生理曲度变直与正常的颈椎有限元建模与分析

建立生理曲度变直和曲度正常的颈椎全节段有限元模型,进行对比与分析.选取颈椎曲度变直患者采集CT数据,采用专用生物力学有限元软件构建高质量颈椎全节段模型,然后采用基于离散微分属性的体网格变形技术,将变直模型映射生成曲度正常模型,在进行有限元模型的验证后,用相同边界条件进行对比分析.结果表明,曲度变直模型活动度范围比正常范围减少16％～28％,应力增加4％～90％,C3-C4和C4-C5小关节、钩突关节、椎间盘容易出现应力集中,表明容易出现损伤和退化.通过使用新型建模软件和体网格变形技术,能方便构建生理曲度变直和正常模型,分析结果对临床诊断有指导意义.     

某高校学生颈椎曲度异常的相关因素分析

目的 分析某高校学生颈椎曲度异常的相关因素。方法 采用方便抽样方法,选取我校医院2022年3月-2023年1月接诊的以颈部疼痛、僵直、肩背部疼痛、头晕等为主诉的学生300例,行颈椎侧位片检查,根据有无颈椎生理曲度异常,分为曲度正常组和曲度异常组,分别向其发放自制调查问卷表,统计学生年级、专业、电子产品使用时间、使用类型、伏案工作时间、学习时间等流行病学资料以及颈椎异常的发病率。结果 300例学生中颈椎曲度异常194例,在曲度异常的学生中有67例临床诊断为颈椎病;不同性别、年级、专业的学生颈椎曲度异常人数比较,差异无统计学意义（P＞0.05）;曲度异常组学生的电子产品使用时间和伏案时间大于曲度正常组学生（P＜0.05）,曲度正常组与曲度异常组学生的学习时间、锻炼时间比较,差异无统计学意义（P＞0.05）。结论 高校学生颈椎曲度异常发生率较高,电子产品的过度使用是重要的原因,建议采用科学的颈部肌肉锻炼改善颈椎疾病。     

不同腰椎生理曲度下牵引的三维有限元分析

文题释义：腰椎牵引：是指令患者平卧于治疗床上,使用束带将患者前臂固定,达到医者固定患者双臂的目的;波浪式滚动气柱以腰背部为作用点进行顶推,控制多层气柱叠加高度使受试者腰部逐渐过伸牵引脊柱关节,实现对软组织的牵伸,并结合自身重力过伸牵引脊柱关节,能够增大椎间隙及调整椎小关节,最终达到理筋整复的作用。 三维有限元分析：是指在获取腰椎的CT图像数据,并导入到Mimics等软件当中建立的有限元模型基础上,将L₃的发生的位移变化带入MSC.Nastam软件中,高度仿真模拟人体在不同生理曲度下,计算分析出全腰椎各节段椎体、椎间关节、椎间盘、前纵韧带的应力值及分布情况的变化。 背景：近年来利用有限元分析方法研究腰椎生物力学成为热点,研究认为腰椎生理性前凸可减少腰椎间盘压力负荷,而对腰椎起保护效应。 目的：研究腰椎在正常生理曲度、屈曲位及最大过伸位下进行腰椎牵引时对L₁-L₅腰椎各节段的生物力学效应,并评估腰椎牵引的最佳生理曲度。 方法：选取1名健康男性志愿者,26岁,身高174 cm,体质量60 kg,既往体健,排除腰椎骨骼异常疾病。以受试者L₃为作用点徒手操作南少林倒盖金被法,利用DR机分别获得受试者腰椎起始位和最大过伸位的腰椎侧位片,构建全腰椎有限元模型。计算腰椎不同生理曲度下全腰椎各节段椎体、椎间关节、椎间盘、前纵韧带的应力值及分布情况的变化。研究方案的实施符合福建中医药大学附属康复医院相关伦理要求,受试者对试验过程完全知情同意。 结果与结论：①模拟腰椎前屈、后伸,左右侧弯,左右旋转6种工况活动度：L₁-L₂的前屈与后伸活动度之和为9.31°,左右侧弯9.84°,左右旋转4.43°;L₂-L₃：前屈与后伸10.22°,左右侧弯12.35°,左右旋转4.57°;L₃-L₄的前屈与后伸的活动度之和为11.20°,左右侧弯11.63°,左右旋转5.32°;L₄-L₅前屈与后伸活动度之和13.16°,左右侧弯11.58°,左右旋转5.05°;②在正常生理曲度牵引腰椎时,腰椎各个结构的应力值远大于过伸位牵引的应力值;前纵韧带应力值正常曲度是2.47 MPa,过伸位是21.20 MPa;L₃的椎体应力值达到最大,是过伸位牵引应力值的4倍;L₂-L₃的椎间关节及椎间盘的应力值在腰椎各个节段是最大的;③结果说明,腰椎在过伸位较正常生理曲度牵引下椎体、椎间关节、椎间盘的压力减轻更大,而且前纵韧带的压力值始终在安全范围内。腰椎在过伸位牵引时可能获得更好的临床疗效,同时具备一定的安全性。 ORCID: 0000-0002-4468-1464(李民) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

