颈腰椎骨性标志X线测量系列研究和膝关节运动节段三维有限元重建
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摘要
目的 (1)研究目前四种常用的测量颈椎曲度方法(Borden氏测量法、改良Borden氏测量法、夹角测量法1、夹角测量法2)的可靠性。(2)研究采用Borden氏测量法探讨颈椎曲度弧顶点的分布规律。(3)观察一种新颖的，可以恢复颈椎前凸曲度牵引器的临床应用价值。(4)探讨腰痛患者腰椎棘突偏歪的变化规律。(5)建立膝关节运动节段的三维有限元模型，并对所建模型做出初步的力学分析。方法 (1)利用53例颈椎侧位X线片，2名医师采用Borden氏测量法、改良Borden氏测量法和两种夹角测量法，分别测量出颈椎曲度值，再进行测量者之间的相关性分析。(2)采用Borden氏测量法在154例颈椎侧位X线片上，测量颈椎生理曲度弧顶点的分布情况。(3)观察15例颈椎曲度变直的颈椎病患者使用牵引器后的颈椎曲度变化情况。(4)采用“椎体棘突四条线法”在89例腰痛患者的腰椎正位X线片上，观察测量腰椎棘突的变化规律。(5)根据螺旋CT扫描图像，利用Ansys有限元软件的由下向上的点、线、面、体的建模原则，对膝关节运动节段的三维有限元模型进行重建，并在重建的基础上模拟髌骨的受力机制，分析其应力大小和应力分布情况。结果 (1)以Borden氏法相关系数(0.901)最大，测量方法简单。改良Borden氏法相关系数(0.811)最小。(2)154例健康志愿者的颈椎曲度弧顶点位置分布的频数是以C_4中分布的频数最多(46.1％)，C_5中次之(18.2％)，C_6上最少(仅0.6％)；对不同弧顶点颈椎曲度值方差分析结果：P=0.103＞0.05，差异无统计学意义。(3)未牵引前的颈曲值：0.4067±0.4598mm，牵引后颈曲值：1.2400±0.3155mm，两者比较P＜0.01，差异有显著性意义。(4)在89例腰痛患者中，腰椎棘突偏歪的占80例，无改变者仅9例；偏歪的棘突以L_2最多，L_5最少；侧线的位置改变可见“成弧”和“成角”两种变化；腰椎棘突顶线偏歪值有显著差异(P=0.002)，以L_1最明显，L_2最小。腰椎棘突尖线偏歪值无显著差异(P＞0.05)。(5)建立了膝关节运动节段的三维有限元模型，对髌骨的有限元分析结果显示应力集中区分布在髌骨的上极和下极。结论 (1)常用的颈椎曲度测量方法中，以Borden氏法最为可靠，且方法简单实用。(2)颈椎曲度弧顶点的分布有一定规律，
主要分布C4中点和CS中点，且不同弧顶点的颈椎曲度值无明显差异。(3)
新型颈椎牵引器简便、实用，能较好地恢复患者的颈椎前凸曲度。(4)椎
体棘突四条线法是触诊有无棘突偏歪的有效手段之一;腰椎棘突偏歪以
L:最多，但偏歪程度以Ll最为明显。(5)建立了膝关节运动节段的三维
有限元模型，该模型能逼真地反应膝关节的真实几何结构。对骸骨的有限
元分析结果显示应力集中区分布在骸骨的上极和下极，说明骨折的好发部
位即在骸骨的上下极，与临床基本相符。
Objective (1) To study the reliability of four measurement methods (Borden method, Modified Borden method, Angle method 1, Angle method 2) for cervical lordosis. (2) To study the distributional characteristic of location of cervical lordosis arc apex on lateral X-ray. (3) To observe the value of clinical application about a novel cervical traction apparatus that could recover cervical lordotic curvature. (4) To explore the deviation rules of spinous process of lumbar vertebra in patients with lumbago. (5) To build a knee joint motion segment three-dimension finite-element model and to make a preliminary force analysis on the founded model. Methods (1) The cervical lordosis on lateral radiographs of 53 subjects were representatively measured by two doctors. The correlations between two doctors were analyzed with SPSS upon the results of cervical lordosis with four measurement methods. (2) The cervical lordosis on lateral radiographs of 154 subjects was representatively measured by Borden's method. The distrib
utional characteristic of location of cervical lordosis arc apex was recorded and analyzed. (3) To observe different changes of 15 cases of cervical spondylosis whose cervical curvature have been straight after the novel cervical traction apparatus was used. (4) In order to detect the changing rules in the spinous process of lumbar vertebra, anteroposterior position radiographs of 89 cases of patients with lumbag were representatively measured by use of Method of Four Lines in vertebrae-spinous process. (5) According to the model-building principle from point to line to area to volume of Ansys software, a knee joint motion segment three-dimension finite-element model was reconstructed on the basis of the images of spiral CT. Furthermore, the stress values and distribution of the patella model, part of the above reconstructed knee joint, were analysed by simulating force mechanism of the patella in human body. Results (1) Borden method had the highest correlation coefficient than other methods and the modifie
d Borden method had the lowest correlation coefficient among all the groups. (2) In the distributional frequency of location of cervical lordosis arc apex of 154
