在上篇中,我们介绍了人体处于站立位时,EOS系统、颅骨的影像学标记、颈椎角度和胸腰椎角度的测量方法。在下篇中,我们将通过对骨盆环角度、下肢角度、前方失平衡的代偿机制的分析,全面讨论从头到足的脊柱平衡状态,同时通过运动学分析将人体行走时的脊柱动态状况呈现出来,有助于判断患者脊柱的真实状态。 Itoi[24]补充了一些关于骨质疏松症患者的代偿角度的概念——股骨胫骨角,由股骨干轴线和胫骨干轴线相交构成。当膝盖弯曲的时候,该角是正值,这是脊柱代偿严重向前失平衡的第二种方式。 Mangione和Sénégas[25]使用股骨骨盆角来评估重度前方失平衡时髋关节的伸展程度,它由股骨干轴线和股骨头中心与骶骨终板中点的连线所构成。 (七)前方失平衡的代偿机制 图3-36 特发性脊柱侧弯“平背”患者的脊柱力线,颈椎呈后凸状态 图3-37 腰椎截骨术后的“向上力线” 图3-38 发育不良性脊柱滑脱术后的脊柱力线 A.术前腰骶椎X线;B.术后腰骶椎X线;C.全脊柱术前X线;D.全脊柱术后X线 图3-39 神经纤维瘤病患者伴有颈椎严重后凸的脊柱向下力线,可以注意到胸椎变平以获得外耳道与股骨头之间力线的最佳匹配 图3-40 行走时,由于臀大肌无法维持骨盆后倾,矢状位失平衡加剧 向下对线很少见,在神经纤维瘤病伴严重的颈椎后凸畸形,可观察到较少见的向下对线,导致胸椎平背畸形(图3-41)。 行走评估 参考文献 [1] Luboga SA, Wood BA. Positionand orientation of the foramen magnum in higher primates. Am J Phys Anthropol.1990;81(1):67–76 [2] Tardieu C, Bonneau N, HecquetJ, et al. How is sagittal balance acquired during bipedal gait acquisition?Comparison of neonatal and adult pelves in three dimensions. Evolutionary implications. J HumEvol. 2013;65(2): 209–222 [3] Duval-Beaupère G, Schmidt C,Cosson P. A barycentremetric study of the sagittal shape of spine and pelvis:the conditions required for an economic standing position. Ann Biomed Eng.1992;20(4):451–462 [4] Morvan G, Wybier M, Mathieu P,Vuillemin V, Guerini H. Clichés simples du rachis: statique et relations entrerachis et bassin [in French]. J Radiol. 2008;89(5 Pt 2):654– 663, quiz 664–666 [5] Schlösser TPC, Janssen MMA,Vrtovec T, et al. Evolution of the ischio-iliac lordosis during natural growthand its relation with the pelvic incidence. Eur Spine J. 2014;23(7):1433–1441 [6] Abitbol MM. Evolution of thelumbosacral angle. Am J Phys Anthropol. 1987;72(3):361–372 [7] Marty C, Boisaubert B, DescampsH, et al. The sagittal anatomy of the sacrum among young adults, infants, andspondylolisthesis patients. Eur Spine J. 2002;11(2):119–125 [8] Goff CW, Landmesser W. Bipedalrats and mice;laboratory animals for orthopaedic research. J Bone Joint Surg Am.1957;39-A(3):616–6–22 [9] Aylott CEW, Puna R, RobertsonPA, Walker C. Spinous process morphology: the effect of ageing throughadulthood on spinous process size and relationship to sagittal alignment. EurSpine J. 2012;21(5):1007–1012 [10] Hadar H, Gadoth N, Heifetz M.Fatty replacement of lower paraspinal muscles: normal and neuromusculardisorders. AJR Am J Roentgenol. 1983;141(5):895–898 [11] Cruz-Jentoft AJ, Baeyens JP,Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis:report of the European Working Group on Sarcopenia in Older People. Age Ageing.2010;39(4):412–423 [12] Fortin M, Videman T, GibbonsLE, Battié MC. Paraspinal muscle morphology and composition: a 15-yrlongitudinal magnetic resonance imaging study. Med Sci Sports Exerc. 2014;46(5):893–901 [13] Vital JM, Gille O, Coquet M.Déformations rachidiennes: anatomopathologie et histoenzymologie [in French].Rev Rhum. 2004;71:263–264 [14] Sénégas J, Bouloussa H,Liguoro D, Yoshida G, Vital JM. Evolution morphologique et fonctionnelle durachis vieillissant. In: Anatomie de la Colonne Vertébrale: Nouveaux Concepts(in French). Montpellier, France: Sauramps Médical;2016:111–155 [15] Solow B, Tallgren A. Naturalhead position in standing subjects. Acta Odontol Scand. 1971;29(5):591–607 [16] Peng L, Cooke MS. Fifteen-yearreproducibility of natural head posture: A longitudinal study. Am J OrthodDentofacial Orthop. 