下腰椎椎弓根高度与宽度差及椎弓根轴线的3D-CT观察

发布时间：2018-06-01 01:37

本文选题：腰椎椎弓根 + CT重建　；参考：《西南医科大学》2016年硕士论文

【摘要】：目的:观察下腰椎(L_(3-5))椎弓根最狭窄处椎弓根高度(Pedicle Outer Height,POH)与椎弓根宽度(Pedicle Outer Width,POW)差值(Pedicel Difference,PD)、椎弓根冠状面长轴与正中矢状面夹角(Coronal inclination,CI)的变化规律,探讨下腰椎椎弓根螺钉置钉与椎弓根形态的匹配性。方法:选取西南医科大学附属医院脊柱外科2015年7月1日~2015年9月30日在我院放射科行全腹增强CT及腰部CT+三维重建的人群作为测量对象,最终选取115例共690个椎弓根,男80例,女35例,男性组,年龄18~78岁平均48.4±14.2岁;身高145~178cm平均167.2±6.1cm;体重44~86kg平均63.7±10.0kg。女性组,年龄18~82岁平均48.20±14.4岁;身高141~163cm平均154.4±4.5cm;体重38~71kg平均54.3±8.9kg。均采用64排螺旋CT从L_3-S1连续扫描,扫描的原始图像传至图像后处理ADW4.4工作站中,运用多平面重建(multiplanar reconstruction,MPR)技术获得椎弓根峡部的横断面和冠状面形态,在其最佳层面观察测量L_3到L_5椎弓根最窄处POW、POH,计算PD,测量CI值。将性别分为男、女两组;年龄分为≤60岁、60岁两组;身高分为≤160cm、160cm两组;体重指数(Body Mass Index,BMI)分24、≥24两组。观察每组各脊椎椎弓根高度与宽度及其差值、椎弓根最窄处冠状面轴线与矢状中线的夹角(ci)的变化规律;每个脊椎椎弓根对应的高度与宽度差值(pd)0mm百分比;椎弓根宽度或高度7mm的百分比。运用microsoftofficeexcel2003和spss17.0软件进行数据统计分析,各脊椎椎弓根高度与宽度差值间、椎弓根冠状面轴线夹角间的对比分析采用两两比较q检验和单因素方差分析(one-wayanalysisofvariance,anova)。结果:本研究收集115例共690个椎弓根,其中男性80例480个椎弓根、女性35例210个椎弓根。统计结果显示各对应脊椎从l3到l5左右两侧poh、pow、pd及ci均无显著性差异(p0.05)。(1)患者下腰椎(l3-5)各对应脊椎poh分别为:l3(12.5±1.4mm)、l4(11.1±1.5mm)、l5(10.4±1.5mm),l3l4l5。pow分别为:l3(8.3±1.6mm)、l4(10.1±1.7mm)、l5(14.1±2.2mm),l3l4l5。pd分别为:l3(4.1±1.9mm)、l4(0.9±1.9mm)、l5(-3.8±2.2mm),最大值在l3:9.1mm;最小值在l5:-12.2mm,l3l4l5。ci分别为:l3(18.1±9.8°)、l4(36.5±9.6°)、l5(43.3±6.5°),最大值在l5:66.2°;最小值在l3及l4:0°,l3l4l5。(2)椎弓根高度与宽度差值(pd)0mm的百分比从l3到l5依次为:2.6、28.3、96.1。(3)从l3到l5脊椎所有poh均大于7mm,pow7mm的百分比从l3到l5依次为:男性:10.3、1.7、0。女性:14.2、2.7、0。在性别、年龄、身高、体重指数分组中,男性各脊椎pd值均小于女性,男性ci平均值均大于女性,但无显著性差异(p≥0.05);pd及ci与性别、年龄、身高、体重相关性无统计学意义(p≥0.05),椎节间差异明显,从l3到l5各对应脊椎pd、ci经两两比较,有统计学差异(p0.05)。结论:1、下腰椎椎弓根PD从L_3到L_5分别为:L_3(4.1±1.9mm)、L_4(0.9±1.9mm)、L_5(-3.8±2.2mm);L_3L_4L_5,且女性PD均大于男性,整体表明在下腰椎女性的POH与POW的变异较男性大。PD与年龄、身高、体重均无明显相关性,椎节是影响PD的重要因素。2、在下腰椎CI分别为:L_3(18.1±9.8°)、L_4(36.5±9.6°)、L_5(43.3±6.5°),L_3L_4L_5,CI与性别、年龄、身高、体重均无明显相关性,椎节是影响CI的重要因素。3、椎弓根高度与宽度差值(PD)0mm的百分比从L_3到L_5逐渐增大分别为:2.6、28.3、96.1,当该差值0mm时,选择螺钉直径应以椎弓根高度为准。4.本研究发现从L_3到L_5脊椎所有POH均大于7mm,POW7mm的百分比从L_3到L_5依次为:12.3、2.2、0。POW小于7mm的比例,女性明显多于男性。
[Abstract]:Objective: To observe the variation of the difference between the pedicle height (Pedicle Outer Height, POH) and the width of the pedicle (Pedicle Outer Width, POW) (Pedicel Difference, PD) and the angle between the long axis of the pedicle and the median sagittal plane of the pedicle of the lower lumbar pedicle (L_ (3-5)), and to explore the pedicle screw and the vertebral arch of the lower lumbar vertebrae. Methods: in the Department of spinal surgery of the Affiliated Hospital of Southwest Medical University in July 1, 2015 ~2015 September 30th ~2015 years in the Department of Radiology, the total abdominal enhancement of CT and the 3D reconstruction of CT+ in the waist were taken as the measurement object. Finally, 115 cases of 690 pedicles were selected, including 80 males, 35 females, male groups, and the average age of 48.4 + 14.2 years old. The average height of 145~178cm was 167.2 + 6.1cm, the average weight of 44~86kg was 63.7 + 10.0kg., the average age was 48.20 + 14.4 years old, the average height 141~163cm was 154.4 + 4.5cm, the average weight 38~71kg was 54.3 + 8.9kg., and 64 rows of spiral CT were scanned from L_3-S1 continuous. The original image of the scan was transmitted to the image post processing ADW4.4 workstation, and the multiplane reconstruction was used. (multiplanar reconstruction, MPR) technique