發(fā)布時(shí)間：2018-06-27 07:49

  本文選題：胸椎黃韌帶骨化 + MSCT�。� 參考：《泰山醫(yī)學(xué)院》2013年碩士論文

【摘要】：背景與目的 黃韌帶骨化（ossification of ligament flavum，OLF）在亞洲國家中發(fā)病率較高，日本居首位，發(fā)病率約占脊柱疾病的2%，占脊柱手術(shù)患者的2.3%[1]，在年手術(shù)總量中占0.9/10萬[2]。該病屬退行性變范疇，中老年人發(fā)病率較高。OLF在頸、胸、腰段均可發(fā)生，但以胸椎特別是下胸椎最為多見，目前被臨床上認(rèn)為是引起胸椎管狹窄的主要原因。 傳統(tǒng)的影像學(xué)檢查為X線平片，但由于胸椎正、側(cè)位片胸椎與多個(gè)結(jié)構(gòu)重疊顯示，漏誤診率較高。螺旋（computed tomography）CT可以清晰的顯示橫斷面圖像，由于OLF呈高密度，觀察較為直觀、明顯。但由于軸位圖像的局限性，僅對(duì)部分類型的黃韌帶骨化顯示較好。而且難以確切判斷韌帶骨化的范圍，對(duì)多發(fā)病變及跳躍性病變也難以觀察。磁共振成像（Magnetic Resonance Imaging MRI）可較大范圍的顯示病灶，，對(duì)多發(fā)病變及跳躍性病變顯示較好。但是OLF在T1WI及T2WI圖像中均為低信號(hào)，不易觀察。 多層螺旋CT(multislice spiral computed tomography MSCT)多平面重建技術(shù)（multiplanar reformation MPR）可對(duì)掃描所得圖像進(jìn)行任意角度的重建，選擇合適的角度，可以較好的觀察胸椎黃韌帶骨化的形態(tài)特點(diǎn)及其對(duì)脊髓的影響，對(duì)多節(jié)段同時(shí)受累及跳躍性病變的觀察也較為方便。 利用MRCT多平面重建技術(shù)研究胸椎黃韌帶骨化（thoracic ossification of ligamentflavum，TOLF）與年齡、性別的相關(guān)性，分析說明這些因素與胸椎黃韌帶骨化的關(guān)系。 材料與方法 觀察性研究1244例行胸部CT受檢者，其中男性771例，女性473例，年齡0-96歲，平均年齡48.48±23.44歲。所有受檢者胸部CT掃描圖像均行MPR，由三名影像科醫(yī)生觀察每個(gè)受檢者12個(gè)胸椎左右雙側(cè)黃韌帶，選擇最佳角度、最佳層面判斷其骨化情況及程度并記錄。 利用SPSS13.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析，方法如下：（1）年齡與左右雙側(cè)胸椎黃韌帶骨化程度作Spearman相關(guān)分析；（2）對(duì)不同年齡組黃韌帶骨化級(jí)別作非參數(shù)的Kruskal-Wallis H檢驗(yàn)；（3）男女之間黃韌帶骨化級(jí)別作非參數(shù)相關(guān)檢驗(yàn)；（4）左右雙側(cè)黃韌帶骨化級(jí)別作非參數(shù)相關(guān)檢驗(yàn)。 結(jié)果 1.左右雙側(cè)胸椎黃韌帶骨化程度程度隨年齡的增加而相應(yīng)增加； 2.黃韌帶骨化程度與年齡呈高度相關(guān)； 3.男女之間左右兩側(cè)黃韌帶骨化程度均無差異； 4.左右雙側(cè)黃韌帶骨化程度在T2、T3、T4、T5、T7等5個(gè)椎體中存在差異，其他胸椎黃韌帶骨化程度在左右雙側(cè)無差異。 結(jié)論 胸椎黃韌帶骨化程度最年齡增加而相應(yīng)增加，與年齡有顯著的相關(guān)性；性別與胸椎黃韌帶骨化沒有相關(guān)性；左右雙側(cè)部分黃韌帶骨化程度存在差異，右側(cè)較左側(cè)發(fā)生率高。
[Abstract]:Background & objective the incidence of ossification of ligamentum flavum (ossification of ligament flavum OLF) is relatively high in Asian countries, with Japan being the first country, accounting for 2% of spinal diseases, accounting for 2.3% of the total number of patients undergoing spinal surgery, accounting for 0.9% -100 000 of the total number of surgeries per year [2]. The disease belongs to the category of degenerative change. The incidence of OLF in middle and old people is higher. OLF can occur in cervical, thoracic and lumbar segments, but the thoracic vertebrae, especially the lower thoracic vertebra, are the most common, which is clinically considered to be the main cause of thoracic spinal canal stenosis. The traditional radiographic examination was X-ray plain film, but the misdiagnosis rate of leakage was higher because the thoracic vertebrae were positive and the lateral position of thoracic vertebrae were overlapped with multiple structures. Spiral (computed tomography) CT can clearly display cross-sectional images, because of its high density, the observation is intuitionistic and obvious. However, due to the limitation of axial images, only partial ossification of ligamentum flavum is shown. Furthermore, it is difficult to determine the extent of ossification of ligaments, and to observe frequently-occurring lesions and leaping lesions. Magnetic Resonance Imaging (MRI) can show the lesion in a wide range, and it can show the leaping lesion well. However, OLF is low signal on T 1 WI and T 2 WI, so it is difficult to observe. Multi-slice spiral CT (multislice spiral computed tomography MSCT multiplanar reconstruction technique (multiplanar reformation MPR) can reconstruct the images at any angle and select a suitable angle to observe the morphological characteristics of ossification of ligamentum flavum in thoracic vertebrae and its effect on spinal cord. It is also convenient to observe multiple segmental involvement and leaping lesions at the same time. The relationship between (thoracic ossification of ligamentum flavum ossification (thoracic ossification of ligamentum flavum TOLF) and age and sex was studied by MRCT multiplanar reconstruction, and the relationship between these factors and ossification of ligamentum flavum in thoracic vertebrae was analyzed. Materials and methods 1244 patients (male 771, female 473, aged 0-96 years, mean age 48.48 鹵23.44 years) underwent chest CT examination. MPRR was performed on all chest CT images. The left and right ligamentum flavum of 12 thoracic vertebrae were observed by three imaging doctors, and the best angle was selected to judge the ossification and the degree of ossification on the best plane and to record the ossification. The data were analyzed by SPSS 13.0 software. The methods were as follows: (1) Spearman correlation analysis between age and ossification of ligamentum flavum in left and right thoracic vertebrae, (2) nonparametric Kruskal-Wallis H test for ossification of ligamentum flavum in different age groups; (3) the ossification grade of ligamentum flavum was tested by nonparametric correlation test between men and women, and (4) the ossification grade of ligamentum flavum on both sides was tested by nonparametric correlation test. Result 1. The ossification degree of ligamentum flavum of left and right thoracic vertebrae increased with the increase of age; 2. Ossification degree of ligamentum flavum was highly correlated with age. There was no significant difference in ossification of ligamentum flavum between male and female. The degree of ossification of right and left ligamentum flavum was different in 5 vertebrae such as T _ 2T _ 3, T _ 4, T _ 5 and T _ 7, while the ossification of other thoracic ligamentum flavum had no difference in left and right sides. Conclusion the degree of ossification of ligamentum flavum in thoracic vertebrae increases with age, and there is a significant correlation between sex and ossification of ligamentum flavum in thoracic vertebrae, the ossification degree of ligamentum flavum in both sides of thoracic vertebrae is different. The incidence was higher on the right side than on the left.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R686;R816.8

