颈椎椎板夹角测量与发育性椎管狭窄的相关性及在脊髓型颈椎病中的价值
发布时间：2019-06-17 21:51
【摘要】：目的:测量颈椎椎板夹角,探讨其差异性及与发育性颈椎管狭窄和脊髓型颈椎病的相关性,以及在伴有发育性颈椎管狭窄的脊髓型颈椎病中的应用价值及临床意义,寻找另一种判断脊髓型颈椎病椎管狭窄程度的测量指标,为临床评价脊髓型颈椎病病人脊髓的功能以及手术治疗提供参考。方法:1选取C3-C6干燥标本10个,CT扫描并重建,测量其上、下椎板夹角,行单样本komogorov-smimov检验是否为正态分布,并与测得的椎管矢状径/椎体矢状径及椎管矢状径做线性双变量Pearson或Spearman相关性分析;2测量15例“正常人”C3-C6椎板夹角、X线椎管矢状径/椎体矢状径、CT椎管矢状径/椎体矢状径及CT椎管矢状径,其中男性8例,女性7例,年龄35-76岁之间,平均56.1岁,行单样本komogorov-smimov检验是否为正态分布,行椎板夹角与X线椎管矢状径/椎体矢状径、CT椎管矢状径/椎体矢状径及CT椎管矢状径线性双变量Pearson或Spearman相关性分析,椎板夹角性别差异性分析行Levene检验男、女椎板夹角均数方差齐性检验并行单样本均数t检验,单因素方差分析每节段椎板夹角的差异性并两两比较;3测量60例脊髓型颈椎病患者C3-C6椎板夹角、X线椎管矢状径/椎体矢状径、CT椎管矢状径/椎体矢状径及CT椎管矢状径,其中男性32例,女性28例,年龄33-73岁之间,平均54.05岁,行单样本komogorov-smimov检验是否为正态分布,行椎板夹角与X线椎管矢状径/椎体矢状径、CT椎管矢状径/椎体矢状径及CT椎管矢状径线性双变量Pearson或Spearman相关性分析,椎板夹角性别差异性分析行Levene检验男、女椎板夹角均数方差齐性检验并行单样本均数t检验,行线性双变量Pearson或Spearman相关性分析分析椎板夹角与JOA的相关性;4行总体(“正常人”+脊髓型颈椎病患者)采用Levene检验椎板夹角均数方差齐性检验并行性别差异性单样本均数t检验;“正常人”与脊髓型颈椎病患者之间的差异性单样本均数t检验,以CT比值为自变量、椎板夹角为因变量直线回归分析病人、正常人的椎板夹角与CT比值的线性关系;5所有数据均采用SPSS19.0软件进行统计学处理,所有数据采用均数x±标准差s表示,确定P0.05为差异有显著性。结果:1标本测量结果:CT椎管矢状径/椎体矢状径a/b=0.978±0.035,CT线椎管矢状径a=14.220±0.369,上椎板夹角α1=96.630°±2.691°、下椎板夹角α2=86.545°±5.444°及均值α=91.588°±3.385°;其中a/b与α2、α呈负相关,r分别为-0.947、-0.903,接近1,可信度较高。2“正常人”测量结果:X线椎管矢状径/椎体矢状径a/b=0.945±0.059,CT椎管矢状径/椎体矢状径a/b=0.840±0.059,CT椎管矢状径a=13.593±1.144,椎板夹角α=97.103°±2.364°;X线比值a/b、CT比值a/b、CT椎管a与α均呈负相关,r值分别为-0.843、-0.751、-0.33,但CT线椎管矢状径a与椎板夹角α相关系数r绝对值0.33小于0.4,可信度不高。男、女α均数分别为97.43°±2.22°、96.73°±2.50°,椎板夹角差异性比较P=0.252,男女无显著性差异。C3-6椎板夹角单因素方差分析P于0.428与1之间,无显著性差异。3脊髓型颈椎病患者测量结果:X线椎管矢状径/椎体矢状径a/b=0.780±0.092,CT椎管矢状径/椎体矢状径a/b=0.689±0.084,CT椎管矢状径a=11.784±1.189,椎板夹角α=109.534°±7.921°;X线比值a/b、CT比值a/b、CT椎管a与α均呈负相关,r值分别为-0.724、-0.690、-0.698。男、女α均数分别为109.16°±8.03°、109.97°±7.81°,椎板夹角差异性比较P=0.431,男女无显著性差异。JOA评分为11.067±2.493,α与JOA评分呈负相关,r值为-0.785。4总体(“正常人”+脊髓型颈椎病患者)男女板夹角均值分别为106.81°±8.64°、107.32°±8.84°,P=0.617,男女无显著性差异。病人、正常人夹角均数分别为109.53°±7.92°、97.10°±2.36°,P=0,病人椎板夹角度数大于正常人椎板夹角度数。脊髓型颈椎病患者、正常人的椎板夹角与CT比值的线性关系经Pearson检验,P均为0,线性方程分别为y°=-64.961x+154.276°,y°=-29.546x+121.922°。结论:1椎板夹角α与X线比值、CT比值均呈负相关,可以定量的反映椎管狭窄的程度;2椎板夹角α与CSM患者JOA评分呈负相关,其对CSM患者的脊髓功能的评价亦有重要的临床意义;3CSM患者、正常人的椎板夹角与CT比值均有直线关系,对颈椎后路开门手术有一定的指导作用。但本研究仍有不足之处,仍需进一步探讨研究。
[Abstract]:Objective: To study the angle of the cervical lamina of the cervical spine, to study the difference and the relationship with the development of cervical spinal stenosis and cervical spondylotic myelopathy, and to the value and clinical significance of the application of the cervical spondylotic myelopathy with the development of cervical spinal stenosis. In order to provide a reference for the clinical evaluation of the function of the spinal cord and the surgical treatment of the cervical spondylotic myelopathy. Methods:10 samples of C3-C6 dried specimen were selected, CT was scanned and reconstructed, the included angle of the upper and lower lamina was measured, and the single-sample komogorov-smimpov was examined for normal distribution, and the linear bivariate Pearson or Spearman-related analysis was performed with the measured sagittal diameter and the sagittal diameter of the vertebral body and the sagittal diameter of the vertebral canal. 2. The included angle of 15 cases of "normal person" C3-C6, the sagittal diameter of the vertebral canal of the X-ray, the sagittal diameter of the vertebral body, the sagittal diameter of the vertebral canal of the vertebral canal, the sagittal diameter of the vertebral body and the sagittal diameter of the vertebral canal of the CT were measured. The included angle of the lamina and the sagittal diameter of the X-ray, the sagittal diameter of the vertebral body, the sagittal diameter of the vertebral canal of the CT, the sagittal diameter of the vertebral body, the linear bivariate Pearson or Spearman correlation between the sagittal diameter of the vertebral canal and the sagittal diameter of the CT, the gender difference of the angle between the vertebral plates and the Levene test male, The included angle of the women's lamina was the same as that of the parallel single-sample, and the difference of the included angle of each section of the single-factor analysis of variance was compared with that of each section. The included angle of the C3-C6, the sagittal diameter of the X-ray and the sagittal diameter of the vertebral body were measured in 60 cases of cervical spondylotic myelopathy. The sagittal diameter of the vertebral canal and the sagittal diameter