计算机脊柱分析系统

SPINALANALYSISSYSTEM

脊柱x线分析系统

功能特点：

脊柱分析系统是临床生物力学和计算机程序的整合。用

于帮助医生确定更有真对性的治疗方案，以恢复脊柱和骨盆

系统的正常形态和功能。分析系统将测得的脊柱机构形态和

动态分析数据结果与理想脊柱模型比对后，将结果以二位图

示直观的表示出来。并附有表格及文字叙述。

分析系统同时也是病人的治疗管理档案。它可以让

医生将病人治疗疗程的前后记性比较以坚定医生的治疗信

心。同时也可让医生及时改善有待改进的地方

分析系统也是一个庞大的数据库。收集了十万张以上的

x光数据。对医生进行案例研究分析和统计也有很大帮助。

此软件已获得美国专利保护

使用说明：

进入分析系统后屏幕首先出现：

按任意键出

1

现主菜单:

DIGITIZEAPATIENTX-RAV.

按键英文中文

F1RETURN返回

F2DIGITIZEX-RAYX光片数据输入

F3RECORDS记录档案管理

MANAGEMENT

F4DATAAPPLICATIONS数据软件

F5COVERREPORT合并报告

F6TRAVELCARD治疗卡

F7SOFTTISSUEDATA软组织数据

F8UTILITYFUNCTIONS多功能

ALTHALTKAYMENUAlt键菜单

选择F2进入X光片的数据输入

2

F2正位全脊柱

F3正位颈椎

F4正位胸椎

F5正位腰椎

F6侧位全脊柱

F7侧位颈椎

F8侧位胸椎

F9侧位腰椎

F10其他

例如选择F7进入颈椎侧位片数据输入

TheSASsystemneedstobecustomizedwithdataparticulartoyourhardware

configurationandofficeinformation.ThisisaccomplishedwiththeUtility

Functions,F8.FromthemainmenuscrolldowntoF8andpress<enter>or

simplypresstheF8functionkey.Thefollowingmenuwillappear.

SETUPSUBMENU

Setupyourofficeandhardwareinformation.

DigitizerPort

PressF2tosetthe

digitizerport,

Thisisaccomplished

byplacingthe

digitizingmouseagainsttheelectromagneticgrid.Youwillseecommunication

portaddresseschangingonthescreen.Repeatedlypressanyofthebuttonson

themouse.TheSASsystemwillfindthedigitizerportautomatically.Whenthe

digitizerporthasbeenfoundthecommunicationportaddresseswillstop

changing.Youwillbepromptedtopressanykey.Thesystemwillreturntothe

utilitysubmenu.

F3PrinterSetUp

PressF3toentertheprintersetup.AHewlettPackardLaserprinterisrequired.

Theusualconnectionfortheprinterisparallelport1.Theprinterisinitially

defaultedtoparallelport1.PressF2then<enter>togglesbetweenparallelport

1andport2.IfyouhaveanetworkprinterpressF3.Ifforanyreasonyour

printerstopsworkingduringprogramoperationpressF4toresettheprinter.

ResettingtheprintercanalsobeaccomplishedbypressingALTRatanyscreen

locationintheprogram.PressFltoreturntothemainmenu..

4

5

F4ProviderInformation

PressF4toentertheproviderinformation.Thefollowingscreenappears.

Enteryourpracticeinformation.

PROVIDER

SUBMENU

Entertheofficeinformation.

1UtilityFunctionProviderInformation

Leavingtheprovidernameemptywillcauseablanklineforyoursignatureon

allreports.Thisisrecommended.Otherwiseyournamewillbeprinted.Press

Fltoacceptyourofficeinformationandreturntothemainmenu.

