成人退行性脊柱侧凸患者术前和术后的摇摆变化及神经肌肉活动与对照组比较。
The Change in Sway and Neuromuscular Activity in Adult Degenerative Scoliosis Patients Pre and Post Surgery Compared With Controls.
机构信息
Texas Back Institute, Plano, Texas.
出版信息
Spine (Phila Pa 1976). 2019 Aug 1;44(15):E899-E907. doi: 10.1097/BRS.0000000000003009.
STUDY DESIGN
Prospective cohort study.
OBJECTIVE
The purpose of this study is to quantify the extent of change in sway associated with maintaining a balanced posture within the cone of economy (CoE), in a group of adult degenerative scoliosis (ADS) patients' pre and postsurgery and compare them to matched non-scoliotic controls.
SUMMARY OF BACKGROUND DATA
Patients with spinal deformities adopt a variety of postural changes in the spine, pelvis, and lower extremities in their effort to compensate for the anterior shift in the gravity line. ADS patients are known to exhibit an increased sway within their CoE. Greater sway expends more energy while standing when compared with healthy controls. Spinal alignment surgery has been shown to improve sagittal vertical axis and balance.
METHODS
Thirty-three ADS patients and performed a series of functional balance tests a week before and 3 months after surgery along with 20 non-scoliotic control.
RESULTS
ADS patients demonstrated more initial CoM (P = 0.001) and head (P = 0.011) displacements. Postoperatively ADS patients exhibited less CoM sway (P = 0.043) and head sway (P = 0.050), in comparison to their presurgery measures. Postsurgical ADS patients demonstrated more CoM (P = 0.002) and head (P = 0.012) displacements and increased muscle activity in comparison to non-scoliotic controls.
CONCLUSION
Surgical alignment reduced the amount of sway, reduced the center of mass displacement, and reduced spine and lower extremity energy expenditure in ADS' patients. In symptomatic preoperative ADS patients, sagittal sway increased along with greater lumbar spine and lower extremity neuromuscular activity in comparison to a non-scoliotic control. Although surgical alignment improved ADS functional parameters during a dynamic balance test, these parameters approached but did not fully achieve non-scoliotic control parameters when measured 3 months after surgery.
LEVEL OF EVIDENCE
研究设计
前瞻性队列研究。
目的
本研究旨在量化一组成人退行性脊柱侧凸（ADS）患者术前和术后在经济锥（CoE）内保持平衡姿势时的摇摆程度变化，并将其与匹配的非脊柱侧凸对照组进行比较。
背景资料总结
脊柱畸形患者在脊柱、骨盆和下肢采取多种姿势变化，以补偿重力线的前移位。已知 ADS 患者在其 CoE 内表现出更大的摇摆。与健康对照组相比，站立时更大的摇摆会消耗更多的能量。脊柱排列手术已被证明可以改善矢状垂直轴和平衡。
方法
33 名 ADS 患者在手术前一周和手术后 3 个月进行了一系列功能性平衡测试，同时还对 20 名非脊柱侧凸对照组进行了测试。
结果
ADS 患者表现出更大的初始 CoM（P=0.001）和头部（P=0.011）位移。与术前测量相比，术后 ADS 患者的 CoM 摇摆（P=0.043）和头部摇摆（P=0.050）均减少。与非脊柱侧凸对照组相比，术后 ADS 患者的 CoM（P=0.002）和头部（P=0.012）位移更大，肌肉活动增加。
结论
手术矫正减少了摇摆幅度，减少了重心位移，并降低了 ADS 患者的脊柱和下肢能量消耗。在有症状的术前 ADS 患者中，与非脊柱侧凸对照组相比，矢状面摇摆增加，腰椎和下肢神经肌肉活动增加。尽管手术矫正在动态平衡测试中改善了 ADS 的功能参数，但这些参数在手术后 3 个月测量时接近但并未完全达到非脊柱侧凸对照组的参数。
证据水平
3 级。
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