of the vertebral body and the sagittal diameter of the CT vertebral canal,32 of the male and 28 in the female, and the age of 33 to 73 years, were the average of 54.05 years. The single-sample komogorov-smimov test was normal, and the included angle of the lamina and the sagittal diameter of the X-ray vertebral canal and the sagittal diameter of the vertebral body were determined. The analysis of the correlation between the sagittal diameter of the vertebral canal and the sagittal diameter of the vertebral body and the linear double-variable Pearson or Spearman in the sagittal diameter of the CT, the analysis of the gender difference of the lamina angle, the level of the included angle of the female and the laminae were examined by the parallel single-sample averaging t. A linear bivariate Pearson or Spearman correlation analysis was performed to analyze the correlation between the angle of the lamina and the JOA, and the four-line overall ("normal person" + cervical spondylotic myelopathy) used the Levene to test the mean square angle of the lamina to test the average number of samples of the parallel sex difference. The difference between the "normal person" and the patients with cervical spondylotic myelopathy is t-tested, the CT ratio is the independent variable, the angle of the lamina is the linear regression of the variable, the linear relationship between the angle of the lamina of the normal person and the CT ratio is analyzed, and all the data is subjected to statistical processing by using the SPSS19.0 software. All data were expressed by mean-number x-standard deviation s, and it was determined that the difference was significant. Results:1 The results of the measurement: The sagittal diameter of the vertebral canal/ the sagittal diameter of the vertebral body is a/ b = 0.978-0.035, the sagittal diameter of the CT line is a = 14.220-0.369, the included angle of the upper lamina is 1 = 96.630 掳, 2.691 掳, the angle of the lower lamina is 2 = 86.545 掳, 5.444 掳, and the mean value is 91.588 掳 and 3.385 掳; where a/ b is negatively related to the ratio of 2 and 2, r is-0.947,-0.903, close to 1, the confidence is high.2. "normal person" measurement results: the sagittal diameter of the X-ray vertebral canal/ the sagittal diameter of the vertebral body is a/ b = 0.945-0.059, the sagittal diameter of the CT vertebral canal/ the sagittal diameter of the vertebral body is a/ b = 0.840-0.059, the sagittal diameter of the CT vertebral canal is a = 13.593-1.144, the angle of the lamina is equal to 97.103--2.364-degree, and the X-ray ratio a/ b, There was a negative correlation between CT ratio a/ b and CT spinal canal a. The r value was-0.843,-0.751,-0.33, but the absolute value of the correlation coefficient r between the sagittal diameter a and the lamina angle of the CT line was less than 0.4 and the reliability was not high. The mean number of female and female was 97.43 掳, 2.22 掳, 96.73 掳 and 2.50 掳 respectively. The difference of the angle of the lamina was P = 0.252, and there was no significant difference between men and women. There was no significant difference between the angle of the C3-6 lamina and the one-factor analysis of variance, P was between 0.428 and 1. The results of the measurement of the cervical spondylotic myelopathy were as follows: the sagittal diameter of the X-ray vertebral canal/ the sagittal diameter of the vertebral body a/ b = 0.780-0.092, the sagittal diameter of the vertebral canal of the CT and the sagittal diameter of the vertebral body a/ b = 0.689-0.084, the sagittal diameter of the CT vertebral canal a = 11.784-1.189, The angle of the lamina was 109.534 掳 and 7.921 掳, the ratio of the X-ray a/ b, the CT ratio a/ b and the CT-spinal canal a were negative and the r-value was-0.724,-0.690,-0.698, respectively. The mean number of female and female was 109.16 掳, 8.03 掳, 109.97 掳 and 7.81 掳 respectively. The difference of the angle of the lamina was P = 0.431, and there was no significant difference between men and women. The mean value of JOA was 11.067-2.493, with a negative correlation with the JOA score, and the r-value of-0.785.4 (normal person "+ cervical spondylotic myelopathy) was 106.81 掳, 8.64 掳, 107.32 掳, 8.84 掳, P = 0.617, and there was no significant difference between men and women. The included angle of the patient and the normal person was 109.53 掳, 7.92 掳, 97.10 掳 and 2.36 掳, P = 0, and the