脊柱骨盆参数评价峡部裂性腰椎滑脱的术前评估和术后结果

发布时间：2018-03-13 08:00

本文选题：腰椎滑脱　切入点：脊柱骨盆参数　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的对比分析正常成人与腰椎滑脱患者手术前后脊柱骨盆矢状位参数的影像学特点以及各参数在术前术后与正常成人之间的差异,分析术后各参数变化对手术疗效的影响,为临床手术治疗峡部裂性腰椎滑脱提供一定的参考。方法收集2014年9月-2016年9月郑州大学一附院手术治疗的腰椎滑脱患者58例,分别测量术前脊柱-骨盆参数并记录,作为腰椎滑脱术前组;测量术后脊柱-骨盆参数并记录,作为腰椎滑脱术后组;同时门诊选取60例无腰椎滑脱的脊柱骨盆曲线作为正常对照组。对术前组和术后组做Oswestry评分调查,并分别测量术前组、术后组和对照组的脊柱骨盆参数。测量的数据包括以下几个参数:PI—骨盆入射角、PT—骨盆倾斜角、SS—骶骨倾斜角、LL—腰椎前凸角、TK—胸椎后凸角、SVA—矢状面平衡、LSJA-腰骶部关节角。根据术后Oswestry评分调查将手术患者分为两组:低改善率组(改善率小于50%)与高改善率组(改善率大于50%)。术前组、术后组患者与对照组之间脊柱-骨盆参数的对比分析采用t检验;术前组和术后组的对比分析用配对t检验;并用Pearson相关系数来评估各参数的相关性;低改善率组与高改善率组之间的对比分析用t检验;改善率和各参数之间的关系分析采用线性回归分析;P0.05被认为差异有统计学意义。所有数据采用SPSS18.0做统计处理。结果1.腰椎滑脱术后组PT、SS、LL、TK、SVA、LSJA与术前组有明显差异(P0.01),术后组PT、TK高于术前组,LL、SS、LSJA、SVA低于术前组;术前组与正常对照组之间有明显差异(P0.01),术前组PI、LL、SS、PT、SVA、LSJA均高于正常对照组,而TK低于正常对照组(见表2、3)。2.术前组与正常对照组相比,PI值有明显差异,且术前组PI值高于对照组,而术前组和术后组的PI值无差异(见表2、3)。3.通过术前组、术后组及正常对照组骨盆参数的相关性分析:(1)正常对照组各参数相关性分析:PI与SS、PT、LL、LSJA有相关性;SS与LL、PT、SVA和LSJA有相关性(见表4)。(2)术前组各参数相关性分析:PI与PT、SS、LL及LSJA有相关性,其中与SS、LL及LSJA相关性显著;LSJA与SS、PT和LL相关,SVA与PT、LL和TK相关(见表4)。(3)术后组各参数相关性分析:PI与SS、PT和LL相关,SS与LSJA、PT和LL相关,SVA与TK和LSJA相关。其中SS与LSJA有显著相关性(见表4)。4.高改善率组SS、LL、LSJA、SVA低于低改善率组(P0.05),而PT、TK高于低改善率组(P0.05)(见表5)。Oswestry评分改善率与各参数相关性分析得出:SS、LL、LSJA与Oswestry评分改善率有显著相关性,其中LSJA的相关性最显著(见表6)。结论1.脊柱骨盆矢状位多个参数异常的共同作用,影响着峡部裂性腰椎滑脱的发生及进展。2.高PI值和LSJA值可能为峡部裂腰椎滑脱的重要病因与进展诱因。3.手术能改善患者的脊柱平衡状态,PT、LL、LSJA与Oswestry评分改善率有显著相关性。因此术前应对这几个参数进行评估,术中应注意对上述参数进行调整,达到最好手术效果,术后可以用这几个参数的改善情况对患者的预后进行预测。
[Abstract]:Objective to compare the imaging characteristics of sagittal parameters of spine and pelvis between normal adults and patients with lumbar spondylolisthesis before and after operation, and to analyze the effect of the parameters on the curative effect. Methods from September 2014 to September 2016, 58 patients with lumbar spondylolisthesis who were treated by operation in a affiliated hospital of Zhengzhou University were collected, and the parameters of spine and pelvis before operation were measured and recorded. As the preoperative group of lumbar spondylolisthesis, the spinal and pelvic parameters were measured and recorded as the postoperative group of lumbar spondylolisthesis. At the same time, 60 cases of spine and pelvis curve without lumbar spondylolisthesis were selected as the normal control group. The Oswestry scores of the preoperative group and the postoperative group were investigated, and the preoperative group were measured respectively. Parameters of the spine and pelvis in the postoperative group and the control group. Data measured include the following parameters: PI- pelvic incidence angle PT- pelvis tilt angle SS-sacral tilt angle LL- lumbar kyphosis angle TK- thoracic kyphosis angle SVA- sagittal balance of LSJA-lumbosacral joint. Angle. According to the postoperative Oswestry score, the patients were divided into two groups: low improvement rate group (improvement rate less than 50%) and high improvement rate group (improvement rate more than 50%). T test was used to compare the parameters of spine and pelvis between postoperative group and control group, paired t test was used to evaluate the correlation between preoperative group and postoperative group, and Pearson correlation coefficient was used to evaluate the correlation of each parameter. T test was used