地面反力解析颈段脊髓型颈椎病的步态改变。
Gait Alteration in Cervical Spondylotic Myelopathy Elucidated by Ground Reaction Forces.
机构信息
Texas Back Institute Research Foundation, Plano, TX.
Texas Back Institute, Rockwall, TX.
出版信息
Spine (Phila Pa 1976). 2019 Jan 1;44(1):25-31. doi: 10.1097/BRS.0000000000002732.
STUDY DESIGN
.: Prospective cohort study.
OBJECTIVE
.: Analyze GRF parameters in cervical spondylotic myelopathy (CSM) patients to elucidate gait alterations as compared with healthy controls.
SUMMARY OF BACKGROUND DATA
.: During the human gait cycle, the magnitude and direction of the force each foot imparts on the ground varies in a controlled fashion to propel the body's center of mass forward. Alterations in GRF patterns can both point to subtle gait disturbances and explain altered gait patterns such as that seen in CSM.
METHODS
.: Thirty-two patients with symptomatic CSM who have been scheduled for surgery, along with 30 healthy controls (HC), underwent clinical gait analysis a week before surgery. Vertical GRF parameters and force magnitude and timing at various points of the gait cycle (i.e., heel contact, maximum weight acceptance, mid-stance, and push off) were analyzed and compared between groups.
RESULTS
.: Increased heel contact (CSM: 60.13% vs. HC: 27.82% of body weight, BW,P = 0.011), maximum weight acceptance (CSM: 120.13% vs. HC: 100.97% of BW, P = 0.016), and diminished push off (CSM: 91.35% vs. HC: 106.54% of BW, P = 0.001) forces were discovered in CSM patients compared with HC. Compared with controls CSM patients had delayed heel contact (CSM: 9.32% vs. HC: 5.12% of gait cycle, P = 0.050) and earlier push off (CSM: 54.96% vs. HC: 59.0% of gait cycle, P = 0.050), resulting in a shorter stance phase.
CONCLUSION
.: This study reinforces how CSM patients commonly exhibit altered gait patterns, but also uniquely demonstrates the increased heel-contract and maximum weight acceptance forces, diminished toe-off forces, and the shorter stance phase to absorb the BW load. When examined from a global perspective, these altered GRF parameters reflect the difficulty CSM patients have with catching their center of mass during heel-contact to avoid falling and with subsequently propelling themselves forward.
LEVEL OF EVIDENCE
研究设计
前瞻性队列研究。
目的
分析颈椎病患者的 GRF 参数，以阐明与健康对照组相比步态的变化。
背景资料概要
在人类步态周期中，脚对地面施加的力的大小和方向以受控的方式变化，以推动身体的质心向前。GRF 模式的改变不仅可以指出微妙的步态障碍，还可以解释改变的步态模式，如颈椎病患者所见。
方法
32 例颈椎病患者（CSM），术前已安排手术，同时 30 例健康对照组（HC），在术前一周进行临床步态分析。分析和比较组间各步态周期点（即足跟接触、最大承重、中间站立和推离）的垂直 GRF 参数、力大小和时间。
结果
CSM 患者的足跟接触（CSM：60.13% vs. HC：27.82% of body weight, BW，P = 0.011）、最大承重（CSM：120.13% vs. HC：100.97% of BW，P = 0.016）和推离（CSM：91.35% vs. HC：106.54% of BW，P = 0.001）力均增加。与对照组相比，CSM 患者的足跟接触延迟（CSM：9.32% vs. HC：5.12% of gait cycle，P = 0.050）和推离提前（CSM：54.96% vs. HC：59.0% of gait cycle，P = 0.050），导致站立相缩短。
结论
本研究再次证实了 CSM 患者通常表现出改变的步态模式，但也独特地展示了增加的足跟接触和最大承重力、减小的足趾离地力以及更短的站立相，以吸收 BW 负荷。从全局角度来看，这些改变的 GRF 参数反映了 CSM 患者在足跟接触时难以捕捉质心以避免摔倒，并随后向前推进。
证据水平
3。
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