Smith Anne, O'Sullivan Peter, Straker Leon
School of Physiotherapy, Curtin University of Technology, Perth, Australia.
Spine (Phila Pa 1976). 2008 Sep 1;33(19):2101-7. doi: 10.1097/BRS.0b013e31817ec3b0.
A prospective study of the sagittal standing posture of 766 adolescents.
To determine whether posture subgroups based on photographic assessment are similar to those used clinically and to previous, radiographically determined subgroups of sagittal standing posture, and whether identified subgroups are associated with measures of spinal pain.
Relatively little research has been performed toward a classification of subjects according to sagittal spinal alignment. Clinical descriptions of different standing posture classifications have been reported, and recently confirmed in a radiographic study. There is limited epidemiological data available to support the belief that specific standing postures are associated with back pain, despite plausible mechanisms. As posture assessment using radiographic methods are limited in large population studies, successful characterization of posture using 2-dimensional photographic images will enable epidemiological research of the association between posture types and spinal pain. METHODS.: Three angular measures of thoraco-lumbo-pelvic alignment were calculated from lateral standing photographs of subjects with retro-reflective markers placed on bony landmarks. Subgroups of sagittal thoracolumbar posture were determined by cluster analysis of these 3 angular measures. Back pain experience was assessed by questionnaire. The associations between posture subgroups and spinal pain variables were evaluated using logistic regression.
Postural subtypes identified by cluster analysis closely corresponded to those subtypes identified previously by analysis of radiographic spinal images in adults and to those described clinically. Significant associations between posture subgroups and weight, height, body mass index, and gender were identified. Those adolescents classified as having non-neutral postures when compared with those classified as having a neutral posture demonstrated higher odds for all measures of back pain, with 7 of 15 analyses being statistically significant.
Meaningful classifications exist for adolescent sagittal thoraco-lumbo-pelvic alignment, and these can be determined successfully from sagittal photographs. More neutral thoraco-lumbo-pelvic postures are associated with less back pain.
对766名青少年的矢状面站立姿势进行前瞻性研究。
确定基于照片评估的姿势亚组是否与临床使用的以及先前通过放射学确定的矢状面站立姿势亚组相似，以及所确定的亚组是否与脊柱疼痛测量指标相关。
针对根据矢状面脊柱排列对受试者进行分类的研究相对较少。已有关于不同站立姿势分类的临床描述，最近在一项放射学研究中得到了证实。尽管有合理的机制，但支持特定站立姿势与背痛相关这一观点的流行病学数据有限。由于在大规模人群研究中使用放射学方法进行姿势评估存在局限性，使用二维照片图像成功表征姿势将有助于对姿势类型与脊柱疼痛之间的关联进行流行病学研究。方法：从在骨性标志点放置反光标记的受试者的侧位站立照片中计算胸腰骨盆排列的三个角度测量值。通过对这三个角度测量值进行聚类分析来确定矢状面胸腰椎姿势亚组。通过问卷评估背痛经历。使用逻辑回归评估姿势亚组与脊柱疼痛变量之间的关联。
通过聚类分析确定的姿势亚型与先前通过对成人放射学脊柱图像分析确定的亚型以及临床描述的亚型密切对应。确定了姿势亚组与体重、身高、体重指数和性别之间的显著关联。与被分类为具有中立姿势的青少年相比，那些被分类为具有非中立姿势的青少年在所有背痛测量指标上的几率更高，15项分析中有7项具有统计学意义。
青少年矢状面胸腰骨盆排列存在有意义的分类，并且可以从矢状面照片中成功确定。更中立的胸腰骨盆姿势与较少的背痛相关。
