L4-S1轴向固定单向锁定影像学研究

发布时间：2019-04-01 12:36

【摘要】：目的:通过对国人L4-S1椎进行影像学的测量与数据分析,探讨L4-S1轴向固定单向锁定的可行性及安全性。方法:随机选取湖南省衡阳市南华大学附属第一医院于2013年3月至2014年3月我院门诊腰骶尾椎64排螺旋CT((Philip Brilliance 64,Philips Medical Systems,Netherland)资料,共两百例,分别选取男女性病人各一百例,患者年龄要求在18-60岁之间,排除发育异常、先天性变异、侧弯畸形、结核、外伤、肿瘤、手术史等。对CT资料行三维重建,通过三维重建软件在三维空间中分别在椎弓根锁定平面及在椎体正中矢状面确定理想的锁定通道及轴向固定通道。通过平移、选择、切割等方法在二维空间上测量L4S1椎体相关数据:L4锁定平面椎体宽度(线AB)、S1锁定平面椎体宽度(线DE)、L4锁定点与L4上终板长度(线GC)、L4锁定点与S1锁定点的长度(线CF)、S1锁定点与轴向螺钉进针点的距离(线FJ)、L4椎弓根的宽度(线MN)、S1椎弓根的宽度(线XY)、L4椎弓根高度(线UV)、S1椎弓根高度(线WZ)、L4椎弓根锁定钉在矢状面的头倾角(角α)、L4锁定钉的外侧角(角γ)、S1椎弓根锁定钉在矢状面的头倾角(角β),S1锁定钉外展角(角δ),测量软件对两点之间距离及两线之间长度进行测量,所有数据通过SPSS19.0进行统计分析,检查各数据是否服从正态分布,比较男女之间是否存在差异。结果:男女两组所有测量的指标通过统计学分析示均服从正态分布,男女两组同一指标比较,显示AB、DE、GC、CF、FJ、MN、XY、UV、WZ各数值存在显著性统计学差异,男女两组内线AB与DE、MN与XY、UV与WZ存在显著统计学差异。线DE、线GC、线CF、线FH、线MN的95%可信区间为男女分别为31.59?32.293、29.32?29.98、11.33?12.18 10.52?11.20、60.85?62.54、58.57?59.95、16.84?19.23、14.97?16.20、1 2.52.?12.86、10.66?11.01。角α、角β、角γ、角δ各数值无明显统计学差异。故男女数据合并统计。角α、角β、角γ、角δ最佳角度分别为85.6?90.1、113.7?115.2、45.2?46.3、71.4?72.7。单向锁定螺钉的大小及长度设计提供参考依据。结论:只要单向锁定螺钉经过椎弓根峡部中点对相应椎体中心进行锁定,L4-S1轴向固定单向锁定是安全可行的。通过统计学分析确定的数据能够为L4-S1轴固定螺钉及
[Abstract]:Objective: to investigate the feasibility and safety of axial fixation of L4-S1 vertebrae in Chinese by imaging measurement and data analysis. Methods: two hundred cases of lumbosacral caudate vertebra (64-slice spiral CT (Philip Brilliance 64, Philips Medical Systems,Netherland) were randomly selected from March 2013 to March 2014 in the first affiliated Hospital of Nanhua University, Hengyang City, Hunan Province. One hundred male and female patients with age between 18 and 60 years old were selected, excluding developmental abnormalities, congenital variation, lateral bending malformation, tuberculosis, trauma, tumor, surgical history and so on. Three-dimensional reconstruction of CT data was performed. In three-dimensional space, the ideal locking channel and axial fixation channel were determined in the pedicle locking plane and the median sagittal plane of vertebral body respectively by three-dimensional reconstruction software. L4S1 vertebral body related data were measured in two dimensional space by translation, selection, cutting and other methods: L4 locking plane width (line AB), S1 locking plane width (line DE), L4 locking point and L4 upper end plate length) (line GC),) The length of the L4 locking point and the S1 locking point (the distance between the line CF), S1 locking point and the axial screw entry point (the width of the linear FJ), L4 pedicle (the width of the linear MN), S1 pedicle (the height of the linear XY), L4 pedicle (line UV),) The height of S1 pedicle (angle 伪) of WZ), L4 locking screw on sagittal plane, the lateral angle of L4 locking nail (angle 纬), the head inclination angle of S1 pedicle locking nail on sagittal plane (angle 尾), the outward angle of S1 locking nail (angle 未), the height of S1 pedicle screw (angle 伪), the lateral angle (angle 纬) of L4 locking nail, the angle 尾 of S1 pedicle locking nail in sagittal plane. The distance between two points and the length between two lines were measured by measuring software. All the data were statistically analyzed by SPSS19.0 to check whether the data obeyed normal distribution and to compare the differences between men and women. Results: all the measured indexes in male and female groups obeyed normal distribution by statistical analysis. Compared with the same indexes in male and female groups, there were significant differences in AB,DE,GC,CF,FJ,MN,XY,UV,WZ values between male and female groups. There was significant difference between male and female in AB, DE,MN, XY,UV and WZ. Line DE, Line GC, Line CF, Line FH, The 95% confidence interval (CI) of the line MN was 31.59 脳 32.293,29.32 / 29.98, 11.33 / 12.18 10.52 / 11.20, 60.85 / 62.54, 58.57 / 59.95,16.84 / 19.23, 14.97 / 16.20, 1,2.52 /? 12.86,10.66?11.01. There was no significant difference in angle 伪, angle 尾, angle 纬 and angle 未 values. Therefore, the combination of male and female data statistics. The optimum angles of angle 伪, angle 尾, angle 纬 and angle 未 were 85.6? 90.1113.7? 115.2, 45.2? 46.3, 71.4? 72.7, respectively. The design of the size and length of unidirectional locking screw provides reference basis. Conclusion: L4-S1 axial fixation is safe and feasible as long as unidirectional locking screws lock the corresponding vertebral center through the midpoint of the pedicle isthmus. The data determined by statistical analysis can be used for L4-S1 shaft fixation screws and
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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