本文選題：雙源CT + MRI表現(xiàn)��； 參考：《河北醫(yī)科大學》2015年碩士論文

【摘要】：目的:目前,關于腰椎在不同靜態(tài)體位(前屈、后伸、側屈、旋轉)對椎間盤影響的相關文獻較多,研究主要針對其生物力學方面的測試。但對于腰椎在某一個方向運動過程中椎間盤的細微變化方面的相關研究較少,其主要原因一方面是受于測量儀器的限制,另一方面是多方面因素可能影響相鄰節(jié)段椎間盤退變。隨著國內對雙源CT的引進,為我們在研究腰椎運動狀態(tài)下各個結構的相互關系及運動變化,提供了方便。本文選擇對2009年6月—2012年5月在我院應用腰椎融合術治療腰椎間盤突出癥的52例患者進行了隨訪,回顧性分析腰椎在運動過程中相鄰節(jié)段椎間盤高度變化,來指導患者術后對脊柱的保護。隨訪觀察L4/5椎間融合術后相鄰節(jié)段椎間盤(L3/4、L5/S1)的運動變化,分析椎間盤的運動變化與退變的相關性。實驗設計、實驗時間及地點、研究對象的選擇及納入的病例:2012年5月—2014年6月在河北醫(yī)科大學附屬石油臨床學院完成。方法:實驗對象:選擇2009年6月—2012年5月在河北醫(yī)科大學附屬石油臨床學院就診,主因腰椎間盤突出癥,病史在3年左右經(jīng)保守治療無效行腰椎融合內固定術的患者52例作為手術組,男性16例,女性36例,年齡:39-60歲,平均年齡:49.5歲。根據(jù)樣本量計算門診選50例腰椎間盤突出患者作為非手術組,病史3年經(jīng)保守治療且行MRI檢查,男性13例,女性37例,年齡:35-62,平均年齡:48.5歲。通過手術組與非手術組比較,應用雙源CT觀察術后相鄰節(jié)段椎間盤在前屈過程(前凸Cobb角30°-60°)中運動變化,并通過MRI影像學表現(xiàn),探究相鄰節(jié)段椎間盤的運動變化與椎間盤退變的關系。觀測指標:根據(jù)VAS評分評估手術組和非手術組腰椎在雙源CT檢查前及檢查中的情況。腰椎在前屈運動過程中椎間盤高度的變化,根據(jù)Pfirrmann分級標準評估椎間盤的退變情況。結果:1 L3/4椎間盤的高度變化:腰椎前凸Cobb角在45°-50°運動過程中,L3/4椎間盤的高度丟失最明顯,手術組2.205±0.053mm,非手術組0.875±0.036mm,其它運動角度手術組和非手術組的L3/4椎間盤高度變化不明顯。L5/S1椎間盤高度變化:腰椎前凸Cobb角在30°-60°全程運動過程中,手術組比非手術組椎間盤高度降低幅度無差別。2手術組和非手術組均出現(xiàn)鄰近節(jié)段椎間盤退變,其中手術組L3/4椎間盤出現(xiàn)II級以上退變的有33例,非手術組L3/4椎間盤出現(xiàn)II級以上退變的有16例。3椎間盤高度變化明顯與退變程度有關系,II級以上退變L3/4椎間盤高度變化更明顯,I、II級退變者L3/4椎間盤高度變化不明顯。4手術組和非手術組在雙源CT檢查前及檢查中的VAS評分差分別為(0.35±0.05)和(0.66±0.06),前屈運動過程中無癥狀加重表現(xiàn),且L3/4椎間盤在45°—50°前屈運動與VAS評分無相關性。結論:腰4/5椎間融合術后,腰椎前凸Cobb角在45°-50°運動過程中,腰3/4椎間盤椎間盤高度變化明顯,存在異�；顒�,且與其退變存在相關性,但這種異常活動與腰椎VAS評分無相關性。
[Abstract]:Objective: at present, there are many literatures about the effect of lumbar vertebrae in different static postures (flexion, extension, lateral flexion, rotation) on intervertebral disc. However, there are few researches on the subtle changes of lumbar intervertebral disc in a certain direction, which is mainly due to the limitation of measuring instruments on the one hand, and the influence of many factors on the degeneration of adjacent segments of intervertebral disc on the other hand. With the introduction of dual-source CT in China, it is convenient for us to study the interrelation and motion change of each structure under the condition of lumbar vertebrae motion. 52 patients with lumbar disc herniation treated by lumbar fusion from June 2009 to May 2012 were followed up. The changes of lumbar disc height in adjacent segments during lumbar movement were analyzed retrospectively. In order to guide patients after the protection of the spinal column. The motion changes of adjacent segments of intervertebral disc after L4 / 5 intervertebral fusion were observed and the correlation between the motor changes and degeneration of the intervertebral disc was analyzed. The experimental design, experimental time and place, the selection of the subjects and the cases included: from May 2012 to June 2014, they were completed in the affiliated Petroleum Clinical College of Hebei Medical University. Methods: the subjects were selected from June 2009 to May 2012 at the Petroleum Clinical College affiliated to Hebei Medical University. The main cause of lumbar disc herniation was lumbar disc herniation. 