双源CT下观察腰椎融合术后相邻节段椎间盘的运动变化与退变的关系

发布时间：2018-06-12 04:37

本文选题：双源CT + MRI表现　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:目前,关于腰椎在不同静态体位(前屈、后伸、侧屈、旋转)对椎间盘影响的相关文献较多,研究主要针对其生物力学方面的测试。但对于腰椎在某一个方向运动过程中椎间盘的细微变化方面的相关研究较少,其主要原因一方面是受于测量仪器的限制,另一方面是多方面因素可能影响相邻节段椎间盘退变。随着国内对双源CT的引进,为我们在研究腰椎运动状态下各个结构的相互关系及运动变化,提供了方便。本文选择对2009年6月—2012年5月在我院应用腰椎融合术治疗腰椎间盘突出症的52例患者进行了随访,回顾性分析腰椎在运动过程中相邻节段椎间盘高度变化,来指导患者术后对脊柱的保护。随访观察L4/5椎间融合术后相邻节段椎间盘(L3/4、L5/S1)的运动变化,分析椎间盘的运动变化与退变的相关性。实验设计、实验时间及地点、研究对象的选择及纳入的病例:2012年5月—2014年6月在河北医科大学附属石油临床学院完成。方法:实验对象:选择2009年6月—2012年5月在河北医科大学附属石油临床学院就诊,主因腰椎间盘突出症,病史在3年左右经保守治疗无效行腰椎融合内固定术的患者52例作为手术组,男性16例,女性36例,年龄:39-60岁,平均年龄:49.5岁。根据样本量计算门诊选50例腰椎间盘突出患者作为非手术组,病史3年经保守治疗且行MRI检查,男性13例,女性37例,年龄:35-62,平均年龄:48.5岁。通过手术组与非手术组比较,应用双源CT观察术后相邻节段椎间盘在前屈过程(前凸Cobb角30°-60°)中运动变化,并通过MRI影像学表现,探究相邻节段椎间盘的运动变化与椎间盘退变的关系。观测指标:根据VAS评分评估手术组和非手术组腰椎在双源CT检查前及检查中的情况。腰椎在前屈运动过程中椎间盘高度的变化,根据Pfirrmann分级标准评估椎间盘的退变情况。结果:1 L3/4椎间盘的高度变化:腰椎前凸Cobb角在45°-50°运动过程中,L3/4椎间盘的高度丢失最明显,手术组2.205±0.053mm,非手术组0.875±0.036mm,其它运动角度手术组和非手术组的L3/4椎间盘高度变化不明显。L5/S1椎间盘高度变化:腰椎前凸Cobb角在30°-60°全程运动过程中,手术组比非手术组椎间盘高度降低幅度无差别。2手术组和非手术组均出现邻近节段椎间盘退变,其中手术组L3/4椎间盘出现II级以上退变的有33例,非手术组L3/4椎间盘出现II级以上退变的有16例。3椎间盘高度变化明显与退变程度有关系,II级以上退变L3/4椎间盘高度变化更明显,I、II级退变者L3/4椎间盘高度变化不明显。4手术组和非手术组在双源CT检查前及检查中的VAS评分差分别为(0.35±0.05)和(0.66±0.06),前屈运动过程中无症状加重表现,且L3/4椎间盘在45°—50°前屈运动与VAS评分无相关性。结论:腰4/5椎间融合术后,腰椎前凸Cobb角在45°-50°运动过程中,腰3/4椎间盘椎间盘高度变化明显,存在异常活动,且与其退变存在相关性,但这种异常活动与腰椎VAS评分无相关性。
[Abstract]:Objective: at present, there are many literatures about the effect of lumbar vertebrae in different static postures (flexion, extension, lateral flexion, rotation) on intervertebral disc. However, there are few researches on the subtle changes of lumbar intervertebral disc in a certain direction, which is mainly due to the limitation of measuring instruments on the one hand, and the influence of many factors on the degeneration of adjacent segments of intervertebral disc on the other hand. With the introduction of dual-source CT in China, it is convenient for us to study the interrelation and motion change of each structure under the condition of lumbar vertebrae motion. 52 patients with lumbar disc herniation treated by lumbar fusion from June 2009 to May 2012 were followed up. The changes of lumbar disc height in adjacent segments during lumbar movement were analyzed retrospectively. In order to guide patients after the protection of the spinal column. The motion changes of adjacent segments of intervertebral disc after L4 / 5 intervertebral fusion were observed and the correlation between the motor changes and degeneration of the intervertebral disc was analyzed. The experimental design, experimental time and place, the selection of the subjects and the cases included: from May 2012 to June 2014, they were completed in the affiliated Petroleum Clinical College of Hebei Medical University. Methods: the subjects were selected from June 2009 to May 2012 at the Petroleum Clinical College affiliated to Hebei Medical University. The main cause of lumbar disc herniation was lumbar disc herniation. 52 patients with a history of 3 years or so who failed to perform lumbar fusion and internal fixation were selected as the operation group. There were 16 males and 36 females, aged from 30 to 60 years, with an average age of 49.5 years. Fifty patients with lumbar disc herniation were selected as non-operative group according to the sample size. The patients had a history of conservative treatment and MRI examination for 3 years. There were 13 males and 37 females, age: 35-62, mean age: 48.5 years. The motion changes of adjacent intervertebral discs (30 掳-60 掳of Cobb angle) were observed by dual-source CT in the operation group and non-operative group, and MRI findings were used. To explore the relationship between the motion changes of adjacent segments of intervertebral disc and the degeneration of intervertebral disc. Outcome measures: according to the VAS score, the lumbar vertebrae in the operation group and non-operative group were evaluated before and after dual source CT examination. The changes of lumbar disc height during anterior flexion were evaluated according to the Pfirrmann classification criteria. Results the height changes of the intervertebral disc of 1 / L / 3 / 4: the height loss of L3 / 4 intervertebral disc was most obvious during 45 掳-50 掳motion of Cobb angle of lumbar kyphosis. 2.205 卤0.053mm in the operation group and 0.875 卤0.036mm in the non-operative group. There was no significant change in L3 / 4 intervertebral disc height between the operation group and the non-operative group. The L5 / S1 intervertebral disc height changed significantly: the lumbar kyphosis Cobb angle was 30 掳-60 掳during the whole course of exercise. The intervertebral disc height of the operation group was lower than that of the non-operative group. 2 there was no difference between the operation group and the non-operative group. Among them, 33 cases of the L3 / 4 disc in the operation group had grade II degeneration. In the non-operative group, 16 patients with L3 / 4 disc degeneration above grade II had significant correlation with the degree of degeneration. The changes of L3 / 4 intervertebral disc height were more obvious in the patients with grade II degeneration than in the patients with grade II degeneration. The changes of intervertebral disc height were unknown in the patients with grade II degeneration of L3 / 4 intervertebral disc. The difference of VAS score before and during dual-source CT examination was 0.35 卤0.05 and 0.66 卤0.06 respectively in the operation group and the non-operative group, and the asymptomatic exacerbation was observed in the anterior flexion exercise process, the difference of VAS between the two groups was 0.35 卤0.05 and 0.66 卤0.06, respectively. There was no correlation between L 3 / 4 disc flexion and VAS score at 45 掳- 50 掳. Conclusion: after lumbar 4 / 5 intervertebral fusion, during 45 掳-50 掳movement of Cobb angle of lumbar kyphosis, the height of lumbar intervertebral disc in 3 / 4 of lumbar vertebrae changes obviously, and there is a correlation between abnormal activity and degeneration, but there is no correlation between this abnormal activity and VAS score of lumbar vertebrae.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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