Department of Rehabilitation, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
Faculty of Medical Technology, Department of Prosthetics and Orthotics and Assistive Technology, Niigata University of Health and Welfare, Niigata, Japan.
PLoS One. 2018 May 10;13(5):e0197228. doi: 10.1371/journal.pone.0197228. eCollection 2018.
Lumbar spinal stenosis causes cauda equina and nerve root compression, resulting in neurological symptoms. Although trunk flexion during level walking may alleviate these symptoms by enabling spinal canal decompression, some patients do not use this strategy. We aimed to identify the kinetic and kinematic variables that affect trunk flexion in patients during level walking. Gait was recorded in 111 patients using a three-dimensional motion capture system and six force plates. From the data recorded, walking velocity, bilateral step length, cycle time, maximum trunk flexion angle, forward pelvic tilt angle, pelvic rotation angle, maximum and minimum joint angles, and moment and power of the lower limb were calculated. Then a step-wise multiple regression analysis was conducted to identify kinetic and kinematic variables affecting trunk flexion. The maximum hip extension angle (β = 0.416), maximum hip flexion moment (β = -0.348), and step length (β = 0.257) were identified as variables significantly affecting the trunk flexion angle. The coefficient of determination adjusted for the degree of freedom was 0.294 (p < 0.05). Our results suggest that patients with lumbar spinal stenosis choose one of two strategies to alleviate symptoms during walking. One strategy is gait with trunk flexion posture to increase step length and hip extension angle. The other strategy is gait with trunk upright posture to decrease step length and hip extension angle.
腰椎管狭窄症导致马尾和神经根受压，从而产生神经症状。虽然在平路行走时躯干前屈可以通过椎管减压来缓解这些症状，但有些患者并不采用这种策略。本研究旨在确定影响平路行走时患者躯干前屈的运动学和运动学变量。通过三维运动捕捉系统和六块测力板记录了 111 名患者的步态。从记录的数据中，计算了行走速度、双侧步长、周期时间、最大躯干前屈角度、骨盆前倾角度、骨盆旋转角度、最大和最小关节角度以及下肢的力矩和功率。然后进行逐步多元回归分析，以确定影响躯干前屈的运动学和运动学变量。最大髋关节伸展角度（β=0.416）、最大髋关节屈曲力矩（β=-0.348）和步长（β=0.257）被确定为显著影响躯干前屈角度的变量。自由度调整的决定系数为 0.294（p<0.05）。我们的研究结果表明，腰椎管狭窄症患者在行走时选择两种策略之一来缓解症状。一种策略是躯干前屈姿势的步态，以增加步长和髋关节伸展角度。另一种策略是躯干直立姿势的步态，以减少步长和髋关节伸展角度。
