DIERS-4D脊柱云纹系统联合QUINTIC步态分析系统评价脊柱疾病
|
摘要
[目的]通过对不同脊柱疾病脊柱-骨盆-下肢运动功能变化的量化分析,探讨不同脊柱疾病的躯体运动变化及代偿特点。[方法] 2016年10月～2017年4月在本院诊治的脊髓型颈椎病患者65例(颈椎病组),腰椎间盘突出症患者77例(腰椎病组),特发性脊柱侧弯患者25例(侧弯组),健康志愿者30人(正常人组)纳入本研究。采用DIERS 4D脊柱云纹系统和QUINTIC步态分析系统检测分析,比较行走时各组脊柱-骨盆-下肢运动参数的差异。[结果]侧弯组胸、腰椎旋转角度大于正常人组(P<0.05)。膝关节角度A在颈椎病组为(191.46±9.54)°、侧弯组为(193.38±11.36)°,均大于正常人组(178.56±2.71)°(P<0.05);腰椎病组膝关节角度A-C均大于正常人组(P<0.05),颈椎病组行走时膝关节角速度为(92.51±7.30) rad/s、角加速度为(869.10±180.22) rad/s~2均大于正常人组(P<0.05),颈椎病组下肢JOA评分与膝关节角加速度为线性负相关(P<0.001);腰椎病组膝关节角速度为(74.11±17.63) rad/s、角加速度为(647.30±137.14) rad/s~2均小于正常人组(P<0.05),腰椎病组JOA评分与膝关节角加速度为线性正相关(P<0.001)。[结论]脊髓型颈椎病及脊柱侧弯患者行走时躯干摆动幅度增大;腰椎间盘突出症患者各时相膝关节角度、角速度、角加速度均减小;脊髓型颈椎病及脊柱侧弯患者步态起始时膝关节角度增大;脊髓型颈椎病行走时膝关节角速度、角加速度增大。
[Objective] To explore the characteristics of body movement and compensation mechanism of different spinal diseases by quantitative assessment of the spinal-pelvic-lower limb motor function. [Methods] From October 2016 to April2017, a prospective study was conducted on 65 patients with cervical spondylotic myelopathy(CSM group), 77 patients with lumbar degenerative disease(LDD group), 25 patients with idiopathic scoliosis(IS group),and 30 healthy volunteers(HV group). The DIERS 4 D graster stereography system and QUINTIC gait analysis system were used to measure the spine-pelviclower limb parameters, which were compared among the 4 groups. [Results] The IS group proved significantly greater thoracic and lumbar vertebral rotation than the HV group(P<0.05). Both the CSM group(191.46±9.54) ° and the IS group(193.38±11.36) ° had significantly greater knee angle A than the HV group(178.56±2.71) °(P<0.05), whereas the LDD group took sigificantly greater knee angles from A to C than the HV group(P<0.05). The CSM group had significantly higher angular velocity(92.51±7.30) rad/s and angular acceleration(869.10±180.22) rad/s~2 of the knee than the HV group(P<0.05), and presented a significantly negative correlation between the JOA score and angular acceleration(P<0.05). Conversely, the LDD group proved significantly less angular velocity(92.51 ± 7.30) rad/s and angular acceleration(869.10 ± 180.22) rad/s~2 of the knee than the HV group(P<0.05), and revealed a significantly positive correlation between the JOA score and angular acceleration(P<0.05). [Conclusion] The patients with CSM or IS have increased trunk swinging amplitude during walk,while those with LDD have decreased ROM of knee joint angle, angular velocity and angular acceleration of all phase in gait cycle compare with the volunteers. The patients with CSM or IS have increased knee joint angel at the starting of gait cycle, and those with CSM have increased knee joint angular velocity and angular acceleration.
