| 基于CT三维重建的上颈椎三维活动度在体测量研究 |
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Received:August 02, 2018
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| 作者 | Author | 单位 | Unit | E-Mail |
| 寨旭 |
ZHAI Xu |
西安交通大学第二附属医院急诊科, 陕西 西安 710004 |
Department of Orthopaedics, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China |
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| 康健 |
KANG Jian |
宝鸡市中医医院骨科, 陕西 西安 710004 |
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| 陈欣 |
CHEN Xin |
西安交通大学第二附属医院影像科, 陕西 西安 710004 |
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| 董军 |
DONG Jun |
西安交通大学第二附属医院骨科, 陕西 西安 710004 |
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| 邱晓文 |
QIU Xiao-wen |
西安交通大学第二附属医院骨科, 陕西 西安 710004 |
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| 丁新爱 |
DING Xin-ai |
西安交通大学第二附属医院急诊科, 陕西 西安 710004 |
Department of Orthopaedics, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China |
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| 刘俊 |
LIU Jun |
西安交通大学第二附属医院急诊科, 陕西 西安 710004 |
Department of Orthopaedics, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China |
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| 贺西京 |
HE Xi-jing |
西安交通大学第二附属医院骨科, 陕西 西安 710004 |
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xijing_h@sina.com |
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| 期刊信息：《中国骨伤》2019年32卷，第7期，第658-665页 |
| DOI：10.3969/j.issn.1003-0034.2019.07.014 |
| 基金项目:陕西省重点研发计划（编号：2017ZDCXL-SF-01-05） |
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目的：采用CT三维重建的方法测量健康成年人上颈椎寰枕关节、寰枢关节的各个方向上的活动度及其耦合运动，以及颈椎病患者上颈椎最大旋转位的三维活动度，并作对比分析，同时验证所使用的测量方法的可靠性。
方法：2014年1月至2015年6月，选取20个健康成年受试者（健康成年组），其中男11例，女9例，年龄22~26（24.0±1.2）岁；26个颈椎病患者（颈椎病组），其中男24例，女2例，年龄36~72（52.8±8.6）岁。采集健康成年人中立位、最大右侧旋转位、最大右侧侧屈位及最大屈曲位、最大背伸位5个位置的及颈椎病患者中立位、最大右侧旋转位上颈椎（含枕骨大孔）的CT图像。利用软件Mimics将所得CT重建为三维图像。在各个椎体（或枕骨）上选取明显的解剖标志点进行标注，根据所标注的解剖标志点建立局部坐标系，局部坐标系即代表了所在椎体的位置及方向。利用Pro/Engineer及MATLAB软件运算出上位椎体（或枕骨）相对下位椎体的活动度及颈部整体三维活动度，并比较颈椎病组和健康成年组差异。因解剖标志点识别有人为差异，选取两名实验员进行3次测量，用组内相关系数（组内ICC）和组间相关系数（组间ICC）验证实验方法的可靠性。
结果：可靠性验证结果：组内ICC、组间ICC结果均在0.90以上，测量方法有很高的可靠性；健康成年组上颈椎三维活动度：最大右侧旋转位时，寰枕关节有（-6.8±1.5）°的耦合左侧屈和（8.9±2.0）°的耦合背伸活动，其余3个位置寰枕关节各方向活动度均很小，最大为（5.3±2.6）°；最大右侧旋转位时寰枢关节右旋（37.9±5.1）°，占整个颈椎活动度[（72.4±5.0）°]的52.34%，其余3个位置寰枢关节仍以旋转活动最为突出；上位椎体（或枕骨）相对下位椎体的平移距离均很小。颈椎病患者颈椎整体平均轴向旋转角度[（62.0±3.4）°]较健康成年组明显下降，但寰枕关节、寰枢关节的平均轴向旋转角度比较健康成年组没有明显差异（P>0.05）。
结论：（1）基于CT三维重建的方法能够很好的描述颈椎的这种复杂的三维运动，并且有很高的可靠性。（2）上颈椎运动是一个复杂的三维运动过程，各个方向活动时均附带有其他方向上的耦合运动。（3）颈椎病患者最大旋转位上颈椎旋转方向的活动度较健康成年人没有明显变化。 |
| [关键词]:上颈椎 三维重建 三维活动度 在体测量 |
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| In vivo measurement of three-dimensional motion of the upper cervical spine using CT three-dimensional reconstruction |
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Abstract:Objective:Using the CT three-dimensional reconstruction to measure the activity degree of atlanto-occipital joint and the atlantoaxial joint in different directions and its coupling movement in healthy volunteers,and three dimensional motion range of the maximum rotation position of the upper cervical spine of cervical spondylosis patients,and to analyze the differences,verifing the reliability of the method at the meantime.
