青少年特发性脊柱侧弯的冠状位平衡与足底压力的相关性

目的 分析青少年特发性脊柱侧弯(AIS)患者的足底压力指标,总结其特征,评价其脊柱冠状位平衡与足底压力参数之间的相关性。 方法 选取2018年9月—2019年3月在上海市儿童医院脊柱外科门诊就诊的44名AIS患者为研究对象。影像学检查包括Cobb角、骶骨中垂线(CSVL)和第7颈椎中垂线(C7PL)之间的偏移(也称为颈7侧方偏移)、主弯顶点侧方偏移(AT)和冠状位骨盆倾斜度(LPT)。对研究对象进行静态的足底压力测试,对双足接触面积和负荷比(相对双足的整体负荷)等生物力学指标进行检测,分析AIS患者的足底压力分布特征。 结果 前足接触面积明显大于后足(均P<0.05),前足的负荷比明显小于后足(均P<0.05)。主弯侧颈7侧方偏移与前足接触面积(r=0.357,P=0.019)和负荷比(r=0.400,P=0.008)均呈正相关,主弯侧主弯顶点侧方偏移与前足的负荷比也呈正相关(r=0.331,P=0.030),但与接触面积无相关性。 结论 在脊柱侧弯中,冠状位平衡与足底压力分布相关。颈7侧方偏移代表了总体冠状位平衡(GCB),主弯顶点侧方偏移(AT)代表局部冠状位平衡,这2个指标最能反应冠状位平衡状态。在主弯侧,颈7侧方偏移与前足接触面积和负荷比均呈正相关,主弯顶点侧方偏移与前足的负荷比也呈正相关。这表明,2个冠状位平衡特征均与足底压力相关。 

Correlation between spinal coronal balance and static plantar pressure in children with adolescent idiopathic scoliosis

Objective To explore the characteristics of the plantar pressure data of the patients with adolescent idiopathic scoliosis(AIS), and evaluate the correlation between plantar pressure parameters and coronal balance status for AIS. Methods A total of 44 patients of AIS were recruited as volunteers. Radiographic studies including Cobb angle, offset between central sacral vertical line(CSVL) and C7 vertebra plumb line(C7 PL)(considered as global coronal balance, GCB), apical translation of the major curve(AT, considered as regional coronal balance) and lateral pelvic tilt(LPT) were measured. The static plantar pressure test was carried out on the subjects, and the biomechanical indexes such as the contact area and the load ratio(relative to the overall load of the feet) of the feet were tested to analyze the plantar pressure distribution characteristics of AIS patients. Results The contact area of the forefoot was significantly larger than that of the rearfoot(P<0.001) and the load ratio of the forefoot was significantly smaller than that of the rearfoot(P<0.001). The offset between CSVL and C7 PL was positively related to the contact area of the forefoot(r=0.357, P=0.019), as well as the load ratio(r=0.400, P=0.008). The AT was also positively related to the load ratio of the forefoot(r=0.331, P=0.030) but had no correlation with contact area. Conclusion In scoliosis, the coronal balance is correlated to plantar pressure distribution. The offset between CSVL and C7 PL, as well as AT are the best describers of coronal balance. These two indexes can best reflect the equilibrium state of coronary position. On the main bend side, the offset between CSVL and C7 PL is positively correlated with the contact area and the load ratio of the forefoot, and the TA is also positively correlated with the load ratio of the forefoot, which indicated that the balance characteristics of the two coronal positions are all correlated with the foot pressure.