中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (9): 1694-1697.doi: 10.3969/j.issn.1673-8225.2011.09.042

• 骨科植入物 orthopedic implant • 上一篇    下一篇

滑脱腰椎椎体间接触面积变化规律在临床应用中的价值

沈爱东1，徐瑞生2   

  1. 1东南大学医学院附属江阴医院，江苏省江阴市  214400
    2无锡市第三人民医院，江苏省无锡市  214041
  • 收稿日期:2010-10-10 修回日期:2010-11-15 出版日期:2011-02-26 发布日期:2011-02-26
  • 作者简介:沈爱东★，男，1981年生，江苏省东台市人，汉族，2008年南通大学毕业，硕士，医师，主要从事创伤外科和脊柱外科研究。
  • 基金资助:

    江苏省无锡市社会发展科技项目(CS055007)。

Change regularity of intervertebral contact areas during lumbar spondylolisthesis and its value in clinical application

Shen Ai-dong1, Xu Rui-sheng2   

  1. 1Affiliated Jiangyin Hospital, Southeast University Medical College, Jiangyin  214400, Jiangsu Province, China
    2Wuxi Third People’s Hospital, Wuxi  214041, Jiangsu Province, China
  • Received:2010-10-10 Revised:2010-11-15 Online:2011-02-26 Published:2011-02-26
  • About author:Shen Ai-dong★, Master, Physician, Affiliated Jiangyin Hospital, Southeast University Medical College, Jiangyin 214400, Jiangsu Province, China sad1129@medmail.com.cn
  • Supported by:

     the Science and Technology Item for Society Development of Wuxi, No. CS055007*

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摘要：

背景：腰椎滑脱直接导致滑脱椎体与下位椎体间接触面积的减少，滑脱椎体间接触面积是决定椎间应力和腰椎退变的重要因素。腰椎椎体截面是不规则的肾形，没有成熟的数学公式可以直接计算出椎体间接触面积的变化规律。
目的：观察腰椎滑脱时椎体间接触面积的变化规律，并分析其临床意义。
方法：采集25套L4椎体下表面和L5椎体上表面的图像，在二维平面上均分为14步模拟腰椎滑脱过程，Image-ProPlus软件计算每一滑脱点(n)椎体间重叠面积Sn，取平均值后再换算成百分面积，Sn%=Sn/S×100%，观察0~100%滑移时椎体间接触面积的变化规律。根据此规律提出新的腰椎滑脱临床分期，并应用其指导治疗56例腰椎滑脱患者。
结果与结论：腰椎滑脱过程中，Sn%的变化是一个双曲线：滑脱率0~23%阶段，Sn%降低较缓慢；23%~44%阶段，Sn%的变化明显加快；44%~100%阶段，Sn%的变化再次变缓，拐点分别出现在一维滑脱率的(23±2)%和(44±2)%处。48例腰椎滑脱患者获得随访，临床疗效按Staufee标准优良率达90%左右。提示腰椎滑脱时椎体间接触面积的变化是非线性的，有助于腰椎稳定性评估并指导腰椎滑脱的临床治疗。

关键词: 腰椎滑脱, 形态学, 图像分析, 诊断, 治疗, 分度

Abstract:

BACKGROUND: Lumbar spondylolisthesis directly reduces contact areas between dislocated vertebral body and subjacent vertebral body, which is an important factor that decides intervertebral stress and lumbar degeneration. The cross section of lumbar is irregular reniform shaped and there is no mathematical formula to calculate changing regularity of intervertebral contact areas of lumbar spondylolisthesis directly.
OBJECTIVE: To study changing regularity of intervertebral contact areas during lumbar spondylolisthesis and to analyze its clinical significance. 
METHODS: Super-surface of L5 vertebra and sub-surface of L4 from 25 cases were taken by a digital camera and computer simulation spondylolisthesis process and every intervertebral contact areas (Sn) were measured by Image-Pro Plus software. The mean value was obtained and converted into percentage area according to Sn%=Sn/S×100%. The change rules of vertebral bodies were observed from 0 to 100% spondylolisthesis. Based on this regularity, a new clinical stage of lumbar spondylolisthesis was proposed and guided for treatment of 56 cases with lumbar spondylolisthesis.
RESULTS AND CONCLUSION: During lumbar spondylolisthesis process, Sn% changes like a hyperbola. Sn% lost slowly during spondylolisthesis rate at 0-23% and quickly during 23%-44%, and then it become slowly once again after spondylolisthesis rate at 44%-100%, the inflection points appeared at (23±2)% and (44±2)%. Totally 48 patients were followed up, according to Staufee standard rate, the clinical curative effect reached approximately 90%. It suggests that the intervertebral contact areas present with a non-linear change, which is helpful to judge the stability of lumbar spine and guide the treatment of lumbar spondylolisthesis.

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