[Objective] To explore the characteristics of body movement and compensation mechanism of different spinal diseases by quantitative assessment of the spinal-pelvic-lower limb motor function. [Methods] From October 2016 to April2017, a prospective study was conducted on 65 patients with cervical spondylotic myelopathy(CSM group), 77 patients with lumbar degenerative disease(LDD group), 25 patients with idiopathic scoliosis(IS group),and 30 healthy volunteers(HV group). The DIERS 4 D graster stereography system and QUINTIC gait analysis system were used to measure the spine-pelviclower limb parameters, which were compared among the 4 groups. [Results] The IS group proved significantly greater thoracic and lumbar vertebral rotation than the HV group(P<0.05). Both the CSM group(191.46±9.54) ° and the IS group(193.38±11.36) ° had significantly greater knee angle A than the HV group(178.56±2.71) °(P<0.05), whereas the LDD group took sigificantly greater knee angles from A to C than the HV group(P<0.05). The CSM group had significantly higher angular velocity(92.51±7.30) rad/s and angular acceleration(869.10±180.22) rad/s~2 of the knee than the HV group(P<0.05), and presented a significantly negative correlation between the JOA score and angular acceleration(P<0.05). Conversely, the LDD group proved significantly less angular velocity(92.51 ± 7.30) rad/s and angular acceleration(869.10 ± 180.22) rad/s~2 of the knee than the HV group(P<0.05), and revealed a significantly positive correlation between the JOA score and angular acceleration(P<0.05). [Conclusion] The patients with CSM or IS have increased trunk swinging amplitude during walk,while those with LDD have decreased ROM of knee joint angle, angular velocity and angular acceleration of all phase in gait cycle compare with the volunteers. The patients with CSM or IS have increased knee joint angel at the starting of gait cycle, and those with CSM have increased knee joint angular velocity and angular acceleration.
引文
[1]Li WS,Li G,Chen ZQ,et al.Sagittal plane analysis of the spine and pelvis in adult idiopathic scoliosis[J].Chin Med J(Engl),2010,123(21):2978-2982.
[2]Roussouly P,Pinheirofranco JL.Biomechanical analysis of the spino-pelvic organization and adaptation in pathology[J].Eur Spine J,2011,20(5):609-618.
[3]Barrey C,Jund J,Noseda O,et al.Sagittal balance of the pelvisspine complex and lumbar degenerative diseases.A comparative study about 85 cases[J].Eur Spine J,2007,16(9):1459.
[4]Strube P,Pumberger M,Sonnow L,et al.Association between lumbar spinal degeneration and anatomic pelvic parameters[J].Clin Spine Surg,2018,31(6):263-267.
[5]Haddas R,Patel S,Arakal R,et al.Spine and lower extremity kinematics during gait in cervical spondylotic myelopathy patients[J]Spine J,2018,18(9):1645-1652.
[6]Yoshida G,Alzakri A,Pointillart V,et al.Global spinal alignment in patients with cervical spondylotic myelopathy[J].Spine,201843(3):154-162.
[7]Yamauchi Y.Scoring system for cervical myelopathy[J].J Jpn Orthop Assoc,1994,68:490-503.
[8]Fairbank JC,Pynsent PB.The Oswestry Disability Index[J]Spine,2000,25(22):2940.
[9]Haher TR,Gorup JM,Shin TM,et al.Results of the Scoliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis.A multicenter study of 244 patients[J].Spine,1999,24(14):1435-1440.
[10]Hosono N,Takenaka S,Mukai Y,et al.Conventional JOA score for cervical myelopathy has a rater’s bias-In comparison with JOAC-MEQ[J].J Orthop Sci,2018,23(3):477-482.
[11]Azimi P,Mohammadi H R,Montazeri A.An outcome measure of functionality and pain in patients with lumbar disc herniation:a validation study of the Japanese Orthopedic Association(JOA)score[J].J Orthop Sci,2012,17(4):341-345.
[12]Liu Y,Liu Z,Zhu F,et al.Validation and reliability analysis of the new SRS-Schwab classification for adult spinal deformity[J]Spine,2013,38(11):902.
