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척추분리증 및 협부형 척추전방전위증에 동반된 요천추부의 선천성 기형에 대한 분석

Other Titles
 (The) analysis of congenital anomalies in the lumbosacral area combined with the spondylolysis and the isthmic spondylolisthesis 
Issue Date
1993
Description
의학과/석사
Abstract
[한글] 척추전방전위증은 척추체가 전방으로 전위되는 질환으로 요통의 주요한 원인이 되고있다. 척추분리증은 5세 이전에는 드물지만 청소년기에는 빈도가 증가한다. 현재까지 척추후궁의 협부의 결손의 원인에 대한 연구와 선천성 및 퇴행성 척추전방전위증에서 척추의 전방전위에 영향을 주는 위험요소에 대해 많은 발표가 있었지만 협부형 척추전방전위증에서 전방전위에 영향을 주는 위험요소와 동반된 요천추부의 선천성 기형의 임상적 의의에 대해서는 연구가 전무한 실정이다. 본 연구에서는 척추분리증 및 협부형 척추전방전위증에서 동반되는 요천추부의 선천성 기형을 조사하고 이러한 기형이 전방전위 정도에 미치는 영향을 조사함으로써 임상적 의의를 찾는데 목적을 두고 1987년 1월부터 1992년 12월까지 척추분리증및 협부형 척추전방 전위증으로 입원했던 48명의 실험군과 20명의 대조군에서 시행한 단순 X-선촬영 및 전산화 단층촬영에서 관절돌기사이관절각, 가성추간판의 정도, 동반된 요천추부의 기형의 빈도율 계측하였다. 실험군은 척추분리증, gradeⅠ,Ⅱ 척추전방전위증으로 구별하고 대조군 을 포함하여 4 그룹간 통계학적 차이가 있는지 조사하였고, 또한 척추의 전위정도와 선형관계를 갖는지를 회귀분석을 통하여 조사하였다. 선천성 기형과 척추전방전위증의 전위정도 사이의 관계를 살펴보면, 천추화는 척추분리증에서 유의한 차이를 보였지만 그 외 기형들은 관계가 없었다. 비대칭성의 돌기관절면의 유무에 따라 실험군과 대조군사이에 차이가 없었고 또한, 척추의 전방전위 정도는 유의 한 차이를 보이지 않았다. 좌우 관절돌기사이관절각의 차이와 척추의전방전위와의 관계는 각의 차이가 증가할수록 척추의 전방전위가 증가하는 양상을 보였지만 회귀분석의 결과, 선형관계를 보이지는 않았다. 그러나 대조군, 척추분리증, gradeⅠ 척추전방전위증, gradeⅡ 척추전방전위증의 4 그룹간 각의 차이는 통계학적 유의한 차이가 없었다. 또한 척추의 전방전위 정도가 좌우 관절돌기사이관절각의 차이에 따른 그룹간에서는 통계학적 유의 한 차이를 보이지 않았다. 가성추간판의 정도는 실험군내에서 통계학적 유의한 차이를 보였고, 척추의 전방전위 정도가 증가할수록 증가하는 양상을 보였고 회귀분석 결과 r**2=0.60으로 가성추간판의 정도와 척추의 전방전위 정도간에 선형관계가 있었다. The ana1ysis of congenital anomalies in the lumbosacral area combined with the spondylolysis and the isthmic spondylolisthesis Nam Hong Choi Department of Medical Science The Graduate School, Yonsei University (Directed by Professor Nam Hyun Kim) The incidence of the spondylolysis is very low before five years but during the adolescence the incidence increase. The etiologic factors of spondylolis-thesis are congenital and acquired. The acquired factors are traumatic and stress fracture. Then there are many congenital properties of the etiologic factors for the spondylolisthesis because several congenital anomalies are combined with spondylolysis or isthmic spondylolisthesis. But there were few articles about relationship between the spondylolysis or isthmic spondylolisthesis and the congenital anomalies around the lumbosacral area. The purpose of this particular study is to search the etiologic factors that increase the degree of the vertebral slippage and relationship between the spondylolysis or isthmic spondylolisthesis around the lumbosacral area. The plain X-ray and computed tomograms were taken in the 48 patients and the 26 control group that has not chronic low back pain previously. The patients were divided into three groups, such as the spondylolysis, grade I spondylolisthesis, gradeⅡ spondylolisthesis. The parameters measured from the plain X-ray were the incidence of congenital anomalies and degree of vertebral slippage. The parameters measured from the computed tomograms werre facet angles and the degree of pseudodisc. Tropism were present for 5 cases, 16 cases at L3-4 facets, 12 cases, 22 cases at L4-5 facets, 10 cases, 28 cases at L5-51 facets in control, patients group. There was no correlation between the presence or absence of tropism and the vertebral slippage. The sacralization was related with the vertebral slippage but other congenital anomalies were not related to the degree of vertebral slippage . There was a increment of vertebral slippage according to the increse of facet angle, but the linear correlation was absent on repression analysis. So statistical significance was absent among the control group and 3 patients groups. And the vertebral slippage was not significantly different among the groups that were divided according to the difference of facet angle. There was a linear correlation between the degree of the pseudodisc and the degree of vertebral slippage of r square=0.60 on regression analysis. A present study, there was a trend of increase of vertebral slippage according to increase of facet angle and presence of the sacralization. And there was a linear correlation between the degree of the pseudodisc and the vertebral slippage.
[영문] The incidence of the spondylolysis is very low before five years but during the adolescence the incidence increase. The etiologic factors of spondylolis-thesis are congenital and acquired. The acquired factors are traumatic and stress fracture. Then there are many congenital properties of the etiologic factors for the spondylolisthesis because several congenital anomalies are combined with spondylolysis or isthmic spondylolisthesis. But there were few articles about relationship between the spondylolysis or isthmic spondylolisthesis and the congenital anomalies around the lumbosacral area. The purpose of this particular study is to search the etiologic factors that increase the degree of the vertebral slippage and relationship between the spondylolysis or isthmic spondylolisthesis around the lumbosacral area. The plain X-ray and computed tomograms were taken in the 48 patients and the 26 control group that has not chronic low back pain previously. The patients were divided into three groups, such as the spondylolysis, grade I spondylolisthesis, gradeⅡ spondylolisthesis. The parameters measured from the plain X-ray were the incidence of congenital anomalies and degree of vertebral slippage. The parameters measured from the computed tomograms werre facet angles and the degree of pseudodisc. Tropism were present for 5 cases, 16 cases at L3-4 facets, 12 cases, 22 cases at L4-5 facets, 10 cases, 28 cases at L5-51 facets in control, patients group. There was no correlation between the presence or absence of tropism and the vertebral slippage. The sacralization was related with the vertebral slippage but other congenital anomalies were not related to the degree of vertebral slippage . There was a increment of vertebral slippage according to the increse of facet angle, but the linear correlation was absent on repression analysis. So statistical significance was absent among the control group and 3 patients groups. And the vertebral slippage was not significantly different among the groups that were divided according to the difference of facet angle. There was a linear correlation between the degree of the pseudodisc and the degree of vertebral slippage of r square=0.60 on regression analysis. A present study, there was a trend of increase of vertebral slippage according to increase of facet angle and presence of the sacralization. And there was a linear correlation between the degree of the pseudodisc and the vertebral slippage.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117156
Appears in Collections:
2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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