手术治疗高位腰椎滑脱症患者的术前和术后三维步态分析。

Preoperative and Postoperative, Three-dimensional Gait Analysis in Surgically Treated Patients With High-grade Spondylolisthesis.

机构信息

Robert Jones Agnes Hunt Hospital, Oswestry and Alderhey Children's Hospital, Liverpool.

Department of Spine Surgery, University Hospitals Sheffield, Sheffield.

出版信息

J Pediatr Orthop. 2021 Feb 1;41(2):111-118. doi: 10.1097/BPO.0000000000001721.

DOI:10.1097/BPO.0000000000001721

PMID:33298766

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7803478/

Abstract

BACKGROUND

High-grade spondylolisthesis (HGS) (Myerding grade III-V) in adolescents can lead to a marked alteration of gait pattern and maybe the presenting symptom in these patients. This characteristic gait pattern in patients with HGS has been referred to as the "pelvic waddle." Modern 3-dimensional (3D) gait analysis serves an important tool to objectively analyze the different components of this characteristic gait preoperatively and postoperatively and is an objective measure of postoperative improvement.This study demonstrates the use of 3D gait analysis preoperatively and postoperatively in a cohort of 4 consecutive patients with HGS treated surgically at a single tertiary referral center and utilize this to objectively evaluate outcome of surgical treatment in these patients. This has not been reported previously in a cohort of patients.

METHODS

This is a prospective analysis of patients with HGS who underwent surgical intervention for spondylolisthesis at a single institution. Patient demographics, clinical, and radiologic assessment were recorded, and all patients underwent 3D gait analysis before and after surgical intervention. Kinetic, kinematic, and spatial parameters were recorded preoperatively and postoperatively for all patients. This allowed the outcome of change in gait deviation index, before and after surgical treatment, to be evaluated.

RESULTS

We were able to review complete records of 4 adolescent patients who underwent surgical treatment for HGS. Mean age at surgery was 13.5 years with a minimum follow-up of 2.5 years postoperatively (average 40 mo). Preoperative gait analysis revealed marked posterior pelvic tilt in 2 patients, reduced hip and knee extension in all 4 patients and external foot progression in 3 of the 4 patients. Along with an observed improvement in gait, there was an objective improvement in gait parameters postoperatively in all 4 patients. Gait deviation index score improved significantly from 78.9 to 101.3 (mean).

CONCLUSIONS

Preoperative gait abnormalities exist in HGS and can be objectively analyzed with gait analysis. Surgical intervention may successfully resolve these gait abnormalities and gait analysis is a useful tool to assess the outcome of surgery and quantify an otherwise intangible benefit of surgical intervention.

LEVEL OF EVIDENCE

Level IV-case series.

摘要

背景

青少年的高级脊椎滑脱（HGS）（迈尔丁 3-5 级）可导致明显的步态模式改变，并且可能是这些患者的首发症状。HGS 患者的这种特征性步态模式被称为“骨盆摇摆”。现代三维（3D）步态分析是一种重要的工具，可以客观地分析术前和术后这种特征性步态的不同组成部分，并且是术后改善的客观衡量标准。本研究展示了在一家三级转诊中心连续治疗的 4 例 HGS 患者的术前和术后 3D 步态分析，并利用该分析客观评估这些患者的手术治疗效果。这在患者队列中以前没有报道过。

方法

这是对在一家机构接受手术治疗脊椎滑脱的 HGS 患者的前瞻性分析。记录患者的人口统计学、临床和影像学评估，所有患者均在手术前后进行 3D 步态分析。记录所有患者术前和术后的动力学、运动学和空间参数。这允许评估步态偏差指数在手术治疗前后的变化结果。

结果

我们能够回顾 4 名接受 HGS 手术治疗的青少年患者的完整记录。手术时的平均年龄为 13.5 岁，术后随访至少 2.5 年（平均 40 个月）。术前步态分析显示 2 例患者存在明显的骨盆后倾，4 例患者的髋关节和膝关节伸展均减少，4 例患者中有 3 例存在外足推进。随着步态的改善，所有 4 例患者术后的步态参数都有客观的改善。步态偏差指数评分从 78.9 显著改善至 101.3（平均）。