A link between parity, trunk muscle function, and degenerative spondylolisthesis

产次、躯干肌肉功能和退行性脊椎滑脱之间的联系

• 批准号: 7988770
• 负责人: Jacek Cholewicki
• 金额: $ 19.99万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-17 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7988770
• 关键词: Abdomen; Abdominal Muscles; Age; American; Back; Biomechanics; Case-Control Studies; Cesarean section; Childbirth; Chronic; Clinical assessments; Control Groups; Development; Diagnosis; Disease; Equilibrium; Ethnic Origin; Female; Future; Healthcare; Hip region structure; Intervention; Lead; Life; Link; Low Back Pain; Measures; Mediating; Muscle; Muscle function; Musculoskeletal Equilibrium; Older Population; Operative Surgical Procedures; Patients; Pelvis; Physical Examination; Precipitating Factors; Pregnancy; Public Health; Questionnaires; Race; Reflex action; Risk Factors; Rosa; Spondylolisthesis; Testing; Time; Vertebral column; Woman; Women' s Group; age group; base; cost; effective intervention; innovation; men; motor control; novel strategies; parity; public health relevance; response; spine bone structure

DESCRIPTION (provided by applicant): This study will examine relationships between pregnancy, cesarean section (CS) and other abdominal surgery, trunk and abdominal muscle deficiency, and degenerative spondylolisthesis (DS) in older females. The key question is whether pregnancy and/or CS mediated trunk muscle deficiency could be a precipitating factor in the development of DS later in life. Three specific aims are to determine whether: (1) parity/CS/other abdominal surgeries are associated with DS, (2) trunk muscle deficiency is associated with DS, and (3) parity/CS/other abdominal surgeries are associated with trunk muscle deficiency. The costs associated with the treatment of degenerative low back disease make it one of the top 5 most expensive conditions in the American healthcare economy. DS is considered one of the major causes of low back pain among the older population. Women suffer from DS at a 3-9 times higher rate than men, as yet, without a clear explanation. Previous studies documented relationships between pregnancy and low back pain, and suggested abdominal muscle deficiency as an underlying cause. Of special concern is the effect of CS. The rates of CS rose three-fold over the last 3 decades and may cause significant public health problems regarding DS in coming years. We propose to conduct a case-control study of 200 DS patients and 200 age-matched (in 5 year age groups) controls, including a more detailed assessment of trunk muscle function in 80 DS and 80 matched control subjects. Group designation will be based on a DS diagnosis from a sagittal view x-ray. The 400 subjects will be administered a detailed questionnaire regarding their parity, CS, previous surgeries, and other potential covariates. A subset of 80 subjects from each group will in addition undergo a physical examination of their abdominal and trunk muscle function and quantitative assessment of motor control. Physical exam will include abdominal muscle and hip extension tests. These tests examine the ability of the abdominal and paraspinal muscles to stabilize pelvis and the lumbar spine during simple hip flexion and extension maneuvers. Motor control tests will quantify muscle reflex latencies in response to sudden trunk perturbations, and postural control while balancing on an unstable seat. Both delayed muscle reflex responses and poor postural control are associated with low back pain and constitute predisposing risk factors to future low back problems. Poor motor control could lead to spine instability, chronic problems and degenerative changes in the spine over time. All measures will be quantified (continuous or categorized) and used in the regression and chi-square analyses to test the hypotheses. Innovative aspects of this proposal comprise of quantifying muscle function objectively and documenting variables related to parity in women with and without DS, which gives a better chance of finding any relationships that might exist. PUBLIC HEALTH RELEVANCE: The costs associated with the treatment of degenerative low back disease make it one of the top 5 most expensive conditions in the American healthcare economy. Women suffer from DS at a 3-9 times higher rate than men, as yet, without a clear explanation. If the number of childbirths and cesarean sections predisposes women to this condition later in life, proactive planning of effective intervention strategies and educational campaigns would be prudent.

描述（由申请人提供）：本研究将检查妊娠、剖宫产（CS）和其他腹部手术、躯干和腹肌缺陷与老年女性退行性脊椎前移（DS）之间的关系。关键问题是妊娠和/或CS介导的躯干肌缺陷是否可能是日后发生DS的促发因素。三个具体目标是确定：（1）产次/CS/其他腹部手术是否与DS相关，（2）躯干肌缺陷是否与DS相关，以及（3）产次/CS/其他腹部手术是否与躯干肌缺陷相关。 与治疗退行性下背部疾病相关的费用使其成为美国医疗保健经济中最昂贵的5种疾病之一。DS被认为是老年人腰痛的主要原因之一。女性患DS的比率比男性高3-9倍，但尚未有明确的解释。以前的研究记录了怀孕和腰痛之间的关系，并建议腹部肌肉不足是一个潜在的原因。特别值得关注的是CS的影响。在过去的30年中，CS的发病率上升了三倍，并可能在未来几年中引起与DS有关的重大公共卫生问题。 我们建议对200例DS患者和200例年龄匹配（5岁年龄组）对照进行病例对照研究，包括对80例DS和80例匹配对照受试者的躯干肌肉功能进行更详细的评估。分组将基于矢状位X线片的DS诊断。将对400例受试者进行关于其产次、CS、既往手术和其他潜在协变量的详细问卷调查。此外，每组80例受试者的亚组将接受腹部和躯干肌肉功能的体格检查以及运动控制的定量评估。体格检查将包括腹部肌肉和髋关节伸展测试。这些测试检查在简单的髋关节屈曲和伸展动作中腹部和椎旁肌肉稳定骨盆和腰椎的能力。运动控制测试将量化对躯干突然扰动的肌肉反射，以及在不稳定座椅上保持平衡时的姿势控制。延迟的肌肉反射反应和不良的姿势控制都与腰痛有关，并构成未来腰痛问题的易感风险因素。运动控制不良可能会导致脊柱不稳定，慢性问题和退行性变化的脊柱随着时间的推移。所有指标都将量化（连续或分类），并用于回归和卡方分析，以检验假设。 该提案的创新方面包括客观地量化肌肉功能，并记录与患有和不患有DS的女性的奇偶性相关的变量，这使得找到可能存在的任何关系的机会更大。 公共卫生关系：与治疗退行性下背部疾病相关的费用使其成为美国医疗保健经济中最昂贵的5种疾病之一。女性患DS的比率比男性高3-9倍，但尚未有明确的解释。如果分娩和剖腹产的数量使妇女在以后的生活中容易出现这种情况，那么积极主动地规划有效的干预策略和教育活动将是谨慎的。