腰椎间盘突出症患者步态周期中的脊柱-骨盆参数变化及其与腰腿疼痛的相关性分析

Changes of spino-pelvic parameters during a gait cycle in patients with lumbar disc herniation and their correlations with lumbago-leg pain

目的:分析腰椎间盘突出症(lumbar disc herniation,LDH)患者步态周期中的脊柱-骨盆参数变化及其与腰腿疼痛的相关性。方法:纳入14例LDH患者(LDH组)和17例健康人(健康对照组)。在运动捕捉场地采用光学运动捕捉系统记录2组受试者的行走过程,采用特定的算法处理数据,绘制步态周期中脊柱-骨盆参数变化趋势图,提取并比较2组受试者步态周期中冠状面平衡距离、矢状面轴向距离、胸椎后凸角、腰椎前凸角、骨盆倾斜角、骨盆入射角的均值(步态周期中某项指标的所有数据之和与数据数量的比值)和范围(步态周期中某项指标的数据最大值与最小值的差)。采用Pearson相关分析,分析LDH患者步态周期中的脊柱-骨盆参数与腰部疼痛视觉模拟量表(visual analogue scale,VAS)评分、腿部疼痛VAS评分的相关性。结果:①步态周期中脊柱-骨盆参数变化分析结果。步态周期中,冠状面平衡距离呈现周期性增减,矢状面轴向距离、胸椎后凸角、腰椎前凸角、骨盆倾斜角呈余弦曲线,骨盆入射角保持基本不变;步态周期中,LDH组冠状面平衡距离、腰椎前凸角的均值均小于健康对照组[(0.0,23.9)mm,(2.0,1.8)mm,Z=-2.024,P=0.043;(37.1°,19.2°),(42.1°,15.6°),Z=-1.945,P=0.043],矢状面轴向距离、骨盆倾斜角的均值均大于健康对照组[(35.4,30.0)mm,(13.0,28.1)mm,Z=-2.898,P=0.004;(18.6°,12.5°),(9.2°,13.4°),Z=-2.104,P=0.035],2组胸椎后凸角、骨盆入射角的均值的差异均无统计学意义[(10.1°,11.3°),(12.8°,8.7°),Z=-0.913,P=0.361;(44.1°,14.8°),(49.4°,7.9°),Z=-1.429,P=0.153)];步态周期中,LDH组矢状面轴向距离、骨盆倾斜角的范围均大于健康对照组[(29.7,15.6)mm,(15.8,2.1)mm,Z=-2.898,P=0.004;(5.3°,0.7°),(3.3°,1.3°),Z=-3.971,P=0.000],胸椎后凸角、腰椎前凸角的范围均小于健康对照组[(4.5°,0.9°),(5.3°,1.1°),Z=-2.541,P=0.011;(7.4°,2.0°),(11.3°,1.1°),Z=-4.010,P=0.000)],2组冠状面平衡距离、骨盆入射角的范围的差异无统计学意义[(37.5,17.0)mm,(34.8,5.2)mm,Z=-0.595,P=0.552;(0.6°,0.1°),(0.6°,0.1°),Z=-1.155,P=0.262]。②LDH患者步态周期中的脊柱-骨盆参数与腰腿疼痛的相关性分析结果。LDH患者步态周期中腰椎前凸角范围与腰部疼痛VAS评分呈负相关(r=-0.880,P=0.000),胸椎后凸角范围、骨盆倾斜角范围与腰部疼痛VAS评分呈正相关(r=0.766,P=0.001;r=0.833,P=0.000),矢状面轴向距离均值、冠状面平衡距离范围与腿部疼痛VAS评分呈正相关(r=0.653,P=0.011;r=0.752,P=0.002),其他脊柱-骨盆参数的均值和范围与腰部疼痛VAS评分、腿部疼痛VAS评分均无相关性。结论:LDH患者步态周期中冠状面平衡距离、矢状面轴向距离、腰椎前凸角、胸椎后凸角、骨盆倾斜角等脊柱-骨盆参数与健康人存在显著差异,且腰椎前凸角范围、胸椎后凸角范围、骨盆倾斜角范围与腰部疼痛程度相关,矢状面轴向距离均值和冠状面平衡距离范围与腿部疼痛程度相关。

