腰椎间盘突出症患者坐立时的运动学特征分析

Analysis on Kinematic Characteristics of Patients with Lumbar Disc Herniation During Sitting and Standing

目的研究腰椎间盘突出症(lumbar disc herniation,LDH)患者在坐-立-坐任务中腰部和臀部的运动学与关节协调性变化。方法应用Vicon三维运动捕捉系统采集20例健康对照与20例LDH受试者的运动学数据,通过统计参数映射(statistical parametric mapping,SPM)比较两组在坐立任务中腰椎与髋关节的运动模式差异。结果在坐立任务中,LDH受试者腰椎屈伸活动度与髋关节外展角度明显受限,髋关节屈曲角度增加;SPM分析显示,两组在从坐到立的起始阶段(10%~13%),腰椎屈曲角度存在统计学差异,LDH受试者屈曲角度明显减少,而2%~14%阶段LDH受试者髋关节屈曲角度明显增加;在从立到坐阶段(65%~68%),LDH受试者则表现为髋关节外展角度增加。结论LDH受试者在坐立过程中腰椎屈曲及髋关节外展功能受限,需代偿以髋关节屈曲活动增加来完成功能任务。在临床评估中,应重点关注脊柱与臀部的运动功能改变。

Objective To study changes in kinematics and joint coordination of the waist and hips during sit-to-stand and stand-to-sit tasks in patients with lumbar disc herniation(LDH).Methods The Vicon 3D motion capture system was used to collect the kinematics data from 20 healthy controls and 20 LDH subjects,and differences in movement patterns of the lumbar spine and hip joints during sitting and standing tasks were compared between two groups through statistical parametric mapping(SPM).Results During sit-to-stand task,the lumbar spine flexion and extension range and hip joint abduction angle of LDH subjects were significantly limited,and the hip flexion angle increased.SPM analysis showed that for both groups at initial stage of sit-to-stand(10%-13%),there was a statistically significant difference in flexion angle of the lumbar spine,and lumbar flexion angle of LDH subjects was significantly reduced,while hip flexion angle at 2%-14%phase was significantly increased.During stand-to-sit phase(65%-68%),LDH subjects showed increased hip abduction angle.Conclusions LDH subjects have limited lumbar flexion and hip abduction functions during sitting and standing,and they need to be compensated with increased hip flexion activities to complete functional tasks.In clinical evaluation,changes in motor function of the spine and hips should be focused on.