X-RAYPROCESSINGDIGITIZINGTHEPATIENTX-RAY

Regionalneutralx-raysaredigitizedandthenmergedintoasinglerecordfor

comprehensivedataanalysis.Tobegintheprocessthex-rayisplacedonthe

electromagneticgridwiththeedgesofthefilmparalleltothegrid.Thepointsto

bedigitizedshouldalsobeplacedatleastaninchawayfromthelightededgeof

thegrid.Marktheosseouslandmarkswitha#2225pencil.Thisvisually

identifiesthepointsinadvanceandmakesthedigitizingprocessmuchfaster

andeasier.Ingeneralthedigitizingpointsarethefourcomersofavertebraon

thelateralviewandthefourcornersofthevertebraandtheinterlaminajunction

ontheA-Pview.Thefourcornersaremarkedtobestapproximatethedisc

space.Thereforewhenspondylosisorexostosisispresentmarkthevertebral

bodysuchthatthediscspaceisbestrepresentedandnotthepathologyorboney

outgrowths.Fullspinex-raysaredigitizedasthreeregionalviewsandthen

mergedintoasinglerecord.

DIGITIZINGYoumustdigitizeallpointsassociatedwithacomplete

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sectionalviewtoanalyzeintheSASprogram.TodigitizeintheSASprogram

press

F2DIGITIZEChoosetheappropriateviewfromthesubmenuchoices.

7

DIGITIZINGSUBMENU

Flexion,extensionand

lateralbendingviewsare

digitizedaslateralorA-P

viewsandlatertaggedto

identifytheappropriate

positionduringthe

SAVEprocess.Follow

theonscreenpromptsfor

theappropriateosseous

pointlocation.

CLOSETHISMENUANDRETURNTOAPREU1OUSMENU.DIGITIZING

2DigitizingSubmenuChooseAppropriateViewPOINTS

GenerallyalllateralandA-Px-raysfollowthesame

digitizingsequence.Thedigitizingpointsforthe

lateralcervicalareillustratedtotheleft.The

digitizingpointsforallA-PandLateralviewsare

illustratedintheappendix.

Afterdigitizingalltheappropriatepointsagraphic

imageappearsandpromptsyoutoaccept<pgdn>or

reject<F1>.IntheSASprogram,vertebraC3

throughC7shouldappearassimpleboxfigures,C2

asatriangle,C1andOcciputaslines.Thefigure

belowillustratesthelateralcervicalasdrawninthe

SASprogram.

Aslongasthevertebraappearsimilartotheprimary

structuresillustratedbelowyoushouldacceptthe

image.Amorerefinedimagewillbedrawninthe

analysesandprintingoperations.

3CervicalDigitizing

Points8

Ifyouinadvertently

digitizeanincorrect

pointyoucanbackup

bypressingthe

4DigitizingSaveScreen1<pgdn>key.Youcan

onlybackupavertebraduringthedigitizingprocess.Ifyoudeterminethatan

incorrectpointhasbeenenteredduringthesaveprocessthenyouhavetore­

digitizetheentirex-ray.

PatientIdentificationScreen

Whenyoupress<pgdn>theprogrammovestothe"patientidentification

screen".Enterthepatientlastnamefollowedbyacommaandaspace,thenenter

thefirstname.Pressing<enter>orusingthe<upanddown>arrowkeysmoves

thecursorfromfieldtofield.

Enterthedateofthex-rayinthe

format[MM/DD/YY],height

(inches)andweight,age,numberof

visits,doctornameandpatientsex.

Onlythepatientnameanddateofx-

rayarerequiredfields.

PatientPosition

5DigitizingSaveScreen2

9

Thelowerpartofthescreenidentifiesthepositionofthepatient,standingor

sitting,andwhetheritwasaneutral,flexion,extension,rightbendorleft

bend.Thesystemdefaultstothestandingpositionandneutral.Ifthisisnotthe

casemovethehighlightcursortothatfield,pressthe<spacebar>toremovethe

"X"andtypean"X"intheappropriatedesignation.Whenallinformationis

completepress<pgdn>toproceedtothenotefield.

NoteField

Anoteisnotnecessary.Press<pgdn>andyouwillbepromptedtoSAVE.

PressingFlwillsavethepatientinformation.PriortotheFlsavethe<pgdn>

and<pgup>keysmoveyouupanddownthenoteandpatientinformation

screens.

Theprogramreturnstothemainmenu.Repeatthedigitizingprocessforasmany

x-raysasyouhavetoprocess.Aslongasyoukeeprepeatingthedigitizing

processtheprogramwillholdthepreviouspatientinformation.

