Thoracic kyphosis and pelvic anteversion in patients with adult spinal deformity increase while walking: analyses of dynamic alignment change using a three-dimensional gait motion analysis system
Thoracic kyphosis and pelvic anteversion in patients with adult spinal deformity increase while walking: analyses of dynamic alignment change using a three-dimensional gait motion analysis system
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DOI：
10.1007/s00586-020-06312-y
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发表时间：
2020-01-31
影响因子：
2.8
通讯作者：
Yamazaki, Masashi
中科院分区：
文献类型：
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作者：
Miura, Kousei;Kadone, Hideki;Yamazaki, Masashi
目的 使用三维 (3D) 步态运动分析确定成人脊柱畸形 (ASD) 患者行走时脊柱骨盆排列的动态变化。方法 这项研究包括 20 名 ASD 患者。 3D 步态运动分析（Vicon）是在连续行走至极限的过程中进行的。使用棘突上的反射标记获得动态参数，将其分为胸椎（T-）、腰椎（L-）和整个脊柱（S-），矢状脊柱距离（SVA）和冠状一（CVA），矢状脊柱与垂直轴（SA）和冠状一（CA）的角度，矢状骨盆与水平轴（P-SA）和冠状（P-CA）的角度，以及胸椎有限脊柱骨盆角 (T-P SA) 和腰椎一角 (L-P SA)。将椭圆形走道最后一圈的动态变量与第一圈的动态变量进行比较。结果脊柱后凸畸形明显恶化。至于骨盆角度，平均 P-SA 参数（第一圈/最后一圈）为 3.2 度/5.2 度。持续行走至极限后骨盆矢状角前倾角明显增大。特别地，对于相对于骨盆角的有限脊柱角，平均T-P SA参数为30.5度/36.2度，L-P SA参数为6.4度/6.8度。胸椎后凸角明显增大，但腰椎后凸角无变化。结论 站立X线片上胸椎后凸和骨盆后倾的减少已被认为是ASD的代偿。我们用于确定脊柱平衡的 3D 步态运动分析发现，自闭症谱系障碍 (ASD) 患者在连续行走至耐力极限直至疲劳后，胸椎后凸和骨盆前倾显着增加，表明自闭症谱系障碍 (ASD) 代偿失败。
Purpose To determine dynamic changes of spinopelvic alignment while walking using a three-dimensional (3D) gait motion analysis in adult spinal deformity (ASD) patients. Methods This study included 20 ASD patients. The 3D gait motion analysis (Vicon) was performed during continuous walking to their limit. Dynamic parameters were obtained using reflective markers on the spinous processes, which were segmented into thoracic (T-), lumbar (L-), and whole spine (S-), sagittal spinal distance (SVA) and coronal one (CVA), sagittal spinal angle to the vertical axis (SA) and coronal one (CA), sagittal pelvic angle to the horizontal axis (P-SA) and coronal (P-CA), and thoracic limited spinal angle to the pelvic angle (T-P SA) and lumbar one (L-P SA). The dynamic variables at the final lap were compared with those at the first lap of an oval walkway. Results Spinal kyphotic deformity deteriorated significantly. As for pelvic angle, the mean P-SA parameters (first lap/final lap) were 3.2 degrees/5.2 degrees. Anteversion of pelvic sagittal angle increased significantly after continuous walking to their limit. In particular, regarding limited spinal angle to the pelvic angle, the mean T-P SA parameters were 30.5 degrees/36.2 degrees and L-P SA parameters were 6.4 degrees/6.8 degrees. Thoracic kyphotic angle increased significantly, but lumbar kyphotic angle did not change. Conclusion Decrease of thoracic kyphosis and pelvic retroversion has been recognized as a compensation for ASD on standing radiograph. Our 3D gait motion analysis to determine spinal balance found thoracic kyphosis and pelvic anteversion increased significantly in patients with ASD after continuous walking to the limit of their endurance until they were fatigued, indicating a failure of compensation for ASD.