青少年原發性胸腰椎型脊椎側彎在步行時之下肢生物力學策略

Biomechanical Strategies of the Lower Limb in Adolescents with Idiopathic Thoracolumbar Scoliosis during Walking

胡家甄(Chia-Chen Hu)

指導教授 ： 呂東武

國立臺灣大學/工學院/醫學工程學研究所/碩士(2017年)

https://doi.org/10.6342/NTU201703565

摘要

原發性脊椎側彎是青少年常見的骨科疾病，其原因為三維脊椎變形所導致。脊椎側彎之臨床症狀為軀幹外觀不對稱、脊椎關節角度受限、身體兩側肌力不對稱、背痛，進而導致心肺功能受限。脊椎側彎之變形與併發症對於姿勢與步態有相當程度的影響。過去研究指出，雖然脊椎側彎不致影響步行之速度、步頻、步寬等時空參數，但不對稱之脊椎側彎會影響步行時之下肢運動學。然而目前仍無探討不同分類之脊椎側彎對於步態影響之相關文獻。本研究目的在於利用Lenke分類系統，探討第五型Lenke脊椎側彎 (Lenke 5)，亦即胸腰椎型脊椎側彎之青少年在步行時之下肢運動學及力動學變化。
本研究徵招15位脊椎側彎之青少年與15位同年齡族群之控制組進行步態分析。經由三維動作分析系統與測力版之資訊，計算受試者在步行過程中之時空參數、關節角度與關節力矩，並比較兩組之間的差異。研究結果發現胸腰椎型脊椎側彎病患在步距有減少的趨勢，髖關節的角度在腳跟著地及對側腳尖離地時較內收且內轉，在力矩部分則是在對側腳尖離地及及對側腳尖著地時內轉力矩減少，與正常人比有較明顯不同；骨盆角度在步行有旋轉角度變大的現象，顯示胸腰椎型脊椎側彎病患可能有步態不穩定之趨勢。此研究結果有助於不同類型脊椎側彎之步態評估與臨床診斷。

關鍵字

脊椎側彎 ； 步態分析 ； 運動學

並列摘要

Idiopathic scoliosis (IS) is one of the common orthopedic disease in adolescents which characterized by a three-dimensional (3D) deformity of the spine. AIS may cause uneven appearance of trunk, spine range of motion limitation, differences in muscle strength between both sides, back pain and may compromise of cardiopulmonary function. The spine deformity and these symptoms have a considerable effect on posture and gait. The previous study showed that there were no significant difference in spatial-temporal parameters including walking speed, cadence and step width when compared scoliosis patients with normal subjects, but the uneven spine curve did cause the changes of lower limb kinematics during ambulation. However, there were no studies discussed those effects in specific classification of scoliosis. The purpose of this study is to explore any asymmetries in gait kinematics and kinetics during walking in patients with thoracolumbar scoliosis which is classified as type 5 in Lenke classification system.
Fifteen adolescents with thoracolumbar scoliosis and fifteen age-matched healthy controls were recruited. All subjects walked at their self-selected speeds while their kinematic and kinetic data were measured. It was found that the step length in scoliosis patients decreased compared with the controls. Pelvis tended to rotate to concave side when walking. The hip angle increased in adduction and internal rotation during heel strike and contralateral toe off. The hip internal rotation moment decreased during contralateral toe off and contralateral heel strike. Those findings indicate that the scoliosis may result in gait instability in adolescents. The results of this study contribute to the gait assessment of different types of scoliosis and clinical diagnosis.

並列關鍵字

Scoliosis ； Gait Analysis ； kinematic

參考文獻

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