【作者】 李永刚；

【导师】 李牧；

【作者基本信息】 山东大学 ， 外科学， 2010， 硕士

【摘要】 目的：为防止现有腰椎人工髓核假体置换术(nucleus pulposus replacement, NPR)后较多的并发症,作者利用对腰椎髓核MRI T2加权像测量的数据,在现有人工髓核假体的基础上对腰椎人工髓核假体的改良提出设想。方法：2009年5月-2009年9月在山东大学齐鲁医院磁共振室,对42例腰椎间盘退行性变病人的相对正常髓核的T2加权像中横径、矢径、高度和椎间隙角度从L1/2到L5/S1分别进行了测量。利用正中矢状位测量髓核的高度和椎间隙的角度,利用椎间隙轴位像测量髓核的横径和矢径；髓核的横断面为近似的椭圆,利用椭圆体的体积计算公式计算出髓核体积,再在现有腰椎人工髓核假体基础上主要对髓核假体的形状和角度方面进行改良。结果：测量结果采用SPSS13.0统计软件进行统计分析：①对不同节段髓核的横径、矢状径、高度、体积及椎间隙角度应用最小显著差(LSD)t检验(p=0.05)分析：髓核的横径和矢状径从L1/2到-L3/4均逐渐递增,从L4/5到L5/S1逐渐递减。髓核中部的高度从L1/2到L4/5逐渐递增,L5/S1略小。髓核体积从L1/2到L3/4体积逐渐增大,L4/5到L5/S1体积递减。椎间隙角度从L1/2到L5/S1均逐渐增大。②同一节段、不同性别间比较采用独立样本t检验(P=0.05)：L1/2和L2/3节段髓核矢径的比较男、女之间的差异有统计学意义,其余节段的比较无统计学意义；L2/3和L3/4节段髓核横径的比较男、女之间的差异有统计学意义,其余节段的比较无统计学意义；L2/3和L3/4节段髓核体积的比较男、女的差异有统计学意义,其余节段的比较无统计学意义；L4/5和L5/S1髓核高度的比较男、女之间的差异有统计学意义,其余节段的高度比较无统计学意义；同节段男女椎间隙的角度的比较差异无统计学意义。③与正常人髓核之间的比较用独立样本t检验(P=0.01)：L5/S1节段横径有统计学意义,正常人的较大,其余节段横径比较无统计学意义；L2/3-L5/S1矢径的比较均有统计学意义,正常人的较大。结论：①因脊髓下端平对L1下缘,L1/2节段不适合于腰椎人工髓核假体置换术。②同节段、不同性别,同性别、不同节段,不同性别、不同节段需要不同的髓核假体型号。③L2/3节段适合平均5.59度的前面呈弧形的髓核,L3/4节段适合平均6.71度的前面呈弧形的髓核,L4/5节段适合平均9.85度的前面呈弧形的髓核,L5/S 1节段适合平均12.30度的前面呈弧形的髓核。④髓核假体的高度根据不同性别、不同节段至少设计出5、6、7、8、9mm五个规格。⑤所测量的患者相对正常髓核数值不能等同于正常人髓核的测量数值。更多还原

【Abstract】 Objective:To prevent the existing complications of lumbar nucleus pulposus replacement, The author use the data measured by the MRI T2-weighted image of lumbar nucleus pulposus to propose a assumption based on the existing lumbar prosthetic disc nucleus.Methods:From May 2009 to September 2009. The transverse diameter, sagittal diameter, height of the nucleus pulposus and intervertebral angle of the relatively normal nucleus pulposus of 42 patients were measured in Qilu Hospital’s MRI room at the Shandong University. The nucleus pulposus height and intervertebral angle were measured by using middle sagittal intervertebral images. The transverse and sagittal diameters of nucleus pulposus were measured by using the intervertebral axial images. The nucleus cross-section is sub-elliptical, Use ellipsoidal Volume formula to calculate the volume of nucleus pulposus. The mainly improvement is the shape and angle on the basis of the existing lumbar prosthetic disc nucleus.Results:The measurement results were analyzed by using SPSS13.0 statistical software:①The comparison with the different segment of the nucleus pulposus’ transverse diameter, sagittal diameter, height and volume and intervertebral angle from L1/2 to L5/S1 segments were analyzed by using LSD(the least significant difference)t-test(P=0.05):the transverse diameter and the sagittal diameter of nucleus pulposus were gradually increased from L1/2 to L3/4 and were gradually reduced from L4/5 to L5/S1. The central height of the nucleus pulposus was gradually increased from L1/2 to L4/5, L5/S1 was slightly small. The volume of nucleus pulposus was gradually increased from L1/2 to L3/4 and was gradually reduced from L4/5 to L5/S1. The intervertebral angle from L1/2 to L5/S1 was gradually increased.②The comparison with the same segment and different gender was used independent samples t-test(P=0.05):The sagittal diameter of L1/2 and L2/3 has statistical difference between male and female, the others segments have no statistical difference. The transverse diameter of L2/3 and L3/4 has statistical difference, the others segments have no statistical difference. The nucleus volume of L2/3 and L3/4 has statistical difference, the others segments have no statistical difference. The height of L4/5 and L5/S1 has statistical difference, the others segments have no statistical difference. The same segment of intervertebral angle has no statistical difference③The comparison with the normal nucleus was used independent samples t-test(P=0.01):the transverse diameter of L5/S1 has statistical difference, the normal nucleus are larger, the others segments have no statistical difference, The sagittal diameter from L2/3 to L5/S1 has statistical difference, the normal nucleus are larger.Conclusions:①The L1/2 segment is not suitable for lumbar prosthesis disc nucleus replacement because L1 is the lower edge of the spinal cord.②The same segment, different genders, the same gender, different segments, the different gender, different segments need different sizes of prosthetic disc nucleus.③The L2/3 segment is suitable for a frontal arched prosthetic disc nucleus with an average angle of 5.59 degrees, L3/4 segment is suitable for a frontal arched prosthetic disc nucleus with an average angle of 6.71 degrees, L4/5 segment is suitable for a frontal arched prosthetic disc nucleus with an average angle of 9.85 degrees, L5/S1 segment is suitable for a frontal arched prosthetic disc nucleus with an average angle of 12.30 degrees.④According to different gender and different segments, the height of the Prosthetic Disc Nucleus should be designed at least five specifications with 5,6,7, 8,9 mm.⑤The data measured of this group can not be considered to be normal nucleus measurements.更多还原