***Makesurethepatientpositionandtypeofviewareproperlyidentified

beforepressingFltoaccept.Afieldchangeisnecessaryforflexion,extension,

leftbendorrightbendviews.***

MERGINGTHEPATIENTX-RAYSINTOASINGLERECORD

Theindividualdigitizedx-raysareheldinanintermediatedatabase.Thex-rays

mustbecombined,savedandmergedintotheactivedatabaseoftheSAS

programpriortoapplyinganydataapplications.

ThemergeprocesswillcombineneutralA-Pandlateralx-raysintoasingle

recordsothattheycanbeanalyzedcollectivelyasafullspine.Allflexion,

extensionandlateralbendingx-raysaresavedasindividualviewswiththe

appropriatedesignationtoidentifythenonneutralposition.Nonneutralx-rays

mustnotbecombinedintoorwithinacombinedrecord.Tomergethex-rays

press

F3RECORDSMANAGEMENT

10

F5MERGEX-RAYS

Inthisprocessyouwillmergeorjointogetherallneutralx-rayviewsfora

uniquepatienttakenonthesamedate.PressF3RECORDSMANAGEMENT

andthenF5MERGEX-RAYS.Youwillenterintothedigitizingdatabase

whereallthesinglex-rayviewsarestored.Eachrecordhasthepatient'sname,

sitting(D)orstanding(U),dateofx-ray,A/PorLateralpositionandN,F,Eview.

Thex-raysarecombinedbyhighlightingalltheneutralviewsandpressingthe

|+|key.Begintheprocessbyfindingthepatient.Press

F2Searchforthepatientbytypingthelastname<enter>

Movetheboxedcursorovereachofthepatients'neutralx-raysandpress

<enter>.Thepatientx-rayviewwillbehighlighted.CONTINUEhighlighting

thepatientneutralx-raysof

thesamedatebypressing

<enter>.

Acompleteneutralrecord

couldholdamaximumof

sixx-rayviews:A/P

cervical,thoracic,lumbar;

LATERALcervical,

thoracic,lumbar.Ifonlyone

x-rayviewisavailableitis

highlightedandsaved.

CLOSETHISMENUANDRETURNTOAPREVIOUSMENU

6CombiningNeutralX-raysF3EDITRECORD

Youcaneditthepatientinfbmiationpriortocombiningthex-rays.Thismaybe

necessaryifanyofthepatientdatafieldsareincorrect.Toeditthepatientdata

movetheboxedcursoroverasinglerecordandpress<F3>.Enterthecorrected

informationandpress<F1>toaccept.

SAVINGTHECOMBINEDRECORD

Afterhighlightingasmanyneutralx-raysofthesamedateasareavailablefora

uniquepatient,savetherecordbypressingthe[+](plus)key.Thehighlight

willberemovedfromtheselectedrecordsindicatingthemergeprocessis

11

complete.Thepatientx-rayshavenowbeencombinedandsavedasasingle

recordintheSASprogramdatabase.Theprogramwillreturnyoutothe

digitizingdatabasewhereyouwillsavethenon-neutralviewsofthepatientasa

singlerecordintotheSASdatabase.

MERGINGNON-NEUTRALX-RAYS

Movetheboxedcursortothenonneutralx-ray,press<enter>tohighlightand

pressthe[+]keytosave.Thex-rayhasbeensavedintotheSASdatabasewith

theproperpositionaldesignation.Whenyouhavefinishedtransferringthe

patientx-rayspressFltoreturntothemainmenu.

SELECTINGANDDESIGNATINGPATIENTRECORDSFORDATA

ANALYSIS

RecordsareselectedfromtheactiveSASdatabasebyhighlightingthex-rayand

designatingthedataoperation.Theusualdataoperationsforaninitialclinical

interpretationareforaSTATICPREandMOTIONanalysis.Pre/Post

comparisonsfollowthesamedesignationprocedure.

FromtheMAINMENU

pressF3Recordsmanagement

F2SelectrecordsorF3clearandselect

F2Searchforpatientrecord.Enterlastname.<enter>.

Movethe[boxed]cursoroverthepatientrecordandpress<enter>.The

designationscreenappearsforDATAAPPLICATIONS.

Thedefaultdataapplicationistheneutralx-rayrecordchosenforaSTATIC

PREanalysis.Simply

pressing<enter>orF2.