Methods:From January 2014 to June 2015,20 healthy adult subjects(healthy adult group),and 26 patients with cervieal spondylosis(cervical spondylosis group) were selected. In healthy adult group,there were 11 males and 9 females,aged from 22 to 26 years old with an average of (24.0±1.2) years,and in cervical spondylosis group,there were 24 males and 2 females,aged from 36 to 72 years old with an average of (52.8±8.6) years. Healthy adults underwent CT examination in neutral position,maximum right rotation,maximum right lateral bending,maximum flexion and extention,and cervical spondylosis patients underwent CT examination in neutral position,maximum right rotation. Then the software Mimics was used to reconstruct occiput (Oc),atlas(C1) and axial(C2) vertebral three-dimensional image. Three virtual non-collinear markers were positioned on prominent structures of foramen magnum,C1 and C2. The 3D spatial coordinates of these virtual anatomical markers entail the definition of an anatomical local coordinate system which represent the position and orientation of the bones. Segmental motions were calculated using Eulerian angle in three major planes,and the difference between cervical spondylosis group and healthy adult group were compared. Due to the inaccuracy in anatomical landmark idenrification,two groups were measured 3 times,and the reliability of the experimental metnod was verified by the intra-group correlation (intra-group ICC)and the inter-group correlation coefficient(inter-group ICC).
Results:Reliability verification results:the intra-group ICC and inter-group ICC results were all above 0.90,and the measurement method had high reliability. Three-dimensional activity of the upper cervical spine in healthy adults:the atlanto-occipital joint had(-6.8±1.5)° coupled left lateral bending and (8.9±2.0)° coupled extension in the maximum right rotation position,and the motion of atlanto-occipital joint had low activity[maximum was(5.3±2.6)°] in the remaining 3 positions;the rotation of atlanto-axial joint was(37.9±5.1)°,accounting for 52.34% of the total cervical spine activity[(72.4±5.0)°] in the maximum right rotation position,and rotational motion was still prominent in the remaining three positions. The relative translations of the upper cervical spine in all direction were small. The average axial rotation angle[(62.0±3.4)]° of the total cervical spine in cervical spondylosis group was significantly lower than that in the healthy adult group,but the mean axial rotation angles of the atlanto-occipital and the atlantoaxial joint were not significantly different from those of the healthy adults(P>0.05).
Conclusion:The three-dimensional CT reconstruction method has high reliability,which can be applied to measure the movement of spine. The upper cervical spine contributed the most to the direction of rotation,and the movement in all directions are accompanied by coupled motion in the other direction. There was no significant difference in the rotation of the upper cervical spine between cervical spondylosis patients and normal subjects. |
| KEYWORDS:Upper cervical spine Three-dimensional reconstruction Three-dimensional movement In vivo measurement s |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 寨旭,康健,陈欣,董军,邱晓文,丁新爱,刘俊,贺西京.基于CT三维重建的上颈椎三维活动度在体测量研究[J].中国骨伤,2019,32(7):658~665 |
| 英文格式: | ZHAI Xu,KANG Jian,CHEN Xin,DONG Jun,QIU Xiao-wen,DING Xin-ai,LIU Jun,HE Xi-jing.In vivo measurement of three-dimensional motion of the upper cervical spine using CT three-dimensional reconstruction[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(7):658~665 |
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