负重对下腰椎椎体间旋转中心的影响

发布时间：2018-03-15 04:34

本文选题：下腰椎　切入点：在体运动学　出处：《天津医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：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,并与生理载荷下下腰椎椎体间旋转中心的位置进行比较,以期从运动学角度分析负重对于下腰椎在体运动可能带来的影响,了解不同载荷时下腰椎椎体间在体运动模式的变化特点及规律。方法:招募无腰椎疾患的健康志愿者14名,男6例,女8例;年龄22-41岁,平均(25±5)岁。采用双X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扫描中获取腰椎L4-5、L5-S1节段的矢状位CT图像并将其重建为三维模型,匹配到双X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,重现出生理载荷及负重状态下腰椎椎体间三维运动状态。在L4、L5及S1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6自由度数值,并通过线性拟合计算出椎体间旋转中心点(center of rotation,COR)的位置。结果:1.不同载荷下腰椎椎体间屈伸运动范围:生理载荷下正常人屈伸运动时L4-5节段沿冠状轴(X轴)、矢状轴(Y轴)、垂直轴(Z轴)位移分别为1.3±1.6mm、2.0±1.7mm、0.3±0.2mm,沿三轴旋转度分别为6.1±3.3°、1.6±1.0°、1.7±1.4°,L5-S1节段沿冠状轴、矢状轴、垂直轴位移分别为2.0±1.3mm、3.3±1.3mm、0.3±0.2mm,沿三轴旋转度分别为7.5±3.0°、1.6±0.7°、2.4±1.8°;负重10KG下L4-5节段沿冠状轴、矢状轴、垂直轴位移分别为0.9±0.6mm、2.2±1.2mm、0.3±0.3mm,沿三轴旋转度分别为4.8±2.2°、2.5±1.1°、1.9±1.7°,L5-S1节段沿冠状轴、矢状轴、垂直轴位移分别为1.4±2.0mm、3.4±1.8mm、0.5±0.5mm,沿三轴旋转度分别为8.1±2.7°、1.7±1.2°、2.8±2.1°。L4-5、L5-S1两节段在负重及无负重状态下,其屈伸运动时的6-自由度数值均无明显统计学差异。但将L4-5与L5-S1节段的运动参数进行比较时发现,不论受试者是否负重,L4-5节段在Y轴上的位移均明显小于L5-S1节段(P0.05)。且负重时L5-S1节段的屈伸角度明显大于L4-5节段(P0.05)。2.不同载荷下腰椎椎体间旋转中心的位置变化规律:生理载荷下正常人L4-5节段整体屈伸运动的COR位于椎体中轴前方约1.0mm处,L5-S1节段整体屈伸运动的COR位于椎体中轴前方约0.7mm处。负重后L4-5节段屈伸运动的COR向后方轻微移动约0.6mm,L5-S1节段屈伸运动的COR向后方轻微移动约0.4mm,差异无显著性意义。若分别计算对比前屈、后伸两部分的COR位置及其移动范围,负重10KG后L4-5、L5-S1节段COR的移动范围较无负重时明显增大(P0.05)。且负重后L5-S1节段前屈部分的COR位置较无负重时明显向椎体前方偏移(P0.05)。结论:负重可使正常人屈伸运动时旋转中心的运动轨迹明显增大,且腰椎椎体间处于屈曲位时更易受到影响。
[Abstract]:Objective: to explore the position of rotation center between lumbar vertebrae during flexion and extension of normal people under load, and to compare it with the position of rotation center between lower lumbar vertebrae under physiological load. The aim of this study was to analyze the possible effects of load loading on the in vivo movement of the lower lumbar vertebrae from a kinematic perspective, and to understand the changing characteristics and rules of the in vivo motion patterns between the lumbar vertebrae under different loads. Methods: 14 healthy volunteers without lumbar disease were recruited. There were 6 males and 8 females, aged 22-41 years, with an average age of 25 卤5 years. The technique of double X-ray fluoroscopy system and spiral CT examination was used, with the aid of computer software. Sagittal CT images of L4-5 and L5-S1 segments of lumbar vertebrae were obtained from thin slice CT scans and reconstructed into three-dimensional models, which were matched to double oblique X-ray images of lumbar vertebrae captured by double X-ray fluoroscopic imaging system. The three-dimensional motion state of lumbar vertebrae was reconstructed under physiological load and weight-bearing condition. Three dimensional coordinate system was established on L4N L5 and S1 vertebrae, thus the 6-DOF values of lumbar vertebrae in flexion, extension and global flexion and extension were obtained. The position of center of rotation core was calculated by linear fitting. Results: 