| 寇博文,张泽佩,刘健超,徐瀚鹏,吴金成,兰 杰,苗 军.坐位下腰椎前屈后伸时轴向载荷对下腰椎在体运动的影响[J].中国脊柱脊髓杂志,2022,(7):631-638. |
| 坐位下腰椎前屈后伸时轴向载荷对下腰椎在体运动的影响 |
| 中文关键词: 腰椎 椎间运动 坐位 在体运动 |
| 中文摘要: |
| 【摘要】 目的：研究坐位下轴向载荷对腰椎前屈后伸时下腰椎节段运动的影响。方法：招募10名志愿者进行研究，其中男性5例，女性5例，年龄31（26，34）岁，体质指数（body mass index，BMI）22.5（22.0，23.4）kg/m2。用CT扫描获取受试者仰卧位时L3~S椎体的影像并进行三维重建。在双透视成像系统中采集受试者坐位L3~S1在中立、最大前屈及最大后伸姿势时的瞬时影像。在Rhinoceros软件环境中将不同坐位姿势的瞬时影像与三维模型配准。测量由仰卧位变化为中立坐位时椎体的相对位移距离和相对旋转角度；在生理条件下和额外轴向载荷（背负10kg特制背心）的坐位下，比较两种状态下最大前屈到最大后伸运动中椎体的活动度（range of motion，ROM），由中立坐位到最大前屈、后伸坐位姿势时腰椎活动度的差异。结果：生理坐位下，由仰卧位变成中立坐位，L5相对于S1向背侧位移1.4（0.6，2.4）mm，前屈旋转11.4°（10.2°，17.9°），L3/4、L4/5在矢状面上旋转0.8°（-2.1°，3.8°）、4.4°（-1.0°，8.9°），旋转幅度较L5/S1无显著性差异（P>0.05）；在前屈后伸过程中，L3~S1各节段在左右方向位移分别为2.0（1.6，2.5）mm、1.8（1.0，2.4）mm、5.9（3.7，6.4）mm；近远端方向位移分别为1.0（0.7，1.2）mm、0.7（0.6，1.3）mm、3.3（1.7，4.0）mm，L5/S1在左右方向及近远端方向的位移较L3/4、L4/5有显著性差异（P<0.05）；在由中立坐位到最大后伸坐位运动过程中，L3~S1各节段在左右方向上的位移分别为0.7（0.3，1.4）mm、0.5（0.3，0.6）mm、2.6（1.3，3.8）mm；在矢状面上的旋转角度分别为4.2°（1.1°，5.6°）、2.2°（1.4°，3.3°）、9.5°（4.6°，12.2°）。加载额外轴向载荷后，与生理坐位相比，由仰卧位变成中立坐位，L5/S1在矢状面上旋转减小1.2°、在头尾方向上压缩1.5mm；前屈后伸运动中，L5/S1在前后、左右及近远端方向的位移分别减少2.8、4.1、1.3mm；中立到最大后伸坐位运动过程中，L5/S1的旋转范围减小6.1°（P=0.038）。结论：由仰卧位转换为中立坐位，下腰椎偏向前屈位置。生理坐位前屈后伸运动中，L5/S1有较大的活动度。伴随着额外轴向载荷的加载，L5/S1活动度减少。相比较于L5/S1，有或无加载额外轴向载荷对L3/4、L4/5在坐位前屈后伸中运动学参数影响较小。 |
Biomechanics analysis of the effect of axial loading on the in vivo movement of the lower lumbar spine during flexion and extension in sitting position |
| 英文关键词:Lumbar spine Intervertebral motion Sitting position In-vivo movement |
| 英文摘要: |
| 【Abstract】 Objectives: To study the the effect of axial loading on the motion characteristics of the lumbar spine during flexion and extension in the sitting position. Methods: Ten subjects were included in the study, five males and five females, aged 31(26, 34) years, with a body mass index(BMI) of 22.5(22.0, 23.4)kg/m2. CT images of the L3－S vertebrae in the supine position were acquired and 3D reconstructed. Transient images of the L3-S1 segments in upright, maximum flexion and extension sitting positions were acquired in dual fluoroscopic imaging system(DFIS). The images were aligned with the 3D model in the Rhinoceros software environment. Relative displacement distances and relative rotation angles of vertebrae from supine to upright sitting position were measured. Range of motion(ROMs) of the vertebrae from maximum flexion to maximum extension in sitting position under physiological conditions and additional axial load(bearing a 10kg special vest) were measured and compared. And the differences in lumbar ROMs from upright sitting to maximum flexion and maximum extension sitting positions were compared. Results: In the physiological sitting position, from supine to upright sitting position, L5 displaced 1.4(0.6, 2.4)mm dorsally relative to S1, and rotated 11.4°(10.2°, 17.9°) in flexion and L3/4 and L4/5 rotated 0.8°(-2.1°, 3.8°) and 4.4°(-1.0°, 8.9°) in the sagittal plane. The rotation magnitudes of L3/4 and L4/5 were with no significant difference from L5/S1(P>0.05). During anterior flexion and posterior extension, the displacement of each segment of L3-S1 in the left-right direction was 2.0(1.6, 2.5)mm, 1.8(1.0, 2.4)mm, and 5.9(3.7, 6.4)mm, respectively; the displacement in the proximal and distal directions was 1.0(0.7, 1.2)mm, 0.7(0.6, 1.3) mm, 3.3(1.7, 4.0)mm, and the displacements of L5/S1 in the left-right and proximal-distal directions were significantly different from those of L3/4 and L4/5(P<0.05); during the movement from neutral sitting to maximum posterior extension sitting, the displacements of each segment of L3-S1 in the left-right direction were 0.7(0.3, 1.4)mm, 0.5(0.3, 0.6)mm, 2.6(1.3, 3.8)mm; the rotation degrees in the sagittal plane were 4.2°(1.1°, 5.6°), 2.2°(1.4°, 3.3°), and 9.5°(4.6°, 12.2°), respectively. Comparing with physiological sitting position, after additional axial loading, the rotation of L5/S1 in the sagittal plane decreased by 1.2° and cranial-caudal direction compressed by 1.5 mm from supine to upright sitting; during flexion and extension, the displacements of L5/S1 reduced by 2.8, 4.1, and 1.3mm at anterior-posterior, left-right, and proximal-distal directions respectively; from upright sitting to maximum extension sitting, the rotation ranges of L5/S1 reduced by 6.1°(P=0.038). Conclusions: Converting from supine to neutral sitting position, the lower lumbar spine tends to be the forward flexion position. There is a greater mobility of L5/S1 in physiological sitting forward flexion and back extension motion. With additional axial loading, L5/S1 mobility decreases. Comparing with L5/S1, the effects on kinematic parameters of additional axial loading on L3/4 and L4/5 during flexion and extension motion in sitting position are less. |
| 投稿时间：2021-12-06 修订日期：2022-05-26 |
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