healthy volunteer, the most is in the middle of C4 vertebral body(46.1%), the second is in the middle of C5 vertebral body(18.2%), the least is in the upper of C6 vertebral body(only 0.6%). (3) The value before traction: 0.4067 + 0.4598mm The value after traction: 1.2400+ 0.3155mm, P<0.01, the difference was significant in contrast. (4) Spinous process deviation can be found in 80 cases among the 89 patients with lumbago, only 9 cases have no spinous process deviation; The number of deviated spinous process located in L2 is the largest, but that located in LS is the least. Two changes, which are arcing and angulating, have been found in lateral line; Significant difference(P=0.002) was discovered in deviation values of spinous process in Top Line, but no significant difference(J^>0.05) was in Tip Line. (5) A knee joint motion segment three-dimension finite-element model was reconstructed. The result of finite-element analysis of patella model indicated the stress mainly concentrated and distributed in the superior pole and inferior pole of patella. Conclusion (1) The results suggested that Borden method is most reliably in all of the measurement methods for cervical lordosis and the method is simply and practical. (2) There is particular regularity in the distributional characteristic of location of cervical lordosis arc apex. The middle of €4 and €5 vertebral body are mainly distributed. No significant difference exits in the results of cervical curvature of different cervical lordosis arc apex. (3) The novel cervical traction apparatus has the characteristics of convenience and utility, furthermore, it was more qualified with the request of recovery of the cervical curvature in the position of cervical lordosis. (4) Method of Four Lines in vertebrae-spinous process is one of the important ways to find spinous process deviation by palpati
主要分布C4中点和CS中点，且不同弧顶点的颈椎曲度值无明显差异。(3)
新型颈椎牵引器简便、实用，能较好地恢复患者的颈椎前凸曲度。(4)椎
体棘突四条线法是触诊有无棘突偏歪的有效手段之一;腰椎棘突偏歪以
L:最多，但偏歪程度以Ll最为明显。(5)建立了膝关节运动节段的三维
有限元模型，该模型能逼真地反应膝关节的真实几何结构。对骸骨的有限
元分析结果显示应力集中区分布在骸骨的上极和下极，说明骨折的好发部
位即在骸骨的上下极，与临床基本相符。
Objective (1) To study the reliability of four measurement methods (Borden method, Modified Borden method, Angle method 1, Angle method 2) for cervical lordosis. (2) To study the distributional characteristic of location of cervical lordosis arc apex on lateral X-ray. (3) To observe the value of clinical application about a novel cervical traction apparatus that could recover cervical lordotic curvature. (4) To explore the deviation rules of spinous process of lumbar vertebra in patients with lumbago. (5) To build a knee joint motion segment three-dimension finite-element model and to make a preliminary force analysis on the founded model. Methods (1) The cervical lordosis on lateral radiographs of 53 subjects were representatively measured by two doctors. The correlations between two doctors were analyzed with SPSS upon the results of cervical lordosis with four measurement methods. (2) The cervical lordosis on lateral radiographs of 154 subjects was representatively measured by Borden's method. The distrib
