腰椎间盘突出患者经椎间孔镜手术前后步态与站立平衡稳定性研究

Gait kinetics and postural balance before and after percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation

摘要:

目的：探讨腰椎间盘突出 (lumbar disc herniation, LDH) 病人经皮椎间孔镜腰椎间盘切除术(percutaneous transforaminal endoscopic discectomy, PTED) 前后步态与站立平衡稳定性。方法：选取2020年8月至2021年8月在我院疼痛科进行PTED的LDH病人82例；另外招募82名无腰椎病变的健康人作为健康对照组，采用日本骨科协会 (Japanese orthopaedic association, JOA) 腰背痛评价问卷评估病人术前及术后1年腰椎功能变化，采用疼痛视觉模拟评分法 (visual analogue score, VAS) 评估病人的术前及术后1年疼痛状态。采用步态分析仪分析病人术前及术后行走步态及平衡稳定性，并分析VAS评分和JOA腰椎评分分别与步态和稳定性参数相关性。结果：LDH组术后与术前的VAS评分和JOA腰椎评分、步速、步长、步频、单足支撑相比较差异有统计学意义 (P < 0.05)，LDH组术前与对照组的步速、步长、步频、单足支撑相比较差异有统计学意义(P < 0.05)，PTED术后步频、单足支撑相与对照组比较差异有统计学意义(P < 0.05)，但步速、步长差异无统计学意义(P > 0.05)。术前、术后及健康对照组间COP路径长度、90%COP包络面积差异均有统计学意义(P < 0.05)。JOA腰椎评分与步速 (R2 = 0.513，P < 0.001) 和步长 (R2 = 0.602，P < 0.001) 显著相关，且与步频、单足支撑相、90%COP包络面积相关(P<0.05)，与COP路径长度不相关 (P > 0.05)。VAS评分与步长 (R2 = 0.602，P < 0.001) 显著相关，且与步速、单足支撑相、90%COP包络面积相关 (P < 0.05)，与步频、COP路径长度不相关 (P > 0.05)。结论：LDH病人行PTED术后步态及平衡稳定性均有明显的改善，但与正常人仍然有差别。JOA腰椎评分和VAS评分可以反应LDH病人步态损伤但不能完全反应平衡能力。

Abstract:

Objective: To investigate gait kinetics and postural balance in patients with lumbar disc herniation (LDH) before and after percutaneous transforaminal endoscopic discectomy (PTED). Methods: Eighty-two LDH patients who underwent PTED in our hospital from August 2020 to August 2021 were selected; In addition, 82 healthy people without Low back pain were recruited as the control group. All LDH patients were evaluated with Japanese Orthopaedic Association (JOA) scoring systems before and 1 year after the PTED, and the degree of pain of the patients was evaluated by the visual analogue pain score (VAS). Gait?analysis?system was used to analyze the gait and postural balance of patients before and one year after operation.We analyze the correlation between VAS, JOA score and gait and postural balance. Results: There were statistically significant differences in VAS score, JOA score, walking speed, step length, cadence and single-limb support phase between LDH patients before and after operation (P < 0.05), and there were statistically significant differences in walking speed, step length, cadence and single-limb support phase between PTED preoperative group and control group (P < 0.05). There were statistically significant differences in cadence and single-limb support phase between PTED postoperative group and control group (P < 0.05), but without statistically significant differences in walking speed and step length (P > 0.05). There were significant differences in cop path length and 90% COP postural sway area between the three groups before and after operation and the control group (P < 0.05). JOA score was significantly correlated with speed (R2=0.513, P < 0.001), step length (R2 = 0.602, P < 0.001), cadence , single support duration, and 90%COP postural sway area (P < 0.05), but not with COP path length (P > 0.05). VAS score was significantly correlated with step length (R2 = 0.602, P < 0.001), speed, single support duration, and 90%COP postural sway area (P < 0.05), but not with cadence and COP path length (P > 0.05). Conclusion: The gait and postural balance of LDH patients after PTED are improved obviously, but there are still differences between patients after operation and normal people. JOA and VAS scores can reflect the gait impairment of LDH patients, but can not well reflect the postural balance.