胸椎运动学受椎间盘退变程度的影响，但不受肋骨的影响：一项体外研究,The Spine Journal

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胸椎运动学受椎间盘退变程度的影响，但不受肋骨的影响：一项体外研究
The Spine Journal ( IF 4.9 ) Pub Date : 2020-03-01 , DOI: 10.1016/j.spinee.2019.10.006
Christian Liebsch ₁ , René Jonas ₁ , Hans-Joachim Wilke ₁

Affiliation

背景背景胸椎三维运动学广为人知。然而，对于手术治疗的评估和数值模型的完整验证，胸椎的运动学数据是必不可少的。目的确定肋骨存在和椎间盘退变程度对胸椎运动学的可能影响，包括三平面螺旋轴和瞬时旋转中心。研究设计/设置椎间盘退变的放射学分级和使用 n = 8 个节段水平 T1-T2、T3-T4、T5-T6、T7-T8、T9-T10 和 T11-的人类胸椎功能性脊柱单元的体外测试- T12 分别在带肋和不带肋的情况下进行，以分析特定的运动学特性。方法以 5 Nm 的纯力矩和 1°/s 的恒定加载速率加载样本，以进行屈曲/伸展、横向弯曲和轴向旋转。执行光学运动跟踪以在三平面 X 射线上可视化螺旋轴和瞬时旋转中心，并评估主要运动范围和耦合运动。结果没有或轻度椎间盘退变的运动段在所有运动平面上都显示出可重复的运动学，而中度或严重退变的标本提供了旋转轴向远端方向的高度变化和偏移以及较低的运动范围。通常未检测到耦合运动。结论随着椎间盘退变的进展，旋转轴显示出更高的变化并倾向于向远侧方向移动，特别是在屈曲/伸展时向前方向移动，而肋骨切除不影响胸椎运动学，但影响其稳定性。临床意义作为脊柱畸形治疗的一部分，肋骨切除会破坏胸椎的稳定性，但不会改变其运动学。然而，年轻和健康的椎间盘可能会受到关于胸椎运动学的胸椎手术治疗的影响。

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Thoracic spinal kinematics is affected by the grade of intervertebral disc degeneration, but not by the presence of the ribs: An in vitro study

BACKGROUND CONTEXT Thoracic spinal three-dimensional kinematics is widely unknown. For the evaluation of surgical treatments and the complete validation of numerical models, however, kinematic data of the thoracic spine are essential. PURPOSE To identify possible effects of rib presence and grade of intervertebral disc degeneration on thoracic spinal kinematics including three-plane helical axes and instantaneous centers of rotation. STUDY DESIGN/SETTING Radiological grading of intervertebral disc degeneration and in vitro tests using n = 8 human thoracic functional spinal units of the segmental levels T1-T2, T3-T4, T5-T6, T7-T8, T9-T10, and T11-T12, respectively, were performed with as well as without ribs to analyze the specific kinematic properties. METHODS Specimens were loaded with pure moments of 5 Nm and constant loading rates of 1°/s in flexion/extension, lateral bending, and axial rotation. Optical motion tracking was performed to visualize helical axes and instantaneous centers of rotation on three-plane x-rays and to evaluate primary ranges of motion and coupled motions. RESULTS Motion segments with no or mild disc degeneration showed reproducible kinematics in all motion planes, while medium or severely degenerated specimens offered high variations and shifts of the rotational axes to the distal direction as well as lower range of motion. Coupled motions were generally not detected. CONCLUSIONS With progressing disc degeneration, the rotational axes show higher variation and tend to shift in distal direction, especially in flexion/extension with a shift to the anterior direction, while rib resection does not affect thoracic spinal kinematics but its stability. CLINICAL SIGNIFICANCE Rib resections as part of spinal deformity treatment destabilize the thoracic spine, but do not alter its kinematics. Young and healthy discs, however, could be affected by surgical treatments of the thoracic spine regarding thoracic spinal kinematics.

更新日期：2020-03-01

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