强直性脊柱炎后凸畸形截骨矫形后腹部变化及膈肌旋转与肺功能损害的相关性研究

发布时间：2018-03-04 21:39

本文选题：强直性脊柱炎　切入点：脊柱后凸　出处：《中国人民解放军医学院》2015年硕士论文　论文类型：学位论文

【摘要】：[目的](1)利用CT三维重建技术测量强直性脊柱炎后凸畸形截骨矫形手术前、后患者腹部变化;(2)分析强直性脊柱炎后凸畸形患者术后腹部变化及其意义;(3)分析强直性脊柱炎后凸畸形患者膈肌矢状位旋转与患者肺功能损害的相关性。[方法](1)收集26例强直性脊柱炎后凸畸形患者腹部及脊柱CT资料,进行三维重建,选取合适测量平面后,测量剑突或内折腹壁的尖部到脊柱的最短距离及在正中矢状面上腹部的面积,测量膈肌在矢状位的旋转程度;(2)通过三维重建CT收集30例强直性脊柱炎后凸畸形患者术前膈肌角及肺功能检查结果;(3)在脊柱全长侧位X片上测量手术前、后CobbT1-S1角度;(4)进行统计学分析,比较强直性脊柱炎后凸畸形患者术后前、后腹部相应的变化,分析腹部各项变化的意义及膈肌旋转程度与肺功能损害的相关性。[结果](1)MD与AMSPA在腹壁内折患者手术前、后存在明显的统计学意义,MD与AMSPA在未发生腹壁内折患者手术前、后不存在统计学意义；(2)强直性脊柱炎后凸畸形患者膈肌在矢状位发生明显的旋转：(3)术前膈肌旋转角数值与术前CobbT1-S1角呈负相关，膈肌旋转角数值与补吸气量(IRV)、补呼气量(ERV)、最大呼气流量(PEF)、肺活量(VC)和用力肺活量(FVC)呈正相关。[结论](1)术前，，在一定程度上腰椎前凸减小或变为后凸对躯干屈曲对腹部脏器的挤压有一定的代偿;(2)通过截骨矫形手术可以消除躯干屈曲对脏器的挤压;(3)强直性脊柱炎胸腰椎后凸畸形患者膈肌在矢状位上的旋转随着后凸程度的增加而加重;(4)膈肌旋转是强直性脊柱炎胸腰椎后凸畸形患者的一个影响因素。
[Abstract]:[objective] to measure the orthopedic osteotomy of kyphosis in ankylosing spondylitis (ankylosing spondylitis) by CT 3D reconstruction. (3) to analyze the relationship between sagittal rotation of diaphragm and pulmonary function damage in patients with kyphosis of ankylosing spondylitis. The CT data of abdominal and spinal column of 26 patients with ankylosing spondylitis and kyphosis were collected. After 3D reconstruction, the shortest distance from the tip of the ventral wall to the spine and the area of the upper abdomen on the median sagittal plane were measured after the appropriate measurement plane was selected. To measure the rotation of diaphragm in sagittal position and measure the degree of rotation of diaphragm in sagittal position. 30 cases of kyphosis with ankylosing spondylitis were collected by 3D reconstruction CT. The results of diaphragm angle and pulmonary function were measured before operation. To compare the changes of anterior and posterior abdomen in patients with ankylosing spondylitis and kyphosis. The significance of abdominal changes and the correlation between the degree of diaphragm rotation and lung function damage were analyzed. [results] before operation, there was significant difference between MD and AMSPA in patients with intraabdominal fracture. There was no statistically significant difference between the rotation angle of diaphragm in sagittal position and the preoperative CobbT1-S1 angle in the patients with kyphosis deformity of ankylosing spondylitis. The rotation angle of the diaphragm was positively correlated with the inspiratory volume (IRV), the expiratory volume (ERV), the maximum expiratory flow (PEF), the vital capacity (VC) and the forced vital capacity (FVC). To some extent, Lumbar Lumbar Lumbar kyphosis decreases or becomes kyphosis. There is a certain compensatory effect on abdominal viscera by compression of trunk flexion. 2) the compression of trunk flexion on viscera can be eliminated by osteotomy. 3) after thoracolumbar vertebrae of ankylosing spondylitis. The rotation of diaphragm in sagittal position is aggravated with the increase of kyphosis. The rotation of diaphragm is an important factor in ankylosing spondylitis with thoracolumbar kyphosis.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R593.23;R687

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