成人型脊柱畸形患者运动功能的三维步态分析

目的 利用三维步态分析系统定量分析成人型脊柱畸形患者(adult spinal deformity,ASD)的步态特征,进一步熟悉ASD患者下肢功能的病理生理变化,为ASD患者的临床诊疗和术后康复提供理论依据。方法 纳入ASD患者51例作为病例组,并根据病例组患者一般情况(性别、年龄、体质量指数、及基础疾病)选出51例健康中老年患者作为对照组。记录所有研究对象的生活质量评分(Healthy Related Questionnaire of Life, HRQOL),包括视觉模拟评分(Visual Analogue Score, VAS)、Oswestry功能障碍指数(Oswestry Disability Index, ODI)及简版生活质量量表-36(Short Form-36,SF-36)评分。使用步态分析系统记录运动学参数。受试者骨盆及下肢特定的位置放置标记后在设定路线内以个体舒适步速行走,至少记录10个步态周期。采用SPSS 23.0软件分析参数。结果 与对照组相比,ASD患者下肢步长、跨步长、步频明显减小,且行走过程中呈逐渐减慢趋势;ASD患者髋、膝关节屈伸活动范围明显减小,组间比较差异均有统计学意义(P<0.05)。ASD患者生活质量评分中的VAS、ODI与步长、跨步长、步频、膝关节屈伸及髋关节屈伸度呈负相关关系(P<0.05);SF-36中的生理部分(Physical Component Summary, PCS)与上述指标呈正相关关系(P<0.05)。结论 ASD患者跨步长、步长、步频、膝关节屈伸活动度、及髋关节屈伸活动度均减小,且活动中逐渐减小;ASD患者生活质量与运动学参数密切相关。

An analysis on three-dimensional gait of patients with adult spinal deformity

Objective The walking characteristics of patients with adult spinal deformity(ASD) at pre-operation were analyzed with the three-dimensional gait analysis systemso as to further understand the pathophysiological changes of the lower limb function among patients with ASD, which probably gives physicians guidelines for diagnosis and treatment. Methods Totally 51 ASD patients were included as the observation group, and 51 healthy elderly patients were recruited as the control group according to the general situation (gender, age, body mass index, and basic diseases) of the observation group.Healthy Related Questionnaire of Life (HRQOL) was recorded for all subjects, including Visual Analogue Score (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36).Kinematic parameters were recorded by gait analysis system.At least 10 gait cycles were recorded after marker placed at specific positions of pelvis and lower limbs. Volunteers walked at individual comfortable pace within the set route.SPSS 23.0 software was used to analyze the parameters. Results Compared with the control group, lower limb step length, stride length and stride frequency of ASD patients decreased significantly, and gradually slowed down during walking.The range of flexion and extension of hip and knee joints was significantly reduced in ASD patients.There were statistically significant differences between groups (P<0.05). VAS and ODI were negatively correlated with step length, stride length, step frequency, knee flexion and hip flexion and extension (P<0.05). There was a positive correlation between Physical Component Summary (PCS) in SF-36 and the above indexes (P<0.05). Conclusions Comparing with healthy volunteers, those patients with ASD walked with much slower step frequency, and shorter step length, stride length, knee range of motion, and hip range of motion. There was significant correlation among kinematics data and HRQOL.