Spinal Alignment and Mobility in Subjects with Chronic Low Back Pain with Walking Disturbance: A Community-Dwelling Study
Spinal Alignment and Mobility in Subjects with Chronic Low Back Pain with Walking Disturbance: A Community-Dwelling Study
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DOI：
10.1620/tjem.221.53
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发表时间：
2010-05-01
影响因子：
2.2
通讯作者：
Shimada, Yoichi
中科院分区：
文献类型：
--
作者：
Miyakoshi, Naohisa;Kasukawa, Yuji;Shimada, Yoichi
慢性下腰痛(LBP)受多种因素影响，通常表现为行走能力下降。然而，在普通人群中，脊柱排列和活动能力对这种情况和行走障碍的影响尚不清楚。研究对象为日本秋田市神谷县672名年龄在20~94岁(平均69岁)的社区居民，分为4组：无LBP病史的对照组(n=121)；有LBP病史的HLBP组(n=323)；慢性LBP无步行障碍的CLBP组(n=89)；慢性LBP伴步行障碍的CLBP-WD组(n=139)。在脊柱后凸角度、活动度和脊柱在直立、屈曲和伸展位置的倾斜度方面，研究了不同组之间的差异，所有这些都是使用计算机辅助设备测量的。与对照组相比，HLBP、CLBP和CLBP-WD组的腰椎伸展明显受限(P<；0.05)。与其他组相比，CLBP-WD组的胸腰椎后凸角度和脊柱倾斜度显著增加(P<；0.05)。在慢性LBP受试者(CLBP和CLBP-WD组)中，采用Logistic回归分析步行障碍与测量变量之间的关系。多因素分析显示，腰椎后凸角度、腰椎伸直位倾斜度与慢性LBP患者步行障碍相关。这些结果表明，腰椎后凸增加和全脊柱伸展受限是慢性LBP患者步行障碍的重要危险因素。
Chronic low back pain (LBP) is influenced by numerous factors and often shows a decline in walking abilities. However, the impact of spinal alignment and mobility on this condition and walking disturbance in the general population is unclear. A total of 672 community-dwelling individuals aged 20-94 years (mean, 69 years) in Kamikoani, Akita, Japan were divided into four groups: controls, subjects with no history of LBP (n = 121); HLBP group, subjects with a history of LBP (n = 323); CLBP group, subjects with chronic LBP without walking disturbance (n = 89); and CLBP-WD group, subjects with chronic LBP with walking disturbance (n = 139). Differences among groups were investigated in terms of angle of kyphosis, mobility, and inclination of the spine in upright, flexed, and extended positions, all measured using a computer-assisted device. HLBP, CLBP, and CLBP-WD groups showed significantly limited lumbar extension compared to controls (P < 0.05). The CLBP-WD group showed significantly increased thoracic and lumbar kyphosis angles and spinal inclination compared to the other groups (P < 0.05). Among subjects with chronic LBP (CLBP and CLBP-WD groups), associations between walking disturbance and measured variables were examined using logistic regression. According to multivariate analysis, lumbar kyphosis angle in upright position and spinal inclination in extended position were identified as indices associated with the presence of walking disturbance in subjects with chronic LBP. These results indicate that increased lumbar kyphosis and limitation of total spinal extension are important risk factors for walking disturbance in subjects with chronic LBP.