腰薦椎之臨床不穩定性系統分析研究-腰薦椎不穩定度的定性與定量量測(II)
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(3) - (II) NSC88-2313-E-006-082 87 8 1
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(5) !. "#$. % % &'()*+,-./012345 6+01234+7829: ;*<= 0>?782@AB*CDEF5G HI&JKLMN 7 ./01234O PQ(1 R 6 S)TUV W 58.1 X(YZ[ 42 X\ 82 X) 12 6+01234OP Q(4 R 8 S)TUV W 46.3 X(YZ[ 35 X\ 73 X)T]^OPQ+_`abcde Ofgh`ijkhli X mnop qI+jkhnors+OPQ12tu vw`xyz{*|}~>I + j k h H Putto’s I@ 782u* I +kT./01234OPQ+ Hl@T782 u > L4-L5 ^¡¢*£;<=¤T¥ ¦§¨¡¢£;*<=©ª6+012 34OPQ+Hl@ T782u > L5-S1 ¨¡¢*< =¤T¥¦§^¡¢*£;<=I+ kT./0 6+01234*OP Q+Hl@T 782u(L1-S1)§^¡¢*£;<=I «¬782T./01234T6+ 01234T9: % ! The purposes of this study are to investigate the differences of lumbosacral kinematics between degenerative and induced spondylolisthetic subjects, and to understand the development and process of lumbosacral. instability. Total of nineteen subjects were included in the study: seven subjects with a diagnosis of degenerative spondylolisthesis (one male and six females, ages ranged from 42 to 82 years with a mean of 58.1 years), and twelve subjects with a diagnosis of induced spondylolisthesis (four males and eight females, ages ranged from 35 to 73 years with a mean of 46.3 years). For each patient, one anteroposterior and three lateral radiographs in the neutral standing, flexion, and extension positions were prepared in the first clinic. In each lateral film we placed a specially designed calibration radiopaque ruler on the midline of the lower back of the subject. Flexion and extension positions were adopted from modified Putto’s method. Computer-assisted method was used to measure intervertebral translation and rotation of different positions. The results showed that the differences of translation among three positions (flexion, standing, and extension) at different level were no statistically significant (p>0.05) except at the level of L4-L5(p<0.05) in degenerative spondylolisthetic subjects and the differences of translation among three positions (flexion, standing, and extension) at different level were statistically significant (p<0.05) except at the level of L5-S1(p>0.05) in induced spondylolisthetic subjects. For rotation, the differences among three positions (flexion, standing, and extension) at different level were statistically significant (p<0.05) in both degenerative and induced spondylolisthetic.
