非侵入式腰椎活动能力评估模式的开发研究
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A STUDY ON DEVELOPING A NON-INVASIVE MODEL FOR EVALUATION OF LUMBAR SPINAL MOBILITY
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    摘要:

    本研究针对腰椎活动能力评估方法进行探讨,重点在于1.比较侵入与非侵入式腰椎活动能力之评估方法2.建立、验证与应用非侵入式腰椎活动能力评估模式,以利临床评估下背功能。第一阶段为了比较侵入与非侵入式衡量腰椎活动能力之差异,共收集24位志愿者参与实验,在矢状面于直立、最大弯曲与最大伸展姿势下,利用X光(侵入式)与动作分析系统(非侵入式)测量受试者背部皮表标记之座标值。经比较发现侵入与非侵入式腰椎活动能力之评估结果有显著差异,这些差异与脊椎骨L1到S1长度差、L4部位脂肪厚度等体位测量因子有关,因此建议透过适当的评估转换模式以减少非侵入式腰椎活动能力之衡量误差,提高其临床实用价值。本研究的第二阶段是考虑背部表皮与体内腰椎位置测量结果之非线性差异,建立数学转换模式。模式之建立系利用15位受试者X光片标记座标值,以非线性回归方式建立评估转换模式,再以7位受测者之X光片为资料与22位受试者之动作分析资料,分别验证并应用评估模式。研究结果显示,转换模式无论在回归的判定系数、腰椎体绝对位置、腰椎角度、活动能力及腰椎活动贡献度的预测误差等均有理想的评估能力。

    Abstract:

    Lumbar spinal flexion and extension motion was measured radiographically- "invasive" and from the back surface curvature- "non-invasive" (using motion analysis system)for evaluating lumbar spinal mobility(LSM). Twenty-four volunteers participated in this study and had their lateral view of lumbar spinal radiographs and photographs taken in three postures(upright, flexion and extension). The lumbar sacral angles(LSA) and the angles of each vertebral segment were obtained both from skin surface curvature and picture of X-ray. The results showed that the LSA and LSM remained the same either calculated based on Cobb angle or overly angle definition. To transform skin marker coordinates into corresponding vertebral body coordinates, a third order regression model was developed.The proposed transformation model demonstrated high coefficient of determination (mean=84.05%)between transformed positions and actual positions in all vertebral bodies, Based on this model, global LSA and intersegmental spinal mobility were recalculated and compared with results from X-ray measurement data. The results showed that the inter-vertebral lumbar spinal mobility could be obtained with errors ranging from 0.06 to 0.62 degrees. The results of this study indicated that in addition to the total motion in region of lumbar spine, we are able to discriminate the contribution of intersegmental spinal mobility through way of "non-invasive" measurement.

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江宏达,李明义,邱文科,李永辉,陈文哲.非侵入式腰椎活动能力评估模式的开发研究[J].医用生物力学,1995,10(3):157-166

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