52 patients with a history of 3 years or so who failed to perform lumbar fusion and internal fixation were selected as the operation group. There were 16 males and 36 females, aged from 30 to 60 years, with an average age of 49.5 years. Fifty patients with lumbar disc herniation were selected as non-operative group according to the sample size. The patients had a history of conservative treatment and MRI examination for 3 years. There were 13 males and 37 females, age: 35-62, mean age: 48.5 years. The motion changes of adjacent intervertebral discs (30 擄-60 擄of Cobb angle) were observed by dual-source CT in the operation group and non-operative group, and MRI findings were used. To explore the relationship between the motion changes of adjacent segments of intervertebral disc and the degeneration of intervertebral disc. Outcome measures: according to the VAS score, the lumbar vertebrae in the operation group and non-operative group were evaluated before and after dual source CT examination. The changes of lumbar disc height during anterior flexion were evaluated according to the Pfirrmann classification criteria. Results the height changes of the intervertebral disc of 1 / L / 3 / 4: the height loss of L3 / 4 intervertebral disc was most obvious during 45 擄-50 擄motion of Cobb angle of lumbar kyphosis. 2.205 鹵0.053mm in the operation group and 0.875 鹵0.036mm in the non-operative group. There was no significant change in L3 / 4 intervertebral disc height between the operation group and the non-operative group. The L5 / S1 intervertebral disc height changed significantly: the lumbar kyphosis Cobb angle was 30 擄-60 擄during the whole course of exercise. The intervertebral disc height of the operation group was lower than that of the non-operative group. 2 there was no difference between the operation group and the non-operative group. Among them, 33 cases of the L3 / 4 disc in the operation group had grade II degeneration. In the non-operative group, 16 patients with L3 / 4 disc degeneration above grade II had significant correlation with the degree of degeneration. The changes of L3 / 4 intervertebral disc height were more obvious in the patients with grade II degeneration than in the patients with grade II degeneration. The changes of intervertebral disc height were unknown in the patients with grade II degeneration of L3 / 4 intervertebral disc. The difference of VAS score before and during dual-source CT examination was 0.35 鹵0.05 and 0.66 鹵0.06 respectively in the operation group and the non-operative group, and the asymptomatic exacerbation was observed in the anterior flexion exercise process, the difference of VAS between the two groups was 0.35 鹵0.05 and 0.66 鹵0.06, respectively. There was no correlation between L 3 / 4 disc flexion and VAS score at 45 擄- 50 擄. Conclusion: after lumbar 4 / 5 intervertebral fusion, during 45 擄-50 擄movement of Cobb angle of lumbar kyphosis, the height of lumbar intervertebral disc in 3 / 4 of lumbar vertebrae changes obviously, and there is a correlation between abnormal activity and degeneration, but there is no correlation between this abnormal activity and VAS score of lumbar vertebrae.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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本文編號：2008387