1999;116(1):82–85 [17] Sugrue PA, McClendon J, Jr,Smith TR, et al. Redefining global spinal balance: normative values of cranialcenter of mass from a prospective cohort of asymptomatic individuals. Spine.2013;38(6):484–489 [18] Vital JM, Sénégas J.Anatomical bases of the study of the constraints to which the cervical spine issubject in the sagittal plane. A study of the center of gravity of the head.Surg Radiol Anat. 1986;8(3):169–173 [19] Vidal J, Marnay T. Sagittaldeviations of the spine, and trial of classification as a function of thepelvic balance (in French). Rev Chir Orthop Repar Appar Mot. 1984;70 Suppl2:124–126 [20] Delmas A, Despanux R. Spinalcurves and intervertebral foramina (in French). Rev Rhum Mal Osteoartic. 1953;20(1):25–29 [21] Roussouly P, Gollogly S, BerthonnaudE, Dimnet J. Classification of the normal variation in the sagittal alignmentof the human lumbar spine and pelvis in the standing position. Spine. 2005;30(3):346–353 [22] Mangione P, Gomez D, SénégasJ. Study of the course of the incidence angle during growth. Eur Spine J. 1997;6(3):163–167 [23] Jean L. Influence of age andsagittal balance of the spine on the value of the pelvic incidence. Eur Spine J. 2014;23(7):1394–1399 [24] Itoi E. Roentgenographicanalysis of posture in spinal osteoporotics. Spine. 1991;16(7):750–756 [25] Mangione P, Sénégas J.Sagittal balance of the spine (in French). Rev Chir Orthop Repar Appar Mot.1997;83(1):22–32 [26] Hovorka I, Rousseau P,Bronsard N, et al. Extension reserve of the hip in relation to the spine: Comparativestudy of two radiographic methods (in French). Rev Chir Orthop Repar Appar Mot.2008;94(8):771–776 [27] Lazennec JY, Charlot N, GorinM, et al. Hip–spine relationship: a radio-anatomical study for optimization inacetabular cup positioning. Surg Radiol Anat. 2004;26(2):136–144 [28] Gangnet N, Pomero V, Dumas R,Skalli W, Vital JM. Variability of the spine and pelvis location with respectto the gravity line: a three-dimensional stereoradiographic study using a forceplatform. Surg Radiol Anat. 2003;25(5)(–) (6):424–433 [29] Lee CS, Lee CK, Kim YT, HongYM, Yoo JH. Dynamic sagittal imbalance of the spine in degenerative flat back:significance of pelvic tilt in surgical treatment. Spine. 2001;26(18):2029–2035 [30] Shiba Y, Taneichi H, Inami S, MoridairaH, Takeuchi D, Nohara Y. Dynamic global sagittal alignment evaluated bythree-dimensional gait analysis in patients with degenerative lumbarkyphoscoliosis. Eur Spine J. 2016;25 (8):2572–2579 [31] Yagi M, Kaneko S, Yato Y,Asazuma T, Machida M. Walking sagittal balance correction by pedicle subtractionosteotomy in adults with fixed sagittal imbalance. Eur Spine J. 2016;25(8):2488–2496 [32] Engsberg JR, Bridwell KH,Reitenbach AK, et al. Preoperative gait comparisons between adults undergoinglong spinal deformity fusion surgery (thoracic to L4, L5, or sacrum) andcontrols. Spine. 2001;26(18):2020–2028 [33] Engsberg JR, Bridwell KH,Wagner JM, Uhrich ML, Blanke K, Lenke LG. Gait changes as the result ofdeformity reconstruction surgery in a group of adults with lumbar scoliosis.Spine. 2003;28(16):1836–1843, discussion 1844 ↑向上滑动阅读全文↑ 来源:《脊柱矢状位平衡》 |
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