Objective:To analyze the changes of spino-pelvic parameters(SPPs)during a gait cycle in patients with lumbar disc herniation(LDH),and to explore their correlations with lumbago-leg pain.Methods:Fourteen LDH patients(LDH group),and 17 healthy individuals(healthy control group)were enrolled in the study.The walking processes of the subjects in the 2 groups were recorded by optical motion capture system(OMCS)in the motion capture experimental site.The collected data was processed by using specific algorithms,and the curve charts of changing trend of SPPs throughout the gait cycle was plotted.After that,the mean values(the ratio of the sum of the values to the number of values of a index)and ranges(the difference between the maximum and minimum values of a index)of coronal balance distance(CBD),sagittal vertical axis(SVA)distance,thoracic kyphosis(TK),lumbar lordosis(LL),pelvic tilt(PT),and pelvic incidence(PI)during the gait cycle were extracted and compared between the 2 groups.Furthermore,the correlations between the SPPs in the gait cycle and the visual analogue scale(VAS)scores of low back pain and leg pain in LDH patients were analyzed by using Pearson correlation analysis.Results:①During the gait cycle,the CBD presented a periodic increase or decrease trend,the SVA distance,TK,LL,and PT exhibited a trend manifesting as cosine curve,while the PI remained essentially unchanged.During the gait cycle,the mean values of CBD and LL were smaller,while the mean values of SVA distance and PT were greater in LDH group compared to healthy control group((0.0,23.9)vs(2.0,1.8)mm,Z=-2.024,P=0.043;(37.1,19.2)vs(42.1,15.6)degrees,Z=-1.945,P=0.043;(35.4,30.0)vs(13.0,28.1)mm,Z=-2.898,P=0.004;(18.6,12.5)vs(9.2,13.4)degrees,Z=-2.104,P=0.035),and the comparison of the mean values of TK and PI revealed no significant differences between the 2 group((10.1,11.3)vs(12.8,8.7)degrees,Z=-0.913,P=0.361;(44.1,14.8)vs(49.4,7.9)degrees,Z=-1.429,P=0.153).During the gait cycle,the ranges of SVA distance and PT were greater,while the ranges of TK and LL were smaller in LDH group compared to healthy control group((29.7,15.6)vs(15.8,2.1)mm,Z=-2.898,P=0.004;(5.3,0.7)vs(3.3,1.3)degrees,Z=-3.971,P=0.000;(4.5,0.9)vs(5.3,1.1)degrees,Z=-2.541,P=0.011;(7.4,2.0)vs(11.3,1.1)degrees,Z=-4.010,P=0.000),and the comparison of the ranges of CBD and PI revealed no significant differences between the 2 group((37.5,17.0)vs(34.8,5.2)mm,Z=-0.595,P=0.552;(0.6,0.1)vs(0.6,0.1)degrees,Z=-1.155,P=0.262).②The results of Pearson correlation analysis showed that the low back pain VAS score was negatively correlated with the range of LL(r=-0.880,P=0.000),but was positively correlated with the ranges of TK and PT,respectively,during the gait cycle in LDH patients(r=0.766,P=0.001;r=0.833,P=0.000);furthermore,the leg pain VAS score was positively correlated with the mean value of SVA distance and the range of CBD,respectively(r=0.653,P=0.011;r=0.752,P=0.002),whereas the mean values and ranges of other SPPs were not correlated with the low back and leg pain VAS scores during the gait cycle in LDH patients.Conclusion:The differences in SPPs such as CBD,SVA distance,LL,TK and PT during the gait cycle are significant between LDH patients and healthy individuals.The ranges of LL,TK and PT are associated with the degree of low back pain,whereas the mean value of SVA distance and the range of CBD are correlated with the degree of leg pain in LDH patients.