Miura Kousei, Koda Masao, Kadone Hideki, Kubota Shigeki, Shimizu Yukiyo, Kumagai Hiroshi, Nagashima Katsuya, Mataki Kentaro, Fujii Kengo, Noguchi Hiroshi, Funayama Toru, Abe Tetsuya, Sankai Yoshiyuki, Yamazaki Masashi
Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan; Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
J Clin Neurosci. 2018 Jun;52:141-144. doi: 10.1016/j.jocn.2018.03.010. Epub 2018 Mar 31.
Dropped head syndrome (DHS) is characterized by a chin-on-chest deformity, which can severely interfere with forward vision and impair activities of daily living. A standardized treatment strategy for DHS has not been established. To our knowledge, this is the first case report describing the efficacy of gait training using a hybrid assistive limb (HAL) for DHS. A 75-year-old man showed apparent head drop in a standing position, resulting in passively reducible chin-on-chest deformity. A radiograph image showed apparent cervical kyphosis. Center of gravity of the head (CGH)-C7 SVA was +115 mm, CL was -40°, and T1S 39°. The patient underwent a treatment program using HAL, in which gait training was mainly performed, 60 min a day, 5 days a week for 2 weeks (10 sessions). After 2-3 sessions, dropped head started to attenuate. At the end of 10 sessions, the patient was able to walk with normal posture and radiograph images showed cervical kyphosis dramatically decreased because of HAL training. CGH-C7 SVA was 42 mm, CL was -1.7°, and T1S was 30°. Three months' outpatient follow-up revealed a slight deterioration of cervical alignment. However, the patient was able to maintain a better cervical alignment than before HAL training and keep walking with forward vision. There were no complications in any HAL treatment session. In conclusion, gait training using HAL is an option for treatment of DHS in addition to previously reported neck extensor muscle training.
低头综合征（DHS）的特征是下巴贴胸畸形，这会严重干扰前方视野并损害日常生活活动。目前尚未建立DHS的标准化治疗策略。据我们所知，这是第一例描述使用混合辅助肢体（HAL）进行步态训练对DHS疗效的病例报告。一名75岁男性在站立位时出现明显的头部下垂，导致下巴贴胸畸形可被动复位。X线片显示明显的颈椎后凸。头部重心（CGH）-C7矢状面垂直轴（SVA）为+115mm，颈椎倾斜角（CL）为-40°，胸椎后凸角（T1S）为39°。该患者接受了使用HAL的治疗方案，其中主要进行步态训练，每天60分钟，每周5天，共2周（10次疗程）。2-3次疗程后，头部下垂开始减轻。10次疗程结束时，患者能够以正常姿势行走，X线片显示由于HAL训练颈椎后凸明显减轻。CGH-C7 SVA为42mm，CL为-1.7°，T1S为30°。三个月的门诊随访显示颈椎排列略有恶化。然而，患者能够保持比HAL训练前更好的颈椎排列，并能够向前看行走。在任何HAL治疗疗程中均无并发症发生。总之，除了先前报道的颈部伸肌训练外，使用HAL进行步态训练是治疗DHS的一种选择。
