中央型腰椎管狭窄症患者间歇性跛行症状出现前后的足底压力分析

Analysis of Plantar Pressure before and after Occurrence of Neurogenic Intermittent Claudication in Patients with Central Lumbar Spinal Stenosis

目的研究中央型腰椎管狭窄症(lumbar spinal stenosis,LSS)患者出现间歇性跛行(neurogenic intermittent claudication,NIC)症状前后的足底压力变化情况及跌倒风险,为足底压力分析应用于LSS患者行走功能判定提供理论与数据参考。方法选取12名患有腰L4~5节段中央型LSS患者作为实验组,同时以12名同年龄健康成人作为对照组,采用Footscan足底压力测试系统进行动态足底压力测试,通过比较实验组运动前后与对照组运动前后站立相时间(contact time,CT)及各分期时间百分比(CT%)、步向角(foot progression angle,FPA)、足底各分区接触面积百分比(CA%)和压强时间积分(pressure-time integral,PTI),评估行走状态下患者足底压力的变化情况。结果实验组症状出现前与对照组相比,足跟触地期(initial contact phase,ICP) CT%减小,前足离地期(forefoot push-off phase,FFPOP) CT%增高,总接触时间、FPA、第1~3跖骨头区PTI以及第2、第3跖骨头区CA%增加;实验组运动至NIC症状出现后,其全足触地期(foot flat phase,FFP)与前足离地期CT%、总接触时间、FPA、第1~4跖骨头区PTI和CA%、足趾区CA%增加,足跟触地期与前足触地期(forefoot contact phase,FFCP) CT%、足跟区PTI和CA%均减小。结论中央型LSS患者在行走时足底压力分布向前足转移,站立相时间周期出现异常。这些异常可因NIC症状出现而进一步加重,患者具有更高的跌倒风险。

Objective To investigate the changes of plantar pressure distributions and risk of falling before and after the occurrence of neurogenic intermittent claudication(NIC)in patients with central lumbar spinal stenosis(LSS),so as to provide theoretical and data references for the application of plantar pressure analysis in judgment of walking abilities for LSS patients.Methods Twelve patients with LSS at the L4-5 segment were selected as the LSS group,while twelve healthy adults at the same age were selected as the control group.Footscansystem was used to measure plantar pressure of these subjects during walking.Contact area percentage of the total foot contact area(CA%),pressure-time integral(PTI),foot progression angle(FPA),contact time percentage of the stance time(CT%)and total stance time(CT)in both LSS group and control group were compared to evaluate changes of plantar pressures during walking.Results Before the occurrence of NIC,compared with the control group,the LSS group had lower CT%during the forefoot push-off phase(FFPOP)and higher CT%during the initial contact phase(ICP),the total CT and FPA also increased,and the PTI of the1st-3rd metatarsals and the CA%of the 2nd and 3rd metatarsals were higher.After the NIC occurred,for LSS group,CT%during ICP and forefoot contact phase(FFCP)decreased,CT%during the foot flat phase(FFP)and FFPOP as well as total CT and FPA increased,the PTI and CA%increased in 1st-4thmetatarsals.Moreover,the CA%also increased in toe zone,both the PTI and CA%decreased in heel zone.Conclusions In patients with central LSS during walking,the distribution of plantar pressure shifts forward,with abnormal phase of the stance time occurring.Such abnormality will be further aggravated by NIC,indicating a higher risk of falling.