腰椎间盘突出症患者斜面站立平衡稳定性研究

关键词：腰椎间盘突出症  平衡稳定性  斜面  COP面积  健患肢承重比

Keywords:lumbar disc herniation  postural steadiness  slope  COP area  weight-bearing ratio

摘要：

      摘要 目的：探讨腰椎间盘突出症(LDH)对在斜面上静止站立时平衡稳定性的影响。 方法：10例腰椎间盘突出症患者，10例性别、年龄与患者相匹配的健康志愿者，在三种平面条件（下降面、水平面和上升面）下，睁眼和闭眼静止站立在Zebris压力平板指定位置各30s。使用健患肢承重比评价身体体重分配情况，使用全身、健肢、患肢的压力中心点(COP)轨迹的95%置信椭圆面积来评估身体的摆动情况，并对COP面积和功能障碍量表得分进行相关性分析。 结果：LDH组的健患肢承重比高于健康对照组且大于1，并且具有较高的变异性。LDH组的全身、健肢、患肢COP面积在所有平面及视觉条件下均高于对照组（P<0.05），但在闭眼时组间差异更加显著。在下降面、闭眼条件下，COP面积与功能障碍量表得分表现出显著的相关性（P<0.05）。 结论：LDH患者健肢承受的体重比例增加，COP面积增大，身体平衡控制能力下降，姿势稳定性降低，跌倒风险增加。闭眼、下降面的站立平衡测试设置有对LDH进行定量诊断和评估的潜力。本研究揭示了LDH对在斜面上静止站立时平衡稳定性的影响，可为LDH的诊断和治疗评估提供新的思路。

Abstract:

      Abstract Objective: To investigate the changes in postural steadiness of patients with lumbar disc herniation (LDH) when standing on a slope. Method: Ten patients with LDH（LDH group） and 10 gender- and age-matched healthy volunteers（control group） were recruited. They were asked to stand on slopes quietly with three different conditions (declining, flat and inclining surfaces) for 30 seconds with or without visual feedback. Foot pressure distributions were recorded simultaneously by force plate of Zebris. The body weight distribution was evaluated using the weight-bearing ratio of load on non-paretic to that on paretic limb. The 95% confidence ellipse area of center of pressure (COP) was used to assess the postural steadiness. Correlations between COP areas and dysfunction scale scores were tested. Result: The weight-bearing ratios of load on non-paretic to that on paretic limb in LDH group were higher than those in healthy control group, with larger values and greater variability. The COP areas of whole body, non-paretic and paretic limb in LDH group were larger than those in control group on all support surfaces with or without visual feedback（P<0.05）. However, differences between the groups were more significant when the eyes of subjects were closed. Under the condition of declining surface and closed eyes, the COP areas showed significant correlations with the dysfunction scale scores（P<0.05）. Conclusion: In LDH group, non-paretic limb bore higher proportion of body weight, with the larger COP areas, the decreased ability of balance control and postural steadiness, and the increased risk of fall. The standing balance test conditioned of declining surface and closed eyes has the potential to be quantitative diagnosis and evaluation method for LDH. This study reveals the effects of LDH on postural steadiness when standing on slopes and may provide a new strategy for clinical diagnosis and evaluation of LDH.