基于量化的动态影像学测量研究手法治疗腰椎不稳症的机制

Lumbar instability is one of the important factors which disabled middle-aged and the elderly people and there are still many disputes in its diagnosis, treatment and curative effect evaluation. Chinese manipulation therapy has been proved to be effective in treatment of lumbar instability but its therapeutic mechanism is still undefined. In this study, we hypothesized that the loss of lumbar kinetic balance result from abnormal movement of vertebral body is the main reason of lumbar instability, and the therapeutic mechanism of manipulation therapy is to rebuild the stability of the lumbar spine by correcting the abnormal movement of vertebral bodies. Quantitative fluoroscopy is an emerging technology for measuring intervertebral motion patterns to investigate the clinical feature of lumbar instability. We plan to study the patients who have positive responses to the manipulation therapy, evaluate and compare the lumbar kinetic balance before and after treatment with manipulation therapy through quantitative fluoroscopy measurement, investigate the correlation between the improvement in symptoms and imageological changes, to discuss the therapeutic mechanism of manipulation therapy. We also intend to build the 3D digitalized model of lumbar instability and learn the character of movement of vertebral bodies in three-dimensional space to have the better understand the mechanism of manipulation therapy.

腰椎不稳症严重影响中老年人群生活质量，且在发病机制、治疗方法和疗效判定上存在争议。中医手法治疗腰椎不稳症取得了良好的疗效，但对治疗机制的认识不足影响其临床研究及疗效评价。本研究以此为切入点，提出椎体间异常活动导致的腰椎动态平衡性丧失是腰椎失稳的重要原因，而手法治疗是通过纠正椎体间异常活动，恢复腰椎的动态平衡性而重建其稳定性。我们以手法治疗有效的腰椎不稳症患者为研究对象，通过量化的动态影像学测量技术，观察腰椎椎体异常活动的特点和规律，评估和对比手法治疗前后腰椎的动态平衡性，并研究临床症状的改善与影像学变化之间的相关性，据此探讨手法治疗腰椎不稳症的机制。通过建立腰椎不稳症的三维数字化模型，了解手法治疗前后失稳腰椎在三维空间的位移变化和位置异常的特点，进一步证实手法治疗是通过恢复失稳腰椎的动态平衡性而实现稳定性的重建。本研究为进一步完善手法治疗腰椎不稳症的理论体系提供新的思路和方法。

腰椎不稳症严重影响中老年人群生活质量，且在发病机制、治疗方法和疗效判定上存在争议。中医手法治疗腰椎不稳症取得了良好的疗效，但对治疗机制的认识不足影响其临床研究及疗效评价。本研究以此为切入点，提出椎体间异常活动导致的腰椎动态平衡性丧失是腰椎失稳的重要原因，而手法治疗是通过纠正椎体间异常活动，恢复腰椎的动态平衡性而重建其稳定性。我们以手法治疗有效的腰椎不稳症患者为研究对象，通过量化的动态影像学测量技术，观察腰椎椎体异常活动的特点和规律，评估和对比手法治疗前后腰椎的动态平衡性，并研究临床症状的改善与影像学变化之间的相关性，据此探讨手法治疗腰椎不稳症的机制。通过对健康对照组及腰椎不稳症患者组的腰椎活动时影像解剖学参数的动态和量化分析，我们发现两组之间有统计学差异，说明健康人与腰椎不稳症患者在腰椎活动时的动态影像学表现上是有差异的。通过对腰椎不稳症患者手法治疗前、后动态影像学的变化，临床症状的改善以及两者之间的相关性（即“结构异常”和“功能异常”的关系），我们进一步探讨了手法治疗重建腰椎稳定性的机制并尝试建立手法治疗腰椎不稳症的疗效评估系统，但该目标实现较为困难，需在今后的工作中进一步努力实现。本研究为进一步完善手法治疗腰椎不稳症的理论体系提供新的思路和方法。