Relationship between trunk muscle forces, static and dynamic postural malalignment in patients with adult spinal deformity

Abstract

Patients with Adult spinal Deformity (ASD) are known to have a deteriorated quality of life (QOL). Severe spinal deformity can develop into postural malalignment caused by a forward shift of the trunk and head. Recent studies have shown that sagittal malalignment in patients with ASD can affect joints and segments’ kinematics during daily life activities [1,2]. On the other hand, ASD patients are known to present with muscular degeneration [3]. However, it is still unknown how trunk muscle’s weakness can affect ASD postural alignment in static position and during daily life activities. To investigate the relationship between muscle forces, radiographic parameters, joint kinematics during daily activities, and QOL scores in ASD. 25 ASD & 19 controls underwent biplanar radiographs in both standing and sitting positions with the calculation of 3D classic spinopelvic and postural alignment parameters (i.e: SVA plumbline between C7 and posterior corner of the sacrum; ODHA angle between line joining odontoid process and middle of hip axis with the vertical). Movement analysis was performed during walking, sit-to-stand, and stair ascent-descent with the calculation of 3D joint and segment kinematics. Participants filled out QOL questionnaires (SF-36 with both physical and mental components, Oswestry Disability Index ODI). The strength of the following muscle groups was measured using a hand-held dynamometer: trunk extensors, flexors, and right & left lateral flexors. ASD were divided into 2 groups based on the age-normalized strength of trunk extensors compared to controls: ASD-normal extensors and ASD-weak extensors (having strength

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成人脊柱畸形患者躯干肌力、静态和动态体位失调的关系

已知成人脊柱畸形(ASD)患者的生活质量(QOL)恶化。严重的脊柱畸形可发展为由躯干和头部前移引起的姿势失调。最近的研究表明，ASD患者矢状面排列失调会影响日常生活活动中关节和节段的运动学[1,2]。另一方面，已知ASD患者表现为肌肉变性[3]。然而，躯干肌肉无力如何影响ASD在静态位置和日常生活活动中的姿势对齐仍然是未知的。探讨ASD患者肌肉力量、影像学参数、日常活动时关节运动学与生活质量评分之间的关系。25名ASD患者和19名对照组患者分别在站立和坐姿下接受双平面x线摄影，并计算三维经典的脊柱骨盆和体位对齐参数(即C7和骶骨后角之间的SVA垂直线;齿状突连接线与髋中轴之间的ODHA夹角(纵)。在行走、坐立和楼梯升降过程中进行运动分析，并计算三维关节和节段运动学。参与者填写生活质量问卷(SF-36，包括身体和精神部分，Oswestry残疾指数ODI)。使用手持式测力仪测量以下肌肉群的力量:躯干伸肌、屈肌和左右侧屈肌。根据与对照组相比躯干伸肌的年龄标准化强度将ASD分为两组:ASD正常伸肌组和ASD弱伸肌组(对照组强度<均值1sd)。比较两组间影像学参数、运动学变量和生活质量评分。6例ASD伸展肌弱(F=20，对照组为26)。与asd正常伸肌相比，asd弱伸肌患者在站立时呈前矢状排列(ODHA=5°vs 3°，SVA =73 mm vs 24 mm)。他们必须在坐着时增加骨盆后倾，以保持水平凝视(坐-骨盆倾斜=41°vs asd正常伸肌35°)。矢状面排列失调在不同的运动过程中持续存在(动态- odha =16°，而asd正常伸肌为9°)。然而，正常伸肌的ASD在放射学和运动学参数上的改变较小。肌无力与生活质量的恶化相关(物理成分- sf36: r=0.55;P <0.001)，步行速度降低(r=0.44;p<0.001，图1)。该初步研究表明，弱躯干伸肌与站立和坐姿以及日常生活活动中的矢状位错位有关。弱伸肌也与ASD患者生活质量的恶化有关。躯干伸肌的正常力量似乎有助于ASD患者补偿他们在静态和运动时的脊柱畸形。未来的研究将探讨肌肉强化对ASD患者静态和动态对齐及其生活质量的影响。图1:躯干伸肌力量、生活质量评分与步行速度的相关性。下载:下载高分辨率图片(46KB)下载:下载全尺寸图片

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