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

Effects of long segment fusion and fixation on lower limb gait in patients with degenerative scoliosis

目的分析退变性脊柱侧弯(DS)患者行长节段融合固定术对下肢步态的影响。方法采用回顾性分析评估2015年1月~2017年6月在河北省沧州中西医结合医院行长节段融合固定术治疗的49例DS患者。观察患者手术前后的测量时空参数(步长、步速、步宽),以及运动学数据(髋关节运动角度、膝关节运动角度、足底压力分布),测量冠状面侧凸角(Cobb)、腰椎前凸角(LL)、骶骨倾斜角(SS),以及腰痛下肢痛视觉模拟评分法(VAS)评分、腰椎Oswestry功能障碍指数(ODI)评分。结果与术前比较,DS患者术后步长、步速、髋关节运动角度均增加,膝关节运动角度减小,差异均有统计学意义(均P<0.05),术后步宽与术前比较,差异无统计学意义(P>0.05)。DS患者术前地面反作用力(GRF)呈高耸单峰曲线,术后GRF变为低平双峰曲线。与术前比较,DS患者术后Cobb角度减小,LL、SS脊柱平衡参数均增加,VAS评分、ODI评分均降低,差异均有统计学意义(均P<0.05)。结论长节段融合固定术能通过改善患者脊柱畸形状态来提高患者的步长、步速等步态参数,实现对患者肢体功能、步态的最终治疗,提高患者生活质量。

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.