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宋阳1,苗军2,冷辉3,张海军1,赵磊1,赵雪晴4▲.下腰椎椎体在不同负荷下屈伸运动特点的分析[J].中国医药科学,2024,14(10):170-174        基金项目:内蒙古医科大学联合项目(YKD2022LH048)
下腰椎椎体在不同负荷下屈伸运动特点的分析
Analysis of flexion and extension motion characteristics of lower lumbar vertebral body under different loads
  
DOI:
中文关键词:  腰椎;在体运动;六个自由度;负重;退行性疾病
英文关键词:Lumbar vertebrae; In vivo motion; Six degrees of freedom; Load; Degenerative disease
作者单位
宋阳1,苗军2,冷辉3,张海军1,赵磊1,赵雪晴4▲ 1. 内蒙古自治区赤峰市医院骨二科,内蒙古赤峰 024000;2. 天津医院脊柱二科,天津 300211; 3. 内蒙古自治区赤峰市医院脊柱外科,内蒙古赤峰 024000;4. 内蒙古自治区赤峰市医院神经内科,内蒙古赤峰 02400 
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中文摘要:
      [摘要] 目的 探索不同负重状态下直立位腰椎 L3、L4 椎体屈伸运动过程中体运动轨迹,分析负重状态下腰椎 在体运动的规律和特点。 方法 招募 2018 年 8 月至 2020 年 8 月 10 名无症状的青年志愿者,使用双荧光透 视系统 DFIS 与 CT 相匹配技术,经平扫 CT 获取 L3 ~ S1 的图像进行三维重建。于放射线透视不同负重下 0、5、10 kg 完成下腰椎的前屈到直立到后伸动作获得 X 线影像,通过轮廓重叠实现二维到三维图像的匹配,还 原下腰椎椎体的三维运动轨迹。 结果 下腰椎在前屈到站立位时:不同负重下腰椎椎体 0、5、10 kg 的 X 轴的运动 位移分别为 -1.05(-2.42,1.72)、0.63(0.15,4.26)、-0.39(-0.75,3.12)mm。X 轴运动位移比较 5 kg>10 kg>0 kg, 差异有统计学意义(P < 0.05)。γ 角度分别为 -0.26(-1.30,5.43)、0.93(0.24,5.42)、-0.95(-2.12,4.32)°。 γ 角度比较 5 kg>0 kg>10 kg,差异有统计学意义(P < 0.05)。下腰椎在站立到后伸位时:不同负重下腰椎椎 体 0、5、10 kg X 轴的运动位移分别为 0.90(-0.82,3.74)、-0.91(-1.55,4.26)、0.07(-0.92,3.25)mm。Z 轴的运动位移 分别为 -0.25(-0.54,1.78)、0.40(-0.68,2.37)、-0.19(-0.92,1.03)mm。X 轴运动位移比较 0 kg>10 kg>5 kg, Z 轴运动位移比较 5 kg>10 kg>0 kg,差异有统计学意义(P < 0.05)。α 角度分别为 0.91(-0.82,2.85)、-0.61 (-0.14,3.79)、0.54(-0.82,3.87)°。γ 角度分别为 1.15(0.24,5.32)、0.92(-0.67,5.45)、0.65(-1.24,5.32)°。 α 角度比较 0 kg>10 kg>5 kg,γ 角度比较 0 kg>5 kg>10 kg,差异有统计学意义(P < 0.05)。 结论 负重 5 kg 下腰椎椎体在体运动的位移和旋转角度和 0 kg 相比差异有统计学意义,可能与腰椎退行性疾病有一定关联。 下腰椎退行性疾病可能与 X 轴位移的关系更为密切。
英文摘要:
      [Abstract] Objective To explore the trajectory of body motion during flexion and extension of L3 and L4 vertebrae in an upright position under different loads, and to analyze the laws and characteristics of in vivo motion of lumbar vertebrae under loads. Methods From August 2018 to August 2020, 10 asymptomatic young volunteers were recruited, and the images of L3-S1 were obtained by plain CT using the matching technology of dual fluoroscopy system DFIS and CT for three-dimensional reconstruction. X-ray images were obtained by performing flexion-uprightextension motions of the lower lumbar spine under different loads of 0, 5 and 10 kg in radiographic perspective, and two-dimensional to three-dimensional images were matched through contour overlapping to restore the three-dimensional motion trajectory of the lower lumbar vertebral body. Results When the lower lumbar vertebrae are bent forward to a standing position, the X-axis displacement of the lumbar vertebrae at 0, 5, and 10 kg under different loads is -1.05 (-2.42, 1.72), 0.63 (0.15, 4.26), -0.39 (-0.75, 3.12) mm, and the X-axis displacement is 5 kg>10 kg>0 kg, with statistical significance difference (P < 0.05). The γ angles are -0.26 (-1.30, 5.43), 0.93 (0.24, 5.42), and -0.95 (-2.12, 4.32) ° , respectively. The difference in γ angle was statistically significant (P < 0.05) ,when compared to 5 kg>0 kg>10 kg. When the lower lumbar vertebrae stand to the extended position, the X-axis displacement of the lumbar vertebrae at 0, 5, and 10 kg under different loads is 0.90 (-0.82, 3.74), -0.91 (-1.55, 4.26), and 0.07 (-0.92, 3.25) mm,respectively. The movement displacement of the Z-axis is -0.25 (-0.54, 1.78), 0.40 (-0.68, 2.37), and -0.19 (-0.92, 1.03) mm, respectively. The X displacement comparison showed a statistically significant difference of 0 kg>10 kg>5 kg, while the Z displacement comparison showed a difference of 5 kg>10 kg>0kg (P < 0.05). The α angles are 0.91 (-0.82, 2.85), -0.61 (-0.14, 3.79), and 0.54 (-0.82, 3.87) degrees, respectively. The γ angles are 1.15 (0.24, 5.32), 0.92 (-0.67, 5.45), and 0.65 (-1.24, 5.32) degrees, respectively. The α angle comparison showed a statistically significant difference between 0 kg>10 kg>5 kg, and the γ angle comparison showed a difference of 0 kg>5 kg>10 kg (P < 0.05). Conclusion There are statistical differences in the in vivo motion displacement and rotation angle between lumbar vertebral bodies under loads of 5 kg and 0 kg, which may be related to lumbar degenerative diseases. Degenerative diseases of lower lumbar spine may be more closely related to X-axis displacement.
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