青少年特发性脊柱侧凸患者步行功能与影像学参数的相关性分析

Correlation analysis of walking function and imaging parameters in patients with adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  三维步态分析  影像学

英文关键词:Adolescent idiopathic scoliosis  Three-dimensional gait analysis  Imaging

中文摘要:

  【摘要】 目的：分析青少年特发性脊柱侧凸患者步行功能与影像学参数的相关性，以期为未来采用三维步态分析辅助评估和诊断提供参考资料。方法：纳入33例AIS患者，其中，男性9例，女性24例，年龄为12.41±2.12岁，身高为155.63±11.34cm，体重为43.42±8.71kg，Cobb角为18.71°±3.42°，下肢长度差值为0.77±0.53cm。使用三维运动捕捉系统采集AIS患者步态特征，主要包括时空参数（步长、步速、步频、支撑相时间百分比、双支撑相时间百分比）、运动学参数（髋关节屈伸范围、髋关节最大内旋角度、足触地时髋关节屈曲角度、膝关节屈伸范围、膝关节内外翻范围、踝关节屈伸范围、踝关节最大背屈角度、踝关节最大跖屈角度、踝关节内外翻范围）、动力学参数（髋关节功率、髋关节最大伸展力矩、髋关节最大外旋力矩、膝关节功率、膝关节最大屈曲力矩、踝关节功率、踝关节最大内翻力矩、踝关节最大外翻力矩）及对称指数；由一名研究者独立对纳入AIS患者的脊柱全长正侧位X线片上进行重复3次测量，测量参数包括主弯Cobb角、胸椎后凸角、腰椎前凸角及骨盆倾斜角。检验数据正态性，符合正态分布采用Pearson相关性检验，不符合正态分布采用Spearman相关性检验。结果：相关性研究结果显示，时空参数与影像学参数之间均无相关性（P＞0.05）。Cobb角与凸侧踝关节内外翻运动范围呈负相关（r=-0.373）；胸椎后凸角与凹侧髋关节最大内旋角度（r=-0.358）、凸侧/凹侧踝关节屈伸运动范围（r=-0.369/r=-0.394）呈负相关，与凸侧踝关节最大跖屈角度呈正相关（r=0.407）；腰椎前凸角与凸侧足触地时髋关节屈曲角度呈正相关（r=0.398）；骨盆倾斜角与凸侧膝关节内外翻运动范围呈负相关（r=-0.433），与凹侧踝关节最大背屈角度呈正相关（r=0.358）。Cobb角与凸侧/凹侧踝关节最大内翻力矩呈正相关（r=0.462/r=0.377）；胸椎后凸角与凸侧髋关节最大伸展力矩呈正相关（r=0.366）；腰椎前凸角与凸侧髋关节最大伸展力矩呈正相关（r=0.393），与凸侧髋关节最大外旋力矩呈负相关（r=-0.417）；骨盆倾斜角与凸侧髋关节功率（r=-0.372）、凸侧髋关节最大伸展力矩（r=-0.559）呈负相关，与凹侧膝关节功率呈负相关（r=-0.388），与凹侧膝关节最大屈曲力矩呈正相关（r=0.440）。胸椎后凸角与髋关节屈伸运动范围SI（r=-0.405）、膝关节屈伸运动范围SI（r=-0.362）呈负相关；腰椎前凸角与髋关节功率SI呈负相关（r=-0.412）；骨盆倾斜角与髋关节屈伸运动范围SI（r=0.691）、步速SI（r=0.374）呈正相关。结论：轻中度青少年特发性脊柱侧凸患者的影像学特征与步行过程中髋关节及踝关节功能相关性强，提示在临床治疗上要考虑脊柱与下肢的相互作用，以实现更有效的矫正效果。

英文摘要:

  【Abstract】 Objectives: To analyze the correlation between walking function and imaging parameters in adolescent idiopathic scoliosis(AIS) patients, in order to provide reference for future assessments and diagnoses using three-dimensional gait analysis. Methods: A total of 33 AIS patients were included, comprising 9 males and 24 females, with an average age of 12.41±2.12 years, an average height of 155.63±11.34cm, an average weight of 43.42±8.71kg, an average Cobb angle of 18.71°±3.42°, and an average lower limb length discrepancy of 0.77±0.53cm. A three-dimensional motion capture system was used to collect gait characteristics of the AIS patients, including spatiotemporal parameters(step length, step speed, step frequency, percentage of support phase time, percentage of double support phase time), kinematic parameters(the range of hip joint flexion and extension, the maximum internal rotation angle of the hip joint, the flexion angle of the hip joint when the foot touches the ground, the range of knee joint flexion and extension, the range of knee joint varus and valgus, the range of ankle joint flexion and extension, the maximum dorsiflexion angle of the ankle joint, the maximum plantar flexion angle of the ankle joint, the range of ankle joint varus and valgus), dynamic parameters(hip joint power, maximum extension moment of the hip joint, maximum external rotation moment of the hip joint, knee joint power, maximum flexion moment of the knee joint, ankle joint power, maximum varus moment of the ankle joint, maximum valgus moment of the ankle joint), and symmetry index. One researcher independently performed three repeated measurements on the full-length lateral X-rays of spine of patients for parameters such as the main curve Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, and pelvic tilt angle. Normality of the data was tested; Pearson correlation analysis was used for normally distributed data, while Spearman correlation analysis was used for non-normally distributed data. Results: The correlation study results indicated that there was no correlation between spatiotemporal parameters and imaging parameters(P＞0.05). The Cobb angle was negatively correlated with the range of internal and external rotation of the convex side ankle joint(r=-0.373). The thoracic kyphosis angle was negatively correlated with the maximum internal rotation angle of the concave side hip joint(r=-0.358) and with the flexion/extension range of motion of both the convex and concave side ankles(r=-0.369/r=-0.394), but positively correlated with the maximum plantar flexion angle of the convex side ankle(r=0.407). The lumbar lordosis angle was positively correlated with the hip flexion angle(r=0.398) when the foot touched the ground on the convex side. The pelvic tilt angle was negatively correlated with the range of internal and external rotation of the convex side ankle joint(r=-0.433), and positively correlated with the maximum dorsiflexion angle of the concave side ankle(r=0.358). The Cobb angle was positively correlated with the maximum inversion moment of the convex and concave ankle joints(r=0.462/r=0.377). The thoracic kyphosis angle was positively correlated with the maximum extension moment of the convex hip joint(r=0.366). The lumbar lordosis angle was positively correlated with the maximum extension moment of the convex hip joint(r=0.393) and negatively correlated with the maximum external rotation moment of the convex hip joint(r=-0.417). The pelvic tilt angle was negatively correlated with the power of the convex hip joint(r=-0.372) and the maximum extension moment of the hip(r=-0.559), and negatively correlated with the power of the concave knee joint(r=-0.388). It was positively correlated with the maximum flexion moment of the concave knee joint(r=0.440). The thoracic kyphosis angle was negatively correlated with the symmetry index(SI) of the ranges of motion for hip flexion and extension(r=-0.405), as well as the SI of knee flexion and extension(r=-0.362); The lumbar lordosis angle was negatively correlated with the SI of hip joint power(r=-0.412); The pelvic tilt angle was positively correlated with the SI of hip flexion and extension range(r=0.691) and step speed(r=0.374). Conclusions: There are strong correlations between radiographic parameters and hip/ankle joint function during walking in patients with mild-to-moderate AIS. These findings suggest that the interaction between the spine and lower limbs should be taken into account in clinical management to achieve more effective corrective outcomes.