摘要
目的研究老年腰椎退变性滑脱椎体的在体运动学特点。方法2014年3至10月在天津市天津医院脊柱外科招募L4退变性滑脱患者9例[年龄(74±9)岁]和健康志愿者9名[年龄(54±4)岁]。运用双荧光透视结合CT扫描技术获得生理载荷下各种姿势(平卧位、站立位、前屈位和后伸位)的椎体不同解剖结构(椎体前缘、椎体后缘、小关节和棘突)的三维运动学数据,对不同解剖结构的稳定性进行了对比。测量了不同姿势下L4-5节段椎间盘角的变化规律。两组间位移差异比较采用配对设计t检验。结果在过伸过屈运动过程中,滑脱组各解剖结构在三维方向上的活动范围均略大于正常组,但差异均无统计学意义(均P>0.05)。亚运动过程分析显示,正常组在前后方向和上下方向中,椎体前缘过屈运动范围[(-1.07±0.84)mm、(-1.27±1.01)mm]明显大于过伸运动[(0.66±1.38)mm、(0.63±0.99)mm](t=3.21、4.03,均P<0.05)。滑脱组在前后方向和上下方向中,椎体前缘的过伸运动幅度[(1.46±1.26)mm、(1.17±0.54)mm]均明显大于过屈运动幅度[(-0.43±0.47)mm、(-0.45±1.24)mm](t=4.22、3.59,均P<0.05)。滑脱组椎间盘角均小于正常组,但差异均无统计学意义,但不同姿势下椎间盘角具有明显差异,正常组和滑脱组均以前屈位时最小。结论老年腰椎退变性滑脱患者并不一定存在腰椎失稳,可能已经发生了再稳定,过伸运动范围增加是老年腰椎滑脱患者运动学特点之一,制定手术方案时应考虑到椎间再稳可能已经发生。
Objective To investigate the in vivo kinematics of the lumbar degenerative spondylolysis (LDS) in senile patients. Methods From March to October in 2014, nine L4-5 LDS patients [mean age (74±9) years] and nine healthy volunteers [mean age,(54±4) years] were recruited. Combined fluoroscopy and CT scanning technique were used to obtain the three dimension kinematic data of the vertebral anatomical structures (vertebral body anterior margin, vertebral body posterior margin, facet joints and spinous process) in various postures (supine, standing, flexion and extension) under physical loads, and to compare the stability of different anatomical structures. The L4-5 segmental disc angle was also measured in different postures. Paired-samples t test was applied to compare the displacement differences between the two groups. Results During flexion-extension motion, all anatomical structures of the LDS group were slightly larger than those in normal group, but the statistical difference was not obvious (all P>0.05). For normal group, in anterior-posterior and cranial-caudal direction, sub-movement analysis showed that the anterior vertebral body margin at the flexion range of motion [(-1.07±0.84) mm,(-1.27±1.01) mm] were larger than the extension range of motion [(0.66±1.38) mm,(0.63±0.99) mm](t=3.21, 4.03, both P<0.05). Whereas for LDS group, in anterior-posterior and cranial-caudal direction, sub-movement analysis showed that the anterior vertebral body margin at the extension range of motion [(1.46±1.26) mm,(1.17±0.54) mm] were significantly greater than the flexion range of motion [(-0.43±0.47) mm,(-0.45±1.24) mm](t=4.22, 3.59, both P<0.05). The disc angles of the LDS group were all smaller than those in normal group, but the statistical difference was not obvious (all P>0.05). However, the disc angles were significantly different under different postures, the flexion were both the smallest in the normal group and LDS group. Conclusions The senile LDS patients may not necessarily have instability, stability m
作者
张泽佩
苗军
胥鸿达
夏群
孙权
王玉冰
白剑强
Zhang Zepei;Miao Jun;Xu Hongda;Xia Qun;Sun Quan;Wang Yubing;Bai Jianqiang(Graduate School of Tianjin Medical University,Tianjin 300070,China;Department of Spine Surgery,Tianjin Hospital,Tianjin 300211,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2019年第15期1172-1177,共6页
National Medical Journal of China
基金
国家自然科学基金(81472140,81572199).
关键词
腰椎退变性滑脱
在体运动
脊柱失稳
Lumbar degenerative spondylolysis
In vivo kinematics
Spinal instability
