Urbanschitz Lukas, Nüesch Corina, Schären Stefan, Mandelli Filippo, Mündermann Annegret, Netzer Cordula
Department of Spine Surgery, University Hospital Basel, Basel, Switzerland.
Department of Spine Surgery, University Hospital Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland, Basel, Switzerland.
Gait Posture. 2024 Oct;114:55-61. doi: 10.1016/j.gaitpost.2024.08.083. Epub 2024 Sep 2.
Patients with symptomatic lumbar spinal stenosis (sLSS) are often limited in their walking range because of worsening symptoms, which is thought to induce changes in the gait pattern. The aim of this study was to determine whether changes in gait pattern and muscle activity in these patients are elicited by a walking stress and differ from asymptomatic controls.
Twenty patients with sLSS and 19 asymptomatic controls performed a 30-minute walking stress. Gait was assessed using seven inertial sensors and sagittal joint range of motion (ROM) was calculated during different phases of gait. Muscle activation of the gluteus medius, erector spinae and multifidus muscles was measured by surface electromyography (EMG) and integrated EMGs (normalized to the maximum during gait) were calculated. Differences between groups and time points (beginning and end) were assessed using mixed factorial analysis of variance.
Patients had less knee extension ROM in terminal stance, less knee flexion ROM in swing and less overall hip flexion/extension ROM than controls (p ≤ 0.03). There were no functionally relevant changes in these parameters during the walking stress. The integrated EMG was greater in all muscles in patients than in controls and increased in both groups during the walking stress in the paraspinal but not in the gluteus medius muscle. There was no interaction between group and time for any of the parameters.
Differences in gait pattern and muscle activity between patients with sLSS and controls are generally present, but are not amplified by a walking stress.
有症状的腰椎管狭窄症（sLSS）患者常因症状加重而行走距离受限，这被认为会导致步态模式发生改变。本研究的目的是确定这些患者的步态模式和肌肉活动变化是否由行走应激引起，以及是否与无症状对照组不同。
20例sLSS患者和19例无症状对照者进行了30分钟的行走应激试验。使用七个惯性传感器评估步态，并在步态的不同阶段计算矢状面关节活动范围（ROM）。通过表面肌电图（EMG）测量臀中肌、竖脊肌和多裂肌的肌肉激活情况，并计算积分肌电图（归一化为步态期间的最大值）。使用混合因子方差分析评估组间和时间点（开始和结束）之间的差异。
与对照组相比，患者在终末站立时膝关节伸展ROM较小，在摆动期膝关节屈曲ROM较小，总体髋关节屈伸ROM较小（p≤0.03）。在行走应激期间，这些参数没有功能上相关的变化。患者所有肌肉的积分肌电图均高于对照组，且在行走应激期间，两组的椎旁肌积分肌电图均增加，但臀中肌未增加。任何参数在组和时间之间均无相互作用。
sLSS患者与对照组之间在步态模式和肌肉活动方面的差异普遍存在，但不会因行走应激而放大。