Therecordwillbe

highlightedatthetopofthe

screenandthedata

applicationdesignationwill

benotedintheupperright

comer.

The[boxedcursor]will

returntothepatientrecord

USESTATICANALYSIS

database.Ifyouhavemotionviewstoanalyzepress<enter>overthesame

neutralrecord(ofcombinedx-rays).Thedataapplicationdesignationscreen

reappears.

PressF4MOTION#1.Thisdesignatesthelateralcervicalx-raywithinthe

neutralrecordasthefirstofthreeviewsrequiredtoperformamotionstudy.The

boxedcursorreturnstothepatientrecorddatabase.Movethecursortothe

patientFLEXIONrecord,press<enter>anddesignatetheflexionviewas

MOTION#2bypressingF5.The[boxed]cursorreturnstothepatientrecord

database.MovethecursoroverthepatientEXTENSIONrecord,press<enter>

anddesignatetheextensionviewasMOTION#3bypressingF6.Thecursor

returnstothepatientrecorddatabase.Thesameprocedureofchoosing

MOTION#2and#3isusedtodesignatelumbarmotionstudiesandcervicalor

lumbarlateralbendingmotionstudies.Afterdesignatingthepatientrecordsfor

specificdataapplicationspressFltoreturntotheMAINmenutobegin

DATAAPPLICATIONS.

F4DATAAPPLICATIONS***A/PANALYSIS***

F4DataApplications

F2StaticPre

F2A/P

F2SelectionsOK

FlReturntopreviousscreen

F2Graphics***A/PANALYSISBEGINS***

F3DataSheet

Thedatasheetisatabularsummaryofalltheindividual

measurementsusedtogeneratethegraphicalanalysis

includingthearchitecturalmeasurementsofeachvertebra.

****TheviewpointofallA-Panalysisisstandingbehindthepatient****

F2GRAPHICS

VBR,STRESSLINE,DISCANGLE

TheA-Panalysisassessesthethreedependentbiomechanicalvariablesofthe

regionallateralbend(a/pstresslines),vertebralbodyrotationsanddiscangles.

13

Theinitialscreenillustratesthepatientx-rayassimplegraphics.Press<pgdn>

toseethepatientmeasurementsingraphicalformat.Thepatientvertebralbody

rotationsaredisplayedintheleftwindowasproportionalhorizontalbargraphs

insolidcolors.Lateralbendingisdisplayedinthemiddlewindowassolidlines.

Discanglesaredisplayedintherightwindowassolidbargraphsindicatingthe

sideoftheopenwedge.IntheexamplebelowthevertebralbodyofL5isrotated

totheleft.Pressing<pgdn>revealsthedataassociatedwiththeVBRandDISC

ANGLEmeasurements.

Pressingthe|TAB]keyaccessestheSUBMENUofavailablefunctionkeys.All

functionkeyoperationsareavailablewithoutusingthesubmenubysimply

pressingtheappropriatefunctionkeywhileviewingthethreewindowanalysis.

WhenyouentertheA-Panalysisforthefirsttimeyouwillwanttosetthecolor

ofthebargraphs.PressingF5changesthecolorsofthepatientbargraphs.

PressingF6changesthecoloroftheidealoverlaybargraphs.Hatchedbar

graphsarerecommendedfortheidealoverlay.

<TAB>SUBMENU

FlReturn

F2Print

F3Overlayideal

8A-PAnalysisScreen2deformationpatternof

idealcompensation.Idealcompensationisthesameasfunctionalrotatory

14

scoliosis.UsuallythebestmatchisachievedbymatchingtheSTRESSLINE

patternofthethoracicregionoradoublematchofthevertebralbodyrotations

andlateralbendinthelumbarregion.PressF3totogglethe[right]or[left]

idealpattern.Ifa"bestfit"isuncertainpressF7tochangetheSTRESSLINES

fromfixedinflectionpointstoabsoluteinflectionpoints.Afterchoosingthebest

fitreturntothefixedinflectionpointsbypressingF7.

Thereisahighlightbarwhichmovesacrossthetopoftheanalysisscreenby

usingthe<right><left>arrowkeys.WhenthehighlightisoverVBRpress

<enter>toentertheVBRanalysis.Press<pgdn>tobypassthepelvicopening

measurement.

