腰椎间盘突出症椎体间在体运动的观察  

Segmental vertebral motion in patients with lumbar disc herniation： an in vivo study

作　　者：宁尚龙[1] 夏群[1] 苗军[1] 白剑强[1] 贺金亮[1] 刘恺 马信龙[1] 

机构地区：[1]天津医科大学骨科临床学院,天津医院脊柱外科,300211

出　　处：《中华骨科杂志》2012年第5期393-397,共5页Chinese Journal of Orthopaedics

基　　金：天津市卫生局攻关项目（2011KG138）

摘　　要：目的研究腰椎间盘突出症患者生理载荷下椎体节段间三维运动学特点。方法L3-4间盘退变突出患者15例，年龄为（40．2±4．1）岁，为实验组；健康志愿者10名，年龄为（54．4±3．5）岁，为对照组。受试者腰椎进行薄层CT扫描，导入三维建模软件中建立椎体模型，将椎体模型与双荧光透视影像系统（dualfluoroscopic imaging system，DFIS）捕获的不同运动状态下（站立、屈伸、旋转及侧弯）的腰椎透视图像进行匹配，以重现生理载荷下腰椎椎体间三维运动状态。通过测量椎体上的三维坐标系，获得病变节段（k）和相邻节段（L3-4）椎体间在体运动学数据。结果实验组病变节段（k）在前屈、后伸时，沿冠状轴、矢状轴和垂直轴的位移与对照组无明显差别，沿冠状轴的旋转角度（3．7°±2．1°）较对照组（1．9°±1.1°）明显增加（P〈0．05）；在左右侧弯时，沿冠状轴位移运动范围[（1．7±0．8）mm]较对照组[（1．0±0．6）mm]明显增加（尸〈0．05），沿冠状轴旋转运动范围（3．4°±5．0°）较对照组（1．9°±2．1°）明显增加（R0．05）；左右旋转时，沿冠状轴位移及旋转运动范围较对照组明显增加（P〈0．05）。实验组相邻节段（L3-4）在前屈、后伸时，沿冠状轴、矢状轴及垂直轴的位移均较对照组增加，但差异无统计学意义；在左右侧弯时，沿垂直轴位移运动范围[（1．1±0．4）mm]较对照组[（0．3±0．2）mm]明显增加（P〈0．05）；在左右旋转时，沿垂直轴位移运动范围较对照组明显增大（P〈0．05）。实验组相邻节段在各体位下的旋转运动范围与对照组相比较差异无统计学意义（P〉0．05）。结论腰椎间盘突出症患者腰椎三维运动模式与正常人不同，表现在病变节段屈伸活动及左右位移增加、沿垂直轴旋转有减少趋势，而头侧相邻节段位移运动范围增加。Objective To observe in vivo segmental lumbar motion in patients with lumbar disc her- niation （LDH） during functional weight-bearing activities. Methods Fifteen patients with LDH at L4-5 were studied as experimental group. Ten healthy volunteers were recruited as control group. Three-dimension（3D） lumbar spine models of L3, L4 and L5 were reconstructed from thin section CT scans. Spine motions were then reproduced by matching lumbar spine models and images got from dual fluoroscopic imaging system （DFIS） under different motion state （standing, flexion-extension, left-right twisting and left-right bending）. From local coordinate systems at the end plates, the motion of the cephalad vertebrae relative to the caudal vertebrae was calculated for vertebrae levels： L4-5 and L3-4. Results The motion pattern at L4-5 was found to be altered. During flexion-extension, the migrations of the affected segments along the frontal axis, sagittal axis, vertical axis were similar with that of the control group, but the rotation angle along the frontal axis was significantly larger than that of the control group （P〈0.05）. During left-right bending and left-right twisting, the migration and rotation angle along the frontal axis were significantly larger than those of control group. During flexionextension, the migrations of the neighboring segments （L3-4） along the three axes were larger than those of the control group, but there were no statistical significances. During left-right bending and left-right twisting, the migrations of the neighboring segments （L3-4） along the vertical axis were significantly larger than those of the control group （P〈0.05）. Conclusion The 3D lumbar motion pattern in LDH patient is different with that of normal people. For the affected segment, compared with the normal people, the range of flexion-extension motion and the translocation in left-right direction were significantly larger, but the rotation range along the vertical axis was smaller.

关 键 词：椎间盘移位 腰椎 活动范围 关节 

分 类 号：R687.3[医药卫生—骨科学]