obtained the transverse and coronal shape of the pedicle isthmus. At its best level, we measured the narrowest location of L_3 to L_5 pedicle POW, POH, and calculated PD, and measured the CI values. The sex was divided into male and female two groups; age was divided into less than 60 years, 60 years old and two groups; height was divided into 160cm, 160cm two groups; mass index (Body) BMI) was divided into groups of 24, 24 and two groups. The height and width of Shiumi Ne's spine in each group and the difference between the coronal axis and the sagittal line (CI) were observed, and the difference between the height and width of the spine (PD) 0mm in each spine, and the percentage of the width of Shiumi Ne (PD), and the percentage of 7mm in the width of Shiumi Ne were used. SPSS17.0 software was used for data statistical analysis, the difference between the vertebral pedicle height and width, and the comparative analysis of the angle between the pedicle coronal axis and the angle of the coronal axis of the vertebral arch by 22 comparison Q test and single factor analysis of variance (one-wayanalysisofvariance, ANOVA). Results: This study collected 690 pedicles, including 80 males and 480 pedicle roots. There were 210 vertebral pedicles in 35 cases. The statistical results showed that there were no significant differences in the corresponding vertebrae from L3 to about L5, pow, PD and CI (P0.05). (1) the lower lumbar vertebrae (L3-5) of the lower lumbar (L3-5) corresponding vertebra poh were L3 (12.5 + 1.4mm), L4 (8.3 + 10.4), 8.3 (10.1 +), 14.1 + L3 (4.1 + 1.9mm), L4 (0.9 + 1.9mm), L5 (-3.8 + 2.2mm), the maximum value in l3:9.1mm; the minimum value is l5:-12.2mm, and l3l4l5.ci is L3 (18.1 + 9.8 degrees), L4 (36.5 + 9.6), 43.3 + 6.5 degrees, and the minimum value of the difference between the height and width of the pedicle (2) All poh of 6.1. (3) from L3 to L5 were greater than 7mm, and the percentage of pow7mm from L3 to L5 was as follows: male: 10.3,1.7,0. female: 14.2,2.7,0. in sex, age, height, body mass index group, the PD value of all vertebrae in male is smaller than that of women, and the average value of male CI is greater than that of women, but there is no significant difference (0.05). There was no significant difference in weight correlation (P > 0.05), there was a significant difference in intervertebral space between L3 and L5, and there was a statistical difference between L3 and L5 (P0.05). Conclusion: 1, the PD from L_3 to L_5 in the lower lumbar vertebrae is L_3 (4.1 + 1.9mm), L_4 (0.9 +), and females are all larger than men, and the whole show in the lower lumbar spine The variation of POH and POW in women has no significant correlation with age, height and weight, and vertebra node is an important factor affecting PD,.2 in the lower lumbar CI: L_3 (18.1 + 9.8 degrees), L_4 (36.5 + 9.6 degrees), L_5 (43.3 + 6.5 degrees), L_3L_4L_5, CI and sex, age, height and weight, and vertebra node is an important factor affecting CI. The percentage of the height and width difference (PD) 0mm of the arch root gradually increased from L_3 to L_5, respectively: 2.6,28.3,96.1. When the difference was 0mm, the diameter of the screw should be determined by the height of the pedicle of the vertebral arch as a quasi.4.. All POH from L_3 to L_5 were larger than 7mm. More than men.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

【相似文献】