Ezaki Seioh, Kadone Hideki, Kubota Shigeki, Abe Tetsuya, Shimizu Yukiyo, Tan Chun Kwang, Miura Kousei, Hada Yasushi, Sankai Yoshiyuki, Koda Masao, Suzuki Kenji, Yamazaki Masashi
Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan.
Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.
Front Neurorobot. 2021 Mar 31;15:650118. doi: 10.3389/fnbot.2021.650118. eCollection 2021.
Ossification of the posterior longitudinal ligament (OPLL) is a hyperostonic condition in which the posterior longitudinal ligament becomes thick and loses its flexibility, resulting in ectopic ossification and severe neurologic deficit (Matsunaga and Sakou, 2012). It commonly presents with myelopathy and radiculopathy and with myelopathy progression motor disorders and balance disorders can appear. Even after appropriate surgical decompression, some motor impairments often remain. The Hybrid Assistive Limb (HAL) is a wearable powered suit designed to assist and support the user's voluntary control of hip and knee joint motion by detecting bioelectric signals from the skin surface and force/pressure sensors in the shoes during movement. In the current study, the HAL intervention was applied to 15 patients diagnosed with OPLL who presented with myelopathy after decompression surgery (6 acute and 9 chronic stage). Following the HAL intervention, there were significant improvements in gait speed, cadence, stride length, in both acute and chronic groups. Joint angle analysis of the lower limbs showed that range of motion (ROM) of hip and knee joints in acute group, and also ROM of hip joint and toe-lift during swing in chronic group increased significantly. ROM of knee joint became closer to healthy gait in both groups. Electromyography analysis showed that hamstrings activity in the late swing phase increased significantly for acute patients. Immidiate effect from HAL session was also observed. EMG of vastus medialis were decreased except chronic 7th session and EMG of gastrocnemius were decreased except acute 7th session, which suggests the patients were learning to walk with lesser knee-hypertension during the sessions. After all, double knee action appeared in both acute and chronic groups after the HAL intervention, rather than knee hyper-extension which is a common gait impairment in OPLL. We consider that these improvements lead to a smoother and healthier gait motion.
后纵韧带骨化（OPLL）是一种骨质增生性疾病，其中后纵韧带增厚并失去弹性，导致异位骨化和严重的神经功能缺损（Matsunaga和Sakou，2012年）。它通常表现为脊髓病和神经根病，随着脊髓病的进展，可能会出现运动障碍和平衡障碍。即使经过适当的手术减压，一些运动障碍往往仍然存在。混合辅助肢体（HAL）是一种可穿戴的动力套装，旨在通过在运动过程中检测皮肤表面的生物电信号以及鞋子中的力/压力传感器，来辅助和支持用户对髋关节和膝关节运动的自主控制。在本研究中，HAL干预应用于15例诊断为OPLL且减压手术后出现脊髓病的患者（6例急性期和9例慢性期）。HAL干预后，急性组和慢性组的步态速度、步频、步幅均有显著改善。下肢关节角度分析表明，急性组髋关节和膝关节的活动范围（ROM）以及慢性组摆动期髋关节和足趾背屈的ROM均显著增加。两组膝关节的ROM均更接近健康步态。肌电图分析表明，急性期患者在摆动后期腘绳肌活动显著增加。还观察到HAL训练的即时效果。除慢性期第7次训练外，股内侧肌的肌电图降低，除急性期第7次训练外，腓肠肌的肌电图降低，这表明患者在训练过程中学会了以较小的膝关节高压行走。毕竟，HAL干预后急性组和慢性组均出现了双膝动作，而非OPLL中常见的步态障碍膝关节过度伸展。我们认为这些改善导致了更平稳、更健康的步态运动。
