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）：本研究将探讨老年女性怀孕、剖腹产（CS）和其他腹部手术、躯干和腹部肌肉缺乏以及退行性脊柱滑脱（DS）之间的关系。关键问题是妊娠和/或 CS 介导的躯干肌肉缺陷是否可能是以后生活中 DS 发展的促发因素。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) 躯干肌肉缺乏症与 DS 相关，以及 (3) 产次/CS/其他腹部手术与躯干肌肉缺乏症相关。 退行性腰背疾病的治疗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 的比率是男性的 3-9 倍，但迄今为止尚无明确的解释。之前的研究记录了怀孕和腰痛之间的关系，并表明腹部肌肉缺乏是一个根本原因。特别值得关注的是CS的效果。在过去 30 年里，CS 的发病率上升了三倍，并可能在未来几年引起与 DS 相关的重大公共卫生问题。 我们建议对 200 名 DS 患者和 200 名年龄匹配（5 岁年龄组）对照受试者进行病例对照研究，包括对 80 名 DS 和 80 名匹配对照受试者的躯干肌肉功能进行更详细的评估。组的指定将基于矢状面 X 射线的 DS 诊断。 400 名受试者将接受一份详细的调查问卷，内容涉及他们的胎次、CS、既往手术和其他潜在的协变量。每组中的 80 名受试者还将接受腹部和躯干肌肉功能的体检以及运动控制的定量评估。体检将包括腹部肌肉和髋部伸展测试。这些测试检查腹部和椎旁肌肉在简单的髋部屈曲和伸展动作中稳定骨盆和腰椎的能力。运动控制测试将量化响应突然的躯干扰动的肌肉反射潜伏期，以及在不稳定的座椅上保持平衡时的姿势控制。肌肉反射反应延迟和姿势控制不良都与腰痛有关，并构成未来腰痛问题的诱发危险因素。随着时间的推移，运动控制不良可能会导致脊柱不稳定、慢性问题和脊柱退行性变化。所有测量都将被量化（连续或分类）并用于回归和卡方分析以检验假设。 该提案的创新之处包括客观量化肌肉功能，并记录与患有和不患有 DS 的女性的性别相关的变量，这提供了更好的机会找到可能存在的任何关系。 公众健康相关性：退行性腰背疾病的治疗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 的比率是男性的 3-9 倍，但迄今为止尚无明确的解释。如果分娩和剖腹产的次数使妇女在以后的生活中容易出现这种情况，那么积极规划有效的干预策略和教育活动将是谨慎的做法。