Hollenbeck Justin F M, Cain Christopher M, Fattor Jill A, Rullkoetter Paul J, Laz Peter J
Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA.
Spine Center, University of Colorado Hospital, Aurora, CO, USA.
J Biomech. 2018 Mar 1;69:146-155. doi: 10.1016/j.jbiomech.2018.01.020. Epub 2018 Feb 2.
The mechanics of the lumbar spine are heavily dependent on the underlying anatomy. Anatomical measures are used to assess the progression of pathologies related to low back pain and to screen patients for surgical treatment options. To describe anatomical norms and pathological differences for the population, statistical shape modeling, which uses full three-dimensional representations of bone morphology and relative alignment, can capture intersubject variability and enable comparative evaluations of subject to population. Accordingly, the objective of this study was to develop a comprehensive set of three-dimensional statistical models to characterize anatomical variability in the lumbar spine, by specifically describing the shape of individual vertebrae, and shape and alignment of the entire lumbar spine (L1-S1), with a focus on the L4-L5 and L5-S1 functional spinal units (FSU). Using CT scans for a cohort of 52 patients, lumbar spine geometries were registered to a template to establish correspondence and a principal component analysis identified the primary modes of variation. Scaling was the most prevalent mode of variation for all models. Subsequent modes of the statistical shape models of the individual bones characterized shape variation within the processes. Subsequent modes of variation for the FSU and entire spine models described alignment changes associated with disc height and lordosis. Quantification of anatomical variation in the spine with statistical models can inform implant design and sizing, assist clinicians in diagnosing pathologies, screen patients for treatment options, and support pre-operative planning.
腰椎的力学机制在很大程度上依赖于其基础解剖结构。解剖学测量用于评估与腰痛相关的病理进展，并为患者筛选手术治疗方案。为了描述人群的解剖学规范和病理差异，统计形状建模利用骨骼形态和相对排列的完整三维表示，可以捕捉个体间的变异性，并实现个体与群体的比较评估。因此，本研究的目的是开发一套全面的三维统计模型，以表征腰椎的解剖学变异性，具体方法是描述单个椎体的形状，以及整个腰椎（L1-S1）的形状和排列，重点关注L4-L5和L5-S1功能脊柱单元（FSU）。利用52名患者的CT扫描数据，将腰椎几何形状与模板进行配准以建立对应关系，主成分分析确定了主要的变异模式。缩放是所有模型中最普遍的变异模式。单个骨骼的统计形状模型的后续模式表征了各突起内的形状变异。FSU和整个脊柱模型的后续变异模式描述了与椎间盘高度和脊柱前凸相关的排列变化。用统计模型对脊柱的解剖学变异进行量化，可以为植入物的设计和尺寸确定提供参考，帮助临床医生诊断病理状况，为患者筛选治疗方案，并支持术前规划。
