| 研究生: |
洪昌甫 Hung, Chang-Fu |
|---|---|
| 論文名稱: |
退化性腰椎側彎病人之脊椎神經孔三維動靜態形態學分析 Three-Dimensional Static and Dynamic Morphometric Study of Neural Foramen in Degenerative Lumbar Scoliosis |
| 指導教授: |
方晶晶
Fang, Jing-Jing |
| 學位類別: |
碩士 Master |
| 系所名稱: |
工學院 - 機械工程學系 Department of Mechanical Engineering |
| 論文出版年: | 2012 |
| 畢業學年度: | 100 |
| 語文別: | 中文 |
| 論文頁數: | 97 |
| 中文關鍵詞: | 腰椎神經孔 、形態學 、靜態分析 、動態分析 |
| 外文關鍵詞: | lumbar scoliosis, 3D static and dynamic morphometric study, neural foramen |
| 相關次數: | 點閱:113 下載:13 |
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針對退化性腰椎側彎患者的影像判讀,大多數研究僅有二維的形態分析,如以X光影像上的側彎角度與側彎形狀分析,或在CT或MRI影像上截圖分析骨骼與軟組織關係,缺乏三維空間幾何資訊,無法建構神經孔與神經根的幾何形態。
本研究透過電腦斷層掃瞄影像三維重組來分析腰椎側彎患者的神經孔形態,藉由最佳對稱面方法改善過去二維分析做法的不確定性與不一致性,除了一般的靜態分析外,本研究更加入動態的模擬分析,不僅讓分析結果有重現性與一致性,更分析模擬椎籠置入手術之神經孔形態的變化,提供醫師術前更全方位的資訊。本研究提出一名退化性腰椎側彎患者的臨床應用,以每隔1mm截面的神經孔截面分析顯示,側彎的凹側最小面積處小於凸側最小面積處;至於神經根截面,在凹側面積最小處,同樣小於凸側神經根最小處。雖然凹側神經孔及神經根可能受壓處明顯小於凸側,但患者症狀卻為兩側坐骨神經痛,說明非受壓側亦有可能因為神經孔形態改變而壓迫神經,造成這類的症狀。另外,動態分析模擬椎籠置入的結果,椎籠置入後,凹側除截面面積增加外,神經孔體積明顯增加了30.45%,凸側也因此略增了4.29%,表示椎籠置入模擬呈現凹側神經孔受壓處有明顯改善,臨床上受壓神經也可能因此得到紓解。
Most of the image examinations in degenerative lumbar scoliosis are focus on two-dimensional morphological analysis. They usually measure the scoliosis angle and provide descriptions of spinal inclination from X-ray images, or assessed spatial relationship between bone and soft tissues from CT or MRI sectional images. Most of outcomes of previous studies lacks of three-dimensional geometric information which cannot reveal the geometry of the neural foramen and nerve root.
In this dissertation, analyses of neural foramen morphology in lumbar scoliosis are carried out by three-dimensional geometric evaluation techniques to improve traditional two-dimensional measurement method. Additional to morphological analysis in 3D regions of interest (ROI) such as neural foramen, neural roots, and its surrounding soft tissues, we also simulate and evaluate the variations of these ROI in cage placement.
In clinical application, we present a degenerative lumbar scoliosis patient using our proposed 3D morphological analysis method. For every 1mm sectional image parallels to the optimal symmetry plane (OSP) of the subject vertebra, we calculate the area of the section plane of the neural foramen. The minimum area of the concave side of the scoliosis is less than the minimum area of the convex side. In terms of the nerve root sections, the minimum area of the concave side of the scoliosis is also less than the minimum area of the convex side. Patient symptoms sciatica lower back pain on both sides, though the neural foramen and nerve root of the concave side may be less than the convex side. This represents a possible clinical situation that the morphological changes of neural foramen may cause nerve compression. The simulation results of vertebral cage placement present the increase of cross-sectional areas of the concave side, nevertheless, volume of the neural foramen is also significantly increased by 30.45%. Meanwhile, neural foramen of the convex side is slightly increased by 4.29%. Cage placement simulation presents significant improvement on the pressure of the neural foramen in the concave side. In clinical, the pressure on the nerve may get relief.
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