16例神经纤维瘤病性脊柱侧弯数字化模型建立及置钉准确性分析

发布时间：2018-02-26 07:13

本文关键词： 神经纤维瘤病性脊柱侧弯椎弓根形态学置钉准确性 3维重建　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：[目的](1)通过CT三维重建测量、分析NF性脊柱侧弯患者椎弓根形态、置钉准确性、椎弓根畸形程度、三维Cobb角等数据;(2)通过CT三维重建测量、分析特发性脊柱侧弯患者椎弓根形态、置钉准确性、椎弓根畸形程度、三维Cobb角等数据;(3)运用统计学的方法将两组结果分析,对比,评估两者之间疗效及其他形态学差别;(4)尝试着归纳总结神经纤维瘤病患者的特点,术中术后需要注意的要点。[方法](1)收集2008年5月到2016年12月我院诊治的276例脊柱侧弯患者,其中特发性脊柱侧弯221例,神经纤维瘤病性脊柱侧弯16例。选择16例特发性侧弯患者与神经纤维瘤病患者相匹配,将术后的CT资料进行三维重建,测量指标包括:椎弓根形态、椎弓根横径、椎弓根一肋骨联合体横径、三维冠状面Cobb角及纠正率等;(2)将两组数据进行统计学分析,比较NF患者与AIS患者椎弓根形态学、置钉准确性、治疗效果之间的差异;[结果](1)NF患者中严重畸形的椎弓根较特发性脊柱侧弯多,两者之间的差异有统计学意义(2)置入NF组患者的142枚螺钉中,88颗螺钉位置良好,其余54枚属于螺钉误置,螺钉误置率=38.02%,置钉满意率=61.98%。在特发性脊柱侧弯患者置入的111枚螺钉中86颗螺钉位置良好,25颗螺钉属于2级或3级,螺钉误置率=22.52%,置钉满意率=77.48%。(3)AIS组患者椎弓根横径测量结果椎弓根横径在2.73~8.33 mm之间,其数值因节段而变化,凹侧最小横径仅为1.77 mm。凹侧椎弓根横径明显小于凸侧。胸椎椎弓根一肋骨联合体横径测量结果,横径为10.04—14.91 mm。从T1向T5逐渐缩小,变化与胸椎节段有关。而NF患者胸椎椎弓根横径在1.37mm~8.21mm之间,胸椎椎弓根一肋骨联合体横径较特发性脊柱侧弯患者少,为8.43—14.55mm。(4)NF患者冠状面治疗效果评估(见表4),术前主弯冠状面Cobb角46°—126°(平均68.6°),术后及时查平片4—58°(平均28.8°),术后矫正率34%—92.5%,平均矫正率58.8%,末次随访时,末次随访时神经纤维瘤病组患者主弯Cobb角4°—62°,矫正率34%—92.5,平均矫正率55.3%。术后矫正疗效确切,且存在矫正丢失的情况。[结论]1、神经纤维瘤病性脊柱侧弯患者椎弓根畸形率高,畸形比特发性脊柱侧弯患者严重临床有,两者的差别有统计学意义;2、后路椎体融合术对纠正神经纤维瘤病性脊柱侧弯患者在冠状面Cobb角上疗效确切,但较特发性脊柱侧弯患者差,差异有统计学意义;3、神经纤维瘤病性脊柱侧弯患者椎弓根较小,置钉难度更高,螺钉误置率更高,手术风险更高。
[Abstract]:[objective] to analyze the pedicle shape, screw placement accuracy, pedicle deformity degree and Cobb angle of pedicle in patients with NF scoliosis by CT 3D reconstruction. To analyze the data of pedicle shape, nail placement, pedicle deformity and three-dimensional Cobb angle in patients with idiopathic scoliosis. To evaluate the curative effect and other morphological differences between the two groups. (4) to summarize the characteristics of neurofibromatosis patients and the main points needing attention during and after operation. [methods] A total of 276 patients with scoliosis were collected from May 2008 to December 2016 in our hospital. There were 221 cases of idiopathic scoliosis and 16 cases of neurofibromatosis scoliosis. Sixteen cases of idiopathic scoliosis and neurofibromatosis were selected to match with the patients with neurofibromatosis. The transverse diameter of pedicle, the transverse diameter of pedicle to rib union, the Cobb angle of three-dimensional coronal plane and the correction rate were analyzed statistically. The morphology of pedicle and the accuracy of screw insertion were compared between NF patients and AIS patients. [results] there were more pedicle deformities in patients with NF than in idiopathic scoliosis, and the difference was statistically significant (P < 0.05) 88 screws out of 142 screws in NF group were in good position. The remaining 54 screws were misplaced, the screw misplacement rate was 38.02 and the satisfaction rate of screw placement was 61.98. 86 of 111 screws placed in idiopathic scoliosis had a good position and 25 screws belonged to grade 2 or grade 3. The rate of screw misplacement was 22.52%, the satisfaction rate of screw placement was 77.48.AIS group. Results the transverse diameter of pedicle was between 2.73 and 8.33 mm, and its value varied with the segment. The minimum transverse diameter of the concave side was only 1.77 mm. the transverse diameter of the concave pedicle was obviously smaller than that of the convex side. The transverse diameter of thoracic pedicle-rib union was 10.04-14.91 mm. from T1 to T5, the transverse diameter decreased gradually. The transverse diameter of thoracic pedicle in NF patients was between 1.37 mm and 8.21 mm, and the transverse diameter of thoracic pedicle and rib union was less than that of idiopathic scoliosis. To evaluate the effect of coronal treatment in patients with NF from 8.43 to 14.55 mm. (see Table 4, Cobb angle 46 掳-126 掳(mean 68.6 掳) on the main curved coronal plane before operation, 4-58 掳(mean 28.8 掳) in time after operation, 34 -92.5% after operation, 58.8% at the last follow-up. At the last follow-up, the Cobb angle of the main curvature was 4 掳-62 掳, the correction rate was 34 掳-92.5, the average correction rate was 55.3%. The effect of postoperative correction was accurate, and there was a case of correction loss. [conclusion] 1. The rate of pedicle deformity was high in patients with neurofibromatosis scoliosis. There were severe clinical manifestations in patients with malformed bit scoliosis, and the difference was statistically significant. Posterior vertebrae fusion was effective in correcting neurofibromatosis scoliosis in coronal Cobb angle. But compared with idiopathic scoliosis, the difference was statistically significant. The pedicle of neurofibromatosis patients was smaller, the difficulty of screw placement was higher, the rate of screw misinsertion was higher, and the risk of surgery was higher.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3;R596

【参考文献】