[13]Knott P,Mardjetko S,Nance D,et al.Electromagnetic topographical technique of curve evaluation for adolescent idiopathic scoliosis[J].Spine(Phila Pa 1976),2006,31(24):E911-915.
[14]Parent EC,Damaraju S,Hill DL,et al.Identifying the best surface topography parameters for detecting idiopathic scoliosis curve progression[J].Stud Health Technol Inform,2010,158(1):78-82.
[15]Davis R,Ounpuu S,Tyburski D,et al.A gait analysis data collection and reduction technique[J].Human Movement Science1991,10:575-587
[16]Hayashi H,Toribatake Y,Murakami H,et al.Gait analysis using a support vector machine for lumbar spinal stenosis[J].Orthopedics,2015,38(11):959-964.
[17]Yokogawa N,Toribatake Y,Murakami H,et al.Differences in gait characteristics of patients with lumbar spinal canal stenosis(L4radiculopathy)and those with osteoarthritis of the hip[J].Plos One,1991,49(4):159-163.
[18]Yoshio S,Masashi S,Keiichi S,et al.Gait analysis of patients with neurogenic intermittent claudication[J].Spine,2002,27:2509-2513.
[19]Kosaka H,Sairyo K,Biyani A,et al.Pathomechanism of loss of elasticity and hypertrophy of lumbar ligamentum flavum in elderly patients with lumbar spinal canal stenosis[J].Spine,2007,32(25):2805.
[20]Takahashi K,Kagechika K,Takino T,et al.Changes in epidural pressure during walking in patients with lumbar spinal stenosis[J].Spine,1995,20(24):2746-2749.
[21]Takahashi K,Miyazaki T,Takino T,et al.Epidural pressure measurements.Relationship between epidural pressure and posture in patients with lumbar spinal stenosis[J].Spine,1995,20(6):650.
[22]Ailish M D,Ciaran B,Louise K,et al.Reliability of three-dimensional gait analysis in cervical spondylotic myelopathy[J].Gait Posture,2010,32(32):552-558.
[23]Mahaudens P,Banse X,Mousny M,et al.Gait in adolescent idiopathic scoliosis:kinematics and electromyographic analysis[J].Eur Spine J,2009,18(4):512-521.
[24]Mahaudens P,Detrembleur C,Mousny M,et al.Gait in adolescent idiopathic scoliosis:energy cost analysis[J].Eur Spine J,2009,18(4):1160-1168.
[25]Jason M.Frerich,Kristen Hertzler,et al.Comparison of radiographic and surface topography measurements in adolescents with idiopathic scoliosis[J].Open Orthop J,2012,6(1):261-265.
[26]Mangone M,Raimondi P,Paoloni M,et al.Vertebral rotation in adolescent idiopathic scoliosis calculated by radiograph and back surface analysis-based methods:correlation between the Raimondi method and rasterstereography[J].Eur Spine J,2013,22(2):367-371.2018-08-16
[2]Roussouly P,Pinheirofranco JL.Biomechanical analysis of the spino-pelvic organization and adaptation in pathology[J].Eur Spine J,2011,20(5):609-618.
[3]Barrey C,Jund J,Noseda O,et al.Sagittal balance of the pelvisspine complex and lumbar degenerative diseases.A comparative study about 85 cases[J].Eur Spine J,2007,16(9):1459.
[4]Strube P,Pumberger M,Sonnow L,et al.Association between lumbar spinal degeneration and anatomic pelvic parameters[J].Clin Spine Surg,2018,31(6):263-267.
[5]Haddas R,Patel S,Arakal R,et al.Spine and lower extremity kinematics during gait in cervical spondylotic myelopathy patients[J]Spine J,2018,18(9):1645-1652.
[6]Yoshida G,Alzakri A,Pointillart V,et al.Global spinal alignment in patients with cervical spondylotic myelopathy[J].Spine,201843(3):154-162.
[7]Yamauchi Y.Scoring system for cervical myelopathy[J].J Jpn Orthop Assoc,1994,68:490-503.
