腰椎间盘突出症患者步态周期中的脊柱-骨盆参数变化及其与腰腿疼痛的相关性分析  

Changes of spino-pelvic parameters during a gait cycle in patients with lumbar disc herniation and their correlations with lumbago-leg pain

作　　者：张楚阅 王兆瀚 薛原 刘轩汇 刘昊明 张雪丽 宋凯 吴兵 王征 ZHANG Chuyue;WANG Zhaohan;XUE Yuan;LIU Xuanhui;LIU Haoming;ZHANG Xueli;SONG Kai;WU Bing;WANG Zheng(The Fourth Medical Center of Chinese PLA General Hospital,Beijing 100048,China;School of Medicine of Nankai University,Tianjin 300071,China;The First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第四医学中心,北京100048 [2]南开大学医学院,天津300071 [3]中国人民解放军总医院第一医学中心,北京100853

出　　处：《中医正骨》2024年第5期19-25,60,共8页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：北京市自然科学基金-海淀原始创新联合基金资助项目(L212049)。

摘　　要：目的:分析腰椎间盘突出症(lumbar disc herniation,LDH)患者步态周期中的脊柱-骨盆参数变化及其与腰腿疼痛的相关性。方法:纳入14例LDH患者(LDH组)和17例健康人(健康对照组)。在运动捕捉场地采用光学运动捕捉系统记录2组受试者的行走过程,采用特定的算法处理数据,绘制步态周期中脊柱-骨盆参数变化趋势图,提取并比较2组受试者步态周期中冠状面平衡距离、矢状面轴向距离、胸椎后凸角、腰椎前凸角、骨盆倾斜角、骨盆入射角的均值(步态周期中某项指标的所有数据之和与数据数量的比值)和范围(步态周期中某项指标的数据最大值与最小值的差)。采用Pearson相关分析,分析LDH患者步态周期中的脊柱-骨盆参数与腰部疼痛视觉模拟量表(visual analogue scale,VAS)评分、腿部疼痛VAS评分的相关性。结果:①步态周期中脊柱-骨盆参数变化分析结果。步态周期中,冠状面平衡距离呈现周期性增减,矢状面轴向距离、胸椎后凸角、腰椎前凸角、骨盆倾斜角呈余弦曲线,骨盆入射角保持基本不变;步态周期中,LDH组冠状面平衡距离、腰椎前凸角的均值均小于健康对照组[(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],矢状面轴向距离、骨盆倾斜角的均值均大于健康对照组[(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组胸椎后凸角、骨盆入射角的均值的差异均无统计学意义[(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)];步态周期中,LDH组矢状面轴向距离、骨盆倾斜角的范围均大于健康对照组[(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、腰椎前凸角的范围均小于健康对照组[(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组冠状面平衡距离�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

关 键 词：椎间盘移位 步态 脊柱 骨盆 三维运动 参数 动态捕捉技术 疼痛 数据相关性 

分 类 号：R681.5[医药卫生—骨科学]