angle of the included angle of the patient was greater than that of the normal persons. The linear relationship between the angle of the lamina and the CT ratio of the patients with cervical spondylotic myelopathy was examined by Pearson, P was 0, and the linear equation was y 掳 =-64.96x + 154.276 掳, y 掳 =-29.546x + 121.922 掳, respectively. Conclusion: There is a negative correlation between the angle of lamina and the ratio of X-ray and the ratio of CT, which can reflect the degree of spinal stenosis quantitatively. The angle of the lamina of lamina is negatively correlated with the score of JOA in CSM. It is also of great clinical significance to the evaluation of the function of the spinal cord in CSM. There is a linear relationship between the angle of the lamina and the CT ratio of the normal person, and it can guide the operation of the posterior open-door of the cervical vertebra. However, there is still some deficiency in this study and still need to be further explored.
【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
本文编号：2501290
[Abstract]:Objective: To study the angle of the cervical lamina of the cervical spine, to study the difference and the relationship with the development of cervical spinal stenosis and cervical spondylotic myelopathy, and to the value and clinical significance of the application of the cervical spondylotic myelopathy with the development of cervical spinal stenosis. In order to provide a reference for the clinical evaluation of the function of the spinal cord and the surgical treatment of the cervical spondylotic myelopathy. Methods:10 samples of C3-C6 dried specimen were selected, CT was scanned and reconstructed, the included angle of the upper and lower lamina was measured, and the single-sample komogorov-smimpov was examined for normal distribution, and the linear bivariate Pearson or Spearman-related analysis was performed with the measured sagittal diameter and the sagittal diameter of the vertebral body and the sagittal diameter of the vertebral canal. 2. The included angle of 15 cases of "normal person" C3-C6, the sagittal diameter of the vertebral canal of the X-ray, the sagittal diameter of the vertebral body, the sagittal diameter of the vertebral canal of the vertebral canal, the sagittal diameter of the vertebral body and the sagittal diameter of the vertebral canal of the CT were measured. The included angle of the lamina and the sagittal diameter of the X-ray, the sagittal diameter of the vertebral body, the sagittal diameter of the vertebral canal of the CT, the sagittal diameter of the vertebral body, the linear bivariate Pearson or Spearman correlation between the sagittal diameter of the vertebral canal and the sagittal diameter of the CT, the gender difference of the angle between the vertebral plates and the Levene test male, The included angle of the women's lamina was the same as that of the parallel single-sample, and the difference of the included angle of each section of the single-factor analysis of variance was compared with that of each section. The included angle of the C3-C6, the sagittal diameter of the X-ray and the sagittal diameter of the vertebral body were measured in 60 cases of cervical spondylotic myelopathy. The sagittal diameter of the vertebral canal and the sagittal diameter of the vertebral body and the sagittal diameter of the CT vertebral canal,32 of the male and 28 in the female, and the age of 33 to 73 years, were the average of 54.05 years. The single-sample komogorov-smimov test was normal, and the included angle of the lamina and the sagittal diameter of the X-ray vertebral canal and the sagittal diameter of the vertebral body were determined. The analysis of the correlation between the sagittal diameter of the vertebral canal and the sagittal diameter of the vertebral body and the linear double-variable Pearson or Spearman in the sagittal diameter of the CT, the analysis of the gender difference of the lamina angle, the level of the included angle of the female and the laminae were examined by the parallel single-sample averaging t. A linear bivariate Pearson or Spearman correlation analysis was performed to analyze the correlation between the angle of the lamina and the JOA, and the four-line overall ("normal person" + cervical spondylotic myelopathy) used the Levene to test the mean square angle of the lamina to test the average number of samples