Schmidt Hendrik, Shirazi-Adl Aboulfazl, Bashkuev Maxim, Becker Luis Alexander, Pumberger Matthias, Duda Georg N, Reitmaier Sandra
Julius Wolff Institut, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.
Division of Applied Mechanics, Department of Mechanical Engineering, École Polytechnique, Montréal, Canada.
Front Bioeng Biotechnol. 2024 Jul 25;12:1411958. doi: 10.3389/fbioe.2024.1411958. eCollection 2024.
Current clinical examination of low back pain (LBP) patients primarily relies on static clinical examinations, which rarely represent the dynamic postures patients adopt during daily activities. To gain an overview on the dynamic kinematics-kinetics changes over a day, the lumbar back kinematics of asymptomatic individuals and LBP patients were measured over 24 h, and the passively resisted bending and torsional moments were estimated. 208 asymptomatic subjects (115 females) and 116 LBP patients (71 females) were analysed. Compared to static upright standing, the mean lumbar lordosis of asymptomatic subjects drops significantly by 21° during everyday life ( < 0.01). Maximum bending moments of 44.0-50.6 Nm were estimated at the L2-L3. LBP patients showed significantly lower ( < 0.01) lumbar flattening during daily life of about 16°. Maximum bending moments of 27-52 Nm were found at the L3-L4. The initial static upright lumbar lordosis was significantly lower in LBP population (by 6°) resulting in almost similar average lumbar shapes during daily activities in both groups. The torsional movements were with 2.2° greatest in L1-L2 independent of sex ( = 0.19) and LBP ( = 0.54) with moments of 6-16 Nm. The lumbar profile and associated internal moments during daily life differ substantially from those recorded during clinical examinations. LBP patients demonstrates significantly lower lordosis at the snapshot assessment and significantly lower movement variations and internal moments during daily life. Only the dynamic long-term assessments unravelled a less flexed posture in LBP population. Apparently, such a reduced dynamic flexed posture indicates a compensatory habit for pain relief.
目前对腰痛（LBP）患者的临床检查主要依赖于静态临床检查，而这些检查很少能反映患者在日常活动中所采取的动态姿势。为了全面了解一天中动态运动学-动力学的变化，对无症状个体和LBP患者的腰部运动学进行了24小时测量，并估算了被动抵抗弯曲和扭转力矩。分析了208名无症状受试者（115名女性）和116名LBP患者（71名女性）。与静态直立站立相比，无症状受试者在日常生活中平均腰椎前凸显著下降21°（P<0.01）。在L2-L3处估计最大弯曲力矩为44.0-50.6 Nm。LBP患者在日常生活中腰椎变平明显更低（P<0.01），约为16°。在L3-L4处发现最大弯曲力矩为27-52 Nm。LBP人群的初始静态直立腰椎前凸明显更低（低6°），导致两组在日常活动中的平均腰椎形状几乎相似。扭转运动在L1-L2处最大，为2.2°，与性别（P=0.19）和LBP（P=0.54）无关，力矩为6-16 Nm。日常生活中的腰椎轮廓和相关内部力矩与临床检查期间记录的有很大不同。LBP患者在快照评估时腰椎前凸明显更低，在日常生活中运动变化和内部力矩也明显更低。只有动态长期评估揭示了LBP人群中较少弯曲的姿势。显然，这种减少的动态弯曲姿势表明是一种缓解疼痛的代偿习惯。
