腰椎退变性滑脱在体运动学研究进展

DEVELOPMENT RESEARCH OF IN VIVO KINEMATICS IN LUMBAR DEGENERATIVE SPONDYLOLISTHESIS

目的综述腰椎退变性滑脱在体运动学研究进展。方法查阅国内外有关腰椎退变性滑脱患者在体运动学研究相关文献,从滑脱节段是否存在失稳、滑脱节段椎体运动模式、滑脱节段椎管形态的运动学改变和滑脱节段术中生物力学测量4个方面进行归纳总结。结果腰椎退变性滑脱是否存在失稳仍有争议,其椎体间稳定性应根据滑脱退变所处的阶段和退变程度具体分析。滑脱节段棘突与小关节突的运动范围以及椎管径线、面积和容积均较正常人明显减小,为明确滑脱患者临床症状的发生提供依据。术中生物力学测定虽能准确了解滑脱节段运动学特点,但因其有创性和伦理性限制了临床应用。但既往相关研究大多局限于矢状面上的屈伸活动,即单平面的腰椎运动学观察,鲜有三维空间内的6个自由度(6-degree-of-freedom,6DOF)运动数据报道。结论腰椎退变性滑脱患者滑脱节段的6DOF数据能准确而全面反映病变节段的三维运动学特点,有待进一步深入研究。

Objective To review the researches of in vivo kinematics in lumbar degenerative spondylolisthesis（DS）.Methods Related literature concerning the in vivo kinematics in patients with lumbar DS was extensively reviewed and comprehensively analyzed in 4 terms of the instability of lumbar DS,vertebral motion pattern,the morphological changes of spinal canal,and intraoperative biomechanical measurement.Results Whether there is lumbar segmental instability in lumbar DS patients is still controversial,which should be based on degenerative stage of lumbar spine and grade of slip.The hypomobility of the lumbar spi nous processes and the facet joint is seen in DS.The diameter,cross-sectional area,and volume of spinal canal in lumbar DS patients are significantly smaller than those of the normal control.Because of its invasive procedure and medical ethics,the use of the intraoperative measurement device is limited.These reported researches of in vivo kinematics in DS are almost on the sagittal plane.However,few data have been reported on the 6-degree-of-freedom（6DOF） kinematics of the diseased levels under physiological loading conditions.Conclusion The 6DOF kinematics data can accurately reflect the segmental motion characteristics in lumbar DS patients,recent studies have been reported,further studies are still needed.