颈椎人工椎间盘置换有限元分析

目的　建立C4~5节段PrestigeTM-LP颈椎人工椎间盘植入后的三维有限元模型,进行手术节段的运动分析。 方法 采用对成年男性的新鲜尸体的颈椎标本进行CT三维扫描方法建立C4~5节段和PrestigeTM-LP人工间盘有限元,模拟完成C4~5人工椎间盘置换手术。测量生理加载下手术节段前屈/后伸、侧弯及轴向旋转运动角度。结果 有限元模型对颈椎的结构,包括椎体间韧带、颈椎关节突关节、钩椎关节等均进行了精确的重建,并较好地模拟手术操作进行PrestigeTM-LP人工间盘植入。运动加载后运动角度,前屈5.7°,后伸3.5°,侧弯5.0°,旋转11.3°,与文献报道结果较为接近。 结论　有限元模型具有精确度高,手术模拟真实的特点,可作为颈椎人工椎间盘生物力学研究的一种较好途径。PrestigeTM-LP颈椎人工椎间盘置换可较好地保留手术节段的运动功能。     

新型实验颈椎枕对于调整颈椎异常曲度的研究

目的 评估新型实验颈椎枕对颈椎矢状位生理曲度参数的影响。方法 于2021年5月-2022年6月招募志愿者131名,均行颈椎标准侧位片并根据Borden法测量确定为颈椎生理曲度异常者,将其随机分为试验组66例和对照组65例,对照组使用普通乳胶枕,试验组使用新型实验颈椎枕。比较两组Borden值、Cobb值及使用舒适度。结果 两组Borden值较试验前均有改善,且试验组改善优于对照组,差异有统计学意义（P＜0.05）;两组Cobb值较试验前均有改善,且试验组改善优于对照组,差异有统计学意义（P＜0.05）;试验组使用舒适度优于对照组,差异有统计学意义（P＜0.05）。结论 新型实验颈椎枕在睡眠中辅助人体颈椎异常生理曲度调整至正常值范围方面具有一定优势。     

腰椎曲度变直时椎间盘病变的特点

目的 通过分析腰椎曲度变直患者腰椎问盘病变的发生情况,揭示T11～S1各椎间盘的不同类型病变对腰椎曲度的影响.方法 回顾分析腰椎曲度变直组(69例)和对照组(同一年龄组,腰椎曲度正常,共 41 例)T11-S1 各椎间盘病变情况,分别观察椎间盘蜕变、突出、椎间隙狭窄的发生情况,在两组问对部分节段不同病变的发生率进行比较.结果 两组中T11-L2段椎间盘病变的发生率很低,在两组间无法进行统计学处理.L2-S1段椎间盘病变的发生率增高,腰椎曲度变直组除L2-3椎间盘突出和椎间隙狭窄与腰椎曲度正常组比较差异无显著性意义外(P＞0.05),其余节段椎间盘蜕变、突出和椎间隙变窄在两组间差异均有显著性意义(P＜0.05或P＜0.001).结论 腰椎曲度变直组病人下腰段(L2-S1)椎间盘病变发生率明显增高,说明腰椎间盘病变作为局部因素可能是腰椎曲度变直的诱因.     

