Tramonti C, Di Martino S, Unti E, Frosini D, Bonuccelli U, Rossi B, Ceravolo R, Chisari C
Unit of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, Italy.
Unit of Neurology, Department of Medical Specialties, University Hospital of Pisa, Italy.
Gait Posture. 2017 Sep;57:130-135. doi: 10.1016/j.gaitpost.2017.05.029. Epub 2017 Jun 10.
This is an observational cross-sectional study evaluating gait dynamics in patients with Parkinson's Disease (PD) and severe postural deformities, PD without axial deviations and healthy subjects. Ten PS individuals with Pisa syndrome (PS) and nine subjects with Camptocormia (CC) performed 3-D Gait Analysis and were evaluated with walking and balance scales. Correlations with clinical and functional scales were investigated. Spatio-temporal and kinematic data were compared to ten PD subjects without postural deformities (PP) and ten healthy matched individuals (CG). Data obtained showed decreased walking velocity, stride and step length in PP, PS and CC groups compared to controls. The correlation analysis showed that stride and step length were associated with reduced functional abilities and disease severity in PS and CC groups. Kinematic data revealed marked reduction in range of movements (ROMs) at all lower-extremity joints in PS group. While, in CC group the main differences were pronounced in hip and knee joints. PS and CC groups presented a more pronounced reduction in hip articular excursion compared to PP subjects, revealing an increased hip flexion pattern during gait cycle. Moreover, the increased hip and knee flexion pattern adversely affected functional performance during walking tests. Results obtained provide evidence that step length, along with stride length, can be proposed as simple and clear indicators of disease severity and reduced functional abilities. The reduction of ROMs at hip joint represented an important mechanism contributing to decreased walking velocity, balance impairment and reduced gait performance in PD patients with postural deformities.
这是一项观察性横断面研究，评估帕金森病（PD）合并严重姿势畸形患者、无轴向偏差的PD患者以及健康受试者的步态动力学。10名患有比萨综合征（PS）的患者和9名患有弯腰驼背（CC）的患者进行了三维步态分析，并通过步行和平衡量表进行评估。研究了与临床和功能量表的相关性。将时空和运动学数据与10名无姿势畸形的PD患者（PP）和10名健康对照个体（CG）进行比较。获得的数据显示，与对照组相比，PP、PS和CC组的步行速度、步幅和步长均降低。相关分析表明，PS和CC组的步幅和步长与功能能力下降和疾病严重程度相关。运动学数据显示，PS组所有下肢关节的运动范围（ROM）明显减小。而在CC组，主要差异在髋关节和膝关节更为明显。与PP受试者相比，PS和CC组的髋关节活动度下降更为明显，表明在步态周期中髋关节屈曲模式增加。此外，髋关节和膝关节屈曲模式增加对步行测试中的功能表现产生了不利影响。获得的结果提供了证据，表明步长与步幅一起，可以作为疾病严重程度和功能能力下降的简单明了的指标。髋关节ROM的减小是导致PD姿势畸形患者步行速度降低、平衡障碍和步态表现下降的重要机制。
