中国组织工程研究与临床康复 第15卷 第9期 20110226 出版 Journal of Clinical Rehabilitative Tissue Engineering Research February 26, 2011 Vol.15, No.9 P.O. Box 1200, Shenyang 110004 cn.zglckf.com 1694 1Affiliated Jiangyin Hospital, Southeast University Medical College, Jiangyin 214400, Jiangsu Province, China; 2Wuxi Third Peoples Hospital, Wuxi 214041, Jiangsu Province, China Shen Ai-dong, Master, Physician, Affiliated Jiangyin Hospital, Southeast University Medical College, Jiangyin 214400, Jiangsu Province, China sad1129medmail. com.cn Supported by: the Science and Technology Item for Society Development of Wuxi, No. CS055007* Received: 2010-10-10 Accepted: 2010-11-15 (20100809005/G) Shen AD, Xu RS. Change regularity of intervertebral contact areas during lumbar spondylolisthesis and its value in clinical application. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2011;15(9): 1694-1679. http:/www.crter.cn http:/en.zglckf.com Change regularity of intervertebral contact areas during lumbar spondylolisthesis and its value in clinical application* Shen Ai-dong1, Xu Rui-sheng2 Abstract BACKGROUND: Lumbar spondylolisthesis directly reduces contact areas between dislocated vertebral body and subjacent vertebral body, which is an important factor that decides intervertebral stress and lumbar degeneration. The cross section of lumbar is irregular reniform shaped and there is no mathematical formula to calculate changing regularity of intervertebral contact areas of lumbar spondylolisthesis directly. OBJECTIVE: To study changing regularity of intervertebral contact areas during lumbar spondylolisthesis and to analyze its clinical significance. METHODS: Super-surface of L5 vertebra and sub-surface of L4 from 25 cases were taken by a digital camera and computer simulation spondylolisthesis process and every intervertebral contact areas (Sn) were measured by Image-Pro Plus software. The mean value was obtained and converted into percentage area according to Sn%=Sn/S100%. The change rules of vertebral bodies were observed from 0 to 100% spondylolisthesis. Based on this regularity, a new clinical stage of lumbar spondylolisthesis was proposed and guided for treatment of 56 cases with lumbar spondylolisthesis. RESULTS AND CONCLUSION: During lumbar spondylolisthesis process, Sn% changes like a hyperbola. Sn% lost slowly during spondylolisthesis rate at 0-23% and quickly during 23%-44%, and then it become slowly once again after spondylolisthesis rate at 44%-100%, the inflection points appeared at (232)% and (442)%. Totally 48 patients were followed up, according to Staufee standard rate, the clinical curative effect reached approximately 90%. It suggests that the intervertebral contact areas present with a non-linear change, which is helpful to judge the stability of lumbar spine and guide the treatment of lumbar spondylolisthesis. INTRODUCTION Lumbar spondylolisthesis is a common reason for lower back pain, which severely affects daily life and work of human. With the construction of diagnostic radiology principle and increasing of spinal fixation instruments and skills, the etiological factor of lumbar spondylolisthesis has better understand. However, there are few documents concerning whether the disease would aggravate1-12, some scholars even dispute whether there is aggravation and its clinical significance13. The treatment plan for lumbar spondylolisthesis still argued, it is not a final conclusion that whether in-time surgery is necessary and which one is better. Imageological manifestation of lumbar spondylolisthesis is presented with anterior displacement of one vertebra in lateral view X-ray film, actually, the changes are contact areas between two vertebral bodies14. The cross section of lumbar is irregular reniform shaped and there is no mathematical formula to calculate overlapped areas. Accordingly, this study using a computer to simulate spondylolisthesis process and the contact areas were calculated by image processing to explore the changing regularity of intervertebral contact area of lumbar spondylolisthesis at 0-100% spondylolisthesis and to analyze its clinical significance in the treatment of lumbar spondylolisthesis. MATERIALS AND METHODS Design An image measurement and analysis experiment; prospective case analysis. Time and setting The experiment was performed at the Laboratory of Mechanobiology and Medical Engineering, School of Medicine, Shanghai Jiao Tong University from August to October 2007. All cases were from Department of Spinal Surgery, Affiliated Jiangyin Hospital, Southeast University Medical College between October 2007 and December 2009. Materials Twenty-five healthy, adult, L4, L5 skeleton specimens of Chinese population, without obviously degenerative diseases, were provided by the Department of Anatomy, Second Military Medical University. Methods Super-surfa