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[1]張楚閱,王兆瀚,薛原,等.腰椎間盤突出癥患者步態(tài)周期中的脊柱-骨盆參數(shù)變化及其與腰腿疼痛的相關(guān)性分析[J].中醫(yī)正骨,2024,36(05):19-25,60.
　ZHANG Chuyue,WANG Zhaohan,XUE Yuan,et al.Changes of spino-pelvic parameters during a gait cycle in patients with lumbar disc herniation and their correlations with lumbago-leg pain[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(05):19-25,60.
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腰椎間盤突出癥患者步態(tài)周期中的脊柱-骨盆參數(shù)變化及其與腰腿疼痛的相關(guān)性分析()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期數(shù):
2024年05期
頁(yè)碼:
19-25,60
欄目:
臨床研究
出版日期:
2024-05-20

文章信息/Info

Title:
Changes of spino-pelvic parameters during a gait cycle in patients with lumbar disc herniation and their correlations with lumbago-leg pain
作者:
張楚閱1; 王兆瀚1; 薛原2; 劉軒匯2; 劉昊明2; 張雪麗3; 宋凱1; 吳兵1; 王征1
1.中國(guó)人民解放軍總醫(yī)院第四醫(yī)學(xué)中心,北京 100048; 2.南開大學(xué)醫(yī)學(xué)院,天津 300071; 3.中國(guó)人民解放軍總醫(yī)院第一醫(yī)學(xué)中心,北京 100853
Author(s):
ZHANG Chuyue1; WANG Zhaohan1; XUE Yuan2; LIU Xuanhui2; LIU Haoming2; ZHANG Xueli3; SONG Kai1; WU Bing1; WANG Zheng1
1.The Fourth Medical Center of Chinese PLA General Hospital,Beijing 100048,China 2.School of Medicine of Nankai University,Tianjin 300071,China 3.The First Medical Center of Chinese PLA General Hospital,Beijing 100853,China
關(guān)鍵詞:
椎間盤移位;  步態(tài);  脊柱;  骨盆;  三維運(yùn)動(dòng);  參數(shù);  動(dòng)態(tài)捕捉技術(shù);  疼痛;  數(shù)據(jù)相關(guān)性
Keywords:
intervertebral disc displacement;  gait;  spine;  pelvis;  three dimensional motion;  parameters;  dynamic capture technology;  pain;  correlation of data
摘要:
目的:分析腰椎間盤突出癥(lumbar disc herniation,LDH)患者步態(tài)周期中的脊柱-骨盆參數(shù)變化及其與腰腿疼痛的相關(guān)性。方法:納入14例LDH患者(LDH組)和17例健康人(健康對(duì)照組)。在運(yùn)動(dòng)捕捉場(chǎng)地采用光學(xué)運(yùn)動(dòng)捕捉系統(tǒng)記錄2組受試者的行走過程,采用特定的算法處理數(shù)據(jù),繪制步態(tài)周期中脊柱-骨盆參數(shù)變化趨勢(shì)圖,提取并比較2組受試者步態(tài)周期中冠狀面平衡距離、矢狀面軸向距離、胸椎后凸角、腰椎前凸角、骨盆傾斜角、骨盆入射角的均值(步態(tài)周期中某項(xiàng)指標(biāo)的所有數(shù)據(jù)之和與數(shù)據(jù)數(shù)量的比值)和范圍(步態(tài)周期中某項(xiàng)指標(biāo)的數(shù)據(jù)最大值與最小值的差)。采用Pearson相關(guān)分析,分析LDH患者步態(tài)周期中的脊柱-骨盆參數(shù)與腰部疼痛視覺模擬量表(visual analogue scale,VAS)評(píng)分、腿部疼痛VAS評(píng)分的相關(guān)性。結(jié)果:①步態(tài)周期中脊柱-骨盆參數(shù)變化分析結(jié)果。步態(tài)周期中,冠狀面平衡距離呈現(xiàn)周期性增減,矢狀面軸向距離、胸椎后凸角、腰椎前凸角、骨盆傾斜角呈余弦曲線,骨盆入射角保持基本不變; 步態(tài)周期中,LDH組冠狀面平衡距離、腰椎前凸角的均值均小于健康對(duì)照組[(0.0,23.9)mm,(2.0,1.8)mm,Z=-2.024,P=0.043;(37.1°,19.2°),(42.1°,15.6°),Z=-1.945,P=0.043],矢狀面軸向距離、骨盆傾斜角的均值均大于健康對(duì)照組[(35.4,30.0)mm,(13.0,28.1)mm,Z=-2.898,P=0.004;(18.6°,12.5°),(9.2°,13.4°),Z=-2.104,P=0.035],2組胸椎后凸角、骨盆入射角的均值的差異均無(wú)統(tǒng)計(jì)學(xué)意義[(10.1°,11.3°),(12.8°,8.7°),Z=-0.913,P=0.361;(44.1°,14.8°),(49.4°,7.9°),Z=-1.429,P=0.153)]; 步態(tài)周期中,LDH組矢狀面軸向距離、骨盆傾斜角的范圍均大于健康對(duì)照組[(29.7,15.6)mm,(15.8,2.1)mm,Z=-2.898,P=0.004;(5.3°,0.7°),(3.3°,1.3°),Z=-3.971,P=0.000],胸椎后凸角、腰椎前凸角的范圍均小于健康對(duì)照組[(4.5°,0.9°),(5.3°,1.1°),Z=-2.541,P=0.011;(7.4°,2.0°),(11.3°,1.1°),Z=-4.010,P=0.000)],2組冠狀面平衡距離、骨盆入射角的范圍的差異無(wú)統(tǒng)計(jì)學(xué)意義[(37.5,17.0)mm,(34.8,5.2)mm,Z=-0.595,P=0.552;(0.6°,0.1°),(0.6°,0.1°),Z=-1.155,P=0.262]。②LDH患者步態(tài)周期中的脊柱-骨盆參數(shù)與腰腿疼痛的相關(guān)性分析結(jié)果。LDH患者步態(tài)周期中腰椎前凸角范圍與腰部疼痛VAS評(píng)分呈負(fù)相關(guān)(r=-0.880,P=0.000),胸椎后凸角范圍、骨盆傾斜角范圍與腰部疼痛VAS評(píng)分呈正相關(guān)(r=0.766,P=0.001; r=0.833,P=0.000),矢狀面軸向距離均值、冠狀面平衡距離范圍與腿部疼痛VAS評(píng)分呈正相關(guān)(r=0.653,P=0.011; r=0.752,P=0.002),其他脊柱-骨盆參數(shù)的均值和范圍與腰部疼痛VAS評(píng)分、腿部疼痛VAS評(píng)分均無(wú)相關(guān)性。結(jié)論:LDH患者步態(tài)周期中冠狀面平衡距離、矢狀面軸向距離、腰椎前凸角、胸椎后凸角、骨盆傾斜角等脊柱-骨盆參數(shù)與健康人存在顯著差異,且腰椎前凸角范圍、胸椎后凸角范圍、骨盆傾斜角范圍與腰部疼痛程度相關(guān),矢狀面軸向距離均值和冠狀面平衡距離范圍與腿部疼痛程度相關(guān)。
Abstract:
