过屈过伸位摄片辅助架在腰椎退行性疾病患者腰椎稳定性评估中的作用

Roles of flexion-extension radiograph bracket in assessing lumbar instability in patients with degenerative lumbar diseases

中文关键词:  腰椎退行性疾病  X线片  过屈过伸位  摄片辅助架  腰椎稳定性

英文关键词:Degenerative lumbar diseases  X-ray  Flexion-extension  Radiograph bracket  Lumbar instability

中文摘要:

  【摘要】 目的：评价自行设计的过屈过伸位摄片辅助架（flexion-extension radiograph bracket，FERB）在评估腰椎退行性疾病患者腰椎稳定性中的价值。方法：2021年5月～2022年1月在我院住院的63例L4/5退行性疾病患者自愿参与本研究。男性35例，女性28例；年龄33～84岁（56.7±14.6岁）。患者入院后拍摄常规站立过伸过屈侧位X线片，同时在过屈过伸位摄片辅助架辅助下拍摄腰椎过伸过屈位X线片。比较两种方法拍摄的X线片上矢状位平移距离（sagittal translation，ST）、椎体间节段成角（segmental angulation，SA）、椎体间后开口角度（posterior opening，PO）和腰椎前凸角度变化（changes of lumbar lordosis，CLL），ST≥3mm或SA≥15°或过屈位片PO≥5°定义为腰椎不稳（lumbar instability，LI），计算并比较两种方法对LI的检出率。结果：63例患者均完成两种方法摄片。61例患者感觉使用过屈过伸位摄片辅助架更舒适，2例腰部严重疼痛患者（轻微伸展和弯曲腰部即感到腰部疼痛难以忍受）感觉两种方法无明显差异。摄片辅助架辅助下腰椎过伸过屈位X线片上ST为2.31mm（0，3.23），SA为9.75°±5.12°，PO为-1.0°（-5.0°，1.0°），CLL为34.81°±15.01°，常规站立过伸过屈侧位X线片上ST为0.5mm（0，1.42），SA为5.67°±3.98°，PO为-1.0°（-4.0°，0°），CLL为25.35°±13.88°，摄片辅助架辅助下腰椎过伸过屈位X线片中ST、LA、PO、CLL均显著性高于常规站立过伸过屈侧位X线片（P<0.05）。摄片辅助架辅助下腰椎过伸过屈位片X线中有24例（38.1%）检测出LI，常规站立过伸过屈侧位片中仅有5例（7.9%）检测出LI，两种方法LI的检出率有统计学差异（P<0.05）。结论：与常规站立过伸过屈侧位X线片相比，过屈过伸位摄片辅助架辅助下摄片可以标准化操作流程，减少患者摄片时的不适感，提高LI的检出率。

英文摘要:

  【Abstract】 Objectives: To investigate the roles of flexion-extension radiograph bracket(FERB) in evaluating lumbar stability in patients with lumbar degenerative diseases. Methods: A total of 63 inhospital patients with L4/5 degenerative lumbar diseases in our hospital participated voluntarily in the study from May 2021 to January 2022. There were 35 males and 28 females, aged 33-84 years(56.7±14.6 years) old. Routine standing lateral flexion-extension radiographs(LFERs) and FERB-aided LFERs(FERB-LFERs) were taken after admissions of patients. Sagittal translation(ST), segmental angulation(SA), posterior opening(PO), and changes of lumbar lordosis(CLL) were measured for comparisons between LFER and FERB-LFER. Lumbar instability(LI) was defined as ST≥3mm or SA≥15° on flexion-extension radiographs, or PO≥5° on flexion radiographs. The detection rates of LI by the two photography methods of X-ray films were calculated and compared. Results: All the 63 patients completed the two methods of photography, respectively. 61 patients felt radiograph aided with FERB more comfortable, and the other 2 patients with severe waist pain(unbearable pain when stretching or bending the waist slightly) felt no significant difference between the two methods. On the lumbar FERB-LFERs, the ST was 2.31mm(0, 3.23), SA was 9.75°±5.12°, PO was -1.0°(-5.0°, 1.0°), CLL was 34.81°±15.01°. On the routine LFERs, the ST was 0.5mm(0, 1.42), SA was 5.67°±3.98°, PO was -1.0°(-4.0°, 0°), and CLL was 25.35°±13.88°. ST, SA, PO and CLL on the FERB-LFERs were significantly higher than those on routine LFERs(P<0.05). LI was detected in 24 cases(38.1%) on the FERB-LFERs, and only in 5 cases(7.9%) on the routine LFERs. The detection rates between the two photography methods were statistically different(P<0.05). Conclusions: Compared with routine lateral flexion-extension radiographs, photography aided with the flexion-extension radiograph bracket can standardize the procedures, reduce the discomfort of patients during the process of radiographs, and increase the detection rate of lumbar indisability.