Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA.
Eur Spine J. 2020 Sep;29(9):2319-2328. doi: 10.1007/s00586-020-06411-w. Epub 2020 Apr 18.
A nonrandomized, prospective, concurrent control cohort study.
To further develop cone of economy (CoE) measurements by identifying compensatory mechanisms at the extremes of the CoE and comparing balance control strategies in a group of adult degenerative scoliosis (ADS) patients with non-scoliotic controls. The CoE concept was first proposed by Dubousset and is frequently referred to when assessing balance in spinal deformity patients. Recently, a method that quantifies the CoE of individual patients through 3D video kinematic and electromyography data was developed. However, this method lacks measurements that describe the motor control strategies utilized by spinal disorder patients to maintain balance.
Twenty ADS patients and 15 non-scoliotic controls.
All test subjects were fitted with a full body marker set. Each subject performed a series of functional balance tests (Romberg's with eyes opened) while being recorded in a human motion capture system. Three-dimensional CoE dimensions, range of sway (RoS), overall sway and lower extremity and trunk range of motion (RoM) were measured and analyzed.
Patients with ADS demonstrated greater overall sway and RoS in the sagittal and coronal planes compared to controls. Moreover, ADS patients presented with more hip flexion and trunk flexion at maximal points of sway and more ankle, knee, hip and trunk RoM when swaying in comparison with controls.
ADS patients have larger CoE dimensions and increased sway when compared to non-scoliotic controls. ADS patients rely on a hip balance control "strategy" and lower extremity RoM to maintain balance, which differed from control subjects. Unlike prior attempts to define compensatory mechanisms in ADS patients, the described technique utilizes dynamic, three-dimensional measurements to define what is occurring within the CoE. By expanding on prior CoE measurements, we were able to define a unique dynamic balance control strategy for each patient.
一项非随机、前瞻性、同期对照队列研究。
通过识别 Cone of Economy（CoE）极限处的代偿机制，并比较一组成人退行性脊柱侧凸（ADS）患者与非脊柱侧凸对照组的平衡控制策略，进一步开发 CoE 测量方法。CoE 概念最初由 Dubousset 提出，在评估脊柱畸形患者平衡时经常被提及。最近，一种通过 3D 视频运动学和肌电图数据量化个体患者 CoE 的方法已经开发出来。然而，这种方法缺乏描述脊柱疾病患者用于维持平衡的运动控制策略的测量。
20 名 ADS 患者和 15 名非脊柱侧凸对照组。
所有测试对象均配备全身标记套装。每位受试者在人体运动捕捉系统中进行一系列功能性平衡测试（睁眼 Romberg）。测量和分析三维 CoE 维度、摆动范围（RoS）、整体摆动和下肢及躯干运动范围（RoM）。
与对照组相比，ADS 患者在矢状面和冠状面的整体摆动和 RoS 更大。此外，与对照组相比，ADS 患者在摆动的最大点处表现出更多的髋关节屈曲和躯干屈曲，并且在摆动时具有更大的踝关节、膝关节、髋关节和躯干 RoM。
与非脊柱侧凸对照组相比，ADS 患者的 CoE 维度更大，摆动幅度更大。ADS 患者依靠髋关节平衡控制“策略”和下肢 RoM 来维持平衡，这与对照组不同。与之前尝试定义 ADS 患者代偿机制的方法不同，所描述的技术利用动态、三维测量来定义 CoE 内发生的情况。通过扩展之前的 CoE 测量，我们能够为每位患者定义独特的动态平衡控制策略。
