骨质疏松症对腰椎形态及其大体活动范围的影响

了解不同程度骨质疏松患者椎骨、椎间盘形态及腰椎矢状面大体活动度。选取34位在我院查体的老年人,并按骨密度值分组(9正常,11骨量缺少,14骨质疏松症),拍摄腰椎侧位片及磁共振图像,并测量活动度。骨质疏松组与其他两组相比,腰椎椎体前部高度增加,骨质疏松与椎间盘中部膨胀和相应椎体的塌陷有关,而与椎间盘性质无关,其腰椎大体活动范围无明显变化。骨质疏松不仅影响骨矿含量,也影响骨周围软组织,且与椎体终板变化继发椎间盘膨胀相关。     

对微创脊柱外科发展历程的思考

微创脊柱外科是现代脊柱外科发展的必然趋势。近几十年来,微创技术不断革新,微创理念也逐渐深入人心。在取得了巨大成就的同时还有许多问题值得我们去思考和探索。我们不仅应注重微创技术的创新和应用,更要注意应用微创理念,做到二者的有机统一。     

Walking breaks can reduce prolonged standing induced low back pain

Standing is commonly recommended to reduce sedentary behavior in the workplace; however, constrained prolonged standing has also been linked to musculoskeletal symptoms, such as low back pain (LBP). Light physical activity breaks, such as walking, may change lumbar spine posture enough to reduce LBP during standing. This study assessed the effectiveness of inserting 5-minute walking breaks every 25 min for reducing prolonged standing-induced LBP development. Nineteen participants completed two bouts of standing lasting 2 h – one with a 5-minute walking break every 25 min and one with no breaks. Pain measures were completed throughout the trial to categorize participants as pain developers (PDs) or non-pain developers (non-PDs). Lumbar region kinematics angle and range of motion were measured continuously. In standing, 58% (11/19) of participants were PDs, compared to just 26% when walking breaks were inserted. Seventy-three percent (8/11) were categorized as non-PDs with walking breaks. Median lumbar flexion increased during walking compared to standing. Lumbar region range of motion in the coronal and transverse planes also increased during walking. The intermittent lumbar flexion may help decrease LBP during prolonged standing. These results demonstrate that walking breaks may help promote lumbar movement and reduce prolonged standing-induced LBP.     

Age-related differences in the timing aspect of lumbopelvic rhythm during trunk motion in the sagittal plane

Forward bending and backward return of the human trunk in the sagittal plane are associated with a specific lumbopelvic rhythm, which consists of magnitude and timing aspects. In this study, the age-related differences in the timing aspect of lumbopelvic rhythm were investigated using the continuous relative phase method. Specifically, the mean absolute relative phase (MARP) between the thoracic and pelvic motions as well as variation in MARP under repetitive motions, denoted by deviation phase (DP), were characterized in sixty participants between 20 and 70 years old. MARP and DP were determined for trunk forward bending and backward return tasks with self-selected slow and fast paces. The MARP and DP were both smaller (p = 0.003, p < 0.001 respectively) in the older versus younger age participants with no gender-related difference. In fast versus slow pace task, the MARP was smaller (p < 0.001) only in forward bending, whereas the DP was smaller (p < 0.001) in both the forward bending and backward return. A more in-phase and more stable lumbopelvic rhythm denoted respectively by smaller MARP and DP in older versus younger individuals maybe a neuromuscular strategy to protect the lower back tissues from excessive strain, in order to reduce the risk of injury.     

An Outline of a Theory of Action Systems

It is argued that the traditional psychological construal of the distinction between central (“open loop”) and peripheral (“closed loop”) neural processes is no longer tenable. A review of the relevant psychobiological research on the control of movement shows that both the central-peripheral dichotomy and the distinction between sensory and motor systems derived from that dichotomy are incompatible with what is known about the processes underlying action. Based on experimental and comparative data, a new theory of action is proposed. The basic concept of this new theory is the action system: Unlike motor systems, action systems involve sensory as well as motor processes; action systems are not organized into response hierarchies, but rather in coalitional structures of adjustable movements and postures. The phylogeny of action systems is discussed, and the eight most important action systems are distinguished in terms of their evolved distinctive functions. The difficulties of developing a taxonomy of actions for functionally specific types of behavior made up of units that can be controlled is resolved by showing how kinds of action are differentiated by the kinds of affordances their components help to realize.     