颈椎有限元模型的建立方法及进展

详细论述建立颈椎有限元模型的四项基本准则（解剖轮廓、材料特性、边界条件和模型验证）及其实现方法。回顾现有的一些具有代表性的颈椎有限元模型，并指出其未来发展的一些新动向。     

颈前路椎体次全切除融合术重建颈椎后纵韧带骨化生理曲度生物力学分析

目的:基于重建异常生理曲度颈椎曲度,利用数字建模软件和有限元分析软件构建颈前路椎体次全切除融合术（ACFF）三维有限元模型,并对构建完成的模型进行验证、加载载荷、计算分析生物力学,为临床手术方案的合理制定和预后的评估提供参考依据。方法:选择临汾市人民医院脊柱外科1例住院患者,将279张颈椎CT扫描DICOM格式图像导入...     

项韧带骨化与颈椎曲度及节段稳定的影像学分析

文题释义：颈椎曲度：颈椎生理曲度的存在能稳定颈椎、保护脊髓。在退行性颈椎病中,因椎体、椎间盘等结构的退变,颈椎的前凸可逐渐变直,甚至反凸。节段稳定：此处的节段稳定,指下颈椎区域的颈椎节段稳定情况,将椎间活动度即角位移>10°或椎体的水平位移>3 mm定义为退行性下颈椎不稳。背景：在颈椎曲度变直或节段不稳相关退行性颈椎病中,由项韧带慢性损伤引起的项韧带骨化是非常常见的。目的：探讨项韧带骨化与颈椎曲度及下颈椎节段稳定性之间的相关性。方法：回顾性分析徐州医科大学附属医院脊柱外科2017-10-01/2018-10-31收治的退行性颈椎病患者109例,男61例,女48例,年龄30-81(55.8±11.1)岁。所有患者对试验方案均知情同意,且得到徐州医科大学附属医院伦理委员会批准。对患者颈椎摄片进行影像学观察,观察内容包括项韧带骨化的分布和骨化程度、颈椎生理曲度的改变、下颈椎节段稳定性;根据患者有无项韧带骨化分为2组,比较2组患者的性别、年龄、颈椎曲度、下颈椎节段稳定性情况;采用Pearson相关性分析探讨项韧带骨化程度和颈椎曲度、下颈椎稳定的关系;采用二元Logistic回归分析项韧带骨化发展的重要危险因素。结果与结论：①109例退行性颈椎病患者中,项韧带骨化患者56例,骨化共累及83个颈椎节段,以C_4-5(39.8%)和C_5-6(42.2%)多见;②项韧带骨化组患者的年龄、颈椎曲度中C₂-C₇ Cobb角、Jackson生理应力曲线、下颈椎不稳的参数角位移和水平位移与无项韧带骨化组差异均有显著性意义(P < 0.05),项韧带骨化程度与角位移呈显著正相关(r=0.486,P < 0.05);③下颈椎不稳患者的项韧带骨化发生率明显增高(P < 0.05),下颈椎不稳参数角位移及年龄是项韧带骨化发展的重要危险因素;④提示项韧带骨化患者更容易出现颈椎曲度变直及下颈椎的节段不稳,尤以节段不稳为著,在诊断和治疗退行性颈椎病患者时,项韧带骨化的存在应引起相应重视。ORCID: 0000-0002-9846-1109(陆炜强)中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

颈椎有限元模型的建立方法及进展

详细论述建立颈椎有限元模型的四项基本准则(解剖轮廓、材料特性、边界条件和模型验证)及其实现方法。回顾现有的一些具有代表性的颈椎有限元模型,并指出其未来发展的一些新动向。     

