腰椎棘突间相关形态学研究及Wallis系统置入治疗LDH的临床观察

发布时间：2018-05-18 20:31

本文选题：腰椎间盘突出症 + Wallis　；参考：《桂林医学院》2015年硕士论文

【摘要】：目的:通过CT扫描三维重建技术探讨腰椎棘突间相关区域间接测量方法及其临床意义,为棘突间动态稳定系统置入治疗国人腰椎退行性疾病提供参考数据及临床可行性;探讨棘突间动态稳定系统(Wallis)置入治疗单纯性腰椎间盘突出症的可行性、手术技巧及临床效果分析。方法:(1)利用美国GE64排CT通过对52例非腰椎退行性疾病患者扫描成像进行形态学测量,男性26名,女性26名,均无外伤、肿瘤及腰椎畸形,年龄24-50岁(平均34±4岁),利用PACS系统通过多方位对腰椎棘突间距、棘突顶距、棘突基底高度、棘突上缘厚度、棘突中央厚度、棘突下缘厚度进行测量,以最佳测量角度取值为准,各测量数据均测量三次并取其均值,通过统计学软件SPSS15.0对所得数据进行正态性检验、T检验;(2)2011年9月~2012年9月收治的腰椎间盘突出症患者10例,10例LDH患者均行腰椎后路开窗髓核摘除术并植入Wallis棘突间动态稳定系统固定治疗,观察术前、术后情况并进行VAS评分、下腰痛JOA评分及Oswestry功能障碍指数变化。结果:(1)棘突基底高度(H)、棘突上缘厚度(TS)及棘突中央厚度(TC)P值均小于0.05,男女之间均有统计学意义;棘突间距(DB)男女之间无统计学意义(P0.1);棘突顶距(DA)中L45节段(P=0.370.1),男女差异无统计学意义;L2椎体和L5椎体的棘突下缘厚度(TI)(P=0.630.1,P=0.280.1)男女无统计学意义。男性DB以L23节段距离最大(11.3±2.63mm),L45节段距离最小(7.83±0.92mm),女性以L12节段距离最大(8.63±1.57mm),L34节段距离最小(6.34±1.63mm);男女性DA和H均呈先增大后减小的趋势,男女性DA均以L12节段距离最大,男性H以L3最高(24.38±2.17mm),女性以L4最高(19.52±2.06mm);男女棘突的厚度均呈TITCTS,男性女性,且每一棘突的下缘厚度均值较相对应的下一棘突上缘厚度大;(2)10例患者均获得随访,随访时间3~13个月(平均9±2个月)。术后患者疼痛消失,症状与体征均有明显改善。治疗后视觉模拟VAS评分较术前明显降低(P0.01),下腰痛JOA评分较术前显著增加(P0.01),ODI评分较术前显著降低(P0.01)。结论:(1)各组测量数据值经检验均呈正态性分布,男性棘突间距、棘突顶距、棘突基底高度及棘突厚度均较女性数值大,说明女性棘突和男性棘突相比较具有矮、薄的特点;基本反映了国人腰椎棘突相关区域的解剖特点,同时也为棘突间动态稳定系统的应用提供了参考数据;(2)Wallis棘突间动态稳定系统置入治疗单纯性腰椎间盘突出症的临床效果良好。
[Abstract]:Objective: to explore the indirect measurement method and its clinical significance of interspinous process related area of lumbar spine by three-dimensional CT scan, and to provide reference data and clinical feasibility for interspinous dynamic stabilization system in the treatment of lumbar degenerative diseases in Chinese. To investigate the feasibility, surgical technique and clinical effect of interspinous dynamic stabilization system (Wallis) in the treatment of simple lumbar disc herniation. Methods the morphology of 52 patients with non-lumbar degenerative diseases was measured by GE64 slice CT scan. There were 26 males and 26 females without trauma, tumors and lumbar deformities. Aged 24-50 years (mean 34 卤4 years old), the distance between spinous process, apical distance of spinous process, basal height of spinous process, thickness of superior edge of spinous process, central thickness of spinous process and thickness of inferior edge of spinous process were measured by PACS system. All the measured data were measured three times and their mean values were taken. 10 patients with lumbar disc herniation admitted from September 2011 to September 2012, 10 patients with LDH underwent posterior fenestration of lumbar vertebrae and Wallis interspinous process implantation. Dynamic stabilization system fixation, The changes of VAS score, low back pain JOA score and Oswestry dysfunction index were observed before and after operation. Results the basal height of spinous process, the thickness of superior margin of spinous process and the central thickness of spinous process were lower than 0.05, and there was statistical significance between male and female. There was no statistical difference between male and female (P 0.1), and there was no significant difference between male and female in L45 segment (P < 0. 370.1). There was no significant difference between male and female. There was no significant difference in the thickness of spinous process between male and female, the thickness of spinous process was 0. 630.1 (P = 0. 280.1). The maximum distance between L23 segment and L45 segment was 11.3 卤2.63 mm in males and 7.83 卤0.92mm-1 in L12 segment, and the smallest distance was 6.34 卤1.63 mm in L12 segment in male and female segment, the DA and H of male and female increased first and then decreased, the maximum distance of male and female was L12 segment. The highest value of H in male was L3 (24.38 卤2.17mm-1) and that in female (L4) was 19.52 卤2.06mm.The thickness of spinous process was TITCTS in male and female, and the mean thickness of lower edge of each spinous process was higher than that of the corresponding upper edge of spinous process. The follow-up time was 3 ~ 13 months (mean 9 卤2 months). Postoperative pain disappeared, symptoms and signs improved significantly. After treatment, visual analog VAS score was significantly lower than that before operation (P 0.01), and low back pain JOA score was significantly increased compared with that before operation (P 0.01). Conclusion (1) the measured data were positively distributed in each group. The distance between spinous process, the apical distance of spinous process, the height of spinous process base and the thickness of spinous process were larger in male than in female, indicating that the spinous process of female was shorter and thinner than that of male. It reflects the anatomical characteristics of spinous process in Chinese and provides reference data for the application of interspinous process dynamic stabilization system. The clinical effect of Wallis interspinous process dynamic stabilization system in the treatment of simple lumbar intervertebral disc herniation is good.
【学位授予单位】：桂林医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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