Normal and spondylolytic pediatric spine movements with reference to instantaneous axis of rotation
Normal and spondylolytic pediatric spine movements with reference to instantaneous axis of rotation
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DOI：
10.1097/00007632-200201150-00004
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发表时间：
2002-01-15
期刊：
影响因子：
3
通讯作者：
Sairyo, K
中科院分区：
文献类型：
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作者：
Sakamaki, T;Katoh, S;Sairyo, K
研究设计。对儿科脊柱腰椎运动学进行了放射学研究。目的。通过测量瞬时旋转轴的位置来阐明患有帕尔缺陷的儿科脊柱的运动学改变。背景数据摘要。在患有脊椎峡部裂的儿科患者中，经常观察到椎体滑移和 L5 楔入等畸形。然而，伴有椎体缺损的儿童腰椎的运动学尚未得到很好的记录。方法。对 70 名患有腰痛的儿科患者（57 名男孩和 13 名女孩）进行了 X 光检查。对照组（无椎弓峡部裂）由 22 名患者组成（15 名男孩和 7 名女孩；平均年龄为 14.6 岁；范围为 10-18 岁），松解组（L5 椎弓峡部裂）由 48 名患者组成（42 名男孩和 6 名女孩；平均年龄为 14.5 岁；范围为 11-18 岁）。根据缺损阶段和是否存在滑移，松解组进一步分为四个亚组：第1组（早期缺损）、第2组（进展期缺损）、第3组（无滑移的末期缺损）和第4组（滑移超过5%的末期缺损；滑脱）。在受试者处于卧姿时拍摄的横向动态射线照片上测量 L4-L5 和 L5-S1 从伸展位置到弯曲位置的瞬时旋转轴。还分析了腰椎指数与L5-S1瞬时旋转轴位置之间的关系。结果。对照组L5-S1、L4-L5瞬时旋转轴部位不位于旋转颅椎。早期亚组11例患者中，1例L5-S1瞬时旋转轴位于颅椎；进展期11例患者中，4例；末期16例患者中，有11例；滑脱亚组10例患者中，瞬时旋转轴位于颅椎中7例。在腰椎指数小于 80% 的严重畸形椎体中，瞬时旋转轴的颅骨偏差比在轻度畸形的椎体中更常见。结论。随着帕尔缺陷阶段的进展以及楔形畸形的增加，瞬时旋转轴会向颅侧偏离。椎弓峡部裂儿童患者腰椎的运动学改变可能会影响终板的软骨细胞，可能导致随后发生的脊柱畸形，继发于椎弓峡部裂。
Study Design. A radiologic study of lumbar kinematics in the pediatric spine was conducted.Objectives. To clarify the kinematic alteration in the pediatric spine with pars defects by measuring the location of the instantaneous axis of rotation.Summary of Background Data. Vertebral slippage and deformities such as wedging of L5 are observed frequently in pediatric patients with spondylolysis. However, the kinematics of pediatric lumbar spine with pars defects has not yet been well documented.Methods. Radiographs of 70 pediatric patients (57 boys and 13 girls) with low back pain were examined. The control group (without spondylolysis) consisted of 22 patients (15 boys and 7 girls; mean age, 14.6 years; range, 10-18 years), and the lysis group (with spondylolysis at L5) consisted of 48 patients (42 boys and 6 girls; mean age, 14.5 years; range, 11-18 years). The lysis group was further divided into four subgroups according to the stage of defects and existence of slippage: Group 1 (early stage defect), Group 2 (progressive stage defect), Group 3 (terminal stage defect without slippage), and Group 4 (terminal stage defect with slippage of more than 5%; olisthesis). The instantaneous axis of rotation at L4-L5 and L5-S1 from the extended to the flexed position was measured on lateral dynamic radiograms taken in with the subject in the recumbent position. The relation between lumbar index and the site of instantaneous axis of rotation at L5-S1 also was analyzed.Results. The site of instantaneous axis of rotation at L5-S1 and L4-L5 in the control group was not located In the rotating cranial vertebra. In 1 of the 11 patients in the early-stage subgroup, the instantaneous axis of rotation at L5-S1 was found in the cranial vertebra, In 4 of the 11 patients in the progressive stage, 11 of the 16 patients in the terminal stage, and in 7 of the 10 patients in the olisthesis subgroup, the instantaneous axis of rotation was located in the cranial vertebra. Cranial deviation in the instantaneous axis of rotation was observed more frequently in the vertebra with severe deformity less than 80% of the lumbar index than in the vertebra with milder deformity.Conclusions. The instantaneous axis of rotation deviated cranially as the stage of pars defects advanced, and as the wedge deformity increased. Kinematic alteration of the lumbar spine in pediatric patients with spondylolysis may affect chondrocytes of the endplate, perhaps contributing to the consequent spine deformities occurring, secondarily to spondylolysis.