Cervical Spine Stenosis Measures in Normal Subjects

OBJECTIVE: To compare 2 methods of determining cervical spinal stenosis (Torg ratio, space available for the cord [SAC]); determine which of the components of the Torg ratio and the SAC account for more of the variability in the measures; and present standardized SAC values for normal subjects using magnetic resonance imaging (MRI). DESIGN AND SETTING: The research design consisted of a posttest-only, comparison-group design. The independent variable was method of measurement (Torg ratio and SAC). The dependent variables were Torg ratio and SAC scores. SUBJECTS: Fourteen men (age = 24.4 +/- 2.5 years, height = 181.0 +/- 5.8 cm, weight = 90 +/- 13.5 kg) participated in this study. The C3 to C7 vertebrae were examined in each subject (n = 70). MEASUREMENTS: The Torg ratio was determined by dividing the sagittal spinal-canal diameter by the corresponding sagittal vertebral-body diameter. The SAC was determined by subtracting the sagittal spinal-cord diameter from the corresponding sagittal spinal-canal diameter. The Torg ratio and SAC were measured in millimeters. RESULTS: The SAC ranged from 2.5 to 10.4 mm and was greatest at C7 in 71% (10 of 14) of the subjects. The SAC was least at C3 or C5 in 71% (10 of 14) of the subjects. A Pearson product moment correlation revealed a significant relationship between the Torg ratio and SAC (r =.53, P <.01). Regression analyses revealed the vertebral body (r (2) =.58) accounted for more variability in the Torg ratio than the spinal canal (r (2) =.48). Also, the spinal canal (r (2) =.66) accounted for more variability in the SAC than the spinal cord (r (2) =.23). CONCLUSIONS: The SAC measure relies more on the spinal canal compared with the Torg ratio and, therefore, may be a more effective indicator of spinal stenosis. This is relevant clinically because neurologic injury related to stenosis is a function of the spinal canal and the spinal cord (not the vertebral body). Further research must be done, however, to validate the SAC measure.     

Head and Cervical Spine Posture in Behaving Rats: Implications for Modeling Human Conditions Involving the Head and Cervical Spine

The aim of this study was to define the temporal and spatial (postural) characteristics of the head and cervical vertebral column (spine) of behaving rats in order to better understand their suitability as a model to study human conditions involving the head and neck. Time spent in each of four behavioral postures was determined from video tape recordings of rats (n = 10) in the absence and presence of an intruder rat. Plain film radiographic examination of a subset of these rats (n = 5) in each of these postures allowed measurement of head and cervical vertebral column positions adopted by the rats. When single they were quadruped or crouched most (～80%) of the time and bipedal either supported or free standing for only ～10% of the time. The introduction of an intruder significantly (P < 0.0001) reduced the proportion of time rats spent quadruped (median, from 71% to 47%) and bipedal free standing (median, from 2.9% to 0.4%). The cervical spine was orientated (median, 25–75 percentile) near vertical (18.8°, 4.2°–30.9°) when quadruped, crouched (15.4°, 7.6°–69.3°) and bipedal supported (10.5°, 4.8°–22.6°) but tended to be less vertical oriented when bipedal free standing (25.9°, 7.7°–39.3°). The range of head positions relative to the cervical spine was largest when crouched (73.4°) and smallest when erect free standing (17.7°). This study indicates that, like humans, rats have near vertical orientated cervical vertebral columns but, in contrast to humans, they displace their head in space by movements at both the cervico‐thoracic junction and the cranio‐cervical regions. Anat Rec, 298:455–462, 2015. © 2014 Wiley Periodicals, Inc.     

颈椎自锁ZEPHIR钢板在外伤性颈椎失稳治疗中的应用

目的：探讨颈椎前路ZEPHIR钢板内固定在外伤性颈椎失稳中应用的临床效果。方法：对15例外伤性颈椎失稳患者行颈椎前路减压、自体髂骨植骨和ZEPHIR钢板内固定术，并对术后植骨愈合、神经功能恢复进行观察。结果：15例患者术后随访6．24个月，平均11个月，椎间植骨均在术后3个月内临床愈合，所有病例神经功能按Frankel分级，均有1～2个级别恢复。本组无严重并发症。结论：ZEPHIR钢板具备优良的植入物设计和力学性能。颈椎前路减压、自体髂骨植骨和ZEPHIR钢板内固定术后颈椎获得即刻稳定，无需附加牢固的外固定，能显著提高植骨融合率。     

