中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (36): 5792-5797.doi: 10.12307/2022.797

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

坐位前屈过程中腰椎间盘形态学改变及应变特征

寇博文1,韩  晔1,郝一光1,徐浩翔1,文王强1,张泽佩2,兰  杰2,苗  军2   

  1. 1天津医科大学,天津市   300000;2天津大学天津医院脊柱外科,天津市   300211
  • 收稿日期:2021-12-08 接受日期:2022-01-13 出版日期:2022-12-28 发布日期:2022-04-27
  • 通讯作者: 苗军,博士,主任医师,天津大学天津医院脊柱外科,天津市 300211
  • 作者简介:寇博文,男,1996年生,湖北省武汉市人,汉族,天津医科大学在读硕士,主要从事脊柱外科方面的研究。
  • 基金资助:
    国家自然科学基金(81472140),项目负责人:苗军

Morphological changes and strain characteristics of lumbar intervertebral disc during sitting in forward flexion

Kou Bowen1, Han Ye1, Hao Yiguang1, Xu Haoxiang1, Wen Wangqiang1, Zhang Zepei2, Lan Jie2, Miao Jun2   

  1. 1Tianjin Medical University, Tianjin 300000, China; 2Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin 300211, China
  • Received:2021-12-08 Accepted:2022-01-13 Online:2022-12-28 Published:2022-04-27
  • Contact: Miao Jun, MD, Chief physician, Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin 300211, China
  • About author:Kou Bowen, Master candidate, Tianjin Medical University, Tianjin 300000, China
  • Supported by:
    the National Natural Science Foundation of China, No. 81472140 (to MJ)

摘要:

文题释义:
椎间盘形态:椎间盘中央部分为髓核,周围部分为纤维环,上下通过软骨终板与椎体骨组织相连。椎间盘形态可以通过放射成像分析来评估。椎间盘高度随着脊柱部分不同而不同,腰椎间盘高度为9-17 mm,且前区厚、后区薄。
椎间盘应变:应变是指物体受应力作用下产生局部相对变形。椎间盘的应变包括由轴向应力所产生的轴向应变,以及由剪切应力所产生的剪切应变。当椎间盘应变超过其耐受极限,会导致其退变加速、纤维环撕裂、髓核脱出,进一步影响椎间盘的正常功能。

背景:日常生活中较多的活动有坐位前屈运动参与,然而,关于坐位前屈过程对腰椎间盘形变及应变特征的影响报道较少。
目的:分析坐位时腰椎间盘的在体形态和应变特征。
方法:采用双透视成像系统和CT对10名无症状受试者的L4-5和L5-S1水平进行椎间盘应变特征分析,男5例,女5例,年龄25-35岁,体质量指数(22.4±1.8) kg/m2。测定受试者在直立坐位和前屈坐位时椎间盘整体、纤维环内外侧的高度改变,以及坐位最大前屈运动中椎间盘的轴向、剪切应变范围。
结果与结论:①直立坐位和前屈坐位下L4-5、L5-S1各区域纤维环内外侧高度比变化规律相似,前屈运动中L4-5各区域高度比的变化范围在0-0.1之间,然而,L5-S1椎间盘高度显著降低,变化范围为0.02-0.39;②坐位前屈运动过程中,L5-S1在各个区域均处于压缩应变,尤其在右侧较L4-5显著压缩了28.3%(P=0.011);而L5-S1的剪切应变均大于上位椎间盘,在中心区域较L4-5应变显著增大14.8%(P=0.011);③提示坐位前屈运动对L5-S1椎间盘各部分高度及应变模式均有较大的影响,而对L4-5影响较小;L5-S1在该过程中整体处于压缩状态,左右两侧压缩不对称,并且各个区域具有更大的剪切应变;这些特征有助于对椎间盘应变改变所致的退变有更深入的了解,也有助于帮助术后患者达到更好的康复状态。

https://orcid.org/0000-0003-0014-1295 (寇博文)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 腰椎, 椎间盘应变, 坐位, 前屈, 形态学, 应变

Abstract: BACKGROUND: More activities in daily life involve sitting forward motion; however, the effect of the sitting forward process on lumbar disc deformation and strain characteristics has been less reported.
OBJECTIVE: To analyze the morphological changes of the lumbar disc during sitting forward flexion and the characteristics of strain.
METHODS: Dual fluoroscopic imaging system and computed tomography were used to determine the strain characteristics of the intervertebral discs. L4-5 and L5-S1 levels were studied in 10 asymptomatic subjects (male/female: 5/5, age: 25-35 years, body mass index: 22.4±1.8 kg/m2). The height changes of the disc as a whole, the medial and lateral annulus fibrosus in upright sitting and forward flexion sitting was measured. The ranges of tensile and shear strains in the disc during maximum forward flexion motion were determined in the sitting position. 
RESULTS AND CONCLUSION: (1) During sitting and forward flexion, L4-5 and L5-S1 showed similar patterns of change in the medial to lateral height ratios in each region of the annulus fibrosus, with a range of 0-0.1 for L4-5 in forward flexion, but a significant decrease in disc height in L5-S1, with a range of 0.02-0.39. (2) During sitting in forward flexion, L5-S1 was under compressive strain in all regions, especially on the right side, where it was 28.3% more compressed than L4-5 (P=0.011). The shear strain of L5-S1 was greater than that of the superior disc, with a significant increase of 14.8% in the central region compared to L4-5 (P=0.011). (3) It is indicated that forward flexion movement during sitting has a greater effect on the height and strain pattern of all parts of the disc at L5-S1, but less at L4-5. L5-S1 is in compression as a whole during the process, with asymmetric compression on the left and right sides, and with greater shear strain in each region. These characteristics help us to gain a better understanding of degeneration due to altered disc strain and to help postoperative patients achieve a better state of recovery.

Key words: lumbar spine, intervertebral disc deformation, sitting position, forward flexion, morphology, strain

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