D'Amico Moreno, Roncoletta Piero, Di Felice Francesca, Porto Daniele, Bellomo Rosagrazia, Saggini Raoul
Skeleton Movement Analysis & Advanced Rehabilitation Technology, Università D'Annunzio, Chieti, Italy.
Stud Health Technol Inform. 2012;176:146-50.
The aetiological aspects as well as postural attitude implications represent an open question in scoliosis evaluation and treatment. Leg length discrepancy (LLD) is often recognised in scoliotic patients, but surprisingly still controversial is the use of underfoot wedge corrections in order to compensate pelvis tilt. In fact, literature reports conflicting results on the efficacy of LLD equalization also given the argued uncertainty of LLD clinical assessment and limitations related to X-ray measurements. Moreover concern is about anatomic and functional LLD and associated estimation of the pelvic torsion. In such a topic, a significant helpful tool has been demonstrated to be 3D kinematic optoelectronic measurements and other useful data obtained from force platforms and/or baropodographic systems. 135 (94.4%) out of 143 Scoliotic patients sample (av. age 16.4±10.2 Y range 4-66 Y), have been found to improve posture when LLD was corrected. The 143 patients showed a mean lower limb discrepancy of μ=10.2±5.2mm associated to a mean main scoliotic curve μ=16.4°±9.4° Cobb (frontal plane), mean Spinal offset μ=7.5±5.5mm and mean Global offset μ=10.1±7.1mm. The applied paired t-test comparison (indifferent vs. corrected orthostasis) showed significant (p < 0.05) postural improvements could be obtained in the whole or in a part of the considered postural parameters, after the application of suitable under-foot wedge. The present investigation confirm results of a previous study demonstrating the efficacy of under-foot wedge use in leg asymmetry correction, posture re-balancing and spine deformities reduction, pointing out the significant contribution of the 3D opto-electronic measurement approach in the critical process of assessing the correct under-foot wedge size, therapy planning and monitoring.
病因学方面以及姿势态度影响在脊柱侧弯评估和治疗中仍是一个悬而未决的问题。脊柱侧弯患者中常发现腿长差异（LLD），但令人惊讶的是，为补偿骨盆倾斜而使用足底楔形矫正器仍存在争议。事实上，鉴于LLD临床评估存在争议的不确定性以及与X射线测量相关的局限性，文献报道了关于LLD均衡疗效的相互矛盾的结果。此外，人们还关注解剖学和功能性LLD以及相关的骨盆扭转估计。在这个主题中，3D运动学光电测量以及从力平台和/或压力足印系统获得的其他有用数据已被证明是一个重要的有用工具。在143例脊柱侧弯患者样本（平均年龄16.4±10.2岁，范围4 - 66岁）中，发现135例（94.4%）在LLD得到矫正后姿势有所改善。这143例患者下肢平均差异为μ = 10.2±5.2mm，主要脊柱侧弯曲线平均为μ = 16.4°±9.4° Cobb（额面），脊柱平均偏移μ = 7.5±5.5mm，整体平均偏移μ = 10.1±7.1mm。应用配对t检验比较（未矫正与矫正后直立位）表明，在应用合适的足底楔形矫正器后，在全部或部分所考虑的姿势参数方面可获得显著（p < 0.05）的姿势改善。本研究证实了先前一项研究的结果，该研究表明使用足底楔形矫正器在矫正腿部不对称、重新平衡姿势和减少脊柱畸形方面具有疗效，指出了3D光电测量方法在评估正确的足底楔形矫正器尺寸、治疗计划和监测的关键过程中的重要贡献。
