症状性腰椎管狭窄症患者步态障碍及手术干预对步态功能影响的前瞻性研究

IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-11-27 DOI:10.1097/BSD.0000000000001752
Aman Verma, Pankaj Kandwal, Aditya K S Gowda, Rajkumar Yadav
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引用次数: 0

摘要

研究设计前瞻性观察队列研究:分析减压手术对狭窄患者步态特征的影响。同时,与匹配的健康对照组相比,检验患者报告的功能结果和步态参数(时空、动力学和运动学测量)在术后会改善并达到正常值的假设:腰椎管狭窄症是导致老年人残疾的主要原因之一。步态障碍是腰椎退行性病变的主要症状之一。研究表明,减压手术可对椎管狭窄患者的步态参数产生积极影响。研究表明,手术后患者的行走速度、步幅和平衡能力都有所改善:前瞻性地招募了 32 名单侧腰椎管狭窄症患者和 32 名健康志愿者。所有患者均按照标准方案进行了术前和术后 6 个月的步态分析。对时空、运动学和动力学参数进行了分析。采用逐步线性回归模型检测功能评分(视觉模拟量表/Oswestry 失能指数)和步态参数变化之间的显著关系:结果:功能评分(PC)明显改善:腰椎管狭窄症减压手术可改善步态参数、疼痛评分和功能结果,显著改善步态和速度。
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A Prospective Study on Gait Impairment in Patients With Symptomatic Lumbar Canal Stenosis and Impact of Surgical Intervention on Gait Function.

Study design: Prospective observational cohort study.

Objective: To analyze the effect of decompression surgery on gait characteristics in patients with stenosis. Also, to test the hypothesis that patient-reported functional outcomes and gait parameters (spatiotemporal, kinetic, and kinematic measures) will improve postoperatively and achieve normal values when compared with matched healthy controls.

Summary of background data: Lumbar spinal stenosis is one of the leading causes of disability among elderly population. Gait impairment is one of the primary symptoms of degenerative conditions involving lumbar spine. Research suggests that decompressive surgery can positively influence gait parameters in patients with spinal stenosis. Studies have shown improvements in walking speed, stride length, and balance post-surgery.

Methods: Thirty-two patients with single-level lumbar stenosis and 32 healthy volunteers were prospectively recruited. All patients underwent gait analysis preoperatively and 6 months postoperatively as per standard protocol. Spatiotemporal, kinematic, and kinetic parameters were analyzed. Stepwise linear regression models were used to detect significant relationships between changes in functional score (Visual Analogue Scale/Oswestry Disability Index) and gait parameters.

Results: Significant improvement was noted in functional scores(P<0.05) 6 months post-surgery. Spatiotemporal (swing phase, mean velocity, cadence, stride length, step length, and step width) and kinetic parameters (hip, knee, and ankle power) were significantly better after surgery, reaching normal levels. Kinematic parameters significantly improved after surgery but did not reach normal levels when compared with controls. A significant correlation was found between changes in functional scores with changes in certain kinematic parameters (knee-power, ankle plantarflexion, swing time, peak ankle dorsiflexion in swing, peak-hip, and knee flexor moment).

Conclusion: Decompression surgery in lumbar stenosis produces improvement in gait parameters, pain scores, and functional outcomes that significantly improve gait posture and speed.

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来源期刊
Clinical Spine Surgery
Clinical Spine Surgery Medicine-Surgery
CiteScore
3.00
自引率
5.30%
发文量
236
期刊介绍: Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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