基于量化X线测量技术的手法治疗腰椎不稳症的影像学改变与临床疗效的相关性研究

发布时间：2018-04-24 04:06

本文选题：腰椎不稳症 + 量化X线技术　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:(1)通过动态影像学参数测量及计算,研究椎体追踪算法。(2)通过临床观察和随访,研究手法治疗腰椎不稳的疗效及治疗前后影像学变化。(3)探讨手法治疗腰椎不稳症的临床疗效和动态影像学变化的相关性。方法:选择无锡市中医医院骨伤科自2015年1月至2016年12月符合受试者纳入标准的患者15例。手法治疗前后均行量化X线检查,记录受试者手法前及手法后的功能评分(JOA评分和ODI指数),得出动态影像学资料。对纳入患者进行6个月随访,通过影像学参数测量及计算,验证椎体追踪算法,并根据椎体追踪算法得到的影像学数据,采用相应的统计学方法,比较手法前手法后的功能评分以及影像学数据变化,评价手法治疗腰椎不稳症的疗效;将所有患者手法治疗前后的功能评分与影像学改变进行相关性分析,研究二者之间的相关性。结果:所有符合纳入标准的受试者均完成手法治疗及治疗前后的动态影像学检查,治疗期间未出现不良症状,所有受试患者临床症状均有不同程度缓解。治疗前JOA评分17.67±2.289,治疗后当天 JOA 评分 23.53±2.232,治疗后 6 月 JOA 评分 23.47±1.598。治疗前ODI指数67.2±3.783,治疗后当天ODI指数29.6±3.621,治疗后6月ODI指数29.93±3.035。t检验得手法治疗前后2个时期比较均有统计学差异(p0.05),证明经过手法治疗后腰椎不稳症患者疼痛较治疗前缓解。而治疗后当天与治疗后6月的JOA评分、ODI指数无统计学差异(p0.05),说明手法治疗后疼痛症状没有明显变化。治疗前,治疗后当天与治疗后6月椎体AZ、BZ、CZ、RX、RX2进行t检验,治疗前椎体矢状位及冠状位椎体的位移及旋转、治疗后椎体矢状位及冠状位椎体的位移及旋转比较有统计学意义(p值均0.05),表明随访6月后的椎体矢状位及冠状位椎体的位移及旋转无统计学差异(p0.05)。将治疗后JOA评分改善率、ODI指数改善率分别与治疗后AZ改变率、BZ改变率、CZ改变率、RX改变率、RX2改变率进行相关性分析,结果发现各组均有统计学差异(PO.O5),即说明治疗后的功能改善与影像学改变之间存在相关性。结论:通过对15例腰椎不稳症患者手法治疗前后的临床疗效观察及影像学分析,证明手法治疗腰椎不稳症的疗效值得肯定。通过算法验证,证明KLT追踪算法在椎体追踪上效果更佳。手法治疗后的椎体在矢状面及冠状面上的位移及角度均有变化。手法治疗腰椎不稳症的临床疗效与动态影像学有相关性。
[Abstract]:Objective: to study the vertebral body tracking algorithm by measuring and calculating the dynamic imaging parameters. To study the effect of manipulative treatment of lumbar instability and the imaging changes before and after treatment) to explore the correlation between the clinical efficacy and dynamic imaging changes of manipulation in the treatment of lumbar instability. Methods: 15 patients in Department of Orthopedics and Trauma of Wuxi traditional Chinese Medicine Hospital from January 2015 to December 2016 were selected. Quantitative X-ray examination was performed before and after manual therapy. The functional scores before and after manipulation and ODI index were recorded and the dynamic imaging data were obtained. The patients were followed up for 6 months. The vertebral body tracking algorithm was verified by measuring and calculating the imaging parameters. According to the imaging data obtained by the vertebral body tracking algorithm, the corresponding statistical method was used. The functional score and imaging data before and after manipulation were compared to evaluate the efficacy of manipulation in the treatment of lumbar instability, and the correlation analysis was made between the functional scores of all patients before and after manipulation treatment and the imaging changes. To study the correlation between the two. Results: all the subjects who met the inclusion criteria completed manual therapy and dynamic imaging examination before and after treatment. There were no adverse symptoms during the treatment and all the patients' clinical symptoms were relieved to varying degrees. The JOA score was 17.67 卤2.289 before treatment, the JOA score was 23.53 卤2.232 on the day after treatment, and the JOA score was 23.47 卤1.598at 6 months after treatment. The ODI index was 67.2 卤3.783 before treatment, the ODI index was 29.6 卤3.621 on the day after treatment, and the ODI index was 29.93 卤3.035.t at 6 months after treatment. However, there was no significant difference in the JOA score and ODI index between the day of treatment and 6 months after treatment, indicating that there was no significant change in pain symptoms after manual therapy. Before treatment, on the day of treatment and 6 months after treatment, t test was carried out on the vertebral body AZOBZCZCZCZCX RX2, and the displacement and rotation of the vertebral body in sagittal and coronal position before treatment. There were significant differences in displacement and rotation between sagittal and coronal vertebrae after treatment, indicating that there was no significant difference in displacement and rotation between sagittal and coronal vertebrae after 6 months follow-up. The correlation analysis was carried out between the improvement rate of JOA score and the improvement rate of JOA index after treatment and the change rate of BZ and the change rate of CZ and RX and RX2, respectively. The results showed that there was statistical difference in all groups, that is to say, there was a correlation between the functional improvement and the imaging changes after treatment. Conclusion: the clinical curative effect and imaging analysis of 15 cases of lumbar vertebrae instability before and after manipulation treatment proved that the therapeutic effect of manipulation on lumbar instability is worthy of affirmation. It is proved that KLT tracking algorithm is more effective in vertebra tracking. The displacement and angle of vertebral body in sagittal plane and coronal plane changed after manual therapy. The clinical effect of manipulative treatment of lumbar instability is correlated with dynamic imaging.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R244.1

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