摘要：

文題釋義：
下腰曲線轉(zhuǎn)折點(diǎn)的三維成角：對Ⅲ、Ⅳ型腰椎間盤突出癥患者而言，單(多)個椎體發(fā)生位移，棘突連線所呈直線中斷，成角形成一或多個折線，同時造成脊柱畸形曲線彈性固定，經(jīng)下腰曲線彈性固定轉(zhuǎn)折點(diǎn)的脊溝曲線、截面曲線在冠狀面、矢狀面、軸面的投影線與人體豎直線和水平線所形成的夾角。該角的大小決定了兩側(cè)椎旁肌形態(tài)對稱性、髂嵴兩側(cè)高低對稱性以及人體脊柱旋轉(zhuǎn)的程度。
體表地形圖：基于雙目立體視覺方法，可以產(chǎn)生代表物體表面形狀的等高線波紋，隨體表形狀不同而變形，可用于脊柱變形引發(fā)背部表面不對稱性的測量，定量分析脊柱側(cè)凸和旋轉(zhuǎn)角度，實(shí)現(xiàn)人體背部形態(tài)及脊柱非侵入性的數(shù)字化和直觀再現(xiàn)。

背景：腰椎間盤突出癥患者背部形態(tài)呈現(xiàn)特征性表現(xiàn)，目前對腰型的判斷主要通過望診觀察、采用定性描述，馮天有教授從望診角度總結(jié)出“腰型”四步規(guī)律——腰曲變平、腰骶(功能)上移、旋盆翹臀、旋腰挺胸。
目的：測量Ⅲ/Ⅳ型與Ⅰ/Ⅱ型腰椎間盤突出癥患者下腰曲線轉(zhuǎn)折點(diǎn)的三維成角，分析通過三維成角判斷腰型的可行性。
方法：順次納入住院腰椎間盤突出癥患者110例，其中Ⅰ/Ⅱ腰型70例，Ⅲ/Ⅳ腰型40例。通過人體脊柱形態(tài)評價系統(tǒng)采集患者背部體表地形圖，應(yīng)用分析軟件測量患者三維成角，初步判斷三維成角的穩(wěn)定性，計(jì)算Ⅲ/Ⅳ型與Ⅰ/Ⅱ型患者三維成角的差異性及診斷臨界值，并對三維成角的真實(shí)性進(jìn)行初步評價。
結(jié)果與結(jié)論：①此次指標(biāo)穩(wěn)定性良好，3次三維成角測量數(shù)據(jù)比較，差異無顯著性意義(P > 0.05)；②Ⅲ/Ⅳ型與Ⅰ/Ⅱ型患者的三維成角差異極顯著：冠狀位成角Ⅲ/Ⅳ型平均11.04°，遠(yuǎn)大于Ⅰ/Ⅱ型(中位數(shù)1.24°)；矢狀位成角Ⅲ/Ⅳ型平均9.02°，遠(yuǎn)大于Ⅰ/Ⅱ型(平均數(shù)2.96°)；軸位成角Ⅲ/Ⅳ型平均9.65°，遠(yuǎn)大于Ⅰ/Ⅱ型(平均數(shù)3.01°)；③依據(jù)ROC曲線值得出Ⅲ/Ⅳ型腰型患者的三維成角(冠狀位、矢狀位、軸位)的診斷臨界值分別為5.43°，4.77°，4.83°。此次三維成角結(jié)果真實(shí)性可靠，冠狀位、矢狀位、軸位成角結(jié)果顯示：靈敏度分別為86.66%，93.33%，86.66%；特異度分別為95.23%，85.72%，90.47%；約登指數(shù)分別為0.818，0.790，0.771；總符合率分別為91.66%，88.88%，88.88%；④該研究利用人體背部體表三維地形圖技術(shù)，分析通過三維成角判斷腰型的可行性，發(fā)現(xiàn)該指標(biāo)穩(wěn)定性好，尤其能夠反映旋盆翹臀和旋腰挺胸型的特征，該角度作為一個腰椎間盤突出癥腰型分類的關(guān)鍵指標(biāo)，對于定量描述腰型變化邁出了重要的一步。

https://orcid.org/0000-0003-3665-9133 (馬超) 

