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研究生:洪昌甫
研究生(外文):Chang-FuHung
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
論文名稱(外文):Three-Dimensional Static and Dynamic Morphometric Study of Neural Foramen in Degenerative Lumbar Scoliosis
指導教授:方晶晶方晶晶引用關係
指導教授(外文):Jing-Jing Fang
學位類別:碩士
校院名稱:國立成功大學
系所名稱:機械工程學系碩博士班
學門:工程學門
學類:機械工程學類
論文種類:學術論文
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 scoliosis3D static and dynamic morphometric studyneural foramen
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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.

摘要 I
Abstract II
致謝 III
目錄 IV
圖目錄 VIII
表目錄 XII
第一章 前言 1
1.1 研究背景 2
1.2 研究動機 2
1.3 研究目的 3
1.4 本文架構 4
第二章 文獻回顧 5
2.1 脊椎形態學分析 6
2.1.1 脊椎側彎形態 6
2.1.2 脊椎滑脫形態 7
2.2 脊椎側彎類型 8
2.2.1 退化性腰椎側彎 9
2.2.2 原發性脊椎側彎 9
2.3 脊椎滑脫常見類型 10
2.3.1 退化性脊椎滑脫 12
2.3.2 峽部裂脊椎滑脫 13
2.4 脊椎神經孔形態 14
第三章 形態學分析方法 17
3.1 前處理 17
3.1.1 資料來源 17
3.1.2 重建脊椎模型 19
3.1.3 最佳對稱面 19
3.1.4 座標轉換 20
3.1.5 脊椎模型截面計算 23
3.2 靜態分析 26
3.2.1 分析座標定義 27
3.2.2 神經孔形態 29
3.3 動態模擬分析 32
3.3.1 椎節運動關係 34
3.3.2 椎籠置入手術計畫 37
3.3.3 神經孔形態 39
第四章 分析軟體操作與臨床應用 41
4.1 應用對象 41
4.2 靜態分析 41
4.2.1 資料載入 42
4.2.2 截面移動 42
4.2.3 選取範圍 43
4.3 動態模擬 48
4.3.1 資料讀入 49
4.3.2 動態座標設定 50
4.3.3 椎籠移動 50
4.3.4 椎節移動 51
4.3.5 選取範圍 53
4.4 精度驗證 55
4.4.1 面積誤差 57
4.4.2 體積誤差 59
4.5 臨床應用 61
第五章 結論與未來展望 79
5.1 結論 79
5.2 討論 83
5.3 未來展望 85
參考文獻 87
附錄A 94
附錄B 97
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