Objective:To analyze the changes of spino-pelvic parameters(SPPs)during a gait cycle in patients with lumbar disc herniation(LDH),and to explore their correlations with lumbago-leg pain.Methods:Fourteen LDH patients(LDH group),and 17 healthy individuals(healthy control group)were enrolled in the study.The walking processes of the subjects in the 2 groups were recorded by optical motion capture system(OMCS)in the motion capture experimental site.The collected data was processed by using specific algorithms,and the curve charts of changing trend of SPPs throughout the gait cycle was plotted.After that,the mean values(the ratio of the sum of the values to the number of values of a index)and ranges(the difference between the maximum and minimum values of a index)of coronal balance distance(CBD),sagittal vertical axis(SVA)distance,thoracic kyphosis(TK),lumbar lordosis(LL),pelvic tilt(PT),and pelvic incidence(PI)during the gait cycle were extracted and compared between the 2 groups.Furthermore,the correlations between the SPPs in the gait cycle and the visual analogue scale(VAS)scores of low back pain and leg pain in LDH patients were analyzed by using Pearson correlation analysis.Results:①During the gait cycle,the CBD presented a periodic increase or decrease trend,the SVA distance,TK,LL,and PT exhibited a trend manifesting as cosine curve,while the PI remained essentially unchanged.During the gait cycle,the mean values of CBD and LL were smaller,while the mean values of SVA distance and PT were greater in LDH group compared to healthy control group((0.0,23.9)vs(2.0,1.8)mm,Z=-2.024,P=0.043;(37.1,19.2)vs(42.1,15.6)degrees,Z=-1.945,P=0.043;(35.4,30.0)vs(13.0,28.1)mm,Z=-2.898,P=0.004;(18.6,12.5)vs(9.2,13.4)degrees,Z=-2.104,P=0.035),and the comparison of the mean values of TK and PI revealed no significant differences between the 2 group((10.1,11.3)vs(12.8,8.7)degrees,Z=-0.913,P=0.361;(44.1,14.8)vs(49.4,7.9)degrees,Z=-1.429,P=0.153).During the gait cycle,the ranges of SVA distance and PT were greater,while the ranges of TK and LL were smaller in LDH group compared to healthy control group((29.7,15.6)vs(15.8,2.1)mm,Z=-2.898,P=0.004;(5.3,0.7)vs(3.3,1.3)degrees,Z=-3.971,P=0.000;(4.5,0.9)vs(5.3,1.1)degrees,Z=-2.541,P=0.011;(7.4,2.0)vs(11.3,1.1)degrees,Z=-4.010,P=0.000),and the comparison of the ranges of CBD and PI revealed no significant differences between the 2 group((37.5,17.0)vs(34.8,5.2)mm,Z=-0.595,P=0.552;(0.6,0.1)vs(0.6,0.1)degrees,Z=-1.155,P=0.262).②The results of Pearson correlation analysis showed that the low back pain VAS score was negatively correlated with the range of LL(r=-0.880,P=0.000),but was positively correlated with the ranges of TK and PT,respectively,during the gait cycle in LDH patients(r=0.766,P=0.001; r=0.833,P=0.000); furthermore,the leg pain VAS score was positively correlated with the mean value of SVA distance and the range of CBD,respectively(r=0.653,P=0.011; r=0.752,P=0.002),whereas the mean values and ranges of other SPPs were not correlated with the low back and leg pain VAS scores during the gait cycle in LDH patients.Conclusion:The differences in SPPs such as CBD,SVA distance,LL,TK and PT during the gait cycle are significant between LDH patients and healthy individuals.The ranges of LL,TK and PT are associated with the degree of low back pain,whereas the mean value of SVA distance and the range of CBD are correlated with the degree of leg pain in LDH patients.

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備注/Memo

備注/Memo:
基金項(xiàng)目:北京市自然科學(xué)基金-海淀原始創(chuàng)新聯(lián)合基金資助項(xiàng)目(L212049)
通訊作者:王征 E-mail:[email protected]
更新日期/Last Update: 1900-01-01