Reference values and functional descriptions of transverse plane spinal dynamics during gait based on surface topography

Spinal dynamics during gait have been of interest in research for many decades. Based on respective previous investigations, the pelvis is generally expected to be maximally forward rotated on the side of the reference leg at the beginning of each gait cycle and to reach its maximum counterrotation approximately at the end of the reference leg’s stance phase. The pelvic–upper-thoracic-spine coordination converges towards an anti-phase movement pattern in high velocities during ambulation. The vertebral bodies around the seventh thoracic vertebra are considered to be an area of transition during human ambulation where no or at least little rotary motion can be observed. The respective cranial and caudal vertebrae meanwhile are expected to rotate conversely around this spinal point of intersection. However, these previous assumptions are based on scarce existing research, whereby only isolated vertebrae have been analyzed contemporaneously. Due to huge methodological differences in data capturing approaches, the results are additionally hardly comparable to each other and involved measurement procedures are often not implementable in clinical routines. Furthermore, none of the above-mentioned methods provided reference data for spinal motion during gait based on an appropriate number of healthy participants. Hence, the aim of this study was to present such reference data for spinal rotary motion of every vertebral body from C7 down to L4 and the pelvis derived from surface topographic back shape analyses in a cohort of 201 healthy participants walking on a treadmill at a given walking speed of 5 km/h. Additionally, the spine‘s functional movement behavior during gait should be described in the transverse plane based on data derived from this noninvasive, clinically suitable measurement approach and, in conclusion, the results shall be compared against those of previous research findings derived from other measurement techniques. Contrary to the previous functional understanding, the area of the mid-thoracic spine was found to demonstrate the largest amplitude of rotary motion of all investigated vertebrae and revealed an approximately counterrotated movement behavior compared to the rotary motion of the pelvis. In both directions, spinal rotation during gait seemed to be initiated by the pelvis. The overlying vertebrae followed in succession in the sense of an ongoing movement. Therefore, the point of intersection was not statically located in a specific anatomical section of the spine. Instead, it was found to be dynamic, ascending from one vertebra to the next from caudal to cranial in dependence of the pelvis’s rotation initiation.     

脊柱转移瘤个体化综合治疗中的临床决策

脊柱转移是恶性肿瘤最重要的并发症,其个体化综合治疗应遵循循证医学原则,根据患者机体状况、肿瘤病理类型、临床分期和发展趋势等,优化多学科综合治疗手段,努力做到临床决策的科学性,以期最大幅度地提高患者临床疗效及改善患者生活质量。     

腰椎疾病病因、诊疗方法的研究

腰椎疾病近年来发病率呈上升趋势,以退行性疾病、腰椎间盘突出和骨折创伤为主要类型。从疾病起源、发展、转归的角度,结合自然辩证法的理论,针对腰椎疾病的病因、诊断标准、治疗方法及效果三个方面进行了阐述和展望。对哲学应用于临床实践和科研教学等方面的基本问题,如对疾病发展规律的研究,诊断理论的建构等,进行了论述。     

Multi-segmental thoracic spine kinematics measured dynamically in the young and elderly during flexion

In contrast to the cervical and lumbar region, the normal kinematics of the thoracic spine have not been thoroughly investigated. The aim of this study was to characterize normal multi-segmental continuous motion of the whole thoracolumbar spine, during a flexion maneuver, in young and elderly subjects. Forty-two healthy volunteers were analyzed: 21 young (age = 27.00 ± 3.96) and 21 elderly (age = 70.1 ± 3.85). Spinal motion was recorded with a motion-capture system and analyzed using a 3rd order polynomial function to approximate spinal curvature throughout the motion sequence. The average motion profiles of the two age groups were characterized. Flexion timing of the thoracic region of the spine, as compared to the lumbar spine and hips, was found to be different in the two age groups (p = 0.011): a delayed/sequential motion type was observed in most of the young, whereas mostly a simultaneous motion pattern was observed in the elderly subjects. A similar trend was observed in flexion of the lower thoracic segments (p = 0.017). Differences between age groups were also found for regional and segmental displacements and velocities. The reported characterization of the thoracic spine kinematics may in the future support identification of abnormal movement or be used to improve biomechanical models of the spine.     

Early static standing is associated with prolonged standing induced low back pain

Previous research points to the lack of movement during prolonged standing as a pre-disposing factor to low back pain (LBP). Such movements could be at the level of the lumbar spine or at the foot–ground interface. The primary purpose of this in vivo study was to determine if there were differences in magnitude, region, and frequency of movement patterns between non-pain developers (non-PDs) and standing induced pain developers (PDs). Thirty-two participants reported their LBP development using a visual analog scale over 2-h of prolonged standing. Time-varying lumbar spine kinematics were used to assess the magnitude and frequency of lumbar spine fidgets and shifts. Ground reaction forces were used to assess the magnitude and frequency of whole body weight transfers and anterior–posterior center of pressure movements. Fourteen of 32 participants (43.75%) were categorized as PDs. The first 15 min of standing distinguished the two pain groups, as non-PD performed a higher frequency of lumbar spine flexion/extension fidgets and large body weight transfers. Both of these differences may be pre-disposing factors for transient LBP development, as they both occurred prior to PDs reaching the 10 mm visual analog scale threshold for LBP classification.