世界中医药

作者	单位
刘丹，唐占英，肖静，李薇薇，林婕，袁薇娜，胡志俊	上海中医药大学附属龙华医院康复科，上海，200032

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中文摘要:

目的:从生物力学角度着手探索青少年特发性脊柱侧凸症（Adolescent Idiopathic Scoliosis，AIS）的病理机制，通过对患者与正常青少年脊柱两侧肌肉生物力学指标的分析进一步研究青少年特发性脊柱侧凸症对患者运动功能的影响。加强对AIS的病理现象和机制的分析和认识，解释AIS的重要病理现象。方法：选取2014年3月至2014年9月在上海中医药大学附属龙华医院康复科就诊的青少年20例，其中特发性脊柱侧凸患者及无脊柱侧凸青少年各10例。以步态分析、表面肌电检测技术手段为检测途径，对患者与正常青少年运动学指数、平衡指数等生物力学指标进行比较。针对运动学指标的实验研究共选取10例AIS患者为研究组与对照组10例患者进行对比。检测步频指数、各步态时相所占百分比等步态时空参数；步长、跨步长、步态周期及膝关节、踝关节、髋关节三个关节的活动角度等运动特征。结果：青少年特发性脊柱侧凸症患者在单步时间、跨步时间方面差异有统计学意义（P<0.05），但其他时空指标并未出现明显的异常。髋关节活动角度范围等平衡参数相明显大于正常组，两者相比差异有统计学意义（P<0.05）。结论：1）AIS可能使患者双侧下肢运动学特征产生改变。同时也提示双侧下肢运动学特征的改变很有可能是青少年特发性脊柱侧凸症的一个重要发病诱因；2）AIS患者支撑能力可能没有明显异常；3）特发性脊柱侧凸患者两侧肢体关节周围肌群动作的不协调或两侧肢体应力改变是导致这一步态特征的主要原因。

English Summary:

To explore the pathological mechanism of adolescent idiopathic scoliosis(AIS)from the point of biomechanics，we further study the impact of AIS on adolescent patients motor function with the analysis of both patients and typical adolescents biomechanics indexes.We enhance the analysis and understanding of pathological mechanism of AIS to explain its important pathological phenomena.Methods:20 adolescents who visited the Rehabilitation Department of Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine from March to September during 2014 were selected，among which 10with AIS and 10 without AIS.With gait analysis and surface electromyography，we compared the kinematic and equilibrium indexes between adolescents with AIS and without AIS.Against the experimental study of kinematic indexes，10 cases are adolescents with AIS(research group)and 10 cases are without AIS(control group).We tested the stride frequency indexes，ratio of gait phases，step length，stride length，gait cycle，activity angles of knee joint，ankle joint and hip joint.Results:There was significant difference between the time of single step and stride step of AIS(P<0.05)，and no significant difference in other indexes of time and space.The activity angles of hip joint were obviously larger than those in control group(P<0.05).Conclusion:1）AIS may change the kinematic characteristic of adolescent patients bilateral lower limbs.Simultaneously，that change could be an important predisposing factors of AIS.2）There may be no significant difference in supporting capacity of adolescents with AIS.3）Either the uncoordinated movement of muscle groups around bilateral limbs and joints of adolescents with AIS or the stress change of bilateral limbs is the major cause of asymmetric gaits of AIS.

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