1. The range of flexion and extension of lumbar vertebrae under different loads: under physiological load, L4-5 segment along the coronal axis of X axis, sagittal. The displacement of Y axis and Z axis were 1.3 卤1.6 mm / 2 卤1.7 mm and 0.3 卤0.2 mm, respectively. The rotation along the triaxial axis was 6.1 卤3.3 掳/ 1.6 卤1.0 掳/ 1.7 卤1.4 掳/ L ~ (5-S1) along the coronal axis, respectively. The displacement of sagittal axis and vertical axis were 2.0 卤1.3mm / 3.3 卤1.3mm / 0.3 卤0.2mm respectively, and the degree of rotation along triaxial axis were 7.5 卤3.0 掳/ 1.6 卤0.7 掳/ 2.4 卤1.8 掳respectively, and the displacement of L4-5 segment along coronal axis, sagittal axis and vertical axis were 0.9 卤0.6mm 2.2 卤1.2 mm / 0.3 卤0.3 卤0.3 mm, 4.8 卤2.2 掳/ 2.5 卤1.1 掳/ 1.9 卤1.7 掳L _ 1 / 5, respectively. The vertical axis displacement was 1.4 卤2.0 mm / 3.4 卤1.8 mm / 0.5 卤0.5 mm, and the rotation along the triaxial axis was 8.1 卤2.7 掳/ 1.7 卤1.2 掳/ 2.8 卤2.1 掳/ L _ 4-5 / L _ 5 / L _ 5-S _ 1 respectively, and there was no significant difference in the 6-DOF values between the two segments under load and without load. However, when comparing the motion parameters of L4-5 and L5-S1 segments, it was found that there was no significant difference in the motion parameters between L4-5 and L5-S1 segments. The displacement of L4-5 segment on Y axis was significantly lower than that of L5-S1 segment P0.05A, and the flexion and extension angle of L5-S1 segment was obviously larger than that of L4-5 segment P0.05U. 2. Under different loads, the position of rotation center between lumbar vertebrae was changed regularly: (1) the displacement of L4-5 segment was significantly lower than that of L5-S1 segment (P < 0.05), and the flexion and extension angle of L5-S1 segment was higher than that of L4-5 segment. Under physiological load, the COR of the whole flexion and extension motion of normal L4-5 segment is located about 1.0 mm in front of the midaxis of the vertebra and the COR of the whole flexion and extension motion of the L5-S1 segment is about 0.7 mm in front of the midaxis of the vertebral body. After loading, the COR of the flexion and extension motion of the L4-5 segment is slightly backward. The COR moving about 0.6mm / L _ 5-S _ 1 segment flexion and extension moved slightly to the rear about 0.4mm, there was no significant difference. The COR position and moving range of the two parts. The moving range of COR in L4-5N L5-S1 segment after 10 KG loading was significantly larger than that in the non-loaded L5-S1 segment, and the COR position of the anterior flexion part of L5-S1 segment after loading was obviously shifted to the front of the vertebral body than that of the non-loaded L5-S1 segment. Conclusion: the load can make the normal person rotate during flexion and extension. The motion path of the center is obviously enlarged. And the interbody of lumbar vertebrae in flexion position is more easy to be affected.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R681.5

【参考文献】