CAJ | 학술논문

目的观察退变性腰椎失稳症患者生理载荷下失稳节段间三维运动学特点以建立腰椎失稳的三维诊断标准.方法 2011年9月至2013年6月间天津医院脊柱外科收治的L3/4节段失稳症患者8例为失稳组(L3/4节段),年龄29 ～65(54±13)岁;L4/5节段失稳症患者9例为失稳组(L4/5节段),年龄51 ～60(54±2)岁;健康志愿者10名为正常组,年龄为26 ～51(35±9)岁.受试者行腰椎CT薄层扫描,导入三维建模软件(Rhinoceros)建立椎体模型,将椎体模型与双X线透视系统获得的腰椎双斜位透视像匹配,真实重现生理载荷下腰椎椎体间的三维运动状态,通过测定腰椎相邻椎体间椎体中心点的三维坐标空间位移和旋转,最终获得生理载荷下腰椎失稳症患者失稳节段间的三维运动学数据.结果失稳组(L3/4失稳节段)相对于正常组(L3/4)在前屈后伸位,沿矢状轴位移增大(3.2±2.2)mm(P ＜0.05);沿垂直轴旋转角度增大(4.8±4.6)°(P＜0.05);沿垂直轴位移减小(0.4 ±0.2)mm(P ＜0.05).在左右旋转位,沿垂直轴旋转角度增大(4.2±2.0)°(P＜0.05).失稳组(L4/5失稳节段)相对于正常组(L4/5)在前屈后伸位,沿矢状轴位移范围增大(2.6±2.2)mm(P＜0.05).在左右侧弯位:沿矢状轴旋转角度增大(6.5±5.6)°(P＜0.05).在左右旋转位,沿矢状轴旋转角度增大(5.0±2.5)°(P＜0.05);沿垂直轴位移(1.6±0.9)mm,沿垂直轴的旋转角度减小(2.0±1.6)°(P＜0.05).结论腰椎失稳节段与正常相对应节段相比三维运动学特点明显不同,L3/4失稳节段与L4/5失稳节段三维运动特点也不同,建议分别建立不同节段腰椎失稳的三维诊断标准,以更符合实际情况.
목적 관찰퇴변성요추실은증환자생리재하하실은절단간삼유운동학특점이건립요추실은적삼유진단표준.방법 2011년9월지2013년6월간천진의원척주외과수치적L3/4절단실은증환자8례위실은조(L3/4절단),년령29 ～65(54±13)세;L4/5절단실은증환자9례위실은조(L4/5절단),년령51 ～60(54±2)세;건강지원자10명위정상조,년령위26 ～51(35±9)세.수시자행요추CT박층소묘,도입삼유건모연건(Rhinoceros)건립추체모형,장추체모형여쌍X선투시계통획득적요추쌍사위투시상필배,진실중현생리재하하요추추체간적삼유운동상태,통과측정요추상린추체간추체중심점적삼유좌표공간위이화선전,최종획득생리재하하요추실은증환자실은절단간적삼유운동학수거.결과 실은조(L3/4실은절단)상대우정상조(L3/4)재전굴후신위,연시상축위이증대(3.2±2.2)mm(P ＜0.05);연수직축선전각도증대(4.8±4.6)°(P＜0.05);연수직축위이감소(0.4 ±0.2)mm(P ＜0.05).재좌우선전위,연수직축선전각도증대(4.2±2.0)°(P＜0.05).실은조(L4/5실은절단)상대우정상조(L4/5)재전굴후신위,연시상축위이범위증대(2.6±2.2)mm(P＜0.05).재좌우측만위:연시상축선전각도증대(6.5±5.6)°(P＜0.05).재좌우선전위,연시상축선전각도증대(5.0±2.5)°(P＜0.05);연수직축위이(1.6±0.9)mm,연수직축적선전각도감소(2.0±1.6)°(P＜0.05).결론 요추실은절단여정상상대응절단상비삼유운동학특점명현불동,L3/4실은절단여L4/5실은절단삼유운동특점야불동,건의분별건립불동절단요추실은적삼유진단표준,이경부합실제정황.
Objective To explore the characteristics of three-dimensional motion of lumbar instability segmental in vivo under physiological weight bearing so as to establish three-dimensional diagnostic criteria for degenerative lumbar segmental instability (DLSI).Methods Eight patients aged 29-65 years with DLSI at L3/4 were studied as instability group (L3/4), 9 patients aged 51-60 years with DLSI at L4/5 as instability group (L4/5) and 10 healthy volunteers aged 26-51 years as normal group.Three-dimension (3D) reproductions by matching lumbar spine models were reconstructed from thin-section computed tomography scans.Spine motions were then reproduced by matching lumber spine models and images from dual fluoroscopic imaging system (DFIS).The models were matched to the osseous outlines of images from two orthogonal views to determine the SD position of vertebrae for each pose.From local coordinate systems at end plates, the motion of cephalad vertebrae relative to cauddal vertebrae was calculated for vertebrae levels.Results The motion pattern at L3/4 was altered.During flexion-extension,migration was significantly larger than normal group along sagittal axis (P ＜ 0.05) ; rotation was significantly larger than normal group along vertical axis; migration was significantly smaller than normal group along vertical axis; during left-right twisting, rotation was significantly larger than normal group along vertical axis (P ＜ 0.05).The motion pattern at L4/5 was also altered.During flexion-extension, migrations was significantly larger than normal group along sagittal axis (P ＜ 0.05).During left-right twisting, migration and rotation were significantly smaller than normal group along vertical axis (P ＜ 0.05).Rotation was significantly larger than normal group along sagittal axis.During left-right bending, rotation was significantly larger than normal group along sagittal axis (P ＜ 0.05).Conclusion Lumbar instability segments were significantly different compared with normal lumbar segments.And lumbar instability segments (at L3/4) were also different from lumbar instability segments (at L4/5).Different three-dimensional diagnostic criteria should be formulated for different lumbar instability segments.