应用数字骨科技术观测腰椎失稳节段间在体三维运动特点  

Application of digital orthopedic technology for observing degenerative lumbar segmental instability of three-dimensional kinematic characteristics in vivo

作　　者：王博韬[1] 夏群[2] 苗军[2] 胥鸿达 喻华[1] Shaobai Wang Guoan Li 

机构地区：[1]天津中医药大学研究生院,300193 [2]天津医院脊柱外科 [3]美国哈佛大学麻省总医院骨科生物工程实验室

出　　处：《中华医学杂志》2014年第29期2264-2268,共5页National Medical Journal of China

基　　金：国家自然科学基金（81371992）;天津市卫生局攻关项目（2011KG138）

摘　　要：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.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 lumb

关 键 词：关节不稳定性 腰椎 X线透视检查 成像 三维 

分 类 号：R687.3[医药卫生—骨科学]