腰椎行双源CT连续动态扫描评价腰椎不同曲度对椎间孔和椎间盘的影响

发布时间：2018-06-17 09:02

本文选题：腰椎间盘突出症 + 椎间盘　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:对腰椎间盘突出症患者腰椎行双源CT连续动态扫描观察腰椎间盘突出与腰椎椎间孔的变化情况。方法:选择40名常规CT已经确诊L4-5节段腰椎间盘突出症的患者利用双源CT(Siemens somatom definition flash CT)采用VPC Dynmuti 4D方式扫描得到腰椎从屈曲位20度到背伸位20度运动过程中不同时间分辨率的DICOM图像文件。将图像导入Inspace工作站后以L4-5节段矢状位Cobb角的测量方法确定腰椎进行连续动态扫描过程中腰椎的曲度,分别测量L4-5椎体在运动过程中和静止仰卧位椎间盘突出情况和椎间孔面积,并分析在运动过程中椎间孔和椎间盘突出的改变情况和两者的相互关系。结果:1.40名腰椎间盘突出患者在进行从屈曲位到背伸位运动过程中,L4-5椎间盘后缘突出程度逐渐增加,从中立位向过屈位运动时L4-5节段椎间盘突出程度变化更加明显(Table 1)。腰椎屈曲运动过程中每屈曲10°椎间盘突出减少约0.87±0.26mm;腰椎伸展运动过程中每伸展10°椎间盘突出增加约1.24±0.45mm。2.40名患者全部诊断为L4-5腰椎间盘突出症,测量其L4-5节段不同曲度变化时的椎间孔面积情况(Table 2)。腰椎运动过程中,每伸展10°其椎间孔面积比仰卧位静态扫描时平均减小约8.02±0.34 mm2;屈曲运动时腰椎屈曲10°位置时90%患者椎间孔面积比常规仰卧位扫描时减小约6.72±0.23mm2;屈曲20°时,82%患者L4-5节段椎间孔面积比静态扫描时大约7.02±0.15 mm2;18%患者在屈曲20°时椎间孔面积没有变化。从腰椎不同曲度椎间孔面积可知突出的椎间盘在腰椎进行屈伸运动时对椎间孔的影响是有差异的,伸展位可造成椎间孔变小,但向过屈位运动时可能会造成椎间孔面积变大或变小。结论:1.双源CT腰椎连续动态扫描可以应用于腰椎间盘突出症常规CT扫描阴性的患者或者是常规CT扫描结果与临床症状差异较大的患者。2.腰椎间盘突出患者在腰椎在屈曲位时,其椎间盘突出程度要小于中立位时的程度,而腰椎在伸展位时其椎间盘突出程度大于中立位时,可以通过腰椎不同曲度对腰椎间盘突出情况做尽可能准确的判断,而且对于腰椎间盘突出症责任椎的确定也有指导意义。3.双源CT腰椎连续动态扫描能够更准确的显示出腰椎椎间盘突出和腰椎神经、血管和椎间孔改变以及三者直接的解剖关系,对腰椎间孔狭窄的变化情况评估也更全面、更直观,也为对腰椎退行性疾病进行治疗时选择植入人工间盘或腰椎融合术时植入的Cage的高度以恢复相对正常的椎间孔面积和椎间相对正常的高度提供了参考依据,可以更深入的认识腰椎间盘突出症,并且可以对腰椎间盘突出症手术进行术前更合理的规划。
[Abstract]:Objective: to observe the changes of lumbar intervertebral disc herniation and intervertebral foramen in lumbar disc herniation patients with lumbar disc herniation. Methods: 40 patients with L4-5 segment lumbar intervertebral disc herniation diagnosed by conventional CT were examined by dual source CT Siemens somatom definition flash and VPC Dynmuti 4D method was used to obtain lumbar vertebrae motion from flexion position 20 degree to back extension position 20 degree motion at different time. Resolution of the DICOM image file. After the image was imported into Inspace workstation, the curvature of lumbar spine during continuous dynamic scanning was determined by measuring the Cobb angle of L4-5 segment sagittal position. The intervertebral disc herniation and intervertebral foramina area were measured in the motion and static supine position of L4-5 vertebrae, and the changes of intervertebral foramen and intervertebral disc herniation were analyzed. Results during the motion from flexion position to dorsal extension position, the posterior edge of L4-5 disc herniation increased gradually in 1.40 patients with lumbar intervertebral disc herniation, and the change of L4-5 segment disc herniation degree was more obvious when moving from neutral position to overflexion position. During lumbar flexion exercise, 10 掳lumbar disc herniation was reduced by 0.87 卤0.26 mm, and 1. 24 卤0.45mm.2.40 per 10 掳lumbar disc herniation was diagnosed as L4-5 lumbar disc herniation. The area of intervertebral foramen was measured with different curvature of L4-5 segment. During lumbar movement, The area of intervertebral foramen decreased by about 8.02 卤0.34mm-2 per extension of 10 掳, and the area of intervertebral foramen was decreased by 6.72 卤0.23mm2 in 90% of patients with flexion at 10 掳of lumbar flexion, and by 6.72 卤0.23 mm-2 at 20 掳flexion in 82% of patients with L4-5 segment. The area of intervertebral foramen was not changed at 20 掳flexion in 18% of the patients with intervertebral foramina, which was about 7.02 卤0.15 mm ~ 2 ~ (-1) compared with that of static scanning. According to the area of intervertebral foramen of different curvature of lumbar vertebrae, the effect of intervertebral disc on intervertebral foramen is different when the lumbar vertebrae is flexion and extension, and the extension position can cause the intervertebral foramen to become smaller. However, the area of intervertebral foramen may become larger or smaller when it moves to flexion position. Conclusion 1. Dual-source CT continuous dynamic scanning of lumbar spine can be used in patients with lumbar disc herniation with negative conventional CT scan or in patients with different clinical symptoms. The degree of lumbar disc herniation in flexion position of lumbar disc herniation was lower than that in neutral position, and the degree of disc herniation in extension position was greater than that in neutral position. Lumbar disc herniation can be judged as accurately as possible by different curvature of lumbar vertebrae, and the determination of responsibility vertebrae of lumbar disc herniation is of guiding significance. Dual-source CT continuous dynamic scanning of lumbar spine can more accurately display lumbar disc herniation, lumbar nerve, vascular and intervertebral foramen changes and the direct anatomical relationship among them, and evaluate the changes of lumbar intervertebral foramen stenosis more comprehensively and intuitively. It also provides a reference for selecting the height of Cage implanted in artificial disc or lumbar fusion in order to restore the relative normal area of intervertebral foramina and the relative normal height of intervertebral body when treating lumbar degenerative diseases. More in-depth understanding of lumbar disc herniation and more rational preoperative planning for lumbar disc herniation.
【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】：R681.5

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