不同体位对脊柱骨盆矢状序列影响的研究进展  

The effect of various position on sagittal spinal alignment： a literature review

作　　者：陈熙棒 王克[1] 王向阳[1] 

机构地区：[1]温州医科大学附属第二医院骨科,325027

出　　处：《中华骨科杂志》2017年第22期1424-1431,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金面上项目（81371988）

摘　　要：躯体矢状平衡由脊柱骨盆及下肢共同协调、维持.脊柱骨盆序列对躯体矢状平衡起重要作用,还参与腰椎滑脱、青少年特发性脊柱侧凸、腰椎退变等疾病的发病机制.另外脊柱骨盆矢状位序列还与脊柱畸形手术策略制定和临床预后密切相关.脊柱骨盆冠、矢状参数是脊柱骨盆序列数值化表现,通常是通过影像学资料上测量所获得.人体脊柱骨盆正侧位X线片是通过人体站立位姿势获得的,是一种经济、易用、高效的骨显像辅助检查,其为脊柱骨盆序列的研究提供重要的途径.但是在摄脊柱骨盆侧位X线片时,人体放松站立位下上肢位于身体两侧对躯干的遮挡使脊柱显影不清,导致相关参数难以测量.因此,早期研究人员及临床医生采用屈曲肩关节使上肢前移的摄片体位从而获得较清的显像,但这种方式的体位会对脊柱骨盆矢状序列产生显著性影响,表现为部分参数偏离原有的真实值.即使是相同的体位,摆放姿势的微小变异还可能掩盖或者增大多次摄片的差异,如脊柱矫形治疗中,通过手术前后X线片比较时对矫正度数的错误判断.因此,不同摄片体位会对我们的临床治疗及研究产生不可忽视的影响.提供一种精确、稳定且有代表性的摄片体位十分重要,为此多位学者各自提出数种不同的摄片体位并进行评估.其中体位包括上肢有支撑的被动体位和无支撑的主动体位,涉及不同的屈肩及屈膝角度.本文通过相关文献总结对不同摄片体位进行综述.The sagittal balance of the body is jointly maintained the by spine,pelvis and lower limb.Spino-pelvic alignment plays an important role on body sagittal balance,it is also involved in the pathogenesis of lumbar spondylolisthesis,adolescent idiopathic scoliosis,lumbar degeneration and other diseases.In addition,the sagittal spino-pelvic alignments are also related closely to the surgery strategy formulation of spinal deformity and clinical outcome.Coronal and sagittal parameters of the spine and pelvis are numerical representations of the spino-pelvic alignment which are usually obtained by imaging data.For the reason that X-ray radiography is economical,convenient and avaiable auxiliary examination to perform direct visualization of spine in the standing position.It provides an important way for the study of spino-pelvic alignment.But in the lateral pelvis X-ray films,arms at sides in relaxed standing position prevents adequate visualization of the spine on a lateral radiograph,resulting in difficulty measuring the relevant parameters.Thus,flexion of shoulders is required to bring the upper limbs forward by the early researchers to obtain a clearer lateral spino-pelvic radiograph.The variation in position has been confirmed to have significant effects on the sagittal spinal alignment.Even in the same position,slight variations in positioning may also mask or increase the difference between multiple radiographs.For example,in spine surgery,the erroneous judgment of the degree of correction when comparing radiographs before and after operation.Therefore,the important influence by the various standing position on our clinical treatment and research can not be ignored.In summary,providing an accurate,consistent and representative position is urgently significant.Some scholars propounded proper positioning of the subjects during lateral radiographs of the spine to yield and evaluate sagittal spinal alignment.The body position includes the passive upper body support position and unsupported active position,involving v

关 键 词：青少年特发性脊柱侧凸 摄片体位 矢状位 骨盆 序列 立位姿势 影像学资料 X线片 

分 类 号：R68[医药卫生—骨科学] R816.8[医药卫生—外科学]