論文 前2條

1 崔泰銘;陳胤;王健;;青少年特發(fā)性脊柱側彎發(fā)病機理的研究進展[J];中國學校衛(wèi)生;2007年09期

2 邱貴興;莊乾宇;;青少年特發(fā)性脊柱側彎的流行病學研究進展[J];中華醫(yī)學雜志;2006年11期

相關碩士學位論文 前1條

1 童沖杰;特發(fā)性脊柱側彎胸主動脈與相鄰椎體位置關系的研究[D];北京協(xié)和醫(yī)學院;2010年

，

本文編號：1910526