Weight distribution in the sitting position in patients with paralytic scoliosis: pre- and postoperative evaluation
Weight distribution in the sitting position in patients with paralytic scoliosis: pre- and postoperative evaluation
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麻痹性脊柱侧凸患者坐位时的体重分布：术前和术后评估
DOI：
10.1007/s00586-001-0373-7
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发表时间：
2002
影响因子：
2.8
通讯作者：
B. Öberg
中科院分区：
文献类型：
--
作者：
E. Larsson;S. Aaro;H. Normelli;B. Öberg
麻痹性脊柱侧凸患者大部分时间处于坐姿。脊柱畸形、骨盆畸形和座椅表面上不均匀的重量分布需要在轮椅中频繁地进行座椅调整。在这项前瞻性研究中，对45名轮椅患者进行了术前和43名术后评估。术前和术后评价由独立观察员进行。1993年至1996年间进行了手术矫正。评估包括在箱子上的坐姿平衡;轮椅上的座椅支撑数量;使用计算机化EMED系统测量的座椅表面上的重量分布; Cobb角;髋关节脱位; T1和顶椎相对于从S1棘突向上绘制的垂直线的内外侧平移;以及髂嵴最近端点之间绘制的线的骨盆稳定性。坐位X线测量Cobb角和骨盆弯曲度。获得了27名正常受试者的座椅表面正常重量分布的参考值，并显示单侧支撑重量的平均值为59%。对术前结果进行逐步回归分析，结果显示骨盆的稳定性和胸腰椎/腰椎的不平衡解释了座位表面的重量分布（R2=0.45）。术后1年，除坐位平衡和T1不平衡外，所有变量均显著改善。当将材料分为两个亚组时，结果显示术后体重分布均匀（一侧50-59%）和不均匀（一侧60-100%）的个体之间的脊柱侧凸、骨盆弯曲或坐姿的任何评估参数均无显著差异。评估结果显示，手术矫正后有明显改善，但大多数仍有骨盆畸形和坐位体重分布不均匀。术前座位表面上的重量分布由胸腰椎/腰椎不平衡和骨盆不平衡解释，R2 = 0.45。体重分布均匀和体重分布不均匀的个体在任何变量上都没有显著差异。而体重分布均匀组的平均骨盆倾斜度为6°，体重分布不均匀组的平均骨盆倾斜度为12°。对于麻痹性脊柱侧凸患者，应注意座椅表面和调整座椅位置。
Patients with paralytic scoliosis spend most of their time in the sitting position. The spinal deformity, pelvic obliquity and uneven weight distribution on the seating surface necessitates frequent seating adaptations in the wheelchair. In this prospective study, 45 wheelchair-bound patients were evaluated preoperatively and 43 postoperatively. The pre- and postoperative evaluation was done by an independent observer. Surgical correction was performed between 1993 and 1996. Assessments included sitting balance on a box; number of seating supports in the wheelchair; weight distribution on the seating surface, measured with a computerized EMED system; Cobb angle; hip dislocation; mediolateral translation of T1 and of the apex vertebra with reference to a perpendicular line drawn upwards from the spinal process of S1; and pelvic obliquity from a line drawn between the most proximal points in the iliac crests. X-rays for the measurement of Cobb angle and pelvic obliquity were performed in sitting position. Reference values for normal weight distribution on the seating surface were obtained for 27 normal subjects and revealed a mean value of 59% of weight supported on one side. A stepwise regression analysis on the preoperative results showed that pelvic obliquity and thoracolumbar/lumbar spinal imbalance explained weight distribution on the seating surface (R2=0.45). There were significant improvements in all variables except in sitting balance and imbalance of T1, 1 year postoperatively. When dividing the material into two subgroups, the results showed no significant difference in any of the assessed parameters of the scoliosis, pelvic obliquity, or sitting position between individuals with even (50–59% on one side) and those with uneven (60–100% on one side) weight distribution postoperatively. The results of the assessment showed a significant improvement after surgical correction, but the majority still had pelvic obliquity and uneven weight distribution in a sitting position. The weight distribution on the seating surface preoperatively was explained by thoracolumbar/lumbar spinal imbalance and pelvic obliquity, withR2= 0.45. There were no significant differences in any variables in comparisons between individuals with even weight distribution and those with uneven weight distribution. For the group with even weight distribution, however, the mean pelvic obliquity was 6° and in the group with uneven weight distribution the mean pelvic obliquity was 12°. Attention to seating surface and adjustment of seating position is needed for patients with paralytic scoliosis.