腰椎退化病人功能性活動中關節生物力學及關節間協調性之研究

Abstract

脊椎退化症為好發於老年人的主要疾病之一並且可能會導致嚴重的功能障礙等問題，其中又以腰椎退化最為常見。脊椎退化症經常伴隨著脊椎力學與相關神經控制的改變，並造成人體全身在靜態站立、走路、跨越障礙物、以及坐到站等日常功能性活動中之力學與控制的改變。由於目前仍缺乏有效且敏感的臨床評估工具，因此，不同層級的脊椎退化如何影響關節與全身的控制與協調仍是非常值得探討的。本研究利用一配有七台紅外線攝影機之動作分析系統量測正常受測者與脊椎退化受測者進行靜態站立、平地走路、跨越障礙物及坐到站之運動學資料，並利用兩塊測力板量測地面反作用力。本研究將先建立健康中年人於功能性活動中之力學與平衡控制資料，並以此為基礎進一步探討患脊椎退化症之中年人於站立時之站姿控制能力，與功能性活動中之關節力學及關節間協調。本研究之結果指出腰椎退化患者在站姿控制能力較正常受試者差，尤其以左右搖晃之情況較顯著；走路或跨越障礙物時，腰椎退化患者之步寬明顯增加，且步速也有下降之情形，但腰椎退化患者可維持腳尖與障礙物之垂直距離；關節間協調性可看出腰椎退化患者與正常受試者於走路或跨越障礙物時，肢段遠端有不同之協調情形，而從坐到站動作中則發現肢段近端之協調性與正常受試者不同。總結上述之結果，病患與正常受試者有不同之站姿控制能力、關節生物力學及關節間協調性。

Spondylosis is a major cause of morbidity among the elderly and may extend beyond the patient’s obvious symptoms leading to severe disability, the lumbar spines being the most common areas of involvement. Apart from the changed spinal mechanics, neurological disorders are usually accompanied with spondylosis, both leading to altered mechanics and control of the whole body during functional activities of daily living, such as quiet standing, level walking, obstacle crossing and sit-to-stand. The altered motion patterns due to spondylosis can be variable depending on the spinal level of lesion as the mechanics and neurological control of lumbar spondylosis are fundamentally different. Owing to the limitation of sensitivity of clinical assessment tools, it remains unclear as to how the level of spondylosis affects the control and coordination of the joints on the performance of functional activities of daily living. Motion data including quiet standing, level walking, obstacle-crossing and sit-to-stand were measured using a motion analysis system equipped with 7 ultra-high resolution infrared cameras. The results were compared to the normal controls. As indicated by the center of pressure indexes, patients with lumbar spondylosis manifest greater index, suggesting a degradation of balance performance during quiet standing, especially in the medial-lateral direction. During level walking, patients with lumbar spondylosis were unable to maintain normal temporal-spatial parameters with slower walking speed and wider step width. The patients with patients in the current study maintain normal swing toe-clearance. However, slower crossing speed and smaller heel-obstacle distance were found in patients with lumbar spondylosis as this phenomenon was similar to that found during level walking. For the inter-joint coordination, continuous relative phase curves indicated that the two groups had relatively different inter-joint coordination patterns. During the task of sit-to-stand, the hip and knee joint owned relatively movable segments compared to the fix distal end at the ankle joints. In conclusion, patient group had altered postural control, joint biomechanics and inter-joint coordination.