退变性脊柱畸形脊柱柔韧性及矢状面代偿模式的影像学评估

发布时间：2018-06-22 00:33

本文选题：Bending位平片 + 退变性脊柱侧凸　；参考：《东南大学》2015年硕士论文

【摘要】：目的：评价术前Bending位平片对退变性脊柱侧凸(degenerative scoliosis,DS)术后矫形效果的预测能力,并比较Bending位片对预测单纯后路矫形与后路截骨矫形手术效果的差异。方法：65例接受脊柱矫形手术的DS患者纳入研究,选取每位患者的站立位全脊柱正位片、Bending位片,术后立位全脊柱正位片,分别在以上三种平片上测量侧凸主弯的Cobb角,分析术前Bending位片Cobb角与术后立位片Cobb角及弯曲柔韧性(BF)与矫形率(CR)的相关性；根据是否行截骨术,将65例患者分为37例单纯后路矫形组与28例伴截骨矫形组,分别分析两组术前Bending位片Cobb角与术后立位片Cobb角以及BF与CR的相关性。结果：(1)65例患者术前Bending位片Cobb角与术后立位片Cobb角具有明显相关性(r=0.652,p0.001),BF与CR的具有明显相关性(r=0.451,p0.001),平均CR为62.22±14.50%：(2)37例单纯后路矫形患者术前Bending位片Cobb角与术后立位片Cobb角具有明显相关性(r=0.772,p0.001),BF与CR的具有明显相关性(r=0.729,p0.001),平均CR为60.36±14.98%;28例伴有截骨矫形患者术前Bending位片Cobb角与术后立位片Cobb角具有相关性(r--0.596,p=0.001),BF与CR相关性差(r=0.237,p=0.225),平均CR为64.66+13.73%。结论：术前Bending位平片可以预测退变性脊柱侧凸术后矫形效果,其预测单纯后路矫形效果的能力明显优于后路截骨矫形效果的能力。目的：探究椎间盘退变程度对退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)脊柱柔韧性的影响。方法：回顾性分析2008年5月至2014年2月66例诊断为DLS患者的一般资料,其中男性10例,女性56例,平均年龄58.4岁(45-70岁),所有患者均具备完整的影像学资料,包括术前立位全脊柱正位片、Bending位片、胸腰椎磁共振(MRI)等,分别测量术前立位全脊柱正位片主弯Cobb角和椎间角,Bending位片主弯Cobb角和椎间角,根据椎间盘Pfirrmann分级评估记录主弯区间各个椎间盘退变等级,计算脊柱整体柔韧性与各节段柔韧性,分析椎间盘退变等级与脊柱整体柔韧性以及节段柔韧性的相关性。结果：(1)66例DLS患者术前立位片平均主弯Cobb角为35.53。±13.32。,Bending位片平均Cobb角为20.54。±11.42。,平均柔韧性为45.32%±14.97%；共评估记录268个椎间盘的退变等级,其中I级8个,II级68个,Ⅲ级83个,Ⅳ级91个,V级18个；(2)主弯跨度内椎间盘平均退变等级与脊柱整体的柔韧性具有显著相关性(r=-0.727,p0.001)；(3)各节段椎间盘退变等级与相应节段柔韧性具有显著相关性(p0.01)；(4)顶椎区椎间盘相对于其他椎间盘退变程度严重(p0.001),其节段柔韧性也最差(p0.001)。结论：椎间盘退变程度与DLS脊柱柔韧性密切相关,即椎间盘退变越严重,脊柱的柔韧性越差。目的：比较退变性胸腰椎后凸(DTK)与陈旧性胸腰椎骨折后凸(PTK)矢状面代偿模式的差异。方法：回顾性分析2010年6月至2015年2月在我科门诊或在院接受诊疗的32例DTK患者和28例PTK患者一般资料,并纳入30例健康成人作为对照组,90例研究对象中男性42例,女性48例,平均年龄47.2岁(30-70岁),所有研究对象均拍摄立位全脊柱正、侧位平片等相关影像学检查。分别测量三组研究对象矢状位后凸角(KA),胸椎后凸角(TK),腰椎前凸角(LL),骨盆入射角(PI),骨盆倾斜角(PT),骶骨倾斜角(SS)以及矢状位平衡(SVA),比较三组之间以上脊柱骨盆参数的差异。结果：(1)DTK组、PTK组和对照组平均年龄分别为56.0±7.3岁、39.04±8.5岁和45.5±5.5岁,DTK组年龄显著大于其他两组(P0.001)；(2)DTK组TK明显大于PTK组(26.5°±5.8°vs 23.3°±7.8°,P0.05),而DTK组与对照组TK(26.0°±6.3°)无显著差异(P0.05)；(3)DTK组LL、SS(分别23.1°±12.4°,20.4°±7.7°)均明显小于PTK组(分别43.4°±7.8°,30.4°±6.6°)(P0.001);DTK组SVA、PT(分别62.7±17.5mmm,26.1°±11.9°)均明显大于PTK组(分别16.7±7.1mmm,16.7°±8.6°)(P0.001),而PTK组与对照组SVA、PT(分别15.8±7.4mmm,15.4°±6.6°)无显著差异(P0.05)；(4)DTK组与PTK组KA(分别46.7°±12.8°,46.0°±13.8°)无显著差异(P0.05)；DTK组、PTK组和对照组三组PI(分别45.5°±9.7°,46.1°±8.8°,45.1°±8.8°)无显著差异(P0.05)。结论：本组退变性胸腰椎后凸患者表现为腰椎前凸减小,骨盆后旋转,并最终出现躯干前倾的矢状面失代偿；陈旧性胸腰椎骨折后凸患者仅表现为TK减小、骨折椎体为中心的局部后凸,而未发生整体脊柱骨盆参数的代偿。
[Abstract]:Objective: To evaluate the predictive ability of preoperative Bending position for the correction of degenerative scoliosis (DS) after surgery, and to compare the difference of the effect of Bending tablet in predicting the effect of simple posterior orthopedics and posterior osteotomy. 65 cases of DS patients receiving spinal orthopedic surgery were included in the study to select each patient. The standing total spinal column, Bending position, and orthostatic full spine position after operation were used to measure the Cobb angle of the main bending of scoliosis on the above three plain films, and the correlation between the Cobb angle of Bending position and the postoperatively the Cobb angle and the flexural flexibility (BF) and the orthopedic rate (CR) was analyzed. According to whether or not osteotomy was performed, the patients were divided into 37 simple cases. In the posterior orthopedics group and 28 cases with osteotomy, the correlation between the Cobb angle of Bending position before operation and the Cobb angle of the postoperatively, and the correlation between BF and CR were analyzed. Results: (1) there was a significant correlation between the Cobb angles of Bending position and the Cobb angle of the postoperatively in 65 cases (r=0.652, p0.001), and the significant correlation between BF and CR. The average CR was 62.22 + 14.50%: (2), 37 cases of simple posterior orthopedic patients had significant correlation (r=0.772, p0.001) in the Cobb angle of Bending position tablet before operation. BF and CR had a significant correlation (r=0.729, p0.001) and the average CR was 60.36 + 14.98%. 