Motion Analysis Laboratory, Shriners Hospitals for Children-Salt Lake City, Fairfax Road at Virginia Street, Salt Lake City, UT 84103. E-mail address:
J Bone Joint Surg Am. 2013 Dec 4;95(23):e1841-8. doi: 10.2106/JBJS.L.01469.
This study quantifies the three-dimensional motion of lumbar vertebrae during gait via direct in vivo measurement with the use of indwelling bone pins with retroreflective markers and motion capture. Two previous studies in which bone pins were used were limited to instrumentation of two vertebrae, and neither evaluated motions during gait. While several imaging-based studies of spinal motion have been reported, the restrictions in measurement volume that are inherent to imaging modalities are not conducive to gait applications.
Eight healthy volunteers with a mean age of 25.1 years were screened to rule out pathology. Then, after local anesthesia was administered, two 1.6-mm Kirschner wires were inserted into the L1, L2, L3, L4, L5, and S1 spinous processes. The wires were clamped together, and reflective marker triads were attached to the end of each wire couple. Subjects underwent spinal computed tomography to anatomically register each vertebra to the attached triad. Subjects then walked several times in a calibrated measurement field at a self-selected speed while motion data were collected.
Less than 4° of lumbar intersegmental motion was found in all planes. Motions were highly consistent between subjects, resulting in small group standard deviations. The largest motions were in the coronal plane, and the middle lumbar segments exhibited greater motions than the segments cephalad and caudad to them. Intersegmental lumbar flexion and axial rotation motions were both extremely small at all levels.
The lumbar spine chiefly acts to contribute abduction during stance and adduction during swing to balance the relative motions between the trunk and pelvis. The lumbar spine acts in concert with the thoracic spine. While the lumbar spine chiefly contributes coronal plane motion, the thoracic spine contributes the majority of the transverse plane motion. Both contribute flexion motion in an offset phase pattern.
This is a valid model for measuring the three-dimensional motion of the spine. Normative data were obtained to better understand the effects of spine disorders on vertebral motion over the gait cycle.
本研究通过使用带有反光标记的内置骨钉和运动捕捉技术进行直接体内测量，定量分析了腰椎在步态过程中的三维运动。之前有两项使用骨钉的研究仅限于对两个椎体进行仪器操作，并且都没有评估步态过程中的运动。虽然已经有几项基于影像学的脊柱运动研究，但影像学方法固有的测量体积限制不利于步态应用。
筛选了 8 名平均年龄为 25.1 岁的健康志愿者，以排除疾病。然后，在局部麻醉下，将两根 1.6 毫米的克氏针插入 L1、L2、L3、L4、L5 和 S1 的棘突。将这些钢针夹在一起，并将反光标记三联体附着在每个钢针对的末端。受试者进行脊柱计算机断层扫描，将每个椎体与附着的三联体进行解剖学配准。然后，受试者在标定的测量场中以自选速度行走几次，同时收集运动数据。
在所有平面上，腰椎节段间运动小于 4 度。受试者之间的运动高度一致，导致组内标准偏差较小。最大的运动发生在冠状面，中段腰椎的运动幅度大于其上方和下方的节段。腰椎节段间的屈伸和轴向旋转运动在所有水平都非常小。
腰椎主要在站立时起外展作用，在摆动时起内收作用，以平衡躯干和骨盆之间的相对运动。腰椎与胸椎协同作用。虽然腰椎主要贡献冠状面运动，但胸椎贡献了大部分横断面上的运动。两者都以偏移相位模式贡献屈曲运动。
这是一种测量脊柱三维运动的有效模型。获得了正常数据，以更好地理解脊柱疾病对步态周期中椎体运动的影响。
