Asano Futoshi, Inami Satoshi, Takeuchi Daisaku, Moridaira Hiroshi, Ueda Haruki, Aoki Hiromichi, Iimura Takuya, Taneichi Hiroshi
Department of Orthopaedic Surgery, Washiya Kinen Hospital, Utsunomiya, Japan.
Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Japan.
Spine Surg Relat Res. 2024 Jun 10;8(6):631-636. doi: 10.22603/ssrr.2024-0028. eCollection 2024 Nov 27.
Patients with adult spinal deformity (ASD) lean forward with their trunks when walking, even if they can remain upright during static standing. However, it remains unclear which part of the spinal column is involved in forward trunk tilt and the details of the relationships between sagittal alignment during static standing and changes in dynamic parameters during walking. Therefore, this study aimed to clarify the above by analyzing the walking motion of ASD patients using inertial measurement units (IMUs).
Preoperative ASD patients were included in this study. Dynamic parameters during gait were measured by IMUs attached on the skin at the T1, T12, and S1 spinous processes, thigh, and lower leg. Walking data were divided into three phases of 10 s each (initial, middle, and final), and the average dynamic parameters at each phase were statistically compared. The relationships between the standing radiographic and dynamic parameters in the final phase were evaluated by linear regression analyses.
A total of 34 patients were included in this study. Their mean age was 72 years. The inclination of IMUs on the T1, T12, and S1 and the flexion angle of T12-S1 IMUs significantly increased over time. Pelvic tilt (PT) of standing radiography was positively correlated with the inclination angles of T12 (r=0.22, p=0.0048) and S1 (r=0.16, p=0.0178) and the flexion angle of T12-S1 IMUs (r=0.29, p=0.0011).
This study showed that anteversion of the trunk in patients with ASD is due to an increase in lumbar forward bending and anterior tilt of the pelvis. Lumbar forward bending was significantly correlated with PT on standing radiography. It is important to consider the presence of poorer posture during gait than during standing when we evaluate patients with high PT.
成年脊柱畸形（ASD）患者在行走时会躯干前倾，即便他们在静止站立时能够保持直立。然而，目前尚不清楚脊柱的哪个部分参与了躯干前倾，以及静止站立时矢状面排列与行走时动态参数变化之间关系的细节。因此，本研究旨在通过使用惯性测量单元（IMU）分析ASD患者的行走运动来阐明上述问题。
本研究纳入了术前ASD患者。通过附着在T1、T12和S1棘突、大腿及小腿皮肤处的IMU测量步态期间的动态参数。行走数据被分为三个各10秒的阶段（初始阶段、中间阶段和最终阶段），并对每个阶段的平均动态参数进行统计学比较。通过线性回归分析评估最终阶段站立位X线片参数与动态参数之间的关系。
本研究共纳入34例患者。他们的平均年龄为72岁。T1、T12和S1处IMU的倾斜度以及T12 - S1处IMU的屈曲角度随时间显著增加。站立位X线片的骨盆倾斜度（PT）与T12的倾斜角度（r = 0.22，p = 0.0048）、S1的倾斜角度（r = 0.16，p = 0.0178）以及T12 - S1处IMU的屈曲角度（r = 0.29，p = 0.0011）呈正相关。
本研究表明，ASD患者的躯干前倾角是由于腰椎前屈增加和骨盆前倾所致。腰椎前屈与站立位X线片上的PT显著相关。在评估PT较高的患者时，考虑到其步态时的姿势比站立时更差是很重要的。