28 cases with osteotomy orthopedics were accompanied by preoperative radiographs and postoperative orthostatic tablets. The angle has correlation (r--0.596, p=0.001), the correlation between BF and CR (r=0.237, p=0.225), the average CR is 64.66+13.73%. conclusion: preoperative Bending bit flat can predict the effect of orthopedic effect after degenerative scoliosis, and its ability to predict simple posterior orthopedic effect is obviously superior to the ability of posterior osteotomy effect. The effect of degree on the flexibility of degenerative lumbar scoliosis (DLS). Methods: a retrospective analysis of 66 cases of DLS from May 2008 to February 2014 was reviewed, including 10 males and 56 females, with an average age of 58.4 years (45-70 years old). All patients had complete imaging data, including preoperative erect. The total spinal column, Bending position, and the thoracolumbar magnetic resonance (MRI) were used to measure the main bend Cobb angle and intervertebral angle of the anterior vertical position of the spinal column, the Cobb angle and the intervertebral angle of the main curve of the Bending position. The degeneration grade of the intervertebral disc in the main bend section was recorded according to the Pfirrmann grading of the intervertebral disc, and the overall flexibility of the spine and the flexiacity of each segment were calculated. The correlation between intervertebral disc degeneration grade and spinal integrity flexibility and segmental flexibility. Results: (1) the average main bend Cobb angle of the preoperative orthostatic film in 66 cases of DLS was 35.53. + 13.32., the average Cobb angle of Bending bit was 20.54. + 11.42. and the average flexibility was 45.32% + 14.97%. The regression grade of 268 intervertebral discs was recorded, of which I was recorded. Grade 8, II level 68, grade III 83, grade IV 91, and V grade 18; (2) the average degeneration level of intervertebral disc in the main curved span has significant correlation with the overall flexibility of the spine (r=-0.727, p0.001); (3) there is a significant correlation between the degeneration grade of the intervertebral disc and the corresponding segment flexibility (P0.01); (4) the intervertebral disc in the apical region is relative to the other intervertebral The degree of disc degeneration is severe (p0.001) and its segment flexibility is the worst (p0.001). Conclusion: the degree of disc degeneration is closely related to DLS spinal flexibility, that is, the more severe the disc degeneration is, the worse the flexibility of the spine. Objective: To compare the difference between the degenerative thoracolumbar kyphosis (DTK) and the old thoracolumbar fracture kyphosis (PTK) sagittal compensatory pattern. Methods: a retrospective analysis of the general data of 32 DTK patients and 28 cases of PTK patients received from June 2010 to February 2015 in our department or in our hospital, and 30 healthy adults as the control group, 90 subjects were male 42, 48 women, and the average age was 47.2 years (30-70 years). All the subjects photographed the orthostatic positive and lateral position of the spine. KA, posterior convex angle of thoracic vertebra (TK), lumbar anterior convex angle (LL), pelvis incidence angle (PI), pelvic inclination (PT), sacral inclination (SS) and sagittal balance (SVA) were measured in three groups of subjects. Results: (1) DTK, PTK and control groups were compared with those of the three groups. The average age was 56 + 7.3 years, 39.04 + 8.5 years and 45.5 + 5.5 years old. The age of DTK group was significantly greater than the other two groups (P0.001), and (2) DTK group TK was significantly greater than PTK group (26.5 + 5.8 / vs 23.3 + 7.8, P0.05), while DTK group and control group were not significantly different (P0.05). Less than group PTK (43.4 + 7.8, 30.4 + 6.6 degrees) (P0.001), SVA, PT (62.7 + 17.5mmm, 26.1 + 11.9 degrees) in group DTK were significantly greater than those in PTK group (16.7 + 7.1mmm, 16.7 + 8.6) (P0.001), while PTK group and control group were SVA, PT (15.8 +, 15.4, 6.6 degrees, respectively); There was no significant difference between 0 and 13.8 degrees (P0.05). There was no significant difference between group DTK, group PTK and control group of three groups (45.5 / 9.7, 46.1, 8.8, 45.1). Conclusion: degenerative thoracolumbar kyphosis showed the decrease of lumbar lordosis, posterior pelvis rotation, and final torso sagittal decompensation; obsolete thoracolumbar Vertebral fracture kyphosis patients showed only TK reduction, fracture vertebral centrally located kyphosis, and no overall spinal pelvic parameters compensation.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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