Sarwahi Vishal, Boachie-Adjei Oheneba, Backus Sherry I, Taira Gaku
Hospital for Special Surgery, New York, New York 10021, USA.
Spine (Phila Pa 1976). 2002 Nov 1;27(21):2328-37. doi: 10.1097/00007632-200211010-00005.
This study prospectively analyzed gait in 21 patients with flatback and reviewed radiographs and charts.
To analyze the effect of sagittal imbalance on gait and hip and knee joints.
Loss of lumbar lordosis causes anterior displacement of the center of gravity, which creates instability and increases the work of gait. Several compensatory changes occur in response. The long-term effect of these changes on extra-axial joints has not been reported, nor have many studies analyzed the gait deviations in patients with flatback. Over time, as patients' ability to compensate is limited, increased gait deviations result.
A total of 21 of 44 patients who had gait analysis as part of the preoperative workup were selected based on outlined criteria. Kinetics and kinematics data were analyzed along with radiographic and chart review. Normal healthy individuals served as controls.
Gait deviations were present in gait kinetics and kinematics, including decreased stride length and velocity, to almost 60% of controls. Stance duration was prolonged with increased hip and knee flexion during stance. Hip and knee extensor moments were decreased with vertical ground reaction force showing slower rate of loading, reduced peak values, and flattening of normal loading response.
Patients with flatback develop several compensatory mechanisms. The goal of the compensation is to maintain an efficient gait and decrease joint damage, but these safeguards fail over time. Flatback not only causes backache, abnormal posture, and abnormal body mechanics but also compromises the stability of gait and taxes the knee and hip joints adversely.
本研究对21例平背患者的步态进行了前瞻性分析，并回顾了X线片和病历。
分析矢状面失衡对步态以及髋关节和膝关节的影响。
腰椎前凸的丧失导致重心向前移位，从而产生不稳定并增加步态工作量。相应地会出现几种代偿性变化。这些变化对轴外关节的长期影响尚未见报道，也很少有研究分析平背患者的步态偏差。随着时间的推移，由于患者的代偿能力有限，步态偏差会增加。
根据既定标准，从44例将步态分析作为术前检查一部分的患者中选取了21例。对动力学和运动学数据以及X线片和病历回顾进行了分析。正常健康个体作为对照。
步态动力学和运动学中存在步态偏差，包括步幅长度和速度降低，几乎达到对照组的60%。站立期延长，站立时髋关节和膝关节屈曲增加。髋关节和膝关节伸肌力矩降低，垂直地面反作用力显示加载速率减慢、峰值降低以及正常加载反应变平。
平背患者会出现几种代偿机制。代偿的目的是维持高效步态并减少关节损伤，但随着时间的推移这些保护措施会失效。平背不仅会导致背痛、姿势异常和身体力学异常，还会损害步态稳定性并对膝关节和髋关节产生不利影响。
