基于躯干细化模型腰椎间盘突出症患者与健康人群在3种日常活动下的运动学差异

Kinematic Differences Between Patients with Lumbar Disc Herniation and Healthy People in Three Daily Activities Based on Refined Trunk Model

目的建立由不同腰椎节段和集成胸椎、骨盆构成的躯干细化模型,分析腰椎间盘突出症(lumbar disc herniation,LDH)患者与健康人群在3种日常活动下的运动学差异,并与采用全腰节段的躯干简略模型作对比,探讨进行LDH患者运动学分析时采用躯干细化模型的必要性。方法使用NDI运动捕捉系统采集15名健康男性和7名男性LDH患者在水平行走、躯干前屈、对侧拾物中各节段的运动角度,分别通过两种模型比较患者与健康人群的运动学差异。结果水平行走过程中,LDH患者胸椎节段和骨盆旋转增加,全腰节段运动角度无明显变化,但L4~5节段旋转角度显著减小;躯干前屈过程中,LDH患者所有腰椎节段屈伸角度都不同程度地减小,L3~4节段屈伸角度与健康人群差异性较大;对侧拾物过程中矢状面上的表现与躯干前屈类似,但LDH患者L3~4节段和L4~5节段侧弯角度显著低于健康人群。结论 LDH患者在日常活动中主要限制了损伤腰椎节段的运动。在某些运动中,只有躯干细化模型才能发现损伤腰椎节段的异常运动。因此,在进行LDH患者运动学分析时,有必要将腰椎细分成5个独立节段。

Objective To establish a refined model of trunk composed of different lumbar segments,lumped thoracic spine and pelvis,analyze the kinematic differences between patients with lumbar disc herniation( LDH)and healthy people during three daily activities,and to compare the refined trunk model with the simplified trunk model adopting the whole lumbar segment,and discuss the necessity of using the refined trunk model for kinematic analysis of LDH patients.Methods Motion capture system NDI was used to collect kinematic parameters of each segment from 15 healthy people and 7 male LDH patients during level walking,trunk flexion and contralateral pickup,then the kinematic differences between patients and healthy people by the two models were compared respectively.Results During level walking,the rotation of the thoracic segment and pelvis for LDH patients increased,while no significant change was found in motion angle of the whole lumbar segment,and the rotation angle of L4-5 segment significantly reduced.During trunk flexion,the flexion angles of all lumbar segments for LDH patients were reduced by varying degrees,and the flexion angle of L3-4 segment was significantly different from that of healthy people.During contralateral pickup,the performance on the sagittal plane was similar to that during flexion.However,the lateral bending angles of L3-4 segment and L4-5 segment for LDH patients were significantly lower than those for healthy people.Conclusions LDH patients mainly restrict the motion of injured lumbar segments in daily activities.During some motions,only refined model can discover the abnormal motion of injured lumbar segments.Therefore,it is necessary to subdivide the lumbar spine into5 independent segments for analyzing the kinematic characteristics of LDH patients.