[8]Fairbank JC,Pynsent PB.The Oswestry Disability Index[J]Spine,2000,25(22):2940.
[9]Haher TR,Gorup JM,Shin TM,et al.Results of the Scoliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis.A multicenter study of 244 patients[J].Spine,1999,24(14):1435-1440.
[10]Hosono N,Takenaka S,Mukai Y,et al.Conventional JOA score for cervical myelopathy has a rater’s bias-In comparison with JOAC-MEQ[J].J Orthop Sci,2018,23(3):477-482.
[11]Azimi P,Mohammadi H R,Montazeri A.An outcome measure of functionality and pain in patients with lumbar disc herniation:a validation study of the Japanese Orthopedic Association(JOA)score[J].J Orthop Sci,2012,17(4):341-345.
[12]Liu Y,Liu Z,Zhu F,et al.Validation and reliability analysis of the new SRS-Schwab classification for adult spinal deformity[J]Spine,2013,38(11):902.
[13]Knott P,Mardjetko S,Nance D,et al.Electromagnetic topographical technique of curve evaluation for adolescent idiopathic scoliosis[J].Spine(Phila Pa 1976),2006,31(24):E911-915.
[14]Parent EC,Damaraju S,Hill DL,et al.Identifying the best surface topography parameters for detecting idiopathic scoliosis curve progression[J].Stud Health Technol Inform,2010,158(1):78-82.
[15]Davis R,Ounpuu S,Tyburski D,et al.A gait analysis data collection and reduction technique[J].Human Movement Science1991,10:575-587
[16]Hayashi H,Toribatake Y,Murakami H,et al.Gait analysis using a support vector machine for lumbar spinal stenosis[J].Orthopedics,2015,38(11):959-964.
[17]Yokogawa N,Toribatake Y,Murakami H,et al.Differences in gait characteristics of patients with lumbar spinal canal stenosis(L4radiculopathy)and those with osteoarthritis of the hip[J].Plos One,1991,49(4):159-163.
[18]Yoshio S,Masashi S,Keiichi S,et al.Gait analysis of patients with neurogenic intermittent claudication[J].Spine,2002,27:2509-2513.
[19]Kosaka H,Sairyo K,Biyani A,et al.Pathomechanism of loss of elasticity and hypertrophy of lumbar ligamentum flavum in elderly patients with lumbar spinal canal stenosis[J].Spine,2007,32(25):2805.
[20]Takahashi K,Kagechika K,Takino T,et al.Changes in epidural pressure during walking in patients with lumbar spinal stenosis[J].Spine,1995,20(24):2746-2749.
[21]Takahashi K,Miyazaki T,Takino T,et al.Epidural pressure measurements.Relationship between epidural pressure and posture in patients with lumbar spinal stenosis[J].Spine,1995,20(6):650.
[22]Ailish M D,Ciaran B,Louise K,et al.Reliability of three-dimensional gait analysis in cervical spondylotic myelopathy[J].Gait Posture,2010,32(32):552-558.
[23]Mahaudens P,Banse X,Mousny M,et al.Gait in adolescent idiopathic scoliosis:kinematics and electromyographic analysis[J].Eur Spine J,2009,18(4):512-521.
[24]Mahaudens P,Detrembleur C,Mousny M,et al.Gait in adolescent idiopathic scoliosis:energy cost analysis[J].Eur Spine J,2009,18(4):1160-1168.
[25]Jason M.Frerich,Kristen Hertzler,et al.Comparison of radiographic and surface topography measurements in adolescents with idiopathic scoliosis[J].Open Orthop J,2012,6(1):261-265.
[26]Mangone M,Raimondi P,Paoloni M,et al.Vertebral rotation in adolescent idiopathic scoliosis calculated by radiograph and back surface analysis-based methods:correlation between the Raimondi method and rasterstereography[J].Eur Spine J,2013,22(2):367-371.2018-08-16