本文選題：下腰椎　切入點(diǎn)：在體運(yùn)動(dòng)學(xué)　出處：《天津醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探索負(fù)重狀態(tài)下正常人屈伸活動(dòng)時(shí)下腰椎椎體間旋轉(zhuǎn)中心的位置,并與生理載荷下下腰椎椎體間旋轉(zhuǎn)中心的位置進(jìn)行比較,以期從運(yùn)動(dòng)學(xué)角度分析負(fù)重對(duì)于下腰椎在體運(yùn)動(dòng)可能帶來(lái)的影響,了解不同載荷時(shí)下腰椎椎體間在體運(yùn)動(dòng)模式的變化特點(diǎn)及規(guī)律。方法:招募無(wú)腰椎疾患的健康志愿者14名,男6例,女8例;年齡22-41歲,平均(25±5)歲。采用雙X線透視影像系統(tǒng)和螺旋CT檢查相結(jié)合技術(shù),在計(jì)算機(jī)軟件輔助下,從薄層CT掃描中獲取腰椎L4-5、L5-S1節(jié)段的矢狀位CT圖像并將其重建為三維模型,匹配到雙X線透視影像系統(tǒng)捕獲的前屈、中立和后伸時(shí)腰椎雙斜位X射線透視圖像上,重現(xiàn)出生理載荷及負(fù)重狀態(tài)下腰椎椎體間三維運(yùn)動(dòng)狀態(tài)。在L4、L5及S1椎體上建立三維坐標(biāo)系,從而獲得腰椎椎體間在前屈、后伸及整體屈伸運(yùn)動(dòng)中的6自由度數(shù)值,并通過線性擬合計(jì)算出椎體間旋轉(zhuǎn)中心點(diǎn)(center of rotation,COR)的位置。結(jié)果:1.不同載荷下腰椎椎體間屈伸運(yùn)動(dòng)范圍:生理載荷下正常人屈伸運(yùn)動(dòng)時(shí)L4-5節(jié)段沿冠狀軸(X軸)、矢狀軸(Y軸)、垂直軸(Z軸)位移分別為1.3±1.6mm、2.0±1.7mm、0.3±0.2mm,沿三軸旋轉(zhuǎn)度分別為6.1±3.3°、1.6±1.0°、1.7±1.4°,L5-S1節(jié)段沿冠狀軸、矢狀軸、垂直軸位移分別為2.0±1.3mm、3.3±1.3mm、0.3±0.2mm,沿三軸旋轉(zhuǎn)度分別為7.5±3.0°、1.6±0.7°、2.4±1.8°;負(fù)重10KG下L4-5節(jié)段沿冠狀軸、矢狀軸、垂直軸位移分別為0.9±0.6mm、2.2±1.2mm、0.3±0.3mm,沿三軸旋轉(zhuǎn)度分別為4.8±2.2°、2.5±1.1°、1.9±1.7°,L5-S1節(jié)段沿冠狀軸、矢狀軸、垂直軸位移分別為1.4±2.0mm、3.4±1.8mm、0.5±0.5mm,沿三軸旋轉(zhuǎn)度分別為8.1±2.7°、1.7±1.2°、2.8±2.1°。L4-5、L5-S1兩節(jié)段在負(fù)重及無(wú)負(fù)重狀態(tài)下,其屈伸運(yùn)動(dòng)時(shí)的6-自由度數(shù)值均無(wú)明顯統(tǒng)計(jì)學(xué)差異。但將L4-5與L5-S1節(jié)段的運(yùn)動(dòng)參數(shù)進(jìn)行比較時(shí)發(fā)現(xiàn),不論受試者是否負(fù)重,L4-5節(jié)段在Y軸上的位移均明顯小于L5-S1節(jié)段(P0.05)。且負(fù)重時(shí)L5-S1節(jié)段的屈伸角度明顯大于L4-5節(jié)段(P0.05)。2.不同載荷下腰椎椎體間旋轉(zhuǎn)中心的位置變化規(guī)律:生理載荷下正常人L4-5節(jié)段整體屈伸運(yùn)動(dòng)的COR位于椎體中軸前方約1.0mm處,L5-S1節(jié)段整體屈伸運(yùn)動(dòng)的COR位于椎體中軸前方約0.7mm處。負(fù)重后L4-5節(jié)段屈伸運(yùn)動(dòng)的COR向后方輕微移動(dòng)約0.6mm,L5-S1節(jié)段屈伸運(yùn)動(dòng)的COR向后方輕微移動(dòng)約0.4mm,差異無(wú)顯著性意義。若分別計(jì)算對(duì)比前屈、后伸兩部分的COR位置及其移動(dòng)范圍,負(fù)重10KG后L4-5、L5-S1節(jié)段COR的移動(dòng)范圍較無(wú)負(fù)重時(shí)明顯增大(P0.05)。且負(fù)重后L5-S1節(jié)段前屈部分的COR位置較無(wú)負(fù)重時(shí)明顯向椎體前方偏移(P0.05)。結(jié)論:負(fù)重可使正常人屈伸運(yùn)動(dòng)時(shí)旋轉(zhuǎn)中心的運(yùn)動(dòng)軌跡明顯增大,且腰椎椎體間處于屈曲位時(shí)更易受到影響。
[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 鹵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 鹵1.6 mm / 2 鹵1.7 mm and 0.3 鹵0.2 mm, respectively. The rotation along the triaxial axis was 6.1 鹵3.3 擄/ 1.6 鹵1.0 擄/ 1.7 鹵1.4 擄/ L ~ (5-S1) along the coronal axis, respectively. The displacement of sagittal axis and vertical axis were 2.0 鹵1.3mm / 3.3 鹵1.3mm / 0.3 鹵0.2mm respectively, and the degree of rotation along triaxial axis were 7.5 鹵3.0 擄/ 1.6 鹵0.7 擄/ 2.4 鹵1.8 擄respectively, and the displacement of L4-5 segment along coronal axis, sagittal axis and vertical axis were 0.9 鹵0.6mm 2.2 鹵1.2 mm / 0.3 鹵0.3 鹵0.3 mm, 4.8 鹵2.2 擄/ 2.5 鹵1.1 擄/ 1.9 鹵1.7 擄L(fēng) _ 1 / 5, respectively. The vertical axis displacement was 1.4 鹵2.0 mm / 3.4 鹵1.8 mm / 0.5 鹵0.5 mm, and the rotation along the triaxial axis was 8.1 鹵2.7 擄/ 1.7 鹵1.2 擄/ 2.8 鹵2.1 擄/ 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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R681.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 李宏達(dá);夏群;白劍強(qiáng);苗軍;劉佳男;魏冬;;健康成人下頸椎在體三維瞬時(shí)運(yùn)動(dòng)特點(diǎn)研究[J];中國(guó)修復(fù)重建外科雜志;2015年12期

