Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory (CMAL), University Hospitals Leuven, Leuven, Belgium.
Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.
Gait Posture. 2022 Feb;92:15-23. doi: 10.1016/j.gaitpost.2021.11.004. Epub 2021 Nov 7.
Research interest on the impact of adult spinal deformity (ASD) on spinopelvic and whole body motion has increased over the past years. Studies focusing on overground walking, showed that patients with ASD indeed present with functional impairments. Functional tasks challenging the spinopelvic complex, such as sit-to-stand-to-sit, might identify clinically relevant biomechanical parameters and could further increase our insights on how ASD impacts functioning and disability.
Do patients with ASD use different spinopelvic strategies during sit-to-stand (STSt) and stand-to-sit (StTS) compared to healthy controls?
In this prospective study, marker-based motion analysis and a subject-specific polynomial fit were used to assess spinopelvic kinematics (thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), trunk, pelvis) during STSt/StTS in 42 patients with ASD and 18 control subjects. All parameters were compared between controls and patients with ASD, divided in three groups based on their sagittal alignment (ASD 1: decompensated sagittal malalignment; ASD 2: compensated sagittal malalignment; ASD 3: scoliosis and normal sagittal alignment). Continuous kinematic and kinetic data were analyzed through statistical parametric mapping.
Patients with ASD showed decreased LL and increased trunk flexion and SVA during STSt/StTS compared to controls. These differences were mainly observed in sagittal deformity patients (ASD 1 and 2). In contrast, coronal patients (ASD 3) did not differ from controls. Dynamic LL and SVA significantly correlated with radiographic LL and SVA, however these relations decreased during the middle third of the motion cycle.
Patients with ASD use aberrant spinopelvic strategies during STSt/StTS compared to healthy controls. Only partial correlation to static radiographic parameters suggests other mechanisms need to be identified in addition to spinal malalignment. These might include impaired neuromuscular control or muscle weakness. Further research on movement patterns during functional tasks might ultimately result in treatment strategies that aim to augment activity participation by targeting improvements in movement function.
近年来，人们对成人脊柱畸形（ASD）对脊柱骨盆和整个身体运动的影响的研究兴趣不断增加。专注于地面行走的研究表明，ASD 确实存在功能障碍。挑战脊柱骨盆复合体的功能任务，例如从坐到站再到坐，可能会确定临床相关的生物力学参数，并进一步提高我们对 ASD 如何影响功能和残疾的认识。
与健康对照组相比，ASD 患者在从坐到站（STSt）和站到站（StTS）过程中是否使用不同的脊柱骨盆策略？
在这项前瞻性研究中，使用基于标记的运动分析和特定于受试者的多项式拟合来评估 42 例 ASD 患者和 18 例对照组在 STSt/StTS 期间的脊柱骨盆运动学（胸椎后凸（TK），腰椎前凸（LL），矢状垂直轴（SVA），躯干，骨盆）。将所有参数与 ASD 患者和 ASD 患者进行比较，根据其矢状面排列（ASD 1：失代偿性矢状面畸形; ASD 2：代偿性矢状面畸形; ASD 3：脊柱侧弯和正常矢状面排列）分为三组。通过统计参数映射分析连续运动学和动力学数据。
与对照组相比，ASD 患者在 STSt/StTS 期间显示出 LL 减少和躯干前屈增加以及 SVA 增加。这些差异主要在矢状面畸形患者（ASD 1 和 2）中观察到。相比之下，冠状面患者（ASD 3）与对照组没有差异。动态 LL 和 SVA 与放射学 LL 和 SVA 显著相关，但在运动周期的中间三分之一时，这些关系减弱。
与健康对照组相比，ASD 患者在 STSt/StTS 期间使用异常的脊柱骨盆策略。与静态放射学参数的部分相关性表明，除了脊柱畸形之外，还需要确定其他机制。这些机制可能包括受损的神经肌肉控制或肌肉无力。对功能任务期间运动模式的进一步研究最终可能会导致旨在通过针对运动功能改善来提高活动参与度的治疗策略。
