腰椎间盘突出的数字化三维模型的初步建立

发布时间：2018-01-28 18:48

本文关键词： 三维重建腰椎间盘突出症可视化　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：腰椎间盘突出症是脊柱外科最为常见、多发的疾病，自开展腰椎间盘摘除手术至今已有八十余年的历史，脊柱外科医生对腰椎间盘突出症的诊疗水平不断的提高，但有不少文献报道提出腰椎间盘突出症的误诊、二次手术或多次手术的临床病例报告，对于腰椎间盘突出症不同病理类型、不同临床表现的治疗原则、手术方案值得商榷，在诊断分型方面,国内外学者提出了很多种方法，但都有一定的局限和误差，需要一种先进的技术去进一步的完善，本文通过三维成像技术对腰椎间盘突出症患者的原始影像学图片进行三维重建，在三维结构下观察突出间盘位置以及毗邻神经根的关系，并综合一些分型、诊断的方法对腰椎间盘突出症诊断临床治疗提供理论基础。方法：选取1例自2014年1月至2015年1月期间我院住院治疗的腰椎间盘突出症患者，将符合入选标准的腰椎间盘突出症患者的原始CT、MRI图像导入数字化三维医学影像交互式处理系统17.0，通过选择阈值、三维模型计算、分割、修整等一系列步骤，建立腰椎间盘突出症患者的腰椎模型，根据我们提出的实验设计对腰椎间盘突出症分型、突出间盘与神经根的位置关系、神经根发育异常分型等进行观测。选取1例符合标准的正常成年人CT、MRI原始图片进行三维重建，观察两组之间的差别。结果：入选一例35岁男性腰椎间盘突出症患者，突出节段为腰4/5，根据设计的腰椎间盘突出观测流程图对突出间盘进行观察、测量，首先进行区域定位，间盘突出偏向右侧，间盘的左右位置在中央管区、关节突下区，观察到突出的间盘上下的位置在椎间盘水平，并观察到神经根与突出间盘的位置关系为腋部突出，观察神经根的走行未发现合并神经根发育异常，我们测量得到突出物的矢状径为12.08mm和矢状径中点的横径为8.20mm，并在腰5椎体上测量椎管的最大矢状径为17.04mm，该矢状径中点的横径为24.22mm，，得到的椎间盘突出指数为0.24。符合正常组为一例年龄23岁男性，腰椎各节段未见明确间盘突出，神经根发育未见异常。结论：腰椎三维重建技术能够清晰的显示间盘突出与神经根之间的位置关系，并且在腰椎间盘突出分型方面减少了以往二维层面诊断所带来的误差，更加清晰、直观，由于三维的建立需要不断的修整，本文仅对2例腰椎影像学图片进行三维重建、对比，我们需要进一步结合腰椎间盘突出症患者的临床症状，对分型的内容附加评分，在建模过程中，我们应该增加韧带、肌肉等其它组织，观察对结构造成的影响，使得模型更加完整,为腰椎间盘突出症提供更加方便、实用的诊断和治疗。
[Abstract]:Objective: lumbar disc herniation is the most common and frequent disease in spinal surgery. It has been more than 80 years since the operation of lumbar disc excision. The level of diagnosis and treatment of lumbar disc herniation has been continuously improved by spinal surgeons, but there are many reports of misdiagnosis of lumbar disc herniation, secondary operations or multiple operations. For different pathological types of lumbar disc herniation, different clinical manifestations of the treatment principles, surgical plans are open to question, in the diagnosis of classification, domestic and foreign scholars put forward a lot of methods. However, there are certain limitations and errors, need an advanced technology to further improve, this paper through three-dimensional imaging technology to the original image of lumbar disc herniation patients for three-dimensional reconstruction. The position of herniated disc and the relation of adjacent nerve root were observed under three dimensional structure. Some types and diagnostic methods were used to provide a theoretical basis for the diagnosis and treatment of lumbar disc herniation. Methods: a case of lumbar disc herniation was selected from January 2014 to January 2015. MRI image is imported into digital 3D medical image interactive processing system 17.0, through selecting threshold, 3D model calculation, segmentation, trimming and a series of steps. The lumbar vertebrae model of patients with lumbar disc herniation was established. According to the experimental design we proposed the classification of lumbar disc herniation and the position relationship between herniated disc and nerve root. The types of nerve root dysplasia were observed and the difference between the two groups was observed by using the original CT MRI images of one normal adult and three dimensional reconstruction. Results: a 35-year-old male patient with lumbar disc herniation was selected. The lumbar disc herniation was observed and measured according to the designed flow chart of lumbar disc herniation. First of all, the location of the intervertebral disc protruding to the right, the left and right position of the intervertebral disc was in the central canal area and the inferior articular process area, and the position of the upper and lower intervertebral disc was observed at the intervertebral disc level. The position relationship between nerve root and herniated disc was observed as axillary herniation, and no abnormal development of nerve root was found in the observation of nerve root. We measured the sagittal diameter of the protrusion 12.08 mm and the transverse diameter of the midpoint of the sagittal diameter 8.20mm, and the maximum sagittal diameter of the spinal canal measured on the lumbar 5 vertebrae was 17.04mm. The transverse diameter of the midpoint of the sagittal diameter was 24.22 mm, and the disc herniation index was 0.24 mm. There was no abnormal development of nerve root. Conclusion: Three-dimensional reconstruction of lumbar vertebrae can clearly display the position relationship between disc herniation and nerve root, and reduce the error caused by the previous two-dimensional diagnosis in the classification of lumbar disc herniation. More clear, intuitive, because the establishment of three-dimensional needs to constantly repair, this article only 2 cases of lumbar imaging images of three-dimensional reconstruction, contrast, we need to further combine the clinical symptoms of patients with lumbar disc herniation. In the process of modeling, we should increase ligaments, muscles and other tissues, observe the impact on the structure, make the model more complete, and provide more convenient for lumbar disc herniation. Practical diagnosis and treatment.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R681.53

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