Effects of long segment fusion and fixation on lower limb gait in patients with degenerative scoliosis
GAO Shunxing WANG Fangfang WU Linlin FENG Juanjuan WANG Jun TAO Xiaobing CHEN Yanping
The First Department of Spinal Cord Surgery, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province, Cangzhou 061001, China
Abstract：Objective To analyze the effects of long segment fusion fixation surgery on lower limb gait in patients with degenerative scoliosis (DS). Methods A retrospective analysis was performed to evaluate 49 patients with DS who underwent long segment fusion fixation surgery in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province from January 2015 to June 2017. The surgery were observed before and after treatment of measuring spatiotemporal parameters (step size, step speed and step width), and the kinematic data (hip joint motion angle, knee joint motion angle and plantar pressure distribution), and measurement of coronal plane scoliosis angle (Cobb), lumbar lordosis angle (LL), sacral slope (SS), visual analogue scale (VAS) score of lumbago and lower limb pain, lumbar Oswestry disability index (ODI) score Results Compared with the preoperative results, the postoperative step size, step speed and hip joint motion angle of DS patients all increased, while the knee joint motion angle decreased, with statistically significant differences (all P ＜ 0.05). There was no significant difference of the step width between the postoperative and the preoperative (P ＞ 0.05). The preoperative ground reaction force (GRF) of DS patients showed a high single peak curve, and the postoperative GRF changed into a low level bimodal curve. Compared with preoperative results, the postoperative Cobb angle of DS patients decreased, spinal balance parameters of LL and SS increased, VAS score and ODI score decreased, and the differences were all statistically significant (all P ＜ 0.05). Conclusion Long segment fusion fixation surgery can improve patients′ gait parameters, such as step size and step speed, by improving patients′ spinal deformity, so as to achieve the ultimate treatment of patients′ limb function and gait and improve their quality of life.
郜顺兴 王芳芳 吴琳琳 冯娟娟 王军 陶晓冰 陈彦平. 退变性脊柱侧弯患者长节段融合固定术对下肢步态的影响[J]. 中国医药导报, 2020, 17(15): 76-79.
GAO Shunxing WANG Fangfang WU Linlin FENG Juanjuan WANG Jun TAO Xiaobing CHEN Yanping. Effects of long segment fusion and fixation on lower limb gait in patients with degenerative scoliosis. 中国医药导报, 2020, 17(15): 76-79.
[1] Global Burden of Disease Study 2013 Collaborators. Global，regional，and national incidence，prevalence，and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries，1990-2013：a systematic analysis for the Global Burden of Disease Study 2013 [J]. Lancet，2015，386（9995）：743-800.
[2] Liu CY，Zygourakis CC，Yoon S，et al. Trends in Utilization and Cost of Cervical Spine Surgery Using the National Inpatient Sample Database，2001 to 2013 [J]. Spine（Phila Pa 1976），2017，42（15）：E906-E913.
[3] Zygourakis CC，Liu CY，Wakam G，et al. Geographic and Hospital Variation in Cost of Lumbar Laminectomy and Lumbar Fusion for Degenerative Conditions [J]. Neurosurgery，2017，81（2）：331-340.
[4] Buser Z，Ortega B，D'Oro A，et al. Spine Degenerative Conditions and Their Treatments：National Trends in the United States of America [J]. Global Spine J，2018，8（1）：57-67.
[5] Devin CJ，Chotai S，Parker SL，et al. A Cost-Utility Analysis of Lumbar Decompression With and Without Fusion for Degenerative Spine Disease in the Elderly [J]. Neurosurgery，2015，77 Suppl 4：S116-S124.
[6] Bassel GD，Neil VS，Oheneba BA，et al. Adult spinal deformity [J]. Lancet，2019，394（10193）：160-172.
[7] 刘啸，王雷，于淼，等.DIERS-4D脊柱云纹系统联合QUINTIC步态分析系统评价脊柱疾病[J].中国矫形外科杂志，2019，27（1）：73-78.
[8] Haddas R，Ju KL，Belanger T，et al. The use of gait analysis in the assessment of patients afflicted with spinal disorders [J]. Eur Spine J，2018，27（8）：1712-1723.
[9] 李危石，费晗，陈仲强，等.退变性腰椎侧凸患者腰椎前凸矫正程度与疗效的关系[J].中国脊柱脊髓杂志，2016， 26（10）：912-918.
[10] Xie D，Zhang J，Ding W，et al. Abnormal change of paravertebral muscle in adult degenerative scoliosis and its association with bony structural parameters [J]. Eur Spine J，2019，28（7）：1626-1637.
[11] Yagi M，Ohne H，Konomi T，et al. Walking balance and compensatory gait mechanisms in surgically treated patients with adult spinal deformity [J]. Spine J，2017，17（3）：409-417.
[12] Haddas R，Hu X，Lieberman IH. The Correlation of Spinopelvic Parameters With Biomechanical Parameters Measured by Gait and Balance Analyses in Patients With Adult Degenerative Scoliosis [J]. Clin Spine Surg，2020， 33（1）：E33-E39.
[13] 罗长良，郑倩.脊柱侧弯矫形器对AIS患者步态影响的探讨[J].中国康复，2019，34（9）：498-501.
[14] Mahaudens P，Detrembleur C，Mousny M，et al. Gait in adolescent idiopathic scoliosis：energy cost analysis [J]. Eur Spine J，2009，18（8）：1160-1168.
[15] 潘永雄，陈锦，王大伟，等.足底压力测试系统的常用步态分析指标[J].临床医学工程，2018，25（9）：1267-1269.
[16] 朴雪梅，孙晏舲，薛鸾，等.三维步态分析系统在强直性脊柱炎病情评价中的应用研究[J].中国药物与临床，2013，13（7）：845-849.
[17] Shin SS，Yu JS，Yoon JY，et al. Strategy on navigating obstacle in patients with lumbar spinal stenosis：Relationship among trunk and pelvic movement，swing toe clearance，and muscle coordination of the stance limb [J]. J Back Musculoskel Rehabil，2018，13（6）：1131-1138.
[18] 岳剑宁，郭玉娜，刘京杰，等.腰椎管狭窄症患者步态下脊柱和骨盆运动与腰痛加重的相关性分析[J].颈腰痛杂志，2019，40（4）：433-437.
[19] Haddas R，Lieberman IH，Kakar RS. A Comparison of Muscular Activity During Gait Between Walking Sticks and a Walker in Patients With Adult Degenerative Scoliosis [J]. Spine Deform，2019，7（3）：454-466.
[20] 潘志良，黎锦灵，单敏瑜，等.石膏固定与足外展矫形器治疗脑瘫患儿马蹄内翻足的临床研究[J].中国医药科学，2018，8（3）：9-12.
[21] 李阳，宋毓，姜淑云，等.三维步态分析技术在矫形器领域的应用[J].中国康复医学杂志，2018，33（7）：874-877.
2020, Vol. 17 
京公网安备 11010502046598号