2 胥鴻達(dá);夏群;苗軍;;腰椎退變滑脫對(duì)相鄰節(jié)段在體運(yùn)動(dòng)的影響[J];中華醫(yī)學(xué)雜志;2014年47期

3 夏群;胥鴻達(dá);苗軍;白劍強(qiáng);張繼東;Shaobai Wang;Guoan Li;;生理載荷下腰椎峽部裂滑脫與退變滑脫的三維瞬時(shí)運(yùn)動(dòng)特征[J];中華骨科雜志;2014年12期

4 王博韜;夏群;苗軍;胥鴻達(dá);喻華;Shaobai Wang;Guoan Li;;應(yīng)用數(shù)字骨科技術(shù)觀測(cè)腰椎失穩(wěn)節(jié)段間在體三維運(yùn)動(dòng)特點(diǎn)[J];中華醫(yī)學(xué)雜志;2014年29期

5 胡均平;;腰椎屈伸運(yùn)動(dòng)時(shí)即時(shí)旋轉(zhuǎn)中心和椎弓根螺釘進(jìn)釘點(diǎn)的位置變化[J];中外醫(yī)學(xué)研究;2011年30期

6 白劍強(qiáng);夏群;閻廣輝;;腰椎椎弓根在體相對(duì)運(yùn)動(dòng)軌跡的研究[J];中華骨科雜志;2011年05期

7 何其臻;羅卓荊;杜俊杰;;腰椎屈伸運(yùn)動(dòng)時(shí)即時(shí)旋轉(zhuǎn)中心和椎弓根螺釘進(jìn)釘點(diǎn)的位置變化[J];中國(guó)脊柱脊髓雜志;2010年05期

，

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