青少年特发性脊柱侧凸患者步态参数、肌肉参数与影像学的相关性

Correlation of gait parameters and muscle parameters with imaging in adolescent idiopathic scoliosis patients

背景:步态分析作为一种没有辐射的动态评估方法,可以辅助影像学检查对脊柱侧凸患者进行评估,从而减少辐射暴露。目的:分析青少年特发性脊柱侧凸患者步态参数与影像学参数的相关性,并通过OpenSim仿真建模初步探索潜在机制。方法:选取Cobb角10°-45°、年龄10-18岁的青少年特发性脊柱侧弯患者20例为青少年特发性脊柱侧凸组;对照组是同年龄阶段,且相同体质量指数区间的正常儿童,共计纳入40例受试者。比较两组受试者步行时空参数、运动学参数、动力学参数及步态偏差指数的差异,探索病理步态与冠状面平衡的相关性,并对相关机制进行初步研究。结果与结论:(1)步态参数组间比较结果表明,青少年特发性脊柱侧凸组患者左侧支撑相、左侧双支撑相占整个步态周期的百分比增加,同时左侧摆动相占整个步态周期的百分比减少(P <0.05);青少年特发性脊柱侧凸组患者左侧髋关节最大内收角度大于对照组,双侧髋关节最大外展角度明显小于对照组(P <0.05);两组双侧足跟初始着地时踝关节角度相比差异有显著性意义(P <0.05);青少年特发性脊柱侧凸患者蹬离地面时右侧髋关节屈曲肌群峰值功率显著变小(P <0.05);(2)相关性研究结果显示,右侧髋关节最大外展角度与Cobb角呈显著正相关(r=0.552,P=0.012),右侧髋关节屈曲肌群峰值功率和C7侧方偏移呈显著负相关(r=-0.475,P=0.034),左侧足跟着地时踝关节角度与冠状面骨盆倾斜度呈显著正相关(r=0.476,P=0.034);(3)肌肉长度模拟计算结果表明,青少年特发性脊柱侧凸患者臀中肌肌纤维长度变化显著减少(P <0.05),双侧腹内斜肌肌纤维长度变化显著减少(P <0.05);比较两组受试者在足跟着地时的肌纤维长度发现,青少年特发性脊柱侧凸患者足跟初始着地时腓肠肌内外侧头和比目鱼肌的肌纤维长度均变短(P <0.05);(4)结果发现,青少年特发性脊柱侧凸患者躯干的姿势稳定性控制下降,表现为步频变慢、支撑相双支撑相百分比增加及摆动相百分比减少;普遍存在低足跟着地模式,是由双侧跟腱紧张引起的;青少年特发性脊柱侧凸患者存在髋屈曲肌群做功能力下降,可能与关节角速度及主弯方向相关。

BACKGROUND:Gait analysis,as a radiation-free dynamic assessment method,may be able to assist imaging to evaluate patients with scoliosis,thereby reducing radiation exposure.OBJECTIVE:To analyze the correlation between gait parameters and imaging parameters in adolescent idiopathic scoliosis patients,and preliminarily explore the potential mechanism through OpenSim simulation modeling.METHODS:Twenty adolescent idiopathic scoliosis patients aged 10-18 years with Cobb angle of 10°-45°were selected as adolescent idiopathic scoliosis group.The control group was normal children of the same age and the same body mass index range,and a total of 40 subjects were included.The differences in spatiotemporal parameter,kinematic parameters,dynamic parameters,and gait deviation index of the two groups were compared to explore the correlation between pathological gait and coronal balance.The related mechanisms were preliminarily studied.RESULTS AND CONCLUSION:(1)The comparison of gait parameters between groups showed that the percentage of bilateral support phase and double support phase increased in adolescent idiopathic scoliosis patients,and the percentage of bilateral swing phase decreased(P<0.05).The maximum adduction angle of the left hip joint of patients in the adolescent idiopathic scoliosis group was greater than that of the control group,and the maximum abduction angle of the bilateral hip joints was significantly less than that of the control group(P<0.05).The ankle joints of the two groups when the bilateral heels initially touched the ground;the difference between angles was significant(P<0.05).The peak power of right hip flexor muscle group in adolescent idiopathic scoliosis patients was significantly decreased when they pushed off the ground(P<0.05).(2)The results of the correlation study showed that the maximum abductive angle of the right hip joint was significantly positively correlated with the Cobb angle(r=0.552,P=0.012),and the right peak power of right hip flexor muscle and C7 lateral offset were significantly negatively correlated(r=-0.475,P=0.034).There was a significant positive correlation between ankle angle and lateral pelvic tilt when left foot followed the ground(r=0.476,P=0.034).(3)The simulation results of muscle length showed that the change of muscle fiber length of gluteal medium muscle in adolescent idiopathic scoliosis patients was significantly reduced(P<0.05).The change of muscle fiber length of the bilateral internal oblique muscle was significantly reduced in adolescent idiopathic scoliosis patients(P<0.05).Comparing the muscle fiber length of the two groups when foot followed the ground,it was found that the muscle fiber length of the calf triceps of the adolescent idiopathic scoliosis patients was significantly shorter when foot followed the ground(P<0.05).(4)The results showed that the postural stability control of the trunk of adolescent idiopathic scoliosis patients was decreased,which was manifested as slow step frequency,increased percentage of double support phase and decreased percentage of swing phase.The common pattern of low foot striking pattern is caused by bilateral Achilles tendon tension.In adolescent idiopathic scoliosis patients,the ability of hip flexor muscle to do work is decreased,which may be related to joint angular velocity and main bend direction.