Discrepancy Between Standing Posture and Sagittal Balance During Walking in Adult Spinal Deformity Patients
Discrepancy Between Standing Posture and Sagittal Balance During Walking in Adult Spinal Deformity Patients
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DOI：
10.1097/brs.0000000000001709
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发表时间：
2017-01-01
期刊：
影响因子：
3
通讯作者：
Matsuyama, Yukihiro
中科院分区：
文献类型：
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作者：
Arima, Hideyuki;Yamato, Yu;Matsuyama, Yukihiro
研究设计。回顾性案例系列。目的。本研究旨在确定站立和行走姿势存在差异的成人脊柱畸形 (ASD) 患者的特征。背景数据摘要。站立放射照相参数通常用于评估自闭症谱系障碍 (ASD) 患者。然而，据报道，站立 X 线摄影中矢状面排列相对较好的自闭症谱系障碍 (ASD) 患者行走时躯干前倾。方法。纳入 2011 年至 2013 年间在我院接受矫正手术和术前步态分析的 ASD 患者（n = 93；13 名男性，80 名女性；平均年龄，65.0 岁）。术前获取脊柱X光片和步态分析数据。测量侧位站立 X 射线上的站立躯干倾斜角 (STA)、侧向步态图像的步态躯干倾斜角 (GTA) 以及脊柱和骨盆的放射学参数（腰椎前凸 [LL]、骨盆倾斜和矢状垂直轴）。我们通过从 GTA 中减去 STA 来计算增加的躯干倾斜角 (ITA)，用作步行时站立姿势和矢状平衡之间差异的指标。我们检查了射线照相参数和 ITA 结果之间的关系。术前平均 STA 和 GTA 分别为 3.5 度和 11.1 度。术前平均 ITA 为 7.6 度，代表站立姿势与行走时矢状平衡之间的差异程度。术前平均矢状垂直轴、LL、骨盆倾角 (PI)、骨盆倾斜度和 PI 减去 LL 分别为 102.6 mm、20.3 度、52.9 度、32.1 度和 32.6 度。 PI减去LL失配与ITA呈正相关（R = 0.237，P = 0.023）。特别是，PI 减去 LL 失配超过 40 度的 ASD 患者的 ITA 显着更高。结论。步态分析显示，术前站立行走差异与严重的 PI - LL 不匹配有关。
Study Design. Retrospective case series.Objective. The present study aimed to determine the characteristics of patients with adult spinal deformity (ASD) with a discrepancy between standing and walking postures.Summary of Background Data. Standing radiographic parameters are typically used to evaluate patients with ASD. Patients with ASD with relatively good sagittal alignment on standing radiography have, however, been reported to walk with a forward trunk tilt.Methods. Patients with ASD (n = 93; 13 men, 80 women; mean age, 65.0 yr) who underwent corrective surgery and preoperative gait analysis at our hospital between 2011 and 2013 were included. Spine radiographs and gait analysis data were acquired preoperatively. Standing-trunk tilt angle (STA) on lateral standing x-ray, gait-trunk tilt angle (GTA) from lateral gait images, and radiographic parameters of the spine and pelvis (lumbar lordosis [LL], pelvic tilt, and sagittal vertical axis) were measured. We calculated the increasing trunk tilt angle (ITA), by subtracting the STA from the GTA, for use as an index of discrepancy between standing posture and sagittal balance during walking. We examined the relation between radiographic parameters and ITA.Results. The mean preoperative STA and GTA were 3.5 degrees and 11.1 degrees, respectively. The mean preoperative ITA, which represents the degree of discrepancy between standing posture and sagittal balance during walking, was 7.6 degrees. The mean preoperative sagittal vertical axis, LL, pelvic incidence (PI), pelvic tilt, and PI minus LL were 102.6 mm, 20.3 degrees, 52.9 degrees, 32.1 degrees, and 32.6 degrees, respectively. The PI minus LL mismatch was positively correlated with the ITA (R = 0.237, P = 0.023). In particular, patients with ASD with a PI minus LL mismatch of more than 40 degrees had a significantly greater ITA.Conclusion. Gait analysis revealed that a preoperative standing-walking discrepancy is associated with severe PI - LL mismatch.