(6) subjects. Key WordsLumbosacral, Degenerative and Induced spondylolisthesis, Kinematics. . 782*@ABT®¯°±²³´ µ`¶·¸¹Tªº}782@AB* »¼H X m½*¾¿ ÀÁ Ã* X m½¾¿Ä X m½¾¿IDª ÅÆ;ÇÈ H* X m½¾¿É ÊIË Knutsson Ì+ 50 fÍ® ÎÏTÐÑÒ^BÓÊ12Ô:*ÕI 1953 Tanz '(Ö× TØÙ· BÓÊ(angulation)*ÚTÐGÛ Ü WÝÞªßàTªáâ=0ãä I+ 1990 Putto et al[1]å QÎÏæ H X m½¾¿ç782@AB èº}T¢é^ê#ëìBíTîï #ëfgð*T@ñòó_ô72\ _`82(L2-S1)*Ô:õöTªáò ÷ãøùúTûó^ü¶*²³ãòÈ ýOI+ 1987 Friberg[2]ÎÏTÈÀÁ Ã* X m½¾¿ç_þ7234* t T ¾ l T ¾ z ¨ ´ (asymptomatic) t å ´ (moderate symptoms) ü ¶ ´ (severe symptoms)IGÛ_þ72Éf (maximal forward displacement)5´¨£ ;ÓTÐ_þ72f*5 ´^£;*Ó(p<0.001)T´ü ¶TI
(7) ç 782@A Bµ 0BÓ 0BÓ` hµTó782@AB*c ÞIDBÓ;^T +ÅÆ;ÇÈH* X m½¾¿ º}782@ABTDªËPT +Ê*t^ä*â=0Tª !Ë+ÅÆ;TÈ"BT#Q ÊT#Q=ÊIDª 1994 Lin et al[3] å Qç $#%BÊ&@ABT®^. '(I)öf]òÈ hT*á +xµu*â=0I ª)f'(,¾-./çÊ&@ Ê12Täà,-@Ê12 782@AB*õöT¸Ë&JK'(* )*·+,-./01234 6+0 1234+7829: *<=0>? 782@AB*CDEF5GHI. . &JK*OPQ§C!"#$ ,12¤$bctÜ01T¯#$ !2c./01234´(degenerative spondylolisthesis) È6+0*1234 ´Q(induced listhesisT34Ê*jk X mÊTÐ* X m½ò¢éÏ2u Ô:*=Ê)©55&JK*OPQ67 89:;<(1)=eO>?@Q (2)¨¥Ñü¶*1AkB&âCT$: 1AjD1AgD(3)67-^`x E(_F725_þ72µu(L4-L5)1 234*Tá34*åG_`xå G(grade I) (4 Ò^7282/(lumbar sacralization)& 8272/(sacral lumbarization) (5)^ú9 55HQI. X I`OPQVJ 4 i X m½T *eOfgh jkh+jK (sidelying) H@*eOj kh* X m782noLJM`iIfg hÎNOPpq©jkh'(*¾ ¿IùOPQ+r*fkhjkh X m782no*rQ+OPQgkRw `x^STU*S~T+fkhJn X-ray rTSU·çVOjQ*WXtY©+j khJn X-ray rTSU·çVOPQ* Z[\,tYIˤT+I`i*jkh norT]^{>`x|}~(radiopaque ruler)TJn X m½rVvw OPQ*1.
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(13) H § ^ ¡ ¢ * £ ;<=(p<0.05)Iª L5-S1 >5¨¡¢*<=¤ (p>0.05)T¥¦5H5H§ ^¡¢*£;<=(p<0.05)I ª6+0 1234*OPQ+Hl @T782u(L1-S1)*£ ;<=5./01234OPQøI ¨`¢é+Ô:YZ kTD6+01234OPQ+ Ô:YZ > L5-S1 ¤T¥¦782ud õ./01234´OPQTÐ+£ ; > L3-L4 ^ ¡ ¢ * < = ¤ (t=-2.832Tp<0.05)T¥¦782u§¨¡ ¢*£;<=(p>0.05)I ¨`¢é +Ô:YZkTD6+012 34OPQ+Ô:YZdõ./0 1234OPQTÐ+£;§¨¡¢ *£;<=(p>0.05)I +./01234¶OPQt^l «¬Ft¬T·^+ L4-L5 level É Ô:YZ*UVÕ rV<µ¨ôI ¨ô¢ét¬ ./01234OPQ+É Ô:YZdõ«¬TЯ Mann-Whitney U eK¾¿«¬ t ¬./01234OPQ+ L4-L5 level É Ô:YZTæ Q ¾ z § @ ¯ ^ £ ; ¢ *<= (p=0.4Tp=1.0) I +6+01234¸ôOPQt^ ¹«¬¹t¬T·^+ L4-L5 level É Ô:YZ* UVÕ rV<µ¨lI ¨l¢é t¬6+01234OPQ+É Ô:YZdõ«¬TÐ ¯ Independent-Sample t-test ¾¿«¬ t¬6+01234OPQ+ L4-L5 level É Ô:YZT æQ¾z§@¯^£;¢*<= (p=0.078Tp=0.111) I ./0 6+01234OPQ+ L4-L5 level ¾zçÔ:YZ . Ô:YZÖ*«±è'(T[¨` º . / 0 6 + 0 1 2 3 4 OPQ+ L4-L5 level *Ô:YZ Ô :YZdõ¥Ñ level T¯ Pearson ø «±v*£¾¿gTGÛ+./0 1234OPQ+ L4-L5 level *Ô :YZ Ô:YZÖµuÒ^« ±»+(p=0.504, r=-0.306)Iª6+012 34OPQ+ L4-L5 level *Ô:Y Z Ô:YZÖµu¯ Pearson ø«±v*£¾¿gTæQµuã Ò^«±»+(p=0.369, r=0.300)I. : X m½P sOt£&©*¼<X m½o½*¾¿ &©12®^¥ÑUk *o jIÀ¥P*pqT¸ X m½ o½s°RI¸ËT+]^*JKEF tT>ßÁ)_¸Â*ojT]^0à o½¾¿* X m½T*á+M X m½*r Q]^s+OPQ*12tuRw`x| }~TÈf*'(õö@¶}|}~*¶ ·0T+è:*EFt]^sÄÅ12 ÆE 20 &jyDÆE 10 T )ÇÍ@soj]^+ X m½;1r¤ [6]T)Ç+*pqÈVI+ Pt£kT]^ê`im½1 26 kT ¶É 20 aP TGÛ *â=±vd+òeO*YZI¸ ËT]^]\*pqòN5e*TÊ `@Ë*EÍMN*v@ÌÍI DHm½¾¿OPQ°:* 9:õ:*9:T)xθòÈ. OPQ+r¸Ï³È f *Ô:O §IDª&JK\ cde ]^ Putto’s T)û óOPQ^ü¶*²³ãòÈPÐT] ÈËÑ°:9:*<=ÒÖ*TÓ ÔòÈÕÖ*I1234*´ø ùÍT^*^´T^*¨´©^*.
