體脂肪分布形態對於退化性腰椎疾病合併過重之女性患者的站立平衡影響

Abstract

背景：退化性腰椎疾病(Degenerative lumbar disease, DLD)是女性年長者常見的腰椎退化性病變，過去研究顯示退化性腰椎疾病患者多數有體重過重(Overweight)問題，並且會伴隨平衡問題以及有較高的跌倒風險。然而，探討退化性腰椎疾病合併過重族群患者在站立平衡與功能性表現之影響的研究卻相當有限。 研究目的：評估不同體脂肪分布形態(蘋果型、梨型、正常體重)退化性腰椎疾病女性患者疼痛程度、失能問題、脊椎排列、身體組成、站立平衡與功能性表現之差異。以及退化性腰椎疾病女性患者與年齡相符之健康女性受試者相比之站立平衡與功能性表現之差異。 研究設計：橫斷型研究 研究方法：本研究受測者共納入30位年紀介於50至80歲、經國立臺灣大學附設醫院神經外科醫師診斷為退化性腰椎疾病之女性患者，依身體脂肪分布形態(腰臀比)分為三組：蘋果型(Android-type)、梨型(Gynoid-type)與正常體重(Normal weight)；此外，本研究亦納入10位年齡相符之健康女性受試者。退化性腰椎疾病組量測內容含：基本資料與影像學資料收集、身體組成成分量測、問卷調查、站立平衡測試與功能性表現測試。年齡相符之健康女性受試者之量測內容含：基本資料、站立平衡測試與功能性表現測試。統計分析使用one-way ANOVA，以體脂肪分布為獨立變數(分四個水準：蘋果型/梨型/正常體重/健康組)，顯著程度設定於0.05，並做Scheffé test事後分析。 結果：在臨床問卷調查中三組退化性腰椎疾病患者間無顯著差異。蘋果型過重組相較於其他兩組有統計上顯著提升的體脂肪率、內臟脂肪面積、統計上顯著下降的下肢平均肌肉量(p<0.05)。此外也有較高的腰椎前凸角度(p<0.05)；在站立平衡測試中，蘋果型過重組的晃動面積、前後方向之整體偏移量也顯著高於其他兩組(p<0.05)；過重組功能性表現結果所花費時間也較正常體重組長。此外，蘋果形過重組的足底壓力中心之晃動面積、前後方向以及內外方向之偏移量亦明顯高於年齡相符之健康女性受試者(p<0.05)。 結論：蘋果型過重組有較多的內臟脂肪，可能導致脊椎排列不理想、此外下肢支撐力不足也可能進而導致在維持前後及內外方向之站立平衡能力受到影響。此研究成果可應用於退化性腰椎疾病患者之物理治療，依照不同體脂肪分布形態給予特定之平衡訓練與下肢肌力訓練指導，以期達到理想的治療效果。

Background: Degenerative lumbar disease (DLD) is a prevalent disorder that predominantly affects the elderly population, especially female. Previous research has demonstrated that overweight individuals have a higher susceptibility to developing DLD and an increased risk of falling. However, there is limited research available on the standing balance and functional performance of overweight females with DLD. Purpose: To evaluate pain intensity, disability, spinal alignment, body composition, standing balance, and functional activities performance in female individuals with DLD among normal weight, android-type, gynoid-type groups, and age-matched control female participants. Design: Cross-sectional study Methods: A total of 30 female participants diagnosed with DLD were recruited from the National Taiwan University Hospital. Participants were allocated into three groups based on body fat distribution: the normal weight group, android-type group, and gynoid-type group. A control group of ten age-matched females with normal weight was recruited. The DLD groups be recruited to collect the basic data with the clinical questionnaires, imaging examination, body composition, standing balance, and functional performance. The age-matched group be recruited to collect standing balance and functional performance. The one-way ANOVA will be used to compare variables among individuals with DLD among the android-type overweight, gynoid-type overweight, normal weight groups, and age-matched control. The significance level will be set at 0.05, and Scheffé test will be chosen as the post-hoc analysis. Results: The clinical questionnaires did not show significant differences among the three body fat distribution types. Android-type group had higher body fat percentage, visceral fat area, lower lean muscle mass of lower extremities, and increased lumbar Cobb angle (p<0.05). For standing balance, the android-type showed greater 95% confidence ellipse area, total excursion, and mean distance in the AP direction compared with the other DLD groups (p<0.05). During the functional performance assessments, the android-type group had longer durations in both the 5STS and TUG compared with the other groups (p<0.05). In addition, the android-type showed greater CoP ellipse area, total excursion and mean distance in AP and ML direction compared with age-matched control group (p<0.05). Conclusion: Android-type overweight group exhibited excessive visceral fat, which could lead to spinal misalignment. Additionally, they also demonstrated postural instability in the AP and ML direction, decreased functional performance, and insufficient muscle strength and mass in the lower extremities. These findings might help physical therapists in planning interventions for DLD patients, as they imply that patients with DLD may require specific types of standing balance training and lower extremities muscle-strengthening based on their body fat distribution to achieve the best results.