负重状态对下腰椎椎体间旋转中心的影响  

Effect of weight-bearing activity on the center of rotation in the lower lumbar vertebrae

作　　者：刘佳男[1,2] 夏群[2] 苗军[2] 李宏达[1,2] 魏冬[2,3] 

机构地区：[1]天津医科大学研究生院,天津市300070 [2]天津市天津医院,天津市300211 [3]天津中医药大学研究生院,天津市300193

出　　处：《中国组织工程研究》2016年第9期1282-1288,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(81572199;81472140)~~

摘　　要：背景:目前的流行病学调查显示,过度的负重运动是导致腰椎退变的重要危险因素之一,但负重对于正常人腰椎在体运动模式的影响仍不明了。目的:探索负重状态下正常人屈伸活动时下腰椎椎体间旋转中心的位置变化特点及规律。方法:招募无腰椎疾患的健康志愿者14例,年龄(25±5)岁。采用双X射线透视影像系统和螺旋CT检查相结合技术,在计算机软件辅助下,从薄层CT扫描获取腰椎L_(4-5)、L_5-S_1节段三维重建模型,匹配到双X射线透视影像系统捕获的前屈、中立和后伸时腰椎双斜位X射线透视图像上,重现生理载荷及负重状态下腰椎椎体间三维运动状态。在L_4-S_1相邻椎体上建立三维坐标系,从而获得腰椎椎体间在前屈、后伸及整体屈伸运动中的旋转中心点。结果与结论:(1)生理载荷下:正常人L_(4-5)节段整体屈伸运动的旋转中心点位于椎体中轴前方约1.0 mm处,L_5-S_1节段整体屈伸运动的旋转中心点位于椎体中轴前方约0.7 mm处。(2)负重后:两节段屈伸运动的旋转中心点仅向后方轻微移动约0.5 mm,差异无显著性意义。(3)分别计算对比前屈后伸两部分旋转中心点的位置及其移动范围:负重10 kg后L_(4-5)、L_5-S_1节段旋转中心点的移动范围较无负重时明显增大(P<0.05),且负重后L_5-S_1节段前屈部分的旋转中心点位置较无负重时明显向椎体前方偏移(P<0.05)。(4)结果提示,负重使正常人旋转中心的运动轨迹异常增大,且腰椎椎体间处于屈曲位时更易受到影响。BACKGROUND： Epidemiologic reports have indicated that excessive weight-bearing exercise is one of important risk factors for lumbar degeneration, but the effects of weight-bearing activity on normal lumbar motion pattern are still not clear. OBJECTIVE： To measure the changing characteristics and rules of position at the center of rotation of the lower lumbar spine during a weight-lifting activity of normal person. METHODS： Fourteen asymptomatic subjects with a mean age of（25±5） years were recruited for this study. The L_（4-5） and L_5-S_1 segments of each subject were CT-scanned to construct 3D models using dual X-ray imaging system and spiral CT examination combined technology in the aid of computer software. The physiological load and lumbar spinal 3D motion under the loading condition were reproduced when matching the flexion, neutrality and extension in the dual X-ray imaging system and on dual oblique lumbar X-ray image. Coordinate systems were established at the vertebral body of L_4-S_1 to obtain the center of rotation during flexion-to-neutral, neutral-to-extension and the full flexion-extension motion. RESULTS AND CONCLUSION：（1） Under physiological load, the center of rotation of L_（4-5） of normal person was located about 1.0 mm anterior to the central axis of the vertebral body, and the center of rotation of L_5-S_1 was located about 0.7 mm anterior to the central axis of the vertebral body.（2） With weight loading, the center of rotation of both two segments shifted backward about 0.5 mm. There was no statistical difference between these two loading conditions.（3） When the center of rotation in flexion and extension was calculated respectively, the moving range of the center of rotation at both L_（4-5） and L_5-S_1 became larger due to taking loads of 10 kg（P〈0.05）. In flexion, the center of rotation at L_5-S_1 significantly shifted forward during a weight-lifting activity（P〈0.05）.（4） These results confirm that compared with non-weight-bearing condition

关 键 词：组织工程 腰椎 生物力学 骨科植入物 脊柱植入物 负重 健康成人 三维重建模型 透视 在体运动 屈伸活动 生理载荷 旋转中心 瞬时 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]