VertebralBodyRotation(VBR)Analysis

ThisanalysisproducesaspecificVBRanalysiswithreport.Itisnotnecessaryto

producethisreporttoproduceapatienttreatmentcard.Thevertebralbody

rotationanalysisassessestheorganizationoftheindividualvertebratoachievea

stablebiomechanicalconfiguration.Ithasbeenobservedthatthemostefficient

configurationisonethatappearsthesameasfunctionalrotatoryscoliosis.In

thisconfigurationintersegmentalmisalignmentisminimizedtherebyminimizing

functionalstenosis.Thepatientsvertebralbodyrotationsareillustratedassolid

horizontalbargraphsproportionaltotheamountofrotation.

<TAB>SUBMENU

FlReturn

F2Print

F3OverlayIdeal

left/rightVBR

F4Toggleguide

<pgdn>Nextscreen

<pgup>Priorscreen

<home>Topscreen

<end>Lastscreen

PATTERN

ANALYSIS

CLICKMOUSE<ORPRESSTABKEY)TOSEEMENU.

9VBRAnalysisPatternAnalysisScreen2

Thecursormovestothepatternanalysisscreen.Byfillingintheblanks

“custom“sentenceswillbeinsertedintothevertebralbodyrotationreport.

Thesystemwantsyoutodescribethemajoritypositionofthepatientvertebral

bodyrotationsincomparisontotheidealcompensatorypatternforeachregion

ofthespine.

CervicalInfigure14therearethreevertebrawithrotationstotheright

andthreevertebrawithrotationstotheleft.Thepatternistherefora

|mixed]pattern.Ifamajorityofrotationsaretotherightitwouldbe

considereda[right]patternandifthemajorityofrotationsaretotheleftit

wouldbea[left]pattern.

Thepatientpatterniscomparedtotheidealpatterntodetermineifthe

patientpatternisnormal(sameasidealpattern)orabnormal(opposite

theidealpattern).Amixedpatternisalwaysabnormal.

Deficientrotationsidentifieswhichvertebradonotcorrespondtothe

idealpattern.Theseselectionsarenotnecessarilythevertebrawhichwill

bechosenforadjustment.Adjustmentvertebraaretaggedinthe

adjustmentscreen.

Whenyouhavecompletedeachregionofthespinepress<pgdn>toenterthe

notefieldandadjustmentscreen.Pressing<TAB>revealsthepulldown

submenus.Functionkeyscontroltheanalysissubmenuoptionswhile<arrow>

keysand<alt>keyscontroleditingfunctionsofthewordprocessorwithinthe

memofield.Typeinthenotefieldanyappropriatecomments.PressingF9will

allowyoutosaveandretrieveuptothreecustomcomments.SeeNOTEFIELD

below.

Pressthe<TAB>key

toremovethesubmenu

options.

ADJUSTMENT

MENU

10VBRAnalysisTabSubmenuScreen3

PressingF10entersthepatientadjustmentrecommendationscreen.Taggingthe

segmentallevelsforadjustmentmarksyourchoicesonthepatienttreatmentcard

andprintsthoseselectionswithinthebodyoftheVBRreport.Ifyoudonot

designateanyadjustmentsallvertebrallevelsonthetravelcardwillbeleftblank

Adjustmentscanthenbemarkedonthetravelcardbyhand.Thisis

recommendedwhenanassistantisprocessingthex-rays.

Usethe<arrow>keystomovetoaspecificvertebrallevel.Usethe<enter>key

totogglefromaL,RorNOadjustment.Left/rightdesignationsforindividual

adjustmentsarereferencingthetransverseprocessasthecontactside.

<TAB>SUBMENU

PATIENTNIEGAND,RAV

X-RAYED1t/29Z36Thesubmenuisnot

：

MEMOUBRCOMMENTSavailablewhenthe

COUNTERROTATIONS：C6CAC3C7C5

T9T1OTilT2T3TST4T7T6T12

T1T8L.3L2I_1L5LAadjustmentwindowis

ADJUSTMENTS：C3-RC6-RT5-LT1O-Lopen.