(14) `E34T^*æxEÈ;*3 4Tªá34*åG×@`ÇI¸ËT& JK>·V%12@ABT]^ ]MN*OPQd`xE34T^ ´*1234áåG Grade I & Grade IIIÐ &JKMN*ru^ v@ ÌÍTÈ Ò^ Grade II 1234*O PQT¸Ë¨¾¿^« Grade II 123 4OPQ*pqI +./0 6+0*kTL1-L5 level 5HÒ^¡¢£;*<=T òÈ +r«kõöØÙíá «kyõöÚyk(sagittal plane)TÈ gH*Ô:ÛußÁ *ÜÝIª L5-S1 level +5Ò^ £;<=TòÈ+ L5-S1 level gk* Þßiàõ¥Ñ level ᥫkõöÚ yâk(coronal plane) TÈ f rÔ:sO\ §©+kT6+ 0 L1-L5 level +5HÒ^£;< =TòÈã r«kõöØÙ íTÈ gH*Ô:ßÁ*Ü ÝIª L5-S1 level Ò^£;<=TòÈ + L5-S1 level gk*Þßiàõ¥Ñ level ᥫkõöÚyâk(coronal plane)Tª@Ñ L1-L5 level *«k`Ç õöÚyk(sagittal plane)TÈ frÔ:sO\ §I [¨`tGÛ6+01234 Ô : Y Z Ô : YZ > L5-S1 Ô:YZ¤¥¦dõ./0 1234Ô:YZ Ô:Y ZTD-^+ L3-L4 level Ô: YZ^£;*<=¤T¥¦V¨¡¢£ ;*<=TÐ)òÈÍ782[@A B\AB*CDEF5GH*`ãI [JKt¨ô ¨lGÛ./0 6 +0t¬õ«¬*É Ô:YZUVÕTШ¡¢£; *<=T)Ñ 1987 Friberg[1]ç 45 1 234OPQ]è*'(+ɨ£ ;*<=TÐ+Ô:YZ^£. ;*<=@*TòÈ*θ M N«¬t¬v@Ì&Q. äåæçÞßiàÝÞ]è*I¸ ËT·ÍÅÆOPQT{*é êÈ;pq*â/TÈë]^È¾ì ¡í@´*ü¶F®sç Ô:YZ^ojI [¨îGÛ./01234+ L4-L5 level Ô:YZ Ô:YZõ ¥Ñ level dTÐ[&JK*¢éæ QµuÒ^ï#ø«ã©[¨`GÛ6 +01234+ L4-L5 level Ô:Y Z Ô:YZõ¥Ñ level dT¥ ã¢éæQµuÒ^ï#ø«ãI )5 1990 Kalebo et al [7]ç 29 ^ ´*1234OPQ]è*'(ø ðI ËòºT+34E*Ô: YZ*@ª¨Ô:YZI. &JKÈH X m½ç./ 0 6+01234OPQT,-l@ 782u *¾¿T ¾¿ÈñI (1) 6+0*Ô:YZ Ô :YZ+ L1-S1 uÓÔdõ./0* Ô:YZ Ô:YZT)òÈ Í782[@AB\AB*CDEF5 GH*`ãI (2) [\H*EFtT* âÓÔ[öÖ*fò\ö*fò I (3) ´ü¶F*@ª¨+34E ÉÔ:YZ*I (4) +34E*Ô:YZ* @ª¨Ô:YZI. [1]E. Putto and K. Tallroth,”.
