Byl N N, Holland S, Jurek A, Hu S S
University of California, San Francisco, USA.
J Orthop Sports Phys Ther. 1997 Aug;26(2):60-8. doi: 10.2519/jospt.1997.26.2.60.
Sporadic research reports of decreased proprioception and balance problems have been reported in subjects with idiopathic scoliosis, yet these sensory motor deficits have not been addressed in conservative clinical management programs. The purpose of this study was to compare both balance reactions and vibratory sensitivity (as an estimate of proprioception) in patients with idiopathic scoliosis (N = 24) and age-matched controls (N = 24). Balance was measured by the ability to pass a series of simple static and complex sensory-challenged balance tasks. Vibratory thresholds were measured with the Bio-Thesiometer at the cervical spine, wrist, and foot. Compared with age-matched controls, regardless of curve severity or spinal fusion, the subjects with idiopathic scoliosis had similar simple static balance responses when the somatosensory system was stable (with or without vision or head turning), but they were significantly more likely to fail the complex, sensory-challenged balance tasks when the somatosensory system was challenged by an unstable position of the feet, particularly when the eyes were closed. The vibratory thresholds were similar in subjects with scoliosis and their age-matched controls, but individuals with moderate to severe scoliosis (> 25 degrees) had significantly higher vibratory thresholds than those with mild curves. These findings suggest there may be problems with postural righting in patients with idiopathic scoliosis, particularly when the balance task challenges the vestibular pathways. Although vibration sensitivity did not distinguish normal healthy individuals from individuals with idiopathic scoliosis, those with more severe scoliotic curves appear to have a high threshold to vibration. These balance and vibratory differences could either be interpreted as etiologic risk factors or as consequences of spinal asymmetry. In either case, given that curves can continue to progress even into the adult years, improving the ability to right the body with gravity could help maintain the balance of the spine despite structural asymmetry.
关于特发性脊柱侧凸患者本体感觉下降和平衡问题的零星研究报告已有发表，但这些感觉运动缺陷在保守的临床管理方案中尚未得到解决。本研究的目的是比较特发性脊柱侧凸患者（N = 24）和年龄匹配的对照组（N = 24）的平衡反应和振动敏感性（作为本体感觉的一种估计）。通过完成一系列简单的静态和复杂的感觉挑战性平衡任务的能力来测量平衡。使用生物感觉阈值测量仪在颈椎、手腕和足部测量振动阈值。与年龄匹配的对照组相比，无论曲线严重程度或脊柱融合情况如何，特发性脊柱侧凸患者在躯体感觉系统稳定时（有或没有视觉或头部转动）具有相似的简单静态平衡反应，但当躯体感觉系统因脚部不稳定位置而受到挑战时，尤其是闭眼时，他们在复杂的、感觉挑战性平衡任务中失败的可能性显著更高。脊柱侧凸患者与其年龄匹配的对照组的振动阈值相似，但中度至重度脊柱侧凸（> 25度）的个体比轻度曲线患者的振动阈值显著更高。这些发现表明，特发性脊柱侧凸患者可能存在姿势矫正问题，尤其是当平衡任务挑战前庭通路时。虽然振动敏感性无法区分正常健康个体和特发性脊柱侧凸个体，但脊柱侧凸曲线更严重的个体似乎对振动的阈值较高。这些平衡和振动差异既可以被解释为病因风险因素，也可以被解释为脊柱不对称的后果。在任何一种情况下，鉴于曲线甚至在成年期仍可能继续进展，提高利用重力矫正身体的能力有助于在存在结构不对称的情况下维持脊柱的平衡。
