退变性腰椎滑脱软骨终板改变的影像学研究

发布时间：2018-04-01 08:43

本文选题：软骨终板　切入点：退变性腰椎滑脱　出处：《安徽医科大学》2017年硕士论文

【摘要】：目的通过磁共振成像研究退变性腰椎滑脱患者椎间盘软骨终板的改变,比较正常人与退变性腰椎滑脱患者相同阶段椎间盘软骨终板的差异,并且分析椎间盘软骨终板的退变与退变性腰椎滑脱的关系。方法选取临床影像学检查(X线、CT、磁共振)确诊为L4或L5腰椎椎体滑脱的患者82例,年龄45~65岁,分为L4前滑脱组和L5前滑脱组(L4滑脱组60例,L5滑脱组22例);其中男18例,女64例。同时选取30例腰椎结构及功能完好的正常体检者组成对照组,其中男性7名,女性23名,年龄45~65岁,既往身体健康,均无腰椎疾病,且无慢性全身性疾病。患者组与正常组之间性别、年龄比较无统计学差异。对所有受检者的L4/L5、L5/S1椎间盘行正中矢状位T2加权磁共振扫描,本实验共扫描椎间盘224个,软骨终板448个,用Carestream放射成像软件对扫描图像进行放大、增强,并且测量每位被扫描者椎间盘软骨终板前半终板倾角及后半终板倾角。计算出前半倾角与后半倾角的比值作为该终板的变异率。分别比较滑脱组与正常组对应阶段的椎间盘软骨终板变异率的差异。实验采用MS Excel 365进行数据整理与绘图,IBM SPSS 22.0进行数据分析,分类资料比较用x2,计量资料采用均数±标准差(`x±s)表示,对各指标进行正态性检验,结果均较好,两组间正态分布计量资料均值比较采用独立样本t检验,自身两组指标对比采用配对t检验,α=0.05为检验水准;三组参数间的差异比较采用方差分析。结果L4滑脱组:L4/L5椎间盘上、下终板变异率与正常组之间差异均有统计学意义;但L5/S1椎间盘上、下终板变异率与正常组之间差异均无统计学意义。L5滑脱组:L4/L5椎间盘上、下终板变异率与正常组之间差异均有统计学意义;L5/S1椎间盘上、下终板变异率与正常组之间差异均有统计学意义。滑脱组椎间盘上、下终板的自身对比:L4滑脱组中,L4/L5椎间盘上终板与下终板之间有统计学差异,L5/S1椎间盘上终板与下终板之间无统计学差异;L5滑脱组中,L4/L5椎间盘上终板与下终板之间有统计学差异,L5/S1上终板与下终板之间有统计学差异。正常组椎间盘上、下终板自身对比:L4/L5椎间盘上、下终板之间有统计学差异;L5/S1椎间盘上、下终板之间无统计学差异。结论退变性腰椎滑脱可致滑脱阶段软骨终板退变,且同一软骨终板前、后半终板的退变程度不对称:椎间盘上终板的后半终板退变程度比前半终板严重,而下终板的前半终板退变程度比后半终板严重;退变性腰椎滑脱对非滑脱阶段椎间盘软骨终板的退变无明显影响。
[Abstract]:Objective to study the changes of cartilage endplate in degenerative lumbar spondylolisthesis by magnetic resonance imaging (MRI), and to compare the difference of cartilage endplate between normal and degenerative lumbar spondylolisthesis at the same stage. Methods 82 patients with L4 or L5 lumbar spondylolisthesis, aged 45 to 65 years, were diagnosed as L4 or L5 lumbar spondylolisthesis by magnetic resonance imaging (MRI), and the relationship between degeneration of intervertebral cartilage endplate and degenerative lumbar spondylolisthesis was analyzed. The patients were divided into two groups: L4 group (n = 60) and L5 group (n = 60), including 18 males and 64 females. 30 normal subjects with intact structure and function of lumbar vertebrae were selected as control group, including 7 males and 23 females. Age 45 to 65 years old, health, no lumbar disease, no chronic systemic disease. Sex between patient group and normal group. There was no significant difference in age. All the intervertebral discs of L 4 / L 5 and L 5 / S 1 were scanned by T 2 weighted magnetic resonance imaging with median sagittal position. In this experiment, 224 discs and 448 cartilage endplates were scanned. The scanning images were amplified and enhanced by Carestream radiography software. The inclination angle of anterior end plate and posterior end plate of intervertebral disc were measured. The ratio of anterior half angle to posterior half angle was calculated as the rate of variation of the end plate. The corresponding order between the slippage group and the normal group was compared. The variation rate of endplate of intervertebral disc cartilage was analyzed by MS Excel 365. The standard deviation (`x 卤s) and the mean value (x 卤s) were used to compare the classified data. The results of normality test for each index were satisfactory. The comparison of the mean values of the normal distribution data between the two groups was carried out by independent sample t test. Two groups of indexes were compared by paired t test with 伪 -0. 05 as the test level, and the differences among the three groups were analyzed by ANOVA. Results the variation rate of upper and lower endplate in L4 slippage group was significantly higher than that in normal group. However, there was no significant difference in the rate of variation of the inferior endplate between the L5/S1 disc and the normal group. There was no significant difference between the L5 / L4 / L5 intervertebral disc and the L5 / S1 intervertebral disc in the L5 / L5 slippage group, and there was significant difference between the L5 / S1 intervertebral disc and the lower endplate variation rate in the normal group. The rate of variation of inferior endplate was significantly different from that of normal group. Comparison of the inferior endplate in the L4 / L4 slippage group there was a statistical difference between the superior endplate and the inferior endplate of the L4 / L5 intervertebral disc. There was no statistical difference between the superior endplate and the inferior endplate of the L5 / S1 intervertebral disc. There was no statistical difference between the upper endplate and the inferior endplate in the L5 slippage group. There was statistical difference between L5 / S1 superior endplate and inferior endplate. There was statistical difference between the lower end plate and the lower end plate. Conclusion the degenerative lumbar spondylolisthesis can result in the degeneration of the cartilage endplate in the spondylolisthesis stage, and the same end plate is present in the same cartilage endplate, and there is no statistical difference between the lower end plate and the lower end plate. The degree of degeneration of the posterior endplate was asymmetric: the degree of degeneration of the posterior endplate of the superior endplate of intervertebral disc was more serious than that of the anterior endplate, while the degree of degeneration of the anterior endplate of the lower endplate was more serious than that of the posterior endplate. Degenerative lumbar spondylolisthesis had no significant effect on degenerative cartilage endplate in non-spondylolisthesis stage.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R681.5

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