Zheng Chen-Fan, Liu Yan-Cheng, Hu Yong-Cheng, Xia Qun, Miao Jun, Zhang Ji-Dong, Zhang Kuan
Department of Biomechanics and Rehabilitation Engineering, School of Biomedical Engineering, and Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China.
Rehabilitation Engineering Research Department, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.
Orthop Surg. 2016 Nov;8(4):447-453. doi: 10.1111/os.12280.
Japanese Orthopaedic Association (JOA) scoring systems were developed to evaluate the neurological function of patients with cervical or lumbar degeneration. As patient-based and multi-dimensional clinical evaluation tools, these systems should be capable of reflecting the walking disability of patients. The association between JOA scores and gait parameters, however, are not well characterized. The purpose of this study was to determine the correlations between JOA scores and gait parameters of patients with cervical spondylotic myelopathy (CSM) and lumbar intervertebral disc herniation (LDH).
A total of 32 CSM and 30 LDH patients with gait dysfunction were recruited for the present study. All patients were diagnosed by two senior orthopaedic doctors and evaluated with JOA scoring systems. A body-mounted motion analyzer, the Intelligent Device for Energy Expenditure and Activity (IDEEA), was applied to measure gait parameters of patients across 30 m of flat floor in an orthopaedic ward. A linear regression model was used to determine the correlations between JOA scores and gait parameters. Multiple linear regressions were used to identify the relationships between subsections of the JOA systems and gait parameters.
Japanese Orthopaedic Association scores of LDH patients from the JOA lumbar scoring system are significantly correlated with gait speed (R = 0.557, P < 0.001) and stride length (R = 0.544, P < 0.001). JOA scores are also correlated with double support duration, step duration, cycle duration and cadence, and weakly correlated with single support duration. For the four subsections of the JOA lumbar scoring system, "restriction of activities of daily living" is the significant predictor of all gait parameters, especially gait speed (R = 0.573, P < 0.001) and stride length (R = 0.553, P < 0.001). However, JOA scores of CSM patients from the JOA cervical scoring system are only weakly correlated with these measures (all R < 0.3). For the four subsections of the JOA cervical scoring system, "motor function of the lower extremity" is a weak predictor of gait parameters (all R < 0.3).
There is a significant correlation between gait parameters and functional disability as measured by the JOA lumbar scoring system, which indicates that the JOA lumbar scoring system can reflect gait impairment. The JOA cervical scoring system, however, may need to be improved for efficiently evaluating the walking ability of CSM patients in the assessment of motor function of the lower extremity.
日本骨科协会（JOA）评分系统旨在评估颈椎或腰椎退变患者的神经功能。作为基于患者的多维度临床评估工具，这些系统应能够反映患者的行走障碍。然而，JOA评分与步态参数之间的关联尚未得到充分描述。本研究的目的是确定脊髓型颈椎病（CSM）和腰椎间盘突出症（LDH）患者的JOA评分与步态参数之间的相关性。
本研究共纳入32例有步态功能障碍的CSM患者和30例LDH患者。所有患者均由两位资深骨科医生确诊，并采用JOA评分系统进行评估。应用一种身体佩戴式运动分析仪，即能量消耗与活动智能设备（IDEEA），在骨科病房的30米平坦地面上测量患者的步态参数。采用线性回归模型确定JOA评分与步态参数之间的相关性。采用多元线性回归分析JOA系统各亚组与步态参数之间的关系。
JOA腰椎评分系统中LDH患者的日本骨科协会评分与步态速度（R = 0.557，P < 0.001）和步长（R = 0.544，P < 0.001）显著相关。JOA评分还与双支撑持续时间、步幅持续时间、周期持续时间和步频相关，与单支撑持续时间弱相关。对于JOA腰椎评分系统的四个亚组，“日常生活活动受限”是所有步态参数的显著预测因素，尤其是步态速度（R = 0.573，P < 0.001）和步长（R = 0.553，P < 0.001）。然而，JOA颈椎评分系统中CSM患者的JOA评分与这些指标仅呈弱相关（所有R < 0.3）。对于JOA颈椎评分系统的四个亚组，“下肢运动功能”是步态参数的弱预测因素（所有R < 0.3）。
JOA腰椎评分系统所测量的步态参数与功能障碍之间存在显著相关性，这表明JOA腰椎评分系统能够反映步态损害。然而，JOA颈椎评分系统可能需要改进，以便在评估下肢运动功能时有效评估CSM患者的行走能力。