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李方財(cái),陳其昕;胸椎黃韌帶骨化癥研究進(jìn)展[J];國外醫(yī)學(xué).骨科學(xué)分冊(cè);2003年02期

2 朱建平,劉富華,吳耀義,倪斌,賈連順;胸椎黃韌帶骨化及脊髓壓迫癥的診斷與治療[J];頸腰痛雜志;1997年03期

3 張國梁;趙建民;;脊柱韌帶骨化的研究進(jìn)展[J];內(nèi)蒙古醫(yī)學(xué)院學(xué)報(bào);2007年03期

4 楊寶廉,韓華,張東;42例黃韌帶肥厚致椎管狹窄MRI分析[J];實(shí)用放射學(xué)雜志;2000年12期

5 王向;賈連順;;黃韌帶骨化癥發(fā)病機(jī)制與病理研究進(jìn)展[J];中國骨科臨床與基礎(chǔ)研究雜志;2010年01期

6 孫建民,于錫欣,王躍明;胸椎黃韌帶骨化的診斷與治療[J];中國矯形外科雜志;2000年04期

7 顏廷賓,張佐倫,于錫欣,袁澤農(nóng);胸椎黃韌帶骨化與HLA-DQA1等位基因的相關(guān)性研究[J];中國矯形外科雜志;2002年S2期

8 王玉梅;林永;王向東;馮躍鴿;;黃韌帶病變的MRI、CT診斷對(duì)比研究[J];中國矯形外科雜志;2006年17期

9 張海波;王義生;;黃韌帶骨化癥型胸椎管狹窄癥的臨床特點(diǎn)及手術(shù)治療[J];中國矯形外科雜志;2009年07期

10 秦德安;張佐倫;李曉東;崔新剛;劉峰;;胸椎椎板傾斜角在胸椎黃韌帶骨化中的解剖學(xué)意義[J];中國臨床解剖學(xué)雜志;2006年06期

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