Kinetic and kinematic variables affecting trunk flexion during level walking in patients with lumbar spinal stenosis
Kinetic and kinematic variables affecting trunk flexion during level walking in patients with lumbar spinal stenosis
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DOI：
10.1371/journal.pone.0197228
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发表时间：
2018-05-10
期刊：
影响因子：
3.7
通讯作者：
Matsudaira, Ko
中科院分区：
文献类型：
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作者：
Igawa, Tatsuya;Katsuhira, Junji;Matsudaira, Ko
腰椎管狭窄导致马尾和神经根受压，产生神经症状。尽管水平行走时躯干屈曲可以通过椎管减压来缓解这些症状，但有些患者不使用这种策略。我们的目的是确定影响患者水平行走期间躯干屈曲的动力学和运动学变量。使用三维运动捕捉系统和六个测力板记录了 111 名患者的步态。根据记录的数据，计算步行速度、双侧步长、循环时间、最大躯干屈曲角度、骨盆前倾角度、骨盆旋转角度、最大和最小关节角度以及下肢力矩和功率。然后进行逐步多元回归分析，以确定影响躯干屈曲的动力学和运动学变量。最大髋部伸展角度（β = 0.416）、最大髋部屈曲力矩（β = -0.348）和步长（β = 0.257）被确定为显着影响躯干屈曲角度的变量。根据自由度调整的决定系数为 0.294 (p < 0.05)。我们的结果表明，腰椎管狭窄症患者可以选择两种策略之一来缓解行走过程中的症状。一种策略是采取躯干屈曲姿势的步态，以增加步长和髋部伸展角度。另一种策略是躯干直立姿势的步态，以减少步长和髋部伸展角度。
Lumbar spinal stenosis causes cauda equina and nerve root compression, resulting in neurological symptoms. Although trunk flexion during level walking may alleviate these symptoms by enabling spinal canal decompression, some patients do not use this strategy. We aimed to identify the kinetic and kinematic variables that affect trunk flexion in patients during level walking. Gait was recorded in 111 patients using a three-dimensional motion capture system and six force plates. From the data recorded, walking velocity, bilateral step length, cycle time, maximum trunk flexion angle, forward pelvic tilt angle, pelvic rotation angle, maximum and minimum joint angles, and moment and power of the lower limb were calculated. Then a step-wise multiple regression analysis was conducted to identify kinetic and kinematic variables affecting trunk flexion. The maximum hip extension angle (beta = 0.416), maximum hip flexion moment (beta = -0.348), and step length (beta = 0.257) were identified as variables significantly affecting the trunk flexion angle. The coefficient of determination adjusted for the degree of freedom was 0.294 (p < 0.05). Our results suggest that patients with lumbar spinal stenosis choose one of two strategies to alleviate symptoms during walking. One strategy is gait with trunk flexion posture to increase step length and hip extension angle. The other strategy is gait with trunk upright posture to decrease step length and hip extension angle.