Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
Institut de Biomécanique Humaine Georges Charpak, Arts Et Métiers, Paris, France.
Eur Spine J. 2022 Nov;31(11):3069-3080. doi: 10.1007/s00586-022-07348-y. Epub 2022 Aug 27.
To evaluate 3D kinematic alterations during gait in Adult Spinal Deformity (ASD) subjects with different deformity presentations.
One hundred nineteen primary ASD (51 ± 19y, 90F), age and sex-matched to 60 controls, underwent 3D gait analysis with subsequent calculation of 3D lower limb, trunk and segmental spine kinematics as well as the gait deviation index (GDI). ASD were classified into three groups: 51 with sagittal malalignment (ASD-Sag: SVA > 50 mm, PT > 25°, and/or PI-LL > 10°), 28 with only frontal deformity (ASD-Front: Cobb > 20°) and 40 with only hyperkyphosis (ASD-HyperTK: TK > 60°). Kinematics were compared between groups.
ASD-Sag had a decreased pelvic mobility compared to controls with a decreased ROM of hips (38 vs. 45°) and knees (51 vs. 61°). Furthermore, ASD-Sag exhibited a decreased walking speed (0.8 vs. 1.2 m/s) and GDI (80 vs. 95, all p < 0.05) making them more prone to falls. ASD-HyperTK showed similar patterns but in a less pronounced way. ASD-Front had normal walking patterns. GDI, knee flex/extension and walking speed were significantly associated with SVA and PT (r = 0.30-0.65).
Sagittal spinal malalignment seems to be the driver of gait alterations in ASD. Patients with higher GT, SVA, PT or PI-LL tended to walk slower, with shorter steps in order to maintain stability with a limited flexibility in the pelvis, hips and knees. These changes were found to a lesser extent in ASD with only hyperkyphosis but not in those with only frontal deformity. 3D gait analysis is an objective tool to evaluate functionality in ASD patients depending on their type of spinal deformity.
Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
评估不同畸形表现的成人脊柱畸形（ASD）患者在步态中的三维运动学变化。
119 例原发性 ASD（51±19 岁，90 例女性）与 60 例对照组相匹配，年龄和性别相匹配，均接受三维步态分析，随后计算三维下肢、躯干和节段脊柱运动学以及步态偏差指数（GDI）。ASD 分为三组：51 例矢状面失平衡（ASD-Sag：SVA>50mm，PT>25°，和/或 PI-LL>10°），28 例仅存在额状面畸形（ASD-Front：Cobb>20°），40 例仅存在胸椎后凸（ASD-HyperTK：TK>60°）。对各组间的运动学进行比较。
与对照组相比，ASD-Sag 组骨盆活动度降低，髋关节（38 对 45°）和膝关节（51 对 61°）活动度减小。此外，ASD-Sag 组的行走速度（0.8 对 1.2m/s）和 GDI（80 对 95，均 P<0.05）降低，使其更易摔倒。ASD-HyperTK 表现出相似的模式，但程度较轻。ASD-Front 组行走模式正常。GDI、膝关节屈伸和行走速度与 SVA 和 PT 显著相关（r=0.30-0.65）。
矢状面脊柱失平衡似乎是 ASD 步态改变的驱动因素。GT、SVA、PT 或 PI-LL 较高的患者倾向于走得更慢，步幅更短，以维持稳定性，骨盆、髋关节和膝关节的灵活性有限。在仅存在胸椎后凸的 ASD 中，这些变化程度较小，但在仅存在额状面畸形的 ASD 中则没有。3D 步态分析是一种评估 ASD 患者功能的客观工具，取决于其脊柱畸形的类型。
证据水平 I：诊断：具有一致应用参考标准和盲法的个体横断面研究。