utional characteristic of location of cervical lordosis arc apex was recorded and analyzed. (3) To observe different changes of 15 cases of cervical spondylosis whose cervical curvature have been straight after the novel cervical traction apparatus was used. (4) In order to detect the changing rules in the spinous process of lumbar vertebra, anteroposterior position radiographs of 89 cases of patients with lumbag were representatively measured by use of Method of Four Lines in vertebrae-spinous process. (5) According to the model-building principle from point to line to area to volume of Ansys software, a knee joint motion segment three-dimension finite-element model was reconstructed on the basis of the images of spiral CT. Furthermore, the stress values and distribution of the patella model, part of the above reconstructed knee joint, were analysed by simulating force mechanism of the patella in human body. Results (1) Borden method had the highest correlation coefficient than other methods and the modifie
d Borden method had the lowest correlation coefficient among all the groups. (2) In the distributional frequency of location of cervical lordosis arc apex of 154
healthy volunteer, the most is in the middle of C4 vertebral body(46.1%), the second is in the middle of C5 vertebral body(18.2%), the least is in the upper of C6 vertebral body(only 0.6%). (3) The value before traction: 0.4067 + 0.4598mm The value after traction: 1.2400+ 0.3155mm, P<0.01, the difference was significant in contrast. (4) Spinous process deviation can be found in 80 cases among the 89 patients with lumbago, only 9 cases have no spinous process deviation; The number of deviated spinous process located in L2 is the largest, but that located in LS is the least. Two changes, which are arcing and angulating, have been found in lateral line; Significant difference(P=0.002) was discovered in deviation values of spinous process in Top Line, but no significant difference(J^>0.05) was in Tip Line. (5) A knee joint motion segment three-dimension finite-element model was reconstructed. The result of finite-element analysis of patella model indicated the stress mainly concentrated and distributed in the superior pole and inferior pole of patella. Conclusion (1) The results suggested that Borden method is most reliably in all of the measurement methods for cervical lordosis and the method is simply and practical. (2) There is particular regularity in the distributional characteristic of location of cervical lordosis arc apex. The middle of €4 and €5 vertebral body are mainly distributed. No significant difference exits in the results of cervical curvature of different cervical lordosis arc apex. (3) The novel cervical traction apparatus has the characteristics of convenience and utility, furthermore, it was more qualified with the request of recovery of the cervical curvature in the position of cervical lordosis. (4) Method of Four Lines in vertebrae-spinous process is one of the important ways to find spinous process deviation by palpati
引文
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[2] 韦坚，韦贵康．颈椎曲度变化与退变关系的生物力学分析[J]．中医正骨，1999；11(3)：9-11．
[3] 齐石源．x线测量与投照[M]．长沙：湖南出版社，1981．89．
[4] 王欠昆．新编临床医学数据手册[M]．北京：金盾出版社，1994．57．
[5] 王成林，王政民，龚小龙等．颈椎生理曲度x线测量方法研究[J]．中国中医骨伤科杂志，1991，7：3-5．
[6] 程黎明，贾连顺，陈雄生等．计算机测量脊柱颈曲的临床意义[J]．第二军医大学学报，1997，18：544-547．
[7] 方文，石志才，贾连顺等．颈椎病患者颈椎曲度的x线测量[J]．颈腰痛杂志，1999，20：83-86．
[8] 李义凯．颈椎曲度的变化及意义[J]．中医正骨，1995，7：39-41．
[9] 钱铭辉．颈椎病x线诊断的探讨[J]．中华放射学杂志，1978；12(1)：332
[10] 叶发刚，陈伯华，周秉文．退变性颈椎失稳的x线观察及诊断[J]．中华外科杂志，1993；31(8)：46-55
[11] 傅国根，林亚辉．颈性高血压28例临床与x线分析[J]．河北医药，1995；17(3)：1497
[12] 茹欢孟．800例颈椎病x线治疗分析和选择治疗[J]．颈腰痛杂志，1995；16(4)：23-38
[13] 李军朋，余克强，李义凯．颈椎曲度和活动度的测量及意义[J]．颈腰痛杂志 2002；23(3)：252-254
[14] 谢大钊，尹青山，李瑞云．颈椎病x线诊断(附526例临床及x线分析)[J]．中华骨科杂志，1982；2：16-19．
[15] 韦坚，韦贵康．颈椎曲度变化与退变关系的生物力学分析[J]．中医正骨，1999；11(3)：10-13．
[16] 刘惠芳，高鸿举，曹导源，冯志品．临床x线测量[M]．济南．山东科技出版社．1982．33．
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