of the parallel sex difference. The difference between the "normal person" and the patients with cervical spondylotic myelopathy is t-tested, the CT ratio is the independent variable, the angle of the lamina is the linear regression of the variable, the linear relationship between the angle of the lamina of the normal person and the CT ratio is analyzed, and all the data is subjected to statistical processing by using the SPSS19.0 software. All data were expressed by mean-number x-standard deviation s, and it was determined that the difference was significant. Results:1 The results of the measurement: The sagittal diameter of the vertebral canal/ the sagittal diameter of the vertebral body is a/ b = 0.978-0.035, the sagittal diameter of the CT line is a = 14.220-0.369, the included angle of the upper lamina is 1 = 96.630 掳, 2.691 掳, the angle of the lower lamina is 2 = 86.545 掳, 5.444 掳, and the mean value is 91.588 掳 and 3.385 掳; where a/ b is negatively related to the ratio of 2 and 2, r is-0.947,-0.903, close to 1, the confidence is high.2. "normal person" measurement results: the sagittal diameter of the X-ray vertebral canal/ the sagittal diameter of the vertebral body is a/ b = 0.945-0.059, the sagittal diameter of the CT vertebral canal/ the sagittal diameter of the vertebral body is a/ b = 0.840-0.059, the sagittal diameter of the CT vertebral canal is a = 13.593-1.144, the angle of the lamina is equal to 97.103--2.364-degree, and the X-ray ratio a/ b, There was a negative correlation between CT ratio a/ b and CT spinal canal a. The r value was-0.843,-0.751,-0.33, but the absolute value of the correlation coefficient r between the sagittal diameter a and the lamina angle of the CT line was less than 0.4 and the reliability was not high. The mean number of female and female was 97.43 掳, 2.22 掳, 96.73 掳 and 2.50 掳 respectively. The difference of the angle of the lamina was P = 0.252, and there was no significant difference between men and women. There was no significant difference between the angle of the C3-6 lamina and the one-factor analysis of variance, P was between 0.428 and 1. The results of the measurement of the cervical spondylotic myelopathy were as follows: the sagittal diameter of the X-ray vertebral canal/ the sagittal diameter of the vertebral body a/ b = 0.780-0.092, the sagittal diameter of the vertebral canal of the CT and the sagittal diameter of the vertebral body a/ b = 0.689-0.084, the sagittal diameter of the CT vertebral canal a = 11.784-1.189, The angle of the lamina was 109.534 掳 and 7.921 掳, the ratio of the X-ray a/ b, the CT ratio a/ b and the CT-spinal canal a were negative and the r-value was-0.724,-0.690,-0.698, respectively. The mean number of female and female was 109.16 掳, 8.03 掳, 109.97 掳 and 7.81 掳 respectively. The difference of the angle of the lamina was P = 0.431, and there was no significant difference between men and women. The mean value of JOA was 11.067-2.493, with a negative correlation with the JOA score, and the r-value of-0.785.4 (normal person "+ cervical spondylotic myelopathy) was 106.81 掳, 8.64 掳, 107.32 掳, 8.84 掳, P = 0.617, and there was no significant difference between men and women. The included angle of the patient and the normal person was 109.53 掳, 7.92 掳, 97.10 掳 and 2.36 掳, P = 0, and the angle of the included angle of the patient was greater than that of the normal persons. The linear relationship between the angle of the lamina and the CT ratio of the patients with cervical spondylotic myelopathy was examined by Pearson, P was 0, and the linear equation was y 掳 =-64.96x + 154.276 掳, y 掳 =-29.546x + 121.922 掳, respectively. Conclusion: There is a negative correlation between the angle of lamina and the ratio of X-ray and the ratio of CT, which can reflect the degree of spinal stenosis quantitatively. The angle of the lamina of lamina is negatively correlated with the score of JOA in CSM. It is also of great clinical significance to the evaluation of the function of the spinal cord in CSM. There is a linear relationship between the angle of the lamina and the CT ratio of the normal person, and it can guide the operation of the posterior open-door of the cervical vertebra. However, there is still some deficiency in this study and still need to be further explored.
【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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