退变性脊柱侧凸患者的步态特征及其与脊柱X线片上影像学参数的相关性分析

Correlation analysis of gait characteristics and X-ray parameters in patients with degenerative scoliosis

中文关键词:  退变性脊柱侧凸  步态分析  动态评估

英文关键词:Degenerative scoliosis  Gait motion analysis  Dynamic evaluation

中文摘要:

  【摘要】 目的：分析退变性脊柱侧凸（degenerative scoliosis，DS）患者的步态特征，探讨其与脊柱X线片影像学参数的相关性。方法：纳入9例DS患者，年龄63~73（67.7±3.1）岁。使用红外运动捕捉系统（SMART-D 400）对患者进行三维步态运动分析，主要包括时空参数（跨步时长、支撑时长、摆动时长、支撑周期、摆动周期、单足支撑周期、双足支撑周期、绝对速度、相对速度、步频、步长、步宽）、步态偏差指数（gait deviation index，GDI）和脊柱平衡参数[步态分析过程中第一个5m和最后一个5m的冠状面的偏斜角（thoracic-whole spine coronal angle，TS-CA）、矢状面偏斜角（thoracic-whole spine sagittal angle，TS-SA）、运动周期骨盆倾斜角（pelvic tilt in motion cycle，PTM）]。在脊柱全长X线片上测量患者胸椎后凸角（T5/T12 Cobb）、腰椎前凸角（L1/L5 Cobb）、骶骨倾斜角（sacral slope，SS）、骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骨盆入射角与腰椎前凸角之差 PI-LL、矢状垂直轴（sagittal vertical axis，SVA）和退变性侧凸节段和角度（Cobb）。统计患者GDI值是否在正常范围（＞100），使用配对T检验比较第一个5m和最后一个5m的脊柱平衡参数，归纳DS患者步态特征。使用Spearman相关分析时空参数与脊柱X线片影像学参数的相关关系。结果：患者的时空参数具体如下：跨步时长为1.16±0.21s、支撑时长为0.79±0.15s、摆动时长为0.37±0.07s，支撑周期为（67.98±2.14）%、摆动周期为（32.02±2.41）%、单足支撑周期为（54.32±5.12）%、双足支撑周期为（45.68±5.12）%、绝对速度为0.73±0.17m/s、相对速度为45.33±11.20（%height/s）、步长为0.41±0.09m、步宽为0.09±0.03m、步频为106.66±17.59次/min。患者均存在异常步态（右下肢GDI为82.3±7.4，左下肢GDI为85.1±7.3）。步态最后一个5m的TS-CA、TS-SA、PTM均大于第一个5m（P＜0.05）。相关分析显示，绝对速度和相对速度与腰椎前凸呈强正相关，相关系数分别为0.707（P=0.033）、0.795（P=0.010）；PI-LL与TS-SA呈强正相关，相关系数0.703（P=0.035）。而摆动时长与腰椎前凸呈强负相关，相关系数为-0.703（P=0.035），骶骨倾斜角与步宽呈强负相关，相关系数为-0.868（P=0.002）；与其余参数无明显相关。结论：DS患者存在明显步态异常，且在行走过程中，脊柱失衡明显加重，患者的步态异常情况与脊柱失衡（腰椎前凸变小、PI-LL减少、骶骨倾斜角变大）存在明显相关。

英文摘要:

  【Abstract】 Objectives: To analyze the gait characteristics of patients with degenerative scoliosis(DS) and explore the relationship between the gait characteristics and image parameters on X-ray. Methods: 9 DS patients of 67.7±3.1 years old(63-73 years) were included in the study. The three-dimensional gait motion of the patients was analyzed with a SMART-D 400 infrared motion capture system, including spatiotemporal parameters(stride length, stance time, swing time, stance cycle, swing cycle, single limb support cycle, double limb support cycle, absolute velocity, relative velocity, step frequency, step length, and step width), gait deviation index(GDI), and spinal balance parameters[thoracic-whole spine coronal angles(TS-CA) of the first 5m and the last 5m, the dynamic pelvic tilt in motion cycle(PTM)]. The thoracic kyphosis angle(T5/T12 Cobb), lumbar lordosis(LL) angle(L1/L5 Cobb), sacral slope(SS), pelvic incidence(PI), pelvic tilt(PT), difference between PI angle and LL angle(PI-LL), sagittal vertical axis(SVA), degenerative scoliosis segments and angles were measured on the full-length X-ray. The patient′s GDI values were counted whether within the normal range(>100), and then paired T-test was used to compare the spinal balance parameters of the first 5m with those of the last 5m. The gait characteristics of DS patients were summarized. Spearman correlation analysis was used to examine the relationship between spatiotemporal parameters and radiographic parameters. Results: The spatiotemporal parameters of the patients were: the stride duration 1.16±0.21s, the support duration 0.79±0.15s, the swing duration 0.37±0.07s, the support period (67.98±2.14)%, the swing period (32.02±2.41)%, the single foot support period (54.32±5.12)%, and the double foot support period (45.68±5.12)%, the absolute velocity 0.73±0.17m/s, the relative velocity 45.33±11.20(%height/s), the step length is 0.41±0.09m, the step width 0.09±0.03m, the step frequency 106.66±17.59 times/min. Abnormal gait existed in all the patients(GDI of the right and left lower extremities were 82.3±7.4 and 85.1±7.3, respectively). The TS-CA, TS-SA, and PTM of the last 5m were all greater than those of the first 5m(P<0.05). The correlation analysis showed that absolute velocity and relative velocity were positively correlated with LL, with correlation coefficients of 0.707(P=0.033) and 0.795(P=0.010), respectively. And PI-LL was stronly positively correlated with TS-SA, with a coefficient of 0.703(P=0.035). The swing time was strongly negatively correlated with LL with a correlation coefficient of -0.703(P=0.035). SS was strongly negatively correlated with step width, with a correlation coefficient of -0.868(P=0.002), but no significant correlation with other parameters. Conclusions: DS patients have significant gait abnormalities, and spinal imbalance increases significantly during walking. The abnormal gait of patients is significantly related to spinal imbalance (reduced LL and PI-LL, and increased SS).