腰椎退变滑脱对相邻节段在体运动的影响  

Vertebral in vivo motion of adjacent segments in patients with degenerative spondylolisthesis

作　　者：胥鸿达 夏群[2] 苗军[2] 

机构地区：[1]天津医科大学研究生院,300070 [2]天津医院脊柱外科

出　　处：《中华医学杂志》2014年第47期3731-3734,共4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：观察有临床症状的腰椎退变滑脱（ DS）患者生理载荷下滑脱椎体相邻节段三维运动特性。方法2013年3至10月天津医院脊柱外科需要住院手术治疗的L4退变滑脱患者15例为研究组。无腰痛症状和其他脊柱疾病的健康志愿者15名为正常健康对照组。采用双X线透视系统（ DFIS）和CT扫描相结合技术，从受试者腰椎薄层CT获取腰椎三维重建模型，匹配到DFIS捕获的不同活动体位时腰椎双斜位X线透视图像上，重现生理载荷下不同体位腰椎椎体三维运动状态。通过在DS患者L3－S1各椎体中心建立三维坐标系测量相邻椎体间的活动度，并与正常组相比较。结果DS组L3－4左右侧弯时沿矢状轴旋转度（4．4±2．8）°，大于正常组（2．1±1．7）°（P＜0．05）；左右旋转时沿垂直轴旋转度（4．3±2．8）°，大于正常组（2．1±1．3）°（P＜0．05）；前屈后伸时沿冠状轴旋转度（3．9±3．3）°，虽较正常组（3．2±2．5）°有增大趋势但差异无统计学意义。 DS组滑脱节段L4－5及相邻尾侧节段L5－S1与正常组相比，沿X、Y、Z轴位移和旋转度差异均无统计学意义。结论 L4－5DS滑脱节段相对稳定，相邻头侧椎间盘L3－4节段活动度增加，相临尾侧椎间盘（ L5－S1）相对稳定。Objective To observe the in vivo vertebral motion of adjacent segments in patients with degenerative spondylolisthesis （ DS ） during functional weight-bearing activities.Methods A total of 15 symptomatic L4 DS patients （ mean age 54.4 years） and 15 asymptomatic volunteers （ mean age 53.4 years） were recruited. The vertebral segment motion of each subject was reconstructed with three-dimensional computed tomography and solid modeling software.In vivo lumbar vertebral motion during functional postures （ flexion-extension, left-right twisting and left-right bending） was observed with dual fluoroscopic imaging. Coordinate systems were established at the vertebral center of L3-S1 to obtain the intervertebral range of motion （ROM） at L3/4, L4/5 and L5/S1 in DS and normal groups.Results The motion pattern at L3/4 with DS was altered.During left-right bending, the rotation along sagittal axis was significantly larger than normal group （4.4°±2.8°vs 2.1°±1.7°, P＆lt;0.05）.During left-right twisting, the rotation along vertical axis was significantly larger than normal group （4.3°±2.8°vs 2.1°±1.3°, P＆lt;0.05）.During flexion to extension, the rotation along frontal axis was larger than DS group （3.9°±3.3°vs 3.2°±2.5°）.However the difference was insignificant.The motion pattern at L4/5 and L5/S1 with DS had no significant difference with normal group.Conclusion The slipped segments of degenerative spondylolisthesis are stable. However, the ROM of cranial segment increases.

关 键 词：腰椎 脊椎前移 生物力学 X线透视检查 退变滑脱 

分 类 号：R687.3[医药卫生—骨科学]