慢性非特异性腰痛患者的静态平衡和稳定极限

Static balance and limits of stability in patients with chronic nonspecific low back pain

背景:平衡能力是影响慢性非特异性腰痛患者姿势控制的重要因素和引发跌倒、骨折、残疾的主要原因。现有研究大多仅从双足站位下分析比较,却鲜见在辨别优势腿和非优势腿带来混杂因素等影响的前提下去探讨单、双足静态平衡和稳定极限的特征报道。目的:分析慢性非特异性腰痛患者的静态平衡和稳定极限特征。方法:2020年4月至2021年12月在广州市番禺区中心医院实习生中招募慢性非特异性腰痛患者20例(腰痛组),健康者20例(健康组)。选择Pro-kin平衡仪,进行单/双足站立静态平衡和稳定极限测试,并记录相应测试的指标数值,例如:双足站立时的足底压力中心和稳定极限,以及单双足站立下的前后和左右摆动幅度标准差、前后和左右平均运动速度、运动面积、运动长度等。结果与结论:(1)睁/闭眼状态下,健康组的足底压力中心呈轴心处集中分布,腰痛组相较呈更大离散分布,并以非优势腿上分布为主;(2)比较双足站立静态平衡:睁眼状态下两组间无显著差异(P> 0.05),闭眼状态下腰痛组各静态平衡指标数值大于健康组(P <0.05);(3)比较单足站立静态平衡:腰痛组优势腿各静态平衡指标数值大于非优势腿(P <0.05),健康组优和非优势腿间无明显差异(P> 0.05);腰痛组优势腿各静态平衡指标数值明显大于健康组(P <0.05),非优势腿上两组间无显著差别(P> 0.05);(4)健康组在左方(正左方、左前方、左后方)和右方(正右方、右前方、右后方)上的稳定极限数值均显著大于腰痛组(P <0.05);(5)结果提示,慢性非特异性腰痛患者闭眼状态下的双足站立静态平衡、优势腿的单足站立静态平衡以及左、右方上的稳定极限平衡能力均出现显著下降,平衡能力的维持存在视觉依赖,并有较大跌倒风险。

BACKGROUND: Balance ability is an important factor affecting the posture control of patients with chronic nonspecific low back pain and the main reason for falling, fractures and disabilities. Most of the existing studies only analyze the position of bipedal, and rarely report the static equilibrium characteristics and limits of stability of monopodial and bipedal on the premise of distinguishing the mixed factors brought by dominant and non-dominant legs. OBJECTIVE: To analyze the characteristics of static balance and limits of stability in patients with chronic nonspecific low back pain.METHODS: From April 2020 to December 2021, 20 chronic nonspecific low back pain patients(low back pain group) and 20 healthy subjects(healthy group) were recruited among the interns of Guangzhou Panyu Central Hospital. The Pro-kin balancer was chosen to perform the static balance of single/biped standing and limit of stability test and to record the index values of the corresponding test, such as: plantar pressure center and limit of stability when bipedal standing, as well as such as the vertical and horizontal amplitude, the mean of vertical and horizontal sway velocities, the area of the movement, and the length of the movement when single and bipedal standing. RESULTS AND CONCLUSION:(1) Under the eyes open/closed state, the plantar center of pressure of the healthy group was concentrated in the axial center, while the low back pain group showed a larger discrete distribution, and the distribution was mainly on the non-dominant leg.(2) Comparing the static balance of bipedal standing: There was no significant difference between the two groups in the open eye state(P > 0.05), and the low back pain group had higher values of static balance indexes than the healthy group in the closed eye state(P < 0.05).(3) Comparing the static balance of standing on one foot: The values of the static balance indexes of the dominant leg in the low back pain group were greater than those of the non-dominant leg(P < 0.05), and there was no significant difference between the superior and non-dominant legs in the healthy group(P > 0.05). The static balance index value of the dominant leg in the low back pain group was significantly greater than that of the healthy group(P < 0.05), and there was no significant difference between the two groups on the non-dominant leg(P > 0.05).(4) The limit of stability values on the le?t side(positive le?t, front le?t, rear le?t) and right side(positive right, front right, rear right) of the healthy group were significantly greater than those of the low back pain group(P < 0.05).(5) The results indicated that the static balance of standing on two feet with eyes closed, the static balance of standing on one foot of the dominant leg and the limit of stability balance ability on the le?t and right sides was significantly decreased, and the maintenance of balance ability was visually dependent, and there was a great risk of falling.