中國組織工程研究雜志出版內(nèi)容重點(diǎn)：人工關(guān)節(jié)；骨植入物；脊柱；骨折；內(nèi)固定；數(shù)字化骨科；組織工程

關(guān)鍵詞: 腰椎間盤突出癥, 腰型, 體表地形圖, 三維成角, 數(shù)字化骨科

Abstract: BACKGROUND: The back morphology of patients with lumbar disc herniation presents characteristic manifestations. At present, the judgment of lumbar type is mainly through observation and qualitative description. Professor Feng Tianyou summed up the four steps of “l(fā)umbar types” from the perspective of observation: the lumbar curve becomes flat, the lumbosacral upward movement, the rotary basin-buttock, and the rotary waist and chest.  
OBJECTIVE: To measure the three-dimensional angulation at the turning point of low back curve between type-III/IV and type-I/II patients and analyze the feasibility of judging lumbar type by three-dimensional angulation.
METHODS:  A total of 110 hospitalized patients with lumbar intervertebral disc herniation were enrolled sequentially, including 70 cases of type-I/II patients and 40 cases of type-III/IV patients. The topographic map of the patient’s back surface was collected through the human spine morphology evaluation system. The analysis software was used to measure the patient’s three-dimensional angulation. The stability of three-dimensional angulation was preliminarily determined. The difference and diagnostic critical value of three-dimensional angulation between type-III/IV and type-I/II patients were calculated, and the authenticity of 3D angle formation was evaluated.  
RESULTS AND CONCLUSION: (1) The index was stable, and there was no statistical significance in the comparison of the three times for three-dimensional angulation measurement data (P > 0.05). (2) There was significant difference in three-dimensional angulation between type-III/IV and type-I/II patients. Coronal angulation of type-III/IV was 11.04° on average, which was much larger than that of type-I/II (median 1.24°). Sagittal angulation of type-III/IV was 9.02° on average, which was much larger than that of type-I/II (mean 2.96°). Axial angulation of type-III/IV was 9.65° on average, which was much larger than that of type-I/II (mean 3.01°). (3) According to the ROC curve, the diagnostic critical value of three-dimensional angulation (coronal, sagittal, and axial) in III/IV-type patients were 5.43°, 4.77°, and 4.83°, respectively. The authenticity of the three-dimensional angulation results was reliable. The coronal, sagittal, and axial angulation results showed that the sensitivity was 86.66%, 93.33%, and 86.66%; the specificity was 95.23%, 85.72%, and 90.47%. The Youden index was 0.818, 0.790, and 0.771. The total compliance rate was 91.66%, 88.88%, and 88.88%. (4) In this study, three-dimensional topographic map technology of human back surface was used to analyze the feasibility of judging the lumbar type by three-dimensional angulation. It was found that the index had good stability, especially could reflect the characteristics of the rotary basin-buttock, and the rotary waist and chest.

Key words: lumbar disc herniation, lumbar types, body surface topographic map, three-dimensional angulation, digital orthopedics

中圖分類號: 

R459.9

R394.2

R542.2

相關(guān)知識

活血化瘀法治療急性腰椎間盤突出癥療效觀察
腰椎間盤突出癥的康復(fù)指導(dǎo)
腰痛不僅只腰椎間盤突出，您的腰痛屬哪一種？
腰痛病（腰椎間盤突出癥）的健康指導(dǎo)
腰椎間盤突出癥認(rèn)識存3誤區(qū)
腰椎盤突出康復(fù)運(yùn)動
腰椎間盤突出的康復(fù)訓(xùn)
腰椎間盤突出有哪些護(hù)理方法
腰椎間盤突出急、慢性期康復(fù)訓(xùn)練方案，超全圖文詳解
腰椎間盤突出急、慢性期康復(fù)訓(xùn)練方案，超全圖文詳解@MedSci

網(wǎng)址: 應(yīng)用體表地形圖量化腰椎間盤突出癥腰型客觀化指標(biāo)：下腰曲線彈性固定轉(zhuǎn)折點(diǎn)的三維成角 http://www.u1s5d6.cn/newsview410508.html