Lenke1型青少年特发性脊柱侧弯胸主动脉与邻近椎体相对位置关系的初步研究

发布时间：2018-05-19 14:52

本文选题：青少年特发性脊柱侧弯 + 主动脉　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:1.探讨青少年特发性脊柱侧弯胸主动脉与邻近椎体的相对位置关系,为临床医师术前评估提供相关信息及指导2.探究CT扫描对青少年特发性脊柱侧弯术前检查的应用价值方法:收集我院2015年12月至2016年12月期间来我院检查、治疗的Lenke1型青少年特发性脊柱侧弯患者14例,先天性脊柱发育畸形、神经肌肉病变或外伤致脊柱侧弯的患者除外。所有患者均有较完整的临床资料,均行站立位全脊柱正侧位X线摄影、全脊柱CT扫描及三维重建。在站立位全脊柱正位X线影像上测量侧弯脊柱的Cobb角,确定顶椎、上端椎、下端椎位置、明确Lenke分型;利用CT三维重建MPR技术重建顶椎椎弓根最粗的层面,以该层面为研究平面,分别过椎弓根轴线做两条直线,交左、右侧横突与O、O’,链接OO’,以此为x轴,以O点为原点,作与x轴向垂直的直线为y轴,建立直角坐标系,连接O与主动脉中心A交主动脉后壁与B点,则OB为主动脉离原点最小距离,OB与y轴间的夹角为主动脉-椎体角,记为α;在原始图像上定位顶椎位置,以顶椎层面椎管与椎体中心的连线与重垂线的夹角为椎体旋转角度β。判断不同性别组间主动脉-椎体角α、椎体旋转角度β、OB值是否存在差异;分别判断年龄与主动脉-椎体角α、椎体旋转角度β、OB值之间是否存在相关性;分别判断主动脉-椎体角α、椎体旋转角度β、OB值与Cobb角之间是否具有相关性。结果:1.不同性别组间主动脉-椎体角α、椎体旋转角度β、OB值的差别无统计学意义,P0.05。2.年龄与主动脉-椎体角α、OB值之间的无显著相关性,年龄与椎体旋转角度β存在轻度相关性。3.Cobb角与主动脉-椎体角α之间的无显著相关性,与OB值之间存在轻度负相关,与椎体旋转角度β中度正相关。结论:1.在Lenke1型青少年特发性脊柱侧弯患者中,性别与胸主动脉位置无明显相关;2.椎体旋转角β和OB值可以作为临床Cobb角测量的有效补充;3.CT扫描可以清楚显示胸主动脉与椎体的相对位置关系,可在术前为临床医师提供手术风险评估及手术入路指导。
[Abstract]:Purpose 1. To explore the relationship between thoracic aorta and adjacent vertebrae in adolescent idiopathic scoliosis, and to provide relevant information and guidance for clinicians in preoperative evaluation. To explore the value of CT scan in preoperative examination of adolescent idiopathic scoliosis: 14 cases of Lenke1 type adolescent idiopathic scoliosis from December 2015 to December 2016 were collected. Patients with congenital spinal deformities, neuromuscular lesions or traumatic scoliosis are excluded. All the patients had complete clinical data. All patients underwent standing position axial and lateral radiography, CT scan and three-dimensional reconstruction. The Cobb angle of scoliosis was measured on the orthographic X-ray images of the standing whole spine, the position of the top, upper and lower vertebrae was determined, and the Lenke classification was determined, and the thickest plane of the pedicle was reconstructed by using the MPR technique of CT three-dimensional reconstruction. Taking this plane as the plane of study, two straight lines are made respectively across the axis of pedicle, the transverse processes of right and left are intersected with OOO, and the OOO is linked to OOO, which is taken as the x axis, with O as the origin, and as the straight line perpendicular to the x axis as y axis, the right angle coordinate system is established. Connecting the posterior wall of aorta with point B, the angle between OB and y axis is the angle of aorta-vertebral body angle, and the position of the parietal vertebrae is located on the original image, the angle between OB and y axis is the angle of aorta and vertebral body, and the position of the parietal vertebrae is located on the original image. The angle between the line between the vertebral canal and the center of the vertebral body and the heavy perpendicular line was taken as the rotation angle of the vertebral body 尾. To determine whether there are differences in Aortic-vertebral body angle 伪, vertebral rotation angle 尾 OB value between different sex groups, and to judge whether there is correlation between age and aortic vertebral body angle 伪, vertebral body rotation angle 尾 OB value, and to determine whether there is a correlation between age and aortic vertebral body angle 伪, vertebral body rotation angle 尾 OB value. The correlation between aorta-vertebral angle 伪, vertebral rotation angle 尾 -OB and Cobb angle was determined. The result is 1: 1. There was no significant difference in Aorta-vertebral body angle (伪) and vertebral rotation angle (尾 -OB) between different sex groups (P0.05.2). There was no significant correlation between age and Aorta-vertebral angle 伪 OB, but there was no significant correlation between age and vertebral rotation angle 尾. 3. There was no significant correlation between age and aorta-vertebral angle 伪, and there was a slight negative correlation between age and OB value. There was a moderate positive correlation with vertebral rotation angle 尾. Conclusion 1. There was no significant correlation between sex and thoracic aortic position in Lenke1 type adolescent idiopathic scoliosis. Vertebral rotation angle 尾 and OB value can be used as an effective supplement for clinical Cobb angle measurement. Ct scan can clearly show the relative position of thoracic aorta and vertebral body, and can provide preoperative risk assessment and surgical approach guidance for clinicians.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.8;R816.8

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