(15) Extension-flexion radiographs for motion studies of the lumbar spine: A comparison of two methods”, Spine 15:2:107-110, 1990. [2]O. Friberg, ”Lumbar instability: A dynamic approach by traction-compression Radiography”, Spine 12:119-29, 1987. [3]RM Lin, CJ Chang, FC Su and CY Yu,”Flexion-Extension Rhythm in the Lumbosacral Spine”, Spine 19:2204-2209,1994. [4]AA White and MM Panjabi,” Clinical. Biomechanics of the spine” Second Ed.Philadephia,J.B.Lippincoot,1990. [5]
(16) ósôõö÷øùúûùüýþùü5-ýü9öõ% [6]EN Hanley, RE Matteri and JW Frymoyer,”Accurate Roentgenograohic Determination of Lumbar Flexion-Extension”, Clinical Orthopedic and Related Research 115: 145-148,1976. [7]P Kalebo, Kadziolka R and Sward L,” Compression-traction radiography of lumbar segmental instability”, Spine 15:351-355,1990..
(17) (mm) u. ´z. . Ô :YZ. . . H. Ô :YZ. L4-L5 ./0 -0.7(0.7) -0.2(1.0) -0.6(0.8). 0.3(1.0). 7.5(2.4). 4.1(3.0). 8.6(3.6). 4.5(2.5). L1-L2 L4-L5 6+0 -0.6(0.9) 0.2(1.0) -0.6(1.2). 0.8(1.0). 9.5(3.5). 3.7(1.9). 9.8(3.2). 6.0(3.6). L4-L5 ./0 -1.5(0.5) -0.7(0.3) -1.0(0.7). 0.3(0.9). 9.9(4.0). 6.0(2.5). 11.8(3.3). 5.8(2.3). L2-L3 L4-L5 6+0 -1.2(1.0) 0.0(0.7) -1.1(1.1). 1.1(0.8). 14.3(3.6). 5.4(2.6). 13(2.6). 7.6(2.4). L4-L5 ./0 -1.8(1.7) -0.9(1.2) -1.4(1.8). 0.6(0.9). 12.5(3.1). 6.0(2.7). 13.6(2.6). 7.6(3.4). L3-L4 L4-L5 6+0 -1.3(0.9) 0.3(1.4) -1.6(1.2). 1.9(1.0). 14.9(3.1). 2.7(3.9). 13.9(3.2) 11.2(3.8). 5.0(2.6) 3.2(2.3). 1.8(1.1). 9.6(4.9). 4.6(4.4). 12.4(4.2). L4-L5 L4-L5 6+0 -0.7(1.3) 1.2(2.6) -1.1(0.8). 2.2(2.3). 14.5(5.7). 3.7(4.0). 16.1(5.6) 12.5(5.7). 14(5.2). 11.3(6.1). 18(5.4). 6.7(3.5). 13.8(8.3). 9.7(4.1). 20(7.7). 10.2(6.1). L4-L5 ./0 3.9(2.8). . H. (degrees). L4-L5 ./0 -1.6(1.7) -2.0(2.0) -1.6(1.6) -0.4(0.7) L5-S1 L4-L5 6+0 -1.2(1.1) -1.1(1.3) -1.3(1.6). 0.2(1.3). 7.7(4.8). ¨` ./0 6+01234OPQ+Hl@T782u *U VÕ(rV<). ´z L4-L5 ./0. u. ü¶. É. Ô:YZ. «¬. 3.8(2.3). 1.7(1.3). t¬. 5.9(2.6). 1.9(1.0). L4-L5. ¨ô «¬ t¬./01234+ L4-L5 level É Ô:YZUVÕ(rV<). ´z L4-L5 6+0. u. ü¶. É. Ô:YZ. «¬. -0.2(1.2). 1.2(0.8). t¬. 2.5(3.1). 3.3(2.9). L4-L5. ¨l «¬ t¬6+01234+ L4-L5 level É Ô:YZUVÕ(rV<).
(18)
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