Shin Sun-Shil, Yoo Won-Gyu
Technol Health Care. 2019;27(1):1-11. doi: 10.3233/THC-171082.
Patients with LSS tend to adopt a flexed lumbar posture and trunk position, particularly when stepping over an obstacle, as this activity alters the biomechanical demands placed on the trunk and lower extremities.
To investigate the effects of lumbar spinal stenosis (LSS) on patients' trunk and lower-extremity kinematics, and on activities involving the gluteus medius (GMed) and vastus lateralis (VL).
All participants (9 older adult patients with LSS and 11 control subjects) were required to negotiate an obstacle while walking. Trunk and lower-extremity kinematic data and GMed and VL activities were recorded using a synchronized 3D motion capture system and surface electromyography.
The thoracic (12.01∘± 8.82∘ and 16.45∘± 10.80∘) and spinal (9.92∘± 14.03∘ and 5.99∘± 15.94∘) flexion angles of the leading and trailing swing limbs were higher, and the pelvic anterior tilting angle (2.37∘± 7.76∘ and 10.38∘± 8.07∘) was lower in the LSS group than in the control group (p< 0.05). With the exception of toe-off and normalized GMed activities in the contralateral leading limb (p> 0.05), all GMed (256.73 ± 112.22%, 174.00 ± 75.79%, and 270.57 ± 114.45%, respectively) and VL (208.98 ± 124.81%, 182.97 ± 93.23%, 283.91 ± 154.71%, and 394.42 ± 108.94%, respectively) activities of the contralateral leading and trailing swing limb (heel-strike and toe-off normalized activities) were significantly higher in the LSS group than in the control group (p< 0.05).
Patients with LSS exhibited trunk-flexed postures when stepping over an obstacle, and these trunk alignments placed higher demands on the GMed and VL activities normalized by double-limb support during joint loading in the single-leg stance. These findings support clinical recommendations for regulating the physical activity of obstacle negotiation that may be beneficial in the management of patients with LSS.
腰椎管狭窄症（LSS）患者倾向于采取腰椎前屈姿势和躯干位置，尤其是在跨过障碍物时，因为这种活动会改变施加在躯干和下肢上的生物力学需求。
研究腰椎管狭窄症（LSS）对患者躯干和下肢运动学以及对涉及臀中肌（GMed）和股外侧肌（VL）活动的影响。
所有参与者（9名老年LSS患者和11名对照受试者）在行走时都需要跨过一个障碍物。使用同步3D运动捕捉系统和表面肌电图记录躯干和下肢运动学数据以及GMed和VL的活动。
LSS组中，领先和落后摆动肢体的胸椎（分别为12.01°±8.82°和16.45°±10.80°）和脊柱（分别为9.92°±14.03°和5.99°±15.94°）前屈角度更高，而骨盆前倾角度（分别为2.37°±7.76°和10.38°±8.07°）低于对照组（p<0.05）。除了对侧领先肢体在离地时以及GMed活动标准化后（p>0.05），LSS组中对侧领先和落后摆动肢体（足跟触地和离地时的活动标准化）的所有GMed活动（分别为256.73±112.22%、174.00±75.79%和270.57±114.45%）和VL活动（分别为208.98±124.81%、182.97±93.23%、283.91±154.71%和394.42±108.94%）均显著高于对照组（p<0.05）。
LSS患者在跨过障碍物时表现出躯干前屈姿势，并且这些躯干姿势在单腿站立时关节负荷期间对由双下肢支撑标准化后的GMed和VL活动提出了更高要求。这些发现支持了关于调节障碍物跨越身体活动的临床建议，这可能对LSS患者管理有益。
