Fakhoury Marc, Rachkidi Rami, Semaan Karl, Abi Karam Krystel, Saadé Maria, Ayoub Elma, Chaaya Celine, Rteil Ali, Jaber Elena, Mekhael Elio, Nassim Nabil, Karam Mohamad, Abinahed Julien, Ghanem Ismat, Massaad Abir, Assi Ayman
Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon.
Institute of Physiotherapy, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon.
Brain Spine. 2024 Dec 10;5:104153. doi: 10.1016/j.bas.2024.104153. eCollection 2025.
Adults with spinal deformity (ASD) are known to have spinal malalignment, which can impact their quality of life and their autonomy in daily life activities. Among these tasks, ascending and descending stairs is a common activity of daily life that might be affected.
What are the main kinematic alterations in ASD during stair ascent and descent?
112 primary ASD patients and 34 controls filled HRQoL questionnaires and underwent biplanar X-from which spino-pelvic radiographic parameters were calculated. Patients were divided into 3 groups: 44 with sagittal malalignment (ASD-Sag: PT > 25°, SVA>5 cm or PI-LL>10°), 42 with isolated thoracic hyperkyphosis (ASD-HyperTK: TK > 60°), 26 with isolated frontal spine deformity (ASD-Front: Cobb>20°). All participants underwent 3D motion analysis of the whole body while ascending and descending a stair step from which kinematic waveforms were extracted.
During stair ascent, ASD-Sag exhibited an increased thorax flexion (20 vs 5°), a decreased lumbar lordosis L1L3-L3L5 (7 vs 14°), and an increased ROM of lumbo-pelvic joint (15 vs 10°, all p < 0.05), compared to controls. Similar compensations were shown while descending the stairstep. ASD-HyperTK had similar kinematic limitations as ASD-Sag but to a lesser extent. ASD-Front had normal kinematic patterns. PCS-SF36 correlated to thorax flexion (r = -0.45) and ODI was correlated to pelvic tilt ROM (r = 0.46).
ASD subjects with sagittal malalignment tend to ascend and descend stairs with increased thorax flexion, making them more prone to falls. Compensation mechanisms occur at the head and lumbo-pelvic levels to maintain balance and avoid falling forward.
已知患有脊柱畸形（ASD）的成年人存在脊柱排列不齐的情况，这会影响他们的生活质量以及日常生活活动的自主性。在这些日常活动中，上下楼梯是一项可能会受到影响的常见活动。
在ASD患者上下楼梯过程中，主要的运动学改变是什么？
112名原发性ASD患者和34名对照者填写了健康相关生活质量问卷，并接受了双平面X线检查，从中计算出脊柱骨盆影像学参数。患者被分为3组：44例矢状面排列不齐（ASD-Sag：PT>25°，SVA>5 cm或PI-LL>10°），42例孤立性胸椎后凸（ASD-HyperTK：TK>60°），26例孤立性额状面脊柱畸形（ASD-Front：Cobb>20°）。所有参与者在上下楼梯时均接受了全身三维运动分析，从中提取运动学波形。
与对照组相比，在楼梯上升过程中，ASD-Sag患者表现出胸廓前屈增加（20°对5°），腰椎前凸L1L3-L3L5减小（7°对14°），腰骶关节活动度增加（15°对10°，所有p<0.05）。在下楼梯时也表现出类似的代偿情况。ASD-HyperTK患者的运动学限制与ASD-Sag患者相似，但程度较轻。ASD-Front患者的运动学模式正常。PCS-SF36与胸廓前屈相关（r=-0.45），ODI与骨盆倾斜活动度相关（r=0.46）。
矢状面排列不齐的ASD受试者在上下楼梯时往往会增加胸廓前屈，这使他们更容易跌倒。在头部和腰骶部水平会出现代偿机制以维持平衡并避免向前跌倒。