配合做好颈椎骨折后深静脉血栓的临床护理分析

目的配合实施颈椎骨折后深静脉血栓(DVT)的预防和诊断工作,做好针对性护理。方法将我科2002年1月~2013年2月收治的311例颈椎骨折患者按处理措施不同分为对照组和观察组,进行回顾性分析。结果对照组148例患者共发生19例DVT,发生率为12.83%。观察组163例患者共发生9例DVT,发生率为5.22%。两组分别有1例因肺动脉栓塞死亡,其余患者未发生严重并发症。结论颈椎骨折患者中,伴有脊髓损伤、多发伤者更易发生DVT。采取综合预防措施及有效护理可有效预防颈椎骨折后深静脉血栓形成,及时诊断有效护理对预后至关重要。     

C2～7颈椎振动特性的有限元分析

目的研究正常C2～7颈椎有限元模型的振动特性和颈椎小关节不同程度受损及切除的振动特性变化。方法基于颈椎CT扫描影像,建立正常C2～7颈椎有限元模型并验证有效性,提取前10阶固有频率和振型。颈椎小关节分别为无约束、有约束且摩擦系数分别为0.01、0.1和0.2,模拟颈椎小关节切除以及小关节轻度、中度、重度受损,研究颈椎受损程度不同对固有频率的影响。结果正常C2～7颈椎模型最低固有频率出现在后伸、侧弯振型,约为12Hz,大位移主要出现在寰椎齿凸。小关节有约束模型的固有频率高于无约束模型,小关节摩擦系数不同对颈椎固有频率无影响。结论研究颈椎的固有频率、振型和振幅等参数,是进一步研究颈椎动态特性的基础,对颈椎护理和治疗有重要意义。在生活和颈椎治疗中,应尽量避开12Hz环境,防止共振对颈椎造成大的损伤。     

Motion in the Unstable Cervical Spine When Transferring a Patient Positioned Prone to a Spine Board

Context:

Two methods have been proposed to transfer an individual in the prone position to a spine board. Researchers do not know which method provides the best immobilization.

Objective:

To determine if motion produced in the unstable cervical spine differs between 2 prone logrolling techniques and to evaluate the effect of equipment on the motion produced during prone logrolling.

Design:

Crossover study.

Setting:

Laboratory.

Patients or Other Participants:

Tests were performed on 5 fresh cadavers (3 men, 2 women; age = 83 ± 8 years, mass = 61.2 ± 14.1 kg).

Main Outcome Measure(s):

Three-dimensional motions were recorded during 2 prone logroll protocols (pull, push) in cadavers with an unstable cervical spine. Three equipment conditions were evaluated: football shoulder pads and helmet, rigid cervical collar, and no equipment. The mean range of motion was calculated for each test condition.

Results:

The pull technique produced 16% more motion than the push technique in the lateral-bending angulation direction (F_1,4 = 19.922, P = .01, η² = 0.833). Whereas the collar-only condition and, to a lesser extent, the football-shoulder-pads-and-helmet condition demonstrated trends toward providing more stability than the no-equipment condition, we found no differences among equipment conditions. We noted an interaction between technique and equipment, with the pull maneuver performed without equipment producing more anteroposterior motion than the push maneuver in any of the equipment conditions.

Conclusions:

We saw a slight difference in the motion measured during the 2 prone logrolling techniques tested, with less lateral-bending and anteroposterior motion produced with the logroll push than the pull technique. Therefore, we recommend adopting the push technique as the preferred spine-boarding maneuver when a patient is found in the prone position. Researchers should continue to seek improved methods for performing prone spine-board transfers to further decrease the motion produced in the unstable spine.Key Words: injuries, transfer techniques, logroll

Key Points

• A slight difference in motion was measured between the 2 prone logrolling techniques, with the push technique producing less lateral-bending and anterior-posterior motion than the pull technique.
• The logroll push technique should be adopted as the preferred spine-boarding maneuver when a patient is found in the prone position.
• Individuals who may need to perform this rescue procedure should practice and become proficient in the logroll push technique.
• Researchers should continue to seek improved methods for transferring patients positioned prone to spine boards to further reduce the motion transmitted to the unstable spine.