to analyze the comparison between the low improvement rate group and the high improvement rate group. Linear regression analysis was used to analyze the relationship between the improvement rate and the parameters. All the data were treated with SPSS18.0. Results 1. There was significant difference between the postoperative group and the preoperative group (P 0.01). The PTT TK of the posterior group was higher than that of the preoperative group. There was a significant difference between the preoperative group and the normal control group (P 0.01). The preoperative group had higher PIL LSSN PTSVA LSJA, while TK was lower than the normal control group (see Table 2, 3. 2). There was a significant difference between the preoperative group and the normal control group, and the Pi value of the preoperative group was higher than that of the control group, and the Pi value of the preoperative group was higher than that of the control group. However, there was no difference in Pi between preoperative and postoperative groups (see Table 2 / 3. 3). Correlation analysis of pelvis parameters between postoperative group and normal control group (1) correlation analysis of each parameter in normal control group (P < 0.01). There was a correlation between SS and LSJA (see Table 4. 2) the correlation between Pi and LSJA was significant before operation, and there was a correlation between Pi and LSJA in the preoperative group, and there was no correlation between the parameters of the control group and the control group (see Table 4. 2) the correlation between the parameters of the control group and the control group was higher than that of the control group (P < 0.01). There was significant correlation between LSJA and SSPT and LL (see Table 4. 3). The correlation between SS and LSJA and LL correlation between SS and LSJAPT and LL were significantly correlated with TK and TK, and SS was significantly correlated with LSJA. Correlation (see table 4, p. 4). The improvement rate of SSLLLLSJASVA in the high improvement rate group was lower than that in the low improvement rate group (P 0.05), while the PTTK was higher than that in the low improvement rate group (see table 5, the improvement rate of the Oswestry score and the correlation between the parameters and the improvement rate of SSLLLSJA was significantly correlated with the improvement rate of the Oswestry score. The correlation of LSJA is the most significant (see Table 6). Conclusion 1. The joint action of multiple parameter anomalies in the sagittal position of the spine and pelvis, High Pi value and LSJA value may be the important cause and cause of spondylolisthesis of isthmus spondylolisthesis. 3. Operation can improve the balance of spine and improve the score of LSJA and Oswestry in patients with isthmic spondylolisthesis. There is a significant improvement rate of LSJA and Oswestry score in patients with isthmic spondylolisthesis. Therefore, these parameters should be evaluated before operation, The parameters mentioned above should be adjusted during the operation to achieve the best operative effect. The improvement of these parameters can be used to predict the prognosis of the patients after operation.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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