Sinaki Mehrsheed, Brey Robert H, Hughes Christine A, Larson Dirk R, Kaufman Kenton R
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA.
Osteoporos Int. 2005 Aug;16(8):1004-10. doi: 10.1007/s00198-004-1791-2. Epub 2004 Nov 12.
This controlled trial was designed to investigate the influence of osteoporosis-related kyphosis (O-K) on falls. Twelve community-dwelling women with O-K (Cobb angle, 50-65 degrees measured from spine radiographs) and 13 healthy women serving as controls were enrolled. Mean age of the O-K group was 76 years (+/-5.1), height 158 cm (+/-5), and weight 61 kg (+/-7.9), and mean age of the control group was 71 years (+/-4.6), height 161 cm (+/-3.8), and weight 66 kg (+/-11.7). Quantitative isometric strength data were collected. Gait was monitored during unobstructed level walking and during stepping over an obstacle of four different heights randomly assigned (2.5%, 5%, 10%, and 15% of the subject's height). Balance was objectively assessed with computerized dynamic posturography consisting of the sensory organization test. Back extensor strength, grip strength, and all lower extremity muscle groups were significantly weaker in the O-K group than the control group (P <0.05), except right ankle plantar flexors (P =0.09). There was a significant difference in the anteroposterior and mediolateral displacements and velocities. The O-K subjects had less anteroposterior displacement, greater mediolateral displacement, reduced anteroposterior velocity, and increased mediolateral velocity compared with controls for all conditions of unobstructed and obstructed level walking. Obstacle height had a significant effect on all center-of-mass variables. The O-K subjects had significantly greater balance abnormalities on computerized dynamic posturography than the control group (P =0.002). Data show that thoracic hyperkyphosis on a background of reduced muscle strength plays an important role in increasing body sway, gait unsteadiness, and risk of falls in osteoporosis.
这项对照试验旨在研究骨质疏松相关驼背（O-K）对跌倒的影响。招募了12名社区居住的患有O-K的女性（Cobb角，通过脊柱X光片测量为50-65度）和13名健康女性作为对照。O-K组的平均年龄为76岁（±5.1），身高158厘米（±5），体重61千克（±7.9），对照组的平均年龄为71岁（±4.6），身高161厘米（±3.8），体重66千克（±11.7）。收集了定量等长力量数据。在无障碍水平行走以及跨过随机分配的四种不同高度（受试者身高的2.5%、5%、10%和15%）的障碍物时监测步态。通过由感觉组织测试组成的计算机化动态姿势描记法客观评估平衡。除右踝跖屈肌外（P = 0.09），O-K组的背部伸肌力量、握力和所有下肢肌肉群均明显弱于对照组（P < 0.05）。前后和内外侧位移及速度存在显著差异。与对照组相比，在所有无障碍和有障碍水平行走条件下，O-K受试者的前后位移较小，内外侧位移较大，前后速度降低，内外侧速度增加。障碍物高度对所有质心变量有显著影响。O-K受试者在计算机化动态姿势描记法上的平衡异常明显大于对照组（P = 0.002）。数据表明，在肌肉力量减弱的背景下，胸椎后凸增加在骨质疏松症患者身体摇摆增加、步态不稳和跌倒风险增加中起重要作用。
