目的 研究青少年脊柱侧凸与各种生物力学因素的关系。方法 2016年12月,对昭通市昭阳区沙坝小学的637例4~6年级学生进行脊柱侧凸筛查,最终对经拍摄脊柱全长X线确诊的脊柱侧凸患者(病例组,n=19)进行病例对照研究,依据匹配标准纳入42例学生作为对照组,对两组进行11个生物力学因素的分析评估,包括高低肩、颈侧屈、颈旋转、胸侧屈、胸旋转、腰侧屈、腰旋转、骨盆侧倾、骨盆前后倾、长短腿和足弓类型。采用二分类Logistic回归分析进行相关性分析。结果 与结论 高低肩、胸旋转不对称、骨盆侧倾、长短腿、扁平足是脊柱侧凸的危险因素(P<0.05)。临床上对有脊柱不对称的患者,应进行详细的姿势评估,发现导致异常姿势的生物力学因素,从而进行更有针对性的医疗干预。
Objective To study the relationship between adolescent scoliosis and various biomechanical factors.Methods A total of 637 students in grade four to six in a primary school of Zhaoyang District in Zhaotong, Yunnan, China were screened for scoliosis in December, 2016. Finally, a case control study of 19 patients with idiopathic scoliosis who had been diagnosed by X-ray was carried out. According to the matching criteria, 42 students were collected as control group. Then, eleven biomechanical factors were analyzed and evaluated in two groups. Those factors included unequal shoulders, cervical lateral flexion, cervical rotation, thoracic lateral flexion, thoracic rotation, lumbar lateral flexion, lumbar rotation, lateral tilt of pelvis, anterior and posterior pelvic tilt, leg inequality and flat foot. Eventually, the biomechanical factors were statistically analyzed with binary Logistic regression analysis.Results and Conclusion The unequal shoulders, thoracic rotation, lateral tilt of pelvis, leg inequality and flat foot were the risk factors for scoliosis (P<0.05). Detailed posture assessment should be carried out to find the biomechanical factors leading to abnormal posture, and achieve the goals of the more targeted medical intervention for the patients with spinal asymmetry.
[1] Negrini S, Aulisa AG, Aulisa L, et al.2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth[J]. Scoliosis, 2012, 7(1): 1-35.
[2] Hong A, Jaswal N, Westover L, et al.Surface topography classification trees for assessing severity and monitoring progression in adolescent idiopathic scoliosis (AIS)[J]. Spine (Phila Pa 1976), 2017, 42(13): E781-E787.
[3] Nedelcu T, Georgescu I, Leroux J, et al.Surgical treatment using The Unit Rod in children with neuromuscular scoliosis[J].J Med Life, 2016, 9(4): 399-407.
[4] Lufler RS, Stefanik JJ, Niu J, et al.The association of forefoot varus deformity with patellofemoral cartilage damage in older adult cadavers[J]. Anat Rec (Hoboken), 2017, 300(6): 1032-1038.
[5] Dvoretskiĭ EN, Baryshnikova GV, Deviatkova VS, et al.[Early manifestations of static deformities in the locomotor system][J]. [in Russian]. Gig Sanit, 2010(4): 71-75.
[6] Papaioannou T, Stokes I, Kenwright J.Scoliosis associated with limb-length inequality[J]. J Bone Joint Surg Am, 1982, 64(1): 59-62.
[7] Findley T, Chaudhry H, Dhar S.Transmission of muscle force to fascia during exercise[J]. J Bodyw Mov Ther, 2015, 19(1): 119-123.
[8] Resende RA, Kirkwood RN, Deluzio KJ, et al.Ipsilateral and contralateral foot pronation affect lower limb and trunk biomechanics of individuals with knee osteoarthritis during gait[J]. Clin Biomech (Bristol, Avon), 2016, 34: 30-37.
[9] Szotek S, Dawidowicz J, Eyden B, et al.Morphological features of fascia lata in relation to fascia diseases[J]. Ultrastruct Pathol, 2016, 40(6): 297-310.
[10] Bateman AH, Balkovec C, Akens MK, et al.Closure of the annulus fibrosus of the intervertebral disc using a novel suture application device-in vivo porcine and ex vivo biomechanical evaluation[J]. Spine J, 2016, 16(7): 889-895.
[11] Zhang X, Li B, Liang K, et al.An optimized design of in-shoe heel lifts reduces plantar pressure of healthy males[J]. Gait Posture, 2016, 47: 43-47.
[12] Tenhula JA, Rose SJ, Delitto A.Association between direction of lateral lumbar shift, movement tests, and side of symptoms in patients with low back pain syndrome[J]. Phys Ther, 1990, 70(8): 480-486.
[13] Watson AW, Mac Donncha C.A reliable technique for the assessment of posture: assessment criteria for aspects of posture[J]. J Sports Med Phys Fitness, 2000, 40(3): 260-270.
