腰椎间盘突出症患者步态特征的研究

A study on gait characteristics in patients with lumbar disc herniation

目的:利用三维步态分析系统定量分析腰椎间盘突出症患者的步行特征,为腰椎间盘突出症患者的临床诊疗、康复训练计划制定及康复疗效评定提供客观依据。方法:共纳入20例健康志愿者和20例腰椎间盘突出症(lumbar disc herniation,LDH)患者,并对20例患者进行Oswestry功能障碍指数(Oswestry disability index,ODI)评分、下腰痛JOA(Japanese Orthopaedic Association)评分及VAS(Visual Analogue Score)评分。利用三维步态分析系统采集所有受试者的运动学数据,即在受试者身体表面腰痛相关位点粘贴红外线标示点,共19处,受试者在平地上规定的路线内行走,要求受试者以舒适的速度行走5m以上的距离,共行走4次。采用SPSS 22.0软件对患者的量表评分及所有受试者的运动学数据进行统计学分析。结果:①腰椎间盘突出症患者组患侧肢体与健侧肢体比较发现:患肢的步长明显减小,步频明显加快;②腰椎间盘突出症患者患侧肢体与健康志愿者同侧肢体比较发现:患者患侧肢体的步长、跨步长、膝关节屈伸活动范围及髋关节前屈后伸活动范围明显减小;③腰椎间盘突出症患者健侧肢体与健康志愿者同侧肢体比较发现:患者健侧肢体的步长、跨步长、步频、膝关节屈伸活动范围及髋关节前屈后伸活动范围明显减小;④通过相关性分析发现:JOA、ODI、VAS评分与患者的步长、跨步长、髋关节前屈后伸活动范围有相关性(P<0.05),与患者的步频、膝关节屈伸活动范围无明显相关(P>0.05)。结论:腰椎间盘突出症患者受腰痛的影响,导致步长及跨步长减小,步频加快,膝关节屈伸活动范围及髋关节前屈后伸活动范围减小。

Objective:The walking characteristics of patients with lumbar disc herniation were quantitatively analyzed by using the three-dimensional gait analysis system,which provided objective basis for clinical diagnosis and treatment,rehabilitation training plan formulation and rehabilitation effect evaluation of patients with lumbar disc herniation.Method:A total of 20 healthy volunteers and 20 patients with low back pain(LBP)were included,and 20 patients were evaluated with the Oswestry disability index(ODI),the Japanese Orthopaedic Association(JOA)and Visual Analogue Score(VAS).The kinematics data of all subjects were collected by using the three-dimensional gait analysis system.Infra-red markers were pasted on the low back pain related sites,a total of 19 markers were pasted,and the subject walked within the prescribed route on the flat ground.Subjects were required to walk over a distance of 5 meters at a comfortable speed 4 times.The SPSS 22.0 software was used for statistical analysis of patient scale scores and kinematics data of all subjects.Result:①The step length of the affected limb is obviously reduced and the step frequency is obviously accelerated.②Compared with the same limb of healthy volunteers,the limb length,stride length,the flexion and extension range of knee joint and the flexion and extension range of hip joint of the patient with lumbar disc herniation were significantly reduced.③The comparison between the healthy side limb of the patient with lumbar disc herniation and the same side limb of the healthy volunteers showed that the step length,stride length,step frequency,the flexion and extension range of knee joint and the flexion and extension range of hip joint of the healthy side limb of the patient were significantly reduced.④It was found that JOA,ODI and VAS scores were correlated with patient's step length,stride length and the flexion and extension range of hip joint(P<0.05),but not with patient's step frequency and the flexion and extension range of knee joint(P>0.05).Conclusion:Patients with lumbar disc herniation are affected by low back pain,resulting in decreased step length and stride length,increased step frequency,and reduced the flexion and extension range of knee joint and the flexion and extension range of hip joint.