Each year, 12 000 incidents of nonfatal spinal cord injury are reported in the United States.¹ Approximately 8.0% of these injuries occur during sport participation.¹ Of all US sports, American football has by far the greatest number of spinal injuries. Between 1982 and 2007, the incidence of direct injuries in males playing American football was 1.89 per 100 000 participants in a college setting and 0.75 per 100 000 participants in a high school setting.²The prehospital management of spinal cord injuries is critical to prevent exacerbation of the injury. In 3% to 25% of patients, neurologic deterioration occurs during the initial management of spinal cord injuries.³ During immobilization and transportation of the patient to the hospital, precautions must be taken to transmit as little motion as possible to the spine. One of the first transfers that rescuers must perform is placing the injured athlete onto a long, rigid spine board. When the injured athlete is supine, lift-and-slide spine-board transfers produce less motion in the spine than logroll spine-board transfers.^4–6 However, when the patient is found in the prone position, a lift-and-slide transfer cannot be performed successfully, and a logroll technique must be used.Swartz et al⁷ recommended how to best manage a catastrophic spine injury in the athlete. They described 2 techniques for logrolling an athlete who is positioned prone: the prone logroll push and the prone logroll pull. Researchers⁸ have shown that the logroll push produces less motion in the unstable thoracolumbar spine. No one knows which of the prone spine-boarding techniques provides the best immobilization in the unstable cervical spine. Therefore, the primary purpose of our study was to determine if motion produced in the unstable cervical spine differs between 2 prone logrolling techniques. Our null hypothesis was that no difference would exist in the amount of motion allowed between the 2 prone logrolling techniques. Our secondary purpose was to evaluate the effect of equipment on the motion produced during the prone logrolling technique. Our null hypothesis was that no difference would exist in the amount of motion allowed among any of the equipment conditions.     

Cervical Spine Motion in Football Players During 3 Airway-Exposure Techniques

OBJECTIVE: Immediate rescue breathing, or cardiopulmonary resuscitation, may be necessary for the cervical spine-injured football player without removal of the helmet. The purpose of our study was to compare 2 pocket-mask insertion techniques with a face-mask rotation technique to determine which allowed the quickest initiation of rescue breathing with the least cervical spine motion. DESIGN AND SETTING: In a biomechanics laboratory, 3 airway-preparation techniques were tested: chin-insertion technique (pocket mask inserted between the chin and face mask), eye-hole-insertion technique (pocket mask inserted through the face mask eye hole), and screwdriver technique (side loop straps removed using manual screwdriver followed by mask rotation). SUBJECTS: One athletic trainer team and 12 National Collegiate Athletic Association Division III football players. MEASUREMENTS: Time to initiate rescue breathing and induced helmet motion. RESULTS: Both pocket-mask techniques allowed quicker initiation of rescue breathing. Cervical spine anterior-posterior displacement was greater for the chin technique than for the screwdriver or eye-hole techniques. Lateral translation was greater for the screwdriver technique than for either pocket-mask technique. Peak displacement from initial cervical spine position was greater for the chin technique than for the eye-hole technique. CONCLUSIONS: Both pocket-mask techniques allowed quicker initiation of rescue breathing than did rotation of the face mask via loop strap screw removal. The eye-hole insertion technique was faster and produced less cervical spine motion than the other 2 techniques. Each technique produced significantly smaller amounts of cervical spine displacement than that caused by cutting face-mask loop straps as reported earlier. We suggest a protocol for field management of cervical spine injuries in football players.     

正常青年体表温度分布的红外热像分析

利用TTM红外热成像系统对208例正常青年男女进行体表温度测量.根据人体解剖学分区,获得人体体表21个部位的温度分布特征,并分析了人体左右两侧温度的对称性.结果表明正常青年体表的温度对称性很好,两侧温差不超过0.2 ℃.本研究初步建立了青年男女体表温度参考值范围的数据库,其结果可为红外热成像技术用于疾病诊断和健康评估提供一种参考标准.