U2-RU5-U

FlClosesthe

adjustmentmenu

***

F2PrinttheVBR

analysis

***

11VBRAnalysisAdjustmentMenuScreen3

DETERMININGTHE

ADJUSTMENT

Therearethreecriteriafordetermininganadjustment;

1)reducethehighestrotationaldifference/counterrotation

betweentwovertebra,

2)alignthevertebralrotationstoconformtotheidealpatternand

3)adjustasfewvertebraaspossible.

Reducingintersegmentalmisalignmentandaligningthevertebrainthe

compensatorypatternminimizesfunctionalstenosis.Italsoestablishesthemost

efficientcompensatorypatterntoachievestabilization.

17

COUNTERROTATIONS

Adescendinglistofmis-alignmentseverityforeachregionofthespineis

indicatedintheupperrightportionofthescreenundercounterrotations.

Counterrotationsaredeterminedbycomparingthepositionofaninferior

vertebratothatofthevertebraimmediatelysuperior.Thislistisintendedto

directthedoctorsattentiontospecificvertebrallevelswheresegmental

misalignmentisthehighest.Infigure15,C6islistedasthemostseverecounter

rotationinthecervicalregion.C6hasthehighestrotationalmisalignmentinthe

cervicalregionwhencomparingitspositiontothevertebraabove.C4hasthe

nexthighestrotationalmisalignmentetc,etc.

OnFigure15adjustingC6ontherighti.e.,contactingthevertebrabodyright

andmovingitleft,woulddiminishthecounterrotationbetweenC6andC5and

atthesametimemoveC6towardtheidealpattern.AdjustingC3bodyright

woulddiminishtherotationaldifferencebetweenC2andC4andatthesame

timemoveC3towardtheidealpattern.PressFltoacceptyouradjustmentsand

returntothenotefield.

NOTEFIELDSSavingandGettingNarratives

Narrativesareuserdefined.Typeanarrativeinanynotefieldandsaveand

retrievebypressingF9.

ANALVSISSTATICPREA/PPATIENTMIEGAND.RAV

REPORTUERTEBRALBODVROTATIONX-RAYED11Z29Z96

C2

C3PressF9

CA

C5F2Saveasnarrative1

C6

C7F3Saveasnarrative2

T1

T2

T3F4Saveasnarrative3

TA

T5F5Getnarrative1

T6

T7F6Getnarrative2

T8

T9

T1OF7Getnarrative3

Til

T12

LI

l_2

L3

L4

LS

12VBRAnalysisNoteSubmenuScreen3

18

Whenyouareinanotefield,apreviouslysavednotecanberetrievedby

pressingF9.ChoosetheappropriatesavednotebypressingF5,F6,F7.The

cursorreturnsyoutotheVBRanalysisandnotefieldwiththeretrievednote

inserted.Onceanoteisretrieveditcanbeedited.

Notesareoptional.TheyarenotrequiredinordertoproducetheVBRreport.

Notescustomizethenarrativereportbyaddingyourparticularcomments.Once

youcompleteyournotefield,pressingthe<pgdn>keymovesyouforward

throughtheVBRanalysis.

ROTATIONANDROTATIONALDIFFERENCEGRAPH

Thefollowingscreenshowsthevertebralbodyrotationsandvertebralbody

rotationaldifference(counterrotation)graphs.Thedifferencegraphillustrates

themisalignmentfromonevertebratothenextusingthesuperiorvertebraasthe

reference.InthispatientexampletherotationgraphontheleftindicatesL5isto

theleftofL4andL4istotherightofL3.Thecounterrotationgraphontheright

showstherelativepositionoftheinferiorvertebraincomparisontoitssuperior

neighborandbyhowmuch.ThereforethecounterrotationgraphshowsL5as

0.8mmtotheleftofL4,L4is0.2mmtotherightofL3,T11is3.0mmtothe

rightofT10,T10is3.6mmtotheleftofT9etc,etc.Therotationaldifference

graphvisuallyidentifiesthosevertebrawhicharemostseverelymisaligned.The

calculateddifferencemeasurementsareplacedinadescendingorderofseverity

foreachregionofthespineandlistedontopofthepreviousVBRscreenand

listedasfixations