Schimmel Janneke Jp, Groen Brenda E, Weerdesteyn Vivian, de Kleuver Marinus
Sint Maartenskliniek Research, Sint Maartenskliniek, P.O box 9011, Nijmegen, GM The Netherlands 6500.
Sint Maartenskliniek Research, Sint Maartenskliniek, P.O box 9011, Nijmegen, GM The Netherlands 6500 ; Radboud University Medical Centre, Donders Institute for Neuroscience, Department of Rehabilitation, Nijmegen, The Netherlands.
Scoliosis. 2015 Jun 9;10:18. doi: 10.1186/s13013-015-0042-y. eCollection 2015.
The spinal curvature in patients with Adolescent Idiopathic Scoliosis (AIS) causes an asymmetry of upper body postural alignment, which might affect postural balance. However, the currently available studies on balance in AIS patients are not consistent. Furthermore, it is not known whether potential deficits are similar between patients with single and double curves. Finally, the effects of a corrective posterior spinal fusion on postural balance have not yet been well established.
Postural balance was tested on a force plate, in 26 female subjects with AIS (12-18 years old; preoperative Cobb-angle: 42-71°; single curve n = 18, double curve n = 6) preoperatively, at 3 months and 1 year postoperatively. We also conducted a balance assessment in 18 healthy age-matched female subjects. Subjects were tested during quiet double-leg standing in four conditions (eyes open/closed; foam/solid surface), while standing on one leg, while performing a dynamic balance (weight shifting) task and while performing a reaching task in four directions.
AIS subjects did not demonstrate greater COP velocities than controls during the double-leg standing tasks. In the reaching task, however, they achieved smaller COP displacements than healthy controls, except in the anterior direction. AIS patients with double curves had significantly greater COP velocities in all test conditions compared to those with a single curve (p < 0.05). For the AIS group, a slight increase in COP velocities was observed in the foam eyes closed and right leg standing condition at 3 months post surgery. At 1-year post surgery, however, there were no significant differences in any of the outcome measures compared to the pre-surgery assessment, irrespective of the curve type.
Postural balance in AIS patients scheduled for surgery was similar to healthy age matched controls, except for a poorer reaching capacity. The latter finding may be related to their reduced range of motion of the spine. Patients with double curves demonstrated poorer balance than those with a single curve, despite the fact that they have a more symmetrical trunk posture. Postural balance one year after surgery did not improve as a result of the better spinal alignment, neither did the reduced range of trunk motion inherent to fusion negatively affect postural balance.
青少年特发性脊柱侧弯（AIS）患者的脊柱侧弯会导致上身姿势排列不对称，这可能会影响姿势平衡。然而，目前关于AIS患者平衡的研究结果并不一致。此外，尚不清楚单曲线和双曲线患者的潜在平衡缺陷是否相似。最后，矫正性后路脊柱融合术对姿势平衡的影响尚未明确。
对26名患有AIS的女性受试者（12 - 18岁；术前Cobb角：42 - 71°；单曲线18例，双曲线6例）在术前、术后3个月和1年时，使用测力台测试姿势平衡。我们还对18名年龄匹配的健康女性受试者进行了平衡评估。受试者在安静双腿站立的四种条件下（睁眼/闭眼；泡沫/坚实表面）、单腿站立时、进行动态平衡（重心转移）任务时以及在四个方向进行伸手任务时接受测试。
在双腿站立任务中，AIS受试者的重心（COP）速度并不比对照组更快。然而，在伸手任务中，除了向前方向外，他们的COP位移比健康对照组更小。与单曲线患者相比，双曲线AIS患者在所有测试条件下的COP速度均显著更高（p < 0.05）。对于AIS组，术后3个月在泡沫表面闭眼且右腿站立的条件下观察到COP速度略有增加。然而，术后1年时，与术前评估相比，无论曲线类型如何，任何一项结果指标均无显著差异。
计划接受手术的AIS患者的姿势平衡与年龄匹配的健康对照组相似，但伸手能力较差。后一发现可能与他们脊柱活动范围减小有关。双曲线患者的平衡比单曲线患者差，尽管他们的躯干姿势更对称。术后一年，尽管脊柱排列改善，但姿势平衡并未改善，融合固有的躯干活动范围减小也未对姿势平衡产生负面影响。
