Nikaido Yasutaka, Akisue Toshihiro, Urakami Hideyuki, Kajimoto Yoshinaga, Kuroda Kenji, Kawami Yuki, Sato Hisatomo, Ohta Yoshiyuki, Hinoshita Tetsuya, Iwai Yuka, Nishiguchi Tadayuki, Ohno Hiroshi, Saura Ryuichi
Clinical Department of Rehabilitation, Osaka Medical College Hospital, Osaka, Japan; Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan.
Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan.
Clin Neurol Neurosurg. 2018 Sep;172:46-50. doi: 10.1016/j.clineuro.2018.06.032. Epub 2018 Jun 30.
This study aimed to confirm whether cerebrospinal fluid (CSF) shunting for idiopathic normal-pressure hydrocephalus (iNPH) improves postural instability, and to investigate the relationship between postural control and gait ability.
Twenty-three iNPH patients and 18 age-matched healthy controls (HC) were examined using the timed up and go (TUG) test and a force platform for calculating the center of pressure (COP) trajectory during voluntary multidirectional leaning and quiescent standing. We determined the patients' TUG values and COP trajectories before and after shunt surgery.
Postural sway was greater in iNPH patients before shunt surgery and the TUG value was lower in iNPH patients before shunt surgery than in HC. Voluntary COP movements were significantly improved in iNPH patients at 1 week post-surgery, but no significant changes in quiescent standing were found between pre- and post-surgery. Significant correlations were found between the TUG value and voluntary COP movements in iNPH patients before and after surgery, but no significant correlations were observed between the TUG value and quiescent standing.
Our results indicate that CSF shunting in iNPH patients may improve voluntary postural control and reduce the risk of falling. Impaired voluntary COP control in iNPH patients may reflect the underlying pathophysiological mechanisms of balance disturbance in iNPH.
本研究旨在确认特发性正常压力脑积水（iNPH）的脑脊液（CSF）分流术是否能改善姿势不稳，并研究姿势控制与步态能力之间的关系。
对23例iNPH患者和18例年龄匹配的健康对照者（HC）进行定时起立行走（TUG）测试，并使用测力平台计算在自主多方向倾斜和安静站立期间的压力中心（COP）轨迹。我们测定了分流手术前后患者的TUG值和COP轨迹。
iNPH患者在分流手术前的姿势摆动更大，且分流手术前iNPH患者的TUG值低于HC。iNPH患者在术后1周时自主COP运动有显著改善，但手术前后安静站立时未发现显著变化。iNPH患者手术前后的TUG值与自主COP运动之间存在显著相关性，但TUG值与安静站立之间未观察到显著相关性。
我们的结果表明，iNPH患者的CSF分流术可能会改善自主姿势控制并降低跌倒风险。iNPH患者自主COP控制受损可能反映了iNPH平衡障碍的潜在病理生理机制。
