Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Sci Rep. 2021 May 27;11(1):11179. doi: 10.1038/s41598-021-90884-2.
This study aimed to evaluate the subclinical gait abnormalities and the postoperative gait improvements in patients with degenerative cervical myelopathy using three-dimensional gait analysis. We reviewed the gait analysis of 62 patients who underwent surgical treatment for degenerative cervical myelopathy. The asymptomatic gait group included 30 patients and the gait disturbance group included 32 patients who can walk on their own slowly or need assistive device on stairs. The step width (17.2 cm vs. 15.9 cm, P = 0.003), stride length (105.2 cm vs. 109.1 cm, P = 0.015), and double-limb support duration (13.4% vs. 11.7%, P = 0.027) improved only in the asymptomatic gait group. Preoperatively, the asymptomatic gait group exhibited better maximum knee flexion angle (60.5° vs. 54.8°, P = 0.001) and ankle plantarflexion angle at push-off (- 12.2° vs. - 6.5°, P = 0.001) compared to the gait disturbance group. Postoperatively, maximum knee flexion angle (62.3° vs. 58.2°, P = 0.004) and ankle plantarflexion angle at push-off (- 12.8° vs. - 8.3°, P = 0.002) were still better in the asymptomatic gait group, although both parameters improved in the gait disturbance group (P = 0.005, 0.039, respectively). Kinematic parameters could improve in patients with gait disturbance. However, temporospatial parameters improvement may be expected when the operative treatment is performed before apparent gait disturbance.
本研究旨在使用三维步态分析评估退行性颈椎病患者的亚临床步态异常和术后步态改善。我们回顾了 62 例接受退行性颈椎病手术治疗患者的步态分析。无症状步态组包括 30 例，步态障碍组包括 32 例，这些患者在缓慢行走或上下楼梯时需要辅助设备。无症状步态组的步宽（17.2cm 比 15.9cm，P=0.003）、步长（105.2cm 比 109.1cm，P=0.015）和双支撑期（13.4%比 11.7%，P=0.027）有所改善。术前，无症状步态组的最大膝关节屈曲角度（60.5°比 54.8°，P=0.001）和蹬离时的踝关节跖屈角度（-12.2°比-6.5°，P=0.001）优于步态障碍组。术后，无症状步态组的最大膝关节屈曲角度（62.3°比 58.2°，P=0.004）和蹬离时的踝关节跖屈角度（-12.8°比-8.3°，P=0.002）仍然更好，尽管步态障碍组的这两个参数也有所改善（P=0.005，0.039）。即使在步态障碍患者中，运动学参数也可以得到改善。然而，当在明显步态障碍之前进行手术治疗时，可能会期望出现时间-空间参数的改善。
